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Results for “Sleep Apnea, Obstructive”

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PubMed1999

Oral and maxillofacial surgery for the management of obstructive sleep apnea syndrome.

The initial reports of treating obstructive sleep apnea using the uvulopalatopharyngoplasty were encouraging; however, as further trials of this procedure were reported, it began to show disappointing results. It was found that the retropalatal airway was not the only site of obstruction and procedures would need to be developed that would address obstruction in the other portions of the airway involved, notably in the retrolingual or hypopharyngeal portion of the airway. It was first reported by oral surgeons that mandibular surgery could also improve sleep apnea and through their work and the work of others, techniques have been developed using skeletal surgery to enhance the patency of the airway during sleep. This article describes some of these techniques and their indications, complications, and results.

Humans↗

PubMed2002

[Importance of routine examinations in patients with obstructive sleep apnea syndrome].

BACKGROUND AND OBJECTIVE: In patients with obstructive sleep apnea syndrome (OSAS) there is an increased comorbidity of internal diseases such as hypertension, coronary heart disease, chronic obstructive pulmonary disease and endocrine diseases. We analyzed prospectively frequency and consequences of pathological results in routine examinations of internal medicine in sleep laboratory. METHODS: 250 patients with OSAS underwent routine bodyplethysmography, blood- gas analysis, electrocardiogram and laboratory studies after anamnesis and clinical examination. Prior to this we indicated, whether we based on history and physical examination deemed any of these examinations necessary. Frequency and kind of pathological results as well as the consequences were analyzed. RESULTS: 129 results of bodyplethysmography and blood-gas analysis were pathological (51.6 % of all investigations), most frequently hypoxemia (22 %) and obstructive pattern (16.4 %). Further steps were necessary in 19 patients (7.6 %); the indication was seen before in 13 patients, therefore 6 results with consequences (2.4 %) were not expected. Laboratory studies were abnormal in 133 patients (53.2 % of all investigations), most of them hyperglycaemia (26.8 %) and elevated liver enzymes (20.4 %). 29 results (11.6 %) had consequences, of which 16 (6.4 %) were not expected. 82 electrocardiograms were pathological (32.8 % of all investigations), presenting most frequently as coronary heart disease (21.2 %). Further steps were necessary in 5 patients (2 %), while that was not expected in 3 patients (1.2 %). CONCLUSIONS: Routine examinations of internal medicine in patients with OSAS frequently present pathological results, which seldom have further consequences. As most of the important results can be predicted by history and clinical investigation, pathological by chance diagnoses are rare. With the exception of blood sugar tests routine examinations for patients with OSAS should be considered critically.

Blood Gas Analysis↗

PubMed2000

Detection of obstructive sleep apnea by analysis of phase angle using the forced oscillation signal.

Pharyngeal collapse in patients with obstructive sleep apnea syndrome (OSAS) is linked to decreased upper airway muscle activity. We hypothesised that decreased muscle activity causes decreased stiffness of the upper airway wall and assumed that a decrease in wall stiffness would result in a change point (CP) of the morphology of phase angle time series phi(t) obtained by forced oscillation technique (FOT). We developed an algorithm to detect CPs in φ(t) and investigated phi(t) data measured in parallel to all-night polysomnography in seven patients. A total of 2724 CPs were detected by algorithm. The CPs were marked on the polysomnograms and compared with polysomnogram scoring performed jointly by three sleep expert physicians. A total of 791 (67%) of the 1172 handscored respiratory events showed a CP in phi(t) within a time interval of 8 sec before and 6 sec after the marked onset. A total of 672 (57%) respiratory events were detected at an earlier time by algorithm, and 119 (10%) were algorithmically detected later. The average detection time by the CP algorithm was 4.0+/-1.1 sec earlier than the manual scoring. We conjecture that a CP in phi(t) indicates a change in upper airway collapsibility and that phi(t) might be a potentially useful parameter for detection of impending upper airway obstruction.

Adult↗

PubMed2003

Multilevel temperature-controlled radiofrequency therapy of soft palate, base of tongue, and tonsils in adults with obstructive sleep apnea.

