Increased Behavioral Problems in Children with Sleep-Disordered Breathing

Introduction: Healthy sleep is essential for children’s cognitive, behavioral, and emotional development. Therefore, this study was aimed to assess the behavioral consequences of sleep disturbances examining children with sleep-disordered breathing compared to control participants. Methods: 78 children with SDB (average age: 6.7 years (SD = 1.83); 61 had OSA and 17 had primary snoring) and 156 control subjects (average age: 6.57 years (SD = 1.46) participated in the study. We matched the groups in age (t(232) = 0.578, p = 0.564) and gender (χ2(1) = 2.192, p = 0.139). In the SDB group, the average Apnea-Hypopnea Index was 3.44 event/h (SD = 4.00), the average desaturation level was 87.3 % (SD = 6.91). Parent-report rating scales were used to measure the children’s daytime behavior including Attention Deficit Hyperactivity Disorder Rating Scale, Strengths and Difficulties Questionnaire, and Child Behavior Checklist. Results: Our results showed that children with SDB exhibited a higher level of inattentiveness and hyperactive behavior. Furthermore, the SDB group demonstrated more internalizing (anxiety, depression, somatic complaints, social problems) (p < 0.001) and externalizing (aggressive and rule-breaking behavior) problems compare to children without SDB, irrespective of severity. Conclusion: Based on our findings we supposed that even snoring and mild OSA had a risk for developing behavioral and emotional dysfunctions as much as moderate-severe OSA. Therefore, clinical research and practice need to focus more on the accurate assessment and treatment of sleep disturbances in childhood, particularly primary snoring, and mild obstructive sleep apnea.

H3K23/H3K36 hypoacetylation and HDAC1 up-regulation are associated with adverse consequences in obstructive sleep apnea patients

The aim of this study is to determine the roles of global histone acetylation (Ac)/methylation (me), their modifying enzymes, and gene-specific histone enrichment in obstructive sleep apnea (OSA). Global histone modifications, and their modifying enzyme expressions were assessed in peripheral blood mononuclear cells from 56 patients with OSA and 16 matched subjects with primary snoring (PS). HIF-1α gene promoter-specific H3K36Ac enrichment was assessed in another cohort (28 OSA, 8 PS). Both global histone H3K23Ac and H3K36Ac expressions were decreased in OSA patients versus PS subjects. H3K23Ac expressions were further decreased in OSA patients with prevalent hypertension. HDAC1 expressions were higher in OSA patients, especially in those with excessive daytime sleepiness, and reduced after more than 6 months of continuous positive airway pressure treatment. H3K79me3 expression was increased in those with high C-reactive protein levels. Decreased KDM6B protein expressions were noted in those with a high hypoxic load, and associated with a higher risk for incident cardiovascular events or hypertension. HIF-1α gene promoter-specific H3K36Ac enrichment was decreased in OSA patients versus PS subjects. In vitro intermittent hypoxia with re-oxygenation stimuli resulted in HDAC1 over-expression and HIF-1α gene promoter-specific H3K36Ac under-expression, while HDAC1 inhibitor, SAHA, reversed oxidative stress through inhibiting NOX1. In conclusions, H3K23/H3K36 hypoacetylation is associated with the development of hypertension and disease severity in sleep-disordered breathing patients, probably through up-regulation of HDAC1, while H3K79 hypermethylation is associated with higher risk of cardiovascular diseases, probably through down-regulation of KDM6B.

P134 Modified uvulopalatopharyngoplasty and radiofrequency-in-saline tongue in the management of snoring

Objective The modified uvulopalatopharyngoplasty has not been investigated as an option in primary snoring. The aim of this study was to determine whether combined palatal and tongue surgery to enlarge and stabilize the upper airway is an effective treatment for patients with primary snoring who cannot tolerate or decline device therapy. Study design This was a retrospective cohort study, and included adult patients with primary snoring who underwent modified uvulopalatopharyngoplasty and radiofrequency-in-saline tongue between January 2009 and December 2020. Patients with clinically significant obstructive sleep apnoea were excluded. Setting Single centre study, based in New South Wales, Australia. Methods Primary outcome measures were the Snoring Severity Scale (a questionnaire, which indicates loudness and frequency of snoring) completed both prior to and following surgery, and the Epworth Sleepiness Scale. Mean questionnaire scores prior to and at three-month follow-up were analysed. Results 97 adult patients underwent upper airway surgery for simple snoring, of which 68 were included in the present study (37.3 ± 11.5 years, n=17 female). The mean SSS prior to surgery was 7.0 ± 1.6 and 1.9 ± 2.3 at 3-month follow up (P &lt; 0.0001).The mean ESS prior to surgery was 9.0 ± 4.8 and 4.1 ± 2.8 at 3-month follow up (P &lt;0.0001). Conclusion The results of this study indicate that modified uvulopalatopharyngoplasty with radiofrequency-in-saline tongue is an effective treatment modality with a low complication rate. This procedure should be offered to carefully selected patients with primary snoring who have failed or declined device therapy.

