SEARCH · PubMed Health

Results for “Sleep Apnea, Obstructive”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 595 records · Page 33Linked to original sources

PubMed2006

Concurrent presence of metabolic syndrome in obstructive sleep apnea syndrome exacerbates the cardiovascular risk: a sleep clinic cohort study.

This cross-sectional study was conducted to examine whether the obstructive sleep apnea syndrome (OSAS) is associated with elevation of the pulse wave velocity (PWV) and increase in the plasma levels of C-reactive protein (CRP), both of which are known markers of cardiovascular risk, and also to determine if the concurrent presence of the metabolic syndrome might exacerbate this elevation in the levels of these cardiovascular risk markers in subjects with OSAS. With these objectives, the PWV and serum CRP were measured in 184 subjects attending a sleep clinic. It was found that the PWV and CRP were higher in the subjects with OSAS (n=94) than in those without OSAS (n=90). Furthermore, among the subjects with OSAS, the PWV and CRP were higher in those with the concurrent presence of the metabolic syndrome (n= 41; PWV=1,562+/-19 cm/s; CRP=1.8+/-0.2 mg/l) than in those without metabolic syndrome (n=53; PWV=1,432+/-21 cm/s; CRP=1.2+/-0.1 mg/l) (p<0.05). A general linear model analysis demonstrated that OSAS and metabolic syndrome were independently associated with elevated PWV and increase of the plasma levels of CRP. OSAS appears to be associated with increased cardiovascular risk, as reflected by both elevated PWV and increase of the plasma CRP. The concurrent presence of metabolic syndrome may exacerbate this increase in cardiovascular risk in subjects with OSAS. Therefore, the concurrent presence of metabolic syndrome may constitute an additive cardiovascular risk factor in subjects with OSAS.

Adult↗

PubMed2004

Evaluation of the accuracy of SNAP technology sleep sonography in detecting obstructive sleep apnea in adults compared to standard polysomnography.

OBJECTIVE: To determine the accuracy of snoring and apnea analysis by SNAP (SNAP Laboratories; Glenview, IL), a technology that uses snoring recorded by a home microphone system and nasal airflow, to diagnose obstructive sleep apnea (OSA) as well as determine its severity. METHODS: For all patients who had undergone a prior SNAP study and were referred to the Sleep Disorders Center of Lifespan Hospitals for polysomnography testing from January 2000 through December 2001, we compared the results of the SNAP study to standard polysomnography (polysomnography). The severity of each apnea-hypopnea index (AHI) [mild, moderate, or severe, as defined by the AHI Severity Task Force of the American Academy of Sleep Medicine] recorded by SNAP was compared to that of the polysomnography result. All polysomnography tests were scored independently and without the prior knowledge of any SNAP results. RESULTS: For the 31 patients on whom data were available, the mean age, body mass index, and Epworth sleepiness scale scores were 50.3 years (range, 29 to 77 years), 31.6 kg/m(2) (range, 24 to 44 kg/m(2)), and 11.3 (range, 1 to 20), respectively. The mean follow-up time between the two studies was 5 months. The severity criteria indicated by the SNAP study accurately assessed the true severity confirmed by polysomnography in only 11 of 31 patients (35.5%). When the AHI severity score from the SNAP study was compared to polysomnography using a kappa statistic measure of agreement, there was overall agreement with a kappa value of 0.23 (p = 0.008), but the agreement was only fair. SNAP study severity scores were overestimated in 13 of 31 patients (41.9%) compared to the polysomnography results. In the majority of these subjects (8 of the 13 "overestimated" patients or 8 of 31 total patients [25.8%]), the SNAP study diagnosed OSA when the patient had a normal polysomnography finding. CONCLUSION: Although there may be some night-to-night variability in polysomnography testing, these results suggest that SNAP studies do not appear to accurately assess the severity of OSA.

Adult↗

PubMed2002

Diagnosis and treatment of obstructive sleep apnea in a stroke rehabilitation unit: a feasibility study.

