SANReSP: A new Italian questionnaire to screen patients for obstructive sleep apnea.

PURPOSE: Obstructive sleep apnea (OSA) is a common, prevalent, and underdiagnosed disorder. Its lack of diagnosis and treatment is associated with increased morbidity and mortality. Previous screening questionnaires investigated parameters including body mass index, age, neck circumference, and sex, in addition to symptoms. This study aimed to validate a new Italian, self-administered, and easy-to-use six-item questionnaire that evaluates only subjective symptoms. PATIENTS AND METHODS: The present study included 2622 patients (male, 2011; female, 611). Patients who were at least 18 years old, spoke Italian, referred to our sleep clinic for possible OSA, and completed the self-administered SANReSP questionnaire were recruited for the study. The predictive performance of the questionnaire was also evaluated. RESULTS: Nocturnal study showed 89.9% of OSA patients had apnea-hypopnea index (AHI) ≥ 5/h; 68.7%, AHI ≥ 15/h; and 48.2%, AHI ≥ 30/h. The optimal SANReSP score for AHI ≥ 5/h was >3 with a sensitivity and specificity of 74.76% and 67.92%, respectively, and an area under receiver operating characteristic curve (ROC) of 0.76. For moderate-severe OSA, the optimal SANReSP score was >3 (sensitivity, 78.18%; specificity, 46.53%; ROC, 0.66). For severe OSA, the optimal SANReSP score was >4 (sensitivity, 59.10%; specificity, 64.73%; ROC, 0.65). The probability of OSA increased with higher SANReSP scores (98.7% and 97.9% in men and women, respectively). CONCLUSION: The SANReSP questionnaire is a short, easy-to-use, and self-administered screening tool for OSA. Its performance is similar to that of other widely used questionnaires; furthermore, it is advantageous in that it does not require anthropometric measurements.

Obstructive sleep apnea in developmental age. A narrative review.

Sleep is a physiological function that undergoes, at different stages of life, to considerable variations in neurophysiological and behavioral functions. The developmental age is a period characterized by a continuous process of physical and neuropsychological changes and synaptic remodeling processes that are the neurophysiological basis of brain plasticity, typical of this developmental phase, occurring mainly during sleep. In the description of obstructive sleep apnea (OSA) in children, two main points should be highlighted: its variability in different age groups, and its specificity compared with OSA in adults. The definition and criteria used for the diagnosis of OSA in adults are not applicable to OSA in developmental age. Although the adenotonsillar hypertrophy is the most common risk factor for pediatric OSA, obesity is becoming an increasingly prevalent risk factor, mostly in early childhood (6-9 years) and adolescence. OSA has been shown to affect cognitive function in children and adults. However, OSA impact on cognitive function in children is more severe since acting on the plastic brain structures can change the neuro-psychic development, learning skills, and social interactions. There is a clear difference in the definition of pathology between developmental age and adulthood according to the instrumental parameters: an AHI ≥ 5, which represents, in the pediatric age, the cut-off for a therapeutic pathway necessary to avoid a long-term effect on the child, instead, it represents in adulthood, the lower limit value for the definition of disease. This is a narrative review concerning obstructive sleep apnea in developmental age.Conclusions: OSA is a common disorder in children and those at risk must be identified, studied, and treated promptly because untreated OSA can be responsible for cardiovascular, metabolic, and neurocognitive morbidities and may induce, sometimes, non-reversible deficits given his insistence on a period of physical and neuro-psychic development.What is Known:•This is a review concerning Obstructive Sleep Apnea in developmental age•Clinical manifestation, diagnostic and therapeutic criteria of sleep apnea in developmental ageWhat is New:•This is a "narrative" review•This narrative review describes sleep apnea comparing and analyzing the different ages of life.

OSA and CPAP therapy: effect of gender, somnolence, and treatment adherence on health-related quality of life.

