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PubMed2000

Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea.

OBJECTIVE: To determine the utility of pulse oximetry for diagnosis of obstructive sleep apnea (OSA) in children. METHODS: We performed a cross-sectional study of 349 patients referred to a pediatric sleep laboratory for possible OSA. A mixed/obstructive apnea/hypopnea index (MOAHI) greater than or equal to 1 on nocturnal polysomnography (PSG) defined OSA. A sleep laboratory physician read nocturnal oximetry trend and event graphs, blinded to clinical and polysomnographic results. Likelihood ratios were used to determine the change in probability of having OSA before and after oximetry results were known. RESULTS: Of 349 patients, 210 (60%) had OSA as defined polysomnographically. Oximetry trend graphs were classified as positive for OSA in 93 and negative or inconclusive in 256 patients. Of the 93 oximetry results read as positive, PSG confirmed OSA in 90 patients. A positive oximetry trend graph had a likelihood ratio of 19.4, increasing the probability of having OSA from 60% to 97%. The median MOAHI of children with a positive oximetry result was 16.4 (7.5, 30.2). The 3 false-positive oximetry results were all in the subgroup of 92 children who had diagnoses other than adenotonsillar hypertrophy that might have affected breathing during sleep. A negative or inconclusive oximetry result had a likelihood ratio of.58, decreasing the probability of having OSA from 60% to 47%. Interobserver reliability for oximetry readings was very good to excellent (kappa =.80). CONCLUSIONS: In the setting of a child suspected of having OSA, a positive nocturnal oximetry trend graph has at least a 97% positive predictive value. Oximetry could: 1) be the definitive diagnostic test for straightforward OSA attributable to adenotonsillar hypertrophy in children older than 12 months of age, or 2) quickly and inexpensively identify children with a history suggesting sleep-disordered breathing who would require PSG to elucidate the type and severity. A negative oximetry result cannot be used to rule out OSA.

Adenoids↗

PubMed2004

[Surgical treatment of patients with severe obstructive sleep apnea syndrome].

No standard indications currently exist for surgical treatment of severe obstructive sleep apnea syndrome (OSAS). We treated 15 patients with severe OSAS surgically, evaluated surgical indications, and evaluated surgical success. We retrospectively reviewed 15 cases of surgery for OSAS in which polysomnography met 2 or more criteria for the following surgical indications: (1) apnea hypopnea index (AHI) > or = 50, (2) minimum SpO2 below 80%, and (3) enlarged tonsils (grade III, Mackenzie's classification). Among the 15, mean AHI was 85.1. Surgery was done under general anesthesia, with uvulopalatopharyngoplasty (UPPP) in 13 and tonsillectomy alone in 2. Postoperative AHI was measured in 9 patients. According to Nishimura's criteria for assessing surgical success, improvement was "excellent" in 5, "good" in 1, "fair" in 1, and "poor" in 2. When we compared preoperative and postoperative use of continuous positive airway pressure (CPAP) in 7, we found that surgery decreased CPAP requirements. Surgical success was assessed in patients requiring CPAP and improvement was "excellent" in 5, "good" in 1, and "fair" in 1. In conclusion, surgical indications for severe OSAS, including the criterion of enlarged tonsils, were useful. Surgery decreased CPAP requirements and the degree of improvement in this requirement and AHI was valuable in assessing surgical success.

Adult↗

PubMed2000

[Mini-invasive surgical approach for obstructive sleep apnea syndrome (OSAS). A case report].

It is well known that the obstructive sleep apnea syndrome (OSAS) is caused by the collapse of the pharyngeal walls and subsequent reduction in the diameter of all viscera. It is possible to increase the antero-posterior diameter by shifting the genioglosso muscle forward and suspending it; on the other hand the latero-lateral diameter can be achieved by sectioning the hyoid bone along the midline and through lateral fixation of the resulting stumps to the mandibula. This paper presents a clinical case of OSAS which underwent surgery using a procedure combining suspension of the genioglosso muscle and sectioning and suspension of the hyoid performed using a REPOSEa kit.

Humans↗

PubMed2002

Procedural skill learning in obstructive sleep apnea syndrome.