Obstructive sleep apnea can be diagnosed in approximately 60% of stroke survivors in the postacute period and has been found to be associated with increased mortality and a worse functional outcome at 3 and 12 mo after discharge. In this study, 38 patients undergoing rehabilitation after stroke underwent sleep studies by using the AutoSet Portable II Plus device; obstructive sleep apnea was found in 18 of the patients, and five consecutively diagnosed patients were treated on the ward with nasal continuous positive airway pressure. The research has shown that it is feasible to routinely implement a diagnostic and therapeutic approach to sleep apnea on the rehabilitation ward, which is hoped to have a positive influence on mortality, functional outcome, and secondary prevention.

Adult↗

PubMed2001

A cost-minimization study of telemedicine. The case of telemonitored polysomnography to diagnose obstructive sleep apnea syndrome.

OBJECTIVES: In a context where sleep laboratories are overwhelmed by a growing demand to diagnose obstructive sleep apnea syndrome (OSAS), efficient substitutive solutions to in-laboratory polysomnography should be found. To compare the effectiveness and costs of home unattended polysomnography (Hpsg) and telemonitored polysomnography (TMpsg), a cost minimization study was performed. METHODS: In a crossover trial, 99 patients underwent on two consecutive nights TMpsg and Hpsg according to a randomized order. A legibility recording criterion was retained to measure effectiveness. A microcosting study of TMpsg and Hpsg was performed. The risks to adopt home strategy or telemonitored strategy, according to different scenario chosen to reach the diagnosis in case of failure of Hpsg or TMpsg, were analyzed. RESULTS: The recording was considered to be ineffective in 11.2% of TMpsg (95% CI, 4.9-17.4) and in 23.4% (95% CI, 19.12-27.68) of Hpsg. The effectiveness differential was 12.2% (95% CI, 1.8-22.6) (p = .02). Assuming that in case of failure PSGs would be re-realized in the same condition to reach the diagnosis, then TMpsg could be selected if Hc/TMc (cost of Hpsg/cost of TMpsg) > 0.97; Hpsg could be selected if Hc/TMc < 0.76. If 0.76 < or = Hc/TMc < or = 0.97, the choice of TMpsg would be ambiguous. TMc was estimated to be $244, while Hc was $153 (Hc/TMc = 0.63). CONCLUSION: Unless some specific geographical situations generate significant transport costs, the implementation of a strategy based on unattended polysomnography at home is cost-saving compared to a telemonitoring strategy.

Cost Savings↗

PubMed2001

Mandibular advancement device in patients with obstructive sleep apnea : long-term effects on apnea and sleep.

STUDY OBJECTIVES: To evaluate the long-term effects on apneas and sleep and the tolerability of a mandibular advancement device in patients with obstructive sleep apnea. DESIGN: Prospective study. SETTING: Department of Respiratory Medicine, University Hospital, Umeå, Sweden. PATIENTS: Thirty-three consecutively treated patients. INTERVENTIONS: Individually adjusted mandibular advancement devices. MEASUREMENTS AND RESULTS: Polysomnographic sleep recordings on 1 night without the device and 1 night with the device were performed after 0.7 +/- 0.5 years (mean +/- SD) and after 5.2 +/- 0.4 years from the start of treatment. Nineteen of the 33 patients experienced a short-term satisfactory treatment result with an apnea-hypopnea index of < 10 events per hour and a satisfactory reduction in snoring. Fourteen patients were regarded as being insufficiently treated with the device. Seventeen of the short-term satisfactorily treated patients (90%) and 2 of the remaining patients continued treatment on a long-term basis. The apnea-hypopnea index was reduced by the device from 22 +/- 17 to 4.9 +/- 5.1 events per hour (p < 0.001) in these 19 long-term treatment patients, which did not differ from what was found at the short-term follow-up visits in these patients. Patients with their devices replaced or adjusted experienced a better long-term effect than patients still using their original devices (p < 0.05). CONCLUSIONS: The long-term effect and tolerability of a mandibular advancement device are good in patients who are recommended the treatment on the basis of a short-term sleep recording, provided that the device is continuously adjusted or replaced with a new one when needed. A short-term follow-up is valuable in the selection of patients who will benefit from long-term treatment with a mandibular advancement device.