BACKGROUND: Obstructive sleep apnea (OSA) often has a significant impact on health-related quality of life (HRQoL) with social and psychological implications. For most OSA patients, a reduction in their HRQoL is due to symptoms such as poor sleep quality, excessive daytime somnolence, and fatigue with differences between gender. PURPOSE: This study explores the CPAP treatment effect on self-perceived HRQoL related to gender, somnolence, and CPAP adherence. METHODS: Out of 1082 consecutive Italian outpatients, 125 (82 M) (60.3 ± 9.6 years) completed the prospective observational study and were evaluated at the first visit (T0), and the follow-up visit (T1). Two self-reported HRQoL questionnaires were administered: six subscales Psychological General Well-Being Index (PGWBI) and 12-Item Short-Form Health Survey (SF-12). RESULTS: Scores of PGWBI and SF-12 MCS improved from T0 to T1. Patients with CPAP use ≥ 4 h/night showed a significant improvement in all dimensions evaluated, except for SF-12 PCS. At T1, participants with ESS > 10 improved in all scores, except SF-12 PCS. Gender comparison shows better-perceived HRQoL in males at first visit and CPAP follow-up visit. Variation of PGWBI was significantly correlated with CPAP use, ESS at T0 and T1 (p < 0.0001; r2 = 0.26). CONCLUSIONS: This study provides evidence on the effectiveness of CPAP treatment on perceived HRQoL. Participants with greater adherence to therapy, greater sleepiness, and greater improvement of daytime sleepiness with CPAP therapy, reported a higher quality of life improvement. Gender comparison shows better-perceived HRQoL in males at first visit and CPAP follow-up, despite a more considerable improvement in females.

Immediate effect of CPAP titration on perceived health related quality of life: a prospective observational study.

BACKGROUND: Perceived Health Related Quality of Life (HRQoL) is impaired in obstructive sleep apnea (OSA). This study examines changes in HRQoL aspects occurring immediately after CPAP titration. Furthermore, we analyzed variations in each gender and in patients undergoing home or laboratory-based CPAP titration pathways. METHODS: Twohundredfive outpatients (151 M) (56.7 ± 10.3 years) were evaluated, before first visit and nocturnal diagnostic examination (T0), and the morning after CPAP titration (T1). Two self-reported HRQoL questionnaires were administered: Psychological General Well-Being Index (PGWBI), composed by six subscales, and 12-Item Short-Form Health Survey (SF-12), including Physical (PCS) and Mental Component Summaries (MCS). CPAP titration was performed using auto-adjusting CPAP units at patients' home or in the sleep laboratory. RESULTS: PGWBI scores at T1 improved compared to T0 (p < 0.0001). A similar improvement was observed in SF-12 MCS (p = 0.0011), but not in SF-12 PCS. Changes were independent from anthropometric parameters, OSA severity and excessive daytime sleepiness. Gender comparisons showed better HRQoL in males at both times. At T0, patients who received home or laboratory CPAP titration pathways did not show any differences in PGWBI and SF-12 scores. At T1, PGWBI and SF-12 MCS improved in both home and laboratory groups. CONCLUSIONS: This study gives evidence that first time CPAP application for titration can lead to a general increase in perceived well-being. Gender comparisons showed better perceived HRQoL with more subscales improvements in males after CPAP titration. The improvement was similar with both home and laboratory CPAP titration pathways.

Gel pillow designed specifically for obstructive sleep apnea treatment with continuous positive airway pressure.

