Obstructive sleep apnea and obesity

OSA affects approximately 1 per cent of the adult male population and is more common among obese patients. The mechanism for the relationship between obesity and OSA may be mechanical obstruction or hypoxemia. Patients with obesity often have other medical problems that can exacerbate or complicate OSA. The physician should look for other problems such as diabetes, hypertension, and coronary disease while evaluating an obese patient with OSA. Weight loss is important either as a primary therapy or in conjunction with surgical treatment of OSA. Weight loss methods include behavior modification with diet, very low calorie diets with behavior modification, and bariatric surgery. In morbidly obese patients, more dramatic means such as bariatric surgery or very low calorie diets seem to be preferable because of the significant reduction in the length of time it takes for patients to lose weight. Because of a tendency for obese patients to regain weight, it is important to follow the patients long term to prevent the regaining of weight.     

Obstructive sleep apnea in patients with pharyngeal tumours.

Six consecutive patients with pharyngeal tumours were investigated regarding disordered breathing during sleep. In addition to pulse oximetry, the investigations involved oral and nasal airflow as well as thoracic respiratory movements in four of the patients in whom the oxygen desaturation index (ODI, number of desaturations per hour of estimated sleep) was on average 24 (range 10-58). An almost total predominance of obstructive apnea was found in evaluated cases. In the 2 cases in whom only pulse oximetry was performed, numerous desaturations were found throughout the night (ODI 19 and 88, respectively). The overnight minimum oxygen saturation before treatment varied but was below 80% in 5 of the 6 patients (range less than 50-89%). On reinvestigation (n = 5) 3-4 months after treatment (radical surgery or, in one case, nasal continuous positive airway pressure (CPAP)), desaturations were totally or almost totally abolished in all patients. It is concluded that the obstructive sleep apnea syndrome may be a common finding in patients with tumours in the pharyngeal region. Radical surgery and/or nasal CPAP may result in complete disappearance of the disordered breathing during sleep in these patients.     

Obstructive sleep apnea in young infants

Obstructive sleep apnea (OSA) was diagnosed in 14 infants less than 18 months of age. Snoring, apnea, failure to thrive, developmental delay and recurrent respiratory infections were the main presenting symptoms. The diagnosis was made by polysomnographic studies or overnight monitoring. Adenotonsillectomy resulted in the relief of symptoms and signs in 13 children. In one infant prolonged nasopharyngeal intubation was needed. An increased awareness of OSA in young infants may prevent the delay in diagnosis, will allow early treatment and thus prevent the development of sequela or complications associated with this syndrome.     

Obstructive sleep apnea syndrome in children

Obstructive sleep apnea syndrome (OSAS) in children is often caused by obstruction of the upper airway due to hypertrophy of the adenoids and palatine tonsils. Between October 1988 and December 1991, 50 children (34 males, 16 females) visited our department due to attacks of sleep apnea and underwent adenotomy or adeno-tonsillectomy. Respiratory monitoring during sleep was performed before and after operation, and the usefulness of the surgery was evaluated. Before operation, 27/ 50 children (54.0%) were diagnosed as having OSAS. Their age distribution showed peaks at the ages of 4 and 5 years and the male:female ratio was 2:1. Concerning the degree of improvement in clinical symptoms after surgery, marked effects were observed in 40/50 patients (80.0%), moderate effects in 7 (14.0%) and slight effects in 3 (6.0%). Concerning the degree of improvement in the apnea index after surgery in the 27 patients with OSAS, marked effects were observed in 22 patients (81.50%), moderate effects in 2 (7.4%), slight effects in 1 (3.7%) and no change in 2 (7.4%).     

Obstructive sleep apnea syndrome is associated with metabolic syndrome and inflammation

Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity and mortality. However, the underlying mechanism is unclear. In this cross-sectional study, we investigated the influence of OSA on metabolic syndrome (MetS) and inflammation, which were considered as cardiovascular risks. A total of 144 consecutive male patients who underwent standard polysomnography were enrolled. Fasting blood samples were obtained from all patients for glucose, high-sensitivity C-reactive protein (hs-CRP) and lipids measurement. A metabolic score was established as the total number of the positive diagnostic criteria of metabolic syndrome for each patient. Systolic blood pressure, diastolic blood pressure, fasting glucose, hs-CRP and metabolic score significantly increased with the aggravation of OSA severity. Metabolic score increased from 1.74 ± 1.20 to 2.89 ± 0.99 with OSA severity (p = 0.000). hs-CRP increased from 0.68 (0.43–1.10) to 1.44 (0.62–4.02) mg/L with OSA severity (p = 0.002). After adjustment for confounders, apnea–hypopnea index and body mass index (BMI) were the major contributing factors for metabolic score (β = 0.257, p = 0.003 and β = 0.344, p = 0.000, respectively), lowest O₂ saturation and BMI were the independent predictors of hs-CRP (β = ?0.255, p = 0.003 and β = 0.295, p = 0.001, respectively). OSA is independently associated with sum of metabolic components and hs-CRP.     

