scholarly journals Examination of the diaphragm in obstructive sleep apnea using ultrasound imaging

2021 ◽  
Author(s):  
Viktória Molnár ◽  
András Molnár ◽  
Zoltán Lakner ◽  
Dávid László Tárnoki ◽  
Ádám Domonkos Tárnoki ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Screening Tool ◽  
Clinical Settings ◽  
Deep Inspiration ◽  
Control Groups ◽  
Obstructive Sleep ◽  
Left And Right ◽  
And Control ◽  
Larger Sample

Abstract Purpose The aim of this study was to analyze the effect of obstructive sleep apnea (OSA) on the ultrasound (US) features of the diaphragm and to determine if diaphragmatic US may be a useful screening tool for patients with possible OSA. Methods Patients complaining of snoring were prospectively enrolled for overnight polygraphy using the ApneaLink Air device. Thickness and motion of the diaphragm during tidal and deep inspiration were measured. Logistic regression was used to assess parameters of the diaphragm associated with OSA. Results Of 100 patients, 64 were defined as having OSA. Thicknesses of the left and right hemidiaphragms were significantly different between OSA and control groups. Using a combination of diaphragmatic dimensions, diaphragm dilation, age, sex, and BMI, we developed an algorithm that predicted the presence of OSA with 91% sensitivity and 81% specificity. Conclusion A combination of anthropometric measurements, demographic factors, and US imaging may be useful for screening patients for possible OSA. These findings need to be confirmed in larger sample sizes in different clinical settings.

scholarly journals Neuropsychological and behavioral functioning in children with and without obstructive sleep apnea referred for tonsillectomy

2008 ◽  
Vol 14 (4) ◽  
pp. 571-581 ◽  
Author(s):  
BRUNO GIORDANI ◽  
ELISE K. HODGES ◽  
KENNETH E. GUIRE ◽  
DEBORAH L. RUZICKA ◽  
JAMES E. DILLON ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Sleep Problems ◽  
University Hospital ◽  
Control Groups ◽  
Recurrent Tonsillitis ◽  
Obstructive Sleep ◽  
And Control ◽  
Disordered Breathing

Adenotonsillectomy (AT) is among the most common pediatric surgical procedures and is performed as often for obstructive sleep apnea (OSA) as for recurrent tonsillitis. This study compared behavioral, cognitive, and sleep measures in 27 healthy control children recruited from a university hospital-based pediatric general surgery clinic with 40 children who had OSA (AT/OSA+) and 27 children who did not have OSA (AT/OSA−) scheduled for AT. Parental ratings of behavior, sleep problems, and snoring, along with specific cognitive measures (i.e., short-term attention, visuospatial problem solving, memory, arithmetic) reflected greater difficulties for AT children compared with controls. Differences between the AT/OSA− and control groups were larger and more consistent across test measures than were those between the AT/OSA+ and control groups. The fact that worse outcomes were not clearly demonstrated for the AT/OSA+ group compared with the other groups was not expected based on existing literature. This counterintuitive finding may reflect a combination of factors, including age, daytime sleepiness, features of sleep-disordered breathing too subtle to show on standard polysomnography, and academic or environmental factors not collected in this study. These results underscore the importance of applying more sophisticated methodologies to better understand the salient pathophysiology of childhood sleep-disordered breathing. (JINS, 2008,14, 571–581.)

scholarly journals A detection dog for obstructive sleep apnea: could it work in diagnostics?

2020 ◽  
Vol 24 (4) ◽  
pp. 1653-1656
Author(s):  
Jenni Vaarno ◽  
Jyri Myller ◽  
Adel Bachour ◽  
Heli Koskinen ◽  
Leif Bäck ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Urine Sample ◽  
Screening Tool ◽  
Urine Samples ◽  
Clinical Settings ◽  
Healthy Controls ◽  
Obstructive Sleep ◽  
Respiratory Event ◽  
Detection Dog

Abstract Purpose We have previously demonstrated that dogs can be trained to distinguish the urine of patients with obstructive sleep apnea (OSA) from that of healthy controls based on olfaction. Encouraged by these promising results, we wanted to investigate if a detection dog could work as a screening tool for OSA. The objective of this study was to prospectively assess the dogs’ ability to identify sleep apnea in patients with OSA suspicion. Methods Urine samples were collected from 50 patients suspected of having OSA. The urine sample was classified as positive for OSA when the patient had a respiratory event index of 5/h or more. The accuracy of two trained dogs in identifying OSA was tested in a prospective blinded setting. Results Both of the dogs correctly detected approximately half of the positive and negative samples. There were no statistically significant differences in the dogs’ ability to recognize more severe cases of OSA, as compared to milder cases. Conclusion According to our study, dogs cannot be used to screen for OSA in clinical settings, most likely due to the heterogenic nature of OSA.

