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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 January 2020) | Viewed by 26906

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Special Issue Editor

Dr. Hiroshi Kadotani

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Guest Editor

Department of Psychiatry, Shiga University of Medical Science, Seta-Tsukinowa-Cho, Otsu 520-2192, Japan
Interests: sleep apnea; sleep disordered breathing; sleep medicine; mental health; epidemiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear colleagues,

Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by upper airway obstruction during sleep. OSA is associated with adverse clinical outcomes, including cardiovascular disease, hypertension, cognitive impairment, metabolic abnormalities, and mortality. OSA is also a cause of huge economic burden to society manifested through lost productivity, motor vehicle accidents, and workplace accidents. However, evidence of the prevalence of OSA, especially severe OSA, is limited, and there is insufficient information concerning the screening for or treatment of OSA in asymptomatic adults or in adults with unrecognized symptoms.

The present Special Issue is aimed not only at reporting the outcomes and prevalence of OSA, but also at new approaches, methodologies, and perspectives regarding the screening and diagnosis of OSA.

Dr. Hiroshi Kadotani
Guest Editor

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Keywords

sleep apnea
sleep disordered breathing
sleep apnea syndrome
obstructive sleep apnea

Published Papers (7 papers)

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Research

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11 pages, 6134 KiB

Open AccessArticle

Occurrence of Cortical Arousal at Recovery from Respiratory Disturbances during Deep Propofol Sedation

by Ryuma Urahama, Masaya Uesato, Mizuho Aikawa, Reiko Kunii, Shiroh Isono and Hisahiro Matsubara

Int. J. Environ. Res. Public Health 2019, 16(18), 3482; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16183482 - 18 Sep 2019

Cited by 2 | Viewed by 2990

Abstract

Recent evidences suggest that non-arousal mechanisms can restore and stabilize breathing in sleeping patients with obstructive sleep apnea. This possibility can be examined under deep sedation which increases the cortical arousal threshold. We examined incidences of cortical arousal at termination of apneas and hypopneas in elderly patients receiving propofol sedation which increases the cortical arousal threshold. Ten elderly patients undergoing advanced endoscopic procedures under propofol-sedation were recruited. Standard polysomnographic measurements were performed to assess nature of breathing, consciousness, and occurrence of arousal at recovery from apneas and hypopneas. A total of 245 periodic apneas and hypopneas were identified during propofol-induced sleep state. Cortical arousal only occurred in 55 apneas and hypopneas (22.5%), and apneas and hypopneas without arousal and desaturation were most commonly observed (65.7%) regardless of the types of disordered breathing. Chi-square test indicated that incidence of no cortical arousal was significantly associated with occurrence of no desaturation. Higher dose of propofol was associated with a higher apnea hypopnea index (r = 0.673, p = 0.033). In conclusion, even under deep propofol sedation, apneas and hypopneas can be terminated without cortical arousal. However, extensive suppression of the arousal threshold can lead to critical hypoxemia suggesting careful respiratory monitoring. Full article

(This article belongs to the Special Issue Sleep Apnea Syndrome)

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9 pages, 446 KiB

Open AccessArticle

Japanese Cross-Sectional Multicenter Survey (JAMS) of Oral Appliance Therapy in the Management of Obstructive Sleep Apnea

by Kentaro Okuno, Akifumi Furuhashi, Shuhei Nakamura, Hiroshi Suzuki, Takehiro Arisaka, Hitoshi Taga, Masataka Tamura, Haruto Katahira, Minoru Furuhata and Chisato Iida

Int. J. Environ. Res. Public Health 2019, 16(18), 3288; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16183288 - 06 Sep 2019

Cited by 5 | Viewed by 2555

Abstract

We conducted a multicenter survey for oral appliance (OA) therapy to grasp and analyze the current situation of OA therapy, including efficacy, side effects, and follow-up, in Japan. The Japanese cross-sectional multicenter survey (JAMS) for obstructive sleep apnea (OSA) was undertaken by patients in 10 institutions associated with oral appliance therapy during two years, from 2014 to 2015, retrospectively. Age, sex, body mass index (BMI), baseline apnea–hypopnea index (AHI), OA type, adjustment, adverse reactions with OA, and AHI with OA were elicited from the patient clinical record. The number of included OSA patients was 3217. The number of patients with OA therapy was 2947. We evaluated 1600 patients for the OA treatment. The patients treated with OA, both male and female, were most commonly in their 50s. In terms of OSA severity, snoring was 2.3%, mild was 38.5%, moderate was 39.9%, and severe was 19.3%. The use of mono bloc appliance was 91.8%, bi bloc appliance was 7.9%, and tongue-retaining device (TRD) was 0.3%. After OA treatment, AHI decreased from 22.4/h to 9.3/h. The AHI reduction rate with OA was 52.0%. The rate of AHI <5 with OA was 35.6%. Adverse reactions developed in 14.7% of the subjects. OA reassessment was conducted for 54.3%. This study revealed the current situation of efficacy and side effects of OA therapy, and the problem that the reassessment rate of OA was low in Japan. Full article

