Automatic identifying OSAHS patients and simple snorers based on Gaussian mixture models.

Objective.Snoring is a typical symptom of Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS). In this study, an effective OSAHS patient detection system based on snoring sounds is presented.Approach.The Gaussian mixture model (GMM) is proposed to explore the acoustic characteristics of snoring sounds throughout the whole night to classify simple snores and OSAHS patients respectively. A series of acoustic features of snoring sounds of are selected based on the Fisher ratio and learned by GMM. Leave-one-subject-out cross validation experiment based on 30 subjects is conducted to validation the proposed model. There are 6 simple snorers (4 male and 2 female) and 24 OSAHS patients (15 male and 9 female) investigated in this work. Results indicates that snoring sounds of simple snorers and OSAHS patients have different distribution characteristics.Main results.The proposed model achieves average accuracy and precision with values of 90.0% and 95.7% using selected features with a dimension of 100 respectively. The average prediction time of the proposed model is 0.134 ± 0.005 s.Significance.The promising results demonstrate the effectiveness and low computational cost of diagnosing OSAHS patients using snoring sounds at home.

[Prevalence of childhood obstructive sleep apnoea syndrome in a referral sleep unit]. / Prevalencia del síndrome de apnea obstructiva del sueño infantil en una unidad de sueño de referencia.

INTRODUCTION: Obstructive sleep apnoea syndrome (OSAS) affects between 1% and 6% of children. Its diagnosis includes: a) snoring and/or apnoea; and b) an apnoea and hypopnoea index >3/hour obtained by polysomnography (PSG). The main aim of this work is to determine the prevalence of OSAS in our study population. PATIENTS AND METHODS: We conducted a descriptive study with a sample of 151 children aged between 1 and 12 years, who had been referred to the sleep unit of the Hospital General Universitario Gregorio Maranon for a PSG. We analysed the demographic variables sex and age; the clinical variables snoring, apnoeas and tonsillar hypertrophy; and the presence of OSAS based on the polysomnographic diagnostic criterion of an apnoea and hypopnoea index >3/hour. RESULTS: The mean age of the sample was 5.37 years (standard deviation: 3.05) and 64.9% were males. In 90.1% of cases, the reason for the visit was suspected OSAS. Snoring, apnoeas and tonsillar hypertrophy were observed in 73.5, 48.7 and 60% of cases, respectively. OSAS was diagnosed en 19 children (12.6%); in 13.5% of snorers; in 15.1% of those with apnoeas; and in 15.6% of the children with tonsillar hypertrophy. CONCLUSIONS: In our study, the prevalence of OSAS in children was 12.6%, which is higher than that reported in most epidemiological studies that include PSG for the diagnosis of OSAS.

TITLE: Prevalencia del síndrome de apnea obstructiva del sueño infantil en una unidad de sueño de referencia.Introducción. El síndrome de apnea obstructiva del sueño (SAOS) afecta a entre el 1 y el 6% de la población infantil. En su diagnóstico, se incluyen: a) ronquidos y/o apneas; y b) un índice de apneas e hipopneas >3/hora obtenido en la polisomnografía (PSG). El objetivo principal de este trabajo es determinar la prevalencia del SAOS en nuestra población de estudio. Pacientes y métodos. Estudio descriptivo con una muestra de 151 niños con edades comprendidas entre 1 y 12 años, remitidos a la unidad de sueño del Hospital General Universitario Gregorio Marañón para la realización de una PSG. Se analizaron las variables demográficas sexo y edad; las variables clínicas ronquidos, apneas e hipertrofia amigdalar; y la presencia de SAOS basada en el criterio diagnóstico polisomnográfico de un índice de apneas e hipopneas >3/hora. Resultados. La edad media de la muestra fue de 5,37 años (desviación estándar: 3,05) y el 64,9% eran varones. En el 90,1% de los casos, el motivo de consulta fue sospecha de SAOS. Los ronquidos, las apneas y la hipertrofia amigdalar se observaron en el 73,5, el 48,7 y el 60% de los casos, respectivamente. Se diagnosticó SAOS en 19 (12,6%) niños; en el 13,5% de los roncadores; en el 15,1% de los niños con apneas; y en el 15,6% de los niños con hipertrofia amigdalar. Conclusiones. En nuestro estudio, la prevalencia del SAOS en niños fue del 12,6%, superior a la descrita en la mayoría de los estudios epidemiológicos, pero similar a la observada en los que incluyen la PSG para el diagnóstico del SAOS.