scholarly journals Implementing an educational program to increase preoperative screening for obstructive sleep apnea using the stop-bang questionnaire

2016 ◽  
Vol 5 (1) ◽  
pp. 56 ◽  
Author(s):  
Adam Davies ◽  
Monaghan W. Patrick ◽  
Hogan Gerard
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Technology Acceptance ◽  
Registered Nurse ◽  
Screening Tool ◽  
Perioperative Complications ◽  
Nurse Anesthetists ◽  
Perceived Usefulness ◽  
Obstructive Sleep ◽  
Registered Nurse Anesthetists

<p><strong>Background:</strong> Obstructive sleep apnea (OSA) is a potentially fatal disease process that has been linked to higher rates of morbidity and mortality as well as increased perioperative complications. OSA is characterized by repetitive pauses in breathing during sleep. Greater than 92% of women and 82% of men who are plagued by moderate to severe sleep apnea are undiagnosed and may go unrecognized in the perioperative setting. The gap between a high prevalence of undiagnosed OSA in the adult population and the low level of clinical recognition has been well-documented. The term “STOP-BANG” is an acronym for eight independent elements predictive of OSA—three are OSA-related symptoms, three are physiological measurements, and two are patient characteristics.</p><p><strong>Methods:</strong> This project used a quasi-experimental design using a 16-question self-developed survey based on the technology acceptance model (TAM). Participants were asked to read an educational pamphlet on OSA and then complete the survey.</p><p><strong>Results:</strong> This study found strong evidence to suggest that among Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs), those with higher scores on Perceived Ease of Use (PEOU), Perceived Usefulness (PU), and Attitude toward Use (AT), tend to have a higher Behavioral Intention to Use (BIU) the STOP-BANG screening tool.</p><p><strong>Conclusions:</strong> The results suggest that programs targeted at raising CRNAs’ and SRNAs’ PEOU, PU, and AT regarding the STOP-BANG questionnaire will culminate in increased use of the STOP-BANG screening tool. The use of this screening tool will detect patients previously unidentified as having OSA, and ultimately prevent perioperative complications associated with this disease.</p>

scholarly journals Validation of the Spanish Version of the STOP-Bang Questionnaire: Usefulness as a Screening Tool for Obstructive Sleep Apnea in Adults

2020 ◽  
pp. 014556132093233
Author(s):  
Beatriz Delgado-Vargas ◽  
Leticia Acle-Cervera ◽  
Gianmarco Narciso López
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Screening Tool ◽  
Sleep Apnea Syndrome ◽  
Spanish Version ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Good Internal Consistency ◽  
The Mean ◽  
Apnea Syndrome

Objectives: Obstructive sleep apnea syndrome (OSAS) is an increasing health problem, the diagnosis of which is generally delayed due to long waiting lists for the tests used to identify it. Therefore, tools that help on classifying patients at higher risk of suffering this syndrome have been developed. Methods: One hundred ninety-three consecutive patients, with and without OSAS, filled in the Spanish version of the STOP-Bang questionnaire in Hospital Universitario de Torrejón (Spain). Polysomnographies were performed to diagnose the presence and severity of the OSAS. Statistics analysis of the demographic characteristics of the sample and the questionnaire results was performed. Results: Most patients were male (73%) and the mean age was 50.4 years (ranging from 19-77 years). Cronbach α coefficient in the sample was 0.8072. A statistically significant difference was noted in the questionnaire scores between patients with OSAS and those without the syndrome. Conclusions: The Spanish version of the STOP-Bang questionnaire possess a good internal consistency that allows us to rely on it as a screening tool for patients with OSAS. In our sample, a difference in the questionnaire score was appreciated between patients with and without the syndrome, which strongly supports the utility of the questionnaire for its purpose.

scholarly journals Cardiorespiratory Polygraphy for Detection of Obstructive Sleep Apnea in Patients With Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Michiel Delesie ◽  
Lieselotte Knaepen ◽  
Johan Verbraecken ◽  
Karolien Weytjens ◽  
Paul Dendale ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Screening Tool ◽  
Area Under The Curve ◽  
Screening Tools ◽  
Apnea Hypopnea Index ◽  
Automated Algorithm ◽  
Obstructive Sleep ◽  
At Home

