Obstructive sleep apnea: acute effects of CPAP on polyssonographic variables

Introduction The use of non-invasive ventilation in the form of continuous positive airway pressure (CPAP) is among the main therapeutic options for patients with obstructive sleep apnea (OSA). Yet the effects of CPAP obtained on the first night of use are underreported. Objective To evaluate the acute effects of CPAP on polysomnographic variables in patients with OSA. Materials and methods This study is a case series with 31 patients (55.8 ± 11.4 years; 22 men) in the initial phase of CPAP treatment. The subjects were evaluated by means of polysomnography with and without CPAP (10.2 ± 3.1 cmH2O) and without CPAP, on different days, by means of the following variables: sleep stages 1, 2 and 3 (N1, N2 and N3), rapid eye movement (REM) sleep, apnea and hypopnea index (AHI), AHI in REM sleep (AHIREM) and the micro-arousal index (MAI). Results The use of CPAP resulted in a reduction of N2 (p < 0.001), AHI (p < 0.001), AHIREM (p < 0.001) and MAI (p = 0.001). There was an increase in N3 (p = 0.006) and REM sleep (p < 0.001) during the night with use of CPAP. Conclusion This study demonstrated that, from the first night of use by patients with OSA, CPAP promotes greater balance between sleep phases, and improves sleep quality. These results should be presented to patients and their families in order to encourage greater adherence in the initial phase of treatment with CPAP.

Download Full-text

Does Obstructive Sleep Apnea Worsen During REM Sleep?

Physiological Research ◽

10.33549/physiolres.932457 ◽

2013 ◽

pp. 569-575 ◽

Cited By ~ 5

Author(s):

I. PEREGRIM ◽

S. GREŠOVÁ ◽

M. PALLAYOVÁ ◽

B. L. FULTON ◽

J. ŠTIMMELOVÁ ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Rem Sleep ◽

Body Position ◽

Statistical Significance ◽

Nrem Sleep ◽

Sleep Stages ◽

Lateral Body ◽

Obstructive Sleep ◽

Significant Difference

Although it is thought that obstructive sleep apnea (OSA) is worse during rapid eye movement (REM) sleep than in non-REM (NREM) sleep there are some uncertainties, especially about apnoe-hypopnoe-index (AHI). Several studies found no significant difference in AHI between both sleep stages. However, REM sleep is associated more with side sleeping compared to NREM sleep, which suggests that body position is a possible confounding factor. The main purpose of this study was to compare the AHI in REM and NREM sleep in both supine and lateral body position. A retrospective study was performed on 422 consecutive patients who underwent an overnight polysomnography. Women had higher AHI in REM sleep than NREM sleep in both supine (46.05±26.26 vs. 23.91±30.96, P<0.01) and lateral (18.16±27.68 vs. 11.30±21.09, P<0.01) body position. Men had higher AHI in REM sleep than NREM sleep in lateral body position (28.94±28.44 vs. 23.58±27.31, P<0.01), however, they did not reach statistical significance in supine position (49.12±32.03 in REM sleep vs. 45.78±34.02 in NREM sleep, P=0.50). In conclusion, our data suggest that REM sleep is a contributing factor for OSA in women as well as in men, at least in lateral position.

Download Full-text

Sleep Architecture in Children With Down Syndrome With and Without Obstructive Sleep Apnea

Otolaryngology ◽

10.1177/0194599820960454 ◽

2020 ◽

pp. 019459982096045

Author(s):

Christine H. Heubi ◽

Philip Knollman ◽

Susan Wiley ◽

Sally R. Shott ◽

David F. Smith ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Down Syndrome ◽

