1
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Kim H, Kim KT, Shin WC, Yang KI, Ha JY, Cho YW. Erectile dysfunction in patient with obstructive sleep apnea: effects of continuous positive airway pressure. Aging Male 2024; 27:2317165. [PMID: 38389408 DOI: 10.1080/13685538.2024.2317165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is linked to various health complications, including erectile dysfunction (ED), which is more prevalent in individuals with OSA. This study explored ED in Korean OSA patients and assessed the impact of continuous positive airway pressure (CPAP) therapy on ED. METHODS A total of 87 male patients with OSA from four different sleep centers underwent physical measurements and completed sleep and mental health (MH) questionnaires, including the Korean version of the International index of erectile function (IIEF), before and three months after initiating CPAP therapy. RESULTS After three months of CPAP therapy, the patients demonstrated a significant improvement in ED as measured on the IIEF. However, the study found no significant correlation between the duration of CPAP use and the improvement in IIEF score. It did identify the SF36 quality of life assessment as a significant factor influencing ED improvement after CPAP. CONCLUSIONS ED is a prevalent issue that escalates with age and is associated with OSA. CPAP therapy has shown potential in alleviating ED symptoms, particularly in those with underlying psychological conditions, although further research is required to confirm these findings and understand the underlying mechanisms.
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Affiliation(s)
- Hyeyun Kim
- Department of Neurology, Sleep Medicine Research Center, College of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, Korea
| | - Won Chul Shin
- Department of Neurology, School of Medicine, Kyunghee University, Seoul, Korea
| | - Kwang Ik Yang
- Department of Neurology, Sleep Disorders Center, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Ji Yong Ha
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University School of Medicine, Daegu, Korea
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2
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Kim B, Kim TY, Choi EJ, Lee M, Kim W, Lee SA. Restless legs syndrome in patients with obstructive sleep apnea: Association between apnea severity and symptoms of depression, insomnia, and daytime sleepiness. Sleep Med 2024; 117:40-45. [PMID: 38507975 DOI: 10.1016/j.sleep.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/26/2024] [Accepted: 03/09/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To determine if the prevalence and severity of restless legs syndrome (RLS) varies with apnea severity and analyze differences between the sexes in terms of comorbid RLS with symptoms of depression, insomnia, and daytime sleepiness in patients with obstructive sleep apnea (OSA). METHODS Symptoms of depression, insomnia, and daytime sleepiness were defined as Patient Health Questionnaire-9 score ≥10, Insomnia Severity Index score ≥15, and Epworth Sleepiness Scale score ≥11. Multivariate logistic and linear regression analyses were conducted. RESULTS In 707 adults with OSA (85.1% males), 16.1% (n = 114) had comorbid RLS. The prevalence of RLS was markedly lower in those with moderate and severe OSA than in those with mild OSA. Similarly, the odds of RLS significantly decreased with increasing apnea-hypopnea index. After controlling for age and sex, in patients with comorbid RLS, the International RLS Study Group Rating Scale scores were negatively correlated with apnea-hypopnea index and a nadir peripheral oxygen saturation during sleep. The presence of RLS was more likely to be associated with symptoms of depression, insomnia, and daytime sleepiness after controlling for confounding variables, but only in men. CONCLUSIONS RLS is frequently noted in combination with OSA, with a female preponderance. The severities of OSA and RLS may be negatively associated. In patients with OSA, sex-related differences in terms of comorbid RLS with symptoms of depression, insomnia, and daytime sleepiness warrant further investigations.
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Affiliation(s)
- Boyoung Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Tae-Young Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Eun-Ju Choi
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Myeongwoo Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Wontae Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, South Korea
| | - Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, South Korea.
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3
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Solis RN, Aulakh SS, Velazquez-Castro OS, Farber NI, Olarewaju AM, Nandalike K, Tollefson TT, Senders CW, Funamura JL. Utility of Screening for Obstructive Sleep Apnea with the Pediatric Sleep Questionnaire (PSQ) in Children with Craniofacial Anomalies. Cleft Palate Craniofac J 2024; 61:882-887. [PMID: 36572962 DOI: 10.1177/10556656221147815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To determine the accuracy of the Pediatric Sleep Questionnaire (PSQ) as a screening tool for obstructive sleep apnea in children with craniofacial anomalies. DESIGN Retrospective cohort study. SETTING Multidisciplinary cleft and craniofacial clinic at a tertiary care center. PATIENTS Children with craniofacial anomalies 2 to ≤18 years of age who both completed a PSQ screen and underwent polysomnography (PSG) without interval surgery. MAIN OUTCOME MEASURES Sensitivity and specificity of the PSQ in detecting an obstructive apnea-hypopnea index (AHI) ≥ 5 events/hour. RESULTS Fifty children met study criteria, with 66% (n = 33) having an associated syndrome. Mean patient age at time of PSQ was 9.6 + 4.0 years. Overall, 33 (64%) screened positive on the PSQ, while 20 (40%) had an AHI ≥ 5. The sensitivity and specificity for identifying AHI ≥ 5 was 70% and 40%, respectively. With subgroup analysis, the sensitivity and specificity were higher (100% and 50%) in children with non-syndromic palatal clefting but lower (65% and 31%) in children with a syndrome or chromosomal anomaly. There was no correlation detected between PSQ score and AHI severity (p = 0.25). The mean obstructive AHI in the study population was 10.1 ± 22.7 despite 44% (n = 22) undergoing prior adenotonsillectomy. CONCLUSIONS The PSQ was less sensitive and specific in detecting an AHI ≥ 5 in children with craniofacial anomalies than in a general population, and particularly poor in for children with syndrome-associated craniofacial conditions. Given the high prevalence of OSA in this patient population, a craniofacial-specific validated screening tool would be beneficial.
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Affiliation(s)
- Roberto N Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Sukhkaran S Aulakh
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Oscar S Velazquez-Castro
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Nicole I Farber
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Adebola M Olarewaju
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Kiran Nandalike
- Department of Pediatrics, Division of Pulmonology and Sleep Medicine, University of California, Davis, Sacramento, California, USA
| | - Travis T Tollefson
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Craig W Senders
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
| | - Jamie L Funamura
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, USA
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Ng NBH, Lim CYS, Tan SCHL, Foo YW, Tok CLX, Lim YY, Goh DYT, Loke KY, Lee YS. Screening for obstructive sleep apnea (OSA) in children and adolescents with obesity: A scoping review of national and international pediatric obesity and pediatric OSA management guidelines. Obes Rev 2024; 25:e13712. [PMID: 38355893 DOI: 10.1111/obr.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
Obstructive sleep apnea (OSA) is a prevalent complication that affects up to 60% of children and adolescents with obesity. It is associated with poorer cardiometabolic outcomes and neurocognitive deficits. Appropriate screening and intervention for OSA are crucial in the management of children with obesity. We performed a scoping review of international and national pediatric obesity (n = 30) and pediatric OSA (n = 10) management guidelines to evaluate the recommendations on OSA screening in pediatric obesity. Sixteen (53%) of the pediatric obesity guidelines had incorporated OSA screening to varying extents, with no consistent recommendations on when and how to screen for OSA, and subsequent management of OSA in children with obesity. We provide our recommendations that are based on the strength and certainty of evidence presented. These include a clinical-based screening for OSA in all children with body mass index (BMI) ≥ 85th percentile or those with rapid BMI gain (upward crossing of 2 BMI percentiles) and the use of overnight polysomnography to confirm the diagnosis of OSA in those with high clinical suspicion. We discuss further management of OSA unique to children with obesity. An appropriate screening strategy for OSA would facilitate timely intervention that has been shown to improve cardiometabolic and neurocognitive outcomes.
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Affiliation(s)
- Nicholas Beng Hui Ng
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carey Yun Shan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | - Sarah Caellainn Hui Lin Tan
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | | | | | - Yvonne Yijuan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Yam Thiam Goh
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kah Yin Loke
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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5
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Gul F, Kocak O, Babademez MA. Eustachian Tube Function Symptoms in Palatal Surgeries for OSA: 3-Month Postoperative Analysis. Laryngoscope 2024; 134:2471-2477. [PMID: 37905770 DOI: 10.1002/lary.31124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/24/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES To assess the influence of different soft palate surgeries for obstructive sleep apnea (OSA) on eustachian tube function symptoms, considering various potential factors. METHODS A prospective, cohort study was conducted on patients who underwent isolated palatal surgeries for OSA at a single academic medical center between 2017 and 2022. Eustachian Tube Dysfunction Questionnaire (ETDQ-7) were assessed at baseline, 1-month, 2-month, and 3-month time points. Patients with retropalatal obstruction underwent tailored surgeries: anterior palatoplasty (AP), expansion sphincter palatoplasty (ESP), or barbed palatoplasty (BP). Baseline OSA severity between baseline and follow-up time points were also examined. RESULTS In this study, 96 patients with OSA were enrolled and allocated to three surgical groups: AP (n = 30), ESP (n = 32), and BP (n = 34). The mean age was 44.3 ± 10.2 years, with 86% male participants. No significant differences were found between the groups in terms of age, sex, and BMI. A two-way repeated measures ANOVA revealed a significant main effect of time on ETDQ-7 scores (p < 0.001), but no significant main effect of groups (p = 0.109) or interaction between time and groups (p = 0.082). Subgroup analysis showed a significant interaction for the 3-month change in ETDQ-7 scores by OSA severity (p = 0.046). In post hoc analysis, the BP group exhibited a higher mean ETDQ-7 score compared with the AP group at the 3-month follow-up. CONCLUSION This study highlights the importance of considering individual patient factors, such as OSA severity and eustachian tube function symptoms, when selecting the most appropriate surgical treatment to optimize outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2471-2477, 2024.
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Affiliation(s)
- Fatih Gul
- Department of Otorhinolaryngology, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
| | - Ozgenur Kocak
- Department of Otorhinolaryngology, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
| | - Mehmet A Babademez
- Department of Otorhinolaryngology, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
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6
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Wulterkens BM, Den Teuling NGP, Hermans LWA, Asin J, Duis N, Overeem S, Fonseca P, van Gilst MM. Multi-night home assessment of sleep structure in OSA with and without insomnia. Sleep Med 2024; 117:152-161. [PMID: 38547592 DOI: 10.1016/j.sleep.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To explore sleep structure in participants with obstructive sleep apnea (OSA) and comorbid insomnia (COMISA) and participants with OSA without insomnia (OSA-only) using both single-night polysomnography and multi-night wrist-worn photoplethysmography/accelerometry. METHODS Multi-night 4-class sleep-staging was performed with a validated algorithm based on actigraphy and heart rate variability, in 67 COMISA (23 women, median age: 51 years) and 50 OSA-only (15 women, median age: 51) participants. Sleep statistics were compared using linear regression models and mixed-effects models. Multi-night variability was explored using a clustering approach and between- and within-participant analysis. RESULTS Polysomnographic parameters showed no significant group differences. Multi-night measurements, during 13.4 ± 5.2 nights per subject, demonstrated a longer sleep onset latency and lower sleep efficiency for the COMISA group. Detailed analysis of wake parameters revealed longer mean durations of awakenings in COMISA, as well as higher numbers of awakenings lasting 5 min and longer (WKN≥5min) and longer wake after sleep onset containing only awakenings of 5 min or longer. Within-participant variance was significantly larger in COMISA for sleep onset latency, sleep efficiency, mean duration of awakenings and WKN≥5min. Unsupervised clustering uncovered three clusters; participants with consistently high values for at least one of the wake parameters, participants with consistently low values, and participants displaying higher variability. CONCLUSION Patients with COMISA more often showed extended, and more variable periods of wakefulness. These observations were not discernible using single night polysomnography, highlighting the relevance of multi-night measurements to assess characteristics indicative for insomnia.
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Affiliation(s)
- Bernice M Wulterkens
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Philips Sleep and Respiratory Care, Eindhoven, the Netherlands.
| | | | - Lieke W A Hermans
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jerryll Asin
- Center for Sleep Medicine, Amphia Hospital, Breda, the Netherlands
| | - Nanny Duis
- Center for Sleep Medicine, Amphia Hospital, Breda, the Netherlands
| | - Sebastiaan Overeem
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Sleep Medicine Center Kempenhaeghe, Heeze, the Netherlands
| | - Pedro Fonseca
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Philips Sleep and Respiratory Care, Eindhoven, the Netherlands
| | - Merel M van Gilst
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Sleep Medicine Center Kempenhaeghe, Heeze, the Netherlands
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7
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Alqudah AM, Elwali A, Kupiak B, Hajipour F, Jacobson N, Moussavi Z. Obstructive sleep apnea detection during wakefulness: a comprehensive methodological review. Med Biol Eng Comput 2024; 62:1277-1311. [PMID: 38279078 PMCID: PMC11021303 DOI: 10.1007/s11517-024-03020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/11/2024] [Indexed: 01/28/2024]
Abstract
Obstructive sleep apnea (OSA) is a chronic condition affecting up to 1 billion people, globally. Despite this spread, OSA is still thought to be underdiagnosed. Lack of diagnosis is largely attributed to the high cost, resource-intensive, and time-consuming nature of existing diagnostic technologies during sleep. As individuals with OSA do not show many symptoms other than daytime sleepiness, predicting OSA while the individual is awake (wakefulness) is quite challenging. However, research especially in the last decade has shown promising results for quick and accurate methodologies to predict OSA during wakefulness. Furthermore, advances in machine learning algorithms offer new ways to analyze the measured data with more precision. With a widening research outlook, the present review compares methodologies for OSA screening during wakefulness, and recommendations are made for avenues of future research and study designs.
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Affiliation(s)
- Ali Mohammad Alqudah
- Biomedical Engineering Program, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada
| | - Ahmed Elwali
- Biomedical Engineering Program, Marian University, 3200 Cold Sprint Road, Indianapolis, IN, 46222-1997, USA
| | - Brendan Kupiak
- Electrical and Computer Engineering Department, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada
| | | | - Natasha Jacobson
- Biosystems Engineering Department, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada
| | - Zahra Moussavi
- Biomedical Engineering Program, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada.
