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PubMed2003

Obstructive sleep apnea in a referral population in India.

There are few published studies of obstructive sleep apnea in the Asian subcontinent. The objectives were to describe the syndrome and evaluate the utility of computed tomography (CT) cephalometry in patients found to have obstructive sleep apnea (OSA) by polysomnography. This article reports on a retrospective case series in a referral population. A total of 880 patients (560 males and 320 females) were seen in a referral center in Hyderabad, South India, during the last 7 years. All patients with suspected obstructive sleep apnea were evaluated with 16-channel polysomnogram by overnight sleep study; 600 subjects (68%; 480 males and 120 females) underwent evaluation with CT cephalometry. Mean age was 51.4 +/- 9.5 years (standard deviation). The mean apnea-hypopnea index (AHI) was 27.93 +/- 3.8. The majority of patients had more than 10 AHI; mean percentage of sleep efficiency was 80.62 +/- 15.38; mean percentage of rapid eye movement (REM) sleep was 13.79 +/- 7.89; mean awake arterial oxygen saturation (SaO2) was 90%; mean sleep SaO2 was 84% +/- 4.4%; mean Epworth Sleepiness Scale (ESS) score was 12.3 +/- 2.8. The tongue base area (TBA) was found to be significantly associated with obstructive sleep apnea (OSA), with mean TBA 1032.8 +/- 427 mm2 compared with normal controls at 561.1 +/- 197.6 mm2 (p < 0.001). Mean gonion-gnathion-hyoid angle (Go-Gn-H) was 28.5 +/- 10.5 in OSA and 16 +/- 16.7 in controls; uvula area was 452.5 +/- 145.8 mm2 in OSA and 221.4 +/- 49.85 mm2 in controls; uvula diameter was 13.8 +/- 2.74 mm in OSA and 10.1 +/- 1.72 mm in controls. A total of 704 patients with OSA (80%) were found to be hypertensive, with daytime mean blood pressure of 160/100 +/- 8.5/4.8 mm Hg. Mean duration of reported hypertension was 2 years. The present study showed moderate to severe OSA in a majority of suspected cases referred for polysomnogram. Mild disease was seen in 20.45% of patients (n = 180). On CT cephalometry, the TBA correlated significantly with OSA; hypertension is common in patients with OSA.

Cephalometry↗

PubMed2005

Lipid peroxides, superoxide dismutase and circulating IL-8 and GCP-2 in patients with severe obstructive sleep apnea: a pilot study.

Obstructive sleep apnea (OSA) is associated with cardiovascular morbidity and mortality and many other physiological and immunological disorders. An increase in hypoxia due to OSA may cause generation of reactive oxygen species (ROS). ROS are toxic to biomembranes and may lead to peroxidation of lipids. An increase in systemic biomarkers of inflammation and oxidative stress has been found in patients with OSA. The first aim of this study was to test the hypothesis that OSA is linked to increased oxidative stress (lipid peroxidation) and decreased antioxidant defense [superoxide dismutase (SOD)]. The second aim was to measure the serum levels of neutrophil chemokines [interleukin-8 (IL-8)], and granulocyte chemotactic protein-2 (GCP-2) in OSA patients. Twenty five patients with severe OSA and 17 healthy subjects were recruited. IL-8 and GCP-2 were measured in the serum by a specific enzyme immunoassay kit. Oxidative stress level was quantitated by measurement of thiobarbituric acid reactive substances. SOD enzymatic activity was measured by purely chemical system based on NAD(P)H oxidation. Mean SOD and lipid peroxidation concentrations of patients were not significantly different from those of control subjects (0.29+/-0.015 vs 0.31+/-0.01 U/ml and 4.64+/-0.57 vs 4.62+/-0.54 mmol/ml, respectively). Higher concentrations of IL-8 and GCP-2 were found in OSA patients (198.8+/-4.76 vs 180.83+/-3.38 and 383.34+/-46.19 vs 218+/-13.16 pg/ml, respectively, p<0.005). The present study does not support the hypothesis that OSA is linked to increased oxidative stress and decreased antioxidant defense. On the other hand, it suggests that systemic inflammation characterizes OSA patients.