Preliminary short-term outcomes of rapid maxillary expansion on periodic limb movements during sleep in pediatric sleep-disordered breathing.

OBJECTIVE: To assess the short-term outcome of rapid maxillary expansion (RME) on periodic limb movement disorder (PLMD) in children with residual snoring after late adenotonsillectomy (AT). METHODS: This prospective clinical trial included 24 patients treated with rapid maxillary expansion (RME). Participants' inclusion criteria were children with maxillary constriction aged 5-12 years who had AT for more than two years and those whose parents/guardians reported that they still snored ≥4 nights per week. Of which 13 had primary snoring, and 11 had OSA. All patients underwent laryngeal nasofibroscopy evaluation and complete polysomnography. The Quality of life (QOL) Questionnaire (OSA-18), the Pediatric Sleep Questionnaire (PSQ), the Conners Abbreviated Scale (CAE), and the Epworth Sleep Scale (ESS) were applied before and after palatal expansion. RESULTS: The OSA 18 domain, PSQ total, CAE, and ESS scores were significantly reduced in both groups (p < 0.001). There was a decrease in PLMS indices. In the total sample, the mean decreased significantly from 4.15 to 1.08. In the Primary Snoring group, the mean decreased from 2.64 to 0.99; in the OSA group, the average decreased significantly from 5.95 to 1.19. CONCLUSION: This preliminary study suggests that the improvement of PLMS in the OSA group with maxillary constriction is correlated with a favorable neurological impact of the treatment. We suggest a multi-professional approach to the treatment of sleep disorders in children.

Comparison of the pharyngeal airway in snoring and non-snoring patients based on the lateral cephalometric study: A case-control study.

BACKGROUND: Normal airways are a key factor during the craniofacial growth of the young. Therefore, sleep-disordered breathing (SDB) without treatment can have harmful consequences for development and health. OBJECTIVES: This study aimed to evaluate the cephalometric characteristics in non-snoring individuals and snoring subjects, and investigate differences in the pharyngeal airway space between the 2 groups. MATERIAL AND METHODS: This case-control study included 70 patients aged over 18 years, selected from a radiology center. The patients were divided into 2 groups: case (35 patients with a history of habitual snoring); and control (35 healthy patients). The Berlin sleep questionnaire was administered to the parents of the patients. The nasopharyngeal airway was measured according to the analysis of Linder-Aronson (1970), and 4 indices were measured and analyzed in each of the lateral cephalometric radiographs. RESULTS: No statistically significant differences were observed in the pharyngeal measurements between the 2 groups, although all means in the control group were higher than in the experimental group. However, there was a significant relationship between gender and the Ba-S-PNS and PNS-AD2 indices. CONCLUSIONS: Although the patients with nocturnal snoring had smaller airway dimensions, their pharyngeal measurements were not significantly different from the control group.

Predictive value of NoSAS questionnaire combined with the modified Mallampati grade for hypoxemia during routine sedation for gastrointestinal endoscopy.

