non-OSA Group Research Articles

Retinal Nerve Fiber Layer Thickness Alteration in Apneic Children.

We examined retinal nerve fiber layer (RNFL) thickness alterations in children with chronic upper airway obstructions (UAOs) and obstructive sleep apnea syndrome (OSAS). We also investigated whether it was affected by an adenotonsillectomy operation. Forty-two children aged 3 to 8 years with chronic UAO resulting from adenotonsillar enlargement and 34 age-matched controls were included in the study. Patients underwent a Brouillette scoring questionnaire to be divided into mild (N = 10), moderate (N = 22), severe (N = 10), and total (N = 42) UAO groups. According to the scoring, the severe UAO group was defined as the severe OSAS group, the moderate group was suspicious for OSAS, and the mild UAO group was defined as the non-OSAS group. The patients' demographic data for age, sex, and body mass index were obtained. Ophthalmologic evaluations were performed with optical coherence tomography. Central corneal thickness, macular thickness, intraocular pressure (IOP), and RNFL thickness were measured. An adenotonsillectomy was performed on all patients, and eye examinations and scoring were repeated after the surgery. Higher IOP levels were obtained between the total UAO group and the control group (p > 0.05). There were significant differences between UAO groups and the control group except for the moderate UAO group. There was no significant difference in RNFL thickness (p > 0.05) between preoperative UAO groups and the control group. However, after surgery, some significant differences emerged in the superior, inferior, and average RNFL thickness (p < 0.05). Also, IOP levels were significantly lower in the mild, moderate, and total UAO groups after the operation (p < 0.05). Upper airway obstruction and OSAS seem to worsen some RNFL and IOP parameters in children, and eye examinations may be useful in these patients.

Obstructive Sleep Apnea in Patients with Branch Retinal Vein Occlusion: A Preliminary Study.

PurposeOur study aimed to determine whether obstructive sleep apnea (OSA) is common among branch retinal vein occlusion (BRVO) patients without systemic risk factors using a Watch PAT-100 portable monitoring device.MethodsThe study participants included consecutive patients with BRVO of less than 3 months duration without any risk factors known to be associated with OSA (diabetes, coronary artery disease, stroke, hematologic diseases, autoimmune disease, etc.) except for hypertension. All patients underwent full-night unattended polysomnography by means of a portable monitor Watch PAT-100 device. The apnea-hypopnea index (AHI) was calculated as the average number of apnea and hypopnea events per hour of sleep, and an AHI score of five or more events was diagnosed as OSA.ResultsAmong 19 patients (6 males and 13 females), 42.1% (8 of 19) had an AHI reflective of OSA. In the 13 patients who had no concurrent illness, including hypertension, 30.8% (4 of 13) had positive test results for OSA; three of these patients were ranked as mild OSA, while one had moderate OSA. The OSA group had an average AHI of 12.3 ± 7.8, and the average AHI was 2.0 ± 0.9 in the non-OSA group. Although it was not statistically proven, we found that OSA patients experienced a more severe form of BRVO.ConclusionsWe found a higher than expected rate of OSA in BRVO patients lacking concomitant diseases typically associated with OSA. Our findings suggest that OSA could be an additional risk factor in the pathogenesis of BRVO or at least a frequently associated condition that could function as a triggering factor.

Nocturnal Hypoxemia Is Associated with White Matter Hyperintensities in Patients with a Minor Stroke or Transient Ischemic Attack.

