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Fractional exhaled nitric oxide-a possible biomarker for risk of obstructive sleep apnea in snorers.Journal of Clinical Sleep Medicine :... Jan 2024Airway inflammation in patients with obstructive sleep apnea (OSA) has been described and can be assessed by measuring the biomarker fractional exhaled nitric oxide...
STUDY OBJECTIVES
Airway inflammation in patients with obstructive sleep apnea (OSA) has been described and can be assessed by measuring the biomarker fractional exhaled nitric oxide (FeNO). In this pilot study, we investigated FeNO measurements in identification of OSA among persons with snoring.
METHODS
In this study we aimed to investigate (1) if FeNO could be used in screening for OSA, (2) if daytime sleepiness correlated to FeNO levels, and (3) whether asthma affected FeNO levels. Persons with snoring were prospectively included in three primary care ear, nose, and throat clinics. Patients underwent spirometry, FeNO tests, and partial polygraphy. They filled out questionnaires on sinonasal and asthma symptoms, daytime sleepiness, and quality of life. Current smokers, patients with upper airway inflammatory conditions, and patients treated with steroids were excluded.
RESULTS
Forty-nine individuals were included. Median apnea-hypopnea index was 11.4, mean age was 50.9 years, and 29% were females. OSA was diagnosed in 73% of the patients of whom 53% had moderate-severe disease. Patients with moderate-severe OSA had significantly higher FeNO counts than patients with no or mild OSA ( = .024). Patients younger than 50 years with a FeNO below 15 had the lowest prevalence of moderate-severe OSA. No correlation was found between FeNO measurements and daytime sleepiness, and asthma did not affect FeNO levels.
CONCLUSIONS
We found a low prevalence of moderate-severe OSA in persons with snoring when FeNO and age were low. This might be considered in a future screening model, though further studies testing the FeNO cutoff level and the diagnostic accuracy are warranted.
CLINICAL TRIAL REGISTRATION
Registry: ClinicalTrials.gov; Name: NO Measurements in Screening for Asthma and OSA, in Patients With Severe Snoring; URL: https://clinicaltrials.gov/study/NCT03964324; Identifier: NCT03964324.
CITATION
Kiaer E, Ravn A, Jennum P, et al. Fractional exhaled nitric oxide-a possible biomarker for risk of obstructive sleep apnea in snorers. . 2024;20(1):85-92.
Topics: Female; Humans; Middle Aged; Male; Fractional Exhaled Nitric Oxide Testing; Snoring; Quality of Life; Pilot Projects; Sleep Apnea, Obstructive; Biomarkers; Asthma; Disorders of Excessive Somnolence
PubMed: 37707290
DOI: 10.5664/jcsm.10802 -
Frontiers in Physiology 2023The apnea-hypopnea index (AHI), defined as the number of apneas and hypopneas per hour of sleep, is still used as an important index to assess sleep disordered...
The apnea-hypopnea index (AHI), defined as the number of apneas and hypopneas per hour of sleep, is still used as an important index to assess sleep disordered breathing (SDB) severity, where hypopneas are confirmed by the presence of an oxygen desaturation or an arousal. Ambulatory polygraphy without neurological signals, often referred to as home sleep apnea testing (HSAT), can potentially underestimate the severity of sleep disordered breathing (SDB) as sleep and arousals are not assessed. We aim to improve the diagnostic accuracy of HSATs by extracting surrogate sleep and arousal information derived from autonomic nervous system activity with artificial intelligence. We used polysomnographic (PSG) recordings from 245 subjects (148 with simultaneously recorded HSATs) to develop and validate a new algorithm to detect autonomic arousals using artificial intelligence. A clinically validated auto-scoring algorithm (Somnolyzer) scored respiratory events, cortical arousals, and sleep stages in PSGs, and provided respiratory events and sleep stages from cardio-respiratory signals in HSATs. In a four-fold cross validation of the newly developed algorithm, we evaluated the accuracy of the estimated arousal index and HSAT-derived surrogates for the AHI. The agreement between the autonomic and cortical arousal index was moderate to good with an intraclass correlation coefficient of 0.73. When using thresholds of 5, 15, and 30 to categorize SDB into none, mild, moderate, and severe, the addition of sleep and arousal information significantly improved the classification accuracy from 70.2% (Cohen's = 0.58) to 80.4% ( = 0.72), with a significant reduction of patients where the severity category was underestimated from 18.8% to 7.3%. Extracting sleep and arousal information from autonomic nervous system activity can improve the diagnostic accuracy of HSATs by significantly reducing the probability of underestimating SDB severity without compromising specificity.