BACKGROUND: The incidence of hypoxemia during painless gastrointestinal endoscopy remains a matter of concem. To date, there is no recognized simple method to predict hypoxemia in digestive endoscopic anesthesia. The NoSAS (neck circumference, obesity, snoring, age, sex) questionnaire, an objective and simple assessment scale used to assess obstructive sleep apnea (OSA), combined with the modified Mallampati grade (MMP), may have certain screening value. This combination may allow anesthesiologists to anticipate, manage, and consequently decrease the occurrence of hypoxemia. METHODS: This study was a prospective observational trial. The primary endpoint was the incidence of hypoxaemia defined as pulse oxygen saturation (SpO2) < 95% for 10 s. A total of 2207 patients admitted to our hospital for painless gastrointestinal endoscopy were studied. All patients were measured for age, height, weight, body mass index, neck circumference, snoring, MMP, and other parameters. Patients were divided into hypoxemic and non-hypoxemic groups based on the SpO2. The ROC curve was plotted to evaluate the screening value of the NoSAS questionnaire separately and combined with MMP for hypoxemia. The total NoSAS score was evaluated at cut-off points of 8 and 9. RESULTS: With a NoSAS score ≥ 8 as the critical value for analysis, the sensitivity for hypoxemia was 58.3%, the specificity was 88.4%, and the area under the ROC was 0.734 (P < 0.001, 95% CI: 0.708-0.759). With a NoSAS score ≥ 9 as a critical value, the sensitivity for hypoxemia was 36.50%, the specificity rose to 96.16%, and the area under the ROC was 0.663 (P < 0.001, 95% CI: 0.639-0.688). With the NoSAS Score combined with MMP for analysis, the sensitivity was 78.4%, the specificity was 84%, and the area under the ROC was 0.859 (P < 0.001, 95%CI:0.834-0.883). CONCLUSIONS: As a new screening tool, the NoSAS questionnaire is simple, convenient, and useful for screening hypoxemia. This questionnaire, when paired withMMP, is likely to be helpful for the screening of hypoxemia.

The effect of disease severity and chronic CPAP-therapy on cognitive functions and event related potentials in OSAS.

Background and purpose:

Obstructive sleep apnea syndrome (OSAS) may cause daytime sleepiness, mood changes and dysfunction in various cognitive areas due to recurrent arousals and / or chronic intermittent hypoxia. Different possibilities have been proposed regarding the most affected cognitive areas and mechanisms of OSAS. However, it is difficult to compare findings of the different studies due to the fact that individuals with different disease severities were included in the study groups. In the current study, we aimed to determine the relationship between severity of OSAS and cognitive functions, to investigate the effect of continuous positive airway pressure (CPAP) titration treatment on cognitive functions and the relationship between these changes and electrophysiological potential. 

The study included 4 groups of patients with simple snoring and mild, mo­de­rate and severe OSAS. In the pre-treatment evaluations, verbal fluency, visuospatial me­mory, attention, executive functions, lan­guage abilities and electrophysiological tests for event-related potential were performed. The same procedure was reapplied after 4 months of CPAP-therapy. 

Long-term recall scores and total word fluency scores were found to be low in the groups with moderate and severe disease compared to the patients with simple snoring (p: 0.04, p: 0.03, respectively). The information processing time was higher in patients with severe disease compared to patients with simple snoring (p: 0.02). The P200 and N100 latencies related to event related potentials (ERP) were significantly different between the groups (p: 0.004, p: 0.008, respectively). After CPAP treatment, significant differences were found in N100 amplitude and latencies and all cognitive areas except abstraction. In addition, N100 amplitude and latency change rate as well as change in attention and memory abilities were correlated (r: 0.72, p: 0.02; r: 0.57, p: 0.03, respectively). 

In the current research, disease severity was found to negatively affect long-term logical memory, sustained attention and verbal fluency. Moreover, significant improvement was detected in all cognitive areas with CPAP treatment. The findings of our study support that changes in N100 potential have the potential to be used as a biomarker that can be used to monitor cognitive function recovery after treatment.

Impact of sleep posture and breathing pattern on soft palate flutter and pharynx vibration in a pediatric airway using fluid-structure interaction.

