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Revol, Bruno. "Pharmacoépidémiologie des apnées du sommeil Impact of concomitant medications on obstructive sleep apnoea Drugs and obstructive sleep apnoeas Diagnosis and management of central sleep apnea syndrome Baclofen and sleep apnoea syndrome: analysis of VigiBase® the WHO pharmacovigilance database Gabapentinoids and sleep apnea syndrome: a safety signal from the WHO pharmacovigilance database Valproic acid and sleep apnea: a disproportionality signal from the WHO pharmacovigilance database Ticagrelor and Central Sleep Apnea What is the best treatment strategy for obstructive sleep apnoea-related hypertension? Who may benefit from diuretics in OSA? A propensity score-matched observational study." Thesis, Université Grenoble Alpes, 2020. http://www.theses.fr/2020GRALV026.
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Avant leur mise sur le marché, l'évaluation clinique des médicaments repose sur des essais contrôlés randomisés. Bien qu'ils représentent la méthode de référence, leurs résultats sont nécessairement limités aux patients inclus dans ces essais. De plus, ils sont d’abord conçus pour mesurer l'efficacité des traitements, avant d’évaluer leurs effets indésirables. Concernant le syndrome d'apnées du sommeil (SAS), alors que de nombreux essais médicamenteux ont été menés, la plupart des résultats sont de faible niveau de preuve, voire contradictoires. Outre la durée et les effectifs limités de ces essais, une explication est que le SAS est une pathologie hétérogène en termes de symptômes et de physiopathologie, incluant divers "phénotypes" de patients. Des données de vie réelle sont donc nécessaires pour définir quels médicaments pourraient améliorer le SAS ou les comorbidités associées et quels patients pourraient en bénéficier. Au contraire, les cliniciens doivent être avertis que certains médicaments peuvent induire ou aggraver le SAS.La pharmacoépidémiologie fait désormais partie de toute enquête de pharmacovigilance, car elle permet une approche à la fois descriptive et comparative des notifications spontanées. Des associations entre l'exposition à un ou plusieurs médicaments et l'apparition d'effets indésirables peuvent ainsi être recherchées. Comme pour toutes les études observationnelles, la principale difficulté consiste à contrôler les facteurs de confusion. L'un des modèles couramment utilisés est l'analyse cas/non-cas, qui étudie la disproportionnalité entre le nombre d’effets indésirables rapportés avec le médicament d’intérêt, par rapport aux effets notifiés pour les autres médicaments. Nous avons ainsi montré des associations significatives entre l'utilisation de baclofène, des gabapentinoïdes ou de l'acide valproïque et la survenue de SAS dans la base de pharmacovigilance de l'OMS, suggérant le rôle du système GABAergique dans la pathogenèse des apnées centrales d’origine médicamenteuse. Un signal de disproportionnalité a également été observé pour le ticagrélor, reposant sur un mécanisme d'action différent.Les analyses pharmacoépidémiologiques permettent également d'étudier le bénéfice des médicaments en vie réelle. Le score de propension est utilisé pour minimiser les biais de sélection et recréer des conditions de comparabilité proches de celles des essais randomisés. À l'aide de ces méthodes statistiques, nous avons évalué l'intérêt potentiel de cibler le système rénine-angiotensine pour la prise en charge de l'hypertension artérielle chez les patients atteints d’apnées obstructives, en particulier avec l’utilisation des sartans. Chez ces mêmes patients apnéiques et hypertendus, nos travaux suggèrent que les diurétiques pourraient diminuer la sévérité des apnées, notamment en cas de surpoids ou d’obésité modérée. Des études prospectives sont désormais nécessaires afin de confirmer ces résultats, car les données de vie réelle ne peuvent se substituer aux essais cliniques contrôlés<br>The clinical evaluation of drugs before approval is based on randomized controlled trials. Although they are considered as the gold standard for testing drugs, their results are necessarily limited to patients included in the trials. Moreover, almost all clinical trials are primarily designed to assess the efficacy of a treatment, so safety is only a secondary concern. Regarding sleep apnea syndrome (SAS), while many drug trials have been conducted, most of the results are weak or even contradictory. In addition to limited trial duration and population size, one explanation is that the sleep apnea population is highly heterogeneous with respect to symptoms and physiological traits linked to disease pathogenesis, giving various patient “phenotypes”. Real-life data are therefore needed to define which drugs could improve SAS or associated comorbidities and who might benefit from them. On the contrary, clinicians need to be aware that some drugs may induce or worsen sleep apnea.Pharmacoepidemiology is now part of any pharmacovigilance survey, as it provides both descriptive and comparative approaches of spontaneous reports. Associations between the exposure to one or more drugs and the occurrence of adverse effects can thus be sought. As for all observational studies, the major difficulty is to control for confounding factors. One of the study designs commonly used, is the case/non-case analysis, which investigates disproportionality between the numbers of adverse drug reactions reported with the drug of interest compared to the number reported with all other drugs. In this way, we showed significant associations between the use of baclofen, gabapentinoids or valproic acid and the reporting of SAS in the WHO drug adverse event database, suggesting a role of the GABAergic system in the pathogenesis of drug-induced central sleep apnea. A disproportionality signal was also found for ticagrelor, based on a different mechanism of action.Pharmacoepidemiological analyses also make it possible to study the benefit of drugs in real-life. Propensity scores are used to minimize selection bias, leading to a comparability between the exposure groups close to that observed in randomized trials. Using these statistical methods, we have investigated the potential value of targeting the renin-angiotensin system for the management of hypertension in obstructive sleep apnea (OSA) patients, especially the use of sartans. For hypertensive apneic patients, our work suggests that diuretics could decrease the severity of OSA, particularly in the overweight or moderately obese. Prospective studies are now needed to confirm these findings, because real-life data cannot be a substitute for controlled clinical trials
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Solin, Peter 1964. "Central sleep apnoea in heart failure : recognition and pathogenesis." Monash University, Dept. of Medicine, 2000. http://arrow.monash.edu.au/hdl/1959.1/8972.
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Shepherd, Kelly. "Gastro-oesophageal reflux in obstructive sleep apnoea : prevalence and mechanisms." University of Western Australia. School of Anatomy and Human Biology, 2009. http://theses.library.uwa.edu.au/adt-WU2009.0085.
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Background. Obstructive Sleep Apnoea (OSA) is associated with an increase in nocturnal gastro-oesophageal reflux (nocturnalGOR) events and symptoms, however the mechanism for this remains undefined. Treatment of OSA with continuous positive airway pressure (CPAP) has been shown to reduce nocturnalGOR in individuals with OSA however the reasons for this reduction are not clear. The combination of OSA and nocturnalGOR could be particularly problematic for individuals who have had a lung transplant in whom Bronchiolitis Obliterans Syndrome (BOS) limits survival. It is thought that GOR plays a role in the development of BOS in these individuals. Methods and Results. Five interrelated studies were undertaken. The first two studies sought to determine and compare the prevalence and risk factors of nocturnalGOR in OSA patients with the general population. To do this, a GOR questionnaire was completed by 2,042 members of the general community as part of the Busselton Health Survey and by 1,116 patients with polysomnography-diagnosed OSA. Risk of OSA in the general population was determined using a standardised sleep questionnaire. 137 of the OSA patients completed the questionnaire before and after treatment with CPAP. The prevalence of nocturnalGOR symptoms reported more than once a week (frequent symptoms) was greater in OSA patients (10.1%) than the general population (5.8%) (p<0.001), in individuals from the general population at high (11.2%) than low risk of OSA (4.5%) (p<0.001) and in patients with severe (14.7%) than mild OSA (5.2%) (p<0.001). Treatment of OSA with CPAP decreased the prevalence of frequent nocturnalGOR from 9.0% to 3.8% (p=0.04). In the general population, high risk of OSA was independently associated with a 2.4-fold increased risk of frequent ABSTRACT vi nocturnalGOR symptoms than low risk. In the OSA group, disease severity was independently associated with nocturnalGOR symptoms, with an adjusted odds ratio of 1.7 for frequent nocturnalGOR symptoms.
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Lai, Yuen-kwan Agnes, and 賴婉君. "Continuous positive airway pressure education on adherence in adults with obstructive sleep apnoea." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/198849.
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Poor adherence to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnoea (OSA) limits its therapeutic effectiveness and has a major impact on clinical outcomes. Effective education programme is important to enhance CPAP use. However, existing education programmes are either manpower or resource demanding and may not be feasible in clinical practice. Moreover, the Self-Efficacy Measure for Sleep Apnoea (SEMSA) has been widely adopted for assessing adherence-related cognitions on CPAP therapy in OSA patients, but it was not available for Chinese.
The aims of this thesis are: (i) to perform linguistic and psychometric evaluation of a Chinese version of SEMSA (SEMSA-C); (ii) to examine the efficacy of brief motivational enhancement education programme in addition to standard care versus standard care only on improving adherence to CPAP treatment in patients with OSA.
The SEMSA-C was obtained after the standard forward-backward translation process. A randomised controlled trial was then conducted on newly diagnosed OSA patients. Patients in the control group received standard care (SC) comprising advice on the importance of CPAP therapy and its care while those in the intervention group received SC plus motivational enhancement education programme (ME). ME focused to enhance subjects’ knowledge, motivation and self-efficacy to use CPAP, comprising one 45-minute session on the day after CPAP titration and one 10-minute telephone follow-up shortly after commencing CPAP treatment. Epworth Sleepiness Scale (ESS), SEMSA-C, and quality of life were assessed. CPAP usage data were downloaded at the completion of this 3-month study. The primary outcome was the CPAP adherence. Furthermore, 21 patients were randomly sampled at baseline and completed the SEMSA-C at one week.
