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Ferreira CLP, Castelo PM, Zanato LE, Poyares D, Tufik S, Bommarito S. Relation between oro-facial thermographic findings and myofunctional characteristics in patients with obstructive sleep apnoea. J Oral Rehabil 2021; 48:720-729. [PMID: 33682155 DOI: 10.1111/joor.13163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/31/2021] [Accepted: 03/01/2021] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the thermographic characteristics of oro-facial structures and submental triangle of participants with obstructive sleep apnoea (OSA), as well as to investigate its correlation with the anatomy, posture and functions of the oro-facial structures. METHOD Eighteen patients diagnosed with OSA by polysomnography (OSA group; 57.4 ± 15.8 years) and 13 healthy participants screened for OSA (control group; 57.8 ± 18.1 years) were included. All participants answered to questionnaires for OSA and excessive daytime sleepiness, and were submitted to infrared image thermography analysis of facial regions of interest (ROIs), oro-facial myofunctional evaluation (OMES-E protocol) and masticatory performance. Statistical analysis included one-way ANOVA and Pearson/Spearman correlation test. RESULTS Obstructive sleep apnoea group showed lower thermographic measures in many ROIs in the frontal and lateral views of the face, including the submental triangle region, and lower scores of aspect/posture and performance of oro-facial structures, as well lower total score of OMES-E evaluation (P < .05). Scores of aspect/posture and mobility were correlated with the temperature of some ROIs in the frontal and lateral views. CONCLUSION Lower facial skin and submental triangle region temperatures, measured by infrared thermography, and a worse oro-facial myofunctional condition were identified in the group of individuals with OSA. The higher temperatures of the ROIs were correlated with the better status of aspect/posture and performance of the oro-facial myofunctional structures.
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Affiliation(s)
| | - Paula Midori Castelo
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo, Diadema, Brazil
| | - Luciana Escanoela Zanato
- Speech Therapy Course - Centro Universitário das Faculdades Metropolitanas Unidas - FMU, São Paulo, Brazil
| | - Dalva Poyares
- Departament of Psychobiology, Sleep Medicine Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Departament of Psychobiology, Sleep Medicine Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Silvana Bommarito
- Department of Speach Therapy, School of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
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2
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Pace A, Iannella G, Rossetti V, Visconti IC, Gulotta G, Cavaliere C, De Vito A, Maniaci A, Cocuzza S, Magliulo G, Ciofalo A. Diagnosis of Obstructive Sleep Apnea in Patients with Allergic and Non-Allergic Rhinitis. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E454. [PMID: 32911862 PMCID: PMC7559128 DOI: 10.3390/medicina56090454] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
Background and objectives: Rhinitis could be considered a risk factor for obstructive sleep apnea (OSA). Studies were conducted to evaluate the relation between OSA and Allergic rhinitis (AR). Non-allergic rhinitis with eosinophilia syndrome (NARES) is a condition with a symptomatology apparently similar to AR. The aim of this study was to evaluate the different presence of OSA in patients suffering from NARES and AR. Materials and Methods: Sixty patients were enrolled and subdivided into NARES, AR and control groups. NARES and AR diagnosis were performed using ARIA (Allergic Rhinitis and its Impact on Asthma) protocol. All patients were screened for OSA with home sleep apnea testing (HSAT) exam analyzing AHI (Apnea Hypopnea Index) values. Results: Results showed that 60% of patients affected by NARES presented OSA. On the contrary, altered AHI was found only in 35% of patients affected by AR and in 10% of patients belonging to the control group. Conclusions: In conclusion, data showed that there was an increased risk of OSA in NARES patients respect to AR patients and healthy patients.
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Affiliation(s)
- Annalisa Pace
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Giannicola Iannella
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Valeria Rossetti
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Irene Claudia Visconti
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Giampiero Gulotta
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Carlo Cavaliere
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Andrea De Vito
- Otorinolaringoatria Department, Santa Maria delle Croci Hospital of Ravenna, Viale Vincenzo Randi, 5, 48121 Ravenna, Italy;
| | - Antonino Maniaci
- Otorinolaringoiatria Department, University of Catania, Piazza Università, 2, 95131 Catania, Italy; (A.M.); (S.C.)
| | - Salvatore Cocuzza
- Otorinolaringoiatria Department, University of Catania, Piazza Università, 2, 95131 Catania, Italy; (A.M.); (S.C.)
