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Zhang Y, Leng S, Hu Q, Li Y, Wei Y, Lu Y, Qie D, Yang F. Pharmacological interventions for pediatric obstructive sleep apnea (OSA): Network meta-analysis. Sleep Med 2024; 116:129-137. [PMID: 38460418 DOI: 10.1016/j.sleep.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 03/11/2024]
Abstract
IMPORTANCE Pediatric obstructive sleep apnea (OSA) is a common disease that can have significant negative impacts on a child's health and development. A comprehensive evaluation of different pharmacologic interventions for the treatment of OSA in children is still lacking. OBJECTIVE This study aims to conduct a comprehensive systematic review and network meta-analysis of pharmacological interventions for the management of obstructive sleep apnea in pediatric population. DATA SOURCES PubMed, Web of Science, Embase, The Cochrane Library, and CNKI were searched from 1950 to November 2022 for pediatric OSA. STUDY SELECTION Multiple reviewers included Randomized controlled trials (RCTs) concerning drugs on OSA in children. DATA EXTRACTION AND SYNTHESIS Multiple observers followed the guidance of the PRISMA NMA statement for data extraction and evaluation. Bayesian network meta-analyses(fixed-effect model) were performed to compare the weighted mean difference (WMD), logarithmic odds ratios (log OR), and the surface under the cumulative ranking curves (SUCRA) of the included pharmacological interventions. Our protocol was registered in PROSPERO website (CRD42022377839). MAIN OUTCOME(S) AND MEASURE(S) The primary outcomes were improvements in the apnea/hypopnea index (AHI), while secondary outcomes included adverse events and the lowest arterial oxygen saturation (SaO2). RESULTS 17 RCTs with a total of 1367 children with OSA aged 2-14 years that met the inclusion criteria were eventually included in our systematic review and network meta-analysis. Ten drugs were finally included in the study. The results revealed that Mometasone + Montelukast (WMD-4.74[95%CrIs -7.50 to -2.11], Budesonide (-3.45[-6.86 to -0.15], and Montelukast(-3.41[-5.45 to -1.39] exhibited significantly superior therapeutic effects compared to the placebo concerning apnea hypopnea index (AHI) value with 95%CrIs excluding no effect. Moreover, Mometasone + Montelukast achieved exceptionally high SUCRA values for both AHI (85.0 %) and SaO2 (91.0 %). CONCLUSIONS AND RELEVANCE The combination of mometasone furoate nasal spray and oral montelukast sodium exhibits the highest probability of being the most effective intervention. Further research is needed to investigate the long-term efficacy and safety profiles of these interventions in pediatric patients with OSA.
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Affiliation(s)
- Yuxiao Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Siqi Leng
- Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qian Hu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Yingna Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Yumeng Wei
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - You Lu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Di Qie
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Fan Yang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China.
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Lo Giudice A, La Rosa S, Ronsivalle V, Isola G, Cicciù M, Alessandri-Bonetti G, Leonardi R. Indications for Dental Specialists for Treating Obstructive Sleep Apnea with Mandibular Advancement Devices: A Narrative Review. Int J Dent 2024; 2024:1007237. [PMID: 38585252 PMCID: PMC10999292 DOI: 10.1155/2024/1007237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
Obstructive sleep apnea (OSA) syndrome is characterized by repeated airway collapse during sleep. It determines cardiovascular, pulmonary, and neurocognitive consequences and is associated with several daytime and nighttime symptoms that influence the patient's quality of life. The contribution of the dental specialist in the clinical management of OSA patients entails participating in the screening process as diagnostic sentinels and providing adequate treatment using mandibular advancement devices (MADs). Since the treatment of OSA requires a multidisciplinary approach, including different medical specialists, dentists should have a comprehensive understanding of medical and dental factors that influence the strategy and effectiveness of OSA treatment with MAD. Such expertise is crucial in determining the appropriate treatment indications and helps clinicians establish a consolidated position within the multidisciplinary OSA team. In this regard, this review summarizes the evidence of the clinical indications for MAD treatment and provides the dental specialist with helpful information about medical, functional, and other relevant factors that should be considered during diagnosis, treatment plan, and follow-up stages. Information retrieved was organized and discussed, generating specific domains/queries oriented to the clinical management of OSA patients from the clinical perspective of dental specialists.
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Affiliation(s)
- Antonino Lo Giudice
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, Policlinico Universitario “Gaspare Rodolico—San Marco”, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Salvatore La Rosa
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, Policlinico Universitario “Gaspare Rodolico—San Marco”, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Vincenzo Ronsivalle
- Department of General Surgery and Medical-Surgical Specialties, Section of Oral Surgery, Policlinico Universitario “Gaspare Rodolico—San Marco”, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Gaetano Isola
- Department of General Surgery and Medical-Surgical Specialties, Section of Periodontology, Policlinico Universitario “Gaspare Rodolico—San Marco”, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Marco Cicciù
- Department of General Surgery and Medical-Surgical Specialties, Section of Oral Surgery, Policlinico Universitario “Gaspare Rodolico—San Marco”, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Giulio Alessandri-Bonetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Bologna, Italy
| | - Rosalia Leonardi
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthodontics, Policlinico Universitario “Gaspare Rodolico—San Marco”, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
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Lai YJ, Li CY, Hung CH, Lin CY. Severity of tongue base collapse in various body positions in patients with obstructive sleep apnea: A trajectory analysis. J Formos Med Assoc 2024:S0929-6646(24)00086-X. [PMID: 38423924 DOI: 10.1016/j.jfma.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Drug-induced sleep endoscopy (DISE) is used for evaluating upper airway anatomy and determining airway obstruction patterns. It is typically performed with the patient in the supine position. Airway collapse severity is influenced by body position and level of consciousness; the resultant dynamic changes may vary across patients. In this study, we evaluated the severity of upper airway collapse through awake endoscopy and DISE and identified factors affecting the pattern of airway collapse severity. METHODS This study included 66 patients with obstructive sleep apnea. The patients underwent type 1 polysomnography, tongue strength assessment, awake endoscopy in the sitting and supine positions, and DISE. Group-based trajectory modeling was performed to identify patients with different collapse severity patterns in different body positions and at different levels of consciousness. RESULTS Patient with similar severity trajectory were assigned to the same group. Two different severity trajectories (group 1 and group 2) were identified at the tongue base level. Tongue depression strength varied significantly between groups 1 and 2 (47.00 vs. 35.00 kPa; P = .047). During awake endoscopy, collapse severity was significantly higher in group 2 than in group 1. Group 1 had lower rapid eye movement/nonrapid eye movement apnea-hypopnea index ratios and higher tongue depression strength than did group 2. CONCLUSION In patients with obstructive sleep apnea, tongue strength may vary depending on body position. Our results should be interpreted with caution because of the limited sample size. Future studies should investigate the effect of oropharyngeal rehabilitation on tongue strength and collapse severity.
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Affiliation(s)
- Yi-Ju Lai
- Institute of Physical Education, Health and Leisure Studies, College of Management, National Cheng Kung University, Tainan, Taiwan; Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Ching-Hsia Hung
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Environmental and Occupational Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Ciavarella D, Lorusso M, Campobasso A, Cazzolla AP, Montaruli G, Burlon G, Lo Muzio E, Laurenziello M, Tepedino M. Craniofacial morphology in Obstructive Sleep Apnea patients. J Clin Exp Dent 2023; 15:e999-e1006. [PMID: 38186919 PMCID: PMC10767735 DOI: 10.4317/jced.61104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024] Open
Abstract
Background To evaluate the correlation between cephalometric skeletal parameters and Obstructive Sleep Apnea syndrome (OSAs) severity, in adult patients with OSAs. Material and Methods One hundred patients (94 males,6 females mean age 59,3) with diagnosis of OSAs were retrospectively enrolled. Each patient received Home Sleep Apnea Testing (HSAT) and latero-lateral radiograph. Eight cephalometric parameters (cranial deflection angle, saddle angle, articular angle, divergence angle, cranial base angle, skull base length, mandibular length, maxilla length) were analyzed and then related to Apnea/Hypopnea Index (AHI) and to the Oxygen Desaturation Index (ODI), recorded by HSAT. A Spearman's rho correlation test between cephalometric measurements and HSAT indices was performed. Statistical significance was set at p< 0.05. Results A negative statistically significant correlation was found between mandibular length (Condilion-Gnathion distance) and AHI (rho= -0,2022; p<0,05) and between maxilla length (Ans-Pns) and AHI (rho= -0,2984; p<0,01) and ODI (rho= -0,2443; p<0,05). A statistically significant correlation was also observed between the divergence angle (S-N^Go-Me) and AHI (rho=0,2263; p<0,05) and between cranial deflection angle (Fh^NBa) and AHI (rho=0,2212; p<0,05) and ODI (rho=0,1970; p<0,05). Conclusions The OSAs severity may be related to certain predisposing features in craniofacial morphology, such as maxillary and mandibular length, divergence and cranial deflection. Key words:OSAs, Home Sleep Apnea Testing, AHI, ODI, Cephalometry, Airway.
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Affiliation(s)
- Domenico Ciavarella
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Mauro Lorusso
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Alessandra Campobasso
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Angela-Pia Cazzolla
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Graziano Montaruli
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Giuseppe Burlon
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Eleonora Lo Muzio
- Department of Translational Medicine and for Romagna, School of Orthodontics, University of Ferrara, Ferrara, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, Dental School of L'Aquila, University of L'Aquila, L'Aquila, Italy
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Blaszczyk B, Wieckiewicz M, Kusztal M, Michalek-Zrabkowska M, Lachowicz G, Mazur G, Martynowicz H. Fabry disease and sleep disorders: a systematic review. Front Neurol 2023; 14:1217618. [PMID: 37869133 PMCID: PMC10586315 DOI: 10.3389/fneur.2023.1217618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Background Fabry disease (FD) is an X-chromosome-linked disorder characterized by a reduced or complete absence of the enzyme α-galactosidase, resulting in the accumulation of lysosomal globotriaosylceramide. Despite the presence of these deposits in multiple organs, the problem of sleep disorders within this population has very rarely been documented. Objective This study aimed to investigate the types and prevalence of sleep disorders among patients with FD. Methods Screening of the following medical databases using key terms was performed on 10 February 2023: PubMed, Scopus, and Embase. A total of 136 records were identified. The quality assessment of the studies was conducted by using tools from the National Institutes of Health (NIH) and critical appraisal tools from the Joanna Briggs Institute (JBI). Results The study included nine studies on sleep disorders in patients with FD. The overall quality of the majority of these studies was assessed as either poor or fair. Among 330 patients, there was a slightly higher representation of female patients (56%). Sleep problems manifested 4-5 years after the onset of FD and sometimes even after 10-11 years. Genotypes of disease associated with sleep problems were rarely described. Within the FD population, the most commonly reported conditions were excessive daytime sleepiness (EDS) as well as obstructive and central sleep apnea (OSA, CSA). However, EDS occurred more frequently in FD patients, while the prevalence of OSA and CSA was within the ranges observed in the general population. The studies included indicated a lack of association between organ impairment by primary disease and EDS and OSA. The effectiveness of enzyme replacement therapy (ERT) in treating sleep disorders was not demonstrated. Conclusion The findings of this report revealed the presence of many sleep-related disorders within the FD population. However, very few studies on this subject are available, and their limited results make it difficult to truly assess the real extent of the prevalence of sleep disturbances among these individuals. There is a need to conduct further studies on this topic, involving a larger group of patients. It is important to note that there are no guidelines available for the treatment of sleep disorders in patients with FD.
