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1.
Eur J Paediatr Dent ; 23(2): 128-130, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35722851

RESUMO

AIM: Obstructive sleep apnoea syndrome (OSAS) is a common clinical condition in which the throat narrows or collapses repeatedly during sleep, causing obstructive sleep apnoea events. This disorder is present in the paediatric population with a prevalence estimated between 1.2% and 5.8%. Down Syndrome (DS) is the most common chromosomal alteration associated with mental disability and characterised by other clinical manifestations, and its incidence is estimated at 1/800 births worldwide. Most of the craniofacial features typical of DS represent a risk factor for the development of OSAS. Routine screening has been recommended in some countries but it is still not a standard practice. The aim of this study is the Italian linguistic validation of a questionnaire for the diagnosis of OSAS in children with Down Syndrome. METHODS: After careful review of the existing scientific literature, a specific questionnaire was selected for the diagnosis of OSAS in children with DS. The questionnaire was then translated into Italian and administered to 111 parents of children with Down syndrome, for online completion. The last part of the questionnaire was dedicated to the comprehension of the questionnaire itself, with a specific focus on its clarity, accuracy and difficulty in completing it. CONCLUSION: The positive feedback registered in the comprehension part of the questionnaire, certified the good quality of the Italian translation and confirmed the questionnaire as a useful screening method to identify the comorbidity of OSAS and DS.


Assuntos
Síndrome de Down , Apneia Obstrutiva do Sono , Criança , Síndrome de Down/complicações , Síndrome de Down/diagnóstico , Síndrome de Down/epidemiologia , Humanos , Linguística , Faringe , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Inquéritos e Questionários
2.
Ann Otol Rhinol Laryngol ; 132(1): 69-76, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35172622

RESUMO

OBJECTIVE: No national study to date has specifically evaluated the predictive variables associated with extended hospitalization and other postoperative complications following laryngeal surgery in children with obstructive sleep apnea (OSA). The goals of this study were to identify perioperative risk factors and provide a descriptive analysis of surgical outcomes in these children using the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) database. METHODS: Patients aged 0 to 18 years who underwent laryngeal surgery with a postoperative diagnosis of OSA were queried via the 2014-2018 NSQIP-P database using Current Procedural Terminology code 31541. Variables collected included age, sex, ethnicity, body mass index (BMI), medical comorbidities, American Society of Anesthesiologists (ASA) physical classification, operative time, and concurrent procedures. Endpoints of interest were length of stay, unplanned reoperation, readmission, reintubation, and postoperative complications. Univariate and multivariate linear regression analyses were performed. RESULTS: A total of 181 cases were identified (57.5% male and 42.5% female, mean age 4.36 years, range 14 days-17.7 years). Body mass index (P = .015, OR = 0.96), structural CNS abnormality (P = .034, OR = 1.95), preoperative oxygen supplementation (P = .043, OR = 1.28), operative time (P = .019, OR = 1.84, 95% CI = 1.28-2.54), and concurrent procedure (P < .001, OR = 2.21) were all independently associated with LOS. Postoperative complications had no significantly associated variables, with an overall low incidence of readmission (5.0%), reoperation (1.7%), and reintubation (1.1%). CONCLUSION: In this data set, children with OSA undergoing laryngeal surgery experienced minimal postoperative complications. Recognition of the factors associated with increased LOS could lead to improvement in the quality of care for children with OSA.


Assuntos
Readmissão do Paciente , Apneia Obstrutiva do Sono , Humanos , Masculino , Criança , Feminino , Recém-Nascido , Reoperação/efeitos adversos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/complicações , Estudos Retrospectivos
3.
BMC Pulm Med ; 22(1): 396, 2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36329414

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) is a modifiable risk factor for acute coronary syndrome (ACS), with high prevalence but low diagnostic rates. Therefore, it is particularly important to develop strategies for better screening for OSA in newly admitted ACS patients. METHODS: From March 2017 to October 2019, consecutive eligible patients with ACS underwent cardiorespiratory polygraphy during hospitalization. OSA was defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. All anthropometric and oropharyngeal parameters are measured by specialist nurses. RESULTS: Finally, 761 ACS patients were recruited in the present study. Prevalence of moderate/severe OSA was 53.2% based on diagnostic criteria of AHI ≥ 15. Correlation analysis illustrated that AHI was positively correlated with anthropometric characteristics. In the multivariate model, only micrognathia (OR 2.02, 95% CI 1.02-4.00, P = 0.044), waist circumference (OR 1.08, 95% CI 1.04-1.11, P < 0.001), and STOP-BANG Questionnaire (SBQ) score (OR 1.45, 95% CI 1.27-1.66, P < 0.001) were independently associated with the prevalence of OSA. Receiver operating characteristic curve (ROC) analysis showed that the area under curve (AUC) of multivariable joint diagnosis (waist circumference, micrognathia combined with SBQ) was significantly better than the AUC of Epworth Sleepiness Scale (ESS) and SBQ (p < 0.0001 and p = 0.0002, respectively), and the results showed that AUC was 0.728. Under the optimal truncation value, the sensitivity was 73%, and the specificity was 61%, which was higher than the single index. Finally, we also constructed a nomogram model based on multiple logistic regression, to easily determine the probability of OSA in ACS patients. CONCLUSIONS: The new screening tool has greater power than single questionnaire or measurements in screening of OSA among ACS patients. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT03362385, registered December 5, 2017.


