Effect of adenotonsillectomy in children with obstructive sleep apnea and major psychiatric disorders on obstructive apnea-hypopnea index and Epworth Sleepiness Scale scores

Objective.This study examined the association between obstructive sleep apnea (OSA), daytime sleepiness, functional activity, and objective physical activity.Setting.Subjects (N=37) being evaluated for OSA were recruited from a sleep clinic.Participants. The sample was balanced by gender (53% male), middle-aged, primarily White, and overweight or obese with a mean BMI of 33.98 (SD=7.35;median BMI=32.30). Over 40% reported subjective sleepiness (Epworth Sleepiness Scale (ESS) ≥10) and had OSA (78% with apnea + hypopnea index (AHI) ≥5/hr).Measurements.Evaluation included questionnaires to evaluate subjective sleepiness (Epworth Sleepiness Scale (ESS)) and functional outcomes (Functional Outcomes of Sleep Questionnaire (FOSQ)), an activity monitor, and an overnight sleep study to determine OSA severity.Results.Increased subjective sleepiness was significantly associated with lower scores on the FOSQ but not with average number of steps walked per day. A multiple regression analysis showed that higher AHI values were significantly associated with lower average number of steps walked per day after controlling patient's age, sex, and ESS.Conclusion.Subjective sleepiness was associated with perceived difficulty in activity but not with objectively measured activity. However, OSA severity was associated with decreased objective physical activity in aging adults.

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Assessment of Screening for Nasal Obstruction among Sleep Dentistry Outpatients with Obstructive Sleep Apnea

Dentistry Journal ◽

10.3390/dj8040119 ◽

2020 ◽

Vol 8 (4) ◽

pp. 119

Author(s):

Arisa Sawa ◽

Hiroshi Suzuki ◽

Hideo Niwa ◽

Sumito Oguchi ◽

Tatsuo Yagi ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Obstruction ◽

Standard Technique ◽

Apnea Hypopnea Index ◽

Nasal Airflow ◽

Nose Scale ◽

Symptom Evaluation ◽

Obstructive Sleep ◽

Scale Scores

Oral appliances (OA), a common treatment modality for obstructive sleep apnea (OSA), are not suitable for patients with nasal obstruction. Rhinomanometry, the gold standard technique to assess nasal airway resistance, is not readily available in sleep dentistry clinics. We demonstrate the use of a portable lightweight peak nasal inspiratory flow (PNIF) rate meter to objectively assess nasal airflow and utilized the Nasal Obstruction Symptom Evaluation (NOSE) scale to subjectively assess nasal obstruction in 97 patients with OSA and 105 healthy controls. We examined the correlations between the following variables between the groups: demographics, body mass index, PNIF, NOSE scale scores, apnea–hypopnea index (AHI), minimum SpO2 (SpO2min), Mallampati classification, and Epworth Sleepiness Scale (ESS) scores. Patients with OSA had significantly lower PNIF values and higher NOSE scores than controls. In the patient group, PNIF was not significantly correlated with AHI, SpO2min, Mallampati classification, or NOSE or ESS scores. Lower PNIF values and higher NOSE scores suggested impaired nasal airflow in the OSA group. As daytime PNIF measurement bears no relationship to AHI, this cannot be used alone in predicting the suitability of treatment for OSA with OA but can be used as an adjunct for making clinical decisions.

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Polysomnographic Outcomes After Observation for Mild Obstructive Sleep Apnea in Children Younger Than 3 Years

Otolaryngology ◽

10.1177/0194599820954383 ◽

2020 ◽

pp. 019459982095438

Author(s):

Kathleen M. Sarber ◽

Douglas C. von Allmen ◽

Raisa Tikhtman ◽

Javier Howard ◽

Narong Simakajornboon ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Care Center ◽

