Snoring Sleep Research Articles

Application of detail nursing in the treatment of Crouzon syndrome in children with maxillary distraction osteogenesis

Objective To investigate the effect of detail nursing in the treatment of Crouzon syndrome in children with maxillary distraction osteogenesis. Methods A total of 6 cases of Crouzon syndrome were randomly divided into study group and control group, with 3 cases each.Maxillary distraction osteogenesis was used in the control group, and detail nursing was used in the study group.The intervention effect, complications, average length of stay and satisfaction, self-rating anxiety scale(SAS), self-rating depression scale(SDS)and quality of life were compared between the two groups. Results The improvement of facial profile, protruding eye degree and sleep snoring in the study group were better than those in the control group(P<0.05). The mean length of hospitalization and complications in the study group were better than those of the control group(P<0.05). The satisfaction of the study group was higher than that of the control group(P<0.05). The SDS and SAS scores of the children and their families in the study group were lower than those in the control group(P<0.05). The quality of life of the study group was higher than that of the control group(P<0.05). Conclusions Clinical application of maxillary distraction osteogenesis in the treatment of Crouzon syndrome in children can significantly reduce the occurrence of complications in the treatment, shorten the length of hospital stay, and improve the psychological state of the children and their families. Key words: Detail care; Maxillary distraction osteogenesis; Crouzon syndrome

Attitudes, knowledge, opinions, and practice of physicians and dentists toward obstructive sleep apnea syndrome and snoring

Attitudes, knowledge, opinions, and practice of physicians and dentists toward obstructive sleep apnea syndrome and snoring

Chronic insomnia remitting after maxillomandibular advancement for mild obstructive sleep apnea: a case series

BackgroundChronic insomnia and obstructive sleep apnea are both common sleep disorders. Chronic insomnia is thought to result from stress-related physiologic hyperarousal (somatic arousal) that makes it difficult for an individual to fall or stay asleep. Obstructive sleep apnea is thought to result from obstructive respiratory events causing arousals, sleep fragmentation, and recurrent oxygen desaturation. Although the two disorders seem different, they predispose to the same long-term, stress-related illnesses, and when they occur in the same individual, each affects the other’s response to treatment; they interact. This report of three cases describes patients with both chronic insomnia and obstructive sleep apnea in whom the chronic insomnia remitted with no specific treatment following treatment of obstructive sleep apnea with maxillomandibular advancement.Case presentationsOur three Caucasians patients each presented with severe, chronic insomnia associated with somatic arousal and fatigue occurring either alone, in association with bipolar disorder, or with temporomandibular joint syndrome. Polysomnography revealed that each patient also had mild obstructive sleep apnea, despite only one snoring audibly. One patient experienced a modest improvement in her somatic arousal, insomnia severity, and fatigue with autotitrating nasal continuous positive airway pressure, but the other two did not tolerate nasal continuous positive airway pressure. None of the patients received treatment for insomnia. All three patients subsequently underwent maxillomandibular advancement to treat mild obstructive sleep apnea and experienced prolonged, complete resolution of somatic arousal, chronic insomnia, and fatigue. The patient with bipolar disorder also experienced complete remission of his symptoms of depression during the 1 year he was followed postoperatively.ConclusionsThese three cases lend support to the hypothesis that chronic insomnia and obstructive sleep apnea share a pathophysiology of chronic stress. Among patients with obstructive sleep apnea, the stress response is directed at inspiratory airflow limitation during sleep (hypopnea, snoring, and inaudible fluttering of the throat). Therefore, when chronic insomnia and obstructive sleep apnea occur in one individual, aggressive treatment of obstructive sleep apnea may lead to a reduction in chronic stress that causes the patient’s chronic insomnia to remit.

