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[PMID]: 29524092
[Au] Autor:Chang ET; Baik G; Torre C; Brietzke SE; Camacho M
[Ad] Address:Department of Surgery, Division of Otolaryngology, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA. etchan78@gmail.com.
[Ti] Title:The relationship of the uvula with snoring and obstructive sleep apnea: a systematic review.
[So] Source:Sleep Breath;, 2018 Mar 09.
[Is] ISSN:1522-1709
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:Currently, the relationship between uvula size and sleep-disordered breathing (snoring and obstructive sleep apnea) lacks data for objective interpretation. This study conducted a systematic review of the international literature for research describing the measurable characteristics of the uvula (i.e., size, length, width) and any association with snoring and obstructive sleep apnea (OSA). PubMED, Scopus, Google Scholar, Embase, and the Cochrane Library were each systematically searched from inception through November 15, 2016. We screened 1037 titles and abstracts. We conducted a full review of 54 downloaded articles. Sixteen articles met inclusion and exclusion criteria. The 16 studies included a total of 2604 patients. The selected articles included data and information for (1) normative data for uvular size in the control groups, (2) snoring and uvula size, (3) OSA and uvula size, and (4) overall uvula function. Our review noted variability in findings; however, in general, a uvular length > 15 mm was considered elongated and a uvular width > 10 mm was considered to be wide. The studies included in this systematic review reveal a relationship between uvula size, snoring, and OSA. Further, larger uvulas appear associated with more severe snoring and OSA. The direct correlation between uvula size and its relationship specifically to snoring and OSA remain as topics for future prospective research.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher
[do] DOI:10.1007/s11325-018-1651-5

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[PMID]: 29523819
[Au] Autor:Li HY; Lee LA; Kezirian EJ; Nakayama M
[Ad] Address:Department of Otorhinolaryngology - Head and Neck Surgery, Sleep Center, Linkou-Chang Gung Memorial Hospital, Taoyuan City, 33305, Taiwan R.O.C.. hyli38@cgmh.org.tw.
[Ti] Title:Suspension Palatoplasty for Obstructive Sleep Apnea- A Preliminary Study.
[So] Source:Sci Rep;8(1):4224, 2018 Mar 09.
[Is] ISSN:2045-2322
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Suspension palatoplasty, a new surgical technique to treat obstructive sleep apnea (OSA), has been developed to correct the retropalatal obstruction in patients with small tonsils (grade I/II) and anterior-posterior palatal (A-P) obstruction. The objecteive of this preliminary study was to investigate the effectiveness and change in retropalatal airway dimensions after suspension palatoplasty. This retrospective case series study included 25 consecutive male adults with OSA. Unique technical features of suspension palatoplasty are exposure of pterygomandibular raphe and suspension of palatopharyngeus muscle to the raphe. Six months after suspension palatoplasty, apnea-hyponea index significantly reduced from 39.8 to 15.1 (effect size = 1.6). None experienced postoperative bleeding and velopharyngeal insufficiency 1 month following surgery. Subjective snoring severity (visual analogue scale) and daytime sleepiness (the Epworth Sleepiness Scale) significantly improved (8.7 vs 2.0 and 10.2 vs 4.9, respectively). A-P dimension of the retropalatal airspace widened significantly on perioperative endoscopy (23.0 units vs 184.6 unites) as well as posterior air space in cephalometry (7.6 mm vs 10.2 mm). Our preliminary findings show that suspension palatoplasty seems to be an effective OSA surgery in the specific patient population with minimal complications, however, further studies including a large number of patients are required to confirm the findings.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.1038/s41598-018-22710-1

