Reversibility of retinochoroidal vascular alteration in patients with obstructive sleep apnea after continuous positive air pressure and surgical intervention

IGFBP4 is the smallest member of the insulin-like growth factor binding protein family (IGFBP). It is a hepatic protein that plays a role in modulating the activity and bioavailability of IGF-I. The expression of IGFBP4 was found to increase under conditions of hypoxia. Obstructive sleep apnea (OSA) is a common disorder, characterized by cyclic episodes of intermittent hypoxia and fragmented sleep. Our aim was to quantify levels of circulating IGFBP1, IGFBP2, IGFBP3, IGFBP4, and IGFBP7 in fasting plasma samples of 69 Kuwaiti participants and explore its correlation with indices of OSA. The quantification was performed using multiplexing assay. The study involved 28 controls and 41 patients with OSA. Levels of circulating IGFBP4 were significantly higher in people with OSA ( 289.74 ± 23.30 ng/ml) compared to the control group ( 217.60 ± 21.74 ng/ml, p = 0.028 ). The increase in IGFBP4 correlated significantly and positively with AHI ( r = .574 , p = .01 ) and AI ( r = .794 , p = .001 ) in people with moderate and severe OSA. There was a significant decline in circulating IGFBP4 after 3 months of surgery ( 225.89 ± 18.16 ng/ml, p = 0.012 ). This was accompanied by a prominent improvement in OSA (AHI 8.97 ± 2.37 events/h, p = 0.001 ). In this study, our data showed a significant increase in circulating IGFBP4 in people with OSA. We also report a significant positive correlation between IGFBP4 and indices of OSA at baseline, which suggests IGFBP4 as a potential diagnostic biomarker for OSA. There was a significant improvement in OSA after 3 months of surgical intervention, which concurred with a significant decline in IGFBP4 levels. Altogether, the detected change suggests a potential link between IGFBP4 and OSA or an OSA-related factor, whereby OSA might play a role in triggering the induction of IGFBP4 expression.

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A novel intermittent negative air pressure device ameliorates obstructive sleep apnea syndrome in adults

Sleep And Breathing ◽

10.1007/s11325-018-01778-z ◽

2019 ◽

Vol 23 (3) ◽

pp. 849-856

Author(s):

Tzu-Chun Hung ◽

Tien-Jen Liu ◽

Wen-Yeh Hsieh ◽

Bo-Nien Chen ◽

Wen-Ko Su ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Air Pressure ◽

Obstructive Sleep ◽

Apnea Syndrome

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Nasal patency and the effectiveness of nasal continuous positive air pressure in obstructive sleep apnea☆☆☆★

Otolaryngology ◽

10.1016/s0194-5998(98)70234-7 ◽

1998 ◽

Vol 118 (5) ◽

pp. 643-647 ◽

Cited By ~ 1

Author(s):

GARY L. SCHECHTER ◽

J.CATESBY WARE ◽

JAMES PERLSTROM ◽

REUBEN H. McBRAYER

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Air Pressure ◽

Nasal Patency ◽

Obstructive Sleep

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Reviews of Science for Science Librarians: The 40th Anniversary of Dr. Colin Sullivan’s Invention of Continuous Positive Air Pressure (CPAP) for Obstructive Sleep Apnea (OSA)

Science & Technology Libraries ◽

10.1080/0194262x.2021.1932696 ◽

2021 ◽

pp. 1-18

Author(s):

Tony Stankus

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Air Pressure ◽

40Th Anniversary ◽

Obstructive Sleep

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550 Laryngomalacia and obstructive sleep apnea in infants with PWS

SLEEP ◽

10.1093/sleep/zsab072.548 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A218-A218

Author(s):

Weston Powell ◽

Joanna Wrede ◽

Parisa Salehi

Keyword(s):

Growth Hormone ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Surgical Intervention ◽