OBJECTIVE:: To determine whether the use of a gel pillow with side cutouts designed to accommodate a continuous positive airway pressure (CPAP) mask and reduce head temperature improves the efficacy of and adherence to auto-CPAP therapy. METHODS:: Twenty-three consecutive CPAP-naïve patients with obstructive sleep apnea were enrolled in the study. Patients were given an auto-CPAP machine with an appropriate CPAP mask and were instructed to use CPAP for 15 nights. They were instructed to sleep with their own pillow (the control pillow) from nights 1 to 5 and with either a foam pillow or a gel pillow, both of which had side cutouts, for 5 consecutive nights each, in random order. After night 15, auto-CPAP machine data were downloaded and patients rated their satisfaction with each pillow on a visual analog scale. RESULTS:: Twenty-two patients completed the protocol. The pressures administered, residual apnea-hypopnea index, air leaks, and mean duration of CPAP use did not differ among the periods during which each pillow was used. Patients were significantly more satisfied with the gel pillow than with the control pillow and the foam pillow (p = 0.022 and p = 0.004, respectively), their level of satisfaction with the gel pillow correlating significantly with excessive daytime sleepiness (r2 = 0.19; p = 0.0443). CONCLUSIONS:: Among obstructive sleep apnea patients treated with nasal CPAP, the use of a gel pillow with side cutouts appears to have no impact on treatment effectiveness. Nevertheless, such patients seem to prefer a gel pillow over other types of pillows. OBJETIVO:: Determinar se o uso de um travesseiro de gel com recortes laterais para acomodar a máscara de continuous positive airway pressure (CPAP, pressão positiva contínua nas vias aéreas) e diminuir a temperatura em torno da cabeça melhora a eficácia do tratamento com auto-CPAP e a adesão dos pacientes ao tratamento. MÉTODOS:: Foram incluídos no estudo 23 pacientes consecutivos com apneia obstrutiva do sono que nunca haviam recebido tratamento com CPAP. Os pacientes receberam um aparelho de auto-CPAP com uma máscara apropriada e foram instruídos a usar CPAP durante 15 noites. Foram também instruídos a dormir com seu próprio travesseiro (o travesseiro controle) nas 5 primeiras noites e com um travesseiro de espuma ou um travesseiro de gel, ambos com recortes laterais, durante 5 noites consecutivas cada, em ordem aleatória. Depois da 15ª noite, os dados registrados nos aparelhos de auto-CPAP foram baixados e os pacientes determinaram seu grau de satisfação com cada travesseiro por meio de uma escala visual analógica. RESULTADOS:: Vinte e dois pacientes completaram o protocolo. Não houve diferenças entre os períodos durante os quais cada travesseiro foi usado quanto às pressões administradas, índice de apneia-hipopneia residual, vazamentos de ar e média de duração da CPAP. Os pacientes ficaram significativamente mais satisfeitos com o travesseiro de gel do que com o travesseiro controle e o travesseiro de espuma (p = 0,022 e p = 0,004, respectivamente), com correlação entre o grau de satisfação com o travesseiro de gel e a sonolência diurna excessiva (r2 = 0,19; p = 0,0443). CONCLUSÕES:: Em pacientes com apneia obstrutiva do sono tratados com CPAP nasal, o uso de um travesseiro de gel com recortes laterais aparentemente não tem nenhum impacto na eficácia do tratamento. No entanto, esses pacientes aparentemente preferem um travesseiro de gel a outros tipos de travesseiros.

Gel pillow designed specifically for obstructive sleep apnea treatment with continuous positive airway pressure / Travesseiro de gel com formato específico para o tratamento de apneia obstrutiva do sono com pressão positiva contínua nas vias aéreas

ABSTRACT Objective: To determine whether the use of a gel pillow with side cutouts designed to accommodate a continuous positive airway pressure (CPAP) mask and reduce head temperature improves the efficacy of and adherence to auto-CPAP therapy. Methods: Twenty-three consecutive CPAP-naïve patients with obstructive sleep apnea were enrolled in the study. Patients were given an auto-CPAP machine with an appropriate CPAP mask and were instructed to use CPAP for 15 nights. They were instructed to sleep with their own pillow (the control pillow) from nights 1 to 5 and with either a foam pillow or a gel pillow, both of which had side cutouts, for 5 consecutive nights each, in random order. After night 15, auto-CPAP machine data were downloaded and patients rated their satisfaction with each pillow on a visual analog scale. Results: Twenty-two patients completed the protocol. The pressures administered, residual apnea-hypopnea index, air leaks, and mean duration of CPAP use did not differ among the periods during which each pillow was used. Patients were significantly more satisfied with the gel pillow than with the control pillow and the foam pillow (p = 0.022 and p = 0.004, respectively), their level of satisfaction with the gel pillow correlating significantly with excessive daytime sleepiness (r2 = 0.19; p = 0.0443). Conclusions: Among obstructive sleep apnea patients treated with nasal CPAP, the use of a gel pillow with side cutouts appears to have no impact on treatment effectiveness. Nevertheless, such patients seem to prefer a gel pillow over other types of pillows.

