29/01/2013 - RISCHI ALLA SALUTE PER CHI RUSSA

Una ricerca dell'Henry Ford Hospital di Detroit dimostra che russare di notte mette a serio rischio la salute delle persone in sovrappeso, di quelle con il colesterolo alto e dei fumatori. I pericoli maggiori sono l'ispessimento e le anomalie della carotide, precursori dell'aterosclerosi, indurimento delle arterie responsabile di molte malattie vascolari. "Russare e' un'attivita' molto piu' rischiosa di quanto si pensi e non deve essere ignorata", ha spiegato Robert Deeb, autore dello studio pubblicato sulla rivista Laryngoscope. "Si tende a liquidare il russare come un semplice fastidio notturno ma non e' cosi'", ha continuato Deeb. "I pazienti che russano devono farsi curare allo stesso modo dei pazienti che soffrono di apnea del sonno, pressione alta e di altri fattori di rischio correlati alle malattie cardiovascolari", ha aggiunto. Lo studio ha dimostrato che russare provoca cambiamenti nella carotide anche in quelle persone che non sono soggette ad apnea del sonno. Le mutazioni nella carotide sono probabilmente provocate dalle infiammazioni e dai traumi causati dalle vibrazioni del russare. "Le malattie cardiovascolari possono insorgere nelle persone che russano molto prima che il disturbo si trasformi in apnea ostruttiva del sonno", ha concluso.

[Fonte - Sanitanews]

5/01/2012 - MAGNETIC RESONANCE SPECTROSCOPY IN OSA BEFORE AND AFTER CPAP
Magnetic Resonance Spectroscopy and Neurocognitive Dysfunction in Obstructive Sleep Apnea before and after CPAP Treatment [fonte www.journalsleep.org VOLUME 35, ISSUE 01]

http://dx.doi.org/10.5665/sleep.1582

Fergal J. O'Donoghue, MBBCh, PhD^1,2,4; R. Mark Wellard, BSc(hons), MSc, PhD^2,3; Peter D. Rochford, B App Sci¹; Andrew Dawson, BA (hons)¹; Maree Barnes, MBBS¹; Warren R. Ruehland, BSc(hons)^1,4; Melinda L. Jackson, PhD¹; Mark E. Howard, MBBS, PhD^1,4; Robert J. Pierce, MBBS, MD^1,4; Graeme D. Jackson, BSc, MBBS, MD^2,4

¹Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia; ²Brain Research Institute, Florey Neuroscience Institutes, Heidelberg West, Australia; ³Queensland University of Technology, Brisbane, Australia; ⁴University of Melbourne, Parkville, Australia

Abstract

Study Objectives:

To determine whether cerebral metabolite changes may underlie abnormalities of neurocognitive function and respiratory control in OSA.

Design:

Observational, before and after CPAP treatment.

Setting:

Two tertiary hospital research institutes.

Participants:

30 untreated severe OSA patients, and 25 age-matched healthy controls, all males free of comorbidities, and all having had detailed structural brain analysis using voxel-based morphometry (VBM).

Measurements and Results:

Single voxel bilateral hippocampal and brainstem, and multivoxel frontal metabolite concentrations were measured using magnetic resonance spectroscopy (MRS) in a high resolution (3T) scanner. Subjects also completed a battery of neurocognitive tests. Patients had repeat testing after 6 months of CPAP. There were significant differences at baseline in frontal N-acetylaspartate/choline (NAA/Cho) ratios (patients [mean (SD)] 4.56 [0.41], controls 4.92 [0.44], P = 0.001), and in hippocampal choline/creatine (Cho/Cr) ratios (0.38 [0.04] vs 0.41 [0.04], P = 0.006), (both ANCOVA, with age and premorbid IQ as covariates). No longitudinal changes were seen with treatment (n = 27, paired t tests), however the hippocampal differences were no longer significant at 6 months, and frontal NAA/Cr ratios were now also significantly different (patients 1.55 [0.13] vs control 1.65 [0.18] P = 0.01). No significant correlations were found between spectroscopy results and neurocognitive test results, but significant negative correlations were seen between arousal index and frontal NAA/Cho (r = −0.39, corrected P = 0.033) and between % total sleep time at SpO₂ < 90% and hippocampal Cho/Cr (r = −0.40, corrected P = 0.01).