| | - Giuseppe Magliulo
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Andrea Ciofalo
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
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Li J, Li S, Jiang H, Jiang L, Qiu L. Factors affecting airway compliance and resistance in children receiving general anesthesia during adenotonsillectomy. Medicine (Baltimore) 2020; 99:e22101. [PMID: 32899092 PMCID: PMC7478555 DOI: 10.1097/md.0000000000022101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Airway compliance is an important index in the surgery of pediatric patients. This study aimed to explore factors affecting dynamic airway compliance (Cdyn) and airway resistance (Raw) after general anesthesia endotracheal intubation for adenotonsillectomy of pediatric patients.A prospective study was undertaken of 107 children who underwent adenotonsillectomy in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine between January and June 2018. The values of Cdyn and Raw were recorded at 5, 10, and 15 minute during general anesthesia endotracheal intubation. Univariate analysis and multiple linear regression analysis were performed for factors that affected Cdyn and Raw.Of the 107 patients aged 56.67 ± 18.28 months, 69 (64%) patients were male, and 26 (24%) and 12 (11%) had an upper respiratory infection in the past week and 1 to 2 weeks, respectively. During anesthesia, Cdyn showed a decreasing trend (P < .001) while Raw showed an increasing trend (P < .001). Multivariate analysis revealed that height (β=0.177-0.193) had the strongest correlation with Cdyn; rales during pulmonary auscultation (β= -2.727 to -1.363) and sputum suction (β= -1.670 to -0.949) were also associated with Cdyn (all P < .05). Height was the factor with the strongest negative correlation with Raw (β= -0.382 to -0.305). Rales during pulmonary auscultation (β=10.063-11.326) and sputum suction (β=3.863-9.003) were also associated with Raw (All P < .05).Height, rales during preoperative auscultation and sputum suction were all associated with intraoperative Cydn and Raw for pediatric patients undergoing adenotonsillectomy and should be considered before the surgery.
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Affiliation(s)
- Jingjie Li
- Department of Anesthesiology, Shanghai Ninth People's Hospital
| | - Siyuan Li
- Department of Anesthesiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Jiang
- Department of Anesthesiology, Shanghai Ninth People's Hospital
| | - Lai Jiang
- Department of Anesthesiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Qiu
- Department of Anesthesiology, Shanghai Ninth People's Hospital
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Pladeck T, Happel A, Mand N, Galetke W. Asthma bronchiale und Schlaf. SOMNOLOGIE 2020. [DOI: 10.1007/s11818-020-00249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jarnalo M, Vardasca R, Mendes JG, Drummond M. Antero-cervical thermophysiological characterization of obstructive sleep apnea patients. Sleep Breath 2018; 22:1111-1116. [DOI: 10.1007/s11325-018-1644-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 02/08/2018] [Accepted: 02/13/2018] [Indexed: 11/28/2022]
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Cough hypersensitivity in patients with obstructive sleep apnea hypopnea syndrome. Sleep Breath 2018; 23:33-39. [PMID: 29453637 DOI: 10.1007/s11325-018-1641-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to investigate cough hypersensitivity and its potential mechanisms in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS Fifteen OSAHS patients, 12 simple snoring patients, and 15 healthy volunteers received cough sensitivity test and induced sputum cytology. Cough thresholds C2 and C5 (the minimum of capsaicin inducing ≥ 2 and ≥ 5 coughs, respectively), total cell count, cell differentials and the levels of bradykinin, histamine, prostaglandin E2, substance P, calcitonin gene-related peptide, pepsin, and interleukin-2 in the induced sputum detected by enzyme-linked immunosorbent assay were compared. The linear correlation between lgC2 and lgC5 and apnea hypopnea index, cell differentials, and inflammatory mediators in the induced sputum was calculated in OSAHS patients. RESULTS OSAHS patients presented with a significant lower C2 and C5 (P < 0.01), increased lymphocyte but decreased macrophage and neutrophil proportions in the induced sputum (P < 0.01), and higher contents of substance P, calcitonin gene-related peptide and interleukin-2 (P < 0.01) but similar levels of bradykinin, pepsin, prostaglandin E2, and histamine (P > 0.05) in the supernatant of induced sputum, when compared with simple snoring patients and healthy volunteers. However, theses variable were comparable between simple snoring patients and healthy volunteers (P > 0.05). Finally, lgC2 or lgC5 was negatively related to apnea hypopnea index, lymphocyte percentage, and the levels of substance P, calcitonin gene-related peptide or interleukin-2 in the sputum (P < 0.01). There was a positive linear correlation between lymphocyte percentage and interleukin-2 level in the induced sputum (r = 0.63, P = 0.00). CONCLUSION OSAHS patients have a predisposition of cough hypersensitivity associated with airway inflammation.
