OSA-related Symptoms Research Articles

Gluten-free diet may improve obstructive sleep apnea-related symptoms in children with celiac disease

BackgroundEnlarged tonsils and adenoids are the major etiology of obstructive sleep apnea (OSA) in children. Lymphatic hyperplasia is common to both OSA and celiac disease. We aimed to investigate the effect of a gluten-free diet on OSA symptoms in children with celiac disease.MethodsChildren with celiac disease aged 2–18 years were prospectively recruited before the initiation of a gluten-free diet. Children with negative celiac serology who underwent gastrointestinal endoscopies for other indications served as controls. All participants completed a validated OSA-related symptoms questionnaire and the pediatric sleep questionnaire (PSQ) at baseline and 6 months later.ResultsThirty-four children with celiac disease (mean age 6.6 ± 3.5 years) and 24 controls (mean age 7.3 ± 4.6 years, P = 0.5) were recruited. There were no significant differences in gender, body mass index or season at recruitment between the two groups. The rate of positive PSQ scores was higher (more OSA-related symptoms) in the control group compared to the celiac group, both at recruitment and at the 6-month follow-up (33.3% vs. 11.8%, P = 0.046, and 16.7% vs. 0, P = 0.014, respectively). PSQ scores improved significantly in both groups at the 6-month follow-up (P < 0.001 for both). Improvement was significantly higher in the celiac group compared to controls (0.1 ± 0.09 vs.0.06 ± 0.06, respectively, P = 0.04).ConclusionsChildren with celiac disease had fewer OSA-related symptoms than controls, but the degree of improvement following the initiation of a gluten-free diet was significantly higher. These findings suggest that a gluten-free diet may improve OSA-related symptoms in children with celiac disease.

The influence of gender on symptoms associated with obstructive sleep apnea.

It has been reported that the clinical expression of obstructive sleep apnea (OSA) may differ in women and men. The objective of this study was to evaluate the influence of gender on reported OSA-related symptoms in a large clinical population of patients. The database from the sleep laboratory of a tertiary care center was examined. Adult patients who had undergone a diagnostic polysomnography and completed the Berlin questionnaire, a sleep questionnaire, and the Epworth sleepiness scale were selected. Multiple logistic regression analysis was performed to assess the relationship between OSA-associated symptoms and different potential explanatory variables. The study sample included 1084 patients, median age was 53years, 46.5% (504) were women, 72.7% (788) had OSA (apnea/hypopnea index ≥ 5), and 31.2% were obese. After adjusting for age, body mass index, and apnea/hypopnea index, men were more likely to report snoring (OR 4.06, p < 0.001), habitual or loud snoring (OR 2.34, p < 0.001; 2.14, p < 0.001, respectively) and apneas (OR 2.44, p < 0.001), than women. After controlling for multiple variables, female gender was an independent predictive factor for reported tiredness (OR 0.57, p 0.001), sleep onset insomnia (OR 0.59, p 0.0035), and morning headaches (OR 0.32, p < 0.001). Reports of excessive daytime sleepiness, nocturia, midnight insomnia, and subjective cognitive complaints were not significantly associated with gender. Women with OSA were more likely to report tiredness, initial insomnia, and morning headaches, and less likely to complain of typical OSA symptoms (snoring, apneas) than men.

Surgical Closure of the Cleft Palate Has a Transient Obstructive Effect on the Upper Airway in Children.

To prospectively investigate the occurrence of respiratory symptoms related to obstructive sleep apnea (OSA) following primary palatoplasty in children with cleft palate (CP). Fifty-six nonsyndromic children presenting CP with a previously repaired cleft lip (CL) or without CL were assessed before and after palate repair. Twenty nonsyndromic children with isolated CL were analyzed as controls before and after lip repair. Respiratory symptoms were investigated preoperatively, and at early and late postoperative periods. Based on the parent reports of "difficulty of breathing (D), apnea events (A) and/or snoring (S) during sleep, a validated OSA index (1.42D + 1.41A + 0.71S - 3.83) was used to predict absence of OSA, possible OSA, and presence of OSA, at the 3 periods analyzed. Screening for OSA showed that the CP group exhibited an increased mean index at the early postoperative assessment, suggesting "possible OSA," and a higher frequency of snoring at the early and late postoperative assessments, as compared to the CL group (P < .05). Sleep apnea events were not reported. Surgical closure of the palate has an obstructive effect on the upper airway in the short term, causing OSA-related respiratory symptoms, mostly transient. However, the high prevalence of snoring still observed in the long term indicate that children with a palatal cleft who undergo surgical repair are at risk for OSA. The results support the conclusion that OSA is underappreciated in this population.

