scholarly journals Evaluation of Acromegaly patients with sleep disturbance related symptoms

2021 ◽  
Vol 37 (4) ◽  
Author(s):  
Deniz Çelik ◽  
Sezgi Şahin Duyar ◽  
Funda Aksu ◽  
Selma Fırat ◽  
Bülent Çiftçi
Keyword(s):  
Sleep Disturbance ◽  
Sleep Disordered Breathing ◽  
Respiratory Drive ◽  
Pairwise Correlation ◽  
Creative Commons ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Active Acromegaly ◽  
Simple Snoring ◽  
Open Access Article

Background and Objectives: It is known that the prevalence of obstructive sleep apnea (OSA) is increased in acromegaly. Craniofacial anomalies, macroglossia, and thickening of the laryngeal wall caused by the increase in soft tissue in these patients lead to OSA. Also, the increase in growth hormone can trigger central apnea by causing a decrease in respiratory drive. Determining the polysomnographic characteristics of acromegaly patients is important to reveal the effect of these mechanisms. Methods: The demographic and polysomnographic characteristics of 33 acromegaly patients who underwent polysomnography (PSG) with suspicion of sleep disorders between 2011 and 2018 in the sleep laboratory of our hospital were retrospectively analyzed. One of the patients was excluded from the analysis because PSG was performed in the postoperative period. The remaining 32 patients with active acromegaly were grouped according to their gender and the presence of OSA and compared with statistical methods in terms of polysomnographic and clinical features. Results: OSA (AHI>5) was detected in 78.1% of 32 active acromegaly patients (18 females, 14 males) who underwent PSG with suspicion of sleep-disordered breathing. Moderate-severe OSA (62.5%) was found in most patients, and there was no difference between the sexes in terms of OSA detection rate and OSA severity. Respiratory events appear to be predominantly obstructive hypopneas. Also, the polysomnographic features of female and male acromegaly patients with OSA were found to be similar. It is seen that the OSA group is similar to the group with simple snoring in terms of body mass index (BMI), but is statistically significantly older (p=0,007). A positive correlation was found between age and AHI in pairwise correlation analysis (r:0,426 p:0,015, respectively). Conclusion: Considering that the prevalence of OSA in the population is approximately 5%, our results show that the risk of OSA in acromegaly increases, and obstructive pathways are effective in this increase. The probability of OSA occurrence and polysomnographic features between the genders are similar. Although the median BMI of the patients with and without OSA was similar, the median age was higher in the group with OSA, middle-aged acromegaly patients should be evaluated in terms of OSA even if there is no obvious obesity. doi: https://doi.org/10.12669/pjms.37.4.4229 How to cite this:Celik D, Duyar SS, Aksu F, Firat S, Ciftci B. Evaluation of Acromegaly patients with sleep disturbance related symptoms. Pak J Med Sci. 2021;37(4):---------. doi: https://doi.org/10.12669/pjms.37.4.4229 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Recognition of Sleep-disordered Breathing in Children

PEDIATRICS ◽  
1996 ◽  
Vol 98 (5) ◽  
pp. 871-882 ◽  
Author(s):  
Christian Guilleminault ◽  
Rafael Pelayo ◽  
Damien Leger ◽  
Alex Clerk ◽  
Robert C. Z. Bocian
Keyword(s):  
Gold Standard ◽  
Sleep Disordered Breathing ◽  
Clinical Symptoms ◽  
Upper Airway ◽  
Esophageal Pressure ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Abnormal Breathing ◽  
Polygraphic Recording ◽  
Disordered Breathing

