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Sleep Advances : a Journal of the Sleep... 2024Polygraphy (PG) is often used to diagnose obstructive sleep apnea (OSA). However, it does not use electroencephalography, and therefore cannot estimate sleep time or...
Polygraphy (PG) is often used to diagnose obstructive sleep apnea (OSA). However, it does not use electroencephalography, and therefore cannot estimate sleep time or score arousals and related hypopneas. Consequently, the PG-derived respiratory event index (REI) differs from the polysomnography (PSG)-derived apnea-hypopnea index (AHI). In this study, we comprehensively analyzed the differences between AHI and REI. Conventional AHI and REI were calculated based on total sleep time (TST) and total analyzed time (TAT), respectively, from two different PSG datasets ( = 1561). Moreover, TAT-based AHI (AHI) and TST-based REI (REI) were calculated. These indices were compared keeping AHI as the gold standard. The REI, AHI, and REI were significantly lower than AHI ( < 0.0001, ≤ 0.002, and ≤ 0.01, respectively). The total classification accuracy of OSA severity based on REI was 42.1% and 72.8% for two datasets. Based on AHI, the accuracies were 68.4% and 85.9%, and based on REI, they were 65.9% and 88.5% compared to AHI. AHI was most correlated with REI ( = 0.98 and = 0.99 for the datasets) and least with REI ( = 0.92 and = 0.97). Compared to AHI, REI had the largest mean absolute errors (13.9 and 6.7) and REI the lowest (5.9 and 1.9). REI had the lowest sensitivities (42.1% and 72.8%) and specificities (80.7% and 90.9%) in both datasets. Based on these present results, REI underestimates AHI. Furthermore, these results indicate that arousal-related hypopneas are an important measure for accurately classifying OSA severity.
PubMed: 38264141
DOI: 10.1093/sleepadvances/zpad054 -
Journal of Clinical Medicine Jan 2024Obstructive sleep apnea (OSA) is common in professional truck drivers. It is important that OSA is recognized since undiagnosed and/or untreated sleep apnea is a risk...
Obstructive sleep apnea (OSA) is common in professional truck drivers. It is important that OSA is recognized since undiagnosed and/or untreated sleep apnea is a risk factor for sleepiness-related traffic accidents. In this study, we developed a new simple tool to screen for obstructive sleep apnea (OSA) in this population. Altogether, 2066 professional truck drivers received a structured questionnaire. A total of 175 drivers had a clinical examination and were invited to participate in sleep laboratory studies, including cardiorespiratory polygraphy. We studied associations of different risk factors with the presence of sleep apnea. We established a new simple screening tool for obstructive sleep apnea (OSA) that was compared to other existing screening tools. A total of 1095 drivers completed the questionnaire. Successful cardiorespiratory polygraphy was obtained for 172 drivers. Full data were available for 160 male drivers included in the analyses. The following five risk factors for sleep apnea formed the BAMSA score (0 to 5): BMI > 30 kgm, age > 50 years, male gender, snoring at least one night per week, and the presence of apnea at least sometimes. BAMSA showed a sensitivity of 85.7% and a specificity of 78.8% in detecting AHI ≥ 15 when using a cut-off point of 4, and the ROC area was 0.823. BAMSA is a sensitive and easy-to-use tool in predicting obstructive sleep apnea in male professional drivers.
PubMed: 38256656
DOI: 10.3390/jcm13020522 -
Sleep Medicine: X Dec 2024
PubMed: 38213881
DOI: 10.1016/j.sleepx.2023.100097 -
BMC Pediatrics Jan 2024Recombinant human growth hormone (rhGH) therapy is beneficial for children with Prader-Willi syndrome (PWS) in improving short stature and metabolism, but the effect of...
Evaluating the effect of recombinant human growth hormone treatment on sleep-related breathing disorders in toddlers with Prader-Willi syndrome: a one-year retrospective cohort study.
