Cushing Syndrome is Associated with Increased Stage N2 Sleep and
                    Decreased SWS Partially Reversible After Treatment

AbstractThe aim of the present study was to evaluate the sleep parameters of patients with Cushing syndrome (CS) at the time of diagnosis and 12-months after treatment. Thirty four newly diagnosed patients with endogenous CS (17 with ACTH-secreting pituitary adenoma, 17 with adrenal CS) and 23 controls with similar age were included in the study. Two polysomnography (PSG) recordings were performed; one at the time of diagnosis and the other 12 months after resolution of hypercortisolemia. Control group had only baseline PSG. Based on the PSG findings, stage N2 sleep was found to be prolonged, stage N3 and REM sleep were shortened in patients with CS. Average heart rate and mean Apnea Hypopnea Index (AHI) score were higher in patients with CS than the control subjects. Sixteen (47.1%) patients with CS and 4 (17.4%) controls had obstructive sleep apnea (OSA; AHI ≥5). There were no significant differences in sleep parameters of patients according to the etiology of CS (adrenal vs. pituitary) patients. Following 12-months of treatment, a significant decrease in stage N2 sleep and a significant increase in stage N3 sleep were detected, but there was no change in terms of AHI. In conclusion, Cushing syndrome has disturbing effects on sleep structure and these effects are at least partially reversible after treatment. However, the increased risk of OSA was not reversed a year after treatment indicating the importance of early diagnosis and treatment of CS.

Download Full-text

Diagnosis of Obstructive Sleep Apnea in Patients with Allergic and Non-Allergic Rhinitis

Medicina ◽

10.3390/medicina56090454 ◽

2020 ◽

Vol 56 (9) ◽

pp. 454

Author(s):

Annalisa Pace ◽

Giannicola Iannella ◽

Valeria Rossetti ◽

Irene Claudia Visconti ◽

Giampiero Gulotta ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Allergic Rhinitis ◽

Sleep Apnea ◽

Control Group ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Increased Risk ◽

Home Sleep Apnea Testing ◽

Non Allergic Rhinitis ◽

And Control

Background and objectives: Rhinitis could be considered a risk factor for obstructive sleep apnea (OSA). Studies were conducted to evaluate the relation between OSA and Allergic rhinitis (AR). Non-allergic rhinitis with eosinophilia syndrome (NARES) is a condition with a symptomatology apparently similar to AR. The aim of this study was to evaluate the different presence of OSA in patients suffering from NARES and AR. Materials and Methods: Sixty patients were enrolled and subdivided into NARES, AR and control groups. NARES and AR diagnosis were performed using ARIA (Allergic Rhinitis and its Impact on Asthma) protocol. All patients were screened for OSA with home sleep apnea testing (HSAT) exam analyzing AHI (Apnea Hypopnea Index) values. Results: Results showed that 60% of patients affected by NARES presented OSA. On the contrary, altered AHI was found only in 35% of patients affected by AR and in 10% of patients belonging to the control group. Conclusions: In conclusion, data showed that there was an increased risk of OSA in NARES patients respect to AR patients and healthy patients.

Download Full-text

Endothelial Function and Arterial Stiffness Should Be Measured to Comprehensively Assess Obstructive Sleep Apnea in Clinical Practice

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.716916 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jinmei Luo ◽

Xiaona Wang ◽

Zijian Guo ◽

Yi Xiao ◽

Wenhao Cao ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Arterial Stiffness ◽

Endothelial Function ◽

Augmentation Index ◽

Reactive Hyperemia ◽

Control Group ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Tnf Α

Objective: An effective clinical tool to assess endothelial function and arterial stiffness in patients with obstructive sleep apnea (OSA) is lacking. This study evaluated the clinical significance of subclinical markers for OSA management in males without serious complications.Patients/Methods: Males without serious complications were consecutively recruited. Clinical data, biomarker tests, reactive hyperemia index (RHI), and augmentation index at 75 beats/min (AIx75) measured by peripheral arterial tonometry were collected. An apnea hypopnea index (AHI) cutoff of ≥15 events/h divided the patients into two groups.Results: Of the 75 subjects, 42 had an AHI ≥15 events/h. Patients with an AHI ≥15 events/h had higher high-sensitivity C-reactive protein, tumor necrosis factor-alpha (TNF-α), vascular endothelial growth factor, and AIx75 values than the control group but no statistical difference in RHI was observed. After controlling for confounders, TNF-α was negatively correlated with the average oxygen saturation (r = −0.258, P = 0.043). RHI was correlated with the rapid eye movement (REM) stage percentage (r = 0.306, P = 0.016) but not with AHI (P > 0.05). AIx75 was positively correlated with the arousal index (r = 0.289, P = 0.023) but not with AHI (r = 0.248, P = 0.052).Conclusions: In males with OSA without severe complications, TNF-α and AIx75 are independently related to OSA. The role of RHI in OSA management requires further elucidation. These markers combined can comprehensively evaluate OSA patients to provide more evidence for the primary prevention of coronary heart disease and treatment response assessment.

