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Compliance to CPAP therapy in patients with severe obstructive sleep apnea
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Abstracts/Sleep Medicine 16 (2015) S2–S199
advancement appliances (MAA) at the 75% advancement position. Sleep with appliance was tested after a period of 7 nights of habituation. Sleep quality and oral appliance comfort was assessed on morning using 100 mm VAS. Rhythmic masticatory muscle activity (RMMA), a biomarker of SB was scored from jaw electromyographic recordings during sleep using published criteria. RMMA index (# event/h) and sleep variables were compared between the baseline night (no appliance) and the ones with the two kinds of appliances using ANOVA or Friedman test. Questionnaire data were compared between OS and MAA nights with the Wilcoxon signed rank test. Statistical significance was set at p < 0.05. Results: Total sleep time of each experiment night was divided into three sections from sleep onset. There was no interaction between conditions and three night sections (p = 0.66). However, there were significant difference among conditions in second part of night (p = 0.01): during the OS and MAA nights the index of RMMA/SB episode/h of sleep was lower than during the baseline night (p = 0.01 and p < 0.001, respectively). Index of RMMA bursts and episodes with noise during night showed the same trend. Moreover, OS nights showed a significant reduction of index of phasic and mixed episodes than baseline night (p = 0.04 and p = 0.05, respectively) However, for tonic episodes, no significantly difference among baseline night, OS, and MAA was observed. During OS night sleep efficiency and percent of Stage N2 (light sleep) period were significantly higher than during baseline (p < 0.01 and p = 0.04, respectively). There was a reduction of N3 (deep sleep) and of awakening index during the OS night in comparison with the baseline night (p = 0.05 and p < 0.001, respectively). No effect was observed between MAA and baseline night for sleep variables. Subjects evaluated the OS as providing better sleep quality (median OS = 82.8, MAA = 57.5, p = 0.05) and comfort (median OS = 79.3, MAA = 16.5, p < 0.001) than MAA. Conclusion: The RMMA index of SB was reduced using either OS or MAA. Only OS seem to improve overall sleep quality and comfort; MAA was not better than OS. Use of smaller and more comfortable MAA for SB subjects with snoring and/or sleep apnea is to be tested. Acknowledgements: This study was supported by a Canadian Institutes of Health Research. We would like to thank Hajar ElAlaoui, Christiane Manzini, Régis Schwab and the whole staff at the Centre d’étude du sommeil (Hôpital du Sacré-Coeur de Montréal) for their expertise in conducting this study. http://dx.doi.org/10.1016/j.sleep.2015.02.1432
Effect of coronary artery bypass grafting surgery on sleep apnea in Omani patients M. Al Hooti SQU, Oman
Introduction: Coronary artery bypass grafting surgery (CABG) is an effective way of treating coronary artery disease (CAD). Prevalence of obstructive sleep apnea (OSA) causing hypoxic stress is higher in patients with CAD. This study is aimed at evaluating effect of CABG on sleep apnea in Omani patients undergoing CABG. Materials and methods: Patients with severe ischemic heart disease posted for CABG were recruited for the study. Portable sleep study was performed in the in-patient ward 1 day before the surgery, and sleep study was repeated on 6th and the 30th day of the surgery. All patients underwent on-pump CABG. Patients who had blood pressure of more than 200/120 and post prandial glucose more than 10 mmol were rejected. Results: Thirty-two patients volunteered to participate in the study (28 males; 4 females; age 62.6 + 9.6 years). Twenty patients
completed all three sleep studies. Pre-CABG study indicated that all patients had sleep apnea (AHI: 37.05 + 4.95) which persisted on day 6 and day 30. The baseline desaturation index was 21.38 + 3.27. There was no significant difference in obstructive sleeps apneas, hypopneas, apnea–hypopnea index, mean saturation index, maximum saturation index and desaturation index amongst pre CABG study and day 6 and day 30 of CABG (p > 0.05). Central sleep apnea (CSA) was found to be reduced on day 6 post-surgery but increased again on day 30 (Pre CABG: 12 ± 17; Day 6: 6 ± 12; Day 30: 27 ± 66: p > 0.05). Conclusion: All patients undergoing CABG had moderate to severe obstructive sleep apnea–hypopnea syndrome. The CABG did not change the sleep apnea parameters. http://dx.doi.org/10.1016/j.sleep.2015.02.1433
