The Association of Upper Airway Anatomy with Brain Structure: The Multi-Ethnic Study of Atherosclerosis.

Sleep apnea, affecting an estimated 1 in 4 American adults, has been reported to be associated with both brain structural abnormality and impaired cognitive function. Obstructive sleep apnea is known to be affected by upper airway anatomy. To better understand the contribution of upper airway anatomy to pathways linking sleep apnea with impaired cognitive function, we investigated the association of upper airway anatomy with structural brain abnormalities. Based in the Multi-Ethnic Study of Atherosclerosis, a longitudinal cohort study of community-dwelling adults, a comprehensive sleep study and an MRI of the upper airway and brain were performed on 578 participants. Machine learning models were used to select from 74 upper airway measures those measures most associated with selected regional brain volumes and white matter hyperintensity volume. Linear regression assessed associations between the selected upper airway measures, sleep measures, and brain structure. Maxillary divergence was positively associated with hippocampus volume, and mandible length was negatively associated with total white and gray matter volume. Both coefficients were small (coefficients per standard deviation 0.063 mL, p = 0.04, and - 7.0 mL, p < 0.001 respectively), and not affected by adjustment for sleep study measures. Self-reported snoring >2 times per week was associated with larger hippocampus volume (coefficient 0.164 mL, p = 0.007), and higher percentage of time in the N3 sleep stage was associated with larger total white and gray matter volume (4.8 mL, p = 0.004). Despite associations of two upper airway anatomy measures with brain volume, the evidence did not suggest that these upper airway and brain structure associations were acting primarily through the pathway of sleep disturbance.

Inflammatory Rhabdomyoblastic Tumor of the Posterior Pharyngeal Wall.

This case report describes a healthy man in his 40s who presented with a 1-year history of snoring, sleep apnea, dysphonia, and dysphagia owing to a large mass of the posterior pharynx and was diagnosed with an inflammatory rhabdomyoblastic tumor.

Associations between sleep-related symptoms, obesity, cardiometabolic conditions, brain structural alterations and cognition in the UK biobank.

OBJECTIVES: Sleep disturbances are increasingly recognized as adversely affecting brain health in aging. Our aim was to investigate interrelations between subjective sleep-related symptoms, obesity, cardiometabolic disorders, brain structure and cognitive decline in a population-based aging sample. METHODS: Data were extracted from the UK Biobank for anthropometric and demographic information, self-reported sleep behaviours, cardiometabolic measures, structural brain magnetic resonance imaging and cognitive test scores. "Sleep-related symptoms" (SRS) were measured using four questionnaire items: loud snoring, daytime sleepiness, likelihood to nap and difficulty getting up in the morning. Associations were tested using a structural equation model (SEM), adjusted for confounders. Further, multiple regression analysis was used to test for direct relationships between SRS and specific cognitive domains. RESULTS: Among 36,468 participants with an average age of 63.6 (SD 7.5) years and 46.7% male, we found that SRS were associated with obesity and several pre-existing cardiometabolic disturbances. In turn, cardiometabolic disorders were associated with increased white matter hyperintensities and cortical thinning, which were related to cognitive dysfunction. SRS were also directly related to several structural brain changes and to cognitive dysfunction. Regression analyses showed that SRS were directly associated with slower reaction times, and lower scores in fluid intelligence, working memory and executive function. CONCLUSIONS: Self-reported sleep-related symptoms were associated with cognitive dysfunction directly and through pre-existing cardiometabolic disorders and brain structural alterations. These findings provide evidence that symptoms of sleep disturbances, here defined primarily by hypersomnolence and snoring, are important risk factors or markers for cognitive dysfunction in an aging population.

miR-21-5p Under-Expression in Patients with Obstructive Sleep Apnea Modulates Intermittent Hypoxia with Re-Oxygenation-Induced-Cell Apoptosis and Cytotoxicity by Targeting Pro-Inflammatory TNF-α-TLR4 Signaling.

