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Results for “Sleep Apnea, Obstructive”

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PubMed2006

Obstructive sleep apnea: Should all children with Down syndrome be tested?

OBJECTIVES: To determine the incidence of obstructive sleep apnea syndrome in children aged 2 to 4 years with Down syndrome and to determine parents' ability to predict sleep abnormalities in this patient population. DESIGN: Prospective cohort study. SETTING: Tertiary care pediatric referral center. PATIENTS: Sixty-five children participating in a 5-year longitudinal study in which the otolaryngologic problems seen in Down syndrome were evaluated. Fifty-six completed overnight polysomnography (PSG) between 4 and 63 months of age (mean age, 42 months). INTERVENTIONS: Overnight PSG was performed. Parents also completed a questionnaire regarding their impressions of their child's sleep patterns before PSG. MAIN OUTCOME MEASURES: Polysomnograms were classified as abnormal if the obstructive index was greater than 1, if the carbon dioxide level was greater than 45 mm Hg for more than two thirds of the study or greater than 50 mm Hg for more than 10% of the study, and/or if there was unexpected hypoxemia less than 92% during sleep or repeated intermittent desaturations less than 90%. We also identified a group of children whose PSGs findings were normal except for an arousal index greater than 10 and were associated with increased work of breathing. RESULTS: The PSGs revealed that 57% of the children had abnormal results and evidence of obstructive sleep apnea syndrome. If we also include an elevated arousal index, 80% of the PSGs had abnormal results. Sixty-nine percent of parents reported no sleep problems in their children, but in this group, 54% of PSGs had abnormal results. Of the parents who reported sleep problems in their children, only 36% had abnormal sleep study results. CONCLUSION: Because of the high incidence of obstructive sleep apnea syndrome in young children with Down syndrome, and the poor correlation between parental impressions of sleep problems and PSG results, baseline PSG is recommended in all children with Down syndrome at age 3 to 4 years.

Child, Preschool↗

PubMed2006

Relationship between upper airway and inspiratory pump muscle force in obstructive sleep apnea.

BACKGROUND: Upper airway (UA) patency during inspiration is determined by the balance between dilating forces generated by UA dilator muscle activity and collapsing forces related to the decreased intraluminal pressure that accompanies flow generated by inspiratory muscle activity. It is possible that the relative strengths of UA dilator and inspiratory pump muscles could be an important determinant of the susceptibility to UA collapse during sleep (ie, obstructive sleep apnea [OSA]). METHODS: Measurements of tongue protrusion (TP) force and maximum inspiratory pressure (Pimax) were obtained in 94 patients admitted for overnight polysomnography for suspected OSA, quantified by apnea-hypopnea index (AHI). RESULTS: There was a direct linear relationship between TP force and Pimax (r(2) = 0.37, p < 0.001). A high ratio of TP force to Pimax (greater than group 90th percentile, 0.027 kg/cm H(2)O) appeared to protect against OSA, as moderate-to-severe OSA (AHI > 20/h) was not observed in any individual with a ratio above this threshold. AHI was not linearly related to TP force, Pimax, or the ratio of TP force to Pimax. CONCLUSIONS: UA muscle strength is linearly related to inspiratory pump muscle strength. The ratio of UA muscle strength (TP force) and inspiratory pump muscle strength (Pimax) was not different between individuals with and without OSA; however, a high wakeful ratio of TP force to Pimax appears to be associated with a reduced propensity to moderate-to-severe OSA.

Adult↗

PubMed2004

[Correlations between gastroesophageal reflux disease and obstructive sleep apnea].

INTRODUCTION: Several studies have reported an increased prevalence of gastroesophageal reflux disease in patients with obstructive sleep apnea. The increasingly negative intrathoracic and transdiaphragmatic pressure should facilitate of reflux-events during apnea. AIMS: The aim of the present study was to investigate whether there exists a link between endoscopic severity of reflux disease and the parameters of obstructive sleep apnea and the typical symptoms of reflux disease. METHODS: 57 patients with proven obstructive sleep apnea were divided into two groups according to the severity of the sleep apnea: "mild-moderate"--apnea-hypopnea index > or = 5-30, n = 27, "severe"--apnea-hypopnea index > 30, n = 30. All patients underwent upper panendoscopy, apnea monitoring during the night and were asked about existing and frequency of typical reflux symptoms. RESULTS: All examined patients in both groups showed significant overweight and there was a positive correlation between body mass index and the degree of sleep apnea (p = 0.0002). The occurrence of erosive reflux disease was significantly higher in "severe" group (p = 0.0001). Using a logistic regression analysis a positive correlation was found between endoscopic severity of reflux disease and apnea-hypopnea index (p = 0.016). 49.5% of all patients experienced the typical symptoms of reflux disease at least three times a week and there was not significant difference between groups. CONCLUSION: The study reveals that in patients with severe obstructive sleep apnea, erosive reflux disease is more frequent and a positive correlation can be found between severity of reflux disease and sleep apnea as well.

