Browsing by Subject "obstructive sleep apnea"
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Item Computed Tomography Characterization and Comparison With Polysomnography for Obstructive Sleep Apnea Evaluation(Elsevier, 2017) Chousangsuntorn, Khaisang; Bhongmakapat, Thongchai; Apirakkittikul, Navarat; Sungkarat, Witaya; Supakul, Nucharin; Laothamatas, Jiraporn; Radiology and Imaging Sciences, School of MedicinePurpose We hypothesized that computed tomography (CT) combined with portable polysomnography (PSG) might better visualize anatomic data related to obstructive sleep apnea (OSA). The present study evaluated the CT findings during OSA and assessed their associations with the PSG data and patient characteristics. Patients and Methods We designed a prospective cross-sectional study of patients with OSA. The patients underwent scanning during the awake state and apneic episodes. Associations of the predictor variables (ie, PSG data, respiratory disturbance index [RDI]), patient characteristics (body mass index [BMI], neck circumference [NC], and waist circumference [WC]), and outcome variables (ie, CT findings during apneic episodes) were assessed using logistic regression analysis. The CT findings during apneic episodes were categorized regarding the level of obstruction, single level (retropalatal [RP] or retroglossal [RG]) or multilevel (mixed RP and RG), degree of obstruction (partial or complete), and pattern of collapse (complete concentric collapse [CCC] or other patterns). Results A total of 58 adult patients with OSA were scanned. The mean ± standard deviation for the RDI, BMI, NC, and WC were 41.6 ± 28.55, 27.80 ± 5.43 kg/m2, 38.3 ± 4.3 cm, and 93.8 ± 13.6 cm, respectively. No variables distinguished between the presence of single- and multilevel airway obstruction in the present study. A high RDI (≥30) was associated with the presence of complete obstruction and CCC (odds ratio 6.33, 95% confidence interval 1.55 to 25.90; and odds ratio 3.77, 95% confidence interval 1.02 to 13.91, respectively) compared with those with a lesser RDI. Conclusions An increased RDI appears to be an important variable for predicting the presence of complete obstruction and CCC during OSA. Scanning during apneic episodes, using low-dose volumetric CT combined with portable PSG provided better anatomic and pathologic findings of OSA than did scans performed during the awake state.Item Does Acute Exercise Improve Driving Performance In Patients With Untreated Sleep Apnea?(Office of the Vice Chancellor for Research, 2013-04-05) Patel, Parag; Pritchard, KevinDecreased awareness among drivers with obstructive sleep apnea (OSA), a condition in which the airflow decreases during breathing, has been shown to increase motor vehicular crash risk. Those who suffer from OSA have been found to have between a two and tenfold increase of accident risk due to feelings of fatigue resulting from fragmented sleep (George, C.F.P. 2007). Treatment using continuous positive airway pressure (CPAP) has shown mixed effects in improving driver performance (Vkaulin, et al., 2011). Therefore, our objective is to determine if acute aerobic exercise (i.e. walking) prior to driving for patients with OSA can reduce the amount of accidents. Patients with OSA that are awaiting sleep apnea treatment will first undergo a ten minute moderate-intensity exercise session and then use a high fidelity driving simulator for the next fifteen minutes. A nighttime countryside scenario with two naturalistic obstacles at random times will be used. While the subject is driving, the simulator will record lane deviation, collision events, and braking response time. The same subjects will also test the simulator without doing any exercise in order to determine if there was any benefit from the exercise. The order of the simulator sessions, both with and without exercise, will be randomized to prevent practice effect. We hope to see improved driving behavior when the subjects undergo a ten minute aerobic exercise prior to driving.Item Effect of myofunctional therapy on children with obstructive sleep apnea: a meta-analysis(Elsevier, 2020-11) Bandyopadhyay, Anuja; Kaneshiro, Kellie; Camacho, Macario; Pediatrics, School of MedicineObjective To systematically review the current literature for articles describing the effect of myofunctional therapy on pediatric obstructive sleep