Association between Flexible Nasal Endoscopy, Polysonography Findins and Obstructive Sleep Apnea Severety

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.

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Obstructive Sleep Apnea in Acromegaly and the Effect of Treatment: A Systematic Review and Meta-Analysis

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz116 ◽

2019 ◽

Vol 105 (3) ◽

pp. e23-e31 ◽

Cited By ~ 1

Author(s):

Matteo Parolin ◽

Francesca Dassie ◽

Luigi Alessio ◽

Alexandra Wennberg ◽

Marco Rossato ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Meta Analysis ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Cross Sectional ◽

Obstructive Sleep ◽

Before And After ◽

The Difference

Abstract Background Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway collapse requiring nocturnal ventilatory assistance. Multiple studies have investigated the relationship between acromegaly and OSA, reporting discordant results. Aim To conduct a meta-analysis on the risk for OSA in acromegaly, and in particular to assess the role of disease activity and the effect of treatments. Methods and Study Selection A search through literature databases retrieved 21 articles for a total of 24 studies (n = 734). Selected outcomes were OSA prevalence and apnea-hypopnea index (AHI) in studies comparing acromegalic patients with active (ACT) vs inactive (INACT) disease and pretreatment and posttreatment measures. Factors used for moderator and meta-regression analysis included the percentage of patients with severe OSA, patient sex, age, body mass index, levels of insulin-like growth factor 1, disease duration and follow-up, and therapy. Results OSA prevalence was similar in patients with acromegaly who had ACT and INACT disease (ES = −0.16; 95% CI, −0.47 to 0.15; number of studies [k] = 10; P = 0.32). In addition, AHI was similar in ACT and INACT acromegaly patients (ES = −0.03; 95% CI, −0.49 to 0.43; k = 6; P = 0.89). When AHI was compared before and after treatment in patients with acromegaly (median follow-up of 6 months), a significant improvement was observed after treatment (ES = −0.36; 95% CI, −0.49 to −0.23; k = 10; P < 0.0001). In moderator analysis, the percentage of patients with severe OSA in the populations significantly influenced the difference in OSA prevalence (P = 0.038) and AHI (P = 0.04) in ACT vs INACT patients. Conclusion Prevalence of OSA and AHI is similar in ACT and INACT patients in cross-sectional studies. However, when AHI was measured longitudinally before and after treatment, a significant improvement was observed after treatment.

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Tracheal hysteresis in sleep apnea

Journal of Applied Physiology ◽

10.1152/jappl.1989.67.4.1349 ◽

1989 ◽

Vol 67 (4) ◽

pp. 1349-1353 ◽

Cited By ~ 6

Author(s):

I. Katz ◽

N. Zamel ◽

A. S. Slutsky ◽

A. S. Rebuck ◽

V. Hoffstein

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Muscle Tone ◽

Upper Airway ◽

Lung Parenchyma ◽

Apnea Hypopnea Index ◽

Cross Sectional ◽

Acoustic Reflection ◽

Obstructive Sleep ◽

Pharyngeal Muscles

The collapsibility of pharyngeal walls, characteristic of patients with obstructive sleep apnea, likely results from reduced tone of the pharyngeal muscles. This reduction in the upper airway muscle tone may not end at the pharynx but may extend further distally, e.g., into the trachea. Because tracheal tone cannot be measured directly in conscious humans, we inferred the tone from the relative hysteresis of the tracheal area compared with the lung. Relative hysteresis was measured by plotting the cross-sectional area of a tracheal segment obtained by the acoustic reflection technique vs. lung volume. All measurements were performed during wakefulness. We found that in 42 patients with obstructive sleep apnea (apnea/hypopnea index greater than 10), relative hysteresis of the proximal trachea was predominantly clockwise, i.e., smaller than that of the lung parenchyma; in the 33 nonapneic patients (apnea/hypopnea index less than or equal to 10), it was predominantly counter-clockwise, i.e., larger than that of the lung parenchyma. For the distal trachea all patients, apneic and nonapneic, had similar, clockwise, relative hysteresis. We conclude that reduction in the upper airway muscle tone in patients with obstructive sleep apnea extends into the trachea.

