Senare års forskning visar på att obstruktivt sömnapnésyndrom, OSAS, är en både underdiagnostiserad och underbehandlad sjukdom. Detta beror delvis på att många personer med OSAS är omedvetna om sitt tillstånd. Sjukdomen innebär återkommande totala andningsuppehåll under sömn och en hypoxi som leder till en rad olika komplikationer, däribland hjärtkärlsjukdomar. Syftet med denna studie var att utreda vad som påverkar OSAS och vilken roll sjuksköterskan kan spela i vården av dessa patienter. Metoden som användes var en litteraturundersökning. Resultatet baseras på tio vetenskapliga artiklar som erhölls genom databaserna PUBMED samt SAMSÖK. Teman som utkristalliserades var sömnposition, kroppsvikt och tandstatus. Trots att behandlingen av OSAS till stor del bygger på medicinska åtgärder visar resultaten i denna litteraturundersökning att sjuksköterskor har en viktig funktion i både upptäckten av nya fall samt i behandlingen. Omvårdnadsåtgärder såsom information om förändrad sömnposition och viktnedgång har visat sig ha signifikant betydelse för obstruktiv andning. / Medical research in recent years has shown that Obstructive Sleep Apnea Syndrome, OSAS, is an affliction for which both diagnosis and treatment are often inadequate. In part, this is due to the fact that many people suffering from OSAS are not aware of the problem. The disease causes recurrent complete stops of breathing during sleep and hypoxia that may bring about various complications, for instance cardiovascular disorders. The purpose of this study, carried out as a literature survey, was to determine what factors affect OSAS and what role the nurse may play in the care of patients suffering from this disease. The survey of the literature by means of the data bases PUBMED and SAMSÖK yielded ten scientific articles showing that although various medical measures constitute the treatment of choice of OSAS the nurse plays an important role in the treatment and the diagnosis of new cases. Preventive care measures such as information about appropriate sleeping positions and reduction of weight have proven to be of significant value in the treatment of OSAS.

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第23574号 / 人健博第94号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 任 和子, 教授 木下 彩栄, 教授 平井 豊博 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

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INTRODUCTION: Several studies identified a link between gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA). GERD is a condition in which acid reflux from the stomach to the esophagus causes troublesome symptoms. On the other hand, OSA is defined as a sleep-related breathing disorder in which airflow significantly decreases or ceases due to upper airway obstruction, leading to arousal from sleep. OSA was found to be associated with GERD. In this study, we aim to study the characteristics and concurrent risk factors associated with GERD and OSA in a large population-based study. METHODS: Patients with the diagnosis of GERD were extracted from the National Inpatient Database (NIS) for the years 2016 to 2019. Patients' age, gender, race, and hospital information, including region and bed size, were extracted and considered as baseline characteristics. The comorbidities included are hypertension (HTN), atrial fibrillation (AFib), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), pulmonary hypertension (PHTN), obesity, and smoking. Patients younger than 18 years old were excluded from this study. Results: Out of 22,677,620 patients with the diagnosis of GERD, 12.21% had a concurrent diagnosis of OSA (compared to 4.79% in patients without GERD, p-value <0.001). The mean age of patients with GERD and OSA was 64.47 years vs 65.42 years in patients without OSA (p-value <0.001). The GERD and OSA group had almost identical gender distribution compared to the GERD only group, as it was predominantly female patients. The white and black races were slightly more prevalent in the GERD and OSA group compared to the GERD only group. Regarding comorbidities, the prevalence of obesity was more clear in the GERD and OSA group. It was noted that the group of patients who carry a diagnosis of GERD and OSA have more prevalence of diabetes (DM), hypertension (HTN), obesity, atrial fibrillation (Afib), congestive heart failure (CHF), and pulmonary hypertension (PHTN). Patients with GERD and OSA were 21% less likely to be older than 65 years rather than younger (95% CI: 0.79-0.8, p-value <0.001), 35% less likely to be females (95% CI: 0.65-0.65, p-value <0.001), and 22% less likely to be non-white (95% CI: 0.77-0.8, p-value <0.001). Obesity was found to be the strongest association with this population, followed by PHTN, CHF, DM, HTN, Afib, and lastly smoking. CONCLUSION: Patients with GERD and OSA were found more likely to be female, white, living in the southern part of the United States, obese, diabetes mellitus type 2, and being active smokers.

