scholarly journals Identifying Signs and Symptoms of Obstructive Sleep Apnea in a Men’s Health Clinic: The Utility of Home Sleep Apnea Testing During COVID-19

2021 ◽  
Vol 15 (3) ◽  
pp. 155798832110294
Author(s):  
Alexander Hart ◽  
Steffanie Robertus ◽  
Mark Dyken ◽  
Amy Pearlman
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Health Clinic ◽  
Apnea Test ◽  
Sleep Study ◽  
Presenting Symptoms ◽  
Obstructive Sleep ◽  
Home Sleep Apnea Testing

The objective of the study was to identify symptoms of men presenting for an outpatient urology visit that prompted referral for a Home Sleep Apnea Test (HSAT) to assess for obstructive sleep apnea (OSA) by a single provider. To assess the proportion of patients referred for the HSAT who underwent the test and, out of these patients, the proportion of men diagnosed with sleep apnea, we performed a retrospective chart review of men 18–99 years old seen by a single provider in the Department of Urology referred for an HSAT to evaluate for presenting symptoms. Patients with a prior diagnosis of OSA were excluded. Eighteen patients were identified (mean age at time of referral 51 + SD 13 years). Half of patients reported erectile dysfunction/concerns, 56% reported nocturia, 44% had been diagnosed with testosterone deficiency, and 39% reported low libido. Nearly all (89%) of patients snored, all reported fatigue, 56% were over the age of 50, 44% had a BMI >35, and 78% had hypertension. Twelve patients completed the HSAT, all of whom were diagnosed with OSA for which continuous positive airway pressure (CPAP) therapy was initiated. Men presenting with genitourinary concerns to an outpatient urology clinic may also have OSA. About half of included patients reported genitourinary concerns. Hundred percent of patients who completed their sleep study were diagnosed with OSA. Genitourinary concerns, in addition to signs and symptoms commonly associated with OSA, should prompt consideration of sleep apnea evaluation.

scholarly journals 0610 Prevalence of Positional Obstructive Sleep Apnea Based on 3% Vs 4% Oxygen Desaturation Using Home Sleep Apnea Testing

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A233-A234
Author(s):  
M Mandal ◽  
R Rengan ◽  
S Rani ◽  
J Ramzy ◽  
M Vega Sanchez ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Desaturation ◽  
Apnea Hypopnea Index ◽  
Apnea Test ◽  
Positional Obstructive Sleep Apnea ◽  
Obstructive Sleep ◽  
Respiratory Event ◽  
Home Sleep Apnea Testing ◽  
Definition Of

Abstract Introduction Approximately 30% of patient with obstructive sleep apnea (OSA) have positional OSA [non-supine apnea-hypopnea index (AHI) < 5 events/hr]. However, the prevalence is based on variable definitions for hypopneas related to the degree of oxygen desaturation. In addition, use of a home sleep apnea test (HSAT) to identify positional OSA is limited. We hypothesized that in patients evaluated with an HSAT, using a definition for hypopneas based on 4% compared to 3% oxygen desaturation will significantly decrease the percentage diagnosed with positional OSA. Methods Fourteen patients with positional OSA based on a non-supine respiratory event index (REI) < 5 events/hr were included. The initial diagnosis was determined based on a hypopnea definition of ≥ 3% oxygen desaturation. The studies were reanalyzed using a hypopnea definition of ≥ 4% oxygen desaturation. Results Fourteen patients [9 (64%) males, 46±14 yrs, BMI 31±6 kg/m2, ESS 7±5, REI 9±3 events/hr, mean SaO2 94±2%, lowest SaO2 81±6%, %TST SaO2 < 90% 4±6%] were identified with positional OSA (supine REI 16±7 events/hr, non-supine REI 3±1 events/hr) using a hypopneas definition of ≥ 3% oxygen desaturation. When reanalyzed using a hypopnea ≥ 4% oxygen desaturation there was a significant decrease in the REI to 7±2 events/hr (p<0.001). Three patients (21%) no longer were considered to have OSA. These patients were younger (32±14 vs. 50±11yrs, p=0.03) and had less severe OSA (REI 6±1 vs. 9±3 events/hr (p=0.04), but there was no difference in BMI (32±11 vs. 31±5 kg/m2, p=0.9) or mean and lowest SaO2 (96±0.4 vs. 94±2%, p=0.13, and 82±8 vs. 81±6%, p=0.9, respectively). Conclusion In patients with mild positional OSA, using a hypopnea definition of at least 4% vs. 3% oxygen desaturation on a HSAT will have a significant effect on the overall REI and often exclude patients who would otherwise be treated for OSA. Support None.

