Obstructive sleep apnea

Obstructive sleep apnea (OSA) is a chronic condition characterized by chronic intermittent hypoxia (IH) and is associated with cardiovascular (CVD) and chronic kidney diseases (CKD). There is increased biomarkers of aging, such as telomere shortening , in patients with OSA . We assessed telomere lengths in aortic and renal tissues from mice exposed to 8 weeks of IH using a PCR protocol, and demonstrate significant telomere shortening in both tissues. This data indicates that IH, a hallmark of OSA, can accelerate vascular and renal aging that may contribute to OSA-induced CVD and CKD

Medical records show frequent psychoactive drug treatments among the elderly with respiratory depression as a potential side effect. We evaluate their impact in patients undergoing noninvasive ventilation (NIV) for acute hypercapnic respiratory failure (AHRF) with acidosis. Methods : Prospective study in 103 consecutive admissions (71 M, age 74,9±9 yrs) starting NIV for AHRF with acidosis in a Monitoring Unit (Oct.08-Jan.12) Two groups based on previous therapy with psychoactive drugs and significant sedative effect. Variables : pH, pO 2 , pCO 2 , pO 2 /FiO 2 at admission(1), 2h of NIV(2) and 24h of NIV(3); in-hospital mortality and combined in-hospital and 30-day post-discharge mortality, length of stay (LOS) and intubation %. We recorded main diagnosis and thoracic comorbidities. Stat. analysis : χ 2 /MWW. Results : 39 pts (37,9%) received sedatives: M 22,5%,F 71,8%; BZDs 89,7%. Main diagnosis (% sedatives): COPD 48 (25%), OHS 20 (55%),Acute heart failure 16 (56,2%), Pneumonia 7 (...

Home respiratory polygraphy may be a simpler alternative to in-laboratory polysomnography for the management of more symptomatic obstructive sleep apnea patients, but its effectiveness has not been evaluated across a broad clinical spectrum. To compare the long-term effectiveness (6 months) of home respiratory polygraphy and polysomnography management protocols in patients with intermediate to high sleep apnea suspicion (most patients requiring a sleep study). A multicentric, non-inferiority, randomized controlled trial with two open parallel arms and a cost-effectiveness analysis was performed in twelve tertiary hospitals in Spain. Sequentially screened patients with sleep apnea suspicion were randomized to respiratory polygraphy or polysomnography protocols. Moreover, both arms received standardized therapeutic decision-making, continuous positive airway pressure (CPAP) treatment or a healthy habit assessment, autoCPAP titration (for CPAP indication), health-related quality-of-lif...

Rationale: Measures of unstable ventilatory control (loop gain) can be obtained directly from the periodic breathing duty ratio on polysomnography in patients with Cheyne-Stokes respiration/ central sleep apnea and can predict the efficacy of continuous positive airway pressure (CPAP) therapy. Objectives: In this pilot study, we aimed to determine if this measure could also be applied to patients with complex sleep apnea (predominant obstructive sleep apnea, with worsening or emergent central apneas on CPAP). We hypothesized that loop gain was higher in patients whose central events persisted 1 month later despite CPAP treatment versus those whose events resolved over time. Methods: We calculated the duty ratio of the periodic central apneas remaining on the CPAP titration (or second half of the split night) while patients were on optimal CPAP with the airway open (obstructive apnea index , 1/h). Loop gain was calculated by the formula: LG = 2p/[(2pDR 2 sin(2pDR)]. Patients were followed on CPAP for 1 month. Post-treatment apnea-hypopnea index and compliance data were recorded from smart cards. Measurements and Main Results: Thirty-two patients with complex sleep apnea were identified, and 17 patients had full data sets. Eight patients continued to have a total of more than five events per hour (11.8 6 0.5/h) (nonresponders). The remaining nine patients had an apnea-hypopnea index less than 5/h (2.2 6 0.4/h) (responders). Loop gain was higher in the nonresponders versus responders (2.0 6 0.1 vs. 1.7 6 0.2, P = 0.026). Loop gain and the residual apnea-hypopnea index 1 month after CPAP were associated (r = 0.48, P = 0.02). CPAP compliance was similar between groups. In this pilot study, loop gain was higher for patients with complex sleep apnea in whom central apneas persisted after 1 month of CPAP therapy (nonresponders). Loop gain measurement may enable an a priori determination of those who need alternative modes of positive airway pressure.

and colleagues added the use of CPAP to long-term oxygen therapy and observed differences in long term survival of 71% versus 26%. Recently, Marin et al. have shown that hospitalization rates and mortality from COPD can be mitigated if CPAP is prescribed, compared to those with COPD alone, 6 but the amount of use of CPAP required to achieve optimal outcomes remains unknown. In the present study we reviewed records from a large community-based sample of patients with OSA, COPD, and overlap syndrome to assess the impact of CPAP use and other risk factors on mortality. We hypothesized greater CPAP adherence would reduce mortality in the overlap syndrome. Background: The overlap syndrome, defi ned by concurrent existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), is associated with poor outcomes. From a large outpatient cohort we aimed to defi ne better the risk factors for increased mortality in the overlap syndrome and hypothesized that CPAP adherence would be associated with improved survival in patients with overlap syndrome. Methods: A post hoc analysis from an outpatient database of 10,272 patients from 2007-2010, identifi ed 3,396 patients which were classifi ed in 6 groups; patients both alive or deceased, with the known diagnosis of COPD, OSA, and the overlap of COPD plus OSA. Information regarding their gender, age, pulmonary function, obstructive sleep apnea parameters, and CPAP compliance was collected. A multivariate Cox proportional hazards model was generated for the determinants of mortality. Results: 1,112 COPD patients and 2,284 OSA patients were identifi ed by diagnostic coding and then comprehensive chart review. Of these, 227 patients were identifi ed with the overlap syndrome. From this group, 17 patients (7.4%) died. Multivariate analysis revealed hours of CPAP use and age as independent predictors of mortality (HR 0.71 and 1.14, p < 0.001, 0.002). Greater time on CPAP was associated with reduced mortality; although age did not correlate with CPAP use (p = 0.2), mean age of those with CPAP use < 2 hours per night was signifi cantly higher than those using CPAP > 2 hours per night. Conclusions: From this observational cohort, mortality in the overlap syndrome is impacted by CPAP use. Age is also an independent factor which has a negative association with survival and CPAP usage.

