scholarly journals Reliability of Sonoelastography Measurement of Tongue Muscles and Its Application on Obstructive Sleep Apnea

2021 ◽  
Vol 12 ◽  
Author(s):  
Cheng-An Chu ◽  
Yunn-Jy Chen ◽  
Ke-Vin Chang ◽  
Wei-Ting Wu ◽  
Levent Özçakar
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Muscle Stiffness ◽  
Tongue Muscle ◽  
Intraclass Correlation Coefficients ◽  
Obstructive Sleep

Few studies have explored the feasibility of shear-wave ultrasound elastography (SWUE) for evaluating the upper airways of patients with obstructive sleep apnea (OSA). This study aimed to establish a reliable SWUE protocol for evaluating tongue muscle elasticity and its feasibility and utility in differentiating patients with OSA. Inter-rater and intra-rater reliability of SWUE measurements were tested using the intraclass correlation coefficients. Submental ultrasound was used to measure tongue thickness and stiffness. Association between the ultrasound measurements and presence of OSA was analyzed using multivariate logistic regression. One-way analysis of variance was used to examine if the values of the ultrasound parameters varied among patients with different severities of OSA. Overall, 37 healthy subjects and 32 patients with OSA were recruited. The intraclass correlation coefficients of intra‐ and inter-rater reliability for SWUE for tongue stiffness ranged from 0.84 to 0.90. After adjusting for age, sex, neck circumference, and body mass index, the risk for OSA was positively associated with tongue thickness [odds ratio 1.16 (95% confidence interval 1.01–1.32)] and negatively associated with coronal imaging of tongue muscle stiffness [odds ratio 0.72 (95% confidence interval 0.54–0.95)]. There were no significant differences in tongue stiffness among OSA patients with varying disease severity. SWUE provided a reliable evaluation of tongue muscle stiffness, which appeared to be softer in patients with OSA. Future longitudinal studies are necessary to investigate the relationship between tongue softening and OSA, as well as response to treatment.

Urgent Adenotonsillectomy

2003 ◽  
Vol 99 (3) ◽  
pp. 586-595 ◽  
Author(s):  
Karen A. Brown ◽  
Isabelle Morin ◽  
Chantal Hickey ◽  
John J. Manoukian ◽  
Gillian M. Nixon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Medical Intervention ◽  
Control Group ◽  
Respiratory Complications ◽  
Obstructive Sleep ◽  
Postoperative Respiratory Complications

Background The aim of this study was to determine the frequency and type of respiratory complications after urgent adenotonsillectomy (study group) for comparison with a control group of children undergoing a sleep study and adenotonsillectomy for obstructive sleep apnea syndrome. A second aim was to assess risk factors predictive of respiratory complications after urgent adenotonsillectomy. Methods The perioperative course of children who underwent adenotonsillectomy between January 1, 1999, and March 31, 2001, was reviewed. Two groups of children were identified from two different databases: the hospital database for surgical procedures (the study group) and the sleep laboratory database (the control group). The retrospective chart review focused on the preoperative status (including an evaluation for obstructive sleep apnea), anesthetic management, and need for postoperative respiratory interventions. Results A total of 64 consecutive cases for urgent adenotonsillectomy were identified, and 54 children met the inclusion criteria. Thirty-three children (60%) had postoperative respiratory complications necessitating a medical intervention; 11 (20.3%) required a major intervention (reintubation, ventilation, and/or administration of racemic epinephrine or Ventolin), and 22 (40.7%) required a minor intervention (oxygen administration). Six children (11.1%) required reintubation in the recovery room for respiratory compromise. Risk factors for respiratory complications were an associated medical condition (odds ratio, 8.15; 95% confidence interval, 1.81-36.73) and a preoperative saturation nadir less than 80% (odds ratio, 5.54; 95% confidence interval, 1.15-26.72). Sixteen (49%) of the medical interventions were required within the first postoperative hour. Atropine administration, at induction, decreased the risk of postoperative respiratory complications (odds ratio, 0.18; 95% confidence interval, 0.11-1.050. Control Group Of 75 children who underwent a sleep study and adenotonsillectomy, 44 had sleep apnea and were admitted to hospital after elective adenotonsillectomy. Sixteen (36.4%) children had postoperative respiratory complications necessitating a medical intervention. Six percent of the children (n = 3) required a major medical intervention. No child required reintubation for respiratory compromise. Conclusions Severe obstructive sleep apnea syndrome and an associated medical condition are risk factors for postadenotonsillectomy respiratory complications. Risk reductions strategies should focus on their assessment.