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Sundbom F, Janson C, Malinovschi A, Lindberg E. Effects of Coexisting Asthma and Obstructive Sleep Apnea on Sleep Architecture, Oxygen Saturation, and Systemic Inflammation in Women. J Clin Sleep Med 2018; 14:253-259. [PMID: 29394961 DOI: 10.5664/jcsm.6946] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/26/2017] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVES Both asthma and obstructive sleep apnea (OSA) are strongly associated with poor sleep. Asthma and OSA also have several features in common, including airway obstruction, systemic inflammation, and an association with obesity. The aim was to analyze the effect of asthma, OSA, and the combination of asthma and OSA on objectively measured sleep quality and systemic inflammation. METHODS Sleep and health in women is an ongoing community-based study in Uppsala, Sweden. Three hundred eighty-four women ages 20 to 70 years underwent overnight polysomnography and completed questionnaires on airway diseases and sleep complaints. C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor α were analyzed. RESULTS The group with both asthma and OSA had higher CRP, higher IL-6, a longer sleeping time in stage N1 sleep and stage N2 sleep, and less time in stage R sleep than the control group with no asthma or OSA. The group with both asthma and OSA had lower mean oxygen saturation (93.4% versus 94.7%, P = .04) than the group with OSA alone. The results were consistent after adjusting for age, body mass index, and smoking status. Asthma was independently associated with lower oxygen saturation, whereas OSA was not. CONCLUSIONS Our data indicate that coexisting asthma and OSA are associated with poorer sleep quality and more profound nocturnal hypoxemia than either of the conditions alone. The results are similar to earlier findings related to OSA and chronic obstructive pulmonary disease, but they have not previously been described for asthma.
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Affiliation(s)
- Fredrik Sundbom
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Lacedonia D, Carpagnano GE, Patricelli G, Carone M, Gallo C, Caccavo I, Sabato R, Depalo A, Aliani M, Capozzolo A, Foschino Barbaro MP. Prevalence of comorbidities in patients with obstructive sleep apnea syndrome, overlap syndrome and obesity hypoventilation syndrome. CLINICAL RESPIRATORY JOURNAL 2018; 12:1905-1911. [PMID: 29227046 DOI: 10.1111/crj.12754] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/22/2017] [Accepted: 12/05/2017] [Indexed: 02/05/2023]
Affiliation(s)
- Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia; Foggia Italy
| | | | - Giulia Patricelli
- Department of Medical and Surgical Sciences, University of Foggia; Foggia Italy
| | - Mauro Carone
- Pulmonary Division, ICS Maugeri Spa SB; IRCCS Cassano delle Murge Italy
| | - Crescenzio Gallo
- Department of Clinical and Experimental Medicine, University of Foggia; Foggia Italy
| | - Incoronata Caccavo
- Department of Medical and Surgical Sciences, University of Foggia; Foggia Italy
| | - Roberto Sabato
- Department of Medical and Surgical Sciences, University of Foggia; Foggia Italy
| | - Annarita Depalo
- Department of Medical and Surgical Sciences, University of Foggia; Foggia Italy
| | - Maria Aliani
- Pulmonary Division, ICS Maugeri Spa SB; IRCCS Cassano delle Murge Italy
| | - Alberto Capozzolo
- Pulmonary Division, ICS Maugeri Spa SB; IRCCS Cassano delle Murge Italy
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9
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Schwarz EI, Engler A, Kohler M. Exhaled breath analysis in obstructive sleep apnea. Expert Rev Respir Med 2017; 11:631-639. [DOI: 10.1080/17476348.2017.1338950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Esther I Schwarz
- Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | - Anna Engler
- Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
- Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
