The risk assessment by clinical background and cephalometry for obstructive sleep apnea with CPAP indication in Japanese

AbstractObstructive sleep apnea (OSA) is a disease characterized by a brief period of cessation or marked decline in ventilation. The standard treatment is continuous positive airway pressure (CPAP). To determine the indication, full-night polysomnography (PSG) is required; however, it is a stressful examination. We verified the usefulness of pulse-oximetry at home as a predictor for CPAP indication before PSG. Simultaneously, the clinical background and cephalometry were also verified. Among 376 subjects who received PSG at our hospital from February 2005 to April 2020, 138 subjects received pulse-oximetry at home before PSG were enrolled retrospectively and performed logistic regression analysis on those with CPAP indication. Concurrently, 262 of 376 subjects received cephalometry were enrolled, and logistic regression analysis were performed using clinical background and cephalometry. A 3% oxygen desaturation (3% ODI) on the pulse-oximeter was a predictor for CPAP indication. The positive predictive value of 3% ODI ≥ 28.5 events/h was 73.3% and the negative predictive value was 62.5%. Older age, higher body mass index (BMI), stronger lower jaw retraction (wider ∠ANB), and longer distance from the anterior superior tip of the hyoid bone to the mandibular plane (MP-H) on cephalometry were also independent predictors. The positive predictive value when both BMI ≥ 26.0 kg/m2 and MP-H ≥ 17.5 mm were present was 88.2% and the negative predictive value when both were absent was 71.3%. The combination of clinical background and cephalometry would be a useful screening tool as well as a pulse-oximetry at home for CPAP indication.

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Abstract TP221: Using Berlin Questionnaire and Epworth Sleepiness Scale to Identify Stroke Patients at Risk for the Sleep Apnea Syndrome

Stroke ◽

10.1161/str.44.suppl_1.atp221 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Millene Camilo ◽

Alan Eckeli ◽

Heidi Sander ◽

Regina Fernandes ◽

Joao Leite ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Ischemic Stroke ◽

Sleep Apnea ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Epworth Sleepiness Scale ◽

Berlin Questionnaire ◽

Stroke Patients ◽

Obstructive Sleep

Background: Sleep-disordered breathing (SDB) is frequent in the acute phase of stroke. Obstructive sleep apnea (OSA) has been found in 62% of stroke patients. The impact of OSA is significant after ischemic stroke, including early neurological deterioration, poor functional outcome and increased long-term mortality. However, performing polysomnography (PSG) for all patients with acute stroke for diagnose OSA is still impracticable. Therefore clinical tools to select patients at higher risk for OSA would be essential. The aim of this study was to determine the validity of the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS) to identify stroke patients in whom the PSG would be indicated. Methods: Subjects with ischemic stroke were stratified into high and low risk groups for SDB using a BQ. The ESS ≥ 10 was used to define excessive daytime sleepiness. The BQ and ESS were administered to the relatives of stroke patients at hospital admission. All patients were submitted to a full overnight PSG at the first night after symptoms onset. OSA severity was measured by the apnea-hypopnea index (AHI). Results: We prospectively studied 40 ischemic stroke patients. The mean age was 62 ± 12.1 years and the obstructive sleep apnea (AHI ≥ 15) was present in 67.5%. On stratifying risk of OSA in these patients based on the QB, 77.5% belonged to the high-risk and 50% to the ESS ≥ 10. The sensitivity of QB was 85%, the specificity 35%, the positive predictive value 74% and the negative predictive value 55%. For ESS was respectively 63%, 85%, 89% and 52%. The diagnostic value of the BQ and ESS in combination to predict OSA had a sensitivity of 58%, a specificity of 89%, a positive predictive value of 95% and a negative predictive value of 38%. Conclusions: The QB even applied to the bed-partners of stroke patients is a useful screening tool for OSA.

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Age and seasons influence on at-home pulse oximetry results in children evaluated for suspected obstructive sleep apnea

Italian Journal of Pediatrics ◽

10.1186/s13052-017-0428-y ◽

2017 ◽

Vol 43 (1) ◽

Cited By ~ 1

Author(s):

Martino Pavone ◽

Elisabetta Verrillo ◽

Nicola Ullmann ◽

Serena Caggiano ◽

Valentina Negro ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Pulse Oximetry ◽

Obstructive Sleep ◽

At Home

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EK Sign: A Wrinkling of Uvula and the Base of Uvula in Obstructive Sleep Apnea-Hypopnea Syndrome

Sleep Disorders ◽

10.1155/2015/749068 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Venkata Koka ◽

