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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
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
476 Article Increased circulating endothelial progenitor cells and anti-oxidant capacity in obstructive sleep apnea after surgical treatment. 2015

Lu, Cheng-Hsien / Lin, Hsin-Ching / Huang, Chih-Cheng / Lin, Wei-Che / Chen, Hsiu-Ling / Chang, Hsueh-Wen / Friedman, Michael / Chen, Chao Tung / Tsai, Nai-Wen / Wang, Hung-Chen / Kung, Chia-Te / Su, Yu-Jih / Cheng, Ben-Chung. ·Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China. Electronic address: chlu99@ms44.url.com.tw. · Department of Otolaryngology and Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. · Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. · Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. · Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan. · Department of Otolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, IL, United States; Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, IL, United States. · Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. · Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. · Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. · Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. ·Clin Chim Acta · Pubmed #26093341.

ABSTRACT: BACKGROUND: Obstructive sleep apnea (OSA) has increased risk of cardiovascular diseases. Profiles of endothelial progenitor cells (EPCs) reflect the degree of endothelial impairment. This study tested the hypothesis that surgical treatment not only improves clinical outcomes but also increases the number of circulating EPCs and antioxidant capacity. METHODS: The number of circulating EPCs (CD133(+)/CD34(+) [%], KDR(+)/CD34(+) [%]), biomarkers for oxidative stress (thiols and TBARS), and polysomnography (PSG) study was prospectively evaluated in 62 OSA patients at two time points (pre-operative and at least 3-month post-operative). The biomarkers and PSG were compared with those of 31 age- and body mass index (BMI)-matched healthy controls. RESULTS: Levels of HbA1c and LDL-C were significantly higher while CD133(+)/CD34(+) (%) and HDL were significantly lower in OSA patients than in healthy controls. The levels of CD133(+)/CD34(+) (%) and thiols significantly increased in both mild/moderate and severe OSA. The TBAR levels also significantly decreased in severe OSA patients after >3months of follow-up. The number of CD133(+)/CD34(+) (%) negatively correlated with both age and mO2 of <90% but positively correlated with thiols. Clinical efficiency after OSA surgery assessed by PSG showed improvement and mean systolic blood pressure (SBP) (night and morning) reduction and improved lipid profile in the severe OSA group while only the snoring index improved in the mild/moderate OSA group. CONCLUSIONS: OSA surgery not only improves clinical outcomes, SBP reduction and improved lipid profile but also increases the number of circulating EPCs and antioxidant capacity, especially in patients with severe OSA.

477 Article Successful delivery of adjuvant external beam radiotherapy for ependymoma in a patient with Ondine׳s curse. 2015

Choi, Mehee / Thoma, Miranda / Tolekidis, George / Byrne, Richard W / Diaz, Aidnag Z. ·Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL. · Department of Radiation Oncology, Rush University Medical Center, Chicago, IL. · Department of Neurosurgery, Rush University Medical Center, Chicago, IL. · Department of Radiation Oncology, Rush University Medical Center, Chicago, IL; Department of Neurosurgery, Rush University Medical Center, Chicago, IL. Electronic address: aidnag_diaz@rush.edu. ·Med Dosim · Pubmed #26087849.

ABSTRACT: Ondine׳s curse is a rare, potentially life-threatening disorder characterized by loss of automatic breathing during sleep and preserved voluntary breathing. It is seldom encountered in the radiotherapy clinic but can pose significant technical challenges and safety concerns in the delivery of a prescribed radiation course. We report a unique case of successful delivery of radiotherapy for ependymoma in a patient with Ondine׳s curse. A 53-year-old gentleman presented with vertigo when lying down. Brain magnetic resonance imaging revealed an enhancing mass in the floor of the fourth ventricle. He underwent maximal safe resection. Pathology revealed ependymoma. The patient was referred for radiotherapy. Computed tomography simulation was performed in supine position with 3-point thermoplastic mask immobilization. Sequential TomoTherapy plans were developed. At first scheduled treatment, shortly after mask placement, his arms went limp and he was unresponsive. Vitals showed oxygen saturation 83%, pulse 127, and blood pressure 172/97mmHg. He was diagnosed with Ondine׳s curse thought secondary to previous brainstem damage; the combination of lying flat and pressure from the mask was causing him to go into respiratory arrest. As supine positioning did not seem clinically advisable, he was simulated in prone position. A RapidArc plan and a back-up conformal plan were developed. Prescriptions were modified to meet conservative organs-at-risk constraints. Several strategies were used to minimize uncertainties in set-up reproducibility associated with prone positioning. He tolerated prone RapidArc treatments well. The report highlights the importance of applying practical patient safety and treatment planning/delivery strategies in the management of this challenging case.

478 Article National Institutes of Health Funding for Obstructive Sleep Apnea: An Opportunity for Otolaryngologists. 2015

Gouveia, Christopher J / Qureshi, Hannan A / Kern, Robert C / Shintani Smith, Stephanie. ·Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Christopher.gouveia@northwestern.edu. · Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. · Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. ·Otolaryngol Head Neck Surg · Pubmed #26084829.

ABSTRACT: OBJECTIVE: To describe current levels and trends of funding for the National Institutes of Health (NIH) in obstructive sleep apnea (OSA) and to recognize the current status of otolaryngologists in OSA research. STUDY DESIGN: Scientometric analysis. METHODS: The NIH RePORTER database was queried for the search term "obstructive sleep apnea" for all available years. Sex, degree, academic department, NIH funding source, geography, funding totals and years, and h-index of principal investigators (PIs) were collected and summarized. RESULTS: A total of 397 projects spanning 1242 total funding years were funded. Of the 273 individual PIs, 33.3% (91/273) were female. Regarding credentials, 52.4% of PIs (143/273) were MD or MD/PhD, and 41.0% (112/273) were PhD alone. Academic departments of PIs were most often medicine (34.1%), pediatrics (12.1%), cell biology/physiology (10.6%), and psychiatry (7.7%). Seven otolaryngology faculty members had received NIH funding for OSA research (2.6% of total PIs) since 2000. They accounted for 8 grants (0.25% of total grants) and $7,235,729 (1.5% of total dollars) of research funding. CONCLUSION: Despite studies showing increasing levels of OSA surgery being performed and major areas of research and clinical opportunity, otolaryngologists represent a small minority of OSA research funding. This information may help direct our specialty when setting priorities regarding research funding, as research into the basic science and clinical management of OSA represents a broad and interdisciplinary pursuit.

479 Article Insights into Selected Aspects of Pediatric Sleep Medicine. 2015

Gileles-Hillel, Alex / Philby, Mona F / Lapping-Carr, Gabrielle. ·1 Section of Pediatric Sleep Medicine and. · 2 Section of Pediatric Hematology-Oncology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, Illinois. ·Am J Respir Crit Care Med · Pubmed #26075424.

ABSTRACT: -- No abstract --

480 Article Obstructive sleep apnea and adverse outcomes in surgical and nonsurgical patients on the wards. 2015

Lyons, Patrick G / Zadravecz, Frank J / Edelson, Dana P / Mokhlesi, Babak / Churpek, Matthew M. ·University of Chicago Internal Medicine Residency, Chicago, Illinois. · Department of Medicine, Section of Hospital Medicine, University of Chicago Medicine, Chicago, Illinois. · Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, Illinois. ·J Hosp Med · Pubmed #26073058.

