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Schiza S, Schwarz EI, Bonsignore MR, McNicholas WT, Pataka A, Bouloukaki I. Co-existence of OSA and respiratory diseases and the influence of gender. Expert Rev Respir Med 2023; 17:1221-1235. [PMID: 38198636 DOI: 10.1080/17476348.2024.2304065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/08/2024] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Sleep-disordered breathing (SDB), especially obstructive sleep apnea (OSA), is commonly associated with respiratory diseases, such as COPD, asthma and interstitial lung disease. AREAS COVERED This narrative review aims to comprehensively synthesize the existing information on SDB in respiratory diseases, investigate the role of gender in this association, and highlight the importance of OSA management in improving sleep, quality of life, and disease prognosis in these specific patient populations. EXPERT OPINION Research indicates a synergistic link between OSA and chronic respiratory diseases, which leads to greater morbidity and mortality compared to each disorder alone. Given the lack of an optimal OSA screening tool for these patients, a comprehensive patient approach and overnight diagnostic sleep study are imperative. Despite the limited evidence available, it seems that gender has an impact on the prevalence, severity, and susceptibility of this coexistence. Recognizing the role of gender in the coexistence of OSA and other respiratory diseases can enhance everyday medical practice and enable clinicians to adopt a more personalized approach toward optimal screening and diagnosis of these patients.
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Affiliation(s)
- Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete School of Medicine, Crete, Greece
| | - Esther I Schwarz
- Department of Pulmonology, University Hospital Zurich and University of Zurich, University of Zurich Faculty of Medicine, Zurich, Switzerland
| | - Maria R Bonsignore
- Division of Respiratory Medicine, PROMISE Department, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Athanasia Pataka
- Respiratory Failure Unit, G Papanikolaou Hospital, Medical School, Aristoteleio Panepistemio Thessalonikes Schole Epistemon Ygeias, Thessaloniki, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete School of Medicine, Crete, Greece
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Lee JH, Jang JH, Park JH, Lee S, Kim JY, Ko J, Jung SY, Kim DW, Hong S, Jang HJ. Prevalence and clinical impacts of obstructive sleep apnea in patients with idiopathic pulmonary fibrosis: A single-center, retrospective study. PLoS One 2023; 18:e0291195. [PMID: 37751461 PMCID: PMC10522004 DOI: 10.1371/journal.pone.0291195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease with chronic, progressive lung fibrosis with a poor prognosis. Recent studies have reported a high prevalence of obstructive sleep apnea (OSA) in IPF patients and an association with poor prognosis. This study aimed to evaluate the prevalence, risk factors, and clinical effects on mortality of OSA in patients with IPF. METHODS Clinical data were retrospectively analyzed in 167 patients with IPF at Haeundae-Paik Hospital, Republic of Korea. A type 4 portable device was used to monitor OSA, and an apnea-hypopnea index of 5 events per sleep hour and above was diagnosed as OSA. RESULTS The mean follow-up period and age were 26.9 months and 71.4 years, respectively, with male predominance. OSA was confirmed in 108 patients (64.7%). Mild OSA was the most common (62.1%). Independent risk factors for OSA in the multivariate logistic regression analysis were age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.13, p = 0.007), body weight (OR 1.05, 95% CI 1.02-1.09, p = 0.002), and risk based on the Berlin questionnaire (OR 2.76, 95% CI 1.12-6.80, p = 0.028). Shorter six-minute walk distance (6MWD) (hazard ratio [HR] 1.00, 95% CI: 1.00-1.00, p < 0.001), acute exacerbation (AE) (HR 13.83, 95% CI: 5.71-33.47, p < 0.001), and higher percentage of cumulative time with oxygen saturation below 90% in total sleep time (HR 1.08, 95% CI: 1.02-1.14, p = 0.007) were risk factors for mortality in IPF patients in the Cox regression analysis. CONCLUSION Approximately two-thirds of the IPF patients had OSA. Older age, higher body weight, and high risk based on the Berlin questionnaire were independent risk factors for OSA in IPF patients. Shorter 6MWD, experience of AE, and night hypoxemia during sleep were associated with a higher risk of mortality in patients with IPF.
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Affiliation(s)
- Jae Ha Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ji Hoon Jang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jin Han Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sunggun Lee
- Division of Rheumatology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ji Yeon Kim
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Junghae Ko
- Division of Endocrinology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - So Young Jung
- Department of Dermatology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Dae-Wook Kim
- Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - SungMin Hong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Hang-Jea Jang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Bokov P, Dudoignon B, Delclaux C. Determinants of awake oropharyngeal volume reduction between sitting and supine positions in children evaluated for snoring. J Sleep Res 2023. [PMID: 36866820 DOI: 10.1111/jsr.13867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Pharyngeal collapsibility is a major determinant of obstructive sleep apnea (OSA) pathophysiology, but its anatomical predictors in children are largely unknown. We hypothesised that anatomical (tonsillar hypertrophy, narrow palate, nasal obstruction, dental/skeletal malocclusion, obesity) and OSA-related (apnea-hypopnea index, AHI) parameters could be related to a measure of awake pharyngeal collapsibility. We performed acoustic pharyngometry in children evaluated for suspected OSA, allowing us to measure the reduction of oropharyngeal volume in supine versus sitting position normalised for the volume in supine position (ΔV%), a measure of pharyngeal collapsibility. In addition to polysomnography and a clinical examination (anatomical parameters), acoustic rhinometry was used to assess nasal obstruction. A total of 188 snoring children were included, 118 (63%) of whom were obese and 74 (39%) of whom had moderate to severe OSA (AHI ≥5/h). The median (25th-75th percentiles) ΔV% in the whole population was 20.1% (4.7; 43.3). ΔV% was independently and positively associated with AHI (p = 0.023), z-score of BMI (p = 0.001), tonsillar hypertrophy (p = 0.007), narrow palate (p = 0.035), and African (p < 0.001) ancestry. By contrast, ΔV% was not modified by dental or skeletal malocclusion, Friedman palate position class or nasopharyngeal obstruction. Tonsillar hypertrophy, obesity, narrow palate and African ancestry are independently associated with an increase in pharyngeal collapsibility in snoring children, thus increasing the risk of OSA. Increased pharyngeal compliance in African children may explain the increased risk of residual OSA after adenotonsillectomy observed in this population.
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Affiliation(s)
- Plamen Bokov
- Université de Paris-Cité, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Paris, France
| | - Benjamin Dudoignon
- Université de Paris-Cité, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Paris, France
| | - Christophe Delclaux
- Université de Paris-Cité, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Paris, France
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Alkhader M, Alrashdan MS, Abdo N, Abbas R. Usefulness of Hard Palate Measurements in Predicting Airway Dimensions in Patients Referred for Cone Beam CT. Open Dent J 2021. [DOI: 10.2174/1874210602115010505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
The aim of the study was to evaluate the usefulness of hard palate measurements in predicting airway dimensions in patients referred for cone-beam CT (CBCT).
Materials and Methods:
Six hundred forty-three patients (239 males and 404 females) were examined by CBCT. Using dedicated CBCT software (Kodak CS 3D imaging version 3.8.6, Carestream, Rochester, NY, USA); different hard palate (palatal interalveolar length, palatal arch depth, maxillo-palatal arch angle, and alveolar width) and airway measurements (airway volume, minimum cross-sectional area, minimum anteroposterior distance, minimum right to left distance and airway length) were obtained and correlated using Pearson’s correlation coefficients and regression analysis.
Results:
Although the correlation between hard palate and airway measurements was weak (Pearson coefficient (r) < 0.40), there were significant (P < 0.05) additive effects for hard palate measurements in predicting airway dimensions. Maxillo-palatal arch angle was the only hard palate measurement that had no effect in predicting airway dimensions.
Conclusion:
Hard palate measurements are considered useful in predicting airway dimensions in patients referred for CBCT.
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Opsahl UL, Berge M, Lehmann S, Bjorvatn B, Opsahl P, Johansson A. Acoustic pharyngometry - A new method to facilitate oral appliance therapy. J Oral Rehabil 2020; 48:601-613. [PMID: 33314265 PMCID: PMC8246767 DOI: 10.1111/joor.13134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/04/2020] [Indexed: 12/14/2022]
Abstract
Background There is lack of reliable and accurate methods to predict treatment outcomes of oral appliance (OA) treatment. Acoustic pharyngometry (AP) is a non‐invasive technique to evaluate the volume and minimal cross‐sectional area of the upper airway, which may prove useful to locate the optimal position of OAs. Objective This retrospective study aimed to evaluate the effect of applying AP to OA treatment of patients with obstructive sleep apnoea (OSA). Methods All patients (n = 244) treated with OAs following an AP protocol at two dental clinics between 2013 and 2018 were invited to participate. A total of 129 patients accepted the invitation, and 120 patients (75 men, 45 women) were included in the analyses. Mean baseline age, BMI and apnoea hypopnea index (AHI) were 59.1 ± 0.9 years, 27.8 ± 0.4 and 21.9 ± 1.1, respectively. Mean follow‐up time was 318 ± 24 days. Results AHI at follow‐up was 6.4 ± 0.7, resulting in a treatment success rate of 86.7% (≥50% reduction of baseline AHI). The number of failures (<50% reduction of baseline AHI) did not differ significantly among patients with mild, moderate and severe OSA. 87.6% of the patients reported OA usage every night, and 95.5% reported > 5 hours usage per night, when worn. Conclusion The AP protocol applied seems to contribute to the excellent effect of OA treatment in this study. Further research on the application of AP in OA treatment is necessary in order to clarify its possible beneficial contribution to improving OA therapy.