Download Full-text

Sleep-Related Leg Movements in Patients with Transient Ischemic Attack and Controls

European Neurology ◽

10.1159/000487666 ◽

2018 ◽

Vol 79 (3-4) ◽

pp. 171-176 ◽

Cited By ~ 2

Author(s):

Mirjam H. Schipper ◽

Korné Jellema ◽

Diego Alvarez-Estevez ◽

Johan Verbraecken ◽

Roselyne M. Rijsman

Keyword(s):

Cardiovascular Diseases ◽

Transient Ischemic Attack ◽

Sleep Apnea Syndrome ◽

Control Group ◽

Periodic Leg Movements ◽

Obstructive Sleep ◽

Increased Risk ◽

Significant Difference ◽

Ischemic Attack ◽

Leg Movements

Background: Periodic leg movements during sleep (PLMS) have been associated with an increased risk for cardiovascular diseases and there is a high prevalence of PLMS found in patients with obstructive sleep apnea syndrome (OSAS). We evaluated patients with transient ischemic attack (TIA) for PLMS and respiratory related leg movements (RRLM), versus a control group without TIA. Methods: Twenty-five patients with TIA and 34 patients with no vascular diagnosis were referred for polysomnography. Diagnosis of PLMS was made if the periodic leg movement index (PLMI) was ≥5 and clinical significant as PLMI ≥15. Results: There was no significant difference in PLMI ≥5 and ≥15 between patients with and without TIA. In the absence of OSAS, 2 out of 5 TIA patients (40%) had a PLMI ≥15 compared to 1 of the 19 patients without TIA (5%; p = 0.037). There was no increase in RRLMs when OSAS was present. Conclusions: TIA patients did not have higher PLMI compared to controls, and in the presence of OSAS, there was no increase in RRLMs compared to patients without TIA. In selective patients, PLMS could be associated with cardiovascular diseases, since PLMS was clinically more often found in the TIA group without OSAS.

Download Full-text

Abstract WP437: Sleep Apnea and Cerebral Blood Flow: the Role of Autoregulation

Stroke ◽

10.1161/str.48.suppl_1.wp437 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sara K Rostanski ◽

Andrew J Westwood ◽

Mehran Baboli ◽

Randolph S Marshall

Keyword(s):

Risk Factor ◽

Sleep Apnea ◽

Phase Shift ◽

Cerebral Autoregulation ◽

Apnea Hypopnea Index ◽

Stroke Risk Factor ◽

Vasomotor Reactivity ◽

Obstructive Sleep ◽

Increased Risk ◽

Dynamic Cerebral Autoregulation

Objective: Obstructive sleep apnea (OSA) is a stroke risk factor and is increasingly recognized as a risk factor for cognitive impairment. Altered cerebral autoregulation may play a role in these relationships. We measured the association between OSA and two forms of cerebral autoregulation: (1) dynamic cerebral autoregulation (DCA), which plays a homeostatic role; and (2) vasomotor reactivity (VMR), which is a measure of cerebrovascular reserve. We hypothesized that both VMR and DCA would be impaired in subjects with OSA. Methods: We recruited subjects with untreated OSA. VMR and DCA were measured with continuous transcranial Doppler (TCD) of the middle cerebral arteries (MCA). DCA was measured with phase shift analysis where lower degrees of phase shift indicate greater impairment; values <24 degrees are abnormal. VMR was measured as % change in MCA velocity in response to 5% CO2 inhalation; values <2% change are abnormal. We assessed the relationship between apnea-hypopnea index (AHI) and autoregulation using bivariate correlations (Pearson coefficient). We also assessed the association between moderate to severe OSA (AHI≥15) and abnormal autoregulation (Fisher’s exact test). Results: Twelve subjects were enrolled; 11 had TCD data. Mean age was 53 (SD 11) and the majority had moderate to severe OSA (median AHI 27, IQR 16-37). Mean VMR (% change in MCA velocity) was 3.1 (SD 0.7); mean phase shift was 34 degrees (SD 15). There was a moderate association between AHI and phase shift (r=-0.40); the correlation with VMR was weaker (r=-0.25). The proportion of subjects with abnormal DCA was greater among those with moderate-severe OSA compared to those with mild OSA (66.7% vs. 0%, p=0.2). No enrolled subjects had abnormal VMR. Conclusion: Moderate to severe OSA is associated with abnormal dynamic cerebral autoregulation and normal vasomotor reactivity. The mechanism underlying this dissociation may involve OSA-mediated inflammation and endothelial dysfunction. Further study may clarify how this dissociation relates to increased risk of cerebral ischemia among patients with OSA.

