2,726 research outputs found
Therapeutic alternatives with CPAP in obstructive sleep apnea
Obstructive Sleep Apnea (OSA), characterized by airflow cessation (apnea) or reduction (hypopnea) due to repeated pharyngeal obstructions during sleep, causes frequent disruption of sleep and hypoxic events. The condition is linked to many adverse health related consequences, such as neurocognitive and cardiovascular disorders, and metabolic syndrome. OSA is a chronic condition requiring long-term treatment, so treatment using continuous positive airway pressure (CPAP) has become the gold standard in cases of moderate or severe OSA. However, its effectiveness is influenced by patientsâ adherence. Surgery for OSA or treatment with oral appliances can be successful in selected patients, but for the majority, lifestyle changes such as exercise and dietary control may prove useful. However, exercise training remains under-utilized by many clinicians as an alternative treatment for OSA. Other interventions such as oral appliance (OA), upper way stimulation, and oropharyngeal exercises are used in OSA. Because the benefit of all these techniques is heterogeneous, the major challenge is to associate specific OSA therapies with the maximum efficacy and the best patient compliance
Can Weight Loss Improve the Cardiovascular Outcomes of Patients with Obesity and Obstructive Sleep Apnea?
Cardiovascular events are the primary cause of mortality in patients with obstructive sleep apnea and obesity. The rising prevalence of obstructive sleep apnea in recent decades has been linked to increasing rates of obesity. Obstructive sleep apnea has also been linked with many different cardiovascular diseases including coronary artery disease, stroke, heart failure, hypertension, and atrial fibrillation. Obesity is an increasing health concern globally, in part because obesity complications such as hypertension, diabetes, and obstructive sleep apnea increase the risk of cardiovascular diseases. More than 10% weight loss may be required to prevent or reverse obesity complications. Treatment approaches to obesity include nutritional therapy, exercise therapy, pharmacotherapy, and surgical therapies. This review intends to identify the effects of weight loss on cardiovascular outcomes in patients with obesity and obstructive sleep apnea. Despite the strong association between cardiovascular diseases and obstructive sleep apnea, randomized trials have failed to demonstrate that treatment of obstructive sleep apnea reduces cardiovascular events, even in patients with established cardiovascular diseases. Weight loss in patients with obstructive sleep apnea improves HbA1c, systolic blood pressure, HDL cholesterol, and triglycerides, but thus far no changes in cardiovascular events have been shown. The combination of weight loss with continuous positive airway pressure (CPAP) appears more beneficial than either treatment in isolation. Large well-controlled trials in patients with obstructive sleep apnea to assess the effects of different weight reduction programs on cardiovascular disease are still needed
The Role of Phenotyping in the Personalised Management of OSA
Background: Obstructive sleep apnoea (OSA) is estimated to affect up to 1 billion people in the world. Those who fail first-line continuous positive airway pressure (CPAP) therapy have salvage treatment options available. Patient assessment can incorporate multidisciplinary teams to better select therapy. Traditional parameters that define OSA severity do not always correlate with symptoms of the disease. Newly identified pathophysiological âphenotypesâ of airway vulnerability, low arousal threshold, loop gain and muscle responsiveness may explain the heterogeneity of OSA for up to two-thirds of patients. Little data exists on the effectiveness of phenotyping in a real-world clinical setting for patients undergoing contemporary management paradigms.
Aims and Hypothesis: To evaluate the prevalence of the four OSA phenotypic traits and explore the clinical validity of endotyping in predicting future treatment outcomes. It is expected that non-responders to treatment will have unfavourable non-anatomical phenotypes.
Design: An observational prospective cohort study of 49 patients referred after failure of CPAP for consideration of salvage therapy was conducted. Treatments included upper airway surgery (n = 17), mandibular advancement splint (n = 7), positional therapy (n = 7), weight loss (n = 4), nerve stimulation (n = 5) and combination therapy (n = 9). Treatment âsuccessâ was defined using polysomnographic parameters and patient-reported outcome measures of sleepiness and function. Phenotypic traits were analysed according to these outcomes.
