Lack of Correlation Between Physical Exam(PE), Mini RQLQ (MRQLQ), and Nasal Peak Inspiratory Flow (nPIF) as Measures of Nasal Congestion in Obstructive Sleep Apnea (OSA) Patients With Rhinitis

Aims Obstructive sleep apnea (OSA) is a widespread disease with high global socio-economic impact. However, detailed pathomechanisms are still unclear, partly because current animal models of OSA do not simulate spontaneous airway obstruction. We tested whether polytetrafluoroethylene (PTFE) injection into the tongue induces spontaneous obstructive apneas. Methods and results PTFE (100 μl) was injected into the tongue of 31 male C57BL/6 mice and 28 mice were used as control. Spontaneous apneas and inspiratory flow limitations were recorded by whole-body plethysmography and mRNA expression of the hypoxia marker KDM6A was quantified by qPCR. Left ventricular function was assessed by echocardiography and ventricular CaMKII expression was measured by Western blotting. After PTFE injection, mice showed features of OSA such as significantly increased tongue diameters that were associated with significantly and sustained increased frequencies of inspiratory flow limitations and apneas. Decreased KDM6A mRNA levels indicated chronic hypoxemia. 8 weeks after surgery, PTFE-treated mice showed a significantly reduced left ventricular ejection fraction. Moreover, the severity of diastolic dysfunction (measured as E/e’) correlated significantly with the frequency of apneas. Accordingly, CaMKII expression was significantly increased in PTFE mice and correlated significantly with the frequency of apneas. Conclusions We describe here the first mouse model of spontaneous inspiratory flow limitations, obstructive apneas, and hypoxia by tongue enlargement due to PTFE injection. These mice develop systolic and diastolic dysfunction and increased CaMKII expression. This mouse model offers great opportunities to investigate the effects of obstructive apneas.

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Obstructive sleep apnea in children aged 3 years and younger: Rate and risk factors

Paediatrics & Child Health ◽

10.1093/pch/pxz097 ◽

2019 ◽

Vol 25 (7) ◽

pp. 432-438

Author(s):

Sarah Selvadurai ◽

Giorge Voutsas ◽

Evan J Propst ◽

Nikolaus E Wolter ◽

Indra Narang

Keyword(s):

Risk Factors ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Congestion ◽

Retrospective Chart Review ◽

Binary Logistic Regression ◽

High Rate ◽

Binary Logistic Regression Analysis ◽

Healthy Children ◽

Obstructive Sleep

Abstract Objective Undiagnosed and untreated obstructive sleep apnea (OSA) can predispose children to neurobehavioural consequences. However, there is a lack of data identifying rate of, and risk factors for, OSA in very young healthy children. The objective of this study was to determine the rate of OSA and identify risk factors associated with the presence and severity of OSA in children aged 3 years and younger. Methods This was a retrospective chart review of healthy children between 1 and 3 years old who had a baseline polysomnogram (PSG) between January 2012 and June 2017. Patient demographics, referral history, and PSG data were recorded. Results One hundred and thirteen children were referred for a PSG, of which 66 (58%) were diagnosed with OSA and 47 (42%) did not have OSA. In the OSA group, 13 (20%) were mild and 53 (80%) were moderate-severe. Nasal congestion (P=0.001), adenoid hypertrophy (P=<0.001), and tonsillar hypertrophy (P=0.04) reported at the time of referral were more common in the OSA group compared to the no-OSA group. Binary logistic regression analysis showed that referral from an otolaryngologist (odds ratio=2.6, 95% confidence interval=1.1 to 6.0) were associated with moderate-severe OSA. Conclusion A high rate of OSA was found among children aged 3 years and younger. Children referred by an otolaryngologist are more likely to be diagnosed with moderate-severe OSA. Children aged 3 years and younger with symptoms of OSA should be considered high-risk for OSA and be prioritized for early PSG and management.

