Sleep Med 2006 May 17; (Read article online)

Stepnowsky CJ, Marler MR, Palau J, Annette Brooks J

BACKGROUND AND PURPOSES: Obstructive sleep apnea (OSA) is a condition with serious medical and psychosocial consequences. However, poor adherence with nasal continuous positive airway pressure (CPAP) treatment limits the effectiveness of treatment. Behavior change factors offer one avenue of research to better understand the correlates of CPAP adherence. PATIENTS AND METHODS: Fifty-eight participants who had been diagnosed with OSA and prescribed CPAP treatment agreed to complete questionnaires that assessed sleep apnea symptoms, behavior change factors, and CPAP side effects, and to have their CPAP data downloaded. Behavior change factors from both social cognitive theory (SCT) and the transtheoretical model (TM) were assessed. The primary aim of the study was to examine the relationship between these social-cognitive factors and objectively measured CPAP adherence. RESULTS: Participants had been using CPAP for a mean of 2.1 years. SCT variables (adjusted R(2)=0.115, P=.008) and TM variables (adjusted R(2)=0.157, P<.0001) each accounted for a statistically significant amount of variance in CPAP adherence. CONCLUSIONS: The results suggest that social-cognitive factors may be associated with CPAP adherence in experienced CPAP users. The principal advantage to these theory-driven and empirically validated factors is that they are modifiable and can provide the basis for effective interventions to increase CPAP adherence.

Prog Cardiovasc Dis 2006 May-Jun; 48(6): 387-96 (Read article online)

Calhoun DA

Resistant hypertension is defined as an elevated blood pressure in spite of treatment with 3 different antihypertensive agents. The prevalence of resistant hypertension is unknown, but recent cross-sectional analyses and hypertension outcome studies suggest it is a common clinical problem and will become even more so with an aging and increasingly heavy population. Secondary causes of hypertension are common in patients with resistant hypertension, in particular, obstructive sleep apnea and hyperaldosteronism. Treatment of resistant hypertension is predicated upon identification and reversal of secondary causes of hypertension, as possible, and effective use of multidrug regimens. Recent clinical studies indicate that aldosterone antagonists, spironolactone and amiloride, provide significant additional blood pressure reduction when added to treatment regimens of patients with resistant hypertension. Both agents are generally well tolerated. Hyperkalemia is an uncommon complication of aldosterone antagonists, but it can occur; therefore, biochemical monitoring is necessary, particularly in high-risk patients.

Growth Horm IGF Res 2006 May 19; (Read article online)

Inge TH

Obesity is one of the most common metabolic disorders affecting the US population: 31% of adults and 16% of adolescents now meet the criteria for obesity. Similar to the rising prevalence of morbid obesity in adults, the prevalence of more severe obesity is also increasing in pediatric patients. The most effective treatment for morbid obesity is bariatric surgery, a procedure most commonly performed in the fifth and sixth decades of life. Although it is clear that rapid, profound weight loss can significantly improve multiple comorbid conditions in adults, including disordered carbohydrate metabolism, obstructive sleep apnea, and cardiovascular risk factors, it is not clear to what degree similar comorbidities are affected in adolescents undergoing surgical weight loss. In this paper, the indications, contraindications, and early surgical outcomes of gastric bypass surgery for morbidly obese adolescents are reviewed, and important directions for future research are discussed.

Endocr J 2006 May 23; (Read article online)

