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PubMed2006

Incremental risk of obstructive sleep apnea on cardiac surgical outcomes.

AIM: Obstructive sleep apnea (OSA) is not generally acknowledged as a perioperative risk factor. High incidence of Sleep disordered breathing has been noticed in patients with cardiovascular disease. The Sleep Heart Health Research Study Group found Apnea-Hypopnea indices (AHI) as modest as 1-10 to be associated with cardiovascular disease manifestations. Given the lack of data we chose to study the incremental risk of OSA in patients undergoing cardiac surgery. METHODS: We looked at 25 587 patients who underwent cardiac surgery at the Cleveland Clinic. Of these, 37 patients were also identified on the Cleveland Clinic Sleep center database as having OSA. Each of these 37 cases were propensity matched for multiple covariates with 5 controls within a distance of 0.001 units. An assumption was made that if the surgery was performed within two years of the diagnosis of OSA, the patient had OSA at the time of the surgery. RESULTS: Higher incidence of encephalopathy (p=0.008), postoperative infection (0.028) and increased ICU length of stay (p=0.031) were noted in the group with OSA after cardiac surgery. The difference in the rates of infection was mostly accounted for by the presence of mediastinitis (8.1% vs 1.6%). Differences in the rates of reintubation, tube time, and overall postoperative morbidity were not statistically significant. CONCLUSIONS: | Increased risk for postoperative complications is suggested in patients with OSA undergoing cardiac surgery. This risk is underestimated on account of lack of awareness about the incidence of OSA in the general population and the cardiovascular population in particular, difficulties in clinical suspicion and diagnosis and limited use of polysomnography.

Aged↗

PubMed2006

[Exhaled nitric oxide in patients with obstructive sleep apnea syndrome].

UNLABELLED: Exhaled nitric oxide has been extensively investigated as a non-invasive marker of airway inflammation. Some authors have suggested that morning FE(NO) in obstructive sleep apnea syndrome (OSAS) patients is elevated due to inflammation of upper airways, while others have not found any differences between patients and healthy subjects. The purpose of this study was to analyze concentration of exhaled nitric oxide (FE(NO)) in OSAS patients. METHODS: 119 (99 M, 20 F) consecutive patients of sleep laboratory participated in this study. Standard overnight sleep studies with polysomnography or portable screening device were carried out in the whole group: OSAS was diagnosed in 66 patients and 53 no-OSAS served as controls. FE(NO) was measured on-line with a flow rate kept at 0.045 - 0.055 l/s, according to the recommendations of ATS using a chemiluminescence analyzer twice: before the sleep study (8-10 p.m.) and after termination of data collection (6 - 8 a.m.). There were no differences in age between patients and controls. Respiratory disturbance index (RDI) was 40.3+/-24.9 in patients and 3.7+/-2.8 in controls (p<0.001). In OSAS patients both evening and morning FE(NO) was significantly higher compared to controls (23.1+/-14.8 ppb vs. 16.8+/-9.8 ppb and 22.4+/-13.2 ppb vs. 15.3+/-8.1 ppb respectively, p<0.05). Weak but statistically significant correlations for the whole group between morning FE(NO) and mean and minimum arterial oxygen saturation (SaO2) during sleep and number of study minutes with SaO2<90% were observed. Lower evening FE(NO) in OSAS patients with coexisting arterial hypertension when compared to normotensive OSAS patients was also noticed (19.1+/-10.8 ppb vs. 27.1+/-19.1 ppb; p<0.05). CONCLUSIONS: The increase in FE(NO) in OSAS patents may be caused by repetitive apneas and hypoxemia during sleep.

Adult↗

PubMed1991

[Cardiopulmonary risk factors in patients with sleep apnea].

