Signs Of Obstructive Sleep Apnea Research Articles

Nocturia in Menopausal Women: The Link Between Two Common Problems of the Middle Age.

The aim of this review is to discuss the link between menopause and nocturia and to give an overview of the increasing prevalence, risk factors, causative factors, treatment needs and options for nocturia in peri-menopausal women. This opinion article is a narrative review based on the expertise and consensus of a variety of key opinion leaders, in combination with an extensive literature review.This literature search included a thorough analysis of potential publications on both the PubMed Database and the Web of Science and was conducted between November 2022 and December 2022. The following key words were used "nocturia" and "menopause" or "nocturnal frequency and menopause." Moreover, key words including "incidence," "prevalence," "insomnia," "estrogen therapy," "metabolic syndrome," and "hot flushes" were used in combination with the aforementioned key words. Last, the reference lists of articles obtained were screened for other relevant literature. The perimenopause can be a trigger for inducing nocturia. Typically, obesity, body mass index (BMI), and waist circumference are risk factors for developing peri-menopausal nocturia. Presumably the development of peri-menopausal nocturia is multifactorial, with interplay among bladder, sleep, and kidney problems due to estrogen depletion after the menopause. First, impaired stimulation of estrogen receptors in the urogenital region leads to vaginal atrophy and reduced bladder capacity. Moreover, menopause is associated with an increased incidence of overactive bladder syndrome. Second, estrogen deficiency can induce salt and water diuresis through blunted circadian rhythms for the secretion of antidiuretic hormone and the activation of the renin-angiotensin-aldosterone system. Additionally, an increased incidence of sleep disorders, including vasomotor symptoms and obstructive sleep apnea signs, is observed. Oral dryness and a consequent higher fluid intake are common peri-menopausal symptoms. Higher insulin resistance and a higher risk of cardiovascular diseases may provoke nocturia. Given the impact of nocturia on general health and quality of life, bothersome nocturia should be treated. Initially, behavioral therapy should be advised. If these modifications are inadequate, specific treatment should be proposed. Systemic hormone replacement is found to have a beneficial effect on nocturia, without influencing sodium and water clearance in patients with nocturnal polyuria. It is presumed that the improvement in nocturia from hormonal treatment is due to an improvement in sleep disorders.

Gas exchange parameters for the prediction of obstructive sleep apnea in infants.

Sleep laboratory polysomnography (PSG) is the gold standard for obstructive sleep apnea (OSA) diagnosis in infants, but its access remains limited. Oximetry-capnography is another simple and widely used tool that can provide information on the presence of desaturations and alveolar hypoventilation. However, its reliability is debated. This study aimed at examining its use in determining OSA severity in infants. This retrospective study was conducted in a sleep unit in a tertiary hospital, in infants < 4 months old with clinical signs of OSA or Pierre Robin Sequence (PRS) who underwent a one-night PSG coupled with oximetry-capnography. Among the 78 infants included (median [IQR] age: 61 [45-89] days at PSG), 44 presented with PRS, and 34 presented with isolated airway obstruction. The clinical, sleep and respiratory characteristics were not significantly different between the two subgroups. In the entire cohort, 63.5% had severe OSA. Median OAHI was 14.5 events/h [7.4-5.9], SpO2 was 97.4% [96.5-98.1], and PtcCO2 was 41.1 mmHg [38.3-44.9]. The optimal threshold to predict OAHI > 10 events/h was 6 events/h for ODI3% (sensitivity 95.7%, specificity 51.9%) and 2 events/h for ODI4% (sensitivity 95.7%, specificity 48.1%). Whereas transcutaneous capnography does not appear to be sufficient in predicting severe OSA in infants < 4 months old with PRS or clinical signs of OSA, oximetry may be a useful alternative for the screening of severe OSA in infants in the absence of PSG.

