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1.
Sarcoidosis Vasc Diffuse Lung Dis ; 37(2): 169-178, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33093780

RESUMO

Rationale: An increased incidence of Obstructive Sleep Apnea (OSA) in sarcoidosis has been described in small sample size studies. Fatigue is common in sarcoidosis and OSA could be a relevant, treatable comorbidity. To date, the effect of Continuous Positive Airway Pressure (CPAP) on fatigue has never been assessed. Objectives: To investigate the prevalence of OSA in sarcoidosis, fatigue status and daytime sleepiness in patients of our center. To explore the effect of CPAP in fatigue and daytime sleepiness after 3 months using validated questionnaires. Method: Single group, one center, open-label prospective cohort study. Measurements and main result: We enrolled 68 patients and OSA was diagnosed in 60 (88.2%): 25 (36.8%) were mild while 35 (51.5%) were moderate-to-severe. 38 (55.9%) patients received CPAP but only 20 (30.9%) were compliant at 3-month evaluation. Questionnaires demonstrated fatigue in 34 (50%) and daytime sleepiness in 21 (30.9%). In multivariate regression analysis, Scadding stage and FAS behave as predictors of Apnea-Hypopnea Index (AHI) severity while sleepiness and steroids weren't associated. FAS score (ΔFAS = 6.3; p = 0.001) and ESS score (ΔESS = 2.8; p = 0.005) improved after three months of CPAP. Conclusions: OSA is highly prevalent in patients affected by sarcoidosis. ESS questionnaire is not reliable for OSA screening and other pre-test probability tool should be evaluated in further studies. CPAP leads to a significative reduction of fatigue and daytime sleepiness at three-month. Further studies are needed to confirm the high prevalence of OSA in sarcoidosis and the positive role of CPAP in fatigue. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 169-178).


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Fadiga/prevenção & controle , Pulmão/fisiopatologia , Respiração , Sarcoidose/epidemiologia , Apneia Obstrutiva do Sono/terapia , Transtornos do Sono-Vigília/prevenção & controle , Sono , Idoso , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Fadiga/diagnóstico , Fadiga/epidemiologia , Fadiga/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Risco , Roma/epidemiologia , Sarcoidose/diagnóstico , Sarcoidose/fisiopatologia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
2.
Curr Opin Ophthalmol ; 31(6): 508-513, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33009084

RESUMO

PURPOSE OF REVIEW: The aim of this article is to summarize up-to-date research on the effects of obstructive sleep apnea (OSA) on retinal vascular conditions. RECENT FINDINGS: OSA is associated with the development of diabetic retinopathy, retinal vein occlusion, and central serous chorioretinopathy. The severity of OSA and biomarkers such as the apnea-hypopnea index (AHI) correlate with the severity of retinal disease. Dysregulation of circadian locomotor output cycles kaput (CLOCK) genes that govern circadian rhythm is associated with development of proliferative retinal disease. SUMMARY: OSA and retinal vascular disease have a high cost burden on the healthcare system. OSA creates systemic changes and hypoxic conditions that may incite or exacerbate retinal vascular diseases. Retinal changes may be the first clinical manifestation of otherwise undiagnosed OSA, so it is important to refer patients with new-onset retinal vascular disease for appropriate sleep testing.


Assuntos
Oftalmopatias/complicações , Apneia Obstrutiva do Sono , Biomarcadores , Ritmo Circadiano , Humanos , Polissonografia , Doenças Retinianas/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/fisiopatologia
3.
JAMA ; 324(12): 1168-1179, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32886102

