Search Results (14)

Introduction: Comorbid insomnia and obstructive sleep apnea (COMISA) is not a well-identified sleep disorder, despite having a significant impact on health. This study investigates the relationship between sleep bruxism (SB) and sleep architecture in patients with COMISA, obstructive sleep apnea (OSA), and in those without any sleep disorders. Methods: 119 patients were included in the study and divided into three groups: OSA, COMISA, and a control group. Polysomnographic (PSG) examination provided parameters related to sleep architecture, OSA, and characteristics of SB. Results: The bruxism episode index (BEI) and other SB parameters were not found to be statistically different between the three groups (p > 0.05). There was no statistical difference in measured sleep architecture between the COMISA and OSA groups (p > 0.05). In comparison to the control group, participants in the COMISA group were found to have an increased apnea–hypopnea index (AHI), oxygen desaturation index (ODI), respiratory disturbance index (RDI), all arousals (AA), and respiratory arousals (RA) (p < 0.05). Among COMISA patients, AA and RA were shown to have a positive linear correlation with the number of bradycardia events per hour (r = 0.49, r = 0.48, p < 0.05). Conclusions: SB does not occur in patients with COMISA more frequently than in patients with OSA or those without any sleep disorders. PSG parameters are not specific for COMISA; therefore, in order to differentiate this disorder from OSA alone, a comprehensive patient assessment has to be performed. Full article

Positive airway pressure (PAP) is an important treatment tool for patients with moderate and severe obstructive sleep apnea (OSA), and adherence to PAP significantly affects treatment outcomes. Disease severity, adverse effects, and psychosocial factors are known to predict medication adherence. Cephalometric parameters have been reported to positively correlate with upper airway collapse. However, research on the correlation between these cephalometric parameters and PAP adherence remains insufficient. This study aimed to identify this relationship. This study included 185 patients with OSA who were prescribed PAP. Polysomnography (PSG) was performed to diagnose OSA, and paranasal sinus computed tomography (PNS CT) was performed to check for comorbidities of the upper airway. In addition, cephalometric parameters such as the hyoid–posterior nasal spine (H-PNS), posterior nasal spine–mandibular plane (PNS-MP), and hyoid–mandibular plane (H-MP) were measured in the midsagittal and axial CT views. Adherence was evaluated 3–12 months after the PAP prescription. A total of 136 patients were PAP-adherent, and 49 were nonadherent. There were more males in the adherent group and a higher average height in the adherent group. The PSG results showed that the apnea–hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), arousal index (AI), rapid eye movement (REM) AHI, and supine AHI were significantly higher, and the lowest oxygen saturation was lower in the adherent group. In the analysis of covariance (ANCOVA) model adjusted for sex and height, among the cephalometric parameters, H-MP was significantly longer in the adherent group (p = 0.027), and H-PNS showed a longer tendency (p = 0.074). In the logistic regression analysis model, the odds ratio (OR) and 95% confidence intervals (95% CI) of adherence and severe OSA in the third tertile compared to the first tertile of H-MP were 2.93 (1.25–6.86) and 4.00 (1.87–8.56). In the case of H-PNS, they were 2.58 (1.14–5.81) and 4.86 (2.24–10.54), respectively. This study concluded that an inferiorly placed hyoid bone in adult patients is associated with PAP adherence and disease severity. Full article

