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Sleep Apnea Syndromes: HELP
Articles from Chicago
Based on 569 articles published since 2008
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These are the 569 published articles about Sleep Apnea Syndromes that originated from Chicago during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
226 Article Changing Rates of Morbidity and Mortality in Obstructive Sleep Apnea Surgery. 2017

Friedman, Jacob J / Salapatas, Anna M / Bonzelaar, Lauren B / Hwang, Michelle S / Friedman, Michael. ·1 University of Illinois College of Medicine, Chicago, Illinois, USA. · 2 ChicagoENT, Advanced Center for Specialty Care, Chicago, Illinois, USA. · 3 Loyola University Medical Center, Maywood, Illinois, USA. · 4 Johns Hopkins University, Baltimore, Maryland, USA. · 5 Rush University Medical Center, Chicago, Illinois, USA. ·Otolaryngol Head Neck Surg · Pubmed #28508712.

ABSTRACT: Objective Whereas uvulopalatopharyngoplasty (UPPP) was the standard surgical procedure for obstructive sleep apnea prior to 2007, multilevel surgery has become the standard since that time. This study compares morbidity and mortality rates of the stand-alone UPPP with those of multilevel sleep surgery that includes UPPP. Methods Patients undergoing UPPP between 2007 and 2014 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. UPPP was defined by Current Procedural Terminology codes 42145 and 42950. Primary outcomes were incidence of morbidity and mortality. Rates were compared between a control group with UPPP only and a group with multilevel surgery. Results A total of 2674 cases were analyzed. The incidence of complications in the UPPP-only group was 1.6% (0.09% fatal); in the multilevel surgery group, 4.63% (0.19% fatal). The difference in overall and nonfatal complications is statistically significant ( P < .01); however, values for fatal complications are too low for comparison. There is a statistically significant ( P < .01) positive correlation ( R

227 Article Angiopoietin-2 and soluble Tie-2 receptor plasma levels in children with obstructive sleep apnea and obesity. 2017

Gozal, David / Khalyfa, Abdelnaby / Qiao, Zhuanghong / Smith, Dale L / Philby, Mona F / Koren, Dorit / Kheirandish-Gozal, Leila. ·Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois, USA. · Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA. ·Obesity (Silver Spring) · Pubmed #28474375.

ABSTRACT: OBJECTIVE: Obstructive sleep apnea (OSA) is a prevalent condition, especially in children with obesity, and is associated with increased risk for metabolic syndrome (MetS). Angiopoietins have been identified as potential biomarkers of endothelial dysfunction and MetS. In adults, angiopoietin-2 (Ang-2) and its soluble receptor (sTie-2) are associated with diabetes, hypertension, and obesity and could be increased in children with OSA and obesity, particularly those with evidence of cardiometabolic alterations. METHODS: One hundred twenty-six children (7.4 ± 2.0 years) were consecutively recruited and underwent overnight polysomnography, as well as endothelial function and BMI z score assessments and a fasting blood draw the morning after the sleep study. In addition to lipid profile, glucose and insulin levels, and homeostatic model assessment of insulin resistance (HOMA-IR), Ang-2 and sTie-2 concentrations were determined. RESULTS: Children with obesity and OSA had significantly elevated plasma Ang-2 and sTie-2 levels compared to corresponding controls with and without obesity. Furthermore, endothelial function (Tmax) and HOMA-IR were linearly and independently associated with Ang-2 and sTie-2 levels. In a small subset of children (n = 14), treatment of OSA by adenotonsillectomy resulted in reductions of Ang-2 and sTie-2 (P < 0.01). CONCLUSIONS: Ang-2 and sTie-2 plasma levels are increased in pediatric OSA and obesity, particularly when endothelial dysfunction or insulin resistance is detectable, and appear to decrease upon OSA treatment.

228 Article Risk of obstructive sleep apnea in African American patients with chronic rhinosinusitis. 2017

Hui, Jessica W / Ong, Jason / Herdegen, James J / Kim, Hajwa / Codispoti, Christopher D / Kalantari, Vahid / Tobin, Mary C / Schleimer, Robert P / Batra, Pete S / LoSavio, Phillip S / Mahdavinia, Mahboobeh. ·Department of Internal Medicine and Pediatrics, Rush University Medical Center, Chicago, Illinois. · Sleep Disorders Service and Research Center, Rush University Medical Center, Chicago, Illinois. · Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Illinois. · Department of Immunology and Microbiology, Allergy/Immunology Section, Rush University Medical Center, Chicago, Illinois. · Division of Allergy-Immunology, Departments of Medicine, Otolaryngology, and Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois. · Department of Immunology and Microbiology, Allergy/Immunology Section, Rush University Medical Center, Chicago, Illinois. Electronic address: Mahboobeh_mahdavinia@rush.edu. ·Ann Allergy Asthma Immunol · Pubmed #28457643.

ABSTRACT: BACKGROUND: It is widely known that patients with chronic rhinosinusitis (CRS) commonly experience sleep disruption. Many of these patients have the associated diagnosis of obstructive sleep apnea (OSA). However, little is known about the risk factors for developing OSA in the CRS population. OBJECTIVE: To identify the risk factors for OSA in CRS to determine who should be screened for OSA among patients with CRS. METHODS: We evaluated a large cohort of patients with confirmed diagnostic criteria for CRS. Patient medical records were reviewed to identify those with OSA confirmed by overnight polysomnography. Records were further reviewed for demographic information (age, sex, race, and ethnicity), body mass index, and medical history, including the presence of nasal polyps, asthma, aspirin-exacerbated respiratory disease, allergic rhinitis, and eczema. The number of endoscopic sinus operations, duration of CRS, presence of subjective smell loss, and computed tomography Lund-Mackay score were also ascertained. RESULTS: A total of 916 patients with CRS were included in the study. Implementation of a multivariable regression model for identifying adjusted risk factors revealed that African American patients had a significantly higher risk for OSA than white patients, with an adjusted odds ratio of 1.98 (95% confidence interval, 1.19-3.29). Furthermore, patients with CRS without nasal polyps were at higher risk for OSA, with an odds ratio of 1.63 (95% confidence interval, 1.02-2.61) compared with patients with CRS with nasal polyps. CONCLUSION: African American patients with CRS were at higher risk for OSA compared with white patients, and this patient group needs to be screened for OSA.

229 Article Assessing the severity of sleep apnea syndrome based on ballistocardiogram. 2017

Wang, Zhu / Zhou, Xingshe / Zhao, Weichao / Liu, Fan / Ni, Hongbo / Yu, Zhiwen. ·School of Computer Science, Northwestern Polytechnical University, Xi'an, Shaanxi, China. ·PLoS One · Pubmed #28445548.