RESUMO

Importance: Many adults with obstructive sleep apnea (OSA) use device treatments inadequately and remain untreated. Objective: To determine whether combined palatal and tongue surgery to enlarge or stabilize the upper airway is an effective treatment for patients with OSA when conventional device treatment failed. Design, Setting, and Participants: Multicenter, parallel-group, open-label randomized clinical trial of upper airway surgery vs ongoing medical management. Adults with symptomatic moderate or severe OSA in whom conventional treatments had failed were enrolled between November 2014 and October 2017, with follow-up until August 2018. Interventions: Multilevel surgery (modified uvulopalatopharyngoplasty and minimally invasive tongue volume reduction; n = 51) or ongoing medical management (eg, advice on sleep positioning, weight loss; n = 51). Main Outcomes and Measures: Primary outcome measures were the apnea-hypopnea index (AHI; ie, the number of apnea and hypopnea events/h; 15-30 indicates moderate and >30 indicates severe OSA) and the Epworth Sleepiness Scale (ESS; range, 0-24; >10 indicates pathological sleepiness). Baseline-adjusted differences between groups at 6 months were assessed. Minimal clinically important differences are 15 events per hour for AHI and 2 units for ESS. Results: Among 102 participants who were randomized (mean [SD] age, 44.6 [12.8] years; 18 [18%] women), 91 (89%) completed the trial. The mean AHI was 47.9 at baseline and 20.8 at 6 months for the surgery group and 45.3 at baseline and 34.5 at 6 months for the medical management group (mean baseline-adjusted between-group difference at 6 mo, -17.6 events/h [95% CI, -26.8 to -8.4]; P < .001). The mean ESS was 12.4 at baseline and 5.3 at 6 months in the surgery group and 11.1 at baseline and 10.5 at 6 months in the medical management group (mean baseline-adjusted between-group difference at 6 mo, -6.7 [95% CI, -8.2 to -5.2]; P < .001). Two participants (4%) in the surgery group had serious adverse events (1 had a myocardial infarction on postoperative day 5 and 1 was hospitalized for observation following hematemesis of old blood). Conclusions and Relevance: In this preliminary study of adults with moderate or severe OSA in whom conventional therapy had failed, combined palatal and tongue surgery, compared with medical management, reduced the number of apnea and hypopnea events and patient-reported sleepiness at 6 months. Further research is needed to confirm these findings in additional populations and to understand clinical utility, long-term efficacy, and safety of multilevel upper airway surgery for treatment of patients with OSA. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12614000338662.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Palato Mole/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/terapia , Sonolência , Língua/cirurgia , Adulto , Pressão Sanguínea , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Polissonografia , Autorrelato , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/fisiopatologia , Latência do Sono
4.
Medicine (Baltimore) ; 99(34): e21915, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846859

RESUMO

This retrospective study aimed at identifying the predictors of oxygen desaturation (OD) (i.e., SpO2 < 95%) in patients with obstructive sleep apnea (OSA) requiring deep sedation and developing an algorithm to predict OD.We studied 66 OSA patients undergoing propofol-induced deep sedation for drug-induced sleep endoscopy (DISE). The patients were divided into prediction (n = 35) and validation (n = 31) groups. Patient characteristics and polysomnographic parameters were analyzed with receiver operating characteristic curve and Chi-squared test to identify significant predictors of OD for developing an algorithm in the prediction group. The predictive accuracy, sensitivity, positive predictive value, and negative predictive value of the algorithm were determined in the validation group.Six polysomnographic predictors of OD were identified, including Apnea-Hypopnea Index of total sleep time (AHI-TST), AHI at the stage of rapid eye movement (AHI-REM), percentage of time with oxygen saturation <90% (mO2 < 90%), average SpO2, lowest SpO2, and desaturation index. Stepwise multiple logistic regression analysis demonstrated that low average SpO2 (<95.05%) and high AHI-REM (>16.5 events/h) were independent predictors of OD. The algorithm thus developed showed that patients with an average SpO2 < 95.05% and those with an average SpO2 ≥ 95.05% together with an AHI-REM > 16.5 events/h would be at risk of OD under sedation. The predictive accuracy, sensitivity, positive predictive value, and negative predictive value were 84%, 100%, 83%, 100%, respectively.For patients with OSA, average SpO2 and AHI-REM may enable clinicians to predict the occurrence of oxygen desaturation under deep sedation. Future large-scale studies are needed to validate the findings.


