scholarly journals 0598 Blurred Binaries: The Clinical Management of Obstructive Sleep Apnea in Transgender Patients

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A229-A229
Author(s):  
B Peters-Mathews ◽  
M Lee ◽  
A Sabzpoushan
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Gender Identity ◽  
Mood Disorders ◽  
Case Series ◽  
Careful Consideration ◽  
Comorbid Conditions ◽  
Loss To Follow Up ◽  
Obstructive Sleep

Abstract Introduction Transgender patients require careful clinical assessment to identify the effects of hormones on their risk of obstructive sleep apnea. Testosterone increases sleep apnea risk and assigned males at birth may develop the condition earlier. Estrogen and progesterone are known to reduce sleep apnea risk. Depending on the use of supplemental hormones and surgical status, the risk of sleep apnea may be altered in a transgender patient. Comorbid conditions, including mood disorders and obesity, may further impact sleep. This topic has not been well-studied, and this pilot project identifies special needs that exist in transgender populations. Methods This retrospective chart review included 25 subjects who identify as transgender who have been managed at an urban sleep disorders center from 2017 to 2019. The case series was assessed to identify characteristics that impact the diagnosis and treatment of obstructive sleep apnea (natural and supplemental hormonal effects, surgical effects, comorbid conditions, etc.). Results The average age of the cohort was 34 years (range 16 to 76). Fourteen subjects were assigned females at birth and identify as men and 11 subjects were assigned males at birth and identify as women. Preferred pronoun usage was concordant with gender identity in 21 subjects, discordant in 1 subject, and gender-neutral (they/them) was used by 3 subjects. Based on 24 subjects, the average BMI was 35.5 (range 23.5 to 53.1). The measured neck circumference was <16 inches in 9 subjects, >17 inches in 6 subjects,and a risk factor for sleep apnea based on birth-assigned sex but not gender identity in 4 subjects. Hormone therapy was used by 24 subjects to enhance their gender identities. When documented, 6 subjects had mastectomies and 2 also had total hysterectomies. Anxiety or depression had been diagnosed in 20 subjects. Testing revealed sleep apnea in 18 subjects. Loss to follow up affected 9 subjects. Conclusion Transgender patients deserve respectful evaluation and careful consideration regarding risk factors for obstructive sleep apnea that may be impacted by gender-affirming hormonal therapy or surgery, and weight gain. Higher rates of mood disorders and loss to follow up may put these patients at long-term risk. Support N/A

scholarly journals Effects of China-Germany Follow Up Systems on Ventilator Therapy in Patients with Obstructive Sleep Apnea Syndrome

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Yujie Chen ◽  
Linglin Yang ◽  
Yong Li ◽  
Qinze He ◽  
Yi Wang
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Loss To Follow Up ◽  
Obstructive Sleep ◽  
Ventilator Therapy ◽  
Apnea Syndrome ◽  
Chinese Group

Objective: To investigate the effects of different follow-up systems in China and Germany on ventilator therapy in patients with obstructive sleep apnea syndrome. Method: From March 2013 to October 2015, three hundred patients with moderate to severe obstructive sleep apnea syndrome and those who are suitable for ventilator treatment were followed up according to the follow-up system of both China and Germany. The follow-up was carried out for one year to compare the rate of loss to follow-up, ventilator therapy compliance, treatment effect, ventilator side effects and others in the two groups of patients. Statistical analysis was performed using x2 test, P<0.05 for the difference was statistically significant. Results: The rate of loss to follow-up in the German group was lower than that in the Chinese group. The compliance of the German group with respiratory therapy was lower than that of the Chinese group. The side effects of ventilator treatment were lower than those in the Chinese group (P<0.05). Conclusion: The German follow-up system is more effective than the Chinese follow-up system in improving the compliance and effectiveness of ventilator therapy in patients with obstructive sleep apnea syndrome.   

scholarly journals Follow-up and Time to Treatment in an Urban Cohort of Children with Sleep-Disordered Breathing

2018 ◽  
Vol 159 (2) ◽  
pp. 371-378 ◽  
Author(s):  
Vandra C. Harris ◽  
Anne R. Links ◽  
Julia M. Kim ◽  
Jonathan Walsh ◽  
David E. Tunkel ◽  
...  
Keyword(s):  
Primary Care ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Loss To Follow Up ◽  
Obstructive Sleep Apnea Severity ◽  
Obstructive Sleep ◽  
Lost To Follow Up ◽  
Disordered Breathing