Assuntos
Síndrome Coronariana Aguda , Micrognatismo , Apneia Obstrutiva do Sono , Humanos , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Programas de Rastreamento/métodos , Micrognatismo/complicações , Papel do Profissional de Enfermagem , Polissonografia , Estudos Prospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/complicações , Inquéritos e Questionários
4.
Sleep Med Clin ; 17(4): 597-617, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36333079

RESUMO

Comorbid insomnia and sleep apnea (COMISA) is a highly prevalent and debilitating condition that is more difficult to treat compared with insomnia alone or sleep apnea alone. Approximately 30% to 50% of sleep clinic patients with sleep apnea report comorbid insomnia symptoms. Comorbid insomnia is associated with lower adherence to positive airway pressure therapy for obstructive sleep apnea. Management approaches that include targeted treatments for both insomnia and sleep apnea lead to the best treatment outcomes for patients with COMISA. Therefore, sleep clinics should incorporate insomnia and COMISA management pathways including access to cognitive behavioral therapy for insomnia.


Assuntos
Terapia Cognitivo-Comportamental , Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/epidemiologia , Síndromes da Apneia do Sono/terapia , Comorbidade
5.
Sleep Med Clin ; 17(4): 647-656, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36333083

RESUMO

Obstructive sleep apnea (OSA) is highly prevalent sleep disorder that causes sleep fragmentation, frequent awakenings, and intermittent hypoxia. Both OSA and cognitive decline increase in prevalence with factors such as increasing age and body mass. Multiple areas of cognition can be affected, including attention, executive function, memory, as well as emotional functioning through direct effects on brain health. Although positive airway pressure therapy has shown to improve some aspects of cognitive functioning, it does not fully alleviate all cognitive complaints. Inclusion of complementary approaches to comorbidities associated with OSA could potentially enhance treatment outcomes.


Assuntos
Disfunção Cognitiva , Apneia Obstrutiva do Sono , Humanos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapia , Função Executiva , Cognição , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/terapia , Disfunção Cognitiva/etiologia , Atenção
6.
Ann Afr Med ; 21(4): 403-409, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36412342

RESUMO

Introduction: Obstructive sleep apnea (OSA) and hypothyroidism are closely linked as hypothyroidism has been shown to lead to the development of OSA through multiple mechanisms. With the changing lifestyle patterns worldwide and increased prevalence of obesity, the burden of OSA has substantially increased. The association of OSA with hypothyroidism is essential to establish. If identified early, treatment of OSA and associated hypothyroidism can be done timely to minimize the potential harmful complications of OSA on all aspects of the patient's health. Aims: This study was done to find out the prevalence of OSA in hypothyroidism patients. Setting and Designs: It was a cross-sectional study, done over a period of 1 year in a tertiary care hospital. Materials and Methods: A total of 100 hypothyroidism patients were enrolled after taking written consent. All patients were subjected to STOP-Bang questionnaire and patient falling in intermediate-high risk (score3-8), were taken for overnight polysomnography to confirm the diagnosis of OSA (AHI ≥5). Statistical Analysis Used: The Statistical Package for the Social Sciences version 21.0 statistical analysis software. Results: Out of 100 patients, who underwent polysomnography, 74 (74%) cases had OSA (AHI ≥5). Out of total 74 OSA cases, 29 (39.2%) cases had mild OSA (AHI 5-14), 15 (20.3%) cases had moderate OSA (AHI 15-30), and 30 (40.5%) cases had severe OSA. The age of the study population ranged between 24 and 78 years and the mean age was 58.28 ± 11.22 years. The mean age of the patients in the OSA group (59.27 ± 11.17 years) was higher than the non-OSA group (55.46 ± 11.09 years). Majority (64%) of our cases were male, and the proportion of males was found to be higher than females in both the groups (OSA/non-OSA). The body mass index (BMI) of the OSA group was found to be statistically higher as compared to that of the non-OSA group (P = 0.040). The BMI was found to be higher in severe OSA, but it was not statistically significant (P = 0.128). The mean value of FT4 was lower and thyroid-stimulating hormone (TSH) was higher in the OSA group as compared with the non-OSA group. However, no significant association was found between FT4 and TSH values in both the groups. Out of 100 cases, 41 patients were treatment naïve with mean TSH value of 13.1 ± 7 and 59 were on treatment with mean TSH of 8.3 ± 4. Treatment-naïve patients had a statistically higher number (85.3%) of OSA cases in comparison to patients on treatment (66.1) (P = 0.030). Conclusions: Prevalence of OSA is quite high in hypothyroidism. Patients with hypothyroidism should be screened for OSA for early diagnosis, especially in individuals with higher BMI. Treatment of hypothyroidism reduces the prevalence of OSA.


