Pub Date : 2022-10-19DOI: 10.5005/jp-journals-10069-0104
A. Kadu, B. Jayan, G. Singh, Neetu Kadu, Uday Kamat
{"title":"Correlation of Tonsillar Grading, Adenoid Grading, and Combined Adenotonsillar Hypertrophy with Various Inter- and Intra-arch Dental Parameters: An Early Predictor for Pediatric Sleep Apnea","authors":"A. Kadu, B. Jayan, G. Singh, Neetu Kadu, Uday Kamat","doi":"10.5005/jp-journals-10069-0104","DOIUrl":"https://doi.org/10.5005/jp-journals-10069-0104","url":null,"abstract":"","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48963901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-19DOI: 10.5005/jp-journals-10069-0105
K. Utpat, U. Desai, S. Bhalerao, Dhiraj Bhatkar
{"title":"Comparison of Various Pretest Probability Scores in Obstructive Sleep Apnea Syndrome","authors":"K. Utpat, U. Desai, S. Bhalerao, Dhiraj Bhatkar","doi":"10.5005/jp-journals-10069-0105","DOIUrl":"https://doi.org/10.5005/jp-journals-10069-0105","url":null,"abstract":"","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49329159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Elphick, Philippa Howsley, N. Mills, Vicki Beevers, Lisa Artis
Objectives: Children and young people (CYP) with special educational needs (SEN) are more likely to experience disturbed sleep and poor mental wellbeing. This study explored the differential impact of the coronavirus disease 2019 (COVID-19) pandemic on the sleep and mental wellbeing of CYP with and without SEN.Methods: The National Institute of Health Research Children and Young People MedTech Cooperative, Sheffield Children’s National Health Service (NHS) Foundation Trust, and The Sleep Charity carried out an online survey between June 23, 2020, and August 17, 2020. The 77-item survey was shared on social media platforms.Results: A total of 559 participants were included in the analyses, and 15.74% of them reported having CYP with SEN. While sleep changes due to the pandemic were largely similar for both groups, CYP with SEN were more likely to get up or wake up during the night than those without SEN (40.91% vs. 27.18%). CYP with SEN were significantly more likely than those without SEN to be demotivated (61.44% vs. 31.57%), sad and tearful (36.15% vs. 19.35%), or anxious and stressed (41.67% vs. 18.54%) during the pandemic, and the increased anxiety was more likely to contribute to poorer sleep (43.48% vs. 14.82%).Conclusions: While the majority of CYP in both groups reported sleep changes due to the pandemic, CYP with SEN experienced more sleep disturbance. The findings provide initial evidence to suggest that the pandemic may have had a greater impact on the sleep and mental wellbeing of CYP with SEN than those without SEN.
{"title":"Observational Study of the Impact of COVID-19 on Sleep in Children With and Without Special Educational Needs","authors":"H. Elphick, Philippa Howsley, N. Mills, Vicki Beevers, Lisa Artis","doi":"10.13078/jsm.220004","DOIUrl":"https://doi.org/10.13078/jsm.220004","url":null,"abstract":"Objectives: Children and young people (CYP) with special educational needs (SEN) are more likely to experience disturbed sleep and poor mental wellbeing. This study explored the differential impact of the coronavirus disease 2019 (COVID-19) pandemic on the sleep and mental wellbeing of CYP with and without SEN.Methods: The National Institute of Health Research Children and Young People MedTech Cooperative, Sheffield Children’s National Health Service (NHS) Foundation Trust, and The Sleep Charity carried out an online survey between June 23, 2020, and August 17, 2020. The 77-item survey was shared on social media platforms.Results: A total of 559 participants were included in the analyses, and 15.74% of them reported having CYP with SEN. While sleep changes due to the pandemic were largely similar for both groups, CYP with SEN were more likely to get up or wake up during the night than those without SEN (40.91% vs. 27.18%). CYP with SEN were significantly more likely than those without SEN to be demotivated (61.44% vs. 31.57%), sad and tearful (36.15% vs. 19.35%), or anxious and stressed (41.67% vs. 18.54%) during the pandemic, and the increased anxiety was more likely to contribute to poorer sleep (43.48% vs. 14.82%).Conclusions: While the majority of CYP in both groups reported sleep changes due to the pandemic, CYP with SEN experienced more sleep disturbance. The findings provide initial evidence to suggest that the pandemic may have had a greater impact on the sleep and mental wellbeing of CYP with SEN than those without SEN.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89769325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obstructive sleep apnea (OSA) and atrial fibrillation (AF) are associated with increased morbidity and mortality. OSA and AF share multiple risk factors, including hypertension, cardiovascular disorders, congestive heart failure, and metabolic syndrome. Although the two conditions are likely to have a bidirectional association, recent studies have suggested that OSA contributes to the development of AF through direct mechanical effects on cardiac remodeling. We report a patient with severe OSA showing immediate conversion of AF to normal sinus rhythm with optimal continuous positive airway pressure (CPAP) therapy. This supports that OSA may lead to AF, which can be effectively reversed with CPAP therapy.