Makino S, Iwata M, Fujiwara M, Ike S, Tateyama H

A 55-year-old female was admitted to our hospital with severe hypertension (274/140 mmHg). Endocrinological examination revealed that her plasma levels of norepinephrine (NE) was elevated with high levels of urinary NE, normetanephrine and vanillylmandelic acid (VMA), suggesting the presence of pheochromocytoma. However, neither computed tomography nor MIBG scintigraphy detected any catecholamine-producing tumor in or outside the adrenal glands. She was screened with full polysomnography because of heavy snoring, and the diagnosis of severe obstructive sleep apnea syndrome (OSAS) was made. She was treated with calcium channel blocker for three weeks, but severe hypertension persisted. After treatment with nasal continuous positive airway pressure (CPAP) was added, her blood pressure gradually lowered week by week. Concomitantly, the levels of plasma and urinary NE, urinary normetanephrine and urinary VMA were normalized following nasal CPAP therapy for 2 weeks. Additional treatments with alpha-adrenergic blocker further decreased her home blood pressure. After a year, she continued nasal CPAP therapy and her blood pressure was nearly below 160/100 mmHg. Urinary NE level was slightly above normal range and other catecholamines stayed within the normal range. This case shows that patients with OSAS could develop severe hypertension through elevated sympathetic tone, mimicking pheochromocytoma. Nasal CPAP therapy is recommended not only to improve hypertension and catecholamine excess but also to distinguish the condition from pheochromocytoma.

Sleep Med 2006 May 17; (Read article online)

Verin E, Petelle B, Raux M, Vincent G, Fleury B, Similowski T

BACKGROUND: Mandibular advancement (MA) can be an alternative to continuous positive airway pressure (CPAP) in the treatment of obstructive sleep apnea syndrome. This study was designed to describe its effects on upper airway mechanics. METHODS: Six awake healthy subjects (four men, 31+/-8 years, body mass index (BMI) 25+/-2kg/m2) were studied supine. Phrenic stimulation was used to measure pressure-flow relationships in response to diaphragm contractions without pre-activation of upper airway dilators during progressive MA. RESULTS: Phrenic stimulation consistently induced flow limitation (initial peak V'-t1, corresponding to the limiting pressure; reduction to a nadir V'-t2; reincrease to a second peak V'-t3). The upper airway resistances were negatively correlated with MA. Their values at 4mm were significantly lower than at baseline. Further MA reduced resistances. CONCLUSIONS: As with CPAP, MA in normal subjects decreases the propensity of the upper airway to collapse in response to a negative pressure pulse.

J Appl Physiol 2006 Jun; 100(6): 2057-64 (Read article online)

Datta A, Tipton M

The ventilatory responses to immersion and changes in temperature are reviewed. A fall in skin temperature elicits a powerful cardiorespiratory response, termed "cold shock," comprising an initial gasp, hypertension, and hyperventilation despite a profound hypocapnia. The physiology and neural pathways of this are examined with data from original studies. The respiratory responses to skin cooling override both conscious and other autonomic respiratory controls and may act as a precursor to drowning. There is emerging evidence that the combination of the reestablishment of respiratory rhythm following apnea, hypoxemia, and coincident sympathetic nervous and cyclic vagal stimulation appears to be an arrhythmogenic trigger. The potential clinical implications of this during wakefulness and sleep are discussed in relation to sudden death during immersion, underwater birth, and sleep apnea. A drop in deep body temperature leads to a slowing of respiration, which is more profound than the reduced metabolic demand seen with hypothermia, leading to hypercapnia and hypoxia. The control of respiration is abnormal during hypothermia, and correction of the hypoxia by inhalation of oxygen may lead to a further depression of ventilation and even respiratory arrest. The immediate care of patients with hypothermia needs to take these factors into account to maximize the chances of a favorable outcome for the rescued casualty.

Eur Arch Otorhinolaryngol 2006 May 19; (Read article online)