ABSTRACT: BACKGROUND: Obstructive sleep apnea (OSA) has been associated with clinical deterioration in postoperative patients and patients hospitalized with pneumonia. Paradoxically, OSA has also been associated with decreased risk of inpatient mortality in these same populations. OBJECTIVES: To investigate the association between OSA and in-hospital mortality in a large cohort of surgical and nonsurgical ward patients. DESIGN: Observational cohort study. SETTING: A 500-bed academic tertiary care hospital in the United States. PATIENTS: A total of 93,676 ward admissions from 53,150 unique adult patients between November 1, 2008 and October 1, 2013. INTERVENTION: None. MEASUREMENTS: OSA diagnoses and comorbidities were identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Logistic regression was used to control for patient characteristics, location prior to ward admission, and admission severity of illness. The primary outcome was in-hospital death. Secondary outcomes included rapid response team (RRT) activation, intensive care unit (ICU) transfer, intubation, and cardiac arrest on the wards. MAIN RESULTS: OSA was identified in 5,625 (10.6%) patients. Patients with OSA were more likely to be older, male, and obese, and had higher rates of comorbidities. OSA patients had more frequent RRT activations (1.5% vs 1.1%) and ICU transfers (8% vs 7%) than controls (P < 0.001 for both comparisons), but a lower inpatient mortality rate (1.1% vs 1.4%, P < 0.05). OSA was associated with decreased adjusted odds for ICU transfer (odds ratio [OR]: 0.91 [0.84-0.99]), cardiac arrest (OR: 0.72 [0.55-0.95]), and in-hospital mortality (OR: 0.70 [0.58-0.85]). CONCLUSIONS: After adjustment for important confounders, OSA was not associated with clinical deterioration on the wards and was associated with significantly decreased in-hospital mortality.

481 Article Treatment outcomes of obstructive sleep apnoea in obese community-dwelling children: the NANOS study. 2015

Alonso-Álvarez, María Luz / Terán-Santos, Joaquin / Navazo-Egüia, Ana Isabel / Martinez, Mónica Gonzalez / Jurado-Luque, María José / Corral-Peñafiel, Jaime / Duran-Cantolla, Joaquin / Cordero-Guevara, José Aurelio / Kheirandish-Gozal, Leila / Gozal, David / Anonymous110833. ·Sleep Unit, Hospital Universitario de Burgos, Burgos, Spain CIBER of Respiratory Diseases, Instituto Carlos III, CIBERES, Spain Hospital Universitario de Burgos (HUBU), Burgos, Spain mlalonso@hubu.es. · Sleep Unit, Hospital Universitario de Burgos, Burgos, Spain CIBER of Respiratory Diseases, Instituto Carlos III, CIBERES, Spain Hospital Universitario de Burgos (HUBU), Burgos, Spain. · Sleep Unit, Hospital Universitario de Burgos, Burgos, Spain Hospital Universitario de Burgos (HUBU), Burgos, Spain. · Sleep Unit, Hospital Universitario de Burgos, Burgos, Spain Hospital Universitario Valdecilla, Santander, Spain. · Sleep Unit, Hospital Universitario de Burgos, Burgos, Spain CIBER of Respiratory Diseases, Instituto Carlos III, CIBERES, Spain Hospital Val D´Hebron, Barcelona, Spain. · Sleep Unit, Hospital Universitario de Burgos, Burgos, Spain CIBER of Respiratory Diseases, Instituto Carlos III, CIBERES, Spain Hospital San Pedro de Alcantara, Caceres, Spain. · Sleep Unit, Hospital Universitario de Burgos, Burgos, Spain CIBER of Respiratory Diseases, Instituto Carlos III, CIBERES, Spain Hospital Universitario de Araba, Vitoria, Spain. · Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA. ·Eur Respir J · Pubmed #26065566.

ABSTRACT: The first line of treatment of obstructive sleep apnoea syndrome (OSAS) in children consists of adenotonsillectomy (T&A). The aim of the present study was to evaluate treatment outcomes of OSAS among obese children recruited from the community.A cross-sectional, prospective, multicentre study of Spanish obese children aged 3-14 years, with four groups available for follow-up: group 1: non-OSAS with no treatment; group 2: dietary treatment; group 3: surgical treatment; and group 4: continuous positive airway pressure treatment.117 obese children (60 boys, 57 girls) with a mean age of 11.3±2.9 years completed the initial (T0) and follow-up (T1) assessments. Their mean body mass index (BMI) at T1 was 27.6±4.7 kg·m(-2), corresponding to a BMI Z-score of 1.34±0.59. Mean respiratory disturbance index (RDI) at follow-up was 3.3±3.9 events·h(-1). Among group 1 children, 21.2% had an RDI ≥3 events·h(-1) at T1, the latter being present in 50% of group 2, and 43.5% in group 3. In the binary logistic regression model, age emerged as a significant risk factor for residual OSAS (odds ratio 1.49, 95% confidence interval 1.01-2.23; p<0.05) in obese children surgically treated, and RDI at T0 as well as an increase in BMI emerged as significant risk factors for persistent OSAS in obese children with dietary treatment (OR 1.82, 95% CI 1.09-3.02 (p<0.03) and OR 8.71, 95% CI 1.24-61.17 (p=0.03)).Age, RDI at diagnosis and obesity are risk factors for relatively unfavourable OSAS treatment outcomes at follow-up.

482 Article Treatment of neuroblastoma in congenital central hypoventilation syndrome with a PHOX2B polyalanine repeat expansion mutation: New twist on a neurocristopathy syndrome. 2015

Armstrong, Amy E / Weese-Mayer, Debra E / Mian, Amir / Maris, John M / Batra, Vandana / Gosiengfiao, Yasmin / Reichek, Jennifer / Madonna, Mary Beth / Bush, Jonathan W / Shore, Richard M / Walterhouse, David O. ·Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. · Ann & Robert H. Lurie Children's Hospital of Chicago, Center for Autonomic Medicine in Pediatrics (CAMP), Northwestern University of Feinberg School of Medicine and Stanley Manne Children's Research Institute, Chicago, Illinois. · Department of Pediatric Hematology-Oncology, College of Medicine, Arkansas Children's Hospital, University of Arkansas Medical Sciences, Little Rock, Arkansas. · Division of Hematology, Oncology & Transplantation, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine and Abramson Family Center Research Institute, Philadelphia, Pennsylvania. · Division of Hematology, Oncology & Transplantation, Robert Lurie Comprehensive Cancer Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Department of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois. ·Pediatr Blood Cancer · Pubmed #26011159.

