Breathing during sleep: Studies related to upper airway calibre in pregnancy

Snoring is common in pregnancy, and has been associated with an increased incidence of both maternal hypertension and preeclampsia, as well as an increased incidence of low birth weight infants and significantly poorer Apgar scores at birth. Patients with pre-eclampsia have episodes of partial upper airway (UA) obstruction during sleep. These repeated episodes are associated with further increases in blood pressure (BP). Preliminary evidence indicates that preventing episodes of airflow obstruction with continuous positive airway pressure (CPAP) therapy may reduce BP in pre-eclampsia. Snoring and apnoea-hypopnoea index (AHI) subside within a few months of delivery. However, there have been no studies measuring the effect of pregnancy or the postpartum period on UA dimension. The present study aimed to compare UA dimensions in pregnant and nonpregnant women and in patients with pre-eclampsia with a follow-up of the pregnant women post partum. Apart from snoring, excessive daytime sleepiness (EDS) is the most common complaint among pregnant women. A majority of the pregnant women including preeclamptic women have experienced EDS during pregnancy, but it is not clear whether EDS is associated with snoring. Thus, this thesis also examines whether snoring and sleepiness are linked in pregnancy and pre-eclampsia. In a cross-sectional study with a 3 way comparison, 50 pregnant, 37 pregnant women with pre-eclampsia in the third trimester of pregnancy, and 50 nonpregnant women were consecutively recruited. Control subjects were matched with pregnant women (both healthy pregnant and pre-eclamptic women) for age and pre-pregnancy BMI. UA dimensions were measured using acoustic reflection. Habitual snoring was reported by 15% of nonpregnant women, 28% of pregnant women, and 48% of pre-eclamptic women (p 0.3). When seated, pregnant women had wider UAs than nonpregnant women (p < 0.02). There was a non-significant trend for pregnant women to have narrower airways than non-pregnant women when supine. The data suggest that there may be pregnancy related changes in UA dimension, but this was not clear from this cross-sectional study of 3 groups, non-pregnant, pregnant and pre-eclamptic women. In a cross sectional study (with a 2 way comparison) with follow up of the pregnant women at least three months after their delivery, 100 women in the third trimester of pregnancy and 100 nonpregnant women, matched for age and BMI, were recruited. Fifty women agreed to be restudied 3 months after delivery. UA dimensions were measured using acoustic reflection. Snoring was less common in nonpregnant (17%) than pregnant women (41%) and returned to nonpregnant levels after delivery (18%). Pregnant women had significantly smaller UAs than nonpregnant women at the oropharyngeal junction when seated and smaller mean pharyngeal areas in the seated, supine and lateral postures compared with the nonpregnant females (p< 0.05). Pregnant women had smaller mean pharyngeal areas compared with post-partum in the seated, supine and lateral postures (p< 0.03). This study confirmed increased snoring and showed narrower UAs during the third trimester of pregnancy. One-hundred sixty-seven healthy and 82 pre-eclamptic women in the third trimester of pregnancy and 160 non-pregnant women completed a sleep questionnaire in a prospective questionnaire-based study. Age and height did not differ significantly between groups (P>0.2), but pre-eclamptic women were heavier than pregnant and non-pregnant women and had higher BMI than pregnant women before pregnancy (all P0.1). Sleepiness was reported by 12% of non-pregnant, 23% of pregnant and 15% of pre-eclamptic women (p<0.04), but non-pregnant women had lower mean Epworth Sleepiness scores than both pregnant and pre-eclamptic groups (P<0.001). Snoring was correlated with (p=0.002), but explained only <2% of the variance in sleepiness. The studies presented in this thesis indicate that UA narrowing occurs in the third trimester of pregnancy, probably due to pregnancy-related changes. It is likely that reduced UA calibre may contribute to the increased rate of snoring, breathing pauses and sleepiness in the third trimester of pregnancy, especially in patients with pre-eclampsia. However, sleepiness in pregnancy is largely due to factors other than snoring or breathing pauses

Clinical audit of subjects with snoring & sleep apnoea/hypopnoea syndrome fitted with mandibular repositioning splint