RESUMO Objetivo: Determinar se o uso de um travesseiro de gel com recortes laterais para acomodar a máscara de continuous positive airway pressure (CPAP, pressão positiva contínua nas vias aéreas) e diminuir a temperatura em torno da cabeça melhora a eficácia do tratamento com auto-CPAP e a adesão dos pacientes ao tratamento. Métodos: Foram incluídos no estudo 23 pacientes consecutivos com apneia obstrutiva do sono que nunca haviam recebido tratamento com CPAP. Os pacientes receberam um aparelho de auto-CPAP com uma máscara apropriada e foram instruídos a usar CPAP durante 15 noites. Foram também instruídos a dormir com seu próprio travesseiro (o travesseiro controle) nas 5 primeiras noites e com um travesseiro de espuma ou um travesseiro de gel, ambos com recortes laterais, durante 5 noites consecutivas cada, em ordem aleatória. Depois da 15ª noite, os dados registrados nos aparelhos de auto-CPAP foram baixados e os pacientes determinaram seu grau de satisfação com cada travesseiro por meio de uma escala visual analógica. Resultados: Vinte e dois pacientes completaram o protocolo. Não houve diferenças entre os períodos durante os quais cada travesseiro foi usado quanto às pressões administradas, índice de apneia-hipopneia residual, vazamentos de ar e média de duração da CPAP. Os pacientes ficaram significativamente mais satisfeitos com o travesseiro de gel do que com o travesseiro controle e o travesseiro de espuma (p = 0,022 e p = 0,004, respectivamente), com correlação entre o grau de satisfação com o travesseiro de gel e a sonolência diurna excessiva (r2 = 0,19; p = 0,0443). Conclusões: Em pacientes com apneia obstrutiva do sono tratados com CPAP nasal, o uso de um travesseiro de gel com recortes laterais aparentemente não tem nenhum impacto na eficácia do tratamento. No entanto, esses pacientes aparentemente preferem um travesseiro de gel a outros tipos de travesseiros.

Relaxin in Obstructive Sleep Apnea: Relationship with Blood Pressure and Inflammatory Mediators.

BACKGROUND: Obstructive sleep apnea (OSA) is associated with nocturnal intermittent hypoxia, which may be responsible for increased circulating levels of vascular endothelial growth factor (VEGF) and inflammatory mediators, such as metalloproteinases (MMPs), and which contributes to the pathogenesis of systemic hypertension. Why some OSA patients remain normotensive is poorly understood. Relaxin-2, a pregnancy hormone, may sometimes circulate in men and could increase in hypoxic conditions. It exerts a vasodilatory activity and can modulate the release of molecules, such as MMPs and VEGF. OBJECTIVES: The objective of this study was to explore if circulating relaxin-2 in male OSA subjects may be related to OSA severity, to circulating levels of MMPs, of their inhibitors (tissue inhibitors of metalloproteinases; TIMPs), and of VEGF, and if it may protect from hypertension. PATIENTS AND METHODS: Fifty untreated male subjects with suspected OSA were recruited. After nocturnal polysomnography, a morning venous blood sample was withdrawn. Then, 24-hour ambulatory blood pressure (BP) monitoring was performed. RESULTS: The respiratory disturbance index in the sample was 30.4 [interquartile range (IQR) 15.6-55.2]. Relaxin-2 was detectable in 20 subjects. These subjects did not differ in OSA severity or diurnal and nocturnal BP from subjects with undetectable relaxin-2, but they showed lower TIMP-1 (126.8 ± 29.1 vs. 156.9 ± 41.7 pg/ml, respectively; p = 0.007) and a marginally higher MMP-9/TIMP-1 molar ratio [0.58 (IQR 0.23-1.35) vs. 0.25 (IQR 0.15-0.56); p = 0.052]. CONCLUSIONS: Relaxin-2 in male subjects was not related to OSA severity, but it was associated with lower TIMP-1. As it was often undetectable, even when BP values were normal, it is unlikely that it plays a role as a major factor protecting from hypertension in OSA.

Obstructive Sleep Apnea Is Associated with Liver Damage and Atherosclerosis in Patients with Non-Alcoholic Fatty Liver Disease.