The purpose of this study is to explore the anti-inflammatory role of microRNAs (miR)-21 and miR-23 targeting the TLR/TNF-α pathway in response to chronic intermittent hypoxia with re-oxygenation (IHR) injury in patients with obstructive sleep apnea (OSA). Gene expression levels of the miR-21/23a, and their predicted target genes were assessed in peripheral blood mononuclear cells from 40 treatment-naive severe OSA patients, and 20 matched subjects with primary snoring (PS). Human monocytic THP-1 cell lines were induced to undergo apoptosis under IHR exposures, and transfected with miR-21-5p mimic. Both miR-21-5p and miR-23-3p gene expressions were decreased in OSA patients as compared with that in PS subjects, while TNF-α gene expression was increased. Both miR-21-5p and miR-23-3p gene expressions were negatively correlated with apnea hypopnea index and oxygen desaturation index, while TNF-α gene expression positively correlated with apnea hypopnea index. In vitro IHR treatment resulted in decreased miR-21-5p and miR-23-3p expressions. Apoptosis, cytotoxicity, and gene expressions of their predicted target genes-including TNF-α, ELF2, NFAT5, HIF-2α, IL6, IL6R, EDNRB, and TLR4-were all increased in response to IHR, while all were reversed with miR-21-5p mimic transfection under IHR condition. The findings provide biological insight into mechanisms by which IHR-suppressed miRs protect cell apoptosis via inhibit inflammation, and indicate that over-expression of the miR-21-5p may be a new therapy for OSA.

Nasal cytology in children with primary snoring and obstructive sleep apnoea syndrome.

OBJECTIVE: Rhinitis is an acute or chronic inflammatory condition due to several causes (i.e. infections, allergens). There are controversial results that point out the role of nasal inflammation in primary snoring and obstructive sleep apnoea syndrome (OSAS). METHODS: The aim of the present investigation is to study the nasal cytology in 58 children aged from 1 to 15 affected by sleep disordered breathing. RESULTS: Inflammation of the nasal mucous was found in 88% of children. The most frequent problems were infectious rhinitis (36%), followed by non-allergic rhinitis (28%) and allergic rhinitis (21%). Infectious rhinitis was found in 31% of children with primary snoring and 41% with OSAS. Allergic rhinitis was found in 35% of children with primary snoring, and 6% with OSAS. Non-allergic rhinitis was found in 19% of children with primary snoring, and 34% with OSAS. Bacteria was found in 59% of children with OSAS and 46% in children with primary snoring. CONCLUSION: the most prevalent forms of rhinitis in primary snoring were the allergic rhinitis, and in OSAS group were the non-allergic rhinitis. Bacteria were equally distributed in primary snoring and OSAS children. The nasal cytology provided interesting information that can be used to plan possible treatment strategies.

Desmin and dystrophin abnormalities in upper airway muscles of snorers and patients with sleep apnea.

BACKGROUND: The pathophysiology of obstruction and swallowing dysfunction in snores and sleep apnea patients remains unclear. Neuropathy and to some extent myopathy have been suggested as contributing causes. Recently we reported an absence and an abnormal isoform of two cytoskeletal proteins, desmin, and dystrophin, in upper airway muscles of healthy humans. These cytoskeletal proteins are considered vital for muscle function. We aimed to investigate for muscle cytoskeletal abnormalities in upper airways and its association with swallowing dysfunction and severity of sleep apnea. METHODS: Cytoskeletal proteins desmin and dystrophin were morphologically evaluated in the uvula muscle of 22 patients undergoing soft palate surgery due to snoring and sleep apnea and in 10 healthy controls. The muscles were analysed with immunohistochemical methods, and swallowing function was assessed using videoradiography. RESULTS: Desmin displayed a disorganized pattern in 21 ± 13% of the muscle fibres in patients, while these fibers were not present in controls. Muscle fibres lacking desmin were present in both patients and controls, but the proportion was higher in patients (25 ± 12% vs. 14 ± 7%, p = 0.009). The overall desmin abnormalities were significantly more frequent in patients than in controls (46 ± 18% vs. 14 ± 7%, p < 0.001). In patients, the C-terminus of the dystrophin molecule was absent in 19 ± 18% of the desmin-abnormal muscle fibres. Patients with swallowing dysfunction had 55 ± 10% desmin-abnormal muscle fibres vs. 22 ± 6% in patients without swallowing dysfunction, p = 0.002. CONCLUSION: Cytoskeletal abnormalities in soft palate muscles most likely contribute to pharyngeal dysfunction in snorers and sleep apnea patients. Plausible causes for the presence of these abnormalities is traumatic snoring vibrations, tissue stretch or muscle overload.

Effects of Increased Pharyngeal Tissue Mass Due to Fluid Accumulation in the Neck on the Acoustic Features of Snoring Sounds in Men.