100 patients (Men : Women, 84 : 16) with OSA indicated for CPAP treatment were recruited, with an average age of 52±10 years, and apnoea hypopnoea index (AHI) of 36.2±22 events/hour. Factor analysis of SEMSA-C identified three factors: risk perception, outcome expectancies and treatment self-efficacy. Their corresponding internal consistency was high with Cronbach’s alpha >0.88, which were larger than all correlations between subscales (Range: 0.14 to 0.58). The correlations between items and their hypothesized subscale (Range: 0.58 to 0.85) were generally higher than the correlations between items and their competing subscales (Range: -0.10 to 0.58). One-week test-retest intra-class correlation ranged from 0.70 to 0.82. CPAP adherence was associated with outcome expectancies and treatment self-efficacy at 3-month assessment. Furthermore, SEMSA-C demonstrated an improvement in self-efficacy (standardised response mean = 0.33, p = .044) but no significant changes were observed in the other two factors, after CPAP use.
The 100 patients were followed for 3 months. The interventional effects maintained during the 3-month study period. There were a better CPAP use [higher daily CPAP usage of 2 hours/day (Cohen d = 1.33, p < .001), four-fold the number of subjects using CPAP for ≥ 70% of days with ≥ 4 hours per day (p < 0.001)], and greater improvements in ESS by 2.2 (p = 0.001) and treatment self-efficacy by 0.2 (p = 0.012) in the intervention group, relative to the control group.
The traditional Chinese SEMSA-C possesses satisfactory psychometric properties. It is a reliable and responsive instrument to measure perceived risks, outcome expectancies and treatment self-efficacy in Chinese patients with OSA. Moreover, the newly developed brief motivational enhancement education programme in addition to standard care is effective in improving adherence to CPAP treatment, treatment self-efficacy and daytime sleepiness.<br>published_or_final_version<br>Nursing Studies<br>Doctoral<br>Doctor of Nursing
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Ahrens, Anika. "A randomized clinical trial of the treatment of obstructive sleep apnoea using oral appliances." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B47849599.
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Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder and is associated with a range of adverse physical, social and psychological outcomes that affect quality of life (QoL). Two systematic reviews of the literature (part of this thesis work) found there is conflicting evidence of how different mandibular advancement device (MAD) designs features may affect clinical and subjective OSA outcomes in certain patients. Therefore, a randomized cross-over trial was conducted. Firstly, the correlation between clinical OSA indicators and QOL was explored among patients referred for OSA treatment using MADs. In addition, associations of OSA risk factors, dental status and demographic variables with clinical OSA indicators and QoL indices were determined. Secondly, the efficacy of two different MADs in the treatment of adult OSA patients was assessed and compared. Thirdly, the efficacy of the two MADs in the treatment of adult OSA patients from the subjective perspective of their bed partners was determined.
A consecutive sample of 45 adult OSA patients referred from Queen Mary Hospital Sleep Centre to the Prince Philip Dental Hospital for oral appliance therapy was recruited and treated with a monobloc MAD and a twinblock MADs for a period of 3 months per MAD (cross-over randomised trial). Changes in clinical OSA outcomes were assessed by polysomnography (PSG) and changes in subjective outcomes by the disease-specific Sleep Apnoea Quality of Life Index (SAQLI) questionnaire, the Functional Outcome of Sleep Questionnaire (FOSQ) and Epworth Sleepiness Scale (ESS). Patient compliance, side-effects and MAD preference, as well as MAD treatment impact on the patients’ bed partner was also assessed.
At baseline, some clinical OSA indicators, subjective QoL and certain OSA risk factors were significantly correlated (p<0.05). There were significant variations in clinical OSA indicators and subjective QoL indices with respect to certain risk factors (p<0.05), demographic variables (p<0.05) and dental status (p<0.01).
There was a significant difference in favour of the monobloc MAD in terms of improving the apnoea-hypopnoea index (AHI) (p<0.05) and oxygen desaturation index (ODI) (p<0.01). Significantly more patients achieved clinical treatment success with the monobloc compared to the twinblock (p<0.05). Both MADs were efficacious in improving patients’ SAQLI score (p<0.01), FOSQ score (p<0.01) and ESS score (p<0.01). Significantly more patients achieved QoL treatment success with the monobloc (p<0.05) compared to the twinblock. More patients were ‘very satisfied’ with the monobloc treatment (p<0.05) and 63% preferred it to the twinblock.
No significant difference was found between patients’ and bed partners perceptions of symptom improvement post treatment, however, the monobloc resulted in a significant reduction in bed partners’ daytime sleepiness (p<0.01) and allowed significantly more co-sleeping at night (p<0.05).
This study concluded that the monobloc is superior in improving subjective QoL and clinical OSA indicators. The monobloc was the preferred MAD and patients were more satisfied with it; bed partners rated this MAD as superior in improving their own daytime sleepiness and co-sleeping.<br>published_or_final_version<br>Dentistry<br>Doctoral<br>Doctor of Philosophy
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Wakwella, Ajith S. "Processing of snore related sounds for the diagnosis of obstructive sleep apnoea (OSA) /." [St. Lucia, Qld.], 2005. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18755.pdf.
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Harris, Ricci, and n/a. "Obstructive sleep apnoea syndrome : symptoms and risk factors among Maori and non-Maori adults in Aotearoa." University of Otago. Weelington School of Medicine & Health Sciences, 2003. http://adt.otago.ac.nz./public/adt-NZDU20070507.112047.
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More is becoming known about the importance of sleep to health, with inadequate sleep recognised as a significant public health issue. Sleep clinics have reported disproportionate numbers of Māori and Pacific peoples with more severe obstructive sleep apnoea syndrome (OSAS), raising concerns about accessibility of services and possible differences in prevalence between ethnic groups.
Prevalence information on sleep disorders in Aotearoa is needed to assess its public health impact and plan for population health care needs. This thesis presents a national study examining the prevalence of OSAS symptoms and risk factors among Maori and non-Maori adults in Aotearoa.
This project is also situated within the wider scope of ethnic inequalities in health between Maori and non-Maori and is concerned with making a positive contribution to Maori health and the elimination of disparities. Kaupapa Maori Research (KMR) is the underlying methodology that drives this study. As such, it assumes a Maori norm, and prioritises Maori needs. A Maori/non-Maori analytical framework is used that distinguishes Maori as tangata whenua, addresses Maori health needs as well as non-Maori, and enables the monitoring of guarantees as outlined by the Treaty of Waitangi.
The goals of this thesis were to estimate the prevalence of OSAS symptoms and risk factors among Maori and non-Maori adults in New Zealand, and to examine independent predictive variables for specific OSAS symptoms. An objective was also to contribute to KMR through designing and undertaking a KMR project using a quantitative method, with the development of concepts for use in other areas of research.
In April 1999, a short questionnaire was sent to a sample of 10000 New Zealands (5500 of Maori descent and 4500 non-Maori participants to enable research questions to be examined with equal statistical power for both groups.
The results demonstrate that the prevalence of OSAS symptoms and risk factors, particularly among non-Maori, are comparable to other international studies, indicating that OSAS is likely to be a common problem among adults in Aotearoa. Furthermore, the results suggest that Maori are significantly more likely to suffer from OSAS than non-Maori, with higher rates of symptoms and risk factors of OSAS among both men and women. As an area of medicine that is under-serviced in Aotearoa, the results provide important information with which to plan for population needs.
There are a number of health implications from this study, relating specifically to the diagnosis and management of OSAS in Aotearoa, and to Maori health and the elimination of disparities. These are multi-levelled and include health service implications across the continuum of care, from specialist sleep services to primary care; public health implications that involve preventive measures and broader determinants of health; and KMR principles that can be applied to interventions and health research in general. As a KMR project the implications and recommendations focus on Maori health research in general. As a KMR project the implications and recommendations focus on Maori health gain and addressing disparities in health. This is consistent with Maori health rights, and a population approach that considers health inequalities and the role of wider determinants of health and health services.
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Joffe, David. "Obstructive sleep apnoea the genesis of daytime somnolence and cognitive impairment : arousals, hypoxia and circadian rhythm /." Connect to full text, 1997. http://hdl.handle.net/2123/382.
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Thesis (Ph. D.)--University of Sydney, 1998.<br>Title from title screen (viewed Apr. 15, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Respiratory Medicine, Royal North Shore Hospital, Faculty of Medicine. Degree awarded 1998; thesis submitted 1997. Includes bibliography. Also available in print form.
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Desai, Anup. "Obstructive sleep apnoea and driver performance prevalence, correlates, and implications for driver fatigue /." Connect to full text, 2002. http://hdl.handle.net/2123/589.
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Thesis (Ph. D.)--University of Sydney, 2003.<br>Includes tables and questionnaires. Title from title screen (viewed Apr. 29, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Faculty of Medicine. Degree awarded 2003; thesis submitted 2002. Includes bibliography. Also available in print form.
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Baillieul, Sébastien. "Syndrome d'apnées du sommeil et cerveau : une relation bidirectionnelle Continuous positive airway pressure improves gait control in severe obstructive sleep apnoea: A prospective study Hypoxic conditioning and the central nervous system: A new therapeutic opportunity for brain and spinal cord injuries?" Thesis, Université Grenoble Alpes, 2020. https://thares.univ-grenoble-alpes.fr/2020GRALS025.pdf.
