INTRODUCTIONPatients with obstructive sleep apnoea (OSA) often present with excessive daytime sleepiness (EDS) as measured by the Epworth Sleepiness Scale (ESS). However, the relationship between EDS and OSA severity as measured by the apnoea-hypopnoea index (AHI) remains inconsistent. We hypothesise that this may be due to the usage and equal weightage of apnoea and hypopnoea events used in determining AHI and that apnoea and hypopnoea load as measured by their total durations may be a better metric to use. We sought to investigate if apnoea or hypopnoea load can display better correlation with ESS.

MATERIALS AND METHODSRetrospective analysis of 821 patients with AHI ≥5, who underwent in-laboratory polysomnogram for suspected OSA from January 2015-December 2015, was performed. Objective factors on polysomnogram were correlated with ESS.

RESULTSESS was correlated with age (r = -0.148, <0.001), number of apnoeas (r = 0.096, = 0.006), apnoea load (r = 0.102, = 0.003), apnoea index (r = 0.075, = 0.032), number of desaturations (r = 0.081, = 0.020), minimum SpO (r = -0.071, = 0.041), time SpO <85% (r = 0.075, = 0.031) and REM sleep duration (r = 0.099, = 0.004). Linear regression analysis found age ( <0.001), apnoea load ( = 0.005), REM ( = 0.021) and stage 1 sleep duration ( = 0.042) as independent factors correlated to ESS. The apnoea load calculated using duration in apnoea correlate with ESS in patients with severe OSA by AHI criteria compared to the mild category.

CONCLUSIONAHI does not correlate with ESS. Younger age, longer apnoea, stage 1 and REM sleep were independently related to higher ESS though the correlations were weak. Apnoea load should be taken into account when determining OSA severity.

Adult ; Age Factors ; Disorders of Excessive Somnolence ; diagnosis ; etiology ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; methods ; Retrospective Studies ; Severity of Illness Index ; Singapore ; Sleep Apnea Syndromes ; physiopathology ; Sleep Apnea, Obstructive ; complications ; diagnosis ; physiopathology ; Sleep, REM ; physiology ; Statistics as Topic

OBJECTIVETo determine the clinical value of portable sleep testing by Watch-PAT (PAT) in children with obstructive sleep apnea syndrome (OSAS).

METHODFifty cases of snoring children aged 3-11 years were randomly selected to undergo the polysomnography (PSG) and PAT simultaneously at the same night. The consistency of sleep parameters in OSAS and non - OSAS children were compared with PSG as reference standard, and ROC curve analysis was performed to assess the sensitivity and specificity in the diagnosis of OSAS with PAT portable sleep monitor.

RESULTFourteen cases were diagnosed as OSAS in 6-11 years group by PAT and PSG. But in 3-5 years group, only six children were diagnosed as OSAS, there was significant difference between PAT and PSG (P < 0.05). Among those 6-11 years old children, compared with non-OSAS, PAT study showed that III+IV stage sleep ((30.5 ± 2.4)% vs. (38.2 ± 2.3)%, χ(2)=4.31, P<0.05), REM sleep duration ((8.9 ± 2.5)% vs. (18.3 ± 2.1)%, χ² =4.31, P<0.05), TST ((458 ± 78) min vs. (522 ± 56) min, t=4.85, P<0.05) and sleep efficiency ((83.5 ± 3.1)% vs. (93.5 ± 3.5)%, t=3.75, P<0.05) decreased, I+II stage sleep ((61.5 ± 4.4)% vs. (44.1 ± 3.5)%, χ² =6.07, P<0.05), arousal index ((29.5 ± 8.2)/h vs. (10.6 ± 5.6)/h, t=3.70, P<0.05), AHI ((7.6 ± 5.3)/h vs. (2.1 ± 2.0)/h, t=2.40, P<0.05), RDI((18.2 ± 5.1)/h vs. (6.5 ± 3.9)/h, t=3.85, P<0.05) increased in OSAS children. Furthermore, the total sleep time (TST) ((458 ± 78) min vs. (430 ± 76) min, t=2.90, P<0.05) and sleep efficiency ((83.5 ± 3.1) % vs. (81.9 ± 4.3) %, t=2.45, P<0.05) were higher by PAT than scored by PSG. ROC curve analysis showed the best threshold selection of AHI 5.0, the sensitivity was 0.952, the specificity was 0.858. AHI 7.0, the sensitivity was 0.968, the specificity was 0.985. AHI 10, the sensitivity was 0.985 and the specificity was 0.99, but AHI 1.0, the sensitivity was 0.852 and the specificity was 0.785.

