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Submaximal exercise and flow-volume loops in subjects with moderate to severe obstructive sleep apnea syndrome
S84
Abstracts/Sleep Medicine 16 (2015) S2–S199
polysomnography monitoring performed by E-Series System made by Compumedics Company in Australia. Polysomnographic parameters were recorded including ODI, L-SaO2, TS90%, TST,etc. Serum aminotransferases (ALT, AST) and gamma glutamyltransferas (GGT) were systematically performed. The upper limit normal cutoff values for ALT, AST and GGT were ≤43, ≤38 and ≤50 U/l, respectively. Aminotransferase values were categorically recorded as normal or elevated. Patients with elevated liver enzymes were defined as having a level of serum ALT, AST and/or GGT higher than the upper limit of normal. Results: Elevated liver enzymes was present in 42.3% of patients with OSAS. Elevated GGT was present in 40.3%, which was higher significantly than the patients without OSAS. Elevated AST was present in 12.0% of patients with severe OSAS, which was higher significantly than 4.1% of patients with mild/moderate OSAS (p < 0.01). ALT of the patients with OSAS was (31.42 ± 2.08) mol/l, which was significantly higher than patients without OSAS. The higher the AHI was, the higher the ALT level. The GGT level of the severeOSAS group was significantly higher than patients without OSAS (p < 0.05) and higher than the mild/moderate-OSAS group with no significance (p = 0.05). In partial correlation analysis, the ALT level was negatively correlated with age, that is, younger patients were more easily to have higher ALT level. The ALT level was positively correlated with TST, sleep efficiency, TS90% and AHI, that is, hypoxia and hypersomnia may be the risk factors for the elevated ALT. The GGT level was only negatively correlated with age. Our study made the ALT level as dependent variable and age, TST, sleep efficiency, TS90% and AHI as independent variables, at last, age, TS90% and AHI entered the regression equation. Conclusion: Finally, OSAS is an independent risk factor of elevated liver enzymes. The heavier the degree of OSAS is, the higher the liver enzyme levels, excluding obesity. We thought OSAS caused the damage to liver mainly through hypoxia and the duration of hypoxia.
collected from both tasks using the spirometry device (model Pneumotrac 6800, Vitalograph, England). Dyspnea scale was used to measure the rate of perceived exertion (RPE) before and after 6MWT. Each subject underwent a single 6MWT within 1 month of the sleep study. The studies were conducted at the Tainan Hospital, Ministry of Health and Welfare, Taiwan. Normal distribution of all parameters was confirmed with a Kolmogorov– Smirnov test. Statistical analysis for Wilcoxon–Mann–Whitney test was performed (SPSS 17.0; SPSS, Chicago, IL) to compare between groups. A value of p < 0.05 was considered statistically significant. Results: The moderate OSAS group (male = 5, female = 1, age = 43.13 ± 13.19 years; body weight = 71.25 ± 12.93 kg; body mass index = 24.68 ± 3.74 kg/m2; AHI index = 20.89 ± 3.10; distance = 563.14 ± 65.68; mean ± SD) and the severe OSAS group (male = 9, female = 2, age = 51.27 ± 15.11 years; body weight = 80.25 ± 18.51 kg; body mass index = 29.03 ± 5.96 kg/m2; AHI index = 53.56 ± 22.03; distance = 525.41 ± 90.90; mean ± SD) were compared based on the AHI index. In both groups, the severity of OSAS (AHI index) from the given information impacted on gender, but not affected by other factors such as age, body weight, and BMI in our study. However, the other parameters, such as heart rate, distance and oxygen saturation, were not significantly different. The FV-loops data had important effects on FEV1/FVC, FEF 75–85 and FIF50/ FEF50 before-6MWT in the two OSAS groups (p < 0.05). The after-6MWT showed changes in FV-loops, especially at FEV1/FVC, FEF 25–75 and FEF 75–85 in the two OSAS groups (p < 0.05). Conclusion: There were no correlations between the 6MWT distance and the severity of OSAS. There was significant difference in flow-volume loops at before and after-6MWT, which displayed the importance between the two OSAS groups. Acknowledgements: The authors wish to thank the participants who generously gave us their time. We would like to thank Dr. Cheng-Yu Lin and the members of Occupational Medicine Sleep Center at Tainan Hospital, Ministry of Health and Welfare, Taiwan.
