What is more affected in patients wit obstructive sleep apnea: the right or the left heart?

The aim of the study. To assess the echocardiographic signs of structural and left heart functional changes in the working age individuals with obstructive sleep apnea syndrome. Materials and methods. Cross-sectional prospective observational study of 67 working age individuals was performed. The main group included 45 patients diagnosed with obstructive sleep apnea syndrome. The control group consisted of 22 subjects without any pathology revealed by means of polysomnography. There were no significant differences in gender, age, body mass index, presence of diabetes mellitus, arterial hypertension in patients of both groups. To assess the structural and functional changes in the left heart all subjects underwent echocardiographic heart examination in M and B modes, pulse-wave and tissue Doppler study. Results. According to echocardiographic studies of working age patients with OSAS, the anteroposterior size of the left atrium (LA) and the LA volume index are statistically significantly higher than those in the control group: 38.0 (36.0 - 40.0) mm versus 35.0 (30, 3 - 38.0) mm (p <0.01) and 35.0 (33.0 - 37.0) ml / m2 versus 30 (29.3 - 31.0) ml / m2 (p <0.001), respectively. Mean group values of the end-diastolic volume (115.0 (99.5 - 135.5) ml versus 95.0 (72.5 - 104.8) ml (p <0.01)), the end-systolic volume (47.0 (34.0 - 56.0) ml versus 35.0 (27.3 - 41.5) ml (p <0.01)), the thickness of the posterior wall of the left ventricle (LV) (11.0 (10, 0 - 12.0) mm versus 10.0 (9.00 - 10.8) mm (p <0.05)) in the main group exceeded the required data in the group of healthy individuals. While comparing LV diastolic function in patients with obstructive sleep apnea syndrome with the group of people without intermittent hypoxia, higher indicators of the slowing time of the early left ventricle diastolic filling DT 187.0 (154.0-196.0) ms versus 155.0 (130.0 - 169.0) ms were recorded (p < 0.05) and the velocity of late diastolic movement of the mitral valve lateral wall Am 12.0 (10.0 - 14.0) cm / s versus 9.0 (8.0 - 12.0) cm / s (p <0.05). A direct moderate relationship was established between the presence of intermittent hypoxia and structural and functional changes in the left heart: the LP volume index (r = 0.422, p <0.01), LV end-diastolic volume (r = 0.351, p <0.005), end-systolic LV volume (r = 0.315, p <0.05) and the rate of late diastolic LV filling Am (r = 0.373; p <0.05), and inverse - between the apnea / hypopnea index and the ratio of the rate of early and late diastolic LV filling E \ A (r = -0.371, p <0.05). Conclusion. Echocardiographic examination of working age patients with newly diagnosed obstructive sleep apnea syndrome revealed a significantly more frequent tendency of the left heart region remodeling according to the myocardial hypertrophy type, diastolic left ventricle dysfunction and dilatation of the left atrium associated with the presence of intermittent hypoxia.

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Ansa Cervicalis Stimulation Increases Pharyngeal Patency in Patients with Obstructive Sleep Apnea

Journal of Applied Physiology ◽

10.1152/japplphysiol.00076.2021 ◽

2021 ◽

Author(s):

David T. Kent ◽

William C. Scott ◽

David Zealear ◽

Alan R. Schwartz

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Hypoglossal Nerve ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Ansa Cervicalis ◽

Obstructive Sleep ◽

The Right ◽

Stimulation Of

Rationale: Hypoglossal nerve stimulation (HNS) is an alternative treatment option for obstructive sleep apnea (OSA) that reduces pharyngeal collapsibility, but HNS non-responders often demonstrate continued retropalatal and lateral pharyngeal wall collapse. Recent evidence suggests that caudal pharyngeal traction with sternothyroid muscle contraction via ansa cervicalis stimulation (ACS) can also stabilize the pharynx, but the underlying mechanisms have not been elucidated. Objectives: To evaluate the effect of ACS on pharyngeal patency during expiration when the airway is most hypotonic. Methods: Eight participants with OSA underwent sustained ultrasound-guided fine-wire stimulation of the medial branch of the right hypoglossal nerve with and without transient stimulation of the branch of the ansa cervicalis nerve plexus innervating the right sternothyroid muscle during drug-induced sleep endoscopy. Airway cross-sectional area and expiratory airflow (VE) were measured from endoscopy video with ImageJ and pneumotachometry, respectively. Measurements and Main Results: ACS significantly increased retropalatal cross-sectional area (CSArp) to 211% [159-263] of unstimulated CSArp (p<0.05). Adding ACS to HNS increased CSArp from baseline by 341% [244-439] (p<0.05), a 180% [133-227] increase over isolated HNS (p<0.05). ACS increased VE from baseline by 177% [138-217] (p < 0.05). Adding ACS to HNS increased VE by 254% [207-301], reflecting decreases in pharyngeal collapsibility. Conclusions: Combining ACS with HNS increased retropalatal cross-sectional area and increased expiratory airflow, suggesting decreases in pharyngeal collapsibility. Our findings suggest that ACS exerts caudal traction on the upper airway through sternothyroid muscle contraction, and that it may augment HNS efficacy in patients with OSA.