Résumé Introduction: L'apnée obstructive du sommeil (OSA) et l'hypothyroïdie sont étroitement liées car l'hypothyroïdie s'est avérée conduire au développement de l'AOS à travers de multiples mécanismes. Avec l'évolution des modèles de style de vie dans le monde et une prévalence accrue de l'obésité, le fardeau de l'AOS a considérablement augmenté. L'association de l'AOS avec l'hypothyroïdie est essentielle à établir. S'il est identifié tôt, le traitement de l'AOS et de l'hypothyroïdie associée peuvent être effectués en temps opportun pour minimiser les complications nocives potentielles de l'AOS sur tous les aspects de la santé du patient. Aims: Cette étude a été réalisée pour découvrir la prévalence de l'AOS chez les patients hypothyroïdiennes. Cadre et conception: C'était une étude transversale, réalisée sur une période de 1 an dans un hôpital de soins tertiaires. Matériaux et méthodes: Un total de 100 patients hypothyroïdiennes ont été inscrits après avoir pris consentement écrit. Tous les patients ont été soumis à un questionnaire d'arrêt de bang et à la chute des patients à risque élevé (score3-8), ont été pris pour la polysomnographie d'une nuit pour confirmer le diagnostic de l'AOS (AHI ≥5). Analyse statistique utilisée: Le logiciel Statistical Package for the Social Sciences Version 21.0 Analyse statistique. Résultats: Sur 100 patients, qui ont subi une polysomnographie, 74 (74%) cas avaient une OSA (AHI ≥5). Sur le total de 74 cas d'ASA, 29 (39,2%) avaient des cas légers de l'ASA (AHI 5­14), 15 (20,3%) avaient des cas d'ASA modérés (AHI 15-30), et 20 (40,5%) avaient une OSA sévère. L'âge de la population d'étude variait entre 24 et 78 ans et l'âge moyen était de 58,28 ± 11,22 ans. L'âge moyen des patients du groupe OSA (59,27 ± 11,17 ans) était plus élevé que le groupe non-OSA (55,46 ± 11,09 ans). La majorité (64%) de nos cas étaient des hommes, et la proportion d'hommes s'est révélée plus élevée que les femmes dans les deux groupes (OSA / non-OSA). L'indice de masse corporelle (IMC) du groupe OSA s'est avéré statistiquement plus élevé par rapport à celui du groupe non-OSA (P = 0,040). L'IMC s'est avéré être plus élevé dans l'OSA sévère, mais il n'était pas statistiquement significatif (p = 0,128). La valeur moyenne de FT4 était inférieure et l'hormone stimulante thyroïdienne (TSH) était plus élevée dans le groupe OSA par rapport au groupe non-OSA. Cependant, aucune association significative n'a été trouvée entre les valeurs FT4 et TSH dans les deux groupes. Sur 100 cas, 41 patients étaient naïfs de traitement avec une valeur TSH moyenne de 13,1 ± 7 et 59 étaient sous traitement avec une TSH moyenne de 8,3 ± 4. Les patients naïfs de traitement avaient un nombre statistiquement plus élevé (85,3%) des cas d'AOS par rapport à patients sous traitement (66,1) (p = 0,030). Conclusions: La prévalence de l'AOS est assez élevée en hypothyroïdie. Les patients atteints d'hypothyroïdie doivent être dépistés pour l'AOS pour un diagnostic précoce, en particulier chez les personnes atteintes d'IMC plus élevée. Le traitement de l'hypothyroïdie réduit la prévalence de l'AOS. Mots-clés: Indice d'apnée - hypene, indice de masse corporelle, hypothyroïdie, apnée obstructive du sommeil, polysomnographie, ronflement, fatigue pendant la journée, apnée observée et hypertension, indice.


