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PubMed2004

Obstructive sleep apnea in children.

Obstructive sleep-disordered breathing is common in children. From 3 percent to 12 percent of children snore, while obstructive sleep apnea syndrome affects 1 percent to 10 percent of children. The majority of these children have mild symptoms, and many outgrow the condition. Consequences of untreated obstructive sleep apnea include failure to thrive, enuresis, attention-deficit disorder, behavior problems, poor academic performance, and cardiopulmonary disease. The most common etiology of obstructive sleep apnea is adenotonsillar hypertrophy. Clinical diagnosis of obstructive sleep apnea is reliable; however, the gold standard evaluation is overnight polysomnography. Treatment includes the use of continuous positive airway pressure and weight loss in obese children. These alternatives are tolerated poorly in children and rarely are considered primary therapy. Adenotonsillectomy is curative in most patients. Children with craniofacial syndromes, neuromuscular diseases, medical comorbidities, or severe obstructive sleep apnea, and those younger than three years are at increased risk of developing postoperative complications and should be monitored overnight in the hospital.

Child↗

PubMed2003

Obstructive sleep apnea in epilepsy patients: the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) is a useful screening instrument for obstructive sleep apnea in a disease-specific population.

OBJECTIVE: To determine useful cutoffs on the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) in an epilepsy population. BACKGROUND: Epilepsy and obstructive sleep apnea (OSA) frequently coexist, and treating OSA in epilepsy patients may reduce seizure frequency and improve daytime sleepiness. The SA-SDQ, a 12-item validated measure of sleep-related breathing disorders, may be a useful tool to screen epilepsy patients for OSA, although appropriate cutoff points have not been established in this population. Previously suggested SA-SDQ cutoff points for OSA in a non-epilepsy population were 32 for women and 36 for men. PATIENTS AND METHODS: One hundred twenty-five subjects with epilepsy undergoing polysomnography completed a survey about their sleep, including the 12-item SA-SDQ scale. Receiver-operating characteristics curves were constructed to determine optimal sensitivity and specificity. RESULTS: Sixty-nine of the 125 subjects (45%) had apnea-hypopnea indices greater than five, indicating OSA. The area under the curve was 0.744 for men and 0.788 for women. For men, an SA-SDQ score of 29 provided a sensitivity of 75% and a specificity of 65%. For women, an SA-SDQ score of 26 provided a sensitivity of 80% and a specificity of 67%. CONCLUSIONS: The SA-SDQ is a useful screening instrument for OSA in an epilepsy population. Our results indicate that the previously suggested cutoffs for OSA (36 for men and 32 for women) may be too high for this specific population. We suggest screening cutoffs of 29 for men and 26 for women.

Disorders of Excessive Somnolence↗

PubMed2006

Do we neglect women with sleep apnea?

Obstructive sleep apnea (OSA) affects approximately 5% of women and 15% of men in the middle-aged adults, and associated with adverse health outcomes. The prevalence and severity of OSA in women increase across the menopause, as the cardiovascular death and events do. Unfortunately, women with OSA might be under-diagnosed due to circumstances related to the family lifestyle and socio-cultural factors in addition to the different OSA clinical expression. Evaluation of cardiovascular global risk assessment in women with OSA is very important to prevent the high potential cardiovascular morbidity and mortality, since they are poorly informed about cardiovascular disease (CVD). So, we should be aware of the clues suspecting OSA and cardiovascular risk in women admitting to sleep clinics.

Aged↗

PubMed2000

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.

Journal Article↗

PubMed1999

The medical cost of undiagnosed sleep apnea.