OBJECTIVES/HYPOTHESIS: The concept of two-level pharyngeal collapse in patients with obstructive sleep apnea is too simplified. Aggressive multilevel surgeries addressing several airway segments, including skeletal surgery, demonstrate improved success rates. STUDY DESIGN: The study aimed to evaluate the safety and efficacy of multilevel radiofrequency application to soft palate, tonsils, and base of tongue in 16 white patients (mean age, 56.9 +/- 11.1 y; mean body mass index, 27.3 +/- 2.6 kg/m2) with obstructive sleep apnea. There was one dropout. Therapeutic effects after one treatment session were assessed 20.6 +/- 12.6 weeks postoperatively. Treatment outcome measurements were based on Epworth Sleepiness Scale, Likert scales, and polysomnography. METHODS: Every patient received 16 treatment sites with a total dose of 9750 J radiofrequency energy into soft palate, base of tongue, and tonsils. Success was defined as respiratory disturbance index equal to or less than 20 or at least 50% improvement if baseline respiratory disturbance index was less than 20. Statistical analysis was determined with the Spearman rank test. RESULTS: Mean score on Epworth Sleepiness Scale decreased from 11.1 to 8.2 (P =.0001). Of the patients, 53.3% reported improvement of their daytime sleepiness. Snoring was assessed with 10-point Lickert scale, and score decreased from 7.5 to 4.9 (P =.08). Mean respiratory disturbance index decreased from 32.6 +/- 17.4 to 22.0 +/- 15.0 (P =.003). By our definition of success, 5 of 15 patients (33%) have been treated successfully surgically and 4 of 15 (27%) had remarkable improvement after one treatment session; 1 patient (6.6%) demonstrated deterioration. There were two adverse effects, one superficial ulceration of the soft palate and one unilateral tonsillar abscess formation, with an overall complication rate of 13.3% for our patients and 0.41% for all treatment sites (n = 240). CONCLUSION: Moderate to severe obstructive sleep apnea usually requires multilevel pharyngeal surgery. Radiofrequency offers the potential of altering the upper airway on different sites.

Adult↗

PubMed2002

Histopathology of the uvula and the soft palate in patients with mild, moderate, and severe obstructive sleep apnea.

OBJECTIVE: To study morphometric and qualitative histopathologic changes of the soft palate and uvula in patients with mild, moderate, and severe obstructive sleep apnea. STUDY DESIGN: A prospective, nonrandomized controlled study. METHODS: The distal soft palate and uvula were excised during uvulopalatopharyngoplasty from 34 male patients with obstructive sleep apnea. Control specimens were retrieved from 7 male cadavers with no related disorders. All specimens underwent routine processing and the mid-sagittal sections were studied. Morphometric analysis of the relative proportions of the tissue constituents was carried out. Also, a qualitative assessment was performed to detect possible pathologic changes. RESULTS: The body mass index of patients was significantly higher from that of control subjects. The area fraction occupied by the tissue constituents of the distal portion of the soft palate and uvula in patients with mild, moderate, and severe obstructive sleep apnea and in control subjects was similar, with small and insignificant differences regarding the contents of glands, muscle, fat, blood vessels, and the epithelium. Only the connective tissue was significantly greater in patients with moderate obstructive sleep apnea than in those with severe obstructive sleep apnea and control subjects. The qualitative assessment of the specimens disclosed normal tissue architecture without evidence of destruction. Vascular engorgement, fibrosis, edema, inflammatory cell infiltration, and dilated glandular ducts were observed in a portion of patients and control subjects. CONCLUSIONS: The structure of the distal soft palate and uvula of patients with obstructive sleep apnea undergoes insignificant changes and is independent of the body mass index levels, indicating that the pathologic changes are probably the sequela of airway obstruction rather than its cause.

Adult↗

PubMedDate not supplied

[Influence of nocturnal hypoxemia on the function of the visual tract in the course of the obstructive sleep apnea syndrome].

