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PubMed2004

Occupational screening for obstructive sleep apnea in commercial drivers.

Excluding the presence of obstructive sleep apnea in commercial drivers is valuable, as the syndrome may increase their risk of sleepiness-related accidents. Using polysomnography as the criterion standard, we prospectively compared accuracies of five strategies in excluding the presence of severe sleep apnea and, secondarily, any sleep apnea among 406 commercial drivers. These strategies were as follows: (1) symptoms; (2) body mass index; (3) symptoms plus body mass index; (4) a two-stage approach with symptoms plus body mass index for everyone, followed by oximetry for a subset; and (5) oximetry for all. For excluding severe apnea, the two-stage strategy was highly successful, with 91% sensitivity and specificity, and a negative likelihood ratio of 0.10. This strategy was comparable in accuracy to oximetry, which had a negative likelihood ratio of 0.12, and was 88% sensitive and 95% specific. If we avoided oximetry altogether, then symptoms together with body mass index were 81% sensitive and 73% specific, with a negative likelihood ratio of 0.26. On the other hand, excluding any apnea could not be done with reasonable accuracy unless oximetry was used. We conclude that two-stage screening is likely to be a viable means of excluding severe sleep apnea among commercial drivers.

Adult↗

PubMedDate not supplied

Clinical versus electrophysiological assessment of dysautonomia in obstructive sleep apnea syndrome.

To assess the autonomic system in obstructive sleep apnea syndrome (OSAS), the sympathetic skin response (SSR) and the R-R interval variation (RRIV) tests were studied in 34 OSAS patients and in 32 healthy controls. The aim of the study was to evaluate the sympathetic and parasympathetic system function in OSAS, to define the pattern of autonomic abnormalities found in SSR and RRIV in patients, and to analyze the usefulness of both tests in paraclinical assessment of the dysautonomia, compared with clinical symptoms and signs of autonomic nervous system involvement. The correlations between both autonomic tests results were also studied. In OSAS patients, SSR test results were abnormal in about 44% and RRIV results were abnormal in about 21% of patients. The mean values of parameters studied in SSR were significantly different in OSAS patients and controls (P < 0.05), whereas the differences between RRIV results were less important. The SSR and RRIV results in patients with mild apnea (Apnea/ Hypopnea Index (AHI) < 15) were more frequently within normal limits if compared with those of patients with severe apnea, but without reaching statistical significance. The clinical studies results (according to the Autonomic Symptoms Questionnaire) were related to the SSR results (p < 0.05 on chi and Fisher exact test). According to these results, SSR and RRIV are simple paraclinical electrophysiologic tests that confirm clinical dysautonomia. They may be useful as screening tests for assessment of dysautonomia in OSAS.

Adult↗

PubMed2002

Adhesion molecules in patients with coronary artery disease and moderate-to-severe obstructive sleep apnea.

STUDY OBJECTIVES: It has been suggested that obstructive sleep apnea (OSA)-induced hypoxic stress might contribute to cardiovascular disorders by promoting expression of soluble adhesion molecules. The reported increase of circulating adhesion molecules in patients with OSA remains controversial because confounders such as cardiovascular risk factors and left ventricular function have not been adequately controlled for. We hypothesized that soluble intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1, L-selectin, and E-selectin levels are correlated with OSA independent of coexisting coronary artery disease (CAD). SETTINGS: University-affiliated teaching hospitals. DESIGN AND PARTICIPANTS: A prospective study of 61 consecutive subjects with angiographically proven CAD deemed to have stable angina. INTERVENTIONS: Fifteen patients (mean +/- SD) 61.2 +/- 1.9 years old with moderate-to-severe OSA (apnea-hypopnea index [AHI] > or = 20/h) were matched to a control group (AHI < or = 5/h) for age, gender, body mass index, and severity of CAD. Venous blood samples were collected the morning of the sleep study and assayed for human ICAM-1, VCAM-1, L-selectin, and E-selectin with commercially available enzyme-linked immunosorbent assay kits. RESULTS: All but L-selectin were significantly increased in the OSA group compared to the control subjects (ICAM-1, 367.4 +/- 85.2 ng/mL vs 252.8 +/- 68.4 ng/mL, p = 0.008; VCAM-1, 961.5 +/- 281.7 ng/mL vs 639.1 +/- 294.4 ng/mL, p = 0.004; E-selectin, 81.0 +/- 30.4 ng/mL vs 58.1 +/- 23.2 ng/mL, p = 0.03, respectively). The increased levels of adhesion molecules correlated with the AHI and the oxygen desaturation index but not with the severity of hypoxemia or the frequency of arousals. CONCLUSIONS: These findings suggest that OSA modulates the expression of proinflammatory mediators. Further studies should evaluate the influence of adhesion molecules on cardiovascular outcome in CAD patients with OSA.