Obstructive sleep apnea is an under-diagnosed, but common disorder with serious adverse consequences. Cost data from the year prior to the diagnosis of sleep-disordered breathing in a consecutive series of 238 cases were used to estimate the potential medical cost of undiagnosed sleep apnea and to determine the relationship between the severity of sleep-disordered breathing and the magnitude of medical costs. Among cases, mean annual medical cost prior to diagnosis was $2720 versus $1384 for age and gender matched controls (p<0.01). Regression analysis showed that the reciprocal of the apnea hypopnea index among cases was significantly related to log-transformed annual medical costs after adjusting for age, gender, and body mass index (p<0.05). We conclude that patients with undiagnosed sleep apnea had considerably higher medical costs than age and sex matched individuals and that the severity of sleep-disordered breathing was associated with the magnitude of medical costs. Using available data on the prevalence of undiagnosed moderate to severe sleep apnea in middle-aged adults, we estimate that untreated sleep apnea may cause $3.4 billion in additional medical costs in the U.S. Whether medical cost savings occur with treatment of sleep apnea remains to be determined.

Adult↗

PubMed1995

Medical treatment of sleep apnea.

Obstructive sleep apnea is a common disorder. Since 1981 the treatment of choice has shifted from tracheostomy or weight loss to uvulopalatopharyngoplasty and then to continuous positive airway pressure. This review encompasses the most recent literature, focusing mainly on current treatment options and other potential and experimental modes of therapy. We review in detail continuous positive airway pressure therapy, including unwanted effects; compliance and possible ways to improve it; and ways to deal with the difficult patient. We also review dental appliances, electrical stimulation, and potential hormonal and nicotine treatment.

Administration, Cutaneous↗

PubMed1996

Influence of treatment on muscle sympathetic nerve activity in sleep apnea.

Obstructive sleep apnea (OSA) is a common disorder associated with systemic hypertension, myocardial infarction, stroke, and premature death. Elevated sympathetic tone has been documented previously in OSA and may contribute to the cardiovascular risk. As OSA therapy appears to reduce mortality, we wondered if decreased apnea activity would attenuate the sympathetic hyperactivity of untreated patients. Muscle sympathetic nerve activity (MSNA) was measured during wakefulness via peroneal microneurography in seven patients with documented OSA before and at least 1 mo after compliance-monitored nasal continuous positive airway pressure (CPAP) therapy. Before institution of CPAP therapy, MSNA was high in all patients and decreased after CPAP therapy (baseline versus CPAP: 69.4 +/- 15.3 versus 53.9 +/- 10.5 bursts/min, mean +/- SD; p<0.01). However, the decrease in MSNA was limited to the four patients with the greatest nightly use of CPAP (> or = 4.5 h/night), whereas it remained unchanged in the three patients who were less compliant. There was a direct linear correlation between the decrease in MSNA (bursts/min) and the average hours of CPAP use per night (r = 0.87, p = 0.01). We conclude that in patients with OSA effective reduction in apnea activity with CPAP therapy diminishes the high sympathetic tone present during resting wakefulness.

Adult↗

PubMed2006

Sleep apnea.

Obstructive sleep apnea is a common disorder characterized by repetitive collapse of the pharyngeal airway during sleep. The disorder results primarily from an anatomically small upper airway in conjunction with pharyngeal dilator muscles that can compensate for the anatomic deficiency awake, but not asleep. Ventilatory control instability and a low arousal threshold may contribute to the disorder as well. The consequences of sleep apnea fall into two domains: (1) neurocognitive dysfunction (sleepiness and decreased quality of life) resulting from sleep fragmentation and (2) cardiovascular disease (hypertension, stroke, myocardial infarction, and heart failure) likely resulting from the intermittent hypoxia. The disorder is generally diagnosed in the sleep laboratory over the course of a night, although alternative approaches in the home are also utilized. A number of treatment options are available. Continuous positive airway pressure remains the most consistently effective approach, although oral appliances (generally mandibular-advancing devices) and a number of surgical procedures have some demonstrated efficacy. Thus, therapy must be individualized to the patient's desires and the severity of the apnea.

Behavior Control↗

PubMed1998

[Severity of obstructive sleep apnea syndrome relates to sleep architecture changes].