Biomarkers↗

PubMed2006

Prevalence of sleep apnoea in patients undergoing operation.

Obstructive sleep apnoea (OSA) is defined as episodes of obstructive apnoeas and hypopnoeas during sleep with daytime somnolence. The gold standard in diagnostic tool patients with these symptoms is polisomnography. The goals of this study were to determine the frequency of OSA symptoms and the prevalence of OSA in patients undergoing operation. Patients were asked questions pertaining to symptoms of sleep apnoea. The patients who had two major symptoms or one major and two minor symptoms were invited to undergo a sleep study. Patients were diagnosed as OSA when they had apnoea-hypopnoea index higher than five. Forty-one patients with two major or one major and two minor symptoms of 433 patients were referred to the sleep laboratory. The most frequent major symptom was snoring, and the most frequent minor symptom was morning tiredness. In this connection, 18 (43.9%) patients accepted to be studied in the sleep laboratory (14 with two major, 4 with one major and two minor symptoms). Obstructive sleep apnoea was finally diagnosed in 14 patients or 3.2% of the initial entire population. Thirteen of them had two major symptoms, and only one of the 14 had one major and two minor symptoms. Six of the OSA patients were women. High percentage of OSA focus attention on anaesthesiology concerns of OSA. The exact management of each sleep apnoea patient with regard to intubation, extubation and pain control requires judgement and is a function of many anaesthesia, medical and surgical considerations. Therefore, we suggest that all patients should be asked for OSA symptoms, and patients with two major OSA symptoms must be evaluated with polisomnography.

Adolescent↗

PubMed1994

Weight loss for obstructive sleep apnea: the optimal therapy for obese patients.

Obstructive sleep apnea (OSA) is a common disorder in which upper-airway obstruction during sleep results in cessation of breathing. OSA is associated with increased morbidity and mortality and impaired daytime functioning. Upper-body obesity is a risk factor for OSA, and it is well documented that weight loss has a notable ameliorative impact on the occurrence of OSA. Nasal continuous positive airway pressure (nCPAP) during sleep is the primary treatment for OSA, and is usually effective in relieving upper-airway obstruction. However, compliance with prolonged nCPAP use has been proven problematic. Upper-airway surgeries may be efficacious for the treatment of OSA in carefully selected patients, but often are not successful for obese patients with OSA. The concomitant use of nCPAP and behavioral weight loss therapy in obese patients with OSA may result in enhanced weight loss. In moderately obese patients, modest weight reduction may alleviate the need for long-term nCPAP therapy or upper-airway surgery. Severely obese patients usually require more substantial weight loss and may be candidates for behavioral therapy in combination with gastric surgery. The role of the dietitian in the treatment of OSA cannot be overemphasized and warrants further development and study.

Behavior Therapy↗

PubMedDate not supplied

Clinical features as diagnostic guides in obstructive sleep apnea.

Obstructive sleep apnea (OSA) may induce psychiatric problems, but clinical risk factors do not reliably predict laboratory-verified OSA. Therefore, OSA diagnosis requires laboratory sleep monitoring. To find additional clinical features that would sharpen indications for sleep monitoring, we applied univariate analyses to clinical data for 137 OSA patients seen in a psychiatry sleep clinic. A symptomatology questionnaire was obtained from 101 of these patients: 71 had morning and 86 had afternoon vigilance tests, and all had upper-airway evaluation and polysomnography. Cigarette consumption but no other clinical features differed among OSA severity groups and total sleep period groups; upper-airway findings differed among vigilance groups. Multidiscriminant clinical predictor terms categorized several patients with severe OSA into less severe OSA categories. Clinical features did not accurately predict OSA. OSA will continue to be identified primarily by sleep laboratory testing. A two-phase laboratory routine, reserving full laboratory testing for patients with negative results on initial, less expensive screening tests, might conserve resources.