Recently obesity has been defined as a disease and has turned bariatric surgery into a part of a chronic illness management. Obesity induces several comorbidities leading to cardiovascular disease and mortality. The effects of bariatric surgery on these comorbidities used to be classified as weight-loss induced. However bariatric surgery has recently been termed metabolic surgery because of the suspected direct, weight loss independent effect of bariatric procedures on the physiopathological mechanisms causing excess fat storage and insulin resistance. This review describes the standard procedures commonly performed and their specific outcomes on metabolic diseases in order to work towards more patient tailored treatment of obesity and to reduce side effects. Furthermore this review focuses on gaps in understanding the pathogenesis of obesity and its treatment with bariatric surgery. Surgery failures as well as new techniques are discussed and evaluated.

The purpose of this study was to examine the process of care in an interdisciplinary sleep clinic for patients with obstructive sleep apnea (OSA) and comorbid insomnia. A mixed-methods approach was used to examine clinical and patient-centered measures for 34 patients who received positive-airway pressure and/or cognitive-behavior therapy for insomnia. The results revealed baseline-to-follow-up improvements on several self-reported sleep parameters and measures of daytime functioning. Qualitative analyses from patient interviews revealed three themes: conceptual distinctions about each sleep disorder, importance of treating both sleep disorders, and preferences with regards to the sequence of treatment. These findings indicate that patients with OSA and comorbid insomnia encounter unique challenges and a dimensional approach to assessment and treatment is proposed for future research.

The purpose of this study was to examine the process of care in an interdisciplinary sleep clinic for patients with obstructive sleep apnea (OSA) and comorbid insomnia. A mixed-methods approach was used to examine clinical and patient-centered measures for 34 patients who received positive-airway pressure and/or cognitive-behavior therapy for insomnia. The results revealed baseline-to-follow-up improvements on several self-reported sleep parameters and measures of daytime functioning. Qualitative analyses from patient interviews revealed three themes: conceptual distinctions about each sleep disorder, importance of treating both sleep disorders, and preferences with regards to the sequence of treatment. These findings indicate that patients with OSA and comorbid insomnia encounter unique challenges and a dimensional approach to assessment and treatment is proposed for future research.

Nötrofil ve lenfosit oranı (NLO)'nın inflamatuar belirteç olarak inflamatuar hastalıklarda rolü keşfedilmiştir. Obstruktif uyku apne sendromu (OSAS)'da komorbiditeler ile OSAS'da artan NLO arasındaki ilişki değerlendirildi. Yöntem: Toplam 232 OSAS hastası çalışmaya alındı. 50 OSAS olmayan olgu kontrol grubunu oluşturdu. NLO her hasta ve kontrol olgusu için hesaplandı ve kaydedildi. Nötrofil lenfosit oranıyla hipertansiyon arasındaki ilişki hipertansiyonu olan ve olmayan iki alt hasta grubunda değerlendirildi. Bulgular: Çalışmada 100 kadın (%43.1), 132 erkek (%56.9) hasta mevcuttu. OSAS hastalarında ortalama NLO (1.76±0.77), kontrol grubunda ortalama NLO (1.31±0.74) ile karşılaştırıldığında anlamlı olarak daha yüksekti (p= 0.000). Hipertansiyon (HT) olan (3.59±14.92) ve olmayan (1.72±0.69) OSAS'lı hastalarda NLO'da anlamlı farklılık saptandı (p= 0.014). Sonuç: OSAS'da NLO inflamatuar belirteç olarak değerli olabilir. OSAS'da artan NLO, bu hastalardaki HT gibi komorbid durumlardan kaynaklanabilir. Bu ucuz ve pratik method, günlük klinik pratikte, OSAS hastalarında komorbiditeyi öngörmek için kullanılabilir.

Background Pharyngeal lavage was reported as a novel technique for noninvasive assessment of inflammation of the pharynx. Aim To study upper airway inflammation in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and its correlation with systemic inflammation. Patients and methods A total of 36 patients with known OSAHS, admitted to the Chest Department, Alexandria Main University Hospital (group I), and 15 healthy volunteers (group II) were enrolled into the study. Informed consent was taken from all participants. The two groups underwent complete history taking, assessment of BMI, measurement of serum C-reactive protein (CRP), overnight polysomnography, and oropharyngeal lavage (OPL) analysis. In group I, the most prevalent cell type of OPL was lymphocytes followed by neutrophils. Compared with control group (group II), the most prevalent cell type in OPL was macrophages followed by epithelial cells. Regarding the OPL differential cell count which denotes local pharyngeal inflammation, there was a statistically significant difference between both groups (P<0.001). Similarly, CRP, a marker of systemic inflammation, showed a significant statistical difference between both groups (P<0.001). Strikingly, there was no statistically significant correlation between CRP and apnea-hypopnea index (P=0.604). Snoring, apnea-hypopnea index, and other sleep parameters correlated significantly with lymphocytic predominance in OPL (P<0.001), whereas CRP correlates significantly with neutrophils and eosinophil's in OPL (P<0.001 and P=0.015, respectively). Our study had provided a novel vision into the pathophysiology of OSAHS in emphasizing the existence of upper airway lymphocytic inflammation. OPL is a simple, applicable, and easy noninvasive procedure for assessment of upper airway inflammation.

