Partial epiglottectomy improves residual apnea-hypopnea index in patients with epiglottis collapse.
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ABSTRACT:
SUBMITTER: Jeong SH
PROVIDER: S-EPMC7970606 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Despite the widespread use of the apnea-hypopnea index in research, its scientific and statistical properties have not been examined thoroughly. The index may be viewed either as a rate (number of events per hour of sleep) or as a ratio of two variables (number of events/number of hours of sleep). When considered as a rate, the apnea-hypopnea index may be modeled as the dependent variable, provided that researchers explicitly state which physical property they assume to be measuring. On the other hand, the index is rarely, if ever, the preferred model of exposure to sleep-disordered breathing (an independent variable), regardless of whether it is considered a rate or a ratio variable. Continued indiscriminate use of the apnea-hypopnea index in sleep research should be discouraged.
| S-EPMC3982973 | biostudies-other
Project description:The aim of this study was to assess associations between fat pad areas at various anatomic levels and the sites of lateral wall collapse and disease severity in adult patients with obstructive sleep apnea (OSA). Forty-one patients with OSA who prospectively underwent drug-induced sleep computed tomography were included. Areas of parapharyngeal fat pads and degrees of lateral wall collapse at three representative anatomic levels (nasopharynx, oropharynx, and subglosso-supraglottis), and apnea-hypopnea index (AHI) were measured. In the subglosso-supraglottic region, the parapharyngeal fat pad area in 17 (41%) patients with complete lateral wall collapse was significantly larger than that in 24 (59%) patients without complete collapse (median, 236.0 mm2 vs 153.0 mm2; P?=?0.02). In multivariate regression analysis, the parapharyngeal fat pad area at the subglosso-supraglottic level (??=?0.02; P?=?0.01) and body mass index (??=?3.24; P?=?0.01) were independently associated with AHI. Our preliminary results supported that parapharyngeal fat pads at the subglosso-supraglottic level may be involved in the development of lateral wall collapse and then determine the severity of OSA. Further studies are warranted to investigate the effect of reducing parapharyngeal fat pads in the treatment of OSA.
| S-EPMC6881471 | biostudies-literature
Project description:Rationale: Patients with obstructive sleep apnea (OSA) experience respiratory events with greater frequency and severity while in the supine sleeping position. Postural preference (associated with the sleep monitoring device) and "first night effect" could explain a night-to-night variability in OSA severity. Objectives: We evaluated the variability of internight polysomnography (PSG) in a large group of OSA patients and explored factors explaining this variability. Methods: 188 patients referred for probable OSA (aged 54.9 ± 11.8 y) underwent two consecutive nights of at-home PSG. The effect of age, gender, obesity, neck circumference, sleep position and sleep parameters were considered to explain changes in respiratory parameters. Main Results: The mean apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) were respectively, 36.3 ± 27.5 and 22.0 ± 22.7 in the first night, with a tendency to decrease during the second night. While in mild cases (5 ? AHI < 15) there was a significant increase in AHI related to an increase in dorsal position time during the second night, there were no changes in moderate cases (15 ? AHI < 30); and in severe cases (AHI ? 30) there was a significant decrease in both AHI and ODI during the second night independent of sleep position. Conclusion: The internight variability in AHI and ODI was related to changes in sleep structure with a contribution of indices of sleep fragmentation and dorsal position. Since the changes were greater in mild OSA cases, a second night could be routinely proposed in cases with relevant clinical uncertainty.
| S-EPMC6630080 | biostudies-literature
Project description:BackgroundOne of the key mechanisms underlying OSA is reduced pharyngeal muscle tone during sleep. Data suggest that pharmacologic augmentation of central serotonergic/adrenergic tone increases pharyngeal muscle tone.Research questionWe hypothesized that venlafaxine, a serotonin-norepinephrine reuptake inhibitor, would improve OSA severity.Study design and methodsIn this mechanistic, randomized, double-blind, placebo-controlled crossover trial, 20 patients with OSA underwent two overnight polysomnograms ≥ 4 days apart, receiving either 50 mg of immediate-release venlafaxine or placebo before bedtime. Primary outcomes were the apnea-hypopnea index (AHI) and peripheral oxygen saturation (Spo2) nadir, and secondary outcomes included sleep parameters and pathophysiologic traits with a view toward understanding the impact of venlafaxine on mechanisms underlying OSA.ResultsOverall, there was no significant difference between venlafaxine and placebo regarding AHI (mean reduction, -5.6 events/h [95% CI, -12.0 to 0.9]; P = .09) or Spo2 nadir (median increase, +1.0% [-0.5 to 5]; P = .11). Venlafaxine reduced total sleep time, sleep efficiency, and rapid eye movement (REM) sleep, while increasing non-REM stage 1 sleep (Pall < .05). On the basis of exploratory post hoc analyses venlafaxine decreased ("improved") the ventilatory response to arousal (-30%; P = .049) and lowered ("worsened") the predicted arousal threshold (-13%; [P = .02]; ie, more arousable), with no effects on other pathophysiologic traits (Pall ≥ .3). Post hoc analyses further suggested effect modification by arousal threshold (P = .002): AHI improved by 19% in patients with a high arousal threshold (-10.9 events/h [-3.9 to -17.9]) but tended to increase in patients with a low arousal threshold (+7 events/h [-2.0 to 16]). Other predictors of response were elevated AHI and less collapsible upper airway anatomy at baseline (|r| > 0.5, P ≤ .02).InterpretationIn unselected patients, venlafaxine simultaneously worsened and improved various pathophysiologic traits, resulting in a zero net effect. Careful patient selection based on pathophysiologic traits, or combination therapy with drugs countering its alerting effects, may produce a more robust response.Trial registryClinicalTrials.gov; No.: NCT02714400; URL: www.clinicaltrials.gov.