Compliance to CPAP therapy in patients with severe obstructive sleep apnea A. Aladab 1, A. H 2, I. A 2, A. A 2, A. A 2, M. A 2, A. O 2 1 College of Medicine, King Saud University, Riyadh, Saudi Arabia 2 Saudi Arabia
Introduction: Positive airway pressure (PAP) therapy is considered the gold standard treatment for obstructive sleep apnea. Compliance with treatment is a major obstacle for the success of treatment. Compliance among Saudi patients has not been documented objectively before. This prospective study to objectively determine compliance, and to identify predictors of compliance. Materials and methods: The main objective was to determine the specific reasons that could help patients to compliance with their adherence to CPAP, and improve their comorbid illness. The selected patients who were >18 years old and suspected to have OSA during the two year period between December 2010 to January 2012, had undergone type 1 PSG (polysomnography), have had AHI of more than 10 events/h. Objective assessment by full night diagnostic PSG and subsequent laboratory titration studies had been performed after first 2 h of recording according to study protocol was used. Exclusion criteria include any patients who had chronic pulmonary disease, daytime hypercapnia, congestive heart failure, neuromuscular disease, and was on home oxygen therapy. In the first 2 weeks of CPAP therapy patient underwent three training session on (day 1, day 7, day 14). Then a follow up in the clinic was done at 2 and 4 weeks after CPAP therapy. During each follow-up visit, patients complete data entry form and received training on their devices. Compliance with CPAP was determined at each visit subjectively and filling a questionnaire at each visit assessed the patients’ concerns. Good compliance was defined as using CPAP for >4 h/night for >70% of the recorded period. Results: Total of 156 patients recruited in the study period with a mean age of 52.6 ± 12.8 years, BMI of 38.1 ± 8.8 kg/m2, Epworth Sleepiness Scale (ESS) of 10.0 ± 5.8 and an apnea–hypopnea index (AHI) of 66.1 ± 34.6/h. During CPAP device titration in the sleep disorders center (SDC) 94.9% accepted titration with good objective improvement in sleep quality and respiratory events. All CPAP devices were provided with heated humidifiers. At 1 month, 56% met the criteria of good compliance. By the end of 10 months there was no difference in compliance between males and females (56.9% vs. 54.2%) and between patients who used conventional CPAP or autotitrating CPAP (44.4% vs. 42.3%). However, patients who purchased their CPAP devices had better compliance compared with patients who obtained it free from the hospital (59.7% vs. 47.2%). There were no differences regarding demographics data, symptoms, comorbidities, PSG parameters, AHI or type of mask used. Most
Abstracts/Sleep Medicine 16 (2015) S2–S199
common adverse effects were mask discomfort (35.4%), mouth and nose dryness (35.4%) and eye irritation (7.1%). Since there was no universal definition of compliance, it was defined by mean hours of daily use, which was over 4 hours as shown in our data. During follow up visit, ESS scores were improved and there was decrease in sleepiness. Conclusion: CPAP compliance among Saudi OSA patients is relatively low. Close follow up, proper training and encouragement on CPAP therapy improve adherence, but there was no difference between compliant and non-compliant of similar gender and age. University Sleep Disorder Centre (USDC) had its own strategies to improve compliance, by education and intervention. Acknowledgements: I express my warm thanks to Dr. BaHammam for his support and guidance, and I am using this opportunity to express my gratitude to everyone who supported the study. I am thankful for their aspiring guidance and friendly advice during the work. I am sincerely grateful to them for sharing their views. http://dx.doi.org/10.1016/j.sleep.2015.02.1434
Assessment of fatigue in obstructive sleep apnea by using salivary human herpes virus (HHV)-6 and HHV-7 reactivation as a biomarker R. Aoki, N. Kobayashi, W. Yamadera, M. Iwashita, K. Kondo, H. Itoh, K. Nakayama The Jikei University School of Medicine, Japan