Thoracoscopy, as a minimally invasive surgical technique in the field of thoracic surgery, has been widely utilized due to its minimally invasive nature, cost-effectiveness, and short hospital stay. Most thoracoscopic surgeries involve intraoperative single-lung ventilation, aiming to maintain intraoperative oxygen saturation (SPO2) above 93% by increasing the respiratory rate and administering a high concentration of oxygen. However, the high concentration of oxygen administered during surgery and postoperative pain in thoracic surgery often result in decreased ventilation and hypoxia in patients. This case report details a patient who underwent bilateral thoracoscopic surgery with single-lung ventilation on both sides, subsequently developing oxygen-associated hypercapnia in the post-anesthesia care unit (PACU) and necessitating reintubation.

Whether gender differences exist in clinical manifestations of obstructive sleep apnea (OSA) and whether women's responses to continuous positive airway pressure (CPAP) are similar to those of men are critical areas of exploration in sleep disordered breathing. This exploratory analysis addressed these questions by examining gender differences over a wide range of clinical outcomes at baseline and in response to CPAP in participants with severe OSA. Methods: Data from 152 men and 24 women who participated in a multicenter CPAP effectiveness study were analy�ed. Gender differ-CPAP effectiveness study were analy�ed. Gender differ-effectiveness study were analy�ed. Gender differences in functional status (functional outcomes of sleep questionnaire, sickness impact profile), daytime sleepiness (epworth sleepiness scale, multiple sleep latency test), mood disturbance (profile of mood states), apnea symptoms (multivariable apnea prediction index), and neurobehavioral performance (psychomotor vigilance task) were examined. Treatment response was examined by the change in each outcome from baseline to 3 months after treatment. Results: Despite similar age, body mass index, and apnea-hypopnea index, women reported significantly lower functional status, more subjective daytime sleepiness, higher frequency of apnea symptoms, more mood disturbance, and poorer neurobehavioral performance compared to men at baseline. CPAP treatment significantly improved functional status and relieved symptoms for both genders. The magni- The magni-he magnitude of improvement in each clinical outcome did not vary by gender. conclusions: Women with OSA showed greater impairment in daytime functioning and symptoms than men. Both genders benefit from CPAP treatment. Adequately powered studies considering possible re-treatment. Adequately powered studies considering possible re-treatment. Adequately powered studies considering possible referral and response bias are necessary to examine gender differences in OSA clinical manifestations and response to CPAP treatment.

Cardiovascular defects characterized by geometrical anomalies of the aorta and its effect on the blood flow are investigated. The flow characteristics change with the aorta geometry and the rheological properties of the blood. Flow characteristics such as wall shear stress often play an important role in the development of vascular disease. In the present study, blood is considered to be non-Newtonian and is modeled using the Quemada model, an empirical model that is valid for different red blood cell loading. Three patient-specific aortic geometries are studied using Large Eddy Simulations (LES). The three geometries represent malformations that are typical in patients populations having a genetic disorder called Turner syndrome. The results show a highly complex flow with regions of recirculation that are enhanced in two of the three aortas. Moreover, blood flow is diverted, due to the malformations, from the descending aorta to the three side branches of the arch. The geometry having an elongated transverse aorta has larger areas of strong oscillatory wall shear stress.

Many women experience sleep problems during pregnancy. This includes difficulty initiating and maintaining sleep due to physiologic changes that occur as pregnancy progresses, as well as increased symptoms of sleepdisordered breathing (SDB). Growing evidence indicates that sleep deficiency alters glucose metabolism and increases risk of diabetes. Poor sleep may exacerbate the progressive increase in insulin resistance that normally occurs during pregnancy, thus contributing to the development of maternal hyperglycemia. Here, we critically review evidence that exposure to short sleep duration or SDB during pregnancy is associated with gestational diabetes mellitus (GDM). Several studies have found that the frequency of GDM is higher in women exposed to short sleep compared with longer sleep durations. Despite mixed evidence regarding whether symptoms of SDB (e.g., frequent snoring) are associated with GDM after adjusting for BMI or obesity, it has been shown that clinically-diagnosed SDB is prospectively associated with GDM. There are multiple mechanisms that may link sleep deprivation and SDB with insulin resistance, including increased levels of oxidative stress, inflammation, sympathetic activity, and cortisol. Despite emerging evidence that sleep deficiency and SDB are associated with increased risk of GDM, it has yet to be demonstrated that improving sleep in pregnant women (e.g., by extending sleep duration or treating SDB) protects against the development of hyperglycemia. If a causal relationship can be established, behavioral therapies for improving sleep can potentially be used to reduce the risk and burden of GDM.