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Les contraintes physiologiques cérébrales rendent le cerveau humain vulnérable à l'hypoxie, qu’elle soit environnementale (haute altitude) ou en lien avec une pathologie hypoxémiante. Parmi ces pathologies, et en raison de sa forte prévalence dans la population générale, le syndrome d'apnées obstructives du sommeil (SAOS) est un modèle physiopathologique reconnu des effets délétères de l'hypoxie sur le cerveau. Les épisodes cycliques d'apnées et d'hypopnées survenant au cours du sommeil qui caractérisent le SAOS entraînent une hypoxie intermittente, une fragmentation du sommeil et des fluctuations de la pression intra-thoracique, tous trois facteurs déclenchant des mécanismes intermédiaires contribuant au développement de maladies cardio-métaboliques ainsi que des répercussions cérébrales (troubles cognitifs et accidents vasculaires cérébraux (AVC)). Ce travail de thèse explore la relation bidirectionnelle entre les syndromes d’apnées du sommeil (SAS) et le cerveau. Le premier axe se concentre sur les conséquences neurocognitives du SAOS au travers du contrôle de la marche. Les répercussions neurocognitives du SAOS sont à ce jour bien décrites et des troubles de la marche ont récemment été mis en évidence, avec une relation de type dose-réponse entre la gravité du SAOS et la sévérité des troubles de la marche. Il a ainsi été suggéré que la marche pouvait représenter un marqueur des répercussions cérébrales du SAOS. Les effets du traitement par pression positive continue (PPC) sur le contrôle de la marche ont été investigués au cours de ce travail de Thèse, avec des résultats contrastés. Dans une première étude prospective contrôlée, 8 semaines de traitement par PPC entraînaient une amélioration du contrôle de la marche chez des patients atteints de SAOS sévère (Baillieul et al., 2018, Plos One). Afin de valider ces résultats et d'étudier les corrélats neurophysiologiques du lien entre marche et SAOS, nous avons mené un essai contrôlé randomisé étudiant l'impact de 8 semaines de traitement par PPC comparativement à la Sham-PPC (Baillieul et al., 2020, Soumis). Contrairement à notre hypothèse, nous n'avons constaté aucune amélioration du contrôle de la marche dans le groupe PPC, résultat corroboré par l'absence d'impact de la PPC sur les déterminants du contrôle de la marche. Le deuxième axe est centré sur les répercussions cérébro-vasculaires des SAS. SAS et AVC sont deux pathologies graves et étroitement liées, le SAS pouvant être à la fois cause et conséquence potentielle des AVC. Le présent travail est axé sur l'identification des traits phénotypiques de SAS chez les patients post-AVC, afin d'en améliorer le diagnostic (Baillieul et al., en préparation). Le dépistage du SAS post-AVC est crucial en raison du risque élevé de morbi-mortalité et de conséquences fonctionnelles associées au SAS après AVC, mais il ne peut être effectif sans une identification plus précise des patients à risque de SAS. Le troisième axe a été conçu comme une perspective qui servira au développement du deuxième axe. Dans ce dernier axe, le potentiel de l'imagerie cérébrale et en particulier de l'imagerie par résonance magnétique pour développer des marqueurs de récupération et étudier les mécanismes physiopathologiques des déficiences liées aux AVC sont présentés, au travers de la marche et de son contrôle. Les corrélats neuronaux de la marche comme activité post-AVC sont mis en évidence, en utilisant une approche de type Voxel-based lesion-symptom mapping (Baillieul et al., 2019, Hum. Mov. Sci.). Les marqueurs d'imagerie basés sur l’utilisation du Diffusion tensor imaging pour prédire la récupération de la marche post-AVC sont également présentés (Soulard et al., 2019, Neurology). Ces travaux sur les marqueurs d'imagerie cérébrale de la récupération post-AVC serviront à développer des outils pour les recherches à venir sur les corrélats neuronaux des SAS post-AVC<br>The human brain is a perfect example of our dependence on oxygen. Brain physiological constraints render it vulnerable to hypoxia, such as encountered in environmental conditions (high altitude exposure) or pathological hypoxemic conditions. Among those pathological conditions, and due to its high prevalence in general population and the various levels of hypoxia resulting of the different degrees of severity of the pathology, obstructive sleep apnoea syndrome (OSAS) is a pathophysiological model of choice to investigate the detrimental effects of hypoxia on the brain. The cyclical, repeated episodes of apnoea and hypopnea during sleep that characterize OSAS result in intermittent hypoxia, sleep fragmentation and fluctuations in intrathoracic pressure, which are stressors that triggers mechanisms contributing to the initiation and progression of life-threatening cardiometabolic diseases, as well as several brain repercussions, such as cognitive impairment and stroke. This Thesis work explores the bidirectional relationship between sleep apnoea syndromes (SAS) and the brain. The first axis is focused on the neurocognitive consequences of OSAS through the lens of gait control. The neurocognitive signature of OSAS has been thoroughly investigated but recently, gait impairments have been highlighted in severe OSAS, with dose-response relationship between OSAS severity and the magnitude of gait impairments. As gait control relies at least partly on frontal lobe functions, it has been suggested that gait could represent a marker of OSAS brain repercussions. We investigated the effects of continuous positive airway pressure (CPAP) treatment on gait control, with contrasting results. In a first prospective controlled study, eight weeks of CPAP improved gait control in severe OSAS patients (Baillieul et al., 2018, Plos One). In order to validate those results and investigate the neurophysiological correlates of the link between gait control and OSAS, we conducted a randomized controlled trial which investigated the impact of an 8-week CPAP treatment compared to sham-CPAP on gait control in severe OSAS patients (Baillieul et al., 2020, Submitted). Contrary to our hypothesis, we found no improvement in gait control in the CPAP group and this result is substantiated by the absence of impact of CPAP on the determinants of gait control, further illustrating the complexity of the OSAS-neurocognitive relationship. The second axis is focused on the cerebrovascular repercussions of SAS. SAS and stroke are both severe intertwined conditions, SAS being both cause and potentially consequence of stroke. The present work is focused on the identification of phenotypic traits of SAS in post-stroke patients, to improve diagnosis of SAS following stroke (Baillieul et al., in preparation). Screening stroke patients for SAS is crucial due to the high risk of morbimortality and functional consequences associated to SAS following stroke but cannot be achieved without a more accurate identification of patients at risk to develop SAS following stroke. The third axis has been conceived as a perspective that will serve the development of the second axis. In this last axis, the potential of brain imagery and in particular magnetic resonance imagery to develop markers of stroke recovery as well as investigate the pathophysiological mechanisms underlying stroke-related deficiencies are presented, with a specific focus on gait and walking activity. The neural correlates of walking activity following stroke are highlighted, using a voxel-based lesion-symptom mapping approach (Baillieul et al., 2019, Hum. Mov. Sci.). Imagery markers of walking recovery following stroke using diffusion tensor imaging are also presented (Soulard et al. 2019, Neurology). This work on brain imagery markers of stroke recovery will further serve the development of investigations focused on the neural correlates of SAS following stroke
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Lam, Chung-mei Jamie. "Obstructive sleep apnea and cardiometabolic complications." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43085854.
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Lebret, Marius. "Etude des déterminants des fuites non-intentionnelles au cours du traitement des troubles respiratoires du sommeil par pression positive et développement de stratégies innovantes pour le choix des masques et la gestion des fuites Factors contributing to unintentional leak during CPAP treatment : a systematic review Determinants of unintentional leak during CPAP treatment in obstructive sleep apnea syndrome Nasal Obstruction Symptom Evaluation Score to Guide Mask Selection in CPAP-Treated Obstructive Sleep Apnea N and Borel J-C. Comparison of auto-and fixed -continuous positive airway pressure on -air-leak in patients with obstructive sleep apnoea : data from a randomized controlled trial Adherence to CPAP with a nasal mask combined with mandibular advancement device versus an oronasal mask: a randomized crossover trial Nasal obstruction and male gender contribute to the persistence of mouth opening during sleep in CPAP-treated obstructive sleep apnoea." Thesis, Université Grenoble Alpes (ComUE), 2019. http://www.theses.fr/2019GREAS025.
