scholarly journals Increasing Hypopnea in Sleep Breathing Disturbance Improves Postoperative Oxygen Saturation in Patients with Very Severe Obstructive Sleep Apnea

2020 ◽  
Vol 10 (18) ◽  
pp. 6539 ◽  
Author(s):  
Ethan I. Huang ◽  
Shu-Yi Huang ◽  
Yu-Ching Lin ◽  
Chieh-Mo Lin ◽  
Chin-Kuo Lin ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Apnea Hypopnea Index ◽  
Severe Obstructive Sleep Apnea ◽  
Oxyhemoglobin Saturation ◽  
Surgical Success ◽  
Obstructive Sleep ◽  
The Mean

In patients of very severe obstructive sleep apnea (OSA) with confined framework, reducing volume is difficult to achieve a postoperative apnea-hypopnea index (AHI) qualifying the classical surgical success. However, a higher AHI with a larger part of hypopneas may have similar or even less severity of oxygen (O2) desaturation, compared to a lower index mostly made of apneas. Here, in 27 consecutive enrolled patients, we show that besides the improvement of mean AHI, the multilevel surgery increased hypopnea in AHI from 29.1% to 77.3%, and improves postoperative O2 saturation by reducing desaturation frequency (mean desaturation index decreased from 62.5 to 24.4 events/h) and level (mean oxyhemoglobin saturation of pulse oximetry (SpO2) desaturation cut down from 10.0 to 5.8%). The mean SpO2 improved from 92.3% to 94.7%, and the improvement was positively related to the proportion increase of hypopnea/AHI. The results suggest that the non-framework surgery could help patients with very severe OSA whose AHIs are ≥60 events/h in terms of improving postoperative O2 saturation. Due to the improvement also presented in those not qualified as classical surgical success, further studies are needed to clarify the connection between O2 desaturation and various consequences to reconsider defining a surgical success.

Postoperative Monitoring Following Adenotonsillectomy for Severe Obstructive Sleep Apnea

2018 ◽  
Vol 127 (11) ◽  
pp. 783-790 ◽  
Author(s):  
Cecil Bryant Rhodes ◽  
Anas Eid ◽  
Grant Muller ◽  
Amanda Kull ◽  
Tim Head ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Supplemental Oxygen ◽  
Postanesthesia Care Unit ◽  
Apnea Hypopnea Index ◽  
Severe Obstructive Sleep Apnea ◽  
Postoperative Monitoring ◽  
Obstructive Sleep ◽  
The Mean ◽  
Pediatric Icu

Introduction: Patients undergoing adenotonsillectomy (T&A) for severe obstructive sleep apnea (OSA) are usually admitted for observation, and many surgeons use the intensive care unit (ICU) for observation due to the risk of postsurgical airway obstruction. Given the limited resources of the pediatric ICU (PICU), there is a push to better define the patients who require postoperative monitoring in the PICU for monitoring severe OSA. Methods: Forty-five patients were evaluated. Patients who had cardiac or craniofacial comorbidities were excluded. Patients undergoing T&A for severe OSA were monitored in the postanesthesia care unit (PACU) postoperatively. If patients required supplemental oxygen or developed hypoxia while in the PACU within the 3-hour monitoring period, they were admitted to the PICU. Results: Overall, 16 of 45 patients were admitted to the ICU for monitoring. Patients with an Apnea-Hypopnea Index (AHI) >50 or with an oxygen nadir <80% were significantly more likely to be admitted to the PICU. The mean AHI of patients admitted to the PICU was 40.5, and the mean oxygen nadir was 69.9%. Patients younger than 2 years were significantly more likely to be admitted to the PICU. Conclusion: Based on the data presented here and academy recommendations, not all patients with severe OSA require ICU monitoring.