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Choosing the right interface for positive airway pressure therapy in patients with obstructive sleep apnea

Sleep And Breathing ◽

10.1007/s11325-017-1490-9 ◽

2017 ◽

Vol 21 (3) ◽

pp. 569-575 ◽

Cited By ~ 13

Author(s):

Ahmed S. BaHammam ◽

Tripat Singh ◽

Smitha George ◽

Karen Lorraine Acosta ◽

Kashmira Barataman ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Pressure Therapy ◽

Positive Airway Pressure Therapy ◽

Obstructive Sleep ◽

The Right

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Proboscis Lateralis with Rhinosinusitis

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v32i1.185 ◽

2017 ◽

Vol 32 (1) ◽

pp. 41-43

Author(s):

Laurence Michael N. Vera Cruz ◽

Gil M. Vicente

Keyword(s):

Congenital Anomaly ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Paranasal Sinuses ◽

Multidisciplinary Approach ◽

Sinus Surgery ◽

Rare Congenital Anomaly ◽

Obstructive Sleep ◽

The Right ◽

Proboscis Lateralis

Objective: This report aims to describe unique manifestations of proboscis lateralis and highlight the importance of a multidisciplinary approach to address the problems that arise from this rare congenital anomaly. Methods: Study Design: Case Report Setting: Tertiary Government Hospital Patient: One Results: A 13 year-old girl diagnosed with proboscis lateralis presented with a trunk-like appendage projecting from the surface of the right supramedial canthal area. She also had clear nasal discharge, nasal congestion, mouth-breathing, and snoring since birth. Paranasal Sinus (PNS) CT scan with 3D reconstruction showed agenesis of the right paranasal sinuses, and expansile aeration of the left paranasal sinuses. Due to her condition, the drainage system of the paranasal sinuses was obstructed, causing chronic rhinosinusitis (CRS). This hindered plans for reconstructive surgery despite medical management, hence the patient underwent Endoscopic Sinus Surgery (ESS). Conclusion: Proboscis lateralis is a rare congenital anomaly that results in aesthetic problems as well as airway concerns, such as rhinosinusitis and obstructive sleep apnea syndrome (OSAS). Management entails a multidisciplinary approach to address functional and aesthetic problems of the patient. Keywords: proboscis lateralis, chronic rhinosinusitis, obstructive sleep apnea, endoscopic sinus surgery, multidisciplinary approach, plastic surgery, reconstructive surgery

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Polysomnography outcomes on patients with obstructive sleep apnea after upper airways repermeabilization surgery

Romanian Journal of Rhinology ◽

10.2478/rjr-2018-0011 ◽

2018 ◽

Vol 8 (30) ◽

pp. 103-115

Author(s):

Ionut Tanase ◽

Claudiu Manea ◽

Codrut Sarafoleanu

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Obstruction ◽

Upper Airway ◽

Upper Respiratory Tract ◽

Upper Airways ◽

Respiratory Events ◽

Non Invasive Ventilation ◽

Obstructive Sleep ◽

The Right

Abstract BACKGROUND. Sleep apnea is a pathology with an ever-increasing spread, the causes being the most diverse. In this study we focus on sleep breathing disorders caused by nasal obstruction and also by soft palate and uvula anatomical changes. The right treatment recommended in this pathology according to the American Academy Sleep Medicine (AASM) is non-invasive ventilation – positive airway pressure (CPAP). A substantial percentage of patients with obstructive sleep apnea seek alternatives to CPAP and the solution for this can be upper airway surgery. OBJECTIVE. The attempt to demonstrate the viability of upper respiratory tract surgery as an alternative to CPAP treatment, demonstrating objectives by pre- and postoperative polysomnographic control. RESULTS. Aggregating the data from all 54 patients with nasal obstruction and pharyngeal modifications, we observed a decrease in AHI from 20.406/h to 15.86/h, representing 32.36%, an improvement in sleep architecture and especially REM sleep from 41.5 minutes initially to 67.8 minutes (increased value with 63.37 percent). CONCLUSION. The benefits of nasopharyngeal repermeabilization surgery are represented by decreasing the severity of respiratory events and, second to this, lowering the number of arousals. By reducing the number of arousals, one will obtain a better percentage regarding the deep sleep phase - REM, having a beneficial effect on reducing the daytime sleepiness – which is a major symptom that patients are present.

