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.
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.
MATERIAL AND METHODS: RCTs comparing postoperative comorbid disease resolution such as hypertension, dyslipidemia, obstructive sleep apnea, joint and musculoskeletal conditions, gastroesophageal reflux disease, and menstrual irregularities following LVSG and LRYGB were included for analysis. The studies were selected from PubMed, Medline, EMBASE, Science Citation Index, Current Contents, and the Cochrane database and reported on at least one comorbidity resolution or improvement. The present work was undertaken according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA). The Jadad method for assessment of methodological quality was applied to the included studies.
RESULTS: Six RCTs performed between 2005 and 2015 involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on the resolution or improvement of comorbid disease following LVSG and LRYGB procedures. Both bariatric procedures provide effective and almost comparable results in improving or resolving these comorbidities.
CONCLUSIONS: This systematic review of RCTs suggests that both LVSG and LRYGB are effective in resolving or improving preoperative nondiabetic comorbid diseases in obese patients. While results are not conclusive at this time, LRYGB may provide superior results compared to LVSG in mediating the remission and/or improvement in some conditions such as dyslipidemia and arthritis.
METHODS: After institutional approval and written informed consent, patients received a brief remifentanil infusion during continuous monitoring of ventilation. We compared minute ventilation in 30 patients with moderate-to-severe obstructive sleep apnea diagnosed by polysomnography and 20 controls with no to mild obstructive sleep apnea per polysomnography. Effect site concentrations were estimated by a published pharmacologic model. We modeled minute ventilation as a function of effect site concentration and the estimated carbon dioxide. Obstructive sleep apnea status, body mass index, sex, age, use of continuous positive airway pressure, apnea/hypopnea events per hour of sleep, and minimum nocturnal oxygen saturation measured by pulse oximetry in polysomnography were tested as covariates for remifentanil effect site concentration at half-maximal depression of minute ventilation (Ce50) and included in the model if a threshold of 6.63 (P < 0.01) in the reduction of objective function was reached and improved model fit.
RESULTS: Our model described the observed minute ventilation with reasonable accuracy (22% median absolute error). We estimated a remifentanil Ce50 of 2.20 ng · ml (95% CI, 2.09 to 2.33). The estimated value for Ce50 was 2.1 ng · ml (95% CI, 1.9 to 2.3) in patients without obstructive sleep apnea and 2.3 ng · ml (95% CI, 2.2 to 2.5) in patients with obstructive sleep apnea, a statistically nonsignificant difference (P = 0.081). None of the tested covariates demonstrated a significant effect on Ce50. Likelihood profiling with the model including obstructive sleep apnea suggested that the effect of obstructive sleep apnea on remifentanil Ce50 was less than 5%.
CONCLUSIONS: Obstructive sleep apnea status, apnea/hypopnea events per hour of sleep, or minimum nocturnal oxygen saturation measured by pulse oximetry did not influence the sensitivity to remifentanil-induced ventilatory depression in awake patients receiving a remifentanil infusion of 0.2 μg · kg of ideal body weight per minute.
OBJECTIVES: To determine the association between obstructive sleep apnea and 30-day risk of cardiovascular complications after major noncardiac surgery.
DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study involving adult at-risk patients without prior diagnosis of sleep apnea and undergoing major noncardiac surgery from 8 hospitals in 5 countries between January 2012 and July 2017, with follow-up until August 2017. Postoperative monitoring included nocturnal pulse oximetry and measurement of cardiac troponin concentrations.
EXPOSURES: Obstructive sleep apnea was classified as mild (respiratory event index [REI] 5-14.9 events/h), moderate (REI 15-30), and severe (REI >30), based on preoperative portable sleep monitoring.
MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of myocardial injury, cardiac death, heart failure, thromboembolism, atrial fibrillation, and stroke within 30 days of surgery. Proportional-hazards analysis was used to determine the association between obstructive sleep apnea and postoperative cardiovascular complications.