STUDY OBJECTIVES: Snoring sounds are generated by the vibration of pharyngeal tissue due to the upper airway narrowing. While recorded by a microphone placed over the neck, snoring can pass through the pharyngeal tissue surrounding the upper airway. Thus, changes in the pharyngeal tissue content may change the acoustic properties of the snoring sounds. Rostral fluid shift and the consequent increases in neck fluid volume (NFV) and neck circumference (NC) can increase pharyngeal tissue mass. Therefore, the goal of this study was to investigate the relationship between increases in pharyngeal tissue mass, as assessed by increased NFV and NC, and snoring sounds features. METHODS: We obtained data from a previous study where 20 males who were not obese participated in a daytime polysomnography and their NC and NFV were measured before and after sleep. During sleep, snoring sounds were recorded with a microphone placed over the neck. Spectral centroid of the snoring sounds was estimated. Then, the first five snoring segments were selected from the first and last 30 minutes of stage N2 sleep. RESULTS: We found a significant decrease in the snoring spectral centroid from the beginning to end of sleep. We also found that spectral centroid from the end of sleep in frequency ranges below 200 Hz was inversely correlated with the increases in NFV and NC from before to after sleep. CONCLUSIONS: These results suggest that snoring spectral centroid can be used as a noninvasive and convenient method to assess variations in the pharyngeal tissue mass.

Axon and Schwann Cell Degeneration in Nerves of Upper Airway Relates to Pharyngeal Dysfunction in Snorers and Patients With Sleep Apnea.

BACKGROUND: The pathophysiologic mechanism of nocturnal obstruction and swallowing dysfunction commonly occurring in patients with sleep apnea is unclear. The goal of this study was to investigate whether nerve injuries in the upper airways of snorers and patients with sleep apnea are associated with pharyngeal dysfunction and severity of sleep apnea. METHODS: Twenty-two patients undergoing palatal surgery due to snoring and sleep apnea were investigated for a swallowing dysfunction by using videoradiography. Twelve healthy nonsnoring subjects were included as control subjects. Tissue samples from the soft palate at the base of the uvula were obtained in all patients and control subjects. Nerves and muscle were analyzed with immunohistochemical and morphologic methods, and the findings were correlated with swallowing function and degree of sleep apnea. RESULTS: In the soft palate of patients, nerve fascicles exhibited a significantly lower density of axons (5.4 vs 17.9 × 10-3 axons/µm2; P = .02), a smaller percentage area occupied by Schwann cells (17.5% vs 45.2%; P = .001) and a larger number of circular shaped Schwann cells lacking central axons (43.0% vs 12.7%; P < 0.001) compared with control subjects. The low density of axons was significantly related to degree of swallowing dysfunction (r = 0.5; P = .03) and apnea-hypopnea index > 5 (P = .03). Regenerating axons were frequently observed in patients compared with control subjects (11.3 ± 4.2% vs 4.8 ± 2.4%; P = .02). CONCLUSIONS: Axon degeneration in preterminal nerves of the soft palate is associated with pharyngeal dysfunction in snorers and patients with sleep apnea. The most likely cause for the nerve injuries is traumatic snoring vibrations and tissue stretch, leading to swallowing dysfunction and increased risk for upper airway obstruction during sleep.

[The obstructive sleep apnoea syndrome is not only bad for the heart!] / Le syndrome d'apnées obstructives du sommeil n'est pas mauvais que pour le cœur !

Obstructive sleep apnoea (OSA) is common in the general population, particularly in the elderly. This syndrome is frequently responsible for severe cardiovascular complications. However, the indications for its treatment in the elderly remain controversial. We report the case of a 79-year-old man with severe, undiagnosed OSA who inhaled his fixed dental bridge during sleep. The inhaled foreign body came to rest in the lumen of the left main stem bronchus. The association of obesity with a body mass index of 30kg/m2, snoring with breathing pauses reported by his partner, nocturia, morning headache and an Epworth score of 11 led to polysomnography which confirmed OSA with an apnoea/hypopnoea index of 53 per hour. This case report emphasises that OSA may constitute a risk fact for foreign body inhalation in elderly subjects due to arousal-induced hyperventilation following the apnoeic event.

Snoring classified: The Munich-Passau Snore Sound Corpus.

