On Obstructive Sleep Apnea Patients Research Articles

Hyperoxidized Peroxiredoxin 2 Is a Possible Biomarker for the Diagnosis of Obstructive Sleep Apnea.

Peroxiredoxin (Prx) 2 in red blood cells (RBCs) reacts with various reactive oxygen species and changes to hyperoxidized Prx2 (Prx2-SO2/3). Therefore, Prx2 may serve as an indicator of oxidative stress in vivo. This study aimed to analyze Prx2-SO2/3 levels in clinical samples to examine whether the oxidation state of Prx2 in human RBCs reflects the pathological condition of oxidative stress diseases. We first focused on obstructive sleep apnea (OSA), a hypoxic stress-induced disease of the respiratory system, and investigated the levels of Prx2-SO2/3 accumulated in the RBCs of OSA patients. In measurements on a small number of OSA patients and healthy subjects, levels of Prx2-SO2/3 accumulation in patients with OSA were clearly increased compared to those in healthy subjects. Hence, we proceeded to validate these findings with more samples collected from patients with OSA. The results revealed significantly higher levels of erythrocytic Prx2-SO2/3 in patients with OSA than in healthy subjects, as well as a positive correlation between the severity of OSA and Prx2-SO2/3 levels in the RBCs. Moreover, we performed a chromatographic study to show the structural changes of Prx2 due to hyperoxidation. Our findings demonstrated that the Prx2-SO2/3 molecules in RBCs from patients with OSA were considerably more hydrophilic than the reduced form of Prx2. These results implicate Prx2-SO2/3 as a promising candidate biomarker for OSA.

Comorbidities in Clinical and Polysomnographic Features of Obstructive Sleep Apnea: A Single Tertiary Care Center Experience

BackgroundResearch on obstructive sleep apnea (OSA) is inadequate in Saudi Arabia, particularly among patients with comorbidities. This study investigates comorbidities in patients with different severity of apnea based on the Apnea–Hypopnea Index (AHI).MethodsThe retrospective charts review that included a cohort of 4391 patients who underwent polysomnography (PSG) between 2003 and 2019. The AHI is classified into four ordinal groups: normal, mild, moderate, and severe. Ordinal logistic regression was used to model proportional odds of a higher AHI category.ResultsGender was distributed equally in the study sample. The average age was 49.6 ± 14.8 years and the average AHI was 16.1 ± 22 per hour. Hypertension (43.2%) and diabetes mellitus (37.3%) were the most common comorbidities: Mild OSA 28.9%, Moderate OSA 15.6%, and severe 16.4%. The severity of apnea increased with age and BMI classes. The prevalence of hypertension increased with the severity of apnea: 42.9% in mild, 47.4% in moderate, and 54.6% in severe AHI. The prevalence of coronary artery disease (CAD), congestive heart failure (CHF), and diabetes mellitus (DM) increased with the severity of apnea. Comorbidities was more among OSA patients with excessive sleepiness. After adjustment for age and gender, greater proportional odds of severe AHI were observed in males (aOR = 1.8), 30–59 years (aOR = 2.064), 60 years or above (aOR = 2.873), obese class II (aOR = 2.016), obese class III (aOR = 2.527), and in patients with hypertension (aOR = 1.272).ConclusionHypertension and obesity were highly prevalent in the study cohort and were associated with greater proportional odds of severe AHI.

Head rotation improves airway obstruction, especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse.

