Risk Factor For OSA Research Articles

Obstructive Sleep Apnea in Patients With Primary-open Angle Glaucoma: No Role for a Screening Program.

It has been proposed that OSA might be a contributing factor in the development of POAG and by extension that there could be a role for screening people with POAG for OSA. To assess whether the prevalence of OSA among patients with POAG is different from that in people without glaucoma and to examine for associations between apnea-hypopnea index (AHI) and markers of functional and structural changes in POAG. Unselected POAG patients and control subjects were consecutively recruited in a single center. A comprehensive ocular assessment and nocturnal multichannel cardiorespiratory monitoring were performed. Data from 395 participants, 235 POAG patients, and 160 controls were analyzed. The prevalence of OSA was 58% [95% confidence interval (CI), 52-65] in POAG patients and 54% (95% CI, 47-62) in controls, with 22% (95% CI, 16-27) of POAG patients and 16% (95% CI, 11-22) of controls diagnosed with moderate or severe OSA. A total of 160 POAG participants were matched to the controls using propensity score matching. There was no significant difference in OSA prevalence between the matched groups (P=0.91 for AHI≥5 and P=0.66 for AHI≥15). The AHI was not associated with the severity of visual field defect or retinal nerve fiber layer thinning after adjustment for confounders. This study confirms a high prevalence of OSA among patients with POAG which is, however, not higher than in people without glaucoma matched for known OSA risk factors. Our results do not support screening for OSA in patients with POAG.

How OSA Evolves From Childhood to Young Adulthood: Natural History From a 10-Year Follow-up Study

Understanding the natural history of childhood OSA can help to determine disease prognosis and to guide risk stratification and management strategies. To evaluate the natural history of childhood OSA and factors associated with spontaneous remission and persistent and incident OSA from childhood to late adolescence/early adulthood, a longitudinal analysis of a prospective community-based cohort was designed. Subjects from a cohort established for an OSA prevalence study were invited to participate in this 10-year follow-up study. Two hundred and forty-three participants (59%male) took part, and their mean age was 9.8 (SD, ± 1.8) and 20.2 (SD, ± 1.9) years at baseline and follow-up, respectively. The mean follow-up duration was 10.4 (SD, ± 1.1) years. Associations between baseline and follow-up log-transformed obstructive apnea-hypopnea index (OAHI) differed by age; a significant positive association was observed only among participants aged 10 years or older at baseline. Overall polysomnographic remission rate (with OAHI< 1 event/h at follow-up) of childhood OSA was 30%, and 69%had an OAHI< 5 events/h at follow-up. Complete remission of OSA was associated with female sex. Incidence of adolescent/adult OSA with an OAHI≥ 5 events/h at follow-up was 22%. Male sex and higher baseline BMI z score were associated with incident OSA. A proportion of children with OSA, particularly female children, had complete resolution during transition to late adolescence or early adulthood. Childhood and adolescent OSA are distinct entities, with the latter more likely to persist into adulthood. Obesity and male sex are consistent key risk factors for incident OSA.

Chronic Rhinosinusitis Is an Independent Risk Factor for OSA in World Trade Center Responders

Many respiratory conditions have been attributed to toxic dust and fume exposure in World Trade Center (WTC) rescue and recovery workers, who frequently report symptoms of OSA. We examined the prevalence of new-onset OSA and tested if the prevalence and severity of OSA are related to the presence of chronic rhinosinusitis (CRS). A total of 601 subjects (83%men; age, 33-87 years; BMI, 29.9 ± 5.5kg/m2) enrolled in the WTC Health Program, excluding those with significant pre-September 11, 2001, snoring or prior CRS, underwent two nights of home sleep testing. OSA was defined as Apnea Hypopnea Index 4%≥ 5 events/h or respiratory disturbance index of≥ 15 events/h. CRS was assessed using nasal symptom questionnaires. The prevalence of OSA was 75%(25%no OSA, 46%mild OSA, 19%moderate OSA, and 10%severe OSA), and the prevalence of CRS was 43.5%. Compared with no CRS, new and worsening CRS was a significant risk factor for OSA with an OR of 1.80 (95%CI, 1.18-2.73; P= .006) unadjusted and 1.76 (95%CI, 1.08-2.88; P= .02) after adjustment for age, BMI, sex, gastroesophageal reflux disorder, and alcohol use. The high prevalence of OSA in WTC responders was not explained fully by obesity and sex. Possible mechanisms for the elevated risk of OSA in subjects with CRS include increased upper airway inflammation and/or elevated nasal/upper airway resistance, but these need confirmation.

