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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
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476 Article Depressive symptoms and obesity as predictors of sleepiness and quality of life in patients with REM-related obstructive sleep apnea: cross-sectional analysis of a large clinical population. 2011

Pamidi, Sushmita / Knutson, Kristen L / Ghods, Farbod / Mokhlesi, Babak. ·Sleep Disorders Center, Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL 60637, USA. ·Sleep Med · Pubmed #21978724.

ABSTRACT: BACKGROUND: The clinical significance of rapid eye-movement (REM)-related obstructive sleep apnea (OSA) is unknown. Moreover, it is unclear what the determinants of sleepiness and quality of life (QoL) are among these patients. Our aim was to identify whether the apnea-hypopnea index during REM sleep (AHI(REM)), AHI during NREM sleep (AHI(NREM)), depressive symptoms, or obesity are independent predictors of excessive daytime sleepiness and reduced QoL in patients with REM-related OSA. We also assessed if these characteristics were predictors of sleepiness and QoL in all patients with OSA (AHI ≥ 5) as well as in non-stage specific OSA. METHODS: This was a cross-sectional analysis of a clinic-based population with OSA. In order to minimize the contribution of AHI(NREM), we defined REM-related OSA using the following criteria: an overall AHI ≥ 5, AHI(REM)/AHI(NREM) ≥ 2, AHI(NREM) the lowest quartile of the entire cohort. We examined the predictors of subjective sleepiness using the Epworth Sleepiness Scale (ESS) and QoL using the short-form quality of life questionnaire-12 (SF-12). RESULTS: Of 1019 consecutive adults that were referred for their first in-laboratory polysomnogram for suspicion of OSA over a 10 month period, 931 had OSA. REM-related OSA was present in 126 patients. In adjusted linear regression models, AHI(NREM) was a significant predictor of sleepiness in the entire cohort of patients with OSA as well as non-stage specific OSA, but not in the REM-related OSA group. AHI(REM) was not a significant predictor of ESS or QoL in any of the three groups. However, greater depressive symptoms and body mass index were significant independent predictors of ESS and reduced QoL in the REM-related OSA group. CONCLUSION: Higher depression scores and obesity, rather than the severity of OSA (as measured by AHI(NREM) and AHI(REM)), were predictive of sleepiness and QoL scores in patients with REM-related OSA.

477 Article Sleep telemedicine: patient satisfaction and treatment adherence. 2011

Parikh, Roshni / Touvelle, Megan Nicole / Wang, Huaping / Zallek, Sara Nath. ·University of Illinois College of Medicine, Peoria, Illinois 61602, USA. roshni.parikh06@gmail.com ·Telemed J E Health · Pubmed #21859348.

ABSTRACT: OBJECTIVE: Obstructive sleep apnea is common, but access to diagnosis remains limited. Telemedicine may allow greater access to care; however, its effect on patient satisfaction and treatment adherence is unknown. This study compares patient satisfaction and continuous positive airway pressure (CPAP) adherence of patients seen by videoconference with those seen in person. MATERIALS AND METHODS: New patients seen via video or in person at a sleep center completed a survey, with three questions pertaining to satisfaction with the provider. Questions were scored 1-5; the sum was the patient satisfaction score. CPAP adherence was retrospectively analyzed in patients who met the physician via video or in person. Percentage of nights CPAP was used for ≥4 h and average minutes of CPAP use per night over 2 consecutive weeks were compared. RESULTS: A Mann-Whitney test compared patient satisfaction of the 90 subjects (of whom, 56 met physician in person and 34 via video). Mean scores (in person, 14.82; video, 14.91; p=0.851) did not differ between groups. Mann-Whitney tests compared CPAP adherence in the 172 subjects (of whom, 111 met physician in person and 61 via video). Mean percentage of nights CPAP was used ≥4 h (in person, 71%; video, 65%; p=0.198) and the average minutes per night of CPAP use (in person, 340.55; video, 305.31; p=0.153) did not differ between groups. CONCLUSIONS: The findings indicate that patients were equally satisfied with their provider and adherent to CPAP treatment whether they were seen in person or via video. Videoconferencing may improve access to patient care without reducing patient satisfaction or treatment adherence.

478 Article Ictal central apnea as a predictor for sudden unexpected death in epilepsy. 2011

Schuele, Stephan U / Afshari, Mitra / Afshari, Zahra S / Macken, Michael P / Asconape, Jorge / Wolfe, Lisa / Gerard, Elizabeth E. ·Department of Neurology, Northwestern University, Chicago, IL 60611, USA. s-schuele@northwestern.edu ·Epilepsy Behav · Pubmed #21816679.

ABSTRACT: Epidemiological evidence associating ictal hypoventilation during focal seizures with a heightened risk for subsequent sudden unexpected death in epilepsy (SUDEP) is lacking. We describe a patient with temporal lobe epilepsy with two focal seizures recorded in the epilepsy monitoring unit that were associated with central apnea lasting 57 and 58 seconds. During these events, she demonstrated oxygen desaturation down to 68 and 62%. The patient subsequently died at home from autopsy-confirmed SUDEP. The family was not alerted of any seizure activity by the auditory alarm system in her room nor by sleeping in the adjacent room with open doors. This case emphasizes the fact that ictal hypoxia and SUDEP may occur in seizures without noticeable convulsive activity. The report gives credibility to the growing body of literature suggesting that epilepsies affecting the autonomic nervous system may predispose to SUDEP independent of the effects of a secondary generalized convulsion.

479 Article No association between leptin levels and sleep duration or quality in obese adults. 2011

Knutson, Kristen L / Galli, Giulia / Zhao, Xiongce / Mattingly, Megan / Cizza, Giovanni / Anonymous4520701. ·Department of Medicine, University of Chicago, Chicago, Illinois, USA. ·Obesity (Silver Spring) · Pubmed #21799479.

