Using clinical data to predict obstructive sleep apnea

BackgroundObstructive sleep apnea (OSA) is a common disorder and associated with motor vehicle accidents, reduced quality of life and various comorbidities. It is necessary to identify clinical parameters that may predict the presence and severity of OSA.MethodsSubjects with suspected OSA were consecutively recruited for development and validation of the models. Clinical data collected from participants included general information, OSA-related symptoms, questionnaire responses, and physical examination. Logistic and linear regressions were used to develop models to determine the presence and severity of OSA.ResultsAll 202 subjects (157 men, 45 women; age range, 18–68 years) underwent polysomnography (PSG) and clinical assessment, of whom 62.3% were diagnosed with OSA. The presence of OSA was defined using the equation, 1.00 × central obesity + 2.05 × snoring + 1.80 × witnessed nocturnal apnea + 1.73 × lateral narrowing – 3.25; and apnea-hypopnea index (AHI) was defined using, 12.5 × central obesity + 17.1 × witnessed nocturnal apnea + 6.2 × tonsillar size + 9.0 × lateral narrowing – 19.7. The model demonstrated a sensitivity of 81.1% (95% CI: 73.2–87.5%) and a specificity of 76.0% (95% CI: 64.7–85.1%) at the optimal cut-off value for OSA detection. The positive and negative likelihood ratios were 3.4 (95% CI: 2.2–5.1) and 0.3 (95% CI: 0.2–0.4), respectively. The area under the receiver operating characteristic curve for the predictive model (83.7%) was significantly greater than that of the Berlin Questionnaire (53.5%), Epworth Sleepiness Scale (61.1%), and STOP-BANG questionnaire (73.8%). 101 subjects were recruited as the validation group. The models to determine the presence and severity of OSA had an accuracy of 0.812 and 0.416 in the validation group.ConclusionsResults of the present study suggest that a combination of clinical data may be helpful in identify patients who are at increased risk for OSA.     

Laryngocele and epiglottic cyst as rare causes of obstructive sleep apnea

Introduction  Upper airway pathologies have been reported to cause obstructive sleep apnea (OSA). Case report  We present two rare cases of OSA, one with laryngocele secondary to partial laryngectomy and the other with epiglottic cyst. Conclusion  In the management of cases with OSA symptoms, a detailed evaluation of upper airways, including endoscopic and radiological examinations as well as polysomnography, should be done.     

阻塞性睡眠呼吸暂停合并肺癌的研究进展

阻塞性睡眠呼吸暂停(OSA)是患者在夜间睡眠时形成周期性缺氧-复氧循环,即间歇性缺氧。肺癌是最常见的恶性肿瘤,预后差。近年来,越来越多的研究探讨了OSA对肺癌的影响,提示OSA可增强肺癌细胞的增殖、侵袭及迁移能力。这可能与OSA造成的间歇性缺氧诱导缺氧诱导因子-1α(HIF-1α)增加及肺癌细胞中程序性死亡配体1(PD-L1)表达增强有关。该文综述了OSA与肺癌的关系及影响肺癌的可能机制,总结了模拟OSA样间歇性缺氧合并肺癌的细胞及动物模型。     

The pathogenesis of obstructive sleep apnea

Obstructive sleep apnea (OSA) is a major source of cardiovascular morbidity and mortality, and represents an increasing burden on health care resources. Understanding underlying pathogenic mechanisms of OSA will ultimately allow for the development of rational therapeutic strategies. In this article, we review current concepts about the pathogenesis of OSA. Specifically, we consider the evidence that the upper airway plays a primary role in OSA pathogenesis and provide a framework for modelling its biomechanical properties and propensity to collapse during sleep. Anatomical and neuromuscular factors that modulate upper airway obstruction are also discussed. Finally, we consider models of periodic breathing, and elaborate generalizable mechanisms by which upper airway obstruction destabilizes respiratory patterns during sleep. In our model, upper airway obstruction triggers a mismatch between ventilatory supply and demand. In this model, trade-offs between maintaining sleep stability or ventilation can account for a full range of OSA disease severity and expression. Recurrent arousals and transient increases in airway patency may restore ventilation between periods of sleep, while alterations in neuromuscular and arousal responses to upper airway obstruction may improve sleep stability at still suboptimal levels of ventilation.     