Maximal Mouth Opening in Infants: A Single-Group Prospective Cohort Study

BackgroundDetection of mandibular range of motion variations in infants may allow for early diagnosis of pathologic conditions to the temporomandibular joint. PurposeThe purpose of this study was to determine the normal ranges for maximal mouth opening (MMO) in healthy infants under 12 months of age. Study design, setting, sampleA single-group prospective cohort study of consecutive patients below 12 months of age was conducted in an outpatient setting at the Florida Craniofacial Institute in Tampa, Florida. Patients were excluded if they had trismus, presented with signs of obstructive sleep apnea, suffered a facial fracture, or were diagnosed with a craniofacial syndrome. Predictor/exposure/independent variableAge (in months) at the time of presentation, measured as a continuous variable. Main outcome variable(s)The main outcome variable was MMO. This was measured by placing a thumb and forefinger in the infant’s mouth and apply slight pressure to encourage maximal mouth opening. In older infants with erupted central incisors, MMO was measured from the gingival margins. CovariatesThe covariates were sex, race, and gestational age. AnalysesFindings were presented as means with 95% confidence intervals. A multivariate linear regression analysis was conducted to evaluate changes in MMO with increasing age. ResultsThe sample was composed of 151 infants with a mean age of 5.2 months (95% CI 4.8 to 5.6), and 33% were female. The mean MMO was 32.1 mm (95% CI 31.5 to 32.7). Results of the linear regression analysis showed MMO to significantly increase with increasing age, increasing at a mean rate of approximately 1 mm per month (coefficient 1.06, 95% CI 0.88 to 1.23, p<0.001). In neonates <1 month of age, the mean MMO was 22.0 mm (95% CI 20.4-23.6), compared to a mean of 36.7 mm (95% CI 34.8-38.6) in infants 11 months of age. Conclusions and RelevanceThe results of this study provide normative data of the association of age with MMO, which may be of value in assessing for infants with jaw mobility disorders.

Awareness and Sources of Knowledge about Obstructive Sleep Apnea: A Cross Sectional Survey Study

Obstructive sleep apnea (OSA) is a multifactorial sleep breathing disorder, seriously impacting quality of life and involving approximately 1 billion of the world’s population. It is characterized by episodes of total cessation of breathing or decreases in airflow during sleep. Available data suggest that most cases of OSA remain undiagnosed even in developed countries. This is due to a lack of widespread knowledge about this pathology and the medical morbidities and mortality it brings about, among both laypeople and physicians. Moreover, despite receiving indications about the need to undergo specific evaluations for OSA signs and symptoms, sometimes patients do not pay sufficient attention to the problem. This is probably due to a lack of correct information on these issues. The present investigation analyzed the level of knowledge about OSA pathology and the sources through which a group of OSA patients gained information on their condition. A survey of 92 patients diagnosed with OSA (mean age 60.55 ± 10.10) and referred to the Unit of Orthodontics and Dental Sleep Medicine of the University of Bologna was conducted by means of a questionnaire investigating sociodemographic characteristics, the level of general knowledge on OSA pathology and its possible medical consequences. Despite about two third (67.38%) of the population demonstrating extensive knowledge, remarkably, a group of subjects (20.65%) had poor awareness of the OSA condition. A statistically significant correlation emerged between the level of knowledge about OSA and the level of education (p = 0.002). A great effort should be made to improve the quality of information and the communication modalities for OSA to enable a fully appropriate awareness of the condition among patients.

0514 Risk Factors for Symptoms and Signs of Sleep Apnea Impacting Quality of Life in an Urban Pediatric Community-Based Sample

Abstract Introduction Pediatric obstructive sleep apnea (OSA) disproportionately affects children from minority groups and children living in disadvantaged neighborhoods, but the risk factors that drive this risk are not well understood. We investigated the relationship between minority race/ethnicity, household risk factors (smoking, socio-economic status [SES]), and neighborhood disadvantage with OSA-related quality of life (QOL) scores in participants in the Environmental Assessment of Sleep Youth (EASY) observational study. Methods Families of children 5-12 years old recruited from largely low-income Boston-area neighborhoods participated in an extensive in-home evaluation of OSA risk factors. OSA-related QOL was assessed with parent-reported OSA-18 questionnaire (values &amp;gt;37 indicative of negative impact of symptoms and signs of OSA on QOL). Secondhand smoking (SHS) was defined by parent-report of smoking in the home. Neighborhood disadvantage was characterized using geocoded addresses, calculating the Neighborhood Socioeconomic (NSES) index. We performed logistic regression with OSA-18 &amp;gt;37 as the dependent variable and age, gender, race/ethnicity, BMI, household smoking, household measures of SES and NSES index as independent variables. Results The sample included 256 children (40%-Hispanic ethnicity, 31%-Black, 20%-White, 9%-Other; 56% were female), with a mean age 9.1±1.9 and BMI percentile 69.9±29.8. 33% and 40% of children were from households with income &amp;lt;$25,000 and $25,000-$75,000, respectively, and 10% had SHS exposure. Mean NSES index was 47.9±15.4 (national average of 50). An elevated OSA-18 was reported for 35% of participants and significantly associated with Hispanic ethnicity and smoking exposure (OR=2.16, CI 1.01-4.62 and OR=2.71, CI 1.2-6.3) after adjusting for age, gender, and BMI percentile. Further adjustment for family income attenuated the association of OSA-18 with Hispanic ethnicity, but a significant association with household smoking persisted. NSES index and BMI percentile were not associated with OSA-18. Conclusion High symptoms and signs of OSA impacting QOL were associated with Hispanic ethnicity, household smoking and SES in this diverse cohort of children living in urban and predominantly low-income communities. The study points to the need for strategies to reduce household smoking as one strategy for decreasing sleep health disparities, and the further need to understand other factors associated with low SES that increase risk for poor sleep health. Support (If Any) NIH-NHLBI/T32HL007901, R35HL1358181, P30ES000002, K24AI106822, R01Hl137192, K23ES031663

