Underwent Polysomnography Testing Research Articles

A study to see association between vitamin d level and obstructive sleep apnea

Obese patients have low levels of serum 25-hydroxy vitamin D due to feedback inhibition of hepatic synthesis of the metabolite by increased circulating 1,25(OH) vitamin D. Obese individuals have more physical activity which limits their exposure to sunlight resulting in lower levels of 25(OH)D. Sleep fragmentation in OSA leads to daytime drowsiness, fatigue and hence decreased outdoor activity contributing to the same. Hence, OSA aggravates obesity and obesity aggravates OSA creating a vicious cycle and together contribute to the depletion of serum vitamin D level.Patients attending the special clinic of sleep were included in the study and were screened using STOP-BANG scoring system for OSA Patients with score of >2 were included in the study and further underwent polysomnography test. Among the study population, cases had an apnea-hypopnea index (AHI) > 5 in polysomnography and controls had AHI <5. Controls were further matched for age, sex and BMI with cases. Vitamin D Level was tested in both cases and controls for comparison using arterial blood sample.Total ninety-three patients were included in the study, out of whom 59 were cases which formed the OSA group, had mean age of 48.02 ±8.435 years, mean body mass index (BMI) 33.73 ±7.48 kg/m2, mean neck circumference 37.8 cm ±5.08 Mean vitamin D level in the case and control was 21.02 ± 7.27 and 24.48 ± 6.92 respectively with a p value < 0.05, with a negative correlation of AHI with serum vitamin D level (p< 0.001, r = −0.286).Different mechanisms play a role in OSA patients affecting. This study shows inverse relationship between vitamin D level and AHI (apnea-hypopnea index) which was statistically significant and vitamin D level was higher in controls than cases. Thus it can be said that 25(OH)D levels and OSAS are related, but it is difficult to establish a direct causal association between them.

Effect of combined use of tolterodine and continuous positive airway pressure vs continuous positive airway pressure only treatment on overactive bladder symptoms in women with moderate-to-severe obstructive sleep apnea syndrome: a randomized clinical trial.

Obstructive sleep apnea syndrome is associated with urological symptoms, including overactive bladder (OAB). This study aims to determine whether combined tolterodine and CPAP therapies are more effective for patients with OSAS than CPAP treatment only. Women who underwent polysomnography test and were diagnosed with moderate-to-severe OSAS with apnea-hypopnea index (AHI) were included in the study. Data were collected on AHI, OAB awareness-8-item tool (OAB-V8), incontinence questionnaire-urinary incontinence short form (ICIQ-UI-SF), total daily urine volume (DUV), and the Benefit, satisfaction with treatment and willingness (BSW) tool. Eligible patients were randomized to receive either CPAP treatment only or combined CPAP and tolterodine treatment for 3 months. Among 103 participants, a total of 60 were included. Patients in both treatment arms showed significant improvements in OAB-V8, ICIQ-UI-SF, and total DUV compared to their baseline. The mean OAB-V8 was 15.7 at baseline and 5.6 at 3 months for the combined treatment arm and 16.6 and 7.6 at 3 months for the CPAP group only (mean baseline-adjusted between-group difference -1.1 [95% CI, -12.3 to -7.4]; p < 0.001). The improvement in the mean ICIQ-UI-SF was also statistically more significant in the combined therapy group than in the CPAP only arm (mean baseline-adjusted between-group difference -3.27 [95% CI, -4.6 to -1.59]; p < 0.001). No statistical significance was found in the improvement of total DUV between the groups. In this study, combined use of tolterodine with CPAP provides beneficial effects to CPAP treatment only regarding OAB symptoms. Further research is required to confirm these findings in a large cohort.