减重手术对肥胖阻塞性睡眠呼吸暂停患者通气和换气功能改善的影响

目的　分析减重手术对肥胖的阻塞性睡眠呼吸暂停（obstructive sleep apnea,OSA）患者通换气功能改善的影响。方法　2021年1月～2021年6月邯郸明仁医院收治的80例肥胖OSA患者作为研究对象,所有患者均接受减重手术治疗,对比患者治疗前后的通气和换气功能改善情况及症状改善情况。结果　患者手术后的呼吸暂停低通气指数（AHI）、体质量指数（BMI）及气道阻力指标相较于手术前均显著降低,差异有统计学意义（P 均＜0.05）;平均夜间血氧饱和度（oxygen saturation,SaO2）和最低SaO2、每分钟 最大通气量（maximum ventilation per minute,MVV）、最大呼气中段流量（maximum mid-expiratory flow,MMF）、最大吸气压（maximum suction pressure,PImax）、最大呼气压（maximum expiratory pressure,PEmax）、一氧化碳弥散量（diffusion capacity for carbon monoxide of lung,DLCO）、第一秒用力呼气量（forced expiratory volume in 1 second,FEV1）、用力肺活量（forced vital capacity,FVC）及FEV1/FVC较手术前均明显升高,差异有统计学意义（P 均＜0.05）。结论　减重手术可以有效改善肥胖OSA患者的肺部通换气功能,提高患者的肺功能指标,促进患者OSA症状的改善,宜广泛应用及推广。     

Same-day discharge for selected patients undergoing combined nasal and palatal surgery for obstructive sleep apnea

To determine the safety of same-day discharge for patients who undergo combined nasal and palatal surgery for obstructive sleep apnea syndrome, we undertook a retrospective review and analysis of 2 groups of patients (total, 86 patients) who underwent such surgery. The patients with obstructive sleep apnea syndrome who underwent combined nasal and palatal surgery were considered for same-day discharge if they fulfilled the following postoperative criteria: sustained O2 saturation of 94% or greater on room air while asleep, no history of cardiopulmonary disease or diabetes mellitus, adequate oral analgesia and oral intake, hemostasis, and normal vital signs. Twenty-three patients met these criteria and were assigned to group 1. The remaining 63 patients were admitted overnight for monitoring and were assigned to group 2. The data collected included patient demographics, respiratory disturbance index, lowest O2 saturation, body mass index, and postoperative complications. The mean age, respiratory disturbance index, lowest O2 saturation, and body mass index for group 1 were 45.9 years, 36 events per hour, 84.9%, and 28.7 kg/m2, respectively. For group 2, the results were 48 years, 36.5 events per hour, 82%, and 32.5 kg/m2. There were no postoperative complications in group 1, and 3 in group 2. There were no incidents of airway compromise or cardiopulmonary events in the immediate postoperative period in either group. There were no readmissions for either group. We conclude that same-day discharge for patients who have undergone combined nasal and palatal surgery for obstructive sleep apnea syndrome is relatively safe in selected cases in which significant comorbid diseases are not present. These selected cases would have constituted a minority of the patients studied.     

鼾症对妊娠的影响(附465例孕妇分析)

目的 :探讨鼾症对妊娠的影响。方法 :观察 4 6 5例孕妇孕期鼾症的发生情况 ,鼾症与妊娠高血压、先兆子痫的关系 ,以及对胎儿的影响。结果 :孕前鼾症为 4 .9% (2 3/ 4 6 5 ) ;妊娠后鼾症为 2 4 .7% (115 / 4 6 5 )。鼾症者中 2 8.7%诊断为睡眠呼吸暂停综合征 (OSAS) ,12 .2 %出现妊娠高血压 ,7.8%出现了先兆子痫 ,5 .2 %新生儿为低出生体重儿。鼾症孕妇较非鼾症孕妇有明显的统计学差异。结论 :鼾症对妊娠和胎儿有明显的不良影响 ;OSAS为高危妊娠的独立因素 ,因此应特别重视鼾症孕妇的围产期保健。     