Obstructive sleep apnea (OSA) is underrecognized. Between 10% and 69% of preoperative patients have undiagnosed OSA. To reduce the risk of peri-operative complications related to undiagnosed OSA, patients planned to undergo bariatric surgery are screened for OSA. To understand the OSA detection rate with screening practices, the prevalence of OSA within patients who underwent publicly funded bariatric surgery in Ontario between 2010 and 2016 was measured. Secondly, to understand the effect of OSA screening practices on perioperative and longer-term health care costs, health care utilization and costs were compared between patients with OSA and matched patients without OSA in the 30 days post-bariatric surgery, as well as in the 1 year post-bariatric surgery. The Ontario Bariatric Registry (OBR) linked to the ICES health administrative databases were used. A diagnosis of OSA was identified if recorded in the OBR at time of initial bariatric consultation, or if recorded in ICES databases from the bariatric surgery admission records. Costs were calculated based on the “Guidelines on Person-Level Costing Using Administrative Databases in Ontario” using ICES costing algorithms. The overall prevalence of OSA was 47% (95% CI 46% to 47%). Total health care costs per patient, in the 30-day post-operative period, were 1% lower (95% CI 1% to 1%, p < 0.001) in patients with OSA compared to matched patients without OSA. Similarly, at 1 year postbariatric surgery, total health care costs per patient, were 1% lower (95% CI 1% to 1%, p < 0.001) in patients with OSA compared to matched patients without OSA. At 30 days and 1 year, this difference was driven by lower hospitalization-related costs. OSA screening practices at surgical centers in our network led to similar rates of OSA detection as reported in the literature. However, the literature suggests that screening practices lead to missed OSA diagnoses. Further study is required to understand the reduced post-bariatric surgery costs in patients with OSA compared to matched controls without OSA; and, we postulate that missed OSA diagnoses may be a contributor. / Thesis / Master of Science (MSc) / Obstructive sleep apnea (OSA) is underrecognized and a good proportion of patients with OSA are undiagnosed. To reduce the risk of peri-operative complications related to undiagnosed OSA, patients planned to undergo bariatric surgery are screened for OSA. To understand the performance of OSA screening practices, using a province-wide registry, the proportion of patients diagnosed with OSA within patients who underwent publicly-funded bariatric surgery in Ontario between 2010 and 2016 was measured at 47%. Furthermore, to understand the effect of OSA screening practices on peri-operative costs and longer-term health care costs, health care utilization and costs were compared between patients with OSA and matched patients without OSA in the 30 days and 1 year post-bariatric surgery. Total health care costs per patient were 1% lower in patients with OSA compared to patients without OSA, and this difference was driven by lower hospitalization-related costs.

No description available.

Introduction: Untreated obstructive sleep apnea (OSA) has deleterious effects on one's overall health. Recent literature suggests that craniofacial abnormalities, as noted on a lateral cephalometric radiograph (ceph) or clinically by the presence of a posterior crossbite, may be associated with OSA. Literature also suggests that if abnormal ceph measurements are noted or if a patient presents with a posterior crossbite, then further questioning about that patients sleep habits and snoring should be addressed. The primary purpose of this study is to explore any possible associations between ceph measurements, and/or presence of a posterior crossbite with OSA, as determined by the Berlin sleep questionnaire, in the orthodontic population. The second purpose of this research is to outline a part 2 follow-up study through administration of an at home sleep test, the Nox-T3 sleep monitor, to further validate presence of OSA. The overall goal is to see if the combined data from the Berlin score, the clinical presence or absence of a posterior crossbite, and standard orthodontic ceph measurements can increase the predictive value of patients in the orthodontic office who might be suffering from obstructive sleep apnea. Methods: A total of 85 consecutive subjects who were already undergoing records in 5 private practice orthodontic offices around the greater Philadelphia area were recruited for voluntary participation in the study. A Berlin questionnaire, lateral ceph, and any noted presence of a posterior crossbite were collected on all subjects. 12 ceph measurements (SNA, SNB, ANB, Co-A, Co-Gn, A-Na perp, Pg-Na perp, SN-MP, FH-MP, Ba-SN, Wits, and MP-Hyoid) were traced by a second year orthodontic resident. 5 subjects were then selected using a random numbers table and given the Nox-T3 sleep monitor for self-administration to record their sleep for one night. Statistical analyses were run using SAS version 9.2 to evaluate any associations. Results: A total of 76 subjects completed data collection, whereas 9 subjects either failed to report their height, and/or weight, and/or failed to complete the Berlin questionnaire in its entirety thus excluding them from the study. A total of 11, or 14% of subjects scored high on the Berlin, meaning a high risk of suffering from OSA. Of all ceph measurements, the only one that showed a statistically significant association with the high Berlin score was MP-Hyoid (p=0.0033). BMI alone was not found to be associated with the Berlin score (p=0.3712). Presence of a posterior crossbite also did not show any correlation with the Berlin score (p= 0.1000). Conclusions: 1) BMI was not found to be associated with the Berlin score among the orthodontic subject population. 2) MP-hyoid was found to be associated with the Berlin score, at a high level of statistical significance. 3) All other cephalometric measurements, including SNA, SNB, ANB, Co-A, Co-Gn, A-Na perp, Pg-Na perp, SN-MP, FH-MP, Ba-SN, and Wits, failed to show any statistically significant correlation to the Berlin score. 4) Posterior crossbite was not found to be associated with the Berlin Score among the orthodontic subject population. Key words: Obstructive sleep apnea, Berlin sleep questionnaire, cephalometric, posterior crossbite, Nox-T3 sleep monitor, orthodontic population / Oral Biology