ABSTRACT: Neuroblastoma in patients with congenital central hypoventilation syndrome (CCHS) as part of a neurocristopathy syndrome is a rare finding and has only been associated with paired-like homeobox 2b (PHOX2B) non-polyalanine-repeat-expansion mutations. To the best of our knowledge, we report the first case of a child with CCHS and Hirschsprung disease who had a PHOX2B polyalanine-repeat-expansion mutation (PARM) (genotype 20/33) and developed high-risk neuroblastoma. We further describe his treatment including chemotherapy and therapeutic I(131) -metaiodobenzylguanidine. This case highlights the need to consider neuroblastoma in patients with CCHS and the longest PHOX2B PARMs and to individualize treatment based on co-morbidities.

483 Article Caregiver perception of sleep-disordered breathing-associated symptoms in children of rural Andean communities above 4000 masl with chronic exposure to biomass fuel. 2015

Accinelli, Roberto A / Llanos, Oscar / López, Lidia M / Matayoshi, Sebastián / Oros, Yuliana P / Kheirandish-Gozal, Leila / Gozal, David. ·Laboratorio de Respiración del Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru; Hospital Nacional Cayetano Heredia, Lima, Peru; Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru. · Laboratorio de Respiración del Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru. · Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA. · Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA. Electronic address: dgozal@uchicago.edu. ·Sleep Med · Pubmed #26002760.

ABSTRACT: BACKGROUND: Previous studies have uncovered a very high prevalence of sleep disorders in general, and of sleep-disordered breathing in particular among children exposed to indoor biomass fuel pollution. However, despite the significant symptomatology, parents are unlikely to report these issues during health-care visits. OBJECTIVE: The objective of this study was to determine whether reduced caregiver perception of sleep disorders may account for the infrequent diagnosis and treatment of such problems in children residing at high altitudes and exposed to high biomass pollution. METHODS: Parents of children aged 9-15 years of three communities residing in the Pasco region in Peru located between 3800 and 4200 meters above sea level were surveyed using a validated questionnaire instrument focused on symptoms associated with sleep-disordered breathing as well as whether caregivers perceived that their child suffered from a sleep disorder. RESULTS: Among the 77 children included, 48.1% had nocturnal awakenings and 46.8% had repetitive movements and restless sleep. Habitual snoring was present in 33.8% of all children. However, only 10.4% of mothers considered that their children had sleep problems, and all of their children had positive answers for ≥4 sleep symptoms. CONCLUSIONS: Children residing at high altitudes and exposed to traditional biomass-fueled stoves exhibit an extremely high frequency of sleep symptoms that are misperceived by their mothers as being "normal." Interventions aimed at increasing parental recognition and awareness of sleep problems will be essential to foster improved diagnosis and treatment.

484 Article Postoperative sleep-disordered breathing in patients without preoperative sleep apnea. 2015

Chung, Frances / Liao, Pu / Yang, Yiliang / Andrawes, Maged / Kang, Weimin / Mokhlesi, Babak / Shapiro, Colin M. ·From the *Department of Anesthesia, Toronto Western Hospital, University Health Network and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; †Anesthesia and Psychiatry and Sleep Research Unit, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; ‡Section of Pulmonary and Critical Care Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois; and §Psychiatry and Sleep Research Unit, Department of Psychiatry, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. ·Anesth Analg · Pubmed #25988633.

ABSTRACT: BACKGROUND: Recently published data show that postoperative apnea-hypopnea index (AHI) is significantly increased in some patients without preoperative sleep apnea. These patients may be at risk of developing perioperative adverse events related to sleep-disordered breathing (SDB). The objective of this study was to investigate the incidence and predictors of postoperative moderate-to-severe SDB (AHI > 15 events/h) in patients without sleep apnea preoperatively. METHODS: In a prospective observational fashion, patients were invited to undergo sleep studies with a portable device (Embletta X100) preoperatively at home and postoperatively on the first and third night after surgery in the hospital or at home. The primary outcome was the incidence of postoperative moderate-to-severe SDB (AHI > 15 events/h) in non-sleep apnea patients (preoperative AHI ≤ 5 events/h). Logistic regression was used to evaluate the association of clinical factors and preoperative sleep parameters with the occurrence of postoperative moderate-to-severe SDB. RESULTS: A total of 120 non-sleep apnea patients completed the study, of which 31 (25.8% [95% confidence interval: 18.3%-34.6%]) patients were found to have AHI > 15 events/h on postoperative night 1 and/or postoperative night 3 (postoperative SDB group), and 89 (74%) patients had an AHI ≤ 15 events/h on both postoperative night 1 and 3 (postoperative non-SDB group). The patients in the postoperative SDB group were older (60 ± 13 vs 53 ± 12 years, P = 0.008) with more smokers (32.3% vs 15.7%, P = 0.048) and had a greater increase in the obstructive apnea index (adjusted P = 0.0003), central apnea index (adjusted P = 0.0012), and hypopnea index (adjusted P = 0.0004). Multivariate logistic regression analysis found that age and preoperative respiratory disturbance index (RDI) were significantly associated with the occurrence of postoperative moderate-to-severe SDB, P = 0.018 and P = 0.006, respectively. The sensitivity privilege cutoff of RDI at 4.9 events/h identified 70.2% to 96.4%patients developing postoperative moderate-to-severe SDB. CONCLUSIONS: At least 18.3% of non-sleep apnea patients developed moderate-to-severe SDB after surgery. Age and preoperative RDI were associated with the occurrence of postoperative moderate-to-severe SDB.

485 Article Association of sleep characteristics with atrial fibrillation: the Multi-Ethnic Study of Atherosclerosis. 2015

Kwon, Younghoon / Gharib, Sina A / Biggs, Mary L / Jacobs, David R / Alonso, Alvaro / Duprez, Daniel / Lima, Joao / Lin, Gen-Min / Soliman, Elsayed Z / Mehra, Reena / Redline, Susan / Heckbert, Susan R. ·Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA. · Department of Medicine, University of Washington, Seattle, Washington, USA. · Department of Biostatistics, University of Washington, Seattle, Washington, USA. · Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA. · Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA. · Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. · Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA Department of Medicine, Hualien-Armed Forces General Hospital, Hualien, Taiwan. · Department of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA. · Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA. · Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center; Harvard Medical School, Boston, Massachusetts, USA. · Department of Epidemiology, University of Washington, Seattle, Washington, USA. ·Thorax · Pubmed #25986436.

ABSTRACT: BACKGROUND: Population-based studies have linked measures of sleep disordered breathing to nocturnally occurring atrial fibrillation (AF) episodes. Whether measures of sleep disordered breathing and sleep quality are associated with prevalent AF has not been studied in an unselected population. We investigated the cross-sectional association with prevalent AF of objectively collected prespecified measures of overnight sleep breathing disturbances, sleep stage distributions, arousal and sleep duration. METHODS: AF prevalence, defined by diagnosis codes, study electrocardiography and sleep study were examined among Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent polysomnography in the MESA Sleep Study (n=2048). MEASUREMENTS AND MAIN RESULTS: Higher apnoea hypopnoea index (AHI) was associated with increased odds of AF, although the significance was attenuated after full adjustment for covariates including prevalent cardiovascular disease (OR: 1.22 (0.99 to 1.49) per SD (17/h), p=0.06). Analyses of sleep architecture measures and AF revealed significantly lower odds of AF associated with longer duration of slow wave sleep (OR: 0.66 (0.5 to 0.89) per SD (34 min), p=0.01) which persisted after additionally adjusting for AHI (OR: 0.68 (0.51 to 0.92), p=0.01). Higher sleep efficiency was significantly associated with lower likelihood of AF but the significance was lost when adjusted for AHI. No significant association was present between sleep duration and AF. In a model including AHI and arousal index, the association between AHI and AF was strengthened (AHI: OR 1.49 (1.15 to 1.91) per SD, p=0.002) and a significant inverse association between arousal index and AF was observed (OR 0.65 (0.50 to 0.86) per SD (12/h), p=0.005). CONCLUSIONS: In a study of a large multiethnic population, AF was associated with AHI severity, and was more common in individuals with poor sleep quality as measured by reduced slow wave sleep time, a finding that was independent of AHI.

