Physiological determinants of nocturnal arterial oxygenation in patients with obstructive sleep apnea

1985 ◽  
Vol 59 (5) ◽  
pp. 1364-1368 ◽  
Author(s):  
T. D. Bradley ◽  
D. Martinez ◽  
R. Rutherford ◽  
F. Lue ◽  
R. F. Grossman ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Linear Regression Analysis ◽  
Gas Analysis ◽  
Apnea Hypopnea Index ◽  
Pulmonary Mechanics ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Nocturnal Hypoxemia ◽  
Obstructive Sleep

Among patients with similar degrees of obstructive sleep apnea (OSA) there is considerable variability in the degree of associated nocturnal hypoxemia. The factors responsible for this variability have not been clearly defined. Therefore we studied 44 patients with OSA to identify the physiological determinants of nocturnal arterial O2 saturation (SaO2). All patients underwent pulmonary function testing, arterial blood gas analysis, and overnight polysomnography. Mean nocturnal SaO2 ranged from 96 to 66% and apnea-hypopnea index from 11 to 128 per hour of sleep. Several anthropometric, respiratory physiological, and polysomnographic variables that could be expected to influence nocturnal SaO2 were entered into a stepwise multiple linear regression analysis, with mean nocturnal SaO2 as the dependent variable. Three variables [awake supine arterial PO2 (PaO2), expiratory reserve volume, and percentage of sleep time spent in apnea] were found to correlate strongly with mean nocturnal SaO2 (multiple R, 0.854; P less than 0.0001) and accounted for 73% of its variability among patients. Body weight, other lung volumes, and airflow rates influenced awake PaO2 and expiratory reserve volume but had no independent influence on nocturnal SaO2. In a further group of 15 patients with OSA a high correlation was obtained between measured nocturnal SaO2 and that predicted by the model (r = 0.87; P less than 0.001). We conclude that derangements of pulmonary mechanics and awake PaO2 (generally attributable to obesity and diffuse airway obstruction) are of major importance in establishing the severity of nocturnal hypoxemia in patients with OSA.

scholarly journals Effect of arterial blood bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire screening for obstructive sleep apnea

2021 ◽  
Author(s):  
Chong Pei ◽  
Shuyu Gui
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sensitivity And Specificity ◽  
Statistical Significance ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Apnea Hypopnea Index ◽  
Berlin Questionnaire ◽  
Arterial Blood ◽  
Obstructive Sleep

Abstract Background To evaluate the effect of arterial bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire (SBQ) screening for obstructive sleep apnea (OSA). Methods A total of 144 patients with suspected OSA were included. Polysomnograms (PSG) and blood gas analysis were performed, and the Epworth Sleepiness Scale (ESS), STOP-Bang questionnaire, and Berlin questionnaire were completed. The correlation between the arterial HCO3− concentration, apnea hypopnea index (AHI), and other related indicators was analyzed. The scoring results of the ESS, SBQ, and Berlin questionnaire were compared with the PSG results, and the sensitivity and specificity were calculated in the form of a four-cell table. The changes in the sensitivity and specificity of OSA screening after SBQ alone and combined with HCO3− concentration were compared, and ROC curves were drawn. Results Arterial HCO3− concentration was positively correlated with AHI (r = 0.537, P < 0.001). The ratio of HCO3− concentration ≥ 24.6 mmol/L in the non-OSA group was significantly lower than that in the OSA group (25.0% VS 80.8%, P < 0.001). The sensitivity of the SBQ was higher than that of the ESS (97.5% VS 81.7%, P < 0.001) and the Berlin questionnaire (97.5% VS 79.2%, P < 0.001). There was no statistical significance in the specificity of the three scales (25%, 37.5%, 37.5%). A combined SBQ score ≥ 3 and HCO3− concentration ≥ 24.6 mmol/L showed increased specificity and decreased sensitivity compared with an SBQ score ≥ 3 alone, with a corresponding AUC of 0.771 (P < 0.01) and 0.613 (P > 0.05), respectively. Conclusion The sensitivity of the SBQ was better than that of the Berlin questionnaire and ESS. After combining arterial blood HCO3− concentration, the SBQ questionnaire increased the specificity of OSA prediction and decreased the sensitivity, which improved the accuracy of screening.