Head rotation is thought to have an effect on obstructive sleep apnea (OSA) severity. However, keeping the head rotated fully during sleep is difficult to maintain, and the effect of head rotation is not the same in all OSA patients. Thus, this study aimed to identify whether less head rotation has an effect on airway patency and determine the responder characteristics to the head rotation maneuver (HRM). We recruited 221 patients who underwent overnight polysomnography and drug-induced sleep endoscopy (DISE) in a tertiary hospital from June 2019 to July 2020. Airway patency and the site of airway collapse were determined in the supine position with the head at 0, 30, and 60 degrees of rotation (HRM0°, HRM30°, and HRM60°, respectively) during DISE. The site of collapse was determined using the VOTE classification system: the velum (palate), oropharyngeal lateral walls, tongue base, and epiglottis. Each structure was labeled as 0, 1, or 2 (patent, partially obstructed, and completely obstructed, respectively). Airway response to the HRM30° and 60° and the clinical characteristics associated with airway opening were analyzed. The study population had a median age of 52 (25-61) years, a body mass index of 26.7(24.6-29.4) kg/m2, and the apnea-hypopnea index (AHI) of 28.2(13.7-71.9) events/h. HRM influenced airway patency positively not only with HRM60° (p<0.001) but also following limited rotation (HRM30°, p<0.001). Patients with tongue base (40.0% with HRM 60°) and epiglottic (52.6% with HRM 60°) collapse responded particularly well to HRM. Multivariate analysis revealed that lower AHI (p<0.001) and an absence of oropharyngeal lateral walls collapse (p = 0.011) were significant predictors of responders to HRM. Head rotation improved airway obstruction in OSA patients, even with a small degree of rotation, and should be further explored as a potential form of therapy in appropriately selected patients.

Longer-term effects of supervised physical activity on obstructive sleep apnea and subsequent health consequences.

Although recent trials have shown promising benefits of exercise on obstructive sleep apnea (OSA) severity, the long-term effect of these interventions remains unknown. The aim of this study was to assess the effect of a 9-month community physical activity program on OSA severity one year later in free-living conditions. OSA patients, previously included in a 9-month randomized controlled trial (EXESAS study) evaluating the effects of supervised community physical activity on OSA severity, were invited to participate in an extra one-year observational study. Twenty-eight patients completed the study. Although OSA severity did not significantly worsen over the real-life period (9 to 21months of follow-up), reductions in apnea-hypopnea index (AHI) and oxygen desaturation index were no longer significant after 21months of follow-up compared to baseline (baseline AHI: 22.2±6.3 /h; 9months: 16.3±6.4 /h; 21months: 18.7±8.9 /h). Benefits observed at 9months on daytime sleepiness and mental health were preserved at 21months, whereas cardiorespiratory fitness slightly decreased. Per-protocol analysis revealed that patients who stopped exercise at 9months had worsened OSA severity compared to those who continued exercise during the real-life period (AHI: +9.0±8.8 vs. -1.3±5.3 /h; p<.01). In conclusion, our study suggested that improvements in OSA severity remain transient and is dependent on long-term adherence to regular physical activity practice.

The inverted-L ramus osteotomy versus sagittal split ramus osteotomy in maxillomandibular advancement for the treatment of obstructive sleep apnea patients: A retrospective study

This study aimed to compare the effectiveness and feasibility of inverted-L osteotomy (ILO) and sagittal split ramus osteotomy (SSRO) on obstructive sleep apnea (OSA) treatment. According to different surgery procedures, 28 OSA patients who underwent maxillomandibular advancement (MMA) were divided into 2 groups (group A: ILO, n = 9; group B: SSRO, n = 19). Polysomnography (PSG) and Epworth sleepiness scale (ESS) on T0, T1and T2 were used to evaluate the effectiveness of OSA treatments. Patients’ airway structures and facial appearances were also evaluated. From T0 to T1, the mean apnea-hypopnea index (AHI,/per hour) dropped from 69.2 ± 8.4 to11.2 ± 2.4 (P < 0.01) in group A and from 54.6 ± 14.6 to 9.4 ± 5.4 (P < 0.01) in group B; LSpO2 (lowest pulse oxygen saturation, %) increased from 66.5 ± 7.7% to 88.2 ± 4.6 (P < 0.01) and from 76.6 ± 10.7%to 89.4 ± 2.4% (P < 0.01) while the mean ESS score decreased by 51% in group A and 44% in group B. Most patients (group A: 88.9%; group B: 84.3%) were satisfied with their postoperative appearance. Mild relapse was observed in both groups on T2. This study concluded that MMA containing ILO and MMA containing SSRO are both feasible and effective for selected OSA patients.

