Signs Of Obstructive Sleep Apnea Research Articles

Sleep Disturbances Detected by a Sleep Apnea Monitor in Craniofacial Surgical Patients

Sleep apnea in craniofacial surgery was investigated. Between January 1999 and December 2003, 18 patients were measured at an at least 6-month interval before and after surgery. Eight patients underwent palatoplasty for cleft palate, and the other 10 patients underwent orthognathic surgery, syndromic craniosynostosis, and postpharyngeal flap surgery. All patients included in the study demonstrated clinical signs of obstructive sleep apnea, such as snoring and cessation of breathing during sleep. An apnomonitor was used for presurgical and postsurgical sleep apnea status by measuring: 1) position during sleep; 2) percutaneous oxygen saturation; 3) respiratory analysis, such as the type of apnea-hypopnea, frequency of the events, and duration of apnea-hypopnea; 4) heart rate; and 5) snore analysis, such as trains, time, mean, and minimal and maximal amplifications. The apnea-hypopnea index (AHI) was significantly improved after surgery, especially in cases other than palatoplasty (7.4 +/- 8.73/h and 1.6 +/- 0.43/h, before and after surgery, respectively; P < 0.05 excluding palatoplasty). The percentage of snoring to total sleep was also improved significantly (22.4 +/- 19.74% and 9.0 +/- 8.54%, before and after surgery, respectively; P < 0.01 in all patients). Therefore, changes in sleep apnea parameters were elucidated in craniofacial surgery. Palatoplasty did not necessarily worsen the sleep apnea status, although there were snoring and anatomic abnormalities. Detachment of the pharyngeal flaps improved sleep apnea, and bimaxillary advancement was effective in normalizing sleep apnea.

Polysomnography in patients with intracranial tumors before and after operation.

To evaluate the breathing and sleep patterns in patients with brain tumors before and after operation, and assess their relation to the location and size of the tumor, as well as to the post-operative outcome. Polysomnographic studies were performed in 11 patients with intracranial tumors (nine supra- and two infratentorial) before and after surgery. Pre-operatively, the mean apnea-hypopnea index (AHI) was 23.3. Six patients demonstrated signs of obstructive sleep apnea (SA) and one had mixed obstructive and central type SA. After operation, the mean AHI decreased to 8.1(P < 0.05). The duration of random eye movement sleep stage increased after tumor removal (P < 0.04). No relation was found between the characteristics of the tumor, nor the post-operative outcome and SA. Patients with brain tumors often suffer from SA and this can further worsen their symptoms related to increased intracranial pressure. Removal of the tumor results in a substantial decrease in sleep-related disturbances and may thus play a role in clinical recovery.

Self-reported organic and nonorganic sleep problems in schoolchildren aged 11 to 15 years in Vienna.

To estimate the prevalence of self-reported sleep problems, to examine associations among demographic characteristics, familial factors, and sleep problems, and to investigate the association between the symptoms of obstructive sleep apnea (OSA) and nonorganic sleep disorders. An anonymous questionnaire with 22 questions was designed. 332 schoolchildren (aged 11-15 years, mean age 12 years and 9 months; median, 12 years; 56% female, 44% male) from two high schools in Vienna were investigated with regard to self-reported symptoms characteristic for obstructive sleep apnea and for parasomnia/insomnia. Data were analyzed by definition of three groups (problem, occasional problem, and nonproblem sleepers, and by calculation of an insomnia/parasomnia sum score). Statistical analysis included nonparametric tests (Mann Whitney-U and Kruskal), Pearson correlation test, and multiple regression analysis. Twelve percent reported at least one sleep problem every night, 76% reported occasional sleep problems, and 12% had no sleep problems. Girls were affected more frequently than boys (p <.01). Children with sleep problems suffered more often from concentration difficulties (p <.05), daytime fatigue (p <.001), and daytime naps (p <.05). Children who snored had nightmares (10% vs. 2%, p <.01), night terrors (4% vs. 1.5%, p <.001), sleepwalking (1.4% vs. 1%, p <.05), and nocturnal awakening (16% vs. 5%, p <.01) more frequently. On multiple regression analysis, 23% of the variability of a defined parasomnia/insomnia sum score had the characteristic OSA symptoms of nocturnal sweating, dryness of the mouth, snoring, hyperactivity, and daytime fatigue. 12% of schoolchildren aged 11-15 years reported sleep problems almost every night. The children suffer from daytime fatigue, naps, and concentration difficulties. Nearly one-fourth of the symptoms of parasomnia/insomnia were associated with characteristic signs of OSA, suggesting the importance of a routine clinical investigation in children with so-called nonorganic sleep disorders.

Sleep Apnea in Moderate-Severe Obese Patients.