BACKGROUND AND PURPOSE: In patients with obstructive sleep apnea (OSA) syndrome the episodes of upper airway obstruction lead to hypoxemia during sleep. The aim of the study was to establish the influence of sleep hypoxemia on the function of the visual tract in OSA patients. MATERIAL AND METHODS: The latency and amplitude of wave P100 of visual evoked potentials have been studied in 35 patients with OSA syndrome (mean apnea index 48+/-19). The diagnosis of OSA was established on the basis of continuous recordings of the respiratory function during sleep with additional full polysomnography in 17 patients. RESULTS: Mean absolute latency of P100 was longer in OSA patients than in healthy controls (117.0+/-8.8 ms vs. 104.3+/-4.6 ms, p<0.001). The differences in the amplitude of P100 were not significant (5.9+/-2.6 mV in OSA patients and 7.62+/-3.04 mV in healthy persons). In 60% of patients the latency of P100 exceeded 118 ms; in this group of patients the mean SaO2 during sleep apneas was lower than in patients with normal P100 latency (46+/-15% vs. 69+/-10%, p<0.05). Full polysomnographic studies revealed that in patients with prolonged latencies as compared with patients with normal P100 latencies there were lower: minimal SaO2 during NREM sleep (63+/-12% vs. 78+/-8%, p<0.05), as well as mean and minimal SaO2 during REM sleep (53+/-15% vs. 80+/-5% and 46+/-15% vs. 69+/-10%, p<0.05), without differences in apnea index or apnea duration. CONCLUSIONS: In patients with OSA syndrome the electrophysiological abnormalities suggesting damage of the optical tract may develop probably as a consequence of profound sleep hypoxemia.

Adult↗

PubMed1995

Obstructive sleep apnea. Trends in therapy.

The National Commission on Sleep Disorders Research, in its report to Congress, concluded that the primary care community generally does not understand sleep disorders. Obstructive sleep apnea carries a risk of substantial morbidity and mortality. Excessive daytime sleepiness results from fragmented sleep and microarousals associated with apneic events. It causes poor work performance and increases the incidence of automobile accidents due to driving while drowsy. The commission estimates that the loss of productivity in the United States from excessive daytime sleepiness is more than $20 billion per year. Obstructive sleep apnea is strongly associated with hypertension, myocardial infarction, and stroke. Risk factors for obstructive sleep apnea include male sex, obesity, older age, craniofacial anomalies, and familial risk. Treatment is based on documenting the disorder by polysomnography. Medical management of the syndrome includes weight loss and nasal continuous positive airway pressure. A network of follow-up and support is necessary to maintain compliance. Surgical treatment is reserved for those for whom nasal airway pressure treatment fails. A surgical protocol is presented that demonstrates efficacy equal to nasal airway pressure treatment. Primary care physicians should assume the responsibility of identifying patients at risk for obstructive sleep apnea and refer them appropriately.

Humans↗

PubMed1993

[Effect of obstructive sleep apnea on preload of the right heart].

Obstructive sleep apnea (OSA) is characterized by a total inspiratory occlusion of the extrathoracic airways with persisting respiratory effort. During obstructive breathing efforts the intrathoracic pressure (ITP) falls below-20 Torr. This should augment venous return by depleting the blood from the extrathoracic veins into the thoracic veins, thus pre- and afterload of the right heart rises. Until now preload of the right heart during OSA was not measured. This study shows the filling pressures (tmPRA) of the right heart during OSA. In five patients the in- and expiratory right atrial pressure and the intrathoracic pressure were measured, beat by beat, during the non REM hour in which the most apnea episodes occurred. The tmPRA values were calculated as follows: tmPRA = PRA-ITP. The rising tmPRA with falling ITP shows that the venous return, during apnea episodes, rises mostly unhampered. Only in one patient did a cut-off of the increasing tmPRA occur. This patient showed a flow limitation of venous return. Two more patients developed different trends. One part of the measurements led to a linear increase of tmPRA, the other part shows a plateau up from a certain ITP. In two patients tmPRA increases linearly, in the extreme, with decreasing ITP. This indicates no flow limitation of venous return. The results of this investigation suggest that the protective mechanism of the limitation of venous return, occurring under artificial conditions, does not regularly appear in patients with OSA. This leads to repetitive volume overloads of the right heart.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1986

[Obstructive sleep apnea syndrome in children; an indication for tonsillectomy and adenoidectomy].