New developments in the use of positive airway pressure for obstructive sleep apnea

Obstructive sleep apnea (OSA) is a disorder which afflicts a large number of individuals around the world. OSA causes sleepiness and is a major cardiovascular risk factor. Since its inception in the early 1980’s, continuous positive airway pressure (CPAP) has emerged as the major treatment of OSA, and it has been shown to improve sleepiness, hypertension, and a number of cardiovascular indices. Despite its successes, adherence with treatment remains a major limitation. Herein we will review the evidence behind the use of positive airway pressure (PAP) therapy, its various modes, and the methods employed to improve adherence. We will also discuss the future of PAP therapy in OSA and personalization of care.     

Condyle displacement in obstructive sleep apnea patients with oral appliance

目的 明确阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea,OSA)患者戴入治疗有效的口腔矫治器后髁状突的位置变化.方法 选取21例使用口腔矫治器成功治疗的OSA患者参加研究,采用经颅咽方向投照双侧颞下颌关节的方法摄取闭口位、最大开口位及戴有效的口腔矫治器后双侧颞下颌关节的数字化X线片.测量髁状突的位置并作三个不同下颌位置的比较,对髁状突位置的变化及戴用口腔矫治器后的疗效变化作相关分析.结果 三个髁状突位置明显不同.患者戴入治疗有效的口腔矫治器后髁状突的最上点座标为X(-1.21±1.98)mm,Y(-0.68±1.08)mm.髁状突位置的变化与口腔矫治器疗效的变化无明显相关性,x值的相关系数为r=0.057,y值的相关系数为r=0.024.结论 戴入有效的口腔矫治器后髁状突的最上点为靠近于颞下颌关节的结节点.     

Clinical manifestations of sleep apnea

Obstructive sleep apnea (OSA) may manifest in a number of ways from subtle intrusion into daily life to profound sleepiness, snoring, witnessed apneas and other classic symptoms. Although there is increasing evidence suggesting OSA can adversely affect health in a variety of ways, this disorder remains underdiagnosed. The most well-escribed health consequences of OSA relate to the cardiovascular system. Hypertension and arrhythmias have a strong association with OSA, and evidence suggests that treatment of OSA in patients with refractory hypertension and in patients planning cardioversion for atrial fibrillation may be of particularly importance. Significant associations between heart failure and OSA as well as complex sleep apnea have also been well-described. Cerebrovascular insult, impaired neurocognition, and poorly controlled mood disorder are also associated with in OSA. Therapy for OSA may ameliorate atherosclerotic progression and improve outcomes post-cerebrovascular accident (CVA). OSA should be considered in patients complaining of poor concentration at work, actual or near-miss motor vehicle accidents, and patients with severe sleepiness as a component of their co-morbid mood disorders. The metabolic impact of OSA has also been studied, particularly in relation to glucose homeostasis. Also of interest is the potential impact OSA has on lipid metabolism. The adverse effect untreated OSA has on glucose tolerance and lipid levels has led to the suggestion that OSA is yet another constituent of the metabolic syndrome. Some of these metabolic derangements may be related to the adverse effects untreated OSA has on hepatic health. The cardiovascular, neurocognitive, and metabolic manifestations of OSA can have a significant impact on patient health and quality of life. In many instances, evidence exists that therapy not only improves outcomes in general, but also modifies the severity of co-morbid disease. To mitigate the long-term sequela of this disease, providers should be aware of the subtle manifestations of OSA and order appropriate testing as necessary.     

