Prevalence of probable obstructive sleep apnea risk and severity in a population of dental patients

Obstructive sleep apnea is a commonly undiagnosed chronic disease. While dentists represent an important resource for identifying people at risk for primary snoring and sleep apnea, less than 50% of dentists are capable of identifying the common signs and symptoms of sleep disordered breathing. The aim of this study is to assess the prevalence of probable obstructive sleep apnea/sleep disordered breathing and symptoms associated with this condition in a population of dental patients using a validated questionnaire and software that could be administered in a dental office. A retrospective analysis conducted at two dental practices using questionnaire responses obtained from 175 men and 156 women, and sleep study data obtained in the patient’s homes from 75 men and 30 women with a portable recorder. Forty-six percent of the men and 19% of the women reported snoring frequently or always. Of the 67% of the men and 28% of the women identified as having a high pre-test probability (high risk) of having at least mild sleep apnea, over 33% of the men and 6% of the women surveyed were predicted to have moderate or severe sleep apnea. In a subgroup of 105 patients classified at high risk who completed an overnight sleep study, 96% had an apnea hypopnea index (AHI) greater than five events per hour. Seventy percent of those predicted to have moderate or severe OSA by questionnaire had an AHI greater than 20. All patients previously diagnosed with sleep apnea were correctly classified at high risk by ARES questionnaire. There was a high concordance between the predicted OSA risk and the degree of sleep disordered breathing. The high prevalence of undiagnosed sleep apnea in dental patients suggests that dentists could provide a valuable service to their patients by incorporating sleep apnea screening and treatment into their practice. Those who practice sedation dentistry should consider additional precautions when managing patients with risk of sleep apnea.     

Intracranial pressure and obstructive sleep apnea

In order to describe variation in AP and ICP during OSA, six patients with severe OSA were examined, with determination of ICP, AP, CVP, respiration, tcPO2, tcPCO2, and nocturnal sleep polygraphy. During apnea, elevations of AP and ICP were observed, related to the apneic episodes. The elevations in pressure were only observed in relation to apneic episodes. While awake, none of the patients showed pressure elevations. There were highly significant correlations between duration of apnea and variation in AP and ICP and between variations in AP and ICP. Values for ICP while awake were above normal (greater than 15 mm Hg; intracranial hypertension) in four of six patients. Morning ICP was higher than evening ICP. Systolic, mean, and diastolic ICP and AP increased during sleep above awake values. The ICP increased during NREM stages 1 to 4, and the highest values were observed during REM sleep. Vascular response was not changed during REM sleep, and the higher ICP during REM could solely be explained by the longer apneas during REM sleep. The CPP decreased during apnea.     

伴阻塞性睡眠呼吸暂停低通气综合征高血压患者的血压控制研究

目的探讨伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的高血压患者,同时服用降压药和接受持续气道正压通气(CPAP)是否能有效控制血压。方法选取2014年1月至2015年6月南京医科大学第一附属医院睡眠中心就诊的伴有OSAHS高血压患者180例,根据服用降压药物后血压是否被有效控制,分为控制组(n=87)和未控制组(n=93),两组在服用降压药同时接受CPAP 6个月,比较服用不同降压药方案和CPAP治疗前后血压是否得到有效控制的关系。结果所有患者共使用13种不同的降压药方案进行治疗。控制组与未控制组患者降压药方案差异无统计学意义(P0.05),多因素logistic回归分析表明降压药方案不是影响伴OSAHS高血压患者血压控制的独立预测因子(OR=1.897,P=0.094)。使用CPAP后控制组、非控制组夜间收缩压(SBP)和舒张压(DBP)均下降,差异有统计学意义(P0.01)。结论伴OSAHS高血压病患者的降压治疗方案与血压控制无明显相关性,而CPAP治疗可使降压药有效组和无效组患者的夜间血压都降低。     

Relationship between the severity of obstructive sleep apnea and impaired glucose metabolism in patients with obstructive sleep apnea