Assuntos
Algoritmos , Sedação Profunda/efeitos adversos , Oxigênio/sangue , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/fisiopatologia , Adulto , China/epidemiologia , Sedação Profunda/métodos , Endoscopia/métodos , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Polissonografia/instrumentação , Valor Preditivo dos Testes , Propofol/administração & dosagem , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico , Sono REM
5.
PLoS One ; 15(8): e0238083, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853299

RESUMO

PURPOSE: Discrepancies between subjective and objective measures of total sleep time (TST) are frequent among insomnia patients, but this issue remains scarcely investigated in obstructive sleep apnea (OSA). We aimed to evaluate if sleep perception is affected by the severity of OSA. METHODS: We performed a 3-month cross-sectional study of Brazilian adults undergoing overnight polysomnography (PSG). TST was objectively assessed from PSG and by a self-reported questionnaire (subjective measurement). Sleep perception index (SPI) was defined by the ratio of subjective and objective values. Diagnosis of OSA was based on an apnea/hypopnea index (AHI) ≥ 5.0/h, being its severity classified according to AHI thresholds: 5.0-14.9/h (mild OSA), 15.0-29.9/h (moderate OSA), and ≥ 30.0/h (severe OSA). RESULTS: Overall, 727 patients were included (58.0% males). A significant difference was found in SPI between non-OSA and OSA groups (p = 0.014). Mean SPI values significantly decreased as the OSA severity increased: without OSA (100.1 ± 40.9%), mild OSA (95.1 ± 24.6%), moderate OSA (93.5 ± 25.2%), and severe OSA (90.6 ± 28.2%), p = 0.036. Using logistic regression, increasing SPI was associated with a reduction in the likelihood of presenting any OSA (p = 0.018), moderate/severe OSA (p = 0.019), and severe OSA (p = 0.028). However, insomnia was not considered as an independent variable for the presence of any OSA, moderate/severe OSA, and severe OSA (all p-values > 0.05). CONCLUSION: In a clinical referral cohort, SPI significantly decreases with increasing OSA severity, but is not modified by the presence of insomnia symptoms.


Assuntos
Percepção , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/psicologia , Sono/fisiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
PLoS One ; 15(8): e0236667, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32756570

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) is associated with cardiovascular co-morbidities and mortality. Arterial stiffness is an independent predictor of cardiovascular risk and mortality, and is influenced by the presence of OSA and related comorbidities. There is a paucity of data regarding long-term evolution of arterial stiffness in CPAP-treated OSA patients. We aimed to prospectively study long term PWV variations and determinants of PWV deterioration. METHODS: In a prospective obese OSA cohort, at time of diagnosis and after several years of follow-up we collected arterial stiffness measured by carotid-femoral pulse wave velocity (PWV), clinical and metabolic parameters, and CPAP adherence. Univariate and multivariate analyses were performed in order to determine contributing factors. RESULTS: Seventy two OSA patients (men: 52.8%, median age: 55.8 years and median BMI of 38.5 kg/m2) with a prevalence of hypertension: 58.3%, type 2 diabetes: 20.8%, hypercholesterolemia: 33.3%, current or past smoking: 59.7%, were evaluated after a median follow-up of 7.4 [5.8; 8.3] years. Over the period of follow-up, the median increase in PWV was 1.34 [0.10; 2.37] m/s. In multivariate analysis, the increase in PWV was associated with older age (10 extra years was associated with a 5.24 [1.35; 9.12] % increase in PWV) and hypertension (a significant increase in PWV of 8.24 [1.02; 15.57] %). No impact of CPAP adherence on PWV evolution was found. CONCLUSION: PWV progression in CPAP-treated OSA patients is mainly related to pre-existing cardio-metabolic comorbidities and not influenced by CPAP adherence. In this high cardiovascular risk population, it is crucial to associated weight management and exercise with CPAP treatment.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Obesidade/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Rigidez Vascular/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Pressão Positiva Contínua nas Vias Aéreas/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico por imagem , Obesidade/epidemiologia , Polissonografia , Fatores de Risco , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico por imagem , Apneia Obstrutiva do Sono/fisiopatologia
7.
PLoS One ; 15(7): e0236284, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687512

