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Journal of the American Medical... May 2024The prevalence of obstructive sleep apnea (OSA) escalates with advancing age. Although the apnea-hypopnea index (AHI) is the standard measure for assessing OSA severity,...
OBJECTIVES
The prevalence of obstructive sleep apnea (OSA) escalates with advancing age. Although the apnea-hypopnea index (AHI) is the standard measure for assessing OSA severity, it does not account for additional oximetric parameters that may influence disease progression in older adults. This study aimed to evaluate disparities in respiratory polygraphy/polysomnography parameters among patients with OSA, stratified by age and sex.
DESIGN
Retrospective propensity score-matched study.
SETTING AND PARTICIPANTS
Sleep unit of a university hospital; 11,747 participants, 210 aged 80 years or older.
METHODS
Propensity score matching was used to establish 4 age cohorts, with the 210 oldest adults serving as the reference group. Primary outcome variables included the total sleep time with oxygen saturation (SaO) below 90% (T90), average SaO, minimum SaO, and AHI. The association between T90 and AHI, as well as the severity of OSA, was assessed across the 4 age categories.
RESULTS
Despite comparable AHI scores, the oldest patients with OSA exhibited the highest T90 and the lowest SaO levels compared to younger counterparts. The proportion of patients with severe OSA and T90 in the highest quartile increased with age: 12.5% in young adults, 14.8% in adults, 21.7% in the old, and 34% in the very old participants (P < .001). old and very old patients had a greater likelihood of being in the most severe OSA category compared to the younger ones, with odds ratios (OR) 2.57 (95% CI 1.42-4.65) and 5.52 (95% CI 3.06-9.97), respectively. These patterns were more pronounced in women of advanced age, indicating a sex-specific variation in disease severity with increasing age.
CONCLUSIONS AND IMPLICATIONS
Old patients with OSA, particularly women, demonstrate elevated T90 and reduced SaO levels, irrespective of AHI, indicating a hypoxemia increased risk. The diagnostic criteria, management, and outcomes for OSA may require adaptations to address the unique needs of very old populations.
PubMed: 38763163
DOI: 10.1016/j.jamda.2024.105023 -
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 -
Thorax Jun 2024Diaphragmatic sleep disordered breathing (dSDB) has been recently identified as sleep dysfunction secondary to diaphragmatic weakness in Duchenne muscular dystrophy...
BACKGROUND
Diaphragmatic sleep disordered breathing (dSDB) has been recently identified as sleep dysfunction secondary to diaphragmatic weakness in Duchenne muscular dystrophy (DMD). However, scoring criteria for the identification of dSDB are missing.This study aimed to define and validate dSDB scoring criteria and to evaluate whether dSDB severity correlates with respiratory progression in DMD.
METHODS
Scoring criteria for diaphragmatic apnoea (dA) and hypopnoeas (dH) have been defined by the authors considering the pattern observed on cardiorespiratory polygraphy (CR) and the dSDB pathophysiology.10 sleep professionals (physiologists, consultants) blinded to each other were involved in a two-round Delphi survey to rate each item of the proposed dSDB criteria (Likert scale 1-5) and to recognise dSDB among other SDB. The scorers' accuracy was tested against the authors' panel.Finally, CR previously conducted in DMD in clinical setting were rescored and diaphragmatic Apnoea-Hypopnoea Index (dAHI) was derived. Pulmonary function (forced vital capacity per cent of predicted, FVC%pred), overnight oxygen saturation (SpO2) and transcutaneous carbon dioxide (tcCO2) were correlated with dAHI.
RESULTS
After the second round of Delphi, raters deemed each item of dA and dH criteria as relevant as 4 or 5. The agreement with the panel in recognising dSDB was 81%, kappa 0.71, sensitivity 77% and specificity 85%.32 CRs from DMD patients were reviewed. dSDB was previously scored as obstructive. The dAHI negatively correlated with FVC%pred (r=-0.4; p<0.05). The total number of dA correlated with mean overnight tcCO2 (r 0.4; p<0.05).
CONCLUSIONS
dSDB is a newly defined sleep disorder that correlates with DMD progression. A prospective study to evaluate dSDB as a respiratory measure for DMD in clinical and research settings is planned.