Split-Night CPAP Therapy for OSA to Improve Joint Immobility

A 47-year-old woman presented to clinic with exertional breathlessness, snoring, choking, witnessed apnoeas and daytime somnolence. Past history included Idiopathic Juvenile Arthritis, diagnosed at age 8, since when she had been taking prednisolone. Her sleep study identified severe Obstructive Sleep Apnoea (OSA). She was commenced on Continuous Positive Airway Pressure (CPAP) therapy, which improved her sleep quality so much that she hardly moved at night and consequently woke up with early morning joint stiffness. She therefore limited her CPAP use and her symptoms persisted. Over time she developed a regime of split-night CPAP use that improved her OSA-related symptoms and joint discomfort.

Comparisons of Office and 24-Hour Ambulatory Blood Pressure Monitoring in Children with Obstructive Sleep Apnea

To compare office blood pressure (BP) and 24-hour ambulatory BP (ABP) monitoring to facilitate the diagnosis and management of hypertension in children with obstructive sleep apnea (OSA). Children aged 4-16 years with OSA-related symptoms were recruited from a tertiary referral medical center. All children underwent overnight polysomnography, office BP, and 24-hour ABP studies. Multiple linear regression analyses were applied to elucidate the association between the apnea-hypopnea index and BP. Correlation and consistency between office BP and 24-hour ABP were measured by Pearson correlation, intraclass correlation, and Bland-Altman analyses. In the 163 children enrolled (mean age, 8.2 ± 3.3 years; 67% male). The prevalence of systolic hypertension at night was significantly higher in children with moderate-to-severe OSA than in those with primary snoring (44.9% vs 16.1%, P = .006). Pearson correlation and intraclass correlation analyses revealed associations between office BP and 24-hour BP, and Bland-Altman analysis indicated an agreement between office and 24-hour BP measurements. However, multiple linear regression analyses demonstrated that 24-hour BP (nighttime systolic BP and mean arterial pressure), unlike office BP, was independently associated with the apnea-hypopnea index, after adjustment for adiposity variables. Twenty-four-hour ABP is more strongly correlated with OSA in children, compared with office BP.

Obstructive Sleep Apnea Following Pharyngeal Flap Surgery for Velopharyngeal Insufficiency: A Prospective Polysomnographic and Aerodynamic Study in Middle-Aged Adults.

To compare the frequency and severity of obstructive sleep apnea (OSA) in middle-aged adults who underwent pharyngeal flap surgery for velopharyngeal insufficiency (VPI) with matched subjects who did not undergo pharyngeal flap surgery and to verify the relationship between OSA severity and internal pharyngeal dimensions. National referral care center for cleft lip and palate. Prospective study on 42 nonsyndromic subjects with repaired cleft palate with flap (F group, n = 22) and without flap (NF group, n = 20), aged 40 to 58 years. The main outcome measure was the apnea-hypopnea index (AHI), measured by in-lab nocturnal polysomnography (PSG). The OSA-related symptoms were investigated by Pittsburgh, Epworth, and Berlin questionnaires. The nasopharyngeal or velopharyngeal (NP/VP) cross-sectional area was measured by modified anterior rhinomanometry in subgroups of the F (n = 14) and NF (n = 10) groups at rest and during speech. Differences were considered significant at P < .05. Questionnaire scores and frequency of self-reported symptoms of snoring, nasal obstruction, and breathing interruptions during sleep did not differ between groups. OSA was diagnosed by PSG in 60% and 77% of the NF and F subjects, respectively. The difference was not significant. No cases of severe OSA were observed. There was no correlation between AHI and NP/VP area. A significant number of middle-aged adults with repaired cleft palate had OSA and related symptoms, regardless of the presence of a pharyngeal flap. Results suggest that VPI treatment with a flap may not cause sleep-disordered breathing in the cleft population. Besides advancing age, congenital upper airway abnormalities may be involved.