apnea (OSA) and to perform a meta-analysis on the sleep study data. Methods Three authors (A.B., K.K. and M.C.) independently searched from inception through April 20, 2020 in PubMed/MEDLINE, Scopus, Embase, Google Scholar and The Cochrane Library. Mean difference (MD), standard deviations and 95% confidence intervals were combined in the meta-analysis for apnea-hypopnea index (AHI), mean oxygen saturations, and lowest oxygen saturations (nadir O2). Results 10 studies with 241 patients met study criteria and were further analyzed. The AHI reduced from 4.32 (5.2) to 2.48 (4.0) events/hr, a 43% reduction. Random effects modeling demonstrated a mean difference in AHI of −1.54 (95% CI -2.24,-0.85)/hr, z-score is 4.36 (p < 0.0001). Mean oxygen saturation increased by 0.37 (95% CI 0.06,0.69) percent, z-score is 2.32 (p = 0.02). There was no significant increase in nadir O2. Conclusions Despite heterogeneity in exercises, myofunctional therapy decreased AHI by 43% in children, and increased mean oxygen saturations in children with mild to moderate OSA and can serve as an adjunct OSA treatment.Item Morning Blood Pressure is Associated with Sleep Quality in Obese Adolescents(Elsevier, 2014-02) Hannon, Tamara S.; Tu, Wanzhu; Watson, Sara E.; Jalou, Hasnaa; Chakravorty, Sangeeta; Arslanian, Silva; Department of Pediatrics, IU School of MedicineObjective To examine relationships between blood pressure (BP), adiposity, and sleep quality using overnight polysomnography (PSG) in obese adolescents. Study design Overnight PSG and morning BP measurements were performed in obese (BMI >97th %ile) non-diabetic adolescents (eligible age range 12-18 years, n=49). Subjects were stratified into two groups, one with normal BP, and one with elevated BP, and demographic and clinical characteristics compared between the groups. Multiple linear regression analysis was used to assess the BP effects of sleep quality measures. Results Participants (n=27) had normal morning BP, and 22 (44.9%) had elevated morning BP. There were no differences in age (p=0.53), sex (p=0.44), race (p=0.58) or BMI (p=0.56) between the two BP groups. The group with elevated BP spent shorter percentages of time in rapid eye movement (REM; p=0.006) and slow-wave sleep (SWS; p=0.024). Multiple linear regression analysis showed a lower percent of both REM and SWS were associated with increased morning BP, after adjusting for pubertal stage, sex, race, and BMI. Conclusion Lack of deeper stages of sleep, REM sleep and SWS, is associated with higher morning BP in obese adolescents, independent of BMI. Poor sleep quality should be considered in the work-up of obese youth with hypertension. Intervention studies are needed to evaluate whether improving the quality of sleep will reduce blood pressure elevation.Item Obstructive Sleep Apnea in Young Infants with Down Syndrome Evaluated in a Down Syndrome Specialty Clinic(Wiley, 2015) Goffinski, Alida; Stanley, Maria A.; Shepherd, Nicole; Duvall, Nichole; Jenkinson, Sandra B.; Davis, Charlene; Bull, Marilyn J.; Roper, Randall J.; Biology, School of ScienceChildren with Down syndrome (DS) experience congenital and functional medical issues that predispose them to obstructive sleep apnea (OSA). Research utilizing stringent age criteria among samples of infants with DS and OSA is limited. This study examines clinical correlates of OSA among infants with DS. A retrospective chart review was conducted of infants ≤6 months of age referred to a DS clinic at a tertiary children's hospital over five-years (n = 177). Chi-square tests and binary logistic regression models were utilized to analyze the data. Fifty-nine infants underwent polysomnography, based on clinical concerns. Of these, 95% (56/59) had studies consistent with OSA. Among infants with OSA, 71% were identified as having severe OSA (40/56). The minimum overall prevalence of OSA among the larger group of infants was 31% (56/177). Significant relationships were found between OSA and dysphagia, congenital heart disease (CHD), prematurity, gastroesophageal reflux disease (GERD), and other functional and anatomic gastrointestinal (GI) conditions. Results indicate that odds of OSA in this group are higher among infants with GI conditions in comparison to those without. Co-occurring dysphagia and CHD predicted the occurrence of OSA in 36% of cases with an overall predictive accuracy rate of 