Neck circumference as a predictor for the presence and the severity of obstructive sleep apnea in snoring patients

To assess if the neck circumference (NC) can be used to predict the presence and the severity of obstructive sleep apnea syndrome (OSA) in a group of patients had snoring and witnessed apnea from Almoosa Hospital, Alhasa, Saudi Arabia. A retrospective study for patients had snoring and witnessed apnea referred to a sleep lab for the diagnosis of obstructive sleep apnea (OSA) by overnight full polysomnogram from August 2016 to August 2020. Apnea-hypopnea index (AHI) was used to categorize the severity of sleep apnea. Age, sex, neck circumference (NC) body mass index (BMI), comorbidities, and sleep parameters were recorded. Receiver-operating characteristic (ROC) curve was used to assess the ability of NC for the diagnosis of the OSA. Sensitivity and specificity were calculated for different cut-off points. The study included 450 patients who met the inclusion criteria with a mean age 52.5 ± 14.6. The mean NC (cm), and BMI were 39.4 ± 3.1, and 35.2 ± 9.0, respectively. OSA was diagnosed in 378 (84.0%) patients. OSA was more detected among males, those with an increased age, NC, BMI, and among patients had hypertension and type 2 diabetes. The mean BMI was significantly higher among females (p=0.031) while NC was significantly higher among males. Significant positive correlations were detected between both NC and BMI with the severity of OSA. Neck circumference can be used to predict the presence as well as the severity of obstructive sleep apnea in snoring patients. BMI, and male gender are independent predictors.

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Polysomnographic and clinical characteristics of positional obstructive sleep apnea patients

Egyptian Journal of Bronchology ◽

10.1186/s43168-021-00085-8 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Seda Beyhan Sagmen ◽

Sevda Cömert

Keyword(s):

Body Mass Index ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Body Mass ◽

Severe Disease ◽

Upper Airway ◽

Neck Circumference ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

The Mean

Abstract Background Obstructive sleep apnea is a condition characterized by the complete or partial obstruction of the upper airway during sleep. This study aimed to compare the clinical and polysomnographic characteristics of our obstructive sleep apnea patients according to their positional and non-positional features. Results Two hundred eighty patients were included in the study. One hundred two patients (36.43%) were female, while 178 patients (63.57%) were male. While 88 (31.43%) of these patients were defined as positional patients, 192 (68.57%) were defined as non-positional patients. The mean age of the positional patients (46.78 ± 9.66) was lower than the mean age of the non-positional patients (50.90 ± 10.96) (p 0.001). Similarly, the mean body mass index of the positional patients (29.39 ± 3.80) was lower than the mean body mass index of the non-positional patients (33.30 ± 6.45) (p < 0.001). Neck circumference values of the positional patients (40.36 ± 2.65) were lower compared to the non-positional patients (43.32 ± 2.54) (p < 0.001). Sleep values were compared based on the presence of positional sleep apnea. In the positional patients, sleep duration, sleep efficiency (percentage), duration of stage N3, minimum, and mean saturation values were found to be higher compared to the non-positional patients, while nightlong apnea hypopnea index, apnea index, percentage of sleep time with oxygen saturation below 90%, oxygen desaturation index, mean heart rate, and periodic limb movement index values were found to be lower (p < 0.05). The rate of severe sleep apnea (7.95%) in the positional patients was lower than the non-positional patients (53.65%) (p < 0.001). Conclusion In the light of these data, positional OSA is a very important condition presented in 31.43% of OSA patients and it was determined that these patients were younger, had less body mass index, and shorter neck circumference. The rate of severe disease was found to be lower in positional OSA patients

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Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome

International Archives of Otorhinolaryngology ◽

10.1055/s-0037-1607227 ◽

2017 ◽

Vol 22 (03) ◽

pp. 266-270 ◽

Cited By ~ 8

Author(s):