ABSTRACT: BACKGROUND: Sleep Apnea Syndrome (SAS) is a common sleep-related breathing disorder, which affects about 4-7% males and 2-4% females all around the world. Different approaches have been adopted to diagnose SAS and measure its severity, including the gold standard Polysomnography (PSG) in sleep study field as well as several alternative techniques such as single-channel ECG, pulse oximeter and so on. However, many shortcomings still limit their generalization in home environment. In this study, we aim to propose an efficient approach to automatically assess the severity of sleep apnea syndrome based on the ballistocardiogram (BCG) signal, which is non-intrusive and suitable for in home environment. METHODS: We develop an unobtrusive sleep monitoring system to capture the BCG signals, based on which we put forward a three-stage sleep apnea syndrome severity assessment framework, i.e., data preprocessing, sleep-related breathing events (SBEs) detection, and sleep apnea syndrome severity evaluation. First, in the data preprocessing stage, to overcome the limits of BCG signals (e.g., low precision and reliability), we utilize wavelet decomposition to obtain the outline information of heartbeats, and apply a RR correction algorithm to handle missing or spurious RR intervals. Afterwards, in the event detection stage, we propose an automatic sleep-related breathing event detection algorithm named Physio_ICSS based on the iterative cumulative sums of squares (i.e., the ICSS algorithm), which is originally used to detect structural breakpoints in a time series. In particular, to efficiently detect sleep-related breathing events in the obtained time series of RR intervals, the proposed algorithm not only explores the practical factors of sleep-related breathing events (e.g., the limit of lasting duration and possible occurrence sleep stages) but also overcomes the event segmentation issue (e.g., equal-length segmentation method might divide one sleep-related breathing event into different fragments and lead to incorrect results) of existing approaches. Finally, by fusing features extracted from multiple domains, we can identify sleep-related breathing events and assess the severity level of sleep apnea syndrome effectively. CONCLUSIONS: Experimental results on 136 individuals of different sleep apnea syndrome severities validate the effectiveness of the proposed framework, with the accuracy of 94.12% (128/136).

230 Article Monitoring mandibular movements to detect Cheyne-Stokes Breathing. 2017

Martinot, Jean-Benoît / Borel, Jean-Christian / Le-Dong, Nhat-Nam / Guénard, Hervé Jean-Pierre / Cuthbert, Valerie / Silkoff, Philip E / Gozal, David / Pepin, Jean-Louis. ·Centre du Sommeil et de la Vigilance, CHU UCL Namur Site Ste Elisabeth, 15, Place Louise Godin, 5000, Namur, Belgium. martinot.j@scarlet.be. · AGIR à dom. Association, 38240, Meylan, France. · University Grenoble Alpes, HP2 INSERM U1042, 38000, Grenoble, France. · RespiSom, Chaussée de Marche 571, 5101, Erpent, Belgium. · Laboratory of Physiology, Bordeaux University, Bordeaux, France. · Centre du Sommeil et de la Vigilance, CHU UCL Namur Site Ste Elisabeth, 15, Place Louise Godin, 5000, Namur, Belgium. · Temple University, Philadelphia, PA, USA. · University of Chicago, Chicago, IL, USA. · CHU de Grenoble, Laboratoire EFCR, Pôle THORAX et VAISSEAUX, Grenoble, France. ·Respir Res · Pubmed #28427400.

ABSTRACT: BACKGROUND: The patterns of mandibular movements (MM) during sleep can be used to identify increased respiratory effort periodic large-amplitude MM (LPM), and cortical arousals associated with "sharp" large-amplitude MM (SPM). We hypothesized that Cheyne Stokes breathing (CSB) may be identified by periodic abnormal MM patterns. The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard. The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard. METHODS: In 573 consecutive patients attending an in-laboratory PSG for suspected sleep disordered breathing (SDB), MM signals were acquired using magnetometry and scored manually while blinded from the PSG signal. Data analysis aimed to verify the concordance between the CSB identified by PSG and the presence of LPM or SPM. The data were randomly divided into training and validation sets (985 5-min segments/set) and concordance was evaluated using 2 classification models. RESULTS: In PSG, 22 patients (mean age ± SD: 65.9 ± 15.0 with a sex ratio M/F of 17/5) had CSB (mean central apnea hourly indice ± SD: 17.5 ± 6.2) from a total of 573 patients with suspected SDB. When tested on independent subset, the classification of CSB based on LPM and SPM is highly accurate (Balanced-accuracy = 0.922, sensitivity = 0.922, specificity = 0.921 and error-rate = 0.078). Logistic models based odds-ratios for CSB in presence of SPM or LPM were 172.43 (95% CI: 88.23-365.04; p < 0.001) and 186.79 (95% CI: 100.48-379.93; p < 0.001), respectively. CONCLUSION: CSB in patients with sleep disordered breathing could be accurately identified by a simple magnetometer device recording mandibular movements.

231 Article Effect of Continuous Positive Airway Pressure Treatment on Health-Related Quality of Life and Sleepiness in High Cardiovascular Risk Individuals With Sleep Apnea: Best Apnea Interventions for Research (BestAIR) Trial. 2017

Zhao, Ying Y / Wang, Rui / Gleason, Kevin J / Lewis, Eldrin F / Quan, Stuart F / Toth, Claudia M / Morrical, Michael / Rueschman, Michael / Weng, Jia / Ware, James H / Mittleman, Murray A / Redline, Susan / Anonymous6210903. ·Division of Sleep Medicine and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA. · Harvard Medical School, Boston, MA. · Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA. · Department of Public Health Sciences, University of Chicago, Chicago, IL. · Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA. · Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA. · Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. ·Sleep · Pubmed #28419387.

