A Novel Clinical Tool to Detect Severe Obstructive Sleep Apnea.

Purpose: Obstructive sleep apnea (OSA) is a disease with high morbidity and is associated with adverse health outcomes. Screening potential severe OSA patients will improve the quality of patient management and prognosis, while the accuracy and feasibility of existing screening tools are not so satisfactory. The purpose of this study is to develop and validate a well-feasible clinical predictive model for screening potential severe OSA patients. Patients and Methods: We performed a retrospective cohort study including 1920 adults with overnight polysomnography among which 979 cases were diagnosed with severe OSA. Based on demography, symptoms, and hematological data, a multivariate logistic regression model was constructed and cross-validated and then a nomogram was developed to identify severe OSA. Moreover, we compared the performance of our model with the most commonly used screening tool, Stop-Bang Questionnaire (SBQ), among patients who completed the questionnaires. Results: Severe OSA was associated with male, BMI≥ 28 kg/m2, high blood pressure, choke, sleepiness, apnea, white blood cell count ≥9.5×109/L, hemoglobin ≥175g/L, triglycerides ≥1.7 mmol/L. The AUC of the final model was 0.76 (95% CI: 0.74-0.78), with sensitivity and specificity under the optimal threshold selected by maximizing Youden Index of 73% and 66%. Among patients having the information of SBQ, the AUC of our model was statistically significantly greater than that of SBQ (0.78 vs 0.66, P = 0.002). Conclusion: Based on common clinical examination of admission, we develop a novel model and a nomogram for identifying severe OSA from inpatient with suspected OSA, which provides physicians with a visual and easy-to-use tool for screening severe OSA.

Muscle type of palatopharyngeal muscle in children with severe obstructive sleep apnea.

STUDY OBJECTIVES: To investigate the fiber-type distribution in palatopharyngeal muscle via adenosine triphosphatase and quantitative real-time polymerase chain reaction in children with severe obstructive sleep apnea (OSA). METHODS: Study participants were 12 children with severe OSA and 15 children with simple snoring as the control group. Both groups were diagnosed by polysomnography and treated with tonsillectomy. The samples of palatopharyngeus muscle were studied under adenosine triphosphatase staining and quantitative real-time polymerase chain reaction to classify the different fiber types. RESULTS: There were no differences in baseline age, body mass index, tonsil size, or sleep stage constitution between the 2 groups. Dominance (>60%) of type I fiber was observed both in children with simple snoring (3/15, 20%) and in those with severe OSA (1/12, 8.3%) via adenosine triphosphatase staining. Predominance of type II fibers was seen in 3/15 (20%) in the control group and 6/12 (50%) in the severe OSA group, respectively. Type grouping was also seen in 8/15 (53.3%) in non-OSA and 6/12 (50%) in severe OSA groups, respectively. There was no difference in distribution of subtype fibers assessed by quantitative real-time polymerase chain reaction between the 2 groups; the mean percentages of type I fibers were 25.8% ± 19.5% and 20.9% ± 16.6%, respectively (P > .05), similar to type IIa fibers (35.2% ± 23.4% and 40.9% ± 28.8%) (P > .05). There was a decrease in the percentage of type I fibers between children younger and older than 12 years (P < 0.05), although this was not due to OSA (P > 0.05). CONCLUSIONS: There were no specific changes via adenosine triphosphatase staining or a difference in distribution of subtype fibers via quantitative real-time polymerase chain reaction between children with severe pediatric OSA and those with simple snoring, whereas the percentage of type I fiber decreased dynamically due to age but not OSA. CLINICAL TRIAL REGISTRATION: Registry: Chinese Clinical Trials Registry; Name: A study of the mechanism of the conversion of upper airway expasion muscle's fiver types of OSA patient which may be mediated by estrogen-related receptor alpha; URL: https://www.chictr.org.cn/showproj.aspx?proj=6144; Identifier: ChiCTR-CCC-13003415.

Z-palatopharyngoplasty combined with 70-degree endoscopy-assisted coblator partial medial glossectomy on severe obstructive sleep apnea.

Background: Patients with severe obstructive sleep apnea (OSA) require safe and effective surgical treatment. Objectives: To evaluate the effectiveness of combined Z-palatopharyngoplasty (ZPPP) and partial glossectomy via 70-degree endoscopy-assisted coblation (Eco-TBR) on severe OSA. Materials and methods: Twenty-two consecutive patients with severe OSA were enrolled between September 2014 and July 2016. The lingual artery was evaluated by contrasted computed tomography (CT). Drug-induced sleep endoscopy (DISE) was performed to determine the necessity of multilevel surgery. Combined ZPPP and Eco-TBR were performed. Polysomnographic parameters were collected pre-operatively and 6 months post-operatively. Results: No adverse events were observed postoperatively. The short-term ( < 12 months) rate of total surgical effectiveness was 63.6% (14/22), with Friedman classifications as follows: I (1/1), Friedman II (6/10) and Friedman III (7/11). There were no differences between Friedman classification groups. The differences in AHI, apnea index (AI), mean blood oxygen, and percentage of cumulative time with oxygen saturation < 90% (CT 90%) were different compared to preoperative levels. Tonsil size was also significantly larger in the multi-level surgery group (2.14 ± 1.03) compared with the control group (1.13 ± 0.64). Conclusions and significance: Combined ZPPP and Eco-TB is safe and effective, with good surgical effectiveness for the treatment of severe OSA patients.