Worsening Of Obstructive Sleep Apnea Research Articles

1202 Worsening of Obstructive Sleep Apnea Following Resection of a Vagal Nerve Schwannoma

1202 Worsening of Obstructive Sleep Apnea Following Resection of a Vagal Nerve Schwannoma

1024 A Challenging Inspire Case: All Roads Do Not Necessarily Lead to Rome

Abstract Introduction Hypoglossal nerve stimulation (HNS) for the treatment of obstructive sleep apnea (OSA) in patients who have failed positive airway pressure (PAP) therapy for one reason or the other is now standard of care. Once the device is implanted and activated, voltage to stimulate the nerve has to be titrated over time, ultimately leading to an HNS titration study. There are 4 possible electrode configurations to stimulate different fibers in the nerve that can be employed for treatment. We present a case of a patient who was a challenge with worsening of OSA with Inspire. Report of case(s) A 65-year-old woman with hypertension, and severe OSA, intolerant of positive airway pressure or oral appliances was implanted with Inspire. Post activation, there was symptomatic improvement with reduction of overall apnea-hypopnea index (AHI) from 34 per hour of sleep to 6.3 per hour. However, patient slept exclusively on the sides with evidence of significant residual disease in REM sleep. During subsequent weeks, patent reported inability to restrict position and discomfort and anxiety associated with up titration. Both awake endoscopy and advanced overnight HNS titration were pursued. All 4 electrode configurations were tested during both procedures. With the exception of (minus-plus-minus) configuration, there was worsening of sleep disordered breathing and higher residual AHI of 60 per hour on polysomnography and evidence of poor tongue motion and collapsed velopharynx on awake endoscopy. Inspire settings were readjusted to (minus-plus-minus) configuration with instructions for very slow outpatient uptitration and co-management of anxiety and discomfort with anxiolytics and sleep aids. Conclusion We make two important conclusions from this case. Firstly, although there are established criteria for patient selection for hypoglossal nerve stimulation therapy, certain other factors that impact success which are not as easily defined include the patients’ expectations, tolerance of discomfort, propensity to anxiety and personality type which impact the ability to successfully titrate voltage with the Inspire device over time. Secondly, as the tongue is a complex muscle, both under titration and over titration may be counterproductive and additionally, electrode configuration may also have varying effects on tongue protrusion and impact success. Support (if any)

GLP-1 receptor agonists, SGLT-2 inhibitors, and obstructive sleep apnoea: can new allies face an old enemy?

Obstructive sleep apnoea (OSA) is the most common form of abnormal sleep pattern (ASP). It is characterized by narrowing of the upper airways (complete or partial) during sleep. Although continuous positive airway pressure is recognized as the gold standard treatment of OSA, unfortunately treatment adherence is often suboptimal and does not address the pathophysiological mechanisms governing its pathogenesis. Weight gain is an important risk factor for the development and worsening of OSA both in adults and in children. Meaningful and sustained weight reduction using lifestyle modifications alone remains difficult and challenging. Novel therapeutic strategies are vital because currently there are no approved pharmacological therapies. This paper explores thoroughly both preclinical and clinical studies that investigated the possible role of GLP-1 receptor agonists and SGLT-2 inhibitors in individuals with ASP and especially OSA. It also discusses their future role in order to ameliorate the global burden of OSA.

Muscle and visceral fat infiltration: A potential mechanism to explain the worsening of obstructive sleep apnea with age

Study objectivesAging is a major risk factor for obstructive sleep apnoea (OSA) and is associated with increased upper airway collapsibility, but the mechanisms are largely unknown. We hypothesized that the increase in OSA severity and upper airway collapsibility with age are partially mediated by upper airway, visceral and muscle fat infiltration. MethodsMale subjects underwent full polysomnography, upper airway collapsibility determination (Pcrit) after sleep induction with midazolam, upper airway and abdominal computed tomography. Tongue and abdominal muscle fat infiltration were assessed by the determination of muscle attenuation with computed tomography. ResultsEighty-four males with a wide range of age (47 ± 13 years, range 22–69 years) and apnea-hypopnea index (AHI) (30 [14–60] events/h, range 1–90 events/h), were studied. Younger and older males were grouped according to the mean age. Despite similar body mass-index (BMI), older subjects had higher AHI, higher Pcrit, larger neck and waist circumference, higher visceral and upper airway fat volumes (P < 0.01) as compared to younger subjects. Age was associated with OSA severity, Pcrit, neck and waist circumference, upper airway fat volume and visceral fat (P < 0.05), but not with BMI. Older subjects had lower tongue and abdominal muscle attenuation as compared to younger subjects (P < 0.001). Age was inversely associated with tongue and abdominal muscle attenuation, indicating muscle fat infiltration. ConclusionsThe associations between age, upper airway fat volume, visceral and muscle fat infiltration may help to explain the worsening of OSA and increased upper airway collapsibility with aging.