Abd Tantawy ◽

Sherif Askar ◽

Hazem Amer ◽

Ali Awad ◽

Mohammad El-Anwar

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Apnea Syndrome ◽

Apnea Hypopnea Index ◽

Absorbable Suture ◽

Drug Induced ◽

Multilevel Surgery ◽

Obstructive Sleep ◽

Hyoid Suspension ◽

The Mean

Introduction Since oropharyngeal surgery alone is often insufficient to treat obstructive sleep apnea (OSA), advances have been developed in hypopharyngeal surgery. Objective To assess hyoid suspension surgery as part of a multilevel OSA surgery, also including palatal surgery. Methods The study included patients with OSA symptoms with apnea hypopnea index (AHI) > 15. They were scheduled for hyoid suspension after a nasoendoscopy during Müller maneuver and drug induced sleep endoscopy (DISE). All patients had body mass index (BMI) < 35 kg/m2. Hyoidothyroidopexy combined with tonsillectomy and palatal suspension was performed in all cases. Results The mean AHI dropped significantly (p < 0.0001) from 68.4 ± 25.3 preoperatively to 25.6 ± 9.52 postoperatively. The mean lowest oxygen (O2) saturation level increased significantly from 66.8 ± 11.3 to 83.2 ± 2.86 (p < 0.0001). In addition, the snoring score significantly decreased (p < 0.0001) from a preoperative mean of 3.4 ± 0.54 to 2 ± 0.7 at 6 months postoperatively. In regard to the Epworth sleepiness scale (ESS), it showed significant improvements (p < 0.0001) as its mean diminished from 13.8 ± 5.4 preoperatively to 5.2 ± 1.6 postoperatively. Conclusion Hyoidothyroidopexy using absorbable suture seems to produce a good outcome in treating OSA. It could be effectively and safely combined with other palatal procedures in the multilevel surgery for OSA.

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Cervical computed tomography in patients with obstructive sleep apnea: influence of head elevation on the assessment of upper airway volume

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562016000000092 ◽

2016 ◽

Vol 42 (1) ◽

pp. 55-60 ◽

Cited By ~ 8

Author(s):

Fábio José Fabrício de Barros Souza ◽

Anne Rosso Evangelista ◽

Juliana Veiga Silva ◽

Grégory Vinícius Périco ◽

Kristian Madeira

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Apnea Syndrome ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Neutral Position ◽

Cardiovascular Risks ◽

Upper Airways ◽

Obstructive Sleep ◽

The Mean

Objective : Obstructive sleep apnea syndrome (OSAS) has a high prevalence and carries significant cardiovascular risks. It is important to study new therapeutic approaches to this disease. Positional therapy might be beneficial in reducing the apnea-hypopnea index (AHI). Imaging methods have been employed in order to facilitate the evaluation of the airways of OSAS patients and can be used in order to determine the effectiveness of certain treatments. This study was aimed at determining the influence that upper airway volume, as measured by cervical CT, has in patients diagnosed with OSAS. Methods : This was a quantitative, observational, cross-sectional study. We evaluated 10 patients who had been diagnosed with OSAS by polysomnography and on the basis of the clinical evaluation. All of the patients underwent conventional cervical CT in the supine position. Scans were obtained with the head of the patient in two positions (neutral and at a 44° upward inclination), and the upper airway volume was compared between the two. Results : The mean age, BMI, and neck circumference were 48.9 ± 14.4 years, 30.5 ± 3.5 kg/m2, and 40.3 ± 3.4 cm, respectively. The mean AHI was 13.7 ± 10.6 events/h (range, 6.0-41.6 events/h). The OSAS was classified as mild, moderate, and severe in 70%, 20%, and 10% of the patients, respectively. The mean upper airway volume was 7.9 cm3 greater when the head was at a 44° upward inclination than when it was in the neutral position, and that difference (17.5 ± 11.0%) was statistically significant (p = 0.002). Conclusions : Elevating the head appears to result in a significant increase in the caliber of the upper airways in OSAS patients.

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Insulin resistance and affecting factors in patients with obstructive sleep apnea syndrome

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20174319 ◽

2017 ◽

Vol 3 (4) ◽

pp. 986

Author(s):

Hatice Beyazal Polat ◽

Metin Çeliker ◽

Songül Özyurt ◽

Suat Terzi ◽

Abdülkadir Özgür

Keyword(s):

Insulin Resistance ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Apnea Hypopnea Index ◽

