Prediction of obstructive sleep apnea syndrome in a large Greek population

Purpose

We aimed to evaluate the predictive value of anthropometric measurements and self-reported symptoms of obstructive sleep apnea syndrome (OSAS) in a large number of not yet diagnosed or treated patients. Commonly used clinical indices were used to derive a prediction formula that could identify patients at low and high risk for OSAS.

Methods

Two thousand six hundred ninety patients with suspected OSAS were enrolled. We obtained weight; height; neck, waist, and hip circumference; and a measure of subjective sleepiness (Epworth sleepiness scale??ESS) prior to diagnostic polysomnography. Excessive daytime sleepiness severity (EDS) was coded as follows: 0 for ESS????3 (normal), 1 for ESS score 4?C9 (normal to mild sleepiness), 2 for score 10?C16 (moderate to severe sleepiness), and 3 for score >16 (severe sleepiness). Multivariate linear and logistic regression analysis was used to identify independent predictors of apnea?Chypopnea index (AHI) and derive a prediction formula.

Results

Neck circumference (NC) in centimeters, body mass index (BMI) in kilograms per square meter, sleepiness as a code indicating EDS severity, and gender as a constant were significant predictors for AHI. The derived formula was: $ {\hbox{AHIpred}} = {\hbox{NC}} \times 0.{84} + {\hbox{EDS}} \times {7}.{78} + {\hbox{BMI}} \times 0.{91} - [{8}.{2} \times {\hbox{gender constant }}\left( {\hbox{1 or 2}} \right) + {37}] $ . The probability that this equation predicts AHI greater than 15 correctly was 78%.

Conclusions

Gender, BMI, NC, and sleepiness were significant clinical predictors of OSAS in Greek subjects. Such a prediction formula can play a role in prioritizing patients for PSG evaluation, diagnosis, and initiation of treatment.     

Oxidative stress in patients with obstructive sleep apnea syndrome

Purpose

We aimed to investigate whether systemic oxidative stress is increased in patients with obstructive sleep apnea syndrome (OSAS).

Methods

A total of 18 patients with severe OSAS and 13 controls were included in the study. Inclusion criteria for OSAS patients were: snoring and apnea–hypopnea index (AHI) of >30 in full polysomnography, no previous treatment for OSAS, non-smoking status, and a medical history of being free of comorbidities known to increase oxidative stress. Controls were recruited among subjects assessed for snoring in the Sleep Laboratory Department if they had AHI<5. At baseline, patients were evaluated by the Epworth Sleepiness Scale and underwent spirometry, echocardiography, and full polysomnographic study. Blood samples were collected for evaluation of oxidative stress biomarkers [protein carbonyls, reduced (GSH) and oxidized (GSSG) glutathione, 8-isoprostane, thiobarbituric acid-reactive substances (TBARS), catalase activity, Cu–Zn superoxide dysmutase (SOD), total antioxidant capacity (TAC)] before and on the morning following polysomnography.

Results

The overnight (morning–night) change (%) of GSH/GSSG ratio and GSH was significantly different between OSAS and controls (p?=?0.03 and p?=?0.048, respectively). Plasma protein carbonyls, erythrocyte catalase activity, 8-isoprostane, SOD, TBARS, and TAC plasma values were not different between OSAS and controls (p?>?0.05). No significant correlation was found between changes in the levels of biomarkers and AHI, arousal, or desaturation index.

Conclusion

The present prospective investigation in a population free of comorbidities or factors which may increase systemic oxidative stress provides evidence that obstructive sleep apnea per se might be associated with increased oxidative burden possibly via GSH/GSSG pathway.     

Serum S100A12 levels are associated with the presence and severity of obstructive sleep apnea syndrome in male patients

Purpose

Inflammation plays a critical role in the pathogenesis of obstructive sleep apnea syndrome (OSAS). S100A12 is a newly identified inflammatory biomarker. This study aims to investigate whether serum S100A12 levels are associated with the presence and severity of OSAS in male patients.

Methods

A total of 126 male patients with OSAS and 74 controls were enrolled in this study. The presence and severity of OSAS was assessed by apnea–hypopnea index (AHI). Serum S100A12 levels were detected by enzyme-linked immunosorbent assay.

