Utility of Neck, Height, and Tonsillar Size to Screen for Obstructive Sleep Apnea among Obese Youth

2017 ◽  
Vol 158 (4) ◽  
pp. 745-751 ◽  
Author(s):  
Indra Narang ◽  
Suhail Al-Saleh ◽  
Reshma Amin ◽  
Evan J. Propst ◽  
Saadoun Bin-Hasan ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Predictive Ability ◽  
Ambulatory Setting ◽  
Apnea Hypopnea Index ◽  
Predictive Tool ◽  
Anthropometric Measures ◽  
Cross Sectional ◽  
Obese Youth ◽  
Obstructive Sleep

Objectives To determine whether neck:height ratio combined with adenoid and tonsillar size is a good predictive tool for obstructive sleep apnea in obese youth. Study Design Cross-sectional study. Setting Sleep clinics at the Hospital for Sick Children, Toronto, Canada. Subjects and Methods Consented obese individuals aged 8 to 18 years were recruited between 2013 and 2015. Anthropometric measures were obtained by a trained research coordinator in a standardized manner. Otolaryngologists evaluated adenoid and tonsil sizes. Obstructive sleep apnea was diagnosed with an overnight polysomnogram as an obstructive apnea-hypopnea index ≥2. Multivariable logistic regressions investigated the relationship between potential predictors and obstructive sleep apnea. The C-statistic measured the predictive ability. Results Of the 53 subjects (median age, 13 years; 55% males), 28 (53%) were diagnosed with obstructive sleep apnea, with a median index of 10.6 per hour. In a logistic regression controlling for adenoid size, enlarged tonsils were significantly associated with the presence of obstructive sleep apnea ( P < .01). Adding neck:height ratio into the model improved the model predictive ability (C-index increased from 0.73 to 0.84). Controlling for tonsil and adenoid sizes, an increase in neck:height ratio was significantly associated with the presence of obstructive sleep apnea ( P = .01). Conclusion Our study suggests that neck:height ratio combined with tonsillar hypertrophy may have a strong predictive ability for obstructive sleep apnea and may be useful in an ambulatory setting to screen obese youth at high risk. These findings should be confirmed in a larger study.

Abstract TMP55: Polysomnographic and Sleep-related Variables Associated to Leukoaraiosis in Patients with Obstructive Sleep Apnea

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kevin R Duque ◽  
Brian Villafuerte ◽  
Fiorella Adrianzen ◽  
Rodrigo Zamudio ◽  
Andrea Mendiola ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Logistic Regression ◽  
Sleep Apnea ◽  
Multinomial Logistic Regression ◽  
Sleep Time ◽  
Cross Sectional Study ◽  
Apnea Hypopnea Index ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Medical Histories

Introduction: Obstructive sleep apnea (OSA) is a biological plausible risk factor for leukoaraiosis (LA). We tested the hypothesis that polysomnographic (PSG) and sleep-related variables are associated to LA in OSA patients. Methods: Cross-sectional study in which PSG records, medical histories and brain 1.5T MRI were collected from all consecutive patients who had attended a Sleep Medicine Center between 2009-2014. LA was graded from 0 to 9 with the ’Atherosclerosis Risk In Communities’ study scale. OSA was defined by The International Classification of Sleep Disorders, 2014, and its severity categorizing according to apnea-hypopnea index (AHI, <15 mild, 15 to <30 moderate, 30 to <45 severe and ≥45 very severe). A multinomial logistic regression was performed to describe the association between OSA severity and LA (divided into 2 groups: mild-to-moderate LA and non-to-minimal LA). The covariates for all regression models were age, gender, BMI, hypertension, ischemic stroke, myocardial infarction, diabetes and pack-year of smoking. Results: From 82 OSA patients (77% male; mean age 58±9 years, range 19-91), 54 (66%) had LA. Mild-to-moderate LA was found in 13 patients (8 mild and 5 moderate LA) and non-to-minimal LA in 69 (41 minimal and 28 non LA). Spearman’s correlation coefficient between AHI and LA grade was 0.41 (p<0.001). Furthermore, the higher OSA severity, the higher LA severity (p<0.001, for Jonckheere-Terpstra test for ordered alternatives). In the multinomial logistic regression model adjusted for cofounders, severe OSA patients had higher risk for mild or moderate LA (HR 12.8, 95% IC 1.2-141) compared to mild-to-moderate OSA patients. Additionally, self-reported habitual sleep duration from 7 to 9 hours (HR 0.36, 90% IC 0.14-0.90) and proportion of time in apnea/hypopnea over total sleep time (HR 1.04 for one unit increase, 90% IC 1.01-1.08) could be associated with the presence of LA (adjusted only for age and gender). In a multiple regression analysis with all the aforementioned variables, age (p=0.002), diabetes (p=0.003), and OSA severity (p=0.04) were predictors of the presence of LA. Conclusion: Patients with severe OSA had higher risk for mild to moderate LA when compared to patients with mild or moderate OSA.