A New FDA Cleared ExpiratoryResistance Device for Treatment ofSnoring and Low Levels ofObstructive Sleep Apnea

Expiratory Positive Airway Pressure (EPAP) devices have been successfully used to treat obstructive sleep apnea and snoring. A new EPAP device called “Optipillows EPAP Mask” has recently been cleared by the FDA for treatment of snoring. The goal of this study is to describe the new EPAP mask and characterize its resistance properties. The EPAP mask consists of a nasal pillow type mask with head straps and with a proprietary micro valve on the front of it. The EPAP mask allows inhalation with minimal resistance, but with more resistance during exhalation causing the pressure to be elevated. The expiratory resistance can be adjusted according to patient’s comfort. The pressure generated by the EPAP mask was evaluated using a breathing system that simulated normal breathing pattern at rest. With the expiratory resistance fully open (minimal resistance) peak expiratory pressure generated by the mask was 1.3 to 3.2 cm H2O depending on tidal volume. A larger tidal volume generated more pressure during expiration. Peak expiratory pressure increased as the expiratory resistance was increased. The expiratory resistance range of the EPAP mask is comparable to previous EPAP devices. EPAP devices have limitations. A patient must take as long as necessary to learn to sleep comfortably with low resistance on the EPAP mask, before rushing to increase the resistance. For treatment of snoring a low level of expiratory resistance may be sufficient. The EPAP mask may also be useful for treatment of low levels of obstructive sleep apnea.

Contribution to Time and Frequency Analysis of Irregular Sleep Snoring

The purpose of this paper is to give a summary analysis of human snoring and its episodes. In particular, we consider an acute snoring. In order to extract some frequency information of snoring signal, we apply the Fast Fourier Transform (FFT), Short Time Fourier Transform (STFT) algorithms, Discrete Wavelet Technique, and Power Spectral Density (PSD). Once irregular snoring characterized, we use a Voice Activity Detection (VAD) for snoring episode detection. Furthermore, we give comparative study of three types of thresholds that can control the VAD approach, a fixed threshold, a soft threshold, and a Gaussian threshold. Next, we use a Perceptual Evaluation of Speech Quality (PESQ) method to evaluate the efficiency of the VAD. We find that VAD based on Gaussian threshold is better.

0566 Innovative Methodology and Device Detecting Head Position for the Treatment of Obstructive Sleep Apnea and Snoring

0566 Innovative Methodology and Device Detecting Head Position for the Treatment of Obstructive Sleep Apnea and Snoring

0189 Work Productivity Loss Associated with Sleep Duration, Insomnia Severity, Sleepiness, and Snoring

0189 Work Productivity Loss Associated with Sleep Duration, Insomnia Severity, Sleepiness, and Snoring

Abstract P347: Association Between Sleep Patterns and the American Heart Association Life’s Simple 7 Among Women

Introduction: The American Heart Association’s Life’s Simple 7 (AHA LS7) is a measure of cardiovascular health that evaluates seven lifestyle behaviors and clinical risk factors to track the population’s progress towards the AHA 2020 strategic goals. Sleep is an emerging lifestyle risk factor for cardiovascular disease that is not currently included in the AHA LS7. Our aim was to assess the relation of sleep with the AHA LS7 within a diverse sample of women. Hypothesis: We hypothesized that a longer sleep duration, good sleep quality, low risk for obstructive sleep apnea (OSA), and absence of insomnia and snoring would be associated with a higher global AHA LS7 score and its component scores, as measures of compliance to overall and individual AHA LS7 guidelines. Methods: Baseline data from the AHA Go Red for Women Strategically Focused Research Network cohort at Columbia University Medical Center, an ongoing prospective study, were examined (n=323, &gt;50% minority/Hispanic, mean age: 39y, range: 20-76y). Sleep was self-reported using validated questionnaires. A standardized scoring system was used to compute the global AHA LS7 score using criteria for smoking, diet, physical activity, body mass index (BMI), blood pressure (BP), total cholesterol, and fasting glucose. Women received a score of 2 (optimal), 1 (average), or 0 (poor) based on their compliance with each AHA LS7 guideline. The seven component scores were summed to create the global AHA LS7 score. T-tests, Fischer’s exact test and multivariable-adjusted regression models were used to evaluate associations between sleep and the global AHA LS7 score and its components. Results: The median global AHA LS7 score was 10; 31.3%, 33.3% and 35.3% of women had a score of 0-8 (poor), 9-10 (average), and 11-14 (optimal), respectively. Participants with sleep duration ≥7 hours, lack of insomnia and snoring, and low risk for OSA were more likely to meet ≥4 of the AHA LS7 metrics (p≤0.04). Those with sleep duration ≥7 hours, good sleep quality, no insomnia and snoring, and at low risk of OSA were more likely to meet the AHA LS7 optimal guideline for physical activity, BMI, BP, glucose, and cholesterol (p≤0.04). In multivariable-adjusted linear regression models, a lower global AHA LS7 score was associated with a higher Pittsburgh Sleep Quality Index, indicative of poorer sleep quality (β=-0.08, p=0.019), higher insomnia severity index (β=-0.05, p=0.027), and higher risk for OSA (β=-0.84, p=0.016). Conclusions: In this cohort of women, better sleep habits were associated with meeting the AHA LS7 guidelines. Our results warrant confirmation in larger prospective studies and within other population groups, but nonetheless highlight the potential importance of screening for sleep habits in conjunction with other lifestyle behaviors to identify those at risk of cardiovascular disease.

