Supine Apnea-hypopnea Index Research Articles

Effect of an Anti-Supine Shirt for Treatment of Supine-related Obstructive Sleep Apnea

Background and Objective: To evaluate the effects of a t-shirt designed to prevent patients from sleeping supine (anti-supine shirt) on the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index) in patients with supine-related obstructive sleep apnea. Methods: Twenty-seven consecutive patients found to have supine-related obstructive sleep apnea on a diagnostic polysomnogram were prescribed an anti-supine shirt and then underwent a follow up polysomnogram while wearing this shirt. We then compared the amount of supine sleep time and apnea-hypopnea index between the baseline and follow-up polysomnograms. Results: A comparison between the baseline and follow-up polysomnograms revealed that there was no significant difference in total sleep time (from 297.2 ± 76.5 to 289.8 ± 101.6 min, p=0.654), but there was a significant reduction in the amount of supine sleep time while wearing the anti-supine shirt (from 149.2 ± 82.9 to 21.3 ± 52.9 min, p<0.001). This was accompanied by a 55% reduction in the total apnea-hypopnea index (from 23.8 ± 8.0 to 10.7 ± 14.7, p<0.001) Conclusions: The anti-snore shirt reduced the severity of supine-related obstructive sleep apnea by reducing the amount of time spent sleeping supine.

Magnetic resonance imaging study of peripharyngeal mucosal intensity in obstructive sleep apnea patients

Introduction Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive episodes of airway closure which usually occur in the retro-palatal region of the oropharynx. It has been known that upper airway mucosa in OSA patients is described as edematous. Recurrent injuries owing to vibration of the upper airway tissues or repetitive negative pressure may contribute to this phenomenon. On the other hand, fluid redistribution from the lower to the upper body during nocturnal recumbency could shift the fluid into neck and tissue around airway. The combination of these might contribute the occurrence or worsening of OSA by compressing the airway. Therefore, this study aims to investigate and establish simple magnetic resonance imaging (MRI) parameters, namely T2 mucous-to- masseter intensity ratio (T2MMIR), to assess the degree of tissue water content at the retro-palatal level and its relationship with sleep parameters in OSA patients. Materials and methods Twenty-seven subjects with OSA underwent polysomnography and cervical MRI with 1.5-tesla during wakefulness (age 55.0 ± 16.5 y, 77.8% male, with apnea-hypopnea index (AHI) 54.1 ± 27.6 and a body mass index (BMI) 29.4 ± 5.5) were included. On the axial T2-weighted images from the epipharynx to the oropharynx, the signal intensities for masseter muscle and peripharyngeal mucosa were measured. T2 mucous-to-masseter intensity ratio was calculated, and was used as an estimate of water content in the retro-palatal region. Pearson correlation analysis was performed to examine the correlation between peripharyngeal T2MMIR and polysomnography parameters. Results T2 mucous-to-masseter intensity ratio had moderate, positive correlation with supine AHI ( r = 0.388, P r = 0.408, P r = 0.411, P r = 0.419, P r = 0.645, P r = −0.401, P Conclusion This is the first report to establish peripharyngeal T2MMIR as one simple parameter representing peripharyngeal mucosal water contents due to inflammatory edema and/or fluid redistribution during recumbency, related to severity of OSA. This finding suggested its potential usefulness in reevaluation of change of peripharyngeal mucosa after OSA treatment to confirm its success.

Is oral appliance as efficacious as NCPAP in patients with positional-dependent obstructive sleep apnea?