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[PMID]: 29523262
[Au] Autor:Louis JM; Koch MA; Reddy UM; Silver RM; Parker CB; Facco FL; Redline S; Nhan-Chang CL; Chung JH; Pien GW; Basner RC; Grobman WA; Wing DA; Simhan HN; Haas DM; Mercer BM; Parry S; Mobley D; Carper B; Saade GR; Schubert FP; Zee PC
[Ad] Address:Case Western Reserve University, Cleveland, OH. Electronic address: jlouis1@health.usf.edu.
[Ti] Title:Predictors of sleep-disordered breathing in pregnancy.
[So] Source:Am J Obstet Gynecol;, 2018 Feb 02.
[Is] ISSN:1097-6868
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Sleep-disordered breathing (SDB) is common in pregnancy, but there are limited data on predictors. OBJECTIVES: The objective of this study was to develop predictive models of sleep-disordered breathing during pregnancy. STUDY DESIGN: Nulliparous women completed validated questionnaires to assess for symptoms related to snoring, fatigue, excessive daytime sleepiness, insomnia, and restless leg syndrome. The questionnaires included questions regarding the timing of sleep and sleep duration, work schedules (eg, shift work, night work), sleep positions, and previously diagnosed sleep disorders. Frequent snoring was defined as self-reported snoring ≥3 days per week. Participants underwent in-home portable sleep studies for sleep-disordered breathing assessment in early (6-15 weeks gestation) and mid pregnancy (22-31 weeks gestation). Sleep-disordered breathing was characterized by an apnea hypopnea index that included all apneas, plus hypopneas with ≥3% oxygen desaturation. For primary analyses, an apnea hypopnea index ≥5 events per hour was used to define sleep-disordered breathing. Odds ratios and 95% confidence intervals were calculated for predictor variables. Predictive ability of the logistic models was estimated with area under the receiver-operating-characteristic curves, along with sensitivities, specificities, and positive and negative predictive values and likelihood ratios. RESULTS: Among 3705 women who were enrolled, data were available for 3264 and 2512 women in early and mid pregnancy, respectively. The corresponding prevalence of sleep-disordered breathing was 3.6% and 8.3%, respectively. At each time point in gestation, frequent snoring, chronic hypertension, greater maternal age, body mass index, neck circumference, and systolic blood pressure were associated most strongly with an increased risk of sleep-disordered breathing. Logistic regression models that included current age, body mass index, and frequent snoring predicted sleep-disordered breathing in early pregnancy, sleep-disordered breathing in mid pregnancy, and new onset sleep-disordered breathing in mid pregnancy with 10-fold cross-validated area under the receiver-operating-characteristic curves of 0.870, 0.838, and 0.809. We provide a supplement with expanded tables, integrated predictiveness, classification curves, and an predicted probability calculator. CONCLUSION: Among nulliparous pregnant women, logistic regression models with just 3 variables (ie, age, body mass index, and frequent snoring) achieved good prediction of prevalent and incident sleep-disordered breathing. These results can help with screening for sleep-disordered breathing in the clinical setting and for future clinical treatment trials.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

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[PMID]: 29423748
[Au] Autor:Lim JH; Park P; Wee JH; Gelera JE; Shrestha KK; Rhee CS; Kim JW
[Ad] Address:Department of Otolaryngology-Head and Neck Surgery, National Police Hospital, Seoul, South Korea.
[Ti] Title:Evaluation of the success of obstructive sleep apnea surgery using criteria based on long-term symptoms and incident hypertension.
[So] Source:Eur Arch Otorhinolaryngol;275(4):1015-1022, 2018 Apr.
[Is] ISSN:1434-4726
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To identify appropriate success criteria, based on long-term symptoms and incident hypertension, after surgery for obstructive sleep apnea (OSA). METHODS: This observational cohort study included 97 adult OSA patients (90 men) who underwent surgical treatment at our tertiary medical center. Subjective symptoms [witnessed sleep apnea and snoring, and Epworth sleepiness scale (ESS) scores] were evaluated through a telephone survey, and incident hypertension was assessed from medical records. The subjects were divided into success and failure groups according to seven different criteria, and data were analyzed to identify the criteria that could significantly differentiate the success from failure groups. RESULTS: The participants had a mean age of 48.8 ± 11.9 years and a mean preoperative body mass index of 26.5 ± 3.5 kg/m . The mean preoperative and postoperative apnea-hypopnea index (AHI) values were 36.1/h and 19.4/h, respectively. The mean follow-up duration was 77.0 ± 31.1 months. Postoperative witnessed apnea, snoring, and the ESS scores decreased significantly compared to preoperative scores in both the success and failure groups based on most of the seven criteria. Among the seven criteria, success and failure groups based on a postoperative AHI cutoff of 15 or 20/h differed significantly in witnessed apnea, snoring, or ESS scores. Kaplan-Meier survival analysis based on incident hypertension revealed that no criterion could significantly distinguish between the two groups. CONCLUSIONS: Our results suggest that some of the success criteria analyzed may be more useful in differentiating between success and failure groups after surgery, in terms of long-term improvement of subjective OSA-related symptoms.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Process
[do] DOI:10.1007/s00405-018-4894-7