Since the interaction between disorders of the respiratory coordination and cardiovascular or cardiopulmonary regulation is still largely unknown the intention of the present investigation is to point out the coincidence of cardiac arrhythmias, such as premature ventricular capture (PVC) beats and conduction blocks, with obstructive sleep apnea (OSA). For the first time a group of more than 300 patients with suspected OSA is examined concerning risk factors and frequent diagnoses as obesity, hypertension, coronary heart disease (CHD), heart insufficiency, chronic obstructive pulmonary disease (COPD), and daytime hypoxaemia. Summarizing the results of lung function test, blood gas analysis, strain-ECG, Holter-ECG and inductive plethysmography with oxygen partial pressure measurement by ambulatory work-up the following statements can be made: PVC beats occurring markedly during sleep give hints for OSA being the underlying cause, especially if the patients are young and overweight. Hypoxaemia increasing during the apnea episodes should be considered as one possible pathogenetic mechanism. Second- and third degree conduction blocks and sinus arrest coincident very often with OSA. They suggest to be life-limiting factors the more so since they often go along with CHD or heart insufficiency. Systemic arterial hypertension and overweight have the highest prevalence in OSA, signs for heart insufficiency and daytime hypoxaemia are also significantly more frequent than in non-OSA patients. We could find no hints for direct pathogenetic coherence between CHD and OSA or between COPD and OSA, nevertheless pronounced nocturnal changes in blood gases and intrathoracic hemodynamics have important influence on the cardiopulmonary and cardiovascular system, as partly illuminated in other more pathogenetic oriented studies by the present time.

Arrhythmias, Cardiac↗

PubMed1989

Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnoea and weight matched controls.

It has been suggested that deposition of fat in the soft tissues surrounding the upper airway may be an important factor in the pathogenesis of obstructive sleep apnoea (OSA) in obese subjects. We have used magnetic resonance imaging to determine the site(s) and size(s) of fat deposits around the upper airway in six obese patients with OSA (116-153% of ideal body weight) and five weight-matched controls without OSA (107-152% of ideal body weight). In all subjects, large deposits of fat were present postero-lateral to the oropharyngeal airspace at the level of the soft palate. Significantly more fat was present in these regions in the patients with OSA (p = 0.03). Fat deposits in the soft palate were observed in 4 of the 6 patients with OSA but none of the controls. Fatty streaks were observed in the tongue in 2 of the 5 controls and 3 of the 6 patients with OSA. Fat deposits were observed anterior to the laryngopharyngeal airspace, in submental regions, in all obese subjects. This study shows that more fat is present in those areas surrounding the collapsable segment of the pharynx in patients with OSA, compared to equally obese control subjects without OSA.

Adipose Tissue↗

PubMed1995

Pharmacologic treatment of obstructive sleep apnea.

From this review it is obvious that no one pharmacologic agent is universally useful in the treatment of OSA. However, as mentioned in the introductory remarks above, the expectation of beneficial results in a heterogenous population of patients with OSA by specific-acting pharmacologic agents may be somewhat irrational. In addition to this problem, studies performed to date are often not controlled and are usually investigations in small numbers of subjects. However, from the data produced it is apparent that OSA precipitated by endocrinologic problems will improve with hormone replacement. Medroxyprogesterone has been shown to be especially useful in patients with an obesity-hypoventilation component to their disease. Protriptyline may also be useful, but its usefulness is impaired by significant adverse effects. Most likely, both medroxyprogesterone and protriptyline would be more tolerable in female OSA patients, but unfortunately, most of the OSA patient groups studied to date have been composed exclusively of male subjects. Therefore, we do not know if these agents would be more effective and better tolerated in female patients with OSA. The roles of ACE inhibitors and buspirone are not yet established. Serotonin-active agents may be useful in some patients with OSA, but the characteristics of responders are not defined for appropriate patient selection. Much work remains ahead to identify effective pharmacologic agents for OSA. Once identified, these agents must be tested in representative patient groups with a double-blind, placebo-controlled study design in multicenter trials to test the value of these agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Endocrine System Diseases↗

PubMed1995

Relation between CT axial cross-sectional area of the oropharynx and obstructive sleep apnea syndrome in adults.

PURPOSE: To look for correlation between obstructive sleep apnea syndrome (OSAS) and axial cross-sectional area of the narrowed oropharyngeal lumen. METHODS: Thirty-six men with OSAS and 10 control subjects underwent polysomnography with registration of oxygen saturation and number of sleep apnea episodes and their duration. Nine of them underwent uvulopalatopharyngoplasty and repeated polysomnography. Each polysomnography was followed by high-resolution CT scan with reconstructions in sagittal and coronal planes. Measurements of the axial cross-sectional area of the oropharyngeal lumen were taken at the level of the narrowing. RESULTS: Twenty-seven patients with severe OSAS (high number and prolonged episodes of OSAS and 22% or greater decrease in oxygen saturation) had a narrowed oropharyngeal cross-sectional area less than 50 mm2 wide. The control subjects and 6 patients who had uvulopalatopharyngoplasty without OSAS had a minimal pharyngeal cross-sectional area of 110 mm2. Eight patients with moderate OSAS and 3 patients who had uvulopalatopharyngoplasty and diagnoses of OSAS had intermediate values of the narrowest pharyngeal level--between 60 mm2 and 100 mm2. CONCLUSION: The measurement of the axial cross-sectional area of the pharyngeal lumen can play an important role in evaluation of OSAS and indications for surgery.