Snoring is a common condition in the general population, and the management of snoring requires a better understanding of its mechanism through a fluid-structure interaction (FSI) perspective. Despite the recent popularity of numerical FSI techniques, outstanding challenges are accurately predicting airway deformation and its vibration during snoring due to complex airway morphology. In addition, there still needs to be more understanding of snoring inhibition when lying on the side, and the possible effect of airflow rates, as well as nose or mouth-nose breathing, on snoring remains to be investigated. In this study, an FSI method verified against in vitro models was introduced to predict upper airway deformation and vibration. The technique was applied to predict airway aerodynamics, soft palate flutter, and airway vibration in four sleep postures (supine, left/right lying, and sitting positions) and four breathing patterns (mouth-nose, nose, mouth, and unilateral nose breathing). It was found that, at given elastic properties of soft tissues, the evaluated flutter frequency of 19.8 Hz in inspiration was in good agreement with the reported frequency of snoring sound in literature. Reduction in flutter and vibrations due to the mouth-nose airflow proportion changes were also noticed when having side-lying and sitting positions. Breathing through the mouth results in larger airway deformation than breathing through the nose or mouth-nose. These results collectively demonstrate the potential of FSI for studying the physics of airway vibration and clarify to some degree the reason for snoring inhibition during sleep postures and breathing patterns.

Tonsil volume and outcome of radiofrequency uvulopalatoplasty with or without tonsillectomy in adults with sleep-disordered breathing.

PURPOSE: Predictors for the outcome of uvulopalatopharyngoplasty with and without tonsillectomy (UPPP ± TE) in sleep-disordered breathing have not been fully established. This study investigates tonsil grade, volume, and preoperative examination in predicting radiofrequency UPP ± TE outcomes. METHODS: All patients undergoing radiofrequency UPP with tonsillectomy if tonsils were present between 2015 and 2021 were retrospectively analyzed. Patients underwent a standardized clinical examination, including Brodsky palatine tonsil grade from 0 to 4. Preoperatively and 3 months after surgery, sleep apnea testing was performed using respiratory polygraphy. Questionnaires were administered assessing daytime sleepiness using the Epworth Sleepiness Scale (ESS) and snoring intensity on a visual analog scale. Tonsil volume was measured intraoperatively using water displacement. RESULTS: The baseline characteristics of 307 patients and the follow-up data of 228 patients were analyzed. Tonsil volume increased by 2.5 ml (95% CI 2.1-2.9 ml; P < 0.001) per tonsil grade. Higher tonsil volumes were measured in men, younger patients, and patients with higher body mass indices. The preoperative apnea-hypopnea index (AHI) and AHI reduction strongly correlated with tonsil volume and grade, whereas postoperative AHI did not. The responder rate increased from 14% to 83% from tonsil grade 0 to 4 (P < 0.01). ESS and snoring were significantly reduced after surgery (P < 0.01), but the reduction was not influenced by tonsil grade or volume. No other preoperative factor other than tonsil size could predict surgical outcomes. CONCLUSIONS: Tonsil grade and intraoperatively measured volume correlate well and predict the reduction of AHI, while they are not predictive of ESS and snoring response after radiofrequency UPP ± TE.

Expansion sphincter pharyngoplasty in OSA: a 15 year review.

OBJECTIVE: A 15 year review of the outcomes and success rates of the Expansion Sphincter Pharyngoplasty (ESP) in the treatment of patients with obstructive sleep apnea (OSA). METHODS: A systemic review with two independent searches of MEDLINE, Google Scholar, Cochrane Library and Evidence-Based Medicine Reviews to identify publications relevant to OSA and Expansion Pharyngoplasty. All relevant studies published before 31 December 2021 were included. RESULTS: Sixteen studies were included in this strict systematic review with a total of 747 patients who had the ESP procedure were included. The mean age was 41.3 years, mean BMI 28.2, the mean pre-op AHI was 32.3 and post-op AHI was 10.0 (p < 0.05), the mean pre-op ESS was 11.4, had reduced to post-op 5.3 (p < 0.05), and the mean pre-op snore VAS decreased from 8.7 to 2.9 (p < 0.05), with a mean follow-up time of 9.5 months. The overall pooled success rate for all the 747 patients was 80.0%. There were no significant reported complications noted in these studies. CONCLUSION: After 15 years of presence, the expansion sphincter pharyngoplasty has shown to be reliably effective in the management of patients with OSA.

