Sleep and Breathing最新文献

Purpose: Obstructive sleep apnoea syndrome (OSAHS) is a respiratory disorder that greatly affects the health and quality of life of patients. OSAHS affects up to 5.7% of children aged up to 18 years old, and its prevalence is doubled in children with risk factors such as obesity, craniofacial syndromes, Prader-Willi syndrome or trisomy 21. The most common aetiology of OSAHS in children is tonsil hypertrophy, and the first line treatment proposed for the majority of patients is the surgical removal of these tonsils. However, the risk of residual OSAHS after surgery is approximately 10-20%, and, thus, other therapeutic options are being developed to improve patient care. The objective of this scoping review is to assess the extent of the evidence regarding the effectiveness of the different types of treatments offered for OSAHS in children.

Methods: Relevant studies over a 13 year period were identified using three search engines: PubMed, Scopus and Web of Science. The selection of studies was made using previously defined inclusion and exclusion criteria based on a review of the title and abstracts initially, followed by a full reading of the texts. The studies were classified based on their design and following the grades and level of scientific proof defined by the Health High Authority.

Results: Twenty-nine manuscripts were included for synthesis. The first-line treatment proposed for the majority of patients with OSAHS is surgical removal of the tonsils, but the risk of residual OSAHS after surgery remains significant, and other less invasive options, such as orthodontics, are also useful for improving the management of these patients.

Conclusion: OSAHS treatment recommendations should consider orthodontic treatment as a minimally invasive approach with beneficial effects.

Introduction: The hypertriglyceridemia-waist (HTGW) phenotype is a prevalent risk factor for cardiovascular diseases and obstructive sleep apnea (OSA). However, the impactof the HTGW phenotype on the simultaneous occurrence of OSA and cardiovascular diseases remains unexplored. This study aimed to determine whether the HTGW phenotype elevates the incidence of major adverse cardiovascular events (MACE) in patients with OSA, such as hospitalization for unstable angina and heart failure, myocardial infarction, and cardiovascular death, in patients with OSA.

Methods: A total of 1,290 patients with OSA were recruited from six hospitals for follow-up. According to the Chinese population criteria recommended by the International Diabetes Federation, the patients were divided into four groups: normal triglyceride waist circumference (NTNW) phenotype, pure high triglyceride (HTNW) phenotype, pure high waist circumference (NTGW) phenotype, and HTGW phenotype. The prognosis for MACE was evaluated using Cox proportional hazards analysis. The prognosis of MACE was evaluated using Cox proportional hazards analysis.

Results: 207 (17.9%) developed an HTGW phenotype. After a median of 42 months of follow-up, 119 (10.3%) experienced MACE. Cox proportional hazards analysis revealed that patients exhibiting the HTGW phenotype had a 1.963-fold higher risk of developing MACE than patients with the NTNW phenotype (P = 0.012). These results remained significant after adjusting for confounders, and a 2.186-fold increased risk of MACE was found in patients with NTGW phenotype (P = 0.012). Subgroup analyses revealed an increased risk of MACE in OSA patients with HTGW phenotype and NTGW phenotype that were older than or equal to 70 years, male, and had moderate-to-severe OSA (all P-values < 0.05).

Conclusion: The HTGW and NTGW phenotypes significantly increase MACE risk among elderly patients with OSA.

Background: Sleep disorder is common among hospitalized patients and also has a high prevalence after traumatic brain injury. Sleep disorder can have serious detrimental effects on disease recovery. One of the simple and non-invasive methods to improve the sleep quality of these patients is use of complementary medicine interventions and aromatherapy massage is one of these methods that may help to improve their sleep quality. Therefore, this study explored the effect of aromatherapy massage with mint and sweet almond oils on the sleep quality of patients with traumatic brain injury in intensive care units.

Methods: This study was a randomized clinical trial. In this study, 60 patients admitted to the intensive care unit were assigned to the intervention and sham therapy groups. The hands and feet of patients in the intervention group were massaged for 20 min with a combination of mint and sweet almond oils for three consecutive days. In the sham therapy group, hands and feet of patients were massaged with Vaseline. Both groups completed demographic questionnaire and Richards-Campbell Sleep Questionnaire (RCSQ) before and after the intervention. Data were analyzed using SPSS ver. 22 via central tendency and dispersion indices (frequency, percentage, average, and standard deviation), the chi-square test, independent t-test, and paired t-test with a significance level of 0.05.

Results: Aromatherapy massage significantly increased the sleep quality of traumatic brain injury patients in intensive care units, meaning that the mean score of sleep quality in the intervention group compared to the sham therapy group after the intervention showed a significant increase. (P < 0.05).

Conclusions: According to the results of this study, the use of aromatherapy with a combination of mint oil and sweet almonds increases the sleep quality of traumatized patients admitted to intensive care units. Using a combination of mint oil and sweet almond oil to increase the sleep quality of patients similar to the research community can be helpful.