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

1993 ◽  
Vol 74 (3) ◽  
pp. 1123-1130 ◽  
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)

scholarly journals 0569 Soft Palate Fat Between Lean Adults with Obstructive Sleep Apnea and Healthy Control

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A218-A218
Author(s):  
L Xu ◽  
B T Keenan ◽  
A S Wiemken ◽  
A I Pack ◽  
R J Schwab
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Soft Palate ◽  
Intraclass Correlation ◽  
Normal Subjects ◽  
Reconstruction Algorithms ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Fat Volume ◽  
Fat Pads

Abstract Introduction Previous studies have shown that obese patients with obstructive sleep apnea (OSA) have a significantly greater percentage of fat tissue in soft palate than normal subjects. However, the influence of soft palate fat is not clear in non-obese adults with OSA. This study compared the volume of fat in the soft palate between lean adults with OSA and lean controls. Methods We examined soft palate fat in 21 lean OSA cases and 16 lean controls with body mass index (BMI) &lt;25 kg/m2. All subjects underwent a magnetic resonance imaging (MRI) with three-point Dixon scan. We used volumetric reconstruction algorithms to quantify the amount of soft palate fat, which was compared between apnecis and controls. Analysis reproducibility was quantified using intraclass correlation coefficients (ICC) from repeated analyses of 20 randomly-chosen MRIs. Results Analysis of soft palate fat was highly reproducible, with an ICC (95% confidence interval) of 0.968 (0.923, 0.987). Lean apneics were younger than lean controls (45.3±13.0 vs. 62.1±10.4 years; p&lt;0.0001). No significant differences between apneics and controls were observed in the average BMI (23.4±2.2 vs. 23.5 ± 2.6 kg/m2; p=0.824), the fat pads volume (4198±1728 vs. 3880±1544 mm3; p=0.646), and the proportion of males (61.9% vs. 68.8%; p=0.666). In unadjusted analyses, the lean OSA group showed significantly higher soft palate fat volume than lean controls (7605±2109 vs. 5327±1783 mm3; p=0.003). When adjusting for age, gender and BMI, no differences was observed between groups in soft palate fat volume (p=0.122) and fat pads volume (p=0.702). Conclusion Analysis of soft palate fat volume from Dixon MRI is highly reproducible. Our results indicate no significant difference in deposition of fat at soft palate between lean patients with OSA and lean controls when accounting for age, gender and BMI. Support This study is supported by National Institutes of Health Grant: 2P01HL094307-06A1. LX is supported by Young Elite Scientists Sponsorship Program of China Association for Science and Technology.

scholarly journals Characteristics of Patients with Obstructive Sleep Apnea at High Risk for Cardiovascular Disease

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1265
Author(s):  
Izolde Bouloukaki ◽  
Michail Fanaridis ◽  
Georgios Stathakis ◽  
Christina Ermidou ◽  
Eleftherios Kallergis ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Obstructive Sleep Apnea ◽  
Depressive Symptoms ◽  
Sleep Apnea ◽  
Odds Ratio ◽  
Clinical Population ◽  
Clinical Patient ◽  
Athens Insomnia Scale ◽  
Obstructive Sleep ◽  
And Gender

Background and Objectives: To evaluate the influence of obstructive sleep apnea (OSA)-related symptoms on prevalent cardiovascular disease (CVD) in a large clinical population of patients. Materials and Methods: A total of 2127 patients (mean age 55 years, 24% women) underwent diagnostic polysomnography and were evaluated using the Epworth sleepiness scale (ESS), the Athens Insomnia Scale (AIS), and the Beck Depression Inventory (BDI). We investigated the predictive value of OSA-associated symptoms for prevalent cardiovascular disease, after adjustment for relevant confounding factors including age, obesity, and co-morbidities. Results: Patients with OSA and CVD were older and had a higher Body Mass Index (BMI); the percentage of obese patients was also higher (83% vs. 70%, p < 0001). They also had greater neck, waist, and hip circumferences and a higher waist-to-hip ratio. Excessive daytime sleepiness (ESS ≥ 10) [odds ratio (95% CI) 1.112 (0.708–1.748), p = 0.64], insomnia symptoms (AIS ≥ 6) [odds ratio (95% CI) 0.748 (0.473–1.184), p = 0.21], frequent awakenings [odds ratio (95% CI) 1.599 (1.019–2.508), p = 0.06], and nocturia [odds ratio (95% CI) 1.359 (0.919–2.009), p = 0.124] were not associated with CVD after adjustment for the previous confounders. On the other hand, depressive symptoms (BDI ≥ 10) independently predicted prevalent CVD [odds ratio (95% CI) 1.476 (1.154–1.887), p = 0.002]. Further analysis in subgroups stratified by age, BMI, and gender demonstrated that depressive symptoms predicted prevalent CVD but only in the subgroup of younger (age group < 60 years), obese (BMI group ≥ 30), and male (OR = 1.959, 95% CI = 1.209–3.175, p = 0.006) OSA patients. Conclusions: OSA patients with CVD were more likely to complain of less typical OSA symptoms and depressive symptoms compared to patients without CVD in this large clinical patient cohort, supportingthecomplexity and heterogeneityof OSA.