RESUMO

OBJECTIVE: To investigate the frequency distribution of various craniofacial skeletal patterns in a large Korean adult obstructive sleep apnea (OSA) population, and to find a relationship between craniofacial risks and respiratory and sleep characteristics. METHODS: A total of 1226 OSA patients (mean age of 44.9±13.3 years) were included in this retrospective cross-sectional study. All subjects were evaluated for gender and age using fourteen polysomnographic, five cephalometric, two comorbid variables, and three self-reported indexes. Frequency analysis was used to screen the distribution of main skeletal patterns and subtypes. Intergroup comparisons were performed using independent t-test, chi-square test or analysis of variance. Univariable regression analysis was done to find a relationship between skeletal risks and OSA characteristics. RESULTS: The frequency distribution of skeletal patterns was as follows: sagittally 57.2%, 32.3%, and 10.5% of Class II, Class I, and Cass III; vertically 54.0%, 26.7%, and 19.3% of hyperdivergent, normodivergent, and hypodivergent type, respectively. Polysomnographic, symptomatic, and comorbid variables showed no differences among patients with different skeletal patterns. Conversely, skeletal variables showed no differences according to OSA severity. The prevalence of highly risky skeletal pattern of hyperdivergent Class II was more likely to be females (OR 4.52, P < .01) and less obese (OR 3.21, P < .01), irrelevant to OSA and sleep characteristics. CONCLUSION: Characteristic frequency distributions of skeletal patterns and subtypes were observed in adult OSA patients however, no statistical association was found between the skeletal patterns and OSA characteristics due to the large interindividual variation.


Assuntos
Cefalometria/estatística & dados numéricos , Cabeça/anatomia & histologia , Obesidade/epidemiologia , Testes de Função Respiratória/estatística & dados numéricos , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Grupo com Ancestrais do Continente Asiático , Variação Biológica da População , Comorbidade , Estudos Transversais , Feminino , Cabeça/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Polissonografia , República da Coreia/epidemiologia , Fenômenos Fisiológicos Respiratórios , Estudos Retrospectivos , Fatores de Risco , Autorrelato , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia
8.
Pneumologie ; 74(8): 509-514, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32492719

RESUMO

INTRODUCTION: Snoring was monitored in patients with obstructive sleep apnea (OSA) using the LEOSound-Monitor and simultaneously polysomnographic (PSG) recording. In obstructive apneas snoring is normally apparent after apnea termination and the beginning of ventilation. We wanted to know how often obstructive apneas are terminated by ventilation in combination with snoring. METHODS AND INTENTION: In 40 patients with OSA (AHI > 15/h) simultaneous polysomnographic recordings were performed amongst long-term respiratory sound monitoring using the LEOSound monitor. Patients' average age was 57 ±â€Š11 years. Average weight was 100 ±â€Š19 kg by a mean body  mass  index (BMI) of 33 ±â€Š7 kg/m2. 12 out of 40 recordings had to be rejected for further analysis because of artifacts. Snoring recorded by polysomnography was compared with snoring monitored by LEOSound. RESULTS: 3778 obstructive apnea episodes were monitored. LEOSound identified snoring in 1921 (51,0 %), polysomnography in 2229 (58,8 %) obstructive apneas. Only in one patient there was a higher difference in snoring episodes between PSG and LEOSound. DISCUSSION: In nearly 60 % of obstructive apnea events we found snoring during apnea-terminating hyperpnoea. LEOSound is a good diagnostic tool to monitor snoring. It is necessary to clarify why only 60 % of all obstructive events/hyperpnoea develop snoring. From a pathophysiological point of view opening of collapsed upper airway should lead in a very high percentage to turbulences in airstream and committed snoring.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Polissonografia/métodos , Apneia Obstrutiva do Sono/fisiopatologia , Ronco/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Respiração , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Ronco/etiologia
11.
Pediatr Pulmonol ; 55(8): 2082-2088, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32501635