Download Full-text

Defining Risk of Postoperative Obstructive Sleep Apnea in Patients With 22q11.2DS Undergoing Pharyngeal Flap Surgery for Velopharyngeal Dysfunction Using Polysomnographic Evaluation

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619900871 ◽

2020 ◽

Vol 57 (7) ◽

pp. 808-818

Author(s):

Alfred Lee ◽

Brian L. Chang ◽

Cynthia Solot ◽

Terrence B. Crowley ◽

Vamsee Vemulapalli ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Tertiary Care ◽

22Q11.2 Deletion Syndrome ◽

Deletion Syndrome ◽

Apnea Hypopnea Index ◽

Pressure Therapy ◽

Obstructive Sleep ◽

Increased Risk ◽

Pharyngeal Flap

Objective: To determine pre- and postoperative prevalence of obstructive sleep apnea (OSA) in patients with 22q11.2 deletion syndrome (DS) undergoing wide posterior pharyngeal flap (PPF) surgery for velopharyngeal dysfunction (VPD). Design: Retrospective study using pre- and postoperative polysomnography (PSG) to determine prevalence of OSA. Medical records were reviewed for patients’ medical comorbidities. Parents were surveyed about snoring. Setting: Academic tertiary care pediatric hospital. Patients: Forty patients with laboratory confirmed 22q11.2DS followed over a 6-year period. Interventions: Pre- and postoperative PSG, speech evaluation, and parent surveys. Main Outcome Measure: Severity and prevalence of OSA, defined by obstructive apnea hypopnea index (OAHI), before and after PPF surgery to determine whether PPF is associated with increased risk of OSA. Results: Mean OAHI did not change significantly after PPF surgery (1.1/h vs 2.1/h, P = .330). Prevalence of clinically significant OSA (OAHI ≥ 5) was identical pre- and postoperatively (2 of 40), with both cases having severe-range OSA requiring positive airway pressure therapy. All other patients had mild-range OSA. Nasal resonance was graded as severe preoperatively in 85% of patients. None were graded as severe postoperatively. No single patient factor or parent-reported concern predicted risk of OSA (OAHI ≥ 1.5). Conclusions: Patients with 22q11.2DS are medically complex and are at increased risk of OSA at baseline. Wide PPF surgery for severe VPD does not significantly increase risk of OSA. Careful perioperative planning is essential to optimize both speech and sleep outcomes.

Download Full-text

Olfactory Bulb Volume and Olfactory Sulcus Depth in Patients With OSA: An MRI Evaluation

Ear Nose & Throat Journal ◽

10.1177/0145561319881571 ◽

2019 ◽

Vol 99 (7) ◽

pp. 442-447

Author(s):

Adil Doğan ◽

Nuray Bayar Muluk ◽

Hamza Şahin

Keyword(s):

Olfactory Bulb ◽

Upper Airway ◽

Magnetic Resonance Images ◽

Control Group ◽

Apnea Hypopnea Index ◽

Female Patients ◽

Proinflammatory Mediators ◽

Obstructive Sleep ◽

Picture Archiving And Communication ◽

The Right

Objectives: We evaluated olfactory functions in patients with obstructive sleep apnea (OSA). Methods: The cranial magnetic resonance images of 58 adult patients (36 males and 22 females) aged 27 to 79 years were retrieved from the hospital picture archiving and communication system (PACS) system. There were 29 patients with OSA (17 males and 12 females), diagnosed according to the polysomnography results. A control group consisted of 29 healthy patients without OSA. Olfactory bulb (OB) volume and olfactory sulcus (OS) depth measurements were performed. Nasal septal deviation (SD) was also evaluated and recorded as no SD, deviation to the right, and deviation to the left in all groups. Results: Olfactory bulb volumes of the OSA group were significantly lower than those of the control group ( P < .05), whereas OS depth values were not different ( P > .05). There was a positive correlation between the right and left OB volumes and right and left OS depth values ( P < .05). In older patients with OSA and in female patients with OSA, OB volumes decreased bilaterally ( P < .05). Olfactory sulcus depth of the right side was lower in the female patients with OSA compared to the male patients with OSA ( P < .05). There were no significant correlations between apnea–hypopnea index and OB volumes and OS depth values in the OSA group ( P > .05) Conclusion: In patients with OSA, OB volumes decreased bilaterally. It may be related to intermittent nocturnal hypoxia/reoxygenation episodes, which may be a trigger for upper airway inflammation; and proinflammatory mediators maybe harmful on olfactory neuroepithelium and olfactory impairment may occur.

