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Sleep Apnea Syndromes: HELP
Articles from Boston University
Based on 85 articles published since 2010
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These are the 85 published articles about Sleep Apnea Syndromes that originated from Boston University during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Editorial Supplemental Oxygen for Obstructive Sleep Apnea: Is There a Role After All? 2019

Gottlieb, Daniel J. ·1 VA Boston Healthcare System Boston, Massachusetts. · 2 Brigham & Women's Hospital Boston, Massachusetts and. · 3 Harvard Medical School Boston, Massachusetts. ·Am J Respir Crit Care Med · Pubmed #30063842.

ABSTRACT: -- No abstract --

2 Editorial Does Obstructive Sleep Apnea Treatment Reduce Cardiovascular Risk?: It Is Far Too Soon to Say. 2017

Gottlieb, Daniel J. ·Medical Service, VA Boston Healthcare System, Boston, Massachusetts2Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts. ·JAMA · Pubmed #28697240.

ABSTRACT: -- No abstract --

3 Editorial The link between sleep-disordered breathing and cognition in the elderly: New opportunities? 2017

Auerbach, Sanford / Yaffe, Kristine. ·From the Departments of Neurology, Psychiatry, and Behavioral Neurosciences (S.A.), Boston University School of Medicine and Sleep Disorders Center, Boston Medical Center, MA · and Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California, San Francisco, and San Francisco VA Medical Center. ·Neurology · Pubmed #28039313.

ABSTRACT: -- No abstract --

4 Editorial Does Treatment of Sleep Apnea Prevent Perioperative Complications? Wish We Knew! 2015

Gottlieb, Daniel J. ·VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston MA. ·Sleep · Pubmed #26194573.

ABSTRACT: -- No abstract --

5 Editorial Obstructive sleep apnea: how much is too much? 2015

Gottlieb, Daniel J. ·VA Boston Healthcare System, Brigham & Women's Hospital, and Harvard Medical School, Boston, MA. ·Sleep · Pubmed #25845683.

ABSTRACT: -- No abstract --

6 Editorial Sleep apnea and the risk of atrial fibrillation recurrence: structural or functional effects? 2014

Gottlieb, Daniel J. ·VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA. ·J Am Heart Assoc · Pubmed #24390147.

ABSTRACT: -- No abstract --

7 Review The shifting relationship between weight and pediatric obstructive sleep apnea: A historical review. 2019

Keefe, Katherine R / Patel, Prachi N / Levi, Jessica R. ·Boston University School of Medicine, Boston, Massachusetts. · Department of Otolaryngology, Boston University Medical Center, Boston, Massachusetts, U.S.A. ·Laryngoscope · Pubmed #30474230.

ABSTRACT: OBJECTIVES: For more than a century, pediatric obstructive sleep apnea (OSA) was associated with failure to thrive. However, that association has faded over the last few decades. A 21st century child with OSA is much more likely to be overweight than underweight. This raises the question: Has pediatric OSA changed over time, or has the rise of childhood obesity in the United States created a new, separate disease? This literature review explores the historical shift in the relationship between weight and OSA, and the associated changes in treatment. RESULTS: We demonstrate a clear transition in the prevalence of failure to thrive and obesity in the OSA literature in the mid-2000s. What is less clear is whether these two clinical phenotypes should be considered two distinct diseases, or whether subtle differences in one set of pathophysiologic pathways-adenotonsillar hypertrophy, altered inflammation, and increased energy expenditure-can lead to divergent metabolic outcomes. More research is needed to fully elucidate the pathophysiology of OSA in children with obesity. CONCLUSIONS: We may need new and different treatments for obesity-associated OSA as adenotonsillectomy-which is effective at reversing failure to thrive in OSA-is not as effective at treating OSA in children with obesity. One option is drug-induced sleep endoscopy, which could personalize and improve surgical treatment of OSA. There is some evidence that therapies used for OSA in adults (e.g., weight loss and positive airway pressure) are also helpful for overweight/obese children with OSA. Laryngoscope, 129:2414-2419, 2019.

8 Review Effect of continuous positive airway pressure treatment on pulmonary artery pressure in patients with isolated obstructive sleep apnea: a meta-analysis. 2016

Imran, Tasnim F / Ghazipura, Marya / Liu, Spencer / Hossain, Tanzib / Ashtyani, Hormoz / Kim, Bernard / Michael Gaziano, J / Djoussé, Luc. ·Department of Medicine, Brigham & Women's Hospital, VA Boston Healthcare System, Harvard Medical School, 1620 Tremont St, Boston, MA, 02120, USA. TFImran@partners.org. · Department of Population Health, New York University Langone Medical Center, 650 First Avenue, New York, NY, 10001, USA. · Heart Failure and Pulmonary Hypertension Program, Rutgers, New Jersey Medical School, 30 Prospect St, Hackensack, NJ, 07103, USA. · Department of Medicine, Brigham & Women's Hospital, VA Boston Healthcare System, Harvard Medical School, 1620 Tremont St, Boston, MA, 02120, USA. ·Heart Fail Rev · Pubmed #27000753.

