Sleep Apnea Group Research Articles

Sleep Architecture in Patients With Primary Snoring and Obstructive Sleep Apnea.

Introduction:This study aimed to investigate sleep architecture in patients with primary snoring and obstructive sleep apnea.Methods:In this study, we analyzed polysomnographic data of 391 clients who referred to Sleep Disorders Research Center (SDRS). These people were classified into three groups based on their Apnea-Hypopnea Index (AHI) and snoring; control, Primary Snoring (PS), and Obstructive Sleep Apnea (OSA) group. Sleep architecture variables were then assessed in all groups.Results:The results of this study indicated a decrease in deep sleep or Slow Waves Sleep (SWS) and increase in light sleep or stage 1 of non-REM sleep (N1) in OSA patients compared with the control and PS groups. After controlling the effects of confounding factors, i.e. age and Body Mass Index (BMI) (which was performed through multiple regression analysis) significant differences were observed among the three groups with regard to N1. However, with regard to SWS, after controlling confounding variables (age and BMI), no significant difference was found among the groups.Conclusion:The results indicated that OSA, regardless of age and BMI, may increase light (N1) sleep possibly via a decline in blood oxygen saturation (SpO2 ). Such increase in N1 may be responsible for brain arousal. In addition, by controlling confounding factors (age and BMI), OSA did not affect SWS in OSA patients. However, further research is necessary to determine sleep architecture in more detail in the patients with OSA.

Magnetic resonance imaging of the upper airway in patients with quadriplegia and obstructive sleep apnea.

The aim of this study was to investigate upper airway anatomy in quadriplegics with obstructive sleep apnea. Fifty subjects were recruited from three hospitals in Australia: people with quadriplegia due to spinal cord injury and obstructive sleep apnea (n=11), able-bodied people with obstructive sleep apnea (n=18), and healthy, able-bodied controls (n=19). All underwent 3-Tesla magnetic resonance imaging of their upper airway. A subgroup (n=34) received a topical vasoconstrictor, phenylephrine and post-phenylephrine magnetic resonance imaging. Mixed-model analysis indicated no significant differences in total airway lumen volume between the three groups (P=0.086). Spinal cord injury-obstructive sleep apnea subjects had a significantly larger volume of soft palate (P=0.020) and retroglossal lateral pharyngeal walls (P=0.043) than able-bodied controls. Able-bodied-obstructive sleep apnea subjects had a smaller mandible volume than spinal cord injury-obstructive sleep apnea subjects and able-bodied control subjects (P=0.036). No differences were seen in airway length between groups when controlling for height (P=0.055). There was a marginal increase in velopharyngeal volume across groups post-phenylephrine (P=0.050), and post hoc testing indicated the difference was confined to the able-bodied-obstructive sleep apnea group (P<0.001). No other upper airway structures showed significant changes with phenylephrine administration. In conclusion, people with obstructive sleep apnea and quadriplegia do not have a structurally smaller airway than able-bodied subjects. They did, however, have greater volumes of soft palate and lateral pharyngeal walls, possibly due to greater neck fat deposition. The acute response to upper airway topical vasoconstriction was not enhanced in those with obstructive sleep apnea and quadriplegia. Changes in upper airway anatomy likely contribute to the high incidence in obstructive sleep apnea in quadriplegic subjects.

Sleep disorders in patients with erectile dysfunction.

To assess the prevalence of obstructive sleep apnoea (OSA) in men presenting with erectile dysfunction (ED) at a single centre. All men attending a specialised andrology outpatient department with a new diagnosis of ED were included in this prospective study. All patients completed three questionnaires: the International Index of Erectile Function (IIEF) and two sleep questionnaires [the Obstructive Sleep Apnoea Screening questionnaire and the Insomnia Severity Index (ISI)]. Their ED management was subsequently undertaken in accordance with local and European guidelines. An OSA diagnosis was made based on a score of ≥3 on the Obstructive Sleep Apnoea Screening questionnaire and those patients were referred for specialist management. Between February and September 2016, 129 patients with ED completed the study questionnaires. In all, 71 patients (55%) had a score of ≥3 on the Obstructive Sleep Apnoea Screening questionnaire, indicating a need for specialist sleep referral. Men who scored ≥3 on the Obstructive Sleep Apnoea Screening questionnaire were significantly older (61.4 vs 46.5years; P < 0.001) and had a significantly higher body mass index (29.4 vs 26.7kg/m2 ; P < 0.001) when compared to the control group (OSA score of <3). The sleep apnoea group (OSA score of ≥3) had significantly worse IIEF-ED scores (6.2 vs 9.1; P = 0.018) and ISI scores (7.9 vs 5.5; P = 0.061). Men presenting to the andrology clinic with ED are at significant risk of having undiagnosed sleep disorders. This has serious adverse health consequences, as well as being associated with potential dangers at work and travel. The patient compliance was high with 78% completing all three questionnaires. It is feasible to screen this population for sleep disturbance and this should be part of the ED assessment.

