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Sleep Apnea Syndromes: HELP
Articles from Crete
Based on 56 articles published since 2010
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These are the 56 published articles about Sleep Apnea Syndromes that originated from Crete during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
26 Article Cardiovascular Effect and Symptom Profile of Obstructive Sleep Apnea: Does Sex Matter? 2019

Bouloukaki, Izolde / Mermigkis, Charalampos / Markakis, Manolis / Pataka, Athanasia / Alexaki, Ioanna / Ermidou, Christina / Moniaki, Violeta / Mauroudi, Eleni / Michelakis, Stylianos / Schiza, Sophia E. ·Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece. ·J Clin Sleep Med · Pubmed #31855159.

ABSTRACT: STUDY OBJECTIVES: To evaluate the influence of sex on obstructive sleep apnea (OSA)-related symptoms and prevalent cardiovascular disease (CVD) in a large clinical population of patients. METHODS: A total of 6,716 patients (mean age 52 years, 24% women) had undergone diagnostic polysomnography and completed the Epworth Sleepiness Scale (ESS), Athens Insomnia Scale, and Beck Depression Inventory. We investigated the predictive value of sex on associated symptoms and prevalent cardiovascular disease, after adjustment for relevant confounding factors including age, obesity, and comorbidities. RESULTS: Most of the patients (90%) had OSA (apnea-hypopnea index [AHI] ≥ 5 events/h), and 66% were obese. Women were older than men and had a higher body mass index; however, men had a thicker neck circumference, a higher waist-to-hip ratio, and increased OSA severity (AHI 36 versus 27 events/h, P < .001). Female sex independently predicted prevalent CVD after adjustment for confounders (odds ratio [95% CI] 1.476 [1.154-1.887], P = .002). Men independently were more likely to report driving problems (3.359 [2.470-4.569], P < .001) and excessive daytime sleepiness (ESS ≥ 16) (1.355 [1.036-1.773], P = .027). Furthermore, female sex was an independent predictive factor for depressive symptoms (2.473 [1.831-3.340], P < .001), frequent awakenings (1.703 [1.323-2.192], P < .001), nocturia (1.727 [1.340-2.226], P < .001) and morning headaches (1.855 [1.488-2.326], P < .001). CONCLUSIONS: Females referred for sleep studies were more likely to exhibit CVD and less likely to complain of typical OSA symptoms than males in this large clinical patient cohort.

27 Article Use of the Clinical Global Impression scale in sleep apnea patients - Results from the ESADA database. 2019

Dieltjens, Marijke / Verbraecken, Johan A / Hedner, Jan / Vanderveken, Olivier M / Steiropoulos, Paschalis / Kvamme, John A / Saaresranta, Tarja / Tkacova, Ruzena / Marrone, Oreste / Dogas, Zoran / Schiza, Sofia / Grote, Ludger / Anonymous1191060. ·Antwerp University Hospital, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Belgium. · Department of Sleep Medicine, Sahlgrenska University Hospital, Sweden; Sahlgrenska Academy, Gothenburg University, Sweden. · Sleep Unit, Department of Pneumonology, Democritis University of Thrace, Alexandroupolis, Greece. · Sleep Laboratory and ENT Department, Förde Central Hospital, Förde, Norway. · Division of Medicine and Department of Pulmonary Diseases, Turku University Hospital and Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Finland. · Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P. J. Safarik University and L. Pasteur University Hospital, Kosice, Slovakia. · National Research Council, Institute of Biomedicine and Molecular Immunology, Palermo, Italy. · Sleep Medicine Center, Department of Neurosciences, University of Split School of Medicine, Split, Croatia. · Sleep Disorders Centre, University Hospital, Crete, Greece. · Department of Sleep Medicine, Sahlgrenska University Hospital, Sweden; Sahlgrenska Academy, Gothenburg University, Sweden. Electronic address: ludger.grote@lungall.gu.se. ·Sleep Med · Pubmed #30555029.

ABSTRACT: OBJECTIVE/BACKGROUND: The Clinical Global Impression scale (CGI) reflects the clinician's assessment of the disease impact on patient's global functioning. We assessed predictors of CGI scale rating in patients with obstructive sleep apnea (OSA). PATIENTS/METHODS: Consecutive patients with suspected OSA (n = 7581) were identified in the European Sleep Apnea Database (ESADA). Anthropometrics, comorbidities, apnea severity obtained by polygraphy or polysomnography, and daytime sleepiness [Epworth Sleepiness Scale (ESS)] were assessed. The CGI 7-point scale was completed at the end of the diagnostic process (CGI-severity, ie, CGI-S) and, in a subpopulation, at treatment follow-up (CGI-Improvement). RESULTS: CGI-S was rated mild to moderate in 44% of patients. CGI rating at any given apnea intensity was worse in women than in men (p < 0.01). Patients undergoing polygraphy (n = 5075) were more frequently rated as severely ill compared to those studied with polysomnography (19.0% vs 13.0%, p < 0.001). In patients aged ≤65 years, CGI scoring was generally better than in the elderly despite a similar degree of OSA (eg, 'normal, not ill' 24.2% vs 15.3%, p < 0.01, respectively). Independent predictors of CGI rating included age, BMI, AHI, ESS, cardio-metabolic comorbidities, and diagnosis based on polygraphy. CGI-improvement rating (Beta = -0.406, p < 0.01) was superior to sleep apnea severity or ESS-score (Beta = 0.052 and -0.021, p = 0.154 and 0.538 respectively) at baseline for prediction of good CPAP compliance at follow-up. CONCLUSIONS: CGI rating is confounded by gender, age class and the type of sleep diagnostic method. As OSA phenotypes differ, CGI may contribute as a clinical tool to reflect the significance of clinical disease.

