Clinical and polysomnographic data of positional sleep apnea and its predictors

Introduction

In Asian population, facial structure may contribute to the primary pathophysiology of obstructive sleep apnea (OSA). We hypothesized that sleep position may have more effect on OSA in Asians compared to the Western population. If this hypothesis is accurate, positional therapy will have a major impact on treatment of OSA among Asians.

Patients/methods

We reviewed 263 polysomnographic studies from our laboratory from January 1, 2010 to June 30, 2010. Criteria for positional and non-positional OSA were (1) supine respiratory disturbance index (RDI)/non-supine RDI ??2 and total RDI ??5 and (2) supine RDI/non-supine RDI <2 and total RDI ??5, respectively. We aimed to determine the difference in baseline characteristics, polysomnographic findings, and predictors for positional OSA.

Results

We found 144 patients diagnosed with OSA (RDI ??5), and 96 patients met the criteria for positional OSA (67%), in which in almost half of these patients (47%), RDI was normalized (RDI?<?5) in non-supine position. Snoring frequency were significantly lower among positional OSA and OSA was less severe indicated by lower RDI and arousal index, higher mean and nadir oxygen saturation, and higher %NREM3. We also found that low snoring frequency (less than 20% of total sleep time) was a significant predictor for positional OSA (odd ratio of 3.27; p?=?0.011), contrarily to low mean oxygen saturation (<95%) which was found to be a negative predictor (odd ratio of 0.31; p?=?0.009). Among OSA patients, low RDI (<15) was a significant predictor for normalization of RDI in non-supine position (odd ratio of 8.77; p?=?<?0.001), contrarily to low mean oxygen saturation (<95%) which was also found to be a negative predictor (odd ratio of 0.13; p?=?0.001).

Conclusion

Positional OSA is very prevalent and noted in almost 70% of our patients. Low snoring frequency was noted to be a positive predictor for positional OSA, contrarily to low mean oxygen saturation which was found to be a negative predictor. These findings are encouraging that positional therapy can be very beneficial as the treatment modality for OSA among Asians.     

Factors associated with corneal astigmatism change after ptosis surgery

AIM: To evaluate the predictive factors of postoperative corneal astigmatism change in ptosis patients who underwent ptosis surgical repair. METHODS: Patients who underwent levator resection at Oculoplastic service of the Department of Ophthalmology, Naresuan University Hospital, Thailand between September 2017 and August 2019 were retrospectively evaluated. Changes in degree and axis of corneal astigmatism after ptosis surgery were compared based on patient factors consisting of age at operation, sex, preoperative margin-reflex distance (MRD) 1, and preoperative degree and axis of corneal astigmatism. RESULTS: Forty-two eyes of 28 patients were included in the study. Wilcoxon signed ranks test showed a significant postoperative corneal astigmatism change only in a subgroup of eyes with preoperative astigmatism of ≥1.5 diopters (D; P=0.006). Furthermore, 72.2% (13/18) of the eyes with preoperative astigmatism of ≥1.5 D showed a reduction of astigmatism after eyelid surgery, with the mean astigmatic change of 0.65 D. Majority of preoperative eyes demonstrated with-the-rule astigmatism pattern (45.2%), of which 57.9% showed a reduced degree of astigmatism. CONCLUSION: In patients undergoing ptosis surgery, the data demonstrate for the first time the association between postoperative corneal astigmatism change and a preoperative corneal astigmatism of ≥1.5 D. Thus, we encourage considering severity of corneal astigmatism prior to cataract or refractive surgery planning in ptosis patients, especially with toric-intraocular lens, to avoid the possibility of calculation error.     

Optical coherence tomography in central nervous system demyelinating diseases related optic neuritis

