Obstructive Sleep Apnea In Order Research Articles

STOP-BANG QUESTIONNAIRE - AN EASY TOOL FOR IDENTIFYING OBSTRUCTIVE SLEEP APNEA SYNDROME IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.

Patients with type 2 diabetes mellitus (T2DM) have a higher risk of developing obstructive sleep apnea (OSA) compared to the general population. Our study aims to analyze the usefulness of the STOP-BANG score, tool which was not yet validated in patients with diabetets, as a tool that estimates the severity of OSA, in patients with T2DM. 120 patients, who answered the STOP-BANG questionnaire and underwent polysomnography, were included in the study. The patients were divided into 3 groups, depending on the severity of OSA, defined by the apnea/hypopnea index (AHI). A significant percentage of participants (42.1%) had a severe form of OSA (AHI ≥30) and a high percentage of subjects had a STOP-BANG score ≥5 (58.7%), equivalent to a severe form of the disease. The STOP-BANG score increased proportionally with AHI (p<0.001). The area under the ROC curve for the STOP-Bang score indicated an optimal cut-off value of 4.5, with a sensitivity of 88.2% and a specificity of 62.9% (p <0.001), STOP-BANG score ≥5 being an independent predictor for severe OSA in patients with T2DM. The STOP-BANG score can be used in patients with diabetes to detect severe OSA in order to establish appropriate therapeutic measures.

Integrity of Multiple Memory Systems in Individuals With Untreated Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is associated with working- and autobiographical-memory impairments, and high rates of mood disorder. This study aimed to examine (i) behavioral responses and (ii) neural activation patterns elicited by autobiographical and working memory tasks in moderate-severe untreated OSA patients and healthy controls, and (iii) whether variability in autobiographical and working memory activation are associated with task performance, OSA severity and psychological symptomatology (depression, anxiety). In order to control for the potential confounding effect of elevated rates of clinical depression in OSA, we excluded individuals with a current psychiatric condition. Seventeen untreated OSA participants and 16 healthy controls were comparable with regards to both activation and behavioral performance. OSA was associated with worse subclinical mood symptoms and poorer personal semantic memory. Higher levels of nocturnal hypoxia were associated with increased activation in the occipital cortex and right cerebellum during the working memory task in OSA participants, however, no significant relationships between activation and task performance or depressive/anxiety symptomatology were observed. The neurocognitive substrates supporting autobiographical recall of recent events and working memory in younger, recently diagnosed individuals with OSA appear to be indistinguishable from healthy age-matched individuals. These findings point to the importance of early diagnosis and treatment of OSA in order to preserve cognitive function.

Obstructive sleep apnea in children: How it affects parental psychological status?

Purpose of the studyThe aim of this study was to evaluate the influence of obstructive sleep apnea (OSA) in children on maternal and paternal anxiety. Patients and methodsThis prospective study was conducted from January 2013 until January 2016 in the Ear, Nose and Throat (ENT) Department at the University Hospital of Split, Croatia. The parents of 59 children with a median age of 5 years (range: 2–9) who were suffering from obstructive sleep apnea (OSA) due to adenotonsillar hypertrophy were enrolled into the study. All children were scheduled for adenoidectomy or adenotonsillectomy because of airway obstruction. In addition, their parents completed the 20-item State-Trait Anxiety Inventory-1 (STAI-1) and 20-item State-Trait Anxiety Inventory-2 (STAI-2) questionnaires before the operation and 30 days after the surgery when their children had considerable improvements in breathing during their sleep. The STAI is an instrument that quantifies both state (STAI-1) and trait (STAI-2) anxiety. State-Trait Anxiety Inventory-1 (state anxiety) is intended to measure transitory anxiety at a specific time (related to OSA symptoms in our study), whereas STAI-2 (trait anxiety) measures long-term anxiety. ResultsOverall, the study included 57 mothers and 53 fathers of 59 children diagnosed with OSA. The mean preoperative STAI-2 score of parents was 31.1 ± 7.5; for fathers it was 28.2 ± 6.3, and for mothers it was 33.7 ± 7.6. The STAI-1 and STAI-2 scores showed significant differences before and after the surgery according to gender. The mean score of mothers was 5.5 (95% CI: 2.8 to 8.1) higher than the mean score of fathers (t = 4.1, p < 0.001) on the STAI-2 scale. The mean score of mothers was 5.6 (95% CI: 0.48 to 0.7) higher than the mean score of fathers (t = 2.2; p = 0.032) on the preoperative STAI-1 scale. The mean score of mothers was 1.95 (95% CI: 0.35 to 3.6) higher than the mean score of fathers (t = 2.4; p = 0.017) on the postoperative STAI-1 scale. The mean score of mothers was 6.22 higher than the mean score of fathers (p = 0.029) on the preoperative STAI-1 scale, adjusted for the STAI-2 scale. The mean score of mothers was 1.8 higher than the mean score of fathers (p = 0.039) on the postoperative STAI-1 scale, adjusted for the STAI-2 scale. These data suggest that differences between the preoperative and postoperative STAI-1 score for mothers was the highest (51 ± 7) in children with severe OSA and the lowest (28 ± 14) in children with mild OSA (p < 0.001). The difference between the preoperative and postoperative STAI-1 score for fathers was the highest (48 ± 6.6) in children with severe OSA and the lowest (25 ± 10) in children with mild OSA. ConclusionThe results of our study suggest that obstructive sleep apnea in children is a disturbing symptom for parents and is associated with a significant level of anxiety that depends on OSA severity. After the surgical treatment of the children (adenoidectomy or adenotonsillectomy), the anxiety level of both parents decreased. We suggest that preoperative psychological intervention should be considered in selected cases for mothers and fathers of children with severe OSA in order to diminish the symptoms of anxiety that can compromise normal postoperative recovery in operated children.