Obstructive sleep apnea (OSA) is a risk factor for stroke, which is modulated by accompanying nocturnal hypoxemia. White matter hyperintensities (WMH) share many of the same risk factors as stroke. The purpose of this study was to investigate whether OSA and nocturnal hypoxemia are associated with white matter disease in patients with minor stroke and transient ischemic attack. Patients with minor stroke or TIA were recruited. Level 3 diagnostic sleep testing was used to diagnose OSA and quantify nocturnal hypoxemia. Significant OSA was defined as respiratory disturbance index ≥ 15, and nocturnal hypoxemia was defined as oxyhemoglobin saturation < 90% for ≥ 12% of total monitoring time. WMH were assessed and quantified on FLAIR MRI. The volume of WMH was compared between those with and without significant OSA and between those with and without nocturnal hypoxemia. One hundred nine patients were included. Thirty-four (31%) had OSA and 37 (34%) had nocturnal hypoxemia. Total WMH volume was significantly greater in the OSA than in the non-OSA groups (p = 0.04). WMH volume was also significantly higher in the hypoxic than the non-hypoxic groups (p = 0.001). Mutivariable analysis with adjustment for age, hypertension, and diabetes showed that nocturnal hypoxemia was independently associated with WMH volume (p = 0.03) but OSA was not (p = 0.29). We conclude that nocturnal hypoxemia, predominantly related to OSA, is independently associated with WMH in patients who present with minor ischemic stroke and TIA and may contribute to its pathogenesis.

Parental Analgesic Knowledge and Decision Making for Children With and Without Obstructive Sleep Apnea After Tonsillectomy and Adenoidectomy

Tonsillectomy is a common and painful procedure often indicated for children with obstructive sleep apnea (OSA) who are at risk for opioid-related toxicity. Whether parents whose children have OSA understand the risks of opioids is unknown. The purpose of this study was to examine whether parents whose children have OSA have greater opioid risk understanding and would be less likely to give an opioid to a child exhibiting oversedation compared to parents whose children do not have OSA. The study design was a secondary analysis of a prospective observational study. The study was conducted in a large academic, tertiary care children's hospital in the Midwest. 224 parents whose children with or without OSA underwent tonsillectomy with/without adenoidectomy were included. Parents were assessed for opioid adverse event understanding and then made decisions to give/withhold opioids for a child exhibiting adverse effects. After discharge, parents recorded all opioid doses they gave their child. There were no differences in opioid understanding between OSA and non-OSA groups, and nearly half in both would give an opioid to the child exhibiting oversedation. Similar amounts of opioids were given at home. OSA did not predict parents' opioid decisions; however, around-the-clock instruction predicted greater opioid use at home. Parents whose children had OSA had a similar understanding of opioid-related oversedation compared to other parents, and half would give a prescribed opioid when signs of oversedation were present, suggesting a need for improved understanding and recognition of this sign of toxicity, and of what to do should this symptom present.

Prevalence of Obstructive Sleep Apnoea Among Patients Admitted for Bariatric Surgery. A Prospective Multicentre Trial.

Obesity has become one of the greatest public health concerns worldwide and is known to be the most important risk factor for obstructive sleep apnoea (OSA). Prevalence of OSA has increased over the last two decades, but it is estimated that the majority of cases still remain undiagnosed. The aim of this study was to investigate the prevalence of OSA in Finnish bariatric surgery candidates. In this prospective multicentre study, standard overnight cardiorespiratory recording was conducted in 197 consecutive patients from three different hospitals. A sleep questionnaire was also administered. Anthropometric and demographic measurements included age, weight, body mass index (BMI) and waist and neck circumference. Altogether, 71% of the patients were diagnosed with OSA. The prevalence was higher in males (90%) than in females (60%) (p < 0.001). In OSA patients' group, the mean neck and waist circumference was larger (p < 0.001) and the body weight higher (p < 0.01) than in non-OSA group. When separating patients by gender, a significant difference remained only concerning neck circumference in female patients. OSA is very common among bariatric surgery patients, especially in men. Considering this and the increased long-term morbidity and mortality generally related to OSA, a routine screening for OSA seems indicated in bariatric patients, particularly men.

Breathing sounds characteristics correlate with structural changes of upper airway due to obstructive sleep apnea.

This paper reports on a pilot study of acoustic properties of respiratory sounds in relation to obstructive sleep apnea (OSA). Data were breathing sounds of 60 individuals in three groups of non-, Moderate and Severe OSA using the apnea/hypopnea index (AHI) (20 in each group). The sounds power spectral energy and phase responses were calculated for each respiratory phase, and investigated among the groups. The results of power spectral analysis, congruent with imaging studies' findings, suggest a regional narrowing in upper airway that shows its effect in low and high frequencies as an opposite pattern between the OSA and non-OSA groups. The results of phase analysis also support an increased nonlinearity in high frequencies that is speculated to be related to the regional narrowing and thus regional elasticity of the airway during wakefulness.

