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Sleep Science (Sao Paulo, Brazil) 2018To establish the prevalence of positional (PP) OSA patients using self-administered home-based respiratory polygraphy (RP).
OBJECTIVE
To establish the prevalence of positional (PP) OSA patients using self-administered home-based respiratory polygraphy (RP).
MATERIALS AND METHODS
52 month retrospective study based on RP records.
RESULTS
200 PR records: 70.5% men 29.5% women. 76% were diagnosed with OSA and 54.6% with PP OSA. There were no significant differences in Epworth Sleepiness Scale, apnea hypopnea index and oxygen desaturation index. PP OSA patients were younger, had a lower BMI (30.3±0.9 vs. 35.3±1.2) (<0.0001), and the time they spent with oxygen saturation <90% (T<90) was lower (8.8 vs. 28.7±6.7, =0.0038). The PP OSA group spent 43% of total recording time in the supine position.
CONCLUSIONS
The prevalence of PP OSA patients studied with RP is similar to the one described by sleep laboratories. They have lower BMI, present mostly mild OSA with less desaturation, and are less likely to receive CPAP therapy.
PubMed: 29796194
DOI: 10.5935/1984-0063.20180003 -
Swiss Medical Weekly Feb 2007Sleep related breathing disorders (SBD) are common and associated with morbidity and mortality. Since polysomnography, the conventional diagnostic gold standard is... (Review)
Review
BACKGROUND
Sleep related breathing disorders (SBD) are common and associated with morbidity and mortality. Since polysomnography, the conventional diagnostic gold standard is costly and not generally available, ambulatory respiratory polygraphic sleep studies (RP) are used. To evaluate whether RP reimbursement by health insurance companies was justified, the Swiss Federal Office of Public Health (FOPH) requested registration of RP during 36 months and a literature review on RP. The results are reported here.
METHODS
RP reimbursed from July 2002 to December 2005 by Swiss health insurance companies were analysed. A review of the literature from 2003 comparing RP with PSG was updated. The outcome of interest was the apnoea/hypopnoea index.
RESULTS
Datasets on 11,485 RP were evaluated, 8179 were performed to evaluate suspected obstructive sleep apnoea syndrome (OSAS). In patients with snoring, witnessed apnoea and hypersomnia (n = 4180), 80.2% of RP confirmed OSAS, 3.5% of RP were inconclusive prompting polysomnography. Six studies published between 2003 and 2005 were pooled with a former review of 12 studies. With a mean pre-test probability of 64% for OSAS, the post-test probability after a negative result ranged from 8% (negative likelihood ratio of 0.05) to 23% (negative likelihood ratio of 0.20). The post-test probability after a positive result was within a range of 98% (positive likelihood ratio of 23.8) to 90% (positive likelihood ratio of 5.7).
CONCLUSIONS
In selected patients with clinically suspected OSAS RP allows accurate and simple diagnosis of OSAS. According to the practice in Switzerland as reflected by the registry additional PSG are rarely required, suggesting relevant cost savings by RP. Granting reimbursement for RP as introduced in the meantime by the FOPH seems justified.
Topics: Humans; Insurance Claim Review; Monitoring, Ambulatory; Polysomnography; Practice Guidelines as Topic; Predictive Value of Tests; Pulmonary Medicine; Registries; Respiration; Sleep Apnea Syndromes; Switzerland
PubMed: 17370146
DOI: 10.4414/smw.2007.11654 -
Tidsskrift For Den Norske Laegeforening... Jan 2013Sleeping problems are very common, and many patients need a comprehensive assessment with polysomnography, possibly followed by a sleep latency test. These methods and... (Review)
Review
BACKGROUND
Sleeping problems are very common, and many patients need a comprehensive assessment with polysomnography, possibly followed by a sleep latency test. These methods and indications for the tests are described below.
