Cut-off points of neck and waist circumference as predictors of obstructive sleep apnea in the Colombian population: a comparison with polysomnography

ABSTRACT BACKGROUND: Neck circumference (NC) is a useful anthropometric measure for predicting obstructive sleep apnea (OSA). Ethnicity and sex also influence obesity phenotypes. NC cut-offs for defining OSA have not been established for the Latin American population. OBJECTIVES: To evaluate NC, waist circumference (WC), and body mass index (BMI) as predictors of OSA in the Colombian population and to determine optimal cut-off points. DESIGN AND SETTING: Diagnostic tests were conducted at the Javeriana University, Bogota. METHODS: Adults from three cities in Colombia were included. NC, WC, and BMI were measured, and a polysomnogram provided the reference standard. The discrimination capacity and best cut-off points for diagnosing OSA were calculated. RESULTS: 964 patients were included (57.7% men; median age, 58 years) and 43.4% had OSA. The discrimination capacity of NC was similar for men and women (area under curve, AUC 0.63 versus 0.66, P = 0.39) but better for women under 60 years old (AUC 0.69 versus 0.57, P < 0.05). WC had better discrimination capacity for women (AUC 0.69 versus 0.57, P < 0.001). There were no significant differences in BMI. Optimal NC cut-off points were 36.5 cm for women (sensitivity [S]: 71.7%, specificity [E]: 55.3%) and 41 cm for men (S: 56%, E: 62%); and for WC, 97 cm for women (S: 65%, E: 69%) and 99 cm for men (S: 53%, E: 58%). CONCLUSIONS: NC and WC have moderate discrimination capacities for diagnosing OSA. The cut-off values suggest differences between Latin- and North American as well as Asian populations.

Correlation analysis of cardiopulmonary exercise test indices and conditions of overweight patients with obstructive sleep apnea: a retrospective study

ABSTRACT BACKGROUND: The cardiopulmonary function of patients with obstructive sleep apnea (OSA) is significantly lower than that of patients with simple snoring and is significantly related to the severity of OSA. Currently, only a few studies have been conducted on cardiopulmonary exercise testing in overweight patients with OSA. OBJECTIVE: To analyze the correlation between cardiopulmonary exercise test (CPET) indices and the condition of overweight patients with OSA. DESIGN AND SETTING: Retrospective study in Guangdong Provincial Hospital of Chinese Medicine. METHODS: This study included 73 hospitalized overweight patients. The patients were divided into no, mild, moderate, and severe OSA groups. Differences in the CPET indices among the four groups were compared. The correlation between the CPET indices and conditions was analyzed. RESULTS: No, mild, moderate, and severe OSA groups had 18 men and 5 women, 11 men and 3 women, 12 men and 2 women, and 21 men and 1 woman, respectively (P > 0.05). No significant difference was observed in resting pulmonary function among the four groups (P > 0.05). In the CPET, the anaerobic threshold, maximum oxygen uptake, and oxygen pulse were significantly lower in the severe OSA group than those in the normal OSA group (P < 0.05). Moreover, CPET indices negatively correlated with the apnea-hypopnea index. CONCLUSION: Changes in CPET indices occurred earlier than changes in resting pulmonary function in patients with OSA. CPET might be a potential method for evaluating the severity of OSA combined with overweight status.

Twin pregnancies with chronic hypertension and sleep apnea-hypopnea syndrome treated with continuous positive airway pressure: report of three cases / 中华围产医学杂志

This paper reports the maternal and fetal outcomes of three twin pregnancies with chronic hypertension and obstructive sleep apnea-hypopnea syndrome (OSAHS) who were treated with continuous positive airway pressure (CPAP). All three women with twin pregnancies were diagnosed with chronic hypertension. Furthermore, symptoms such as snoring and apnea assisted the diagnosis of OSAHS through polysomnography monitoring. Case 1 was treated with CPAP at 28 gestational weeks. The blood pressure increased gradually after the first month of CPAP treatment, with an elevated urine protein concentration. At 34 gestational weeks, the pregnant woman underwent a cesarean section due to the development of hemolysis, elevated liver enzymes, and low platelet syndrome. Case 2 was treated with CPAP at 11 gestational weeks, with stable blood pressure throughout the pregnancy, and was delivered through cesarean section at 37 weeks of pregnancy. Case 3 started CPAP at 13 gestational weeks for four months, and increased blood pressure and urine protein were observed. Medication brought the blood pressure down, and urine protein became negative. At 32 gestational weeks, a cesarean section was performed because of premature rupture of the membrane. Her CPAP treatment continued till delivery with good maternal and infant outcomes. The treatment outcomes of the three cases suggest that CPAP may prolong the time of blood pressure rise among twin pregnancies where chronic hypertension and OSAHS coexist, which potentially reduces the occurrence of adverse maternal and infant outcomes.

Brain white matter variation in patients with obstructive sleep apnea-hypopnea syndrome with diffusional kurtosis imaging / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the changes of brain white matter of the patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)with magnetic resonance diffusional kurtosis imaing(DKI).METHODS There were 38 patients with OSAHS examined by polysomnogram(PSG)from November 2017 to June 2021,and 32 non-OSAHS controls matched in gender and age who were included in this study.All the subjects were scanned by DKI.The different encephalic regions through comparing kurtosis fractional anisotropy(KFA)values of all encephalic regions between the two groups were found,and the relationship between the KFA values of the different encephalic regions in OSAHS patients and the apnea-hypopnea index(AHI),lowest saturation oxygen(LSaO2)and the percent of the total record time spent below 90%oxygen saturation(TS90%)in PSG were analyzed.RESULTS The KFA values of white matter fiber tracts in corpus callosum,bilateral corona radiata,cingulate gyrus,right superior cerebellar peduncle and inferior cerebellar peduncle of OSAHS group were obviously lower than control group(P<0.05).After controlling for age and body mass index(BMI),the partial correlation between AHI and the KFA values of corpus callosum,left posterior corona radiata,right anterior corona radiata,cingulate gyrus in OSAHS group were also negative(r=-0.344,-0.380,-0.406,-0.53,P<0.05).The partial correlation between LSaO2 and the KFA values of corpus callosum,left posterior corona radiata,right anterior corona radiata,cingulate gyrus,right superior cerebellar peduncle in OSAHS group were also positive(r=0.366,0.406,0.446,0.404,0.342,P<0.05).The partial correlation between TS90%and the KFA values of corpus callosum,left posterior corona radiata,right anterior corona radiata,cingulate gyrus,right superior cerebellar peduncle and inferior cerebellar peduncle in OSAHS group were also negative(r=-0.414,-0.352,-0.355,-0.336,-0.456,-0.360,P<0.05).CONCLUSION Recurrent apnea and hypoxemia at night of OSAHS patients can cause damage to white matter fibers in parts of encephalic regions.