Impact of obstructive sleep apnea on lung volumes and mechanical properties of the respiratory system in overweight and obese individuals.

BackgroundEven through narrowing of the upper-airway plays an important role in the generation of obstructive sleep apnea (OSA), the peripheral airways is implicated in pre-obese and obese OSA patients, as a result of decreased lung volume and increased lung elastic recoil pressure, which, in turn, may aggravate upper-airway collapsibility.MethodsA total of 263 male (n = 193) and female (n = 70) subjects who were obese to various degrees without a history of lung diseases and an expiratory flow limitation, but troubled with snoring or suspicion of OSA were included in this cross-sectional study. According to nocturnal-polysomnography the subjects were distributed into OSA and non-OSA groups, and were further sub-grouped by gender because of differences between males and females, in term of, lung volume size, airway resistance, and the prevalence of OSA among genders. Lung volume and respiratory mechanical properties at different-frequencies were evaluated by plethysmograph and an impulse oscillation system, respectively.ResultsFunctional residual capacity (FRC) and expiratory reserve volume were significantly decreased in the OSA group compared to the non-OSA group among males and females. As weight and BMI in males in the OSA group were greater than in the non-OSA group (90 ± 14.8 kg vs. 82 ± 10.4 kg, p < 0.001; 30.5 ± 4.2 kg/m2 vs. 28.0 ± 3.0 kg/m2, p < 0.001), multiple regression analysis was required to adjust for BMI or weight and demonstrated that these lung volumes decreases were independent from BMI and associated with the severity of OSA. This result was further confirmed by the female cohort. Significant increases in total respiratory resistance and decreases in respiratory conductance (Grs) were observed with increasing severity of OSA, as defined by the apnea-hypopnea index (AHI) in both genders. The specific Grs (sGrs) stayed relatively constant between the two groups in woman, and there was only a weak association between AHI and sGrs among man. Multiple-stepwise-regression showed that reactance at 5 Hz was highly correlated with AHI in males and females or hypopnea index in females, independently-highly correlated with peripheral-airway resistance and significantly associated with decreasing FRC.ConclusionsTotal respiratory resistance and peripheral airway resistance significantly increase, and its inverse Grs decrease, in obese patients with OSA in comparison with those without OSA, and are independently associated with OSA severity. These results might be attributed to the abnormally increased lung elasticity recoil pressure on exhalation, due to increase in lung elasticity and decreased lung volume in obese OSA.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-015-0063-6) contains supplementary material, which is available to authorized users.

PP.37.01

Objective: Sympathetic activity is suspected to be an underlying mechanism in obstructive sleep apnea (OSA) and morning blood pressure (BP) surge (MS). Few studies have evaluated the association between OSA and MS.Design and method: This study aimed to examine the association between OSA and MS in never-treated subjects with essential hypertension. This prospective study included a total of 58 patients (mean age: 51.7 years; 55.2% male) with never-treated essential hypertension. The patients were divided into non-OSA (n = 23, 49.3 ± 12.7 years) and OSA (n = 35, 53.2 ± 9.8 years) groups. The OSA group was defined as having an apnea-hypopnea index (AHI) level > 5 measured by the WATCH-PAT200. We collected the 24-hour ambulatory BP, pulse wave velocity, ankle brachial index, plasma aldosterone concentration (PAC), and plasma renin activity (PRA) from all of the patients. Results: The measured sleep-trough morning systolic blood pressure (SBP) increases were higher in the OSA group than in the non-OSA group (28.7 ± 11.8 mmHg vs. 19.6 ± 12.8 mmHg, P = 0.008). The sleep-trough morning SBP increase was inversely correlated with the lowest O2 saturation (r = −0.272, P = 0.039). The AHI was correlated with the morning SBP and DBP(r = 0.281, P = 0.032)(r = 0.319, P = 0.015). The OSA group had greater day, night, and 24-hour SBP than the non-OSA group. Additionally, there were no differences of PAC, PRA, and aldosterone-renin ratio (PAC/PRA) between groups. Conclusions: OSA known to be associated with increased daytime and nocturnal sympathetic activity was associated with significantly higher sleep-trough morning SBP levels in this study.