ABSTRACT: Previous research in lean subjects has found lower leptin levels associated with shorter sleep duration. Since leptin levels are higher and some of the actions of leptin are impaired in obese individuals, one cannot assume that sleep will be similarly associated with leptin in obese individuals. The aim of this paper was to examine the cross-sectional association between habitual sleep duration and quality and plasma leptin levels in a sample of 80 obese men and premenopausal women aged 18-50 years. Leptin levels (ng/ml) were assayed on a fasting blood sample taken in the morning. We calculated a relative leptin level by dividing leptin by body fat percentage. Sleep duration and sleep efficiency were measured by 2 weeks of wrist actigraphy and respiratory disturbance index (RDI), a measure of sleep disordered breathing, was assessed by a portable screening device on a single night. Mean leptin levels and body fat percentage were higher in women than men (P < 0.001), however, mean RDI was higher in men (P = 0.01). There were no significant associations between relative leptin level and any of the sleep measures, including sleep duration, sleep efficiency, and sleep disordered breathing. There was also no difference between men and women in the association between sleep and leptin. In conclusion, contrary to what has been reported in other studies, measures of sleep duration and quality were not associated with leptin levels in our sample of obese adults.

480 Article Monocarboxylate transporter 2 and stroke severity in a rodent model of sleep apnea. 2011

Wang, Yang / Guo, Shang Z / Bonen, Arend / Li, Richard C / Kheirandish-Gozal, Leila / Zhang, Shelley X L / Brittian, Kenneth R / Gozal, David. ·Department of Pediatrics, University of Chicago, Chicago, Illinois 60637, USA. ·J Neurosci · Pubmed #21753001.

ABSTRACT: Stroke is not only more prevalent but is also associated with more severe adverse functional outcomes among patients with sleep apnea. Monocarboxylate transporters (MCT) are important regulators of cellular bioenergetics, have been implicated in brain susceptibility to acute severe hypoxia (ASH), and could underlie the unfavorable prognosis of cerebrovascular accidents in sleep apnea patients. Rodents were exposed to either intermittent hypoxia (IH) during sleep, a characteristic feature of sleep apnea, or to sustained hypoxia (SH), and expression of MCT1 and MCT2 was assessed. In addition, the functional recovery to middle cerebral artery occlusion (MCAO) in rats and hMCT2 transgenic mice and of hippocampal slices subjected to ASH was assessed, as well as the effects of MCT blocker and MCT2 antisense oligonucleotides and siRNAs. IH, but not SH, induced significant reductions in MCT2 expression over time at both the mRNA and protein levels and in the functional recovery of hippocampal slices subjected to ASH. Similarly, MCAO-induced infarcts were significantly greater in IH-exposed rats and mice, and overexpression of hMCT2 in mice markedly attenuated the adverse effects of IH. Exogenous pyruvate treatment reduced infarct volumes in normoxic rats but not in IH-exposed rats. Administration of the MCT2 blocker 4CN, but not the MCT1 antagonist p-chloromercuribenzene sulfonate, increased infarct size. Thus, prolonged exposures to IH mimicking sleep apnea are associated with increased CNS vulnerability to ischemia that is mediated, at least in part, by concomitant decreases in the expression and function of MCT2. Efforts to develop agonists of MCT2 should provide opportunities to ameliorate the overall outcome of stroke.

481 Article Effect of fluticasone furoate on interleukin 6 secretion from adenoid tissues in children with obstructive sleep apnea. 2011

Esteitie, Rania / Emani, Janaki / Sharma, Shilpy / Suskind, Dana L / Baroody, Fuad M. ·Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medical Center, IL 60637, USA. ·Arch Otolaryngol Head Neck Surg · Pubmed #21690510.

ABSTRACT: OBJECTIVE: To determine the effect of intranasal corticosteroid therapy on T-regulatory cells and other inflammatory cytokines in adenoid tissues in children with obstructive sleep apnea syndrome. DESIGN: Randomized, prospective, exploratory study. SETTING: Academic pediatric otolaryngology practice in a tertiary care children's hospital. PATIENTS: Participants included 24 children between the ages of 2 and 12 years who were undergoing adenotonsillectomy for polysomnogram-documented obstructive sleep apnea syndrome. INTERVENTION: Children were randomized to either no treatment (n = 13) or treatment with fluticasone furoate nasal spray, 55 μg/nostril daily (n = 11), for 2 weeks before adenotonsillectomy. Adenoid tissue was obtained at the time of the procedure. MAIN OUTCOME MEASURES: The number of tissue T-regulatory cells, as determined by staining with FOXP3, CD4, and CD25, was the primary outcome measure. Staining for interleukin (IL)-10 and transforming growth factor-β protein by immunohistochemistry, and adenoid mononuclear cell spontaneous and induced release of cytokines (IL-10, IL-6, IL-12, IL-13, tumor necrosis factor, and transforming growth factor β) were secondary outcomes. RESULTS: Cells isolated from fluticasone furoate nasal spray-treated adenoid tissue released significantly less IL-6 spontaneously as well as upon stimulation with anti-CD3 monoclonal antibody (P = .05) compared with nontreated adenoid tissue. There were no significant differences in the number of CD4/FOXP3-, CD25/FOXP3-, or transforming growth factor β-positive cells. Intensity of staining for IL-10 was also comparable between the groups. CONCLUSIONS: In this study, we show reduction of IL-6, a proinflammatory cytokine, in adenoid tissue obtained from children with obstructive sleep apnea syndrome treated with fluticasone furoate nasal spray. This reduction could contribute to the clinical efficacy of this class of medications in the treatment of childhood obstructive sleep apnea syndrome.

