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PubMedDate not supplied

Impact of obstructive sleep apnea on right ventricular global function: sleep apnea and myocardial performance index.

BACKGROUND: Obstructive sleep apnea (OSA) is characterized by repetitive upper airway obstructions during sleep, and it might cause cardiovascular complications such as heart failure, arrhythmias, myocardial infarction, systemic and pulmonary hypertension. OBJECTIVES: To determine right ventricular diameters and myocardial performance index (MPI) reflecting ventricular global function in uncomplicated OSA patients. METHODS: 49 subjects without hypertension, diabetes mellitus, or any cardiac or pulmonary disease referred for evaluation of OSA had overnight polysomnography and complete echocardiographic assessment. According to the apnea-hypopnea index (AHI), subjects were divided into three groups: group 1: control subjects (AHI <5, n = 20), group 2: patients with mild OSA (AHI: 5-14, n = 11), and group 3: moderate-severe OSA (AHI > or = 15, n = 18). Right ventricular free wall diameter was measured by M mode, and right ventricular MPI was calculated as (isovolumic contraction time + isovolumic relaxation time)/pulmonary ejection time. RESULTS: There were no differences of age, body mass index, heart rates, systolic and diastolic blood pressures among the groups (p > 0.05). Right ventricular end-diastolic and end-systolic diameters were not statistically different between the groups, and were within normal limits. Also, right ventricular free wall diameter was not significantly different between the groups of control, mild OSA and moderate-severe OSA (6.7 +/- 0.9, 6.9 +/- 1.0, 7.1 +/- 1.1 mm, p > 0.05). Right ventricular diastolic dysfunction was shown only in group 3 patients. Right ventricular MPI was statistically higher in group 3 (0.62 +/- 0.18) than in group 2 patients (0.50 +/- 0.10), and group 1 patients (0.48 +/- 0.08, p < 0.001). CONCLUSIONS: It was suggested that patients with moderate-severe OSA had a right ventricular global dysfunction, in addition to the presence of a diastolic dysfunction.

Adult↗
PubMed2006

Association of elevated levels of vascular endothelial growth factor in obstructive sleep apnea syndrome with patient age rather than with obstructive sleep apnea syndrome severity.

BACKGROUND: Although certain studies report high levels of vascular endothelial growth factor (VEGF) in obstructive sleep apnea syndrome (OSAS), the effect of systemic hypoxia on circulating VEGF remains controversial. OBJECTIVES: To study the association of serum VEGF and OSAS in a large group of patients. METHODS: One hundred patients with OSAS (mean age 58.1+/-12.4 years, mean body mass index 30.6+/-5.4 kg/m2) were tested for serum VEGF levels, and the findings were correlated with the severity of OSAS, as determined by the apnea-hypopnea index (AHI) on the basis of polysomnography and background data. RESULTS: The mean AHI was 40.0+/-21.2 (range 10-106). Mean minimal oxygen saturation was 80.6+/-11.7% (range 43-98%) and mean time of oxygen saturation under 90% was 50.0+/-75.0 min (range 0-300 min). The mean VEGF level was 445.2+/-289.8 pg/ml in the study group (vs. 280 pg/ml reported in normal controls). The mean platelet count was 233.8+/-64.4 10(3)/ml and the mean VEGF/platelet ratio was 1.95+/-1.40 pg/10(6). There was no association of VEGF or VEGF/platelets with the severity of OSAS. However, both factors showed a significant correlation with patient age (r=0.224, p=0.01 and r=0.425, p=0.01, respectively). Age was the only parameter to significantly predict VEGF and VEGF/platelets on multivariate analysis (R2=0.713, p=0.001 and R2=0.844, p=0.001, respectively). CONCLUSION: The elevation of serum VEGF in OSAS is not associated with the severity of the disease, but it is associated with patient age. VEGF might be involved in the long-term adaptive mechanism in OSAS, and its age-dependent increase might partly explain the reduced mortality in elderly OSAS patients.

Adult↗
PubMed1993

The relationship between the severity of sleep apnea syndrome and 24-h blood pressure values in patients with obstructive sleep apnea.

Automated ambulatory 24-h BP monitoring was made in 38 patients with obstructive sleep apnea syndrome. Stepwise multiple regression analysis revealed that diastolic, systolic, and mean BP values during sleep as well as during wakefulness were significantly related to apnea/hypopnea index and age. Minimal arterial O2 saturation and total sleep time also significantly contributed to diastolic and mean BP values during sleep. Body mass index did not significantly contribute to any of the BP values. These results support a causal relationship between the severity of sleep apnea syndrome and systemic hypertension.