Results

Serum S100A12 levels were significantly higher in the OSAS group than in the control group (132.17 (range 101.86 to 174.49) ng/ml vs. 78.40 (range 58.35 to 129.44) ng/ml, P?<?0.01). Multivariate logistic regression demonstrated that S100A12 was the only significant and independent predictor of OSAS (odds ratio 1.012, 95 % confidence interval 1.006 to 1.017; P?<?0.01). Serum S100A12 levels elevated with the increase in the severity of OSAS (S100A12 levels of 106.04 (range 83.92 to 135.13) ng/ml in mild OSAS group, 133.51 (range 109.64 to 208.95) ng/ml in moderate OSAS group, and 173.04 (range 131.88 to 275.77) ng/ml in severe OSAS group; P?<?0.001). Serum S100A12 levels were independently correlated with AHI scores (r?=?0.324, P?<?0.001)

Conclusions

Serum S100A12 levels were independently associated with the presence and severity of OSAS. These findings suggest that serum S100A12 level could be a potential biomarker for reflecting the presence and severity of OSAS.     

Validation of ApneaLink Ox™ for the diagnosis of obstructive sleep apnea

Objective

The aim of the study was to validate the automatic and manual analysis of ApneaLink Ox? (ALOX) in patients with suspected obstructive sleep apnea (OSA).

Methods

All patients with suspected OSA had a polysomnography (PSG) and an ALOX performed in the sleep laboratory. For automatic analysis, hypopnea was defined as a decrease in airflow ≥30 % of baseline for at least 10 s plus oxygen desaturation ≥3 or 4 %. While for the manual analysis, hypopnoea was considered when a reduction of airflow ≥30 % of ≥10 s plus oxygen desaturation ≥3 % or increase in cardiac rate ≥5 beats/min were identified or, when only a reduction of airflow ≥50 % was observed. OSA was defined as a respiratory disturbance index (RDI) ≥5. The apnea/hypopnea automatic index (AHI3-a, AHI4-a) and manual index were estimated. Receiver operating characteristics (ROC) analysis and the agreement between ALOX and PSG were performed.

Results

Fifty-five patients were included (38 men; mean age, 48.2; median, RDI 15.1; median BMI, 30 Kg/m²). The automatic analysis of ALOX under-estimated the RDI from PSG, mainly for the criterion of oxygen desaturation ≥4 % (AHI3-a–RDI, ?3.6?±?10.1; AHI4-a–RDI, ?6.5?±?10.9, p?<?0.05). The autoscoring from ALOX device showed a better performance when it was set up to identify hypopneas with an oxygen desaturation criterion of ≥3 % than when it was configured with an oxygen desaturation criterion of ≥4 % (area under the receiver operator curves, 0.87 vs. 0.84). Also, the manual analysis was found to be better than the autoscoring set up with an oxygen desaturation of ≥3 % (0.923 vs. 0.87). The manual analysis showed a good interobserver agreement for the classification of patients with or without OSA (k?=?0.81).

Conclusion

The AHI obtained automatically from the ApneaLink Ox? using oxygen desaturation ≥3 % as a criterion of hypopnea had a good performance to diagnose OSA. The manual scoring from ApneaLink Ox? was better than the automatic scoring to discriminate patients with OSA.     

Personality profiles in patients with obstructive sleep apnea

Objective

The Minnesota Multiphasic Personality Inventory (MMPI) responses between snorers and obstructive sleep apnea (OSA) may be different. Thus, we compared the MMPI responses between snorers and OSA.

Design

A clinical-based cross-sectional survey.

Participants

This is a survey of 94 treatment-naive sleep-disordered breathing (SDB) subjects.

Method

Clinical information, body mass index (BMI), 36-item Short Form Health Survey, the Turkish version of the MMPI, Epworth sleepiness scale (ESS), fatigue scale, attention-deficit scale, and polysomnography were collected. All patients with OSA and snorers was accepted as individuals with SDB (AHI?>?0 events/h). The threshold of five apnea and hypopnea per hour of sleep was chosen to define both OSA and snorers. Disability profile is consisting of four or more MMPI clinical scale elevations.

