Fractional Exhaled Nitric Oxide Measurements and Screening of Obstructive Sleep Apnea in a Sleep-Laboratory Setting: A Cross-Sectional Study

Duarte, Ricardo Luiz de Menezes; Rabahi, Marcelo Fouad; Sá, Tiago; Magalhães-da-Silveira, Flavio J; Mello, Fernanda C. Q.; Gozal, David

doi:10.1007/s00408-018-0190-y

Cited by 14 publications

(10 citation statements)

References 33 publications

(55 reference statements)

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“…Methodological discrepancies have been claimed as the reason, which is why these studies cannot be easily compared [32]. A mild increase in FeNO was reported in children with OSA [33][34][35], whereas in our study we found no difference in FeNO between children with higher ODI, those with mild (ODI ≥ 1-3 events/h) and moderate-severe (ODI > 3 events/h) and the controls. Summarizing, OSA alone was not the cause of increased FeNO levels.…”

Section: Discussioncontrasting

confidence: 89%

“…Children with OSA are noted to have increased pro-inflammatory cytokine levels [30,31]. Studies involving children with OSA in which FeNO was measured as an inflammatory parameter have produced contradictory results [32][33][34][35]. Methodological discrepancies have been claimed as the reason, which is why these studies cannot be easily compared [32].…”

Section: Discussionmentioning

confidence: 99%

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Morning Fractional Exhaled Nitric Oxide in Children with Recurrent Desaturation During Sleep

Nosetti¹,

Cairati

Agosti

et al. 2020

BJSTR

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Objective: The aim was to assess the relationship between morning fractional exhaled NO (FeNO) and nocturnal oxygen desaturation in children. Design: prospective study. Setting: The study was conducted from January 2012 to January 2018, in the division of pediatric at tertiary-care hospital.Patients: Of the total of 112 children initially enrolled, 109 (case children; 65.1% males; age 7.0± 3.1 years) met the criteria of the oxygen desaturation index (≥ 1 desaturations measured by pulse oximetry). An additional 63 healthy children (controls, 60.3% males; age 7.9±2.9 years) were enrolled as external controls. Children underwent pulse oximetry (172 subjects), were assessed for FeNO and for inhalant allergens (skin prick test). Comorbidities were allergy and obesity. Methods: Nocturnal at-home oximetry and morning FeNO levels.Results: FeNO levels was comparable between case children without comorbidities and controls (p = 0.346). FeNO levels were much higher in case children with atopy compared to controls (p=0.0011) and in those with atopy and overweight compared to controls (p<0.0001) while FeNO levels increased in case children overweight compared to controls (p=0.0311). Conclusion:Atopy was the main determinant of elevated FeNO levels in children with nocturnal oxygen desaturation. A novel finding is that the FeNO levels were significantly increased in obese children as compared to controls. Further studies are needed to confirm our findings and to compare FeNO levels in obese children with or without recurrent desaturation events during sleep.

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Section: Discussioncontrasting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Morning Fractional Exhaled Nitric Oxide in Children with Recurrent Desaturation During Sleep

Nosetti¹,

Cairati

Agosti

et al. 2020

BJSTR

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“…The study of FeNO in the diagnosis of OSAS has led to contradictory findings. Indeed, while some studies described a raising of FeNO level in OSAS [20,21,22,23,24,25], the majority did not confirm the finding [26,27,28,29,30] or just showed a higher concentration in OSAS patients when compared with non-obese healthy controls [31,32,33]. Besides, even considering only those studies with a positive finding, the FeNO level, albeit statistically higher than healthy controls, did not reach a clinical significance.…”

Section: Resultsmentioning

confidence: 99%

Exhaled Breath Analysis in Obstructive Sleep Apnea Syndrome: A Review of the Literature