Adult↗

PubMed1996

Obstructive sleep apnoea and cardiovascular morbidity.

Obstructive sleep apnoea (OSA) has been implicated through epidemiologic studies as a co-morbid factor in cardiovascular disease. There is a greater incidence of hypertension and atherosclerosis related diseases such as stroke, angina, and acute myocardial infarction in patients with OSA. However, obesity is a common problem in OSA as well as cardiovascular disease and is argued by some to be the etiologic factor for both OSA and cardiovascular morbidity. Clearly, there is shortened longevity in patients with untreated or inadequately treated OSA. Other factors which could account for this early mortality in OSA are sudden death during sleep (arrhythmia) or even fatalities from sleep related automobile accidents. The reason that the association between OSA and cardiovascular disease remains unclear is that the relationship thus far is demonstrated only by epidemiological association, not by mechanisms showing a cause-effect relationship. Some of these possible mechanisms are discussed below. Regardless of the mechanisms, the evidence is that OSA needs to be treated aggressively if patient morbidity and mortality from cardiovascular disease is to be reduced.

Cardiovascular Diseases↗

PubMed1997

[Chemical control of breathing in patients with obstructive sleep apnea].

The authors have studied chemical control of breathing in 37 normocapnic patients with OSA. These patients had increased apnea-hypopnea index (AHI = 51 +/- 22), obesity (BMI = 32.4 +/- 5.6 kg/m2) and normal lung function tests. Control group consisted of 20 healthy subjects with normal weight (BMI = 23.1 +/- 2.4 kg/m2). Respiratory responses (ventilatory and P0.1) to hypercapnic and hypoxic stimulation during rebreathing tests were measured with computerized methods. The obtained results in OSA patients were compared with the data of the control group. The results exceeding mean values of the control group above 1.64 SD were recognized as hyperreactive responses. The majority e.g. 26 patients (OSA-N) had normal respiratory responses during hypercapnic stimulation. delta V/delta PCO2 = 16.8 +/- 4.5 L/min/kPa, P0.1/delta PCO2 = 3.5 +/- 2.4 cm H2O/kPa/. In remaining 11 patients (OSA-H) respiratory responses were significantly increased delta V/delta PCO2 = 39.1 +/- 18.8 L/min/kPa, P0.1/delta PCO2 = 8.6 +/- 3.9 cm H20/kPa). During isocapnic hypoxic stimulation majority e.g. 25 patients (OSA-H) had significantly increased respiratory responses delta V/delta SaO2 = 3.28 +/- 1.63 L/min/%, delta P0.1/delta SaO2 = 0.54 +/- 0.43 cm H2O/%/. In remaining 12 patients (OSA-N) respiratory responses were within normal limits delta V/SaO2 = 1.2 +/- 0.28 L/min/%, delta P0.1/ delta SaO2 = 0.21 +/- 0.07 cm H2O/%/. The above results indicated, that majority OSA patients (67.5%) had increased ventilatory and P0.1 responses to hypoxic stimulation. Among them also 11 patients had increased respiratory responses to hypercapnia. It seems, that increased respiratory responses to hypoxic stimulus in OSA patients are symptoms of protective reaction to hypoxaemia occurring during repetitive sleep apnoea and reveals increased neuro-muscular output.

Adult↗

PubMed1997

[Nasal strips without effect on obstructive sleep apnea and snoring].

