1065 A Bout of Sleep Apnea or a Posttrauma Nightmare Occurrence?

Abstract Introduction The enigmatic nature of Posttrauma Nightmares (PTNs) has left research without an agreed upon operational definition. This is partially due to PTNs often containing well remembered content that is similar to the triggering trauma, but also manifesting as severe nighttime awakenings without a concise or remembered dream narrative. Given that recent research has linked episodes of Obstructive Sleep Apnea (OSA) to PTNs, this study aimed to examine if OSA could explain why some distressed awakenings occur without memory of nightmare content. Methods Participants included 36 trauma survivors who reported experiencing PTNs, recruited from a clinical referral or at a Veterans Affairs Hospital. Presence of OSA was captured from self-reports of previous polysomnography-based sleep study results. PTNs were measured via a self-report measure that assessed past month nightmare frequency and if the content was remembered upon awakening. Analysis included descriptive statistics and chi-square tests. Results Out of the group with a reported diagnosis of OSA (N = 8), 75% (n = 6) reported they did not remember the content of their nightmares upon awakening, whereas out of the group without a reported OSA diagnosis (N = 28), only 4% of participants (n = 1) reported not remembering the content of their nightmares. There was a significant difference between OSA diagnosis and remembering nightmare content (X2 = 57.83, p < 0.001). Conclusion Individuals with diagnosed OSA commonly experienced nightmares that were often not remembered upon awakening, while the group without OSA most often remembered the content of their nightmares. Due to this relationship, it is possible that some PTNs experienced by the OSA group may instead be misinterpreted respiratory events. Understanding the relationship between OSA and PTNs is crucial for developing the most effective treatment course. Support None.

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Clinical and Polysomnographic Characteristics of Patients with Extreme Obstructive Sleep Apnea, AHI > 100: A Case-Control Study

Shiraz E-Medical Journal ◽

10.5812/semj.109587 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Forogh Soltaninejad ◽

Negarsadat Neshat ◽

Mehrzad Salmasi ◽

Babak Amra

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Study Results ◽

Significant Difference ◽

Severe Manifestation ◽

The Mean ◽

Nocturnal Polysomnography ◽

Control Study

Background: Severe obstructive sleep apnea (OSA), defined by apnea-hypopnea index (AHI) as more than 30 events per hour, was previously related to more comorbidity. However, limited studies separated the patients with AHI > 100 from those with a less severe manifestation of the disease. Objectives: The current study aimed at describing the characteristics of this subgroup and comparing them with less severe conditions. Methods: A retrospective analysis was conducted on 114 patients with OSA. Nocturnal polysomnography was used to diagnose severe OSA. Patients were categorized into two groups: (1) 60 < AHI < 100 (very severe OSA), (2) AHI ≥ 100 (extreme OSA). Demographic, medical history, and polysomnographic variables were evaluated and compared between the two groups. Results: Extreme OSA was diagnosed in 19 patients, the mean body mass index (BMI) was significantly higher in this group (39.26 ± 5.93 vs. 35.68 ± 6.45 kg/m2, P = 0.025). They also had lower minimal O2 saturation (65.68 ± 10.16 vs. 74.10 ± 8.74, P = 0.003) and more time with < 90% O2 saturation (T < 90%) (81.78 ± 22.57 vs. 58.87 ± 33.14, P = 0.01). OHS prevalence was significantly higher in the group with extreme OSA (P = 0.04). The most frequent comorbidity was hypertension, with an incidence of 60.5%, for the extreme group, although there was no significant difference between the two groups in terms of clinical associations. Conclusions: The current study results suggested that greater BMI and lower minimal O2 saturation, as well as increased T < 90%, were associated with extreme OSA, although no differences were observed in the associated diseases between the compared groups.

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Night-to-night variability of respiratory events in obstructive sleep apnoea: a systematic review and meta-analysis

Thorax ◽

10.1136/thoraxjnl-2020-214544 ◽

2020 ◽

Vol 75 (12) ◽

pp. 1095-1102 ◽

Cited By ~ 1

Author(s):

Maurice Roeder ◽

Matteo Bradicich ◽

Esther Irene Schwarz ◽

Sira Thiel ◽

Thomas Gaisl ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Evidence Synthesis ◽