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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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Functional Upper Airway Space Endoscopy: A Prognostic Indicator in Obstructive Sleep Apnea Treatment with Mandibular Advancement Devices

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052393 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2393

Author(s):

Giulio Gasparini ◽

Gianmarco Saponaro ◽

Mattia Todaro ◽

Gabriele Ciasca ◽

Lorenzo Cigni ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Upper Airway ◽

Prognostic Indicator ◽

Mandibular Advancement ◽

Apnea Hypopnea Index ◽

Upper Airways ◽

Obstructive Sleep ◽

Group A ◽

Group B

Purpose: The use of a mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA) is a consolidated therapy. This study aimed to evaluate the predictive value of awake upper airways (UA) functional endoscopy in identifying the outcome of MAD therapy. Methods: This observational prospective study included 30 adult OSA patients, all patients underwent pre-treatment awake UA functional endoscopy, during the exam subjects were instructed to advance their mandible maximally, and they were divided into three different groups according to the response of the soft tissue, group A (expansion), group B (stretch), group C (unchanged). The results of this test were used in combination with other noninvasive indexes to predict the treatment outcome in terms of apnea-hypopnea index (AHI) reduction. Results: We found that a substantial AHI reduction occurred in group A and group B while e slight AHI reduction was measured in group C. Conclusion: Based on our experience the awake UA endoscopy is a valid prognostic exam for discriminating responder and non-responder patients; in addition our results indicate the possibility of predicting a range of post-treatment AHI index values.

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Comparing REM- and NREM-Related Obstructive Sleep Apnea in Jordan: A Cross-Sectional Study

Canadian Respiratory Journal ◽

10.1155/2018/9270329 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

K. Al Oweidat ◽

S. A. AlRyalat ◽

M. Al-Essa ◽

N. Obeidat

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Upper Airway ◽

Cross Sectional Study ◽

Apnea Hypopnea Index ◽

Cross Sectional ◽

Sleep Study ◽

Broad Definition ◽

Obstructive Sleep ◽

Strict Definition

Obstructive sleep apnea (OSA) is a common disorder that includes an intermittent mechanical obstruction of the upper airway during sleep, which can occur either during rapid eye movement (REM) phase or non-REM (NREM) phase. In this study, we aim to evaluate the differences in demographic and polysomnographic features between REM- and NREM-related OSA in a Jordanian sample, using both the broad and the restricted definitions of REM-related OSA. All patients who were referred due to clinical suspicion of OSA and underwent sleep study were screened. We included patients with a diagnosis of OSA who had Apnea-Hypopnea Index (AHI) greater than or equal to five. We classified patients into REM-related OSA according to either the broad definition (AHIREM/AHINREM ≥ 2) or the strict definition (AHIREM > 5 and AHINREM < 5 with a total REM sleep duration of at least 30 minutes), and patients with AHIREM/AHINREM less than two were classified as NREM-related OSA. A total of 478 patients were included in this study with a mean age of 55.3 years (±12.6). According to the broad definition of REM-related OSA, 86 (18%) of OSA patients were classified as having REM-related OSA compared to only 13 (2.7%) patients according to the strict definition. Significant differences were found between both NREM-related OSA and REM-related OSA according to the broad and to the strict definitions for arousal index (p<0.001 and p<0.032), respectively, duration of saturation below 90% (p<0.001 for both), and saturation nadir (p<0.036 and p<0.013), respectively. No significant differences were found between this group and other OSA patients regarding age, BMI, ESS, and snoring. Our study showed that the stricter the definition for REM-related OSA, the milder the associated clinical changes.

