scholarly journals Predicting response to oxygen therapy in obstructive sleep apnoea patients using a 10-minute daytime test

2018 ◽  
Vol 51 (1) ◽  
pp. 1701587 ◽  
Author(s):  
David Wang ◽  
Keith K. Wong ◽  
Luke Rowsell ◽  
Garrick W. Don ◽  
Brendon J. Yee ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Oxygen Therapy ◽  
Characteristic Curve ◽  
Personalised Medicine ◽  
Sleep Apnoea ◽  
Low Flow ◽  
Response Threshold ◽  
Clinical Tool ◽  
Obstructive Sleep ◽  
Osa Treatment

There is no satisfactory treatment for obstructive sleep apnoea (OSA). Supplemental low-flow oxygen therapy (LFO2) has been shown to reduce hypoxaemia and is well tolerated by patients with OSA. However, oxygen therapy may be beneficial only to certain subsets of patients with OSA. In this study, we evaluated a 10-min awake ventilatory chemoreflex test in predicting individual OSA response to 2 months of LFO2therapy.At baseline, patients with OSA underwent ventilatory chemoreflex testing in the afternoon, prior to the overnight polysomnography. Subjects were reassessed with polysomnography after 2 months of nocturnal oxygen treatment.20 patients with OSA completed the study. After 2 months of O2treatment, changes in the apnoea–hypopnoea index (AHI) were significantly correlated with baseline CO2ventilatory response threshold (VRT) and chemosensitivity (p<0.05). In predicting a fall in AHI, the area under the receiver operating characteristic curve (AUC) was 0.79 for VRT and 0.89 for chemosensitivity. When these two variables were combined in a logistic regression model, the prediction effect became stronger with an AUC of 0.97, sensitivity of 0.92 and specificity of 0.83.Our awake ventilatory chemoreflex test could be considered a simple potential clinical tool to predict individual OSA response to oxygen therapy. It could provide a novel personalised medicine approach to OSA treatment.

Pierre Robin sequence causes position-dependent obstructive sleep apnoea in infants

2021 ◽  
pp. archdischild-2020-320527
Author(s):  
Hanna-Leena Kristiina Kukkola ◽  
Pia Vuola ◽  
Maija Seppä-Moilanen ◽  
Päivi Salminen ◽  
Turkka Kirjavainen
Keyword(s):  
Eye Movement ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Sleep Position ◽  
Pierre Robin Sequence ◽  
Rapid Eye Movement ◽  
Obstructive Sleep ◽  
Osa Treatment ◽  
Sleep Positioning ◽  
Pierre Robin

IntroductionObstructive sleep apnoea (OSA) and feeding difficulties are key problems for Pierre Robin sequence (PRS) infants. OSA management varies between treatment centres. Sleep positioning represents the traditional OSA treatment, although its effectiveness remains insufficiently evaluated.DesignTo complete a polysomnographic (PSG) evaluation of effect of sleep position on OSA in PRS infants less than 3 months of age. We analysed a 10-year national reference centre dataset of 76 PRS infants. PSG was performed as daytime recordings for 67 in the supine, side and prone sleeping position when possible. In most cases, recording included one cycle of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep in each position.ResultsOne-third of infants (9/76, 12%) had severe OSA needing treatment intervention prior to PSG. During PSG, OSA with an obstructive apnoea and hypopnoea index (OAHI) >5 per hour was noted in 82% (55/67) of infants. OSA was most severe in the supine and mildest in the side or in the prone positions. The median OAHI in the supine, side and prone positions were 31, 16 and 19 per hour of sleep (p=0.003). For 68% (52/67) of the infants, either no treatment or positional treatment alone was considered sufficient.ConclusionsThe incidence of OSA was 84% (64/76) including the nine infants with severe OSA diagnosed prior to PSG. For the most infants, the OSA was sleep position dependent. Our study results support the use of PSG in the evaluation of OSA and the use of sleep positioning as a part of OSA treatment.