OBJECTIVE: To explore how obstructive sleep apnea syndrome (OSAS) affects sleep architecture and if OSAS severity and treatment relate to it. METHOD: A computer-assistant diagnostic system was used for polysomnography(PSG) recording. Respiratory events were scored automatically and corrected manually. Sleep was scored manually according to the standard set by Rechtschaffen. 31 controls and 147 OSAS patients(RDI > or = 5) were defined by PSG. 11 OSAS patients(RDI = 62.5 +/- 20.8) accepted nCPAP therapy. PSG were recorded both before and during nCPAP treatment. RESULT: (1) Compared with controls, OSAS group had increased sleep shift number (120 +/- 71 vs 92 +/- 60, P = 0.0106); (2) The number of slow wave sleep(SWS) (5 +/- 9 vs 8 +/- 8, P = 0.0035) and the ratio of total SWS time over total sleep time(TST) (5% +/- 8% vs 8% +/- 9%, P = 0.0062), were decreased and the rate of SWS deprivation(48% vs 26%, P < 0.05) were increased greatly in OSAS patients; (3) REM were less affected by OSAS than SWS because the ratio of its total time over TST, its onset number and deprivation rate had no significant difference between the two groups; (4) OSAS group had increased number of WASO (wake after sleep onset) (27 +/- 28 vs 19 +/- 18, P = 0.017) but the ratio of total WASO time over total sleep period had no significant difference between the two groups; (5) The ratio of total RWS(rapid wave sleep) time over TST (94 +/- 10 in OSAS group vs 91 +/- 12, P = 0.0136) and total RWS number(88 +/- 54 in OSAS group vs 65 +/- 45, P = 0.0075) were increased in OSAS group; (6) The above parameters were obviously disturbed in OSAS patients with RDI > or = 25 but had almost no change in patients with RDI < 25 compared with controls. (7) nCPAP could improve the above parameters but only number of WASO(no therapy: 34 +/- 20 vs therapy: 23 +/- 22, P = 0.011), shift number (no therapy: 151 +/- 62 vs therapy: 97 +/- 50, P = 0.019) and the ratio of total RWS time over TST (no therapy: 115 +/- 58 vs therapy: 69 +/- 34, P = 0.025) had statistical significance. CONCLUSION: OSAS severity relates to sleep architecture changes. Those had RDI < 25 had no change compared with control group. Sleep architecture changes could be improved by effective nCPAP therapy.

Adult↗

PubMed1996

Sleep apnea: is your patient at risk? National Heart, Lung, and Blood Institute Working Group on Sleep Apnea.

Obstructive sleep apnea is a breathing disorder characterized by repeated collapse of the upper airway during sleep, with cessation of breathing. Four percent of middle-aged men and 2 percent of middle-aged women meet minimal criteria for the sleep apnea syndrome. Risk factors include loud, chronic snoring, obesity (especially nuchal), hypertension, excessive daytime sleepiness, and an increased tendency for automobile and work-related accidents. Cardiovascular comorbidity and complications include systemic hypertension, arrhythmias and possibly myocardial ischemia and myocardial infarction in patients with coronary artery disease. Diagnosis is confirmed by a sleep study; currently, polysomnography is the optimum test. Treatment options range from behavioral therapy alone for mild cases to a combination of behavioral approaches and continuous positive airway pressure and/or surgery for moderate and severe cases. Continuous positive airway pressure is the most effective noninvasive treatment. Primary care physicians play a key role in the identification, management and follow-up of patients with sleep apnea.

Comorbidity↗

PubMed1996

[Driving performance and auto accidents in patients with sleep apnea].

Obstructive sleep apnea is a common disorder in which the airway repetitively collapses during sleep; patients with sleep apnea are often inattentive and sleepy. This review discusses driving performance and automobile accidents in patients with sleep apnea. Finally, we discuss the effect of therapy upon driving performance and reported accidents in these subjects.

