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Biomedical subjects

Arie Oksenberg

Publications and source records attributed to Arie Oksenberg.

14 recordsLinked to original sources
PubMed2006

Does the severity of obstructive sleep apnea predict patients requiring high continuous positive airway pressure?

STUDY OBJECTIVES: To investigate polysomnographic and anthropomorphic factors predicting need of high optimal continuous positive airway pressure (CPAP). DESIGN: Retrospective data analysis. PATIENTS: Three hundred fifty-three consecutive obstructive sleep apnea (OSA) patients who had a successful manual CPAP titration in our sleep disorders unit. MEASUREMENTS AND RESULTS: The mean optimal CPAP was 9.5 +/- 2.4 cm H2O. The optimal CPAP pressure increases with an increase in OSA severity from 7.79 +/- 2.2 in the mild, to 8.7 +/- 1.8 in the moderate, and to 10.1 +/- 2.3 cm H2O in the severe OSA group. A high CPAP was defined as the mean + 1 standard deviation (SD; > or =12 cm H2O). The predictor variables included apnea-hypopnea index (AHI), age, sex, body mass index (BMI), Epworth Sleepiness Scale (ESS), and the Multiple Sleep Latency Test (MSLT). High CPAP was required in 2 (6.9%), 6 (5.8%), and 63 (28.6%) patients with mild, moderate, and severe OSA, respectively. On univariate analysis, AHI, BMI, ESS score, and the proportion of males were significantly higher in those needing high CPAP. They also have a lower MSLT mean. On logistic regression, the use of high CPAP was 5.90 times more frequent (95% confidence interval 2.67-13.1) in severe OSA patients after adjustment for the other variables. The area under the receiver operator curve was 72.4%, showing that the model was adequate. CONCLUSIONS: Severe OSA patients are much more likely to need high CPAP levels. However, because of the low positive predictive value (only 28.6%), the clinical value of such information is limited. ESS and MSLT did not increase the predictive value for the need for high CPAP.

Body Mass Index↗
PubMed2006

Positional therapy for obstructive sleep apnea patients: A 6-month follow-up study.

BACKGROUND: Approximately half of obstructive sleep apnea (OSA) patients are positional (i.e., the majority of their breathing abnormalities during sleep appear in the supine posture). Little information exists as to whether avoiding the supine posture during sleep (positional therapy) is a valuable form of therapy for these patients. AIM: To assess the use of positional therapy (by the tennis ball technique [TBT]) during a 6 month period in 78 consecutive positional OSA patients. METHODS: Demographic, polysomnographic, and self-reported questionnaire data on the use of the TBT were analyzed. RESULTS: Of the 50 patients who returned the questionnaire, 19 (38%) (group A) said they were still using the TBT, and 12 (24%) (group B) said they used it initially and stopped using it within a few months but were still avoiding the supine position during sleep. Nineteen patients (38%) (group C) stopped using the TBT within a few months but did not learn how to avoid the sleep supine posture. Patients still using the TBT showed a significant improvement in their self-reported sleep quality (P < .005) and daytime alertness (P < .046) and a decrease in snoring loudness (P < .001). Patients of groups A and B were older than patients who did not comply with this therapy (P < .001). The main reason for patients stopping the use of the TBT in group C was that using it was uncomfortable. CONCLUSIONS: Positional therapy appears to be a valuable form of therapy mainly for some older aged positional OSA patients.

Aged↗
PubMed2006

Dry mouth upon awakening in obstructive sleep apnea.

The aim was to assess the significance of dry mouth upon awakening as a symptom of obstructive sleep apnea (OSA). The participants were 668 consecutive adults referred for polysomnographic evaluation (PSG) because of snoring and suspected OSA, and 582 adults who were attending a general health check-up. Data were obtained from self-administered questionnaires and PSG evaluation. The participants were asked to answer the following question: 'During the last month, did you experience waking up in the morning with a dry mouth?'. The response scale consisted of five categories: 'never', 'rarely', 'sometimes', often', or 'almost always'. We classified patients as having dry mouth upon awakening complaint only if they reported experiencing the symptom 'almost always'. The prevalence of dry mouth upon awakening was twofold higher in patients with OSA (31.4%) than in primary snorers (16.4%, P < 0.001), and increased linearly from 22.4%, to 34.5%, and 40.7% in mild, moderate, and severe OSA respectively (P < 0.001). The prevalence of dry mouth upon awakening in the control group was 3.2%. Logistic regression results indicated that this symptom significantly differentiated OSA patients from primary snorers after adjusting for age, BMI, gender, hypertension, and other classical OSA symptoms (OR 2.33, 95% CI 1.34-4.07). Dry mouth upon awakening appears as a significant symptom of OSA. We suggest that increased sleep time spent with an open mouth is a likely explanation for these findings.