Validation of a Wrist-Worn Reflectance Pulse Oximeter During Sleep and Prediction of Obstructive Sleep Apnea: A Proof-of-Concept Study (Preprint)

2021 ◽  
Author(s):  
Hyunjun Jung ◽  
Dongyeop Kim ◽  
Wonkyu Lee ◽  
Hyejung Seo ◽  
Jinwoo Seo ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Pulse Oximeter ◽  
Mean Squared Error ◽  
Oxygen Desaturation ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Reflectance Pulse Oximetry

BACKGROUND Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive upper airway obstruction during sleep, thereby resulting in oxygen desaturation, frequent arousals, and increased sympathetic activity. Wearable devices that measure peripheral oxygen saturation have been developed for the screening of OSA. OBJECTIVE This study aimed to validate and characterize the estimation function of oxygen saturation measured by wrist-worn reflectance pulse oximetry during sleep and to predict the derived OSA using the oxygen desaturation index (ODI). METHODS Oxygen saturation was simultaneously measured using reflectance pulse oximetry from the Samsung Galaxy Watch 4 series (SM-R890N, SM-R860N, Samsung Electronics Co.; GW4) and transmittance pulse oximetry from polysomnography as a reference (SpO2Ref). The performance was evaluated by the root mean squared error (RMSE) and coverage rate, and it was compared according to the apnea-hypopnea index (AHI). The GW4-ODI was used to predict moderate to severe OSA. RESULTS A total of 97 adults (44.4 ± 13.0 years; men 76.3%, women 23.7%) participated in this study. Depending on the AHI, participants were classified as either normal (n=18), mild (n=21), moderate (n=23), or severe OSA (n=35). Wrist-worn reflectance pulse oximetry showed an overall RMSE of 2.3% and negligible bias of -0.2%. A Bland-Altman density plot showed good agreement of oxygen saturation between GW4 and the reference pulse oximeter. RMSEs were 1.65 ± 0.57%, 1.76 ± 0.65%, 1.93 ± 0.54%, and 2.93 ± 1.71% for normal, mild, moderate, and severe OSA, respectively. GW4-ODI ≥5/h had the highest predictive ability for moderate to severe OSA with a sensitivity of 89.7%, a specificity of 64.1%, an accuracy of 79.4%, and an area under the curve of 0.908 (95% CI, 0.852–0.963). CONCLUSIONS GW4 was successfully validated for measuring oxygen saturation with reflectance pulse oximetry during sleep. This study demonstrates the feasibility of GW4 for screening moderate to severe OSA.

Tonsillectomy for Obstructive Sleep Apnea in Obese Children

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P69-P70
Author(s):  
Dary J Costa ◽  
Ron B Mitchell
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Weighted Mean Difference ◽  
Mean Difference ◽  
Apnea Hypopnea Index ◽  
Obese Children ◽  
Weighted Mean ◽  
Obstructive Sleep ◽  
The Mean

Objective To determine the effectiveness of adenotonsillectomy (T&A) for treating obstructive sleep apnea (OSA) in obese children. Methods Meta-analysis of studies that reported sleep parameters in obese children with OSA before and after T&A. Data was analyzed using the random effects model. Statistical significance was P less than 0.05. Results Data from four studies that included 110 children were analyzed. Mean sample size was 27.5 (range: 18 - 33). Mean body mass index (BMI) z-score was 2.81. The mean pre-and postoperative apnea-hypopnea index (AHI) was 29.0 (range 22.2 - 34.3) and 9.9 (range 6.0 - 12.2) respectively. The weighted mean difference between pre- and postoperative AHI was a significant reduction of 18.3 events per hour (95% CI 11.2–25.5). The mean pre- and postoperative oxygen saturation nadir was 78.9% (range 73.9 -81.1%) and 85.7% (83.6 -89.9%) respectively. The weighted mean difference was a significant increase in the oxygen saturation nadir of 6.3% (95% CI 3.9 to 8.7). Approximately 43% of children had a postoperative AHI less than 5, 21% of children had a postoperative AHI less than 2, and 11% of children had a postoperative AHI less than 1. Conclusions T&A improves but does not resolve OSA in the majority of obese children. Up to 89% of obese children have persistent OSA after T&A. The efficacy and role of additional therapeutic options requires more study. The high incidence of obesity in children makes this a public health priority.