ABSTRACT: Pulmonary hypertension (PH) can occur in patients with obstructive sleep apnea (OSA) in the absence of cardiac or lung disease. Data on the development and severity of PH, and the effect of continuous positive airway pressure (CPAP) therapy on pulmonary artery (PA) pressures in these patients have been inconsistent in the literature. We sought to determine whether CPAP therapy affects PA pressures in patients with isolated OSA in this meta-analysis. We searched PubMed, Medline, EMBASE and other databases from January 1980 to August 2015. Studies of patients with OSA, defined as an apnea-hypopnea index >10 events/h, and PH, defined as PA pressure >25 mmHg were included. Two reviewers independently extracted data and assessed risk of bias. A total of 222 patients from seven studies (341.53 person-years) had reported PA pressures before and after treatment with CPAP therapy. 77 % of participants were men, with a mean age of 52.5 years, a mean apnea-hypopnea index of 58 events/h, and mean PA pressure of 39.3 ± 6.3 mmHg. CPAP treatment duration ranged from 3 to 70 months. Using fixed effects meta-analysis, CPAP therapy was associated with a decrease in PA pressure of 13.3 mmHg (95 % CI 12.7-14.0) in our study population. This meta-analysis found that CPAP therapy is associated with a significantly lower PA pressure in patients with isolated OSA and PH.

9 Review Chronic Pulmonary Complications of Sickle Cell Disease. 2016

Mehari, Alem / Klings, Elizabeth S. ·Department of Pulmonary Diseases, Howard University College of Medicine, Washington, DC. · Pulmonary Center, Boston University School of Medicine, Boston, MA. Electronic address: klingon@bu.edu. ·Chest · Pubmed #26836905.

ABSTRACT: Sickle cell disease (SCD), the most common genetic hemolytic anemia worldwide, affects 250,000 births annually. In the United States, SCD affects approximately 100,000 individuals, most of African descent. Hemoglobin S (HbS) results from a glutamate-to-valine mutation of the sixth codon of the β-hemoglobin allele; the homozygous genotype (HbSS) is associated with the most prevalent and severe form of the disease. Other SCD genotypes include HbSC, composed of one HbS allele and one HbC (glutamate-to-lysine mutation) allele; and HbS-β-thalassemia(0) or HbS-β-thalassemia(+), composed of one HbS allele and one β-thalassemia allele with absent or reduced β-chain production, respectively. Despite advances in care, median survival remains in the fifth decade, due in large part to chronic complications of the disease. Chronic pulmonary complications in SCD are major contributors to this early mortality. Although our understanding of these conditions has improved much over the past 10 to 15 years, there remains no specific treatment for pulmonary complications of SCD. It is unclear whether conventional treatment regimens directed at non-SCD populations have equivalent efficacy in patients with SCD. This represents a critical research need. In this review, the authors review the state-of-the-art understanding of the following pulmonary complications of SCD: (1) pulmonary hypertension; (2) venous thromboembolic disease; (3) sleep-disordered breathing; (4) asthma and recurrent wheezing; and (5) pulmonary function abnormalities. This review highlights the advances as well as the knowledge gaps in this field to update clinicians and other health care providers and to garner research interest from the medical community.

10 Review Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction. 2014

Mentz, Robert J / Kelly, Jacob P / von Lueder, Thomas G / Voors, Adriaan A / Lam, Carolyn S P / Cowie, Martin R / Kjeldsen, Keld / Jankowska, Ewa A / Atar, Dan / Butler, Javed / Fiuzat, Mona / Zannad, Faiez / Pitt, Bertram / O'Connor, Christopher M. ·Duke University, Durham, North Carolina. Electronic address: robert.mentz@duke.edu. · Duke University, Durham, North Carolina. · Oslo University Hospital Ulleval, University of Oslo, and Institute of Clinical Sciences, University of Oslo, Oslo, Norway. · University of Groningen, Groningen, the Netherlands. · Framingham Heart Study, Framingham, Boston University School of Medicine, Boston, Massachusetts. · National Heart and Lung Institute, Imperial College and Imperial College London, Royal Brompton Hospital, London, United Kingdom. · Copenhagen University Hospital (Rigshospitalet), Copenhagen, and Aalborg University, Aalborg, Denmark. · Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland. · Emory University, Atlanta, Georgia. · INSERM, Centre d'Investigations Cliniques, Université de Lorraine and CHU de Nancy, Nancy, France. · University of Michigan School of Medicine, Ann Arbor, Michigan. ·J Am Coll Cardiol · Pubmed #25456761.

ABSTRACT: Heart failure patients are classified by ejection fraction (EF) into distinct groups: heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF). Although patients with heart failure commonly have multiple comorbidities that complicate management and may adversely affect outcomes, their role in the HFpEF and HFrEF groups is not well-characterized. This review summarizes the role of noncardiac comorbidities in patients with HFpEF versus HFrEF, emphasizing prevalence, underlying pathophysiologic mechanisms, and outcomes. Pulmonary disease, diabetes mellitus, anemia, and obesity tend to be more prevalent in HFpEF patients, but renal disease and sleep-disordered breathing burdens are similar. These comorbidities similarly increase morbidity and mortality risk in HFpEF and HFrEF patients. Common pathophysiologic mechanisms include systemic and endomyocardial inflammation with fibrosis. We also discuss implications for clinical care and future HF clinical trial design. The basis for this review was discussions between scientists, clinical trialists, and regulatory representatives at the 10th Global CardioVascular Clinical Trialists Forum.