Abstract 10101: Obstructive Sleep Apnea Syndrome Attenuates HDL Functions

Background: High density lipoprotein (HDL) exerts anti-atherogenic functions including cholesterol efflux capacity and anti-oxidative activities. Obstructive sleep apnea (OSA) is associated with increased risk for cardiovascular disease via inflammation and oxidative stress. However, HDL functions in patients with OSA remains to be elucidated. We therefore investigated cholesterol efflux capacity and anti-oxidative activity in order to assess whether OSA would affect HDL functions. Methods and Results: A total of 116 OSA patients who underwent polysomnography tests from April 2017 to April 2019 were enrolled in this cross-sectional study. Blood samples were obtained at the next day of polysomnography test. We measured cholesterol efflux capacity in OSA patients and found that CEC was significantly lower in SAS groups (apnea hypoxia index (AHI)≧5) compared with non-SAS groups.(AHI&lt;5)(1.06±0.15 vs 0.96±0.14 p=0.01) Among OSA parameters, minimal pulse oxygen saturation(minSpO2), a highly correlated parameter with AHI (r=-0.76 p&lt;0.001), was found to be positively correlated with CEC (r=0.19 p=0.034) In multiple regression analysis , CEC was associated with minSpO2 independently of several clinical parameters including BMI, age, PON1, smoking, hypertension, dyslipidemia, diabetes mellitus, TC, logTG, HDL-C.(β=0.25 p=0.02) Further, CEC was inversely correlated with log hsCRP adjusted with the same model.(β=-0.25 p=0.01).With regard to anti-oxidative function, assessed by AAPH and PON1 activity, AHI or min SpO2 did not correlate with anti-oxidaitive activity by AAPH or PON1 activity. Conclusion: Obstructive sleep apnea syndrome attenuated cholesterol efflux capacity. Min SpO2 may be a good predictor of HDL dysfunction in OSA.

Anxiety and depression in patients with chronic obstructive pulmonary disease and obstructive sleep apnea: the overlap syndrome.

Psychological symptoms are increasingly being noted in patients with chronic diseases. Currently, little evidence is available on the mental health of patients with overlap syndrome (OVS, chronic obstructive pulmonary disease plus obstructive sleep apnea). This study aimed to describe the prevalence and identify influencing factors of anxiety and depression in patients with OVS. We recruited patients admitted for chronic obstructive pulmonary disease (COPD) from July 2018 to July 2019 who also underwent polysomnography tests to assess obstructive sleep apnea (OSA). COPD patients who had an apnea-hypopnea index (AHI) ≥ 5/h were defined as OVS. COPD patients who had an AHI < 5/h were identified as pure COPD. Questionnaires were administered to evaluate depression and anxiety in all subjects. We compared the differences in scores between patients with OVS and pure COPD. Two hundred and fifty-two patients were included, 180 (71%) patients had OVS, while only 72 patients had pure COPD. In the OVS group, 54% of the patients had depression, and 77% of the patients had anxiety. We found that patients with OVS had higher anxiety (8.00 (4.00, 10.00) vs. 6.00 (3.00, 9.00), p = 0.018) and depression (8.00 (4.00, 10.00) vs. 5.50 (2.25, 10.00), p = 0.022) scores than patients with pure COPD. A higher proportion of patients with hypertension (41% vs. 21%) and coronary heart disease (14% vs. 4%) were found in the OVS group. Chest pain, COPD Assessment Test (CAT) score, and OVS were independent risk factors for depression (P<0.05). A positive correlation was shown between anxiety and depression (r=0.638, p < 0.001). Anxiety and depression were more severe in patients with OVS than in patients with pure COPD. More attention should be paid to the mental health of OVS patients. ClinicalTrials.gov; URL: www. gov . NO.:NCT03182309. Registered on June 9, 2017; https://clinicaltrials.gov/ct2/show/NCT03182309?term=NCT+03182309&draw=2&rank=1.

The influence of opioids and nonopioid central nervous system active medications on central sleep apnea: a case-control study.

Opioids are known to contribute to central sleep apnea (CSA), but the influence of nonopioid central nervous system active medications (CNSAMs) on CSA remains unclear. In light of the hypothesized impact of nonopioid CNSAMs on respiration, we examined the relationships between the use of opioids only, nonopioid CNSAMs alone, and their combination with CSA. Among all adults who underwent polysomnography testing at the University of Michigan's sleep laboratory between 2013 and 2018 (n = 10,606), we identified 212 CSA cases and randomly selected 300 controls. Participants were classified into four groups based on their medication use: opioids alone, nonopioid CNSAMs only, their combination, and a reference group, including those who did not use any of these medications. We defined CSA as a binary outcome and as a continuous variable using central apnea index data. Logistic and linear regression were used to examine associations between medication use, CSA diagnosis, and central apnea index. Study participants included 58% men, and mean age was 50 (± 14 standard deviation years. Nearly half of the study participants did not use opioids or nonopioid CNSAMs, 6% used opioids alone, 27% nonopioid CNSAMs alone, and 16% used a combination of these medications. In adjusted analyses, opioids-only users had a nearly twofold increase in CSA odds, whereas those who used a combination of opioids and nonopioid CNSAMs had fivefold higher odds of CSA relative to the reference group. In contrast, the use of nonopioid CNSAMs alone had protective associations with CSA. This report showed increased odds of CSA, particularly among patients with sleep complaints who were prescribed opioids in combination with nonopioid CNSAMs compared with those who did not use any of these medications.