Results: Nearly all surgical patients had unfavourable loop gain (LG1 \u3e 0.72), which improved after surgical treatment (p \u3c .05). Patients who had decreased sleepiness (Epworth Sleepiness Scale reduction â„ 3, total score \u3c 10, p = .01) after any treatment had favourable traits of low loop gain, lower arousal threshold and lower muscle compensation. There may be a potential role for phenotyping in predicting expected outcomes from salvage treatment for OSA, although more prospective clinical data is required to further investigate its utility and relevance
The Validity and Reliability of the PAVS and IPAQ-SF as Physical Activity Assessment Tools in Patients with Obstructive Sleep Apnea
Indiana University-Purdue University Indianapolis (IUPUI)Efforts to encourage the medical community to prescribe exercise for disease
prevention and management have increased significantly in recent years. In patients with
obstructive sleep apnea (OSA), it is encouraging that exercise has been shown to improve
sleep efficiency, daytime sleepiness, and disease severity. However, in order to better
understand the dose-response relationship between exercise and OSA-related outcomes,
accurate and reliable methods for assessing physical activity habits are needed. Purpose:
To determine the test-retest reliability and validity of two self-report physical activity
questionnaires [Physical Activity Vital Sign (PAVS); International Physical Activity
Questionnaire-Short Form (IPAQ-SF)] in an OSA population. Methods: 39 adults with
moderate-to-severe OSA wore an accelerometer for seven consecutive days and
completed the PAVS and IPAQ-SF (twice within 10 d), along with questionnaires on
quality of life, sleepiness, and treatment adherence. Test-retest reliability was determined
using intraclass correlation coefficients (ICC). Criterion and construct validity were
determined using Pearson (r) and Spearman correlation coefficients (Ï), respectively.
Results: PAVS and IPAQ-SF scores were reported as total min/wk of moderate-vigorous
physical activity (MVPA). Test-retest reliability for MVPA was excellent for PAVS
(ICC = 0.982) and good for IPAQ-SF (ICC = 0.766). MVPA assessed via accelerometry
was strongly correlated with PAVS (r = 0.802) and moderately with IPAQ-SF (r =
0.569). Both PAVS and IPAQ-SF were significantly correlated with body mass index (BMI) (Ï = -0.273 and -0.268, respectively), but no other variables. Conclusions: The
PAVS and IPAQ-SF are reliable and valid PA questionnaires and may be utilized as a
tool for accurately assessing physical activity levels in OSA patients
Therapeutic alternatives with CPAP in obstructive sleep apnea
Obstructive Sleep Apnea (OSA), characterized by airflow cessation (apnea) or reduction (hypopnea) due to repeated pharyngeal obstructions during sleep, causes frequent disruption of sleep and hypoxic events. The condition is linked to many adverse health related consequences, such as neurocognitive and cardiovascular disorders, and metabolic syndrome. OSA is a chronic condition requiring long-term treatment, so treatment using continuous positive airway pressure (CPAP) has become the gold standard in cases of moderate or severe OSA. However, its effectiveness is influenced by patientsâ adherence. Surgery for OSA or treatment with oral appliances can be successful in selected patients, but for the majority, lifestyle changes such as exercise and dietary control may prove useful. However, exercise training remains under-utilized by many clinicians as an alternative treatment for OSA. Other interventions such as oral appliance (OA), upper way stimulation, and oropharyngeal exercises are used in OSA. Because the benefit of all these techniques is heterogeneous, the major challenge is to associate specific OSA therapies with the maximum efficacy and the best patient compliance
The effect of respiratory event type and duration on heart rate variability in suspected obstructive sleep apnea patients
Abstract. Obstructive sleep apnea (OSA) patients have often reduced long-term heart rate variability (HRV) which is a known risk factor for several cardiovascular diseases such as hypertension and stroke. Albeit OSA being actively studied, it has remained uncharacterized how the duration and type of respiratory events affect the heart rate (HR), i.e. RR intervals, and ultra-short-term HRV during and immediately after the individual respiratory events. This study aimed to investigate whether the changes in ultra-short-term HRV and HR are modulated by the duration and type of the individual respiratory events and whether these changes are sex-specific. It was hypothesized that longer respiratory events cause higher ultra-short-term HRV and greater differences between RR intervals during and after the respiratory event. Moreover, it was hypothesized that the higher HRV and greater differences in HR are associated with apneas and men stronger than hypopneas and women.