Correlation between serum asprosin and apropin levels and disease severity in elderly patients with obstructive sleep apnea syndrome / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the correlation between serum levels of asprosin and adropin in elderly patients with obstructive sleep apnea syndrome(OSAS)and the disease severity.METHODS From August 2021 to August 2023,131 elderly OSAS patients admitted to Ezhou Central Hospital were collected as observation subjects(OSAS group),according to the sleep apnea hypopnea index(AHI),there were 40 cases in the mild group,52 cases in the moderate group,and 39 cases in the severe group,meantime,124 healthy individuals who came to health clinic of our hospital for physical examination were collected as the control group.Enzyme-linked immunosorbent assay(ELISA)was applied to determine the levels of asprosin and apropin in the serum of OSAS patients;Pearson method was applied to analyze the correlation between serum asprosin,apropin levels and AHI,ODI,and LSaO2.ROC curve was used to analyze the diagnostic value of serum asprosin and adropin levels in OSAS and the severity of OSAS patients.RESULTS Compared with the control group,the asprosin level in the OSAS group was obviously increased,while the adropin level was obviously reduced(P<0.05).There was no statistically obvious difference in gender,age,coronary heart disease,hypertension,TC,TG,HDL-C,LDL-C among the mild,moderate,and severe groups(P>0.05);compared with the mild group,the levels of BMI,AHI,ODI,and asprosin in the moderate and severe groups were obviously increased,while the levels of LSaO2 and apropin were obviously reduced(P<0.05);compared with the moderate group,the levels of BMI,AHI,ODI,and asprosin in the severe group were obviously increased,while the levels of LSaO2 and apropin were obviously reduced(P<0.05).The serum asprosin level in OSAS patients was positively correlated with AHI and ODI,and negatively correlated with LSaO2(P<0.05);the level of apropin was negatively correlated with AHI and ODI,and positively correlated with LSaO2(P<0.05).The AUC of serum asprosin,apropin levels,and their combination in diagnosing moderate and severe OSAS was 0.832,0.882,and 0.942,respectively,the combined diagnostic value of the two was superior to that of single diagnosis(Z=3.435,2.560,P=0.001,0.011).Serum asprosin,adropin levels and AUC of combined diagnosis of OSAS were 0.818,0.804 and 0.893,respectively.The value of combined diagnosis was better than that of single diagnosis(Z=3.886,4.126,P=0.000,0.000).CONCLUSION The serum level of asprosin is increased and the level of adropin is decreased in patients with OSAS,which is closely related to the severity of the disease,and may be used in the clinical diagnosis of OSAS and the evaluation of the severity of OSAS.

Evaluation of thyroid functions and obesity in obstructive sleep apnea syndrome

SUMMARY OBJECTIVE: Obstructive sleep apnea syndrome is associated with many chronic diseases. METHODS: Obesity and thyroid function tests were evaluated retrospectively and cross-sectionally for 782 obstructive sleep apnea syndrome patients. RESULTS: The mean patient age was 49.3±11.5 years, and the majority were obese (67.9%) or overweight (26.6%). The mean age of the patients in Group 2 (moderate/severe obstructive sleep apnea syndrome) was higher than that of Group 1 (simple snoring/mild obstructive sleep apnea syndrome). The rate of severe obstructive sleep apnea syndrome among obese patients (35.2%) was significantly higher than that of normal-weight (11.6%) and overweight (18.3%) patients (p=0.001). The oxygen desaturation index/apnea-hypopnea index and levels of leukocytes and C-reactive protein were significantly higher, while mean/minimum saturation values and hemoglobin, hematocrit, and free triiodothyronine levels were significantly lower among obese patients compared with overweight and normal-weight patients (p=0.001). Leukocytes, C-reactive protein, and apnea-hypopnea index/oxygen desaturation index values were higher, and mean/minimum saturation values were lower in Group 2 than in Group 1. CONCLUSION: There were relationships between obstructive sleep apnea syndrome severity and body mass index. Obesity could be a critical predisposing factor for sleep disturbances. The prevention and control of obesity is important while being treated for obstructive sleep apnea syndrome.

Características clínicas y demográficas de los pacientes con apnea obstructiva de sueño manejados quirúrgicamente en el servicio de otorrinolaringología del Hospital Militar Central entre los años 2016-2020 / Clinical and demographic characteristics of patients with obstructive sleep apnea surgically managed in the otorhinolaryngology service of the Central Military Hospital of Bogota between 2016-2020