Clinical trial registration number: IRCT20151107024919N12.

Purpose: The association between sleep apnea syndrome (SAS) severity and white matter hyperintensities (WMHs) has been previously described. However, the associated anatomical details of WMHs remain unclear. The WMHs were divided into periventricular hyperintensity (PVH) and deep and subcortical white matter hyperintensity (DWMH). PVH is characterized as a non-vascular entity, whereas DWMH is vascular in nature. This study aimed to clarify the association between SAS and the anatomical details of WMHs.

Methods: Patients (n = 237) diagnosed with neurologically asymptomatic SAS (1999-2016) were enrolled. Any symptomatic SAS patients, whose MRI was conducted more than six months prior to SAS diagnosis, or whose data were incomplete were excluded. For patients with multiple MRI scans, the most recent imaging was employed. SAS diagnosis was defined as an apnea-hypopnea index (AHI) ≥ 5. PVH and DWMH were graded from 0 to IV according to severity. Age, sex, medical history, body mass index, AHI, estimated duration of SAS, and MRI findings were collected. Factors associated with PVH and DWMH grade ≥ I were analyzed.

Results: PVH grade ≥ I was associated with the estimated duration of SAS (odds ratio, 1.01; 95% confidence interval, 1.00-1.02), DWMH grade ≥ I (102.04; 21.40-486.49), hypertension (4.05; 1.53-10.74), and cerebral atrophy (17.47; 1.36-225.28). Age (1.07; 1.03-1.12) and PVH grade ≥ I (88.73; 19.07-412.86) were significantly associated with DWMH grade ≥ I.

Conclusion: This study confirmed that PVH rather than DWMH is associated with SAS. This study may contribute to research on the mechanism of WMHs caused by SAS.

Introduction: Patients with pulmonary hypertension (PH) often have comorbid sleep apnea (SA), but the prevalence, severity, and clinical characteristics of PH patients with SA have not been well studied.

Methods: Using a combination of the keywords "pulmonary hypertension" and "sleep apnea," the PubMed, Embase, Web of Science, and Scopus databases were searched for articles reporting the prevalence, severity, and clinical characteristics of PH patients with SA that were available through June 25, 2024.

Results: Of the 7969 studies, 39 were included in the final analysis. Prevalence of obstructive and central SA was 45.4% [39.2%, 51.6%]) and 9.3% [6%, 14.2%], respectively. The mean apnea hypopnea index (AHI) of patients with obstructive SA and PH was 18 [13.6, 22.4] with a standard error of 2.2. Subgroup analysis revealed that 51.4% [38.4%, 64.2%] had mild SA, 28% [22.5%, 33.6%] had moderate, and 20% [15.2%, 25%] had severe SA. PH patients with SA were characterized by male sex (odds ratio (OR) = 1.86 [1.45, 2.37], P < 0.001), older age (mean difference (MD) = -9.37 [-14.23, -4.43], P < 0.001), and higher body mass index (BMI) (MD = -2.16 [-3.32, -1.00], P < 0.001) compared to those without SA. However, mean pulmonary arterial pressure (mPAP) was not significantly different between SA and non-SA (MD = -2.4 [-5.1, 0.3], P = 0.078). Meta-regression showed no significant association between mPAP and AHI among patients with PH and SA (P = 0.13).

Conclusion: Our study found that SA is common in PH patients with certain clinical characteristics. We recommend conducting sleep studies in all PH patients, especially in older, overweight male patients.

Introduction: Obstructive Sleep Apnoea (OSA) is a heterogeneous disorder characterized by recurrent upper airway obstructions during sleep. Positional OSA (POSA) and non-positional OSA are major subgroups that differ in clinical, polysomnographic, and treatment aspects. Furthermore, POSA can be classified into supine-isolated POSA (siPOSA) and supine-predominant POSA (spPOSA), which exhibit distinct characteristics. This study compares POSA and non-POSA patients, as well as siPOSA and spPOSA subgroups, focusing on their clinical, demographic, and polysomnographic differences.

Materials and methods: This retrospective observational study included patients who underwent polysomnography (PSG) in a tertiary care hospital between 2007 and 2021 due to suspected sleep-breathing disorders. Patients were classified into POSA and non-POSA groups, with POSA further divided into siPOSA and spPOSA subgroups. POSA was defined as an AHI at least twice as high in the supine position compared to other positions. siPOSA included patients with a non-supine AHI < 5 events/h, whereas spPOSA included those with a non-supine AHI > 5 events/h. Demographic, anthropometric, and PSG parameters were compared.

Results: Among 2390 OSA patients, 884 were siPOSA, 519 spPOSA, and 987 non-POSA. POSA patients were younger (50.7 vs. 52.9 years, p < 0.001), had lower BMI (30.6 vs. 34.8 kg/m², p < 0.001), and milder OSA severity compared to non-POSA. spPOSA patients showed higher AHI and more severe OSA than siPOSA (p < 0.001).