Activator Appliances↗

PubMed2003

Pulmonary hemodynamics in obstructive sleep apnea: frequency and causes of pulmonary hypertension.

The association between nocturnal apneas and transient pulmonary hypertension (PHT) has been well documented. However, there is controversy over the frequency and pathophysiological mechanisms of daytime pulmonary hypertension in patients with obstructive sleep apnea (OSAS). The present study sought to evaluate frequency and mechanisms of pulmonary hypertension in patients with OSAS. It included 49 consecutive patients with polysomnographically proven OSAS without pathological lung function testing. All patients performed daytime measurements of pulmonary hemodynamics at rest and during exercise (50-75W). Six patients (12%) had resting PHT mean pulmonary of artery pressure (PAPM) of >20 mmHg), whereas 39 patients (80%) showed PHT during exercise (PAPM >30 mmHg). Multiple regression analysis revealed 3 independent contributing factors for mean pulmonary artery pressure during exercise (PAPMmax): body mass index, age and total lung capacity % of predicted. Twenty-five of the 39 patients with pathologically high PAPMmax (64%) showed elevated pulmonary capillary wedge pressures (PCWPmax > 20 mmHg), whereas no patient had elevated pulmonary vascular resistance (PVRmax > 120 dynes x s x cm(-5)). In conclusion, daytime PHT during exercise is frequently seen in patients with OSAS and normal lung function testing and is mainly caused by abnormally high PCWP, whereas PVR seems to play a minor role.

Adult↗

PubMed2001

Arousals and obstructive sleep apnea syndrome in children.

OBJECTIVE: Observations of children with obstructive sleep apnea syndrome (OSAS) show a restless sleep. But there is no significant disturbance of sleep macrostructure as in adult OSAS patients. It will be proved, whether the analysis of arousals permits a comprehensive characterization of this respiratory related sleep disturbance. Considering the problems in EEG-arousals detection in dependence of age and maturation we will compare the results of analysis of EEG- and movement arousals to find out a more practicable way for arousal analysis in childhood. METHODS: Twenty OSAS pediatric patients (aged 3.1-14.3 years, median 7.5 years) and 20 age matched children with no OSAS (aged 3.3-13.9 years, median 7.9 years) were examined polysomnographically. Clinically confirmed OSAS patients with an apnea/hypopnea index (AHI) > or = 5/h TST (total sleep time) were examined during 1 whole night before treatment (diagnostic night - baseline) and after/under receiving therapy. Various polygraphic parameters to describe the macrostructure of sleep (sleep efficiency, NREM 1-4, REM) and the microstructure of sleep (EEG- and movement arousals) were analyzed. Furthermore the AHI, heart rate and oxygen saturation were evaluated. RESULTS: Patients with clinically and polysomnographically confirmed OSAS had significantly more EEG (median 21.0/interquartile range 9.31 /h TST) and movement arousals (20.4/13.1 /h TST) before therapy than after/under therapy (EEG: 9.9/6.3 /h TST; movement: 9.2/3.8/h TST). The frequency of arousals was comparable in OSAS children after/under treatment and controls (EEG: 9.0/4.2/h TST; movement 9.3/3.4/h TST). In the 3 groups there was no significant correlation between AHI and number of EEG-arousals and movement arousals. AHI was significantly higher in OSAS children in comparison to controls and treated OSAS. In contrast to adults, sleep efficiency and macrostructure of sleep were not different in controls and OSAS children with or without treatment. Also, oxygen saturation and heart rate, had the same values in controls, OSAS children and OSAS children after/under treatment. CONCLUSIONS: OSAS in children is characterized by a restless sleep, i.e. by an enhanced number of movement and EEG-arousals. The microstructure of sleep but not the macrostructure is changed. There is a high coincidence between EEG arousals and movement arousals. The evaluation of arousals especially the analysis of movement arousals is helpful to estimate treatment effect in OSAS patients.

Adolescent↗

PubMed2005

Retrospective study of 18 patients treated by maxillomandibular advancement with adjunctive procedures for obstructive sleep apnea syndrome.