Introducción: la apnea obstructiva del sueño (AOS) conlleva un alto riesgo cardiovascular, metabólico y neurológico. Los dispositivos de presión positiva continua (CPAP) o dispositivos de avance mandibular (DAM) pueden ferulizar la vía aérea superior (VAS) y mejorar la obstrucción; sin embargo, la adherencia es muy baja. Se ha demostrado que los procedimientos quirúrgicos de la VAS pueden llevar a una reducción significativa en la frecuencia de apneas e hipopneas. El objetivo del estudio fue describir las características clínicas y demográficas y los cambios en la somnolencia diurna excesiva, en el índice de apnea e hipopnea (IAH) y en la saturación de oxígeno (SpO2 ) de los pacientes con AOS manejados quirúrgicamente en el Servicio de Otorrinolaringología entre los años 2016 a 2020. Materiales y métodos: Se realizó un estudio observacional descriptivo tipo serie de casos. Resultados: se incluyeron nueve pacientes que cumplían los criterios de inclusión, el 77,8 % presentaban sobrepeso u obesidad. Se disminuyó la puntuación de la Epworth Sleepiness Scale (ESS) en el 100 % de los pacientes pre y posquirúrgicos. Adicionalmente, la polisomnografía (PSG) pre y posoperatoria mostró un aumento en la eficiencia de sueño con la mejoría de parámetros de oxigenación. Se encontró una disminución en el IAH en el 88,8 % de los pacientes. Conclusión: los hallazgos en este estudio sugieren que la cirugía de VAS es segura para realizar en pacientes con AOS. No todos los pacientes son candidatos a manejo quirúrgico y es importante una selección adecuada para disminuir las complicaciones.

Introduction: Obstructive sleep apnea (OSA) is a pathology that leads to a high risk of developing cardiovascular, metabolic, and neurological diseases. Positive airway pressure (CPAP) or mandibular advancement devices (MAD) can open superior airway (SAW) improve the obstruction, however, adherence is too low. It has already been shown that surgical SAW procedures, compared with medical management, can lead to a significant reduction in the frequency of apneas and hypopneas. The aim of this study was to describe the clinical and demographic characteristics, changes in excessive daytime sleepiness using Epworth Sleepiness Scale (ESS), apnea-hipopnea index (AHI) and SpO2 in patients with OSA managed surgically. Methods: A descriptive observational case series type study was carried out. Results: Nine patients were included, 77.8% were overweight or obese. A decrease in the ESS was found in 100% of the patients when pre- and post-operative scores were compared. Additionally, pre and postoperative polysomnography (PSG) showed an increase in sleep efficiency with improvement in oxygenation parameters such as mean saturation and minimum saturation. Regarding respiratory events, we found a decrease in AHI in 88.8% of patients. Conclusion: The findings in this study suggest that SAW surgery is safe to perform in patients with OSA. However, it is necessary to keep in mind that not all patients are candidates for surgical management and that adequate patient selection is important to reduce procedural complications.

Evaluation of comorbid diseases in obstructive sleep apnea syndrome

SUMMARY OBJECTIVE: It is known that obstructive sleep apnea syndrome affects many systems due to hypoxemia and hypercarbia. We aimed to demonstrate with the utilization of well-standardized questionnaire tools and electrophysiological tests that cognitive impairment, depression, autonomic dysfunction, and metabolic syndrome may occur in association with obstructive sleep apnea syndrome. METHODS: The electrophysiological examination protocol of autonomic nervous system functions was performed with sympathetic skin response and R-R Interval. Patients were administered Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Montreal Cognitive Assessment, and Hamilton Depression Rating Scale by physicians in face-to-face interviews. RESULTS: This study included 148 participants, consisting of 73 patients and 75 controls. There was a statistically significant difference between the patient group and control group with regard to sympathetic skin response, R-R Interval, post-hyperventilation R-R Interval, and R-R Interval variation (p<0.001). A statistically significant difference was observed between the patient group and control group in terms of median Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Montreal Cognitive Assessment scores. It was observed that the control group achieved significantly better scores than the patient group in delayed recall (p<0.001) and language (p<0.05) categories. CONCLUSION: Obstructive sleep apnea syndrome patients should be screened for diseases, especially in the cardiovascular system, that cause serious morbidity and impair functionality such as dementia and depression. We believe that many comorbid diseases encountered in obstructive sleep apnea syndrome patients can be prevented with early diagnosis and continuous positive airway pressure treatment.

Triglyceride-glucose index as a predictor of obstructive sleep apnoea severity in the absence of traditional risk factors / Índice de triglicerídeos-glicose como preditor de gravidade da apneia obstrutiva do sono na ausência de fatores de risco tradicionais

Abstract Objective We evaluated the association between the triglyceride-glucose (TG) index, a marker of insulin resistance, and obstructive sleep apnoea (OSA) severity in patients without diabetes mellitus, obesity, and metabolic syndrome. Methods This retrospective cohort study included 1,527 patients. We used univariate and multivariate analyses to identify the independent predictors associated with OSA. Results Most patients were males (81.5%) with a mean age of 43.9 ± 11.1 (15-90) years. Based on the apnoea-hypopnea index (AHI), 353 (23.1%) patients were included in the control group, whereas 32.4%, 23.5%, and 21% had mild, moderate, and severe OSA, respectively. The TG index values demonstrated significant associations with OSA patients compared with the control group (p = 0.001). In addition, the mean values of the oxygen desaturation index (ODI), AHI, minimum oxygen saturation, and total sleep time percentage with saturation below 90% demonstrated statistically significant differences among the TG index groups (p: 0.001; p:0.001; p:0.001; p:0.003). The optimal TG index cutoff value to predict OSA was 8.615 (AUC = 0.638, 95% CI = 0.606-0.671, p = 0.001). In multivariate logistic regression analysis, after adjusting for age, sex, and body mass index, the TG index was independently associated with OSA patients. Conclusion The TG index is independently associated with increased risk for OSA. This indicates that this index, a marker for disease severity, can be used to identify severe OSA patients on waiting lists for PSG.