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Affiliation(s)
- Bartlomiej Blaszczyk
- Student Research Club No K133, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, Wrocław, Poland
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Monika Michalek-Zrabkowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Gabriella Lachowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
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Sindi MA, Mirdad M, Al-Sebaei M, Bamashmous M. Identification of Patients at Risk of Obstructive Sleep Apnea in Dental Settings. Cureus 2023; 15:e44646. [PMID: 37799224 PMCID: PMC10548844 DOI: 10.7759/cureus.44646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Objectives This study aims to assess the risk of obstructive sleep apnea (OSA) in the Saudi Arabian population at a dental hospital using the Berlin Questionnaire (BQ) and investigate the association of gender, age, neck circumference, systolic blood pressure (SBP), diastolic blood pressure (DBP), and smoking habits with the risk of OSA. Methodology Participants were recruited through random selection from walk-in patients aged between 18 and 80 years. BQ was used to screen for OSA. In addition, age, gender, smoking habits, neck circumference, and blood pressure were collected. Data were analyzed using descriptive statistics, Student's t-test, and chi-square test. Results In this study, 55 participants were screened for OSA using BQ. Of the participants, 44 (80%) were considered to be at low risk of OSA. Age, neck circumference, BMI, SBP, and DBP were statistically significantly associated with high risk of OSA (P < 0.05). Age and neck circumference were found to be statistically significant predictors of OSA, even after controlling for gender and smoking status (P < 0.05). Conclusions BQ is a reliable tool for assessing the risk of OSA in the Saudi Arabian population. Age, neck circumference, BMI, SBP, and DBP are all significant factors of OSA, while age and neck circumference are significant predictors of OSA. Dental practitioners can play a valuable role in the early detection and referral of patients at high risk of OSA.
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Affiliation(s)
| | | | - Maisa Al-Sebaei
- Oral and Maxillofacial Surgery, King Abdulaziz University, Jeddah, SAU
| | - Mohamed Bamashmous
- Dental Public Health, King Abdulaziz University, Jeddah, SAU
- Orthodontic and Dentofacial Orthopedics, Boston University, Boston, USA
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Lv R, Liu X, Zhang Y, Dong N, Wang X, He Y, Yue H, Yin Q. Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome. Signal Transduct Target Ther 2023; 8:218. [PMID: 37230968 DOI: 10.1038/s41392-023-01496-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common breathing disorder in sleep in which the airways narrow or collapse during sleep, causing obstructive sleep apnea. The prevalence of OSAS continues to rise worldwide, particularly in middle-aged and elderly individuals. The mechanism of upper airway collapse is incompletely understood but is associated with several factors, including obesity, craniofacial changes, altered muscle function in the upper airway, pharyngeal neuropathy, and fluid shifts to the neck. The main characteristics of OSAS are recurrent pauses in respiration, which lead to intermittent hypoxia (IH) and hypercapnia, accompanied by blood oxygen desaturation and arousal during sleep, which sharply increases the risk of several diseases. This paper first briefly describes the epidemiology, incidence, and pathophysiological mechanisms of OSAS. Next, the alterations in relevant signaling pathways induced by IH are systematically reviewed and discussed. For example, IH can induce gut microbiota (GM) dysbiosis, impair the intestinal barrier, and alter intestinal metabolites. These mechanisms ultimately lead to secondary oxidative stress, systemic inflammation, and sympathetic activation. We then summarize the effects of IH on disease pathogenesis, including cardiocerebrovascular disorders, neurological disorders, metabolic diseases, cancer, reproductive disorders, and COVID-19. Finally, different therapeutic strategies for OSAS caused by different causes are proposed. Multidisciplinary approaches and shared decision-making are necessary for the successful treatment of OSAS in the future, but more randomized controlled trials are needed for further evaluation to define what treatments are best for specific OSAS patients.
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Affiliation(s)
- Renjun Lv
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Xueying Liu
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Yue Zhang
- Department of Geriatrics, the 2nd Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Na Dong
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Xiao Wang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Yao He
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Hongmei Yue
- Department of Pulmonary and Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
| | - Qingqing Yin
- Department of Geriatric Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
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Chen T, Li F, Xi Y, Deng Y, Chen S, Tao Z. Association between sleep-disordered breathing and self-reported sinusitis in adults in the United States: NHANES 2005-2006. EAR, NOSE & THROAT JOURNAL 2023:1455613231167884. [PMID: 37097775 DOI: 10.1177/01455613231167884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVES The association between sleep-disordered breathing (SDB) and sinusitis has been widely studied; however, research on SDB-related sleep problems and sinusitis are limited. This study aims to determine the relationship between SDB-related sleep problems, SDB symptom score, and sinusitis. METHODS After the screening, data were analyzed from 3414 individuals (≥20 years) from the 2005-2006 National Health and Nutrition Examination Survey questionnaire. Data on snoring, daytime sleepiness, obstructive sleep apnea (snorting, gasping, or cessation of breathing while sleeping), and sleep duration were analyzed. The SDB symptom score was determined based on a summary of the scores of the above four parameters. Pearson chi-square test and logistic regression analysis were used in statistical analyses. RESULTS After adjusting for confounders, self-reported sinusitis was strongly correlated with frequent apneas (OR: 1.950; 95% CI: 1.349-2.219), excessive daytime sleepiness (OR: 1.880; 95% CI: 1.504-2.349), and frequent snoring (OR: 1.481; 95% CI: 1.097-2.000). Compared to an SDB symptom score of 0, the higher the SDB symptom score, the higher the risk of self-reported sinusitis. For the subgroup analyses, this association was significant in females and across ethnic groups. CONCLUSION In the United States, SDB is significantly associated with self-reported sinusitis in adults. In addition, our study suggests that patients with SDB should be aware of the risk of developing sinusitis.
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Affiliation(s)
- Tian Chen
- Department of Otolaryngology, Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fen Li
- Institute of Otolaryngology, Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yang Xi
- Department of Otolaryngology, Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuqin Deng
- Department of Otolaryngology, Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shiming Chen
- Department of Otolaryngology, Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Otolaryngology, Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zezhang Tao
- Department of Otolaryngology, Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
- Institute of Otolaryngology, Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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Rhodes S, Waters D, Brockway B, Skinner M. Exercise and motivational text messaging to support physical activity behaviour change in a population with obstructive sleep apnoea: a feasibility study. J Prim Health Care 2022; 14:318-325. [PMID: 36592765 DOI: 10.1071/hc22033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/17/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Patients with obstructive sleep apnoea (OSA) commonly present in primary care. Increasing physical activity reduces symptoms and severity of OSA. Low motivation is a barrier to physical activity in adults with OSA. Aim To investigate the feasibility and acceptability of an exercise and personalised text messaging programme to enhance motivation and support physical activity behaviour change in adults with OSA. Methods Participants were recruited from the local Sleep Clinic. Exclusion criteria were unstable angina, and/or poorly controlled hypertension. The intervention comprised three groups, who received either individual exercise prescription, personalised text messages or both over a 24-week period. Participants were allocated to one of the three groups. The primary outcome was feasibility of study design including participant recruitment and retention. Secondary outcomes were a change in 6-min walk distance and exercise self-efficacy over time. Results Thirty participants were recruited, 17 male and 13 female, with a mean age of 54.6 years. The study design appears feasible and the outcome measures used were acceptable to participants. Recruitment and retention rates were lower than anticipated. A trend towards increased functional exercise capacity was identified in all three groups, along with a corresponding increase in exercise self-efficacy over time. Discussion Exercise and personalised text messaging both appear to offer an acceptable and feasible means to increase physical activity in adults with OSA. A larger scale trial may provide justification for physiotherapist input to support patients with OSA to address physical inactivity.
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Affiliation(s)
- Sarah Rhodes
- School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, New Zealand
| | - Debra Waters
- Department of Medicine/School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, New Zealand
| | - Ben Brockway
- Department of Medicine, University of Otago, 201 Great King Street, Dunedin, New Zealand
| | - Margot Skinner
- School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin 9016, New Zealand
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Khalaji A, Behnoush AH, Shobeiri P, Saeedian B, Teixeira AL, Rezaei N. Association between brain-derived neurotrophic factor levels and obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath 2022; 27:829-841. [DOI: 10.1007/s11325-022-02707-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/31/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
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Saxena V, Pal A, Talukdar SK, Gupta R. Relationship of obstructive sleep apnea with major depressive disorder and development of metabolic syndrome. Indian J Psychiatry 2022; 64:505-509. [PMID: 36458080 PMCID: PMC9707668 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_797_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 05/31/2022] [Accepted: 06/22/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Major depressive disorder (MDD) is often linked with a number of coexisting disorders with a relation that is poorly understood. The aim of this study was to find out the role of obstructive sleep apnea (OSA) in metabolic syndrome (MS) in subjects with MDD and to develop a model for factors leading to MS. METHODS It was a cross-sectional study conducted on 119 subjects. They were evaluated on sociodemographic and clinical parameters, Berlin questionnaire, and Quick Inventory of Depressive Symptomatology. Comparisons were made using appropriate statistics. Binary logistic regression was used to find out the role of clinical parameters in the development of MS. RESULTS A total of 34% with MDD had a high risk of developing OSA while 19% had metabolic syndrome. Among all clinical variables, antidepressant exposure in terms of total fluoxetine units, duration of treatment, and risk of developing OSA was found to be significantly more in patients with MS. A higher risk of OSA was found to have a higher likelihood to cause MS in patients with MDD. CONCLUSION There is a high risk of MS and OSA in subjects with MDD. The increased risk of MS is contributed by an increased risk of developing OSA among patients with MDD. Cross-sectional design and limited generalizability are the major limitations of this study.
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Affiliation(s)
- Vrinda Saxena
- Department of Psychiatry, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun, Uttarakhand, India
| | - Arghya Pal
- Department of Psychiatry, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun, Uttarakhand, India
| | - S K Talukdar
- Department of Psychiatry, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun, Uttarakhand, India
| | - Ravi Gupta
- Department of Psychiatry and Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Nikisha GN, Mohana Karthikeyan S. Modified Uvulopalatopharyngoplasty with Tonsillectomy in Treatment of Obstructive Sleep Apnoea. Indian J Otolaryngol Head Neck Surg 2022; 74:272-278. [PMID: 36213474 PMCID: PMC9535061 DOI: 10.1007/s12070-021-02443-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022] Open
Abstract
Obstructive sleep apnoea is a common problem with many long-term consequences if left untreated. The purpose of this study is to find the efficacy of modified uvulopalatopharyngoplasty with tonsillectomy in the treatment of OSA symptoms, apnoea-hypopnoea index, Epworth sleepiness scale and its effect on blood pressure and cardiac status. Patients with obstructive sleep apnoea with apnoea-hypopnoea index more than 15 with tonsillar hypertrophy, Friedman stage < 3 and palatal collapse or obstruction at the level of velum as diagnosed by DISE were included in this prospective analytical cross-sectional study. Modified uvulopalatopharyngoplasty with tonsillectomy was done in all patients. History of nocturnal and daytime OSA symptoms, Epworth sleepiness scale, snoring score, polysomnogram, drug induced sleep endoscopy, blood pressure, echocardiogram to measure velocity across pulmonary and aortic valve and ECG were taken preoperatively and 6 months postoperatively. A total of 129 participants were recruited. 82 of the 129 patients (63.5%) were men; mean (SD) age was 44.2 (6.78) years. The patients were post operatively classified as responders and non-responders by the DISE finding. 107 patients (82.9%)-responders, had no narrowing and 22 patients (17.1%)-non-responders, had persistent narrowing of velum. Non-responders had increased baseline BMI when compared to responders. All the parameters were statistically improved in responders (p < 0.001). In non-responders, there was no statistical improvement in any of the parameters. Modified uvulopalatopharyngoplasty provides significant improvement in sleep parameters like AHI, Epworth sleepiness scale and other polysomnographic parameters. It significantly reduces the cardiac burden in OSA patients without any complications. Trial registration www.ctri.nic.in identifier: CTRI/2020/06/025759.