Recently a nose plaster (NP, Breathe-Right) has been increasingly used in the treatment of obstructive sleep apnoea (OSA) and snoring. Hence, we examined the use of the NP as a treatment of both OSA and snoring without OSA. The NP has a elastic spine that increases the diameter of the nostril and is thought to reduce the degree of OSA and snoring. According to the polysomnographic data two groups were differentiated: Group A (30 patients with OSA, apnoea index > 10/h, 26 men) and Group B (20 snorers, without OSA, 13 men). After the diagnostic polysomnography the efficacy of the NP was measured with a cardiorespiratory polygraph on the 2 following nights. In the group A the polygraphic data (apnoea index, time of apneas, desaturation index, time of desaturations, mean and nadir SaO2) were studied; in group B the snoring index (snoring events/hour) was measured. A questionnaire scored quality of sleeping, daytime condition and the quality of nose breathing. In neither group were the recorded polygraphic findings different with the NP although with the NP an improved nose breathing was scored in both groups. In group A 90% of the patients scored the daytime sleepiness unchanged and 10 of 30 patients described an improved quality of sleep. In group B there was no change in the frequency of snoring events with the NP. Neither the degree of OSA nor of snoring without OSA were changed by the NP, which can therefore not be considered a treatment of these conditions. However, the majority of the study population were impressed by the symptomatic improvement in nose breathing.

Dilatation↗

PubMed1997

[Changes in the time spent awake in obstructive sleep apnea and snoring--results of a pilot study].

Continuous positive airway pressure (CPAP) therapy reduces sleeping time per day and daytime sleepiness in obstructive sleep apnoea (OSA) and heavy snoring. Due to sleep fragmentation the OSA and heavy snoring are associated with a daytime sleepiness and increased necessity of sleep. In this pilot study the effect of CPAP-therapy on daytime sleepiness and sleep time during 24 hours were assessed in patients with OSA or heavy snoring (daytime sleepiness, none or slight apnoea with AHI < 10/h and benefit of CPAP). We studies 42 patients with OSA (AHI: 34.5 +/- 23.6) and 15 patients with heavy snoring: inclusion criteria: Patients with OSA (AHI > 10/h, ESS-Score > 8) and heavy snoring (AHI < 10/h, ESS-Score > 8) who were treated with nCPAP. Before and 2 months after initiation the CPAP-therapy all patients completed diary cards recording the sleeping time/day for 1 month; additionally they scored sleepiness using the Epworth sleepiness scale (ESS-score ranged from 0 to 24, the higher the score the worse the sleepiness) before and 2 months after initiation the CPAP-therapy. In the whole study population nCPAP-therapy reduced the sleeping time significantly by a mean period of 46 minutes per 24 hours (from 8.3 +/- 1.3 to 7.5 +/- 1.2 hours, p < 0.001) and improved the ESS score from 13.7 +/- 4.6 to 6.1 +/- 3.6 (p < 0.0001). In respect of the change of sleeping time/day and of the sleepiness score there was no significant difference between the OSA and heavy snoring group. With CPAP the AHI in OSA patients was reduced from 34.5 +/- 23.6/h to 3.2 +/- 3.2/h. Due to the improvement of sleep-related breathing disorders CPAP therapy reduced the mean sleeping time/day by approximately 10% and the daytime sleepiness score both in patients with OSA and heavy snoring compared to the pretreatment period.

Airway Obstruction↗

PubMed1998

Susceptibility of LDL to oxidative stress in obstructive sleep apnea.

Cardiovascular diseases are more common in patients with obstructive sleep apnea (OSA) than in the general population. We hypothesized that severe hypoxemia during sleep in these patients may cause an imbalance between reactive oxygen species and the antioxidant reserve that is important for the detoxification of these molecules. We tested the hypothesis that low-density lipoproteins (LDL) in hypoxic OSA patients may be more susceptible to oxidative stress than LDL of nonhypoxic OSA patients and normal controls. Fifteen OSA patients were included in this study, six with severe hypoxia (hypoxic group) who spent more than 10 minutes during sleep with SaO2 < 85% (mean 96 minutes), and nine OSA patients (nonhypoxic group) who spent less than 10 minutes during sleep with SaO2 < 85% (mean 1.1 minutes). Six healthy nonsmoking males of the same age group were included as a control group. The susceptibility of each individual's LDL to oxidative stress was examined after free-radical challenge in vitro by assessing changes in levels of conjugated dienes. The LDL in OSA patients with severe hypoxia was not more susceptible to oxidative stress compared to the LDL of nonhypoxic OSA patients and normal controls. After 6 hours of exposure to an oxidative agent, the changes in the mean conjugated diene were not different among the three groups (p = 0.75). The time required to reach 50% of maximal absorbance was also not different, p = 0.199. Glutathione peroxidase and catalase activities in red blood cells in the hypoxic and nonhypoxic patient groups were not significantly different. One night of CPAP therapy in each patient group did not significantly change the level of the antioxidant enzymes. Our results did not show any difference in the susceptibility to oxidative stress between hypoxic and nonhypoxic OSA patients and normal controls.