Adult↗
PubMed2001

Breath-to-breath variability correlates with apnea-hypopnea index in obstructive sleep apnea.

BACKGROUND: Breathing in patients with obstructive sleep apnea (OSA) is frequently interrupted by periods of hypopnea and apnea. There is limited information regarding a possible disturbance of breathing outside these periods. STUDY OBJECTIVE: To analyze the degree of breathing disturbance during nonocclusion. DESIGN: Prospective determination of breathing variability during full polysomnographic sleep studies. PATIENTS: Breath-to-breath variation was monitored in 34 patients with OSA and in 9 healthy subjects. MEASUREMENTS AND RESULTS: All breath-to-breath intervals were automatically analyzed from flow signal, displayed, and manually corrected for artifacts. Distribution of all nonapneic breath intervals was analyzed for the extent of difference from a normal distribution pattern by specifying kurtosis. In untreated OSA patients, kurtosis was significantly reduced (0.0 +/- 0.5, mean +/- SD) compared to control subjects (0.8 +/- 0.5), indicating increased variability of nonoccluded breathing. This effect was present in all sleep stages, and the extent depended significantly on the degree of disease. Continuous positive airway pressure breathing was able to normalize kurtosis (1.0 +/- 0.9) immediately. CONCLUSIONS: Breathing in OSA is not only characterized by interruptions of breathing during occlusion, but by a greater variation in the pattern of normal-length breaths.

Adult↗
PubMed2003

Transitory increased blood pressure after upper airway surgery for snoring and sleep apnea correlates with the apnea-hypopnea respiratory disturbance index.

A transitory increase in blood pressure (BP) is observed following upper airway surgery for obstructive sleep apnea syndrome but the mechanisms implicated are not yet well understood. The objective of the present study was to evaluate changes in BP and heart rate (HR) and putative factors after uvulopalatopharyngoplasty and septoplasty in normotensive snorers. Patients (N = 10) were instrumented for 24-h ambulatory BP monitoring, nocturnal respiratory monitoring and urinary catecholamine level evaluation one day before surgery and on the day of surgery. The influence of postsurgery pain was prevented by analgesic therapy as confirmed using a visual analog scale of pain. Compared with preoperative values, there was a significant (P < 0.05) increase in nighttime but not daytime systolic BP (119 5 vs 107 3 mmHg), diastolic BP (72 4 vs 67 2 mmHg), HR (67 4 vs 57 2 bpm), respiratory disturbance index (RDI) characterized by apnea-hypopnea (30 10 vs 13 4 events/h of sleep) and norepinephrine levels (22.0 4.7 vs 11.0 1.3 g l-1 12 h-1) after surgery. A positive correlation was found between individual variations of BP and individual variations of RDI (r = 0.81, P < 0.01) but not between BP or RDI and catecholamines. The visual analog scale of pain showed similar stress levels on the day before and after surgery (6.0 0.8 vs 5.0 0.9 cm, respectively). These data strongly suggest that the cardiovascular changes observed in patients who underwent uvulopalatopharyngoplasty and septoplasty were due to the increased postoperative RDI.

Analysis of Variance↗
PubMed2000

[Results of 248 patients with sleep apnea syndrome treated by continuous positive pressure ventilation between 1990 and 1995. A study of compliance and outcome of the apnea-hypopnea index].