482 Article Fatty-acid binding protein 4 gene polymorphisms and plasma levels in children with obstructive sleep apnea. 2011

Bhushan, Bharat / Khalyfa, Abdelnaby / Spruyt, Karen / Kheirandish-Gozal, Leila / Capdevila, Oscar Sans / Bhattacharjee, Rakesh / Kim, Jinkwan / Keating, Brendan / Hakonarson, Hakon / Gozal, David. ·Department of Pediatrics, Comer Children's Hospital, University of Chicago, Chicago, IL 60637, USA. ·Sleep Med · Pubmed #21664182.

ABSTRACT: INTRODUCTION: Obstructive sleep apnea (OSA) is associated with increased risk for metabolic syndrome in both adults and children. In adults with OSA, serum levels of fatty acid binding protein 4 (FABP4) are elevated and associated with the degree of metabolic insulin resistance, independent of obesity. Therefore, we assessed plasma FABP4 levels and FABP4 allelic variants in obese and non-obese children with and without OSA. METHODS: A total of 309 consecutive children ages 5-8years were recruited. Children were divided into those with OSA and without OSA (NOSA) based on the apnea-hypopnea index (AHI). Subjects were also subdivided into obese (OB) and non-obese (NOB) based on BMI z score. Morning fasting plasma FABP4 levels were assayed using ELISA, and 11 single-nucleotide polymorphisms (SNPs) within the FABP4 region were genotyped. RESULTS: Morning plasma FABP4 levels were increased in all children with OSA, even in NOB children. However, plasma FABP4 levels were strongly associated with BMI z score. Of the 11 SNPs tested, the frequency of rs1054135 (A/G) minor allele (A) was significantly increased in OSA. This SNP was also associated with increased plasma FABP4 levels in both OSA and obese subjects. The minor allele frequency of all other SNPs was similar in OSA and NOSA groups. CONCLUSIONS: Childhood obesity and OSA are associated with higher plasma FABP4 levels and thus promote cardiometabolic risk. The presence of selective SNP (e.g., rs1054135) in the FABP4 gene may account for increased plasma FABP4 levels in the context of obesity and OSA in children.

483 Article Intermittent hypoxia-induced cognitive deficits are mediated by NADPH oxidase activity in a murine model of sleep apnea. 2011

Nair, Deepti / Dayyat, Ehab A / Zhang, Shelley X / Wang, Yang / Gozal, David. ·Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, Illinois, United States of America. ·PLoS One · Pubmed #21625437.

ABSTRACT: BACKGROUND: In rodents, exposure to intermittent hypoxia (IH), a hallmark of obstructive sleep apnea (OSA), is associated with neurobehavioral impairments, increased apoptosis in the hippocampus and cortex, as well as increased oxidant stress and inflammation. Excessive NADPH oxidase activity may play a role in IH-induced CNS dysfunction. METHODS AND FINDINGS: The effect of IH during light period on two forms of spatial learning in the water maze and well as markers of oxidative stress was assessed in mice lacking NADPH oxidase activity (gp91phox(_/Y)) and wild-type littermates. On a standard place training task, gp91phox(_/Y) displayed normal learning, and were protected from the spatial learning deficits observed in wild-type littermates exposed to IH. Moreover, anxiety levels were increased in wild-type mice exposed to IH as compared to room air (RA) controls, while no changes emerged in gp91phox(_/Y) mice. Additionally, wild-type mice, but not gp91phox(_/Y) mice had significantly elevated levels of NADPH oxidase expression and activity, as well as MDA and 8-OHDG in cortical and hippocampal lysates following IH exposures. CONCLUSIONS: The oxidative stress responses and neurobehavioral impairments induced by IH during sleep are mediated, at least in part, by excessive NADPH oxidase activity, and thus pharmacological agents targeting NADPH oxidase may provide a therapeutic strategy in sleep-disordered breathing.

484 Article Comparison of two servo ventilator devices in the treatment of complex sleep apnea. 2011

Kuzniar, Tomasz J / Patel, Smita / Nierodzik, Cynthia L / Smith, Loretta C. ·Division of Pulmonary and Critical Care Medicine, NorthShore University HealthSystem, Evanston, IL, USA. tkuzniar@northshore.org ·Sleep Med · Pubmed #21576036.

ABSTRACT: OBJECTIVE: Servo ventilation (SV) devices generate positive airway pressure with a variable pressure support that changes in response to a patient's own respiratory output. Two currently available SV devices-VPAP-AdaptSV® and BIPAP-AutoSV®-have been used in treatment of complex sleep apnea (CompSAS), but no side-by-side comparisons are available. METHODS: Data of 76 consecutive patients with complex sleep apnea, who were prescribed a VPAP-AdaptSV® or BIPAP-AutoSV® in a non-randomized parallel design, were retrospectively analyzed. Patients underwent a diagnostic polysomnogram followed by a continuous positive airway pressure (CPAP) titration and a SV titration study. Objective compliance with the device was assessed at the first visit at 4-6weeks of its use. RESULTS: Thirty-five patients received a VPAP-AdaptSV® device, while 41 patients were treated with BIPAP-AutoSV®. Patients treated with BIPAP-AutoSV® had a significantly higher apnea-hypopnea index during their CPAP titration study than patients treated with VPAP-AdaptSV® [49/h (28-60) vs. 35/h (19.5-49.5), median (interquartile range), p<0.001]. On follow-up, 56 patients (73.7%) were using their device. Mean nightly use was 5.0h (2.8-6.4) for VPAP-AdaptSV® group and 6.0h (3.5-7.2) for BIPAP-AutoSV® group (p=0.081); an improvement in Epworth Sleepiness Scale score was higher in the BIPAP-AutoSV® group than in the VPAP-AdaptSV® group [4 (1-9) vs. 2.5 (0-5), p=0.02]. CONCLUSION: Our retrospective data indicate that the two servo-ventilation devices are comparable means of controlling complex sleep apnea, and the compliance with them is high.