METHOD
The article is based on the authors' own literature archives, clinical experience and Retningslinjer for metoder i klinisk neurofysiologi [Guidelines for methodology in clinical neurophysiology]
RESULTS
Polysomnography involves monitoring sleep through the course of one night and scoring the stages of sleep on the basis of EEG activity, eye movements and muscular tension. Also recorded are inter alia respiratory variables. Polysomnography followed by a multiple sleep latency test (MSLT) is used when narcolepsy or excessive daytime sleepiness is suspected. If parasomnia is suspected, the examination should include polysomnography, preferably with video recording. If sleep apnoea is suspected in adults, respiratory polygraphy is often sufficient. As a rule, polysomnography is preferable to respiratory polygraphy for studying sleep disorders in children.
INTERPRETATION
Sleep disorders take many forms and are dealt with by many different specialities. Good cooperation between the different specialities is necessary to ensure an optimal result for the patients.
Topics: Humans; Polysomnography; Sleep; Sleep Wake Disorders
PubMed: 23306997
DOI: 10.4045/tidsskr.12.0172 -
International Journal of Molecular... Sep 2023An association has been suggested between acute myocardial infarction (AMI) and obstructive sleep apnea (OSA). Considering the role of adipose-tissue-derived...
An association has been suggested between acute myocardial infarction (AMI) and obstructive sleep apnea (OSA). Considering the role of adipose-tissue-derived inflammatory mediators (adipokines) and the shared risk factor of obesity in OSA and AMI, this study aimed to investigate the involvement of adipokines in AMI patients with and without OSA. Serum levels of adipokines and inflammatory mediators were quantified, and home respiratory polygraphy was conducted. A total of 30 AMI patients and 25 controls were included. Patients with AMI exhibited elevated levels of resistin (7.4 vs. 3.7 ng/mL), interleukin-6 (8.8 vs. 1.3 pg/mL), and endothelin-1 (3.31 vs. 1.8 pg/mL). Remarkably, AMI patients with concomitant OSA exhibited higher levels of resistin (7.1 vs. 3.7 ng/mL), interleukin-6 (8.9 vs. 1.3 pg/mL), endothelin-1 (3.2 vs. 1.8 pg/mL), creatin kinase (1430 vs. 377 U/L), creatine kinase-MB (64.6 vs. 9.7 ng/mL), and troponin T (2298 vs. 356 pg/mL) than their non-OSA counterparts. Leptin showed a correlation with OSA severity markers. OSA was associated with greater cardiac damage in AMI patients. Our findings underscore that adipokines alone are not sufficient to discriminate the risk of AMI in the presence of OSA. Further research is necessary to determine the potential mechanisms contributing to exacerbated cardiac damage in patients with both conditions.
Topics: Humans; Adipokines; Resistin; Interleukin-6; Endothelin-1; Myocardial Infarction; Sleep Apnea, Obstructive; Inflammation Mediators
PubMed: 37834123
DOI: 10.3390/ijms241914674 -
The European Respiratory Journal Dec 2023Hypoxic burden (HB) has emerged as a strong predictor of cardiovascular risk in obstructive sleep apnoea (OSA). We aimed to assess the potential of HB to predict the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Hypoxic burden (HB) has emerged as a strong predictor of cardiovascular risk in obstructive sleep apnoea (OSA). We aimed to assess the potential of HB to predict the cardiovascular benefit of treating OSA with continuous positive airway pressure (CPAP).
METHODS
This was a analysis of the ISAACC trial (ClinicalTrials.gov: NCT01335087) including non-sleepy patients with acute coronary syndrome (ACS) diagnosed with OSA (apnoea-hypopnoea index ≥15 events·h) by respiratory polygraphy. Patients were randomised to CPAP or usual care and followed for a minimum of 1 year. HB was calculated as the total area under all automatically identified desaturations divided by total sleep time. Patients were categorised as having high or low baseline HB according to the median value (73.1%min·h). Multivariable Cox regression models were used to assess whether the effect of CPAP on the incidence of cardiovascular outcomes was dependent on the baseline HB level.