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[PMID]: 29338353
[Au] Autor:Robbins R; Senathirajah Y; Williams NJ; Hutchinson C; Rapoport DM; Allegrante JP; Cohall A; Rogers A; Ogedegbe O; Jean-Louis G
[Ad] Address:a Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health , NYU School of Medicine.
[Ti] Title:Developing a Tailored Website for Promoting Awareness about Obstructive Sleep Apnea (OSA) Among Blacks in Community-Based Settings.
[So] Source:Health Commun;:1-9, 2018 Jan 17.
[Is] ISSN:1532-7027
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Blacks are at greater risk for lower sleep quality and higher risk for obstructive sleep apnea (OSA) than other racial groups. In this study, we summarize the development of a tailored website including visuals, key messages, and video narratives, to promote awareness about sleep apnea among community-dwelling blacks. We utilized mixed methods, including in-depth interviews, usability-testing procedures, and brief surveys (n = 9, 55% female, 100% black, average age 38.5 years). Themes from the qualitative analysis illuminated varied knowledge regarding OSA symptoms and prevalent self-reported experience with sleep disturbance and OSA symptoms (e.g., snoring). On a scale from 1 (not at all) to 5 (very high), participants provided favorable ratings of website usefulness (mean = 4.9), user friendliness (mean = 4.9) and attractiveness (mean = 4.3). Our findings suggest although tailored health communication has potential for serving as a tool for advancing health equity, usability-testing of health materials is critical to ensure that culturally and linguistically tailored messages are acceptable and actionable in the intended population.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1080/10410236.2018.1423865

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[PMID]: 29275425
[Au] Autor:Camacho M; Guilleminault C; Wei JM; Song SA; Noller MW; Reckley LK; Fernandez-Salvador C; Zaghi S
[Ad] Address:Division of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI, 96859, USA. drcamachoent@yahoo.com.
[Ti] Title:Oropharyngeal and tongue exercises (myofunctional therapy) for snoring: a systematic review and meta-analysis.
[So] Source:Eur Arch Otorhinolaryngol;275(4):849-855, 2018 Apr.
[Is] ISSN:1434-4726
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: Oropharyngeal and tongue exercises (myofunctional therapy) have been shown to improve obstructive sleep apnea. However, to our knowledge, a systematic review has not been performed for snoring. The study objective is to perform a systematic review, with a meta-analysis, dedicated to snoring outcomes after myofunctional therapy. METHODS: PubMed/MEDLINE and three other databases were searched through November 25, 2017. Two authors independently searched the literature. Eligibility (1) patients: children or adults with snoring, (2) intervention: oropharyngeal and/or tongue exercises, (3) comparison: pre and post-treatment data for snoring, (4) outcomes: snoring frequency and snoring intensity, (5) study design: publications of all study designs. RESULTS: A total of 483 articles were screened, 56 were downloaded in their full text form, and nine studies reported outcomes related to snoring. There were a total of 211 patients (all adults) in these studies. The snoring intensity was reduced by 51% in 80 patients from pre-therapy to post-therapy visual analog scale values of 8.2 ± 2.1 (95% CI 7.7, 8.7) to 4.0 ± 3.7 (95% CI 3.2, 4.8). Berlin questionnaire snoring intensity reduced by 36% in 34 patients from 2.5 ± 1.0 (95% CI 2.2, 2.8) to 1.6 ± 0.8 (95% CI 1.3, 1.9). Finally, time spent snoring during sleep was reduced by 31% in 60 patients from 26.3 ± 18.7% (95% CI 21.6, 31.0) to 18.1 ± 20.5% (95% CI 12.9, 23.3) of total sleep time. CONCLUSIONS: This systematic review demonstrated that myofunctional therapy has reduced snoring in adults based on both subjective questionnaires and objective sleep studies.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1712
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Process
[do] DOI:10.1007/s00405-017-4848-5