Quality of life in children with Robin Sequence

IntroductionParents may play an important role during the management of children with Robin Sequence (RS). However, so far only one study has been done on both parent-reported health-related quality of life (HRQoL) and obstructive sleep apnea (OSA) symptoms in children with RS. MethodsOverall, 63 children with RS, aged 1 and 18, were included in this cross-sectional study. Fifty-three parents of children with RS with a median age of 8.9 [IQR 5.1–12.7] completed questionnaires on HRQoL (OSA-18) and symptoms of OSA (the Brouillette score) in their child with RS. Ten children between 12 and 18 years filled out the self-reported HRQoL questionnaire OSA-12. ResultsAt cross-section, 10 children still had respiratory problems. Overall, parents of children with RS reported a lower HRQoL in their child compared with parents in the general population. Parents of children with RS who still had respiratory problems, i.e. OSA or airway support, reported significantly worse OSA-18 scores compared with parents of RS children without OSA. Children with RS themselves (n = 10) reported less physical suffering and less emotional distress on the OSA-12 compared with children in the norm population. Parental perceptions of OSA-related symptoms were accurate, except for the incidence of snoring. In assessing snoring, the multidimensional OSA-18 sleep domain was more informative. ConclusionsParents of children with RS reported a lower HRQoL in their child compared with parents in the general population. Parental perceptions of health and HRQoL in children with RS might have an additional value to recognize and treat respiratory problems.

Implementing an educational program to increase preoperative screening for obstructive sleep apnea using the stop-bang questionnaire

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Obstructive sleep apnea (OSA) is a potentially fatal disease process that has been linked to higher rates of morbidity and mortality as well as increased perioperative complications. OSA is characterized by repetitive pauses in breathing during sleep. Greater than 92% of women and 82% of men who are plagued by moderate to severe sleep apnea are undiagnosed and may go unrecognized in the perioperative setting. The gap between a high prevalence of undiagnosed OSA in the adult population and the low level of clinical recognition has been well-documented. The term “STOP-BANG” is an acronym for eight independent elements predictive of OSA—three are OSA-related symptoms, three are physiological measurements, and two are patient characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This project used a quasi-experimental design using a 16-question self-developed survey based on the technology acceptance model (TAM). Participants were asked to read an educational pamphlet on OSA and then complete the survey.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; This study found strong evidence to suggest that among Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs), those with higher scores on Perceived Ease of Use (PEOU), Perceived Usefulness (PU), and Attitude toward Use (AT), tend to have a higher Behavioral Intention to Use (BIU) the STOP-BANG screening tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The results suggest that programs targeted at raising CRNAs’ and SRNAs’ PEOU, PU, and AT regarding the STOP-BANG questionnaire will culminate in increased use of the STOP-BANG screening tool. The use of this screening tool will detect patients previously unidentified as having OSA, and ultimately prevent perioperative complications associated with this disease.&lt;/p&gt;

Physical Inactivity Is Associated with Moderate-Severe Obstructive Sleep Apnea.

To investigate whether low levels of physical activity were associated with an increased occurrence of obstructive sleep apnea (OSA), OSA-related symptoms, and cardiometabolic risk. A case-control study design was used. OSA cases were patients referred to a sleep clinic for suspected OSA (n = 2,340). Controls comprised participants from the Busselton community (n = 1,931). Exercise and occupational activity were derived from questionnaire data. Associations were modelled using logistic and linear regression and adjusted for confounders. In comparison with moderate exercise, the high, low, and nil exercise groups had an odds ratio (OR) for moderate-severe OSA of 0.6 (95% CI 0.5-0.8), 1.6 (95% CI 1.2-2.0), and 2.7 (95% CI 1.9-3.7), respectively. Relative to men in heavy activity occupations, men in medium, light and sedentary occupations had an OR for moderate-severe OSA of 1.7 (95% CI 1.1-2.5), 2.1 (95% CI 1.4-3.2), and 1.8 (95% CI 1.2-2.8), respectively. Relative to women in medium activity occupations, women in light and sedentary occupations had an OR for moderate-severe OSA of 4.2 (95% CI 2.6-7.2) and 3.5 (2.0-6.0). OSA patients who adequately exercised had lower: levels of doctor-diagnosed depression (p = 0.047); symptoms of fatigue (p < 0.0001); systolic (p = 0.015) and diastolic blood pressure (p = 0.015); and C-reactive protein (CRP) (p = 0.003). Low levels of physical activity were associated with moderate-severe OSA. Exercise in individuals with OSA is associated with lower levels of depression, fatigue, blood pressure and CRP.

