Obstructive Sleep Apnea-hypopnea Syndrome Patients Research Articles

Titrated mandibular advancement versus positive airway pressure for sleep apnoea

The aim of this study was to compare mandibular advancement device (MAd) therapy and continuous positive airway pressure (CPAP) for obstructive sleep apnoea/hypopnoea syndrome (OSAHS) after one-night polysomnographic (PSG) titration of both treatments. 59 OSAHS patients (apnoea/hypopnoea index (AHI): 34+/-13 events x h(-1); Epworth scale: 10.6+/-4.5) were included in a crossover trial of 8 weeks of MAd and 8 weeks of CPAP after effective titration. Outcome measurements included home sleep study, sleepiness, health-related quality of life (HRQoL), cognitive tests, side-effects, compliance and preference. The median (interquartile range) AHI was 2 (1-8) events x h(-1) with CPAP and 6 (3-14) events x h(-1) with MAd (p<0.001). Positive and negative predictive values of MAd titration PSG for treatment success were 85% and 45%, respectively. Both treatments significantly improved subjective and objective sleepiness, cognitive tests and HRQoL. The reported compliance was higher for MAd (p<0.001) with >70% of patients preferring this treatment. These results support titrated MAd as an effective therapy in moderately sleepy and overweight OSAHS patients. Although less effective than CPAP, successfully titrated MAd was very effective at reducing the AHI and was associated with a higher reported compliance. Both treatments improved functional outcomes to a similar degree. One-night titration of MAd had a low negative predictive value for treatment success.

Z-palatopharyngoplasty for obstructive sleep apnea/hypopnea syndrome

Objective To explore the feasibility, outcomes, and factors affecting the outcome of Z-palatopharyngoplasty (ZP3) in the treatment of severe obstructive sleep apnea/hypopnea syndrome (OSAHS). Study Design Case series with chart review. Methods ZP3 was performed on 34 Friedman stage II/III OSAHS patients with a posterior airway space (PAS) ≥ 11 mm. Postoperative follow-up was at least 6 months, and the differences between responders and nonresponders were analyzed. Results On the basis of success criteria, defined as an apnea-hypopnea index < 20 and a decrease > 50 percent, the success rate was 64.7 percent. The lowest oxygen saturation (LSaO 2), percentage of time with an oxyhemoglobin saturation below 90 percent (CT 90), mandibular plane angle (MPA), mandibular body length, position of the tongue, and Friedman clinical stage differed significantly between responders and nonresponders. The logistic regression analysis showed that MPA and Friedman stage were the key predictors of ZP3 surgical success. The best cutoff points for LSaO 2, CT 90, and MPA were 72 percent, 22.80 percent, and 29.40°, respectively. Conclusions Factors affecting the outcome of ZP3 included LSaO 2, CT 90, MPA, mandibular body length, position of the tongue, and Friedman clinical stage. Of these, the MPA and Friedman clinical stage were most influential.

Relationship between the Body Position-Specific Apnea-Hypopnea Index and Subjective Sleepiness

Background: It is well known that the sleeping position influences the rate of apnea-hypopnea events; however, whether events in one position may have more influence on daytime sleepiness than events in another position has not been thoroughly investigated. Objectives: We retrospectively examined the relationship between the body position-specific apnea-hypopnea index (AHI) and daily sleepiness. Methods: We assessed the sleeping body position, the body position-specific AHI and the Epworth Sleepiness Scale (ESS) in a total of 699 patients who were referred for suspected obstructive sleep apnea-hypopnea syndrome (OSAHS) and underwent diagnostic polysomnography. Results: For all subjects, only the lateral position-specific AHI (L-AHI) showed a weak but significant correlation with the ESS (r = 0.102; p < 0.05). For mild-to-moderate OSAHS patients, there was no correlation between the ESS and the AHI at any position. For severe OSAHS patients, the ESS showed a closer correlation with the L-AHI (r = 0.266; p < 0.001) than with the supine position-specific AHI (S-AHI; r = 0.141; p < 0.05). In a subgroup analysis, divided into positional and non-positional severe OSAHS patients, the correlation coefficients also identified a link between the L-AHI and the ESS. Finally, a multiple linear regression analysis indicated that the ESS was better explained by the L-AHI than by the S-AHI in severe OSAHS patients. Conclusion: The L-AHI is considered to have a stronger influence on daytime sleepiness than the S-AHI in Japanese patients with severe OSAHS.

