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Obesity and Obstructive Sleep Apnoea
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Dagmara Hering, Jacek Wolf, Marzena Chrostowska, Krzysztof Narkiewicz
Patients presenting with typical OSA symptoms (e.g. hypersomnolence, sleep-time choking, snoring, observed apnoeas) are diagnosed if five or more scoreable respiratory events (predominantly obstructive or mixed apnoeas, hyponoeas or respiratory effort—related arousals [RERAs]) per hour of sleep are reported on PSG. Alternatively, 15 respiratory events per hour of sleep on reporting PSG justifies diagnosis, irrespective of patient’s complaints (12). Based on the index denoting average number of apnoeic and hypopnoeic episodes per hour of sleep (AHI) or obstructive respiratory disturbance index (RDI) if RERAs are considered, OSA is classified as follows: mild, AHI ≥5 and >15 events per hour; moderate, AHI ≥15 and ≤30 events per hour; and severe, AHI >30 events per hour (13).
Impairment of pulmonary functions
Published in Ramar Sabapathi Vinayagam, Integrated Evaluation of Disability, 2019
In “apnea,” there is a reduction in airflow by 90% or more of the pre-apnea reference level detected by an oronasal thermal sensor or other recommended sensors, and the decrease in airflow extends for 10 seconds or longer. In “hypopnea,” there is a decline in airflow by 30% or more of the pre-hypopnea reference level detected by nasal pressure sensors or other specified sensors, and the decrease in airflow remains for 10 seconds or longer, and oxygen desaturation also remains 3% or more from the pre-hypopnea reference level. Respiratory effort related arousal (RERA) may accompany hypopnea (18). Alpha and theta activity, or waveforms, greater than 16 cycles/second in EEG detect respiratory effort related arousal RERA (17). Respiratory disturbance index (RDI) refers to the combined number of respiratory events, namely hypopnea, apnea, and RERA per hour of sleep. RDI is 5-15 events per hour of sleep in mild apnea, 15-30 per hour of sleep in moderate apnea, and over 30 per hour of sleep in severe apnea (17).
Specific causes of automatism
Published in John Rumbold, Automatism as a Defence in Criminal Law, 2018
The assessment of OSAHS requires a PSG plus either multiple sleep latency tests or, more appropriately, maintenance of wakefulness tests. The latter is considered more directly relevant to driving as it is conducted in conditions close to driving. In severe sleep apnoea the apnoea/hypopnoea index (AHI – the total number of episodes of apnoea and hypopnoea divided by the number of hours of sleep) should be greater than 30/hour.4 The usefulness of the AHI is disputed (Stradling and Davies, 2004) and there are several other measures e.g. the Respiratory Disturbance Index (RDI – average number per sleep hour of apnoeas, hypopnoeas and respiratory effort-related arousals), Oxygen Desaturation Index (ODI – the average number of significant oxygen desaturations per hour of sleep) and arousal index (number of EEG arousals per hour). Sleepiness is usually assessed by the Epworth Sleepiness Scale, those scoring over 12 having EDS (normal average score is five) (Johns, 1991). The test that is most applicable to driving is the maintenance of wakefulness test. This test will be relevant to other causes of hypersomnia such as narcolepsy.
