Untreated Obstructive Sleep Apnea Research Articles

Globus sensation in obstructive sleep apnea patients; A cross-sectional study of 120 patients.

Globus pharyngeus (GP) is a common complaint in many disciplines, especially otolaryngology. Pharyngeal symptoms and abnormalities, including GP, are frequent in obstructive sleep apnea (OSA) patients. This study aims to investigate globus sensation in non-operated OSA patients. After translation and validation, the Laryngopharyngeal Measure of Perceived Sensation (LUMP) was administered to 120 untreated OSA patients. All patients underwent polysomnography and thorough physical examination. The association between LUMP scores and OSA measures was evaluated. LUMP score had a significant correlation with the Epworth Sleepiness Scale (ESS) (Spearman's ρ = 0.269, p = 0.004), and BMI (Spearman's ρ = 0.249, p = 0.007), the anatomical position of the tongue (ρ = -0.191, p = 0.04) and the Friedman grade of tonsils (ρ = 0.241, p = 0.01). It correlated with SpO2 nadir, though it did not reach statistical significance. The results of our study depict a relationship between a self-report measure of globus sensation and daytime sleepiness, BMI and tonsil size. In the absence of a direct relationship between OSA severity parameters and GP, we hypothesize a role for shared comorbidities and anatomical phenotypes. The increased frequency of GP in OSA patients should be considered when evaluating the complications of surgical interventions in these patients.

Cognitive complaints in patients with untreated obstructive sleep apnea versus patients with neurological and respiratory diseases: prevalence, severity and risk factors

PurposeLittle is known about cognitive complaints (self-reported problems in cognitive functioning) in patients with Obstructive Sleep Apnea (OSA). We compared the prevalence and severity of cognitive complaints in patients with untreated OSA to patients with neurological and respiratory diseases. We also studied risk factors for cognitive complaints across these diseases, including OSA.MethodsWe used a convenience sample to compare untreated OSA patients (N = 86) to patients with stroke (N = 166), primary brain tumor (N = 197) and chronic obstructive pulmonary disease (COPD, N = 204) on cognitive complaints (Cognitive Failure Questionnaire, CFQ), anxiety and depression (Hospital Anxiety and Depression Scale, HADS) and cognitive impairments using neuropsychological tests. We combined all patient groups (OSA, stroke, brain tumor and COPD) and studied potential risk factors (demographic variables, anxiety, depression and cognitive impairments) for cognitive complaints across all patient groups using regression analysis.ResultsThe prevalence of cognitive complaints was higher in OSA patients and complaints of forgetfulness and distractibility were more severe compared to stroke and primary brain tumor patients, but similar to or lower than COPD patients. Regression analysis for the combined sample of all patient groups showed that cognitive complaints were most strongly associated with symptoms of anxiety and depression.ConclusionA high rate of OSA reported clinically significant cognitive complaints, comparable to other respiratory and neurological patients. Symptoms of anxiety and depression are important risk factors for cognitive complaints in patients with various neurological and respiratory diseases. Future studies should examine the relation between anxiety, depression and cognitive complaints in patients with OSA.

OBSTRUCTIVE SLEEP APNEA REMAINS A RISK FACTOR FOR MAJOR ADVERSE CARDIOVASCULAR AND CEREBROVASCULAR EVENTS IN HYPERTENSVIE PATIENTS UNDER TREATMENT: THE UROSAH DATA

