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Sleep Apnea Syndromes: HELP
Articles from Chicago
Based on 701 articles published since 2010
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These are the 701 published articles about Sleep Apnea Syndromes that originated from Chicago during 2010-2020.
 
+ Citations + Abstracts
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226 Article The relationship between obstructive sleep apnoea and postoperative delirium and pain: an observational study of a surgical cohort. 2019

Strutz, P K / Kronzer, V / Tzeng, W / Arrington, B / McKinnon, S L / Ben Abdallah, A / Haroutounian, S / Avidan, M S. ·Department of Anesthesiology, Washington University School of Medicine in St. Louis, MO, USA. · University of Illinois at Chicago College of Medicine Chicago, Illinois, USA. · Department of Medicine, Mayo Clinic, Rochester, MN, USA. · Meharry Medical College, Nashville, TN, USA. · Washington University Pain Center, St. Louis, MO, USA. ·Anaesthesia · Pubmed #31531850.

ABSTRACT: Patients with obstructive sleep apnoea are at increased risk of adverse postoperative outcomes, such as cardiac and respiratory complications. It has been hypothesised that obstructive sleep apnoea also increases the risk for postoperative delirium and acute postoperative pain. We conducted a retrospective, observational study investigating the relationship of obstructive sleep apnoea with postoperative delirium and acute postoperative pain severity. Patients were classified as being at high risk for obstructive sleep apnoea if they had been diagnosed with this condition, or if they were positive for more than four factors using the 'STOP-BANG' screening tool. Adjusted logistic regression was used to investigate the association between obstructive sleep apnoea and postoperative delirium, and multivariable linear regression to study the relationship between obstructive sleep apnoea and postoperative pain severity. The incidence of postoperative delirium was 307 in 1441 patients (21.3%; 95%CI 19.2-23.5%). In unadjusted analysis, high risk for obstructive sleep apnoea was associated with delirium, with an odds ratio (95%CI) of 1.77 (1.22-2.57; p = 0.003). After adjustment for pre-specified variables, the association was not statistically significant with odds ratio 1.34 (0.80-2.23; p = 0.27). The mean (SD) maximum pain (resting or provoked) reported for the entire cohort was 63.8 (27.9) mm on a 0-100 mm visual analogue scale. High risk for obstructive sleep apnoea was not associated with postoperative pain severity (β-coefficient 2.82; 95%CI, -2.34-7.97; p = 0.28). These findings suggest that obstructive sleep apnoea is unlikely to be a strong risk factor for postoperative delirium or acute postoperative pain severity.

227 Article Update on Research and Practices in Major Sleep Disorders: Part I. Obstructive Sleep Apnea Syndrome. 2019

Chaiard, Jindarat / Weaver, Terri E. ·Assistant Professor, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand. · Xi and Alpha Lambda, Dean, College of Nursing, Professor of Biobehavioral and Health Science, College of Nursing, Professor of Nursing in the Department of Medicine, College of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Illinois at Chicago, Chicago, IL, USA. ·J Nurs Scholarsh · Pubmed #31512821.

ABSTRACT: PURPOSE: The purpose of this first of two review articles providing an update on sleep disorders was to examine the pathophysiology, epidemiology, and treatment of obstructive sleep apnea (OSA). OSA is a common sleep disorder whose prevalence is similar to asthma. As with other sleep disorders, OSA has a broad impact on individuals, affecting their daily behaviors, cognitive abilities, and performance, and putting them at increased risk for accidents, mood disorders, cancer, cardiovascular disease, and hypertension. Thus, early recognition and management, much of which can be implemented by nurses, can reduce health and accident risks and improve daily functioning. METHODS: This narrative review utilized medical databases such as PubMed to identify relevant English language original and systematic review articles predominantly from peer-reviewed journals from 2012 to 2018. However, as background, findings from classic articles prior to 2012 were also included. CLINICAL RELEVANCE: OSA is a common condition with considerable impact on daily functioning and potential for accidents and serious comorbidities such as hypertension, cardiovascular disease, diabetes, and depressed mood. The impairments and comorbidities associated with OSA can be reduced through early detection, encouraging treatment, providing education about sleep and OSA, and, importantly, promoting adherence to the predominant therapy, positive airway pressure.

228 Article The association of sleep disturbances with glycemia and obesity in youth at risk for or with recently diagnosed type 2 diabetes. 2019

Mokhlesi, Babak / Temple, Karla A / Tjaden, Ashley H / Edelstein, Sharon L / Nadeau, Kristen J / Hannon, Tamara S / Manchanda, Shalini / Sam, Susan / Barengolts, Elena / Utzschneider, Kristina M / Ehrmann, David A / Van Cauter, Eve / Anonymous1401191. ·University of Chicago, Chicago, Illinois. · George Washington University Biostatistics Center (RISE Coordinating Center), Rockville, Maryland. · University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, Denver, Colorado. · Indiana University School of Medicine, Indianapolis, Indiana. · Jesse Brown VA Medical Center, Chicago, Illinois. · VA Puget Sound Health Care System and University of Washington, Seattle, Washington. ·Pediatr Diabetes · Pubmed #31486162.

ABSTRACT: OBJECTIVE: Poor sleep may increase obesity and type 2 diabetes (T2D) risk in youth. We explored whether subjective sleep duration, sleep quality, or risk for obstructive sleep apnea (OSA) are associated with glycemia, body mass index (BMI), or blood pressure (BP) in overweight/obese youth. METHODS: Two-hundred and fourteen overweight/obese youth of 10 to 19 years of age at risk for or recently diagnosed with T2D who were screened for the Restoring Insulin Secretion (RISE) Study had a 2-hour oral glucose tolerance test (OGTT) and completed a Cleveland Adolescent Sleepiness questionnaire and a Sleep Disturbances Scale questionnaire. Independent associations between sleep variables and measures of glycemia, BMI, and BP were evaluated with regression models. RESULTS: The multiethnic cohort was 67% female, 14.1 ± 2.1 years, and BMI 35.9 ± 6.5 kg/m CONCLUSIONS: In overweight/obese youth with or at risk for T2D, daytime sleepiness was associated with higher HbA1c. In addition, poor sleep quality and OSA risk were associated with higher BMI. These findings support intervention studies aimed at improving sleep quality in obese youth.

