Polysomnography For Obstructive Sleep Apnea Research Articles

Lean Metabolic Syndrome vis-à-vis Obese Metabolic Syndrome: Observations from an Eastern Indian Tertiary Set-up

Background: Metabolic syndrome (MetS) in obese is a fairly common entity. However, excluding the waist circumference (WC) criteria, other components of the MetS are also seen in lean or nonobese people. Our study aimed to determine the prevalence of lean MetS among newly diagnosed MetS cases and compare the biochemical parameters and insulin resistance in lean versus overweight/obese MetS. Methods: A cross-sectional, observational study was conducted over 12 months and included adult patients of either sex, newly diagnosed with MetS. Fever cases, infections such as tuberculosis/HIV/chronic infectious disease, chronic inflammatory diseases, those having endocrine causes of obesity such as Cushing syndrome, known cases of ischemic heart disease, and those on antiobesity medications were excluded. Diagnosed MetS patients were categorized as lean or obese based on the standard criteria. A convenient sample of 50 was considered for either group (lean MetS vs. obese MetS). Included patients were investigated for lipid, liver, glycemic, and insulin resistance profiles. Other parameters included serum uric acid, thyroid function, whole abdomen ultrasound, electrocardiography, two-dimensional echocardiography (ECHO), fibroscan, and polysomnography for obstructive sleep apnea (OSA). Results: The prevalence of lean MetS was 9.87%. Variables such as body mass index, WC, low-density lipoprotein, and systolic blood pressure were significantly higher in the obese MetS in comparison to the lean MetS group. Fasting insulin was also significantly higher in the obese MetS compared to lean MetS. Biochemical measures such as aspartate aminotransferase and alanine transferase were significantly higher for the obese MetS, while the change was nonsignificant for other biochemical measures. Except for complications such as polycystic ovary syndrome, acanthoses nigricans, and gallstones which were significantly higher in the obese MetS group, the rest of the complications were similar in both groups. Conclusion: MetS among nonobese or lean subjects differs in certain aspects from those with obesity. As lean MetS is an emerging entity, clinicians must be aware of it to avoid morbidity.

Insights on mandibular jaw movements during polysomnography in obstructive sleep apnea.

Malhotra A, Martinot J-B, Pépin J-L. Insights on mandibular jaw movements during polysomnography in obstructive sleep apnea. J Clin Sleep Med. 2024;20(1):151-163.

Obstructive sleep apnea due to nasal obstruction: a review of the literature

Ksenija Kuzborskaja-Riaukė1 1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lietuva Abstract Background. Obstructive sleep apnea (OSA) is a sleep disorder associated with episodic collapses of the upper airway during sleep. Risk factors include conditions leading to reduced pharyngeal radius and increased airway laxity. OSA can have a negative impact on a person’s quality of life, so timely diagnosis is essential. Aim: to identify and summarize the principles of diagnosis and treatment of obstructive sleep apnea due to nasal obstruction. Methods. The Google Scholar and PubMed databases were used for the literature review, with keywords and their combinations: “nasal obstruction”, “obstructive sleep apnea”, “allergic rhinitis”, “nasal surgery” in the regular and advanced search fields. Articles written in English were selected, with priority given to publications not older than 5 years. For this review, 45 articles were analysed and 34 were selected for the further analysis. Results. Endoscopic, rhinomanometric and polysomnographic examinations are used to diagnose nasal obstruction and obstructive sleep apnea. Endoscopy and rhinomanometry are used to differentiate the cause and severity of nasal obstruction, while polysomnography is used to diagnose and differentiate obstructive sleep apnea. Depending on the etiology of nasal obstruction, conservative and surgical methods are indicated. Conclusions. The diagnosis of nasal obstruction and OSA is based on risk factors, clinical symptoms and instrumental tests, the most common being endoscopic examination for nasal obstruction and polysomnography for obstructive sleep apnea. Conservative treatment isn‘t always effective and, depending on the etiology of nasal obstruction and OSA, surgical treatment is indicated. Keywords: nasal obstruction, obstructive sleep apnea, allergic rhinitis, nasal surgery. Full article https://doi.org/10.53453/ms.2023.2.5

