Background: Obstructive sleep apnea (OSA) is a sleep disorder characterized by episodes of cessation of breathing (apnea) during sleep. Unfortunately, a significant number of surgical patients are unaware they are afflicted with this disorder increasing the risks of postoperative complications. The lingering effect of general anesthesia causes an increase in frequency of airway collapse, leading to longer periods of apnea. This increasingly common sleep disorder is concerning for many anesthesia providers. Purpose: The purpose of this study was to evaluate the anesthesia provider's knowledge and postoperative management of patients with suspected or diagnosed OSA. Setting: The study setting was a local urban hospital Mountain Vista Medical Center (MVMC) in Gilbert, AZ. The study included (N=7) participants, who were predominantly male (85%) and a majority of the participants were Master’s prepared (85%) anesthesia providers. Method: An online survey was disseminated to participants via email. The survey included questions regarding the anesthesia provider's knowledge and postoperative practice habits of patients with suspected or diagnosed OSA at MVMC. Results: The response rate was (24%). All the respondents acknowledged that OSA was a risk factor for postoperative complications. Over half of the respondents (85%) reported encountering postoperative complications such as desaturation and apnea in their patients with OSA. The main complication that was encountered was postoperative apnea (50%), followed by decreased in saturations (33.33%), and one respondent (16.67%) encountered re-intubation during the postoperative period. However, the most important finding of the study is that over half of the providers did not routinely include continued positive airway pressure (CPAP)/noninvasive positive pressure ventilation (NIPPV) in their postoperative management of patients with suspected or known OSA due to the time needed to initiate the therapy. Conclusion: The study illustrates that a majority of anesthesia providers at MVMC agreed OSA is a significant risk factor for postoperative complications, but time constraints limited the implementation of noninvasive ventilation (NIV) therapies. Recommended strategies would be to establish a task force to examine this barrier to therapy and develop plans to address it.

STOP-Bang is a tool for predicting the likelihood for sleep-disordered breathing (SDB). In the conventional score, all variables are dichotomous. Our aim was to identify whether modifying the STOP-Bang scoring tool by weighting the variables could improve test characteristics.

The impact of sleep on quality of life (QoL) has been well documented; however, there is a great need for reliable QoL measures for persons with obstructive sleep apnea (OSA). We compared the QoL scores between the 36-Item Short Form of the Medical Outcomes Survey (SF-36), Calgary Sleep Apnea Quality of Life Index (SAQLI), and Functional Outcomes Sleep Questionnaire (FOSQ) in persons with OSA.

Background: Obstructive sleep apnea (OSA) has been associated with atrial enlargement in response to high arterial and pulmonary pressures and increased sympathetic tone. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA; its impact on atrial electrical remodeling has not been investigated however. Signal-averaged p-wave (SAPW) is a non-invasive quantitative method to determine p-wave duration, an accepted marker for atrial electrical remodeling. The objective was to determine whether CPAP induces reverse atrial electrical remodeling in patients with severe OSA. Methods: Prospective study in consecutive patients attending the Sleep Clinic at Kingston General Hospital. All patients underwent full polysomnography. OSA-negative and severe OSA were defined as apnea-hypopnea index (AHI) < 5 events/hour and AHI ≥ 30 events/hour, respectively. In severe OSA patients, SAPW was determined pre- and post-intervention with CPAP for 4 - 6 weeks. In OSA-negative controls, SAPW was recorded at baseline and 4 - 6 weeks thereafter without any intervention. Results: A total of 19 severe OSA patients and 10 controls were included in the analysis. Mean AHI and minimum O2 saturation were 41.4 ± 10.1 events/hour and 80.5 ± 6.5% in severe OSA patients and 2.8 ± 1.2 events/hour and 91.4 ± 2.1% in controls. Baseline BMI was different between severe OSA patients and controls (34.3 ± 5.4 vs 26.6 ± 4.6 kg/m2; p < 0.001). At baseline, severe OSA patients had a greater SAPW duration than controls (131.9 ± 10.4 vs 122.8 ± 10.5 ms; p = 0.02). After CPAP intervention, there was a significant reduction of SAPW duration in severe OSA (131.9 ± 10.4 to 126.2 ± 8.8 ms; p < 0.001). In controls, SAPW duration did not change within 4 - 6 weeks. Conclusion: CPAP induced reverse atrial electrical remodeling in patients with severe OSA as represented by a significant reduction in SAPW duration. / Thesis (Master, Physiology) -- Queen's University, 2011-07-29 12:53:09.134