Objective: The impact of the co-occurrence of hypertension and obstructive sleep apnea (OSA) on the risk of long-term cardiovascular disease (CVD) outcomes has not been extensively studied in the Asian population, and the residual effect of OSA on CVD in patients under antihypertensive treatment is not clear. The study aimed to explore the impact of OSA on the risk of CVD outcomes in a large-scale Asian cohort under antihypertensive treatment using retrospective design. Design and method: Hypertensive patients who underwent polysomnography (PSG) test in January 2011 to December 2013 were recruited from the UROSAH cohort, which was conducted in Hypertension Center of People's Hospital. OSA was defined as apnea hypopnea index over 5. Outcomes were extended major adverse cardiovascular and cerebrovascular events (MACCE), including the first occurrence of nonfatal myocardial infarction, nonfatal stroke, revascularization, rehospitalization due to unstable angina or heart failure and all-cause death. Cox regression analysis was performed to explore the effect of OSA and hypertension coexistence on MACCE. Results: A total of 3329 hypertension patients were enrolled, of whom 2585 patients (about 77.7%) suffered from OSA. During a median follow-up period of 7.0 years, 415 patients developed extended MACCE. The incidence of extended MACCE was significantly greater in patients with OSA than those without OSA (hazard ratio [HR]: 1.59; 95% confidence interval [CI]: 1.27-1.99; P<0.001). Overall, patients with OSA had an increased risk of cardiac events of 57% compared to those without OSA [HR (95%CI): 1.57 (1.04-2.39), P=0.034] and the association did not change in further sensitivity analysis. Particularly in uncontrolled hypertension, OSA was found to have a 93% increased risk of cardiac events, compared with patients without OSA (P=0.036). Conclusions: Untreated OSA seemed to be a factor affecting the prognosis of cardiac events in hypertensive patients, although the association between OSA and cardiac events would be attenuated by the pharmacological-induced blood pressure control, which highlights the need to treat OSA.

Sex Differences in Central Hemodynamics of Patients with Untreated Obstructive Sleep Apnea

Patients with obstructive sleep apnea (OSA) have increased risk for cardiovascular diseases. Data from the Atherosclerosis Risk in the Communities and Sleep Heart Health Study suggest that OSA is more deleterious to females versus males, although mechanistic data are lacking. Estimates of central (aortic) blood pressure (BP) are superior in predicting future cardiovascular events than traditional brachial BP measurements. While patients with OSA have altered central hemodynamics (e.g., higher aortic pulse wave velocity; PWV), potential sex differences are unexplored. We tested the hypothesis that females with OSA (n=7, 50±3yrs, 35.1±1.9kg/m2, 22.2±7.6 events/hr) have worse central hemodynamics than males with OSA (n=9, 47±3yrs, 35.0±1.4kg/m2, 31.7±6.2 events/hr). Data collection consisted of an overnight sleep study (polysomnography) to identify the presence, and characterize the severity, of OSA via the apnea-hypopnea index (AHI). Then, duplicate measures of central (aortic) and peripheral (brachial) BP, as well as central artery stiffness (PWV) and wave reflection (AIx), were made in the morning after ≥15min of quiet, supine rest. Additional hemodynamic measurements were made if data differed by ≥2% (AIx) or ≥0.5m/s (PWV). Data that met these criteria were averaged and used for analysis. Comparisons were made using two-tailed, independent samples t-tests or nonparametric Mann-Whitney Rank Sum tests, as indicated. No differences were observed in age (p=0.44), body mass index (p=0.96), nor AHI (p=1.00) between sexes. Similarly, no sex differences were observed in brachial systolic (female vs. male: 129±7 vs. 134±8mmHg, p=0.83), diastolic (77±5 vs. 85±4mmHg, p=0.26), or mean BP (96±6 vs. 101±5mmHg, p=0.45). Similarly, central systolic (122±6 vs. 125±7mmHg, p=0.96), diastolic (78±5 vs. 86±4mmHg, p=0.25), and augmentation (21±2 vs. 15±2mmHg, p=0.07) BP did not differ between sexes. Resting heart rate was also comparable between groups (67±3 vs. 65±2bpm, p=0.64). However, AIx (AIx; 42±3 vs. 35±4%) and AIx normalized to a heart rate of 75bpm (42±3 vs. 30±3%) were higher in females with OSA relative to males with OSA (p<0.05 for both). Interestingly, the forward (30±3 vs. 28±2mmHg, p=0.63) and reflected (20±2 vs. 18±2mmHg, p=0.44) pulse heights, as well as PWV (7.3±0.6 vs. 7.4±0.6m/s, p=0.85), were similar between groups. Our data indicate that despite a trend towards higher BP in males with OSA (~5mmHg) that may be clinically, though not statistically different, females with OSA have a higher AIx. As AIx is positively associated with left ventricular hypertrophy, these data also suggest that altered central (aortic) hemodynamics may contribute to the sex differences in cardiovascular risk with OSA. This work was supported by the National Institutes of Health T32-HL007111 and U54AG044170 (JMB), HL065176 (PS and VKS), and HL134885 (VKS). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Sleep-wake behavior, perceived fatigability, and cognitive reserve in older adults.