Background: Obstructive sleep apnea is associated with an increased prevalence of cardiovascular disease. The mechanism of these associations is not completely understood. We aimed to investigate the association of the apnea hypopnea index and the degree of airflow limitation with endothelial dysfunction. Methods: This was a single-center prospective study of patients admitted for diagnostic coronary angiography (CAG). Endothelial function was assessed by the non-invasive EndoPAT system by reactive hyperemia index (RHI) and divided into two groups: endothelial dysfunction and normal endothelial function. Sleep apnea signs were detected by WatchPAT measuring the respiratory disturbance index (pRDI), the apnea and hypopnea index (pAHI), and the oxygen desaturation index (ODI). Patients underwent spirometry and body plethysmography. Based on CAG, the severity of coronary artery disease was assessed as follows: no significant coronary artery disease, single-, two- and three-vessel disease. Results: A total of 113 patients were included in the study. Breathing disorders measured by WatchPAT and spirometry were more severe in patients with endothelial dysfunction: pRDI (27.3 vs. 14.8, p = 0.001), pAHI (24.6 vs. 10.3, p < 0.001), ODI (13.7 vs. 5.2, p = 0.002), forced expiratory volume in one second (FEV₁) (81.2 vs. 89, p = 0.05). In a multivariate regression analysis, pAHI and FEV₁ were independent predictors of endothelial dysfunction assessed by RHI. There was no correlation between the severity of coronary artery disease and endothelial dysfunction. Conclusions: Obstructive sleep apnea signs and greater airflow limitation were associated with endothelial dysfunction regardless of the severity of the coronary artery disease. Full article

Objective: Individuals with obstructive sleep apnea (OSA) are at increased risk to suffer from further somatic and sleep-related complaints. To assess OSA, demographic, anthropometric, and subjective/objective sleep parameters are taken into consideration, but often separately. Here, we entered demographic, anthropometric, subjective, and objective sleep- and breathing-related dimensions in one model. Methods: We reviewed the demographic, anthropometric, subjective and objective sleep- and breathing-related data, and polysomnographic records of 251 individuals with diagnosed OSA. OSA was considered as a continuous and as categorical variable (mild, moderate, and severe OSA). A series of correlational computations, X²-tests, F-tests, and a multiple regression model were performed to investigate which demographic, anthropometric, and subjective and objective sleep dimensions were associated with and predicted dimensions of OSA. Results: Higher apnea/hypopnea index (AHI) scores were associated with higher BMI, higher daytime sleepiness, a higher respiratory disturbance index, and higher snoring. Compared to individuals with mild to moderate OSA, individuals with severe OSA had a higher BMI, a higher respiratory disturbance index (RDI) and a higher snoring index, while subjective sleep quality and daytime sleepiness did not differ. Results from the multiple regression analysis showed that an objectively shorter sleep duration, more N2 sleep, and a higher RDI predicted AHI scores. Conclusion: The pattern of results suggests that blending demographic, anthropometric, and subjective/objective sleep- and breathing-related data enabled more effective discrimination of individuals at higher risk for OSA. The results are of practical and clinical importance: demographic, anthropometric, and breathing-related issues derived from self-rating scales provide a quick and reliable identification of individuals at risk of OSA; objective assessments provide further certainty and reliability. Full article

Obstructive sleep apnea (OSA) is a sleeping breathing disorder. In children, adenotonsillar hypertrophy remains the main anatomical risk factor of OSA. The aim of this study was to assess the current scientific data and to systematically summarize the evidence for the efficiency of adenotonsillectomy (AT) and orthodontic treatment (i.e., rapid maxillary expansion (RME) and mandibular advancement (MA)) in the treatment of pediatric OSA. A literature search was conducted in several databases, including PubMed, Embase, Medline, Cochrane and LILACS up to 5th April 2020. The initial search yielded 509 articles, with 10 articles being identified as eligible after screening. AT and orthodontic treatment were more effective together than separately to cure OSA in pediatric patients. There was a greater decrease in apnea hypoapnea index (AHI) and respiratory disturbance index (RDI), and a major increase in the lowest oxygen saturation and the oxygen desaturation index (ODI) after undergoing both treatments. Nevertheless, the reappearance of OSA could occur several years after reporting adequate treatment. In order to avoid recurrence, myofunctional therapy (MT) could be recommended as a follow-up. However, further studies with good clinical evidence are required to confirm this finding. Full article