ABSTRACT: Study Objectives: The long-term effect of continuous positive airway pressure (CPAP) on health-related quality of life (HRQOL) in patients with high cardiovascular disease risk and obstructive sleep apnea (OSA) without severe sleepiness is uncertain. We aimed to determine the effect of CPAP treatment on HRQOL in individuals with moderate or severe OSA and cardiovascular disease (CVD) or multiple CVD risk factors without severe sleepiness. Methods: In this randomized, controlled, parallel group study, 169 participants were assigned to treatment with CPAP or the control group (conservative medical therapy [CMT] or CMT with sham CPAP). Analyses were based on an intention-to-treat approach. Linear mixed effect models were fitted to compare the changes in the Medical Outcomes Study Short Form-36 (SF-36) and in subjective sleepiness (Epworth Sleepiness Scale [ESS]) between groups from baseline to the average of 6- and 12-month measurements. Results: CPAP improved several domains of HRQOL including bodily pain (treatment effect 9.7 [95% confidence interval, CI 3.9 to 15.4]; p = .001), vitality (5.7 [95% CI 1.5 to 9.9]; p = .008), general health (8.2 [95% CI 3.7 to 12.7]; p < .001), physical functioning (5.5 [95% CI 1.1 to 10.0]; p = .016), and the physical health summary score (3.3 [95% CI 1.4 to 5.3]; p = .001). CPAP also resulted in less daytime sleepiness (mean change in ESS -1.0 point [95% CI -2.0 to -0.0]; p = .040). Conclusions: In patients with moderate-severe OSA at high risk of cardiovascular events and without severe sleepiness, CPAP improved daytime sleepiness and multiple domains of HRQOL over 6 to 12 months of follow-up, with the largest improvement observed for bodily pain.

232 Article Altered CD8+ T-Cell Lymphocyte Function and TC1 Cell Stemness Contribute to Enhanced Malignant Tumor Properties in Murine Models of Sleep Apnea. 2017

Akbarpour, Mahzad / Khalyfa, Abdelnaby / Qiao, Zhuanghong / Gileles-Hillel, Alex / Almendros, Isaac / Farré, Ramon / Gozal, David. ·Department of Pediatrics, Pritzker School of Medicine, The University of Chicago, Chicago, IL. · Unitat Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-CIBERES-IDIBAPS, Barcelona, Spain. ·Sleep · Pubmed #28364502.

ABSTRACT: Study Objective: The presence of obstructive sleep apnea (OSA) in patients with cancer appears to be accompanied by poorer outcomes. However, the mechanisms underlying such association are unknown. Tumor infiltrating lymphocytes (TILs), including CD8+ T cells, function as cytotoxic T lymphocytes (CTLs) and mount immune responses to cancer by the release of cytolytic enzymes, including granzyme B (GzmB), perforin (Prf), and cytokines such as interferon (IFN)-γ. Methods: Using established in vivo mouse models, we investigated CD8+ T cells and cancer stem cells (CSCs) in intermittent hypoxia (IH) and sleep fragmentation (SF) in the context of tumor environment. Results: Both IH and SF promoted increased tumor growth and invasion toward adjacent tissues compared to controls. The number and frequency of GzmB-producing CD8+ T cells per milligram of tumor tissue was significantly reduced in IH-exposed mice with impaired cytolytic function in both the groups and correlated with tumor weight. We also found that Oct4+ and CD44+CD133+ expressing CSCs were considerably increased in IH and SF tumors, respectively. Conclusions: Reductions in GzmB in intratumoral CD8+ T cells in combination with the changes in tumor microenvironment that maintain the ability of CSCs to self-renew and even confer this capability to the nonstem population are compatible with reduced immunosurveillance and adverse tumor outcomes in animal models of OSA.

233 Article Sleep Duration, Snoring Prevalence, Obesity, and Behavioral Problems in a Large Cohort of Primary School Students in Japan. 2017

Sakamoto, Naoko / Gozal, David / Smith, Dale L / Yang, Limin / Morimoto, Noriko / Wada, Hiroo / Maruyama, Kotatsu / Ikeda, Ai / Suzuki, Yohei / Nakayama, Meiho / Horiguchi, Itsuko / Tanigawa, Takeshi. ·Department of Epidemiologic Research, Toho University, Tokyo, Japan. · Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago,Chicago, IL. · Department of Health Sciences, University of Chicago, Chicago, IL. · Medical Support Center for Japan Environment and Children's Study, Tokyo, Japan. · National Center for Child Health and Development, Tokyo, Japan. · Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan. · Department of Otolaryngology and Good Sleep Center, Nagoya City University, Nagoya, Japan. · Center for Relations Strategy, Nagasaki University, Nagasaki, Japan. ·Sleep · Pubmed #28364432.

ABSTRACT: Study Objectives: Poor or short sleep and the presence of snoring indicative of sleep-disordered breathing (SDB) have been associated with behavioral problems in school-aged children. We examined the relationship between SDB, sleep duration, obesity risk, and behavioral characteristics in Japanese elementary school students using a large-scale survey. Methods: We conducted a cross-sectional study of children enrolled in all 46 public primary schools in Matsuyama city, Japan. The children's parents or guardians completed a questionnaire that covered sleep habits, presence of SDB risk, and behavioral characteristics. Results: In total, 24 296 responses were received (90% response rate). After excluding incomplete responses, we analyzed complete datasets for 17 769 children. Mean sleep duration decreased with age, as did the prevalence of pediatric SDB. We found an increased risk for the presence of SDB and short sleep among overweight/obese children. With SDB or short sleep, we observed significantly increased odds of restless behaviors, fidgety behaviors, and poor concentration in school. Conclusions: Shorter sleep duration was associated with increased risk of obesity, and in turn, obesity increased SDB risk. Both short sleep duration and SDB risk were significantly associated with behavioral problems in school.

234 Article Automated Screening of Children With Obstructive Sleep Apnea Using Nocturnal Oximetry: An Alternative to Respiratory Polygraphy in Unattended Settings. 2017

Álvarez, Daniel / Alonso-Álvarez, María L / Gutiérrez-Tobal, Gonzalo C / Crespo, Andrea / Kheirandish-Gozal, Leila / Hornero, Roberto / Gozal, David / Terán-Santos, Joaquín / Del Campo, Félix. ·Sleep-Ventilation Unit, Pneumology Service, Río Hortega University Hospital, Valladolid, Spain. · Biomedical Engineering Group, University of Valladolid, Valladolid, Spain. · Unidad Multidisciplinar de Sueño, CIBER Respiratorio, Hospital Universitario de Burgos, Burgos, Spain. · Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois. ·J Clin Sleep Med · Pubmed #28356177.

