Combined Elliptical Window Genioglossus Advancement, Hyoid Bone Suspension, and Uvulopalatopharyngoplasty Decrease Apnea Hypopnea Index and Subjective Daytime Sleepiness in Obstructive Sleep Apnea

Background. The occurrence and severity of excessive daytime sleepiness (EDS) vary considerably among obstructive sleep apnea (OSA) patients. This study was designed to investigate the characteristics of EDS and identify its contributing factors in OSA patients. Methods. This was a cross-sectional study from a tertiary medical center in China. A total of 874 consecutive patients with newly diagnosed OSA were included. Subjective daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). The subjects were assigned to the non-EDS group (582 patients), mild to moderate EDS group (227 patients), and severe EDS group (65 patients) according to the ESS scores. The clinical features and polysomnographic parameters were acquired and analyzed to identify the differences between groups and the determinants of EDS. Results. The age of patients with severe EDS (49.5 ± 11.3) was slightly greater than that of patients with mild to moderate EDS (44.5 ± 10.2) (p<0.05) and non-EDS patients (45.2 ± 12.0) (p<0.05). Body mass index (BMI) was highest in the severe EDS group (29.1 ± 3.6 kg/m2) (p<0.0001), intermediate in the mild to moderate EDS group (27.9 ± 3.3 kg/m2), and lower in the non-EDS group (26.8 ± 3.3 kg/m2). Logistic regression analysis showed waist circumference, memory loss, work/commute disturbances, and sleep efficiency were independently associated with mild to moderate EDS, and the microarousal index, apnea-hypopnea index (AHI), and saturation impair time below 90% were independent contributing factors of mild to moderate EDS. Meanwhile, age, neck circumference, gasping/choking, memory loss, work/commute disturbances, and sleep latency were independently associated with severe EDS, and the AHI and mean SpO2 were independent contributing factors of severe EDS. Conclusions. OSA patients with various severities of EDS are more obese and have more comorbid symptoms compared to patients without EDS. Sleep fragmentation, respiratory events, and nocturnal hypoxia may be predictors of EDS. Comprehensive consideration of demographic, clinical, and polysomnographic factors is required when evaluating OSA patients.

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Comparison of nasal geometry among adults with obstructive sleep apnea: a preliminary study

Revista CEFAC ◽

10.1590/1982-0216/201921610719 ◽

2019 ◽

Vol 21 (6) ◽

Cited By ~ 1

Author(s):

Jackson Ítalo Tavares da Rocha ◽

Anna Myrna Jaguaribe de Lima ◽

Hilton Justino da Silva ◽

Adriana de Oliveira Camargo Gomes ◽

Paulo Augusto Vitorino ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Daytime Sleepiness ◽

Anterior Part ◽

Posterior Part ◽

Apnea Hypopnea Index ◽

Nasal Valve ◽

Significance Level ◽

Nasal Turbinate ◽

Obstructive Sleep

ABSTRACT Purpose: to compare nasal geometry between two groups of patients with different degrees of obstructive sleep apnea and to correlate apnea-hypopnea index, apnea severity and degree of daytime sleepiness with nasal areas and volume. Methods: a total of 20 adults (15 women and 5 men, mean age of 52.0±11.4 years old) without nasal obstruction were submitted to polysomnography. The subjects were divided into two groups: a) 10 individuals without apnea or with mild-grade apnea; b) 10 with moderate or severe apnea. Nasal geometry was evaluated by acoustic rhinometry. The volume, comprising the distance from the nasal valve to the posterior part of the middle nasal turbinate, and the three sectional areas corresponding to nasal valve, anterior part of the inferior nasal turbinate and posterior part of the inferior nasal turbinate, were considered. The Shapiro-Wilk, Mann-Whitney, Student’s t tests for independent samples and Spearman’s correlation coefficient were used for the analysis, with a significance level lower than 5%. Results: group 2 presented lower values in the area corresponding to the nasal valve (on the right), and higher values in the nasal turbinate areas. There was no correlation between the drowsiness scale and nasal areas and volumes. Conclusion: the area of the nasal valve was unilaterally smaller in the group with moderate and severe apnea. There was no correlation between volumes and nasal areas and excessive daytime sleepiness.