BACKGROUND/AIMS: We assessed whether obstructive sleep apnea (OSA) and nocturnal hypoxemia are associated with severity of liver fibrosis and carotid atherosclerosis in patients with biopsy-proven NAFLD and low prevalence of morbid obesity. Secondary aim was to explore the association of OSA and hypoxemia with NASH and severity of liver pathological changes. METHODS: Consecutive patients (n = 126) with chronically elevated ALT and NAFLD underwent STOP-BANG questionnaire to estimate OSA risk and ultrasonographic carotid assessment. In patients accepting to perform cardiorespiratory polygraphy (PG, n = 50), OSA was defined as an apnea/hypopnea index ≥5. A carotid atherosclerotic plaque was defined as a focal thickening >1.3 mm. RESULTS: Prevalence of high OSA risk was similar in patients refusing or accepting PG (76% vs 68%, p = 0.17). Among those accepting PG, overall OSA prevalence was significantly higher in patients with F2-F4 fibrosis compared to those without (72% vs 44%; p = 0.04). Significant fibrosis was independently associated with mean nocturnal oxygen saturation (SaO2)<95% (OR 3.21, 95%C.I. 1.02-7.34; p = 0.04). Prevalence of OSA tended to be higher in patients with, than in those without, carotid plaques (64% vs 40%; p = 0.08). Carotid plaques were independently associated with %time at SaO2<90% >1 (OR 6.30, 95%C.I. 1.02-12.3; p = 0.01). CONCLUSIONS: In NAFLD patients with chronically elevated ALT at low prevalence of morbid obesity, OSA was highly prevalent and indexes of SaO2 resulted independently associated with severity of liver fibrosis and carotid atherosclerosis. These data suggest to consider sleep disordered breathing as a potential additional therapeutic target in severe NAFLD patients.

Effect of obstructive sleep apnea diagnosis on health related quality of life.

BACKGROUND: Perceived Health Related Quality of Life (HRQoL) is impaired in obstructive sleep apnea (OSA). To our knowledge, no study has analyzed the effect of OSA diagnosis communication on HRQoL. We evaluated self-perceived HRQoL in patients afferent to our sleep center, in order to examine the effect of the diagnosis disclosure on their HRQoL. METHODS: Two hundred ninety-seven consecutive outpatients (227 M) (mean age 54.1 ± 11.6 yrs, range 23-80 yrs) were evaluated, before first clinical visit and nocturnal diagnostic examination (Time A), and after diagnosis disclosure (Time B), with two self-reported questionnaires for HRQoL assessment: Psychological General Well-Being Index (PGWBI), consisting of anxiety, depressed mood, positive well-being, self-control, general health, vitality subscales, and 12-Item Short-Form Health Survey (SF-12), comprising Physical (PCS) and Mental Component Summaries (MCS). RESULTS: Comparison of mean HRQoL scores at Time A with reference values, showed worse scores. Mean PGWBI Total and subscales scores improved at Time B. Similar improvement was observed for SF-12 MCS (p = 0.0148), but nor for SF-12 PCS. At Time B, Anxiety, Depression and Well-being PGWBI subscales became similar to reference values, while the scores in the other PGWBI subscales and SF-12 remained worse. Comparison between males and females showed higher HRQoL values for males at both times. Score changes were independent from age, gender, BMI, AHI, TSat90 and excessive daytime sleepiness. CONCLUSIONS: Diagnosis communication improves patients' HRQoL, regardless of the severity. Changes in HRQoL after diagnosis disclosure may be due to patients' motivation for medical check and diagnostic expectations.

Usefulness of reinforcing interventions on continuous positive airway pressure compliance.

BACKGROUND: Obstructive sleep apnea (OSA) is a high prevalence sleep disorder characterized by upper airway obstruction during sleep, nocturnal intermittent hypoxemia, poor sleep quality, risk for cardiovascular and metabolic diseases. The adherence to CPAP is the key for an effective management of these patients.The aim of the study was to assess the adherence to CPAP therapy with and without early reinforcing interventions, consisting of motivational reinforcement and technical support in the first month of therapy. METHODS: Forty patients with OSA undergoing counseling and a one year follow-up on a quarterly basis were included in the study. Twenty subjects (intervention group) underwent reinforcing interventions with telephone interviews in the first month of therapy, and twenty (control group) remained without reinforcing interventions. The two populations were homogeneous for age, severity of illness and BMI. RESULTS: During the first month, intervention group patients showed a higher number of nights with a device use ≥4 hours. Average treatment adherence in the first month (days of therapy with at least 4 hours per night on the total number of days from device delivery) was 77.5% in the intervention group and 55.7% in the control group (p = 0.022). At one year the differences between the two groups were not significant. CONCLUSIONS: Our findings suggest that it is important that adequate time and effort is spent to ensure patient comfort at the time of CPAP therapy start to optimize acceptance and adherence to treatment, and suggest that it is necessary to maintain reinforcing interventions over time.