Multi-feature fusion and improved BO and IGWO metaheuristics based models for automatically diagnosing the sleep disorders from sleep sounds.

A night of regular and quality sleep is vital in human life. Sleep quality has a great impact on the daily life of people and those around them. Sounds such as snoring reduce not only the sleep quality of the person but also reduce the sleep quality of the partner. Sleep disorders can be eliminated by examining the sounds that people make at night. It is a very difficult process to follow and treat this process by experts. Therefore, this study, it is aimed to diagnose sleep disorders using computer-aided systems. In the study, the used data set contains seven hundred sound data which has seven different sound class such as cough, farting, laugh, scream, sneeze, sniffle, and snore. In the model proposed in the study, firstly, the feature maps of the sound signals in the data set were extracted. Three different methods were used in the feature extraction process. These methods are MFCC, Mel-spectrogram, and Chroma. The features extracted in these three methods are combined. Thanks to this method, the features of the same sound signal extracted in three different methods are used. This increases the performance of the proposed model. Later, the combined feature maps were analyzed using the proposed New Improved Gray Wolf Optimization (NI-GWO), which is the improved version of the Improved Gray Wolf Optimization (I-GWO) algorithm, and the proposed Improved Bonobo Optimizer (IBO) algorithm, which is the improved version of the Bonobo Optimizer (BO). In this way, it is aimed to run the models faster, reduce the number of features, and obtain the most optimum result. Finally, Support Vector Machine (SVM) and k-nearest neighbors (KNN) supervised shallow machine learning methods were used to calculate the metaheuristic algorithms' fitness values. Different types of metrics such as accuracy, sensitivity, F1 etc., were used for the performance comparison. Using the feature maps optimized by the proposed NI-GWO and IBO algorithms, the highest accuracy value was obtained from the SVM classifier with 99.28% for both metaheuristic algorithms.

Pediatric sleep-disordered breathing in Shanghai: characteristics, independent risk factors and its association with malocclusion.

OBJECTIVES: This study aimed to determine the prevalence and independent risk factors of SDB, and explore its association with malocclusion among 6-11-year-old children in Shanghai, China. METHODS: A cluster sampling procedure was adopted in this cross-sectional study. Pediatric Sleep Questionnaire (PSQ) was applied to evaluate the presence of SDB. Questionnaires including PSQ, medical history, family history, and daily habits/environment were completed by parents under instruction, and oral examinations were implemented by well-trained orthodontists. Multivariable logistic regression was applied to identify independent risk factors for SDB. Chi-square tests and Spearman's Rank Correlation were used to estimate the relationship between SDB and malocclusion. RESULTS: A total of 3433 subjects (1788 males and 1645 females) were included in the study. The SDB prevalence was about 17.7%. Allergic rhinitis (OR 1.39, 95% CI 1.09-1.79), adenotonsillar hypertrophy (OR 2.39, 95% CI 1.82-3.19), paternal snoring (OR 1.97, 95% CI 1.53-2.53), and maternal snoring (OR 1.35, 95% CI 1.05-1.73) were independent risk factors for SDB. The SDB prevalence was higher in children with retrusive mandibles than in proper or excessive ones. No significant difference was observed in the correlation between SDB and lateral facial profile, mandible plane angle, constricted dental arch form, the severity of anterior overjet and overbite, degree of crowding and spacing, and the presence of crossbite and open bite. CONCLUSIONS: The prevalence of SDB in primary students in the Chinese urban population was high and highly associated with mandible retrusion. The independent risk factors included Allergic rhinitis, adenotonsillar hypertrophy, paternal snoring, and maternal snoring. More efforts should be made to enhance public education about SDB and related dental-maxillofacial abnormalities.

Effects of demographic and sleep-related factors on snoring sound parameters.