Cell Adhesion Molecules↗

PubMed2002

An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome.

BACKGROUND: For the treatment of nonsevere obstructive sleep apnea syndrome (OSAS), mandibular advancement devices (MADs) are employed as an alternative to nasal continuous positive airway pressure (CPAP) therapy. However, very few specific data on the effectiveness of MADs in this group of patients are available. We therefore compared an individually adjustable intraoral sleep apnea device (ISAD) that permits movements of the lower jaw in three dimensions, with CPAP in the treatment of patients with an apnea/hypopnea index (AHI) < or = 30/h. METHODS: In a randomized crossover study, 16 men and 4 women (mean +/- SD age, 56.5 +/- 10.2 years; body mass index, 31.2 +/- 6.4; AHI, 17.5 +/- 7.7/h) were treated for 6 weeks with each modality. RESULTS: In the initial phase, a significant improvement in AHI (baseline, 17.5 +/- 7.7/h; ISAD, 10.5 +/- 7.5/h [p < 0.05]; CPAP, 3.5 +/- 2.9/h [p < 0.01]) and in breathing-related arousals (baseline, 8.9 +/- 6.1/h; ISAD, 3.7 +/- 3.3/h [p < 0.01]; CPAP, 1.4 +/- 1.6/h [p < 0.01]) was achieved with both modalities. Considering all 20 subjects, after 6 weeks of treatment, normalization of the respiratory parameters was seen only with CPAP. However, 30% of the patients had a lasting reduction in AHI to < 10/h with the ISAD also. The patients considered the ISAD to be easier to use (scale of 1 to 6: ISAD, 1.8 +/- 1.1; CPAP, 3.1 +/- 1.5 [p < 0.05]), and indicated greater utilization of the device in comparison with CPAP. CONCLUSION: Even in patients with mild-to-moderate OSAS, CPAP is the more effective long-term treatment modality. In the individual case, the better compliance seen with the ISAD may be advantageous.

Cross-Over Studies↗

PubMed2004

[Dermatoglyphics and body composition in obstructive sleep apnea].

Obesity is the main risk factor for obstructive sleep apnea syndrome (OSAS) and genetic patterns can modulate the pathogenesis of the disease. The aim of this study is to describe the anthropometrics and dermatoglyphics features among OSAS carriers. We collected information on Body Mass Index (BMI), Conicity Index (CI), Body Fat Mass (BFM), somatotype and fingerprints. Thirty-one cases of OSAS were compared to an equal number of controls. Membership to the obese category is based on observed BMI and BFM. The CI distribution among cases shows a strong central obesity component. The endomorph-mesomorph somatotype category predominates among cases showing high adiposity and relative muscle-skeletic development, such as relative linearity of great mass per unit of height. Increased morbidity, as given by more serious indices of apnea, correlates positively with higher mesomorphic predominance in the body composition. Analysis of dermatoglyphic data does not show significant statistical differences between OSAS--patients and controls.

Body Composition↗

PubMed2004

Obstructive sleep apnea: Part I. Pathophysiology, diagnosis, and medical management.

Obstructive sleep disordered breathing (OSDB) is a spectrum of disease resulting from changes in the upper airway. It affects a large proportion of the adult population, and in its most severe form, obstructive sleep apnea syndrome (OSAS), patients suffer the adverse effects of sleep disturbance and oxygen desaturation. Daytime somnolence leads to a significantly higher incidence of automobile and work-related accidents, while nocturnal hypoxia is associated with multiple physiological derangements. Patients with OSAS have higher incidences of hypertension, coronary artery disease, congestive heart failure, and arrhythmias. Noninvasive testing is used to confirm the diagnosis, and treatment may be conservative, medical, or surgical. Treatment is designed to improve daytime somnolence and has been shown to improve morbidity and mortality among patients with OSDB.