한국 성인 남성에서 체질량지수를 이용한 현재의 비만 기준과 중증 수면무호흡과의 상관관계

Background and Objectives: We tried to assess the effect of body mass index (BMI) on obstructive sleep apnea (OSA) in Korean male patients by using portable polysomnography. Materials and Methods: We evaluated 796 patients whose Apnea+hypopnea index (AHI) were over 5 as the result of overnight portable polysomnography from September 2011 to December 2016. The subjects were classified into 2 groups on basis of the AHI severity : A group : 5≤AHI&lt;30 ; B group : 30≤AHI. The subjects were classified into 3 groups on basis of the BMI : X group : BMI&lt;25 ; Y group : 25≤BMI&lt;27.7 ; Z group: 27.7≤BMI. By multiple logistic regression analysis, we studied the relationship of AHI as dependent variable to BMI and age in each group. Results: There was significant correlation between 30≤AHI group and 27.7≤BMI group (odds ratio, 3.443 ; p&lt; 0.01). Conclusions: Weight reduction is more needed in the 27.7≤BMI group due to the risk of 30≤AHI in Korean male OSA patients. (J Clinical Otolaryngol 2018;29:53-56)

A comparison of probabilistic classifiers for sleep stage classification

Objective: To compare conditional random fields (CRF), hidden Markov models (HMMs) and Bayesian linear discriminants (LDs) for cardiorespiratory sleep stage classification on a five-class sleep staging task (wake/N1/N2/N3/REM), to explore the benefits of incorporating time information in the classification and to evaluate the feasibility of sleep staging on obstructive sleep apnea (OSA) patients. Approach: The classifiers with and without time information were evaluated with 10-fold cross-validation on five-, four- (wake/N1 + N2/N3/REM) and three-class (wake/NREM/REM) classification tasks using a data set comprising 443 night-time polysomnography (PSG) recordings of 231 participants (180 healthy participants, 100 of which had a ‘regular’ sleep architecture, and 51 participants previously diagnosed with OSA). Main results: CRF with time information (CRFt) outperforms all other classifiers on all tasks, achieving a median accuracy and Cohen’s κ for all participants of 62.8% and 0.44 for five classes, 68.8% and 0.47 for four classes, and 77.6% and 0.55 for three classes. An advantage was found in training classifiers, specifically for ‘regular’ and ‘OSA’ participants, achieving an improvement in classification performance for these groups. For ‘regular’ participants, CRFt achieved a median accuracy and Cohen’s κ of 67.0% and 0.51, 70.8% and 0.53 and 81.3% and 0.62 for five-, four- and three-classes respectively, and for ‘OSA’ patients, of 59.9% and 0.40, 69.7% and 0.45, and 75.8% and 0.51 for five-, four- and three-classes respectively. Significance: The results suggest that CRFt is not only better at learning and predicting more complex and irregular sleep architectures, but that it also performs reasonably well in five-class classification—the standard for sleep scoring used in clinical PSG. Additionally, and albeit with a decrease in performance when compared with healthy participants, sleep stage classification in OSA patients using cardiorespiratory features and CRFt seems feasible with reasonable accuracy.

YouTube as a source of information for obstructive sleep apnea

PurposeAssess the quality of information on obstructive sleep apnea (OSA) presented on YouTube for patients. Materials and methods“Obstructive sleep apnea” was entered into the YouTube search. Two independent reviewers categorized and analyzed videos utilizing a customized scoring-system along with search position, likes, and views. ResultsForty-eight videos were analyzed. Most were educational (52.1%). Educational and news videos had significantly higher scores, but had no significant differences in search position, likes/day, or views/day. Most videos mentioned positive airway pressure (65%), and nearly half (44%) mentioned mandibular devices in the management of OSA. Few videos discussed surgery (13%) or otolaryngology (15%). ConclusionYouTube is a promising source of information for OSA patients. Educational and news videos are of highest quality. General quality measures like search position, views, and likes are not correlated with formally scored value. Sleep surgery and otolaryngologists are minimally mentioned, representing an opportunity for improvement.