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Affiliation(s)
- G. N. Nikisha
- Department of ENT and Head and Neck Surgery, Karpaga Vinayaka Institute of Medical Sciences and Research Center, Chinna Kolambakkam, Madurantagam, 603308 Tamil Nadu India
| | - S. Mohana Karthikeyan
- Department of ENT and Head and Neck Surgery, Karpaga Vinayaka Institute of Medical Sciences and Research Center, Chinna Kolambakkam, Madurantagam, 603308 Tamil Nadu India
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Ludwig K, Huppertz T, Radsak M, Gouveris H. Cellular Immune Dysfunction in Obstructive Sleep Apnea. Front Surg 2022; 9:890377. [PMID: 35874140 PMCID: PMC9299259 DOI: 10.3389/fsurg.2022.890377] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022] Open
Abstract
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Repetitive pauses in breathing during sleep cause a brief but recurrent decrease in oxygen saturation in organs and tissues (chronic intermittent tissue hypoxia). Many studies have proven a pro-inflammatory status in OSA patients. However, few reports are available on the effects of OSA on the cellular immune system, mostly focusing on single immune cell types and their subtypes. The aim of this Mini-Review is to summarize these reports, as OSA is associated with a high prevalence and comorbidities such as atherosclerosis, which are known to involve the cellular immune system.
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Affiliation(s)
- Katharina Ludwig
- Sleep Medicine Center, Department of Otorhinolaryngology, Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Tilman Huppertz
- Sleep Medicine Center, Department of Otorhinolaryngology, Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Markus Radsak
- IIIrd Department of Medicine, Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Haralampos Gouveris
- Sleep Medicine Center, Department of Otorhinolaryngology, Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
- Correspondence: Haralampos Gouveris
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14
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Post-Operative Patients’ Satisfaction and Quality of Life Assessment in Adult Patients with Obstructive Sleep Apnea Syndrome (OSAS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106273. [PMID: 35627810 PMCID: PMC9141812 DOI: 10.3390/ijerph19106273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 01/27/2023]
Abstract
Background: The treatment for severe OSAS includes maxillomandibular advancement surgical option in selected cases. The aim of this study was to evaluate the post-operative impact of bimaxillary surgery on satisfaction and consequently the quality of life of these patients. Methods: This study included 18 patients with severe OSAS who received maxillomandibular advancement surgery. Patients were divided into Group A (operated by CAD/CAM) and Group B (conventional surgery). The impact of bimaxillary surgery on satisfaction and quality of life of these patients was evaluated by utilizing post-operative life quality and Rustemeyer’s patient-satisfaction-based survey. Results: A total of 18 adult OSAS patients (Group A: 11 patients, Group B: 7 patients) with a mean age of 44.39 years (SD ± 9.43) were included. Mean follow-up period was 32.64 months (SD ± 21.91). No intra-operative complications were seen in any patients. Post-operative complication was seen in one patient and the mandible did not integrate. According to the results, overall post-operative satisfaction score was 79.72% (SD ± 9.96). There was no significant difference among those in Group A and Group B. Conclusion: Maxillomandibular advancement surgery seems to be beneficial in terms of patients’ satisfaction in severe adult OSAS patients and can be considered as a valuable option in selected cases.
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15
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Lin KY, Eow PY, Kohli S, Math SY. Correlation of Medical Comorbidities and Upper Airway Measurements among Dental Patients at Risk of Developing Obstructive Sleep Apnea. Clin Pract 2022; 12:284-298. [PMID: 35645311 PMCID: PMC9149922 DOI: 10.3390/clinpract12030034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Obstructive Sleep Apnea (OSA) is a partial or total upper airway collapse resulting in sleep-breathing disturbances. There are many medical comorbidities associated with OSA; hence, this study is important as the prevalence of patients with medical comorbidities associated with OSA is increasing. The study aimed to correlate medical comorbidities and OSA symptoms of the patients along with their upper airway dimensions using Cone Beam Computed Tomography (CBCT) scans to identify patients at risk of developing OSA. This cross-sectional study included patients who had CBCT imaging taken between 2014 and 2020. A questionnaire was used to gather information on patients’ medical history and OSA symptoms. The upper airway dimensions of the CBCT scans were evaluated before logistic regression and Fisher’s exact test were carried out to determine the relationships between the variables. p ≤ 0.05 was considered statistically significant. Logistic regression revealed an association of longer length (p = 0.016), smaller total volume (p = 0.017) and width (p = 0.010) of upper airways with hypertension. Furthermore, loud snoring was seen in patients with hypertension, heart disease and obesity whereas difficulty concentrating during the day was present in subjects with deviated nasal septum, tonsillitis and depression. For upper airway dimensions, a smaller average volume was associated with loud snoring (p = 0.037), difficulty concentrating during the day (p = 0.002) and mood changes (p = 0.036). A larger anterior-posterior dimension was also associated with excessive daytime sleepiness (p = 0.042), difficulty concentrating during the day (p < 0.001) and mood changes (p = 0.009). Longer airway length was additionally found to be associated with loud snoring (p = 0.021). CBCT taken for dental investigations could be correlated with patients’ medical history and OSA symptoms to screen patients at risk of OSA.
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16
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Pattipati M, Gudavalli G, Zin M, Dhulipalla L, Kolack E, Karki M, Devarakonda PK, Yoe L. Continuous Positive Airway Pressure vs Mandibular Advancement Devices in the Treatment of Obstructive Sleep Apnea: An Updated Systematic Review and Meta-Analysis. Cureus 2022; 14:e21759. [PMID: 35251830 PMCID: PMC8890605 DOI: 10.7759/cureus.21759] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder which has various treatment options, however, continuous positive airway pressure (CPAP) remains the gold standard. The aim of this meta-analysis is to compare the current first-line treatment of OSA, i.e., the continuous positive airway pressure (CPAP) with mandibular advancement devices (MADs) in mild to severe OSA. Objective: This meta-analysis is a comparison of the efficacy of continuous positive airway pressure vs mandibular advancement devices in patients with mild to severe obstructive sleep apnea. The primary objective of the meta-analysis is to compare the efficacy of CPAP vs MADs in the treatment of OSA. This meta-analysis includes randomized control and cross-over studies that compare the efficacy of CPAP and MAD and outcomes are reported in terms of apnea-hypopnea index (AHI), lowest oxygen saturation, and Epworth sleepiness scale both pre- and post-treatment. Data sources and study selection: A PubMed and Cochrane database search was conducted in May 2021 and study bibliographies were reviewed. Randomized clinical trials comparing the effect of CPAP and MAD on AHI, lowest oxygen saturation, and ESS in patients with obstructive sleep apnea were selected. Of the 436 studies initially identified, eight were selected for analysis after screening. The quantitative measures used for comparing the efficacy of CPAP and MAD were post-treatment apnea-hypopnea index (AHI), lowest oxygen saturation, and post-treatment Epworth score scale (ESS). Data extraction and synthesis: A network of meta-analyses was performed using RevMan (Copenhagen, Denmark: Nordic Cochrane Center) where multivariate random-effects models were used to generate pooled estimates. Data were analyzed using generic inverse variance method and P < 0.05 is regarded as statistically significant. Combined summary statistics of standardized (STD) paired difference in mean for individual studies and combined studies was calculated. A chi-square-based test of homogeneity was performed and the inconsistency index (I2) statistic was determined. Results: Compared the AHI, lowest oxygen saturation, and ESS from baseline to follow-up pre- and post-treatment in both CPAP and MAD groups; after the database search 436 records were identified, eight studies were included in the RCT, and three were RCT crossover studies. The duration of treatment varies in each group. AHI, ESS, and lowest oxygen saturation are calculated pre- and post-treatment. Compared with MAD, CPAP was associated with decrease in AHI with a mean difference of -5.83 (95% CI, -8.85, -2.81, P < 0.01). The lowest oxygen saturation was also decreased in CPAP group compared to MAD group with a mean difference of 0.72 (95% CI, 0.51, 0.94, P < 0.01). However, there was no statistically significant difference in ESS between CPAP and MAD group with a mean difference of 0.23 (95% CI, -0.24, 0.70, P = 0.34). The meta-analysis states that among patients with obstructive sleep apnea, both CPAP and MADs are effective in reducing the AHI and lowest oxygen saturation, however, no significant difference was found in ESS pre- and post-treatment. Conclusions: CPAP still remains the gold standard for the treatment of OSA and should continue to be recommended as a treatment for OSA. MAD can be used as adjunctive treatment or as a treatment for those who cannot readily access or do not prefer CPAP.
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Torensma B, Dooijeweerd S, Faraj D, Eldawlatly AA. Incidence of postoperative delirium in patients with preoperative and postoperative Obstructive Sleep Apnea Syndrome. A Systematic Review of the literature. Saudi J Anaesth 2022; 16:94-103. [PMID: 35261596 PMCID: PMC8846253 DOI: 10.4103/sja.sja_559_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/02/2021] [Accepted: 08/08/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction: Methods: Results: Conclusion:
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18
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Kucuk H, Acar N, Ünsal A, Kılınç A. Evaluation of the Relationship between Occupational Accidents and Obstructive Sleep Apnea Risk among Employees of a University Hospital. Indian J Occup Environ Med 2022; 26:3-8. [PMID: 35571542 PMCID: PMC9106125 DOI: 10.4103/ijoem.ijoem_361_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/17/2022] [Accepted: 02/05/2022] [Indexed: 11/04/2022] Open
Abstract
Context Occupational accidents are still one of the important causes of morbidity and mortality. Sleep apnea is a significant risk factor for occupational accidents in hospitals. Aims To determine the frequency of occupational accidents and their relationship with the risk of obstructive sleep apnea (OSAS). Settings and Design Cross-sectional study in a hospital setting. Methods and Material This study was conducted on 331 hospital workers between 2019-2020. Accidents from the Social Security Institution records were used. The risk of OSAS was evaluated with Berlin Survey, daytime sleepiness with Epworth Sleepiness Scale, sleep quality with Pittsburg Sleep Quality Scale. Statistical Analysis The Chi-square test was used for analysis; P < 0.05 was accepted as a statistical significance value. Results Of the participants, 231 (69.8%) were female. Their ages ranged between 19 and 55; the mean age was 33.8 ± 8.0 years. The frequency of occupational accidents was 8.8%, 51.4% had a high risk of OSAS, 80.4% had high daytime sleepiness, and 53.5% had poor sleep quality. Conclusion The study group had a high risk of sleep disorders. No relationship was found between sleep disorders and occupational accidents. More comprehensive studies are needed to clarify this relationship.
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Affiliation(s)
- Halime Kucuk
- Department of Occupational Health and Safety, Eskisehir Osmangazi University, Medical Faculty, Eskişehir, Turkey,Address for correspondence: Dr. Halime Kucuk, Department of Occupational Health and Safety, Eskisehir Osmangazi University, Medical Faculty, 26040 Eskisehir, Turkey. E-mail:
| | - Nurdan Acar
- Department of Emergency Medicine, Eskisehir Osmangazi University, Medical Faculty, Eskişehir, Turkey
| | - Alaettin Ünsal
- Department of Public Health, Eskisehir Osmangazi University, Medical Faculty, Eskişehir, Turkey
| | - Ali Kılınç
- Department of Public Health, Eskisehir Osmangazi University, Medical Faculty, Eskişehir, Turkey
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Guijarro-Herráiz MM, Arias-Palencia NM, Lucas-de la Cruz L, Guijarro-Herráiz B, Notario-Pacheco B, Palomo-Carrión R, García-Klepzig JL, Solera-Martínez M. Alternatives to continuous positive airway pressure treatment in sleep apnoeas and hypopnoeas syndrome related to myofunctional and postural reeducation therapy: protocol for a systematic review. BMJ Open 2021; 11:e049286. [PMID: 34857560 PMCID: PMC8640639 DOI: 10.1136/bmjopen-2021-049286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The main treatment for sleep apnoeas and hypopnoeas syndrome (SAHS) is continuous positive airway pressure (CPAP). However, patients sometimes do not adhere to the treatment protocol. Supplementary and complementary therapies have appeared as alternatives. Some of the therapies which are especially important are those related to myofunctional (MFT) and postural therapy (PT), as all of them are non-invasive, and their application is simpler than that of CPAP. We aim to present a protocol for a systematic review and meta-analysis for investigating new SAHS treatments, including the protocols and frequency of use and the effects they have on patient signs, symptoms and quality of life. METHODS AND ANALYSIS The literature search will be conducted using the Cochrane, Web of Science, Medline (via PubMed) and Scopus databases, from January 2020 to December 2020. All types of studies written in English and Spanish that investigate the use of alternative SAHS treatments related to MFT, or more importantly, the combination of MFT and PRT, will be selected. To evaluate their quality, the Critical Appraisal Checklist for Analytical Cross-Sectional will be applied. The primary factor valued in the studies will be the inclusion of MFT and PT reeducation in the treatment. Subgroup analyses will be carried out evaluating the specific type of treatments chosen and the improvements or deteriorations in the level of health and quality of life in the patients. Finally, several patient-related outcomes, namely sleep quality, quality of life and sleep Apnoeas and Hypoapnoeas Index, will be examined. ETHICS AND DISSEMINATION In this case, ethical approval is not necessary. The data used in the review will be exclusively obtained from published studies, implying there are no privacy concerns. The information obtained will be relevant to understand if the new treatments applied in SAHS are effective, and if postural and MFT therapy used together can be considered an appropriate approach to treat this disease.The results will be published in a peer-reviewed journal.