28 Article Nutrigenetic genotyping study in relation to Sleep Apnea Clinical Score. 2019

Gkouskou, K / Vlastos, I M / Chaniotis, D / Markaki, A / Choulakis, K / Prokopakis, E. ·Embiodiagnostics, Melissinon and Damvergidon, Heraklion, Crete, Greece. · Department of Biomedical Sciences, University of West Attica, 28, Agiou Spiridonos, Egaleo, Athens, Greece. · ENT Private Office, 29 Voreiou Ipirou Str, Athens, Greece. giannisvlastos@yahoo.gr. · Department of Nutrition and Dietetics, Technological Educational Institute of Crete, Heraklion, Greece. · ENT Private Office, 29 Voreiou Ipirou Str, Athens, Greece. · Department of Otolaryngology Head and Neck Surgery, University Hospital of Heraklion, Crete, Greece. ·Sleep Breath · Pubmed #30334133.

ABSTRACT: BACKGROUND: Conflicting results regarding associations between single nucleotide polymorphisms (SNPs) in IRS1, ACE, APOE, PPARG, MTHFR, 5HT2AR, BDNF, and FTO genes and obstructive sleep apnea have been reported in previous studies. OBJECTIVE: To assess pleiotropic associations between these gene polymorphisms that are commonly being studied in a nutrigenetic test and sleep apnea. METHODS: One hundred and nine subjects of Caucasian origin who have performed a commercially available nutrigenetic test that includes the aforementioned polymorphisms were divided into two groups depending on the results of their Sleep Apnea Clinical Score (SACS ≤ 15 or > 15). Statistical significant differences in the prevalence of the polymorphisms under study between the groups were assessed with the Chi-squared test. Possible associations of the polymorphisms with SACS and BMI were further evaluated with logistic regression analyses. RESULTS: From the polymorphisms studied, only variant rs9939609 in the FTO gene was more prevalent in people with high sleep apnea clinical score (χ CONCLUSION: We failed to confirm previously reported associations between the majority of the studied polymorphisms and sleep apnea. Body weight seems to be an important cofounding factor that needs to be accounted for, when genetic association studies are performed for sleep apnea.

29 Article The Association Between Adherence to Positive Airway Pressure Therapy and Long-Term Outcomes in Patients With Obesity Hypoventilation Syndrome: A Prospective Observational Study. 2018

Bouloukaki, Izolde / Mermigkis, Charalampos / Michelakis, Stylianos / Moniaki, Violeta / Mauroudi, Eleni / Tzanakis, Nikolaos / Schiza, Sophia E. ·Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece. ·J Clin Sleep Med · Pubmed #30176976.

ABSTRACT: STUDY OBJECTIVES: To assess the role of different levels of adherence and long-term effects of positive airway pressure (PAP) therapy on gas exchange, sleepiness, quality of life, depressive symptoms, and all-cause mortality in patients with obesity hypoventilation syndrome (OHS). METHODS: A total of 252 patients with newly diagnosed OHS were followed up for a minimum of 2 years after PAP initiation. PAP adherence (h/night) was monitored. Arterial blood gas samples were taken with patients being alert for more than 4 hours after morning awakening. Subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]), quality of life (Short Form 36 [SF-36]) and patient's depressive symptoms (Beck Depression Inventory [BDI]) were assessed before and at the end of the follow-up period, along with all-cause mortality. RESULTS: At the end of the follow-up period (median duration [25th-75th percentile], 30 [24-52] months), PaO CONCLUSIONS: Increased hours of use and long-term therapy with PAP are effective in the treatment of patients with OHS. Clinicians should encourage adherence to PAP therapy in order to provide a significant improvement in clinical status and gas exchange in these patients. COMMENTARY: A commenary on this article appears in this issue on page 1455. CLINICAL TRIAL REGISTRATION: Title: PAP Therapy in Patients With Obesity Hypoventilation Syndrome, Registry: ClinicalTrials.gov, Identifier: NCT03449641, URL: https://clinicaltrials.gov/ct2/show/NCT03449641.

30 Article Clinical presentation of patients with suspected obstructive sleep apnea and self-reported physician-diagnosed asthma in the ESADA cohort. 2018

Bonsignore, Maria R / Pepin, Jean-Louis / Anttalainen, Ulla / Schiza, Sophia E / Basoglu, Ozen K / Pataka, Athanasia / Steiropoulos, Paschalis / Dogas, Zoran / Grote, Ludger / Hedner, Jan / McNicholas, Walter T / Marrone, Oreste / Anonymous4950954. ·Biomedical Department of Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy. · CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy. · Université Grenoble Alpes, INSERM U1042, CHU de Grenoble, Grenoble, France. · Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland. · Department of Physiology, Sleep Research Centre, University of Turku, Turku, Finland. · Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece. · Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey. · Department of Respiratory Medicine, G. Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece. · Sleep Unit, Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece. · Split Sleep Medicine Center and Department of Neuroscience, University of Split School of Medicine, Split, Croatia. · Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. · Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. · Department of Respiratory and Sleep Medicine, St. Vincent's University Hospital, Dublin, Ireland. · Conway Research Institute, University College Dublin, Dublin, Ireland. ·J Sleep Res · Pubmed #29998568.

ABSTRACT: Obstructive sleep apnea (OSA) and asthma are often associated and several studies suggest a bidirectional relationship between asthma and OSA. This study analyzed the characteristics of patients with suspected OSA from the European Sleep Apnea Database according to presence/absence of physician-diagnosed asthma. Cross-sectional data in 16,236 patients (29.1% female) referred for suspected OSA were analyzed according to occurrence of physician-diagnosed asthma for anthropometrics, OSA severity and sleepiness. Sleep structure was assessed in patients studied by polysomnography (i.e. 48% of the sample). The prevalence of physician-diagnosed asthma in the entire cohort was 4.8% (7.9% in women, 3.7% in men, p < 0.0001), and decreased from subjects without OSA to patients with mild-moderate and severe OSA (p = 0.02). Obesity was highly prevalent in asthmatic women, whereas BMI distribution was similar in men with and without physician-diagnosed asthma. Distribution of OSA severity was similar in patients with and without physician-diagnosed asthma, and unaffected by treatment for asthma or gastroesophageal reflux. Asthma was associated with poor sleep quality and sleepiness. Physician-diagnosed asthma was less common in a sleep clinic population than expected from the results of studies in the general population. Obesity appears as the major factor raising suspicion of OSA in asthmatic women, whereas complaints of poor sleep quality were the likely reason for referral in asthmatic men.