- Electrical and Computer Engineering Department, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada.
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8
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Albertsen IE, Bille J, Piazza G, Lip GYH, Nielsen PB. Cardiovascular Risk in Young Patients Diagnosed With Obstructive Sleep Apnea. J Am Heart Assoc 2024; 13:e033506. [PMID: 38563371 DOI: 10.1161/jaha.123.033506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND In older adults, obstructive sleep apnea (OSA) has been associated with several cardiovascular complications. Whether young patients diagnosed with OSA also are at higher risk of developing subsequent cardiovascular disease is uncertain. We aimed to estimate the risk of developing an incident cardiovascular event among young patients diagnosed with OSA. METHODS AND RESULTS We linked nationwide Danish health registries to identify a cohort of patients aged ≤50 years with OSA using data from 2010 through 2018. Cases without OSA from the general population were matched as controls (1:5). The main outcome was any cardiovascular event (including hypertension, diabetes, atrial fibrillation, ischemic heart disease, ischemic stroke, heart failure, and venous thromboembolism). All-cause mortality was a secondary outcome. The study included 20 240 patients aged ≤50 years with OSA (19.6% female; mean±SD age 39.9±7.7 years) and 80 314 controls. After 5-year follow-up, 31.8% of the patients with OSA developed any cardiovascular event compared with 16.5% of the controls, with a corresponding relative risk (RR) of 1.96 (95% CI, 1.90-2.02). At 5-year follow-up, 27.3% of patients with OSA developed incident hypertension compared with 15.0% of the controls (RR, 1.84 [95% CI, 1.78-1.90]). Incident diabetes occurred in 6.8% of the patients with OSA and 1.4% of controls (RR, 5.05 [95% CI, 4.60-5.54]). CONCLUSIONS Similar to older adults, young adults with OSA demonstrate increased risk of developing cardiovascular events. To prevent cardiovascular disease progression, accumulation of cardiovascular risk factors, and mortality, risk stratification and prevention strategies should be considered for these patients.
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Affiliation(s)
- Ida E Albertsen
- Department of Otolaryngology Head and Neck Surgery and Audiology Aalborg University Hospital Aalborg Denmark
| | - Jesper Bille
- Department of Otolaryngology Head and Neck Surgery and Audiology Aarhus University Hospital Aarhus Denmark
| | - Gregory Piazza
- Division of Cardiovascular Medicine Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UK
- Department of Clinical Medicine Danish Center for Health Services Research Aalborg University Aalborg Denmark
| | - Peter B Nielsen
- Department of Clinical Medicine Danish Center for Health Services Research Aalborg University Aalborg Denmark
- Department of Cardiology Aalborg University Hospital Aalborg Denmark
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Parekh A, Kam K, Wickramaratne S, Tolbert TM, Varga AW, Osorio RS, Andersen ML, de Godoy LBM, Palombini LO, Tufik S, Ayappa I, Rapoport DM. Reply to Gan et al.: Ventilatory Burden in Obstructive Sleep Apnea: A Novel Indicator for Assessing Severity? Am J Respir Crit Care Med 2024; 209:1037-1038. [PMID: 38271706 DOI: 10.1164/rccm.202311-2188le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/23/2024] [Indexed: 01/27/2024] Open
Affiliation(s)
- Ankit Parekh
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Korey Kam
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sajila Wickramaratne
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas M Tolbert
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrew W Varga
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Monica L Andersen
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; and
- Sleep Institute, São Paulo, Brazil
| | - Luciana B M de Godoy
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | - Luciana O Palombini
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | - Sergio Tufik
- Disciplina de Medicina e Biologia do Sono, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; and
- Sleep Institute, São Paulo, Brazil
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David M Rapoport
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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10
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Gan Q, Zhang Y, Liu Q, Zhang N, Wu K. Ventilatory Burden in Obstructive Sleep Apnea: A Novel Indicator for Assessing Severity? Am J Respir Crit Care Med 2024; 209:1035-1036. [PMID: 38271708 DOI: 10.1164/rccm.202309-1681le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/23/2024] [Indexed: 01/27/2024] Open
Affiliation(s)
- Qiming Gan
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; and
| | - Yuting Zhang
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; and
| | - Quanzhen Liu
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; and
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Nuofu Zhang
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; and
| | - Kang Wu
- Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; and
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11
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Zhang Q, Yue Y, Wang X, Cui H, Liu Y, Gao M, Liu T, Xiao L. Tandem Mass Tag-Labeled Quantitative Proteome Analyses Identify C1R and A2M as Novel Serum Biomarkers in Pregnant Women with Obstructive Sleep Apnea. J Proteome Res 2024; 23:1232-1248. [PMID: 38407963 DOI: 10.1021/acs.jproteome.3c00664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
The aim of this study was to identify serum diagnostic biomarkers associated with the severity of obstructive sleep apnea (OSA) during pregnancy. Differentially expressed proteins (DEPs) were identified in the control (C), mild (O), and moderate (MO) OSA groups (n = 3 in each group). Bioinformatics analysis was conducted to identify the underlying functions, pathways, and networks of the proteins. Receiver operating characteristic curves were used to assess the diagnostic value of the identified DEPs. The enzyme-linked immunoassay was performed to detect serum levels of the complement C1r subcomponent (C1R) and alpha-2-macroglobulin (A2M) in 79 pregnant women with OSA (mild OSA [n = 32]; moderate OSA [n = 29], and severe OSA [n = 18]) and 65 healthy pregnant women without OSA. Pearson's correlation analysis was conducted to analyze the correlation between C1R and A2M levels and OSA clinicopathological factors. In total, 141 DEPs, 29 DEPs, and 103 DEPs were identified in the three groups (i.e., the mild OSA vs control group, the moderate OSA vs mild apnea group, and the moderate OSA vs control group, respectively). C1R and A2M were identified as continuously up-regulated proteins, and the levels of C1R and A2M were associated with OSA severity. C1R and A2M were found to be correlated with body mass index, systolic blood pressure, apnea-hypopnea index, oxygen desaturation index, time with saturation below 90%, and lowest SaO2. Adverse maternal and neonatal outcomes were observed in pregnant women with OSA. C1R and A2M have been identified as diagnostic biomarkers and are associated with the severity of OSA during pregnancy.
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Affiliation(s)
- Qiang Zhang
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yuanyi Yue
- Department of Gastroenterology Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Xueqing Wang
- Department of Gastroenterology Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Hong Cui
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yishu Liu
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Sleep Medicine Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Man Gao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Tong Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Li Xiao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Sleep Medicine Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
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12
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Mira FA, Favier V, Dos Santos Sobreira Nunes H, de Castro JV, Carsuzaa F, Meccariello G, Vicini C, De Vito A, Lechien JR, Chiesa-Estomba C, Maniaci A, Iannella G, Rojas EP, Cornejo JB, Cammaroto G. Chat GPT for the management of obstructive sleep apnea: do we have a polar star? Eur Arch Otorhinolaryngol 2024; 281:2087-2093. [PMID: 37980605 DOI: 10.1007/s00405-023-08270-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/29/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE This study explores the potential of the Chat-Generative Pre-Trained Transformer (Chat-GPT), a Large Language Model (LLM), in assisting healthcare professionals in the diagnosis of obstructive sleep apnea (OSA). It aims to assess the agreement between Chat-GPT's responses and those of expert otolaryngologists, shedding light on the role of AI-generated content in medical decision-making. METHODS A prospective, cross-sectional study was conducted, involving 350 otolaryngologists from 25 countries who responded to a specialized OSA survey. Chat-GPT was tasked with providing answers to the same survey questions. Responses were assessed by both super-experts and statistically analyzed for agreement. RESULTS The study revealed that Chat-GPT and expert responses shared a common answer in over 75% of cases for individual questions. However, the overall consensus was achieved in only four questions. Super-expert assessments showed a moderate agreement level, with Chat-GPT scoring slightly lower than experts. Statistically, Chat-GPT's responses differed significantly from experts' opinions (p = 0.0009). Sub-analysis revealed areas of improvement for Chat-GPT, particularly in questions where super-experts rated its responses lower than expert consensus. CONCLUSIONS Chat-GPT demonstrates potential as a valuable resource for OSA diagnosis, especially where access to specialists is limited. The study emphasizes the importance of AI-human collaboration, with Chat-GPT serving as a complementary tool rather than a replacement for medical professionals. This research contributes to the discourse in otolaryngology and encourages further exploration of AI-driven healthcare applications. While Chat-GPT exhibits a commendable level of consensus with expert responses, ongoing refinements in AI-based healthcare tools hold significant promise for the future of medicine, addressing the underdiagnosis and undertreatment of OSA and improving patient outcomes.
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Affiliation(s)
- Felipe Ahumada Mira
- ENT Department, Hospital of Linares, Linares, Chile
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), Paris, France
| | - Valentin Favier
- ENT Department, University Hospital of Montpellier, Montpellier, France
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), Paris, France
| | - Heloisa Dos Santos Sobreira Nunes
- ENT and Sleep Medicine Department, Nucleus of Otolaryngology, Head and Neck Surgery and Sleep Medicine of São Paulo, São Paulo, Brazil
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), Paris, France
| | - Joana Vaz de Castro
- ENT Department, Armed Forces Hospital, Lisbon, Portugal
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), Paris, France
| | - Florent Carsuzaa
- ENT Department, University Hospital of Poitiers, Poitiers, France
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), Paris, France
| | - Giuseppe Meccariello
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, Via Forlanini, 47121, Forlì, Italy
| | - Claudio Vicini
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, Via Forlanini, 47121, Forlì, Italy
| | - Andrea De Vito
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, Via Forlanini, 47121, Forlì, Italy
| | - Jerome R Lechien
- Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology and Head and Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), Paris, France
| | - Carlos Chiesa-Estomba
- Department of Otorhinolaryngology, Biodonostia Research Institute, Donostia University Hospital, Osakidetza, 20014, San Sebastian, Spain
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), Paris, France
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Piazza Università 2, 95100, Catania, Italy
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), Paris, France
| | - Giannicola Iannella
- Department of 'Organi di Senso', University "Sapienza", Viale Dell'Università 33, 00185, Rome, Italy
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), Paris, France
| | | | | | - Giovanni Cammaroto
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, Via Forlanini, 47121, Forlì, Italy.
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), Paris, France.
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Maqsudlu A, Nathan AS, Silber EJ, Danis DO, Levi JR. Analysis of the Clinical Course of Children With Initial Negative Polysomnography. Ann Otol Rhinol Laryngol 2024; 133:424-430. [PMID: 38251665 DOI: 10.1177/00034894241227038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
OBJECTIVES To determine the clinical course of children with initial negative polysomnography (PSG) tests. METHODS A retrospective chart review was performed on pediatric patients seen by an otolaryngologist who underwent a PSG between October 2012 and March 2019 for obstructive sleep apnea at a single, academic, tertiary-care center. Data including demographics, follow-up PSG tests, and surgeries were collected. RESULTS A total of 2018 pediatric patients underwent PSG during the timeframe. About 535/2018 (26.5%) patients were negative for obstructive sleep apnea by PSG and had no prior adenotonsillectomy. About 408/535 (76.3%) did not obtain follow-up testing or surgeries; 69/535 (12.9%) underwent subsequent adenotonsillectomy for worsening symptoms without repeat PSG; and 58/535 (10.8%) obtained 1 or multiple follow-up PSG tests. Of the 58 who obtained repeat PSG, 25 (43.1%) were subsequently positive, with 17 of those 25 (29.3% of 58) undergoing adenotonsillectomy. Taken together, 94/535 (17.6%) of patients with initial negative PSG had worsening sleep disordered breathing. CONCLUSION A significant minority of children who initially tested negative for pediatric obstructive sleep apnea met criteria for diagnosis on follow up PSG. Additionally, other children with initial negative PSG underwent adenotonsillectomy for worsening symptoms in lieu of repeat testing. Patients should be educated that snoring in children could persist or worsen over time, even in the setting of a initial negative PSG.
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Affiliation(s)
- Arman Maqsudlu
- Cooper Medical School of Rowan University/Cooper University Hospital, Camden, NJ, USA
| | - Ajay S Nathan
- Division of Otolaryngology-Head and Neck Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - Elizabeth J Silber
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - David O Danis
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, MA, USA
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, MA, USA
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Zhang Q, Zhang Q, Li X, Du G, Feng X, Ding R, Chi Y, Liu Y. Association of obstructive sleep apnea symptoms with all-cause mortality and cause-specific mortality in adults with or without diabetes: A cohort study based on the NHANES. J Diabetes 2024; 16:e13538. [PMID: 38599827 PMCID: PMC11006614 DOI: 10.1111/1753-0407.13538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 11/30/2023] [Accepted: 01/18/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The association between obstructive sleep apnea syndrome (OSAS) and mortality has not been extensively researched among individuals with varying diabetic status. This study aimed to compare the relationship of OSAS with all-cause and cause-specific mortality in US individuals with or without diabetes based on data from the National Health and Nutrition Examination Survey (NHANES). METHODS The study included participants from the NHANES 2005-2008 and 2015-2018 cycles with follow-up information. OSAS data (OSAS.MAP10) was estimated from the questionnaire. Hazard ratios (HRs) and the 95% confidence interval (CI) of OSAS for mortality were calculated by Cox regression analysis in populations with different diabetes status. The relationships between OSAS and mortality risk were examined using survival curves and restricted cubic spline curves. RESULTS A total of 13 761 participants with 7.68 ± 0.042 follow-up years were included. In the nondiabetic group, OSAS.MAP10 was positively associated with all-cause, cardiovascular, and cancer mortality. In individuals with prediabetes, OSAS.MAP10 was positively related to all-cause mortality (HR 1.11 [95% CI: 1.03-1.20]) and cardiovascular mortality (HR 1.17 [95% CI: 1.03-1.33]). The relationship between OSAS.MAP10 and the risk of all-cause mortality and cancer mortality exhibited L-shaped curves in diabetes patients (both with nonlinear p values <.01). Further threshold effect analysis revealed that OSAS was positively related to death risk when OSAS.MAP10 exceeded the threshold scores. CONCLUSION The relationship between OSAS and mortality differed among participants with or without diabetes. Individualized clinical treatment plans should be developed in clinical practice to reduce the risk of death for patients with different metabolic conditions.