Sandrine Baron ◽

Darius Abedipour ◽

Vincent Latournerie ◽

Pierre El Chater

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Positive Predictive Value ◽

Clinical Sign ◽

Clinical Data ◽

Predictive Value ◽

Strong Predictor ◽

Obstructive Sleep ◽

Maxilla And Mandible ◽

Hypopnea Syndrome

Introduction. Diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) is suspected in the presence of symptoms and/or pharyngeal alterations and skeletal abnormalities of maxilla and mandible. Our aim is to find a new clinical sign that leads to suspicion of OSAHS in snorers.Methods. We reviewed the clinical data of 69 snoring patients with or without OSAHS. We defined EK sign as the presence of horizontal wrinkling of uvula and the base of uvula and tried to correlate its presence with OSAHS.Results. EK sign was present in 25 of 69 patients. The positive predictive value of EK sign is 100%. The presence of EK sign significantly correlated with OSAHS (44% if AHI ≥ 5 and 0% if AHI < 5;p= 0.01) and severity of OSAHS (7% if AHI < 15 and 58% with AHI ≥ 15;p< 0.001).Conclusions. The EK sign is a strong predictor of OSAHS with a specificity of 100%. We recommend performing sleep tests in presence of EK sign in snorers even in the absence of other abnormalities or symptoms.

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Assessment of Neck Grasp as a Screening Tool for Identifying Obstructive Sleep Apnea in Community-Dwelling Older Adults

Journal of Primary Care & Community Health ◽

10.1177/2150132720984421 ◽

2020 ◽

Vol 11 ◽

pp. 215013272098442

Author(s):

Oscar H. Del Brutto ◽

Robertino M. Mera ◽

Bettsy Y. Recalde ◽

Pablo R. Castillo

Keyword(s):

Older Adults ◽

Obstructive Sleep Apnea ◽

Logistic Regression ◽

Sleep Apnea ◽

Predictive Value ◽

Regression Models ◽

Community Dwelling ◽

Logistic Regression Models ◽

Obstructive Sleep ◽

Community Dwelling Older Adults

Background Inability to encircle the neck by hands (neck grasp) has been proposed as an indicator of obstructive sleep apnea (OSA) that would be useful for recognition of candidates for polysomnography (PSG). We assessed the value of neck grasp for predicting OSA in community-dwelling older adults of Amerindian ancestry. Methods Neck grasp was evaluated in individuals aged ≥60 years undergoing PSG. The association between neck grasp and OSA was assessed by logistic regression models adjusted for relevant covariates. Mediation analysis was used to establish the proportion of the effect of the association between neck grasp and OSA, which is mediated by the neck circumference (a well-known OSA biomarker). Receiver operator characteristics curve analysis was used to estimate diagnostic accuracy of neck grasp for predicting OSA. Results Of 201 individuals undergoing PSG, 167 (83%) had the neck grasp test. The remaining 34 could not perform the test because of different factors. Neck grasp was positive in 127 (76%) cases, and 114 (68%) individuals had OSA (apnea-hypopnea index ≥5). Multivariate logistic regression models disclosed a significant association between neck grasp and OSA. The neck circumference was the single covariate remaining independently significant in these models. Neck grasp was not efficient at predicting OSA (sensitivity: 83.3%, specificity: 39.6%, positive predictive value: 0.75 and negative predictive value: 0.53). The area under the curve disclosed only a moderate predictive capability (61.5%) of neck grasp. Conclusion Results do not support the use of neck grasp as an independent predictor of OSA in the study population.

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Night-to-night consistency of at-home nocturnal pulse oximetry testing for obstructive sleep apnea in children

Pediatric Pulmonology ◽

10.1002/ppul.22685 ◽

2013 ◽

Vol 48 (8) ◽

pp. 754-760 ◽

Cited By ~ 23

Author(s):

Martino Pavone ◽

Renato Cutrera ◽

Elisabetta Verrillo ◽

Teresa Salerno ◽

Serena Soldini ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Pulse Oximetry ◽

Obstructive Sleep ◽

At Home

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760 Does Obstructive Sleep Apnea Increase Suicidality in Patients with Bipolar Disorder?