{"title":"Conversion of Atrial Fibrillation to Normal Sinus Rhythm With Optimal Continuous Positive Airway Pressure Therapy in Severe Obstructive Sleep Apnea","authors":"B. Lee, Seong Kyu Yang, D. Oh, C. Yun, J. Yoon","doi":"10.13078/jsm.220012","DOIUrl":"https://doi.org/10.13078/jsm.220012","url":null,"abstract":"Obstructive sleep apnea (OSA) and atrial fibrillation (AF) are associated with increased morbidity and mortality. OSA and AF share multiple risk factors, including hypertension, cardiovascular disorders, congestive heart failure, and metabolic syndrome. Although the two conditions are likely to have a bidirectional association, recent studies have suggested that OSA contributes to the development of AF through direct mechanical effects on cardiac remodeling. We report a patient with severe OSA showing immediate conversion of AF to normal sinus rhythm with optimal continuous positive airway pressure (CPAP) therapy. This supports that OSA may lead to AF, which can be effectively reversed with CPAP therapy.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79693998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: The prevalence of obstructive sleep apnea (OSA) and its association with perioperative comorbidities in patients who undergo bariatric surgery remain unclear in South Korea. We investigated the prevalence of OSA and its association with metabolic parameters in patients who underwent bariatric surgery.Methods: This retrospective study included 144 patients who underwent bariatric surgery; 98 patients underwent a sleep study and were included in this study. Patients were categorized into two groups based on the apnea-hypopnea index (AHI) cut-off value of 15/hour.Results: Overall, 52 (53.1%) of the patients showed an AHI ≥15/hour. The neck circumference was larger (43.0±4.7 cm vs. 40.5±3.6 cm, p=0.005) and prevalence of diabetes was higher (65.4% vs. 45.7%, p=0.049) in patients with AHI ≥15/hour than in those with AHI <15/hour. Furthermore, fasting blood glucose levels were higher (134.7±50.5 mg/dL vs. 114.8±34.3 mg/dL , p= 0.028) and serum high-density lipoprotein levels were lower (46.8±9.9 mg/dL vs. 52.8±13.3 mg/dL, p=0.013) in the AHI ≥15/hour than in the AHI <15/hour group.Conclusions: More than 50% of patients who underwent bariatric surgery had moderate-to-severe OSA. The prevalence of metabolic comorbidities was higher in those with moderate-to-severe OSA than in those without. OSA screening may be useful for evaluation of the metabolic complications of morbid obesity.
目的:在韩国接受减肥手术的患者中，阻塞性睡眠呼吸暂停(OSA)的患病率及其与围手术期合并症的关系尚不清楚。我们调查了接受减肥手术的患者中OSA的患病率及其与代谢参数的关系。方法:本回顾性研究纳入144例接受减肥手术的患者;98名患者接受了睡眠研究，并被纳入本研究。根据呼吸暂停-低通气指数(AHI)临界值15/小时将患者分为两组。结果:总体而言，52例(53.1%)患者的AHI≥15/小时。AHI≥15/小时的患者颈围较大(43.0±4.7 cm vs. 40.5±3.6 cm, p=0.005)，糖尿病患病率较高(65.4% vs. 45.7%， p=0.049)。此外，AHI≥15/小时组空腹血糖水平高于AHI <15/小时组(134.7±50.5 mg/dL比114.8±34.3 mg/dL, p= 0.028)，血清高密度脂蛋白水平低于AHI <15/小时组(46.8±9.9 mg/dL比52.8±13.3 mg/dL, p=0.013)。结论:接受减肥手术的患者中超过50%患有中度至重度OSA。中度至重度OSA患者的代谢合并症患病率高于无OSA患者。OSA筛查可能有助于评估病态肥胖的代谢并发症。
{"title":"Metabolic Effect of Obstructive Sleep Apnea in Patients Undergoing Bariatric Surgery","authors":"Seungmin Lee, J. Byun, S. Choi, W. Shin","doi":"10.13078/jsm.220008","DOIUrl":"https://doi.org/10.13078/jsm.220008","url":null,"abstract":"Objectives: The prevalence of obstructive sleep apnea (OSA) and its association with perioperative comorbidities in patients who undergo bariatric surgery remain unclear in South Korea. We investigated the prevalence of OSA and its association with metabolic parameters in patients who underwent bariatric surgery.Methods: This retrospective study included 144 patients who underwent bariatric surgery; 98 patients underwent a sleep study and were included in this study. Patients were categorized into two groups based on the apnea-hypopnea index (AHI) cut-off value of 15/hour.Results: Overall, 52 (53.1%) of the patients showed an AHI ≥15/hour. The neck circumference was larger (43.0±4.7 cm vs. 40.5±3.6 cm, p=0.005) and prevalence of diabetes was higher (65.4% vs. 45.7%, p=0.049) in patients with AHI ≥15/hour than in those with AHI <15/hour. Furthermore, fasting blood glucose levels were higher (134.7±50.5 mg/dL vs. 114.8±34.3 mg/dL , p= 0.028) and serum high-density lipoprotein levels were lower (46.8±9.9 mg/dL vs. 52.8±13.3 mg/dL, p=0.013) in the AHI ≥15/hour than in the AHI <15/hour group.Conclusions: More than 50% of patients who underwent bariatric surgery had moderate-to-severe OSA. The prevalence of metabolic comorbidities was higher in those with moderate-to-severe OSA than in those without. OSA screening may be useful for evaluation of the metabolic complications of morbid obesity.