Results

OSA patients compared to snorers have significantly higher absolute scores on hypochondriasis (Hs) (65.0?±?12.0 vs 58.4?±?7.9, p?=?0.01, respectively). OSA patients compared to snorers have significantly higher rate of clinical elevation on both psychopathic deviance (13.0 vs 0?%, p?=?0.03, respectively) and Hs (26.1 vs 3.3?%, p?=?0.01, respectively). People with disability profile has lower the quality of life, a higher score for inattention, a higher fatigue scores, and higher sleepiness scores. The quality of life and attention deficit and daytime sleepiness scores were associated with total MMPI absolute score in individuals with SDB in bivariate analyses.

Conclusion

Present study indicated that patients with OSAS compared to snorers displayed significantly more hyopchondriasis and psychopathic deviance personality characteristics. The daytime functions in individuals with sleep-disordered breathing may be influenced by the severity of psychopathology.     

Complete denture wear during sleep in elderly sleep apnea patients—a preliminary study

Objectives

There is no consensus in the literature about the impact of complete denture wear on obstructive sleep apnea (OSA). The goal of this randomized clinical study was to assess if complete denture wear during sleep interferes with the quality of sleep.

Materials and methods

Elderly edentulous OSA patients from a complete denture clinic were enrolled and received new complete dentures. An objective sleep analysis was determined with polysomnography performed at the sleep laboratory for all patients who slept either with or without their dentures.

Results

Twenty-three patients (74% females) completed the study with a mean age of 69.6?years and a mean body mass index of 26.7?kg/m². The apnea and hypopnea index (AHI) was significantly higher when patients slept with dentures compared to without (25.9?±?14.8/h vs. 19.9?±?10.2/h; p?>?0.005). In the mild OSA group, the AHI was significantly higher when patients slept with the dentures (16.6?±?6.9 vs. 8.9?±?2.4; p?p?=?0.2). The supine AHI in mild patients was related to a higher increase in AHI while wearing dentures (12.7?±?8.4/h vs. 51.9?±?28.6/h; p?Conclusions Contrary to previous studies, we found that OSA patients may experience more apneic events if they sleep with their dentures in place. Specifically, in mild OSAS patients, the use of dentures substantially increases the AHI especially when in the supine position.     

Negative association between self-reported jaw symptoms and apnea–hypopnea index in patients with symptoms of obstructive sleep apnea syndrome: a pilot study

Objectives

Prior to oral appliance therapy for snoring and obstructive sleep apnea syndrome (OSAS), patients are screened for jaw symptoms (e.g., pain). However, the presence of jaw symptoms in a large spectrum of OSAS patients remains unknown. This study aimed to assess the distribution of subjective jaw symptoms in patients with symptoms of OSAS.

Methods

Five hundred and eleven consecutive patients (66 female, 445 male; mean age 49.6?±?12.6 years) with clinical symptoms of OSAS were enrolled for cardiorespiratory evaluation. Self-administered questionnaires were used to assess jaw symptoms, tooth grinding and clenching during sleep, morning oral dryness, morning heartburn sensation, and pain in the neck and back.

Results

The mean apnea–hypopnea (AHI) index was 32.5?±?30.6 per hour of sleep. Nineteen percent of patients (n?=?96) reported at least one jaw symptom. The presence of jaw symptoms was more frequently reported by patients with AHI less than 15 (25 %) than those with AHI of 15 and more (15 %, p?=?0.012). In the crude analyses, jaw symptoms were associated with tooth grinding, tooth clenching, morning oral dryness, morning heartburn sensation, and neck/back pain. Multiple logistic regression analysis confirmed that jaw symptoms were associated with AHI less than 15 (odds ratio (OR) 1.99, p?=?0.009), tooth clenching (OR 1.79, p?=?0.006), morning oral dryness (OR 2.17, p?=?0.02), and neck/back pain (OR 1.99, p?=?0.005).

Conclusions

Jaw symptoms can be found in 19 % of patients with symptoms of OSAS and are more frequently reported in patients with lower AHI, a patient population for whom oral appliances are often prescribed.     