Analysis of 24-Hour Ambulatory Blood Pressure Monitoring in Children With Obstructive Sleep Apnea: A Hospital-Based Study.

In the present study, we aimed to verify associations between ambulatory blood pressure (ABP) and pediatric obstructive sleep apnea (OSA) in a hospital-based population.This was a cross-sectional observational study on children aged 4 to 16 years with OSA-related symptoms from a tertiary referral medical center. All children received overnight polysomnography and 24-hour recording of ABP. Severity of the disease was classified as primary snoring (apnea-hypopnea index, AHI <1), mild OSA (AHI 1–5), and moderate-to-severe OSA (AHI >5).For 195 children enrolled in this study (mean age, 7.8 ± 3.4 years; 69% boy), ABP increased as severity of OSA increased. During daytime, children with moderate-to-severe OSA had significantly higher systolic blood pressure (BP) (117.0 ± 12.7 vs 110.5 ± 9.3 mmHg), mean arterial pressure (MAP) (85.6 ± 8.1 vs 81.6 ± 6.8 mmHg), and diastolic BP load (12.0 ± 9.6 vs 8.4 ± 10.9 mmHg) compared with children with primary snoring. During nighttime, children with moderate-to-severe OSA had significantly higher systolic BP (108.6 ± 15.0 vs 100.0 ± 9.4 mmHg), MAP (75.9 ± 9.6 vs 71.1 ± 7.0 mmHg), systolic BP load (44.0 ± 32.6 vs 26.8 ± 24.5 mmHg), systolic BP index (0.5 ± 13.1 vs −6.8 ± 8.5 mmHg), and higher prevalence of systolic hypertension (47.6% vs 14.7 %) compared with children with primary snoring. Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP and MAP after adjusting for adiposity variables.This large hospital-based study showed that children with moderate-to-severe OSA had a higher ABP compared with children who were primary snorers. As elevated BP in childhood predicts future cardiovascular risks, children with severe OSA should be treated properly to prevent further adverse cardiovascular outcomes.

Relationship between sleep postures and sleep-disordered breathing parameters in people with Down syndrome in Japan

People with Down syndrome (DS) are prone to develop sleep-disordered breathing (SDB), especially obstructive sleep apnea (OSA) and they are reported to sleep in unusual sleep postures. The purpose of this study was to determine the relationship between sleep postures and SDB parameters, including the objective nocturnal oxygen desaturation in people with DS in Japan. Overnight pulse oximetry was measured in 32 people with DS (male 44%, mean age 18 ± 10 years) and a questionnaire was completed to obtain information on sleep postures and OSA-related symptoms. Subjects were divided by their dominant sleep postures into three groups: usual postures (supine and lateral), prone, and unusual postures (leaning forward and sitting). Subjects who slept mainly in unusual postures were younger (9.6 ± 5.0 years) than those who slept in prone (18.6 ± 12.4 years) and in usual postures (21.1 ± 8.9 years) (P < 0.05). Snoring was the most reported symptom (81.3%) and was the only symptom positively correlated with 4% oxygen desaturation index (ODI) (r = 0.386, P < 0.05). There was no significant association between 4% ODI and sleep postures among the three groups. DS children with prone and unusual sleep postures had significantly better 4% ODI and minimum SpO2 level compared with those of usual postures (P < 0.05). Our results indicated that prone and unusual sleep postures in DS children might be compensation to alleviate against SDB. These postures could be related to alleviation of SDB resulting from the immaturity of people with DS.

