Estudio de prevalencia de Síndrome de Apneas - Hipopneas Obstructivas del Sueño en pacientes con obesidad

Introducción: La obesidad es una enfermedad epidémica multifactorial en constante aumento en los últimos años. Asocia el desarrollo de múltiples patologías con aumento de la morbimortalidad, entre ellas el síndrome de apneas e hipopneas obstructivas del sueño (SAHOS). Objetivo: Estudiar la prevalencia de SAHOS en una población de obesos pertenecientes a un Programa de Obesidad y Cirugía Bariátrica de un hospital público de Montevideo. Metodología: Estudio observacional descriptivo de cohorte transversal. Se incluyeron pacientes en valoración preoperatoria desde abril 2015 a marzo 2020. Se les realizó una polisomnografía. Se evaluó la prevalencia de SAHOS y la relación con otros factores de riesgo cardiovascular. El análisis estadístico se realizó con SPSS versión 25.0. Resultados: Se estudiaron 358 pacientes con predominio del sexo femenino (86,3%), edad media de 42,8 ± 10,7 años y un índice de masa corporal (IMC) promedio de 50,1 ± 11,4 kg/m2. Se evidenció una prevalencia de SAHOS de 69%: 43,3% leve; 23,9% moderada y 32,8% severo. El Índice apnea hipopnea (IAH) se correlacionó positivamente con IMC (p ≤ 0,001). Se demostró la asociación de SAHOS con hipertensión arterial (HTA), diabetes 2 (DM2), sexo masculino e hipertrigliceridemia. Conclusiones: El SAHOS es altamente prevalente en la obesidad. Este estudio sugiere la realización de un screening en todos los obesos, así como su estudio con polisomnografía o poligrafía respiratoria a aquellos que vayan a someterse a una cirugía bariátrica.

Introduction: Obesity is a multifactorial epidemic disease that has been constantly increasing in recent years. It associates the development of multiple pathologies with increased morbidity and mortality, including obstructive sleep apnea and hypopnea syndrome (OSAHS). Objective: To study the prevalence of OSAHS in a population of obese patients belonging to an Obesity and Bariatric Surgery Program of a public hospital in Montevideo. Methodology: Observational descriptive cross-sectional study. Patients in preoperative evaluation were included from April 2015 to March 2020. A polysomnography was performed. The prevalence of OSAHS and the relationship with other cardiovascular risk factors were evaluated. Statistical analysis was performed with SPSS version 25.0. Results: 358 patients were studied, predominantly female (86.3%), mean age of 42.8 ± 10.7 years and mean BMI of 50.1 ± 11.4 kg/m2. A prevalence of OSAHS of 69% was evidenced: 43.3% mild; 23.9% moderate and 32.8% severe. The Apnea Hypopnea Index (AHI) was positively correlated with the Body Mass Index (BMI) (p=<0.001). The association of OSAHS with arterial hypertension (AHT), diabetes 2 (DM2), male gender and hypertriglyceridemia was demonstrated. Conclusions: OSAHS is highly prevalent in obesity. This study suggests screening all obese people, as well as polysomnography or respiratory polygraphy for those who are going to undergo bariatric surgery.

Introdução: A obesidade é uma doença epidêmica multifatorial que vem aumentando constantemente nos últimos anos. Associa o desenvolvimento de múltiplas patologias ao aumento da morbimortalidade, incluindo a síndrome da apneia e hipopneia obstrutiva do sono (SAHOS). Objetivo: Estudar a prevalência de SAHOS em uma população de pacientes obesos pertencentes a um Programa de Obesidade e Cirurgia Bariátrica de um hospital público de Montevidéu. Metodologia: Estudo observacional descritivo transversal. Os pacientes em avaliação pré-operatória foram incluídos de abril de 2015 a março de 2020. Foi realizada polissonografia. A prevalência de SAHOS e a relação com outros fatores de risco cardiovascular foram avaliadas. A análise estatística foi realizada com SPSS versão 25.0. Resultados: Foram estudados 358 pacientes, predominantemente do sexo feminino (86,3%), idade média de 42,8 ± 10,7 anos e IMC médio de 50,1 ± 11,4 kg/m2. Evidenciou-se prevalência de SAHOS de 69%: 43,3% leve; 23,9% moderado e 32,8% grave. O Índice de Apnéia e Hipopnéia (IAH) correlacionou-se positivamente com o Índice de Massa Corporal (IMC) (p=<0,001). Foi demonstrada a associação da SAHOS com hipertensão arterial (HA), diabetes 2 (DM2), sexo masculino e hipertrigliceridemia. Conclusões: A SAHOS é altamente prevalente na obesidade. Este estudo sugere a triagem de todos os obesos, bem como a polissonografia ou poligrafia respiratória para aqueles que serão submetidos à cirurgia bariátrica.

A single-centre, observational, retrospective study to evaluate coexistence of cardiovascular comorbidities and obstructive sleep apnoea in South Indians using apnea link air home sleep testing device

Background:The aim of thestudy was to explore whether there is a relationship between Cardiovascular (CV) comorbidities and the prevalence and severity of Obstructive sleep apnea (OSA).Methods:Secondary data analysis of 146 patients with suspected sleep-disordered breathing was conducted who were presented to the department of medicine, KIMS Hospital, Hyderabad, from June 2021 to November 2021. Participants aged ?18 years were included in the analysis. Demographic details, clinical history, comorbidities, medication history, were analyzed. AHI score, ODI (Oxygen desaturation index) score and average O2saturation were recorded with the help of a home sleep testing device. Data were entered and analyzed with Epi info 7.Results:The overall prevalence of OSA was 78.8% in patients with suspected sleep-disordered breathing. Prevalence of mild, moderate, and severe OSA was 28.8%, 15.1%, and 34.9%, respectively. Proportions of diabetes and hypertensionwere significantly high among patients with obstructive sleep apnea. Correlation analysis revealed a weak positive linear relationship (r=0.14) between the number of risk factors and the AHI score.Conclusions:Thisstudy showed high prevalence of OSA among out patients presented with suspected sleep disordered breathing. Hypertension, diabetes and obesity were highly prevalent CV comorbidities among South Indian patients diagnosed with OSA.