Is portable monitoring for diagnosing obstructive sleep apnea syndrome suitable in elderly population?

Purpose

Obstructive sleep apnea syndrome (OSAS) is highly prevalent in the elderly. Unattended, at-home portable monitoring (PM) is a diagnostic alternative to polysomnography in adults with high clinical probability of OSAS. However, no studies have evaluated the diagnostic accuracy of PM in elderly population. The aim of our study was to evaluate the effectiveness of PM in elderly patients.

Methods

We selected patients aged over 65 years with suspected OSAS. Two-order randomized evaluations were performed: one night of at-home PM (PMhome) and one night of simultaneous PM and polysomnography (PSG) in the sleep lab (PSG+PM). We obtained three different apnea–hypopnea index (AHI): AHI from PSG (AHI PSG), AHI from at-home PM (AHI PMhome), and AHI from PM+PSG (AHI PM+PSG). Two technicians, blinded to the recording order, scored each sleep study.

Results

We studied a total of 43 patients. No difference between the AHI values for each of the different recordings was found (p?>?0.05). There was good correlation between AHI PSG and AHI PMhome (r?=?0.67) and AHI PSG+PM (r?=?0.84). The area under the receiver operator curve was above 0.83, indicating good sensitivity and a positive predictive value for AHI with cutoffs of 5, 15, and 30 and good specificity and negative predictive value for AHI values above 15. Correlation, accuracy, and agreement were greater when the recordings were made simultaneously.

Conclusions

PM was effective for diagnosing OSAS in the elderly and can be used as an alternative to PSG in elderly patients with a high clinical probability of OSAS.     

Obstructive sleep apnea syndrome and anthropometric obesity indexes

Background

The purpose of this study is to investigate whether the general body adiposity or regional adiposity was a risk factor in the evolution of obstructive sleep apnea syndrome (OSAS) by examining the relationships between the anthropometric obesity indexes such as waist (WC) and neck circumference index (NC), body mass index (BMI), and OSAS in Turkish adult population, and to access the possible differences by gender.

Methods

The data related to polysomnographic, demographic, and anthropometric indexes of the 499 subjects were examined retrospectively. The patients whose apnea?Chypopnea index was ??5 were determined as OSAS group.

Results

The avarage BMI, WC, and NC of the OSAS group (n?=?431) were statistically higher than the control group (p?<?0.001). According to logistic regression analysis, BMI, WC, and NC enlargement were observed as significant risk factors for OSAS development. Risk coefficients were determined 5.53 for NC, 4.48 for WC, and 2.22 for BMI. Cutoff point values for anthropometric obesity indexes as OSAS determiner were recorded as below: BMI for male >27.77?kg/m² and female >28.93?kg/m², NC index for male >40?cm and female >36?cm, and WC index for male >105?cm and female >101?cm.

Conclusions

BMI, WC, and NC enlargement were determined as significant risk factors for OSAS development. This was an initial study to determine the cutoff points of which increase the OSAS risk in BMI, WC, and NC index in Turkish adult population.     

The evaluation of the Croatian version of the Epworth sleepiness scale and STOP questionnaire as screening tools for obstructive sleep apnea syndrome

Purpose

Growing awareness of obstructive sleep apnea syndrome (OSAS) has increased the need for concise and reliable screening tools. The Epworth sleepiness scale (ESS) has been validated in numerous languages and ethnic groups, since it was originally designed for the English-speaking population. The STOP questionnaire was developed as a novel OSAS screening tool in surgical patients, but has not been validated in the general population. The present study was undertaken to provide reliable and validated ESS in the Croatian language and to evaluate the ESS and STOP as screening instruments for OSAS.

Methods

The Croatian version of ESS and STOP questionnaire was administered to 217 patients referred to the Split Sleep Medicine Center and 208 healthy control subjects. Test?Cretest reliability was investigated in 20 healthy subjects.

Results

The ESS score was significantly higher for the patients referred to the Split Sleep Medicine Center compared to the control group (8.2?±?5.0 vs. 5.9?±?3.8, p?5/h was 0.64, and for the STOP questionnaire, it was 0.84.