Obstructive Sleep Apnea Using Watch-PAT 200 Is Independently Associated With an Increase in Morning Blood Pressure Surge in Never-Treated Hypertensive Patients.

This study aimed to examine the association between obstructive sleep apnea (OSA) and morning blood pressure surge in never-treated patients with essential hypertension. This prospective study included a total of 58 patients (mean age, 51.7years; 55.2% men) with never-treated essential hypertension. The patients were divided into non-OSA (n=23, 49.3±12.7years) and OSA (n=35, 53.2±9.8years) groups. The OSA group was defined as having an apnea-hypopnea index level >5 as measured by the Watch-PAT 200. The authors collected 24-hour ambulatory BP, plasma aldosterone concentration, and plasma renin activity data from all of the patients. The measured sleep-trough morning systolic blood pressure (SBP) increases were higher in the OSA group than in the non-OSA group (28.7±11.8mm Hg vs 19.6±12.8mm Hg, P=.008). The sleep-trough morning SBP increase was inversely correlated with the lowest oxygen saturation (r=-0.272, P=.039). OSA known to be associated with increased daytime and nocturnal sympathetic activity was associated with significantly higher sleep-trough morning SBP levels in this study.

The Effects of Obstructive Sleep Apnea on Autonomic Function during Steady-State Exercise

Obstructive sleep apnea (OSA) is a disorder that significantly disrupts autonomic function, and is a mechanism for an increased risk for hypertension and cardiovascular disease seen with OSA. Heart rate variability (HRV) is an easy, non-invasive way to assess autonomic function. To date, diminished HRV has been shown at rest in OSA but not during steady-state exercise. PURPOSE: To assess HRV at rest and during submaximal exercise in OSA patients versus a non-OSA control group. METHODS: Subjects were classified as OSA (n=10) or non-OSA (n=16) based on results from an at-home sleep assessment. Measures of body composition, physical activity, and HRV were recorded at rest in each subject. Subjects completed a 5 minute walking trial at light intensity (35% of predicted VO2 Reserve) and at vigorous intensity (70%). Heart rate, blood pressure, time-domain and frequency-domain HRV variables were collected. Time-domain measures include the standard deviation of all NN or RR intervals (SDNN) and the square root of the mean of the sum of squares of differences between adjacent NN intervals (RMSSD). SDNN represents a general picture of HRV. Frequency-domain measures include total power, low frequency (LF), high frequency (HF), and the LF-HF ratio. Total power is the variance of NN intervals over the time period analyzed. LF represents parasympathetic and sympathetic activity; HF represents parasympathetic activity. The LF-HF ratio is the relationship between low and high frequency activity. HRV variables not normally distributed were log transformed before statistical analysis. RESULTS: Physical activity and body composition did not differ between groups. At rest, the OSA group had lower SDNN (OSA: 1.57 ± 0.31, CON: 1.85 ± 0.29; P = 0.027), RMSSD (OSA: 1.37 ± 0.27, CON: 1.78 ± 0.37; P = 0.006), and Total Power (OSA: 3.26 ± 0.65, CON: 3.79 ± 0.57; P = 0.041). A lower LF-HF ratio was found in the OSA group compared to the control group during exercise (Light = OSA: 2.25 ± 0.44, CON: 2.51 ± 0.45; Vigorous = OSA: 2.03 ± 0.45, CON: 2.34 ± 0.39; P = 0.048). CONCLUSION: A unique finding of this study was evidence for a lack of parasympathetic withdrawal during exercise in the OSA group. OSA may lead to altered autonomic function during steady-state exercise due to sympathetic dominance and a blunted parasympathetic response.