Objective To evaluate follow-up and timing of sleep-disordered breathing diagnosis and treatment in urban children referred from primary care. Study Design Retrospective longitudinal cohort analysis. Setting Tertiary health system. Subjects and Methods Pediatric outpatients with sleep-disordered breathing, referred from primary care for subspecialty appointment or polysomnography in 2014, followed for 2 years. Timing of polysomnography or subspecialty appointments, loss to follow-up, and sleep-disordered breathing severity were main outcomes. Chi-square and t-test identified differences in children referred for polysomnography, surgery, and loss to follow-up. Logistic regression identified predictors of loss to follow-up. Days to polysomnography or surgery were evaluated using the Kaplan-Meier estimator, with Cox regression comparing estimates by polysomnography receipt and disease severity. Results Of 216 children, 188 (87%) had public insurance. Half (109 [50%]) were lost to follow-up after primary care referral. More children were lost to follow-up when referred for polysomnography (50 [76%]) compared with subspecialty evaluation (35 [32%]; P < .001). Children referred to both polysomnography and subspecialty were more likely to be lost to follow-up (odds ratio = 2.73, 95% confidence interval = 1.29-5.78; P = .009). For children who obtained polysomnography, an asymmetric distribution of obstructive sleep apnea severity was not observed ( P = .152). Median time to polysomnography and surgery was 75 and 226 days, respectively. Obstructive sleep apnea severity did not influence time to surgery ( P = .410). Conclusion In this urban population, half of the children referred for sleep-disordered breathing evaluation are lost to follow-up from primary care. Obstructive sleep apnea severity did not predict follow-up or timeliness of treatment. These findings suggest social determinants may pose barriers to care in addition to the clinical burden of sleep-disordered breathing.

Adenoidectomy Without Tonsillectomy for Pediatric Obstructive Sleep Apnea

2020 ◽  
pp. 019459982095517
Author(s):  
Stephen R. Chorney ◽  
Karen B. Zur
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Chart Review ◽  
Case Series ◽  
Primary Objective ◽  
Apnea Hypopnea Index ◽  
Palatine Tonsils ◽  
Younger Age ◽  
Obstructive Sleep

Objective The primary objective was to determine if obstructive sleep apnea (OSA) can improve after adenoidectomy. Study Design Case series with chart review. Setting Tertiary children’s hospital between 2016 and 2018. Methods The study included children under 3.5 years with small (1+ or 2+) palatine tonsils, large (3+ or 4+) adenoids, and documented OSA on polysomnogram (PSG). Results Seventy-one children were included. Age at adenoidectomy was 2.0 years (95% CI, 1.8-2.2) and 71.8% were male. Mean follow-up was 2.5 years (95% CI, 2.3-2.7). Twenty-six children (36.6%) obtained a repeat PSG at a mean of 9.7 months (95% CI, 6.3-13.2) after adenoidectomy. Among those with a postoperative PSG, apnea-hypopnea index decreased in 77.0% (mean, –3.2 events/h; 95% CI, –14.1 to 7.6), and the proportion with moderate to severe OSA decreased from 65.4% to 30.8% ( P = .03). Six children (23.1%) had a normal PSG after adenoidectomy. Tonsillectomy was performed in 14.1% of children at 12.1 months (95% CI, 7.5-16.7) after adenoidectomy. Despite similar preoperative PSG variables, younger children (1.5 vs 2.1 years, P = .02) were more likely to require tonsillectomy. Substantial adenoid regrowth was identified in 1 child at the time of tonsillectomy. Conclusion Adenoidectomy may improve OSA in young children with large adenoids and small tonsils. However, younger age predicted the need for subsequent tonsillectomy. Prospective studies with additional PSG data are necessary to corroborate these findings.

Improvement in Obstructive Sleep Apnea (OSA) in Super Morbidly Obese Patients After Bariatric Surgery

2020 ◽  
Vol 103 (8) ◽  
pp. 725-728
Keyword(s):  
Bariatric Surgery ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lifestyle Modification ◽  
Apnea Hypopnea Index ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Obstructive Sleep ◽  
Objective Evidence

Background: Lifestyle modification is the mainstay therapy for obese patients with obstructive sleep apnea (OSA). However, most of these patients are unable to lose the necessary weight, and bariatric surgery (BS) has been proven to be an effective modality in selected cases. Objective: To provide objective evidence that BS can improve OSA severity. Materials and Methods: A prospective study was conducted in super morbidly obese patients (body mass index [BMI] greater than 40 kg/m² or BMI greater than 35 kg/m² with uncontrolled comorbidities) scheduled for BS. Polysomnography (PSG) was performed for preoperative assessment and OSA was treated accordingly. After successful surgery, patients were invited to perform follow-up PSG at 3, 6, and 12 months. Results: Twenty-four patients with a mean age of 35.0±14.0 years were enrolled. After a mean follow-up period of 7.8±3.4 months, the mean BMI, Epworth sleepiness scale (ESS), and apnea-hypopnea index (AHI) significantly decreased from 51.6±8.7 to 38.2±6.8 kg/m² (p<0.001), from 8.7±5.9 to 4.7±3.5 (p=0.003), and from 87.6±38.9 to 28.5±21.5 events/hour (p<0.001), respectively. Conclusion: BS was shown to dramatically improve clinical and sleep parameters in super morbidly obese patients. Keywords: Morbid obesity, Bariatric surgery, Obstructive sleep apnea (OSA)

4-Year Follow-up of Treatment With Dental Appliance or Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