Accidents, Traffic↗

PubMed2003

Continuous positive airway pressure treatment rapidly improves insulin sensitivity in patients with obstructive sleep apnea syndrome.

The obstructive sleep apnea syndrome is typically associated with conditions known to increase insulin resistance as hypertension, obesity, and diabetes. We investigated whether obstructive sleep apnea itself is an independent risk factor for increased insulin resistance and whether continuous positive airway pressure (CPAP) treatment improves insulin sensitivity. Forty patients (apnea-hypopnea index > 20) were treated with CPAP. Before, 2 days after, and after 3 months of effective CPAP treatment, hyperinsulinemic euglycemic clamp studies were performed. Insulin sensitivity significantly increased after 2 days (5.75 +/- 4.20 baseline versus 6.79 +/- 4.91 micromol/kg.min; p = 0.003) and remained stable after 3 months of treatment. The improvement in insulin sensitivity after 2 days was much greater in patients with a body mass index less than 30 kg/m2 than in more obese patients. The improved insulin sensitivity after 2 nights of treatment may reflect a decreasing sympathetic activity, indicating that sleep apnea is an independent risk factor for increased insulin resistance. The effect of CPAP on insulin sensitivity is smaller in obese patients than in nonobese patients, suggesting that in obese individuals insulin sensitivity is mainly determined by obesity and, to a smaller extent, by sleep apnea.

Body Mass Index↗

PubMed1995

Effect of prone position on apnea severity in obstructive sleep apnea.

We describe a patient with obstructive sleep apnea (OSA) whose apnea-hypopnea index (AHI) improved remarkably in the prone position accompanied by an improved sleep quality, despite a higher AHI in the supine position and even in the lateral position. Magnetic resonance imaging revealed the most dilated upper airway in the prone position, which suggests the role of anatomical narrowing of the upper airway as an important component in the pathophysiology of positional apnea patients. Further studies are needed to determine the therapeutic efficacy of a prone sleeping position in patients with OSA.

Humans↗

PubMed2006

The impact of long-term conventional treatment for overlap syndrome (obstructive sleep apnea and chronic obstructive pulmonary disease) on concurrent erectile dysfunction.

PURPOSE: To assess the improvement of concurrent erectile dysfunction (ED) in men with overlap syndrome (obstructive sleep apnea and chronic obstructive pulmonary disease), treated with continuous positive airway pressure (CPAP) and bronchodilators. MATERIAL AND METHODS: We evaluated 48 men of a mean age of 52.8+/-10 years suffering from both obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), and concurrent ED. They were treated with conventional for pulmonary obstruction therapy (CPAP and bronchodilators) for 6 months and then their erectile function (EF) status was reassessed. ED was considered as improved, if ED intensity score increased for at least five points compared to that of baseline. The determinants for improvement of ED were also evaluated, as well as patient's personal degree of satisfaction with the treatment they received as far as the disorder was concerned. RESULTS: EF was improved in 12 patients (25%), but only two thirds of them were satisfied with the grade of improvement after treatment. ED improvement was related positively with age and apnea/hypopnea index and negatively with ED duration. ED intensity score, O(2) saturation at night and BMI were not significantly related to the outcome of EF improvement. CONCLUSIONS: Conventional treatment for OSA and COPD, has a positive effect on concurrent ED on the minority of patients. This effect is possibly due to the improvement of respiration during sleep with CPAP and of oxygenation with bronchodilators continuously. Of the improved men, one third was not satisfied with the impact of this treatment modality on their EF. It is likely that specific for ED treatment is needed in these individuals.

Age Factors↗

PubMedDate not supplied

The perioperative implications of obstructive sleep apnea.

Patients with obstructive sleep apnea provide significant challenges to the perioperative team. This disorder is often undiagnosed and coexists with other disease processes such as hypertension, congestive heart failure, and cor pulmonale. The prevalence of obesity in American society suggests that an increasing number of patients with sleep apnea will present for surgery. During the perioperative period, life-threatening problems can occur during anesthetic induction and emergence. The pathophysiology of obstructive sleep apnea is reviewed here along with the anesthesia implications of this disease process. Members of the perioperative team need to be aware of the implications of sleep apnea so that surgical outcomes can be optimized.