PubMed: 37693002
DOI: 10.3389/fphys.2023.1254679 -
Acta Paediatrica (Oslo, Norway : 1992) Dec 2023The aims of the study were to examine the signal quality (SQ) of home polygraphy (PG) in children and adolescents and to compare automatic and manual scoring of the PGs.
AIM
The aims of the study were to examine the signal quality (SQ) of home polygraphy (PG) in children and adolescents and to compare automatic and manual scoring of the PGs.
METHODS
Clinical Trials Registration: NCT04964830. Participants and caregivers were instructed to set up the equipment and perform home PGs themselves. The PGs were analysed according to SQ and their interpretability and differences in automatic vs. manual scoring regarding apnoea-hypopnoea index (AHI), apnoea index (AI), hypopnoea index (HI) and oxygen desaturation index (ODI) were examined.
RESULTS
54 healthy children aged 9-14 years participated in the study. 86% of the PGs were interpretable with mean SQ of 79.1% (CI 95%: 73.5%; 84.8%). Significant differences between the automatic and manual scoring were found for AHI, AI, HI and ODI (p < 0.0001).
CONCLUSION
Home PGs of children and adolescents are feasible to be performed with good SQ. Significantly higher markers of sleep-disordered breathing were achieved in the automatic scoring in comparison with the manual scoring.
Topics: Humans; Child; Adolescent; Polysomnography; Sleep Apnea Syndromes; Oxygen
PubMed: 37661830
DOI: 10.1111/apa.16964 -
Disaster Medicine and Public Health... Sep 2023To study the respiratory patterns and the hemodynamic variations related to postural changes in inpatients with coronavirus disease (COVID-19).
OBJECTIVE
To study the respiratory patterns and the hemodynamic variations related to postural changes in inpatients with coronavirus disease (COVID-19).
METHODS
This report is a prospective study in a cohort of inpatients admitted with COVID-19. We recruited 10 patients admitted to the hospital with moderate or severe COVID-19 who showed improvement in oxygen saturation with prone positioning. We performed cardiorespiratory polygraphy and hemodynamic evaluations by thoracic electrical bioimpedance.
RESULTS
We observed a median minimum oxygen saturation of 85.00% (IQR: 7.00) in the supine position versus 91.00% (IQR: 8.00) ( = 0.173) in the prone position. The airflow restriction in the supine position was 2.70% (IQR: 6.55) versus 1.55% (IQR: 2.80) ( = 0.383) in the prone position. A total of 36.4% of patients were classified as having a normo-hemodynamic state in the supine position, whereas 54.5% were classified in this group in the prone position ( = 0.668). A decrease in vascular resistance was observed in the prone position (18.2% of vasoconstriction) compared to the supine position (36.4% of vasoconstriction) ( = 0.871).
CONCLUSION
This brief report describes the effects of prone positioning on respiratory and hemodynamic variables in 10 patients with moderate or severe COVID-19.
Topics: Humans; Prone Position; Prospective Studies; COVID-19; Hemodynamics; Patient Positioning; COVID-19 Testing
PubMed: 37655396
DOI: 10.1017/dmp.2023.152 -
Frontiers in Medicine 2023The obstructive sleep apnea syndrome (OSA) is a highly prevalent condition. In Spain and other countries, only 5%-9% of patients with OSA have been diagnosed and...