CHEST Journal ◽  
2002 ◽  
Vol 121 (3) ◽  
pp. 739-746 ◽  
Author(s):  
Marie-Louise Walker-Engström ◽  
Åke Tegelberg ◽  
Bo Wilhelmsson ◽  
Ivar Ringqvist
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep ◽  
Dental Appliance

scholarly journals The Worsening of Positional Mild Obstructive Sleep Apnea over Time Is Associated with an Increase in Body Weight: Impact on Blood Pressure and Autonomic Nervous System

Respiration ◽  
2021 ◽  
pp. 1-10
Author(s):  
Wei-Hsiu Chang ◽  
Hsien-Chang Wu ◽  
Chou-Chin Lan ◽  
Yao-Kuang Wu ◽  
Mei-Chen Yang
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Sleep Apnea ◽  
Obstructive Sleep ◽  
Mild Obstructive Sleep Apnea ◽  
Positional Dependency ◽  
Over Time

<b><i>Background:</i></b> Most patients with mild obstructive sleep apnea (OSA) are positional dependent. Although mild OSA worsens over time, no study has assessed the natural course of positional mild OSA. <b><i>Objectives:</i></b> The aim of this study was to evaluate the natural course of positional mild OSA, its most valuable progression predictor, and its impact on blood pressure (BP) and the autonomic nervous system (ANS). <b><i>Methods:</i></b> This retrospective observational cohort study enrolled 86 patients with positional mild OSA and 26 patients with nonpositional mild OSA, with a follow-up duration of 32.0 ± 27.6 months and 37.6 ± 27.8 months, respectively. Polysomnographic variables, BP, and ANS functions were compared between groups at baseline and after follow-up. <b><i>Results:</i></b> In patients with positional mild OSA after follow-up, the apnea/hypopnea index (AHI) increased (9.1 ± 3.3/h vs. 22.0 ± 13.2/h, <i>p</i> = 0.000), as did the morning systolic BP (126.4 ± 13.3 mm Hg vs. 130.4 ± 15.9 mm Hg, <i>p</i> = 0.011), and the sympathetic activity (49.4 ± 12.3% vs. 55.3 ± 13.1%, <i>p</i> = 0.000), while the parasympathetic activity decreased (50.6 ± 12.3% vs. 44.7 ± 13.1%, <i>p</i> = 0.000). The body mass index changes were the most important factor associated with AHI changes among patients with positional mild OSA (Beta = 0.259, adjust <i>R</i><sup>2</sup> = 0.056, <i>p</i> = 0.016, 95% confidence interval 0.425 and 3.990). The positional dependency disappeared over time in 66.3% of patients with positional mild OSA while 69.2% of patients with nonpositional mild OSA retained nonpositional. <b><i>Conclusions:</i></b> In patients with positional mild OSA, disease severity, BP, and ANS regulation worse over time. Increased weight was the best predictor for its progression and the loss of positional dependency. Better treatments addressing weight control and consistent follow-up are needed for positional mild OSA.

Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up

2007 ◽  
Vol 8 (2) ◽  
pp. 128-134 ◽  
Author(s):  
Maria Pia Villa ◽  
Caterina Malagola ◽  
Jacopo Pagani ◽  
Marilisa Montesano ◽  
Alessandra Rizzoli ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Rapid Maxillary Expansion ◽  
Maxillary Expansion ◽  
Obstructive Sleep ◽  
Apnea Syndrome

scholarly journals CPAP treatment, glycemia and diabetes risk in obstructive sleep apnea and comorbid cardiovascular disease

2020 ◽  
Author(s):  
Kelly A. Loffler ◽  
Emma Heeley ◽  
Ruth Freed ◽  
Rosie Meng ◽  
Lia R. Bittencourt ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Glycemic Control ◽  
Usual Care ◽  
Serum Glucose ◽  
Cpap Therapy ◽  
Cpap Treatment ◽  
Obstructive Sleep

Objective: Despite evidence of a relationship between obstructive sleep apnea (OSA), metabolic dysregulation and diabetes mellitus (DM), it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and DM risk in patients with cardiovascular disease (CVD) and OSA. <strong>Research Design and Methods: </strong>Blood, medical history, and personal data were collected in a <strong>substudy of 888 participants in the </strong>Sleep Apnea Cardiovascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were r<strong>andomized</strong> to receive CPAP plus Usual Care, or Usual Care alone. Serum glucose and glycated hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) were measured at baseline, and six months, two- and four years, and incident diabetes diagnoses recorded. Results: Median follow-up was 4.3 years. In those with pre-existing DM (n=274), there was no significant difference between CPAP and Usual Care groups in serum glucose, HbA<sub>1c</sub> or anti-diabetic medications during follow-up. There were also no significant between-group differences in participants with pre-diabetes (n=452), nor in new diagnoses of DM. Interaction testing suggested that women with diabetes did poorly in the Usual Care group while their counterparts on CPAP therapy remained stable. <strong>Conclusions</strong><b>:</b> Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affected glycemic control in those with diabetes or pre-diabetes, or DM risk over standard of care treatment. The potential differential effect according to sex deserves further investigation.

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