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[PMID]: 29361188
[Au] Autor:Cai GH; Janson C; Theorell-Haglöw J; Benedict C; Elmståhl S; Lind L; Lindberg E
[Ad] Address:Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
[Ti] Title:Both Weight at Age 20 and Weight Gain Have an Impact on Sleep Disturbances Later in Life: Results of the EpiHealth Study.
[So] Source:Sleep;41(1), 2018 Jan 01.
[Is] ISSN:1550-9109
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Study Objectives: Obesity is often associated with impaired sleep, whereas the impact of body mass index (BMI) at younger age and previous weight gain on sleep problems remains unknown. Methods: The present study utilized data from the Swedish EpiHealth cohort study. A total of 15845 participants (45-75 years) filled out an internet-based questionnaire. BMI was calculated from both measured data at study time and self-reported data at age 20 from the questionnaire. Results: Sleep-related symptoms were most common among obese individuals (BMI > 30 kg/m2). An association between weight gain and sleep problems was found and those with a low BMI at age 20 were most vulnerable to weight gain when it came to risk of sleep problems. Among those who were underweight (BMI < 18.5 kg/m2) at age 20, weight gain (kg/year) was associated with difficulties initiating sleep with an adjusted OR of 2.64 (95% CI: 1.51-4.62) after adjusting for age, sex, smoking, alcohol consumption, physical activity, education, and civil status. The corresponding adjusted OR's among those who had been normal weight (BMI 18.5-24.99) and overweight (BMI 25-29.99 kg/m2) at age 20 were 1.89 (1.47-2.45) and 1.02 (0.48-2.13), respectively. Also difficulties maintaining sleep and snoring were most strongly related to weight gain among those who were underweight at age 20 with decreasing odds with increasing BMI at that age. Conclusions: Sleep problems are related to weight gain and obesity. The impact of weight is most pronounced among those who had a low BMI when young.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1093/sleep/zsx176

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[PMID]: 29267958
[Au] Autor:Horne RSC; Roy B; Walter LM; Biggs SN; Tamanyan K; Weichard A; Nixon GM; Davey MJ; Ditchfield M; Harper RM; Kumar R
[Ad] Address:The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia.
[Ti] Title:Regional Brain Tissue Changes and Associations with Disease Severity in Children with Sleep Disordered Breathing.
[So] Source:Sleep;, 2017 Dec 15.
[Is] ISSN:1550-9109
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Study Objectives: Children with sleep-disordered breathing (SDB) exhibit behavioral, cognitive, and autonomic deficits, suggestive of neural injury. We assessed whether the tissue alterations resulted from acute or chronic processes, and if alterations correlated with disease severity. Methods: Brain tissue integrity was examined with mean diffusivity (MD) (3.0-Tesla scanner) in 20 non-snoring controls (mean age±sem, 12.2±0.6y; 10 male) and 18 children with SDB (12.3±0.7y; 11 male). Sleep, cognitive, and behavioral measures were compared between groups following overnight polysomnography using Student's t-tests. Whole-brain MD maps were realigned and averaged, normalized, smoothed, and compared between groups using ANCOVA (covariates; age, gender, and socioeconomic status). Partial correlations were calculated between whole-brain smoothed MD maps and obstructive apnea hypopnea indices (OAHI). Results: Age, gender, and sleep variables did not differ between groups. The SDB group showed higher OAHI, body mass indices, and systolic blood pressure. Significantly reduced MD values (acute changes) appeared in the hippocampus, insula, thalamus, temporal and occipital cortices, and cerebellum, but were increased (chronic damage) in the frontal and prefrontal cortices in the SDB group over controls. Both positive and negative correlations appeared with extent of tissue changes and disease severity. Externalizing and Total Problem Behaviors were significantly higher in SDB children. Verbal, performance and total IQ scores trended lower, and behavioral scores trended higher. Conclusions: Pediatric SDB is accompanied by predominantly acute brain changes in areas that regulate autonomic, cognitive, and mood functions, and chronic changes in frontal cortices essential for behavioral control. Interventions need to be keyed to address acute vs chronic injury.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/sleep/zsx203

