Defining Risk of Postoperative Obstructive Sleep Apnea in Patients With 22q11.2DS Undergoing Pharyngeal Flap Surgery for Velopharyngeal Dysfunction Using Polysomnographic Evaluation

Objective: To determine pre- and postoperative prevalence of obstructive sleep apnea (OSA) in patients with 22q11.2 deletion syndrome (DS) undergoing wide posterior pharyngeal flap (PPF) surgery for velopharyngeal dysfunction (VPD). Design: Retrospective study using pre- and postoperative polysomnography (PSG) to determine prevalence of OSA. Medical records were reviewed for patients’ medical comorbidities. Parents were surveyed about snoring. Setting: Academic tertiary care pediatric hospital. Patients: Forty patients with laboratory confirmed 22q11.2DS followed over a 6-year period. Interventions: Pre- and postoperative PSG, speech evaluation, and parent surveys. Main Outcome Measure: Severity and prevalence of OSA, defined by obstructive apnea hypopnea index (OAHI), before and after PPF surgery to determine whether PPF is associated with increased risk of OSA. Results: Mean OAHI did not change significantly after PPF surgery (1.1/h vs 2.1/h, P = .330). Prevalence of clinically significant OSA (OAHI ≥ 5) was identical pre- and postoperatively (2 of 40), with both cases having severe-range OSA requiring positive airway pressure therapy. All other patients had mild-range OSA. Nasal resonance was graded as severe preoperatively in 85% of patients. None were graded as severe postoperatively. No single patient factor or parent-reported concern predicted risk of OSA (OAHI ≥ 1.5). Conclusions: Patients with 22q11.2DS are medically complex and are at increased risk of OSA at baseline. Wide PPF surgery for severe VPD does not significantly increase risk of OSA. Careful perioperative planning is essential to optimize both speech and sleep outcomes.

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Randomized controlled trial of an integrated approach to treating insomnia and improving the use of positive airway pressure therapy in veterans with comorbid insomnia disorder and obstructive sleep apnea

SLEEP ◽

10.1093/sleep/zsaa235 ◽

2020 ◽

Author(s):

Cathy A Alessi ◽

Constance H Fung ◽

Joseph M Dzierzewski ◽

Lavinia Fiorentino ◽

Carl Stepnowsky ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Sleep Onset ◽

Apnea Hypopnea Index ◽

Sleep Onset Latency ◽

Pressure Therapy ◽

Comorbid Insomnia ◽

Obstructive Sleep

Abstract Study Objectives Cognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway pressure (PAP) adherence program and tested effects on sleep and PAP use. Methods 125 veterans (mean age 63.2, 96% men, 39% non-Hispanic white, 26% black/African American, 18% Hispanic/Latino) with comorbid insomnia and newly-diagnosed OSA (apnea-hypopnea index ≥ 15) were randomized to 5-weekly sessions integrating CBTI with a PAP adherence program provided by a “sleep coach” (with behavioral sleep medicine supervision), or 5-weekly sleep education control sessions. Participants and assessment staff were blinded to group assignment. Outcomes (baseline, 3 and 6 months) included Pittsburgh Sleep Quality Index (PSQI), 7-day sleep diary (sleep onset latency [SOL-D], wake after sleep onset [WASO-D], sleep efficiency [SE-D]), 7-day actigraphy (SE-A), and objective PAP use (hours/night and nights ≥ 4 h). Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) were also collected. Results Compared to controls, intervention participants showed greater improvement (baseline to 3 and 6 months, respectively) in PSQI (−3.2 and −1.7), SOL-D (−16.2 and −15.5 minutes), SE-D (10.5% and 8.5%), SE-A (4.4% and 2.6%) and more 90-day PAP use (1.3 and 0.9 more hours/night, 17.4 and 11.3 more nights PAP ≥ 4 h). 90-day PAP use at 3 months was 3.2 and 1.9 h/night in intervention versus controls. Intervention participants also had greater improvements in ISI, ESS, and FOSQ-10 (all p < 0.05). Conclusions An intervention integrating CBTI with a PAP adherence program delivered by a supervised sleep coach improved sleep and PAP use in adults with comorbid insomnia and OSA. Trial Registration ClinicalTrials.gov Study name: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older Veterans URL: https://clinicaltrials.gov/ct2/results?cond=&term=NCT02027558&cntry=&state=&city=&dist= Registration: NCT02027558