Diagnostic methods and criteria of obstructive sleep apnea hypopnea syndrome in children / 口腔疾病防治

@#Obstructive sleep apnea hypopnea syndrome (OSAHS), which is a common childhood disease, is a trending topic in clinical multidisciplinary research due to its detriment to the growth and development of children. Due to the wide variety and specificity of pathogenesis and clinical manifestations, the clinical diagnosis of OSAHS is sophisticated and difficult and remains controversial in the field. This review summarizes the common diagnostic methods in OSAHS for children, including polysomnography,which is known as the current “gold standard”, pulse oximetry, fiberoptic nasopharyngoscopy, nasopharyngeal lateral X-ray, CT, and magnetic resonance imaging (MRI). Furthermore, it emphasizes the new diagnostic critical value from Chinese guidelines for the diagnosis and treatment of obstructive sleep apnea in children (2020) for children with OSAHS released by China in 2020: the obstructive apnea hypopnea index (OAHI) is ≥ 1 time/h; it also emphasizes the importance of history and physical examination to contribute to clinical diagnosis and treatment for children with OSAHS.

Cardiac functional alterations and its risk factors in elderly patients with obstructive sleep apnea syndrome free of cardiovascular disease / 南方医科大学学报

OBJECTIVE@#To evaluate the changes of cardiac structure and function and their risk factors in elderly patients with obstructive sleep apnea syndrome (OSA) without cardiovascular complications.@*METHODS@#Eighty-two elderly OSA patients without cardiovascular disease admitted between January, 2015 and October, 2016 were enrolled in this study. According to their apnea-hypopnea index (AHI, calculated as the average number of episodes of apnoea and hypopnoea per hour of sleep), the patients were divided into mild OSA group (AHI < 15) and moderate to severe OSA group (AHI ≥ 15). The demographic data and the general clinical data were recorded and fasting blood samples were collected from the patients on the next morning following polysomnographic monitoring for blood cell analysis and biochemical examination. Echocardiography was performed within one week after overnight polysomnography, and the cardiac structure, cardiac function and biochemical indexes were compared between the two groups.@*RESULTS@#Compared with those with mild OSA group, the patients with moderate to severe OSA had significantly higher hematocrit (0.22±0.08 @*CONCLUSIONS@#Cardiac diastolic function impairment may occur in elderly patients with moderate or severe OSA who do not have hypertension or other cardiovascular diseases, and the severity of the impairment is positively correlated with AHI.

Correlation between severity of obstructive sleep apnea syndrome and red cell distribution width in elderly patients / 南方医科大学学报

OBJECTIVE@#To investigate the correlation between the severity of obstructive sleep apnea syndrome (OSAS) and red cell distribution width (RDW) in elderly patients.@*METHODS@#A cross-sectional study was conducted among 311 elderly patients diagnosed with OSAS in the snoring clinic between January, 2015 and October, 2016 and 120 healthy controls without OSAS from physical examination populations in the General Hospital of PLA. The subjects were divided into control group with apnea-hypopnea index (AHI) <5 (=120), mild OSAS group (AHI of 5.0-14.9; =90), moderate OSAS group (AHI of 15.0-29.9; =113) and severe OSAS group (AHI ≥ 30; =108). The clinical characteristics and the results of polysomnography, routine blood tests and biochemical tests of the subjects were collected. Multiple linear regression analysis was used to examine the correlation between OSAS severity and RDW.@*RESULTS@#The levels of RDW and triglyceride were significantly higher in severe OSAS group than in the other groups ( < 0.01). The levels of fasting blood glucose and body mass index were significantly higher in severe and moderate OSAS groups than in mild OSAS group and control group ( < 0.05 or < 0.01). Multiple linear regression analysis showed that AHI was positively correlated with body mass index (β=0.111, =0.032) and RDW (β=0.106, =0.029). The area under ROC curve of RDW for predicting the severity of OSAS was 0.687 (=0.0001).@*CONCLUSIONS@#The RDW increases as OSAS worsens and may serve as a potential marker for evaluating the severity of OSAS.