Adult↗

PubMed2003

Marked improvement in nocturnal gastroesophageal reflux in a large cohort of patients with obstructive sleep apnea treated with continuous positive airway pressure.

BACKGROUND: Nocturnal gastroesophageal reflux (nGER) is common in patients with obstructive sleep apnea (OSA). Small, short-term studies have shown that treatment with nasal continuous positive airway pressure (CPAP) decreases esophageal acid exposure. OBJECTIVE: To examine the relationship between OSA and nGER, and the effect of CPAP on nGER, in a long-term follow-up study of a large cohort of patients with OSA and nGER. METHODS: We prospectively studied 331 patients diagnosed as having OSA between October 1, 1993, and November 30, 2000. At baseline, patients graded their frequency of nGER symptoms on a scale of 1 (never) to 5 (always). All patients were prescribed CPAP for their OSA. At follow-up, the frequency of nGER symptoms was obtained by telephone interview. RESULTS: Of the 331 patients with OSA, nGER was present in 204 (62%) before treatment with CPAP. Follow-up was obtained in 181 patients (89%). Of these 181 patients, 165 (91%) were still using CPAP and 16 (9%) were not, forming the treatment and control groups, respectively. The patients compliant with CPAP had a significant improvement in nGER score, from a mean of 3.38 before CPAP treatment to 1.75 after treatment (48% improvement; P<.001), while patients not using CPAP (control subjects) showed no improvement (mean, 3.56 to 3.44; P =.55). There was a strong correlation between CPAP pressure and improvement in nGER score (correlation, r = 0.70; P<.001), with patients with higher CPAP pressures demonstrating a greater improvement in nGER score. CONCLUSIONS: Nocturnal GER is common in patients with OSA. Treatment with nasal CPAP decreases the frequency of nGER symptoms by 48%. Higher nasal CPAP pressures are associated with greater improvement in nGER.

Adult↗

PubMed1998

Evaluation of patients with sleep apnea after tracheotomy.

OBJECTIVE: To determine the effect of tracheotomy on polysomnographic and arterial blood gas data in patients with obstructive sleep apnea (OSA). DESIGN: A retrospective study of all patients who underwent tracheotomy and were studied polysomnographically at the Johns Hopkins Sleep Disorders Center, Baltimore, Md, since 1981. SETTING: A regional sleep disorders center. PATIENTS: Twenty-eight patients (8 women and 20 men), aged 22 through 77 years. Patients were categorized into 2 groups on the basis of whether they had already undergone tracheotomy before polysomnography. Group 1 patients all had a polysomnographic diagnosis of OSA before tracheotomy. They were further subdivided on the basis of whether cardiopulmonary decompensation had been absent (group 1a, n=10) or present (group 1b, n=13). Group 2 patients (n=5) had undergone tracheotomy to treat upper airway obstruction that developed after non-apnea-related upper aerodigestive tract surgeries. INTERVENTION: Tracheotomy. MAIN OUTCOME MEASURES: Nocturnal non-rapid eye movement, apnea-hypopnea index, percentage oxyhemoglobin saturation, and arterial blood gas data. RESULTS: Patients with OSA underwent tracheotomy as definitive treatment for the apnea (n=15), to prevent postoperative upper airway compromise after uvulopalatopharyngoplasty (n=7), and to treat upper airway compromise after non-apnea-related upper aerodigestive tract surgeries (n=6). Tracheotomy alleviated apnea in all 10 patients with uncomplicated sleep apnea (group 1a). For patients with OSA complicated by cardiopulmonary decompensation (group 1b), tracheotomy improved but did not eliminate sleep apnea in 7 of the 13 patients, despite overall improvement in arterial blood gas values. For patients whose sleep apnea had not been diagnosed polysomnographically before tracheotomy (group 2), tracheotomy was still required to treat OSA that had previously not been recognized. CONCLUSIONS: Tracheotomy effectively treated patients with uncomplicated OSA, but was much less effective in treating patients with OSA and cardiopulmonary decompensation. In patients who underwent tracheotomy in conjunction with other upper aerodigestive tract surgeries, concomitant obstructive sleep apnea often required continued use of a tracheotomy to maintain upper airway patency.