Between 1990 and 1995, 369 patients were investigated for obstructive sleep apnea syndrome (OSAS) by polysomnography. Among them, 248 patients with a mean Apnea-Hyponea index (AHI) of 37.7 per hour were treated by nasal continuous positive airway pressure (n-CPAP). Mean follow up was 39.5 +/- 20.4 months. In this group, 23 patients (9.2%) refused nCPAP immediately or after the first night and 39 (15.7%) gave up later. 15 patients (6%) died during the period of the study. The cumulative compliance reached 70% at 72 months. Non compliant patients usually gave up n-CPAP before the end of the first year. We compared the group of 150 patients always treated at the date of 31/12/95 with the group of 62 patients who refused nCPAP initially or gave up later. There was no difference in clinical parameters or polysomnographic data between the two groups. In 94 patients treated by nCPAP for more than a year we evaluated the outcome of AHI by a polysomnography performed after 72 hours of nCPAP cessation. Mean AHI of the group at this time was 38.2 +/- 20.3/h and was well correlated with the initial index (r = 0.41, p < 0.0001). However for 28 patients (29.7%) we observed, at the time of this second AHI determination, a variation (plus or minus) of at least 50% of the index. 6 patients, without any significative weigth loss, had an AHI below 5/h at this second determination. In this small group nCPAP was interrupted for 6 to 12 months, then another polysomnography was performed. At this time mean AHI was 42.4/h and clinical symptoms had reappeared in all patients. This study demonstrated that compliance to nCPAP in OSAS patients is good. No clinical or polysomnographic factors allow to predict non compliance. AHI is not modified by long term treatment with nCPAP.

Female↗
PubMed1988

Obstructive sleep apnea: a polysomnographic study of sleep apnea before and after tonsillectomy and adenoidectomy.

We report about polysomnographic studies including EEG, EOG, EMG, ECG, measurement of oropharyngeal airflow, recording of chest wall movements and transcutaneous measurements of pO2 and pCO2 in a 4-year-old girl with severe obstructive sleep apnea. Her sleep profile was characterized by a disturbed cyclic pattern of sleep stages with onset of sleep at stage 4, shortening of REM-sleep periods and of sleep stages 1 and 2, and an increased quantity of sleep stage 4. The total time spent in apneic episodes was 11.3% of the total sleep period (only obstructive events). Apneic attacks were recorded mainly in REM and light NREM sleep states. Tonsillectomy and adenoidectomy resulted in marked improvement without further evidence of abnormal sleeping pattern or of sleep apneas.

Adenoidectomy↗
PubMed1985

Achondroplasia and obstructive sleep apnea: correction of apnea and abnormal sleep-entrained growth hormone release by tracheostomy.

Severe obstructive sleep apnea in a patient with achondroplasia syndrome was found to result in a definitive deficiency of overnight growth hormone secretion related to absence of slow-wave sleep. Resolution of the apnea by tracheostomy resulted in normalization of growth hormone release and normal growth rates postoperatively. Sleep-related growth hormone deficiency may contribute to the short stature so often seen in a variety of craniofacial syndromes. Furthermore, this short stature may be reversible.

Achondroplasia↗
PubMed1996

[Anamnestic and polygraphic parameters in obstructive sleep apnea syndrome patients with reduced nasal respiration during the day in comparison with obstructive sleep apnea patients with normal nasal respiration].

Nasal obstruction is a predictive factor for snoring and may contribute to the development of an obstructive sleep apnea syndrome (OSAS). The aim of this study was to further evaluate the impact of nasal obstruction in OSAS. Therefore, we investigated 2 groups of OSAS-patients, matched pairs concerning gender, age, and BMI: OSAS-patients with nasal obstruction (N, n = 28), total nasal airflow < 500 ccm/s (referred to 150 pa pressure of difference or unilateral nasal resistance > 1 pa/ccm/s), and 28 OSAS-patients without nasal obstruction (control-group K, total nasal airflow > 700 ccm/s [referred to 150 pa pressure of difference or unilateral nasal resistance > 1 pa/ccm/s]). We performed anterior rhinomanometry, lung-function testing, cardio-respiratory polygraphy, and patients answered a standardized questionnaire. We found the following significant differences: 1) N complained more often (n = 17) about dyspnea at night than K (n = 7, p < 0.05, Chi2-test). 2) N had a higher apnea index (20.4 +/- 19.0/h) than K (9.6 +/- 10.0/h, p < 0.05, Student's t-test). There were, however, no significant differences concerning lung function, number of nocturnal hypopneas, nocturnal SaO2 and heart rate. Our results underline the importance of nasal ventilation in the pathogenesis of OSAS. At least in moderate cases of OSAS a therapy of nasal obstruction might be of success in order to abolish nCPAP-therapy or might reduce nasal problems during nCPAP-therapy and thus ameliorate patient's therapy compliance.

Airway Resistance↗
PubMed1995

A dental and medical approach to sleep apnea. Part I: An overview of sleep apnea.