486 Article Effect of Wakefulness-Promoting Agents on Sleepiness in Patients with Sleep Apnea Treated with CPAP: A Meta-Analysis. 2015

Sukhal, Shashvat / Khalid, Madiha / Tulaimat, Aiman. ·Division of Pulmonary, Critical Care Medicine, and Sleep Medicine, John H Stroger, Jr. Hospital of Cook County, Chicago, IL. · Division of Pulmonary and Critical Care Medicine, Albert Einstein Medical Center, Philadelphia, PA. ·J Clin Sleep Med · Pubmed #25979103.

ABSTRACT: STUDY OBJECTIVES: To perform a meta-analysis of the effect of wakefulness-promoting agents (modafinil and armodafinil) in patients with residual sleepiness after CPAP therapy for obstructive sleep apnea. METHODS: We conducted a systematic search of MEDLINE (1966 to September 2014), EMBASE (1980 to September 2014) and Cochrane Database for randomized placebo controlled trials on modafinil or armodafinil in patients who met established criteria for diagnosis of obstructive sleep apnea, adequate continuous positive airway pressure use, and who complained of residual sleepiness. Risk of bias was assessed. Primary outcomes were the Epworth Sleepiness Scale and mean sleep latencies on the maintenance of wakefulness test. Secondary outcomes were the Clinical Global Impression of Change, change in daily continuous positive airway pressure use, and the frequency of headaches. RESULTS: Out of 118 abstracts screened and 12 full text articles reviewed, we included 6 studies (total of 1,479 participants) in our final meta-analysis: Three evaluated modafinil, and three armodafinil. Risk of bias was unclear in one or more key domains for four studies. When compared with placebo, wakefulness promoting agents decreased Epworth Sleepiness Scale by 2.51 points (95% CI, 2.00-3.02), increased sleep latency in maintenance of wakefulness test by 2.73 minutes (95% CI, 2.12-3.34), increased the reporting of minimal improvement on the Clinical Global Impression of Change by 26% (RR 1.59; 95% CI, 1.36-1.86), and increased the risk of headaches by 8% (RR 1.98; 95% CI, 1.48-2.63). Also, there was a trend for decreased continuous positive airway pressure after treatment with these agents. CONCLUSION: Wakefulness promoting agents improve objective and subjective measures of sleepiness, wakefulness, perception of disease severity in patients with residual sleepiness after CPAP therapy for OSA, and are generally well tolerated.

487 Article Reduced NADPH oxidase type 2 activity mediates sleep fragmentation-induced effects on TC1 tumors in mice. 2015

Zheng, Jiamao / Almendros, Isaac / Wang, Yang / Zhang, Shelley X / Carreras, Alba / Qiao, Zhuanhong / Gozal, David. ·Section of Pediatric Sleep Medicine; Department of Pediatrics; Pritzker School of Medicine; Biological Sciences Division; The University of Chicago ; Chicago, Illinois, USA. ·Oncoimmunology · Pubmed #25949873.

ABSTRACT: The molecular mechanisms underlying how sleep fragmentation (SF) influences cancer growth and progression remain largely elusive. Here, we present evidence that SF reduced ROS production by downregulating

488 Article Interrelationships between obesity, obstructive sleep apnea syndrome and cardiovascular risk in obese adolescents. 2015

Koren, D / Chirinos, J A / Katz, L E L / Mohler, E R / Gallagher, P R / Mitchell, G F / Marcus, C L. ·Pediatrics-Section of Endocrinology, Diabetes and Metabolism, The University of Chicago, Chicago, IL, USA. · Perelman School of Medicine and Philadelphia VA Medical Center, University of Pennsylvania, Philadelphia, PA, USA. · Pediatrics-Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, USA. · Department of Medicine, Cardiovascular Division, Vascular Medicine Section, Perelman School of Medicine at the University of Pennsylvania,Philadelphia, PA, USA. · Biostatistics Core, Clinical and Translational Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA. · Cardiovascular Engineering Inc, Norwood, MA, USA. · Pediatrics-Sleep Center, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA. ·Int J Obes (Lond) · Pubmed #25913504.

ABSTRACT: BACKGROUND/OBJECTIVES: Obstructive sleep apnea syndrome (OSAS) may be a cardiovascular disease (CVD) risk factor independently of obesity in adults. Pediatric studies have associated OSAS with endothelial dysfunction, but few studies have examined relationships between OSAS and macrovascular sequelae. Our objective was to examine OSAS's independent contribution to macrovascular CVD risk measures in obese adolescents. SUBJECTS/METHODS: This cross-sectional observational study was conducted at Children's Hospital of Philadelphia Clinical Research and Academic Sleep Centers, and University of Pennsylvania Vascular Research Unit. Thirty-one obese non-diabetic adolescents underwent anthropometric measurements, overnight polysomnography, fasting laboratory draw and cardiovascular imaging. Cardiovascular outcome measures included maximal carotid intima-media thickness (cIMTmax), a measure of carotid structural changes, and carotid-femoral pulse wave velocity (CFPWV), an aortic stiffness measure whose relationship vis-à-vis OSAS in children has not been previously examined. Carotid diameter and augmentation index (AIx, measuring central pressure augmentation from wave reflections) were assessed. Potential confounding variables examined included blood pressure, lipoproteins, high-sensitivity C-reactive protein, insulin and glucose. RESULTS: The apnea hypopnea index, a primary OSAS measure, was not associated with cIMTmax, carotid diameter, CFPWV or AIx. body mass index (BMI) associated positively with cIMTmax (r=0.52, P=0.006) and CFPWV (r=0.45, P=0.01). Mean asleep end-tidal CO2 was negatively associated with carotid diameter (r=-0.63, P<0.0005). Insulin levels were negatively associated with AIx (r=-0.53, P=0.02). CONCLUSIONS: OSAS did not predict carotid structural changes or arterial stiffness independently of BMI in obese adolescents. Higher insulin levels associated with lower central pressure wave augmentation. Finally, long-term hypercapnia may predispose to carotid narrowing.

489 Article Eight Hours of Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea Improves Glucose Metabolism in Patients with Prediabetes. A Randomized Controlled Trial. 2015

Pamidi, Sushmita / Wroblewski, Kristen / Stepien, Magdalena / Sharif-Sidi, Khalid / Kilkus, Jennifer / Whitmore, Harry / Tasali, Esra. ·1 Respiratory Division, Department of Medicine, McGill University, Montreal, Quebec, Canada; and. · 2 Department of Public Health Sciences and. · 3 Department of Medicine, University of Chicago, Chicago, Illinois. ·Am J Respir Crit Care Med · Pubmed #25897569.