Extreme REM Rebound during Continuous Positive Airway Pressure Titration for Obstructive Sleep Apnea in a Depressed Patient.

A 20% increase in REM sleep duration has been proposed as a threshold to identify REM rebound in patients with obstructive sleep apnea (OSA) who start continuous positive airway pressure (CPAP) treatment. We describe the case of one patient with OSA who showed an unexpectedly high degree of REM rebound during titration of CPAP. A 34-year-old man was diagnosed with OSA. He remained untreated for many years, during which he developed systemic hypertension, depression, and severe daytime somnolence. When he was reevaluated sixteen years later, his Epworth sleepiness score was 18, and his OSA had greatly worsened (apnea/hypopnea index: 47, lowest nocturnal saturation: 57%). He underwent a successful CPAP titration during nocturnal polysomnography. Electroencephalographic analysis of the sleep recording revealed a huge amount of REM sleep, accounting for 72% of the total sleep time. When asked, the patient referred that he had suddenly interrupted paroxetine assumption three days before the polysomnography. The very large REM rebound observed in this patient could be due to additional effects of initiation of CPAP therapy and suspension of antidepressive treatment. This case does not report any dangerous consequence, but sudden antidepressive withdrawal could be dangerous for patients with OSA who develop hypoventilation during REM sleep with CPAP application.

Quality of life in patients at first time visit for sleep disorders of breathing at a sleep centre.

INTRODUCTION: Sleep-disordered breathing adversely affects daytime alertness and cognition. Obstructive sleep apnea (OSA) patients have several typical symptoms including habitual snoring, excessive daytime sleepiness, fatigue, lack of concentration, memory impairment, and at times psychological disturbances. We evaluated different aspects in the health related quality of life (HRQoL) in subjects referred to our sleep laboratory for their first examination for suspicion of OSA. METHODS: One hundred ninety-eight consecutive outpatients (152 M) (mean age 52.7 ± 12.8 years, range 18-82 years; mean BMI 31.0 ± 6.5 kg/m(2), range 17.3-57.8 kg/m(2) were evaluated with two self-reported questionnaires for HRQoL assessment: Psychological General Well-Being Index (PGWBI), that asses anxiety, depressed mood, positive well-being, self-control, general health, vitality, and 12-Item Short-Form Health Survey (SF-12), consisting assesses of Physical and Mental Component Summaries (PCS and MCS). Epworth Sleepiness Scale (ESS) was used to assess daytime sleepiness before nocturnal diagnostic examination. RESULTS: Subjects showed variable HRQoL scores. HRQoL was worse in women than men and it decreased with age. No relation was found with AHI severity (range 0-129 n/h). BMI and TSat90 (range 0-87.9%) affected physical health perception (SF-12 PCS). Furthermore TSat90 influenced PGWBI Vitality subscale. Subjects with ESS > 10 showed a worse HRQoL profile (p < 0.001) in SF-12 and in PGWBI. Multiple regression analysis showed that age, BMI and ESS were significant predictors of SF-12 PCS (p < 0.001; r(2) = 0.23). CONCLUSIONS: A worse HRQoL perception among subjects referred for OSA suspicion was not related to disease severity. BMI and hypoxemia influenced only some HRQoL dimensions, while excessive daytime sleepiness worsens all HRQoL components considered.

Comorbidities and survival in obstructive sleep apnoea beyond the age of 50.

