Upper airways sarcoidosis presenting as obstructive sleep apnoea

Abstract Background Obstructive sleep apnoea (OSA) is an independent risk factor of hypertension and cardiovascular diseases. Recurrent episodes of upper airways collapse during sleep causing blood oxygen desaturation, hypercapnia, and micro-arousals, are known to activate the sympathetic nervous system (SNS). However, whether changes in the renin-angiotensin-aldosterone system and endothelial activation also occur remains contentious. Methods Based on routine use of drug-induced sleep endoscopy (DISE) for the work-up of OSA patients in our centre, we designed a prospective study to investigate the haemodynamic and humoral changes occurring during the apnoeic episodes reproduced in vivo in the course of DISE. Specifically, plasma aldosterone concentration and renin activity, C-terminal fragment of proendothelin-1, as a marker of endothelial damage, and free plasma catecholamines, will be measured at fixed times during DISE. The activity of catechol-O-methyltransferase (COMT), a key catecholamine-inactivating enzyme that has been scantly investigated thus far owing to the lack of commercially available kits, will be also determined by a newly developed high performance liquid chromatography method, which is herein described. Results and conclusions The aim of this study is to provide novel information on the haemodynamic, hormonal, and SNS changes, and also on COMT activity modification concomitantly occurring during apnoea, thus contributing substantively to the understanding of the pathophysiology of OSA.

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Obstructive sleep apnoea in a patient with chronic lymphocytic leukaemia

BMJ Case Reports ◽

10.1136/bcr-2018-228763 ◽

2019 ◽

Vol 12 (7) ◽

pp. e228763

Author(s):

Gregory Paul Stimac ◽

Asefa Jejaw Mekonnen

Keyword(s):

Chronic Lymphocytic Leukaemia ◽

Obstructive Sleep Apnoea ◽

Lymphocytic Leukaemia ◽

Oral Appliance ◽

Sleep Apnoea ◽

Caucasian Woman ◽

Upper Airways ◽

Airway Narrowing ◽

Obstructive Sleep ◽

Structural Abnormalities

A 69-year-old Caucasian woman presented with chronic lymphocytic leukaemia (CLL; stage 1-Rai System), significant oropharyngeal lymphoid enlargement, snoring and fatigue. Overnight polysomnography revealed moderately severe obstructive sleep apnoea (OSA), which was managed successfully with oral appliance therapy with resolution of snoring and daytime fatigue. Structural abnormalities of the upper airways are known to cause OSA. Airway narrowing can result from bony structural abnormalities, nasopharyngeal growth, soft tissue redundancy, macroglossia, malignant and benign growth of the upper aero-digestive tract, and adenotonsilar enlargement. Clinicians should be encouraged to consider a diagnosis of OSA in patients with CLL when they present with symptoms of worsening fatigue.

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Selected Recommendations from International Guidelines on Obstructive Sleep Apnoea

Journal of Clinical and Health Sciences ◽

10.24191/jchs.v2i2.5882 ◽

2017 ◽

Vol 2 (2) ◽

pp. 19

Author(s):

Nurul Yaqeen Mohd Esa ◽

Ahmad Izuanuddin Ismail

Keyword(s):

Obstructive Sleep Apnoea ◽

Asian Population ◽

Diagnostic Procedures ◽

Sleep Apnoea ◽

Upper Airways ◽

Specific Patient ◽

Major Health ◽

Asian Patients ◽

Obstructive Sleep ◽

Management Aspect

Obstructive sleep apnoea (OSA) is increasingly seen as a major health threat globally. However, it is still underdiagnosed mainly among Asian population partly due to lack of understanding on the pathophysiology, and limited access to the diagnostic and management aspect of the disease. Recurring complete and/or partial collapses of the upper airways define OSA. Based on the number of apnoeas and/or hypopnoeas per hour of sleep, OSA is categorized as mild, moderate and severe. Both the American Association of Sleep Medicine (AASM) and American College of Physicians (ACP) has published guidelines regarding the management of OSA in adults. Three recommendations have been suggested by the guidelines which can be used to tailor the management of OSA. The aim of this article is to select relevant recommendations from these guidelines in epidemiology, pathophysiology, diagnostic procedures and treatment for proper management of OSA, while considering specific patient populations, such as hypertensive, diabetic, obese and Asian patients.

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Drug-Induced Sleep Endoscopy Changes the Treatment Concept in Patients with Obstructive Sleep Apnoea

BioMed Research International ◽

10.1155/2016/6583216 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 12

Author(s):

Jaroslava Hybášková ◽

Ondřej Jor ◽

Vilém Novák ◽

Karol Zeleník ◽

Petr Matoušek ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Sleep Apnoea ◽

Treatment Concept ◽

Sleep Endoscopy ◽

Upper Airways ◽

Drug Induced ◽

Drug Induced Sleep Endoscopy ◽

Obstructive Sleep

The present study evaluated whether drug-induced sleep endoscopy (DISE) helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA). A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP) treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%). The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse (n=17, 33.3%), followed by palatal and oropharyngeal collapse (n=12, 23.5%). Pathology of the larynx (epiglottis) was observed in 16 patients (31.4%). The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3%) patients. After DISE, the surgical plan was changed in 31 patients (60.8%). The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA.