Surgery vs ventilation in adult severe obstructive sleep apnea syndrome

Background and purpose Management of severe obstructive sleep apnea-hypopnea syndrome (OSAHS) is challenging and needs multidisciplinary cooperation. Ventilation is considered the gold standard of treatment in severe OSAHS. The aim of the study was to compare the therapeutical efficacy of a type of surgery (maxillomandibular advancement [MMA]) vs a ventilatory treatment modality (autotitrating positive airway pressure [APAP]). Materials and methods At the ENT Department of Forlì Hospital (University of Pavia), in strict cooperation with the Sleep Lab of the University of Bologna, a prospective randomized controlled trial was designed and performed. After fully informing them, 50 consecutive patients who have severe OSAHS were enrolled and randomized into a conservative (APAP) or surgical (MMA) section. Demographic, biometric, polysomnogram (PSG) and Epworth Sleepiness Scale profiles of the 2 groups were statistically not significantly different. Results One year after surgery or continuous APAP treatment, both groups showed a remarkable improvement of mean Apnea-Hypopnea Index (AHI) and Epworth Sleepiness Scale levels; the degree of improvement was not statistically different. Conclusions Given the relatively small sample of subjects studied and the relatively brief follow-up, MMA proved to be a valuable alternative therapeutical tool in our adult and severe OSAHS patient group, with a success rate not inferior to APAP.

A study on the change in blood pre-adaptation factors among patients with obstructive sleep apneahypopnea syndrome

Objective To investigate the changes in serum level of vascular endothelial growth factor (VEGF), nitric oxide (NO), erythropoietin (EPO) and plasma level of carbon monoxide (CO) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and their clinical significance. Methods Sixty-four patients diagnosed as OSAHS by polysomnography (PSG), were divided into two groups according to apnea-hypopnea index (AHI), 20 in mild group [5/h≤AHI≤20/h, with a mean of (12± 5)/hi and 44 in moderate-severe group[AHI > 20/h, with a mean of (63±23)/h]. Blood samples were obtained from all the patients after PSG for measurement of levels of serum VEGF, NO and EPO and plasma CO. Results Levels of serum VEGF [(101±91) ng/L], NO [(10.3±3.3) μmol/L]and plasma CO [(0.56±0. 35) mg/L]in moderate-severe OSAHS group were significantly higher than those in mild group (all P 0.05). Levels of serum VEGF, NO and plasma CO in OSAHS patients positively correlated with AHI and percentage of time with percutaneous arterial blood oxygen saturation lower than 0. 9 (SLT90) of all sleep time (all P 0.05). No correlation between EPO and all the indicators was found (P>0.05). Multiple linear regression analysis showed that LSaO2 was an independent risk factor to affect levels of serum VEGF and plasma CO (R2=0.198, P=0.001, and R2=0.210, P=0.000, respectively) and SLT90 was an independent risk factor to affect serum level of NO (R2= 0. 148, P=0.004) in OSAHS patients. Conclusion Hypoxia at night is a main cause leading to increased level of serum VEGF, NO and plasma CO in OSAHS patients. Key words: Sleep apnea, obstructive; Vascular endothelial growth factor A; Nitrric oxide; Carbon monoxide

Study into the use of continuous positive airway pressure in obstructive sleep apnoea-hypopnoea syndrome patients with daytime drowsiness

BackgroundObstructive sleep apnoea-hypopnoea syndrome (OSAHS) is a respiratory disorder with high morbidity and mortality. Continuous positive airway pressure (CPAP) is the most commonly prescribed conservative treatment for adults with OSAHS. CPAP therapy normalises or decreases OSAHS symptoms and can reduce and prevent OSAHS complications. AimsTo evaluate adherence to nasal CPAP treatment and CPAP impact on daytime drowsiness. MethodA sample of 20 patients evaluated for daytime drowsiness using the Epworth sleepiness scale and interviewed for adherence to nasal CPAP use. ResultsThere was a significant decrease in the level of daytime sleepiness of the patients users of nasal CPAP (p=0.017); patients not using nasal CPAP experienced a decrease without statistical significance (p=0.162). 100% of CPAP users reported benefits and 50% of these reported related discomforts. ConclusionsPatients with OSAHS that use CPAP have a greater reduced level of sleepiness than those who do not use it.