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Zhang D, Luo J, Qiao Y, Xiao Y, Huang R, Zhong X. Measurement of exhaled nitric oxide concentration in patients with obstructive sleep apnea: A meta-analysis. Medicine (Baltimore) 2017; 96:e6429. [PMID: 28328850 PMCID: PMC5371487 DOI: 10.1097/md.0000000000006429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Exhaled nitric oxide (eNO) has been proposed as a noninvasive measure of airway inflammation. However, its value in patients with obstructive sleep apnea (OSA) is still controversial. The authors aim to assess the difference in eNO levels between patients with OSA and controls by a meta-analysis. METHODS A systematic search was performed in the PubMed, EMBASE, the Cochrane Library, and MEDLINE databases to collect relevant studies published from 1996 to 2016. Eligible studies that reported eNO levels in patients with OSA were included. STATA (version 12.0) was used for data analysis. RESULTS Two hundred eighty-four studies were reviewed for inclusion, with 16 studies pooled for analysis (16 studies for fractional exhaled nitric oxide [FENO], 5 for alveolar nitric oxide [CANO], and 4 for the maximum airway wall flux of nitric oxide [J'awNO]). The FENO levels were significantly higher in patients with OSA compared with that in the control groups (6.32 ppb, 95% confidence interval [CI] 4.46-8.33, P < 0.001). Furthermore, FENO was significantly increased (4.00 ppb, 95% CI 1.74-6.27, P = 0.001) after overnight sleep in patients with OSA, but not in healthy controls. Additionally, long-term continuous positive airway pressure (CPAP) therapy reduced FENO levels (-5.82 ppb, 95% CI -9.6 to -2.01, P < 0.001). However, the CANO (-0.01 ppb, 95% CI -1.66 to 1.64, P = 0.989) and J'awNO levels (220.32 pl/s, 95% CI -49.31 to 489.94, P = 0.109) were not significantly different between the OSA groups and non-OSA groups. CONCLUSION The results of the meta-analysis suggest that OSA is significantly associated with airway inflammation and elevated FENO levels can be modified by long-term CPAP therapy. J'awNO and CANO levels were not significantly different between the OSA groups and control groups.
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Azuma M, Murase K, Tachikawa R, Hamada S, Matsumoto T, Minami T, Inouchi M, Tanizawa K, Handa T, Oga T, Mishima M, Chin K. Relationship between obstructive sleep apnea and endogenous carbon monoxide. J Appl Physiol (1985) 2016; 122:104-111. [PMID: 27856716 DOI: 10.1152/japplphysiol.00658.2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/31/2016] [Accepted: 11/14/2016] [Indexed: 11/22/2022] Open
Abstract
Endogenous carbon monoxide (CO) levels are recognized as a surrogate marker for activity of heme oxygenase-1, which is induced by various factors, including hypoxia and oxidative stress. Few reports have evaluated endogenous CO in patients with obstructive sleep apnea (OSA). Whether OSA more greatly affects exhaled or blood CO is not known. Sixty-nine patients with suspected OSA were prospectively included in this study. Exhaled and blood CO were evaluated at night and morning. Blood and exhaled CO levels were well correlated both at night and morning (r = 0.52, P < 0.0001 and r = 0.61, P < 0.0001, respectively). Although exhaled CO levels both at night and morning significantly correlated with total sleep time with arterial oxygen saturation < 90% (ρ = 0.41, P = 0.0005 and ρ = 0.27, P = 0.024, respectively), blood CO levels did not correlate with any sleep parameter. Seventeen patients with an apnea and hypopnea index (AHI) < 15 (control group) were compared with 52 patients with AHI ≥ 15 (OSA group). Exhaled CO levels at night in the OSA group were significantly higher than in the control group (3.64 ± 1.2 vs. 2.99 ± 0.70 ppm, P < 0.05). Exhaled CO levels at night decreased after 3 mo of continuous positive airway pressure (CPAP) therapy in OSA patients (n = 36; P = 0.016) to become nearly the same level as in the control group (P = 0.21). Blood CO levels did not significantly change after CPAP therapy. Exhaled CO was positively related to hypoxia during sleep in OSA patients, but blood CO was not. Exhaled CO might better correlate with oxidative stress associated with OSA than blood CO. NEW & NOTEWORTHY Endogenous carbon monoxide (CO) levels are recognized to be a surrogate marker of oxidative stress. No study has evaluated both exhaled and blood CO at the same time in obstructive sleep apnea (OSA) patients. Here we provide evidence that exhaled CO levels positively correlated with hypoxia during sleep in OSA patients, but blood CO levels did not, and that continuous positive airway pressure therapy significantly decreased exhaled CO levels in the OSA group, but did not significantly affect blood CO.