Sleep Apnea ◽

Rem Sleep ◽

Total Sleep Time ◽

Sleep Time ◽

Sleep Architecture ◽

Children With Down Syndrome ◽

Arousal Index ◽

Obstructive Sleep

Objective To characterize polysomnographic sleep architecture in children with Down syndrome and compare findings in those with and without obstructive sleep apnea. Study Design Case series with retrospective review. Setting Single tertiary pediatric hospital (2005-2018). Methods We reviewed the electronic health records of patients undergoing polysomnography who were referred from a specialized center for children with Down syndrome (age, ≥12 months). Continuous positive airway pressure titration, oxygen titration, and split-night studies were excluded. Results A total of 397 children were included (52.4% male, 81.6% Caucasian). Mean age at the time of polysomnography was 4.7 years (range, 1.4-14.7); 79.4% had obstructive sleep apnea. Sleep variables were reported as mean (SD) values: sleep efficiency, 85% (11%); sleep latency, 29.8 minutes (35.6); total sleep time, 426 minutes (74.6); rapid eye movement (REM) latency, 126.8 minutes (66.3); time spent in REM sleep, 22% (7%); arousal index, 13.3 (5); and time spent supine, 44% (28%). There were no significant differences between those with obstructive sleep apnea and those without. Sleep efficiency <80% was seen in 32.5%; 34.3% had a sleep latency >30 minutes; 15.9% had total sleep time <360 minutes; and 75.6% had an arousal index >10/h. Overall, 69.2% had ≥2 metrics of poor sleep architecture. REM sleep time <20% was seen in 35.3%. REM sleep time decreased with age. Conclusion In children with Down syndrome, 32.5% had sleep efficiency <80%; 75.6% had an elevated arousal index; and 15.9% had total sleep time <360 minutes. More than a third of the patients had ≥3 markers of poor sleep architecture. There was no difference in children with or without obstructive sleep apnea.

Download Full-text

Children With Down Syndrome and Obstructive Sleep Apnea: Outcomes After Tonsillectomy

Otolaryngology ◽

10.1177/01945998211023102 ◽

2021 ◽

pp. 019459982110231

Author(s):

Claire A. Abijay ◽

Anna Tomkies ◽

Swathi Rayasam ◽

Romaine F. Johnson ◽

Ron B. Mitchell

Keyword(s):

Obstructive Sleep Apnea ◽

Down Syndrome ◽

Sleep Apnea ◽

Odds Ratio ◽

Medical Center ◽

Case Series ◽

Apnea Hypopnea Index ◽

Children With Down Syndrome ◽

Arousal Index ◽

Obstructive Sleep

Objective To evaluate outcomes of tonsillectomy and predictors for persistent obstructive sleep apnea (OSA) in children with Down syndrome in an ethnically diverse population. Study Design Case series with chart review. Setting UT Southwestern/Children’s Medical Center Dallas. Methods Polysomnographic, clinical, and demographic characteristics of children with Down syndrome ages 1 to 18 years were collected, including pre- and postoperative polysomnography. Simple and multivariable regression models were used for predictors for persistent OSA. P≤ .05 was considered significant. Results Eighty-one children were included with a mean age of 6.6 years, 44 of 81 (54%) males, and 53 of 81 (65%) Hispanic. Preoperatively, 60 of 81 (74%) patients had severe OSA. Posttonsillectomy improvements occurred for apnea-hypopnea index (27.9 to 14.0, P < .001), arousal index (25.2 to 18.8, P = .004), percent time with oxygen saturations <90% (8.8% to 3.4%, P = .003), and oxygen nadir (81.4% to 85%, P < .001). Forty-seven children (58%) had persistent OSA. Fifteen children (18.5%) had increased apnea-hypopnea index postoperatively: 2 from mild to moderate, 2 from mild to severe, and 2 from moderate to severe obstructive sleep apnea. Persistent OSA predictors were asthma (odds ratio, 4.77; 95% CI, 1.61-14.09; P = .005) and increasing age (odds ratio, 1.25; 95% CI, 1.09-1.43; P = .001). Conclusion Children with Down syndrome are at high risk for persistent OSA after tonsillectomy with about 20% worsening after tonsillectomy. Asthma and increasing age are predictors for persistent OSA in children with Down syndrome.