Adult↗

PubMed2004

Plasma homocysteine in obstructive sleep apnoea.

AIMS: Whether increased homocysteine is one mechanism linking obstructive sleep apnoea (OSA) to cardiovascular abnormalities is unclear. We hypothesised that plasma homocysteine would be higher in OSA patients than in control subjects, would increase further during sleep, and decrease after treatment with continuous positive airway pressure (CPAP). METHODS AND RESULTS: For study A, homocysteine was measured in 22 OSA patients and 20 controls first before sleep, then after 5 h of untreated OSA, and then in the morning after CPAP treatment. Homocysteine was similar in the OSA and control subjects at all three time points, and declined overnight in both groups (P=0.0017, P=0.036, respectively). To further assess this diurnal variation, we studied plasma homocysteine under a full-night protocol in 10 OSA patients and 12 controls (study B). Homocysteine was measured before sleep, in the morning after sleep, and at noon. Results in both OSA and control groups showed an overnight decline in homocysteine which was reversed by noon (repeated measures ANOVA: OSA, P=0.04; controls, P=0.02). Study C showed that disturbed sleep did not affect homocysteine levels in normal subjects. CONCLUSION: There is a significant diurnal variation in plasma homocysteine, so that homocysteine is lower in the morning after waking. Neither OSA nor disturbed sleep elicit acute or chronic changes in homocysteine.

Analysis of Variance↗

PubMed2006

Comparison of the effects of depressive symptoms and apnea severity on fatigue in patients with obstructive sleep apnea: a replication study.

BACKGROUND: Links between fatigue and depressive symptoms in medically ill patients are well-documented; however, few studies controlled for illness severity. Obstructive sleep apnea (OSA) is a common, frequently devastating disease that often includes daytime sleepiness and fatigue. Fatigue is also a hallmark depressive symptom. We previously reported that depressive symptoms explained ten times the variance in fatigue in OSA patients as did OSA severity itself (respiratory disturbance index, oxyhemoglobin saturation). OSA severity explained 4.2% of variance in fatigue while depressive symptoms explained an additional 42.3%. Here, we report a replication of these findings in a new, independent sample. METHODS: 56 untreated OSA patients had their sleep monitored with polysomnography on the UCSD GCRC. Participants completed the Center for Epidemiologic Studies-Depression (CESD), Profile of Mood States (POMS) and Medical Outcomes Studies (MOS) surveys. Data were analyzed using hierarchical linear regression. RESULTS: OSA severity explained 13.4% (p=0.022) of variance in POMS fatigue while CESD scores explained an additional 24.5% (p<0.001). Results were robust to changes in the scales used to measure these constructs. LIMITATIONS: Cross-sectional design precludes determination of direction of causality. Assessment of depressive symptoms and fatigue was based on validated self-report measures. CONCLUSIONS: These results reaffirm that depressive symptoms are dramatically and independently associated with worse fatigue in OSA patients. While the independent contribution of OSA severity varied between studies, depressive symptoms were the strongest predictor of fatigue in both studies. Assessment and treatment of mood symptoms-not just treatment of OSA itself-might reduce fatigue in these patients.

Adult↗

PubMed2006

Increased brain activation during verbal learning in obstructive sleep apnea.

This study examined the cerebral response to a verbal learning (VL) task in obstructive sleep apnea (OSA) patients. Twelve OSA patients and 12 controls were studied with functional magnetic resonance imaging (FMRI). As hypothesized, VL performance was similar for both groups, but OSA patients showed increased brain activation in several brain regions. These regions included bilateral inferior frontal and middle frontal gyri, cingulate gyrus, areas at the junction of the inferior parietal and superior temporal lobes, thalamus, and cerebellum. Better free recall performance in the OSA group was related to increased cerebral responses within the left inferior frontal gyrus and left supramarginal area. Recall was negatively related to activation within the left inferior parietal lobe. The findings support the predictions that intact performance in OSA patients is associated with increased cerebral response. Recruitment of additional brain regions to participate in VL performance in OSA patients likely represents an adaptive compensatory recruitment response, similar to that observed in young adults following total sleep deprivation and in healthy older adults. These data, and those of the only other FMRI study in OSA, suggest that individuals with OSA show characteristic differences in the BOLD signal response to cognitive challenges. Including subjects with untreated OSA in neuroimaging studies may potentially influence the results by altering individual and group level activation patterns. Given this, future neuroimaging studies may want to be aware of this potential confound.