Pediatric sleep apnea and depressive disorders risk: A population-based 15-year retrospective cohort study.

BackgroundStudies have shown a higher risk of depressive disorders in children with sleep apnea than in those without sleep apnea. However, the association between sleep apnea and subsequent depressive disorders in the pediatric population remains undetermined. Thus, this study investigated the risk of depressive disorders among pediatric patients with sleep apnea.MethodsIn this study, the population-based National Health Insurance Research Database of Taiwan was used to identify patients who had first been diagnosed with sleep apnea between 1999 and 2013. Patients with sleep apnea who were younger than 18 years were included in the sleep apnea group. Controls (those without sleep apnea) were matched to patients with sleep apnea at a 1:10 ratio by age, sex, and index year. Patients who had baseline or inherited depressive disorders before the enrollment date were excluded. The two groups were followed up until December 31, 2013. The primary endpoint was the occurrence of one or more depressive disorders.ResultsAt the end of this study, 6,237 children had been enrolled, comprising 567 children with sleep apnea and 5,670 children without sleep apnea. During the mean follow-up period of 5.87 years, a total of 77 children (1.23%) developed one or more depressive disorders; 14 (2.46%) from the sleep apnea group and 63 (1.11%) from the control group. Kaplan–Meier analysis showed that children with sleep apnea had a significantly higher risk of depressive disorders (log-rank test, p = 0.002). After adjusting for covariates, the risk of subsequent depressive disorders among children with sleep apnea was still significantly higher (hazard ratio [HR] = 2.25; 95% confidence interval [CI] = 1.25–4.05; p = 0.006). Moreover, boys with sleep apnea had a significantly higher risk than those without sleep apnea (adjusted HR = 3.77; 95% CI, 1.82–7.54; p < 0.001). Furthermore, in sleep apnea group, children older than 12 years of age had more risk to depression (hazard ratio (HR) = 7.1833, 95% confidence interval (CI), 2.3734 to 21.7411; p = 0.0004).ConclusionsThis study found a significantly higher subsequent risk of depressive disorders in children with sleep apnea, particularly boys and those older than 12 years of age. The study findings strongly suggest that clinicians should provide psychological evaluation and supportive care for children with sleep apnea, in addition to medical treatment.

Evaluation of the association between sleep apnea and polyunsaturated fatty acids profiles in patients after percutaneous coronary intervention.

The long-term outcome is poor in patients with sleep apnea and cardiovascular disease. Polyunsaturated fatty acid (PUFA) is also known as an independent predictor for adverse clinical events. However, the profile of PUFA in sleep apnea patients with coronary artery disease (CAD) is still unclear. This study aimed to clarify the association between sleep apnea and PUFA profiles in patients with CAD. Two hundred seventy-four consecutive patients undergoing percutaneous coronary intervention (PCI) were screened for sleep apnea using nocturnal oximetry. Oxygen desaturation index down to 4% (4%ODI) ≥5 was used as an indicator of sleep apnea. Baseline characteristics, including PUFA profiles, were compared between patients with and without sleep apnea. Among 243 enrolled patients, 134 (55%) had sleep apnea. The sleep apnea group included a significantly higher rate of patients with obesity, insulin-requiring diabetes, peripheral artery disease (PAD), and a higher C-reactive protein level than the non-sleep apnea group. The sleep apnea group had a significantly lower eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio than the non-sleep apnea group (0.33 vs. 0.44, respectively, p=0.024). Additionally, EPA value and EPA/AA ratio were significantly correlated with 4%ODI (r=-0.15, p=0.028; r=-0.16, p=0.019, respectively). Results of logistic regression analysis indicated that the comorbidities of obesity, PAD, heart failure and EPA/AA ratio had a significant association with sleep apnea. Our results suggested that patients with sleep apnea who underwent PCI had a lower EPA/AA ratio than those without sleep apnea, and EPA value and EPA/AA ratio were significantly correlated with 4%ODI.

