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PubMed2006

Follow-up on metabolic markers in children treated for obstructive sleep apnea.

RATIONALE: In adults, obstructive sleep apnea (OSA) is associated with metabolic dysfunction that improves with treatment of OSA. No equivalent studies exist in children. OBJECTIVE: To examine the relationship between metabolic markers and OSA with time and treatment in children. METHODS: Metabolic markers measured on a fasting morning blood sample at diagnostic polysomnography and follow-up 1.3 +/- 0.6 yr later. MEASUREMENTS AND MAIN RESULTS: Forty-five children (34 males), aged 6.9 +/- 3.5 yr, and including 12 obese subjects, were in the final analysis. There were no differences in metabolic markers between children with and without OSA at initial study; however, obese children had significantly higher insulin (106.1 +/- 72.1 vs. 66.7 +/- 37.6 pmol/L; p = 0.028), insulin/glucose ratio (23.7 +/- 14.3 vs. 14.7 +/- 8.0; p = 0.02), and significantly lower high-density lipoprotein cholesterol (1.3 +/- 0.2 vs. 1.6 +/- 0.4 nmol/L; p = 0.005) than nonobese children. Twenty children underwent surgical removal of adenotonsillar tissue, whereas 12 children with OSA elected not to have treatment. OSA persisted after treatment in five children, and resolved in 27. Thirteen children did not have OSA on initial or follow-up studies. At follow-up, there was a small but significant improvement in total cholesterol in those children whose OSA was resolved (4.8 +/- 0.8 to 4.7 +/- 0.6 nmol/L; p = 0.005) and a trend for obese children with persisting OSA to have elevated insulin levels compared with obese children without OSA (p = 0.07). CONCLUSION: Obesity appears to be the major influence on metabolic dysfunction in children with OSA, but these preliminary data also suggest that resolution or persistence of OSA may affect changes in metabolic function over time.

Blood Glucose↗

PubMed2001

[Obstructive sleep apnea syndrome in childhood].

Obstructive sleep apnea syndrome (OSAS) is a well-known clinical entity in adults but until now it has been less well studied in children. Several studies have shown that the prevalence of pediatric OSAS is high (between 1% and 3%) and its consequences can be serious. Major risk factors for OSAS in children include adeno-tonsillar hypertrophy, neuromuscular disease and syndromes such as Down's or Pierre-Robin's syndrome. Definitive diagnosis is by nocturnal polysomnography while other methods such as cardiorespiratory records and nocturnal pulse oximetry are undoubtedly useful. Adenotonsillectomy plays a major role in the treatment of OSAS. Nasal continuous positive airway pressure is an alternative in children who show poor response to surgical treatment or in those with craniofacial alterations. In a few cases, nocturnal oxygen administration can be useful.

Child↗

PubMed2001

Persistent hypercapnia in children after treatment of obstructive sleep apnea syndrome by adenotonsillectomy.

Obstructive sleep apnea syndrome (OSAS) in childhood is frequently in part a consequence of enlarged adenoids and/or tonsils and may lead to hypoxemia and hypercapnia during sleep. Whereas long-term blood gas alterations are well documented in adults, only few polygraphic data are available for children. It was the aim of this study to document blood gas alterations before and after treatment in this population. 9 children with OSAS (6 male, 3 female, median age 5.9 years, range 1.1-13.5 years) were investigated by polysomnography before and after adenotonsillectomy. Prior to intervention most children presented with moderate hypercapnia (ETCO2 mean 44.3 +/- 3.8 mm Hg, ETCO2 maximum 53.2 +/- 5.2) and hypoxemic episodes (oxygen saturation mean 93.2 +/- 3.2%, minimum 74.4 +/- 16.5%). Following adenotonsillectomy subsequent polygraphic investigations displayed normalisation of oxygen saturation (saturation mean 96.1 +/- 0.8%, minimum 90.1 +/- 3.1%). In contrast, moderate hypercapnia in several patients persisted up to five months after treatment (ETCO2 mean 44.9 +/- 2.8 mm Hg, ETCO2 maximum 51.2 +/- 3.6). Persistent hypercapnia most likely reflects an adaptation process of chemosensitivity and respiratory control due to preceding long-term hypercapnia.