Electrocardiograms (ECG) of 862 suspected OSA patients were collected during clinical polysomnography (PSG) at the Princess Alexandra Hospital (Brisbane, Australia) and they were analyzed retrospectively. Ultra-short-term HRV was studied with time-domain parameters determined from the ECG segments measured during (in-event) and 15 seconds after (post-event) the respiratory event. The respiratory events of all subjects were divided into groups based on the sex, the type of the respiratory events (apneas and hypopneas), and the duration of the respiratory events (10â20 s, 20â30 s, over 30 s).
A clear bradycardia-tachycardia rhythm associated with respiratory events was observed. The ultra-short-term HRV and the difference between in- and post-event RR intervals increased with increasing respiratory event duration. However, the difference between in- and post-event HRV parameter values decreased with increasing duration of the respiratory events. Furthermore, higher ultra-short-term HRV and a greater decrease in RR interval were observed in apneas and men.
Based on the results, the duration and type of the respiratory events modulate the HR and ultra-short-term HRV during and after the respiratory events, and these phenomena appear to be sex-specific. Therefore, considering the characteristics of respiratory events and ultra-short-term HRV could be useful in OSA diagnostics when estimating the OSA-related cardiac consequences. A scientific article based on the results of this thesis, Hietakoste et al. Longer apneas and hypopneas are associated with greater ultra-short-term HRV in OSA, has been submitted to a peer-reviewed scientific journal.TiivistelmÀ. Uniapneapotilailla havaitaan usein matalaa pitkÀn aikavÀlin sykevÀlivaihtelua, jonka tiedetÀÀn myös olevan riskitekijÀ useille sydÀn- ja verisuonisairauksille. Ei kuitenkaan tiedetÀ, miten uniapneaan liittyvÀt erimittaiset hengityskatkot tai niiden tyyppi vaikuttavat yksittÀisten hengityskatkojen aikaiseen ja jÀlkeiseen ultralyhyeen sykevÀlivaihteluun ja sydÀmen lyöntien vÀliseen kestoon, ts. RR-intervalleihin. TÀssÀ tutkimuksessa tavoitteena oli tutkia ultralyhyen sykevÀlivaihtelun ja RR-intervallien sukupuolisidonnaisia muutoksia eri mittaisten apneoiden ja hypopneoiden aikana ja jÀlkeen. Hypoteesina oli, ettÀ pidemmÀt hengityskatkot aiheuttavat suurempia muutoksia hengityskatkojen aikaisen ja jÀlkeisen keskimÀÀrÀisen RR-intervallien kestojen vÀlille ja siten korkeampaa ultralyhyttÀ sykevÀlivaihtelua. Oletettiin myös, ettÀ apneat aiheuttavat suurempia muutoksia kuin hypopneat ja havaitut muutokset ovat suurempia miehillÀ kuin naisilla.
