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The impact of obstructive sleep apnea in diabetes mellitus
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Abstracts / Sleep Medicine 14S (2013) e239–e317
servoventilation (ASV) and the PSG after ASV showed resolution of the central events (RDI = 4,8/h; CT90 = 1.4%). Conclusion: We demonstrate the effectiveness of servoventilation upon resolving central sleep apnea associated with CM-I, on a patient previously submitted to surgery. Acknowledgement: Workers and managers of the Sleep Unit. http://dx.doi.org/10.1016/j.sleep.2013.11.709
The impact of obstructive sleep apnea in diabetes mellitus J. Vale, P. Manuel, A. Oliveira, I. Gil, E. Nascimento, A. Sanchez Centro Hospitalar Tondela-Viseu, Portugal
Introduction: There is convincing evidence that obstructive sleep apnea (OSA) is highly associated with impaired glucose metabolism, independently of obesity. The effect of OSA in glucose metabolism could be exerted via intermittent hypoxia, sleep fragmentation and sleep deprivation. Our objectives were analyze the prevalence of OSA in type 1 and type 2 diabetes mellitus (DM) and evaluate the influence of OSA on glycemic control. Materials and methods: The adult patients with diabetes mellitus (DM) followed in the department of internal medicine were referred to our Sleep Unit. A home respiratory polygraphy was then performed in all patients with body mass index (BMI) <40 kg/m2. The glycemic control was assessed by the value of glycated hemoglobin (HbA1c) in the previous 3 months. Results: A total of 46 patients were studied (20 men and 26 women), The mean age was 5115 years and mean BMI was 28.7 ± 4,5 kg/m2. The mean Hba1c was 8.2 ± 1.2 and the mean ESS score was 7.8 ± 4.5. Twenty-four patients had type 2 DM and 22 patients had type 1 DM. Twenty-eight patients (60.9%) had OSA and 6.5% had severe OSA (AHI > 30/h). The mean CT90 was 5.3 ± 12,5 and the mean AHI was 13.3 ± 12.5. The mean AHI was similar between type I and type 2 DM (15.3 ± 5.3 vs 11.6 ± 1.8; p = 0.52). There was no difference in the mean AHI and CT90 between obese and non obese patients. The AHI was not correlated with the BMI. Type 2 DM patients with poorer glycemic control (HbA1c > 7.5% ) have an higher mean AHI (14.5 ± 2.5 vs. 7.4 ± 1,8; p = 0.032). Conclusion: The prevalence of OSA in type 1 DM was similar to that founded in type 2 DM. The prevalence of OSA in our small size sample seems to be independent of the presence of obesity. A poor glycemic control was associated with more severe OSA in type 2 DM. Acknowledgement: Workers and managers of the Sleep Unit and of the Diabetes Unit of Hospital Center Tondela-Viseu.
http://dx.doi.org/10.1016/j.sleep.2013.11.710
Stop-bang questionnaire is a good test in discriminating OSA in obese women but no in men M. Valencia-Flores 1, V. Santiago-Ayala 2, M. Resendiz-García 2, V. Castaño-Meneses 2, A. Mendoza-Pacheco 2, G. García-Ramos 3 1 Clinica de Trastornos del Dormir, INCMNSZ-UNAM, Mexico 2 INCMNSZ, Mexico 3 Departamento de Neurología, INCMNSZ, Mexico
Introduction: Recently, the STOP-Bang (SB) questionnaire was identified as a clinical screening tool for Obstructive Sleep Apnea (OSA) easy to use, and having a favorable diagnostic odds ratio, making it suitable for predicting severe OSA in the preoperative setting. OSA is considered a significant risk factor for perioperative morbidity and mortality. Our study explores the diagnostic test
characteristics of SB against PSG in obese subjects, as it is recognized that obese are always at higher risk for surgical complications. Materials and methods: Patients were recruited from the Sleep Clinic at INCMNSZ in Mexico City. The study was approved by the local ethics committee. To be included in the study, patients had to have a BMI P 30 kg/m2 and to give their informed consent. Patients (n = 214, Women = 134, men = 80), BMI women = 49.0 ± 8.9, Men = 47.6 ± 12.5; age women = 40.0 ± 11.5, men = 38.3 ± 12.5 were studied on two PSG consecutive nights. SB questionnaire was applied the night before first PSG. An AHI P 5 was considered positive diagnostic of OSA on PSG. We use Receiver operating characteristic curve (ROC) analysis to assess the diagnostic accuracy of the SB. We performed the ROC analysis by sex to see whether there were differences in accuracy. Results: The diagnotic test’s discriminatory power at a cutoff of P3 for men, and for women at P2 cutoff were: Men, Area under the ROC Curve = 0.755, Standard Error = 0.06, p = 0.003, 95% CI = 0.640–0.870; Women, Area under the ROC Curve = 0.664, Standard error = 0.06, p = 0.003, 95% CI = 0.556–0.772. Sensitivity for Men = 0.909, Specificity = 0.857, FPR (1-Specificity) = 0.143, FNR (1sensitivity) = 0.091; Sensitivity for Women = 0.990, Specificity = 0.842, FPR (1-Specificity) = 0.158, FNR (1-sensitivity) = 0.01. The diagnostic odds ratio (DOR) which combines data on sensitivity and specificity to give an indication of a test’s ability to rule in or rule out OSA condition were for Women = 17.9, for Men = 1.67. Conclusion: Stop-Bang questionnaire in obese patients seems to be a good test in discriminating OSA in obese women but with no value in prediction in obese men, as DOR value was <2. Acknowledgement: This work was supported by PAPIIT IN209109 and CONACYT-46257-H.