Assessment of bariatric surgery efficacy on Obstructive Sleep Apnea (OSA)

A worldwide rise in weight and obesity is taking place, associated with an increase in several comorbid conditions, such as Obstructive Sleep Apnea (OSA). Bariatric surgery is an effective treatment approach for obesity, with resultant improvement in obesity-related comorbidities. However, the relationship between this type of treatment and OSA is not well established. This systematic review aims to assess and characterize the impact that different types of bariatric surgery have on obese OSA patients. 22 articles with stated preoperative apnea–hypopnea index (AHI), apnea index (AI) or respiratory disturbance index (RDI) were analyzed in this review. A significant improvement in AHI/AI/RDI occurred after surgery, in addition to the foreseeable reduction in body mass index (BMI). Moreover, almost every study stated a postoperative reduction of the AHI to < 20/h and/or a >50% postoperative reduction of AHI, with few exceptions. The interventions with a combined malabsorptive and restrictive mechanism, like roux-en-Y gastric bypass (RYGB), were more efficacious in resolving and improving OSA than purely restrictive ones, like laparoscopic adjustable gastric banding (LAGB).In conclusion, bariatric surgery has a significant effect on OSA, leading to its resolution or improvement, in the majority of cases, at least in the short/medium term (1–2 years). However, the different results must be interpreted with caution as there are many potential biases resulting from heterogeneous inclusion criteria, duration of follow-up, diagnostic methodology and assessed variables.

Health Related Quality of Life in Adult Obstructive Sleep Apnea

Objective: To review the literature on Obstructive Sleep Apnea (OSA) and Health Related Quality of Life (HRQoL). Method: We conducted systematic review of the literature on HRQoL and OSA. Summary: Our review of published literature on quality of life in adult OSA suggest that there is significant impairment of HRQoL in obstructive sleep apnea but the magnitude of QoL impairment is not proportional to the severity of OSA as determined by AHI. There is paucity of data over effect of treatment on quality of life but the available data suggest that there is improvement in QoL with CPAP treatment at least in moderate and severe OSA patients. Effect of other treatment modalities is unclear yet.

Assessment of subclinical left ventricular dysfunction in obstructive sleep apnea patients with speckle tracking echocardiography

In this study, our aim was to evaluate the LV (left ventricle) subclinical myocardial dysfunction using the two-dimensional speckle tracking echocardiography (2D-STE) method on obstructive sleep apnea (OSA) patients with preserved left ventricular ejection fraction (LVEF) and without any confounding disease that may result myocardial dysfunction. Twenty-one healthy individuals and 58 OSA patients were enrolled in the study. The patients were categorized into mild, moderate and severe OSA groups according to the apnea-hypopnea index (AHI). Conventional- and tissue Doppler echocardiography imagings were performed in all the individuals besides the 2D-STE. The longitudinal strain (S) and systolic strain rate (SR(S)) values decreased as the severity of disease increased from moderate towards severe OSA. The circumferential S and SR(S) values were observed to be lower in the severe OSA patients. Despite the increase in the radial S and SR(S) in moderate and mild OSA patients, these measurements decreased in those with severe OSA. Although the longitudinal, circumferential and radial early diastolic strain rates (SR(E)) decreased as the severity of disease increased form moderate to severe, the late diastolic strain rates (SR(A)) were observed to increase. In the early stages of OSA, longitudinal systolic LV dysfunction is detected in addition to the diastolic dysfunction. The circumferential mechanics of the LV deteriorate in the later stages of the OSA. Despite a compensatory increase in the radial LV function in the early stages of OSA, in later stages, the LV radial function also deteriorates. The assessment of the myocardial functions using the STE method in patients with OSA with preserved LVEF has the potential to detect the subclinical LV dysfunction and might provide useful information for risk stratification.

Beneficial effect of donepezil on obstructive sleep apnea: A double-blind, placebo-controlled clinical trial

Previous publications have shown beneficial effects of cholinergic medication on obstructive sleep apnea (OSA) in Alzheimer's disease (AD) patients. We hypothesized that cholinergic medication could also improve OSA in non-AD patients. The present study evaluated the effects of donepezil on OSA in non-AD patients. A randomized, double-blind, placebo-controlled study was conducted. The final sample consisted of 21 male patients with mild to severe OSA and AHI >10 divided into two groups, a donepezil-treated group (n=11) and a placebo-treated group (n=10). The dosage was one tablet/day (5 mg) for the first two weeks and two tablets/day (10 mg) for the last two weeks. Polysomnography and sleepiness evaluations were performed at baseline and after one month of treatment. Groups were compared using two-way ANOVA for repeated measures with treatment-group and treatment-time as the main factors and time-treatment as an interaction effect. Considering the effect of the interaction with time-treatment, there was a significant improvement in the obstructive apnea/hypopnea index, desaturation index, percentage of time with O(2) saturation ≤3% lower than baseline, lowest oxygen saturation, and the Epworth Sleepiness Scale (ESS) scores with donepezil treatment (p<0.05). Sleep efficiency significantly decreased (p<0.01). Donepezil treatment improved obstructive sleep apnea index, oxygen saturation, and sleepiness in parallel with a reduction in sleep efficiency. Our findings support the concept that cholinergic transmission may influence breathing regulation in OSA patients.