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Comparison of Polysomnographic and Cephalometric Parameters Based on Positional and Rapid Eye Movement Sleep Dependency in Obstructive Sleep Apnea

10.21203/rs.3.rs-1103666/v1 ◽

2021 ◽

Author(s):

Jung-Hwan Jo ◽

Sung-Hun Kim ◽

Ji-Hee Jang ◽

Ji-Woon Park ◽

Jin-Woo Chung

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Eye Movement ◽

Rem Sleep ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Rapid Eye Movement ◽

Maximum Width ◽

Obstructive Sleep ◽

Positional Dependency

Abstract The aim of this study is to investigate the differences in polysomnographic and cephalometric features according to positional and rapid eye movement (REM) sleep dependencies in obstructive sleep apnea patients. Standard polysomnography and cephalometric analyses were performed on 133 OSA patients. The subjects were categorized into positional and non-positional, and REM-related and not-REM-related OSA groups according to positional and REM sleep dependency on severity of sleep apnea. Polysomnographic and cephalometric parameters were compared between groups. Positional and REM-related OSA patients showed significantly lower non-supine apnea-hypopnea index (AHI), non-REM (NREM) AHI and overall AHI and higher NREM oxygen saturation (SpO2) and mean SpO2 compared to non-positional and not-REM-related OSA patients, respectively. Cephalometric features between positional and non-positional OSA patients did not show any significant differences. However, REM-related OSA patients showed significantly larger inferior oral airway space and shorter perpendicular distance between mandibular plane and anterior hyoid bone and the distance between uvula and posterior nasal spine, and narrower maximum width of soft palate than not-REM-related OSA patients. Positional and REM-related OSA patients have lower severity of sleep apnea, suggesting the possibility of lower collapsibility of the upper airway. Anatomical factors maybe more closely related to REM sleep than positional dependency.

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Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽

10.1159/000516243 ◽

2021 ◽

pp. 1-8

Author(s):

Lifeng Li ◽

Demin Han ◽

Hongrui Zang ◽

Nyall R. London

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Obstruction ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Nasal Surgery ◽

Subjective Sleep Quality ◽

Obstructive Sleep ◽

Significant Difference ◽

The Impact

Objective: The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. Methods: Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. Results: By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (p < 0.05), while the Apnea-Hypopnea Index (AHI) changed little (p = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all p < 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (p < 0.05), except with the AHI (p > 0.05). Conclusion: Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

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Predicting critical closing pressure in children with obstructive sleep apnea using fluid structure interaction simulations

Journal of Applied Physiology ◽

10.1152/japplphysiol.00694.2020 ◽

2021 ◽

Author(s):

Goutham Mylavarapu ◽

Ephraim Gutmark ◽

Sally Shott ◽

Robert J. Fleck ◽

Mohamed Mahmoud ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Upper Airway ◽

Dynamic Mri ◽

Patient Specific ◽

Apnea Hypopnea Index ◽

Structure Interaction ◽

Obstructive Sleep ◽

Mri Scans ◽

Closing Pressure

Surgical treatment of obstructive sleep apnea (OSA) in children requires knowledge of upper airway dynamics, including the closing pressure (Pcrit), a measure of airway collapsibility. We applied a Flow-Structure Interaction (FSI) computational model to estimate Pcrit in patient-specific upper airway models obtained from magnetic resonance imaging (MRI) scans. We sought to examine the agreement between measured and estimated Pcrit from FSI models in children with Down syndrome. We hypothesized that the estimated Pcrit would accurately reflect measured Pcrit during sleep and therefore reflect the severity of OSA as measured by the obstructive apnea hypopnea index (AHI). All participants (n=41) underwent polysomnography and sedated sleep MRI scans. We used Bland Altman Plots to examine the agreement between measured and estimated Pcrit. We determined associations between estimated Pcrit and OSA severity, as measured by AHI, using regression models. The agreement between passive and estimated Pcrit showed a fixed bias of -1.31 (CI=-2.78, 0.15) and a non-significant proportional bias. A weaker agreement with active Pcrit was observed. A model including AHI, gender, an interaction term for AHI and gender and neck circumference explained the largest variation (R2 = 0.61) in the relationship between AHI and estimated Pcrit. (P <0.0001). Overlap between the areas of the airway with lowest stiffness, and areas of collapse on dynamic MRI, was 77.4%±30% for the nasopharyngeal region and 78.6%±33% for the retroglossal region. The agreement between measured and estimated Pcrit and the significant association with AHI supports the validity of Pcrit estimates from the FSI model.

