Feasibility study of determining a risk assessment model for obstructive sleep apnea in children based on local findings and clinical indicators

Objective: To develop a clinical assessment model for predicting moderate to severe obstructive sleep apnea (OSA). Materials and Methods: All patients suspected of having OSA and undergoing the laboratory polysomnography (PSG) were enrolled. The clinical data, associated factors and PSG finding were reviewed. Significant risk factors for the model were chosen using multivariate logistic regression analysis. The predictive parameters of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: Of the 929 patients, 580 (62.4%) had moderate to severe OSA. Patient ages ranged between 18 and 85 years, with the majority between 30 and 60 years (71.5%). Males were significantly prominent in the moderate to severe OSA group (76.4%). Forty-three percent had a body mass index (BMI) greater than 30 and 52% had a neck circumference (NC) greater than 40. Multivariate analysis showed the male gender, a BMI of 30 or greater, a NC of 40 or greater, a waist to height ratio (WHtR) of 0.5 or greater, the presence of hypertension (HT), and observed apnea were significant factors correlated with moderate to severe OSA. The clinical assessment model was created by using their estimated coefficients. The optimal cutoff points for predicting apnea-hypopnea index (AHI) of 15 or greater was 2, with sensitivity of 85.5% and specificity of 49.6%. Conclusion: The present clinical risk assessment model appears to be a useful practical tool for identifying patients at risk for moderate to severe OSA, with acceptable predictive performance. Keywords: Obstructive sleep apnea, Clinical assessment model, Predicting, Sleep apnea

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Inspiratory Muscle Training for Obstructive Sleep Apnea: Protocol Development and Feasibility of Home Practice by Sedentary Adults

Frontiers in Physiology ◽

10.3389/fphys.2021.737493 ◽

2021 ◽

Vol 12 ◽

Author(s):

Beatrix Krause-Sorio ◽

Eunjoo An ◽

Andrea P. Aguila ◽

Fernando Martinez ◽

Ravi S. Aysola ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Feasibility Study ◽

Daily Practice ◽

Inspiratory Muscle ◽

Inspiratory Muscle Training ◽

Muscle Training ◽

Adjunct Treatment ◽

Obstructive Sleep ◽

Inspiratory Resistance

Background: Inspiratory muscle training (IMT) may improve respiratory and cardiovascular functions in obstructive sleep apnea (OSA) and is a potential alternative or adjunct treatment to continuous positive airway pressure (CPAP). IMT protocols were originally designed for athletes, however, we found some OSA patients could not perform the exercise, so we aimed for a more OSA-friendly protocol. Our feasibility criteria included (1) participants successfully managing the technique at home; (2) participants completing daily practice sessions and recording data logs; and (3) capturing performance plateaus to determine an optimal length of the intervention.Methods: Five sedentary OSA patients participated in this feasibility study (three men, mean age = 61.6 years, SD = 10.2). Using a digital POWERbreathe K4 or K5 device, participants performed 30 daily inhalations against a resistance set at a percentage of maximum, recalculated weekly. Participants were willing to perform one but not two daily practice sessions. Intervention parameters from common IMT protocols were adapted according to ability and subjective feedback. Some were unable to perform the typically used 75% of maximum inspiratory resistance so we lowered the target to 65%. The technique required some practice; therefore, we introduced a practice week with a 50% target. After an initial 8 weeks, the intervention was open-ended and training continued until all participants demonstrated at least one plateau of inspiratory strength (2 weeks without strength gain). Weekly email and phone reminders ensured that participants completed all daily sessions and logged data in their online surveys. Weekly measures of inspiratory resistance, strength, volume, and flow were recorded.Results: Participants successfully completed the practice and subsequent 65% IMT resistance targets daily for 13 weeks. Inspiratory strength gains showed plateaus in all subjects by the end of 10 weeks of training, suggesting 12 weeks plus practice would be sufficient to achieve and capture maximum gains. Participants reported no adverse effects.Conclusion: We developed and tested a 13-week IMT protocol in a small group of sedentary, untreated OSA patients. Relative to other IMT protocols, we successfully implemented reduced performance requirements, a practice week, and an extended timeframe. This feasibility study provides the basis for a protocol for clinical trials on IMT in OSA.

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