Influence of Apnea Hypopnea Index and the Degree of Airflow Limitation on Endothelial Function in Patients Undergoing Diagnostic Coronary Angiography.

Simple SummaryObstructive sleep apnea and airflow limitation disorders are linked to increased cardiovascular morbidity and mortality in patients with chronic coronary syndrome. Although the exact mechanism associated with this phenomenon remains poorly elucidated, the impairment of endothelial function observed in both breathing disorders and cardiovascular disease is one of the possible pathophysiological processes linking those conditions. In the present study, we sought to determine the possible relationship between the endothelial function, signs of disturbed respiration during sleep, and airflow limitation in chronic coronary syndrome patients undergoing diagnostic invasive coronary angiography. Our study showed that obstructive sleep apnea signs measured by WatchPAT (respiratory disturbance index, apnea and hypopnea index, and oxygen desaturation index) were associated with endothelial dysfunction. Additionally, greater airflow limitation by spirometry was detected in patients with endothelial dysfunction. Patients with endothelial dysfunction showed an increase in left ventricular hypertrophy with a trend of increase in left atrial enlargement, indicating underlying diastolic dysfunction. However, the endothelial dysfunction was independent of the presence or severity of obstructive coronary artery disease in coronary angiography. We believe that our study may complement and extend the current understanding of endothelial dysfunction in the mechanism, explaining the relationship between sleep apnea and cardiovascular diseases.Background: Obstructive sleep apnea is associated with an increased prevalence of cardiovascular disease. The mechanism of these associations is not completely understood. We aimed to investigate the association of the apnea hypopnea index and the degree of airflow limitation with endothelial dysfunction. Methods: This was a single-center prospective study of patients admitted for diagnostic coronary angiography (CAG). Endothelial function was assessed by the non-invasive EndoPAT system by reactive hyperemia index (RHI) and divided into two groups: endothelial dysfunction and normal endothelial function. Sleep apnea signs were detected by WatchPAT measuring the respiratory disturbance index (pRDI), the apnea and hypopnea index (pAHI), and the oxygen desaturation index (ODI). Patients underwent spirometry and body plethysmography. Based on CAG, the severity of coronary artery disease was assessed as follows: no significant coronary artery disease, single-, two- and three-vessel disease. Results: A total of 113 patients were included in the study. Breathing disorders measured by WatchPAT and spirometry were more severe in patients with endothelial dysfunction: pRDI (27.3 vs. 14.8, p = 0.001), pAHI (24.6 vs. 10.3, p < 0.001), ODI (13.7 vs. 5.2, p = 0.002), forced expiratory volume in one second (FEV1) (81.2 vs. 89, p = 0.05). In a multivariate regression analysis, pAHI and FEV1 were independent predictors of endothelial dysfunction assessed by RHI. There was no correlation between the severity of coronary artery disease and endothelial dysfunction. Conclusions: Obstructive sleep apnea signs and greater airflow limitation were associated with endothelial dysfunction regardless of the severity of the coronary artery disease.

Oral health problems linked to obstructive sleep apnea are not always recognized within dental care-As described by dental professionals.

ObjectivesObstructive sleep apnea (OSA) has an impact on an individual's quality of life and general health, and can also affect their oral health. The patient's experiences, together with intraoral signs and symptoms could indicate the presence of OSA. Knowledge that the patient has, or is at high risk for having OSA can help the dental healthcare provider maintain the oral health and general health for these patients. The purpose was to explore dentists and dental hygienists' experiences when encountering adult patients with potential, untreated and treated OSA.MethodsA qualitative inductive approach was used. Experienced dentists and dental hygienists working within Swedish Public Dental Service were strategically selected. Semi‐structured face‐to‐face interviews were performed followed by qualitative content analysis.ResultsInterviews from 13 participants, seven dental hygienist and six dentists, led to three areas describing varied experience: Importance of the patient encounter and identifying intraoral signs both of which describe experiences related to the importance of the initial unstructured conversation and focused clinical assessments, and strategies for nurturing care which point to interest about care, treatment, and collaborations with medical health care providers.ConclusionsDental professionals are not able to consistently recognize patients who have, or are at high risk for OSA. During the patient encounter, is it important to determine if a patient is at risk for, or has oral signs of OSA.