OBJECTIVE: Snoring can be excited in different locations within the upper airways during sleep. It was hypothesised that the excitation locations are correlated with distinct acoustic characteristics of the snoring noise. To verify this hypothesis, a database of snore sounds is developed, labelled with the location of sound excitation. METHODS: Video and audio recordings taken during drug induced sleep endoscopy (DISE) examinations from three medical centres have been semi-automatically screened for snore events, which subsequently have been classified by ENT experts into four classes based on the VOTE classification. The resulting dataset containing 828 snore events from 219 subjects has been split into Train, Development, and Test sets. An SVM classifier has been trained using low level descriptors (LLDs) related to energy, spectral features, mel frequency cepstral coefficients (MFCC), formants, voicing, harmonic-to-noise ratio (HNR), spectral harmonicity, pitch, and microprosodic features. RESULTS: An unweighted average recall (UAR) of 55.8% could be achieved using the full set of LLDs including formants. Best performing subset is the MFCC-related set of LLDs. A strong difference in performance could be observed between the permutations of train, development, and test partition, which may be caused by the relatively low number of subjects included in the smaller classes of the strongly unbalanced data set. CONCLUSION: A database of snoring sounds is presented which are classified according to their sound excitation location based on objective criteria and verifiable video material. With the database, it could be demonstrated that machine classifiers can distinguish different excitation location of snoring sounds in the upper airway based on acoustic parameters.

A simple diagnostic scale based on the analysis and screening of clinical parameters in paediatric obstructive sleep apnoea hypopnea syndrome.

OBJECTIVE: This study aimed to develop a simple and accurate method to diagnose paediatric obstructive sleep apnoea hypopnea syndrome. METHODS: A total of 311 children with suspected paediatric obstructive sleep apnoea hypopnea syndrome were included in the study. Multiple clinical parameters, including sex, age, body mass index, history of snoring or gasping, history of nasal obstruction, history of running nose, palatine tonsil size, adenoid to nasopharynx ratio, and tympanogram type, were compared with polysomnography results using relevant correlation and regression analyses. A diagnostic scale was established using the regression equation and the correlation between the polysomnography result and scale result was determined. RESULTS: The apnoea-hypopnea index correlated significantly with a history of snoring or gasping, palatine tonsil size, and tympanogram type. Stepwise logistic regression analysis revealed that the polysomnography result correlated significantly with a history of snoring or gasping, palatine tonsil size, and the adenoid to nasopharynx ratio. The percentage correlation between the scale and polysomnography results was 77.8 per cent. CONCLUSION: The diagnostic scale can be used to diagnose paediatric obstructive sleep apnoea hypopnea syndrome for clinical application when polysomnography cannot be performed. However, it is not suitable for assessing the severity of paediatric obstructive sleep apnoea hypopnea syndrome.

Evaluation of effects of anterior palatoplasty operation on upper airway parameters in computed tomography in patients with pure snoring and obstructive sleep apnea syndrome.

AIM: To investigate changes in upper airway volume parameters measured by computerized tomography scans in patients with surgically treated by anterior palatoplasty of whom having pure snoring and mild-moderate obstructive sleep apnea. METHOD: A prospective study on consecutively anterior palatoplasty performed pure snoring and obstructive sleep apnea patients. Computerized tomography scans were obtained preoperatively and following anterior palatoplasty procedure to measure changes in upper airway volume. Patients underwent diagnostic drug induced sleep endoscopy to assess the site of obstruction. Preoperative and postoperative measurements were compared using student's t test and Chi-square test. RESULTS: Twenty-two patients (16 men and 6 women, age 48.22 ± 9.23, body mass index 25.85 ± 2.57) completed the trial. Anterior palatoplasty was associated with an increase in total upper airway volume from 4.81 ± 1.73 cm3 before treatment to 6.57 ± 2.03 cm3 after treatment (p < 0.005). Change in soft palate thickness did not vary significantly (p < 0.039). The mean soft palate length has changed from 4.13 ± 0.41 to 3.93 ± 0.51 cm (p < 0.001). The preoperative and postoperative measurements of cross-sectional areas and volumes all showed significant difference except velopharynx minimal lateral airway dimension. The operational procedure increased the total upper airway volume much more in men than in women (p < 0.05). CONCLUSION: Results of this study indicate that anterior palatoplasty operation appears to produce significant increase in upper airway volume and cross sectional area. It does not seem to have an effect on lateral airway dimension. Computerized tomography is a quick and noninvasive imaging technique that allows for quantitative assessment of the velopharyngeal patency changes.