Markers of glycemic control and insulin resistance in non-diabetic patients with Obstructive Sleep Apnea Hypopnea Syndrome: Does adherence to CPAP treatment improve glycemic control?

Background and Aim Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) is associated with glucose dysmetabolism and insulin resistance, therefore the amelioration of breathing disturbances during sleep can allegedly modify the levels of markers of glucose regulation and insulin resistance, such as glycated hemoglobin, fasting glucose, insulin and HOMA IR. The aim of this study was to explore the association between these parameters and sleep characteristics in non-diabetic OSAHS patients, as well as the effect of 6 months CPAP therapy on these markers, according to adherence to CPAP treatment. Methods Euglycemic patients ( n = 56; mean age ± SD: 46.07 ± 10.67 years) with newly diagnosed OSAHS were included. Glycated hemoglobin, fasting glucose, insulin levels and HOMA IR were estimated at baseline and 6 months after CPAP application. According to CPAP adherence, patients were classified as follows: group 1 (mean CPAP use ⩾ 4 h/night), group 2 (mean CPAP use < 4 h/night) and group 3 (refused CPAP treatment), and comparisons of levels of the examined parameters were performed. Results At baseline, average SpO 2 during sleep was negatively correlated with insulin levels and HOMA IR while minimum SpO 2 during sleep was also negatively correlated with insulin levels. After 6 months, only group 1 patients demonstrated a significant decrease in glycated hemoglobin ( p = 0.004) accompanied by a decrease in hs-CRP levels ( p = 0.002). No other statistically significant change was observed. Conclusions Nighttime hypoxia can affect fasting insulin levels in non-diabetic OSAHS patients. Good adherence to long-term CPAP treatment can significantly reduce HbA 1C levels, but has no effect on markers of insulin resistance.

Obstructive Sleep Apnea–Hypopnea Syndrome—The Role of Bariatric and Maxillofacial Surgeries

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a complex disease with multifactorial etiology. It is marked by the occurrence of apnea and hypopnea events caused by repeated obstructions of the upper airways. OSAHS is strongly associated with obesity, and the prevalence of this disease in morbidly obese patients is very high. Nevertheless, not all patients with OSAHS are obese, and for this reason, there may be other anatomical predispositions to airway collapse. In obese patients, fatty deposition in the parapharyngeal region results in airway reduction and predisposes to airway collapse, worsened by neurologic loss of the normal dilator muscle tone of the neck. However, in nonobese patients, specific craniofacial characteristics such as posterior air pharyngeal space, tongue length, hyoid position, and maxillomandibular deficiencies may predispose some people to develop OSAHS. Treatment strategies for OSAHS patients vary from clinical treatment with continuous positive airway pressure, oral appliances, or medications for mild and moderate OSAHS patients, bariatric surgery for severe obese OSAHS patients to maxillomandibular advancement for obese or nonobese OSAHS patients.

Research on the relationship between obstructive sleep apnea hypopnea syndrome and gastroesophageal reflux

To study the relationship between obstructive sleep apnea and nocturnal gastroesophageal reflux (GER). Seventy-six patients with obstructive sleep apnea hypopnea syndrome (OSAHS) underwent polysomnography (PSG) and nocturnal distal esophageal pH monitoring, to assess the prevalence of GER in OSAHS patients. Among these patients, thirty-two OSAHS patients with GER disease had been operated on. Surgical treatment included uvulopalatopharyngoplasty (UPPP), inferior turbinate reduction, nasal septoplasty et al. After 6 months of surgical treatment, the PSG and pH probe testing were rechecked. The pre and post operative apnea-hypopnea index (AHI), micro-arousal index (MAI), lowest artery oxygen saturation (LSaO2), acidified index of distal esophagus (pHI) and percentage of acid contact time of esophagus were compared. The correlation analysis was also employed. The AHI of 76 OSAHS patients was (38.6 +/- 29.5)/h (average +/- s), GER was present in 48 patients (63.2 %). The pre and post operative AHI, MAI, LSaO2, pHI and percentage of ACT in 32 OSAHS patients associated with GER were (51.2 +/- 23.1)/h and (17.3 +/- 10.3)/h, (38.3 +/- 21.4 )/h and (14.5 +/- 10.0)/h, 0.698 +/- 0.107 and 0.858 +/- 0.076, (12.5 +/- 6.6)/h and (6.3 +/- 4.2)/h, (10.3 +/- 5.2)% and (4.5 +/- 2.9)%. The differences were statistically significant by matching t test (t were 10.95, 7.82, 15.97, 6.12, 7.62 respectively, P < 0.001). There were positive relationships between the reductions of AHI, MAI and the reductions of pHI (r were 0.775, 0.764, P < 0.001). The improved levels of AHI and MAI were correlated with the reduction of the percentage of ACT (r were 0.607, 0.730, P < 0.001). GER is prevalent in OSAHS patients. Surgical treatment of OSAHS has significant reduction in AHI, MAI as well as marked improvement in the GER, which suggests that nocturnal gastroesophageal reflux is correlated with the disorder of sleep respiration and the sleep disturbances.