Tertiary Care ◽

Apnea Hypopnea Index ◽

Optimal Timing ◽

Obstructive Apnea ◽

Obstructive Sleep ◽

Mild Obstructive Sleep Apnea ◽

The Impact

Objective Mild obstructive sleep apnea (OSA), particularly in young children, is often treated with observation. However, there is little evidence regarding the outcomes with this approach. Our aim was to assess the impact of observation on sleep for children aged <3 years with mild OSA. Study Design Case-control study. Setting Pediatric tertiary care center. Methods We reviewed cases of children (<3 years old) diagnosed with mild OSA (obstructive apnea-hypopnea index, 1-5 events/h) who were treated with observation between 2012 and 2017 and had at least 2 polysomnograms performed 3 to 12 months apart. Demographic data and comorbid diagnoses were collected. Results Twenty-six children met inclusion criteria; their median age was 7.2 months (95% CI, 1.2-22.8). Nine (35%) were female and 24 (92%) were White. Their median body mass index percentile was 39 (95% CI, 1-76). Comorbidities included cardiac disease (42.3%), laryngomalacia (42.3%), allergies (34.6%), reactive airway disease (23.1%), and prematurity (7.7%). The obstructive apnea-hypopnea index significantly decreased from 2.7 events/h (95% CI, 1-4.5) to 1.3 (95% CI, 0-4.5; P = .013). There was no significant improvement in median saturation nadir (baseline, 86%; P = .76) or median time with end-tidal carbon dioxide >50 mm Hg (baseline, 0 minutes; P = .34). OSA resolved in 8 patients (31%) and worsened in 1 (3.8%). Only race was a significant predictor of resolution per regression analysis; however, only 2 non-White children were included. Conclusion In our cohort, resolution of mild OSA occurred in 31% of patients treated with 3 to 12 months of observation. The presence of laryngomalacia, asthma, and allergies did not affect resolution. Larger studies are needed to better identify factors (including race) associated with persistent OSA and optimal timing of intervention for these children. Level of Evidence 4.

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The utility of patient-completed and partner-completed Epworth Sleepiness Scale scores in the evaluation of obstructive sleep apnea

Sleep And Breathing ◽

10.1007/s11325-016-1370-8 ◽

2016 ◽

Vol 20 (4) ◽

pp. 1347-1354 ◽

Cited By ~ 6

Author(s):

Sushanth Bhat ◽

Hinesh Upadhyay ◽

Vincent A DeBari ◽

Muhammad Ahmad ◽

Peter G Polos ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Epworth Sleepiness Scale ◽

Obstructive Sleep ◽

Scale Scores

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Comparison of Predictor of Desaturation Disorders and Daytime Sleepiness Based On Epworth Sleepiness Scale and STOP-BANG Questionnaires in Mild to Moderate Obstructive Sleep Apnea Patients

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.258 ◽

2018 ◽

Vol 6 (9) ◽

pp. 1617-1621 ◽

Cited By ~ 1

Author(s):

Zohreh Kahramfar ◽

Besharat Rahimi

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Epworth Sleepiness Scale ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Predictive Values ◽

Desaturation Index ◽

Obstructive Sleep ◽

Significant Difference ◽

Severity Of The Disease

BACKGROUND: Obstructive sleep apnea (OSA) is characterised by recurrence in upper airway obstruction during sleep. AIM: This study aimed to compare the predictive values of the Epworth Sleepiness Scale (ESS) and STOP-BANG in the desaturation of patients with mild to moderate obstructive apnea based on the apnea-hypopnea index (AHI) scale. METHODS: A group of 79 patients (43 male and 36 female) were selected. The suspected patients were introduced to the sleep clinic, and the ESS and STOP-BANG questionnaires were filled up, then subjected to polysomnography test, and the scores of the disease were also determined based on an apnoea-hypopnoea index (AHI). Finally, the desaturation rate (SO2 < 3% based on the baseline) and desaturation index were determined in patients. Consequently, the finding was compared with the results of the questionnaires. RESULTS: Patients with STOP-BANG score above 3 had significantly higher weight, oxygen desaturation index (ODI) index and average desatu, while peripheral capillary oxygen saturation (SpO2) base and average SpO2 were lower than those with scores below 3 (P < 0.05). However, there was no significant difference between the patients with the ESS questionnaire score above 10 and below 10 (P > 0.05). CONCLUSION: The results of these two questionnaires reflect the unsaturated oxygen index in the blood, and can be considered for the evaluation of the severity of the disease.

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S248 – Supraglottoplasty for Laryngomalacia with Sleep Apnea

Otolaryngology ◽

10.1016/j.otohns.2008.05.423 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P158-P158

Author(s):