Obstructive sleep apnoea and schizophrenia: a primer for psychiatrists

2011 ◽  
Vol 23 (5) ◽  
pp. 201-209 ◽  
Author(s):  
Abdulkader Alam ◽  
Kadiamada Nanaiah Roy Chengappa
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Daytime Sleepiness ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Sleep Apnoea ◽  
Diagnosis And Treatment ◽  
Adverse Health Outcomes ◽  
Ovid Medline ◽  
Obstructive Sleep ◽  
Osa Treatment

Alam A, Chengappa KNR. Obstructive sleep apnoea and schizophrenia: a primer for psychiatristsObjective:The main objective of this review is to improve psychiatric clinician awareness of obstructive sleep apnoea (OSA) and its potential consequences in patients with schizophrenia. This article will also discuss the diagnosis and treatment options for OSA while considering the significant role psychiatrists can play in facilitating the diagnosis and treatment of OSA.Data sources:Ovid, Medline and PsychInfo databases were searched for articles between 1960 and 2010. Search terms used wereSleep apnoeaorapnoeaandschizophreniaorpsychosis. The number of articles retrieved was 38. Articles were carefully reviewed for any data pertinent to OSA in patients with schizophrenia.Conclusions:OSA is a common disorder that is frequently unrecognised. As a chronic breathing condition, OSA is associated with adverse health outcomes and high mortality. OSA may co-occur with schizophrenia or evolve over time, especially with weight gain. The diagnosis should be considered whenever a patient presents with risk factors or clinical manifestations that are highly suggestive of OSA. Those who report snoring, daytime sleepiness and are obese or have a large neck circumference should be considered for an OSA diagnosis. Appropriate diagnosis and treatment of OSA can reduce daytime sleepiness, improve cardiovascular and other medical conditions, as well as reduce mortality. Psychiatrists can play very important role in suspecting OSA in their patients and making the initial referral. Furthermore, behavioural management, especially promoting weight loss and smoking cessation, are effective components of OSA treatment that psychiatrists are positioned to facilitate with their patients.

P4404Prognostic value of novel nocturnal oxygen saturation metrics in patients with obstructive sleep apnoea and high cardiovascular event risk

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Linz ◽  
K Loffler ◽  
P Sanders ◽  
P Catcheside ◽  
C Anderson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Oxygen Saturation ◽  
Obstructive Sleep Apnoea ◽  
Controlled Trial ◽  
Characteristic Curve ◽  
Sleep Apnoea ◽  
Time Ratio ◽  
Event Risk ◽  
Obstructive Sleep

Abstract Aim To determine prognostic value of novel oximetry-derived metrics in patients with obstructive sleep apnoea (OSA) and high cardiovascular (CV) event risk. Methods and results Ancillary study of the Sleep Apnoea CV Endpoints (SAVE) randomised controlled trial, which investigated the effects of CPAP treatment on secondary CV event outcomes in 2687 participants with moderate-severe OSA and established CV disease. Associations between baseline characteristics, standard sleep and pulse oximetry-derived metrics, and CV outcomes were determined in Cox proportional hazards regression models stratified for treatment allocation. Metrics evaluated included: oxygen desaturation index, time below 90% oxygen saturation (SpO2), average SpO2across recordings (mean SpO2), across episodic desaturation events (desaturation SpO2), and baseline interpolated through episodic desaturation events (baseline SpO2); duration and desaturation/resaturation time ratio of episodic desaturation events; and mean and standard deviation of pulse rate. No SpO2 metric was associated with the composite outcome. Mean and baseline SpO2 were negatively associated with heart failure (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.69–0.95; P=0.009 and 0.78, 0.67–0.90; P=0.001, respectively) and myocardial infarction risk (0.86, 0.77–0.95; P=0.003 and 0.81, 0.73–0.90; P<0.001, respectively) and marginally positively associated with stroke risk (1.09, 1.00–1.20; P=0.065 and 1.13, 1.02–1.26; P=0.020, respectively). Desaturation duration and desaturation/resaturation time ratio, with established risk factors, predicted heart failure (area under the receiver-operating-characteristic curve 0.86, 95% CI 0.79–0.93). Conclusions Higher mean and baseline SpO2 were associated with reduced risk of heart failure and myocardial infarction, and small increases in stroke rate. Desaturation shape may have predictive utility for future CV events. Clinical trial registration: clinicaltrials (NCT00738179).

Smartphone videos to predict the severity of obstructive sleep apnoea

2021 ◽  
pp. archdischild-2020-320752
Author(s):  
Rahul J Thomas ◽  
Samuel Dalton ◽  
Katharine Harman ◽  
Julie Thacker ◽  
Rosemary S C Horne ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Obstructive Sleep Apnoea ◽  
Predictive Value ◽  
Work Of Breathing ◽  
Sleep Apnoea ◽  
Clinical Tool ◽  
Neck Extension ◽  
Obstructive Sleep ◽  
Sensitivity Specificity