SLEEP ◽

10.1093/sleep/zsab072.757 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A296-A296

Author(s):

Abhishek Reddy ◽

Zeeshan Mansuri ◽

Chintan Trivedi ◽

Ramu Vadukapuram

Keyword(s):

Bipolar Disorder ◽

Obstructive Sleep Apnea ◽

Logistic Regression ◽

Regression Analysis ◽

Sleep Apnea ◽

Suicidal Ideation ◽

Logistic Regression Analysis ◽

Primary Diagnosis ◽

Adult Patients ◽

Obstructive Sleep

Abstract Introduction Bipolar disorder (BPD) is associated with suicidality in adult population. There are several risk factors for suicide, however the relationship between Obstructive Sleep Apnea (OSA) and suicidality in patients with BPD has not been explored. Hence, we decided to perform this study with primary objective of comparison of suicidality by OSA diagnosis in patients with BPD. Methods We used inpatient hospitalization data from National Inpatient sample dataset year 2016–2018. Our primary population (BPD + OSA) was composed of adult patients admitted to the hospital with the primary diagnosis of Bipolar Disorder and secondary diagnosis of Obstructive sleep apnea. Age-gender matched (1:4 matching) control population was selected with primary diagnosis of BPD having no OSA (BPD-OSA). Data on suicidality (suicidal ideation/attempt) were collected and compared between the groups using logistic regression analysis methods by including OSA, age, gender, race, substance use disorder and personality disorder as predictors. Results From the dataset, 17895 patients were obtained for the BPD + OSA group (average age: 50.5 years, male 45.5%). After 1:4 age-gender matching, 71575 patients were included in the BPD-OSA group. In the unadjusted analysis, suicidal ideation was significantly high BPD+OSA group compared the BPD-OSA group (38.4% vs. 31.9%, p < 0.001). Rate of suicide attempt and self-inflicted injuries were similar in two groups (3.5% vs. 3.3%, p: 0.27). In the adjusted logistic regression analysis odds of suicidality were 36% more in BPD+OSA group compared to BPD-OSA (Odds Ratio: 1.36, 95% Confidence interval: 1.25–1.48, p < 0.001). Conclusion In adult patients with BPD, diagnosis of OSA significantly increases the odds of suicidality. Addressing OSA in patients with BPD, can improve management, and potentially reduce the incidence of suicide. We believe our study will be helpful in guiding future research and development on this issue. Support (if any) None

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High-resolution wrist-worn overnight oximetry has high positive predictive value for obstructive sleep apnea in a sleep study referral population

Sleep And Breathing ◽

10.1007/s11325-015-1251-6 ◽

2015 ◽

Vol 20 (2) ◽

pp. 583-587 ◽

Cited By ~ 8

Author(s):

Ken M. Kunisaki ◽

Oksana A. Bohn ◽

Erin E. Wetherbee ◽

Thomas S. Rector

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

High Resolution ◽

Positive Predictive Value ◽

Predictive Value ◽

Sleep Study ◽

Obstructive Sleep ◽

High Positive Predictive Value ◽

Overnight Oximetry

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Comparison of Polysomnographic and Portable Home Monitoring Assessments of Obstructive Sleep Apnea in Saskatchewan Women

Canadian Respiratory Journal ◽

10.1155/2011/408091 ◽

2011 ◽

Vol 18 (5) ◽

pp. 271-274 ◽

Cited By ~ 10

Author(s):

JA Gjevre ◽

RM Taylor-Gjevre ◽

R Skomro ◽

J Reid ◽

M Fenton ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

High Risk ◽

Positive Predictive Value ◽

Predictive Value ◽

Diagnostic Methods ◽

Apnea Hypopnea Index ◽

Exclusion Criteria ◽

Obstructive Sleep ◽

Significant Difference

OBJECTIVES: To compare a commercially available, level III in-home diagnostic sleep test (Embletta, Embletta USA) and in-laboratory polysomnography (PSG) in women with suspected obstructive sleep apnea (OSA).METHODS: Consecutive women scheduled for routine PSG testing for evaluation of clinically suspected OSA and who met inclusion/exclusion criteria, were invited to participate. An in-home Embletta portable monitor test was performed one week before or after diagnostic PSG.RESULTS: Forty-seven of 96 women who met the inclusion/exclusion criteria agreed to participate. The mean (± SD) age of the patients was 52.0±11.0 years, with a mean body mass index of 34.86±9.04 kg/m2, and 66% (31 of 47) of patients were at high risk for OSA according to the Berlin score. Paired analysis of the overall population revealed no significant difference in mean apnea/hypopnea index (AHI) between the two diagnostic methods (P=0.475). At an AHI of ≥5, the Embletta test was highly sensitive (90.6%) in determining abnormal versus normal OSA, with a positive predictive value of 82.7%. However, a higher Embletta AHI threshold of ≥10 may be more useful, with a higher level of agreement (kappa coefficient) with PSG testing and a positive predictive value of 92.3%. The in-home study was less useful at distinguishing severe from nonsevere OSA, yielding a sensitivity of 50%.CONCLUSIONS: In women believed to be at high-risk for OSA, Embletta in-home sleep testing is useful for the detection of sleep disordered breathing.

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