http://dx.doi.org/10.1016/j.sleep.2015.02.216 http://dx.doi.org/10.1016/j.sleep.2015.02.217
Submaximal exercise and flow-volume loops in subjects with moderate to severe obstructive sleep apnea syndrome H. Lin 1,2, J. Ong 3, C. Lin 4, C. Hung 1,3 1 Institute of Allied Health Sciences, National Cheng Kung University, Taiwan 2 Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Taiwan 3 Department of Physical Therapy, National Cheng Kung University, Taiwan 4 Tainan Hospital, Ministry of Health and Welfare, Taiwan
Introduction: This studies have used the 6-min walk test (6MWT) applied at force vital capacity response to flow-volume loops (FVloops) in subjects with moderate to severe obstructive sleep apnea syndrome (OSAS). Materials and methods: We studied consecutive, newly diagnosed, OSAS subjects (aged >20 years). All patients underwent sleep study at our Sleep Disorders Center in a hospital. Eighteen subjects were divided into two groups based on the apnea hypopnea index (AHI index) (times/h). The study population was divided into two groups: moderate OSAS group (AHI index = 15 H−1 ≤ AHI < 30 H−1, n = 6) and severe OSAS group (AHI index = AHI ≥ 30 H−1, n = 11). Subjects were instructed to walk as far as possible in the designed pathway for 6 minutes. Flow-volume loops (FV-loops) data were
Tongue morphology analysis in upper airway MRI for classification of severe obstructive sleep apnea T. Mikami 1, K. Yonezawa 2, Y. Kojima 1, M. Yamamoto 3 1 National Institute of Technology, Tomakomai College, Japan 2 National Hospital Organization Hakodate Hospital, Japan 3 Hokkaido University, Japan
Introduction: Morphological features of upper airway soft tissues give much information about the severity of obstructive sleep apnea (OSA), but clinical experience is necessary to evaluate the severity using the MRI. This study proposes a possible objective criterion for classifying severe OSA from the tongue morphology in the sagittal plane. Materials and methods: The upper airway MRIs of 46 male OSA patients are analyzed in this study. All subjects received overnight polysomnography (PSG) and apnea/hypopnea index (AHI), which shows severity of sleep apnea, is estimated from the PSG results by medical technologists. Ethical approval was received from the Ethical Committee at NHO Hakodate Hospital. Firstly, tongue region in the sagittal plane of MRI is segmented with manual tracing using image processing software. Then, the center of gravity of the segmented tongue region is calculated. From this point, straight lines are radially extended with the fixed angular
Abstracts/Sleep Medicine 16 (2015) S2–S199
polysomnography monitoring performed by E-Series System made by Compumedics Company in Australia. Polysomnographic parameters were recorded including ODI, L-SaO2, TS90%, TST,etc. Serum aminotransferases (ALT, AST) and gamma glutamyltransferas (GGT) were systematically performed. The upper limit normal cutoff values for ALT, AST and GGT were ≤43, ≤38 and ≤50 U/l, respectively. Aminotransferase values were categorically recorded as normal or elevated. Patients with elevated liver enzymes were defined as having a level of serum ALT, AST and/or GGT higher than the upper limit of normal. Results: Elevated liver enzymes was present in 42.3% of patients with OSAS. Elevated GGT was present in 40.3%, which was higher significantly than the patients without OSAS. Elevated AST was present in 12.0% of patients with severe OSAS, which was higher significantly than 4.1% of patients with mild/moderate OSAS (p < 0.01). ALT of the patients with OSAS was (31.42 ± 2.08) mol/l, which was significantly higher than patients without OSAS. The higher the AHI was, the higher the ALT level. The GGT level of the severeOSAS group was significantly higher than patients without OSAS (p < 0.05) and higher than the mild/moderate-OSAS group with no significance (p = 0.05). In partial correlation analysis, the ALT level was negatively correlated with age, that is, younger patients were more easily to have higher ALT level. The ALT level was positively correlated with TST, sleep efficiency, TS90% and AHI, that is, hypoxia and hypersomnia may be the risk factors for the elevated ALT. The GGT level was only negatively correlated with age. Our study made the ALT level as dependent variable and age, TST, sleep efficiency, TS90% and AHI as independent variables, at last, age, TS90% and AHI entered the regression equation. Conclusion: Finally, OSAS is an independent risk factor of elevated liver enzymes. The heavier the degree of OSAS is, the higher the liver enzyme levels, excluding obesity. We thought OSAS caused the damage to liver mainly through hypoxia and the duration of hypoxia.