BACKGROUND: The relationship between the severity of obstructive sleep apnea (OSA) and impaired glucose metabolism (IGM) has not yet been fully elucidated in patients with OSA. Accordingly, we sought to clarify this relationship in Japanese patients with OSA. METHODS: The study population consisted of 129 Japanese patients with OSA (apnea-hypopnea index [AHI] >/=5). A 75-g oral glucose tolerance test was performed in all patients who had not been diagnosed as diabetes mellitus (DM). IGM was defined as either diabetes mellitus (DM) or impaired glucose tolerance (IGT). RESULTS: IGM was observed in 78 (60.5%) patients: DM in 39 (30.2%) and IGT in 39 (30.2%). The frequency of IGM was significantly different among patients with AHI >/=30, those with 15 /=5), and the prevalence of IGM increased according to the severity of OSA. Furthermore, the AHI was independently associated with IGM, thus suggesting that OSA may contribute to the development of IGM.     

Epidemiology of obstructive sleep apnea: a population health perspective

Population-based epidemiologic studies have uncovered the high prevalence and wide severity spectrum of undiagnosed obstructive sleep apnea, and have consistently found that even mild obstructive sleep apnea is associated with significant morbidity. Evidence from methodologically strong cohort studies indicates that undiagnosed obstructive sleep apnea, with or without symptoms, is independently associated with increased likelihood of hypertension, cardiovascular disease, stroke, daytime sleepiness, motor vehicle accidents, and diminished quality of life. Strategies to decrease the high prevalence and associated morbidity of obstructive sleep apnea are critically needed. The reduction or elimination of risk factors through public health initiatives with clinical support holds promise. Potentially modifiable risk factors considered in this review include overweight and obesity, alcohol, smoking, nasal congestion, and estrogen depletion in menopause. Data suggest that obstructive sleep apnea is associated with all these factors, but at present the only intervention strategy supported with adequate evidence is weight loss. A focus on weight control is especially important given the expanding epidemic of overweight and obesity in the United States. Primary care providers will be central to clinical approaches for addressing the burden and the development of cost-effective case-finding strategies and feasible treatment for mild obstructive sleep apnea warrants high priority.     

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.     

Positional sensitivity as a confounder in diagnosis of severity of obstructive sleep apnea

Purpose

The apnea–hypopnea index (AHI) is used to grade obstructive sleep apnea (OSA) into mild, moderate, and severe forms. Obstructive events are most common in the supine position. The amount of supine sleep thus influences total AHI. Our aim was to determine the prevalence of position-dependent OSA (POSA) and its relation to OSA severity classification as recommended by the American Academy of Sleep Medicine (AASM).

Methods

Two hundred sixty-five subjects were recruited from primary care hypertension clinics. Whole-night respiratory recordings were performed to determine the AHI in the supine and non-supine positions, respectively. POSA was defined as supine AHI twice the non-supine AHI with supine AHI ≥5.

Results

Fifty-three percent had POSA, 22% had non-position-dependent OSA, and 25% had normal respiration. By AASM classification, 81 subjects did not have OSA, but 42% of them had some degree of obstruction when supine, and 5 subjects would have been classified as moderate–severe if they had only slept supine. Conversely, of the 53 classified as mild OSA, 30% would have changed to a more severe classification if they had exclusively slept supine.

Conclusions

POSA was common both in subjects that by AASM classification had OSA as well as those without. The severity of OSA, as defined by AASM, could be dependent on supine time in a substantial amount of subjects.     

Relative validity of self-reported snoring as a symptom of sleep apnea in a sleep clinic population

The purpose of this study was to evaluate the relative validity of responses to three different questions about snoring as indicators for sleep apnea in a population referred to a sleep clinic. Secondary goals were to evaluate the meaning of a "don't know" response to these questions and to examine how the associations between snoring and sleep apnea are influenced by demographics. Results from 1,409 patients in a sleep clinic indicated that nearly all levels of estimated snoring frequency were associated with a greater likelihood of sleep apnea. In addition, a "don't know" response indicated a likelihood of sleep apnea. In the sample from this clinic, sensitivities approximating 90 percent were obtained in men, and specificities approximating 90 percent were obtained in women, but high diagnostic accuracy (high specificity in men; high sensitivity in women) could not be achieved with the three snoring questions used here. Generally, associations between snoring and sleep apnea were independent of age and sex. Single persons, persons living alone, and persons customarily sleeping alone of both sexes all showed associations between self-reported snoring and the presence of sleep apnea.     