Validity and reliability of the Berlin questionnaire for the detection of moderate or severe obstructive sleep apnea in patients aged 40 years or older detected from primary care.
BACKGROUND
The obstructive sleep apnea syndrome (OSA) is a highly prevalent condition. In Spain and other countries, only 5%-9% of patients with OSA have been diagnosed and treated. The lack of accessibility to diagnosis is considered the main cause of this situation through easy-to-use screening instruments, it is necessary to check their validity and reliability in the context where they are to be used.
OBJECTIVE
To validate the Spanish translation of the Berlin questionnaire for screening for moderate or severe OSA in patients aged 40 years or more detected in primary care.
METHODS
A descriptive observational study, with a first qualitative phase of transcultural adaptation to Spanish using the translation-back-translation method. Setting: primary care level of the Spanish National Health System. A total of 255 patients recruited from 7 healthcare centers completed the study. The Berlin questionnaire was administered to the recruited patients, and subsequently, a respiratory polygraphy was performed to confirm the diagnosis of OSA. The concurrent criterion validity of the questionnaire and its reliability in terms of internal consistency and reproducibility (intra-observer agreement) were analyzed.
RESULTS
The patients' mean age was 54.76 years (SD: 6.57; 95% CI: 53.53-54.99), and 54.12% were men (95% CI: 47.96-60.27). We found that 61.57% (95% CI: 55.57-67.57) presented OSA (apnea-hypopnea index-AHI >5), and 45.5% (95% CI: 17.05-57.92) presented moderate or severe (AHI >15) OSA. The Berlin questionnaire, with a cut-off point of 4.5, showed a sensitivity of 76.77% (95% CI: 67.94-85.59), a specificity of 74.49% (95% CI: 65.35-83.63), a positive predictive value of 75.25% (95% CI: 66.34-84.16), a negative predictive value of 76.04% (95% CI: 66.98-85.10), and an area under the curve of 0.786 (95% CI: 0.721-0.851). Cronbach's alpha coefficient was 0.730 (95% CI: 0.668-0.784), and the Kappa index was 0.739 (95% CI, 0.384-1.000).
CONCLUSION
The Spanish adaptation of the Berlin questionnaire has good validity and reliability as a test for the diagnostic screening of moderate or severe OSA in patients aged 40 years or older. The findings of our study confirm that primary care physicians should use such screening tools to predict OSA.
PubMed: 37644989
DOI: 10.3389/fmed.2023.1229972 -
Children (Basel, Switzerland) Aug 2023Obstructive sleep-disordered breathing (SDB) has significant impacts on health, and therefore, a timely and accurate diagnosis is crucial for effective management and... (Review)
Review
Obstructive sleep-disordered breathing (SDB) has significant impacts on health, and therefore, a timely and accurate diagnosis is crucial for effective management and intervention. This narrative review provides an overview of the current approaches utilised in the diagnosis of SDB in children. Diagnostic methods for SDB in children involve a combination of clinical assessment, medical history evaluation, questionnaires, and objective measurements. Polysomnography (PSG) is the diagnostic gold standard. It records activity of brain and tibial and submental muscles, heart rhythm, eye movements, oximetry, oronasal airflow, abdominal and chest movements, body position. Despite its accuracy, it is a time-consuming and expensive tool. Respiratory polygraphy instead monitors cardiorespiratory function without simultaneously assessing sleep and wakefulness; it is more affordable than PSG, but few paediatric studies compare these techniques and there is optional recommendation in children. Nocturnal oximetry is a simple and accessible exam that has high predictive value only for children at high risk. The daytime nap PSG, despite the advantage of shorter duration and lower costs, is not accurate for predicting SDB. Few paediatric data support the use of home testing during sleep. Finally, laboratory biomarkers and radiological findings are potentially useful hallmarks of SDB, but further investigations are needed to standardise their use in clinical practice.