ABSTRACT: RATIONALE: Although obstructive sleep apnea (OSA) is associated with impaired glucose tolerance and diabetes, it remains unclear whether OSA treatment with continuous positive airway pressure (CPAP) has metabolic benefits. OBJECTIVES: To determine the effect of 8-hour nightly CPAP treatment on glucose metabolism in individuals with prediabetes and OSA. METHODS: In a randomized controlled parallel group study, 39 participants were randomly assigned to receive either 8-hour nightly CPAP (n = 26) or oral placebo (n = 13). Sleep was polysomnographically recorded in the laboratory on each night. CPAP adherence was ensured by continuous supervision. Participants continued their daily routine activities outside the laboratory. Glucose metabolism was assessed at baseline and after 2 weeks of assigned treatment using both the oral and intravenous glucose tolerance tests. The primary outcome was the overall glucose response as quantified by the area under the curve for glucose during 2-hour oral glucose tolerance testing. Secondary outcomes included fasting and 2-hour glucose and insulin, the area under the curves for insulin and insulin secretion, norepinephrine, insulin sensitivity, acute insulin response to glucose, and 24-hour blood pressure. MEASUREMENTS AND MAIN RESULTS: The overall glucose response was reduced (treatment difference: -1,276.9 [mg/dl] · min [95% confidence interval, -2,392.4 to -161.5]; P = 0.03) and insulin sensitivity was improved (treatment difference: 0.77 [mU/L](-1) · min(-1) [95% confidence interval, 0.03-1.52]; P = 0.04) with CPAP as compared with placebo. Additionally, norepinephrine levels and 24-hour blood pressure were reduced with CPAP as compared with placebo. CONCLUSIONS: In patients with prediabetes, 8-hour nightly CPAP treatment for 2 weeks improves glucose metabolism compared with placebo. Thus, CPAP treatment may be beneficial for metabolic risk reduction. Clinical trial registered with www.clinicaltrials.gov (NCT 01156116).

490 Article Sleep Disordered Breathing in Four Resource-Limited Settings in Peru: Prevalence, Risk Factors, and Association with Chronic Diseases. 2015

Schwartz, Noah G / Rattner, Adi / Schwartz, Alan R / Mokhlesi, Babak / Gilman, Robert H / Bernabe-Ortiz, Antonio / Miranda, J Jaime / Checkley, William / Anonymous480826. ·Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD. · Pritzker School of Medicine, University of Chicago, Chicago, IL. · Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. · CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru. · Departamento de Medicina, Escuela de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru. ·Sleep · Pubmed #25845694.

ABSTRACT: STUDY OBJECTIVES: Sleep disordered breathing (SDB) is a highly prevalent condition in high-income countries, with major consequences for cardiopulmonary health, public safety, healthcare utilization, and mortality. However, its prevalence and effect in low- and middle-income countries are less well known. We sought to determine the prevalence, risk factors, and comorbidities of SDB symptoms in four resource-limited settings. DESIGN: Cross-sectional analysis of the CRONICAS Cohort, a population-based age- and sex-stratified sample. SETTING: Four resource-limited settings in Peru varying in altitude, urbanization, and air pollution. PARTICIPANTS: There were 2,682 adults aged 35 to 92 y. MEASUREMENTS AND RESULTS: Self-reported SDB symptoms (habitual snoring, observed apneas, Epworth Sleepiness Scale), sociodemographics, medical history, anthropometrics, spirometry, blood biomarkers were reported. We found a high prevalence of habitual snoring (30.2%, 95% confidence interval [CI] 28.5-32.0%), observed apneas (20.9%, 95% CI 19.4-22.5%) and excessive daytime sleepiness (18.6%, 95% CI 17.1-20.1%). SDB symptoms varied across sites; prevalence and adjusted odds for habitual snoring were greatest at sea level, whereas those for observed apneas were greatest at high altitude. In multivariable analysis, habitual snoring was associated with older age, male sex, body mass index (BMI), and higher socioeconomic status; observed apneas were associated with BMI; and excessive daytime sleepiness was associated with older age, female sex, and medium socioeconomic status. Adjusted odds of cardiovascular disease, depression, and hypertension and total chronic disease burden increased progressively with the number of SDB symptoms. A threefold increase in the odds of having an additional chronic comorbid disease (adjusted odds ratio 3.57, 95% CI 2.18-5.84) was observed in those with all three versus no SDB symptoms. CONCLUSIONS: Sleep disordered breathing symptoms were highly prevalent, varied widely across four resource-limited settings in Peru, and exhibited strong independent associations with chronic diseases.

491 Article Effects of adenotonsillectomy on plasma inflammatory biomarkers in obese children with obstructive sleep apnea: A community-based study. 2015

Kheirandish-Gozal, L / Gileles-Hillel, A / Alonso-Álvarez, M L / Peris, E / Bhattacharjee, R / Terán-Santos, J / Duran-Cantolla, J / Gozal, D. ·Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA. · 1] Sleep Unit, Burgos, Spain [2] CIBER of Respiratory Diseases. Instituto Carlos III.CIBERES, Burgos, Spain [3] Hospital Universitario de Burgos (HUBU), Burgos, Spain. · 1] Sleep Unit, Burgos, Spain [2] CIBER of Respiratory Diseases. Instituto Carlos III.CIBERES, Burgos, Spain [3] Hospital Universitario de Araba, Vitoria, Spain. ·Int J Obes (Lond) · Pubmed #25801692.

ABSTRACT: BACKGROUND: Obesity and obstructive sleep apnea syndrome (OSA) are highly prevalent and frequently overlapping conditions in children that lead to systemic inflammation, the latter being implicated in the various end-organ morbidities associated with these conditions. AIM: To examine the effects of adenotonsillectomy (T&A) on plasma levels of inflammatory markers in obese children with polysomnographically diagnosed OSA who were prospectively recruited from the community. METHODS: Obese children prospectively diagnosed with OSA, underwent T&A and a second overnight polysomnogram (PSG) after surgery. Plasma fasting morning samples obtained after each of the two PSGs were assayed for multiple inflammatory and metabolic markers including interleukin (IL)-6, IL-18, plasminogen activator inhibitor-1 (PAI-1), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9), adiponectin, apelin C, leptin and osteocrin. RESULTS: Out of 122 potential candidates, 100 obese children with OSA completed the study with only one-third exhibiting normalization of their PSG after T&A (that is, apnea-hypopnea index (AHI) ≤1/hour total sleep time). However, overall significant decreases in MCP-1, PAI-1, MMP-9, IL-18 and IL-6, and increases in adropin and osteocrin plasma concentrations occurred after T&A. Several of the T&A-responsive biomarkers exhibited excellent sensitivity and moderate specificity to predict residual OSA (that is, AHI⩾5/hTST). CONCLUSIONS: A defined subset of systemic inflammatory and metabolic biomarkers is reversibly altered in the context of OSA among community-based obese children, further reinforcing the concept on the interactive pro-inflammatory effects of sleep disorders such as OSA and obesity contributing to downstream end-organ morbidities.