Does Bilateral Gap Arthroplasty Increase the Severity of Obstructive Sleep Apnea in Patients With Temporomandibular Joint Ankylosis?

Obstructive sleep apnea (OSA) is common in patients with bilateral temporomandibular joint ankylosis (TMJA). The purpose of this study was to compare the preoperative and postoperative apnea-hypopnea index (AHI) in patients with TMJA undergoing bilateral gap arthroplasty (BGA). The investigators implemented a prospective cohort study on patients with bilateral TMJA treated with BGA. The primary predictor variable was time (before and after BGA). The primary outcome variable was AHI and secondary outcome variable included posterior airway space, skeletal changes, Epworth sleepiness scale, minimum oxygen, average oxygen saturation, and maximal incisal opening at preoperative time (T0), 1 month (T1), and at 6 months (T2). The statistical test used were Greenhouse-Geisser test, repeated measure ANOVA (1 way), followed by post hoc Bonferroni test. The P-value was taken significant when <0.05 at a confidence interval of 95%. The study sample included 12 (m:f=1:2) patients of bilateral TMJA with a mean age of 14.9±4.8years and mean follow-up of 6 months. Mean duration of ankylosis was 10.5±6.9years (median=12). Trauma was the main etiological factor in 11 (91.7%) patients followed by infection in 1 (8.3%) patient. The mean increase in AHI was 8.6 (T0 to T1) with P-value=.002 and 23.4 (T1 to T2) and was statistically significant (P=.001). The mean decrease in posterior airway space was 4.5±1.0 to 3.5±0.5 (T0 to T2) and was statistically significant (P=.02). Mean difference in minimum oxygen was 6.8 (P-value=.015). Skeletal changes are consistent with clockwise rotation of the mandible and statistically significant changes in horizontal and vertical dimension. The mean change in average oxygen was statistically insignificant (P=1.0). The present study concludes that gap arthroplasty in patients with bilateral TMJA can lead to development or worsening of pre-existing mild to moderate OSA. Ramus-condyle reconstruction should be performed to prevent the retropositioning of mandible and worsening of OSA.

The Effect of Cleft Palate Repair on Polysomnography Results.

In view of the risk that surgical repair of cleft palate may induce or worsen obstructive sleep apnea (OSA), the goal of this study was to assess presurgical and postsurgical polysomnography (PSG) results for children who underwent primary palatoplasty. Retrospective case-control series for children with cleft palate repair performed between January 2008 and December 2016 at a tertiary pediatric center. Children underwent PSG before and after surgery. Sixty-four children (53.1% female) with a mean age of 2.0 ± 2.8 years (range 0.6-16.4) were included in the study. Pierre-Robin sequence was the most common comorbidity (67%). Before palatal repair, the mean obstructive apnea-hypopnea index (oAHI) was 3.4 ± 3.9 (range 0-17.9) events/h; this did not significantly change, with 5.9 ± 14.5 (range 0-105.7) events/h after surgery (P = 0.30). However, 34.4% of patients had a worsening of more than 1 obstructive event/h and 18.9% had a worsening of 5 or more obstructive events/h. The presence of a concomitant syndrome (eg, Treacher Collins) was a risk factor for postoperative OSA (odds ratio 4.2, 95% confidence interval 1.1-15.8, P = .03). OSA did not develop or worsen following primary palatoplasty. However, the oAHI increased by 5 or more events/h in approximately 20% of study participants. The presence of a syndrome was the only factor predictive of worsening OSA after palatoplasty. These findings suggest that palatoplasty does not worsen or cause OSA in most patients, and that nonsyndromic children are at low risk for the development or worsening of OSA.

