scholarly journals Obstructive Sleep Apnea, Palatal Morphology, and Aortic Dilatation in Marfan Syndrome Growing Subjects: A Retrospective Study

2021 ◽  
Vol 18 (6) ◽  
pp. 3045
Author(s):  
Giuseppina Laganà ◽  
Nicolò Venza ◽  
Arianna Malara ◽  
Claudio Liguori ◽  
Paola Cozza ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Marfan Syndrome ◽  
Aortic Disease ◽  
Control Group ◽  
Study Group ◽  
Aortic Dilatation ◽  
Aortic Dilation ◽  
Obstructive Sleep ◽  
High Prevalence

The main cause of mortality in Marfan syndrome (MS) is aortic disease. Obstructive sleep apnea (OSA) is highly prevalent in MS, and it is also associated with cardiovascular risk and maxillary deformities. The aim of this research was to analyze the possible relations between OSA, palatal morphology, and aortic root diameters in growing subjects. A group of 15 growing subjects with MS and a control group of healthy peers was selected. All of them underwent nocturnal polygraphic monitoring, digital dental casts, and transthoracic echocardiography. The results showed that OSA indexes and aortic diameters were significantly higher in the study group. Transversal palatal dimension was smaller in MS patients. Moreover, OSA severity was not related with maxillary contraction severity in MS. No correlation between OSA severity and increased aortic diameters occurred. A high prevalence of OSA, increased aortic dimensions, and significant contraction of palatal dimensions were observed in MS compared with the control group. None of these single factors may directly be associated with aortic dilation, but together, they might contribute to the development and progression of aortic aneurysm from a young age.

scholarly journals Obstructive sleep apnea is prevalent in patients with pulmonary embolism

2013 ◽  
Vol 36 (6) ◽  
pp. 277 ◽  
Author(s):  
Deniz Kosovalı ◽  
Meral Uyar ◽  
Osman Elbek ◽  
Nazan Bayram ◽  
İlker Özsaraç ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Sleep Stage ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Study Group ◽  
Obstructive Sleep

Purpose: Obstructive sleep apnea (OSA) syndrome causes systemic consequences due to hypoxia and endothelial dysfunction. The purpose of this study was to investigate whether OSA is more common in subjects with pulmonary embolism (PE). Methods: This prospective study was conducted between November 2009 and December 2010 in the Department of Pulmonary Medicine of Gaziantep University. Twenty-eight patients with PE were included in the study group along with forty-five subjects with OSA as the control group. The control group was selected from among subjects who were referred to the sleep clinic. Full night polysomnography was performed for each subject. Results: Mean apnea-hypopnea index (AHI) was found to be higher in the PE group compared with the control group (p=0.010). Severe OSA was detected in 21.4% of the PE group but in no controls (p=0.015). Sleep stage 2 was longer in control group whereas stage 1 and rapid eye movement (REM) sleep was longer in the PE group. Snoring and excessive daytime sleepiness were more common in the control group compared with the study group. AHI severity and thrombus localization were not significantly different between the groups (p=0.350). Conclusion: Our study findings suggest that OSA is more prevalent and severe in subjects with PE compared with control subjects. The clinical significance of less prevalent excessive daytime sleepiness and snoring in subjects with PE should be evaluated in further studies.

scholarly journals Effect of Cooling Irrigating Saline in Tongue Base Ablation in Obstructive Sleep Apnea

OTO Open ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 2473974X2198959
Author(s):  
Ahmed Yassin Bahgat
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Controlled Trial ◽  
Tongue Base ◽  
Control Group ◽  
University Hospitals ◽  
Energy Field ◽  
Obstructive Sleep ◽  
Prospective Randomized Controlled Trial ◽  
Significant Difference