Adult↗

PubMed2000

Long-term follow-up of obstructive sleep apnea syndrome following surgery in children and adults.

Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent apneas during sleep, resulting in repetitive hypoxemia. The present study retrospectively analyzed subjective and objective assessments of the patients with OSAS in a relatively long-term follow-up. From February 1986 to August 1996, 53 patients received surgical treatment for OSAS and snoring. Thirty-seven (27 males and 10 females) out of 53 patients completed the questionnaire and postoperative sleep study was obtained in 6 patients. In 20 children (<15 years), snoring, sleep apnea, and daytime sleepiness completely disappeared in 12, 19, and 16, and improved in 8, 1, and 4, respectively. These findings confirm that tonsillectomy and/or adenoidectomy in children may be the first selection for treatment. In 17 adults, snoring, sleep apnea, and daytime sleepiness completely disappeared in 2, 5, and 8, improved in 11, 8, and 7, and was unchanged in 4, 4, and 1, respectively. The apnea index in adults was significantly decreased in both early and late postoperative periods. These results suggest that surgery is a satisfactory alternative for adult patients if performed accurate preoperative diagnosis of the localization of the airway collapse and careful long-term follow-up.

Adenoidectomy↗

PubMed2000

Obstructive sleep apnea syndrome: differences between children and adults.

The obstructive sleep apnea syndrome is a common cause of morbidity in childhood. The clinical presentation, pathophysiology, polysomnographic characteristics and treatment differ between children and adults. Measurements of the upper airway pressure-flow characteristics can be useful in evaluating upper airway function in patients with OSAS as well as the normal population.

Adenoids↗

PubMed2002

[Obstructive sleep apnea: clinical significance and correlations with arterial hypertension].

Obstructive sleep apnea (OSA) occurs rather frequently. It often combines with arterial hypertension (AH) and contributes to development and course of such severe conditions as stroke, myocardial infarction, arrhythmia, sudden death in sleep. Lack of adequate knowledge of relevant symptoms, cause-effect relationships leads to mistakes in management of patients. AH patients with OSA should receive combined treatment including hypotensive drugs and correctors of sleep respiratory disorders.

Antihypertensive Agents↗

PubMed2000

[The upper airway MRI of obstructive sleep apnea patients].

OBJECTIVE: To investigate the mechanisms of obstructive sleep apnea syndrome(OSAS) through observing the upper airway caliber and its corresponding pharyngeal wall of OSAS patients by MRI. METHODS: The upper airway(UA) of 18 OSAS patients were examined by MRI. The cross-sectional area of the UA and lateral parapharyngeal fat pad (LPFP) were calculated. The thickness of lateral and posterior pharyngeal wall (LW & PW) and other related indices were also measured. Nineteen nonsnoring age-matched normal subjects were selected as the control group. RESULTS: 1. The retropalatal (RP) and retroglossal (RG) region UA cross-sectional areas of OSAS patients were smaller than that of the control (P < 0.05). The epiglottal (EPC) region UA cross-sectional area was not significantly different between the 2 groups (P = 0.204). 2. The anterior-posterior/Lateral ratio(A-P/L) of UA in RP, RG, EPG regions was bigger in patients group than that of the control (P < 0.05). 3. The cross-sectional area of LPFP in patients group was larger than that of the control group (P = 1.76E-7). 4. The thickness of the PW in the RP, RG and EPG region was thicker in patients group than that of the control (P < 0.05). Although the thickness of the LW in the RP region was not statistically different between the 2 groups (P = 0.94), this index in RG and EPG region was larger in patients group than that of the control (P = < 0.05). 5. Sagittal MRI image showed that the length, thickness and cross-sectional area of the palate in patient group was larger than that of the control (P < 0.01). CONCLUSIONS: The study suggests that the pathogenesis of OSAS is related to the following factors: UA caliber and its AP/L ratio, the thickness of LW and PW, the size of LPFP in RP region, and the size and length of the palate.