Adult↗
PubMed2006

Low socioeconomic status is a risk factor for cardiovascular disease among adult obstructive sleep apnea syndrome patients requiring treatment.

STUDY OBJECTIVE: To evaluate the possible role of low socioeconomic status (SES) as a risk factor for cardiovascular disease (CVD) among obstructive sleep apnea syndrome (OSAS) patients requiring treatment. DESIGN: Polysomnographic and demographic characteristics and associated morbidity were measured in 686 prospectively recruited adult OSAS patients from two regions in Israel. SETTING: Two university-affiliated sleep laboratories. MEASUREMENTS AND RESULTS: The multiple logistic regression (after adjusting for gender, body mass index [BMI], and smoking) revealed that the following are independent determinants for CVD in OSAS patients requiring treatment: each decrease in income level category (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1 to 1.7), age > or = 1 year (OR, 1.07; 95% CI, 1.04 to 1.1), hypertension (OR, 2.0; 95% CI, 1.3 to 3.1), and hyperlipidemia (OR, 3.7; 95% CI, 2.4 to 5.8); area under the receiver operating characteristic (ROC) = 81.9%. The multivariate determinants describing the low-SES OSAS patients included: minorities and immigrants combined (OR, 6.0; 95% CI, 2.9 to 12), female gender (OR, 2.4; 95% CI, 1.6 to 3.9), increased BMI (OR, 1.9; 95% CI, 1.3 to 2.9), unmarried status (OR, 1.9; 95% CI, 1.2 to 3.1), and years of education (> or = 1 year) [OR, 0.8; 95% CI, 0.7 to 0.8]; area under the ROC = 78.1%. CONCLUSION: In addition to the already known traditional risk factors, low SES was found to be a novel independent risk factor for CVD among adult OSAS patients requiring treatment.

Adult↗
PubMed2003

The KickStrip: a novel testing device for periodic limb movement disorder.

STUDY OBJECTIVES: In light of the ongoing debate over the clinical significance of periodic limb movement disorder (PLMD) and its monitoring in overnight sleep studies, we introduce a novel, portable, low-cost device for PLMD testing. The KickStrip is a disposable device, which includes a movement sensor, a central processing unit with real-time software, and a display. In the present study, the KickStrip final score (Kscore) is validated against the traditional periodic limb movement index (PLMI) based on overnight recordings in the sleep laboratory. DEISGN: Patients underwent full polysomnographic recordings concomitantly with the use of the KickStrip for a single night. SETTING: Sleep Disorders Unit at Loewenstein Rehabilitation Hospital and Sleep Medicine Center at Rambam Medical Center, Israel. PATIENTS: Eighty-two patients referred for overnight sleep recordings due to sleep disturbance of any kind. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The Kscores were collected and the PLMI computed for each leg separately. Pearson correlations between Kscores and PLMI ranged between r = 0.83 to r = 0.88 (p < 0.001). Sensitivity and specificity values of the Kscores for increasing PLMD thresholds showed sensitivity ranging from 50% to 100% and specificity ranging from 83% to 100%. Receiver operating characteristic curves showed area-under-the-curve values ranging from 82% to 92%. Bland-Altman plot showed high agreement between the methods. CONCLUSIONS: Comparisons between the Kscores and the traditional PLMI show increased accuracy with severity level and excellent agreement. The KickStrip is a valuable tool for PLMD testing for both clinical and research purposes.

Adolescent↗
PubMed2003

Sleep-related breathing disorders and rehabilitation outcome of stroke patients: a prospective study.