The effects of sleep-wake behavior on perceived fatigability and cognitive abilities when performing daily activities have not been investigated across levels of cognitive reserve (CR). CR Index Questionnaire (CRIq) data were collected and subjected to moderated mediation analysis. In amnestic mild cognitive impairment (aMCI; n=41), CR moderated sleep-related impairments (SRIs), and fatigability at low CR (CRIq<105.8, p=0.004) and mean CR (CRIq=126.9, p=0.03) but not high CR (CRIq>145.9, p=0.65) levels. SRI affected cognitive abilities mediated by fatigability at low CR (p<0.001) and mean CR (p=0.003) levels. In healthy controls (n=13), SRI in fatigability did not alter cognitive abilities across CR levels; controls had higher leisure scores than patients with aMCI (p=0.003, effect size=0.93). SRI can amplify impaired cognitive abilities through exacerbation of fatigability in patients with aMCI with below-mean CR. Therefore, improving sleep-wake regulation and leisure activities may protect against fatigability and cognitive decline. Clinical fatigue and fatigability cannot be alleviated by rest. Clinical fatigability disrupts daily activities during preclinical Alzheimer's. High cognitive reserve mitigates sleep-wake disturbance effects. High cognitive reserve attenuates clinical fatigability effects on daily functioning. Untreated obstructive sleep apnea potentiates Alzheimer's pathology in the brain.

522 Testosterone Supplementation in Patients with Burn Hypermetabolism

Abstract Introduction After major burn injuries, patients experience a hypermetabolic response that leads to hyperdynamic circulatory, physiologic, catabolic, and immune system responses. Many transdisciplinary approaches have been tested to mitigate this postburn hypermetabolic syndrome such as comprehensive burn rehabilitation, nutritional support, monitoring, and pharmacological interventions. Oxandrolone, a synthetic analog of testosterone, has been shown to have higher anabolic properties and minimal androgenic effects and studied intensely in burn care. In 2023, the FDA asked all manufacturers of oxandrolone to cease production and subsequently removed the drug from market on June 28, 2023. Our study examines the cost and operationalization of an intramuscular (IM) testosterone protocol as an alternative in male burn patients with ≥20% total body surface area (TBSA). Methods A cost analysis was conducted using the National Drug Codes (NDC) and commercially available benchmarking data. The cost of oxandrolone and testosterone were included in our analysis. Following a thorough literature review, a protocol was developed for adult male patients with &amp;gt;20% TBSA burn injuries. Patients undergoing gender affirming hormone therapy, untreated obstructive sleep apnea, or hormonal blockers for cancer were excluded from the protocol. Results The protocol begins with total serum testosterone levels at the time of admission and weekly thereafter for male patients with ≥20% TBSA injury. Once a testosterone level &amp;lt; 150 ng/dL is detected, supplementation of testosterone with 200 mg IM once weekly for two weeks is started. Weekly evaluations include total body weight, metabolic panels, and nutritional panels. Cost comparison between oxandrolone and testosterone show an equivalent unit cost of $8.62 versus $8.38, respectively. Conclusions Drug shortages and supply chain challenges are becoming more common in burn care. We hypothesize testosterone to be both a clinically effective and cost-effective alternative to oxandrolone in the setting of burn hypermetabolism in male patients with major burns. Currently, burn experts are working with endocrinologists to assess pharmacologic alternatives for female patients and have obtained IRB-approval to evaluate both safety and efficacy of testosterone supplementation in the setting of burn hypermetabolism. Applicability of Research to Practice This study evaluates the safety and efficacy of testosterone supplementation as an alternative to oxandrolone in the setting of burn hypermetabolism. This study helps provide guidance to other burn centers in filling the gap in therapy that now exists in the pharmacologic management of hypermetabolic syndrome in patients with severe burns.