Adult↗

PubMed2004

Oral airway resistance during wakefulness in eucapnic and hypercapnic sleep apnea syndrome.

The purpose of this study was to evaluate whether there was an abnormal increase of upper airway resistance in the sitting and supine positions in hypercapnic obstructive sleep apnea syndrome (OSAS) patients compared with eucapnic OSAS or normal controls as measured by impulse oscillometry (IOS) while awake. Twenty subjects without OSAS served as controls (group I), and 20 patients with moderate or severe eucapnic OSAS (group II) and another eight hypercapnic severe OSAS patients (group III) were studied. Group II was further divided into two subgroups. Group IIa consisted of 14 subjects whose BMI was less than 35 and group IIb of six subjects whose BMI was greater than 35. All subjects also had an overnight sleep study. Oral airway resistance (AR) (including impedance (Zrs), resistance (R) and reactance (X)) was measured by impulse oscillometry (IOS) (MasterScreen IOS, VIASYS Healthcare GmbH, Germany) in the upright (seated) position and then in the supine position while awake. The results demonstrated that in both group I and group II, Zrs was normal in the sitting position. However, there was a high Zrs in the supine position for group II patients. In contrast, in group III patients, there was a high Zrs in both the sitting and supine positions. In conclusion, upper airway resistance was increased both sitting and supine in the hypercapnic OSAS patients; this would presumably increase the work of breathing and might explain why these subjects were hypercapnic while awake, while eucapnic OSAS patients and normal controls were not. Secondly, the increased upper airway resistance in the supine position in the eucapnic OSAS patients may contribute to their OSAS.

Adult↗

PubMed2006

Increased myocardial vulnerability and autonomic nervous system imbalance in obstructive sleep apnea syndrome.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is characterized by the repeated episodes of upper airway obstruction during sleep, leading to significant hypoxia. Noninvasive evaluation of autonomic nervous system (ANS) and myocardial vulnerability may help determination of OSAS patients who are under high risk of malignant cardiac arrhythmias. The aim of this study was to show the effects of OSAS on predictors of arrhythmias by the evaluation of heart rate turbulence (HRT), heart rate variability (HRV) and QT dynamicity reflecting the ANS balance and myocardial vulnerability. METHODS: After polysomnographic study, 80 patients with OSAS and 55 age matched OSAS (-) subjects were included in the study. Twenty-four-hour Holter monitoring was performed in all subjects. HRT, HRV and QT dynamicity parameters were calculated. RESULTS: Turbulence slope was significantly decreased in OSAS patients whereas turbulence onset was increased (P<0.001). QT/RR slopes were significantly increased for QT end and QT apex (P<0.001). In HRV analysis, autonomic balance changed in favor of sympathetic system at night in OSAS patients. Furthermore, HRT and QT dynamicity parameters are found to be correlated with Apnea-Hypopnea Index (AHI). CONCLUSION: OSAS is associated with a significant worsening in HRV, HRT, and QT dynamicity parameters. Our results may indicate that HRV and QT dynamicity parameters can be useful noninvasive methods that may detect autonomic nervous system activity and ventricular vulnerability in OSAS.

Aged↗

PubMed2004

A stepped approach for prediction of obstructive sleep apnea in overtly asymptomatic obese subjects: a hospital based study.