PubMed: 37628330
DOI: 10.3390/children10081331 -
Nutrition, Metabolism, and... Dec 2023The association of comorbidities on the prognosis of patients with acute coronary syndrome (ACS) was well documented. However, the impact of obstructive sleep apnea...
BACKGROUND AND AIMS
The association of comorbidities on the prognosis of patients with acute coronary syndrome (ACS) was well documented. However, the impact of obstructive sleep apnea (OSA) on this association has been less studied.
METHODS AND RESULTS
Between June 2015 to Jan 2020, we included consecutively eligible patients with ACS who underwent cardiorespiratory polygraphy. The definition of OSA was apnea-hypopnea index (AHI) ≥15 events/hour. Charlson Comorbidity Index (CCI) was used to evaluate the comorbidities. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, and hospitalization for unstable angina or heart failure. In the 1927 ACS patients, 1014 (52.6%) had OSA. The prevalence of the mild (CCI = 0), moderate (CCI = 1-2), and severe (CCI≥3) comorbidity were 23.6%, 65.9%, and 10.5%, respectively. During a median follow-up of 2.9 (1.5, 3.6) years, compared with patients without OSA, the presence of OSA increased the risk of MACCE in the moderate comorbidity group (22.6% vs. 17.5%; adjusted HR: 1.327; 95% CI: 1.019-1.728, p = 0.036) and severe comorbidity group (36.2% vs. 18.6%; adjusted HR: 2.194; 95% CI: 1.170-4.117, p = 0.014). There was no significant difference between OSA and non-OSA patients in the mild comorbidity group.
CONCLUSION
Among ACS patients, OSA was associated with an increased risk of subsequent events in the moderate and severe comorbidity groups but not in the mild comorbidity group. ACS patients with comorbidities should not be overlooked for OSA screening.
Topics: Humans; Acute Coronary Syndrome; Sleep Apnea, Obstructive; Myocardial Infarction; Comorbidity; Prognosis; Risk Factors
PubMed: 37586922
DOI: 10.1016/j.numecd.2023.07.024 -
Sleep & Breathing = Schlaf & Atmung Mar 2024Advances in treatment enables most patients with congenital heart diseases (CHD) to survive into adulthood, implying the need to address comorbid conditions in this...
PURPOSE
Advances in treatment enables most patients with congenital heart diseases (CHD) to survive into adulthood, implying the need to address comorbid conditions in this growing cohort of patients. The aim of this study was to evaluate the prevalence of sleep-disordered breathing (SDB) and lung function abnormalities in patients with adult congenital heart disease (ACHD).
METHODS
Patients with ACHD underwent level 3 sleep testing (Embletta MPR polygraphy) and pulmonary function testing. Results were stratified by the underlying haemodynamic ACHD lesion group.
RESULTS
Patients with ACHD (n = 100) were middle-aged (42.3 ± 14.6 years), 54% male and slightly overweight (BMI 25.9 ± 5.5 kg/m). Polygraphy revealed a prevalence of sleep apnoea of 39% with 15% of patients presenting with predominantly obstructive apnoeic episodes, while 23% of patients presenting primarily with central sleep apnoea. The distribution of mild, moderate, and severe sleep apnoea in the total study population was 26%, 7% and 6%, respectively. Comparison of apnoea-hypopnoea index, presence of sleep apnoea, and apnoea severity did not offer significant differences between the four ACHD lesion groups (p = 0.29, p = 0.41 and p = 0.18, respectively). Pulmonary function testing revealed obstructive lung disease in 19 of 100 patients. Concomitant chronic obstructive pulmonary disease and obstructive sleep apnoea were diagnosed in 3% of patients and were associated with profound nocturnal desaturation.
CONCLUSION
The findings suggest a mild propensity amongst patients with ACHD to develop SDB that seems to be unaffected by the specific underlying congenital lesion.
Topics: Middle Aged; Humans; Male; Adult; Female; Heart Defects, Congenital; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Sleep; Lung
PubMed: 37552390
DOI: 10.1007/s11325-023-02899-w -
Pediatric Research Dec 2023This study aimed to determine patterns of nocturnal pulse oximetry indices in moderate to late preterm infants, and investigate the relationship between oxygen...