Effects of Increased Pharyngeal Tissue Mass Due to Fluid Accumulation in the Neck on the Acoustic Features of Snoring Sounds in Men.

Snoring sounds are generated by the vibration of pharyngeal tissue due to the upper airway narrowing. While recorded by a microphone placed over the neck, snoring can pass through the pharyngeal tissue surrounding the upper airway. Thus, changes in the pharyngeal tissue content may change the acoustic properties of the snoring sounds. Rostral fluid shift and the consequent increases in neck fluid volume (NFV) and neck circumference (NC) can increase pharyngeal tissue mass. Therefore, the goal of this study was to investigate the relationship between increases in pharyngeal tissue mass, as assessed by increased NFV and NC, and snoring sounds features. We obtained data from a previous study where 20 males who were not obese participated in a daytime polysomnography and their NC and NFV were measured before and after sleep. During sleep, snoring sounds were recorded with a microphone placed over the neck. Spectral centroid of the snoring sounds was estimated. Then, the first five snoring segments were selected from the first and last 30 minutes of stage N2 sleep. We found a significant decrease in the snoring spectral centroid from the beginning to end of sleep. We also found that spectral centroid from the end of sleep in frequency ranges below 200 Hz was inversely correlated with the increases in NFV and NC from before to after sleep. These results suggest that snoring spectral centroid can be used as a noninvasive and convenient method to assess variations in the pharyngeal tissue mass.

A9357 The genetic polymorphisms of TWIK-related acid-sensitive K+ channel-3 (TASK-3) were associated with obstructive sleep apnea in patients with hypertension

Objectives: TWIK-related acid-sensitive K+ channel-3 was reported to be a risk factor for OSA in animal models. The present study aimed to evaluate the relationship between human TASK-3 gene polymorphisms and obstructive sleep apnea in patients with hypertension. Methods: 176 subjects with non-OSA and 169 subjects with severe OSA by full night polysomnography were selected. And we chose three represent single nucleotide polymorphisms (SNPs) such as rs2615374, rs3808403 and rs888345, according to principle of linkage disequilibrium (r2 > 0.8) and minimum allele frequency (MAF) > 5%. Blood samples were collected from all subjects and genotyping of the 3 SNPs was performed by Kompetitive Allele Specifc PCR. Results: The significant differences in additive model (P = 0.047), alleles (P = 0.014) and dominant model (P = 0.02) of rs2615374 were observed between severe and non OSA subjects. The distributions of additive (P = 0.005) and dominant model (P = 0.015) of rs3808403 were also significantly different between two groups. CT+TT genotype of rs3808403 was considered as risk factors for Severe OSA (CT+TT: [OR] = 2.09, 95%CI: 1.13–3.88, P = 0.019). In addition, mutant group of rs2615374 and rs3808403 showed significantly higher triglyceride levels than wild group. Conclusion: Our study suggested that the polymorphisms of rs2615374 and rs3808403 in the TASK-3 gene were associated with OSA, and CT+TT genotype of rs3808403 locus was a risk factor for severe OSA among the Chinese people. However, further studies should be conducted to confirm this association.

A retrospective analysis on patients at high-risk for obstructive sleep apnea undergoing ear, nose, and throat surgeries.