229 Article High-Resolution Pulse Oximetry and Titration of a Mandibular Advancement Device for Obstructive Sleep Apnea. 2019

Metz, James E / Attarian, Hrayr P / Harrison, Mickey C / Blank, James E / Takacs, Christopher M / Smith, Dale L / Gozal, David. ·The Metz Center for Sleep Apnea, Columbus, OH, United States. · Circadian Rhythms and Sleep Research Lab, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. · Department of Behavioral Sciences, Olivet Nazarene University, Bourbonnais, IL, United States. · Department of Child Health, University of Missouri School of Medicine, Columbia, MO, United States. ·Front Neurol · Pubmed #31379712.

ABSTRACT:

230 Article Air Pollution, Asthma, and Sleep Apnea: New Epidemiological Links? 2019

Mutlu, Gökhan M / Peker, Yüksel. ·1Department of Medicine, Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, Illinois. · 2Department of Pulmonary Medicine, Koc University School of Medicine, Istanbul, Turkey. · 3Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden; and. · 4Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. ·Ann Am Thorac Soc · Pubmed #31339334.

ABSTRACT: -- No abstract --

231 Article Impact of montelukast and fluticasone on quality of life in mild pediatric sleep apnea. 2019

Bluher, Andrew E / Brawley, Craig C / Cunningham, Tina D / Baldassari, Cristina M. ·Department of Otolaryngology - Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA. Electronic address: andrew.bluher@childrens.harvard.edu. · Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. · Healthcare Delivery Science Program, Eastern Virginia Medical School, Norfolk, VA, USA. · Department of Pediatric Otolaryngology, Children's Hospital of the King's Daughters, Norfolk, VA, USA. ·Int J Pediatr Otorhinolaryngol · Pubmed #31260810.

ABSTRACT: OBJECTIVES: Research has shown improvement in apnea-hypopnea index in children with mild obstructive sleep apnea treated with anti-inflammatory medications. Data on quality of life outcomes in children receiving these medications is lacking. We aim to assess quality of life in children with mild obstructive sleep apnea treated with montelukast and fluticasone. METHODS: Children between 3 and 16 years old with mild sleep apnea (apnea-hypopnea index > 1 and ≤ 5) presenting to a pediatric otolaryngology clinic were recruited prospectively and treated with 4 months of montelukast and fluticasone. Subjects' caregivers completed the OSA-18, a validated quality of life survey, at baseline and 4 months. Children with ongoing obstruction at follow-up underwent adenotonsillectomy. RESULTS: Thirty-one patients were included. Mean (SD) age was 6.8 (3.9) years. Most subjects (54.8%) were black and 48% were obese. Mean (SD) apnea-hypopnea index of the subjects was 2.8 (1.0). The mean (SD) baseline OSA-18 score was 60.2 (18.5), indicating a moderate impact of sleep disturbance on quality of life. Following treatment, there was significant improvement (p < 0.005) in mean OSA-18 score. Four children discontinued montelukast due to behavioral side effects. Seven children (22%) underwent adenotonsillectomy after failing medical therapy. Demographic factors such as obesity [OR 0.63 (0.11, 3.49)] and apnea hypopnea index [OR 1.38 (0.59, 3.66)] failed to predict which children would respond to anti-inflammatory medications. CONCLUSIONS: Children with mild obstructive sleep apnea treated with montelukast and fluticasone experience significant improvements in quality of life. Further research is needed to determine optimal duration of therapy.

232 Article Preoperative Sleep Questionnaires Identify Medical Emergency Team Activation in Older Adults. 2019

Namen, Andrew M / Forest, Daniel J / Ahmad, Zeeshan N / Chatterjee, Arjun B / Saha, Amit K / Kumar, Sandhya / Edwards, Angela F / Ohar, Jill A / Kassis, Nicholas / Sy, Alexander O / Peters, Stephen P / Haponik, Edward F. ·Department of Internal Medicine, Section of Pulmonary, Critical Care and Allergy and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC. Electronic address: anamen@wakehealth.edu. · Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC. · Pulmonary, Critical Care and Sleep Medicine, Rowan Diagnostic Clinic, Salisbury, NC. · Department of Internal Medicine, Section of Pulmonary, Critical Care and Allergy and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC. · Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC. · Loyola University Chicago Stritch School of Medicine, Maywood, IL. ·J Am Med Dir Assoc · Pubmed #31201101.

ABSTRACT: Patients with obstructive sleep apnea (OSA) have increased postoperative complications that are important for patient safety and healthcare utilization. Questionnaires help identify patients at risk for OSA; however, among older adults who preoperatively self-administered OSA questionnaires, the frequency of postoperative Medical Emergency Team Activation (META), rapid response, code blue, code stroke, is unknown. OBJECTIVES: Identify whether having OSA questionnaires completed by patients is feasible in the preoperative clinic. Determine the frequency of META among older patients at risk for OSA. DESIGN AND INTERVENTION: Cohort of prospective patients independently completed 2 OSA questionnaires in a preoperative clinic, STOP-Bang (SB) and ISNORED (IS). Observers blinded to questionnaire responses recorded incidence of META. SETTING AND PARTICIPANTS: Of the 898 consecutive patients approached in the preoperative assessment clinic and surgical navigation center, 575 (64%) consented and completed the questionnaires in <5 minutes and were included in the analysis. MEASURES: Sleep questionnaire responses and frequency of inpatient postoperative META. RESULTS: With an affirmative response to ≥3 questions on either questionnaire, 65% of patients enrolled were at risk for OSA. Of these, 3.1% sustained an META. In patients at risk for OSA, META occurred in 7.6% (SB+) and 7.2% (IS+) vs 2.5% (SB+) and 1.7% (IS+) for low risk. METAs were disproportionately higher among patients aged ≥65 years (6.3% vs 1.7%; P < .018), American Society of Anesthesiologists (ASA) physical status class ≥3, and IS+. All patients with META positively answered ≥3 of 15 components of the 2 questionnaires. CONCLUSIONS/IMPLICATIONS: Preoperative, self-administration of SB and IS questionnaires is feasible. Overall, 65% of those with affirmative responses to ≥3 questions were at risk for OSA and associated with a disproportionate number of postoperative META in older patients. Additionally, risk of OSA identified by preoperative sleep questionnaires was associated with postoperative META among older adults. Use of clinical tools and OSA questionnaires may improve preoperative identification of META in this population.