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Au cours du traitement du syndrome d’apnées obstructives du sommeil (SAOS) par pression positive continue (PPC), les fuites non-intentionnelles sont un des effets indésirables les plus fréquents mais leur étiologie est mal comprise. Les objectifs de cette thèse étaient d’identifier les facteurs déterminants des fuites non-intentionnelles au cours du traitement du SAOS par PPC et de proposer des stratégies pour le choix du masque et la gestion des fuites.Dans notre revue de la littérature, nous avons arbitrairement classifié les déterminants potentiels à l’origine de fuites non-intentionnelles en deux catégories. 1) les déterminants non évolutifs au cours de la nuit : l’obstruction nasale, l’âge, un indice de masse corporel élevé, une distribution centrale des masses adipeuses et le genre masculin étaient des déterminants potentiels des fuites non-intentionnelles. Le masque naso-buccal était également associé à des fuites non-intentionnelles plus élevées que le masque nasal ; et 2) les déterminants évolutifs au cours du sommeil tels que les stades de sommeil, la position, l’ouverture buccale. Nous avons étudié ces déterminants évolutifs dans une population de 74 patients SAOS traités par PPC auto-pilotée : l’ouverture buccale, le niveau de pression de la PPC, la position du sujet et le sommeil paradoxal contribuaient au risque de fuite non-intentionnelle. Nous avons également mis en évidence que le masque naso-buccal réduisait le risque de fuite non-intentionnelle en cas d’ouverture buccale et au cours du sommeil paradoxal. Puisque le niveau de pression est un déterminant des fuites non-intentionnelles, nous avons évalué par une analyse ancillaire d’un essai randomisé contrôlé, si le mode de PPC (fixe versus autopiloté) pouvait contribuer aux fuites : nous n’avons pas montré d’association entre le mode et le niveau de fuites après 4 mois de traitement. Le mode PPC n’influençait pas le type de masque utilisé par les patients. Enfin, au cours d’une étude prospective incluant de 214 patients, nous avons évalué l’intérêt du questionnaire Nasal Obstruction Syndrom Evaluation (NOSE) comme outil pour guider le choix du masque. Un score NOSE > 50/100 à l’initiation de la PPC était indépendamment associé à l’utilisation d’un masque naso-buccal après 4 mois de traitement. Ce score est un outil simple pour évaluer objectivement les symptômes d’obstruction nasale et faciliter le choix de l’interface la plus appropriée. En conclusion, au cours de cette thèse nous avons développé une méthode innovante d’analyse des déterminants des fuites non-intentionnelles dont l’application clinique pourrait permettre la mise en place des stratégies de corrections individualisées des fuites. Cela devra faire l’objet d’une évaluation prospective, tout comme l’intérêt clinique de l’utilisation en routine du score NOSE pour guide le choix du masque.Mots clés : syndrome d’apnées obstructives du sommeil, pression positive continue, fuites, masque, interface, obstruction nasale, sommeil<br>Continuous Positive Airway Pressure (CPAP) is the first-line treatment for moderate to severe Obstructive Sleep Apnea (OSA) syndrome. Unintentional leakage and its annoying consequences are the most frequently reported adverse effects. However, the causes of unintentional leaks are poorly understood. This thesis aimed at identifying the determining factors of unintentional leaks during CPAP treatment in OSA and developping innovative strategies for the selection of masks and leaks management.In our systematic review we have arbitrarily split the potential determining factors of leaks into two categories: 1) the non evolving factors overnight: nasal obstruction, age, high body mass index, central fat distribution and male sex were potential contributing factors associated with unintentional leakage. The oronasal mask was associated with higher unintentional leaks than the nasal mask; and 2) the evolving factors overnight such as sleep stages, body position, mouth opening and CPAP level. We studied these evolving factors in 74 OSA patients treated with auto-adjusting CPAP: mouth opening, CPAP level, body position and REM sleep were independently associated with an increased risk of unintentional leakage. We also highlighted that oronasal masks reduced the risk of unintentional leaks in cases of mouth opening and REM sleep. Since the CPAP level is a determining factor of leakage we evaluated through an ancillary analysis of a randomised controlled trial whether the type of CPAP (fixed versus auto-adjusting) could contribute to leakage. In this study, there was no effect of type of CPAP on leaks or the type of interface used after 4 month of treatment. Finally, in 214 patients, we prospectively evaluated the relevance of the Nasal Obstruction Syndrom Evaluation (NOSE) score as a simple decision-making tool to guide the choice of mask during CPAP initiation. A NOSE score > 50/100 at the initiation was independently associated with the use of an oronasal mask at 4 month. This score could be a simple tool for the objective assessment of nasal obstruction related to symptoms, facilitating the choice of an appropriate interface. As a conclusion, during this thesis we have developed a novel methodology to characterise and analyse the overnight determinants of unintentional leakage. Its clinical application could lead to individualised corrective measures of leaks. Further studies are needed to prospectively validate this model, as well as the clinical relevance of the NOSE score to guide the choice of mask in daily practice
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Attali, Valérie. "Stabilité des voies aériennes supérieures et intégration centrale." Thesis, Paris 6, 2015. http://www.theses.fr/2015PA066450.
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Le syndrome des apnées obstructives du sommeil (SAOS) est caractérisé par des épisodes répétitifs de collapsus des voies aériennes supérieures (VAS) durant le sommeil. Au cours du SAOS les propriétés mécaniques des voies aériennes supérieures sont altérées, dans le sens d'une réduction de leur capacité à laisser passer l'air, ce qui peut être assimilé à une "charge" inspiratoire. Les apnées obstructives ne se produisent jamais à l'éveil, suggérant qu'il existe, des mécanismes protecteurs d'origine corticale, de type " compensation de charge ", liés à l'éveil. Ce travail permis de caractériser ces mécanismes chez le sujet sain et le patient SAOS. Une première étude a décrit la relation pression/débit des VAS à l'éveil afin d'approcher le phénomène de compensation de charge, avant et après un traitement modulant le contrôle neurovégétatif des VAS par la compression du ganglion ptérygopalatin. La deuxième étude a mis en évidence à l'éveil chez les patients SAOS, une activité corticale motrice liée à la respiration (présence de potentiels électroencephalographiques - PPI), dont l'origine semble liée à la dysfonction des VAS, et qui est susceptible d'expliquer l'augmentation du niveau de contrôle respiratoire central connu dans le SAOS. La troisième étude a mis en évidence un phénomène de filtrage des sensations respiratoires à l'éveil chez des patients SAOS, avec restauration des ces sensations sous orthèse d'avancée mandibulaire, permettant de relier l'amélioration des propriétés mécaniques des VAS à l'intégration centrale des sensations respiratoires. Enfin la relation pression/débit a fait l'objet de deux modélisations<br>The obstructive sleep apnoea syndrome (OSAS) involves recurrent sleep-related upper airways (UA) collapse. UA mechanical properties and neural control are altered imposing a mechanical load on inspiration. UA collapse does not occur during wakefulness, hence arousal-dependent compensation. Three studies in healthy and apnoeic patients allowed characterizing it. From upper-airway pressure-flow relationships, the first study described local compensation mechanisms, before and after a neurovegetative modulation based on ptérygopalatin node compression. The second study showed a respiratory-related cortical activity that could contribute to the increased neural drive to upper airway and to inspiratory muscles that has previously been described in OSAS, and could therefore contribute to the arousal-dependent compensation of upper airway abnormalities. The third study showed a sensory gating-out process of breathing sensations in OSAS that could be reversed by mandibular advancement device, allowing linking upper-airway stability improvement to central integration of respiratory sensations. Finally, upper-airway pressure-flow relationship was approached by two models
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Riha, Renata Ludmilla. "Genetics of the sleep apnoea/hypopnoea syndrome." Thesis, University of Edinburgh, 2004. http://hdl.handle.net/1842/25122.
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This thesis examined possible candidate genes that might contribute towards the development of OSAHS. The genes of interest included tumour necrosis factor –alpha (potential associations with ageing, hypercytokinaemia in OSAHS, obesity and sleepiness). Apolioprotein E (associations with the development of cerebrovascular disease), the serotonin receptor 2A (modulation of upper airway muscle tone and response to selective serotonin re-uptake inhibitors), beta-2 adrenoreceptor (growth, fat metabolism and blood pressure) and the growth hormone receptor (influence on postnatal bone growth and height including the craniofacial complex). 557 consecutive subjects with a diagnosis of OSAHS were approached at the Scottish Sleep Centre. 104 subjects (all Caucasian) were recruited together with 107 of their siblings as well as an additional 17 unrelated subjects without OSAHS and underwent overnight polysomnography and cephalometry. Blood was taken for DNA analysis. Subjects were classified as having definite OSAHS (n=110), indeterminate status (n=34) or not having OSAHS (n=83) based on their apnoea/hypopnoea frequency and sleepiness as measured by the Epworth Sleepiness Score. DNA was extracted using standard techniques and polymorphisms in the candidate genes were examined using allelic discrimination testing with TaqMan™. The Apolipoprotein E4 polymorphisms were determined using polymerase chain reaction, restriction fragment length polymorphism. DNA from192 random, healthy UK blood donors (assumed not to have OSAHS) was used as an additional control. Differences between subjects with and without OSAHS were as expected: there were over twice as many men in the OSAHS group compared to the non-OSAHS group (p<0.0001) and systolic blood pressure was significantly higher (p = 0.002) in the OSAHS group. Furthermore, the OSAHS group were more obese (p<0.0001) and had a greater neck circumference (p<0.0001) than the non-OSAHS group. Cephalometry revealed that both male and female apnoeics had significantly lower-set hyoid bones than non-apnoeic snorers (p = 0.01 and p = 0.038 respectively). In male subjects with OSAHS, a smaller mandible and lower-set hyoid were the most important characteristics distinguishing siblings with from sibs without OSAHS, independently of age and BMI. However, age, sex, BMI and edentulism were found to influence craniofacial parameters in both groups. For the genetic analyses, the Apo E e4 allele (examined in 73 subjects) was not associated significantly with a diagnosis of OSAHS. In addition, the TNF-a – 308 A allele showed significant association with the OSAHS phenotype when comparing siblings discordant for carriage of this allele. The increased prevalence of some of the minor polymorphisms in the study population with OSAHS suggested there may be abnormalities in metabolism and the regulation of growth, which may directly contribute to its aetiology. These preliminary findings would require exploration in other populations, but are compatible with OSAHS being a polygenic disorder. This thesis highlights that there is much to be done in our search for relevant genetic factors that will lead to a greater understanding of this complex, chronic and very common disease.
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Lam, Chung-mei Jamie, and 林頌眉. "Obstructive sleep apnea and cardiometabolic complications." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43085854.
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Lam, Yau-min, and 林宥冕. "Obstructive sleep apnea in children with Down syndrome: a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48423786.
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While obstructive sleep apnea among children with Down syndrome is very common, the pre-existing risk factors and its impact to neurodevelopment are not well known. The aims and objectives of this systematic review are to determine the prevalence of OSA among DS children and to identify the associated risk factors. 6 articles that met the inclusion criteria were retrieved after using PubMed and Google Scholar in literature searching. The prevalence of OSA has great variation among different countries but are relatively high, ranging from 57% to 79%. OSA was significant associated with obesity, age and tonsil size. It is also known to associate with behavioral problem in DS children and delay their neurodevelopment. Therefore, early treatment followed by appropriate modification in lifestyle and diet is crucial in managing OSA.<br>published_or_final_version<br>Public Health<br>Master<br>Master of Public Health
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Donoghue, Simon. "The cardiovascular consequences of obstructive sleep apnoea hypopnoea syndrome." Thesis, University of Liverpool, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269700.
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Moss, James. "Physiological effects of treatments in obstructive sleep apnoea syndrome." Thesis, Sheffield Hallam University, 2013. http://shura.shu.ac.uk/20763/.
