OBJECTIVE: This study was intended to assess the knowledge and attitude towards OSA and compare it among dental and medical undergraduate students of University Sains Malaysia (USM).
METHODS: In this study, a total of 216 clinical undergraduate students (36 from each year; 108 from medical and 108 from dental school) of University Sains Malaysia (USM) Health campus were recruited for the study by non-probability stratified random sampling method. Total study period was October 2017 to October 2018. A self-administered questionnaire was used to assess the sociodemographic status and OSAKA questionnaire was used to assess knowledge and attitude regarding sleep apnoea of the respondents. Descriptive analysis was carried out to assess the knowledge and attitude of OSA amongst dental and medical undergraduate students of USM. The Mann-Whitney U test was carried out to compare the knowledge and attitude of OSA amongst dental and medical undergraduate students of USM.
RESULTS: Our study findings revealed that 0.9 %and 6.5 %of the dental undergraduate students and medical undergraduate students could answer all the questions correctly regarding knowledge of OSA. Based on the assessment of the difference between medical and dental students in terms of knowledge towards OSA patients, significant difference was observed at the significance level of 95%, where p
MATERIALS AND METHODS: The present study included the assessment of all the patients who underwent prosthetic rehabilitation by dental implants. An experienced registered prosthodontist was given duty for examination of all the cases from the record file data. Prosthetic complications in the patients were identified using photographs, radiographs, and all other relevant data of the patients obtained from the record files. All types of complications and other factors were recorded separately and analyzed.
RESULTS: While correlating the prosthetic complications in OSA patients grouped based on number of dental implants, nonsignificant results were obtained. Significant correlation was observed while comparing the prosthetic complications divided based on type of prosthesis. Fracture of the porcelain was observed in four and eight cases respectively, of screwed and cemented dental implant cases.
CONCLUSION: Some amount of significant correlation existed between the incidences of prosthetic complications and OSA.
CLINICAL SIGNIFICANCE: Proper history of the patients undergoing dental implant procedures should be taken to avoid failure.
METHODS: A prospective 7-country clinical trial of 302 OSA patients, who met the selection criteria, and underwent nose, palate and/or tongue surgery. Pre- and post-operative data were recorded and analysed based on both the Sher criteria (apnoea hypopnea index, AHI reduction 50% and <20) and the SLEEP-GOAL.
RESULTS: There were 229 males and 73 females, mean age of 42.4±17.3 years, mean BMI 27.9±4.2. The mean VAS score improved from 7.7±1.4 to 2.5±1.7 (p<0.05), mean Epworth score (ESS) improved from 12.2±4.6 to 4.9±2.8 (p<0.05), mean body mass index (BMI) decreased from 27.9±4.2 to 26.1±3.7 (p>0.05), gross weight decreased from 81.9±14.3kg to 76.6±13.3kg. The mean AHI decreased 33.4±18.9 to 14.6±11.0 (p<0.05), mean lowest oxygen saturation (LSAT) improved 79.4±9.2% to 86.9±5.9% (p<0.05), and mean duration of oxygen <90% decreased from 32.6±8.9 minutes to 7.3±2.1 minutes (p<0.05). The overall success rate (302 patients) based on the Sher criteria was 66.2%. Crosstabulation of respective major/minor criteria fulfilment, based on fulfilment of two major and two minor or better, the success rate (based on SLEEP-GOAL) was 69.8%. Based solely on the Sher criteria, 63 patients who had significant blood pressure reduction, 29 patients who had BMI reduction and 66 patients who had clinically significant decrease in duration of oxygen <90% would have been misclassified as "failures".
CONCLUSION: AHI as a single parameter is unreliable. Assessing true success outcomes of OSA treatment, requires comprehensive and holistic parameters, reflecting true end-organ injury/function; the SLEEP-GOAL meets these requirements.
METHODOLOGY: Prospective series of 405 OSA patients (350 males/55 females) who had upper airway surgery. Procedures included functional endoscopic sinus surgery, septoplasty, turbinate reduction, palate/tonsil surgery, and/or tongue base surgery. Intubation difficulty (ID) was assessed using Mallampati grade, Laryngoscopic grade (Cormack and Lehane), and clinical parameters including BMI, neck circumference, thyromental distance, jaw adequacy, neck movements and glidescope grading.
RESULTS: Mean age was 41.6 years old; mean BMI 26.6; mean neck circumference 44.5cm; mean Apnea Hypopnea Index (AHI) was 25.0; and mean LSAT 82%. The various laryngeal grades (based on Cormack and Lehane), grade 1 - 53 patients (12.9%), grade 2A - 127 patients (31.0%), grade 2B - 125 patients (30.5%), grade 3 - 93 patients (22.7%) and grade 4 - seven patients (1.7%); hence, 24.4% had difficulties in intubation. Parameters that adversely affected intubation were, age of the patient, opening of mouth, retrognathia, overbite, overjet, limited neck extension, thyromental distance, Mallampati grade, and macroglossia (p<0.001). Body mass index (BMI) (p=0.087), neck circumference (p=0.645), neck aches (p=0.728), jaw aches (p=0.417), tonsil size (p=0.048), and AHI (p=0.047) had poor correlation with intubation. BMI-adjusted for Asians and Caucasians, showed that Asians were more likely to have difficulties in intubation (adjusted OR = 4.6 (95%Confidence Interval: 1.05 to 20.06) (p=0.043), compared to the Caucasian group.