Resumo Objetivo Avaliamos a associação entre o índice triglicerídeos-glicose (TG), um marcador de resistência à insulina, e a gravidade da apneia obstrutiva do sono (AOS) em pacientes sem diabetes mellitus, obesidade e síndrome metabólica. Métodos Este estudo de coorte retrospectivo incluiu 1.527 pacientes. Utilizamos análises univariadas e multivariadas para identificar os preditores independentes associados à AOS. Resultados A maioria dos pacientes era do sexo masculino (81,5%) com idade média de 43,9 ± 11,1 anos (15-90). Com base no índice apneia-hipopneia (IAH), 353 (23,1%) pacientes foram incluídos no grupo de controle, enquanto 32,4%, 23,5% e 21% tinham AOS leve, moderada e grave, respectivamente. Os valores do índice TG demonstraram associações significativas com pacientes com AOS em comparação com o grupo de controle (p = 0,001). Além disso, os valores médios do índice de dessaturação de oxigênio (IDO), IAH, saturação mínima de oxigênio e porcentagem de tempo total de sono com saturação abaixo de 90% demonstraram diferenças estatisticamente significativas entre os grupos de índice TG (p = 0,001; p = 0,001; p = 0,001; p = 0,003). O valor de corte ideal do índice TG para prever a AOS foi de 8,615 (AUC=0,638, IC de 95% = 0,606-0,671, p = 0,001). Na análise de regressão logística multivariada, após o ajuste para idade, sexo e índice de massa corporal, o índice TG foi independentemente associado a pacientes com AOS. Conclusão O índice TG está independentemente associado a um maior risco de AOS. Isso indica que este índice, um marcador de gravidade da doença, pode ser usado para identificar pacientes com AOS grave em listas de espera para polissonografia.

Sleep parameters in patients with chronic hypersensitivity pneumonitis: a case-control study / Parâmetros do sono em pacientes com pneumonite de hipersensibilidade crônica: estudo de caso-controle

ABSTRACT Objective: To compare patients with chronic hypersensitivity pneumonitis (cHP) and controls with normal spirometry in terms of their sleep characteristics, as well as to establish the prevalence of obstructive sleep apnea (OSA) and nocturnal hypoxemia. Secondary objectives were to identify factors associated with OSA and nocturnal hypoxemia; to correlate nocturnal hypoxemia with the apnea-hypopnea index (AHI) and lung function, as well as with resting SpO2, awake SpO2, and SpO2 during exercise; and to evaluate the discriminatory power of sleep questionnaires to predict OSA. Methods: A total of 40 patients with cHP (cases) were matched for sex, age, and BMI with 80 controls, the ratio of controls to cases therefore being = 2:1. The STOP-Bang questionnaire, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index, the Berlin questionnaire and the Neck circumference, obesity, Snoring, Age, and Sex (NoSAS) score were applied to all cases, and both groups underwent full-night polysomnography. Results: The patients with cHP had longer sleep latency, lower sleep efficiency, a lower AHI, a lower respiratory disturbance index, fewer central apneas, fewer mixed apneas, and fewer hypopneas than did the controls. The patients with cHP had significantly lower nocturnal SpO2 values, the percentage of total sleep time spent below an SpO2 of 90% being higher than in controls (median = 4.2; IQR, 0.4-32.1 vs. median = 1.0; IQR, 0.1-5.8; p = 0.01). There were no significant differences between cases with and without OSA regarding the STOP-Bang questionnaire, NoSAS, and ESS scores. Conclusions: The prevalence of OSA in cHP patients (cases) was high, although not higher than that in controls with normal spirometry. In addition, cases had more hypoxemia during sleep than did controls. Our results suggest that sleep questionnaires do not have sufficient discriminatory power to identify OSA in cHP patients.

RESUMO Objetivo: Comparar pacientes com pneumonite de hipersensibilidade crônica (PHc) e controles com espirometria normal quanto às características do sono, bem como estabelecer a prevalência de apneia obstrutiva do sono (AOS) e hipoxemia noturna. Os objetivos secundários foram identificar fatores associados à AOS e hipoxemia noturna; correlacionar a hipoxemia noturna com o índice de apneias e hipopneias (IAH), função pulmonar, SpO2 em repouso, SpO2 em vigília e SpO2 durante o exercício; e avaliar o poder discriminatório de questionários do sono para predizer AOS. Métodos: Um total de 40 pacientes com PHc (casos) foram emparelhados por sexo, idade e IMC com 80 controles (2:1). O questionário STOP-Bang, a Escala de Sonolência de Epworth (ESE), o Índice de Qualidade do Sono de Pittsburgh, o questionário de Berlim e o escore Neck circumference, obesity, Snoring, Age, and Sex (NoSAS, circunferência do pescoço, obesidade, ronco, idade e sexo) foram aplicados a todos os casos, e ambos os grupos foram submetidos a polissonografia de noite inteira. Resultados: Os pacientes com PHc apresentaram maior latência do sono, menor eficiência do sono, menor IAH, menor índice de distúrbio respiratório, menos apneias centrais, menos apneias mistas e menos hipopneias do que os controles. Os pacientes com PHc apresentaram SpO2 noturna significativamente menor; a porcentagem do tempo total de sono com SpO2 < 90% foi maior que nos controles (mediana = 4,2; IIQ: 0,4-32,1 vs. mediana = 1,0; IIQ: 0,1-5,8; p = 0,01). Não houve diferenças significativas entre os casos com e sem AOS quanto à pontuação no questionário STOP-Bang, no NoSAS e na ESE. Conclusões: A prevalência de AOS em pacientes com PHc (casos) foi alta, embora não tenha sido maior que a observada em controles com espirometria normal. Além disso, os casos apresentaram mais hipoxemia durante o sono do que os controles. Nossos resultados sugerem que os questionários do sono não têm poder discriminatório suficiente para identificar AOS em pacientes com PHc.