Assessment of various shapes of Soft Palate-A Retrospective Lateral Cephalometric Study

Aim: The aim of our study is to investigate the morphological variants of the soft palate among patient seeking orthodontic treatment. Materials and methods: A retrospective study was carried out in the Department of Oral Medicine and Radiology, Saveetha Dental College by analysing 100 lateral cephalometric radiographs of patients seeking orthodontic treatment from October 2016 to December 2016.The morphological variants of soft palate was assessed on Digital lateral Cephalometric radiograph and were allocated to one of the six patterns as described by You et al. Results: In our study, the frequency of rat tail shaped(type 2) soft palate(47%) was seen in highest proportion while butt like(type 3) soft palate(2%) was least in both the genders. Conclusion: The knowledge of morphological variants of the soft palate helps us to get a better understanding of velopharyngeal closure, structural and functional repair in cases of cleft palate and in the etiological study of obstructive sleep apnoea and snoring.

Obstructive sleep apnea-hypopnea syndrome and snoring disease: about 79 cases

Obstructive sleep apnea-hypopnea syndrome and snoring disease: about 79 cases

The relationship between sleep and working memory in children with neurological conditions

ABSTRACTThe objective of this study is to investigate whether sleep problems might account for the increased working memory deficits observed in school-aged children with neurological conditions. A novel, transdiagnostic approach to the investigation was chosen, and sleep is treated as a process that can potentially account for working memory difficulties across a range of neurological conditions. Prevalence estimates of sleep problems are also examined. Archival data of 237 children aged 6 to 11 years were collected from a Western Australian statewide neuropsychological service for the period 26 July 2011 to 14 January 2014. Measures of parent-reported sleep quality, snoring, and daytime sleepiness were obtained, in addition to objective measures of verbal and spatial working memory, storage capacity, and processing speed. The results of the data analysis reveal that over one third of participants reported having clinically-significant levels of sleep problems and that poor sleep quality is significantly associated with verbal working memory difficulties. This association remains after partialling out the variance contributed to performance by storage capacity and processing speed, suggesting that sleep is impacting upon an executive component of working memory. No other significant associations are observed. The results suggest that poor sleep quality is associated with an executive component of verbal (rather than spatial) working memory in children with neurological conditions. This has implications for the biological mechanisms thought to underlie the relationship between sleep and cognition in children. The results also demonstrate the clinical utility of a transdiagnostic approach when investigating sleep and cognition in children with neurological conditions.

Prevalence of obstructive sleep apnea and central apnea in Overweight and Obese children

Introduction: Obstructive sleep disordered breathing with snoring, breathing through the mouth, apnea during sleep is very common among children. Many of these children outgrow the condition as the symptoms are very mild and reduce with age. Enlargement of adenoids or tonsils can lead to tonsilolectomey and adenoidectomy, further leading to OSA. Materials and Methods: 46 obese or overweight children between the ages 3-15 years with suspected sleep apnea were subjected to vigorous physical and clinical examinations. Demographic details were noted apart from details such as sleep pattern, symptoms and snoring, daily routine, health history etc with reference to the Paediatric Sleep Questionnaire (PSQ). All the children underwent polysomnography testing, Apnea- Hypopnea Index (AHI), oxygen saturation, desaturation levels and sleep efficiency. Results: Out of the 46 children, 29 (59.2%) were boys and 17 (40.8%) were girls. The girls were older than the boys with their mean age being 8.6 in comparison to 5.9 of the boys. 31 patients were overweight and 15 were obese. Obstructive sleep apnea was observed in 18 (39.1%) patients with 9 patients each presenting with mild OSA and moderate to severe OSA. Central apnea was observed in 4 obese and 2 overweight children. AHI and desaturation levels were significantly higher among the OSA patients than in the normal range in the other patients. Conclusion: Though all snoring cases may not be OSA but most of the OSA cases are associated with snoring, it is therefore advisable that all the snoring children with other presentation of SDB be screened for OSA and central apnea.