阻塞性睡眠呼吸暂停综合征与心律失常

目的:探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者病情严重程度与夜间心律失常的关系,以及经鼻持续气道内正压(nCPAP)通气治疗对心律失常的影响。方法:183例OSAS患者按睡眠呼吸暂停／低通气指数(AHI)分轻、中、重三组,观察夜间最低血氧饱和度,窦停,Ⅱ、Ⅲ度房室传导阻滞,室早总数、心律失常总数及发生率,比较组间差异性,并对130例患者进行了nCPAP治疗前后上述各项参数的比较。结果:OSAS夜间心律失常随病情程度加重而明显加重。轻度、中度、重度患者组间两两比较上述各项参数有显著差异(P均<0．05);nCPAP治疗7 h 后心律失常均明显改善(P<0．05)。心律失常的发生总数与SaO2最低值呈负相关(r=-0．51,P<0．01)。结论:夜间心律失常随OSAS病情加重而明显加重,nCPAP治疗能明显减轻夜间心律失常。     

阻塞性睡眠呼吸暂停低通气综合征严重程度的危险因素

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)严重程度的危险因素。 方法选取我院及北京朝阳医院于2016年3月至2020年1月收治的600例OSAHS患者为研究对象,根据OSAHS的严重程度分为轻中度、重度组,分析不同OSAHS严重程度的临床资料,探索其危险因素。 结果不同病情OSHAS患者年龄、体质指数(BMI)、颈围、腰围、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、糖化血红蛋白(HbALc)、尿酸(UA)、肌酐(Scr)、同型半胱氨酸(Hcy)、甘油三酯(TG)不同,差异有统计学意义,P<0.05。单因素分析,轻中度OSAHS患者其年龄、BMI、颈围、腰围、SBP、DBP、FPG、HbALc、UA、Scr、Hcy、TG均低于重度OSHAS,差异有统计学意义,P<0.05。多因素Logistic回归分析发现,BMI、颈围、FPG、UA、Hcy是重度OSAHS的危险因素。 结论BMI、颈围、FPG、UA、Hcy是重度OSAHS的独立危险因素,值得临床关注。     

Obesity and obstructive sleep apnea.

There is a very high prevalence of OSA in obese individuals and a high prevalence of obesity in patients with OSA. The pathophysiology of OSA is intimately linked to obesity. Anatomic and functional considerations of the pharyngeal airway, the CNS, central obesity, and leptin likely interact in the development of OSA in obese individuals. OSA may itself predispose individuals to worsening obesity because of sleep deprivation, daytime somnolence, and disrupted metabolism. The diagnosis of OSA requires the clinician's awareness of its potential to cause a spectrum of acute and chronic neurocognitive, psychiatric, and nonspecific symptoms in patients who may be unaware that their sleep is disturbed. Symptoms and examination findings help predict which obese individuals have OSA, and polysomnography is the gold standard by which to make the diagnosis and assess the effects of treatment. Numerous disease states are associated with both OSA and obesity, and it is becoming clear that the relationships are mediated by complex interrelated mechanisms. Common diseases and disease mechanisms in OSA and obesity suggest that conditions related to obesity may be better managed if patients, particularly those who are morbidly obese, are evaluated and treated for previously undiagnosed OSA. OSA is cured in only specific cases with craniofacial or upper airway surgery, and the general application of UVP is not efficacious. OSA also can be cured with sufficient lifestyle-mediated or surgical weight loss; however, in the absence of long-term weight maintenance, OSA returns with weight gain. Although not curative, nasal CPAP is the initial treatment of choice for most patients because of its noninvasive approach and technical efficacy. It is limited, however, by patient acceptance and long-term compliance. Advances in mask comfort and use of humidified air should increase its acceptance. Future management strategies include newer generations of positive airway devices that automatically titrate pressures (which are not yet recommended by expert organizations) and multidisciplinary approaches to managing the care of patients with OSA.     