http://dx.doi.org/10.1016/j.sleep.2013.11.711
Influence of the obstructive sleep apnea treatment in the glaucoma control M. Moussalli 1, J. Bekerman 1, C. Cuello Oderiz 1,2, S. Valiensi 2 1 Glaucoma Service Hospital Italiano, Buenos Aires 2 Ophtalmology Service Hospital Italian, Hospital Italiano Buenos Aires Argentina, Argentina 2 Servicio de Neurologia del Hospital Italiano, Argentina
Introduction: The information of the relationship between the obstructive Sleep Apnea Syndrome treatment (OSAS) with glaucoma and the importance of the approach to treatment of both together, is limited. Purpose: Formulate the association of Obstructive Sleep Apnea Syndrome (OSAS) and Glaucoma, through the presentation of a clinical case. Materials and methods: A retrospective study in 41 patients with Glaucoma and OSAS was held over two years in joint management with Ophtalmology and Sleep Neuroly Service.The patients were controlled with applanation tonometry, Photo of the optic disc, Gonioscopy, Computerized Visual field, Optic disk OCT, in spite of the medical glaucoma treatment, there was Visual Field and RNFL defects progress. At the clinical control of the cardiovascular risk factors, OSAS was diagnosed by Polisomnography. A sample case of a male patient of 62 years of age with open angle glaucoma of 8 years of evolution under treatment with Timolol and Bimatoprost and 14 mmHg Intraocular Pressure) IOP with progression on the defects of the Visual Field and OCT will be discussed as an example. (became worse) Distant visual acuity with correction (sph + 2) was 20/20 in both eyes until December 2012 lowered to 20/25 in both eyes (macular epiretinal membrane was detected). Slit Lamp Biomicroscopy
Abstracts / Sleep Medicine 14S (2013) e239–e317
servoventilation (ASV) and the PSG after ASV showed resolution of the central events (RDI = 4,8/h; CT90 = 1.4%). Conclusion: We demonstrate the effectiveness of servoventilation upon resolving central sleep apnea associated with CM-I, on a patient previously submitted to surgery. Acknowledgement: Workers and managers of the Sleep Unit. http://dx.doi.org/10.1016/j.sleep.2013.11.709
The impact of obstructive sleep apnea in diabetes mellitus J. Vale, P. Manuel, A. Oliveira, I. Gil, E. Nascimento, A. Sanchez Centro Hospitalar Tondela-Viseu, Portugal
Introduction: There is convincing evidence that obstructive sleep apnea (OSA) is highly associated with impaired glucose metabolism, independently of obesity. The effect of OSA in glucose metabolism could be exerted via intermittent hypoxia, sleep fragmentation and sleep deprivation. Our objectives were analyze the prevalence of OSA in type 1 and type 2 diabetes mellitus (DM) and evaluate the influence of OSA on glycemic control. Materials and methods: The adult patients with diabetes mellitus (DM) followed in the department of internal medicine were referred to our Sleep Unit. A home respiratory polygraphy was then performed in all patients with body mass index (BMI) <40 kg/m2. The glycemic control was assessed by the value of glycated hemoglobin (HbA1c) in the previous 3 months. Results: A total of 46 patients were studied (20 men and 26 women), The mean age was 5115 years and mean BMI was 28.7 ± 4,5 kg/m2. The mean Hba1c was 8.2 ± 1.2 and the mean ESS score was 7.8 ± 4.5. Twenty-four patients had type 2 DM and 22 patients had type 1 DM. Twenty-eight patients (60.9%) had OSA and 6.5% had severe OSA (AHI > 30/h). The mean CT90 was 5.3 ± 12,5 and the mean AHI was 13.3 ± 12.5. The mean AHI was similar between type I and type 2 DM (15.3 ± 5.3 vs 11.6 ± 1.8; p = 0.52). There was no difference in the mean AHI and CT90 between obese and non obese patients. The AHI was not correlated with the BMI. Type 2 DM patients with poorer glycemic control (HbA1c > 7.5% ) have an higher mean AHI (14.5 ± 2.5 vs. 7.4 ± 1,8; p = 0.032). Conclusion: The prevalence of OSA in type 1 DM was similar to that founded in type 2 DM. The prevalence of OSA in our small size sample seems to be independent of the presence of obesity. A poor glycemic control was associated with more severe OSA in type 2 DM. Acknowledgement: Workers and managers of the Sleep Unit and of the Diabetes Unit of Hospital Center Tondela-Viseu.
