scholarly journals Oxygen desaturation during flexible bronchoscopy with propofol sedation is associated with sleep apnea: the PROSA-Study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrei M. Darie ◽  
Desiree M. Schumann ◽  
Marco Laures ◽  
Werner Strobel ◽  
Kathleen Jahn ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Conscious Sedation ◽  
Flexible Bronchoscopy ◽  
Oxygen Desaturation ◽  
Clinical Indication ◽  
Apnea Hypopnea Index ◽  
Berlin Questionnaire ◽  
Upper Airways ◽  
Peripheral Oxygen Saturation ◽  
Obstructive Sleep

Abstract Background Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial obstruction of the upper airways during sleep. Conscious sedation for flexible bronchoscopy (FB) places patients in a sleep-like condition. We hypothesize that oxygen desaturation during flexible bronchoscopy may help to detect undiagnosed sleep apnea. Methods Single-centre, investigator-initiated and driven study including consecutive patients undergoing FB for clinical indication. Patients completed the Epworth Sleepiness Scale (ESS), Lausanne NoSAS score, STOP-BANG questionnaire and the Berlin questionnaire and underwent polygraphy within 7 days of FB. FB was performed under conscious sedation with propofol. Oxygen desaturation during bronchoscopy was measured with continuous monitoring of peripheral oxygen saturation with ixTrend (ixellence GmbH, Germany). Results 145 patients were included in the study, 62% were male, and the average age was 65.8 ± 1.1 years. The vast majority of patients (n = 131, 90%) proved to fulfill OSA criteria based on polygraphy results: 52/131 patients (40%) had mild sleep apnea, 49/131 patients (37%) moderate sleep apnea and 30/131 patients (23%) severe sleep apnea. Patients with no oxygen desaturation had a significantly lower apnea–hypopnea index than patients with oxygen desaturation during bronchoscopy (AHI 11.94/h vs 21.02/h, p = 0.011). This association remained significant when adjusting for the duration of bronchoscopy and propofol dose (p = 0.023; 95% CI 1.382; 18.243) but did not hold when also adjusting for age and BMI. Conclusion The severity of sleep apnea was associated to oxygen desaturation during flexible bronchoscopy under conscious sedation. Patients with oxygen desaturation during bronchoscopy might be considered for sleep apnea screening. Trial registration: The Study was approved by the Ethics Committee northwest/central Switzerland, EKNZ (EK 16/13) and was carried out according to the Declaration of Helsinki and Good Clinical Practice guidelines. Due to its observational character, the study did not require registration at a clinical trial registry.

Abstract WP189: Prediction of Apnea Hypopnea Index among Stroke and TIA Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jason Sico ◽  
Susan Ofner ◽  
H. Klar Yaggi ◽  
Dawn Bravata
Keyword(s):  
Blood Pressure ◽  
Sleep Apnea ◽  
Prediction Model ◽  
Cerebrovascular Disease ◽  
Medical History ◽  
Neck Circumference ◽  
Apnea Hypopnea Index ◽  
Berlin Questionnaire ◽  
Past Medical History ◽  
Obstructive Sleep

INTRODUCTION: Obstructive sleep apnea (OSA) is common among patients with stroke and TIA. Previously validated OSA screening instruments used in the general population are largely based on reported symptoms; when applied to those with cerebrovascular disease, they have shown poor correlation with the presence of OSA diagnosed via polysomnography (PSG). We sought to develop a cerebrovascular disease specific prediction model for OSA that is less reliant on symptomatology. Methods: We used data from a multi-site randomized, controlled strategy trial that included ischemic stroke and TIA patients at two VA hospitals. Data on patient demographics, vital signs, anthropomorphic measurements, past medical history, medications, stroke severity, and sleep questionnaires were obtained. All patients received PSG. Sleep apnea was defined as present if the apnea-hypopnea index (AHI) was ≥5. Because approximately half of subjects had OSA, discrimination was difficult; thus, AHI was used as the outcome for our prediction model. Epworth Sleepiness Scale (ESS)≥10, the Berlin Questionnaire>10, and Sleep Apnea Clinical Score (SACS)≥15 were considered ‘high risk’ for OSA. Bivariate regression models were used to assess the strength of the association between predictors and the outcome (log AHI+1); those statistically significant at the 0.1 level were entered into a multi-variable regression model. Backward elimination was used until all remaining variables were significant at the 0.05 level. Results: Among 194 Veterans, 119 (61.3%) had an AHI≥5. Neck circumference > 16 inches, systolic blood pressure less than 132 mmHg, peripheral vascular disease, and recent hospitalization for congestive heart failure were associated with increase in log AHI; history of chronic obstructive pulmonary disease/asthma was associated with a decrease in log AHI (R2=0.13). ESS≥10 (p=0.86) and Berlin Questionnaire >10 (p=0.80) were not associated with log AHI. The SACS≥15 was associated with AHI (p=0.01); however, it did not remain significant in the final model. Conclusions: A model using blood pressure, neck circumference and past medical history data was predictive of AHI. Further work is required to validate the use of this model in a larger cerebrovascular disease cohort.