Download Full-text

Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000737 ◽

2019 ◽

Vol 7 (1) ◽

pp. e000737 ◽

Cited By ~ 2

Author(s):

Xiao Wang ◽

Jingyao Fan ◽

Yunhui Du ◽

Changsheng Ma ◽

Xinliang Ma ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Acute Coronary Syndrome ◽

Sleep Apnea ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Apnea Hypopnea Index ◽

Coronary Syndrome ◽

Diabetes Status ◽

Obstructive Sleep ◽

Increased Risk

ObjectiveThe prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to diabetes mellitus (DM) status remains unclear. We aimed to elucidate the association of OSA with subsequent cardiovascular events in patients with ACS with or without DM.Research design and methodsIn this prospective cohort study, consecutive eligible patients with ACS underwent cardiorespiratory polygraphy between June 2015 and May 2017. OSA was defined as an Apnea Hypopnea Index ≥15 events/hour. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure.ResultsAmong 804 patients, 248 (30.8%) had DM and 403 (50.1%) had OSA. OSA was associated with 2.5 times the risk of 1 year MACCE in patients with DM (22.3% vs 7.1% in the non-OSA group; adjusted HR (HR)=2.49, 95% CI 1.16 to 5.35, p=0.019), but not in patients without DM (8.5% vs 7.7% in the non-OSA group, adjusted HR=0.94, 95% CI 0.51 to 1.75, p=0.85). Patients with DM without OSA had a similar 1 year MACCE rate as patients without DM. The increased risk of events was predominately isolated to patients with OSA with baseline glucose or hemoglobin A1c levels above the median. Combined OSA and longer hypoxia duration (time with arterial oxygen saturation <90%>22 min) further increased the MACCE rate to 31.0% in patients with DM.ConclusionsOSA was associated with increased risk of 1 year MACCE following ACS in patients with DM, but not in non-DM patients. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS and DM are warranted.

Download Full-text

Ultrasonic Measurement of Lingual Artery and Its Application for Midline Glossectomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420913581 ◽

2020 ◽

Vol 129 (9) ◽

pp. 856-862

Author(s):

Chun Liu ◽

Jie Qin ◽

Dengxiang Xing ◽

Haibo Lu ◽

Ruiyi Yue ◽

...

Keyword(s):

Body Mass Index ◽

High Sensitivity ◽

Ultrasonic Measurement ◽

Lingual Artery ◽

Control Group ◽

Apnea Hypopnea Index ◽

Tube Insertion ◽

Obstructive Sleep ◽

Operative Planning ◽

Tongue Position

Objective: To explore the application of lingual artery ultrasound (US) for midline glossectomy in patients with obstructive sleep apnea (OSA). Methods: Lingual artery US was performed in 57 OSA patients (OSA group) and 20 normal persons (control group). The differences in the depths of the lingual arteries and the distances between the bilateral lingual arteries were compared between two groups. The correlations between apnea-hypopnea index (AHI), AHI after the nasopharyngeal tube insertion (NPT-AHI), Friedman tongue position (FTP) and all the parameters of lingual arteries were analyzed. Results: Both the depths of the lingual arteries and the distances between the bilateral lingual arteries in the OSA group were larger than those in the control group ( P < .01). All the parameters of the lingual arteries in OSA patients were positively correlated with AHI, NPT-AHI and FTP ( P < .05). While controlling for body mass index (BMI), all the parameters of the lingual arteries in OSA patients were still correlated with NPT-AHI positively ( P ≤ .01). Conclusion: Pre-operative US can show the course of the lingual artery clearly for pre-operative planning. The depth and width of the lingual artery in OSA patients were different from controls. NPT-AHI has high sensitivity in predicting all the parameters of the lingual arteries. FTP is closely correlated with the depth of the lingual arteries.