BACKGROUND
Recombinant human growth hormone (rhGH) therapy is beneficial for children with Prader-Willi syndrome (PWS) in improving short stature and metabolism, but the effect of early rhGH treatment on respiratory and sleep parameters for PWS children under three years old remains elusive. Thus, this study aimed to investigate the impact of rhGH treatment on sleep-related breathing disorders (SRBDs) for toddlers with PWS.
METHODS
A total of 17 age-matched PWS patients receiving rhGH treatment (rhGH group) and 17 control individuals not receiving rhGH treatment (non-rhGH group) were recruited for this study between October 2018 and January 2023. Data related to polysomnography-polygraphy (PSG) and serum levels of insulin-like growth factor (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) were collected.
RESULTS
The mean age in the rhGH group was 20.76 ± 9.22 months, which was comparable to that of the non-rhGH group (25.23 ± 13.81 months). The demographic and anthropometric parameters were similar across the two groups after 52 weeks of treatment. Administration of rhGH to toddlers did not exert adverse effects on the obstructive apnea-hypopnea index (OAHI), central apnea index (CAI), oxygen desaturation index (ODI), mean percutaneous oxygen saturation (SpO), lowest SpO, duration when SpO is lower than 90%, or proportion of the patients with SpO lower than 90%. Furthermore, the increased IGF-1 z-score and IGFBP-3 level did not worsen SRBDs.
CONCLUSION
Treatment with rhGH for 52 weeks on young toddlers with PWS showed no deleterious effects on SRBDs. This shed more light on the importance of initiating rhGH therapy early in PWS patients.
Topics: Humans; Child, Preschool; Infant; Human Growth Hormone; Insulin-Like Growth Factor Binding Protein 3; Insulin-Like Growth Factor I; Prader-Willi Syndrome; Retrospective Studies; Sleep
PubMed: 38200464
DOI: 10.1186/s12887-023-04513-0 -
Zdravstveno Varstvo Mar 2024The aim of our study was to validate the Slovene translation of the STOP-BANG (SBQ) questionnaire for use in the primary practice setting.
AIM
The aim of our study was to validate the Slovene translation of the STOP-BANG (SBQ) questionnaire for use in the primary practice setting.
METHODS
We recruited 158 randomly selected visitors at four primary practice clinics who came to the practice for any reason. Participants completed the Slovene SBQ and underwent type 3 respiratory polygraphy, which was analysed by an experienced somnologist. The SBQ was previously translated in to Slovene and validated for the sleep clinic.
RESULTS
Of 158 participants, 153 had valid recordings. The mean age of the participants was 49.5 years (±13.0 years), and 47.7% were male. OSA was identified in 49.0% of the participants. The questionnaire, with a cutoff of ≥3, demonstrated an area under the curve of 0.823 for any OSA (REI≥5), 0.819 for moderate and severe OSA (REI≥15) and 0.847 for severe OSA (REI≥30). Sensitivity was 65.3%, 81.8%, and 90.0%, and specificity was 87.2%, 73.3% and 65.0% for any, moderate to severe and severe OSA, respectively.
CONCLUSIONS
The Slovene translation of the SBQ is a reliable instrument for OSA risk stratification in the primary practice setting.
PubMed: 38156334
DOI: 10.2478/sjph-2024-0003 -
Children (Basel, Switzerland) Nov 2023The aim of the study was to investigate how obesity can influence sleep respiratory parameters in obstructive sleep apnea syndrome (OSAS) in children.
UNLABELLED
The aim of the study was to investigate how obesity can influence sleep respiratory parameters in obstructive sleep apnea syndrome (OSAS) in children.
METHODS
The study analyzes 56 Caucasian children and adolescents aged 11 ± 2.79 years with a BMI > 5th percentiles and a PSQ value ≥ 0.33. Children were divided into Obesity Group (OG) with BMI ≥ 95th and Control Group (CG) with 5th < BMI > 95th percentile. All selected children underwent PG. Respiratory parameters AHI (Apnea-Hypopnea Index), SaO (Saturation of Oxygen), ODI (Oxygen Desaturation Index), and Nadir (the lowest value of SaO registered during PG) were extracted from the PG. AHI was used to divide the severity of OSAS into four levels: snoring (AHI ≤ 1), mild (AHI > 1 and ≤5), moderate (AHI > 5 and <10), and severe (AHI ≥ 10).