Oral appliance is generally accepted to be less efficacious than nasal continuous positive airway pressure (nCPAP) for the treatment of Obstructive Sleep Apnea (OSA). However, it was hypothesized that oral appliance was as efficacious as nCPAP when positional-dependent OSA (pOSA) patients were targeted. The gender (male), Body Mass Index (BMI) (20 < BMI < 30), age (30 < age < 60), and the Apnea Hypopnea Index (AHI) (15 < AHI < 30) were considered for inclusion. Patients were defined as positional-dependent OSA when the ratio of a lateral AHI to a supine AHI was <0.5 in conjunction with a lateral AHI < 15. Subjects whose lateral sleep time less than 60 min were excluded. Twenty-six patients were recruited for oral appliance group while 32 patients were joined for nCPAP therapy. Second polysomnography was undertaken with oral appliance in place for oral appliance group, whereas it was undertaken during an overnight titration study for nCPAP patients.recruited for oral appliance group while 32 patients were joined for nCPAP therapy. Second polysomnography was undertaken with oral appliance in place for oral appliance group, whereas it was undertaken during an overnight titration study for nCPAP patients. There was no significant difference in the baseline AHI between oral appliance patients (20.92 ± 4.34) and nCPAP subjects (22.84 ± 2.65). The AHI was lowered significantly with oral appliance in place (16.05 ± 6.44, p < 0.01) similarly to the AHI of nCPAP users (20.19 ± 5.12, p < 0.01). While controlling effect of AHI at the baseline, no significant difference was observed between follow-up AHI in oral appliance subjects (4.49 ± 0.72) and the AHI obtained from nCPAP titration study (3.70 ± 0.65). These findings suggest that oral appliances are as efficacious as nCPAP in the treatment for patient with positional-dependent OSA. This information is available in discussing treatment of choice for OSA patients.

Relationship of arterial hypertension and obstructive sleep apnea syndrome

Introduction In recent years, obstructive sleep apnea (OSAS) has been defined as a cardio- metabolic disorder being considered an important risk factor for arterial hypertension. Intermitent hypoxia and sleep deprivation or defragmentation typical of OSAS, in the long term, can entail pathophysiological changes that induce the onset of this disease. The purpose of this study was to analyze the prediction of arterial hypertension in patients with OSAS. Materials and methods We examined the records of 151 patients reffering to our Sleep Laboratory Center, between February to December 2011, to have nocturnal cardio-respiratory poligraphy for the evaluation of OSAS and extracted clinical data, blood pressure measurements, blood tests, weight and height as well as Epworth Sleepiness Scale (ESS). Including criteria was cut-off value of ⩾ 15 events/h according to the Apnea Hypopnea Index (AHI). Results Ninety-nine patients (65.56%) had severe OSAS ( ⩾ 30 events/h); 100 patients (66.22%) had hypertension. Univariate analysis for categorical data has found statistic significance for: ischemic cardiopathy 32 (88.89%) vs 68 (59.13%), p 0.01; snoring 98 (68.53%) vs 2 (25%), p = 0.03; restless sleep 79 (71.82%) vs 21 (51.22%), p = 0.02. A lower tendency was seen for diabetics 29 (78.38%) vs 71 (62.28%), p = 0.07; heart failure 14 (87.5%) vs 86 (63.7%), p = 0.06; sleep suffocation 57 (73.08%) vs 43 (58.9%), p = 0.07. Receiver operating characteristics (ROC) analysis reveals statistic significance for: age (p 0.01, AUC = 0.69, cut-off = 49 years), neck circumference (p 0.01, AUC = 0.67, cut-off = 44 cm), abdominal circumference (p 0.01, AUC = 0.70, cut-off = 112 cm), BMI (p 0.01, AUC = 0.70, cut-off = 32.03 kg/m2), glycemia (p = 0.03, AUC = 0.59, cut-off = 93 mg/dl), supine AHI position (p = 0.03, AUC = 0.59, cut-off = 48 events/h), medium O2 saturation (p 0.01, AUC = 0.70, cut-off 95%), oxygen desaturation index (p 0.01, AUC = 0.63, cut-off = 17.88 ) and ESS (p = 0.03, AUC = 0.59, cut-off = 8). Multivariate analysis on logistic model on body mass index, neck circumference, age, abdominal circumference, glycemia, desaturation index, heart failure, medium O2saturation, snoring, sleep restless, sleep suffocation, supine AHI position and ESS retains only body mass index, neck circumference and age. Conclusion 1. Arterial hypertension from OSAS is significantly influenced by body mass index, neck circumference and age. 2. An increase of BMI by 1 kg/m2 would entail the risk of hypertension by 2.4%. An increase of 1 cm neck circumference would entail the risk of hypertension by 0.6%. An increase in age by 10 years would entail the risk of hypertension by 7.8%.