BackgroundObstructive sleep apnea (OSA) may be related to episodes of oxygen de‐saturation, hypercapnia, cardiovascular dysfunction, cor‐pulmonale, and pulmonary hypertension. STOP‐BANG is an acronym for eight specific questions used to assess the likelihood of OSA. If the individual exhibits three or more of these indicators, he/she should be considered to be at high risk for OSA complications. Therefore, the decision of proceeding with inpatient versus outpatient ENT surgery still remains controversial. The primary objective of the study was to identify and correlate desaturation (SPO2 <90%) episodes and risk factors.MethodsWe conducted a single‐center retrospective study between October 1, 2011 and August 31, 2014 in order to identify postoperative complications during the first 24 hours that justify postoperative monitoring and hospital admission. A total of 292 subjects were included for data analysis. Patients were divided into two groups based on the number of OSA risk factors: group A with 3–4 risk factors (n = 166), and group B with ≥5 risk factors (n = 126). The following information was collected: demographics, ASA, preoperative STOP‐BANG score, length of surgery, intraoperative complications, opioid consumption, post anesthesia care unit (PACU) and overall length of stay, supplemental oxygen requirement, oxygen desaturation, and postoperative opioid consumption.ResultsNo statistically significant difference was found when comparing demographic variables between both groups. All STOP‐BANG variables showed statistical significance. PACU and inpatient variables were similar among both groups, with the exception of length of hospital stay (longer stay in group B when compared to group A [p = 0.003]). Desaturation differences between both groups during PACU were statistically significant (p = 0.008). A post‐hoc analysis showed a 0% incidence of overall desaturation in the group with three STOP‐BANG indicators.ConclusionsOur retrospective analysis concluded that patients diagnosed with three STOP‐BANG risk factors did not experience postoperative complications and hospital admission was not justified.Level of Evidence4

Overnight pulse oximetry for screening of obstructive sleep apnea in at-risk adult patients in the primary care setting: prospective case series

Objective To estimate prevalence of OSA among at risk adult patients in primary care setting. To test the correlation and agreement between overnight pulse oximetry and polysomnography (PSG). To test the OSA screening performance of overnight pulse oximetry. Design and Setting Prospective case series involving adult Chinese patients with risk factors for OSA at a primary care clinic of Hong Kong. Methods The prevalence and severity of OSA were established based on overnight pulse oximetry derived oxygen desaturation index (ODI). Screening performance of overnight pulse oximetry was compared directly with gold standard diagnostic test PSG. Results Three hundred and five male and 229 female patients were recruited. Snoring (48.3%) was the top presenting symptom. Three hundred and twenty five patients (60.9%) were screened positive to have OSA. One hundred and nine patients had performed PSG, the ODI_4 and apnoea-hypopnea index (AHI) had Pearson correlation coefficient 0.71 (P Conclusion The prevalence of OSA is 60.9% among adult primary care population who are at risk for OSA. Overnight pulse oximetry shows good performance as a screening tool for the screening of OSA.

Obstructive sleep apnea in pregnancy. Is it a new syndrome in obstetrics?

BackgroundSleep disordered breathing (SDB) is a frequent disorder and its severity superfats as pregnancy progresses. The exact prevalence or incidence of such disorder in pregnant women is still unknown. ObjectivesTo assess the incidence and severity of OSA in pregnant women and to discover the risk factors for OSA during pregnancy. MethodsA total of 30 pregnant women and 30 age matched controls completed Epworth Sleepiness Scale and Stop-Bang questionnaire. SDB diagnosis was based on polysomnography. ResultsThe incidence of OSA among our studied pregnant women was 36.7% and 53.3% of pregnant women were snorers. They demonstrated significantly higher AHI (4.38 ± 4.45) and ODI (3.72 ± 4.03). There was a significant positive correlation between gestational age and ESS, BMI, AHI and ODI, as they are of their highest levels among cases in the third trimester. Binary logistic regression analysis showed that gestational age and body mass index were independent risk factors with odds ratio (2.23 & 4.99) and 95% CI (1.05–5.32 & 1.75–33.28) respectively while the neck circumference and ESS were considered as dependent risk factors. ConclusionPregnancy is a risk condition for OSA which aggravated by neck circumference and base line BMI. The susceptibility and severity increase by increasing gestational age.