Topics: Muscular Dystrophy, Duchenne; Humans; Sleep Apnea Syndromes; Diaphragm; Delphi Technique; Male; Polysomnography; Severity of Illness Index; Disease Progression; Vital Capacity; Adolescent; Child
PubMed: 38729626
DOI: 10.1136/thorax-2023-220729 -
Rheumatology International Jun 2024This cross-sectional study aimed to determine the prevalence and risk factors for sleep-related breathing disorders (SRBD) in newly diagnosed, untreated rheumatoid...
OBJECTIVES
This cross-sectional study aimed to determine the prevalence and risk factors for sleep-related breathing disorders (SRBD) in newly diagnosed, untreated rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients, and to develop a screening algorithm for early detection.
METHODS
We evaluated newly diagnosed RA or PsA patients using the Epworth Sleepiness Scale (ESS) questionnaire, cardiorespiratory polygraphy (RPG), and clinical and laboratory assessments. Sleep apnea syndrome (SAS) was diagnosed based on pathological RPG findings excessive daytime sleepiness, defined as ESS score above 10.
RESULTS
The study included 39 patients (22 RA, 17 PsA) and 23 controls. In RPG, SRBD was identified in 38.5% of arthritis patients compared to 39.1% of controls (p = 1.00), with male gender (p = .004) and age (p < .001) identified as risk factors. Excessive daytime sleepiness was noted in 36.4% of RA patients, 17.6% of PsA patients, and 21.7% of controls. Of the 24 patients diagnosed with SRBD, 41.6% met the criteria for SAS. SAS prevalence was 31.8% among RA patients, 0% in PsA patients, and 13% in controls. A significant association was observed between excessive daytime sleepiness and SRBD (p = .036).
CONCLUSION
Our findings reveal a high prevalence of SRBD in newly diagnosed, untreated RA and PsA patients in ESS and RPG, with excessive daytime sleepiness being a reliable predictor of SRBD. Patients with RA exhibited a higher predisposition to SAS. We therefore suggest incorporating ESS and RPG as screening tools in RA or PsA for early detection and management of SRBD.
Topics: Humans; Male; Cross-Sectional Studies; Arthritis, Psoriatic; Female; Middle Aged; Sleep Apnea Syndromes; Arthritis, Rheumatoid; Adult; Prevalence; Risk Factors; Aged; Polysomnography; Case-Control Studies; Surveys and Questionnaires
PubMed: 38713410
DOI: 10.1007/s00296-024-05610-8 -
Journal of Oral and Maxillofacial... Apr 2024Bilateral internal ramus distraction (BIRD) is now part of select protocols for treating obstructive sleep apnea (OSA). Introducing a home monitoring protocol offers a...
BACKGROUND
Bilateral internal ramus distraction (BIRD) is now part of select protocols for treating obstructive sleep apnea (OSA). Introducing a home monitoring protocol offers a valuable alternative to overnight laboratory polysomnography (PSG).
PURPOSE
The purpose of this study was to evaluate and compare OSA parameters obtained via home respiratory polygraphy (HRP) and hospital PSG in a cohort of patients undergoing mandibular distraction for OSA management.
STUDY DESIGN, SETTING, SAMPLE
Hospital Universitario La Princesa (Madrid) researchers conducted a prospective cohort study with patients diagnosed with moderate (apnea-hypopnea index (AHI) = 15 to 30) to severe (AHI>30) OSA undergoing BIRD followed by LeFort maxillary osteotomy. Exclusion criteria were as follows: severe systemic diseases, central apneas, smoking, poor dental hygiene, or prior OSA interventions.
PREDICTOR VARIABLE
The predictor variable was PSG and HRP techniques.
MAIN OUTCOME VARIABLES
The main outcome variable comprises a collection of OSA parameters, including the AHI, oxygen desaturation index (ODI), and time spent below 90% oxygen saturation (T90). These data were measured both before and after distraction, as well as after 6 mm, 9 mm, and 12 mm of mandibular distraction.
COVARIATES
The covariates were age, sex, cardiovascular risk parameters, and the Epworth sleepiness scale.
ANALYSES
Pearson's correlation analyzed AHI, ODI, and T90 values from PSG and HRP. Wilcoxon Signed Rank-Sum Test compared 2 distraction stages, and the Friedman Test evaluated 3 stages (P < .05). Multiple regression analysis assessed if covariates were independent risk factors for postoperative persistent OSA.