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Affiliation(s)
- Qian Zhang
- Department of General PracticeAffiliated Hospital of Weifang Medical UniversityWeifangChina
| | - Qi Zhang
- Department of Endocrinology and MetabolismAffiliated Hospital of Weifang Medical UniversityWeifangChina
| | - Xiaomin Li
- Department of General PracticeAffiliated Hospital of Weifang Medical UniversityWeifangChina
| | - Gang Du
- Department of Endocrinology and MetabolismAffiliated Hospital of Weifang Medical UniversityWeifangChina
| | - Xiaojin Feng
- Department of Endocrinology and MetabolismAffiliated Hospital of Weifang Medical UniversityWeifangChina
- Department of Clinical Research CenterAffiliated Hospital of Weifang Medical UniversityWeifangChina
| | - Runtao Ding
- Judicial appraisal centerAffiliated Hospital of Weifang Medical UniversityWeifangChina
| | - Yuhua Chi
- Department of General PracticeAffiliated Hospital of Weifang Medical UniversityWeifangChina
| | - Yongping Liu
- Department of Endocrinology and MetabolismAffiliated Hospital of Weifang Medical UniversityWeifangChina
- Department of Clinical Research CenterAffiliated Hospital of Weifang Medical UniversityWeifangChina
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Roeder M, Sievi NA, Frei N, Schwarz EI, Steinack C, Gaisl T, Kohler M. The effect of longitudinal sleep monitoring on clinician agreement in obstructive sleep apnea diagnosis: The ELSA study. J Sleep Res 2024; 33:e13943. [PMID: 37197997 DOI: 10.1111/jsr.13943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/08/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
There is strong evidence for clinically relevant night-to-night variability of respiratory events in patients with suspected obstructive sleep apnea. Sleep experts retrospectively evaluated diagnostic data in 56 patients with suspected obstructive sleep apnea. Experts were blinded to the fact that they were diagnosing the same case twice, once based on a short report of a single in-laboratory respiratory polygraphy and once with the additional information of 14 nights of pulse oximetry at home. All experts (n = 22) were highly qualified, 13 experts (59.1%) treated > 100 patients with suspected obstructive sleep apnea per year. In 12 patients, the apnea-hypopnea index in the respiratory polygraphy was < 5 per hr, but the mean oxygen desaturation index of 14 nights of pulse oximetry was ≥ 5 per hr. The additional information of 14 nights of pulse oximetry helped to diagnose obstructive sleep apnea with a 70% consensus in two of those patients (16.7% [95% confidence interval: 4.7/44.8]). In eight patients, experts could not agree to a 70% consensus regarding continuous positive airway pressure therapy recommendation after respiratory polygraphy. The additional information of multiple-night testing led to a consensus in three of those cases (37.5% [95% confidence interval: 14/69]). Change of obstructive sleep apnea diagnosis and continuous positive airway pressure recommendation was significantly negatively associated with the number of treated obstructive sleep apnea patients > 100 per year compared with 0-29 patients per year (Coef. [95% confidence interval] -0.63 [-1.22/-0.04] and -0.61 [-1.07/-0.15], respectively). Experts found already a high level of consensus regarding obstructive sleep apnea diagnosis, severity and continuous positive airway pressure recommendation after a single respiratory polygraphy. However, longitudinal sleep monitoring could help increase consensus in selected patients with diagnostic uncertainty.
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Affiliation(s)
- Maurice Roeder
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Noriane A Sievi
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Nina Frei
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Esther I Schwarz
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Carolin Steinack
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Gaisl
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Te TT, Keenan BT, Veatch OJ, Boland MR, Hubbard RA, Pack AI. Identifying clusters of patient comorbidities associated with obstructive sleep apnea using electronic health records. J Clin Sleep Med 2024; 20:521-533. [PMID: 38054454 PMCID: PMC10985292 DOI: 10.5664/jcsm.10930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023]
Abstract
STUDY OBJECTIVES The objectives of this study were to understand the relative comorbidity burden of obstructive sleep apnea (OSA), determine whether these relationships were modified by sex or age, and identify patient subtypes defined by common comorbidities. METHODS Cases with OSA and noncases (controls) were defined using a validated electronic health record (EHR)-based phenotype and matched for age, sex, and time period of follow-up in the EHR. We compared prevalence of the 20 most common comorbidities between matched cases and controls using conditional logistic regression with and without controlling for body mass index. Latent class analysis was used to identify subtypes of OSA cases defined by combinations of these comorbidities. RESULTS In total, 60,586 OSA cases were matched to 60,586 controls (from 1,226,755 total controls). Patients with OSA were more likely to have each of the 20 most common comorbidities compared with controls, with odds ratios ranging from 3.1 to 30.8 in the full matched set and 1.3 to 10.2 after body mass index adjustment. Associations between OSA and these comorbidities were generally stronger in females and patients with younger age at diagnosis. We identified 5 distinct subgroups based on EHR-defined comorbidities: High Comorbidity Burden, Low Comorbidity Burden, Cardiovascular Comorbidities, Inflammatory Conditions and Less Obesity, and Inflammatory Conditions and Obesity. CONCLUSIONS Our study demonstrates the power of leveraging the EHR to understand the relative health burden of OSA, as well as heterogeneity in these relationships based on age and sex. In addition to enrichment for comorbidities, we identified 5 novel OSA subtypes defined by combinations of comorbidities in the EHR, which may be informative for understanding disease outcomes and improving prevention and clinical care. Overall, this study adds more evidence that OSA is heterogeneous and requires personalized management. CITATION Te TT, Keenan BT, Veatch OJ, Boland MR, Hubbard RA, Pack AI. Identifying clusters of patient comorbidities associated with obstructive sleep apnea using electronic health records. J Clin Sleep Med. 2024;20(4):521-533.
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Affiliation(s)
- Tue T. Te
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Brendan T. Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Olivia J. Veatch
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, Kansas
| | - Mary Regina Boland
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca A. Hubbard
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allan I. Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Wiechens B, Backhaus SJ, Oestreicher D, Beutner D, Schliephake H, Meyer-Marcotty P, Brockmeyer P. Assessment of oropharyngeal respiratory volume and sleep apnoea scores using peripheral arterial tonometry may improve diagnosis and treatment planning of combined dysgnathia therapy approaches. J Oral Rehabil 2024; 51:733-742. [PMID: 38100245 DOI: 10.1111/joor.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND Increased daytime sleepiness is a frequently reported symptom in patients with pronounced dysgnathia. OBJECTIVES This study investigated possible correlations using home peripheral arterial tonometry (PAT) and oropharyngeal airway volume determination in patients with dysgnathia and daytime sleepiness. METHODS Twenty patients (13 male, median age 27.6 ± 6.8 years) with abnormal sleep history and 10 skeletal neutral configured controls (6 male, median age 29.5 ± 4.2 years) with normal sleep history were examined. Patients and controls were evaluated for apnoea-hypopnoea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), snoring volume (dB), total sleep time (TST) and REM-percentage (REM). Airway volumetry was measured via CBCT. Individual user experience for PAT was assessed using the User Experience Questionnaire (UEQ). RESULTS Patients had significantly higher respiratory scores than controls. AHI increased 4.6-fold (p = .006), RDI 2.5-fold (p = .008) and ODI 6.4-fold (p < .001). Oropharyngeal volumes showed a 30% decrease (p = .003). dB, TST and REM showed no significant differences. AHI (r = -.51; p = .005), ODI (r = -.60; p < .001) and RDI (r = -.45; p = .016) correlated negatively with pharyngeal volume. Wits appraisal correlated negatively with oropharyngeal volume (r = -.47; p = .010) and positively with AHI (r = .41; p = .03) and ODI (r = .49; p = .007). dB and TST (r = -.49; p = .008) and REM and RDI (r = -.43; p = .02) correlated negatively. UEQ-KPI (2.17 ± 0.24) confirmed excellent usability of PAT. CONCLUSION Patients with mandibular retrognathia and abnormal sleep history showed significantly higher respiratory indices and smaller oropharyngeal volumes than neutrally configured controls. The dygnathia severity directly influenced the risk of obstructive sleep apnoea.
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Affiliation(s)
- Bernhard Wiechens
- Department of Orthodontics, University Medical Center Goettingen, Goettingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology University Medical Center Goettingen, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
| | - David Oestreicher
- Department of Otorhinolaryngology, University Medical Center Goettingen, Goettingen, Germany
| | - Dirk Beutner
- Department of Otorhinolaryngology, University Medical Center Goettingen, Goettingen, Germany
| | - Henning Schliephake
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
| | | | - Phillipp Brockmeyer
- Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany
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Parekh M, Triantafillou V, Keenan BT, Seay EG, Thuler E, Schwartz AR, Dedhia RC. Airway Collapsibility during Drug-Induced Sleep Endoscopy Relates with Clinical Features of Obstructive Sleep Apnea. Laryngoscope 2024; 134:1978-1985. [PMID: 37850859 PMCID: PMC10947963 DOI: 10.1002/lary.31114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/17/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Increased pharyngeal collapsibility leads to obstructive sleep apnea (OSA). Positive airway pressure titration during drug-induced sleep endoscopy (DISE-PAP) provides objective collapsibility metrics, the pharyngeal opening pressure (PhOP), and active pharyngeal critical pressure (PcritA ). We examined the interrelationships between risk factors of OSA, airway collapsibility measures, and clinical manifestations of the disease. METHODS This is a cross-sectional analysis of consecutive OSA patients undergoing DISE-PAP. Nasal PAP was increased stepwise until inspiratory flow limitation was abolished, signifying PhOP. PcritA was derived from the resulting titration pressure-flow relationships. Clinical data including demographics, anthropometrics, sleep studies, and patient-symptom questionnaires were obtained from the electronic medical record. Multivariate regression was used to evaluate the relationship between risk factors, airway collapsibility, and clinical data. RESULTS On average, the 164 patients meeting inclusion criteria were middle-aged (54.2 ± 14.7 years), overweight/obese (BMI 29.9 ± 4.5 kg/m2 ), male (72.6%), White (79.3%) and had severe OSA (AHI 32.0 ± 20.5 events/hour). Mean PhOP was 7.5 ± 3.3 cm H2 O and mean PcritA was 0.80 ± 3.70 cm H2 O. Younger age (Standardized β = -0.191, p = 0.015) and higher BMI (Standardized β = 0.176, p = 0.028) were associated with higher PhOP, but not PcritA . PhOP and PcritA were both associated with AHI, supine AHI, and SpO2 nadir. Higher PhOP was associated with higher snoring scores (Standardized β = 0.246, p = 0.008), but not other patient-reported outcomes. CONCLUSION Objective assessment of passive and active airway mechanics during DISE relates with clinical risk factors for OSA. Quantitative measures of collapsibility provide accessible and meaningful data, enhancing the standard sleep surgery evaluation. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1978-1985, 2024.
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Affiliation(s)
- Manan Parekh
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
| | | | | | - Everett G. Seay
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
| | - Eric Thuler
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
| | - Alan R. Schwartz
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
| | - Raj C. Dedhia
- Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
- Department of Medicine, University of Pennsylvania
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Alessandri-Bonetti A, Guglielmi F, Deledda G, Sangalli L, Brogna C, Gallenzi P. Malocclusions, Sleep Bruxism, and Obstructive Sleep Apnea Risk in Pediatric ADHD Patients: A Prospective Study. J Atten Disord 2024; 28:1017-1023. [PMID: 38327066 DOI: 10.1177/10870547231226139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Literature presents conflicting results regarding malocclusions, Obstructive Sleep Apnea (OSA) and sleep bruxism in children with ADHD. Aim of this study was to evaluate the prevalence of these parameters. METHODS A prospective study was conducted on 40 consecutive ADHD children referred to the Paediatric Dentistry Unit of Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome. All subjects underwent an orthodontic examination and were screened for OSA and sleep bruxism. Data were compared to a sex- and aged-matched control group. RESULTS Prevalence of high risk of OSA in children with ADHD was 62.5% compared to 10% in the control group (p < .00001). No differences were found in any of the occlusal variables examined between children with ADHD and controls (p > .05). An increased prevalence of sleep bruxism was observed in ADHD children (40%) compared to controls (7.5%) (p < .001). CONCLUSIONS A higher prevalence of OSA risk and probable sleep bruxism were observed in ADHD patients compared with controls. No significant differences were observed in malocclusions d.
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Affiliation(s)
| | | | - Giulia Deledda
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome
| | | | - Claudia Brogna
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome
| | - Patrizia Gallenzi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome
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Sano A, Kozuka T, Watatani N, Kunita Y, Kawabata Y, Gose K, Shirahase K, Yoshikawa K, Yamazaki R, Nishikawa Y, Omori T, Nishiyama O, Iwanaga T, Sano H, Haraguchi R, Tohda Y, Matsumoto H. Role of bronchial hyperresponsiveness in patients with obstructive sleep apnea with asthma-like symptoms. Allergol Int 2024; 73:231-235. [PMID: 37951731 DOI: 10.1016/j.alit.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/26/2023] [Accepted: 10/15/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is one of the major co-morbidities and aggravating factors of asthma. In OSA-complicated asthma, obesity, visceral fat, and systemic inflammation are associated with its severity, but the role of bronchial hyperresponsiveness (BHR) is unclear. We investigated the involvement of BHR and mediastinal fat width, as a measure of visceral fat, with OSA severity in patients with OSA and asthma-like symptoms. METHODS Patients with OSA who underwent BHR test and chest computed tomography scan for asthma-like symptoms were retrospectively enrolled. We evaluated the relationship between apnea-hypopnea index (AHI) and PC20 or anterior mediastinal fat width, stratified by the presence or absence of BHR. RESULTS OSA patients with BHR (n = 29) showed more obstructive airways and frequent low arousal threshold and lower mediastinal fat width, and tended to show fewer AHI than those without BHR (n = 25). In the overall analysis, mediastinal fat width was significantly positively correlated with AHI, which was significant even after adjustment with age and gender. This was especially significant in patients without BHR, while in OSA patients with BHR, there were significant negative associations between apnea index and airflow limitation, and hypopnea index and PC20. CONCLUSIONS Risk factors for greater AHI differed depending on the presence or absence of BHR in OSA patients with asthma-like symptoms. In the presence of BHR, severity of asthma may determine the severity of concomitant OSA.