OBJECTIVE: Sleep-related breathing disorder (SRBD) is more prevalent in stroke patients than in age- and sex-matched controls, but the relationship between SRBD, functional levels at admission, and subsequent recovery is unclear. We evaluated patients after a first stroke to determine the prevalence of SRBD and the influence of SRBD on the recovery of discharge functional status after a rehabilitation program. DESIGN: In a prospective study, 30 stroke patients were studied by continuous overnight pulse oximetry during sleep for the presence of desaturation events (fall of arterial saturation of > 4% from the baseline). The Respiratory Disturbance Index was defined as number of desaturations per hour of sleep. Functional assessment was done at admission using the FIM instrument. The patients were asked about total hours of sleep and the presence or absence of habitual snoring before and after the stroke. The outcome measure at discharge was the FIM score. RESULTS: On linear regression, after including the FIM score at admission, in the model, the Respiratory Disturbance Index score was negatively correlated with the FIM gain (coefficient, -0.635 +/- 0.27; P = 0.025), and together, the variables explained 20.9% of the total variance (adjusted r2). All patients with an admission FIM score of > or = 70 (only mild functional impairment) had a good outcome (FIM score of > 100 at discharge). However, only two of six of those with FIM scores of < 70 with SRBD (defined as a Respiratory Disturbance Index score of > 10) had significant improvement (> or = 30 points), whereas this occurred in seven of nine of those without SRBD (prevalence ratio, 0.43; 95% confidence interval, 0.13-1.40; P = 0.085) CONCLUSIONS: Even after adjusting for the admission functional status, the presence of hypoxic events during sleep predicts a poorer recovery, especially in stroke patients with poor function at admission.

Activities of Daily Living↗
PubMed2002

Excessive daytime sleepiness and risk of occupational injuries in non-shift daytime workers.

STUDY OBJECTIVES: Only a few studies have examined the possible association between excessive daytime sleepiness (EDS) and risk of occupational injuries, and most of them were based on self-reports. This study tested this association in daytime workers using injury data taken from organizational archives. DESIGN: A retrospective and prospective study. It covered injury occurrence during two years prior to a sleep disorder assessment/education procedure and injury occurrence in the following year. The workers were given the assessment results and, when applicable, a letter to the treating physician. SETTING: Eight industrial plants. Lectures and discussions on sleep disorders, treatment, and implications to safety and quality of life were conducted with small groups who completed the sleep assessment questionnaire beforehand. The workers completed the sleep assessment questionnaire prior to the lecture/discussion. PARTICIPANTS: 532 non-shift daytime workers. INTERVENTIONS: N/A. MEASURES AND RESULTS: A battery of questionnaires to assess EDS (by the Epworth Sleepiness Scale), suspected sleep disorders, sleep habits, and job and environmental conditions. Of the workers studied 22.6% had EDS. Most of those (96.3%) indicated that they had experienced this propensity for the past two years or more and 56% of them had experienced it for 10 years or more. Logistic regression analysis indicated that during the two-year period prior to the procedure, EDS was associated with an increased risk of sustaining a work injury (OR=2.23, 95% CI 1.30-3.81), even after controlling for possible confounders, including factory category, job and environmental conditions. In the year after the procedure, the injury rate decreased by one-third in the workers with EDS but remained unchanged in the workers without EDS. Consequently, the association between EDS and injury was no longer significant (OR=1.42, 95% CI 0.71-2.85). CONCLUSION: EDS is a prevalent phenomenon in non-shift daytime workers. Workers with EDS had over two-fold higher risk of sustaining an occupational injury. Providing workers with the assessment results and of the implications of EDS for safety may explain the decrease in occupational injuries upon follow-up. This decrease might have occurred either because of workers taking steps to reduce EDS and/or adopting safety behaviors.

Adult↗
PubMed2002

Treating obstructive sleep apnea improves essential hypertension and quality of life.

About one half of patients who have essential hypertension have obstructive sleep apnea, and about one half of patients who have obstructive sleep apnea have essential hypertension. A growing body of evidence suggests that obstructive sleep apnea is a major contributing factor in the development of essential hypertension. Despite many patients with obstructive sleep apnea having clear symptoms of the disorder, an estimated 80 to 90 percent of cases are undiagnosed. When physicians routinely seek the diagnosis of obstructive sleep apnea by asking patients (especially those with hypertension) three basic sleep-related questions about snoring, excessive daytime sleepiness and reports of witnessed apneic events, the number of cases diagnosed and treated increases by about eightfold. Eliminating snoring and occurrences of apneic-hypopneic episodes will dramatically improve patients' quality of sleep and eliminate excessive daytime sleepiness, which has a detrimental effect on general functioning. Increased alertness will reduce the likelihood that patients will be involved in motor vehicle crashes. In most studies in which blood pressure was measured following treatment for obstructive sleep apnea, daytime and nighttime blood pressure levels were found to decrease significantly. This decrease in blood pressure may also reduce the likelihood of cardiovascular complications. The key to the diagnosis of obstructive sleep apnea is physician knowledge about the disorder. The dramatic improvement in quality of life that occurs when patients are successfully treated for obstructive sleep apnea makes detecting and treating this disorder imperative.

Diagnosis, Differential↗
PubMed2002

Sleep bruxism related to obstructive sleep apnea: the effect of continuous positive airway pressure.