STUDY OBJECTIVES: To better characterize the cognitive deficits observed in obstructive sleep apnea syndrome (OSAS) by examining procedural skill learning abilities. DESIGN: Procedural skill learning was assessed using Mirror Tracing and Rotary Pursuit skill learning tasks. Subjects also completed a comprehensive neuropsychological test battery. SETTING: Cognitive testing was performed during the day following the second of two consecutive nights during which sleep and respiratory variables were recorded. PARTICIPANTS: Two groups (28 OSAS patients and 18 normal controls) with equivalent mean age and education levels. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: No significant differences in learning rates were observed between the groups on the Rotary Pursuit Task. On the Mirror Tracing Task, overall learning of the skill and transfer to a new figure or to the reverse tracing direction was similar in the OSAS and NC groups. However, there was a subgroup of OSAS subjects (n=11) who showed marked difficulties in the initial acquisition of the Mirror Tracing Task. This subgroup's performance was no longer significantly different from that of controls and OSAS subjects without initial adaptation difficulty in the subsequent trials. Performance of subjects who had difficulty with initial adaptation on the Mirror Tracing was also significantly lower on tests of frontal executive function, but not on episodic memory tests. Sleep and respiratory variables did not distinguish between the two subgroups of OSAS patients. However, none of the young OSAS subjects (<40 years) presented this deficit. CONCLUSION: Results indicate that contrary to this study's hypothesis, OSAS patients did not show procedural skill learning deficits. A subgroup of OSAS patients, however, did show deficits in initial skill adaptation and difficulties on other neuropsychological tests. Frontal dysfunction and decrement in psychomotor efficiency and vigilance appeared to be the most consistent explanation for characterizing the profile of neuropsychological test results among the OSAS patients.

Adult↗

PubMed2002

[Study of serum leptin level in patients with obstructive sleep apnea].

OBJECTIVE: To explore the change of serum leptin in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Polysomnography was performed in 58 patients with OSAS and in 21 simple obese controls without differences in age and body mass index (BMI). Serum leptin level was measured by radioimmunoassay. RESULTS: (1) The serum leptin level in patients with OSAS was higher, in both males (6.1 +/- 1.7) microg/L and females (19.5 +/- 9.9) microgram/L, than that in the simple obese controls [male (4.5 +/- 1.7) microgram/L, female (10.5 +/- 2.4) microgram/L] (P < 0.01, P < 0.05). (2) Serum leptin levels were significantly correlated with BMI in both OSAS patients (r = 0.64, P < 0.01) and simple obese controls (r = 0.59, P < 0.01), but only in OSAS patients was the leptin level significantly correlated with apnea and hypopnea index (AHI) (r = 0.47, P < 0.01) and with neck circumference (r = 0.64, P < 0.01). CONCLUSIONS: Serum leptin levels were higher in OSAS patients than in simple obese controls. Besides obesity and neck circumference, OSAS may also influence the leptin system, resulting in increased serum leptin level.

Body Mass Index↗

PubMed2002

[Epidemiology and laser correction of chronic diseases observed in snoring and obstructive sleep apnea].

Investigations of snoring have been initiated because snoring is associated with obstructive sleep apnea syndrome (OSAS) and some chronic diseases eventuating in invalidity. Questionnaire survey provided evidence on snoring and OSAS incidence among different age groups of male and female population of St-Petersburg. Associated chronic diseases were also evaluated. Snoring and OSAS were corrected by laser uvulopalatoplasty. The correction was conducted in the contact regimen by Nd-YAG laser. As a result of the treatment, snoring and apnea in mild OSAS ceased in all the patients and decreased by at least 60% in severe OSAS. This effect was confirmed by polysomnographic findings.

Adult↗

PubMed2003

Obstructive sleep apnea in head and neck cancer patients post treatment ... something to consider?

Obstructive sleep apnea (OSA) occurs due to enlarged tissue such as tonsils, base of tongue or palate, pharyngeal space narrowing, or decreased muscle tone of the pharyngeal dilator muscles. Treatments for head and neck cancer may cause physical changes resulting in OSA. Based on recent anecdotal experience and limited research available looking at the incidence of OSA in post treatment head and neck cancer patients, assessment for signs and symptoms of OSA by otorhinolaryngology nurses seems warranted. Prompt diagnosis and treatment of OSA in the patient with head and neck cancer may significantly improve the person's health and quality of life.

Carcinoma, Squamous Cell↗

PubMed2003

Cephalometric evaluation of craniofacial and upper airway structures in Japanese patients with obstructive sleep apnea.