BACKGROUND AND PURPOSE: Prevalence of obstructive sleep apnea (OSA) is high in obese subjects, many of whom may not be overtly symptomatic. Polysomnography (PSG) is a costly and time-consuming investigation. Since it is not feasible to subject all obese individuals to PSG, it is useful to define predictors of OSA among these subjects. PATIENTS AND METHODS: One hundred and eighteen obese subjects [body mass index (BMI)> or =25 kg/m(2)] presenting to the hospital with non-sleep related complaints were included, of which 53 subjects with PSG evidence of OSA [apnea-hypopnea index (AHI)> or =15/h] were defined as cases and 65 subjects without any evidence of OSA (AHI<15/h) were defined as controls. Anthropometry, biochemical investigations, blood gas analysis, pulmonary function tests, and PSG were performed for all subjects. RESULTS: Waist hip ratio (WHR) (as percentage of a standard) [odds ratio (95% CI): 1.07 (1.00-1.14); P = 0.049] male gender [odds ratio (95% CI): 3.97 (0.99-15.81); P = 0.046] and neck circumference (NC) [odds ratio (95% CI): 1.23 (1.03-1.47); P = 0.023] were found to be independent predictors of OSA. Overnight oxygen desaturation data were evaluated in patients selected as having OSA on the basis of these clinical markers, and the best cut-off for level of desaturation (10%) was defined. The stepped approach had a specificity, sensitivity, positive and negative predictive value of 89.2, 88.5, 86.8 and 90.6%, respectively, for the diagnosis of OSA. CONCLUSIONS: Male gender, WHR and NC are independent predictors of OSA in overtly asymptomatic obese subjects. A stepped approach to diagnose OSA should be used, as it is accurate and cost-effective.

Adult↗

PubMed2000

Effect of improved nasal breathing on obstructive sleep apnea.

OBJECTIVES: The goal was to compare the effect of an improved nasal airway on obstructive sleep apnea (OSA) by use of subjective and objective measures. METHODS: A prospective study of 50 consecutive patients with nasal airway obstruction and OSA was carried out. RESULTS: Subjectively, nasal breathing improved in 49 (98%) patients, whereas snoring decreased or disappeared in 17 (34%); the remaining 33 (66%) patients did not notice any significant change in their snoring. Daytime energy levels increased in 39 (78%) patients and remained unchanged or worsened in 11 (22%). In review of the polysomnographic data, the group overall did not have significant changes in respiratory disturbance index (RDI) or lowest oxygen saturation levels (LSaO(2)). Continuous positive airway pressure (CPAP) levels required to correct OSA decreased after nasal surgery (P < 0.01). Patients with mild OSA showed significant worsening in RDI (P < 0.05), whereas LSaO(2) levels were improved in the group with moderate OSA (P < 0.05). In patients with severe OSA neither the RDI levels nor the LSaO(2) changed, but CPAP levels required to alleviate the obstruction after surgery were reduced (P < 0.01). CONCLUSIONS: Most patients report improvement in nasal and sleep symptoms after correction of nasal airway obstruction. However, nasal surgery alone does not consistently improve OSA when measured objectively. Depending on the severity of OSA, nasal airway reconstruction may contribute to a decrease in CPAP level and improvement in oxygen saturation. Correction of the obstructed nasal airway should certainly be included in the overall treatment plan for OSA.

Adult↗

PubMed2002

Preliminary evidence of behavioral and cognitive sequelae of obstructive sleep apnea in children.

OBJECTIVES: To characterize the daytime sequelae of obstructive sleep apnea (OSA) in children. BACKGROUND: OSA syndrome is a common disorder in children with estimates of prevalence ranging from 1.1 to 2.9%. Numerous studies have documented neuropsychological deficits in adults with OSA, although only a few preliminary studies have described these problems in children with OSA. METHODS: In the present study, otherwise healthy children with OSA (n=28), and a healthy age-matched comparison group (n=10) were assessed with standard measures of sleep, behavior, and cognitive function. RESULTS: Children with OSA had significantly more behavior problems than the healthy comparison group based on parents' reports (F=7.29, P<0.005). Children diagnosed with moderate to severe OSA had significantly lower scores on a timed cancellation task that assesses sustained attention (F=10.0, P<0.01). A significant association was found between OSA severity (rho=-86, P<0.01) and measures of verbal ability. CONCLUSIONS: These initial findings suggest that there are identifiable daytime sequelae of childhood OSA and that it is important to evaluate these daytime disturbances in making determinations about intervention.

