No description available.

No description available.

No description available.

Obstructive sleep apnea syndrome (OSAS) is a serious disorder that affects an estimated 24% of middle-age males, and 9% of middle-aged females. In addition, a large portion of individuals with OSAS go undiagnosed. OSAS is associated with several adverse health problems, including the metabolic syndrome. Therefore, there is a clear need to identify new methods for assessing OSAS risk. The exercise test has been used effectively as a diagnostic and prognostic tool for those at high risk for cardiovascular disease and hypertension. Research into the cardiopulmonary responses to exercise testing in young adult men with OSAS has not been examined. Objectives: The objectives of this study were to: 1) evaluate whether OSAS is characterized by exaggerated ventilatory responses to ramp exercise testing, with a secondary aim to evaluate if variations in serum leptin concentration might exert a regulatory in ventilatory responses during exercise; 2) To evaluate whether autonomic control of the cardiovascular response during exercise is distorted by OSAS in young overweight men, as manifested by a blunting of heart rate and exaggeration of blood pressure responses.; 3) To explore whether various simple clinical measures and response patterns from graded exercise testing might serve to discriminate between young men with and without OSAS. Methods: For objectives one and two, 14 obese men with OSAS [age = 22.4 ± 2.8; body mass index (BMI) = 32.0 ± 3.7; apnea-hypopnea index (AHI) = 22.7 ± 18.5], 16 obese men without OSAS (age = 21.4 ± 2.6; BMI = 31.4 ± 3.7), and 14 normal weight subjects (objective 2) (age = 21.4 ± 2.1; BMI = 22.0 ± 1.3) were recruited. For objective three, 91 men (age = 21.6 ± 2.8; AHI range = 0.6 – 60.5; BMI range = 19.0 – 43.9) were recruited. Subjects completed a ramp cycle ergometer exercise test, and a fasting blood sample was obtained to measure plasma leptin and blood lipid levels. Repeated measures ANOVA and stepwise linear regression was used to examine objectives 1 and 2. For objective 3, stepwise linear regression and receiver operator curve (ROC) analysis was utilized. Results: Ventilation (VE), the ventilatory equivalents for oxygen (VE/VO₂) and carbon dioxide (VE/VCO₂) were greater in the OSAS subjects vs. the overweight subjects without OSAS (P = 0.05, P < 0.05 and P < 0.005, respectively) at all exercise intensities. Heart rate (HR) recovery was attenuated in the overweight OSAS subjects compared to the No-OSAS and Control groups throughout 5 minutes of active recovery (P = 0.009). Oxygen uptake, HR, and blood pressure did not differ throughout exercise. Leptin was not associated with ventilatory responses at any exercise intensity. Linear regression analysis revealed hip-to-height ratio (HHR), hip circumference (HC), triglyceride levels, and recovery systolic blood pressure ratio (SBPR) at 2 and 4 minutes were independent predictors of AHI (model fit: R² = 0.68, p <0.0001). ROC analysis determined that percent body fat, HHR, and recovery HR at 2 minutes and 4 minutes were the best single predictors of OSAS risk (AUC = 0.77 for each measure, p = 0.003). Conclusions: Unique ventilatory and hemodynamic characteristics to maximal exercise testing are exhibited in young men with OSAS. These characteristics may be related to alterations in the sympathetic nervous system and chemoreceptor activation, and may be early clinical signs in the progression of OSAS. These exercise characteristics, along with anthropometric and body composition measures may provide useful information in identifying young men at risk for OSAS. / Ph. D.

Background and Purpose: Little is known about influences of obstructive sleep apnea syndrome (OSAS) on dietary intake and body composition. The purpose of this study was to evaluate dietary status, body fat distribution and leptin in overweight young men with and without OSAS in comparison to published values for normal weight counterparts. Methods: Groups were comprised of 24 sedentary overweight young men with and without OSAS, who had a body mass index (BMI) greater than 25 kg/m². Serum leptin concentration was measured in the 24 subjects using radioimmunoassay, while OSAS assessment was done using nighttime home somnography. Analysis of 4-day diet recalls was performed using Nutritionist Pro (First DataBank, Inc., San Bruno, CA). A Healthy Eating Index (HEI) score was calculated for the 24 overweight subjects. Results: There were no differences between the two overweight groups for total fat mass, central abdominal fat, BMI, waist circumference, leptin, or the HEI. The HEI was not predictive of overall OSAS severity; however, BMI was moderately related to OSAS severity (r = 0.39; p=0.05). The normal weight group did have a 50% higher report of carbohydrate intake, and consumed on average, 500 more kilocalories per day. The normal weight group consumed 50% less sodium, and 50% more Vitamin's C and E including a 13% increase in the HEI. Conclusions: Regulation of eating behavior and related influences on diet composition may be affected by a number of neurohormonal disturbances associated with OSAS and/or obesity, itself. Further research is needed to quantify these possible differences on dietary status and the underlying mechanism involved. / Master of Science