31 Article Change in weight and central obesity by positive airway pressure treatment in obstructive sleep apnea patients: longitudinal data from the ESADA cohort. 2018

Basoglu, Ozen K / Zou, Ding / Tasbakan, Mehmet S / Hedner, Jan / Ryan, Silke / Verbraecken, Johan / Escourrou, Pierre / Antalainen, Ulla / Kvamme, John A / Bonsignore, Maria R / Schiza, Sofia / Grote, Ludger / Anonymous1630948. ·Department of Chest Diseases, Ege University, Izmir, Turkey. · Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. · Sleep Disorders Center, Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. · Department of Respiratory Medicine, St Vincent's University Hospital, University College Dublin, School of Medicine, Dublin, Ireland. · Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium. · Service dÉxplorations Fonctionnelles Multidisciplinaires Hospital Antoine Beclere, Clamart, France. · Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital and Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland. · Sleep Laboratory, ENT Department, Førde Central Hospital, Førde, Norway. · Biomedical Department of Internal and Specialistic Medicine (DiBiMIS), Section of Pneumology, University of Palermo and CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy. · Department of Thoracic Medicine, Sleep Disorders Center, University of Crete, Heraklion, Greece. ·J Sleep Res · Pubmed #29797754.

ABSTRACT: The effect of positive airway pressure treatment on weight and markers of central obesity in patients with obstructive sleep apnea remains unclear. We studied the change in body weight and anthropometric measures following positive airway pressure treatment in a large clinical cohort. Patients with obstructive sleep apnea with positive airway pressure treatment from the European Sleep Apnea Database registry (n = 1,415, 77% male, age 54 ± 11 [mean ± SD] years, body mass index 31.7 ± 6.4 kg/m

32 Article Evaluation of Inflammatory Markers in a Large Sample of Obstructive Sleep Apnea Patients without Comorbidities. 2017

Bouloukaki, Izolde / Mermigkis, Charalampos / Tzanakis, Nikolaos / Kallergis, Eleftherios / Moniaki, Violeta / Mauroudi, Eleni / Schiza, Sophia E. ·Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece. ·Mediators Inflamm · Pubmed #28831208.

ABSTRACT: Systemic inflammation is important in obstructive sleep apnea (OSA) pathophysiology and its comorbidity. We aimed to assess the levels of inflammatory biomarkers in a large sample of OSA patients and to investigate any correlation between these biomarkers with clinical and polysomnographic (PSG) parameters. This was a cross-sectional study in which 2983 patients who had undergone a polysomnography for OSA diagnosis were recruited. Patients with known comorbidities were excluded. Included patients (

33 Article The role of compliance with PAP use on blood pressure in patients with obstructive sleep apnea: is longer use a key-factor? 2017

Bouloukaki, I / Mermigkis, C / Tzanakis, N / Giannadaki, K / Mauroudi, E / Moniaki, V / Kallergis, E M / Schiza, S E. ·Department of Thoracic Medicine, Sleep Disorders Center, University of Crete, Heraklion, Greece. ·J Hum Hypertens · Pubmed #27465978.

ABSTRACT: Scientific data about the effects of positive airway pressure (PAP) treatment on blood pressure (BP) control are continuously increasing; however, they are controversial. We aimed to determine the long-term effects of compliance with PAP therapy on BP in both hypertensive and normotensive patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). One thousand one hundred sixty eight consecutive patients with newly diagnosed OSAHS, who had been recommended PAP therapy, were followed up for a minimum of 2 years. Patients with previous cardiovascular disease were excluded. BP was measured at baseline and after 2 years of PAP treatment. In addition, the correlation between the changes in BP with different levels of PAP compliance was assessed. At the end of the follow-up period, in the hypertensive group of patients (n=586), a significant decrease was shown in systolic (-11.2 mm Hg, P<0.001) and diastolic BP (-4.2 mm Hg, P<0.001). Furthermore, in the patients without hypertension (n=528), a significant decrease was noted both in systolic and diastolic BP (-3.6, P<0.001 and -2.4, P<0.001, respectively). A correlation between the magnitude of change in systolic and diastolic BP and hours of use of PAP (r=0.14, P=0.002 and r=0.1, P=0.025, respectively) was observed in all patients. Long-term use of PAP treatment, as well as increased hours of PAP in patients with OSAHS use showed significant reductions in BP not only in patients with hypertension, but also in normotensive patients. Therefore a significant potential reduction in cardiovascular mortality and morbidity should be expected in these patients.

34 Article Sleep apnoea and the hypothalamic-pituitary-adrenal axis in men and women: effects of continuous positive airway pressure. 2016

Kritikou, Ilia / Basta, Maria / Vgontzas, Alexandros N / Pejovic, Slobodanka / Fernandez-Mendoza, Julio / Liao, Duanping / Bixler, Edward O / Gaines, Jordan / Chrousos, George P. ·Sleep Research and Treatment Center, Dept of Psychiatry, Pennsylvania State University, College of Medicine, Hershey, PA, USA. · Sleep Research and Treatment Center, Dept of Psychiatry, Pennsylvania State University, College of Medicine, Hershey, PA, USA Dept of Psychiatry, University of Crete School of Medicine, Heraklion, Greece. · Sleep Research and Treatment Center, Dept of Psychiatry, Pennsylvania State University, College of Medicine, Hershey, PA, USA avgontzas@hmc.psu.edu. · Dept of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA, USA. · First Dept of Pediatrics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece. ·Eur Respir J · Pubmed #26541531.