Relationship between sleep architecture and severity of obstructive sleep apnea / 浙江大学学报·医学版

OBJECTIVE@#To investigate the effect of obstructive sleep apnea (OSA) on different sleep stages, and the relationship between N3 stage of non-rapid eye movement sleep and respiratory abnormal events.@*METHODS@#A total of 188 adult patients who underwent overnight polysomnography(PSG)monitoring in Sir Run Run shaw Hospital of Zhejiang University from June 24th to December 26th 2019 were enrolled in the study. OSA patients were classified into 3 groups (mild, moderate and severe) according to the apnea-hypopnea index (AHI). PSG data, AHI and the lowest SPO in each stage of sleep were compared among three groups.@*RESULTS@#There was no significant difference in total sleep time and sleep efficiency among patients with different severity of OSA (all >0.05). The proportion of N3 stage in moderate and severe OSA groups were significantly smaller than that in mild OSA group (all <0.05). The proportion of N3 stage in severe OSA group was also smaller than that in moderate OSA group (<0.05). In addition, severe OSA group had a longer latency of N3 stage than mild and moderate OSA groups (all <0.05). The latency of N3 stage in moderate OSA group was longer than that in mild OSA group (<0.05). The AHI in N3 stage was markedly lower than that in other sleep stages (all <0.01), regardless of the severity of OSA. Supine AHI in N3 stage in mild and moderate groups was significantly lower than that in N1, N2 and rapid eye movement (REM) stages (all <0.01). Supine AHI in N3 stage in severe group was also lower than that in N2 and REM stages (<0.05 or <0.01). The lowest SPO in N3 stage was significantly higher than that in N1, N2 and REM stages (<0.05 or <0.01), regardless of the severity of OSA.@*CONCLUSIONS@#s The proportion of N3 stage is lower in OSA patients, and N3 stage has less sleep respiratory events than non-N3 stages. The results suggest that the increased N3 stage proportion may indicate less severity of OSA.

Clinical Characteristics of Patients with Very Severe Obstructive Sleep Apnea

Introduction: The presence of obstructive sleep apneas (OSA) is a prevalent disease, whose severity is determined from the Apnea- Hypopnea Index (AHI). Very severe OSA (vsOSA) is defined by an AHI ≥ 60 events/hour; with clinical characteristics that could be different. The purpose of this study was to describe the clinical characteristics of patients with sOSA and compare them with less severe manifestations of this disease. Materials and Methods: Retrospective study of patients referred to a specialized hypertension center who met clinical criteria for the study of OSA. Patients were analyzed by means of a respiratory polygraphy, Ambulatory Monitoring of Arterial Pressure (AMAP), questionnaires and laboratory tests. We used non-parametric tests for the analysis of the results. Results: Of the 115 patients with OSA included in the study, 57 showed moderate OSA (mOSA), 48 sOSA and 10 vsOSA. No statistically significant differences were observed in age, Body Mass Index (BMI), glycemia, percentage of diabetic patients, or waist or neck diameter. We observed that the proportion of patients with arterial hypertension became higher as the severity of the OSA increased. This increase was significant only regarding the value of diastolic arterial pressure in very severe patients (vsOSA: 94.0 ± 7.7 mmHg vs. sOSA: 87.9 ± 8.7 mmHg and mOSA: 84.4 ± 8.2 mmHg; p < 0.05 and p < 0.01, respectively). Conclusions: In agreement with previous studies, our patients with vsOSA showed a higher degree of diastolic hypertension with clinical characteristics similar to less severe manifestations of OSA.

Nature of Disordered Sleep in Patients with Moderate to Very Severe Chronic Obstructive Pulmonary Disease

Introduction: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world. Comorbiditiesoccur frequently in COPD patients.Aim: The present study was an observation based cross-sectional prospective study carried out with an aim to evaluate thebreathing disorders during sleep in patients with COPD and to correlate this disorder with the stage of the disease.Materails and Methods: A total of 50 patients were eligible for participation in our study. 18 patients had moderate COPD,19 patients had severe COPD, and 13 patients had very severe COPD as per the global initiative for chronic obstructive lungdisease guidelines.Results: Mean sleep efficiency was low at 53.25 ± 18.15. Sleep latency was normal in three patients only. We found abnormalsleep architecture in all three groups with decreased duration of stage N3 and stage rapid eye movement. Obstructive sleepapnea (OSA) was present in 23 of 50 subjects of COPD (Overlap syndrome).Conclusion: In present study, it was found that OSA is highly prevalent in patients with moderate to very severe COPD. Sleepquality is also poor among this selected group.

Lack Of Association Between The Friedman's Tongue Position Type IV And Obstructive Sleep Apnea In Older Adults Of Amerindian Ancestry / Ausencia De Asociación Entre La Posición De La Lengua Tipo IV De Friedman Y Apnea Obstructiva De Sueño En Adultos Mayores Con Ancestro Amerindio

ABSTRACT Background: The burden of obstructive sleep apnea (OSA) in rural settings is unknown. In these regions, devices needed for OSA diagnosis are not available, and mass screening with field instruments may be complicated due to cross-cultural factors and illiteracy. The association between the Friedman's tongue position (FTP) and OSA has been assessed in people from different ethnic groups but not in Amerindians. Objective: We aimed to assess whether a FTP type IV is associated with OSA severity and with the apnea-hypopnea index (AHI) in community-dwelling older adults of Amerindian ancestry living in rural Ecuador. Methods: A total of 201 Atahualpa residents aged ≥60 years, who underwent tongue position assessment, brain MRI, and polysomnography were included. After adjusting for relevant confounders, ordinal logistic regression models were fitted to assess the association between the presence of a FTP type IV and OSA categories (none, mild, and moderate-to-severe), and generalized linear models with a Gaussian link were fitted to assess the association between the presence of a FTP type IV and the continuous AHI. Results: A FTP type IV was identified in 153 (76%) individuals, the mean AHI per hour was 11.9 ± 12.4, and 49 (24%) individuals had moderate-to-severe OSA, 88 (44%) had mild OSA, and the remaining 64 (32%) had no OSA. Fully-adjusted generalized linear models showed no independent association between the investigated exposure and the AHI (β: 0.09; 95% C.I.: -1.56 - 1.76; p=0.909). Likewise, ordinal logistic regression models showed no independent association between the investigated exposure and categories of OSA (β: 0.42; 95% C.I.: -0.47 - 1.31; p=0.357). Conclusion: A FTP type IV is not associated with the AHI or the severity of OSA in this population of Amerindians. This lack of association could be related to phenotypic characteristics of people from this ethnic group (mostly their elliptic hard palate).