Objectives Maxillomandibular advancement (MMA) confers consistent and high rates of surgical success for obstructive sleep apnea (OSA). In the era of value-based medicine, identifying factors that affect the stability of rigid fixation and allow rapid return to function are important targets for improvement. The aim of this study was to identify patient and surgical factors associated with mandibular sagittal split outcomes associated with optimal postoperatively skeletal stability. Study design Retrospective cohort study. Materials and methods Forty-six subjects (43 males and 3 females) with postoperative CT scans including three-dimensional reconstruction from which mandibular split patterns could be analyzed were enrolled. Patient factors (age and polysomnographic measures) and surgical factors (extent of osteotomy prior to controlled fracture) were assessed. Outcome measures include (1) bone thickness for rigid fixation and (2) area of passive bony overlap after advancement. Results Age and severity of disease did not contribute significantly to optimal mandibular split patterns. For optimal area for passive bony overlap and thickness of buccal and lingual plates for rigid fixation, the most important factors are related to surgical technique. Conclusions Anterior osteotomy just to the midline of inferior border and horizontal osteotomy to the mandibular foramen are associated with split patterns that result in optimal rigid fixation and passive bony overlap for OSA patients undergoing MMA. Clinical relevance Optimal surgical technique has the most significant influence in allowing rapid return to function after MMA in patients with OSA.

Material and Methods: 100 male patients had been included for this study that were applied to our clinic for erectile dysfunction and planned to be started sildenafil sitrate. As a diagnosis criteria we used the first 5 questions of International Index for Erectile Function and the patients ...

Gereç ve Yöntem: Kliniğimize ED şikayeti ile başvuran ve medikal tedavi olarak sildenafil sitrat başlanması planlanan 100 erkek hasta çalışmada yer aldı. ED tanı kriteri olarak tüm hastaların Uluslararası Erektil Fonksiyon İndeksi&#x27;nin ilk beş sorusu (IIEF-5)&#x27;na göre skoru &lt;21 olan ...

Purpose of Review The prevalence of obstructive sleep apnea (OSA) is increasing worldwide, in line with the increase in obesity prevalence. Taken into consideration the low compliance rates to continuous positive airway pressure (CPAP) treatment, and since obesity is a risk factor for OSA, these patients should receive additional counseling for weight loss through a diet plan. The aim of this review is to examine the role of a structured diet management plan on OSA severity, nocturnal oxygen indices, and subjective sleep parameters. Recent Findings Τhis systematic review of the literature resulted in four studies and demonstrated that severity of OSA, assessed by the apnea-hypopnea index, is reduced by a dietary management plan when delivered through an educational program. Moreover, nocturnal oxygenation is improved, as well as subjective sleep parameters, when initiating a diet on top of CPAP use. Summary In summary, the present systematic review reports on the beneficial effects ...

(4%) subjects used it for 1-49% of the nights (group B); 5 (9%) used it for between 50-74% of nights (group C) and 39 (70%) used it for >75% of nights (group D) for >4 hours each. At 18 months there was no change in groups A and D. In group B, 1 used it for > 80% nights. In group C, 2 subjects' adherence increased to 88%. We determined that the majority of children with Down Syndrome followed in our clinic were adherent 1 year post PAP initiation. In our experience, children with Down Syndrome can be successful with PAP therapy.

Introduction: Childhood obesity is the major risk factor sleep disordered breathing (SDB). Severely obese young people may require bariatric surgery for correction of obesity, if other methods of weight loss have failed. We aim to assess the effect of bariatric surgery on SDB, in adolescents and young adults. Methods: We conducted a retrospective chart review study of patients who underwent bariatric surgery between January 1, 2006 and August 31, 2019 at Cincinnati Children's Hospital. Only patients who had pre-operative and post-operative polysomnograms were included in the study. Results: Twenty-seven children and young adults (female: 59.2%) met the criteria for entry into analysis. The mean age of subjects at the time of weight loss surgery was 17.9 years (range: 12.9 to 32.5). Majority of the patients underwent laparoscopic partial gastrectomy (85.2%) and the remaining underwent laparoscopic gastric bypass surgery (14.8%). The average duration of follow up for post study measurements after the surgery was 10.4 months (Range: 0.4 to 57.5). The median Body Mass Index (BMI) was significantly lower at post-surgery (49.9 kg/m 2 [IQR: 45.4-55.9][pre] vs 39.3 kg/m2[IQR: 33.9-46][post], P<0.001). The median obstructive AHI was significantly reduced at post-surgery ( .7/hr[IQR: 3.1-16.4][pre] vs 2.6/hr[IQR: 1.6-6][post], P= 0.03). Median heart rate (HR) during REM (79 bpm[IQR:67-90][pre] vs 67 bpm[IQR: 59.7-72][post], P<0.0001) and NREM (81 bpm[IQR:65-91][pre] vs 65 bpm[IQR: 58-73][post], P<0.0001) sleep were significantly lower at post-surgery. There was no statistically significant difference in sleep architecture (sleep latency, arousal index and percentage of REM, N1 and N3 sleep, P> 0.05) except N2 sleep (53.1% [