SummarySnoring and obstructive sleep apnoea/hypopnoea syndrome (OSAHS) are often treated with mandibular repositioning splints (MRS), but the efficacy and satisfaction of them has not been comprehensively addressed. A survey on the use of and satisfaction with MRS was posted to 177 patients referred by a hospital orthodontic department for custom-fitting of a MRS. Data were analysed using non-parametric techniques. The response rate was 81% (n=144). Responders (30F, 114M) had mean (SD) age of 51 (11) years, apnoea+hypopnoea index (AHI) of 24 (21) per hr and Epworth Score of 10 (5) at diagnosis, and had been supplied with their MRS a median 7 (IQR 5–11) months previously. Fifty of the 144 patients (35%) had been offered continuous positive airway pressure (CPAP) treatment but had declined or abandoned this. Self-reported MRS use was 5 (2) h/night, with 74 of the 144 patients (51%) continuing to use MRS at least occasionally at a median 7 months after fitting. Survival analysis showed 12% still using MRS at 12 months. Epworth score fell slightly with MRS therapy [−2.4 (3.5); P=0.005] and 7 daytime and 2 nocturnal symptoms improved in MRS users (all P<0.05). Marital satisfaction did not change with MRS. Problems preventing MRS use in 70 non-users included: non-retention (n=12), sore mouth (n=13) or jaw (n=7), difficulties falling asleep (n=10) or breathing (n=7), excessive salivation (n=4), dental damage (n=4) and other problems (n=3). Continued use of MRS therapy was associated with a higher number of teeth, low marital satisfaction perceived by partners and greater improvement in symptoms reported by patients and partners. Continuance with MRS may be low and linked to tolerance problems

Sleep disordered breathing in pregnancy

Key points Sleep disordered breathing (SDB) is common and the severity increases as pregnancy progresses.; Frequent snoring, older age and high pre-pregnancy body mass index (>25 kg⋅m−2) could be reliable indicators for SDB in early pregnancy.; SDB screening tools, including questionnaires, used in the nonpregnant population have poor predictive ability in pregnancy.; Accumulating evidence suggests that SDB during pregnancy may be associated with increased risk of adverse pregnancy outcomes, including gestational diabetes and pre-eclampsia. However, the results should be interpreted cautiously because several studies failed to adjust for potential maternal confounders and have other study limitations.; There are no pregnancy-specific practice guidelines for SDB treatment. Many clinicians and practices follow recommendations for the treatment in the general population. Women with pre-existing SDB might need to be reassessed, particularly after the sixth month of pregnancy, because symptoms can worsen with nasal congestion and weight gain.; Educational aims To highlight the prevalence and severity of sleep disordered breathing (SDB) in the pregnant population.; To inform readers about risk factors for SDB in pregnancy.; To explore the impact of SDB on adverse maternal and fetal outcomes, and biological pathways for associated adverse maternal and fetal outcomes.; To introduce current management options for SDB in pregnancy, including medical and behavioural approaches.; Sleep disordered breathing (SDB) is very common during pregnancy, and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, one of the major risk factors for SDB, together with physiological changes in pregnancy may predispose women to develop SDB. SDB has been associated with poor maternal and fetal outcomes. Thus, early identification, diagnosis and treatment of SDB are important in pregnancy. This article reviews the pregnancy-related changes affecting the severity of SDB, the epidemiology and the risk factors of SDB in pregnancy, the association of SDB with adverse pregnancy outcomes, and screening and management options specific for this population

Special Issue: The Diagnosis and Management of OSA

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing (SDB) and is demonstrating an increasing prevalence worldwide [...