Objective. To determine whether upper airway resistance syndrome (UARS) can be recognized and distinguished from obstructive sleep apnea syndrome (OSAS) in prepubertal children based on clinical evaluations, and, in a subgroup of the population, to compare the efficacy of esophageal pressure (Pes) monitoring to that of transcutaneous carbon dioxide pressure (tcPco2) and expired carbon dioxide (CO2) measurements in identifying UARS in children. Study Design. A retrospective study was performed on children, 12 years and younger, seen at our clinic since 1985. Children with diagnoses of sleep-disordered breathing were drawn from our database and sorted by age and initial symptoms. Clinical findings, based on interviews and questionnaires, an orocraniofacial scale, and nocturnal polygraphic recordings were tabulated and compared. If the results of the first polygraphic recording were inconclusive, a second night's recording was performed with the addition of Pes monitoring. In addition, simultaneous measurements of tcPco2 and endtidal CO2 with sampling through a catheter were performed on this second night in 76 children. These 76 recordings were used as our gold standard, because they were the most comprehensive. For this group, 1848 apneic events and 7040 abnormal respiratory events were identified based on airflow, thoracoabdominal effort, and Pes recordings. We then analyzed the simultaneously measured tcPCo2 and expired CO2 levels to ascertain their ability to identify these same events. Results. The first night of polygraphic recording was inconclusive enough to warrant a second recording in 316 of 411 children. Children were identified as having either UARS (n = 259), OSAS (n = 83), or other sleep disorders (n = 69). Children with small triangular chins, retroposition of the mandible, steep mandibular plane, high hard palate, long oval-shaped face, or long soft palate were highly likely to have sleep-disordered breathing of some type. If large tonsils were associated with these features, OSAS was much more frequently noted than UARS. In the 76 gold standard children, Pes, tcPco2, and expired CO2 measurements were in agreement for 1512 of the 1848 apneas and hypopneas that were analyzed. Of the 7040 upper airway resistance events, only 2314 events were consonant in all three measures. tcPco2 identified only 33% of the increased respiratory events identified by Pes; expired CO2 identified only 53% of the same events. Conclusions. UARS is a subtle form of sleep-disordered breathing that leads to significant clinical symptoms and day and nighttime disturbances. When clinical symptoms suggest abnormal breathing during sleep but obstructive sleep apneas are not found, physicians may, mistakenly, assume an absence of breathing-related sleep problems. Symptoms and orocraniofacial information were not useful in distinguishing UARS from OSAS but were useful in distinguishing sleep-disordered breathing (UARS and OSAS) from other sleep disorders. The analysis of esophageal pressure patterns during sleep was the most revealing of the three techniques used for recognizing abnormal breathing patterns during sleep.

Investigating the Association between Wake-Up Stroke and Obstructive Sleep Apnea: A Meta-Analysis

2021 ◽  
pp. 1-10
Author(s):  
Xin Lu ◽  
Wenhong Liu ◽  
Hui Wang
Keyword(s):  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Meta Analysis ◽  
Sleep Apnea Syndrome ◽  
Stroke Patients ◽  
Respiratory Effects ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Appropriate Therapy ◽  
Meta Analyses

<b><i>Background:</i></b> Management of wake-up stroke (WUS) is always a challenge as no clear time of onset could be ascertained, and how to choose an appropriate therapy remains unclear. Sleep-disordered breathing (SDB) has been regarded as a potential risk factor to WUS, yet no consensus was achieved. Motivated by the need for a deeper understanding of WUS and its association with sleep apnea, meta-analyses summarizing the available evidence of respiratory events and indices were conducted, and sensitivity analysis was also used for heterogeneity. <b><i>Methods:</i></b> Electronic databases were systematically searched, and cross-checking was done for relevant studies. Collected data included demographic characteristics, and sleep apnea parameters were extracted with stroke patients divided into WUS and NWUS groups. Clinical data of stroke patients accompanied with sleep apnea syndrome (OSA, SAS, and severe SAS) were also extracted for meta-analysis. <b><i>Results:</i></b> A total of 13 studies were included in the analysis. The meta-analysis results showed that OSA, SAS, and severe SAS were significantly higher in WUS patients. A significantly higher AHI (WMD 7.74, 95% CI: 1.38–14.11; <i>p</i> = 0.017) and ODI (WMD of 3.85, 95% CI: 0.261–7.438; <i>p</i> = 0.035) than NWUS patients was also observed in the analysis of respiratory indices. <b><i>Conclusion:</i></b> WUS patients have severer SDB problems compared to NWUS patients suggesting that respiratory events during sleep might be underlying the induction of WUS. Besides, the induction of WUS was significantly associated with men rather than women. Therefore, early diagnosis and management of potential WUS patients should benefit from the detection of SDB status and respiratory effects.

scholarly journals 0451 Fully Automatic Detection of Sleep Disordered Breathing Events

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A172-A173
Author(s):  
J Thybo ◽  
A N Olesen ◽  
M Olsen ◽  
E Leary ◽  
P Arnal ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Central Sleep Apnea ◽  
Poor Correlation ◽  
Event Type ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Consensus Score ◽  
Fully Automatic ◽  
Event Basis