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Multilevel Sleep Surgery Including the Palate in Nonsyndromic, Neurologically Intact Children with Obstructive Sleep Apnea

OTO Open ◽

10.1177/2473974x19851473 ◽

2019 ◽

Vol 3 (2) ◽

pp. 2473974X1985147

Author(s):

Jason E. Cohn ◽

George E. Relyea ◽

Srihari Daggumati ◽

Brian J. McKinnon

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Tertiary Care ◽

Case Series ◽

T Test ◽

Velopharyngeal Insufficiency ◽

Apnea Hypopnea Index ◽

Sleep Surgery ◽

Obstructive Sleep ◽

Neurologically Intact

Objective To examine the effects of multilevel sleep surgery, including palate procedures, on obstructive sleep apnea parameters in the pediatric population. Study Design A case series with chart review was conducted to identify nonsyndromic, neurologically intact pediatric patients who underwent either uvulectomy or uvulopalatopharyngoplasty as part of multilevel sleep surgery from 2011 through 2017. Setting A tertiary care, university children’s hospital. Subjects and Methods Unpaired Student t test was used to compare average pre- and postsurgical apnea-hypopnea index (AHI) and oxygen saturation nadir (OSN). Paired Student t test was used to compare the mean pre- and postsurgical AHI and OSN within the same patient for the effects of adenotonsillectomy (T&A) vs multilevel sleep surgery. Results In patients who underwent T&A previously, multilevel sleep surgery, including palate procedures, resulted in improved OSA severity in 6 (86%) patients and worsened OSA in 1 (14%) patient. Multilevel sleep surgery, including palate procedures, significantly decreased mean AHI from 37.98 events/h preoperatively to 8.91 events/h postoperatively ( P = .005). However, it did not significantly decrease OSN. Conclusion This study includes one of the largest populations of children in whom palate procedures as a part of multilevel sleep surgery have been performed safely with no major complications and a low rate of velopharyngeal insufficiency. Therefore, palatal surgery as a part of multilevel sleep surgery is not necessarily the pariah that we have traditional thought it is in pediatric otolaryngology.

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Polysomnographic Outcomes After Observation for Mild Obstructive Sleep Apnea in Children Younger Than 3 Years

Otolaryngology ◽

10.1177/0194599820954383 ◽

2020 ◽

pp. 019459982095438

Author(s):

Kathleen M. Sarber ◽

Douglas C. von Allmen ◽

Raisa Tikhtman ◽

Javier Howard ◽

Narong Simakajornboon ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Care Center ◽

Tertiary Care ◽

Apnea Hypopnea Index ◽

Optimal Timing ◽

Obstructive Apnea ◽

Obstructive Sleep ◽

Mild Obstructive Sleep Apnea ◽

The Impact

Objective Mild obstructive sleep apnea (OSA), particularly in young children, is often treated with observation. However, there is little evidence regarding the outcomes with this approach. Our aim was to assess the impact of observation on sleep for children aged <3 years with mild OSA. Study Design Case-control study. Setting Pediatric tertiary care center. Methods We reviewed cases of children (<3 years old) diagnosed with mild OSA (obstructive apnea-hypopnea index, 1-5 events/h) who were treated with observation between 2012 and 2017 and had at least 2 polysomnograms performed 3 to 12 months apart. Demographic data and comorbid diagnoses were collected. Results Twenty-six children met inclusion criteria; their median age was 7.2 months (95% CI, 1.2-22.8). Nine (35%) were female and 24 (92%) were White. Their median body mass index percentile was 39 (95% CI, 1-76). Comorbidities included cardiac disease (42.3%), laryngomalacia (42.3%), allergies (34.6%), reactive airway disease (23.1%), and prematurity (7.7%). The obstructive apnea-hypopnea index significantly decreased from 2.7 events/h (95% CI, 1-4.5) to 1.3 (95% CI, 0-4.5; P = .013). There was no significant improvement in median saturation nadir (baseline, 86%; P = .76) or median time with end-tidal carbon dioxide >50 mm Hg (baseline, 0 minutes; P = .34). OSA resolved in 8 patients (31%) and worsened in 1 (3.8%). Only race was a significant predictor of resolution per regression analysis; however, only 2 non-White children were included. Conclusion In our cohort, resolution of mild OSA occurred in 31% of patients treated with 3 to 12 months of observation. The presence of laryngomalacia, asthma, and allergies did not affect resolution. Larger studies are needed to better identify factors (including race) associated with persistent OSA and optimal timing of intervention for these children. Level of Evidence 4.

