scholarly journals Validation of Oximetry for Diagnosing Obstructive Sleep Apnea in a Clinical Setting

2020 ◽  
Vol 2 (3) ◽  
pp. 364-374
Author(s):  
Kazuki Ito ◽  
Masahiro Uetsu ◽  
Hiroshi Kadotani
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Epidemiological Study ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Reliability And Validity ◽  
Obstructive Sleep ◽  
Study Participants ◽  
Metabolic Comorbidities ◽  
Severe Sleep Apnea

A large epidemiological study using oximetry to analyze obstructive sleep apnea (OSA) and metabolic comorbidities was performed in Japan; however, reliability and validity of oximetry in the Japanese population remains poorly understood. In this study, oximetry data from the epidemiological study were compared with data from clinically performed polysomnography (PSG) and out-of-center sleep testing (OCST) in epidemiological study participants who later attended our outpatient units. The oxygen desaturation index (ODI) from oximetry showed a moderate positive relationship (correlation coefficient r = 0.561, p < 0.001) with apnea/hypopnea data from PSG/OCST. The area under the receiver operating characteristic curve showed moderate accuracy of this method in the detection of moderate-to-severe or severe OSA. However, the optimal ODI thresholds to detect moderate-to-severe OSA and severe OSA were the same (ODI > 20.1). Oximetry may be a useful tool for screening moderate-to-severe or severe sleep apnea. However, it may be difficult to set an appropriate threshold to distinguish between moderate and severe sleep apnea by oximetry alone.

scholarly journals Associations of Obstructive Sleep Apnea, Obestatin, Leptin, and Ghrelin with Gastroesophageal Reflux

2021 ◽  
Vol 10 (21) ◽  
pp. 5195
Author(s):  
Piotr Pardak ◽  
Rafał Filip ◽  
Jarosław Woliński ◽  
Maciej Krzaczek
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Gastroesophageal Reflux ◽  
Ph Monitoring ◽  
Sleep Study ◽  
Esophageal Ph ◽  
Obstructive Sleep ◽  
The Relationship ◽  
Gerd Symptoms ◽  
Severe Sleep Apnea

Gastroesophageal reflux disease (GERD) is commonly observed in patients with obstructive sleep apnea (OSA). Hormonal disorders observed in OSA may be relevant in the development of GERD. The aim of the study was to assess the correlations between ghrelin, obestatin, leptin, and the intensity of GERD in patients with OSA. The study included 58 patients hospitalized due to clinical suspicion of sleep disorders during sleep. All patients underwent a sleep study, and blood samples were collected overnight for hormonal tests. Survey data concerning symptoms of GERD, gastroscopy, and esophageal pH monitoring results were included in the study. In patients with OSA, GERD was twice as common when compared to the group without OSA. Among subjects with severe sleep apnea (AHI > 30; n = 31; 53%), we observed lower ghrelin levels, especially in the second half of the night and in the morning (p5.00 = 0.0207; p7.00 = 0.0344); the presence of OSA had no effect on obestatin and leptin levels. No significant differences in hormonal levels were observed between the groups depending on the diagnosis of GERD. However, correlations of ghrelin levels with the severity of esophagitis, leptin and ghrelin levels with the severity of GERD symptoms, and leptin levels with lower esophageal pH were found. GERD is more frequent among patients with OSA. In both GERD and OSA, deviations were observed in the levels of ghrelin and leptin. However, our analysis demonstrates that the relationship between OSA and GERD does not result from these disorders.