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The original research in this thesis aimed to investigate physiological effects of different treatment approaches in obstructive sleep apnoea syndrome (OSAS). OSAS is a prevalent public health concern independently associated with increased cardiovascular risk. Specifically, study 1 examined the feasibility of conducting a pragmatic lifestyle intervention in patients reporting compliance with continuous positive airway pressure (CPAP) and collected provisional data about its efficacy, and study 2 investigated the physiological effects of low compliance to CPAP therapy in a four-arm observational study. The intervention in study 1 involved supervised exercise, dietary advice and behaviour change counselling. Primary outcome measures were recruitment, retention and compliance data and secondary outcome measures assessed anthropometrics, cardiovascular risk, quality of life and exercise capacity. Study 2 investigated macro-and microvascular function, anthropometrics, quality of life, cardiovascular risk and exercise capacity. The novel findings of this research were: 1) the lifestyle intervention was feasible to deliver; 2) the intervention improved key health outcomes such as exercise capacity (A +16%) and serum C-reactive protein (A -57%), which were maintained after 3 months of independence (A +22% and -57%, respectively); 3) self-reported CPAP compliance is an unreliable indicator of actual compliance; 4) it is difficult to recruit low-compliance patients onto research trials, and recruiting newly diagnosed patients is also difficult without interrupting the patient pathway; 5) vascular function seems impaired in low-compliance patients versus high-compliance patients, although further work is needed to confirm this. These findings contribute to the growing evidence base for the role of lifestyle intervention in OSAS, and provide provisional data on the effects of low compliance to CPAP therapy on vascular endothelial function. In summary, future research investigating pragmatic lifestyle interventions in OSAS and the physiological effects of low-compliance to CPAP is certainly warranted.
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Ulander, Martin. "Psychometric aspects of obstructive sleep apnea syndrome." Doctoral thesis, Linköpings universitet, Avdelningen för neurovetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-97475.
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Introduction: Obstructive sleep apnea (OSA) is a common chronic disorder consisting of episodes with impaired breathing due to obstruction of the upper airways. Treatment with Continuous Positive Airway Pressure (CPAP) is a potentially effective treatment, but adherence is low. Several potential factors affecting adherence, e.g., subjective sleepiness and personality, are only quantifiable through questionnaires. Better knowledge about psychometric properties of such questionnaires might improve future research on CPAP adherence and thus lead to better treatment options. Aim: Study I: To describe the devlopment and initial testing of the Side Effects of CPAP treatment Inventory (SECI) questionnaire. Study II: To describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. Study III: To study whether any of the items in the Epworth Sleepiness Scale (ESS) exhibit differential item functioning and, if so, to which degree. Study IV: To examine the evolution of CPAP side effects over time; and prospectively assess correlations between early CPAP side effects and treatment adherence. Patients and Methods: In study I, SECI items were based on a literature review, an expert panel and interviews with patients. It was then mailed to 329 CPAP-treated OSAS patients. Based on this, a principal component analysis was performed, and SECI results were compared between adherent and non-adherent patients. In study II, the population consisted of 247 OSAS patients with ongoing CPAP treatment. The DS14 was used to assess the prevalence of type D personality, and SECI and adherence data from medical records were used to correlate Type D personality to side effects and adherence. In study III, the population consisted of pooled data from 1,167 subjects who had completed the ESS in five other studies. Ordinal regression and Rasch analysis were used to assess the existence of differential item functioning for age and gender. The cutoff for age was 65 years in the Rasch analysis. In study IV, SECI was sent to 186 subjects with newly diagnosed OSAS three times during the first year on CPAP. SECI results were followed over time within subjects, and were correlated to treatment dropout during the first year and machine usage time after 6 months. Results: SECI provides a valid and reliable instrument to measure side effects, and non-adherent patients have higher scores (i.e., were more bothered by side effects) than adherent patients (study I). Type D personality was prevalent in approximately 30 % of CPAP treated OSAS patients, and was associated to poorer objective and subjective adherence as well as more side effects (study II). Differential item functioning was present in items 3, 4 and 8 for age in both DIF analyses, and to gender in item 8 the Rasch analysis (study III). Dry mouth and increased number of awakenings were consistently associated to poorer adherence in CPAP treated patients. Side effects both emerged and resolved over time (study IV). Conclusions: Differences in previous research regarding side effects and CPAP adherence might be explained by differences in how side effects and adherence are defined. While some side effects are related to adherence, others are not. Side effects are furthermore not stable over time, and might be related to personality. ESS scores are also related to CPAP adherence according to previous research, but might be affected by other factors than sleepiness, such as age and possibly gender.
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Cloonan, Yona Keich. "Sleep outcomes in children with craniofacial microsomia /." Thesis, Connect to this title online; UW restricted, 2007. http://hdl.handle.net/1773/10877.
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Wong, Keith K. H. "Measuring sleep and neurobiological functional parameters in patients with obstructive sleep apnea." Connect to full text, 2007. http://hdl.handle.net/2123/2245.
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Thesis (Ph. D.)--University of Sydney, 2008.<br>Title from title screen (viewed Mar. 12, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Discipline of Medicine, Faculty of Medicine. Degree awarded 2008; thesis submitted 2007. Includes bibliography. Also issued in print.
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Gagnon, Victoria Lee. "Obstructive sleep apnea syndrome and associated health risks /." Abstract Full Text (HTML) Full Text (PDF), 2008. http://eprints.ccsu.edu/archive/00000538/02/1986FT.htm.
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Thesis (M.S.) -- Central Connecticut State University, 2008.<br>Thesis advisor: Ruth Rollin. "... in partial fulfillment of the requirements for the degree of Master of Science in Biology." Includes bibliographical references (leaves 39-41). Also available via the World Wide Web.
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Mathur, Rajat. "Family studies in patients with the sleep apnoea/hypopnoea syndrome." Thesis, University of Edinburgh, 1995. http://hdl.handle.net/1842/19996.
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The predisposing factors leading to the development of sleep apnoea/hypopnoea syndrome (SAHS) in many cases are unclear. Snoring, a prerequisite for SAHS, runs in families. There have been reports of familial SAHS in several families but this may have resulted from an association with obesity. I have therefore investigated whether SAHS is familial. In a pilot study breathing and oxygen desaturation data during sleep in 40 first degree relatives of 20 non obese SAHS patients has been compared with that in retrospective controls. Ten out of 40 relatives had >15 apnoeas+hypopnoeas/hr of sleep and 8 had >5 4% desaturations/hr. These frequencies of irregular breathing (p<0.005) and desaturation (p<0.0001) are significantly higher than in the British population. A case control study has therefore been performed examining sleep symptoms, sleep studies, upper airway calibre by acoustic reflectance and facial structure by cephalometry in first degree relatives of non obese (BMI<30 kg/m<SUP>2</SUP>) patients with SAHS and matched controls drawn from a general practitioner's register. In a pilot study to determine whether there might be any association between SAHS and Sudden Infant Death Syndrome, it was found that 8 unexpected sudden infant deaths were reported in 28 SAHS families compared to none in 35 control families (p<0.01). This preliminary observation requires independent verification. Thus SAHS is familial and this family tendency is associated with anatomical changes which predispose to upper airway narrowing.
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Faccenda, Jacqueline Frances. "Systemic blood pressure in the obstructive sleep apnoea/hypopnoea syndrome." Thesis, University of Edinburgh, 2002. http://hdl.handle.net/1842/23341.
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The purpose of this thesis was to demonstrate in a randomised controlled trial whether BP was higher in untreated OSAHS. The study was crossover in design with the patients acting as their own controls, so increasing the power of the study. Sixty-eight patients were studied with at least two major symptoms of OSAHS, and a mean AHI of 15 events/hour slept and a mean age of 49 years (27-77). Diastolic Blood Pressure (DBP) was reduced by CPAP in patients with OSAHS. These data were analysed on an intention to treat basis, including all 68 patients including poorly compliant patients. This showed a 1.5 mmHg drop in DBP (p = 0.043) with CPAP. In an <i>a priori </i>compliant subset (CPAP use 3.5 hours/night) DBP remained significantly lower by a magnitude of 1.9 mmHg (p = 0.042). In the other <i>a priori </i>subset of severely hypoxaemic patients (4% desaturation index 20/hour) there were also falls in Systolic BP (4.0 mmHg, p = 0.011), DBP (5.0 mmHg, p = 0.001) and mean arterial pressure (3.4 mmHg, P=0.023). Although all the reductions in pressures were small, data from population studies suggest such reductions may be associated with significant health benefits. In addition the effects may have been underestimated as the equipment used to measure BP may cause an arousal from sleep there by artificially elevating the night-time BP recorded. The baroreceptor function was not different between the two treatments. The urinary microalbumin was abnormal in 35% of the patient group, the reasons for this needs further investigation. The benefits found in quality of life confirmed previous studies although this is the first randomised controlled trial to show benefits in the Functional Outcomes of Sleep Questionnaire. The lack of improvement in the neuropsychological testing may reflect the tests used. The CPAP compliance on this study was less than ideal, but similar to those in other prospective studies.
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Al-Abri, Mohammed A. "Studies in blood pressure and obstructive sleep apnoea/hypopnoea syndrome." Thesis, University of Edinburgh, 2007. http://hdl.handle.net/1842/24009.
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This thesis aims to explore baroreflex sensitivity (BRS) in a randomised controlled trial. The hypothesis is that BRS is impaired in sleep apnoea patients, which might be reversed with one month of CPAP therapy. The study was designed to test for BRS in newly diagnosed OSAHS patients and perform a single blinded placebo controlled crossover trial of the effect of CPAP. Twenty-nine patients were recruited with Epworth Sleepiness Scale (ESS) of more than 10 and apnoea/hypopnoea index (AHI) was more than 15. Ten healthy control subjects were also studied. The study has shown weak difference between controls and OSAHS patients in the sequential analysis measure of BRS (P=0.05) but there was no difference with other BRS variables (P>0.05). However, the study did not show any significant difference between CPAP and placebo in terms of an effect on any measure of BRS not of 24-hour blood pressure. Even a priori sub group analyses of desaturating and compliant patients (4% Desaturating Index > 10 & CPAP use > 3.9 hour/night) showed no effect of CPAP (P>0.05). Patients did improve symptomatically with CPAP (P=0.02).The main criticisms of this study are the lack of reproducibility of the BRS measuring technique. Furthermore, relatively small sample size, may perhaps, had a negative impact on the results. The new methods were investigated further by another study, looking into the reproducibility of eth technique and the principles of BRS measurement, either the sequence as well as the spectral analysis of heart rate and systolic blood pressure. This study has revealed that spontaneous methods of BRS particularly the spectral domains are quite variables over time and thus difficult to reproduce. The third study was to assess endothelial function, as part of the process of understanding the pathogenesis of development hypertension and cardiovascular diseases in OSAHS patients and the contribution of hypoxemia in these disorders. The 24 blood pressure monitoring analysis revealed that hypoxemia is a putative predictor for hypertension.