233 Article The differences in the relationship between obstructive sleep apnea severity and trabecular bone score in men and women with type 2 diabetes. 2019

Nimitphong, Hataikarn / Siwasaranond, Nantaporn / Sritara, Chanika / Saetung, Sunee / Chailurkit, La-Or / Chirakalwasan, Naricha / Ongphiphadhanakul, Boonsong / Reutrakul, Sirimon. ·Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. · Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. · Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. · Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand. · Division of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, Chicago, IL, USA. ·J Clin Transl Endocrinol · Pubmed #31193067.

ABSTRACT: Aims: Type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) may adversely affect bone. Gender is a well-established factor influencing bone health. We investigated the impact of OSA on bone mineral density (BMD) and trabecular bone score (TBS) in T2DM. Methods: Eighty-one T2DM patients [33 men and 48 women] participated. OSA was diagnosed using an overnight monitor, with its severity assessed by an apnea hypopnia index (pAHI). The measurements of hypoxia, including the percentage of total sleep time in which oxygen saturation remains below 90% (pT90), the oxygen desaturation index (pODI) and minimum O Results: Sixty-five patients (80.2%) had OSA. pAHI, pT90, pODI and min O Conclusions: In T2DM patients, there is a complex interrelationship among OSA severity, gender and TBS. More severe OSA predicted lower TBS in men, but predicted higher TBS in postmenopausal women.

234 Article Obstructive sleep apnea co-morbidity in patients with fibromyalgia: a single-center retrospective analysis and literature review. 2019

Meresh, Edwin S / Artin, Hewa / Joyce, Cara / Birch, Steven / Daniels, David / Owens, Jack H / La Rosa, Alvaro J / Rao, Murali S / Halaris, Angelos. ·Department of Psychiatry, Loyola University Medical Center, Maywood, IL 60153, USA. · Loyola Stritch School of Medicine, Maywood, IL 60153, USA. · Biostatistics Core, Clinical Research Office, Loyola University Medical Center, Maywood, IL 60153, USA. · Informatics and Systems Development, Loyola University Medical Center, Maywood, IL 60153, USA. ·Open Access Rheumatol · Pubmed #31118843.

ABSTRACT:

235 Article The role of sham continuous positive airway pressure as a placebo in controlled trials: Best Apnea Interventions for Research Trial. 2019

Reid, Michelle L / Gleason, Kevin J / Bakker, Jessie P / Wang, Rui / Mittleman, Murray A / Redline, Susan. ·Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston MA. · Department of Public Health Sciences, University of Chicago, Chicago, IL. · Division of Sleep Medicine, Harvard Medical School, Boston, MA. · Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, MA. · Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA. · Department of Epidemiology, Harvard University T.H. Chan School of Public Health, Boston, MA. · Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. ·Sleep · Pubmed #31116848.

ABSTRACT: STUDY OBJECTIVES: The main objective of this study was to evaluate the role of sham continuous positive airway pressure (CPAP) compared to conservative medical therapy (CMT) as a control arm in the Best Apnea Interventions for Research (BestAIR) study by assessing differences in subjectively and objectively measured outcomes, adverse events, adherence, and retention rates. METHODS: BestAIR is a clinical trial aimed to identify important design features for future randomized controlled trials of CPAP. Participants with obstructive sleep apnea were randomized to one of four groups; two control arms (CMT, sham-CPAP) and two active CPAP arms (with and without behavioral interventions). Blood pressure and health-related quality of life outcomes were assessed at baseline, 6 and 12 months. Study outcomes, retention, and adverse event rates were compared between the two control arms. Sham-CPAP adherence and self-efficacy were also compared to active-CPAP adherence (without behavioral intervention). RESULTS: Our sample included 86 individuals in the control arms and 42 participants in the active-CPAP arm. There were no differences in longitudinal profiles in blood pressure, health-related quality of life outcomes, dropout rates, or adverse events in sham-CPAP group compared to CMT-only group (all ps > 0.05); standardized differences were generally small and with inconsistent directionality across measurements. When compared to active-CPAP, sham-CPAP was associated with 93 fewer minutes/night of usage over 12 months (p = 0.007) and lower outcome expectations (p < 0.05). CONCLUSION: We observed no evidence of differences in objectively or subjectively measured outcomes with the use of sham-CPAP compared to CMT group. The lower adherence on sham-CPAP and poorer self-efficacy compared to active-CPAP may suggest differences in perceived benefit. REGISTRATION: NCT01261390 Best Apnea Interventions for Research (BestAIR) www.clinicaltrials.gov.

236 Article Sex Differences in the Association Between Smoking and Sleep-Disordered Breathing in the Hispanic Community Health Study/Study of Latinos. 2019

Cohen, Oren / Strizich, Garrett M / Ramos, Alberto R / Zee, Phyllis C / Reid, Kathryn J / Mani, Venkatesh / Rapoport, David M / Redline, Susan / Kaplan, Robert C / Shah, Neomi A. ·Icahn School of Medicine at Mount Sinai, New York, NY. · Albert Einstein College of Medicine, Bronx, NY. · University of Miami, Miller School of Medicine, Miami, FL. · Northwestern University, Feinberg School of Medicine, Chicago, IL. · Brigham and Women's Hospital, Harvard Medical School, Boston, MA. · Albert Einstein College of Medicine, Bronx, NY; Fred Hutchinson Cancer Research Center, Seattle, WA. · Icahn School of Medicine at Mount Sinai, New York, NY; Albert Einstein College of Medicine, Bronx, NY. Electronic address: neomi.shah@mssm.edu. ·Chest · Pubmed #31103694.

ABSTRACT: BACKGROUND: Results of previous studies examining associations between cigarette smoking and sleep-disordered breathing (SDB) are inconsistent. We therefore investigated this association in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). METHODS: A total of 13,863 US Hispanic/Latino subjects, 18 to 76 years old, provided smoking histories and underwent home SDB testing. Logistic regression analyses were conducted to assess the independent association of smoking and SDB with covariate adjustment. Sex- and age-stratified analyses were performed. RESULTS: The weighted prevalence of moderate to severe SDB was 9.7% (95% CI, 9.0-10.5). No independent and statistically significant association was observed between ever smoking (defined as minimum lifetime cigarette use of 100) and moderate to severe SDB (defined as an apnea-hypopnea index ≥ 15 events per hour) (OR, 1.02; 95% CI, 0.85-1.22; P = .85). Sex and age were effect modifiers of the aforementioned association. Stratification according to age and sex revealed that younger (aged 35-54 years) female smokers had 83% higher odds of SDB compared with younger female never smokers (OR, 1.83; 95% CI, 1.19-2.81; P = .01). A significant dose-response relation was noted between smoking intensity and SDB in younger female smokers (P < .01). Lastly, use of ≥ 10 cigarettes per day was associated with a nearly threefold increase in SDB odds in younger female ever smokers. These associations were not observed in younger male subjects. CONCLUSIONS: In the HCHS/SOL, no independent and statistically significant association was found between smoking and SDB. Sex and age stratification revealed a novel statistically significant association between smoking and SDB in younger (35-54 years old) female smokers. Our findings highlight the importance of investigating sex- and age-specific associations of SDB risk factors.