Adaptation, Physiological↗

PubMed2003

[Obstructive sleep apnea and cardiovascular diseases].

Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by repetitive episodes of apnea or hypopnea during sleep. Apnea and hypopnea cause temporary elevations in blood pressure associated with blood oxygen desaturation, arousal, and sympathetic activation and may cause elevated blood pressure during the daytime. Numerous studies have shown that OSAS was associated with an increased cardiovascular morbidity and mortality. In this review, we describe the normal hemodynamic changes that occur during sleep, the acute hemodynamic events associated with OSAS and finally we summarize the evidence for causal connection between sleep apnea and cardiovascular disease.

Cardiovascular Diseases↗

PubMedDate not supplied

Obstructive sleep apnea: A practical review.

Obstructive Sleep Apnea (OSA) is a condition of repetitive stoppage of breathing during sleep. OSA has assumed major clinical importance as it is linked with the pathophysiology of many serious medical conditions such as congestive heart failure and stroke. We shall review the history, epidemiology, clinical presentation, evaluation, and management of sleep apnea.

Humans↗

PubMed2006

Alternatives to CPAP in the treatment of the obstructive sleep apnea syndrome.

The obstructive sleep apnoea syndrome (OSAS) results in excessive daytime sleepiness, impaired quality of life, and is associated with an increased risk of traffic accidents and cardiovascular disease. Nasal continuous positive airway pressure (CPAP), the standard treatment for OSAS provides immediate relief of symptoms and has only minor side effects. Nevertheless, an alternative treatment is needed if CPAP is not feasible for medical or psychological reasons. Removable oral appliances that advance the mandible when fitted to the teeth during sleep also improve nocturnal breathing disturbances, symptoms, quality of life, vigilance and blood pressure in OSAS patients. Their long-term effectiveness and side effects require further study. In morbidly obese patients suffering from OSAS bariatric surgery should be considered as a treatment that reduces obesity and at the same time improves OSAS. In selected patients including those with adeno-tonsillar hypertrophy, and cranio-facial malformations various surgical techniques that enlarge the upper airway may be a treatment option for OSAS.

Algorithms↗

PubMed1988

Improvement in upper airway function after weight loss in patients with obstructive sleep apnea.

Overweight patients with obstructive sleep apnea (OSA) are improved by weight reduction, although the underlying mechanisms are not clear. We tested the hypothesis that improvement in OSA after weight loss is associated with improvement in pharyngeal function. Consequently, we measured pharyngeal area at functional residual capacity (AFRC) and at residual volume (ARV), the percent change in pharyngeal area between FRC and RV (delta Aph%) defined as (AFRC - ARV)/AFRC x 100, and lung volume dependence of pharyngeal area (LVD) defined as the difference between AFRC and ARV normalized for the expiratory reserve volume (ERV)--in 12 overweight apneic patients before and after weight loss. We found that after a 26 +/- 18 kg weight loss, there was a significant reduction in the apnea/hypopnea index from 57 +/- 29 to 14 +/- 10 (p less than 0.0005) and increase in the lowest nocturnal oxygen saturation from 54 +/- 20% to 80 +/- 8% (p less than 0.001). This improvement was associated with a significant reduction in delta Aph% from 25 +/- 15% to 9 +/- 18% (p less than 0.05) and a significant decrease in LVD from 1.98 +/- 1.52 cm2/L to 0.16 +/- 0.88 cm2/L (p less than 0.005). There were four patients in whom baseline LVD was low and relatively unchanged after weight loss. Three of these patients exhibited paradoxical inspiratory narrowing of the glottis, which reversed after weight loss; these glottic abnormalities were not present in the rest of the patients with OSA. We conclude that improvement in obstructive sleep apnea after weight loss may be related to improvement in pharyngeal and glottic function.

