Clinical efficacy and indication of acetazolamide treatment on sleep apnea syndrome

The efficacy and indication of acetazolamide treatment on patients with sleep apnea syndrome (SAS) were discussed from assessing the changes of polysomnographic findings with the treatment in 75 SAS patients. For the patients as a whole, respiratory disorder variables improved significantly during the treatment. However, the number of acetazolamide treatment responders who showed a decrease of apnea hypopnea index (AHI) to 50% or less of the pretreatment value numbered only 34 (45.3%). The lower values of body mass index and AHI in the responder group indicated that monotherapy with acetazolamide is the treatment choice only for mild SAS cases without obesity. However, combined treatment with acetazolamide and uvulopalatopharyngoplasty was thought to be beneficial for severe cases.     

Differences in arousal response between aged and middle-aged patients with obstructive sleep apnea syndrome

Abstract The aim of this study is to show the clinical significance of the differences in arousal response at a termination of apnea/hypopnea between aged and middle-aged patients with obstructive sleep apnea syndrome (OSAS). We polygraphically assessed electrocardiographic (ECG) and electroencephalographic (EEG) arousal. Electrocardiographic arousal was defined as an abrupt increase in heart rate at a termination of apnea/hypopnea. Our findings showed that EEG and ECG arousal at a termination of apnea/hypopnea were significantly suppressed in aged patients with OSAS, which might provide useful information on the pathophysiology of OSAS.     

Sleep architectures of obstructive sleep apnea syndrome in the young child

The sleep architectures of obstructive sleep apnea syndrome (OSAS) in the young child (child-OSAS, n = 17; mean age: 5.9+/-2.7 years; male:female 14:3) were compared with that of OSAS in the adult (n = 19; mean age: 44.7+/-10.7 years; male:female 18:1) and that of primary snoring in the child (n = 5; mean age: 7.0+/-2.4 years; male:female 5:0). Child-OSAS and OSAS in the adult had the same severity in oxygen desaturation. Child-OSAS showed lower Apnea-Hypopnea Index compared with OSAS in the adult. Sleep continuity in child-OSAS was not impaired compared with OSAS in the adult. Sleep fragmentation in child-OSAS was not so remarkable. The quantity of slow wave sleep in child-OSAS was similar to that of primary snoring in the child. Both profiles of sleep architectures showed nearly the same pattern.     

A review of executive functions in obstructive sleep apnea syndrome

OBJECTIVES: To provide an update on recent research concerning obstructive sleep apnea syndrome (OSAS) and executive functions. METHODS: A systematic review was carried out on reports drawn from MEDLINE and PSYCHLIT (January 1990-December 2005) and identified from lists of references in these reports. The selection criteria were met by 40 articles. RESULTS: The sample sizes in the reviewed studies varied widely and consisted mostly of selected groups. Most patient samples were heterogeneous in terms of the severity of OSAS. Executive functions were generally assessed with standardized test methods. Half of the studies assessed executive functions using only one or two tests. The most defected domains of executive functions were working memory, phonological fluency, cognitive flexibility, and planning. Continuous positive airway pressure (CPAP) treatment improved performance times, cognitive flexibility, and planning. Deficits in working memory and phonological fluency persisted. CONCLUSIONS: Executive functions are the most defected cognitive domain in OSAS. Previous studies are affected by the heterogeneity of patient samples and the definitions of the domains of executive functions. Executive functions in OSAS should be assessed with a standardized neuropsychological test battery including assessments of different domains of executive functions. More research is needed on the efficiency of CPAP treatment on executive dysfunctions.     