Assuntos
Hipotireoidismo , Apneia Obstrutiva do Sono , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Adulto , Estudos Transversais , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/diagnóstico , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/epidemiologia , Polissonografia/efeitos adversos , Tireotropina
7.
Indian J Public Health ; 66(Supplement): S12-S16, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36412466

RESUMO

Background: The coexistence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) is termed "Overlap syndrome (OS)." Objectives: The present study aimed at estimating the prevalence of OS among patients diagnosed with OSA. Methods: It was a prospective observational study conducted on patients presenting to respiratory medicine outpatient department (sleep clinic) with symptoms of sleep-disordered breathing and was found to have OSA by overnight polysomnography. These patients were then subjected to spirometry to diagnose COPD. Results: The prevalence of OS in the study population was found to be 41.3%. Excessive daytime sleepiness was found to be higher in overlap group patients (P = 0.033), the difference was statistically significant. The mean age (59.9 ± 9.6 years) was found to be high in the OS group compared to those without the same. The mean forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC (pre- and postbronchodilator) spirometry parameters were found to be lower in patients with OS. Conclusion: The study showed that the prevalence of OS in the present study was 41.3%. Excessive daytime sleepiness and age >60 years were risk factors for OS in a patient with OSA. OS patients had lower pulmonary function values.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Doença Pulmonar Obstrutiva Crônica , Apneia Obstrutiva do Sono , Humanos , Pessoa de Meia-Idade , Idoso , Prevalência , Índia/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia
8.
BMC Pulm Med ; 22(1): 419, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36384528

RESUMO

BACKGROUND: Chronic cough is an extremely common clinical symptom of various diseases. However, the relationship between obstructive sleep apnea (OSA) and chronic cough in the general population has not been sufficiently studied. METHODS: Using the 2019 Korean National Health and Nutrition Examination Survey data, we identified a group at high-risk of OSA via the STOP-Bang questionnaire and determined the association between OSA and chronic cough by a regression model. RESULTS: Of the eligible 4,217 participants, 97.1% and 2.9% were classified into the non-chronic cough and chronic cough groups, respectively. The chronic cough group had higher STOP-Bang scores than those of the group without chronic cough (2.32 ± 1.38 vs. 2.80 ± 1.39; P < 0.001). In the group at high-risk of OSA, 40.4% and 52.0% of participants scored ≥ 3 in STOP-Bang, depending on the absence or presence of chronic cough (P = 0.012), respectively. Chronic cough independently correlated with impaired lung function (forced expiratory volume in one second ≥ 50-<80% predicted value, P = 0.001; <50, P < 0.001), low household income (P = 0.015), and a group at high-risk of OSA (STOP-Bang score 3-4, P = 0.004; 5-8, P < 0.001). Obesity I had a protective role against the occurrence of chronic cough (P = 0.023). CONCLUSION: A high-risk for OSA is a significant risk factor for chronic cough. OSA should be considered when evaluating chronic cough patients.


Assuntos
Tosse , Apneia Obstrutiva do Sono , Humanos , Polissonografia , Inquéritos Nutricionais , Tosse/epidemiologia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/diagnóstico , República da Coreia/epidemiologia
9.
Eur Rev Med Pharmacol Sci ; 26(21): 8022-8029, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36394753

RESUMO

OBJECTIVE: This study aimed to investigate the relationship between baseline atherogenic index of plasma (AIP) and new-onset myocardial infarction (MI) in hypertensive patients with obstructive sleep apnoea (OSA). PATIENTS AND METHODS: 2,281 participants were included in this analysis after strict adherence to the inclusion and exclusion criteria. Hazard ratio (HR) and 95% confidence interval (CI) were estimated using multivariable Cox regression models. A generalized additive model was employed to determine nonlinear relationships. RESULTS: In multivariate-adjusted models, there was a positive association between AIP and new-onset MI (per SD increase; HR=1.42, 95% CI: 1.22-1.65). Smoothing curve fitting revealed a J-shaped association between AIP and new-onset MI, with a turning point of approximately -0.08. The addition of AIP to a model with established risk factors improved the C-index (p=0.007), integrated discrimination improvement (p=0.007), and continuous net reclassification improvement (p=0.027) for the new-onset MI. CONCLUSIONS: A J-shaped relationship was observed between AIP and new-onset MI.