Anthropometric Measurements as a Screening for OSA Among Employees of Philippine Heart Center

SESSION TITLE: Sleep 2 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Obesity is a key risk factor for the development of OSA and if undiagnosed and untreated, may lead to serious complications. This study aims to determine the association of anthropometric measurements with risk for OSA, through utilization Berlin Questionnaire, among employees of Philippine Heart Center. METHODS: This is a cross sectional study conducted at the Philippine Heart Center. Anthropometric measurements of 260 employees were obtained and assessed for high risk for OSA through Berlin questionnaire. RESULTS: Subjects who were high risk for OSA based on the Berlin Questionnaire were significantly more likely than those at low risk to have an increased weight 73.9 kg ± 15.1 vs low risk 64.3 kg ± 13.2 (p value <0.001), increased BMI 28.5 ± 4.09 vs low risk 24.5 ± 4.1 (p value <0.001); larger neck circumference 36.9 cm ± 3.7 vs low risk 34.9 cm ± 3.8 (p value 0.0003), larger waist circumference 91.8 cm ± 10.5 vs low risk 82.4 cm ± 12.7 (p value <0.001), greater hip circumference 102.9 cm ± 8.4 vs low risk 95.8 cm ± 10.7 (p value<0.001) and thigh circumference 56.8 cm ± 6.3 vs low risk 53.5 cm ± 8.5 (p value 0.0053). Logistic regression analysis was used after obtaining cut off values for BMI, neck circumference, waist circumference and waist-to-hip ratio. The results showed that increased BMI, waist circumference and waist to hip ratio were statistically significant risk factor for OSA. It is 4.6 times likely to occur if BMI is 28.72 kg/m2 (p value <0.001). Likewise, there was a threefold increase in the probability of OSA if the subject’s waist circumference was >97 cm (p value 0.002) and a twofold more likely of OSA if the subject waist-to-hip ratio >1 in men and >0.85 in women (p value 0.004). Though, neck circumference was close to being statistically significant (p value 0.051). CONCLUSIONS: The result of our study showed that anthropometric indices like BMI, waist circumference, and waist to hip ratio, are significant risk for OSA. On the other hand, our results suggest that neck circumference is not a good predictor of OSA. Thigh circumference was also associated with high risk for OSA which is not included in other studies. CLINICAL IMPLICATIONS: It is important that these anthropometric measurements should be taken on all patients especially if they present with snoring, daytime somnolence, fatigue and hypertension, as they provide cost-effective test in screening OSA prior to polysomnography. DISCLOSURE: The following authors have nothing to disclose: Mander Cambonga, Ma. Encarnita Limpin, Aileen Banzon No Product/Research Disclosure Information

139 - Comorbidity Management in Patients Referred to a Heart Failure with Preserved Ejection Fraction Clinic

