557 Nasal cavity narrowing in pediatric obstructive sleep apnea

Abstract Introduction The contribution of nasal cavity narrowing to obstructive sleep apnea (OSA) in children has not been well-defined. Acoustic rhinometry is a non-invasive technique that uses acoustic pulses to measure nasal cavity cross-sectional area (CSA) at defined distances from the tip of the naris. This study evaluated the relationship between nasal cavity CSA and OSA in children. We hypothesized that OSA severity would correlate with reduced nasal CSA. Methods Children 5–12 years of age with OSA underwent polysomnography and acoustic rhinometry at baseline and after 3 months and 12 months of growth as part of a randomized controlled trial. Statistical analysis of the nasal cavity CSA up to 6 cm from the tip of the naris was performed using mixed-effects linear regression model with visit month, age at visit, trial number, OSA severity, and side (left or right naris), and statistical interaction between OAHI category and distance from the tip of the nose as a fixed effect and the random effects set on the level of individual subject. Least significant differences were used to account for multiple comparisons. An unbiased approach using latent class analysis was used to determine OSA severity categories based on obstructive apnea hypopnea index (OAHI). Post-hoc analysis was used assess the model adjusted (marginal) means and pairwise effects. Results 112 participants completed testing (50% male, aged 7.9±2.1 years). Median (IQR) OAHI for subjects with mild OSA (n=69) was 4.4/hr (3.2), moderate OSA (n=35) was 9.7/hr (7.1), and severe OSA (n=8) was 21.3/hr (17.2). There was a significant difference in linear trend for nasal cavity narrowing of the CSA between patients with mild vs. moderate OSA, p=0.023. There was no difference in nasal cavity narrowing between the severe group and other groups, likely due to the small sample size of this group. Conclusion There is a difference in the anterior nasal cavity narrowing between children with mild OSA and moderate OSA. In addition to structural narrowing from adenotonsillar hypertrophy, this may be another contributor to pediatric OSA. Support (if any) R01 HL120909 K23 HL135346 K01 HL130719

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Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽

10.1159/000516243 ◽

2021 ◽

pp. 1-8

Author(s):

Lifeng Li ◽

Demin Han ◽

Hongrui Zang ◽

Nyall R. London

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Obstruction ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Nasal Surgery ◽

Subjective Sleep Quality ◽

Obstructive Sleep ◽

Significant Difference ◽

The Impact

Objective: The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. Methods: Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. Results: By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (p < 0.05), while the Apnea-Hypopnea Index (AHI) changed little (p = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all p < 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (p < 0.05), except with the AHI (p > 0.05). Conclusion: Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

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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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Severity of obstructive sleep apnea (OSA) in 382 Han and Uyghur patients with sleep disorders

Traditional Medicine and Modern Medicine ◽

10.1142/s2575900018500106 ◽

2018 ◽

Vol 01 (02) ◽

pp. 163-169

Author(s):

Aman Gul ◽

Nassirhadjy Memtily ◽

Aikeranmu Aihemaiti ◽

Amir Abdukadir ◽

Palidan Wushuer

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Race And Ethnicity ◽

Impact Factors ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Significant Difference ◽

Adults And Children ◽

Respiratory Disturbance ◽

Distinctive Difference

Objective: Race and ethnicity may impact the prevalence and severity of Obstructive Sleep Apnea (OSA) in adults and children. In this study, we aim to investigate the ethnologic influence on OSA severity between Han and Uyghur OSA patients in Xinjiang, China.Methods: We enrolled total of 382 (205 Han and 177 Uyghur) patients diagnosed with OSA with apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) [Formula: see text] 5. During admission, the severity of OSA was evaluated by polysomnography (PSG).Results: From demographic characteristics of enrolled patients, we found that there was no significant difference in sex, age, BMI, and neck circumference between two study populations. Uyghur OSA patients had longer sleep latency, longer REM sleep and N3 stage, but shorter N1 phase than Han OSA patients. AHI and apnea RDI level, but not hypopnea RDI, were evidently higher in Han patients compared with Uyghur patients. There was no distinctive difference between two ethnic populations in average and minimum peripheral capillary oxygen saturation (SaO2) level.Conclusion: Better understanding of impact factors encompassing ethnicity may help improve OSA diagnosis accuracy, management and treatment for patients in Xinjiang.

