Obstructive sleep apnea

Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive Sleep Apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or comorbidities or ≥ 15 such episodes without any sleep related symptoms or comorbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation....

Objectives: To assess the risk of obstructive sleep apnea (OSA) and its associated risk factors among patients with type 2 diabetes in the south of Saudi Arabia. Methodology: This is a cross-sectional study conducted in the Armed Forces Hospital in Jazan. The prevalence of OSA was assessed through a validated Arabic translation of the STOP-BANG screening questionnaire. The odds of a higher OSA risk were calculated via regression analysis according to the measured clinical and demographic variables. Results: The total number of participants was 306, of which 213 (70%) were over the age of 50; 247 (81%) were married, and 161 (53%) were females. The overall median score of the OSA risk level assessed by the STOP-BANG items was three on a scale of 0-8 of which 193 (63.1%) of the participants in the sample were classified as being at high risk of developing OSA. Several statistically significant associations were identified where odds ratios (ORs) with a higher OSA risk level were detected according to age, gender, social status, waist and neck circumference, hemoglobin A1c (HbA1c) and body mass index (BMI) levels, duration of diabetes, and comorbidity with hypertension (p-values <0.05). Conclusions: The higher risk of OSA identified in our sample of diabetic patients can be related to a high prevalence of obesity, larger neck circumferences, hypertension, and other factors related to the duration and treatment of diabetes. Additionally, the association between waist circumference, HbA1c, and duration since the diagnosis of diabetes suggests an interaction effect requiring further investigations. Response to Reviewers: Dear Journal Office Thank you for your feedback. All responses to reviewers' comments have been .attached with the submission. Below are responses to your editorial comments Best wishes Corresponding author Ibrahim Gosadi Itemized Responses to Editorial Comments Comment 1. Article category Response: The article title was modified to indicate the type of the article category as the : following Assessment of Risk of Obstructive Sleep Apnea among Patients with Type 2 diabetes and Associated Factors using STOP-BANG questionnaire: a cross-sectional study (Comment 2. 3 names of each author (first, last, and initial of middle name Response: The 3 names of each author (first, last, and initial of middle name) have

To determine the association between body position and obstructive events during sleep as determined by polysomnography (PSG) in infants of ages 8–12 months with obstructive sleep apnea (OSA).Consecutive nocturnal polysomnograms (NPSGs) of 50 children ages 8–12 months old referred to the sleep disorders center between 1 January 2003 and 1 June 2006 for possible sleep-disordered breathing were retrospectively reviewed. Data on total obstructive apnea index (AI), total obstructive apnea–hypopnea index (AHI), AI by body position, AHI by body position, rapid eye movement (REM) and non-REM sleep AHI and REM and non-REM AI were recorded.The mean age was 9.5 ± 1.9 S.D. months and 46% of the patients were females. There were no significant differences between the mean non-supine AHI (2.0 ± 5.1) and supine AHI (2.5 ± 5.4), p = 0.63. When comparing specific body positions, there were also no significant differences between the mean supine AHI (2.5 ± 5.4), prone AHI (2.9 ± 7.3), left-lateral decubitus AHI (1.1 ± 6.1), or the right-lateral decubitus AHI (2.5 ± 7.6), p = 0.71. Additionally, there were also no significant differences between the mean non-supine AI (0.7 ± 2.9) and supine AI (1.4 ± 3.0), p = 0.23, and no differences between the supine AI (0.7 ± 2.9), prone AI (1.0 ± 2.9), left-lateral decubitus AI (0.3 ± 2.9) or the right-lateral decubitus AI (1.1 ± 3.0), p = 0.44. Children spent an average of 50% of their total sleep time supine. OSA was significantly worse in REM sleep as compared to non-REM sleep (REM AHI 4.3 ± 7.3 versus non-REM AHI 1.4 ± 3.9, p = 0.015; REM AI 5.1 ± 4.9 versus non-REM AI 1.5 ± 4.9, p < 0.001). Mean time in REM sleep was 26% (range 5–42%).There was no significant effect of body position on sleep-disordered breathing in 8–12 months old infants, although REM sleep represented a significant risk factor for OSA.

Purpose The purpose of this study was to investigate apnea–hypopnea index (AHI) across two polysomnographies (PSGs) to examine AHI variability and impact on clinical diagnosis. Materials and methods Two-night PSGs of 193 sleep clinic patients were reviewed, and the AHI variability was analyzed. Anonymized records from five patients with significant night-to-night AHI variability were used in this study: the two-night PSGs from two patients were represented as four individual PSGs; the two-night PSG for two others were represented as being obtained from two different sleep clinics; the last patient’s PSG was shown as a two-night study. Twenty-two sleep experts attending the Associated Professional Sleep Societies meeting were recruited to make diagnoses based on the PSGs. They were told that the PSGs were from seven patients: four with single-night PSG; two with two PSGs, each one from a different clinic; and one patient with a two-night PSG. Results Twenty-one percent of the 193 sle...