collected from both tasks using the spirometry device (model Pneumotrac 6800, Vitalograph, England). Dyspnea scale was used to measure the rate of perceived exertion (RPE) before and after 6MWT. Each subject underwent a single 6MWT within 1 month of the sleep study. The studies were conducted at the Tainan Hospital, Ministry of Health and Welfare, Taiwan. Normal distribution of all parameters was confirmed with a Kolmogorov– Smirnov test. Statistical analysis for Wilcoxon–Mann–Whitney test was performed (SPSS 17.0; SPSS, Chicago, IL) to compare between groups. A value of p < 0.05 was considered statistically significant. Results: The moderate OSAS group (male = 5, female = 1, age = 43.13 ± 13.19 years; body weight = 71.25 ± 12.93 kg; body mass index = 24.68 ± 3.74 kg/m2; AHI index = 20.89 ± 3.10; distance = 563.14 ± 65.68; mean ± SD) and the severe OSAS group (male = 9, female = 2, age = 51.27 ± 15.11 years; body weight = 80.25 ± 18.51 kg; body mass index = 29.03 ± 5.96 kg/m2; AHI index = 53.56 ± 22.03; distance = 525.41 ± 90.90; mean ± SD) were compared based on the AHI index. In both groups, the severity of OSAS (AHI index) from the given information impacted on gender, but not affected by other factors such as age, body weight, and BMI in our study. However, the other parameters, such as heart rate, distance and oxygen saturation, were not significantly different. The FV-loops data had important effects on FEV1/FVC, FEF 75–85 and FIF50/ FEF50 before-6MWT in the two OSAS groups (p < 0.05). The after-6MWT showed changes in FV-loops, especially at FEV1/FVC, FEF 25–75 and FEF 75–85 in the two OSAS groups (p < 0.05). Conclusion: There were no correlations between the 6MWT distance and the severity of OSAS. There was significant difference in flow-volume loops at before and after-6MWT, which displayed the importance between the two OSAS groups. Acknowledgements: The authors wish to thank the participants who generously gave us their time. We would like to thank Dr. Cheng-Yu Lin and the members of Occupational Medicine Sleep Center at Tainan Hospital, Ministry of Health and Welfare, Taiwan.
http://dx.doi.org/10.1016/j.sleep.2015.02.216 http://dx.doi.org/10.1016/j.sleep.2015.02.217
Submaximal exercise and flow-volume loops in subjects with moderate to severe obstructive sleep apnea syndrome H. Lin 1,2, J. Ong 3, C. Lin 4, C. Hung 1,3 1 Institute of Allied Health Sciences, National Cheng Kung University, Taiwan 2 Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Taiwan 3 Department of Physical Therapy, National Cheng Kung University, Taiwan 4 Tainan Hospital, Ministry of Health and Welfare, Taiwan
Introduction: This studies have used the 6-min walk test (6MWT) applied at force vital capacity response to flow-volume loops (FVloops) in subjects with moderate to severe obstructive sleep apnea syndrome (OSAS). Materials and methods: We studied consecutive, newly diagnosed, OSAS subjects (aged >20 years). All patients underwent sleep study at our Sleep Disorders Center in a hospital. Eighteen subjects were divided into two groups based on the apnea hypopnea index (AHI index) (times/h). The study population was divided into two groups: moderate OSAS group (AHI index = 15 H−1 ≤ AHI < 30 H−1, n = 6) and severe OSAS group (AHI index = AHI ≥ 30 H−1, n = 11). Subjects were instructed to walk as far as possible in the designed pathway for 6 minutes. Flow-volume loops (FV-loops) data were
Tongue morphology analysis in upper airway MRI for classification of severe obstructive sleep apnea T. Mikami 1, K. Yonezawa 2, Y. Kojima 1, M. Yamamoto 3 1 National Institute of Technology, Tomakomai College, Japan 2 National Hospital Organization Hakodate Hospital, Japan 3 Hokkaido University, Japan
Introduction: Morphological features of upper airway soft tissues give much information about the severity of obstructive sleep apnea (OSA), but clinical experience is necessary to evaluate the severity using the MRI. This study proposes a possible objective criterion for classifying severe OSA from the tongue morphology in the sagittal plane. Materials and methods: The upper airway MRIs of 46 male OSA patients are analyzed in this study. All subjects received overnight polysomnography (PSG) and apnea/hypopnea index (AHI), which shows severity of sleep apnea, is estimated from the PSG results by medical technologists. Ethical approval was received from the Ethical Committee at NHO Hakodate Hospital. Firstly, tongue region in the sagittal plane of MRI is segmented with manual tracing using image processing software. Then, the center of gravity of the segmented tongue region is calculated. From this point, straight lines are radially extended with the fixed angular