The effect of fluid overload on sleep apnoea severity in haemodialysis patients.

As in heart failure, obstructive and central sleep apnoea (OSA and CSA, respectively) are common in end-stage renal disease. Fluid overload characterises end-stage renal disease and heart failure, and in heart failure plays a role in the pathogenesis of OSA and CSA. We postulated that in end-stage renal disease patients, those with sleep apnoea would have greater fluid volume overload than those without.End-stage renal disease patients on thrice-weekly haemodialysis underwent overnight polysomnography on a nondialysis day to determine their apnoea-hypopnoea index (AHI). Extracellular fluid volume of the total body, neck, thorax and right leg were measured using bioelectrical impedance.28 patients had an AHI ≥15 (sleep apnoea group; OSA:CSA 21:7) and 12 had an AHI <15 (no sleep apnoea group). Total body extracellular fluid volume was 2.6 L greater in the sleep apnoea group than in the no sleep apnoea group (p=0.006). Neck, thorax, and leg fluid volumes were also greater in the sleep apnoea than the no sleep apnoea group (p<0.05), despite no difference in body mass index (p=0.165).These findings support a role for fluid overload in the pathogenesis of both OSA and CSA in end-stage renal disease.

Erythropoietin levels in patients with sleep apnea: a meta-analysis

Currently available data regarding the blood levels of erythropoietin (EPO) in sleep apnea (SA) patients are contradictory. The aim of the present meta-analysis was to evaluate the EPO levels in SA patients via quantitative analysis. A systematic search of Pubmed, Embase, and Web of Science were performed. EPO levels in SA group and control group were extracted from each eligible study. Weight mean difference (WMD) or Standard mean difference (SMD) with 95% confidence interval (CI) was calculated by using fixed-effects or random effect model analysis according to the degree of heterogeneity between studies. A total of 9 studies involving 407 participants were enrolled. The results indicated that EPO levels in SA group were significantly higher than that in control group (SMD 0.61, 95% CI 0.11–1.11, p = 0.016). Significantly higher EPO levels were found in patients with body mass index <30 kg/m2, and cardiovascular complications in the subsequent subgroup analysis (both p < 0.05). High blood EPO levels were found in SA patients in the present meta-analysis.

Prevalence of M75 Streptococcus pyogenes Strains Harboring slaA Gene in Patients Affected by Pediatric Obstructive Sleep Apnea Syndrome in Central Italy.

Recently we reported an association between pediatric obstructive sleep apnea syndrome (OSAS) and Group A streptococcus (GAS) sub-acute chronic tonsil colonization. We showed that GAS may contribute to tonsil hyperplasia via a streptolysin O (SLO)-dependent cysteinyl leukotrienes (CysLTs) production, which can trigger T and B cell proliferation. In the present study, we characterized the GAS strains isolated from pediatric OSAS patients in comparison with a panel of age and sex matched GAS strains unrelated to OSAS, but isolated in the same area and during the same period ranging from 2009 to 2013. We found that slaA gene, previously reported to be associated to CysLTs production pathway, was significantly associated to GAS OSAS strains. Moreover, the most numerous group (32%) of the GAS OSAS strains belonged to M75 type, and 6 out of 7 of these strains harbored the slaA gene. Multilocus Sequence Typing (MLST) experiments demonstrated that the clone emm75/ST49/ smeZ, slaA was associated to OSAS cases. In conclusion, we found an association between slaA gene and the GAS OSAS strains, and we showed that the clone emm75/ST49 harboring genes smeZ and slaA was exclusively isolated from patients affected by OSAS, thus suggesting that this genotype might be associated to the pathogenesis of OSAS, although further studies are needed to elucidate the possible role of SlaA in tonsil hypertrophy development.

