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This review focuses on the clinical presentation of the obstructive sleep apnoea/hypopnoea syndrome in adults. Features consistent with the diagnosis are described. A brief discussion of the objective measurement of sleep-disordered breathing, largely in the form of overnight monitoring, is undertaken.
Context in source publication
Context 1
... recent multicentre cohort study concluded that apnoea and sleep disruption were not the primary determinants of EDS, although patients with EDS had longer sleep duration, increased slow-wave sleep and sleep fragmentation [Roure et al. 2008]. In considering the sleepy patient presenting with symptoms of sleep apnoea, one should not exclude consideration and assessment of metabolic status, the presence of depression or other possible causes of EDS [Vgontzas, 2008] (see Table 2). ...Similar publications
Background
Currently, there is limited and controversial clinical research on the correlation between sleep-disordered breathing (SDB) and dyslipidemia. This discrepancy in findings may be because studies that primarily focused on hospital-based populations may not be applicable to community-based populations. Therefore, the primary objective of th...
Background: Sleep disordered breathing (SDB) is a frequent disorder and its severity superfats as pregnancy progresses. The exact prevalence or incidence of such disorder in pregnant women is still unknown.
Objectives: To assess the incidence and severity of OSA in pregnant women and to discover the risk factors for OSA during pregnancy.
Methods: A...
Background:
The prevalence of obstructive sleep apnea (OSA) is suggested to differ according to different age groups. While its prevalence has been extensively investigated among middle-aged and old individuals, very few studies have summarized its prevalence among young adults. The present study aimed to conduct a systematic review and meta-analy...
Purpose of review:
Diagnosis of sleep apnoea was performed in sleep laboratories with polysomnography. This requires a room with supervision and presence of technologists and trained sleep experts. Today, clinical guidelines in most countries recommend home sleep apnoea testing with simple systems using six signals only. If criteria for signal qua...
Pneumonia caused by COVID-19 is a severe health risk that sometimes leads to fatal outcomes. Due to constraints in medical care systems, technological solutions should be applied to diagnose, monitor, and alert about the disease’s progress for patients receiving care at home. Some sleep disturbances, such as obstructive sleep apnea syndrome, can in...
Citations
... Awakening with a feeling of choking, observed in 76% of the patients with AHI of $15/h and 77% of those with RDI of $15/h, was another important factor in the present study and considered one of the clinical signs of obstructive sleep apnea severity that should be considered in the clinical assessment of obstructive sleep apnea. 29 Awakening with a feeling of choking is related to the pathophysiology of obstructive sleep apnea, i.e., airway obstruction during sleep, which results in inadequate alveolar ventilation, reduced oxygen saturation, and partial increase in carbon dioxide (CO 2 ) that terminate with the patients' arousal and cause the feeling of choking for the patient. 30 These factors also cause daytime sleepiness, lack of concentration, tiredness, and unrefreshed feeling at daytime. ...
Background:
Polysomnography is the gold standard diagnostic method for obstructive sleep apnea syndrome, and on-time treatment can help prevent further complications of obstructive sleep apnea. However, polysomnography is associated with some difficulties for the patients and physicians, which hinder its application. This study aimed to evaluate the clinical features and polysomnography findings of patients with obstructive sleep apnea.
Methods:
Data were retrospectively collected from polysomnography studies at the Sleep Laboratory of Namazi Hospital, Shiraz, Iran, from February 2013 to December 2017. Polysomnography was performed for any patients suspected of obstructive sleep apnea. The researcher reviewed the data extracted and selected the essential clinical features for the statistical analysis. The association of variables with the polysomnography findings was analyzed.
Results:
Significant associations were observed between the following factors and severity of obstructive sleep apnea: older age (p = 0.01), snoring (p = 0.122), history of sleep disorders (p = 0.11), no sedatives before sleep (p = 0.039), nocturia (p = 0.001), apnea (p = 0.035), no smoking (p = 0.039), no substance abuse (p = 0.011), hypertension (p = 0.001), cardiac diseases (p = 0.025), and overweight and obesity (p < 0.001).
Conclusion:
Considering the concomitant occurrence of obstructive sleep apnea with obesity, hypertension, cardiac disease, snoring, and observed apnea, polysomnography is recommended in these patients before further assessments.