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Heated Humidification during Nasal Continuous Positive Airway Pressure for Obstructive Sleep Apnea Syndrome: Objective Evaluation of Efficacy with Nasal Peak Inspiratory Flow Measurements

American Journal of Rhinology ◽

10.1177/194589240201600310 ◽

2002 ◽

Vol 16 (3) ◽

pp. 175-177 ◽

Cited By ~ 4

Author(s):

João C. Winck ◽

J. Lúis Delgado ◽

João M. Almeida ◽

José A. Marques

Keyword(s):

Obstructive Sleep Apnea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Sleep Apnea Syndrome ◽

Peak Inspiratory Flow ◽

Nasal Symptoms ◽

Obstructive Sleep ◽

Heated Humidification ◽

Apnea Syndrome ◽

Nasal Peak Inspiratory Flow

Background Nasal obstruction is one of the most frequent and sometimes troublesome side effects of nasal continuous positive airway pressure (nCPAP) therapy for obstructive sleep apnea syndrome (OSAS). Methods We describe a 60-year-old man with allergic seasonal rhinitis and OSAS, with worsening nasal symptoms 1 week after beginning home nCPAP, making nCPAP use difficult (nasal peak inspiratory flow [nPIF], 80 L/minute [57% of his best]). Results No significant improvement was obtained with topical steroids or cold humidification. Heated humidification was then considered, achieving an improvement in mean nPIF and symptom scores. An acceptable compliance with CPAP could be obtained during the heated humidification period (3.9 hours of mean daily use). Conclusion In this patient with moderately severe OSAS and allergic rhinitis, monitoring nasal symptoms and nasal PIF objectively showed the benefit of heated humidification to overcome nasal intolerance and increase compliance to nCPAP treatment.

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Obstructive Sleep Apnea and Associated Factors Among Hypertensive Patients Attending a Tertiary Cardiac Center in Tanzania: a Comparative Cross-sectional Study

10.21203/rs.3.rs-496326/v1 ◽

2021 ◽

Author(s):

Pedro Pallangyo ◽

Lucy R. Mgopa ◽

Zabella Mkojera ◽

Makrina Komba ◽

Jalack Millinga ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Family History ◽

Nasal Congestion ◽

Positive Family History ◽

Cross Sectional Study ◽

Excess Body Weight ◽

Cross Sectional ◽

Obstructive Sleep ◽

History Of

Abstract Background: There is mounting evidence for a reciprocal yet bidirectional association between sleep-disordered breathing and hypertension. Obstructive sleep apnea (OSA), a common cause of systemic hypertension is an independent risk factor for hypertension-related cardiovascular morbidity and mortality. In this comparative hospital-based cross-sectional study, we sought to explore the burden of obstructive sleep apnea and its associated risk factors among hypertensive patients attending Jakaya Kikwete Cardiac Institute.Methodology: A total of 1974 individuals (i.e. 1289 hypertensive and 685 normotensives) were consecutively enrolled in this study. The Berlin questionnaire and Epworth Sleepiness Scale were utilized in the assessment of OSA and excessive daytime sleepiness (EDS) respectively. Logistic regression analyses were employed in the determination of associated factors for OSA. Results: The mean age was 53.4 years and females constituted the large majority (60.4%) of participants. About three quarters (74.1%) of participants had excess body weight, 11.6% had diabetes, 8.0% had asthma and 18.6% had history of recurrent nasal congestion. Positive family history of snoring was reported by 43.1% of participants and 36.9% had a personal history of snoring. Persons with hypertension displayed a higher frequency (42.1%) of OSA compared to their normotensive counterparts (11.8%), p<0.001. Multivariate logistic regression analyses revealed hypertension (OR 5.1, 95% CI 3.2-8.2, p<0.001), diabetes mellitus (OR 2.2, 95% CI 1.3-3.5, p<0.01), chronic nasal congestion (OR 1.6, 95% CI 1.1-2.5, p = 0.01), obesity (OR 2.4, 95% CI 1.8-3.3, p<0.001), increased neck circumference (OR 2.7, 95% CI 1.2-6.4, p = 0.02), family history of snoring (OR 5.5, 95% CI 4.0-7.5, p<0.001), and working >8hrs/24hr (OR 0.6, 95% CI 0.4-1.0, p = 0.03) to have an independent association for OSA. Furthermore, participants with hypertension displayed superior odds for OSA compared to their normotensive counterparts across all subgroup analyses. Conclusion: OSA is considerably common among hypertensives in a tertiary health care setting in Tanzania. Positive family history of snoring was the strongest associated factor; however, excess body weight proved to be the strongest modifiable risk factor. In view of its pervasiveness, OSA should be an integral part of the medical evaluation in hypertensive individuals.