阻塞性睡眠呼吸暂停综合征患者事件相关电位研究

目的　研究阻塞性睡眠呼吸暂停患者事件相关电位Ｐ３ 的变化,探讨可能的机制。方法　入组受试者分为阻塞性睡眠呼吸暂停患者组（ｎ ＝ ３０） 及正常对照组（ｎ ＝ ３０） ,均进行睡眠多导仪、听觉诱发事件相关电位（Ｐ３） 、临床记忆量表检查及神经系统查体。结果采用ｔ 检验和Ｓｐｅａｒｍａｎ 等级相关分析。结果　阻塞性睡眠呼吸暂停患者组记忆商（ＭＱ）为９０ ±１２ ,Ｐ３ 潜伏期为（３５９±３０） 毫秒（Ｆｚ 记录点） ,（３６５±３１） 毫秒（Ｃｚ 记录点） ;正常对照组ＭＱ为１０４±１６,Ｐ３ 潜伏期为（３３７±２９） 毫秒（Ｆｚ记录点） ,（３３９±３１）毫秒（Ｃｚ 记录点） 。阻塞性睡眠呼吸暂停患者组与正常对照组的Ｐ３ 潜伏期和记忆商差异存在显著性意义（Ｐ＜ ０．０５）。结论　阻塞性睡眠呼吸暂停患者有认知功能损害,夜间低氧血症可能起重要作用。     

Headache characteristics in obstructive sleep apnea syndrome and insomnia

OBJECTIVES: To determine headache characteristics in the obstructive sleep apnea syndrome (OSAS) and in insomnia. PATIENTS AND METHODS: Fifty-six OSAS patients and 50 insomnia patients were assessed in the same time period. Patients in both groups underwent an accurate interview to investigate headache occurrence and its characteristics. Results - Headache was reported by 49% of OSAS patients and 48% of insomnia patients. In OSAS patients headache had most frequently a tension-type pattern. Headache occurred on awakening in 74% of OSAS patients, more frequently than in insomnia patients (40%) (chi(2); P < 0.04). The occurrence of morning headache appears to be significantly correlated with nocturnal oxygen desaturation and OSAS severity. CONCLUSION: Headache is a common finding in both OSAS and insomnia patients. Because morning headache seems to be more specific for OSAS than insomnia, and in OSAS its occurrence seems to be associated with disease severity, we hypothesize the involvement of certain pathogenic mechanisms associated with OSAS.     

The influence of sleep position and obesity on sleep apnea

The influence of sleep position and the degree of obesity were examined in 257 subjects with sleep apnea. Subjects were divided into three groups according to obesity: normal weight (body mass index (BMI) under 24.0 kg/m2), mild obese (BMI 24.0-26.4 kg/m2) and obese group (BMI 26.4 kg/m2 and heavier). The apnea + hypopnea index (AHI), the intraesophageal pressure and the lowest oxygen saturation became significantly worse according to the degree of obesity. The subjects were also divided into two groups according to the reduction in the AHI by lateral position: good responders showed 50% or more reduction of AHI in lateral position and poor responders indicated less than 50% reduction. The percentage of good responders to sleep position change was 90.9% in normal weight group, 74.0% in mild obese group and 57.4% in the obese group. The ratio of the subjects who had indicated two or more obstructive sites in normal weight group was 36.0% in good responders and 40.0% in poor responders. The ratio in the mild obese group was 51.8% in good responders and 66.7% in poor responders. In the obese group, the ratio was 59.4% in good responders and 78.9% in poor responders.     

Differential diagnosis of obstructive sleep apnea syndrome patients and snorers using cephalograms

Severe snoring is thought by many to be an early stage of obstructive sleep apnea syndrome (OSAS), but the anatomical relation between snoring and OSAS, if any, has remained unclear. To compare the morphology of the airway between snorers and OSAS patients for possible similarities, we conducted a cephalometric analysis of Japanese OSAS patients (n=10), habitual snorers (n=10), and non-snoring controls (n=50). There was no significant difference in SNB (the angle formed by the sella, nasion and point B) between OSAS patients and the control subjects. Obstructive sleep apnea syndrome patients tended to have an anteriorly positioned maxilla, and an anteroposterior misalignment between the maxilla and mandible. There was also a tendency toward skeletal openbite. Both OSAS patients and snorers had large tongues and large soft palates, thus causing constriction of the airway with resultant smaller airway diameter and smaller airway surface area. Significant differences between OSAS patients and snorers were found in thickness and length of soft palate surface area, and thickness, length, and position of the hyoid bone. These results suggest that cephalographic measurements may be of considerable use in determining the seriousness of a patient's condition.     