Journal Article↗

PubMed2003

Antioxidant capacity in obstructive sleep apnea patients.

OBJECTIVES: Obstructive sleep apnea syndrome (OSA) results in oxygen desaturation and arousal from sleep. Free oxygen radicals are highly reactive molecules, which can be produced by the OSA phenomenon known as hypoxia/reoxygenation. Hypoxic conditions, such as OSA, may also result in transient depletion of cellular reductants, which constitute a main line of antioxidant defense. Both apneas and hypopneas usually end in arousal, where reoxygenation causes the production of reactive oxygen species (free radicals). Living organisms have developed complex antioxidant systems to counteract reactive oxygen species and to reduce their damage. We evaluated the antioxidant capacity in serum from OSA patients and healthy people in order to confirm the hypothesis that there is a relationship between oxidative stress and OSA. MATERIALS AND METHODS: A physician interviewed 25 participants, determining age, smoking habits and symptoms such as excessive daytime sleepiness and snoring. Physical examination and polysomnography were performed during patients' hospitalization. Antioxidant capacity was measured in blood samples by Trolox Equivalent Antioxidant Capacity assay. RESULTS: Seventeen out of 25 subjects had an apnea/hypopnea index (AHI) greater than 10 (OSA group). The measurement of antioxidant capacity did not differ between the OSA patients and our healthy sample (of 25 subjects, seven with an AHI less than 10). Furthermore, patients with severe OSA (AHI >20, N=14) had linearly negative correlation between antioxidant capacity in their blood samples and AHI (R=-0.551, P=0.041). CONCLUSIONS: Reduced antioxidant capacity in serum is an index of excessive oxidative stress. Patients with severe OSA have reduced values of antioxidant capacity.

Adult↗

PubMed2004

Is there a relationship between obstructive sleep apnea and gastroesophageal reflux disease?

BACKGROUND AND AIMS: The causative relationship between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD) remains an area of controversy. The aim of the study is to further explore the relationship between OSA and GERD in a large group of patients with OSA. METHODS: One hundred thirty-six patients referred for polysomnographic studies at the University of Arizona Sleep Center were included in this study. All patients were assessed by means of a demographic survey, the validated GERD Symptom Checklist, and the Sleep Heart Health Study Sleep Habits Questionnaire. Polysomnograms were scored for objective measures of sleep and breathing. OSA is defined as an apnea-hypopnea index > 5 with compatible symptoms. RESULTS: Of the 136 subjects, 101 (74%) were found to have OSA. Self-report of heartburn or acid regurgitation symptoms was unrelated to severity of sleep apnea. Additionally, OSA was not influenced by the severity of GERD. Objective measures of disordered sleep had stronger associations with age, smoking, and alcohol use than GERD in men and stronger associations with age and body mass index than GERD in women. Subjectively reported sleep quality was affected more strongly by GERD severity than by age, smoking, alcohol use, or the presence of OSA. Only females administered antireflux medications were less likely to report poor sleep quality. CONCLUSIONS: Subjective reports of sleep quality were affected by GERD severity, but an objective correlation between OSA and GERD was lacking. This may suggest that GERD and OSA are common entities that share similar risk factors, but appear not to be causally linked.

Adult↗

PubMed1995

Can obstructive sleep apnoea be a complication of uvulopalatopharyngoplasty?