Several studies have reported that sleep bruxism rarely occurs in isolation. Recently, in an epidemiological study of sleep bruxism and risk factors in the general population, it was found that among the associated sleep symptoms and disorders obstructive sleep apnea (OSA) was the highest risk factor for tooth grinding during sleep. The purpose of this report was to evaluate the effect of continuous positive airway pressure (CPAP) on sleep bruxism in a patient with both severe OSA and sleep tooth grinding. Two polysomnographic (PSG) recordings were carried out. The first showed 67 events of sounded tooth grinding, most of them appearing as an arousal response at the end of apnea/hypopnea events in both the supine and lateral postures. During the CPAP titration night most breathing abnormalities were eliminated and a complete eradication of the tooth grinding events was observed. The results of this study suggest that when sleep bruxism is related to apnea/hypopneas, the successful treatment of these breathing abnormalities may eliminate bruxism during sleep.

Journal Article↗
PubMed2002

Rapid Eye Movement (REM) sleep behavior disorder: a sleep disturbance affecting mainly older men.

Rapid Eye Movement (REM) sleep behavior disorder is characterized by the intermittent loss of REM-related muscle atonia and the appearance of elaborated motor behaviors (sometimes violent behavior) and vocalizations associated with dream mentation. Nine patients were diagnosed in our Sleep Disorders Unit with this syndrome during the period August 1997-April 2000. All were male, average age 67.9 +/- 6.9 years. The complaint of all our patients was the occurrence of violent or injurious sleep behavior mainly during the dream stage. Jumping or falling out of bed and slapping or beating their wives were more common. None had history or showed signs of dementia, Parkinson or other neurodegenerative diseases. A relative high amount of SWS (20.9%) was found. Seven showed an intermittent increase in chin EMG tonus while the other two had an almost continuous high chin EMG tonus during REM sleep. We did not observe any violent motor behavior during the polysomnographic recordings. Phasic activities during REM sleep were high but density quantification was not performed. Six patients had also Periodic Limb Movement (PLM) Disorders, four had also Obstructive Sleep Apnea (OSA) Syndrome. The treatment recommended to all patients was Clonazepam beginning with a 0.5-mg dose. Four patients reported a decrease or disappearance of sleep agitation and nightmares and were very happy with the treatment and without side effects. The others decided not to try Clonazepam or stopped after a few days of using it. RBD appears to be a sleep disturbance affecting mainly aged men. Its violent expression may frighten the patients and their bed-partners and may cause injury to both. In some cases this sleep disorder seems to be an early manifestation of a neurodegenerative disorder while in others it may represent only an idiopathic form. Clonazepam at lower doses is a good agent for the treatment of this condition.

Adult↗
PubMed2002

Cheyne-Stokes respiration during sleep: a possible effect of body position.

BACKGROUND: Cheyne-Stokes Respiration (CSR) is a common finding in Chronic Heart Failure and Stroke patients. The body position effect during sleep on obstructive breathing abnormalities is well known. However, the effect of body position during sleep on breathing abnormalities of central type like CSR has not been well documented. MATERIAL/METHODS: Six sleep studies (two complete Polysomnographic (PSG) evaluations and four Pulse Oximetry recordings (PO)), were carried out in a 57-year-old female patient with a recent Cerebro Vascular Accident (CVA who had both Obstructive Sleep Apnea (OSA) and CSR. RESULTS: The first PSG was carried out two months post-stroke and revealed a severe, continuous CSR pattern during Non Rapid Eye Movements (NREM) sleep (mainly with central apneas), and Obstructive Sleep Apnea (OSA) during Rapid Eye Movements (REM) sleep, independent of body position: Supine Respiratory Disturbance Index (SRDI) = 85.2 and Lateral RDI (LRDI) = 95.4. A second PSG was performed three months later after an overall clinical improvement and showed a complete disappearance of CSR during NREM sleep and OSA during REM sleep in her lateral posture (LRDI = 0), while the RDI in the supine posture was only slightly improved (SRDI = 73.2). The CSR pattern was less severe and was characterized mainly by central hypopneas. Two PO recordings between the PSG studies showed similar improvement trends. Two additional PO recordings, two and three weeks after the last PSG (the first one with the patient lying supine and the second one with the patient lying on her side throughout the night), revealed a further significant improvement in the supine posture (SRDI = 37.5). CONCLUSIONS: The results of this study suggest that body posture may play a role not only in the prevalence and severity of obstructive breathing disorders, but also in CSR, a central type of breathing abnormalities during sleep.

Cheyne-Stokes Respiration↗