Adult↗

PubMed2003

Role of arousals in the pathogenesis of obstructive sleep apnea.

Arousal is believed to be needed for upper airway opening in obstructive hypopneas-apneas, without compelling evidence to support this notion. The association may be incidental. I studied the temporal relation between arousal and opening and impact of arousal on flow response at opening in 82 patients (apnea-hypopnea index, 46 +/- 35/hour). Obstructive apneas-hypopneas were induced by dial-down of continuous positive airway pressure. Obstructions and hypopneas occurred in 44 and 56% of dial-downs, respectively. When arousal occurred (83% of dial-downs), the temporal relation between arousal and opening was inconsistent between and within patients. Frequency of opening without or before arousal increased with milder obstructions (p < 10(-9)) and with delta power of EEG (p < 10(-6)). Time of opening was unaffected by whether arousal occurred before or after opening (18.0 +/- 9.8 vs. 18.1 +/- 10.5 seconds). Flow response was already excessive when opening occurred without or before arousal (180 +/- 148% of initial flow decline) and was considerably higher when arousal occurred (267 +/- 154%, p < 10(-10)). Flow undershoot after first ventilatory response was greater if arousal occurred (p < 0.01). It is concluded that arousals are incidental events that occur when thresholds for arousal and for arousal-independent opening are close. They are not needed to initiate opening or to obtain adequate flow and they likely increase the severity of the disorder by promoting greater ventilatory instability.

Airway Resistance↗

PubMed1996

[Obstructive sleep apnea in patients with coronary heart disease].

Patients with obstructive sleep apnea have an increased cardiovascular morbidity and mortality, those with co-existent coronary artery disease being particularly at risk. The object of our study was to evaluate the prevalence of obstructive sleep apnea in patients with coronary artery disease. 153 patients (117 men, 36 women) with verified coronary artery disease were given a highly sensitive standardized questionnaire. The 59 patients with pathological results were then checked with a 6-channel non-laboratory monitoring system. 22.2% of all patients had a respiratory disturbance index (RDI) above 5/h. and 14.4% above 10/h. 13.3% had a pathological RDI and additionally suffered from excessive daytime sleepiness. Patients with coronary artery disease have a high prevalence of obstructive sleep apnea and should consequently be screened for this sleep-related breathing disorder.

Aged↗

PubMed1989

Depression as a manifestation of obstructive sleep apnea: reversal with nasal continuous positive airway pressure.

Fifty-five patients with obstructive sleep apnea each completed a Zung Self-Rating Depression Scale (SDS), Twenty-five patients (45%) had SDS scores greater than or equal to 50, consistent with depression. The SDS scores did not correlate with age, the number of respiratory events per hour sleep, antihypertensive medication, or the oxygen saturation baseline or nadir. The group with SDS scores of 50 or greater, however, had 68.0 +/- 8.8 respiratory events per hour compared with 47.9 +/- 4.7 in the group with SDS scores under 50 (p less than .05). Nineteen patients who were treated with nasal continuous positive airway pressure completed a follow-up SDS Inventory. After treatment, the SDS scores fell from 60.5 +/- 1.9 to 44.4 +/- 2.6 (p less than .001) in the 11 patients with baseline elevated scores. The authors conclude that obstructive sleep apnea can produce prominent symptoms of depression that appear to be related to the severity of the underlying apnea; furthermore, treatment of obstructive sleep apnea may result in alleviation of these symptoms in certain patients.

Adult↗

PubMed1994

Acquired laryngomalacia as a cause of obstructive sleep apnea.