Screening tools for identifying a high probability of obstructive sleep apnea

2012 ◽  
Vol 19 (3) ◽  
pp. 123-125
Author(s):  
Juris Svaza ◽  
Jekaterina Grava ◽  
Jana Smolko
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Perioperative Complications ◽  
Signs And Symptoms ◽  
Medical Problem ◽  
The Body ◽  
Screening Tools ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
Patient Questionnaires

Background. Obstructive sleep apnea (OSA) is a common medical problem that affects up to 5% of the population. The majority of OSA patients are undiagnosed and have a potential for perioperative complications. Our study was conducted to validate the most widely used screening tools for identifying high risk OSA patients and to find the most predictable physical signs and symptoms of OSA. Materials and methods. At the Sleep Laboratory of Riga Stradins University, 100 patients with suspected OSA were asked to fill in patient questionnaires prior to the sleep study. The patients’ anthropometric data, physical signs and medical history were collected. To confirm the diagnosis of OSA, all patients underwent a full night sleep study. To find the possible correlation, the data collected from the questionnaires were compared with the data from sleep studies. Results. Patients (n = 100) at a mean age of 47 yrs. (23–73), 22 women, 78 men. No OSA was found in 17%, mild OSA in 23%, moderate OSA in 21%, severe OSA in 39% of the patients. A strong correlation between the body mass index (BMI; p 

419 STOP-Bang Score and History of Radiation Predicts Risk of Obstructive Sleep Apnea in Cancer Patients: A Machine Learning Study

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A166-A166
Author(s):  
Ankita Paul ◽  
Karen Wong ◽  
Anup Das ◽  
Diane Lim ◽  
Miranda Tan
Keyword(s):  
Machine Learning ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cancer Patients ◽  
Prediction Accuracy ◽  
Screening Tools ◽  
Cancer Type ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
History Of

Abstract Introduction Cancer patients are at an increased risk of moderate-to-severe obstructive sleep apnea (OSA). The STOP-Bang score is a commonly used screening questionnaire to assess risk of OSA in the general population. We hypothesize that cancer-relevant features, like radiation therapy (RT), may be used to determine the risk of OSA in cancer patients. Machine learning (ML) with non-parametric regression is applied to increase the prediction accuracy of OSA risk. Methods Ten features namely STOP-Bang score, history of RT to the head/neck/thorax, cancer type, cancer stage, metastasis, hypertension, diabetes, asthma, COPD, and chronic kidney disease were extracted from a database of cancer patients with a sleep study. The ML technique, K-Nearest-Neighbor (KNN), with a range of k values (5 to 20), was chosen because, unlike Logistic Regression (LR), KNN is not presumptive of data distribution and mapping function, and supports non-linear relationships among features. A correlation heatmap was computed to identify features having high correlation with OSA. Principal Component Analysis (PCA) was performed on the correlated features and then KNN was applied on the components to predict the risk of OSA. Receiver Operating Characteristic (ROC) - Area Under Curve (AUC) and Precision-Recall curves were computed to compare and validate performance for different test sets and majority class scenarios. Results In our cohort of 174 cancer patients, the accuracy in determining OSA among cancer patients using STOP-Bang score was 82.3% (LR) and 90.69% (KNN) but reduced to 89.9% in KNN using all 10 features mentioned above. PCA + KNN application using STOP-Bang score and RT as features, increased prediction accuracy to 94.1%. We validated our ML approach using a separate cohort of 20 cancer patients; the accuracies in OSA prediction were 85.57% (LR), 91.1% (KNN), and 92.8% (PCA + KNN). Conclusion STOP-Bang score and history of RT can be useful to predict risk of OSA in cancer patients with the PCA + KNN approach. This ML technique can refine screening tools to improve prediction accuracy of OSA in cancer patients. Larger studies investigating additional features using ML may improve OSA screening accuracy in various populations Support (if any):

scholarly journals Subjective and Objective Appraisal of Activity in Adults with Obstructive Sleep Apnea