Obstructive Sleep Apnea in Acromegaly and the Effect of Treatment: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 105 (3) ◽  
pp. e23-e31 ◽  
Author(s):  
Matteo Parolin ◽  
Francesca Dassie ◽  
Luigi Alessio ◽  
Alexandra Wennberg ◽  
Marco Rossato ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Meta Analysis ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Before And After ◽  
The Difference

Abstract Background Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway collapse requiring nocturnal ventilatory assistance. Multiple studies have investigated the relationship between acromegaly and OSA, reporting discordant results. Aim To conduct a meta-analysis on the risk for OSA in acromegaly, and in particular to assess the role of disease activity and the effect of treatments. Methods and Study Selection A search through literature databases retrieved 21 articles for a total of 24 studies (n = 734). Selected outcomes were OSA prevalence and apnea-hypopnea index (AHI) in studies comparing acromegalic patients with active (ACT) vs inactive (INACT) disease and pretreatment and posttreatment measures. Factors used for moderator and meta-regression analysis included the percentage of patients with severe OSA, patient sex, age, body mass index, levels of insulin-like growth factor 1, disease duration and follow-up, and therapy. Results OSA prevalence was similar in patients with acromegaly who had ACT and INACT disease (ES = −0.16; 95% CI, −0.47 to 0.15; number of studies [k] = 10; P = 0.32). In addition, AHI was similar in ACT and INACT acromegaly patients (ES = −0.03; 95% CI, −0.49 to 0.43; k = 6; P = 0.89). When AHI was compared before and after treatment in patients with acromegaly (median follow-up of 6 months), a significant improvement was observed after treatment (ES = −0.36; 95% CI, −0.49 to −0.23; k = 10; P &lt; 0.0001). In moderator analysis, the percentage of patients with severe OSA in the populations significantly influenced the difference in OSA prevalence (P = 0.038) and AHI (P = 0.04) in ACT vs INACT patients. Conclusion Prevalence of OSA and AHI is similar in ACT and INACT patients in cross-sectional studies. However, when AHI was measured longitudinally before and after treatment, a significant improvement was observed after treatment.

scholarly journals 0722 The Association Between Obstructive Sleep Apnea and Neurobehavioural Function in Men: A Large, Population-Based Cohort Study

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A274-A275
Author(s):  
J L Parker ◽  
R J Adams ◽  
S L Appleton ◽  
Y A Melaku ◽  
A Vakulin
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Inspection Time ◽  
Sleep Disruption ◽  
Clinical Samples ◽  
Apnea Hypopnea Index ◽  
Cross Sectional ◽  
Obstructive Sleep

Abstract Introduction Obstructive sleep apnea (OSA) is linked with impaired vigilance, attention, memory and executive function. However, this evidence largely comes from small experimental studies or larger studies in clinical samples and therefore the scope and magnitude of OSA driven neurobehavioural dysfunction in the general population remains unclear. This study aimed to examine the cross-sectional association between OSA and neurobehavioural function in a large community sample of men. Methods A total of 837 participants from the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study, a longitudinal cohort of men 40+ years, underwent full overnight polysomnography. Participants completed the inspection time (IT) test, mini-mental state examination (MMSE), Fuld object memory evaluation (FOME), and trail-making test (TMT) part A (TMT-A) and part B (TMT-B). Using regression models adjusted for multiple important covariates, we examined the association between neurobehavioural function scores, clinical metrics of OSA severity (Apnea-Hypopnea Index (AHI); percentage total sleep time with oxygen saturation &lt;90% (TST90), and measures of sleep disruption (duration of rapid eye movement (REM) and non-REM (NREM) sleep; and total sleep time (TST). Results In multivariable linear regressions, greater TST was associated with worse IT scores (B=13.688, 95% CI [0.134, 27.241], P=0.048) and TMT-B scores (B=19.255, 95% CI [0.931, 37.578], P=0.040). In logistic regressions, greater TST was associated with better MMSE scores (Odds ratio [OR]=0.440, 95% CI [0.194, 0.997], P=0.049); and higher AHI was strongly associated with worse FOME scores in fully adjusted models (OR=1.358, 95% CI [1.252, 1.472], P&lt;0.001). Conclusion The AHI and TST were positively, significantly associated with neurobehavioural function across different domains. This cross-sectional data shows that neurobehavioural function deficits in OSA are directly related to sleep and breathing disruptions. Future large prospective studies are needed to determine if OSA and sleep disruption predict future onset of neurobehavioural dysfunction and cognitive decline. Support National Health and Medical Research Council and the Adelaide Institute for Sleep Health.