Tension-type headache associated with obstructive sleep apnea: a nationwide population-based study.

BackgroundThere is still controversy regarding the association between primary headaches and obstructive sleep apnea. We explored the relationship between tension-type headache (TTH) and obstructive sleep apnea (OSA) using a large nationwide population-based data set in Taiwan.MethodsWe identified 4759 patients diagnosed with OSA from the Taiwan Longitudinal Health Insurance Database, based on polysomnography, as the OSA group. We then randomly selected 19036 subjects without OSA, matched by sex and age, to serve as the non-OSA group. The multivariate Cox proportional hazards model with matching for age and sex was used to assess the possible associations between TTH and OSA among the patients.ResultsThe prevalence of TTH was 10.2% among OSA patients and 7.7% among non-OSA patients (p < 0.001). The multivariate Cox proportional hazards model revealed patients with OSA were more likely to have TTH (hazard ratio, 1.18; 95% CI, 1.06–1.31) (p = 0.003) than patients in the non-OSA group.ConclusionPatients with OSA had a higher likelihood of developing TTH than patients in the non-OSA group. Further studies of physiological patterns between OSA and TTH are needed to confirm the study findings.

The impact of obstructive sleep apnea on high-sensitivity C-reactive protein in subjects with or without metabolic syndrome.

It is unclear whether obstructive sleep apnea (OSA) is independently associated with increased levels of the acute-phase reactant C-reactive protein (CRP). The purpose of this study was to evaluate the relationship between OSA and high-sensitivity CRP (hs-CRP) levels according to the presence or absence of metabolic syndrome (MetS). This study recruited 245 male bus drivers from one transportation company in Taiwan. Each participant was evaluated by a polysomnography (PSG) test, blood lipids examination, and hs-CRP. Severity of OSA was categorized according to the apnea-hypopnea index (AHI). Subjects were categorized into severe OSA group (n = 44; 17.9%), moderate and mild OSA group (n = 117; 47.8%), and non-OSA group (n = 84; 34.3%). AHI had a significant association with hs-CRP (β = 0.125, p = 0.009) adjusting for age, smoking, drinking, and MetS status. Hs-CRP was elevated with severe OSA (β = 0.533, p = 0.005) even adjusting for BMI and MetS. Moreover, there was an independent effect for adjusted odds ratios (AORs) between the stratification of the severity for OSA and MetS. Elevated hs-CRP level is associated with severe OSA, independent of known confounders. The effect of OSA in CRP is independent of MetS was identified.

Improving detection of obstructive sleep apnoea by overnight oximetry in children using pulse rate parameters.

Overnight oximetry is a simple tool for investigation of obstructive sleep apnoea (OSA) in children, but only severe cases will be detected, and children with obstructive events resulting in arousal, but not desaturation, will have a normal (inconclusive) result. We hypothesised that pulse rate rises using pulse rate indices per hour (PRI) and pulse rate standard deviation (PR-SD) automatically calculated from commercially available software would improve oximetry as a diagnostic tool. Children having home overnight oximetry for suspected OSA were identified over 12months, and those with a normal result who went on to have polysomnography (PSG) were included. Oximetry, including PR-SD and PRI (rises of 8, 10 and 15 beats/min per hour), was analyzed using commercially available software. PR parameters were compared between those with OSA (obstructive apnoea-hypopnoea index (OAHI) >1 event/h) and those without OSA. One hundred sixteen children had normal oximetry, of whom 93 (median age 4.5years; 55%M) had PSG. Fifty-seven of 93 (61%) children had OSA (median OAHI 4.5 events/h, range 1.1-24). PR-SD was not different between the OSA and non-OSA groups (p = 0.87). PRI tended to be higher in those with OSA, but there was considerable overlap between the groups: PRI-8 (mean ± SD 58.5 ± 29.0/h in OSA group vs 48.6 ± 20.2/h in non-OSA group, p = 0.07), PRI-10 (45.1 ± 25.0 vs 36.2 ± 16.7, p = 0.06) and PRI-15 (24.4 ± 14.5 vs 18.9 ± 9.0, p = 0.04). A PRI-15 threshold of >35/h had specificity of 97% for OSA. The PRI-15 shows promise as an indicator of OSA in children with normal oximetry.