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Patients’ symptoms as a reason for consulting a doctor and obtaining a diagnosis of obstructive sleep apnea

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh160310033k ◽

2017 ◽

Vol 145 (3-4) ◽

pp. 136-140

Author(s):

Dimitar Karkinski ◽

Dejan Dokic

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Medical History ◽

Disease Severity ◽

Daytime Sleepiness ◽

Apnea Hypopnea Index ◽

Common Symptom ◽

Self Awareness ◽

Obstructive Sleep ◽

To Come

Introduction/Objective. Obstructive sleep apnea (OSA) is characterized by a number of symptoms of which the patient is sometimes not aware. The aim of this study was to determine the symptoms due to which patients came to our sleep department, and to examine to which extent patients? self-awareness plays a role in diagnosing OSA. Methods. The study included 388 patients who came to the Sleep Department of the Clinic of Pulmonology, Skopje, Macedonia, from 2012 to 2016, with suspicion of OSA. Medical history was taken from all patients and polysomnography was performed in order to diagnose OSA. All patients with symptoms of OSA and Apnea?Hypopnea Index score of over 5 were diagnosed with OSA. Results. We identified a list of 23 symptoms that lead patients to visit a doctor. The most common symptom was snoring, which occurs in 86% of patients. It is followed by a feeling of under-sleeping with 68% and witnessed apnea with 63%. A total of 258 patients were diagnosed with OSA. The most important primary symptoms that led OSA-positive patients to our clinic were snoring, witnessed apnea, and daytime sleepiness. The percentage of snoring was decreasing with disease severity. Percentage of witnessed apnea and daytime sleepiness were increasing with disease severity. Self-awareness of symptoms led a majority of the patients to come to the Sleep Department. Conclusion. Patients who have symptoms such as snoring, witnessed apnea, and daytime sleepiness are likely to suffer from OSA. Most of the patients are aware of their symptoms and seek help from a doctor.

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Validity of the STOP-Bang Questionnaire in Identifying OSA in a Dental Patient Cohort

Medicina ◽

10.3390/medicina56070324 ◽

2020 ◽

Vol 56 (7) ◽

pp. 324 ◽

Cited By ~ 1

Author(s):

Letizia Lonia ◽

Marco Scalese ◽

Gianluca Rossato ◽

Giovanni Bruno ◽

Francesca Zalunardo ◽

...

Keyword(s):

At Risk ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Diagnostic Tools ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Type 3

Background and objectives: Obstructive Sleep Apnea represents a widespread problem in the population, but it is often not diagnosed and not considered a true pathology. Different diagnostic tools are available for the diagnosis of sleep apnea. This study aims to demonstrate the ability of the STOP-Bang (Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender) questionnaire in identifying subjects with Obstructive Sleep Apnea (OSA) Syndrome, highlighting the role of dentists as epidemiological sentinels. Materials and methods: the STOP-Bang questionnaire was administered to a cohort of 1000 patients, assessing three private dental clinics in Italy. Excessive daytime sleepiness was measured using Epworth Sleepiness Scale (ESS) and defined as ≥ 10. Subjects were considered at risk of OSA if they had three or more positive items at STOP-Bang and were invited to undergo further examination with a type 3 polygraph. Presence of OSA was measured with the apnea-hypopnea index (AHI) and defined as AHI ≥ 5. Results: 482/1000 subjects (48.2%) had three or more positive items in the STOP-Bang questionnaire and were considered at risk for Obstructive Sleep Apnea Syndrome (OSAS). Excessive daytime sleepiness (EDS ≥ 10) was more frequent among subjects at risk for OSAS (73/482, 15.1%) vs. those not at risk for OSAS (30/518, 5.8%) (p < 0.0001). Moreover, 153/482 subjects at risk for OSAS (31.7%) accepted further examination with a type 3 polygraph. Presence of OSAS (AHI ≥ 5) was suggested in 121/153 subjects (79.1%, 95% CI 71.6% to 85.1%), with 76/121 subjects (62.8%) needing treatment (AHI ≥ 15). Conclusion: the high prevalence of OSAS highlights the role of dentists as “epidemiological sentinels”. The STOP-Bang questionnaire is a simple and efficacious instrument for screening sleep apnea patients.