... "Obstructive Sleep Apnea Syndrome" (OSAS) is the most severe form of sleep disorders with the highest prevalence in the community. OSAS is a syndrome characterized by recurrent partial or complete collapse of the upper respiratory tract during sleep [1]. If OSAS is not treated, it can lead to cardiovascular system diseases such as hypertension, heart failure, stroke, arrhythmia and cognitive disorders [2][3][4]. ...
Evaluation of the knowledge level and attitude of physicians towards obstructive sleep apnea syndrome Abstract Aim: The knowledge level and approach of physicians in Turkey to obstructive sleep apnea syndrome (OSAS) is unknown. The aim of this study is to evaluate the knowledge level and attitudes of physicians from various branches to OSAS. Materials and Methods: In this cross-sectional analytical study, Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) questionnaire was performed in order to measure knowledge levels and attitudes to OSAS. SPSS 22 package program was used for statistical analysis of data, p-value <0.05 was considered significant. Results: Four hundred forty-four physicians (16 from fundamental sciences, 295 from internal branches, 99 from surgical branches and 34 general practitioners) participated in the study. The mean knowledge score was 11.41 ± 3.05 (0-18). The knowledge score of physicians aged 30 years and younger was significantly higher than those aged 31 years and older (p <0.001). There was a negative correlation between knowledge score and age of doctors (rs=-0.214, p <0.001). The level of knowledge of pulmonologists and ENT specialists was higher compared to physicians of other branches (p <0.05). No significant difference was detected between the knowledge scores of academicians and non-academicians (p> 0.05). There was no correlation between knowledge scores and academic degrees (rs=-0.072, p = 0.188). It was observed that the knowledge level of physicians whose professional experience was 4 years or less was higher than that of those whose professional experience was 5 years or more (p = 0.001). A negative correlation was also detected between knowledge scores and professional experience (rs=-0.193, p <0.001). Discussion: It was determined that physicians' level of knowledge about OSAS was not sufficient and they felt insufficient about the management of OSAS patients. It would be appropriate to raise awareness of OSAS among practicing physicians within the scope of vocational training as well as in medical faculties and institutions providing specialist training.
... Obstructive sleep apnea (OSA) is defined as repeated episodes of upper airway closure during sleep, resulting in oxy-hemoglobin desaturation and sleep fragmentation. This produces diurnal sleepiness and can lead to cognitive impairment and cardiovascular morbidity [1]. An estimated 2-4% of the middle-aged population is affected [2,3]. ...
... Total knowledge scores were computed as the percentage of correct answers to the 18 knowledge questions and ranged from zero to 100%. Two attitude questions asked about importance of OSA, and responses were scored on a 5-point Likert scale, ranging from not important [1] to extremely important [5]. The other three attitude questions dealt with one's confidence in diagnosing and treating patients with OSA, and responses were scored from strongly disagree [1] to strongly agree [5]. ...
... Two attitude questions asked about importance of OSA, and responses were scored on a 5-point Likert scale, ranging from not important [1] to extremely important [5]. The other three attitude questions dealt with one's confidence in diagnosing and treating patients with OSA, and responses were scored from strongly disagree [1] to strongly agree [5]. Mean scores were computed for each of the two attitude scales. ...
Background: We aimed to assess recent Latin American medical school graduates’ knowledge and attitudes about OSA and examine whether their knowledge and attitudes about OSA differed from practicing physicians. Methods: Recent medical graduates completed the Spanish translation of the OSA Knowledge and Attitudes (OSAKA) questionnaire at the 2013 national primary-care residency-placement meeting in Ecuador. The OSAKA includes 18 knowledge and five attitudinal items about OSA. We compared recent graduates’ data with data collected in 2010–2011 from practicing physicians using chi-square tests of associations among categorical variables and analysis of variance of differences in mean knowledge and attitude scores. Unadjusted logistic regression models tested the odds that recent graduates (vs. practicing physicians) answered each item correctly. Results: Of 265 recent graduates, 138 (52.1%) were male, and mean age was 25.9 years. Although mean knowledge was low overall, scores were lower for recent graduates than for the 367 practicing physicians (53.5% vs. 60.4%; p < 0.001). Practicing physicians were significantly more likely to answer specific items correctly with one exception—recent graduates were more likely to know that < 5 apneas-hypopneas/h is normal (OR 1.47, 1. 03–2.07). Physicians in practice attributed greater importance to OSA as clinical disorder and the need for identifying patients with OSA; but recent graduates reported greater confidence in managing patients with OSA and CPAP. Conclusions: OSA-focused educational interventions during medical school should help to improve recent medical graduates’ abilities to diagnose and treat OSA. We recommend a greater number of hours of medical students’ exposure to sleep education.