Mark E Zafereo ◽

Rodney J Taylor ◽

Kevin D Pereira

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Apnea Hypopnea Index ◽

Obstructive Apnea ◽

Respiratory Parameters ◽

Obstructive Sleep ◽

Respiratory Disturbance ◽

Student’S T

Objectives To determine if supraglottoplasty is effective in reversing abnormal respiratory parameters in children with laryngomalacia and obstructive sleep apnea. Methods 10 patients with laryngomalacia and obstructive sleep apnea as documented by polysomnography underwent supraglottoplasty at a tertiary referral children's hospital between 2005 and 2007. Retrospective data collection included age, findings on flexible and rigid endoscopy, type of procedure performed, and postoperative course. The postoperative polysomnographies were reviewed to identify changes in obstructive apnea index (OAI), obstructive apnea/hypopnea index (OAHI), respiratory disturbance index (RDI), and low arterial oxygen saturation (O2 nadir) after supraglottoplasty. Pre- and postoperative mean data were calculated, and comparisons were made with a Student's T-test. Results All 10 patients were successfully extubated following supraglottoplasty. There were no perioperative or postoperative complications, and no patient required a subsequent airway procedure. Each patient had a postoperative nocturnal polysomnography performed following supraglottoplasty at 11 weeks (range 2–29 weeks). Caregivers reported mild improvement (10%), significant improvement (70%), and complete resolution (20%) of stridor and nocturnal snoring at a follow-up visit 4 weeks after hospital discharge. Marked improvements were observed in OAI, OAHI, RDI and O2 nadir, all of which were statistically significant (p<0.05). Conclusions Polysomnography should be included in the initial evaluation of infants with laryngomalacia to rule out obstructive sleep apnea. Supraglottoplasty is an effective treatment for infants with laryngomalacia and obstructive sleep apnea. The significant benefits of the procedure outweigh the low morbidity. Improvement after surgery can be reliably confirmed by polysomnography.

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Comparison of Anterior Palatoplasty and Uvulopalatal Flap Placement for Treating Mild and Moderate Obstructive Sleep Apnea

Ear Nose & Throat Journal ◽

10.1177/014556131809700308 ◽

2018 ◽

Vol 97 (3) ◽

pp. 69-78 ◽

Cited By ~ 2

Author(s):

Süheyl Haytoğlu ◽

Osman Kürşat Arikan ◽

Nuray Bayar Muluk ◽

Birgül Tuhanioğlu ◽

Mustafa Çörtük

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Apnea Syndrome ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Flap Procedure ◽

Scale Scores ◽

Vas Scores ◽

The Difference ◽

Anterior Palatoplasty

We prospectively compared the efficacy of anterior palatoplasty and the uvulopalatal flap procedure for the treatment of patients with mild and moderate obstructive sleep apnea syndrome (OSAS). Our study group was made up of 45 patients who had been randomly assigned to undergo one of the two procedures. Palatoplasty was performed on 22 patients—12 men and 10 women, aged 28 to 49 years (mean: 39.2)—and the flap procedure was performed on 23 patients—14 men and 9 women, aged 28 to 56 years (mean: 41.3). Our primary outcomes measure was the difference in pre- and postoperative apnea-hypopnea index (AHI) as determined by polysomnography at 6 months after surgery. Surgical success was observed in 18 of the 22 palatoplasty patients (81.8%) and in 19 of the 23 flap patients (82.6%). Compared with the preoperative values, mean AHIs declined from 17.5 to 8.1 in the former group and from 18.5 to 8.6 in the latter; the improvement in both groups was statistically significant (p < 0.001). In addition, significant postoperative improvements in both groups were seen in mean visual analog scale (VAS) scores for snoring, in Pittsburgh Sleep Quality Index values, and in Epworth Sleepiness Scale scores (p < 0.001 for all). VAS scores for pain at rest were significantly lower in the palatoplasty group than in the flap group at 2, 4, and 8 hours postoperatively and on postoperative days 4 through 7 (p < 0.002). Likewise, VAS scores for pain during swallowing were significantly lower in the palatoplasty group at 2, 4, 8, and 16 hours and on days 4 through 7 (p < 0.009). We conclude that both anterior palatoplasty and uvulopalatal flap procedures are effective for the treatment of mild and moderate OSAS in patients with retropalatal obstruction. However, our comparison of postoperative pain scores revealed that anterior palatoplasty was associated with significantly less morbidity.

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The Role of Weight Management as First-line Treatment Modality in Obstructive Sleep Apnea of Obese Patients

Eurasian Journal of Family Medicine ◽

10.33880/ejfm.2020090206 ◽

2020 ◽

Vol 9 (2) ◽

pp. 103-108

Author(s):

Duygu Ayhan Baser ◽

Serdar Baser ◽

Adin Selcuk

Keyword(s):

Weight Loss ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Epworth Sleepiness Scale ◽