ABSTRACT: Previous findings on the association of obstructive sleep apnoea (OSA) and the hypothalamic-pituitary-adrenal (HPA) axis are inconsistent, partly due to the confounding effect of obesity and infrequent sampling. Our goal was to examine whether in a relatively nonobese population, OSA is associated with elevated cortisol levels and to assess the effects of a 2-month placebo-controlled continuous positive airway pressure (sham-CPAP) use.72 subjects (35 middle-aged males and post-menopausal females with OSA, and 37 male and female controls) were studied in the sleep laboratory for four nights. 24-h blood sampling was performed every hour on the fourth day and night in the sleep laboratory at baseline, after sham-CPAP and after CPAP treatment.In both apnoeic men and women, OSA was associated with significantly higher 24-h cortisol levels compared with controls, whereas CPAP lowered cortisol levels significantly, close to those of controls.These results suggest that OSA in nonobese men and slightly obese women is associated with HPA axis activation, similar albeit stronger compared with obese individuals with sleep apnoea. Short-term CPAP use decreased cortisol levels significantly compared with baseline, indicating that CPAP may have a protective effect against comorbidities frequently associated with chronic activation of the HPA axis, e.g. hypertension.

35 Article Chronic fatigue syndrome and fibromyalgia in diagnosed sleep disorders: a further test of the 'unitary' hypothesis. 2015

Pejovic, Slobodanka / Natelson, Benjamin H / Basta, Maria / Fernandez-Mendoza, Julio / Mahr, Fauzia / Vgontzas, Alexandros N. ·Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA. bobapejovic@gmail.com. · Department of Neurology, Pain and Fatigue Study Center, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, 10003, USA. bnatelson@bethisraelny.org. · Department of Psychiatry, School of Medicine, University of Crete, Iraklion, Greece. mbasta@med.uoc.gr. · Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA. jfernandezmendoza@hmc.psu.edu. · Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA. fmahr@hmc.psu.edu. · Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA. axv3@psu.edu. ·BMC Neurol · Pubmed #25884538.

ABSTRACT: BACKGROUND: Since chronic fatigue syndrome (CFS) and fibromyalgia (FM) often co-exist, some believe they reflect the same process, somatization. Against that hypothesis are data suggesting FM but not CFS was common in patients with sleep-disordered breathing (SDB). The presence of discrete case definitions for CFS and FM allowed us to explore rates of CFS alone, CFS with FM, and FM alone in SDB patients compared to those with sleep complaints that fulfilled criteria for insomnia. METHODS: Participants were 175 sequential patients with sleep-related symptoms (122 had SDB and 21 had insomnia) and 39 healthy controls. Diagnoses were made by questionnaires, tender point count, and rule out labs; sleepiness was assessed with Epworth Sleepiness Scale and mood with Beck Depression Inventory. RESULTS: Rates of CFS, FM or CFS + FM were high: 13% in SDB and 48% in insomnia. CFS occurred frequently in SDB and insomnia, but FM occurred frequently only in insomnia. SDB patients with CFS and/or FM had higher daytime sleepiness than those without these disorders. CONCLUSION: CFS patients should complete Epworth scales, and sleep evaluation should be considered for those with scores ≥ 16 before receiving the diagnosis of CFS; the coexistence of depressed mood in these patients suggests some may be helped by treatment of their depression. That FM was underrepresented in SDB suggests FM and CFS may have different underlying pathophysiological causes.

36 Article Gender differences in the association of sleep apnea and inflammation. 2015

Gaines, Jordan / Vgontzas, Alexandros N / Fernandez-Mendoza, Julio / Kritikou, Ilia / Basta, Maria / Bixler, Edward O. ·Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA. · Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA. Electronic address: avgontzas@psu.edu. · Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Crete, Greece. ·Brain Behav Immun · Pubmed #25535861.

ABSTRACT: Over the last 15years, many studies have established an association of sleep apnea with inflammation and metabolic aberrations. However, no controlled studies have examined potential gender effects in this association. We recruited 120 middle-aged, predominantly non-obese mild-to-moderate sleep apneics and controls (62 males, 58 females). All participants underwent a clinical history, physical examination, and 1-night 8-h polysomnography recording and provided a single fasting blood sample for assessment of interleukin-6 (IL-6), tumor necrosis factor receptor 1 (TNFR1), C-reactive protein (CRP), leptin, and adiponectin levels. Among non-sleep apneics, females had higher levels of TNFR1 (p=0.01), CRP (p=0.005), leptin (p<0.001), and adiponectin (p<0.001) compared to males, independent of age and body mass index. When analyzed separately by gender, sleep apneic men had elevated TNFR1 (p=0.04), CRP (p=0.06) and IL-6 (p=0.11) relative to control men; in sleep apneic females, only CRP was elevated (p=0.04). Furthermore, CRP was associated with apnea severity in a dose-response manner (p-linear=0.04 in both genders) and was independently associated with comorbid hypertension in apnea (p-linear=0.005 for women; p-linear=0.09 for men). In conclusion, although women have naturally higher levels of inflammatory and metabolic markers than men, sleep apneic men appear to have a more severe inflammatory profile compared to women. Our findings suggest that these markers should be analyzed and interpreted separately in men and women, and that a single measure of plasma CRP appears to be a clinically-useful marker of apnea severity and comorbid cardiovascular morbidity.

37 Article The prevalence of obstructive sleep apnea-hypopnea syndrome-related symptoms and their relation to airflow limitation in an elderly population receiving home care. 2014

Kleisiaris, Christos F / Kritsotakis, Evangelos I / Daniil, Zoe / Tzanakis, Nikolaos / Papaioannou, Agelos / Gourgoulianis, Konstantinos I. ·Department of Nursing, Technological Educational Institute of Crete, Heraklion, Greece. · School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England. · Respiratory Medicine Department, Medical School, University of Thessaly, Larissa, Greece. · Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece. · Department of Medical Laboratories, Technological Educational Institute of Thessaly, Larissa, Greece. ·Int J Chron Obstruct Pulmon Dis · Pubmed #25336942.