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Do the turbinates play an important role in obstructive sleep apnea syndrome? – Our experience

Romanian Journal of Rhinology ◽

10.1515/rjr-2016-0011 ◽

2016 ◽

Vol 6 (22) ◽

pp. 93-98

Author(s):

Nicoleta Dumitrescu ◽

Raluca Enache ◽

Codrut Sarafoleanu

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Apnea Hypopnea Index ◽

Nasal Airflow ◽

Nasal Surgery ◽

Obstructive Sleep ◽

Significant Difference ◽

Apnea Syndrome

Abstract BACKGROUND. Nasal obstruction may trigger obstructive sleep apnea syndrome (OSAS) and it is considered to be a cofactor in its pathophysiology. However, the relation between cause and effect still remains a matter of debate. MATERIAL AND METHODS. 18 patients diagnosed with chronic hypertrophic rhinitis and obstructive sleep apnea syndrome were included in the present study. All patients underwent nasal surgery as the single treatment for their sleep breathing disorders. Rhinomanometric (total nasal airflow, logReff, logVR) and polygraphic parameters (apnea-hypopnea index - AHI, snore flags index – SFI) were evaluated pre- and 2 months postoperatively. RESULTS. There was a statistically significant difference between the values of the preoperative and postoperative total nasal airflow (p-value<0.0001). In case of AHI, there was a decrease in its value from 31.56 preoperatively to 30.03 postoperatively, but the difference was not statistically significant (p=0.937). The SFI, on the other hand, presented a significant decrease (p=0.05), from a mean value of 93.15 preoperatively to 56.02 after the surgery. The correlation of the total nasal airflow with AHI and SFI, revealed that nasal surgery had an important impact upon snoring characteristics (r=0.24) and less upon OSAS severity (r=0.21). CONCLUSION. The nasal cavity obstruction contributes less to OSAS, but still represents a disorder that needs to be corrected in case of such patients. Turbinates reduction surgery may be applied in the treatment of OSAS and combined with palate and/or tongue surgery.

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Increased prevalence of obstructive sleep apnea in women diagnosed with endometrial or breast cancer

PLoS ONE ◽

10.1371/journal.pone.0249099 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249099

Author(s):

Ayey Madut ◽

Veronika Fuchsova ◽

Hong Man ◽

Shabeel Askar ◽

Ritu Trivedi ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Endometrial Cancer ◽

Sleep Apnea ◽

Small Sample Size ◽

Small Sample ◽

Apnea Hypopnea Index ◽

Cross Sectional ◽

Obstructive Sleep ◽

Incidence And Mortality ◽

High Prevalence

Background Epidemiological studies demonstrate associations between obstructive sleep apnea (OSA) and cancer incidence and mortality. The aim of this study was to measure OSA in women with breast (BC) or endometrial cancer (EC) and associations with clinico-pathological tumor variables. Methods and findings In a cross sectional study, women with BC (12 months) or EC (3 months) post-diagnosis were recruited from cancer clinics. We collected demographic, anthropometric data, cancer stage, grade, histopathology and history of cancer treatment and all subjects had in-laboratory polysomnography. Sleepiness was assessed with the Epworth Sleepiness Scale (ESS). We compared anthropometric and polysomnographic data between cancer groups (unpaired t-tests), and assessed relationships between cancer characteristics and OSA variables (Fishers exact test). There were no significant differences between average age (BC:59.6±8.7 years(n = 50); EC:60.3±7.7 years(n = 37)), or ESS score (BC:6.4±4.4; EC 6.8±4.7; mean±SD; all p>0.2), however, BMI was higher in EC (BC: 29.7±7.9kgm-2; EC: 34.2±8.0 kgm-2; p<0.05). BC had longer sleep latency (BC:31.8±32minutes; EC:19.3±17.9 minutes), less Stage 3 sleep (BC:20.0±5.2%; EC:23.6±8.2%) and more REM sleep (BC:21.1±6.9%; EC: 16.6±5.7%), all p<0.05. EC had lower average awake and asleep oxygen saturation levels (BC: 95.6±1.3%; EC: 94.6±1.9% [awake]: BC: 94.8±2.1%; EC: 93.3±2.4% [asleep]; both p<0.05). Apnea-Hypopnea Index (AHI) (BC: 21.2(7.3–36.9) events/hr; EC: 15.7 (10–33.5) events/hour (median (interquartile range)) was not different p = 0.7), however, 58% and 57% of women with BC and EC respectively, had an AHI>15 events/hour. In this small sample size group, no significant associations (all p>0.1) were detected between OSA metrics and clinico-pathological tumor variables. Conclusion In postmenopausal women with breast or endometrial cancer there is high prevalence of OSA, with no association with specific tumor characteristics detected. Recognition of the high prevalence of OSA in women with cancer is important to recognise as it may impact on surgical risk and quality of life.