RESULTS
The population (362 patients assigned to CPAP and 365 patients assigned to usual care) was middle-aged (mean age 59.7 years), overweight/obese and mostly male (84.5%). A significant interaction was found between the treatment arm and the HB categories. In the high HB group, CPAP treatment was associated with a significant reduction in the incidence of cardiovascular events (HR 0.57, 95% CI 0.34-0.96). In the low HB group, CPAP-treated patients exhibited a trend toward a higher risk of cardiovascular outcomes than those receiving usual care (HR 1.33, 95% CI 0.79-2.25). The differential effect of the treatment depending on the baseline HB level followed a dose-response relationship.
CONCLUSION
In non-sleepy ACS patients with OSA, high HB levels were associated with a long-term protective effect of CPAP on cardiovascular prognosis.
Topics: Middle Aged; Humans; Male; Female; Continuous Positive Airway Pressure; Sleep Apnea, Obstructive; Proportional Hazards Models; Acute Coronary Syndrome; Hypoxia
PubMed: 37734857
DOI: 10.1183/13993003.00828-2023 -
Polymers Nov 2022Multi-structural polymer composites are widely used in the mechanical engineering, automotive, aviation and oil refining industries, as well as in the printing industry...
Multi-structural polymer composites are widely used in the mechanical engineering, automotive, aviation and oil refining industries, as well as in the printing industry as a shock-absorbing deckle on the offset cylinders of printing machines. During offset printing, composites come into contact with inks and washing solutions, the components of which penetrate the material and cause the polymers to swell. This process degrades the print quality, and for this reason the study of its features is relevant. The prerequisites for this work are the study of the fundamental laws of diffusion and sorption of liquids by polymers with different micro- and macro-structures in different physical states and in different forms (e.g., films, sheets, fibers and fabrics). The combination of polymer materials in the composition of multi-structural fabric blankets makes it possible to obtain materials with unique mechanical properties and high resistance to liquid penetrating media and to use them in high-tech processes of multi-color printing with high resolution and color rendering. This article reports for the first time the kinetics and thermodynamics results obtained from the swelling of multi-structural polymeric blankets in solvents used in printing, and the effect of sorption of different polar liquids on the viscoelastic strain under compression during the operation of the damping systems of printing machines. Using mathematical models of activated liquid diffusion in polymers and deformation of a viscoelastic body, the swelling rate constants, solvent diffusion coefficients (the kinetic characteristics of the swelling process) and Flory−Huggins parameters (the thermodynamic characteristics of the interaction of the solvent with the composite) for composite−solvent systems with several chemical composition variants were determined. The elastic modulus and the viscosity coefficient of the composite under liquid saturation were calculated based on the experimental cyclic compression data. The range of change in the compression and restoration times of the polymeric blankets (0.09 s ÷ 0.78 s) was determined. It was shown that the composite swelled to a limited extent in all the studied liquids. All solvents used were thermodynamically poor (χ > 0.5). It has been established that rubber−fabric blankets coated with nitrile rubber are the least resistant to the action of dichloroethane, and that blankets with layers of polyolefins are not resistant to ethyl acetate. Water significantly affects the physicochemical properties of rubber−fabric blankets with a large proportion of cotton fabric layers. The data obtained can serve as a basis for optimizing the compositions of inks and cleaning solutions, as well as a theoretical basis for the thermodynamics of composite−solvent systems.
PubMed: 36501569
DOI: 10.3390/polym14235177 -
Revista Chilena de Pediatria Jun 2019The early diagnosis of Sleep Disordered Breathing (SDB) may allow proper intervention. Currently, polygraphy (PG) is a reliable and accessible alternative.
INTRODUCTION
The early diagnosis of Sleep Disordered Breathing (SDB) may allow proper intervention. Currently, polygraphy (PG) is a reliable and accessible alternative.
OBJECTIVE
To describe and analyze the PG of children > 1 year old with suspicion of SDB.