RESULTS
The comparison analysis between the OG and CG showed a statistical significance only for ODI ( = 0.02). A statistically significant correlation between BMI and AHI (r = 0.02), SaO (r = 0.01), and Nadir O (r = 0.02) was found.
CONCLUSIONS
There was no strong correlation between obesity and OSAS, but a positive association was found between BMI and AHI severity.
PubMed: 38136076
DOI: 10.3390/children10121874 -
International Archives of Occupational... Jan 2024Obstructive sleep apnea (OSA) is a common respiratory sleep disorder, related to increased mortality, poor quality of life, and higher risk of work accidents and...
PURPOSE
Obstructive sleep apnea (OSA) is a common respiratory sleep disorder, related to increased mortality, poor quality of life, and higher risk of work accidents and injuries. Studies on the risk of OSA (rOSA) among health workers (HW) are scant. The aims of this study were to investigate this issue in a large University Hospital and to assess the effectiveness of a screening program.
METHODS
The STOP-BANG questionnaire (SBQ) was sent via e-mail to the 5031 HW employed at the University Hospital of Verona. HW who completed the SBQ were classified at low, moderate, and high rOSA. HW at high rOSA were invited to undergo nocturnal polygraphy. The determinants of rOSA were studied by non-parametric Kruskal-Wallis test, Pearson's chi-squared, and multinomial logistic model.
RESULTS
Of 5031 HW, 1564 (31.1%) completed the online questionnaire. Responders with low, moderate, and high rOSA were 72.7%, 13.7%, and 13.6%. Male gender, older age, and higher body mass index (BMI) were significant predictors of high rOSA, as expected. Physicians had the lowest probability of being in the high-risk category. Polygraphy was performed in 64 subjects. The positive predictive value of the self-administered SBQ was 68.8% (95%C.I. 55.9-79.8%) but raised to 96.9% (95%C.I. 89.2-99.6%) when re-administered by medical staff.
CONCLUSION
SBQ showed its effectiveness as a screening tool in detecting undiagnosed OSA in HW. Systematic screening for OSA in work settings could allow early diagnosis and treatment, reducing short- and long-term health effects of OSA.
Topics: Humans; Male; Mass Screening; Quality of Life; Polysomnography; Sleep Apnea, Obstructive; Surveys and Questionnaires; Hospitals; Italy
PubMed: 38085278
DOI: 10.1007/s00420-023-02029-9 -
International Journal of Cardiology.... Dec 2023In atrial fibrillation (AF) patients, presence of expiratory airflow limitation may negatively impact treatment outcomes. AF patients are not routinely screened for...
BACKGROUND
In atrial fibrillation (AF) patients, presence of expiratory airflow limitation may negatively impact treatment outcomes. AF patients are not routinely screened for expiratory airflow limitation, but existing examinations can help identify at-risk individuals. We aimed to assess the diagnostic value of repurposing existing assessments from the pre-ablation work-up to identify and understand the characteristics of affected patients.
METHODS
We screened 110 consecutive AF patients scheduled for catheter ablation with handheld spirometry. Routine pre-ablation work-up included cardiac computed tomographic angiography (CCTA), transthoracic echocardiography and polygraphy. CCTA was analyzed qualitatively for emphysema and airway abnormalities. Multivariate logistic regression analysis was performed to determine predictors of expiratory airflow limitation.
RESULTS
We found that 25 % of patients had expiratory airflow limitation, which was undiagnosed in 86 % of these patients. These patients were more likely to have pulmonary abnormalities on CCTA, including emphysema (odds ratio [OR] 4.2, 95 % confidence interval [CI] 1.12-15.1, p < 0.05) and bronchial wall thickening (OR 2.6, 95 % CI 1.0-6.5, p < 0.05). The absence of pulmonary abnormalities on CCTA accurately distinguished patients with normal lung function from those with airflow limitation (negative predictive value: 85 %). Echocardiography and polygraphy did not contribute significantly to identifying airflow limitation.