Obesity induces multiple physiologic changes at the respiratory and circulatory systems level. A study was developed to identify symptoms and signs able to discriminate subjects at high risk of obstructive sleep apnea (OSA) and to evaluate the presence of OSA in a population of obese patients referred to the Clinical Nutrition Service of the Luigi Sacco Hospital for weight loss therapy. Twenty-seven obese patients (14 males, 13 females) without neurologic, cardiac, and lung diseases were measured for height, weight, neck, waist, and hip circumference; a sample of venous blood was taken for hematological data; and were given a pulmonary function test, hemogasanalysis, and full-night polysomnography. Statistical analysis were performed using paired and unpaired StudentOs t test, PearsonOs chi square, and Spearmann Rank correlation; the significance level was set at p<0.05. The results showed hemotological values in the normal range and pulmonary function findings were not different from predicted, but expiratory reserve volume (ERV), as expected in obese subjects, was significantly reduced (p<0.001). Waist, hip, and neck circumference, and waist/hip ratio were 114 +/-14, 118 +/-12, 44 +/-4, and 0.96 +/-0.4 cm respectively. An apnea-hypopnea index (AHI) cutoff value of <15 was used to classify the patients as suffering from OSA: 15 patients (12 males, 3 females, age in years 55 +/-12, body mass index (BMI) kg/m(2) 37 +/-6, AHI 30 +/-12) were OSA and 12 patients were non OSA (2 males, 10 females, age in years 49 +/-20, BMI kg/m(2) 35 +/-2, AHI 3 +/-2). PaO2 and pH were lower and PaCO2 higher in OSA (p<0.05, p<0.01, p<0.05, respectively). Red blood cells (RBC), Hb, and neck circumference were increased in OSA (p<0.05). In OSA patients, S3%, S4% of total sleep time, SaO2% mean of nadir were reduced (p<0.001), and DEF increased (p<0.0001). In obese patients, AHI was correlated with neck circumference (r = 0.74, p<0.0001) and waist/hip ratio (r = 0.48. p<0.01). DEF was correlated with RBC, Hb, Htc% (r = 0.82, 0.71, 0.66, p<0.001). SaO2;% mean of nadir was significantly related to RBC, Hb, and Htc% (r = 0.44, 0.40, p<0.05, respectively). Our data showed a prevalence of OSA in 55% of the obese patients. A significant correlation exists between RBC, Hb, Htc%, with desaturation events frequency (DEF) and SaO2% of nadir indicating that transient, episodic desaturation during sleep is linked to a moderate increase of RBC and Hb found in obese patients with OSA, in contrast to obese, nonOSA patients. The most important result of the present study was the determination that classical symptoms and signs of OSA, such as male gender, neck circumference, waist/hip ratio, RBC, and Hb at the upper limit of normal, are simple inexpensive screening tools, and useful predictors of sleep-disordered breathing and discriminate the individuals with higher risk of OSA.

Down syndrome: identification and surgical management of obstructive sleep apnea.

To date, a paucity of information is available on the optimal management of obstructive sleep apnea in Down syndrome, which may have particularly important implications in this already vulnerable patient population. The objective of this study was to evaluate prospectively the results of a new surgical approach for the treatment of obstructive sleep apnea. Patients with Down syndrome and obstructive sleep apnea underwent preoperative and postoperative polysomnography and clinical and radiologic evaluation to determine prospectively the efficacy of sleep apnea surgery. Statistical testing of apnea index, respiratory disturbance index, and lowest oxygen saturation were compared by means of paired t tests. Seven children (five boys, two girls) from 3 to 12 years of age were subjected to a management protocol that included an aggressive surgical approach to the treatment of obstructive sleep apnea. Clinical symptoms and signs of obstructive sleep apnea, apnea index, respiratory disturbance index, lowest oxygen saturation, and surgical morbidity were the main outcome measures. Surgical treatment consisted of a combination of soft-tissue and skeletal alterations including tongue reduction (n = 6), tongue hyoid advancement (n = 4), uvulopalatopharyngoplasty (n = 7), and maxillary or midface advancement (n = 2). Polysomnography was obtained preoperatively and postoperatively in six patients. One patient was intubated preoperatively. Mean preoperative apnea index and respiratory disturbance index were 34.00 and 52.46 compared with mean postoperative values of 1.62 and 6.46, respectively. Clinically, all patients were improved symptomatically in terms of snoring, noisy breathing, and oxygen requirements. The one patient who had been intubated preoperatively for respiratory failure was extubated successfully but later developed recurrent tricuspid regurgitation and was found to have fixed pulmonary hypertension with cor pulmonale. This patient represented the only treatment failure and underwent tracheostomy. An aggressive surgical approach aimed at correcting all anatomic abnormalities associated with upper airway obstruction was applied successfully to the treatment of obstructive sleep apnea in Down syndrome. We suggest periodic polysomnography in patients with Down syndrome, especially if there is unexplained deterioration in mental capacity or other signs and symptoms of obstructive sleep apnea. Surgical treatment should address both the soft-tissue abnormalities and the skeletal deformities such as midface retrusion. Preoperative cardiac ultrasonography is important to determine the presence of right-sided heart failure, which may be an indication for cardiac catheterization to determine pulmonary venous pressures.

Obstructive sleep apnea: the use of nasal CPAP in 80 children.

This is a retrospective review of children 15 years of age or younger, who underwent overnight sleep studies between 1980 and 1993. All were diagnosed and treated for obstructive sleep apnea (OSA). Overnight studies were performed for OSA in 413 children. One hundred seventy-five (42.4%) children were treated with adenotonsillectomy and 80 (19.4%) with nasal mask continuous positive airway pressure (nCPAP). The proportion of male children was greater than expected in both the entire study group (69%, p < 0.001) and in those treated with nCPAP for OSA (71% p < 0.001). There was no significant difference between the mean age of the children treated with nCPAP (5.7 +/- 0.5 yr) and the entire group studied (5.04 +/- 0.21 yr). A greater proportion of the children who received nCPAP therapy had a congenital syndrome or malformation than in the group with OSA as a whole; 27.7% of children assessed for OSA were affected, and 53% of those children with OSA who received treatment with nCPAP (p < 0.001). Therapy with nCPAP (mean duration 15 +/- 3 mo, mean pressure 7.9 cm H2O) eliminated the signs of OSA in 72 children (90%). Respiratory disturbance index fell from a mean of 27.3 +/- 20.2 to 2.55 +/- 2.74 (p < 0.001). Eight of 32 children who underwent pressure determination studies could not tolerate nCPAP above an upper limit because of hypoventilation or frequent central apneas. Nevertheless, we conclude that nCPAP is an effective and generally well-tolerated therapy for treatment of OSA in infants and children.