Objective snoring time and carotid intima-media thickness in non-apneic female snorers.

Controversy persists about whether snoring can affect atherosclerotic changes in adjacent vessels, independently of obstructive sleep apnea and other cardiovascular risk factors. This study examined the independent association between snoring and carotid artery intima-media thickness (IMT) in non-apneic snorers and non-snorers. We studied 180 non-apneic snorers and non-snorers participating in a full-night home-based sleep study. Snoring sound was measured objectively by a microphone. Based on snoring time across the night, participants were classified as non-snorers (snoring time: 0%), mild snorers (1-25%) and moderate to heavy snorers (≥25%). We measured IMT on both common carotid arteries. The three groups were matched by age, body mass index, cholesterol, blood pressure and glucose levels, using weights from generalized boosted-propensity score models. Mean carotid IMT increased with increased snoring time across the night in women: non-snorers (0.707 mm), mild (0.718 mm) and moderate to heavy snorers (0.774 mm), but not in men. Snoring during at least one-fourth of a night's sleep is associated independently with subclinical changes in carotid IMT in women only.

Predicting obstructive sleep apnea using the STOP-Bang questionnaire in the general population.

OBJECTIVE: The STOP-Bang questionnaire was developed as a quick and simple screening tool for obstructive sleep apnea (OSA) in preoperative clinics. We aimed to evaluate the validity of the STOP-Bang questionnaire to predict moderate-to-severe and severe OSA in the general population. METHODS: A sample of 242 subjects selected from a population-based cohort in Singapore completed home-based sleep testing with a type 3 monitor. Subjects were asked to complete the STOP questionnaire while body mass index (BMI), age, neck circumference, and sex were recorded. A score of ≥3 on the questionnaire indicated high risk of OSA. RESULTS: A total of 68 subjects (28.1%) and 26 subjects (10.7%) had an apnea-hypopnea index (AHI) of ≥15 and ≥30 events per hour, respectively. Of the subjects, 89 (36.8%) were classified as high risk based on the questionnaire. The sensitivity of a STOP-Bang score of ≥3 was 66.2% to detect AHI ≥15 and 69.2% to detect AHI ≥30. The specificities were 74.7% and 67.1%, respectively. The negative predictive values were 85% for moderate-to-severe OSA and 94.8% for severe OSA. The corresponding positive predictive values were 50.6% and 20.2%, respectively. Using BMI cutoffs of 30 and 27.5 for Asians compared to the original cutoff of 35 did not improve the questionnaire performance significantly. CONCLUSION: The STOP-Bang questionnaire can be used as a screening tool in the general population in view of its moderate sensitivity and high negative predictive value for subjects with moderate-to-severe and severe OSA. The cutoff of BMI >35 can be used in Asians, as lower BMI cutoffs did not improve questionnaire performance.

Prevalence and predictors of obstructive sleep apnoea in young children with Down syndrome.

BACKGROUND: Children with Down syndrome (DS) are vulnerable to obstructive sleep apnoea (OSA) because of their unique craniofacial anatomy and hypotonia. Understanding the predictors of OSA in DS may enable targeted screening. METHODS: Children with DS (n = 202) aged from six months to below six years (110 boys) were recruited from three UK children's hospitals. The clinical assessment included height, weight and tonsillar size. The parents either set up cardiorespiratory polygraphy at home or chose laboratory studies. Studies with less than four hours of interpretable data were repeated where possible. American Academy of Sleep Medicine (AASM) 2012 scoring criteria were used to derive an obstructive apnoea/hypopnoea index (OAHI). Predictors of moderate to severe OSA were examined. RESULTS: In total, 188/202 (93%) participants were successfully studied. Of these, 169 studies were completed at home and 19 in a sleep laboratory. Moderate to severe OSA, defined by an OAHI of >5/h, was found in 14% and mild to moderate OSA (1/h≥OAHI <5/h) was found in 59% of the children. Male gender and habitual snoring predicted OSA but did not have independent predictive power in the presence of the other factors. Age in months, body mass index (BMI) centile and tonsillar size did not predict OSA. CONCLUSIONS: Moderate to severe OSA is common in very young children with DS. Examination of tonsillar size did not predict OSA severity. Population-based screening for OSA is recommended in these children, and domiciliary cardiorespiratory polygraphy is an acceptable screening approach. Further research is required to understand the natural history, associated morbidity, optimal screening methodology and treatment modality for OSA in these children.