RESUMEN Antecedentes: Se desconoce la prevalencia de la apnea obstructiva del sueño (AOS) en entornos rurales. En esas regiones, los equipos necesarios para el diagnóstico de AOS no están disponibles, y la detección de AOS con instrumentos de campo puede ser complicada debido a factores interculturales y analfabetismo. La asociación entre la posición de la lengua de Friedman (FTP) y AOS se ha evaluado en personas de diferentes grupos étnicos, pero no en Amerindios. Objetivo: Evaluar si al tipo IV de FTP está asociado con la severidad de la AOS y con el índice de apnea-hipopnea (IAH) en adultos mayores que viven en una comunidad de ascendencia Amerindia en zonas rurales de Ecuador. Métodos: Se incluyeron 201 residentes de Atahualpa de edad ≥60 años, que fueron sometidos a evaluación de la posición de la lengua, resonancia magnética cerebral y polisomnografía. Después de ajustar por factores de confusión relevantes, modelos de regresión logística ordinal evaluaron la probable asociación entre la presencia de un FTP tipo IV y las categorías AOS (ninguna, leve y moderada a grave), y se ajustaron modelos lineales generalizados con un enlace gaussiano para evaluar la asociación entre la presencia de un FTP tipo IV y el IAH continuo. Resultados: Se identificó un tipo IV de FTP en 153 (76%) individuos, el IAH promedio por hora fue de 11.9 ± 12.4 y 49 (24%) individuos tenían AOS de moderada a grave, 88 (44%) tenían AOS leve. y los 64 restantes (32%) no tenían AOS. Los modelos lineales generalizados, ajustados por confusores, no mostraron una asociación independiente entre la exposición investigada y el IAH (β: 0.09; 95% C.I.: -1.56 - 1.76; p = 0.909). Del mismo modo, los modelos de regresión logística ordinal no mostraron una asociación independiente entre la exposición investigada y las categorías de AOS (β: 0,42; 95% C.I.: -0,47 - 1.31; p = 0,357). Conclusión: El tipo IV de FTP no está asociado con el IAH o la gravedad de la AOS en esta población de Amerindios. Esta falta de asociación podría estar relacionada con las características fenotípicas de las personas de este grupo étnico (principalmente su paladar óseo de tipo elíptico).

The role of body fat rate in the evaluation of obstructive sleep apnea / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the role of body fat ratio in the evaluation of obstructive sleep apnea(OSA).@*Methods@#A retrospective analysis was made on 174 cases (between November, 2017 and April, 2018 showed that) of sleep monitoring in the Department of Otorhinolaryngology in Peking University Third Hospital. The data included the gender, age, body fat rate, body mass index (BMI), neck circumference, and apnea-hypopnea index (AHI). The above data were analyzed by non parametric correlation analysis, receiver operating characterristic (ROC) curve analysis and multiple factor Logistic regression analysis to study the relationship between the gender,age,body fat rate,BMI,neck circumference and other indexes of the patients with AHI.@*Results@#Nonparametric correlation analysis showed that the correlation from strong to weak to AHI among women was BMI (r=0.621, P<0.001),body fat rate (r=0.602, P<0.001), age (r=0.570, P<0.001), neck circumference (r=0.402, P=0.014), respectively. BMI (r=0.599, P<0.001), neck circumference (r=0.493, P<0.001), body fat rate (r=0.318, P<0.001), and age (r=0.256, P=0.003) among men. ROC curve analysis showed that the strong to weak index (area under curve,AUC) of the AHI>15/h among women was the body fat rate (AUC=0.884, P=0.001), BMI(AUC=0.810, P=0.008), neck circumference (AUC=0.759, P=0.027), age (AUC=0.750, P=0.033), and the male was BMI (AUC=0.765,P<0.001), neck circumference (AUC=0.720, P<0.001), age (AUC=0.634, P=0.008), and body fat rate (AUC=0.632, P=0.010), respectively. Multifactor Logistic regression analysis showed that the body fat rate (OR=1.704,95%CI=1.012-2.870) in women was an independent risk factor for AHI greater than 15/h; the age of male (OR=1. 044, 95%CI=1.005-1.085) and BMI (OR=1.285, 95%CI=1.056-1.562) were independent risk factors for AHI greater than 15/h.@*Conclusion@#Body fat rate can be used as a new indicator for predicting the severity of OSA,especially in adult female population. In adult female moderate to severe OSA patients (AHI>15/h), compared with BMI,neck circumference and age,the body fat rate has the greatest correlation with AHI. Compared with BMI,neck circumference and age,the body fat rate has a decisive role in predicting moderate to severe OSA (AHI>15/h).