Potilasaineisto koostui 862 uniapneasta epĂ€illyn potilaan sydĂ€nsĂ€hkökĂ€yristĂ€ (EKG), jotka oli mitattu Prinsessa Alexandran sairaalassa (Brisbane, Australia) osana kliinistĂ€ unipolygrafiaa. Ultralyhyen sykevĂ€livaihtelun mÀÀrittĂ€miseen kĂ€ytettiin keskimÀÀrĂ€istĂ€ RR-intervallien kestoa ja aikatason sykevĂ€livaihteluparametreja, jotka mÀÀritettiin hengityskatkojen aikaisista ja jĂ€lkeisistĂ€ (15 s hengityskatkon jĂ€lkeen) EKG-segmenteistĂ€. Tutkittavat hengityskatkot jaettiin ryhmiin niiden tyypin (apneat ja hypopneat) ja keston (10â20 s, 20â30 s ja yli 30 s) perusteella. LisĂ€ksi miesten ja naisten hengityskatkoja tutkittiin erikseen.
Tutkimuksessa havaittiin, ettÀ hengityskatkojen aikaisten ja jÀlkeisten RR-intervallien ero sekÀ ultralyhyt sykevÀlivaihtelu kasvoivat hengityskatkojen keston kasvaessa riippumatta sukupuolesta tai hengityskatkojen tyypistÀ. Havaittiin myös, ettÀ ero hengityskatkojen aikaisten ja jÀlkeisten sykevÀlivaihteluparametrien arvojen vÀlillÀ pieneni hengityskatkojen pidentyessÀ riippumatta sukupuolesta tai hengityskatkojen tyypistÀ. Apneat kuitenkin aiheuttivat suuremman muutoksen kuin hypopneat, ja muutokset olivat suurempia miehillÀ.
Tulosten perusteella hengityskatkojen tyyppi ja kesto vaikuttavat ultralyhyeen sykevÀlivaihteluun ja RR-intervalleihin. Ultralyhyen sykevÀlivaihtelun ja hengityskatkojen ominaisuuksien huomioonottaminen uniapnean diagnostiikassa voisi olla hyödyllistÀ arvioitaessa taudin vakavuutta ja sydÀnterveyteen liittyviÀ riskejÀ. TÀmÀn tutkimuksen tuloksista on kirjoitettu tieteellinen artikkeli Hietakoste ym. Longer apneas and hypopneas are associated with greater ultra-short-term HRV in OSA, joka on lÀhetetty vertaisarvioitavaksi alan kansainvÀliseen tieteelliseen julkaisusarjaan
Obstructive Sleep Apnea Syndrome: From Phenotype to Genetic Basis
Obstructive sleep apnea syndrome (OSAS) is a complex chronic clinical syndrome, characterized by snoring, periodic apnea, hypoxemia during sleep, and daytime hypersomnolence. It affects 4-5% of the general population. Racial studies and chromosomal mapping, familial studies and twin studies have provided evidence for the possible link between the OSAS and genetic factors and also most of the risk factors involved in the pathogenesis of OSAS are largely genetically determined. A percentage of 35-40% of its variance can be attributed to genetic factors. It is likely that genetic factors associated with craniofacial structure, body fat distribution and neural control of the upper airway muscles interact to produce the OSAS phenotype. Although the role of specific genes that influence the development of OSAS has not yet been identified, current researches, especially in animal model, suggest that several genetic systems may be important. In this chapter, we will first define the OSAS phenotype, the pathogenesis and the risk factors involved in the OSAS that may be inherited, then, we will review the current progress in the genetics of OSAS and suggest a few future perspectives in the development of therapeutic agents for this complex disease entity
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Sleep apnoea and cardiac surgery: Screening, prevalence and postoperative outcomes
Introduction: An excess of postoperative complications have been reported in patients with Obstructive Sleep Apnoea (OSA) following surgical procedures, however, studies reporting outcomes in patients with OSA following cardiac surgery are sparse and of limited quality. The cause of worse surgical outcomes in the OSA population is unknown but deleterious effects of opiates/opioids, common pain relieve medication following surgery have previously been proposed. There is a move towards pre-operative screening for OSA prior to surgery but the best screening methodology has not yet been established and more importantly the effect of treatment, in particular Continuous Positive Airway Pressure (CPAP), on surgical outcomes in patients with OSA is unknown.