In order to investigate the morphological characteristics of Japanese patients with obstructive sleep apnea (OSA) and basis for selection of an oral appliance (OA) therapy, the craniofacial skeleton, soft tissue and upper airway were analyzed on lateral cephalograms from 103 patients with OSA and 98 control subjects. At first, the 103 OSA patients were divided into two groups according to their body mass index (BMI). The results were the following: Micrognathia was a major risk factor of Japanese OSA patients instead of obesity; the narrowing in the hypopharynx was observed due to the inferior-located hyoid bone, especially in the obese group, an enlarged tongue and sticking of fatty-tissue to upper airway wall were observed in addition. Secondly, the 103 OSA patients were treated by OA, and were classified according to the reduction ratio of AHI (rAHI) again. The results suggested that the patients group which showed rAHI > or = 50% had a balanced relationship between the maxilla and mandible. These findings proved that the morphological characteristics specific to Japanese patients with OSA and patients who were allowed to accept the OA therapy were exist.

Adult↗

PubMed2003

Feasibility study of Flextube reflectometry for localisation of upper airway obstruction in obstructive sleep apnea.

One hundred and twenty-three patients with snoring problems and/or obstructive Sleep Apnea Syndrome (OSAS) were offered Rhinosleep Flextube-reflectometry during sleep registration to assess the upper airway. The main point of interest was patient acceptance of the procedure. 36 patients with OSAS received Rhino Flextube reflectometry. Of these, 19 (53%) completed a whole night registration with the Rhinosleep tube and 17 (47%) did not. This low success rate is multifactorial and will be discussed in detail in the text. The development of Rhinosleep is a challenge, as it improves the topical diagnostic work-up of OSAS patients. At present however various practical problems have to be solved to make it a viable alternative to sleep endoscopy.

Endoscopy↗

PubMed2004

[Respiratory control in obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To evaluate the role of ventilatory control in obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Thirty-five patients with OSAHS were compared with 15 obese controls in pulmonary function, hypoxic ventilatory response (HVR), hypercapnic ventilatory response (HCVR) and polysomnography (PSG). RESULTS: (1) There were no differences in HVR and HCVR between patients with OSAHS and the control (t = 1.28, 0.57; P > 0.05). In OSAHS patients, HVR was correlated with nadir nocturnal oxygen saturation (MmS(P)O(2)) (r = -0.54, P < 0.01) and HCVR (r = 0.57, P < 0.01). (2) Patients with mild and moderate OSAHS had higher HVR than those with severe OSAHS (t = 2.74, P < 0.01). When 5 < or = apnea and hypopnea index (AHI) < 40, HVR was negatively correlated to forced expiratory volume in one second (FEV(1))/peak expiratory flow (PEF) (r = -0.42, P < 0.05) and AHI (r = -0.68, P < 0.01). For those whose AHI > or = 40, HVR was negatively correlated with MmSpO(2) (r = -0.58, P < 0.05) and positively correlated with HCVR (r = 0.59, P < 0.05). CONCLUSION: In OSAHS patients, HCVR did not show significant change, but HVR showed two phasic change-increase first and then decrease-following the elevation of AHI, which was also related to MmSpO(2) and HCVR.

Adult↗

PubMed2005

[Mandibular distraction osteogenesis in the treatment of obstructive sleep apnea syndrome in children with micrognathia].

OBJECTIVE: To evaluate the treatment of obstructive sleep apnea syndrome (OSAS) in children with congenital micrognathia using mandibular distraction osteogenesis and to discuss the advantages and disadvantages of this approach. METHODS: 6 patients (4 males, 2 females) had undergone mandibular distraction osteogenesis, 12 distraction devices were placed through extraoral incision for bilateral distraction. The mean age of treatment was 1 year and 9 months (range 4 months to 9 years). Every patient had been evaluated pre and postoperatively with cephalometry. The period of consolidation was 4 - 11 weeks. The period of follow-up was from 2 to 10 months. RESULTS: The average distraction distance was 19.2 mm (range 15 to 25 mm). The osteotomy and distraction processes were smooth in all the cases, the osteogenesis was good, without infection and other complications. The posterior airway space was increased from averaged 4.5 mm preoperatively to 10. 1mm after surgery. Five children had normal respiration and sleep restored with naso-pharyngeal airway removal or tracheostomy decannulation. One patient is to receive a planned second stage of distraction with a horizontal vector. The results were stable without relapse during a follow-up period of 2 to 10 months. CONCLUSIONS: Application of mandibular distraction osteogenesis is an important component and effective in the treatment of OSAS and permits mandibular advancement in the younger child. As more experience is gained with distraction osteogenesis in the treatment of children with OSAS, the role of distraction will become better defined.