Auditory Deficits in Patients With Mild and Moderate Obstructive Sleep Apnea Syndrome: A Speech Syllable Evoked Auditory Brainstem Response Study

OBJECTIVES: The energy consumption process of cochlea and neural signal transduction along the auditory pathway are highly dependent on blood oxygen supply. At present, it is under debate on whether the obstructive sleep apnea syndrome (OSAS) would affect the auditory function since the patients suffer from low oxygen saturation. Moreover, it is difficult to detect the functional state of auditory in less severe stage of OSAS. Recently, speech-evoked auditory brainstem response (speech-ABR) has been reported to be a new electrophysiological tool in characterizing the auditory dysfunction. The aim of the present study is to evaluate the auditory processes in adult patients with mild and moderate OSAS by speech-ABR. METHODS: An experimental group of 31 patients with mild to moderate OSAS, and a control group without OSAS diagnosed by apnea hypopnea index in polysomnogram were recruited. All participants underwent otologic examinations and tests of pure-tone audiogram, distortion product otoacoustic emissions, click-evoked auditory brainstem response (click-ABR) and speech-ABR, respectively. RESULTS: The results of pure-tone audiogram, distortion product otoacoustic emissions, and click-ABR in OSAS group showed no significant differences compared with the control group (P>0.05). Speech-ABRs for OSAS participants and controls showed similar morphological waveforms and typical peak structures. There were significant group differences for the onset and offset transient peaks (P < 0.05), where OSAS group had longer latencies for peak V (6.69± 0.33 ms vs. 6.39±0.23 ms), peak C (13.48±0.30 ms vs. 13.31±0.23 ms), and peak O (48.27±0.39 ms vs. 47.60± 0.40 ms) compared to the control group. The latency of these peaks showed significant correlations with apnea hypopnea index for peak V (r=0.37, P=0.040), peak C (r=0.36, P=0.045), as well as peak O (r=0.55, P=0.001). CONCLUSION: These findings indicate that some auditory dysfunctions may be present in patients with mild and moderate OSAS, and the damages were aggravated with the severity of OSAS, which suggests that speech-ABR may be a potential biomarker in the diagnosis and evaluation at early stage of OSAS.

Obstructive sleep apnea is associated with increased QT corrected interval dispersion: the effects of continuous positive airway pressure / Apneia obstrutiva do sono está associada a maior dispersão do intervalo QT corrigido: efeitos da pressão positiva contínua nas vias aéreas

Abstract Introduction: Severe obstructive sleep apnea is associated with increased QT corrected interval dispersion and continuous positive airway pressure is thought to improve this arrhythmogenic marker. Objective: The aim of the study was to determine the decrease of ratio of cardiovascular risk in patients with obstructive sleep apnea. Methods: The study included 65 patients with severe obstructive sleep apnea who had an apnea-hypopnea index score of >30. Each patient underwent 12-channel electrocardiogram monitoring and polysomnography. Patients with an apnea-hypopnea index score of <5 were used as the control group. The control group also underwent electrocardiogram monitoring and polysomnography testing. The QT corrected interval dispersion levels of both groups were calculated. Three months after continuous positive airway pressure treatment, electrocardiogram recordings were obtained from the 65 patients with severe obstructive sleep apnea again, and their QT corrected interval dispersion values were calculated. Results: There were 44 male and 21 female patients with severe obstructive sleep apnea syndrome. The age, gender, body mass index, initial saturation, minimum saturation, average saturation, and desaturation index were determined in both groups. The QT corrected intervals of the obstructive sleep apnea patients (62.48 ± 16.29 ms) were significantly higher (p = 0.001) than those of the control group (29.72 ± 6.30 ms). There were statistically significant differences between the QT corrected values before and after the continuous positive airway pressure treatment, with pretreatment QT corrected intervals of 62.48 ± 16.29 ms and 3-month post-treatment values of 41.42 ± 16.96 ms (p = 0.001). There was a positive and significant correlation between QT corrected interval dispersion periods and the apnea-hypopnea index and hypopnea index in obstructive sleep apnea patients (p = 0.001; r = 0.71; p = 0.001; r = 0.679, respectively). Conclusion: Continuous positive airway pressure treatment reduced the QT corrected interval dispersion in patients with severe obstructive sleep apnea. In addition, shortening the QT corrected interval dispersion periods in patients with severe obstructive sleep apnea may reduce their risk of arrhythmias and cardiovascular disease.

Resumo Introdução: A apneia obstrutiva do sono grave está associada a uma maior dispersão do intervalo QT corrigido e acredita-se que a pressão positiva contínua nas vias aéreas melhore esse marcador arritmogênico. Objetivo: Determinar a diminuição da razão de risco cardiovascular em pacientes com apneia obstrutiva do sono. Método: O estudo incluiu 65 pacientes com apneia obstrutiva do sono grave que apresentavam índice de apneia-hipopneia > 30. Cada paciente foi submetido à monitoração por eletrocardiograma de 12 derivações e polissonografia. Os pacientes com escore de índice de apneia-hipopneia < 5 foram utilizados como o grupo de controle. O grupo de controle também foi submetido à monitoração por eletrocardiograma e teste de polissonografia. Os níveis de dispersão do intervalo QT corrigido dos dois grupos foram calculados. Três meses após o tratamento com pressão positiva contínua nas vias aéreas, os registros de eletrocardiograma foram novamente obtidos dos 65 pacientes com apneia obstrutiva do sono grave e seus valores de dispersão do intervalo QT corrigido foram calculados. Resultados: Havia 44 pacientes do sexo masculino e 21 do feminino com síndrome de apneia obstrutiva do sono grave. Idade, sexo, índice de massa corporal, saturação inicial, saturação mínima, saturação média e índice de dessaturação foram determinados em ambos os grupos. Os intervalos QT corrigido dos pacientes com apneia obstrutiva do sono (62,48 ± 16,29 ms) foram significativamente maiores (p = 0,001) do que os do grupo controle (29,72 ± 6,30 ms). Houve diferenças estatisticamente significativas entre os valores de QT corrigido antes e após o tratamento com pressão positiva contínua nas vias aéreas, com intervalos QT corrigido pré-tratamento de 62,48 ± 16,29 ms e três meses pós-tratamento, de 41,42 ± 16,96 ms (p = 0,001). Houve uma correlação positiva e significativa entre os períodos de dispersão do intervalo QT corrigido e o índice de apneia-hipopneia e índice de hipopneia em pacientes com apneia obstrutiva do sono (p = 0,001; r = 0,71; p = 0,001; r = 0,679, respectivamente). Conclusão: O tratamento com pressão positiva contínua nas vias aéreas reduziu a dispersão do intervalo QT corrigido em pacientes com apneia obstrutiva do sono grave. Além disso, o encurtamento de dispersão do intervalo QT corrigido em pacientes com apneia obstrutiva do sono grave pode reduzir o risco de arritmias e doenças cardiovasculares.