Background: Obstructive sleep apnea (OSA) is a modifiable risk factor of atrial fibrillation (AF) but is underdiagnosed in these patients due to absence of good OSA screening pathways. Polysomnography (PSG) is the gold standard for diagnosing OSA but too resource-intensive as a screening tool. We explored whether cardiorespiratory polygraphy (PG) devices using an automated algorithm for Apnea-Hypopnea Index (AHI) determination can meet the requirements of a good screening tool in AF patients.Methods: This prospective study validated the performance of three PGs [ApneaLink Air (ALA), SOMNOtouch RESP (STR) and SpiderSAS (SpS)] in consecutive AF patients who were referred for PSG evaluation. Patients wore one of the three PGs simultaneously with PSG, and a different PG during each of three consecutive nights at home. Severity of OSA was classified according to the AHI during PSG (&lt;5 = no OSA, 5–14 = mild, 15–30 = moderate, &gt;30 = severe).Results: Of the 100 included AF patients, PSG diagnosed at least moderate in 69% and severe OSA in 33%. Successful PG execution at home was obtained in 79.1, 80.2 and 86.8% of patients with the ALA, STR and SpS, respectively. For the detection of clinically relevant OSA (AHI ≥ 15), an area under the curve of 0.802, 0.772 and 0.803 was calculated for the ALA, STR and SpS, respectively.Conclusions: This study indicates that home-worn PGs with an automated AHI algorithm can be used as OSA screening tools in AF patients. Based on an appropriate AHI cut-off value for each PG, the device can guide referral for definite PSG diagnosis.

scholarly journals 0572 Using Anthropometric Measures to Screen for Obstructive Sleep Apnea in the Sleep Heart Health Study Cohort

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A219-A219
Author(s):  
K D Vana ◽  
G E Silva ◽  
J D Carreon ◽  
S F Quan
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Screening Tool ◽  
Health Study ◽  
Heart Health ◽  
Height Ratio ◽  
Cut Point ◽  
Proxy Variables ◽  
Obstructive Sleep ◽  
Significant Difference

Abstract Introduction Individuals at high risk for obstructive sleep apnea (OSA) may not access sleep clinics for reasons including immobility, transportation difficulties, or living in rural areas. An easy-to-administer OSA screening tool for different body types, independent of witnessed apneas or body mass index (BMI), is lacking to identify this group quickly. We compared the sensitivities (SNs), specificities (SPs), and receiving operator curves (ROCs) of the neck circumference/height ratio (NHR) and waist circumference/height ratio (WHR) in predicting moderate and severe OSA (apnea-hypopnea index [AHI] ≥15/hr) with the SN, SP, and ROC of the derived Stop-Bang Questionnaire (dSBQ), which was created from proxy variables from the Sleep Heart Health Study (SHHS). Methods Data from the SHHS baseline evaluation were used and included participants (N=5431) who completed polysomnograms and had neck and waist circumferences, height measurements, and the SHHS proxy variables. This data then was divided randomly into 1/3 for derivation and 2/3 for validation analyses. Results No statistical differences were seen for gender, age, or ethnicity between the derivation and validation samples. In the validation sample (n=3621), the NHR cut-point of 0.21 resulted in a SN of 91% and a SP of 26% for AHI ≥15/hr. The WHR cut-point of 0.51 resulted in a SN of 91% and a SP of 21% for AHI ≥15/hr. Comparing the validation NHR and the dSBQ ROC curves showed no significant difference (AUCs=0.69 and 0.70, respectively; p=0.22). However, the ROC curve for WHR was significantly lower than for the dSBQ (AUCs=0.63 and 0.70, respectively; p&lt;0.0001). Comparing the derivation and validation ROCs showed no significant differences between NHR ROCs, p=0.81, or between WHR ROCs, p=0.67. Conclusion The NHR is a viable screening tool, independent of witnessed apneas and BMI, that can be used for different body types and is statistically comparable to the dSBQ. Support This work was supported by U01HL53938 and U01HL53938-07S (University of Arizona).

scholarly journals 0906 Identification Of Physical Exam Findings With High Predictive Value For Moderate To Severe Pediatric Obstructive Sleep Apnea(osa) In Overweight/obese Children