A 3-year-old girl with obstructive sleep apnea syndrome associated with tonsillar and adenoid hypertrophy is discussed. Nocturnal sleep registration, 4 months after adeno-tonsillectomy revealed complete arrest of apnea episodes and there was improvement in sleep pattern. In the early detection of obstructive sleep apnea in children a careful history and nocturnal sleep registration are essential. In children, tonsillar and adenoid hypertrophy are the main causes of obstructive sleep apnea.

Adenoidectomy↗

PubMed1984

Electromyographic study of some accessory muscles of respiration in children with obstructive sleep apnea.

To further elucidate the pathogenesis of obstructive sleep apnea (OSA), we recorded sternocleidomastoid (SCM), genioglossal (GG), and abdominal (ABD) muscle activity, using surface electromyograms (EMGs), during 45 polygraphic studies in 39 children referred for possible OSA. For each muscle, an index of electromyographic (EMG) activity was developed, allowing an interpatient regression analysis of EMG amplitude versus highest PACO2 and lowest transcutaneous O2 tension (tcPO2) during sleep. Phasic inspiratory SCM activity was present during more than 50% of sleep time in 16 of 20 patients with OSA versus only 2 of 15 patients without OSA; SCM EMG activity increased with increasing PACO2 (r = 0.45, p less than 0.02) and decreasing tcPO2 (r = 0.51, p less than 0.01). Phasic inspiratory GG activity was present during more than 50% of sleep time in 15 of 18 patients with OSA versus none of 4 without OSA; GG EMG activity increased with increasing PACO2 (r = 0.51, p less than 0.05) and with decreasing tcPO2 (r = 0.60, p less than 0.02). Phasic expiratory ABD activity was present during more than 50% of sleep time in 10 to 20 patients with OSA versus 1 of 12 patients without OSA. These findings suggest the following conclusions: (1) inspiratory (SCM), airway-maintaining (GG), and expiratory (ABD) muscles contract during sleep-related partial airway obstruction in children; (2) augmented GG activity during periods of sleep-related partial airway obstruction suggests that pediatric OSA involves pathogenic mechanisms other than GG hypotonia; (3) expiratory ABD muscle activity suggests that some children with OSA have increased expiratory, as well as inspiratory, airway resistance during sleep.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗

PubMed2005

Acoustic arousal responses in children with obstructive sleep apnea.

Our objectives were to study the arousal responses to nonrespiratory (acoustic) stimuli in children with obstructive sleep apnea syndrome (OSAS). The acoustic arousal response was studied in children with OSAS due to adenotonsillar hypertrophy compared to normal, age-matched children. Acoustic stimuli were delivered incrementally from 30-100 dB during stage 2, slow wave sleep, and rapid eye movement (REM) sleep. The percentage of children who aroused in response to acoustic stimuli, and the arousal threshold (i.e., sound level at which arousal occurred), were compared between groups and sleep stages. The percentage of children who aroused was similar between children with OSAS and controls. The percentage of children who aroused was lower during slow wave sleep than REM sleep and stage 2 in both OSAS and controls. There were no statistically significant differences in acoustic arousal threshold between OSAS and control children. There was no difference in arousal response to moderate acoustic stimulation between children with OSAS and controls. These results contrast with previous data showing blunted arousal responses to hypercapnia and upper airway loading during sleep in children with OSAS, suggesting that children with OSAS have an arousal deficit specific to respiratory stimuli. However, further studies evaluating arousal to both respiratory and nonrespiratory stimuli in the same subjects are needed.

Acoustic Stimulation↗

PubMed2005

Altered luteinizing hormone and testosterone secretion in middle-aged obese men with obstructive sleep apnea.