Impact of a Simulated Workday of Sit-stand Desk Use on Sleep Among Adults Screened as High Risk for Sleep Apnea

Exercise improves sleep and reduces apnea severity in adults with obstructive sleep apnea (OSA). However, whether reducing sedentary behavior impacts sleep and apnea severity is unknown. PURPOSE: To examine whether reducing prolonged sitting during a simulated workday by use of a sit-stand desk leads to changes in sleep compared to a sedentary workday in a sample of adults at high risk for OSA. METHODS: Eight inactive adults (5 males, 53.8±8.5 yr, body mass index: 29.8±5.5 kg/m2) who were classified as ‘high risk’ for OSA based upon the STOP-BANG screening algorithm participated in a randomized crossover trial consisting of two simulated 8-h workdays: (1) continuous sitting (SIT); and (2) alternating periods of sitting and standing every 30 min (SIT-STAND). Sleep and apnea were assessed on the night following each simulated workday by wrist-worn actigraphy and a portable OSA testing device, respectively. Actigraphic measures of total sleep time (TST) and wake after sleep onset (WASO) served as the primary sleep variables, while the apnea-hypopnea index (AHI) assessed OSA severity from the OSA testing device by a blinded assessor. Natural logarithm transformation of AHI was performed due to non-normality. Effect sizes (Hedges’ g) and Pearson correlations evaluated differences in sleep following each condition and associations between changes in sleep measures, respectively. RESULTS: In the full sample, trivial improvements in WASO (g=0.16) and TST (g=0.03) were observed following SIT-STAND compared to SIT. In contrast, a small increase in AHI (i.e., worsening of OSA) was observed following SIT-STAND compared to SIT (g=0.31). The change in AHI was associated with the change in actigraphic WASO (r=.63, P=.09). Four of the 8 adults had clinically significant OSA (i.e., mean AHI≥10 across conditions). Among those with clinically significant OSA, large increases in WASO and AHI were seen following SIT-STAND relative to SIT (g=1.16 and 0.89, respectively). In those without significant OSA, small- to moderate-sized reductions in WASO and AHI were observed following SIT-STAND compared to SIT (g=0.68 and 0.30, respectively). CONCLUSION: Following sedentary behavior reduction during a simulated workday, changes in sleep and apnea seemed to differ based upon the presence of clinically significant OSA.

Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management

(Anesth Analg. 2018;127:1167–1177) Sleep-disordered breathing (SDB) is often comorbid with obesity; among obese pregnant women, 15% to 20% have obstructive sleep apnea (OSA), and prevalence increases with body mass index (BMI). Untreated OSA has been associated with a range of cardiovascular, pulmonary, and metabolic comorbidities. The authors of this review discussed pregnancy as a vulnerable period for the development or worsening of OSA, associations between OSA and adverse maternal and fetal outcomes, current screening modalities for OSA in pregnancy, and current recommendations regarding peripartum management of OSA.

MECHANISMS OF ENDOCRINOLOGY: Mechanisms of disease: the endocrinology of obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) is a common disorder that is associated with serious comorbidities with a negative impact on quality of life, life expectancy and health costs. As OSA is related to obesity and is associated with sleep disruption, increased inflammation and oxidative stress, it is not surprising that OSA has an impact on the secretion of multiple hormones and is implicated in the development of many endocrine conditions. On the other hand, many endocrine conditions that can affect obesity and/or upper airways anatomy and stability have been implicated in the development or worsening of OSA. This bidirectional relationship between OSA and the endocrine system has been increasingly recognised in experimental and epidemiological studies and there are an increasing number of studies examining the effects of OSA treatment on endocrine conditions and vice versa. In this review article, we will critically appraise and describe the impact of OSA on the endocrine system including obesity, dysglycaemia, the pituitary, the thyroid, the adrenals, the reproductive system and the bones. In each section, we will assess whether a bidirectional relationship exists, and we will describe the potential underlying mechanisms. We have focused more on recent studies and randomised controlled trials where available and attempted to provide the information within clinical context and relevance.

Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management.

Among obese pregnant women, 15%-20% have obstructive sleep apnea (OSA) and this prevalence increases along with body mass index and in the presence of other comorbidities. Prepregnancy obesity and pregnancy-related weight gain are certainly risk factors for sleep-disordered breathing in pregnancy, but certain physiologic changes of pregnancy may also increase a woman's risk of developing or worsening OSA. While it has been shown that untreated OSA in postmenopausal women is associated with a range of cardiovascular, pulmonary, and metabolic comorbidities, a body of literature is emerging that suggests OSA may also have serious implications for the health of mothers and fetuses during and after pregnancy. In this review, we discuss the following: pregnancy as a vulnerable period for the development or worsening of OSA; the associations between OSA and maternal and fetal outcomes; the current screening modalities for OSA in pregnancy; and current recommendations regarding peripartum management of OSA.

