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Obesity Surgery Jun 2022Preoperative assessment of obstructive sleep apnea (OSA) in patients scheduled for bariatric surgery can be performed by in-laboratory polysomnography (PSG) or by...
BACKGROUND
Preoperative assessment of obstructive sleep apnea (OSA) in patients scheduled for bariatric surgery can be performed by in-laboratory polysomnography (PSG) or by portable polygraphy (PP) at home. We aimed to evaluate the association between PSG/PP, OSA diagnosis, and implementation of continuous positive airway pressure (CPAP) therapy.
METHODS
All patients who underwent bariatric surgery from 2015 to 2017 were retrospectively reviewed. Patients underwent preoperative PSG or PP, based on prevailing protocols or at the physician's discretion. Logistic regression analyses were performed to determine predictors of CPAP implementation. OSA-related postoperative complications were analyzed in both groups.
RESULTS
During the study period, 1464 patients were included. OSA was diagnosed in 79% of 271 patients undergoing PSG, compared to 64% of 1193 patients undergoing PP (p < 0.001), with median apnea-hypopnea index (AHI) of 15.8 and 7.7, respectively. CPAP treatment was initiated in 52% and 27% of patients, respectively, p < 0.001. Predictors (with adjusted odds ratio) in multivariate regression analysis for CPAP implementation were as follows: male gender (5.15), BMI ≥ 50 (3.85), PSG test (2.74), hypertension (2.38), and age ≥ 50 (1.87). OSA-related complications did not differ between groups (p = 0.277).
CONCLUSION
Both PSG and PP are feasible options for preoperative OSA assessment in bariatric patients. When PP is performed, some underdiagnosis may occur as cases of mild OSA may be missed. However, clinically relevant OSA is detected by both diagnostic tools. No difference in OSA-related complications was found. PP is a safe, less invasive option and can be considered as a suitable measure for OSA assessment in this population.
Topics: Bariatric Surgery; Continuous Positive Airway Pressure; Humans; Male; Obesity, Morbid; Polysomnography; Retrospective Studies; Sleep Apnea, Obstructive
PubMed: 35396662
DOI: 10.1007/s11695-022-06038-4 -
European Archives of... Apr 2017While managing obstructive sleep apnea (OSA) or suspicious OSA patients, the otorhinolaryngologist frequently has to deal with patients undergoing repeated...
While managing obstructive sleep apnea (OSA) or suspicious OSA patients, the otorhinolaryngologist frequently has to deal with patients undergoing repeated polysomnography (PSG) or portable monitoring (PM) and, on the other hand, should be confident about the quality and consistency of the polysomnographic diagnosis. The main polysomnographic traces compressed in a unique epoch, defined as compact PSG/PM (CP), which should be reported in all PSG/PM report, could represent an efficient tool to confirm the quality of PSG/PM diagnosis and to recognize the sleep breathing disorders (SBD): OSA, no-OSA SBD and overlap of OSA with no-OSA SBD. In this study, a synthetic and clear guided iconography and an easy decision-making algorithm based on desaturation patterns (phasic, prolonged and overlap desaturation patterns) identifiable on the CP are suggested for a quick check of the quality of PSG/PM diagnosis and to achieve an improvement in the patient's clinical management.
Topics: Adult; Algorithms; Clinical Decision-Making; Female; Humans; Italy; Male; Oximetry; Patient Care Management; Polysomnography; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 27844222
DOI: 10.1007/s00405-016-4372-z -
Revue Medicale Suisse Nov 2019Obesity hypoventilation syndrome is an underdiagnosed pathology, whose prevalence is increasing due to the progressively higher prevalence of obesity in the general... (Review)
Review
Obesity hypoventilation syndrome is an underdiagnosed pathology, whose prevalence is increasing due to the progressively higher prevalence of obesity in the general population. Early detection allows early management and lowers the risk of acute exacerbation, hospitalization and mortality. The diagnosis is done by excluding other, pulmonary or extra pulmonary, reasons of hypercapnia; a nocturnal polygraphy is mandatory to diagnose an associated obstructive sleep apnea syndrome. The pneumological treatment is a ventilatory support by CPAP or biPAP (bilevel Positive Airways Pressure).
Topics: Continuous Positive Airway Pressure; Humans; Obesity; Obesity Hypoventilation Syndrome
PubMed: 31742941
DOI: No ID Found -
Deutsche Medizinische Wochenschrift... Jan 2016Obstructive sleep apnea (OSA) is a clinically significant condition associated with an increase in cardiovascular risk, daytime sleepiness and in risk of accidents.... (Review)
Review
Obstructive sleep apnea (OSA) is a clinically significant condition associated with an increase in cardiovascular risk, daytime sleepiness and in risk of accidents. Diagnosis usually relies on a detailed anamnesis and an ambulatory nocturnal polygraphy. Suspecting the presence of OSA or a persisting unclear daytime sleepiness in need of treatment further polysomnographic diagnosis should be performed in a specialized sleep center. Cardiorespiratory polysomnography is the diagnostic gold standard in differentiating sleep-related breathing and movement disorders.
