Annotated Bibliography on High Prevalence of Obstructive Sleep Apnea in General Population

Obstructive sleep apnea in the general population: highly prevalent but minimal symptoms. Erj.ersjournals.com

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The article assesses the prevalence of obstructive sleep apnea in the general population as defined by the apnea-hypopnea index. The subjects of the study were the Icelandic population present in the European Community Respiratory Health Survey (ECRHS). The cohort answered a questionnaire on smoking, chronic diseases and general health and listed their medication use in a manner that was similar to the previous ECHRS studies. Chi-square test and t-tests were used for the nominal and continuous variables. The results from the study showed that the males had a higher severity of OSA on average with habitual snoring than females. The females, however, had a higher prevalence of sleep-related symptoms such as dry mouth, nocturnal sweating, morning headache, and RLS symptoms than males. The study concluded that in a large general sample of Icelanders aged between 40 and 60 years, one out of five subjects had OSA as explained by the AHI>15 cut-offs. Those between 15 and 30 with AHI did not report sleep-related symptoms, impaired objective vigilance or excessive daytime sleepiness.

Barbaro, R., Xu, Y., Borasino, S., Truemper, E., Watson, R.... and Curley, M. (2018). Does extracorporeal membrane oxygenation improve survival in pediatric acute respiratory failure? American Thoracic Society.

Barbaro, Xu & Borasino et al. (2018) compares the mortality and functional status of children with severe acute respiratory failure that was supported with and without ECMO. The method used was a randomized RESTORE clinical trial. A detailed demographic and daily physiological data was used to match the patients. The primary variable was in-hospital mortality while the secondary outcomes included hospital-free days, a change in functional status at hospital discharge and ventilator-free days. The results showed that out of the 2,449 children that were on the RESTORE trial, 35.9% of the non-ECMO-supported patients with severe ARDS were eligible to match to 2.5% ECMO-supported children. There were no variations between ECMO-supported and non-ECMO-supported patients in any secondary outcomes (Barbaro et al., 2012). To conclude, there is no difference between ECMO-supported and non-ECMO-supported children with severe ARDS. However, definitive answers will require a rigorous multisite randomized and controlled trial.

Campos-Juantaney, F., Fernandez-Barriales, M., Gonzalez, M. and Portillo-Martin, J. (2017). Effects of obstructive sleep apnea and its treatment over the erectile dysfunction: a systematic review. Asian Journal of Andrology.

The study provides a systematic review of the effects of obstructive sleep apnea and its treatment over erectile function. It conducts a systematic review and provides a meta-analysis of the observable studies in epidemiology in line with the MOOSE guidelines. The results of the research showed that the prevalence of ED varies in different studies and depends on the diagnostic tools used and age. OSA was an independent risk factor for ED and correlates positively with both entities. The MAD is a less studied treatment for OSA with regards to erectile function but failed to prove its benefits (Campos-Juanatey, et al., 2017). The Study concluded by finding evidence on the risk of ED in OSA patients. However, treatment of sleep-disordered breathing is likely to improve the sexual results via CPAP therapy.

Downard, C., Jaksic, T., Garza, J., Dzakovic, A., Nemes, L.... and Wilson, J. (2013). Analysis of an improved survival rate for congenital diaphragmatic hernia. Elsevier Inc.

The article provides an analysis of an improved survival rate for congenital diaphragmatic hernia. The methodology involved an evaluation of a consecutive series of neonates with CDH beginning on January 1, 2000. The predicted survival rates were estimated using a logistic regression equation that was published by the CDH study group. The actual rates of survival were calculated and later compared to the predicted values using a one-test binomial test. The results showed that 93% of the neonates with CDH survived while the predicted rate of survival for the cohort was 68% (Downard et al., 2013). The study concluded that consecutive series of neonates with CDH and treated in one hospital would have a higher significance of the survival rates compared to the predicted survival rates. It is, therefore, vital to identify other centers with higher than expected survival rates to establish therapeutic strategies associated with decreased mortality.

Genta, P., Marcondes, B., Danzi, N. and Lorenzi-Filho, G. (2008). Ethnicity as a risk factor for obstructive sleep apnea: comparison of Japanese descendants and white males in Sao Paulo, Brazil. Brazilian Journal of Medical and Biological Research.

The study analyses ethnicity as a risk factor for obstructive sleep apnea by comparing Japanese descendants and the white males in Sao Paulo, Brazil. It involved analyzing polysomnographic studies which included electrooculography, electroencephalography, chin and leg electro-myography, oximetry, electrocardiography, and measurements of airflow with a nasal pressure cannula. The study involved 586 patients with 61 of Japanese descent. The results showed that the proportion of individuals with OSA was similar to that of the Japanese descent and white patients (88 and 89% respectively) (Genta, Marcondes, Danzi & Lorenzi-Filho, 2008). The white OSA patients and Japanese descendants were similar with respect to educational levels, symptoms, age and associated disorders. The paper concluded that the Japanese descendants with OSA had a lower BMI but similar AHI compared to white patients. Moreover, the risk for OSA associated with obesity may be largely under-recognized among the Japanese descendants.