http://dx.doi.org/10.1016/j.sleep.2013.11.710
Stop-bang questionnaire is a good test in discriminating OSA in obese women but no in men M. Valencia-Flores 1, V. Santiago-Ayala 2, M. Resendiz-García 2, V. Castaño-Meneses 2, A. Mendoza-Pacheco 2, G. García-Ramos 3 1 Clinica de Trastornos del Dormir, INCMNSZ-UNAM, Mexico 2 INCMNSZ, Mexico 3 Departamento de Neurología, INCMNSZ, Mexico
Introduction: Recently, the STOP-Bang (SB) questionnaire was identified as a clinical screening tool for Obstructive Sleep Apnea (OSA) easy to use, and having a favorable diagnostic odds ratio, making it suitable for predicting severe OSA in the preoperative setting. OSA is considered a significant risk factor for perioperative morbidity and mortality. Our study explores the diagnostic test
characteristics of SB against PSG in obese subjects, as it is recognized that obese are always at higher risk for surgical complications. Materials and methods: Patients were recruited from the Sleep Clinic at INCMNSZ in Mexico City. The study was approved by the local ethics committee. To be included in the study, patients had to have a BMI P 30 kg/m2 and to give their informed consent. Patients (n = 214, Women = 134, men = 80), BMI women = 49.0 ± 8.9, Men = 47.6 ± 12.5; age women = 40.0 ± 11.5, men = 38.3 ± 12.5 were studied on two PSG consecutive nights. SB questionnaire was applied the night before first PSG. An AHI P 5 was considered positive diagnostic of OSA on PSG. We use Receiver operating characteristic curve (ROC) analysis to assess the diagnostic accuracy of the SB. We performed the ROC analysis by sex to see whether there were differences in accuracy. Results: The diagnotic test’s discriminatory power at a cutoff of P3 for men, and for women at P2 cutoff were: Men, Area under the ROC Curve = 0.755, Standard Error = 0.06, p = 0.003, 95% CI = 0.640–0.870; Women, Area under the ROC Curve = 0.664, Standard error = 0.06, p = 0.003, 95% CI = 0.556–0.772. Sensitivity for Men = 0.909, Specificity = 0.857, FPR (1-Specificity) = 0.143, FNR (1sensitivity) = 0.091; Sensitivity for Women = 0.990, Specificity = 0.842, FPR (1-Specificity) = 0.158, FNR (1-sensitivity) = 0.01. The diagnostic odds ratio (DOR) which combines data on sensitivity and specificity to give an indication of a test’s ability to rule in or rule out OSA condition were for Women = 17.9, for Men = 1.67. Conclusion: Stop-Bang questionnaire in obese patients seems to be a good test in discriminating OSA in obese women but with no value in prediction in obese men, as DOR value was <2. Acknowledgement: This work was supported by PAPIIT IN209109 and CONACYT-46257-H.
http://dx.doi.org/10.1016/j.sleep.2013.11.711
Influence of the obstructive sleep apnea treatment in the glaucoma control M. Moussalli 1, J. Bekerman 1, C. Cuello Oderiz 1,2, S. Valiensi 2 1 Glaucoma Service Hospital Italiano, Buenos Aires 2 Ophtalmology Service Hospital Italian, Hospital Italiano Buenos Aires Argentina, Argentina 2 Servicio de Neurologia del Hospital Italiano, Argentina
Introduction: The information of the relationship between the obstructive Sleep Apnea Syndrome treatment (OSAS) with glaucoma and the importance of the approach to treatment of both together, is limited. Purpose: Formulate the association of Obstructive Sleep Apnea Syndrome (OSAS) and Glaucoma, through the presentation of a clinical case. Materials and methods: A retrospective study in 41 patients with Glaucoma and OSAS was held over two years in joint management with Ophtalmology and Sleep Neuroly Service.The patients were controlled with applanation tonometry, Photo of the optic disc, Gonioscopy, Computerized Visual field, Optic disk OCT, in spite of the medical glaucoma treatment, there was Visual Field and RNFL defects progress. At the clinical control of the cardiovascular risk factors, OSAS was diagnosed by Polisomnography. A sample case of a male patient of 62 years of age with open angle glaucoma of 8 years of evolution under treatment with Timolol and Bimatoprost and 14 mmHg Intraocular Pressure) IOP with progression on the defects of the Visual Field and OCT will be discussed as an example. (became worse) Distant visual acuity with correction (sph + 2) was 20/20 in both eyes until December 2012 lowered to 20/25 in both eyes (macular epiretinal membrane was detected). Slit Lamp Biomicroscopy