492 Article Adipose tissue macrophage polarization by intermittent hypoxia in a mouse model of OSA: effect of tumor microenvironment. 2015

Almendros, Isaac / Gileles-Hillel, Alex / Khalyfa, Abdelnaby / Wang, Yang / Zhang, Shelley X / Carreras, Alba / Farré, Ramon / Gozal, David. ·Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL 60637, USA. · Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona-IDIBAPS, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Bunyola, Spain. · Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL 60637, USA. Electronic address: dgozal@uchicago.edu. ·Cancer Lett · Pubmed #25779675.

ABSTRACT: Intermittent hypoxia (IH)-induces alterations in tumor-associated macrophages (TAMs) that are associated with adverse cancer outcomes, as reported in patients suffering from sleep apnea. Adipose tissues (AT) and bone-marrow (BM)-derived cells are the inferred sources of macrophages infiltrating malignant tumors. Here, the sources of TAMs and the phenotypic changes induced by IH in the ipsilateral and contralateral AT were investigated by using a syngeneic murine solid tumor model (TC1). C57/B6 male mice were exposed to either IH or room air (RA) for 6 weeks, with TC1 cells being inoculated in the 2nd week. Macrophage content, phenotype and tissue origin were assessed in tumors, and ipsilateral and contralateral AT. IH induced a ~2.2-fold increase in TAM tumor infiltration. However, differential responses in the tumor ipsilateral and contralateral AT emerged: IH increased infiltration of preferentially M1 macrophages in contralateral AT, while reductions in macrophages emerged in ipsilateral AT and primarily consisted of the M2 phenotype. These changes were accompanied by reciprocal increases in resident and BM-derived TAMs in the tumor. IH-induced phenotypic alterations in AT macrophages surrounding the tumor and their increased infiltration within the tumor may contribute to the accelerated tumor progression associated with IH.

493 Article Factors associated with hypertrophy of the lingual tonsils. 2015

Hwang, Michelle S / Salapatas, Anna M / Yalamanchali, Sreeya / Joseph, Ninos J / Friedman, Michael. ·Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA. · Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA Rush University Medical Center, Chicago, Illinois, USA mfriedman@chicagoent.com. ·Otolaryngol Head Neck Surg · Pubmed #25754182.

ABSTRACT: OBJECTIVE: To identify factors that may be associated with lingual tonsil hypertrophy (LTH). STUDY DESIGN: Case series with chart review. SETTING: Tertiary academic center. SUBJECTS AND METHODS: Retrospective chart review identified 380 patients from August 2013 to April 2014 with graded lingual tonsils, documented during routine flexible laryngoscopy. Lingual tonsils were graded using a 0 to 4 scale: 0 = complete absence of lymphoid tissue, 1 = lymphoid tissue scattered over tongue base, 2 = lymphoid tissue covers entirety of tongue base with limited thickness, 3 = lymphoid tissue 5 to 10 mm in thickness, 4 = lymphoid tissue >1 cm in thickness (rising above the tip of epiglottis). Reflux symptom index (RSI collected during patient intake), presence of obstructive sleep apnea hypopnea syndrome (OSAHS; confirmed by polysomnogram), smoking habits, and basic demographics were gathered. Chi-square and linear multivariate regression analyses were used to identify significant relationships with LTH levels. RESULTS: Overall, 59.8% were male with a mean age of 50.2 ± 16.5 years and BMI of 30.1 ± 18.0. Chi-square analysis revealed no significant relationship between OSAHS and LTH (P = .059). When RSI was stratified to ≥ 10 or < 10, a Cochran-Armitage test supported the trend hypothesis that as RSI increases, lingual tonsil grading increases. Significant univariate correlates included younger age (r = -0.307, P < .001) and smoking (r = 0.186, P = .002). Multivariate regression revealed the combination of younger age, increasing RSI, and smoking (r = -0.297, P < .001) to be a significant correlate. CONCLUSION: LTH does not seem to be associated with OSAHS or BMI in this group of patients. High RSI, younger age, and gender may be factors associated with increased lingual tonsil thickness.

494 Article NuMoM2b Sleep-Disordered Breathing study: objectives and methods. 2015

Facco, Francesca L / Parker, Corette B / Reddy, Uma M / Silver, Robert M / Louis, Judette M / Basner, Robert C / Chung, Judith H / Schubert, Frank P / Pien, Grace W / Redline, Susan / Mobley, Daniel R / Koch, Matthew A / Simhan, Hyagriv N / Nhan-Chang, Chia-Ling / Parry, Samuel / Grobman, William A / Haas, David M / Wing, Deborah A / Mercer, Brian M / Saade, George R / Zee, Phyllis C. ·Department of Obstetrics and Gynecology, Magee-Womens Research Institute & Foundation, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: faccof@upmc.edu. · RTI International, Research Triangle Park, NC. · Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD. · Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT. · Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, Cleveland, OH. · Department of Clinical Medicine, College of Physicians and Surgeons, Columbia University, New York, NY. · Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, Irvine, CA. · Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN. · Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. · Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. · Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. · Department of Obstetrics and Gynecology, Magee-Womens Research Institute & Foundation, University of Pittsburgh School of Medicine, Pittsburgh, PA. · Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY. · Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA. · Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL. · Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX. · Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. ·Am J Obstet Gynecol · Pubmed #25746730.

ABSTRACT: OBJECTIVE: The objective of the Sleep Disordered Breathing substudy of the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be (nuMoM2b) is to determine whether sleep disordered breathing during pregnancy is a risk factor for adverse pregnancy outcomes. STUDY DESIGN: NuMoM2b is a prospective cohort study of 10,037 nulliparous women with singleton gestations that was conducted across 8 sites with a central Data Coordinating and Analysis Center. The Sleep Disordered Breathing substudy recruited 3702 women from the cohort to undergo objective, overnight in-home assessments of sleep disordered breathing. A standardized level 3 home sleep test was performed between 6(0)-15(0) weeks' gestation (visit 1) and again between 22(0)-31(0) weeks' gestation (visit 3). Scoring of tests was conducted by a central Sleep Reading Center. Participants and their health care providers were notified if test results met "urgent referral" criteria that were based on threshold levels of apnea hypopnea indices, oxygen saturation levels, or electrocardiogram abnormalities but were not notified of test results otherwise. The primary pregnancy outcomes to be analyzed in relation to maternal sleep disordered breathing are preeclampsia, gestational hypertension, gestational diabetes mellitus, fetal growth restriction, and preterm birth. RESULTS: Objective data were obtained at visit 1 on 3261 women, which was 88.1% of the studies that were attempted and at visit 3 on 2511 women, which was 87.6% of the studies that were attempted. Basic characteristics of the substudy cohort are reported in this methods article. CONCLUSION: The substudy was designed to address important questions regarding the relationship of sleep-disordered breathing on the risk of preeclampsia and other outcomes of relevance to maternal and child health.