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Affiliation(s)
- Masanori Azuma
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and
| | - Kimihiko Murase
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and
| | - Satoshi Hamada
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and
| | - Takeshi Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and
| | - Takuma Minami
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and
| | - Morito Inouchi
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and
| | - Toru Oga
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Michiaki Mishima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; and
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Yang CH, Shen YJ, Lai CJ, Kou YR. Inflammatory Role of ROS-Sensitive AMP-Activated Protein Kinase in the Hypersensitivity of Lung Vagal C Fibers Induced by Intermittent Hypoxia in Rats. Front Physiol 2016; 7:263. [PMID: 27445853 PMCID: PMC4922301 DOI: 10.3389/fphys.2016.00263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/14/2016] [Indexed: 12/18/2022] Open
Abstract
Obstructive sleep apnea (OSA), manifested by airway exposure to intermittent hypoxia (IH), is associated with excess reactive oxygen species (ROS) production in airways, airway inflammation, and hyperreactive airway diseases. The cause-effect relationship for these events remains unclear. We investigated the inflammatory role of ROS-sensitive AMP-activated protein kinase (AMPK) in IH-induced airway hypersensitivity mediated by lung vagal C fibers (LVCFs) in rats. Conscious rats were exposed to room air (RA) or IH with or without treatment with N-acetyl-L-cysteine (NAC, an antioxidant), Compound C (an AMPK inhibitor), ibuprofen (a cyclooxygenase inhibitor), or their vehicles. Immediately after exposure (24 h), we found that intravenous capsaicin, phenylbiguanide, or α,β-methylene-ATP evoked augmented LVCF-mediated apneic responses and LVCF afferent responses in rats subjected to IH exposure in comparison with those in RA rats. The potentiating effect of IH on LVCF responses decreased at 6 h after and vanished at 12 h after the termination of IH exposure. The potentiating effect of IH on LVCF-mediated apneic and LVCF afferent responses was significantly attenuated by treatment with NAC, compound C, or ibuprofen, but not by their vehicles. Further biochemical analysis revealed that rats exposed to IH displayed increased lung levels of lipid peroxidation (an index of oxidative stress), AMPK phosphorylation (an index of AMPK activation), and prostaglandin E2 (a cyclooxygenase metabolite), compared with those exposed to RA. IH-induced increase in lipid peroxidation was considerably suppressed by treatment with NAC but not by compound C or ibuprofen. IH-induced increase in AMPK phosphorylation was totally abolished by NAC or compound C but not by ibuprofen. IH-induced increase in prostaglandin E2 was considerably prevented by any of these three inhibitor treatments. The vehicles of these inhibitors exerted no significant effect on the three IH-induced responses. These results suggest that 24-h IH exposure sensitizes LVCFs, leading to an exaggerated reflex and afferent responses to chemical stimulants in rats. Moreover, this IH-induced LVCF sensitization is mediated through a cascade of inflammatory responses in the airways involving increases in ROS, AMPK activation, and cyclooxygenase metabolite release.
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Affiliation(s)
- Chang-Huan Yang
- Institute of Physiology, School of Medicine, National Yang-Ming University Taipei, Taiwan
| | - Yan-Jhih Shen
- Department of Pharmacology and Toxicology, School of Medicine, Tzu Chi University Hualien, Taiwan
| | - Ching Jung Lai
- Department of Physiology, Tzu Chi University Hualien, Taiwan
| | - Yu Ru Kou
- Institute of Physiology, School of Medicine, National Yang-Ming University Taipei, Taiwan
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Bikov A, Hull JH, Kunos L. Exhaled breath analysis, a simple tool to study the pathophysiology of obstructive sleep apnoea. Sleep Med Rev 2016; 27:1-8. [DOI: 10.1016/j.smrv.2015.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
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Study of Exhaled Nitric Oxide in Subjects with Suspected Obstructive Sleep Apnea: A Pilot Study in Vietnam. Pulm Med 2016; 2016:3050918. [PMID: 26881073 PMCID: PMC4737467 DOI: 10.1155/2016/3050918] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 11/20/2022] Open
Abstract
Background and Objective. The concentration of exhaled nitric oxide (eNO), reflecting the activity of inducible NO synthase in airway epithelium, has been found to increase in patients with obstructive sleep apnea (OSA). This study aimed to measure eNO concentration in patients with suspected OSA and to correlate different eNO parameters with clinical and sleep apnea characteristics. Methods. In this cross-sectional study, all patients underwent in-lab overnight polysomnography (PSG) and eNO measurement using a method of multiple flow rates before and after PSG (pre- and post-PSG). Results. According to the result of PSG, 82 persons were divided into two groups: control subjects (n = 30; 54 ± 14 years) and patients with OSA defined as apnea-hypopnea index (AHI) ≥ 5/hour (n = 52; 53 ± 12 years). Body mass index (BMI) and neck and abdomen circumferences of OSA patients were significantly higher than those from control subjects. In OSA group, post-PSG alveolar NO concentration (CANO) (5.3 ± 1.9 ppb) was significantly higher than pre-PSG CANO (4.0 ± 1.7 ppb; P < 0.001). Significant correlations have been found between CANO and AHI (P < 0.001) and between CANO and nadir SpO2 (P < 0.05). The daytime CANO value of more than 4.1 ppb can be used to screen symptomatic subjects for the presence of OSA with a high specificity of 93.3%. Conclusion. Our findings indicate CANO as a surrogate marker for OSA in persons with suggestive symptoms.