Effectiveness of prosthetic mandibular advancement for obstructive sleep apnea:Analysis by sleep position

Abstract Fifteen patients with obstructive sleep apnea were treated using prosthetic mandibular advancement (PMA). Each patient was evaluated in the supine and lateral decubitus positions with and without PMA. After PMA treatment, the mean intraesophageal pressure (Peso) in the supine position improved from -42.6 to -27.3 cmH₂O and the mean apnea + hypopnea index (AHI) decreased from 48.8/h to 23.7/h. The mean Peso in the lateral decubitus position improved from -27.9 to -18.6 cmH₂O and the mean AHI decreased from 9.6/h to 6.6/h. With PMA, respiratory disturbance during sleep further improved by changing the body position from the supine to lateral decubitus position.     

Diurnal variation in daytime sleepiness of patients with sleep apnea syndrome

Diurnal variations in daytime sleepiness were studied in 26 men with sleep apnea syndrome (SAS) [age, 41.7 +/- 9.9 years (mean +/- SD); body mass index, 30.0 +/- 6.2 kg/m2; Epworth Sleepiness Score, 8.7 +/- 4.1; apnea-hypopnea index, 50.2 +/- 22.0]. Sleep latencies measured at 09.00 h, 11.00 h, 13.00 h, 15.00 h, and 17.00 h were 3.4 +/- 3.6 min, 4.7 +/- 5.5 min, 5.2 +/- 4.4 min, 5.3 +/- 5.4 min, and 9.3 +/- 7.2 min, respectively (ANOVA, P < 0.05). Daytime sleepiness in patients with SAS was more pronounced in the morning than in the afternoon and evening.     

Sleep and libido in men with obstructive sleep apnea syndrome

ObjectivesThe objectives of this study were to investigate the relationship between a low libido and objective sleep parameters as well as mood disturbances in patients with obstructive sleep apnea syndrome (OSA).MethodsWe enrolled 436 untreated patients who were newly diagnosed with OSA (all male, mean age 42.8 years). Patients completed the Symptom checklist-90-Revised (SCL-90-R), Epworth Sleepiness Scale (ESS), Beck Depression Inventory-II (BDI), and Beck Anxiety Inventory (BAI). Patients were divided into low-libido and normal-libido groups according to their response to the statement “Loss of sexual interest or pleasure” on the SCL-90-R.ResultsApproximately 23% of patients reported a low libido. Patients with a low libido were older (47.5 ± 9.0 vs. 41.4 ± 11.1 years; p < 0.001), had more nocturia (33.3% vs. 16.6%; p < 0.001), higher BDI (9.0 (5.0–14.0) vs. 5.0 (2.0–9.0); p < 0.001) and BAI score (11.0 (6.3–16.8) vs. 5.0 (2.0–10.0); p < 0.001). These patients had a lower non-REM sleep stage 3 (N3) % (0.1 (0–4.0) vs. 2.3 (0.1–7.9); p < 0.001). Multivariate analysis revealed that older age and higher BDI score were independent factors associated with a low libido.ConclusionsMen with untreated OSA suffered from a low libido. Older age and depressed mood were the most important factors of low libido in middle-aged men with OSA.     

Diagnostic use of daytime polysomnography versus nocturnal polysomnography in sleep apnea syndrome

The usefulness of daytime polysomnography (DPSG) in the diagnosis of sleep apnea syndrome (SAS) is examined. Diagnostic use was investigated by conducting DPSG of two different time periods (Group M, 11.00–14.00 h, and Group A, 15.00–18.00 h). The subjects were 30 patients (28 men and two women; mean age, 54.0 years). Nocturnal polysomnography (NPSG) and DPSG were investigated by comparing indices of sleep, apnea index (AI) and arterial oxygen saturation (SaO₂). There was no significant difference among these indices but there was a significant positive correlation between NPSG and DPSG in all variables related to sleep apnea. Moreover, there was no significant difference in the frequency of each type of apnea between NPSG and DPSG in either group. These findings suggest that DPSG is useful not only in diagnosing SAS but in evaluating its severity.     