Carbon Dioxide↗

PubMed2002

Usefulness of uvulopalatopharyngoplasty with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea.

OBJECTIVE: To evaluate the usefulness of uvulopalatopharyngoplasty plus mandibular osteotomy with genioglossus and hyoid advancement in the treatment of obstructive sleep apnea syndrome (OSAS). DESIGN: Prospective study of 20 consecutive patients with OSAS. SETTING: University medical center. PATIENTS AND INTERVENTIONS: Twenty OSAS patients with multilevel upper airway obstruction who refused continuous positive airway pressure treatment. All patients were evaluated before and 6 months after surgery by clinical history, the Epworth Sleepiness Scale, physical examination, fiberoptic nasopharyngoscopy combined with the Müller maneuver, cephalometric analysis, nocturnal polysomnography, and a second-night polysomnography with upper airway pressure recording during sleep. Surgery procedures were uvulopalatopharyngoplasty plus mandibular osteotomy with genioglossus and hyoid advancement. Surgical successful outcome was defined as an apnea-hypopnea index (AHI) lower than 20 plus subjective resolution of daytime symptoms. MAIN OUTCOME MEASURE: Surgical success rate. RESULTS: Mean +/- SD AHI decreased from 60.5 +/- 16.5 to 44.6 +/- 27(P =.007), and CT90 (percentage of time with oxyhemoglobin saturation below 90%) decreased from 39.5% +/- 26% to 25.1% +/- 26.4% (P =.002). The overall surgical success rate was 35% but increased to 57% in patients with moderate OSAS (AHI, 41-60) and to 100% in mild OSAS (AHI, 21-40). In the group of severe OSAS, the success rate was 9%. Predictors of surgical outcome success were the AHI, CT90, stages 2 and 3-4 sleep percentages, and the cephalometric ANB angle (angle formed from the deepest point on the maxillary outer contour to the nasion to the deepest point on the outer mandibular contour). CONCLUSION: Patients with mild and moderate OSAS and multilevel obstruction in the upper airway may benefit from uvulopalatopharyngoplasty plus genioglossus and hyoid advancement.

Adult↗

PubMed2004

Quality of life after adenotonsillectomy for obstructive sleep apnea in children.

OBJECTIVE: To study changes in quality of life in children after adenotonsillectomy for obstructive sleep apnea (OSA) documented by full-night polysomnography. DESIGN AND SETTING: Prospective study of children with OSA at the University of New Mexico Children's Hospital, Albuquerque. METHODS: Caregivers for children were asked to complete the OSA-18 quality of life survey prior to polysomnography. Children who met inclusion criteria and had a respiratory distress index higher than 1 were enrolled in the study and underwent adenotonsillectomy. Caregivers completed a second OSA-18 survey within 6 months of surgery. Scores from the preoperative and postoperative surveys were compared using the paired t test. RESULTS: The study population included 60 children (mean age, 7.1 [range, 3-12] years), of whom 43 (72%) were male and 30 (50%) were younger than 6 years. Forty-seven children (78%) had a respiratory distress index of 10 or higher. The mean interval between the 2 surveys was 126 days. The mean total OSA-18 score was 71.4 before surgery and 35.8 after surgery. The domain with the greatest change in mean score was sleep disturbance, which improved by 11.5. The changes in total score, in the scores for each domain, and for each item of the OSA-18 survey were highly significant (P<.002). CONCLUSIONS: Children without significant comorbidities show a marked improvement in the domains of sleep disturbance, physical symptoms, emotional symptoms, and daytime functioning as reported by their caregivers after adenotonsillectomy for OSA.

Adenoidectomy↗

PubMed2005

Child behavior and quality of life in pediatric obstructive sleep apnea.