The purpose of the current study was to test the hypothesis that chronic hypoxia associated with sleep-disordered breathing relates to abnormal Nitric Oxide (NO) production and vascular endothelial growth factor (VEGF) expression patterns that contribute to aberrancy of specific determinates of cardiovascular and cardiopulmonary function before, during, and after graded exercise. These patterns may further reflect pathologic alteration of signaling within the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt-1) transduction network. To this end, 7 medically diagnosed OSA patients (3 male, 4 female), mean age 48 years and 7 apparently healthy control subjects (3 male, 4 female), mean age 42 years, underwent baseline venous blood draws and maximal bicycle ergometry. Mononuclear cells isolated from peripheral blood were utilized as reporter cells for measurement of VEGF, Akt-1, hypoxia inducible factor-1 alpha (HIF-1 alpha), and vascular endothelial growth factor receptor-2 (VEGFR2) gene expression by redundant oligonucleotide DNA microarray and real-time PCR technologies. Circulating angiogenic progenitor cells expressing VEGFR2 were profiled by flow cytometry. Plasma and serum concentrations of VEGF, nitrates/nitrites, catecholamines, and dopamine were measured by enzyme-linked immunosorbent assay (ELISA) and high performance liquid chromatography (HPLC). Arterial blood pressure, cardiac output, oxygen consumption and total peripheral resistance were determined at Baseline, 100W, and peak ergometric stress by standard techniques. There were no apparent differences (p < .05) observed in biochemical markers relating to vascular function and adaptation including, serum nitrates/nitrites, norepinephrine, dopamine, and plasma VEGF. No differences were found relative to cardiac output, stroke volume, cardiopulmonary or myocardial oxygen consumption, expired ventilation, heart rate, arteriovenous oxygen difference, total peripheral resistance, and mean arterial pressure. Due to methodological issues related to the redundant oligonucleotide DNA microarray and real-time PCR gene expression analyses, results of these experiments were uninterpretable. Thus, the research hypothesis was rejected. Conversely, significant (p < .05) differences were observed in waist: hip ratios, recovery: peak systolic blood pressure ratio at 1 minute post-exercise and %VEGFR2 expression. OSA was associated with elevations in both waist: hip ratios and recovery: peak systolic blood pressure ratio at 1 minute post-exercise as well as significant depression of %VEGFR2 profiles. Moreover, significant negative correlations were found regarding waist: hip ratios and %VEGFR2 expression (r = -.69;p =.005) and recovery: peak systolic blood pressure ratio at 1 minute post-exercise and %VEGFR2 expression (r = -.65;p =.01). These findings did not provide evidence that NO-dependent vasoactive mechanisms are suppressed nor did they support the supposition that angiogenic mechanisms are pathologically activated in sleep-disordered breathing. / Ph. D.