485 Article The influence of intermittent hypoxemia on platelet activation in obese patients with obstructive sleep apnea. 2011

Rahangdale, Shilpa / Yeh, Susie Yim / Novack, Victor / Stevenson, Karen / Barnard, Marc R / Furman, Mark I / Frelinger, Andrew L / Michelson, Alan D / Malhotra, Atul. ·Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. srahangdale@northshore.org ·J Clin Sleep Med · Pubmed #21509332.

ABSTRACT: OBJECTIVES: Literature regarding platelet function in obstructive sleep apnea (OSA) has considerable limitations. Given the central role of platelets in atherothrombosis and the known cardiovascular risk of OSA, we hypothesized that OSA severity is predictive of platelet function, independent of known comorbidities. DESIGN: Obese subjects, without comorbidities, underwent overnight, in-lab polysomnography. The following morning, 5 biomarkers of platelet activation were measured by whole-blood flow cytometry at baseline and in response to agonists (no stimulation, stimulation with 5 μM ADP agonist, and stimulation with 20 μM ADP agonist): platelet surface P-selectin, activated glycoprotein (GP) IIb/IIIa, and GPIb receptor expression, platelet-monocyte aggregation (PMA) and platelet-neutrophil aggregation (PNA). RESULTS: Of the 77 subjects, 47 were diagnosed with OSA (median apnea-hypopnea index [AHI] of 24.7 ± 28.1/h in subjects with OSA and 3.0 ± 3.9/h in subjects without OSA, p < 0.001). The groups were matched for body mass index, with a mean body mass index of 40.3 ± 9.6 kg/m(2) in subjects with OSA and 38.9 ± 6.0 kg/m(2) in subjects without OSA (p = 0.48). A comparison of time spent with an oxygen saturation of less than 90% showed that subjects who had 1 minute or more of desaturation time per hour of sleep had lower GPIb fluorescence in circulating platelets, as compared with those subjects who had less than 1 minute of desaturation time per hour of sleep; similar findings were observed following 5 μM and 20 μM of ADP stimulation, as compared with control vehicle, suggesting higher levels of circulating platelet activity. In multivariate analyses, only nocturnal hypoxemia and female sex predicted agonist response. Platelet surface P-selectin, platelet surface-activated GPIIb/IIIa, PMA, and PNA were not significantly correlated with markers of OSA. CONCLUSIONS: In obese patients with OSA, platelet activation is associated with greater levels of oxygen desaturation, compared with matched control subjects. Metrics other than AHI (e.g., hypoxemia) may determine OSA-related thrombotic risk.

486 Article Association of PPARγ2 (Pro12Ala) and neuropeptide Y (Leu7Pro) gene polymorphisms with obstructive sleep apnea in obese Asian Indians. 2011

Bhushan, Bharat / Guleria, Randeep / Misra, Anoop / Luthra, Kalpana / Kumar, Guresh. ·Department of Surgery, Children's Memorial Hospital, Northwestern University, Chicago, USA. ·Dis Markers · Pubmed #21508507.

ABSTRACT: BACKGROUND: Obstructive sleep apnea (OSA) is prevalent in 7.5% in urban Asian Indians. Peroxisome proliferator activated receptor gamma2 (PPARγ2) has been implicated in adipocyte differentiation. Neuropeptide Y (NPY) is also considered as a candidate gene for excess body fat accumulation. The association of PPARγ2 (Pro12Ala)} and NPY (Leu7Pro) gene polymorphisms with OSA has not been studied in Asian Indians. OBJECTIVE: To study the distribution of PPARγ2 (Pro12Ala) and NPY (Leu7Pro) polymorphism in Asian Indians with and without OSA. METHODS AND RESULTS: This study was carried out in 252 obese subjects [(body mass index (BMI > 25 kg/m2]; 142 with OSA and 110 without OSA. Measurements included anthropometric and biochemical parameters (fasting blood glucose, lipid profile, various circumferences and skin-fold thicknesses). PPARγ2 (Pro12Ala) and NPY (Leu7Pro) gene} polymorphisms were studied in all subjects. The frequency of the variant allele (Ala12) of PPARγ2 gene was significantly higher in subjects with OSA (14.4%) when compared with subjects without OSA (5.5%; χ2= 9.7; p = 0.001). The distribution of the variant allele (Pro7) of NPY gene was comparable in subjects with OSA (3.5%) and without OSA (3.6%; χ2= 0.001, p = 0.94). CONCLUSION: This study reveals a significantly higher frequency of PPARγ2 (Ala12) allele in obese Asian Indians with OSA when compared to obese Asian Indians without OSA.

487 Article Leukotriene B4 receptor-1 mediates intermittent hypoxia-induced atherogenesis. 2011

Li, Richard C / Haribabu, Bodduluri / Mathis, Steven P / Kim, Jinkwan / Gozal, David. ·Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA. rcli@uchicago.edu ·Am J Respir Crit Care Med · Pubmed #21493735.