scholarly journals Euthyroid goitre and sleep apnea

2016 ◽  
Vol 65 (1) ◽  
Author(s):  
A. De Felice ◽  
S. Fuschillo ◽  
M. Martucci ◽  
E. De Angelis ◽  
G. Balzano
Keyword(s):  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Gas Analysis ◽  
Apnea Hypopnea Index ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Volume Curve ◽  
Obstructive Sleep ◽  
Euthyroid Goitre

A number of predisposing factors (obesity, nasal obstruction, adenoidal hypertrophy, macroglossia, etc) have been related to obstructive sleep apnea syndrome (OSAS). In addition hypothyroidism and large goitres have been reported to be associated to OSAS, but this association has not been adequately studied. We describe an obese patient with euthyroid goitre associated with OSAS. The patient showed a body mass index (BMI) of 47 and a large neck with a circumference of 60 cm. The flow-volume curve demonstrated an expiratory plateau suggesting an intrathoracic upper airway obstruction. Arterial blood gas analysis results were: pH 7.39; PCO2 54.2 mmHg; P O2 47 mmHg. Nocturnal polisomnography showed an apnea/hypopnea index (AHI) of 31 episodes/hour. Upper airway collapse was overcome by a nasal continuous positive airway pressure (nCPAP) of 14 cmH2O. Weight loss obtained by a hypocaloric diet was not accompanied by any OSAS improvement. After thyroidectomy, a nCPAP of 4 cmH2O was sufficient to prevent upper airway closure. Discontinuation of nCPAP treatment for 4 consecutive nights did not determine worsening of sleep apnea symptoms, nor a worsening of overnight oxymetry. A new polysomnography carried out after 4 nights off nCPAP showed an AHI of 33 episodes/hour. OSAS should be suspected in patients with large goitres. Decisions regarding discontinuation of nCPAP treatment after thyroidectomy should be based on polisomnographic results.

scholarly journals Evaluation of Obstructive Sleep Apnea Phenotypes Treatment Effectiveness

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 335
Author(s):  
Karolina Charčiūnaitė ◽  
Rasa Gauronskaitė ◽  
Goda Šlekytė ◽  
Edvardas Danila ◽  
Rolandas Zablockis
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Treatment Effectiveness ◽  
Response To Treatment ◽  
Periodic Limb Movements ◽  
Apnea Hypopnea Index ◽  
Arterial Blood Gas ◽  
Treatment Techniques ◽  
Arterial Blood ◽  
Obstructive Sleep

Background and Objective: Obstructive sleep apnea (OSA) is a heterogeneous chronic sleep associated disorder. A common apnea-hypopnea index (AHI)-focused approach to OSA severity evaluation is not sufficient enough to capture the extent of OSA related risks, it limits our understanding of disease pathogenesis and may contribute to a modest response to conventional treatment. In order to resolve the heterogeneity issue, OSA patients can be divided into more homogenous therapeutically and prognostically significant groups–phenotypes. An improved understanding of OSA phenotype relationship to treatment effectiveness is required. Thus, in this study several clinical OSA phenotypes are identified and compared by their treatment effectiveness. Methods and materials: Retrospective data analysis of 233 adult patients with OSA treated with continuous positive airway pressure (CPAP) was performed. Statistical analysis of data relating to demographic and anthropometric characteristics, symptoms, arterial blood gas test results, polysomnografic and respiratory polygraphic tests and treatment, treatment results was performed. Results: 3 phenotypes have been identified: “Position dependent (supine) OSA” (Positional OSA), “Severe OSA in obese patients” (Severe OSA) and “OSA and periodic limb movements (PLM)” (OSA and PLM). The highest count of responders to treatment with CPAP was in the OSA and PLM phenotype, followed by the Positional OSA phenotype. Treatment with CPAP, despite the highest mean pressure administered was the least effective among Severe OSA phenotype. Conclusions: Different OSA phenotypes vary significantly and lead to differences in response to treatment. Thus, treatment effectiveness depends on OSA phenotypes and treatment techniques other than CPAP may be needed. This emphasizes the importance of a more individualized approach when treating OSA.

scholarly journals Effect of arterial blood bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire screening for obstructive sleep apnea

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chong Pei ◽  
Shuyu Gui
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sensitivity And Specificity ◽  
Statistical Significance ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Apnea Hypopnea Index ◽  
Berlin Questionnaire ◽  
Arterial Blood ◽  
Obstructive Sleep