(This article belongs to the Special Issue Sleep Apnea Syndrome)

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11 pages, 865 KiB

Open AccessArticle

The Most Effective Amount of Forward Movement for Oral Appliances for Obstructive Sleep Apnea: A Systematic Review

by Yuki Sakamoto, Akifumi Furuhashi, Eri Komori, Hiroyuki Ishiyama, Daichi Hasebe, Kazumichi Sato and Hidemichi Yuasa

Int. J. Environ. Res. Public Health 2019, 16(18), 3248; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16183248 - 04 Sep 2019

Cited by 11 | Viewed by 3175

Abstract

This systematic review clarifies the amount of effective protrusion in mandibular advancement devices of oral appliances required for obstructive sleep apnea (OSA). The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Review Manager 5 and GRADEpro were used to combine trials and analyze data. The present review included three studies. In mild to moderate OSA cases, measured using the apnea–hypopnea index (AHI), 50% protrusion was more effective than 75% protrusion. However, 75% protrusion was more effective for severe cases. Sleep stage, Epworth Sleepiness Scale (ESS), snoring index, and side effects significantly differed between the groups. Additionally, 75% protrusion was more effective (AHI: 0.38, 95% CI: −0.89 to 1.65, p = 0.56; sleep stage 3: −1.20, 95% CI: 9.54–7.14, p = 0.78; ESS: 1.07, 95% CI: −0.09 to 2.24, p = 0.07; snoring index: 0.09, 95% CI: 0.05–0.13, p < 0.05; side effects: RR: 1.89, 95% CI: 0.36–9.92, p = 0.45). As per the AHI, 75% protrusion was effective in severe cases, whereas 50% protrusion was effective in moderate cases. Analysis of different surrogate outcomes indicated that 75% protrusion was more effective. Further, well-designed, larger trials should determine the benefits for patients. Additionally, investigations of adherence and side effects with long-term follow-up are needed. Full article

(This article belongs to the Special Issue Sleep Apnea Syndrome)

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9 pages, 301 KiB

Open AccessArticle

Impact of Gender and Age on Rapid Eye Movement-Related Obstructive Sleep Apnea: A Clinical Study of 3234 Japanese OSA Patients

by Mamiko Mano, Tetsuro Hoshino, Ryujiro Sasanabe, Kenta Murotani, Atsuhiko Nomura, Reiko Hori, Noriyuki Konishi, Masayo Baku and Toshiaki Shiomi

Int. J. Environ. Res. Public Health 2019, 16(6), 1068; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16061068 - 25 Mar 2019

Cited by 27 | Viewed by 3971

Abstract

Rapid eye movement (REM)-related obstructive sleep apnea (OSA) is characterized by apnea and hypopnea events due to airway collapse occurring predominantly or exclusively during REM sleep. Previous studies have reported that REM-related OSA occurs more commonly in women and younger individuals. However, external validity of this tendency has not been confirmed in a large clinical sample. The objective of this study was to evaluate the effect of gender and age on REM-related OSA after adjustment for several covariates based on their established clinical relationships to gender difference in OSA. A total of 3234 Japanese patients with OSA were enrolled in this study. We confirmed that female sex is an important risk factor for REM-related OSA, as reported by previous studies. Moreover, we showed that women aged over 50 years were at a greater risk than those aged under 50 years. These results suggest that hormonal changes in women might play an important role in REM-related OSA and might reflect its unknown pathophysiological characteristics. Full article

(This article belongs to the Special Issue Sleep Apnea Syndrome)

18 pages, 974 KiB

Open AccessArticle

Sleep-Disordered Breathing in Hospitalized Geriatric Patients with Mild Dementia and Its Association with Cognition, Emotion and Mobility

by Janine Gronewold, Robert Haensel, Christoph Kleinschnitz, Helmut Frohnhofen and Dirk M. Hermann

Int. J. Environ. Res. Public Health 2019, 16(5), 863; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16050863 - 09 Mar 2019

Cited by 17 | Viewed by 5253

Abstract

Sleep-disordered breathing (SDB) is an emerging dementia risk factor. Data on the prevalence of SDB in dementia patients and its association with cognitive impairment is so far only based on patients with severe dementia. In 101 geriatric patients mostly with mild dementia recruited on German geriatric wards, SDB was assessed during overnight polygraphy in the patient room with a portable sleep apnea examination device and associations of SDB severity with severity of impairment in cognitive and emotional function as well as mobility were investigated. We also elucidated which factors influence compliance of SDB diagnostics. In 82 of the 101 dementia patients (81.2%), SDB could be assessed. Of those, only 12.2% had an apnea-hypopnea index (AHI) < 5/h demonstrating the absence of SDB. 40.2% exhibited 5/h ≤ AHI < 15/h representing mild SDB, and 47.6% revealed an AHI ≥ 15/h representing moderate/severe SDB. Patients in these three AHI categories did not significant differ from each other in demographical and clinical characteristics. Patients with an AHI ≥ 15/h particularly often presented with heart failure and vitamin D deficiency. We observed a low to moderate association between severity of SDB and severity of dementia. Tolerance of the nasal airflow sensor of at least 6 h was present in less than one third of all patients. The tolerant group exhibited more symptoms of depression and higher physical fitness compared to the non-tolerant group. We observed a high prevalence of SDB also in geriatric patients with mild dementia underlining the importance of SDB screening in the elderly. Full article