Obese Patients ◽

Obstructive Sleep ◽

The Mean ◽

Apnea Syndrome

Background: Metabolic syndrome and insulin resistance are common in patients with obstructive sleep apnea syndrome (OSAS) independently of obesity. This study aims to examine and evaluate the insulin resistance and the factors affecting the insulin resistance in patients with OSAS.Methods: Patients admitted to the sleep disorders clinic of our hospital with snoring complaints and diagnosed with OSAS in the last 6 months were included to the study. Insulin resistance was calculated by the Homa-IR formula. >2.7 was considered insulin resistance. Results: The mean Homa-IR value was 3.86±4.69 and 42 (49.4%) patients were found to have insulin resistance. Mean insulin resistance was 2.68±2.2 in normal weight patients, 2.30±1.41 in overweight patients, 3.96±1.83 in obese patients, and 8.61±12.13 in morbid obese patients. The mean apnea hypopnea index of the patients was 22.95±15.20; 30 (35.2%) were with mild, 26 (30.6%) were with moderate and 29 (34.1%) were with severe OSAS. Insulin resistance was 2.35±1.36 in patients with mild AHI; 3.09±1.30 in patients with moderate AHI, and 6.11±7.35 in severe cases. In our study, the most significant relationship was found to be between insulin resistance in OSAS patients with insulin resistance and BMI and AHI.Conclusions: Insulin resistance is common in patients with OSAS independently of obesity. In our study, BMI and AHI were found to be the most important factors associated with insulin resistance in patients with OSAS.

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Endothelial dysfunction in obstructive sleep apnea patients

Sleep And Breathing ◽

10.1007/s11325-021-02382-4 ◽

2021 ◽

Author(s):

Michał Harańczyk ◽

Małgorzata Konieczyńska ◽

Wojciech Płazak

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Endothelial Dysfunction ◽

Right Ventricular ◽

Contractile Function ◽

Sleep Apnea Syndrome ◽

Apnea Hypopnea Index ◽

Endothelin 1 ◽

Obstructive Sleep

Abstract Purpose Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular diseases. The aim of the study was to assess the influence of OSAS on endothelial dysfunction and thrombosis biomarkers and to evaluate the effect of treatment with continuous positive airway pressure (CPAP) on biomarker levels. Methods NT-proBNP, sICAM-1, endothelin-1, von Willebrand factor, D-dimers, and thrombin-antithrombin complex (TAT) were measured in 50 patients diagnosed with moderate-to-severe OSAS. All patients underwent transthoracic echocardiography, and 38 months after the inclusion, 16 CPAP users and 22 non-CPAP users were reassessed. Results Sleep-related indices of apnea-hypopnea index (AHI) and mean SpO2 were associated with higher sICAM-1 levels (AHI < 30: 7.3 ± 4.7 vs. AHI ≥ 30: 19.5 ± 19.4 mg/ml, p = 0.04; SpO2 ≥ 90%: 11.9 ± 9.3 vs. SpO2 < 90%: 23.6 ± 25.8, p = 0.04). sICAM-1 levels were significantly higher in obese patients, particularly with BMI ≥ 40. Plasma levels of TAT were significantly correlated with the increased right ventricular size (right ventricular diameter ≤ 37 mm: 0.86 ± 0.70 vs. > 37 mm: 1.96 ± 1.20 ng/ml, p = 0.04). Endothelin-1 levels were higher in patients with decreased right ventricular function (right ventricle TDI-derived S′ ≥ 12 cm/s: 11.5 ± 10.9 vs. < 12 cm/s: 26.0 ± 13.2 pg/ml, p = 0.04). An increase in NT-proBNP was related to impaired parameters of the right ventricular contractile function. There were no correlations between long-term CPAP therapy and the levels of biomarkers. Conclusion Severe OSAS influences endothelial damage as manifested by an increase in sICAM-1 levels. Changes in right ventricular structure and function, observed mainly in patients with higher TAT and endothelin-1 levels, are also manifested by an increase in NT-proBNP levels. Long-term CPAP treatment does not seem to influence biomarkers in patients with moderate-to-severe OSAS, which may help to explain the lack of influence of CPAP on cardiovascular risk reduction.