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Affiliation(s)
- Akiko Sano
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takenori Kozuka
- Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nanase Watatani
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yuuki Kunita
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoshiyuki Kawabata
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kyuya Gose
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ken Shirahase
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazuya Yoshikawa
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ryo Yamazaki
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yusaku Nishikawa
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takashi Omori
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Osamu Nishiyama
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takashi Iwanaga
- Center for General Medical Education and Clinical Training, Kindai University Hospital, Osaka, Japan
| | - Hiroyuki Sano
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ryuta Haraguchi
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yuji Tohda
- Kindai University Hospital, Osaka, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan.
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Peng D, Yue H, Tan W, Lei W, Chen G, Shi W, Zhang Y. A bimodal feature fusion convolutional neural network for detecting obstructive sleep apnea/hypopnea from nasal airflow and oximetry signals. Artif Intell Med 2024; 150:102808. [PMID: 38553148 DOI: 10.1016/j.artmed.2024.102808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/14/2023] [Accepted: 02/08/2024] [Indexed: 04/02/2024]
Abstract
The most prevalent sleep-disordered breathing condition is Obstructive Sleep Apnea (OSA), which has been linked to various health consequences, including cardiovascular disease (CVD) and even sudden death. Therefore, early detection of OSA can effectively help patients prevent the diseases induced by it. However, many existing methods have low accuracy in detecting hypopnea events or even ignore them altogether. According to the guidelines provided by the American Academy of Sleep Medicine (AASM), two modal signals, namely nasal pressure airflow and pulse oxygen saturation (SpO2), offer significant advantages in detecting OSA, particularly hypopnea events. Inspired by this notion, we propose a bimodal feature fusion CNN model that primarily comprises of a dual-branch CNN module and a feature fusion module for the classification of 10-second-long segments of nasal pressure airflow and SpO2. Additionally, an Efficient Channel Attention mechanism (ECA) is incorporated into the second module to adaptively weight feature map of each channel for improving classification accuracy. Furthermore, we design an OSA Severity Assessment Framework (OSAF) to aid physicians in effectively diagnosing OSA severity. The performance of both the bimodal feature fusion CNN model and OSAF is demonstrated to be excellent through per-segment and per-patient experimental results, based on the evaluation of our method using two real-world datasets consisting of polysomnography (PSG) recordings from 450 subjects.
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Affiliation(s)
- Dandan Peng
- The Cyberspace Institute of Advanced Technology, Guangzhou University, Guangzhou, 510006, China.
| | - Huijun Yue
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Wenjun Tan
- The Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, 110189, China.
| | - Wenbin Lei
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Guozhu Chen
- The Cyberspace Institute of Advanced Technology, Guangzhou University, Guangzhou, 510006, China.
| | - Wen Shi
- The Cyberspace Institute of Advanced Technology, Guangzhou University, Guangzhou, 510006, China.
| | - Yanchun Zhang
- School of Computer Science, Zhejiang Normal University, Jinhua, 321000, China; The Department of New Networks, Peng Cheng Laboratory, Shenzhen, 695571, China.
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22
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Bonacina CF, Soster LM, Bueno C, Diniz JS, Bozzini MF, Di Francesco RC, Olegário IC, de Oliveira Lira A. Sleep bruxism and associated physiological events in children with obstructive sleep apnea: a polysomnographic study. J Clin Sleep Med 2024; 20:565-573. [PMID: 38059335 PMCID: PMC10985302 DOI: 10.5664/jcsm.10950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
STUDY OBJECTIVES The aim of this study was to evaluate the physiological events associated with sleep bruxism (Sleep Bruxism [SB]; presence of mandibular movement activity) and the control window (4 minutes prior to SB event, where no mandibular movement activity was detected) in a polysomnography study in children with mild sleep apnea. METHODS Polysomnography data from children aged 4 to 9 years old diagnosed with mild sleep apnea were analyzed by 2 trained examiners. The mandibular movement activity (bruxism event; SB) was classified into phasic and tonic. The control window was selected 4 minutes prior to the SB event. All physiological events were recorded in both bruxism and control windows, including sleep phase (N1, N2, N3, and rapid eye movement), arousal, leg movements, tachycardia, bradycardia, oxygen desaturation, and number of obstructive and central sleep apnea events. The moment in which those phenomena occurred when associated with SB was also analyzed (before/after). Data were analyzed using 95% confidence intervals (α = 5%). RESULTS A total of 661 mandibular movements were analyzed and classified as tonic (n = 372) or phasic (n = 289). The mean apnea-hypopnea index was 1.99 (SD = 1.27) events/h. The frequency of leg movements, microarousal, and tachycardia was increased in SB events when compared with the control window (P < .05). There was an increase in bradycardia frequency in the control window when compared with SB (in both tonic and phasic events). The frequency of obstructive and central apnea during SB was lower when compared with the other physiological phenomena. CONCLUSIONS There is a difference in the physiological parameters evaluated in children with mild sleep apnea when comparing the 2 windows (SB and control). Sleep bruxism is associated with other physiological phenomena, such as leg movements, tachycardia, and microarousal. The use of a control window (where no mandibular activity was detected) was representative since it did not show activation of the sympathetic nervous system. CITATION Bonacina CF, Soster LMSFA, Bueno C, et al. Sleep bruxism and associated physiological events in children with obstructive sleep apnea: a polysomnographic study. J Clin Sleep Med. 2024;20(4):565-573.
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Affiliation(s)
| | - Leticia M.S.F.A. Soster
- Department of Neurology, Children’s Institute of the Clinical Hospital at University of Sao Paulo Medical School (Clinical Hospital HCFMUSP), Medical School, University of São Paulo, São Paulo, Brazil
| | - Clarissa Bueno
- Department of Neurology, Children’s Institute of the Clinical Hospital at University of Sao Paulo Medical School (Clinical Hospital HCFMUSP), Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Maria F. Bozzini
- Department of Otolaryngology, Children's Institute of the Clinical Hospital at University of Sao Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Renata C. Di Francesco
- Department of Otolaryngology, Children's Institute of the Clinical Hospital at University of Sao Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Isabel Cristina Olegário
- Department of Public and Child Dental Health, Dublin Dental University Hospital, Trinity College, Dublin, Ireland
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Barbera L, Pasta A, Calabrese F, Zentilin P, Fragale M, Barbieri M, Peretti G, Savarino EV, Giannini EG, Marabotto E. Evaluation of the pathophysiological association between the GERD and OSAS: Esophageal pH-monitoring results beyond Lyon criteria. J Gastroenterol Hepatol 2024; 39:772. [PMID: 38221800 DOI: 10.1111/jgh.16488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/02/2024] [Indexed: 01/16/2024]
Affiliation(s)
- L Barbera
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - A Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - F Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - P Zentilin
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Fragale
- Unit of Otolaryngology, ASL 4 Liguria, Hospital of Lavagna, Genoa, Italy
| | - M Barbieri
- Unit of Otolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - G Peretti
- Unit of Otolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - E V Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università of Padua, Padua, Italy
| | - E G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - E Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Wickwire EM, Zhang X, Munson SH, Benjafield AV, Sullivan SS, Payombar M, Patil SP. The OSA patient journey: pathways for diagnosis and treatment among commercially insured individuals in the United States. J Clin Sleep Med 2024; 20:505-514. [PMID: 37950451 PMCID: PMC10985293 DOI: 10.5664/jcsm.10908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/12/2023]
Abstract
STUDY OBJECTIVES The aims of this study were to characterize obstructive sleep apnea (OSA) care pathways among commercially insured individuals in the United States and to investigate between-groups differences in population, care delivery, and economic aspects. METHODS We identified adults with OSA using a large, national administrative claims database (January 1, 2016-February 28, 2020). Inclusion criteria included a diagnostic sleep test on or within ≤ 12 months of OSA diagnosis (index date) and 12 months of continuous enrollment before and after the index date. Exclusion criteria included prior OSA treatment or central sleep apnea. OSA care pathways were identified using sleep testing health care procedural health care common procedure coding system/current procedural terminology codes then selected for analysis if they were experienced by ≥ 3% of the population and assessed for baseline demographic/clinical characteristics that were also used for model adjustment. Primary outcome was positive airway pressure initiation rate; secondary outcomes were time from first sleep test to initiation of positive airway pressure, sleep test costs, and health care resource utilization. Associations between pathway type and time to treatment initiation were assessed using generalized linear models. RESULTS Of 86,827 adults with OSA, 92.1% received care in 1 of 5 care pathways that met criteria: home sleep apnea testing (HSAT; 30.8%), polysomnography (PSG; 23.6%), PSG-Titration (19.8%), Split-night (14.8%), and HSAT-Titration (3.2%). Pathways had significantly different demographic and clinical characteristics. HSAT-Titration had the highest positive airway pressure initiation rate (84.6%) and PSG the lowest (34.4%). After adjustments, time to treatment initiation was significantly associated with pathway (P < .0001); Split-night had shortest duration (median, 28 days), followed by HSAT (36), PSG (37), PSG-Titration (58), and HSAT-Titration (75). HSAT had the lowest sleep test costs and health care resource utilization. CONCLUSIONS Distinct OSA care pathways exist and are associated with differences in population, care delivery, and economic aspects. CITATION Wickwire EM, Zhang X, Munson SH, et al. The OSA patient journey: pathways for diagnosis and treatment among commercially insured individuals in the United States. J Clin Sleep Med. 2024;20(4):505-514.
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Affiliation(s)
- Emerson M. Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Xuan Zhang
- Boston Strategic Partners, Inc., Boston, Massachusetts
| | | | | | | | | | - Susheel P. Patil
- Sleep Medicine Program, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Fields CM, Poupore NS, Barengo JH, Smaily H, Nguyen SA, Angles J, Clemmens CS, Pecha PP, Carroll WW. Does REM AHI Predict Persistent OSA After Pediatric Adenotonsillectomy? Ann Otol Rhinol Laryngol 2024; 133:431-440. [PMID: 38258762 DOI: 10.1177/00034894241227030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE The utility of REM AHI in managing pediatric obstructive sleep apnea (OSA) is not fully understood. This study aimed to evaluate the relationship of preoperative REM AHI to postoperative persistence of OSA in children who underwent adenotonsillectomy. METHODS This retrospective chart review identified children under the age of 18 years that received an adenotonsillectomy for OSA and a preoperative and postoperative polysomnogram. Children with craniofacial or neuromuscular disorders or a tracheostomy were excluded. The primary outcome was the postoperative persistence of OSA, defined as a postoperative obstructive apnea-hypopnea index (oAHI) ≥ 1.5 events/hour. REM-predominant OSA was defined as a ratio of REM/NREM AHI ≥ 2. REM AHI minus NREM AHI and REM AHI minus oAHI helped to identify patients with a larger distribution of REM AHI. RESULTS A total of 353 patients were included. Postoperative persistent OSA was seen in 232 (65.7%) children. The preoperative REM AHI, REM AHI minus NREM AHI, and REM AHI minus oAHI of children with persistent OSA did not differ significantly from children with resolution of OSA. Rates of persistence were not different between those with REM-predominant OSA and REM-independent OSA (63.8% vs 70.7%, P = .218). CONCLUSION This study suggests that preoperative REM AHI may be a poor predictor of OSA persistence after adenotonsillectomy. Further study is needed to help characterize how pre-operative REM AHI should impact clinicians' decision making, family counseling and recommendations.
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Affiliation(s)
- Caroline M Fields
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Nicolas S Poupore
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jenna H Barengo
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Hussein Smaily
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jacqueline Angles
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Clarice S Clemmens
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Phayvanh P Pecha
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - William W Carroll
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Emara TA, Elmonem MSAA, Khaled AM, Genedy HAH, Youssef RS. Anterolateral advancement pharyngoplasty versus barbed reposition pharyngoplasty in patients with obstructive sleep apnea. Eur Arch Otorhinolaryngol 2024; 281:1991-2000. [PMID: 38170209 PMCID: PMC10943148 DOI: 10.1007/s00405-023-08402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To compare functional outcomes and complication rates of anterolateral advancement pharyngoplasty (ALA) versus barbed reposition pharyngoplasty (BRP) in the treatment of obstructive sleep apnea patients with palatal and lateral pharyngeal wall collapse. STUDY DESIGN Prospective study. SETTING University hospitals. SUBJECTS AND METHODS Forty-six patients were included in this study. Patients were divided into two groups randomly, group 1 (23 cases) underwent anterolateral advancement pharyngoplasty and group 2 (23 cases) underwent barbed relocation pharyngoplasty. According to the following criteria: both sex, age between 18 and 65 years, body mass index ≤ 32 kg/m2, Friedman stage II or III, type I Fujita, nocturnal polysomnography study diagnostic for OSA, retropalatal and lateral pharyngeal wall collapse, diagnosis with flexible nasoendoscopy during a Muller's maneuver based on a 5-point scale and drug-induced sleep endoscopy. Patients who suffered from retroglossal airway collapse were rolled out. RESULTS Apnea-hypopnea index decreased from 27.50 ± 11.56 to 11.22 ± 7.63 (P ≤ .001) in group 1 and from 33.18 ± 10.94 to 12.38 ± 6.77 (P ≤ .001) in group 2. Retropalatal posterior airway space increased from 9.84 ± 1.29 mm to 21.48 ± 2.8 mm (P ≤ .001) in group 1 and increased from 10.26 ± 1.2 mm to 22.86 ± 2.62 mm (P ≤ .001) in group 2. Retropalatal space volume increased from 1.9 ± 0.68 cm3 to 2.75 ± 0.7 cm3 (P ≤ .001) in group 1 and increased from 1.96 ± 0.88 cm3 to 2.82 ± 0.83 cm3 (P ≤ .001) in group 2. Surgical success was 86.95% in group 1 compared to 82.6% in group 2. CONCLUSIONS Both techniques appear to be effective with a high surgical success rate in the treatment of OSA patients with retropalatal and lateral pharyngeal wall collapse.