ABSTRACT: STUDY OBJECTIVES: Nocturnal oximetry has become known as a simple, readily available, and potentially useful diagnostic tool of childhood obstructive sleep apnea (OSA). However, at-home respiratory polygraphy (HRP) remains the preferred alternative to polysomnography (PSG) in unattended settings. The aim of this study was twofold: (1) to design and assess a novel methodology for pediatric OSA screening based on automated analysis of at-home oxyhemoglobin saturation (SpO METHODS: SpO RESULTS: For a cutoff of 1 event/h, the optimal logistic regression model significantly outperformed both conventional HRP-derived ODI3 and OAHI: 85.5% accuracy (HRP 74.6%; ODI3 65.9%) and 0.97 area under the receiver operating characteristics curve (AUC) (HRP 0.78; ODI3 0.75) were reached. For a cutoff of 3 events/h, the logistic regression model achieved 83.4% accuracy (HRP 85.0%; ODI3 74.5%) and 0.96 AUC (HRP 0.93; ODI3 0.85) whereas using a cutoff of 5 events/h, oximetry reached 82.8% accuracy (HRP 85.1%; ODI3 76.7) and 0.97 AUC (HRP 0.95; ODI3 0.84). CONCLUSIONS: Automated analysis of at-home SpO

235 Article The state of academic sleep surgery: A survey of United States residency and fellowship programs. 2017

Gouveia, Christopher J / Kern, Robert C / Liu, Stanley Yung-Chuan / Capasso, Robson. ·Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A. · Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, California, U.S.A. ·Laryngoscope · Pubmed #28349537.

ABSTRACT: OBJECTIVES/HYPOTHESIS: Our objectives were to describe otolaryngology residency programs' experience in and attitudes toward sleep surgery, and describe current otolaryngology sleep fellowships and their impact on future academic practice. STUDY DESIGN: E-mail survey. METHODS: A survey was e-mailed to program directors of 106 Accreditation Council for Graduate Medical Education-accredited otolaryngology residencies assessing resident sleep medicine experience, program satisfaction, and impact of sleep faculty. A separate survey was sent to directors of the seven sleep medicine otolaryngology fellowships. Frequency of graduates pursuing academic careers was examined. RESULTS: Forty-six (43.4%) residency programs responded. Thirty-one (67.4%) have a faculty member with any time spent practicing sleep medicine or surgery. Nineteen (41.3%) have a faculty member with >50% dedicated sleep practice and/or who is board certified in sleep medicine. These programs were significantly more likely to respond "extremely" or "very" satisfied with resident sleep exposure than those without (P < .001). Most programs (69.6%) "strongly agreed" or "agreed" their program would benefit from a dedicated sleep surgeon; there was no significant difference in response rates between programs already with and those without dedicated sleep faculty. All fellowship directors responded. In the past 5 years these programs have trained 11 total fellows. Ten (90.9%) have remained in academic practice. CONCLUSIONS: There is significantly increased satisfaction in resident sleep education at otolaryngology programs with dedicated sleep providers. Concurrently, there is strong program interest in sleep surgeons' involvement in resident training. Sleep fellowships are producing surgeons who pursue academic careers. This study provides support to training fellowship-specialized sleep surgeons and encouraging otolaryngology sleep faculty. LEVEL OF EVIDENCE: NA Laryngoscope, 127:2423-2428, 2017.

236 Article Prolonged Exposures to Intermittent Hypoxia Promote Visceral White Adipose Tissue Inflammation in a Murine Model of Severe Sleep Apnea: Effect of Normoxic Recovery. 2017

Gileles-Hillel, Alex / Almendros, Isaac / Khalyfa, Abdelnaby / Nigdelioglu, Recep / Qiao, Zhuanhong / Hamanaka, Robert B / Mutlu, Gökhan M / Akbarpour, Mahzad / Gozal, David. ·Sections of Pediatric Sleep Medicine and Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL. · Department of Medicine, Section of Pulmonary and Critical Care, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL. ·Sleep · Pubmed #28329220.

ABSTRACT: Study Objective: Increased visceral white adipose tissue (vWAT) mass results in infiltration of inflammatory macrophages that drive inflammation and insulin resistance. Patients with obstructive sleep apnea (OSA) suffer from increased prevalence of obesity, insulin resistance, and metabolic syndrome. Murine models of intermittent hypoxia (IH) mimicking moderate-severe OSA manifest insulin resistance following short-term IH. We examined in mice the effect of long-term IH on the inflammatory cellular changes within vWAT and the potential effect of normoxic recovery (IH-R). Methods: Male C57BL/6J mice were subjected to IH for 20 weeks, and a subset was allowed to recover in room air (RA) for 6 or 12 weeks (IH-R). Stromal vascular fraction was isolated from epididymal vWAT and mesenteric vWAT depots, and single-cell suspensions were prepared for flow cytometry analyses, reactive oxygen species (ROS), and metabolic assays. Results: IH reduced body weight and vWAT mass and IH-R resulted in catch-up weight and vWAT mass. IH-exposed vWAT exhibited increased macrophage counts (ATMs) that were only partially improved in IH-R. IH also caused a proinflammatory shift in ATMs (increased Ly6c(hi)(+) and CD36(+) ATMs). These changes were accompanied by increased vWAT insulin resistance with only partial improvements in IH-R. In addition, ATMs exhibited increased ROS production, altered metabolism, and changes in electron transport chain, which were only partially improved in IH-R. Conclusion: Prolonged exposures to IH during the sleep period induce pronounced vWAT inflammation and insulin resistance despite concomitant vWAT mass reductions. These changes are only partially reversible after 3 months of normoxic recovery. Thus, long-lasting OSA may preclude complete reversibility of metabolic changes.

237 Article Cross-Sectional Comparison of Sleep-Disordered Breathing in Native Peruvian Highlanders and Lowlanders. 2017

Pham, Luu V / Meinzen, Christopher / Arias, Rafael S / Schwartz, Noah G / Rattner, Adi / Miele, Catherine H / Smith, Philip L / Schneider, Hartmut / Miranda, J Jaime / Gilman, Robert H / Polotsky, Vsevolod Y / Checkley, William / Schwartz, Alan R. ·1 Division of Pulmonary and Critical Care and Sleep Medicine, Department of Medicine, School of Medicine, Johns Hopkins University , Baltimore, Maryland. · 2 Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, Maryland. · 3 School of Medicine, Johns Hopkins University , Baltimore, Maryland. · 4 University of Chicago Pritzker School of Medicine , Chicago, Illinois. · 5 School of Medicine, Universidad Peruana Cayetano Heredia , Lima, Peru . · 6 CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Lima, Peru . ·High Alt Med Biol · Pubmed #28306414.