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Effect of a Graduated Walking Program on the Severity of Obstructive Sleep Apnea Syndrome. A Randomized Clinical Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176334 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6334

Author(s):

Antonio Jurado-García ◽

Guillermo Molina-Recio ◽

Nuria Feu-Collado ◽

Ana Palomares-Muriana ◽

Adela María Gómez-González ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Intervention Group ◽

Exercise Program ◽

Density Lipoprotein ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Apnea Syndrome

Background: Obstructive sleep apnea syndrome (OSAS) is a common disease. The objective of this research was to determine the effectiveness of a graduated walking program in reducing the apnea–hypopnea index number in patients with obstructive sleep apnea syndrome (OSAS). Methods: A randomized controlled clinical trial with a two-arm parallel in three tertiary hospitals was carried out with seventy sedentary patients with moderate to severe OSAS. Twenty-nine subjects in each arm were analyzed by protocol. The control group received usual care, while usual care and an exercise program based on progressive walks without direct supervision for 6 months were offered to the intervention group. Results: The apnea–hypopnea index decreased by six points in the intervention group, and improvements in oxygen desaturation index, total cholesterol, and Low-Density Lipoprotein of Cholesterol (LDL-c) were observed. A higher decrease in sleep apnea–hypopnea index (45 ± 20.6 vs. 34 ± 26.3/h; p = 0.002) was found in patients with severe vs. moderate OSAS, as well as in oxygen desaturation index from baseline values (43.3 vs. 34.3/h; p = 0.046). Besides, High-Density Lipoprotein of Cholesterol (HDL-c) values showed a higher increase in the intervention group (45.3 vs. 49.5 mg/dL; p = 0.009) and also, a higher decrease in LDL-c was found in this group (141.2 vs. 127.5 mg/dL; p = 0.038). Conclusion: A home physical exercise program is a useful and viable therapeutic measure for the management of OSAS.

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S296 – Thyroidectomy for Goiter Improves Obstructive Sleep Apnea

Otolaryngology ◽

10.1016/j.otohns.2008.05.472 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P173-P174

Author(s):

Mark T Agrama

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Total Thyroidectomy ◽

Community Hospital ◽

Apnea Hypopnea Index ◽

Tracheal Compression ◽

Obstructive Sleep ◽

The Mean ◽

Postoperative Improvement ◽

Symptomatic Control

Objectives Evaluate the effects of total thyroidectomy for euthyroid goiter causing tracheal compression on the apnea hypopnea index (AHI) in patients with obstructive sleep apnea (OSA). Demonstrate a relationship between tracheal compression and OSA. Methods A retrospective study of 8 patients with euthyroid goiter causing tracheal compression who had moderate or severe OSA. Between January 2004 and December 2007, 8 patients with these conditions were treated in a community hospital by the author. At least 1 compressive symptom (dysphagia, dyspnea, and/or orthopnea) was reported by all patients. Computed tomography of the neck and chest was used to confirm the extent of goiter and tracheal compression. OSA was confirmed with preoperative polysomnography. Total thyroidectomy was performed. Postoperative polysomnography was obtained after 90 days. Outcome measures were changes in compressive symptoms and AHI using paired t test. Results All 8 patients reported symptomatic control of compressive symptoms after thyroidectomy. 7 of 8 patients demonstrated postoperative improvement of AHI. The mean postoperative AHI decreased significantly from 52.1 to 36.6 (P < 0.05). Conclusions Total thyroidectomy for goiter causing tracheal compression can significantly improve symptoms and AHI in those patients who have OSA. Evaluation of patients with OSA should include screening for tracheal compression from goiter.

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Cardiac arrhythmias and conduction disturbances in the obstructive sleep apnea syndrome

In a good rythm ◽

10.5604/01.3001.0012.0392 ◽

2018 ◽

Vol 2 (47) ◽

pp. 10-15

Author(s):

Danuta Łoboda ◽

Karolina Simionescu ◽

Anna Szajerska-Kurasiewicz ◽

Dorota Lasyk ◽

Grzegorz Jarosiński ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cardiac Arrhythmias ◽

Sleep Apnea Syndrome ◽

The Body ◽

Apnea Hypopnea Index ◽

Premature Ventricular Contractions ◽

Mortality And Morbidity ◽

Conduction Disturbances ◽

Obstructive Sleep

Cardiac arrhythmias during sleep are reported in almost half of the population suffering from obstructive sleep apnea (OSA). The most common are bradyarrhythmias and atrial fibrillation whereas premature ventricular contractions and nonsustained ventricular tachycardia are less frequent. The risk of arrhythmia is proportional to the body mass index (BMI), number of respiratory events per hour of sleep described with apnea/hypopnea index (AHI) and the level of oxygen desaturation during these episodes. Continuous positive airway pressure (CPAP) treatment in OSA reduces the incidence of cardiac arrhythmias therefore reduce mortality and morbidity from cardiovascular disease.

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