Adult↗

PubMed1998

Obstructive sleep apnea due to endogenous testosterone production in a woman.

Obstructive sleep apnea (OSA) is a common condition characterized by snoring, recurrent episodes of cessation of breathing (obstructive apneas), disrupted sleep, and excessive daytime somnolence. Associated serious complications are hypertension, increased risk of heart disease, stroke, and increased susceptibility to industrial and motor vehicle accidents. OSA is considerably more common in men than in women. In postmenopausal women, the incidence of OSA increases. These factors suggest that reproductive hormones have a role in the cause of OSA. Treatment with testosterone has been reported to cause OSA in men, and exogenous androgen administration has been reported to cause OSA in one woman. In a review of the English literature, we found no previous reports of OSA that was induced by endogenous testosterone in women. Herein we describe a nonobese 70-year old woman with clinically significant OSA and a benign testosterone-producing ovarian tumor. After successful removal of the tumor, her OSA resolved, and her testosterone level normalized. This unique case supports the theory of male hormonal (testosterone) influence in the OSA syndrome.

Aged↗

PubMed2005

Obstructive sleep apnea and modifications in sedation.

Obstructive sleep apnea is a common problem affecting all ages, particularly in conjunction with other pre-existing conditions. Compounding the disorder with the added insult of surgery, anesthesia, analgesia, and sedation requires the medical team continuously to re-evaluate this particular patient population. Physicians and nurses have recognized an increase in morbidity and mortality in patients with obstructive sleep apnea when they are administered anesthesia in conjunction with sedation. There are few reports of sedation alone and obstructive sleep apnea; most studies have been in relation to anesthesia, surgery, patient-controlled analgesia, and sleep-disordered breathing.

Anesthesia↗

PubMed2006

Obstructive sleep apnea in Costello syndrome.

Costello syndrome (CS) was initially described by Costello in 1971; it is caused by a germline mutation in HRAS proto-oncogene. The aim of the present study was to evaluate the respiratory activity during sleep in a group of subjects with CS. We studied 10 consecutive patients, 4 males and 6 females, aged 3-29 years, affected by CS. All patients underwent clinical, neurological, otholaryngologic and radiologic evaluation, and a full-night polysomnography in the sleep laboratory. Polysomnography showed that seven patients presented a relevant number of respiratory events of obstructive type during sleep. The apnea-hypopnea index (AHI) ranged from 0 to 19.2 events per hour (mean index = 7.5 +/- 6.9 events/hr). In one patient AHI was not evaluable because of tracheostomy. Apnea induced mild or moderate hemoglobin desaturations (mean of lowest SpO2 values = 85.4 +/- 5.5%). Only sporadic respiratory pauses of central type were observed (mean number of central apnea per study: 7.2 +/- 6.8 events/hr). Sleep structure was fragmented, with a high number of awakenings (mean number of awakenings was 13.2 +/- 8.1; of these, 4.8 +/- 2.5 lasted longer than 2 min). In all patients, otolaryngologic and radiologic observations revealed one or more sites of narrowing in the upper airways. Our results suggest that Costello patients have a high prevalence of obstructive sleep-related respiratory disorders, which need to be assessed by means of polysomnography.

Abnormalities, Multiple↗

PubMed1998

[Abbreviated diurnal polysomnographic records in the diagnosis of sleep obstructive apnea syndrome].