The deterioration of driving performance over time in drivers with untreated sleep apnea

Sleep apnea increases risk of driving crashes when left untreated. This study examined the driving performance decrements of untreated, undiagnosed sleep apnea drivers compared with healthy controls in a monotonous highway driving simulator task. It was hypothesized that the sleep apnea group would perform worse during a driving simulator test compared with the control group. A significant group by time interaction occurred indicating that sleep apnea participants’ performance degraded more quickly over the course of the drive. In contrast with previous studies, this sleep apnea group did not include sleep disorder center patients, but rather community volunteers whose screening indicated a significant apnea/hypopnea index of 15 or greater. There may be inherent differences between patients and nonpatients with sleep apnea, as patients may have a more significant impact on their quality of life, causing them to seek treatment. Still, the results are clear that although the sleep apnea group drove similarly to the control group at the start of the drive, they are sensitive to time on task effects. These results support the need to diagnose and treat sleep apnea.

Prevalence of Sleep Disordered Breathing among Patients with Nocturia at a Urology Clinic.

We assessed the prevalence of sleep disordered breathing (SDB) and characteristics among patients who visited a urology clinic complaining of nocturia (URO group) and those who visited a sleep apnea (SA) clinic complaining of excessive daytime sleepiness (EDS) (SA group). Additionally, we evaluated the effects of continuous positive airway pressure (CPAP) therapy in the URO group patients with nocturia and SDB resistant to conventional therapy for nocturia. Questionnaires were used to assess EDS, nocturia and lower urinary tract symptoms in 34 URO group patients and 49 age-matched SA group patients. We also compared these factors in the male patients in both groups and the male and female patients in the SA group. Significant SDB was diagnosed as a 3% oxygen desaturation index (3%ODI) on pulse oximeter of >5/h. The treatment response was analyzed in six URO group patients treated with CPAP after not responding to the conventional medical treatment. SDB was found in 91.8% of the SA group patients and 70.6% of the URO group patients. The level of EDS and lower urinary tract symptoms were similar in both groups. The SA group showed higher 3%ODI values, while the frequency of urination during bedtime was higher in the URO group. The frequency of nocturnal urination was reduced after CPAP in the subjects resistant to conventional therapy. SDB is as prevalent in patients who visit a urology clinic complaining of nocturia as in those who visit a sleep apnea clinic. Patients who complains of nocturia must be assessed for SDB before starting therapy for nocturia.

Systemic prostacyclin and thromboxane production in obstructive sleep apnea

PurposeObstructive sleep apnea increases the risk of cardiovascular diseases. Alternations in prostacyclin and thromboxane concentrations and balance could constitute one of mechanisms linking sleep apnea and cardiovascular events. Thus we aimed to assess the concentrations of 6-keto-prostaglandin F1α (6-keto-PGF1α) (metabolite of prostacyclin) and thromboxane B2 (TXB2) (metabolite of thromboxane A2) in urine and blood of obstructive sleep apnea patients and controls (snoring subjects with otherwise normal polysomnogram). Material and methodsOvernight urine and morning blood samples were taken from subjects and controls at baseline and in sleep apnea group during continuous positive airway pressure (CPAP) treatment. Samples were analyzed using mass chromatography/gas spectrometry. ResultsWe analyzed data from 26 obstructive sleep apnea subjects (mean apnea–hypopnea index 45.4±17.3) and 22 well-matched controls. At baseline sleep apnea patients, when compared to controls, have higher 6-keto-PGF1α in urine (0.89±0.15 vs 0.34±0.06, p=0.01) and blood (24.49±1.54 vs 19.70±1.77, p=0.04). TXB2 levels in urine and blood were not different across groups. CPAP treatment significantly decreased 6-keto-PGF1α in urine (0.92±0.17 vs 0.22±0.10, p=0.04), but not in blood. TXB2 levels during CPAP treatment did not change significantly. ConclusionsThese results suggest augmented systemic prostacyclin production in obstructive sleep apnea patients, which potentially could constitute a protective mechanism against detrimental effects of sleep apnea.

Sleep apnea is associated with new-onset atrial fibrillation after coronary artery bypass grafting