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80952731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obstructive sleep apnea (OSA) and dizziness are common conditions observed in the general population, and several epidemiological studies have reported an association between OSA and dizziness. Vestibular dysfunction, autonomic instability, and cerebellar degeneration secondary to recurrent hypoxia are implicated as mechanisms underlying dizziness in patients with OSA. Moreover, OSA is a risk factor for many diseases associated with dizziness, including Meniere disease, stroke, and psychiatric conditions. A dizziness questionnaire, vestibular function tests, and tests for autonomic function are useful for evaluation of OSA and concomitant dizziness. A growing body of evidence has shown that effective treatment of OSA including continuous positive airway pressure therapy reduces dizziness in these patients. Greater attention to dizziness is warranted in patients with OSA.
{"title":"Dizziness in Patients With Obstructive Sleep Apnea","authors":"Jae Rim Kim, Soo-Ryun Park, Hea Ree Park, E. Joo","doi":"10.13078/jsm.220010","DOIUrl":"https://doi.org/10.13078/jsm.220010","url":null,"abstract":"Obstructive sleep apnea (OSA) and dizziness are common conditions observed in the general population, and several epidemiological studies have reported an association between OSA and dizziness. Vestibular dysfunction, autonomic instability, and cerebellar degeneration secondary to recurrent hypoxia are implicated as mechanisms underlying dizziness in patients with OSA. Moreover, OSA is a risk factor for many diseases associated with dizziness, including Meniere disease, stroke, and psychiatric conditions. A dizziness questionnaire, vestibular function tests, and tests for autonomic function are useful for evaluation of OSA and concomitant dizziness. A growing body of evidence has shown that effective treatment of OSA including continuous positive airway pressure therapy reduces dizziness in these patients. Greater attention to dizziness is warranted in patients with OSA.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84053413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Insomnia is a disorder that involves poor sleep quality at nighttime and various symptoms in the daytime. Although it is known to increase cardiovascular risk as well as psychiatric comorbidities such as depression and anxiety, less attention has been paid to daytime sleepiness in patients with insomnia. This study aimed to investigate clinical and polysomnographic characteristics and identify factors influencing excessive daytime sleepiness in patients with insomnia.Methods: Between 2014 and 2022, 1,241 patients with insomnia as the primary symptom who underwent polysomnography were included in the study. Patients with an Epworth sleepiness scale ≥10 were classified as having insomnia accompanied by daytime sleepiness, and sleep-related questionnaire responses and polysomnography findings were utilized for analysis.Results: A total of 327 patients (26.3%) had daytime sleepiness, and a higher prevalence was observed in younger and male individuals. Poor sleep quality, severe depression, and insomnia were identified through the questionnaire. Polysomnography showed longer total sleep times, a higher proportion of stage N3 sleep, and higher sleep efficiency. The variables related to the Epworth sleepiness scale identified in multiple regression analysis were age, the Korean Beck Depression Inventory-II, sleep latency, and the apnea-hypopnea index on polysomnography.Conclusions: Insomnia with excessive daytime sleepiness was more affected by depression than indicated by polysomnography findings. The pathophysiology is presumed to be related to sleep misperception, and further studies are needed to elucidate the discrepancy between excessive daytime sleepiness and polysomnography findings.