Exact Solution of Two-Dimensional Unsteady Airflow in an Inclined Trachea

&lt;p&gt;The exact solution of the two-dimensional momentum and continuity equations governing the unsteady airflow in an inclined trachea was carried out. The oscillating airflow was described by setting one side of the boundaries be a periodic pressure function. The solution was obtained using Bromwich integral. The present results show that the inclination angle θ and gravitational force g reduces the pressure drop and has a greater effect on the velocity profile of airflow from the trachea to the lungs. Therefore, sleeping in a horizontal position may lead to negative effects for many patients. However, the inclined position is better, and it is dependent on the slope angle position taking, the benefits of gravitational force and utilizing it to improve the breathing of the body. These results are of help in breathing problems, mild sleep apnea, snoring, asthma and chronic obstructive pulmonary disease.&lt;/p&gt;

Association between sleep duration and stroke in adults

To explore the association between sleep duration and stroke in adults. Baseline data of 57 704 subjects who were aged 30-79 years and enrolled into China Kadoorie Biobank (CKB) study from Tongxiang county, Zhejiang province were analyzed. Multiple logistic regression analysis was conducted to investigate the putative association between sleep duration and stroke after adjusting for potential confounders. The mean age of the subjects was (53.15 ± 10.20) years in males and (51.72 ± .69) years in females, respectively. There were 14.43% of males and 15.30% of females reporting sleep durations ≤ 6 hours per day and 5.39% of males and 5.95% of females reporting long duration of sleep (≥ 10 hours per day). The prevalence of stroke was 0.92% in males compared with 0.44% in females. The prevalence of stroke showed a U-shaped distribution with sleep duration. Compared with 7 hours sleep duration per day, long sleep duration (≥ 10 hours per day) was associated with stroke. The odds ratios (OR) were 2.11 (95%CI: 1.32-3.37) for males and 2.13 (95%CI: 1.24-3.65) for females after adjusting for age, socioeconomic status, health behaviors and health status. No statistical significant association was found between short sleep duration and stroke. Meanwhile, frequent sleep snoring was found to be associated with stroke in females (OR=1.63, 95% CI: 1.11-2.40). Longer sleep duration was found to be associated with higher risk of stroke in both males and females. Frequent sleep snoring would increase the risk of stroke in females.

Drug-induced sleep endoscopy and simulated snoring in patients with sleep-disordered breathing: agreement of anatomic changes in the upper airway.

Drug-induced sleep endoscopy (DISE) and simulated snoring (SimS) are performed as part of the diagnostic procedure in patients with suspected sleep-disordered breathing (SDB). Despite both techniques frequently performed, they have rarely been evaluated yet in terms of agreement of the obtained results. Both diagnostic procedures were performed consecutively in 40 patients with SDB and documented identically. The obtained data were analysed with respect to the agreement of both procedure at different levels of the oropharynx as well as different patterns of obstruction and vibration. The anterior-posterior collapsibility of the soft palate/uvula revealed a moderate agreement between SimS and DISE (κ = 0.42; 95 % CI 0.22-0.63). The dorsal shift of the tongue base agreed moderate for patients with an AHI below 10 (κ = 0.47) and above 25 (κ = 0.44) between SimS ad DISE. The lateral and circular pharyngeal collapsibility at velum and tongue base level did not agree between SimS and DISE, was higher for DISE and could be partially reversed by mandibular protrusion. Collapse patterns of the soft palate and uvula can be induced by SimS and resemble the patterns induced by DISE. The dorsalization of the tongue base can be simulated to a lower extent by SimS. Lateral and circular patterns of collapse at the upper and lower oropharynx induced by DISE do not seem to be simulated by SimS. SimS seems to be an additional method to screen the collapsibility of the soft palate and uvula prior to DISE.