11 Review Strategies in postoperative analgesia in the obese obstructive sleep apnea patient. 2013

Porhomayon, Jahan / Leissner, Kay B / El-Solh, Ali A / Nader, Nader D. ·Departments of *Anesthesiology, Division of Critical Care Medicine §Medicine, Division of Pulmonary, Critical Care, and Sleep, Medicine ∥Anesthesiology, Division of Cardiothoracic Anesthesia and Pain Medicine, VA Western New York Healthcare System, Buffalo School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY †Division of Anesthesia and Critical Care Medicine, VA Boston Healthcare System, Boston University School of Medicine, West Roxbury ‡Department of Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. ·Clin J Pain · Pubmed #23370080.

ABSTRACT: OBJECTIVE: Obstructive sleep apnea (OSA) has become an epidemic worldwide, and OSA patients frequently present for surgery. Comorbidities such as cardiovascular disease, diabetes, hypertension, stroke, gastrointestinal disorder, metabolic syndrome, chronic pain, delirium, and pulmonary disorder increase the perioperative risk for OSA patients. METHODS: This is a narrative review of the impact of sedative and analgesic therapy on the intraoperative and postoperative course of an obese OSA patient. RESULTS: An understanding of postoperative complications related to OSA and drug interactions in the context of opioid and nonopioid selection may benefit pain practitioner and patients equally. CONCLUSIONS: Management of acute postoperative pain in OSA patient remains complex. A comprehensive strategy is needed to reduce the complications and adverse events related to administration of analgesics and anesthetics.

12 Clinical Trial Measuring upper and lower airway resistance during sleep with the forced oscillation technique. 2012

Campana, Lisa M / Owens, R L / Suki, B / Malhotra, A. ·Boston University, Boston, MA, USA. lcampana@bu.edu ·Ann Biomed Eng · Pubmed #22127514.

ABSTRACT: The forced oscillation technique (FOT) is a non-invasive technique to monitor airway obstruction in those with asthma. The aim of this study was to design and validate a system to use FOT during sleep, both with and without bi-level positive airway pressure (BPAP), and to separate upper airway resistance from lower. 8 Hz pressure oscillations were supplied, over which the subject breathed, pressure and flow measurements were then used to calculate impedance. A phase-shift induced by the pressure transducer tubing was characterized, and FOT resistance was compared to steady flow resistance both with and without BPAP. A Millar catheter was used to measure pressure at the epiglottis, allowing the separation of upper from lower airway resistance. A phase shift of -0.010 s was calculated for the pressure transducer tubing, and the average error between FOT and steady flow resistance was -0.2 ± 0.2 cmH₂O/L/s without BPAP and 0.4 ± 0.2 cmH₂O/L/s with BPAP. The system was tested on three subjects, one healthy, one with obstructive sleep apnea, and one with asthma. The FOT was well tolerated and resistance was separated into upper and lower airway components. This setup is suitable for monitoring both upper and lower airway obstruction during sleep in those with and without asthma.

13 Clinical Conference Caring for patients with limited health literacy: a 76-year-old man with multiple medical problems. 2011

Paasche-Orlow, Michael. ·Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA. mpo@bu.edu ·JAMA · Pubmed #21828309.

ABSTRACT: Health literacy is the degree to which individuals have the capacity to obtain, process, and understand health information, skills, and services needed to make informed health decisions and take informed actions. Narratives from Mr J, a 76-year-old man with multiple medical problems and limited health literacy, and his physician exhibit some of the difficulties experienced by patients with limited health literacy. Clinicians can help patients with limited health literacy by removing unneeded complexity in their treatment regimens and in the health care system and by using teach-back methods to assess and improve understanding. Rather than a selective screening approach for limited health literacy, a patient-based universal precaution approach for confirming patient comprehension of critical self-care activities helps ensure that all patients have their health literacy needs identified.

14 Article Sex and age differentially affect GABAergic neurons in the mouse prefrontal cortex and hippocampus following chronic intermittent hypoxia. 2020

Rubin, Batsheva R / Milner, Teresa A / Pickel, Virginia M / Coleman, Christal G / Marques-Lopes, Jose / Van Kempen, Tracey A / Kazim, Syed Faraz / McEwen, Bruce S / Gray, Jason D / Pereira, Ana C. ·Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065, United States of America; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, United States of America. Electronic address: reichb@bu.edu. · Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065, United States of America; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, United States of America. Electronic address: tmilner@med.cornell.edu. · Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, United States of America. · Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065, United States of America; Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY 10029, United States of America; Nash Family Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America. · Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065, United States of America. · Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065, United States of America; Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY 10029, United States of America; Nash Family Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America. Electronic address: ana.pereira@mssm.edu. ·Exp Neurol · Pubmed #31837319.