Conclusions

Both ESS and STOP questionnaires successfully distinguished healthy subjects from subjects with OSAS. The STOP questionnaire had better probability to correctly predict high-risk patients for OSAS compared to ESS. We propose that the STOP questionnaire could be used as an easy-to-use and accurate screening tool in identification of patients with risk for OSAS in the general population, but it has not been tested in the Croatian population yet.     

Sleep-disordered breathing and C-reactive protein in obese children and adolescents

Purpose

Sleep-disordered breathing (SDB) is common among overweight and obese children. It is a risk factor for several health complications, including cardiovascular disease. Inflammatory processes leading to endothelial dysfunction are a possible mechanism linking SDB and cardiovascular disease. Elevated C-reactive protein (CRP) is a risk factor for cardiovascular disease and is independently correlated with obstructive sleep apnea syndrome (OSAS) in adults. Our goal is to evaluate the relationship between CRP and OSAS in overweight and obese children and adolescents.

Methods

One hundred and twenty children were prospectively studied (85 without OSAS, 20 mild OSAS, 15 moderate-to-severe OSAS). All subjects underwent polysomnography, and a blood sample was taken to determine CRP levels.

Results

No significant differences were found in CRP between subjects with or without OSAS, and no correlations were found between CRP and OSAS severity, despite the relationship between CRP and BMI (r?=?0.21, p?=?0.015) and between CRP and fat mass (r?=?0.31, p?<?0.001).

Conclusion

These results suggest that CRP levels are correlated with the level of obesity but are not influenced by SDB in obese children and adolescents; hence, this in contrast to that in adult population.     

Continuous positive airway pressure intolerance associated with elevated nasal resistance is possible mechanism of complex sleep apnea syndrome

Purpose

Complex sleep apnea syndrome (CompSAS) is diagnosed after an elimination of obstructive events with continuous positive airway pressure (CPAP), when a central apnea index ??5/h or Cheyne?CStokes respiration pattern emerges in patients with obstructive sleep apnea syndrome (OSAS). However, the pathophysiology of CompSAS remains controversial.

Methods

Of the 281 patients with suspected OSAS, all of whom underwent polysomnography conducted at Nagoya University Hospital, we enrolled 52 patients with apnea?Chypopnea index ??15/h (age 51.4?±?13.3?years). The polysomnographic findings, left ventricular ejection fraction (LVEF), and nasal resistance were compared between the CompSAS patients and OSAS patients.

Results

Forty-three patients were diagnosed with OSAS and nine patients with central sleep apnea syndrome by natural sleep PSG. Furthermore, 43 OSAS patients were classified into the OSAS patients (OSAS group, n?=?38) and the CompSAS patients (CompSAS group, n?=?5) by the night on CPAP PSG. The nasal resistance was significantly higher in CompSAS group than in OSAS group (0.30?±?0.10 vs. 0.19?±?0.07?Pa/cm³/s, P?=?0.004). The arousal index, percentage of stage 1 sleep, and oxygen desaturation index were significantly decreased, and the percentage of stage REM sleep was significantly increased in the OSAS group with the initial CPAP treatment, but not in the CompSAS group. In addition, the patients with CompSAS showed normal LVEF.

Conclusion

CPAP intolerance secondary to an elevated nasal resistance might relate to frequent arousals, which could presumably contribute to an increase in central sleep apnea. Further evaluation in a large study is needed to clarify the mechanism of CompSAS.     

Insomnia symptoms influence CPAP compliance

Purpose

The aim of this study is to determine parameters which influence 6-month compliance of continuous positive airway pressure therapy (CPAP) in patients with obstructive sleep apnea syndrome (OSAS).

Methods

This prospective study investigated 73 patients (24 females) with OSAS and medical indication for CPAP therapy: age 55.1?±?11.5 years, body mass index (BMI) 30.8?±?5.0 kg/m2, Apnea–Hypopnea Index (AHI) 39.2?±?26.7/h, Oxygen Desaturation Index (ODI) 33.2?±?25.4/h, minimum O₂ saturation 78.9?±?7.6%. The influence of baseline parameters (demographic and polysomnographic data, sleeping medication intakes, BMI, psychometrics [Epworth Sleepiness Scale, Regensburg Insomnia Scale, Vigilance test and Beck Depression Inventory]) on 6-month compliance was evaluated with a correlation and a linear regression analysis.