scholarly journals Obstructive Sleep Apnea as a Risk Factor for Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Author(s):  
Jacqueline H. Geer ◽  
Guido J. Falcone ◽  
Kevin N. Vanent ◽  
Audrey C. Leasure ◽  
Daniel Woo ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Logistic Regression ◽  
Risk Factor ◽  
Sleep Apnea ◽  
Intracerebral Hemorrhage ◽  
Odds Ratio ◽  
Berlin Questionnaire ◽  
Multivariable Logistic Regression Model ◽  
Obstructive Sleep ◽  
Increased Risk

Background and Purpose: To determine whether obstructive sleep apnea (OSA) is associated with intracerebral hemorrhage (ICH) risk, we assessed premorbid OSA exposure of patients with nontraumatic ICH and matched controls. Methods: Ethnic/Racial Variations of Intracerebral Hemorrhage is a multicenter, case-control study evaluating risk factors for ICH that recruited 3000 cases with ICH and 3000 controls. OSA status was ascertained using the Berlin Questionnaire as a surrogate for premorbid OSA. We performed logistic regression analyses to evaluate the association between OSA and ICH. Results: Two thousand and sixty-four (71%) cases and 1516 (52%) controls were classified as having OSA by the Berlin Questionnaire. Cases with OSA were significantly more likely to be male and have hypertension, heart disease, hyperlipidemia, and higher body mass index compared with those without OSA. OSA was more common among cases compared with controls (71% versus 52%, odds ratio, 2.28 [95% CI, 2.05–2.55]). In a multivariable logistic regression model, OSA was associated with increased risk for ICH (odds ratio, 1.47 [95% CI, 1.29–1.67]). Conclusions: OSA is a risk factor for ICH.

Clinical correlates and implications of the reliability of the frailty index in the Canadian Longitudinal Study on Aging

2021 ◽  
Author(s):  
Quoc Dinh Nguyen ◽  
Erica M Moodie ◽  
Mark R Keezer ◽  
Christina Wolfson
Keyword(s):  
Odds Ratio ◽  
Frailty Index ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Community Dwelling ◽  
Deficit Accumulation ◽  
Intraclass Correlation Coefficients ◽  
Reliability Estimates ◽  
Predicted Probability ◽  
The Impact

Abstract Background Deficit-accumulation frailty indices (FIs) are widely used to characterize frailty. FIs vary in number and composition of items; the impact of this variation on reliability and clinical applicability is unknown. Methods We simulated 12,000 studies using a set of 70 candidate deficits in 12,080 community-dwelling participants 65 years and older. For each study, we varied the number (5, 10, 15, 25, 35, 45) and composition (random selection) of items defining the FI and calculated descriptive and predictive estimates: frailty score, prevalence, frailty cut-off, mortality odds ratio, predicted probability of mortality for FI=0.28 (prevalence threshold), and FI cut-off predicting 10% mortality over the follow-up. We summarized the estimates’ medians and spreads (0.025-0.975 quantiles) by number of items and calculated intraclass correlation coefficients (ICC). Results Medians of frailty scores were 0.11-0.12 with decreasing spreads from 0.04-0.24 to 0.10-0.14 for 5-item and 45-item FIs. The median cut-offs identifying 15% as frail was 0.19-0.20 and stable; the spreads decreased with more items. However, medians and spreads for the prevalence of frailty (medians: 11% to 3%), mortality odds ratio (medians:1.24 to 2.19), predicted probability of mortality (medians: 8% to 17%), and FI cut-off predicting 10% mortality (medians: 0.38 to 0.20) varied markedly. ICC increased from 0.19 (5-item FIs) to 0.84 (45-item FIs). Conclusions Variability in the number and composition of items of individual FIs strongly influences their reliability. Estimates using FIs may not be sufficiently stable for generalizing results or direct application. We propose avenues to improve the development, reporting, and interpretation of FIs.