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0709 Using The Sleep Adjusted Residual Apnea Hypopnea Index In The Real-World Monitoring Of Obstructive Sleep Apnea

SLEEP ◽

10.1093/sleep/zsaa056.705 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A270-A270

Author(s):

E Viteri ◽

V McGhee ◽

J V Tackett ◽

A X Freire

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Time ◽

Small Sample ◽

Apnea Hypopnea Index ◽

Sleep Study ◽

Convenience Sample ◽

Obstructive Sleep ◽

Adjusted Residual

Abstract Introduction Treatment efficacy of obstructive sleep apnea (OSA) depends on controlling respiratory events for the majority of sleep time. Apnea-hypopnea index (AHI) and adherence are frequently used to determine efficacy of continuous positive airway (CPAP) therapy, but fail to capture the effect of residual events during untreated sleep-time. The Sleep Adjusted Residual AHI (SARAHI) consolidates treated and untreated AHI and CPAP use into a single number: SARAHI = [(Untreated AHI × Hours Untreated) + (Treated AHI × Hours Treated)] / (Total Sleep Hours). We attempted to determine the clinical applicability of this index as a determinant of OSA control and its relation with sleepiness improvement. Methods As part of a quality assessment project, a convenience sample was haphazardly collected from a database of patients initiated on CPAP in a Veteran’s Affairs Hospital. Patients initiating treatment after OSA diagnosis by polysomnogram or portable sleep study were included. Information from a CPAP-download within a year of diagnosis and Epworth Sleepiness Scale (ESS) at diagnosis and follow-up were collected. SARAHI was calculated using two different measures of “total sleep hours”: 8 hours (SARAHI-8hrs) or recorded sleep time during sleep study (SARAHI-PSG). Results Thirteen patients (12 male) with a mean age of 53.3 years were included. At diagnosis, mean AHI was 26.0 events/hour and ESS was 14.6. At follow-up, CPAP mean adherence was 338 min and average use was 61.8% of days; mean residual AHI was 4.4 events/hour and mean ESS 13.7. SARAHI-8hrs was 16.0 events/hour and SARAHI-PSG was 13.8 events/hr. Simple linear regression did not show a significant correlation between ESS improvement and either of these indexes or with improvement in AHI. Conclusion SARAHI showed no correlation with ESS in this small sample. We recommend further research as SARAHI is simple to use and provides more information than currently used parameters. Support None

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Robotic Modification of Epiglottis Trimming in the Treatment of Obstructive Sleep Apnea

Otolaryngology ◽

10.1177/01945998211064610 ◽

2021 ◽

pp. 019459982110646

Author(s):

Mehmet Ali Babademez ◽

Fatih Gul ◽

Kadir Sinasi Bulut ◽

Mecit Sancak ◽

Saliha Kusoglu Atalay

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Tertiary Hospital ◽

Apnea Hypopnea Index ◽

Complete Relief ◽

Sleep Endoscopy ◽

Drug Induced ◽

Drug Induced Sleep Endoscopy ◽

Obstructive Sleep ◽

Significant Difference

Objective With the widespread use of drug-induced sleep endoscopy, it has been suggested that epiglottis pathologies are present at high rates in patients with sleep apnea. The aim of our study was to evaluate the efficacy of trimming the curled-inward epiglottis as an updated surgical technique in patients with omega epiglottis. Study Design Retrospective study. Setting Tertiary hospital. Methods Among the 283 patients with epiglottis pathology, 21 with isolated omega-shaped epiglottis (age, 33-53 years) fulfilled the inclusion criteria between May 2016 and April 2019. Drug-induced sleep endoscopy was used to detect epiglottic collapse compressed by the lateral parts during inspiration. An epiglottoplasty technique was applied as single-level sleep surgery in patients with an isolated omega-shaped epiglottis. The medical data were also reviewed. Results The mean pre- and postoperative total apnea-hypopnea index (AHI) scores were 27.89 and 10.58, respectively, and this difference was statistically significant ( P < .001). There was a statistically significant difference between the pre- and postoperative supine AHI scores (27.02 vs 10.48, P < .001). Surgical success, defined as AHI <20 and a decrease in AHI by 50%, was documented in 85.71% of patients (18/21), and 12 patients found complete relief from obstructive sleep apnea symptoms (AHI <5); the cure rate was 38.09% (8/21). Conclusion Trimming the curled-inward epiglottis may represent an excellent option for epiglottis surgery in patients with obstructive sleep apnea by being less invasive than techniques currently in use.