Objective Plasma is formed by creating a high-density energy field within an electrically conductive fluid such as saline. Sometimes ablated bits of tissue get stuck between the electrodes of the wand, obstructing the suction channel. The purpose of this study is to investigate the effect of cooling the irrigating saline during ablation of the hypertrophied tongue base in patients with obstructive sleep apnea. Study Design Prospective randomized controlled trial. Setting An otorhinolaryngology department in Main University hospitals. Methods Sixty adult patients with obstructive sleep apnea and tongue base hypertrophy underwent tongue base ablation surgery. Patients were randomly divided into 2 groups of 30 patients each: cooled saline and room temperature saline. The Coblation wand used was the EVac 70 Xtra HP (Smith & Nephew). Results In this study, a significant difference in operative time (mean ± SD) was seen between groups: 21.2 ± 5.5 minutes in the cold group and 47 ± 9.5 minutes in the control group ( P = .001). The wands in the cold group did not obstruct, while all the wands in the control group were obstructed by tissue clogs with variable degrees, hence wasting more time to clean the wands’ tips. Conclusion Cooling the irrigating saline overcame the problem of wand clogs, and the wand tip did not occlude at all during the procedures, thus saving time lost in wand cleaning and demonstrating a faster and safer surgical procedure. Further studies are needed to identify the hemostatic effect of the cooled saline over the regular one.

Evaluation of corneal endothelium using specular microscopy in patients with obstructive sleep apnea syndrome

2021 ◽  
pp. 112067212110065
Author(s):  
Murat Serkan Songur ◽  
Yavuz Selim İntepe ◽  
Seray Aslan Bayhan ◽  
Hasan Ali Bayhan ◽  
Ender Şahin ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Coefficient Of Variation ◽  
Corneal Endothelium ◽  
Corneal Thickness ◽  
Sleep Apnea Syndrome ◽  
Control Group ◽  
Specular Microscopy ◽  
Obstructive Sleep ◽  
Apnea Syndrome

Purpose: In the present study we evaluate the corneal endothelium using specular microscopy in patients with obstructive sleep apnea syndrome (OSAS). Methods: The study included a total of 100 patients including 35 patients with mild OSAS, 34 patients with moderate OSAS and 31 patients with severe OSAS, and the right eyes of 30 patients as a control group. Patients were examined to exclude the possibility of ocular diseases. Cellular density in the cornea epithelium (cell/mm2), corneal thickness (µ), percentage of hexagonal cells (%) and the coefficient of variation were evaluated using a specular microscope. Results: Corneal thickness was significantly decreased in all OSAS groups when compared to the control group ( p = 0.002), while no significant difference was identified among the OSAS groups. The corneal endothelial cell density, percentage of hexagonal cells and coefficient of variation were significantly different between the OSAS groups and the control group ( p < 0.001). Conclusion: More significant impairments were noted in the corneal endothelium of the patients in the OSAS group than in the control group, and specular microscopy is in valuable in the follow-up and treatment of such patients.

scholarly journals Development of a pediatric obstructive sleep apnea triage algorithm

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
D. S. Heath ◽  
H. El-Hakim ◽  
Y. Al-Rahji ◽  
E. Eksteen ◽  
T. C. Uwiera ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Univariate Analysis ◽  
Individual Risk ◽  
Obstructive Sleep ◽  
High Prevalence ◽  
Grade Scale ◽  
Overnight Oximetry ◽  
Triage Algorithm ◽  
Pediatric Sleep