{"title":"Exploration of Insomnia With Excessive Daytime Sleepiness From Clinical and Polysomnographic Perspectives","authors":"Min Jae Seong, Jae Rim Kim, S. Choi, E. Joo","doi":"10.13078/jsm.220014","DOIUrl":"https://doi.org/10.13078/jsm.220014","url":null,"abstract":"Objectives: Insomnia is a disorder that involves poor sleep quality at nighttime and various symptoms in the daytime. Although it is known to increase cardiovascular risk as well as psychiatric comorbidities such as depression and anxiety, less attention has been paid to daytime sleepiness in patients with insomnia. This study aimed to investigate clinical and polysomnographic characteristics and identify factors influencing excessive daytime sleepiness in patients with insomnia.Methods: Between 2014 and 2022, 1,241 patients with insomnia as the primary symptom who underwent polysomnography were included in the study. Patients with an Epworth sleepiness scale ≥10 were classified as having insomnia accompanied by daytime sleepiness, and sleep-related questionnaire responses and polysomnography findings were utilized for analysis.Results: A total of 327 patients (26.3%) had daytime sleepiness, and a higher prevalence was observed in younger and male individuals. Poor sleep quality, severe depression, and insomnia were identified through the questionnaire. Polysomnography showed longer total sleep times, a higher proportion of stage N3 sleep, and higher sleep efficiency. The variables related to the Epworth sleepiness scale identified in multiple regression analysis were age, the Korean Beck Depression Inventory-II, sleep latency, and the apnea-hypopnea index on polysomnography.Conclusions: Insomnia with excessive daytime sleepiness was more affected by depression than indicated by polysomnography findings. The pathophysiology is presumed to be related to sleep misperception, and further studies are needed to elucidate the discrepancy between excessive daytime sleepiness and polysomnography findings.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78529141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity hypoventilation syndrome (OHS) is defined as the combination of daytime hypercapnia (awake PaCO2 ≥45 mm Hg) and obesity (body mass index ≥30 kg/m2). Untreated OHS is associated with comorbidities, including cardiovascular diseases, heart failure, pulmonary hypertension, and metabolic syndrome. Continuous positive airway pressure (PAP) therapy with non-invasive ventilation is the gold standard for treating OHS. PAP therapy is highly effective; however, some adverse effects can affect long-term compliance. Air leakage through the mouth or around a mask is a common adverse effect of PAP therapy. Air leakage through the nasolacrimal duct or due to unsealed circuits has also been reported as a complication of PAP therapy; however, it is relatively rare. Considering the negative association between the level of air leakage and adherence to PAP therapy, clarifying the cause of air leakage during PAP therapy and minimizing it are key to successful outcomes. We report a case of air leakage through the nasolacrimal duct that was improved by inserting a gel foam patch inside the lacrimal sac of a patient with OHS with a history of reconstructive surgery for nasolacrimal duct obstruction.