BACKGROUND
This study aimed to determine patterns of nocturnal pulse oximetry indices in moderate to late preterm infants, and investigate the relationship between oxygen desaturations, the apnoea hypopnoea index, and both corrected gestational and postnatal age.
METHODS
21 healthy infants born at 32 + 0 - 36 + 6 weeks gestation underwent serial nocturnal pulse oximetry studies and respiratory polygraphy studies until 40 weeks corrected gestational age (CGA). The main outcome measures were number of >3% oxygen desaturations/hour (ODI3), mean oxygen saturations, and number of apnoeas and hypopnoeas/hour.
RESULTS
Median ODI3 increased between weeks 1 and 3 from 49.9 to 85.4/hour (p = 0.017). Mean oxygen saturations reached a corresponding nadir of 96.0% in week 3, then increased to 96.8% in week 6 (p = 0.019). Mixed effects modelling demonstrated that ODI3 and mean saturations were influenced by postnatal age but not CGA (p < 0.05). Desaturations frequently occurred without an apnoea or hypopnoea.
CONCLUSION
ODI3 rises then falls during the first 8 weeks of life in moderate to late preterm infants, independently of CGA. These interesting preliminary results highlight the importance of further serial data collection to generate age-specific normal ranges, and develop a better understanding of respiratory control in preterm infants.
IMPACT
The frequency of >3% oxygen desaturations (ODI3) in healthy moderate to late preterm infants rises then falls after birth, peaking in postnatal week 3. There is a corresponding nadir in mean saturations. There were significant non-linear relationships between ODI3/mean saturations and postnatal age, but not corrected gestational age. The majority of brief oxygen desaturations occurred without an apnoea or hypopnoea. Normal ranges for oxygen saturation indices are not known in this population. These results demonstrate the need for further serial data collection to generate age-specific normal ranges and inform oxygen prescribing guidelines.
Topics: Infant; Humans; Infant, Newborn; Infant, Premature; Pilot Projects; Apnea; Oxygen Saturation; Oxygen; Oximetry
PubMed: 37542167
DOI: 10.1038/s41390-023-02741-9 -
Children (Basel, Switzerland) Jul 2023The aim of this paper is to describe the multidisciplinary management pathway for pediatric patients with suspected obstructive sleep apnea syndrome (OSAS) conducted by...
AIM
The aim of this paper is to describe the multidisciplinary management pathway for pediatric patients with suspected obstructive sleep apnea syndrome (OSAS) conducted by the Pediatric and Orthodontic Department of the Dental Clinic of Padua.
MATERIALS AND METHODS
All pediatric subjects undergo a comprehensive medical history, including the completion of the Pediatric Sleep Questionnaire (PSQ), and a physical examination. Patients with suspected OSAS are placed on a waiting list for home respiratory polygraphy testing. The respiratory polygraphy examination is conducted over two consecutive nights and interpreted by a neurologist. Additionally, patients diagnosed with OSAS undergo a case study involving intraoral and extraoral photography, as well as radiographic evaluation.
RESULTS
Between September 2021 and May 2023, a total of 134 subjects (including 76 males), with an average age of 9.2 years, were identified as diagnostic suspects. Among these, 38 patients (28.3%) tested positive based on respiratory polygraphic results. Depending on the severity and etiopathogenetic characteristics of the disease, the positive cases were referred to various specialists.
CONCLUSION
In the daily clinical practice of dentistry, particularly in orthodontics and pedodontics, the establishment of a defined management pathway for pediatric patients with OSAS is crucial. The collaboration of a multidisciplinary team with a shared objective of achieving accurate diagnosis and implementing targeted treatment in a timely manner is essential. Regular re-evaluation of patients through clinical and instrumental examinations is recommended.
PubMed: 37508722
DOI: 10.3390/children10071225