PATIENTS AND METHOD
PG of children > 1 year old and adolescents from Concepcion, Chile, with suspected SDB were included, from December 2011 to Au gust 2017. Demographic, clinical and polygraphic variables were collected. It was used descriptive sta tistics, expressing results in median and range. The association between apnea-hypopnea index (AHI) and oxygen saturation was determined by Spearman's Rho, considering significance of p < 0.05. Re sults: 190 studies were analyzed. Age 7.9 years old (1.0-20.6), 61% males.
DIAGNOSIS
neuromuscular disease (NMD) (24.2%), chronic lung damage (21.1%), upper airway obstruction (UAO) (19.5%), neurological damage (11%), Down syndrome (8.9%), upper airway malformations (7.4%), central hypoventilation (3.7%), obesity (2.6%), and others (1.6%). 55.3% were altered PG, with 53.3% of mild Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS), 30.5% moderate, and 16.2% severe. There were no significant differences in AHI between groups of pathologies (p = 0.032), highlighting a higher AHI in obese patients 9 (0.41-51), and those with NMD 23.9 (0.4-36.6). It was found asso ciation between AHI and oxygen saturation parameters: mean saturation (rho = -0.425; p = 0.001), minimum (rho = -0.654; p = 0.001), and oxygen saturation below 90% (rho = 0.323; p = 0.001) in the whole sample.
DISCUSSION
There was a high percentage of OSAHS in at-risk pediatric patients, especially in those with NMD and obesity. PG is an accessible and implementable tool in a public hospital, a situation that can potentially be extrapolated to other healthcare centers.
Topics: Adolescent; Child; Child, Preschool; Chile; Female; Humans; Infant; Male; Neuromuscular Diseases; Oxygen; Pediatric Obesity; Polysomnography; Retrospective Studies; Risk Factors; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 31344191
DOI: 10.32641/rchped.v90i3.769 -
Journal of Clinical and Experimental... Sep 2022Rapid maxillary expansion (RME) treatment is prescribed in patients with maxillary compression, achieving increases in transverse palate and nasal cavity dimensions... (Review)
Review
BACKGROUND
Rapid maxillary expansion (RME) treatment is prescribed in patients with maxillary compression, achieving increases in transverse palate and nasal cavity dimensions together with an increase in the distance between the pterygoid processes. Sleep apnoea-hypopnoea syndrome (SAHS) in children is often associated with anatomical risk factors and treatment may involve surgery, drugs, dentofacial orthopaedics, myofunctional and positional approaches.
MATERIAL AND METHODS
The aim of this systematic review it to obtain scientific evidence of the effect of RME on the apnoea-hypopnoea index (AHI) in growing patients. PubMed, Cochrane Library and EMBASE were the online databases used for the search. The scientific publications selected met the following inclusion criteria: articles published from 2011 to May 2021; growing patients undergoing rapid maxillary expansion surgery; and studies with records of AHI before and after rapid maxillary expansion using polysomnography or respiratory polygraphy.
RESULTS
Seven articles that provided the necessary quality of scientific evidence were finally selected. The review followed the Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0, and the GRADE approach for rating the certainty of evidence. Data analysis was performed using Numbers 4.3 and ReviewManager (RevMan) 5.4.1 software and GRADEpro and Mendeley online platforms.
CONCLUSIONS
The results show a reduction in AHI following RME therapy in growing patients. More research is needed with larger sample sizes, more specific inclusion criteria and standardised data sharing. Rapid maxillary expansion, maxillary distraction, sleep apnoea, children.
PubMed: 36158770
DOI: 10.4317/jced.59750 -
Scientific Reports Nov 2022The aim of this cross-sectional study was to objectively assess the salivary flow rate and composition and periodontal inflammation in obstructive sleep apnoea (OSA)...