ABSTRACT: RATIONALE: Obstructive sleep apnea, which is characterized by intermittent hypoxia (IH) during sleep, has emerged as an independent risk factor for cardiovascular disease, including atherosclerosis. Leukotriene B4 (LTB4) production is increased in patients with obstructive sleep apnea and negatively correlates to hypoxic levels during sleep, with continuous positive airway pressure therapy decreasing LTB4 production. OBJECTIVES: Determine the potential role of LTB4 in IH-induced atherosclerosis in a monocyte cellular model and a murine model. METHODS: THP-1 cells were exposed to IH for 3, 6, 24, and 48 hours. Macrophage transformation and foam cell formation were assessed after IH exposures. Apolipopotein E (ApoE)(-/-) or BLT1(-/-)/ApoE(-/-) mice were fed an atherogenic diet and exposed to IH (alternating 21% and 5.7% O(2) from 7 am to 7 PM each day) for 10 weeks. Atherosclerotic lesion formation in en face aorta was examined by oil red O staining. MEASUREMENTS AND MAIN RESULTS: IH increased production of LTB4 and the expression of 5-lipoxygenase and leukotriene A4 hydrolase, the key enzymes for producing LTB4. IH was associated with transformation of monocytes to activated macrophages, as evidenced by increased expression of CD14 and CD68. In addition, IH exposures promoted increased cellular cholesterol accumulation and foam cell formation. The LTB4 receptor 1 (BLT1) antagonist U-75302 markedly attenuated IH-induced changes. Furthermore, IH promoted atherosclerotic lesion formation in ApoE(-/-) mice. IH-induced lesion formation was markedly attenuated in BLT1(-/-)/ApoE(-/-) mice. CONCLUSIONS: BLT1-dependent pathways underlie IH-induced atherogenesis, and may become a potential novel therapeutic target for obstructive sleep apnea-associated cardiovascular disease.

488 Article Impact of nasal obstruction on obstructive sleep apnea. 2011

Friedman, Michael / Maley, Alexander / Kelley, Kanwar / Leesman, Chris / Patel, Akshay / Pulver, Tanya / Joseph, Ninos / Catli, Tolgahan. ·Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA. hednnek@aol.com ·Otolaryngol Head Neck Surg · Pubmed #21493302.

ABSTRACT: OBJECTIVES: The purpose of this study was to investigate the relationship between nasal obstruction and sleep-disordered breathing. The effect of postoperative nasal packing on sleep parameters was compared between patients with mild obstructive sleep apnea (OSA) and those with moderate/severe OSA. STUDY DESIGN: A prospective, nonrandomized controlled study. SETTING: Tertiary care center. SUBJECTS AND METHODS: Participants were recruited among adult patients with a history of snoring scheduled to undergo nasal surgery from November 2009 to February 2010. All subjects underwent polysomnogram (PSG) testing within 30 days prior to surgery. Patients underwent nasal surgery and received postoperative nasal packing, and a PSG was repeated on the first postoperative night with nasal packing in place. Outcome measures included a change in respiratory disturbance index (RDI), minimum oxygen saturation, oxygen desaturation index (ODI), and duration of snoring. RESULTS: Forty-nine patients were included in the study. Patients were stratified into 2 groups: those with RDI ≥15 (n = 23) and those with RDI <15 (n = 26). Nasal packing was found to significantly increase RDI (5.2 ± 4.0 vs 10.4 ± 10.0; P = .0001), duration of snoring (86.5% ± 13.1% vs 79.3% ± 15.3%; P = .008), and ODI (7.6 ± 7.1 vs 9.9 ± 7.4; P = .001) in patients with mild OSA but not in patients with moderate/severe OSA. Mean minimum arterial oxygen saturation was unchanged in both groups. CONCLUSION: Postoperative nasal packing aggravated measures of OSA in patients with mild OSA but not in patients with moderate/severe OSA.

489 Article Synchronous airway lesions in children younger than age 3 years undergoing adenotonsillectomy. 2011

Rastatter, Jeffrey C / Schroeder, James W / French, Adam / Holinger, Lauren. ·Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. jrastatter@childrensmemorial.org ·Otolaryngol Head Neck Surg · Pubmed #21493277.

ABSTRACT: OBJECTIVE: Determine the prevalence of synchronous airway lesions (SALs) in children younger than age 3 years undergoing adenoidectomy or adenotonsillectomy for sleep-disordered breathing (SDB) at Children’s Memorial Hospital. DESIGN: Case series with chart review. SETTING: Tertiary care pediatric hospital. CHILDREN: One hundred ten children 3 years of age or younger who underwent adenoidectomy or adenotonsillectomy along with a full-airway evaluation that included flexible fiber-optic laryngoscopy, direct laryngoscopy, and rigid bronchoscopy for SDB from January 2003 to January 2009. OUTCOME MEASURES: Prevalence of SALs and rate of SALs that required intervention. RESULTS: Sixty-seven percent of children were found to have at least 1 SAL. Four children required surgical intervention for a SAL. There was no significant difference in preoperative respiratory distress index (RDI) between children with normal airway examinations compared with children with a SAL. There was no significant difference in the rate of SALs between children younger than 18 months old and those 18 to 36 months old. CONCLUSIONS: There is a high incidence of SALs in children younger than 3 years old with SDB. There was no significant difference in the rate of SALs in children younger than 18 months old compared with children 18 to 36 months old. The RDI determined by a polysomnography was not predictive of the presence of a SAL. Tracheal cobblestoning was the most common SAL discovered.

490 Article Obstructive sleep apnea in poorly controlled asthmatic children: effect of adenotonsillectomy. 2011

Kheirandish-Gozal, Leila / Dayyat, Ehab A / Eid, Nemr S / Morton, Ronald L / Gozal, David. ·Sections of Pediatric Pulmonology and Pediatric Sleep Medicine, Department of Pediatrics, University of Chicago, Chicago, Illinois 60637-1470, USA. lgozal@peds.bsd.uchicago.edu ·Pediatr Pulmonol · Pubmed #21465680.