OBJECTIVE: To assess behavior and quality of life in children with obstructive sleep apnea (OSA) undergoing tonsillectomy and adenoidectomy compared with control children. DESIGN: Prospective controlled study. SETTING: Hospital-based pediatric otolaryngology practice. PARTICIPANTS: Forty-two children (25 boys and 17 girls; mean [SD] age, 5.8 [2.5] years) with OSA confirmed by positive findings on polysomnography undergoing tonsillectomy and adenoidectomy and 41 control children (29 boys and 12 girls; mean [SD] age, 7.3 [3.8] years) with no history of snoring undergoing unrelated elective surgery. INTERVENTIONS: Parents completed the standardized Child Behavior Checklist and a validated pediatric OSA quality-of-life survey before and 3 months after surgery. MAIN OUTCOME MEASURES: Child Behavior Checklist T scores and score classifications and quality-of-life survey mean scores. RESULTS: Change in mean total problem T score was significantly greater in the OSA group (from 51.6 at baseline to 48.3 at follow-up) than in controls (from 45.5 at baseline to 46.7 at follow-up) (P = .03). The improvement in total T score classification (normal vs borderline or abnormal) was significant for children with OSA compared with control children (P = .009). Children with OSA had significant improvements in the quality-of-life survey mean total score and all individual domain scores compared with controls (P<.001). CONCLUSIONS: Behavioral and emotional difficulties are found in children with documented OSA compared with control children, and they improve after treatment. Large improvements in disease-specific quality of life are also found. Scores on a standardized measure of behavior assessment demonstrated significant correlation with scores on a validated quality-of-life instrument.

Adenoidectomy↗

PubMed2005

Quality of life and sleep study findings after adenotonsillectomy in children with obstructive sleep apnea.

OBJECTIVES: To assess polysomnogram (PSG) results and global and disease-specific quality of life (QOL) in children with obstructive sleep apnea (OSA), before and after adenotonsillectomy, and to assess the association between PSG findings and QOL. DESIGN: Prospective observational study. We performed overnight PSG using standardized techniques and assessed disease-specific and global QOL using validated instruments. Follow-up was assessed at 1 year. We compared QOL outcomes between children who underwent adenotonsillectomy and children who did not. SETTING: A large tertiary care children's hospital. PATIENTS: Children with sleep-disordered breathing who were suspected of having OSA. INTERVENTION: Adenotonsillectomy. MAIN OUTCOME MEASURES: We evaluated PSG parameters, disease-specific QOL, and global QOL. RESULTS: We enrolled 47 children, 31 of whom met PSG criteria for OSA. Disease-specific and global QOL were not significantly different between children with OSA and children without. Global QOL was significantly worse for children with OSA than healthy children on several subscales: general health perception, behavior, and parental impact-emotional. Children who underwent adenotonsillectomy had significant improvements in QOL scores and PSG parameters (apnea-hypopnea index, P = .004; minimum saturation, P = .004). We found significantly larger QOL changes in children who underwent surgery compared with children without surgery (subscales: infections, P = .01; airway, P = .002; swallowing, P = .02; and behavior, P = .03). No strong association was identified between QOL scores and PSG parameters. CONCLUSIONS: Children with OSA and sleep-disordered breathing have significantly worse QOL than healthy children. However, the association between PSG findings and QOL was only moderate. Children with OSA treated with adenotonsillectomy demonstrated large improvements in disease-specific and global QOL as well as PSG parameters.

Adenoidectomy↗

PubMed2003

Prospective polysomnographic analysis of obstructive sleep apnea in down syndrome.

OBJECTIVES: To investigate obstructive sleep apnea (OSA) in a consecutively encountered, nonselected population of young patients with Down syndrome using standard overnight polysomnography and to determine the effects of therapy. METHODS: In a population of patients seen for routine developmental evaluations, 9 boys and 10 girls were studied using standard overnight polysomnography. RESULTS: Using pediatric standards, OSA was found in 79% of the subjects (95% confidence interval, 54%-94%), with a median apnea index of 3 events per hour (interquartile range, 2-5), a median apnea-hypopnea index of 6 events per hour (interquartile range, 3-8), and a median arterial oxygen saturation (SaO2) low point of 88% (interquartile range, 84%-90%). Higher body mass index was significantly associated with a higher apnea index and a lower SaO2 level, and there was a significant inverse relationship between age and the lowest SaO2 value as well as a possible association between sleep-related symptoms at the time of diagnosis and the lowest SaO2 value. In addition, patients with OSA had a significantly higher movement arousal index than those without OSA. CONCLUSIONS: Using rigid polysomnographic standards, this pilot study revealed OSA in a high percentage of young subjects with Down syndrome and an association between OSA and obesity, age, and poor sleep quality. These findings justify larger and more detailed population studies to further define clinical factors that are concomitant with OSA in Down syndrome and to improve therapy.

Adenoidectomy↗