Talking about sleep apnea

Do you often wake up tired, even though you have gotten a full 8 hours of sleep? Have people told you that you snore? If so, you might not be getting good quality sleep. Daytime sleepiness and snoring are 2 of the main symptoms of obstructive sleep apnea (OSA). With OSA, the back of the throat and the tongue relax and block the airway during sleep. If you cannot get a breath, you may wake up slightly to reposition yourself and clear your airway. This can happen several times a night, keeping you from getting a restful night’s sleep. It may seem odd to talk to your dentist about your sleep habits, but he or she has a strong knowledge of the oral structures that can cause OSA. Your dentist might also detect oral signs of OSA, like dry mouth (as a result of mouth breathing)1Apessos I. Andreadis D. Steiropoulos P. Tortopidis D. Angelis L. Investigation of the relationship between sleep disorders and xerostomia.Clin Oral Invest. 2020; 24: 1709-1716Google Scholar or ridges in the tongue, which could indicate forward pressure as you try to open the airway during sleep.2Rundo J.V. Obstructive sleep apnea basics.Cleve Clin J Med. 2019; 86: 2-9Google Scholar Your dentist can be a key player in treating OSA. While OSA can occur in children, it is more common in adults. The risk of having OSA increases with age. Hormones may play a role in OSA as well. Before menopause, women are less likely than men to have OSA. That risk remains lower for women who take hormone replacement therapy after menopause, but it evens out between women who do not take hormone replacement therapy and men.2Rundo J.V. Obstructive sleep apnea basics.Cleve Clin J Med. 2019; 86: 2-9Google Scholar Other factors that can increase your risk include2Rundo J.V. Obstructive sleep apnea basics.Cleve Clin J Med. 2019; 86: 2-9Google Scholar▪being overweight▪tobacco use▪alcohol use. Despite no evidence that 1 condition causes the other, people with OSA seem to be at higher risk of having a number of other conditions, including▪high blood pressure▪diabetes▪heart attack▪stroke. If you think you may have OSA, talk to your dentist. He or she can work with your physician in addressing the issue. Your physician may ask you to complete a sleep study, where you go to a medical office overnight. While you sleep, a specially trained technician will monitor your breathing and the quality of your sleep. The first steps to managing OSA might be addressing some contributing factors, including losing weight, quitting smoking, and avoiding alcohol. In addition, a continuous positive airway pressure (CPAP) machine can be used to treat OSA. The CPAP machine has a mask that covers your nose only or your nose and mouth while you sleep. It lightly blows air to help keep your airway open. It is effective for nearly 3 of 4 people.3Chang H.P. Chen Y.F. Du J.K. Obstructive sleep apnea treatments in adults.Kaohsiung J Med Sci. 2020; 36: 7-12Google Scholar However, if the CPAP machine does not work for you, your dentist may be able to make an oral appliance that can hold your tongue or jaw forward while you sleep. Throughout your treatment, your dentist will check that your oral appliance continues to fit properly. Although there are also surgical options to addressing OSA, less invasive approaches are most often the preferred first options to try. One breathing problem that can interrupt your sleep is OSA. It can leave you feeling tired during the day. Several other health concerns, such as obesity, high blood pressure, and diabetes, are associated with OSA. Behavioral changes like losing weight, quitting smoking, and avoiding alcohol can help address OSA. Many people try CPAP machines to help treat OSA. If CPAP does not work for you, another option might be an oral appliance made by your dentist.

One-year impact of bariatric surgery on echocardiographic markers of vascular disease: results from the prospective FatWest study