Röösli C, Schneider S, Häusler R

A modified uvulopalatopharyngoplasty (UPPP) was carried out between January 1992 and December 2003 at the ENT Department of the Inselspital in Bern in 146 patients with habitual or complicated rhonchopathy. The operation consisted of a classical tonsillectomy or residual tonsil resection and additional shortening of the uvula. The natural mucosal fold between the uvula and the upper pole of the tonsils was carefully preserved. A wide opening to the rhinopharynx was created by asymmetric suturing of the glossopalantine and pharyngopalatine arches. A retrospective questionnaire with regard to rhonchopathy, phases of apnea, daytime drowsiness, obstruction of nasal breathing, long-term complications and patient satisfaction was used to evaluate the short-term and long-term effectiveness of the modified UPPP as well as the incidence of adverse side effects. Complete postoperative courses were evaluated in 116 patients. Surgical complications were restricted to one case with postoperative hemorrhage. A velum insufficiency or postoperative rhinopharyngeal stenosis did not occur. Eighty-three patients (72%) confirmed a persistent suppression or substantial improvement of the rhonchopathy. Disappearance or decrease of sleep apnea was confirmed in 12 (63%) out of 19 postoperative polysomnographic follow-up investigations. Long-term complications occurred in a total of 27 (23%) of 116 patients. They were confined to minor problems such as dryness of the mouth (n = 12), slight difficulty in swallowing (n = 7), discrete speech disturbances (n = 1), and slight pharyngeal dysesthesias (n = 7) with feeling of a lump in the throat and compulsive clearing of the throat. Eighty-five patients (73%) reported that they were satisfied with the postoperative result even several years after the operation. Looking back, 31 patients (27%) would no longer have the operation performed. The inadequate result of the rhonchopathy was specified as the reason by 21 patients. Ten patients had unpleasant memories of the operation because of intensive postoperative pain. Snoring and apneic phases are suppressed or improved by non-traumatic UPPP in the majority of patients. This effect persisted even years after the operation.

J Oral Maxillofac Surg 2006 Jun; 64(6): 886-91 (Read article online)

Hoekema A, de Lange J, Stegenga B, de Bont LG

PURPOSE: The present study comprises a retrospective evaluation of the potential application of mandibular repositioning appliance (MRA) therapy preceding maxillomandibular advancement (MMA) surgery in the treatment of the Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). Our initial experiences with a new surgical protocol, in which MRA therapy serves as a predictor for success of MMA surgery, are reported. PATIENTS AND METHODS: Forty-three consecutive patients with OSAHS treated with MRA therapy were considered for inclusion (mean +/- SD; Apnea-Hypopnea Index [AHI] = 27 +/- 20; age = 53 +/- 9 years). All patients displaying a substantial improvement in their AHI with MRA therapy (ie, >50% reduction) who preferred surgical rather than "prosthetic" advancement of the mandible were offered MMA surgery. Accordingly, 4 out of 43 patients were treated with MMA surgery. The AHI was used as the primary outcome measure, with MMA surgery being considered successful in case of a postoperative AHI <5. RESULTS: All 4 patients included displayed substantial improvement in their AHI following MRA therapy. Moreover, in 3 patients MRA therapy resulted in a post-treatment AHI

Lin Chuang Er Bi Yan Hou Ke Za Zhi 2006 Feb; 20(4): 166-8 (Read article online)

Hui L, Yan A, Yu G

OBJECTIVE: To assess the adenoid size in children by flexible fibrescope examination and outline an effective therapeutic program according to the examination. METHOD: In this study, the flexible fibrescope examination of the nasal cavity and nasopharynx and a lateral skull radiograph examination were performed in 130 children with snoring and the same examinations were performed in another 30 children without snoring. RESULT: The size of adenoid was negatively associated with the degree of snoring. (P < 0.01). There is a high correlation between the flexible fibrescope examination and the lateral skull radiograph examination (r = 0.435, P < 0.01). CONCLUSION: The application of the flexible fibrescope examination of the nasal cavity and nasopharynx has proved to be of great clinical value, especially in the selection of children for adenoidectomy. It is an examination with minor invasion which can be well tolerated by most children, giving more information than a lateral skull radiograph and avoiding unnecessary radiation.

Respiration 2006 May 23; (Read article online)

Tanriverdi H, Evrengul H, Kara CO, Kuru O, Tanriverdi S, Ozkurt S, Kaftan A, Kilic M