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Mimicking a flow-limited human upper airway using a collapsible tube: relationships between flow patterns and pressures in a respiratory model

Journal of Applied Physiology ◽

10.1152/japplphysiol.00877.2017 ◽

2018 ◽

Vol 125 (2) ◽

pp. 605-614 ◽

Cited By ~ 2

Author(s):

Kaixian Zhu ◽

Ramon Farré ◽

Ira Katz ◽

Sébastien Hardy ◽

Pierre Escourrou

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Upper Airway ◽

Flow Patterns ◽

Inspiratory Flow ◽

Flow Limitation ◽

Collapsible Tube ◽

Obstructive Sleep ◽

Bench Testing ◽

Bench Model

The upper airway (UA) in humans is commonly modeled as a Starling resistor. However, negative effort dependence (NED) observed in some patients with obstructive sleep apnea (OSA) contradicts predictions based on the Starling resistor model in which inspiratory flow is independent of inspiratory driving pressure when flow is limited. In a respiratory bench model consisting of a collapsible tube and an active lung model (ASL5000), inspiratory flow characteristics were investigated in relation to upstream, downstream, and extra-luminal pressures (denoted as Pus, Pds, and Pout, respectively) by varying inspiratory effort (muscle pressure) from −1 to −20 cmH2O in the active lung. Pus was provided by a constant airway pressure device and varied from 4 to 20 cmH2O, and Pout was set at 10 and 15 cmH2O. Upstream resistance at onset of flow limitation and critical transmural pressure (Ptm) corresponding to opening of the UA were found to be independent of Pus, Pds, and Pout. With fixed Ptm, when Pds fell below a specific value (Pds′), inspiratory peak flow became constant and independent of Pds. NED plateau flow patterns at mid-inspiration (V̇n) were produced within the current bench setting when Pds fell below Pds′. V̇n was proportional to Pds, and the slope (ΔV̇n/ΔPds) increased linearly with Ptm. Ptm and Pds were the two final independent determinants of inspiratory flow. Our bench model closely mimics a flow-limited human UA, and the findings have implications for OSA treatment and research, especially for bench-testing auto-titrating devices in a more physiological way. NEW & NOTEWORTHY A respiratory model consisting of a collapsible tube was used to mimic a flow-limited human upper airway. Flow-limited breathing patterns including negative effort dependence were produced. Transmural and downstream pressures acting on the tube are the two independent determinants of the resulting inspiratory flow during flow limitation. The findings have implications for obstructive sleep apnea treatment and research, especially for bench-testing auto-titrating devices in a more physiological way.