474 Phenotyping of patients with Moderate to Severe OSA on Polysomnography after Negative Home Sleep Apnea Testing

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A187-A187
Author(s):  
Sarah Sarfraz ◽  
Lindsay McCullough ◽  
Henry Arantes ◽  
Alejandra Lastra
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Flow Time ◽  
Apnea Hypopnea Index ◽  
Apnea Test ◽  
Recording Time ◽  
Time Flow ◽  
Obstructive Sleep ◽  
Severe Sleep Apnea ◽  
Apnea Testing

Abstract Introduction Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnea (OSA). Given cost, insurance restrictions and in some cases limited access to sleep center testing, the use of home based sleep apnea testing is becoming increasingly more common. A proportion of patients with technically adequate HSAT who are negative end up having significant disease on PSG. The characteristics of patients who are found to have moderate to severe sleep apnea on polysomnogram (PSG) after a negative home sleep apnea test (HSAT) are not known. We aim to phenotype these patients. Methods We conducted a retrospective chart review from March 2018 to February 2020. A total of 953 adult patients (18 years old and older) underwent HSAT, 248 tests resulted negative (apnea-hypopnea index &lt;5/h). Out of the negative HSAT, 17 patients had moderate to severe obstructive sleep apnea on PSG. Those were included for analysis. Data on patient characteristics such as age, body mass index (BMI), gender, STOP-BANG, ESS and comorbidities was gathered. Respiratory disturbance index, recording time, flow time, oximetry time on HSAT was recorded. PSG recording time, baseline AHI, supine AHI and non-supine AHI were also noted. Technically inadequate HSAT were excluded from analysis. Results The percentage of patients with negative HSAT who were found to have moderate to severe sleep apnea on PSG and were included for analysis was 6.85% (n17). Mean age was 41 years. Mean BMI was 33 kg/m2. Common comorbidities were hypertension (29%), asthma (17.6 %), depression (17.6%), anxiety (11.7%) and reflux (5.9%). Average ESS was 11.7 and STOP-BANG was 3.8. The mean recording time was 477 minutes, flow time 391 minutes and oximetry time was 426 minutes on HSAT. Average PSG recording time was 433 minutes. Average AHI was 24 with supine being 33.2/h and non-supine 17.9/h. Conclusion A proportion of patients with negative HSAT have moderate to severe OSA on follow-up polysomnogram. These patients were young, with lower-class obesity, more positional OSA, and no associated complex comorbidities. Re-evaluation of current diagnostic algorithms and further research is needed to phenotype this at-risk group, as first-line PSG may be more cost-effective and efficient. Support (if any):

scholarly journals An assessment of a simple clinical technique to estimate pharyngeal collapsibility in people with obstructive sleep apnea

SLEEP ◽  
2020 ◽  
Vol 43 (10) ◽  
Author(s):  
Amal M Osman ◽  
Benjamin K Tong ◽  
Shane A Landry ◽  
Bradley A Edwards ◽  
Simon A Joosten ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Characteristic Curve ◽  
Upper Airway ◽  
Clinical Intervention ◽  
Apnea Hypopnea Index ◽  
Cpap Titration ◽  
Obstructive Sleep ◽  
Airway Collapsibility ◽  
Upper Airway Collapsibility

Abstract Study Objectives Quantification of upper airway collapsibility in obstructive sleep apnea (OSA) could help inform targeted therapy decisions. However, current techniques are clinically impractical. The primary aim of this study was to assess if a simple, novel technique could be implemented as part of a continuous positive airway pressure (CPAP) titration study to assess pharyngeal collapsibility. Methods A total of 35 participants (15 female) with OSA (mean ± SD apnea–hypopnea index = 35 ± 19 events/h) were studied. Participants first completed a simple clinical intervention during a routine CPAP titration, where CPAP was transiently turned off from the therapeutic pressure for ≤5 breaths/efforts on ≥5 occasions during stable non-rapid eye movement (non-REM) sleep for quantitative assessment of airflow responses (%peak inspiratory flow [PIF] from preceding 5 breaths). Participants then underwent an overnight physiology study to determine the pharyngeal critical closing pressure (Pcrit) and repeat transient drops to zero CPAP to assess airflow response reproducibility. Results Mean PIF of breaths 3–5 during zero CPAP on the simple clinical intervention versus the physiology night were similar (34 ± 29% vs. 28 ± 30% on therapeutic CPAP, p = 0.2; range 0%–90% vs. 0%–95%). Pcrit was −1.0 ± 2.5 cmH2O (range −6 to 5 cmH2O). Mean PIF during zero CPAP on the simple clinical intervention and the physiology night correlated with Pcrit (r = −0.7 and −0.9, respectively, p &lt; 0.0001). Receiver operating characteristic curve analysis indicated significant diagnostic utility for the simple intervention to predict Pcrit &lt; −2 and &lt; 0 cmH2O (AUC = 0.81 and 0.92), respectively. Conclusions A simple CPAP intervention can successfully discriminate between patients with and without mild to moderately collapsible pharyngeal airways. This scalable approach may help select individuals most likely to respond to non-CPAP therapies.