Abstract Introduction Diagnosis and treatment of obstructive sleep apnea (OSA) in children is often delayed due to the high prevalence and limited physician and sleep testing resources. As a result, children may be referred to multiple specialties, such as pediatric sleep medicine and pediatric otolaryngology, resulting in long waitlists. Method We used data from our pediatric OSA clinic to identify predictors of tonsillectomy and/or adenoidectomy (AT). Before being seen in the clinic, parents completed the Pediatric Sleep Questionnaire (PSQ) and screening questionnaires for restless leg syndrome (RLS), nasal rhinitis, and gastroesophageal reflux disease (GERD). Tonsil size data were obtained from patient charts and graded using the Brodsky-five grade scale. Children completed an overnight oximetry study before being seen in the clinic, and a McGill oximetry score (MOS) was assigned based on the number and depth of oxygen desaturations. Logistic regression, controlling for otolaryngology physician, was used to identify significant predictors of AT. Three triage algorithms were subsequently generated based on the univariate and multivariate results to predict AT. Results From the OSA cohort, there were 469 eligible children (47% female, mean age = 8.19 years, SD = 3.59), with 89% of children reported snoring. Significant predictors of AT in univariate analysis included tonsil size and four PSQ questions, (1) struggles to breathe at night, (2) apneas, (3) daytime mouth breathing, and (4) AM dry mouth. The first triage algorithm, only using the four PSQ questions, had an odds ratio (OR) of 4.02 for predicting AT (sensitivity = 0.28, specificity = 0.91). Using only tonsil size, the second algorithm had an OR to predict AT of 9.11 (sensitivity = 0.72, specificity = 0.78). The third algorithm, where MOS was used to stratify risk for AT among those children with 2+ tonsils, had the same OR, sensitivity, and specificity as the tonsil-only algorithm. Conclusion Tonsil size was the strongest predictor of AT, while oximetry helped stratify individual risk for AT. We recommend that referral letters for snoring children include graded tonsil size to aid in the triage based on our findings. Children with 2+ tonsil sizes should be triaged to otolaryngology, while the remainder should be referred to a pediatric sleep specialist. Graphical abstract

scholarly journals Initiation of therapy for obstructive sleep apnea syndrome: a randomized comparison of outcomes of telemetry-supported home-based vs. sleep lab-based therapy initiation

2021 ◽  
Author(s):  
Ingo Fietze ◽  
Sebastian Herberger ◽  
Gina Wewer ◽  
Holger Woehrle ◽  
Katharina Lederer ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Control Group ◽  
Sleep Laboratory ◽  
Home Therapy ◽  
Home Management ◽  
Therapy Initiation ◽  
Home Based ◽  
Obstructive Sleep ◽  
At Home

Abstract Purpose Diagnosis and treatment of obstructive sleep apnea are traditionally performed in sleep laboratories with polysomnography (PSG) and are associated with significant waiting times for patients and high cost. We investigated if initiation of auto-titrating CPAP (APAP) treatment at home in patients with obstructive sleep apnea (OSA) and subsequent telemonitoring by a homecare provider would be non-inferior to in-lab management with diagnostic PSG, subsequent in-lab APAP initiation, and standard follow-up regarding compliance and disease-specific quality of life. Methods This randomized, open-label, single-center study was conducted in Germany. Screening occurred between December 2013 and November 2015. Eligible patients with moderate-to-severe OSA documented by polygraphy (PG) were randomized to home management or standard care. All patients were managed by certified sleep physicians. The home management group received APAP therapy at home, followed by telemonitoring. The control group received a diagnostic PSG, followed by therapy initiation in the sleep laboratory. The primary endpoint was therapy compliance, measured as average APAP usage after 6 months. Results The intention-to-treat population (ITT) included 224 patients (110 home therapy, 114 controls); the per-protocol population (PP) included 182 patients with 6-month device usage data (89 home therapy, 93 controls). In the PP analysis, mean APAP usage at 6 months was not different in the home therapy and control groups (4.38 ± 2.04 vs. 4.32 ± 2.28, p = 0.845). The pre-specified non-inferiority margin (NIM) of 0.3 h/day was not achieved (p = 0.130); statistical significance was achieved in a post hoc analysis when NIM was set at 0.5 h/day (p < 0.05). Time to APAP initiation was significantly shorter in the home therapy group (7.6 ± 7.2 vs. 46.1 ± 23.8 days; p < 0.0001). Conclusion Use of a home-based telemonitoring strategy for initiation of APAP in selected patients with OSA managed by sleep physicians is feasible, appears to be non-inferior to standard sleep laboratory procedures, and facilitates faster access to therapy.