A surgical protocol in the treatment of obstructive sleep apnea syndrome (OSAS) is presented. Eighteen patients with particular craniofacial characteristics consisting in maxillomandibular retroposition or retromandibulism underwent bimaxillary advancement by way of Lefort I and bilateral sagittal ramus osteotomies. Adjunctive procedures (genioplasty, uvuloplasty, and glossoplasty) were performed in the same surgical procedure. In all cases, the patients were evaluated before and 6 months after surgery by a physical examination, Delaire cephalometric analysis, and polysomnography. Surgery was considered successful when the postoperative apnea/hypopnea index (AHI) was less than 15/h and with at least a 50% reduction of the initial index. The surgical success rate was 84%. AHI decreased from 54/h (+/-20.7) to 9.66/h (+/-6.67). The results of this study indicate that successful surgical treatment by maxillomandibular advancement with adjunctive procedures at the same operative time is efficient with a high percentage of success when patients are clearly selected.

Body Mass Index↗

PubMed2004

A comparison of polysomnography and a portable home sleep study in the diagnosis of obstructive sleep apnea syndrome.

OBJECTIVE: To validate the role of a portable sleep monitor device (SNAP) in the diagnosis of obstructive sleep apnea syndrome (OSAS). Inter-reader variability was also assessed for both PSG and SNAP. STUDY DESIGN AND SETTING: Sixty consecutive adults referred for PSG at The University of Chicago Sleep Disorder Clinic were prospectively enrolled. RESULTS: There was no significant difference between total number of apnea and hypopnea, respiratory disturbance index (RDI), and minimum oxygen obtained by PSG and SNAP, but there was a significant difference between sleep time and mean oxygen. Pearson's correlation coefficient for RDI > or = 15 was 0.92. CONCLUSION: There was a significant correlation of RDIs between SNAP and PSG. SNAP has good sensitivity, specificity, positive and negative predictive values. Differences between SNAP and PSG could be attributed to inter-reader variability and not necessarily due to technical limitations of SNAP. SNAP is an excellent tool for the diagnosis of OSAS in the laboratory setting. Future studies should be performed to evaluate SNAP's accuracy in the home setting in the diagnosis of OSAS. EBM RATING: B-2.

Adult↗

PubMed2004

[Characteristics of hypotensive effect in patients with arterial hypertension and desaturation signs of obstructive sleep apnea syndrome during sleep].

AIM: To estimate the efficacy of 8-week antihypertensive monotherapy in patients with arterial hypertension (AH) regarding the presence of obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: We analysed the results of 24-h blood pressure (BP) monitoring of 26 inpatients (mean age 54 +/- 2 years) with mild (n = 18) and moderate (n = 8) AH before and after 8 weeks of treatment with 5-10 mg amlodipine or 50-100 mg of losartan once daily to assess blood pressure profile parameters. The patients underwent nocturnal monitoring of arterial oxygen saturation (pulsoximeter NONIN-8500 M, USA). The presence of OSAS was confirmed when a characteristic clinical picture was combined with the presence of significant (> 4%) sleep desaturation episodes > 15 episodes per hour or the presence of group desaturation episodes below 90%. Seven hypertensive patients with OSAS were assigned to group 1, nineteen patients without OSAS--to group 2. The differences in estimated parameters between the groups were tested by Mann-Whitney U test, the dynamics of BP profile parameters--by Wilcoxon matched pairs test. RESULTS: In group 1 there were no significant differences by most of BP profile parameters before and after antihypertensive treatment, except mean nocturnal systolic BP. In group 2 a significant hypotensive effect was seen by all parameters of BP profile except BP variability. Hypotensive efficacy in group 2 was 1.5-2 times higher vs group 1, but the difficulties were not significant. CONCLUSION: Antihypertensive therapy in hypertensive patients with OSAS is less effective than in those without OSAS but it is not uneffective.

Adult↗

PubMed2004

Physiotherapy in obstructive sleep apnea syndrome: preliminary results.