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Severity Of desaturations reflects obstructive sleep apnea (OSA) related daytime sleepiness better than apnea hypopnea index (AHI)

Sleep Medicine ◽

10.1016/j.sleep.2019.11.802 ◽

2019 ◽

Vol 64 ◽

pp. S286

Author(s):

A. Oksenberg ◽

S. Kainulainen ◽

J. Toyras ◽

H. Korkalainen ◽

S. Sefa ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Daytime Sleepiness ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Better Than

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Prevalence of Obstructive Sleep Apnea in Patients With Acute Stroke

Journal of Stroke Medicine ◽

10.1177/2516608519870702 ◽

2019 ◽

Vol 2 (2) ◽

pp. 128-135

Author(s):

Mantha Satya Padmaja ◽

Uma Maheswari Krishnaswamy ◽

Mahendra V. Javali

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Acute Stroke ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Apnea Hypopnea Index ◽

Stroke Severity ◽

Stroke Patients ◽

Obstructive Sleep ◽

Level 3

Background: Obstructive sleep apnea (OSA) is an eminently modifiable and emerging risk factor for acute stroke. This prospective study was conducted in a tertiary care center to estimate the proportion of OSA in patients presenting with acute stroke. Materials and Methods: Consecutive stable patients with acute stroke were included. Stroke severity, subtype, and anatomical location were classified using standardized scales. Included subjects were screened for OSA with a detailed history (intrusive snoring, witnessed apneas, and excessive daytime sleepiness), quantification of sleepiness (Epworth Sleepiness Scale), clinical examination, and level-3 polysomnography. OSA severity was quantified based on the Apnea–Hypopnea Index. Results: 104 clinically stable stroke patients (67 males and 37 females) were included in the study; mean age was 60.9±13.2 years. Most patients (92 [88.5%]) had ischemic stroke, 9 (8.7%) had hemorrhagic stroke, and 3 (2.9%) had a transient ischemic attack. Intrusive snoring was reported by 37 (35.6%) patients, excessive daytime sleepiness by 32 (30.8%) and witnessed apneas by 19 (18.3%) patients. On level-3 polysomnography, 74 (71.2%) patients were diagnosed to have OSA. Mild OSA was diagnosed in 34 patients, while moderate and severe OSA were diagnosed in 20 patients each. Conclusions: Our study has demonstrated a strong causal relationship between OSA and stroke, thus reinforcing the need to screen all patients with stroke for OSA. Timely institution of nocturnal noninvasive ventilation in stroke patients with OSA would help to reduce the effects of OSA on stroke morbidity and recurrence.

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Expansion Hyoidthyroidpexy: Combined Hyoid Surgery Techniques for Obstructive Sleep Apnea: All in One

Otolaryngology ◽

10.1177/0194599818815658 ◽

2018 ◽

Vol 160 (2) ◽

pp. 355-358 ◽

Cited By ~ 1

Author(s):

Sherif M. Askar ◽

Mohammad Waheed El-Anwar ◽

Ali Awad

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Hyoid Bone ◽

Case Series ◽

Lateral Wall ◽

Late Complications ◽

Apnea Hypopnea Index ◽

Oxygen Saturation Level ◽

Bone Surgery ◽

Obstructive Sleep

We provide expansion hyoidthyroidpexy as a novel surgical procedure for obstructive sleep apnea (OSA) that could combine different techniques of hyoid bone surgery in 1 procedure. This case series included patients with OSA who had an apnea-hypopnea index (AHI) >15 and showed predominant lateral wall hypopharyngeal collapse. In 21 patients, the procedure was performed smoothly without technical difficulties or operative adverse events, resulting in lateral expansion of each horn of the hyoid bone by ≥1 cm without early or late complications. At 6 months postoperatively, both AHI and the mean lowest oxygen saturation level were significantly improved ( P < .0001). The new expansion hyoidthyroidpexy technique is a reliable, easy, and effective procedure with good surgical outcomes in patients with OSA. It is feasible to be employed in the protocol of multilevel surgery for OSA.