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Osteopathic Manipulation of the Sphenopalatine Ganglia Versus Sham Manipulation, in Obstructive Sleep Apnoea Syndrom: A Randomised Controlled Trial

Journal of Clinical Medicine ◽

10.3390/jcm11010099 ◽

2021 ◽

Vol 11 (1) ◽

pp. 99

Author(s):

Valérie Attali ◽

Olivier Jacq ◽

Karine Martin ◽

Isabelle Arnulf ◽

Thomas Similowski

Keyword(s):

Adverse Events ◽

Nasal Obstruction ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Obstructive Sleep Apnoea Syndrome ◽

Upper Airways ◽

Osteopathic Manipulation ◽

Obstructive Sleep ◽

Significant Difference ◽

Randomised Controlled

(1) Background: osteopathic manipulation of the sphenopalatine ganglia (SPG) blocks the action of postganglionic sensory fibres. This neuromodulation can reduce nasal obstruction and enhance upper airway stability. We investigated the manipulation of the SPG in 31 patients with obstructive sleep apnoea syndrome (OSAS); (2) Methods: Randomised, controlled, double-blind, crossover study. Participants received active (AM), then sham manipulation (SM), or vice versa. The primary endpoint was apnoea-hypopnoea index (AHI). Secondary endpoints were variation of nasal obstruction evaluated by peak nasal inspiratory flow (PNIF) and upper airways stability evaluated by awake critical closing pressure [awake Pcrit]), at 30 min and 24 h. Schirmer’s test and pain were assessed immediately post-manipulation. Tactile/gustatory/olfactory/auditory/nociceptive/visual sensations were recorded. Adverse events were collected throughout. (3) Results: SPG manipulation did not reduce AHI (p = 0.670). PNIF increased post-AM but not post-SM at 30 min (AM-SM: 18 [10; 38] L/min, p = 0.0001) and 24 h (23 [10; 30] L/min, p = 0.001). There was no significant difference on awake Pcrit (AM-SM) at 30 min or 24 h). Sensations were more commonly reported post-AM (100% of patients) than post-SM (37%). Few adverse events and no serious adverse events were reported. (4) Conclusions: SPG manipulation is not supported as a treatment for OSAS but reduced nasal obstruction. This effect remains to be confirmed in a larger sample before using this approach to reduce nasal congestion in CPAP-treated patients or in mild OSAS.

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Resistance in upper airways: a simple tool in the management of obstructive sleep apnoea

10.1183/13993003.congress-2019.pa883 ◽

2019 ◽

Author(s):

Julia Herrero Huertas ◽

Ramón Fernández ◽

Gemma Rubinos ◽

Marta Íscar ◽

María José Vázquez ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Upper Airways ◽

Simple Tool ◽

Obstructive Sleep

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Coagulation and Fibrinolysis in Obstructive Sleep Apnoea

International Journal of Molecular Sciences ◽

10.3390/ijms22062834 ◽

2021 ◽

Vol 22 (6) ◽

pp. 2834

Author(s):

Andras Bikov ◽

Martina Meszaros ◽

Esther Irene Schwarz

Keyword(s):

Obstructive Sleep Apnoea ◽

Systemic Inflammation ◽

Sleep Apnoea ◽

Future Research ◽

Common Disease ◽

Upper Airways ◽

Obstructive Sleep ◽

Cardiovascular Morbidity And Mortality ◽

Increased Risk ◽

Coagulation And Fibrinolysis

Obstructive sleep apnoea (OSA) is a common disease which is characterised by repetitive collapse of the upper airways during sleep resulting in chronic intermittent hypoxaemia and frequent microarousals, consequently leading to sympathetic overflow, enhanced oxidative stress, systemic inflammation, and metabolic disturbances. OSA is associated with increased risk for cardiovascular morbidity and mortality, and accelerated coagulation, platelet activation, and impaired fibrinolysis serve the link between OSA and cardiovascular disease. In this article we briefly describe physiological coagulation and fibrinolysis focusing on processes which could be altered in OSA. Then, we discuss how OSA-associated disturbances, such as hypoxaemia, sympathetic system activation, and systemic inflammation, affect these processes. Finally, we critically review the literature on OSA-related changes in markers of coagulation and fibrinolysis, discuss potential reasons for discrepancies, and comment on the clinical implications and future research needs.

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MECHANISMS OF ENDOCRINOLOGY: Mechanisms of disease: the endocrinology of obstructive sleep apnoea

Acta Endocrinologica ◽

10.1530/eje-18-0411 ◽

2019 ◽

Vol 180 (3) ◽

pp. R91-R125 ◽

Cited By ~ 4

Author(s):

Aikaterini Lavrentaki ◽

Asad Ali ◽

Brendan G Cooper ◽

Abd A Tahrani

Keyword(s):

Obstructive Sleep Apnoea ◽

Negative Impact ◽

Endocrine System ◽

Epidemiological Studies ◽

Sleep Apnoea ◽

Upper Airways ◽

Obstructive Sleep ◽

Bidirectional Relationship ◽

Randomised Controlled ◽

The Impact

Obstructive sleep apnoea (OSA) is a common disorder that is associated with serious comorbidities with a negative impact on quality of life, life expectancy and health costs. As OSA is related to obesity and is associated with sleep disruption, increased inflammation and oxidative stress, it is not surprising that OSA has an impact on the secretion of multiple hormones and is implicated in the development of many endocrine conditions. On the other hand, many endocrine conditions that can affect obesity and/or upper airways anatomy and stability have been implicated in the development or worsening of OSA. This bidirectional relationship between OSA and the endocrine system has been increasingly recognised in experimental and epidemiological studies and there are an increasing number of studies examining the effects of OSA treatment on endocrine conditions and vice versa. In this review article, we will critically appraise and describe the impact of OSA on the endocrine system including obesity, dysglycaemia, the pituitary, the thyroid, the adrenals, the reproductive system and the bones. In each section, we will assess whether a bidirectional relationship exists, and we will describe the potential underlying mechanisms. We have focused more on recent studies and randomised controlled trials where available and attempted to provide the information within clinical context and relevance.

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