Conclusion: POSA represents a milder subgroup compared to non-POSA, and siPOSA is milder than spPOSA. Identifying these subgroups enables tailored, patient-specific treatment approaches, enhancing therapeutic outcomes.

Background: Sleepiness significantly contributes to traffic accidents, with obstructive sleep apnea syndrome (OSA) being the leading medical cause. Effective treatment of OSA has been shown to reduce accident-related deaths and injuries. Turkish legislation has been updated to address driver's license issues for individuals with OSA, but implementation challenges and debates persist.

Methods: Data from 159 patients who applied to obtain or renew their driver's licenses and underwent polysomnography between January 2020 and January 2024 were evaluated retrospectively.

Results: The body mass index of 126 patients (79.24%) exceeded 33 kg per meter of height squared. OSA (apnea hypopnea index greater than 5) was detected in 85.5% of our patients, and the rate of severe OSA was 31.4%. We evaluated the presence of severe OSA using logistic regression analysis. Among the variables, the most important factor was neck circumference Receiver operating characteristic curve analysis identified severe OSA risk thresholds as neck circumference of 42.5 cm or greater and waist circumference of 122 cm or greater.

Conclusions: Considering neck and waist circumference rather than body mass index may facilitate informed decisions based on empirical measurements to identify OSA in driver's license applicants who require overnight polysomnography assessment.

Purpose: Obstructive sleep apnea (OSA) is a recognized cardiovascular risk factor, yet the benefits of intervention remain uncertain due to the heterogeneity among OSA patients. We aimed to explore the association of OSA with cardiovascular outcomes in acute coronary syndrome (ACS) patients with dual risk of elevated remnant cholesterol (RC) and low-grade inflammation indicated by high-sensitivity C-reactive protein (hs-CRP).

Methods: This study is a post-hoc analysis of OSA-ACS project enrolled 1833 ACS patients from January 2015 to December 2019, who underwent a sleep study, categorized into four groups by median levels of RC and hs-CRP: RC and low-grade inflammation risk (RCIR), low-grade inflammation risk (LDIR), RC risk (RCR), and no residual risk. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina or heart failure, and ischemia-driven revascularization. Cox proportional hazards models were used to assess the association between OSA and cardiovascular events.

Results: After a median follow-up of 35.13 months, OSA significantly increased the risk of MACCE (adjusted hazard ratio [HR] 1.58, 95% confidence interval [CI] 1.01-2.47; p = 0.045) and stroke (adjusted HR 5.23, 95% CI 1.19-22.99; p = 0.027) in the RCIR group. In the RCIR group, the log-transformed AHI (Log-AHI) and ODI (Log-ODI) were both significantly associated with an increased risk of MACCE, with adjusted hazard ratios of 1.711 (95% CI: 1.092-2.679; p = 0.019) and 1.813 (95% CI: 1.039-3.163; p = 0.036), respectively. Moreover, log-transformed nadir SaO2 (Log-Nadir SaO2) demonstrated a significant inverse association with MACCE risk (adjusted HR: 0.033; 95% CI: 0.001-0.769; p = 0.034).

Conclusions: OSA is prevalent and more severe in ACS patients with dual risk of elevated RC and low-grade inflammation, significantly increasing MACCE and stroke risk, highlighting the need for routine screening and comprehensive management to reduce cardiovascular risk.

Purpose: The main purpose of this study is to evaluate the facial morphology of obstructive sleep apnoea (OSA) individuals by using a handheld blue light three-dimensional (3D) scanner (HBL-3DS) in comparison to conventional lateral cephalometric radiography (LCR). Moreover, our research question is to explores the correlation between 3D facial and neck measurements with OSA indices, encompassing the hypoxic burden.

Method: This prospective cross-sectional study included forty-four adults with OSA. We compared three measurements between LCR and HBL-3DS images: modified facial profile angle (MFPA), nasolabial angle (NLA), and mandibular length (ML). Additionally, the 3D images of thirty-four participants with OSA indices were analysed for seventeen parameters, such as angles, ratios, and linear distances.

Results: This study revealed significant strong correlations (p < 0.001) between LCR and HBL-3DS in the measurements of MFPA (r = 0.675), NLA (r = 0.723), and ML (r = 0.675). However, no significant correlation was found between all predictors and the Apnoea-Hypopnea Index (AHI) or Oxygen Desaturation Index (ODI) in the 3D images of the thirty-four participants. Multivariate regression analysis demonstrated an independent negative correlation between mandibular width (MW) and nadir oxygen levels, while an independent positive correlation was observed between inner canthal width and the Rapid-Eye-Movement percentage (REM).

Conclusions: The study highlighted a significant association between LCR and HBL-3DS. HBL-3DS delivers precise 3D facial and neck measurements, presenting itself as a potentially cost-effective, radiation-free, and portable screening method for participants with OSA in clinical settings.