Association of Snoring Characteristics with Predominant Site of Collapse of Upper Airway in Obstructive Sleep Apnoea Patients

SLEEP ◽  
2021 ◽  
Author(s):  
Arun Sebastian ◽  
Peter A Cistulli ◽  
Gary Cohen ◽  
Philip de Chazal
Keyword(s):  
Acoustic Analysis ◽  
Audio Signal ◽  
Upper Airway ◽  
Lateral Wall ◽  
Sleep Apnoea ◽  
Machine Learning Algorithms ◽  
Classification Model ◽  
Individual Site ◽  
Obstructive Sleep ◽  
The Individual

Abstract Study objectives Acoustic analysis of isolated events and snoring by previous researchers suggests a correlation between individual acoustic features and individual site of collapse events. In this study, we hypothesised that multi-parameter evaluation of snore sounds during natural sleep would provide a robust prediction of the predominant site of airway collapse. Methods The audio signals of 58 OSA patients were recorded simultaneously with full night polysomnography. The site of collapse was determined by manual analysis of the shape of the airflow signal during hypopnoea events and corresponding audio signal segments containing snore were manually extracted and processed. Machine learning algorithms were developed to automatically annotate the site of collapse of each hypopnoea event into three classes (lateral wall, palate and tongue-base). The predominant site of collapse for a sleep period was determined from the individual hypopnoea annotations and compared to the manually determined annotations. This was a retrospective study that used cross-validation to estimate performance. Results Cluster analysis showed that the data fits well in two clusters with a mean silhouette coefficient of 0.79 and an accuracy of 68% for classifying tongue/non-tongue collapse. A classification model using linear discriminants achieved an overall accuracy of 81% for discriminating tongue/non-tongue predominant site of collapse and accuracy of 64% for all site of collapse classes. Conclusions Our results reveal that the snore signal during hypopnoea can provide information regarding the predominant site of collapse in the upper airway. Therefore, the audio signal recorded during sleep could potentially be used as a new tool in identifying the predominant site of collapse and consequently improving the treatment selection and outcome.

scholarly journals CORRELATION BETWEEN DIFFERENT ANTHROPOMETRIC VARIABLES AND SEVERITY OF APNOEAASSESSED BY APNEA-HYPOPNEA INDEX (AHI) IN PATIENTS OF OBSTRUCTIVE SLEEPAPNOEA

2020 ◽  
pp. 1-3
Author(s):  
Shradha Suman ◽  
Bhaskar Saha ◽  
Monalisa Panda
Keyword(s):  
Upper Airway ◽  
Sleep Apnoea ◽  
Social Consequences ◽  
Health Concern ◽  
Apnea Hypopnea Index ◽  
Strong Positive Correlation ◽  
Random Group ◽  
Obstructive Sleep ◽  
Risk Patients ◽  
The Individual

Obstructive sleep apnea (OSA) is repeated episodes of upper airway closure during sleep that result in recurrent oxyhemoglobin desaturation and sleep fragmentation. It is considered a major public health concern, which can manifest serious physical and social consequences if not managed properly. Obesity, in particular the presence of visceral fat, is considered a predictive factor for OSA. Different anthropometric measurements of obesity e.g., body mass index (BMI), neck circumference (NC), waist circumference (WC) can be used used both to assess the need for patient referral to polysomnographic evaluation and to anticipate treatment in high-risk patients. This study was carried out in a random group of 100 cases of sleep apnoea where we stratified the patients into different severity groups according to Apnea-Hypopnea Index (AHI) and tried to correlate that with the BMI, NC and WC of the individual patients. We found WC is least predictable to signify the severity of sleep apnoea, whereas BMI predicts the severity more accurately. Analysing the correlation both BMI and NC posses strong positive correlation with AHI whereas strength of association with WC is moderate.

α-Methyldopa selectively reduces alae nasi activity

1988 ◽  
Vol 74 (5) ◽  
pp. 547-551 ◽  
Author(s):  
K. C. Lahive ◽  
J. W. Weiss ◽  
S. E. Weinberger
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Normal Subjects ◽  
Sleep Apnoea ◽  
Emg Activity ◽  
Obstructive Sleep ◽  
Ventilatory Parameters ◽  
The Mean ◽  
Preliminary Study ◽  
The Individual

1. Sedatives such as the benzodiazepines and alcohol reduce upper airway muscle activity. We hypothesized that a sedating antihypertensive, α-methyldopa, might have similar effects. To investigate this hypothesis we studied the effect of α-methyldopa on alae nasi electromyographic (EMG) activity during hypercapnia. 2. We studied ten healthy subjects and three subjects with obstructive sleep apnoea during CO2-stimulated breathing. In a preliminary study four subjects demonstrated a fall in alae nasi EMG activity 4 h after the ingestion of 500 mg of α-methyldopa during CO2 rebreathing. 3. In six additional normal subjects and three subjects with obstructive sleep apnoea, we studied the alae nasi EMG activity during steady-state hypercapnia with PCO2 held constant 5 torr (0.7 kPa) above baseline. On 2 separate days we studied subjects before and 2 h after they had ingested 750 mg of α-methyldopa or placebo. 4. In the normal subjects the mean alae nasi EMG activity fell by 34% 2 h after ingestion of α-methyldopa (P < 0.05) without a change in other ventilatory parameters. 5. In the sleep apnoea group the individual mean alae nasi EMG activity fell 16–49%, with ventilation and tidal volume falling in one patient. 6. We conclude that α-methyldopa selectively reduces upper airway motor activity.