Anterior palatoplasty for selected mild and moderate obstructive sleep apnea: preliminary results

The aim of this prospective study was to evaluate the long-term efficacy anterior palatoplasty (AP) technique in treatment of patients with mild to moderate obstructive sleep apnea (OSA). Forty-two patients were diagnosed with mild to moderate OSA. Participants were treated with AP for mild or moderate OSA. Patients were evaluated with one night polysomnography before the surgery and 24 months after the surgery. Patients completed Epworth sleepiness scale (ESS), snoring VAS (visual analog scale) before and 24 months after the surgery. Forty two patients with a mean age of 39.2 ± 7.6 were included study. Success rate was 57.1%. Total apnea-hypopnea index (AHI) values significantly decreased after 2 years (p < 0.025). Non-REM AHI and supine AHI values significantly decreased after 2 years (p < 0.025). The oxygen desaturation index changes significantly decreased after AP (p < 0.025). Snoring VAS values significantly decreased after AP (p < 0.025). ESS scores of patients significantly decreased (p < 0.001). We believe that AP is an effective, inexpensive technique for mild and moderate OSA patients.

Effect of topical corticosteroids on allergic airway inflammation and disease severity in obstructive sleep apnoea

The incidence of sleep-related breathing disorders is correlated with lower and upper airway inflammatory diseases, such as asthma and allergic rhinitis. We hypothesized that corticosteroids treatment would lead to a greater reduction in disease severity in obstructive sleep apnoea syndrome (OSAS) patients with concomitant allergic rhinitis vs. non-allergic OSAS patients by reducing the level of inflammation in upper airway tissues. This study was performed to determine whether treatment with intranasal corticosteroids could reduce upper airway inflammation and improve sleep parameters in obstructive sleep apnoea syndrome patients with or without concomitant allergic rhinitis. Obstructive sleep apnoea syndrome patients with (n=34) or without (n=21) documented allergic rhinitis voluntarily enrolled in the study and were assessed at baseline and after corticosteroids treatment for 10-12weeks. Sleep studies were performed and biopsies were obtained from the inferior turbinate, nasopharynx, and uvula. The apnoea-hypopnoea index, sleep quality, and level of daytime alertness were determined, and immunocytochemistry was used to phenotype tissue inflammation. Standard sleep indices improved following treatment in the entire cohort of obstructive sleep apnoea syndrome patients, with greater improvement seen in the allergic rhinitis group. Allergic rhinitis patients demonstrated significantly improved O2 saturation and a lower supine apnoea-hypopnoea index score after corticosteroid treatment; similar improvements were not seen in the non-allergic rhinitis group. Eosinophilia was detected at all three sites in the allergic rhinitis group, but not in the non-allergic rhinitis group. Following treatment, fewer eosinophils and CD4 lymphocytes were documented at all three biopsy sites in the allergic group; the reduction in inflammation was less apparent in the non-allergic rhinitis group. This study has provided important molecular and clinical evidence regarding the ability of corticosteroids to reduce upper airway inflammation and improve obstructive sleep apnoea syndrome morbidity patients with concomitant allergic rhinitis.

Change in position dependency in non-responders after multilevel surgery for obstructive sleep apnea: analysis of polysomnographic parameters

This study was aimed to evaluate the change in positional dependency by analyzing polysomnographic data in non-responders who previously underwent multilevel surgery for obstructive sleep apnea. A total of 48 consecutive patients who had a <50% reduction of apnea/hypopnea index (AHI) and a postoperative AHI of ≤20 after multilevel surgery were enrolled in this study. Postoperative polysomnography (PSG) was carried out at least 6 months after surgical treatment, and both pre- and postoperative PSG data were analyzed. No significant differences were found in any of the measured polysomnographic parameters before and after multilevel surgery in non-responders. In position-dependent patients, supine AHI, non-supine AHI, supine oxygen desaturation index (ODI) and non -supine ODI did not significantly improve after surgery. However, non-supine AHI and non-supine ODI in non-position-dependent patients (NPPs) improved significantly. Ten of 15 initially NPPs had position dependency after surgery, increasing the proportion of PPs from 68.8% (33/48) to 83.3% (40/48). These results suggest that positional therapy may be a useful adjuvant therapy in non-responders with position dependency.