Topics: Diagnosis, Differential; Diagnostic Techniques, Cardiovascular; Diagnostic Techniques, Respiratory System; Humans; Polysomnography; Sleep Apnea, Obstructive; Sleep Medicine Specialty
PubMed: 26710202
DOI: 10.1055/s-0041-106846 -
Journal of Oral Rehabilitation May 2024Polysomnography (PSG) is the gold standard for sleep bruxism (SB) assessment, it is expensive, not widely accessible, and time-consuming.
BACKGROUND
Polysomnography (PSG) is the gold standard for sleep bruxism (SB) assessment, it is expensive, not widely accessible, and time-consuming.
OBJECTIVE
Given the increasing prevalence of SB, there is a growing need for an alternative, readily available, reliable and cost-effective diagnostic method. This study aimed to evaluate the diagnostic validity of portable respiratory polygraphy (PRPG) compared with PSG for SB diagnosis.
METHODS
One hundred and three subjects underwent simultaneous examinations using PRPG (NOX T3, NOX Medical) and PSG (NOX A1, NOX Medical) in a sleep laboratory.
RESULTS
The mean Bruxism Episodes Index (BEI) measured by PRPG was 4.70 ± 3.98, whereas PSG yielded a mean BEI of 3.79 ± 3.08. The sensitivity for detecting sleep bruxism (BEI >2) by PRPG was 48.3%, with a specificity of 81.2%. The positive predictive value was estimated at 51.9%, and the negative predictive value at 78.9%. However, when distinguishing between mild bruxism (BEI >2 < 4) and severe bruxism (BEI >4), PRPG demonstrated a sensitivity of 77.8% and 68.3% and a specificity of 48.6% and 71.4%, respectively.
CONCLUSION
Polysomnography continues to be the SB diagnostic gold standard tool, as the sensitivity and specificity of PRPG are significantly lower when compared with PSG. Nevertheless, PRPG could serve as an alternative tool for SB screening or diagnosis, despite its limitations. Furthermore, our data indicate that comorbidities such as sleep apnea and sleep quality do not influence the diagnostic accuracy of PSG, suggesting its potential as a screening instrument in individuals with other sleep disorders.
PubMed: 38751053
DOI: 10.1111/joor.13733 -
Brain Sciences Jun 2022Obstructive sleep apnea (OSA) and sleep bruxism (SB) may appear concomitantly. Data on the relationship between OSA and SB are limited. It was shown that in a population...
Obstructive sleep apnea (OSA) and sleep bruxism (SB) may appear concomitantly. Data on the relationship between OSA and SB are limited. It was shown that in a population with an increased risk of OSA, OSA was dependently correlated with SB on the degree of OSA severity only in mild and moderate cases of OSA. We aimed to confirm this relationship and affecting factors in a group of dental office patients in a prospective, observational study. Adult patients (n = 119) were evaluated using respiratory polygraphy. The risk of OSA was assessed using a STOP-Bang questionnaire (SBQ). The episodes of bruxism and respiratory events were scored according to the standards of the American Academy of Sleep Medicine. The prevalence of OSA and SB was found to be 63.02% and 41.17%, respectively. The bruxism episode index (BEI) was increased in the group with a higher risk of OSA (SBQ ≥ 3) compared to the group with a lower risk of OSA (3.49 ± 3.63 vs. 2.27 ± 2.50, p = 0.03). The sensitivity and specificity of the SBQ were not sufficient to predict SB. A positive linear correlation between AHI and BEI in the group with AHI < 23/h was found. The study confirmed that OSA was associated with SB in the group of patients with OSA and/or SB risk. The relationship between OSA and SB depended on the degree of severity of OSA and occurred in mild and moderate cases of OSA.
PubMed: 35884635
DOI: 10.3390/brainsci12070828 -
Sleep Medicine: X Dec 2024
PubMed: 38213881
DOI: 10.1016/j.sleepx.2023.100097 -
Sleep Science (Sao Paulo, Brazil) 2017Patients that started on Non-Invasive Ventilation (NIV) need to define several parameters selected on the basis of diurnal arterial blood gas and underlying disease. We...