Conclusions:

OSA patients have brain metabolite changes detected by MRS, suggestive of decreased frontal lobe neuronal viability and integrity, and decreased hippocampal membrane turnover. These regions have previously been shown to have no gross structural lesions using VBM. Little change was seen with treatment with CPAP for 6 months. No correlation of metabolite concentrations was seen with results on neurocognitive tests, but there were significant negative correlations with OSA severity as measured by severity of nocturnal hypoxemia.

Citation:

O'Donoghue FJ; Wellard RM; Rochford PD; Dawson A; Barnes M; Ruehland WR; Jackson ML; Howard ME; Pierce RJ; Jackson GD. Magnetic resonance spectroscopy and neurocognitive dysfunction in obstructive sleep apnea before and after CPAP treatment. SLEEP 2012;35(1):41-48.

21/12/2010 IL COSTO SOCIO-ECONOMICO DEI DISTURBI DEL SONNO

Uno studio pubblicato su Acta Neurological Scandinavia ha valutato l'incidenza di narcolessia, sindrome delle gambe senza riposo, apnee notturne e difficolta' respiratorie legate all'obesità. Chi ne e' affetto e' colpito da gravi crisi di sonno durante il giorno, durante il lavoro, la guida o i pasti. I ricercatori del Center for Healthy Aging dell'Universita' di Copenaghen e del e il Danish Institute for Health Services Research stimano che tra farmaci, visite mediche, degenze in ospedale e costi lavorativi, narcolessia e ipersonnia costino rispettivamente 10.223 e 2.190 euro l'anno.

02/12/2010 - Loud Snoring Predicts Metabolic Syndrome
 
By Cole Petrochko, Staff Writer, MedPage Today - Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Patients with sleep symptoms are at higher risk for developing metabolic syndrome, a prospective study found.

Difficulty falling asleep, snoring loudly, and unrefreshing sleep were significant predictors of metabolic syndrome (P<0.05). Snoring doubled the risk, while difficulty falling asleep increased the risk by 80%, Wendy Troxel, PhD, of the University of Pittsburgh, and colleagues reported in Sleep.

Loud snoring also was associated with doubled risks of other metabolic abnormalities, and remained a significant metabolic syndrome predictor after further apnea-hypopnea index (AHI) adjustment, whereas other sleep symptoms were only marginally significant, the researchers noted.

The study evaluated 2,000 patients enrolled in an ongoing, community-based prospective heart health study. Patients were ages 45 to 74, lived in or around the Pittsburgh metropolitan area, and had no comorbidity limiting life expectancy to less than five years.

Exclusion criteria included non-black or non-white race, presence of metabolic syndrome or diabetes at baseline, and missing sleep or covariate data at baseline.

The final sample included 812 patients, with a subset of 294 patients agreeing to undergo further evaluation at home in a follow-up analysis adjusted for AHI.

The primary outcome was the presence or absence of metabolic syndrome at the three-year follow-up. Waist circumference, fasting glucose, and lipids were measured at baseline and annually for three years.

Patients were given the Insomnia Sleep Questionnaire and the Multivariable Apnea Prediction Questionnaire to evaluate sleep-disordered breathing and insomnia symptoms. Covariate measures included history of smoking, alcohol consumption, physical activeness, and depressive symptoms.

At the three year follow-up, 14% of patients developed metabolic syndrome. After adjustment for loud snoring, difficulty falling asleep remained a significant predictor (OR 1.78, 95% CI 1.05 to 3.02), while unrefreshing sleep showed marginal significance (OR 1.56, 95% CI 0.96 to 2.53).

The significant symptoms also were compared against the AHI. Only loud snoring remained significant as a predictor (OR 3.01, 95% CI 1.39 to 6.55), while difficulty falling asleep was marginal (OR 1.91, 95% CI 0.80 to 4.58).