Introduction: Complaints of fatigue are frequent in patients with obstructive sleep apnea (OSA). However, medical studies relating to “fatigue” have only been fragmentarily conducted, and hardly any studies have been done on decisive means or quantitative standards for quantitatively and objectively expressing “fatigue”, which is a subjective symptom. Materials and methods: Viruses belonging to the herpes virus family can lie dormant in the body for long periods and are known to be reactivated by fatigue. Human herpesvirus (HHV)-6 and HHV-7 are the causative agent of exanthema subitum and establish latency in almost all individuals. These viruses reactivate frequently and are shed in saliva, and have a potential to be a useful biomarker for physical fatigue. Fifty-five patients with diagnosed OSA were enrolled in this study. Sixty-five control subjects were also recruited. Subjective fatigue was measured with Profile of Mood State-Short form Fatigue subscale (POMS-F), and depressive mood was measured with Beck depression inventory (BDI). The study was approved by the Ethics Committees of The Jikei University School of Medicine. Written informed consent was obtained from each subject. A sample of saliva was collected from all participants. Viral DNA was extracted from 400 μl samples of saliva by automatic isolation with the BioRobot EZ1 workstation and EZ1 virus mini kit v2.0 (QIAGEN). Copies of HHV-6 and HHV-7 DNA in the saliva samples were quantified by real-time PCR. Results: There were no significant differences between OSA and healthy control on the self-rated fatigue POMS-F and HHV-6 DNA copy numbers. HHV-7 DNA copy numbers are significantly decreased in OSA than controls. In the OSA patients, POMS-F scores are not correlated with HHV DNA copy numbers. On the other hand, POMS-F scores are correlated with BDI scores. Conclusion: HHV-6 and HHV-7 are biomarkers for physical fatigue. However, reactivation of HHV-6 and HHV-7 is not observed in patients with OSA. Depressive symptoms have association with fatigue in OSA; therefore, the fatigue in OSA is a mental symptom. Acknowledgements: The present work was supported by The Ministry of Education, Culture, Sports, Science and Technology
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(MEXT)-Supported Program for the Strategic Research Foundation at Private Universities [grant number S1201032], Japan. http://dx.doi.org/10.1016/j.sleep.2015.02.1435
Neuro-cognitive assessment in obstructive sleep apnea syndrome (OSAS) versus primary insomnia patients: A comparative study in an Egyptian sample T. Asaad 1, A. Said 2 1 Psychiatry, Egypt 2 Neurology, Egypt
Introduction: Cognitive impairment is a common complaint in both OSAS and primary insomnia, hypothesized to be possibly related to the attentional capacity impairment. The aim of the present study was to objectively evaluate the cognitive profile, mainly executive functions, in OSAS patients, compared with patients with primary insomnia. Materials and methods: The study included 20 patients with OSAS (moderate to severe), diagnosed depending on both clinical and PSG criteria, in addition to 20 age and sex-matched patients, diagnosed as primary insomnia (PSG-guided), as well as 20 matched healthy subjects. Exclusion criteria included subjects above 45 years (to exclude the mere effect of age on cognitive testing), and the presence of either psychiatric or major medical comorbidity, including the use of psychotropics as sleep aids in the past 2 weeks prior to assessment. All subjects were assessed using the following neuropschological tests : Trail Making Test (TMT), parts A and B, Digit Span Test, Digit Symbol Substitution Test (DSST), Wisconsin Card Sorting Test (WCST), and Go/ No Go Test for Recognition Reaction Time Measurement. Both OSAS and primary insomnia patients were further assessed by Epworth Sleepiness Scale, as a measure of severity of daytime sleepiness. Results: Patients with OSAS showed significantly more impairment in all cognitive tasks considered (p < 0.05 ), compared with both healthy controls and patients with primary insomnia. On the other hand, patients with primary insomnia differed significantly from controls in only Recognition Reaction Time Test, more impairment being correlated with the severity of daytime sleepiness in Epworth Scale. Conclusion: Executive dysfunction in OSAS was not similarly shown in patients with primary insomnia, hence, it could not be entirely attributed to the mere presence of attentional capcity decreament, but other factors do play a role, like the detrimental effect of chronic hypoxia on brain functioning, especially PFC. Acknowledgements: The authors are very grateful to Mr.Abdel Gawaad, clinical psychologist in Ain Shams University Psychiatric Institute, for his great help in accomplishing the neuropschological tesing in our study. http://dx.doi.org/10.1016/j.sleep.2015.02.1436
Familial aggregation of obstructive sleep apnoea in children without tonsillar hypertrophy C. Au 1, J. Zhang 2, Y. Wing 2, A. Li 1 1 Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 2 Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