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Affiliation(s)
| | | | | | - Hisham Ahmed Hasan Genedy
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
- Faculty of Medicine, ENT Department, Beni-Suef University, Beni Suef, Egypt
| | - Rabie Sayed Youssef
- Faculty of Medicine, ENT Department, Beni-Suef University, Beni Suef, Egypt.
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Chang SW, Kang JW. Increasing obstructive sleep apnea risk is associated with albuminuria in Korean adults: cross-sectional analysis. Sci Rep 2024; 14:6676. [PMID: 38509240 PMCID: PMC10954636 DOI: 10.1038/s41598-024-57394-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/18/2024] [Indexed: 03/22/2024] Open
Abstract
Several studies have shown an association between albuminuria and obstructive sleep apnea (OSA). However, studies on the relationship between the STOP-BANG questionnaire that can screen for OSA and microalbuminuria are still insufficient. Therefore, this study attempted to clarify the relationship between microalbuminuria and OSA risk using the STOP-BANG questionnaire in Korean adults. A total of 7478 participants (3289 men and 4189 women) aged over 40 were enrolled in the Korean National Health and Nutrition Examination Survey from 2019 to 2020. STOP-BANG questionnaire to screen OSA was obtained from subjects. The urinary albumin/creatinine ratio (ACR) and proteinuria were measured via a single dipstick to evaluate renal function. The high OSA risk group had a higher mean ACR value than the low OSA risk group (36.8 ± 172.2 vs 17.7 ± 82.5; P < 0.001). The proportion of subjects with values of 30 ≤ ACR < 300 mg/g (11.9% vs 6.1%; P < 0.001) and ACR > 300 mg/g (2.1% vs 0.7%; P < 0.001) was significantly higher in high OSA risk group. Multivariate logistic regression results confirmed that microalbuminuria (OR 1.279, 95% confidence interval (CI) 1.068-1.532, P = 0.008) was significantly correlated with high OSA risk. In addition, significant correlation with high OSA risk was also found in macroalbuminuria (OR 1.684, 95% CI 1.073-2.530, P = 0.022) and proteinuria (OR 1.355, 95% CI 1.030-1.783, P = 0.030). We confirmed a significant correlation between high OSA risk and albuminuria/proteinuria in Korean adults. Therefore, renal function evaluation is required in high OSA risk patients, and OSA diagnosis through PSG test and treatment is necessary.
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Affiliation(s)
- Suk Won Chang
- Department of Otorhinolaryngology, Jeju National University College of Medicine, Jeju, Korea
- Department of Otorhinolaryngology, Jeju National University Hospital, Jeju, Korea
| | - Ju Wan Kang
- Department of Otorhinolaryngology, Yongin Severance Hospital, Yonsei University College of Medicine, 363, Dongbaekjukjeon-Daero, Giheung-gu, Yongin, 16995, Korea.
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Macrea M, Malhotra A, ZuWallack R, Oursler K, Casaburi R. A Cross-Sectional Study Evaluating the Association of Brachial Artery Flow Mediated Vasodilation with Physical Activity Measured by Accelerometry in Patients with the Overlap of Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2024; 19:773-778. [PMID: 38524399 PMCID: PMC10960536 DOI: 10.2147/copd.s432243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/30/2024] [Indexed: 03/26/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Overlap Syndrome (OS), the co-occurrence of Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease. Clustering of patients in subgroups with similar pre-clinical manifestations (ie, endothelial dysfunction) may identify relevant therapeutic phenotype categories for patients with OS who are at high risk of CVD. We therefore conducted a cross-sectional pilot study of endothelial function in 7 patients with OS (Forced Expiratory Volume in 1 second/Forced Vital Capacity < 0.7) on continuous positive airway pressure therapy (n = 7) to assess the relationship between FMD and physical activity. We found a strong association between FMD and step counts (rho = 0.77, p = 0.04); and FMD and moderate physical activity (rho = 0.9, p = 0.005). Further, larger studies are needed to confirm that FMD may identify patients with OS at high risk of CVD who benefit from increased physical activity.
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Affiliation(s)
- Madalina Macrea
- Department of Pulmonary and Sleep Medicine, Salem Veterans Affairs Medical Center, University of Virginia, Charlottesville, VA, USA
| | - Atul Malhotra
- Department of Pulmonary, Critical Care and Sleep Medicine, University of California at San Diego, San Diego, CA, USA
| | - Richard ZuWallack
- Department of Pulmonary, Critical Care, and Sleep Medicine St. Francis Hospital, Hartford, CT, USA
| | - Krisann Oursler
- Department of Geriatrics and Infection Disease, Salem Veterans Affairs Medical Center, Carilion Virginia Tech School of Medicine, Roanoke, VA, USA
| | - Richard Casaburi
- Division of Respiratory and Critical Care Physiology and Medicine, Lundquist Institute for Biomedical Innovation at Harbor-University of California at Los Angeles Medical Center, Torrance, CA, USA
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Selby A, Buchan E, Davies M, Hill CM, Kingshott RN, Langley RJ, McGovern J, Presslie C, Senior E, Shinde SS, Yuen HM, Samuels M, Evans HJ. Role of overnight oximetry in assessing the severity of obstructive sleep apnoea in typically developing children: a multicentre study. Arch Dis Child 2024; 109:308-313. [PMID: 38253431 DOI: 10.1136/archdischild-2023-326191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND AND OBJECTIVE Cardiorespiratory polygraphy (CRP) is the predominant technology used to diagnose obstructive sleep apnoea (OSA) in tertiary centres in the UK. Nocturnal pulse oximetry (NPO) is, however, cheaper and more accessible. This study evaluated the ability of NPO indices to predict OSA in typically developing (TD) children. METHODS Indices from simultaneous NPO and CRP recordings were compared in TD children (aged 1-16 years) referred to evaluate OSA in three tertiary centres. OSA was defined as an obstructive apnoea-hypopnoea index (OAHI) ≥1 event/hour. Receiver operating characteristic curves assessed the diagnostic accuracy of NPO indices including ODI3 (3% Oxygen Desaturation Index, ODI4 (4% Oxygen Desaturation Index), delta 12 s index and minimum oxygen saturation. Two-by-two tables were generated to determine the sensitivities and specificities of whole number cut-off values for predicting OAHIs ≥1, 5 and 10 events/hour. RESULTS Recordings from 322 TD children, 197 male (61.2%), median age 4.9 years (range 1.1-15.6), were reviewed. OAHI was ≥1/hour in 144 (44.7%), ≥5/hour in 61 (18.9%) and ≥10/hour in 28 (8.7%) cases. ODI3 and ODI4 had the best diagnostic accuracy. ODI3 ≥7/hour and ODI4 ≥4/hour predicted OSA in TD children with sensitivities/specificities of 57.6%/85.4% and 46.2%/91.6%, respectively. ODI3 ≥8/hour was the best predictor of OAHI ≥5/hour (sensitivity 82.0%, specificity 84.3%). CONCLUSION Raised ODI3 and ODI4 predict OSA in TD children with high specificity but variable sensitivity. NPO may be an alternative to diagnose moderate-severe OSA if access to CRP is limited. Low sensitivities to detect mild OSA mean that confirmatory CRP is needed if NPO is normal.
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Affiliation(s)
- Anna Selby
- Faculty of Medicine, University of Southampton, Southampton, UK
- Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elise Buchan
- Respiratory and Sleep Physiology, Royal Hospital for Children, Glasgow, UK
| | - Matthew Davies
- Respiratory Sleep Unit, Great Ormond Street Hospital for Children, London, UK
| | - Catherine M Hill
- Faculty of Medicine, University of Southampton, Southampton, UK
- Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ruth N Kingshott
- Department of Respiratory Medicine, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Ross J Langley
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
| | - Julia McGovern
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Callum Presslie
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Emily Senior
- Paediatric Sleep and Respiratory Medicine Department, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | | | - Ho Ming Yuen
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Martin Samuels
- Paediatric Respiratory and Sleep Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Hazel J Evans
- Child Health, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Sonsuwan N, Houngsuwannakorn K, Chattipakorn N, Sawanyawisuth K. An association between heart rate variability and pediatric obstructive sleep apnea. Ital J Pediatr 2024; 50:54. [PMID: 38500213 PMCID: PMC10949611 DOI: 10.1186/s13052-024-01576-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 01/03/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND There are different findings on heart rate variability (HRV) and pediatric obstructive sleep apnea (pOSA) by an overnight HRV or a 1-hr HRV. However, there is limited data of HRV and pOSA diagnosis by using a 24-h HRV test. This study aimed to evaluate if HRV had potential for OSA diagnosis by using a 24-h HRV test. METHODS This was a prospective study included children age between 5 and 15 years old, presenting with snoring, underwent polysomnography and a 24-h Holter monitoring. Predictors for pOSA diagnosis were analyzed using logistic regression analysis. RESULTS During the study period, there were 81 pediatric patients met the study criteria. Of those, 65 patients (80.25%) were diagnosed as OSA. There were three factors were independently associated with OSA: standard deviation of all normal interval (SDNN), high frequency (HF), and low frequency (LF). The adjusted odds ratios of these factors were 0.949 (95% confidence interval 0.913, 0.985), 0.786 (95% confidence interval 0.624, 0.989), and 1.356 (95% confidence interval 1.075, 1.709). CONCLUSIONS HRV parameters including SDNN, HF, and LF were associated with pOSA diagnosis in children by using the 24-h Holter monitoring.
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Affiliation(s)
- Nuntigar Sonsuwan
- Department of Otolaryngology Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | | | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mitraparp Road, 40002, Khon Kaen, Thailand.
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31
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Li J, Zhou K, Chen X. Changes of Serum Adiponectin Level in Patients with Obstructive Sleep Apnea Hypopnea Syndrome and Its Relationship with Sleep Monitoring Indexes. Can Respir J 2024; 2024:4071131. [PMID: 38524144 PMCID: PMC10959586 DOI: 10.1155/2024/4071131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024] Open
Abstract
Objective To observe the changes of serum adiponectin (AP) levels in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and explore the correlation between serum AP and polysomnography (PSG) parameters in patients with OSAHS. Methods The data of subjects who underwent PSG at the hospital between January 2021 and December 2022 were collected retrospectively and divided into simple snoring group (AHI < 5 times/h, n = 45), mild OSAHS group (5 ≤ AHI < 15 times/h, n = 63), moderate OSAHS group (15 ≤ AHI ≤ 30 times/h, n = 52), and severe OSAHS group (AHI > 30 times/h, n = 60). The general data, PSG indices, and serological indices of the subjects were collected and compared between groups. Pearson correlation analysis and partial correlation analysis were employed to examine the correlation between serum AP level and PSG parameters. Ordered logistic regression was employed to analyze the risk factors influencing the severity of OSAHS. The predictive capability of the serum AP level in determining the occurrence of OSAHS was assessed using ROC. The serum AP levels of subjects with different subtypes of PSG indicators were compared. Results In the simple snoring group, mild OSAHS group, moderate OSAHS group, and severe OSAHS group, there were statistically significant differences in microarousal count, MAI, AHI, times of blood oxygen decreased by ≥ 3%, L-SaO2, and TS90% among the 4 groups (P < 0.05). The level of serum AP was positively correlated with L-SaO2 and negatively correlated with the proportion of REM, microarousal count, MAI, AHI, times of blood oxygen decreased by ≥ 3%, TS90%, and LP (P < 0.05). High AHI was a risk factor affecting the severity of OSAHS (95% CI: 1.446-4.170). The AUC of serum AP level in diagnosing OSAHS was 0.906 (95% CI: 0.8601-0.9521), and when the Youden Index was 0.678, the sensitivity was 88.9%, and the specificity was 78.9% (P < 0.0001). In the population with a high microarousal count, high AHI, and high times of blood oxygen decreased by ≥ 3% and high TS90%, the serum AP level was lower than that in the low-level population (P < 0.05). In the population with high L-SaO2, the serum AP level was higher than that in low-level population (P < 0.05). Conclusion The level of serum AP decreased with the increase of the disease severity of patients with OSAHS and demonstrates a significant predictive capability for the occurrence of OSAHS. Monitoring the level of serum AP can effectively forecast the risk of OSAHS. Furthermore, alterations in serum AP levels are associated with both hypoxemia and a heightened frequency of arousal in patients with OSAHS.
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Affiliation(s)
- Ji Li
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Ningbo University, China
| | - Kejing Zhou
- Ningbo Yinzhou Second Hospital, Ningbo, China
| | - Xing Chen
- Ningbo Yinzhou Second Hospital, Ningbo, China
- Department of Ophthalmology, Yinzhou Second Hospital, Ningbo, China
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Wickwire EM, Cole KV, Dexter RB, Malhotra A, Cistulli PA, Sterling KL, Pépin JL. Depression and comorbid obstructive sleep apnea: Association between positive airway pressure adherence, occurrence of self-harm events, healthcare resource utilization, and costs. J Affect Disord 2024; 349:254-261. [PMID: 38159653 PMCID: PMC10922426 DOI: 10.1016/j.jad.2023.12.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/08/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Previous studies have shown that treatment of obstructive sleep apnea (OSA) with positive airway pressure (PAP) therapy in patients with depression may improve depression symptoms and response to antidepressant therapy. We investigated the association between PAP therapy adherence, self-harm events, healthcare resource utilization (HCRU), and costs over 2 years in a national sample of patients with pre-existing depression and newly diagnosed comorbid OSA. METHODS Administrative claims data were linked to objective PAP therapy usage. Inverse probability treatment weighting was used to compare outcomes over 2 years across PAP adherence levels. The predicted numbers of emergency room (ER) visits and hospitalizations by adherence level were assessed using risk-adjusted generalized linear models. RESULTS 37,459 patients were included. Relative to non-adherent patients, consistently adherent patients had fewer self-harm events (0.04 vs 0.05, p < 0.001) after 1 year, and significantly (all p < 0.001) fewer ER visits (0.66 vs 0.86) and all-cause hospitalizations (0.13 vs 0.17), and lower total ($11,847 vs $11,955), inpatient hospitalization ($1634 vs $2274), and ER visit ($760 vs $1006) costs per patient in the second year of PAP therapy. Consistently adherent patients showed lower risk for hospitalizations and ER visits. LIMITATIONS Using observational claims data, we were unable to assess clinical characteristics including sleep, sleepiness, and daytime symptoms, or important social determinants of health. We were limited in assessing care received outside of the included health plans. CONCLUSION Consistent adherence to PAP therapy over 2 years was associated with improved HCRU outcomes for patients with pre-existing depression newly diagnosed with comorbid OSA.