A validation study of an esophageal probe–based polygraph against polysomnography in obstructive sleep apnea

Study objectivesThe aim of this study was to validate the automatically scored results of an esophageal probe–based polygraph system (ApneaGraph® Spiro) against manually scored polysomnography (Nox A1, PSG) results. We compared the apnea–hypopnea index, oxygen saturation index, and respiratory disturbance index of the devices.MethodsConsenting patients, referred for obstructive sleep apnea workup, were tested simultaneously with the ApneaGraph® Spiro and Nox A1® polysomnograph. Each participant made one set of simultaneous registrations for one night. PSG results were scored independently. Apnea–hypopnea index, oxygen desaturation index, and respiratory disturbance index were compared using Pearson’s correlation and scatter plots. Sensitivity, specificity, and positive likelihood ratio of all indices at 5, 15, and 30 were calculated.ResultsA total of 83 participants had successful registrations. The apnea–hypopnea index showed sensitivity of 0.83, specificity of 0.95, and a positive likelihood ratio of 5.11 at an index cutoff of 15. At a cutoff of 30, the positive likelihood ratio rose to 31.43. The respiratory disturbance index showed high sensitivity (> 0.9) at all cutoffs, but specificity was below 0.5 at all cutoffs. Scatterplots revealed overestimation in mild OSA and underestimation in severe OSA for all three indices.ConclusionsThe ApneaGraph® Spiro performed acceptably when OSA was defined by an AHI of 15. The equipment overestimated mild OSA and underestimated severe OSA, compared to the PSG.

Clinical utility of limited channel sleep studies versus polysomnography for obstructive sleep apnoea

Clinical utility of limited channel sleep studies versus polysomnography for obstructive sleep apnoea

Is the Sleep Perception of Obstructive Sleep Apnea Patients Reliable?

Aim: The aim of this study, is to evaluate the consistency with the polysomnography (PSG) data of the patients and the data reported by the patients themselves after PSG examination in the morning.Material and Methods: One hundred and thirty-four consecutive individuals who were admitted to the Chest Disease Polyclinic for Sleep Disorders of Duzce University Medical Faculty were included in the study. PSG and the questions related to sleep perception was applied by the same physician with face to face interview to all participants.Results: Of the patients included in the study 90 (67.2%) were male and 44 (32.8%) were female, and the mean age was 47.3±12.6 years. While there was a significant correlation (p=0.042, r=0.301) between the sleep time reported by the patients themselves after waking up in the morning and the sleep time measured by the PSG in patients without obstructive sleep apnea (OSA), there was no correlation in OSA (+) patients (p=0.269, r=0.125). Similarly, while there was a significant correlation (p=0.026, r=0.352) between the sleep latency reported by the patients themselves after waking up in the morning and the sleep latency measured by the PSG in OSA (-) patients, there was no correlation in OSA (+) patients (p=0.060, r=0.223).Conclusion: While evaluating OSA patients and explaining their treatment before and after PSG, it should be kept in mind that they might have impaired perception. Therefore, we thought that we should spend more time to patients, and to make our explanations more clearly and understandably.

The diagnostic accuracy of type IV portable sleep monitors versus polysomnography for obstructive sleep apnea in children: a systematic review

The diagnostic accuracy of type IV portable sleep monitors versus polysomnography for obstructive sleep apnea in children: a systematic review

Quantifying the Arousal Threshold Using Polysomnography in Obstructive Sleep Apnea.