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[PMID]: 29246266
[Au] Autor:Di Pauli F; Stefani A; Holzknecht E; Brandauer E; Mitterling T; Holzinger B; Högl B
[Ad] Address:Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
[Ti] Title:Dream Content in Patients With Sleep Apnea: A Prospective Sleep Laboratory Study.
[So] Source:J Clin Sleep Med;14(1):41-46, 2018 Jan 15.
[Is] ISSN:1550-9397
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:STUDY OBJECTIVES: Few studies have addressed dreaming in patients with sleep apnea. We hypothesized that respiratory events and subsequent oxygen desaturation act as an important physiological trigger and may thus influence dream content in patients with a sleep-related breathing disorder. METHODS: Seventy-six patients (28 women, mean age 54 years, range 20-82) who underwent polysomnography because of suspected sleep apnea participated in this study. Dream reports and dream questionnaires were collected immediately after first morning awakening, at 5:30 AM, at the sleep laboratory. Dream content analysis with respect to possible respiratory-related content was performed. Patients were stratified into primary snoring, mild, moderate, and severe sleep apnea groups. RESULTS: In 63 patients sleep apnea was diagnosed (mild n = 31, 49.2%, moderate n = 13, 20.6%, severe n = 19, 30.2%), and 13 subjects in whom a sleep-related breathing disorder was not confirmed were included as a control group with primary snoring. There was no significant difference in respiratory-related dream topics between patients and controls. Also, no influence of respiratory parameters measured during polysomnography on dream content was detectable. CONCLUSIONS: We failed to detect a difference in dream content between patients with sleep apnea and controls. Further studies are required to determine whether these results indicate that the incorporation of respiratory events into dreams is absent in patients with sleep apnea or represents a bias due to the collection of dream content in the early morning hours.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.5664/jcsm.6876

  10 / 6685 MEDLINE  
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[PMID]: 29237080
[Au] Autor:Thomas RJ; Wood C; Bianchi MT
[Ad] Address:Division of Pulmonary, Critical Care & Sleep, Department of Medicine, Beth Israel Deaconess Medical center, Boston, Massachusetts, USA.
[Ti] Title:Cardiopulmonary coupling spectrogram as an ambulatory clinical biomarker of sleep stability and quality in health, sleep apnea and insomnia.
[So] Source:Sleep;, 2017 Dec 09.
[Is] ISSN:1550-9109
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Study Objectives: Ambulatory tracking of sleep and sleep pathology is rapidly increasing with the introduction of wearable devices. The objective of this study was to evaluate a wearable device which used novel computational analysis of the electrocardiogram (ECG), collected over multiple nights, as a method to track the dynamics of sleep quality in health and disease. Methods: This study used the electrocardiogram as a primary signal, a wearable device, the M1, and an analysis of cardiopulmonary coupling to estimate sleep quality. The M1 measures trunk movements, the ECG, body position, and snoring vibrations. Data from three groups of patients were analyzed, healthy subjects, sleep apnea, and insomnia patients, obtained from multiple nights of recording. Analysis focused on summary measures and night-to-night variability, specifically the intra-class coefficient. Results: Data was collected from 10 healthy, 18 positive pressure treated sleep apnea, and 20 insomnia patients, 128, 65 and 121 nights respectively. In any subject, all nights were consecutive. High frequency coupling, the signal biomarker of stable breathing and stable sleep, showed high ICC's in healthy subjects and sleep apnea patients (0.83, 0.89) but only 0.66 in insomnia subjects. The only statistically significant difference between weekday vs. weekend in healthy subjects was HFC duration: 242.8 ± 53.8 vs. 275.8 ± 57.1 minutes (89 vs. 39 total nights), F(1,126)=9.86, p: 0.002. Conclusions: The M1 and similar wearable devices provide new opportunities to measure sleep in dynamic ways not possible before. These measurements can yield new biological insights, and aid clinical management.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/sleep/zsx196


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