Abstract Background To evaluate the effect of arterial bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire (SBQ) screening for obstructive sleep apnea (OSA). Methods A total of 144 patients with suspected OSA were included. Polysomnograms (PSG) and blood gas analysis were performed, and the Epworth Sleepiness Scale (ESS), STOP-Bang questionnaire, and Berlin questionnaire were completed. The correlation between the arterial HCO3− concentration, apnea hypopnea index (AHI), and other related indicators was analyzed. The scoring results of the ESS, SBQ, and Berlin questionnaire were compared with the PSG results, and the sensitivity and specificity were calculated in the form of a four-cell table. The changes in the sensitivity and specificity of OSA screening after SBQ alone and combined with HCO3− concentration were compared, and ROC curves were drawn. Results Arterial HCO3− concentration was positively correlated with AHI (r = 0.537, P < 0.001). The ratio of HCO3− concentration ≥ 24.6 mmol/L in the non-OSA group was significantly lower than that in the OSA group (25.0% VS 80.8%, P < 0.001). The sensitivity of the SBQ was higher than that of the ESS (97.5% VS 81.7%, P < 0.001) and the Berlin questionnaire (97.5% VS 79.2%, P < 0.001). There was no statistical significance in the specificity of the three scales (25%, 37.5%, 37.5%). A combined SBQ score ≥ 3 and HCO3− concentration ≥ 24.6 mmol/L showed increased specificity and decreased sensitivity compared with an SBQ score ≥ 3 alone, with a corresponding AUC of 0.771 (P < 0.01) and 0.613 (P > 0.05), respectively. Conclusion The sensitivity of the SBQ was better than that of the Berlin questionnaire and ESS. After combining arterial blood HCO3− concentration, the SBQ questionnaire increased the specificity of OSA prediction and decreased the sensitivity, which improved the accuracy of screening.

scholarly journals Prediction of optimal continuous positive airway pressure in Thai patients with obstructive sleep apnea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Narongkorn Saiphoklang ◽  
Kanyada Leelasittikul ◽  
Apiwat Pugongchai
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Linear Regression Analysis ◽  
Prediction Equation ◽  
Apnea Hypopnea Index ◽  
Predictive Equation ◽  
Obstructive Sleep

AbstractContinuous positive airway pressure (CPAP) is simple and effective treatment for obstructive sleep apnea (OSA) patients. However, the CPAP prediction equation in each country is different. This study aimed to predict CPAP in Thai patients with OSA. A retrospective study was conducted in Thai patients, who OSA was confirmed by polysomnography and CPAP titration from January 2015 to December 2018. Demographics, body mass index (BMI), neck circumference (NC), Epworth sleepiness scale, apnea–hypopnea index (AHI), respiratory disturbance index (RDI), mean and lowest pulse oxygen saturation (SpO2), and optimal pressure were recorded. A total of 180 subjects were included: 72.8% men, age 48.7 ± 12.7 years, BMI 31.0 ± 6.3 kg/m2, NC 40.7 ± 4.1 cm, AHI 42.5 ± 33.0 per hour, RDI 47.1 ± 32.8 per hour, and lowest SpO2 77.1 ± 11.0%. Multiple linear regression analysis identified NC, BMI, RDI, and lowest SpO2. A final CPAP predictive equation was: optimal CPAP (cmH2O) = 4.614 + (0.173 × NC) + (0.067 × BMI) + (0.030 × RDI) − (0.076 × lowest SpO2). This model accounted for 50.0% of the variance in the optimal pressure (R2 = 0.50). In conclusion, a CPAP prediction equation can be used to explain a moderate proportion of the titrated CPAP in Thai patients with OSA. However, the CPAP predictive equation in each country may be different due to differences of ethnicity and physiology.Trial registration: TCTR20200108003.

scholarly journals Serum S100A12 and S100B Proteins are Independent Predictors of the Presence and Severity of Obstructive Sleep Apnea

2019 ◽  
Author(s):  
GÖZDE DEMİRCİ ◽  
ADİL ZAMANİ ◽  
ŞEBNEM YOSUNKAYA ◽  
İBRAHİM KILINÇ
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Linear Regression ◽  
Linear Regression Analysis ◽  
Treatment Compliance ◽  
Serum Levels ◽  
Enzyme Linked Immunosorbent Assay ◽  
Apnea Hypopnea Index ◽  
Protein Levels ◽  
Obstructive Sleep

