Patterns Of Obstructive Sleep Apnea Research Articles

Knowledge, attitudes, and practice patterns of obstructive sleep apnea among speech-language pathologists.

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterised by repeated narrowing and closure of the upper airway during sleep. Despite growing evidence that dysphagia is a frequent sequela of OSA, the role of speech-language pathologists (SLPs) in managing OSA remains unclear. The aim of this international study was to evaluate SLPs knowledge, attitudes, and experience of OSA. A validated questionnaire, OSA Knowledge and Attitudes (OSAKA), was distributed to SLPs internationally via an online survey. Additional information on demographics, educational history, and clinical practices was ascertained. From a total of 1647 respondents, 822 clinicians from twenty-four countries were included in the final analysis. Knowledge of OSA among SLPs was limited; the mean (SD) rate of correct answers was 55% (22%). Over half of SLPs reported patients with OSA on their caseload, with the majority of patients referred for dysphagia services. Yet, only half of SLPs reported confidence in their ability to assess or manage dysphagia in patients with OSA. SLPs' experience of OSA had an effect on their knowledge and attitudes [F (2, 817) = 17.279, p < 0.001]. SLPs are involved in the management of patients with OSA but are practising with limited knowledge and confidence. The findings highlight the need to increase OSA education and training for SLPs. In addition, there is a need for targeted research to increase the evidence base for development of clinical practice guidelines for dysphagia management in patients with OSA.

OBSTRUCTIVE SLEEP APNEA SYNDROME: A COMPARISON BETWEEN TWO ETHNIC GROUPS PRESENTING TO TERTIARY HOSPITAL IN NEPAL

Background: Obstructive sleep apnea is a common problem with many health-related con­sequences. Factors such as age, sex, ethnicity, obesity, upper airway anatomy are risk factors for obstructive sleep apnea. This study was aimed to compare the pattern of obstructive sleep apnea between two ethnic groups of Nepal in a tertiary care center. Methods: A cross-sectional study was conducted among the patients with obstructive sleep apnea at Kathmandu Medical College and Teaching Hospital. Seventy patients between the age of 18 to 65 years diagnosed as obstructive sleep apnea were included in the study by using convenience sampling method. The patients were divided into Aryan and Mongol group. Data was presented in the form of mean, standard deviation, median and interquartile range. Chi-square, student’s t-test and Mann-Whitney U test were used. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) version 16. Results: Out of 70 patients, 35 patients were Aryan group and 35 in the Mongol group. Male pa­tients were predominantly present in both the groups. Patients were more in the age group of 41- 60 years. Enlarged tonsils were present in 15 (42.9%) of Aryans and 14 (40.0%) of Mongols. Among that, grade 2 tonsil, 8 (22.9%) was present in majority of both Aryans and Mongols. There was statistically significant association observed between Aryan group and Modified Mallampati score. Conclusions: Obstructive sleep apnea has variation among the ethnicity. However, in this study only significant difference between Modified Mallampati Score and ethnicity as observed.

Prevalence and pattern of obstructive sleep apnea in chronic obstructive pulmonary disease patients from northern India

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, hyperinflation, and ventilation-perfusion mismatch. It is now considered as a systemic disease. The prevalence of obstructive sleep apnea (OSA) in COPD is variable with a paucity of literature from Indian subcontinent. AIM: This study was conducted to observe the regional prevalence and pattern of OSA in patients of COPD. MATERIALS AND METHODS: The present prospective study was carried out in the Department of Internal Medicine, Pt. B.D. Sharma, PGIMS, Rohtak, for a period of 20 months, i.e. during July 2012 to February 2014. Patients seeking care at the Department of Internal Medicine and diagnosed with COPD formed the study population. COPD patients stable for at least 6 weeks were included in this study. Mild COPD patients, ischemic heart disease patients, any comorbid state, known case of OSA, and patients having COPD with acute exacerbation were excluded. The prescreening tools for the identification of OSA are Berlin sleep questionnaire and the Epworth sleepiness scale (ESS). Polysomnography was done using Somnologica studio 3.3.2 Embla N7000 sleep unit system. RESULTS: OSA with apnea–hypopnea index (AHI) ≥5/h was present in 10 out of 40 participants (25.0%). Berlin scores were found to be 0.10 ± 0.03 and 0.70 ± 0.04 in nonsleep-disordered breathing (SDB) and SDB participants, respectively. ESS scores were observed to be 2.60 ± 0.82 and 7.90 ± 2.51 between non-SDB and SDB participants, respectively. The difference in AHI between patients with non-SDB and SDB was statistically highly significant (1.36 ± 0.37, 13.41 ± 3.40; P CONCLUSIONS: The prevalence of OSA in COPD patients was found to be in the higher range. Sleep was significantly distorted in all its aspects in patients of COPD. ESS was found efficient in screening the patients of COPD for coexistent OSA. Berlin's questionnaire can be used to evaluate patients of overlap syndrome.