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Kingshott, Ruth N. "Factors affecting daytime function in the sleep apnoea/hypopnoea syndrome." Thesis, University of Edinburgh, 1998. http://hdl.handle.net/1842/28365.
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This thesis examines the relationships between a wide range of nocturnal sleep and breathing variables and daytime function. Additionally this thesis examines the use of subjective and objective measures of daytime sleepiness, to determine which tests provide the most useful information for SAHS patients. A pilot study found that neither the 103 patients' nor their partners' Epworth rating of sleepiness were strong predictors of SAHS severity. In 150 patients with a wide range of SAHS severity, relationships between nocturnal events and daytime function were examined using newer definitions of arousal and measures of sleep continuity. A broad battery of daytime tests were used including the Maintenance of Wakefulness Test (MWT) and the Short Form (SF)-36. Unlike previous studies, all correlations were controlled for age and awake oxygen saturation, known to influence the variables measured. The current study also examined these correlations in an unselected patient sample with a range of disease severity. The study showed a lack of strong relationships between conventional nocturnal sleep and breathing variables and daytime function. Few baseline variables significantly predicted CPAP use. Daytime function measures were compared within the 150 patients. The Multiple Sleep Latency Test (MSLT) and the MWT displayed a weak, discordant relationship. Measures of cognitive function, psychological well-being and subjective sleepiness better related to the MWT than MSLT, suggesting that the MWT may be a more useful tool in assessing functional impairment in sleep apnoea. The studies presented in this thesis demonstrate a lack of identified factors affecting daytime function in a group of unselected SAHS patients. This may be due to inter-individual patient variability. Also, more sophisticated nocturnal SAHS measures should be examined, as should more 'real-life' daytime assessments, such as ambulatory EEG recorded during a patient's normal daily routine.
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Ghiassi, Ramesh. "The development of pictorial tools for obstructive sleep apnoea syndrome." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/24435.
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Introduction: Obstructive sleep apnoea syndrome (OSAS) is common but remains underdiagnosed and is linked with several disease states and increased risk of mortality. The key symptom, excessive daytime sleepiness, is commonly measured with the Epworth Sleepiness Scale which is not always easily completed by patients. The aim of this thesis is to develop pictorial material for assessing sleepiness and risk of OSAS. Methods: Health literacy was measured in a sample sleep population and the Epworth Sleepiness Scale was investigated for ease of use. Images were developed to translate the Epworth into pictures and the response to pictures of 'driving while sleepy' was investigated in detail. A new tool, the pictorial Sleepiness and Sleep Apnoea Scale, was devised by adding four sleepiness images from the pictorial Epworth to four new images representing 'risk of OSAS'. Evaluations were made in two populations of the tool's potential in predicting those at risk of OSAS. Results: Poor or impaired health literacy was found in 16% of patients attending the sleep clinic. Evaluation of the Epworth Sleepiness Scale found that a third of new patients made quantifiable errors. A preference for the pictorial Epworth Sleepiness Scale was reported by 55% of users and a kappa statistic indicated good agreement between the pictorial and traditional Epworth Sleepiness Scale. Drivers were more inclined to record feeling sleepy if the image in Q8 depicted the sleepy person in the car as a passenger. In a sleep clinic population the pictorial Sleepiness and Sleep Apnoea Scale was slightly better at predicting disease than the Epworth. In a cardiac rehabilitation clinic use of the witnessed apnoea image from the pictorial Sleepiness and Sleep Apnoea Scale, along with the Epworth Sleepiness Scale, helped to identify symptoms suggestive of sleep apnoea in a third of those screened. When investigated with a sleep study, the prevalence of sleep-disordered breathing in this patient group was 14.8%. Conclusion: Pictorial tools for patients with potential obstructive sleep apnoea syndrome have clinical value and can help bridge the gap between poor or impaired health literacy and the material we use to assess sleepiness and likelihood of obstructive sleep apnoea syndrome.
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Wåhlin, Larsson Britta. "Skeletal muscle in Restless legs syndrome (RLS) and Obstructive sleep apnoea syndrome (OSAS) /." Örebro : Örebro University, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-6245.
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Wåhlin, Larsson Britta. "Skeletal muscle in Restless legs syndrome (RLS) and Obstructive sleep apnoea syndrome (OSAS)." Doctoral thesis, Örebro universitet, Hälsoakademin, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-6245.
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Restless legs syndrome (RLS) and Obstructive sleep apnoea syndrome (OSAS) are two sleep disorders that affect daily life with symptoms such as sleepiness and fatigue. It was therefore hypothesised that the skeletal muscle could be affected as symptoms from skeletal muscle are common. The overall aim of the thesis was to investigate aerobic capacity and structure of skeletal muscle in patients with OSAS and RLS and an age matched control group to provide information regarding the underlying mechanisms. The specific aims were to investigate muscle fibre composition, capillary network, capillary proliferation and sings of local inflammation in musculus tibialis anterior of RLS and OSAS.OSAS and RLS patients had a significantly lower predicted VO2 max expressed in ml/min/kg compared with the control group and in the OSAS group apnoes-hyponea index (AHI) was inversely correlated to maximal oxygen uptake Fibre type composition and muscle fibre cross sectional area in the tibialis anterior muscle was equal in all groups with a predominant proportion of slow type I fibres and a smaller fibre area in slow type I fibres compared to fast type II fibres. The distribution of fast fibres (I/IIA, IIA) did not differ except for the group IIX and IIA/IIX where OSAS and RLS had a significantly higher percentage. OSAS patients had a significantly higher number of capillaries per fibre (CAF) for slow type I fibres and CAF per fibre area (CAFA) for fast type II fibres. CFPE- index (capillary to fibre perimeter exchange) and LC/PF-index (length of capillary/perimeter of fibre) were higher in both patient groups. Vascular endothelial growth factor (VEGF) and proliferating endothelial cells were analysed by double-immunofluorescence staining and were presented to a greater extent in the patient groups compared with the healthy controls. Based on normal amounts of T-cells and macrophages in the histological picture it was also demonstrated that local inflammation was not present in the tibialis anterior muscle of RLS and OSAS whish was also supported by the absence of expression of major histocompatibility complex class I molecules (MHC class I) on the surface of the tibialis anterior muscle fibres.In conclusion, the low predicted VO2 max together with higher percentage of type IIX and IIA/IIX muscle fibres indicates a low central capacity in the patient groups. The increased capillary network and the absence of inflammation indicate the occurrence of local hypoxia in tibialis anterior muscle in patients OSAS and RLS.
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Patel, Mayur Mahendra. "A comparison of the edentulous and dentate prosthodontic patient for the occurrence of obstructive sleep apnea." Morgantown, W. Va. : [West Virginia University Libraries], 2004. https://etd.wvu.edu/etd/controller.jsp?moduleName=documentdata&jsp%5FetdId=3321.
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Thesis (M.S.)--West Virginia University, 2004.<br>Title from document title page. Document formatted into pages; contains vii, 47 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 30-31).
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Hill, Elizabeth Anne. "Prevalence and treatment of obstructive sleep apnoea/hypopnoea syndrome in adults with Down syndrome." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/22917.
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Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is characterised by repeated cycles of upper airway obstruction during sleep, leading to diurnal symptoms. Individuals with Down syndrome (DS) are predisposed to this as the DS phenotype overlaps with OSAHS risk factors. Around 2-4% of the general adult population and 55% of children with DS have OSAHS but, to date, no large-scale study has assessed OSAHS prevalence or efficacy of treatment in DS adults. This study aimed to: 1) Systematically assess subjective and objective OSAHS prevalence; 2) Assess the effectiveness of continuous positive airway pressure (CPAP) in an adult DS population. Standard questionnaires including pictorial Epworth Sleepiness Scale (pESS) and Developmental Behaviour Checklist for Adults (DBC-A) were sent to UK adults aged ≥16yr with DS and their caregivers. All questionnaire responders were invited to undergo home polygraphy. Symptomatic adults with DS with ≥10 apnoeas/hypopnoeas per hour in bed (AH) on home polygraphy were invited to participate in a prospective randomised controlled trial (RCT) of CPAP v. lifestyle advice, with review at 1, 3, 6 and 12m. Participants in the lifestyle arm were offered CPAP at 1m. Standard measurements of sleepiness, behaviour, cognitive function and general health were undertaken. Standard statistical analyses were conducted, with significance set at p < 0.001 to control for multiple testing. Of 5270 questionnaires sent, 1105 responses were valid (21%). Responders (55% males) were overweight/obese young adults: mean BMI 29.0±6.8kg/m2; mean age 28±9 years. Women had a higher BMI (p < 0.0001), but collar size was greater in men (p < 0.0001). Mean pESS scores were broadly within the normal range (7±5/24). No significant gender differences in OSAHS symptoms were noted. Individuals with probable OSAHS had higher pESS and DBC-A scores, and significantly more symptoms of OSAHS. Subjective OSAHS prevalence was estimated at 35%. Of the 790 individuals invited, 149 underwent polygraphy, with 134 valid studies obtained: mean AH 21.8(10.9-42.7); mean oximetry desaturation index (ODI) 6.6(2.3-20.0). No significant gender differences were observed. Forty-two percent of participants met standard clinical diagnostic criteria for OSAHS. Twenty-eight eligible adults with DS (19 male) were randomised: age 28±9yr; BMI 31.5±7.9kg/m2; AH 28.6(14.8-47.9); ODI 7.3(1.8-21.9); pESS 11±6/24. Groups did not differ significantly at baseline. By 12m, 4 participants had withdrawn (all remaining participants on CPAP). The pESS (p=0.001), DBC-A Disruptive (p < 0.0001) and Kaufmann Brief Intelligence Test verbal subscale (p=0.001) scores improved significantly. This first large study of OSAHS prevalence in the adult DS population estimates a prevalence of 35-42% - around 10 times higher than in the general adult population. Sustained, significant improvements in sleepiness, cognitive function and behavioural/emotional outcomes with CPAP use over a 12m period were demonstrated during this first RCT of CPAP in adults with DS. A larger trial of CPAP in this population is warranted.