Plasma resistin level in obstructive sleep apnea hypopnea syndrome

To explore the changes and clinical implications of plasma resistin level in obstructive sleep apnea hypopnea syndrome (OSAHS). Plasma resistin level was measured by radioimmunoassay in 30 obese OSAHS patients (obese OSAHS group), 7 in the low apnea hypopnea index (AHI) subgroup, 9 in the medium AHI subgroup, and 14 in the high AHI subgroup, 30 obese subjects (obese group), and 28 normal healthy adults (control group). Stepwise multiple linear regression analysis was conducted to determine the correlation of plasma resistin level with body mass index (BMI), body fat percentage, waist to hip ratio (WHR), fasting blood glucose (FBG), blood lipid, AHI, and lowest arterial oxygen saturation (LSaO(2)). The plasma resistin levels of the obese OSAHS group and obese group were (8.48 +/- 1.44) and (7.60 +/- 1.53) microg/L respectively, both significantly higher than that of the control group [(5.78 +/- 1.62) microg/L, both P < 0.05], and that of the obese OSAHS group was significantly higher than that of the obese group (P < 0.05). The plasma resistin level of the high AHI obese OSAHS subgroup was (9.60 +/- 0.51) microg/L, significantly higher than those of the medium and low AHI obese OSAHS subgroups [(7.96 +/- 1.06) and (6.90 +/- 1.32) microg/L respectively, both P < 0.01]. Correlation analysis demonstrated that the fasting plasma resistin level was positively correlated with BMI, neck circumference, waist circumference, WHR, FBG, total cholesterol, triglyceride, and AHI (r = 0.52, 0.66, 0.74, 0.52, 0.59, 0.48, 0.46, and 0.80, all P < 0.05); and negatively correlated with high-density lipoprotein cholesterol and LSaO(2) (r = -0.52, r = -0.60, both P < 0.01). A stepwise multiple linear regression analysis showed that AHI was the most significant contributing factor for the increased plasma resistin level in the obese OSAHS group (R(2) = 0.618). Plasma resistin level in obese OSAHS patients are increased, and are positively correlated with AHI. It may be used as an important biological index to evaluate the severity of OSAHS.

Severity of obstructive sleep apnoea/hypopnoea syndrome and subsequent waking EEG spectral power

It is well known that most patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS) suffer sleepiness, although the underlying mechanisms of this relationship remain unclear. The present study examined the relationship between nocturnal variables and the subsequent waking electroencephalogram (EEG), in order to determine if sleepiness was related to OSAHS severity and due to sleep fragmentation or to nocturnal hypoxaemia. In total, 12 moderate-to-severe OSAHS patients underwent a total sleep night followed by a 24-h period of sustained wakefulness where the waking EEG was measured every hour. The results showed that alpha (7.9-12.6 Hz) and beta (12.7-29.2 Hz) activities were strongly related to OSAHS severity, mainly reflected by the apnoea index. Moreover, spectral power in most of the waking EEG components was significantly correlated with nocturnal hypoxaemia indices, namely alpha and beta activity when hypoxaemia becomes severe. However, no correlation was found between the waking EEG and sleep fragmentation parameters. In conclusion, the present results suggest that the difficulty in maintaining an optimal level of alertness, reflected by a higher activity in awake alpha and beta bands (7.9-29.2 Hz) in obstructive sleep apnoea/hypopnoea syndrome, was better explained by: 1) the apnoea as opposed to the hypopnoea index; and 2) nocturnal hypoxaemia as opposed to sleep fragmentation.