Obese Patients ◽

Obstructive Sleep ◽

Diet And Exercise ◽

Scale Scores ◽

Questionnaire Form ◽

Body Mass Indexes

Aim: Weight loss has been shown to improve obstructive sleep apnea and is considered the first choice of treatment. The aim of this study is to evaluate the weight-management strategies and the relationship between the weight loss and obstructive sleep apnea on obese patients. Methods: A prospective study was applied on consecutive 50 patients with obstructive sleep apnea whose body mass indexes over 25. The first part of questionnaire form and the Epworth Sleepiness Scale scores was applied to patients by face to face interviews at first visit between November 2017 and May 2018. All of the patients who applied to the snoring policlinic were offered weight loss. The second part of questionnaire form and Epworth Sleepiness Scale scores was applied to patients after 3 months later and the weights 3 months after weight loss recommendation were also recorded. For the statistical analysis, SPSS 15.0 program was used. Results: All patients were offered to lose weight. 26% of them had only diet; 12% had only exercise and 12% had both diet and exercise. 50% of the patients did nothing to lose weight. 76.9% of the dieters; 100% of the exercisers and 83.3% of those who did diet and exercise, lost weight. There was a statistically significant difference between beginning and control (after 3 months) body mass indexes and Epworth Sleepiness Scale scores of the patients. Conclusion: When weight loss is considered as the patient's attempt, along with the pursuance and maintenance, its compliance is high. Although the number of sample in our study was not suitable for generalization, we confirmed that weight loss had a positive effect on obstructive sleep apnea. Keywords: sleep apnea syndromes, weight loss, obesity

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0900 Obstructive Sleep Apnea Severity, Symptoms Of Attention Deficit Hyperactivity Disorder And Other Comorbid Psychiatric Disorders In Children And Adolescents: A Retrospective Data Analysis

SLEEP ◽

10.1093/sleep/zsaa056.896 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A342-A343

Author(s):

M Skoulos ◽

K Sedky ◽

D Bennett

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Children And Adolescents ◽

Psychiatric Disorders ◽

Attention Deficit ◽

Apnea Hypopnea Index ◽

Comorbid Psychiatric Disorders ◽

Hyperactivity Disorder ◽

Obstructive Sleep

Abstract Introduction Children and adolescents with obstructive sleep apnea (OSA) are often diagnosed with attention deficit hyperactivity disorder (ADHD). However, the connection between the severity of Apnea/Hypopnea Index (AHI) and ADHD is controversial with research evidence pointing in opposing directions. Methods A retrospective study was conducted in a pediatric sleep center at a university hospital setting to investigate the effect between AHI severity, ADHD and/or other comorbid psychiatric disorders. One hundred and thirty-eight participants between the age of 6 and 18 were examined in terms of AHI severity level and their correlation with scores from the Child Behavior Checklist (CBCL) using SPSS program. Results A negative correlation between AHI scores and Attention Problems for the entire group of participants was found. Additionally, female adolescents had positive correlations between AHI scores and several affective disorder variables from the CBCL, while male adolescents had negative correlations between AHI levels and several CBCL scores that are typically associated with ADHD and Anxiety disorders. Conclusion This study suggests a relationship between OSA severity and psychiatric conditions. However, this relationship can vary depending on age, gender and AHI severity. More research is required to understand this relationship. Support Chervin, R.D. How many children with ADHD have sleep apnea or periodic leg movements on polysomnography? Sleep. 2005: 28(9): 1041-1042. Sedky K, Bennett DS, Carvalho KS. Attention deficit hyperactivity disorder and sleep disordered breathing in pediatric populations: A meta-analysis. Sleep Medicine Reviews. 2014; 18: 349-356

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620 Description of 14&6 variant on polysomnography

SLEEP ◽

10.1093/sleep/zsab072.618 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A243-A244

Author(s):

Weston Powell ◽

Jessica Nash ◽

Chris Ruth ◽

Jeremy Chan ◽

Carey Lockhart

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Retrospective Review ◽

Incidental Findings ◽

Developmental Disorders ◽

Clinical Findings ◽

Apnea Hypopnea Index ◽

Obstructive Apnea ◽

Obstructive Sleep ◽

Age And Sex

Abstract Introduction Benign variants or incidental findings are often identified on routine polysomnography. One such variant is 14-and-6 hertz positive spikes, first described on EEG in 1951; however, the significance of 14-and-6 positive spikes found on polysomnography has not been previously described. Methods We conducted a retrospective review of patients with 14-and-6 Hz spikes on polysomnography and compared clinical findings on polysomnography with age and sex-matched controls. Results Mean age was 8.6 years (range 2–16). Sleep indices did not differ between cases and controls. Patients with 14-and-6 Hz spikes had lower obstructive apnea-hypopnea index and were less likely to be diagnosed with obstructive sleep apnea. Patients with 14-and-6 Hz spikes did not differ from controls in frequency of formal neurology evaluation, whether a full EEG was obtained, or neurologic diagnoses. Patients with 14-and-6 Hz spikes were less likely to be diagnosed with behavioral or developmental disorders. Conclusion 14-and-6 Hz spikes can be seen in children of all ages and does not seem to be associated with any sleep, neurologic, or developmental disorders. Support (if any):

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