Epworth Sleepiness Scale and sleep studies in patients with obstructive sleep apnea syndrome

Excessive daytime sleepiness (EDS) is the major symptom of patients with obstructive sleep apnea syndrome (OSAS). In this study, we examined the relationship between subjective EDS scored with the Epworth Sleepiness Scale (ESS), objective EDS measured with the multiple sleep latency test (MSLT) and sleep variables evaluated with polysomnography for patients with OSAS. Subjects were 10 patients (51.7+/-19.0 years old). The average ESS and MSLT scores were 10.6+/-5.6 and 7.7+/-5.6, respectively. There was no significant relationship between ESS and MSLT. The Multiple Sleep Latency Test had a significant negative relationship with the number of awakenings and the apnea/hypopnea index. No relationship was found between nocturnal hypoxia and either ESS or MSLT. Our findings suggest that objective EDS in OSAS is related with fragmentation of sleep, and that several patients are not aware of their EDS.     

Obstructive sleep apnea in a clinical series of adult epilepsy patients: frequency and features of the comorbidity

PURPOSE: The aim of this study was to evaluate the rate and features of obstructive sleep apnea (OSA) in adult epilepsy patients. METHODS: Two hundred eighty-three adult epilepsy patients (137 men; mean age, 33 years; range, 18-70 years) were prospectively screened for OSA by means of a structured interview. Those in whom OSA was clinically suspected were monitored for a full night by using a portable device (Polymesam), and OSA was diagnosed when they had an Apnea/Hypopnea Index greater than five. RESULTS: Coexistence of OSA with epilepsy was found in 10.2% (15.4% of the male and 5.4% of the female) epilepsy patients investigated. The OSA was mild in 66.6%, moderate in 22.2%, and severe in 11.1% of the cases. The "epilepsy + OSA" patients were older, heavier, more frequently male, and sleepier (p < 0.05) than those with "epilepsy only." Furthermore, they experienced their first seizure at an older age (p < 0.05). CONCLUSIONS: Systematic investigation reveals that OSA is frequent in epilepsy patients. The major risk factors for OSA in our epilepsy patients were the same as those typically found in the general population. Of the epilepsy-related factors, older age at onset of seizures appears to be significantly related to comorbidity with OSA (p < 0.05). The presence in epilepsy patients of these features should alert the clinician to the possibility of an underlying OSA.     

Polysomnographic and urodynamic changes in a case of obstructive sleep apnea syndrome with enuresis

A 53-year-old female patient with obstructive sleep apnea syndrome was reported. She had complained of enuresis as well as a 15-year history of snoring, but she had no complaint of sleep and awake disturbance. Polysomnographic study showed repeated obstructive apnea and hypopnea with an apnea/hypopnea index of 52.6, and severe oxygen desaturation during sleep. On cystometography during sleep, the changing amplitude of the spike wave corresponds to the changes of respiratory efforts against a closed upper airway. The patient was treated successfully with imipramine and acetazolamide for the obstructive sleep apnea and enuresis. Apnea/hypopnea index, nocturnal oxygen desaturation, and sleep architecture were improved, and enuresis completely disappeared. Cystometrography during sleep showed that the average amplitude of the spike wave tended to be low. Percentage urinary volume during sleep compared with 24 h volume was significantly reduced. We considered that the enuresis was mainly related to increased intra-abdominal pressure produced by respiratory efforts and enhanced nocturnal urine production.     

Polysomnographic features of idiopathic central sleep apnea

Two patients with idiopathic central sleep apnea (ICSA), which is an uncommon condition, were recently encountered. This study examines the polysomnographic features of ICSA. The characteristic findings of ICSA are summarized as follows: (i) central apneas and hypopneas are progressively less frequent as sleep state deepens from stage 1 to stage 2 to stage 3 + 4 to stage REM (rapid eye movement); (ii) desaturation related to apneas and hypopneas is mild; and (iii) periodic breathing is commonly observed. However, the two patients demonstrated apparently different findings. It is suggested that the mechanisms underlying apnea and hypopnea in ICSA are heterogeneous.     