S301 – ZPPP Combined with RF Surgery for Moderate/Severe OSAHS

Objectives To retrospectively investigate the outcomes of Z-palatopharyngoplasty (ZPPP) combined with radiofrequency (RF) surgery for the treatment of moderate/severe obstructive sleep apnea/hypopnea syndrome (OSAHS). Methods 43 patients with moderate/severe OSAHS who failed CPAP therapy and then underwent ZPPP combined with RF tongue base reduction were enrolled in this study. The subjective symptoms and objective PSG parameters were collected preoperatively and 6 months postoperatively. Statistical analysis was determined by paired t-test. Results 2 females and 41 males (mean, 39 years) had a minimum follow-up of 6 months and complete data available for analysis. None of the patients had perioperative or postoperative complications. No long-term velopharyngeal insufficiency was encountered. The classical success rate was 60.5% (26/43). 6 months after the treatment, the Epworth sleepiness scale changed from 12.8 ± 5.1 to 10.0 ± 4.3 (P = 0.002). The apnea/hypopnea index (/hr.), lowest oxygen saturation (%), and bedpartner's snoring visual analog scale (0–10) changed from 51.5 ± 25.4 to 23.4 ± 24.7, 75.5 ± 10.4 to 82.1 ± 10.9, 8.4 ± 1.6 to 2.9 ± 1.6, respectively (all p&lt;0.0001). Conclusions This study shows the significant benefits of ZPPP combined with RF surgery in moderate/severe OSAHS patients.

Subjective sleepiness among patients with obstructive sleep apnea-hypopnea syndrome who were treated with a continuous positive airway pressure device

It has been reported that continuous positive airway pressure (CPAP) improves daytime sleepiness in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). However, in some patients, the Epworth sleepiness scale (ESS) score is high even on CPAP. We assessed the prevalence, quality of life (QOL), and other factors related to subjective sleepiness among Japanese patients with OSAHS who were treated with CPAP. Data regarding the patients’ characteristics, ESS score, QOL using the MOS 36-item short-form health survey, symptoms or problems, and CPAP-related factors, including CPAP compliance, were collected. The patients were divided into two groups according to their ESS score (≥11 or <11). Overall, 484 patients were assessed, of whom 108 (22.3%) had subjective sleepiness on CPAP. Patients with subjective sleepiness on CPAP had a lower score on several SF-36 subscales. On multivariate logistic analysis regression, shorter sleeping time (odds ratio [OR] 0.67 [0.53–0.85]), presence of mask-related problems (OR 1.96 [1.24–3.11]), and poor compliance (OR 1.68 [1.01–2.63]) were significantly associated with subjective sleepiness on CPAP. In conclusion, the prevalence of subjective sleepiness on CPAP among Japanese OSAHS patients was determined. Such patients had an impaired QOL. As significant associations between several factors and such sleepiness were found, these factors should be addressed in such patients.

Effects of short-term continuous positive airway pressure treatment on arterial stiffness in patients with obstructive sleep apnea hypopnea syndrome

To investigate the effect of short-term continuous positive airway pressure (CPAP) treatment on the arterial stiffness in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Cardio ankle vascular index (CAVI) and blood pressure (BP) were measured before and after sleep in 60 non-hypertensive patients with OSAHS and gender and 60 age-matched healthy controls. CPAP was administrated in 22 of the 60 OSAHS patients. And on the first and third days of the CPAP treatment CAVI and BP were measured in the morning, i. e., after sleep. In the morning, the CAVI of the OSAHS patients was 8.0 +/- 1.2 m/s, significantly higher than that before sleep (7.3 +/- 1.0, P = 0.000), the diastolic BP (DBP) was (86 +/- 12) mm Hg, significantly higher than that before sleep (83 +/- 13 mmHg, P = 0.001), and the mean BP (MBP) was (101 +/- 12) mm Hg, significantly higher than that before sleep (98 +/- 14, P = 0.00116). However, there were no significant differences in these parameters among the controls The systolic BP (SBP) of the OSAHS patients did not changed significantly after sleep, however, there was a tendency to decrease in the controls [(123 +/- 14) vs (121 +/- 13) mm Hg, P = 0.074). After the first night treatment, the CAVI, SBP, DBP, and mean BP of the 22 severe OSAHS patients decreased significantly (all P < 0.05), and after three nights treatment, only the CAVI showed further significant decrease (P < 0.05). Sleep induces increase of artery stiffness in OSAHS patients, but not in the normal controls. Short-term CPAP may decrease CAVI without affecting the blood pressures. Early atherosclerosis in the patients with OSAHS may be reversed by CPAP therapy.