ObjectiveDiagnosis of obstructive sleep apnoea (OSA) is made on overnight polysomnography (PSG). Given the widespread availability of smartphone video technology, we aimed to develop and test a standardised scoring system for smartphone videos and compare these scores to PSG results.MethodsChildren aged 1–16 years undergoing PSG for suspected OSA were included. Parents were asked to take 1–2 min videos of the breathing they were concerned about. Videos were scored using a newly developed and tested tool on five components: inspiratory obstructive noises (1–4), presence of obstructive events (0–1), increased work of breathing (0–1), mouth breathing (0–1) and neck extension (0–1). Video scores and the Obstructive Apnoea Hypopnoea Index (OAHI) were compared using Spearman correlation. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for different cut-off scores to achieve the best results.ResultsVideos from 43 children (28 men (65.1%), median age 5.7 years (range 2.6–14.0 years), median OAHI 3.8/hour (range 0–82 events/hour) were included. Nine children (20.9%) had a video score of <3, all of whom had an OAHI of ≤5 events/hour. For a video score of ≥3, sensitivity was 100%; specificity was 36%; positive predictive value was 53%; and negative predictive value 100% for moderate to severe OSA (OAHI>5 events/hour) .ConclusionWe have developed and validated a simple clinical tool (the Monash Obstructive Sleep Apnoea Video Score) to quantify abnormalities in breathing seen on short video recordings made on a smartphone. A low score rules out moderate–severe OSA and may be valuable in the triage of children with symptoms of OSA.

scholarly journals Personalised medicine in sleep respiratory disorders: focus on obstructive sleep apnoea diagnosis and treatment

2017 ◽  
Vol 26 (146) ◽  
pp. 170069 ◽  
Author(s):  
Maria R. Bonsignore ◽  
Monique C. Suarez Giron ◽  
Oreste Marrone ◽  
Alessandra Castrogiovanni ◽  
Josep M. Montserrat
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Treatment Options ◽  
Personalised Medicine ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Lifestyle Changes ◽  
Mandibular Advancement ◽  
Considerable Proportion ◽  
Special Focus ◽  
Obstructive Sleep

In all fields of medicine, major efforts are currently dedicated to improve the clinical, physiological and therapeutic understanding of disease, and obstructive sleep apnoea (OSA) is no exception. The personalised medicine approach is relevant for OSA, given its complex pathophysiology and variable clinical presentation, the interactions with comorbid conditions and its possible contribution to poor outcomes. Treatment with continuous positive airway pressure (CPAP) is effective, but CPAP is poorly tolerated or not accepted in a considerable proportion of OSA patients. This review summarises the available studies on the physiological phenotypes of upper airway response to obstruction during sleep, and the clinical presentations of OSA (phenotypes and clusters) with a special focus on our changing attitudes towards approaches to treatment. Such major efforts are likely to change and expand treatment options for OSA beyond the most common current choices (i.e. CPAP, mandibular advancement devices, positional treatment, lifestyle changes or upper airway surgery). More importantly, treatment for OSA may become more effective, being tailored to each patient's need.

scholarly journals Endoscopy evaluation to predict oral appliance outcomes in obstructive sleep apnoea

2016 ◽  
Vol 47 (5) ◽  
pp. 1410-1419 ◽  
Author(s):  
Kentaro Okuno ◽  
Yasuhiro Sasao ◽  
Kanji Nohara ◽  
Takayoshi Sakai ◽  
Benjamin T. Pliska ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Characteristic Curve ◽  
Multivariate Logistic Regression Analysis ◽  
Oral Appliance ◽  
Expansion Ratio ◽  
Sleep Apnoea ◽  
Receiver Operator Characteristic Curve ◽  
Mandibular Advancement ◽  
Cross Sectional ◽  
Obstructive Sleep

The objective of this study was to determine the utility of nasoendoscopy of the upper airway as a predictor of the efficacy of oral appliance treatment in obstructive sleep apnoea (OSA).A total of 61 consecutive patients with moderate-to-severe polysomnographically diagnosed OSA were recruited for this study. Using nasoendoscopy, we prospectively assessed the velopharynx and oro/hypopharynx in each patient while awake and in the supine position. We measured cross-sectional area (CSA), and anteroposterior and lateral diameters of the airway before and after mandibular advancement, and expressed the changes in dimensions as expansion ratios (after/before). We then compared the measurements of responders and nonresponders with oral appliance treatment.The expansion ratio (median (interquartile range)) for the CSA was greater in responders compared with nonresponders in the velopharynx (2.9 (2.3–5.0)versus1.7 (1.5–1.9), p<0.001) and in the oro/hypopharynx (3.4 (2.5–5.6)versus2.4 (1.8–3.7), p<0.05). Baseline apnoea–hypopnoea index and the CSA expansion ratio of the velopharynx were independent predictors of oral appliance treatment outcome based on a multivariate logistic regression analysis. The estimated area under the receiver operator characteristic curve was 0.87 and the cut-off value of the expansion ratio was 2.00.These results indicate that nasoendoscopy may have significant clinical utility in predicting the success of oral appliance treatment.