Abstract Background Aortic root plaque and aortic valve sclerosis (AVS) are known echocardiographic markers of atherosclerosis. Obesity increases the atherothrombotic risk, while large surgical weight loss improves the cardiovascular risk profile. It is unclear whether the severity of vascular disease associated with severe obesity changes after bariatric surgery. Purpose To assess the 1-year impact of bariatric surgery on aortic root wall thickness (ART) and AVS. Methods 91 severely obese patients (43±10 years, preoperative body mass index [BMI] 41.7±4.9 kg/m2, 55% hypertensive, 17% diabetic) underwent echocardiography preoperatively and 14 months after Roux-en-Y bypass surgery in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study. We measured the end-diastolic maximum ART and categorized AVS as mild, moderate or severe based on combined aortic cusp thickness and hyperechoic valve lesions. Left ventricular (LV) structural remodelling was assessed by LV mass and geometry. In 52 patients with clinical signs of obstructive sleep apnea, preoperative polysomnography data including apnea-hypopnea index and mean nightly oxygen saturation were evaluated. Results Preoperatively, 39% had mild-moderate AVS, and an average ART of 4.9±1.7mm (Figures 1–2). Presence of AVS at baseline was associated with higher LV mass, while ART was higher in men, older patients and increased with lower nightly oxygen saturation (r=−0.29, p&amp;lt;0.05). During the first preoperative 14 months, patients experienced a 12.9±3.8kg/m2 BMI and 0.6±1.9mm ART reduction, and AVS prevalence lowered by 45% (Figures 1 and 2). In backward stepwise multivariate regression analyses with adjustment for changes in clinical variables, LV mass and geometry, less ART reduction at 14 months was independently predicted by higher age, higher postoperative BMI and presence of AVS (R2 0.53, all p&amp;lt;0.05). Persistent AVS was associated with higher age and preoperative diabetes (R2 0.24, p&amp;lt;0.05). Conclusion In patients undergoing bariatric surgery, a reduction in echocardiographic markers of vascular disease was observed 1 year postoperatively, particularly in younger, non-diabetic patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Helse Vest Figure 1Figure 2

Prevalence and Risk of Obstructive Sleep Apnea and Association with Orofacial Symptoms in Patients Attending the Dental Clinics.

Background:Dentists have a vital role in detection of the signs and symptoms of obstructive sleep apnea (OSA) as it modifies in anatomy of orofacial structures.Aims and Objectives:This study aims to assess the prevalence of OSA risk in patients attending dental department and explore the factors related with high-risk OSA.Materials and Methods:The study was carried in the Al-Farabi Dental College, Jeddah, Saudi Arabia, on 200 consecutive dental patients from June 1, 2018, to July 31, 2019. Demographic details and the OSA risk were evaluated based on the Berlin questionnaire (Arabic version). Two qualified investigators independently did anthropometric measurements, medical and dental examination.Results:About 3.7% of males and 13.8% of females were found to be at high risk of OSA. Obese individuals almost had twice more likely chance to have OSA symptoms.Conclusion:Our findings confirm that dentists have an important role in recognizing the OSA signs and symptoms.

Obstructive sleep apnea in Norwegian adults with achondroplasia: a population-based study

BackgroundPrevious studies have found a high prevalence of obstructive sleep apnea (OSA) in children with achondroplasia, but clinical studies on this complication in adults with achondroplasia are lacking.ObjectivesThis population-based, cross-sectional study investigated the prevalence, severity, and predictive factors of OSA in Norwegian adults with achondroplasia.MethodsWe collected clinical data on 49 participants. Participants without a preexisting diagnosis of OSA had an overnight sleep registration. OSA was defined as an apnea–hypopnea index (AHI) ≥ 5 plus characteristic clinical symptoms, or AHI ≥ 15. We used the Berlin Questionnaire to assess clinical symptoms of OSA.ResultsOSA was found in 59% (29/49) of the participants (95% confidence interval 44 to 73%), of whom 59% (17/29) had moderate to severe OSA (AHI ≥ 15), and 48% (14/29) were previously undiagnosed. Variables predictive of OSA were: excessive daytime sleepiness; unrested sleep; loud snoring; observed nocturnal breathing stops; hypertension; age > 40 years; and BMI > 30 kg/m2.ConclusionOSA was highly prevalent in Norwegian adults with achondroplasia, which we believe is representative of this population worldwide. Follow-up of adults with achondroplasia should include assessment of symptoms and signs of OSA, with a low threshold for conducting an overnight sleep registration if findings suggestive of OSA are present.

Pediatric obstructive sleep apnea-Dental professionals can play a crucial role.

The significant contribution of dental professionals to the management of selected adult obstructive sleep apnea (OSA) cases is understood. Among children, it has also been suggested that dental professionals may also help screen and manage this morbidity in selected cases. It has also been noted that our understanding of pediatric OSA lags significantly behind adult OSA. During the screening process for potential pediatric OSA cases, dental professionals may be quite helpful as specific craniofacial abnormalities have been previously associated with pediatric OSA, including Class II malocclusion, vertical facial growth and maxillary transversal deficiency. As dental professionals assess children more frequently than physicians, they can help screen sleep-disordered breathing signs and symptoms using validated questionnaires. In more advanced cases, orthodontists may be leading contributors to the management of selected cases where a craniofacial involvement is suspected. Rapid maxillary expansion and mandibular or maxillary anterior repositioning devices have been proposed as managing alternatives. So far, there is no substantial evidence if these approaches can be adopted to treat OSA fully or if the reported OSA signs and symptoms improvements observed in a selected group of patients are stable long-term. Nevertheless, dentists and orthodontists' integration into a transdisciplinary team should be encouraged to play a significant role. This review discusses dentists or orthodontists' potential contribution to screen and manage selective pediatric OSA patients as part of a transdisciplinary team.