Child↗

PubMed2002

Dental devices; classification for intraoral devices for snoring and/or obstructive sleep apnea. Final rule.

The Food and Drug Administration (FDA) is classifying the intraoral devices for snoring and/or obstructive sleep apnea into class II (special controls). These devices are used to control or treat simple snoring and/or obstructive sleep apnea. This classification is based on the recommendations of the Dental Devices Panel (the Panel), and is being taken to establish sufficient regulatory controls that will provide reasonable assurance of the safety and effectiveness of these devices. This action is being taken under the Federal Food, Drug, and Cosmetic Act (the act), as amended by the Medical Device Amendments of 1976 (the 1976 amendments), the Safe Medical Devices Act of 1990 (the SMDA), and the Food and Drug Administration Modernization Act of 1997 (FDAMA). Elsewhere in this issue of the Federal Register, FDA is publishing a notice of availability of the guidance document that will serve as the special control for this final rule.

Dental Devices, Home Care↗

PubMed2006

Treatment of moderate obstructive sleep apnea syndrome with acupuncture: a randomised, placebo-controlled pilot trial.

BACKGROUND AND PURPOSE: To investigate the efficacy of acupuncture in the treatment of moderate obstructive sleep apnea syndrome (OSAS), assessed by polysomnography (PSG) and questionnaires of functional quality of life (SF-36) and excessive daytime sleepiness (Epworth). PATIENTS AND METHODS: We performed a randomised, placebo-controlled, single-blinded study, with blinded evaluation on 36 patients presenting an apnea/hypopnea index (AHI) of 15-30/h, assessed by PSG. The study took place at the Public Hospital of the Universidade Federal de São Paulo, Brazil, in the Division of Sleep Disorders of the Department of Psychobiology, between January, 2002 and August, 2004. Patients were randomly assigned to three groups: the acupuncture group (n=12); the sham group, submitted to needle insertion in non-acupoints (n=12); and the control group, receiving no treatment (n=12). Patients received acupuncture or sham acupuncture once a week for 10 weeks. RESULTS: Twenty-six patients completed the study. The AHI (P=0.005), the apnea index (AI) (P=0.008) and the number of respiratory events (P=0.005) decreased significantly in the acupuncture group but not in the sham group. On the other hand, the control group displayed significant deterioration in some of the polysomnographic parameters, with a significant increase in the number of respiratory events (P=0.025). Acupuncture treatment significantly improved (before vs. after treatment) several dimensions of the SF-36 and Epworth questionnaires. There was no significant association between changes in the body mass index (BMI) and AHI. CONCLUSIONS: Acupuncture is more effective than sham acupuncture in ameliorating the respiratory events of patients presenting with moderate OSAS.

Acupuncture Therapy↗

PubMed1998

[Relationship between lung function and nocturnal hypoxemia in patients with obstructive sleep apnea syndrome].

OBJECTIVE: To explore the relationship between the changes of lung function resulted from position changes and obesity, and nocturnal hypoxemia in patients with obstructive sleep apnea syndrome. METHOD: 34 patients with obstructive sleep apnea syndrome were detected by polysomnography with lung function and blood gas analysis in sitting and supine positions during wake, and the relationship between results of lung function and blood gas analysis, IBW% to the AI, and < 90% T (percentage of the duration of SaO2 below 90% to total sleep time) was analyzed. RESULT: The mean age of the patients was 44 +/- 13 years. The AI was 36 +/- 22 time.hour-1. On changing from sitting to supine position, PaO2, VC%, ERV, FRC, FRC%, RV%, TLC% decreased significantly, especially ERV and FRC%, which decreased 47% and 29% respectively. AI had positive correlation with VC% (r = 0.477, P < 0.01) and TLC% (r = 0.443, P < 0.01) in supine position, < 90% T had negative correlation with PaO2(r = -0.479, P < 0.01) and ERV (r = -0.416, P < 0.05) in sitting position. The IBW% had negative correlation with VC% in sitting (r = -0.547, P < 0.01) and supine position (r = -0.491, P < 0.01). IBW% also had negative correlation with ERV in sitting (r = -0.523, P < 0.01) and supine (r = -0.413, P < 0.01) position and FRC (r = -0.402, P < 0.05) in sitting position. The IBW% had positive correlation with the < 90% T(r = 0.514, P < 0.01). CONCLUSION: These results suggest that positional changes and obesity have effects on lung function in patients with OSAS, and lead to the deterioration of hypoxemia during apnea.