CONCLUSIONPAT can be used at home in school age children due to the high consistency with PSG and the high compliance.

Child ; Child, Preschool ; Humans ; Polysomnography ; methods ; ROC Curve ; Sensitivity and Specificity ; Sleep ; Sleep Apnea, Obstructive ; diagnosis ; Sleep Stages ; Snoring ; physiopathology

BACKGROUND/AIMS: Obstructive sleep apnea (OSA) is associated with an increased risk of obesity and non-alcoholic fatty liver disease (NAFLD), but it remains unclear whether the risk of NAFLD is independently related to OSA regardless of visceral obesity. Thus, the aim of the present study was to examine whether OSA alone or in combination with excessive daytime sleepiness (EDS) or short sleep duration was associated with NAFLD independent of visceral fat in Korean adults. METHODS: A total of 621 participants were selected from the Korean Genome and Epidemiology Study (KoGES). The abdominal visceral fat area (VFA) and hepatic fat components of the participants were assessed using computed tomography scans and they were then categorized into four groups depending on the presence of OSA and EDS. RESULTS: The proportions of NAFLD were 21.1%, 18.5%, 32.4%, and 46.7% in participants without OSA/EDS, with only EDS, with only OSA, and with both OSA and EDS, respectively. A combination of OSA and EDS increased the odds ratio (OR) for developing NAFLD (OR, 2.75; 95% confidence interval [CI], 1.21 to 6.28) compared to those without OSA/EDS, and this association remained significant (OR, 2.38; 95% CI, 1.01 to 5.59) even after adjusting for VFA. In short sleepers (< 5 hours) with OSA, the adjusted OR for NAFLD was 2.50 (95% CI, 1.08 to 5.75) compared to those sleeping longer than 5 hours without OSA. CONCLUSIONS: In the present study, OSA was closely associated with NAFLD in Korean adults. This association was particularly strong in those with EDS or short sleep duration regardless of VFA.
*Adiposity ; Aged ; Asian Continental Ancestry Group ; Chi-Square Distribution ; Disorders of Excessive Somnolence/diagnosis/*epidemiology/physiopathology ; Female ; Humans ; Intra-Abdominal Fat/*physiopathology ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Non-alcoholic Fatty Liver Disease/diagnosis/*epidemiology/physiopathology ; Obesity, Abdominal/diagnosis/*epidemiology/physiopathology ; Odds Ratio ; Republic of Korea/epidemiology ; Risk Factors ; *Sleep ; Sleep Apnea, Obstructive/diagnosis/*epidemiology/physiopathology

OBJECTIVETo get a comprehensive understanding about the relationship between obstructive sleep apnea (OSA) and asthma by reviewing the epidemiology, pathophysiology, and clinical manifestation and then summarizing the latest progress on diagnosis and treatment.

DATA SOURCESArticles referred in this review were mainly collected from a comprehensive search of the PubMed published in English from 1990 to 2015 with the terms "OSA" and "asthma" as the main keywords. Highly regarded older publications were also included.

STUDY SELECTIONInformation about the features of the two diseases in common, the pathophysiologic association between them and their current treatments from the literature search were identified, retrieved, and summarized.

RESULTSBoth OSA and asthma are very prevalent conditions. The incidences of them have kept on rising in recent years. Asthma is often accompanied by snoring and apnea, and OSA often combines with asthma, as well. They have many predisposing and aggravating factors in common. Possible shared direct mechanistic links between them include mechanical effects, intermittent hypoxia, nerve reflex, inflammation, leptin, etc. Indirect mechanistic links include medication, nose diseases, smoking, obesity, and gastroesophageal reflux disease. Since OSA presents many similar features with nocturnal asthma, some scholars termed them as a sole syndrome - "alternative overlap syndrome," and proved that asthma symptoms in those patients could be improved through the treatment of continuous positive airway pressure.

CONCLUSIONSOSA and asthma are closely associated in pathogenesis, symptoms, and therapies. With the growing awareness of the relationship between them, we should raise our vigilance on the coexistence of OSA in those difficult-to-control asthmatic patients. Further studies are still needed to guide the clinical works.