Heart Rate Variability (HRV) currently is utilized when assessing the risk of mortality in individuals suffering from coronary heart disease or diabetic neuropathy. Research has shown that patients with Obstructive Sleep Apnea (OSA) also show a decrease in HRV, as well as an increase in sympathetic drive characterized by an increase in the low-frequency component of HRV. HRV, in conjunction with other indicators, may represent a non-invasive, low cost method for the confirmation of severity of OSA in some patients and therefore may represent an additional tool for the assessment of risk in these individuals. This becomes especially true when urinary catecholamines, fitness level, and quality of life (QOL) assessment are included. The purpose of this study was to determine if a correlation exists between severity of OSA as assessed by respiratory distress index (RDI) and the selected measures HRV, fitness, QOL, and catecholamine output. Subjects were 6 men and 5 women who were recently diagnosed with OSA by polysomnographic (PSG) study. HRV and blood pressure was measured during two consecutive trials consisting of 512 heartbeats. Catecholamine levels were determined by HPLC following 24-hour urine collection. Fitness levels were established following cycle ergometer testing and QOL following questionnaire completion. Subjects with lower weight, BMI, and neck circumference had significantly higher parasympathetic influence as analyzed through the amount of high frequency component of HRV (r =.738, .726, .789, respectively; p<0.05). Respiratory distress index (RDI) was negatively related to the average heart rate (HR=RR average, r = -.610, p<0.05), while the amount of total sleep (r = .657, p<0.05) and REM sleep (r = .739, p<0.01) increased as HR increased. The average HR was correlated to the predicted VO2max (r = .677, p<0.05). When the frequency components of HRV, fitness, QOL, and catecholamines were combined, the association to RDI increased dramatically (r = .984, p = .02). The results indicate that as the severity of OSA increases, markers of fitness, QOL, and sleep decrease. There is also an inverse relationship between autonomic function and severity of OSA. It is concluded that HRV and fitness levels are inversely related to the severity of OSA, and that these measures may be developed into a risk assessment tool for use in OSA patient evaluatio / Master of Science

Obstructive sleep apnea syndrome (OSAS) is a complex disorder characterized by repetitive bouts of upper airway collapse during sleep, causing subsequent intermittent hypoxia, hypercapnia, and fragmented sleep and is also associated with significant morbidity including daytime sleepiness, hypertension, and elevated cardiovascular risk. OSAS affects at least 4% of men and 2% of women; unfortunately, it is estimated that 80% to 90% of adults with OSAS remain undiagnosed. Both clinical characteristics and complex genetic and environmental interactions have made it difficult to understand OSAS disease etiology and identifying patients at risk is still elusive. A pattern of gene expression in cells or tissues related to a disease state for OSAS would provide beneficial information to be most effective in screening or diagnosing this disease. Objectives: The objectives of this study were to: 1) map out the study design and bench assay strategies by which to investigate this issue; 2) find out if there are specific differences in the global gene expression profiles of adult females with OSAS compared to those without OSAS, under conditions in which subjects were clinically similar (BMI, diabetes, cardiovascular disease, etc.); and 3) assess the protein expression differences that could potentially be linked via well-established molecular pathways associated with any differences found in global gene expression profiles in the presence and absence of OSAS. Methods: Subjects were overweight premenopausal Caucasian women with untreated OSAS (n=6; age = 40.7 ± 3.4; BMI = 49.04 ± 6.97; apnea-hypopnea index = 27.3 ± 16.02), and control subjects (n=10) (age = 38.2 ± 7.6; BMI = 47.94 ± 6.15; apnea-hypopnea index < 5), and matched for other clinical characteristics (diabetes, cardiovascular disease status, medications, etc.) recruited from either Carilion Clinic Pulmonary/Sleep Medicine or Carilion Clinic Bariatric Surgery practices. Subjects provided a fasting blood sample in which the monocytes were isolated from whole blood. The RNA was extracted from the monocytes, assessed for purity and quantity, frozen and shipped to collaborators at Dana-Farber Cancer Institute and hybridized to Affymetrix whole human genome chips on a gene chip. The initial computational evaluation and interpretation generated the hypothesis. Two-step quantitative real time polymerase chain reaction (qPCR) was performed to verify the results from the microarray analysis. The laminin enzyme immunoassay (EIA), and cellular adhesion assays were performed to determine if genomic changes resulted in proteomic and phenotypic assessments. Results: OSAS subjects had nine aberrantly regulated genes, of which three genes (LAMC-1, CDC42, and TACSTD2) showed a pattern in segregation between OSAS and controls subjects based on expression patterns. In addition, qPCR indicated a 2.1 fold increase in LAMC-1 and a 1.1 fold increase CDC42 expression unique to the tissue samples of patients with OSAS. Though the serum laminin EIA did not differ between groups, a statistically significant increase in peripheral blood mononuclear cells (PBMC) cellular adhesion in OSAS patients versus control subjects was found. The OSAS subjects had a well cell count of 9.27 ± 1.54 cells vs. controls 5.75 ± 0.78 cells (p Ë‚ 0.05), which is relative to the 103 cells/field that were plated. Conclusions: Cells isolated from women with moderate-severe OSAS show an abnormality in cellular adhesion, a process driven in part by the gene LAMC-1, which was also aberrantly expressed in these subjects. This suggests that inflammation may be linked to the pathogenesis of OSAS. This pilot study has provided the framework and preliminary data needed to propose a larger study with extramural research funding. / Ph. D.