Results

The baseline value of the Regensburg Insomnia Scale (RIS) predicts 6-month CPAP compliance (r?=??0.376, R ²?=?0.14, p?<?0.001), although no other baseline parameter correlates. Patients with a compliance of <4 h/night show higher RIS scores, i.e., more insomnia symptoms (17.6?±?8.8) compared to those with ≥4 h/night (12.6?±?6.9; p?<?0.05).

Conclusions

Insomnia symptoms prior to the beginning of CPAP treatment show a negative influence on CPAP compliance. Further studies should clarify, if a treatment of insomnia symptoms leads to a benefit in compliance.     

Analysis of anatomical and functional determinants of obstructive sleep apnea

Purpose

Craniofacial abnormalities have an important role in the occurrence of obstructive sleep apnea (OSA) and may be particularly significant in Asian patients, although obesity and functional abnormalities such as reduced lung volume and increased airway resistance also may be important. We conducted simultaneous analyses of their interrelationships to evaluate the relative contributions of obesity, craniofacial structure, pulmonary function, and airway resistance to the severity of Japanese OSA because there are little data in this area.

Methods

A cross-sectional observational study was performed on 134 consecutive Japanese male patients. A sleep study, lateral cephalometry, pulmonary function tests, and impulse oscillometry (IOS) were performed on all patients.

Results

Age, body mass index (BMI), position of the hyoid bone, and proximal airway resistance on IOS (R20) were significantly related to the apnea/hypopnea index (AHI) (p?<?0.05) in multiple regression analysis. Subgroup analysis showed that, for moderate-to-severe OSA (AHI????15 events/h), neck circumference and R20 were predominantly related to AHI, whereas for non-to-mild OSA (AHI?<?15 events/h), age and expiratory reserve volume were the predominant determinants. In obese subjects (BMI????25?kg/m²), alveolar?Carterial oxygen tension difference, position of the hyoid bone, and R20 were significantly associated with AHI, whereas age alone was a significant factor in nonobese subjects (BMI?<?25?kg/m²).

Conclusions

Aside from age and obesity, anatomical and functional abnormalities are significantly related to the severity of Japanese OSA. Predominant determinants of AHI differed depending on the severity of OSA or the magnitude of obesity.     

Bone mineral density in patients with obstructive sleep apnea syndrome

Purpose

Obstructive sleep apnea syndrome (OSAS) is a disorder that is characterized by repetitive pauses in breathing during sleep. Airway obstruction episodes can lead to ischemia or hypoxia in tissues. Hypoxia may also have an effect on bone metabolism. In this study, we aim to investigate both the bone metabolic abnormalities and bone mineral density (BMD) in OSAS patients compared to individuals without OSAS.

Methods

Twenty-one male patients with OSAS and 26 control subjects, also male, enrolled in this study. Serum calcium, phosphorus, alkaline phosphatase, and urinary desoxypiridinoline levels were measured in all participants, and BMD was evaluated using DEXA (Hologic QDR 2000). The BMD was measured in the lumbar spine (L1–L4), the femoral neck, and total femur region.

Results

No statistically significant difference was noted between the two groups with respect to demographic data, except for body mass index (BMI). We adjusted the statistical analyses in line with the BMI and noted significant differences between OSAS patients and control subjects with regard to lumbar L1–L4 t score, lumbar L1–L4 BMD, and femoral neck BMD values (p?≤?0.001). We find significant correlations with lumbar L1-L4 BMD (r?=??0.4; p?=?0.023) and lumbar L1–L4 t score values (r?=??0.5; p?=?0.012).

Conclusion

Our study indicates that there is a relationship between OSAS and osteoporosis. However, further controlled studies comprising a greater number of patients are needed to investigate the relationship between osteoporosis and OSAS.     