ABSTRACT: Pham, Luu V., Christopher Meinzen, Rafael S. Arias, Noah G. Schwartz, Adi Rattner, Catherine H. Miele, Philip L. Smith, Hartmut Schneider, J. Jaime Miranda, Robert H. Gilman, Vsevolod Y. Polotsky, William Checkley, and Alan R. Schwartz. Cross-sectional comparison of sleep-disordered breathing in native Peruvian highlanders and lowlanders. High Alt Med Biol. 18:11-19, 2017. BACKGROUND: Altitude can accentuate sleep disordered breathing (SDB), which has been linked to cardiovascular and metabolic diseases. SDB in highlanders has not been characterized in large controlled studies. The purpose of this study was to compare SDB prevalence and severity in highlanders and lowlanders. METHODS: 170 age-, body-mass-index- (BMI), and sex-matched pairs (age 58.2 ± 12.4 years, BMI 27.2 ± 3.5 kg/m RESULTS: Sleep apnea prevalence was greater in highlanders than in lowlanders (77% vs. 54%, p < 0.001). Compared with lowlanders, highlanders had twofold elevations in AHI due to increases in central rather than obstructive apneas. In highlanders compared with lowlanders, S CONCLUSIONS: High altitude and hypoxemia at both high and low altitude were associated with increased SDB prevalence and severity. Our findings suggest that a large proportion of highlanders remain at risk for SDB sequelae.

238 Article Reduced Regional Grey Matter Volumes in Pediatric Obstructive Sleep Apnea. 2017

Philby, Mona F / Macey, Paul M / Ma, Richard A / Kumar, Rajesh / Gozal, David / Kheirandish-Gozal, Leila. ·Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA. · UCLA School of Nursing University of California at Los Angeles, Los Angeles, CA 90095, USA. · The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA. · Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA 90095, USA. · Department of Bioengineering, University of California at Los Angeles, Los Angeles, CA 90095, USA. · Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA 90095, USA. ·Sci Rep · Pubmed #28303917.

ABSTRACT: Pediatric OSA is associated with cognitive risk. Since adult OSA manifests MRI evidence of brain injury, and animal models lead to regional neuronal losses, pediatric OSA patients may also be affected. We assessed the presence of neuronal injury, measured as regional grey matter volume, in 16 OSA children (8 male, 8.1 ± 2.2 years, AHI:11.1 ± 5.9 events/hr), and 200 control subjects (84 male, 8.2 ± 2.0 years), 191 of whom were from the NIH-Pediatric MRI database. High resolution T1-weighted whole-brain images were assessed between groups with voxel-based morphometry, using ANCOVA (covariates, age and gender; family-wise error correction, P < 0.01). Significant grey matter volume reductions appeared in OSA throughout areas of the superior frontal and prefrontal, and superior and lateral parietal cortices. Other affected sites included the brainstem, ventral medial prefrontal cortex, and superior temporal lobe, mostly on the left side. Thus, pediatric OSA subjects show extensive regionally-demarcated grey matter volume reductions in areas that control cognition and mood functions, even if such losses are apparently independent of cognitive deficits. Since OSA disease duration in our subjects is unknown, these findings may result from either delayed neuronal development, neuronal damaging processes, or a combination thereof, and could either reflect neuronal atrophy or reductions in cellular volume (neurons and glia).

239 Article Role of Cyclooxygenase-2 on Intermittent Hypoxia-Induced Lung Tumor Malignancy in a Mouse Model of Sleep Apnea. 2017

Campillo, Noelia / Torres, Marta / Vilaseca, Antoni / Nonaka, Paula Naomi / Gozal, David / Roca-Ferrer, Jordi / Picado, César / Montserrat, Josep Maria / Farré, Ramon / Navajas, Daniel / Almendros, Isaac. ·Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, 08036-Barcelona, Spain. · Institute for Bioengineering of Catalonia, 08028-Barcelona, Spain. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, 28029-Madrid, Spain. · Laboratori del Son. Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona 08036-Barcelona, Spain. · Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL 60637, USA. · Institut d'Investigacions Biomèdiques August Pi i Sunyer, 08036-Barcelona, Spain. · Department of Pneumology and Respiratory Allergy, Hospital Clinic, 08036-Barcelona, Spain. ·Sci Rep · Pubmed #28300223.

ABSTRACT: An adverse role for obstructive sleep apnea (OSA) in cancer epidemiology and outcomes has recently emerged from clinical and animal studies. In animals, intermittent hypoxia (IH) mimicking OSA promotes tumor malignancy both directly and via host immune alterations. We hypothesized that IH could potentiate cancer aggressiveness through activation of the cyclooxygenase-2 (COX-2) pathway and the concomitant increases in prostaglandin E2 (PGE

240 Article Ageing and chronic intermittent hypoxia mimicking sleep apnea do not modify local brain tissue stiffness in healthy mice. 2017

Jorba, Ignasi / Menal, Maria José / Torres, Marta / Gozal, David / Piñol-Ripoll, Gerard / Colell, Anna / Montserrat, Josep M / Navajas, Daniel / Farré, Ramon / Almendros, Isaac. ·Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain; Institut de Bioenginyeria de Catalunya, Barcelona, Spain. · Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain. · Sleep Lab, Hospital Clinic Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain. · Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA. · Unitat Trastorns Cognitius, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria, Lleida, Spain. · Dept. Mort i Proliferació Cel.lular, Institut d'Investigacions Biomèdiques de Barcelona (IIBB-CSIC), CIBERNED, Spain; Institut Investigacions Biomediques August Pi Sunyer, Barcelona, Spain. · Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain; Institut de Bioenginyeria de Catalunya, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain. · Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain; Institut Investigacions Biomediques August Pi Sunyer, Barcelona, Spain. · Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain; Institut Investigacions Biomediques August Pi Sunyer, Barcelona, Spain. Electronic address: isaac.almendros@ub.edu. ·J Mech Behav Biomed Mater · Pubmed #28284842.

ABSTRACT: Recent evidence suggests that obstructive sleep apnea (OSA) may increase the risk of Alzheimer´s disease (AD), with the latter promoting alterations in brain tissue stiffness, a feature of ageing. Here, we assessed the effects of age and intermittent hypoxia (IH) on brain tissue stiffness in a mouse model of OSA. Two-month-old and 18-month-old mice (N=10 each) were subjected to IH (20% O

241 Article Relation of Obstructive Sleep Apnea and a Common Variant at Chromosome 4q25 to Atrial Fibrillation. 2017

Patel, Neel J / Wells, Quinn S / Huang, Shi / Upender, Raghu P / Darbar, Dawood / Monahan, Ken. ·Division of Cardiovascular Medicine, Vanderbilt Medical Center, Nashville, Tennessee. · Department of Biostatistics, Vanderbilt Medical Center, Nashville, Tennessee. · Division of Sleep Medicine, Department of Neurology, Vanderbilt Medical Center, Nashville, Tennessee. · Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois. · Division of Cardiovascular Medicine, Vanderbilt Medical Center, Nashville, Tennessee. Electronic address: ken.monahan@vanderbilt.edu. ·Am J Cardiol · Pubmed #28258728.