We present the case of a 52 year-old obese (BMI = 46.2 kg/m²) man with severe obstructive sleep apnea (RDI of 60). Before CPAP treatment was applied, the patient was diagnosed with complete respiratory failure and polycythemia. During effective autoCPAP treatment (after 10 days AHI was 5.5 at 10 mbar pressure) we observed normalization of arterial blood gases (PaCO₂ of borderline value). After one month’s treatment with autoCPAP at home, we found normalization of blood morphology parameters and PaCO₂ had returned to normal, and the patient was properly oxygenated. The patient lost 22 kg during therapy (9 kg in hospital, and 13 kg at home) which resulted in the spirometric measurements returning to their normal value. Full article

Introduction: Obstructive sleep apnoea (OSA) is a risk factor for cardiovascular morbidity and mortality. The aim of this study was to assess relations between cardiovascular diseases (CVD) and age in OSA subjects. Material and Methods: 10, Epworth score > 9 points) were evaluated. The chest X-ray, spirometry, arterial blood gases, ECG, blood morphology and biochemistry were performed during trial treatment with autoCPAP. Results: We studied 533 consecutive OSA patients, mean age 55.6 ± 10.3 years (range 24–81), with obesity (BMI 34.4 ± 6.6 kg/m²) and severe OSA (AHI/RDI 37.8 ± 21.8). To evaluate relations between CVD and age, patients were divided into three groups. Group 1 < 50 years (123 subjects, 23.1%), Group 2 aged 50–60 years (250 subjects, 46.9%) and Group 3 > 60 years (160 subjects, 30%). Subjects < 50 years were more obese and had higher AHI/RDI when compared to older groups. Incidence of arterial hypertension, coronary artery disease, atrial fibrillation, heart failure and stroke increased with age (higher in subjects > 60 years). Conclusions: Cardiovascular diseases were prevalent in OSA patients > 60 years. However the youngest group presented with more severe obesity and higher AHI/RDI. Full article

Introduction: OSA is a well-recognized risk factor of cardiovascular disorders and is related to metabolic syndrome. The aim of this study was to evaluate the effect of BMI and AHI/RDI on metabolic disturbances in patients suspected of OSA. Material and methods: Ninety-nine patients referred with suspected OSA underwent standard polysomnography or limited sleep study. AHI/RDI ≥ 10/h was considered relevant for OSA diagnosis. Subjects with AHI/RDI < 10 were considered as controls. We assessed apnea-hypopnea index or respiratory disturbances index (AHI/RDI), Epworth sleepiness scale (ESS), body mass index (BMI), C-reactive protein (CRP, mg/L), glycosylated haemoglobin (HbA1c, %), fasting serum total cholesterol, HDL-, LDL-cholesterol, triglycerides (TG), glucose (G), insulin (INS, IU/mL) and HOMA index. Results: Data are presented as mean ± SD or median (interquartile range) for parametric and nonparametric data respectively. Twenty-two patients were included as controls (age 51.8 ± 10 vs. 55 ± 11 in OSA; p = NS). AHI/RDI in the OSA group was 23 (16–31.3) and 7 (3.8–8.1) in controls (p < 0.001). BMI in OSA 32.2 ± 5.8 vs. 30.4 ± 4.6 in controls (p = NS). Patients with OSA had higher TG (160 ± 75.9 vs. 130.2 ± 51.9 mg/dL, p = 0.046), G (5.04 ± 0.6 vs. 4.47 ± 0.6, p = 0.0037), HOMA (2.31 ± 1.5 vs. 1.85 ± 1.7, p = 0.046). G correlated best with AHI/RDI (p < 0.001, r = 0.41). Significant differences were observed in OSA patients between obese (51 pts, BMI 35.2 ± 4.8) and non-obese (26 pts, BMI 26.61 ± 1.9) pts in: HDL-cholesterol (50.8 ± 13.2 vs. 60.9 ± 18.4 mg/dL; p = 0.02), TG (178.7 ± 69.9 vs. 124 ± 75.3 mg/dL, p < 0.001), G (5.15 ± 0.7 vs. 4.8 ± 0.5 mmol/L, p = 0.01), INS (11.7 ± 5.9 vs. 6.57 ± 4.7, p < 0.001), HOMA (2.7 ± 1.4 vs. 1.4 ± 1.2, p < 0.001), HbA1c (5.89 ± 0.9 vs. 5.4 ± 0.8, p = 0.03), CRP (2.2 ± 2.9 vs. 1.09 ± 1.2, p = 0.01). Conclusions: Our findings support the results of previous studies showing the influence of OSA alone on metabolic disturbances. However, BMI has major impact on metabolic variables. Full article