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Sam, Kim. "Short term effects of an oral appliance in the treatment of mild to moderate Obstructive Sleep Apnea in Chinese subjects." Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B21879278.
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Cheng, Hai-kiu Kelvin. "Evaluation on the quality of life for patients with obstructive sleep apnea using the continuous positive airway pressure device treatment." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B4072041X.
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Iliescu, Eduard Andrei. "Prevalence of proteinuria in the obstructive sleep apnea syndrome." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0018/MQ54460.pdf.
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Chittenden, Thomas William. "Chronic Hypoxia and Cardiovascular Dysfunction in Sleep Apnea Syndrome." Diss., Virginia Tech, 2002. http://hdl.handle.net/10919/28718.
Full textAbstract:
The purpose of the current study was to test the hypothesis that chronic hypoxia associated with sleep-disordered breathing relates to abnormal Nitric Oxide (NO) production and vascular endothelial growth factor (VEGF) expression patterns that contribute to aberrancy of specific determinates of cardiovascular and cardiopulmonary function before, during, and after graded exercise. These patterns may further reflect pathologic alteration of signaling within the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt-1) transduction network. To this end, 7 medically diagnosed OSA patients (3 male, 4 female), mean age 48 years and 7 apparently healthy control subjects (3 male, 4 female), mean age 42 years, underwent baseline venous blood draws and maximal bicycle ergometry. Mononuclear cells isolated from peripheral blood were utilized as reporter cells for measurement of VEGF, Akt-1, hypoxia inducible factor-1 alpha (HIF-1 alpha), and vascular endothelial growth factor receptor-2 (VEGFR2) gene expression by redundant oligonucleotide DNA microarray and real-time PCR technologies. Circulating angiogenic progenitor cells expressing VEGFR2 were profiled by flow cytometry. Plasma and serum concentrations of VEGF, nitrates/nitrites, catecholamines, and dopamine were measured by enzyme-linked immunosorbent assay (ELISA) and high performance liquid chromatography (HPLC). Arterial blood pressure, cardiac output, oxygen consumption and total peripheral resistance were determined at Baseline, 100W, and peak ergometric stress by standard techniques. There were no apparent differences (p < .05) observed in biochemical markers relating to vascular function and adaptation including, serum nitrates/nitrites, norepinephrine, dopamine, and plasma VEGF. No differences were found relative to cardiac output, stroke volume, cardiopulmonary or myocardial oxygen consumption, expired ventilation, heart rate, arteriovenous oxygen difference, total peripheral resistance, and mean arterial pressure. Due to methodological issues related to the redundant oligonucleotide DNA microarray and real-time PCR gene expression analyses, results of these experiments were uninterpretable. Thus, the research hypothesis was rejected. Conversely, significant (p < .05) differences were observed in waist: hip ratios, recovery: peak systolic blood pressure ratio at 1 minute post-exercise and %VEGFR2 expression. OSA was associated with elevations in both waist: hip ratios and recovery: peak systolic blood pressure ratio at 1 minute post-exercise as well as significant depression of %VEGFR2 profiles. Moreover, significant negative correlations were found regarding waist: hip ratios and %VEGFR2 expression (r = -.69;p =.005) and recovery: peak systolic blood pressure ratio at 1 minute post-exercise and %VEGFR2 expression (r = -.65;p =.01). These findings did not provide evidence that NO-dependent vasoactive mechanisms are suppressed nor did they support the supposition that angiogenic mechanisms are pathologically activated in sleep-disordered breathing.<br>Ph. D.
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Wichmann, Mark William. "A device for the treatment of adult Sleep Apnea Syndrome." Thesis, Virginia Tech, 1988. http://hdl.handle.net/10919/45960.
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<p>An electronically-controlled positive-displacement bellows-type air pump
has been developed in the Bio-medical Engineering Laboratory for the
treatment of adult Sleep Apnea Syndrome (SAS). An electronically-controlled
positive-displacement pump has been employed in order to eliminate the
pressure regulator and accompanying noise of present therapeutic devices.
The positive-displacement pump is found to quietly and effectively provide
the required airway pressures for the treatment of adult Sleep Apnea
Syndrome. New developments in the reduction of the size and noise levels
of current therapeutic devices, however, preclude mass production of the
bellows-type pump because of its size disadvantage. The custom nasal mask
and exhalation valve, control system, pressure-monitoring alarm system, and
the controlled humidifier of the positive-displacement pump should be
incorporated within the present fanâ type Nasal Continuous Positive Airway
Pressure (NCPAP) system to provide quieter, more comfortable, and safer
NCPAP therapy. Before the design and development of the positive displacement
NCPAP pump is detailed in this thesis, however, the problem
of adult Sleep Apnea Syndrome is introduced, available therapies are
investigated, and the current NCPAP therapy system is examined.</p><br>Master of Science
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Dingwall, Kylie. "Effects of medication on the sleep architecture of patients with obstructive sleep apnea syndrome (OSAS) /." [St. Lucia, Qld.], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe19264.pdf.
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Mok, Yuk-wan Wendy. "A validation of the Calgary Sleep Apnea quality of life index (Chinese version) and an evaluation of treatment effectiveness and patient perference by physiological and neurobehavioural outcome measures in Chinese sleep apnea patients /." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B2520564x.
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Santos, Telma Cristiana Resse Nunes dos. "Erectile disfunction in obstrutive sleep apnea syndrome - prevalence and determinants." Dissertação, Faculdade de Medicina da Universidade do Porto, 2010. http://hdl.handle.net/10216/61110.
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Groenewald, Liechka. "The prevalence of sleep apnea in patients with Cushing's syndrome." Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/77081.
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Patients with Cushing’s syndrome often complain about sleep disruption and excessive day time sleepiness, which could contribute to worsening quality of life and metabolic comorbidities (obesity, hypertension, diabetes mellitus, dyslipidaemia) associated with hypercortisolism. Sleep disorders have been shown to increase the risk of developing cardiovascular disease and that the risk of cardiovascular disease in patients with hypercortisolism may be worsened by impaired sleep. Cushing’s syndrome patients may also be at increased risk for obstructive sleep apnea due to their obesity.<br>Dissertation (MSc)--University of Pretoria, 2020.<br>Physiology<br>MSc<br>Restricted
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Santos, Telma Cristiana Resse Nunes dos. "Erectile disfunction in obstrutive sleep apnea syndrome - prevalence and determinants." Master's thesis, Faculdade de Medicina da Universidade do Porto, 2010. http://hdl.handle.net/10216/61110.
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Breslin, Jennifer H. "Sleep Disturbance, Cognition, and Behavior in Down Syndrome." Diss., The University of Arizona, 2011. http://hdl.handle.net/10150/201494.
Full textAbstract:
Children and adolescents with Down Syndrome (DS) have a high incidence of sleep problems, including Obstructive Sleep Apnea Syndrome (OSAS). They are also likely to have deficits in neuropsychological tasks tapping prefrontal function and hippocampal function. There has recent revival of literature suggesting an active role for sleep in memory consolidation and problem-solving in both children and adults. Furthermore, given the cognitive and behavioral sequellae of OSAS in typically developing children it is logical to test if the hypoxemia and increased sleep fragmentation, the two major pathophysiological mechanisms of OSAS, seen in children with DS and OSAS may exacerbate learning or behavior disorders.Forty children with DS aged 7-18 were administered the Arizona Cognitive Test Battery (ACTB) for DS (Edgin et al., 2010), and in-home ambulatory polysomnography. Their parents were asked to complete several questionnaires assessing their child's sleep and behavior. Seventy-seven percent (n = 40) of our sample met criteria for pediatric sleep apnea (AHI>1.5), and the mean apnea hypoppnea index (AHI) was 8.4 events per hour. Our sample had a mean arousal index of 10.3, a respiratory arousal index of 3.2, and a SaO2 nadir of 86.9%. Over 70% of our sample had a SaO2 nadir below 90%. We examined the relationship between OSAS severity and cognitive and behavioral outcomes. We found that children with DS with a lower apnea hypopnea index (AHI) attained a greater number of stages on the CANTAB PAL task compared to chronologically age-matched children with higher AHI, and the variance in performance was partially explained by sleep fragmentation (i.e., the arousal index) and experimenter-rated "attention" but not hypoxemia. In addition, we also found that the low apnea group showed a trend toward outperforming the high apnea group on the KBIT-II Verbal IQ scale and DAS-2 Pattern Construction subtest.These findings have important clinical implications. First, these results suggest that early screening for OSAS in DS is important, as OSAS severity seems to explain some of the variance in cognitive functioning. Second, these findings suggest that an early intervention for OSAS might be warranted.
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Ng, Kwok-keung Daniel. "Sleep related breathing disorders in children /." View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36223724.
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Ng, Kwok-keung Daniel, and 吳國強. "Sleep related breathing disorders in children." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B45007688.