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Affiliation(s)
- Ulrik Leidland Opsahl
- Department of Clinical Dentistry - Prosthodontics, Faculty of Medicine, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Tannhelsesenteret Lørenskog og Sogndal, Lørenskog, Norway
| | - Morten Berge
- Department of Clinical Dentistry - Prosthodontics, Faculty of Medicine, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Sverre Lehmann
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Section for Thoracic Medicine, Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Per Opsahl
- Tannhelsesenteret Lørenskog og Sogndal, Lørenskog, Norway
| | - Anders Johansson
- Department of Clinical Dentistry - Prosthodontics, Faculty of Medicine, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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Lee JH, Park CS, Song JW. Obstructive sleep apnea in patients with interstitial lung disease: Prevalence and predictive factors. PLoS One 2020; 15:e0239963. [PMID: 33017401 DOI: 10.1371/journal.pone.0239963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Interstitial lung diseases (ILDs) are chronic, progressive, parenchymal lung diseases with high morbidity and mortality. In recent studies, the prevalence of obstructive sleep apnea (OSA) in patients with ILD has been reported to be high. However, the prevalence and predictive factors of OSA in Korean ILD patients are not well defined. Therefore, the aim of this study was to evaluate the prevalence and predictive factors of OSA in Korean patients with ILD. Clinical data from 86 patients with ILD enrolled from December 2017 to April 2019 at Haeundae-Paik Hospital, Busan, South Korea, were retrospectively analyzed. OSA was monitored with a level 4 portable device and defined as an apnea-hypopnea index of more than 5 per hour of sleep. The median follow-up period was 7 months. The mean age was 69.8 years, and 64% of participants were men. Among the ILDs, idiopathic pulmonary fibrosis (IPF) was the most common (66.3%), followed by connective tissue disease-associated ILD (16.3%) and cryptogenic organizing pneumonia (5.8%). Forty-six ILD patients (53.5%) were diagnosed with OSA, and IPF patients had OSA more frequently (64.9% vs. 31.0%, p = 0.003) than those with other ILDs. Older age (odds ratio [OR], 1.11, 95% CI 1.04-1.19, p = 0.002), higher body weight (OR 1.05, 95% CI 1.01-1.10, p = 0.012), and diabetes mellitus (OR 4.03, 95% CI 1.26-12.91, p = 0.019) were independent risk factors for OSA in the multivariable logistic regression analysis. In the multivariable Cox analysis, an IPF diagnosis was a significant risk factor for one-year mortality (hazard ratio [HR] 7.92, 95% CI: 1.01-61.83, p = 0.048) in ILD patients; however, OSA was not. In conclusion, half of Korean patients with ILD had OSA. Older age, higher body weight, and diabetes mellitus were risk factors for OSA in patients with ILD.
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Li J, McEvoy RD, Zheng D, Loffler KA, Wang X, Redline S, Woodman RJ, Anderson CS. Self-reported Snoring Patterns Predict Stroke Events in High-Risk Patients With OSA: Post Hoc Analyses of the SAVE Study. Chest 2020; 158:2146-2154. [PMID: 32679238 DOI: 10.1016/j.chest.2020.05.615] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The relation of snoring to risks of stroke and other major cardiovascular (CV) events is uncertain. RESEARCH QUESTION We aimed to determine associations of snoring patterns and major CV events in relation to OSA among participants of the international Sleep Apnea cardiovascular Endpoints (SAVE) trial. STUDY DESIGN AND METHODS Post hoc analyses of the SAVE trial, which involved 2,687 patients with coexisting moderate-to-severe OSA and established coronary or cerebral CV disease, who were randomly allocated to CPAP treatment plus usual care or usual care alone, and followed-up for a median 3.5 years. Associations of self-reported snoring patterns (frequency and loudness) and breathing pauses collected on the Berlin questionnaire at baseline and multiple times during follow-up, and adjudicated composites of CV outcomes (primary, CV death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for unstable angina, heart failure, or transient ischemic attack; and separately of cardiac and cerebral events), were evaluated in time-dependent Cox proportional hazards models adjusted for various confounders including the apnea-hypopnea index. RESULTS Increase (per category) of snoring frequency (adjusted hazard ratio [HR], 1.10; 95% CI, 1.02-1.20; P = .015), loudness (HR, 1.16; 95% CI, 1.06-1.27; P = .001), and breathing pauses (HR, 1.16; 95% CI, 1.08-1.25; P < .001) at any time point during follow-up were each associated with the primary composite CV outcome. These associations were driven by significant associations for cerebral rather than cardiac events, and positive interactions between the three snoring patterns for cerebral events. There was no significant interaction between CPAP treatment and snoring variables for cerebral events. INTERPRETATION Snoring in patients with OSA with established CV disease is associated with greater risks of cerebral but not cardiac events, independent of CPAP treatment and frequency of apnea and hypopnea events. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00738179; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Jingwei Li
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China; Department of Cardiology, People's Liberation Army General Hospital, Beijing, China; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - R Doug McEvoy
- The Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Danni Zheng
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Pharmacology Discipline, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kelly A Loffler
- The Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Susan Redline
- The Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Richard J Woodman
- Centre for Biostatistics & Epidemiology, Flinders University, Adelaide, SA, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; The George Institute China at Peking University Health Science Center, Beijing, China; Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, NSW, Australia; Heart Health Research Center, Beijing, China; Universidad del Desarrollo, School of Medicine-Clínica Alemana, ICIM, Center for Clinical Studies, Santiago, Chile.
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Liu Y, Li C, Wu C, Li P, Su Y, Chen Q. Efficacy of continuous positive airway pressure on subcutaneous adipose tissue in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. Sleep Breath 2021; 25:1-8. [PMID: 32333260 DOI: 10.1007/s11325-020-02078-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/22/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE It remains inconclusive whether continuous positive airway pressure (CPAP) therapy can significantly reduce subcutaneous adipose tissue (SAT) in patients with obstructive sleep apnea (OSA). This meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the impact of CPAP treatment on SAT in patients with OSA. METHODS We searched Pubmed, Cochrane, Web of Science, and Embase for RCTs, which investigated the effectiveness of CPAP treatment in reducing SAT among patients with OSA. Following the PRISMA guidelines, we extracted information on the study and patient characteristics, and pre- and post-CPAP measures of SAT. We then calculated the overall effects using the standardized mean difference (SMD) with a 95% confidence interval (CI). RESULTS A total of 5 RCTs (comprising 153 patients) met inclusion criteria for the meta-analysis. We found that the SAT did not change before and after CPAP treatment in patients with OSA (SMD = - 0.02, 95% CI - 0.25 to 0.2, z = 0.19, p = 0.85). Subgroup analyses indicated that the outcome was not affected by age, CPAP therapy duration, baseline body mass index, and measure utilized. CONCLUSION This meta-analysis of RCTs suggests that CPAP therapy does not significantly decrease the level of SAT among patients with OSA. Further large-scale, and high-quality randomized controlled trials are needed to better address this issue.
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Lee JH, Park CS, Song JW. Obstructive sleep apnea in patients with interstitial lung disease: Prevalence and predictive factors. PLoS One 2020; 15:e0239963. [PMID: 33017401 PMCID: PMC7535061 DOI: 10.1371/journal.pone.0239963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
Interstitial lung diseases (ILDs) are chronic, progressive, parenchymal lung diseases with high morbidity and mortality. In recent studies, the prevalence of obstructive sleep apnea (OSA) in patients with ILD has been reported to be high. However, the prevalence and predictive factors of OSA in Korean ILD patients are not well defined. Therefore, the aim of this study was to evaluate the prevalence and predictive factors of OSA in Korean patients with ILD. Clinical data from 86 patients with ILD enrolled from December 2017 to April 2019 at Haeundae-Paik Hospital, Busan, South Korea, were retrospectively analyzed. OSA was monitored with a level 4 portable device and defined as an apnea-hypopnea index of more than 5 per hour of sleep. The median follow-up period was 7 months. The mean age was 69.8 years, and 64% of participants were men. Among the ILDs, idiopathic pulmonary fibrosis (IPF) was the most common (66.3%), followed by connective tissue disease-associated ILD (16.3%) and cryptogenic organizing pneumonia (5.8%). Forty-six ILD patients (53.5%) were diagnosed with OSA, and IPF patients had OSA more frequently (64.9% vs. 31.0%, p = 0.003) than those with other ILDs. Older age (odds ratio [OR], 1.11, 95% CI 1.04-1.19, p = 0.002), higher body weight (OR 1.05, 95% CI 1.01-1.10, p = 0.012), and diabetes mellitus (OR 4.03, 95% CI 1.26-12.91, p = 0.019) were independent risk factors for OSA in the multivariable logistic regression analysis. In the multivariable Cox analysis, an IPF diagnosis was a significant risk factor for one-year mortality (hazard ratio [HR] 7.92, 95% CI: 1.01-61.83, p = 0.048) in ILD patients; however, OSA was not. In conclusion, half of Korean patients with ILD had OSA. Older age, higher body weight, and diabetes mellitus were risk factors for OSA in patients with ILD.
