scholarly journals Review article on sleep apnea

2021 ◽  
pp. 18-24
Author(s):  
Simhavalli.Godavarthi ◽  
B. Pravallika ◽  
B. Tushara ◽  
L. Krishnapriya
Keyword(s):  
Sleep Apnea ◽  
Upper Airway ◽  
The Body ◽  
Apnea Hypopnea Index ◽  
Quality Of Sleep ◽  
Blood Oxygen Saturation ◽  
Normal Breathing ◽  
Obstructive Sleep ◽  
The Brain

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that involves a reduces or complete halt in airflow despite an ongoing effort to breathe. It occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway. This results in partial reductions (hypopneas) and complete block (apneas) in breathing that lasts a minimum of 10 seconds during sleep. Most pauses last between 10 and 30 seconds, but some may persist for one minute or longer. This can cause abrupt reductions in blood oxygen saturation. The brain responds to the lack of oxygen by alerting the body, causing a brief arousal from sleep that restores normal breathing. This pattern can occur many times in one night. The result is a fragmented quality of sleep that often produces an excessive level of daytime sleepiness. Most people with OSA snore loudly and regullarly, with periods of silence when airflow is reduced or blocked. They then make choking, snorting or gasping sounds when their airway reopens. A common measurement of sleep apnea is the apnea-hypopnea index (AHI).

scholarly journals Tongue Function: An Underrecognized Component in the Treatment of Obstructive Sleep Apnea with Mandibular Repositioning Appliance

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Wei Wang ◽  
Changping Di ◽  
Skaff Mona ◽  
Lin Wang ◽  
Mark Hans
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Hypoglossal Nucleus ◽  
Quality Of Sleep ◽  
Obstructive Sleep ◽  
Function Recovery ◽  
Mandibular Repositioning Appliance ◽  
Oropharyngeal Exercises

Obstructive sleep apnea (OSA) is a common but still underrecognized disorder. A mandibular repositioning appliance (MRA) is used to treat OSA by advancing the mandible and thereby reducing the collapsibility of the upper airway. It has been found that an MRA increases the volume of the upper airway, especially the velopharyngeal area, in OSA patients. We hypothesize that this increase in the velopharyngeal volume is associated with an anterior displacement of the tongue, but likely not with a stretching of the soft tissue connecting the soft palate, lateral pharynx, palatopharyngeal arch, and mandible. Since the function and structure of the genioglossus and hypoglossal nerve are always abnormal in patients with OSA, the tongue does not always move simultaneously with the mandible when an MRA is being used. Oropharyngeal exercises, especially tongue exercises, can improve the quality of life of OSA patients, including reduction of daytime sleepiness and snoring, better quality of sleep, and partial decrease in the AHI. Further, in animal models, tongue exercise is also found to be effective in tongue function recovery and in the remodeling of the hypoglossal nucleus. We suggest that a combination of tongue exercises along with MRA is a promising approach for patients who do not respond to an MRA alone.

Glottic and cervical tracheal narrowing in patients with obstructive sleep apnea

1989 ◽  
Vol 67 (6) ◽  
pp. 2427-2431 ◽  
Author(s):  
I. Rubinstein ◽  
T. D. Bradley ◽  
N. Zamel ◽  
V. Hoffstein
Keyword(s):  
Body Mass Index ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Body Mass ◽  
Upper Airway ◽  
The Body ◽  
Apnea Hypopnea Index ◽  
Structural Abnormality ◽  
Pathophysiological Mechanism ◽  
Obstructive Sleep

There are several studies showing that patients with idiopathic obstructive sleep apnea (OSA) have a narrow and collapsible pharynx that may predispose them to repeated upper airway occlusions during sleep. We hypothesized that this structural abnormality may also extend to the glottic and tracheal region. Consequently, we measured pharyngeal (Aph), glottic (Agl), cervical tracheal (Atr1), midtracheal (Atr2), and distal (Atr3) tracheal areas during tidal breathing in 66 patients with OSA (16 nonobese and 50 obese) and 8 nonapneic controls. We found that Aph, Agl, and Atr1, but not Atr2 or Atr3, were significantly smaller in the OSA group than in the control group. Obese patients with OSA had the smallest upper airway area, although the nonapneic controls had the largest areas. Multiple linear regression analysis revealed that the pharyngeal area, cervical tracheal area, and body mass index were all independent determinants of the apnea-hypopnea index, accounting for 31% of the variability in apnea-hypopnea index. Aph, Agl, and Atr showed significant correlation with the body mass index. We conclude that sleep-disordered breathing is associated with diffuse upper airway narrowing and that obesity contributes to this narrowing. Furthermore, we speculate that a common pathophysiological mechanism may be responsible for this reduction in upper airway area extending from the pharynx to the proximal trachea.

Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽  
2021 ◽  
pp. 1-8
Author(s):  
Lifeng Li ◽  
Demin Han ◽  
Hongrui Zang ◽  
Nyall R. London
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Nasal Surgery ◽  
Subjective Sleep Quality ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

<b><i>Objective:</i></b> The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. <b><i>Methods:</i></b> Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. <b><i>Results:</i></b> By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (<i>p</i> &#x3c; 0.05), while the Apnea-Hypopnea Index (AHI) changed little (<i>p</i> = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all <i>p</i> &#x3c; 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (<i>p</i> &#x3c; 0.05), except with the AHI (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

Predicting critical closing pressure in children with obstructive sleep apnea using fluid structure interaction simulations

2021 ◽  
Author(s):  
Goutham Mylavarapu ◽  
Ephraim Gutmark ◽  
Sally Shott ◽  
Robert J. Fleck ◽  
Mohamed Mahmoud ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Dynamic Mri ◽  
Patient Specific ◽  
Apnea Hypopnea Index ◽  
Structure Interaction ◽  
Obstructive Sleep ◽  
Mri Scans ◽  
Closing Pressure

Surgical treatment of obstructive sleep apnea (OSA) in children requires knowledge of upper airway dynamics, including the closing pressure (Pcrit), a measure of airway collapsibility. We applied a Flow-Structure Interaction (FSI) computational model to estimate Pcrit in patient-specific upper airway models obtained from magnetic resonance imaging (MRI) scans. We sought to examine the agreement between measured and estimated Pcrit from FSI models in children with Down syndrome. We hypothesized that the estimated Pcrit would accurately reflect measured Pcrit during sleep and therefore reflect the severity of OSA as measured by the obstructive apnea hypopnea index (AHI). All participants (n=41) underwent polysomnography and sedated sleep MRI scans. We used Bland Altman Plots to examine the agreement between measured and estimated Pcrit. We determined associations between estimated Pcrit and OSA severity, as measured by AHI, using regression models. The agreement between passive and estimated Pcrit showed a fixed bias of -1.31 (CI=-2.78, 0.15) and a non-significant proportional bias. A weaker agreement with active Pcrit was observed. A model including AHI, gender, an interaction term for AHI and gender and neck circumference explained the largest variation (R2 = 0.61) in the relationship between AHI and estimated Pcrit. (P <0.0001). Overlap between the areas of the airway with lowest stiffness, and areas of collapse on dynamic MRI, was 77.4%±30% for the nasopharyngeal region and 78.6%±33% for the retroglossal region. The agreement between measured and estimated Pcrit and the significant association with AHI supports the validity of Pcrit estimates from the FSI model.

Cardiac arrhythmias and conduction disturbances in the obstructive sleep apnea syndrome

2018 ◽  
Vol 2 (47) ◽  
pp. 10-15
Author(s):  
Danuta Łoboda ◽  
Karolina Simionescu ◽  
Anna Szajerska-Kurasiewicz ◽  
Dorota Lasyk ◽  
Grzegorz Jarosiński ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiac Arrhythmias ◽  
Sleep Apnea Syndrome ◽  
The Body ◽  
Apnea Hypopnea Index ◽  
Premature Ventricular Contractions ◽  
Mortality And Morbidity ◽  
Conduction Disturbances ◽  
Obstructive Sleep

Cardiac arrhythmias during sleep are reported in almost half of the population suffering from obstructive sleep apnea (OSA). The most common are bradyarrhythmias and atrial fibrillation whereas premature ventricular contractions and nonsustained ventricular tachycardia are less frequent. The risk of arrhythmia is proportional to the body mass index (BMI), number of respiratory events per hour of sleep described with apnea/hypopnea index (AHI) and the level of oxygen desaturation during these episodes. Continuous positive airway pressure (CPAP) treatment in OSA reduces the incidence of cardiac arrhythmias therefore reduce mortality and morbidity from cardiovascular disease.