Intermittent Hypoxemia and OSA: Implications for Comorbidities

OSA is a common chronic disorder that is associated with significant morbidity and mortality including cardiovascular, metabolic, and neurocognitive disease and increased cancer-related deaths. OSA is characterized by recurrent episodes of apneas and hypopneas associated with repetitive episodes of intermittent hypoxemia, intrathoracic pressure changes, and arousals. Intermittent hypoxemia (IH) is now being recognized as a potential major factor contributing to the pathogenesis of OSA-related comorbidities. OSA-related high-frequency IH is characterized by cycles of hypoxemia with reoxygenation that is distinctly different than sustained low-frequency hypoxia and contributes to ischemia-reperfusion injury. Data from both animal and human studies support mechanistic links between IH and its adverse impact at the tissue level. IH promotes oxidative stress by increased production of reactive oxygen species and angiogenesis, increased sympathetic activation with BP elevation, and systemic and vascular inflammation with endothelial dysfunction that contributes to diverse multiorgan chronic morbidity and mortality affecting cardiovascular disease, metabolic dysfunction, cognitive decline, and progression of cancer. Data from observational studies in large population groups also support the role for hypoxia in the pathogenesis of OSA comorbidity. Treatment with CPAP to reverse OSA-related symptoms and comorbidities has been shown to provide variable benefit in some but not all patient groups. Early treatment with CPAP makes intuitive sense to promote maximal functional recovery and minimize residual injury. More studies are needed to determine the interacting effects of IH and obesity, differential effects of both short-term and long-term hypoxemia, and the effect of CPAP treatment.

Do Obstructive Sleep Apnea Syndrome Patients Underestimate Their Daytime Symptoms before Continuous Positive Airway Pressure Treatment?

Daytime somnolence is an important feature of the obstructive sleep apnea (OSA) hypopnea syndrome and is usually subjectively assessed using the Epworth Sleepiness Scale (ESS). To compare the scores of the ESS and different domains of the Quebec Sleep Questionnaire (QSQ) assessed before and after the first months of continuous positive airway pressure (CPAP) treatment, as well as retrospectively without treatment. The ESS score and domain scores of the QSQ were obtained before and after a three-month period of CPAP treatment using a retrospective assessment of the pretreatment scores in 76 untreated OSA patients. Fifty-two patients completed the study. The ESS and QSQ scores significantly improved following CPAP therapy. Retrospective evaluation of the ESS score was significantly worse than pre- and post-treatment values (mean [± SD] pretreatment score 11.0±4.8; retrospective pretreatment score 13.5±5.1). Such differences were not observed in any domain of the QSQ, including the domain assessing hypersomnolence. OSA patients underestimated their sleepiness according to the most widely used instrument to assess hypersomnolence. This finding may not be observed with other methods used to assess OSA-related symptoms such as quality of life questionnaires.

Long-term adherence to nasal continuous positive airway pressure therapy by hypertensive patients with preexisting sleep apnea

Background and objectiveAlthough positive screening for and treatment of obstructive sleep apnea (OSA) have been recommended for patients with cardiovascular problems, patient adherence to nasal continuous positive airway pressure (CPAP) therapy primarily for a cardiovascular concern is unknown. Therefore, this study aimed to determine the adherence to CPAP therapy by hypertensive patients with OSA after a screening test performed regardless of OSA-related symptoms. Subjects and methodsCPAP therapy was administered to 194 of the 1365 hypertensive patients who underwent the screening. The monthly dropout from CPAP therapy and the adequate use level (4h every night, 70% days in a month) were assessed using the Kaplan–Meier analysis over a 3-year follow-up period. ResultsOf the patients, 106 (55%) refused or abandoned the therapy by the end of the follow-up period (adherence, 45%). An adequate use level was maintained by 76 patients (39%). Most of the patients’ background characteristics, including age, sex, Epworth sleepiness scale scores, and parameters obtained on polysomnography, were not related to adherence or adequate use level. The good-compliance level on the first visit after CPAP therapy introduction was most strongly related to adherence (95% CI, 0.05–0.32; p<0.001) and adequate use level (95% CI, 0.06–0.33; p<0.05). Fourth quartile of apnea hypopnea index value (greater than 67/h) was also related to adherence (95% CI, 0.21–0.98; p<0.02) and adequate use level (95% CI, 0.19–0.88; p<0.05). ConclusionsThe adherence and use level in this population may not be satisfactory but are comparable with those in previous sleep center reports treating symptomatic OSA patients. Thus, the present results would encourage hypertensive patients to undergo positive screening for OSA, regardless of OSA-related symptoms. However, an outcomes study with the same cohort is needed.