scholarly journals Desipramine improves upper airway collapsibility and reduces OSA severity in patients with minimal muscle compensation

2016 ◽  
Vol 48 (5) ◽  
pp. 1340-1350 ◽  
Author(s):  
Luigi Taranto-Montemurro ◽  
Scott A. Sands ◽  
Bradley A. Edwards ◽  
Ali Azarbarzin ◽  
Melania Marques ◽  
...  
Keyword(s):  
Crossover Trial ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Double Blind ◽  
Healthy Humans ◽  
Dilator Muscle ◽  
Obstructive Sleep ◽  
Airway Collapsibility ◽  
Upper Airway Collapsibility

We recently demonstrated that desipramine reduces the sleep-related loss of upper airway dilator muscle activity and reduces pharyngeal collapsibility in healthy humans without obstructive sleep apnoea (OSA). The aim of the present physiological study was to determine the effects of desipramine on upper airway collapsibility and apnoea–hypopnea index (AHI) in OSA patients.A placebo-controlled, double-blind, randomised crossover trial in 14 OSA patients was performed. Participants received treatment or placebo in randomised order before sleep. Pharyngeal collapsibility (critical collapsing pressure of the upper airway (Pcrit)) and ventilation under both passive (V′0,passive) and active (V′0,active) upper airway muscle conditions were evaluated with continuous positive airway pressure (CPAP) manipulation. AHI was quantified off CPAP.Desipramine reduced activePcrit(median (interquartile range) −5.2 (4.3) cmH2O on desipramineversus−1.9 (2.7) cmH2O on placebo; p=0.049) but not passivePcrit(−2.2 (3.4)versus−0.7 (2.1) cmH2O; p=0.135). A greater reduction in AHI occurred in those with minimal muscle compensation (defined asV′0,active−V′0,passive) on placebo (r=0.71, p=0.009). The reduction in AHI was driven by the improvement in muscle compensation (r=0.72, p=0.009).In OSA patients, noradrenergic stimulation with desipramine improves pharyngeal collapsibility and may be an effective treatment in patients with minimal upper airway muscle compensation.

Volume-pressure properties of the upper airway in normal subjects and patients with obstructive sleep apnoea

Respirology ◽  
1999 ◽  
Vol 4 (1) ◽  
pp. 69-75 ◽  
Author(s):  
Denan Wu ◽  
Wataru Hida ◽  
Yoshihiro Kikuchi ◽  
Shinichi Okabe ◽  
Hajime Kurosawa ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Normal Subjects ◽  
Sleep Apnoea ◽  
Obstructive Sleep

scholarly journals P019 Obstructive sleep apnoea endotypes in people with multiple sclerosis

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A27-A28
Author(s):  
S Carter ◽  
H Hensen ◽  
A Krishnan ◽  
A Chiang ◽  
J Carberry ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Obstructive Sleep Apnoea ◽  
Group Analysis ◽  
Respiratory Control ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Loop Gain ◽  
Male Predominance ◽  
Arousal Threshold ◽  
Obstructive Sleep

Abstract Purpose Obstructive sleep apnoea (OSA) is common in people with multiple sclerosis (MS) despite a lack of typical risk factors for OSA in people with MS such as obesity and male predominance. Therefore, underlying factors other than sex and obesity may be particularly important in the pathogenesis of OSA in people with MS. Thus, the primary aim of this study was to determine the relative contributions of OSA endotypes in people with MS and compare this to matched controls with OSA only. Methods Eleven people with MS and OSA (MS-OSA group) (apnoea-hypopnoea index [AHI]&gt;5events/h) and eleven controls matched for OSA severity, age and sex without MS (OSA group) were studied. Participants underwent a detailed overnight polysomnography with an epiglottic pressure catheter and genioglossus intramuscular electrodes to allow for quantification of pathophysiological contributors to OSA. This included the respiratory arousal threshold, genioglossus muscle responsiveness, respiratory loop gain and upper airway collapsibility. Results Measures of the four primary OSA endotypes were not different between the MS-OSA and OSA groups (e.g. NREM respiratory arousal threshold -27±15 vs. -23±8 cmH2O respectively, p=0.24). Within group analysis indicated higher loop gain in non-obese MS-OSA participants compared to obese MS-OSA participants (0.53±0.11 vs. 0.37±0.11, p=0.04). Conclusions Overall, OSA endotypes are similar between MS-OSA participants and matched OSA controls. However, within the MS-OSA group, non-obese participants have higher loop gain (unstable respiratory control) compared to obese participants. Thus, unstable respiratory control may play an important role in OSA pathogenesis in many people with MS.