Background: Obstructive Sleep Apnea (OSA) is a chronic breathing disorder that is estimated to affect 20% of the US adult population. Intermittent hypoxia and sleep fragmentation caused by OSA likely affects cardiometabolic function. Individuals with OSA might be at risk of developing hypertension and type 2 diabetes (T2DM), with a dose-response relationship related to OSA severity. The objective of this study was to estimate the association between severity of OSA at diagnosis with 1) incidence of hypertension incidence of hypertension and 2) incidence of T2DM. Methods: We conducted a retrospective cohort study of Kaiser Permanente members diagnosed with OSA during 2000-2005. Adults without baseline hypertension or T2DM were eligible. Patients were excluded if hypertension or T2DM was diagnosed within one year prior to OSA diagnosis, and right censored at the end of follow-up or at the time Kaiser Permanente membership ended. Kaplan-Meier curves and Cox Proportional Hazard models were used to estimate the association between OSA severity and incident hypertension and incident diabetes. Results: Overall 719 patients were diagnosed with OSA during the study periods; 614 were included as those at risk of developing either hypertension (N=265) or T2DM (N=489). Overall, 261 had severe OSA at diagnosis. Those with severe OSA were more likely to be middle aged, overweight, and have prevalent hypertension or T2DM. Among those without prevalent hypertension at OSA diagnosis, 47.4% (126/266) were subsequently diagnosed with hypertension. Among those without prevalent T2DM at OSA diagnosis, 16.3% (80/491) were subsequently diagnosed with T2DM. After adjusting for BMI and prevalent T2DM, the hazard rate of incident hypertension among patients with severe OSA was 1.35 (95%CI: 0.88-2.06) compared to the rate among patients with mild OSA. The hazard rate of incident T2DM among patients with severe OSA was 1.49 (95%CI: 0.83-2.67) compared to the rate among patients with mild OSA after adjusting for BMI and prevalent hypertension. Discussion: We found high incidence rates of hypertension and T2DM among adults diagnosed with OSA. Severe OSA at diagnosis was associated with increased risk of either incident hypertension or T2DM, but not significantly (for p≤0.05).

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / O objetivo deste estudo foi verificar a presenÃa de parÃmetros morfolÃgicos maxilares na SÃndrome da ApnÃia Obstrutiva do Sono (SAOS) A amostra consistiu nos modelos de gesso da maxila de 23 indivÃduos (11 masculinos e 12 femininos) com diagnÃstico polissonogrÃfico de SÃndrome da ApnÃia Obstrutiva do Sono leve 34 indivÃduos (17 masculinos e 17 femininos) com sÃndrome moderada e 17 indivÃduos com sÃndrome grave (14 masculinos e 3 femininos) O grupo controle era composto por modelos de gesso da maxila de 50 jovens brasileiros de ambos os sexos com oclusÃo normal e sem indÃcios de SÃndrome da ApnÃia Obstrutiva do Sono Os resultados encontrados demonstraram que os parÃmetros morfolÃgicos da maxila avaliados nÃo apresentaram associaÃÃo com o Ãndice de apnÃia e hipopnÃia (IAH) mas ocorreram menores dimensÃes transversais da arcada dentÃria superior principalmente ao nÃvel de molares associado a um aumento da dessaturaÃÃo de oxi-hemoglobina (SaO2mÃn)IndivÃduos com SÃndrome da ApnÃia Obstrutiva do Sono tambÃm apresentaram dimensÃes transversais da maxila mais estreitas e maior profundidade do palato na regiÃo de prÃ-molares e molares quando comparados ao grupo controle / The objective of this study was to verify the presence of maxillary morphologic parameters on the Obstructive Sleep Apnea Syndrome (OSA) The sample was consisted on maxilla dental models of 23 individuals (11 males and 12 females) with the polyssonographic diagnosis of mild SAOS, 34 individuals (17 males and 17 females) with moderate SAOS and 17 individuals with severe SAOS (14 males and 3 females) Measures of maxilla dental models of 50 young Brazilians were used for the control group, both males and females and with normal occlusion and without any indication OSA The results found show that the maxillary morphologic parameters evaluated didnât show the association with the apnea/hypopnea index (AHI) but minor transversal dimensions of the maxilla mainly at the level of the molars associated to the increase of the dessaturation of oxyhemoglobin (minSaO2) The individuals with OSA also presented maxilla transversal dimensions narrower and more height on the palate at the region of pre-molars and molars when compared to the control group