OBJECTIVE: To elucidate the causes for the decline in testosterone levels observed in men with obstructive sleep apnea (OSA). RESEARCH METHODS AND PROCEDURES: We determined serum luteinizing hormone (LH) and testosterone levels every 20 minutes between 7 pm and 7 am with simultaneous sleep recordings in five obese middle-aged men with OSA, in five age- and BMI-matched controls, and in six lean young healthy men. RESULTS: The mean and area under the curve (AUC) values of LH and testosterone were significantly lower in men with OSA compared with controls. Young controls had significantly more testosterone pulses of shorter interpulse duration than OSA subjects and middle-aged controls. After adjusting for age and BMI, the three groups differed in mean and AUC values of LH and testosterone. Analysis of covariance, using BMI as a covariate, revealed a statistically significant group effect on mean and AUC testosterone values (p = 0.03; p < 0.003, respectively). Eliminating young controls, there was a significant positive correlation between the amount of LH and testosterone secreted at night. After partialling out age alone and BMI alone, the mean LH and mean testosterone were still positively correlated. DISCUSSION: Thus, OSA is associated with decreased pituitary-gonadal function. The decline in testosterone concentrations is due to obesity and advanced age and to a lesser degree to sleep fragmentation and hypoxia.

Body Mass Index↗

PubMed2002

Obstructive sleep apnea syndrome: its relationship with hypertension.

Respiratory disturbance during sleep, in its most common form, obstructive sleep apnea, is a prevalent condition in the general population. During the past several years, researchers have investigated a possible link between obstructive sleep apnea and hypertension. This article discusses the available epidemiologic and clinical evidence supporting this link. The possible mechanisms leading to the development of hypertension in patients with obstructive sleep apnea will also be discussed, as well as the effects of therapeutic interventions on arterial blood pressure. Last, the clinical importance of such interaction, which may lead to excessive cardiovascular morbidity and mortality, will be addressed.

Adult↗

PubMed1997

Cephalometric and demographic characteristics of obstructive sleep apnea: an evaluation with partial least squares analysis.

Obstructive sleep apnea (OSA) is caused by repeated obstruction of the upper airway during sleep. The purpose of this study was to test the relative contributions of specific demographic and cephalometric measurements to OSA severity. Demographic, cephalometric, and overnight polysomnographic records of 291 male OSA patients and 49 male nonapneic snorers were evaluated. A partial least squares (PLS) analysis was used for statistical evaluation. The results revealed that the predictive powers of obesity and neck size variables for OSA severity were higher than the cephalometric variables used in this study. Compared with other cephalometric characteristics, an extended and forward natural head posture, lower hyoid bone position, increased soft palate and tongue dimensions, and decreased nasopharyngeal and velopharyngeal airway dimensions had relatively higher associations with OSA severity. The respiratory disturbance index (RDI) was the OSA outcome variable that was best explained by the demographic and cephalometric predictor variables. We conclude that the PLS analysis can successfully summarize the correlations between a large number of variables, and that obesity, neck size, and certain cephalometric measurements may be used together to evaluate OSA severity.

Adolescent↗

PubMed2002

The effect of upper airway obstruction and arousal on peripheral arterial tonometry in obstructive sleep apnea.

We evaluated the effects of airflow limitation and arousal on digital vascular tone in 10 patients with obstructive sleep apnea (OSA) using the recently developed, noninvasive technique of peripheral arterial tonometry (PAT). Subjects were maintained at a therapeutic level of continuous positive airway pressure, and nasal pressure was acutely dropped for three to five breaths during nonrapid eye movement sleep over a range of pressures from 9.3 +/- 1.3 to 1.9 +/- 1.3 cm H2O, leading to increasing airway obstruction and decreasing levels of inspiratory airflow. In the absence of a detectable electroencephalographic (EEG) arousal, severe reductions of inspiratory airflow to below 200 ml/second caused significant decreases in PAT amplitude (1.000 +/- 0.007 to 0.869 +/- 0.007 arbitrary units; p < 0.001), whereas mild airflow limitation (> 200 ml/second) had no effect (1.000 +/- 0.009 to 1.011 +/- 0.007 arbitrary units). The presence of an EEG arousal accentuated the response to airflow obstruction, such that the PAT amplitude decreased more (p < 0.001) in the presence of arousal (1.000 +/- 0.007 to 0.767 +/- 0.010 arbitrary units) than in the absence of arousal (1.000 +/- 0.007 to 0.923 +/- 0.007 arbitrary units). We conclude that airflow obstruction in patients with OSA causes an acute digital vasoconstriction that is accentuated in the presence of an EEG arousal.