Voice Disorders in Obstructive Sleep Apnea: Prevalence, Risk Factors, and the Role of CPAP

2018 ◽  
Vol 128 (3) ◽  
pp. 249-262 ◽  
Author(s):  
Nelson Roy ◽  
Ray M. Merrill ◽  
Jenny Pierce ◽  
Krishna M. Sundar
Keyword(s):  
Quality Of Life ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Voice Disorders ◽  
Acid Reflux ◽  
Voice Disorder ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
A Current

Objective: Obstructive sleep apnea (OSA) is characterized by frequent interruptions in breathing related to upper airway collapse during sleep and may adversely affect phonatory function. This study aimed to: (1) establish the prevalence, risks, and quality of life burden of voice disorders in OSA and (2) explore the relation between voice disorders and positive airway pressure (PAP) therapy. Study Design: Cross-sectional, descriptive epidemiology study. Methods: Analyses were based on 94 individuals with OSA (53 men, 41 women; mean age = 54.7 ± 12.8 years) who completed a telephone interview. Results: Twenty-eight percent of participants reported having a current voice disorder. Of those with a current voice disorder, 83% had experienced symptoms for at least a year, and 58% had symptoms for at least 4 years. The prevalence of a current voice disorder was greater in women than men (44% vs 15%, P = .0020) but did not vary significantly across different age groups, body mass index (BMI), apnea/hypopnea index (AHI) severity, or medical history. After adjusting for sex, consistent use of PAP therapy (with humidification) was associated with (1) lower occurrence of voice disorders in women (Mantel-Haenszel [MH] χ2 P = .0195), (2) reduced snoring severity accompanied by fewer voice disorders in men (MH χ2 P = .0101), and (3) fewer reports of acid reflux as a possible trigger for voice problems (MH χ2 P = .0226). Patients with OSA who also had a current voice disorder experienced lower overall quality of life compared to those without. Conclusions: Chronic, longstanding voice disorders are common in women with OSA and produce significant adverse effects on quality of life. Nightly PAP use (with humidification) was associated with fewer voice symptoms and reduced severity of snoring and acid reflux as possible contributors. Further research is necessary to better understand the origin of these voice disorders in OSA and their potential response to treatment.

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.

scholarly journals Speech Signal and Facial Image Processing for Obstructive Sleep Apnea Assessment

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Fernando Espinoza-Cuadros ◽  
Rubén Fernández-Pozo ◽  
Doroteo T. Toledano ◽  
José D. Alcázar-Ramírez ◽  
Eduardo López-Gonzalo ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Speech Processing ◽  
Upper Airway ◽  
Support Vector ◽  
Apnea Hypopnea Index ◽  
Active Appearance Models ◽  
Obstructive Sleep ◽  
Craniofacial Features ◽  
Low Dimensional

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by recurring breathing pauses during sleep caused by a blockage of the upper airway (UA). OSA is generally diagnosed through a costly procedure requiring an overnight stay of the patient at the hospital. This has led to proposing less costly procedures based on the analysis of patients’ facial images and voice recordings to help in OSA detection and severity assessment. In this paper we investigate the use of both image and speech processing to estimate the apnea-hypopnea index, AHI (which describes the severity of the condition), over a population of 285 male Spanish subjects suspected to suffer from OSA and referred to a Sleep Disorders Unit. Photographs and voice recordings were collected in a supervised but not highly controlled way trying to test a scenario close to an OSA assessment application running on a mobile device (i.e., smartphones or tablets). Spectral information in speech utterances is modeled by a state-of-the-art low-dimensional acoustic representation, called i-vector. A set of local craniofacial features related to OSA are extracted from images after detecting facial landmarks using Active Appearance Models (AAMs). Support vector regression (SVR) is applied on facial features and i-vectors to estimate the AHI.

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