PurposeNew-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG) remains a prevalent problem. We investigated the relationship between sleep apnea and new-onset post-CABG AF during inhospital stay. Materials and methodsWe prospectively recruited 171 patients listed for an elective CABG for an overnight sleep study. Sleep apnea was defined as apnea-hypopnea index greater than or equal to 5. ResultsAmong the 160 patients who completed the study, those in the sleep apnea group (n = 128; 80%) had larger left atrial diameter (40.4 ± 5.4 vs 38.4 ± 6.0 mm; P = .03) and left ventricular end-diastolic dimension (52.6 ± 7.9 vs 49.2 ± 6.8 mm; P = .03) than those in the non–sleep apnea group. The incidence of new-onset post-CABG AF was higher for the sleep apnea than non–sleep apnea groups (24.8% vs 9.7%; P = .07). There was 1 inhospital death and 2 patients with acute renal failure requiring dialysis after CABG in the sleep apnea group. None of the patients developed inhospital stroke. Multiple logistic regression analysis showed that sleep apnea was an independent predictor of post-CABG AF (odds ratio, 4.4; 95% confidence interval, 1.1-18.1; P = .04). ConclusionSleep apnea is prevalent in patients undergoing CABG. It increases the susceptibility to new-onset AF after CABG, probably related to atrial and ventricular remodeling.

Choking during sleep: can it be expression of arousal disorder?

BackgroundChoking during sleep may be caused by various respiratory and non-respiratory problems. ObjectiveWe aimed at documenting a new, rare cause of hallucinatory choking. MethodsWe documented the clinical and video-polysomnographic features of 11 adult patients referred for swallowing and choking during sleep. We conducted a systematic search for similar sensations in 68 consecutive adult patients with sleepwalking/sleep terrors and in 37 patients with obstructive sleep apnea. ResultsThe 11 patients with sleep-related swallowing and choking were all current or former sleepwalkers. The symptoms occurred during the first third of the night. The patients consistently reported a frequent hallucinatory feeling of swallowing an unusual object (ring, nails, pebble, chewing gum, spoon, fork, electrical cables, lizard tail, needles, brush, computer, or gas container) that blocked the upper airways during sleep, followed by attempts to unblock them by spitting or swallowing water. When monitored, the choking sensations were not stereotypic, and occurred exclusively during arousals from N3 sleep, despite normal airway patency and absence of epileptic activity. The patients demonstrated simultaneous intense adrenergic stimulation and emotional distress. Of the 68 sleepwalkers, 13% had occasional choking sensations and 4% once inhaled a fictitious object. In the sleep apnea group, choking was never the motive of referral, but 38% of patients had occasional choking sensations, and 5% once inhaled something fictitious. ConclusionAlthough insular seizure could also be discussed, these results suggest that sleep-related swallowing and choking syndrome may be a rare, specialized variant of the arousal disorders in some cases.

Effect of obstructive sleep apnoea on severity and short-term prognosis of acute coronary syndrome.

The goal of this study was to evaluate the influence of obstructive sleep apnoea on the severity and short-term prognosis of patients admitted for acute coronary syndrome. Obstructive sleep apnoea was defined as an apnoea-hypopnoea index (AHI) >15 h(-1). We evaluated the acute coronary syndrome severity (ejection fraction, Killip class, number of diseased vessels, and plasma peak troponin) and short-term prognosis (length of hospitalisation, complications and mortality). We included 213 patients with obstructive sleep apnoea (mean±sd AHI 30±14 h(-1), 61±10 years, 80% males) and 218 controls (AHI 6±4 h(-1), 57±12 years, 82% males). Patients with obstructive sleep apnoea exhibited a higher prevalence of systemic hypertension (55% versus 37%, p<0.001), higher body mass index (29±4 kg·m(-2) versus 26±4 kg·m(-2), p<0.001), and lower percentage of smokers (61% versus 71%, p=0.04). After adjusting for smoking, age, body mass index and hypertension, the plasma peak troponin levels were significantly elevated in the obstructive sleep apnoea group (831±908 ng·L(-1) versus 987±884 ng·L(-1), p=0.03) and higher AHI severity was associated with an increased number of diseased vessels (p=0.04). The mean length of stay in the coronary care unit was higher in the obstructive sleep apnoea group (p=0.03). This study indicates that obstructive sleep apnoea is related to an increase in the peak plasma troponin levels, number of diseased vessels, and length of stay in the coronary care unit.