CONCLUSION: This study illustrates that difficult intubation can be predicted pre-surgery in order to avert any anaesthetic morbidity.
STUDY DESIGN: Systematic Review of Literature.
METHODS: PubMed, the Cochrane Library, and SCOPUS databases were searched through November 2019.
RESULTS: Eight studies (1,924 patients) met criteria (age range: 28-70.9 years, body mass index range: 21.9-37 kg/m2 , and AHI range: 0.5-62 events/hour). Five studies compared ODI and AHI simultaneously, and three had a week to months between assessments. Sensitivities ranged from 32% to 98.5%, whereas specificities ranged from 47.7% to 98%. Significant heterogeneity was present; however, for studies reporting data for a 4% ODI ≥ 15 events/hour, the specificity for diagnosing OSA ranged from 75% to 98%, and only one study reported the positive predictive value, which was 97%. Direct ODI and AHI comparisons were not made because of different hypopnea scoring, different oxygen desaturation categories, and different criteria for grading OSA severity.
CONCLUSION: Significant heterogeneity exists in studies comparing ODI and AHI. Based on currently published studies, consideration should be given for diagnosing adult OSA with a 4% ODI of ≥ 15 events/hour and for recommending further evaluation for diagnosing OSA with a 4% ODI ≥ 10 events/hour. Screening with oximetry may be indicated for the detection of OSA in select patients. Further study is needed before a definitive recommendation can be made. Laryngoscope, 131:440-447, 2021.
METHODS: The patients included in this study were those recently diagnosed with OSA (AHI > 5) and given nCPAP therapy, as well as being referred to a sleep laboratory for an assessment of their sleep disordered breathing. Prior to the start of nCPAP therapy and polysomnography evaluation, patients were asked to complete the validated Quebec sleep questionnaire (QSQ), and their baseline measurements were recorded.
RESULTS: Among the study population, 14.41% (n = 31) had mild OSA with an apnea and hypopnea index of 5 to 14.9 events/h, while 26.97% (n = 58) had moderate OSA and 40% (n = 86) had severe OSA. The overall average apnea and hypopnea index of the study population was 30.24 ± 9.73 events/h; mild OSA patients had an average apnea and hypopnea index of 10.09 ± 2.65 events/h, moderate OSA patients had 21.48 ± 4.40 events/h, and severe OSA patients had 59.16 ± 22.14 events/h. A significant difference was observed between the scores before treatment and after 6 months of therapy in all domains of the QSQ QoL scores (P sleep apnea.
METHODS: Children having home overnight oximetry for suspected OSA were identified over 12 months, and those with a normal result who went on to have polysomnography (PSG) were included. Oximetry, including PR-SD and PRI (rises of 8, 10 and 15 beats/min per hour), was analyzed using commercially available software. PR parameters were compared between those with OSA (obstructive apnoea-hypopnoea index (OAHI) >1 event/h) and those without OSA.
RESULTS: One hundred sixteen children had normal oximetry, of whom 93 (median age 4.5 years; 55 % M) had PSG. Fifty-seven of 93 (61 %) children had OSA (median OAHI 4.5 events/h, range 1.1-24). PR-SD was not different between the OSA and non-OSA groups (p = 0.87). PRI tended to be higher in those with OSA, but there was considerable overlap between the groups: PRI-8 (mean ± SD 58.5 ± 29.0/h in OSA group vs 48.6 ± 20.2/h in non-OSA group, p = 0.07), PRI-10 (45.1 ± 25.0 vs 36.2 ± 16.7, p = 0.06) and PRI-15 (24.4 ± 14.5 vs 18.9 ± 9.0, p = 0.04). A PRI-15 threshold of >35/h had specificity of 97 % for OSA.
CONCLUSION: The PRI-15 shows promise as an indicator of OSA in children with normal oximetry.
METHODOLOGY: This is a descriptive cross-sectional study at the Sleep Clinic, Department of Otorhinolaryngology-Head and Neck Surgery. Flexible nasopharyngolaryngoscopy was performed in seated erect and supine position. Retropalatal and retroglossal regions were continuously recorded during quiet breathing and Mueller's maneuver in both positions. Captured images were measured using Scion Image software and narrowing rate was calculated. Level of each site was classified based on Fujita classification and severity of obstruction using Sher scoring system for Mueller's maneuver.
RESULTS: A total of 59 patients participated in this study. Twenty-nine (49.2%) participants had type 1 (retropalatal) obstruction, 23 (38.9%) had type 2 (retropalatal and retroglossal), and seven (11.9%) in type 3 (retroglossal) obstruction. Fifty (84.7%) of the patients have severe obstruction at the retropalatal region in supine position (SRP) followed by 35 (59.3%) at retropalatal region in erect position (ERP), 27 (45.8%) at retroglossal region in supine position (SRG) and eight (13.5%) at retroglossal region in erect position (ERG). The average oxygen saturation showed significant association in ERP (P = 0.012) and SRP (P < 0.001), but not significant in ERG and SRG.