Download Full-text

Melatonin Effects in REM Sleep Behavior Disorder Associated with Obstructive Sleep Apnea Syndrome: A Case Series

Current Alzheimer Research ◽

10.2174/1567205014666170523094938 ◽

2017 ◽

Vol 14 (10) ◽

Cited By ~ 8

Author(s):

Carolin Schaefer ◽

Dieter Kunz ◽

Frederik Bes

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Rem Sleep ◽

Sleep Apnea Syndrome ◽

Case Series ◽

Rem Sleep Behavior Disorder ◽

Behavior Disorder ◽

Sleep Behavior ◽

Obstructive Sleep ◽

Apnea Syndrome

Download Full-text

EEG microstate in obstructive sleep apnea patients

Scientific Reports ◽

10.1038/s41598-021-95749-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xin Xiong ◽

Yuyan Ren ◽

Shenghan Gao ◽

Jianhua Luo ◽

Jiangli Liao ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Correlation Analysis ◽

Transition Probability ◽

Transient State ◽

Sample Entropy ◽

Sleep Stages ◽

Fluctuation Analysis ◽

Alpha Power ◽

Obstructive Sleep

AbstractObstructive sleep apnea (OSA) is a common sleep respiratory disease. Previous studies have found that the wakefulness electroencephalogram (EEG) of OSA patients has changed, such as increased EEG power. However, whether the microstates reflecting the transient state of the brain is abnormal is unclear during obstructive hypopnea (OH). We investigated the microstates of sleep EEG in 100 OSA patients. Then correlation analysis was carried out between microstate parameters and EEG markers of sleep disturbance, such as power spectrum, sample entropy and detrended fluctuation analysis (DFA). OSA_OH patients showed that the microstate C increased presence and the microstate D decreased presence compared to OSA_withoutOH patients and controls. The fifth microstate E appeared during N1-OH, but the probability of other microstates transferring to microstate E was small. According to the correlation analysis, OSA_OH patients in N1-OH showed that the microstate D was positively correlated with delta power, and negatively correlated with beta and alpha power; the transition probability of the microstate B → C and E → C was positively correlated with alpha power. In other sleep stages, the microstate parameters were not correlated with power, sample entropy and FDA. We might interpret that the abnormal transition of brain active areas of OSA patients in N1-OH stage leads to abnormal microstates, which might be related to the change of alpha activity in the cortex.

Download Full-text

Arterial blood pressure responses to graded transient arousal from sleep in normal humans

Journal of Applied Physiology ◽

10.1152/jappl.1993.74.3.1123 ◽

1993 ◽

Vol 74 (3) ◽

pp. 1123-1130 ◽

Cited By ~ 177

Author(s):