Weight gain may affect mandibular advancement device therapy in patients with obstructive sleep apnea: a retrospective study

The aim was to analyze whether or not weight gain influences the treatment outcome of patients with obstructive sleep apnea (OSA) treated with mandibular advancement devices (MAD). As a part of a follow-up study among OSA patients treated with MAD in primary oral health care, a group of 28 patients reporting worsening of daytime or nighttime symptoms of OSA was given closer examination. Altogether, 21 subjects had a complete set of recordings and were enrolled into the study. Only three subjects had lost weight during the study period. The mean weight gain of 3.6kg ± 7.1kg was significant (p = 0.035). According to linear regression, weight gain was independently significantly associated with lower mean peripheral oxygen saturation 92.4 (SD 1.8 (% per hour) (p = 0.019)) and lowest oxygen saturation 80.1 (SD 7.2 (%) (p = 0.024)) scores. Weight gain is detrimentally associated with MAD treatment in patients with OSA. These findings suggest that regular follow-up by an experienced dentist is advisable to assess for possible worsening of OSA. Patient support to encourage weight control may be an important adjunct to MAD treatment for OSA.

Is Perioperative Fluid and Salt Balance a Contributing Factor in Postoperative Worsening of Obstructive Sleep Apnea?

An understanding of the potential mechanisms underlying recurrent upper airway collapse may help anesthesiologists better manage patients in the postoperative period. There is convincing evidence in the sleep medicine literature to suggest that a positive fluid and salt balance can worsen upper airway collapse in patients with obstructive sleep apnea through the redistribution of fluid from the legs into the neck and upper airway while supine, in a process known as "rostral fluid shift." According to this theory, during the day the volume from a fluid bolus or from fluid overload states (i.e., heart failure and chronic kidney disease) accumulates in the legs due to gravity, and when a person lies supine at night, the fluid shifts rostrally to the neck, also owing to gravity. The fluid in the neck can increase the extraluminal pressure around the upper airways, causing the upper airways to narrow and predisposing to upper airway collapse. Similarly, surgical patients also incur large fluid and salt balance shifts, and when recovered supine, this may promote fluid redistribution to the neck and upper airways. In this commentary, we summarize the sleep medicine literature on the impact of fluid and salt balance on obstructive sleep apnea severity and discuss the potential anesthetic implications of excessive fluid and salt volume on worsening sleep apnea.

Physiological mechanisms of upper airway hypotonia during REM sleep.

Rapid eye movement (REM)-induced hypotonia of the major upper airway dilating muscle (genioglossus) potentially contributes to the worsening of obstructive sleep apnea that occurs during this stage. No prior human single motor unit (SMU) study of genioglossus has examined this possibility to our knowledge. We hypothesized that genioglossus SMUs would reduce their activity during stable breathing in both tonic and phasic REM compared to stage N2 sleep. Further, we hypothesized that hypopneas occurring in REM would be associated with coincident reductions in genioglossus SMU activity. The activity of genioglossus SMUs was studied in (1) neighboring epochs of stage N2, and tonic and phasic REM; and (2) during hypopneas occurring in REM. Sleep laboratory. 29 subjects (38 ± 13 y) (17 male). Natural sleep, including REM sleep and REM hypopneas. Subjects slept overnight with genioglossus fine-wire intramuscular electrodes and full polysomnography. Forty-two SMUs firing during one or more of stage N2, tonic REM, or phasic REM were sorted. Twenty inspiratory phasic (IP), 17 inspiratory tonic (IT), and five expiratory tonic (ET) SMUs were characterized. Fewer units were active during phasic REM (23) compared to tonic REM (30) and stage N2 (33). During phasic REM sleep, genioglossus IP and IT SMUs discharged at slower rates and for shorter durations than during stage N2. For example, the SMU peak frequency during phasic REM 5.7 ± 6.6 Hz (mean ± standard deviation) was less than both tonic REM 12.3 ± 9.7 Hz and stage N2 16.1 ± 10.0 Hz (P < 0.001). The peak firing frequencies of IP/IT SMUs decreased from the last breath before to the first breath of a REM hypopnea (11.8 ± 10.9 Hz versus 5.7 ± 9.4 Hz; P = 0.001). Genioglossus single motor unit activity is significantly reduced in REM sleep, particularly phasic REM. Single motor unit activity decreases abruptly at the onset of REM hypopneas.