ABSTRACT: BACKGROUND: Asthma and obstructive sleep apnea (OSA) in children share multiple epidemiological risk factors and the prevalence of snoring is higher in asthmatic children, suggesting that the latter may be at increased risk for OSA. Since both asthma and OSA are inflammatory disorders, we hypothesized that polysomnographically demonstrated OSA would be more frequent among poorly controlled asthmatics (PCA), and that treatment of OSA, if present, would ameliorate the frequency of acute asthmatic exacerbations (AAE). METHODS: Children with PCA were referred for an overnight sleep study, and adenotonsillectomy (tonsillectomy and adenoidectomy, T&A) was performed if OSA was present. Frequency of asthma symptoms and exacerbations were compared. RESULTS: Ninety-two PCA children, ages 3-10 years, with a mean frequency of AAE of 3.4 ± 0.4/year were prospectively referred for a sleep study. OSA (i.e., AHI > 5/hrTST) was present in 58 patients (63.0%; OR: 40.9, 12.9-144.1, P < 0.000001 compared to the prevalence of OSA in a non-asthmatic population). Information at 1-year follow-up was available for 35 PCA children after T&A. The annual frequency of AAE, rescue inhaled use, and asthma symptoms in this sub-group decreased compared to no changes in the group without OSA. CONCLUSIONS: The prevalence of OSA is markedly increased among PCA children and treatment of OSA appears to be associated with substantial improvements in the severity of the underlying asthmatic condition.

491 Article Sleep disordered breathing and subjective sleepiness in the elderly: a deadly combination? 2011

Mokhlesi, Babak / Pamidi, Sushmita / Yaggi, H Klar. ·Sleep Disorders Center, Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL 60637, USA. bmokhles@medicine.bsd.uchicago.edu ·Sleep · Pubmed #21461318.

ABSTRACT: -- No abstract --

492 Article Hypoxia-inducible factor 1 mediates increased expression of NADPH oxidase-2 in response to intermittent hypoxia. 2011

Yuan, Guoxiang / Khan, Shakil A / Luo, Weibo / Nanduri, Jayasri / Semenza, Gregg L / Prabhakar, Nanduri R. ·Institute for Integrative Physiology and The Center for Systems Biology of O2 Sensing, Biological Science Division, University of Chicago, Illinois 60637, USA. ·J Cell Physiol · Pubmed #21302291.

ABSTRACT: Sleep-disordered breathing with recurrent apnea is associated with intermittent hypoxia (IH). Cardiovascular morbidities caused by IH are triggered by increased generation of reactive oxygen species (ROS) by pro-oxidant enzymes, especially NADPH oxidase-2 (Nox2). Previous studies showed that (i) IH activates hypoxia-inducible factor 1 (HIF-1) in a ROS-dependent manner and (ii) HIF-1 is required for IH-induced ROS generation, indicating the existence of a feed-forward mechanism. In the present study, using multiple pharmacological and genetic approaches, we investigated whether IH-induced expression of Nox2 is mediated by HIF-1 in the central and peripheral nervous system of mice as well as in cultured cells. IH increased Nox2 mRNA, protein, and enzyme activity in PC12 pheochromocytoma cells as well as in wild-type mouse embryonic fibroblasts (MEFs). This effect was abolished or attenuated by blocking HIF-1 activity through RNA interference or pharmacologic inhibition (digoxin or YC-1) or by genetic knockout of HIF-1α in MEFs. Increasing HIF-1α expression by treating PC 12 cells with the iron chelator deferoxamine for 20 h or by transfecting them with HIF-1alpha expression vector increased Nox2 expression and enzyme activity. Exposure of wild-type mice to IH (8 h/day for 10 days) up-regulated Nox2 mRNA expression in brain cortex, brain stem, and carotid body but not in cerebellum. IH did not induce Nox2 expression in cortex, brainstem, carotid body, or cerebellum of Hif1a(+/-) mice, which do not manifest increased ROS or cardiovascular morbidities in response to IH. These results establish a pathogenic mechanism linking HIF-1, ROS generation, and cardiovascular pathology in response to IH.

493 Article Seasonal variability of sleep-disordered breathing in children. 2011

Gozal, David / Shata, Ahmad / Nakayama, Meiho / Spruyt, Karen. ·Department of Pediatrics and Comer Children's Hospital, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA. dgozal@uchicago.edu ·Pediatr Pulmonol · Pubmed #21284096.

ABSTRACT: INTRODUCTION: Snoring and sleep-disordered breathing (SDB) are frequent pediatric conditions. Although allergies and respiratory viruses have been pathophysiologically implicated in these conditions, their seasonal distribution has not been examined. METHODS: The records of all children participating in a prospective, cross-sectional community-based research study that included a questionnaire on snoring frequency and loudness and an overnight sleep study were retrospectively assessed for seasonal patterns based on the day the children were evaluated. RESULTS: A total of 1,051 children were included with a mean age of 7 years. There were no seasonal differences in the number of children evaluated or in their demographic characteristics. However, the odds of increased snoring frequency and loudness were significantly higher in spring and summer and lowest in fall (P < 0.001). However, the mean AHI was highest and the nadir SaO(2) was lowest in winter and spring compared to summer and fall (P < 0.001 and P < 0.03, respectively). CONCLUSION: Snoring and the severity of SDB exhibit distinct and essentially non-overlapping patterns of seasonal variation, with peaks in spring-summer for snoring and peaks in winter-spring for SDB severity. These findings suggest that both seasonal viral and allergen burdens may contribute to SDB severity and may prompt differing clinical referral patterns throughout the year.