婴幼儿阻塞性睡眠呼吸暂停低通气综合征诊治特点

目的探讨婴幼儿阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的临床特征及诊断和治疗要点。方法回顾性分析2004年1月～2007年6月收治的80例年龄在30个月以下的OSAHS患儿的临床资料。其中男61例,女19例,男女比例3.2:1;平均年龄(23.9±5.3)个月;平均病程(8.9±6.1)个月。80例患儿存在不同程度的睡眠打鼾、张口呼吸、呼吸暂停、反复上呼吸道感染和生长发育迟缓等症状。经体格检查、纤维鼻咽镜检查和多道睡眠图监测明确诊断。80例均行手术治疗,术后随访3个月～1年。结果80例患儿手术顺利,术中、术后无1例并发症发生;5例患儿术前、术后给予正压通气治疗。术后随访,治愈64例,显效14例,有效2例。结论婴幼儿OSAHS是一种严重危害婴幼儿身心健康,影响婴幼儿生长发育的疾病,应根据婴幼儿OSAHS特有的临床特征,详细询问病史,进行相关检查,及时明确诊断,早期给予包括手术在内的综合治疗,从而减少并发症的出现。     

Obstructive sleep apnea in Treacher Collins syndrome

The aim of the present study was to investigate the prevalence of obstructive sleep apnea syndrome (OSAS) among the Norwegian population with Treacher Collins syndrome (TCS). A secondary aim was to establish whether TCS phenotype severity is associated with OSAS severity. A prospective case study design was used. Individuals who were 5 years old and above with a known diagnosis of TCS in Norway were invited to participate in a study. The study included genetic testing, medical and dental examinations and polysomnography. All participants demonstrated disturbed respiration during sleep; 18/19 met the diagnostic criteria for OSAS. Subjectively evaluated snoring was not a reliable predictor of OSAS. We found no significant association between TCS phenotype severity and the severity of OSAS. OSAS is common in TCS, but there is no association with the phenotype severity. Individuals diagnosed with TCS must undergo sleep studies to identify the presence of OSAS.     

儿童阻塞性睡眠呼吸暂停低通气综合征与高血压

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是儿童常见的睡眠呼吸障碍疾病,长期发展会严重影响儿童的健康。目前研究认为儿童OSAHS会引起高血压、心血管靶器官的损害,相对于在成人已经确定OSAHS是高血压的独立危险因素,儿童这方面的研究还不够明确。本文旨在阐明儿童OSAHS和高血压之间关系的最新研究进展。     

Obstructive sleep apnea in patients with Parkinson's disease--report of two cases and review

BACKGROUND: The use of continuous positive airway pressure (CPAP) is well established in treatment of moderate and severe obstructive sleep apnea syndrome (OSAS). The judgement of clinical symptoms like daytime sleepiness and hypersomnolence with loss in concentration is complicated in patients with diagnosis of Morbus Parkinson (MP) because the disease itself and pharmacologic therapy may mimic clinical features of OSAS. PATIENTS AND METHODS: Diagnostic pathways and differential diagnostic considerations are demonstrated in two case reports of patients with MP and OSAS. The cases are discussed within the framework of literature concerning sleep disturbances and MP. RESULTS: In both cases respiration could be treated effectively by continuous positive airway pressure (CPAP). Patients clearly responded to therapy and regained more daytime activity. The medication for MP was satisfactory. CONCLUSIONS: The evaluation and treatment of daytime sleepiness in patients with MP and obstructive sleep apnea need an interdisciplinary framework with a practitioner, a neurologist, and a sleep expert. Associated symptoms as increased nycturia, hypokinesia, restless-leg-symptoms, and depression as well as the effects of medication may mimic details of concomitant sleep apnea. Therefore, sleep diagnostic evaluation is recommended to rule out sleep apnea as a frequent cause for hypersomnolence.     

Obstructive sleep apnea: Variations in surgical management

Forty patients with obstructive sleep apnea (OSA) were either treated by submucous resection, alone or by palatopharyngoplasty (PPP). Before surgery, each patient underwent a thorough sleep evaluation for the diagnosis of OSA. Of the 23 patients treated by submucous resection alone, eight had more than a 50% reduction in their apnea index and were considered successfully treated. Of the remaining 15, ten received a supplemental tongue retaining device (TRD). Five of the ten were markedly improved. The overall success rate in this group was 57%. Of the 17 patients treated by submucous resection and PPP, ten were treated successfully. Six of the remaining seven patients were subsequently treated with a TRD, which was successful in four. The overall success rate in this group was 82%.