Aim: This thesis examined the prevalence of sleep apnoea and its association with postoperative outcomes in patients undergoing major cardiac surgery. It also explored the usefulness of the STOP-Bang questionnaire, as a screening tool for OSA prior to cardiac surgery. In addition, current evidence regarding the effects of opiates/opioids and sedatives on patients with OSA was investigated and summarised in the Systematic Cochrane Review. The effect of morphine on severity of sleep apnoea in patients with moderate OSA was examined in a separate study.
Methods: The prevalence and association of sleep apnoea with postoperative outcomes in patients undergoing cardiac surgery and the usefulness of the STOP-Bang questionnaire in identifying patients at risk of OSA prior surgery was examined in a prospective, observational cohort study. The Systematic Cochrane review included randomised controlled trials examining the effects of opioids and sedatives, compared to placebo on severity of OSA in patients with established diagnosis of OSA. The effect of intravenous morphine sulphate on the severity of sleep apnoea was examined in a prospective, paired design trial which recruited patients with moderate OSA.
Results: A high prevalence of sleep apnoea (47%) and a significant association between its severity and postoperative complications was found in 122 participants undergoing major cardiac surgery. The most significant risk factor for complications was found to be oxygen desaturations during the night reflecting the severity of sleep apnoea (OR=1.1 for each unit increase in oxygen desaturation index (ODI), 95% CI 1.02-1.17; p=0.014). It was found that the STOP-Bang scores between 0-2 would with high confidence exclude patients with at least moderate sleep apnoea prior surgery. The best diagnostic performance for diagnosis of at least moderate sleep apnoea was found at higher STOP-Bang scores of â„6 which could identify those patients who might benefit from a sleep study before cardiac surgery. A systematic Cochrane review found that opiates/opioids, sedatives and hypnotics have no deleterious effect on the severity of OSA but most of the studies included in the review were of short duration, small size and with indiscernible methodological quality. The results of the Systematic Cochrane Review informed the development of my study, studying the effect of opiate, morphine sulphate, on patients with moderate OSA. This showed no change in Apnoea/Hypopnoea Index (AHI) where median difference (MD) was -12.95, IQR 9.45, p=0.173 but showed significant improvement in sleep apnoea indices including: obstructive apnoea index (MD -2.7, IQR 7.37, p=0.03), central apnoea index (MD â 0.35, IQR 0.83, p=0.04 ).However there was a fall in median nocturnal oxygen saturation.
Conclusion: This thesis reports high prevalence of sleep apnoea which was also found to be a risk factor for postoperative complications in patients undergoing major cardiac surgery. In this population, STOP-Bang score â„6 could identify patients in need of a sleep study to identify those who may be at increased risk of postoperative complications. To date there is no strong evidence supporting deleterious effects of opioids/opiates on patients with OSA but larger studies are needed to clarify its effect.Funded by the Royal Papworth Hospital, department of the Respiratory Support and Sleep Centr
Sleep-Disordered Breathing in Women
Sleep-disordered breathing (SDB) is underdiagnosed in women, probably due to the different gender-related manifestation. We investigated the differences in presentation, symptoms and co-morbidities of SDB in men and in pre- and postmenopausal women by a clinical, retrospective, cross-sectional study of 601 consecutively referred women and 233 age- and BMI-matched male-female pairs studied with the static-chargesensitive bed (SCSB) and an oximeter. Data on the use of nasal CPAP were gathered from the Paimio hospital database, and the co-morbidity information was based on reimbursed medication data from the National Agency for Medicines and the Social Insurance institution.
The abnormal breathing episodes at night were more frequent in men than in women, and in postmenopausal women compared to premenopausal ones. Partial upper airway obstruction was the most common type of SDB in both genders but especially in females. BMI and the major symptoms of SDB were similar in pre- and postmenopausal women, and a menopause effect on symptoms was not found. CPAP adherence did not differ between symptomatic patients with partial upper airway obstruction and those presenting with conventional obstructive sleep apnea. Comorbidities were more frequent in SDB patients than in the general Finnish population. Compared to sleep apnea, partial upper airway obstruction was associated with a threefold prevalence of asthma and/or COPD in both genders, and with a 60% reduced prevalence of hypertension in females matched for age and BMI.