Assessment of Upper-Airway Configuration in Obstructive Sleep Apnea Syndrome With Computed Tomography Imaging During Müller Maneuver.

BACKGROUND: The purpose of this observational study was to investigate the relationship between upper-airway configuration assessed by CT imaging during the Müller maneuver state and the severity of obstructive sleep apnea syndrome (OSAS). METHODS: A total of 358 snoring subjects who underwent standard polysomnography and upper-airway configuration by using CT imaging were enrolled. According to the apnea-hypopnea index (AHI), subjects were classified into 4 groups: snoring group (simple snoring), AHI < 5; mild OSAS, 5 ≤ AHI < 15; moderate OSAS, 15 ≤ AHI < 30; and severe OSAS, AHI ≥ 30. We also divided the upper airway into 3 parts, named the nasopharynx, oropharynx, and hypopharynx, from the CT scan and evaluated the minimal cross-sectional area (mCSA) and the shape of each airway level and calculated upper-airway length and distance from mandibular plane to hyoid bone (MPH). RESULTS: Multivariate logistic stepwise regression analysis identified body mass index (BMI), mCSA of nasopharynx, upper-airway length, and MPH as risk factors for the severity of OSAS. When subdivided for BMI and sex, upper-airway length was a risk factor for OSAS in non-obese (BMI < 27 kg/m2) and male subjects, and MPH was a risk factor only in obese (BMI ≥ 27 kg/m2) subjects. Meanwhile, mCSA of nasopharynx was significantly associated with the severity of OSAS independent of BMI. CONCLUSIONS: Subjects with severe OSAS have more significant abnormalities of the upper airway. Obesity, mCSA of nasopharynx, upper-airway length, and MPH may contribute to the severity of OSAS. Obesity and sex should be taken into account when evaluating the abnormalities of upper-airway anatomy in snorers and patients with OSAS.

Snoring Sounds Predict Obstruction Sites and Surgical Response in Patients with Obstructive Sleep Apnea Hypopnea Syndrome.

Snoring sounds generated by different vibrators of the upper airway may be useful indicators of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This study aimed to investigate associations between snoring sounds, obstruction sites, and surgical responses (≥50% reduction in the apnea-hypopnea index [AHI] and <10 events/hour) in patients with OSAHS. This prospective cohort study recruited 36 OSAHS patients for 6-hour snoring sound recordings during in-lab full-night polysomnography, drug-induced sleep endoscopy (DISE), and relocation pharyngoplasty. All patients received follow-up polysomnography after 6 months. Fifteen (42%) patients with at least two complete obstruction sites defined by DISE were significantly, positively associated with maximal snoring sound intensity (40-300 Hz; odds ratio [OR], 1.25, 95% confidence interval [CI] 1.05-1.49) and body mass index (OR, 1.48, 95% CI 1.02-2.15) after logistic regression analysis. Tonsil obstruction was significantly, inversely correlated with mean snoring sound intensity (301-850 Hz; OR, 0.84, 95% CI 0.74-0.96). Moreover, baseline tonsil obstruction detected by either DISE or mean snoring sound intensity (301-850 Hz), and AHI could significantly predict the surgical response. Our findings suggest that snoring sound detection may be helpful in determining obstruction sites and predict surgical responses.

Expression of cysteinyl leukotriene receptor 1 and 2 (CysLTR1 and CysLTR2) in the lymphocytes of hyperplastic tonsils: comparison between allergic and nonallergic snoring children.