AIM: To compare the thickness of the peripapillary retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) among patients with various forms of optic neuritis (ON) and to identify whether any particular parameters or their thinning pattern can be used to distinguish the type of ON. METHODS: This prospective study was conducted at the Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Thailand, between January, 2015 and December, 2016. We enlisted patients over 18 years of age with history of ON and categorized patients into 4 groups: 1) aquaporin 4 antibodies (AQP4-IgG) positive; 2) multiple sclerosis (MS); 3) myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) positive; 4) idiopathic-ON patients. Healthy controls were also included during the same study period. All patients underwent complete ophthalmological examination and spectral domain optical coherence tomography (OCT) imaging to analyze RNFL and GCIPL thickness after at least 3mo since the last episode of acute ON. The generalized estimating equation (GEE) models were used to compare the data amongst ON groups. RESULTS: Among 87 previous ON eyes from 57 patients (43 AQP4-IgG+ON, 17 MS-ON, 8 MOG-IgG+ON, and 19 idiopathic-ON), mean logMAR visual acuity of AQP4-IgG+ON, MS-ON, MOG-IgG+ON, and idiopathic-ON groups was 0.76±0.88, 0.12±0.25, 0.39±0.31, and 0.75±1.08, respectively. Average, superior, and inferior RNFL were significantly reduced in AQP4-IgG+ON, MOG-IgG+ON and idiopathic-ON eyes, relative to those of MS-ON. Differences were not statistically significant for RNFL or GCIPL between the AQP4-IgG+ON and MOG-IgG+ON groups, whereas visual acuity in MOG-IgG+ON was slightly, but not significantly, better (0.39 vs 0.76). Although RNFL thickness in MOG-IgG+ON was significantly reduced as compared to MS-ON, mean visual acuity and GCIPL were not different. CONCLUSION: Thinning of superior and inferior quadrants of RNFL are more commonly seen in MOG-IgG+ON and AQP4-IgG+ON. Long term visual acuity in MOG-IgG+ON is often better than AQP4-IgG+ON, whereas the structural change from OCT is comparable.     

Psychosocial acceptance of cleft patients: has something changed?

Objective

The main purpose of this study was to analyse the reactions of a panel (non-cleft adults) when observing cleft lip morphology. Although rehabilitation of cleft lip and palate is improving, there are still indications of social rejection of cleft patients by the people around them. Polarity profiles have been used since 1973 to measure social distance with regard to cleft patients. Because rehabilitation results and education of the society have improved in recent decades, we investigated whether social distance has been affected.

Setting

The setting of this study is the Department of Oral, Craniomaxillofacial, and Facial Plastic Surgery, University Hospital of Leipzig, Germany

Patients and participants

Using a cross-sectional study design, we enrolled a sample of adult laypersons (n = 273). For the survey, we followed the concept of photograph presentation and questionnaire investigation reported by Sergl and Schmid (1973). We presented anonymised frontal and profile pictures of the faces of 50 cleft patients and asked the laypersons to specify social distance. Three predictor variables (layperson gender, profession and year of evaluation) were grouped.

Results

Although social distance has reduced during the last 40 years, life situations which require emotional proximity still cause some concern. Professional background and gender affect laypersons’ attitudes.

Conclusion

Although rehabilitation of cleft lip and palate is much better than 40 years ago, social distance remains a problem in society. It is necessary to improve both results of rehabilitation of cleft patients and social acceptance by the people around them.

     

Associations between hypoxia parameters in obstructive sleep apnea and cognition,cortical thickness,and white matter integrity in middle-aged and older adults

Sleep and Breathing - This study aimed to investigate the association between each parameter of intermittent hypoxia in obstructive sleep apnea (OSA) and the cognitive profile, cortical thickness,...     

Does CPAP treatment in mild obstructive sleep apnea affect blood pressure?

ObjectivesObstructive sleep apnea (OSA) is associated with significant cardiovascular (CV) morbidity. Continuous positive airway pressure (CPAP) is the standard treatment for moderate to severe OSA, resulting in a reduction in CV morbidity. No studies have compared CV outcomes between CPAP and no CPAP in mild OSA (5 ? AHI < 15).MethodsRetrospective cohort study of subjects (age ? 18) with mild OSA diagnosed between 2004 and 2006. Subjects with a history of hypertension, angina, stroke and smoking were excluded. Subjects were stratified into two groups: CPAP (n = 93) or no CPAP (n = 162). The mean blood pressures (MBP) were compared 2 years after the diagnosis of OSA was established.ResultsUnmatched for covariates (age, sex, BMI, neck circumference, AHI, arousal index and family h/o CV disorders), subjects with mild OSA on CPAP had a 1.97 point reduction, and no CPAP resulted in a 9.61 point elevation (p < 0.0001) in MBP. With propensity score matching for covariates, the mean difference in MBP was ?1.97 (95% CI: ?14.03, ?9.92; p < 0.0001) with a sensitivity analysis of 2.646.ConclusionThis study shows an elevation of the MBP in mild OSA patients who were not treated with CPAP. CPAP treatment in mild OSA patients decreased the MBP over a 2-year period.     

Obstructive sleep apnea as a risk factor for preeclampsia–eclampsia

Sleep and Breathing - Preeclampsia–eclampsia remains one of the leading causes of maternal and perinatal morbidity and mortality. Emerging evidence suggests that obstructive sleep apnea...