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Yuan X, Guo X, Deng Y, Zhu D, Shang J, Liu H. Chronic intermittent hypoxia-induced neuronal apoptosis in the hippocampus is attenuated by telmisartan through suppression of iNOS/NO and inhibition of lipid peroxidation and inflammatory responses. Brain Res 2014; 1596:48-57. [PMID: 25463026 DOI: 10.1016/j.brainres.2014.11.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/04/2014] [Accepted: 11/16/2014] [Indexed: 01/14/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) plays a critical role in the initiation and progression of Alzheimer׳s disease (AD), but little is known about the precise mechanism of OSAS-induced AD. Nitric oxide synthase (NOS) and nitric oxide (NO) are known to play key roles in the development of AD. Several studies have confirmed that an angiotensin II type 1 receptor blocker, telmisartan, beneficially regulates NOS and NO. Here, we examined the neuroprotective effects of telmisartan against hippocampal apoptosis induced by chronic intermittent hypoxia (CIH), the most characteristic pathophysiological change of OSAS. Adult male Sprague Dawley rats were subjected to 8h of intermittent hypoxia per day with or without telmisartan for eight weeks. Neuronal apoptosis in the hippocampal CA1 region, NOS activity, NO content, and the presence of inflammatory agents and radical oxygen species in the hippocampus were determined. The results showed that CIH activated inducible nitric oxide synthase (iNOS), increased NO content, and enhanced lipid peroxidation and inflammatory responses in the hippocampus. Treatment with telmisartan inhibited excessive iNOS and NO generation and reduced lipid peroxidation and inflammatory responses. In addition, telmisartan significantly ameliorated the hippocampal apoptosis induced by CIH. In conclusion, Pre-CIH telmisartan administration attenuated CIH-induced hippocampal apoptosis partly by regulating NOS activity, inhibiting excessive NO generation, and reducing lipid peroxidation and inflammatory responses.
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Affiliation(s)
- Xiao Yuan
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, No.1095 Jiefang Road, Wuhan, 430030, China
| | - Xueling Guo
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, No.1095 Jiefang Road, Wuhan, 430030, China
| | - Yan Deng
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, No.1095 Jiefang Road, Wuhan, 430030, China
| | - Die Zhu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, No.1095 Jiefang Road, Wuhan, 430030, China
| | - Jin Shang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, No.1095 Jiefang Road, Wuhan, 430030, China
| | - Huiguo Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Huazhong University of Science and Technology, No.1095 Jiefang Road, Wuhan, 430030, China.