494 Article Circulating microparticles in children with sleep disordered breathing. 2011

Kim, Jinkwan / Bhattacharjee, Rakesh / Kheirandish-Gozal, Leila / Spruyt, Karen / Gozal, David. ·Section of Pediatric Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, University of Chicago, Chicago, IL; Division of Pediatric Sleep Medicine, University of Louisville School of Medicine, Louisville, KY. ·Chest · Pubmed #21273295.

ABSTRACT: BACKGROUND: Endothelial dysfunction is a common complication of pediatric obstructive sleep apnea (OSA). Circulating cell-derived microparticles (MPs) have emerged as reliable biomarkers of endothelial dysfunction and atherosclerosis. METHODS: Children underwent blood drawing the morning after a sleep study. Endothelial function was assessed using a modified hyperemic test after cuff-induced occlusion of the brachial artery. Circulating MP levels in plasma, including levels of endothelial MPs, endothelial progenitor MPs, leukocyte MPs, and platelet MPs, were measured using flow cytometry after staining with cell-specific antibodies. RESULTS: The levels of endothelial MPs, endothelial progenitor MPs, leukocyte MPs, and platelet MPs were significantly different according to the severity of OSA in children. Leukocyte CD11b+ MPs and platelet CD41a+ MPs correlated with the apnea-hypopnea index (AHI) (r = 0.334, P < .001; and r = 0.301, P < .001, respectively), and associations emerged between leukocyte CD11b+ MPs and apolipoprotein B (r = 0.206, P < .05) and between endothelial MPs and low-density lipoprotein cholesterol (r = 0.240, P < .01). In a multivariate regression model, the BMI z score (β ± SE, 0.045 ± 0.020; P = .020) and the CD41a MPs to leukocyte CD45 MPs ratio (β ± SE, 0.074 ± 0.032; P = .021) were independently associated with peak hyperemic responses. After controlling for age, gender, race, BMI z score, and apolipoprotein B levels, endothelial MPs, endothelial progenitor MPs, and leukocyte MPs showed independent associations with the AHI. Complex significant associations emerged between endothelial function, the AHI, and CD41a MPs. CONCLUSIONS: Childhood OSA is associated with higher circulating MP levels that can promote cardiovascular risk. Platelet-derived MPs emerge as being significantly associated with the vascular dysfunction associated with OSA in children and could potentially account for increased risk for altered endothelial function. However, the clinical use of MPs as reliable biomarker indicators of vascular risk will have to await further studies.

495 Article Marked improvement of heart failure upon adequate titration of continuous positive airway pressure in a patient with obstructive sleep apnea. 2011

Raval, Deena / Bernstein, Lawrence P / Williams, Randall E / Kuzniar, Tomasz J. ·Department of Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA. ·Pneumonol Alergol Pol · Pubmed #21190153.

ABSTRACT: Sleep disordered breathing (SDB) is frequently present in heart failure (HF), and it may take the form of obstructive (OSA) and central (CSA) sleep apnea. The use of continuous positive airway pressure (CPAP) in patients with OSA and HF is associated with an improved neuroendocrine profile and cardiac function. The degree of upper airway obstruction and the airway closing pressure (and the PAP pressure used to relieve it) may all be highly variable in a setting of uncontrolled HF, mostly due to variable airway oedema. We present a case of a man with HF whose cardiac symptoms radically improved after adequate treatment of his OSA with an auto-adjusting PAP device.

496 Article Complex sleep apnea unmasked by the use of a mandibular advancement device. 2011

Kuźniar, Tomasz J / Kovačević-Ristanović, Ružica / Freedom, Thomas. ·Division of Pulmonary and Critical Care Medicine, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL 60201, USA. tkuzniar@northshore.org ·Sleep Breath · Pubmed #21190088.

ABSTRACT: According to most accepted definitions, complex sleep apnea syndrome (CompSAS) is described as an emergence of central apneas in a patient with obstructive sleep apnea (OSA) upon introduction of continuous positive airway pressure therapy (CPAP). We present two patients who developed comparable central apnea activity when treated with either a CPAP device or a mandibular advancement device. As similar findings have been previously documented in patients with OSA treated with maxillofacial surgery or tracheostomy, we propose that the current definition of CompSAS should broaden to include diagnosis of CompSAS in non-PAP-treated patients, who are managed with either a dental appliance or a surgical procedure.

497 Article Treatment of obstructive sleep apnea improves cardiometabolic function in young obese women with polycystic ovary syndrome. 2011

Tasali, Esra / Chapotot, Florian / Leproult, Rachel / Whitmore, Harry / Ehrmann, David A. ·Department of Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, Illinois 60637, USA. ·J Clin Endocrinol Metab · Pubmed #21123449.

ABSTRACT: CONTEXT: Women with polycystic ovary syndrome (PCOS) are insulin resistant and have a high risk of early-onset diabetes and cardiovascular disease. Obstructive sleep apnea (OSA) has adverse cardiometabolic consequences and is highly prevalent in women with PCOS. We sought to determine whether continuous positive airway pressure (CPAP) treatment of OSA has beneficial effects on cardiometabolic function in PCOS. METHODS: Laboratory polysomnography and cardiometabolic measurements including insulin sensitivity and secretion (iv glucose tolerance test); 24-h profiles of plasma catecholamines, cortisol, and leptin; and daytime profiles of blood pressure and cardiac autonomic activity (heart rate variability) were obtained at baseline and again after 8 wk of home CPAP treatment with daily usage monitoring. RESULTS: CPAP treatment modestly improved insulin sensitivity after controlling for body mass index (P = 0.013). The change in insulin sensitivity correlated positively with CPAP use (adjusted P = 0.027) and negatively with body mass index (adjusted P = 0.003). Daytime and nighttime norepinephrine levels were decreased after CPAP (P = 0.002), and the reductions were greater with increased CPAP use (P = 0.03). Epinephrine, cortisol, and leptin levels were not changed significantly. Daytime diastolic blood pressure decreased by an average of 2.3 mm Hg after CPAP (P = 0.035). Cardiac sympathovagal balance was 44% lower (P = 0.007) after CPAP, reflecting a shift toward lower sympathetic activity. CONCLUSIONS: In young obese women with PCOS, successful treatment of OSA improves insulin sensitivity, decreases sympathetic output, and reduces diastolic blood pressure. The magnitude of these beneficial effects is modulated by the hours of CPAP use and the degree of obesity.

