The Effect of Continuous Positive Airway Pressure on Basal Metabolism Rate in Patients with Severe Obstructive Sleep Apnoea Syndrome

ABSTRACT Objective: To assess the effect of the continuous positive airway pressure (CPAP) treatment on basal metabolism rate (BMR) in patients with severe obstructive sleep apnoea syndrome (OSAS). Methods: Demographic characteristics, body mass index (BMI), apnoea-hypopnoea index (AHI) and smoking history of the patients were recorded. Basal metabolism rate was measured via indirect calorimetry in the morning following nights of polysomnography and CPAP titration. Basal metabolism rate, oxygen consumption (VO2) and carbon dioxide output (VCO2) levels were compared before and after CPAP administration. Results: A total of 25 patients with a mean age of 51.4 ± 13.7 years were included in the study: 6 (24%) female and 19 (76%) male. A significant reduction in the BMR (p = 0.049), VO2 (p = 0.042) and VCO2 (p = 0.008) values were observed after a single night administration of CPAP as compared to before treatment. Furthermore, it was detected that this reduction provided by CPAP treatment was more significant in current smokers, patients with AHI > 60 and BMI ≥ 30. Conclusion: It is suggested that there is a correlation between BMR and the severity of OSAS, and it is possible to provide a significant reduction in BMR with single night administration of CPAP depending on the patient's smoking history, degree of obesity and disease severity.

Managing obstructive sleep apnoea in children: the role of craniofacial morphology

Obstructive sleep apnoea syndrome is a type of sleep-disordered breathing that affects 1 to 5% of all children. Pharyngeal and palatine tonsil hypertrophy is the main predisposing factor. Various abnormalities are predisposing factors for obstructive sleep apnoea, such as decreased mandibular and maxillary lengths, skeletal retrusion, increased lower facial height and, consequently, increased total anterior facial height, a larger cranio-cervical angle, small posterior airway space and an inferiorly positioned hyoid bone. The diagnosis is based on the clinical history, a physical examination and tests confirming the presence and severity of upper airway obstruction. The gold standard test for diagnosis is overnight polysomnography. Attention must be paid to identify the craniofacial characteristics. When necessary, children should be referred to orthodontists and/or sleep medicine specialists for adequate treatment in addition to undergoing an adenotonsillectomy.

Diagnosis and treatment of children with sleep apnea / 国际儿科学杂志

Sleep apnea includes obstructive sleep apnea,central sleep apnea and mixed sleep apnea.Ob-structive sleep apnoea syndrome(OSAS)is affecting up to 5.7% of children,which hss adverse impact on growth,development cognitive and behavioral outcomes,and untreated OSAS increases cardiovascular risk,so paying closer attention to childhood OSAS early diagnosis and treatment seems more important.First-line treat-ment in OSAS children is adenotonsillectomy,although other treatment options available include continuous posi-tive airways pressure,anti-inflammatory therapies,airway adjuncts and orthodontic appliances.Central sleep ap-nea may be related to respiratory regulation center immaturity or dysplasia.Central sleep apnea may be hereditary or acquired.Therefore,the treatment of central sleep apnea should be focused on primariy etiology.

Prevalence and influencing factors of obstructive sleep apnoea syndrome among hypertensive patients / 中国综合临床

Objective To explore the prevalence and influencing factors of obstructive sleep apnoea syndrome(OSAS)among hypertensive patients. Methods Two hundred and ninety-eight hypertensive patients who used a portable OSAS monitoring device were selected as our subjects. Of which,197 patients who completed their OSAS monitoring were divided into OSAS group( 165 cases) and non-OSAS group. Stepwise linear regression and Logistic regression analysis were used to analyze the relevant factors correlated to AHI and OSAS with hypertension. Results The average age of the 197 patients(122 were males)were 59. 93 ± 10. 18 years old. The prevalence of OSAS was 83. 8% in hypertension patients. Body mass index( BMI),systolic pressure (SBP),diastolic pressure(DBP),low density lipoprotein cholesterol(LDL-C)and waist circumference in OSAS groups were(26. 37 ± 2. 77)kg/ m2 ,(159. 59 ± 14. 42)mmHg,(98. 71 ± 9. 40)mmHg,(2. 85 ± 0. 82)mmol/L,(90. 56 ± 8. 62)cm,higher than those in non-OSAS group((22. 43 ± 2. 04)kg/ m2 ,(146. 83 ± 4. 60) mmHg,(85. 51 ± 7. 52)mmHg,(2. 22 ± 0. 60)mmol/ l. ,(81. 84 ± 8. 00)cm). There were statistical differences between the two groups(t = - 7. 654,- 4. 945,- 7. 490,- 4. 110 and - 5. 289;P < 0. 001). BMI,SBP and DBP were positively associated with AHI,and they were in depended risk factors of OSAS(OR(95% CI)=2. 554(1. 408 - 4. 632),1. 432(1. 154 - 1. 777),1. 286(1. 058 - 1. 562);P < 0. 05). Conclusion The prevalence of OSAS is high in hypertension patients. Higher BMI,SBP,DBP are associated with OSAS in hypertension pateints.