Researchers noted the study was limited by self-reported sleep disturbance and lack of sleep duration measures. The AHI analysis was limited by small subsample size and the cross-sectional nature of the AHI assessment.

Healthcare professionals should look for common sleep symptoms while assessing a patient due to the measured health risks associated with some symptoms, the researchers concluded, adding that future research could look at subjective sleep complaints and psychological factors affecting patients' poor sleep related to cardiovascular morbidity and mortality.

Co-authors reported relationships with ResMed, Respironics, Actelion, Arena, Cephalon, Eli Lilly, GlaxoSmithKline, Merck, Neurocrine, Neurogen, Pfizer, sanofi-aventis, Sepracor, Servier, Somnus, Stress Eraser, Takeda, and Transcept.

Primary source: Sleep
Source reference: Troxel WM "Sleep symptoms predict the development of the metabolic syndrome" SLEEP 2010; 33: 1633-1640.

[fonte medpagetoday.com]

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(ANSA) - ROMA, 19 GIU - Fino al 20% degli incidenti stradali potrebbe essere dovuto all'apnea notturna, patologia dovuta a un'alterazione delle vie respiratorie. Il dato e' emerso a Fiuggi, al simposio sulla 'Sindrome delle apnee ostruttive del Sonno'. Uno dei principali sintomi, spiegano gli esperti, e' la sonnolenza diurna, che puo' condurre nel tempo a disturbi dell'attenzione, deficit cognitivi, scarsa capacita' di concentrazione e colpi di sonno che possono rivelarsi letali quando si e' alla guida.

03/02/2010 - BRAIN GRAY MATTER CONCENTRATIONS IN OSA

Reduced Brain Gray Matter Concentration in Patients With Obstructive Sleep Apnea Syndrome

Eun Yeon Joo, MD, PhD¹; Woo Suk Tae, PhD²; Min Joo Lee, MS¹; Jung Woo Kang, MD¹; Hwan Seok Park, MD¹; Jun Young Lee, MD¹; Minah Suh, PhD³; Seung Bong Hong MD, PhD¹

¹Sleep Center, Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; ²Neuroscience Research Institute, Kangwon National University College of Medicine, Chunchon City, Korea; ³Department of Biological Science, Sungkyunkwan University, Suwon, Korea

Study Objectives: To investigate differences in brain gray matter concentrations or volumes in patients with obstructive sleep apnea syndrome (OSA) and healthy volunteers.
Designs: Optimized voxel-based morphometry, an automated processing technique for MRI, was used to characterize structural differences in gray matter in newly diagnosed male patients.
Setting: University hospital
Patients and Participants: The study consisted of 36 male OSA and 31 non-apneic male healthy volunteers matched for age (mean age, 44.8 years).
Interventions: Using the t-test, gray matter differences were identified. The statistical significance level was set to a false discovery rate P < 0.05 with an extent threshold of k_E > 200 voxels.
Measurements and Results: The mean apnea-hypopnea index (AHI) of patients was 52.5/ h. On visual inspection of MRI, no structural abnormalities were observed. Compared to healthy volunteers, the gray matter concentrations of OSA patients were significantly decreased in the left gyrus rectus, bilateral superior frontal gyri, left precentral gyrus, bilateral frontomarginal gyri, bilateral anterior cingulate gyri, right insular gyrus, bilateral caudate nuclei, bilateral thalami, bilateral amygdalo-hippocampi, bilateral inferior temporal gyri, and bilateral quadrangular and biventer lobules in the cerebellum (false discovery rate P < 0.05). Gray matter volume was not different between OSA patients and healthy volunteers.
Conclusions: The brain gray matter deficits may suggest that memory impairment, affective and cardiovascular disturbances, executive dysfunctions, and dysregulation of autonomic and respiratory control frequently found in OSA patients might be related to morphological differences in the brain gray matter areas.
Keywords: Obstructive sleep apnea, Brain, Gray matter concentration, MRI, Voxel based morphometry

Citation: Joo EY; Tae WS; Lee MJ; Kang JW; Park HS; Lee JY; Suh M; Hong SB. Reduced brain gray matter concentration in patients with obstructive sleep apnea syndrome. SLEEP 2010;33(2):235-241.