Background and Objective: Obstructive sleep apnea (OSA) has a critical association with cardiovascular mortality and morbidity. Carotid intima-media thickness (IMT), flow-mediated dilatation (FMD) and aortic stiffness are early signs of atherosclerosis. The presence of subclinical atherosclerosis was assessed in OSA patients using these parameters. Methods: 40 patients with OSA showing an apnea-hypopnea index (AHI) >/=5 (mean age 51.3 +/- 9 years, 32 males) and 24 controls (AHI < 5, mean age 51.9 +/- 5.2 years, 19 males) were enrolled in the study. In all subjects, polysomnographic examination and recordings were performed during sleep. IMT of the carotid artery, endothelium-dependent/-independent vasodilation of the brachial artery and aortic elastic parameters were investigated using high-resolution Doppler echocardiography. Results: The demographic data of the patients with OSA and controls were not significantly different. Subjects with OSA demonstrated higher values of aortic stiffness (7.1 +/- 1.88 vs. 6.42 +/- 1.56, respectively) and IMT (0.85 +/- 0.13 vs. 0.63 +/- 0.11 mm, p = 0.0001, respectively) but lower distensibility (9.47 +/- 1.33 vs. 11.8 +/- 3.36 cm(2)/dyn/10(6)) and FMD (4.57 +/- 1.3 vs. 6.34 +/- 0.83%, p = 0.0001, respectively) than the controls. The respiratory disturbance index correlated positively with aortic stiffness and IMT and negatively with distensibility and FMD. Conclusion: We observed blunted endothelium-dependent dilatation, increased carotid IMT and aortic stiffness in patients with OSA compared with matched control subjects. This is evident in the absence of other diseases, suggesting that OSA is an independent cause of atherosclerosis. These simple and non-invasive methods help to detect subclinical atherosclerosis in OSA. Copyright (c) 2006 S. Karger AG, Basel.

Arch Otolaryngol Head Neck Surg 2006 May; 132(5): 489-93 (Read article online)

Valera FC, Tamashiro E, de Araújo MM, Sander HH, Küpper DS

OBJECTIVE: To evaluate the clinical and polysomnographic evolution of patients with severe laryngomalacia who underwent supraglottoplasty. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Seven children with severe laryngomalacia. MAIN OUTCOME MEASURES: The patients were evaluated with a questionnaire given to their parents and with polysomnographic examination before and 3 months after surgery. The clinical data of respiratory and swallowing symptoms as well as the parameters of minimum oxygen saturation and respiratory disturbance index were evaluated after bilateral supraglottoplasty and compared with the preoperative data. RESULTS: Two patients had pharyngolaryngomalacia and required tracheotomy. Four patients had a marked improvement of respiratory and deglutition symptoms. Polysomnographic data showed a significant improvement in the respiratory disturbance index after surgery (P<.05) but not in the minimum oxygen saturation level. However, this improvement was only partially achieved in 3 patients, in whom there were associated airway or neurologic changes. No serious surgical complications were observed. CONCLUSION: Supraglottoplasty led to a marked improvement in all 5 patients without pharyngolaryngomalacia, but the 2 patients with pharyngolaryngomalacia required tracheotomy.

Am J Respir Crit Care Med 2006 May 18; (Read article online)

Waters KA, Sitha S, O'brien LM, Bibby S, de Torres C, Vella S, de la Eva R

Rationale: In adults, obstructive sleep apnea (OSA) is associated with metabolic dysfunction that improves with treatment of OSA. No equivalent studies exist in children. Objective: To examine the relationship between metabolic markers and OSA with time and treatment in children. Methods: Metabolic markers measured on a fasting morning blood sample at diagnostic polysomnography and follow-up 1.3+/-0.6 years later. Measurements and main results: Forty-five children (34 males), aged 6.9+/-3.5 and including 12 obese subjects, were in the final analysis. There were no differences in metabolic markers between children with and without OSA at initial study, however obese children had significantly higher insulin (106.1+/-72.1 vs 66.7+/-37.6; p=0.028), insulin/glucose ratio (23.7+/-14.3 vs 14.7+/-8.0; p=0.02) and significantly lower HDL cholesterol (1.3+/-0.2 vs 1.6+/-0.4; p=0.005) than non-obese children. Twenty children underwent surgical removal of adenotonsillar tissue while 12 children with OSA elected not to have treatment. OSA persisted after treatment in 5 children, and resolved in 27. Thirteen children did not have OSA on initial or follow up studies. At follow-up, there was a small but significant improvement in total cholesterol in those children whose OSA was resolved (4.8+/-0.8 to 4.7+/-0.6; p=0.005) and a trend for obese children with persisting OSA tended to have elevated insulin levels compared to obese children without OSA (p=0.07). Conclusion: Obesity appears to be the major influence on metabolic dysfunction in children with OSA, but this preliminary data also suggests that resolution or persistence of OSA may affect changes in metabolic function over time.