Nocturia through the menopausal transition and beyond: a narrative review.

Nocturia, defined as the act of waking to pass urine during sleeping, is a common problem in older women and is associated with significant morbidity and impairments in health-related quality of life. The aim of this review was to synthesize the current evidence regarding the incidence, impact, pathophysiology, and specific diagnostic approach of nocturia in the postmenopausal population. We searched PubMed and Web of Science databases to identify relevant studies published through June 2020. Reference lists of the reviews obtained were screened for other articles deemed pertinent by the authors. Genitourinary symptoms attributed to the menopause have been reported to occur in nearly 90% of postmenopausal women, and nocturia is one of the most common. The relative deficiency in endogenous estrogen production after the menopause is thought to exacerbate all major pathophysiological mechanisms that may underlie nocturia, including reduced bladder capacity, nocturnal polyuria, global polyuria, and sleep disorders. Diminished estrogen may induce anatomical and physiological bladder changes, contributing to a reduction in functional bladder capacity. Excess nocturnal urine production can also be provoked by estrogen depletion, either via free water-predominant diuresis by an impaired secretion of antidiuretic hormone, or a salt-predominant diuresis owing to diminished activation of the renin-angiotensin-aldosterone axis. Additionally, a relationship between the transition to menopause and impaired sleep has been described, mediated by increased incidence in vasomotor symptoms and obstructive sleep apnea signs during the menopause. Further research is necessary to better characterize and manage nocturia in postmenopausal women.

Surgical treatment outcome of obstructive sleep apnea patient with nasal cavity and oropharyngeal airway abnormality

Background: The purpose of this study was to evaluate the result of the multilevel single-stage procedure for obstructive sleep apnea (OSA) with a narrow nasal cavity and oropharyngeal, velopharyngeal airspace. A retrospective study was performed in OSA patients who underwent surgery in Khon Kaen hospital, Thailand. Methods: A retrospective study was conducted and medical records were reviewed between 2015 May and 2019 November in patients with loud snoring and having symptoms and signs of OSA, 43 patients included for evaluation history taking and physical examination by fiberoptic laryngoscope and performed multilevel single-stage procedure and evaluated clinical postoperative. Results: All patients were evaluated preoperatively by a history taking and physical examination for clinical assessment including fiberoptic laryngoscope examination. There were 3 surgical procedure, Procedure 1: 12 patients underwent Tonsillectomy with uvulopalatopharyngoplasty (27.9%), Procedure 2: 22 patients underwent Tonsillectomy with uvulopalatopharyngoplasty and inferior turbinoplasty (51.2%), Procedure 3: 9 patients underwent Tonsillectomy with uvulopalatopharyngoplasty and inferior turbinoplasty, and septoplasty (20.9%). After a 1-week post-operation 41 patients (95.3%), all (100.0%) no symptoms of OSA, and 60.9% improved their loud snoring more than 80.0%. After 3-week post-operation, 32 patients (74.4%) followed up and all (100.0%) no symptoms of OSA, 27 patients (84.4%) improved their loud snoring by more than 80.0%. Conclusion: Clinical assessment in patient with OSA is important before treatment. The Multilevel single-stage procedure is alternative choice for first treatment of OSA patients who reject continuous positive airway pressure (CPAP) or failure using CPAP. The results outcome is good for both obesity and non-obesity patients and improve clinical in OSA.

The role of dry mouth in screening sleep apnea

Purpose of the studyEffective screening questionnaires are essential for early detection of obstructive sleep apnea (OSA). The STOP-Bang questionnaire has high sensitivity but low specificity. Dry mouth is a typical...

Nocturnal hypoventilation in Down syndrome children with or without sleep apnea.