14/02/2009 - Congresso "Schlaf und Krankheit" Lipsia/Halle 12-14 Novembre 2009 in occasione della 17^ Convention annuale della DGSM -  Deutschen Gesellschaft für Schlafforschung und Schlafmedizin.

[http://www.dgsm2009.de/]

29/10/2008 Definition of Dental Sleep Medicine Dental Scope of Practice Protocol

Dental Sleep Medicine focuses on the management of sleep-related breathing disorders (SBD), which includes the continuum of snoring to obstructive sleep apnea (OSA), with oral appliance therapy (OAT) and upper airway surgery. OSA is a potentially life-threatening medical disorder that is more prevalent in males, and progressively worsens with advancing age and weight gain. It is caused by repetitive collapse and blockage of the upper airway while asleep that results in reduced oxygen delivery to body organs, most critically the heart and brain. Snoring and excessive daytime sleepiness (EDS) are the two most common symptoms of OSA. It may also cause memory loss, morning headaches, irritability, depression, decreased sex drive, and impaired concentration. Left untreated, OSA can result in hypertension, strokes, heart attacks, and sudden death while asleep, as well as motor vehicle accidents due to drowsiness while driving.
According to the Institute of Medicine’s 461 page report released in April 2006 entitled “Sleep Disorders and sleep Deprivation: An Unmet Public Health Problem” (http://nap.edu), an estimated 50-70 million Americans suffer from chronic sleep disorders, including OSA. EDS alone costs $150 billion annually in lost productivity and mishaps, and another $48 billion in medical costs related to motor vehicle accidents that involve drowsy drivers. Almost 20% of all serious car crash injuries are associated with driver EDS, independent of alcohol effects. Unfortunately the vast majority of these SBD go undiagnosed and untreated. Dentists, together with sleep physicians, are challenged to share responsibility in responding to this alarming data on the healthcare risks and economic impact of the largely undiagnosed and untreated SBD in the general population. Dentists have pioneered the scientific research and clinical development of OAT for SBD. OAT involves the selection, fabrication, fitting, adjustments, and long term follow-up care (and management of potential complications such as malocclusion and temporomandibular joint dysfunction) of custom-designed oral devices, worn only during sleep, to reposition the mandible and tongue base anteriorly to enlarge and stabilize the oropharyngeal airway. Based in large part on these numerous studies and successful outcomes, the American Academy of Sleep Medicine (AASM) in February 2006 published updated “Practice Parameters” for the treatment of OSA with OAT, followed by a comprehensive review article, which further validates the important role of OAT in the treatment of SBD, particularly mild to moderate OSA (Sleep 2006:29;240-262). Upper airway surgery is indicated when other therapies (eg., positional therapy, weight loss, and continuous positive airway pressure – by sleep physicians) are non-applicable, unsuccessful, or intolerable. Surgery may be an effective treatment for SBD, but only if performed competently and on correctly identified specific anatomic sites that contribute to upper airway obstruction, which varies between different patients.

The dental specialty of oral & maxillofacial surgery has pioneered the development of jaw, ie., maxillomandibular advancement (MMA), which is the most therapeutic surgery (excluding tracheostomy) for selected cases of moderate to severe OSA. MMA permanently advances the soft palate and tongue base (suspended from the maxilla and mandible, respectively) to enlarge and stabilize the entire velo-oro-hypopharyngeal airway and can be combined safely with adjunctive extrapharyngeal procedures in a single-staged operation. There are minimal risks of airway embarrassment due to edema in the immediate post-operative period or recurrent OSA
due to cicatricial scarring and contracture, because the tissue dissection and bony osteotomies are performed outside the pharyngeal airway lumen The American Academy of Dental Sleep Medicine and the AASM advocate the following medical-dental scope of practice protocol. The diagnosis of SBD, particularly the potentially life-threatening medical disorder OSA, as well as the differential diagnosis of narcolepsy, periodic limb movements of sleep, insufficient sleep syndrome, and other medical conditions that also exhibit EDS, must be determined by sleep physicians. Although research is needed to determine the efficacy and validity of evolving technology regarding portable monitoring, polysomnography, performed and interpreted by a sleep physician in an accredited sleep center or laboratory, is currently the best method to diagnose SBD. The treatment of selected SBD cases with OAT should be performed by qualified dentists, and upper airway surgery by qualified surgeons. This medical-dental practice protocol must continue to be promoted and implemented for the health and safety of our patients (and to comply with our state licensure
boards). Simply put, this scope of practice is just good (sleep and dental sleep) medicine.