Med Hypotheses 2006 May 13; (Read article online)

Simpson JD, Doux JD, Lee PY, Yun AJ

Peripheral arterial disease in the legs represents a subset of atherosclerosis that manifests a particularly sinister profile. A predominance of sympathetic activity in the periphery favors the development of neurogenic atherosclerosis. Atherosclerosis may then produce flow derangements and decreased physical activity that serves to escalate sympathetic bias in a vicious cycle. Restoration of normal flow in peripheral arterial disease may not only produce local benefit due to improved perfusion, but also represent a gateway to correcting many systemic conditions that may at first glance appear unrelated but share a common etiology of autonomic dysfunction, such as gout, acute coronary syndromes, stroke, sleep apnea, arrhythmias, depression, erectile dysfunction, inflammation, hypercoagulability, sleep disorders, bowel dysfunction, renal failure, and aging.

J Gastroenterol Hepatol 2006 Feb; 21(1 Pt 1): 116-21 (Read article online)

Tsang SW, Ng WF, Wu BP, Chow DA, Li ET, Wong TC

Background and Aim: Non-alcoholic steatohepatitis (NASH) is increasingly recognized as an important cause of chronic liver disease. However, data on Asians with NASH is lacking in the literature. The aim of the present study was to describe the clinical, biochemical and histological characteristics of NASH in Asians and to determine the predictors for septal fibrosis. Method: Sixty consecutive patients aged over 18 years with elevated serum alanine transferase, sonographic evidence of steatosis, and consent for liver biopsy were included. Patients with chronic hepatitis B or C, alcoholic, autoimmune, genetic, or drug-induced liver disease were excluded. Clinical, biochemical and histological variables were tested for association with septal liver fibrosis (F2/3). Results: Median age of the cohort was 45.5 years (range 21-75 years) and 63% were male. Ninety percent of patients were obese (body mass index [BMI]>/= 25), 70% had hypertriglyceridemia, 68% had hypercholesterolemia, 58% had metabolic syndrome, 53% had hypertension, 47% had diabetes mellitus (DM), and 18% had obstructive sleep apnea. Sixty-eight percent had gamma-glutamyl transferase (GGT) >/= 2 x upper limit of normal (ULN), 55% had alanine aminotransferase (ALT) >/= 2 x ULN, and 23% had aspartate aminotransferase (AST) >/= 2 x ULN. Of the 40 non-diabetic patients undergoing oral glucose tolerance testing, 45% had normal tests, 30% had impaired glucose tolerance, 23% DM, and 2% impaired fasting glucose. Eighteen patients (30%) had septal fibrosis (F2/3), but none had cirrhosis. Necroinflammatory grade >/= 2 (odds ratio [OR] 13), AST >/= 2 x ULN (OR 5.3) and DM (OR 5) were significantly and independently correlated with septal fibrosis. Conclusion: Septal fibrosis is common in Asians with NASH. Necroinflammatory grade >/= 2, AST >/= 2 x ULN and DM are independent predictors for septal fibrosis.

Prim Care Respir J 2005 Jun; 14(3): 131-42 (Read article online)