RESULTS: Among a total of 1364 patients recruited for the study, 1218 patients (mean age, 67 [SD, 9] years; 40.2% women) were included in the analyses. At 30 days after surgery, rates of the primary outcome were 30.1% (41/136) for patients with severe OSA, 22.1% (52/235) for patients with moderate OSA, 19.0% (86/452) for patients with mild OSA, and 14.2% (56/395) for patients with no OSA. OSA was associated with higher risk for the primary outcome (adjusted hazard ratio [HR], 1.49 [95% CI, 1.19-2.01]; P = .01); however, the association was significant only among patients with severe OSA (adjusted HR, 2.23 [95% CI, 1.49-3.34]; P = .001) and not among those with moderate OSA (adjusted HR, 1.47 [95% CI, 0.98-2.09]; P = .07) or mild OSA (adjusted HR, 1.36 [95% CI, 0.97-1.91]; P = .08) (P = .01 for interaction). The mean cumulative duration of oxyhemoglobin desaturation less than 80% during the first 3 postoperative nights in patients with cardiovascular complications (23.1 [95% CI, 15.5-27.7] minutes) was longer than in those without (10.2 [95% CI, 7.8-10.9] minutes) (P sleep apnea was significantly associated with increased risk of 30-day postoperative cardiovascular complications. Further research would be needed to assess whether interventions can modify this risk.
Methods: This was a prospective cross-sectional study. A total of 3303 subjects aged 40 years and above from two large population-based cohorts, the Singapore Malay Eye Study-2 (n = 1191, 2011-2013) and the Singapore Indian Eye Study-2 (n = 2112, 2013-2015), were included. The presence of symptoms of dry eye was defined as having at least one of six symptoms often or all the time. Sleep questionnaires included the Epworth Sleepiness Scale, Berlin Questionnaire, STOP-bang questionnaire, and Insomnia Severity Index. Poor sleep quality was defined as meeting the respective questionnaire thresholds. General health questionnaires (including sleep duration) and standardized ocular and systemic tests were also used.
Results: Of 3303 participants, 6.4% had excessive sleepiness, 20.5% had high risk for sleep apnea, 2.7% had clinical insomnia, and 7.8% had <5 hours of sleep. These sleep factors were associated with symptoms of dry eye. After adjusting for relevant demographic, medical, and social factors, the following were associated with higher odds of symptoms of dry eye: excessive sleepiness (Epworth Sleepiness Scale: odds ratio [OR] = 1.77 [1.15-2.71]), high risk of sleep apnea (Berlin Questionnaire: OR = 1.55 [1.17-2.07], STOP-Bang Questionnaire: OR = 2.66 [1.53-4.61]), clinical insomnia (Insomnia Severity Index: OR = 3.68 [2.17-6.26]) and <5 hours of sleep (OR = 1.73 [1.17-2.57], reference sleep duration 5-9 hours). Sleep apnea, insomnia, and sleep duration were each shown to be independently associated with symptoms of dry eye.
Conclusion: Short sleep duration and poor quality are both significantly and independently associated with symptoms of dry eye.
METHODS: In this cross sectional study, the Malay version of SAQLI was administered to 82 OSA patients seen at the OSA Clinic, Hospital Universiti Sains Malaysia prior to their treatment. Additionally, the patients were asked to complete the Malay version of Medical Outcomes Study Short Form (SF-36). Twenty-three patients completed the Malay version of SAQLI again after 1-2 weeks to assess its reliability.
RESULTS: Initial factor analysis of the 40-item Malay version of SAQLI resulted in four factors with eigenvalues >1. All items had factor loadings >0.5 but one of the factors was unstable with only two items. However, both items were maintained due to their high communalities and the analysis was repeated with a forced three factor solution. Variance accounted by the three factors was 78.17% with 9-18 items per factor. All items had primary loadings over 0.5 although the loadings were inconsistent with the proposed construct. The Cronbach's alpha values were very high for all domains, >0.90. The instrument was able to discriminate between patients with mild or moderate and severe OSA. The Malay version of SAQLI correlated positively with the SF-36. The intraclass correlation coefficients for all domains were >0.90.
CONCLUSIONS: In light of these preliminary observations, we concluded that the Malay version of SAQLI has a high degree of internal consistency and concurrent validity albeit demonstrating a slightly different construct than the original version. The responsiveness of the questionnaire to changes in health-related quality of life following OSA treatment is yet to be determined.
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: 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.
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.