Obstructive sleep apnea (OSA) and metabolic comorbidities

2013 ◽  
Vol 24 ◽  
pp. e233-e234
Author(s):  
R.B. Haider ◽  
S. Khattak ◽  
A. Naqvi ◽  
A.M. O'Connell ◽  
J. Power ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep ◽  
Metabolic Comorbidities

Abstract 15: Obstructive Sleep Apnea is a Risk Factor for Incident Diagnosed Diabetes: The Sleep Heart Health-Atherosclerosis Risk in Communities Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Mako Nagayoshi ◽  
Naresh M Punjabi ◽  
Elizabeth Selvin ◽  
James S Pankow ◽  
Eyal Shahar ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Atherosclerosis Risk In Communities ◽  
Obstructive Sleep ◽  
Atherosclerosis Risk ◽  
Diagnosed Diabetes ◽  
Objectively Measured ◽  
Severe Sleep Apnea

Background: Sleep apnea has been associated with diabetes in many cross-sectional studies, but prospective data is sparse. Most prior studies defined sleep apnea by self-reported sleep symptoms. Hypothesis: Objectively measured obstructive sleep apnea is associated with greater risk of incident diabetes. Design: We conducted a prospective cohort study of 1,465 non-diabetic participants of the Sleep Heart Health-Atherosclerosis Risk in Communities Study with in-home polysomnography conducted in 1996-1998 (baseline). Participants were categorized into four groups according to number of events per hour, as defined by the apnea-hypopnea index: <5.0 (normal), 5.0-14.9 (mild sleep apnea), 15.0-29.9 (moderate sleep apnea), and ≥30.0 (severe sleep apnea). Incident diagnosed diabetes or diabetes medication use was ascertained during annual follow-up calls through 2010. Cox proportional hazards models were used to examine the association between sleep apnea severity and incident diagnosed diabetes. Results: During a median follow-up of 12 years, there were 279 incident self-reported diabetes cases among the study participants (mean age 63 years, 99% white, 47% male). The risk of diabetes among those with moderate or severe sleep apnea was significantly higher than in those without sleep apnea after adjustment for demographics measures and other confounders. The association persisted among those with severe sleep apnea even after adjustment for body mass index and waist circumference. Across all models there was evidence of a dose-response association between the sleep apnea severity and the risk of incident diabetes ( Table ). There was no evidence for an interaction by sex. Conclusions: In this community-based study, persons with objectively measured obstructive severe sleep apnea were at higher risk of diabetes compared to persons without sleep apnea, independent of body mass index and waist circumference. Screening and treatment of sleep apnea may be beneficial for the prevention of diabetes.

scholarly journals Validation of the STOP-Bang questionnaire as a means of screening for obstructive sleep apnea in adults in Brazil

2017 ◽  
Vol 43 (6) ◽  
pp. 456-463 ◽  
Author(s):  
Ricardo Luiz de Menezes Duarte ◽  
Lorena Barbosa de Moraes Fonseca ◽  
Flavio José Magalhães-da-Silveira ◽  
Erika Aparecida da Silveira ◽  
Marcelo Fouad Rabahi
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Characteristic Curve ◽  
Apnea Hypopnea Index ◽  
Language Version ◽  
Culturally Adapted ◽  
Obstructive Sleep ◽  
The Mean ◽  
And Gender ◽  
Sensitivity Specificity