수면무호흡증 환자에서 수면다원검사와 두부규격방사선사진을 이용한 하악전방이동장치의 치료효과에 관한 연구

본 연구의 목적은 폐쇄성수면무호흡증 환자의 표준 수면다원검사와 두부규격방사선사진 분석을 이용하여 하악전방이동 장치의 치료 효과에 영향을 주는 요소들을 분석하는데 있다. 서울대학교치과병원 구강내과에 내원한 27명의 수면무호흡증 환자들을 대상으로 측두두부규격방사선사진 촬영 및 계측점을 이용하여 SNA, ANB, <TEX>$AH{\bot}MP$</TEX>, AH-C3, SPT, PNS-U, NAS, SOAS, MOAS, HAS 등을 분석하였으며, 하악전방이동장치를 제작하여 장치 장착 전후 수면다원검사를 시행하였다. 장치 장착 전후 수면무호흡지수, 산소포화도, 각성지수 등을 비교하였고 무호흡-저호흡지수와 두부규격방사선사진 계측치와의 상관관계를 분석하였다. 하악전방이동장치 장착 전후 전체 수면무호흡지수, 최소 산소포화도 및 전체 각성지수에서 통계적으로 유의한 개선이 있었다. 또한 장치 장착 전후 NREM수면에서 산소분압과 무호흡지수에서 통계적으로 유의한 개선이 있었던 반면 REM수면에서는 산소분압과 무호흡지수에서 통계적으로 유의한 개선이 없었다. 장치 장착 전후 수면의 단계에서 stage I의 유의한 감소, stage II와 REM수면의 유의한 증가가 관찰되었으나 stage III의 변화는 유의하지 않았다. 두부규격방사선사진 계측치중 SNA와 SOAS가 전체 수면무호흡지수와 유의한 상관관계가 관찰되었으며 NAS는 앙와위 수면무호흡지수와 유의한 상관관계가 관찰되었다. 하악전방이동장치의 효과는 환자의 ANB 각도가 클수록 유의하게 높게 나타났다. 표준 수면다원검사를 이용하여 하악전방이동장치 장착 전후를 비교해 보았을 때 하악전방이동장치는 수면무호흡증 치료에 효과적인 치료법이며 두부규격방사선사진 분석은 수면무호흡증 환자를 평가하고 치료 결과를 예측하는 데 유용할 수 있다. Objecives : The purpose of the study was to evaluate treatment outcome of mandibular advancement device(MAD) in obstructive sleep apnea (OSA) patients using full night polysomnography and cephalometry. Methods : Twenty-seven OSA patients were confirmed by full night, lab-attended polysomnography. Cephalometric examinations were conducted to obtain SNA, ANB, <TEX>$AH{\bot}MP$</TEX>, AH-C3, SPT, PNS-U, NAS, SOAS, MOAS, and HAS. Mandibular advancement devices (MADs) were fabricated and delivered for all subjects. After acclimation period of MAD, the second polysomnographic examinations were conducted in the same manner. Polysomnographic variables were compared between before and after MAD placement. Also, correlation coefficients were calculated between apnea-hypopnea index (AHI) and each item of cephalometric parameters. Results : There were significant improvements in total AHI, lowest <TEX>$SpO_2$</TEX>, and total arousal index after MAD therapy. Also, there were significant improvements in NREM <TEX>$SpO_2$</TEX> and NREM AHI, but not in REM <TEX>$SpO_2$</TEX> and REM AHI with MAD. Stratifying the sleep stage, there were significant decrease in stage I and significant increases in stage II and REM, but change in stage III was not significant. SNA and SOAS were significantly correlated with total AHI and NAS was significantly correlated with supine AHI. ANB was significantly associate with the effect of MAD. Conclusions : MAD is an effective treatment in OSA patients comparing polysomnographic variables before and after treatment. Cephalometric examination can be useful to evaluate OSA patients and predict treatment outcome of MAD.