Introduction: Obesity and male gender are the main risk factors for the development of obstructive sleep apnoea (OSA); however, some epidemiological data has shown that neck circumference (NC) ≥ 43 cm is a better predictor of obstructive event frequency than body mass index (BMI). The aim of this study was to assess the relation between NC and BMI on OSA severity in males. Material and methods: The subjects completed a sleep questionnaire and Epworth sleepiness scale before the sleep study (full polysomnography or PolyMesam study). We studied 133 consecutive males with confirmed OSA (AHI/RDI > 10, Epworth score > 9 points). Chest X-ray, spirometry, arterial blood gases, ECG, blood morphology and biochemistry were performed during treatment trial with autoCPAP. Results: Subjects presented with obesity—BMI = 35.8 ± 6.1 kg/m², NC = 46 ± 3.4 cm and severe disease—AHI/RDI = 45.3 ± 23.6. Mean age was 52.7 ± 11.3 years. The majority of subjects had NC ≥ 43 cm (116 pts, 87.2%—group 1), 17 pts (12.8%—group 2) had NC < 43 cm had 17 pts. Comparison of both groups showed significant differences only for BMI (gr. 1—36.8 ± 5.7, gr. 2—28.6 ± 3.7; p < 0.0001). Linear regression analysis revealed significant correlation between NC and AHI/RDI (R² = 0.07, r = 0.26; p = 0.003); however, the correlation between BMI and AHI/RDI was stronger (R² = 0.14, r = 0.37; p < 0.0001). In multiple linear regression analysis we found significant correlation between AHI/RDI and age (β = –0.31, p = 0.003) and BMI (β = 0.34, p = 0.02). Conclusions: The strongest correlation between AHI/RDI, younger age and BMI was found in males with OSA. Correlation between neck circumference and AHI/RDI was significant but less when compared to BMI. Full article

Introduction: The aim of this study was to assess results of 6MWT in non-selected group of obstructive sleep apnoea (OSA) patients. In healthy adult subjects 6-minute walking distance (6MWD) range from 400 to 700 m. Obesity, the main symptom of OSA, is one of the factors associated with reduction of 6MWD (another common factors: older age, shorter height, female sex, pulmonary, cardiovascular and musculoskeletal diseases). Material and methods: Subjects completed sleep questionnaire and Epworth sleepiness scale before sleep studies (full polysomnography [PSG] or PolyMesam study [PM]). Consecutive OSA subjects (AHI/RDI >10, Epworth score > 9 points) were evaluated. The 6MWT, chest X-ray, spirometry, arterial blood gases, ECG, blood morphology and biochemistry were performed during trial treatment with autoCPAP. Results: We studied 151 subjects (119 males—78.8% and 32 females—21.2%), mean age 53.4 ± 10.5 years. Subjects were obese—BMI = 35.7 ± 6.2 kg/m² and presented severe OSA—AHI/RDI = 42.4 ± 23.2. To assess relations between 6MWD and AHI/RDI, BMI, age and concomitant diseases we divided subjects in two groups: 1st with 6MWD ≥ lower limit of normal (LLN) (123 pts; 81.5%) and 2nd with 6MWD < LLN (28 pts; 18.5%). Significant differences between groups were found for BMI, FVC (% of predicted) and Borg dyspnea scale before and after 6MWT. In multiple linear regression analysis we found significant correlation between 6MWD and BMI (β = 0.41, p < 0.0001) and arterial hypertension (β = –0.16, p = 0.04). Females had significantly shorter 6MWD than males (401.1 ± 83.6 m and 451.8 ± 107 m, respectively; p = 0.01). Difference was significant after adjustment for BMI and age (analysis of covariance)—R = 0.61, R² = 0.38 (p < 0.0001). Conclusions: BMI, female sex, arterial hypertension and lower FVC (% of predicted) were related to shorter 6-minute walking distance in OSA patients. Full article