ABSTRACT: Obstructive sleep apnea (OSA), a chronic sleep disorder characterized by repetitive reduction or cessation of airflow during sleep, is widely prevalent and is associated with adverse neurocognitive sequelae including increased risk of Alzheimer's disease (AD). In humans, OSA is more common in elderly males. OSA is characterized by sleep fragmentation and chronic intermittent hypoxia (CIH), and recent epidemiological studies point to CIH as the best predictor of neurocognitive sequelae associated with OSA. The sex- and age- specific effects of OSA-associated CIH on specific cell populations such as γ-aminobutyric acid (GABA)-ergic neurons in the hippocampus and the medial prefrontal cortex (mPFC), regions important for cognitive function, remain largely unknown. The present study examined the effect of 35 days of either moderate (10% oxygen) or severe (5% oxygen) CIH on GABAergic neurons in the mPFC and hippocampus of young and aged male and female mice as well as post-accelerated ovarian failure (AOF) female mice. In the mPFC and hippocampus, the number of GABA-labeled neurons increased in aged and young severe CIH males compared to controls but not in young moderate CIH males. This change was not representative of the individual GABAergic cell subpopulations, as the number of parvalbumin-labeled neurons decreased while the number of somatostatin-labeled neurons increased in the hippocampus of severe CIH young males only. In all female groups, the number of GABA-labeled cells was not different between CIH and controls. However, in the mPFC, CIH increased the number of parvalbumin-labeled neurons in young females and the number of somatostatin-labeled cells in AOF females but decreased the number of somatostatin-labeled cells in aged females. In the hippocampus, CIH decreased the number of somatostatin-labeled neurons in young females. CIH decreased the density of vesicular GABA transporter in the mPFC of AOF females only. These findings suggest sex-specific changes in GABAergic neurons in the hippocampus and mPFC with males showing an increase of this cell population as compared to their female counterparts following CIH. Age at exposure and severity of CIH also differentially affect the GABAergic cell population in mice.

15 Article Effects of continuous positive airway pressure on blood pressure in obstructive sleep apnea patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES). 2019

Javaheri, Sogol / Gottlieb, Daniel J / Quan, Stuart F. ·Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. · VA Boston Healthcare System, Boston, MA, USA. · Asthma and Airways Disease Research Center, University of Arizona, Tucson, AZ, USA. ·J Sleep Res · Pubmed #31726485.

ABSTRACT: Obstructive sleep apnea is associated with hypertension, and short-term studies have demonstrated a modest reduction in blood pressure with continuous positive airway pressure therapy. We evaluated the effects of continuous positive airway pressure versus sham continuous positive airway pressure on blood pressure in 1,101 participants with obstructive sleep apnea from the Apnea Positive Pressure Long-term Efficacy Study, a randomized, sham-controlled double-blinded study designed to assess the impact of continuous positive airway pressure on neurocognition. Participants with apnea-hypopnea index ≥ 10 were randomly assigned to continuous positive airway pressure or sham continuous positive airway pressure. Blood pressures measured in the morning and evening at baseline, 2 months and 6 months were analysed post hoc using a mixed-model repeated-measures analysis of variance. The largest magnitude reduction was approximately 2.4 mmHg in morning systolic pressure that occurred at 2 months in the continuous positive airway pressure arm as compared with an approximate 0.5 mmHg reduction in the sham group (continuous positive airway pressure effect -1.9 mmHg, p = .008). At 6 months, the difference between groups was diminished and no longer statistically significant (continuous positive airway pressure effect -0.9 mmHg, p = .12). Sensitivity analysis with use of multiple imputation approaches to account for missing data did not change the results. Treatment with continuous positive airway pressure for obstructive sleep apnea reduces morning but not evening blood pressure in a population with well-controlled blood pressure. The effect was greater after 2 than after 6 months of treatment.

16 Article Sequencing Analysis at 8p23 Identifies Multiple Rare Variants in DLC1 Associated with Sleep-Related Oxyhemoglobin Saturation Level. 2019

Liang, Jingjing / Cade, Brian E / He, Karen Y / Wang, Heming / Lee, Jiwon / Sofer, Tamar / Williams, Stephanie / Li, Ruitong / Chen, Han / Gottlieb, Daniel J / Evans, Daniel S / Guo, Xiuqing / Gharib, Sina A / Hale, Lauren / Hillman, David R / Lutsey, Pamela L / Mukherjee, Sutapa / Ochs-Balcom, Heather M / Palmer, Lyle J / Rhodes, Jessica / Purcell, Shaun / Patel, Sanjay R / Saxena, Richa / Stone, Katie L / Tang, Weihong / Tranah, Gregory J / Boerwinkle, Eric / Lin, Xihong / Liu, Yongmei / Psaty, Bruce M / Vasan, Ramachandran S / Cho, Michael H / Manichaikul, Ani / Silverman, Edwin K / Barr, R Graham / Rich, Stephen S / Rotter, Jerome I / Wilson, James G / Anonymous2621053 / Anonymous2631053 / Redline, Susan / Zhu, Xiaofeng. ·Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA. · Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142, USA. · Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA. · Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, USA. · Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; Center for Precision Health, School of Public Health and School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA. · Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, USA; VA Boston Healthcare System, Boston, MA 02132, USA. · California Pacific Medical Center Research Institute, San Francisco, CA 94107, USA. · Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90509, USA; Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90509, USA. · Department of Medicine, Computational Medicine Core, Center for Lung Biology, UW Medicine Sleep Center, University of Washington, Seattle, WA 98195, USA. · Family, Population, and Preventive Medicine, Program in Public Health, Stony Brook University School of Medicine, Stony Brook, NY 11794, USA. · Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia. · Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA. · Sleep Health Service, Respiratory and Sleep Service, Southern Adelaide Local Health Network, Adelaide, South Australia 5042, Australia; Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia 5042, Australia. · Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA. · School of Public Health, University of Adelaide, South Australia 5000, Australia. · Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA(19)Center for Genomic Medicine and Department of Anesthesia, Pain and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Anesthesia, Pain and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. · Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. · Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02142, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA(19)Center for Genomic Medicine and Department of Anesthesia, Pain and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Anesthesia, Pain and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. · Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA. · Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA. · Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA. · Department of Medicine, Division of Cardiology, Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27710, USA. · Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA 98101, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA. · Framingham Heart Study, Framingham, MA 01702, USA; Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; Section Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA. · Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. · Center for Public Health Genomics, University of Virginia, Charlottesville, VA 22908, USA; Department of Public Health Sciences, Biostatistics Section, University of Virginia, Charlottesville, VA 22908, USA. · Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA. · Center for Public Health Genomics, University of Virginia, Charlottesville, VA 22908, USA. · Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS 39216, USA. · A list of members and affiliations appears in the Supplemental Data. · Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. Electronic address: sredline@bwh.harvard.edu. · Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA. Electronic address: xxz10@case.edu. ·Am J Hum Genet · Pubmed #31668705.