Characteristics of obstructive sleep apnea in patients with Parkinson's disease

Parkinson's disease (PD) patients frequently develop obstructive sleep apnea (OSA). In order to clarify the clinical significance of OSA in PD, we compared descriptive variables between PD patients with OSA (PD+OSA) and without (PD−OSA), and between the PD+OSA group and a group of OSA patients without PD (control OSA). The apnea hypopnea index (AHI) cutoff of 15 episodes/hour on polysomnogram (PSG) was used to assign 107 PD patients to groups; OSA-related symptoms and PSG findings were then compared. Demographic and PSG variables were compared between PD+OSA patients and 31 OSA controls.Twenty-four patients with PD (22.4%) were classified as PD+OSA. There were no significant differences in descriptive variables between the PD+OSA and PD−OSA groups. The PD+OSA group had a higher arousal index on PSG than the PD−OSA group, although the two groups had similar ESS scores. The PD+OSA patients had a lower respiratory arousal index and a smaller decrease in oxygen saturation than the control OSA group, despite having a similar AHI.The prevalence of OSA in PD did not differ from that in the general elderly population, indicating that the clinical significance of OSA as a contributor to daytime sleepiness in PD is low.

Berlin questionnaire study in surgical patient in Alzahra Hospital in year 2010

Background:To examine the prevalence of high-risk subjects of obstructive sleep apnea (OSA) and its predictive factors in patients undergoing elective surgery by using the Berlin Questionnaire.Materials and Methods:300 surgical ASA physical status I, II, III, and IV patients were surveyed. Patients were screened with the Berlin questionnaire for obstructive sleep apnea. Data of sex, age, BMI and HTN also evaluated. Data were analyzed by Chi-square test and P < 0.05 was meaningful.Results:The Berlin questionnaire identified 25.3% (76/300) of patients as being at high risk of sleep apnea (95% confidence interval, 20%-28%). This group consisted of 195 (65%) males and 105 (35%) females. The prevalence of high-risk subjects in men were more significantly than women (P = 0.001). High-risk subjects also were increasing with age (P = 0.000) and increasing with obesity (P = 0.000) and arterial hypertension (P = 0.000).Conclusions:Predictors of high risk for OSA-related symptoms were female sex, age more than 50 years, and body mass index.

Enuresis—an unattended comorbidity of childhood obesity

Obstructive sleep apnea (OSA), attention deficit/hyperactivity disorder (ADHD), type 2 diabetes mellitus and psychopathological problems co-occur at increased rates among both obese and enuretic children. We hypothesized that the prevalence of enuresis will be increased in obese children and adolescents. A cross-sectional study. 281 children and adolescents aged 7-18 years, who completed a questionnaire regarding enuresis, medical conditions and sociodemographic parameters; 158 were normal weight, 37 overweight (85thBMI (body mass index)<95th percentiles) and 86 obese (BMI95th percentile). Occurrence of enuresis among obese children and adolescents. Enuresis was reported in 14 (8.8%) normal weight, 6 (16%) overweight and 26 (30%) obese youth. Odds ratio (OR)=6.5, 95% confidence interval (CI)=2.67-15.78 for enuresis among obese compared with normal weight (P<0.0001). Each increment of one BMI-Z score unit was associated with an increased risk of enuresis, OR of 2.14, 95% CI (1.46-3.12), P=0.00008. Male gender (OR 2.84, 95% CI (1.10-5.58), P=0.028), first-degree relative with current/past enuresis (OR 4.24, 95% CI (1.62-11.08), P=0.003), voiding dysfunction symptoms (OR 3.067, 95% CI (1.05-9.00), P=0.041) and ADHD (OR 2.31, 95% CI (0.99-5.34), P=0.051) increased the risk of enuresis. OSA-related symptoms, academic achievements in school, sharing a bedroom, family size relative to number of rooms in home, parental education, family status and religious observance were not found to increase the risk for enuresis. Obese children are at increased risk for enuresis. Enuresis should be clarified during the primary workup of every obese child and adolescent.