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Effects of Upper Airway Surgery on Daytime Sleepiness in Nonobese Patients with Obstructive Sleep Apnea/Hypopnea Syndrome

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418800089 ◽

2018 ◽

Vol 127 (12) ◽

pp. 912-918 ◽

Cited By ~ 2

Author(s):

Chi-Chih Lai ◽

Pei-Wen Lin ◽

Hsin-Ching Lin ◽

Michael Friedman ◽

Hsueh-Wen Chang ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Daytime Sleepiness ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Upper Airway Surgery ◽

Airway Surgery ◽

Obstructive Sleep ◽

Nonobese Patients ◽

Hypopnea Syndrome

Introduction: The aim of this study was to evaluate the effects of upper airway surgery on daytime sleepiness in nonobese patients with obstructive sleep apnea/hypopnea syndrome (OSA). Methods: This retrospective study included 121 consecutive adult nonobese patients with OSA from a tertiary academic medical center. Patients with OSA who refused continuous positive airway pressure therapy, or in whom it was unsuccessful, and then underwent OSA surgery were enrolled. Evaluations of excessive daytime sleepiness using the Epworth Sleepiness Scale (ESS) and major parameters of objective full-night polysomnography were collected preoperatively and at least 3 months postoperatively. Statistical analysis was performed using the Wilcoxon signed rank test and Wilcoxon rank sum test. Results: When pre- and postoperative ESS and polysomnographic parameters were compared in all patients, ESS scores, apnea/hypopnea index, and snoring index showed statistically significant improvements ( P = .007, P < .001, and P < .001, respectively). When patients were classified into mild, moderate, and severe OSA groups, snoring index had statistically significant improvements in all 3 groups, and apnea/hypopnea index had statistically significant decreases in the moderate and severe OSA groups. Although reductions in ESS scores were found in all 3 groups, the most statistically significant improvement was noted only in the severe OSA group. Conclusions: OSA surgery can improve daytime sleepiness in nonobese patients with OSA, especially for patients with severe OSA. This study elucidates the effects of OSA surgery on daytime sleepiness by excluding the major confounding factor of obesity. This study adds to the literature on the effects of upper airway surgery for nonobese patients with OSA on daytime quality of life.

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Contributing Factors of Excessive Daytime Sleepiness in Morbid Obese Patients with Obstructive Sleep Apnea

Journal of the Korean Neurological Association ◽

10.17340/jkna.2021.4.5 ◽

2021 ◽

Vol 39 (4) ◽

pp. 298-304

Author(s):

Sangil Park ◽

Jung-Ick Byun ◽

Sun-Min Yoon ◽

Seungmin Lee ◽

Kunwoo Park ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Odds Ratio ◽

Apnea Hypopnea Index ◽

Obese Patients ◽

Obstructive Sleep ◽

Morbid Obese ◽

Insomnia Severity

Background: Obesity, obstructive sleep apnea (OSA), and excessive daytime sleepiness (EDS) are common conditions and are interrelated. Obesity is a risk factor for OSA and independently associated with EDS. We aimed to evaluate frequency of EDS in morbid obese patients with OSA and to identify contribution factor for EDS.Methods: This was a retrospective cross-sectional study in single sleep center. Consecutive patients with OSA (with apnea-hypopnea index 5/h or more) with morbid obesity (body mass index over 35 kg/m2) was enrolled. EDS were defined as Epworth Sleepiness Scale of 10 points or more. Clinical and polysomnographic variables were compared between those with and without EDS.Results: Total 110 morbid obese patients with OSA were enrolled, and 34 (31%) of them had EDS. Those with EDS had higher subjective symptom of insomnia and depression. Rapid eye movement sleep latency was shorter and minimum saturation was lower for those with EDS. Multivariate logistic regression analysis identified insomnia severity (odds ratio, 1.117) and minimum saturation (odds ratio, 0.952) as independent contribution factor for EDS.Conclusions: Result of this study suggest that 31.4% of morbid obese patients with OSA have EDS, and it can be affected by insomnia severity and desaturation during sleep.

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