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Affiliation(s)
- E M Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - K V Cole
- ResMed Science Center, San Diego, CA, USA
| | - R B Dexter
- ResMed Science Center, Halifax, Nova Scotia, Canada
| | - A Malhotra
- University of California San Diego, La Jolla, CA, USA
| | - P A Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | | | - J L Pépin
- Univ. Grenoble Alpes, Institut National de la Santé et de la Recherche Médicale (INSERM) U 1300, HP2 Laboratory (Hypoxia: Pathophysiology), Grenoble Alpes University, Grenoble, France
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Lin H, Zhou C, Li J, Ma X, Yang Y, Zhu T. A risk prediction nomogram for resistant hypertension in patients with obstructive sleep apnea. Sci Rep 2024; 14:6127. [PMID: 38480770 PMCID: PMC10937983 DOI: 10.1038/s41598-024-56629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/08/2024] [Indexed: 03/17/2024] Open
Abstract
Patients with obstructive sleep apnea (OSA) are liable to have resistant hypertension (RH) associated with unfavorable cardiovascular events. It is of necessity to predict OSA patients who are susceptible to resistant hypertension. Hence, we conducted a retrospective study based on the clinical records of OSA patients admitted to Yixing Hospital Affiliated to Jiangsu University from January 2018 to December 2022. According to different time periods, patients diagnosed between January 2018 and December 2021 were included in the training set (n = 539) for modeling, and those diagnosed between January 2022 and December 2022 were enrolled into the validation set (n = 259) for further assessment. The incidence of RH in the training set and external validation set was comparable (P = 0.396). The related clinical data of patients enrolled were collected and analyzed through univariate analysis and least absolute shrinkage and selection operator (LASSO) logistic regression analysis to identify independent risk factors and construct a nomogram. Finally, five variables were confirmed as independent risk factors for OSA patients with RH, including smoking, heart disease, neck circumference, AHI and T90. The nomogram established on the basis of variables above was shown to have good discrimination and calibration in both the training set and validation set. Decision curve analysis indicated that the nomogram was useful for a majority of OSA patients. Therefore, our nomogram might be useful to identify OSA patients at high risk of developing RH and facilitate the individualized management of OSA patients in clinical practice.
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Affiliation(s)
- Hongze Lin
- Department of General Practice, The Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
- Department of Respiratory and Critical Care Medicine, Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
| | - Chen Zhou
- Department of General Practice, The Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
- Department of Respiratory and Critical Care Medicine, Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
| | - Jiaying Li
- Department of General Practice, The Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
- Department of Respiratory and Critical Care Medicine, Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
| | - Xiuqin Ma
- Department of Respiratory and Critical Care Medicine, Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China
| | - Yan Yang
- Department of Respiratory and Critical Care Medicine, Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China.
| | - Taofeng Zhu
- Department of General Practice, The Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China.
- Department of Respiratory and Critical Care Medicine, Yixing Hospital affiliated to Jiangsu University, Yixing, 214200, China.
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Vidigal TA, Haddad FLM, Guimaraes TM, Silva LO, Andersen ML, Schwab R, Cistulli PA, Pack AI, Tufik S, Bittencourt LRA. Can intraoral and facial photos predict obstructive sleep apnea in the general and clinical population? Sleep 2024; 47:zsad307. [PMID: 38038363 DOI: 10.1093/sleep/zsad307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
STUDY OBJECTIVES This study aimed to evaluate and compare measurements of standardized craniofacial and intraoral photographs between clinical and general population samples, between groups of individuals with an apnea-hypopnea index (AHI) ≥ 15 and AHI < 15, and their interaction, as well as the relationship with the presence and severity of obstructive sleep apnea (OSA). METHODS We used data from 929 participants from Sleep Apnea Global Interdisciplinary Consortium, in which 309 patients from a clinical setting and 620 volunteers from a general population. RESULTS AHI ≥ 15 were observed in 30.3% of the total sample and there were some interactions between facial/intraoral measures with OSA and both samples. Mandibular volume (p < 0.01) and lateral face height (p = 0.04) were higher in the AHI ≥ 15 group in the clinical sample compared to the AHI ≥ 15 group in the general population and AHI < 15 group in the clinical sample. When adjusted for sex and age, greater mandible width (p < 0.01) differed both in the clinical and in the general population samples, reflecting AHI severity and the likelihood of OSA. The measure of smaller tongue curvature (p < 0.01) reflected the severity and probability of OSA in the clinical sample and the higher posterior mandibular height (p = 0.04) showed a relationship with higher AHI and higher risk of OSA in the general population. When adjusted for sex, age, and body mass index, only smaller tongue curvature (p < 0.01) was associated with moderate/severe OSA. CONCLUSIONS Measures of greater tongue and mandible were associated with increased OSA risk in the clinical sample and craniofacial measurement was associated in the general population sample.
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Affiliation(s)
- Tatiana A Vidigal
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Fernanda L M Haddad
- Departamento de Otorrinolaringologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thaís M Guimaraes
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luciana O Silva
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica L Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
- Sleep Institute, São Paulo, Brazil
| | - Richard Schwab
- Division of Sleep Medicine, Pulmonary, Allergy and Critical Care Division, Department of Medicine, Penn Sleep Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Centre for Sleep Health and Research, Royal NorthShore Hospital, St Leonards, NSW, Australia
| | - Alan I Pack
- Division of Sleep Medicine/Department of Medicine, Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
- Sleep Institute, São Paulo, Brazil
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35
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Bai XQ, Sun XG. [Sleep apnea and ocular diseases]. Zhonghua Yan Ke Za Zhi 2024; 60:296-302. [PMID: 38462381 DOI: 10.3760/cma.j.cn112142-20230722-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Sleep apnea presents as recurrent respiratory arrests or shallow breathing during sleep, resulting in decreased oxygen saturation and sleep disruption. Among its various types, obstructive sleep apnea is the most common. Over the past few decades, the prevalence of sleep apnea has been on the rise, drawing increasing attention, particularly with the growing obesity and aging population. Prolonged exposure to a hypoxic environment due to sleep apnea not only damages multiple systems throughout the body but may also pose a threat to vision. Examining the relationship between sleep apnea and ocular diseases, along with exploring its pathogenesis, has become a prominent research topic in recent years. This article provides a comprehensive review of the existing literature concerning the correlation between sleep apnea and ocular diseases such as glaucoma, optic nerve diseases, retinal and choroidal diseases, and anterior eye segment diseases. In clinical practice, prioritizing early screening and treatment for sleep apnea is crucial to prevent the worsening of associated ophthalmic conditions.
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Affiliation(s)
- X Q Bai
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - X G Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing 100730, China
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Luo J, Zhao Y, Liu H, Zhang Y, Shi Z, Li R, Hei X, Ren X. SST: a snore shifted-window transformer method for potential obstructive sleep apnea patient diagnosis. Physiol Meas 2024; 45:035003. [PMID: 38316023 DOI: 10.1088/1361-6579/ad262b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/05/2024] [Indexed: 02/07/2024]
Abstract
Objective.Obstructive sleep apnea (OSA) is a high-incidence disease that is seriously harmful and potentially dangerous. The objective of this study was to develop a noncontact sleep audio signal-based method for diagnosing potential OSA patients, aiming to provide a more convenient diagnostic approach compared to the traditional polysomnography (PSG) testing.Approach.The study employed a shifted window transformer model to detect snoring audio signals from whole-night sleep audio. First, a snoring detection model was trained on large-scale audio datasets. Subsequently, the deep feature statistical metrics of the detected snore audio were used to train a random forest classifier for OSA patient diagnosis.Main results.Using a self-collected dataset of 305 potential OSA patients, the proposed snore shifted-window transformer method (SST) achieved an accuracy of 85.9%, a sensitivity of 85.3%, and a precision of 85.6% in OSA patient classification. These values surpassed the state-of-the-art method by 9.7%, 10.7%, and 7.9%, respectively.Significance.The experimental results demonstrated that SST significantly improved the noncontact audio-based OSA diagnosis performance. The study's findings suggest a promising self-diagnosis method for potential OSA patients, potentially reducing the need for invasive and inconvenient diagnostic procedures.
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Affiliation(s)
- Jing Luo
- Shaanxi Key Laboratory for Network Computing and Security Technology, School of Computer Science and Engineering, Xi'an University of Technology, Xi'an, Shaanxi, 710048, People's Republic of China
- Human-Machine Integration Intelligent Robot Shaanxi University Engineering Research Center, Xi'an University of Technology, Xi'an, Shaanxi, 710048, People's Republic of China
| | - Yinuo Zhao
- Shaanxi Key Laboratory for Network Computing and Security Technology, School of Computer Science and Engineering, Xi'an University of Technology, Xi'an, Shaanxi, 710048, People's Republic of China
- Human-Machine Integration Intelligent Robot Shaanxi University Engineering Research Center, Xi'an University of Technology, Xi'an, Shaanxi, 710048, People's Republic of China
| | - Haiqin Liu
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, People's Republic of China
| | - Yitong Zhang
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, People's Republic of China
| | - Zhenghao Shi
- Shaanxi Key Laboratory for Network Computing and Security Technology, School of Computer Science and Engineering, Xi'an University of Technology, Xi'an, Shaanxi, 710048, People's Republic of China
- Human-Machine Integration Intelligent Robot Shaanxi University Engineering Research Center, Xi'an University of Technology, Xi'an, Shaanxi, 710048, People's Republic of China
| | - Rui Li
- School of Mechanical and Instrumental Engineering, Xi'an University of Technology, Xi'an, Shaanxi, 710048, People's Republic of China
| | - Xinhong Hei
- Shaanxi Key Laboratory for Network Computing and Security Technology, School of Computer Science and Engineering, Xi'an University of Technology, Xi'an, Shaanxi, 710048, People's Republic of China
- Human-Machine Integration Intelligent Robot Shaanxi University Engineering Research Center, Xi'an University of Technology, Xi'an, Shaanxi, 710048, People's Republic of China
| | - Xiaorong Ren
- Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, People's Republic of China
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37
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Flores-Mir C, Almeida FR, Khosravi R, Vora S. Use of facial features to predict obstructive sleep apnea presence and severity. Sleep 2024; 47:zsae017. [PMID: 38243823 DOI: 10.1093/sleep/zsae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Indexed: 01/22/2024] Open
Affiliation(s)
- Carlos Flores-Mir
- Professor, Department of Dentistry, University of Alberta, Edmonton, AB, Canada
- Part-time Private Practice limited to Orthodontics, Edmonton, AB, Canada
| | - Fernanda R Almeida
- Professor, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
- Part-time Private Practice limited to Dental Sleep Disorders, Vancouver, BC, Canada
| | - Rooz Khosravi
- Clinical Associate Professor of Orthodontics, Department of Orthodontics, University of Washington, Seattle, WA, USA
- Full-time Private Practice limited to Orthodontics, Sammamish, WA, USA
| | - Siddharth Vora
- Associate Professor, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
- Part-time Private Practice limited to Orthodontics, Vancouver, BC, Canada
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Huang B, Huang Y, Zhai M, Zhou Q, Ji S, Liu H, Zhuang X, Zhang Y, Zhang J. Association of Sex With Cardiovascular Outcomes in Heart Failure Patients With Obstructive or Central Sleep Apnea. J Am Heart Assoc 2024; 13:e031186. [PMID: 38410942 PMCID: PMC10944038 DOI: 10.1161/jaha.123.031186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 11/21/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND This study investigated the association of sex with cardiovascular outcomes in a prospective cohort of patients with heart failure (HF) with obstructive sleep apnea or central sleep apnea. METHODS AND RESULTS Patients were screened for sleep apnea on admission using multichannel cardiopulmonary monitoring from May 2015 to July 2018. The primary outcome was a composite of cardiovascular death or unplanned hospitalization for worsening HF. Ultimately, 453 patients with HF with obstructive sleep apnea or central sleep apnea were included; 71 (15.7%) and 382 (84.3%) were women and men, respectively. During a median follow-up of 2.33 years, 248 (54.7%) patients experienced the primary outcome. In the overall population, after adjusting for potential confounders, women had an increased risk of the primary outcome (66.2% versus 52.6%; hazard ratio [HR], 1.47 [95% CI, 1.05-2.04]; P=0.024) and HF rehospitalization (62.0% versus 46.6%; HR, 1.55 [95% CI, 1.10-2.19]; P=0.013) compared with men but a comparable risk of cardiovascular death (21.1% versus 23.3%; HR, 0.78 [95% CI, 0.44-1.37]; P=0.383). Likewise, in patients with HF with obstructive sleep apnea, women had a higher risk of the primary outcome (81.8% versus 46.3%, HR, 2.37 [95% CI, 1.28-4.38]; P=0.006) and HF rehospitalization (81.8% versus 44.7%, HR, 2.46 [95% CI, 1.32-4.56], P=0.004). However, in patients with HF with central sleep apnea, there was no statistically significant difference between women and men. CONCLUSIONS In hospitalized patients with HF, female sex was associated with an increased risk of the primary outcome and HF rehospitalization, especially in those with obstructive sleep apnea. Screening for sleep apnea should be emphasized to improve the prognosis. REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02664818.