Asthma ; diagnosis ; physiopathology ; Humans ; Risk Factors ; Sleep Apnea, Obstructive ; diagnosis ; physiopathology

OBJECTIVE: to investigate the origin characters of snore in simple snorers and provide the basis for its treatment. METHOD: Thirty-two simple snorers diagnosed by polysomnography were induced to sleep by propofol and dexmedetomidine, then we observed the vibration sites, pattern and concomitant collapse of soft tissue in pharyngeal cavity by nasendoscopy. RESULT: Thirteen cases showed palatal fluttering only, and 1 case showed vibration of epiglottis only. Six cases showed palatal fluttering with vibration of epiglottis, and 2 cases showed palatal fluttering with vibration of epiglottis and tongue base. Five cases showed palatal fluttering with vibration of pharyngeal lateral wall, and 5 cases showed palatal fluttering with vibration of lateral wall, epiglottis and tongue base together. Palate and pharyngeal lateral wall vibrated strongly and always collapsed with vibrating, but epiglottis and tongue base usually vibrated slightly and seldom collapsed. CONCLUSION The palatal fluttering is the main source of snoring sounds for most simple snorers, then followed by vibration of palatal and pharyngeal lateral wall together. The site of collapse in pharyngeal cavity is consistent with the main site of vibration.
Endoscopy ; Epiglottis ; physiopathology ; Humans ; Palate ; physiopathology ; Pharynx ; physiopathology ; Polysomnography ; Propofol ; Sleep ; Sleep Apnea, Obstructive ; Snoring ; diagnosis ; Tongue ; physiopathology

OBJECTIVE: To study the clinical value of polysomnography (PSG) and ApneaGraph (AG200) in the diagnosis evaluation of obstructive sleep apnea hypopnea syndrome (OSAHS). METHOD: From January to December in 2012, 67 OSAHS patients diagnosed by PSG were examined by AG200. The apnea hypopnea index (AHI), hypopnea index (HI), apnea index (AI), the lowest oxygen saturation (LSaO2) was were detected and the results were analyzed statistically. RESULT: Significant differences were observed in AI, AHI, LSaO2 between AG200 and PSG (P < 0.05, respectively). No statistically significant difference was found in HI. The differences in HI between AG200 and PSG were not significant (P > 0.05). AHI, HI and LSaO2 was were significantly correlated between AG200 and PSG (r = 0.870, 0.743, 0.374, 0.716, P < 0.01). CONCLUSION AG200 could not replace PSG but could identify the level of upper airway obstruction.
Female ; Humans ; Male ; Polysomnography ; methods ; Sleep Apnea, Obstructive ; diagnosis ; physiopathology

OBJECTIVE: To assess the accuracy of a wrist worn Watch PAT 200 in diagnosing obstructive sleep apnea hypopnea syndrome (OSAHS) by comparing with the standard polysomnography (PSG). METHOD: Twenty-eight adults with suspected OSAHS underwent a standard in-lab PSG while wearing a Watch PAT 200. PSG events were manually scored according to standard criteria (AASM). Watch PAT data were collected including changes of apnea hypopnea, sleep stages, peripheral arterial volume, signal oxygen saturation and heart rate, and then apnea hypopnea index (AHI) was analyzed by an automatic algorithm. RESULT: For PSG, the mean score of AHI was (23.00 +/- 21.55)/h, and for Watch PAT, a mean score of AHI was (25.99 +/- 19.09)/h. There is a statistically positive correlation between PSG-AHI and PAT-AHI (r = 0.92, P < 0.01). The Coincidence rate of the sleep-wake assessment based on 30-second bins between the PSG and Watch PAT 200 was (89 +/- 6)%. CONCLUSION Watch PAT 200 could detected OSAHS based on AHI with comparable accuracy with standard PSG. And it would provide a reasonably accurate estimation of sleep and wakefulness stages in patients with OSAHS.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Monitoring, Ambulatory ; instrumentation ; Polysomnography ; instrumentation ; Sleep Apnea, Obstructive ; diagnosis ; physiopathology ; Sleep Stages