CONCLUSIONS: Videoendoscopy utilizing flexible nasopharyngolaryngoscopy and Scion Image software is reliable, minimally invasive, and useful as an office procedure in evaluating the multilevel obstruction of upper airway in OSA patients. The retropalatal region has more severe obstruction compared with retroglossal region either in erect or supine position.
OBJECTIVE: To localize and quantify geometric morphometric differences in facial soft tissue morphology in adults with and without OSA.
MATERIALS AND METHODS: Eighty adult Malays, consisting of 40 patients with OSA and 40 non-OSA controls, were studied. Both groups were evaluated by the attending physician and through ambulatory sleep studies. 3-D stereophotogrammetry was used to capture facial soft tissues of both groups. The 3-D mean OSA and control facial configurations were computed and subjected to principal components analysis (PCA) and finite-element morphometry (FEM).
RESULTS: The body mass index was significantly greater for the OSA group (32.3 kg/m(2) compared to 24.8 kg/m(2), p < 0.001). The neck circumference was greater for the OSA group (42.7 cm compared to 37.1 cm, p < 0.001). Using PCA, significant differences were found in facial shape between the two groups using the first two principal components, which accounted for 50% of the total shape change (p < 0.05). Using FEM, these differences were localized in the bucco-submandibular regions of the face predominantly, indicating an increase in volume of 7-22% (p < 0.05) for the OSA group.
CONCLUSION: Craniofacial obesity in the bucco-submandibular regions is associated with OSA and may provide valuable screening information for the identification of patients with undiagnosed OSA.
METHODS: A prospective cross-sectional study was performed among young doctors less than 40 years old, working at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, and Hospital Kuala Lumpur, Kuala Lumpur, Malaysia, using questionnaires and home sleep apnea testing (Apnealink™Plus). The primary objective of this study was to evaluate the prevalence of OSA (apnea-hypopnea index (AHI) ≥5). The secondary objectives were to evaluate the prevalence of obstructive sleep apnea syndrome (OSAS) defined by AHI ≥5 + excessive daytime sleepiness (EDS), sleep deprivation (the difference of weekend (non-workdays) and weekday (workdays) wake-up time of at least 2 h), EDS (Epworth Sleepiness Scale score ≥10), tiredness, and perception of inadequate sleep as well as to identify their predictors.
RESULTS: Total of 52 subjects completed the study. Mean age and mean body mass index (BMI) were 31.3 ± 4 and 23.3 ± 3.6, respectively. The prevalence of OSA and OSAS were 40.4 and 5.8 %, respectively. One third of OSA subjects were at least moderate OSA. Prevalence of sleep deprivation, EDS, tiredness, and perception of inadequate sleep were 44.2, 15.4, 65.4, and 61.5 %, respectively. History of snoring, being male, and perception of inadequate sleep were significant predictors for OSA with the odds ratio of 34.5 (p = 0.016, 95 % CI = 1.92-619.15), 18.8 (p = 0.001, 95 % CI = 3.10-113.41), and 7.4 (p = 0.037, 95 % CI = 1.13-48.30), respectively. Only observed apnea was a significant predictor for OSAS with odds ratio of 30.7 (p = 0.012, 95 % CI = 2.12-442.6). Number of naps per week was a significant predictor for EDS with the odds ratio of 1.78 (p = 0.007, 95 % CI = 1.17-2.71). OSA and total number of call days per month were significant predictors for tiredness with the odds ratio of 4.8 (p = 0.036, 95 % CI = 1.11-20.72) and 1.3 (p = 0.050, 95 % CI = 1.0004-1.61), respectively. OSA was the only significant predictor for perception of inadequate sleep with the odd ratios of 4.5 (p = 0.022, 95 % CI = 1.24-16.59).
CONCLUSIONS: Our results demonstrated relatively high prevalence of OSA and OSAS among young doctors. Snoring, being male, and perception of inadequate sleep were significant predictors for OSA. Observed apnea was a significant predictor for OSAS. OSA was a significant predictor for tiredness and perception of inadequate sleep.
METHODS: A cross-sectional survey was conducted among physicians who were currently working in primary care clinics in the capital state of Kuala Lumpur. The validated "Obstructive Sleep Apnea Knowledge and Attitudes Questionnaire" (OSAKA) and nine additional practice questions were used as the survey instrument.
RESULTS: Of 207 physicians queried, the response rate was 100%. The mean (± SD) total knowledge score was 11.6 (± 2.8) (range 1-18). The majority of respondents had a positive attitude towards the importance of OSA but lacked confidence in managing OSA. Primary care doctors' most common practice for patients with suspected OSA was referral to the ear, nose, and throat (ENT) clinic.
CONCLUSIONS: The study shows that primary care doctors demonstrated adequate knowledge about OSA and were aware of the importance of OSA as a core clinical problem. However, only a minority felt confident in managing patients with OSA. The results of the study may encourage improvement of primary care doctors' efforts to prevent and manage OSA.