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Eileen R. Chasens ◽  
Susan M. Sereika ◽  
Martin P. Houze ◽  
Patrick J. Strollo
Keyword(s):  
Physical Activity ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Epworth Sleepiness Scale ◽  
Functional Outcomes ◽  
Apnea Hypopnea Index ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
Subjective Sleepiness ◽  
Aging Adults

Objective.This study examined the association between obstructive sleep apnea (OSA), daytime sleepiness, functional activity, and objective physical activity.Setting.Subjects (N=37) being evaluated for OSA were recruited from a sleep clinic.Participants. The sample was balanced by gender (53% male), middle-aged, primarily White, and overweight or obese with a mean BMI of 33.98 (SD=7.35;median BMI=32.30). Over 40% reported subjective sleepiness (Epworth Sleepiness Scale (ESS) ≥10) and had OSA (78% with apnea + hypopnea index (AHI) ≥5/hr).Measurements.Evaluation included questionnaires to evaluate subjective sleepiness (Epworth Sleepiness Scale (ESS)) and functional outcomes (Functional Outcomes of Sleep Questionnaire (FOSQ)), an activity monitor, and an overnight sleep study to determine OSA severity.Results.Increased subjective sleepiness was significantly associated with lower scores on the FOSQ but not with average number of steps walked per day. A multiple regression analysis showed that higher AHI values were significantly associated with lower average number of steps walked per day after controlling patient's age, sex, and ESS.Conclusion.Subjective sleepiness was associated with perceived difficulty in activity but not with objectively measured activity. However, OSA severity was associated with decreased objective physical activity in aging adults.

Abstract P195: Lack of Association between Sleep Duration and ECG Arrhythmia Risk Measures: Chicago Area Sleep Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Jason Ng ◽  
Phyllis C Zee ◽  
Jeffrey J Goldberger ◽  
Kristen L Knutson ◽  
Kiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Duration ◽  
Low Risk ◽  
Qtc Interval ◽  
Sleep Study ◽  
Chicago Area ◽  
Obstructive Sleep ◽  
Pr Interval

Introduction Sleep duration is significantly associated with cardiovascular disease risk factors such as hypertension, diabetes, and obesity in adults at low risk for obstructive sleep apnea. Although it is known that apnea increases the risk for sudden cardiac death, it is not known whether adults with short sleep duration independent of apnea have a higher risk for cardiac arrhythmias Hypothesis We tested the hypothesis that sleep duration in adults at low risk for obstructive sleep apnea would be associated with ECG measures that are known risk factors for ventricular arrhythmias. Methods The Chicago Area Sleep Study recruited 610 participants via commercially available telephone listings. Participants were screened using in-home apnea detection equipment (ApneaLinkTM) for one night to exclude subjects with apnea/hypopnea index ≥ 15. Participants wore wrist actigraphs for 7 days to objectively determine sleep duration. A 10-minute 12-lead ECG was recorded for each subject. Standard measures of heart rate, PR interval, and QTc interval were obtained along with markers of ventricular repolarization, Tpeak to Tend interval (Tpe) and spatial QRS-T angle. Signal-averaged ECG analysis was performed to measure filtered QRS duration (fQRSd), RMS voltage of terminal 40 ms (RMS), and duration of terminal QRS signals <40μV (LAS). Participants with atrial fibrillation, >20% ectopic beats and those using antihypertensive and sleep medications were excluded from analysis. The effect of sleep duration on the ECG parameters was estimated using a multiple linear regression model adjusting for demographics (sex, age, and race) and cardiovascular risk factors (BMI, hypertension, coronary heart disease, and diabetes). Results ECGs from a total of 504 participants (200 male, 48±8 years old) were analyzed. Mean sleep duration was 7±1 hrs, heart rate was 64±9 bpm, PR interval was 165±18 ms, and QTc interval was 424±23 ms. Mean Tpe interval was 83±14 ms and spatial QRS-T angle was 29±26 deg. The signal-averaged ECG measures of fQRSd, RMS, and LAS had mean values of 78±12 ms, 58±34 μV, and 24±9 ms, respectively. In an unadjusted model, there was a borderline association between sleep duration and QTc (β=0.004 ms/hr, SE=0.0023, p=0.08). However, that association was no longer significant following adjustment with demographics and cardiovascular risk factors. No other ECG measures were associated with sleep duration. Conclusions In a population at low risk of obstructive sleep apnea, ECG-based measures of cardiovascular risks were not associated with sleep duration. Previously reported associations between short sleep and cardiovascular events may not be arrhythmic in origin.