肥胖低通气综合征(OHS)定义为白天高碳酸血症(清醒PaCO2≥45 mm Hg)和肥胖(体重指数≥30 kg/m2)的结合。未经治疗的OHS与合并症有关，包括心血管疾病、心力衰竭、肺动脉高压和代谢综合征。无创通气的持续气道正压(PAP)治疗是治疗OHS的金标准。PAP疗法非常有效;然而，一些不良反应会影响长期依从性。口腔或口罩周围漏气是PAP治疗常见的不良反应。通过鼻泪管或由于未密封的回路引起的漏气也被报道为PAP治疗的并发症;然而，这是相对罕见的。考虑到漏气水平与PAP治疗依从性之间的负相关关系，明确PAP治疗过程中漏气的原因并尽量减少漏气是成功结果的关键。我们报告了一例鼻泪管漏气的病例，该病例通过在有鼻泪管阻塞重建手术史的OHS患者的泪囊内插入凝胶泡沫片而得到改善。
{"title":"Air Regurgitation Through the Nasolacrimal Duct During Bilevel Positive Airway Pressure Therapy in a Patient With Obesity Hypoventilation Syndrome","authors":"Seong Kyu Yang, B. Lee, D. Oh, C. Yun, J. Yoon","doi":"10.13078/jsm.220013","DOIUrl":"https://doi.org/10.13078/jsm.220013","url":null,"abstract":"Obesity hypoventilation syndrome (OHS) is defined as the combination of daytime hypercapnia (awake PaCO2 ≥45 mm Hg) and obesity (body mass index ≥30 kg/m2). Untreated OHS is associated with comorbidities, including cardiovascular diseases, heart failure, pulmonary hypertension, and metabolic syndrome. Continuous positive airway pressure (PAP) therapy with non-invasive ventilation is the gold standard for treating OHS. PAP therapy is highly effective; however, some adverse effects can affect long-term compliance. Air leakage through the mouth or around a mask is a common adverse effect of PAP therapy. Air leakage through the nasolacrimal duct or due to unsealed circuits has also been reported as a complication of PAP therapy; however, it is relatively rare. Considering the negative association between the level of air leakage and adherence to PAP therapy, clarifying the cause of air leakage during PAP therapy and minimizing it are key to successful outcomes. We report a case of air leakage through the nasolacrimal duct that was improved by inserting a gel foam patch inside the lacrimal sac of a patient with OHS with a history of reconstructive surgery for nasolacrimal duct obstruction.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80222159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The mandibular advancement device (MAD) is a therapeutic option for obstructive sleep apnea syndrome (OSAS); however, for severe cases, it has a lower efficacy compared to continuous positive airway pressure (CPAP). This report aimed to present the efficacy of MAD in a patient with severe OSAS who refused CPAP. Video-polysomnography and polygraphy were performed before and after treatment, respectively. Three months after fitting and titrating the MAD, the apnea–hypopnea index was reduced from 56.2 events/h to 1.3 events/h and the minimum oxyhemoglobin saturation increased from 80% to 91%. Snoring time reduced from 75.2% to 0.2%. Our patient presented with low body fat, retrognathia, pharyngeal obstruction mainly along the anteroposterior axis and at the base of the tongue, and the ability to make wide protrusive movements with the jaw. In our opinion, these features could constitute a phenotype that may predict a positive response to MAD treatment even in severe cases of OSAS.
{"title":"Mandibular Advancement Device for Severe Obstructive Sleep Apnea: A Case Report Indicating a Way to Personalize Treatment","authors":"Marco De Pieri, M. Manconi, S. Miano","doi":"10.13078/jsm.220009","DOIUrl":"https://doi.org/10.13078/jsm.220009","url":null,"abstract":"The mandibular advancement device (MAD) is a therapeutic option for obstructive sleep apnea syndrome (OSAS); however, for severe cases, it has a lower efficacy compared to continuous positive airway pressure (CPAP). This report aimed to present the efficacy of MAD in a patient with severe OSAS who refused CPAP. Video-polysomnography and polygraphy were performed before and after treatment, respectively. Three months after fitting and titrating the MAD, the apnea–hypopnea index was reduced from 56.2 events/h to 1.3 events/h and the minimum oxyhemoglobin saturation increased from 80% to 91%. Snoring time reduced from 75.2% to 0.2%. Our patient presented with low body fat, retrognathia, pharyngeal obstruction mainly along the anteroposterior axis and at the base of the tongue, and the ability to make wide protrusive movements with the jaw. In our opinion, these features could constitute a phenotype that may predict a positive response to MAD treatment even in severe cases of OSAS.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84683867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Carbon dioxide (CO2) accumulation in an enclosed space might cause drowsiness. This study aimed to assess the effect of bedtime exposure to low concentrations of CO2 gas on the sleep quality of adults with insomnia.Methods: In this double-blind, randomized, sham-controlled cross-over study, we consecutively recruited 24 adults (9 men; age, 55.4±6.3 y) complaining of sleep disturbances (Pittsburgh Sleep Quality Index ≥5). The following two interventions were used in the study: exposure to 2% low-concentration edible CO2 gas (experimental intervention) and exposure to room air (sham-controlled intervention). A sleep air device (Gosleep®, NYX), which atomizes CO2 gas, was used in both experimental and sham-controlled interventions. For the sham session, room air was generated for 18 min, and then, gradually reduced by degrees in the next 5 min with the device finally being turned off.Results: The group exposed to CO2 gas had longer time in bed (361.3±55.2 min vs. 347.2±35.7 min, p=0.034) and total sleep time (311.0±74.3 min vs. 287.2±69.4 min, p=0.010) than the group exposed to room air. Meanwhile, the total arousal (19.7±9.5/h vs. 24.0±13.7/h, p=0.011) and non-REM arousal (20.9±11.3/h vs. 25.1±14.9/h, p=0.008) indices were lower in the group exposed to CO2 gas than in the group exposed to room air. However, perceived total sleep time or sleep latency and Karolinska Sleepiness Scale scores were not significantly different between the two groups.Conclusion: Exposure to low concentrations of CO2 improved the total sleep time and arousal index in adults with insomnia. Unexpectedly, CO2 administration was found to be effective for sleep maintenance.