495 Article Quality measures for the care of pediatric patients with obstructive sleep apnea. 2015

Kothare, Sanjeev V / Rosen, Carol L / Lloyd, Robin M / Paruthi, Shalini / Thomas, Sherene M / Troester, Matthew M / Carden, Kelly A. ·NYU Langone Medical Center, New York, NY. · University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH. · Mayo Clinic, Rochester, MN. · Saint Louis University School of Medicine, St. Louis, MO. · American Academy of Sleep Medicine, Darien, IL. · Phoenix Children's Hospital, Phoenix, AZ. · Saint Thomas Sleep Specialists, Nashville, TN. ·J Clin Sleep Med · Pubmed #25700879.

ABSTRACT: ABSTRACT: The Board of Directors of the American Academy of Sleep Medicine (AASM) commissioned a Task Force to develop quality measures as part of its strategic plan to promote high quality patient-centered care. Among many potential dimensions of quality, the AASM requested Workgroups to develop outcome and process measures to aid in evaluating the quality of care of five common sleep disorders: insomnia, obstructive sleep apnea in adults, obstructive sleep apnea in children, restless legs syndrome, and narcolepsy. This paper describes the rationale, background, general methods development, and considerations in implementation of these quality measures in obstructive sleep apnea (OSA) in children. This document describes measurement methods for five desirable process measures: assessment of symptoms and risk factors of OSA, initiation of an evidence-based action plan, objective evaluation of high-risk children with OSA by obtaining a polysomnogram (PSG), reassessment of signs and symptoms of OSA within 12 months, and documentation of objective assessment of positive airway pressure adherence. When these five process measures are met, clinicians should be able to achieve the two defined outcomes: improve detection of childhood OSA and reduce signs and symptoms of OSA after initiation of a management plan. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with childhood OSA.

496 Article Quality measures for the care of adult patients with obstructive sleep apnea. 2015

Aurora, R Nisha / Collop, Nancy A / Jacobowitz, Ofer / Thomas, Sherene M / Quan, Stuart F / Aronsky, Amy J. ·Johns Hopkins University, School of Medicine, Baltimore, MD. · Emory Sleep Center, Atlanta, GA. · ENT and Allergy Associates and Mount Sinai Hospital, New York, NY. · American Academy of Sleep Medicine, Darien, IL. · Division of Sleep Medicine, Harvard Medical School, Boston, MA. · Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA. · Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ. · CareCentrix, Hartford, CT. ·J Clin Sleep Med · Pubmed #25700878.

ABSTRACT: ABSTRACT: Obstructive sleep apnea (OSA) is a prevalent disorder associated with a multitude of adverse outcomes when left untreated. There is significant heterogeneity in the evaluation and management of OSA resulting in variation in cost and outcomes. Thus, the goal for developing these measures was to have a way to evaluate the outcomes and reliability of the processes involved with the standard care approaches used in the diagnosis and management of OSA. The OSA quality care measures presented here focus on both outcomes and processes. The AASM commissioned the Adult OSA Quality Measures Workgroup to develop quality care measures aimed at optimizing care for adult patients with OSA. These quality care measures developed by the Adult OSA Quality Measures Workgroup are an extension of the original Centers for Medicare & Medicaid Services (CMS) approved Physician Quality Reporting System (PQRS) measures group for OSA. The measures are based on the available scientific evidence, focus on public safety, and strive to improve quality of life and cardiovascular outcomes for individual OSA patients. The three outcomes that were selected were as follows: (1) improve disease detection and categorization; (2) improve quality of life; and (3) reduce cardiovascular risk. After selecting these relevant outcomes, a total of ten process measures were chosen that could be applied and assessed for the purpose of accomplishing these outcomes. In the future, the measures described in this document may be reported through the PQRS in addition to, or as a replacement for, the current OSA measures group. The overall objective for the development of these measures is that implementation of these quality measures will result in improved patient outcomes, reduce the public health burden of OSA, and provide a measurable standard for evaluating and managing OSA.

497 Article Periodontitis and Sleep Disordered Breathing in the Hispanic Community Health Study/Study of Latinos. 2015

Sanders, Anne E / Essick, Greg K / Beck, James D / Cai, Jianwen / Beaver, Shirley / Finlayson, Tracy L / Zee, Phyllis C / Loredo, Jose S / Ramos, Alberto R / Singer, Richard H / Jimenez, Monik C / Barnhart, Janice M / Redline, Susan. ·Department of Dental Ecology, University of North Carolina, Chapel Hill, NC. · Department of Prosthodontics, Center for Pain Research and Innovation, University of North Carolina, Chapel Hill, NC. · Department of Biostatistics, University of North Carolina, Chapel Hill, NC. · Sanford-Brown College, Skokie, IL. · Graduate School of Public Health, San Diego State University, San Diego, CA. · Center for Sleep and Circadian Biology, Northwestern University, Chicago, IL. · Sleep Medicine Center and VA Pulmonary Sleep Disorders laboratory, University of California San Diego School of Medicine, San Diego, CA. · Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL. · Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL and Brigham and Women's Hospital Harvard Medical School, Boston, MA. · Albert Einstein College of Medicine of Yeshiva University, Bronx, NY. · Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. ·Sleep · Pubmed #25669183.

ABSTRACT: STUDY OBJECTIVES: To investigate the association between sleep disordered breathing (SDB) and severe chronic periodontitis. DESIGN: Cross-sectional data analysis from the Hispanic Community Health Study/Study of Latinos. SETTING: Community-based setting with probability sampling from four urban US communities. PARTICIPANTS: 12,469 adults aged 18-74 y. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Severe chronic periodontitis was defined using the Centers for Disease Control and Prevention/American Academy of Periodontology case classification based on full-mouth periodontal assessments performed by calibrated dentists. SDB was evaluated in standardized home sleep tests, and defined as the number of apnea plus hypopnea events associated with ≥ 3% desaturation, per hour of estimated sleep. SDB was quantified using categories of the apnea-hypopnea index (AHI): 0.0 events (nonapneic); 0.1-4.9 (subclinical); 5.0-14.9 (mild); and ≥ 15 (moderate/severe). Covariates were demographic characteristics and established periodontitis risk factors. C-reactive protein was a potential explanatory variable. Using survey estimation, multivariable binary logistic regression estimated odds ratios (OR) and 95% confidence limits (CL). Following adjustment for confounding, the SDB and periodontitis relationship remained statistically significant, but was attenuated in strength and no longer dose-response. Compared with the nonapneic referent, adjusted odds of severe periodontitis were 40% higher with subclinical SDB (OR = 1.4, 95% CL: 1.0, 1.9), 60% higher with mild SDB (OR = 1.6, 95% CL: 1.1, 2.2) and 50% higher with moderate/severe SDB (OR = 1.5, 95% CL: 1.0, 2.3) demonstrating an independent association between SDB and severe periodontitis. CONCLUSIONS: This study identifies a novel association between mild sleep disordered breathing and periodontitis that was most pronounced in young adults.

