Clinical Predictors of Pediatric Obstructive Sleep Apnea Syndrome

2018 ◽  
Vol 127 (9) ◽  
pp. 608-613 ◽  
Author(s):  
Chi-Chih Lai ◽  
Pei-Wen Lin ◽  
Hsin-Ching Lin ◽  
Michael Friedman ◽  
Hsueh-Wen Chang ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Linear Regression Analysis ◽  
Mouth Breathing ◽  
Apnea Hypopnea Index ◽  
Physical Factors ◽  
Z Score ◽  
Adequate Model ◽  
Obstructive Sleep

Objective: To develop an adequate model using reliable clinical and physical factors to predict pediatric obstructive sleep apnea/hypopnea syndrome (OSAS). Methods: Complete anthropometric measurements including BMI z score, tonsil size grading, and updated Friedman tongue position (uFTP) were evaluated. Subjective assessments of clinical symptoms/signs, including snoring visual analog scale (VAS), nasal obstruction, and mouth breathing, were recorded. Results: Eighty-eight children (57 boys and 31 girls, mean age = 9.0 years) were confirmed to have OSAS by comprehensive polysomnography (PSG). When the aforementioned variables were analyzed individually, the results indicated that snoring VAS, nasal obstruction, mouth breathing, and BMI z score were reliable predictors of apnea/hypopnea index (AHI/h) values (correlation coefficient r = 0.386, P < .001; r = 0.416, P < .001; r = 0.255, P = .02; and r = 0.243, P = .02, respectively). When all significant factors were included in the stepwise multiple linear regression analysis, the final predictive model is: Pediatric AHI = 0.108 + 0.103 snoring VAS + 0.894 nasal obstruction + 0.207 BMI z score ( F = 4.06, P = .01). Conclusion: The proposed noninvasive, simple, inexpensive, and easy to perform screening tool could be used to predict pediatric OSAS. An abnormal calculated AHI may prompt clinical physicians to conduct further PSG diagnostics and treatment.

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

ORL ◽  
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

<b><i>Objective:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (<i>p</i> &#x3c; 0.05), while the Apnea-Hypopnea Index (AHI) changed little (<i>p</i> = 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 <i>p</i> &#x3c; 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (<i>p</i> &#x3c; 0.05), except with the AHI (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> 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.

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 Assessment of Screening for Nasal Obstruction among Sleep Dentistry Outpatients with Obstructive Sleep Apnea

2020 ◽  
Vol 8 (4) ◽  
pp. 119
Author(s):  
Arisa Sawa ◽  
Hiroshi Suzuki ◽  
Hideo Niwa ◽  
Sumito Oguchi ◽  
Tatsuo Yagi ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Standard Technique ◽  
Apnea Hypopnea Index ◽  
Nasal Airflow ◽  
Nose Scale ◽  
Symptom Evaluation ◽  
Obstructive Sleep ◽  
Scale Scores

Oral appliances (OA), a common treatment modality for obstructive sleep apnea (OSA), are not suitable for patients with nasal obstruction. Rhinomanometry, the gold standard technique to assess nasal airway resistance, is not readily available in sleep dentistry clinics. We demonstrate the use of a portable lightweight peak nasal inspiratory flow (PNIF) rate meter to objectively assess nasal airflow and utilized the Nasal Obstruction Symptom Evaluation (NOSE) scale to subjectively assess nasal obstruction in 97 patients with OSA and 105 healthy controls. We examined the correlations between the following variables between the groups: demographics, body mass index, PNIF, NOSE scale scores, apnea–hypopnea index (AHI), minimum SpO2 (SpO2min), Mallampati classification, and Epworth Sleepiness Scale (ESS) scores. Patients with OSA had significantly lower PNIF values and higher NOSE scores than controls. In the patient group, PNIF was not significantly correlated with AHI, SpO2min, Mallampati classification, or NOSE or ESS scores. Lower PNIF values and higher NOSE scores suggested impaired nasal airflow in the OSA group. As daytime PNIF measurement bears no relationship to AHI, this cannot be used alone in predicting the suitability of treatment for OSA with OA but can be used as an adjunct for making clinical decisions.

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 0893 Myofunctional Therapy in Children With Mild Obstructive Sleep Apnea: A Meta-Analysis

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A340-A340
Author(s):  
A Bandyopadhyay ◽  
K N Kaneshiro ◽  
M Camacho
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Meta Analysis ◽  
Upper Airway ◽  
Mouth Breathing ◽  
Apnea Hypopnea Index ◽  
Facial Growth ◽  
Myofunctional Therapy ◽  
Obstructive Sleep ◽  
Mild Obstructive Sleep Apnea