Background/aim: Obstructive sleep apnea (OSA) is associated with serious cardio-metabolic risks. Early diagnosis and treatment compliance are important. For this purpose, research is being carried out on biomarkers associated with the pathogenesis of the disease. We aimed to investigate whether serum S100A12 and S100B proteins could be used as biochemical markers in OSA patients to determine disease presence and severity. Materials and Methods: A total of 60 (16 women, 44 men) patients with OSA and 50 (20 women, 30 men) controls were enrolled in this cross-sectional study. Each subject included in the study underwent full-night polysomnography (PSG). The presence and severity of OSA was assessed by the apnea?hypopnea index (AHI). In the OSA group, 17-cases were mild, 18 were moderate, and 25 were severe. The serum levels of S100A12 and S100B were measured using the enzyme-linked immunosorbent assay (ELISA) technique. These protein levels were compared using the Student?s t-test in the patient and control groups. Spearman's rho correlation coefficients and corresponding p-values were calculated to determine the correlations between these protein levels and polysomnographic parameters. For evaluating the association between OSA and biomarkers, as well as possible confounding factors with S100A12 and S100B, we employed multiple linear regression analyses for the patients with OSA. Results: Serum levels of S100A12 and S100B were higher in patients than controls (p=0.01 and p=0.005, respectively), and a significant correlation was determined between S100A12 and S100B values and AHI (p=0.0001; p=0.0001), sleep time with SpO2< 90% (p=0.032; p=0.01), minimum SpO2 during sleep (p=0.019; p=0.007), and oxygen desaturation index ODI (p=0.001; p=0.0001). In the linear regression analysis, AHI was independently related with both S100A12 (p<?0.0001) and S100B (p=?0.011). Receiving operating curves (ROC) identified patients with OSA: AUC for S100A12=0.643; AUC for S100B=0.655 (p<0.05). Conclusion: Serum levels of S100B and S100A proteins have high diagnostic performance in OSA and are independent predictors of OSA presence and severity.

scholarly journals Interlink between Obesity Hypoventilation Syndrome and Obstructive Sleep Apnea. Do we need to screen patients for OHS in obese OSA patients?

2020 ◽  
Vol 4 (1) ◽  
pp. 17-20
Author(s):  
S.S. Dhakal ◽  
R. Maskey ◽  
M. Bhattarai
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Research Centre ◽  
Apnea Hypopnea Index ◽  
Obese Patients ◽  
Obesity Hypoventilation Syndrome ◽  
Arterial Blood ◽  
Obstructive Sleep ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

Introduction: Around 90% of patients with OHS have coexistent obstructive sleep apnea (OSA) defined by an apnea–hypopnea index (AHI) >5 events/h, with nearly 70% having severe OSA (AHI > 30 events/h). Prevalence of OHS is between 8% and 20% in obese patients referred to sleep centers for evaluation of SDB. As prevalence of OHS in OSA patients data from Nepal is not available we planned to carry out the study and to address gaps in diagnosis and management. Methodology: This is a cross sectional observational study done in OM hospital and research centre from 2018 January to 2019 June. Awake daytime Arterial blood gas ( ABG) was obtained and patients having PaCO2 more than 45 mmHg were diagnosed as obesity hypoventilation syndrome in a recently diagnosed patients with OSA. Results: 32 patients diagnosed to have OSA and whose BMI is more than 30 were included in the study. Among 32 patients 26 (81.25%) were male and 6 (18.75) were female. Among all patients who underwent level A polysomnography 3 (12.5%) had mild OSA,4(16.66%) had moderate and 17 (53.12%) had severe OSA. 8 (25%) patients had normal diagnostic polysomnography. Among these patients 3(12.5%) who had mild OSA has BMI between 30-35,16 (66.66%) patients who had BMI between 30-35, 2 had mild 3 had moderate and 11 had severe OSA. Patients with BMI more than 40,5 (28.3%) had OSA among which 21 had moderate and 4 had severe OSA. Conclusions: As OHS is often misdiagnosed even in patients with severe obesity, we strongly recommended screening in obese patients with OSA for OHS as early recognition and effective treatment are important in improving morbidity and mortality in this group of patients.

scholarly journals The Association Between Obstructive Sleep Apnea and Lung Nodule, Carcinoembryonic Antigen