Meta Analysis ◽

Sleep Apnoea ◽

Study Data ◽

Sleep Study ◽

Diagnostic Threshold ◽

Respiratory Events ◽

Obstructive Sleep ◽

Significant Difference

BackgroundIt is current practice to use a single diagnostic sleep study in the diagnostic workup of obstructive sleep apnoea (OSA). However, a relevant night-to-night variability (NtNV) of respiratory events has been reported.MethodsWe evaluated the NtNV of respiratory events in adults with suspected or already diagnosed OSA who underwent more than one diagnostic sleep study. Data sources were PubMed, Cochrane and Embase up to 23 January 2019. Random-effects models were used for evidence synthesis. For moderator analysis, mixed-effects regression analysis was performed. The study was registered with PROSPERO (CRD42019135277).ResultsOf 2143 identified papers, 24 studies, comprising 3250 participants, were included. The mean Apnoea-Hypopnoea Index (AHI) difference between the first and second night was −1.70/hour (95% CI −3.61 to 0.02). REM time differences (first to second night) were significantly positive associated with differences in mean AHI (β coefficient 0.262 (95% CI 0.096 to 0.428). On average, 41% (95% CI 27% to 57%) of all participants showed changes of respiratory events >10/hour from night to night. Furthermore, 49% (95% CI 32% to 65%) of participants changed OSA severity class (severity thresholds at 5/hour, 15/hour and 30/hour) at least once in sequential sleep studies. Depending on the diagnostic threshold (5/hour, 10/hour or 15/hour), on average 12% (95% CI 9% to 15%), 12% (95% CI 8% to 19%) and 10% (95% CI 8% to 13%) of patients would have been missed during the first night due to single night testing.ConclusionWhile there was no significant difference between mean AHI in two sequential study nights on a group level, there was a remarkable intraindividual NtNV of respiratory events, leading to misdiagnosis and misclassification of patients with suspected OSA.

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0880 A Pilot Study Evaluating the Effect of Head Elevation During Sleep on Obstructive Sleep Apnea in Pre-Pubertal Children with Down Syndrome

SLEEP ◽

10.1093/sleep/zsaa056.876 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A335-A335

Author(s):

K Kaplan ◽

D Spielberg ◽

L Petitto ◽

M Musso ◽

D Glaze

Keyword(s):

Obstructive Sleep Apnea ◽

Down Syndrome ◽

Sleep Apnea ◽

Pediatric Population ◽

Sleep Time ◽

Sleep Study ◽

Children With Down Syndrome ◽

Head Elevation ◽

Obstructive Sleep ◽

Significant Difference

Abstract Introduction Children with down syndrome are at high risk for developing obstructive sleep apnea when compared to typically developing children. Treatment of obstructive sleep apnea is complicated as these children often struggle with traditional therapies such as positive airway pressure. In adult populations it has been shown that head elevation is successful in reducing the severity of OSA (AHI). The hypothesis of this study is that head elevation (30°) would improve OSA in a cohort of pre-pubertal children with down syndrome. Methods Children with down syndrome, aged 4-13, presenting to the sleep clinic at Texas Children’s Hospital were screened for enrollment into the study (n=21; 11 male). Subjects were randomized to begin a diagnostic polysomnogram with either the head of the bed flat (0°) or elevated (30°). Head position was alternated every 2 hours during the study. Studies were performed in an AASM pediatric sleep center by a registered PSG technologist. Studies were scored using AASM pediatric scoring rules. Data was analyzed using paired student t-tests. Each subject served as their own control. Results There was no significant difference in AHI (p=0.71), RDI (p=0.7), O2 nadir (p=0.17), total sleep time (p=0.34), sleep efficiency (p=0.28), time in REM sleep (p=0.94) or arousal index (p=0.14) when the head of the bed was flat (0°) versus elevated (30°). The study shows that head elevation is not successful in significantly reducing obstructive sleep apnea in a pre-pubertal pediatric population of children with down syndrome. Conclusion In children with down syndrome, aged 4-13, referred for a diagnostic sleep study, there is no improvement in OSA due to head elevation (30°) when compared to sleeping flat (0°). These findings were independent of if the subject started with the head of the bed flat or elevated. Other cofounders were eliminated as each subject served as their own control. Support No external funding was utilized for this study.