RESUMO

INTRODUCTION: There is limited evidence on the accuracy of oximetry in the evaluation of infant obstructive sleep apnea (OSA). We aimed to determine the utility of overnight oximetry to stratify infants at risk for OSA, to determine urgency for definitive screening with an overnight in-laboratory polysomnogram (PSG). METHODS: Retrospective single-institution cohort study of infants undergoing PSG and a separate overnight oximetry over an 8-year period. Correlations, using oximetry in both in-hospital (attended) or at-home (unattended) settings, for ODI410 (decrease in oxygen saturation ≥ 4% from baseline, duration ≥ 10 seconds) and ODI40 (duration > 0 second) with the obstructive apnea-hypopnea index (AHIo) were obtained. The area under the curve was calculated, and sensitivity and specificity values have been presented as receiver operating characteristic curves. RESULTS: Thirty-eight infants were included. The mean (SD) age (months) was 5.7 (3.9) at diagnostic PSG and 5.5 (3.7) at the time of oximetry. The mean AHIo for the entire cohort was 6.7 (6.2). The mean (SD) ODI40 was 8.6 (9.0) and the mean (SD) ODI410 was 5.4 (5.1).The correlation between ODI and AHIo was statistically significant for the cohort (ODI40 vs. AHIo [r = .59, P < .001] and ODI410 vs AHIo [r = .55, P = .0003]). Using an ODI40 cutoff of 3, the sensitivity, specificity, negative predictive value and positive predictive value for diagnosing OSA was: 86%, 40%, 50%, and 80% respectively for an AHIo greater than 2, and 100%, 35%, 100%, and 58% respectively for an AHIo greater than or equal to 5. CONCLUSION: There is a significant positive correlation between the ODI4 obtained from oximetry and the AHIo obtained from PSG in infants at risk for OSA. An ODI40 greater than 3 may be useful to stratify infants at risk for moderate to severe OSA when used in attended (in-hospital) or unattended (in-home) settings.


Assuntos
Oximetria , Apneia Obstrutiva do Sono/diagnóstico , Algoritmos , Feminino , Hospitais , Humanos , Lactente , Masculino , Programas de Rastreamento , Polissonografia , Curva ROC , Sensibilidade e Especificidade , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/fisiopatologia
12.
Int J Pediatr Otorhinolaryngol ; 134: 110056, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32361256

RESUMO

OBJECTIVE: To describe how drug-induced sleep endoscopy (DISE) findings in children with obstructive sleep apnea (OSA) change with lateral positioning. METHODS: Children undergoing DISE for OSA in 2018-19 at a tertiary care children's hospital were positioned first supine and then in left lateral (LL) and findings were compared. RESULTS: 63 children were included, 30 (47.6%) female and 33 (52.4%) male, mean age 4.64 years, and a mean Z-score 0.70. Mean pre-op Apnea Hypopnea Index (AHI) was 6.41 and REM AHI was 15.04. In supine position, 20 had obstruction at the palate (31.7%), 39 (61.9%) had obstruction at each of the base of tongue and the larynx, 17 (27.0%) had obstruction at the tonsils. In LL position, 11 (17.5%) were obstructed at the palate, 21 (33.3%) at the tonsils, 8 (12.7%) at the base of tongue and 7 (11.1%) at the larynx. Larynx and base of tongue were most likely to improve in LL position, as 54% of patients obstructed in supine position were open in LL position. Overall 38 (60.3%) patients improved on LL, 18 (28.6%) had no change, and 7 (11.1%) worsened. 30 (47.6%) patients improved in 1 site while 12 (19.0%) improved in more than 1 site. 16 (25.4%) patients worsened in 1 site and 9 (56.3%) of these had improvement in another site. CONCLUSION: A significant number of patients improved airway patency, particularly at the base of tongue/larynx, during DISE when placed in LL position as compared to standard supine positioning.


Assuntos
Endoscopia/métodos , Posicionamento do Paciente , Apneia Obstrutiva do Sono/fisiopatologia , Pré-Escolar , Feminino , Humanos , Laringe/fisiopatologia , Masculino , Tonsila Palatina/fisiopatologia , Índice de Gravidade de Doença , Decúbito Dorsal , Língua/fisiopatologia
13.
J Med Internet Res ; 22(5): e17252, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32441656