伴中重度阻塞性睡眠呼吸暂停低通气综合征的抑郁症患者多导睡眠监测特点

目的 探讨伴中重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的抑郁症患者多导睡眠监测（PSG）特点。方法 回顾性分析2017年12月-2019年10月在苏州市广济医院睡眠医学中心完成整夜多导睡眠监测（PSG）的门诊和住院患者以及健康体检人群,从中筛选出四组被试,分别为伴中重度OSAHS的抑郁症患者（n=31）、不伴OSAHS的抑郁症患者（n=79）、中重度OSAHS患者（n=96）和正常对照组（n=32）。比较四组被试睡眠进程相关指标（总睡眠时间、睡眠潜伏期、觉醒次数）和睡眠结构相关指标（N1、N2、N3期及REM期占总睡眠时间的比例,REM潜伏期、REM期持续时间）以及睡眠呼吸相关指标（氧减指数）等参数。结果 睡眠进程方面,四组被试总睡眠时间、睡眠潜伏期和觉醒次数差异均有统计学意义（F=2.874、3.959、12.291,P<0.05或0.01）。睡眠结构方面,四组被试N2期、N3期占总睡眠时间比例差异均有统计学意义（F=13.885、48.013,P均<0.01）;四组被试REM潜伏期、REM期持续时间、REM期占总睡眠时间比例差异均有统计学意义（F=41.492、11.827、10.552,P均<0.01）。睡眠呼吸相关指标方面,四组被试氧减指数差异有统计学意义（F=170.585,P<0.05）。结论 伴中重度OSAHS的抑郁症患者存在严重的睡眠进程和结构紊乱,同时伴有更频繁和更严重的呼吸相关事件。     

The genetics of sleep apnea

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a complex chronic condition that is undoubtedly influenced by multiple factors. Accumulating data suggest that there are strong genetic underpinnings for this condition. It has been estimated that approximately 40% of the variance in the apnea hypopnea index (AHI) may be explained by familial factors. It is likely that genetic factors associated with craniofacial structure, body fat distribution and neural control of the upper airway muscles interact to produce the OSAHS phenotype. Although the role of specific genes that influence the development of OSAHS have not yet been identified, current research in rodents suggests that several genetic systems may be important. In this chapter, we shall first define the OSAHS phenotype, and then review the evidence that suggests an underlying genetic basis of OSAHS, the risk factors for OSAHS that may be inherited, and potential candidate genes.     

The effect of aging and severity of sleep apnea on heart rate variability indices in obstructive sleep apnea syndrome

Objective

This study aims to analyze how much heart rate variability (HRV) indices discriminatively respond to age and severity of sleep apnea in the obstructive sleep apnea syndrome (OSAS).

Methods

176 male OSAS patients were classified into four groups according to their age and apnea-hypopnea index (AHI). The HRV indices were compared via analysis of covariance (ANCOVA). In particular, the partial correlation method was performed to identify the most statistically significant HRV indices in the time and frequency domains. Stepwise multiple linear regressions were further executed to examine the effects of age, AHI, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and sleep parameters on the significant HRV indices.

Results

The partial correlation analysis yielded the NN50 count (defined as the number of adjacent R-wave to R-wave intervals differing by more than 50 ms) and low frequency/high frequency (LF/HF) ratio to be two most statistically significant HRV indices in both time and frequency domains. The two indices showed significant differences between the groups. The NN50 count was affected by age (p<0.001) and DBP (p=0.039), while the LF/HF ratio was affected by AHI (p<0.001), the amount of Stage 2 sleep (p=0.005), and age (p=0.021) in the order named in the regression analysis.

Conclusion

The NN50 count more sensitively responded to age than to AHI, suggesting that the index is mainly associated with an age-related parasympathetic system. On the contrary, the LF/HF ratio responded to AHI more sensitively than to age, suggesting that it is mainly associated with a sympathetic tone likely reflecting the severity of sleep apnea.     

Prevalence of ischemic heart disease among patients with sleep apnea syndrome

Abstract We investigated the prevalence of ischemic heart disease (IHD) in sleep apnea syndrome (SAS) and the presence of coronary risk factors involved in the onset of IHD in 386 subjects with suspected SAS due to heavy snoring. The prevalence of IHD among patients with untreated SAS was found to be 23.8%, and the percentage of patients having SAS complicated with IHD was high among those with moderate or severe SAS. Sleep apnea syndrome patients with IHD also showed high prevalences of hypertension and hyperlipidemia. It appears that sleep apnea aggravates the factors that cause coronary vascular disorders, and is involved in the onset of IHD.