OBJECTIVE: To demonstrate the validity of diurnal polysomnography for the diagnosis of obstructive sleep apnea syndrome (OSAS). METHODS: Twenty-five patients with suspect of OSAS were studied with two serial polysomnographic recordings: one during nighttime-nocturnal polysomnography (NPLS) and then a second polysomnographic study during the following morning (DPLS). In both recordings the Sensor Medic Polysomnograph 4250 was used. The certainty OSAS diagnosis was considered when an apnea-hypopnea index (AHI) > or = 10 in the nocturnal recording was obtained. The statistical study was performed with the R-Sigma Horus SA software and sensitivity and specificity values following formulas next indicated. RESULTS: The male/female ratio was 72%/28%. All patients were snorers and 64% had diurnal hypersomnia. Fourteen out of the 25 patients were true positive, five true negative, five false negative and one false positive patients. The specificity and sensitivity of DPLS were 83% and 73%, respectively, with a positive predictive value of 93% and a negative predictive value of 50%. CONCLUSIONS: Abbreviated diurnal polysomnographic recordings, performed with conventional polysomnography, have a good sensitivity and specificity for the diagnosis of OSAS. Given the possibility of false negative results in DPLS, a NPLS should be performed in the patient with presumed OSAS and negative diurnal polysomnographic study.

Adult↗

PubMed2002

Increased 8-isoprostane and interleukin-6 in breath condensate of obstructive sleep apnea patients.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is characterized by repeated episodes of upper airways obstruction during sleep that result in episodes of hypoxia. An increase of systemic biomarkers of inflammation and oxidative stress has been found in patients with OSA and obesity. DESIGN: The aim of this study was to measure the levels of markers of inflammation (interleukin [IL]-6) and oxidative stress (8-isoprostane) in the exhaled breath condensate of OSA and obese patients. PATIENTS AND METHODS: Eighteen OSA patients (13 men; mean [+/- SEM] age, 44 +/- 7 years), 10 obese subjects (4 men; mean age, 39 +/- 8 years), and 15 healthy age-matched subjects (8 men; mean age, 42 +/- 4 years) were recruited. IL-6 and 8-isoprostane were measured in exhaled breath condensate by a specific enzyme immunoassay kit. MEASUREMENTS AND RESULTS: Higher concentrations of IL-6 were found in OSA patients (8.7 +/- 0.3 pg/mL) than in healthy control subjects (1.6 +/- 0.1 pg/mL; p < 0.0001). Obese subjects also had higher levels than healthy control subjects, but lower levels than OSA patients (2.1 +/- 0.2 pg/mL, p < 0.05 and p < 0.0001 respectively). Furthermore, 8-isoprostane levels were found to be higher in OSA patients (7.4 +/- 0.7 pg/mL) than in obese subjects (5 +/- 0.3 pg/mL; p = 0.4) and healthy subjects (4.5 +/- 0.5 pg/mL; p < 0.005). We found a positive correlation between these two markers and neck circumference and apnea/hypopnea index. CONCLUSIONS: These findings suggest that inflammation and oxidative stress are characteristic in the airways of OSA patients but not in obese subjects, and that their levels depend on the severity of the OSA. The measurement of IL-6 and 8-isoprostane levels may prove to be useful in screening and monitoring obese patients who have a high risk of developing OSA.

Adult↗

PubMed2005

Association of serotonin transporter gene polymorphism with obstructive sleep apnea syndrome.

BACKGROUND AND OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is a common condition characterized by repetitive pharyngeal collapse during sleep and daytime sleepiness. There is genetic predisposition to sleep disorders. Serotonin is involved in the regulation of sleep. The synaptic 5-hydroxytryptamine (HT) is inactivated by presynaptic reuptake, which is mediated by the serotonin transporter. Blockage of the serotonin transporter leads to increased extracellular 5-HT. Polymorphism of the serotonin transporter gene (STG) leads to alterations in serotonin level and may be important in OSAS. In this study, we aimed to assess the role of STG polymorphism in OSAS. METHODS: Twenty-seven OSAS patients and 162 healthy volunteers were involved in the study. STG polymorphism was investigated using leukocytes obtained from peripheral blood. RESULTS: There was no difference between the genotypes and allele frequencies of the patients and controls regarding VNTR and HTTLPR polymorphisms (P > .05). The VNTR and HTTLPR variants and the frequencies of 12/12, 12/10, L, and S alleles were not significantly different between male and female control subjects (P > .05). The 12/12 and SS genotypes were over-represented in the female patients, whereas 12/10 and LL genotypes were over-represented in the male patients (P < .05). The genotypes 12 to 12 were over-represented in the male controls, whereas the genotypes 12 to 10 and L/S were over-represented in the male patients (P < .05). The alleles 10 and L were more frequent in the male patients than male controls (P < .05). The genotypes of female patients and female controls were not significantly different (P > .05). The allele 10 and L were less frequent in the female patients than female controls with Fisher's exact testing (P < .05). There was no relation between genotypes and clinical data of the patients (P > .05). CONCLUSION: STG polymorphism appears to be associated with the occurrence of OSAS, especially in male patients. Absence of association of between genetic variants and polysomnography findings may suggest that some mechanisms other than STG polymorphism are involved in OSAS pathophysiology. Our results need confirmation in a larger group of patients with OSAS.