Assuntos
Hipertensão , Infarto do Miocárdio , Apneia Obstrutiva do Sono , Humanos , Estudos de Coortes , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Hipertensão/epidemiologia , Fatores de Risco , Infarto do Miocárdio/epidemiologia
10.
Br J Hosp Med (Lond) ; 83(9): 1-9, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36193921

RESUMO

Obstructive sleep apnoea represents a sizable public health and economic burden. Owing to rising obesity rates, the prevalence of obstructive sleep apnoea is increasing, and it is a condition that is significantly underdiagnosed. Exacerbated by the COVID-19 pandemic, the backlog of elective surgeries is also sizable and growing. A combination of these factors means that many patients due to have surgery will have obstructive sleep apnoea, either diagnosed or otherwise. Patients with obstructive sleep apnoea have a significantly increased risk of operative complications, but the evidence base for optimum perioperative management of these patients is limited. This article reviews sleep apnoea, its prevalence and its impact on operative management and perioperative outcomes for patients. The evidence base for screening and treating undiagnosed obstructive sleep apnoea is also comprehensively assessed. Finally, a pathway to manage patients with possible undiagnosed obstructive sleep apnoea is proposed, and areas for further research identified.


Assuntos
COVID-19 , Medicina Perioperatória , Apneia Obstrutiva do Sono , COVID-19/epidemiologia , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Pandemias , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia
11.
Medicine (Baltimore) ; 101(41): e31039, 2022 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-36253984

RESUMO

To investigate whether previous exposure to obstructive sleep apnea (OSA) increases the risk of obesity in obese and nonobese patients. We identified 24,363 obese patients diagnosed between January 1, 2000, and December 31, 2015, in the Taiwan Longitudinal Health Insurance Database (LHID) 2005 National Health Insurance Research Database; 97,452 sex-, age- and index date-matched nonobese patients were identified from the same database. This study is based on the ninth edition of the International Classification of Sleep Disorders. Multiple logistic regression was used to analyze the previous exposure of obese patients to OSA. P < .05 was considered significant. The average age of 121,815 patients was 44.30 ±â€…15.64 years old; 42.77% were males, and 57.23% were females. Obese patients were more likely to be exposed to OSA than nonobese patients (adjusted odds ratio [AOR] = 2.927, 95% CI = 1.878-4.194, P < .001), and the more recent the exposure period was, the more severely obese the patient, with a dose-response effect (OSA exposure < 1 year, AOR = 3.895; OSA exposure 1 year, <5 years, AOR = 2.933; OSA exposure 5 years, AOR = 2.486). The probability of OSA exposure in obese patients was 2.927 times that in nonobese patients, and the longer the exposure duration was, the more severe the obesity situation, with a dose-response effect (OSA exposure < 1 year, AOR = 2.251; OSA exposure 1 year, <5 years, AOR = 2.986; OSA exposure 5 years, AOR = 3.452). The risk of obesity in subjects with OSA was found to be significantly higher in this nested case-control study; in particular, a longer exposure to OSA was associated with a higher likelihood of obesity, with a dose-response effect.


Assuntos
Apneia Obstrutiva do Sono , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Razão de Chances , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia
12.
J Comp Eff Res ; 11(17): 1241-1251, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36200444

RESUMO

Aim: We investigated the relationship between obstructive sleep apnea (OSA), 30/90-day readmission rates and perioperative complications (postoperative cardiovascular, gastrointestinal, infectious or intraoperative complications) in patients undergoing total knee arthroplasty. Materials & methods: We analyzed records of patients who underwent total knee arthroplasty using State Inpatient Databases. Demographics, comorbidities, 30/90-day readmission rates and complications were compared by OSA status. For NY, USA we analyzed outcomes by anesthetic type (regional vs general). Results: OSA patients were mostly male, had more comorbidities and had increased 30/90-day readmission rates. There were no differences in complications. In NY, there were no differences in outcomes by anesthetic type. Conclusion: OSA was associated with increased 30/90-day readmission rates. Within NY, anesthetic type was not associated with any outcomes.


By analyzing records of patients who underwent total knee replacement, we investigated the relationship between obstructive sleep apnea (OSA), rates of readmission to the hospital at 30 and 90 days after surgery and perioperative complications (postoperative cardiovascular, gastrointestinal, infectious or intraoperative complication). In the NY, USA population, we analyzed outcomes based on anesthetic type (regional vs general anesthesia). We found that OSA patients were mostly male, had more medical conditions and had increased rates of 30 and 90-day readmission. There were no differences in complications. In NY, there were no differences in outcomes by anesthetic type. In conclusion, OSA was associated with increased rates of readmission to the hospital at 30 and 90 days after surgery. Within NYS, anesthetic type was not associated with any outcomes.