scholarly journals The correlation of the severity of polysomnography with clinical assessment in cases of adult OSA in a tertiary hospital

2018 ◽  
Vol 4 (4) ◽  
pp. 1076
Author(s):  
Suresh V. ◽  
Gowri Shankar M. ◽  
Prabhu D. ◽  
Natarajan S.
Keyword(s):  
Heart Rate ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Clinical Assessment ◽  
Apnea Hypopnea Index ◽  
Tertiary Referral Centre ◽  
Sleep Related Breathing Disorders ◽  
Obstructive Sleep ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Now days increasing number of people with sleep related breathing disorders especially obstructive sleep apnea are reporting every day in our institute, which is a tertiary referral centre. The objective was to correlate between clinical assessment andpolysomnographic features in an obstructive sleep apnea patient.</p><p class="abstract"><strong>Methods:</strong> A total number of 60 cases were analyzed retrospectively and those who were already clinically assessed and diagnosed as OSA by AHI&gt;5/h in overnight PSG study. The clinical history, body mass index, Epworth sleepiness scale score and full night polysomnograpic data were obtained for all 60 cases. The age and gender differences in OSA cases were analyzed. The correlations between the BMI, ESS score, AHI, oxygen saturation sleep apnea, Epworth sleeps scale and apnea hypopnea index were explored.  </p><p class="abstract"><strong>Results:</strong> Of the 60 cases OSA were analyzed, the mean (SD) age was 36.62 (±11.90) years and the men was mostly affected 96.7% than women only 3.3%. Of 60 cases, 30% of patients having mild form, 25% of patients moderate form, 45% of patients having severe form. The obese patients affected more 83.3% (50/60) than normal only 10% (6/60). The clinical symptom were analyzed by ESS score the normal 18.3%, mild 18.3%, moderate 28.3% and severe 35%. The mean oxygen saturation and heart rate of OSA patients were 72.35 (±11.47) and 69.90 (±15.26) respectively.</p><p><strong>Conclusions:</strong> The BMI and ESS score were positively correlated with severity of OSA. The oxygen saturation and heart rate were negatively correlated with OSA. </p>

scholarly journals Continuous Positive Airway Pressure-Mandibular Advancement Device Combination Therapy for Moderate-to-Severe Obstructive Sleep Apnea: A Preliminary Study

2021 ◽  
Author(s):  
Thyagaseely Sheela Premaraj ◽  
Jacob Stadiem ◽  
Shyamaly Arya Premaraj ◽  
Charles R. Davies ◽  
Matthew Dennis ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Daytime Sleepiness ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Severe Obstructive Sleep Apnea ◽  
Obstructive Sleep ◽  
The Mean

Abstract Objectives The purpose of this pilot study was to determine whether compliance to auto-adjusting positive airway pressure (APAP) improves with the addition of a mandibular advancement device (MAD). Secondary outcome measures included were APAP pressure, subjective daytime sleepiness, apnea–hypopnea index (AHI), and mask leaks. Setting and Sample Population Participants included were diagnosed with moderate-to-severe obstructive sleep apnea (OSA) and became noncompliant to prescribed APAP. Thirteen participants with a mean age of 61.6 years were recruited for this study. Materials and Methods All participants were given a MAD to use with their APAP. Parameters measured included APAP pressure, AHI, mask leak reported via ResMed AirViewTM software, and self-reported daytime sleepiness (Epworth Sleepiness Scale [ESS]). A paired two-sample for mean t-test was performed to determine significance. Results The mean difference of pre- and postintervention APAP compliance was 23.1%, which was statistically significant (p = 0.015). The mean APAP air pressures were unchanged. The difference between pre- and postintervention mean ESS scores was 1.4 and was statistically significant (p = 0.027). The mean difference between pre- and postintervention AHI values and mask leak showed no significant difference. Conclusion This study showed that combination of APAP-MAD therapy, for patients with moderate-to-severe OSA who were noncompliant to APAP use, significantly increased compliance with APAP therapy, and significantly decreased the daytime sleepiness of participants.