Descripción de la frecuencia de factores de mala adherencia en la terapia con presión positiva en la vía aérea (CPAP-BPAP-APAP) en pacientes con AOS pertenecientes al Hospital Militar Central de Colombia entre 2015-2020 / Description of the frequency of poor adherence factors in positive airway pressure therapy (CPAP-BPAP-APAP) in patients with OSA belonging to the Central Military Hospital of Colombia between 2015-2020

Introducción: la apnea obstructiva del sueño (AOS) es una enfermedad de etiología multifactorial. Existen diversos factores que condicionan la baja adherencia al manejo con sistemas de presión positiva desde problemas con el equipo hasta condiciones inherentes al paciente. El objetivo de este estudio es describir la frecuencia de los factores de mala adherencia reportados en la literatura en pacientes manejados entre 2015-2020. Metodos: estudio observacional, descriptivo, tipo serie de casos. Se realizó la revisión de historia clínica y diligenciamiento de una encuesta. Se caracterizaron y describieron las variables clínicas, físicas y relacionadas con el dispositivo. Resultados: se analizaron 26 pacientes, 76,9 % de sexo masculino y 23.1% de sexo femenino (23,1 %). La edad promedio de los pacientes era de 51,2 ± 13,2 anÞos. El índice de masa corporal (IMC) promedio fue de 27,8, de los cuales solo siete pacientes tenían un índice normal (<25; 26.9%). 10 pacientes al momento de la primera consulta no tenían somnolencia diurna (38,5 %). El índice de apnea-hipopnea (IAH) fue en promedio de 37,4/hora ± 17,5. Seis pacientes con presión de tratamiento menor o igual a 8 cmH2O (30 %) y 14 pacientes con presiones superiores (70 %). El promedio de IAH residual fue de 8,3 eventos/hora ± 10,1. Conclusiones: la frecuencia de factores relacionados con baja adherencia al tratamiento sugiere la necesidad de una valoración psicosocial exhaustiva del paciente, una historia clínica detallada y un examen físico completo con el fin de identificar limitantes para la adherencia al manejo y proporcionar estrategias terapéuticas.

Introduction: Obstructive sleep apnea (OSA) is a complex condition with multiple causative factors contributing to poor adherence to positive pressure systems since problems with device and conditions inherent to the patient. This study aims to describe the frequency of such factors reported in the literature for patients treated between 2015-2020. Methods: Observational, descriptive, case series study. The medical history was reviewed, and a survey was completed. Clinical, physical, and device-related variables were characterized and described. Results: 26 patients were analyzed in this study, 76.9% were male and 23.1% female. The average age of the patients was 51.2 ± 13.2 years. The body mass index (BMI) was 27.8, of which only 7 patients had a normal index (<25; 26.9%). 10 patients at the time of the first consultation do not have daytime sleepiness (38.5%). The apnea hypopnea index (AHI) was on average 37.4/hour ± 17.5. 6 patients with treatment pressure less than or equal to 8 cmH2O (30%) and 14 patients with pressure greater (70%). The residual AHI was on average 8.3 events/hour ± 10.1. Conclusions: The fre-quency of factors associated with poor treatment adherence underscores the need for comprehensive psychosocial assessments, detailed clinical histories, and tho-rough physical assessment to identify barriers to adherence and develop effective therapeutic strategies.

Avaliação neuropsicológica de crianças diagnosticadas com apneia obstrutiva do sono / Neuropsychological evaluation of children diagnosed with obstructive sleep apnea

A apneia obstrutiva do sono (AOS) pediátrica é um distúrbio respiratório, caracterizado por episódios recorrentes de obstrução das vias aéreas superiores. Muitas pesquisas evidenciam déficits relacionados aos distúrbios do sono, como dificuldade em atenção, memória, habilidades visuomotoras e funções executivas. A patogênese das comorbidades associadas à AOS está ligada à hipoxemia e às fragmentações no sono. A AOS infantil afeta negativamente resultados de testes neuropsicológicos, que incluem habilidades de linguagem expressiva e receptiva. A principal conduta terapêutica citada na literatura é cirúrgica, porém existem outras alternativas. A polissonografia (PSG) é o exame padrão para diagnóstico, e define a gravidade da doença, além de registrar outros parâmetros fisiológicos relacionados à arquitetura do sono. Por meio desse exame, foram selecionadas crianças com AOS para realizar um teste neuropsicológico e associar os resultados de ambos. A presente dissertação apresentará dois estudos, um de revisão de literatura e um estudo observacional transversal. OBJETIVOS: o objetivo do primeiro estudo é realizar uma revisão da literatura sobre a presença de déficits neuropsicológicos em crianças com apneia do sono; e o objetivo do segundo estudo é pesquisar crianças do ensino fundamental, diagnosticadas com AOS, por meio da associação dos seus resultados de um teste neuropsicológico, com seus respectivos dados polissonográficos. MÉTODOS: para o primeiro estudo foi realizada uma revisão integrativa da literatura, buscando publicações dos últimos dez anos que descreveram aspectos neuropsicológicos de crianças, de 6 a 12 anos, com AOS. Para o segundo estudo, observacional analítico transversal, a amostra incluiu 17 crianças, faixa etária entre 6 e 12 anos, com diagnóstico de AOS e sem comorbidades associadas, tais como síndromes genéticas e alterações craniofaciais. O diagnóstico de AOS foi feito com PSG, realizada em laboratório de sono. Nessa instituição, foram selecionados os laudos e contactadas as famílias para aplicação do teste NEUPSILIN-Inf, em um único encontro. Em seguida, realizou-se análise estatística descritiva, por meio do teste Mann-Whitney associando as variáveis explicativas (tarefas neuropsicológicas) e os desfechos (dados da PSG). RESULTADOS: os resultados são apresentados por meio da produção de dois artigos científicos. O Estudo 1, que é apresentado pelo artigo de revisão de literatura, consistiu em 21 artigos, selecionados entre 219 artigos encontrados em bases de dados. Foram incluídos ensaios clínicos randomizados, revisões da literatura, estudos transversais e de coorte. Dificuldade em atenção, memória e habilidades visuomotoras, verbais e funções executivas foram alterações neuropsicológicas, associadas a distúrbios do sono, destacadas nas pesquisas selecionadas. O segundo estudo incluiu avaliação neuropsicológica de crianças na faixa etária citada, associação entre os resultados do teste e dados polissonográficos. Valores significativos entre o índice de dessaturação inadequado e déficits de linguagem oral e escrita foram encontrados, evidenciando que prejuízos na qualidade de sono podem afetar negativamente habilidades neuropsicológicas. CONCLUSÃO: a AOS pode causar déficits neuropsicológicos relacionados à atenção, à memória declarativa, às funções executivas e às habilidades de linguagem. Na análise estatística foram encontrados valores significativos entre o índice de dessaturação inadequado e déficits de linguagem oral e escrita. Tais quadros podem ser amenizados com tratamento adequado, porém a relação entre dados diagnósticos e prognósticos carece de mais evidências. É de suma importância a abordagem preventiva e interdisciplinar de crianças com queixas respiratórias de sono para definir melhor intervenção, otimizar desempenho escolar e qualidade de vida das crianças com esse diagnóstico.