Bakgrund: Obstruktivt sömnapnésyndrom (OSAS) är en vanlig sömnrelaterad andningsstörning som innebär att patienten får apnéer (totalt andningsflödesstopp) och/eller hypoapnéer (delvis andningsflödesstopp) under nattsömnen. Dessa leder till störd nattsömn, vilket leder till kroppslig påverkan. OSAS ger både fysisk och psykisk påverkan, vilket i sin tur resulterar i att många patienter upplever sämre livskvalité. En av de vanligaste behandlingarna för OSAS är CPAP (Continuous Positive Airway Pressure) som med hjälp av övertrycksandning hjälper till att hålla de övre luftvägarna öppna under sömn.   Syfte: Syftet med litteraturöversikten var att undersöka hur patienters livskvalité påverkas av behandling med CPAP samt om det finns vetenskapligt bevisade omvårdnadsåtgärder som underlättar för patienter att uppnå god livskvalité vid CPAP-behandling. Metod: En systematisk litteraturöversikt baserad på 10 kvantitativa originalartiklar. Resultat: Majoriteten av de genomgångna studierna visade att användning av CPAP minskar psykiska och fysiska symptom och därmed förbättrar patienternas livskvalité. Genom att följa upp patienter i sjukvården, erbjuda dem utbildningar samt gruppdiskussioner främjar man deras hälsa och höjer livskvalitén. Studierna visade också att grunden för en god omvårdnad är att sjuksköterskan har evidensbaserade kunskaper för att kunna planera och genomföra omvårdnadsåtgärder samt följa upp hur CPAP-behandlingen påverkar patienternas livskvalité. Slutsats: Användningen av CPAP förbättrar OSAS-patienternas livskvalité, bland annat genom att minska symptom. Det är av stor vikt att sjuksköterskan har tillräckliga kunskaper för att kunna undervisa samt informera patienten om sin sjukdom och behandling. Detta hjälper patienter till en bättre egenvård, vilket har en stor betydelse för livskvalitet.

Sömnen är en naturlig del av människans liv och sömnstörning påverkar den vakna tidens kvalité samt det allmänna välmående. För att bibehålla en god hälsa är det av stor vikt att sova utan avbrott. Obstruktiv sömnapné (OSA) är ett tillstånd som orsakar andningsuppehåll under sömn och stör därmed sömnens effekt vilket ökar risk för andra allmänna sjukdomstillstånd. Tandvården är en organisation som träffar patienter regelbundet för undersökning av den orala hälsan. Patientens egen berättelse samt intra orala markörer kan vara tecken på symtom på OSA. Det finns brist på fördjupad kunskap kring tandvårdens erfarenhet kring patienter med OSA. Syftet med studien var att beskriva legitimerad tandvårdspersonals erfarenheter av vuxna tandvårdspatienter med obstruktiv sömnapné (OSA). Resultat Resultatet visar att erfarenheter hos tandvårdspersonalen varierar vad det gäller patienter med OSA. ”Kliniska erfarenheter av OSA” med underkategorier som patientmötet, betydelsen av hälsodeklarationen, kliniska markörer samt ”Omhändertagande” med underkategorierna prevention oral hälsa och samarbete med hälso- och sjukvården, var det som speglade tandvårdspersonalens erfarenheter. Slutsats Legitimerad tandvårdpersonal har en betydande roll för den orala och allmänna hälsan. Patienter med OSA symtom kan uppmärksammas i tandvården men mer kunskap och verktyg krävs inom området för att ett samarbete med hälso- och sjukvården kan skapas.