Increased alveolar nitric oxide concentration is related to nocturnal oxygen desaturation in obstructive sleep apnoea

PurposeTo assess distal/alveolar inflammation in patients with suggestive symptoms of obstructive sleep apnoea (OSA) using exhaled nitric oxide (NO) measured by two-compartment model (2-CM) after correction for axial NO back-diffusion (trumpet model). MethodsNinety five patients suspected for OSA prospectively underwent pulmonary function test, overnight polysomnography (PSG), and exhaled NO measurement. Patients with apnoea–hypopnoea index (AHI) < 5/hour were included in non-OSA group. Exhaled NO was repeatedly measured after PSG in 21 OSA patients and 8 non-OSA subjects. ResultsAlveolar NO concentration (CANO) was significantly higher in OSA patients (n = 71; 4.07 ± 1.7ppb) as compared with non-OSA subjects (n = 24; 2.24 ± 1.06ppb; p < 0.0001) whilst maximal bronchial NO flux (J′awNO) and fractional exhaled NO (FENO) did not differ between the two groups. CANO was strongly associated to AHI (r = 0.701; p < 0.0001) and to recording time with SaO2 < 90% (ST-90%; r = 0.659; p < 0.0001) in OSA patients but not in non-OSA persons. The area under ROC curve for screening patients with OSA and significant nocturnal oxygen desaturation (ST-90% > 1%) was 0.865 ± 0.036 (95% IC, 0.793–0.937; p < 0.0001). CANO at 4.5 ppb could detect these patients with specificity of 94% and sensitivity of 46%. Increase of CANO measured after PSG was significantly related to oxygen desaturation index (ST-90%) in OSA patients. ConclusionsIncreased alveolar NO concentration was related to the severity of nocturnal oxygen desaturation in patients with OSA, linking the distal airway inflammation to intermittent hypoxia. (250 words)

Comparative evaluation of craniofacial anthropometric measurements in Indian adult patients with and without obstructive sleep apnea: A pilot study.

Aims:The study aimed to compare the craniofacial features of North Indian patients suffering from obstructive sleep apnea (OSA) to that of normal North Indian population.Materials and Methods:Selected 25 North Indian subjects (age: 18–65 years) were divided into two groups (OSA group [n = 14] and non-OSA group [n = 9]) according to the results of full night polysomnographic sleep study. Body mass index (BMI), neck circumference (NC), and lateral cephalograms were recorded for each subject in both groups and total 22 parameters of craniofacial anthropometric features were measured on lateral cephalograms for each subject. The differences in BMI, NC, and craniofacial features between the OSA and non-OSA groups were compared statistically.Results:Independent sample t-test was used to compare the differences between OSA group and non-OSA group. The results showed that the BMI, NC, bulk of tongue (tongue length, tongue height, and tongue area) and length of the soft palate (PNS-U) were significantly higher in OSA group. OSA group was also found to have inferior positioning of hyoid bone (MP-H, ANS-H, PNS-H, ANS-Eb), narrower superior and middle airway space (SPAS and MAS), antero-inferior positioning of mandible (Gn-C3, ANS-Me, SNB, N-Me) and lower cranial base flexure angle (N-S-Ba).Conclusion:Craniofacial features, which play an important role in the pathophysiology of OSA, differ significantly between North Indian patients suffering from OSA and normal North Indian population.

Overnight fluid shifts in subjects with and without obstructive sleep apnea.