Electrocardiographic characteristics of children with obstructive sleep apnea in a tertiary health center in Kano

Background: Obstructive sleep apnea in children may be associated with cardiovascular complications and these may be identifiable on the electrocardiogram. Some of those changes seen in adults include ventricular hypertrophy and arrhythmias; however the exact prevalence of these in children is not known. Therefore, this study seeks to characterize the electrocardiographic features in children with obstructive sleep apnea. Materials and Methods: This study reviewed 43 electrocardiograms (ECGs) of children clinically diagnosed with obstructive sleep apnea (OSAS) aged 4-14 years; their ECG parameters were compared with 43 apparently healthy controls matched for age and sex. Results: There were 21 males and 22 females with male to female ratio of 1:1. The PR interval and QRS duration were higher in the obstructive sleep apnea group in the 4-9-year age group except for the QRS and P-wave axes. While in the 10-14-year-old age group lower values in the QRS axis, PR interval, QRS duration, and T-wave axis were recorded in those with obstructive sleep apnea; however, these were not statistically significant. The mean R- and S-waves amplitude in V 4 R, V 2 , V 5 and V 6 though higher in the obstructive sleep apnea group, but were not statistically significant. Premature ventricular complex was identified in only one of the subjects, phasic sinus arrhythmia in three of the subjects, and two ECGs had premature junctional complexes. T-wave inversion involving precordial leads V 4 R to V 3 was most predominant in all the age groups Conclusion: The ECG characteristics of children with OSAS in this study were comparable to previous report in children and the prevalence of arrhythmia was also low.

Obstructive Sleep Apnea during Pregnancy and the Morbidity Outcome

Obstructive Sleep Apnea during Pregnancy and the Morbidity Outcome Background: There is an increasing concern that obstructive sleep apnea is a risk factor of a poor pregnancy outcome. Our research design used polysomnography, which gives an objective measurement in defining obstructive sleep apnea in non-high risk pregnancy. This study was carried out to measure the prevalence of obstructive sleep apnea in pregnancy and show whether obstructive sleep apnea is a risk factor of poor pregnancy outcome. Methods: A prospective cohort study had been carried out at Chiang Mai University Hospital. 50 pregnancy women who received antenatal care at Chiang-Mai University hospital were included in the study. All subjects were assessed by physical examination and polysomnography at GA 28th-32nd weeks and were followed until the end of the pregnancy to see the difference in poor pregnancy outcomes in the obstructive sleep apnea and non-obstructive sleep apnea group. Results: The prevalence of obstructive sleep apnea in pregnancy was 12%. Obstructive sleep apnea related to overall more poor pregnancy outcomes (RR=7.33(2.45-21.86), p=0.004), more preterm labor (RR=22.0(2.70-178.99), p-0.004), more preeclampsia (p=0.012). Conclusions: Obstructive sleep apnea was a high risk in pregnancy and should be screened for with multidisciplinary team cooperation, to establish the diagnosis and treatment to enhance maternal and child health

Pharyngeal airway analysis in obese and non-obese patients with obstructive sleep apnea syndrome

BackgroundSleep disorders are a group of disorders characterized by abnormalities of respiration during sleep. OSA (Obstructive Sleep Apnea) is characterized by the repetitive episodes of complete or partial collapse of the upper airway during sleep, causing a cessation or a significant reduction of airflow. MethodThe study population consisted of 30 control patients (AHI ≤ 5) events per hour, 74 patients with OSAS, including 34 Obese (BMI ≥ 27) and 40 non-obese (BMI ≤ 27). Polysomnography and measurements of 21 cephalometric variables were carried out for all patients with OSAS. ResultsObese patient with OSAS showed significant difference in following cephalometric parameters: (1) PAS (2) MPT (3) MPH (4) PNS-P (5) SAS. In addition, obese patient had longer tongue (TGL), more anteriorly displaced hyoid bones (H-VL) and more anterior displacement of mandible (G-VL) when compared with control groups. The findings of non-obese patients when compared to controls showed all the findings of obese patients and in addition to that narrow bony oropharynx were significant. Step wise regression analysis showed the significant predictors for all patients were MPH, PNS-P, bony nasopharynx (PNSBa), MPT, and palatal length (ANS-PNS) for AHI. The significant predictors for obese OSA (obstructive sleep apnea) group were MAS while for non-obese OSA group ANS-PNS was significant predictor for AHI (apnea-hypopnea index). ConclusionCraniofacial landmarks such as increase in hyoid distance, longer tongue and soft palate with increased thickness and narrowing of superior pharyngeal, oropharyngeal and hypopharyngeal airway space may be important risk factors for development of OSAS.