Assuntos
Anestesia , Anestésicos , Artroplastia do Joelho , Apneia Obstrutiva do Sono , Humanos , Masculino , Feminino , Artroplastia do Joelho/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Anestesia/efeitos adversos
13.
Adv Exp Med Biol ; 1384: 63-78, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36217079

RESUMO

Obstructive sleep apnea is a highly prevalent disease across the lifespan and imposes substantial morbidities, some of which may become irreversible if the condition is not diagnosed and treated in a timely fashion. Here, we focus on the clinical and epidemiological characteristics of pediatric obstructive sleep apnea, describe some of the elements that by virtue of their presence facilitate the emergence of disrupted sleep and breathing and its downstream consequences, and also discuss the potential approaches to diagnosis in at-risk children.


Assuntos
Apneia Obstrutiva do Sono , Criança , Humanos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia
14.
Adv Exp Med Biol ; 1384: 281-293, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36217091

RESUMO

The novel coronavirus disease-2019 (COVID-19) and the ensuing pandemic have greatly impacted the global healthcare system due to its high infectiousness, associated high mortality, and a complete lack of immunity in the population. Globally, the COVID-19 pandemic has unleashed a health crisis that has not only seriously disrupted people's lives but also affected their normal sleep, along with physical and mental health; this situation is especially exacerbated in people suffering from pre-existing conditions, such as sleep apnea. A recent meta-analysis of 18 studies by Miller et al. (September 2020) showed that obstructive sleep apnea (OSA) is related to higher mortality and morbidity in patients with COVID-19 and is most likely independent of other risk factors. A recent meta-analysis indicated that COVID-19 patients with OSA are more severely affected than those without OSA, thereby providing further evidence that concurrent OSA may elevate the severity of COVID-19 infection, along with the risk of mortality. The COVID-19 pandemic has significantly impacted the diagnosis and therapeutic management of patients with OSA. Thus, it is necessary to identify and develop new diagnostic and therapeutic avenues in the future. In this context, the current study summarizes known associations between COVID-19 and OSA and the regular diagnostic and therapeutic strategies for OSA in the light of COVID-19 pandemic prevention and control.


Assuntos
COVID-19 , Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , COVID-19/complicações , Humanos , Pandemias , Fatores de Risco , Síndromes da Apneia do Sono/epidemiologia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia
15.
Otol Neurotol ; 43(10): 1222-1226, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36214499

RESUMO

OBJECTIVE: To report the frequency of radiographic superior semicircular canal dehiscence (SSCD) and tegmen dehiscence in patients with and without obstructive sleep apnea (OSA). STUDY DESIGN: Retrospective matched cohort study. SETTING: Tertiary care center. PATIENTS: Adults with OSA and fine-cut computed tomographic scans including the temporal bone were matched to patients without OSA by age, sex, and type of computed tomography (protocol, scanner type, slice thickness). Ears with otologic surgery or temporal bone tumors were excluded. MAIN OUTCOME MEASURES: Prevalence of SSCD and tegmen dehiscence assessed by two independent reviewers. RESULTS: The average body mass index of the OSA patients was 29.2 kg/m 2 with an average apnea-hypopnea index of 36.8. The control group had an average body mass index of 26.2 kg/m 2 . Of the 352 temporal bones, 34 (9.7%) had SSCD in the OSA cohort versus 37 (10.5%) in the control group ( p > 0.05). Seven OSA patients (25.6% of those with SSCD) had bilateral SSCD versus 8 controls (27.6% of those with SSCD; p > 0.05). The majority (87.3%) of dehiscences involved the temporal lobe, with the remaining involving the superior petrosal sinus or both. Of the 352 OSA ears, 90 (25.6%) had a tegmen dehiscence versus 95 (27.0%) in the control group ( p > 0.05). Neither group had a laterality preference for SSCD or tegmen dehiscence. CONCLUSION: The prevalence of radiographic SSCD and tegmen dehiscences in OSA patients does not significantly differ from age- and sex-matched controls. This is in contrast to a previous case-control study finding patients with symptomatic SSCD to have higher rates of OSA. This may suggest that the effect size of OSA on SSCD prevalence may be limited despite OSA being a risk factor for elevated intracranial pressure.