RESUMO

BACKGROUND: Sleep apnea is a respiratory disorder characterized by an intermittent reduction (hypopnea) or cessation (apnea) of breathing during sleep. Depending on the presence of a breathing effort, sleep apnea is divided into obstructive sleep apnea (OSA) and central sleep apnea (CSA) based on the different pathologies involved. If the majority of apneas in a person are obstructive, they will be diagnosed as OSA or otherwise as CSA. In addition, as it is challenging and highly controversial to divide hypopneas into central or obstructive, the decision about sleep apnea type (OSA vs CSA) is made based on apneas only. Choosing the appropriate treatment relies on distinguishing between obstructive apnea (OA) and central apnea (CA). OBJECTIVE: The objective of this study was to develop a noncontact method to distinguish between OAs and CAs. METHODS: Five different computer vision-based algorithms were used to process infrared (IR) video data to track and analyze body movements to differentiate different types of apnea (OA vs CA). In the first two methods, supervised classifiers were trained to process optical flow information. In the remaining three methods, a convolutional neural network (CNN) was designed to extract distinctive features from optical flow and to distinguish OA from CA. RESULTS: Overnight sleeping data of 42 participants (mean age 53, SD 15 years; mean BMI 30, SD 7 kg/m2; 27 men and 15 women; mean number of OA 16, SD 30; mean number of CA 3, SD 7; mean apnea-hypopnea index 27, SD 31 events/hour; mean sleep duration 5 hours, SD 1 hour) were collected for this study. The test and train data were recorded in two separate laboratory rooms. The best-performing model (3D-CNN) obtained 95% accuracy and an F1 score of 89% in differentiating OA vs CA. CONCLUSIONS: In this study, the first vision-based method was developed that differentiates apnea types (OA vs CA). The developed algorithm tracks and analyses chest and abdominal movements captured via an IR video camera. Unlike previously developed approaches, this method does not require any attachment to a user that could potentially alter the sleeping condition.


Assuntos
Aprendizado Profundo/normas , Polissonografia/métodos , Apneia do Sono Tipo Central/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Espectrofotometria Infravermelho/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Apneia do Sono Tipo Central/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia
14.
Lancet Gastroenterol Hepatol ; 5(6): 616-624, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32416862

RESUMO

Sleep quality and sleep disorders affect symptom manifestation and the pathogenesis of digestive diseases. Sleep is largely regulated by the light-dark cycle and associated circadian rhythms. These occurrences are closely regulated through several mechanisms with direct effects on the gastrointestinal tract. Misalignment of the circadian system is a common cause of sleep complaints, which play an important role in the presentation of many gastrointestinal disorders. This Review will focus on sleep disorders and how these alterations in sleep play an important role in many commonly encountered digestive diseases, such as gastro-oesophageal reflux disease, irritable bowel syndrome, inflammatory bowel disease, and non-alcoholic fatty liver disease. Therapeutic interventions focusing on resolving sleep disorders could optimise treatment and improve quality of life in these patients.


Assuntos
Relógios Biológicos/fisiologia , Refluxo Gastroesofágico/fisiopatologia , Doenças Inflamatórias Intestinais/fisiopatologia , Síndrome do Intestino Irritável/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Transtornos do Sono-Vigília/fisiopatologia , Ritmo Circadiano/fisiologia , Refluxo Gastroesofágico/metabolismo , Trato Gastrointestinal/fisiologia , Trato Gastrointestinal/fisiopatologia , Humanos , Doenças Inflamatórias Intestinais/metabolismo , Síndrome do Intestino Irritável/metabolismo , Hepatopatia Gordurosa não Alcoólica/metabolismo , Sono/fisiologia , Apneia Obstrutiva do Sono/metabolismo , Apneia Obstrutiva do Sono/fisiopatologia , Transtornos do Sono-Vigília/metabolismo
16.
Nutr Metab Cardiovasc Dis ; 30(7): 1115-1120, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32446869

RESUMO

BACKGROUND AND AIMS: Obstructive sleep apnea (OSA) is a global disease that is a manifestation of metabolic syndrome. Epicardial adipose tissue (EAT), a special type of visceral adipose tissue, has been proposed to be an independent predictor of visceral adiposity. Both OSA and EAT have a close association with diabetes and coronary artery disease. Whether EAT thickness is associated with OSA is controversial. METHODS AND RESULTS: Several databases were searched from their inception to October 13, 2019. We estimated the summarized weighted mean difference (WMD) with 95% confidence intervals (CIs) for EAT thickness in the OSA and non-OSA groups. Then, we conducted a meta-analysis to evaluate the association between EAT thickness and OSA. The relationship between EAT thickness and OSA severity was also assessed. Nine studies with a total of 1178 participants were included. Globally, patients with OSA had a higher EAT thickness than patients without OSA (WMD = 0.95, 95% CI: 0.73-1.16, P < 0.001). Compared to the non-OSA patients, those with mild, moderate, and severe OSA had a progressively higher EAT thickness (WMD = 0.62, 95% CI: 0.41-0.83; WMD = 0.83, 95% CI: 0.50-1.15; and WMD = 1.06, 95% CI: 0.70-1.43, respectively; all P < 0.001). CONCLUSION: EAT thickness was shown to be higher in patients with OSA than in patients with non-OSA measured by echocardiography. The increase in the EAT thickness was associated with OSA severity.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Ecocardiografia , Pericárdio/diagnóstico por imagem , Apneia Obstrutiva do Sono/diagnóstico por imagem , Tecido Adiposo/fisiopatologia , Adiposidade , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pericárdio/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-32443526