et al. 2019

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Background and Objectives: Obstructive sleep apnea syndrome (OSAS) represents an independent risk factor for cardiovascular, metabolic and neurological events. Polysomnography is the gold-standard for the diagnosis, however is expensive and time-consuming and not suitable for widespread use. Breath analysis is an innovative, non-invasive technique, able to provide clinically relevant information about OSAS. This systematic review was aimed to outline available evidence on the role of exhaled breath analysis in OSAS, taking into account the techniques’ level of adherence to the recently proposed technical standards. Materials and Methods: Articles reporting original data on exhaled breath analysis in OSAS were identified through a computerized and manual literature search and screened. Duplicate publications, case reports, case series, conference papers, expert opinions, comments, reviews and meta-analysis were excluded. Results: Fractional exhaled Nitric Oxide (FeNO) is higher in OSAS patients than controls, however its absolute value is within reported normal ranges. FeNO association with AHI is controversial, as well as its change after continuous positive airway pressure (C-PAP) therapy. Exhaled breath condensate (EBC) is acid in OSAS, cytokines and oxidative stress markers are elevated, they positively correlate with AHI and normalize after treatment. The analysis of volatile organic compounds (VOCs) by spectrometry or electronic nose is able to discriminate OSAS from healthy controls. The main technical issues regards the dilution of EBC and the lack of external validation in VOCs studies. Conclusions: Exhaled breath analysis has a promising role in the understanding of mechanisms underpinning OSAS and has demonstrated a clinical relevance in identifying individuals affected by the disease, in assessing the response to treatment and, potentially, to monitor patient’s adherence to mechanical ventilation. Albeit the majority of the technical standards proposed by the ERS committee have been followed by existing papers, further work is needed to uniform the methodology.

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“…Therefore, OSA is probably the essential attribution of airway inflammation. Although the analysis of exhaled NO is a non-invasive, harmless, and still not fully standardized method to investigate the pathophysiology of OSA, 13,[31][32][33] based on our findings, CANO could be used as marker of endothelial dysfunction for differentiating patients from healthy subjects. However, the contradictions with the CANO value measured using the simple linear model should be considered the limitation of this technique.…”

Section: Discussionmentioning

confidence: 81%

Exhaled Nitric Oxide as a Surrogate Marker for Obstructive Sleep Apnea Severity Grading: An In-Hospital Population Study

Dang-Thi-Mai¹,

Le-Dong²,

Vu³

et al. 2021

NSS

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Purpose Our study aimed to evaluate the relationship between exhaled nitric oxide (eNO) markers and obstructive sleep apnea (OSA) severity and verify the changes in eNO profiles among mild, moderate, and severe OSA subgroups. Methods This study was a cross-sectional and in-hospital population-based study. We investigated 123 OSA patients (17 mild, 23 moderate and, 83 severe OSA) in the department of respiratory diseases. Studied data included anthropometry, respiratory polygraphy, biological markers, spirometry, and multi-flow eNO measurements. Data analysis implied linear correlation, non-parametric ANOVA, and pair-wise comparison. Results No significant difference could be found among 3 OSA severity subgroups for FENO at – four sampling flow rates (50–350 mL/s). The bronchial production rate of NO (J’awNO) was proportionally increased, with median values of 11.2, 33.9, and 36.2 in mild, moderate, and severe OSA, respectively (p=0.010). The alveolar concentration of NO (CANO) changed with a non-linear pattern; it was increased in moderate (6.49) vs mild (7.79) OSA but decreased in severe OSA (5.20, p = 0.015). The only correction that could be established between OSA severity and exhaled nitric oxide markers is through J’AWNO (rho=0.25, p=0.02) and CANO (rho= 0.18, p=0.04). There was no significant correlation between FENO measured at three different flow rates and the OSA severity. We also found a weak but significant correlation between FENO 100 and averaged SpO2 (rho = 0.07, p= 0.03). Conclusion The present study showed that J’AWNO, which represents eNO derived from the central airway, is proportionally increased in more severe OSA, while eNO from alveolar space, indicated by CANO, was also associated with OSA severity and relatively lower in the most severe OSA patients. In contrast, stand-alone FENO metrics did not show a clear difference among the three severity subgroups.

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Fractional Exhaled Nitric Oxide Measurements and Screening of Obstructive Sleep Apnea in a Sleep-Laboratory Setting: A Cross-Sectional Study

Cited by 14 publications

References 33 publications

Morning Fractional Exhaled Nitric Oxide in Children with Recurrent Desaturation During Sleep

Morning Fractional Exhaled Nitric Oxide in Children with Recurrent Desaturation During Sleep

Exhaled Breath Analysis in Obstructive Sleep Apnea Syndrome: A Review of the Literature

Exhaled Nitric Oxide as a Surrogate Marker for Obstructive Sleep Apnea Severity Grading: An In-Hospital Population Study

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