Jacidfar, J., Brodie, D., Sonett, J. and Bacchetta, M. (2012). Venovenous extracorporeal membrane oxygenation using a single cannula in patients with pulmonary hypertension and atrial septal defects. The Journal of thoracic and cardiovascular surgery. Vol 143 (4)

The article studies the venovenous extracorporeal membrane oxygenation using a single cannula in patients with pulmonary hypertension and atrial septal defects. It involved an analysis of two adults with secundum ASD and Eisenmenger's syndrome that were selected for modified cannulation technique after there was a failure of a conventional medical therapy to treat their acute decompensations. Both patients were, however, on the transplant list. The results indicated an adequate flow, good gas exchange, ventricular decompression and improved hemodynamics (Javidfar et al., 2012). Both patients recorded an uncomplicated ECMO course. Patient 1 recovered after resting on venovenous ECMO for 23 days and lived 4 months before dying of acute pneumonia. Patient 2 extubated on ECMO shortly after cannulation, bridged to double lung transplantation after 6 days and discharged. She has returned to normal activities. The paper concludes that venovenous ECMO with Avalon Elite can be used as a bridge to recovery or transplantation in adults with ASD who present exacerbations of chronic lung disease and right heart failure.

Kao, L., Hung, S., Lin, H., Liu, C., Huang, H. and Wu, C. (2016). Obstructive sleep apnea and the subsequent risk of chronic rhinosinusitis: A population-based study. Scientific Reports.

Kao et al. (2016), conducted a population-based study on the obstructive sleep apnea and subsequent risk of chronic rhinosinusitis. Data were obtained from the Taiwan Longitudinal Health Insurance Database of 2005. The sample included 2955 patients who received a diagnosis of OSA during an ambulatory care visit between January 2001 and December 2007. Analyses were performed using the SAS windows system and chi-square tests were used to compare the differences between the study and comparison cohorts of monthly insurance salary, geographical location, urbanization level, and tobacco use. The results showed that 2.76% of the total sampled patients were diagnosed with CRS and subsequent incidences of CRS were found in 6.59% of the patients with OSA and 2.0% of those without OSA. Kao et al. (2016) concluded that patients with OSA had a higher risk of subsequent CRS compared to those without OSA regardless of gender. Physicians should, therefore, conduct regular nasal examinations for patients with OSA.

Lee, J., Lee, C., Lee, S. Ryu, Y., Lee, W.... and Kim, J. (2013). Mortality of patients with obstructive sleep apnea in Korea. Journal of Clinical Sleep Medicine.

The research analyzes the mortality of patients with obstructive sleep apnea in Korea. The research used a sample of 2,240 patients who underwent laboratory full-night polysomnography due to sleep apnea or snoring. The patients were categorized based on sleep apnea-hypopnea index. The analysis was performed using the Cox-proportional hazard regression model and Kaplan-Meier survival curve. According to Lee et al. (2013), the all-cause mortality risk as adjusted for sex, age, diabetes, body mass index, cardiovascular diseases and previous records of stroke were significantly associated with the increased severity in OSA. The study concluded that the increase in mortality was associated with the increase in severity of OSA among Koreans as indicated in the studies that were performed in the western countries.

Li, W. and Wang, W. (2018). Therapeutic approaches to obstructive sleep apnea in China. Institute of Respiratory Disease, China.

The paper studies the therapeutic approaches of obstructive sleep apnea in China. It does this by analyzing the effectiveness of the continuous positive airway pressure (CPAP) among OSA patients, optimizing the therapeutic effect of mandibular advancement oral appliances (OA), evaluating the role of surgery in OSA management and highlighting other novel alternative therapies. The results showed that the application of CPAP prediction formula may improve the manual CPAP titration. CPAP and OA would be effective methods if correctly used. Moreover, the patients who fail in the approaches may benefit from adjustments in lifestyle such as weight loss (Li & Wang, 2013). The paper concludes that the high prevalence of OSA in China and its mortality and attendant morbidity provide a strong incentive to improve the recognition of the disorder. However, the application of OA or the noninvasive CPAP device provides an opportunity for OSA patients.

Mirrakhimov, A., Sooronbaev, T. and Mirrakhimov, M. (2013). Prevalence of obstructive sleep apnea in Asian adults: a systematic review of the literature. BMC Pulmonary Medicine.

Mirrakhimov, A., Sooronbaev and Mirrakhimov, E. (2013) provide a systematic review of the prevalence of obstructive sleep apnea in Asian adults. The study involved a search for articles on Scopus, PubMed/Medline and Google Scholar that were published from 1993 to May 2012. The articles were to have reported the prevalence of OSA diagnosed via sleep monitoring and the prevalence of at-risk patients for OSA as assessed by symptomatology and sleep questionnaires. The prevalence of OSA ranged from 3.7% to 97.3% (Mirrakhimov, A., Sooronbaev and Mirrakhimov, E., (2013). The male gender, old age, greater neck circumference, smoking, snoring, arterial hypertension, and daytime sleepiness were associated with OSA. The systematic review concluded by highlighting a lack of data with regards to the prevalence of OSA in Asians. Only a few studies provided an approximate estimate of the OSA burden on some Asian communities.

Niwa, K., Perloff, J., Kaplan, S., Child, J and Miner, P. (1999). Eisenmenger Syndrome in Adults: Ventricular Septal Defect, Truncus Arteriosus, Univentricular Heart. Journ...