Three-dimensional analysis of changes in airway space after bimaxillary orthognathic surgery with maxillomandibular setback and their association with obstructive sleep apnea / 대한악안면성형재건외과학회지

BACKGROUND: Bimaxillary orthognathic surgery with maxillomandibular setback is often accompanied by changes in airway space. We analyzed the changes in airway space before and after surgery and assessed their association with obstructive sleep apnea. METHODS: This study is based on the cohort of 13 adult patients (9 males, 4 females, average age 23.85 years) who underwent bimaxillary orthognathic surgery with maxillomandibular setback. We performed computed tomography and portable polysomnography before and after the surgery to assess changes in airway space and Apnea-Hypopnea Index (AHI) values (total, supine, non-supine). RESULTS: The oropharyngeal airway volume decreased by 29% after the surgery, which was statistically significant (p < .05). The upper airway volume and hypopharyngeal airway volume were decreased, but not significantly (4 and 19%, respectively). The changes in airway surface area were statistically significant at all levels examined (p < .05). Changes in the maximum anteroposterior width of the airway were also significant at all levels (p < .05). However, the changes in maximum lateral width were only statistically significant at C2 level (p < .05). AHI values were increased after the surgery but not significantly at any position. CONCLUSIONS: Although bimaxillary surgery with maxillomandibular setback significantly reduces the airway space, it does not affect AHI values or induce obstructive sleep apnea.

Modest Improvement of Untreated Severe Sleep-Disordered Breathing in the Middle-Aged and Elderly

OBJECTIVE: It has been reported that untreated sleep-disordered breathing (SDB) deteriorates over time, however this remains contentious. The aim of the present study is to evaluate the clinical course of SDB in middle-aged and older SDB patients, and to identify how relevant factors contribute to the change in SDB severity. METHODS: Baseline and follow-up polysomnographic data of 56 untreated SDB patients (mean age, 61.2±5.71) were obtained retrospectively and the mean interval was 62.4±22.0 months. Subgroup analysis was performed based on the baseline severity, and the factors associated with the course of SDB were analyzed. RESULTS: At the baseline, 13 subjects were simple snorers, 15 had mild to moderate SDB, and 28 were severe SDB patients. While there was no significant change in apnea-hypopnea index (AHI) as a whole, subgroup analysis showed decrease of AHI in severe SDB patients (43.9±10.6 to 35.6±20.0, p=0.009). The change in supine time percent and baseline AHI were associated with the change in AHI (β=0.387, p=0.003; β=-0.272, p=0.037). CONCLUSION: Untreated SDB did not deteriorate over time with modest improvement in severe SDB. A proportion of severe SDB patients might expect decrease in SDB severity irrespective of changes in sleep position or body weight.

Effect of Positional therapy on Patients with Obstructive Sleep Apnea: Meta-Analysis

BACKGROUND AND OBJECTIVES: Positional therapy is a therapeutic method for obstructive sleep apnea (OSA). However, little is known about the effectiveness of positional OSA treatment based on meta-analysis. Therefore, we undertook a review and meta-analysis of studies to assess the effect of positional therapy on OSA. SUBJECTS AND METHOD: We searched PubMed (Medline), OVID Medline, EMBASE, Cochrane Library, SCOPUS, KoreaMed, MedRIC, and KSI KISS using the key words “obstructive sleep apnea” and “positional therapy”. To estimate the effect of positional OSA therapy, we analyzed the ratio of means (ROM) for pre- and post-treatment polysomnographic data including apnea-hypopnea index (AHI), lowest oxygen saturation, arousal index, and sleep efficiency. RESULTS: Finally, twenty two studies from 21 papers were included in the meta-analysis. Positional therapy significantly decreased AHI by 54.1% [ROM, 0.459; 95% confidence interval (CI), 0.394 to 0.534] and increased lowest oxygen saturation by 3.3% (ROM, 1.033; 95% CI, 1.020 to 1.046). However, positional therapy did not significantly change arousal index (ROM, 0.846; 95% CI, 0.662 to 1.081) or sleep efficiency (ROM, 1.008; 95% CI, 0.990 to 1.027). CONCLUSION: Positional therapy significantly improves respiratory parameters including AHI and lowest oxygen saturation in patients with OSA.