Abstract 438: Association between Insomnia and Use of BP-lowering Drugs in hypertensive Patients: a Cross-sectional Cohort Study

Purpose: Insomnia and short sleep duration have been associated with increased prevalence, incidence and severity of hypertension. However, the relationship between insomnia and use of different antihypertensive drug classes has not been ascertained yet. Methods: 371 hypertensive patients at their first visit in a tertiary Hypertension Outpatient Unit were enrolled. Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAY-Y2) were administered. Insomnia was defined as ISI&gt;8, depressive symptoms as BDI&gt;10, trait anxiety as STAI -Y2&gt;40. Patients with self-reported sleep apneas or snoring (n=29) or with incomplete data (n=12) were excluded. Results: Data from 330 patients were analyzed (males 51%, mean age 57±13 years, antihypertensive treatment 84%, previous CV events 9%, diabetes 7%, obesity 24%, smoking 13%, hypercholesterolemia 67%). Insomniacs (n=70, 21%) were older than non-insomniacs (60±11 vs 56±13 years, p=0.02); female gender (62 vs 46%, p=0.01), anxiety (68 vs 34%, p&lt;0.0001) and depressive symptoms (30 vs 6%, p&lt;0.0001) were more prevalent in insomniacs. Insomniacs were treated with higher number of antihypertensive drugs (1.8±1.0 vs 1.5±1.0, p=0.04) and more frequently with angiotensin-receptor-blockers (ARBs, 49 vs 31%, p=0.009) and diuretics (50 vs 28%, p=0.0007), whereas the use of other drug classes was similar. In a multiple logistic regression analysis, adjusted for cardiovascular and psychiatric variables, ARBs use (OR 2.4, CL95% 1.1-5.2), depressive symptoms (OR 3.2, CL95%1.2-8.7) and anxiety (OR 2.9, CL95%1.4-6.1) were associated with a higher probability of insomnia. Conclusions: This cross-sectional analysis suggests that ARBs use may be associated with insomnia in a cohort of hypertensive patients

Audio signal analysis in combination with noncontact bio-motion data to successfully monitor snoring.

This paper proposes a novel algorithm for automatic detection of snoring in sleep by combining non-contact bio-motion data with audio data. The audio data is captured using low end Android Smartphones in a non-clinical environment to mimic a possible user-friendly commercial product for sleep audio monitoring. However snore detection becomes a more challenging problem as the recorded signal has lower quality compared to those recorded in clinical environment. To have an accurate classification of snore/non-snore, we first compare a range of commonly used features extracted from the audio signal to find the best subject-independent features. Thereafter, bio-motion data is used to further improve the classification accuracy by identifying episodes which contain high amounts of body movements. High body movement indicates that the subject is turning, coughing or leaving the bed; during these instances snoring does not occur. The proposed algorithm is evaluated using the data recorded over 25 sessions from 7 healthy subjects who are suspected to be regular snorers. Our experimental results showed that the best subject-independent features for snore/non-snore classification are the energy of frequency band 3150-3650 Hz, zero crossing rate and 1st predictor coefficient of linear predictive coding. The proposed features yielded an average classification accuracy of 84.35%. The introduction of bio-motion data significantly improved the results by an average of 5.87% (p<;0.01). This work is the first study that successfully used bio-motion data to improve the accuracy of snore/non-snore classification.

Mandible behaviour interpretation during wakefulness, sleep and sleep‐disordered breathing

The mandible movement (MM) signal provides information on mandible activity. It can be read visually to assess sleep-wake state and respiratory events. This study aimed to assess (1) the training of independent scorers to recognize the signal specificities; (2) intrascorer reproducibility and (3) interscorer variability. MM was collected in the mid-sagittal plane of the face of 40 patients. The typical MM was extracted and classified into seven distinct pattern classes: active wakefulness (AW), quiet wakefulness or quiet sleep (QW/S), sleep snoring (SS), sleep obstructive events (OAH), sleep mixed apnea (MA), respiratory related arousal (RERA) and sleep central events (CAH). Four scorers were trained; their diagnostic capacities were assessed on two reading sessions. The intra- and interscorer agreements were assessed using Cohen's κ. Intrascorer reproducibility for the two sessions ranged from 0.68 [95% confidence interval (CI): 0.59-0.77] to 0.88 (95% CI: 0.82-0.94), while the between-scorer agreement amounted to 0.68 (95% CI: 0.65-0.71) and 0.74 (95% CI: 0.72-0.77), respectively. The overall accuracy of the scorers was 75.2% (range: 72.4-80.7%). CAH MMs were the most difficult to discern (overall accuracy 65.6%). For the two sessions, the recognition rate of abnormal respiratory events (OAH, CAH, MA and RERA) was excellent: the interscorer mean agreement was 90.7% (Cohen's κ: 0.83; 95% CI: 0.79-0.88). The discrimination of OAH, CAH, MA characteristics was good, with an interscorer agreement of 80.8% (Cohen's κ: 0.65; 95% CI: 0.62-0.68). Visual analysis of isolated MMs can successfully diagnose sleep-wake state, normal and abnormal respiration and recognize the presence of respiratory effort.