DNA Primers↗

PubMed1992

[Efficacy of weight loss in the treatment of obstructive sleep apnea syndrome. Experience in 135 patients].

BACKGROUND: The verification of the results of weight loss as a therapy in the obstructive apnea sleep syndrome (OSAS) is reported given the scarcity of bibliography concerning the same, despite most patients being obese. METHODS: One hundred thirty-five patients fulfilling the polysomnographic requisites of OSAS and who had lost more that 50% of their excess weight limit with a diet of 1,000 kcal/day as their only therapy were studied. Two groups of patients were established; the first being made up of 89 obese patients (excess weight greater than 15%) and the second 46 non obese patients. Polysomnography was performed prior to and following the diet and the apnea hypopnea index (AHI) were compared with the diminution being related to the loss of weight. RESULTS: The 89 obese patients had a mean excess of weight of 35% (+/- 20) and an AHI of 64 (+/- 24). Following the loss of weight the same were 11% (+/- 14) and 34 (+/- 28) respectively (p less than 0.001). The 46 non obese patients had an initial medium excess of weight of 9% (+/- 6) and an AHI of 45 (+/- 21) with the same being 1% (+/- 2) and 28 (+/- 26) (p less than 0.001) following the diet. A cure was achieved (AHI less than 10) in 29 cases (33%) in the obese group and in 19 (41%) in the non obese group. CONCLUSIONS: The efficacy of weight loss in the treatment of patients with OSAS is confirmed. Although the percentages of cure may seem low the innocuousness of this therapeutic method is recommended as an initial measure prior to the decision of surgery.

Adult↗

PubMedDate not supplied

[Restless legs syndrome and periodic limb movements during sleep in a patient with obstructive sleep apnea].

A case of moderate obstructive sleep apnea in which effective treatment with continuous positive airway pressure did not reduce excessive daytime sleepiness was described. Polysomnography with tibial muscles activity recording revealed frequent periodic limb movements in sleep (PLMS) with sleep fragmentation. PLMS index was 13.6/h of sleep. Clonazepam combined with iron and magnesium supplementation reduced limb movements, excessive daytime sleepiness and improved the patient's mood. Causes of PLMS and treatment options are discussed. PLMS and restless legs syndrome (RLS) should be considered in the differential diagnosis of excessive daytime sleepiness.

Anticonvulsants↗

PubMed1997

Magnetic therapy is ineffective for the treatment of snoring and obstructive sleep apnea syndrome.