OBJECTIVE: To investigate the effect of frequently reported between-individual (viz., age, gender, body mass index [BMI], and apnea-hypopnea index [AHI]) and within-individual (viz., sleep stage and sleep position) snoring sound-related factors on snoring sound parameters in temporal, intensity, and frequency domains. METHODS: This study included 83 adult snorers (mean ± SD age: 42.2 ± 11.3 yrs; male gender: 59%) who underwent an overnight polysomnography (PSG) and simultaneous sound recording, from which a total of 131,745 snoring events were extracted and analyzed. Data on both between-individual and within-individual factors were extracted from the participants' PSG reports. RESULTS: Gender did not have any significant effect on snoring sound parameters. The fundamental frequency (FF; coefficient = -0.31; P = 0.02) and dominant frequency (DF; coefficient = -12.43; P < 0.01) of snoring sounds decreased with the increase of age, and the second formant increased (coefficient = 22.91; P = 0.02) with the increase of BMI. Severe obstructive sleep apnea (OSA; AHI ≥30 events/hour), non-rapid eye movement sleep stage 3 (N3), and supine position were all associated with more, longer, and louder snoring events (P < 0.05). Supine position was associated with higher FF and DF, and lateral decubitus positions were associated with higher formants. CONCLUSIONS: Within the limitations of the current patient profile and included factors, AHI was found to have greater effects on snoring sound parameters than the other between-individual factors. The included within-individual factors were found to have greater effects on snoring sound parameters than the between-individual factors under study.

Healthy sleep pattern reduce the risk of cardiovascular disease: A 10-year prospective cohort study.

OBJECTIVE: To identify the association between quantified sleep factors and the incidence of cardiovascular disease (CVD) through a 10-year prospective cohort study. METHODS: A total of 45,919 individuals were recruited in this population-based prospective study. The healthy sleep score was constructed by four sleep measures (sleep duration, insomnia symptoms, snoring and daytime sleepiness), which were collected by questionnaire. The hazard ratio (HR) and 95% confidence intervals (CIs) were calculated by the multivariate-adjusted Cox proportional hazards model. Restricted cubic spline analysis was used to examine the dose‒response relationships between healthy sleep scores and outcomes. RESULTS: During a median follow-up of 10.73 years (interquartile range: 10.08-11.72 years), 10,523 cases of total CVD incidence, 3766 cases of CHD, and 3967 cases of stroke incidence were documented. Our results found that participants who maintained four healthy sleep measures (including no insomnia, snoring, or frequent daytime sleepiness and sleeping 7-8 h/d) had a 12% (HR: 0.88, 95% CI: 0.84-0.93) and 16% (HR: 0.84, 95% CI: 0.78-0.92) lower risk of developing CVD and CHD, respectively, but not stroke. There was a dose‒response relationship between sleep scores and the risk of cardiovascular events. With an increasing healthy sleep score, the risk of cardiovascular events decreases. Compared to those with a sleep score of 0-1, participants with a score of 4 had 27% (HR: 0.73, 95% CI: 0.67-0.79), 25% (HR: 0.75, 95% CI: 0.65-0.87), and 24% (HR: 0.76, 95% CI: 0.66-0.86) reduced risks of CVD, CHD, and stroke, respectively. CONCLUSIONS: In this large prospective cohort study, a healthy sleep pattern effectively reduced the risk of CVD, CHD, and stroke.

Prevalence of sleep problems and habits among children in Saudi Arabia: A cross-sectional study.