Precision medicine for obstructive sleep apnea (OSA) requires noninvasive estimates of each patient's pathophysiological "traits." Here, we provide the first automated technique to quantify the respiratory arousal threshold-defined as the level of ventilatory drive triggering arousal from sleep-using diagnostic polysomnographic signals in patients with OSA. Ventilatory drive preceding clinically scored arousals was estimated from polysomnographic studies by fitting a respiratory control model (Terrill et al.) to the pattern of ventilation during spontaneous respiratory events. Conceptually, the magnitude of the airflow signal immediately after arousal onset reveals information on the underlying ventilatory drive that triggered the arousal. Polysomnographic arousal threshold measures were compared with gold standard values taken from esophageal pressure and intraoesophageal diaphragm electromyography recorded simultaneously (N = 29). Comparisons were also made to arousal threshold measures using continuous positive airway pressure (CPAP) dial-downs (N = 28). The validity of using (linearized) nasal pressure rather than pneumotachograph ventilation was also assessed (N = 11). Polysomnographic arousal threshold values were correlated with those measured using esophageal pressure and diaphragm EMG (R = 0.79, p < .0001; R = 0.73, p = .0001), as well as CPAP manipulation (R = 0.73, p < .0001). Arousal threshold estimates were similar using nasal pressure and pneumotachograph ventilation (R = 0.96, p < .0001). The arousal threshold in patients with OSA can be estimated using polysomnographic signals and may enable more personalized therapeutic interventions for patients with a low arousal threshold.

Effectiveness of home single-channel nasal pressure for sleep apnea diagnosis.

Home single-channel nasal pressure (HNP) may be an alternative to polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis, but no cost studies have yet been carried out. Automatic scoring is simpler but generally less effective than manual scoring. To determine the diagnostic efficacy and cost of both scorings (automatic and manual) compared with PSG, taking as a polysomnographic OSA diagnosis several apnea-hypopnea index (AHI) cutoff points. We included suspected OSA patients in a multicenter study. They were randomized to home and hospital protocols. We constructed receiver operating characteristic (ROC) curves for both scorings. Diagnostic efficacy was explored for several HNP AHI cutoff points, and costs were calculated for equally effective alternatives. Of 787 randomized patients, 752 underwent HNP. Manual scoring produced better ROC curves than automatic for AHI < 15; similar curves were obtained for AHI ≥ 15. A valid HNP with manual scoring would determine the presence of OSA (or otherwise) in 90% of patients with a polysomnographic AHI ≥ 5 cutoff point, in 74% of patients with a polysomnographic AHI ≥ 10 cutoff point, and in 61% of patients with a polysomnographic AHI ≥ 15 cutoff point. In the same way, a valid HNP with automatic scoring would determine the presence of OSA (or otherwise) in 73% of patients with a polysomnographic AHI ≥ 5 cutoff point, in 64% of patients with a polysomnographic AHI ≥ 10 cutoff point, and in 57% of patients with a polysomnographic AHI ≥ 15 cutoff point. The costs of either HNP approaches were 40% to 70% lower than those of PSG at the same level of diagnostic efficacy. Manual HNP had the lowest cost for low polysomnographic AHI levels (≥ 5 and ≥ 10), and manual and automatic scorings had similar costs for higher polysomnographic cutoff points (AHI ≥ 15) of diagnosis. Home single-channel nasal pressure (HNP) is a cheaper alternative than polysomnography for obstructive sleep apnea diagnosis. HNP with manual scoring seems to have better diagnostic accuracy and a lower cost than automatic scoring for patients with low apnea-hypopnea index (AHI) levels, although automatic scoring has similar diagnostic accuracy and cost as manual scoring for intermediate and high AHI levels. Therefore, automatic scoring can be appropriately used, although diagnostic efficacy could improve if we carried out manual scoring on patients with AHI < 15. Clinicaltrials.gov identifier: NCT01347398.

The effect of nightly nasal CPAP treatment on nocturnal hypoxemia and sleep disorders in mustard gas-injured patients