Abstract 14771: Obstructive Sleep Apnea is Associated With Cardiac Dysfunction in Children With Congenital Heart Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Daniel Combs ◽  
Vanessa Fernandez ◽  
brent j barber ◽  
Wayne J Morgan ◽  
Chiu-Hsieh Hsu ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Obstructive Sleep Apnea ◽  
Heart Disease ◽  
Sleep Apnea ◽  
Right Ventricular ◽  
Cardiac Dysfunction ◽  
Congenital Heart ◽  
Left Ventricular ◽  
Sleep Study ◽  
Obstructive Sleep

Introduction: Obstructive sleep apnea (OSA) is associated with cardiac dysfunction in children without congenital heart disease (CHD). Children with CHD are at increased risk for OSA and may be susceptible to further cardiovascular consequences due to OSA but the extent and nature of such cardiovascular effects of OSA are unknown. Methods: Children (6-17 years old) with corrected CHD without current cyanosis or Down syndrome were recruited from pediatric cardiology clinic. Home sleep tests were done to determine the presence and severity of OSA. OSA was defined as an obstructive apnea hypopnea index (oAHI) ≥1. Mild OSA was defined as an oAHI of ≥1 to <5 and moderate OSA was defined as an oAHI of ≥5 to <10. Standard clinically indicated echocardiograms were performed in clinic. Echocardiographic findings were compared between children with CHD with and without comorbid OSA using t-tests, Wilcoxon-sign rank tests as well as linear or logistic regression as appropriate. Results: Thirty-two children had sleep study and echocardiographic data available. OSA was present in 18 children (56%). OSA was mild in 89% and moderate in 11% of cases. There were no significant differences in age, body mass index, CHD severity, gender or ethnicity between children with and without OSA. Children with OSA had larger height-indexed right ventricular end-diastolic diameter (RVDi) compared to those without OSA (median 1.35, 95% CI 1.09, 1.56 vs. 1.21, 95% CI 1.01, 1.57; p=0.04). Children with moderate OSA had a reduced left ventricular shortening fraction compared to both those with mild OSA and no OSA (30.0 ± 6.1% vs. 38.7 ± 4.4%; p=0.009 and 39.2 ± 3.6%; p=0.007, respectively). Children with moderate OSA had increased left ventricular end-systolic diameter compared to those with mild OSA and no OSA (3.4 ± 0.4 cm vs. 2.5 ± 0.4; p=0.007 and 2.4 ± 0.5; p=0.001, respectively). Children with an RVDi above the median were seven times more likely to have OSA than those with an RVDi below the median (odds ratio 6.9.; 95% CI 1.3, 35; p=0.02). Conclusions: OSA is associated with changes in cardiac morphology and reduced contractility in children with CHD. Additionally, the presence of right ventricular dilation may suggest the need for OSA evaluation in children with CHD.

Shar Pei Larynx: Supraglottic and Postcricoid Mucosal Redundancy and Its Association With Medical Comorbidities

2018 ◽  
Vol 128 (2) ◽  
pp. 121-127 ◽  
Author(s):  
Yin Yiu ◽  
Kathleen M. Tibbetts ◽  
C. Blake Simpson ◽  
Laura A. Matrka
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Laryngopharyngeal Reflux ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Future Research ◽  
Morbidly Obese ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Obstructive Sleep

Objectives: The aim of this study is to describe a clinical entity the authors term “Shar Pei larynx,” characterized by redundant supraglottic and postcricoid mucosa that the authors hypothesize coexists in patients with obstructive sleep apnea, laryngopharyngeal reflux, and obesity. By exploring this hypothesis, the authors hope to set the foundation for future research with the goal of identifying whether Shar Pei larynx is a marker for untreated sleep apnea or other diseases. Study Design: Retrospective chart review. Setting: Two tertiary care academic institutions. Methods: Data were collected from a 5-year period by querying for patients described to have “Shar Pei larynx” or “posterior supraglottic and/or postcricoid mucosal redundancy” on laryngoscopic findings. Relevant demographic and clinical characteristics were analyzed, with a focus on associations with obesity, sleep apnea, and laryngopharyngeal reflux. Results: Thirty-two patients were identified with physical findings consistent with Shar Pei larynx. Twenty-six patients (81.3%) were obese; 16 (50%) were morbidly obese. Twenty-two patients (68.8%) either had an existing diagnosis of obstructive sleep apnea or were diagnosed on polysomnography performed after initial evaluation. Sixteen patients (50%) had type 2 diabetes mellitus, and 87.5% of these patients were obese. Twenty-eight patients (87.5%) noted histories of reflux, with a median reflux symptom index of 27 of 45. Five patients underwent procedures to reduce mucosal redundancy related to Shar Pei larynx. Conclusions: This pilot study confirms that the majority of patients diagnosed with Shar Pei larynx also had diagnoses of obesity, obstructive sleep apnea, and reflux disease. The demonstrated association is strong enough to warrant further study.