Over the last decade there has been increasing evidence that obstructive sleep apnea is a common and potentially serious medical problem. Until recently the condition was primarily dealt with by pulmonary, sleep, and ENT physicians. With the development of the oral mandibular advancement devices for the treatment of sleep apnea, dentists have played an increasing role in the treatment of the condition. This series of articles will review the pathophysiology, clinical manifestations, diagnostic strategies and treatment options for this condition.

Disease Susceptibility↗
PubMed2006

Comparison of the effects of depressive symptoms and apnea severity on fatigue in patients with obstructive sleep apnea: a replication study.

BACKGROUND: Links between fatigue and depressive symptoms in medically ill patients are well-documented; however, few studies controlled for illness severity. Obstructive sleep apnea (OSA) is a common, frequently devastating disease that often includes daytime sleepiness and fatigue. Fatigue is also a hallmark depressive symptom. We previously reported that depressive symptoms explained ten times the variance in fatigue in OSA patients as did OSA severity itself (respiratory disturbance index, oxyhemoglobin saturation). OSA severity explained 4.2% of variance in fatigue while depressive symptoms explained an additional 42.3%. Here, we report a replication of these findings in a new, independent sample. METHODS: 56 untreated OSA patients had their sleep monitored with polysomnography on the UCSD GCRC. Participants completed the Center for Epidemiologic Studies-Depression (CESD), Profile of Mood States (POMS) and Medical Outcomes Studies (MOS) surveys. Data were analyzed using hierarchical linear regression. RESULTS: OSA severity explained 13.4% (p=0.022) of variance in POMS fatigue while CESD scores explained an additional 24.5% (p<0.001). Results were robust to changes in the scales used to measure these constructs. LIMITATIONS: Cross-sectional design precludes determination of direction of causality. Assessment of depressive symptoms and fatigue was based on validated self-report measures. CONCLUSIONS: These results reaffirm that depressive symptoms are dramatically and independently associated with worse fatigue in OSA patients. While the independent contribution of OSA severity varied between studies, depressive symptoms were the strongest predictor of fatigue in both studies. Assessment and treatment of mood symptoms-not just treatment of OSA itself-might reduce fatigue in these patients.

Adult↗
PubMed1993

Apnea spells, sudden death, and the role of the apnea monitor.

SIDS is the most common cause of death between the ages of 1 week and 1 year. It affects 1 out of every 500 to 600 live births. The etiology of SIDS is unknown. There are no tests currently available to predict the infant who will die from SIDS prior to death. SIDS cannot be prevented. Many infants experience serious apneic spells, however, that require diagnostic evaluation and treatment. Even if the treatment of these infants does not have a large impact on the SIDS rate for the general population, thorough diagnostic evaluations and appropriate use of home apnea-bradycardia monitoring is indicated for this population and may reduce their risk of morbidity or mortality.

Female↗
PubMed2000

Obstructive sleep apnea in infants: relation to family history of sudden infant death syndrome, apparent life-threatening events, and obstructive sleep apnea.

OBJECTIVES: Familial aggregation of obstructive sleep apnea (OSA) has been shown to be associated with sudden infant death syndrome (SIDS) and apparent life-threatening events (ALTE) in infants. We wanted to determine the incidence of OSA in infants with siblings with ALTE and SIDS referred to our sleep clinic and to ascertain whether OSA was more common in infants who have family histories of SIDS, ALTE, and OSA. STUDY DESIGN: We studied 125 infants (mean age, 11.5 +/- 0.6 weeks) who were separated into 2 groups on the basis of their family history; polysomnographic studies were performed on each infant. RESULTS: Twenty infants had a multiple family history of SIDS, ALTE, or OSA (group 1), whereas the other 105 infants (group 2) had only one case of SIDS or ALTE within the family and no known history of OSA. We found that 19 of 20 infants in group 1 had OSA, whereas only 31 of 105 infants in group 2 had OSA (chi-squared analysis, P <.05). The OSA recorded was more frequent in infants of group 1 than in those of group 2. Follow-up studies in some infants with OSA demonstrated a progressive decrease in OSA, which resolved between 6 and 12 months of age. CONCLUSION: We conclude that infants of families with multiple histories of SIDS, ALTE, and OSA are more likely to have OSA than infants of families with only one case of SIDS or ALTE.

Age Factors↗
PubMed2004

Obstructive sleep apnea: Part II. Surgical approaches to sleep apnea.