237 Article Effects of OSA Surgery on Ophthalmological Microstructures. 2019

Lin, Pei-Wen / Lin, Hsin-Ching / Friedman, Michael / Chang, Hsueh-Wen / Salapatas, Anna M / Lin, Meng-Chih / Chin, Chien-Hung. ·1 Department of Ophthalmology, Division of Glaucoma, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. · 2 Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. · 3 Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. · 4 Robotic Surgery Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. · 5 Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Rush University Medical Center, Chicago, IL, USA. · 6 Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, IL, USA. · 7 Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan. · 8 Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. ·Ann Otol Rhinol Laryngol · Pubmed #31091983.

ABSTRACT: OBJECTIVE: Obstructive sleep apnea/hypopnea syndrome (OSA) could compromise oxygenation of the optic nerve and cause glaucomatous optic neuropathy; however, there were no studies to investigate the changes of visual function and retinal microstructures in OSA patients after upper airway surgery. We aim to assess the changes in the visual sensitivity and retinal fiber layer thickness in OSA patients before and after surgery. METHODS: This prospective single-blind study enrolled patients with OSA from a tertiary academic medical center who had unsuccessful conservative therapy and then underwent surgery. The patients were referred for comprehensive ophthalmologic evaluation at baseline and 6 months after OSA surgery. The polysomnographic findings were collected pre- and postoperatively. Visual sensitivities on standard automated perimetry (SAP) were assessed. Peripapillary retinal nerve fiber layer (RNFL) thickness and macular layer (ML) thickness parameters were measured by spectral-domain optical coherence tomography (OCT). RESULTS: A total of 108 OSA patients were enrolled. Six months after surgery, the major parameters of polysomnography (PSG), mean deviation, and pattern standard deviation of SAP significantly improved in these OSA patients. Regarding the OCT parameters, thickness of ML in the nasal-outer, superior-inner, temporal-inner, inferior-inner, nasal-inner sectors, and total ML thickness significantly increased 6 months after upper airway surgery in the severe OSA group (apnea/hypopnea index ⩾30 per hour). CONCLUSION: The visual sensitivities on SAP, ML thickness on OCT, and oxygenation status on PSG significantly improved 6 months after upper airway surgery in patients with severe OSA. Upper airway surgery may ameliorate the microstructures of the retina in patients with severe OSA.

238 Article Validation of the MediByte Portable Monitor for the Diagnosis of Sleep Apnea in Pediatric Patients. 2019

Masoud, Ahmed I / Patwari, Pallavi P / Adavadkar, Pranshu A / Arantes, Henry / Park, Chang / Carley, David W. ·Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. · University of Illinois Hospital and Health Sciences System, University of Illinois College of Medicine, Chicago, Illinois. · Rush Children's Hospital, Rush University Medical Center, Chicago, Illinois. · Departments of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, Illinois. ·J Clin Sleep Med · Pubmed #31053204.

ABSTRACT: STUDY OBJECTIVES: Polysomnography (PSG) is considered the gold standard in the diagnosis of sleep apnea. In pediatric patients, because of limited availability and access to laboratory-based PSG, there can be significant delays in the diagnosis and management of sleep apnea that can result in progressive associated comorbidities. The main objective of the current study was to test the diagnostic value of a portable sleep monitor (PM), the MediByte, in comparison with laboratory PSG in pediatric patients wearing both setups simultaneously. METHODS: A consecutive series of pediatric patients referred to the University of Illinois Sleep Science Center wore the MediByte during simultaneous PSG. The apnea-hypopnea index (AHI) was calculated for PSG and both manual and autoscoring functions of the PM. Pearson correlation and Bland-Altman plots were assessed. RESULTS: A total of 70 patients successfully completed simultaneous PSG and PM studies (median age 10.8 years). The AHI obtained both manually and automatically scored PM studies strongly correlated with the AHI obtained from the PSG ( CONCLUSIONS: Although PSG is still recommended for the diagnosis of sleep apnea, PMs can play a valuable role in diagnosing moderate and severe sleep apnea, especially in older pediatric patients. COMMENTARY: A commentary on this article appears in this issue on page 685.

239 Article Polysomnography Outcomes after Supraglottoplasty in Children with Obstructive Sleep Apnea. 2019

Bhushan, Bharat / Schroeder, James W / Billings, Kathleen R / Giancola, Nicholas / Thompson, Dana M. ·Division of Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA. · Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. · School of Medicine, Creighton University, Phoenix, Arizona, USA. ·Otolaryngol Head Neck Surg · Pubmed #31012379.

ABSTRACT: OBJECTIVE: Laryngomalacia has been reported to contribute to the severity of obstructive sleep apnea (OSA) in children. It is unclear if surgical treatment of laryngomalacia improves polysomnography (PSG) outcomes in these patients. The objective of this study is to report the impact of supraglottoplasty on PSG parameters in children with laryngomalacia-related OSA. STUDY DESIGN: Retrospective case series. SETTING: Tertiary care medical center. SUBJECTS AND METHODS: Historical cohort study of consecutive children with laryngomalacia who underwent supraglottoplasty and who had undergone overnight PSG before and after surgery. RESULTS: Forty-one patients were included in the final analysis: 22 (53.6%) were male, and 19 (46.3%) were female. The mean ± SEM age of patients at preoperative PSG was 1.3 ± 0.89 years (range, 0.003-2.9). In entire cohort, the mean obstructive apnea-hypopnea index score was reduced from 26.6 events/h before supraglottoplasty to 7.3 events/h after surgery ( CONCLUSION: Overall, supraglottoplasty significantly improved several PSG outcomes in children with laryngomalacia. However, mild to moderate OSA was still present postoperatively in most children. This suggested a multifactorial cause for OSA in this population.

240 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.