RESUMO

Upper airway abnormalities increase the risk of pediatric morbidity in infants. A multidisciplinary approach to obstructive sleep apnea syndrome (OSAS) poses challenges to clinical practice. The incidence and causes of OSA are poorly studied in children under 2 years of age. To fill this gap, we performed this retrospective observational study to determine the causes of obstructive sleep apnea (OSA) in children admitted to our hospital between January 2016 and February 2018, after a brief unexplained event (BRUE) or for OSA. We reviewed the medical charts of 82 patients (39 males; BRUE n = 48; OSAS n = 34) and divided them into two age groups: < 1 year old (1-12 months; n = 59) and >1 year old (>12-24 months; n = 23). Assessment included nap polysomnography, multichannel intraluminal impedance-pH, and nasopharyngoscopy. Sleep disordered breathing was comparable between the two groups. Omega-shaped epiglottis, laryngomalacia, and nasal septum deviation were more frequent in the younger group, and nasal congestion in older group. Tonsillar and adenoidal hypertrophy was more frequent in the older group, while laryngomalacia and gastroesophageal reflux was more frequent in the younger group. Tonsil and adenoid size were associated with grade of apnea-hypopnea index severity in the older group, and laryngomalacia and gastroesophageal reflux in the younger group. The main causes of respiratory sleep disorders differ in children before or after age 1 year. Our findings have potential clinical utility for assessing the pathophysiology of obstructive sleep disordered breathing in patients less than 2 years old.


Assuntos
Obstrução das Vias Respiratórias , Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Idoso , Obstrução das Vias Respiratórias/complicações , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Polissonografia , Estudos Retrospectivos , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/fisiopatologia
18.
J Stroke Cerebrovasc Dis ; 29(8): 104876, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32417236

RESUMO

BACKGROUND AND AIMS: Obstructive sleep apnea (OAS) is a common contributor as well as a frequent co-morbid condition in ischemic stroke. This study aimed to detect the correlation between OSA severity and post-stroke depression (PSD) in ischemic stroke patients. METHODS: From Mar 2017 to Dec 2018, 265 patients with symptom onset less than 14 days were consecutively recruited. All patients underwent polysomnography examination for diagnosis of OSA during hospitalization. PSD was identified using the Chinese version of the Structured Clinical Interview for DSM-IV at admission and 3-month. Logistic regression analyses were performed to assess the association between OSA severity and PSD. RESULTS: Among the 265 patients, the distribution of patients in terms of the OSA severity was as follows: 48 (18.1%) had no OSA, 85 (32.1%) had mild OSA, 54 (20.4%) had moderate OSA, and 78 (29.4%) had severe OSA. Patients diagnosed as PSD at admission and 3-month were 63 (23.8%) and 86 (32.5%), respectively. Univariate analysis showed that reduced OSA severity was correlated with PSD at 3-month (P = 0.003), but not at admission (P = 0.373). In multivariable analysis, after adjustment for covariates, severe OSA (compared with the patients without OSA; odds ratio, 4.04; 95% confidence interval, 1.38-9.62; P = 0.036) was significantly associated with increasing risk of 3-month PSD. Furthermore, multiple-adjusted spline regression model further confirmed a dose-response relationship between apnea-hypopnea index and 3-month PSD (P for linearity < 0.001). CONCLUSIONS: Our data showed that OSA severity was positively associated with 3-month PSD in ischemic stroke patients.