The relationship between vascular lesion and serological changes in patients with coronary heart disease and obstructive sleep apnea hypopnea syndrome / 天津医药

Objective To investigate the relationship between vascular lesion and serological changes in patients with coronary heart disease (CHD) complicated with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods According to the standard, a total of 168 patients of OSAHS complicated with CHD were selected in this study. Those patients were divided into 3 groups according to the apnea hypopnea index (AHI) level:light group (AHI, 5-14/h), moderate group (AHI, 15-30/h) and severe group (AHI,>30/h). Syntax scores were performed on three groups according to coronary angiography results. The data of hemoglobin (Hb), platelet count (PLT), fibrinogen (FIB), D-Dimer (DD), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triacylglycerol (TG), alanine aminotransferase (ALT), aspartate transaminase (AST), uric acid (UA), creatinine (Cr) and echocardiographic examination index were collected and analyzed in three groups. Results The Syntax score was significantly higher in severe group than that in mild and moderate groups (P 0.05). Conclusion The serology and cardiac structure can change gradually in severe OSAHS patients, and the coronary artery lesion will be more complex. Therefore, the clinical treatment should pay attention to screening for OSAHS in patients with coronary heart disease.

Escala de Epwoth y cuestionario de Stop Bang como predictores del síndrome de apneas hipopneas obstructivas del sueño / Epworth Sleepiness Scale and Stop Bang questionnaire as predictors for the obstructive sleep apnea syndrome / Escala de Epworth e questionário PARAR BANG como preditores de hipopnéias apneia obstrutiva do sono. Síndrome do sono

Introducción: El SAHOS (Síndrome de Apneas e Hipopneas Obstructivas del Sueño) surge de apneas e hipopneas que generan una hipoxia intermitente. La polisomnografía es el gold standard para su diagnóstico. La Escala de Somnolencia de Epworth (ESS) identifica pacientes con somnolencia diurna. El cuestionario Stop Bang reconoce pacientes con riesgo de SAHOS. El objetivo es describir la sensibilidad y especificidad de la ESS y Stop Bang para el diagnóstico de SAHOS realizado con polisomnografía. Métodos: 125 pacientes completaron la ESS, Stop Bang y realizaron una polisomnografía de noche completa. Se confeccionaron dos grupos: pacientes con IAH < 15, y pacientes con IAH ≥ 15. Se calcularon sensibilidad, especificidad, razón de probabilidades (OR) y curvas ROC para el diagnóstico de SAHOS de la ESS y el Stop Bang. Resultados: La prevalencia del grupo IAH ‹ 15 fue de 36%, y del grupo IAH ≥ 15 fue de 64%. Para la ESS, 71 pacientes presentaron somnolencia diurna, 49,3% con un IAH < 15 y 50,7% con un IAH ≥ 15. Especificidad 77,78%, sensibilidad 55%, área bajo la curva ROC 0,6553. Para el cuestionario Stop Bang, 110 pacientes presentaron alto riesgo para SAHOS, 30% con un IAH < 15 y 70% con IAH ≥ 15. Especificidad 26,67%, sensibilidad 96,25%, área bajo la curva ROC 0,7671. Se enfrentaron ambos cuestionarios y calcularon sus OR: ESS, OR=1,1014 (p=0,038); Stop Bang, OR=8,099 (p=0,002). Conclusiones: La sensibilidad de ESS es baja y su área bajo la curva ROC poco significativa. La gran sensibilidad del cuestionario Stop Bang junto con su área bajo la curva ROC, lo convierten en una herramienta de importancia para realizar screening de SAHOS.

Introduction: osa (obstructive sleep apnea) arises from apneas and hypopneas that cause intermittent hypoxia. Polysomnography is the gold standard for its diagnosis. The Epworth Sleepiness Scale (ESS) measures daytime sleepiness. The Stop Bang Questionnaire (SBQ) recognizes patients at risk of OSA. Objectives: describe the sensitivity and specificity of the ESS and SBQ for the diagnosis of OSA accomplished by polysomnography. Methods: 125 adult patients completed the ESS, SBQ and a full night polysomnography. Patients were grouped into two: those with AHI < 15 and those with AHI ≥ 15. Sensibility, specificity, odds ratio (OR) and ROC curves were determined for the ESS and SBQ. Results: The group with AHI ≥ 15 prevailed (64%). 71 patients (56.8%) showed an abnormal ESS´s score; 49.3% showed an AHI < 15 and 50.7% AHI ≥ 15. The specificity was 77.78% and sensitivity 55%. The area under the ROC curve was 0.6553. Regarding the SBQ, 110 patients were within the high risk group; 30% corresponded to an AHI < 15 and 70% AHI ≥ 15. The specificity was 26.67% and sensitivity 96.25%. The area under the ROC curve was 0.7671. The OR for the ESS was 1.1014 (p=0.038) and SBQ, OR = 8.099 (p=0.002). Conclusion: The sensitivity of the ESS is low and the area under the ROC curve insubstantial. The SBQ shows high sensitivity and a remarkable area under the ROC curve, which turn it into an important tool for screening OSA.

Introdução: sahos (síndrome da apneia e hipopneia obstrutiva do sono) surge de apnéias e hipopnéias que geram hipóxia intermitente. A polissonografia (PSG) é o gold standard para o diagnóstico. A Escala de Sonolência de Epworth (ESS) identifica pacientes com sonolência diurna. O questionário Stop bang reconhece pacientes em risco de doenca de SAHOS. O objetivo de este trabalho é descrever a sensibilidade e especificidade da ESS e do questionario Stop Bang para diagnóstico de SAHOS feito coma PSG. Métodos: 125 pacientes completaram a ess, o stop bang efisseram uma psg con oximetria de noite completa. Dividiram-se os pacientes em dois grupos: com IAH < 15 e 50,7% com um IAH ≥ 15. A especificidade foi de 77,78%, a sensibilidade de 55%, e a área abaixo da curva ROC 0,6553. Enquanto ao questionário stop bang, 110 pacientes apresentaram alto risco de SAHOS, 30% com um IAH < 15 e 70% com IAH ≥ 15. Especificidade de 26,67%, 96,25% de sensibilidade, e 0,7671 da área abaixo da curva. Se comparam ambos questionários e foi calculada sua OR: ESS, OR = 1,1014 (p = 0,038); Stop Bang, OR = 8,099 (p = 0,002). Conclusões: a sensibilidade ess é baixa e a área baixo da curva roc insignificante. A alta sensibilidade do questionário Stop Bang junto com a área baixo da curva ROC o tornam uma ferramenta muito importante para o sreening de esta doença.