To investigate the characteristics of baseline body fluid content and overnight fluid shifts between non-obstructive sleep apnea (non-OSA) and obstructive sleep apnea (OSA) subjects. A case-controlled study was performed between February 2013 and January 2014, with 36 (18 OSA and 18 non-OSA) outpatients enrolled in this study. Polysomnographic parameters and results of body fluid were compared between the two groups. There were no differences in age, weight, and body mass index (BMI) between groups. Compared with the non-OSA group, OSA group had significantly higher neck circumference (NC) and fluid volume shift in the legs. OSA patients had higher left and right leg fluid indices than non-OSA subjects. There were significant correlations between apnoea-hypopnoea index and baseline fluid indices in both legs as well as the reduction in overnight change in both legs fluid volume. The increase in NC was also significantly correlated with the reduction in overnight change in both legs fluid volume, but not with the change in head and neck fluid volume. There were significant correlations between change in NC and increased fluid shifts in head and neck volume. OSA patients had a higher baseline fluid content in both legs as compared with non-OSA subjects, which may be the basic factor with regards to fluid shifts in OSA patients. The increase in head and neck fluid shift volume did not directly correlate with the severity of OSA.

Urinary proteomics in obstructive sleep apnoea and obesity.

Obstructive sleep apnoea (OSA) is a common complication of obesity and can have a substantial negative impact on a patient's quality of life and risk of cardiovascular disease. The aim of this case-control study was to undertake discovery profiling of urinary peptides using capillary electrophoresis-mass spectrometry (CE-MS) in obese subjects with and without OSA, without a history of coronary artery disease. Urinary samples were analysed by CE-MS. Body composition and blood pressure measurements were recorded. Overnight polysomnography was conducted to confirm or refute OSA. OSA patients were naïve to continuous positive airway pressure treatment. Sixty-one subjects with OSA (age 47 ± 9 years, BMI 43 ± 8 kg/m(2)) and 31 controls (age 49 ± 10 years, BMI 40 ± 5 kg/m(2)) were studied; P = ns for age and BMI. Apnoea-hypopnoea Index was higher in patients with OSA (24 ± 18·6) than controls without OSA (non-OSA) (2·6 ± 1·1; P < 0·0001). Metabolic syndrome was present in 35 (57%) of those with OSA compared with 4 (13%) of controls (P < 0·0001). Twenty-four polypeptides were candidates for differential distribution (P < 0·01), although these differences did not reach significance after multiple testing. Sequences were determined for eight peptides demonstrating origins from collagens and fibrinogen alpha. In this study, we report for the first time, urinary proteomic profile analyses using CE-MS in OSA and non-OSA obese groups. The differences in urinary proteomic profiles prior to adjustment for multiple testing, with increased metabolic syndrome in obese OSA subjects, suggest that there may be a role for CE-MS in characterising urinary profiles in severely obese populations with OSA.

Do salivary and serum collagenases have a role in an association between obstructive sleep apnea syndrome and periodontal disease? A preliminary case–control study

ObjectivesDespite increasing evidence for an association of obstructive sleep apnea syndrome (OSAS) and periodontal disease, the pathophysiological linking mechanisms remain unclear. This study aims to evaluate the salivary and serum matrix metalloproteinase-2, -8, -9 (MMP-2, -8, -9), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), myeloperoxidase (MPO), neutrophil elastase (NE), neutrophil gelatinase-associated lipocalin (NGAL), as well as degree of activation of MMP-2, -9 of patients with and without OSAS. DesignA total of 50 individuals were included in the study. There were 13, 17 and 20 individuals, respectively in the control (non-OSAS) group, mild-to-moderate OSAS and severe OSAS groups. Saliva, serum samples and clinical periodontal parameters were collected. Biofluid samples were analysed by immunofluorometric assay (IFMA), enzyme-linked immunosorbent assay (ELISA), western immunoblotting and gelatine zymography. Statistical analyses were performed using D’Agostino–Pearson omnibus normality test, Kruskal–Wallis test and Spearman rho rank correlation analysis. ResultsThere were no statistically significant differences in clinical periodontal parameters between the study groups. Salivary NE and proMMP-2 levels were significantly lower in the OSAS groups than the control group (p<0.05). Serum proMMP-9 concentration and the degree of MMP-9 activation in saliva were significantly lower in the severe OSAS group than the control group (p<0.05). There were significant correlations between salivary and serum proMMP-9 and -2 concentrations (p<0.05). Serum proMMP-2, NE and salivary proMMP-9 and -2 negatively correlated with indicators of OSAS severity (p<0.05). ConclusionsThe present findings do not support a pathophysiological link between the severity of OSAS and clinical periodontal status via neutrophil enzymes or MMPs.