阻塞性睡眠呼吸暂停综合征的嗜睡及残余嗜睡

嗜睡是阻塞性睡眠呼吸暂停综合征（OSAS）的常见症状。人们普遍期望对OSAS的有效治疗可以清除或改善白天过度嗜睡,但仍有一些接受治疗的OSAS患者在觉醒时有嗜睡,称为残余嗜睡。对OSAS患者残余嗜睡的进一步诊治取决于发生残余嗜睡的原因。最近,已获得来自临床实验的数据,为对残余嗜睡的OSAS患者进行评估和处理提供了方向。     

关于阻塞性睡眠呼吸暂停治疗方法的新探讨

阻塞性睡眠呼吸暂停(obstructive sleep apnoea,OSA)是临床常见的疾病,主要表现为打鼾,夜间睡眠反复出现呼吸暂停,白天过度嗜睡等症状.目前有许多的临床研究和流行病学的结果都显示了OSA是一种对多器官和多系统都有损害的睡眠呼吸疾病,它是高血压、冠状动脉粥样硬化性心脏病、心律失常、充血性心力衰竭、脑卒中等多种疾病的独立危险因素[1].严重影响着患者的生活质量,其发病率也越来越高.因此,这就使得进一步的研究探讨OSA的治疗方法成为必要.     

Time-dependence and comparison of regional and overall anthropometric features between Asian and Caucasian populations with obstructive sleep apnea: a cumulative meta-analysis

BackgroundAnthropometric measurements are simple and reachable tools for self-evaluating and screening patients with a high risk of obstructive sleep apnea (OSA). However, the accumulated relationship of obesity on the anthropometric characteristics of OSA is not well understood. The aim of the study was to show the time-dependent trend of OSA patients and compare overall and regional anthropometric between two ethnicities.MethodsA cumulative meta-analysis was performed to assess obesity metrics in patients with and without OSA between Asians and Caucasians. We searched PubMed, Web of Science, Embase, and Scopus up to Jun 2020. Included studies used body mass index (BMI), neck circumference (NC), waist circumference (WC) and waist-to-hip ratio (WHR) as measures of anthropometric features in the adult OSA population and controls, utilized in-lab polysomnography or home sleep testing with apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) classification, reported ethnicity/race, and were published in English. Any studies lacking one of these criteria or sufficient data were excluded.ResultsForty studies with a total of 19,142 subjects were investigated. Comparison of changes between patients with and without OSA showed that OSA patients had a higher BMI [mean difference (MD) 3.12, 95% confidence interval (CI): 2.51–3.73], NC (MD 3.10, 95% CI: 2.70–3.51), WC (MD 9.84, 95% CI: 8.42–11.26) and waist-hip ratio (MD 0.04, 95% CI: 0.03–0.05) than the control subjects. The accumulated time-dependent increase in population with OSA was significantly apparent with all anthropometric features. BMI increased from 2000 (MD 0.50) to 2012 (MD 3.08–3.48) and remained stable afterwards (MD 2.70–3.17), NC increased from 2000 (MD 0.40) to 2013 (MD 3.09) and remained stable afterwards too (MD 3.06–3.21). WC increased from 2000 (MD 2.00) to 2012 (MD 9.37–10.03) and also remained stable afterwards (MD 8.99–9.84). WHR was stable from 2000 to 2004 with an MD of 0.01 and then stable from 2007 onwards with an increased MD of 0.03–0.04. Compared with Caucasian patients, Asian patients had lower obesity relevant variates.ConclusionsBMI, NC, WC and WHR are associated with OSA in both ethnic groups. Anthropometry for overall and regional obesity could facilitate differentiation of patients with OSA from individuals without OSA by ethnicity.     

An effective model for screening moderate-to-severe obstructive sleep apnea based on the STOP-BANG questionnaire

BackgroundThis study aimed to develop a more effective screening model for moderate-to-severe obstructive sleep apnea (OSA) based on the best tool among Epworth Sleepiness Scale (ESS), NoSAS score and STOP-BANG questionnaire (SBQ).MethodsThis study screened 2,031 consecutive subjects referred with suspected OSA from 2012 to 2016, including the test cohort from 2012 to 2014 and the validation cohort from 2014 to 2016. Anthropometric measurements, polysomnographic data, ESS, NoSAS scores and SBQ scores were recorded. Receiver operating characteristic curve analyses were performed and the final predictive models were verified in a validation cohort.ResultsA total of 1,840 adults were finally included. The performance of ESS, NoSAS score and SBQ in screening OSA was compared. The diagnostic accuracy of SBQ was superior to ESS and NoSAS. A predictive model based on SBQ yielded an area under the curve (AUC) of 0.931 (95% CI: 0.915–0.946), and the sensitivity and specificity were 84.47 (95% CI: 81.4–87.2) and 87.36 (95% CI: 83.9–90.3) respectively. In the validation cohort, the AUC was 0.955 (95% CI: 0.938–0.969), with a sensitivity and specificity of 86.79 (95% CI: 83.2–89.9) and 90.88 (95% CI: 87.2–93.8) respectively. In addition, the model performed moderately in screening mild OSA with the AUC being 0.771 (95% CI: 0.721–0.815).ConclusionsThe SBQ was effective in screening moderate-to-severe OSA. And a SBQ -based predictive model afforded excellent diagnostic efficacy, which could be applied in clinical practice.     