House Dust Mite Related Allergic Rhinitis and REM Sleep Disturbances.

Sleep disturbances are common in patients with allergic rhinitis (AR). Perennial allergens like house dust mites (HDM) are difficult to avoid and have nocturnal impacts on the respiratory system and Quality of Life (QOL). The Rapid Eye Movement (REM) sleep stage is associated with memory, cognition, dreams, and overall restfulness, which can be impaired in AR patients with Sleep Disordered Breathing (SDB) even when normal all-night apnea-hypopnea (AHI) or respiratory disturbance (RDI) indices are noted on polysomnography (PSG). We hypothesized that AR HDM allergen positive patients would show REM-specific SDB reflected in their objectively elevated REM-RDI values. This retrospective analysis of 100 patients included 47 with HDM positive allergy testing. All patients underwent PSG testing calculating the RDI during REM. Multivariate logistic regression models evaluated relationships between allergic statuses and sleep parameters while controlling for potential confounders. Compared with allergy negative patients, HDM allergen positive patients were significantly more likely (OR 4.29, 95%CI 1.26-14.62) to have a REM-RDI in the moderate/severe range (≥15events/h). Our study highlighted the significance of respiratory allergies to HDM in patients with SDB. We revealed a significant relationship between HDM allergen positivity and SDB characterized by elevated REM-RDI regardless of all-night AHI, RDI, or REM-AHI values. Clinical implications of knowing about disturbed REM and/or HDM allergenicity include better preparation, treatment, outcomes, and QOL for allergic, SDB, and upper airway surgery patients.

0723 Associations Between Opioids, Non-Opioids and Central Sleep Apnea: A Case-Control Study

Abstract Introduction Opioids are known to contribute to central sleep apnea (CSA), as they depress responsiveness to carbon dioxide and hypoxia. However, the role of non-opioid medications (antihistamines, myorelaxants, neuroleptics, antidepressants, and hypnotics) in CSA remains unclear. Given the hypothesized impact of non-opioids on the central nervous system, we examined associations between opioid and non-opioid medications and CSA. Methods Among all adults who underwent polysomnography testing at the University of Michigan’s Sleep Center between 2013-2018 (n=10,479), we identified 105 cases of CSA. Of these patients, we randomly selected 300 controls. Demographic and health characteristics, use of medications were obtained from medical charts. We classified study participants into three categories based on medication use: non-opioids only, opioids alone or in combination with non-opioids, and none. CSA was defined as a binary outcome using polysomnographic criteria as per the International Classification of Sleep Disorders-Third Edition. We used logistic regression to examine associations between medication use and CSA. Results Among participants, male:female ratio was 1:1 with a mean age of 49 (±14.3 SD) years. Opioid use alone was rare (4%), but more common in combination with non-opioids (17%), while the exclusive use of non-opioids was found among 38%. In adjusted analyses for age and sex, those who used non-opioid alone were less likely to have a CSA diagnosis (OR=0.88, (95% CI 0.5-1.6); however, the use of opioids (alone or in combination with non-opioids) was associated with a 4-fold higher odds of CSA. Conclusion These data suggest that non-opioids have a protective influence on CSA. Conversely, opioids, alone, or in combination with non-opioids, were associated with increased CSA risk, that may be attributed to opioids alone, or to opioids and non-opioids interactions. However, as opioids were mostly co-prescribed with non-opioids, the sole effect of opioids from the synergistic effect with non-opioids are difficult to disentangle. Support Dr. Gavidia was supported by a T32 Post-Doctoral Fellowship in Neuroscience NIH/NINDS T32 NS 007222

Performance of the STOP-Bang in the Detection of OSA, a Brazilian study.

Assess the performance of the Stop-Bang questionnaire in Brazilian patients for the screening of OSA. A cross-sectional study with historical and consecutive analysis of all patients who underwent polysomnography tests in the Sleeping Sector of the Ear, Nose, and Throat, and Cardiopulmonary (LabSono) Departments of the Gaffrée and Guinle University Hospital (HUGG), from 10/17/2011 to 04/16/2015. The variables relating to the SB questionnaire were collected by direct research from the medical records of patients. In a series of 83 patients, we found that our sample were similar to other studies conducted in specialized centers of Sleep Medicine, and the population presented characteristics similar to those found by studies in Latin America. Men and women only behaved similarly in relation to the presence of Observed Apnea and body mass index, with a predominance of women who had systemic hypertension over men. In our study, the discriminatory value of 4 or more positive answers to the questionnaire had the best performance in identifying patients with an hourly Apnea-Hypopnea Index greater than 15/h, with a sensitivity of 72.97% (55.9% - 86.2%) and specificity of 67.39% (52.0% - 80.5%). The Stop-Bang questionnaire proved to be, in our sample, a good screening instrument for diagnosing OSA Syndrome.