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Polysomnography Outcomes after Supraglottoplasty in Children with Obstructive Sleep Apnea

Otolaryngology ◽

10.1177/0194599819844512 ◽

2019 ◽

Vol 161 (4) ◽

pp. 694-698 ◽

Cited By ~ 3

Author(s):

Bharat Bhushan ◽

James W. Schroeder ◽

Kathleen R. Billings ◽

Nicholas Giancola ◽

Dana M. Thompson

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Tertiary Care ◽

Case Series ◽

Apnea Hypopnea Index ◽

Historical Cohort ◽

Tertiary Care Medical Center ◽

Obstructive Sleep ◽

The Mean ◽

The Impact

ObjectiveLaryngomalacia has been reported to contribute to the severity of obstructive sleep apnea (OSA) in children. It is unclear if surgical treatment of laryngomalacia improves polysomnography (PSG) outcomes in these patients. The objective of this study is to report the impact of supraglottoplasty on PSG parameters in children with laryngomalacia-related OSA.Study DesignRetrospective case series.SettingTertiary care medical center.Subjects and MethodsHistorical cohort study of consecutive children with laryngomalacia who underwent supraglottoplasty and who had undergone overnight PSG before and after surgery.ResultsForty-one patients were included in the final analysis: 22 (53.6%) were male, and 19 (46.3%) were female. The mean ± SEM age of patients at preoperative PSG was 1.3 ± 0.89 years (range, 0.003-2.9). In entire cohort, the mean obstructive apnea-hypopnea index score was reduced from 26.6 events/h before supraglottoplasty to 7.3 events/h after surgery ( P = .003). Respiratory disturbance index was reduced from 27.3 events/h before supraglottoplasty to 7.8 events/h after surgery ( P = .003). The percentage of REM sleep decreased from 30.1% ± 2.4 to 24.8% ± 1.3 ( P = .04). Sleep efficiency was improved ( P = .05).ConclusionOverall, supraglottoplasty significantly improved several PSG outcomes in children with laryngomalacia. However, mild to moderate OSA was still present postoperatively in most children. This suggested a multifactorial cause for OSA in this population.

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Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000737 ◽

2019 ◽

Vol 7 (1) ◽

pp. e000737 ◽

Cited By ~ 2

Author(s):

Xiao Wang ◽

Jingyao Fan ◽

Yunhui Du ◽

Changsheng Ma ◽

Xinliang Ma ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Acute Coronary Syndrome ◽

Sleep Apnea ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Apnea Hypopnea Index ◽

Coronary Syndrome ◽

Diabetes Status ◽

Obstructive Sleep ◽

Increased Risk

ObjectiveThe prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to diabetes mellitus (DM) status remains unclear. We aimed to elucidate the association of OSA with subsequent cardiovascular events in patients with ACS with or without DM.Research design and methodsIn this prospective cohort study, consecutive eligible patients with ACS underwent cardiorespiratory polygraphy between June 2015 and May 2017. OSA was defined as an Apnea Hypopnea Index ≥15 events/hour. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure.ResultsAmong 804 patients, 248 (30.8%) had DM and 403 (50.1%) had OSA. OSA was associated with 2.5 times the risk of 1 year MACCE in patients with DM (22.3% vs 7.1% in the non-OSA group; adjusted HR (HR)=2.49, 95% CI 1.16 to 5.35, p=0.019), but not in patients without DM (8.5% vs 7.7% in the non-OSA group, adjusted HR=0.94, 95% CI 0.51 to 1.75, p=0.85). Patients with DM without OSA had a similar 1 year MACCE rate as patients without DM. The increased risk of events was predominately isolated to patients with OSA with baseline glucose or hemoglobin A1c levels above the median. Combined OSA and longer hypoxia duration (time with arterial oxygen saturation <90%>22 min) further increased the MACCE rate to 31.0% in patients with DM.ConclusionsOSA was associated with increased risk of 1 year MACCE following ACS in patients with DM, but not in non-DM patients. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS and DM are warranted.