Prevalence and Patterns of Obstructive Sleep Apnea in Asian Indians With Congestive Heart Failure.

BackgroundSleep-disordered breathing (SDB) has a potential association with the pathogenesis of congestive heart failure (CHF). We assessed the prevalence and patterns of obstructive sleep apnea (OSA) in patients presenting with CHF.MethodThis was a prospective, observational, all-comers study of consecutive 77 confirmed cases of CHF. All these patients were clinically assessed and evaluated for OSA with sleep study after routine blood testing, electrocardiogram (ECG), chest X-ray, and echocardiography.ResultsOf 77 patients with CHF 38 (49.4%) had apnea-hypopnea index (AHI) <5 while 39 (50.6%) had AHI >5. Of these 39, 37 (94.8%) patients showed the clinical features of OSA. The majority (64.9%) of them were males. The majority of OSA (64.9%) had coronary artery disease (CAD) (p<0.05) as the etiology of CHF, followed by dilated cardiomyopathy (32.4%) and valvular heart disease (2.7%). The prevalence of OSA was higher amongst New York Heart Association (NYHA) class 2 (51.4%) as compared to NYHA class 3 (37.8%) and NYHA class 4 (10.8%). There were 12 (32.8%) patients, each having OSA with a heart rate between 71 and 80 bpm and 81 and 90 bpm. Twenty-two (59.5%) had systolic blood pressure (BP) more than 120 mmHg and 20 (54.1%) had diastolic BP more than 80 mmHg. The majority (64.9%) patients had the lowest O2 saturation between 80% and 90%. A significantly large number of patients (62.2%) had ejection fraction 21%-30% (p<0.05). The majority (62.16%) of patients with OSA had AHI between 5 and 15. With 5-15 AHI, 20 (87%) patients with OSA had a snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-Bang) score between 3 and 7 with AHI 5-15 (p<0.05).ConclusionsIn our cohort, the prevalence of OSA in CHF was 50.6%. Predictors of OSA in CHF were left ventricular ejection fraction (LVEF) 20%-30% and NYHA class 2. The majority had AHI between 5 and 15. Sleep apnea screening should be routinely implemented in the evaluation and follow-up of heart failure patients.

Sleep Symptoms and Polysomnographic Patterns of Obstructive Sleep Apnea in Obese Children.

This study was conducted to investigate the sleep symptoms and polysomnographic patterns of obstructive sleep apnea in overweight and obese children. Overweight or obese children aging 6-18 yr old referred during 2010 to Endocrinology Clinic of Ghods Hospital in Ghazvin, central Iran were enrolled in the study. Polysomnography was done for the diagnosis of obstructive sleep apnea and the BEARS and Children's Sleep Habits questionnaires were used to survey sleep behaviors. We enrolled 30 children (14 males, 16 females). Twenty-one cases had body mass index (BMI) >95% and 9 had 85% <BMI<95%. Respiratory disturbance in polysomnography was seen in 90% of cases. Symptoms included snoring 18 (60%); frequent awakening 17 (56.6%); nocturnal sweating 15 (50%); daytime sleepiness 12 (40%); sleep talking 10 (33.3%); bedtime resistance 9 (30%); nightmares 8 (26.6%); waking up problems 6 (20%); sleep walking 6 (20%); difficult breathing 4 (13.3%); bedwetting 3 (10%) and sleep onset delay 2 (6.06%). Severe, moderate and mild apnea - hypopnea Index (AHI) were seen in 12, 9 and 6 subjects, respectively. A significant Pearson correlation was found between the BMI values and sleep latency. Prevalence of obstructive sleep apnea is high among overweight and obese children. Physicians should be familiar with its manifestations and consider polysomnography as an invaluable diagnostic test. There was no relation between the degree of obesity and severity of obstructive sleep apnea.

A comparative study on the clinical and polysomnographic pattern of obstructive sleep apnea among obese and non-obese subjects