241 Article Total Sleep Time and BMI z-score Are Associated With Physical Function Mobility, Peer Relationship, and Pain Interference in Children Undergoing Routine Polysomnography: A PROMIS Approach. 2019

Bhushan, Bharat / Beneat, Amanda / Ward, Charles / Satinsky, Alex / Miller, Michael L / Balmert, Lauren C / Maddalozzo, John. ·Division of Otolaryngology Head and Neck Surgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois. · Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Rosalind Franklin University, North Chicago, Illinois. · Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois. · Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. ·J Clin Sleep Med · Pubmed #30952226.

ABSTRACT: INTRODUCTION: Sleep disturbance, especially obstructive sleep apnea (OSA) and inadequate sleep, adversely affect various health-related quality of life (HR-QoL) domains in adults. Few studies have addressed problems with HR-QoL in children with OSA or sleep-related symptoms. METHODS: Patients between ages 5 to 17 years who were referred to the sleep laboratory from June 2017 to August 2017 for overnight polysomnography were approached to participate in the study. RESULTS: A total of 86 patients were included in the final analysis; 45 patients (52.3%) were male; and the median (interquartile range) of their mean BMI z-scores was 1.7 (0.5, 2.4). The patients were categorized by OSA severity as follows: 27 (31.4%) mild OSA, 11 (12.8%) moderate OSA, 24 (27.9%) severe OSA, and 24 (27.9%) without OSA. Severity of OSA was not correlated with any PROMIS domain. In univariable analyses, BMI z-score was negatively correlated with physical function mobility score ( CONCLUSIONS: Total sleep time was associated with physical function mobility and peer relationship. Regression analysis demonstrated a relationship between BMI z-score, physical function mobility, and pain intensity in our study population. COMMENTARY: A commentary on this article appears in this issue on page 541.

242 Article Long-term clinical effectiveness of continuous positive airway pressure therapy versus non-invasive ventilation therapy in patients with obesity hypoventilation syndrome: a multicentre, open-label, randomised controlled trial. 2019

Masa, Juan F / Mokhlesi, Babak / Benítez, Iván / Gomez de Terreros, Francisco Javier / Sánchez-Quiroga, Maria Ángeles / Romero, Auxiliadora / Caballero-Eraso, Candela / Terán-Santos, Joaquin / Alonso-Álvarez, Maria Luz / Troncoso, Maria F / González, Mónica / López-Martín, Soledad / Marin, José M / Martí, Sergi / Díaz-Cambriles, Trinidad / Chiner, Eusebi / Egea, Carlos / Barca, Javier / Vázquez-Polo, Francisco-José / Negrín, Miguel A / Martel-Escobar, María / Barbe, Ferran / Corral, Jaime / Anonymous2750985. ·Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain. Electronic address: fmasa@separ.es. · Department of Medicine, University of Chicago, Chicago, IL, USA. · Respiratory Department, Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain. · Respiratory Department, Virgen del Puerto Hospital, Plasencia, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, University Hospital, Burgos, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, IIS Fundación Jiménez Díaz, Madrid, Spain. · Respiratory Department, Valdecilla Hospital, Santander, Spain. · Respiratory Department, Gregorio Marañon Hospital, Madrid, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Miguel Servet Hospital, Zaragoza, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Valld'Hebron Hospital, Barcelona, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Doce de Octubre Hospital, Madrid, Spain. · Respiratory Department, San Juan Hospital, Alicante, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Alava University Hospital IRB, Vitoria, Spain. · Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain; Nursing Department, Extremadura University, Cáceres, Spain. · Department of Quantitative Methods, Las Palmas de Gran Canarias University Canary Islands, Spain. ·Lancet · Pubmed #30935737.

ABSTRACT: BACKGROUND: Obesity hypoventilation syndrome is commonly treated with continuous positive airway pressure or non-invasive ventilation during sleep. Non-invasive ventilation is more complex and costly than continuous positive airway pressure but might be advantageous because it provides ventilatory support. To date there have been no long-term trials comparing these treatment modalities. We therefore aimed to determine the long-term comparative effectiveness of both treatment modalities. METHODS: We did a multicentre, open-label, randomised controlled trial at 16 clinical sites in Spain. We included patients aged 15-80 years with untreated obesity hypoventilation syndrome and an apnoea-hypopnoea index of 30 or more events per h. We randomly assigned patients, using simple randomisation through an electronic database, to receive treatment with either non-invasive ventilation or continuous positive airway pressure. Both investigators and patients were aware of the treatment allocation. The research team was not involved in deciding hospital treatment, duration of treatment in the hospital, and adjustment of medications, as well as adjudicating cardiovascular events or cause of mortality. Treating clinicians from the routine care team were not aware of the treatment allocation. The primary outcome was the number of hospitalisation days per year. The analysis was done according to the intention-to-treat principle. This study is registered with ClinicalTrials.gov, number NCT01405976. FINDINGS: From May 4, 2009, to March 25, 2013, 100 patients were randomly assigned to the non-invasive ventilation group and 115 to the continuous positive airway pressure group, of which 97 patients in the non-invasive ventilation group and 107 in the continuous positive airway pressure group were included in the analysis. The median follow-up was 5·44 years (IQR 4·45-6·37) for all patients, 5·37 years (4·36-6·32) in the continuous positive airway pressure group, and 5·55 years (4·53-6·50) in the non-invasive ventilation group. The mean hospitalisation days per patient-year were 1·63 (SD 3·74) in the continuous positive airway pressure group and 1·44 (3·07) in the non-invasive ventilation group (adjusted rate ratio 0·78, 95% CI 0·34-1·77; p=0·561). Adverse events were similar between both groups. INTERPRETATION: In stable patients with obesity hypoventilation syndrome and severe obstructive sleep apnoea, non-invasive ventilation and continuous positive airway pressure have similar long-term effectiveness. Given that continuous positive airway pressure has lower complexity and cost, continuous positive airway pressure might be the preferred first-line positive airway pressure treatment modality until more studies become available. FUNDING: Instituto de Salud Carlos III, Spanish Respiratory Foundation, and Air Liquide Spain.