Cross-cultural adaptation and validation of the Greek OSA-18 questionnaire in children undergoing polysomnography

ObjectiveTranslations of validated questionnaires help to compare different countries/cultures populations and establish protocols for global health. OSA-18 is a validated disease-specific questionnaire for pediatric Obstructive Sleep Apnea (OSA). Our aim was to validate OSA-18 in Greek and correlate it with polysomnography results and OSA severity. Study designProspective instrument validation study. Subjects and methodsOSA-18 was translated in Greek and back into English. Children undergoing polysomnography due to snoring were recruited prospectively. OSA-18 was completed by parents during the initial clinic visit (test), in the evening prior to the sleep study (retest), and 3 months postoperatively for subjects who underwent adenotonsillectomy. Internal consistency and test–retest reliability were evaluated. Validity was assessed by exploring correlations between OSA-18 and AHI, by comparing OSA-18 of OSA and non-OSA groups, and by calculating questionnaire's sensitivity and specificity for detecting OSA. Total scores of non-OSA, mild, moderate and severe OSA subgroups were compared. In OSA children who underwent adenotonsillectomy, preoperative and postoperative total scores were compared to assess responsiveness. ResultsTest–retest questionnaires were fully completed for 141 children. OSA-18 in Greek had good internal consistency (Cronbach's alpha 0.951 for test and 0.947 for retest) and test–retest reliability (Pearson's correlation coefficients between test and retest scores: 0.850–0.946; P<0.05). Total and subscale OSA-18 scores and AHI were significantly correlated (Spearman's correlation coefficients: 0.376–0.633; P<0.01), while children with OSA had higher total OSA-18 score than those without OSA [median (interquartile range): 61 (35) vs. 38 (22), respectively; P<0.001)]. Sensitivity was 53.4%, suggesting poor validity compared to polysomnography. All OSA severity subgroups had significant higher score than non-OSA. OSA-18 scores postoperatively were significantly lower compared to preoperatively (22.91±5.49 vs. 67.13±15.27, respectively; P<0.001), indicating good responsiveness. ConclusionGreek OSA-18 is an instrument with satisfactory internal consistency, reliability, and responsiveness, but it is a poor predictor of OSA severity.

Obstructive Sleep Apnea during Pregnancy and Morbidity Outcome

Objectives: Obstructive sleep apnea (OSA) is increasingly a concern for a risk factor of poor pregnancy outcomes. However, to date, most research studies have relied on subjective research such as Epworth Sleepiness Scale (ESS). Therefore, our research design used polysomnography, which is an objective measurement to define OSA in pregnancy. The study aimed to measure the incidence of OSA in pregnancy, to reveal clinical examination which will be objective screening tool for OSA in pregnancy, and prove that OSA is a risk factor of poor pregnancy outcomes. Methods: Fifty healthy pregnant women who received antenatal care at Chiangmai University Hospital during October 2012 through April 2013 were measured by physical examination and polysomnography at GA 28th to 32nd weeks, and followed until the end of pregnancy to see the difference of poor pregnancy outcomes in OSA and non-OSA group. Results: The incidence of OSA in pregnancy was 12%. OSA related to more overall poor pregnancy outcomes (relative risk [RR] = 5.86 [2.16-15.96], P = .007), more preterm labor (RR = 19.33 [3.89-220.79], P &lt; .001), and more preeclampsia (RR = n/a, P = .012). Friedman tongue position (FTP) equal or more than gr III was considered the screening tool for OSA in pregnancy, which yielded 66.7% sensitivity and 84.1% specificity. Conclusions: OSA could lead to a high-risk pregnancy, which should be screened by multidisciplinary teams, to establish diagnosis and treatment for maternal and child health.