Download Full-text

Blood pressure profiles in patients with arterial hypertension and obstructive sleep apnea in different age groups

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2021-27-5-530-535 ◽

2021 ◽

Vol 27 (5) ◽

pp. 530-535

Author(s):

A. N. Kuchmin ◽

V. V. Ekimov ◽

D. A. Galaktionov ◽

I. M. Borisov ◽

A. A. Sheveliov ◽

...

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Age Groups ◽

Pressure Profile ◽

Control Group ◽

Apnea Hypopnea Index ◽

Blood Pressure Profile ◽

Pressure Profiles ◽

Obstructive Sleep

Background. Obstructive sleep apnea (OSA) is frequently associated with hypertension (HTN), and about 50 % hypertensive patients have concomitant OSA. Episodes of transient upper airway obstruction affect the daily blood pressure profile, leading to nocturnal HTN. Although the general relationship between OSA and the daily blood pressure profile is known, the association between the frequency of various daily blood pressure profiles and OSA severity as well as the age-specific differences remain unknown. The aim of the study was to determine the daily blood pressure profiles in patients with HTN and OSA, depending on the OSA severity and age. Design and methods. The study included 236 HTN patients underwent treatment in the period from 2008 to 2021 years and were diagnosed with OSA by cardiorespiratory monitoring: 84 patients had mild OSA (apnea/hypopnea index (AHI) < 15 episodes/h), 46 patients — moderate OSA (15 ≤ AHI < 30 episodes/h), and 106 patients — severe OSA (AHI ≥ 30 episodes/h). The control group included 140 HTN patients without OSA. Both groups were divided into 3 age subgroups: younger than 45 years, 45–59 years and ≥ 60 years. At baseline, all patients underwent cardiorespiratory monitoring (“Kardiotekhnika‑07–3/12P”, Inkart, St Petersburg, Russia) and 24-hour blood pressure (BP) monitoring (BPLab, Nizhny Novgorod, Russia). Results. We found an association between the distribution of daily BP profiles and age, which differs from that in HTN patients without OSA. Non-dipper and night-peaker BP profiles are predominant in young and middle age. Among OSA patients, the severity of OSA was associated with the BP profiles only in the young and middleage groups. Unfavorable BP profiles (non-dipper and night-peaker) were more common in patients with severe OSA, which was not observed in elderly subgroup. In the elderly, compared to younger patients, the overdipper profile was the most common and its frequency was not associated with OSA severity. Conclusions. The study shows the relationship between the age of patients with HTN and OSA, the OSA severity and the distribution of daily BP profiles.

Download Full-text

Analysis of Metabolites Changes on Obstructive Sleep Apnea Patients After Multilevel Sleep Surgery

10.20944/preprints202007.0327.v1 ◽

2020 ◽

Author(s):

Abdulmohsen Alterki ◽

Shibu Joseph ◽

Thangavel Alphonse Thanaraj ◽

Irina Al-Khairi ◽

Preethi Cherian ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Metabolic Status ◽

Apnea Hypopnea Index ◽

P Value ◽

Upper Airways ◽

Sleep Surgery ◽

Post Surgery ◽

Obstructive Sleep ◽

Increased Risk

Background: Obstructive sleep apnea (OSA) is caused by partial or complete obstruction of the upper airways. Corrective surgeries aim at removing obstructions in the nasopharynx, oropharynx, and hypopharynx. OSA is associated with increased risk of various metabolic diseases. Our objective was to evaluate the effect of surgery on the plasma metabolome. Methods: This study included 39 OSA patients who underwent Multilevel Sleep Surgery (MLS). Clinical and anthropometric measures were taken at baseline and 5 months after surgery. Results: The mean Apnea Hypopnea Index (AHI) significantly dropped from 22.0 ± 18.5 events/hour to 8.97 ± 9.57 events/hour (p-Value <0.001). The Epworth’s sleepiness Score (ESS) dropped from 12.8 ± 6.23 to 2.95 ± 2.40 (p-Value <0.001) indicating success of the surgery in treating OSA. Plasma levels of metabolites, phosphocholines (PC) PC.41.5, PC.42.3, ceremide (Cer) Cer.44.0, and triglyceride (TG) TG.53.6, TG.55.6 and TG.56.8 were decreased (p-Value<0.05) whereas lysophosphatidylcholines (LPC) 20.0 and PC.39.3 were increased (p-Value<0.05) after surgery. Conclusion: This study highlights the success of MLS in treating OSA. Treatment of OSA resulted in improvement in metabolic status that was characterized by decreased TG, PCs and Cer metabolites post-surgery indicating that the success of the surgery positively impacted the metabolic status of these patients.

Download Full-text