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Affiliation(s)
- Boping Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yan Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Mei Zhai
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Qiong Zhou
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Shiming Ji
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Huihui Liu
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Xiaofeng Zhuang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
- Key Laboratory of Clinical Research for Cardiovascular Medications, National Health CommitteeBeijingChina
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Tao M, Dong X, Tu J, Fang Q, Shao C. Symptom and comorbidity burden in hypertensive patients with obstructive sleep apnea. Front Endocrinol (Lausanne) 2024; 15:1361466. [PMID: 38501097 PMCID: PMC10944929 DOI: 10.3389/fendo.2024.1361466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Background Obstructive sleep apnea (OSA) is an important but frequently overlooked risk factor for hypertension (HTN). The prevalence of hypertension is high in patients with OSA, but the differences in clinical symptoms and comorbidities between patients with OSA with hypertension and those with normal blood pressure have not been fully defined. Methods This study retrospectively analyzed OSA patients diagnosed for the first time in Lihuili Hospital Affiliated to Ningbo University from 2016 to 2020. Patients were divided into an OSA group with hypertension and an OSA group without hypertension. The sociodemographic information, clinical symptoms, comorbidities, and polysomnography results of the two groups were compared. The independent risk factors associated with hypertension in patients with OSA were explored. Results A total of 1108 patients with OSA initially diagnosed were included in the study, including 387 with hypertension and 721 without. Compared with OSA patients without hypertension, OSA patients with hypertension were older; had a higher body mass index (BMI) and Epworth sleepiness score (ESS); a higher incidence of nocturia; and a higher proportion of diabetes mellitus, coronary heart disease, and cerebrovascular disease. Multivariate analysis showed age (odds ratio [OR]:1.06, 95% confidence interval [CI]:1.04-1.08), BMI (OR:1.17, 95% CI:1.11-1.23), ESS score (OR:0.97, 95%CI: 0.94-1.00) and nocturia symptoms (OR:1.64, 95% CI:1.19-2.27) was independently associated with hypertension in OSA patients, and comorbid diabetes (OR: 3.86, 95% CI: 2.31-6.45), coronary heart disease (OR: 1.90, 95% CI:1.15-3.16), and ischemic stroke (OR: 3.69,95% CI:1.31-10.40) was independently associated with hypertension in OSA patients. Conclusion Compared to OSA patients with normal blood pressure, OSA patients with hypertension had more significant daytime sleepiness, more frequent nocturnal urination, and a higher risk of diabetes, coronary heart disease, and cerebrovascular disease.
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Affiliation(s)
- MengShi Tao
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
| | - Xiaoqi Dong
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Jinjing Tu
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Qing Fang
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Chuan Shao
- Department of Respiratory and Critical Care Medicine, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
- Health Science Center, Ningbo University, Ningbo, China
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40
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Pfeiffer AM, Triplett C, Siengsukon CF. Examining the prevalence of sleep disturbances in patients seeking physical therapy services. Physiother Theory Pract 2024; 40:556-564. [PMID: 36259637 DOI: 10.1080/09593985.2022.2134754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the prevalence of sleep disturbances in adults seeking physical therapy services. METHODS Participants were issued an electronic survey to provide demographic information and the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Sleep Hygiene Index (SHI), Insomnia Severity Index (ISI), STOP-BANG (obstructive sleep apnea (OSA) risk), and restless leg syndrome (RLS) risk. Percentages were calculated to describe prevalence of sleep disturbances, and Spearman's correlations were used to identify associations between pain and sleep questionnaires. RESULTS Eighty-eight participants (47.9 ± 15.8 years, 68 females) completed the survey. Seventy-eight percent (n = 69) scored >5 on the PSQI; 32% (n = 28) scored ≥10 on the ESS; 52% (n = 46) scored ≥16 on the SHI; 51% (n = 45) scored ≥10 on the ISI; 28% (n = 25) had intermediate or high risk of OSA; and 40% (n = 35) indicated possible RLS. Pain level was significantly associated with PSQI (r(86) = 0.277, p = .009) and ISI (r(86) = 0.268, p = .012). CONCLUSIONS There was a higher prevalence of sleep disturbances in adults seeking physical therapy services than in the general population. Increased pain severity was associated with poorer sleep quality and increased insomnia symptoms. This study highlights the need to screen patients for sleep disturbances.
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Affiliation(s)
- Ashley M Pfeiffer
- Department of Exercise Science, School of Behavioral Sciences, Black Hills State University, Spearfish, SD, USA
| | - Craig Triplett
- Department of Exercise Science, School of Behavioral Sciences, Black Hills State University, Spearfish, SD, USA
| | - Catherine F Siengsukon
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
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41
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Günay MM, Saylam G, Fırat İH, Akyıldız İ, Bayır Ö, Mutlu M, Korkmaz MH. Novel clinical screening method to identify patients at risk of obstructive sleep apnea. Cranio 2024; 42:190-198. [PMID: 34053418 DOI: 10.1080/08869634.2021.1933308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate whether the distance between the two retromolar trigones (RMTs) with the distance between the two posterior plicas (PPs) affects obstructive sleep apnea syndrome (OSAS) and to determine a physical examination method that can be used in the selection of patients to be referred to polysomnography (PSG). METHODS The study included 86 OSAS patients and 29 healthy controls. RMTs and PPs were measured using a caliper-like device. The values obtained from these measurements were evaluated in both groups. RESULTS The PPs were narrower, and the RMTs-PPs, RMTs-PPs/RMTs, and RMTs/PPs values were greater in the OSAS group (p < .05) compared to the control group. The cut-off values were 0.612 for RMTs-PPs/RMTs and 2.589 for RMTs/PPs. The specificity of these values for OSAS was 97%, and sensitivity was 57% and 58%, respectively. CONCLUSION The presented method may play a role in preventing unnecessary PSG among patients with suspected OSAS.
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Affiliation(s)
- Mehmet Murat Günay
- Department of Otorhinolaryngology Head and Neck Surgery, Adiyaman Kahta State Hospital, Adiyaman, Turkey
| | - Güleser Saylam
- Department of Otorhinolaryngology Head and Neck Surgery, University of Health Sciences, Ankara Diskapi Training and Research Hospital, Ankara, Turkey
| | - İbrahim Hikmet Fırat
- Department of Chest Diseases, University of Health Sciences, Ankara Diskapi Training and Research Hospital, Ankara, Turkey
| | - İlker Akyıldız
- Department of Otorhinolaryngology Head and Neck Surgery, University of Health Sciences, Ankara Diskapi Training and Research Hospital, Ankara, Turkey
| | - Ömer Bayır
- Department of Otorhinolaryngology Head and Neck Surgery, University of Health Sciences, Ankara Diskapi Training and Research Hospital, Ankara, Turkey
| | - Murad Mutlu
- Department of Otorhinolaryngology Head and Neck Surgery, Adiyaman Kahta State Hospital, Adiyaman, Turkey
| | - Mehmet Hakan Korkmaz
- Department of Otorhinolaryngology Head and Neck Surgery, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
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Gayoso-Liviac MG, Nino G, Montgomery AS, Hong X, Wang X, Gutierrez MJ. Infants hospitalized with lower respiratory tract infections during the first two years of life have increased risk of pediatric obstructive sleep apnea. Pediatr Pulmonol 2024; 59:679-687. [PMID: 38153215 PMCID: PMC10901459 DOI: 10.1002/ppul.26810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/29/2023]
Abstract
RATIONALE Lower respiratory tract infections (LRTI) during the first 2 years of life increase the risk of pediatric obstructive sleep apnea (OSA), but whether this risk varies by LRTI severity is unknown. METHODS We analyzed data from 2962 children, aged 0-5 years, with early-life LRTI requiring hospitalization (severe LRTI, n = 235), treated as outpatients (mild LRTI, n = 394) and without LRTI (reference group, n = 2333) enrolled in the Boston Birth Cohort. Kaplan-Meier survival estimates and Cox proportional hazards models adjusted by pertinent covariables were used to evaluate the risk of pediatric OSA. RESULTS Compared to children without LRTI, those with mild LRTI were at a higher risk of having OSA (hazard ratio [HR] 1.44, 95% confidence interval [CI]: 1.01-2.05), and those with severe LRTI were at the highest risk (HR 2.06, 95% CI: 1.41-3.02), independently of relevant covariables (including maternal age, race, gestational age, and type of delivery). Additional risk factors linked to a higher risk of OSA included prematurity (HR 1.34, 95% CI 1.01-1.77) and maternal obesity (HR 1.82, 95% CI 1.32-2.52). The time elapsed between LRTI and OSA diagnosis was similar in mild and severe LRTI cases, with medians of 23 and 25.5 months, respectively (p = .803). CONCLUSION Infants with severe early-life LRTI have a higher risk of developing OSA, and surveillance strategies to identify OSA need to be particularly focused on this group. OSA monitoring should continue throughout the preschool years as it may develop months or years after the initial LRTI hospitalization.
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Affiliation(s)
- Mirtha G Gayoso-Liviac
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA
| | - Gustavo Nino
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA
| | - Agnes S Montgomery
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington DC, USA
| | - Xiumei Hong
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Center on the Early Life Origins of Disease, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maria J Gutierrez
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Trucco F, Dastagir S, Tan HL. Pseudo-obstructive sleep disordered breathing - definition and progression in Spinal Muscular Atrophy. Sleep Med 2024; 115:61-65. [PMID: 38330697 DOI: 10.1016/j.sleep.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Obstructive sleep disordered breathing (SDB) is prevalent in patients with Spinal Muscular Atrophy (SMA) and possibly reduced by disease modifying treatment (DMT) such as nusinersen. We hypothesized that some obstructive events may in fact be pseudo-obstructive, reflecting the imbalance of chest wall weakness with preserved diaphragmatic function, rather than true upper airway obstruction. If confirmed, these events could represent SMA-specific outcome measures. We aimed to report on the pattern observed in respiratory polygraphies (PG) in paediatric patients with SMA type 2 resembling obstructive SDB. We defined pseudo-obstructive SDB and assessed its changes throughout disease progression. METHODS Retrospective review of 18 PG of 6 SMA type 2 patients naïve from DMT across 3 timepoints (first study, one-year follow-up, latest study). RESULTS At first study patients aged 3-13 years. Four patients were self-ventilating in room air and one of them required non-invasive ventilation (NIV) after the 1-year study. Two patients were on NIV since the first study. The features of pseudo-obstructive SDB included a. paradoxical breathing before, after, and throughout the event, b. the absence of increased respiratory rate during the event, c. the absence of compensatory breath after the event with a return to baseline breathing. Pseudo-obstructive events were progressively more prevalent over time. The derived pseudo-obstructive AHI increased at each timepoint in all patients self-ventilating, whilst it dropped after NIV initiation/adjustments. CONCLUSIONS Pseudo-obstructive SDB is prevalent in SMA type 2. Its number progresses along with the disease and is treatable with NIV. Prospective studies in larger SMA cohorts are planned.
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Affiliation(s)
- Federica Trucco
- Department Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK; Dubowitz Neuromuscular Centre, UCL Institute of Child Health & Great Ormond Street Hospital, London, UK.
| | - Sakina Dastagir
- Department Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Hui-Leng Tan
- Department Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
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Wagner S, Ahrens E, Wachtendorf LJ, Suleiman A, Tartler TM, Shay D, Azimaraghi O, Munoz-Acuna R, Chen G, Ma H, Eikermann M, Schaefer MS. Association of Obstructive Sleep Apnea With Postoperative Delirium in Procedures of Moderate-to-High Complexity: A Hospital-Registry Study. Anesth Analg 2024; 138:626-634. [PMID: 36995964 DOI: 10.1213/ane.0000000000006425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND Patients suffering from obstructive sleep apnea (OSA) experience chronic sleep disturbances and desaturation, factors that have been associated with postoperative delirium and that can be aggravated after anesthesia for complex procedures. We investigated whether OSA is associated with delirium after anesthesia, and whether this association is modified by procedural complexity. METHODS Hospitalized patients ≥60 years who underwent general anesthesia or procedural sedation for procedures of moderate-to-high complexity between 2009 and 2020 at a tertiary health care network in Massachusetts were included. The primary exposure was OSA, defined based on International Classification of Diseases ( Ninth/Tenth Revision, Clinical Modification ) ( ICD-9 / 10-CM ) diagnostic codes, structured nursing interviews, anesthesia alert notes, and a validated risk score (BOSTN [body mass index, observed apnea, snoring, tiredness, and neck circumference]). The primary end point was delirium within 7 days after the procedure. Multivariable logistic regression and effect modification analyses adjusted for patient demographics, comorbidities, and procedural factors were applied. RESULTS A total of 46,352 patients were included, of which 1694 patients (3.7%) developed delirium, 537 (3.2%) with OSA, and 1,157 (4.0%) without OSA. In adjusted analyses, OSA was not associated with postprocedural delirium in the overall cohort (adjusted odds ratio [OR adj ], 1.06; 95% confidence interval [CI], 0.94-1.20; P = .35). However, a high procedural complexity modified the primary association ( P value for interaction = .002). OSA patients had a higher risk of delirium after high-complexity procedures (≥40 work relative value units) such as cardiac (OR adj , 1.33; 95% CI, 1.08-1.64; P = .007, P value for interaction = .005) or thoracic surgery (OR adj , 1.89; 95% CI, 1.19-3.00; P = .007, P value for interaction = .009), but no increased risk after moderate complexity procedures, including general surgery (OR adj , 0.86; 95% CI, 0.55-1.35; P = .52). CONCLUSIONS Compared to non-OSA patients, a history of OSA is associated with a higher risk after high-complexity procedures such as cardiac or thoracic surgery but not after procedures of moderate complexity.