| S-EPMC7417375 | biostudies-literature
Project description:BackgroundThe relationship between the Epworth sleepiness scale (ESS) and the apnea-hypopnea index (AHI) is uncertain and even poor. The major problem associated with the ESS might be a lack of consideration of weight in prediction in clinical practice. Would awarding different item-scores to the four scales of ESS items to develop a weighted ESS scoring system improve the accuracy of the AHI prediction? It is warranted to explore the intriguing hypotheses.MethodsSeven hundred fifty-six adult patients with suspicion of obstructive sleep apnoea syndrome (OSAS) were prospectively recruited to a derivation cohort. This was tested against a prospective validation cohort of 810 adult patients with suspected OSAS. Each ESS item’s increased odds ratio for the corresponding AHI was calculated using univariate logistic regression. The receiver operating characteristic curves were created and the areas under the curves (AUCs) were calculated to illustrate and compare the accuracy of the indices.ResultsThe higher the ESS item-score, the closer the relationship with the corresponding AHI. The odds ratios decreased as a result of the increased AHI. The ESS items were of unequal weight in predicting the corresponding AHI and a weighted ESS was developed. The coincidence rates with the corresponding AHI, body mass indices, and neck circumferences rose as the scores increased, whereas nocturnal nadir oxygen saturations decreased, and the weighted ESS was more strongly associated with these indices, compared with the ESS. The capability in predicting the patients without OSAS or with severe OSAS was strong, especially the latter, and the weighted ESS orchestrated manifest improvement in screening the patients with simple snoring. The patterns of sensitivities, specificities, and Youden’s indices of the four ranks of weighted ESS for predicting the corresponding AHI were better than those of the ESS, and the AUCs of weighted ESS were greater than the corresponding areas of ESS in the two cohorts.ConclusionsThe weighted ESS orchestrated significant improvement in predicting the AHI, indicating that the capability in predicting the patients without OSAS or with severe OSAS was strong, which might have implications for clinical triage decisions to prioritize patients for polysomnography.
| S-EPMC7291446 | biostudies-literature
Project description:Autotitrating continuous positive airway pressure (CPAP) devices adjust pressure in response to changes in airflow and are an alternative to attended in-laboratory titration polysomnography (PSG) to determine optimal pressure levels. The aim of this study was to compare the performance of the System One RemStar Auto A-Flex (Philips Respironics, Murrysville, PA, USA) automatically adjusted positive airway pressure (APAP) mode to manually titrated, fixed pressure CPAP and to validate the device's breathing event detection capabilities against attended in-laboratory PSG.Sixty-one patients investigated in five centers for moderate to severe obstructive sleep apnea between May 2012 and June 2013 were invited to participate. Participants underwent two full-night attended polysomnograms in random order with manually titrated, fixed pressure CPAP versus APAP.Fifty-three participants with a mean apnea-hypopnea index (AHI) of 45.9 ± 23 completed two sleep studies and were included in the analysis. There were significant but not clinically relevant differences between APAP and CPAP respectively: Apnea index [1.0 (2.8 ± 0.8), median (mean ± standard deviation)] versus [1.8 (5.3 ± 11.5)], p = 0.004; percentage of N1 sleep [12.3 (15.9 ± 0.5)] versus [14.3 (18.9 ± 12.7)], p = 0.028. AHI values differed between PSG [2.8 (5.5. ± 9.3)] and device [3.7 (6.0 ± 8.6)], p = 0.003). Regarding residual events detection, intraclass correlation coefficients for AHI were strong (0.956, p < 0.001) and the area under the curve was 0.988 (AHI cut-off value of 10).The new APAP modality was effective and residual apnea-hypopnea indices calculated by the device strongly correlated to those assessed by PSG.A commentary on this article appears in this issue on page 167.