OBJECTIVE:This study was designed to compare the pattern of obstructive sleep apnea (OSA) among obese and nonobese subjects regarding clinical and polysomnographic data obtained for a polysomnographic study.METHODS:A cross-sectional retrospective descriptive study was conducted by analyzing polysomnographic data in 112 consecutive patients underwent a sleep study at our sleep laboratory from January 2009 to July 2010. Out of them, 81 were diagnosed to have OSA (apnea-hypopnoea Index ≥5). These patients were classified in two groups with body mass index (BMI) < 27.5 kg/m2 as nonobese and BMI≥27.5 kg/m2 as obese. Clinical as well as polysomnographic data were evaluated and compared between the two groups. Patients were also evaluated for other risk factors such as smoking, alcoholism, and use of sedatives. Data were subjected to statistical analysis (χ2-test, P value <0.05 considered to be significant). The Fisher Exact test was applied wherever the expected frequency for a variable was ≤5.RESULTS:Of 81 patients with OSA, 36 (44.4%) were nonobese with a mean BMI of 26.62 ± 2.29 kg/m2 and 45 (55.6%) were obese with a mean BMI of 35.14 ± 3.74 kg/m2. Mean AHI per hour was significantly more in the obese than in the nonobese group (50.09 ± 29.49 vs. 24.36 ± 12.17, P<0.001). The use of one or more sedatives was more in nonobese as compared to obese (58.3% vs. 24.4%, P=0.002). The obese group had significantly higher desaturation and arousal index (P<</i>0.001). The minimal oxygen saturation was lower in the obese than the nonobese group (68.5 ± 13.00 vs. 80.3 ± 7.40, P<</i>0.001) and was well below 90% in both groups. Overall, the OSA in nonobese patients was mild-to-moderate as compared to that of the obese and no significant differences were observed between them as regard to age, gender, mean neck circumference, excessive daytime sleepiness, adenoid or tonsillar enlargement, smoking, and remaining polysomnographic parameters.CONCLUSION:Obstructive sleep apnea can occur in nonobese persons though with less severity as compared to obese leading to a concept that OSA is not restricted to obese persons only and there is a high demand of its awareness regarding evaluation, diagnosis, and management in such individuals.

Clinical Patterns of Obstructive Sleep Apnea and Its Comorbid Conditions: A Data Mining Approach

Obstructive sleep apnea often results in a wide range of comorbid conditions. Although some conditions have been clearly identified as comorbid, a full clinical pattern of associated diseases has not been systematically documented. This research aimed to reveal the full pattern of comorbid conditions associated with OSA by employing a data mining technique. A large data repository (the New South Wales inpatient Data Collection) collected between 1999 and 2004 was mined, and all clinical diagnoses were coded with ICD-10-AM codes. A total of 60,197 cases (4% of total records) were identified as related to OSA (72.2% males, 27.8% females). OSA occurrence showed 2 peaks at 0-4 years and 55-59 years. A strikingly low occurrence was observed for the adolescent years. Conditions comorbid with OSA in adults by descending frequency were essential hypertension, obesity, hypercholesterolemia, type 2 diabetes, past or current tobacco use, and ischemic heart conditions. Obesity and OSA showed a similar time course of onset, with a latent period of 5 years for hypertension and type 2 diabetes and 15 years for chronic ischemic heart conditions. Comorbid conditions were predominantly of the cardiovascular, endocrine/metabolic and respiratory systems. The data also indicated OSA patients are high users of health services. The data mining technique confirms the prevalence of the disease, describes the age distribution patterns and time courses of disease development from obesity and OSAto comorbid conditions, and implicates possible interrelationships among these conditions and high cost of treating OSA patients.

BDNF protein exhibits a circadian rhythm in the hypoglossal, but not phrenic, motor nucleus

BDNF is a key molecule in respiratory plasticity, particularly long‐term facilitation (LTF) following intermittent hypoxia (Baker‐Herman et. al., 2004). LTF is prominent in upper airway motor activity and may help to maintain upper airway patency during sleep, preventing the recurrence of obstructive apneas (Mahamed and Mitchell, 2007). Although BDNF exhibits a circadian rhythm within the suprachiasmatic nucleus (Liang et. al., 1998), it is unknown if BDNF exhibits circadian rhythms in regions of interest to respiratory control, such as respiratory motor nuclei. To test the hypothesis that BDNF protein exhibits circadian rhythms in the phrenic and hypoglossal (XII) motor nuclei, tissues were sampled from ventral cervical spinal segments (C3–C5) and XII nucleus in Sprague‐Dawley rats, (light/dark cycle: 6AM/6PM), at 6, 12, 18, and 24 hours. Results: BDNF protein exhibited a circadian cycle in the XII, but not phrenic, motor nucleus; BDNF protein levels were lower during the subjective night (12PM–5PM). At its lowest point (5PM–7PM), BDNF was 66 ± 11.5% (S.E.M.) lower than at 5AM‐7AM (p&lt;0.05). The circadian BDNF rhythm may have important implications for the expression of respiratory plasticity in motor output, particularly to muscles controlling upper airway resistance. Thus, BDNF rhythms may contribute to the pattern of obstructive sleep apnea (Supported by NIH HL 80209).

Good soldier falls: the liver in sleep apnea

severe obstructive sleep apnea fires a complex array of physiological stressors rapidly and relentlessly across each period of sleep. With each occlusion of the upper airway, particularly in obese individuals, arterial oxygen content and delivery fall precipitously, carbon dioxide rises, acidosis

Polygraphic sleep patterns in herrdoataxia: A study of nine cases

A clinical and polygraphic sleep study was carried out in nine patients affected by heredoataxia (three by sporadic olivopontocerebellar ataxia (SOPCA), three by early onset cerebellar ataxia (EOCA) and three by Friedreich's ataxia). None of the patients complained about subjective sleep complaints. Polysomnographic findings showed a decrease in REM time in all the patients considered and a lower REM density in SOPCA and EOCA. A pattern of obstructive sleep-apnea was found in one case of SOPCA.