Abstract 14965: Atrial Conduction During Obstructive Sleep Apnea: Comparison of Stacked Versus Isolated Apnea Episodes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Krishan Patel ◽  
Hussain Basrawala ◽  
Pavan Reddy ◽  
Edwin Valladares ◽  
Vincent Grbach ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
P Wave ◽  
Conduction Delay ◽  
Apnea Hypopnea Index ◽  
Peripheral Oxygen Saturation ◽  
Cardiovascular Comorbidities ◽  
Obstructive Sleep ◽  
Cost Efficient ◽  
The Impact

Introduction: Obstructive sleep apnea (OSA) is associated with increased rates of atrial fibrillation (AF). Recent randomized data suggest that traditional scoring of OSA needs to evolve to improve cardiovascular outcomes. Traditional scoring of OSA does not fully reflect pathophysiological links between OSA and AF, particularly regarding OSA-induced prolongation of p-wave duration (PWD), which is the most powerful predictor of AF occurrence. Hypothesis: We hypothesized that OSA episodes that closely follow each other (serially stacked apneas, ssOSA) exert greater effect on PWD compared to isolated OSA (iOSA) episodes. Methods: Sleeping patients (adults with mild-moderate OSA and presence of both iOSA and ssOSA, but without other cardiovascular comorbidities) undergoing diagnostic polysomnography were recorded by continuous 8-lead ECG. iOSA was defined as OSA episodes with no other episode within 30 seconds. ssOSA consisted of ≥3 consecutive apneas with inter-OSA intervals <30 seconds. PWD was defined from onset of p-wave in any ECG lead to termination in any lead (measured by digital calipers, averaged over 3 beats from first half of OSA and 3 beats from second half of OSA). Wilcoxon rank-sum test was used. Results: We analyzed 208 OSA episodes (51.0% iOSA, 49.0% ssOSA) which occurred in 12 patients (7 women; age 63.1±11.5 years; apnea hypopnea index 16.8±5.4). PWD was longer during ssOSA compared to iOSA (median 117.7ms vs 109.6ms; p<0.0001). The following variables did not differ between ssOSA and iOSA: PR interval (p=0.3139), RR interval (p=0.7531), peripheral oxygen saturation (p=0.7776). Conclusions: The impact of OSA on atrial conduction delay is exacerbated by the phenomenon of OSA stacking, which seems independent of oxygen desaturation and heart rate. Stacking of OSA episodes may be an underused and cost-efficient variable in evaluating the severity of OSA and the effectiveness of OSA treatments with the ultimate goal of reducing occurrence of AF.

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) &lt; 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) &lt; 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 &lt; 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&lt;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.

scholarly journals MAGNETIC RESONANCE TOMOGRAPHY IN SLEEP APNEA SYNDROME DIAGNOSTICS

2015 ◽  
Vol 14 (2) ◽  
pp. 58-61
Author(s):  
M. A. Shariya ◽  
E. A. Butorova ◽  
A. Yu. Litvin ◽  
D. V. Ustyuzhanin ◽  
Е. М. Elfimova ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Magnetic Resonance ◽  
Soft Tissues ◽  
Sleep Apnea Syndrome ◽  
Magnetic Resonance Tomography ◽  
Apnea Hypopnea Index ◽  
Upper Airways ◽  
Obstructive Sleep ◽  
The Mean ◽  
Apnea Syndrome