Clinical Considerations of Obstructive Sleep Apnea with Little REM Sleep

BACKGROUND AND PURPOSE: Obstructive sleep apnea (OSA) is more severe during rapid eye movement (REM) sleep than during non-REM sleep. We aimed to determine the features of patients with OSA who experience little REM sleep. METHODS: Patients with a chief complaint of sleep-disordered breathing were enrolled. All subjects underwent overnight polysomnography (PSG) and completed questionnaires on sleep quality. Patients were divided into the following three groups according to the proportion of REM sleep detected in overnight PSG: little REM sleep [REM sleep 25% of TST). Multiple logistic regression analyses were applied to the data. The success rate of continuous positive airway pressure (CPAP) titration was estimated in these groups. RESULTS: The age and body mass index of the patients were 47.9±15.9 years (mean±SD) and 25.2±4.1 kg/m², respectively. The 902 patients comprised 684 (76%) men and 218 (24%) women. The apnea-hypopnea index (AHI) in the little-REM-sleep group was 22.1±24.4 events/hour, which was significantly higher than those in the other two groups (p<0.05). Multiple logistic regression showed that a higher AHI (p<0.001; odds ratio, 1.512; 95% confidence interval, 1.020–1.812) was independently predictive of little REM sleep. The titration success rate was lower in the little-REM-sleep group than in the normal-REM-sleep group (p=0.038). CONCLUSIONS: The AHI is higher and the success rate of CPAP titration is lower in OSA patients with little REM sleep than those with normal REM sleep.

Long-term effect of adaptive servo ventilation on patients with chronic heart failure and sleep-disordered breathing: Meta analysis / 解放军医学杂志

Objective To evaluate the long-tem effect of adaptive servo ventilation (ASV) on patients with chronic heart failure (CHF) and sleep-disordered breathing (SDB). Methods The controlled clinical articles were searched included in PubMed, Cochrane, EMBASE and CBM, CJFD, WangFang Database from Jan. 1970 to Dec. 2015. Included standard: left ventricular ejection fraction (LVEF) ≤55%, apnea hypopnea index (AHI) ≥15/h, follow up period over 4 weeks. After quality assessment (modified Jadad score) and data extraction by two independent reviewers, mete analysis was performed with RevMan 5.3 software. Results Thirteen studies were recruited including 442 cases being followed over 4 weeks [ASV group 233 cases and control group 216 cases (corssover design 7)]. Compared to control group, LVEF increased [weighted mean difference (WMD)=3.72, 95%CI: 1.80-5.64, PP<0.01] and AHI decreased significantly (WMD=–18.63, 95%CI: –26.19-–11.08), the distance walked in 6 minutes increased (WMD=28.72, 95%CI: 2.26-55.18, P=0.03) and plasma N terminal brain natriuretic peptide precursor (NT-pro BNP) decreased significantly (WMD=–744.03, 95%CI: –1262.45-–225.62, P<0.05) in ASV group. Conclusion Over 4 weeks ASV may improve LVEF and AHI, increase 6-min walking distance and decrease NT-pro BNP in patients with CHF and SDB.

Clinical observation of continuous airway positive pressure ventilation in patients with obstructive sleep apnea hypopnea syndrome and cough syncope / 天津医药

Objective To observe the curative effect of continuous airway positive pressure ventilation (CPAP) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and cough syncope. Methods Forty-three hospitalized patients with OSAHS and cough syncope were collected in the Department of Respiration of Tianjin General Hospital, and analyzed the related information. They were given CPAP treatment, and were divided into good compliance group (n=26) and poor compliance group (n=17) according to CPAP compliance after a half-year treatment. The apnea hypoventilation index (AHI) and c-reactive protein (CRP) were compared before and after treatment between two groups. Results The positive correlation was found between the frequency of the cough syncope and indicators of OSAHS, such as AHI, body mass index (BMI), CRP, sleepiness score (ESS) and circumference of abdomen and neck (r=0.612, 0.431, 0.224, 0.654, 0.435 and 0.344,P<0.05). All these patients were cured after the treatment of both CPAP and medication for 1 or 2 weeks. During a half-year follow-up, the cough syncope didn’t occur in those patients of good compliance group, otherwise cough syncope still happened but with less frequency in patitents of poor compliance group. Before the treatment , there was no significant difference in AHI (45.00±15.69 vs. 48.70±16.47) and CRP (3.46± 1.15 vs. 3.38±0.72) between the two groups. After treatment, AHI (26.97±14.06 vs. 48.18±15.96) and CRP (1.56±0.76 vs. 3.18± 0.78) were significantly lower in the good compliance group than those of the poor compliance group (P<0.01). Conclusion Timely and sustained treatment of OSAHS may help reduce the incidence of cough syncope and significantly improve AHI, CRP and cough symptoms.