Validation study of REM Sleep Behavior Disorder Questionnaire – Hong Kong (RBDQ-HK) in East China

ObjectiveTo validate the REM Sleep Behavior Disorder (RBD) Questionnaire – Hong Kong (RBDQ-HK) in polysomnography (PSG)-confirmed RBD and non-RBD subjects, and to evaluate its usefulness in different clinical populations. MethodsIn total, 325 subjects (115 RBD and 210 controls) from East China were enrolled. After patients had finished the structured interview, and completed the RBDQ-HK and video-PSG test, we evaluated the reliability of RBDQ-HK (areas under the curves (AUC), the best cut-off values, factor 2 of RBDQ-HK, and overall scale) and validated the usefulness of RBDQ-HK between the Parkinson disease (PD) and obstructive sleep apnea (OSA) groups. ResultsThe best cut-off values for factor 2 of RBDQ-HK were located at 7/8 with a sensitivity of 90% and specificity of 82% (AUC=0.911), and for RBDQ-HK overall scale were located at 17 with a sensitivity of 85% and specificity of 81% (AUC=0.892) in all subjects. Both factor 2 and overall scale of RBDQ-HK are valid in all subjects (PD and OSA patients), with a higher accuracy given by factor 2 of RBDQ-HK. ConclusionsRBDQ-HK and its factor 2 are useful and validated RBD screening instruments, and could be used as a tool for screening RBD in patients with PD and OSA.

Waist-to-height ratio distinguish obstructive sleep apnea from primary snoring in obese children.

Sleep-disordered breathing is caused by the interaction of multiple factors, including tonsillar hypertrophy, retrognathia, maxillary atresia, neuromuscular abnormalities, activation of inflammatory mediator cascades, and obesity. The prevalence and severity of obesity among children and adolescents increased worldwide during recent decades and has thus become a public health concern. The aim of this study is to assess the metabolic and anthropometric changes associated with sleep-disordered breathing in obese children. Prospective assessment of prepubertal obese children followed at a pediatric endocrinology outpatient clinic that had history of frequent snoring. Children were submitted to polysomnography, measurements of body weight, height, blood pressure, neck circumference, and waist circumference. BMI, neck-to-height, and waist-to-height ratios were calculated. Laboratory tests included a complete blood count, liver function tests, lipid profile, and glucose metabolism assessment. Additionally, the presence of metabolic syndrome was assessed. Differences between obstructive sleep apnea and primary snoring groups were calculated using unpaired t-test, Fisher's exact test or Mann-Whitney test (p < 0.05). The sample included 20 children with primary snoring and nine with obstructive sleep apnea. The two groups did not differ with regard to age, gender, BMI, or BMI z-score, serum lipids, glucose metabolism, cell count, liver function, or arterial blood pressure. Anthropometric data did not differ between groups. The waist-to-height ratio was greater among children with obstructive sleep apnea, compared to those with primary snoring. In the present study, the waist-to-height ratio was greater in children with obstructive sleep apnea and, thus, could distinguish these children from those with primary snoring.

Sleep apnea increased incidence of primary central nervous system cancers: a nationwide cohort study

IntroductionObstructive sleep apnea (OSA) was associated with increased incidence of all cancers. We aimed to determine the risk for primary central nervous system (CNS) cancers in patients with sleep apnea syndrome. MethodsA total of 23,055 incident cases of newly diagnosed sleep apnea syndrome (sleep apnea group) were identified between 2000 and 2003 in the medical claims database of Taiwan’s National Health Institute (NHI) program and were matched by age and gender to patients without OSA (comparison group) in the same period. The occurrence of primary malignant CNS cancers was measured 2years after the index date over a 10-year period. ResultsThe incidence density of primary CNS cancers (per 10,000 individual-years) was 2.14 and 1.28, respectively, for the OSA and comparison groups. The overall risk for developing primary CNS cancers was significantly higher in the OSA group (adjusted hazard ratio [HR], 1.54; P=0.046) after adjusting for age, gender, and obesity, among other variables. Subgroup analysis revealed a significantly higher risk for primary brain cancers but not primary spinal cord cancers in the OSA subgroup (adjusted HR, 1.71; P=0.027). The analysis also revealed a significantly higher risk for primary CNS cancers in the insomnia with OSA subgroup (adjusted HR, 2.20; P=0.001) and in the OSA without surgical treatment subgroup (adjusted HR, 1.831; P=0.003). ConclusionsOSA, especially with insomnia, may increase the risk for primary CNS cancer development, though surgical treatment may reduce this risk in participants with OSA.