UNLABELLED: Polysomnography is currently used for diagnosis, evaluation and selection of therapy in patients with obstructive sleep apnoea (OSA), but clinically successful uvulopalatopharyngoplasty (UPPP) is not necessarily reflected by post-operative improvement of polysomnographic recordings. Post-operative polysomnography may suggest deterioration of pre-existing OSA or, in snorers, de-novo precipitation of OSA. Thus, if polysomnography is a reliable indicator of OSA, then OSA may be a post-operative risk of UPPP. THE AIMS OF OUR STUDY WERE: (i) to assess the possible deleterious effect of UPPP on sleep patterns; (ii) to further define the role of cardioisotope scanning in the evaluation of OSA; (iii) to assess the reliability of polysomnography given the clinical and cardiosotope scan findings. Symptoms, polysomnography and radionuclide ventriculography were prospectively compared pre- and post-operatively in 41 patients undergoing UPPP. In 12 patients (29 per cent), there were disparate results between pre- or post-operative polysomnography and the clinical and/or radionuclide ventriculography, as follows: In four of 16 patients with abnormal pre-operative ventricular performance, there was pre-operative symptomatology of severe OSA and a bedmate's reports of apnoeic episodes. This was in contrast to normal or near normal sleep apnoea recordings. In eight patients, post-operative improvement of symptoms was reported, despite deterioration of post-operative polysomnographic recordings. In these patients the post-operative improvement of symptoms was also reflected by improved ventricular performance. Worsening of ventricular performance was not demonstrated in any patient. In conclusion, UPPP does not induce OSA. Polysomnography may underestimate or even misdiagnose cases of OSA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1999

Obstructive sleep apnoea in acromegaly: the role of craniofacial changes.

Obstructive sleep apnoea (OSA) is due to craniofacial changes and acromegaly. The question addressed by this study was whether growth hormone (GH) induced craniofacial changes might explain persisting OSA despite endocrine inactivity in acromegaly. Nineteen patients treated for acromegaly were examined cephalometrically for craniofacial changes and polysomnographically for OSA. Twelve patients proved to have OSA with an apnoea/hypopnoea index >15; seven patients showed no evidence of OSA at all. With respect to the endocrinological parameters, there were no differences between the two groups that would explain the presence or absence of OSA. Neither group differed with respect to sex, age, or body mass index. Craniofacial changes were predominantly found in the mandible. The group with OSA proved to have increased vertical, dolichofacial growth compared to those without OSA. Consecutively, in the OSA group the posterior airway space was narrowed, and the hyoid was displaced more caudally. Thus, it seems that craniofacial structures of patients with acromegaly and persisting obstructive sleep apnoea are different from those without obstructive sleep apnoea. Surgical corrections of pertaining acromegaly-induced craniofacial changes should be performed with an awareness of the individual craniofacial condition so as not to enhance obstructive sleep apnoea.

Acromegaly↗

PubMed2005

Therapy Insight: interactions between atrial fibrillation and obstructive sleep apnea.

Atrial fibrillation (AF) and obesity are coinciding epidemics. Obstructive sleep apnea (OSA) correlates directly with obesity and is highly prevalent among middle-aged adults. Emerging evidence supports a strong association between AF and OSA. The rate of AF among patients with OSA is low but is nevertheless higher than that in the general population. The prevalence of OSA among patients with AF is strikingly high-at least 32% and possibly as high as 49%-although differences in the AF populations studied and the criteria used to diagnose OSA have prevented more accurate measurement of this rate. Data in focused populations at risk of AF show that OSA increases the frequency and recurrence of AF. These findings cannot, however, be reliably generalized to the larger OSA population. Although the available information is limited, treatment of OSA, particularly with continuous positive airway pressure, seems to substantially reduce the frequency of AF. If true, this approach would provide a safe and noninvasive therapy for some patients with AF. Randomized controlled trials are necessary to rigorously answer this question. Many data have been obtained from studies with focuses other than the direct relationship between OSA and AF. Studies carefully designed to investigate the relevant issues are now needed.

Atrial Fibrillation↗