scholarly journals From CPAP to tailored therapy for obstructive sleep apnoea

2018 ◽  
Vol 13 ◽  
Author(s):  
Peter A. Cistulli ◽  
Kate Sutherland ◽  
Kristina Kairaitis ◽  
Brendon J. Yee
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Treatment Effectiveness ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Sleep Apnoea ◽  
Patient Acceptance ◽  
Cpap Therapy ◽  
Individual Level ◽  
Obstructive Sleep ◽  
The Individual

Obstructive Sleep Apnoea (OSA) is a common sleep disorder that is associated with daytime symptoms and a range of comorbidity and mortality. Continuous Positive Airway Pressure (CPAP) therapy is highly efficacious at preventing OSA when in use and has long been the standard treatment for newly diagnosed patients. However, CPAP therapy has well recognised limitations in real world effectiveness due to issues with patient acceptance and suboptimal usage. There is a clear need to enhance OSA treatment strategies and options. Although there are a range of alternative treatments (e.g. weight loss, oral appliances, positional devices, surgery, and emerging therapies such as sedatives and oxygen), generally there are individual differences in efficacy and often OSA will not be completely eliminated. There is increasing recognition that OSA is a heterogeneous disorder in terms of risk factors, clinical presentation, pathophysiology and comorbidity. Better characterisation of OSA heterogeneity will enable tailored approaches to therapy to ensure treatment effectiveness. Tools to elucidate individual anatomical and pathophysiological phenotypes in clinical practice are receiving attention. Additionally, recognising patient preferences, treatment enhancement strategies and broader assessment of treatment effectiveness are part of tailoring therapy at the individual level. This review provides a narrative of current treatment approaches and limitations and the future potential for individual tailoring to enhance treatment effectiveness.

scholarly journals A frequent phenotype for paediatric sleep apnoea: short lingual frenulum

2016 ◽  
Vol 2 (3) ◽  
pp. 00043-2016 ◽  
Author(s):  
Christian Guilleminault ◽  
Shehlanoor Huseni ◽  
Lauren Lo
Keyword(s):  
Clinical Investigation ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Obstructive Sleep Apnoea Syndrome ◽  
Systematic Screening ◽  
Obstructive Sleep ◽  
Airway Collapsibility ◽  
Upper Airway Collapsibility ◽  
Oral Anatomy ◽  
Symptoms And Signs

A short lingual frenulum has been associated with difficulties in sucking, swallowing and speech. The oral dysfunction induced by a short lingual frenulum can lead to oral-facial dysmorphosis, which decreases the size of upper airway support. Such progressive change increases the risk of upper airway collapsibility during sleep.Clinical investigation of the oral cavity was conducted as a part of a clinical evaluation of children suspected of having sleep disordered breathing (SDB) based on complaints, symptoms and signs. Systematic polysomnographic evaluation followed the clinical examination. A retrospective analysis of 150 successively seen children suspected of having SDB was performed, in addition to a comparison of the findings between children with and without short lingual frenula.Among the children, two groups of obstructive sleep apnoea syndrome (OSAS) were found: 1) absence of adenotonsils enlargement and short frenula (n=63); and 2) normal frenula and enlarged adenotonsils (n=87). Children in the first group had significantly more abnormal oral anatomy findings, and a positive family of short frenulum and SDB was documented in at least one direct family member in 60 cases.A short lingual frenulum left untreated at birth is associated with OSAS at later age, and a systematic screening for the syndrome should be conducted when this anatomical abnormality is recognised.

Novel avenues to approach non-CPAP therapy and implement comprehensive OSA care

2021 ◽  
pp. 2101788
Author(s):  
Jean-Louis Pépin ◽  
Peter Eastwood ◽  
Danny J. Eckert
Keyword(s):  
Treatment Success ◽  
Clinical Manifestations ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Individual Risk ◽  
Future Research ◽  
Success Rates ◽  
Recent Advances ◽  
Obstructive Sleep

Recent advances in obstructive sleep apnoea (OSA) pathophysiology and translational research have opened new lines of investigation for OSA treatment and management. Key goals of such investigations are to provide efficacious, alternative treatment and management pathways that are better tailored to individual risk profiles to move beyond the traditional, continuous positive airway pressure (CPAP)-focused, “one size fits all”, trial and error approach which is too frequently inadequate for many patients. Identification of different clinical manifestations of OSA (clinical phenotypes) and underlying pathophysiological phenotypes (endotypes), that contribute to OSA have provided novel insights into underlying mechanisms and have underpinned these efforts. Indeed, this new knowledge has provided the framework for precision medicine for OSA to improve treatment success rates with existing non-CPAP therapies such as mandibular advancement devices and upper airway surgery, and newly developed therapies such as hypoglossal nerve stimulation and emerging therapies such as pharmacotherapies and combination therapy. These concepts have also provided insight into potential physiological barriers to CPAP adherence for certain patients. This review summarises the recent advances in OSA pathogenesis, non-CPAP treatment, clinical management approaches and highlights knowledge gaps for future research. OSA endotyping and clinical phenotyping, risk stratification and personalised treatment allocation approaches are rapidly evolving and will further benefit from the support of recent advances in e-health and artificial intelligence.

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