scholarly journals Obstructive Sleep Apnea in Children with Down Syndrome: Demographic, Clinical, and Polysomnographic Features

2018 ◽  
Vol 160 (1) ◽  
pp. 150-157 ◽  
Author(s):  
Bahir H. Chamseddin ◽  
Romaine F. Johnson ◽  
Ron B. Mitchell
Keyword(s):  
Obstructive Sleep Apnea ◽  
Down Syndrome ◽  
Sleep Apnea ◽  
Odds Ratio ◽  
Medical Center ◽  
Case Series ◽  
Apnea Hypopnea Index ◽  
Severe Obstructive Sleep Apnea ◽  
Children With Down Syndrome ◽  
Obstructive Sleep

Objectives To evaluate demographic, clinical, and polysomnographic features of children with Down syndrome suspected of having obstructive sleep apnea. To identify factors that predict severe obstructive sleep apnea among children with Down syndrome. Study Design Case series with chart review. Setting Children’s Medical Center Dallas / University of Texas Southwestern Medical Center. Subject and Methods Demographic, clinical, and polysomnographic data were collected for children with Down syndrome aged 2 to 18 years. Simple and multivariable regression models were used to study predictors of severe obstructive sleep apnea (apnea-hypopnea index ≥10). P≤ .05 was considered significant. Results A total of 106 children with Down syndrome were included, with 89 (84%) <12 years old, 56 (53%) male, 72 (68%) Hispanic, 15 (14%) African American, and 14 (13%) Caucasian. Ninety percent of children had ≥1 medical comorbidities; 95 (90%) patients had obstructive sleep apnea; and 46 (44%) had severe obstructive sleep apnea. The mean SaO2 nadir was lower among obese than nonobese children (80% vs 85%, P = .02). Obese versus nonobese patients had a higher prevalence of severe obstructive sleep apnea (56% vs 35%, P = .03). Severe OSA was associated with heavier weight (odds ratio = 1.0, 95% CI: 1.0-1.1, P = .002) and age ≥12 years (odds ratio = 1.2, 95% CI: 0.2-2.5, P = .02). The multivariable model showed that severe obstructive sleep apnea was associated only with weight (odds ratio = 1.1, 95% CI: 1.0-1.1, P = .02). Conclusion Obese children with DS are at a high risk for severe OSA, with weight as the sole risk factor. The results of this study show the importance of monitoring the weight of children with DS and counseling parents of children with DS about weight loss.

Obstructive Sleep apnea Therapy

2008 ◽  
Vol 87 (9) ◽  
pp. 882-887 ◽  
Author(s):  
A. Hoekema ◽  
B. Stegenga ◽  
P.J. Wijkstra ◽  
J.H. van der Hoeven ◽  
A.F. Meinesz ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Confidence Interval ◽  
Severe Disease ◽  
Lower Boundary ◽  
Oral Appliance ◽  
Apnea Hypopnea Index ◽  
Cpap Therapy ◽  
Oral Appliance Therapy ◽  
Obstructive Sleep

In clinical practice, oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure (CPAP) therapy. We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively. We randomly assigned 103 individuals to oral-appliance or CPAP therapy. Polysomnography after 8–12 weeks indicated that treatment was effective for 39 of 51 persons using the oral appliance (76.5%) and for 43 of 52 persons using CPAP (82.7%). For the difference in effectiveness, a 95% two-sided confidence interval was calculated. Non-inferiority of oral-appliance therapy was considered to be established when the lower boundary of this interval exceeded −25%. The lower boundary of the confidence interval was −21.7%, indicating that oral-appliance therapy was not inferior to CPAP for effective treatment of obstructive sleep apnea. However, subgroup analysis revealed that oral-appliance therapy was less effective in individuals with severe disease (apnea-hypopnea index > 30). Since these people could be at particular cardiovascular risk, primary oral-appliance therapy appears to be supported only for those with non-severe apnea.

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