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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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0170 Association of HIF-1 Alpha and Beta Subunits with Clock and BMAL1 Proteins in Obstructive Sleep Apnea Patients

SLEEP ◽

10.1093/sleep/zsaa056.168 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A67-A67

Author(s):

A Gabryelska ◽

M Sochal ◽

S Turkiewicz ◽

P Bialasiewicz

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Circadian Clock ◽

Hypoxia Inducible Factor ◽

Study Groups ◽

Oxygen Metabolism ◽

Apnea Hypopnea Index ◽

Protein Levels ◽

Obstructive Sleep ◽

Significant Difference

Abstract Introduction Obstructive sleep apnea (OSA) is a chronic condition that is characterized by intermittent hypoxia. Key regulator of oxygen metabolism is hypoxia inducible factor (HIF), which consists of oxygen sensitive subunit and continuously produced subunit. Circadian clock is composed of set of genes, which function as activators - CLOCK and BMAL 1, who similarly to HIF are basic helix-loop-helix-PER-ARNT-SIM transcription factors. Therefore, the aim of the study was to assess the relationship between HIF-1alpha, HIF-1beta, CLOCK, BMAL1 and polysomnography (PSG) variables in healthy individuals and severe OSA patients. Methods The study included 20 individuals, who underwent PSG and based on apnea-hypopnea index (AHI) were divided into severe OSA group (n=10; AHI30; 90% male) and healthy control (n=10; AHI<5; 70% male). All participants had their peripheral blood collected in the evening (9:00-10:00 pm) before and in the morning (6:00-7:00 am) after the PSG. HIF-1alpha, HIF-1beta, CLOCK and BMAL1 protein concertation measurements were performed using ELISA. Results Significant difference was observed in the following protein measurements between study groups: evening and morning HIF-1 (p=0.020 and p=0.043, respectively), evening HIF-1alpha (p=0.047), evening and morning CLOCK (p=0.037 and p=0.019, respectively) and morning BMAL1 (p=0.016). No differences were observed between morning and evening protein levels in both groups. Evening HIF-1beta corraleted with evening CLOCK and morning BMAL1 (R=0.511, p=0.21 and R=0.594, p=0.006, respectively), while morning HIF-1 with evening BMAL1 (R=474, p=0.35). Furthermore, evening and morning HIF-1 correlated with evening BMAL1 (R=564, p=0.010 and R=0.689, p=0.001, respectively). Additionally, morning CLOCK and BMAL1 correlated with AHI (R=0.510, p=0.022 and R=0.560, p=0.010, respectively) and desaturation index (R=0.487, p=0.209 and R=0.570, p=0.009, respectively). Conclusion There is significant correlation between both subunits of HIF-1 protein and circadian clock proteins: CLOCK and BMAL1, which further correlate with increased disease severity. This suggests OSA patients are in risk of circadian clock disruption due to present hypoxia. Support The study was financed by Polish National Centre Grant no. 2018/31/N/NZ5/03931.

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Evaluation of Inflammatory Markers in a Large Sample of Obstructive Sleep Apnea Patients without Comorbidities

Mediators of Inflammation ◽

10.1155/2017/4573756 ◽

2017 ◽

Vol 2017 ◽

pp. 1-13 ◽

Cited By ~ 17

Author(s):

Izolde Bouloukaki ◽

Charalampos Mermigkis ◽

Nikolaos Tzanakis ◽

Eleftherios Kallergis ◽

Violeta Moniaki ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Inflammatory Markers ◽

High Sensitivity ◽

Apnea Hypopnea Index ◽

Cross Sectional ◽

Large Sample ◽

Obstructive Sleep ◽

Significant Difference ◽

Hs Crp

Systemic inflammation is important in obstructive sleep apnea (OSA) pathophysiology and its comorbidity. We aimed to assess the levels of inflammatory biomarkers in a large sample of OSA patients and to investigate any correlation between these biomarkers with clinical and polysomnographic (PSG) parameters. This was a cross-sectional study in which 2983 patients who had undergone a polysomnography for OSA diagnosis were recruited. Patients with known comorbidities were excluded. Included patients (n=1053) were grouped according to apnea-hypopnea index (AHI) as mild, moderate, and severe. Patients with AHI < 5 served as controls. Demographics, PSG data, and levels of high-sensitivity C-reactive protein (hs-CRP), fibrinogen, erythrocyte sedimentation rate (ESR), and uric acid (UA) were measured and compared between groups. A significant difference was found between groups in hs-CRP, fibrinogen, and UA. All biomarkers were independently associated with OSA severity and gender (p<0.05). Females had increased levels of hs-CRP, fibrinogen, and ESR (p<0.001) compared to men. In contrast, UA levels were higher in men (p<0.001). Our results suggest that inflammatory markers significantly increase in patients with OSA without known comorbidities and correlate with OSA severity. These findings may have important implications regarding OSA diagnosis, monitoring, treatment, and prognosis. This trial is registered with ClinicalTrials.gov numberNCT03070769.

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