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Affiliation(s)
- Jae Ha Lee
- Division of Pulmonology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Chan Sun Park
- Division of Allergy, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail:
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11
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Singh M, Tuteja A, Wong DT, Goel A, Trivedi A, Tomlinson G, Chan V. Point-of-Care Ultrasound for Obstructive Sleep Apnea Screening: Are We There Yet? A Systematic Review and Meta-analysis. Anesth Analg 2019; 129:1673-1691. [PMID: 31743189 DOI: 10.1213/ane.0000000000004350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Perioperative diagnosis of obstructive sleep apnea (OSA) has important resource implications as screening questionnaires are overly sensitive, and sleep studies are expensive and time-consuming. Ultrasound (US) is a portable, noninvasive tool potentially useful for airway evaluation and OSA screening in the perioperative period. The objective of this systematic review was to evaluate the correlation of surface US with OSA diagnosis and to determine whether a point-of-care ultrasound (PoCUS) for OSA screening may help with improved screening in perioperative period. METHODS A search of all electronic databases including Medline, Embase, and Cochrane Database of Systematic Reviews was conducted from database inception to September 2017. Inclusion criteria were observational cohort studies and randomized controlled trials of known or suspected OSA patients undergoing surface US assessment. Article screening, data extraction, and summarization were conducted by 2 independent reviewers with ability to resolve conflict with supervising authors. Diagnostic properties and association between US parameters (index test) and OSA diagnosis using sleep study (reference standard) were evaluated. The US parameters were divided into airway and nonairway parameters. A random-effects meta-analysis was planned, wherever applicable. RESULTS Of the initial 3865 screened articles, 21 studies (7 airway and 14 nonairway) evaluating 3339 patients were included. Majority of studies were conducted in the general population (49%), respirology (23%), and sleep clinics (12%). No study evaluated the use of US for OSA in perioperative setting. Majority of included studies had low risk of bias for reference standard and flow and timing. Airway US parameters having moderate-good correlation with moderate-severe OSA were distance between lingual arteries (DLAs > 30 mm; sensitivity, 0.67; specificity, 0.59; 1 study/66 patients); mean resting tongue thickness (>60 mm; sensitivity, 0.85; specificity, 0.59; 1 study/66 patients); tongue base thickness during Muller maneuver (MM; sensitivity, 0.59; specificity, 0.78; 1 study/66 patients); and a combination of neck circumference and retropalatal (RP) diameter shortening during MM (sensitivity, 1.0; specificity, 0.65; 1 study/104 patients). Nonairway US parameters having a low-moderate correlation with moderate-severe OSA were carotid intimal thickness (pooled correlation coefficient, 0.444; 95% confidence interval [CI], 0.320-0.553; P value = .000, 8 studies/727 patients) and plaque presence (sensitivity, 0.24-0.75; specificity, 0.13-1.0; 4 studies/1183 patients). CONCLUSIONS We found that a number of airway and nonairway parameters were identified with moderate to good correlation with OSA diagnosis in the general population. In future studies, it remains to be seen whether PoCUS screening for a combination of these parameters can address the pitfalls of OSA screening questionnaires.
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Affiliation(s)
- Mandeep Singh
- From the Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Toronto Sleep and Pulmonary Centre, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Management, Women's College Hospital, Toronto, Ontario, Canada
| | - Arvind Tuteja
- From the Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David T Wong
- From the Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Akash Goel
- From the Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aditya Trivedi
- Department of Chemistry, McMaster University, Hamilton, ON, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network and Mt Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Chan
- From the Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Kim BY, Cho JH, Kim DH, Kim SW, Kim SW, Kim BG, Park YJ. Utility of acoustic pharyngometry for screening of obstructive sleep apnea. Auris Nasus Larynx 2020; 47:435-42. [PMID: 31732282 DOI: 10.1016/j.anl.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/08/2019] [Accepted: 10/24/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether combining acoustic pharyngometric parameters with cephalometric and clinical parameters could improve the predictive power for significant obstructive sleep apnea (OSA) in a Korean population. METHODS A total of 229 consecutive adult patients with suspected OSA were enrolled. The predictability for significant OSA using acoustic pharyngometric or cephalometric parameters or combining these parameters and clinical factors was calculated and compared using multivariate logistic regression and receiver operating characteristic (ROC) curves. RESULTS In multivariate logistic regression, age, sex, minimum upper airway cross-sectional area (UA-CSA), and mandibular plane to hyoid distance (MPH) were all significant independent predictors of significant OSA. The minimum UA-CSA of 0.85 cm2 provided fair discrimination for OSA [area under the curve (AUC): 0.60, 95% confidence interval (CI): 0.52-0.67]. The MPH of 18.75 mm provided fair discrimination for OSA (AUC; 0.65, 95% CI: 0.58-0.72). The discriminative ability of the final model of multivariate ROC curve analyses that included the minimum UA-CSA, age, sex, body mass index (BMI), and MPH was better than the minimum UA-CSA alone (AUCs: 0.77 vs. 0.60). Optimal cut-off values of predictors for discriminating significant OSA were as follows: male for sex, 40 years for age, 25.5 kg/m2 for BMI, 1.06 cm2 for minimum UA-CSA, and 18 mm for MPH. CONCLUSION Minimum UA-CSA measured using acoustic pharyngometry while sitting might be a useful method to predict OSA. Combining minimum UA-CSA with age, sex, BMI and MPH improved the predictive value for significant OSA.
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Westreich R, Gozlan-Talmor A, Geva-Robinson S, Schlaeffer-Yosef T, Slutsky T, Chen-Hendel E, Braiman D, Sherf Y, Arotsker N, Abu-Fraiha Y, Waldman-Radinsky L, Maimon N. The Presence of Snoring as Well as its Intensity Is Underreported by Women. J Clin Sleep Med 2019; 15:471-476. [PMID: 30853036 DOI: 10.5664/jcsm.7678] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 11/21/2018] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVES Women are underrepresented and thus sleep conditions are underdiagnosed at sleep clinics that evaluate sleep-disordered breathing. The most common sign of obstructive sleep apnea (OSA) is snoring; therefore, it is one of the main red flags for suspected OSA. The aim of this study is to determine whether self-reported snoring and snoring intensity by women and men correlates with snoring volume measured objectively during sleep laboratory study. METHODS Consecutive patients who were referred to a polysomnography (PSG) study in a university hospital over a 2-year period had their snoring volume quantified by means of a calibrated digital sound survey meter. Participants were given a questionnaire in which they were asked to rate the severity of their snoring. The correlation between objective snoring intensity as measured during PSG and the self-reported snoring intensity was evaluated. RESULTS A total of 1,913 patients were enrolled in the study. A positive correlation was found between objectively measured snoring intensity and the intensity listed by each participant in the questionnaire. Measurement of the volume of snoring revealed that women snored as loudly as men; however, 28% of the females (189/675) considered themselves to be nonsnorers compared to only 6.9% of men (P < .05). Furthermore, 36.5% of women (69/189) who reported themselves as nonsnorers turned out to have severe or very severe snoring intensity, whereas, in contrast, only 11.7% of men (10/85) of men had this discrepancy. These findings are in concordance with the finding that fewer women quantified their snoring as very severe or severe (38.4%), significantly less than men of whom 61.5% reported their snoring to be severe or very severe. CONCLUSIONS In a population of individuals referred to a PSG study, although no difference in snoring intensity was found between sexes, women tend to underreport the fact that they snore and to underestimate the loudness of their snoring. Improved awareness of this discrepancy may increase women's access to sleep laboratories, and improve diagnostic rates of sleep apnea in females.
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Affiliation(s)
- Roi Westreich
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Pulmonology Institute, Soroka University Medical Center, Beer-Sheva, Israel.,Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aya Gozlan-Talmor
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shahar Geva-Robinson
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tal Schlaeffer-Yosef
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tzachi Slutsky
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Efrat Chen-Hendel
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dana Braiman
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yehonatan Sherf
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Natan Arotsker
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yasmeen Abu-Fraiha
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Liat Waldman-Radinsky
- Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nimrod Maimon
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Pulmonology Institute, Soroka University Medical Center, Beer-Sheva, Israel.,Department of Internal Medicine B, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Kim JS, Podolanczuk AJ, Borker P, Kawut SM, Raghu G, Kaufman JD, Stukovsky KDH, Hoffman EA, Barr RG, Gottlieb DJ, Redline SS, Lederer DJ. Obstructive Sleep Apnea and Subclinical Interstitial Lung Disease in the Multi-Ethnic Study of Atherosclerosis (MESA). Ann Am Thorac Soc 2017; 14:1786-95. [PMID: 28613935 DOI: 10.1513/AnnalsATS.201701-091OC] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Obstructive sleep apnea (OSA) has been postulated to contribute to idiopathic pulmonary fibrosis by promoting alveolar epithelial injury via tractional forces and intermittent hypoxia. OBJECTIVES To determine whether OSA is associated with subclinical interstitial lung disease (ILD) and with biomarkers of alveolar epithelial injury and remodeling. METHODS We performed cross-sectional analyses of 1,690 community-dwelling adults who underwent 15-channel in-home polysomnography and thoracic computed tomographic imaging in the Multi-Ethnic Study of Atherosclerosis. We measured the obstructive apnea-hypopnea index (oAHI) by polysomnography and high-attenuation areas (HAAs) and interstitial lung abnormalities (ILAs) by computed tomography. Serum matrix metalloproteinase-7 (MMP-7) and surfactant protein-A (SP-A) were measured by ELISA in 99 participants. We used generalized linear models to adjust for potential confounders. RESULTS The mean age was 68 years, and the mean forced vital capacity was 97% predicted. The median oAHI was 8.4 events/h, and 32% had an oAHI greater than 15. After adjusting for demographics, smoking, and center, an oAHI greater than 15 was associated with a 4.0% HAA increment (95% confidence interval [CI], 1.4-6.8%; P = 0.003) and 35% increased odds of ILA (95% CI, 13-61%; P = 0.001). However, there was evidence that these associations varied by body mass index (BMI) (P for interaction = 0.08 and 0.04, respectively). Among those with a BMI less than 25 kg/m2, an oAHI greater than 15 was associated with a 6.1% HAA increment (95% CI, 0.5-12%; P = 0.03) and 2.3-fold increased odds of ILA (95% CI, 1.3-4.1; P = 0.005). Among those with a BMI greater than 30 kg/m2, an oAHI greater than 15 was associated with 1.8-fold greater odds of ILA (95% CI, 1.1-2.9; P = 0.01) but was not associated with HAA. There were no meaningful associations detected among those with a BMI of 25-30 kg/m2. Greater oAHI was associated higher serum SP-A and MMP-7 levels, particularly among those with a BMI less than 25 kg/m2. CONCLUSIONS Moderate to severe OSA is associated with subclinical ILD and with evidence of alveolar epithelial injury and extracellular matrix remodeling in community-dwelling adults, an association that is strongest among normal-weight individuals. These findings support the hypothesis that OSA might contribute to early ILD.