目的:封闭空间内二氧化碳(CO2)的积累可能会导致嗜睡。这项研究旨在评估睡前暴露于低浓度二氧化碳气体对失眠成年人睡眠质量的影响。方法:在这项双盲、随机、假对照的交叉研究中，我们连续招募了24名成年人(9名男性;年龄(55.4±6.3岁)，主诉睡眠障碍(匹兹堡睡眠质量指数≥5)。研究中使用了以下两种干预措施:暴露于2%低浓度可食用二氧化碳气体(实验干预)和暴露于室内空气(假控制干预)。睡眠空气装置(Gosleep®，NYX)可雾化二氧化碳气体，用于实验和假控制干预。在模拟实验中，室内空气产生了18分钟，然后在接下来的5分钟内逐渐减少，最终关闭设备。结果:CO2气体暴露组的卧床时间(361.3±55.2 min比347.2±35.7 min, p=0.034)和总睡眠时间(311.0±74.3 min比287.2±69.4 min, p=0.010)均高于室内空气暴露组。同时，CO2气体暴露组总唤醒(19.7±9.5/h vs. 24.0±13.7/h, p=0.011)和非rem唤醒(20.9±11.3/h vs. 25.1±14.9/h, p=0.008)指标均低于室内空气暴露组。然而，感知总睡眠时间或睡眠潜伏期和卡罗林斯卡嗜睡量表得分在两组之间没有显着差异。结论:暴露于低浓度二氧化碳环境中可改善成人失眠症患者的总睡眠时间和唤醒指数。出乎意料的是，二氧化碳管理被发现对睡眠维持有效。
{"title":"Effects of Low-Concentration Carbon Dioxide Exposure at Bedtime on Sleep in Adults With Insomnia Symptoms","authors":"S. Choi, E. Joo","doi":"10.13078/jsm.220015","DOIUrl":"https://doi.org/10.13078/jsm.220015","url":null,"abstract":"Objectives: Carbon dioxide (CO2) accumulation in an enclosed space might cause drowsiness. This study aimed to assess the effect of bedtime exposure to low concentrations of CO2 gas on the sleep quality of adults with insomnia.Methods: In this double-blind, randomized, sham-controlled cross-over study, we consecutively recruited 24 adults (9 men; age, 55.4±6.3 y) complaining of sleep disturbances (Pittsburgh Sleep Quality Index ≥5). The following two interventions were used in the study: exposure to 2% low-concentration edible CO2 gas (experimental intervention) and exposure to room air (sham-controlled intervention). A sleep air device (Gosleep®, NYX), which atomizes CO2 gas, was used in both experimental and sham-controlled interventions. For the sham session, room air was generated for 18 min, and then, gradually reduced by degrees in the next 5 min with the device finally being turned off.Results: The group exposed to CO2 gas had longer time in bed (361.3±55.2 min vs. 347.2±35.7 min, p=0.034) and total sleep time (311.0±74.3 min vs. 287.2±69.4 min, p=0.010) than the group exposed to room air. Meanwhile, the total arousal (19.7±9.5/h vs. 24.0±13.7/h, p=0.011) and non-REM arousal (20.9±11.3/h vs. 25.1±14.9/h, p=0.008) indices were lower in the group exposed to CO2 gas than in the group exposed to room air. However, perceived total sleep time or sleep latency and Karolinska Sleepiness Scale scores were not significantly different between the two groups.Conclusion: Exposure to low concentrations of CO2 improved the total sleep time and arousal index in adults with insomnia. Unexpectedly, CO2 administration was found to be effective for sleep maintenance.","PeriodicalId":90527,"journal":{"name":"Indian journal of sleep medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87650909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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