CPAP for Obstructive Sleep Apnea in the Post-Operative Setting: An Oximetry Evaluation Study

Objective: To study the prevalence and associations of nocturnal hypoxia following surgery in PAP-treated (CPAP or bilevel pressure support) OSA patients. Patients and Methods: PAP-treated OSA patients presenting for elective surgery (n=38) between August 2007 and October 2008 underwent overnight oximetry monitoring on their prescribed PAP therapy on postoperative night one. The lowest oxygen (O2) saturation (SpO2), time spent with SpO2 <89% and the presence of sleep disordered breathing (saw-tooth oscillations) were determined from the oximetry tracings. Need for supplemental O2, nursing/ respiratory interventions, and complications were recorded. Records were reviewed for the type and duration of surgery and anesthesia, net fluid balance, narcotic / sedative use, demographics and co-morbidities. Results: Seven of 38 subjects (18.4%) spent at least 30 minutes with SpO2 <90% during the night (hypoxic group=HG) on their prescribed PAP therapy. The severity of baseline OSA (total and supine apnea-hypopnea index), pre-CPAP SpO2 (asleep on diagnostic PSG and awake evening after surgery), net fluid balance, and total IV narcotic dose were associated with the HG. Nursing interventions and addition of O2 were more common in the HG, though other adverse events were not. Review of the oximetry tracings suggested 71% of the HG, and 42% of the non-hypoxic group, had findings of uncontrolled sleep apnea. Conclusions: Despite the use of prescribed PAP therapy the night following surgery, some OSA patients become hypoxic. Postoperative oximetry monitoring may be indicated in PAP-treated OSA patients undergoing surgery

Treatment of Obstructive Sleep Apnea-Hypopnea Syndrome With Combined Uvulopalatopharyngoplasty and Midline Glossectomy: Outcomes From a 5-Year Study

The aim of this retrospective long-term follow-up study was to assess 5-year outcomes after combined uvulopalatopharyngoplasty (UPPP) and midline glossectomy surgery for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). A total of 34 subjects with OSAHS with combinatory obstructions of posterior soft palate and posterior tongue area who underwent combined midline glossectomy and UPPP were successfully followed for 5 years to examine the therapeutic effect of treatment. All subjects were of Friedman stage II or III and had major stenoses at the base of the tongue. The apnea-hypopnea index (AHI), and mean lowest S(pO(2)) were measured preoperatively and postoperatively to assess therapeutic efficacy. The mean preoperative AHI was 56.0 ± 8.4 episodes/h, while the mean lowest S(pO(2)) was 62.1 ± 10.6%. AHI and mean lowest S(pO(2)) were significantly increased and decreased, respectively, from preoperative levels at each follow-up point after surgery, up to 5 years (P < .05). The average widened pharyngeal space after surgery was 42 mm(2). At 6 months, surgery was classified as being curative in 27/34 (79.41%) of subjects, and markedly effective or effective in the remaining subjects. At 5 years, surgery was classified as being curative in 7/34 (20.59%) subjects, markedly effective or effective in 25/34 (73.53%) subjects, and not effective in 2/34 (5.88%) subjects. Five years after surgery the average body mass index for the subjects who were not cured was slightly higher than those who were cured, but the difference was not statistically significant (31.3 ± 3.7 kg/m(2) vs 29.7 ± 3.6 kg/m(2), P = .29). Subjects who were cured had lower supine AHI values than those who were not cured (2-year postoperative AHI 36.8 ± 9.2 episodes/h vs 43.8 ± 6.9 episodes/h, P = .03, 5-year post-operation AHI 32.1 ± 7.6 episodes/h vs 41.7 ± 8.2 episodes/h, P = .006). These findings suggest that combined midline glossectomy and UPPP can be an effective treatment for subjects with Friedman stage II or III OSAHS and substantial stenosis around the base of the tongue.