Introduction: Adenotonsillar hypertrophy is the major cause of childhood obstructive sleep apnoea (OSA). It is unclear whether the
Abstracts/Sleep Medicine 16 (2015) S2–S199
advancement appliances (MAA) at the 75% advancement position. Sleep with appliance was tested after a period of 7 nights of habituation. Sleep quality and oral appliance comfort was assessed on morning using 100 mm VAS. Rhythmic masticatory muscle activity (RMMA), a biomarker of SB was scored from jaw electromyographic recordings during sleep using published criteria. RMMA index (# event/h) and sleep variables were compared between the baseline night (no appliance) and the ones with the two kinds of appliances using ANOVA or Friedman test. Questionnaire data were compared between OS and MAA nights with the Wilcoxon signed rank test. Statistical significance was set at p < 0.05. Results: Total sleep time of each experiment night was divided into three sections from sleep onset. There was no interaction between conditions and three night sections (p = 0.66). However, there were significant difference among conditions in second part of night (p = 0.01): during the OS and MAA nights the index of RMMA/SB episode/h of sleep was lower than during the baseline night (p = 0.01 and p < 0.001, respectively). Index of RMMA bursts and episodes with noise during night showed the same trend. Moreover, OS nights showed a significant reduction of index of phasic and mixed episodes than baseline night (p = 0.04 and p = 0.05, respectively) However, for tonic episodes, no significantly difference among baseline night, OS, and MAA was observed. During OS night sleep efficiency and percent of Stage N2 (light sleep) period were significantly higher than during baseline (p < 0.01 and p = 0.04, respectively). There was a reduction of N3 (deep sleep) and of awakening index during the OS night in comparison with the baseline night (p = 0.05 and p < 0.001, respectively). No effect was observed between MAA and baseline night for sleep variables. Subjects evaluated the OS as providing better sleep quality (median OS = 82.8, MAA = 57.5, p = 0.05) and comfort (median OS = 79.3, MAA = 16.5, p < 0.001) than MAA. Conclusion: The RMMA index of SB was reduced using either OS or MAA. Only OS seem to improve overall sleep quality and comfort; MAA was not better than OS. Use of smaller and more comfortable MAA for SB subjects with snoring and/or sleep apnea is to be tested. Acknowledgements: This study was supported by a Canadian Institutes of Health Research. We would like to thank Hajar ElAlaoui, Christiane Manzini, Régis Schwab and the whole staff at the Centre d’étude du sommeil (Hôpital du Sacré-Coeur de Montréal) for their expertise in conducting this study. http://dx.doi.org/10.1016/j.sleep.2015.02.1432
Effect of coronary artery bypass grafting surgery on sleep apnea in Omani patients M. Al Hooti SQU, Oman
Introduction: Coronary artery bypass grafting surgery (CABG) is an effective way of treating coronary artery disease (CAD). Prevalence of obstructive sleep apnea (OSA) causing hypoxic stress is higher in patients with CAD. This study is aimed at evaluating effect of CABG on sleep apnea in Omani patients undergoing CABG. Materials and methods: Patients with severe ischemic heart disease posted for CABG were recruited for the study. Portable sleep study was performed in the in-patient ward 1 day before the surgery, and sleep study was repeated on 6th and the 30th day of the surgery. All patients underwent on-pump CABG. Patients who had blood pressure of more than 200/120 and post prandial glucose more than 10 mmol were rejected. Results: Thirty-two patients volunteered to participate in the study (28 males; 4 females; age 62.6 + 9.6 years). Twenty patients
completed all three sleep studies. Pre-CABG study indicated that all patients had sleep apnea (AHI: 37.05 + 4.95) which persisted on day 6 and day 30. The baseline desaturation index was 21.38 + 3.27. There was no significant difference in obstructive sleeps apneas, hypopneas, apnea–hypopnea index, mean saturation index, maximum saturation index and desaturation index amongst pre CABG study and day 6 and day 30 of CABG (p > 0.05). Central sleep apnea (CSA) was found to be reduced on day 6 post-surgery but increased again on day 30 (Pre CABG: 12 ± 17; Day 6: 6 ± 12; Day 30: 27 ± 66: p > 0.05). Conclusion: All patients undergoing CABG had moderate to severe obstructive sleep apnea–hypopnea syndrome. The CABG did not change the sleep apnea parameters. http://dx.doi.org/10.1016/j.sleep.2015.02.1433
Compliance to CPAP therapy in patients with severe obstructive sleep apnea A. Aladab 1, A. H 2, I. A 2, A. A 2, A. A 2, M. A 2, A. O 2 1 College of Medicine, King Saud University, Riyadh, Saudi Arabia 2 Saudi Arabia