Mandibular Advancement Device Therapy in Obstructive Sleep Apnea and Snoring in Community Dental Care: Two-year Follow-up Study on Self-reported Sleep Quality, Side Effects, and Compliance

Study background: Obesity is constantly increasing health problem worldwide and so are its detrimental consequences, including obstructive sleep apnea (OSA). Mandibular advancement devices (MADs) are proven to be efficient in treating mild to moderate OSA and snoring. We followed for two years 103 patients treated with a titrable MAD in a Community Dental Care setting. Methods: A follow-up questionnaire was mailed in 2012 to 124 patients who had participated in a survey 2010 and given their consent for further study. Results: Of all the 103 respondents 85% (n=88) still used MAD. Subjective tiredness (p<0.05) and the presence of any snoring (p<0.01) were reported more often in the long-term study than in the short-term study. In contrast, difficulty in initiating sleep with the device in situ was seen less often (p<0.05). According to the logistic regression, reduced loud snoring was significantly associated with the compliance of frequent wear of MAD (p<0.05). The majority (82%) of the patients also reported a positive impact of MAD in social (family) life due to reduced loud snoring. Conclusion: Titrable MAD is a noteworthy treatment modality for mild to moderate OSA and especially snoring. Compliance in using MADs and reported subjective health seem to remain at good level. General dentists could probably perform a great part of the care. However, possible worsening of OSA and side effects of MADs should be borne in mind.

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.

Obstructive sleep apnoea in adults: body postures and weight changes interactions

The aim of this work was to study the relationship between changes of body posture dominance and changes of body weight overtime in adults with obstructive sleep apnoea. The participants were 112 non-treated adults with obstructive sleep apnoea who underwent two polysomnographic evaluations at our Sleep Disorders Unit during an average of 6.2years interval. Positional patients - having most of their breathing abnormalities in the supine posture and who became non-positional patients - had a significant gain in weight and a significant increase in apnoea-hypopnoea index, mainly in lateral apnoea-hypopnoea index. On the contrary, non-positional patients who became positional patients had a significant decrease in weight (but less than the increase in weight of positional patients who became non-positional patients) and showed a significant improvement in apnoea-hypopnoea index, again mainly in lateral apnoea-hypopnoea index. These non-positional patients who became positional patients initially had a less severe disease, as judged by apnoea-hypopnoea index, lateral apnoea-hypopnoea index and minimum SaO(2) during non-rapid eye movement sleep, and were less obese than non-positional patients who remained non-positional patients. The later were the patients who showed initially the worst disease and were more obese than the rest of the patients, and their condition did not change significantly over time. Non-positional patients who converted to positional patients showed a decrease in body weight and improvement of obstructive sleep apnoea, while positional patients who converted to non-positional patients showed an increase in body weight and worsening of obstructive sleep apnoea. It appears that weight changes have a modulatory effect on positional dominance, and lateral apnoea-hypopnoea index appears to be a sensitive parameter of these changes.

Overnight Rostral Fluid Shift in Obstructive Sleep Apnea: Does It Affect the Severity of Sleep-Disordered Breathing?

Obstructive sleep apnea (OSA) is a common disorder with multifactorial pathogenesis. It has been proposed that rostral fluid displacement contributes to the pathogenesis of OSA. We hypothesized that if fluid shift is an important factor in OSA, then it would be more severe during the second one-half of the night when there is maximally displaced fluid rostrally.We prospectively enrolled 135 patients who underwent polysomnography. Neck and leg circumferences were measured to determine rostral fluid shift in recumbent position before and after sleep study. Breathing disturbance index (BDI) was derived for non-rapid eye movement sleep during the first and second one-half of the night in the same position.Sixty-five patients with demonstrable rostral fluid shift overnight were included in the analyses. Thirty-two (age, 52.5 ± 2.2 years) had OSA with a mean BDI of 27 ± 3/h (range, 5-80/h), whereas the other 33 with mainly upper airway resistance syndrome (age, 48.7 ± 2.4 years) had a BDI of 13 ± 2/h. Patients in both groups were obese. There was a statistically significant increase in neck circumference in patients with OSA (41.5 ± 0.8 to 42.6 ± 0.7 cm, P < .0001) and without OSA (38.6 ± 0.6 to 40.2 ± 0.6 cm, P < .0001) overnight, with concomitant decreases in leg circumferences. In spite of the fluid shift, BDI did not change (18 ± 3/h and 20 ± 3/h) between the first and second one-half of the night.There is a significant fluid shift rostrally to the neck overnight in patients with and without OSA. However, this fluid shift is not associated with worsening of OSA, thus making it unlikely that fluid displacement is a contributing factor in the pathogenesis or severity of OSA.