Obstructive sleep apnea syndrome (OSAS), a chronic respiratory disorder affecting as many as 1 in 5 adults, is associated with repetitive collapse of the upper airway during sleep and results in fragmented sleep and intermittent periods of hypoxia and hypercapnia. If left untreated, OSAS increases the risk for hypertension, insulin resistance, metabolic syndrome (MetS) in a manner that is independent of obesity in mid-adulthood. However, it is still unknown if evidence of these relationships is apparent in young adults with OSAS who are otherwise healthy and free of other chronic comorbidities. Objectives: To determine if functional and biochemical evidence of insulin resistance, MetS, and vascular endothelial dysfunction (VED) exists in young, overweight men with OSAS and if the combined effects of obesity and OSAS augments the evidence of chronic disease pathogenesis beyond the effects of obesity alone. Subjects: Subjects were 12 overweight men with OSAS (age = 22.8 ± 0.8; BMI = 32.4 ± 1.0; apnea-hypopnea index (AHI) = 25.4 ± 5.4), 17 overweight men without OSAS (age = 22.5 ± 0.7; BMI = 31.6 ± 1.1; AHI = 2.2 ± 0.3), and 18 normal weight men without OSAS (age = 21.1 ± 0.5; BMI = 22.4 ± 0.4; AHI = 1.9 ± 0.3). Methods: Subjects were evaluated for OSAS using an unsupervised, portable polysomnography test. Total fat and central abdominal fat (CAF) were assessed using dual energy x-ray absorptiometry (DEXA). Fasting blood samples were used to quantify biochemical markers for insulin resistance (glucose, insulin, adiponectin, IL-6, and TNF-á) and endothelial dysfunction (CRP, VEGF, and VEGFR2) using ELISA, RIA, and flow cytometry. MetS was defined according to Adult Treatment Panel III (ATP III) clinical standards. Triglycerides, HDL cholesterol, and glucose were measured using a commercial lipid panel. Resting blood pressure was obtained manually via auscultation. VED was measured via strain gauge plethysmography, with endothelium-dependent vasodilatation being assessed from forearm reactive hyperemia after a 5-minute period of upper arm occlusion. Statistics: One-way ANOVA was used to determine group differences in variables. Two-way ANOVA was used to evaluate group x time interactions during the 2-minute recovery period following upper arm occlusion. Pearson partial correlation was used to assess relationships between continuous variables, with analyses being controlled for CAF or OSAS severity. Spearman correlation was used to assess relationships between number of MetS components present and both indices of adiposity and OSAS severity. Stepwise multiple linear regression analysis was used to determine significant predictors of OSAS severity, insulin resistance, components of the MetS, and endothelial dysfunction. Results: Overweight subjects with OSAS had more CAF, higher fasting triglycerides, and lower serum adiponectin concentrations than both overweight and normal weight non-apneic controls. Furthermore, fasting triglycerides were directly correlated to OSAS severity, even after the influence of central abdominal fat was removed. OSAS severity was an independent predictor of triglyceride levels, and vice versa. Insulin resistance, leptin, insulin, and CRP were all higher in overweight subjects than controls, but no further differences were attributable to severity of OSAS. No differences in IL-6, TNF-á, ADMA, and expression of VEGFR2 were noted between any groups. No group or group x time interaction differences existed in regards to postocclusive reactive hyperemia responses. Conclusions: Young men with OSAS exhibit several unique anthropometric and biochemical abnormalities that may indicate early pathogenesis of or increased risk for future development for cardiovascular and metabolic disorders. Identification and treatment of OSAS at this age may be critical to prevent the onset and progression of these chronic disorders. / Ph. D.

Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) is a breathing disorder characterized by recurrent episodes of upper airway collapse during sleep. Measuring cardiac function in OSAHS patients may provide information to help delineate not only chronic effects of autonomic imbalance and ventricular loading in the diseases state, but also possible beneficial effects of clinical treatments. Objectives (Study 1): The aim of this study was to determine the reproducibility of select cardiac variables when monitoring a simulated sleep apnea event using a new improved bioimpedance cardiography system. Methods: Fifteen apparently healthy males were tested on three different days in a protocol requiring their performance of two 15 sec and two 30 sec forced and sustained inspiratory efforts against a closed epiglottis (Müeller Maneuver-MM). Results: Changes in cardiac output (CO), heart rate (HR), stroke volume (SV), myocardial contractility index (MCI) and systemic vascular resistance (SVR) were similar during 15 sec and 30 sec MM in all three days. During 30 sec MM, these changes in cardiac function were pronounced in comparison to the minimal variations observed for the 15 sec MM challenge test. Objectives (Study 2): The aim of this study was to characterize the cardiac responses to negative intrathoracic pressure in OSAHS patients with and without hypertension versus healthy subjects. Methods: Two groups of 10 OSAHS patients, one without HTN and one with HTN were compared with a control group. Each subject underwent two 30 sec (MM) as previously described. Results: During MM, there were similar changes in SV, HR and SVR in all three groups. CO was lower during MM in controls compared to OSAHS groups, whereas MCI decreased during MM in both controls and OSAHS+HTN groups (-7.5% and -1.7%, respectively) compared with an increase in OSAHS group (11.8%). During a Post-MM, both OSAHS groups showed return of cardiac responses toward their pre-MM baseline within 30 sec. Conclusions: The new bioimpedance cardiograph evaluated in this study was found to be reliable for measuring acute changes in cardiac responses to this breathing challenge test. OSAHS may cause acute changes in selected cardiac parameters during and immediately after a breathing challenge test. / Ph. D.