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Upper Airway Collapsibility During REM Sleep in Children with the Obstructive Sleep Apnea Syndrome

SLEEP ◽

10.1093/sleep/32.9.1173 ◽

2009 ◽

Vol 32 (9) ◽

pp. 1173-1181 ◽

Cited By ~ 12

Author(s):

Jingtao Huang ◽

Laurie R. Karamessinis ◽

Michelle E. Pepe ◽

Stephen M. Glinka ◽

John M. Samuel ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Rem Sleep ◽

Sleep Apnea Syndrome ◽

Upper Airway ◽

Obstructive Sleep ◽

Airway Collapsibility ◽

Apnea Syndrome ◽

Upper Airway Collapsibility

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Abstract TMP55: Polysomnographic and Sleep-related Variables Associated to Leukoaraiosis in Patients with Obstructive Sleep Apnea

Stroke ◽

10.1161/str.48.suppl_1.tmp55 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Kevin R Duque ◽

Brian Villafuerte ◽

Fiorella Adrianzen ◽

Rodrigo Zamudio ◽

Andrea Mendiola ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Logistic Regression ◽

Sleep Apnea ◽

Multinomial Logistic Regression ◽

Sleep Time ◽

Cross Sectional Study ◽

Apnea Hypopnea Index ◽

Cross Sectional ◽

Obstructive Sleep ◽

Medical Histories

Introduction: Obstructive sleep apnea (OSA) is a biological plausible risk factor for leukoaraiosis (LA). We tested the hypothesis that polysomnographic (PSG) and sleep-related variables are associated to LA in OSA patients. Methods: Cross-sectional study in which PSG records, medical histories and brain 1.5T MRI were collected from all consecutive patients who had attended a Sleep Medicine Center between 2009-2014. LA was graded from 0 to 9 with the ’Atherosclerosis Risk In Communities’ study scale. OSA was defined by The International Classification of Sleep Disorders, 2014, and its severity categorizing according to apnea-hypopnea index (AHI, <15 mild, 15 to <30 moderate, 30 to <45 severe and ≥45 very severe). A multinomial logistic regression was performed to describe the association between OSA severity and LA (divided into 2 groups: mild-to-moderate LA and non-to-minimal LA). The covariates for all regression models were age, gender, BMI, hypertension, ischemic stroke, myocardial infarction, diabetes and pack-year of smoking. Results: From 82 OSA patients (77% male; mean age 58±9 years, range 19-91), 54 (66%) had LA. Mild-to-moderate LA was found in 13 patients (8 mild and 5 moderate LA) and non-to-minimal LA in 69 (41 minimal and 28 non LA). Spearman’s correlation coefficient between AHI and LA grade was 0.41 (p<0.001). Furthermore, the higher OSA severity, the higher LA severity (p<0.001, for Jonckheere-Terpstra test for ordered alternatives). In the multinomial logistic regression model adjusted for cofounders, severe OSA patients had higher risk for mild or moderate LA (HR 12.8, 95% IC 1.2-141) compared to mild-to-moderate OSA patients. Additionally, self-reported habitual sleep duration from 7 to 9 hours (HR 0.36, 90% IC 0.14-0.90) and proportion of time in apnea/hypopnea over total sleep time (HR 1.04 for one unit increase, 90% IC 1.01-1.08) could be associated with the presence of LA (adjusted only for age and gender). In a multiple regression analysis with all the aforementioned variables, age (p=0.002), diabetes (p=0.003), and OSA severity (p=0.04) were predictors of the presence of LA. Conclusion: Patients with severe OSA had higher risk for mild to moderate LA when compared to patients with mild or moderate OSA.

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