We describe a patient who, 4 years after a radical neck dissection and radiotherapy, presented with obstructive sleep apnea; upon bronchoscopy, he was found to have acquired laryngomalacia. Inspiration induced upper airway obstruction due to a large flaccid epiglottis, large aryepiglottic folds, and edema of the supraglottic area. We suggest that acquired laryngomalacia can lead to obstructive sleep apnea. Patients with obstructive sleep apnea after radical neck dissection need to be evaluated for laryngomalacia with fiberoptic laryngobronchoscopy. Examination of the upper airway is useful to determine the nature and extent of any upper airway collapse.

Adult↗

PubMed2003

Sleepiness and residual sleepiness in adults with obstructive sleep apnea.

Sleepiness is a common, but not necessary symptom of the obstructive sleep apnea syndrome (OSA) and is a frequent chief complaint of patients with OSA who seek medical attention. While sleepiness may seem simple in nature, the underlying mechanisms producing daytime sleepiness in OSA are complex and poorly characterized. Moreover, the meaningful assessment of pathological sleepiness is frequently far from straightforward. Effective treatment of OSA is generally expected to resolve or ameliorate daytime sleepiness. An unknown percentage of treated OSA patients, however, remain sleepy during waking hours. The assessment and treatment of residual sleepiness in treated OSA can range from simple to difficult, depending on the nature and causes of the continued sleepiness. Recently, however, data from clinical trials have been generated which provide direction in the evaluation and management of the OSA patient suffering residual daytime sleepiness.

Evaluation Studies as Topic↗

PubMed2006

Changes in dreaming induced by CPAP in severe obstructive sleep apnea syndrome patients.

To study dream content in patients with severe obstructive sleep apnea syndrome (OSAS) and its modification with Continuous Positive Airway Pressure (CPAP) therapy. We assessed twenty consecutive patients with severe OSAS and 17 healthy controls. Polysomnograms were recorded at baseline in patients and controls and during the CPAP titration night, 3 months after effective treatment and 2 years later in patients. Subjects were awakened 5-10 min after the beginning of the first and last rapid eye movement (REM) sleep periods and we measured percentage of dream recall, emotional content of the dream, word count, thematic units, sleep architecture and REM density. Dream recall in REM sleep was similar in patients at baseline and controls (51.5% versus 44.4% respectively; P = .421), decreased to 20% and 24.3% the first and third month CPAP nights, and increased to 39% 2 years later (P = 0.004). Violent/highly anxious dreams were only seen in patients at baseline. Word count was higher in patients than in controls. REM density was highest the first CPAP night. Severe OSAS patients recall dreams in REM sleep as often as controls, but their dreams have an increased emotional tone and are longer. Despite an increase in REM density, dream recall decreased the first months of CPAP and recovered 2 years later. Violent/highly anxious dreams disappeared with treatment. A dream recall decrease with CPAP is associated with normalization of sleep in OSAS patients.

Adult↗

PubMed2005

Headache characteristics in obstructive sleep apnea syndrome and insomnia.

OBJECTIVES: To determine headache characteristics in the obstructive sleep apnea syndrome (OSAS) and in insomnia. PATIENTS AND METHODS: Fifty-six OSAS patients and 50 insomnia patients were assessed in the same time period. Patients in both groups underwent an accurate interview to investigate headache occurrence and its characteristics. Results - Headache was reported by 49% of OSAS patients and 48% of insomnia patients. In OSAS patients headache had most frequently a tension-type pattern. Headache occurred on awakening in 74% of OSAS patients, more frequently than in insomnia patients (40%) (chi(2); P < 0.04). The occurrence of morning headache appears to be significantly correlated with nocturnal oxygen desaturation and OSAS severity. CONCLUSION: Headache is a common finding in both OSAS and insomnia patients. Because morning headache seems to be more specific for OSAS than insomnia, and in OSAS its occurrence seems to be associated with disease severity, we hypothesize the involvement of certain pathogenic mechanisms associated with OSAS.

Adult↗

PubMed2005

Discrepancy in polysomnography scoring for a patient with obstructive sleep apnea hypopnea syndrome.