ABSTRACT: Obstructive sleep apnea (OSA) and single nucleotide polymorphisms (SNPs) at the 4q25 locus are associated with increased risk of atrial fibrillation (AF). Whether these associations are independent of traditional risk factors for AF remains unknown. Using billing code queries and manual chart review, we assembled a cohort of adults that underwent overnight polysomnography and at least 1 12-lead electrocardiogram. Case status was defined by electrocardiographic data in support of AF or documentation of AF by a staff cardiologist. Controls were defined by a lack of primary evidence of AF and absence of a diagnosis of AF in the medical record. OSA severity was categorized based on Apnea-Hypopnea Index. Genotyping for a key 4q25 SNP (rs2200733) was performed using the Sequenom platform. Logistic regression was used to test for associations of AF with OSA category and 4q25 SNP genotype while adjusting for age, gender, body mass index, ancestry, hypertension status, and heart failure status. The cohort consisted of 674 subjects (62 ± 13 years; 44% women), including 132 patients with AF. After adjustment for established risk factors, the association between AF and OSA severity was borderline significant (odds ratio 1.2, 95% CI 1.0 to 1.5). The association between AF and 4q25 SNP status remained significant in a fully adjusted model that included OSA severity (odds ratio 1.5, 95% CI 1.3 to 5.7). In conclusion, OSA severity and the chromosome 4q25 SNP genotype were associated with AF status independent of clinical risk factors. Knowledge of AF-related SNPs may enhance AF risk stratification for those undergoing polysomnography.

242 Article Aorta macrophage inflammatory and epigenetic changes in a murine model of obstructive sleep apnea: Potential role of CD36. 2017

Cortese, Rene / Gileles-Hillel, Alex / Khalyfa, Abdelnaby / Almendros, Isaac / Akbarpour, Mahzad / Khalyfa, Ahamed A / Qiao, Zhuanghong / Garcia, Tzintzuni / Andrade, Jorge / Gozal, David. ·Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA. · Center for Research Informatics, The University of Chicago, Chicago, IL, USA. ·Sci Rep · Pubmed #28240319.

ABSTRACT: Obstructive sleep apnea (OSA) affects 8-10% of the population, is characterized by chronic intermittent hypoxia (CIH), and causally associates with cardiovascular morbidities. In CIH-exposed mice, closely mimicking the chronicity of human OSA, increased accumulation and proliferation of pro-inflammatory metabolic M1-like macrophages highly expressing CD36, emerged in aorta. Transcriptomic and MeDIP-seq approaches identified activation of pro-atherogenic pathways involving a complex interplay of histone modifications in functionally-relevant biological pathways, such as inflammation and oxidative stress in aorta macrophages. Discontinuation of CIH did not elicit significant improvements in aorta wall macrophage phenotype. However, CIH-induced aorta changes were absent in CD36 knockout mice, Our results provide mechanistic insights showing that CIH exposures during sleep in absence of concurrent pro-atherogenic settings (i.e., genetic propensity or dietary manipulation) lead to the recruitment of CD36(+)

243 Article Mandibular position and movements: Suitability for diagnosis of sleep apnoea. 2017

Martinot, Jean-Benoit / Borel, Jean-Christian / Cuthbert, Valérie / Guénard, Hervé Jean-Pierre / Denison, Stéphane / Silkoff, Philip E / Gozal, David / Pepin, Jean-Louis. ·Laboratory of Sleep Medicine, CHU UCL Namur, Namur, Belgium. · 'AGIR à dom' Association, La Tronche, Grenoble, France. · University Grenoble Alpes, Grenoble, France. · Laboratory of Physiology, Bordeaux University, Bordeaux, France. · Department of Physiology, Temple University, Philadelphia, Pennsylvania, USA. · Department of Medicine, University of Chicago, Chicago, Illinois, USA. · Sleep and Exercise Laboratory, Thorax and Vessels Division, Grenoble Alpes University Hospital, Grenoble, France. ·Respirology · Pubmed #28225162.

ABSTRACT: BACKGROUND AND OBJECTIVE: Mandibular movements (MMs) and position during sleep reflect respiratory efforts related to increases in upper airway resistance and micro-arousals. The study objective was to assess whether MM identifies sleep-disordered breathing (SDB) in patients with moderate to high pre-test probability. METHODS: This was a prospective study of 87 consecutive patients referred for an in-laboratory sleep test. Magnetometer-derived MM signals were incorporated into standard polysomnography (PSG). Respiratory events detected with MM analysis were compared with PSG for respiratory disturbance index (RDI) with a blinded scoring. All records were scored manually according to American Academy of Sleep Medicine rules. Primary outcome was to rule-in obstructive sleep apnoea syndrome (OSAS) defined as RDI cut-off value ≥5 or 15/h total sleep time (TST). RESULTS: High concordance emerged between MM and PSG-derived RDI with high temporal coincidence between events (R CONCLUSION: RDI assessed by MM is highly concordant with PSG, suggesting a role of ambulatory MM recordings to screen for SDB in patients with moderate to high pre-test probability.

244 Article Performance characteristics of the French version of the severity hierarchy score for paediatric sleep apnoea screening in clinical settings. 2017

Nguyên, Xuân-Lan / Lévy, Pierre / Beydon, Nicole / Gozal, David / Fleury, Bernard. ·Unité Sommeil et Fonction Respiratoire, Hôpital Saint-Antoine, Paris, France. Electronic address: nguyenxl@wanadoo.fr. · UPMC & Inserm UMR S 1136 (EPAR team), Département de Santé Publique, Hôpital Tenon, Paris, France. · Unité Fonctionnelle d'Exploration Fonctionnelle Respiratoire et du Sommeil, Hôpital Armand-Trousseau, Groupe Hospitalier Universitaire de l'Est Parisien, (APHP), Paris, France. · Sections of Pediatric Sleep Medicine and Pediatric Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA. · Unité Sommeil et Fonction Respiratoire, Hôpital Saint-Antoine, Paris, France. ·Sleep Med · Pubmed #28215255.