There is a high prevalence of obstructive sleep apnea (OSA) in children with Down syndrome (DS), sometimes associated with alveolar hypoventilation. To compare transcutaneous partial pressure of carbon dioxide (PtcCO2 ) and pulse oximetry (SpO2 ) in children with DS and in control children with OSA. This retrospective case-control study involved children followed in Trousseau Hospital (Paris) Sleep Center. Polysomnography (PSG) recordings and clinical files of children with DS were reviewed to identify clinical signs of OSA and comorbidities associated with DS. Controls were children who presented with OSA of ENT origin without other comorbidities (exceptions: two overweight, one obese, and three with well-controlled asthma). DS subjects and controls were matched for age and apnea hypopnea index. There were 28 children in each group. Mean PtcCO2 during sleep was significantly higher in patients with DS compared to controls (44 mm Hg vs 42 mm Hg, P = .001). Five (21%) patients with DS met the American Academy of Sleep medicine criteria for hypoventilation, compared to one (4%) in the control group. The mean PtcO2 during sleep was significantly lower in patients with DS (77 mm Hg vs 82 mm Hg, P = .003). This is the first study to compare nocturnal gas exchange in children with DS to a control group of children with similar OSA. Our data demonstrate that children with DS have increased PtcCO2 regardless of the presence of OSA and its severity. This may be due to respiratory muscle hypotonia and/or ventilatory control alteration in patients with DS.

Cardiac lipoma causing obstructive sleep apnea: A case report

Introduction. Cardiac lipomas are rare benign cardiac tumors. The symptoms they cause and the diagnosis depend on their size and location. Case Report. We report the case of a 69-year-old male, whose main symptom was progressive dyspnea on exertion and in the supine position. The diagnosis of a large subepicardial lipoma in the wall of the right atrium, causing superior vena cava compression and consecutive obstructive sleep apnea syndrom, was made using different imaging techniques. The patient underwent open heart surgery, and the tumor was extracted with no intraoperative and postoperative complications. During a 1-year follow up, he remained asymptomatic, with no clinical signs of obstructive sleep apnea after the surgery. Conclusion. When it comes to the diagnosis and treatment of obstructive sleep apnea, cardiac tumors should be considered.

Prospective Randomized Controlled Trial on the Efficacy of Continuous Positive Airway Pressure and Adaptive Servo-Ventilation in the Treatment of Chronic Complex Insomnia

BackgroundComplex insomnia, the comorbidity of chronic insomnia and obstructive sleep apnea (OSA), is a common sleep disorder, but the OSA component, whether presenting overtly or covertly, often goes unsuspected and undiagnosed due to a low index of suspicion. Among complex insomniacs, preliminary evidence demonstrates standard CPAP decreases insomnia severity. However, CPAP causes expiratory pressure intolerance or iatrogenic central apneas that may diminish its use. An advanced PAP mode—adaptive servo-ventilation (ASV)—may alleviate CPAP side-effects and yield superior outcomes. MethodsIn a single-site protocol investigating covert complex insomnia (ClinicalTrials.gov identifier: NCT02365064), a low index of suspicion for this comorbidity was confirmed by exclusion of 455 of 660 eligible patients who presented during the study period with overt OSA signs and symptoms. Ultimately, stringent inclusion/exclusion criteria to test efficacy yielded 40 adult, covert complex insomnia patients [average Insomnia Severity Index (ISI) moderate–severe 19.30 (95% CI 18.42–20.17)] who reported no definitive OSA symptoms or risks and who failed behavioral or drug therapy for an average of one decade. All 40 were diagnosed with OSA and randomized (using block randomization) to a single-blind, prospective protocol, comparing CPAP (n = 21) and ASV (n = 19). Three successive PAP titrations fine-tuned pressure settings, facilitated greater PAP use, and collected objective sleep and breathing data. Patients received 14 weeks of treatment including intensive biweekly coaching and follow-up to foster regular PAP use in order to accurately measure efficaciousness. Primary outcomes measured insomnia severity and sleep quality. Secondary outcomes measured daytime impact: OSA-induced impairment, fatigue severity, insomnia impairment, and quality of life. Performance on these seven variables was assessed using repeated measures ANCOVA to account for the multiple biweekly time points. FindingsAt intake, OSA diagnosis and OSA as a cause for insomnia were denied by all 40 patients, yet PAP significantly decreased insomnia severity scores (p = 0.021 in the primary ANCOVA analysis). To quantify effect sizes, mean intake vs endpoint analysis was conducted with ASV yielding nearly twice the effects of CPAP [−13.2 (10.7–15.7), Hedges' g = 2.50 vs −9.3 (6.3–12.3), g = 1.39], and between mode effect size was in the medium-large range 0.65. Clinically, ASV led to remission (ISI < 8) in 68% of cases compared to 24% on CPAP [Fisher's exact p = 0.010]. Two sleep quality measures in the ANCOVA analysis again demonstrated superior significant effects for ASV compared to CPAP (both p < 0.03), and pre- and post-analysis demonstrated substantial effects for both scales [ASV (g = 1.42; g = 1.81) over CPAP (g = 1.04; g = 0.75)] with medium size effects between modes (0.54, 0.51). Measures of impairment, residual objective sleep breathing events, and normalized breathing periods consistently demonstrated larger beneficial effects for ASV over CPAP. InterpretationPAP therapy was highly efficacious in decreasing insomnia severity in chronic insomnia patients with previously undiagnosed co-morbid OSA. ASV proved superior to CPAP in this first efficacy trial to compare advanced to traditional PAP modes in complex insomnia. Future research must determine the following: pathophysiological mechanisms to explain how OSA causes chronic insomnia; general population prevalence of this comorbidity; and, cost-effectiveness of ASV therapy in complex insomnia. Last, efforts to raise awareness of complex insomnia are urgently needed as patients and providers appear to disregard both overt and covert signs and symptoms of OSA in the assessment of chronic insomnia.