Serum Romo1 is significantly associated with disease severity in patients with obstructive sleep apnea syndrome

Purpose

We aim to evaluate reactive oxygen species modulator 1 (Romo1) levels in obstructive sleep apnea syndrome (OSAS) and analyze its possible relationships to OSAS severity, reactive oxygen species (ROS), and C-reactive protein (CRP). Additionally, we also investigated the effects of nasal continuous positive airway pressure (nCPAP) on serum Romo1.

Methods

One hundred and five patients diagnosed with OSAS were classified into the OSAS group, and 41 subjects without OSAS were recruited for the control group. The OSAS group was further divided into mild, moderate, and severe OSAS subgroups. Fifteen patients with moderate and severe OSAS were treated with nCPAP. Serum levels of Romo1, ROS, and CRP were also measured.

Results

Serum Romo1, ROS, and CRP were the lowest in normal subjects and increased across OSAS severities (P?<?0.05). Univariate analysis showed that serum Romo1 was positively correlated with apnea-hypopnea index (AHI), oxygen desaturation index (ODI), time spent below 90% oxygen saturation (Ts90%), arousal index, ROS, and CRP, and was negatively correlated with minimal oxygen saturation (miniSaO₂) (all P?<?0.05). Multiple linear regression analysis showed that serum Romo1 level was significantly associated with AHI and ODI, after adjusting for age, gender, BMI, and CRP. After 6 months of nCPAP therapy, serum Romo1, ROS, and CRP were significantly decreased (P?<?0.05).

Conclusions

The increase of serum Romo1 in OSAS patients was positively correlated with disease severity. Serum Romo1 may be an important parameter for monitoring the severity of OSAS and treatment efficiency.

     

Effects of surgically assisted rapid maxillary expansion on obstructive sleep apnea and daytime sleepiness

Purpose

The aim of the study was to evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on obstructive sleep events and daytime sleepiness in adults with obstructive sleep apnea syndrome (OSAS).

Methods

Sixteen individuals (7 women/9 men) aged 40.2?±?10.2 (range, 24.4 to 62.2 years) with maxillary transverse deficiency and OSAS (respiratory disturbance index [RDI] greater than 5) confirmed with full-night polysomnography (PSG) underwent SARME to evaluate its efficiency for OSAS treatment.

Results

Several PSG parameters and the Epworth Sleepiness Scale (ESS) results were compared in selected individuals before and after they underwent SARME. An RDI reduction from 35.4?±?38.5 to 16.0?±?19.7 was found, corresponding to a mean decrease of 54.6 % (p?=?0.0013). A 56.2 % (33.23?±?39.5 to 14.5?±?19.4, p?=?0.001) decrease was found in the apnea-hypopnea index (AHI), in addition to decreases in the desaturation and microarousal rates, among other parameters. The ESS scores improved from 12.5?±?5.3 to 7.2?±?3.5 (p?<?0.001).

Conclusions

SARME promotes an improvement in OSAS symptoms; decreases the rates of respiratory disturbances; microarousal, and desaturation; and reduces daytime sleepiness.

     

Oxidative stress and inflammatory markers in the exhaled breath condensate of children with OSA

Introduction

Obstructive sleep apnea (OSA) in children has been associated with systemic inflammation and oxidative stress. Limited evidence indicates that pediatric OSA is associated with oxidative stress and inflammation in the airway.

Objective

The objective of this study is to assess the hypothesis that levels of oxidative stress and inflammatory markers in the exhaled breath condensate (EBC) of children with OSA are higher than those of control subjects.

Methods

Participants were children with OSA and control subjects who underwent overnight polysomnography. Morning levels of hydrogen peroxide (H₂O₂) and sum of nitrite and nitrate (NO _x ) in EBC of participants were measured.

Results

Twelve subjects with moderate-to-severe OSA (mean age?±?standard deviation: 6.3?±?1.7?years; apnea?Chypopnea index??AHI, 13.6?±?10.1 episodes/h), 22 subjects with mild OSA (6.7?±?2.1?years; AHI, 2.8?±?1 episodes/h) and 16 control participants (7.7?±?2.4?years; AHI, 0.6?±?0.3 episodes/h) were recruited. Children with moderate-to severe OSA had higher log-transformed H₂O₂ concentrations in EBC compared to subjects with mild OSA, or to control participants: 0.4?±?1.1 versus ?0.9?±?1.3 (p?=?0.015), or versus ?1.2?±?1.2 (p?=?0.003), respectively. AHI and % sleep time with oxygen saturation of hemoglobin <95% were significant predictors of log-transformed H₂O₂ after adjustment by age and body mass index z score (p? x levels.