ABSTRACT: BACKGROUND: Paediatric obstructive sleep apnoea syndrome (OSAS) is a highly prevalent condition carrying increased risk for impaired cognitive and cardiovascular function. The standard diagnosis consists of full-night polysomnography (PSG), but limited access to PSG leads to substantial under-diagnosis. The use of a validated and simple diagnostic screening tool to predict OSAS could prioritise night sleep recordings in children at risk of OSAS, and help in clinical decision-making. OBJECTIVE: This study aimed to prospectively assess the performance of the French version of the severity hierarchy score (SHS) in paediatric OSAS. This score consists of a discriminative subset of six respiratory items, and has already been validated in English for screening OSAS in the general paediatric population. METHODS: A total of 96 children (mean age 7.1 ± 2.4 years; BMI z-score: -0.03 ± 1.50) were recruited; they had been were referred to two academic sleep centres in France for the putative diagnosis of sleep-disordered breathing. The parents completed the SHS questionnaire prior to PSG. Sensitivity and specificity of the SHS for detecting moderate OSAS, defined by an apnoea-hypopnoea index (AHI) of ≥5/hours of total sleep time (TST), were assessed, and ROC analysis was performed. RESULTS: An SHS score of >2.75 exhibited an 82% sensitivity, 81% specificity, and 92% negative predictive value for detecting an AHI of ≥5/hour TST in the cohort. CONCLUSION: The French version of the SHS emerged as favourably suited for the screening for OSAS in children.

245 Article The Effect of OSA Therapy on Glucose Metabolism: It's All about CPAP Adherence! 2017

Kaur, Amanpreet / Mokhlesi, Babak. ·Division of Pulmonary and Critical Care Medicine, Alpert Medical School at Brown University, Providence, RI. · Department of Medicine, Section of Pulmonary and Critical Care, Sleep Disorders Center, The University of Chicago, Chicago, IL. ·J Clin Sleep Med · Pubmed #28212697.

ABSTRACT: -- No abstract --

246 Article Sleep Surgery in the Elderly: Lessons from the National Surgical Quality Improvement Program. 2017

Gouveia, Christopher J / Cramer, John D / Liu, Stanley Yung-Chuan / Capasso, Robson. ·1 Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. · 2 Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, California, USA. ·Otolaryngol Head Neck Surg · Pubmed #28195824.

ABSTRACT: Objective Assess the frequency and nature of postoperative complications following sleep surgery. Examine these issues specifically in elderly patients to provide guidance for their perioperative care. Study Design Retrospective cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program. Methods We identified patients with obstructive sleep apnea undergoing sleep surgery procedures from 2006 to 2013 in the American College of Surgeons National Surgical Quality Improvement Program, a multi-institutional outcomes program designed to improve surgical quality. We analyzed patients by comparing age groups: <65 and ≥65 years. Summary data were analyzed, and multivariate regression was used to adjust for patient characteristics, comorbidities, and surgical procedure. Results We identified 2230 patients who had sleep surgery, which included 2123 patients <65 years old and 107 patients ≥65 years old. Elderly patients were significantly more likely to have hypertension requiring medication ( P < .001) and higher American Society of Anesthesiologists scores ( P < .001). There were no significant differences in the rates of nasal ( P = .87), palate ( P = .59), tongue base ( P = .73), and multilevel ( P = .95) surgery being performed on both groups of patients. Elderly patients had higher rates of wound complications and urinary tract infections as compared with younger patients. On multivariate analysis, age ≥65 was significantly associated with complications from sleep surgery (odds ratio, 2.35; 95% CI, 1.04-5.35). Conclusion Elderly patients undergoing sleep surgery have increased postoperative complication risk as compared with younger patients treated similarly. This information can help direct quality improvement efforts in the care of older patients.

247 Article Endothelial Dysfunction in Children With Obstructive Sleep Apnea Is Associated With Elevated Lipoprotein-Associated Phospholipase A2 Plasma Activity Levels. 2017

Kheirandish-Gozal, Leila / Philby, Mona F / Qiao, Zhuanghong / Khalyfa, Abdelnaby / Gozal, David. ·Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL lgozal@peds.bsd.uchicago.edu. · Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, IL. ·J Am Heart Assoc · Pubmed #28183716.

ABSTRACT: BACKGROUND: Obstructive sleep apnea (OSA) is a highly prevalent condition, especially in obese children, and has been associated with increased risk for endothelial dysfunction and dislipidemia, which are precursors of atherosclerosis. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is recognized as an independent risk factor for cardiovascular risk and atheromatous plaque activity. We hypothesized that Lp-PLA2 levels would be elevated in children with OSA, particularly among obese children who also manifest evidence of endothelial dysfunction. METHODS AND RESULTS: One hundred sixty children (mean age 7.1±2.3 years), either nonobese with (n=40) and without OSA (n=40) or obese with (n=40) and without OSA (n=40) underwent overnight polysomnographic and postocclusive reperfusion evaluation and a fasting blood draw the morning after the sleep study. In addition to lipid profile, Lp-PLA2 plasma activity was assessed using a commercial kit. Obese children and OSA children had significantly elevated plasma Lp-PLA2 activity levels compared to controls. Furthermore, when both obesity and OSA were concurrently present or when endothelial function was present, Lp-PLA2 activity was higher. Treatment of OSA by adenotonsillectomy resulted in reductions of Lp-PLA2 activity (n=37; CONCLUSIONS: Lp-PLA2 plasma activity is increased in pediatric OSA and obesity, particularly when endothelial dysfunction is present, and exhibits decreases on OSA treatment. The short-term and long-term significance of these findings in relation to cardiovascular risk remain undefined.

248 Article A predictive model for obstructive sleep apnea and Down syndrome. 2017

Skotko, Brian G / Macklin, Eric A / Muselli, Marco / Voelz, Lauren / McDonough, Mary Ellen / Davidson, Emily / Allareddy, Veerasathpurush / Jayaratne, Yasas S N / Bruun, Richard / Ching, Nicholas / Weintraub, Gil / Gozal, David / Rosen, Dennis. ·Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts. · Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. · Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Rulex, Inc., Boston, Massachusetts. · Institute of Electronics, Computer, and Telecommunication Engineering, Italian National Research Council, Genoa, Italy. · Down Syndrome Program, Division of Developmental Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts. · Department of Orthodontics, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa. · Division of Orthodontics, Department of Craniofacial Sciences, University of Connecticut School of Dental Medicine, Farmington, Connecticut. · Department of Dentistry, Boston Children's Hospital, Boston, Massachusetts. · Children's Dentistry, El Cerrito, California. · Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Department of Pediatrics, University of Chicago, Chicago, Illinois. · Division of Respiratory Diseases, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts. ·Am J Med Genet A · Pubmed #28124477.