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Efecto de la presión positiva continua en las vías aéreas y de la cirugía de las vías aéreas superiores sobre los biomarcadores en condensado de aire exhalado y en suero en pacientes con apnea del sueño. Arch Bronconeumol 2014; 50:422-8. [DOI: 10.1016/j.arbres.2014.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 11/18/2022]
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Effect of Continuous Positive Airway Pressure and Upper Airway Surgery on Exhaled Breath Condensate and Serum Biomarkers in Patients With Sleep Apnea. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.arbr.2014.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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The association between exhaled nitric oxide and sleep apnea: The role of BMI. Respir Med 2014; 108:1229-33. [DOI: 10.1016/j.rmed.2014.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/15/2014] [Accepted: 05/18/2014] [Indexed: 11/22/2022]
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Memtsoudis SG, Stundner O, Rasul R, Chiu YL, Sun X, Ramachandran SK, Kaw R, Fleischut P, Mazumdar M. The impact of sleep apnea on postoperative utilization of resources and adverse outcomes. Anesth Analg 2014; 118:407-418. [PMID: 24445639 DOI: 10.1213/ane.0000000000000051] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite the concern that sleep apnea (SA) is associated with increased risk for postoperative complications, a paucity of information is available regarding the effect of this disorder on postoperative complications and resource utilization in the orthopedic population. With an increasing number of surgical patients suffering from SA, this information is important to physicians, patients, policymakers, and administrators alike. METHODS We analyzed hospital discharge data of patients who underwent total hip or knee arthroplasty in approximately 400 U.S. Hospitals between 2006 and 2010. Patient, procedure, and health care system-related demographics and outcomes such as mortality, complications, and resource utilization were compared among groups. Multivariable logistic regression models were fit to assess the association between SA and various outcomes. RESULTS We identified 530,089 entries for patients undergoing total hip and knee arthroplasty. Of those, 8.4% had a diagnosis code for SA. In the multivariate analysis, the diagnosis of SA emerged as an independent risk factor for major postoperative complications (OR 1.47; 95% confidence interval [CI], 1.39-1.55). Pulmonary complications were 1.86 (95% CI, 1.65-2.09) times more likely and cardiac complications 1.59 (95% CI, 1.48-1.71) times more likely to occur in patients with SA. In addition, SA patients were more likely to receive ventilatory support, use more intensive care, stepdown and telemetry services, consume more economic resources, and have longer lengths of hospitalization. CONCLUSIONS The presence of SA is a major clinical and economic challenge in the postoperative period. More research is needed to identify SA patients at risk for complications and develop evidence-based practices to aid in the allocation of clinical and economic resources.
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Affiliation(s)
- Stavros G Memtsoudis
- From the *Department of Anesthesiology, Hospital for Special Surgery, †Division of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, New York, New York; ‡Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan; §Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio; and ‖Department of Anesthesiology, NewYork-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York
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Sleep apnea and total joint arthroplasty under various types of anesthesia: a population-based study of perioperative outcomes. Reg Anesth Pain Med 2014; 38:274-81. [PMID: 23558371 DOI: 10.1097/aap.0b013e31828d0173] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The presence of sleep apnea (SA) among surgical patients has been associated with significantly increased risk of perioperative complications. Although regional anesthesia has been suggested as a means to reduce complication rates among SA patients undergoing surgery, no data are available to support this association. We studied the association of the type of anesthesia and perioperative outcomes in patients with SA undergoing joint arthroplasty. METHODS Drawing on a large administrative database (Premier Inc), we analyzed data from approximately 400 hospitals in the United States. Patients with a diagnosis of SA who underwent primary hip or knee arthroplasty between 2006 and 2010 were identified. Perioperative outcomes were compared between patients receiving general, neuraxial, or combined neuraxial-general anesthesia. RESULTS We identified 40,316 entries for unique patients with a diagnosis for SA undergoing primary hip or knee arthroplasty. Of those, 30,024 (74%) had anesthesia-type information available. Approximately 11% of cases were performed under neuraxial, 15% under combined neuraxial and general, and 74% under general anesthesia. Patients undergoing their procedure under neuraxial anesthesia had significantly lower rates of major complications than did patients who received combined neuraxial and general or general anesthesia (16.0%, 17.2%, and 18.1%, respectively; P = 0.0177). Adjusted risk of major complications for those undergoing surgery under neuraxial or combined neuraxial-general anesthesia compared with general anesthesia was also lower (odds ratio, 0.83 [95% confidence interval, 0.74-0.93; P = 0.001] vs odds ratio, 0.90 [95% confidence interval, 0.82-0.99; P = 0.03]). CONCLUSIONS Barring contraindications, neuraxial anesthesia may convey benefits in the perioperative outcome of SA patients undergoing joint arthroplasty. Further research is needed to enhance an understanding of the mechanisms by which neuraxial anesthesia may exert comparatively beneficial effects.