... 2 On a clinical level, history and examination alone, including blood pressure and body mass index (BMI) measurement can predict the presence of OSAHS in about 50% of patients attending a specialised sleep clinic. 3 However, definitive diagnosis requires objective monitoring during sleep using either polygraphy or polysomnography. When screening for OSAHS either in clinical settings or the general population, several algorithms have been developed over the years to more accurately identify its presence in patients presenting with suggestive complaints. ...
... Obstructive sleep apnea (OSA) is defined as repeated episodes of upper airway closure during sleep, resulting in oxy-hemoglobin desaturation and sleep fragmentation. This produces diurnal sleepiness and can lead to cognitive impairment and cardiovascular morbidity [1]. An estimated 2-4% of the middle-aged population is affected [2,3]. ...
... Total knowledge scores were computed as the percentage of correct answers to the 18 knowledge questions and ranged from zero to 100%. Two attitude questions asked about importance of OSA, and responses were scored on a 5-point Likert scale, ranging from not important [1] to extremely important [5]. The other three attitude questions dealt with one's confidence in diagnosing and treating patients with OSA, and responses were scored from strongly disagree [1] to strongly agree [5]. ...
... Two attitude questions asked about importance of OSA, and responses were scored on a 5-point Likert scale, ranging from not important [1] to extremely important [5]. The other three attitude questions dealt with one's confidence in diagnosing and treating patients with OSA, and responses were scored from strongly disagree [1] to strongly agree [5]. Mean scores were computed for each of the two attitude scales. ...
Background
We aimed to assess recent Latin American medical school graduates’ knowledge and attitudes about OSA and examine whether their knowledge and attitudes about OSA differed from practicing physicians.
Methods
Recent medical graduates completed the Spanish translation of the OSA Knowledge and Attitudes (OSAKA) questionnaire at the 2013 national primary-care residency-placement meeting in Ecuador. The OSAKA includes 18 knowledge and five attitudinal items about OSA. We compared recent graduates’ data with data collected in 2010–2011 from practicing physicians using chi-square tests of associations among categorical variables and analysis of variance of differences in mean knowledge and attitude scores. Unadjusted logistic regression models tested the odds that recent graduates (vs. practicing physicians) answered each item correctly.
Results
Of 265 recent graduates, 138 (52.1%) were male, and mean age was 25.9 years. Although mean knowledge was low overall, scores were lower for recent graduates than for the 367 practicing physicians (53.5% vs. 60.4%; p < 0.001). Practicing physicians were significantly more likely to answer specific items correctly with one exception—recent graduates were more likely to know that < 5 apneas-hypopneas/h is normal (OR 1.47, 1.03–2.07). Physicians in practice attributed greater importance to OSA as clinical disorder and the need for identifying patients with OSA; but recent graduates reported greater confidence in managing patients with OSA and CPAP.
Conclusions
OSA-focused educational interventions during medical school should help to improve recent medical graduates’ abilities to diagnose and treat OSA. We recommend a greater number of hours of medical students’ exposure to sleep education.
... Typical symptoms of OSA include excessive daytime sleepiness, unrefreshing sleep and snoring. OSA has been associated with obesity [13], hypertension [14], cardiovascular events, morbidity, stroke [15,16] and traffic accidents [17]. The prevalence of OSA has increased considerably in so-called first world countries. ...