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Noguchi, Tetsuo. "Heat shock protein 72 level decreases during sleep in patients with obstructive sleep apnea syndrome." Kyoto University, 1997. http://hdl.handle.net/2433/202175.
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Xu, Chun Wootton David Macmullen. "Computational mechanics models for studying the pathogenesis of obstructive sleep apnea (OSA) /." Philadelphia, Pa. : Drexel University, 2006. http://dspace.library.drexel.edu/handle/1860/746.
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Pérez, Trenard Diego Oswaldo. "Optimal control of non-invasive neuromodulation for the treatment of sleep apnea syndromes." Thesis, Rennes 1, 2018. http://www.theses.fr/2018REN1S014/document.
Full textAbstract:
Le syndrome d'apnée du sommeil (SAS) est une maladie multifactorielle caractérisée par des épisodes récurrents de pauses respiratoires ou des réductions significatives de l'amplitude respiratoire pendant le sommeil. Ces épisodes peuvent provoquer des réactions cardiorespiratoires aiguës; délétères à long terme. Plusieurs thérapies ont été proposées, étant la pression positive continue des voies respiratoires (CPAP) le traitement de référence. Malgré ces excellents résultats chez les patients symptomatiques, le taux de refus initial est de 15% et une adhésion à long terme est difficile à atteindre. Par conséquent, le développement de méthodes de traitement non invasives, avec une meilleure acceptabilité, reste d’une importance majeure. Dans ce contexte, l’hypothèse qui sous-tend ce travail est qu’une stimulation kinesthésique contrôlée, délivrée au cours de la phase précoce de l’apnée, peut réduire la durée des événements respiratoires et, par la suite, limiter les désaturations d’oxygène associées, par une activation contrôlée du réflexe de sursaut. La première partie de ce manuscrit est consacrée à la description d'un nouveau système (PASITHEA) de surveillance en temps réel et de neuromodulation thérapeutique, qui fonctionne comme un dispositif polyvalent de diagnostic et de traitement de SAS par stimulation kinesthésique. Les principales contributions de cette thèse se concentrent sur les aspects du traitement du signal et du contrôle de ce système, ainsi que sur l'électronique associée. Une autre contribution est liée à l'évaluation de ces méthodes et dispositifs par des protocoles cliniques spécifiques. Dans une deuxième partie, nous proposons une première méthode de contrôle On/Off optimale pour délivrer la stimulation, en utilisant comme variable de contrôle la sortie d'un détecteur d'événements respiratoires en temps réel. Lors de la détection d'un événement, une stratégie de stimulation unique avec amplitude de stimulation constante est appliquée, cette dernière a été mise en œuvre dans le cadre d'un premier protocole clinique dédié à l'évaluation de la réponse du patient au traitement. Les résultats ont montré que 75% des patients répondaient correctement au traitement en termes de durées des épisodes respiratoires. De plus, des diminutions significatives de la variabilité du SaO2 ont également été constatées lors de la mise en œuvre d'une nouvelle méthode d'analyse aiguë. Puisque nous avons supposé qu'une sélection inappropriée des patients pourrait expliquer l'absence de réponse observée chez 25% des patients. Nous avons proposé une méthode pour différencier les patients qui pourraient bénéficier de cette thérapie, basée sur l'estimation d'indices de variabilité cardiaque. Les résultats de ces analyses ont montré que l'efficacité de cette thérapie semble corrélée à un système nerveux autonome fonctionnel. Enfin, une méthode améliorée de contrôle en boucle fermée, intégrant des correcteurs proportionnels-dérivés (PD) couplés et simultanés a été proposée afin de modifier de façon adaptative l’amplitude de stimulation kinesthésique délivrée au patient par le système thérapeutique, en utilisant comme variables de contrôle des signaux physiologiques enregistrés en temps réel. Un deuxième protocole clinique visant à valider l'algorithme de contrôle de la stimulation kinesthésique adaptative spécifique au patient a été initié. Plusieurs améliorations ont été effectuées à la première version du système afin de permettre l'intégration du contrôleur proposé. Les résultats préliminaires de cette étude ont validé le fonctionnement de notre contrôleur et ont montré que notre système était capable de fournir une stimulation kinesthésique adaptative en fonction des réponses propres au patient. Une autre phase de cette étude, mettant en œuvre le contrôleur avec un ensemble des paramètres de contrôle présélectionnés, est actuellement en cours<br>Sleep apnea syndrome (SAS) is a multifactorial disease characterized by recurrent episodes of breathing pauses or significant reductions in respiratory amplitude during sleep. These episodes may provoke acute cardiorespiratory responses along with alterations of the sleep structure, which may be deleterious in the long term. Several therapies have been proposed for the treatment of SAS, being continuous positive airway pressure the gold standard treatment. Despite its excellent results in symptomatic patients, there is a 15% initial refusal rate and long term adherence is difficult to achieve in minimally symptomatic patients. Therefore, the development of non-invasive SAS treatment methods, with improved acceptability, is of major importance. The objective of this PhD thesis is to propose new signal processing and control methods of non-invasive neuromodulation for the treatment of SAS. The hypothesis underlying this work is that bursts of kinesthetic stimulation delivered during the early phase of apneas or hypopneas may elicit a controlled startle response that can activate sub-cortical centers controlling upper airways muscles and the autonomic nervous system, stopping respiratory events without generating a cortical arousal. In this context, the first part of this manuscript is dedicated to the description of a novel real-time monitoring and therapeutic neuromodulation system, which functions as a multi-purpose device for SAS diagnosis and treatment through kinesthetic stimulation. This system has been developed in the framework of an ANR TecSan project led by our laboratory, with the participation of Sorin CRM SAS. The main contributions in this thesis are focused on the signal processing and control aspects of this system, as well as the electronics associated. Another contribution is related to the evaluation of these methods and devices through specific clinical protocols. In a second part, we propose a first optimal On/Off control method for delivering kinesthetic stimulation, using as control variable the output of a real-time respiratory event detector. A unique stimulation strategy where a constant stimulation amplitude is applied upon event detention was implemented in a first clinical protocol, dedicated to assessing the patient response to therapy. Results showed that 75% of the patients responded correctly to therapy, showing statistically significant reductions in respiratory event durations. Also, significant decreases in the SaO2 variability were also found when implementing a novel acute analysis method. Since we hypothesized that inappropriate patient selection could explain the observed lack of response in 25% of patients, we proposed a method to differentiate patients who could benefit from this therapy based on the estimation of complexity-based indexes of heart rate variability. Results of these analyses showed that the effectiveness of this therapy seems correlated to a functional autonomic nervous system. Finally, an improved closed-loop control method integrating concurrent, coupled proportional-derivative (PD) controllers in order to adaptively change the kinesthetic stimulation was proposed. It uses as control variables three physiological signals recorded in real-time: Nasal pressure, oxygen saturation and the electrocardiogram signal. A second clinical protocol with the main objective of validating the control algorithm for patient-specific adaptive kinesthetic stimulation was launched. Several improvements to the first version of the system were developed to allow the integration of the proposed controller. Preliminary results from the first phase of this study validated the proposed controller operation and showed that the controller was able to provide adaptive kinesthetic stimulation in function of the patient-specific responses. A second phase of this study implementing the proposed controller and the set of the selected control parameters from the first phase is currently ongoing
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Fridel, Keith. "Adherence and Effectiveness of Positional Therapy for Obstructive Sleep Apnea Syndrome." Diss., The University of Arizona, 2011. http://hdl.handle.net/10150/203486.
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The purpose of this investigation was to explore how adherence to a positional therapy intervention affected therapeutic outcome in participants with positional-related obstructive sleep apnea syndrome. Eighteen adult participants identified as having positional-related obstructive sleep apnea by an initial overnight polysomnography study were recruited. Participants were instructed to use a “tennis ball technique” positional device for three weeks at home and record their sleep habits and adherence before a final post-treatment polysomnography evaluation. A repeated measures MANOVA found significant effects of treatment between pre- and post-test on the objective polysomnography variables of Total Recording Time [F(1,17) = 5.21, p<.05, η²=.24], Total Sleep Time [F(1,17) = 8.59, p<.01, η²=.34], Sleep Efficiency [F(1,17) = 5.42, p<.05, η²=.24], Total REM sleep time [F(1,17) = 9.91, p<.01, η²=.37], and the Apnea- Hypopnea Index [F(1,17) = 14.28, p<.001, η²=.46]. Sleep onset latency was not statistically significant. There were significant effects of treatment on the subjective measures of the Functional Outcome of Sleep Quality [F(1,17) = 8.92, p<.01, η²=.35], Pittsburgh Sleep Quality Index [F(1,17) = 11.2, p<.01, η²=..39], Epworth Sleepiness Scale [F(1,17) = 6.69, p<.05, η²=.28], and the Brief Symptom Inventory [F(1,17) = 5.14, p<.05, η²=.23]. No significant interaction effects were found between treatment and adherence when participants were grouped post-hoc into an adherent or non-adherent categories based on their self-reported daily log data. In summary, the results of this study indicated that the positional device was efficacious for significantly improving both objective polysomnography variables and subjective variables of sleep. The results also indicated even partially adherent participants reported significant improvements in nighttime sleep quality and quality of life after the three week treatment period. Mixed Linear Modeling demonstrated that significant improvements in sleep quality, time to sleep onset, and total sleep time were not seen until the last weeks of treatment. This study found very acceptable adherence rates with this positional device design; all participants were able to utilize the therapeutic device on at least a portion of every night during the three-week intervention.
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Appelberg, Jonas. "Ventilation and Lung Volume During Sleep and in Obstructive Sleep Apnea." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3363.
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Dingli, Kyra [Verfasser]. "Obstructive sleep apnoea, hypopnoea syndrome : arousals, autonomic activity and home-based diagnosis / Kyra Dingli." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2011. http://d-nb.info/1025239199/34.
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