Phenotypes of obstructive sleep apnea and direct targeted therapy: a literature review

: Obstructive sleep apnea (OSA) is a heterogenous chronic disorder causing hypoxemia, excessive daytime sleepiness, non-refreshing sleep, nocturia, morning headache, irritability, and memory loss. Cardiovascular disease, cognitive impairment, metabolic disorders, and depression are its long-term consequences. The difficulty in treating patients is due to poor compliance, failure to obtain the desired outcome, and complication arising from the multimodality treatment. Direct targeted therapy may overcome these issues. Identification of its phenotypes improves understanding of the disease mechanism, the risk for adverse effects, and predicting response to targeted therapy. Phenotyping of OSA offers us to treat patients according to their inherent disease and not based on a “one size fits all” method which may not be applicable for all patients. This approach may improve patients’ compliance with treatment, minimize the associated morbidities, and consequently improve their quality of life.

Morning Headache as an Obstructive Sleep Apnea-Related Symptom among Sleep Clinic Patients—A Cross-Section Analysis

Morning headache is considered to be a symptom of obstructive sleep apnea syndrome (OSAS). Despite not being as common as excessive daytime sleepiness or unrefreshing sleep, it can similarly impair everyday activities. The aim of the present study was to evaluate the prevalence of and factors associated with morning headaches (MH) among patients referred for polysomnography due to suspected OSAS. This is a retrospective study on 1131 patients who underwent polysomnography between 2013 and 2015. Morning headaches (MH) were reported in 29% of them. In a logistic regression model, a rise in the n probability of MH was associated with female sex (odds ratio, OR, 1.38, 95% confidence interval, CI, 1.08–1.75), history of hypertension (OR 1.25, 95% CI 1.06–1.46), complaint on unrefreshing sleep (OR 1.42, 95% CI 1.19–1.70), choking at night (OR 1.25, 95% CI 1.05–1.49), and fall in total sleep time (OR 0.872 per each hour, 95% CI 0.76–0.99). The risk between MH and apnea–hypopnea index, blood oxygen saturation parameters or arousal index was found to be statistically insignificant. There is a lack of evidence that MH is associated with the severity of OSAS or nocturnal hypoxemia.

Severe Obstructive Sleep Apnea in an young Adult

Obstructive Sleep Apnea (OSA) is a serious common sleep disorder needs life long care. OSA is caused by recurrentupper airway obstruction due to increased upper airway collapsibility during sleep. It is highly associated with obesitywith several endocrine and metabolic diseases. Hypothyroidism may cause OSA, also linked with obesity. Obesity isalso a risk factor for hypertension.This paper is presenting a case of obstructive sleep apnea with obesity, hypertensionand hypothyroidism. A 35 years old male presented with the complaints of excessive day time sleepiness, loud snoring,fragmented sleep, apnea like attack, occasional morning headache. Whole night polysomnography was done anddiagnosed as severe obstructive sleep apnea. At therapeutic part of polysomnography, he was treated with BiPAP. BangladeshCrit Care J September 2019; 7(2): 109-110

A study on assessment of sleep pattern among school-going adolescents in semi-urban Chennai

Adolescent sleep pattern exerts an influence on their physical and mental wellbeing. Several factors such as academic stress, biological and psychosocial factors contribute to adolescent sleep. Reduction in the quantity and quality of sleep can lead to increased daytime sleepiness, interfere with cognitive functioning, memory as well as can lead to behavioural problems.300 adolescent school children in semi-urban Chennai participated by filling a questionnaire which was based on self- reporting of sleep pattern and sleep hygiene. On an average, most adolescents obtained inadequate sleep during the weekdays. The adolescents commonly reported daytime sleepiness, difficulty in falling asleep after going to bed, anxiety, morning headache and feeling tired of waking up in the morning. About half of the participants reported that parents exerted an influence on waking up time. Many adolescents reported the use of social media while going to bed which can reduce sleep duration. Paediatricians can play an important role in promoting healthy sleep practices by providing anticipatory guidance to adolescents and their parents.

Clinical and polysomnographic characteristics in patients with morning headache

Background: The relation between headaches and sleep disorders are complex and heavily questioned. However, there is still controversy about this interrelationship. Objective: To describe the clinical and polysomnographic characteristics of patients with morning headache, and to compare them with patients without morning headaches. Methods: Prospective study between April and August 2009. One hundred and eight patients were included consecutively and by convenience. All patients were submitted to polysomnography and were distributed in the group with headache (group 1) or the group without headache (group 2). Results: Morning headache was reported by 33 (30.6%) patients, 17 (51.5%, p = 0.02) women. The clinical characteristics in the group of morning headache were 42.4% with disease in upper respiratory system, 72.7% with anxiety, 45% with headache in general, 54% with neurocognitive symptoms, 81.2% reported non restorative sleep and 60.6% had insomnia (all p< 0.05). Among the polysomnographic features surveyed, the only variable that showed statistical significance was wake after sleep onset. Almost 43% (vs. 20%) of patients with morning headaches were in normal range. Conclusions: It was not possible to conclude that the presence of the increase apnea/hypopnea indices, desaturation relevant and intermittent and disruption of sleep patterns are sufficient to modulate, by itself, the occurrence of morning headaches. Sleep disorders can act as a trigger for morning headaches in susceptible individuals with specific clinical profile

Headache

This chapter enumerates features that are reassuring and do not point to serious disease, such as carotid artery tenderness, slow evolution of symptoms as in hemisensory or hemiparetic migraine, sensory or motor symptoms on the same side as the headache, and age of symptom onset. Several Red Flags are given that indicate the need for investigation, such as first or worst headache, cough headache, morning headache, coital headache, thunderclap headache, continuous headache in an elderly person, medication overuse headache, and CADASIL syndrome. Clues for cluster headache, orthostatic headache, idiopathic intracranial hypertension, and several other headache syndromes are mentioned. Also listed are a few specific headaches that respond to indomethacin.