R. J. Davies ◽

P. J. Belt ◽

S. J. Roberts ◽

N. J. Ali ◽

J. R. Stradling

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Confidence Interval ◽

Rem Sleep ◽

High Frequency ◽

Pressure Rise ◽

Nrem Sleep ◽

Blood Pressure Rise ◽

Obstructive Sleep

During obstructive sleep apnea, transient arousal at the resumption of breathing is coincident with a substantial rise in blood pressure. To assess the hemodynamic effect of arousal alone, 149 transient stimuli were administered to five normal subjects. Two electroencephalograms (EEG), an electrooculogram, a submental electromyogram (EMG), and beat-to-beat blood pressure (Finapres, Ohmeda) were recorded in all subjects. Stimulus length was varied to produce a range of cortical EEG arousals that were graded as follows: 0, no increase in high-frequency EEG or EMG; 1, increased high-frequency EEG and/or EMG for < 10 s; 2, increased high-frequency EEG and/or EMG for > 10 s. Overall, compared with control values, average systolic pressure rose [nonrapid-eye-movement (NREM) sleep 10.0 +/- 7.69 (SD) mmHg; rapid-eye-movement (REM) sleep 6.0 +/- 6.73 mmHg] and average diastolic pressure rose (NREM sleep 6.1 +/- 4.43 mmHg; REM sleep 3.7 +/- 3.02 mmHg) over the 10 s following the stimulus (NREM sleep, P < 0.0001; REM sleep, P < 0.002). During NREM sleep, there was a trend toward larger blood pressure rises at larger grades of arousal (systolic: r = 0.22, 95% confidence interval 0.02–0.40; diastolic: r = 0.48, 95% confidence interval 0.31–0.62). The average blood pressure rise in response to the grade 2 arousals was approximately 75% of that during obstructive sleep apnea. Arousal stimuli that did not cause EEG arousal still produced a blood pressure rise (mean systolic rise 8.6 +/- 7.0 mmHg, P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Download Full-text

The Specific Characteristics in Children with Obstructive Sleep Apnea and Cor Pulmonale

The Scientific World JOURNAL ◽

10.1100/2012/757283 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Pi-Chang Lee ◽

Betau Hwang ◽

Wen-Jue Soong ◽

C. C. Laura Meng

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Pediatric Patients ◽

Pediatric Population ◽

Clinical Manifestations ◽

Cor Pulmonale ◽

Arousal Index ◽

Obstructive Sleep ◽

Hemodynamic Characteristics ◽

Pulmonary Arterial

Background.The prevalence of obstructive sleep apnea (OSA) in the pediatric population is currently estimated at 1-2% of all children. The purpose of this study was to investigate the clinical and hemodynamic characteristics in pediatric patients with cor pulmonale and OSA.Methods.Thirty children with the diagnosis of OSA were included. These patients consisted of 26 male and 4 female children with a mean age of 7 ± 4 years old. Five of those children were found to be associated with cor pulmonale, and 25 had OSA but without cor pulmonale.Results.The arousal index was much higher in children with OSA and cor pulmonale. The children with OSA and cor pulmonale had much lower mean and minimal oxygen saturation and a higher incidence of bradycardia events. All 5 patients with OSA and cor pulmonale underwent an adenotonsillectomy, and the pulmonary arterial pressure dropped significantly after the surgery.Conclusion.This study demonstrated that the OSA pediatric patients with cor pulmonale had the different clinical manifestations and hemodynamic characteristics from those without cor pulmonale. The adenotonsillectomy had excellent results in both the OSA pediatric patients with and without cor pulmonale.

Download Full-text

Bone Mineral Density Attenuation in Obstructive Sleep Apnea by Derived Computed Tomography Screening

10.21203/rs.3.rs-1049040/v1 ◽

2021 ◽

Author(s):

Sharon Daniel ◽

Yafit Cohen-Freud ◽

Ilan Shelef ◽

Ariel Tarasiuk

Keyword(s):

Computed Tomography ◽

Bone Mineral Density ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Bone Mineral ◽

Clinical Information ◽

Mineral Density ◽

Peak Voltage ◽

Arousal Index ◽

Obstructive Sleep

Abstract The association between obstructive sleep apnea (OSA) and bone mineral density (BMD) is poorly elucidated with contradictory findings. We retrospectively explored the association between OSA and BMD by examining abdominal computed tomography (CT) vertebrae images using clinical information. We included 315 subjects (174 with OSA and 141 without OSA) who performed at least two CT scans (peak voltage of 120 kV). Bone mineral density was attenuated in those with OSA and increased age. BMD attenuation was not associated with the apnea–hypopnea score, nocturnal oxygen saturation, or arousal index. A multivariate linear regression indicated that OSA is associated with BMD attenuation after controlling for age, gender, and cardiovascular diseases. Here, we report that OSA is associated with BMD attenuation. Further studies are required to untangle the complex affect of OSA on BMD loss and possible clinical implication of vertebra depressed fracture or femoral neck fracture.

Download Full-text