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1094 Depression Is Not Associated With The Presence Of Or The Severity Of Obstructive Sleep Apnea: Retrospective Study Of 841 Polysomnography Subjects

SLEEP ◽

10.1093/sleep/zsaa056.1089 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A416-A416

Author(s):

K Im ◽

L Kim ◽

R Immen

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Rating Scale ◽

Numerical Rating Scale ◽

Significant Proportion ◽

Chi Square ◽

Relative Paucity ◽

Obstructive Sleep ◽

Significant Difference ◽

Chi Square Analysis

Abstract Introduction Both depression and obstructive sleep apnea (OSA) are very common medical conditions. Studies showed a co-occurrence of depression and OSA with a higher prevalence of one if the other is present. However, there is relative paucity of studies assessing the rate of depression based on the OSA severity. Methods Retrospective analysis of data collected from patients undergoing polysomnography (PSG) at an academic sleep disorders center was performed. A total of 841 subjects were included and stratified into four groups using AHI. A Chi-square analysis was applied to assess the association of varying levels of AHI and the presence of depression. Results Although a significant proportion of patients with AHI greater than 5 endorsed depression (60/165 in group with AHI 15 or greater and 115/278 in group with AHI between 5 and 15), this finding was also replicated in patients with AHI less than 5 (86/202 in AHI between 1 and 5 and 88/196 in those with AHI less than 1). As there was significant difference in rate of depression among women (54.1%) and men (26.1%) (p <0.0001), Chi-square analysis was performed for the rate of depression based on the level of AHI, adjusted for gender. In women the rate of depression from the most severe AHI to less severe AHI group were 0.48, 0.53, 0.60, and 0.53 respectively and in men it was 0.30, 0.27, 0.20, and 0.27 respectively, with no statistical difference between any groups. Conclusion Among patients who seek PSG assessment, depression appears to be more prevalent than the general public. Rate of depression is much higher among women than men in this group. However, the presence of OSA or severity of OSA does not have any correlation with the rate of depression in both women and men. These findings might be suggestive of the complexity of the association between depression and OSA. One limitation of this study is the dichotomous nature of depression (presence or absence of). The finding from this study warrants a future study utilizing a numerical rating scale of depression for severity measure to correlate it with the severity of OSA. Support NA.

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Comparison between short-term and long-term post-operative evaluation of sleep apnoea after uvulopalatopharyngoplasty

The Journal of Laryngology & Otology ◽

10.1017/s0022215100129998 ◽

1995 ◽

Vol 109 (4) ◽

pp. 308-312 ◽

Cited By ~ 29

Author(s):

Shao-Jung Lu ◽

Shyue-Yih Chang ◽

Guang-Ming Shiao

Keyword(s):

Sleep Apnoea ◽

Obstructive Sleep Apnoea Syndrome ◽

Sleep Study ◽

Obstructive Sleep ◽

Study Results ◽

Significant Difference ◽

Long Term Follow Up ◽

Operative Evaluation

AbstractFor a long time uvulopalatopharyngoplasty (UPPP) has been used to treat the obstructive sleep apnoea syndrome (OSAS). The diverse surgical effects, the inadequate understanding of operation effect consistency, the possibility of disease progression, and the few reported papers for long-term evaluation after UPPP aroused our interest in designing this study. Fifteen OSAS patients who had undergone UPPP with pre-operative, initial post-operative and long-term post-operative polysomnographic studies were included in this study. Long-term post-operative polysomnography was undertaken more than five years after surgery. The polysomnographic evaluations included respiratory disturbance index (RD I), duration of saturation SaO2 <85 per cent (DOS), and the lowest O2 saturation (LOS). Amongst them, 10 patients with initial post-operative RDI reduction > 50 per cent were considered responders. In these responders, the long-term follow-up results of all three parameters showed improvement compared to the preoperative data. In a comparison between the initial and long-term post-operative sleep study results, LOS and DOS showed no significant difference. However, the long-term post-operative RDI result became significantly worse. More than 80 per cent of all cases had subjective symptomatic improvement in the long-term post-operative evaluation. The subjective improvement after operation is not adequately correlated to the polysomnographic result. We suggest that long-term follow-up for patients after UPPP is necessary.

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Relevance of obstructive sleep apnea and smoking: Obstructive sleep apnea and smoking

Family Practice ◽

10.1093/fampra/cmaa112 ◽

2020 ◽

Author(s):

Ayse Didem Esen ◽

Meltem Akpinar

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Rem Sleep ◽

Demographic Data ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Study Results ◽