Uvulopalatopharyngoplasty for nasal blockage 21 years after total rhinectomy

BackgroundTotal rhinectomy is an invasive procedure that significantly impairs the intranasal turbulence, humidification and heating of inspired air. The use of uvulopalatopharyngoplasty for the treatment of sleep-disordered breathing disorders such as primary snoring and obstructive sleep apnoea has diminished over the past years because of the emergence of less invasive procedures and alternative therapeutic options. This clinical record presents the treatment of a long-term side effect of total rhinectomy using uvulopalatopharyngoplasty.Case reportIn 1997, a 62-year-old male underwent total rhinectomy for a nasal schwannoma, followed by rehabilitation with a nasal prosthesis. Twenty-one years later, he presented with severe complaints of nasal blockage and breathing difficulties during both daytime and night-time. Clinical examination revealed no major anomalies besides significant velopharyngeal narrowing. Thus, in 2019, uvulopalatopharyngoplasty was performed to re-establish velopharyngeal patency. Hereafter, the symptoms of nasal blockage disappeared, resulting in an improved quality of life.ConclusionUvulopalatopharyngoplasty may prove useful to treat selected patients with daytime breathing difficulties due to velopharyngeal narrowing.

450 Cellular Energy Monitoring for Diagnosis and Management of Therapy for Sleep Disordered Breathing

Introduction Polysomnogram (PSG) monitoring, including pulse oximetry, is the current diagnostic standard in sleep medicine. However, potentially confounding aspects of PSG testing include: test site other than the subject’s normal bed, distracting sensors and wires, subjective interpretation of complex recorded signals, and limited sensitivity to relevant phenomena. There is currently an unmet need for a sleep test that is more clinically effective than PSG, and that can be administered in the subject’s normal sleeping environment. Additionally, confirmation that home therapy has been optimized cannot be achieved by PSG titration. Methods A recent proof of concept (POC) study of the armband-wearable Reveal Cellular Energy Monitor (CE monitor) directly compared its data product, Cellular Energy Index (CEi), with PSG data. Scoring methods were adapted from AASM guidance for interpretation of PSG data. At-home recording with the CE monitor was also performed prior to and following PSG studies. At-home incremental adjustment of APAP settings and mask selection was documented with CE monitoring and compared with the information recorded by the home APAP machine. Results The comparison of the POC data consistently found the CE monitor to be more sensitive and responsive to hypoxic stress than the PSG pulse oximeter during primary snoring. Obstructive and central apnea events were detected by both, but the CE monitor provided finer resolution of the breath-by-breath effort of breathing compared with PSG RIP and nasal sensors. At-home CE monitor optimization of therapy was documented to often differ from the settings and mask selection determined by PSG titration, and resulted in ‘normal’ sleep breathing data. Conclusion All diagnostically-relevant physiologic responses detected by PSG were also detected by the CE monitor. Evidence of cellular hypoxia in the skin, by CE monitor, was consistently recorded during prolonged periods of ‘primary snoring;’ i.e., SpO2 is less sensitive to hypoxic stress during sleep than CEi. Breath-by-breath effort is detected by the CE monitor. Support (if any) The POC study costs at UCSF were paid by Reveal Biosensors, Inc.

Daytime Neuromuscular Electrical Therapy of Tongue Muscles in Improving Snoring in Individuals with Primary Snoring and Mild Obstructive Sleep Apnea

Study Objectives: Evaluating daytime neuromuscular electrical training (NMES) of tongue muscles in individuals with Primary Snoring and Mild Obstructive Sleep Apnea (OSA). Methods: A multicenter prospective study was undertaken in patients with primary snoring and mild sleep apnea where daytime NMES (eXciteOSA® Signifier Medical Technologies Ltd, London W6 0LG, UK) was used for 20 min once daily for 6 weeks. Change in percentage time spent snoring was analyzed using a two-night sleep study before and after therapy. Participants and their bed partners completed sleep quality questionnaires: Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI), and the bed partners reported on the nighttime snoring using a Visual Analogue Scale (VAS). Results: Of 125 patients recruited, 115 patients completed the trial. Ninety percent of the study population had some reduction in objective snoring with the mean reduction in the study population of 41% (p < 0.001). Bed partner-reported snoring reduced significantly by 39% (p < 0.001). ESS and total PSQI scores reduced significantly (p < 0.001) as well as bed partner PSQI (p = 0.017). No serious adverse events were reported. Conclusions: Daytime NMES (eXciteOSA®) is demonstrated to be effective at reducing objective and subjective snoring. It is associated with effective improvement in patient and bed partner sleep quality and patient daytime somnolence. Both objective and subjective measures demonstrated a consistent improvement. Daytime NMES was well tolerated and had minimal transient side effects.