Comorbid Condition ◽

Sleep Endoscopy ◽

Drug Induced ◽

Surgical Interventions ◽

Obstructive Sleep ◽

Before And After

Abstract Introduction Growth hormone (GH) improves tone, body composition, development, and growth in infants with Prader-Willi Syndrome (PWS). Concerns about sudden death following GH initiation and worsening obstructive sleep apnea (OSA) in children with PWS resulted in guidelines for polysomnography (PSG) evaluation before and after starting GH. We review novel evidence of laryngomalacia as a mechanism for this worsening of OSA and describe the incidence of laryngomalacia in this patient population. Methods A retrospective review of infants and children seen at the Seattle Children’s PWS clinic between October 2014 and May 2020 who had undergone polysomnography (PSG) before and after growth hormone initiation was performed. Findings on otolaryngology evaluation via flexible fiberoptic laryngoscopy (FFL) or drug-induced sleep endoscopy were reviewed to characterize obstruction, diagnosis of laryngomalacia, and response to surgical intervention. Results A total of 28 cases were identified. 12 (41%) were evaluated with FFL between ages 4 and 21 months old (median 5) for noisy breathing, worsening or persistent OSA, or dysphagia. Out of these, 9 (75% of FFL, 31% of total) were diagnosed with laryngomalacia. Children with laryngomalacia were more likely to have worsening of OSA after GH initiation. Surgical interventions including supraglottoplasty or adenotonsillectomy led to improvement in OSA in 86% of children who had worsening after GH initiation. Conclusion Worsening OSA after GH initiation is seen in 38% of patients with PWS. Laryngomalacia is a common comorbid condition and more frequent in those with worsening OSA after GH initiation that is amenable to targeted surgical intervention. Support (if any):

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Titration of the intra-oral negative air pressure in treating the patient with obstructive sleep apnea

10.1183/13993003.congress-2020.2145 ◽

2020 ◽

Author(s):

Chia-Chi Chen ◽

Chen Lin ◽

Chia-Mo Lin

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Air Pressure ◽

Obstructive Sleep

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SURGICAL AND NON-SURGICAL THERAPY OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN CHILDREN

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2015.78 ◽

2014 ◽

Vol 57 (4) ◽

pp. 135-141 ◽

Cited By ~ 7

Author(s):

Anna Šujanská ◽

Peter Ďurdík ◽

Jole Rabasco ◽

Ottavio Vitelli ◽

Nicoletta Pietropaoli ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Surgical Intervention ◽

Sleep Apnea Syndrome ◽

Lifestyle Changes ◽

Promising Alternative ◽

Tonsillar Hyperplasia ◽

Obstructive Sleep ◽

Apnea Syndrome

Interventions of paediatric obstructive sleep apnea syndrome are complex, varied and multidisciplinary. The goal of the treatment is to restore optimal breathing during the night and to relieve associated symptoms. Evidence suggests that the surgical intervention with removal of the tonsils and adenoids will lead to significant improvements in the most incomplicated cases, as recently reported from a meta-analysis. However, post-operative persistence of this syndrome in paediatric population is more frequent than expected, which supports the idea of the complexity of this syndrome. Adenotomy alone may not be sufficient in children with OSAS, because it does not address oropharyngeal obstruction secondary to tonsillar hyperplasia. Continuous positive airway pressure can effectively treat this syndrome in selected groups of children, improving both nocturnal and daytime symptoms, but poor adherence is a limiting factor. For this reason, CPAP is not recommended as first-line therapy for OSAS when adenotonsillectomy is an option. It is now being investigated the incorporation of nonsurgical approaches for milder forms and for residual OSAS after surgical intervention. Althought adenotonsillar hypertrophy is the most common for OSAS in children; obesity is emerging as an equally important etiological factor. Therefore an intensive weight reduction program and adequate sleep hygiene are also important lifestyle changes that may be very effective in mitigating the symptoms of this syndrome. Pharmacological therapy (leukotriene antagonists, topical nasal steroids) is usually use for mild forms of OSAS and in children with associated allergic diseases. Special orthodontic treatment and oropharyngeal exercises are a relatively new and promising alternative therapeutic modality used in selected groups of children with OSAS.

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