BACKGROUND: Cysteinyl leukotriene receptor 1 and 2 (CysLTR1 and CysLTR2) are involved in allergic processes and play a role in adenotonsillar hyperplasia (AH). Clinically, only CysLTR1 may be blocked by montelukast. Our objective was to compare the expression of CysLTR1 and CysLTR2 in the B and T cells of hyperplasic tonsils of sensitized (SE) and control (NS) snoring children. METHODS: Sixty children, 5 to 10 years of age, referred for adenotonsillectomy, were divided into SE and NS groups, according to their responses to the skin-prick test. Cells from the removed tissues were stained for CysLTR1, CysLTR2, CD19, and CD3 and counted via flow cytometry. messenger RNA (mRNA) expression of the CysLTRs genes was measured real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR). RESULTS: The SE group showed reduced expression of the small CD3+/CysLTR1+ lymphocytes (4.6 ± 2.2 vs 6.5 ± 5.0; p = 0.04). Regarding the large lymphocytes, the SE group showed lower expression of CD3+/CysLTR1+ (40.9 ± 14.5 vs 47.6 ± 11.7; p = 0.05), CD19+/CysLTR1+ (44.6 ± 16.9 vs 54.1 ± 12.4; p = 0.01), and CD19+/CysLTR2+ (55.3 ± 11.3 vs 61.5 ± 12.6; p = 0.05) lymphocytes. Considering the total number of lymphocytes, the SE group had fewer CD3+/CysLTR1+ lymphocytes (11.1 ± 5.5 vs 13.7 ± 6.2; p = 0.04). All other cell populations exhibited reduced expression in the SE group without statistical significance. The expression of CysLTR2 was significantly higher (p < 0.05) than CysLTR1 in most studied cell populations. The mRNA expression did not show significant differences between the groups. CONCLUSION: The expression of CysLTR is higher in the lymphocytes of the NS children, and CysLTR2 shows greater expression than CysLTR1 Respiratory allergies do not appear to be a stimulus for AH occurrence. Newer drugs capable of blocking both CysLTRs warrant further study.

Sleep Disordered Breathing and White Matter Hyperintensities in Community-Dwelling Elders.

STUDY OBJECTIVES: To examine the association between markers of sleep-disordered breathing (SDB) and white matter hyperintensity (WMH) volume in an elderly, multiethnic, community-dwelling cohort. METHODS: This is a cross-sectional analysis from the Washington Heights-Inwood Columbia Aging Project (WHICAP), a community-based epidemiological study of older adults. Structural magnetic resonance imaging was obtained starting in 2004; the Medical Outcomes Study-Sleep Scale (MOS-SS) was administered to participants starting in 2007. Linear regression models were used to assess the relationship between the two MOS-SS questions that measure respiratory dysfunction during sleep and quantified WMH volume among WHICAP participants with brain imaging. RESULTS: A total of 483 older adults had both structural magnetic resonance imaging and sleep assessment. Self-reported SDB was associated with WMH. After adjusting for demographic and vascular risk factors, WMH volumes were larger in individuals with frequent snoring (ß = 2.113, P = 0.004) and among those who reported waking short of breath or with headache (ß = 1.862, P = 0.048). CONCLUSIONS: In community-dwelling older adults, self-reported measures of SDB are associated with larger WMH volumes. The cognitive effects of SDB that are increasingly being recognized may be mediated at the small vessel level.

Sleep-disordered breathing in orthodontic practice: Prevalence of snoring in children and morphological findings.

OBJECTIVES: The purpose of this work was to evaluate the prevalence of snoring and its correlation with cranial and upper airway morphology in young individuals with orthodontic treatment need. PATIENTS AND METHODS: Parents of 379 children were consecutively interviewed, using eight questions from a more comprehensive questionnaire about sleep behavior. A total of 100 patients (54 girls, 46 boys, average age 11.3 years) met the inclusion criteria. Based on the parents' interviews, the sample was divided into snorers (n = 53) and nonsnorers (n = 47). Using cephalograms obtained for initial orthodontic diagnostics, airway morphology was measured based on hyoid position and on the posterior airway space (PAS) dimensions at the maxillary, occlusal, and mandibular plane levels (PAS_NL, PAS_OCCL, PAS_ML). Mann-Whitney U testing, ANOVA, and Spearman's rank correlation coefficient were used for statistical analysis. RESULTS: Snoring was reported by 53 % of parents for 63 % (n = 29) of the boys and 44 % (n = 24) of the girls. Significant morphological differences were noted between snorers and nonsnorers. PAS dimensions were significantly reduced in the snorers compared to the nonsnorers at all three anatomical levels tested, which remained statistically significant when adjusted for age and gender. No differences between the two groups emerged for hyoid position or any of the vertical cranial parameters. A significant correlation between sagittal maxillary position (SNA) and PAS_NL was noted, indicating that larger SNA values were mildly associated with larger sagittal PAS dimensions at the maxillary level. CONCLUSION: This random sample of young patients with orthodontic treatment need was found to involve a high prevalence of parent-reported snoring. Characteristic features in cranial and upper airway morphology and thus differences between the snorers and nonsnorers were found.