response was collected unanimously by teachers. High risk children for sleep apnea were identified using apnea-associated symptoms related either to sleeping, anxiety, attention deficiency or emotional behavior. The participants whose information was not available were omitted from the analysis. Uni-variable and multivariable regression and logistic analyses were conducted, using SAS version 9.0 software. Results: More than 90% of care-givers responded to the questionnaire, and 75% of them revealed the STBUR score of 0, while 0.3% did STBUR score of 3 or greater. Mostly 1,800 pupils were regarded as having higher risk for sleep apnea, and thus invited for detailed examination. Data from around 700 participants were available for the subsequent analysis. The prevalence of severe sleep apnea (RDI = 5 or over) was 0.9% in those with STBUR scores of 0, 3.0% with STBUR scores of 1, 6.4% with STBUR scores of 2, and 13.3 with STBUR scores of 3, 4, and 5. According to multivariable logistic analysis odds ratio (95% confidence interval) vs STBURN score 0 were 3.54 ( .76 to 16.64) in STBURN score 1, those STBURN score 2 were 8.10 (1.71 to 38.40) after adjusted with grade, attention deficiency, hyper dyskinesia, while those of STBURN score 2 were 19.61 (3.33 to 115.47) after adjusted with grade, attention deficiency, hyper dyskinesia (p trend <.0001). Conclusion: STBUR scores and RDI values were associated, suggesting that high STBUR score (3 or over) well predicts sleep apnea (5/ hr<RDI).

titration-polysomnography (PSG-AHI) at the optimal pressure in children with OSA. Methods: This was a retrospective study of children with OSA who underwent a PAP titration-PSG at CCHMC between January 2010 and August 2018. Only children with PAP data within 6 months of titration-PSG were included. Demographics, body mass index (BMI), comorbid diseases, PAP-machine data, PSG parameters from the diagnostic and PAP-titration PSGs were collected. Results: 251 children (152 male) met the criteria. The median age at PAP-titration PSG was 12.8 years (IQR: 5.5-21) with 145 children (58%) were ≥12 years old. The average BMI was 28.2±13.1 kg/m 2 ; 61 children (24%) had a BMI >35 kg/m 2 . Almost half of the children (N=125, 49%) had a co-morbid disease. The average obstructive AHI (O-AHI) determined by the diagnostic PSG was 18.5±23.5 events/hour; 91 children (36%) had an O-AHI ≥15 events/hour. The average machine-AHI and PSG-AHI at the optimal pressure were 4.4±4.6 and 2.2±4.4 events/hour respectively (average difference of -2.3±5.9, p-value: <0.0001). Overall, there was a strong correlation between machine-AHI and PSG-AHI (r=0.23; p-value: 0.0002). The subgroup analysis revealed a better correlation in children ≥12 years (r=0.27; p-value: 0.0009), children with a diagnostic O-AHI <15 events/hour (r=0.23; p-value: 0.002) and BMI of ≤35 kg/ m 2 (r=0.20; p-value: 0.006). Multiple regression analysis showed that BMI (p-value: <0.0001) and PSG-AHI (p-value: 0.02) were significant predictors for the machine-AHI. In our study, the PAP machine tended to report a higher AHI in children. Overall, there was a strong correlation between machine-AHI and PSG-AHI. However, the correlation was weak in younger children, and children with higher BMI and more severe OSA.

Study Objectives: Obstructive sleep apnea (OSA) is associated with cardiovascular and cerebrovascular morbidity. Patients with sickle cell disease (SCD) are at increased risk for both neurologic complications (NC) and OSA. However, the relationship between OSA and SCD complications is unclear. We hypothesized that there would be an association between OSA diagnosis and SCD complications.

The aim of this prospective clinical trial is to investigate plasma IL-6, IL-10, TNF α levels in patients with Obstructive Sleep Apnea Syndrome (OSAS). TNF-α, IL-6 and IL-10 were measured in plasma of patients with OSAS. OSAS group with Apnea Hypopnea Index (AHI) ≥5, 42 patients and control group with AHI&lt;5, 40 patients. Plasma levels of IL-6 were statistically significantly higher in OSAS patients, and increased significantly as severity of OSAS increased. Mean IL-10 plasma levels of OSAS patients was statistically significantly lower than that of control group and decreased significantly as severity of OSAS increased. Mean plasma TNF-α level did neither differ significantly between OSAS and control groups, nor did it change significantly as severity of OSAS increased. Linear regression revealed plasma TNF-α level as the only significant independent factor influencing plasma IL-6 level. IL-6 increased as TNF-α increased. According to linear regression, no factor influenced plasm...

Introduction Vagus nerve stimulation (VNS) treatment for patients with intractable epilepsy has been shown to effectively lower seizure frequency and improve quality of life. However, due to stimulation of the vagus nerve, alterations in both central regulation of breathing and laryngeal muscle stimulation can precipitate obstructive sleep apnea (OSA). While there have been case reports describing OSA following VNS implantation, there has yet to be a detailed evaluation of this complication in a large cohort of VNS patients. The objective of this meta-analysis was to determine OSA rates in patients following VNS implantation. Methods English full-text articles were searched for on Pubmed, Scopus, and Embase databases. Articles had to follow patients before and after VNS implantation; report apnea-hypopnea index (AHI), respiratory disturbance index (RDI), or OSA rates following VNS implantation; be from a clinical trial, cohort, or case-control study. Two reviewers reviewed articles ...

The aim of this manuscript is to determine perioperative management of patients with obstructive sleep apnea. Obstructive sleep apnea (OSA) may cause postoperative complications related to upper airway collapse and cardiopulmonary system. Treatment with continue positive airway pressure (CPAP) may offer high standards of living to the patients and may protect them against postoperative complications. Long-acting and potent opioids may cause postoperative airway collapse in this population. Patients should be monitored and closely observed after surgery and anesthesia. In conclusion preoperative and postoperative CPAP administrations reduce the risk of postoperative complications significantly in OSA patients. Opioids should be avoided if possible intraoperatively.