Physiological state of OSAHS patients with nasal intubationation by music therapy

Objective To observe effects of music therapy on heart rate, respiration, blood pressure right after obstructive sleep apnea-hypopnea syndrome (OSAHS) patients with nasal intubation.Methods 58patients with postoperative nasal intubation OSAHS were randomly divided into 60 minutes of music therapy group and the control group.Heart rates, respiration, blood pressure and resting state were observed before and after music therapy.Results Compared with the control group, the heart rate (t = 2.04, P＜0.01 ), blood pressure dropped faster( SBp : t = 3.39, P＜0.01 ; DBp : t = 2.65, P＜0.05 ) , and were more stable in music therapy group.Music therapy can significantly reduce the heart rate, respiration and blood pressure.The tolerance levels of patients in the music therapy group were better than that in the control group.Conclusions Music therapy can improve significantly physiological state of patients after OSAHS patients with nasal intubation. Key words: Music therapy; OSAHS patients with postoperative nasal intubation; Vital signs

Laryngeal and hypopharyngeal obstruction in sleep disordered breathing patients, evaluated by sleep endoscopy

The objectives of our study were to demonstrate the patterns and sites of the upper airway (UA) collapse in obstructive sleep apnea/hypopnea syndrome (OSAHS) patients, utilizing the sleep endoscopy technique, and to describe the technique and summarize our experience in a large series of patients. UA findings during sleep endoscopy with midazolam were examined prospectively in 55 surgical candidates with OSAHS. The uvulopalantine was the most common site of obstruction (89%), followed by the tongue base, hypopharynx and larynx (33% each), and nose (21%); 72% of the patients had multiple obstructions. There was a significant correlation between the number of obstructions and the respiratory distress index (RDI). Laryngeal obstruction was typically supraglottic. Hypopharyngeal obstruction involved concentric UA narrowing. Our findings emphasize the considerable rate of laryngeal and hypopharyngeal obstructions in patients with OSAHS and suggest that their misdiagnosis may explain at least part of the high surgical failure rate of UPPP for OSAHS patients. The number of obstruction sites correlates with respiratory distress index. Sleep endoscopy is safe and simple to perform.

Effect of Posture on Airway Resistance in Obstructive Sleep Apnea-Hypopnea Syndrome by Means of Impulse Oscillation

Background: There is more than one mechanism which contributes to the increases in upper airway resistance in obstructive sleep apnea and hypopnea syndrome. Impulse oscillation provides a convenient way of noninvasive monitoring and differentiating the contributions of airway resistance. Objective: To evaluate the effect of posture on airway resistance in obstructive sleep apnea-hypopnea syndrome (OSAHS) by means of impulse oscillation. Methods: Ten subjects without OSAHS proved by polysomnography served as controls, 14 patients with mild or moderate OSAHS and another 20 severe OSAHS patients were studied. All subjects underwent an overnight sleep study. Airway resistance was measured by impulse oscillometry, and spirometry was performed in the seated position and then in the supine position while awake. Results: Compared with controls, the severe and the mild-moderate OSAHS groups had significantly bigger changes in Zrs, Rrs5, R20 and R35 due to posture. There were also significant differences in R10, R15 and R25 between the severe OSAHS and the control groups. Besides, the group differences between the severe and the mild-moderate groups regarding the magnitude of this change were not significant. The correlation coefficients between apnea/hypopnea index and Zrs, R5 and R20 in supine position were 0.487, 0.486 and 0.485, respectively. Conclusion: The magnitude of change in airway resistance due to posture is bigger in OSAHS than in non-OSAHS. Zrs, R5 and R20 in supine position were associated moderately with apnea/hypopnea index.