Assuntos
Doenças do Labirinto , Deiscência do Canal Semicircular , Apneia Obstrutiva do Sono , Adulto , Humanos , Doenças do Labirinto/cirurgia , Canais Semicirculares/cirurgia , Estudos de Coortes , Estudos Retrospectivos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico por imagem , Apneia Obstrutiva do Sono/epidemiologia
16.
Sleep Med ; 100: 534-541, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36308911

RESUMO

OBJECTIVE: Patients with silent and undiagnosed atrial fibrillation (AF) have increased risk of ischemic stroke. Patients with obstructive sleep apnea (OSA) have an increased risk of both AF and ischemic stroke. Our aim was to investigate the prevalence of silent AF and associated risk factors in patients investigated for OSA or with known OSA. METHODS: This prospective observational study was performed in two sites; one outpatient sleep-clinic at Zealand University Hospital and one private Ear-Nose- and Throat clinic. Patients were investigated with a type-3 portable sleep-monitoring device, while heart rhythm was home-monitored for 7 days with an event-triggered loop recorder. Patients were stratified in groups of mild, moderate and severe OSA based on Apnea-Hypopnea-Index (AHI). RESULTS: In a cohort of 303 patients, 238 (78.5%) were diagnosed with moderate/or severe OSA and 65 (21.5%) with no/mild OSA who constituted the control group. In 238 patients with moderate and severe OSA, AF was detected in 21 patients (8.8%) vs. 1 patient (1.5%,[p=0.045]) with mild OSA. Candidates for anticoagulation therapy were referred for further cardiovascular treatment. The majority of patients had known hypertension (n = 200,66%) and dyslipidemia (n = 235,[77.6%]) In patients with moderate/or severe OSA (AHI≥15), hypertension was more dysregulated (p=0.005) and more patients suffered from unknown prediabetes (n = 36, 3.1% vs. 14.3%[p<0.001]). CONCLUSION: Undiagnosed AF and undertreated cardiovascular modifiable risk factors are common in a cohort of patients with OSA. With this study we propose that long-period home-monitoring in these patients is useful for identifying candidates for preventive anticoagulation, cardiovascular treatment and possibly prevent future ischemic stroke.


Assuntos
Fibrilação Atrial , Doenças Cardiovasculares , Hipertensão , AVC Isquêmico , Apneia Obstrutiva do Sono , Humanos , Fibrilação Atrial/diagnóstico , Prevalência , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/complicações , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Hipertensão/complicações
17.
Adv Exp Med Biol ; 1384: 43-61, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36217078

RESUMO

Obstructive sleep apnea (OSA) is a heterogeneous disease with many physiological implications. OSA is associated with a great diversity of diseases, with which it shares common and very often bidirectional pathophysiological mechanisms, leading to significantly negative implications on morbidity and mortality. In these patients, underdiagnosis of OSA is high. Concerning cardiorespiratory comorbidities, several studies have assessed the usefulness of simplified screening tests for OSA in patients with hypertension, COPD, heart failure, atrial fibrillation, stroke, morbid obesity, and in hospitalized elders.The key question is whether there is any benefit in the screening for the existence of OSA in patients with comorbidities. In this regard, there are few studies evaluating the performance of the various diagnostic procedures in patients at high risk for OSA. The purpose of this chapter is to review the existing literature about diagnosis in those diseases with a high risk for OSA, with special reference to artificial intelligence-related methods.


Assuntos
Fibrilação Atrial , Apneia Obstrutiva do Sono , Idoso , Inteligência Artificial , Fibrilação Atrial/complicações , Comorbidade , Humanos , Polissonografia/métodos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia
18.
Tunis Med ; 100(6): 445-449, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36206063

RESUMO

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular disease (CVD). Red blood cell distribution width (RDW) is reported as a novel marker of cardiovascular disease (CVD) risk. We aimed to investigate the correlation of RDW level with the severity of Obstructive Sleep Apnea Syndrome (OSAS) defined with the apnea-hypopnea index (AHI) and to study the relationship between RDW and CVD in OSAS. METHODS: From retrospective analyses of patients admitted to our department for polygraphy between January 2018 and January 2020, OSAS patients with complete medical records and hemogram analyses were evaluated. RESULTS: The study population consisted of 160 patients (101 females/59 males). The mean age was 52.32 ± 10.83 years. RDW correlated positively with the apnea hypopnea index (AHI) (r=0.392; p < 0.0001) and C-reactive protein (CRP) (r = 0.3, p < 0.001). RDW and CRP were significantly higher in patients with CVD than whom without CVD (p < 0.0001). In multivariate analysis, the independent predictors of CVD in OSAS were RDW (p < 0.0001; OR=3.095; CI: 1.69-5.66), CRP (p=0.046; OR=1.136; CI: 1.002-1.287) and age (p=0.013; OR=1.085; CI: 1.017- 1.157). The cut-off level for RDW with optimal sensitivity and specificity was calculated as 14.45 with sensitivity of 81% and specificity of 75%. CONCLUSIONS: The findings of this study suggest that RDW, a simple, relatively inexpensive and universally available marker could have the ability to predict CVD in OSAS.