Accumulating evidence suggests that volume overload in drug-resistant hypertension (RH) may contribute to the high prevalence of obstructive sleep apnea-hypopnea (OSAH). Upon recumbency, leg fluid volume moves rostrally causing an increase in nuchal and peripharyngeal fluid content, subsequently obstructing airflow. Rostral fluid displacement following lower body positive pressure (LBPP) application and occurring spontaneously overnight were evaluated in subjects with RH (n = 25) and controlled hypertension (n = 15). In both groups, the reduction in mean upper airway cross-sectional area with LBPP strongly related to the amount of fluid displaced from the legs (R2 = 0.41; p<0.0001), although its magnitude was greater in the RH group (p=0.001; adjusted for propensity score). In both groups, the apnea-hypopnea index strongly related to the amount of fluid spontaneously displaced from the legs during sleep (R2 = 0.56; p<0.0001), although its magnitude was greater in the RH group (p=0.01; adjusted for propensity score).

Accumulating evidence suggests that volume overload in drug-resistant hypertension (RH) may contribute to the high prevalence of obstructive sleep apnea-hypopnea (OSAH). Upon recumbency, leg fluid volume moves rostrally causing an increase in nuchal and peripharyngeal fluid content, subsequently obstructing airflow. Rostral fluid displacement following lower body positive pressure (LBPP) application and occurring spontaneously overnight were evaluated in subjects with RH (n = 25) and controlled hypertension (n = 15). In both groups, the reduction in mean upper airway cross-sectional area with LBPP strongly related to the amount of fluid displaced from the legs (R2 = 0.41; p<0.0001), although its magnitude was greater in the RH group (p=0.001; adjusted for propensity score). In both groups, the apnea-hypopnea index strongly related to the amount of fluid spontaneously displaced from the legs during sleep (R2 = 0.56; p<0.0001), although its magnitude was greater in the RH group (p=0.01; adjusted for propensity score).

The diagnosis of obstructive sleep apnea (OSA) syndrome is overnight PSG (mutli-channel system). But it¡¦s hard to be popularized for the general population (about twenty channel signals). In recent decades, several researches were devoted to a replacement system with only one channel signal (oxyhemoglobin saturation). However, it¡¦s hard to match PSG system¡¦s report without EEG wake information. Consequently, two channels (oxyhemoglobin saturation and EEG) were used of this study to enhance the AHI (estimation index for sleep apnea) prediction performance. After surveying the most recent studies, this work proposes a new basleline removal technique for oxygen saturation signal (SpO2) by using median filter. It was proved this technique improves the diagnostic accuracy for OSA. Furthermore, it is also found that by removing the wake periods, diagnostic accuracy can be improved further. By counting the number of times that the desaturation level has dropped more than 2% for at least 3 seconds, the correlation coefficient between AHI and proposed feature is 0.9218. In addition, by removing the wake period, this correlation increases to 0.9425. By using this feature to classify patients with AHI value larger than 5, the proposed approach achieves 93.78% accuracy, 95.94% sensitivity, 78.87% specificity f. Such results demonstrate the feasibility of using single SpO2 channel system for OSA diagnosis.

The present study examined the neuropsychological relevance of poor sleep in a sample of community dwelling healthy older adults and a clinical sample of patients with untreated obstructive sleep apnea (OSA) between 40 and 90 years of age. The cognitive performance of 67 patients with obstructive sleep apnea (OSA) was compared to those of 46 controls screened for OSA using a portable device called ApneaLinkTM. The current study identified common neuropsychological variables associated with poor sleep quality in general (i.e., as a result of daytime sleepiness) and neuropsychological variables unique to only OSA patients (i.e., manifesting oxygen desaturation at night in addition to daytime sleepiness). Results indicated executive functions were related to hypoxemia and sustained attention was related to sleep fragmentation in the current study. A medical sequelae model and a neuropsychological sequelae model were tested. The neuropsychological sequelae model predicted whether one was a control or an OSA patient 70% accurately based on the predictors (scores on Wisconsin Card Sorting Test perseverance error, vigilance task, WAIS III forward digit span, WAIS III Block Design, phonemic and semantic fluency, and WAIS III backward digit span). The medical sequelae model predicted OSA status 89% accurately based on the predictors (BMI, depression, subjective sleep quality, age, hypertension, diabetes, total mood disturbance, gender, and general health). The current study provides further justification for OSA screening in the general population during middle age and late adulthood especially in those most at risk (i.e., overweight, male, hypertensive, and poor subjective sleep quality).