To elaborate a bibliographical review on neuropsychological deficits in children with sleep apnea. METHODS: An integrative review on theoretical literature was used to achieve the purpose, analyzing, thereby, specific literature from the last ten years describing neuropsychological aspects of children with sleep apnea. Database consulted were: "Portal Regional da Biblioteca Virtual de Saúde", "PubMed", "Portal CAPES", "PEDro" and "OTseeker". RESULTS: The sample has 21 selected articles, selected from a population of 219 articles found on the databases. Randomized clinical trials, bibliographical reviews, cross- sectional and cohort studies were included. Both Redundant publications or articles that did not specify for age or focused on comorbidities were not considered. Most of the surveys evidenced the existence of neuropsychological changes related to sleep disturbance, which could cause difficulties at paying attention. Memorization and visual motor, speech and executive functions were compromised. Pathogenesis of comorbidities related to obstructive sleep apnea are caused by hypoxemia and sleep interruptions. Surgery is the main medical intervention mentioned in the literature, since there was no other research so far exploring other possibilities to solve these neuropsychological deficits. CONCLUSION: Articles indicate that sleep apnea can cause neuropsychological deficits on attention, memory, and executive functions. In addition, these articles suggests that this situation could be softened with proper treatment, although prognosis and diagnosis data need further evidence.

Clinical study of the relationship between cellular adhesion molecules and left ventricular geometry and function in patients with obstructive sleep apnea syndrome and prehypertension / 中华超声影像学杂志

Objective:To investigate the correlations between serum E selectin, intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1) and left ventricular geometry and function in patients with obstructive sleep apnea syndrome (OSAS) combined with prehypertension (pre-HT).Methods:A total of 462 patients with pre-HT and OSAS diagnosed by polysomnography (PSG) in the sleep monitoring unit of the Department of Respiratory and Critical Care Medicine at the First Hospital of Shanxi Medical University from July 2019 to July 2022 were restrospectively analysed, and 52 patients with pure pre-HT (pre-HT group) and 73 patients with pure OSAS (OSAS group) in the same period were selected as the control group. OSAS and pre-HT patients were divided into four groups according to left ventricular geometry: normal geometry (NG) group, concentric remodeling (CR) group, eccentric hypertrophy (EH) group and concentric hypertrophy (CH) group. The general clinical data, PSG parameters, blood biochemical parameters and left ventricular structure and function parameters were compared among the six groups. Pearson correlation and multivariate Logistic regression were used to analyze the correlation between E-selection, ICAM-1, VCAM-1, general clinical data, PSG parameters, blood biochemical parameters with left ventricular geometry and function.Results:①Serum E selectin, ICAM-1, and VCAM-1 concentrations increased sequentially from the NG, CR, and EH to CH groups, with the most significant increase in CH group (all P<0.05). In addition, there were statistically significant differences in age, body mass index (BMI), OSAS severity, neck circumference, waist circumference, systolic blood pressure (SBP), diastolic blood pressure (DBP), Glu, lowest oxygen saturation (Lowest-SaO 2), mean oxygen saturation (Mean-SaO 2), percentage of time with oxygen saturation below 90% of total sleep time (T90), left ventricular end-diastolic diameter (LVEDd), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular mass index (LVMI), relative ventricular wall thickness (RWT), left ventricular ejection fraction (LVEF), peak mitral early diastolic flow velocity/peak mitral late diastolic flow velocity (E/A), E wave deceleration time (DT), A wave duration (AD), and isovolumic relaxation time (IVRT), and overall long-axis longitudinal strain (GLS) and so on(all P<0.05). ②Pearson correlation analysis showed that E selectin was negatively correlated with LVEF, E/A, e′, E/e′, IVRT, and GLS ( r=-0.236, -0.131, -0.224, -0.215, -0.285, -0.336; all P<0.05). ICAM-1 was negatively correlated with LVEF, E, E/A, e′, IVRT, and GLS( r=-0.130, -0.129, -0.104, -0.351, -0.252, -0.259; all P<0.05). VCAM-1 was negatively correlated with E, e′, and IVRT ( r=-0.132, -0.312, -0.387; all P<0.001). ③Multifactorial logistic regression analysis showed that E selectin and VCAM-1 were independently correlated with EH (β=1.139, OR=3.124, P=0.030; β=1.288, OR=3.626, P<0.001) and with CH (β=1.178, OR=3.248, P=0.013; β=1.108, OR=3.028, P<0.001). Conclusions:E selection and VCAM-1 were independently correlated with hypertrophic left ventricular geometry, suggesting that E selectin and VCAM-1 may be involved in the process of abnormal left ventricular structure and function in patients with OSAS combined with pre-HT.