Association between radiotherapy and obstructive sleep apnea in cancer patients: A systematic review and meta-analysis.

e17576 Background: With the increase in survival of cancer patients, consequently, increasing their quality of life is mandatory as well. Sleep disturbances, particularly Obstructive Sleep Apnea (OSA), is one of the main complaints of cancer patients in which patients face frequent episodes of upper airway closure during sleep. Possible causes for OSA include either the specific cancer or its treatment whether sedatives, narcotics, radiotherapy, or chemotherapy, but the primary cause is still hard to prove. Our aim was to investigate the association between the occurrence of OSA and radiotherapy in cancer patients. Methods: On the 9th of September, 2018, we have searched comprehensively 12 electronic databases to retrieve relevant studies. All eligible studies that assess the association between OSA and radiotherapy in cancer patients were included in our meta-analysis. Quality assessment of included studies was done using the NIH tool for cohort and cross-sectional studies. Results: Fourteen studies met our selection criteria, eight studies were eligible for our meta-analysis. There was a positive association between the occurrence of OSA and radiotherapy in cancer patients (OR 1.16, 95% CI [0.52–2.56]; P = 0.718). OSA was noted in 103 of 181 cancer patients who received radiotherapy, yielding a remarkable overall prevalence of 63% (95% CI [0.36–0.85]; P = 0.343). A positive risk ratio for the development of OSA in cancer patients treated with radiotherapy was detected (RRs 1.27, 95% CI [0.81–2.00]; P = 0.297). The overall mean of apnea hypopnea index (AHI) for patients with OSA in six studies was 22.45. Conclusions: These findings point to a striking association between OSA risk and radiotherapy in cancer patients. Since the early recognition and management of OSA in such patients may play an important role in improving their quality of life, we recommend screening all cancer patients treated with radiation for early signs of OSA to further improve their survival.

The Presence of Snoring as Well as its Intensity Is Underreported by Women.

Women are underrepresented and thus sleep conditions are underdiagnosed at sleep clinics that evaluate sleep-disordered breathing. The most common sign of obstructive sleep apnea (OSA) is snoring; therefore, it is one of the main red flags for suspected OSA. The aim of this study is to determine whether self-reported snoring and snoring intensity by women and men correlates with snoring volume measured objectively during sleep laboratory study. Consecutive patients who were referred to a polysomnography (PSG) study in a university hospital over a 2-year period had their snoring volume quantified by means of a calibrated digital sound survey meter. Participants were given a questionnaire in which they were asked to rate the severity of their snoring. The correlation between objective snoring intensity as measured during PSG and the self-reported snoring intensity was evaluated. A total of 1,913 patients were enrolled in the study. A positive correlation was found between objectively measured snoring intensity and the intensity listed by each participant in the questionnaire. Measurement of the volume of snoring revealed that women snored as loudly as men; however, 28% of the females (189/675) considered themselves to be nonsnorers compared to only 6.9% of men (P < .05). Furthermore, 36.5% of women (69/189) who reported themselves as nonsnorers turned out to have severe or very severe snoring intensity, whereas, in contrast, only 11.7% of men (10/85) of men had this discrepancy. These findings are in concordance with the finding that fewer women quantified their snoring as very severe or severe (38.4%), significantly less than men of whom 61.5% reported their snoring to be severe or very severe. In a population of individuals referred to a PSG study, although no difference in snoring intensity was found between sexes, women tend to underreport the fact that they snore and to underestimate the loudness of their snoring. Improved awareness of this discrepancy may increase women's access to sleep laboratories, and improve diagnostic rates of sleep apnea in females.