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Molfenter SM, Lenell C, Lazarus CL. Volumetric Changes to the Pharynx in Healthy Aging: Consequence for Pharyngeal Swallow Mechanics and Function. Dysphagia 2019; 34:129-37. [PMID: 30039259 DOI: 10.1007/s00455-018-9924-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
Pharyngeal lumen volume is prone to increase as a consequence of pharyngeal muscle atrophy in aging. Yet, the impact of this on swallowing mechanics and function is poorly understood. We examined the relationship between pharyngeal volume and pharyngeal swallowing mechanics and function in a sample of healthy community-dwelling seniors. Data were collected from 44 healthy seniors (21 male, mean age = 76.9, SD = 7.1). Each participant swallowed 9 boluses of barium (3 × 5 ml thin, 3 × 20 ml thin, 3 × 5 ml nectar). Pharyngeal shortening, pharyngeal constriction, pyriform sinus and vallecular residue were quantified from lateral view videofluorosopic swallowing studies. Pharyngeal lumen volume was captured during an oral breathing task with acoustic pharyngometry. In addition, within-participant measures of strength and anthropometrics were collected. Four linear mixed effects regression models were run to study the relationship between pharyngeal volume and pharyngeal constriction, pharyngeal shortening, pyriform sinus residue, and vallecular residue while controlling for bolus condition, age, sex, and posterior tongue strength. Increasing pharyngeal lumen volume was significantly related to worse constriction and vallecular residue. In general, larger and thicker boluses resulted in worse pharyngeal constriction and residue. Pharyngeal shortening was only significantly related to posterior tongue strength. Our work establishes the utility of acoustic pharyngometry to monitor pharyngeal lumen volume. Increasing pharyngeal lumen volume appears to impact both pharyngeal swallowing mechanics and function in a sample of healthy, functional seniors.
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Dahy K, Takahashi K, Saito K, Kiso H, Rezk I, Oga T, Uozumi R, Chin K, Bessho K. Gender differences in morphological and functional outcomes after mandibular setback surgery. J Craniomaxillofac Surg 2018; 46:887-92. [PMID: 29709333 DOI: 10.1016/j.jcms.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/19/2018] [Accepted: 04/04/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to examine and compare morphological and functional outcomes after either isolated mandibular setback or bimaxillary surgery in males and females. MATERIALS AND METHODS A retrospective study was done on 52 patients, in whom surgical correction for mandibular prognathism was performed either by isolated mandibular setback (30 cases) or by bimaxillary surgery (22 cases). Morphological changes were studied using cephalograms and functional changes studied using impulse oscillometry (IOS) taken before surgery (T0), 3 months (T1) and 1 year after surgery (T2). Also 3% oxygen desaturation index (ODI) was measured at T0 and T2. RESULT Posterior airway space decreased significantly in both groups and both sexes but more so in males after mandibular setback surgery and in females after bimaxillary surgery. Changes in supine R20 (central airway resistance at 20 Hz) and supine R5 (total airway resistance at 5 Hz) in IOS statistically significantly increased in the period T0-T1 in males compared with females after mandibular setback surgery (p < 0.05). CONCLUSION Gender dimorphism is present according to morphological and functional outcomes, with males at a higher risk for obstructive sleep apnea (OSA) after mandibular setback surgery and females after bimaxillary surgery; however, compensatory changes act as a barrier against this.
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Gottsauner-Wolf S, Laimer J, Bruckmoser E. Posterior Airway Changes Following Orthognathic Surgery in Obstructive Sleep Apnea. J Oral Maxillofac Surg 2018; 76:1093.e1-1093.e21. [DOI: 10.1016/j.joms.2017.11.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/17/2017] [Accepted: 11/22/2017] [Indexed: 12/16/2022]
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Abstract
Sleep‐disordered breathing has a high prevalence in the general population, but is especially prominent in patients with heart failure (HF). HF and sleep‐disordered breathing share a bidirectional relationship, with sleep‐disordered breathing being both cause and effect of poor cardiac functioning. The high inter‐individual variability of symptom presentation can impede the clinical diagnostic process. Polysomnography is the gold‐standard method of diagnosing sleep‐disordered breathing. Therapy of sleep‐disordered breathing should always consist of optimizing the treatment of the underlying disorder of HF. Additional therapeutic measures include continuous positive airway pressure ventilation therapy. New therapeutic options using neurostimulation are yielding promising results; however, long‐term benefits still need to be confirmed.
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Affiliation(s)
- Charlotte Pietrock
- Division of Cardiology and Metabolism: Heart Failure, Cachexia and Sarcopenia, Department of Internal Medicine and Cardiology, Charité Medical School, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany
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Gille T, Didier M, Boubaya M, Moya L, Sutton A, Carton Z, Baran-Marszak F, Sadoun-Danino D, Israël-Biet D, Cottin V, Gagnadoux F, Crestani B, d'Ortho MP, Brillet PY, Valeyre D, Nunes H, Planès C. Obstructive sleep apnoea and related comorbidities in incident idiopathic pulmonary fibrosis. Eur Respir J 2017; 49:49/6/1601934. [DOI: 10.1183/13993003.01934-2016] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/28/2017] [Indexed: 11/05/2022]
Abstract
The objectives of this prospective study were: 1) to determine the prevalence and determinants of obstructive sleep apnoea (OSA) in patients with newly diagnosed idiopathic pulmonary fibrosis (IPF); 2) to determine whether OSA was associated with cardiovascular disease (CVD) as well as increased oxidative stress and levels of IPF biomarkers in the blood.A group of 45 patients with newly diagnosed IPF attended polysomnography. The prevalence of CVD and the severity of coronary artery calcification were investigated by high-resolution computed tomography. The levels of 8-hydroxydeoxyguanosine (8-OH-DG) and various IPF biomarkers in the blood were compared between patients with no or mild OSA (apnoea–hypopnoea index (AHI) <15 events·h−1), with moderate OSA (15 ≤AHI <30 events·h−1) and with severe OSA (AHI ≥30 events·h−1).The prevalence of moderate-to-severe OSA and severe OSA was 62% and 40%, respectively. AHI did not correlate with demographic or physiological data. All patients with severe OSA had a medical history of CVD,versus41.2% and 40% of those with no or mild OSA, or with moderate OSA, respectively (p<0.0001). Ischaemic heart disease (IHD) and moderate-to-severe coronary artery calcifications were strongly associated with severe OSA. The 8-OH-DG and matrix metalloproteinase-7 serum levels were significantly increased in the severe OSA group.Moderate-to-severe OSA is highly prevalent in incident IPF and severe OSA is strongly associated with the presence of CVD, particularly IHD.
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Affiliation(s)
- Hye Mi Jee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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Zhao YY, Blackwell T, Ensrud KE, Stone KL, Omachi TA, Redline S. Sleep Apnea and Obstructive Airway Disease in Older Men: Outcomes of Sleep Disorders in Older Men Study. Sleep 2016; 39:1343-51. [PMID: 27091524 DOI: 10.5665/sleep.5960] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 03/22/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the association between obstructive airway disease (OAD) and sleep apnea in older men. METHODS A community-based cross-sectional study of 853 community-dwelling older men (mean age 80.7 ± 4.1 years [range 73 to 90]) across 6 centers in the United States from the Outcomes of Sleep Disorders in Older Men Study. Sleep was objectively measured using full in-home polysomnography and lung function was objectively measured using spirometry. The association of OAD (pre-bronchodilator FEV1/FVC ratio < 0.7 and FEV1 < 80% predicted) and sleep apnea (apnea-hypopnea index [AHI] ≥ 15 events/hour) was assessed using logistic regression. RESULTS OAD and sleep apnea were identified in 111 (13.0%) and 247 (29.0%) men, respectively. In univariate analysis, participants with OAD had a lower AHI (mean ± SD; 8.7 ± 11.7 vs. 12.7 ± 13.8, P = 0.0009) and a lower prevalence of sleep apnea (14.4 vs. 31.1%, P = 0.0003) compared to participants without OAD. OAD remained independently associated with a lower odds of sleep apnea (odds ratio 0.30, 95% CI 0.16 to 0.55, P = 0.0001) after adjustment for demographics, body composition, smoking, and potential mediators (arousal index, time spent in rapid eye movement sleep). Individuals with OAD and sleep apnea (n = 16) had an increased arousal index and lower oxygen saturation level as compared to individuals with OAD alone (P values < 0.05). CONCLUSIONS Obstructive airway disease was associated with a lower prevalence of sleep apnea in a cohort of community-dwelling elderly men, and unexplained by differences in adiposity or sleep architecture. Although uncommon in this cohort, coexisting sleep apnea and OAD was associated with increased sleep fragmentation and nocturnal oxygen desaturation compared to OAD alone.
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Affiliation(s)
- Ying Y Zhao
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Terri Blackwell
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Kristine E Ensrud
- Department of Medicine and Division of Epidemiology & Community Health, University of Minnesota, Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Theodore A Omachi
- San Francisco Sleep Disorders Center, Division of Pulmonary, Critical Care, & Sleep Medicine, University of California, San Francisco, CA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Abstract
In end-stage renal disease (ESRD) and heart failure, conditions characterized by fluid overload, both obstructive sleep apnea (OSA) and central sleep apnea (CSA) are highly prevalent. This observation suggests that fluid overload may be a unifying mechanism in the pathogenesis of both OSA and CSA in these conditions. An overnight rostral fluid shift from the legs to the neck and lungs has been shown to contribute to the pathogenesis of OSA and CSA, respectively, in various different patient populations. This article reviews the evidence that supports a role for fluid overload and overnight fluid shift in the pathogenesis of sleep apnea in ESRD. The diagnosis, epidemiology, and clinical features of sleep apnea in patients with ESRD also are considered.