243 Article Changes in sleep and airway variables in patients with obstructive sleep apnea after mandibular advancement splint treatment. 2019

Mostafiz, Whitney R / Carley, David W / Viana, Maria Grace C / Ma, Serina / Dalci, Oyku / Darendeliler, M Ali / Evans, Carla A / Kusnoto, Budi / Masoud, Ahmed / Galang-Boquiren, Maria Therese S. ·Department of Orthodontics, College of Dentistry, University of Illinois, Chicago, Ill; Department of Orthodontics, New York University, New York, NY. · College of Nursing, College of Medicine, University of Illinois, Chicago, Ill. · Department of Orthodontics, College of Dentistry, University of Illinois, Chicago, Ill. · Department of Orthodontics, University of Sydney, Sydney, New South Wales, Australia. · Department of Orthodontics, College of Dentistry, University of Illinois, Chicago, Ill; Department of Orthodontic, Henry M. Goldman School of Medicine, Boston, Ma. · Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. · Department of Orthodontics, College of Dentistry, University of Illinois, Chicago, Ill. Electronic address: mgalang@uic.edu. ·Am J Orthod Dentofacial Orthop · Pubmed #30935605.

ABSTRACT: INTRODUCTION: Obstructive sleep apnea (OSA) is an extensive public health problem that imposes considerable morbidity. Mandibular advancement splint (MAS) therapy is a well tolerated treatment, but success rates are difficult to predict. Our objective was to investigate the relationship of oropharyngeal airway dimensions, sleep characteristics, patient biometrics, and treatment response within an OSA patient sample. METHODS: Records of 33 adults were assessed retrospectively with the use of Dolphin 3D and Image J to measure the airway on pretreatment supine cone-beam computed tomography images and derived lateral cephalograms. The patients used Somnodent (Somnomed; Crows Nest, Australia) MAS appliances, which were titrated over 6-8 weeks. Appliance titration measurements and pre- and posttreatment polysomnograms were assessed. Respiratory disturbance index (RDI), absolute and percentage changes in RDI, non-rapid eye movement (NREM) RDI, rapid eye movement (REM) RDI, supine and nonsupine NREM and REM RDI, and minimal blood-oxygen saturation variables were evaluated. The associations of measurements from 2D and 3D minimal anterior-posterior linear distance and 3D airway variables with MAS treatment response were estimated. RESULTS AND CONCLUSIONS: Combined effects of baseline total airway volume, body mass index, neck circumference, location of minimal cross sectional area, and OSA severity were associated with treatment response. Patients with higher initial OSA and more superiorly located airway constriction showed enhanced treatment response to MAS therapy. Airway constriction due to maxillofacial disproportions rather than soft tissue obstruction also showed better treatment response. No significant relationships were found in lateral cephalogram measurements.

244 Article Clinical Prediction Model for Obstructive Sleep Apnea among Adult Patients with Habitual Snoring. 2019

Lin, Hsin-Ching / Lai, Chi-Chih / Lin, Pei-Wen / Friedman, Michael / Salapatas, Anna M / Chang, Hsueh-Wen / Lin, Meng-Chih / Chin, Chien-Hung. ·1 Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. · 2 Sleep Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. · 3 Robotic Surgery Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. · 4 Division of Glaucoma, Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. · 5 Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA. · 6 Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA. · 7 Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan. · 8 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. ·Otolaryngol Head Neck Surg · Pubmed #30935275.

ABSTRACT: OBJECTIVE: To identify standard clinical parameters that may predict the presence and severity of obstructive sleep apnea/hypopnea syndrome (OSA). DESIGN: Case series with chart review. SETTING: Tertiary academic medical center. SUBJECTS AND METHODS: A total of 325 adult patients (274 men and 51 women; mean age, 44.2 years) with habitual snoring completed comprehensive polysomnography and anthropometric measurements, including modified Mallampati grade (also known as updated Friedman's tongue position [uFTP]), tonsil size grading, uvular length, neck circumference, waist circumference, hip circumference, and body mass index (BMI). RESULTS: When the aforementioned physical parameters were correlated singly with the apnea/hypopnea index (AHI), we found that sex, uFTP, tonsil size grading, neck circumference, waist circumference, hip circumference, thyroid-mental distance, and BMI grade were reliable predictors of OSA. When all important factors were considered in a multiple stepwise regression analysis, an estimated AHI can be formulated by factoring sex, uFTP, tonsil size grading, and BMI grade as follows: -43.0 + 14.1 × sex + 12.8 × uFTP + 5.0 × tonsil size + 8.9 × BMI grade. Severity of OSA can be predicted with a receiver operating characteristic curve. Predictors of OSA can be further obtained by the "OSA score." CONCLUSION: This study has distinguished the correlations between sex, uFTP, tonsil size, and BMI grade and the presence and severity of OSA. An OSA score might be beneficial in identifying patients who should have a full sleep evaluation.

245 Article Sleep-Disordered Breathing Is Associated with Reduced Mandibular Cortical Width in Children. 2019

Eimar, H / Al-Saleh, M A Q / Cortes, A R G / Gozal, D / Graf, D / Flores-Mir, C. ·1 School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. · 2 College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. · 3 Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil. · 4 Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA. ·JDR Clin Trans Res · Pubmed #30931759.

ABSTRACT: INTRODUCTION: Evidence from the adult population suggests that sleep-disordered breathing (SDB) (i.e., obstructive sleep apnea [OSA]) is negatively associated with bone mineral density. Whether a similar association exists in children with SDB has not been investigated. Using the mandibular cortical width (MCW) as a proxy for skeletal bone density, we investigated if children at risk of SDB or diagnosed with OSA have a reduced mandibular cortical width compared to children without SDB. METHODS: Two retrospective cross-sectional studies were performed. The first study included comparison of MCW between 24 children with polysomnographically (PSG) diagnosed OSA and 72 age- and sex-matched control children. The second study included a cohort of children in which SDB was suggested by the Pediatric Sleep Questionnaire (PSQ) ( n = 101). MCW was measured from panoramic radiographs. RESULTS: Multiple-predictors regression analysis from the first study indicated that in children with a severe form of SDB, as induced by OSA severity, there was a negative association with MCW (β = -0.290, P = 0.049). Moreover, PSG-diagnosed OSA children had thinner MCW (2.9. ± 0.6mm) compared to healthy children (3.5 ± 0.6 mm; P = 0.002). These findings were further supported by the second study illustrating that PSQ total scores were negatively associated with MCW (β = -0.391, P < 0.001). CONCLUSIONS: Findings suggest that children at risk for or diagnosed with SDB exhibit reduced mandibular cortical width that purportedly may reflect alterations in bone homeostasis. KNOWLEDGE TRANSFER STATEMENT: We report that sleep-disordered breathing (including its severe form, obstructive sleep apnea) in children is associated with reduced mandibular cortical width. This association might be a direct consequence of reduced bone health to sleep-disordered breathing or a reflection that reduced bone formation underlies the development of sleep-disordered breathing. Our findings suggest that mandibular cortical width can be used as an adjunct diagnostic parameter for the diagnosis of sleep-disordered breathing.