ABSTRACT: Average arterial oxyhemoglobin saturation during sleep (AvSpO

17 Article Quantifying statistical uncertainty in metrics of sleep disordered breathing. 2019

Thomas, Robert J / Chen, Shuqiang / Eden, Uri T / Prerau, Michael J. ·Harvard Medical School, USA; Pulmonary, Critical Care & Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, USA. · Department of Mathematics and Statistics, Boston University. · Boston University, USA. · Harvard Medical School, USA; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, USA. Electronic address: mprerau@partners.org. ·Sleep Med · Pubmed #31540785.

ABSTRACT: BACKGROUND: The apnea-hypopnea index (AHI) (or one of its derivatives) is the primary clinical metric for characterizing sleep disordered breathing-the value of which with respect to a threshold determines severity of diagnosis and eligibility for treatment reimbursement. The index value, however, is taken as a perfect point estimate, with no measure of statistical uncertainty. Thus, current practice does not robustly account for variability in diagnosis/eligibility due to chance. In this paper, we quantify the statistical uncertainty associated with respiratory event indices for sleep disordered breathing and the effect of uncertainty on treatment eligibility. METHODS: We develop an empirical estimate of uncertainty using a non-parametric bootstrap on the interevent times, as well as a theoretical Poisson estimate reflecting the current formulation of the AHI. We then apply these methods to estimate AHI uncertainty for 2049 subjects (954/1095 M/F, age: mean 69 ± 9.1) from the Multi-Ethnic Study of Atherosclerosis (MESA). RESULTS AND CONCLUSIONS: The mean 95% empirical confidence interval width was 11.500 ± 6.208 events per hour and the mean 95% theoretical Poisson confidence interval width was 5.998 ± 2.897 events per hour, suggesting that uncertainty is likely a major confounding factor within the current diagnostic framework. Of the 278 subjects in the symptomatic population (ESS>10), 27% (76/278) had uncertain diagnoses given the 95% empirical confidence interval. Of the 2049 subjects in the full population, 43% (880/2049) had uncertain diagnoses given the 95% empirical confidence interval. The inclusion of subjects with uncertain diagnoses increases the number of eligible patients by 21.3% for the symptomatic population and by 84.8% for the full population. The exclusion of subjects with uncertain diagnoses given the 95% empirical confidence interval decreases the number of eligible patients by 12.4% for the symptomatic population and by 34.8% for full population. Additional analyses suggest that it is practically infeasible to gain diagnostic statistical significance through additional testing for a broad range of borderline cases. Overall, these results suggest that AHI uncertainty is a vital additional piece of information that would greatly benefit clinical practice, and that the inclusion of uncertainty in epidemiological analysis might help improve the ability for researchers to robustly link AHI with co-morbidities and long-term outcomes.

18 Article Evaluation of upper airway volume and craniofacial volumetric structures in obstructive sleep apnoea adults: A descriptive CBCT study. 2019

Mouhanna-Fattal, Carole / Papadopoulos, Moschos / Bouserhal, Joseph / Tauk, Alain / Bassil-Nassif, Nayla / Athanasiou, Athanasios. ·Abou Saab Building, Private Practice, Main Road, Mansourieh, Lebanon. · Aristotle University of Thessaloniki, Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, 54124 Thessaloniki, Greece. · Saint Joseph University, Department of Orthodontics, Beirut, Lebanon; Boston University, Department of Orthodontics and Dentofacial Orthopedics, Boston, USA. Electronic address: jbs.orthodontics@gmail.com. · Saint Joseph University, Department of Orthodontics, Beirut, Lebanon. · Horsh Tabet, Group Center, Private practice, Sin el Fil, Lebanon. · European University Cyprus, School of Medicine, Department of Dentistry, P.O. Box 22006, Nicosia, Cyprus. ·Int Orthod · Pubmed #31488344.

ABSTRACT: OBJECTIVE: The aim of this investigation was to assess, with a descriptive three-dimensional evaluation, the volume of upper airway (UAWV) and the volume of craniofacial structures in adult patients suffering from obstructive sleep apnoea (OSA) and compare them to the corresponding findings in adults with no sleep disorders. MATERIALS AND METHODS: The sample consisted of 54 adult males, 27 suffering from OSA diagnosed by means of the Apnoea Hypopnea Index and 27 with no history of sleep disorders. All subjects had a cone beam computerized tomography scan performed with the same head position. UAWV was assessed with the Amira® software, and craniofacial volumes by means of a specially developed data-processing program, which allowed the construction of tetrahedrons using anatomical landmarks. Assessed volumes were naso-maxillary, cranium upper anterior, oral cavity, post-oral cavity, hyoid to mandible, and post-hyoid. SPSS (version 19.0) was used for the statistical analysis. The Levene's test for Equality of Variance, the t-test for Equality of Means and the Mann-Whitney test were used to evaluate the variables. The level of significance was set at P ≤ 0.05. RESULTS: The mean value of UAWV was smaller in the OSA group. The post-hyoid volume, the calculated posterior volume, and the ratio of posterior to total volume showed differences between the groups. CONCLUSIONS: Craniofacial structures did not show significant differences between the groups, but in the OSA group the posterior space released for upper airway was significantly bigger and UAWV was significantly smaller.