Breathing during sleep : studies related to upper airway calibre in pregnancy

Snoring is common in pregnancy, and has been associated with an increased incidence of both maternal hypertension and preeclampsia, as well as an increased incidence of low birth weight infants and significantly poorer Apgar scores at birth. Patients with pre-eclampsia have episodes of partial upper airway (UA) obstruction during sleep. These repeated episodes are associated with further increases in blood pressure (BP). Preliminary evidence indicates that preventing episodes of airflow obstruction with continuous positive airway pressure (CPAP) therapy may reduce BP in pre-eclampsia. Snoring and apnoea-hypopnoea index (AHI) subside within a few months of delivery. However, there have been no studies measuring the effect of pregnancy or the postpartum period on UA dimension. The present study aimed to compare UA dimensions in pregnant and nonpregnant women and in patients with pre-eclampsia with a follow-up of the pregnant women post partum. Apart from snoring, excessive daytime sleepiness (EDS) is the most common complaint among pregnant women. A majority of the pregnant women including preeclamptic women have experienced EDS during pregnancy, but it is not clear whether EDS is associated with snoring. Thus, this thesis also examines whether snoring and sleepiness are linked in pregnancy and pre-eclampsia. In a cross-sectional study with a 3 way comparison, 50 pregnant, 37 pregnant women with pre-eclampsia in the third trimester of pregnancy, and 50 nonpregnant women were consecutively recruited. Control subjects were matched with pregnant women (both healthy pregnant and pre-eclamptic women) for age and pre-pregnancy BMI. UA dimensions were measured using acoustic reflection. Habitual snoring was reported by 15% of nonpregnant women, 28% of pregnant women, and 48% of pre-eclamptic women (p 0.3). When seated, pregnant women had wider UAs than nonpregnant women (p 0.2), but pre-eclamptic women were heavier than pregnant and non-pregnant women and had higher BMI than pregnant women before pregnancy (all P0.1). Sleepiness was reported by 12% of non-pregnant, 23% of pregnant and 15% of pre-eclamptic women (p<0.04), but non-pregnant women had lower mean Epworth Sleepiness scores than both pregnant and pre-eclamptic groups (P<0.001). Snoring was correlated with (p=0.002), but explained only <2% of the variance in sleepiness. The studies presented in this thesis indicate that UA narrowing occurs in the third trimester of pregnancy, probably due to pregnancy-related changes. It is likely that reduced UA calibre may contribute to the increased rate of snoring, breathing pauses and sleepiness in the third trimester of pregnancy, especially in patients with pre-eclampsia. However, sleepiness in pregnancy is largely due to factors other than snoring or breathing pauses.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Türk hekimlerinin uyku hastalıklarına bakışı

Bu çalışma ile Türkiye'deki hekimlerin uyku hastalıklarına bakışlarını ve bu konudaki tıbbi bilgilerini tespit etmeyi amaçladık. Yedi tanesi hekimlerin bu konuya bakış açılarını, 17 tanesi ise bu konudaki tıbbi bilgilerini ölçmeyi hedefleyen 24 soruluk bir anket formu hazırladık. Anketi Türkiye'nin başkenti ve ikinci en büyük kenti olan Ankara'daki üniversite ve eğitim hastanelerinde uyguladık. Beş farklı uzmanlık alanından 215 hekime ulaştık ve bunlardan 168 (%78)'i anket formunu tamamladı. Hekimlerin %47'si uyku hastalıkları hakkında çok az bilgi sahibi olduklarını belirttiler, %45'i ise bu konuda yeterli bilgi sahibi olduklarını ifade ettiler, ancak başarı oranları yüksek değildi. Soruların yalnızca %45.3'ü doğru olarak cevaplandırıldı. Bu anketin ışığında, Türkiye'deki uyku hastalıkları tıbbının kalitesini arttırmak için bu konudaki tıp eğitiminin hem süre hem de içerik olarak daha iyi hale getirilmesi gerektiği sonucuna vardık.We aimed to assess the knowledge of Turkish physicians about sleep disorders and the attitude of the physicians towards sleep medicine. We prepared a 24-item-questionnaire, 7 of the questions were about the attitudes of the physicians and 17 of them were about the knowledge of the physicians. We applied the questionnaire in all university and educational hospitals in Ankara, which is the capital city and the second largest city of Turkey. Two-hundred-fifteen medical doctors from 5 different specialties accepted to answer the-questionnaire, and 168 (78%) of them completed the questionnaire. 47% of the physicians rated themselves as they had little knowledge about sleep disorders, and 45% as they had enough knowledge about sleep disorders, however, the overall score was not high. They answered only 45.3% of the questions correctly. In the light of this survey, we concluded that medical education on sleep disorders should be extended both in length and in content to improve the quality of sleep disorders medicine in Turkey