Palmer EL, Wingfield D, Jamrozik K, Partridge MR

INTRODUCTION:: A significant minority of otherwise healthy adults may suffer from disordered breathing during sleep. The commonest problem, known as Obstructive Sleep Apnoea Syndrome (OSAS), results in poor quality sleep, daytime hypersomnolence and excess risk of road traffic crashes. It is also associated with occupational injuries. OSAS can be successfully treated, reducing costs of hospitalisation. There is a gap in the literature regarding the burden of patients with OSAS in primary care, particularly because there is no agreed method for screening. OBJECTIVES:: This pilot study was designed to determine the feasibility of screening for OSAS in a UK inner-city multi-ethnic primary care population, to investigate ways in which it might be detected, and to gain an awareness of the potential size of the burden of OSAS METHODS:: We tested two methods of screening: firstly, postal questionnaires to a random sample of 240 patients from a subset of the population at highest risk of OSAS (men aged 35-65 years); and secondly, the same questionnaire plus two screening tools for detecting hypersomnolence, given to patients attending the practice for pre-registration health checks. RESULTS:: Despite reminders, only 40% of postal questionnaires were returned and there were only 67 (28%) usable responses. The prevalence of snoring was 55%. Almost half of those patients who responded (46%) had a Body Mass Index (BMI) associated with a high risk of OSAS. This was not a positive responder bias because there were no significant differences in BMI between responders and non-responders. 12% had a collar size of greater than 17.5, whilst 34% reported daytime sleepiness, and 24% reported witnessed apnoea. Screening during pre-registration health checks proved both feasible and productive with 38 patients of differing linguistic abilities completing the assessment. CONCLUSION:: Screening for OSAS in primary care by means of a postal questionnaire produced a low response. Whilst there was no evidence of a responder bias in terms of BMI, the numbers reporting large collar size, daytime sleepiness and witnessed apnoea suggest that a sizeable proportion of the population is at risk of OSAS. Questionnaires used in this study provide a means of identifying patients with symptoms suggestive of OSAS, although the sensitivity, specificity and positive predictive value of a self-administered instrument needs to be confirmed by a larger study incorporating ventilatory monitoring during sleep. The addition of screening to pre-registration health checks is feasible, but it would take a long time to screen all those at risk for OSAS by this route.

J Med Syst 2006 Apr; 30(2): 91-9 (Read article online)

Nigam V, Priemer R

This paper presents a snore recorder that can separate snores from their delayed mixtures. This is useful to study the snore sounds of individuals when these sounds occur in a normal in-home sleeping environment, where two people are sleeping together and both produce sounds. Based on methods for blind source separation, we give a snore separator that solves the blind delayed source separation problem and provide a performance index to monitor its convergence. The separated snores can be analyzed to detect symptoms of sleep apnea prior to polysomnography or as a monitoring device after polysomnography has been performed. Experimental results show good performance of the snore separator.

Zhong Nan Da Xue Xue Bao Yi Xue Ban 2005 Dec; 30(6): 666-9 (Read article online)

Wang YN, Yang Y, Luo YQ, Chen LL

OBJECTIVE: To investgate the effects of nasal continuous positive airway pressure (nC-PAP) short-term treatment on the serum level of C-reactive protein (CRP) and intercellular adhesion molecule-1 in obstructive sleep apnea-hypopnea syndrome (OSAHS) patients. METHODS: Twenty patients with OSAHS ( AHI > or = 15 ) and 15 controls (AHI < 15) were recruited. After polysomnography (PSG), the venous blood was collected from all subjects to investigate CRP and ICAM-1. The effects of short-term treatment (4 d) of nCPAP on the serum levels of CRP and ICAM-1 were studied in patients with moderate and severe OSAHS. RESULTS: Before the treatment, there was a significant positive correlation between CRP and AHI in all subjects (r = 0.615, P < 0.001), a significant negative correlation between CRP and the mean nocturnal oxygen saturation (r = -0.682, P < 0.001), and a significant negative correlation between CRP and the lowest nocturnal SaO2 (r = -0.61, P < 0.001). There was a significant positive correlation between ICAM-1 and AHI in all subjects (r = 0.751, P < 0.001), a significant negative correlation between ICAM-1 and the mean nocturnal oxygen saturation (r = -0.68, P < 0.001), and a significant negative correlation between ICAM-1 and the lowest nocturnal oxygen saturation (r = -0.656, P < 0.001). There was a significant positive correlation between CRP and ICAM-1 (r = 0.437, P = 0.009). The levels of CRP and ICAM-1 were significantly higher in patients with moderate and severe OSAHS than in the controls (P < 0.01). nCPAP decreased the levels of CRP and ICAM-1 in patients with moderate and severe OSAHS (P < 0.01). CONCLUSION: Inflammatory reaction exists in OSAHS and can be palliated after nCPAP short-term treatment.