CONCLUSIONS
In conclusion, routine pre-ablation CCTA can detect pulmonary abnormalities in AF patients with airflow limitation, guiding further pulmonary assessment. Future studies should investigate its impact on ablation procedure success.
PubMed: 38053981
DOI: 10.1016/j.ijcha.2023.101305 -
Dentistry Journal Oct 2023The main objective of this prospective study was the evaluation of 1 mm step titration of mandible advancement in the success of treating obstructive sleep apnea (OSA)....
The main objective of this prospective study was the evaluation of 1 mm step titration of mandible advancement in the success of treating obstructive sleep apnea (OSA). For that, a multicenter prospective study was designed to recruit patients with OSA who were eligible to receive a mandibular advancement device. Gradual titration of mandibular advancement (steps of 1 mm) from maximum intercuspidation was performed to determine the optimal mandibular advancement (highest reduction in the apnea-hypopnea index (AHI)). The principal variable was the percentage of patients where a reduction ≥50% of the AHI was achieved at the end of the titration phase. A total of 102 patients participated in this study. Fifty-six percent of the participants were males and 67% had a BMI ≥ 25 kg/m. Most of the patients (79%) had an age ≥ 50 years and the majority (74%) were either non-smokers or ex-smokers. Excessive daytime sleepiness was reported by 40% of the patients. The mean AHI at baseline was 20.6 ± 12.7 events/h. The mean advancement of the mandible was 3.1 ± 1.6 mm. The device achieved a reduction in the AHI in 93% of the patients and success (≥50% reduction in the AHI) in 69% of the patients. Success was achieved in 50%, 81.6%, and 73.3% of the patients with mild, moderate, and severe OSA, respectively. Decreasing the magnitude of mandibular advancement could be possible by controlling the vertical mouth opening and step-by-step titration.
PubMed: 37999010
DOI: 10.3390/dj11110247 -
Sleep Medicine Dec 2023Leakage is a common issue with PAP therapy and may contribute to short-term non-compliance with treatment. PAP manufacturers use different methods to estimate and report...
Leakage is a common issue with PAP therapy and may contribute to short-term non-compliance with treatment. PAP manufacturers use different methods to estimate and report air leaks (median, mean, p90, p95, % of important air leak, time spent on major leaks), which makes the analysis and comparisons challenging. Leak intensity is a well-known parameter of major importance as it can significantly affect the performance of PAP devices. However, there is a lack of knowledge regarding another leakage parameter, namely the leakage pattern. As of now, there is no standard classification for leak patterns in real-life settings. Our objective was to develop and propose a comprehensive nomenclature for leakage patterns observed during nasal auto-PAP therapy. We examined 50 ventilatory polygraphy recordings conducted with auto-PAP, based on data from a prior study in which the unintentional leak flow was precisely measured over time. We have categorized leaks into two main types: continuous leaks, which appear and persist for an extended period, and discontinuous leaks, which vanish more rapidly. Continuous leaks can have both abrupt or gradual apparitions and terminations. Their "shape" can be either interrupted or constant. Discontinuous leaks can have both abrupt or gradual apparitions and terminations. Due to the relatively short observation scale (less than 5 min minutes), this type of leakage is not characterized by a specific shape between apparition and termination. This nomenclature could be a valuable tool that facilitates comparative bench tests or clinical studies. This tool could support manufacturers in developing precise algorithms for leak compensation, residual AHI estimation and the accuracy of CPAP monitoring data. Lastly, establishing a standardized approach for describing and categorizing air leakage patterns could assist clinicians in identifying device-related issues, such as patient discomfort arising from specific types of leakage.
Topics: Humans; Continuous Positive Airway Pressure; Algorithms
PubMed: 37897963
DOI: 10.1016/j.sleep.2023.10.024