This work presents a novel application of ultrasound for the real-time, non-invasive investigation of occlusion of the upper airway during events of obstructive sleep apnea/hypopnea syndrome. It is hypothesized that ultrasonic pulses applied to the neck during apneic events produce spectral and temporal features that can detect apnea occurrence. Theoretical models of ultrasound propagation and an in vitro test were conducted to test this hypothesis in both transmission and reflection modes. Complete specifications and technical details of the system design and fabrication, which is mounted on each subject’s neck, are presented, including the methodology. Nine patients (seven male and two female, mean age of 42 years, with a range of 25 to 56 years, and body mass index 37.6 ± 6.6 kg/m2) were recruited for a full night study, which included simultaneous nocturnal polysomnography for the validation of the results. Nine temporal features and four spectral features were extracted from th...

Drivers suffering from obstructive sleep apnea syndrome (OSAS) have an increased risk for being involved in motor-vehicle collisions. This study estimates, for the first time, the annual OSAS-related collisions, costs, and fatalities in the United States and performs a costbenefit analysis of treating drivers suffering from OSAS with continuous positive airway pressure (CPAP). Design: The MEDLINE-PubMed database (1980 to 2003) was searched for information on OSAS. A meta-analysis was performed of studies investigating the relationship between collisions and OSAS. Data from the National Safety Council were used to estimate OSAS-related collisions, costs, and fatalities and their reduction with treatment. Next, the annual cost of treating OSAS with CPAP was calculated. Finally, multiple 1-way sensitivity analyses were performed. Setting: N/A. Patients or Participants: N/A. Interventions: N/A. Measurements and Results: More than 800,000 drivers were involved in OSAS-related motor-vehicle collisions in the year 2000. These collisions cost $15.9 billion and 1,400 lives in the year 2000. In the United States, treating all drivers suffering from OSAS with CPAP would cost $3.18 billion, save $11.1 billion in collision costs, and save 980 lives annually. Conclusion: Annually, a small but significant portion of motor-vehicle collisions, costs, and deaths are related to OSAS. With CPAP treatment, most of these collisions, costs, and deaths can be prevented. Treatment of OSAS benefits both the patient and the public.

Healthcare Utilization in Women With OSAS-Banno et al This was not an industry supported study. Dr. Kryger has received research support from Sanofi-Synthelabo; is a consultant for Takeda Pharmaceutical North America; and is on the scientific advisory board for Cephalon Pharmaceuticals. Drs. Banno, Manfreda, Walld, and Delaive have indicated no financial conflicts of interest.

OBSTRUCTIVE SLEEP APNEA (OSA) is a syndrome characterized by repetitive obstruction of the upper airway during sleep that leads to apneic episodes with oxygen desaturation. Several chronic cardiovascular complications, including systemic arterial hypertension, 2-7 pulmonary hypertension, 8 myocardial infarction, 9 and stroke have been related to OSA. Studies involving large numbers of untreated patients have documented an increased mortality in OSA patients. Although the cause of this is unclear, it seems primarily to be due to car-diovascular sequelae. In one prospective study involving 34 patients (mean age 46 years), 15% (5 out of 34) died suddenly and unexpectedly within 4 years (3 of myocardial infarction and 2 of pulmonary edema). Atherosclerotic heart disease is the leading cause of death in the world today. Although it is well known that cholesterol and its primary carrier in the blood, low-density lipoprotein (LDL), are closely associated with heart disease, recent data have implicated an oxidized form of LDL as causally related to atherogenesis. Oxidation of LDL by oxygen-derived free radicals in the subendothelial space is now thought to play an important role in the atherosclerotic heart disease. Several studies have suggested that LDL, which is more susceptible to oxidation, may leave patients more susceptible to atherogenesis and, conversely, LDL which is relatively resistant to oxidation may provide Summary: Cardiovascular diseases are more common in patients with obstructive sleep apnea (OSA) than in the general population. We hypothesized that severe hypoxemia during sleep in these patients may cause an imbalance between reactive oxygen species and the antioxidant reserve that is important for the detoxification of these molecules. We tested the hypothesis that low-density lipoproteins (LDL) in hypoxic OSA patients may be more susceptible to oxidative stress than LDL of nonhypoxic OSA patients and normal controls. Fifteen OSA patients were included in this study, six with severe hypoxia (hypoxic group) who spent more than 10 minutes during sleep with SaO 2 <85% (mean 96 minutes), and nine OSA patients (nonhypoxic group) who spent less than 10 minutes during sleep with SaO 2 <85% (mean 1.1 minutes). Six healthy nonsmoking males of the same age group were included as a control group. The susceptibility of each individual's LDL to oxidative stress was examined after free-radical challenge in vitro by assessing changes in levels of conjugated dienes. The LDL in OSA patients with severe hypoxia was not more susceptible to oxidative stress compared to the LDL of nonhypoxic OSA patients and normal controls. After 6 hours of exposure to an oxidative agent, the changes in the mean conjugated diene were not different among the three groups (p = 0.75). The time required to reach 50% of maximal absorbance was also not different, p = 0.199. Glutathione peroxidase and catalase activities in red blood cells in the hypoxic and nonhypoxic patient groups were not significantly different. One night of CPAP therapy in each patient group did not significantly change the level of the antioxidant enzymes. Our results did not show any difference in the susceptibility to oxidative stress between hypoxic and nonhypoxic OSA patients and normal controls.