(This article belongs to the Special Issue Sleep Apnea Syndrome)

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Review

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15 pages, 2326 KiB

Open AccessReview

The Efficacy of Device Designs (Mono-block or Bi-block) in Oral Appliance Therapy for Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis

by Hiroyuki Ishiyama, Daichi Hasebe, Kazumichi Sato, Yuki Sakamoto, Akifumi Furuhashi, Eri Komori and Hidemichi Yuasa

Int. J. Environ. Res. Public Health 2019, 16(17), 3182; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16173182 - 31 Aug 2019

Cited by 13 | Viewed by 3819

Abstract

Oral appliance (OA_m) therapy has demonstrated efficacy in treating obstructive sleep apnea (OSA). The aim of this systematic review was to clarify the efficacy of device designs (Mono-block or Bi-block) in OA_m therapy for OSA patients. We performed a meta-analysis using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Two studies (Mono-block OA_m versus Bi-block OA_m) remained eligible after applying the exclusion criteria. When comparing Mono-block OA_m and Bi-block OA_m, Mono-block OA_m significantly reduced the apnea–hypopnea index (2.92; 95% confidence interval (95%CI), 1.26 to 4.58; p = 0.0006), and patient preference for Mono-block OA_m was significantly higher (2.06; 95%CI, 1.44 to 2.06; p < 0.0001). Lowest SpO₂, arousal index, non-REM stage 3, sleep efficiency, Epworth Sleepiness Scale (ESS), Snoring Scale, and side effects were not significantly different between the two groups (lowest SpO₂: −11.18; 95%CI, −26.90 to 4.54; p = 0.16, arousal index: 4.40; 95%CI, −6.00 to 14.80; p = 0.41, non-REM stage 3: −2.00; 95%CI, −6.00 to 14.80; p = 0.41, sleep efficiency: −1.42, 95%CI, −4.71 to 1.86; p = 0.40, ESS: 0.12; 95%CI, −1.55 to 1.79; p = 0.89, Snoring Scale: 0.55; 95%CI, −0.73 to 1.83, p = 0.55, side effects: 1.00, 95%CI, 0.62 to 1.61, p = 1.00). In this systematic review, the use of Mono-block OA_m was more effective than Bi-block OA_m for OSA patients. Full article

(This article belongs to the Special Issue Sleep Apnea Syndrome)

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13 pages, 2373 KiB

Open AccessReview

Effects of Intermittent Hypoxia on Pulmonary Vascular and Systemic Diseases

by Hiroshi Kimura, Hiroyo Ota, Yuya Kimura and Shin Takasawa

Int. J. Environ. Res. Public Health 2019, 16(17), 3101; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16173101 - 26 Aug 2019

Cited by 31 | Viewed by 4351

Abstract

Obstructive sleep apnea (OSA) causes many systemic disorders via mechanisms related to sympathetic nerve activation, systemic inflammation, and oxidative stress. OSA typically shows repeated sleep apnea followed by hyperventilation, which results in intermittent hypoxia (IH). IH is associated with an increase in sympathetic activity, which is a well-known pathophysiological mechanism in hypertension and insulin resistance. In this review, we show the basic and clinical significance of IH from the viewpoint of not only systemic regulatory mechanisms focusing on pulmonary circulation, but also cellular mechanisms causing lifestyle-related diseases. First, we demonstrate how IH influences pulmonary circulation to cause pulmonary hypertension during sleep in association with sleep state-specific change in OSA. We also clarify how nocturnal IH activates circulating monocytes to accelerate the infiltration ability to vascular wall in OSA. Finally, the effects of IH on insulin secretion and insulin resistance are elucidated by using an in vitro chamber system that can mimic and manipulate IH. The obtained data implies that glucose-induced insulin secretion (GIS) in pancreatic β cells is significantly attenuated by IH, and that IH increases selenoprotein P, which is one of the hepatokines, as well as TNF-α, CCL-2, and resistin, members of adipokines, to induce insulin resistance via direct cellular mechanisms. Clinical and experimental findings concerning IH give us productive new knowledge of how lifestyle-related diseases and pulmonary hypertension develop during sleep. Full article

(This article belongs to the Special Issue Sleep Apnea Syndrome)

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