246 Article Diagnostic techniques and surgical outcomes for persistent pediatric obstructive sleep apnea after adenotonsillectomy: A systematic review and meta-analysis. 2019

Socarras, Melissa A / Landau, Barcleigh P / Durr, Megan L. ·Kaiser Permanente, 3600 Broadway Oakland, Oakland, CA, 94611, USA; Summer Clinical Otolaryngology Research Program Participant, University of Illinois at Chicago College of Medicine, USA. · Kaiser Permanente, 3600 Broadway Oakland, Oakland, CA, 94611, USA. · Kaiser Permanente, 3600 Broadway Oakland, Oakland, CA, 94611, USA. Electronic address: Megan.durr@kp.org. ·Int J Pediatr Otorhinolaryngol · Pubmed #30925395.

ABSTRACT: OBJECTIVE: To evaluate the efficacy of upper airway surgery for children with persistent obstructive sleep apnea after adenotonsillectomy and to assess sleep study outcomes when Drug Induced Sleep Endoscopy, Cine MRI, or other imaging procedure is performed to assist in identifying the location of obstruction and planning surgery. METHODS: Systematic review and meta-analysis was performed. Inclusion criteria was English-language studies with original data including pediatric patients with persistent OSA after T&A. Exclusion criteria included case reports and lack of pre and post-operative sleep study data. Data Sources were PubMed, Cochrane Central, and Embase from 2000 to 2018. PRISMA standards were followed for the selection and review of articles. The Newcastle-Ottawa Quality Assessment scale was used to score the quality of evidence of the studies. All manuscripts were reviewed independently by two investigators. Primary outcome measures were apnea-hypopnea index and minimum oxygen saturation. Data was pooled using a random-effects model. RESULTS: Of the 1902 abstracts identified, 11 studies (214 patients) met inclusion criteria for systematic review, 5 with Drug Induced Sleep Endoscopy as the diagnostic technique, 4 with Cine MRI, and 2 with MRI/CT. All studies were case series. Most subjects had syndromic comorbidities and/or obesity. Ten studies (198 patients) were included in the meta-analysis. Overall, there was a change in apnea hypopnea index of -6.51 (95% CI, -8.17 to - 4.85; p < 0.001) and an increase in minimum oxygen saturation by 3.24% (95% CI, 1.49%-4.98%; p < 0.001) following surgical intervention. Both Drug Induced Sleep Endoscopy and Cine MRI directed surgeries resulted in significant improvement in sleep study parameters. The two techniques could not be directly compared due to significant differences in co-morbidity rates between patients. CONCLUSIONS: Surgery for pediatric persistent obstructive sleep apnea improves apnea hypopnea index and minimum oxygen saturation but does not resolve the disease. This is true when both Drug Induced Sleep Endoscopy and Cine MRI findings were used to direct surgery.

247 Article Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation. 2019

Bavishi, Aakash A / Kaplan, Rachel M / Peigh, Graham / Diaz, Celso L / Baman, Jayson R / Trivedi, Amar / Wasserlauf, Jeremiah / Shen, Mark J / Sattayaprasert, Prasongchai / Chicos, Alexandru B / Kim, Susan / Verma, Nishant / Arora, Rishi / Lin, Albert / Knight, Bradley P / Passman, Rod S. ·Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. · Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. · The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois. ·Pacing Clin Electrophysiol · Pubmed #30912155.

ABSTRACT: BACKGROUND: While several studies have evaluated predictors for atrial fibrillation (AF) recurrence following catheter ablation, there are limited data specific to cryoballoon ablation (CBA). METHODS: We analyzed a prospective registry of patients at a single institution who underwent CBA. Recurrence of AF (RAF) was defined as recurrence of AF by 12-month follow-up, excluding the 3-month blanking period. Univariate analysis was performed to evaluate predictors of RAF. Receiver operating characteristic analysis was used to compare and evaluate the performance of various risk scores for discriminating risk of RAF. RESULTS: There were 542 patients included in the analysis with mean age 61.3 ± 10.6 years, 67.9% male, and 51.6% paroxysmal AF (PAF). Overall, only left atrial diameter (LAD) > 40 mm and ERAF (early recurrence of AF within 0-3 month blanking period) were significant predictors of RAF. In the PAF specific subgroup, LAD > 40 mm, AF duration > 12 months, prior stroke or transient ischemic attack, ERAF, and having previously failed an antiarrhythmic drug were significant predictors of RAF. In persistent AF (PeAF) subgroup, obstructive sleep apnea (OSA) and ERAF were significant predictors of RAF. Out of clinical risk scores tested, BASEAF2 had the highest performance with area under the curve of 0.646 (95% confidence interval [0.548, 0.708]; P < .01). CONCLUSIONS: In this single-center retrospective study of CBA, we found only LAD > 40 mm and ERAF to be predictors of RAF. We identified OSA as a potential targetable risk factor in PeAF patients undergoing CBA. Out of risk scores tested for discriminating risk of RAF, BASEAF2 had the best performance.

248 Article Poor sleep quality and lipid profile in a rural cohort (The Baependi Heart Study). 2019

Geovanini, Glaucylara Reis / Lorenzi-Filho, Geraldo / de Paula, Lilian K / Oliveira, Camila Maciel / de Oliveira Alvim, Rafael / Beijamini, Felipe / Negrão, André Brooking / von Schantz, Malcolm / Knutson, Kristen L / Krieger, José Eduardo / Pereira, Alexandre Costa. ·Genetics and Molecular Cardiology Laboratory, Heart Institute (InCor) - University of São Paulo, Medical School, São Paulo, Brazil; Sleep Laboratory, Pulmonary Division, Heart Institute (InCor) - University of São Paulo, Medical School, São Paulo, Brazil. Electronic address: gal.reis@globo.com. · Sleep Laboratory, Pulmonary Division, Heart Institute (InCor) - University of São Paulo, Medical School, São Paulo, Brazil. · Genetics and Molecular Cardiology Laboratory, Heart Institute (InCor) - University of São Paulo, Medical School, São Paulo, Brazil. · Federal University of Fronteira do Sul, Realeza, PR, Brazil. · Genetics and Molecular Cardiology Laboratory, Heart Institute (InCor) - University of São Paulo, Medical School, São Paulo, Brazil; Department of Psychiatry, University of São Paulo, School of Medicine, São Paulo, Brazil. · Department of Psychiatry, University of São Paulo, School of Medicine, São Paulo, Brazil; Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK. · Center for Circadian and Sleep Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. ·Sleep Med · Pubmed #30897453.