Comparison of Two Techniques in Simple Snoring and Obstructive Sleep Apnea Syndrome Patients: Palatal Implant or Uvulopalatal Flap

Obstruktif uyku apneli ve basit horlam hastalarinda uygulanan pillar palatal implant ve uvulopalatal flep uygulamalari basarilarinin polisomnografik ve subjektif metodlarla karsilastirilmasi. 117 hastanin retrospektif analizine dayanan calismamizda hastalar; Epworth skalasina, preoperatif ve postoperative polisomnografi sonuclarina ve gun icindeki uykululuk, gece horlama ve apne derecelerine gore degerlendirildiler. Calismaya dahil edilen hastalarin 59 tanesine palatal implant uygulamasi, 58 tanesine ise uvulopalatal flep cerrahisi yapildi. Ameliyat oncesi ve sonrasi datalar ve hasta memnuniyetleri karsilastirildi. Palatal implant grubunda ameliyat oncesi apne hipopne indeksi seviyelerinde anlamli bir degisiklik saptanmamasina ragmen uvulopalatal flep grubunda degisiklikler anlamli sekilde azalmisti. Hem palatal implant hem de uvulopalatal flep gruplarindaki Epworth skorlarinda anlamli dusmeler saptandi. Hafif ve orta obstruktif apne sendromlu grupta uygulanan uvulopalatal flep apne ve gunduz uykululuk halinde tercih edilebilir. Basit horlama hastalari icin ise palatal implant metodu tercih edilebilecek bir yontemdir

Abstract P102: Risk of Incident Hypertension and Diabetes Mellitus in Habitual Snorers and Sleep Apneic Individuals; The Multiethnic Study of Atherosclerosis

Background: Data regarding temporal association of sleep apnea and snoring with incident hypertension (HTN) and diabetes mellitus(DM) are limited. Hypothesis: We hypothesized that sleep apnea and snoring are associated with incident HTN and DM. Methods: Participants of age 45 - 65 years from 4 ethnicities (Asian, Hispanic, African American and Caucasian) without known cardiovascular disease from Multi Ethnic Study of Atherosclerosis (MESA) were administered a sleep questionnaire. HTN was defined as being on antihypertensive medication or blood pressure ≥140/90 mmHg. DM was defined as fasting blood glucose ≥126 mg/dL or use of antidiabetic medications. Participants with baseline HTN and DM were excluded. Cox proportional hazard models were constructed to evaluate the association of habitual snoring (defined as snoring on ≥3 days of week) and sleep apnea (self-report of diagnosis by doctor) with hypertension or diabetes. The analysis was adjusted for age, gender, race, body mass index (BMI), exercise, education. Two separate analyses were performed after excluding hypertensives and diabetics at baseline. Results: Out of 6618 participants, 6206 responded to the sleep questionnaire. There were 213 (3.4%) participants with sleep apnea and 1481 (23.8%) were categorized as habitual snorers. 98% of participants reporting sleep apnea also reported snoring. There were 1364 (38.7%) cases of incident hypertension and 619 (11.3%) incident DM over a period of 10 years. Habitual snoring and sleep apnea both were not associated with incident HTN. Habitual snoring was also not associated with incident DM. Sleep apnea was independently associated with incident DM (see table). Conclusion: Despite potential misclassification of sleep apnea due to self -report, our study shows a strong association between sleep apnea and incident DM but not with incident hypertension. The findings support future research addressing role of sleep apnea in development of DM.