OBJECTIVE: To evaluate diagnostic significance of the noninvasive and objective 320-slice CT scan in the high pharynx resilience in the patients with obstructive sleep apnea/hypopnea syndrome. METHOD: Fifty patients with OSAHS and 10 patients with pharyngeal paraesthesia were included in the study. 320 slice CT scan was used to measure the sagittal diameters, transverse diameters and sectional area of the retropalatal region, retroglossal region. Calculating the pharynx wall resilience. Analyzing the correlativity of pharynx wall resilience, BMI and AHI. Fiber endoscope was used to assess the subsidence percentage of the pharynx wall. RESULT: Between OSAHS patients and pharyngeal paraesthesia patients, there was obviously difference in the retropalatal region and retroglossal region upper airway. The pharynx wall resiliences of retropalatal region were much more than that of retroglossal region. The later pharynx wall resiliences were much more than the fore-to-aft pharynx wall resiliences in the retropalatal region. BMI, AHI and the pharynx wall resilience were positive correlative to each other. But AHI and the pharynx wall resilience was nonlinear correlative. There was a good concordance between the pharynx wall resilience detected by 320CT and subsidence percentage of the pharynx wall detected by fiber endoscope. CONCLUSION 320 slice CT is a kind of simple, rapid and objective method to localize the high resilience area of upper respiratory tract, which can be benefit to the clinical diagnosis, the etiological study and the treatment of OSAHS. Based on physical examination, we propose that only one time of CT scan to the patients' upper airway at the Muller' stage is enough to localize the stenosis area, which can reduce radiation dosage dramatically.
Adolescent ; Adult ; Aged ; Female ; Humans ; Lung Compliance ; Male ; Middle Aged ; Sleep Apnea, Obstructive ; diagnosis ; diagnostic imaging ; physiopathology ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVE: To explore the roles of cardiovascular disease in obstructive sleep apnea hypopnea syndrome. METHOD: All 228 OSAHS patients underwent the examination of biochemical and complete blood count. The correlation analysis between AHI, AI, HI, LSaO2, complete blood count, and biochemical examination were employed. Two hundred and twenty-eight cases were divided into 3 groups according to sleep apnea hypopnea index (AHI): group 1 (5 < or = AHI < 15), group 2 (15 < or = AHI < 30), group 3 (30 < or = AHI). Morbidity of diseases in each group was calculated and the value of AHI and AI for morbidity was analyzed by using ROC curve. RESULT: (1) No statistically significant difference was found between group 1 and group 2 (chi2 = 0.428, P > 0.05). There was significant difference between group 3 and group 1, 2 (chi2 = 12.89, P < 0.05). The areas under the ROC curves of AHI and AI were 0. 678 and 0. 679,respectively. (2) There was significant positive correlation between AHI and complete blood count parameters (r = 0.176 to 0.194, P < 0.05). CONCLUSION OSAHS may be one of the predisposing factors of cardiovascular disease.
Adult ; Cardiovascular Diseases ; etiology ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; Risk Factors ; Sleep Apnea, Obstructive ; complications ; diagnosis ; physiopathology ; Young Adult

OBJECTIVE: To evaluate the predictive significance of the simplified Chinese STOP-Bang (S-B) scoring model in predicting obstructive sleep apnea hypopnea syndrome(OSAHS). METHOD: A total of 114 cases with suspected OSAHS were included in this study. S-B questionnaire was filled before polysomnography (PSG) monitoring. According to the PSG monitoring results the patients were divided into simple snoring, mild, moderate and severe OSAHS groups. The average S-B scores and the ratio of patients with S-B score > or = 3 were compared among the four groups respectively. The accuracy of S-B scoring model was analyzed and predictive significance was evaluated. RESULT: Eighty nine of 114 (78.1%) patients were classified as being at high risk of OSAHS by S-B scoring. The S-B scores showed an accrescent tendency as the severity of OSAHS increased. The scores in the four groups were 2.74 +/- 1.39, 3.25 +/- 1.16, 4.30 +/- 1.20, 4.79 +/- 1.41 respectively. Significant difference in S-B scores was found between severe OSAHS group and the other three groups respectively (P < 0.01), and also between moderate OSAHS group and mild OSAHS/simple snoring group (P < 0 01). The ratio of patients with high risk of OSAHS predicted by S-B scoring in OSAHS group (85.7%) was significantly higher than that in simple snoring group (47.8%) (P < 0.01). The sensitivities of S-B scoring model for AHI > or = 5 > or = > 15 and > or = 30 were 85.7%, 92 5% and 100%, respectively; the negative predictive values were 48.0% ,80.0% and 100%. The coincidence rate of S-B scoring model with golden standard to diagnose OSAHS was 78 9 . The area under the ROC curve at AHI cutoff of greater than or equal to 5 was 0 774. CONCLUSION S-B scoring model can be used to evaluate patients with high risk of OSAHS. It is a concise and easy-to-use tool to screen and predict moderate and severe OSAHS with relative high sensitivity and negative predictive value.
Adult ; Female ; Humans ; Male ; Mass Screening ; methods ; Middle Aged ; Polysomnography ; Prospective Studies ; Sleep Apnea, Obstructive ; diagnosis ; physiopathology ; Surveys and Questionnaires ; Young Adult