Effects of chronic obstructive pulmonary disease patients complicated with OSAHS on hypercapnia and related factors / 中华健康管理学杂志

Objective:To analyze the effects of chronic obstructive pulmonary disease (COPD) combined with obstructive sleep apnea hypopnea syndrome (OSAHS) on hypercapnia and its related factors.Methods:In this cross-sectional study, patients with stable COPD were continuously recruited from July 2016 to December 2018 in the Respiratory Department of Peking University Third Hospital. General clinical data of patients were collected, and lung function test, arterial blood gas analysis and portable sleep monitoring were also conducted. Patients with COPD complicated with apnea hypopnea index (AHI)≥10 times/h and apnea events being mainly blockage-type events, accompanied by snoring, sleep apnea, daytime sleepiness and other symptoms were defined as overlapping group, patients with COPD complicated with AHI<10 times/h were defined as simple COPD group. Correlation analysis and logistic regression model were used to explore the determinants of daytime hypercapnia in patients with COPD.Results:Compared with simple COPD group, the median arterial partial pressure of carbon dioxide (PaCO 2) was significantly higher in the overlapping group (42.00 vs 38.95 mmHg (1 mmHg=0.133 kPa), P<0.001), and the rate of daytime hypercapnia was significantly higher (23.3% vs 3.3%, P=0.002). PaCO 2 was correlated with forced vital capacity (FVC), percent predicted forced expiratory volume in one second (FEV 1%pred), the ratio of residual volume (RV) to total lung capacity (TLC), AHI, nocturnal average transcutaneous oxygen saturation (SpO 2), nocturnal minimum SpO 2 and the total sleep time spent with SpO 2≤90% (T90) (all P<0.05). In logistic regression analysis, after adjusting for age, sex, and body mass index (BMI), only severe OSAHS, GOLD Ⅲ-Ⅳ grade (FEV 1%pred<50%), and T90>1% were independent risk factors for hypercapnia. Conclusions:OSAHS can increase the risk of hypercapnia in patients with COPD. AHI, lung function injury and T90 are closely related to hypercapnia.

Evaluation of platelet/lymphocyte ratio in adult of obstructive sleep apnea syndrome / 中国耳鼻咽喉头颈外科

OBJECTIVE Aimed to explore the correlation between platelet/lymphocyte ratio(PLR)and adult obstructive sleep apnea syndrome(OSAS).METHODS The data of 249 patients with OSAS were retrospectively analyzed.According to apnea-hypopnea index(AHI),the patients were divided into mild,moderate and severe groups.Meanwhile,there were 70 healthy adults who underwent physical examination in West China Fourth Hospital,Sichuan University in the control group.The differences of PLR between OSAS group and control group were compared.Pearson correlation analysis was used to analyze the correlation between PLR and AHI,percentage of sleep time spent below 90％oxygen saturation(TS90％),the lowest oxygen saturation at night(LSaO2)and body mass index(BMI).Logistic regression was used to analyze the independent risk factors of OSAS.RESULTS There was no significant difference in PLR between OSAS group(1 16.91±40.98)and control group(110.04±36.92)(P＞0.05),but the severe group(112.03±39.68)was significant lower than that of moderate group(125.67±47.00)and mild group(131.22±36.64)(P＜0.05),severe group was lower than that in mild group(P＜0.05).In patients with severe OSAS,the BMI,AHI,microarousal index,maximum hypopnea time and TS90％in the obese group were higher than those without obese,the LSaO2 and PLR were significant lower than those without obese(P＜0.05).Pearson correlation analysis showed a negative correlation between PLR and BMI(r=-0.216,P＜0.01),and negatively correlated with AHI and TS90％,but there was no statistically significant difference(P＞0.05),PLR and LSaO2 were positively correlated(r=0.146,P＜0.05).PLR(OR=1.014,P=0.002)and BMI(OR=1.743,P=0.000)were independent predictors of OSAS.CONCLUSION Serum PLR values in OSAS patients tended to decrease with the increase of AHI values,and PLR was lower in obese patients with severe OSAS,and PLR was also an independent risk factor for OSAS.

Ten-year changes in clinical features of patients monitored by polysomnography in OSA diagnosis and treatment centers:Data analysis based on a large sample disease database / 中国耳鼻咽喉头颈外科

OBJECTIVE Aimed to analyze the demographic,anthropometric,severity,and common comorbidities of individuals with suspected obstructive sleep apnea(OSA)referred to the OSA diagnosis and treatment center of the Sixth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine from 2012 to 2021.METHODS Data of subjects with suspected OSA who underwent polysomnography(PSG)from January 2012 to December 2021 were collected.Subjects were categorized into five groups based on the PSG study date with a two-year interval.Clinical characteristics trends were compared across groups,focusing on the comparison between 2020-2021 and 2018-2019 to explore changes after COVID-19 epidemic.RESULTS 1.A total of 5870 subjects were included from 2012 to 2019[age(43.2±12.7)years,21.7％females].OSA prevalence was 84.8％.Over the two-year intervals,age,female proportion,OSA severity,and other indicators showed no significant changes.Body mass index(median 26.8kg/m2 to 26.0kg/m2)and overweight rates(78.1％to 73.4％)decreased yearly,as did the proportions of subjects who smoked(38.1％to 27.8％)and consumed alcohol(13.5％to 6.4％).The prevalence of hypertension increased yearly(40.3％to 51.8％),while awareness rates gradually decreased(70.3％to 59.4％).Diabetes prevalence remained relatively stable(9.4％to 9.7％),with increased awareness(49.5％to 66.2％).Dyslipidemia prevalence remained high(76.7％to 78.3％),with low awareness rates(20.8％to 28.7％).2.A total of 805 subjects were included from 2020 to 2021.Compared with 2018-2019,the proportion of females decreased(14.9％vs.22.0％),and OSA severity increased(apnea-hypopnea index 40.4 times/h vs.29.2 times/h).Prevalence rates of hypertension,diabetes,dyslipidemia(47.1％,6.9％,62.1％)and awareness rates(52.4％,57.7％,17.8％)were lower than those from 2018-2019.3.Compared with subjects with known their comorbidities,unknown subjects had significantly higher levels of systolic blood pressure(141 mmHg vs.134 mmHg),diastolic blood pressure(93 mmHg vs.85 mmHg),fasting blood glucose(7.87 mmol/L vs.6.07 mmol/L),and low-density lipoprotein(3.08 mmol/L vs.2.91 mmol/L)(P＜0.05).CONCLUSION From 2012 to 2021,individuals with suspected OSA referred for PSG test showed a tendency toward younger age,lower proportion of females,fewer comorbidities,but increased OSA severity.The awareness rate of comorbidities needs improvement,emphasizing the importance of a multidisciplinary approach to the diagnosis and treatment of OSA.