Background: Obstructive sleep apnea syndrome (OSAS) is a common disorder that remains underdiagnosed in adult females. The Berlin Questionnaire is a validated tool for identifying people at risk for OSAS. The aim of this report was to evaluate the prevalence of common symptoms of OSAS in women and to estimate the risk for OSAS among females in the United States. Methods: This is an analysis of data from the 2007 Sleep in America Poll of the National Sleep Foundation. The NSF Poll is an annual telephone survey of a representative sample of U.S. adults. The 2007 NSF Poll included 1254 women in the United States, with an oversample of pregnant and postpartum women. We used the Berlin Questionnaire to estimate the risk for OSAS among the U.S. female population. This instrument includes questions about self-reported snoring, witnessed apneas, daytime sleepiness, hypertension, and obesity. Also included were questions about sleep habits, sleep problems, menstrual cycle status, and other medical disorders. Results: Twenty-five percent of the female population was found to be at high risk for OSAS. Among women at high risk, such common symptoms of OSAS as habitual snoring (61%), observed apneas (7%), and daytime sleepiness (24%) were highly prevalent. Sleep onset insomnia (32%) or maintenance insomnia symptoms (19%) and restless legs syndrome (RLS) symptoms (33%) or body movements (60%) also were frequently reported. The risk increased with age ( p < 0.05), obesity ( p < 0.001), and menopause ( p < 0.001). The presence of chronic medical disorders was more frequently reported among women at high risk. Conclusions: One in four women in America is at high risk of having OSAS. Awareness by the primary care medical community of this disorder in females should thus be increased.

We performed this review in accordance with PRISMA guidelines for performing meta-analysis. A protocol was prospectively developed, detailing the objectives, criteria for study selection, and approach to assessing the study quality, primary outcome, and methodology. Study Objective: Patients with obstructive sleep apnea (OSA) frequently exhibit higher rates of dyslipidemia, a risk factor for cardiovascular and cerebrovascular disorders. Treatment for OSA by CPAP may improve cholesterol metabolism. This meta-regression analysis (MA) estimates the effect of CPAP treatment on dyslipidemia. Methods: PubMed and Cochrane libraries were searched by utilizing different combinations of keywords: CPAP, obstructive sleep apnea, serum lipids, dyslipidemia, cholesterol, total cholesterol (TC), low density lipoprotein, LDL, high density lipoprotein, HDL, triglyceride, and TG. Inclusion criteria were: (1) English articles and (2) studies with an adult population with the diagnosis of OSA who were treated with CPAP. The OSA group must have cholesterol profi le including TC, LDLc, HDLc, and TG, without and with CPAP treatment. Fifty-four studies were reviewed, while 29 studies pooled for MA. Results: Thirty-four datasets from 29 studies with 1,958 subjects pooled. Treatment duration range was from 2 days to 1 year. TC standardized mean differences (SMD) ranged from -41.5 to -0.077, pooled mean difference (PMD) was -5.660 (LL -6.715 to UL -4.606, p < 0.001). SMD in LDL ranged from -3.7 to 0; PMD was -0.488 (LL -0.715 to UL -0.261, p < 0.001). HDL SMD ranged from -0.498 to 1.94. The PMD was 0.207 (LL 0.05 to UL 0.364, p < 0.01). TG SMD ranged from -9.327 to 1.98; PMD was -0.054 (LL -0.124 to UL 0.016, p < 0.129). Conclusions: CPAP treatment for OSA seems to improve dyslipidemia

To assess the effectiveness of maxillomandibular adavancement for treatment of adults with obstructive sleep apnoea, we report the results obtained after maxillomandibular advancement. A group of 16 patients were studied before surgery, at 6 months after surgery and at followup. The analysis included: upper airway endoscopy during Mueller's manoeuvre, lateral cephalometry, polysomnography and Epworth Sleepiness Scale. The results of surgical treatment were divided into "surgical success" and "surgical cure". The former was defined as an AHI < 20 events/hour and a > 50% reduction in AHI after surgical procedure, while the latter was defined as an AHI < 5 events/hour after surgical procedure. At follow-up, all patients had AHI < 20 events/hour with a surgical success rate of 100%. The surgical cure rate was 37.5%, with 6 patients having an AHI < 5 events/hour. Surgical success and long term stability of outcomes confirm the efficacy and safety of MMA for treatment of obstructive sleep apnoea syndrome. However, a continuous follow-up of these patients is necessary to control their lifestyle and to detect possible relapse.

To assess the effectiveness of maxillomandibular adavancement for treatment of adults with obstructive sleep apnoea, we report the results obtained after maxillomandibular advancement. A group of 16 patients were studied before surgery, at 6 months after surgery and at followup. The analysis included: upper airway endoscopy during Mueller&#39;s manoeuvre, lateral cephalometry, polysomnography and Epworth Sleepiness Scale. The results of surgical treatment were divided into &quot;surgical success&quot; and &quot;surgical cure&quot;. The former was defined as an AHI &lt; 20 events/hour and a &gt; 50% reduction in AHI after surgical procedure, while the latter was defined as an AHI &lt; 5 events/hour after surgical procedure. At follow-up, all patients had AHI &lt; 20 events/hour with a surgical success rate of 100%. The surgical cure rate was 37.5%, with 6 patients having an AHI &lt; 5 events/hour. Surgical success and long term stability of outcomes confirm the efficacy and safety of...