Uykunun fonksiyonel sonuçları ölçeğinin (FOSQ) Türk toplumuna uyarlanması

Uyku anketinin fonksiyonel sonuçlarının Türk versiyonu (FOSQ.tr), obstrüktifuyku apne hipopne sendrorn (OUAHS)'lu hastalarda psikometrik özellikleri yönünden değerlendirildi. FOSQ testi önce Türkçe'ye çevrilip, sonra tekrar ingilizce'ye çevrildi. Psikometrik değerlendirme amacıyla, ardarda seçilmiş 73 hasta ile birlikte 73 kontrol olgusuna test uygulandı. Testlerin geçerlilik ve güvenilirlik çalışmaları yapıldı. FOSQ.tr'nin tümünde (a= 0.92) ve alt skalalarında (o= 0.76-0.80) Cronbach's alfa değerleri, anketin iç güvenilirliğinin tam olduğunu düşündürdü. FOSQ.tr'nin test, retest geçerliliği sosyal sonuçlardan farklı olarak, tüm skorlar (r= 0.7) ve alt skalalar için anlamlıydı (r= 0.5'den 0.8'e kadar, toplamda p< 0.01). FOSQ.tr Epworth uykululuk skalası ile korelasyon gösteriyordu; korelasyon katsayısı alt skalalar için r= -0.5'den-0.62'ye kadar (p< 0.05) ve tüm skor için r= 0.64 (p< 0.01) olarak değişiyordu. Diskriminant analiz sonucu FOSQ.tr'nin normal birey ile hastanın anlamlı derecede ayırt edilebileceğini göstermiştir (p< 0.03). Sonuç olarak, FOSQ.tr'nin psikometrik özellikleri davranışlarda gündüz aşırı uyku halinin etkilerinin saptanmasında geçerli ve güvenilir bir test olduğu gösterilmiştir.Turkish version of functional outcomes of sleep questionnaire (FOSQ.tr) was examined for its psychometric properties in patients with obstructive sleep apnoea hypopnoea syndrome (OSAHS). The FOSQ was translated into Turkish using a for-ward-backward translation. For the psychometric evaluation, 73 consecutive patients were selected along with 73 control subjects. Internal consistency, test-retest reliability, concurrent and discriminant validity were investigated. Values of Cronbach's alpha for the total FOSQ.tr (u= 0.92) and its subscales (a= 0.76-0.80) suggest that the questionnaire was consistent internally. Test-retest reliability of the FOSQ.tr was significant for the total score (r= 0.7) and the sub-scales apart from sodal outcome (r= 0.5 to 0.8, all p< 0.01). FOSQ.tr correlated moderately with Epworth sleepiness scale (ESS), with coefficients ranging from r= -0.5 to -0.62, (all p< 0.05) for the sub-scales, and r= -0.64 (p< 0.01) for total score. Discriminant analysis showed that FOSQ.tr could significantly distinguish the patients from normal subjects (p< 0.03). The psychometric properties of the FOSQ.tr suggest that it is a valid and reliable instrument for the assessment of the impact of disorders of excessive sleepiness on daily behaviour

Racial Differences in Functional and Sleep Outcomes with Positive Airway Pressure Treatment

It is unclear if the response to positive airway pressure (PAP) treatment is different between African American (AA) and European Americans (EA). We examined whether race modifies the effects of PAP on sleep and daytime function. We assessed Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire, Psychomotor Vigilance Task and actigraphy in 185 participants with moderate-to-severe obstructive sleep apnea before and 3–4 months after PAP treatment. The participants were middle-aged (mean, 55.1 years), 83.8% men and 60.5% AA. Linear regression models were used to examine the effect of race on outcomes. The AA had smaller reductions in ESS (mean change (95% confidence interval, CI) AA, −2.30 [−3.35, −1.25] vs. EA, −4.16 [−5.48, −2.84] and frequency of awakenings (AA, −0.73 [−4.92, 3.47] vs. EA, −9.35 [−15.20, −3.51]). A race × PAP usage interaction term was added to the model to examine if the change in outcomes per 1 h increase in PAP usage differed by race. AA exhibited greater improvement in wake after sleep onset (β (95% CI) AA, −8.89 [−16.40, −1.37] vs. EA, 2.49 [−4.15, 9.12]) and frequency of awakening (β (95% CI) AA, −2.59 [−4.44, −0.75] vs. EA, 1.71 [−1.08, 4.50]). The results indicate the importance of race in evaluating outcomes following PAP treatment

Social and Behavioral Determinants of Perceived Insufficient Sleep

Insufficient sleep is associated with cardiometabolic disease and poor health. However, few studies have assessed its determinants in a nationally representative sample. Data from the 2009 behavioral risk factor surveillance system were used ( N = 323,047 adults). Insufficient sleep was assessed as insufficient rest/sleep over 30 days. This was evaluated relative to sociodemographics (age, sex, race/ethnicity, marital status, region), socioeconomics (education, income, employment, insurance), health behaviors (diet, exercise, smoking, alcohol), and health/functioning (emotional support, BMI, mental/physical health). Overall, insufficient sleep was associated with being female, White or Black/African-American, unemployed, without health insurance, and not married; decreased age, income, education, physical activity; worse diet and overall health; and increased household size, alcohol, and smoking. These factors should be considered as risk factors for insufficient sleep