Obstructive sleep apnea in patients with ischemic stroke: mechanism, diagnosis, and treatment / 国际脑血管病杂志

Ischemic stroke is the main cause of death and disability in adults, and its incidence is increasing year by year. Obstructive sleep apnea (OSA) is the most common type of sleep-disordered breathing, which can increase the risk of ischemic stroke and affect the outcomes of patients. There is an increasing amount of research on the relationship between OSA and ischemic stroke. This article reviews the bidirectional relationship between OSA and ischemic stroke, the mechanism of OSA causing ischemic stroke, and the diagnosis and treatment of OSA in patients with ischemic stroke.

Obstructive sleep apnea and vascular cognitive impairment: role of blood-brain barrier impairment / 国际脑血管病杂志

Obstructive sleep apnea (OSA) is a sleep disorder characterized by recurrent upper respiratory tract obstruction, sleep fragmentation, and hypoxia during sleep. This disease often leads to cognitive, emotional, and memory related neurological damage, and its mechanism is closely associated with the disruption of the blood-brain barrier (BBB). This article mainly discusses the relationship between BBB damage caused by OSA and vascular cognitive impairment (VCI), as well as the role of early prevention, intervention, and repairing BBB on reducing VCI.

Impact of obstructive sleep apnea on outcome in patients with acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate the impact of obstructive sleep apnea (OSA) on neurological function outcome in patients with acute ischemic stroke (AIS) at 90 days after onset.Methods:Patients with AIS admitted to Hefei Second People's Hospital from September 2022 to June 2023 were prospectively included. According to the modified Rankin Scale score at 90 days after onset, they were divided into a good outcome group (0-2) and a poor outcome group (>2). The demographic data, vascular risk factors, baseline laboratory tests, National Institutes of Health Stroke Scale (NIHSS) scores at admission, severity of obstructive sleep apnea (OSA), and apnea hypopnea index (AHI) were compared between the two groups. Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcomes. Results:A total of 104 patients with AIS were enrolled, including 62 males (59.6%), with a median age of 65.5 years (interquartile range, 57.0-72.0 years). The median baseline NIHSS score was 3.00 (interquartile range, 2.00-4.00). The median AHI was 18.14/h (interquartile range, 11.34-27.88/h), 43 patients (41.35%) with no/mild OSA and 61 patients (58.65%) with moderate to severe OSA. Seventy-four patients (71.2%) had good outcome, and 30 patients (28.8%) had poor outcome. When introducing AHI as a categorical variable into the logistic regression model, the higher baseline NIHSS score (odds ratio [ OR] 3.041, 95% confidence interval [ CI] 1.797-5.145; P<0.001) and moderate to severe OSA ( OR 4.413, 95% CI 1.032-18.877; P=0.045) were independent risk factors for poor outcome; When introducing AHI as a continuous variable into the logistic regression model, higher baseline NIHSS score ( OR 3.176, 95% CI 1.844-5.472; P<0.001), age ( OR 1.093, 95% CI 1.014-1.177; P=0.020), and AHI ( OR 1.044, 95% CI 1.002-1.089; P=0.042) were independent risk factors for poor outcome. Conclusion:Moderate to severe OSA is an independent risk factor for poor functional outcome in patients with AIS at 90 days after onset, and a higher AHI indicates poor outcome in patients.

Value of triglyceride-glucose index combined with obesity index in predicting nonalcoholic fatty liver disease in individuals with obstructive sleep apnea / 临床肝胆病杂志

Objective To investigate the value of triglyceride-glucose index (TyG), TyG combined with body mass index (BMI), and TyG combined with waist circumference (WC) in predicting nonalcoholic fatty liver disease (NAFLD) in patients with obstructive sleep apnea (OSA). Methods A retrospective analysis was performed for 190 patients who underwent sleep respiratory monitoring and were diagnosed with OSA in The Second Affiliated Hospital of Kunming Medical University from January 2020 to December 2021, and according to the results of ultrasonography, they were divided into OSA+NAFLD group with 107 patients and control group with 83 patients. The t -test or the Mann Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The binary logistic regression analysis was used to explore the influencing factors for the development of NAFLD in patients with OSA. The receiver operating characteristic (ROC) curve was plotted for TyG, TyG combined with BMI, and TyG combined with WC in predicting NAFLD in the patients with OSA, and the area under the ROC curve (AUC) was calculated. The Z test was used for comparison of AUC. Results Compared with the control group, the OSA+NAFLD group had significantly higher BMI, neck circumference, WC, apnea-hypopnea index, oxygen desaturation index, alanine aminotransferase, gamma-glutamyltransferase, triglyceride, fasting plasma glucose, and TyG and significantly lower age, average SpO 2 , LSaO 2 , and high-density lipoprotein cholesterol (all P < 0.05). The binary logistic regression analysis showed that TyG (odds ratio [ OR ]=1.961, 95% confidence interval [ CI ]: 1.03-3.73, P =0.04), BMI ( OR =1.203, 95% CI : 1.03-1.41, P =0.020), and WC ( OR =1.074, 95% CI : 1.01-1.14, P =0.026) were independent risk factors for NAFLD in patients with OSA. TyG, TyG combined with BMI, and TyG combined with WC had an AUC of 0.696 (95% CI : 0.625-0.760), 0.787 (95% CI : 0.722-0.843), and 0.803 (95% CI : 0.739-0.857), respectively, in predicting NAFLD in OSA patients, with an optimal cut-off value of 8.72, 0.36, and 0.60, respectively. TyG combined with BMI had a significantly higher value than TyG in predicting NAFLD in OSA patients ( Z =2.542, P =0.011), and TyG combined with WC also had a significantly higher predictive value than TyG ( Z =2.976, P =0.002 9). Conclusion TyG, TyG combined with BMI, and TyG combined with WC have a good value in predicting NAFLD in OSA patients, among which TyG combined with WC has the best predictive value and is thus expected to become a predictor for the risk of NAFLD in OSA patients.