ABSTRACT Objective: To validate the Portuguese-language version of the STOP-Bang (acronym for Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender) questionnaire, culturally adapted for use in Brazil, as a means of screening for obstructive sleep apnea (OSA) in adults. Methods: In this validation study, we enrolled patients ≥ 18 years of age, recruited between May of 2015 and November of 2016. All patients completed the STOP-Bang questionnaire and underwent overnight polysomnography. To evaluate the performance of the questionnaire, we used contingency tables and areas under the (receiver operating characteristic) curve (AUCs). Results: We included 456 patients. The mean age was 43.7 ± 12.5 years, and 291 (63.8%) of the patients were male. On the basis of the apnea-hypopnea index (AHI), we categorized OSA as mild/moderate/severe (any OSA; AHI ≥ 5 events/h), moderate/severe (AHI ≥ 15 events/h), or severe (AHI ≥ 30 events/h). The overall prevalence of OSA was 78.3%, compared with 52.0%, and 28.5% for moderate/severe and severe OSA, respectively. The most common score on the STOP-Bang questionnaire was 4 points (n = 106), followed by 3 points (n = 85) and 5 points (n = 82). An increase in the score was paralleled by a reduction in sensitivity with a corresponding increase in specificity for all AHI cut-off points. The AUCs obtained for the identification of any, moderate/severe, and severe OSA were: 0.743, 0.731, and 0.779, respectively. For any OSA, the score on the questionnaire (cut-off, ≥ 3 points) presented sensitivity, specificity, and accuracy of 83.5%, 45.5%, and 75.2%, respectively. Conclusions: The STOP-Bang questionnaire performed adequately for OSA screening, indicating that it could be used as an effective screening tool for the disorder.

scholarly journals Gut microbiota in obstructive sleep apnea–hypopnea syndrome: disease-related dysbiosis and metabolic comorbidities

2019 ◽  
Vol 133 (7) ◽  
pp. 905-917 ◽  
Author(s):  
Chih-Yuan Ko ◽  
Qing-Quan Liu ◽  
Huan-Zhang Su ◽  
Hua-Ping Zhang ◽  
Ji-Mim Fan ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Gut Microbiota ◽  
Area Under The Curve ◽  
Variable Regions ◽  
Microbial Dysbiosis ◽  
Obstructive Sleep ◽  
16S Rrna Pyrosequencing ◽  
Hypopnea Syndrome ◽  
Metabolic Comorbidities

Abstract Gut microbiota alterations manifest as intermittent hypoxia and fragmented sleep, thereby mimicking obstructive sleep apnea–hypopnea syndrome (OSAHS). Here, we sought to perform the first direct survey of gut microbial dysbiosis over a range of apnea–hypopnea indices (AHI) among patients with OSAHS. We obtained fecal samples from 93 patients with OSAHS [5 &lt; AHI ≤ 15 (n=40), 15 &lt; AHI ≤ 30 (n=23), and AHI ≥ 30 (n=30)] and 20 controls (AHI ≤ 5) and determined the microbiome composition via 16S rRNA pyrosequencing and bioinformatics analysis of variable regions 3–4. We measured fasting levels of homocysteine (HCY), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α). Results revealed gut microbial dysbiosis in several patients with varying severities of OSAHS, reliably separating them from controls with a receiver operating characteristic-area under the curve (ROC-AUC) of 0.789. Functional analysis in the microbiomes of patients revealed alterations; additionally, decreased in short-chain fatty acid (SCFA)-producing bacteria and increased pathogens, accompanied by elevated levels of IL-6. Lactobacillus levels correlated with HCY levels. Stratification analysis revealed that the Ruminococcus enterotype posed the highest risk for patients with OSAHS. Our results show that the presence of an altered microbiome is associated with HCY among OSAHS patients. These changes in the levels of SCFA affect the levels of pathogens that play a pathophysiological role in OSAHS and related metabolic comorbidities.

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