Adult↗

PubMed1992

[Treatment with continuous positive nasal pressure in obstructive sleep apnea syndrome].

BACKGROUND: The collapse of the soft tissues of the upper airway during sleep is decisive in the pathogenesis of the obstructive sleep apnea syndrome. The administration of an air flow of adjustable pressure through the nose is efficient to overcome the obstruction and favor respiration without apnea. METHODS: Twenty-two patients with obstructive sleep apnea syndrome were treated with continuous positive pressure of the upper airway with the aim of evaluating the effect of this treatment on sleep, respiration and cardiac rhythm following the first night of treatment. RESULTS: Following the night of treatment an increase of the III, IV states and sleep REM with a shortening of REM latency was observed. The number of apneas diminished drastically thus improving cardiac arrhythmias detected in the basal study. CONCLUSIONS: Treatment of the upper airway with continuous positive pressure is efficient not only for the correction of apneas and cardiac arrhythmia but also for the consolidation of a normal sleep cycle.

Adult↗

PubMedDate not supplied

[Predictive value of the Müller maneuver in obstructive sleep apnea syndrome].

Dynamic changes in the upper airway during sleep have been identified in patients with obstructive sleep apnea syndrome (OSAS). Fiberoptic nasopharyngoscopy with the Müller maneuver (FNMM) has been advocated as a practical, clinically useful, preoperative dynamic diagnostic method for assessing the site of collapse. The value of FNMM in predicting response to uvulopalatopharyngoplasty (UPPP) was assessed in patients with obstructive sleep apnea syndrome. Results indicate that preoperative FNMM can reliably enhance surgical success.

Female↗

PubMed2003

[Radiographic anomalies and obstructive sleep apnea syndrome].

BACKGROUND: The purpose of this study was to identify the particular cranio-facial pattern observed in patients with obstructive sleep apnea syndrome and to search for possible correlations between morphological anomalies and disease severity. MATERIAL AND METHODS: The study group included 49 dentate patients, mean age 47.7 years suffering from obstructive sleep apnea syndrome. Most of the patients were overweight. RESULTS: Typical features observed in these patients were a short craniospinal field, a retro-maxillary, a retro-mandibula, antero-inferior vertical excess of the face, and class II malocclusion. No correlation between severity of obstructive sleep apnea syndrome and craniofacial morphology could be identified. DISCUSSION: These results are in agreement with data in the literature. The absence of a morphological correlation appears to be related to the type of patients studied (overweight). Indeed, two categories of sleep apnea patients have been identified: obese patients who have few or no anomalies of the facial skeleton and thin patients with characteristic open bite class II malocclusion.

Adult↗

PubMedDate not supplied

Obstructive sleep apnea uncovered after high spinal anesthesia: a case report.

PURPOSE: To illustrate how a patient's previously undiagnosed obstructive sleep apnea was uncovered after administration of a spinal anesthetic with a high sensory blockade, and to discuss possible explanations for this occurrence and anesthetic implications. CLINICAL FEATURES: A 55-yr-old male presented for osteotomy and open reduction and internal fixation of his left femur secondary to malunion from a previous fracture. Past medical history consisted of hypertension, hypercholesterolemia, bipolar disorder, gastroesophageal reflux disease, and cluster headaches. A combined spinal-epidural technique was chosen. Isobaric bupivacaine 0.5% (15 mg), was provided for the spinal anesthetic, along with 1 mg iv midazolam for procedural sedation and 0.5 mg iv droperidol for mild nausea. Throughout the operation, many apneic events were noted, often with respiratory efforts. The patient was easily arousable during each event and would breathe normally until the next episode. Vital signs remained stable throughout. Postoperative respirology consultation was requested, and a sleep study revealed severe obstructive sleep apnea. The patient was subsequently started on continuous positive airway pressure with marked improvement in symptoms, including the cluster headaches. CONCLUSION: Recent literature suggests that high spinal blockade can result in altered levels of arousal by producing a de-afferentation of peripheral proprioceptive and sensory stimuli necessary for maintaining an awake state. In patients predisposed to upper airway obstruction, decreasing the level of consciousness can result in airway obstruction as occurs during sleep in these patients. This serves to underline the importance of considering capnography for all cases utilizing a neuraxial anesthetic technique.

Anesthesia, Epidural↗