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Affiliation(s)
| | | | | | | | | | - Rocio Palomo-Carrión
- Faculty of Phsysiotheray, Universidad de Castilla-La Mancha - Campus de Toledo, Toledo, Spain
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Arslan B, Şemsi R, İriz A, Sepici Dinçel A. The evaluation of serum brain-derived neurotrophic factor and neurofilament light chain levels in patients with obstructive sleep apnea syndrome. Laryngoscope Investig Otolaryngol 2021; 6:1466-1473. [PMID: 34938889 PMCID: PMC8665460 DOI: 10.1002/lio2.683] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/09/2021] [Accepted: 10/09/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES This study aimed to compare serum levels of brain-derived neurotrophic factor (BDNF) and neurofilament light (NfL) chain in normal individuals and patients with mild and moderate-severe obstructive sleep apnea syndrome (OSAS). METHODS We enrolled 81 subjects referred to Otorhinolaryngology (Ear-Nose-Throat), Gazi University Faculty of Medicine, between 2017 and 2019. Based on the severity of OSAS, patients were divided into three groups: group 1 with mild OSAS (apnea-hypopnea index [AHI] 5-15; n = 26), group 2 with moderate-severe OSAS (AHI > 15; n = 32), and group 3 with normal individuals (AHI scores < 5; n = 23). RESULTS Serum NfL and BDNF levels were evaluated together with the clinical data for all subjects. Significant differences were seen in the oxygen desaturation index (ODI), apnea index, hypopnea index, sleep efficiency, and NfL levels (P < .05) between the three groups. In the moderate-severe group, NfL levels showed a significant positive correlation with apnea index (P < .05, r = .389), hypopnea index (P < .05, r = .455), and ODI (P = .04; r = .362). CONCLUSIONS Our findings clarify the pathophysiology of OSAS in cases of repetitive hypoxia and chronic neuronal damage. Based on our results, we recommend that in addition to BDNF, NfL should also be evaluated in different and larger patient cohorts.
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Affiliation(s)
- Burak Arslan
- Department of Medical BiochemistryGazi University Faculty of MedicineAnkaraTurkey
- Department of Medical BiochemistryErciş State HospitalVanTurkey
| | - Rabia Şemsi
- Department of Medical BiochemistryGazi University Faculty of MedicineAnkaraTurkey
| | - Ayşe İriz
- Department of Otorhinolaryngology (Ear‐Nose‐Throat)Gazi University Faculty of MedicineAnkaraTurkey
| | - Aylin Sepici Dinçel
- Department of Medical BiochemistryGazi University Faculty of MedicineAnkaraTurkey
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Li X, Hu R, Ren X, He J. Interleukin-8 concentrations in obstructive sleep apnea syndrome: a systematic review and meta-analysis. Bioengineered 2021; 12:10666-10681. [PMID: 34747311 PMCID: PMC8809978 DOI: 10.1080/21655979.2021.2001203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Interleukin (IL)-8 has been shown to play an important role in obstructive sleep apnea syndrome (OSAS). However, its role in OSAS development is still controversial. This meta-analysis was to explore the correlation between interleukin (IL)-8 concentration and OSAS. Database (from the inception to July 2021) searches on PubMed, Web of Science, Medline, EMBASE, and Cochrane Library were conducted for studies analyzing the correlation between IL-8 concentration and OSAS, regardless of the language of publication. Standardized mean difference (SMD) and 95% confidence intervals (CI) were used to analyze any prospective association between IL-8 concentration and OSAS. A total of 25 eligible studies, including 2301 participants and 1123 controls, were included in this meta-analysis. The included studies evaluating the association between serum IL-8 concentration and OSAS indicated that adults and children with OSAS had elevated serum concentrations of IL-8 compared with controls (SMD = 0.997, 95% CI = 0.437–1.517, P < 0.001; SMD = 0.431, 95% CI = 0.104–0.759, P = 0.01). Categorization of the study population into subgroups according to body mass index, apnea–hypopnea index (AHI), ethnicity, and sample size also showed that individuals with OSAS had elevated serum concentrations of IL-8 compared with controls. Additionally, the results demonstrated that the higher the AHI, higher was the IL-8 concentration. Similar results were observed in the literature on the association between plasma IL-8 concentration and OSAS. This meta-analysis verified that compared with controls, children and adults with OSAS have significantly elevated IL-8 concentrations.
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Affiliation(s)
- Xiaoyan Li
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, 610500, China.,Department of Endocrinology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, 610500, China
| | - Rong Hu
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, 610500, China.,Medical department, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, 610500, China
| | - Xinyi Ren
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, 610500, China.,Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, 610500, China
| | - Jie He
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, 610500, China.,Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, 610500, China
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22
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Hong H, Hosomichi J, Maeda H, Lekvijittada K, Oishi S, Ishida Y, Usumi-Fujita R, Kaneko S, Suzuki JI, Yoshida KI, Ono T. Intermittent hypoxia retards mandibular growth and alters RANKL expression in adolescent and juvenile rats. Eur J Orthod 2021; 43:94-103. [PMID: 32219305 DOI: 10.1093/ejo/cjaa020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Chronic intermittent hypoxia (IH), a common state experienced in obstructive sleep apnoea (OSA), retards mandibular growth in adolescent rats. The aim of this study was to elucidate the differential effects of IH on mandibular growth in different growth stages. MATERIALS AND METHODS Three-week-old (juvenile stage) and 7-week-old (adolescent stage) male Sprague-Dawley rats underwent IH for 3 weeks. Age-matched control rats were exposed to room air. Mandibular growth was evaluated by radiograph analysis, micro-computed tomography, real-time polymerase chain reaction and immunohistology. Tibial growth was evaluated as an index of systemic skeletal growth. RESULTS IH had no significant impact on the general growth of either the juvenile or adolescent rats. However, it significantly decreased the total mandibular length and the posterior corpus length of the mandible in the adolescent rats and the anterior corpus length in the juvenile rats. IH also increased bone mineral density (BMD) of the condylar head in adolescent rats but did not affect the BMD of the tibia. Immunohistological analysis showed that the expression level of receptor activation of nuclear factor-κB ligand significantly decreased (in contrast to its messenger ribonucleicacid level) in the condylar head of adolescent rats with IH, while the number of osteoprotegerin-positive cells was comparable in the mandibles of adolescent IH rats and control rats. LIMITATIONS The animal model could not simulate the pathological conditions of OSA completely and there were differences in bone growth between humans and rodents. CONCLUSIONS These results suggest that the susceptibility of mandibular growth retardation to IH depends on the growth stage of the rats.
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Affiliation(s)
- Haixin Hong
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.,Department of Forensic Medicine, Graduate School of Medicine, Tokyo Medical University, Japan
| | - Jun Hosomichi
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.,Department of Forensic Medicine, Graduate School of Medicine, Tokyo Medical University, Japan
| | - Hideyuki Maeda
- Department of Forensic Medicine, Graduate School of Medicine, Tokyo Medical University, Japan
| | - Kochakorn Lekvijittada
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.,Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Shuji Oishi
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Yuji Ishida
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Risa Usumi-Fujita
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Sawa Kaneko
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Jun-Ichi Suzuki
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.,Department of Advanced Clinical Science and Therapeutics, Graduate School of Medicine, The University of Tokyo, Japan
| | - Ken-Ichi Yoshida
- Department of Forensic Medicine, Graduate School of Medicine, Tokyo Medical University, Japan
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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Circulating Malondialdehyde Concentrations in Obstructive Sleep Apnea (OSA): A Systematic Review and Meta-Analysis with Meta-Regression. Antioxidants (Basel) 2021; 10:antiox10071053. [PMID: 34210032 PMCID: PMC8300833 DOI: 10.3390/antiox10071053] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 12/29/2022] Open
Abstract
Oxidative stress induced by nocturnal intermittent hypoxia plays a significant pathophysiological role in obstructive sleep apnea (OSA). Malondialdehyde (MDA), one of the most commonly investigated markers of lipid peroxidation, might assist with the monitoring of oxidative balance in OSA. We conducted a systematic review and meta-analysis to evaluate the differences in circulating MDA concentrations between patients with OSA and non-OSA controls. A systematic search was conducted in the electronic databases Pubmed, Web of Science, Scopus and Google Scholar from inception to December 2020 by using the following terms: “malondialdehyde” or “MDA”; and “Obstructive Sleep Apnea Syndrome”, “OSAS” or “OSA”. We identified 26 studies in 1223 OSA patients and 716 controls. The pooled MDA concentrations were significantly higher in patients with OSA (standardized mean difference (SMD) 1.43 μmol/L, 95% confidence interval (CI) 1.03 to 1.83 μmol/L, p < 0.001). There was extreme heterogeneity between the studies (I2 = 92.3%, p < 0.001). In meta-regression analysis, the SMD was significantly associated with age, the assay type used and publication year. In our meta-analysis, MDA concentrations were significantly higher in OSA patients than in controls. This finding suggests that MDA, which is a marker of lipid peroxidation, is involved in the pathogenesis of OSA and provides insights for future studies investigating its potential clinical use.
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Pathak S, Slovarp L, Clary MS, Jetté ME. Laryngeal Chemoreflex in Health and Disease: A Review. Chem Senses 2021; 45:823-831. [PMID: 33247587 DOI: 10.1093/chemse/bjaa069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The larynx plays a key role in airway protection via the laryngeal chemoreflex (LCR). This involuntary reflex can be evoked when hazardous substances activate mucosal receptors, which send signals to be processed within the brainstem. Although the LCR is meant to be protective, the reflex can become hyperstimulated, even to benign stimuli, which can result in pathological disorders, such as chronic cough and inducible laryngeal obstruction. In this review, we will outline the mechanism of the LCR and its associated pathological disorders.