Wstęp: Nykturia (≥2 epizodów oddawania moczu w nocy) jest częstym objawem obturacyjnego bezdechu sennego (OBS). Wzrost ciśnienia w jamie brzusznej w czasie bezdechów, zwiększone wydzielanie przedsionkowego peptydu sodopędnego (ANP), stosowanie leków moczopędnych, współistnienie cukrzycy, nadmierne przyjmowanie płynów oraz przebudzenia w czasie snu powodują częstsze oddawanie moczu w nocy. Celem pracy była ocena częstości występowania nykturii u chorych z umiarkowanym i ciężkim OBS. Materiał i metody: Zbadano 171 otyłych (BMI—35.8 ± 6.3 kg/m²) chorych (135 mężczyzn i 36 kobiet) w średnim wieku 53.6 ± 10.8 lat z zaawansowanymi postaciami choroby (AHI/RDI—43.6 ± 23.2). Wyniki: W celu oceny relacji między nykturią oraz AHI/RDI (apnea hypopnea index/respiratory disturbance index), utlenowaniem w czasie snu, BMI (body mass index) i sennością dzienną badanych podzielono na 2 grupy: pierwszą bez nykturii (60 badanych; 35.1%—grupa N−) i drugą z nykturią (111 badanych; 64.9%—grupa N+). Grupa N+ miała znamiennie wyższy wskaźnik AHI/RDI, 48 ± 22.8 vs. 35.4 ± 21.7 (p = 0.0006), wyższy BMI, 36.8 ± 6.5 vs. 34 ± 5.5 kg/m² (p = 0.004), niższe średnie wysycenie krwi tętniczej tlenem w nocy (SaO₂), 88.6 ± 5.6 vs. 90.4 ± 4.3% (p = 0.03) oraz wyższą punktację w skali Epworth, 14.4 ± 5.1 vs. 11.3 ± 5.5 (p = 0.0002). W analizie regresji wielokrotnej ujawniono znamienne korelacje między nykturią oraz wynikami skali senności Epworth (β = 0.26, p < 0.0009), współistnieniem choroby wieńcowej, (β = 0.23, p = 0.004) i wskaźnikiem AHI/RDI (β = 0.21, p = 0.04). Wnioski: Nykturia jest częstym objawem u chorych na OBS (64.9%). Nocne oddawanie moczu wiązało się z ciężkością choroby, objawami senności dziennej i występowaniem choroby niedokrwiennej serca. Full article

Wstęp: U kobiet obturacyjny bezdech senny (OBS) najczęściej występuje po menopauzie. Celem pracy było porównanie zaawansowania OBS u kobiet po menopauzie (grupa E−) oraz u kobiet z zachowaną aktywnością estrogenową (kobiety przed menopauzą lub stosujące hormonalna terapię zastępczą—grupa E+). Materiał i metody: Zbadano 147 kobiet chorych na OBS w średnim wieku 58.1 ± 9.4 roku. Badane kobiety charakteryzowały się otyłością (BMI = 34 ± 7.9 kg/m²) oraz umiarkowanym lub ciężkim OBS (AHI/RDI = 35.9 ± 20.9), średnie SaO₂ wynosiło 89.4 ± 5.8%. Grupa E− składała się z 116 chorych (75.5%), a grupa E+—z 36 (24.5%). Wyniki: Nasilenie choroby było większe w grupie E+ (AHI/RDI = 42 ± 26.6; BMI = 37.6 ± 10.1 kg/m²) w porównaniu z grupą E− (AHI/RDI = 33.9 ± 18.4; p = 0.04 i BMI = 32.8 ± 6.7 kg/m²; p = 0.001). Analiza regresji wielokrotnej ujawniła znamienną ujemną korelację między AHI/RDI i wiekiem (β = −0.29; p = 0.03). Po wyłączeniu wpływu wieku i BMI (analiza kowariancji) badane grupy nadal się różniły wartościami AHI/RDI (R = 0.24; p = 0.03). Wnioski: Większość kobiet chorych na OBS, które zakwalifikowano do leczenia CPAP, było w okresie menopauzy (75.5%). Nasilenie OBS (AHI/RDI) po wyłączeniu wpływu wieku i masy ciała było większe w grupie z zachowaną aktywnością estrogenową. Full article