The effect of 4-h versus 6-h time restricted feeding on sleep quality, duration, insomnia severity and obstructive sleep apnea in adults with obesity

2021 ◽  
pp. 026010602110023
Author(s):  
Sofia Cienfuegos ◽  
Kelsey Gabel ◽  
Faiza Kalam ◽  
Mark Ezpeleta ◽  
Vicky Pavlou ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Quality ◽  
Sleep Onset ◽  
Control Group ◽  
Sleep Onset Latency ◽  
Restricted Feeding ◽  
Wake Time ◽  
Obstructive Sleep ◽  
Insomnia Severity

Background: Time restricted feeding (TRF) involves deliberately restricting the times during which energy is ingested. Preliminary findings suggest that 8–10-h TRF improves sleep. However, the effects of shorter TRF windows (4–6 h) on sleep, remain unknown. Aims: This study compared the effects of 4-h versus 6-h TRF on sleep quality, duration, insomnia severity and the risk of obstructive sleep apnea. Methods: Adults with obesity ( n = 49) were randomized into one of three groups: 4-h TRF (eating only between 3 and 7 p.m.), 6-h TRF (eating only between 1 and 7 p.m.), or a control group (no meal timing restrictions) for 8 weeks. Results: After 8 weeks, body weight decreased ( p < 0.001) similarly by 4-h TRF (–3.9 ± 0.4 kg) and 6-h TRF (–3.4 ± 0.4 kg), versus controls. Sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI), did not change by 4-h TRF (baseline: 5.9 ± 0.7; week 8: 4.8 ± 0.6) or 6-h TRF (baseline: 6.4 ± 0.8; week 8: 5.3 ± 0.9), versus controls. Wake time, bedtime, sleep duration and sleep onset latency also remained unchanged. Insomnia severity did not change by 4-h TRF (baseline: 4.4 ± 1.0; week 8: 4.7 ± 0.9) or 6-h TRF (baseline: 8.3 ± 1.2; week 8: 5.5 ± 1.1), versus controls. Percent of participants reporting obstructive sleep apnea symptoms did not change by 4-h TRF (baseline: 44%; week 8: 25%) or 6-h TRF (baseline: 47%; week 8: 20%), versus controls. Conclusion: These findings suggest that 4- and 6-h TRF have no effect on sleep quality, duration, insomnia severity, or the risk of obstructive sleep apnea.

scholarly journals Obstructive sleep apnea and CPAP therapy alter distinct transcriptional programs in subcutaneous fat tissue

SLEEP ◽  
2019 ◽  
Vol 43 (6) ◽  
Author(s):  
Sina A Gharib ◽  
Amanda L Hurley ◽  
Michael J Rosen ◽  
James C Spilsbury ◽  
Amy E Schell ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Subcutaneous Adipose Tissue ◽  
Subcutaneous Fat ◽  
Study Group ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
Group 2 ◽  
Subcutaneous Adipose ◽  
Group 1

Abstract Obstructive sleep apnea (OSA) has been linked to dysregulated metabolic states, and treatment of sleep apnea may improve these conditions. Subcutaneous adipose tissue is a readily samplable fat depot that plays an important role in regulating metabolism. However, neither the pathophysiologic consequences of OSA nor the effects of continuous positive airway pressure (CPAP) in altering this compartment’s molecular pathways are understood. This study aimed to systematically identify subcutaneous adipose tissue transcriptional programs modulated in OSA and in response to its effective treatment with CPAP. Two subject groups were investigated: Study Group 1 was comprised of 10 OSA and 8 controls; Study Group 2 included 24 individuals with OSA studied at baseline and following CPAP. For each subject, genome-wide gene expression measurement of subcutaneous fat was performed. Differentially activated pathways elicited by OSA (Group 1) and in response to its treatment (Group 2) were determined using network and Gene Set Enrichment Analysis (GSEA). In Group 2, treatment of OSA with CPAP improved apnea-hypopnea index, daytime sleepiness, and blood pressure, but not anthropometric measures. In Group 1, GSEA revealed many up-regulated gene sets in OSA subjects, most of which were involved in immuno-inflammatory (e.g. interferon-γ signaling), transcription, and metabolic processes such as adipogenesis. Unexpectedly, CPAP therapy in Group 2 subjects was also associated with up-regulation of several immune pathways as well as cholesterol biosynthesis. Collectively, our findings demonstrate that OSA alters distinct inflammatory and metabolic programs in subcutaneous fat, but these transcriptional signatures are not reversed with short-term effective therapy.