Introduction: Positive airway pressure (PAP) therapy is considered the gold standard treatment for obstructive sleep apnea. Compliance with treatment is a major obstacle for the success of treatment. Compliance among Saudi patients has not been documented objectively before. This prospective study to objectively determine compliance, and to identify predictors of compliance. Materials and methods: The main objective was to determine the specific reasons that could help patients to compliance with their adherence to CPAP, and improve their comorbid illness. The selected patients who were >18 years old and suspected to have OSA during the two year period between December 2010 to January 2012, had undergone type 1 PSG (polysomnography), have had AHI of more than 10 events/h. Objective assessment by full night diagnostic PSG and subsequent laboratory titration studies had been performed after first 2 h of recording according to study protocol was used. Exclusion criteria include any patients who had chronic pulmonary disease, daytime hypercapnia, congestive heart failure, neuromuscular disease, and was on home oxygen therapy. In the first 2 weeks of CPAP therapy patient underwent three training session on (day 1, day 7, day 14). Then a follow up in the clinic was done at 2 and 4 weeks after CPAP therapy. During each follow-up visit, patients complete data entry form and received training on their devices. Compliance with CPAP was determined at each visit subjectively and filling a questionnaire at each visit assessed the patients’ concerns. Good compliance was defined as using CPAP for >4 h/night for >70% of the recorded period. Results: Total of 156 patients recruited in the study period with a mean age of 52.6 ± 12.8 years, BMI of 38.1 ± 8.8 kg/m2, Epworth Sleepiness Scale (ESS) of 10.0 ± 5.8 and an apnea–hypopnea index (AHI) of 66.1 ± 34.6/h. During CPAP device titration in the sleep disorders center (SDC) 94.9% accepted titration with good objective improvement in sleep quality and respiratory events. All CPAP devices were provided with heated humidifiers. At 1 month, 56% met the criteria of good compliance. By the end of 10 months there was no difference in compliance between males and females (56.9% vs. 54.2%) and between patients who used conventional CPAP or autotitrating CPAP (44.4% vs. 42.3%). However, patients who purchased their CPAP devices had better compliance compared with patients who obtained it free from the hospital (59.7% vs. 47.2%). There were no differences regarding demographics data, symptoms, comorbidities, PSG parameters, AHI or type of mask used. Most
Abstracts/Sleep Medicine 16 (2015) S2–S199
common adverse effects were mask discomfort (35.4%), mouth and nose dryness (35.4%) and eye irritation (7.1%). Since there was no universal definition of compliance, it was defined by mean hours of daily use, which was over 4 hours as shown in our data. During follow up visit, ESS scores were improved and there was decrease in sleepiness. Conclusion: CPAP compliance among Saudi OSA patients is relatively low. Close follow up, proper training and encouragement on CPAP therapy improve adherence, but there was no difference between compliant and non-compliant of similar gender and age. University Sleep Disorder Centre (USDC) had its own strategies to improve compliance, by education and intervention. Acknowledgements: I express my warm thanks to Dr. BaHammam for his support and guidance, and I am using this opportunity to express my gratitude to everyone who supported the study. I am thankful for their aspiring guidance and friendly advice during the work. I am sincerely grateful to them for sharing their views. http://dx.doi.org/10.1016/j.sleep.2015.02.1434
Assessment of fatigue in obstructive sleep apnea by using salivary human herpes virus (HHV)-6 and HHV-7 reactivation as a biomarker R. Aoki, N. Kobayashi, W. Yamadera, M. Iwashita, K. Kondo, H. Itoh, K. Nakayama The Jikei University School of Medicine, Japan