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Affiliation(s)
- Shivani Pathak
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Laurie Slovarp
- School of Speech, Language, Hearing, & Occupational Sciences, University of Montana, Missoula, MT, USA
| | - Matthew S Clary
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Marie E Jetté
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado, Aurora, CO, USA
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Hong H, Hosomichi J, Maeda H, Ishida Y, Usumi-Fujita R, Yoshida KI, Ono T. Selective β2-Adrenoceptor Blockade Rescues Mandibular Growth Retardation in Adolescent Rats Exposed to Chronic Intermittent Hypoxia. Front Physiol 2021; 12:676270. [PMID: 34220541 PMCID: PMC8247478 DOI: 10.3389/fphys.2021.676270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/25/2021] [Indexed: 01/25/2023] Open
Abstract
Activation of the sympathoadrenal system is associated with sleep apnea-related symptoms and metabolic dysfunction induced by chronic intermittent hypoxia (IH). IH can induce hormonal imbalances and growth retardation of the craniofacial bones. However, the relationship between IH and β2-adrenergic receptor signaling in the context of skeletal growth regulation is unclear. This study aimed to investigate the role of β2-adrenergic receptors in IH-induced mandibular growth retardation and bone metabolic alterations. Male 7-week-old Sprague–Dawley rats were subjected to IH for 3 weeks. IH conditions were established using original customized hypoxic chambers; IH was induced at a rate of 20 cycles per hour (oxygen levels changed from 4 to 21% in one cycle) for 8 h per day during the 12 h “lights on” period. The rats received intraperitoneal administration of a β2-adrenergic antagonist (butoxamine) or saline. To exclude dietary effects on general growth, the normoxic rats with saline, normoxic rats with butoxamine, and IH rats with butoxamine were subjected to food restriction to match the body weight gains between IH and other three groups. Body weight, heart rate, blood pressure, and plasma concentrations of leptin, serotonin, and growth hormone were measured. Bone growth and metabolism were evaluated using radiography, microcomputed tomography, and immunohistochemical staining. Plasma leptin levels were significantly increased, whereas that of serotonin and growth hormone were significantly decreased following IH exposure. Leptin levels recovered following butoxamine administration. Butoxamine rescued IH-induced mandibular growth retardation, with alterations in bone mineral density at the condylar head of the mandible. Immunohistochemical analysis revealed significantly lower expression levels of receptor activator of nuclear factor-kappa B ligand (RANKL) in the condylar head of IH-exposed rats. Conversely, recovery of RANKL expression was observed in IH-exposed rats administered with butoxamine. Collectively, our findings suggest that the activation of β2-adrenergic receptors and leptin signaling during growth may be involved in IH-induced skeletal growth retardation of the mandible, which may be mediated by concomitant changes in RANKL expression at the growing condyle.
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Affiliation(s)
- Haixin Hong
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Forensic Medicine, Graduate School of Medicine, Tokyo Medical University, Tokyo, Japan.,Department of Stomatology, Shenzhen University General Hospital, Shenzhen, China
| | - Jun Hosomichi
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Forensic Medicine, Graduate School of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Hideyuki Maeda
- Department of Forensic Medicine, Graduate School of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yuji Ishida
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Risa Usumi-Fujita
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ken-Ichi Yoshida
- Department of Forensic Medicine, Graduate School of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Nguyen QNT, Le T, Huynh QBT, Setty A, Vo TV, Le TQ. Validation Framework for Sleep Stage Scoring in Wearable Sleep Trackers and Monitors with Polysomnography Ground Truth. Clocks Sleep 2021; 3:274-288. [PMID: 34063579 PMCID: PMC8161815 DOI: 10.3390/clockssleep3020017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022] Open
Abstract
The rapid growth of point-of-care polysomnographic alternatives has necessitated standardized evaluation and validation frameworks. The current average across participant validation methods may overestimate the agreement between wearable sleep tracker devices and polysomnography (PSG) systems because of the high base rate of sleep during the night and the interindividual difference across the sampling population. This study proposes an evaluation framework to assess the aggregating differences of the sleep architecture features and the chronologically epoch-by-epoch mismatch of the wearable sleep tracker devices and the PSG ground truth. An AASM-based sleep stage categorizing method was proposed to standardize the sleep stages scored by different types of wearable trackers. Sleep features and sleep stage architecture were extracted from the PSG and the wearable device's hypnograms. Therefrom, a localized quantifier index was developed to characterize the local mismatch of sleep scoring. We evaluated different commonly used wearable sleep tracking devices with the data collected from 22 different subjects over 30 nights of 8-h sleeping. The proposed localization quantifiers can characterize the chronologically localized mismatches over the sleeping time. The outperformance of the proposed method over existing evaluation methods was reported. The proposed evaluation method can be utilized for the improvement of the sensor design and scoring algorithm.
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Affiliation(s)
- Quyen N. T. Nguyen
- Department of Medical Instrumentation, School of Biomedical Engineering, International University of Vietnam National University, Ho Chi Minh City, Vietnam; (Q.N.T.N.); (Q.B.T.H.); (T.V.V.)
| | - Toan Le
- Department of Biomedical Engineering, North Dakota State University, Fargo, ND 58108, USA;
- Department of Industrial and Manufacturing Engineerring, North Dakota State University, Fargo, ND 58108, USA
| | - Quyen B. T. Huynh
- Department of Medical Instrumentation, School of Biomedical Engineering, International University of Vietnam National University, Ho Chi Minh City, Vietnam; (Q.N.T.N.); (Q.B.T.H.); (T.V.V.)
| | | | - Toi V. Vo
- Department of Medical Instrumentation, School of Biomedical Engineering, International University of Vietnam National University, Ho Chi Minh City, Vietnam; (Q.N.T.N.); (Q.B.T.H.); (T.V.V.)
| | - Trung Q. Le
- Department of Biomedical Engineering, North Dakota State University, Fargo, ND 58108, USA;
- Department of Industrial and Manufacturing Engineerring, North Dakota State University, Fargo, ND 58108, USA
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Obstructive Sleep Apnea as a Predictor of Arrhythmias in 24-h ECG Holter Monitoring. Brain Sci 2021; 11:brainsci11040486. [PMID: 33921257 PMCID: PMC8068975 DOI: 10.3390/brainsci11040486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/07/2021] [Accepted: 04/10/2021] [Indexed: 11/17/2022] Open
Abstract
A relationship between obstructive sleep apnea (OSA) and abnormalities in 24-h electrocardiogram (ECG) Holter monitoring has not been sufficiently documented. The aim of this study was to analyze the relation between the occurrence and the severity of OSA and the parameters of ECG Holter monitoring in a group of patients with diagnosed OSA. Ninety-four patients with clinical suspicion of OSA were qualified for the study (mean age 53.7). All participants underwent a medical history, laboratory tests, 24-h ECG Holter monitoring, and single-night video-polysomnography (vPSG) using the American Academy of Sleep Medicine recommendations. A group of patients with diagnosed OSA was characterized by more frequent occurrence of supraventricular tachycardia (SVT) and ventricular arrhythmias (VPC). A statistically significant positive correlation was shown between the apnea-hypopnea index (AHI) and average heart rate, supraventricular arrhythmias (SVPC) pairs, SVT, and pauses >2.5 s. In regression analysis, higher AHI constituted an independent predicator for the increased number of pauses >2.5 s, SVT, and SVPC pairs in 24-h ECG Holter monitoring. In summary, patients with OSA are characterized by the increased number of abnormalities in 24-h ECG Holter monitoring.
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Chen TYT, Chang R, Chiu LT, Hung YM, Wei JCC. Obstructive sleep apnea and influenza infection: a nationwide population-based cohort study. Sleep Med 2021; 81:202-209. [PMID: 33721597 DOI: 10.1016/j.sleep.2021.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/09/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Influenza infection could trigger acute myocardial infarction. Obstructive sleep apnea (OSA) increases risk for myocardial infarction. Evidence evaluating the risk of influenza in patients with OSA is limited. We aimed to investigate the association between OSA and influenza using a nationwide population-based data set. METHODS A total of 5483 individuals with OSA were enrolled from January, 2000, to December, 2012, and compared with a control group of 21,932 individuals who had never been diagnosed with OSA (at a 1:4 ratio propensity score matched by age, sex, index years, and comorbidities) in the context of subsequent influenza infection. Cox proportional hazard regression analysis was conducted to analyze the association between OSA and influenza incidence. We conducted sensitivity analyses to examine our finding. RESULTS During the 1.81 (±2.12) years of the follow-up period, the incidence rate of influenza infection was higher in the OSA group compared with the non-OSA group (36.40 and 30.09 per 100 person-years). After adjusting for age, sex, comorbidities, outpatients visits, the risk of influenza infection among patients with OSA was significantly higher (hazard ratio = 1.18; 95% confidence interval = 1.14-1.23; P < 0.001). Sensitivity analyses showed consistent positive association. Males with OSA had increased risk of influenza infection compared with males without OSA (adjusted HR, 1.21; 95% CI, 1.16-1.27; P value for interaction = 0.03). CONCLUSIONS This study found a significantly higher risk of influenza infection in patients with OSA, and sex acted as an effect modifier between OSA and risk of influenza infection.
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Affiliation(s)
- Thomas Yen-Ting Chen
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Recreation and Sports Management, Tajen University, Pingtung, Taiwan.
| | - Lu-Ting Chiu
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; College of Health and Nursing, Meiho University, Pingtung, Taiwan; Tajen University, Pingtung, Taiwan.
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
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29
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Eow PY, Lin KY, Kohli S, Math SY. Cone-beam computed tomography assessment of upper airway dimensions in patients at risk of obstructive sleep apnea identified using STOP-Bang scores. Imaging Sci Dent 2021; 51:439-446. [PMID: 34988005 PMCID: PMC8695467 DOI: 10.5624/isd.20210193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/29/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of this study was to identify correlations between the STOP-Bang score and upper airway dimensions using cone-beam computed tomography (CBCT) scans. Materials and Methods This study included 101 subjects (46 men, 55 women) from dental patients who received CBCT scans from 2014 to 2020. The patients were divided into those with a low obstructive sleep apnoea (OSA) risk (STOP-Bang score<3) and those with an intermediate to high OSA risk (STOP-Bang score≥3), and their upper airway dimensions were then analysed on CBCT scans. Comparisons between the low-risk and intermediate/high-risk groups were conducted using the t-test and the Mann-Whitney test. Correlations between the total STOP-Bang score and upper airway dimension parameters were established using Spearman correlation coefficients. P values≤0.05 were considered to indicate statistical significance. Results Intermediate/high-risk subjects were predominantly male and over 50 years of age, with a higher body mass index. They had significantly longer upper airways, smaller average airway volumes, and smaller widths and antero-posterior dimensions of the narrowest upper airway segment. The total upper airway length was positively correlated with the STOP-Bang score (rs= 0.278). The average volume (rs= −0.203) and width of the narrowest upper airway segment (rs= −0.305) were both negatively correlated with STOP-Bang scores. Conclusion Subjects with higher STOP-Bang scores had upper airways that were longer, narrower, and smaller in terms of average volume. CBCT scans taken for dental patients as part of investigative procedures could be correlated with STOP-Bang scores to screen for patients at risk of OSA.
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Affiliation(s)
- Pei Ying Eow
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Kar Yi Lin
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Shivani Kohli
- Division of Restorative Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Swarna Yerebairapura Math
- Division of Clinical Oral Health Sciences, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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30
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Bianchini A, Nardozi L, Nardi E, Scuppa MF. Airways ultrasound in predicting difficult face mask ventilation. Minerva Anestesiol 2020; 87:26-34. [PMID: 33054014 DOI: 10.23736/s0375-9393.20.14455-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Unanticipated difficult airway is a potentially life-threatening event during elective surgery or management of critical conditions. Nevertheless, predicting difficult mask ventilation currently remains a challenge due to the poor sensitivity of available clinical tests. Our primary goal was to verify whether preoperative upper airway ultrasound measurements were useful to predict difficult face mask ventilation. Our secondary goal was to evaluate clinical characteristics and differences between patients who are difficult to ventilate and patients who are not. METHODS We performed a prospective observational study, enrolling 250 adult patients selected for colorectal, gastric, bariatric and pancreatic elective surgery between September 2017 and October 2018. We performed a preoperative US assessment of the airways, following a standardized protocol. We measured the hyomental distance (DIM), the thickness of the base of the tongue (SBL), the thickness of the soft tissues anterior to the hyoid bone (STTi), thyro-hyoid distance (DTI), the thickness of soft tissue anterior to the epiglottis (STTe), to the arytenoid (STTa) and to the commissure of the vocal cords (STTcv). RESULTS SBL had a predictive role of difficult mask ventilation in curarized and noncurarized patients for values higher than 50 mm. Hyomental distance with hyperextension of the head and subluxation of the mandible (DIMs) had a predictive role in the curarized patient (protective parameter). CONCLUSIONS Airways ultrasound evaluation could be an important tool to predict difficult mask ventilation. Further studies are necessary to validate the parameters found and correlate them to the preoperative clinical evaluation.