498 Article Sleep apnea is independently associated with peripheral arterial disease in the Hispanic Community Health Study/Study of Latinos. 2015

Shah, Neomi / Allison, Matthew / Teng, Yanping / Wassertheil-Smoller, Sylvia / Sotres-Alvarez, Daniela / Ramos, Alberto R / Zee, Phyllis C / Criqui, Michael H / Yaggi, Henry K / Gallo, Linda C / Redline, Susan / Kaplan, Robert C. ·From the Department of Medicine, Montefiore Medical Center (N.S.) and Department of Epidemiology and Population Health (N.S., S.W.-S., R.C.K.), Albert Einstein College of Medicine, Bronx, NY · Department of Medicine, University of Southern California San Diego, La Jolla (M.A., M.H.C., L.C.G.) · Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Y.T., D.S.-A.) · Department of Medicine, University of Miami, FL (A.R.R.) · Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.C.Z.) · Department of Medicine, Yale School of Medicine, New Haven, CT (H.K.Y.) · and Department of Medicine, Brigham and Women's Hospital, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.R.). ·Arterioscler Thromb Vasc Biol · Pubmed #25657310.

ABSTRACT: OBJECTIVE: Sleep apnea (SA) has been linked with various forms of cardiovascular disease, but little is known about its association with peripheral artery disease (PAD) measured using the ankle-brachial index. This relationship was evaluated in the Hispanic Community Health Study/Study of Latinos. APPROACH AND RESULTS: We studied 8367 Hispanic Community Health Study/Study of Latinos participants who were 45 to 74 years of age. Sleep symptoms were examined with the self-reported Sleep Health Questionnaire. SA was assessed using an in-home sleep study. Systolic blood pressure was measured in all extremities to compute the ankle-brachial index. PAD was defined as ankle-brachial index <0.90 in either leg. Multivariable logistic regression was used to investigate the association between moderate-to-severe SA, defined as apnea-hypopnea index ≥15, and the presence of PAD. Analyses were adjusted for covariates. The prevalence of PAD was 4.7% (n=390). The mean apnea-hypopnea index was significantly higher among adults with PAD compared with those without (11.1 versus 8.6 events/h; P=0.046). After adjusting for covariates, moderate-to-severe SA was associated with a 70% increase in the odds of PAD (odds ratio, 1.7; 95% confidence interval, 1.1-2.5; P=0.0152). This association was not modified by sex (P=0.8739). However, there was evidence that the association between moderate-to-severe SA and PAD varied by Hispanic/Latino background (P<0.01). Specifically, the odds were stronger in Mexican (adjusted odds ratio, 2.9; 95% confidence interval, 1.3-6.2) and in Puerto Rican Americans (adjusted odds ratio, 2.0; 95% confidence interval, 0.97-4.2) than in other backgrounds. CONCLUSIONS: Moderate-to-severe SA is associated with higher odds of PAD in Hispanic/Latino adults.

499 Article Effects of obstructive sleep apnea on hemodynamic parameters in patients entering cardiac rehabilitation. 2015

Hargens, Trent A / Aron, Adrian / Newsome, Laura J / Austin, Joseph L / Shafer, Brooke M. ·Department of Kinesiology, James Madison University, Harrisonburg, Virginia (Dr Hargens and Ms Shafer) · Departments of Physical Therapy (Dr Aron) and Health and Human Performance (Dr Newsome), Radford University, Radford, Virginia · Department of Cardiac Rehabilitation, Carilion Clinic, Roanoke, Virginia (Dr Austin) · and Department of Kinesiology and Nutrition (Ms Shafer), University of Illinois at Chicago. ·J Cardiopulm Rehabil Prev · Pubmed #25622219.

ABSTRACT: PURPOSE: Obstructive sleep apnea (OSA) is a prevalent form of sleep-disordered breathing. Evidence suggests that OSA may lead to cardiac remodeling, although the literature is equivocal. Previous literature suggests a high percentage of individuals entering a cardiac rehabilitation (CR) program also have OSA. The objective of this study was to determine whether resting hemodynamic variables were altered in OSA subjects entering CR compared with those without OSA, as determined by impedance cardiography. METHODS: Subjects entering an early outpatient CR program were screened for OSA using an at-home screening device and verified by a sleep physician. Subjects were divided into an OSA group (n = 48) or a control group (n = 25) on the basis of the screening results. Hemodynamic variables were measured during supine rest using impedance cardiography. A 6-minute walk test was performed to assess functional capacity. RESULTS: The proportion of cardiac diagnoses was similar between groups. Overall, 66% of the subjects were positive for OSA. Subject groups did not differ by age, body mass index, heart rate, diastolic blood pressure, or functional capacity. Cardiac output, cardiac index, stroke volume, contractility index, and left cardiac work index were all significantly decreased in the OSA group compared with the control group (P < .05). CONCLUSIONS: Findings suggest that OSA results in decreased cardiac function in patients entering CR, likely because of pressure and volume changes associated with apneic events. This may place those individuals at a disadvantage in recovering from their cardiac event, and place them at increased risk for secondary complications.

500 Article Ethics, consent and blinding: lessons from a placebo/sham controlled CPAP crossover trial. 2015

Djavadkhani, Yasaman / Marshall, Nathaniel S / D'Rozario, Angela L / Crawford, Megan R / Yee, Brendon J / Grunstein, Ronald R / Phillips, Craig L. ·NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia. · NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia. · NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia Sydney Local Health District, Sydney, New South Wales, Australia. · NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia Sleep Disorder Services and Research Center, Rush University Medical Center, Chicago, Illinois, USA. · NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. · NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia. ·Thorax · Pubmed #25595508.

ABSTRACT: INTRODUCTION: Performing rigorously designed clinical trials in device-based treatments is challenging. Continuous positive airway pressure (CPAP) is the most effective device-based treatment for obstructive sleep apnoea. We performed a randomised crossover trial of CPAP versus placebo therapy and did not disclose the presence of placebo. We assessed rates of staff unblinding, the likelihood of patient unblinding and obtained patient perceptions on lack of full disclosure. METHODS: All patients (n=30) underwent a semi-structured exit interview. Prior to full disclosure patients were asked questions to ascertain whether they suspected one therapy was ineffective. The use of placebo was then disclosed and additional questions were administered to indicate the likelihood of unblinding had full disclosure occurred during consent. Staff unblinding was determined by means of a questionnaire that was completed after each patient encounter. RESULTS: While the lack of full disclosure prevented patient unblinding during the trial, patients revealed a clear preference for active CPAP. After disclosing the presence of placebo, 73% (n=22) felt they would have been unblinded had they known at the start of the trial. Only one patient described unease about the lack of full disclosure. Staff thought they were unblinded in 6% (n=16/282) of encounters. They correctly identified the treatment device in 69% of cases (n=11/16, p<0.001). CONCLUSIONS: Successful patient blinding was achieved, however this was probably reliant on the lack of full disclosure. Staff unblinding occurred and highlights the difficulty with investigator blinding in device-based trials. Ethical challenges in this type of study are likely to compromise research feasibility. TRIAL REGISTRATION NUMBER: This clinical trial is registered with the Australian and New Zealand Clinical Trials Registry at http://www.anzctr.org.au (ACTRN 12605000066684).

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