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Severe OSA (severe + osa)
Selected AbstractsAn analysis of the evidence-practice continuum: is surgery for obstructive sleep apnoea contraindicated?JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007Adam G. Elshaug BA BSc(Hons) MPH Abstract Rationale, aims and objectives, Currently there are multiple surgical interventions utilized in the treatment of adult obstructive sleep apnoea (OSA). The role of these operations remains controversial, with perspectives on treatment efficacy varying considerably. Despite this, their use is proliferating. Objectives, In this paper, we present the degree of variability that occurs in the application of these procedures, and examine the effectiveness of surgical intervention as a treatment for OSA. Method, A multi-centre retrospective clinical audit of consecutive, unselected surgical cases presenting at the sleep disorder clinics of two teaching hospitals in a major Australian city. Patients acted as their own historical controls, undergoing polysomnography pre and post surgery to gauge effectiveness. Results, On variability demonstrate 94 individuals in this cohort received 220 individual upper airway surgical procedures, 184 occurred in their first operation (mean 2.5 per person; range 1,7) and 36 occurred in a second operation (n = 18; cumulative mean of 4 per person; range 3,7). These 94 individuals received 41 varying combinations of surgery. Results on effectiveness demonstrate an overall physiological success rate of 13% (87% fail). One operation reduced OSA severity by 20% (patients still had severe OSA), and two operations by 35% (still moderate OSA). In contrast, conventional Continuous Positive Airway Pressure therapy controlled OSA (n = 64). Conclusions, This case study demonstrates substantial procedural variability and limited effectiveness. This raises questions as to the quality of care, the treatment-derived health outcomes of this population and of efficient resource allocation. This issue requires greater policy attention. [source] Continuous positive airway pressure treatment for obstructive sleep apnoea reduces resting heart rate but does not affect dysrhythmias: a randomised controlled trialJOURNAL OF SLEEP RESEARCH, Issue 3 2009SONYA CRAIG Summary Obstructive sleep apnoea (OSA) is associated with cardiovascular morbidity and may precipitate cardiac dysrhythmias. Uncontrolled reports suggest that continuous positive airway pressure (CPAP) may reduce dysrhythmia frequency and resting heart rate. We undertook a randomised controlled trial of therapeutic CPAP and compared with a subtherapeutic control which included an exploration of changes in dysrhythmia frequency and heart rate. Values are expressed as mean (SD). Eighty-three men [49.5 (9.6) years] with moderate,severe OSA [Oxygen Desaturation Index, 41.2 (24.3) dips per hour] underwent 3-channel 24-h electrocardiograms during normal daily activities, before and after 1 month of therapeutic (n = 43) or subtherapeutic (n = 40) CPAP. Recordings were manually analysed for mean heart rate, pauses, bradycardias, supraventricular and ventricular dysrhythmias. The two groups were well matched for age, body mass index, OSA severity, cardiovascular risk factors and history. Supraventricular ectopics and ventricular ectopics were frequently found in 95.2% and 85.5% of patients, respectively. Less common were sinus pauses (42.2%), episodes of bradycardia (12%) and ventricular tachycardias (4.8%). Compared with subtherapeutic control, CPAP reduced mean 24-h heart rate from 83.0 (11.5) to 79.7 (9.8) (P < 0.002) in the CPAP group compared with a non-significant rise (P = 0.18) from 79.0 (10.4) to 79.9 (10.4) in the subtherapeutic group; this was also the case for the day period analysed separately. There was no significant change in the frequencies of dysrhythmias after CPAP. Four weeks of CPAP therapy reduces mean 24-h heart rate possibly due to reduced sympathetic activation but did not result in a significant decrease in dysrhythmia frequency. [source] Increased cell-free DNA concentrations in patients with obstructive sleep apneaPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 6 2008Chol Shin md Aim:, Blood concentrations of cell-free DNA, which is considered to be released during apoptosis, are elevated under some pathological conditions such as cardiovascular disease and cancer. The association between obstructive sleep apnea (OSA) and cell-free DNA concentrations has not been reported so far. The purpose of the present study was to examine the association between OSA and plasma DNA concentrations. Methods:, A case,control study was conducted using a total of 164 men aged 39,67 years, who were free of coronary heart disease and cancer. Laboratory-based overnight polysomnography was performed for all participants. Results:, On the basis of polysomnography, patients with an apnea,hypopnea index (AHI) = 5,30 events/h were defined as having mild,moderate OSA (n = 33) and those with >30 events/h were defined as having severe OSA (n = 49). All 82 controls had AHI < 5 events/h. Plasma DNA concentrations from all participants were analyzed for the ,-globin gene using fluorescence-based real-time polymerase chain reaction. Patients with severe OSA had significantly higher plasma DNA concentrations than persons with mild,moderate OSA and those without OSA (P < 