Wstęp: Uwulopalatofaryngoplastyka (UPPP) jest jedną z najczęściej wykonywanych operacji w leczeniu chirurgicznym obturacyjnego bezdechu sennego. Celem pracy była ocena efektów UPPP u pacjentów chorych na OBS. Materiał i metody: Zbadano 22 otyłych mężczyzn (średni BMI = 33.1 ± 4 kg/m^²) w średnim wieku 51.7 ± 9.7 roku. Polisomnografię lub poligrafię (Poly-Mesam) wykonano po 28.5 ± 30.5 miesiąca od UPPP. Wyniki: Badania snu po UPPP ujawniły ciężkie postaci OBS u większości chorych—średni AHI/RDI = 53 ± 33.2, średnie wysycenie krwi tętniczej tlenem (SaO₂) w nocy wynosiło 88.1 ± 5.3%. Badani niemal połowę snu spędzali w niedotlenieniu < 90% (T90 = 46.8 ± 33.8%) oraz charakteryzowali się nadmierną sennością dzienną (punktacja w skali Epworth: 14.3 ± 4.8). Tylko u 3 chorych (13.6%) UPPP była skuteczna (po operacji AHI/RDI ≤ 10). Wnioski: U większości chorych z ciężkimi postaciami obturacyjnego bezdechu sennego UPPP jest zabiegiem nieskutecznym. Full article

The aim of the study was to determine the factors which influence the decision to initiate nCPAPtherapy in patients with OSA. 184 patients with OSA were enrolled to the study. They were divided into two groups: group “T” (“treated”) which consisted of 112 patients who were being treated with nCPAP and group “R” (“resigned”) which consisted of 68 patients who refused nCPAP therapy. The main causes of their refusal were: the possibility of surgical treatment, nCPAP intolerance and high costs associated with the purchase of a nCPAP device. The mean age of the patients was comparable in both groups (49.2 ± 8.7 vs. 50.5 ± 10.6 yrs). Patients from group T had a significantly higher body weight and BMI than the patients from group R (106.6 ± 2.1 kg vs. 94.1 ± 20.9 kg, p < 0.0001 and 35.0 ± 6.3 kg/m² vs. 31.1 ± 6.3 kg/m², p < 0.00005 respectively). The patient evaluation included physical examination, a questionnaire concerning symptoms related with OSA and OSA assessment by poly-MESAM, polysomnography (PSG) before and with nCPAP trial therapy. Results: the following parameters obtained in the poly-MESAM recording differed significantly (p < 0.001) between group T and group R: RDI (54.6 vs. 41.7), HRV index (24 vs. 11), SaO₂ min (67.0 vs. 75% and SaO₂ mean (84 vs. 88%). Analysis of the baseline PSG did not reveal differences in sleep structure in both groups. We found a significantly higher AHI in group T (63.6 vs. 44.9, p < 0.00005). PSG confirmed a significantly lower SaO₂ min and SaO₂ mean in group T (67.0 vs. 75.0%, p < 0.001 and 89.0 vs. 92%, p < 0.00002 respectively) and also revealed a significantly longer total sleep time with SaO₂ < 90% in this group (183.0 vs. 55.0 min, p < 0.0005). We did not find any differences between both study groups in the parameters obtained in PSG with nCPAP trialtherapy. Conclusions: OSA patients who decide to be treated with nCPAP are more obese, have a higher BMI and demon-strate a more severe disease assessed by PSG. Full article