Nocturnal gastro-oesophageal reflux and respiratory symptoms are increased in sleep apnoea: comparison with the general population

AimTo assess respiratory symptoms and nocturnal gastro-oesophageal reflux (nGER) among untreated obstructive sleep apnoea (OSA) patients, compared with the general population. Also, if nGER associates differently with respiratory symptoms among...

Predicting the impact of CPAP on brain health: A study using the sleep EEG-derived brain age index.

This longitudinal study investigated potential positive impact of CPAP treatment on brain health in individuals with obstructive sleep Apnea (OSA). To allow this, we aimed to employ sleep electroencephalogram (EEG)-derived brain age index (BAI) to quantify CPAP's impact on brain health and identify individually varying CPAP effects on brain aging using machine learning approaches. We retrospectively analyzed CPAP-treated (n = 98) and untreated OSA patients (n = 88) with a minimum 12-month follow-up of polysomnography. BAI was calculated by subtracting chronological age from the predicted brain age. To investigate BAI changes before and after CPAP treatment, we compared annual ΔBAI between CPAP-treated and untreated OSA patients. To identify individually varying CPAP effectiveness and factors influencing CPAP effectiveness, machine learning approaches were employed to predict which patient displayed positive outcomes (negative annual ΔBAI) based on their baseline clinical features. CPAP-treated group showed lower annual ΔBAI than untreated (-0.6 ± 2.7 vs. 0.3 ± 2.6 years, p < 0.05). This BAI reduction with CPAP was reproduced independently in the Apnea, Bariatric surgery, and CPAP study cohort. Patients with more severe OSA at baseline displayed more positive annual ΔBAI (=accelerated brain aging) when untreated and displayed more negative annual ΔBAI (=decelerated brain aging) when CPAP-treated. Machine learning models achieved high accuracy (up to 86%) in predicting CPAP outcomes. CPAP treatment can alleviate brain aging in OSA, especially in severe cases. Sleep EEG-derived BAI has potential to assess CPAP's impact on brain health. The study provides insights into CPAP's effects and underscores BAI-based predictive modeling's utility in OSA management.

Knowledge, attitude and perceived barriers in the practical approach of obstructive sleep apnea management

Obstructive sleep apnea (OSA) is a clinical disorder affecting almost 1 billion people globally. Untreated OSA can cause severe medical problems. Present cross-sectional study was conducted amongst 106 dentists. Convenient sampling method was used and predesigned domain-based questionnaire was employed to gather the data.Data was entered and analyzed with Epi Info software (CDC, Atlanta). Measures of central tendency was used to present the data.Most of the respondents were female 69 (65.1%) and 37(34.9%) were male. Out of total participants 81% were general dental practioners whereas orthodontics and consultants accounted for 19%. OSA though highly prevalent amongst the general population but remains highly undiagnosed. Most common perceived barrier was lack of training and cost in the management of OSA.

Obstructive Sleep Apnea Syndrome in Heavy Truck Drivers: A Portuguese Prospective Cohort Study.