scholarly journals The effect of acute morphine on obstructive sleep apnoea: a randomised double-blind placebo-controlled crossover trial

Thorax ◽  
2018 ◽  
Vol 74 (2) ◽  
pp. 177-184 ◽  
Author(s):  
Luke Rowsell ◽  
Keith K H Wong ◽  
Brendon J Yee ◽  
Danny J Eckert ◽  
Andrew A Somogyi ◽  
...  
Keyword(s):  
Controlled Release ◽  
Randomised Controlled Trial ◽  
Obstructive Sleep Apnoea ◽  
Controlled Trial ◽  
Oral Morphine ◽  
Sleep Apnoea ◽  
Response Threshold ◽  
Double Blind ◽  
Obstructive Sleep ◽  
Randomised Controlled

ObjectiveAnaesthesiology guidelines suggest that opioids worsen obstructive sleep apnoea (OSA) despite no randomised controlled trial evidence. We therefore conducted a randomised controlled trial to evaluate the effects of a common clinical dose of morphine on OSA, and to identify clinical phenotype and genotype vulnerability to opioid-respiratory depression.MethodsUnder a double-blind, randomised, crossover design, 60 male patients with OSA attended two visits to the hospital sleep laboratory, at least 1 week apart. Either 40 mg controlled-release oral morphine or placebo was administered. Awake ventilatory chemoreflex tests were performed post dose and prior to overnight polysomnography monitoring. Blood was sampled before sleep and the next morning for toxicology and genotype analyses. Sleep time with oxygen saturation (SpO2) <90% (T90) was the primary outcome.ResultsDespite a large inter-individual variability, 40 mg morphine did not worsen T90 and apnoea–hypopnoea index, and only decreased the SpO2 nadir by 1.3%. In patients with severe OSA, a lower baseline CO2ventilatory response threshold correlated with the worsening of T90, apnoea–hypopnoea index and oxygen desaturation index with morphine use. Patients with OSA and the A118G OPRM1 polymorphism of A/A and A/G had a significantly different morphine effect on awake ventilatory chemosensitivity and T90 during sleep.Conclusions40 mg oral controlled-release morphine did not worsen OSA in men, challenging traditional thinking that OSA will be worsened by opioids. Individual opioid response in patients with OSA may relate to baseline CO2 response threshold and OPRM1 genotype. Our study findings may pave the way for a precision medicine approach to avoid opioid-related risks.Trial registration numberThe Australian and New Zealand Clinical Trial Registry, ACTRN12613000858796.

scholarly journals Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms

2015 ◽  
Vol 47 (1) ◽  
pp. 194-202 ◽  
Author(s):  
Erna S. Arnardottir ◽  
Erla Bjornsdottir ◽  
Kristin A. Olafsdottir ◽  
Bryndis Benediktsdottir ◽  
Thorarinn Gislason
Keyword(s):  
General Population ◽  
Obstructive Sleep Apnoea ◽  
Clinical Symptoms ◽  
Population Sample ◽  
Sleep Apnoea ◽  
Middle Aged ◽  
Sleep Study ◽  
Psychomotor Vigilance Test ◽  
Obstructive Sleep ◽  
Osa Treatment

The aim was to assess the prevalence of obstructive sleep apnoea (OSA) as defined by an apnoea–hypopnea index (AHI) ≥15 in the middle-aged general population, and the interrelationship between OSA, sleep-related symptoms, sleepiness and vigilance.A general population sample of 40–65-year-old Icelanders was invited to participate in a study protocol that included a type 3 sleep study, questionnaire and a psychomotor vigilance test (PVT).Among the 415 subjects included in the study, 56.9% had no OSA (AHI <5), 24.1% had mild OSA (AHI 5–14.9), 12.5% had moderate OSA (AHI 15–29.9), 2.9% had severe OSA (AHI ≥30) and 3.6% were already diagnosed and receiving OSA treatment. However, no significant relationship was found between AHI and subjective sleepiness or clinical symptoms. A relationship with objective vigilance assessed by PVT was only found for those with AHI ≥30. Subjects already on OSA treatment and those accepting OSA treatment after participating in the study were more symptomatic and sleepier than others with similar OSA severity, as assessed by the AHI.In a middle-aged general population, approximately one in five subjects had moderate-to-severe OSA, but the majority of them were neither symptomatic nor sleepy and did not have impaired vigilance.

Sign in / Sign up

Export Citation Format

Share Document