Adult↗

PubMed2001

[Study on the right cardiac structure and function in patients with obstructive sleep apnea syndrome].

OBJECTIVE: To investigate the effect of obstructive sleep apnea syndrome(OSAS) on the right cardiac structure and function. METHODS: The right cardiac structure and function were measured by using M-mode and two-dimension echocardiography in 30 OSAS patients. RESULTS: In moderate and severe OSAS groups, the right ventricular end diastolic volume (RVEDV), stroke volume (SV) and right pulmonary artery inner diameter (RPAD) increased markedly, and the E/A of the right ventricular decreased in the meantime as compared with the control group. CONCLUSION: OSAS not only effects the right cardiac structure, but also the right cardiac systolic and diastolic function.

Adult↗

PubMed2005

[Obstructive sleep apnea syndrome, endothelial dysfunction and coronary atherosclerosis].

In obstructive sleep apnea syndrome (OSAS), repetitive episodes of apnea cause increased sympathetic nerve activity, increased surges in arterial blood pressure, swings in intrathoracic pressure, oxidative stres, hypoxia and hypercapnia. The association of OSAS with some diseases, having endothelial dysfunction in their physiopathology, such as hypertension, diabetes mellitus, obesity, coronary artery diseases, stroke and heart failure is common. Increased sympathetic nerve activity and also endothelial dysfunction which are the results of hypoxia, have important roles in vascular complications of OSAS. When compared with healthy population, an important endothelial dysfunction in OSAS patients and relationship between OSAS severity and endothelial dysfunction have been shown. In this review, the relationship between OSAS and endothelial dysfunction was overviewed.

Coronary Artery Disease↗

PubMed2026

Obstructive sleep apnea and long-term risk of site-specific cancers: A population-based cohort study.

BACKGROUND: Obstructive sleep apnea is common, but its long-term association with site-specific cancers remains unclear. In this study, we examined 15-year risks of site-specific cancers in people with obstructive sleep apnea compared with the general population and to people with overweight or obesity. METHODS: We conducted a nationwide population-based cohort study using Danish registries, 1995-2021. People diagnosed with obstructive sleep apnea were compared with the general population and to people with overweight or obesity. Adjusted (weighted) 15-year risks, risk differences, and risk ratios (RRs) were estimated using the Aalen-Johansen estimator. Confounding was addressed using standardized morbidity ratio weighting. RESULTS: The study included 114,264 people with obstructive sleep apnea, 115,497 members of the general population, and 113,034 with overweight or obesity. After weighting, the distributions of sex (74% male), age (median 53 years), and comorbidities were comparable across the three cohorts. Obstructive sleep apnea was associated with an increased risk of cancers of the brain (adjusted 15-year risk: 5.78 vs. 3.61 per 1,000 persons; aRR 1.60 [95% CI 1.43-1.78]) and spinal cord (1.65 vs. 1.17 per 1,000 persons; aRR 1.41 [95% CI 1.16-1.72]) compared with the general population. Associations persisted when the obstructive sleep apnea cohort was compared with those with overweight or obesity. No associations were observed for other site-specific cancers. CONCLUSION: Obstructive sleep apnea was associated with an increased risk of brain and spinal cord cancers. These findings highlight the importance of effective prevention of obstructive sleep apnea and the need for further research on treatment.

Cohort Study↗

PubMedDate not supplied

Reversible obstructive sleep apnea and right heart failure due to massive tonsillar hypertrophy.

Obstructive sleep apnea is a relatively common but under diagnosed clinical entity in children. Adenotonsillar hypertrophy is the most common cause for upper airway obstruction in pediatric patients. If the obstruction to upper airways is not relieved, then the child can develop obstructive sleep apnea and its consequences. Treatment is simply to remove the obstruction thereby restoring patency of upper airways.

Cardiac Catheterization↗

PubMed1999

Surgical management of obstructive sleep apnea in children with cerebral palsy.