The sleep position trainer: a new treatment for positional obstructive sleep apnoea

Positional obstructive sleep apnoea (POSA), defined as a supine apnoea-hypopnoea index (AHI) twice or more as compared to the AHI in the other positions, occurs in 56 % of obstructive sleep apnoea patients. Positional therapy (PT) is one of several available treatment options for these patients. So far, PT has been hampered by compliance problems, mainly because of the usage of bulky masses placed in the back. In this article, we present a novel device for treating POSA patients. Patients older than 18 years with mild to moderate POSA slept with the Sleep Position Trainer (SPT), strapped to the chest, for a period of 29 ± 2 nights. SPT measures the body position and vibrates when the patient lies in supine position. Thirty-six patients were included; 31 patients (mean age, 48.1 ± 11.0 years; mean body mass index, 27.0 ± 3.7 kg/m(2)) completed the study protocol. The median percentage of supine sleeping time decreased from 49.9 % [20.4-77.3 %] to 0.0 % [range, 0.0-48.7 %] (p < 0.001). The median AHI decreased from 16.4 [6.6-29.9] to 5.2 [0.5-46.5] (p < 0.001). Fifteen patients developed an overall AHI below five. Sleep efficiency did not change significantly. Epworth Sleepiness Scale decreased significantly. Functional Outcomes of Sleep Questionnaire increased significantly. Compliance was found to be 92.7 % [62.0-100.0 %]. The Sleep Position Trainer applied for 1 month is a highly successful and well-tolerated treatment for POSA patients, which diminishes subjective sleepiness and improves sleep-related quality of life without negatively affecting sleep efficiency. Further research, especially on long-term effectiveness, is ongoing.

Exploration of the relationship between sleep position and isolated tongue base or multilevel surgery in obstructive sleep apnea

This study aimed to elucidate the role of sleep position as a confounding factor on apnea hypopnea index (AHI) and surgical success in isolated tongue base or multilevel surgery. This study was conducted using retrospective analysis of patients who underwent hyoid suspension because of obstructive sleep apnea (OSA), in the St. Lucas Andreas Hospital, Amsterdam, The Netherlands, from 2004 to 2011. Concurrent surgical treatment was documented. Sleep positions and corresponding AHIs before and after surgery were compared. A total of 130 patients were included. 94 patients underwent surgery of base of tongue and palate (either uvulopalatopharyngoplasty or Z-palatoplasty), of whom 72 underwent concurrent radiofrequent thermotherapy of the base of tongue. 36 patients underwent base of tongue surgery alone, of whom 22 underwent concurrent radiofrequent thermotherapy of the base of tongue. 65 patients either had a successful reduction in AHI or in AI. Isolated tongue base or multilevel surgery was as successful on the supine AHI as it was on the AHI in other sleeping positions. Surgery was not more successful in the group with position-dependent patients as compared with the non-position-dependent patients (P = 0.615). Successful and non-successful surgical results could not be explained by variations in percentages of supine sleep position. Sleep position is not a confounding factor on surgical outcomes in tongue base surgery. The results of isolated base of tongue or multilevel surgery in position-dependent OSA patients leave room for improvement, possibly through positional therapy.

Positional sensitivity as a confounder in diagnosis of severity of obstructive sleep apnea

The apnea-hypopnea index (AHI) is used to grade obstructive sleep apnea (OSA) into mild, moderate, and severe forms. Obstructive events are most common in the supine position. The amount of supine sleep thus influences total AHI. Our aim was to determine the prevalence of position-dependent OSA (POSA) and its relation to OSA severity classification as recommended by the American Academy of Sleep Medicine (AASM). Two hundred sixty-five subjects were recruited from primary care hypertension clinics. Whole-night respiratory recordings were performed to determine the AHI in the supine and non-supine positions, respectively. POSA was defined as supine AHI twice the non-supine AHI with supine AHI ≥5. Fifty-three percent had POSA, 22% had non-position-dependent OSA, and 25% had normal respiration. By AASM classification, 81 subjects did not have OSA, but 42% of them had some degree of obstruction when supine, and 5 subjects would have been classified as moderate-severe if they had only slept supine. Conversely, of the 53 classified as mild OSA, 30% would have changed to a more severe classification if they had exclusively slept supine. POSA was common both in subjects that by AASM classification had OSA as well as those without. The severity of OSA, as defined by AASM, could be dependent on supine time in a substantial amount of subjects.