Assuntos
Afeto , Isquemia Encefálica/complicações , Depressão/etiologia , Apneia Obstrutiva do Sono/complicações , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , China , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Prognóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo
19.
J Bras Pneumol ; 46(3): e20180422, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32321033

RESUMO

OBJECTIVE: To evaluate the construct validity and reproducibility of the six-minute step test (6MST) in individuals with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). METHODS: We evaluated 48 volunteers diagnosed with OSA and treated with CPAP for at least two months. The volunteers underwent the six-minute walk test (6MWT) and the 6MST, in random order and on different days, with an interval of, at most, seven days between the two tests. RESULTS: A moderate positive correlation was found between the distance walked on the 6MWT and the number of steps climbed on the 6MST (r = 0.520; p < 0.001). There was no significant difference between the two 6MSTs in terms of the number of steps climbed (121.7 ± 27.1 vs. 123.6 ± 26.7). Reproducibility for performance on the 6MST and for cardiovascular variables was considered excellent (intraclass correlation coefficient > 0.8). Regarding cardiovascular responses, the 6MST produced higher values than did the 6MWT for HR at six minutes, percent predicted maximum HR, and leg fatigue at six minutes, as well as for systolic blood pressure at six minutes and at one minute of recovery. CONCLUSIONS: The 6MST is valid and reproducible, producing greater cardiovascular stress than does the 6MWT. However, the 6MST is also characterized as a submaximal test for the assessment of exercise tolerance in individuals with OSA treated with CPAP.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Teste de Esforço/normas , Tolerância ao Exercício/fisiologia , Apneia Obstrutiva do Sono/terapia , Teste de Esforço/métodos , Humanos , Reprodutibilidade dos Testes , Apneia Obstrutiva do Sono/fisiopatologia
20.
Arch Cardiovasc Dis ; 113(5): 350-358, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32224049

RESUMO

Obstructive sleep apnoea syndrome is a growing health concern, affecting nearly one billion people worldwide; it is an independent cardiovascular risk factor, associated with incident obesity, insulin resistance, hypertension, arrhythmias, stroke, coronary artery disease and heart failure. Obstructive sleep apnoea-related cardiovascular and metabolic co-morbidities are a major concern for prognosis and the complexity of obstructive sleep apnoea integrated care. Continuous positive airway pressure, the first-line therapy for the treatment of obstructive sleep apnoea, is highly effective at improving symptoms and quality of life, but has limited effect on co-morbidities. Deciphering the molecular pathways involved in obstructive sleep apnoea metabolic and cardiovascular consequences is a priority to make new pharmacological targets available, in combination with or as an alternative to continuous positive airway pressure. Intermittent hypoxia, a landmark feature of obstructive sleep apnoea, is the key intermediary mechanism underlying metabolic and cardiovascular complications. Experimental settings allowing intermittent hypoxia exposure in cells, rodents and healthy humans have been established to dissect the molecular mechanisms of obstructive sleep apnoea-related co-morbidities. The main objective of this review is to recapitulate the molecular pathways, cells and tissue interactions contributing to the cardiometabolic consequences of intermittent hypoxia. Sympathetic activation, low-grade inflammation, oxidative stress and endoplasmic reticulum stress are triggered by intermittent hypoxia and play a role in cardiometabolic dysfunction. The key role of hypoxia-inducible factor-1 transcription factor will be detailed, as well as the underestimated and less described importance of mitochondrial functional changes in the intermittent hypoxia setting.


Assuntos
Doenças Cardiovasculares/etiologia , Sistema Cardiovascular/fisiopatologia , Hemodinâmica , Hipóxia/etiologia , Apneia Obstrutiva do Sono/complicações , Remodelação Vascular , Animais , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/fisiopatologia , Sistema Cardiovascular/metabolismo , Hipóxia Celular , Estresse do Retículo Endoplasmático , Humanos , Hipóxia/metabolismo , Hipóxia/fisiopatologia , Fator 1 Induzível por Hipóxia/metabolismo , Estresse Oxidativo , Fatores de Risco , Transdução de Sinais , Apneia Obstrutiva do Sono/metabolismo , Apneia Obstrutiva do Sono/fisiopatologia
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