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Ferrarini A, Rupérez FJ, Erazo M, Martínez MP, Villar-Álvarez F, Peces-Barba G, González-Mangado N, Troncoso MF, Ruiz-Cabello J, Barbas C. Fingerprinting-based metabolomic approach with LC-MS to sleep apnea and hypopnea syndrome: a pilot study. Electrophoresis 2013; 34:2873-81. [PMID: 23775633 DOI: 10.1002/elps.201300081] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/19/2013] [Accepted: 05/04/2013] [Indexed: 11/05/2022]
Abstract
Sleep apnea and hypopnea syndrome (SAHS) is a multicomponent disorder, with associated cardiovascular and metabolic alterations, second in order of frequency among respiratory disorders. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, which requires having the patient in hospital. In addition, a more clear classification of patients according to mild and severe presentations would be desirable. The aim of the present study was to assess the relative metabolic changes in SAHS to identify new potential biomarkers for diagnosis, able to evaluate disease severity to establish response to therapeutic interventions and outcomes. For this purpose, metabolic fingerprinting represents a valuable strategy to monitor, in a nontargeted manner, the changes that are at the base of the pathophysiological mechanism of SAHS. Plasma samples of 33 SAHS patients were collected after polysomnography and analyzed with LC coupled to MS (LC-QTOF-MS). After data treatment and statistical analysis, signals differentiating nonsevere and severe patients were detected. Putative identification of 14 statistically significant features was obtained and changes that can be related to the episodes of hypoxia/reoxygenation (inflammation) have been highlighted. Among them, the patterns of variation of platelet activating factor and lysophospholipids, together with some compounds related to differential activity of the gut microflora (bile pigments and pipecolic acid) open new lines of research that will benefit our understanding of the alterations, offering new possibilities for adequate monitoring of the stage of the disease.
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Affiliation(s)
- Alessia Ferrarini
- Center for Metabolomics and Bioanalysis (CEMBIO), Facultad de Farmacia, Universidad CEU San Pablo, Madrid, Spain
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Obstructive sleep apnea and asthma: associations and treatment implications. Sleep Med Rev 2013; 18:165-71. [PMID: 23890469 DOI: 10.1016/j.smrv.2013.04.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/12/2013] [Accepted: 04/24/2013] [Indexed: 12/19/2022]
Abstract
Obstructive sleep apnea (OSA) and asthma are highly prevalent respiratory disorders and are frequently co-morbid. Risk factors common to the two diseases include obesity, rhinitis, and gastroesophageal reflux (GER). Observational and experimental evidence implicates airways and systemic inflammation, neuromechanical effects of recurrent upper airway collapse, and asthma-controlling medications (corticosteroids) as additional explanatory factors. Therefore, undiagnosed or inadequately treated OSA may adversely affect control of asthma and vice versa. It is important for clinicians to be vigilant and specifically address weight-control, nasal obstruction, and GER in these populations. Utilizing validated screening instruments to affirm high risk of co-morbid OSA or asthma in persistently symptomatic patients will allow clinicians to cost-effectively test and treat appropriate patients, potentially improving outcomes. While non-invasive ventilation in acute asthma improves outcomes, the role of chronic continuous positive airway pressure (CPAP; the first-line treatment for OSA) in improving long-term asthma control is not known. Future research should focus on the impact of optimal CPAP therapy and adherence on asthma symptoms and outcomes.
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Kheirandish-Gozal L, Kim J, Goldbart AD, Gozal D. Novel pharmacological approaches for treatment of obstructive sleep apnea in children. Expert Opin Investig Drugs 2012; 22:71-85. [PMID: 23126687 DOI: 10.1517/13543784.2013.735230] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The lymphadenoid tissues in the upper airway are sparse and organized lympho-epithelial structures playing an important role against foreign pathogens, with the palatine tonsils being the major components of the lymphoid tissues contained in the Waldeyer's ring. Obstructive sleep apnea (OSA) has emerged as a very frequent condition in the pediatric age range that is associated with substantial neurobehavioral, cardiovascular and metabolic morbidities. Adenotonsillar hypertrophy is the major pathophysiological contributor to OSA occurrence in children. AREAS COVERED Here, the authors provide a systematic review and summary of some of the known histological and pathological features of human lymphadenoid tissues and their fundamental immunological functions, provide insights into the pathophysiology of pediatric OSA, particularly focusing on inflammatory pathways and the available outcomes associated with targeting such pathways with compounds such as corticosteroids and leukotriene modifiers. Furthermore, they present findings from an unbiased approach to discovery of therapeutic targets and formulate constructs toward putative future interventional approaches for this highly prevalent condition. EXPERT OPINION Surgical approaches for pediatric OSA may not be as effective as previously anticipated. Accordingly, expanded use of existing systemic or topical anti-inflammatory agents or development of novel compounds targeting selected immune cell populations underlying pathophysiological determinants of OSA is needed.
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Affiliation(s)
- Leila Kheirandish-Gozal
- University of Chicago, Comer Children's Hospital, Pritzker School of Medicine, Biological Sciences Division, Department of Pediatrics, Chicago, IL 60637, USA
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Serum, urine, and breath-related biomarkers in the diagnosis of obstructive sleep apnea in children. Curr Opin Pulm Med 2012; 18:561-7. [DOI: 10.1097/mcp.0b013e328358be2d] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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