RESULTS
The study included 32 patients (25% with moderate and 75% with severe OSA). Final AHI was 10.9 ± 8.9 (events/hour) with HRP, compared to 15.2 ± 13.4 with PSG (r = 0.7, P < .05). ODI was 9.0 ± 8.1 (des/h) with HRP and 8.7 ± 9.5 with PSG (r = 0.85, P < .05). T90 was 1.6 ± 2.2 with HRP and 1.3 ± 3.0 with PSG (r = 0.6, P < .05). Based on HRP data, AHI improved from D1 (34.0 ± 19.5) to D2 (20.8 ± 14.1) and D3 (12.5 ± 10.4) (P < .05). ODI decreased from D1 (26.1 ± 19.0) to D2 (16.0 ± 12.6) and D3 (9.4 ± 8.8) (P < .05). T90 reduced from D1 (8.2 ± 12.6) to D2 (4.1 ± 5.2) and D3 (1.9 ± 2.8) (P < .05). Multiple regression analysis of comorbidities produced nonsignificant results.
CONCLUSION AND RELEVANCE
Monitoring BIRD through HRP has demonstrated efficacy in yielding results that align with PSG.
PubMed: 38677325
DOI: 10.1016/j.joms.2024.04.002 -
Cancers Apr 2024Transoral Robotic Surgery (TORS) is utilized for treating various malignancies, such as early-stage oropharyngeal cancer and lymph node metastasis of an unknown primary...
Transoral Robotic Surgery (TORS) is utilized for treating various malignancies, such as early-stage oropharyngeal cancer and lymph node metastasis of an unknown primary tumor (CUP), and also benign conditions, like obstructive sleep apnea (OSA) and chronic lingual tonsillitis. However, the success and failure of TORS have not been analyzed to date. In this retrospective observational multicenter cohort study, we evaluated patients treated with TORS using the da Vinci surgical system. Success criteria were defined as identification of the primary tumor for CUP, >2 mm resection margin for malignant conditions, and improvement on respiratory polygraphy and tonsillitis complaints for benign conditions. A total of 220 interventions in 211 patients were included. We identified predictors of success, such as low comorbidity status ACE-27, positive P16 status, and lower age for CUP, and female gender and OSA severity for benign conditions. For other malignancies, no predictors for success were found. Predictors of failure based on postoperative complications included high comorbidity scores (ASA) and anticoagulant use, and for postoperative pain, younger age and female gender were identified. This study provides valuable insights into the outcomes and predictors of success and failure in TORS procedures across various conditions and may also help in patient selection and counseling.
PubMed: 38672541
DOI: 10.3390/cancers16081458 -
Clinics and Practice Apr 2024We conducted a retrospective case series of seven male COVID-19 patients with respiratory failure and suspected OSA based on clinical features to evaluate the effects...
We conducted a retrospective case series of seven male COVID-19 patients with respiratory failure and suspected OSA based on clinical features to evaluate the effects of undiagnosed obstructive sleep apnea (OSA) on COVID-19 outcomes and the response to a continuous positive airway pressure (CPAP) treatment. Cardiorespiratory polygraphy (CRP) and a continuous positive airway pressure treatment were used for diagnosis and management. They confirmed severe obstructive sleep apnea in all patients (apnea/hypopnea index > 30) and improved overnight oxygenation and symptoms at the 1-month follow-up. Undiagnosed obstructive sleep apnea may negatively impact COVID-19 outcomes by exacerbating respiratory failure. Recognition and treatment with continuous positive airway pressure can optimize the management of such patients.
PubMed: 38666808
DOI: 10.3390/clinpract14020050 -
Journal Der Deutschen Dermatologischen... May 2024Patients with chronic inflammatory skin diseases often suffer from sleep disturbances. However, objective data on sleep architecture, especially to evaluate potential...
INTRODUCTION
Patients with chronic inflammatory skin diseases often suffer from sleep disturbances. However, objective data on sleep architecture, especially to evaluate potential overall influences under therapy, are lacking.
PATIENTS AND METHODS
Pilot study on sleep quality changes including psoriasis and atopic dermatitis patients before and 2 weeks after intensive topical treatment. In addition to disease activity rating, patient-rated outcomes for itch severity and sleep quality and polygraphy was performed before and after topical therapy.