There is evidence that changes in branched-chain amino acid (BCAA) levels may correlate with the efficacy of therapeutic interventions for affecting improvement in metabolic control. The objective of this study was to evaluate whether serum concentrations of BCAAs (leucine, isoleucine, valine) could mediate in insulin sensitivity and glucose tolerance after continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). A prospective randomized controlled trial of OSA patients with morbid obesity was conducted. Eighty patients were randomized into two groups: 38 received conservative treatment and 42 received CPAP treatment for 12 weeks. Plasma levels of BCAA, glucose tolerance and insulin resistance were evaluated at baseline and after treatment. After treatment, significant decreases of leucine levels were observed in both groups when compared with baseline levels (P &lt; 0.005). With respect to patients with normal glucose tolerance (NGT), pat...

Our objective was to characterize sleep-disordered breathing in 88 children with achondroplasia aged 1 month to 12.6 years. At the time of their initial polysomnography, five children had previously undergone tracheostomy, and seven children required supplemental oxygen. Initial polysomnography demonstrated a median obstructive apnea index of 0 (range, 0 to 19.2 apneas/hr). The median number of central apneas with desaturation per study was 0.5 (0 to 49), the median oxygen saturation nadir was 91% (50% to 99%), and the median peak end-tidal pCO2 was 47 mm Hg (36 to 87 mm Hg). Forty-two children (47.7%) had abnormal initial study results, usually caused by hypoxemia. Two children with severe obstructive sleep apnea eventually required continuous positive airway pressure therapy, and three additional children required tracheostomies. (1) Children with achondroplasia often have sleep-related respiratory disturbances, primarily hypoxemia. (2) The majority do not have significant obstructive or central apnea; however, a substantial minority are severely affected. (3) Tonsillectomy and adenoidectomy decreases the degree of upper airway obstruction in most but not all children with achondroplasia and obstructive sleep apnea. (4) Restrictive lung disease can present at a young age in children with achondroplasia.

We previously postulated how evolutionary changes in man's upper respiratory tract to facilitate speech, a phenomenon Jared Diamond calls The Great Leap Forward, have predisposed man to obstructive sleep apnea (OSA) [Diamond J. The Third Chimpanzee: the evolution and future of the human animal. New York: HarperCollins Publishers; 1992. p. 21, 23, 32–54, 54–6; Davidson TM. The Great Leap Forward: the anatomic evolution of obstructive sleep apnea. Sleep Medicine 2003;4:185–94]. We grouped these anatomic changes into four categories: klinorynchy, laryngeal descent, craniobase angulation and supralaryngeal vocal tract (SVT) ratio of SVTH:SVTV. This study was designed to investigate the relationship between cephalometric measures corresponding to these anatomic changes and OSA.One hundred and twenty-three male subjects presenting with symptoms of OSA underwent unattended multi-channel home sleep studies. We obtained cephalometric measurements from standard lateral cephalograms. Pearson correlation coefficients were calculated between cephalometrics and apnea–hypopnea index (AHI), age, and body mass index (BMI).Our results showed significant correlation between AHI and klinorynchy, laryngeal descent, and craniobase angulation.Overall, our data supports the theory that evolutionary anatomic changes to facilitate speech correlate with OSA severity. The cumulative changes in each cephalometric category trended in the directions hypothesized and support the Great Leap theory of OSA evolution.

We sought to reintroduce a historical procedure-intracapsular tonsillar reduction (partial tonsillectomy or tonsillotomy)-for tonsillar hypertrophy causing obstructive sleep disordered breathing (OSDB) in children, as well as to determine whether partial tonsillectomy, compared with conventional (total) tonsillectomy when performed by more than one surgeon, is equally effective for the relief of OSDB while resulting in less pain and more rapid recovery. We conducted a retrospective case series at a tertiary children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s hospital. The charts of children who underwent partial tonsillectomy and total tonsillectomy (1998 through 2002) for postoperative complications were reviewed. The caregivers were surveyed to assess postoperative pain, rapidity of recovery, and effectiveness of surgery for relieving symptoms of OSDB. Two hundred forty-three children underwent partial tonsillectomy and 107 children underwent total tonsillectomy. There were no significant differences in immediate and delayed complications between the groups. Both operations were equally effective in relieving OSDB. Children who had partial tonsillectomy had significantly less postoperative pain and significantly more rapid recovery. Intracapsular tonsillar reduction with an endoscopic microdebrider relieves OSDB as effectively as conventional tonsillectomy, but results in less postoperative pain and a more rapid recovery.

Soto&#39;s syndrome is a genetic disorder caused by mutations in the NSD1 gene. It is characterized by excessive growth in early life. It features craniofacial abnormalities, developmental delay, hypotonia and advanced bone age. A review of the current literature reveals only chronic otitis media and conductive hearing loss as otolaryngologic manifestations of Soto&#39;s syndrome. Our objective was to determine if there are additional manifestations relevant to the otolaryngologist. We performed a retrospective case series in which the Department of Defense electronic medical record was searched for ICD 9 code 253.0 (acromegaly/gigantism). Records were reviewed for genetic testing indicative of Soto&#39;s syndrome. These records were further analyzed for evidence of otolaryngologic problems. Seventeen patients were identified with five having confirmed NSD1 mutations consistent with Soto&#39;s syndrome. Of these, 4/5 had otolaryngologic problems such as conductive hearing loss, aspi...