Effects of unilateral sinonasal surgery on sleep-disordered breathing
Published in Acta Oto-Laryngologica, 2019
Kojiro Ishioka, Hitoshi Okumura, Takanobu Sasaki, Masanao Ikeda, Nao Takahashi, Hironori Baba, Naotaka Aizawa, Arata Horii
3%ODI is adopted in the definition of hypopnea proposed by the American Academy of Sleep Medicine [13]. In previous study, 3%ODI could be considered as an initial diagnostic test for OSA with significantly higher sensitivity than 2%ODI and 4%ODI [14]. It is also reported that 3%ODI well correlated with AHI in patients with particularly moderate-severe OSA [15]. Therefore, we adopted 3%ODI as an easy, simple, and reliable marker of SDB that can be performed even in post-operative hospitalized patients. Preoperative 3%ODI was 10.08 ± 7.32 (times/hour) and it increased to 19.53 ± 13.60 three days after surgery when nasal cavity of the surgical side was still completely packed (p < .05, Figure 2), suggesting that even unilateral complete nasal obstruction could worsen the 3%ODI during sleep. For example, unilateral complete nasal congestion caused by acute rhinitis or pollinosis occurring in the nasal cavity with deflected nasal septum may be very harmful for respiration during sleep. 3%ODI significantly decreased to 7.67 ± 5.79 five days after surgery than preoperative value (p < .05, Figure 2), suggesting that surgery for unilateral sinonasal lesion can improve the respiration during sleep. According to the recent systematic review [18], isolated nasal surgery can reduce the daytime sleepiness, snoring, and RDI (respiratory disturbance index), however, it did not improve the AHI measured by PSG (Polysomnography). Although 3%ODI used in the present study is one of reliable markers of SDB, there still remain possibilities that unilateral sinonasal surgeries would not have impacts on AHI.
Value of pulse oximetry watch for diagnosing pediatric obstructive sleep apnea/hypopnea syndrome
Published in Acta Oto-Laryngologica, 2018
Jing-Ru Ma, Jing-Jing Huang, Qi Chen, Hai-Tao Wu, Kuan-Lin Xiao, Yu-Tian Zhang
With the development of science and technology, the family medical practice has become the ideal model for the management of chronic diseases, deriving a multitude of medical products and related applications. Research on the curative effects of the portable monitor device (PMD) and family follow-up have been conducted by domestic and overseas scholars. WatchPAT is a portable sleep-monitoring device that can judge respiratory events mainly through the distal finger volume innervated by the sympathetic nerve which is associated with sleep apnea and hypopnea events. Some researchers have shown that WatchPAT-respiratory disturbance index (WatchPAT-RDI) was highly related to PSG-RDI, and it could be used for the measurement of the effective apnea hypopnea index (AHI) in a home setting and to assess the effective AHI for any therapeutic intervention [1,2]. Furthermore, the satisfactory sensitivity and specificity of PMD for diagnosing the severity of moderate and severe OSAHS had been reported, and the study implied that PMD could be used for the preliminary diagnosis of patients with moderate and severe OSAHS [3].
Impact of obstructive sleep apnea on blood pressure and cardiovascular risk factors in Japanese men: A cross-sectional study in work-site group
Published in Clinical and Experimental Hypertension, 2018
Yuki Morinaga, Kiyoshi Matsumura, Yasuo Kansui, Satoko Sakata, Kenichi Goto, Yoshie Haga, Emi Oishi, Takunori Seki, Toshio Ohtsubo, Takanari Kitazono
It has been shown that OSA is highly prevalent in adults in epidemiological studies. (11–13) Nakayama-Ashida et al. investigated the prevalence of OSA in a cross-sectional survey in Japan(15). They used a portable monitor which had a minimum of four channels, including ventilation or airflow (at least two channels of respiratory movement, or respiratory movement and airflow), heart rate or ECG and oxygen saturation. The respiratory disturbance index (RDI) which represent the average number of apneas plus hypopneas per hour during the analyzed period were calculated, and they showed that the prevalence of RDI of ≥5 and ≥30 were 59.7% and 6.6%, respectively. Their findings, particularly in prevalence of severe OSA, are consistent with the results of the present study, although prevalence of mild to moderate OSA are different between the two studies. In the present study, primary aim of the screening test for OSA was to detect severe OSA. Therefore, cut-off value of screening test for OSA by using pulse oximeter was set to be mild, and the differences of OSA prevalence between the previous and the present findings might be attributable to the mild cut-off value of screening test used in the present study. The advantage of the present study was that the severity of OSA was evaluated by PSG, which is the only standard method to evaluate OSA correctly.