Adult↗

PubMed2005

Sleep and breathing on the first night after adenotonsillectomy for obstructive sleep apnea.

Adenotonsillectomy (T&A) has established effectiveness for the treatment of obstructive sleep apnea (OSA). However, more than 20% of children with OSA have respiratory compromise requiring medical intervention in the postoperative period. The reasons for this complication are not well-defined. We aimed to compare the nature and severity of sleep-disordered breathing in children with mild and severe OSA on the first night following adenotonsillectomy. Ten children were classified into groups of mild and severe OSA, based on preoperative testing. On the first night after T&A, they underwent polysomnography, including electroencephalograph, submental electromyography, bilateral electro-oculograms, monitoring of respiratory movements, heart rate, ECG, and oxygen saturation. Sleep-disordered breathing was assessed by the apnea-hypopnea index, the SaO(2) nadir, and the desaturation index, including dips in saturation below 90% (DI(90)). Sleep quality was assessed by sleep efficiency, time spent in each sleep state, and respiratory arousal index. Obstructive events occurred postoperatively in all children, but were more frequent in those with severe OSA preoperatively: the median (interquartile range) mixed/obstructive apnea/hypopnea indicies were 6.9 (2.2-9.8) events/hr and 21.5 (15.1-112.1) events/hr for the mild OSA group and the severe OSA group, respectively (P = 0.009). Obstructive events were the major cause of desaturation during sleep postoperatively. Sleep quality was severely disrupted in both groups, with reductions in both slow-wave sleep and rapid eye movement sleep. In conclusion, despite removal of obstructing lymphoid tissue, upper airway obstruction occurred on the first postoperative night in children with OSA. This study is the first to demonstrate the mechanism of respiratory compromise after adenotonsillectomy, a common postoperative complication in children with severe OSA.

Adenoids↗

PubMed1990

Obstructive sleep apnea syndrome.

The diagnosis and treatment of obstructive sleep apnea syndrome (OSAS) is a field of emerging interest to a wide variety of professionals, including dentists. OSAS is now widely recognized as a common clinical disorder with potentially life-threatening consequences. The syndrome is characterized by repeated episodes of upper airway obstruction during sleep. The most prominent clinical manifestations are loud snoring during sleep and daytime hypersomnelence. Bypassing the area of obstruction with a tracheostomy results in an improvement in clinical symptoms. The dentist's role may be to fit a simple mechanical device for anterior repositioning of the mandible, which recently has been introduced as a less invasive mode of treatment, when the cause is functional rather than anatomical.

Cephalometry↗

PubMed1985

Physiological determinants of nocturnal arterial oxygenation in patients with obstructive sleep apnea.

Among patients with similar degrees of obstructive sleep apnea (OSA) there is considerable variability in the degree of associated nocturnal hypoxemia. The factors responsible for this variability have not been clearly defined. Therefore we studied 44 patients with OSA to identify the physiological determinants of nocturnal arterial O2 saturation (SaO2). All patients underwent pulmonary function testing, arterial blood gas analysis, and overnight polysomnography. Mean nocturnal SaO2 ranged from 96 to 66% and apnea-hypopnea index from 11 to 128 per hour of sleep. Several anthropometric, respiratory physiological, and polysomnographic variables that could be expected to influence nocturnal SaO2 were entered into a stepwise multiple linear regression analysis, with mean nocturnal SaO2 as the dependent variable. Three variables [awake supine arterial PO2 (PaO2), expiratory reserve volume, and percentage of sleep time spent in apnea] were found to correlate strongly with mean nocturnal SaO2 (multiple R, 0.854; P less than 0.0001) and accounted for 73% of its variability among patients. Body weight, other lung volumes, and airflow rates influenced awake PaO2 and expiratory reserve volume but had no independent influence on nocturnal SaO2. In a further group of 15 patients with OSA a high correlation was obtained between measured nocturnal SaO2 and that predicted by the model (r = 0.87; P less than 0.001). We conclude that derangements of pulmonary mechanics and awake PaO2 (generally attributable to obesity and diffuse airway obstruction) are of major importance in establishing the severity of nocturnal hypoxemia in patients with OSA.

Adult↗