Drug-induced sleep endoscopy in adults with sleep-disordered breathing: Technique and the VOTE Classification system

Drug-induced sleep endoscopy (DISE) offers an unique evaluation of the upper airway. After pharmacologic induction of unconscious sedation, it is possible to evaluate endoscopically the structures contributing to upper airway obstruction in sleep disordered breathing. The authors describe DISE techniques and the VOTE classification system for reporting of DISE findings. The VOTE classification focuses on the primary structures that contribute to upper airway obstruction and represents a common language to describe the patterns of obstruction during DISE. The latter can facilitate the scientific evaluation of DISE, including its role in directing treatment.

Association between Positional Dependency and Obstruction Site in Obstructive Sleep Apnea Syndrome

ObjectivesThe purpose of this study is to find out associations between positional dependency and obstructive levels based on sleep videofluoroscopy (SVF) in patients with obstructive sleep apnea syndrome (OSAS).MethodsRetrospective review was made of 91 OSAS patients who underwent polysomnography and SVF from August 2009 through June 2010. Polysomnography variables including apnea-hypopnea index (AHI), supine AHI, non-supine AHI, time spent in supine sleep position of the total sleep time and positional dependency (PD) were analyzed. Obstruction sites were evaluated as SVF variables.ResultsOf 91 patients, 65 (71.4%) were positional patients (PP) and 26 (28.6%) were non-positional patients (NPP). An analysis of polysomnography variables according to PD revealed that overall AHI, non-supine AHI and supine AHI in PP was significantly lower than that in NPP. The patients with soft palate obstruction (SP type) were more likely to have PD than the patients with tongue base obstruction (TB type; P=0.046). PD was inversely related to OSAS severity significantly (P=0.001).ConclusionThese results provide evidence that positional dependent patients may have higher success rate of soft palate OSA surgery alone than non-positional dependent patients. Although PD may be associated with obstruction site, PD only itself may not be useful in planning surgical treatment for OSAS.

Evaluation of a new simple treatment for positional sleep apnoea patients

Obstructive sleep apnoea syndrome is a common clinical problem. Positional sleep apnoea syndrome, defined as having a supine apnoea-hypopnoea index of twice or more compared to the apnoea-hypopnoea index in the other positions, occurs in 56% of obstructive sleep apnoea patients. A limited number of studies focus on decreasing the severity of sleep apnoea by influencing sleep position. In these studies an object was strapped to the back (tennis balls, squash balls, special vests), preventing patients from sleeping in the supine position. Frequently, this was not successful due to arousals while turning from one lateral position to the other, thereby disturbing sleep architecture and sleep quality. We developed a new neck-worn device which influences sleep position by offering a vibration when in supine position, without significantly reducing total sleep time. Thirty patients with positional sleep apnoea were included in this study. No side effects were reported. The mean apnoea-hypopnoea index dropped from 27.7 ± 2.4 to 12.8 ± 2.2. Seven patients developed an overall apnoea-hypopnoea index below 5 when using the device in ON modus. We expect that positional therapy with such a device can be applied as a single treatment in many patients with mild to moderate position-dependent obstructive sleep apnoea, while in patients with a more severe obstructive sleep apnoea such a device could be used in combination with other treatment modalities.

Comparison of Minimally Invasive Techniques in Tongue Base Surgery in Patients with Obstructive Sleep Apnea

To compare the effectiveness and morbidity of 3 microinvasive tongue base surgical procedures combined with uvulopalatopharyngoplasty (UPPP) in supine-dependent obstructive sleep apnea (OSA) patients. A prospective, randomized clinical study. A tertiary referral center. Fifty OSA patients were randomly advised to undergo UPPP combined with low-temperature bipolar radiofrequency (group 1), submucosal minimally invasive lingual excision with radiofrequency (SMILE-R; group 2), or submucosal minimally invasive lingual excision with a harmonic scalpel (SMILE-H; group 3). The Epworth Sleepiness Scale, the visual analog scale (VAS) for snoring, the pre- and postoperative 3-month polysomnography (PSG) findings, and the decrease in tongue volume using magnetic resonance imaging (MRI) were compared. The operation times, the postoperative pain VAS score, the analgesic requirement, and the time in commencing a normal diet were compared in the 3 groups. The decrease in apnea-hypopnea index (AHI) and supine AHI values at the postoperative 3-month time point was significant in group 2 (P < .05). The decrease in tongue volume at the 3-month postoperative time point according to the MRI evaluations was higher in groups 1 and 2 (P < .05). In the subjective comparison of effectiveness, there was no significant difference. The operation time was significantly lower in group 3. In the assessment of postoperative pain, no significant difference was found between the groups. When the PSG findings and MRI were evaluated, UPPP + SMILE-R were found to be more effective. No significant difference was found between the 3 techniques when morbidity and complications were compared.