Significant Difference ◽

Study Population ◽

The Impact

Abstract Background The data concerning the association of smoking and obstructive sleep apnea (OSA) are limited. The effects of cigarette smoking on OSA still remain obscure. Objectives To reveal the impact of smoking on obstructive sleep apnea. Methods About 384 patients with the diagnosis of OSA through full night polysomnographic (PSG) examination were included to the study. The demographic data (age, sex and BMI), complaints and medical history, status of smoking as non-smokers and smokers, smoking frequency (cigarettes/day), polysomnograhic data comprising apnea hypopnea index (AHI), non-REM sleep AHI (NREM AHI), REM sleep AHI (REM AHI), minimum oxygen saturation (min SaO2) were recorded for all the subjects. Non-smokers and smokers were compared in terms of severity of OSA. Results The study population consisted of 384 subjects, 253 males and 131 females. Smoking frequency was not found correlated with OSA severity. Among smokers, males had higher severe OSA rate (P = 0.002, P < 0.05). In subjects with BMI < 30, severe OSA rate was higher in smokers (34.44% versus 21%) (P = 0.027, P < 0.05). Conclusions Our study detected higher rate of severe OSA in male smokers and smokers with BMI < 30. PSG data did not yield statistically significant difference in non-smokers and smokers. OSA severity was not found correlated with smoking frequency. Along with the study results, the impact of smoking on OSA is still controversial. Prospective studies with larger sample size may be contributive to further evaluation of the association of OSA with smoking.

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Predicting sleep apnea responses to oral appliance therapy using polysomnographic airflow

SLEEP ◽

10.1093/sleep/zsaa004 ◽

2020 ◽

Vol 43 (7) ◽

Cited By ~ 3

Author(s):

Daniel Vena ◽

Ali Azarbarzin ◽

Melania Marques ◽

Sara Op de Beeck ◽

Olivier M Vanderveken ◽

...

Keyword(s):

Sleep Apnea ◽

Model Performance ◽

Oral Appliance ◽

Apnea Hypopnea Index ◽

Sleep Study ◽

Oral Appliance Therapy ◽

Respiratory Events ◽

Obstructive Sleep ◽

The Difference ◽

Average Drop

Abstract Study Objectives Oral appliance therapy is an increasingly common option for treating obstructive sleep apnea (OSA) in patients who are intolerant to continuous positive airway pressure (CPAP). Clinically applicable tools to identify patients who could respond to oral appliance therapy are limited. Methods Data from three studies (N = 81) were compiled, which included two sleep study nights, on and off oral appliance treatment. Along with clinical variables, airflow features were computed that included the average drop in airflow during respiratory events (event depth) and flow shape features, which, from previous work, indicates the mechanism of pharyngeal collapse. A model was developed to predict oral appliance treatment response (>50% reduction in apnea–hypopnea index [AHI] from baseline plus a treatment AHI <10 events/h). Model performance was quantified using (1) accuracy and (2) the difference in oral appliance treatment efficacy (percent reduction in AHI) and treatment AHI between predicted responders and nonresponders. Results In addition to age and body mass index (BMI), event depth and expiratory “pinching” (validated to reflect palatal prolapse) were the airflow features selected by the model. Nonresponders had deeper events, “pinched” expiratory flow shape (i.e. associated with palatal collapse), were older, and had a higher BMI. Prediction accuracy was 74% and treatment AHI was lower in predicted responders compared to nonresponders by a clinically meaningful margin (8.0 [5.1 to 11.6] vs. 20.0 [12.2 to 29.5] events/h, p < 0.001). Conclusions A model developed with airflow features calculated from routine polysomnography, combined with age and BMI, identified oral appliance treatment responders from nonresponders. This research represents an important application of phenotyping to identify alternative treatments for personalized OSA management.

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864 New-onset Obstructive Sleep Apnea Diagnosis in a COVID-positive Patient

SLEEP ◽

10.1093/sleep/zsab072.861 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A336-A336

Author(s):

Nobel Nguyen ◽

Kimberly Mebust

Keyword(s):

Risk Factors ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Family History ◽