INTRODUÇÃO: Uma alta prevalência de apnéia obstrutiva do sono (AOS) tem sido relatada em paciente com doença arterial coronária (DAC). Vários mecanismos relacionados à AOS, incluindo dessaturação da oxi-hemoglobina e aumento da demanda de oxigênio, aumento da atividade simpática bem como estado pro trombótico, podem ser perigosos nos pacientes com DAC. Entretanto, a AOS é pouco reconhecida e não é rotineiramente pesquisada nos pacientes admitidos em unidade de cuidados coronários (UCC) com DAC. O padrão ouro para o diagnóstico de AOS é a polissonografia noturna (PSG), método impraticável na UCC, pois implica no deslocamento do paciente para o laboratório de sono. OBJETIVOS: Construir e validar um monitor de oximetria para diagnóstico de AOS em pacientes admitidos na UCC com diagnóstico de DAC aguda. MÉTODOS: Foi inicialmente desenvolvido monitor de oximetria continua que registra os dados derivados dos monitores da UCC e permite a determinação do índice de dessaturação da oxi-hemoglobina (IDO) através de análise visual da curva de oximetria. O monitor foi então utilizado em pacientes consecutivos admitidos na UCC com diagnóstico de DAC aguda. Uma amostra desta população foi também estudada através de PSG, num período máximo de três meses após a alta. RESULTADOS: Trinta e sete pacientes foram estudados através de monitorização de oximetria durante a noite na UCC. PSG foi também realizada em vinte pacientes. AOS, diagnosticada pelo monitor de oximetria contínua (IDO > 5/hora), estava presente em 43% dos pacientes. AOS foi diagnosticada em 45% dos pacientes estudados com PSG (índice de apnéia e hipopnéia > 15 eventos por hora). Houve um bom nível de concordância entre o diagnóstico de AOS pelo monitor de oximetria na UCC e pela polissonografia - kappa = 0.898; p < 0.0001. O IDO determinado pelo monitor se correlacionou de forma significativa com o índice de apnéia e hipopnéia (r = 0.737; p < 0.0001). O diagnóstico de AOS através do monitor demonstrou sensibilidade de 88,9% e especificidade de 100%. CONCLUSÃO: O monitor desenvolvido no presente trabalho, que permite o registro da oximetria contínua a partir de dados que já são habitualmente coletados na UCC, é um método simples e preciso para o diagnóstico de AOS na UCC. / BACKGROND: A high prevalence of Obstructive sleep apnea (OSA) has been reported in patients with coronary artery disease (CAD). Several OSA related mechanisms, such as oxygen desaturation, high sympathetic activity, increased cardiac oxygen demand and a prothrombotic state, may be particularly dangerous in acute CAD patients. Nevertheless, OSA is frequently underdiagnosed and patients with CAD are not routinely screened for OSA when admitted to the Coronary Care Unit (CCU). OBJECTIVES: To build and validate a continuous overnight oximetry, by recording oximetry data derived from the CCU monitor, for the detection of OSA in acute CAD patients. DESIGN: We studied consecutive patients recruited on the basis of the presence of acute CAD requiring CCU, analyzed overnight continuous oximetry data and further compared it with full overnight polysomnography (PSG). RESULTS: Thirty-seven patients underwent overnight oxygen saturation monitoring in the CCU and 20 of these patients were submitted to PSG, performed within 3 months after hospital discharge. OSA was present in 43% and 45% of the patients studied by overnight oxygen saturation monitoring and PSG, respectively. The oxymetry derived oxygen desaturation index and the PSG derived apnea hypopnea index were strongly correlated (r = 0,737; p < 0,0001). There was a good level of agreement between abnormal oxymetric results and abnormal PSG results (kappa = 0.898; p < 0,0001). Overnight oximetry had a sensitivity of 88.9% and a specificity of 100% for OSA diagnosis. CONCLUSIONS: Continuous overnight oximetry derived from monitors that are already present in the CCU is a simple and accurate method for the diagnosis of OSA in the CCU.