Abstract Introduction Evaluation of sleep apnea involves manual annotation of Polysomnography (PSG) file, a time-consuming process subject to interscorer variations. The DOSED algorithm has been shown to be helpful in detecting Central Sleep Apnea (CSA), Obstructive Sleep Apnea (OSA), and Hypopnea when merged into a single event type. This work uses a modified version of DOSED capable of detecting each event type separately. Methods The network consists of 3 blocks of 1D convolutional layers followed by 6 blocks of 2D convolutional layers. The network has 2 classification layers, one determines the probability of each class, and the other determines the start and duration time of the event with the highest probability. Four channels from nasal and mouth airflow and position of abdomen and thorax are used as input to the model. The model was trained using 2800 PSG from 4 different cohorts (MESA, MROS, SSC, WSC) and tested on 70 PSG, which have been scored by six technicians (Stanford, U Penn, St Louis). Results On an event by event basis, model F1-scores versus a weighted consensus score based on 6 technicians were 0.60 for OSA, 0.43 for CSA, and 0.34 for Hypopnea. Average F1-scores for the 6 technicians were 0.48 (std 0.04) for OSA, 0.29 (std 0.145) for CSA, and 0.54 (std 0.183) for Hypopnea, indicating that the model functions better on an event-by-event basis than an average technician. Correlations between indices/hr for central apnea, obstructive apnea, and hypopnea indicate excellent correlations for apneas, but poor correlation for hypopnea. We are now adding the snoring channel to explore if predictions can be improved. Conclusion The result shows that deep learning-based models can detect respiratory events with an accuracy similar to technicians. The poor agreement between technicians from different universities indicates that we need better definitions of hypopnea. Support  

TP3-7 Sleep-disordered breathing as a consequence of vagal nerve stimulation

2019 ◽  
Vol 90 (3) ◽  
pp. e20.1-e20
Author(s):  
L Pérez-Carbonell ◽  
S Higgins ◽  
M Koutroumanidis ◽  
G Leschziner
Keyword(s):  
Nerve Stimulation ◽  
Sleep Disordered Breathing ◽  
Sleep Apnoea ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Pressure Therapy ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Drug Resistant Epilepsy ◽  
Disordered Breathing

ObjectivesVagal nerve stimulation (VNS) is a neuromodulatory therapy indicated in drug-resistant epilepsy (DRE). Its side effects are frequently minor, however, sleep-disordered breathing (SDB) has been previously reported.1Obstructive sleep apnoea (OSA) is highly prevalent in individuals with refractory epilepsy, and may be a cause of poor control of seizures.2MethodsThree DRE patients with active VNS underwent a video-polysomnography with 21-channel montage electroencephalography in our centre.ResultsFirst and second patients showed OSA at the time of VNS activation. In the first patient, the apnoeic-induced arousals triggered VNS auto-firing and consequent respiratory events, perpetuating the SDB. The third patient had episodes of stridor, and an increased respiratory rate, coinciding with VNS activation. Our cases are representative of different forms of SDB that occurred as a consequence of the switch-on phase of the VNS device.ConclusionsSleep-related breathing disturbances should be considered before VNS implantation, and should be routinely assessed after having started the therapy. Changes in stimulation parameters, and positive airway pressure therapy, may be required to treat the SDB.

Neuropsychological Consequences of Sleep-Disordered Breathing

2010 ◽  
Author(s):  
Jennifer Janusz ◽  
Ann Halbower
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
Sleep Fragmentation ◽  
Primary Snoring ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Disordered Breathing

Pediatric sleep disorders have been gaining awareness among practitioners due to their potential for cognitive, behavioral, and somatic effects (Gozal 2008; Moore et al. 2006). Sleep-disordered breathing (SDB) is commonly seen in children and encompasses a range of disorders, in primary snoring to obstructive sleep apnea (Marcus 2000). Sleep-disordered breathing is characterized by partial or complete upper airway obstruction during sleep due to collapse or narrowing of the pharynx. This can result in sleep fragmentation due to brief arousals during the night, as well as disruption or cessation of airflow (Blunden and Beebe 2006; Halbower and Mahone 2006). This chapter describes the neuropsychological and behavioral consequences of SDB, comorbid disorders, and effects of treatment. Sleep-disordered breathing is considered a spectrum of airflow limitation, from mild to severe. For instance, primary snoring (PS), defined as snoring without oxygen desaturation or sleep arousals, is at the mild end of the spectrum. Upper airway resistance syndrome (UARS), in the middle of the spectrum, is characterized by increased negative intrathoracic pressure with sleep arousals and sleep fragmentation but no oxygen desaturations (Bao and Guilleminault 2004; Garetz 2008; Lumeng and Chervin 2008). In obstructive sleep apnea (OSA), at the severe end of the spectrum, there are repeated episodes of blockage of the airway with changes in oxygenation. Obstructive sleep apnea results from a combination of factors, including anatomical obstruction from adenoids, tonsils, or a narrow pharynx, and decreased neuromuscular tone required to maintain airway patency (Arens and Marcus 2004). An overnight polysomnogram (PSG) completed in a sleep laboratory and measuring sleep–wake states, respiration, movement, blood levels of oxygen and carbon dioxide, and cardiac activity, is considered the “gold standard” for the diagnosis of OSA (American Academy of Pediatrics 2002). The PSG is used to diagnose respiratory events, cardiac changes, and arousals from different sleep states. Respiratory events include obstructive apneas and hypopneas. Obstructive apnea events are episodes of complete airway obstruction, while hypopneas are partial obstructions or airflow limitations (Garetz 2008; Redline et al. 2007).