ABSTRACT: BACKGROUND: Both airflow limitation and obstructive sleep apnea-hypopnea syndrome (OSAHS)-related symptoms are most prevalent in the elderly population. Previous studies revealed significant associations between OSAHS-related symptoms and obstructive airway diseases in the general population. However, other studies showed that the frequency of OSAHS-related symptoms in patients with obstructive airway diseases decreases after the age of 60 and older. AIMS: To investigate the prevalence of OSAHS-related symptoms (snoring, breathing pauses, and excessive daytime sleepiness [EDS]) and their relations to airflow limitation, for people over 65 years old. METHODS: A full screening spirometry program was performed in a total of 490 aging participants (mean age 77.5 years - range 65-98) who were attending 16 home care settings in central Greece. Airflow limitation was assessed according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric criteria (FEV1/FVC <70%). The Berlin Questionnaire and the Epworth Sleepiness Scale were used to screen individuals for OSAHS-related symptoms. Bivariate associations were described using odds ratio (OR) with 95% confidence intervals (CI). RESULTS: Airflow limitation prevalence was 17.1% (male 24.2% and female 9.9%) and was strongly related to male gender and smoking status. The prevalence rates of frequent snoring, breathing pauses, and EDS were 28.1%, 12.9%, and 11.6%, respectively. However, participants with airflow limitation were less likely to report breathing pauses, frequent snoring, EDS, and obesity. Finally, frequent snoring was significantly more common in males than females. CONCLUSION: This study revealed decreased frequency of OSAHS-related symptoms in participants with airflow limitation suggesting that OSAHS-related symptoms and airflow limitation are not related in our elderly population.

38 Article Intensive versus standard follow-up to improve continuous positive airway pressure compliance. 2014

Bouloukaki, Izolde / Giannadaki, Katerina / Mermigkis, Charalampos / Tzanakis, Nikolaos / Mauroudi, Eleni / Moniaki, Violeta / Michelakis, Stylianos / Siafakas, Nikolaos M / Schiza, Sophia E. ·Sleep Disorders Center, Dept of Thoracic Medicine, University of Crete, Heraklion, Crete, Greece izolthi@gmail.com. · Sleep Disorders Center, Dept of Thoracic Medicine, University of Crete, Heraklion, Crete, Greece. ·Eur Respir J · Pubmed #24993911.

ABSTRACT: We aimed to compare the effect of intensive versus standard interventions on continuous positive airway pressure (CPAP) adherence 2 years after CPAP initiation, as well as on sleepiness, quality of life, depression, hospitalisation and death rate due to cardiovascular disease (CVD). 3100 patients with newly diagnosed sleep apnoea were randomised into the standard group, with usual follow-up care, or the intensive group, with additional visits, telephone calls and education. Subjective daytime sleepiness (Epworth Sleepiness Scale; ESS), quality of life (36-item Short Form Health Survey; SF-36) and the patient's level of depression (Beck Depression Inventory; BDI) were recorded before and 2 years after CPAP initiation, together with CVD hospitalisations and death rate. 2 years after CPAP initiation, the intensive group used CPAP significantly more than the standard group (6.9 versus 5.2 h per night; p<0.001). ESS, SF-36 and BDI scores were also significantly better in the intensive group. Furthermore, the standard group had significantly more deaths and hospitalisations due to CVD. CPAP usage can be improved by both intensive and standard patient support. However, the patients who received intensive CPAP support had significantly better ESS, BDI and SF-36 scores, and lower cardiovascular morbidity and mortality, suggesting that an intensive programme could be worthwhile.

39 Article Abnormal cytokine profile in patients with obstructive sleep apnea-hypopnea syndrome and erectile dysfunction. 2014

Bouloukaki, Izolde / Papadimitriou, Vaios / Sofras, Frank / Mermigkis, Charalampos / Moniaki, Violeta / Siafakas, Nikolaos M / Schiza, Sophia E. ·Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, 711 10 Heraklion, Crete, Greece. · Department of Urology, University of Crete, 711 10 Heraklion, Crete, Greece. ·Mediators Inflamm · Pubmed #24966468.

ABSTRACT: Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) show a high prevalence of erectile dysfunction (ED). Although the underlying pathogenesis is still unknown, endothelial dysfunction, induced by inflammatory cytokines, chemokines, and adhesion molecules, has been proposed as a possible mechanism. The aim of this study was to assess whether OSAHS is associated with activation of the inflammatory cytokine system in patients with ED compared to the matched OSAHS patients with normal sexual function. Thirty-one patients with severe OSAHS and ED were included. Fifteen patients with severe OSAHS and without ED served as controls. Serum concentrations of high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-a), interleukin-6 (IL-6), interleukin-8 (IL-8), and adiponectin were measured after the diagnostic polysomnography. We found that hsCRP levels were significantly elevated in OSAHS patients with ED compared to controls. Similarly, TNF-a levels, IL-6, and IL-8 were elevated in OSAHS patients with ED compared to controls. Serum adiponectin levels were lower in OSAHS-ED patients, but the difference did not reach statistical significance. The presence of ED in patients with severe OSAHS is associated with elevated levels of inflammatory markers, underlining a possible involvement of endothelial dysfunction in the pathogenesis of ED.

40 Article Hooking of the soft palate and a large cervical osteophyte: two troubles in the same airway. 2013

Mermigkis, Charalampos / Mermigkis, Demetrios / Bouloukaki, Izolde / Alogdianakis, Vagelis / Schiza, Sophia E. ·Sleep Disorders Unit (CM, IB, SES), Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Crete, Greece · and Sleep Disorders Unit (CM, DM, VA), Army General Hospital of Athens, Athens, Greece. ·Am J Med Sci · Pubmed #24263081.

ABSTRACT: We report a case of severe obstructive sleep apnea in a 72-year-old, thin male caused by upper airway obstruction due to an enlarged cervical osteophyte at the C2-C3 level in association with a hooking of the soft palate. This is the first reported case with magnetic resonance imaging recognizing 2 simultaneously existing unusual obstructive causes: the oropharynx (hooking palate) and the hypopharynx (large cervical osteophyte).

41 Article Independent associations between fatty acids and sleep quality among obese patients with obstructive sleep apnoea syndrome. 2013

Papandreou, Christopher. ·Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Medical School, University of Crete, Heraklion, Greece. ·J Sleep Res · Pubmed #23432533.