| S-EPMC5263084 | biostudies-other
Project description:BACKGROUND:Diagnostics of obstructive sleep apnea (OSA) is based on apnea-hypopnea index (AHI) determined as full-night average of occurred events. We investigate our hypothesis that intra-night variation in the frequency of obstructive events affects diagnostics and prognostics of OSA and should therefore be considered in clinical practice. METHODS:Polygraphic recordings of 1989 patients (mean follow-up 18.3 years) with suspected OSA were analyzed. Number and severity of individual obstructive events were calculated hourly for the first 6 h of sleep. OSA severity was determined based on the full-night AHI and AHI for the 2 h when the obstructive event frequency was highest (AHI2h). Hazard ratios for all-cause, cardiovascular, and non-cardiovascular mortalities were calculated for different OSA severity categories based on the full-night AHI and AHI2h. RESULTS:Frequency and duration of obstructive events varied hour-by-hour increasing towards morning. Using AHI2h led to a statistically significant rearrangement of patients between the OSA severity categories. The use of AHI2h for severity classification showed clearer relationship between the OSA severity and mortality than the full-night AHI. CONCLUSIONS:Currently, the intra-night variation in frequency and severity of obstructive events is completely ignored by conventional, full-night AHI and considering this information could improve the diagnostics of OSA.
| S-EPMC7127992 | biostudies-literature
Project description:ObjectivesThe aim of this study was to identify correlations between sleep apnea severity and tongue volume or posterior airway space measured via three-dimensional reconstruction of volumetric computerized tomography (CT) images in patients with obstructive sleep apnea (OSA) for use in predicting OSA severity and in surgical treatment. We also assessed associations between tongue volume and Mallampati score.MethodsSnoring/OSA male patients (n = 64) who underwent polysomnography, cephalometry, and CT scans were enrolled in this retrospective study. OSA was diagnosed when the apnea-hypopnea index (AHI) was greater than 5 (mild 5-14; moderate 15-29; severe>30). The patients were also categorized into the normal-mild group (n = 22) and the moderate-severe group (n = 42). Using volumetric CT images with the three-dimensional reconstruction technique, the volume of the tongue, posterior airway space volume, and intra-mandibular space were measured. The volumes, polysomnographic parameters, and physical examination findings were compared, and independent factors that are related to OSA were analysed.ResultsNo associations between tongue volume or posterior airway space and the AHI were observed. However, multivariate linear analyses showed that tongue volume had significantly negative association with lowest O2 saturation (r = 0.365, p = 0.027). High BMI was related to an increase in tongue volume. Modified Mallampati scores showed borderline significant positive correlations with absolute tongue volume (r = 0.251, p = 0.046) and standardized tongue volume (absolute tongue volume / intramandibular area; r = 0.266, p = 0.034). Between the normal-mild and moderate-severe groups, absolute tongue volumes were not different, although the standardized tongue volume in the moderate-severe group was significantly higher.ConclusionAbsolute tongue volume showed stronger associations with lowest O2 saturation during sleep than with the severity of AHI. We also found that high BMI was a relevant factor for an increase in absolute tongue volume and modified Mallampati grading was a useful physical examination to predict tongue size.
| S-EPMC4539216 | biostudies-literature
Project description:PurposeTo evaluate the performance of the NoSAS (neck, obesity, snoring, age, sex) score, the STOP-Bang (snoring, tiredness, observed apneas, blood pressure, body mass index, age, neck circumference, gender) questionnaire, and the Epworth sleepiness score (ESS) as a screening tool for obstructive sleep apnea (OSA) severity based on the apnea-hypopnea index (AHI) and the oxygen desaturation index (ODI).MethodsData from 235 patients who were monitored by ambulant polysomnography (PSG) were retrospectively analyzed. OSA severity was classified based on the AHI; similar classification categories were made based on the ODI. Discrimination was assessed by the area under the curve (AUC), while predictive parameters were calculated by four-grid contingency tables.ResultsThe NoSAS score and the STOP-Bang questionnaire were both equally adequate screening tools for the AHI and the ODI with AUC ranging from 0.695 to 0.767 and 0.684 to 0.767, respectively. Both questionnaires perform better when used as a continuous variable. The ESS did not show adequate discrimination for screening for OSA (AUC ranging from 0.450 to 0.525). Male gender, age, and BMI proved to be the strongest individual predictors in this cohort.ConclusionThis is the first study to evaluate the predictive performance of three different screening instruments with respect to both the AHI and the ODI. This is important, due to increasing evidence that the ODI may have a higher reproducibility in the clinical setting. The NoSAS score and the STOP-Bang questionnaire proved to be equally adequate to predict OSA severity based on both the AHI and the ODI.
| S-EPMC8376723 | biostudies-literature
Project description: Not available
| S-EPMC8606287 | biostudies-literature