0.05). AHI was significantly associated with body mass index (P < 0.001), hypertension (P < 0.001), and plasma DNA concentration (P < 0.05). Conclusion:, After taking into account hypertension and other potential risk factors, persons with high plasma DNA concentrations (>8 µg/L) had approximately fourfold higher odds of OSA than those with low DNA levels. Further data are warranted to confirm the association for men and to evaluate the association for women. [source] Obstructive sleep apnoea is associated with risk factors comprising the metabolic syndromeRESPIROLOGY, Issue 7 2010Toshiki AKAHOSHI ABSTRACT Background and objective: Several features of OSA syndrome suggest that it is a manifestation of the metabolic syndrome (MS). In this study, we investigated the prevalence of the MS among male Japanese patients with OSA, as well as the relationship between OSA in non-obese patients and components of the MS other than obesity (hypertension, dyslipidaemia and glucose intolerance). Methods: The study included 416 Japanese men who were diagnosed as having OSA by polysomnography. Among these, 101 non-obese patients were selected and the severity of OSA, as well as the prevalence of hypertension, dyslipidaemia and glucose intolerance, was assessed. Results: The MS was associated with OSA in 218/416 patients (52.4%). A significant increase in the prevalence of the MS was associated with increased severity of OSA, as categorized according to AHI. In the non-obese patients with OSA (mean age 57.6 years, BMI 22.7 kg/m2, AHI 34.3 events/h), hypertension, dyslipidaemia and glucose intolerance were identified in 70 (69.3%), 43 (42.6%) and 20 patients (19.8%), respectively. At least two of these factors were identified in 40 patients (39.6%). Non-obese patients with severe OSA had a significantly higher prevalence of two or more of these factors (33/59 patients, 55.9%). Conclusions: Although Asians are generally less obese than Caucasians, the prevalence of the MS was high among Japanese patients with OSA, and even among non-obese patients, OSA was associated with risk factors for the MS. [source] Obstructive Sleep Apnea: A Comparison of Black and White SubjectsTHE LARYNGOSCOPE, Issue 7 2002Keith Meetze MD Abstract Objective To determine if the severity of obstructive sleep apnea syndrome (OSA) differs by racial group. Study Design Cross-sectional retrospective review. Setting University-based sleep disorders laboratory. Methods The study reviewed the results of 280 adult (>18 y) patients diagnosed with obstructive sleep apnea syndrome by overnight polysomnogram between July 1, 1999, and June 30, 2000. Factors analyzed included age, sex, race, presence of hypertension, body mass index (kg/m2), respiratory disturbance index (RDI), and lowest oxygen saturation level. Results Blacks with OSA are significantly more obese and have significantly higher rates of hypertension than white subjects with OSA. Black females with OSA are significantly younger than white females at the time of diagnosis (P = .005). Black males with OSA have significantly lower oxygen saturations than white males (P = .025). Conclusion Black males who present to the otolaryngologist-head and neck surgeon for evaluation of sleep-disordered breathing may be at increased risk of severe OSA. [source] Heart Rate Variability in Obstructive Sleep Apnea: A Prospective Study and Frequency Domain AnalysisANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2003Lorne J Gula F.R.C.P.C. Background: Cyclic variation of the heart rate is observed during apneic spells in obstructive sleep apnea (OSA). We hypothesized that autonomic changes would affect frequency-domain measures of heart rate variability (HRV). Methods: We studied 20 patients (15 men, 5 women, mean age 47.2 ± 12.2 years) with suspected OSA undergoing overnight polysomnography, and five patients (4 men, 1 woman, mean age 49.2 ± 8.6 years) with recently diagnosed sleep apnea undergoing polysomnography while wearing continuous positive airway pressure (CPAP). Holter monitors were applied during sleep studies and data were analyzed in 5-minute blocks over the course of the night. Using spectral analysis, low frequency (LF) and high frequency (HF) powers were calculated for each interval. Overall mean and standard deviation (SD) for LF power, HF power, and the LF:HF ratio were recorded for each patient. Comparisons were made between patients with severe OSA (apnea hypopnea index (AHI) > 30, n = 8), moderate OSA (AHI 1,30, n = 5), without OSA (AHI < 10, n = 7), and patients wearing CPAP (n = 5). Results: Assessment of overnight LF or HF power revealed no significant difference between the four groups. The LF:HF ratio, which represents sympathovagal balance, was higher among those with moderate disease compared to normals and those with severe OSA (both P = 0.037). The standard deviation of the LF:HF ratio was higher among those with moderate disease compared to normals (P = 0.0064) and those with severe OSA (P = 0.0006). OSA patients receiving CPAP behaved like patients with moderate OSA, with increased SD of the LF:HF ratio. Conclusions: The observed changes in the LF:HF ratio and its SD suggest an increased sympathetic tone and discordance in sympathovagal activity in moderate OSA, which is blunted in severe OSA. CPAP may restore autonomic defects, characteristic of severe OSA, to moderate levels. [source] | ||||||||||