Reliability of Holter Oximetry for Home Sleep Apnea Testing

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P83-P84 ◽  
Author(s):  
Jordan C Stern ◽  
Conor Heneghan ◽  
Redmond Shouldice
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Patients Âgés ◽  
Home Testing ◽  
Obstructive Sleep ◽  
Adults And Children ◽  
Home Sleep Apnea Testing ◽  
A Prospective Study ◽  
At Home

Objective To test the reliability of the Holter Oximeter for home testing of obstructive sleep apnea. Previous reports have shown a 96% correlation with simultaneous polysomnography and Holter Oximetry in the sleep laboratory. This study was designed to measure reliability of data obtained at home, as well as to obtain information from patients regarding comfort of the device. Methods A prospective study of 120 consecutive patients (ages 5 to 85) presenting to an otolaryngology practice during a 4-month period with complaints of snoring or sleep apnea symptoms. Device: The Holter Oximeter produces an apnea hypopnea index (AHI) based on an automated processing method of a continuous electrocardiogram and pulse oximeter. The reliability of the test was determined by the number of tests completed without interruption due to patient discomfort, electrode or device failure. Results There was 97% data recovery from the home testing device. Data failure was due to faulty memory cards in the device or surface electrode failure. All patients tolerated wearing the device at home, and there were no voluntary interruptions of the tests by patients. On a discomfort scale of 0 to 10 (0: no discomfort and 10: maximal discomfort), the average discomfort score was 2. Conclusions Holter Oximetry represents a new, easy to use, and reliable device for the home diagnosis of obstructive sleep apnea. It can also be used to measure outcomes for the surgical and non-surgical treatment of obstructive sleep apnea in adults and children.

scholarly journals Associations of Obstructive Sleep Apnea, Obestatin, Leptin, and Ghrelin with Gastroesophageal Reflux

2021 ◽  
Vol 10 (21) ◽  
pp. 5195
Author(s):  
Piotr Pardak ◽  
Rafał Filip ◽  
Jarosław Woliński ◽  
Maciej Krzaczek
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Gastroesophageal Reflux ◽  
Ph Monitoring ◽  
Sleep Study ◽  
Esophageal Ph ◽  
Obstructive Sleep ◽  
The Relationship ◽  
Gerd Symptoms ◽  
Severe Sleep Apnea

Gastroesophageal reflux disease (GERD) is commonly observed in patients with obstructive sleep apnea (OSA). Hormonal disorders observed in OSA may be relevant in the development of GERD. The aim of the study was to assess the correlations between ghrelin, obestatin, leptin, and the intensity of GERD in patients with OSA. The study included 58 patients hospitalized due to clinical suspicion of sleep disorders during sleep. All patients underwent a sleep study, and blood samples were collected overnight for hormonal tests. Survey data concerning symptoms of GERD, gastroscopy, and esophageal pH monitoring results were included in the study. In patients with OSA, GERD was twice as common when compared to the group without OSA. Among subjects with severe sleep apnea (AHI > 30; n = 31; 53%), we observed lower ghrelin levels, especially in the second half of the night and in the morning (p5.00 = 0.0207; p7.00 = 0.0344); the presence of OSA had no effect on obestatin and leptin levels. No significant differences in hormonal levels were observed between the groups depending on the diagnosis of GERD. However, correlations of ghrelin levels with the severity of esophagitis, leptin and ghrelin levels with the severity of GERD symptoms, and leptin levels with lower esophageal pH were found. GERD is more frequent among patients with OSA. In both GERD and OSA, deviations were observed in the levels of ghrelin and leptin. However, our analysis demonstrates that the relationship between OSA and GERD does not result from these disorders.

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