Background: A modern paradigm for heart failure with preserved ejection fraction (HFpEF) pathogenesis proposes that comorbidities including diabetes, hypertension, obesity, CAD, and OSA contribute to a systemic pro-inflammatory state that promotes HFpEF development. Methods: We performed a chart review of 106 patients referred to the University of Michigan HFpEF Clinic. We assessed several comorbid conditions including hypertension, diabetes, obesity (BMI ≥ 30 kg/m2), dyslipidemia, CAD, OSA, chronic renal insufficiency (CRI, GFR < 60 mL/min), and atrial fibrillation (AF). Appropriate blood pressure control was defined as SBP < 140 and DBP < 90 mm Hg. Appropriate glycemic control was defined as a hemoglobin A1c < 7.0%. We assessed medical therapy for CAD and statin utilization as per guidelines. We evaluated whether patients with no history of CAD had received an evaluation for CAD. We reviewed rates of anticoagulant use for patients with a CHADs2VASc score ≥ 2. We also reviewed CPAP use for OSA and assessed if patients at risk for OSA (see Table 1) were referred for polysomnography (PSG). Results: A total of 106 patients were reviewed (median age 67; 37% male). Comorbidities were common (45% hypertension, 45% diabetes, 37% CAD, 76% obesity, 73% statin indication, 48% CRI, 64% OSA, 43% AF). Appropriate blood pressure control was observed in 66% of patients with hypertension. Forty-four of 48 patients with diabetes had a hemoglobin A1c measured within the past 3 years; however, only 48% of those had a reading of < 7.0%. Most patients (>80%) with CAD were receiving appropriate medical therapy but only 51% of those without CAD had an ischemic evaluation in the last 5 years. Of those patients with an indication for a statin, 86% were receiving statin therapy. In those patients with OSA, all patients were prescribed CPAP though only 88% were adherent. Of those with at least 3 risk factors for OSA though, only 50% had been referred for polysomnography. Lastly, 100% of patients with a CHADs2VASc ≥ 2 and no documented contraindication to anticoagulation were receiving anticoagulation for AF. Discussion: Patients referred for evaluation of HFpEF have a significant comorbidity burden. Based on data at initial evaluation, improvements can be made to achieve optimal management of these comorbidities. Since improved comorbidity management may prevent HFpEF progression, this highlights that appropriate care for the HFpEF patient requires a multidisciplinary approach.

Digital Morphometrics: A New Upper Airway Phenotyping Paradigm in OSA

OSA is associated with changes in pharyngeal anatomy. The goal of this study was to objectively and reproducibly quantify pharyngeal anatomy by using digital morphometrics based on a laser ruler and to assess differences between subjects with OSA and control subjects and associations with the apnea-hypopnea index (AHI). To the best of our knowledge, this study is the first to use digital morphometrics to quantify intraoral risk factors for OSA. Digital photographs were obtained by using an intraoral laser ruler and digital camera in 318 control subjects (mean AHI, 4.2 events/hour) and 542 subjects with OSA (mean AHI, 39.2 events/hour). The digital morphometric paradigm was validated and reproducible over time and camera distances. A larger modified Mallampati score and having a nonvisible airway were associated with a higher AHI, both unadjusted (P< .001) and controlling for age, sex, race, and BMI (P= .015 and P= .018, respectively). Measures of tongue size were larger in subjects with OSA vs control subjects in unadjusted models and controlling for age, sex, and race but nonsignificant controlling for BMI; similar results were observed with AHI severity. Multivariate regression suggests photography-based variables capture independent associations with OSA. Measures of tongue size, airway visibility, and Mallampati scores were associated with increased OSA risk and severity. This study shows that digital morphometrics is an accurate, high-throughput, and noninvasive technique to identify anatomic OSA risk factors. Morphometrics may also provide a more reproducible and standardized measurement of the Mallampati score. Digital morphometrics represent an efficient and cost-effective method of examining intraoral crowding and tongue size when examining large populations, genetics, or screening for OSA.

Awareness and knowledge of obstructive sleep apnea among the general population

BackgroundObstructive sleep apnea (OSA) is an increasingly prevalent condition that remains largely undiagnosed. We aimed to assess the level of awareness and knowledge of OSA among the general population. MethodsThe Singapore Health 2 was a population-based study that comprised interview and health screening components. Out of 2720 subjects who completed the interview component, 2080 subjects gave consent for further health surveys. We contacted these subjects and conducted a structured telephone interview. ResultsWe completed 1306 telephone interviews (response rate 62.8%). Two hundred and eighty-one (21.5%) respondents were aware of OSA, but only 170 (13.0%) respondents could define OSA correctly. A total of 77 (5.9%), 158 (12.1%), 150 (11.5%) and 110 (8.4%) respondents were able to correctly list at least one risk factor, symptom, health consequence and treatment options for OSA, respectively. The most common sources of information about OSA were traditional media such as newspapers (42.0%), internet (14.2%) or relatives and friends (14.6%). On multivariate analysis, respondents were more likely to define OSA correctly if they were older (≥61years), (odds ratio of 2.99, 95% Confidence Interval [CI]: 1.66–5.41), were Chinese as compared to Indians (odds ratio 2.63, 95% CI: 1.46–4.72), had higher levels of income (odds ratio 2.18, 95% CI 1.16–4.10) and post-secondary education (odds ratio 2.87, 95% CI: 1.28–6.45). ConclusionAwareness and knowledge of OSA among the general population is currently poor. The effectiveness of ongoing health education campaigns to increase awareness should be monitored by examining temporal trends in public knowledge of sleep apnea.