Role of nitric oxide in the diuresis and natriuresis occurring in patients with obstructive sleep apnoea syndrome.

Objective. To determine whether nitric oxide (NO) has any role in the diuresis and natriuresis observed in patients with obstructive sleep apnoea syndrome (OSAS). Methods. We measured 12-hour urine volume in the day and in the night in patients with OSAS (n=20) and determined the concentrations of urinary sodium and nitrate. The frequency of urination in the night was also noted. The measurements were done again after two nights of continuous positive airway pressure (CPAP) therapy and after putting the patients on oral anti-oxidant treatment (vitamin C–100mg BD and vitamin E–400IU BD) for 45 days. Ten healthy normal subjects underwent the same protocol except the CPAP therapy. Results. In patients with OSAS, the night urine volume and sodium concentration were similar and the nitrate levels were higher compared to those in the day. After CPAP therapy, while the urine volume and sodium concentration decreased, the nitrate level became similar to that in the day. Such effects were not observed after anti-oxidant treatment. The frequency of urination was decreased in both the instances. The effects observed after CPAP therapy were similar to those observed in control subjects with or without anti-oxidant treatment. Conclusion. Renal NO promotes diuresis and natriuresis in patients with OSAS.

Continuous positive airway pressure therapy: New generations.

Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS). However, CPAP is not tolerated by all patients with OSAS and alternative modes of pressure delivery have been developed to overcome pressure intolerance, thereby improving patient comfort and adherence. Auto-adjustable positive airway pressure (APAP) devices may be utilised for the long-term management of OSAS and may also assist in the initial diagnosis of OSAS and titration of conventional CPAP therapy. Newer modalities such as C-Flex and A-Flex also show promise as treatment options in the future. However, the evidence supporting the use of these alternative modalities remains scant, in particular with regard to long-term cardiovascular outcomes. In addition, not all APAP devices use the same technological algorithms and data supporting individual APAP devices cannot be extrapolated to support all. Further studies are required to validate the roles of APAP, C-Flex and AFlex. In the interim, standard CPAP therapy should continue as the mainstay of OSAS management.

Influência da síndrome da apnéia obstrutiva do sono no comportamento infantil / Influence of sleep obstructive apnea syndrome on behavior of children

Objetivo: Realizar uma revisão bibliográfica acerca das alterações neurocomportamentais em crianças de 2 a 12 anos de idade que apresentam diagnóstico de síndrome da apnéia obstrutiva do sono. Fontes de dados: Foram realizadas pesquisas bibliográficas por meio da base de dados Medline. As palavras-chaves utilizadas foram obstructive sleep apnea syndrome, snoring, behavior, neurocognitive implications, restringindo a período de tempo de 1993 a 2003, língua inglesa e idade de 2 a 12 anos. Após leitura do título e resumos foram selecionados apenas os trabalhos que avaliaram a relação entre síndrome da apnéia obstrutiva do sono e alterações neurocomportamentais. Síntese dos dados: Observou-se uma relação positiva entre sonolência diurna, ronco e distúrbios do sono com o comportamento de crianças. A presença do ronco durante o sono foi associada com sonolência diurna, sono agitado e hiperatividade, além de ter se mostrado um importante indicador de presença da síndrome da apnéia obstrutiva do sono. Hábito de fumar dos pais, tabagismo materno durante a gravidez e hipertrofia adenotonsilar, com redução das dimensões do orofaringe, foram apontados como os principais fatores que predispõem o público pediátrico ao desenvolvimento de doenças respiratórias do sono. A literatura pesquisada evidenciou que distúrbios do sono exercem influência no comportamento diurno de crianças, sendo o déficit de atenção e a hiperatividade as alterações neurocomportamentais mais observadas. Conclusões: A literatura não estabelece relação de causalidade entre SAOS e distúrbios neurocomportamentais em crianças, porém os resultados dos estudos sugerem que distúrbios do sono em crianças de 2 a 12 anos podem interferir nas funções neurocognitivas.