OBJECTIVES: To investigate children's sleep problems, habits, and lifestyle changes. METHODS: A cross-sectional study was carried out in Riyadh, Saudi Arabia, over a period of 2 months, from August through September 2022, with parents of children aged 2-14 years after reviewing the literature and formulating a validated Google questionnaire containing 30 questions related to sleep habits, problems, and disorders. RESULTS: In total, 585 questionnaires were included in the analysis. The sample comprised 345 (59%) males and 240 (41%) females. The mean age of patients was 7 (range: 2-14) years. Bed-time resistance was the most prevalent sleep problem (70.3%), followed by sleep-onset delay (58.1%), difficulty waking up in the morning on weekdays (41.3%), weekends (38%), and interrupted sleep (31%). An alarmingly high prevalence of hyperactivity (41.8%) and aggressive behaviour (42.2%) was noted. Co-sleeping with parents was reported in 41% of children. Night terror was reported in 20.6% and 26.5% in nightmares. Statistically significant associations were noted between screen time, snoring, and witnessed apnoea with sleep problems. CONCLUSION: Sleep problems are common among children in Saudi Arabia. The study sheds some light on sleep habits and practices in this age group in Saudi Arabia, such as the high prevalence of bed-time resistance and sleep-onset delay, hyperactivity, and sleep-affecting culprits such as screen time, snoring, and witnessed apnoea.

[Effect of Objective Daytime Sleepiness on Heart Rate Variability in Patients With Obstructive Sleep Apnea].

Objective: Excessive daytime sleepiness (EDS) is associated with cardiovascular events in patients with obstructive sleep apnea (OSA). Our study explored the correlation between objective daytime sleepiness assessed with daytime multiple sleep latency tests (MSLT) and heart rate variability (HRV) in OSA patients. The results may provide insight into possible mechanisms underlying increased risk of cardiovascular events in patients with OSA. Methods: A retrospective analysis was conducted with the data of 139 patients with OSA and 35 patients with primary snoring. All subjects underwent polysomnography (PSG) and MSLT at West China Hospital between January 2019 and May 2022. We used mean sleep latency (MSL) to measure the severity of EDS and to categorize OSA patients into three groups, severe EDS, light EDS, and non-EDS, with MSL of less than 5 minutes, 5 to 10 minutes, and greater than 10 minutes as the respective defining criteria for classification. A comparison of sleep structure, clinical characteristics, and HRV parameters was performed in order to evaluate the difference between OSA subgroups with varying levels of objective EDS and the primary snoring group. In addition, we also analyzed the correlation between MSL and HRV parameters. Results: Severe EDS patients had higher values of standard deviation of all N-N intervals (SDNN), total spectral power (TOT), and low-frequency power (LF) as compared to non-EDS patients, which was indicative of sympathetic stimulation ( P<0.05). Additionally, high-frequency power (HF) was also higher in severe EDS patients, which indicated decreased parasympathetic drive. A significantly positive correlation was found between MSL and the values of SDNN, TOT, LF, and HF in OSA patients. Conclusion: OSA patients with objective EDS have elevated sympathetic drive and decreased parasympathetic drive. A positive correlation was found between this change in neural activity and the shortening of MSL.

Obstructive sleep apnea screening in children with asthma.

RATIONALE: Obstructive sleep apnea is highly prevalent in children with asthma, particularly in obese children. The sleep-related breathing disorder screening questionnaire has low screening accuracy for obstructive sleep apnea in children with asthma. Our goal was to identify the questions on the sleep-related breathing disorder survey associated with obstructive sleep apnea in children with asthma. METHODS: Participants completed the survey, underwent polysomnography and their body mass index z-score was measured. Participants with survey scores above 0.33 were considered high risk for obstructive sleep apnea and those with an apnea-hypopnea index ≥ 2 events/h classified as having obstructive sleep apnea. Logistic regression was used to examine the association of each survey question and obstructive sleep apnea. Positive and negative predictive values were calculated to estimate screening accuracy. RESULTS: The prevalence of obstructive sleep apnea was 40% in our sample (n = 136). Loud snoring, morning dry mouth, and being overweight were the survey questions associated with obstructive sleep apnea. The composite survey score obtained from all 22 questions had positive and negative predictive values of 51.0% and 65.5%, while the combined model of loud snoring, morning dry mouth, and being overweight had positive and negative predictive values of 60.3% and 77.6%. On the other hand, the body mass index z-score alone had positive and negative predictive values of 76.3% and 72.2%. CONCLUSIONS: The body mass index z-score is useful for obstructive sleep apnea screening in children with asthma and should be applied routinely given its simplicity and concerns that obstructive sleep apnea may contribute to asthma morbidity.