Anesthesia↗

PubMed2003

Does sleep deprivation worsen mild obstructive sleep apnea?

STUDY OBJECTIVES: Sleep deprivation is believed to worsen obstructive sleep apnea (OSA). We assessed the effect of acute sleep deprivation on polysomnography in a cohort of subjects with mild OSA and a cohort of subjects without OSA. DESIGN: Crossover study in which subjects initially had polysomnography after a normal night's sleep or after 36 hours of sleep deprivation, followed by a 2- to 4-week interval, after which subjects were restudied under the alternate testing condition. SETTING AND PARTICIPANTS: 13 subjects with mild OSA and 16 subjects without OSA were studied in a university teaching hospital sleep laboratory. INTERVENTIONS: 36 hours of supervised sleep deprivation. MEASUREMENTS: Subjects' age, body mass index, neck circumference and Epworth Sleepiness Scale scores were measured; actigraphy and sleep diaries were used to estimate prior sleep debt before each sleep study. RESULTS: Sleep deprivation was found to significantly increase total sleep time, sleep efficiency, and rapid eye movement and slow-wave sleep time. Subjects with OSA showed a lower minimum oxygen saturation after sleep deprivation. However, subjects did not show a significantly different respiratory disturbance index, arousal index, or length of the longest apnea after sleep deprivation. CONCLUSIONS: Acute sleep deprivation did not worsen most OSA parameters as measured by polysomnography. A lower minimum oxygen saturation in mild OSA subjects after sleep deprivation may be important in patients with significant cardiorespiratory disease. More research is needed to assess whether daytime performance and function (eg, driving, sleepiness) is more greatly impaired in OSA subjects who are sleep deprived, compared to normal subjects who are sleep deprived.

Acute Disease↗

PubMed2004

[Functional dynamics of the right ventricle and pulmonary circulation in obstructive sleep apnea. Therapeutic consequences].

Obstructive sleep apnea (OSA) is common with an incidence of at least 500,000 patients in the German population. Typical symptoms are daytime sleepiness, headache in the morning, and snoring. Presumably obstructive sleep apnea via various mechanisms increases cardiovascular morbidity. Hypoxemia causes nocturnal hypertension in most of the patients. Nevertheless, about 20% of the patients develop daytime pulmonary hypertension and right heart dysfunction. Clinical and animal studies demonstrated right ventricular hypertrophy as a consequence of intermittent hypoxemia and pulmonary hypertension. Right ventricular hemodynamics differ essentially from left ventricular hemodynamics. Right ventricular function is substantially influenced by right ventricular afterload, which is mainly determined by pulmonary vascular resistance, and slightly influenced by preload. Application of continuous positive airway pressure (CPAP) via a nose mask normalizes nocturnal breathing disorders and reduces pre- and afterload, especially in patients with cardiomegaly. Therefore, CPAP generates positive effects on the myocardium.

Continuous Positive Airway Pressure↗

PubMed2000

Pediatric obstructive sleep apnea syndrome.

Pediatric obstructive sleep apnea occurs in about 2% of children, and manifests as snoring, difficulty breathing, and witnessed apneic spells. Daytime symptoms include excessive sleepiness with poor performance and behavior problems. Severe forms may be associated with failure-to-thrive or death. The gold standard diagnostic procedure is overnight polysomnography and is indicated in high-risk patients. While most pediatric patients with obstructive sleep apnea can be treated with tonsillectomy and adenoidectomy; uvulopalatopharyngoplasty, tracheotomy, or other procedures are sometimes indicated. Nonsurgical treatment with continuous positive airway pressure is used in some children. Postoperative management in high-risk children includes careful perioperative monitoring and postoperative polysomnography.

Child↗