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Affiliation(s)
- Amedeo Bianchini
- Department of Organ Deficiencies and Transplants, Anesthesia and Intensive Care Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Ludovica Nardozi
- Specialization School of Anesthesia and Intensive Care, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy -
| | - Elena Nardi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Maria F Scuppa
- Specialization School of Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Tsao CH, Huang JY, Huang HH, Hung YM, Wei JCC, Hung YT. Ankylosing Spondylitis Is Associated With Risk of New-Onset Obstructive Sleep Apnea: A Nationwide Population-Based Cohort Study. Front Med (Lausanne) 2019; 6:285. [PMID: 31867336 PMCID: PMC6908486 DOI: 10.3389/fmed.2019.00285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/20/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives: Investigating the risk of obstructive sleep apnea(OSA) among ankylosing spondylitis (AS) patients based on administrative healthcare databases. Methods: We conducted a nationwide cohort study by using the Taiwan National Health Insurance Research Database with 1997–2013 claim records. The AS cohort included 2,210 patients who were newly diagnosed between 2003 and 2013. Randomly selected non-AS controls were matched at a 1:4 ratio. The endpoint was set as OSA occurrence or the end of 2013. Cumulative incidences, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated after adjusting for age, gender, comorbidities, and co-medication. Multivariate analyses were performed using the Cox proportional hazards model. Due to the violation of the proportionality assumption, landmark analysis was conducted to explore the risk of OSA during specific follow-up periods. Results: The adjusted HR (aHR) of OSA in the AS group was 2.826 (95% C.I. = 1.727–4.625) compared to the control group. On landmark analysis, aHR was 7.919 (95% C.I. = 3.169–19.792) for the AS group 0–24 months from the index date and decreased to 1.816 (95% C.I. = 0.944–3.494) at ≥ 24 months from the index date. The increased risks of OSA in the AS group compared to the control group were found for both males and females (aHRs were 4.533 and 2.672). On age-stratified analysis, a significant risk only for the 40–59 age group with aHR of 3.913 (95% C.I. = 1.890–8.102). Conclusions: A higher risk of developing OSA was found among newly diagnosed AS cohort during the maximum 11-year follow-up period, especially within 2 years after newly diagnosed AS and in the 40–59 age group.
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Affiliation(s)
- Chien-Han Tsao
- Department of Otolaryngology, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsin-Hsin Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yao-Min Hung
- Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - James Cheng-Chung Wei
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan.,Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Yin-Tsan Hung
- Department of Otolaryngology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China
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Zeng YM, Hu AK, Su HZ, Ko CY. A review of the association between oral bacterial flora and obstructive sleep apnea-hypopnea syndrome comorbid with cardiovascular disease. Sleep Breath 2019; 24:1261-1266. [PMID: 31758435 DOI: 10.1007/s11325-019-01962-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 09/29/2019] [Accepted: 10/11/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Obstructive sleep apnea-hypopnea syndrome (OSAHS), a common sleep disorder, has been shown to be an independent risk factor for cardiovascular disease (CVD). Recent studies have focused on the important roles of microorganisms in human health; for example, microorganisms are reportedly associated with obesity, metabolic disorders, and CVD. The number of oral bacteria in patients with OSAHS is considerably higher than that in healthy individuals, and infection with oral bacterial pathogens is associated with the development of CVD. However, whether changes in the oral microbiota mediate the development of OSAHS and CVD remains unknown. METHODS Therefore, we attempted to review the association between changes in oral microbiota in patients with OSAHS and the development of CVD. RESULTS Oral microbiota possibly acts via multiple pathways including direct invasion, platelet aggregation, immune response, inflammatory response, and oxidative stress response, leading to the development of CVD in patients with OSAHS. In particular, the strains Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia have demonstrated profound effects. OSAHS leads to changes in the oral bacterial flora and thus may facilitate the occurrence and development of CVD. CONCLUSION We propose that the underlying mechanism of CVDs resulting from oral microbiota in patients with OSAHS should be elucidated in further studies.
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Affiliation(s)
- Yi-Ming Zeng
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan N Rd, Licheng Qu, Quanzhou Shi, 362000, Fujian Province, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, 362000, China.,The Sleep Medicine Key Laboratory of Fujian Medical Universities, Fujian Province University, Quanzhou, 362000, China
| | - An-Ke Hu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan N Rd, Licheng Qu, Quanzhou Shi, 362000, Fujian Province, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, 362000, China.,The Sleep Medicine Key Laboratory of Fujian Medical Universities, Fujian Province University, Quanzhou, 362000, China
| | - Huan-Zhang Su
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan N Rd, Licheng Qu, Quanzhou Shi, 362000, Fujian Province, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, 362000, China.,The Sleep Medicine Key Laboratory of Fujian Medical Universities, Fujian Province University, Quanzhou, 362000, China
| | - Chih-Yuan Ko
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, 34 Zhongshan N Rd, Licheng Qu, Quanzhou Shi, 362000, Fujian Province, China. .,Respiratory Medicine Center of Fujian Province, Quanzhou, 362000, China. .,The Sleep Medicine Key Laboratory of Fujian Medical Universities, Fujian Province University, Quanzhou, 362000, China. .,Department of Clinical Nutrition, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China.
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Tam YY, Shao IH, Wu CC, Hsieh ML. The impact of intranasal fluticasone on patients with obstructive sleep apnea: a prospective study. Braz J Otorhinolaryngol 2019; 87:152-156. [PMID: 31521518 PMCID: PMC9422482 DOI: 10.1016/j.bjorl.2019.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 06/26/2019] [Accepted: 07/22/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Obstructive sleep apnea is the most common type of sleep apnea, which is caused by complete or partial obstructions of the upper airway. Nasal obstruction is also considered as one of the independent risk factors of obstructive sleep apnea. Objective Patients with obstructive sleep apnea. Methods We enrolled patients with obstructive sleep apnea from June to December 2015 and treated them with intranasal corticosteroid spray for four weeks. Several parameters were obtained before and after the treatment, including Nasal Obstruction Symptom Evaluation scores, Pittsburgh Sleep Quality Index questionnaire and Epworth Sleepiness Scale questionnaire. Results Fifty patients completed questionnaires prior to and following the intranasal fluticasone treatments. The average age was 39.7 ± 15.6 y, with a male to female ratio of 3:2. The post-treatment Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Nasal Obstruction Symptom Evaluation scores all indicated a decrease compared to pre-treatment scores, from 10.4 to 8.74, 7.86 to 6.66 and 9.08 to 6.48, respectively. A significant decrease was observed in the Nasal Obstruction Symptom Evaluation ≥10 group in all three categories, but not in the Nasal Obstruction Symptom Evaluation <10 group. Conclusions Intranasal fluticasone treatment may be useful for patients with nasal obstruction-related obstructive sleep apnea to improve sleep quality and limit daytime dysfunction.
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Affiliation(s)
- Yuan-Yun Tam
- Taoyuan General Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Ministry of Health and Welfare, Taoyuan City, Taiwan
| | - I-Hung Shao
- Chang Gung University, Linkou Chang Gung Memorial Hospital, Department of Surgery, Division of Urology, Taoyuan City, Taiwan
| | - Chia-Chen Wu
- Chang Gung University, Linkou Chang Gung Memorial Hospital, Department of Otorhinolaryngology - Head and Neck Surgery, Taoyuan City, Taiwan
| | - Ming-Li Hsieh
- Chang Gung University, Linkou Chang Gung Memorial Hospital, Department of Surgery, Division of Urology, Taoyuan City, Taiwan.
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35
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Sex differences in breathing. Comp Biochem Physiol A Mol Integr Physiol 2019; 238:110543. [PMID: 31445081 DOI: 10.1016/j.cbpa.2019.110543] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 01/15/2023]
Abstract
Breathing is a vital behavior that ensures both the adequate supply of oxygen and the elimination of CO2, and it is influenced by many factors. Despite that most of the studies in respiratory physiology rely heavily on male subjects, there is much evidence to suggest that sex is an important factor in the respiratory control system, including the susceptibility for some diseases. These different respiratory responses in males and females may be related to the actions of sex hormones, especially in adulthood. These hormones affect neuromodulatory systems that influence the central medullary rhythm/pontine pattern generator and integrator, sensory inputs to the integrator and motor output to the respiratory muscles. In this article, we will first review the sex dependence on the prevalence of some respiratory-related diseases. Then, we will discuss the role of sex and gonadal hormones in respiratory control under resting conditions and during respiratory challenges, such as hypoxia and hypercapnia, and whether hormonal fluctuations during the estrous/menstrual cycle affect breathing control. We will then discuss the role of the locus coeruleus, a sexually dimorphic CO2/pH-chemosensitive nucleus, on breathing regulation in males and females. Next, we will highlight the studies that exist regarding sex differences in respiratory control during development. Finally, the few existing studies regarding the influence of sex on breathing control in non-mammalian vertebrates will be discussed.
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Ji K, Risoli TJ, Kuchibhatla M, Chan L, Hachem RA, Jang DW. Symptom Profile of Chronic Rhinosinusitis Versus Obstructive Sleep Apnea in a Tertiary Rhinology Clinic. Ann Otol Rhinol Laryngol 2019; 128:963-969. [DOI: 10.1177/0003489419851527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives: Patients with undiagnosed obstructive sleep apnea (OSA) often present to an otolaryngologist with symptoms of chronic rhinosinusitis (CRS). This study analyzes symptom profiles of such patients to help identify those who may benefit from polysomnography. Methods: This is a 2-year retrospective analysis of adult patients at an academic practice with a rhinologic chief complaint. Results of the 22-Item Sinonasal Outcomes Test (SNOT-22) were compared between patients with untreated OSA without CRS (OSA group) and a control group of CRS patients (CRS group). Univariate analysis with Bonferroni correction and multiple logistic regression were used. Results: Forty-one patients were included in the OSA group (mean apnea-hypopnea index = 28.8, SD = 21.0) and 124 patients in the CRS group. CRS group demonstrated higher scores in nasal, extra-nasal, and ear/facial symptom domains ( P < .001), while OSA group displayed higher psychological ( P = .020) and sleep domain scores ( P = .048). Nasal discharge ( P < .001) and loss of smell/taste ( P = .004) scores were higher in CRS group, whereas facial pain ( P = .285) and nasal obstruction ( P = .822) were not significantly different. On logistic regression, thick nasal discharge, loss of smell/taste, and ear pain were predictive of CRS, while waking up tired was predictive of OSA. Finally, OSA group was more likely to choose a sleep-related issue as a most important symptom (MIS) ( P < .001). Conclusions: OSA and CRS have significant overlap in symptom profiles. The SNOT-22 can help identify those with undiagnosed OSA. OSA should be suspected in patients who report a sleep-related item as a MIS and display higher psychological and sleep domain scores.
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Affiliation(s)
- Keven Ji
- Duke University School of Medicine, Durham, NC, USA
| | - Thomas J. Risoli
- Duke Clinical & Translational Science Institute for Biostatistics, Epidemiology and Research Design (BERD) Methods Core, Duke University, Durham, NC, USA
| | - Maragatha Kuchibhatla
- Duke Clinical & Translational Science Institute for Biostatistics, Epidemiology and Research Design (BERD) Methods Core, Duke University, Durham, NC, USA
| | - Lyndon Chan
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Hospital, Durham, NC, USA
| | - Ralph Abi Hachem
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Hospital, Durham, NC, USA
| | - David W. Jang
- Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Hospital, Durham, NC, USA
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Abstract
Nonalcoholic fatty liver disease (NAFLD), a disorder of altered metabolic pathways, is increasing worldwide. Recent studies established obstructive sleep apnea (OSA) and chronic intermittent hypoxia (CIH) as NAFLD risk factors. Studies have ascertained that CIH is independently related to NAFLD. Continuous positive airway pressure (CPAP) shows inconsistent results regarding its efficacy in improving NAFLD. Observational, longer duration CPAP therapy studies have shown positive outcomes, whereas shorter duration, randomized controlled trials have shown no benefit. A multifaceted approach to NAFLD management with sufficiently longer duration of CPAP therapy may be beneficial in patients with moderate to severe OSA.