Deep bite is one of the most common malocclusions. Traditional techniques correcting overbite features in all malocclusions have been known to be quite complicated, and challenging to orthodontists. The aim of current study was to present a combined approach for management of deep bite adult patients including fixed appliances and myofunctional Trainer for Braces appliance. Materials and methods: The current study included 28 patients (1852 y.). Full orthodontic analyses, including diagnostic radiology, photo documentation and impressions of every patient were before and after the treatment. Inclusion criteria for the study were: Class I and Class II malocclusions (dental and/or skeletal), deep overbite with overlap in incisors&gt; 30%, completed skeletal growth (&gt;18years), malocclusion requiring fixed techniques, oral muscles’ hyperactivity. Patients were grouped – Group 1patients treated only with fixed mechanics and Group 2 patients treated with fixed mechanics and Trainer for...

Body: Background Tissue Doppler Imaging (TDI) is used to better stratify dead risk in patients with congestive heart failure. Up today few studies have used this method to investigate the differences between patients with HF and Cheyne-Stokes breathing (CSB) with ones who haven't it. The aim of this study was to evaluate the impact of CSB on myocardic function by TDI. Materials and Methods 50 consecutive patients who afferent to Heart Failure Unit of University of Foggia were studied by conventional and Tissue Doppler echocardiography, and underwent to nocturnal poligraphy to evaluate the presence of sleep apnea and CSB. Results Mean age was 61,9±11,3 years, LVEF 38,41±11,5% and BMI was 31,6±3,9. 10 patients (20%) had high prevalence of CSB during the night. There wasn't any differences between this group and others ones about age, BMI, LVEF but there were many differences at TDI. Respect to patients without CSB, in ones who had it, late (A') diastolic peak velocity was lower (5,47±2,3 vs 7,9±2,6, p=0.04); the ratio of early to late diastolic velocity (E'/A') was higher (1,70±1,48 vs 0,76±0,31, p<0.01); EAS index [E'/(A' x S')] was higher (0,36±0,29 vs 0,16±0,11, p<0.01) and Isovolumic Relaxation Time (IRT) was lower (60,35±36,6 vs 113,5±48,3, p=0,04). There was also a positive correlation between percentage of CSB during the night and EAS index (0,76, p<0.01) and E'/A' (0,88, p<0.001). The presence of obstructive sleep apnea did not influenced this results. Conclusions Patients with HF and CSB have a worse cardiac function in compare with ones who haven't it. This condition is better evaluate by TDI that conventional echocardiography.

The increased prevalence of obstructive sleep apnea (OSA) mandates the presence of simple but accurate tools to identify patients with this disorder for early detection and prevention of various serious consequences. This study aimed at comparing two sleep questionnaires as regards their predictive probabilities for OSA. Two sleep questionnaires ( Epworth Sleepiness Scale [ESS] and STOP-Bang) were administered to the patients and scoring of the results of the questionnaires was done. Overnight attended polysomnography (PSG) was done for all patients and was considered the gold standard for the diagnosis of OSA. The sensitivity, specificity, positive and negative predictive values of the two questionnaires was calculated. Of 35 screened patients; 30(85%) had OSA. The STOP-Bang questionnaire had the highest sensitivity to predict OSA (96.66%) whereas ESS had a sensitivity of 73.33%. Specificity of STOP-BANG and ESS were 40% and 60% respectively. Positive predictive value of STOP-BANG ...

Based on data from the 1990s, estimated prevalence of obstructive sleep apnea (OSA) in the United States is 10% for mild OSA and 3.8% to 6.5% for moderate to severe OSA; current prevalence may be higher, given the increasing prevalence of obesity. Severe OSA is associated with increased all-cause mortality, cardiovascular disease and cerebrovascular events, diabetes, cognitive impairment, decreased quality of life, and motor vehicle crashes. To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for OSA in asymptomatic adults. The USPSTF reviewed the evidence on the accuracy, benefits, and potential harms of screening for OSA in asymptomatic adults seen in primary care, including those with unrecognized symptoms. The USPSTF also evaluated the evidence on the benefits and harms of treatment of OSA on intermediate and final health outcomes. The USPSTF found insufficient evidence on screening for or treatment of OSA in asymptomatic adults or adults with u...

Giriş: Çalışmanın amacı, obezite parametreleri ile ateroskleroz ile ilişkili olduğu gösterilen hemogram parametrelerinden ortalama trombosit hacmi (MPV), nötrofil-lenfosit oranı (NLO) ve platelet-lenfosit oranı (PLO) arasındaki ilişkinin değerlendirilmesidir. Yöntem: Çalışmaya İç Hastalıkları polikliniğine başvuran 240 birey alındı. Bireyler vücut-kitle indekslerine göre gruplandırıldı. Obez olan bireyler de kendi içinde sınıf I, sınıf II ve sınıf III obezite olarak 3 gruba ayrıldı. Bulgular: Çalışmaya 182 kadın ve 58 erkek hasta dahil edildi. Yaş ortalaması 45,4±13,0 yıl, vücut-kitle indeks ortancası 31,4 (26,2–36,5) kg/m2 idi. Vücut-kitle indeks ile hemoglobin (r=-0,168, p=0,009) ve hematokrit (r=-0,188, p=0,003) değerleri arasında negatif, vücut-kitle indeks ile MPV (r=0,186, p=0,004) arasında ise pozitif korelasyon bulundu. Kilo ile PLO arasında negatif korelasyon bulundu (r=-0,143, p=0,027). Kalça çevresi ile MPV arasında pozitif korelasyon bulundu (r=0,155, p=0,016). Vücut-kit...