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The Role of Severity of Obstructive Sleep Apnea Measured by Apnea–Hypopnea Index in Predicting Compliance With Pressure Therapy, a Meta-analysis

American Journal of Therapeutics ◽

10.1097/mjt.0b013e318249a09d ◽

2014 ◽

Vol 21 (4) ◽

pp. 260-264 ◽

Cited By ~ 10

Author(s):

Essam M. Madbouly ◽

Rashid Nadeem ◽

Mahwish Nida ◽

Janos Molnar ◽

Saurabh Aggarwal ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Meta Analysis ◽

Apnea Hypopnea Index ◽

Pressure Therapy ◽

Obstructive Sleep

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Analysis of Metabolites Changes on Obstructive Sleep Apnea Patients After Multilevel Sleep Surgery

10.20944/preprints202007.0327.v1 ◽

2020 ◽

Author(s):

Abdulmohsen Alterki ◽

Shibu Joseph ◽

Thangavel Alphonse Thanaraj ◽

Irina Al-Khairi ◽

Preethi Cherian ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Metabolic Status ◽

Apnea Hypopnea Index ◽

P Value ◽

Upper Airways ◽

Sleep Surgery ◽

Post Surgery ◽

Obstructive Sleep ◽

Increased Risk

Background: Obstructive sleep apnea (OSA) is caused by partial or complete obstruction of the upper airways. Corrective surgeries aim at removing obstructions in the nasopharynx, oropharynx, and hypopharynx. OSA is associated with increased risk of various metabolic diseases. Our objective was to evaluate the effect of surgery on the plasma metabolome. Methods: This study included 39 OSA patients who underwent Multilevel Sleep Surgery (MLS). Clinical and anthropometric measures were taken at baseline and 5 months after surgery. Results: The mean Apnea Hypopnea Index (AHI) significantly dropped from 22.0 ± 18.5 events/hour to 8.97 ± 9.57 events/hour (p-Value <0.001). The Epworth’s sleepiness Score (ESS) dropped from 12.8 ± 6.23 to 2.95 ± 2.40 (p-Value <0.001) indicating success of the surgery in treating OSA. Plasma levels of metabolites, phosphocholines (PC) PC.41.5, PC.42.3, ceremide (Cer) Cer.44.0, and triglyceride (TG) TG.53.6, TG.55.6 and TG.56.8 were decreased (p-Value<0.05) whereas lysophosphatidylcholines (LPC) 20.0 and PC.39.3 were increased (p-Value<0.05) after surgery. Conclusion: This study highlights the success of MLS in treating OSA. Treatment of OSA resulted in improvement in metabolic status that was characterized by decreased TG, PCs and Cer metabolites post-surgery indicating that the success of the surgery positively impacted the metabolic status of these patients.

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Abstract 120: Prevalence and Impact of Patent Foramen Ovale in Patients with Obstructive Sleep Apnea

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.36.suppl_1.120 ◽

2016 ◽

Vol 36 (suppl_1) ◽

Author(s):

Phillip Camp ◽

Abinash Achrekar ◽

Umar Malik ◽

Warren Laskey

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Patent Foramen Ovale ◽

Right Atrial ◽

Apnea Hypopnea Index ◽

Foramen Ovale ◽

Contrast Injection ◽

Obstructive Sleep ◽

Increased Risk ◽

Study Population

Introduction: It is well known that obstructive sleep apnea (OSA) prevalence increases as body mass index (BMI) increases. Lesser known is patent foramen ovale (PFO) is found in 12 to 35 percent of adults. Patients with OSA experience nocturnal apnea which result in hypoxemia, elevation of right atrial pressure, and an increase in right to left shunting and a theoretical increased risk of stroke. A few studies have suggested an association between the severity of OSA and a PFO. As such, OSA diagnosis and therapy may be tailored to address right-to-left shunting in these patients. If the prevalence of PFO in OSA patients is increased, it may be appropriate to include transthoracic echocardiography (TTE) testing as a component of routine evaluation of patients with OSA. Hypothesis: We hypothesize that patients with hypoxemia related to OSA are more likely to have a PFO with right-to-left shunting than those with less dramatic hypoxemia. We hope to determine the prevalence and clinical relevance of intra-cardiac shunting in patients with OSA by prospectively analyzing and correlating polysomnography and TTE findings. Methods: 80 patients with OSA were referred for TTE by the UNM Sleep Center. All patients underwent saline contrast TTE in the UNM echo lab. The prevalence of PFO in the general UNM echo population was calculated over the last year for comparison. Results: Of 80 patients with varying degrees of OSA, 12.5% had right to left shunting. PFO was not statistically associated with DI (Desaturation Index), nor any AHI (Apnea Hypopnea Index). The only statistically significant association was between OSA and BMI (p=0.013). BMI associated with DI and AHI was statistically significant (p=0.003 and p=0.005, respectively). Over the last year, 216 PFO’s were found from 1858 echo studies with contrast injection performed at UNM with a prevalence rate of 11.6%. Conclusions: In contrast to previous studies, there was no association between OSA of any severity and PFO in our study population. There was a statistically significant association between BMI and OSA, which is well established. Our study prevalence was found to be similar to the UNM general echo population as well, indicating that OSA patients within our study group were not as likely to have an associated PFO.