Introduction: Complaints of fatigue are frequent in patients with obstructive sleep apnea (OSA). However, medical studies relating to “fatigue” have only been fragmentarily conducted, and hardly any studies have been done on decisive means or quantitative standards for quantitatively and objectively expressing “fatigue”, which is a subjective symptom. Materials and methods: Viruses belonging to the herpes virus family can lie dormant in the body for long periods and are known to be reactivated by fatigue. Human herpesvirus (HHV)-6 and HHV-7 are the causative agent of exanthema subitum and establish latency in almost all individuals. These viruses reactivate frequently and are shed in saliva, and have a potential to be a useful biomarker for physical fatigue. Fifty-five patients with diagnosed OSA were enrolled in this study. Sixty-five control subjects were also recruited. Subjective fatigue was measured with Profile of Mood State-Short form Fatigue subscale (POMS-F), and depressive mood was measured with Beck depression inventory (BDI). The study was approved by the Ethics Committees of The Jikei University School of Medicine. Written informed consent was obtained from each subject. A sample of saliva was collected from all participants. Viral DNA was extracted from 400 μl samples of saliva by automatic isolation with the BioRobot EZ1 workstation and EZ1 virus mini kit v2.0 (QIAGEN). Copies of HHV-6 and HHV-7 DNA in the saliva samples were quantified by real-time PCR. Results: There were no significant differences between OSA and healthy control on the self-rated fatigue POMS-F and HHV-6 DNA copy numbers. HHV-7 DNA copy numbers are significantly decreased in OSA than controls. In the OSA patients, POMS-F scores are not correlated with HHV DNA copy numbers. On the other hand, POMS-F scores are correlated with BDI scores. Conclusion: HHV-6 and HHV-7 are biomarkers for physical fatigue. However, reactivation of HHV-6 and HHV-7 is not observed in patients with OSA. Depressive symptoms have association with fatigue in OSA; therefore, the fatigue in OSA is a mental symptom. Acknowledgements: The present work was supported by The Ministry of Education, Culture, Sports, Science and Technology
S123
(MEXT)-Supported Program for the Strategic Research Foundation at Private Universities [grant number S1201032], Japan. http://dx.doi.org/10.1016/j.sleep.2015.02.1435
Neuro-cognitive assessment in obstructive sleep apnea syndrome (OSAS) versus primary insomnia patients: A comparative study in an Egyptian sample T. Asaad 1, A. Said 2 1 Psychiatry, Egypt 2 Neurology, Egypt
Introduction: Cognitive impairment is a common complaint in both OSAS and primary insomnia, hypothesized to be possibly related to the attentional capacity impairment. The aim of the present study was to objectively evaluate the cognitive profile, mainly executive functions, in OSAS patients, compared with patients with primary insomnia. Materials and methods: The study included 20 patients with OSAS (moderate to severe), diagnosed depending on both clinical and PSG criteria, in addition to 20 age and sex-matched patients, diagnosed as primary insomnia (PSG-guided), as well as 20 matched healthy subjects. Exclusion criteria included subjects above 45 years (to exclude the mere effect of age on cognitive testing), and the presence of either psychiatric or major medical comorbidity, including the use of psychotropics as sleep aids in the past 2 weeks prior to assessment. All subjects were assessed using the following neuropschological tests : Trail Making Test (TMT), parts A and B, Digit Span Test, Digit Symbol Substitution Test (DSST), Wisconsin Card Sorting Test (WCST), and Go/ No Go Test for Recognition Reaction Time Measurement. Both OSAS and primary insomnia patients were further assessed by Epworth Sleepiness Scale, as a measure of severity of daytime sleepiness. Results: Patients with OSAS showed significantly more impairment in all cognitive tasks considered (p < 0.05 ), compared with both healthy controls and patients with primary insomnia. On the other hand, patients with primary insomnia differed significantly from controls in only Recognition Reaction Time Test, more impairment being correlated with the severity of daytime sleepiness in Epworth Scale. Conclusion: Executive dysfunction in OSAS was not similarly shown in patients with primary insomnia, hence, it could not be entirely attributed to the mere presence of attentional capcity decreament, but other factors do play a role, like the detrimental effect of chronic hypoxia on brain functioning, especially PFC. Acknowledgements: The authors are very grateful to Mr.Abdel Gawaad, clinical psychologist in Ain Shams University Psychiatric Institute, for his great help in accomplishing the neuropschological tesing in our study. http://dx.doi.org/10.1016/j.sleep.2015.02.1436
Familial aggregation of obstructive sleep apnoea in children without tonsillar hypertrophy C. Au 1, J. Zhang 2, Y. Wing 2, A. Li 1 1 Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong 2 Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
Introduction: Adenotonsillar hypertrophy is the major cause of childhood obstructive sleep apnoea (OSA). It is unclear whether the