scholarly journals Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea

2020 ◽  
Vol 24 (4) ◽  
pp. 1495-1505 ◽  
Author(s):  
Akseli Leino ◽  
Susanna Westeren-Punnonen ◽  
Juha Töyräs ◽  
Sami Myllymaa ◽  
Timo Leppänen ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Transient Ischemic Attack ◽  
Sleep Disordered Breathing ◽  
Apnea Hypopnea Index ◽  
Stroke Patients ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Ischemic Attack

Abstract Purpose Obstructive sleep apnea (OSA) is associated with increased risk for stroke, which is known to further impair respiratory functions. However, it is unknown whether the type and severity of respiratory events are linked to stroke or transient ischemic attack (TIA). Thus, we investigate whether the characteristics of individual respiratory events differ between patients experiencing TIA or acute ischemic stroke and matched patients with clinically suspected sleep-disordered breathing. Methods Polygraphic data of 77 in-patients with acute ischemic stroke (n = 49) or TIA (n = 28) were compared to age, gender, and BMI-matched patients with suspected sleep-disordered breathing and no cerebrovascular disease. Along with conventional diagnostic parameters (e.g., apnea-hypopnea index), durations and severities of individual apneas, hypopneas and desaturations were compared between the groups separately for ischemic stroke and TIA patients. Results Stroke and TIA patients had significantly shorter apneas and hypopneas (p < 0.001) compared to matched reference patients. Furthermore, stroke patients had more central apnea events (p = 0.007) and a trend for higher apnea/hypopnea number ratios (p = 0.091). The prevalence of OSA (apnea-hypopnea index ≥ 5) was 90% in acute stroke patients and 79% in transient ischemic attack patients. Conclusion Stroke patients had different characteristics of respiratory events, i.e., their polygraphic phenotype of OSA differs compared to matched reference patients. The observed differences in polygraphic features might indicate that stroke and TIA patients suffer from OSA phenotype recently associated with increased cardiovascular mortality. Therefore, optimal diagnostics and treatment require routine OSA screening in patients with acute cerebrovascular disease, even without previous suspicion of OSA.

Snoring and sleep apnoea

2020 ◽  
Vol 13 (10) ◽  
pp. 605-607
Author(s):  
Tanvi Agarwal
Keyword(s):  
Sleep Disordered Breathing ◽  
Well Being ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
Restorative Sleep ◽  
The Impact ◽  
Negative Health Outcomes ◽  
Health And Well Being ◽  
Simple Snoring ◽  
Disordered Breathing

Snoring and sleep apnoea lie at the two extremes of sleep-disordered breathing, one mild and one serious. Sleep-disordered breathing can impair a person’s ability to have normal restorative sleep, which is essential for health and well-being. It can lead to significant negative health outcomes and cause chronic disorders such as hypertension, pulmonary hypertension, heart disease and even stroke. It is imperative to differentiate simple snoring from obstructive sleep apnoea, as the management and morbidity differ drastically. This article aims to describe the pathophysiology of sleep-disordered breathing, the impact on lifestyle and health, the differentiation of simple snoring from sleep apnoea, when to refer and interim treatment for paediatric and adult patients.

scholarly journals Long-term Impact of Adenotonsillectomy on the Quality of Life of Children with Sleep-disordered breathing

2020 ◽  
Author(s):  
Juliana Alves Sousa Caixeta ◽  
Jessica Caixeta Silva Sampaio ◽  
Vanessa Vaz Costa ◽  
Isadora Milhomem Bruno da Silveira ◽  
Carolina Ribeiro Fernandes de Oliveira ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Long Term Effects ◽  
Obstructive Sleep ◽  
Long Term Impact ◽  
Disordered Breathing

Abstract Introduction Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear. Objective To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB). Method This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis, p-values lower than 0.05 were defined as statistically significant. Results A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores. Conclusion This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.

scholarly journals Apnoea–hypopnoea indices determined via continuous positive airway pressure (AHI-CPAPflow) versus those determined by polysomnography (AHI-PSGgold): a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044499
Author(s):  
Fanny Bertelli ◽  
Carey Meredith Suehs ◽  
Jean Pierre Mallet ◽  
Marie Caroline Rotty ◽  
Jean Louis Pepin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

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