RESULTS
14 psoriasis, eleven atopic dermatitis patients (10 female, 15 male) with a mean age of 49 years were included. Disease activity scores (EASI and PASI) were significantly reduced with topical therapy after 2 weeks (p < 0.001). Pruritus intensity (NRS) showed a significant influence on deep sleep, which resolved after therapy. Insomnia severity significantly decreased (r > 0.50, p < 0.05) and daytime sleepiness showed a significant reduction in 40% of patients. N3 (deep sleep) and REM sleep significantly improved, showing a strong effect (r > 0.50). The apnea-hypopnea index decreased in one of four patients independent of the individual BMI.
CONCLUSIONS
Through polygraphy, we demonstrated impaired sleep patterns in psoriasis and atopic dermatitis patients with itch as a relevant factor and beyond that, rapid sleep improvement under 2 weeks of topical treatment.
Topics: Humans; Dermatitis, Atopic; Female; Male; Psoriasis; Middle Aged; Sleep Wake Disorders; Pilot Projects; Treatment Outcome; Adult; Pruritus; Administration, Topical; Dermatologic Agents; Cost of Illness
PubMed: 38634699
DOI: 10.1111/ddg.15373 -
Journal of Sleep Research Apr 2024Obstructive sleep apnea is associated with many co-morbidities in children and young people. Obesity has long been recognised as an important risk factor associated with...
Obstructive sleep apnea is associated with many co-morbidities in children and young people. Obesity has long been recognised as an important risk factor associated with obstructive sleep apnea. Currently, polysomnography is regarded as the gold-standard diagnostic tool for obstructive sleep apnea. The validity of oximetry as a screening and diagnostic tool for obstructive sleep apnea has been the subject of several studies in the literature. There is little published evidence on the use of oximetry in children with obesity. This study assesses whether oximetry is a reliable diagnostic tool for obstructive sleep apnea in obese children. We reviewed the medical records of obese children with a suspected diagnosis of obstructive sleep apnea who underwent oximetry and cardiorespiratory polygraphy or full polysomnography at Sheffield Children's Hospital between January 2010 and March 2022. We compared oximetry results with the apnea-hypopnea index from cardiorespiratory polygraphy or full polysomnography for each patient. A total of 60 patient records were included in the analysis. The sensitivity of oximetry in diagnosing obstructive sleep apnea was 70.9%, with a specificity of 65.5% and a positive predictive value of 68.75%. In the subgroup of subjects with severe obstructive sleep apnea (apnea-hypopnea index > 10), oximetry had a sensitivity of 87.5%. We concluded that oximetry could be a helpful initial diagnostic tool for obstructive sleep apnea in obese children, but is not entirely reliable. A negative oximetry result in a symptomatic individual should prompt a referral for more detailed investigations, while a positive result can help in treatment decisions without needing a polysomnography.
PubMed: 38634170
DOI: 10.1111/jsr.14214 -
Paediatric Respiratory Reviews Apr 2024There is an increasing demand for the assessment of sleep-disordered breathing in children of all ages to prevent the deleterious neurocognitive and behaviour... (Review)
Review
There is an increasing demand for the assessment of sleep-disordered breathing in children of all ages to prevent the deleterious neurocognitive and behaviour consequences of the under-diagnosis and under-treatment of obstructive sleep apnoea [OSA]. OSA can be considered in three broad categories based on predominating contributory features: OSA type 1 [enlarged tonsils and adenoids], type II [Obesity] and type III [craniofacial abnormalities, syndromal, storage diseases and neuromuscular conditions]. The reality is that sleep questionnaires or calculations of body mass index in isolation are poorly predictive of OSA in individuals. Globally, the access to testing in tertiary referral centres is comprehensively overwhelmed by the demand and financial cost. This has prompted the need for better awareness and focussed history taking, matched with simpler tools with acceptable accuracy used in the setting of likely OSA. Consequently, we present key indications for polysomnography and present scalable, existing alternatives for assessment of OSA in the hospital or home setting, using polygraphy, oximetry or contactless sleep monitoring.
PubMed: 38616458
DOI: 10.1016/j.prrv.2024.04.002