ABSTRACT: AIM: To test the association between cardiometabolic risk factors and subjective sleep quality assessed by the Pittsburgh sleep quality index (PSQI), independent of obstructive sleep apnea (OSA) and sleep duration. METHODS: A total of 573 participants from the Baependi Heart Study, a rural cohort from Brazil, completed sleep questionnaires and underwent polygraphy for OSA evaluation. Multivariable linear regression analysis tested the association between cardiovascular risk factors (outcome variables) and sleep quality measured by PSQI, adjusting for OSA and other potential confounders (age, sex, race, salary/wage, education, marital status, alcohol intake, obesity, smoking, hypertension, and sleep duration). RESULTS: The sample mean age was 43 ± 16 years, 66% were female, and mean body mass index (BMI) was 26 ± 5 kg/m CONCLUSION: Poorer lipid profile was independently associated with poor sleep quality, assessed by the PSQI questionnaire, regardless of a normal sleep duration and accounting for OSA and socio-economic status.

249 Article How to implant a phrenic nerve stimulator for treatment of central sleep apnea? 2019

Augostini, Ralph S / Afzal, Muhammad R / Costanzo, Maria Rosa / Westlund, Randy / Stellbrink, Christoph / Gutleben, Klaus / Gupta, Sanjaya / Saleem, Moeen / Smith, Timothy W / Peterson, Michael / Drucker, Michael / Merliss, Andrew / Hayes, John / Butter, Christen / Hutchinson, Matthew / Jagielski, Dariusz. ·The Ohio State University Wexner Medical Center, Columbus, Ohio. · Advocate Heart Institute, Chicago, Illinois. · Respicardia Inc, Minnetonka, Minnesota. · Klinikum Bielefeld, Bielefeld, Delaware. · Ruhruniversität Bochum, Bad Oeynhausen, Delaware. · Department of Cardiology, University of Missouri-Kansas City School of Medicine, Saint Luke's Mid-America Heart Institute, Kansas City, Missouri. · Washington University School of Medicine, St Louis, Missouri. · United Heart and Vascular Clinic, St Paul, Minnesota. · Novant Health Cardiology, Winston-Salem, North Carolina. · Bryan Medical Center, Lincoln, Nebraska. · Marshfield Clinic, Marshfield, Wisconsin. · Heart Center Brandenburg in Bernau/Berlin & Brandenburg Medical School, Bernau, Delaware. · University of Arizona College of Medicine, Tucson, Arizona. · 4th Military Hospital, Wroclaw, Poland. ·J Cardiovasc Electrophysiol · Pubmed #30834611.

ABSTRACT: BACKGROUND: Central sleep apnea (CSA) is a breathing disorder caused by the intermittent absence of central respiratory drive. Transvenous phrenic nerve stimulation is a new therapeutic option, recently approved by the FDA , for the treatment of CSA. OBJECTIVE: To describe the technique used to implant the transvenous phrenic nerve stimulation system (the remedē System, Respicardia, Inc). METHODS: The remedē System is placed in the pectoral region, typically on the right side. A single stimulation lead is placed in either the left pericardiophrenic vein (PPV) or the right brachiocephalic vein (RBC). A sensing lead is placed into the azygous vein to detect respiration. RESULTS: In the remedē System Pivotal trial, 147 of 151 (97%) patients were successfully implanted with the system. Sixty-two percent of stimulation leads were placed in the PPV and 35% in the RBC. Mean procedure time was 2.7 ± 0.8 hours and 94% of patients were free from implant-related serious adverse events through 6 months. CONCLUSION: In patients with CSA, transvenous phrenic nerve stimulation is an effective and safe therapy with an implant procedure similar to that of cardiac implantable electronic devices.

250 Article Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. 2019

Patil, Susheel P / Ayappa, Indu A / Caples, Sean M / Kimoff, R Joh / Patel, Sanjay R / Harrod, Christopher G. ·Johns Hopkins University, Baltimore, Maryland. · Icahn School of Medicine at Mount Sinai, New York, New York. · Mayo Clinic, Rochester, Minnesota. · McGill University Health Centre, Montreal, Quebec, Canada. · University of Pittsburgh, Pittsburgh, Pennsylvania. · American Academy of Sleep Medicine, Darien, Illinois. ·J Clin Sleep Med · Pubmed #30736888.

ABSTRACT: INTRODUCTION: The purpose of this systematic review is to provide supporting evidence for the clinical practice guideline for the treatment of obstructive sleep apnea (OSA) in adults using positive airway pressure (PAP). METHODS: The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of PAP with no treatment as well as studies that compared different PAP modalities. Meta-analyses were performed to determine the clinical significance of using PAP in several modalities (ie, continuous PAP, auto-adjusting PAP, and bilevel PAP), to treat OSA in adults. In addition, meta-analyses were performed to determine the clinical significance of using an in-laboratory versus ambulatory strategy for the initiation of PAP, educational and behavioral interventions, telemonitoring, humidification, different mask interfaces, and flexible or modified pressure profile PAP in conjunction with PAP to treat OSA in adults. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations. RESULTS: The literature search resulted in 336 studies that met inclusion criteria; 184 studies provided data suitable for meta-analyses. The data demonstrated that PAP compared to no treatment results in a clinically significant reduction in disease severity, sleepiness, blood pressure, and motor vehicle accidents, and improvement in sleep-related quality of life in adults with OSA. In addition, the initiation of PAP in the home demonstrated equivalent effects on patient outcomes when compared to an in-laboratory titration approach. The data also demonstrated that the use of auto-adjusting or bilevel PAP did not result in clinically significant differences in patient outcomes compared with standard continuous PAP. Furthermore, data demonstrated a clinically significant improvement in PAP adherence with the use of educational, behavioral, troubleshooting, and telemonitoring interventions. Systematic reviews for specific PAP delivery method were also performed and suggested that nasal interfaces compared to oronasal interfaces have improved adherence and slightly greater reductions in OSA severity, heated humidification compared to no humidification reduces some continuous PAP-related side effects, and pressure profile PAP did not result in clinically significant differences in patient outcomes compared with standard continuous PAP.

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