498 Article The Berlin Questionnaire for assessment of sleep disordered breathing risk in parturients and non-pregnant women. 2011

Higgins, N / Leong, E / Park, C S / Facco, F L / McCarthy, R J / Wong, C A. ·Department of Anesthesiology and Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. ·Int J Obstet Anesth · Pubmed #21123046.

ABSTRACT: BACKGROUND: Pregnancy is associated with alteration in sleep patterns and quality. We wished to investigate whether pregnant women have a higher likelihood of a positive Berlin Questionnaire than non-pregnant women. METHODS: Pregnant women ages 18-45 years (n=4074) presenting for delivery, and non-pregnant women ages 18-45 years (n=490) presenting for outpatient surgery provided demographic information and completed the Berlin Questionnaire evaluating self-reported snoring and daytime sleepiness. For the pregnant patients, the infant's birth weight and Apgar scores were also recorded. RESULTS: Of the 1439 patients with a positive Berlin Questionnaire, 96 were in the non-pregnant control population versus 1343 in the pregnant population (20% vs. 33%, respectively, P<0.001; odds ratio 2.0 [95% CI: 1.6-2.5]). There was a positive correlation between infant weight and a positive Berlin Questionnaire. The incidence of preeclampsia was greater (odds ratio 3.9) in the pregnant patients with a positive Berlin Questionnaire as compared with the parturients with a negative Berlin Questionnaire (odds ratio 1.1). CONCLUSION: Parturients are more likely to have a positive Berlin Questionnaire than non-pregnant women. This may indicate an increased likelihood of sleep disordered breathing.

499 Article TNF-α gene polymorphisms and excessive daytime sleepiness in pediatric obstructive sleep apnea. 2011

Khalyfa, Abdelnaby / Serpero, Laura D / Kheirandish-Gozal, Leila / Capdevila, Oscar Sans / Gozal, David. ·Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA. ·J Pediatr · Pubmed #20846669.

ABSTRACT: OBJECTIVE: To assess sleepiness, TNF-α plasma levels, and genomic variance in the TNF-α gene in children with obstructive sleep apnea (OSA). STUDY DESIGN: Children being evaluated for OSA (n = 60) and matched control children (n = 80) were assessed with a modified Epworth Sleepiness Scale questionnaire and underwent a blood draw the morning after nocturnal polysomnography. TNF-α plasma concentrations were assayed using ELISA, and genomic DNA was extracted. Genotyping and allelic frequencies were determined for 4 TNF-α single nucleotide polymorphisms using real-time polymerase chain reaction genotyping assays. RESULTS: Morning TNF-α levels and Epworth Sleepiness Scale scores were increased in the presence of OSA, but substantial variability was present. Although TNF-α plasma concentrations were globally increased in OSA, most of the variance was attributable to the presence or absence of TNF-α -308G gene polymorphism. CONCLUSIONS: TNF-α levels are increased in a subset of children with OSA, particularly among those harboring the TNF-α -308G single nucleotide polymorphism. Among the latter, significant increases in excessive daytime sleepiness symptoms are also present. The relatively high variability of excessive daytime sleepiness in pediatric OSA may be related to underlying TNF-α gene polymorphisms, particularly -308G.

500 Article Self-efficacy contributes to individual differences in subjective improvements using CPAP. 2011

Baron, Kelly Glazer / Berg, Cynthia A / Czajkowski, Laura A / Smith, Timothy W / Gunn, Heather E / Jones, Christopher R. ·Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. k-baron@northwestern.edu ·Sleep Breath · Pubmed #20844971.

ABSTRACT: PURPOSE: Continuous positive airway pressure (CPAP) improves depressive symptoms and daytime sleepiness in patients with obstructive sleep apnea (OSA). However, there is variability in response to CPAP. This study examined individual differences in the daily associations between CPAP use and improvements in affect and sleepiness patients beginning CPAP. METHODS: This observational repeated measures study involved 31 CPAP-naïve patients diagnosed with obstructive sleep apnea at an academic sleep disorders center. Patients completed pre-treatment assessments of OSA knowledge, expectations for CPAP, and treatment self-efficacy as well as a repeated daily assessment of positive affect and negative affect, sleepiness/fatigue, and CPAP adherence for 10 days beginning the first week of treatment. Data were analyzed using multilevel modeling. RESULTS: Nightly CPAP adherence predicted improvements in next-day positive affect, negative affect, and sleepiness/fatigue. The apnea-hypopnea index (AHI), treatment self-efficacy, and outcome expectancies were significant moderators of day-to-day improvement. Higher self-efficacy and lower AHI were associated with a stronger relationship between adherence and next-day improvements in positive affect and sleepiness. Very high-outcome expectances were associated with a weaker relationship between adherence and next-day improvements in sleepiness. Subjective sleepiness at pre-treatment did not give moderate improvements in next-day affect. CONCLUSIONS: Although CPAP use predicted daily improvements in affect and sleepiness for the majority of patients, patients with lower AHI, greater treatment self-efficacy, and moderate outcome expectancies reported stronger daily benefits from CPAP. For patients with high-treatment efficacy, adherence may be reinforced by a stronger link between adherence and daily improvements.

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