Coagulability in obstructive sleep apnea

BACKGROUND:

Obstructive sleep apnea (OSA) is a common disorder that affects both quality of life and cardiovascular health. The causal link between OSA and cardiovascular morbidity/mortality remains elusive. One possible explanation is that repeated episodes of nocturnal hypoxia lead to a hypercoagulable state that predisposes patients to thrombotic events. There is evidence supporting a wide array of hematological changes that affect hemostasis (eg, increased hematocrit, blood viscosity, platelet activation, clotting factors and decreased fibrinolytic activity).

OBJECTIVE:

To provide a comprehensive review of the current evidence associating OSA with increased coagulability, and to highlight areas for future research.

METHODS:

Keyword searches in Ovid Medline were used to identify relevant articles; all references in the articles were searched for relevant titles. The Web of Science was used to identify articles citing the relevant articles found using the Ovid Medline search. All original peer-reviewed articles, meta-analyses and systematic reviews regarding the pertinent topics between 1990 and present were selected for review.

RESULTS:

Hematocrit, blood viscosity, certain clotting factors, tissue factor, platelet activity and whole blood coagulability are increased in patients with OSA, while fibrinolysis is impaired.

CONCLUSION:

There is considerable evidence that OSA is associated with a procoagulant state. Several factors are involved in the procoagulant state associated with OSA. There is a need for adequately powered clinical studies involving well-matched control groups to address potential confounding variables, and to accurately delineate the individual factors involved in the procoagulant state associated with OSA and their response to treatment.     

CPAP increases exercise tolerance in obese subjects with obstructive sleep apnea

Obese subjects commonly suffer from exertional dyspnea and exercise intolerance. Preliminary evidence suggests that treatment with nocturnal continuous positive airway pressure (nCPAP) may improve dyspnea in obese patients with obstructive sleep apnea (OSA), but the effect on exercise tolerance is unknown. This study sought to investigate whether nCPAP improves exercise tolerance and exertional dyspnea in obese patients with OSA. Obese patients prescribed nCPAP for moderate/severe OSA and without cardiopulmonary disease were recruited. Patients completed a constant-load exercise test and Baseline and Transitional Dyspnea Index questionnaires (BDI/TDI) at baseline and after one and three months of nCPAP. Primary outcome was change in constant-load exercise time from baseline to one and three months. Secondary outcomes included changes in isotime dyspnea, isotime leg fatigue and BDI/TDI score at one and three months. Fifteen subjects (body mass index?=?43?kg?m(-2), apnea-hypopnea index?=?49(.)hr(-1)) were studied. Constant-load exercise time increased by 2.0?min (40%, p?=?0.02) at one month and 1.8?min (36%, p?=?0.04) at three months. At one and three months, isotime dyspnea decreased by 1.4 (p?=?0.17) and 2 units (p?=?0.04), and leg fatigue decreased by 1.2 (p?=?0.18) and 2 units (p?=?0.02), respectively. BDI/TDI scores were 2.7 (p?=?0.001) and 4.5 points (p?相似文献   

阻塞性睡眠呼吸暂停综合征术前评估方法的研究进展

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)是一种常见的因郡分或全部上呼吸道反复阻塞引起的睡眠障碍,其特征是睡眠时呼吸气流暂停超过10 s.手术患者合并OSAS可使患者更易发生围手术期并发症.目前OSAS诊断的金标准是多导睡眠图,其术前评估方法有量表法和便携式仪器诊断等多种方法.     