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

PLoS ONE ◽  
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.

Association between Flexible Nasal Endoscopy, Polysonography Findins and Obstructive Sleep Apnea Severety

2021 ◽  
Vol 9 (3) ◽  
pp. 01-06
Author(s):  
Zappelini CEM ◽  
Jeremias LA ◽  
Borba IN ◽  
Machado LZ ◽  
Nicoladelli SJ ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Rem Sleep ◽  
Sleep Stage ◽  
Upper Airway ◽  
Inverse Correlation ◽  
Apnea Hypopnea Index ◽  
Upper Airways ◽  
Cross Sectional ◽  
Obstructive Sleep

Introduction: Obstructive Sleep Apnea (OSA) is a condition with recurrent collapses of the pharyngeal region that result in partial or total reduction in airflow. Its diagnosis and severity depends on the Apnea-Hypopnea Index (AHI), data from the polysomnography exam (PSG). Its pathophysiology includes anatomical disorders of the upper airways that can be assessed through Flexible Nasofibroscopy (FN). Objective: To identify the alterations present in the tests of FN and PSG in patients with OSA and correlate with the AHI. Methods: Cross-sectional study, with data collected from reports of the FN and PSG exams of 81 patients with OSA, seen at an otorhinolaryngology clinic in Tubarão - SC. It was verified the association between the outcome –AHI- and other exposure variables - sociodemographic and clinical. Results: Among the 81 patients, 75.31% were male, 41.98% had mild apnea, 30.86% moderate and 27.16% severe apnea. There was no correlation between FN findings and AHI (p> 0.05). There was a difference between the mean age, number of obstructive episodes per hour of sleep and minimum saturation between the groups with severe and mild apnea (p <0.05). Patients with severe apnea had a higher percentage of sleep phase one and a shorter REM sleep time compared to the mild apnea group (p <0.05). A positive correlation was obtained between: obstructive episodes with sleep stage 1 (p <0.01) and age (p <0.05); between minimum saturation and sleep stage 3 (p <0.05). There was an inverse correlation between obstructive episodes with minimal saturation (p <0.001), with sleep stage 3 (p <0.01) and with REM sleep (p <0.01); between age and minimum saturation (p <0.01). Conclusion: OSA directly interferes with sleep architecture. The present study did not find association between upper airway alterations and OSA severity.

scholarly journals Risk factors for respiratory complications after adenotonsillectomy in children with obstructive sleep apnea

2015 ◽  
Vol 41 (3) ◽  
pp. 238-245 ◽  
Author(s):  
Renato Oliveira Martins ◽  
Nuria Castello-Branco ◽  
Jefferson Luis de Barros ◽  
Silke Anna Theresa Weber
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Teaching Hospital ◽  
Orotracheal Intubation ◽  
Apnea Hypopnea Index ◽  
Respiratory Complications ◽  
Cross Sectional ◽  
Historical Cohort ◽  
Obstructive Sleep