Successful surgical management of obstructive sleep apnea (OSAS) requires a thorough understanding of the pathophysiology and anatomical contributions to this widely variable disease. Early efforts to surgically correct OSAS involved bypassing the upper airway; thus, indirectly improving the symptoms without directly addressing the pathophysiology. Surgical procedures to treat OSAS have evolved over the past several decades as further understanding of the disease continues to be elicited. The surgical techniques employed in the treatment of OSAS are quite varied. Many surgical subspecialties have contributed to the understanding of the complexities of OSAS. Recent surgical management involves site-specific alterations of the upper airway to more directly address the disease process. In addition, current literature suggests an algorithmic and phased approach to the treatment of OSAS. Future technology offers the hope of better diagnostic and therapeutic options for the surgical management of OSAS.

Adult↗
PubMed1991

Long-time follow-up after UPPP for obstructive sleep apnea syndrome. Results of sleep apnea recordings and subjective evaluation 6 months and 2 years after surgery.

Fifty unselected consecutive patients with obstructive sleep apnea syndrome (OSAS) underwent uvulopalatopharyngoplasty (UPPP). The diagnosis was based on the patient's history and recording of respiration movements (Static Charge Sensitive Bed. SCSB) and oximetry, alone or combined with polysomnography. Renewed SCSB oximetry recordings were used to evaluate the success of the treatment. Six months postoperatively 40% of the patients were classified as non-responders, i.e. their oxygen desaturation indices (ODI) were reduced by less than 50% or were still above 20. The mean body mass index (BMI) was significantly higher in the non-responder group. A second recording with complete data was obtained in 45 patients after an average of 21 months. It was found that 9 patients who had been responders in the first postoperative recording had become non-responders. Only 18 of the patients with complete data could be verified as responders after 2 years. The patients who relapsed showed a significant increase in mean BMI between the first and second postoperative recordings compared to the patients who remained responders. There were no significant differences between responders and non-responders concerning age or preoperative severity of OSAS expressed as ODI, nadir SaO2 and percentage of obstructive periodic breathing. Of the non-responders, 47% in the first postoperative recording and 52% in the second reported complete recovery from excessive daytime sleepiness. This subjective improvement was not correlated to the objective results. The conclusions of this study are thus that one postoperative recording is not enough to estimate the outcome of UPPP and that statements of the patient's subjective recovery alone must not be used for this purpose.

Adult↗
PubMed2005

[Vasomotor reactivity throught the voluntary apnea test can be measured without calculating the apnea index].

INTRODUCTION: Vasomotor reactivity (VR) is the capability of the cerebral arterioles to dilate and to constrict in response to determined stimuli. Using transcranial doppler (TCD), there are various test to evaluate it, including the breath holding test. With this test, VR can be calculated two ways: using the increment percentage of the mean velocity with respect to the basal velocity (PIV) or by quantifying the apnea time to obtain what is call the breath holding index (PIV/apnea seconds). The objective of our study is to study the linear correlation between the PIV and the breath holding index. METHODS: This was an observational study performed in a neurology ambulatory setting. A total of 128 subjects, age 16 to 50 years old, were included. We assessed VR using the breath holding test described by Markus and Harrison on the middle cerebral artery. The linear correlation between the two quantitative variables was analysed using Pearson's correlation coefficient. RESULTS: Pearson's correlation coefficient between the PIV and the breath holding index was 0.75 for a significance level of p < 0.0001. CONCLUSION: Given the good linear correlation between these two methods for calculating the VR using the breath holding test, we consider it is not necessary to calculate breath holding test time when using this test.

Adolescent↗
PubMed1996

Obstructive sleep apnea presenting during infantry field exercises: does the Army Weight Control Program protect soldiers from obstructive sleep apnea?

We report two cases of obstructive sleep apnea (OSA) that presented during infantry field exercises as snoring so loud as to risk betraying the unit's position. Both patients exceeded the height-weight standards of the Army Weight Control Program (AWCP). Since high body mass is a strong risk factor for OSA, we asked whether the AWCP reduces the risk of OSA. We found that it should for women in all age groups and for men over 40, but it is less protective for younger men (who constitute a large portion of Army personnel). In light of this and of previous estimates that up to 1.5% of all Army personnel exceed the AWCP standards, we conclude that there may be a significant number of unrecognized cases of OSA in the Army. Additionally, tightening of the AWCP standards may be warranted for women under 30 and men under 50, who currently are permitted to significantly exceed ideal body weight.

Exercise↗