Apneic patients have hypotonia of the lingual and supra-hyoid muscles. The dysfunction of theses muscles leading to a collapse of the upper airway is responsible for the apnea. The goal of this study, designed as a before-after trial, is to determine the effect of lingual and supra-hyoid muscle strengthening on obstructive sleep apnea. Thirty-four patients with obstructive sleep apnea were included (consecutive sample). Only 16 patients completed the study. The treatment consisted of 30 sessions of transcutaneous neuromuscular stimulation administered to the submental region associated with muscular exercises. The effect on apneic events was analyzed with a polysomnography before and after the treatment. Thirteen patients could be analyzed for the statistical studies. The mean apnea-hypopnea index (AHI) decreased from 32.9 to 20.6 (Wilcoxon rank test: P = 0.017). Seven patients ended the study with an AHI of less than 10, and three more patients decreased their AHI by more than 50%. This treatment significantly decreased the AHI in most of the patients. A larger study with more patients and with a long-term follow-up is necessary to determine the place of physiotherapy in the treatment of obstructive sleep apnea.

Adult↗

PubMed2001

[Effect of an oral appliance for obstructive sleep apnea syndrome].

The purpose of this study was to evaluate the effect of an oral appliance (Sleep Splint) for obstructive sleep apnea syndrome (OSAS) patients, and to examine problems with this therapy. Fixed in the oral cavity, the Sleep Splint intends to reduce the occurrence of apnea and prevent blockage of the upper airway during sleep. In this study, the therapy using Sleep Splint was done for 50 patients (41 men and 9 women) who had been introduced by the physician diagnosing with OSAS. Sleep monitoring around an oral appliance mounting was carried out, and the effect was evaluated. In addition, the ESS was used in respect of the evaluation of the daytime sleepiness. However, four patients stopped using the oral appliance due to serious discomfort in the maxillofacial region, and they were excluded from the study. Forty-six patients were classified into three groups by the seriousness of OSAS, or into two groups according to body fatness, and the difference of the effect between each group was compared. The results obtained were as follows. 1. As to the Apnea hypopnea index (AHI), Apnea hypopnea density, Oxygen desaturation, and ESS, there was statistically significant improvement regardless of the seriousness of OSAS and body fatness. 2. About all patients except for the patient group of the mild cases (AHI < 10), the occurrence of snoring showed the statistically significant improvement. These results indicated that oral appliance therapy was an effective treatment for OSAS.

Humans↗

PubMed2001

Obstructive sleep apnea syndrome: diagnosis and management.

Increased awareness that changes in sleeping habits and daytime behaviour may be attributable to obstructive sleep apnea syndrome (OSAS) has led many patients to seek both information and definitive treatment. The purpose of this article is to provide information to dentists that will enable them to identify patients who may have OSAS and to assist these patients in making informed decisions regarding treatment options. In patients who have identifiable anatomic abnormalities of the maxilla and mandible resulting in a narrow pharyngeal airway, orthognathic surgery appears to be an excellent treatment option.

Humans↗

PubMed2003

[Evaluation of cerebral hemodynamics in patients with syndrome of obstructive sleep apnea by long term registration of rheoencephalogram].

AIM: To assess cerebral hemodynamics during sleep in patients with syndrome of obstructive sleep apnea. METHODS: Long term monitoring of rheoencephalogram. Data processing consisted in construction of trends (curves of changes of rheographical parameters during any selected time interval). RESULTS AND CONCLUSION: Cyclical periods of apnea are associated with negative changes of cerebral hemodynamics. At the end of period of apnea despite compensatory vasodilatation cerebral blood flow decreases. This occurs during pronounced hypoxemia and can predispose to ischemic disturbances. In ventilation phase rapid rise of heart rate and blood pressure at the background of continuing cerebral vasodilatation can increase risk of hemorrhagic complications.

Cerebrovascular Circulation↗

PubMed2006

[Obstructive sleep apnea and cardiovascular disease].

Sleep-related breathing disorders are prevalent in the general population and are associated with a wide range of cardiovascular diseases. Obstructive sleep apnea is the most common form of sleep-related breathing disorders and is characterized by repetitive episodes of partial or complete upper airway obstruction, followed by oxygen-desaturation and arousals. These apneic events disrupt normal sleep and lead to various acute and chronic cardiovascular consequences. The current standard treatment with nasal continuous positive airway pressure eliminates apneas, improves sleep fragmentation and prevents consequent hemodynamic changes during sleep. Every patient with hypertension, obesity or heart disease should be asked routinely about symptoms of sleep apnea and referred for a sleep study if necessary.