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Affiliation(s)
- Owen D Lyons
- Sleep Research Laboratory of the University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Ontario, Canada.
| | - T Douglas Bradley
- Sleep Research Laboratory of the University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, University of Toronto, Toronto, Ontario, Canada
| | - Christopher T Chan
- Division of Nephrology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
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Chen H, Aarab G, de Ruiter MHT, de Lange J, Lobbezoo F, van der Stelt PF. Three-dimensional imaging of the upper airway anatomy in obstructive sleep apnea: a systematic review. Sleep Med 2016; 21:19-27. [PMID: 27448467 DOI: 10.1016/j.sleep.2016.01.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/28/2015] [Accepted: 01/16/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The pathogenesis of upper airway collapse in people with obstructive sleep apnea (OSA) is not fully understood. The aim of this study was to systematically review the literature in order to assess the most relevant anatomical characteristics of the upper airway related to the pathogenesis of OSA by analyzing the three-dimensional upper airway anatomy. METHOD A PICO (population/patient, intervention, comparison, outcome) search strategy, focusing on the upper airway anatomy of people with OSA, was conducted using the following databases: MEDLINE (PubMed), Excerpta Medica database (EMBASE), Web of Science, and Cochrane Library. The studies in which three-dimensional images were made from the participants who were awake and in the supine position during quiet breathing were selected in this systematic review. RESULTS Of the 758 unique retrieved studies, eight fulfilled the criteria for this systematic review. The minimum cross-sectional area of the upper airways of people with OSA, which is influenced by many factors such as hard and soft tissues surrounding the upper airway, was significantly smaller than that of those without OSA. CONCLUSION Within the limitation of the selected studies, this systematic review suggested that a small minimum cross-sectional area is the most relevant anatomical characteristic of the upper airway related to the pathogenesis of OSA.
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Affiliation(s)
- Hui Chen
- Department of Oral and Maxillofacial Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands.
| | - Ghizlane Aarab
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Maurits H T de Ruiter
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Paul F van der Stelt
- Department of Oral and Maxillofacial Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands
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Alamin FAERM, Ayad CE. Characterization of Upper Air Way Tract in Snoring and Non-Snoring Patients: A CT Based Study. OJRad 2016; 06:181-190. [DOI: 10.4236/ojrad.2016.63025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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26
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Wilhelm CP, deShazo RD, Tamanna S, Ullah MI, Skipworth LB. The nose, upper airway, and obstructive sleep apnea. Ann Allergy Asthma Immunol 2015; 115:96-102. [PMID: 26250769 DOI: 10.1016/j.anai.2015.06.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Chelle P Wilhelm
- Division of Clinical Immunology/Allergy, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; Division of Pulmonary/Critical Care/Sleep Medicine, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Richard D deShazo
- Division of Clinical Immunology/Allergy, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; Division of Pulmonary/Critical Care/Sleep Medicine, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Sadeka Tamanna
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - M Iftekhar Ullah
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Leigh Baldwin Skipworth
- Division of Clinical Immunology/Allergy, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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27
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Abstract
Objective: The aim was to obtain normative data for cephalometric measurements of the upper airway in the North Indian population. Design: Observational study. Setting: University department and teaching hospital out-patient clinic. Subjects and Methods: A total of 180 healthy patients were included out of which 90 were males (age range, 8-16 years), and 90 were females (age range, 8-16 years), with normal skeletal facial profile, no history of snoring, sleep apnea, upper airway disease, tonsillectomy or adenoidectomy, obesity, or pathology in the pharynx. Twenty cephalometric airway measurements, including size of the tongue, soft palate, nasopharynx, oropharynx, hypopharynx, and relative position of the hyoid bone and valleculae were obtained. Landmarks on cephalometric radiographs were digitized and measurements were made using a specially designed computer program. Error analysis of measurements was performed and comparison of measurements according to sex was made. Results: Significant sex dimorphism was seen for the majority of measurements, with the exception of minimal depth of the airway, oropharyngeal depth of the airway, and the soft palate angle with the hard palate. Conclusion: A minimum sagittal dimension of the upper airway was evident despite differences in measurements between sexes. Findings from this study should be a useful reference for the assessment of sleep apnea in the North Indian population.
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Affiliation(s)
- Dipti Shastri
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pradeep Tandon
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amit Nagar
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Alka Singh
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
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Goel AK, Talwar D, Jain SK. Evaluation of short-term use of nocturnal nasal continuous positive airway pressure for a clinical profile and exercise capacity in adult patients with obstructive sleep apnea-hypopnea syndrome. Lung India 2015; 32:225-32. [PMID: 25983407 PMCID: PMC4429383 DOI: 10.4103/0970-2113.156226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIM The obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common chronic respiratory disease, characterized by repetitive complete or partial collapse of the upper airway during sleep. The clinical spectrum extends between stoppage of breathing, snoring, daytime somnolence, and fatigue, to serious cardiovascular disease, stroke, metabolic syndrome, increased morbidity, and mortality. We aim to evaluate the short-term use of nasal continuous positive airway pressure (nCPAP) therapy for the clinical profile and exercise capacity of patients with OSAHS. PATIENT SELECTION Twenty patients diagnosed with moderate-to-severe OSAHS were enrolled in the study (study group - 15; clinically and PSG-matched control group - 5). MATERIALS AND METHODS Each patient was clinically evaluated for sleep-related symptoms, and also assessed with spirometry, the six-minute walk test (6MWT), and a symptom-limited incremental cardiopulmonary exercise test (CPET). The study group patients were administered nCPAP therapy for eight hours each night for four weeks, while the control group patients were just observed. They were re-assessed after four weeks and the data were statistically analyzed between the two groups. RESULTS The study group patients showed a significant (P- < 0.05) improvement in the OSAHS symptoms-the Epworth sleepiness score, six-minute walk distance; duration of exercise, power output, peak oxygen uptake, anaerobic threshold, diastolic blood pressure, dyspnea, and fatigue-in comparison with the control group patients. The improvement in exercise capacity following nCPAP therapy was attributed to the relief of disabling the OSAHS symptoms and improved cardiovascular, ventilator, and musculoskeletal functions. CONCLUSION All OSAHS patients must be treated with nCPAP.
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Affiliation(s)
- Amrit K Goel
- Department of Respiratory, Sleep, Allergy, and Critical Care Medicine, Metro Centre for Respiratory Diseases, Metro Group of Hospitals, Noida, Uttar Pradesh, India
| | - Deepak Talwar
- Department of Respiratory, Sleep, Allergy, and Critical Care Medicine, Metro Centre for Respiratory Diseases, Metro Group of Hospitals, Noida, Uttar Pradesh, India
| | - Sushil K Jain
- Department of Respiratory, Sleep, Allergy, and Critical Care Medicine, Metro Centre for Respiratory Diseases, Metro Group of Hospitals, Noida, Uttar Pradesh, India
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Abstract
Obstructive and central sleep apnea are far more common in heart failure patients than in the general population and their presence might contribute to the progression of heart failure by exposing the heart to intermittent hypoxia, increased preload and afterload, sympathetic nervous system activation, and vascular endothelial dysfunction. There is now substantial evidence that supports a role for fluid overload and nocturnal rostral fluid shift from the legs as unifying mechanisms in the pathogenesis of obstructive and central sleep apnea in heart failure patients, such that the predominant type of sleep apnea is related to the relative distribution of fluid from the leg to the neck and chest. Despite advances in therapies for heart failure, mortality rates remain high. Accordingly, the identification and treatment of sleep apnea in patients with heart failure might offer a novel therapeutic target to modulate this increased risk. In heart failure patients with obstructive or central sleep apnea, continuous positive airway pressure has been shown to improve cardiovascular function in short-term trials but this has not translated to improved mortality or reduced hospital admissions in long-term randomized trials. Other forms of positive airway pressure such as adaptive servoventilation have shown promising results in terms of attenuation of sleep apnea and improvement in cardiovascular function in short-term trials. Large scale, randomized trials are required to determine whether treating sleep apnea with various interventions can reduce morbidity and mortality.
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30
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Wang TY, Lo YL, Chou PC, Chung FT, Lin SM, Lin TY, Lin HC, Wang CH, Yu CT, Kuo HP. Associated bone mineral density and obstructive sleep apnea in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:231-7. [PMID: 25673983 PMCID: PMC4321657 DOI: 10.2147/copd.s72099] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Osteoporosis is an important issue for patients with chronic obstructive pulmonary disease (COPD). Worse systemic inflammation and reduced exercise capacity have been reported in COPD patients with obstructive sleep apnea (OSA), implying that OSA may be an independent factor for osteoporosis in COPD patients. METHODS A total of 66 patients with bone mineral density (BMD) and polysomnography results from a previous COPD cohort (January 2008 to January 2013) were retrospectively enrolled. Clinical characteristics such as medication, pulmonary function, BMD, and results of polysomnography were analyzed. RESULTS The BMD in those with OSA was significantly lower than in those without OSA (-1.99±1.63 versus -1.27±1.14, P=0.045). In univariate analysis, body mass index, forced expiratory volume in 1 second, percentage of predicted value, incremental shuttle walk test, apnea-hypopnea index, and oxygen desaturation index (ODI) were significantly associated with BMD. After multivariate linear regression analysis, the ODI was still an independent factor for BMD. In addition, smaller total lung capacity is significantly associated with higher ODI and lower BMD, which implies that lower BMD might cause severer OSA via decreased total lung capacity. CONCLUSION OSA may be an independent factor for BMD in patients with COPD, which implies a possible vicious cycle takes place in these patients.
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Affiliation(s)
- Tsai-Yu Wang
- Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Yu-Lun Lo
- Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan ; Healthcare Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Pai-Chien Chou
- Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Shu-Min Lin
- Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Ting-Yu Lin
- Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Chun-Hua Wang
- Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Chih-Teng Yu
- Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
| | - Han-Pin Kuo
- Department of Thoracic Medicine, School of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan
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31
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Troy LK, Corte TJ. Sleep disordered breathing in interstitial lung disease: A review. World J Clin Cases 2014; 2:828-834. [PMID: 25516856 PMCID: PMC4266829 DOI: 10.12998/wjcc.v2.i12.828] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/25/2014] [Accepted: 10/16/2014] [Indexed: 02/05/2023] Open
Abstract
Patients with interstitial lung disease commonly exhibit abnormal sleep architecture and increased sleep fragmentation on polysomnography. Fatigue is a frequent complaint, and it is likely that poor sleep quality is a significant contributor. A number of studies have shown that sleep disordered breathing is prevalent in this population, particularly in the idiopathic pulmonary fibrosis subgroup. The factors that predispose these patients to obstructive sleep apnoea are not well understood, however it is believed that reduced caudal traction on the upper airway can enhance collapsibility. Ventilatory control system instability may also be an important factor, particularly in those with increased chemo-responsiveness, and in hypoxic conditions. Transient, repetitive nocturnal oxygen desaturation is frequently observed in interstitial lung disease, both with and without associated obstructive apnoeas. There is increasing evidence that sleep-desaturation is associated with increased mortality, and may be important in the pathogenesis of pulmonary hypertension in this population.