Catathrenia under sodium oxybate in narcolepsy with cataplexy

This study aims to report on catathrenia occurring in narcolepsy with cataplexy (NC) patients under sodium oxybate (SO) treatment. Catathrenia is a parasomnia characterized by groaning and an abnormal respiratory pattern during sleep. Fifty-one patients with NC and starting SO therapy underwent a baseline overnight polysomnography (PSG) to detect any sleep-related breathing disorders (SRBD). To avoid risks due to a possible central respiratory control depression by SO, all patients with concomitant obstructive sleep apnea (OSA) were treated with a nasal continuous positive airway pressure (nCPAP) device. After 2months of treatment with SO, all patients underwent a follow-up overnight PSG to investigate possible newly occurring SRBD. They also underwent a semi-structured clinical interview to monitor other potential SO side effects. At baseline, four out of 51 patients showed simple snoring, and eight, mild to severe OSA. After a titration PSG night, patients with OSA received a nCPAP device. After 2months of SO treatment, 28 patients (54.9%) showed SO-related side effects, including SRBD in 11 (21.6%). The follow-up PSG showed a respiratory pattern characteristic of catathrenia in seven patients (13.7%) as a newly observed and possibly benign SO side effect, and ruled out a worsening of OSA. Catathrenia should be considered a possible side effect in NC patients under SO treatment and should be accurately identified to prevent unnecessary SO withdrawal.

Modified mandibular advancement appliance for an edentulous obstructive sleep apnea patient: A clinical report

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with periodic reduction or cessation of airflow during sleep. It is associated with loud snoring, disrupted sleep and observed apneas with prevalence up to 54% in elderly people. Treatment of OSA varies from simple measures such as dental appliances and nasal continuous positive airway pressure (CPAP) to surgical procedures like uvulopalatopharyngoplasty and tracheostomy. Dental appliances are a viable nonsurgical treatment alternative in patients with OSA, of which mandibular advancement appliances are most common. Edentulism which contributes to the worsening of OSA reduces the number of available therapeutic strategies and is considered a contraindication to oral appliance therapy. This clinical report describes the treatment of a 61-year old edentulous OSA patient for whom a modified mandibular advancement appliance was designed. The patient reported an improvement in AHI index and he was satisfied with the modified appliance. This clinical report describes the newer technique of fabricating oral appliance for edentulous OSA patient.

Increased Neck Soft Tissue Mass and Worsening of Obstructive Sleep Apnea after Growth Hormone Treatment in Men with Abdominal Obesity

Risk factors for obstructive sleep apnea (OSA) are male gender, obesity and abnormalities in neck soft tissue mass. OSA is associated with both growth hormone (GH) excess and severe GH deficiency in adults. Adults with abdominal obesity have markedly suppressed GH secretion. To study the effect of GH treatment on OSA in abdominally obese men with impaired glucose tolerance. Forty men with abdominal obesity and glucose intolerance were randomized in a prospective, 12-month double-blind trial to receive either GH or placebo. The treatment groups had similar BMI and waist circumference. Overnight polysomnography and computed tomography to assess muscle and fat distribution in the neck and abdomen were performed at baseline and after 12 months. GH treatment increased insulin-like growth-factor-1i from (mean [SD]) 168 (72) to 292 (117) microg/L, the apnea-hypopnea index from (n/h) 31 (20) to 43 (25) and oxygen-desaturation index from (n/h) 18 (14) to 29 (21) (p = 0.0001, 0.001, 0.002). Neck transverse diameter, circumference and total cross-sectional area (p = 0.007, 0.01, 0.02) increased, while abdominal visceral adipose tissue (p = 0.007) was reduced. No between-group differences in total sleep time, REM sleep, NREM sleep, and time spent in supine position were found. The Epworth sleepiness scale score was unchanged. GH treatment increased the severity of OSA in abdominally obese men. The possible mechanism appears to be reflected by the GH-induced increase of measures of neck volume. The present results, to some extent, argue against that low GH/IGF-I activity is a primary cause of OSA in abdominally obese men.