71%. Obstructive sleep apnea is relatively common in young infants with DS and often severe. Medical factors including GI conditions, dysphagia and CHD may help to identify infants who are at greater risk and may warrant evaluation. Further studies are needed to assess the impact of OSA in infants with DS.Item Prevalence of Obstructive Sleep Apnea (OSA) in Spontaneous Cerebrospinal Fluid (CSF) Leaks: A Prospective Cohort Study(Wolters Kluwer, 2018-07) Rabbani, Cyrus; Saltagi, Mohamad; Manchanda, Shalini; Yates, Charles; Nelson, Rick; Otolaryngology -- Head and Neck Surgery, School of MedicineObjective: To determine the prevalence of obstructive sleep apnea (OSA) in a prospective cohort of patients with spontaneous CSF (sCSF) leaks of the temporal bone. Study Design: Prospective cohort study. Setting: Tertiary referral center. Patients: Consecutive sCSF leak patients (21) over a 3-year period. Four patients presented with a history of OSA and 17 patients were prospectively offered polysomnogram (PSG) testing during the initial clinic encounter. Intervention: Level I PSG. Main Outcome Measures: Patient characteristics (age, sex, body mass index), apnea hypopnea index (AHI), presence of snoring, and presence of hypoxia (oxygen saturation <88% for >5 min). OSA was defined as mild (AHI ≥5 and <15/h), moderate (AHI ≥15 and <30/h), and severe (AHI ≥30/h). Results: The prevalence of OSA in sCSF leak patients is 83.3%. PSG studies were performed on 18 of the 21 patients. There were 15 women and 6 men with an average age (standard deviation) of 56.3 (11.2) years and an average body mass index of 35.3 (7.7) kg/m2. Objectively, the AHI ranged from mild to severe (range = 5.7–92, median = 19.8). Snoring was present in 61% of patients and hypoxia was present in 39% of patients. sCSF leak patients with OSA were significantly older than sCSF leak patients without OSA (56.7 [8.3] versus 42.7 [14.5] yr, p = 0.03). Conclusions: OSA is highly prevalent among patients with sCSF leaks. All patients with sCSF leaks should undergo formal PSG testing. Future studies are needed to determine the role of OSA in the development of sCSF leaks.Item Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: A systematic review(Wiley, 2017-04-07) Lobo, Brian C.; Baumanis, Maraya M.; Nelson, Rick F.; Otolaryngology -- Head and Neck Surgery, School of MedicineObjectives To review the safety and efficacy of surgical management for spontaneous cerebrospinal fluid (CSF) leaks of the anterior and lateral skull base. Data Sources A systematic review of English articles using MEDLINE. Review Methods Search terms included spontaneous, CSF, cerebrospinal fluid, endoscopic, middle fossa, transmastoid, leak, rhinorrhea. Independent extraction of articles by 3 authors. Results Patients with spontaneous CSF leaks are often obese (average BMI of 38 kg/m2) and female (72%). Many patients also have obstructive sleep apnea (∼45%) and many have elevated intracranial pressure when measured by lumbar puncture. In addition to thinning of the skull base, radiographic studies also demonstrate cortical bone thinning. Endoscopic surgical repair of anterior skull base leaks and middle cranial fossa (MCF) approach for repair of lateral skull base leaks are safe and effective with an average short‐term failure rate of 9% and 6.5%, respectively. Long‐term failure rates are low. One randomized trial failed to show improved success of anterior leak repairs with the use of a lumbar drain (LD) (95% with vs. 92% without; P = 0.2). In a large retrospective cohort of MCF lateral skull base repairs, perioperative LD use was not necessary in >94% of patients. Conclusions Spontaneous CSF leaks are associated with female gender, obesity, increased intracranial hypertension, and obstructive sleep apnea. Endoscopic repair of anterior skull base leaks and MCF or transmastoid approaches for lateral skull base leaks have a high success rate of repair. In most cases, intraoperative placement of lumbar drain did not appear to result in improved success rates for either anterior or lateral skull base leaks. Level of Evidence 2a, Systematic Review.Item Upper Airway Areas, Volumes, and Linear Measurements Determined on Computed Tomography During Different Phases of Respiration Predict the Presence of Severe Obstructive Sleep Apnea(Elsevier, 