American Academy of Dental Sleep Medicine
One Westbrook Corporate Center #920
Westchester, IL 60154
(708) 273-9366

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22/10/2008 - Snoring and Executive Function

Snoring in children is associated with poor executive function.

Sleep-disordered breathing (SDB) in children has been demonstrated to affect cognition, development, behavior, and school performance negatively. In this study, 39 children ages 3 to 5 years underwent executive-function testing (which evaluated planning, inhibitory control, and working memory); 3 months later, parents completed a sleep questionnaire that elicited parents’ ratings of their children’s snoring as occurring never, rarely, occasionally, frequently, or almost always.

After controlling for age, the authors found that a higher parent-reported risk for SDB was associated with significantly lower executive function. The strongest effect was on inhibition. Children classified as frequent or almost-always snorers performed significantly worse in all three dimensions of executive functioning than did those with less frequent or no snoring.

Comment: This study adds to a growing body of literature implicating childhood SDB in problems with development, cognition, and behavioral function. Although this study did not include polysomnography to determine where on the spectrum of SDB these children lay, previous studies have demonstrated negative developmental and behavioral effects in children who have "only" primary snoring, defined as snoring in the absence of apnea or hypopnea on polysomnography (e.g., Pediatrics 2006; 117:e496). These previous findings raise the issue of whether current standards for performing polysomnography in children and interpreting the results are sufficiently sensitive to identify all those with clinically significant SDB who might benefit from treatment.

— Dennis Rosen, MD

Dr. Rosen is Associate Medical Director of the Sleep Laboratory, Children’s Hospital Boston.

Published in Journal Watch Neurology October 21, 2008

Citation(s):

Karpinski AC et al. Risk for sleep-disordered breathing and executive function in preschoolers. Sleep Med 2008 May; 9:418.

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Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea.
 

Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Kuopio, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland. henri.tuomilehto@kuh.fi
 

RATIONALE: Obesity is the most important risk factor for obstructive sleep apnea (OSA). However, although included in clinical guidelines, no randomized controlled studies have been performed on the effects of weight reduction on mild OSA. OBJECTIVES: The aim of this prospective, randomized controlled parallel-group 1-year follow-up study was to determine whether a very low calorie diet (VLCD) with supervised lifestyle counseling could be an effective treatment for adults with mild OSA. METHODS: Seventy-two consecutive overweight patients (body mass index, 28-40) with mild OSA were recruited. The intervention group (n = 35) completed the VLCD program with supervised lifestyle modification, and the control group (n = 37) received routine lifestyle counseling. The apnea-hypopnea index (AHI) was the main objectively measured outcome variable. Change in symptoms and the 15D-Quality of Life tool were used as subjective measurements. MEASUREMENTS AND MAIN RESULTS: The lifestyle intervention was found to effectively reduce body weight (-10.7 +/- 6.5 kg; body mass index, -3.5 +/- 2.1 [mean +/- SD]). There was a statistically significant difference in the mean change in AHI between the study groups (P = 0.017). The adjusted odds ratio for having mild OSA was markedly lowered (odds ratio, 0.24 [95% confidence interval, 0.08-0.72]; P = 0.011) in the intervention group. All common symptoms related to OSA, and some features of 15D-Quality of Life improved after the lifestyle intervention. Changes in AHI were strongly associated with changes in weight and waist circumference. CONCLUSIONS: VLCD combined with active lifestyle counseling resulting in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA, and the achieved beneficial outcomes are maintained at 1-year follow-up. [fonte PubMed - indexed for MEDLINE]

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