ABSTRACT: The aim of this study was to examine the relationships between gluteal adipose tissue fatty acids and sleep quality in obese patients with obstructive sleep apnoea syndrome after controlling for possible confounders. Sixty-three patients with obstructive sleep apnoea syndrome based on overnight attended polysomnography were included. Gluteal adipose tissue fatty acids were analysed by gas chromatography. Anthropometric measurements were carried out. Depressive symptoms were assessed by the Zung Self-rating Depression Scale. Saturated fatty acids were positively related to total sleep time, sleep efficiency and rapid eye movement sleep. Significant positive associations were found between polyunsaturated fatty acids and sleep efficiency and rapid eye movement sleep. Moreover, n-3 fatty acids were positively associated with sleep efficiency, slow wave sleep and rapid eye movement sleep. This study revealed independent associations between certain gluteal adipose tissue fatty acids and sleep quality after controlling for age, gender, obesity, obstructive sleep apnoea syndrome indices and Zung Self-rating Depression Scale scores in patients with moderate to severe obstructive sleep apnoea syndrome.

42 Article Medical treatment with thiamine, coenzyme Q, vitamins E and C, and carnitine improved obstructive sleep apnea in an adult case of Leigh disease. 2013

Mermigkis, Charalampos / Bouloukaki, Izolde / Mastorodemos, Vasileios / Plaitakis, Andreas / Alogdianakis, Vangelis / Siafakas, Nikolaos / Schiza, Sophia. ·Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Crete, Greece. ·Sleep Breath · Pubmed #23389837.

ABSTRACT: PURPOSE: The multi-organ involvement of mitochondrial diseases means that patients are likely to be more vulnerable to sleep disturbances. We aimed to assess if early recognition and treatment of obstructive sleep apnea (OSA) in patients with Leigh disease may influence primary disease outcome. METHODS: We describe a case of adult-onset Leigh disease presenting as severe brainstem encephalopathy of subacute onset. Based on the clinical symptoms that developed after the appearance of the neurological disease, an attended overnight polysomnography examination was performed. RESULTS: A marked clinical recovery was seen after administration of high doses of thiamine, coenzyme Q, L-carnitine, and vitamins C and E, combined with effective treatment with continuous positive airway pressure for the underlying severe obstructive sleep apnea (OSA). The latter condition was diagnosed on the basis of suggestive symptoms that appeared a few weeks before the establishment of the neurological disease. The improvement in the neurological disease (based on clinical and brain MRI features) with the appropriate medical treatment also resulted in a significant improvement in the OSA. CONCLUSIONS: Early recognition and treatment of sleep apnea may not only improve sleep and overall quality of life but also ameliorate the deleterious effects of nocturnal desaturations on the neurological features. This may be crucial for disease outcome when added to the generally advised pharmacological therapy.

43 Article CPAP therapy in patients with idiopathic pulmonary fibrosis and obstructive sleep apnea: does it offer a better quality of life and sleep? 2013

Mermigkis, Charalampos / Bouloukaki, Izolde / Antoniou, Katerina M / Mermigkis, Demetrios / Psathakis, Kostas / Giannarakis, Ioannis / Varouchakis, Georgios / Siafakas, Nikolaos / Schiza, Sophia E. ·Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Greece, mermigh@gmail.com. ·Sleep Breath · Pubmed #23386371.

ABSTRACT: BACKGROUND: The recent literature shows an increased incidence of obstructive sleep apnea (OSA) in patients with idiopathic pulmonary fibrosis (IPF). On the other hand, there are no published studies related to continuous positive airway pressure (CPAP) treatment in this patient group. Our aim was to assess the effect of CPAP on sleep and overall life quality parameters in IPF patients with OSA and to recognize and overcome possible difficulties in CPAP initiation and acceptance by these patients. METHODS: Twelve patients (ten males and two females, age 67.1 ± 7.2 years) with newly diagnosed IPF and moderate to severe OSA, confirmed by overnight attended polysomnography, were included. Therapy with CPAP was initiated after a formal in-lab CPAP titration study. The patients completed the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), the Functional Outcomes in Sleep Questionnaire (FOSQ), the Fatigue Severity Scale (FSS), the SF-36 quality of life questionnaire, and the Beck Depression Inventory (BDI) at CPAP initiation and after 1, 3, and 6 months of effective CPAP therapy. RESULTS: A statistically significant improvement was observed in the FOSQ at 1, 3, and 6 months after CPAP initiation (baseline 12.9 ± 2.9 vs. 14.7 ± 2.6 vs. 15.8 ± 2.1 vs. 16.9 ± 1.9, respectively, p = 0.02). Improvement, although not statistically significant, was noted in ESS score (9.2 ± 5.6 vs. 7.6 ± 4.9 vs. 7.5 ± 5.3 vs. 7.7 ± 5.2, p = 0.84), PSQI (10.7 ± 4.4 vs. 10.1 ± 4.3 vs. 9.4 ± 4.7 vs. 8.6 ± 5.2, p = 0.66), FSS (39.5 ± 10.2 vs. 34.8 ± 8.5 vs. 33.6 ± 10.7 vs. 33.4 ± 10.9, p = 0.44), SF-36 (63.2 ± 13.9 vs. 68.9 ± 13.5 vs. 72.1 ± 12.9 vs. 74.4 ± 11.3, p = 0.27), and BDI (12.9 ± 5.5 vs. 10.7 ± 4.3 vs. 9.4 ± 4.8 vs. 9.6 ± 4.5, p = 0.40). Two patients had difficulty complying with CPAP for a variety of reasons (nocturnal cough, claustrophobia, insomnia) and stopped CPAP use after the first month, despite intense follow-up by the CPAP clinic staff. Heated humidification was added for all patients in order to improve the common complaint of disabling nocturnal cough. CONCLUSION: Effective CPAP treatment in IPF patients with OSA results in a significant improvement in daily living activities based on the FOSQ, namely an OSA-specific follow-up instrument. Improvement was also noted in other questionnaires assessing quality of life, though not to a statistically significant degree, probably because of the multifactorial influences of IPF on physical and mental health. The probability of poor CPAP compliance was high and could only be eliminated with intense follow-up by the CPAP clinic staff.