Overnight polysomnography (PSG) is indispensable for diagnosis of obstructive sleep apnea hypopnea syndrome. However, studies on interscorer agreement on PSG scoring between laboratories are few. The purpose of this study was to examine the reliability of interscorer agreement on PSG scoring among 16 sleep laboratories in Japan. We found a relatively moderate interscorer reliability of the index of oxygen desaturation and arousal during sleep, but a relatively low reliability of the index of transient reduction in and complete cessation of breathing (apnea hypopnea index). The median rate of interscorer coincidence of sleep staging was the lowest for slow wave (deep) sleep (23.5%), followed by those for Stage 1 (59.8%), Wake (73.2%) and Stage 2 (74.2%) in this order, and rapid eye movement was the most reliably identified stage (91.3%). The median rate of interscorer coincidence for all stages was 71.8%. The present study demonstrates that scorers tend to analyze PSG data according to a relatively empirical decision as opposed to a rule-dependent decision. Further detailed scoring manuals are required to decrease the interscorer discrepancy in PSG scoring.

Adult↗

PubMed2004

Hashimoto thyroiditis and obstructive sleep apnea syndrome: is there any relation between them?

Hashimoto thyroiditis (HT), which is an autoimmune disease of thyroid gland, has been declared to present with concomitant several systemic diseases. In this study, the coexistence of the Hashimoto disease with the sleep apnea syndrome has been examined. Seven female patients (33-66 year of age) with Hashimoto thyroiditis were evaluated for sleep apnea syndrome. The diagnosis of Hashimoto disease was based on the high titers of anti-thyroid antibodies and histological findings. None of the patients had any complaints of sleep disturbances. Seven healthy subjects with similar age and sex characteristics were taken as the control group. All the patients and the control subjects were undertaken a full polysomnography (PSG). Five patients with HT showed the characteristics of obstructive sleep apnea syndrome (one severe, one moderate and three mild OSAS), whereas no sleep breathing disturbance was found in the control group. These findings suggest that sleep related breathing problems may develop in the patients with autoimmune thyroiditis even if they are euthyroid.

Adult↗

PubMed2000

[Obstructive sleep apnea syndrome in infants and children].

Obstructive sleep apnea syndrome (OSAS) is characterized by prolonged, generally partial, upper airway obstruction associated with hypoxemia and/or hypercapnia. Main etiological factors include hypertrophy of the tonsils and adenoids, craniofacial abnormalities with reduction in the upper airway caliber, abnormality of neural upper airway control, or a combination of these factors. Symptoms depend on age, but they always include snoring and breathing difficulties during sleep. Diagnosis of OSAS must be established early in order to prevent complications. It is suspected on history, physical examination and investigative confrontation such as nasofibroscopy and imaging. Polysomnography is the gold standard for diagnosis, scoring of the obstruction and distinction between primary snoring and obstructive breathing. Adenotonsillectomy is an effective therapy. For selected patients, craniofacial surgery may be helpful. Some children require continuous positive airway pressure or the nasopharyngeal tube. Tracheotomy is rarely indicated.

Adult↗

PubMed2002

[Variability of the treatment pressure under continuous positive airway pressure treatment in obstructive sleep apnea syndrome].

BACKGROUND: Selfadjusting CPAP therapy is mostly employed if constant CPAP does not sufficiently suppress respiratory disturbances or is not accepted by the patient. The number of respiratory disturbances and thus the pressure need varies with sleep stages and body position during sleep. However, the analysis of the pressure profile during automatic CPAP therapy indicates a relevant variability of treatment pressure which is independent of the above mentioned criteria. Therefore, we aimed to quantify the pressure variability and its significance in patients with obstructive sleep apnea syndrome (OSAS). METHODS: We analysed the pressure profile during a six-week treatment period with selfadjusting CPAP therapy based on the measurement of the impedance (APAP FOT ). The variability index (VI) was calculated from the deviations of the treatment pressure from the mean pressure. The variability was considered to be low and clinically irrelevant if the VI did not exceed 0.75 as a mean value and in more than 10 % of the nights. PATIENTS: 20 patients (male 19, age 55.5 +/- 10.9 years, BMI 36.6 +/- 26.5 kg/m (2), AHI 36.9 +/- 21.3/h) who were treated with APAP FOT because of intolerance or inefficiency of constant CPAP. RESULTS: The VI was 0.9 +/- 0.7 (range 0.27 +/- 0.05 to 1.95 +/- 0.83). The number of nights with a figure >/= 0.75 reached 17.6 +/- 13.8 (range 0 - 40). In 50 % of the patients the mean VI was lower than 0.75. However, in 7 of these 10 patients the VI exceeded 0.75 in more than 10 % of the nights (4 - 15). Only 3 of 20 patients fulfilled both criteria of pressure stability. The VI showed a significant correlation with P mean (r: 0.66, p < 0.001). CONCLUSIONS: In most patients with difficult-to-treat OSAS a variability of the treatment pressure can be found.