THREE MONTH FOLLOW UP OF THE EFFECTS OF CONTINUOUS POSITIVE PRESSURE DURING SLEEP (CPAP) ON THE VALUE OF GLYCATED HEMOGLOBIN HBA1C AND GLYCOREGULATION IN OBESE DIABETIC PATIENTS WITH CONFIRMED SEVERE OPSTRUCTIVE SLEEP APNEA

Obstructive sleep apnea (OSA) is a serious disorder of breathing during sleep characterized by complete or partial interruption of breathing during sleep for 10 seconds and longer. In this prospective longitudinal clinical study in obese patients with diabetes mellitus type II which is determined by polysomnography heavy degree of OSA is accompanied by the application of positive pressure during sleep in the course of three months and evaluated its impact on the value of glycated hemoglobin HbA1c as an indicator of long-term glycoregulation. A prospective clinical study in the quarterly monitoring included 98 patients (64 men and 34 women), who, after clinical, laboratory, spirometry and diffusion examination of lung function, made of respiratory gas analysis of arterial blood gases in rest, tests Epworth sleepiness scale, underwent polysomnography testing on Philips Respironics Alice PDX device. Out of 98 obese patients suffering from diabetes mellitus type II and heavy degree OSA, average age 50.1, 23 of them were randomized in two groups: experimental - 11 patients with an average HbA1c of 9.9 %, the average BMI 37.1 and average AHI index of 36.7 (31 to 59) who used CPAP during sleep, and control group of 12 patients, with an average HbA1c was 9.1 %, average BMI 39.3 and AHI index was 39.7 (31 to 62). After three-month of using CPAP, the control of HbA1c in both groups was performed. Average HbA1c in the experimental group decreased with statistical significances (p < 0.01) from 9.9 % to 6.7 %, compared to the control group patients with no significant changes. The results of this study indicated that in obese patients with diabetes mellitus II and severe OSA, longterm glycoregulation can be significantly improved using the CPAP during sleep.

Polysomnography Reference Values in Healthy Newborns.

Polysomnography (PSG) is increasingly used in the assessment of infants. Newborn PSG reference values based on recent standardization are not available. This study provides reference values for PSG variables in healthy newborn infants. Cross-sectional study of normal term newborn infants using standardized PSG collection and American Academy of Sleep Medicine interpretation criteria. Thirty infants born between 37 and 42 weeks gestation underwent PSG testing before 30 days of age (mean 19.6 days). The infants had a mean sleep efficiency of 71% with average proportions of transitional, NREM and REM sleep estimated at 16.1%, 43.3% and 40.6% respectively. Mean arousal index was 14.7 events/h with respiratory arousal index of 1.2 events/h. Mean apnea-hypopnea index (AHI) was 14.9 events/h. Central, obstructive, and mixed apnea indices were 5.4, 2.3, and 1.2 events/h respectively. Mean oxygen saturation in sleep was 97.9% with a nadir of 84.4%. Mean end tidal CO2 was 35.4 mmHg with an average of 6.2% of sleep time spent above end-tidal CO2 45 mmHg and 0.6% above 50 mmHg. The sleep efficiency was significantly lower and the AHI was significantly higher compared to healthy children older than 1 year. The AHI was also higher than reported in healthy infants older than 1 month. These findings suggest current severity classifications of sleep apnea may not apply to newborn infants.

The challenge of identifying family medicine patients with obstructive sleep apnea: addressing the question of gender inequality.

The purpose of this study was to examine the sleep characteristics, metabolic syndrome disease and likelihood of obstructive sleep apnea in a sample of older, family medicine patients previously unsuspected for sleep apnea. A total of 295 participants, minimum age 45, 58.7% women, were recruited from two family medicine clinics. None previously had been referred for sleep apnea testing. All participants completed a sleep symptom questionnaire and were offered an overnight polysomnography study, regardless of questionnaire results. 171 followed through with the sleep laboratory component of the study. Health data regarding metabolic syndrome disease (hypertension, hyperlipidemia, diabetes and obesity) were gathered by chart review. Overall, more women than men enrolled in the study and pursued laboratory testing. Of those who underwent polysomnography testing, 75% of the women and 85% of the men were diagnosed with sleep apnea based on an apnea/hypopnea index of 10 or greater. Women and men had similar polysomnography indices, the majority being in the moderate to severe ranges. In those with OSA diagnosis, gender differences in sleep symptom severity were not significant. We conclude that greater gender equality in sleep apnea rates can be achieved in family practice if sleep apnea assessments are widely offered to older patients.