Abstract Introduction OSA affects 2-4% of children and untreated OSA can have adverse behavior and quality of life outcomes. 40% of children can have residual obstructive sleep apnea (OSA)despite first line treatment (adenotonsillectomy). Alternative modalities of treatment for OSA are limited. Myofunctional therapy comprises of exercises targeting upper airway muscles that can improve facial growth and have been shown to treat OSA in adults. There is paucity of data on the role of myofunctional therapy (MT) in children. The objective of this study was to systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for OSA in children and to perform a meta-analysis on the polysomnographic and mouth breathing data. Methods Medline, Embase, CINAHL, Scopus, Web of Science and Cochrane were searched from inception through October 1st, 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. Results Eight studies (91 patients) reported polysomnography and/or mouth breathing outcomes. The pre- and post-MT apnea hypopnea indices (AHI) decreased from a mean ± standard deviation (M ± SD) of 3.75± 3.14/h to 2.08 ± 2.48/h, mean difference (MD) -1.6 [95% confidence interval (CI) -2.42, -0.78], P =0.0001. Mean oxygen saturations improved from 96.03 ± 1.1% to 96.67 ± 0.95%, MD 0.42 (95% CI 0.21, 0.63), P &lt;0.0001. Lowest oxygen saturations improved from 86.6 ± 7.3% to 90.94 ± 3.05%, MD 1.01 (95% CI 0.25, 1.77), P = 0.009. Mouth breathing decreased in all three studies reporting subjective outcomes. Conclusion Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 45% in children with mild obstructive sleep apnea. Mean oxygen saturations, lowest oxygen saturations and mouth breathing outcomes improved in children. Myofunctional therapy could serve as an adjunct to other obstructive sleep apnea treatments. Support None

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 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 Differences in Anthropometric and Clinical Features among Preschoolers, School-Age Children, and Adolescents with Obstructive Sleep Apnea—A Hospital-Based Study in Taiwan

2020 ◽  
Vol 17 (13) ◽  
pp. 4663
Author(s):  
Hai-Hua Chuang ◽  
Jen-Fu Hsu ◽  
Li-Pang Chuang ◽  
Ning-Hung Chen ◽  
Yu-Shu Huang ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Clinical Features ◽  
Neck Circumference ◽  
School Age Children ◽  
Apnea Hypopnea Index ◽  
School Age ◽  
Z Score ◽  
Lymphocyte Ratio ◽  
Obstructive Sleep

Pediatric obstructive sleep apnea (OSA) is associated with adverse health outcomes; however, little is known about the diversity of this population. This retrospective study aims to investigate age-related differences in the anthropometric and clinical features of this population. A total of 253 Taiwanese children (70 (27.7%) girls and 183 (72.3%) boys) with OSA were reviewed. Their median age, body mass index (BMI) z-score, and apnea-hypopnea index were 6.9 years, 0.87, and 9.5 events/h, respectively. The cohort was divided into three subgroups: ‘preschoolers’ (≥2 and <6 years), ‘school-age children’ (≥6 and <10 years), and ‘adolescents (≥10 and <18 years)’. The percentage of the male sex, BMI z-score, neck circumference, systolic blood pressure z-score, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio tended to increase with age. Adenoid grades tended to decrease with age. Overall, disease severity was independently correlated with neck circumference, tonsil size, and adenoid grade. Increased neck circumference and tonsillar hypertrophy were the most influential factors for younger children, whereas adenoidal hypertrophy became more important at an older age. In conclusion, gender prevalence ratio, anthropometric measures, and clinical features varied with age, and the pathogenic drivers were not necessarily the same as the aggravating ones.

scholarly journals Biventricular Myocardial Performance Is Impaired in Proportion to Severity of Obstructive Sleep Apnea

2016 ◽  
Vol 43 (2) ◽  
pp. 119-125 ◽  
Author(s):  
Selahattin Akyol ◽  
Mustafa Cortuk ◽  
Ahmet Oytun Baykan ◽  
Kemal Kiraz ◽  
Abdurrezzak Borekci ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Right Ventricular ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Analysis ◽  
Left Ventricular ◽  
Apnea Hypopnea Index ◽  
Myocardial Performance ◽  
Obstructive Sleep ◽  
Left And Right

Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity and death. Little information is available regarding the relationship between the severity of OSA and myocardial performance in OSA patients who have normal ejection fractions. We prospectively investigated this relationship, using the tissue-Doppler myocardial performance index (TD-MPI). We conducted overnight, full-laboratory polysomnographic examinations of 116 patients, and calculated the left and right ventricular TD-MPIs. Patients were classified into 3 groups in accordance with their apnea-hypopnea index (AHI) levels: AHImild (≥5 to &lt;15), AHImoderate (≥15 to &lt;30), and AHIsevere (≥30). Left and right ventricular TD-MPI values were higher in the AHIsevere group than in the AHImild and AHImoderate groups (all P &lt;0.05). In addition, right ventricular TD-MPI values in the AHImoderate group were higher than those in the AHImild group (P &lt;0.05). Right ventricular TD-MPI was significantly associated with AHI (β=0.468, P &lt;0.001), left ventricular TD-MPI, and right ventricular early-to-late filling velocities (E/A ratio) in multiple linear regression analysis. On the other hand, left ventricular TD-MPI was significantly associated with right ventricular TD-MPI and left ventricular E/A ratio (both P &lt;0.05). Our results show that OSA severity, determined by means of AHI, is independently associated with impaired right and left ventricular function as indicated by TD-MPI in patients who have OSA and normal ejection fractions.

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)

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