Our results emphasize that partial upper airway obstruction is not a milder form of SDB but a different entity, the severity of which is underestimated when using the conventional apnea-hypopnea index. It seems clinically relevant to diagnose and treat the co-morbidities and SDB also in patients with partial upper airway obstruction, especially in elderly and symptomatic women.Siirretty Doriast
Occurrence of obesity and risk of obstructive sleep apnoea syndrome in adult patients presenting for elective surgery at an academic hospital
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree
of
Master of Medicine in the branch of Anaesthesiology
Johannesburg, 2015Background: Worldwide obesity has more than doubled since 1980 and is the fifth
leading cause of death (1). Obesity is a risk factor for the occurrence of obstructive sleep
apnoea syndrome (OSAS) (2). The incidence of OSAS in the USA is reported to be between
9 to 26% with the incidence in the surgical population reportedly being higher (3, 4).
Obesity and OSAS have implications for the anaesthetic management of patients. It is
important for the anaesthesiologist to know the occurrence of obesity and risk of OSAS in
the patient population presenting for surgery (5, 6).
Aim: The aim of this study was to describe the occurrence of obesity and risk of OSAS in
adult, elective surgery patients at an academic hospital.
Method: A descriptive, contextual, prospective study design was used. The height,
weight, used to calculate the BMI, and neck circumference, used as part of the STOPBANG
questionnaire, were taken by the researcher. The STOP-BANG questionnaire was
used to assess for risk of OSAS in all patients.
Results: The study included 250 patients of which 153 (61%) were female and 97 (39%)
were male. There were 223 (89.2%) black patients, 15 (6.0%) coloured, 10 (4.0%) white
and 2 (0.8%) Indian patients. Of these patients 81 (32.4%) had a BMI of â„ 30 (95% CI 26.6-
38.2%) and were classified as obese. There were 69 (45.1%) obese females and 12 (12.4%)
obese males. A STOP-BANG score of < 3 was attained by 205 (82%) patients and â„ 3,
indicating a risk for OSAS, by 45 (18%) patients of which 22 (48.9%) had a BMI of < 30 and
23 (51.1%) a BMI â„ 30. Chi-square tests revealed statistically significant relationships
between obesity and gender with a lower BMI being associated with being male (Ï2 [1] =
29.03, p = 0.001), and age younger than 40 years (Ï2 [1], p = 0.001). Chi-square tests
revealed statistically significant relationships between BMI and risk of OSAS, with lower
risk being associated with a lower BMI (p = 0.003). A lower risk of OSAS was also
associated with being female (p = 0.004) and a higher risk of OSAS was associated with
being â„ than 40 years of age (p = 0.001).
Conclusion: Obesity is a multi systemic disease which carries significant morbidity and
mortality.It is not only important to identify the disease but also to grade its severity and
assess the degree of dysfuction it has caused so that the patient can be optimally
assessed by the anaesthetist. Our study showed a occurrence of obesity of 32.4% which
was comparable with the highest prevalences in the world. This should however be
intepreted with caution as the study may not be generalisable to other communities.
OSAS too is associated with a higher morbidity and mortality. It goes undiagnosed or
under-diagnosed in a large proportion of patients, and poses increased anaesthetic risk.
It should be screened for and identified as well as itâs severity graded in order to institute
appropriate anasthetic management and make plans for post operative care in a
specialised environment. The risk of OSAS was found to be 18% in our study. It was found
to be higher in males, and age older â„ 40. Although there was a high occurence of obesity
in the females there was a lower risk of OSAS. The risk of OSAS was similar in obese and
non obese patients.MT201
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