S296 – Thyroidectomy for Goiter Improves Obstructive Sleep Apnea

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.

scholarly journals Clinical and Polysomnographic Characteristics of Patients with Extreme Obstructive Sleep Apnea, AHI > 100: A Case-Control Study

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Forogh Soltaninejad ◽  
Negarsadat Neshat ◽  
Mehrzad Salmasi ◽  
Babak Amra
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Study Results ◽  
Significant Difference ◽  
Severe Manifestation ◽  
The Mean ◽  
Nocturnal Polysomnography ◽  
Control Study

Background: Severe obstructive sleep apnea (OSA), defined by apnea-hypopnea index (AHI) as more than 30 events per hour, was previously related to more comorbidity. However, limited studies separated the patients with AHI > 100 from those with a less severe manifestation of the disease. Objectives: The current study aimed at describing the characteristics of this subgroup and comparing them with less severe conditions. Methods: A retrospective analysis was conducted on 114 patients with OSA. Nocturnal polysomnography was used to diagnose severe OSA. Patients were categorized into two groups: (1) 60 < AHI < 100 (very severe OSA), (2) AHI ≥ 100 (extreme OSA). Demographic, medical history, and polysomnographic variables were evaluated and compared between the two groups. Results: Extreme OSA was diagnosed in 19 patients, the mean body mass index (BMI) was significantly higher in this group (39.26 ± 5.93 vs. 35.68 ± 6.45 kg/m2, P = 0.025). They also had lower minimal O2 saturation (65.68 ± 10.16 vs. 74.10 ± 8.74, P = 0.003) and more time with < 90% O2 saturation (T < 90%) (81.78 ± 22.57 vs. 58.87 ± 33.14, P = 0.01). OHS prevalence was significantly higher in the group with extreme OSA (P = 0.04). The most frequent comorbidity was hypertension, with an incidence of 60.5%, for the extreme group, although there was no significant difference between the two groups in terms of clinical associations. Conclusions: The current study results suggested that greater BMI and lower minimal O2 saturation, as well as increased T < 90%, were associated with extreme OSA, although no differences were observed in the associated diseases between the compared groups.

scholarly journals Gender differences in the influence of obstructive sleep apnea on optic nerve head circulation

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Tomoaki Shiba ◽  
Mao Takahashi ◽  
Tadashi Matsumoto ◽  
Yuichi Hori
Keyword(s):  
Gender Differences ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Optic Nerve ◽  
Optic Nerve Head ◽  
Laser Speckle ◽  
Laser Speckle Flowgraphy ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
The Mean

AbstractWe investigated gender differences in the optic nerve head (ONH) microcirculation status in association with obstructive sleep apnea (OSA) by using laser speckle flowgraphy (LSFG). We evaluated 150 men (60.5 ± 11.0 yrs) and 45 women (63.0 ± 10.6 yrs) who underwent overnight polysomnography. The mean blur rate (MBR), maximum (Max) MBR, and minimum (Min) MBR were evaluated. The parameters were analyzed separately for the tissues, vessels, and throughout the ONH (All). The apnea hypopnea index (AHI: times/hr), the lowest SpO2%, and the mean SpO2% were calculated as indicators of OSA. We investigated which MBR sections are correlated with OSA parameters separately in the men and women. All MBR sections in the women were significantly positively correlated with the lowest SpO2. In the men, no MBR section was correlated with any OSA parameters. The factors contributing independently to MBR-Tissue were height (β = 0.31) and lowest SpO2 (β = 0.30). The lowest SpO2 in the women was significantly positively correlated with Max MBR-Tissue, Max MBR-All, and Min MBR-All. Our results confirmed a gender difference in characteristics of ONH microcirculation in association with OSA.

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