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Affiliation(s)
- Soeren Wagner
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Anesthesiology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Elena Ahrens
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Luca J Wachtendorf
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Aiman Suleiman
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Tim M Tartler
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Denys Shay
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Omid Azimaraghi
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Ricardo Munoz-Acuna
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Guanqing Chen
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Haobo Ma
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
- Department of Anesthesiology and Critical Care, University Duisburg-Essen, Essen, Germany
| | - Maximilian S Schaefer
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesia, Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
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Güneş ZY, Günaydın FM. The relationship between the systemic immune-inflammation index and obstructive sleep apnea. Sleep Breath 2024; 28:311-317. [PMID: 37725251 DOI: 10.1007/s11325-023-02913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/18/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
AIM To investigate the predictive value of the systemic immune-inflammation index (SII) in patients with obstructive sleep apnea (OSA). MATERIAL AND METHODS Patients diagnosed with OSA formed the patient group, and those with a normal polysomnography (PSG) result formed the control group. The neutrophil, thrombocyte, monocyte, and lymphocyte counts obtained from the hemogram were used to calculate the neutrophil-to-lymphocyte ratio (NLR), thrombocyte-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and the SII values. The two groups were compared with respect to the NLR, PLR, MLR, and SII values. Correlations were examined between the PSG parameters and the NLR, PLR, MLR, and SII values in the patient group. RESULTS Evaluation included 146 subjects with 85 in the patient group and 61 in the control group. Statistically significantly higher SII and NLR values were found in the patient group (p = 0.037, p < 0.05; p = 0.015, p < 0.05). A statistically significant negative correlation was observed between the SII and the lowest O2 saturation measurements (r = - 0.246; p = 0.003; p < 0.01). A statistically significant negative correlation was found between the NLR and the lowest O2 saturation measurement (r = - 0.255; p = 0.002; p < 0.01). The cutoff value for SII was found to be 290, with 84.7% sensitivity and 29.5% specificity. A cutoff value of 1.71 for NLR was determined to have 61.2% sensitivity and 60.7% specificity. CONCLUSION SII may be a new, rapid, low-cost, and easy-to-measure biomarker for the prediction of obstructive sleep apnea.
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Affiliation(s)
- Zahide Yılmaz Güneş
- Neurology Clinic, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
| | - Filiz Manga Günaydın
- Neurology Clinic, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
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Varol Y, Uçar ZZ, Oktay Arslan B, Karasu I. Apnea-hypopnea index and the polysomnographic risk factors for predicting 5- to 8-year mortality in patients with OSA. Sleep Breath 2024; 28:103-112. [PMID: 37422579 DOI: 10.1007/s11325-023-02868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 05/22/2023] [Accepted: 06/02/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the long-term mortality rates of patients with obstructive sleep apnea (OSA) who received an overnight polysomnogram (PSG) for obtaining the diagnosis and to determine the relationship between PSG parameters and overall mortality. METHODS Between 2007 and 2013, patients who had overnight PSG and were diagnosed with OSA were included in the study. Factors which are thought to influence mortality were assessed for 5-year and overall survival using the log rank test and Kaplan-Meier survival curves. Using multivariable Cox regression analysis, a model was constructed for factors influencing 5-year and overall survival. RESULTS A total of 762 patients with a mean age of 52.7 (±10.8) and a dominance of men (74.7%) were studied. Gender, OSA severity subgroups, and apnea hypopnea index (AHI) were not statistically significantly associated with either 5-year or overall mortality (p<0.05 for both). Age, having a cardiovascular comorbidity, proportion of rapid eye movement (%REM), and total sleep time with an oxyhemoglobin saturation of less than 90% (T90) all showed a significant correlation with overall all-cause mortality in the model. For 5-year mortality and overall mortality, the hazard ration (HR) for T90 was 3.6 (95% CI (1.6-8.0) p=0.001) and 3 (95% CI (1.6-5.7) p=0.001), respectively. CONCLUSION The study findings suggest that not AHI but PSG parameters of hypoxia, mainly T90, having cardiovascular comorbidity, and %REM sleep were significant risk factors for all-cause mortality in patients with OSA. The association of OSA, hypoxia, and mortality is an area that deserves further study.
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Affiliation(s)
- Yelda Varol
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey.
| | - Zeynep Zeren Uçar
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
| | - Burcu Oktay Arslan
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
| | - Işıl Karasu
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Education and Training Hospital, Izmir, Turkey
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Rubinstein BJ, Vazifedan T, Baldassari CM. Secondhand Smoke Exposure Measured in Urinary Cotinine Levels and Severity of Pediatric Sleep Apnea. JAMA Otolaryngol Head Neck Surg 2024; 150:226-232. [PMID: 38329735 PMCID: PMC10853874 DOI: 10.1001/jamaoto.2023.4409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/23/2023] [Indexed: 02/09/2024]
Abstract
Importance Exposure to secondhand smoke has been associated with numerous health problems in children, including obstructive sleep apnea. Secondhand smoke exposure may be a risk factor for increased pediatric sleep apnea severity. Objectives To assess the association of secondhand smoke exposure (SHSe), quantified by urinary cotinine levels, with severity of obstructive sleep apnea (OSA) in children. Design, Setting, and Participants This was a prospective cohort trial including pediatric patients from 3 to 16 years of age with sleep-disordered breathing who underwent a polysomnogram at a tertiary-level children's hospital in the US in either March 2014 to October 2016 or March 2020 to March 2021. Urine specimens were analyzed for cotinine, an important metabolite of nicotine. Each child's caregiver completed a validated SHSe questionnaire. Data were analyzed from February to June 2023. Exposure OSA and secondhand smoke. Main Outcome and Measures SHSe and severity of pediatric OSA, quantified by urinary cotinine levels and obstructive apnea hypopnea index (AHI) scores. Secondary outcomes were association of urinary cotinine levels with nadir oxygen saturation, sleep-related quality of life measured by the OSA-18 questionnaire, and caregiver-reported smoking habits (collected through a questionnaire). Results The study included 116 patients with a median (IQR) age of 6 (5-9) years, among whom 51 (45%) had obesity. The median (IQR) AHI was 3.0 (1.2-8.0), with 28 children (30.0%) having severe disease (AHI >10). Thirty-four children (29.0%) were found to have a positive result for urine cotinine screening, with a mean (SD) level of 11.7 (9.4) ng/mL. The percentage of children with SHSe was less than anticipated. There was no association identified between urinary cotinine levels and either AHI (ρ = -0.04; 95% CI, -0.22 to 0.15) or nadir oxygen saturation (ρ = -0.07; 95% CI, -0.26 to 0.11). Furthermore, SHSe was not associated with the presence of severe OSA (odds ratio, 0.70; 95% CI, 0.26 to 1.90). Children whose caregivers reported indoor SHSe were more likely to have a detectable urinary cotinine level (odds ratio, 20.3; 95% CI, 6.67 to 61.8). Conclusions and Relevance This cohort study did not identify any clinically meaningful association between SHSe, quantified by urinary cotinine level, and pediatric OSA severity. Future research with a larger number of children with SHSe is needed to confirm these findings and determine whether SHSe affects OSA treatment outcomes in children.
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Affiliation(s)
- Benjamin J. Rubinstein
- Department of Otolaryngology Head and Neck Surgery, Eastern Virginia Medical School, Norfolk
| | - Turaj Vazifedan
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk
| | - Cristina M. Baldassari
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk
- Division of Sleep Medicine, Children’s Hospital of the King's Daughters, Norfolk, Virginia
- Deputy Editor, JAMA Otolaryngology–Head & Neck Surgery
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Xian ZX, Wang X, Chen YC, Teng YS. Preliminary assessment of portable sleep monitoring for diagnosis of obstructive sleep apnea in children. Sleep Breath 2024; 28:419-425. [PMID: 37718356 PMCID: PMC10955026 DOI: 10.1007/s11325-023-02919-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE By observing the differences in sleep parameters between portable sleep monitoring (PM) and polysomnography (PSG) in children, we aimed to investigate the diagnostic value and feasibility of PM in children with suspected obstructive sleep apnea (OSA). STUDY DESIGN This prospective study enrolled consecutive children (aged 3-14 years) with suspected OSA in Shenzhen Children's Hospital. They had PSG and PM in the sleep laboratory. Clinical parameters of the two sleep monitoring methods were compared. RESULTS A total of 58 children participated. They were classified into two groups according to age: 28 children aged 3 to 5 years and 30 children aged 6 to 14 years. No significant differences were observed in apnea-hypopnea index (AHI), lowest oxygen saturation (LSaO2), and mean oxygen saturation (MSaO2) between PM and PSG, but the sleep efficiency with PM was significantly higher (3-5 years age: 92.2 ± 11.3% vs 85.2 ± 14.3%, 6-14 years age: 93.2 ± 14.5% vs 84.8 ± 16.3%, both P < 0.05) than the sleep efficiency with PSG. Pearson correlation analysis indicated a strong correlation between AHI, LSaO2, MSaO2, and sleep efficiency measured by PSG and PM. Receiver operating characteristic curve (ROC) analysis showed that PM was a reliable diagnostic tool for OSA. PM has high sensitivity (3-5 years age: 95.8%, 6-14 years age: 96.3%) and low specificity (3-5 years age: 25.0%, 6-14 years age: 33.3%) for OSA in children. Thus, there is a low rate of missed diagnoses, but there is some inaccuracy in excluding children who do not have OSA. CONCLUSION The results showed that PM has a good correlation with the various parameters of PSG. PM may be a reliable tool for diagnosing moderate and severe OSA in children, especially those who cannot cooperate with PSG or who have limited access to PSG.
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Affiliation(s)
- Zhi-Xiong Xian
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Xin Wang
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, Guangdong, China
| | - Yong-Chao Chen
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
| | - Yi-Shu Teng
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
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Koseoglu HI, Pazarli AC, Kanbay A, Yakar Hİ, Aykun G, Demir O. NoSAS score predicts cardiovascular disease in patients with obstructive sleep apnea. Sleep Breath 2024; 28:87-93. [PMID: 37420146 DOI: 10.1007/s11325-023-02856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/11/2023] [Accepted: 05/22/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE The Lausanne NoSAS (Neck circumference, Obesity, Snoring, Age, Sex) score is a new tool for the identification of high-risk patients for obstructive sleep apnea (OSA). Up to now, no study has attempted to determine the role of NoSAS score in cardiovascular morbidity of patients with OSA. We aimed to investigate the relationships between NoSAS scores and CVD and also between severity of OSA, polysomnographic parameters, and NoSAS scores in patients with OSA. METHODS Patients with diagnosis of OSA by full-night polysomnography were recruited in the study. Based on apnea-hypopnea index (AHI) scores, the patients were categorized as OSA-negative (AHI < 5), mild OSA (5 ≤ AHI < 15), moderate OSA (15 ≤ AHI < 30), and severe OSA (AHI ≥ 30). The definition of cardiovascular diseases (CVD) included the presence of any of the diseases such as hypertension, coronary artery disease, heart failure, or arrhythmia. RESULTS A total of 1514 patients including cases with 199 OSA-negative, 391 mild, 342 moderate, and 582 severe OSA were enrolled in the study. NoSAS scores were significantly different between mild, moderate, and severe OSA groups. NoSAS scores were negatively correlated with minimum oxygen saturation values and positively with AHI and ODI (oxygen desaturation index) values (P < 0.001). NoSAS scores were significantly higher in patients with CVD, diabetes mellitus, and cerebrovascular disease compared with those without (P < 0.005). NoSAS cut-off values for hypertension (14), congestive heart failure (8.5), coronary artery disease (9), cerebrovascular event (11), and diabetes mellitus (10) were also determined. CONCLUSION NoSAS scores are associated with CVD and the severity of OSA. NoSAS scores may be useful to predict CVD in patients with OSA.
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Affiliation(s)
- Handan Inonu Koseoglu
- Department of Pulmonary Diseases, Faculty of Medicine, Tokat Gaziosmanpasa University, 60100, Tokat, Turkey.
| | - Ahmet Cemal Pazarli
- Department of Pulmonary Diseases, Faculty of Medicine, Tokat Gaziosmanpasa University, 60100, Tokat, Turkey
| | | | - Halil İbrahim Yakar
- Department of Pulmonary Diseases, Faculty of Medicine, Tokat Gaziosmanpasa University, 60100, Tokat, Turkey
| | - Gökhan Aykun
- Department of Pulmonary Diseases, Faculty of Medicine, Tokat Gaziosmanpasa University, 60100, Tokat, Turkey
| | - Osman Demir
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
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Bariani RCB, Bigliazzi R, Medda MG, Micieli APR, Tufik S, Fujita RR, de Mello CB, Moreira GA. Changes in behavioral and cognitive abilities after rapid maxillary expansion in children affected by persistent snoring after long-term adenotonsillectomy: A noncontrolled study. Am J Orthod Dentofacial Orthop 2024; 165:344-356. [PMID: 38142392 DOI: 10.1016/j.ajodo.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION The objective of this study was to verify changes in behavioral abilities and cognitive functions after rapid maxillary expansion (RME) in children with refractory sleep-disordered breathing (SDB) in the long term after adenotonsillectomy. METHODS A prospective clinical trial study using RME therapy was conducted. Participant inclusion criteria were children who had adenotonsillectomy with maxillary transverse deficiency and persistent SDB (obstructive apnea-hypopnea index ≥1). The study included 24 children aged 5-12 years, and of these 24 children, 13 had primary snoring and 11 had obstructive sleep apnea. The patients underwent laryngeal nasofibroscopy and a complete polysomnography. In addition, patients completed the Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire. Behavioral and neurocognitive tests were also completed before and after RME. RESULTS The Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life scores showed a statistically significant decrease in both groups (P <0.001) after RME. The results showed that neurocognitive and behavioral parameters (Child Behavior Checklist scale) were similar in primary snoring and obstructive sleep apnea (OSA) groups before RME. In the OSA group, the mean scores of the "Somatic" and "Aggressiveness" domains decreased significantly (P <0.05). The cognitive functions did not register significant differences pre- and post-RME in any of the cognitive functions, except for visuospatial function in the OSA group. CONCLUSIONS The noncontrolled design was a major limitation of our study. The need for treatment for SDB should consider the association of symptoms and behavioral disturbances with the child's obstructive apnea-hypopnea index. RME might prove to be an alternative treatment for children with SDB refractory to adenotonsillectomy, improving quality of life and behavioral aspects. However, a larger sample size with a control group is needed to substantiate these claims.
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Affiliation(s)
- Rita Catia Brás Bariani
- Department of Otorhinolaryngology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Mariana Gobbo Medda
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ana Paula Roim Micieli
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Reginaldo Raimundo Fujita
- Department of Otorhinolaryngology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Cláudia Berlim de Mello
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gustavo Antonio Moreira
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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