Obstructive sleep apnoea in children –a neglected entity

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Obstructive sleep apnoea syndrome (OSAS) is a spectrum which includes primary snoring, upper airway resistance syndrome, obstructive hypoventilation and obstructive sleep apnoea. Sleep disordered breathing (SDB) is characterized by snoring, witnessed apnoea, frequent arousal, mouth breathing, restless sleep, irritability, recurrent upper respiratory tract infections etc. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This was a prospective observational study which included 20 children who presented to the otorhinolaryngology, pulmonary medicine, paediatric, oral and maxillofacial department were included in the study with clinical symptoms of obstructive sleep apnoea. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 20 children, 13 (65%) males and 7 (35%) females were included. Snoring was the most common complaint.15 (75%) were obese, 5 had adenotonsillar hypertrophy(25%) as the risk factor for OSA. 15 out of the 20 children were graded under mallampati class 1(75%), 4 class 2(20%), 1under class 3(5%). There was no significant association in severity of OSA between 2 genders (p=0.82). &lt;span lang="EN-IN"&gt;Positive correlation (r=0.52) was found between AHI and BMI and is found to be statistically significant (p=0.02), which suggests that degree of obesity does predict the severity of OSA. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Obesity is the most significant risk factor among them followed by adenotonsillar hypertrophy. Hence children who snore should undergo polysomnography and necessary corrective measures should be prescribed.&lt;/span&gt;&lt;/p&gt;

Obstructive sleep apnea: the effect of bariatric surgery after 12 months. A prospective multicenter trial

BackgroundObstructive sleep apnea (OSA) is a highly prevalent sleep disorder, particularly in bariatric patients. It is known to be tightly linked with metabolic abnormalities and cardiovascular morbidity. Obesity is the most noteworthy individual risk factor for OSA. The aim of this study was to investigate the effect of a laparoscopic Roux–en–Y gastric bypass (LRYGB) on OSA one year after surgery. MethodsIn this prospective multicenter study standard overnight cardiorespiratory recording was conducted 12 months after bariatric surgery in 132 patients who had OSA in the baseline recording prior to the operation. The main outcome measures were changes in the prevalence of OSA and apnea–hypopnea index (AHI). In addition, the changes in anthropometric and demographic measurements including weight, body mass index (BMI), and waist and neck circumference were evaluated. A sleep symptom questionnaire was administered at baseline and at 12 months. ResultsThe prevalence of OSA decreased from 71% at baseline to 44% at 12 months after surgery (p < 0.001). OSA was cured in 45% and cured or improved in 78% of the patients, but moderate or severe OSA still persisted in 20% of the patients after the operation. De novo OSA occurred in eight percent of the patients, and total AHI decreased from 27.8 events/h to 9.9 events/h (p < 0.001). ConclusionsLRYGB is effective in treating OSA. However, the findings demonstrate that a postoperative cardiorespiratory recording is needed in order to identify the patients with persistent moderate to severe OSA after the operation. Clinical trial registrationClinalTrials.gov; No.: NCT01080404; URL: www.clinicaltrials.gov.