44 Article Gluteal adipose tissue fatty acids and sleep quality parameters in obese adults with OSAS. 2013

Papandreou, Christopher. ·Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Medical School, University of Crete, PO Box 2208, 71003, Heraklion, Greece, papchris10@gmail.com. ·Sleep Breath · Pubmed #23371890.

ABSTRACT: PURPOSE: The aim of this study was to examine the relationships between gluteal adipose tissue fatty acids and sleep quality parameters in obese patients with obstructive sleep apnoea syndrome (OSAS). METHODS: Fatty acids were measured by gas chromatography in 63 OSAS patients, and sleep was assessed by polysomnography. RESULTS: Significant positive correlations were found between total sleep time, sleep efficiency, slow-wave sleep, and fatty acid concentrations (myristic, palmitic, stearic, saturated fatty acids, oleic acid, polyunsaturated fatty acids, and n - 6 fatty acids). CONCLUSIONS: The current study revealed associations between certain gluteal adipose tissue fatty acids and sleep quality in obese patients with moderate to severe OSAS.

45 Article Levels of TBARS are inversely associated with lowest oxygen saturation in obese patients with OSAS. 2013

Papandreou, Christopher. ·Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Medical School, University of Crete, P.O.B. 2208, 71003, Heraklion, Crete, Greece, papchris10@gmail.com. ·Sleep Breath · Pubmed #23361138.

ABSTRACT: PURPOSE: The aim of this study was to investigate the most important factors that determine lipid peroxidation in obese patients with obstructive sleep apnoea syndrome (OSAS). METHODS: Twenty-one obese patients with OSAS based on overnight attended polysomnography were included. Thiobarbituric acid reactive substances (TBARS) were measured in serum. Anthropometric measurements were carried out. Dietary habits were assessed by a standardised food frequency questionnaire. RESULTS: Spearman's correlation analysis showed significant positive correlations between TBARS and apnoea-hypopnoea index and desaturations/hour while negative between TBARS and mean/lowest oxygen saturation. The most significant predicting factor in the multiple linear regression model was lowest oxygen saturation. CONCLUSIONS: This study has revealed an independent association between lowest oxygen saturation and TBARS levels after controlling for age, gender, diet and obesity in predominantly male patients with moderate to severe OSAS.

46 Article Sleep disordered breathing in patients with acute coronary syndromes. 2012

Schiza, Sophia E / Simantirakis, Emmanuel / Bouloukaki, Izolde / Mermigkis, Charalampos / Kallergis, Eleftherios M / Chrysostomakis, Stauros / Arfanakis, Dimitrios / Tzanakis, Nikolaos / Vardas, Panos / Siafakas, Nikolaos M. ·Sleep Disorders Unit, Department of Thoracic Medicine, Medical School, University of Crete, Greece. schiza@med.uoc.gr ·J Clin Sleep Med · Pubmed #22334805.

ABSTRACT: STUDY OBJECTIVES: Although the prevalence of obstructive sleep apnea/hypopnea syndrome (OSAHS) is high in patients with acute coronary syndromes (ACS), there is little knowledge about the persistence of OSAHS in ACS patients after the acute event. We aimed to assess the prevalence and time course of OSAHS in patients with ACS during and after the acute cardiac event. METHODS: Fifty-two patients with first-ever ACS, underwent attended overnight polysomnography (PSG) in our sleep center on the third day after the acute event. In patients with an apnea hypopnea index (AHI) > 10/h, we performed a follow up PSG 1 and 6 months later. RESULTS: Twenty-eight patients (54%) had an AHI > 10/h. There was a significant decrease in AHI 1 month after the acute event (13.9 vs. 19.7, p = 0.001), confirming the diagnosis of OSAHS in 22 of 28 patients (79%). At 6-month follow-up, the AHI had decreased further (7.5 vs. 19.7, p < 0.05), and at that time only 6 of the 28 patients (21%) were diagnosed as having OSAHS. Twelve of the 16 current smokers stopped smoking after the acute event. CONCLUSIONS: We have demonstrated a high prevalence of OSAHS in ACS patients, which did not persist 6 months later, indicating that, to some degree, OSAHS may be transient and related with the acute phase of the underlying disease or the reduction in the deleterious smoking habit.

47 Article Effect of Mediterranean diet versus prudent diet combined with physical activity on OSAS: a randomised trial. 2012

Papandreou, Christopher / Schiza, Sophia E / Bouloukaki, Izolde / Hatzis, Christos M / Kafatos, Anthony G / Siafakas, Nikolaos M / Tzanakis, Nikolaos E. ·Dept of Social Medicine, Preventive Medicine and Nutrition Clinic, Heraklion, Crete, Greece. papchris10@gmail.com ·Eur Respir J · Pubmed #22034645.

ABSTRACT: We aimed to evaluate the effect of the Mediterranean diet (MD) compared with a prudent diet (PD) combined with physical activity on obese obstructive sleep apnoea syndrome (OSAS) patients who were treated with continuous positive airway pressure. 900 patients were evaluated and 40 obese patients (body mass index ≥ 30.0 kg · m(-2)) who met the inclusion criteria, with moderate-to-severe OSAS (apnoea-hypopnoea index (AHI) >15 events · h(-1) and Epworth Sleepiness Scale score >10) based on overnight attended polysomnography, were included in the study. After randomisation, 20 patients followed the MD and 20 a PD for a 6-month period. All patients were counselled to increase their physical activity. Concerning sleep parameters, only AHI during rapid eye movement (REM) sleep was reduced to a statistically significant degree, by mean ± SD 18.4 ± 17.6 events · h(-1) in the MD group and by 2.6 ± 23.7 events · h(-1) in the PD group (p<0.05). The MD group also showed a greater reduction in waist circumference (WC) (-8.7 ± 3.6 cm), WC/height ratio (-0.04 ± 0.02 cm · m(-1)) and WC/hip ratio (-0.04 ± 0.03 cm · cm(-1)), compared with the other group (-2.6 ± 1.7 events · h(-1), -5.7 ± 3.8 cm, -0.03 ± 0.02 cm · m(-1) and 0.02 ± 0.02 cm · cm(-1), respectively; p<0.05). Our results showed that the MD combined with physical activity for a 6-month period was effective in reducing the AHI during REM sleep without any statistically significant effect in the other sleep parameters, compared with a PD in obese adults with moderate-to-severe OSAS.