19 Article Physical Activity in Overlap Syndrome of COPD and Obstructive Sleep Apnea: Relationship With Markers of Systemic Inflammation. 2019

Fitzgibbons, Christine M / Goldstein, Rebekah L / Gottlieb, Daniel J / Moy, Marilyn L. ·Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, Boston, Massachusetts. · Pulmonary and Critical Care, Boston University School of Medicine, Boston, Massachusetts. · Department of Veterans Affairs, Rehabilitation Research and Development Service, Washington, DC. · Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts. · Harvard Medical School, Boston, Massachusetts. ·J Clin Sleep Med · Pubmed #31383234.

ABSTRACT: STUDY OBJECTIVES: Low physical activity (PA) is associated with poor health outcomes in chronic obstructive pulmonary disease (COPD). Overlap syndrome (OVS), the co-occurrence of COPD and obstructive sleep apnea (OSA), is highly prevalent. Little is known about PA in OVS, and its relationship with markers of systemic inflammation. METHODS: We studied 256 persons with stable COPD, 61 (24%) of whom had OVS, who were well characterized in two previous PA studies. PA was directly assessed with the Omron HJ-720ITC pedometer. C-reactive protein (CRP) and interleukin-6 (IL-6) were assayed from peripheral blood. Linear regression models, adjusting for age and forced expiratory volume in 1 second (FEV1) % predicted, assessed daily step counts and CRP and IL-6 levels in OVS, compared to COPD alone. Linear regression models, adjusting for age, FEV1 % predicted, and coronary artery disease, assessed the relationships between PA and CRP and IL-6 in those with OVS versus those with COPD alone. RESULTS: Compared to COPD alone, persons with OVS walked 672 fewer steps per day (95% CI -1,317 to -28, CONCLUSIONS: Persons with OVS have significantly lower levels of PA and higher levels of inflammatory biomarkers, compared to COPD alone. Lower PA is significantly associated with higher IL-6 levels in OVS.

20 Article Mobile App Use for Insomnia Self-Management: Pilot Findings on Sleep Outcomes in Veterans. 2019

Reilly, Erin D / Robinson, Stephanie A / Petrakis, Beth Ann / Kuhn, Eric / Pigeon, Wilfred R / Wiener, Renda Soylemez / McInnes, D Keith / Quigley, Karen S. ·Center for Social and Community Reintegration Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States. · Center for Healthcare Outcomes and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States. · National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States. · Stanford University School of Medicine, Standford, CA, United States. · Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, United States. · University of Rochester Medical Center, Rochester, NY, United States. · Boston University School of Medicine, Boston, MA, United States. · Boston University School of Public Health, Boston, MA, United States. · Northeastern University, Boston, MA, United States. ·Interact J Med Res · Pubmed #31342904.

ABSTRACT: BACKGROUND: Sleep disturbance is a major health concern among US veterans who have served since 2001 in a combat theater in Iraq or Afghanistan. We report subjective and objective sleep results from a pilot trial assessing self-management-guided use of a mobile app (CBT-i Coach, which is based on cognitive behavioral therapy for insomnia) as an intervention for insomnia in military veterans. OBJECTIVE: The primary aim of this study was to evaluate changes in subjective and objective sleep outcomes from pre to postintervention. METHODS: Subjective outcomes included the Insomnia Severity Index, the Pittsburgh Sleep Quality Inventory, and sleep-related functional status. A wearable sleep monitor (WatchPAT) measured objective sleep outcomes, including sleep efficiency, percent rapid eye movement (REM) during sleep, sleep time, and sleep apnea. A total of 38 participants were enrolled in the study, with 18 participants being withdrawn per the protocol because of moderate or severe sleep apnea and 9 others who dropped out or withdrew. Thus, 11 participants completed the full 6-week CBT-i Coach self-management intervention (ie, completers). RESULTS: Completer results indicated significant changes in subjective sleep measures, including reduced reports of insomnia (Z=-2.68, P=.007) from pre (mean 16.63, SD 5.55) to postintervention (mean 12.82, SD 3.74), improved sleep quality (Z=-2.37, P=.02) from pre (mean 12.82, SD 4.60) to postintervention (mean 10.73, SD 3.32), and sleep-related functioning (Z=2.675, P=.007) from pre (mean 13.86, SD 3.69) to postintervention (mean 15.379, SD 2.94). Among the objective measures, unexpectedly, objective sleep time significantly decreased from pre to postintervention (χ CONCLUSIONS: These findings suggest that the CBT-i Coach app can improve subjective sleep and that incorporating objective sleep measures into future, larger clinical trials or clinical practice may yield important information, particularly by detecting previously undetected sleep apnea. TRIAL REGISTRATION: ClinicalTrials.gov NCT02392000; http://clinicaltrials.gov/ct2/show/NCT02392000.