Obstructive sleep apnea and stroke

Obstructive Sleep Apnea (OSA) is a common co-morbid condition in stroke patients. It represents a very important risk factor for stroke in addition to the other established ones such as hypertension, cardiovascular disease (CVD), hyperlipidemia, atrial fibrillation (AF), type 2 diabetes mellitus (T2DM), stress, smoking, and heavy drinking. Although in the United States the prevalence of OSA has somewhat decreased from the previous years, globally its prevalence remains constant, or in some cases, is on the rise. In this review we present the epidemiology for OSA in stroke populations and discuss the risk factors for stroke as well as the underlying pathogenetic mechanisms linking OSA, stroke and CVD. We also emphasize the more thorough evaluation and control of OSA in order to prevent the disabling side effects of a stroke, which not only compromises the physical and mental health of a person and increases the burden on families, but also adds a severe burden to national health economics. OSA should always be considered when assessing a patient with transient ischemic attacks (TIA). Work up and treatment for OSA will not only help prevent stroke with its devastating consequences, but will also help prevent CVD, and ameliorate co-morbid conditions such as diabetes and hypertension in these vulnerable populations.

Sex Differences in the Impact of Obstructive Sleep Apnea on Glucose Metabolism.

Objectives: Obstructive sleep apnea (OSA) is more prevalent in men and is an independent risk factor for type 2 diabetes. We aimed to determine if there are sex differences in the impact of OSA on glucose metabolism in nondiabetic overweight and obese adults.Methods: One hundred and forty-five men and women (age 33.4 ± 0.6, BMI 37.2 ± 0.7, 70.3% blacks) from the community underwent in-laboratory polysomnography. Severity of OSA was assessed by the apnea-hypopnea index (AHI). Glucose tolerance was assessed using fasting glucose, 1-h glucose, 2-h glucose and the area under the curve (AUC) during the 2-h oral glucose tolerance test (OGTT). Fasting insulin resistance was assessed by HOMA-IR, and insulin sensitivity during the OGTT was assessed by the Matsuda Index. Pancreatic beta-cell function was assessed by fasting HOMA-%B and by AUCinsulin/glucose, insulinogenic index, and oral disposition index (DIoral) during the OGTT. All comparisons were adjusted for age, BMI, race and severity of OSA.Results: There were no significant demographic differences between men and women without OSA. Men and women with OSA were similar in age, BMI, and severity of OSA, but there were more black women with OSA. Compared to women with OSA, men with OSA had significantly higher fasting glucose, 1-h glucose levels, AUCglucose, and AUC for insulin secretion rate (AUCISR) but similar 2-h glucose levels. These differences persisted in adjusted analyses. Men with OSA secreted significantly more insulin than women with OSA in order to achieve similar glucose levels. Men with OSA had significantly worse beta cell function as measured by the DIoral than women with OSA. In contrast, there were no significant sex differences in measures of glucose tolerance and beta-cell function in participants without OSA.Conclusion: Men with OSA secreted more insulin compared to women with OSA in order to maintain glucose homeostasis. The adverse impact of OSA on beta-cell responsiveness was larger in men, which may result in an overall greater risk of type 2 diabetes compared to women.