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Efficacy and adherence of auto-CPAP therapy in patients with obstructive sleep apnea: a prospective study

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2020.468 ◽

2020 ◽

Vol 15 ◽

Author(s):

Hang Dinh-Thi-Dieu ◽

Anh Vo-Thi-Kim ◽

Huong Tran-Van ◽

Sy Duong-Quy

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Congestion ◽

Apnea Hypopnea Index ◽

Cpap Therapy ◽

Short Term ◽

Arousal Index ◽

Obstructive Sleep ◽

A Prospective Study

Introduction: The use of auto-continuous positive airway pressure (auto-CPAP) therapy has been recommended for subjects with moderate-to-severe obstructive sleep apnea (OSA) without significant comorbidities. This study is aimed at evaluating the efficacy and adherence of auto-CPAP therapy in subjects with OSA. Methods: It was a perspective and descriptive study. All study subjects who had apnea-hypopnea index (AHI) >30/h, measured by polysomnography, were included. They were treated with auto-CPAP and followed-up for 6 months for evaluating the effect of CPAP-therapy on clinical and biological features and treatment adherence. Results: One hundred and thirty-nine subjects with severe OSA were accepted for auto-CPAP therapy at inclusion. BMI was 28.4±3.8 kg/m2; neck and abdomen circumferences were 38.2±6.4 and 85.7±11.6. Epworth and Pichot scores were 18.4±6.3 and 28.3±4.5, respectively; AHI was 39±7/h and arousal index was 39±13/hour. At 6th month, 96.4% of study subjects continued to use auto-CPAP-therapy within 6.5±2.4 hours/night. There was a significant correlation between the modification (Δ) of Epworth scores and (Δ) AHI after 3 and 6 months of auto-CPAP-therapy (R=0.568 and P=0.003; R=0.745 and P=0.002; respectively). At 6th month follow-up, the main side effects of auto-CPAP were difficult sleeping, dry mouth or nose, skin marks or rashes, discomfortable breathing, and nasal congestion (36.1%, 32.0%, 20.8%, 16.0%, and 11.9%; respectively). Conclusion: Auto-CPAP is effective in treatment of Vietnamese patients with severe OSA in short-term follow-up.

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Risk factors and clinical prediction formula for the evaluation of obstructive sleep apnea in Asian adults

PLoS ONE ◽

10.1371/journal.pone.0246399 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246399

Author(s):

Do-Yang Park ◽

Ji-Su Kim ◽

Bumhee Park ◽

Hyun Jun Kim

Keyword(s):

Risk Factors ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Goodness Of Fit ◽

Upper Airway ◽

Physical Exam ◽

Berlin Questionnaire ◽

Clinical Prediction ◽

Obstructive Sleep ◽

Tongue Position

Obstructive sleep apnea is a highly prevalent cyclic repetitive hypoxia-normoxia respiratory sleep disorder characterized by intermittent upper-airway collapse. It is mainly diagnosed using in-laboratory polysomnography. However, the time-spatial constraints of this procedure limit its application. To overcome these limitations, there have been studies aiming to develop clinical prediction formulas for screening of obstructive sleep apnea using the risk factors for this disorder. However, the applicability of the formula is restricted by the group specific factors included in it. Therefore, we aimed to assess the risk factors for obstructive sleep apnea and develop clinical prediction formulas, which can be used in different situations, for screening and assessing this disorder. We enrolled 3,432 Asian adult participants with suspected obstructive sleep apnea who had successfully undergone in-laboratory polysomnography. All parameters were evaluated using correlation analysis and logistic regression. Among them, age, sex, hypertension, diabetes mellitus, anthropometric factors, Berlin questionnaire and Epworth Sleepiness Scale scores, and anatomical tonsil and tongue position were significantly associated with obstructive sleep apnea. To develop the clinical formulas for obstructive sleep apnea, the participants were divided into the development (n = 2,516) and validation cohorts (n = 916) based on the sleep laboratory visiting date. We developed and selected 13 formulas and divided them into those with and without physical examination based on the ease of application; subsequently, we selected suitable formulas based on the statistical analysis and clinical applicability (formula including physical exam: sensitivity, 0.776; specificity, 0.757; and AUC, 0.835; formula without physical exam: sensitivity, 0.749; specificity, 0.770; and AUC, 0.839). Analysis of the validation cohort with developed formulas showed that these models and formula had sufficient performance and goodness of fit of model. These tools can effectively utilize medical resources for obstructive sleep apnea screening in various situations.

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