Objectives
Rapid eye movement behaviour disorder (RBD) is a parasomnia in which there is loss of muscle atonia during rapid eye movement (REM) sleep, resulting in dream enactment. The aims of this study were to determine the prevalence of obstructive sleep apnoea (OSA) in RBD patients and determine whether continuous positive airway pressure (CPAP) therapy improved RBD symptoms in patients with concomitant RBD and OSA. MethodsA questionnaire was mailed to 120 patients identified from a tertiary sleep centre with RBD meeting full International Classification for Sleep Disorders-3 (ICSD-3) criteria. Patients were diagnosed as having OSA if they had an apnoea-hypopnea index (AHI) ≥ 5. The questionnaire focused on CPAP-use, compliance and complications. Standard statistical analysis was undertaken using SPSS (v.21, IBM). ResultsOne hundred and seven of the potential participants (89.2%) had an OSA diagnosis. Out of 72 who responded to the questionnaire, (60%) 27 patients were using CPAP therapy. CPAP therapy improved RBD symptoms in 45.8% of this group. Despite this positive response to treatment in nearly half of CPAP-users, there was no significant difference in subjective or objective CPAP compliance between those who reported RBD improvement and those who did not. Subjective compliance with CPAP was over-reported, with mean usage being 7.17 ± 1.7 h per night compared to objective mean compliance of 5.71 ± 1.7. ConclusionsOSA is a very common co-morbidity of RBD. CPAP therapy might improve self-reported RBD symptoms further, in addition to standard RBD treatment. However, further research into its topic is necessary.
... A number of clinical features are associated with OSAHS; many occur in combination and may also be subtle ( Table 4). The predictive value of any single feature is limited (12). ...
... History and clinical examination alone, including blood pressure and body mass index (BMI) measurement can predict the presence of OSAHS in about 50% of patients attending a specialised sleep clinic (12). Further, definitive diagnosis requires additional monitoring during sleep. ...
Sleep disordered breathing (SDB) comprises a number of breathing disturbances occurring during sleep including snoring, the obstructive sleep apnoea/hypopnea syndrome (OSAHS), central sleep apnoea (CSA) and hypoventilation syndromes. This review focuses on sleep disordered breathing and diagnostic approaches in adults, in particular clinical assessment and overnight assessment during sleep. Although diagnostic approaches to respiratory sleep disorders are reasonably straightforward, they do require a degree of clinical acumen when it comes to assessing severity and management options. Diagnosing respiratory sleep disorders on clinical features alone has limitations. Monitoring and measuring respiration during sleep has undergone many advances in the last 40 years in respect of quality and validity, largely regarding OSAHS. Despite the improvement in our diagnostic standards and recognition of sleep disordered breathing, many limitations still need to be overcome. Apart from assessing the individual patient, population screening for sleep disorders continues to preoccupy health professionals and policy makers in many countries. Research in the field is pushing current boundaries in terms of simplifying diagnosis and enhancing screening for sleep disordered breathing in large populations. At present, a number of these newer approaches require further validation.
... Cerebral structural changes and chemical compositions might be the underlying cause of functional deficits, defective memory, emotional disorders, learning ability defects, and sleepwake disturbances [16]. Attention capacity of OSAS patients decreases, which can probably account for memorial difficulties [17]. The damage to the gray matter contributing to cognition, autonomic, and respiratory regulation might be cause those symptoms [18]. ...
The aim of the present study was to evaluate the relationship between obstructive sleep apnea syndrome (OSAS) severity and the hippocampal sulcus width in a cohort of subjects with OSAS and controls. A total of 149 OSAS patients and 60 nonapneic controls were included in the study. Overnight polysomnograpy was performed in all patients. Hippocampal sulcus width of the patients was measured by a radiologist blinded to the diagnosis of the patients. Other variables noted for each patient were as follows: gender, age, body mass index, apnea hypopnea index, Epworth sleepiness scale, sleep efficacy, mean saturation, lowest O2 saturation, longest apnea duration, neck circumference, waist circumference, hip circumference. A total of 149 OSAS patients were divided into three groups: mild OSAS (n = 54), moderate OSAS (n = 40), severe OSAS (n = 55) groups. The control group consisted of patients with AHI n = 60). Hippocampal sulcus width was 1.6 ± 0.83 mm in the control group; while 1.9 ± 0.81 mm in mild OSAS, 2.1 ± 0.60 mm in moderate OSAS, and 2.9 ± 0.58 mm in severe OSAS groups (p p OSAS might be associated with various pathologic mechanisms including increased hippocampal sulcus width.