Complete denture wear during sleep in elderly sleep apnea patients—a preliminary study

There is no consensus in the literature about the impact of complete denture wear on obstructive sleep apnea (OSA). The goal of this randomized clinical study was to assess if complete denture wear during sleep interferes with the quality of sleep. Elderly edentulous OSA patients from a complete denture clinic were enrolled and received new complete dentures. An objective sleep analysis was determined with polysomnography performed at the sleep laboratory for all patients who slept either with or without their dentures. Twenty-three patients (74% females) completed the study with a mean age of 69.6 years and a mean body mass index of 26.7 kg/m(2). The apnea and hypopnea index (AHI) was significantly higher when patients slept with dentures compared to without (25.9 ± 14.8/h vs. 19.9 ± 10.2/h; p > 0.005). In the mild OSA group, the AHI was significantly higher when patients slept with the dentures (16.6 ± 6.9 vs. 8.9 ± 2.4; p < 0.05), while in moderate to severe OSA patients, the AHI was not significantly different when sleeping with dentures (.30.8 ± 15.6 vs. 25.7 ± 7.5; p = 0.2). The supine AHI in mild patients was related to a higher increase in AHI while wearing dentures (12.7 ± 8.4/h vs. 51.9 ± 28.6/h; p < 0.001). A limitation of the study is that the mild OSA patients had a higher BMI when compared to the moderate to severe OSA patients. Ten out of 14 patients who preferred to sleep with their upper and lower dentures showed an increase in their AHI while wearing dentures to sleep. Contrary to previous studies, we found that OSA patients may experience more apneic events if they sleep with their dentures in place. Specifically, in mild OSAS patients, the use of dentures substantially increases the AHI especially when in the supine position.

Effects of an oral appliance with different mandibular protrusion positions at a constant vertical dimension on obstructive sleep apnea

The aim of the study was to assess the influence of four mandibular protrusion positions, at a constant vertical dimension, on obstructive sleep apnea (OSA). Seventeen OSA patients (49.2 +/- 8.5 years) received an adjustable mandibular advancement device (MAD). The patients underwent four polysomnographic recordings with their MAD in situ at, in random order, 0%, 25%, 50%, and 75% of the maximum protrusion. The mean apnea-hypopnea index (AHI) values of the patients differed significantly between the protrusion positions (P < 0.000). The 25% protrusion position resulted in a significant reduction of the AHI with respect to the 0% position, while in the 50% and 75% positions, even lower AHI values were found. The number of side effects was larger starting at the 50% protrusion position. We therefore recommend coming to a weighted compromise between efficacy and side effects by starting a MAD treatment in the 50% protrusion position.

The APOE ε4 allele increases the risk of impaired spatial working memory in obstructive sleep apnea

Background Contradictory data have been published on the influence of Apolipoprotein E (APOE) ε4 allele on obstructive sleep apnea (OSA). The aims of this study were to confirm the presence of specific neuropsychological changes in OSA patients carrying the APOE ε4 allele and to clarify if these changes are due to the sole presence of this allele or to its interactions with OSA pathology. Methods The APOE genotype was examined in 123 patients with OSA and in 121 controls, together with a series of neuropsychological tests. Results OSA and control subjects had similar APOE genotype and allele distribution, but when neuropsychological tests were considered, OSA patients showed significantly lower values for verbal long-term (delayed free recall at the Rey auditory-verbal learning test) and working memory (bisyllabic words). Moreover, spatial span was found to be lower in OSA ε4 allele carriers than in non-carriers; this difference was not observed in controls. Conclusions This study confirms the presence of a verbal memory impairment in OSA patients and provides evidence for a significant interaction of APOE ε4 allele and OSA on frontal lobe function in adults, possibly mediated by the presence of specific frontal lobe neuroanatomical changes in these patients.