INTRODUCTION
Patients that started on Non-Invasive Ventilation (NIV) need to define several parameters selected on the basis of diurnal arterial blood gas and underlying disease. We hypothesize that respiratory polygraphy (RP) could be useful to monitor NIV. This retrospective work describes RP findings and their impact on the setting of continuous flow ventilators from patients on NIV of Intensive Care Unit (ICU).
MATERIAL AND METHODS
Patient's data on NIV from at the ICU of Hospital Británico were included in this study. RP recordings were performed in all of them. Respiratory events, such as ventilatory pattern changes, impact on oximetry or tidal volume, were observed to modify the ventilatory mode after RP.
RESULTS
The RP findings have contributes to change the ventilatory mode for one third of the patients. The mean values of expiratory positive airway pressure (EPAP) and inspiratory positive airway pressure (IPAP) were not significantly different across all the population before or after RP: 8.7±0.3 vs. 8.6±0.4; p<0.88 and 18.6±0.6 vs. 17.7±0.7; p<0.26 respectively, however, half the patients presented > 2 cmHO pressure value changes after RP.
CONCLUSIONS
RP recordings could contribute to broad range of data useful to make decisions about changes in programming and allowed to identify adverse events related to positive pressure.
PubMed: 28966736
DOI: 10.5935/1984-0063.20170006 -
Journal of Sleep Research Oct 2021Obstructive sleep apnea syndrome affects 1%-4% of all children worldwide. Currently, diagnosis of obstructive sleep apnea is based on sea-level guidelines, without...
Obstructive sleep apnea syndrome affects 1%-4% of all children worldwide. Currently, diagnosis of obstructive sleep apnea is based on sea-level guidelines, without taking into account the altitude at which the populations live. It has been shown that at 3,200 m of altitude there is an increase in obstructive events in healthy children aged 7 to 16 years; on the other hand, it is known that SpO dispersion between individuals becomes wider as altitude increases, a phenomenon that is more marked during sleep. About 17 million Colombians live in regions between 2,500 m and 2,700 m, as do significant populations in other Latin American countries. This research aimed to characterize respiratory polygraphy sleep parameters in healthy, non-snoring children aged 4-9 years living at 2,560 m. We carried out home respiratory polygraphy in 32 children with a mean age of 6.2 years (range 4-9 years). The average recorded sleep time was 7.8 h, the median apnea-hypopnea index was 9.2/h, the obstructive apnea-hypopnea index had a median of 8.8/h (p5 4.2 to p95 17.9) and central apnea a median of 0.4/h. The median SpO was 93% (p5 90.5 to p95 94) and transcutaneous CO had a median of 39.4 mmHg (p531.7 to p95 42.3). The median oxygen desaturation index ≥ 3% was 11.2 and median oxygen desaturation index ≥ 4% was 3.9. Normal measurements for respiratory polygraphy obtained at sea level do not apply to children at altitude. If such guidelines are used, obstructive sleep apnea will be over-diagnosed, resulting in unnecessary adenotonsillectomies, among other interventions.
Topics: Altitude; Child; Child, Preschool; Humans; Reference Values; Sleep; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 33723892
DOI: 10.1111/jsr.13341 -
Journal of Clinical Medicine May 2023Restrictive lung disease (predominantly in patients with neuromuscular disease (NMD) and ribcage deformity) may induce chronic hypercapnic respiratory failure, which... (Review)
Review
Restrictive lung disease (predominantly in patients with neuromuscular disease (NMD) and ribcage deformity) may induce chronic hypercapnic respiratory failure, which represents an absolute indication to start home NIV (HNIV). However, in the early phases of NMD, patients may present only diurnal symptoms or orthopnoea and sleep disturbances with normal diurnal gas exchange. The evaluation of respiratory function decline may predict the presence of sleep disturbances (SD) and nocturnal hypoventilation that can be respectively diagnosed with polygraphy and PCO transcutaneous monitoring. If nocturnal hypoventilation and/or apnoea/hypopnea syndrome are detected, HNIV should be introduced. Once HNIV has been started, adequate follow-up is mandatory. The ventilator's built-in software provides important information about patient adherence and eventual leaks to correct. Detailed data about pressure and flow curves may suggest the presence of upper airway obstruction (UAO) during NIV that may occur with or without decrease in respiratory drive. Etiology and treatment of these two different forms of UAO are different. For this reason, in some circumstances, it might be useful to perform a polygraph. PtCO monitoring, together with pulse-oximetry, seem to be very important tools to optimize HNIV. The role of HNIV in neuromuscular disease is to correct diurnal and nocturnal hypoventilation with the consequence of improving quality of life, symptoms, and survival.
PubMed: 37240459
DOI: 10.3390/jcm12103353