Heavy truck drivers with untreated obstructive sleep apnea (OSA) are at higher risk of driving accidents. This study aims to estimate the prevalence of OSA and to identify the most frequent symptoms and comorbidities in heavy truck drivers. This cohort study included the employees of a Portuguese transport company between 2019 and 2022. A home sleep apnea test (HSAT) was performed on all patients. SPSS® was used for statistical analysis, and a p-value lower than 0.05 was considered statistically significant. A total of 86 truck drivers were included, with a mean age of 48.02 years (min. 24, max 66) and a mean body mass index (BMI) of 30.14±4.4 kg/m². After performing an HSAT, it was found that 77.9% of drivers (n=67) had OSA, with a mean apnea-hypopnea index (AHI) of 16.72±14.69 events/hour. Concerning diagnosed patients, 44.78% (n=30) had mild, 31.32% (n=23) moderate, and 20.89% (n=14) severe OSA. Obesity, hypertension, and dyslipidemia had a statistically significant association. There were no statistically significant differences between patients with and without type II diabetes mellitus. The presence of nighttime and daytime symptoms had a statistically significant correlation with OSA diagnosis. Despite only eight patients reporting a high score on the Epworth Sleepiness Scale (ESS), 14 patients reported previous episodes of falling asleep while driving, which might be associated with the non-valorization of daytime sleepiness in these patients. The patients who reported previous episodes of falling asleep while driving were older and had higher BMI, higher ESS, and higher AHI. In the evaluated truck drivers, the prevalence of OSA was very high (77.9%), which reinforces the importance of screening for this pathology since, when left untreated, it is a major risk factor for exercising their profession safely.

Sleep apnea and comorbid diseases - a review

Obstructive sleep apnea (OSA) is a common disease spreading around the world. It is unavoidably linked to the increasing rate of obesity, particularly in Western societies. Associated higher prevalence of sleep disordered breathing has also been observed. There are many diseases that can lead to OSA and many that are a result of untreated OSA. From the widely known cardiovascular complications to indirectly related diseases, such as insomnia, Alzeihmer’s disease or psoriasis. Overall, sleep-disordered breathing have been shown to negatively impact quality of life, including general health perception, physical functioning, social functioning, and vitality. That is why it is important to spread awareness about OSA, often asymptomatic, through medical staff and patients in the risk group. In this review we describe the illness, the ways to diagnose it and discuss comorbid diseases.

The effects of Daridorexant 50 mg on Patients with Comorbid Insomnia Disorder and Untreated Mild Obstructive Sleep Apnea: A Subgroup Post-hoc Analysis of a Phase 3 Clinical Trial

The effects of Daridorexant 50 mg on Patients with Comorbid Insomnia Disorder and Untreated Mild Obstructive Sleep Apnea: A Subgroup Post-hoc Analysis of a Phase 3 Clinical Trial

Daytime sleepiness and vigilance in untreated obstructive sleep apnea patients - the preliminary results from Vietnam

Daytime sleepiness and vigilance in untreated obstructive sleep apnea patients - the preliminary results from Vietnam

Little snores, big concern: A review on pediatric obstructive sleep apnea

Context (Background): Pediatric obstructive sleep apnea (OSA) is a pressing concern, with profound consequences for children's development. This review delves into the epidemiology, pathophysiology, diagnosis, treatment, and complications of pediatric OSA.&#x0D; Aims: Our aim is to provide a comprehensive overview of the current state of knowledge regarding pediatric OSA. By synthesizing the latest research findings, we highlight the importance of understanding this sleep disorder's impact on children.&#x0D; Methods and Materials: We conducted an exhaustive search of English-language publications from various databases, including PubMed and Google Scholar, covering studies, clinical trials, and review articles on pediatric OSA.&#x0D; Conclusions: This review underscores the multifaceted nature of pediatric OSA, emphasizing its effects on children's health. Accurate diagnosis is crucial, as untreated OSA can lead to cognitive and cardiovascular issues. While current treatments, such as adenotonsillectomy and positive airway pressure therapy, show promise, ongoing research is necessary to refine diagnostics and explore innovative treatments.