Aim. To study the specifics of soft tissues surrounding upper airways (STSUA) structure using magnetic resonance tomography (MRI) in patients with obesity and obstructive sleep apnea syndrome (OSAS). Material and methods. Totally 40 men studied with the mean age 44,7±9,6 y. Of those 20 had obesity of I-II grade — with body mass index (BMI) 35,1±3,4 кг/м2 and severe OSAS (apnea-hypopnea index — AHI — was 53,4±15,7). Controls consisted of 20 persons without obesity — BMI 23,8±1,3 kg/m2 . Assessment of upper airways was performed on Philips Achieva 3.0T tomograph. We measured the volumes of soft palate (VSP), tongue (VT), lateral pharyngeal walls (VLPW) and the squares of maximum upper airways narrowing (SMUAN) at retropharyngeal (RP) and retroglossal (RG) levels. Results. In obese patients with OSAS we found higher values of TV — 70,5±12,4 vs 45,0±5,7 cm3 , VSP — 7,5±1,7 vs 3,5±0,7 cm3 , VLPW at the level of RP — 11,7±4,1 vs 3,2±0,8 cm3 , VLPW at the level of RG — 10,4±2,8vs 3,1±8,4 cm3 and lower values of SMUAN at the level of RP — 6,3±3,5 vs 14,0±3,8 cm2 , as RG — 19,3±7,5 vs 27,0±5,0 mm2 . All differences were statistically significant (p<0,001). Conclusion. MRI can be successfully applied for the evaluation of STSUA parameters of upper airways openness.

scholarly journals A Pharyngoplasty with a Dorsal Palatal Flap Expansion: The Evaluation of a Modified Surgical Treatment Method for Obstructive Sleep Apnea Syndrome—A Preliminary Report

2021 ◽  
Vol 10 (16) ◽  
pp. 3746
Author(s):  
Ewa Olszewska ◽  
Piotr Fiedorczuk ◽  
Adam Stróżyński ◽  
Agnieszka Polecka ◽  
Ewa Roszkowska ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Apnea Hypopnea Index ◽  
Upper Airways ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
Apnea Syndrome

Surgical techniques for obstructive sleep apnea syndrome (OSAS) constantly evolve. This study aims to assess the effectiveness and safety of a new surgical approach for an OSAS pharyngoplasty with a dorsal palatal flap expansion (PDPFEx). A total of 21 participants (mean age 49.9; mean BMI 32.5) underwent a type III sleep study, an endoscopy of the upper airways, a filled medical history, a visual analog scale for snoring loudness, an Epworth Sleepiness Scale, and a Short Form Health Survey-36 questionnaire. A follow-up re-evaluation was performed 11 ± 4.9 months post-operatively. The study group (4 with moderate, 17 with severe OSAS) showed an improvement in all measured sleep study characteristics (p < 0.05), apnea-hypopnea index (pre-median 45.7 to 29.3 post-operatively, p = 0.009, r = 0.394), oxygen desaturation index (pre-median 47.7 and 23.3 post-operatively, p = 0.0005, r = 0.812), mean oxygen saturation (median 92% pre-operatively and median 94% post-operatively, p = 0.0002, r = 0.812), lowest oxygen saturation (p = 0.0001, r = 0.540) and time of sleep spent with blood oxygen saturation less than 90% (p = 0.0001, r = 0.485). The most commonly reported complications were throat dryness (11 patients) and minor difficulties in swallowing (5 patients transient, 3 patients constant). We conclude that a PDPFEx is a promising new surgical method; however, further controlled studies are needed to demonstrate its safety and efficacy for OSAS treatment in adults.

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

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 &plusmn; 18.5 events/hour to 8.97 &plusmn; 9.57 events/hour (p-Value &lt;0.001). The Epworth&rsquo;s sleepiness Score (ESS) dropped from 12.8 &plusmn; 6.23 to 2.95 &plusmn; 2.40 (p-Value &lt;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&lt;0.05) whereas lysophosphatidylcholines (LPC) 20.0 and PC.39.3 were increased (p-Value&lt;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.

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.

Agreement Between Oxygen Desaturation Index and Apnea-Hypopnea Index in Adults With Suspected Obstructive Sleep Apnea at an Altitude of 2240 m

2007 ◽  
Vol 43 (12) ◽  
pp. 649-654 ◽  
Author(s):  
Luis Torre-Bouscoulet ◽  
Armando Castorena-Maldonado ◽  
Rocío Baños-Flores ◽  
Juan Carlos Vázquez-García ◽  
María Sonia Meza-Vargas ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Desaturation ◽  
Apnea Hypopnea Index ◽  
Desaturation Index ◽  
Oxygen Desaturation Index ◽  
Obstructive Sleep
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