The aim of this cross-sectional study was to objectively assess the salivary flow rate and composition and periodontal inflammation in obstructive sleep apnoea (OSA) patients. The subjects, who underwent whole-night polysomnography or polygraphy, were referred for saliva sampling and periodontal examination. According to the severity of OSA based on the Apnoea Hypopnea Index (AHI) value, the subjects were classified into groups: no OSA (AHI < 5; N = 17), mild to moderate OSA (AHI 5-29.9; N = 109), and severe OSA (AHI > 30; N = 79). Salivary flow rate, pH, salivary electrolytes, and cortisol were measured from collected saliva samples. Periodontal examination included assessment of the number of teeth, dental plaque, bleeding on probing and periodontal measurements: gingival recession, probing pocket depth, clinical attachment level (CAL) and periodontal inflamed surface area (PISA) score. There were no significant differences in salivary flow rate, salivary pH, salivary electrolyte concentrations or electrolyte ratios among the groups classified according to the severity of OSA. However, subjects without OSA had higher salivary cortisol concentrations than OSA groups (p < 0.001). Increased plaque scores were associated with a higher AHI (r = 0.26; p = 0.003). According to the salivary flow rate, subjects with hyposalivation and reduced salivation had higher concentrations of salivary electrolytes and lower salivary pH than subjects with normal salivation. Subjects with hyposalivation had an increased Mg/PO ratio (p < 0.001) and a reduced Ca/Mg ratio (p < 0.001). Furthermore, subjects with severe OSA tended to have higher CALs and plaque volumes. In conclusion, under pathological conditions, such as OSA, multiple interactions might impact salivary flow and electrolyte composition. Complex interrelationships might affect the integrity of oral health, especially considering OSA severity, inflammation, concomitant diseases and medications.
Topics: Humans; Hydrocortisone; Cross-Sectional Studies; Sleep Apnea, Obstructive; Inflammation; Xerostomia
PubMed: 36371504
DOI: 10.1038/s41598-022-23957-5 -
Genes Feb 2023Cystic fibrosis transmembrane conductance regulator (CFTR) modulators represent targeted therapies directly acting on the CFTR channel. The triple therapy...
Effects of Elexacaftor/Tezacaftor/Ivacaftor on Cardiorespiratory Polygraphy Parameters and Respiratory Muscle Strength in Cystic Fibrosis Patients with Severe Lung Disease.
BACKGROUND
Cystic fibrosis transmembrane conductance regulator (CFTR) modulators represent targeted therapies directly acting on the CFTR channel. The triple therapy Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA) has been demonstrated to improve lung function and quality of life in cystic fibrosis (CF) patients. However, the effects of ELX/TEZ/IVA on sleep-disordered breathing (SDB) and respiratory muscle strength are poorly studied. The aim of this study was to assess the effects of ELX/TEZ/IVA in patients with CF and severe lung disease on cardiorespiratory polygraphy parameters, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) measures.
METHODS
patients with CF aged ≥ 12 who started treatment in a compassionate use program were retrospectively studied through the evaluation of nocturnal cardiorespiratory polygraphy parameters, MIP and MEP; and six-minute walk test (6MWT) at baseline and at months 3, 6, and 12 of treatment.
RESULTS
Nine patients (mean age 30.3 ± 6.5 years) with severe CF (mean baseline ppFEV1 34.6 ± 5.1%) were evaluated. A significant improvement in nocturnal oxygenation measured by mean SpO (92.4 vs. 96.4%, < 0.05), time spent with SpO ≤ 90% (-12.6, -14.6, -15.2 min from baseline at months 3, 6, and 12, respectively, < 0.05), and respiratory rate (RR) was shown, at month 12 and across the time points compared with baseline, as well as in respiratory muscle strength, although only the change in MEP was significant.
CONCLUSIONS
We provide further evidence on the efficacy of the CFTR modulators ELX/TEZ/IVA, adding information about their effect on the respiratory muscles' performance and cardiorespiratory polygraphy parameters in CF patients with severe lung disease.
Topics: Humans; Young Adult; Adult; Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Quality of Life; Respiratory Rate; Retrospective Studies; Respiratory Muscles; Lung
PubMed: 36833376
DOI: 10.3390/genes14020449