Cardiovascular Diseases↗

PubMed2004

Outcome of adenotonsillectomy for severe obstructive sleep apnea in children.

OBJECTIVE: To study changes in sleep behavior and quality of life in children after adenotonsillectomy for severe obstructive sleep apnea identified by a respiratory distress index > or = 30. METHODS: Children enrolled in the study underwent adenotonsillectomy and had both pre- and post-operative polysomnography. Caregivers also completed an OSA-18 quality of life survey prior to polysomnography and within 6 months of surgery. Paired Student's t-tests were used to compare pre- and post-operative scores. RESULTS: The study population included 29 children. The mean age was 7.1 years (range 1.4-17.0). The most common comorbidities were obesity, asthma and allergic disease. The mean pre-operative RDI was 63.9 and the mean post-operative RDI was 14.2 (P < .0001). The mean total OSA-18 score before surgery was 77.6 and after surgery was 33.2. The differences in pre- and post-operative OSA-18 total scores and domain scores were significant (P < .0001). CONCLUSION: Children with severe OSA who undergo adenotonsillectomy show a significant improvement in RDI and in quality of life over a period of several months after surgery. However, OSA does not resolve in the majority of these children and post-operative PSG is recommended to identify those who may require additional therapy.

Adenoidectomy↗

PubMed1998

Blood pressure in children with obstructive sleep apnea.

Hypertension is a common complication of obstructive sleep apnea in adults. However, hypertension has not been studied systematically in children with the obstructive sleep apnea syndrome (OSAS). We therefore measured blood pressure (BP) during polysomnography in 41 children with OSAS, compared to 26 children with primary snoring (PS). Systolic and diastolic BP were measured every 15 min via an appropriately sized arm cuff, using an automated system. This was tolerated by the children without inducing arousals from sleep. Children with OSAS had a significantly higher diastolic BP than those with PS (p < 0.001 for sleep and p < 0.005 for wakefulness). There was no significant difference in systolic BP between the two groups. Multiple linear regression showed that blood pressure could be predicted by apnea index, body mass index, and age. Blood pressure during sleep was lower than during wakefulness (p < 0.001 for diastole and p < 0.01 for systole), but did not differ significantly between rapid eye movement (REM) and non-REM sleep. We conclude that childhood OSAS is associated with systemic diastolic hypertension.

Blood Pressure↗

PubMed2000

Driving simulation with EEG monitoring in normal and obstructive sleep apnea patients.

STUDY OBJECTIVES: To measure simulated driving performance in obstructive sleep apnea patients and its relationship with EEG defined attention lapses. DESIGN: Prospective, mixed design comparing apnea patients and control subjects over a 60-minute driving simulation task while continuously recording both driving performance and EEG measures. SETTING: Sleep disorders center. PARTICIPANTS: 15 polysomnographically diagnosed obstructive sleep apnea patients (mean age 42 +/- 6 yrs.) and 15 healthy volunteers (mean age 38 +/- 6 yrs.). INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: A computer based driving simulator recorded lane position variability, speed variability, steering rate variability, and crash frequency. The frequency and duration of EEG-defined attention lapses were also measured. The results demonstrated that the apnea group had significantly greater variability in lane position, steering rate, and speed than the control group. The apnea group also had more crashes. In addition, the apnea group had more EEG-defined attention lapses of longer duration. Except for speed and steering rate variability, these differences increased over the 60-minute task. Measures of lane position variability and crash frequency had a significant positive correlation with attention lapse frequency and duration. CONCLUSIONS: The driving simulation task unmasked and quantified marked performance impairments in the sleep apnea group that increased over time. The poor performance appeared related to the EEG-defined attention lapses. Lane position variability appeared to be the most sensitive measure for assessing and quantifying impairment. This study suggests that poorer driving performance and crashes are not entirely due to overt sleep, but inattention due to sleepiness.

Accidents, Traffic↗