OBJECTIVES: To evaluate the surgical management of obstructive sleep apnea in children with cerebral palsy. STUDY DESIGN: Retrospective review of 27 children with cerebral palsy who underwent surgical treatment for obstructive sleep apnea. METHODS: Charts were reviewed. Data gathered included primary complaint, coexisting illnesses, initial procedure performed, age at initial surgery, number of days the child was monitored postoperatively in the intensive care unit, notation of postoperative respiratory distress and management, and outcome. RESULTS: Nineteen children underwent adenotonsillectomy for initial treatment of obstructive sleep apnea. Three of these children also had a uvulectomy. Six children had an adenoidectomy alone as their initial procedure. Neither uvulopalatopharyngoplasty nor tracheostomy was performed as an initial procedure. Mean follow-up was 34 months. Seventy-six percent of these children have not required any further surgery. Of the six children who have undergone further surgery, one has required a revision adenoidectomy, and another underwent a tonsillectomy and uvulectomy 2 months after the initial adenoidectomy. Four children ultimately required a tracheotomy. CONCLUSIONS: Eighty-four percent of these children were successfully managed without a tracheotomy. We recommend tonsillectomy and/or adenoidectomy for initial surgical treatment of obstructive sleep apnea in children with cerebral palsy.

Adenoidectomy↗

PubMed1991

Snoring and obstructive sleep apnea.

Evidence shows that snoring and obstructive sleep apnea have significant negative physiologic consequences. These patients should be treated expeditiously once the diagnosis is made and carefully followed to ensure that improvement is maintained.

Humans↗

PubMed1997

Pressure-heart rate responses to alpha-adrenergic stimulation and hormonal regulation in normotensive patients with obstructive sleep apnea.

Seven normotensive untreated patients with obstructive sleep apnea (OSA) and five control subjects without OSA were compared. Patients with cardiac dilation, chronic airflow limitation, liver and kidney disease, or diabetes mellitus were excluded. Change in pressure-heart rate relation to alpha-adrenergic stimulation (P-HRR), extracellular volume (ECV), and plasma volume (Vp) were measured during daytime. Plasma atrial natriuretic peptide (ANP), plasma renin and aldosterone concentrations were obtained at 1 hour intervals during the night. A mean apnea/hypopnea index (AHI) of 52.2 +/- 23.9/h and a mean lowest arterial oxygen saturation (SaO2) of 61.2 +/- 19.3% (mean +/- SD) were determined from polysomnographic monitoring in the patient group. Release of ANP was significantly higher during sleep in OSA patients than in control subjects (P < .01), with a maximum concentration between 4 and 6 AM in the former. Daytime ECV was significantly higher (P < .05) and Vp significantly lower (P < .05) in OSA patients. Night maximum concentration of ANP (max ANP) was negatively related to AHI (P < .05). P-HRR was negatively related to AHI (P < .05) and positively related to max ANP (P < .05). In conclusion, OSA syndrome alters hormonal system control of body fluid compartment regulation. The decreased response in night max ANP secretion in the most severe OSA patients could be explained by the smaller Vp observed in these patients, decreasing atrial and ventricular pressure loading. Furthermore, alteration of P-HRR, correlated to AHI and max ANP, strengthens the hypothesis that patients who develop hypertension are those in whom the protective mechanism of ANP release failed.

Adrenergic alpha-Agonists↗

PubMedDate not supplied

The behavioral morbidity of obstructive sleep apnea.

The behavioral morbidity associated with obstructive sleep apnea (OSA) includes symptoms of excessive daytime sleepiness (EDS), neurocognitive deficits, psychological problems, and possibly an increased chance of accidents. EDS is among the most frequently reported symptoms in patients diagnosed with OSA. The available data suggest that the primary cause of EDS is sleep fragmentation. The subjective measures of sleepiness include the sleep wake activity inventory and the epworth sleepiness scale. Sleepiness can also be evaluated objectively in the sleep laboratory using the multiple sleep latency test or the maintenance of wakefulness test. The neurocognitive manifestations of OSA include impairments in vigilance, concentration, memory, and executive function. There is no agreed on consensus as to how to best quantify neurocognitive deficits in this population. Symptoms consistent with depression or personality changes have also been described, but are likely to be correlates of EDS and/or the chronicity of the disorder. Manifestations of the behavioral morbidity of OSA are reversible, but dependent on the degree of normalization in sleep-disordered breathing and the individual's sleep habits.

Accidents, Traffic↗