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Comparison of Cortical Autonomic Network-Linked Sympathetic Excitation by Mueller Maneuvers and Breath-Holds in Subjects With and Without Obstructive Sleep Apnea

Frontiers in Physiology ◽

10.3389/fphys.2021.678630 ◽

2021 ◽

Vol 12 ◽

Author(s):

Keri S. Taylor ◽

Daniel A. Keir ◽

Nobuhiko Haruki ◽

Derek S. Kimmerly ◽

Philip J. Millar ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Central Sleep Apnea ◽

Blood Oxygen Level Dependent ◽

Apnea Hypopnea Index ◽

Bold Signal ◽

Blood Oxygen Level ◽

Efferent Nerve ◽

Obstructive Sleep ◽

The Right

In healthy young volunteers, acquisition of blood oxygen level-dependent (BOLD) magnetic resonance (MR) and muscle sympathetic nerve (MSNA) signals during simulation of obstructive or central sleep apnea identified cortical cardiovascular autonomic regions in which the BOLD signal changed synchronously with acute noradrenergic excitation. In the present work, we tested the hypothesis that such Mueller maneuvers (MM) and breath-holds (BH) would elicit greater concomitant changes in mean efferent nerve firing and BOLD signal intensity in patients with moderate to severe obstructive sleep apnea (OSA) relative to age- and sex-matched individuals with no or only mild OSA (Apnea Hypopnea Index, AHI, <15 events/h). Forty-six participants, 24 with OSA [59 ± 8 years; AHI 31 ± 18 events/h (mean ± SD); seven women] and 22 without (58 ± 11 years; AHI 7 ± 4; nine women), performed a series of three MM and three BH, in randomly assigned order, twice: during continuous recording of MSNA from the right fibular nerve and, on a separate day, during T2∗-weighted echo planar functional MR imaging. MSNA at rest was greater in those with OSA (65 ± 19 vs. 48 ± 17 bursts per 100 heart beats; p < 0.01). MM and BH elicited similar heart rate, blood pressure, and MSNA responses in the two cohorts; group mean BOLD data were concordant, detecting no between-group differences in cortical autonomic region signal activities. The present findings do not support the concept that recurring episodes of cyclical apnea during sleep alter cortical or peripheral neural responsiveness to their simulation during wakefulness by volitional Mueller maneuvers or breath-holds.

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Impact of obstructive sleep apnea on the right ventricle function

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2021.04.213 ◽

2021 ◽

Vol 13 (2) ◽

pp. 236

Author(s):

S. Antit ◽

H. Chelbi ◽

M. Abdelhedi ◽

O. Zidi ◽

E. Boussabeh ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Right Ventricle ◽

Right Ventricle Function ◽

Obstructive Sleep ◽

The Right ◽

Ventricle Function

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White matter tract-specific alterations in male patients with untreated obstructive sleep apnea are associated with worse cognitive function

SLEEP ◽

10.1093/sleep/zsz247 ◽

2019 ◽

Vol 43 (3) ◽

Author(s):

Dae Lim Koo ◽

Hye Ryun Kim ◽

Hosung Kim ◽

Joon-Kyung Seong ◽

Eun Yeon Joo

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

White Matter ◽

Diffusion Tensor ◽

Brain Connectivity ◽

Digit Span ◽

Memory Function ◽

Mean Diffusivity ◽

Obstructive Sleep ◽

The Right

Abstract Study Objectives Neurocognitive impairment is one of the daytime symptoms of obstructive sleep apnea (OSA). We proposed to use tract-specific statistical analysis (TSSA) to investigate whether there are fiber tract abnormalities in OSA, which may be undiscovered using voxel-based approaches, and whether such tract-specific disruptions in brain connectivity are associated with neuropsychological deficits in patients with untreated OSA. Methods We enrolled 38 patients with OSA diagnosed by overnight polysomnography, and 41 healthy sleepers. Fractional anisotropy (FA) and mean diffusivity (MD) maps were obtained from whole-brain diffusion tensor imaging, and TSSA were used to assess regional deficits of white matter tracts. All participants underwent a battery of neuropsychological tests. To evaluate the association between FA values and clinical, polysomnographic, and neuropsychological parameters in the OSA group, permutation-based tests for correlation were performed preceding cluster-based statistics. Results Compared to healthy controls, patients with OSA showed decreased values of FA in the left and right anterior thalamic radiations, and right uncinate fasciculus (UNC) (p < 0.001, p = 0.005, and p = 0.008, respectively). A lower score of digit span backward was associated with lower FA values of right UNC in the OSA group (p = 0.023). The Rey Complex Figure Test copy score revealed a positive correlation with FA values in the right UNC (p = 0.010). Conclusions The TSSA method indeed identified previously unrevealed tract-specific disruptions in OSA. Furthermore, reduced FA values in the frontal lobe portion of the right UNC which has been known to be involved in working memory function were significantly associated with lower cognitive performance in patients with untreated OSA.

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