Assessment of Obstructive Sleep Apnea Among Patients With Chronic Obstructive Pulmonary Disease in Primary Care.

Observational studies link untreated obstructive sleep apnea (OSA) with adverse outcomes in chronic obstructive pulmonary disease (COPD). The first step in addressing OSA is a clinical assessment. However, given competing demands and a lack of high-quality evidence, it is unclear how often such assessments occur. We explored the documentation of OSA assessment among patients with COPD in primary care, and the patient and provider characteristics associated with these assessments. We conducted a cross-sectional study of patients with clinically diagnosed COPD at 2 primary care practices. We abstracted charts to determine whether providers assessed OSA, defined as documentation of symptoms, treatment, or a referral to sleep medicine. We performed multivariable mixed-effects logistic regression to assess the associations of patient and provider characteristics with OSA assessment. Among 641 patients with clinically diagnosed COPD, 146 (23%) had OSA assessed over a 1-year period. Positive associations with OSA assessment included body mass index ≥ 30 (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8-7.0), pulmonary subspecialist visits (OR 3.9, 95%CI 2.4-6.3), and a prior sleep study demonstrating OSA documented within the electronic medical record (OR 18.0, 95%CI 9.0-35.8). Notably, patients identifying as Black were less likely to have OSA assessed than those identifying as White (OR 0.5, 95%CI 0.2-0.9). Providers document an assessment of OSA among a quarter of patients with COPD. Our findings highlight the importance of future work to rigorously test the impact of assessment on important health outcomes. Our findings also reinforce that additional strategies are needed to improve the equitable delivery of care.

High Risk of Obstructive Sleep Apnea Among Hypertensive Patients at a Selected Tertiary Care Hospital

Introduction: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by partial or complete obstruction of the upper airway, which causes desaturations and arousal. Various studies have shown that OSA is a major modifiable risk factor for hypertension. Untreated OSA is increasingly associated with cardiovascular and neurocognitive sequela. Thus, our study aims to determine the high-risk of obstructive sleep apnea among hypertensive patients at a tertiary care hospital in Malaysia. Methods: A cross-sectional study was conducted among hypertensive patients at a tertiary hospital in Malaysia. A validated Malay version of the Berlin Questionnaire was utilized along with other questions on sociodemographic characteristics and diabetes mellitus. Results: A total of 161 respondents were involved in the study. The mean age was 48.35 years and among these 75% were males and 25 % were females. The majority of respondents were of Malay ethnicity (78%), followed by Chinese (11%) and Indians (10%). Of these,18 % comprised of obese patients and 29.8% had diabetes mellitus. The prevalence of high-risk OSA among hypertensive patients was 18.0% (95% CI). High risk of OSA was found to be prevalent in the elderly age group (p&lt;0.001), female gender (p&lt;0.001), Indian ethnicity (p&lt;0.001) and among diabetes mellitus patients (p&lt;0.001). Conclusion: The study results illustrate the high risk of OSA among hypertensive patients with advancing age and diabetes mellitus. This study finding mandates these high-risk hypertensive patients should be screened for early diagnosis and timely treatment of OSA to prevent further cardiovascular risk, morbidity and mortality.

Obstructive sleep apnea remains a risk factor for major adverse cardiovascular and cerebrovascular events even in hypertensive patients under treatment: the Urumqi Research on Sleep Apnea and Hypertension (UROSAH) data.