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Affiliation(s)
- Malav P Parikh
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, M2 Annex, Cleveland, OH 44114, USA
| | - Niyati M Gupta
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, M2 Annex, Cleveland, OH 44114, USA
| | - Arthur J McCullough
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, M2 Annex, Cleveland, OH 44114, USA; Department of Inflammation and Immunity, Cleveland Clinic Lerner College of Medicine, Case Western University, Cleveland, OH 44195, USA.
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Llewellyn CM, Noller MW, Camacho M. Cautery-assisted palatal stiffening operation for obstructive sleep apnea: A systematic review and meta-analysis. World J Otorhinolaryngol Head Neck Surg 2019; 5:49-56. [PMID: 30775702 PMCID: PMC6364515 DOI: 10.1016/j.wjorl.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/14/2018] [Accepted: 05/21/2018] [Indexed: 12/01/2022] Open
Abstract
Objective To systematically review outcomes for cautery-assisted palatal stiffening operation (CAPSO) as a treatment for adult obstructive sleep apnea (OSA). Methods Five databases (including PubMed/MEDLINE) were searched through July 12, 2017. Results Eight studies (307 patients) met criteria. Overall, CAPSO alone (80 patients) improved AHI from a mean ± standard deviation (M ± SD) of (16.8 ± 11.9) to (9.9 ± 10.9) events/h (41.1% decrease). Mixed CAPSO with/without tonsillectomy (92 patients) improved AHI from a M ± SD of (24.8 ± 12.6) to (10.6 ± 9.5) events/h (61.7% decrease). CAPSO with expansion pharyngoplasty (EP), (78 patients) improved AHI from a M ± SD of (26.3 ± 17.7) to (12.6 ± 5.8) events/h (52.1% decrease). CAPSO alone (90 patients) improved lowest oxygen saturation (LSAT) by 5.4 points. Mixed CAPSO with/without tonsillectomy (77 patients) improved LSAT by 10.6 points, and CAPSO with EP (78 patients) improved LSAT by 5.2 points. Sleepiness improved (182 patients) from an Epworth Sleepiness Scale score of 11.8 to 5.1, P < 0.001. Snoring reduced (120 patients) from 7.9 to 2.5 on visual analog scales (0–10 scale), P < 0.001. Conclusions Apnea-hypopnea index has improved by 41.0% for CAPSO alone, 61.7% for CAPSO with tonsillectomy and 52.1% for CAPSO with expansion pharyngoplasty. Additionally, lowest oxygen saturation, sleepiness and snoring have also improved after CAPSO.
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Affiliation(s)
- Charles M Llewellyn
- Madigan Army Medical Center, Department of Otolaryngology, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA
| | - Michael W Noller
- Walter Reed National Military Medical Center, Department of Otolaryngology, 4494 N Palmer Rd, Bethesda, MD 20889, USA
| | - Macario Camacho
- Tripler Army Medical Center, Division of Otolaryngology, Sleep Surgery and Sleep Medicine, Tripler AMC, 1 Jarrett White Rd, HI 96859, USA
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Ming H, Tian A, Liu B, Hu Y, Liu C, Chen R, Cheng L. Inflammatory cytokines tumor necrosis factor-α, interleukin-8 and sleep monitoring in patients with obstructive sleep apnea syndrome. Exp Ther Med 2018; 17:1766-1770. [PMID: 30783447 PMCID: PMC6364239 DOI: 10.3892/etm.2018.7110] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 11/16/2018] [Indexed: 11/29/2022] Open
Abstract
The present study investigated the changes of tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8) and sleep ability in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). A total of 684 patients who were admitted to Xuzhou Central Hospital between June 2012 and June 2016 were enrolled to serve as the experimental group and 192 healthy subjects were selected as the control group. Polysomnography was performed on both groups, and serum TNF-α and IL-8 levels were measured by ELISA. Pearson's correlation analysis was used to analyze correlations between factors. Compared with control group, the levels of TNF-α and IL-8, the morning systolic and diastolic pressure in OSAHS group were significantly higher (P<0.01). Furthermore, the mean oxygen saturation (MSaO2) and lowest oxygen saturation (LSaO2) of the OSAHS group were significantly lower compared with those in control group (P<0.01). Results also indicated that TNF-α was positively correlated with apnea-hypopnea index (AHI), morning systolic and diastolic pressure (r=0.621, 0.464, 0.539; P<0.05), and negatively correlated with MSaO2 and LSaO2 (r=−0.526, −0.466; P<0.05). Notably, IL-8 was positively correlated with AHI, morning systolic and diastolic pressure (r=0.337, 0.413 and 0.629; P<0.05), and negatively correlated with MSaO2 and LSaO2 (r=−0.329 and −0.417; P<0.05). Therefore, it was concluded that TNF-α and IL-8 may be involved in the occurrence and development of OSAHS, are closely related to OSAHS and may be important risk factors for cardiovascular disease in patients with OSAHS. The present findings suggest that TNF-α and IL-8 can be used to assess the degree of OSAHS.
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Affiliation(s)
- Hao Ming
- Department of Otolaryngology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China.,Department of Otolaryngology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Aimin Tian
- Department of Otolaryngology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Bing Liu
- Department of Otolaryngology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Yuqiang Hu
- Department of Otolaryngology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Chen Liu
- Department of Otolaryngology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Renjie Chen
- Department of Otolaryngology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Liangjun Cheng
- Department of Otolaryngology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
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Differential expression of immune markers in the patients with obstructive sleep apnea/hypopnea syndrome. Eur Arch Otorhinolaryngol 2018; 276:735-744. [DOI: 10.1007/s00405-018-5219-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 11/23/2018] [Indexed: 12/21/2022]
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Brunzini A, Gracco A, Mazzoli A, Mandolini M, Manieri S, Germani M. Preliminary simulation model toward the study of the effects caused by different mandibular advancement devices in OSAS treatment. Comput Methods Biomech Biomed Engin 2018; 21:693-702. [DOI: 10.1080/10255842.2018.1511776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Agnese Brunzini
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Antonio Gracco
- Department of Neuroscience, Section of Dentistry, University of Padua, Padua, Italy
| | - Alida Mazzoli
- Department of Materials, Environmental Sciences and Urban Planning, Università Politecnica delle Marche, Ancona, Italy
| | - Marco Mandolini
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Steve Manieri
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Michele Germani
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Ancona, Italy
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Correlation between Brodsky Tonsil Scale and Tonsil Volume in Adult Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6434872. [PMID: 30474041 PMCID: PMC6220413 DOI: 10.1155/2018/6434872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/14/2018] [Accepted: 10/11/2018] [Indexed: 11/27/2022]
Abstract
Purpose To evaluate the value of Brodsky tonsil scale in predicting the objective tonsil volume and to identify the potential factors that might interfere with the accuracy of prediction. Methods A total of 87 adult patients who underwent single tonsillectomy or uvulopalatopharyngoplasty (UPPP) procedure including tonsillectomy in our hospital between Jan 2015 and Dec 2016 were included. The data of Brodsky tonsil scale evaluated preoperatively and objective tonsil volume evaluated postoperatively were collected for analysis. Results Among the 87 adult patients included, 85 patients underwent bilateral tonsillectomy, while only 2 underwent unilateral procedure. Therefore, a total of 172 tonsils were included. Significant positive correlations were established between Brodsky scale and objective volume for either right (R = 0.647), left (R = 0.664), or overall tonsils (R = 0.654) (all p < 0.001). However, volume overlaps could be found between 2+ and 3+ tonsils. Age [odds ratio (OR) = 4.053, p = 0.003] and body mass index (BMI; OR=1.740, p = 0.044) were found to be independent factors that could influence the consistency between the Brodsky scale and objective volume. As a result, a formula “Index = -1.409+1.399×age+0.554×BMI” was constructed for the evaluation of the consistency. Conclusion Tonsil grading was significantly correlated with tonsil volume; preoperative tonsil grading that reflected the real tonsil volume was regarded as the protocol for the evaluation of the tonsil size. Age and BMI were independent factors that could affect the consistency between tonsil grade and tonsil volume. A mathematical model was estimated to predict the consistency accurately.
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Haytoğlu S, Arikan OK, Muluk NB, Tuhanioğlu B, Çörtük M. Comparison of anterior palatoplasty and uvulopalatal flap placement for treating mild and moderate obstructive sleep apnea. EAR, NOSE & THROAT JOURNAL 2018; 97:69-78. [PMID: 29554400 DOI: 10.1177/014556131809700321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We prospectively compared the efficacy of anterior palatoplasty and the uvulopalatal flap procedure for the treatment of patients with mild and moderate obstructive sleep apnea syndrome (OSAS). Our study group was made up of 45 patients who had been randomly assigned to undergo one of the two procedures. Palatoplasty was performed on 22 patients-12 men and 10 women, aged 28 to 49 years (mean: 39.2)-and the flap procedure was performed on 23 patients-14 men and 9 women, aged 28 to 56 years (mean: 41.3). Our primary outcomes measure was the difference in pre- and postoperative apnea-hypopnea index (AHI) as determined by polysomnography at 6 months after surgery. Surgical success was observed in 18 of the 22 palatoplasty patients (81.8%) and in 19 of the 23 flap patients (82.6%). Compared with the preoperative values, mean AHIs declined from 17.5 to 8.1 in the former group and from 18.5 to 8.6 in the latter; the improvement in both groups was statistically significant (p < 0.001). In addition, significant postoperative improvements in both groups were seen in mean visual analog scale (VAS) scores for snoring, in Pittsburgh Sleep Quality Index values, and in Epworth Sleepiness Scale scores (p < 0.001 for all). VAS scores for pain at rest were significantly lower in the palatoplasty group than in the flap group at 2, 4, and 8 hours postoperatively and on postoperative days 4 through 7 (p < 0.002). Likewise, VAS scores for pain during swallowing were significantly lower in the palatoplasty group at 2, 4, 8, and 16 hours and on days 4 through 7 (p < 0.009). We conclude that both anterior palatoplasty and uvulopalatal flap procedures are effective for the treatment of mild and moderate OSAS in patients with retropalatal obstruction. However, our comparison of postoperative pain scores revealed that anterior palatoplasty was associated with significantly less morbidity.
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Affiliation(s)
- Süheyl Haytoğlu
- ENT Department, Adana Numune Training and Research Hospital, Kırıkkale University Faculty of Medicine, Birlik Mahallesi, Zirvekent 2. Etap Sitesi, C-3 blok, No: 62/43 06610 Çankaya, Kırıkkale, Turkey
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Kahramfar Z, Rahimi B. Comparison of Predictor of Desaturation Disorders and Daytime Sleepiness Based On Epworth Sleepiness Scale and STOP-BANG Questionnaires in Mild to Moderate Obstructive Sleep Apnea Patients. Open Access Maced J Med Sci 2018; 6:1617-1621. [PMID: 30337975 PMCID: PMC6182531 DOI: 10.3889/oamjms.2018.258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is characterised by recurrence in upper airway obstruction during sleep. AIM This study aimed to compare the predictive values of the Epworth Sleepiness Scale (ESS) and STOP-BANG in the desaturation of patients with mild to moderate obstructive apnea based on the apnea-hypopnea index (AHI) scale. METHODS A group of 79 patients (43 male and 36 female) were selected. The suspected patients were introduced to the sleep clinic, and the ESS and STOP-BANG questionnaires were filled up, then subjected to polysomnography test, and the scores of the disease were also determined based on an apnoea-hypopnoea index (AHI). Finally, the desaturation rate (SO2 < 3% based on the baseline) and desaturation index were determined in patients. Consequently, the finding was compared with the results of the questionnaires. RESULTS Patients with STOP-BANG score above 3 had significantly higher weight, oxygen desaturation index (ODI) index and average desatu, while peripheral capillary oxygen saturation (SpO2) base and average SpO2 were lower than those with scores below 3 (P < 0.05). However, there was no significant difference between the patients with the ESS questionnaire score above 10 and below 10 (P > 0.05). CONCLUSION The results of these two questionnaires reflect the unsaturated oxygen index in the blood, and can be considered for the evaluation of the severity of the disease.