Predictors of obstructive sleep apnea

A patient’s condition, such as obesity, plays a key role in the pathophysiology of obstructive sleep apnea (OSA). This study focuses on morphometric data that might be associated with the apnea–hypopnea index (AHI) and could therefore be used to predict OSA in order to better select patients for cardiorespiratory polysomnography (PSG). Data of 110 patients with suspected OSA in the sleep center outpatient department were analyzed retrospectively. The data included morphometric measurements such as neck, waist, and hip circumference; weight; body size; age; and Epworth Sleepiness Scale (ESS). The results of the patients’ overnight polygraphy, the AHI, completed the data. Neck and waist circumference can predict the AHI (p < 0.01). Power of prediction was higher for both factors among male (p < 0.01) compared to female patients (p = 0.05). In the case of neck circumference, the threshold value is 40 cm. Neck circumferences of more than 40 cm are strongly associated with a higher AHI (p < 0.001). It was possible to confirm the roles of waist and neck circumference as important parameters for a prediction model. Nevertheless, these parameters alone are not precise enough to completely neglect factors such as anatomic morphology in order to predict OSA and its severity.

Combination Therapy for Obstructive Sleep Apnea in Order to Achieve Complete Disease Alleviation: from Taboo to New Standard of Care?

O sleep apnea (OSA) is a highly prevalent disease with a complex pathophysiology.1,2 When undiagnosed or untreated OSA leads to subsequent morbidity and significant long-term mortality, also in patients with mild to moderate disease.3 Treatment with continuous positive airway pressure (CPAP) and oral appliance therapy with mandibular advancement devices (OAm) are the two treatments for OSA whose effects on cardiovascular endpoints have been assessed in randomized controlled trials (RCT).4–7 However, both therapeutic options have their possible limitations as CPAP treatment often comes with low patients’ acceptance, poor tolerance and suboptimal compliance, whereas OAm therapy generally has an inferior efficacy as compared to CPAP.4,8–10 Indeed, according to the mean disease alleviation (MDA) concept, the risk that the greater efficacy of CPAP is being offset by its inferior compliance relative to OAm therapy is not imaginary, resulting in a similar overall effectiveness for both therapeutic modalities.4,9 In other words, treatment of OSA with CPAP, OAm or other non-CPAP modalities, as a single treatment, will commonly be associated with an incomplete elimination of the disease with mean values of the MDA index, as a marker of real clinical effectiveness, ranging from 40 to 59 %.8,11,12 Supporting data from the literature on the role and impact of adjunct therapy that can be used as needed in order to improve the MDA index of the primary treatment options are scarce.13 Case series have been published on the combination of CPAP with OAm therapy for the treatment of OSA.14,15 It has been demonstrated that when mandibular protrusion is limited in case of OAm therapy, a combined approach utilizing both mandibular protrusion and tongue retention is able to provide an effective treatment for moderate-to-severe OSA as the addition of a tongue bulb to the OAm provides further therapeutic effectiveness.16 Furthermore, adjunct OAm therapy has been shown to be an effective mode of combination therapy to control OSA after failure of upper airway surgery.2,17 Multilevel surgery, being the combination of more than one surgical technique, can also be considered as combination therapy for OSA.18–23 In obese patients with severe OSA, CPAP requirements might be decreased after bariatric surgery and these lower CPAP pressures may yet lead to an increased CPAP tolerance and an improved overall compliance with CPAP.23 The effectiveness of other conceivable and convenient combinations in specific patients needs to be put into perspective and requires further investigation in ongoing studies or future trials. Interestingly, in addition, at least half of OSA patients are reported to suffer from supine-dependent or positional OSA (POSA), commonly defined as an apnea/hypopnea-index (AHI) being at least twice as high in the supine sleeping position as compared to the AHI in the non-supine positions.24,25 While newer methods to treat POSA with higher compliance rates are emerging, the relevance of this finding of POSA being that common is highly relevant.26–28 Recently, it has been reported that about 1 out of 3 patients still suffer from residual POSA while undergoing OAm therapy.29 The results of a recently published RCT indicate that in these patients with residual POSA under OAm therapy the combination of OAm and a sleep position trainer leads to a significant improvement of the therapeutic effectiveness with an increase of the MDA index changing from 42% with OAm alone to 70% with the combination treatment of OAm and sleep position trainer, respectively.30 Similarly, positional treatment might also be an adjunct treatment in patients on CPAP who require higher pressure levels in the supine sleeping position than in the non-supine positions in order to improve CPAP compliance.31 From a theoretical and conceptual perspective, the combination of positional therapy and surgical upper airway modifications could also result in a significant decrease in OSA severity in patients with POSA.32,33 In summary, the combination of different treatment options for the alleviation of OSA is clearly underestimated, undervalued and underinvestigated in the field of sleep medicine. In order to reach the target, preferably an alleviation of the disease, it might indeed be necessary to prescribe two or more therapies with adjunctive therapies used as needed to supplement the primary treatment options.13 In order to avoid incomplete alleviation of OSA, our field needs to think out of the box and try to get rid of the taboo of combining different treatment options in the individual patients in order to reach a well-defined target correlating with long-term elimination of disease. Further research on the clinical effectiveness of the possible combinations to completely eliminate the patient’s OSA is highly needed.