Oropharyngeal Crowding Closely Relates to Aggravation of OSA

Obesity is known to be an important risk factor for OSA; however, OSA can also be seen in nonobese patients with a small maxilla and/or mandible as well as in all obese patients with such features. Thus, we hypothesized that regional factors, oropharyngeal crowding associated with fat deposition, and maxillomandibular enclosure size closely related to the severity of OSA. A total of 703 male Japanese subjects were enrolled; theywere classified into obese (BMI≥ 30kg/m(2); n= 158) and nonobese (BMI< 30kg/m(2); n= 545) groups. Using lateral cephalometric analysis, we measured the tongue size (TG), lower face cage (LFC), and TG/LFC ratio (ie, oropharyngeal crowding) to evaluate the state of upper airway crowding. The correlations between these cephalometric measurements and BMI, age, and the apnea-hypopnea index (AHI) were evaluated. In obese subjects, the TG/LFC ratio, BMI, and TG positively correlated with AHI, whereas, in nonobese subjects, age, BMI, and TG/LFC significantly correlated with AHI. Subsequent stepwise multiple linear regression analysis revealed that the variables associated with AHI differed between obese and nonobese OSA subjects, although BMI and TG/LFC were significantly associated with AHI in both groups. In particular, the contribution of TG/LFC to AHI was larger than that of BMI in the obese group. Oropharyngeal crowding is a local anatomic factor that independently relates to the severity of OSA in both obese and nonobese patients; the more crowded the upper airway, the more severe the OSA.

Estimating the Prevalence of Sleep-Disordered Breathing Among Collegiate Football Players.

Obstructive sleep apnea is a clinical disorder characterized by loud snoring, apneic episodes, and chronic sleep disruption. Collegiate football players exhibit several risk factors for OSA, including large neck circumference and high body mass index, although the prevalence of OSA in this cohort is unknown. The STOP-BANG questionnaire was administered at random to members of a collegiate football team and used to stratify the players into high and low risk for sleep-disordered breathing (SDB). Those who completed the questionnaire were then evaluated for SDB during preseason camp using a single-channel (finger pulse oximetry) photoplethysmography-based device. SDB was defined as an apnea-hypopnea index of ≥5. Of 56 players who underwent overnight photoplethysmography monitoring, valid results were available for 51. Forty-eight percent of the players were high-risk (neck size = 44.6 ± 2.2 cm, body mass index = 33.0 ± 5.4) versus low-risk (neck size = 41.4 ± 2.8 cm, body mass index = 27.6 ± 3.6) (both P values <.001). An apnea-hypopnea index of ≥5 was found in 2 (8.3%, 95% CI 1.0-20.0%) high-risk and 2 (7.7, 95% CI 1.0-18.4%) low-risk players. Two offensive linemen, a linebacker, and a tight end accounted for the positive cases. Based on our sample, we estimate the prevalence of SDB among collegiate football players to be 8%, regardless of risk stratification. Given the strong link between SDB and cardiovascular disease, these data underscore the importance of screening and subsequent treatment of SDB in this highly conditioned yet potentially vulnerable group of athletes.

Prevalencia de lesión vascular cerebral silente en pacientes con síndrome de apnea/hipopnea obstructiva del sueño

The obstructive sleep apnea syndrome (OSA) confers increased risk of cardiovascular disease, given its association with other vascular risk factors. Both OSA and other vascular risk factors are associated with silent brain lesions. To assess the prevalence of silent brain lesions in patients with OSA. We retrospectively evaluated a cohort of 137 patients with OSA. The mean age was 65 ± 12 years; 45% were women. The silent brain lesions in magnetic resonance imaging were assessed with the Visual Scale of Fazekas (FVS), and the presence of cortical infarcts, lacunar and microbleedings was assessed. Vascular risk factors prevalence was: hypertension 64%, dyslipemia 58%, diabetes 18%, smoking 34%, carotid atherosclerosis 26%, coronary heart disease 13%, and atrial fibrillation 4%. OSA was mild in 47%, moderate in 31% and severe in 22% of the patients. 91% of patients had periventricular hyperintensities, and 66% showed subcortical white matter lesions. The average value of apnea/hipopnea index was higher in patients with score 2 and 3 in FVS, although without statistical significance. Patients with OSA in our study have a high prevalence of silent brain lesions, mainly with microangiopathic pattern. This is possibly explained by the relation between OSA, hypertension and other vascular risk factors.