2021 ◽  
Author(s):  
Ai-Ming Zeng ◽  
Li-Da Chen ◽  
Zhi-Wei Zhao ◽  
Meng-Xue Chen ◽  
Jie-Feng Huang ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Regression Analysis ◽  
Sleep Apnea ◽  
Carcinoembryonic Antigen ◽  
Pulmonary Nodule ◽  
Linear Regression Analysis ◽  
Lung Nodule ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep

Abstract Purpose: The association between obstructive sleep apnea (OSA) and cancer risks gaining more and more attention. Data on the association between OSA and lung cancer risk are limited. This study is to investigate whether a link exists between Low-dose computed tomography (LDCT) scanning of the chest findings, carcinoembryonic antigen (CEA) and OSA in patients suspected of OSA.Methods: The cross-sectional study included patients aged 18 years or older who underwent continuous nocturnal polysomnography at our sleep center between February 2019 and November 2020. All subjects underwent chest LDCT and CEA. Patients with an apnea-hypopnea index(AHI) of ≥15/h were classified as clinically significant OSA group, whereas patients with an AHI ＜15/h were classified as control group.Results: A total of 277 patients were enrolled in the study. 176 patients were categorized into the OSA group, while 101 patients were categorized into the control group. There is no relationship between any OSA-related parameter and presence of lung nodule or presence of ≥6mm lung nodule in the binary logistic regression analysis. OSA group demonstrated a significant higher value of CEA than control group. Stepwise multiple linear regression analysis showed that lowest O2 saturation(β=-0.256, p＜0.001), smoking status (β=0.156, p=0.007) and age (β=0.153, p=0.008) were independent predictors of elevated CEA. Conclusion: In a group of patients suspected of OSA, we confirmed an independent correlation between nocturnal hypoxia and elevated CEA levels. OSA was not related with presence of pulmonary nodule or≥6 mm pulmonary nodule in LDCT.

scholarly journals Obstructive Sleep Apnea Syndrome does not increase the cardiovascular risk in a naïve population of southern Italy

2021 ◽  
Author(s):  
Pierluigi Carratù ◽  
Agostino di Ciaula ◽  
Silvano Dragonieri ◽  
Teresa Ranieri ◽  
Marco Ciccone ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Cardiovascular Risk ◽  
Sleep Apnea ◽  
Smoking Habit ◽  
Sleep Apnea Syndrome ◽  
Normal Weight ◽  
Gas Analysis ◽  
Arterial Blood ◽  
Obstructive Sleep ◽  
Co Morbidity

Background Obstructive Sleep Apnea (OSA) is a worldwide increasing syndrome, which, by promoting endothelial dysfunction, contributes to extend the cardiovascular risk. We evaluated the cardiovascular risk in a group of OSA patients. Methods A total of 185 OSA subjects (19 normal weight, 57 overweight, 109 obeses), seen at the Ambulatory of Sleep Disorders, during one year, entered the study. We assessed anthropometric features, polysomnographic findings, cardiovascular risk factors, smoking habit, Pulmonary Function Test, Arterial Blood Gas Analysis, Epworth Questionnaire, and Charlson Co-morbidities Index (CCI). Subjects were divided into three groups, according to their BMI: individuals with BMI ≥30 Kg/m2 (Group 1 n=109, mean age 61 ± 1; 74.3 % males), individuals with BMI ranging from 25.0 to 29.9 Kg/m2 defined as overweight subjects (Group 2 n=57, mean age 58.8 ± 1.4; 77% males) and subjects with a BMI ranging from 18.5 to 24.9 Kg/m2 defined normal weight subjects (Group 3 n=19, mean age 54.2 ± 2.3; 64,2% males). Results In the whole population, the percentage cardiovascular risk was weakly related with BMI (r=0.33; P<0.001), but not with AHI. The cardiovascular risk was strictly related to the obesity (p<0.00002), while the Epworth Questionnaire score and the Charlson Co-morbidity Index were respectively statistically higher in the group of obese individuals (p=0.006, p=0.00002) than in the other 2 Groups. When AHI values were stratified in tertiles, the percentage cardiovascular risk did not vary with increasing AHI values (Figure 2). Conclusions Further studies are required to investigate the pivotal role of inflammation due to obesity, and underlying increased cardiovascular risk in OSA patients.

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