48 Article Effect of Mediterranean diet on lipid peroxidation marker TBARS in obese patients with OSAHS under CPAP treatment: a randomised trial. 2012

Papandreou, Christopher / Schiza, Sophia E / Tzatzarakis, Manolis N / Kavalakis, Mathaios / Hatzis, Christos M / Tsatsakis, Aristidis M / Kafatos, Anthony G / Siafakas, Nikolaos M / Tzanakis, Nikolaos E. ·Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Medical School, University of Crete, Heraklion, Crete, Greece. papchris10@gmail.com ·Sleep Breath · Pubmed #21918812.

ABSTRACT: PURPOSE: The aim of our study was to examine the possible effect of the Mediterranean diet on thiobarbituric acid reacting substances (TBARS) in obese patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS) who are under continuous positive airway pressure treatment. METHODS: Nine hundred patients were evaluated during a 1-year period (November 2008-October 2009), and 21 obese patients who met the inclusion criteria, with moderate to severe OSAHS based on overnight attended polysomnography, were included in the study. After randomisation, 11 followed the Mediterranean diet and 10 a prudent diet for a 6-month period. TBARS were measured in serum. RESULTS: TBARS levels decreased notably in both groups (p < 0.05), but no difference was observed between them (p > 0.05). There were significant differences in other characteristics. The Mediterranean diet group showed a greater reduction in weight (-10.8 ± 3.8), body mass index (-3.9 ± 1.6), waist circumference (-9.9 ± 3.0) and percentage of body fat (-4.7 ± 2.3) compared with the other group (-6.9 ± 3.1, -2.5 ± 1.0, -5.3 ± 2.6 and -2.2 ± 1.5, respectively; p < 0.05). CONCLUSIONS: Our results showed that the Mediterranean diet did not reduce the TBARS more than the prudent diet.

49 Article Gluteal adipose-tissue polyunsaturated fatty-acids profiles and depressive symptoms in obese adults with obstructive sleep apnea hypopnea syndrome: a cross-sectional study. 2011

Papandreou, Christopher / Schiza, Sophia E / Tsibinos, George / Mermigkis, Charalampos / Hatzis, Christos M / Kafatos, Anthony G / Siafakas, Nikolaos M / Fragkiadakis, George A / Tzanakis, Nikolaos E. ·Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Medical School, University of Crete, Heraklion, Greece. papchris10@gmail.com ·Pharmacol Biochem Behav · Pubmed #21281660.

ABSTRACT: Biomarkers of Polyunsaturated Fatty Acids (PUFAs) have been related to depressive symptoms in healthy adults. It is also known that depression is high prevalent in Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) and obesity. The aim of our study was to examine a possible association between PUFAs of the n-6 and n-3 families and depressive symptoms in obese OSAHS patients. Sixty three patients with OSAHS based on overnight attended polysomnography were included. Gluteal adipose tissue biopsies were performed in all participants. Fatty acids were analyzed by gas chromatography. Depressive symptoms were assessed by the Zung Self-rating Depression Scale. The majority of participants had grade II obesity (BMI: 36.2±4.3 kg/m(2)) and moderate to severe OSAHS. Mild depressive symptoms were found to affect 27.8% of the studied patients. No link between symptoms of depression and individual n-6 and/or n-3 PUFAs of gluteal adipose tissue was detected. However, multiple linear regression analysis showed a positive correlation between depressive symptoms and 20:3n-6/18:3n-6 ratio, and a negative association with age and n-6/n-3 ratio. The possible influence of OSAHS and obesity in depression development and the quiescent nature of gluteal adipose tissue may account for the absence of any significant relations between n-6 and/or n-3 PUFAs and depressive symptoms in our sample. The positive relationship between symptoms of depression and the particular fatty acid ratio probably indicates an increase in prostaglandins family although this needs further research.

50 Article Prediction of obstructive sleep apnea syndrome in a large Greek population. 2011

Bouloukaki, Izolde / Kapsimalis, Fotis / Mermigkis, Charalampos / Kryger, Meir / Tzanakis, Nikos / Panagou, Panagiotis / Moniaki, Violeta / Vlachaki, Eleni M / Varouchakis, Georgios / Siafakas, Nikolaos M / Schiza, Sophia E. ·Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Crete, Greece. izolthi@gmail.com ·Sleep Breath · Pubmed #20872180.

ABSTRACT: PURPOSE: We aimed to evaluate the predictive value of anthropometric measurements and self-reported symptoms of obstructive sleep apnea syndrome (OSAS) in a large number of not yet diagnosed or treated patients. Commonly used clinical indices were used to derive a prediction formula that could identify patients at low and high risk for OSAS. METHODS: Two thousand six hundred ninety patients with suspected OSAS were enrolled. We obtained weight; height; neck, waist, and hip circumference; and a measure of subjective sleepiness (Epworth sleepiness scale--ESS) prior to diagnostic polysomnography. Excessive daytime sleepiness severity (EDS) was coded as follows: 0 for ESS ≤ 3 (normal), 1 for ESS score 4-9 (normal to mild sleepiness), 2 for score 10-16 (moderate to severe sleepiness), and 3 for score >16 (severe sleepiness). Multivariate linear and logistic regression analysis was used to identify independent predictors of apnea-hypopnea index (AHI) and derive a prediction formula. RESULTS: Neck circumference (NC) in centimeters, body mass index (BMI) in kilograms per square meter, sleepiness as a code indicating EDS severity, and gender as a constant were significant predictors for AHI. The derived formula was: AHIpred = NC × 0.84 + EDS × 7.78 + BMI × 0.91 - [8.2 × gender constant (1 or 2) + 37]. The probability that this equation predicts AHI greater than 15 correctly was 78%. CONCLUSIONS: Gender, BMI, NC, and sleepiness were significant clinical predictors of OSAS in Greek subjects. Such a prediction formula can play a role in prioritizing patients for PSG evaluation, diagnosis, and initiation of treatment.

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