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Affiliation(s)
- Zohreh Kahramfar
- Department of Pulmonary and Critical Care Medicine, Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Besharat Rahimi
- Department of Pulmonary and Critical Care Medicine, Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Gu X, Yang W, Luo X, Wang X, Tang J, Cai Z. Bioinformatics analysis to reveal the key genes related to obstructive sleep apnea. Sleep Breath 2018; 23:259-267. [PMID: 29992456 DOI: 10.1007/s11325-018-1694-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/31/2018] [Accepted: 06/26/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is induced by obstruction of the upper airway, which can raise multiple health risks. This study is designed to reveal the key genes involved in OSA. METHODS GSE38792 was extracted from Gene Expression Omnibus database, including ten visceral adipose tissues from OSA patients and eight visceral adipose tissues from normal controls. Differential expression analysis was conducted using limma package, and then the functions of the differentially expressed genes (DEGs) were analyzed using DAVID database, followed by protein-protein interaction (PPI) network, and integrated regulatory network analysis was performed using Cytoscape software. RESULTS A total of 368 DEGs (176 upregulated and 192 downregulated) were identified in OSA samples. Epstein-Barr virus infection (involving IL10RB, MAPK9, and MAPK10) and olfactory transduction were the main pathways separately enriched for the upregulated genes and the downregulated genes. After the PPI network was built, the top ten network nodes (such as TXN) were selected according to node degrees. Two significant PPI network modules were identified. Moreover, the integrated regulatory network was constructed. CONCLUSION IL10RB, MAPK9, MAPK10, and TXN might function in the pathogenesis of OSA.
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Affiliation(s)
- Xiandong Gu
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164, LanXi Road, Shanghai, 200063, China
| | - Wei Yang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164, LanXi Road, Shanghai, 200063, China
| | - Xuming Luo
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164, LanXi Road, Shanghai, 200063, China
| | - Xiongbiao Wang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164, LanXi Road, Shanghai, 200063, China
| | - Jihong Tang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164, LanXi Road, Shanghai, 200063, China
| | - Zhuying Cai
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No.164, LanXi Road, Shanghai, 200063, China.
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Elliot-Portal E, Laouafa S, Arias-Reyes C, Janes TA, Joseph V, Soliz J. Brain-derived erythropoietin protects from intermittent hypoxia-induced cardiorespiratory dysfunction and oxidative stress in mice. Sleep 2018; 41:4985474. [PMID: 29697839 PMCID: PMC6047438 DOI: 10.1093/sleep/zsy072] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/21/2018] [Indexed: 12/21/2022] Open
Abstract
Study Objectives Based on the fact that erythropoietin (Epo) administration in rodents protects against spatial learning and cognitive deficits induced by chronic intermittent hypoxia (CIH)-mediated oxidative damage, here we tested the hypothesis that Epo in the brain protects against cardiorespiratory disorders and oxidative stress induced by CIH in adult mice. Methods Adult control and transgenic mice overexpressing Epo in the brain only (Tg21) were exposed to CIH (21%-10% O2-10 cycles/hour-8 hours/day-7 days) or room air. After CIH exposure, we used the tail cuff method to measure arterial pressure, and whole-body plethysmography to assess the frequency of apneic episodes at rest, minute ventilation, and ventilatory responses to hypoxia and hypercapnia. Finally, the activity of pro-oxidant (XO-xanthine oxidase, and NADPH) and antioxidant (super oxide dismutase) enzymes was evaluated in the cerebral cortex and brainstem. Results Exposure of control mice to CIH significantly increased the heart rate and arterial pressure, the number of apneic events, and the ventilatory response to hypoxia and hypercapnia. Furthermore, CIH increased the ratio of pro-oxidant to antioxidant enzymes in cortex and brainstem tissues. Both physiological and molecular changes induced by CIH were prevented in transgenic Tg21 mice. Conclusions We conclude that the neuroprotective effect of Epo prevents oxidative damage in the brain and cardiorespiratory disorders induced by CIH. Considering that Epo is used in clinics to treat chronic kidney disease and stroke, our data show convincing evidence suggesting that Epo may be a promising alternative drug to treat sleep-disorder breathing.
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Affiliation(s)
- Elizabeth Elliot-Portal
- Centre de Recherche de l’Institut Universitaire, de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Sofien Laouafa
- Centre de Recherche de l’Institut Universitaire, de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Christian Arias-Reyes
- Centre de Recherche de l’Institut Universitaire, de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Tara Adele Janes
- Centre de Recherche de l’Institut Universitaire, de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Vincent Joseph
- Centre de Recherche de l’Institut Universitaire, de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Jorge Soliz
- Centre de Recherche de l’Institut Universitaire, de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
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Haytoğlu S, Arikan OK, Muluk NB, Tuhanioğlu B, Çörtük M. Comparison of Anterior Palatoplasty and Uvulopalatal Flap Placement for Treating Mild and Moderate Obstructive Sleep Apnea. EAR, NOSE & THROAT JOURNAL 2018. [DOI: 10.1177/014556131809700308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We prospectively compared the efficacy of anterior palatoplasty and the uvulopalatal flap procedure for the treatment of patients with mild and moderate obstructive sleep apnea syndrome (OSAS). Our study group was made up of 45 patients who had been randomly assigned to undergo one of the two procedures. Palatoplasty was performed on 22 patients—12 men and 10 women, aged 28 to 49 years (mean: 39.2)—and the flap procedure was performed on 23 patients—14 men and 9 women, aged 28 to 56 years (mean: 41.3). Our primary outcomes measure was the difference in pre- and postoperative apnea-hypopnea index (AHI) as determined by polysomnography at 6 months after surgery. Surgical success was observed in 18 of the 22 palatoplasty patients (81.8%) and in 19 of the 23 flap patients (82.6%). Compared with the preoperative values, mean AHIs declined from 17.5 to 8.1 in the former group and from 18.5 to 8.6 in the latter; the improvement in both groups was statistically significant (p < 0.001). In addition, significant postoperative improvements in both groups were seen in mean visual analog scale (VAS) scores for snoring, in Pittsburgh Sleep Quality Index values, and in Epworth Sleepiness Scale scores (p < 0.001 for all). VAS scores for pain at rest were significantly lower in the palatoplasty group than in the flap group at 2, 4, and 8 hours postoperatively and on postoperative days 4 through 7 (p < 0.002). Likewise, VAS scores for pain during swallowing were significantly lower in the palatoplasty group at 2, 4, 8, and 16 hours and on days 4 through 7 (p < 0.009). We conclude that both anterior palatoplasty and uvulopalatal flap procedures are effective for the treatment of mild and moderate OSAS in patients with retropalatal obstruction. However, our comparison of postoperative pain scores revealed that anterior palatoplasty was associated with significantly less morbidity.
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Affiliation(s)
- Süheyl Haytoğlu
- ENT Clinic, Adana Numune Training and Research
Hospital, Adana, Turkey
| | | | - Nuray Bayar Muluk
- ENT Department, Kırıkkale University
Faculty of Medicine, Kırıkkale, Turkey
| | - Birgül Tuhanioğlu
- ENT Clinic, Adana Numune Training and Research
Hospital, Adana, Turkey
| | - Mustafa Çörtük
- Pulmonary Diseases Department, Karabük
University Faculty of Medicine, Karabük, Turkey
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Omentin-A Novel Adipokine in Respiratory Diseases. Int J Mol Sci 2017; 19:ijms19010073. [PMID: 29283409 PMCID: PMC5796023 DOI: 10.3390/ijms19010073] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 12/23/2017] [Accepted: 12/26/2017] [Indexed: 02/07/2023] Open
Abstract
Adipokines, secreted by the adipose tissue, are extensively involved in the regulation and maintenance of various physiological and pathological processes, including insulin sensitivity, energy expenditure, glucose and lipid metabolism, inflammatory activity, neuroendocrine activity, immunity, cancer, homeostasis, angiogenesis, cardiovascular function, breeding and bone metabolism, and all functions of the endocrine-reproductive system axis. Omentin is a recently identified adipokine, which has become a research hotspot due to its pleiotropic effects on various diseases. However, the specific receptor for omentin has not been identified so far. In this study, we report that omentin levels fluctuate in various diseases. In addition, we have focused on the pleiotropic roles of omentin in pulmonary diseases, as it may act as a biomarker for malignant pleural mesothelioma (MPM) and is related to disease severity. Omentin may play significant roles in other pulmonary diseases, such as asthma, obstructive sleep apnea syndrome (OSAS), pulmonary arterial hypertension (PAH), acute respiratory distress syndrome (ARDS), and chronic obstructive pulmonary disease (COPD). This review summarizes the advances in current knowledge and future trends, which may provide a concise and general view on omentin and its effects on pulmonary biology.
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Therapeutic effects of different drugs on obstructive sleep apnea/hypopnea syndrome in children. World J Pediatr 2017; 13:537-543. [PMID: 29058247 DOI: 10.1007/s12519-017-0062-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 07/15/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study aimed to compare the therapeutic effects of different drugs on obstructive sleep apnea/hypopnea syndrome (OSAHS) in children by using a network meta-analysis approach. METHODS PubMed, Embase and Cochrane Library were searched from the inception of each database to November 2015. Randomized controlled trials (RCTs) concerning the comparisons in the therapeutic effects of eight placebo-controlled drugs on OSAHS in children were included in this study. Network meta-analysis combined direct evidence and indirect evidence to evaluate the weighted mean difference (WMD) and surface under the cumulative ranking curves (SUCRA) of therapeutic effects of eight drugs on OSAHS in children. RESULTS A total of seven RCTs were finally incorporated into our network meta-analysis. Pairwise meta-analysis results revealed that therapeutic effect of placebo was significantly poorer than that of intranasal mometasone furoate, montelukast, budesonide and fluticasone concerning apnea hypopnea index (AHI) value [WMD=1.40, 95% confidence interval (CI)=1.17-1.63; WMD=2.80, 95% CI=1.01-4.59; WMD=3.50, 95% CI=3.34-3.66; WMD=7.20, 95% CI=5.26-9.14, respectively], and fluticasone is better than placebo concerning sleep efficiency (WMD=3.50, 95% CI=2.42-4.58); regarding visual analogue scale, the therapeutic effect of placebo was poorer compared with sucralfate and clindamycin (WMD=1.94, 95% CI=1.13-2.75; WMD=1.06, 95% CI=0.22-1.90), and sucralfate is better than clindamycin (WMD=-0.88, 95% CI=-1.65 to -0.11). However, network meta-analysis results showed no obvious difference in the therapeutic effects of different drugs on OSAHS regarding AHI and sleep efficiency. Furthermore, the best SUCRA value was very high for fluticasone concerning AHI (86.6%) and budesonide concerning sleep efficiency (94.0%) for OSAHS treatment. CONCLUSIONS Fluticasone and budesonide have relatively good effects in the treatment of OSAHS in children, thus providing an important guiding significance for the treatment of OSAHS in children.
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Said EA, Al-Abri MA, Al-Saidi I, Al-Balushi MS, Al-Busaidi JZ, Al-Reesi I, Koh CY, Hasson SS, Idris MA, Al-Jabri AA, Habbal O. Altered blood cytokines, CD4 T cells, NK and neutrophils in patients with obstructive sleep apnea. Immunol Lett 2017; 190:272-278. [DOI: 10.1016/j.imlet.2017.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 12/12/2022]
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