ABSTRACT: Obstructive sleep apnea (OSA) occurs frequently in people with Down syndrome (DS) with reported prevalences ranging between 55% and 97%, compared to 1-4% in the neurotypical pediatric population. Sleep studies are often uncomfortable, costly, and poorly tolerated by individuals with DS. The objective of this study was to construct a tool to identify individuals with DS unlikely to have moderate or severe sleep OSA and in whom sleep studies might offer little benefit. An observational, prospective cohort study was performed in an outpatient clinic and overnight sleep study center with 130 DS patients, ages 3-24 years. Exclusion criteria included previous adenoid and/or tonsil removal, a sleep study within the past 6 months, or being treated for apnea with continuous positive airway pressure. This study involved a physical examination/medical history, lateral cephalogram, 3D photograph, validated sleep questionnaires, an overnight polysomnogram, and urine samples. The main outcome measure was the apnea-hypopnea index. Using a Logic Learning Machine, the best model had a cross-validated negative predictive value of 73% for mild obstructive sleep apnea and 90% for moderate or severe obstructive sleep apnea; positive predictive values were 55% and 25%, respectively. The model included variables from survey questions, medication history, anthropometric measurements, vital signs, patient's age, and physical examination findings. With simple procedures that can be collected at minimal cost, the proposed model could predict which patients with DS were unlikely to have moderate to severe obstructive sleep apnea and thus may not need a diagnostic sleep study.

249 Article Complementary roles of gasotransmitters CO and H2S in sleep apnea. 2017

Peng, Ying-Jie / Zhang, Xiuli / Gridina, Anna / Chupikova, Irina / McCormick, David L / Thomas, Robert J / Scammell, Thomas E / Kim, Gene / Vasavda, Chirag / Nanduri, Jayasri / Kumar, Ganesh K / Semenza, Gregg L / Snyder, Solomon H / Prabhakar, Nanduri R. ·Institute of Integrative Physiology, Biological Sciences Division, University of Chicago, Chicago, IL 60637. · Center for Systems Biology of O2 Sensing, Department of Medicine, University of Chicago, Chicago, IL 60637. · Life Sciences Group, Illinois Institute of Technology Research Institute, Chicago, IL 60616. · Division of Pulmonary, Critical Care & Sleep, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215. · Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215. · Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL 60637. · Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205. · Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205. · Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205. · Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205. · Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205. · Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205. · Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD 21205. · McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205. · Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205; nanduri@uchicago.edu ssnyder@jhmi.edu. · Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205. · Institute of Integrative Physiology, Biological Sciences Division, University of Chicago, Chicago, IL 60637; nanduri@uchicago.edu ssnyder@jhmi.edu. ·Proc Natl Acad Sci U S A · Pubmed #28115703.

ABSTRACT: Sleep apnea, which is the periodic cessation of breathing during sleep, is a major health problem affecting over 10 million people in the United States and is associated with several sequelae, including hypertension and stroke. Clinical studies suggest that abnormal carotid body (CB) activity may be a driver of sleep apnea. Because gaseous molecules are important determinants of CB activity, aberrations in their signaling could lead to sleep apnea. Here, we report that mice deficient in heme oxygenase-2 (HO-2), which generates the gaseous molecule carbon monoxide (CO), exhibit sleep apnea characterized by high apnea and hypopnea indices during rapid eye movement (REM) sleep. Similar high apnea and hypopnea indices were also noted in prehypertensive spontaneously hypertensive (SH) rats, which are known to exhibit CB hyperactivity. We identified the gaseous molecule hydrogen sulfide (H

250 Article Positive Airway Pressure Therapies and Hospitalization in Chronic Obstructive Pulmonary Disease. 2017

Vasquez, Monica M / McClure, Leslie A / Sherrill, Duane L / Patel, Sanjay R / Krishnan, Jerry / Guerra, Stefano / Parthasarathy, Sairam. ·Arizona Respiratory Center, University of Arizona, Tucson. · Dornsife School of Public Health, Drexel University, Philadelphia, Pa. · Department of Medicine, University of Pittsburgh, Pa. · Office of Health Affairs at the University of Illinois Hospital & Health Sciences System, Chicago. · Arizona Respiratory Center, University of Arizona, Tucson; Department of Medicine, University of Arizona, Tucson; CREAL Centre and Universitat Pompeu Fabra, Barcelona, Spain. · Department of Medicine, University of Arizona, Tucson; UAHS Center for Sleep & Circadian Sciences, University of Arizona, Tucson. Electronic address: Spartha1@email.arizona.edu. ·Am J Med · Pubmed #28089799.

ABSTRACT: BACKGROUND: Hospitalization of patients with chronic obstructive pulmonary disease creates a huge healthcare burden. Positive airway pressure therapy is sometimes used in patients with chronic obstructive pulmonary disease, but the possible impact on hospitalization risk remains controversial. We studied the hospitalization risk of patients with chronic obstructive pulmonary disease before and after initiation of various positive airway pressure therapies in a "real-world" bioinformatics study. METHODS: We performed a retrospective analysis of administrative claims data of hospitalizations in patients with chronic obstructive pulmonary disease who received or did not receive positive airway pressure therapy: continuous positive airway pressure, bilevel positive airway pressure, and noninvasive positive pressure ventilation using a home ventilator. RESULTS: The majority of 1,881,652 patients with chronic obstructive pulmonary disease (92.5%) were not receiving any form of positive airway pressure therapy. Prescription of bilevel positive airway pressure (1.5%), continuous positive airway pressure (5.6%), and noninvasive positive pressure ventilation (<1%) in patients with chronic obstructive pulmonary disease demonstrated geographic-, sex-, and age-related variability. After adjusting for confounders and propensity score, noninvasive positive pressure ventilation (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.13-0.27), bilevel positive airway pressure (OR, 0.42; 95% CI, 0.39-0.45), and continuous positive airway pressure (OR, 0.70; 95% CI, 0.67-0.72) were individually associated with lower hospitalization risk in the 6 months post-treatment when compared with the 6 months pretreatment but not when compared with the baseline period between 12 and 6 months before treatment initiation. Stratified analysis suggests that comorbid sleep-disordered breathing, chronic respiratory failure, heart failure, and age less than 65 years were associated with greater benefits from positive airway pressure therapy. CONCLUSION: Initiation of positive airway pressure therapy was associated with reduction in hospitalization among patients with chronic obstructive pulmonary disease, but the causality needs to be determined by randomized controlled trials.

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