Sleep-related breathing disorders are associated with unusual respiratory pattern or an abnormal reduction in gas exchange during sleep that is common in sulfur mustard (SM) exposure. We compared 57 Iranian male patients injured with SM and had any complaints of sleep problems with an age-matched group of 21 Iranian male patients who had complaints of sleep problems and were not chemically injured; this group had Epworth Sleepiness Scale (ESS) above 10 and whom referred for polysomnography. Split-night studies were performed for patients with diagnostic polysomnography for obstructive sleep apnea (OSA) and respiratory events. We then studied respiratory events including episodes of OSA, apnea-hypopnea index (AHI) and respiratory disturbance index (RDI). The mean age in mustard-exposed patients was 48.14±8.04 years and in age-matched group, 48.19±8.39 years. In mustard exposed patients, there were statistical differences for the episodes of OSA (p=0.001), AHI (p=0.001), and RDI (p=0.001) between two segments of split-night studies. In the age-matched group, there were statistically differences for each parameter (episodes of OSA (p=0.001), AHI (p=0.001), and RDI (p=0.001)). There were no significant differences between two groups. This study indicated that the incidence of respiratory events and nocturnal hypoxemia during sleep in mustard-exposed patients were high and treatment with CPAP significantly reduced all these events.

Diagnostic aspects of polysomnography in obstructive sleep apnea

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder which is characterized by intermittent hypoxia and frequent arousals because of partial or complete upper airway obstruction during sleep. This condition may be associated with various clinical sequelae such as hypertension, cardiovascular disorders, and metabolic syndrome in adults, and failure to thrive, deformity of dentofacial structures, behavioral problems, impairment of sleep-related quality of life, and enuresis in children. Although technician-attended, in-laboratory, overnight standard polysomnography (PSG) is considered a basic and important diagnostic test to classify the severity of respiratory disturbance and define the proper treatment modality in adults and children with OSA, it is too expensive and complicated to perform. Recently, in order to overcome the disadvantages of standard PSG in the clinical field, a portable sleep monitoring device has been introduced as an alternative to standard PSG in selected patients. The purpose of this article is to elucidate the clinical indications of polysomnography in OSA, to define the differential characteristics of polysomnographic indices between children and adults with OSA, and to introduce the clinical efficacy of a portable sleep monitoring device.

Accuracy of Residual Apnea and Hypopnea Index Detected by Automatic Continuous Positive Airway Pressure Device in Patients With Obstructive Sleep Apnea

PURPOSE: Continuous positive airway pressure (CPAP) is indicated for treatment of obstructive sleep apnea (OSA). Titration is manual during level 1 polysomnography or by automatic CPAP devices (autoCPAP) where fixed CPAP is chosen from autoCPAP data, provided the residual apnea-hypopnea index (R-AHI) is acceptable. Accuracy of R-AHI from autoCPAP has not been well-studied in unmonitored conditions, yet these titrations are typically unattended. This study compares R-AHI scored by Respironics Remstar AutoCPAP to R-AHI scored manually on simultaneous level 3 polysomnography in OSA.

Ambulatory titration of continuous positive airway pressure was as effective as polysomnography for obstructive sleep apnoea

Ambulatory titration of continuous positive airway pressure was as effective as polysomnography for obstructive sleep apnoea

Ambulatory titration of continuous positive airway pressure was as effective as polysomnography for obstructive sleep apnea

Ambulatory titration of continuous positive airway pressure was as effective as polysomnography for obstructive sleep apnea

Prevalence of Moderate or Severe Left Ventricular Diastolic Dysfunction in Obese Persons with Obstructive Sleep Apnea

We investigated prior to gastric bypass surgery the prevalence of left ventricular diastolic dysfunction (LVDD) by Doppler and tissue Doppler echocardiography in 14 obese women and in 6 obese men, mean age 45 years, with a mean body mass index of 49 ± 5 kg/m² who had nocturnal polysomnography for obstructive sleep apnea (OSA). The Doppler and tissue Doppler echocardiographic data were analyzed blindly without knowledge of the clinical characteristics or whether OSA was present or absent. Of 20 patients, 8 (40%) had no OSA, 4 (20%) had mild OSA, and 8 (40%) had moderate or severe OSA. Moderate or severe LVDD was present in 4 of 8 patients (50%) with moderate or severe OSA and in none of 12 patients (0%) with no or mild OSA (p < 0.01). Obese patients with moderate or severe OSA have a higher prevalence of moderate or severe LVDD than obese patients with no or mild OSA.