scholarly journals Evaluation of tongue/mandible volume ratio in children with obstructive sleep apnea

2018 ◽  
Vol 23 (4) ◽  
pp. 72-78 ◽  
Author(s):  
Kavita Hotwani ◽  
Krishna Sharma ◽  
Arpan Jaiswal
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Soft Tissue ◽  
Volume Ratio ◽  
Radiology Department ◽  
Control Group ◽  
Mr Images ◽  
Early Screening ◽  
Obstructive Sleep ◽  
Tongue Volume

ABSTRACT Objective: The present study was an attempt to investigate tongue/mandible volume ratio in children, using volumetric magnetic resonance imaging (MRI) for early screening and to aid in treatment planning. Methods: Volumetric evaluation of tongue volume/mandible volume ratio (TV/MV ratio) in children with obstructive sleep apnea (OSA) using MRI was carried out retrospectively on available DICOM MR images of children in the age group of 10-14 years. MRI image records of patients diagnosed with OSA were obtained from interventional radiology department records, at Sharad Pawar Dental College and Hospital (Datta Meghe Institute of Medical Sciences, Nagpur/India). The age, gender, height and weight of the subjects were retrieved from patient database and registered. For the control group, available MRI images of healthy subjects without OSA were retrieved. Body mass index (BMI) was also calculated using the height and the weight present in the records. Measurements from MR images were made using DICOM image processing software. Soft tissue and bony structure segmentation was performed by manual tracing. The tongue volume and mandible volume were directly computed using the software. The tongue volume/mandible volume ratio (TV/MV) was generated using the above values and expressed as a percentage for both groups. Results: The difference between OSA group and control group with respect to TV/MV ratio was found to be highly significant at 0.05 level of significance. There was no significant correlation between BMI and TV/MV ratio in OSA group (p= 0.451) as well as in control group (p= 0.094). Conclusion: TV/MV ratio may be an appropriate variable to evaluate the risk of OSA, representing the balance between skeletal morphology and soft tissue morphology in craniofacial complex.

scholarly journals Endothelial Function and Arterial Stiffness Should Be Measured to Comprehensively Assess Obstructive Sleep Apnea in Clinical Practice

2021 ◽  
Vol 8 ◽  
Author(s):  
Jinmei Luo ◽  
Xiaona Wang ◽  
Zijian Guo ◽  
Yi Xiao ◽  
Wenhao Cao ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Arterial Stiffness ◽  
Endothelial Function ◽  
Augmentation Index ◽  
Reactive Hyperemia ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Tnf Α

Objective: An effective clinical tool to assess endothelial function and arterial stiffness in patients with obstructive sleep apnea (OSA) is lacking. This study evaluated the clinical significance of subclinical markers for OSA management in males without serious complications.Patients/Methods: Males without serious complications were consecutively recruited. Clinical data, biomarker tests, reactive hyperemia index (RHI), and augmentation index at 75 beats/min (AIx75) measured by peripheral arterial tonometry were collected. An apnea hypopnea index (AHI) cutoff of ≥15 events/h divided the patients into two groups.Results: Of the 75 subjects, 42 had an AHI ≥15 events/h. Patients with an AHI ≥15 events/h had higher high-sensitivity C-reactive protein, tumor necrosis factor-alpha (TNF-α), vascular endothelial growth factor, and AIx75 values than the control group but no statistical difference in RHI was observed. After controlling for confounders, TNF-α was negatively correlated with the average oxygen saturation (r = −0.258, P = 0.043). RHI was correlated with the rapid eye movement (REM) stage percentage (r = 0.306, P = 0.016) but not with AHI (P &gt; 0.05). AIx75 was positively correlated with the arousal index (r = 0.289, P = 0.023) but not with AHI (r = 0.248, P = 0.052).Conclusions: In males with OSA without severe complications, TNF-α and AIx75 are independently related to OSA. The role of RHI in OSA management requires further elucidation. These markers combined can comprehensively evaluate OSA patients to provide more evidence for the primary prevention of coronary heart disease and treatment response assessment.

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