Nocturnal reduction in circulating adiponectin concentrations related to hypoxic stress in severe obstructive sleep apnea-hypopnea syndrome

Previous reports demonstrated that adiponectin has antiatherosclerotic properties. Obstructive sleep apnea-hypopnea syndrome (OSAHS) is reported to exacerbate atherosclerotic diseases. We investigated nocturnal alternation of serum adiponectin levels before sleep and after wake-up in OSAHS patients and the effect of sustained hypoxia on adiponectin in vivo and in vitro. We measured serum adiponectin concentrations in 75 OSAHS patients and 18 control subjects before sleep and after wake-up and examined the effect of one-night nasal continuous positive airway pressure (nCPAP) on adiponectin in 24 severe OSAHS patients. We investigated the effects of hypoxia on adiponectin in mice and cultured adipocytes with a sustained hypoxia model. Circulating adiponectin levels before sleep and after wake-up were lower in severe OSAHS patients than in control subjects [before sleep: 5.9 +/- 2.9 vs. 8.8 +/- 5.6 microg/ml (P < 0.05); after wake-up: 5.2 +/- 2.6 vs. 8.5 +/- 5.5 microg/ml (P < 0.01), respectively; means +/- SD]. Serum adiponectin levels diminished significantly during sleep in severe OSAHS patients (P < 0.0001), but one-night nCPAP improved the drop in serum adiponectin levels [-18.4 +/- 13.4% vs. -10.4 +/- 12.4% (P < 0.05)]. In C57BL/6J mice and 3T3-L1 adipocytes, hypoxic exposure decreased adiponectin concentrations by inhibiting adiponectin regulatory mechanisms at secretion and transcriptional levels. The present study demonstrates nocturnal reduction in circulating adiponectin levels in severe OSAHS. Our experimental studies showed that hypoxic stress induced adiponectin dysregulation at transcriptional and posttranscriptional levels. Hypoxic stress is, at least partly, responsible for the reduction of serum adiponectin in severe OSAHS. Nocturnal reduction in adiponectin in severe OSAHS may be an important risk for cardiovascular events or other OSAHS-related diseases during sleep.

Estudo comparativo da história clínica e da polissonografia na síndrome da apnéia/ hipopnéia obstrutiva do sono

O reconhecimento dos distúrbios respiratórios do sono tem aumentado a cada ano. Manifestações, como o ronco, consideradas meros incômodos vêm adquirindo importância no que diz respeito à qualidade de vida e seu impacto social. OBJETIVO: Comparar a história clínica com os resultados da polissonografia (PSG), na Síndrome da Apnéia/Hipopnéia Obstrutiva do Sono (SAHOS), é o principal objetivo deste trabalho. MATERIAL E MÉTODOS: Foi realizado um estudo retrospectivo, com 125 pacientes, através da análise de questionários específicos, IMC e Escala de Epworth. RESULTADOS: Dentre os pacientes, 75 eram do sexo masculino e 50 do feminino. O principal sintoma foi a roncopatia. 46% apresentaram PSG normais, 30% SAHOS leve, 15% moderada e 9% severa, não se evidenciando correlação estatística entre a clínica e a PSG. Dentre as queixas, somente a insônia foi relevante, em análise univariada e em pacientes normais e com SAHOS leve (p&lt;0,05), comparada aos pacientes com SAHOS moderada e severa, perdendo sua importância quando analisada na presença de outros fatores. CONCLUSÃO: A história clínica, por si só, não é suficiente para a definição do diagnóstico ou do grau de severidade dos casos de SAHOS.

Comparative study between clinical history and polysomnogram in the obstructive sleep apnea / hypopnea syndrome

SummaryRecognizing sleep-disordered breathing is on the rise every year. Manifestations, such as snoring, that were earlier considered mere inconvenients are now acquiring greater importance concerning life quality and social impact. Aim of the study: To compare the clinical history to polysomnogram (PSG) results in the Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS).Materials and Methods125 patients were analyzed, in a retrospective study. Specific questionnaires, avaliations of Body Mass Index and Epworth Scale were carried out.ResultsAmong the patients, 75 were males and 50 were females. The main symptom was snoring. 46% had normal PSG, 30% had light OSAHS, 15% moderate and 9% severe OSAHS and it was not observed a correlation between clinical data and PSG results. Concerning clinical symptoms, only insomnia has shown relevance when univariably analyzed in normal and light OSAHS patients (p<0,05) compared to patients with moderate and severe OSAHS, losing its importance when analyzed together with other factors.Conclusionthe clinical history, per se, is not sufficient to define OSAHS' diagnosis or it's severity.