Comparison of the cephalometric posterior airway analysis with endoscopic tongue base hypertrophy findings in patients with obstructive sleep apnea syndrome

This study aims to identify the contribution of the cephalometric investigation in the soft tissue evaluation in patients with obstructive sleep apnea syndrome (OSAS). The clininical data of 300 patients (191 males, 109 females; mean age 48.3±9.9 years; range 24 to 76 years) diagnosed with OSAS in our clinic between January 2009 and May 2010 were retrospectively evaluated. All subjects in the test group had overnight polysomnography, cephalometry and flexible endoscopic examination. Distance and angle calculations were performed with the previously determined landmarks on cephalograms. The degrees of tongue base hypertrophy were recorded in the flexible endoscopic examinations. Posterior airway space calculations were compared with tongue base hypertrophy findings by using chi-square analysis. The mean apnea hypopnea index (AHI) score and the mean supine AHI were calculated to be 24.7 and 26.5, respectively. According to the endoscopic examination, the tongue base hypertrophy was grade 0 in 20 patients (6.6%), grade 1 in 60 patients (20%), grade 2 in 122 (40.6%) patients and grade 3 in 98 (32.6%) patients. The posterior airway space value calculated to be 4 mm at minimum and 15 mm at maximum. When the cephalometric measurements of the patients were compared with the magnitude of tongue base hypertrophy detected by endoscopic examination, it was determined that the relationship with the size of the tongue base decreases as the posterior airway space increases. Cephalometric investigation, which is known as adjunct technique in the soft tissue evaluation, does not provide adequate information in the evaluation of the OSAS patients.

Patients with positional versus nonpositional obstructive sleep apnea: a retrospective study of risk factors associated with apnea-hypopnea severity

The aim of this study was to investigate the differences in and risk factors for positional and nonpositional obstructive sleep apnea (OSA). One hundred twenty-three nonpositional (supine apnea-hypopnea index [AHI] < 2 times the lateral AHI), 218 positional (supine AHI ≥ 2 times the lateral AHI), and 109 age-, gender-, and BMI-matched patients with positional OSA performed 2 nights of sleep study. Gender, age, BMI, and percentage of time in supine position, and percentage of time snoring louder than 40 dB were evaluated as risk factors. Both unmatched positional and matched positional patients had less severe overall AHI values, higher mean SpO(2), lower percentage time SpO(2) less than 90%, and lower percentage of time snoring when compared with the nonpositional group. Overall AHI scores were associated with increasing age and percentage of time snoring for positional and nonpositional groups. However, BMIs were associated with the overall AHI only in the nonpositional group. The influence of position on OSA severity may contribute to the choice and prognosis of treatment and may represent 2 distinct groups with probable anatomic differences.

Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients

The aim of the study was to investigate treatment outcome of mandibular advancement devices (MADs) for positional and nonpositional obstructive sleep apnea (OSA). Forty-two positional (supine apnea-hypopnea index [AHI] > or = 2 times lateral AHI) and 30 nonpositional (supine AHI < 2 times lateral AHI) OSA patients performed 2-nights of sleep study before and after insertion of MADs. The decreases in apnea severity based on a reduction in the overall and supine AHI values after MADs therapy were significantly greater for the positional OSA than nonpositional OSA group. A multiple linear regression analysis showed that decrease in overall AHI was significantly associated with being in the positional group (standardized coefficient = 0.505). Age, body mass index, gender, and time in supine position during sleep did not show significant associations with decrease in overall AHI after MAD therapy. Our data suggest that MADs are more effective in positional OSA than nonpositional OSA patients.