The impact of the co-occurrence of hypertension and obstructive sleep apnea (OSA) on the risk of long-term cardiovascular disease (CVD) outcomes has not been extensively studied in the Asian population, and the residual effect of OSA on CVD in patients under antihypertensive treatment is not clear. The study aimed to explore the impact of OSA on the risk of CVD outcomes in a large-scale Asian cohort under antihypertensive treatment using retrospective design. Hypertensive patients who underwent polysomnography (PSG) test from January 2011 to December 2013 were recruited from the Urumqi Research on Sleep Apnea and Hypertension (UROSAH) cohort, which was conducted in Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region. OSA was defined as apnea hypopnea index (AHI) ≥5. Outcomes were extended major adverse cardiovascular and cerebrovascular events (MACCE), including the first occurrence of nonfatal myocardial infarction, nonfatal stroke, revascularization, rehospitalization due to unstable angina or heart failure and all-cause death. Cox regression analysis was performed to explore the effect of OSA and hypertension coexistence on MACCE. A total of 3,329 hypertension patients were enrolled, of whom 2,585 patients (about 77.7%) suffered from OSA. During a median follow-up period of 7.0 years, 415 patients developed extended MACCE. The incidence of extended MACCE was significantly greater in patients with OSA than those without OSA [hazard ratio (HR): 1.59; 95% confidence interval (CI): 1.27-1.99; P<0.001]. Overall, patients with OSA had an increased risk of cardiac events of 57% compared to those without OSA (HR: 1.57; 95% CI: 1.04-2.39, P=0.034) and the association did not change in further sensitivity analysis. Particularly in uncontrolled hypertension, OSA was found to have a 93% increased risk of cardiac events, compared with patients without OSA (P=0.036). Untreated OSA seemed to be a factor affecting the prognosis of cardiac events in hypertensive patients, although the association between OSA and cardiac events would be attenuated by the pharmacological-induced blood pressure control, which highlights the need to treat OSA.

Regional associations between inspiratory tongue dilatory movement and genioglossus activity during wakefulness in people with obstructive sleep apnoea.

Inspiratory tongue dilatory movement is believed to be mediated via changes in neural drive to genioglossus. However, this has not been studied during quiet breathing in humans. Therefore, this study investigated this relationship and its potential role in obstructive sleep apnoea (OSA). During awake supine quiet nasal breathing, inspiratory tongue dilatory movement, quantified with tagged magnetic resonance imaging, and inspiratory phasic genioglossus EMG normalised to maximum EMG were measured in nine controls [apnoea-hypopnea index (AHI) ≤5 events/h] and 37 people with untreated OSA (AHI >5 events/h). Measurements were obtained for 156 neuromuscular compartments (85%). Analysis was adjusted for nadir epiglottic pressure during inspiration. Only for 106 compartments (68%) was a larger anterior (dilatory) movement associated with a higher phasic EMG [mixed linear regression, beta=0.089, 95% CI [0.000, 0.178], t(99)=1.995, P=0.049, hereafter EMG↗/mvt↗]. For the remaining 50 (32%) compartments, a larger dilatory movement was associated with a lower phasic EMG [mixed linear regression, beta=-0.123, 95% CI [-0.224, -0.022], t(43)=-2.458, P=0.018, hereafter EMG↘/mvt↗]. OSA participants had a higher odds of having at least one decoupled EMG↘/mvt↗ compartment (binary logistic regression, odds ratio [95% CI]: 7.53 [1.19, 47.47] (P=0.032). Dilatory tongue movement was minimal (>1 mm) in nearly all participants with only EMG↗/mvt↗ compartments (86%, 18/21). These results demonstrate that upper airway dilatory mechanics cannot be predicted from genioglossus EMG, particularly in people with OSA. Tongue movement associated with minimal genioglossus activity suggests co-activation of other airway dilator muscles. KEY POINTS: Inspiratory tongue movement is thought to be mediated through changes in genioglossus activity. However, it is unknown if this relationship is altered by obstructive sleep apnoea (OSA). During awake supine quiet nasal breathing, inspiratory tongue movement, quantified with tagged magnetic resonance imaging (MRI), and inspiratory phasic genioglossus EMG normalised to maximum EMG were measured in four tongue compartments of people with and without OSA. Larger tongue anterior (dilatory) movement was associated with higher phasic genioglossus EMG for 68% of compartments. OSA participants had an ∼7-times higher odds of having at least one compartment for which a larger anterior tongue movement was not associated with a higher phasic EMG than controls. Therefore, higher genioglossus phasic EMG does not consistently translate into tongue dilatory movement, particularly in people with OSA. Large dilatory tongue movements can occur despite minimal genioglossus inspiratory activity, suggesting co-activation of other pharyngeal muscles.