Siblings' Risk of Adenoid Hypertrophy: A Cohort Study in Children.

BACKGROUND: The aim of this study was to compare adenoid size in preschool-age siblings using flexible nasopharyngoscopy examination (FNE) when they reach the same age. The occurrence of adenoid symptoms in these patients was also analyzed. This study was conducted to analyze the adenoid size in siblings when they reach the same age and substantiate a correlation between adenoid hypertrophy (AH) and adenoid symptoms. METHODS: We analyzed and reported on the symptoms, ENT examination results, and FNE of 49 pairs of siblings who were examined at the same age. RESULTS: There was a strong association in adenoid size between siblings when they are at a similar age (r = 0.673, p < 0.001). Second-born children whose older sibling had IIIo AH (A/C ratio > 65%) had a risk of IIIo AH 26 times greater than patients whose older sibling did not have IIIo AH (OR = 26.30, 95% CI = 2.82-245.54). Over 90% of snoring children whose siblings had confirmed IIIo AH would develop IIIo AH by the time they reach the same age. Second-born children in whom snoring occurs and whose older siblings have a IIIo AH have about a 46 times higher risk of IIIo AH compared to patients who did not meet these two conditions (p < 0.001, OR = 46.67, 95% CI = 8.37-260.30). CONCLUSIONS: A significant familial correlation between adenoid size in siblings when they reach the same age was shown. If the older sibling has a confirmed overgrown adenoid (IIIo AH) and their younger sibling presents adenoid symptoms, particularly snoring, it is highly probable that they will also have an overgrown adenoid.

Tidal Volume Level Estimation Using Respiratory Sounds.

Respiratory sounds have been used as a noninvasive and convenient method to estimate respiratory flow and tidal volume. However, current methods need calibration, making them difficult to use in a home environment. A respiratory sound analysis method is proposed to estimate tidal volume levels during sleep qualitatively. Respiratory sounds are filtered and segmented into one-minute clips, all clips are clustered into three categories: normal breathing/snoring/uncertain with agglomerative hierarchical clustering (AHC). Formant parameters are extracted to classify snoring clips into simple snoring and obstructive snoring with the K-means algorithm. For simple snoring clips, the tidal volume level is calculated based on snoring last time. For obstructive snoring clips, the tidal volume level is calculated by the maximum breathing pause interval. The performance of the proposed method is evaluated on an open dataset, PSG-Audio, in which full-night polysomnography (PSG) and tracheal sound were recorded simultaneously. The calculated tidal volume levels are compared with the corresponding lowest nocturnal oxygen saturation (LoO2) data. Experiments show that the proposed method calculates tidal volume levels with high accuracy and robustness.

Computational fluid-structure interaction analysis of flapping uvula on aerodynamics and pharyngeal vibration in a pediatric airway.

The uvula flapping is one of the most distinctive features of snoring and is critical in affecting airway aerodynamics and vibrations. This study aimed to elucidate the mechanism of pharyngeal vibration and pressure fluctuation due to uvula flapping employing fluid-structure interaction simulations. The followings are the methodology part: we constructed an anatomically accurate pediatric pharynx model and put attention on the oropharynx region where the greatest level of upper airway compliance was reported to occur. The uvula was assumed to be a rigid body with specific flapping frequencies to guarantee proper boundary conditions with as little complexity as possible. The airway tissue was considered to have a uniform thickness. It was found that the flapping frequency had a more significant effect on the airway vibration than the flapping amplitude, as the flapping uvula influenced the pharyngeal aerodynamics by altering the jet flow from the mouth. Breathing only through the mouth could amplify the effect of flapping uvula on aerodynamic changes and result in more significant oropharynx vibration.