Improving continuous positive airway pressure adherence among adults

Study objectives: Continuous positive airway pressure (CPAP) is the gold standard of treatment for patients diagnosed with significant obstructive sleep apnea (OSA).  It has been estimated that approximately 30%-50% of patients diagnosed with OSA reject CPAP immediately and 80% of patients prescribed CPAP are noncompliant within a year after starting CPAP therapy. Nonadherence with CPAP greatly reduces the overall effectiveness of treatment of OSA, leaving these patients at an increased risk for comorbid conditions, impaired daily functioning and decreased quality of life. The purpose of this study was to improve CPAP adherence by implementing an intervention that consisted of an education program and increased patient support options as well as increased provider education. Methods: This study was a quasi-experimental study design.  CPAP adherence rates on 660 patients at an academic sleep center in New York City were collected, 326 patients at baseline and 334 post-intervention. Interventions, included provider education on OSA and CPAP adherence; an improved and actively supported, individualized, patient education program; and additional individual and group patient support options were available for patients. Results: Increased provider education, individualized intense patient education and patient support options increased CPAP adherence by 21%.  Increase in adherence between baseline and post-intervention group was statistically significant ( p = .005). Conclusions: A targeted program of increased patient education and intensive patient support was effective at increasing CPAP adherence. The use of similar approaches may improve CPAP adherence in other centers. It is crucial to improve CPAP adherence among patients diagnosed with significant OSA in order to improve outcomes.

Insulin resistance in obstructive sleep apnea

OSA is a common condition that is primarily characterized by intermittent and recurrent pauses in respiration results in multiple cycles of hypoxia/reoxygenation with an increased production of reactive oxygen species (ROS). Aim of work: Is to assess serum insulin level &insulin resistance in obese patients with & without OSA. Study was performed on 51 obese subjects who had been referred to Chest Department of Kasr Alaini Hospital with clinical suspicion of OSA in order to perform Polysomnography. They were classified into two groups; Cases: consists of 33 obese patients who were diagnosed as obstructive sleep apnea (OSA) & Controls: consists of 18 obese subjects, without OSA as a control group. The two groups were subjected to Full history taking, Clinical examination, Epworth sleepiness scale (ESS), Anthrop-ometric measurements including body mass index (BMI in kg/m2) waist, hip circumferences, waist/hip ratio and neck circumference, Polysomno-graphic study, Serum Insulin by ELISA & Assessment of insulin resistance by calculation of HOMA index. It was found that cases included 10 females (30.3%) & 23 males (69.7%), while controls included 14 females (77.8%) & 4 (22.2%).There was statistically highly significant increase in Epworth slee-piness scale (ESS) among cases compared to controls. As regards the Polysonographic data, there was statistically highly significant increase in AHI, desaturation index & duration of desaturation <90%. among cases compared to control subjects. Regarding minimal O2 sat% & average O2 sat% were lower in cases than in the control subjects and this reduction was statistically significant also there was statistically significant increase in arrhythmias index among cases than control subjects & there was significant increase in snoring index among cases than control subjects. There was statistically highly significant increase in serum insulin, HOMA index among cases as compared to controls. Insulin resistance in OSA is related to sleep associated hypoxaemia & hypoxic stress. Chest Department, Faculty of Medicine Cai-ro University.