... Although clinical features such as obesity (body mass index > 30 kg/m 2 ) and other anthropometric measurements such as neck and waist circumference, oral pharyngeal attributes (narrow mandible, narrow maxilla, retrognathia, dental malocclusion, overbite, reduced nasal patency, high and narrow hard palate, elongated and low-lying uvula, enlarged tonsils and adenoids, macroglossia) may be useful to consider when screening patients, there are limitations in terms of the predictive values of these variables in making the diagnosis [58,59]. ...
Background:
It is recognised that sleep-disordered breathing (SDB), in particular, obstructive sleep apnoea (OSA) is associated with obesity and diabetes. The complications of OSA include dysregulation of metabolic and cardiovascular homeostasis. With the growing population of diabetes and obesity globally, it is becoming apparent that identifying and screening patients who are at risk is becoming increasingly crucial. Many patients may remain unaware of the potential diagnosis and continue to be undiagnosed. The high prevalence of OSA poses a demanding challenge to healthcare providers in order to provide sufficient resources and facilities for patient diagnosis and treatment.
Design:
In this article, we review the evidence in favour of screening populations deemed to be at increased risk of OSA, with particular reference to patients with obesity and diabetes. We consider the recent advances in potential screening methods that may allow new prognostic and predictive tools to be developed. A detailed search of Medline and Web of Science electronic databases for relevant articles in English was performed.
Results:
Apart from the use of screening tools such as questionnaires and clinical decision models, there is increasing evidence to suggest that there are differences in biological parameters in patients with OSA. Although further studies are required, there may be potential for such biomarkers to contribute to and augment the screening process. However, the significance of such biological tools remains to be elucidated.
Conclusions:
A fundamental role for improved screening in patients with conditions such as obesity and diabetes can enable early interventions that may improve health outcomes relating to the adverse consequences of OSA. The future will see further research being carried out in the development of potential screening methods with emphasis on the selection of patients at risk of sleep disorders, thereby allowing more detailed physiological studies to be carried out where needed.
... This feasibility study was conducted at a single center and future investigations reproducing these results at additional centers with varied patient populations would extend these results. [Riha, 2010]. Imaging studies are being conducted using quantitative methods to help clarify how the device works, how it might be improved, and what patient anatomic configurations are most likely to be responsive to OPT [Schwab et al. 2012]. ...
Objective:
This feasibility study examined the initial-use safety and potential utility of a novel noninvasive oral pressure therapy (OPT) system designed to reduce airway obstruction during sleep.
Methods:
This was a single-center, proof-of-concept, single-treatment-night study in which subjects with obstructive sleep apnea (OSA) underwent a baseline polysomnography (PSG) study followed by PSG during use of an OPT system. The OPT system is composed of a bedside console, a polymer mouthpiece, and a flexible tube connecting the mouthpiece to the console. The console contains a pump that creates vacuum intended to pull the soft palate anteriorly and stabilize the tongue to reduce obstruction during sleep.
Results:
Fifty-four men and 17 women, aged 53.2 ± 11.5 years (mean ± SD) had a baseline apnea-hypopnea index (AHI) greater than 5 events per hour. OPT was generally well tolerated with no serious adverse events. OPT significantly decreased AHI from 34.4 ± 28.9 events per hour (mean ± SD) at baseline to 20.7 ± 23.3 (p < 0.001). Treatment produced an AHI less than 10 in 48% of the subjects. OPT significantly improved oxygen desaturation index (p < 0.001) and increased the percentage of the night with oxygen saturation of 90% or greater (p = 0.028). Stage-N1 sleep shifts, total sleep-stage shifts, awakenings and the percentage of sleep time spent in N1 sleep were significantly reduced with treatment.
Conclusion:
This proof-of-concept study suggests that OPT can produce clinically relevant relief of OSA in certain subjects who are readily identified by PSG during trial use of the noninvasive system. OPT shows promise as a new treatment option for OSA in appropriate patients.