A Randomized Controlled Study to Examine the Effect of a Lifestyle Modification Program in OSA

Obesity is an important risk factor for OSA. This study aimed to assess the effect of weight reduction through a lifestyle modification program (LMP) on patients with moderate to severe OSA. This was a parallel group, randomized controlled trial. Altogether, 104 patients with moderate to severe OSA diagnosed on portable home sleep monitoring were randomized to receive a dietician-led LMP or usual care for 12 months. The primary outcome was reduction of apnea-hypopnea index (AHI) at 12 months as assessed by portable home sleep monitoring. In the intention-to-treat analysis (ITT), LMP (n = 61) was more effective in reducing AHI from baseline (16.9% fewer events in the LMP group vs 0.6% more events in the control group, P = .011). LMP was more effective in reducing BMI (-1.8 kg/m2, 6.0% of the initial BMI; -0.6 kg/m2, 2.0% of the initial BMI in control group; P < .001). The reduction in daytime sleepiness as assessed by Epworth Sleepiness Scale was not significant in ITT but was more in the LMP group (-3.5 in the LMP group vs -1.1 in the control group, P = .004) by treatment per protocol analysis. There was modest improvement in mental health in the Short Form Health Survey. Eating behavior was improved with increased intake of protein and fiber. These changes were observed 4 months after the initial intensive diet counseling and persisted at 12 months. LMP was effective in reducing the severity of OSA and daytime sleepiness. The beneficial effect was sustained in 12 months. ClinicalTrials.gov; No.: NCT01384760; URL: www.clinicaltrials.gov.

Obstructive Sleep Apnea in Women and the Elderly

© 2014 by Turkish Thoracic Society.Obstructive sleep apnea (OSA) is a common disease with major consequences. Obesity and aging, as well as male gender, are recognized risk factors for OSA; however, the condition of OSA in women and the elderly has received only minimal attention. OSA in women is perhaps under-appreciated due to the traditional stereotype of an older obese man presenting with OSA. However, OSA in women, particularly post-menopause, can have important sequelae. Similarly, OSA in the elderly may have unique mechanisms, and the consequences are still debated. Further work is clearly needed to define the mechanisms and consequences of OSA in special populations.

Targeted Case Finding for OSA within the Primary Care Setting

The aim was to determine the feasibility of using an unattended 2-channel device to screen for obstructive sleep apnea in a population of high-risk patients using a targeted, case-finding strategy. The case finding was based on the presence of risk factors not symptoms in the studied population. The study took place from June 2007 to May 2008 in rural and metropolitan Queensland and New South Wales. Family doctors were asked to identify patients with any of the following: BMI > 30, type 2 diabetes, treated hypertension, ischemic heart disease. Participants applied the ApneaLink+O2 at home for a single night. The device recorded nasal flow and pulse oximetry. Data were analyzed by proprietary software, then checked and reported by either of two sleep physicians. 1,157 patients were recruited; mean age 53 ± 14.6, M/F% = 62/38, mean BMI = 31.8, obesity = 35%, diabetes = 16%, hypertension = 39%, IHD = 5%, Mean Epworth Sleepiness Scale score (ESS) = 8.3. The prevalence of unrecognized OSA was very high: 71% had an AHI > 5/h, 33% had an AHI > 15/h, and 16% had an AHI > 30/h. The ApneaLink+O2 device yielded technically adequate studies in 93% of cases. The study shows that a "real world" simple low cost case finding and management program, based on unattended home monitoring for OSA, can work well in a population with risk factors and comorbidities associated with OSA, independent of the presence of symptoms. The prevalence of unrecognized OSA was very high.