Conclusions

Children with moderate-to-severe OSA have increased H₂O₂ levels in morning EBC, an indirect index of altered redox status in the respiratory tract.     

Energy expenditure in obstructive sleep apnea: validation of a multiple physiological sensor for determination of sleep and wake

Purpose

Obstructive sleep apnea (OSA) may be associated with increased energy expenditure (EE) during sleep. As actigraphy is inaccurate at estimating EE from body movement counts alone, we aimed to compare a multiple physiological sensor with polysomnography for determination of sleep and wake, and to test the hypothesis that OSA is associated with increased EE during sleep.

Methods

We studied 50 adults referred for routine overnight polysomnography. In addition to polysomnography, the SenseWear Pro3 Armband^TM (Bodymedia Inc.) was placed on the upper right arm. Epoch-by-epoch agreement rate between the measures of sleep versus wake was calculated. Linear regression analyses were performed for EE against apnea–hypopnea index (AHI), 3% oxygen desaturation index (ODI), body mass index (BMI), waist–hip ratio (WHR), gender, age, and average heart rate during sleep.

Results

The epoch-by-epoch agreement rate was high (79.9?±?1.6%) and the ability of the SenseWear to estimate sleep was very good (sensitivity, 88.7?±?1.5%). However, it was less accurate in determining wake (specificity 49.9?±?3.6%). Sleep EE was associated with AHI, 3% ODI, BMI, WHR, and male gender (p?<?0.001 for all). Stepwise multiple linear regression however revealed that BMI, male gender, age, and average heart rate during sleep were independent predictors of EE (Model R ²?=?0.78).

Conclusions

The SenseWear armband provides a reasonable estimation of sleep but a poor estimation of wake. Furthermore, in a selected population of OSA patients, increasing OSA severity is associated with increased EE during sleep, although primarily through an association with increased BMI. However, as our data are not adjusted for fat-free mass and the SenseWear has yet to be validated for EE in OSA patients, these data should be interpreted with caution.     

Obstructive sleep apnea is common in patients with interstitial lung disease

Purpose

The incidence of obstructive sleep apnea (OSA) in interstitial lung disease (ILD) has been reported at different frequencies in several studies. The aims of our study were to evaluate the frequency of OSA in ILD and to analyze the relationship between polysomnography (PSG) findings and pulmonary function, disease severity, parenchymal involvement, and Epworth Sleepiness Scale (ESS) scores.

Methods

ILD patients with parenchymal involvement were evaluated. The disease severity was assessed using an index consisting of body mass index (BMI), carbon monoxide diffusion capacity, the Modified Medical Research Council dyspnea scale, and the 6-min walking distance. All of the patients had lung function, chest X-ray, PSG, ESS scoring, and an upper airway examination. Patients with a BMI?≥?30 or significant upper airway pathologies were excluded.

Results

Of 62 patients, 50 patients comprised the study group (14 male, 36 female; mean age 54?±?12.35 years, mean BMI 25.9?±?3.44 kg/m²) with diagnoses of idiopathic pulmonary fibrosis (IPF; n?=?17), stage II–III sarcoidosis (n?=?15), or scleroderma (n?=?18). The frequency of OSA was 68 %. The mean apnea–hypopnea index (AHI) was 11.4?±?12.5. OSA was more common in IPF patients (p?=?0.009). The frequency of rapid eye movement-related sleep apnea was 52.9 %. The frequency of OSA was higher in patients with a disease severity index ≥3 (p?=?0.04). The oxygen desaturation index and the AHI were higher in patients with diffuse radiological involvement (p?=?0.007 and p?=?0.043, respectively).

Conclusions

OSA is common in ILD. PSG or at minimum nocturnal oximetry should be performed, particularly in patients with functionally and radiologically severe disease.