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Targeted Metabolomics Analysis on Obstructive Sleep Apnea Patients after Multilevel Sleep Surgery

Metabolites ◽

10.3390/metabo10090358 ◽

2020 ◽

Vol 10 (9) ◽

pp. 358

Author(s):

Abdulmohsen Alterki ◽

Shibu Joseph ◽

Thangavel Alphonse Thanaraj ◽

Irina Al-Khairi ◽

Preethi Cherian ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Metabolic Diseases ◽

Metabolic Status ◽

Apnea Hypopnea Index ◽

P Value ◽

Upper Airways ◽

Sleep Surgery ◽

Obstructive Sleep ◽

Increased Risk

Background: Obstructive sleep apnea (OSA) is caused by partial or complete obstruction of the upper airways. Corrective surgeries aim at removing obstructions in the nasopharynx, oropharynx, and hypopharynx. OSA is associated with an increased risk of various metabolic diseases. Our objective was to evaluate the effect of surgery on the plasma metabolome. Methods: This study included 39 OSA patients who underwent Multilevel Sleep Surgery (MLS). Clinical and anthropometric measures were taken at baseline and five months after surgery. Results: The mean Apnea-Hypopnea Index (AHI) significantly dropped from 22.0 ± 18.5 events/hour to 8.97 ± 9.57 events/hour (p-Value < 0.001). Epworth’s sleepiness Score (ESS) dropped from 12.8 ± 6.23 to 2.95 ± 2.40 (p-Value < 0.001), indicating the success of the surgery in treating OSA. Plasma levels of metabolites, phosphocholines (PC) PC.41.5, PC.42.3, ceremide (Cer) Cer.44.0, and triglyceride (TG) TG.53.6, TG.55.6 and TG.56.8 were decreased (p-Value < 0.05), whereas lysophosphatidylcholines (LPC) 20.0 and PC.39.3 were increased (p-Value < 0.05) after surgery. Conclusion: This study highlights the success of MLS in treating OSA. Treatment of OSA resulted in an improvement of the metabolic status that was characterized by decreased TG, PCs, and Cer metabolites after surgery, indicating that the success of the surgery positively impacted the metabolic status of these patients.

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Association between Obstructive Sleep Apnea and SYNTAX Score

Journal of Clinical Medicine ◽

10.3390/jcm9103314 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3314

Author(s):

Sayaki Ishiwata ◽

Yasuhiro Tomita ◽

Sugao Ishiwata ◽

Koji Narui ◽

Hiroyuki Daida ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Coronary Angiography ◽

Smoking Status ◽

Apnea Hypopnea Index ◽

Syntax Score ◽

Obstructive Sleep ◽

Increased Risk ◽

Partial Correlations ◽

Obesity Hypertension

Obstructive sleep apnea (OSA) is related to an increased risk of cardiovascular diseases, including coronary artery disease (CAD). We investigated the association between OSA and the severity of CAD by assessing coronary angiography findings. We retrospectively analyzed patients who underwent their first coronary angiography to evaluate CAD and polysomnography (PSG) to investigate the severity of OSA in our hospital from March 2002 to May 2015. The severity of CAD was determined based on coronary angiography findings using the SYNTAX score. The patients were divided into two groups according to the apnea-hypopnea index (AHI): mild OSA (AHI < 15/h) and moderate-to-severe OSA (AHI ≥ 15/h). Overall, 98 patients were enrolled. The SYNTAX score was significantly different between the two groups (p = 0.001). After adjustment for other risk factors, including age, sex, obesity, hypertension, hyperlipidemia, diabetes mellitus, smoking status, and family history of CAD, moderate-to-severe OSA significantly correlated to the SYNTAX score (partial correlations = 0.24, p = 0.039). These results suggest that the severity of CAD is related to moderate-to-severe OSA.

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