Influence of snoring on microalbuminuria in diabetic patients

Obstructive sleep apnea (OSA) and snoring are known independent risk factors for insulin resistance. Microalbuminuria is an early marker of diabetic nephropathy and an independent risk factor for cardiovascular disease. The aim of our study was to search the prevalence of self-reported snoring and high-risk pre-test OSA diagnosis in diabetic patients and search the influence of snoring on microalbuminuria. A total of 237 diabetic patients (mean age, 58.6 ± 12.4 years; 126 males), were asked to complete the Berlin Questionnaire that includes questions about snoring, witnessed apnea, tiredness, history of high blood pressure and/or BMI < 30 kg/m(2). Also, their past and current medical records were reviewed for their medications, diabetic control, and complications like neuropathy, retinopathy, and microalbuminuria. According to the Berlin Questionnaire, a high pre-test probability for the diagnosis of OSA was found in 47.3% of the patients. Snoring was detected in 60.3% of the patients. The mean Epworth Sleepiness Scale score was 7.8 ± 4.6 and 31.6% of the patients reported excessive daytime sleepiness. We found that the both BMI and waist circumferences were significantly associated with snoring and high-risk pre-test OSA. There were no differences for age, gender, fasting glucose, HbA1c, and lipid panels between snorers and non-snorers, and between high-risk pre-test OSA and low-risk pre-test OSA patients. Microalbuminuria was significantly more common in patients who snore. Although snoring was independently associated with microalbuminuria, there were no differences between groups for other microvascular diabetic complications. Prevalence of OSA-related symptoms was very common in diabetic patients and further prospective studies are needed to elucidate the role of OSA's effect on diabetic control and complications.

Prevalence of sleep apnea-related symptoms in a Persian population

There are no published data regarding the prevalence of obstructive sleep apnea (OSA) in Iran. The purpose of this cross-sectional study was to identify individuals with a high likelihood to suffer from obstructive sleep apnea in the Persian population. This was compared to similar studies in other countries. As a part of a population-based cross-sectional study, 3,600 randomly selected individuals aged 18 years or more, were invited to take part in the survey, 3,529 individuals (98%) agreed to fill out the Berlin sleep questionnaire. Based on the Berlin Criteria, 176 subjects (4.98%) were identified as suspicious for OSA. This group consisted of 74 (42%) males and 102 (58%) females. The prevalence of high-risk Berlin in men and women were not significantly different with chi-square test (p > 0.2). But high-risk Berlin subjects also were increasing with age (p < 0.001) and increasing with obesity (p < 0.001) and decreasing with higher education (p < 0.001) with chi-square test. Predictors of high risk for OSA-related symptoms were female sex, age more than 50 years, and body mass index. We identified persons with a high risk for OSA among a representative Iranian sample. It is concluded that the prevalence of sleep apnea syndrome symptoms is lower in our population as compared with western countries which can be attributed to the excessively young Iranian population.

Surgical intervention represents a feasible option for patients with mild obstructive sleep apnoea

Conclusions: Patients with mild obstructive sleep apnoea (OSA) depict the disease as being detrimental to their health, causing significant symptoms. These patients were found to achieve significant improvements in OSA-related symptoms after surgical intervention. Objectives: Although the effects of surgical treatment on OSA have been encouraging in many previous studies, little is known about its effects in patients with mild OSA. The aim of our study was to assess the evolution of symptoms experienced by mild OSA patients after surgical intervention. Subjects and methods: This was an observational follow-up study in a university hospital in Finland. The change in daytime and night-time symptoms was assessed by a standardized questionnaire before treatment and after a mean follow-up time of 3 years in both operative and control groups in 81 adult patients with mild OSA. Results: At the follow-up, the control group experienced significantly more daytime sleepiness (p<0.001) compared with the operative group. Adjusted odds ratio (OR) for daytime sleepiness was 0.05 (95% CI 0.01–0.25, p<0.001) in operatively treated patients as compared with control patients, with improvement of witnessed apnoeas (p<0.001) and sleep quality (p=0.033). The OR for intensive snoring was 0.06 (95% CI 0.02–0.22) in the operative group as compared with the control group.