Positive airway pressure treatment for obstructive sleep apnea

Positive airway pressure (PAP) is the treatment of choice for patients with moderate-to-severe obstructive sleep apnea (OSA). Randomized controlled trials have demonstrated that PAP can effectively reduce the apnea-hypopnea index and improve subjective and objective sleepiness. Some studies have also demonstrated benefits in sleep quality and quality of life for both the patient and bed partner. Observational studies have shown a reduction in the risk of cardiovascular events in OSA patients treated with PAP compared to untreated patients. Since continuous PAP (CPAP) treatment of OSA was described, additional modes of pressure delivery have been developed (bilevel PAP, autoadjusting PAP, flexible PAP). While none of the variants of PAP improves adherence in unselected patients compared to CPAP, individual patients may respond to a change in pressure mode. Attended PAP titration remains the standard of practice for selecting a treatment pressure. However, use of autotitrating PAP devices in the unattended setting can provide an effective titration alternative with careful patient selection and review of titration results. More choices of mask interface are now available to improve comfort and intervene for mask or mouth leaks. However, despite the increase in PAP treatment options, lack of acceptance and inadequate adherence to PAP therapy remain the major causes of treatment failure. Some studies suggest that heated humidification can improve PAP adherence, especially in patients with nasal congestion or dryness. A systematic approach to PAP treatment including education, objective adherence monitoring, early intervention for side effects, and telephone and clinic support is essential to optimize adherence.     

Nasal pressure recordings to detect obstructive sleep apnea

Obstructive sleep apnea (OSA) is a common disease. Given the costs of in-laboratory polysomnography (PSG), alternative ambulatory methods for accurate diagnosis are desirable. The objective of this study was to evaluate the performance of a simple device (SleepCheck) to identify patients with sleep apnea. A total of 30 consecutive patients with suspected OSA syndrome referred to the sleep clinic were prospectively evaluated with standard PSG and SleepCheck simultaneously during an in-laboratory, supervised full-night diagnostic study. The PSG apnea and hypopnea index (AHI) was evaluated according to standard criteria, and SleepCheck assessed the respiratory disturbance index (RDI) based on nasal cannula pressure fluctuations. Compared to the full-night PSG, SleepCheck systematically overscored respiratory events (the mean difference between SleepCheck RDI and PSG AHI was 27.4±13.3 events per hour). This overscoring was in part related to normal physiologic decreases in flow during rapid eye movement sleep or after an arousal. However, there was reasonable correlation between AHI and RDI (r=0.805). Receiver operating characteristic curves with threshold values of AHI of 10 and 20/h demonstrated areas under the curves (AUCs) of 0.915 and 0.910, respectively. Optimum combinations of sensitivity and specificity for these thresholds were calculated as 86.4/75.0 and 88.9/81.0, respectively. Overall, the SleepCheck substantially overscored apneas and hypopneas in patients with suspected OSA. However, after correction of the bias, the SleepCheck had reasonable accuracy with an AUC, sensitivity, and specificity similar to other ambulatory type 4 devices currently available.This study was conducted at the Sleep Laboratory and Division of Orthodontics, The University of British Columbia, Canada     

阻塞性睡眠呼吸暂停综合征对右心结构和功能的影响

目的 探讨阻塞性睡眠呼吸暂停综合征（OSAS）对右心结构和功能的影响。方法 用二维及多普勒超声心动图测定30例OSAS患者右心结构和功能。结果 中、重度的OSAS患者右室舒张末期容积（RVEDV）、右室搏出量（SV）、右肺动脉内径（RPAD）均较正常组增大,而右室E峰速和A峰速比值（E/A）较正常组减小。结论 OSAS不仅使右心结构发生明显异常,而且使右心舒张功能及收缩功能也受损,成为右心功能不全的重要原因之一。