Automation↗

PubMed2005

Portable monitoring in the diagnosis of the obstructive sleep apnea syndrome.

Portable monitors are classified into three levels (Level II, III, and IV) with decreasing measurements of sleep and respiratory variables. A full overnight sleep study with respiratory measurements and sleep staging (polysomnography) unattended by a sleep technician is Level II, three or more respiratory channels and heart rate generally without sleep staging either attended or unattended is Level III, and one or two channels attended or unattended, usually including oximetry, is Level IV. To date, some Level III portable monitors appear to have sufficient specificity to diagnose the obstructive sleep apnea (OSA) syndrome but are not sufficiently sensitive to exclude OSA. Attended portable monitoring appears to provide better sensitivity and specificity than unattended portable monitoring and is an option for diagnosis of OSA. The role of portable monitoring is evolving but at this time cannot substitute for attended polysomnography as a standalone approach. The exact place of portable monitoring and the cost-benefit depends on local circumstances and cannot be generalized at this time.

Cost-Benefit Analysis↗

PubMed2006

Adherence to continuous positive airway pressure treatment in patients with Alzheimer's disease and obstructive sleep apnea.

OBJECTIVE: This analysis examined whether patients with Alzheimer disease (AD) tolerate continuous positive airway pressure (CPAP). METHOD: Thirty patients with AD were randomized to CPAP or sham CPAP and completed sleep, depression, and quality-of-life questionnaires. Participants could choose to continue treatment after the trial. RESULTS: Patients wore CPAP for 4.8 hours per night. More depressive symptoms were associated with worse adherence (rS=-0.37; N=30, p<0.04). Patients who continued using CPAP had fewer depressive symptoms (t [19]=2.45, p=0.02) and better adherence (t [19]=2.32, p=0.03) during the trial. CONCLUSION: Patients with AD with obstructive sleep apnea can tolerate CPAP. Adherence and long-term use may be more difficult among those patients with more depressive symptoms.

Adult↗

PubMed1985

Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome.

Although right heart failure is a recognized complication of obstructive sleep apnea, the incidence and pathogenesis of this complication have not been established. We therefore studied 50 consecutive patients with obstructive sleep apnea to determine the incidence of right heart failure and the factors involved in its development. Six patients (12%) were found to have right heart failure. There were no differences in the number of apneas between those with right heart failure (mean +/- SE, 30 +/- 10 per h sleep) and those without right heart failure (33 +/- 4 per h sleep). In contrast, mean nocturnal oxygen saturation was lower in patients with right heart failure (76 +/- 3%) than in those without right heart failure (90 +/- 1%; p less than 0.001). Furthermore, patients with right heart failure also had a substantially lower awake arterial PO2 (52 +/- 4 mmHg versus 75 +/- 2 mmHg; p less than 0.001) and a higher PCO2 (51 +/- 2 mmHg versus 36 +/- 1 mmHg; p less than 0.001) than those without right heart failure. Severe nocturnal hypoxemia in the absence of diurnal hypoxemia was not associated with right heart failure. Daytime hypoxemia in the patients with right heart failure was associated with a higher residual volume (p less than 0.001) and lower forced expiratory volume in one second (p less than 0.001) than in the patients without right heart failure. The findings suggest that sustained hypoxemia and/or hypercapnia over a 24-h period is a necessary prerequisite for the development of right heart failure in patients with obstructive sleep apnea, and that diffuse airway obstruction plays a major role in causing such hypoxemia.

Circadian Rhythm↗

PubMed1998

Preoperative, intraoperative, and postoperative management of patients with obstructive sleep apnea syndrome.

The patient with untreated, obstructive sleep apnea may present difficult or potentially life-threatening challenges to the surgical team. This is true even if the anticipated surgery is remote to the upper airway. Preoperative recognition of the obstructive apnea is essential as the first step in preventing potential complications. When recognized, intraoperative and postoperative initiative can result in a satisfactory outcome.

Cephalometry↗