Sex-related Differences in Cardiometabolic Outcomes Associated With Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a common sleep disorder in the United States. OSA has traditionally been thought to be a disease of men; though, recent studies have brought attention to OSA in women. Several reviews have focused on sex disparity in OSA as it pertains to clinical presentation and pathophysiologic mechanisms. However, a review of sex differences in clinical outcomes associated with OSA is absent from the current literature. This review focuses on sex differences in sleep apnea as it relates to clinical outcomes associated with OSA. Specifically, it highlights the existing literature on sex differences in cardiometabolic outcomes associated with OSA such as hypertension, stroke, coronary heart disease, diabetes, and mortality. It also brings to attention the inconsistencies that exist in the current literature on the role of sex as a potential effect modifier of the relationship between OSA and cardiovascular disease. The studies that have investigated the role of sex on the relationship between OSA and cardiovascular outcomes have demonstrated inconsistent findings. Some studies have reported greater susceptibility among men whereas others report higher risk associated with OSA among women. This review emphasizes the need for future investigations assessing sex differences in cardiometabolic outcomes associated with OSA in order to better inform the current guidelines on the role of OSA in the prevention, diagnosis, and treatment of cardiovascular diseases.

Structural Equation Modeling On Health-related Quality of Life in Patients with Obstructive Sleep Apnea

This study was done to test structural equation modeling of health-related quality of life (QOL) of men with obstructive sleep apnea in order to identify parameters affecting QOL and provide guidelines for interventions and strategies to improve QOL in these patients. Model construction was based on 'The conceptual model of patient outcome in health-related QOL' by Wilson and Cleary, using the variables; age, physiological factors, social support, cognitive appraisal, symptoms and QOL. Participants were 201 adult male patients recruited at a tertiary university hospital in Seoul. Data were collected via questionnaires, polysomnography, and clinical records. Age and symptoms directly influenced QOL. Social support and cognitive appraisal about sleep did not have a direct influence on QOL, but indirectly affected it via symptoms. QOL was lower in patients who were younger and had more severe symptoms. Symptoms were more severe for patients with lower social support and more dysfunctional cognitive appraisal. When social support was lower, cognitive appraisal was more dysfunctional. These results suggest it is necessary to not only manage symptoms, but also apply interventions to increase social support and cognitive appraisal about sleep in order to increase QOL in patients with obstructive sleep apnea.

Influence of Obstructive Sleep Apnea on Soluble Intercellular Adhesion Molecule-1 and Vascular Endothelial Growth Factor

Background : Obstructive sleep apnea is a contributory factor of hypertension, arrhythmia, ischemic heart disease and other cardiovascular diseases. However, the pathophysiology underlying this relationship is unclear. Recent reports have shown that the soluble intercellular adhesion molecule-1(sICAM-1) and vascular endothelial growth factor(VEGF) are involved in the initiation and progression of atherosclerosis, and some reports state that increased levels of these cytokines are found in patients with obstructive sleep apnea. In this study, the levels of sICAM-1 and VEGF were measured in patients with obstructive sleep apnea in order to determine if obstructive sleep apnea is involved in the pathophysiology of cardiovascular diseases. Methods : Thirty-seven patients were chosen amongst a population who visited the Sleep Disorders Clinic of St. Paul's Hospital in Seoul, Korea for a diagnosis of obstructive sleep apnea and who had subsequently undergone an overnight polysomnography at the clinic. The sera from these patients were retrieved after an overnight polysomnography session and the samples were kept at . The cytokine levels were determined with ELISA and the relationships between the serum levels of sICAM-1 and VEGF along with polysomnography parameters were analyzed. Results : No statistically significant correlation was observed between the sICAM-1 levels and the apnea-hypopnea index(r=0.27, P>0.05). Positive correlations were found between the apnea-hypopnea index and serum VEGF levels (r=0.50, P