Arch Otolaryngol Head Neck Surg 2006 May; 132(5): 476-80 (Read article online)

Statham MM, Elluru RG, Buncher R, Kalra M

OBJECTIVE: To determine, in a series of children younger than 6 years undergoing adenotonsillectomy for treatment of clinical obstructive sleep apnea syndrome (OSAS), the effect of age on prevalence of postoperative respiratory complications. The primary objective was to define a practice standard for postoperative hospital admission. DESIGN: Retrospective analysis. SETTING: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. PATIENTS: All children younger than 6 years who underwent adenotonsillectomy to treat OSAS from June 1, 1999, to May 31, 2001. MAIN OUTCOME MEASURES: The percentage of children younger than 3 years undergoing adenotonsillectomy to treat OSAS who experience a postoperative respiratory complication. RESULTS: Of 2315 patients younger than 6 years undergoing an adenotonsillectomy for treatment of OSAS, 149 (6.4%) developed a postoperative respiratory complication. Even though there was a lower incidence of comorbid medical conditions in this cohort, children younger than 3 years were at a greater risk for developing a postoperative respiratory complication compared with those aged 3 to 5 years (9.8% vs 4.9%, P<.001). Logistic regression analysis revealed that children younger than 3 years had a nearly 2-fold increased risk for respiratory complications postoperatively (odds ratio, 1.98; 95% confidence interval, 1.41-2.77) when controlling for race and sex. CONCLUSIONS: Adenotonsillectomy to treat OSAS is associated with a significantly higher rate of postoperative respiratory complication in children younger than 3 years compared with children aged 3 to 5 years. Our results support hospital admission for all patients younger than 3 years undergoing adenotonsillectomy for treatment of OSAS.

Monaldi Arch Chest Dis 2006 Mar; 65(1): 52-5 (Read article online)

De Felice A, Fuschillo S, Martucci M, De Angelis E, Balzano G

A number of predisposing factors (obesity, nasal obstruction, adenoidal hypertrophy, macroglossia, etc) have been related to obstructive sleep apnea syndrome (OSAS). In addition hypothyroidism and large goitres have been reported to be associated to OSAS, but this association has not been adequately studied. We describe an obese patient with euthyroid goitre associated with OSAS. The patient showed a body mass index (BMI) of 47 and a large neck with a circumference of 60 cm. The flow-volume curve demonstrated an expiratory plateau suggesting an intrathoracic upper airway obstruction. Arterial blood gas analysis results were: pH 7.39; PCO2 54.2 mmHg; P O2 47 mmHg. Nocturnal polisomnography showed an apnea/hypopnea index (AHI) of 31 episodes/hour. Upper airway collapse was overcome by a nasal continuous positive airway pressure (nCPAP) of 14 cmH2O. Weight loss obtained by a hypocaloric diet was not accompanied by any OSAS improvement. After thyroidectomy, a nCPAP of 4 cmH2O was sufficient to prevent upper airway closure. Discontinuation of nCPAP treatment for 4 consecutive nights did not determine worsening of sleep apnea symptoms, nor a worsening of overnight oxymetry. A new polysomnography carried out after 4 nights off nCPAP showed an AHI of 33 episodes/hour. OSAS should be suspected in patients with large goitres. Decisions regarding discontinuation of nCPAP treatment after thyroidectomy should be based on polisomnographic results.

Neurosci Lett 2006 May 15; (Read article online)

Huupponen E, Saastamoinen A, Eskelinen V, Värri A, Hasan J, Himanen SL

Sleep apnea syndrome is known to disturb sleep. The purpose of the present work was to study spindle frequency in apnea patients. All-night sleep EEG recordings of 15 apnea patients and 15 control subjects with median ages of 47 and 46 years, respectively, were studied. A previously presented and validated multi-channel spindle analysis method was applied for automatic detection and frequency analysis of bilateral frontopolar and central spindles. Bilateral frontopolar spindles of apnea patients were found to show lower frequencies on the left hemisphere than on the right. Such an inter-hemispheric spindle frequency difference in apnea patients is a novel finding. It could be that the hypoxias and hypercapnias caused by apneic episodes result in local disruption in the regulation of sleep in the frontal lobes.