Assuntos
Doenças Cardiovasculares , Apneia Obstrutiva do Sono , Adulto , Biomarcadores/análise , Proteína C-Reativa/análise , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Eritrócitos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia
19.
Ann Med ; 54(1): 2828-2840, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36259469

RESUMO

BACKGROUND: Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder, yet it remains undiagnosed in a large proportion of adults. OBJECTIVE: This study aims to investigate the status of patient delay and provider delay in OSA patients and examine related factors affecting patient delay in OSA individuals in China. METHODS: A cross-sectional design was conducted on a sample of 309 OSA patients (aged from 18 to 76, median age of 47 years, 84.8% male) in Northeast China. Participants were required to complete the sociodemographic questionnaire, the symptom characteristics questionnaire, the help-seeking attitude scale (HSAS), the social support rating scale and the chronic disease self-efficacy scales (CDSES) to test the hypothesis. Binary logistic regression analysis was conducted to explore factors that account for the patient delay. RESULTS: The median patient delay among OAS patients in this study was 22 months, the median provider delay was one month, and the median total delay was 26 months. As shown by multivariate analysis results, patients who have snored for over 6 years (OR = 3.377, 95%CI: 1.175-9.702) were more likely to experience prolonged patient delays. Per capita monthly family income above 3000 RMB (OR = 0.172, 95%CI: 0.052-0.571), taking up residence in cities or towns (OR = 0.484, 95%CI: 0.248-0.946), higher self-recognition of the disease (OR = 0.793, 95%CI: 0.647-0.972), higher objective support (OR = 0.825, 95%CI: 0.739-0.921) and stronger self-efficacy (OR = 0.674, 95%CI: 0.525-0.867) were significantly associated with shorter patient delays. CONCLUSION: Patient delay is common in Chinese OSA patients. The upstream factors affecting the patient delay in individuals with OSA include income, place of residence, and objective support; midstream factors include self-recognition of the disease and self-efficacy; downstream factors include years of snoring.KEY MESSAGESDespite being a high-prevalence disease, many obstructive sleep apnoea (OSA) patients are not clearly diagnosed and treated.The factors affecting the delay in seeking medical treatment in individuals with OSA included income, place of residence, objective support, self-recognition of the disease, self-efficacy and years of snoring.Investigations into OSA patients' care-seeking behaviours can better reflect the secondary prevention of OSA, and it is crucial to pay attention to the delayed phase of patients.


Assuntos
Apneia Obstrutiva do Sono , Ronco , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Transversais , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Prevalência , Inquéritos e Questionários
20.
Obes Surg ; 32(12): 4015-4022, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36205880

RESUMO

BACKGROUND: The aim of the study was to characterize the prevalence of obstructive sleep apnea (OSA) in elective bariatric surgery patients and to determine if OSA is an independent predictor of 30-day serious complications and 30-day mortality among bariatric surgery patients. METHODS: An analysis of the MBSAQIP database from 2015 to 2019 was conducted, and patients were stratified by OSA diagnosis. Data was extracted on patient age, sex, race, and comorbidities. A multivariate logistic regression model was created to evaluate the impact of OSA on 30-day serious complications and 30-day mortality. RESULTS: Of 751,952 patients, 287,180 (38.2%) were identified as having OSA. OSA patients were older (48.0 ± 11.4 vs. 42.2 ± 11.9 years; p < 0.0001) and were of increased BMI (46.5 ± 8.5 kg/m2 vs. 44.6 ± 7.3 kg/m2; p < 0.0001). OSA was not associated with 30-day mortality in the multivariable logistic regression model (OR 0.98, 95% CI 0.83-1.16; p = 0.829). OSA was associated with increased odds of 30-day serious complications (OR 1.33, 95% CI 1.30-1.36; p < 0.0001). In addition, dialysis (OR 3.07, 95% CI 2.68-3.52; p < 0.0001), positive venous thromboembolism history (OR 2.46, 95% CI 2.32-2.60; p < 0.0001), and oxygen dependence (OR 2.42, 95% CI 2.18-2.68; p < 0.0001) were all identified as major predictors of serious complications. CONCLUSION: We identified OSA as a modifiable factor predictive of serious complications following elective bariatric surgery. OSA is highly prevalent in this patient population, and it appears to be an important risk factor that deserves further attention in terms of peri-operative optimization strategies.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Apneia Obstrutiva do Sono , Humanos , Polissonografia , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Cirurgia Bariátrica/efeitos adversos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/diagnóstico
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