Opioid sensitivity in treated and untreated obstructive sleep apnoea: a prospective cohort study

BackgroundOpioid administration to patients with obstructive sleep apnoea (OSA) is controversial because they are believed to be more sensitive to opioids. However, objective data on opioid effects in OSA are lacking. We tested the hypothesis that subjects with untreated OSA have increased sensitivity to opioids compared with subjects without OSA, or with OSA treated with continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP). MethodsThis was a single-centre, prospective cohort study in subjects without OSA (n=20), with untreated OSA (n=33), or with treated OSA (n=21). OSA diagnosis was verified using type III (in-home) polysomnography. Subjects received a stepped-dose remifentanil infusion (target effect-site concentrations of 0.5, 1, 2, 3, 4 ng ml−1). Primary outcome was miosis (pupil area fractional change), the most sensitive opioid effect. Secondary outcomes were ventilatory rate, end-expired CO2, sedation, and thermal analgesia. ResultsThere were no differences in miosis between untreated OSA subjects (mean=0.51, 95% confidence interval [CI] 0.41–0.61) and subjects without OSA (mean=0.49, 95% CI 0.36–0.62) (mean difference=0.02, 95% CI −0.18 to 0.22); between treated OSA subjects (mean=0.56, 95% CI 0.43–0.68) and subjects without OSA (difference=0.07, 95% CI −0.16 to 0.29); or between untreated OSA and treated OSA (difference=−0.05, 95% CI −0.25 to 0.16). There were no significant differences between subjects without OSA, untreated OSA, and treated OSA in ventilatory rate, end-expired CO2, sedation, or thermal analgesia responses to remifentanil. There was no relationship between OSA severity and magnitude of opioid effects. ConclusionsNeither obstructive sleep apnoea nor obstructive sleep apnoea treatment affected sensitivity to the miotic, sedative, analgesic, or respiratory depressant effects of the opioid remifentanil in awake adults. These results challenge conventional notions of opioid effects in obstructive sleep apnoea. Clinical trial registrationNCT02898792 (clinicaltrials.gov).

Metabolic Signature and Obstructive Sleep Apnea in Nepalese Patients

Introduction: Untreated Obstructive Sleep Apnea (OSA) causes sleep related symptoms and also causes increased incidence of RTA, cardiovascular diseases and all cause mortality. Currently OSA has been recognized as the consequence of number of interrelated metabolic and oxidative pathologies. As there are limited data of association of OSA with metabolic stress and its correlation with severity of OSA, study of metabolic profile of these patients in view of defining the Metabolic signature of OSA was carried out in eastern Nepal.&#x0D; Objectives: To study metabolic profile of OSA and its association with clinical severity. Methods: Hospital based descriptive cross sectional study. Biochemical profile results related to metabolic –oxidative pathway of the OSA patients were obtained. Quantitative and qualitative data were obtained. Quantitative data were compared using Mann–Whitney test while qualitative variables compared using Pearson χ2. Correlation was carried out using Pearson and Spearman’s test. P-value&lt;0.05 considered significant.&#x0D; Results: 33 patients of OSA were enrolled. Majority of patients had deranged metabolic and oxidative parameters despite mild OSA. Among metabolic stress parameters, most commonly deranged were decreased high density lipoprotein (HDL), increased mean arterial pressure (MAP), waist circumference (WC) and raised fasting blood sugar (FBS). Increased MAP and increased WC was significantly corelated with severity.&#x0D; Conclusion: Besides symptom complex, OSA is also harbinger of metabolic stress that can lead to various cardiometabolic diseases and premature mortality thus early recognition and treatment can mitigate these consequences.