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Yadollahi A, Gabriel JM, White LH, Taranto Montemurro L, Kasai T, Bradley TD. A randomized, double crossover study to investigate the influence of saline infusion on sleep apnea severity in men. Sleep 2014; 37:1699-705. [PMID: 25197812 DOI: 10.5665/sleep.4084] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/06/2014] [Indexed: 12/24/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is commoner in patients with fluid-retaining states than in those without fluid retention, in men than in women, and worsens with aging. In men, OSA severity is related to the amount of fluid shifting out of the legs overnight, but a cause-effect relationship is not established. Our objective was to test the hypothesis that mimicking fluid overload during sleep would increase severity of OSA more in older (≥ 40 years) than in younger men (< 40 years). DESIGN Randomized, single-blind, double crossover study. SETTING Research sleep laboratory. PATIENTS OR PARTICIPANTS Seven older and 10 younger men with non-severe or no sleep apnea, matched for body mass index. INTERVENTIONS During the control arm, normal saline was infused to keep the vein open. During intervention, subjects received an intravenous bolus of normal saline (22 mL/kg body weight) after sleep onset while they were wearing compression stockings to prevent fluid accumulation in the legs. MEASUREMENTS AND RESULTS Compared to younger men, infusion of similar amounts of saline in older men caused a greater increase in neck circumference (P < 0.05) and in the AHI (32.2 ± 22.1 vs. 2.2 ± 7.1, P = 0.002). CONCLUSIONS Older men are more susceptible to the adverse effects of intravenous fluid loading on obstructive sleep apnea severity than younger men. This may be due to age-related differences in the amount of fluid accumulating in the neck or upper airway collapsibility in response to intravenous fluid loading. These possibilities remain to be tested in future studies.
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Affiliation(s)
- Azadeh Yadollahi
- Sleep Research Laboratory, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Joseph M Gabriel
- Sleep Research Laboratory, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada and Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Laura H White
- Sleep Research Laboratory, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada and Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Canada and Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Canada
| | - Luigi Taranto Montemurro
- Sleep Research Laboratory, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada and Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Canada
| | - Takatoshi Kasai
- Sleep Research Laboratory, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada and Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Canada
| | - T Douglas Bradley
- Sleep Research Laboratory, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada and Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Canada and Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Canada
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Huang KT, Chin CH, Tseng CC, Chang HC, Chen YC, Wang CC, Lin MC, Lin HC, Su MC. The influence of obesity on different genders in patients with obstructive sleep apnea. ScientificWorldJournal 2014; 2014:487215. [PMID: 25126598 DOI: 10.1155/2014/487215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 06/08/2014] [Accepted: 06/17/2014] [Indexed: 12/17/2022] Open
Abstract
Obesity is considered to be a major contributing factor to obstructive sleep apnea (OSA); however, there is limited evidence with regard to gender predominance. We analyzed 2345 patients (339 females) in correlation with body mass index (BMI) and OSA severity. Male AHIs were significantly higher than female AHIs in each BMI group. As the BMI increased, the AHI increased in both males and females, and this trend was more obvious in males. For BMI-matched male and female patients with OSA, the severity of OSA was higher in males. As BMI increased, the severity of OSA increased more obviously in males. Our findings suggest that increased body fat contributes to the pathogenesis of OSA more in males than in females and that obesity plays a more significant role in contributing to OSA in male patients.
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34
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Poirrier AL, Fanielle J, Bruwier A, Chakar B, Poirrier R. Upper airway imaging in sleep-disordered breathing. Acta Neurol Belg 2014; 114:87-93. [PMID: 24442696 DOI: 10.1007/s13760-013-0278-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 12/30/2013] [Indexed: 12/11/2022]
Abstract
Our understanding of sleep-disordered breathing has evolved considerably over the past three decades, and clinical techniques of evaluation have progressed tremendously. Myriad imaging techniques are now available for the physician to approach the dynamic features resulting in turbulent airflow, upper airway narrowing or collapse at different levels. Controversy exists in the choice of investigations, probably because the best evaluation should be a combination of different techniques. Physical, radiographic, endoscopic and acoustic evaluations could be integrated to understand the degree and the levels of airway reduction and/or obstruction in a given patient. This review focuses on cost-effective and easily implemented techniques in daily practice, allowing quality assessment of the dynamic anatomy of sleep-disordered breathing: cephalometry, (sleep-)endoscopy and acoustic reflectometry of the upper airway.
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Bingol Z, Pihtili A, Gulbaran Z, Kiyan E. Relationship between parenchymal involvement and obstructive sleep apnea in subjects with sarcoidosis. The Clinical Respiratory Journal 2014; 9:14-21. [DOI: 10.1111/crj.12098] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/06/2013] [Accepted: 01/04/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Zuleyha Bingol
- Department of Chest Diseases, Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
| | - Aylin Pihtili
- Department of Chest Diseases, Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
| | - Ziya Gulbaran
- Department of Chest Diseases, Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
| | - Esen Kiyan
- Department of Chest Diseases, Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
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36
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Abstract
Airway orthotic therapy, considered mainstream in the treatment of sleep-disordered breathing, has been demonstrated to normalize both structure and function of the pathological airway through manipulation of mandibular posture. Although effective, the literature reports a variable rate of success and no validated candidacy selection protocol. Acoustic reflection has been used to evaluate and document the upper airway and its dynamics with and without an orthotic in place. This paper will discuss the use of acoustic reflection to assess the level of airway normalization resulting from protrusive and vertical repositioning of the mandible and its utility to establish orthotic candidacy, construction, titration, and maintenance parameters. This protocol has potential for use in both medical and dental facilities that treat patients with sleep-disordered breathing.
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37
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Abstract
Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive collapse of the pharyngeal airway during sleep. Control of pharyngeal patency is a complex process relating primarily to basic anatomy and the activity of many pharyngeal dilator muscles. The control of these muscles is regulated by a number of processes including respiratory drive, negative pressure reflexes, and state (sleep) effects. In general, patients with OSA have an anatomically small airway the patency of which is maintained during wakefulness by reflex-driven augmented dilator muscle activation. At sleep onset, muscle activity falls, thereby compromising the upper airway. However, recent data suggest that the mechanism of OSA differs substantially among patients, with variable contributions from several physiologic characteristics including, among others: level of upper airway dilator muscle activation required to open the airway, increase in chemical drive required to recruit the pharyngeal muscles, chemical control loop gain, and arousal threshold. Thus, the cause of sleep apnea likely varies substantially between patients. Other physiologic mechanisms likely contributing to OSA pathogenesis include falling lung volume during sleep, shifts in blood volume from peripheral tissues to the neck, and airway edema. Apnea severity may progress over time, likely due to weight gain, muscle/nerve injury, aging effects on airway anatomy/collapsibility, and changes in ventilatory control stability.
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Affiliation(s)
- David P White
- Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA.
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38
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Deyoung PN, Bakker JP, Sands SA, Batool-Anwar S, Connolly JG, Butler JP, Malhotra A. Acoustic pharyngometry measurement of minimal cross-sectional airway area is a significant independent predictor of moderate-to-severe obstructive sleep apnea. J Clin Sleep Med 2013; 9:1161-4. [PMID: 24235897 DOI: 10.5664/jcsm.3158] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The current gold-standard method of diagnosing obstructive sleep apnea (OSA) is polysomnography, which can be inefficient. We therefore sought to determine a method to triage patients at risk of OSA, without using subjective data, which are prone to mis-reporting. We hypothesized that acoustic pharyngometry in combination with age, gender, and neck circumference would predict the presence of moderate-to-severe OSA. METHODS Untreated subjects with suspected OSA were recruited from a local sleep clinic and underwent polysomnography. We also included a control group to verify differences. While seated in an upright position and breathing through the mouth, an acoustic pharyngometer was used to measure the minimal cross-sectional area (MCA) of the upper airway at end-exhalation. RESULTS Sixty subjects were recruited (35 males, mean age 42 years, range 21-81 years; apnea-hypopnea index (AHI) 33 ± 30 events/h (mean ± standard deviation), Epworth Sleepiness Scale score 11 ± 6, body mass index 34 ± 8 kg/m(2)). In univariate logistic regression, MCA was a significant predictor of mild-no OSA (AHI < 15). A multivariate logistic regression model including MCA, age, gender, and neck circumference significantly predicted AHI < 15, explaining approximately one-third of the total variance (χ(2)(4) = 37, p < 0.01), with only MCA being a significant independent predictor (adjusted odds ratio 54, standard error 130; p < 0.01). CONCLUSIONS These data suggest that independent of age, gender, and neck size, objective anatomical assessment can significantly differentiate those with mild versus moderate-to-severe OSA in a clinical setting, and may have utility as a component in stratifying risk of OSA.