BACKGROUND: Although mortality risk associated with obstructive sleep apnoea (OSA) tends to disappear from the age of 50, it has been suggested that OSA treatment by continuous positive airway pressure (CPAP) improves survival even in older subjects. Life expectancy of subjects with several diseases is worse if OSA coexists. The objectives of this study were to evaluate the relevance of comorbidities in the relationship between OSA and mortality, and in the effect of CPAP on survival, in subjects ≥ 50 years old. METHODS: Data from 810 patients studied by polysomnography for suspected OSA between 1991 and 2000 were retrospectively evaluated. In 2009, state of survival and use of CPAP were enquired. Three hundred and thirteen subjects were < 50 and 497 were ≥ 50 years at diagnosis. RESULTS: Age and comorbidities, but not apnoea/hypopnoea index (AHI) or lowest nocturnal arterial oxygen saturation (Nadir SaO(2)), predicted mortality in the whole sample. Nadir SaO(2) was related to mortality among the younger subjects without comorbidities (P = 0·01), but not among the older subjects. In the older patients with an AHI > 30 CPAP treatment was associated with a better survival only if comorbidities coexisted. CONCLUSIONS: Unlike in younger subjects, in subjects ≥ 50 years old, comorbidities do not mask an effect of OSA on mortality. Among OSA subjects ≥ 50 years old, comorbidities could separate those who may expect an improvement in survival with CPAP treatment from those who may not. Possibly, after the age of 50, OSA per se does not affect survival, but worsens prognosis of subjects with coexisting diseases.

A negative expiratory pressure test during wakefulness for evaluating the risk of obstructive sleep apnea in patients referred for sleep studies.

OBJECTIVE: Obstructive sleep apnea is characterized by increased upper airway collapsibility during sleep. The present study investigated the use of the negative expiratory pressure test as a method to rule out obstructive sleep apnea. METHODS: Flow limitation was evaluated in 155 subjects. All subjects underwent a diurnal negative expiratory pressure test and a nocturnal sleep study. The severity of sleep apnea was determined based on the apnea-hypopnea index. Flow limitation was assessed by computing the exhaled volume at 0.2, 0.5, and 1.0 s (V0.2, V0.5, and V1.0, respectively) during the application of a negative expiratory pressure and expressed as a percentage of the previous exhaled volume. Receiver-operating characteristic curves were constructed to identify the optimal threshold volume at 0.2, 0.5, and 1.0 s for obstructive sleep apnea detection. RESULTS: Mean expiratory volumes at 0.2 and 0.5 s were statistically higher (p <0.01) in healthy subjects than in all obstructive sleep apneic groups. Increasing disease severity was associated with lower expiratory volumes. The V0.2 (%) predictive parameters for the detection of sleep apnea were sensitivity (81.1%), specificity (93.1%), PPV (98.1%), and NPV (52.9%). Sensitivity and NPV were 96.9% and 93.2%, respectively, for moderate-to-severe obstructive sleep apnea, and both were 100% for severe obstructive sleep apnea. CONCLUSION: Flow limitation measurement by V 0.2 (%) during wakefulness may be a very reliable method to identify obstructive sleep apnea when the test is positive and could reliably exclude moderate and severe obstructive sleep apnea when the test is negative. The negative expiratory pressure test appears to be a useful screening test for suspected obstructive sleep apnea.

Upper airway collapsibility evaluated by a negative expiratory pressure test in severe obstructive sleep apnea.

OBJECTIVES: To investigate the usefulness of measuring upper airway collapsibility with a negative expiratory pressure application as a screening test for severe obstructive sleep apnea (OSA). INTRODUCTION: OSA is a risk factor for cardiovascular disease, and it may have serious consequences. Its recognition may have important implications during the perioperative period. Increased upper airway collapsibility is one of the main determinants of OSA, and its evaluation could be useful for identifying this condition. METHODS: Severe OSA and normal subjects (24 in each group) were matched by body mass index and referred to our sleep laboratory. The subjects were enrolled in an overnight sleep study, and a diurnal negative expiratory pressure test was performed. Flow drop (ΔV) and expiratory volume were measured in the first 0.2 s (V(0.2)) of the negative expiratory pressure test. RESULTS: ΔV (%) and V(0.2) (%) values were statistically different between normal and OSA subjects. OSA patients showed a greater decrease in flow than normal subjects. In addition, severely OSA patients exhaled during the first 0.2 s of the negative expiratory pressure application was an average of only 11.2% of the inspired volume compared to 34.2% for the normal subjects. Analysis of the receiver operating characteristics showed that V(0.2) (%) and ΔV (%) could accurately identify severe OSA in subjects with sensitivities of 95.8% and 91.7%, respectively, and specificities of 95.8% and 91.7%, respectively. CONCLUSIONS: V(0.2) (%) and ΔV (%) are highly accurate parameters for detecting severe OSA. The pharyngeal collapsibility measurement, which uses negative expiratory pressure during wakefulness, is predictive of collapsibility during sleep.