2017) Chousangsuntorn, Khaisang; Bhongmakapat, Thongchai; Apirakkittikul, Navarat; Sungkarat, Witaya; Supakul, Nucharin; Laothamatas, Jiraporn; Radiology and Imaging Sciences, School of MedicinePurpose The objective of this study was to analyze the potential of using low-dose volumetric computed tomography (CT) during different phases of respiration for identifying patients likely to have severe obstructive sleep apnea (OSA), defined as a respiratory disturbance index (RDI) higher than 30. Patients and Methods A prospective study was undertaken at the Ramathibodi Hospital (Bangkok, Thailand). Patients with diagnosed OSA (N = 82) were recruited and separated into group 1 (RDI, ≤30; n = 36) and group 2 (RDI, >30; n = 46). The 2 groups were scanned by low-dose volumetric CT while they were 1) breathing quietly, 2) at the end of inspiration, and 3) at the end of expiration. Values for CT variables were obtained from linear measurements on lateral scout images during quiet breathing and from the upper airway area and volume measurements were obtained on axial cross-sections during different phases of respiration. All CT variables were compared between study groups. A logistic regression model was constructed to calculate a patient's likelihood of having an RDI higher than 30 and the predictive value of each variable and of the final model. Results The minimum cross-sectional area (MCA) measured at the end of inspiration (cutoff point, ≤0.33 cm2) was the most predictive variable for the identification of patients likely to have an RDI higher than 30 (adjusted odds ratio [OR] = 5.50; 95% confidence interval [CI], 1.76-17.20; sensitivity, 74%; specificity, 72%,), followed by the MCA measured at the end of expiration (cutoff point, ≤0.21 cm2; adjusted OR = 3.28; 95% CI, 1.05-10.24; sensitivity, 70%; specificity, 68%). Conclusion CT scanning at the ends of inspiration and expiration helped identify patients with an RDI higher than 30 based on measurement of the MCA. Low-dose volumetric CT can be a useful tool to help the clinician rapidly identify patients with severe OSA and decide on the urgency to obtain a full-night polysomnographic study and to start treatment.Item Use of Thromboelastography and Rotational Thromboelastometry in Otolaryngology: A Narrative Review(MDPI, 2022-02) Marsee, Mathew K.; Shariff, Faisal S.; Wiarda, Grant; Watson, Patrick J.; Sualeh, Ali H.; Brenner, Toby J.; McCoy, Max L.; Al-Fadhl, Hamid D.; Jones, Alexander J.; Davis, Patrick K.; Zimmer, David; Folsom, Craig; Medicine, School of MedicineIn the field of otolaryngology—head and neck surgery (ENT), coagulopathies present unique diagnostic and therapeutic challenges. In both hyper- and hypocoagulable patients, management of coagulopathies requires intricate attention to the nature of hemostatic competence. Common coagulation tests (CCTs) offer only a snapshot of hemostatic competence and do not provide a clear insight into the patient’s real-time hemostatic condition. Viscoelastic tests (VETs) offer a holistic and concurrent picture of the coagulation process. Although VETs have found prominent utilization in hepatic transplants, obstetrics, and emergent surgical settings, they have not been fully adopted in the realm of otolaryngology. The objective of this manuscript is to provide an overview of the literature evaluating the current utilization and possible future uses of VETs in the field of otolaryngology. The authors performed a comprehensive literature search of the utilization of VETs in otolaryngology and identified applicable studies that included descriptions of viscoelastic testing. Twenty-five studies were identified in this search, spanning topics from head and neck oncology, microvascular free flap reconstruction, obstructive sleep apnea, adenotonsillectomy, facial trauma, and epistaxis. The applicability of VETs has been demonstrated in head and neck oncology and microvascular free flap management, although their pervasiveness in practice is limited. Underutilization of VETs in the field of otolaryngology may be due to a lack of familiarity of the tests amongst practitioners. Instead, most otolaryngologists continue to rely on CCTs, including PT, PTT, INR, CBC, fibrinogen levels, and thrombin time. Learning to perform, interpret, and skillfully employ VETs in clinical and operative practice can greatly improve the management of coagulopathic patients who are at increased risk of bleeding or thrombosis.