Objective: To identify risk factors for respiratory complications after adenotonsillectomy in children ≤ 12 years of age with obstructive sleep apnea who were referred to the pediatric ICU (PICU). Methods: A cross-sectional historical cohort study analyzing 53 children after adenotonsillectomy who met predetermined criteria for PICU referral in a tertiary level teaching hospital. The Student's t-test, Mann-Whitney test, and chi-square test were used to identify risk factors. Results: Of the 805 children undergoing adenotonsillectomy between January of 2006 and December of 2012 in the teaching hospital, 53 were referred to the PICU. Twenty-one children (2.6% of all those undergoing adenotonsillectomy and 39.6% of those who were referred to the PICU) had respiratory complications. Of those 21, 12 were male. The mean age was 5.3 ± 2.6 years. A high apnea-hypopnea index (AHI; p = 0.0269), a high oxygen desaturation index (ODI; p = 0.0082), a low SpO2 nadir (p = 0.0055), prolonged orotracheal intubation (p = 0.0011), and rhinitis (p = 0.0426) were found to be independent predictors of respiratory complications. Some of the complications observed were minor (SpO2 90-80%), whereas others were major (SpO2 ≤ 80%, laryngospasm, bronchospasm, acute pulmonary edema, pneumonia, and apnea). Conclusions: Among children up to 12 years of age with OSA, those who have a high AHI, a high ODI, a low SpO2 nadir, or rhinitis are more likely to develop respiratory complications after adenotonsillectomy than are those without such characteristics.

Tracheal hysteresis in sleep apnea

1989 ◽  
Vol 67 (4) ◽  
pp. 1349-1353 ◽  
Author(s):  
I. Katz ◽  
N. Zamel ◽  
A. S. Slutsky ◽  
A. S. Rebuck ◽  
V. Hoffstein
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Muscle Tone ◽  
Upper Airway ◽  
Lung Parenchyma ◽  
Apnea Hypopnea Index ◽  
Cross Sectional ◽  
Acoustic Reflection ◽  
Obstructive Sleep ◽  
Pharyngeal Muscles

The collapsibility of pharyngeal walls, characteristic of patients with obstructive sleep apnea, likely results from reduced tone of the pharyngeal muscles. This reduction in the upper airway muscle tone may not end at the pharynx but may extend further distally, e.g., into the trachea. Because tracheal tone cannot be measured directly in conscious humans, we inferred the tone from the relative hysteresis of the tracheal area compared with the lung. Relative hysteresis was measured by plotting the cross-sectional area of a tracheal segment obtained by the acoustic reflection technique vs. lung volume. All measurements were performed during wakefulness. We found that in 42 patients with obstructive sleep apnea (apnea/hypopnea index greater than 10), relative hysteresis of the proximal trachea was predominantly clockwise, i.e., smaller than that of the lung parenchyma; in the 33 nonapneic patients (apnea/hypopnea index less than or equal to 10), it was predominantly counter-clockwise, i.e., larger than that of the lung parenchyma. For the distal trachea all patients, apneic and nonapneic, had similar, clockwise, relative hysteresis. We conclude that reduction in the upper airway muscle tone in patients with obstructive sleep apnea extends into the trachea.

scholarly journals Heart Rate Dynamics in Patients with Obstructive Sleep Apnea: Heart Rate Variability and Entropy

Entropy ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. 927
Author(s):  
Lulu Zhang ◽  
Mingyu Fu ◽  
Fengguo Xu ◽  
Fengzhen Hou ◽  
Yan Ma
Keyword(s):  
Heart Rate ◽  
Obstructive Sleep Apnea ◽  
Heart Rate Variability ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Cross Sectional ◽  
Sleep Study ◽  
Ecg Signals ◽  
Potential Association ◽  
Obstructive Sleep

Background: Obstructive sleep apnea (OSA), a highly prevalent sleep disorder, is closely related to cardiovascular disease (CVD). Our previous work demonstrated that Shannon entropy of the degree distribution (EDD), obtained from the network domain of heart rate variability (HRV), might be a potential indicator for CVD. Method: To investigate the potential association between OSA and EDD, OSA patients and healthy controls (HCs) were identified from a sleep study database. Then EDD was calculated from electrocardiogram (ECG) signals during sleep, followed by cross-sectional comparisons between OSA patients and HCs, and longitudinal comparisons from baseline to follow-up visits. Furthermore, for OSA patients, the association between EDD and OSA severity, measured by apnea-hypopnea index (AHI), was also analyzed. Results: Compared with HCs, OSA patients had significantly increased EDD during sleep. A positive correlation between EDD and the severity of OSA was also observed. Although the value of EDD became larger with aging, it was not OSA-specified. Conclusion: Increased EDD derived from ECG signals during sleep might be a potential dynamic biomarker to identify OSA patients from HCs, which may be used in screening OSA with high risk before polysomnography is considered.

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

2017 ◽  
Vol 2017 ◽  
pp. 1-13 ◽  
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.

Sign in / Sign up

Export Citation Format

Share Document