Upper airway collapsibility evaluated by a negative expiratory pressure test in severe obstructive sleep apnea

OBJECTIVES: To investigate the usefulness of measuring upper airway collapsibility with a negative expiratory pressure application as a screening test for severe obstructive sleep apnea (OSA). INTRODUCTION: OSA is a risk factor for cardiovascular disease, and it may have serious consequences. Its recognition may have important implications during the perioperative period. Increased upper airway collapsibility is one of the main determinants of OSA, and its evaluation could be useful for identifying this condition. METHODS: Severe OSA and normal subjects (24 in each group) were matched by body mass index and referred to our sleep laboratory. The subjects were enrolled in an overnight sleep study, and a diurnal negative expiratory pressure test was performed. Flow drop (DV) and expiratory volume were measured in the first 0.2 s (V02) of the negative expiratory pressure test. RESULTS: DV ( percent) and V02 ( percent) values were statistically different between normal and OSA subjects. OSA patients showed a greater decrease in flow than normal subjects. In addition, severely OSA patients exhaled during the first 0.2 s of the negative expiratory pressure application was an average of only 11.2 percent of the inspired volume compared to 34.2 percent for the normal subjects. Analysis of the receiver operating characteristics showed that V02 ( percent) and DV ( percent) could accurately identify severe OSA in subjects with sensitivities of 95.8 percent and 91.7 percent, respectively, and specificities of 95.8 percent and 91.7 percent, respectively. CONCLUSIONS: V02 ( percent) and DV ( percent) are highly accurate parameters for detecting severe OSA. The pharyngeal collapsibility measurement, which uses negative expiratory pressure during wakefulness, is predictive of collapsibility during sleep.

A negative expiratory pressure test during wakefulness for evaluating the risk of obstructive sleep apnea in patients referred for sleep studies

OBJECTIVE: Obstructive sleep apnea is characterized by increased upper airway collapsibility during sleep. The present study investigated the use of the negative expiratory pressure test as a method to rule out obstructive sleep apnea. METHODS: Flow limitation was evaluated in 155 subjects. All subjects underwent a diurnal negative expiratory pressure test and a nocturnal sleep study. The severity of sleep apnea was determined based on the apneahypopnea index. Flow limitation was assessed by computing the exhaled volume at 0.2, 0.5, and 1.0 s (V0.2, V0.5, and V1.0, respectively) during the application of a negative expiratory pressure and expressed as a percentage of the previous exhaled volume. Receiver-operating characteristic curves were constructed to identify the optimal threshold volume at 0.2, 0.5, and 1.0 s for obstructive sleep apnea detection. RESULTS: Mean expiratory volumes at 0.2 and 0.5 s were statistically higher (p <0.01) in healthy subjects than in all obstructive sleep apneic groups. Increasing disease severity was associated with lower expiratory volumes. The V0.2 ( percent) predictive parameters for the detection of sleep apnea were sensitivity (81.1 percent), specificity (93.1 percent), PPV (98.1 percent), and NPV (52.9 percent). Sensitivity and NPV were 96.9 percent and 93.2 percent, respectively, for moderate-to-severe obstructive sleep apnea, and both were 100 percent for severe obstructive sleep apnea. CONCLUSION: Flow limitation measurement by V 0.2 ( percent) during wakefulness may be a very reliable method to identify obstructive sleep apnea when the test is positive and could reliably exclude moderate and severe obstructive sleep apnea when the test is negative. The negative expiratory pressure test appears to be a useful screening test for suspected obstructive sleep apnea.

Microbiological and clinical periodontal effects of fixed orthodontic appliances in pediatric patients.

The aim of this study was to evaluate changes of microbiota in ten patients undergoing orthodontic treatment. For each patient clinical examination of gingival index (GI) and plaque index (PI) were performed at the first molars at: baseline (T1), 2 (T2), 4 (T3) and 12 weeks (T4). At the same time subgingival plaque and tongue samples were taken for the microbiological study. Clinical results showed that at T4, the mean PI score was significantly lower than T1 and the GI was markedly reduced. Microbiological results showed that at T1 and T4 facultative aerobic bacteria were prevalent, whereas anaerobic bacteria were more common at T2 and T3.