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.

Usefulness of cerebral NIRS in detecting the effects of pediatric sleep apnea

Children with sleep apnea have increased morbidity if the sleep apnea is untreated. Polysomnography (PSG) is used to detect sleep apnea, but in children, there are technical difficulties that make the diagnosis more difficult. Cerebral near infrared spectroscopy (NIRS) has the ability to detect tissue hypoxia by measuring regional oxygen saturation (rSO2 ). We hypothesized that when used as an adjunct to PSG testing, cerebral NIRS would better detect the effects of sleep apnea in children than arterial pulse oximetry (SpO2 ). Specifically, we aimed to show that the apnea/hypopnea index (AHI) calculated with rSO2 from the NIRS would be greater than that calculated with SpO2 . Forty-seven patients under 18 years of age who underwent PSG testing for sleep apnea were evaluated. Cerebral NIRS was utilized in addition to PSG. The AHI was calculated using SpO2 and compared to the AHI calculated using the rSO2 . A pediatric pulmonologist who was unaware of the NIRS data evaluated each patient for sleep apnea. Data are median (interquartile range). The median AHI(rSO2 ) was 2.4(1.2,5.1), significantly greater (P < 0.0001) than the AHI(SpO2 ) of 0.7(0.4,1.2). Four patients were diagnosed with sleep apnea; however, only one had an AHI(SpO2 ) ≥ 5, a typical threshold for the diagnosis of sleep apnea. All 4 subjects had an AHI(rSO2 ) ≥ 5 but 10 patients without sleep apnea had a value ≥5. The sensitivity and specificity for using the AHI(rSO2 ) to diagnose sleep apnea was 100% and 76.7%, respectively. Consistent with the ability of NIRS to detect tissue hypoxia, we found that the AHI calculated with rSO2 was greater than that using SpO2 . We conclude that NIRS has potential as a valuable adjunct to PSG in evaluating patients for sleep apnea and warrants further investigation for this purpose.

Diagnostic values of serum orexin-A levels in children with obstructive sleep apnea-hypopnea syndrome

Currently people regard polysomnography (PSG) monitoring as the golden standard for diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) in children. However, due to the high cost, time and manpower consuming, PSG is not applicable to epidemiological investigation and clinical screening, especially not suitable for child patients and remote hospitals in Xinjiang. Therefore, it is of important clinical significance to find out a simple method (e.g. a kind of serum index) to primarily screen out suspicious patients for early diagnosis and treatment. The present study was conducted to assess the clinical usefulness of the measurement of orexin-A concentration in serum as a diagnostic predictor to screen patients with OSAHS in children. Serum orexin-A concentration was measured with enzyme immunoassay (EIA) kit in 60 patient with snoring before performing polysomnography (PSG). Subsequently all the subjects underwent PSG test. Forty subjects were diagnosed as having OSAHS, and twenty subjects had no OSAHS. These 20 non-OSAHS subjects served as controls. Compared with the PSG results the clinical usefulness of the measurement of orexin-A concentration in serum was assessed as a diagnostic predictor to screen patients with OSAHS. Correlation between orexin-A levels and apnea hypoventilation index (AHI), micro-arousal index (MAI) and lowest SaO2 (LSaO2) were analyzed. The serum orexin-A levels in the OSAHS group [(0.49 +/- 0.10) microg/L] was significantly higher than that of the control group [(0.28 +/- 0.11) microg/L, P < 0.01]. If a patient's level of orexin-A was higher than 0.36 microg/L, the patient more likely to have OSAHS. The sensitivity rate was 85.0% and the specificity was 80.0%. Serum orexin-A levels in children with OSAHS correlated positively with the AHI (r = 0.427, P < 0.05) and MAI (r = 0.468, P < 0.05), but correlated negatively with the LSaO2 (r = -0.527, P < 0.01) and the mean oxygen saturation (MSaO2) (r = -0.541, P < 0.01), not correlated significantly with the BMI (r = -0.212, P > 0.05). The serum orexin-A levels in the OSAHS children after who under went tonsillectomy and adenoidectomy significantly decreased (P < 0.05) 3 months after surgery as compared with pre-operation level. These findings suggest that the serum level of orexin-A could be used as a predictor in screening for OSAHS children and a biological marker of the severity of OSAHS children.