阻塞性睡眠呼吸暂停群与血压的实时研究

目的　观察阻塞性睡眠呼吸暂停 (OSA)患者OSA连续发生 (OSA群 )时的实时血压改变 ,确定OSA群对血压的影响。方法　全部病例年龄均在 6 0岁以下 ,未服用过任何降血压药物治疗。以多导睡眠图 (PSG)检测睡眠过程的呼吸事件 ,同时以PWTT法连续测量血压。确诊为OSA组病人 ,在连续出现OSA群时 ,对血压作 2 0次等时取样 ,并与经PSG检查排除OSA的对照组病人比较 ,确定OSA群发生时的血压改变情况。结果　 92 %的OSA患者在OSA群发生时均有明显的血压升高 ,平均收缩压升高 5 8mmHg,舒张压升高 3 7mmHg ,最高收缩压升高 18 7mmHg ,舒张压升高12mmHg,明显高于非OSA病人 (P <0 0 1)。结论　考虑到其他影响因素 ,仍可认为 ,OSA(特别是连续发生的OSA群 ) ,与血压升高有直接关系 ,血压升高的程度、持续时间与OSA的严重程度正相关     

阻塞性睡眠呼吸暂停对肺循环的影响

阻塞性睡眠呼吸暂停（OSA）是一种常见病和多发病,其对心血管系统包括肺循环和体循环有着重要影响。OSA可引起急性肺动脉高压,主要是由于低氧性肺血管收缩以及机械效应和觉醒状态下的反射性血管收缩,在一些OSA患者中发现了一些长期的改变,这可能是由于大多数患者经常因相关的肺疾病导致日间低氧血症,从而发展成持续的肺动脉高压的结果,但也有证据表明OSA是引起日间肺动脉高压的独立危险因素。现将OSA对肺循环与右心室的已知影响,包括急性和慢性影响作一综述。     

Body position and obstructive sleep apnea syndrome

In adults, influence of body position on the occurrence of respiratory events during sleep is recognized, and increased numbers of respiratory events occur when the supine position is assumed.1-4 In 1985, Orr et al. showed that body position did not influence respiratory events during sleep in children.5 Recently, Fernandes do Prado et al. showed that children had a lower obstructive apnea hypopnea index (AHI) in supine position.6 Results of these two studies are different from others performed on adults. Moreover, upper airway abnormalities were not considered in these studies.The aim of the present study was to evaluate the effect of body position on obstructive respiratory events in children with different upper airway findings.     

Gender differences in Saudi patients with obstructive sleep apnea

Obstructive sleep apnea (OSA) remains under-recognized in women possibly due to differences in clinical presentation, difference in tolerance to symptoms, and rate of usage and referral to sleep services. No reports have addressed OSA in women in the Middle Eastern (Arab) population. Therefore, we conducted this study to assess the differences in demographics, clinical presentation, and polysomnographic (PSG) findings between Saudi women and men diagnosed to have (OSA). The study group comprised 191 consecutive Saudi women and 193 consecutive men who were referred to the Sleep Disorders Centre and were found by in-laboratory PSG to have OSA. Demographic and clinical data were obtained by personal interviews. Women were significantly older than men (53.9 and 43.0 years, respectively; p < 0.001). Similarly, their body mass index was significantly higher than men (p < 0.001). Insomnia was more common among women (39.8%) compared to men (25.9%; p = 0.005). Other sleep symptoms including witnessed apnea, and excessive daytime sleepiness did not show any statistical difference between the two groups. Women were more likely than men to be diagnosed with hypothyroidism, diabetes, hypertension, cardiac disease, and asthma. Apnea–hypopnea index (AHI) was statistically higher in men compared to women; however, most of apnea/hypopnea events in women occurred during rapid eye movement sleep, and the mean duration of hypopnea and apnea was significantly lower in women (p = 0.004). Sleep efficiency was lower in women (71.5% vs. 77.7%) in men (p < 0.001). The desaturation index was higher in men (p = 0.01), but no difference was found in lowest SaO₂ or time with SaO₂ less than 90%. The present study showed important clinical and PSG differences between Saudi women and men with OSA. Clinicians need to be aware of these differences when assessing women for the possibility of OSA as they may be symptomatic at a lower AHI and have significant comorbid conditions that can be adversely affected if their OSA was not timely managed.