21 Article Factors affecting completion of sleep studies in pediatric patients with sleep-disordered breathing. 2019

Kohn, Jocelyn L / Rubin, Samuel J / Patel, Jay / Dia, Reem / Levi, Jessica R / Cohen, Michael B. ·Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, U.S.A. · Boston University School of Medicine, Boston, Massachusetts, U.S.A. · University of Massachusetts Boston, Boston, Massachusetts, U.S.A. · Department of Otolaryngology-Head and Neck Surgery, Veterans Affairs Hospital Boston, Boston, Massachusetts, U.S.A. ·Laryngoscope · Pubmed #31145485.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To determine demographic factors associated with failure to complete ordered polysomnograms (PSGs) in pediatric patients with sleep-disordered breathing (SDB). STUDY DESIGN: Retrospective case series. METHODS: This study was conducted at an urban safety-net hospital and included 829 patients with SDB, ages 0 to 18 years, for whom PSGs were ordered during a 1-year time period. Factors including age, race, language, and insurance status were reported for each patient. The data were reviewed by univariate and multivariate analyses to determine factors associated with failure to complete the PSGs. RESULTS: Of 829 patients, 200 (24%) failed to complete the PSGs. By univariate analysis, age was the only significant factor affecting completion (P < .01), with toddlers having the highest rate of completion (81%) and teenagers the lowest (68%). Primary language and insurance type were not significantly associated with completion rate. Hispanics were more likely than non-Hispanic whites to complete the PSGs (81% vs. 70%), but this did not achieve statistical significance. By multivariate analysis, the teenage group remained significantly less likely to complete sleep study than toddlers (P = .04). There was again no statistically significant difference for race by multivariate analysis. CONCLUSIONS: Among pediatric patients with SDB, age is a significant factor affecting completion of PSGs. Racial minorities and non-English-speaking patients were not less likely to complete PSGs. Other demographic factors do not appear to be associated with completion of PSGs. LEVEL OF EVIDENCE: 4 Laryngoscope, 2019.

22 Article Obstructive Sleep Apnea in Children With Down Syndrome: Screening and Effect of Guidelines. 2019

Hsieh, Adam / Gilad, Amir / Wong, Kevin / Cohen, Michael / Levi, Jessica. ·1 Boston University, Boston, MA, USA. · 2 Boston Medical Center, Boston, MA, USA. ·Clin Pediatr (Phila) · Pubmed #31030547.

ABSTRACT: Previous studies have shown low rates of screening for obstructive sleep apnea in children with Down syndrome (DS), a high-prevalence population. Our study investigated the impact of the 2011 American Academy of Pediatrics guidelines, which recommends screening for obstructive sleep apnea with polysomnogram by age 4 years. We conducted a retrospective chart review of patients 0 to 18 years of age with DS seen at a medical center between 2006 and 2016. Polysomnogram screening frequency was investigated and compared pre- and post-guideline publication. A total of 136 participants were identified. Thirty-two percent (44/136) of children with DS were referred for polysomnogram, all of whom had symptoms. Although overall referral frequency was unaffected, completion frequency by age 18 years improved after publication (30% [21/69] vs 19% [13/67];

23 Article Associations of variants In the hexokinase 1 and interleukin 18 receptor regions with oxyhemoglobin saturation during sleep. 2019

Cade, Brian E / Chen, Han / Stilp, Adrienne M / Louie, Tin / Ancoli-Israel, Sonia / Arens, Raanan / Barfield, Richard / Below, Jennifer E / Cai, Jianwen / Conomos, Matthew P / Evans, Daniel S / Frazier-Wood, Alexis C / Gharib, Sina A / Gleason, Kevin J / Gottlieb, Daniel J / Hillman, David R / Johnson, W Craig / Lederer, David J / Lee, Jiwon / Loredo, Jose S / Mei, Hao / Mukherjee, Sutapa / Patel, Sanjay R / Post, Wendy S / Purcell, Shaun M / Ramos, Alberto R / Reid, Kathryn J / Rice, Ken / Shah, Neomi A / Sofer, Tamar / Taylor, Kent D / Thornton, Timothy A / Wang, Heming / Yaffe, Kristine / Zee, Phyllis C / Hanis, Craig L / Palmer, Lyle J / Rotter, Jerome I / Stone, Katie L / Tranah, Gregory J / Wilson, James G / Sunyaev, Shamil R / Laurie, Cathy C / Zhu, Xiaofeng / Saxena, Richa / Lin, Xihong / Redline, Susan. ·Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States of America. · Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States of America. · Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America. · Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX United States of America. · Center for Precision Health, School of Public Health and School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX United States of America. · Department of Biostatistics, University of Washington, Seattle, WA United States of America. · Department of Psychiatry, University of California, San Diego, CA, United States of America. · The Children's Hospital at Montefiore, Division of Respiratory and Sleep Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America. · Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America. · Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America. · Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America. · California Pacific Medical Center Research Institute, San Francisco, CA, United States of America. · USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States of America. · Computational Medicine Core, Center for Lung Biology, UW Medicine Sleep Center, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle WA, United States of America. · Department of Public Health Sciences, University of Chicago, Chicago, IL, United States of America. · VA Boston Healthcare System, Boston, MA, United States of America. · Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. · Departments of Medicine and Epidemiology, Columbia University, New York, NY, United States of America. · Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, UC San Diego School of Medicine, La Jolla, CA, United States of America. · Department of Data Science, University of Mississippi Medical Center, Jackson, MS, United States of America. · Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia. · Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia. · Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America. · Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States of America. · Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States of America. · Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America. · Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America. · The Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, United States of America. · Department of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, United States of America. · San Francisco VA Medical Center, San Francisco, CA, United States of America. · School of Public Health, University of Adelaide, South Australia, Australia. · Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson MS, United States of America. · Division of Genetics, Brigham and Women's Hospital, Boston, MA, United States of America. · Division of Medical Sciences, Harvard Medical School, Boston, MA, United States of America. · Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States of America. · Center for Genomic Medicine and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, United States of America. · Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America. ·PLoS Genet · Pubmed #30990817.