Snoring and the obstructive sleep apnea syndrome are common and chronic ailments with potentially serious medical complications. There are several accepted treatments, but these can be uncomfortable, inconvenient, and expensive. A number of alternative treatments have been reported to be beneficial in the treatment of obstructive sleep apnea and snoring. They are advertised in magazines, on the radio and television, and on the Internet. The lay press is reporting about the effectiveness of these treatments without the benefit of clinical trials or scientific studies. Among the therapies currently being promoted for the treatment of snoring and sleep apnea is biomagnetic therapy. Unlike many of the other treatments which have not undergone scientific evaluation, biomagnetic therapy has been evaluated in the past. In fact, the evaluation of biomagnetic therapy is one of the first controlled scientific investigations found in the literature. This report showed that magnet therapy had no medicinal value. Despite this clear evidence, magnetic therapy continues to be utilized today and currently is being promoted for the treatment of snoring and sleep apnea. At out Sleep Disorder Center, we have had the opportunity to evaluate a patient with severe obstructive sleep apnea both before and after treatment with magnetic therapy, as well as with conventional therapy. Our study clearly indicates there was no benefit from magnetic therapy in this case. While alternative therapy may be helpful in the treatment of certain medical conditions, extreme care must be exercised to prevent inappropriate treatment or undertreat-ment of significant medical problems. Close clinical follow-up and controlled studies are important in determining the effectiveness of therapies.

Complementary Therapies↗

PubMedDate not supplied

Treatment of hypoxemia in obstructive sleep apnea.

Many patients suffering from obstructive sleep apnea (OSA) have intermittent oxygen desaturation associated with periods of apnea or hypopnea. Oxygen saturation levels below 90% are considered harmful. Usually, treatment is directed at correcting the apnea, which will in turn prevent hypoxemia. Unfortunately, many patients fail or are not candidates for nasal continuous positive airway pressure (CPAP) or surgical correction of their OSA. Forty-three patients with persistent OSA and nocturnal hypoxemia below 90% who were not candidates for additional surgical or CPAP therapy were treated with nocturnal oxygen supplementation. Standard symptoms associated with OSA and the Epworth Sleepiness Scale (ESS) were recorded before treatment and 30 days after the start of the treatment. In 21 patients, polysomnography studies were performed to compare the Respiratory Disturbance Index (RDI) score and minimum oxygen saturation levels when the patients were breathing room air or breathing 4 L/minute of oxygen by nasal cannula. Subjective symptoms of obstructive sleep apnea improved, and the ESS score significantly decreased after a 30-night treatment with oxygen. Split-night polysomnography showed a significant increase in minimum oxygen saturation during oxygen administration. The RDI did not significantly change with treatment. Oxygen administration for the correction of OSA-related nocturnal hypoxemia was both safe and effective in alleviation of OSA-related symptoms. It also appeared to have a beneficial effect on minimum oxygen saturation levels. Thus, oxygen therapy may be considered a treatment option in patients who fail to comply with CPAP and are not candidates for a surgical procedure.

Adult↗

PubMed2003

Sleep characteristics following adenotonsillectomy in children with obstructive sleep apnea syndrome.

OBJECTIVE: To compare the effect of adenotonsillectomy on rapid eye movement (REM)- and non-REM-related respiratory and sleep architecture characteristics in children with obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: This prospective study evaluated 36 children (median age, 6.9 years; range, 1.8 to 12.6 years) with OSAS using polysomnography before and a few months after adenotonsillectomy. Primary outcomes included the number of obstructive apnea and hypopnea and arousals per hour of sleep. RESULTS: At 4.6 months (range, 1 to 16 months) after adenotonsillectomy, there was a significant improvement of all respiratory parameters. The median respiratory disturbance index (RDI) decreased from 4.1/h (range, 0 to 85/h) to 0.9/h (range, 0 to 13/h) after adenotonsillectomy (p < 0.0001). The median non-REM RDI decreased from 3.0/h (range, 0 to 89/h) to 0.4/h (range, 0 to 13/h) [p < 0.001] as compared with REM RDI, which decreased from 7.8/h (range, 0 to 69/h) to 2.3/h (range, 0 to 54/h) after adenotonsillectomy (p < 0.01). Median arousal index decreased following adenotonsillectomy from 17.5/h (range, 7 to 57/h) to 14.0/h (range, 6 to 47/h) [p < 0.03]. CONCLUSIONS: Adenotonsillectomy resulted in a greater improvement in non-REM RDI as compared with REM-RDI, and a decrease in the number of arousals.

Adenoidectomy↗