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Affiliation(s)
- Pamela N Deyoung
- Division of Pulmonary and Critical Care, University of California San Diego, San Diego CA ; Division of Sleep Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, MA
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Khayat R, Small R, Rathman L, Krueger S, Gocke B, Clark L, Yamokoski L, Abraham WT. Sleep-disordered breathing in heart failure: identifying and treating an important but often unrecognized comorbidity in heart failure patients. J Card Fail 2013; 19:431-44. [PMID: 23743494 DOI: 10.1016/j.cardfail.2013.04.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 04/09/2013] [Accepted: 04/18/2013] [Indexed: 01/29/2023]
Abstract
Sleep-disordered breathing (SDB) is the most common comorbidity in patients with heart failure (HF) and has a significant impact on quality of life, morbidity, and mortality. A number of therapeutic options have become available in recent years that can improve quality of life and potentially the outcomes of HF patients with SDB. Unfortunately, SDB is not part of the routine evaluation and management of HF, so it remains untreated in most HF patients. Although recognition of the role of SDB in HF is increasing, clinical guidelines for the management of SDB in HF patients continue to be absent. This article provides an overview of SDB in HF and proposes a clinical care pathway to help clinicians to better recognize and treat SDB in their HF patients.
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Affiliation(s)
- Rami Khayat
- Ohio State University, Division of Pulmonary, Critical Care and Sleep, Columbus, OH 43210, USA.
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Yan N, Ng ML, Man MK, To TH. Vocal tract dimensional characteristics of professional male and female singers with different types of singing voices. Int J Speech Lang Pathol 2013; 15:484-491. [PMID: 23391478 DOI: 10.3109/17549507.2012.744429] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The present study examined the possible relationship between classification of professional singing voices and their vocal tract parameters including vocal tract length and volume, and vowel formant frequencies. Acoustic reflection technology (ART) was used to measure vocal tract length and volume of 107 professional singers: 32 tenors, 25 baritones, 27 sopranos, and 23 mezzo-sopranos. The first three formant frequencies (F1-F3) of the English vowels /a, æ, i/ produced by the professional singers were also obtained. Results indicated significantly shorter oral and vocal tract length, and smaller oral and vocal tract volume associated with sopranos when compared with mezzo-sopranos. Acoustically, sopranos had higher F1, F2, and F3 values than mezzo-sopranos. The present findings suggest that, in addition to vocal tract length, vocal tract volume may also affect formant frequencies, implying the possibility that classifying professional singing voices is based on both vocal tract length and volume information.
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Affiliation(s)
- Nan Yan
- Ambient Intelligence and Multimodal Systems Lab, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences , Shenzhen , PR China
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Joosten SA, O'Driscoll DM, Berger PJ, Hamilton GS. Supine position related obstructive sleep apnea in adults: pathogenesis and treatment. Sleep Med Rev 2013; 18:7-17. [PMID: 23669094 DOI: 10.1016/j.smrv.2013.01.005] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/21/2013] [Accepted: 01/21/2013] [Indexed: 11/26/2022]
Abstract
The most striking feature of obstructive respiratory events is that they are at their most severe and frequent in the supine sleeping position: indeed, more than half of all obstructive sleep apnea (OSA) patients can be classified as supine related OSA. Existing evidence points to supine related OSA being attributable to unfavorable airway geometry, reduced lung volume, and an inability of airway dilator muscles to adequately compensate as the airway collapses. The role of arousal threshold and ventilatory control instability in the supine position has however yet to be defined. Crucially, few physiological studies have examined patients in the lateral and supine positions, so there is little information to elucidate how breathing stability is affected by sleep posture. The mechanisms of supine related OSA can be overcome by the use of continuous positive airway pressure. There are conflicting data on the utility of oral appliances, while the effectiveness of weight loss and nasal expiratory resistance remains unclear. Avoidance of the supine posture is efficacious, but long term compliance data and well powered randomized controlled trials are lacking. The treatment of supine related OSA remains largely ignored in major clinical guidelines. Supine OSA is the dominant phenotype of the OSA syndrome. This review explains why the supine position so favors upper airway collapse and presents the available data on the management of patients with supine related OSA.
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Affiliation(s)
- Simon A Joosten
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Australia; The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Australia.
| | - Denise M O'Driscoll
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Australia; Department of Medicine, Southern Clinical School, Monash University, Clayton, Australia
| | - Philip J Berger
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Australia
| | - Garun S Hamilton
- Monash Lung and Sleep, Monash Medical Centre, Clayton, Australia; The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Australia
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Pihtili A, Bingol Z, Kiyan E, Cuhadaroglu C, Issever H, Gulbaran Z. Obstructive sleep apnea is common in patients with interstitial lung disease. Sleep Breath 2013; 17:1281-8. [PMID: 23563999 DOI: 10.1007/s11325-013-0834-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/26/2012] [Accepted: 03/22/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE The incidence of obstructive sleep apnea (OSA) in interstitial lung disease (ILD) has been reported at different frequencies in several studies. The aims of our study were to evaluate the frequency of OSA in ILD and to analyze the relationship between polysomnography (PSG) findings and pulmonary function, disease severity, parenchymal involvement, and Epworth Sleepiness Scale (ESS) scores. METHODS ILD patients with parenchymal involvement were evaluated. The disease severity was assessed using an index consisting of body mass index (BMI), carbon monoxide diffusion capacity, the Modified Medical Research Council dyspnea scale, and the 6-min walking distance. All of the patients had lung function, chest X-ray, PSG, ESS scoring, and an upper airway examination. Patients with a BMI ≥ 30 or significant upper airway pathologies were excluded. RESULTS Of 62 patients, 50 patients comprised the study group (14 male, 36 female; mean age 54 ± 12.35 years, mean BMI 25.9 ± 3.44 kg/m(2)) with diagnoses of idiopathic pulmonary fibrosis (IPF; n = 17), stage II-III sarcoidosis (n = 15), or scleroderma (n = 18). The frequency of OSA was 68 %. The mean apnea-hypopnea index (AHI) was 11.4 ± 12.5. OSA was more common in IPF patients (p = 0.009). The frequency of rapid eye movement-related sleep apnea was 52.9 %. The frequency of OSA was higher in patients with a disease severity index ≥3 (p = 0.04). The oxygen desaturation index and the AHI were higher in patients with diffuse radiological involvement (p = 0.007 and p = 0.043, respectively). CONCLUSIONS OSA is common in ILD. PSG or at minimum nocturnal oximetry should be performed, particularly in patients with functionally and radiologically severe disease.
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Affiliation(s)
- Aylin Pihtili
- Department of Pulmonary Diseases, Istanbul Medical Faculty, Istanbul University, 34 360, Capa, Istanbul, Turkey
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Gusbin N, Fry S, Mallart A, Wallaert B. [Idiopathic pulmonary fibrosis and sleep disorders]. Rev Pneumol Clin 2013; 69:41-45. [PMID: 23351834 DOI: 10.1016/j.pneumo.2012.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 11/17/2012] [Accepted: 11/20/2012] [Indexed: 06/01/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is the most common interstitial lung disease. Despite progress made in understanding the pathophysiological mechanisms behind the development of the disease, its prognosis is poor. For this reason, any measure to improve the quality of life for these patients should be preferred. Some authors are interested in sleep disorders, and possible impact on quality of life. Patients with IPF have lowered scores of quality of life compared to those found in general population, with some correlation with the scores of sleep quality. There is a hyperfragmentation with many arousals and desaturation events. Some authors also report an apnea-hypopnea index higher in these patients, but these data are not found in all the studies. Correcting these obstructive phenomena may have a beneficial effect on survival, which would make systematic the sleep assessment in these patients. Finally, the relationship between IPF, gastroesophageal reflux and sleep apnea syndrome remains unclear.
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Affiliation(s)
- N Gusbin
- Service de pneumologie et immunoallergologie, centre de compétence maladies pulmonaires rares, clinique des maladies respiratoires, université de Lille 2, hôpital Calmette, CHRU de Lille, boulevard Leclercq, 59037 Lille, France
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Abstract
We previously showed that in hypertensive patients the amount of fluid displaced from the legs overnight is directly related to the severity of obstructive sleep apnea and that the rostral fluid shift was greater in drug-resistant hypertensive patients. The findings suggested that this fluid redistribution increases upper airway collapsibility, yet more direct evidence is lacking. The present study examines the effects of graded lower body positive pressure on leg fluid volume, upper airway cross-sectional area, and neck circumference in patients with drug-resistant hypertension (n=25) and controlled hypertension (n=15). In both groups, the reduction in mean upper airway cross-sectional area and oropharyngeal junction area, assessed by acoustic pharyngometry, and the increase in neck circumference, determined by mercury strain gauge plethysmography, were related to the amount of fluid displaced from the legs (
R
2
=0.41,
P
<0.0001;
R
2
=0.42,
P
<0.0001; and
R
2
=0.47,
P
<0.0001, respectively). Displacement of leg fluid volume was significantly greater in patients with drug-resistant hypertension than in controlled hypertension (
P
<0.0001), and as a consequence, the former experienced greater reductions in mean upper airway cross-sectional area and oropharyngeal junction area (
P
=0.001 and
P
<0.0001, respectively). The findings support the concept that in hypertensive subjects, rostral fluid displacement may participate in the pathogenesis of obstructive sleep apnea by narrowing the upper airway and making it more susceptible to collapse during sleep. The exaggerated fluid volume displacement from the legs and upper airway response to lower body positive pressure in patients with drug-resistant hypertension provide additional evidence of an important link between drug-resistant hypertension and obstructive sleep apnea.