Oxygen Saturation ◽

Sleep Study ◽

Obstructive Sleep ◽

Study Results ◽

Home Sleep Study ◽

New Onset

Abstract Introduction Risk factors for the mortality of COVID-19, such as cardiovascular and lung disease, are commonly seen in patients with obstructive sleep apnea (OSA). Patients with OSA experience approximately 8-fold greater risk for COVID-19 infection compared to a similar age population. Among patients with COVID-19 infection, OSA was associated with an increased risk of hospitalization and approximately doubled the risk of developing respiratory failure. However, there is little information on whether COVID-19 can directly develop OSA. To the best of our knowledge, we describe the first case-presentation of a positive COVID-19 patient who developed sudden-onset OSA. Report of case(s) NL is a 47-year-old female who complains of new-onset snoring, excessive daytime sleepiness, and witnessed apnea events after testing positive for COVID-19 seven months prior after developing mild symptoms. Her ESS score is 12/24, neck circumference is 14.75 cm, BMI is 27.9, and Mallampati II. She has no pertinent PMH and is not a tobacco user. In regards to her sleep, she has no symptoms of restless legs, narcolepsy, or periodic limb movements. She denies any physical disturbances, psychiatric conditions, environmental factors, or medical issues that might affect her sleep. There is no family history of sleep apnea, snoring, or other sleeping disorders. The patient's presentation at the initial sleep visit prompted a home sleep study. Results of her home sleep study revealed 131 total number of sleep-related respiratory events, with an apnea-hypopnea index of 11.9 per hour. Mean oxygen saturation was 94% and the minimum oxygen saturation was 83%. Total estimated sleep time was 7 hours, 59 mins, and sleep quality and duration were deemed adequate. The results from NL's sleep study gave the final diagnosis of mild OSA. Conclusion Besides having a slightly overweight BMI, NL had relatively few risk factors for developing OSA (no family history, no comorbidities, and normal physical exam findings). The link between the virus and the development of OSA in healthy individuals is not readily apparent. We recommend sleep studies for healthy patients who develop OSA like-symptoms after being infected with COVID-19 to prevent unwanted health risks associated with OSA. Support (if any):

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Outcomes of Children with Mild Obstructive Sleep Apnea Treated Nonsurgically: A Retrospective Review

Otolaryngology ◽

10.1177/0194599819829019 ◽

2019 ◽

Vol 160 (6) ◽

pp. 1101-1105 ◽

Cited By ~ 4

Author(s):

Jocelyn L. Kohn ◽

Michael B. Cohen ◽

Prachi Patel ◽

Jessica R. Levi

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Surgical Intervention ◽

Medical Center ◽

Sleep Study ◽

Nonsurgical Management ◽

Obstructive Sleep ◽

Significant Difference ◽

Mild Obstructive Sleep Apnea

Objective Obstructive sleep apnea (OSA) is characterized by partial or complete obstruction of the upper airway and is commonly caused by adenotonsillar hypertrophy in children. Accordingly, adenotonsillectomy is considered first-line treatment. However, in cases of mild OSA, nonsurgical management has been proposed as an alternative. The purpose of this study was to determine the outcomes of pediatric patients with mild obstructive sleep apnea (OSA) treated without surgical intervention. Study Design Case series with chart review. Setting Tertiary care university medical center. Subjects and Methods The medical records of children ages 2 to 18 years with OSA at Boston Medical Center from January 2000 to April 2017 were reviewed. Children with mild OSA (apnea- hypopnea index [AHI] between 1 and 5), who were managed nonsurgically and had serial polysomnograms, were included. Serial sleep studies were compared to assess for patterns of change. Results Of the 201 patients with mild OSA who were identified, 104 (52%) opted for initial nonsurgical management. Of those, 91 had a follow-up sleep study to reassess their OSA. Forty-two (46 %) had a greater than 20% decrease in AHI and 38 (41%) had a greater than 20% increase on the second sleep study. The remaining 11 had changes less than 20% in either direction. There was not a significant difference in the proportion of patients with an increase vs decrease in AHI on follow-up sleep study ( P > .05). Conclusions Mild pediatric OSA has approximately equal chances of worsening or improvement over time without surgical intervention, which is useful for counseling parents on treatment options.

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CME/Answers: Obstructive Sleep Apnea: How to Deal with Night- To-Night Variability of Respiratory Events?

Praxis ◽

10.1024/1661-8157/a003600 ◽

2021 ◽

Vol 110 (1) ◽

pp. 16-18

Author(s):

Maurice Roeder ◽

Esther I. Schwarz ◽

Thomas Gaisl ◽

Malcolm Kohler

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Apnea Hypopnea Index ◽

Night Sleep ◽

Sleep Study ◽

Diagnostic Uncertainty ◽

Sleep Studies ◽

Respiratory Events ◽

Obstructive Sleep ◽

Single Night

Abstract.According to current recommendations, the diagnosis of obstructive sleep apnea (OSA) is established by a single-night sleep study. However, recent reports suggest a remarkable night-to-night variability of OSA severity. We report on a 76-year-old man with suspected OSA who underwent six sleep studies within 13 months. Sleep studies demonstrated a remarkable variability of respiratory events based on an apnea-hypopnea index (AHI) varying between 1.1 and 43.1/h. There were no changes in body weight, alcohol intake, medication or comorbidities during the evaluation period. Due to diagnostic uncertainty and missing subjective benefit, the initially implemented CPAP therapy was stopped after one year of therapy. Considering night-to-night variability of OSA severity, single-night sleep studies might not be accurate enough in order to reliably diagnose or exclude OSA.

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