ABSTRACT: Sleep disordered breathing (SDB)-related overnight hypoxemia is associated with cardiometabolic disease and other comorbidities. Understanding the genetic bases for variations in nocturnal hypoxemia may help understand mechanisms influencing oxygenation and SDB-related mortality. We conducted genome-wide association tests across 10 cohorts and 4 populations to identify genetic variants associated with three correlated measures of overnight oxyhemoglobin saturation: average and minimum oxyhemoglobin saturation during sleep and the percent of sleep with oxyhemoglobin saturation under 90%. The discovery sample consisted of 8,326 individuals. Variants with p < 1 × 10(-6) were analyzed in a replication group of 14,410 individuals. We identified 3 significantly associated regions, including 2 regions in multi-ethnic analyses (2q12, 10q22). SNPs in the 2q12 region associated with minimum SpO2 (rs78136548 p = 2.70 × 10(-10)). SNPs at 10q22 were associated with all three traits including average SpO2 (rs72805692 p = 4.58 × 10(-8)). SNPs in both regions were associated in over 20,000 individuals and are supported by prior associations or functional evidence. Four additional significant regions were detected in secondary sex-stratified and combined discovery and replication analyses, including a region overlapping Reelin, a known marker of respiratory complex neurons.These are the first genome-wide significant findings reported for oxyhemoglobin saturation during sleep, a phenotype of high clinical interest. Our replicated associations with HK1 and IL18R1 suggest that variants in inflammatory pathways, such as the biologically-plausible NLRP3 inflammasome, may contribute to nocturnal hypoxemia.

24 Article Outcomes of Children with Mild Obstructive Sleep Apnea Treated Nonsurgically: A Retrospective Review. 2019

Kohn, Jocelyn L / Cohen, Michael B / Patel, Prachi / Levi, Jessica R. ·1 Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, USA. · 2 Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, VA Boston Medical Center, Boston, Massachusetts, USA. · 3 Boston University School of Medicine, Boston, Massachusetts, USA. ·Otolaryngol Head Neck Surg · Pubmed #30744500.

ABSTRACT: OBJECTIVE: Obstructive sleep apnea (OSA) is characterized by partial or complete obstruction of the upper airway and is commonly caused by adenotonsillar hypertrophy in children. Accordingly, adenotonsillectomy is considered first-line treatment. However, in cases of mild OSA, nonsurgical management has been proposed as an alternative. The purpose of this study was to determine the outcomes of pediatric patients with mild obstructive sleep apnea (OSA) treated without surgical intervention. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care university medical center. SUBJECTS AND METHODS: The medical records of children ages 2 to 18 years with OSA at Boston Medical Center from January 2000 to April 2017 were reviewed. Children with mild OSA (apnea- hypopnea index [AHI] between 1 and 5), who were managed nonsurgically and had serial polysomnograms, were included. Serial sleep studies were compared to assess for patterns of change. RESULTS: Of the 201 patients with mild OSA who were identified, 104 (52%) opted for initial nonsurgical management. Of those, 91 had a follow-up sleep study to reassess their OSA. Forty-two (46 %) had a greater than 20% decrease in AHI and 38 (41%) had a greater than 20% increase on the second sleep study. The remaining 11 had changes less than 20% in either direction. There was not a significant difference in the proportion of patients with an increase vs decrease in AHI on follow-up sleep study ( P > .05). CONCLUSIONS: Mild pediatric OSA has approximately equal chances of worsening or improvement over time without surgical intervention, which is useful for counseling parents on treatment options.

25 Article Clinical Practice Guideline Summary for Clinicians: The Role of Weight Management in the Treatment of Adult Obstructive Sleep Apnea. 2019

Billings, Martha E / Krishnan, Vidya / Su, George / Donovan, Lucas M / Patel, Sanjay R / Hudgel, David W / Ahasic, Amy M / Wilson, Kevin C / Thomson, Carey C. ·1 Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington. · 2 Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio. · 3 Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, California. · 4 Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. · 5 University of Manitoba, Winnipeg, Manitoba, Canada. · 6 Section of Pulmonary and Critical Care Medicine, Department of Medicine, Norwalk Hospital and Western Connecticut Health Network, Norwalk, Connecticut. · 7 Department of Medicine, Boston University School of Medicine, Boston, Massachusetts. · 8 Division of Pulmonary and Critical Care, Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts; and. · 9 Harvard Medical School, Boston, Massachusetts. ·Ann Am Thorac Soc · Pubmed #30742491.

ABSTRACT: -- No abstract --

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