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A344-A345
Author(s):  
A Ajisebutu ◽  
I Kak ◽  
N Thompson ◽  
R Honomichl ◽  
D Moul ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Significant Interaction ◽  
Screening Tool ◽  
Multivariate Model ◽  
Older Age ◽  
Obese Patients ◽  
Obese Children ◽  
Obstructive Sleep ◽  
Age And Sex

Abstract Introduction Obstructive sleep apnea(OSA) is highly prevalent and under-diagnosed in the overweight/obese pediatric population largely due to limitations of existing pediatric OSA screening instruments including lack of efficiency and practical implementation and lack of careful consideration of physical examination(PE) findings with high predictive value for OSA. We sought to identify PE finding(s) predictive of pediatric OSA in overweight/obese patients to inform development of an OSA screening tool. Methods Overweight/obese patients presenting to the Cleveland Clinic weight-management clinic between 2013-2018 with polysomnogram (PSG) data were included. The association of PE predictors: age, sex, race (white, black, other), neck (NC), waist circumference (WC), tonsil size (TS), height, systolic and diastolic blood pressure (BP) percentiles) in relation to OSA defined by apnea-hypopnea index (AHI)≥5,i.e. clinically significant pediatric OSA, were assessed using univariate and multivariate logistic regression models (OR,95%CI). Results Retrospective analysis of 180 overweight/obese patients (BMI percentile&gt;85th for age and sex) and age 12.5±3.7 years were included. The multivariate model showed that only WC was significantly associated (1.03, 1.00 - 1.07, p=0.038) with OSA defined as AHI≥5. A statistically significant interaction of age and sex was observed such that the likelihood of OSA increased in males with older age and conversely decreased in females with older age. (1.26,1.04 -1.52, p=0.038) The reduced multivariate model, which included age, sex, WC, and age*sex interaction term, correctly discriminated AHI &lt;5 vs. ≥ 5 66.5% of the time. Conclusion In this large clinic-based overweight/obese pediatric sample, males, older age and WC were significant predictors of OSA and TS was not. A significant interaction of age and sex was observed supporting increased OSA with increasing age in males. Data generated supports value of PE findings of age, sex and WC to incorporate in development of an OSA screening tool for overweight/obese children. Support  

scholarly journals 1014 Relationship Between Lung Function and Obstructive Sleep Apnea in Cystic Fibrosis

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A385-A385
Author(s):  
A Shakkottai ◽  
S Z Nasr ◽  
F Hassan ◽  
L M O’Brien ◽  
R D Chervin
Keyword(s):  
Cystic Fibrosis ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lung Function ◽  
Forced Expiratory Volume ◽  
Apnea Hypopnea Index ◽  
Lung Function Decline ◽  
Obstructive Sleep ◽  
Larger Sample ◽  
Training Grant

Abstract Introduction The frequency of obstructive sleep apnea (OSA) may be high among patients with cystic fibrosis (CF), a life-shortening, genetic respiratory disease that affects approximately 30,000 Americans. Yet, the potential relationship between OSA and lung function has not been thoroughly explored. Methods Single-center retrospective review of polysomnography (PSG) results from 2009-2017 in referred patients with CF and available pulmonary function data (PFTs) obtained at time of PSG and at 3, 6, 9, and 12-months prior. Results Mean ages were 11.1±3.9 (sd) and 37.1±14.1 years, among 18 children and 16 adults, respectively. Mean body mass index (BMI) was normal in both groups (62.5±26.6% in children; 25.1±6.4 kg/m2 in adults). Twenty-six subjects (76%) had OSA (apnea-hypopnea index &gt;1 in children, ≥5 in adults). Mean forced expiratory volume in 1 second percent predicted (FEV1 PPD) was higher among subjects with vs. without OSA at PSG and at each time-point in the year prior, independent of age and BMI at PSG (longitudinal mixed effects model, β=19.0, SE=8.1, p=0.028). While FEV1 PPD remained unchanged in the non-OSA group, FEV1 PPD at PSG was lower, in comparison to the year prior in subjects with OSA, with the greatest difference observed at 9-months prior to PSG (2-sample t-test, difference of -6.6% vs 0.6% in OSA vs. non-OSA groups respectively, p=0.078). Conclusion The PFTs, as daytime markers of CF lung disease severity, do not seem to reliably predict risk for OSA. In our sample, CF patients with vs. without OSA had better PFTs at baseline but they also showed a greater tendency for decline in PFTs over the year prior to OSA diagnosis. Larger sample size and longer duration of assessment may help, going forward, to assess any potential adverse impact of OSA on lung function decline. Support NIH Training Grant (T32NS007222, F32HL145915)

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