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Affiliation(s)
- Oded Friedman
- From the Prosserman Center for Health Research, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (O.F., A.G.L.); Sleep Research Laboratory, Toronto Rehabilitation Institute, Toronto, Ontario, Canada (T.D.B.); Department of Medicine, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada (O.F.,T.D.B., A.G.L.); Department of Medicine (O.F., T.D.B., A.G.L.) and Center for Sleep Medicine and Circadian Biology (T.D.B.), University of Toronto, Toronto,
| | - T. Douglas Bradley
- From the Prosserman Center for Health Research, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (O.F., A.G.L.); Sleep Research Laboratory, Toronto Rehabilitation Institute, Toronto, Ontario, Canada (T.D.B.); Department of Medicine, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada (O.F.,T.D.B., A.G.L.); Department of Medicine (O.F., T.D.B., A.G.L.) and Center for Sleep Medicine and Circadian Biology (T.D.B.), University of Toronto, Toronto,
| | - Alexander G. Logan
- From the Prosserman Center for Health Research, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada (O.F., A.G.L.); Sleep Research Laboratory, Toronto Rehabilitation Institute, Toronto, Ontario, Canada (T.D.B.); Department of Medicine, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada (O.F.,T.D.B., A.G.L.); Department of Medicine (O.F., T.D.B., A.G.L.) and Center for Sleep Medicine and Circadian Biology (T.D.B.), University of Toronto, Toronto,
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Elias RM, Chan CT, Paul N, Motwani SS, Kasai T, Gabriel JM, Spiller N, Bradley TD. Relationship of pharyngeal water content and jugular volume with severity of obstructive sleep apnea in renal failure. Nephrol Dial Transplant 2012; 28:937-44. [PMID: 23136217 DOI: 10.1093/ndt/gfs473] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In patients with end-stage renal disease (ESRD), fluid overload may contribute to their high prevalence of obstructive sleep apnea (OSA) by increasing the amount of fluid displaced from the legs into the neck overnight, and possibly compressing the upper airway (UA). Indeed, in ESRD patients, the amount of overnight rostral fluid displacement from the legs is related to the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index, AHI). We, therefore, hypothesized that in ESRD patients, the greater the UA-mucosal water content (UA-MWC) and internal jugular vein volume (IJVVol), the higher the AHI. METHODS We studied 20 patients with ESRD on thrice weekly hemodialysis who had undergone diagnostic polysomnography (age 41.0 ± 12.3 years, with a body mass index (BMI) of 25.8 ± 6.3 kg/m(2) and an AHI of 20.2 ± 26.8). The leg fluid volume (LFV) was measured by bioelectric impedance. The IJVVol and MWC were measured by UA magnetic resonance imaging (MRI). RESULTS The only significant independent correlates of the AHI were IJVVol (r = 0.801, P < 0.0001) and UA-MWC (r = 0.720, P = 0.0005) which together explained 72% of its variability. CONCLUSIONS These data suggest that fluid overload via increased IJVVol, and UA-MWC, contributes to the pathogenesis of OSA in patients with ESRD. These findings help us to explain the high prevalence of OSA in ESRD patients, and attenuation of OSA in association with nocturnal dialysis. They also suggest the need for randomized trials to determine whether more aggressive fluid removal in ESRD patients will alleviate OSA.
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Affiliation(s)
- Rosilene M Elias
- Sleep Research Laboratory of the Toronto Rehabilitation Institute, Toronto, Ontario, Canada
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Schwartz AR, Smith PL, Schneider H, Patil SP, Kirkness JP. Invited editorial on "Lung volume and upper airway collapsibility: what does it tell us about pathogenic mechanisms?". J Appl Physiol (1985) 2012; 113:689-90. [PMID: 22858622 DOI: 10.1152/japplphysiol.00716.2012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kairaitis K, Verma M, Amatoury J, Wheatley JR, White DP, Amis TC. A threshold lung volume for optimal mechanical effects on upper airway airflow dynamics: studies in an anesthetized rabbit model. J Appl Physiol (1985) 2012; 112:1197-205. [DOI: 10.1152/japplphysiol.01286.2011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Increasing lung volume improves upper airway airflow dynamics via passive mechanisms such as reducing upper airway extraluminal tissue pressures (ETP) and increasing longitudinal tension via tracheal displacement. We hypothesized a threshold lung volume for optimal mechanical effects on upper airway airflow dynamics. Seven supine, anesthetized, spontaneously breathing New Zealand White rabbits were studied. Extrathoracic pressure was altered, and lung volume change, airflow, pharyngeal pressure, ETP laterally (ETPlat) and anteriorly (ETPant), tracheal displacement, and sternohyoid muscle activity (EMG%max) monitored. Airflow dynamics were quantified via peak inspiratory airflow, flow limitation upper airway resistance, and conductance. Every 10-ml lung volume increase resulted in caudal tracheal displacement of 2.1 ± 0.4 mm (mean ± SE), decreased ETPlat by 0.7 ± 0.3 cmH2O, increased peak inspiratory airflow of 22.8 ± 2.6% baseline (all P < 0.02), and no significant change in ETPant or EMG%max. Flow limitation was present in most rabbits at baseline, and abolished 15.7 ± 10.5 ml above baseline. Every 10-ml lung volume decrease resulted in cranial tracheal displacement of 2.6 ± 0.4 mm, increased ETPant by 0.9 ± 0.2 cmH2O, ETPlat was unchanged, increased EMG%max of 11.1 ± 0.3%, and a reduction in peak inspiratory airflow of 10.8 ± 1.0%baseline (all P < 0.01). Lung volume, resistance, and conductance relationships were described by exponential functions. In conclusion, increasing lung volume displaced the trachea caudally, reduced ETP, abolished flow limitation, but had little effect on resistance or conductance, whereas decreasing lung volume resulted in cranial tracheal displacement, increased ETP and increased resistance, and reduced conductance, and flow limitation persisted despite increased muscle activity. We conclude that there is a threshold for lung volume influences on upper airway airflow dynamics.
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Affiliation(s)
- Kristina Kairaitis
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute and University of Sydney at Westmead Hospital, Westmead, New South Sales, Australia; and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Manisha Verma
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute and University of Sydney at Westmead Hospital, Westmead, New South Sales, Australia; and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jason Amatoury
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute and University of Sydney at Westmead Hospital, Westmead, New South Sales, Australia; and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - John R. Wheatley
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute and University of Sydney at Westmead Hospital, Westmead, New South Sales, Australia; and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David P. White
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute and University of Sydney at Westmead Hospital, Westmead, New South Sales, Australia; and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Terence C. Amis
- Ludwig Engel Centre for Respiratory Research, Westmead Millennium Institute and University of Sydney at Westmead Hospital, Westmead, New South Sales, Australia; and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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48
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Hirata RP, Aguiar IC, Nacif SR, Giannasi LC, Leitão Filho FSS, Santos IR, Romano S, Faria NS, Nonaka PN, Sampaio LMM, Oliveira CS, Carvalho PTC, Lorenzi-Filho G, Braghiroli A, Salvaggio A, Insalaco G, Oliveira LVF. Observational study on efficacy of negative expiratory pressure test proposed as screening for obstructive sleep apnea syndrome among commercial interstate bus drivers--protocol study. BMC Pulm Med 2011; 11:57. [PMID: 22151802 PMCID: PMC3280188 DOI: 10.1186/1471-2466-11-57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 12/07/2011] [Indexed: 11/10/2022] Open
Abstract
Abstract Trial registration Registro Brasileiro de Ensaios Clinicos (local acronym RBEC) [Internet]: Rio de Janeiro (RJ): Instituto de Informaçao Cientifica e Tecnologica em Saude (Brazil); 2010 - Identifier RBR-7dq5xx. Cross-sectional study on efficacy of negative expiratory pressure test proposed as screening for obstructive sleep apnea syndrome among commercial interstate bus drivers; 2011 May 31 [7 pages]. Available from http://www.ensaiosclinicos.gov.br/rg/RBR-7dq5xx/.
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Affiliation(s)
- Raquel P Hirata
- Master's and Doctoral Degree Programs in Rehabilitation Sciences, Nove de Julho, University, Sao Paulo, Brazil
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Moon IJ, Han DH, Kim JW, Rhee CS, Sung MW, Park JW, Kim DS, Lee CH. Sleep magnetic resonance imaging as a new diagnostic method in obstructive sleep apnea syndrome. Laryngoscope 2010; 120:2546-54. [DOI: 10.1002/lary.21112] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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50
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Martinez D, Fiori CZ, Baronio D, Carissimi A, Kaminski RSR, Kim LJ, Rosa DP, Bos Â. Brown adipose tissue: is it affected by intermittent hypoxia? Lipids Health Dis 2010; 9:121. [PMID: 20958998 PMCID: PMC2970595 DOI: 10.1186/1476-511x-9-121] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 10/19/2010] [Indexed: 01/06/2023] Open
Abstract
Background Intermittent hypoxia (IH), a model of sleep apnea, produces weight loss in animals. We hypothesized that changes in brown adipose tissue (BAT) function are involved in such phenomenon. We investigated the effect of IH, during 35 days, on body weight, brown adipose tissue wet weight (BATww) and total protein concentration (TPC) of BAT. Methods We exposed Balb/c mice to 35 days of IH (n = 12) or sham intermittent hypoxia (SIH; n = 12), alternating 30 seconds of progressive hypoxia to a nadir of 6%, followed by 30 seconds of normoxia. During 8 hours, the rodents underwent a total of 480 cycles of hypoxia/reoxygenation, equivalent to an apnea index of 60/hour. BAT was dissected and weighed while wet. Protein was measured using the Lowry protein assay. Results Body weight was significantly reduced in animals exposed to IH, at day 35, from 24.4 ± 3.3 to 20.2 ± 2.2 g (p = 0.0004), while in the SIH group it increased from 23.3 ± 3.81 to 24.1 ± 2.96 g (p = 0.23). BATww was also lower in IH than in SIH group (p = 0.00003). TPC of BAT, however, was similar in IH (204.4 ± 44.3 μg/100 μL) and SIH groups (213.2 ± 78.7 μg/100 μL; p = 0.74) and correlated neither with body weight nor with BATww. TPC appeared to be unaffected by exposure to IH also in multivariate analysis, adjusting for body weight and BATww. The correlation between body weight and BATww is significant (rho= 0.63) for the whole sample. When IH and SIH groups are tested separately, the correlations are no longer significant (rho= 0.48 and 0.05, respectively). Conclusion IH during 35 days in a mice model of sleep apnea causes weight loss, BATww reduction, and no change in TPC of BATww. The mechanisms of weight loss under IH demands further investigation.
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Affiliation(s)
- Denis Martinez
- Cardiology Unit, Universidade Federal do Rio Grande do Sul, Brazil, Hospital de Clínicas de Porto Alegre (HCPA), Ramiro Barcelos, 2350, Porto Alegre, 90035-903, Brazil
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