Measurement of exhaled nitric oxide concentration in patients with obstructive sleep apnea

Zhang, Dongmei; Luo, Jinmei; Qiao, Yupu; Xiao, Yi; Huang, Rong; Xu, Zhifang

doi:10.1097/md.0000000000006429

Cited by 19 publications

(19 citation statements)

References 44 publications

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“…Previous studies have found increased airway inflammation and effects on airway remodelling among subjects with obstructive sleep apnoea, and treatment with positive airway pressure may diminish the airway inflammation. This makes it plausible that sleep disordered breathing may affect the lung function [6, 27]. Our study adds that even habitual snoring in the general population may have detrimental effects on lung function over time.…”

Section: Discussionmentioning

confidence: 84%

Snoring and nocturnal reflux: association with lung function decline and respiratory symptoms

Emilsson¹,

Hägg²,

Lindberg³

et al. 2019

ERJ Open Res

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IntroductionThe study aim was to examine the association of snoring and nocturnal gastro-oesophageal reflux (nGOR) with respiratory symptoms and lung function, and if snoring and/or nGOR associated with a steeper decline in lung function.MethodsData from the third visit of the European Community Respiratory Health Survey (ECRHS) was used for cross-sectional analysis. Pre- and post-bronchodilator spirometry was performed, and information on sleep, nGOR and respiratory symptoms was collected (n=5715). Habitual snoring and nGOR were assessed by questionnaire reports. Pre-bronchodilator spirometry from ECRHS I, II and III (20 years follow-up) were used to analyse lung function changes by multivariate regression analysis.ResultsSnoring and nGOR were independently associated with a higher prevalence of wheeze, chest tightness, breathlessness, cough and phlegm. The prevalence of any respiratory symptom was 79% in subjects with both snoring and nGOR versus 56% in those with neither (p<0.001). Subjects with both snoring and nGOR had more frequent exacerbations (adjusted prevalence 32% versus 19% among “no snoring, no nGOR”, p=0.003). Snoring but not nGOR was associated with a steeper decline in forced expiratory volume in 1 s over 10 years after adjusting for confounding factors (change in % predicted −5.53, versus −4.58 among “no snoring”, p=0.04) and forced vital capacity (change in % predicted −1.94, versus −0.99 among “no snoring”, p=0.03).ConclusionsAdults reporting both habitual snoring and nGOR had more respiratory symptoms and more frequent exacerbations of these symptoms. Habitual snoring was associated with a steeper decline in lung function over time.

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Section: Discussionmentioning

confidence: 84%

Snoring and nocturnal reflux: association with lung function decline and respiratory symptoms

Emilsson¹,

Hägg²,

Lindberg³

et al. 2019

ERJ Open Res

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“…In addition, our study indicated that FeNO values were not significantly different in those patients with or without OSA. Studies investigating the effect of OSA on FeNO measurements are inconsistent and with conflicting results [10][11][12][13][14][15][16][17][18][19]23]. Similar to our findings, a study [19] with 129 consecutive patients, aged ≥ 16 years, showed no value in incorporating FeNO in the screening of OSA, considering that FeNO values were similar among individuals with or without SDB, and also whether SDB was defined by an AHI threshold of ≥ 5.0/h or ≥ 15.0/h.…”

Section: Discussionmentioning

confidence: 99%

“…Fractional exhaled nitric oxide (FeNO) can be easily, rapidly, and non-invasively measured for assessment of airway inflammation, and is extensively used in asthma to evaluate both severity and therapeutic responses [7][8][9]. However, FeNO levels in OSA patients remain somewhat unclear [10]: both elevated FeNO [11][12][13][14][15] and unaltered FeNO levels [16][17][18][19] have been reported when comparing OSA patients to controls. A recent meta-analysis [10] addressed FeNO levels in patients with OSA and concluded that there was a significant increase in FeNO levels in subjects diagnosed with OSA.…”

Section: Introductionmentioning

confidence: 99%

“…However, FeNO levels in OSA patients remain somewhat unclear [10]: both elevated FeNO [11][12][13][14][15] and unaltered FeNO levels [16][17][18][19] have been reported when comparing OSA patients to controls. A recent meta-analysis [10] addressed FeNO levels in patients with OSA and concluded that there was a significant increase in FeNO levels in subjects diagnosed with OSA. Moreover, FeNO levels were significantly increased upon waking up in patients with OSA, but such pattern was not present in non-OSA groups.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, long-term continuous positive airway pressure (CPAP) significantly lowered FeNO levels in OSA patients. Notwithstanding the conclusions of the meta-analysis, some limitations are worthy of mention: (i) the available literature contains studies with a relatively small sample size; (ii) different techniques and instruments were used for FeNO measurements; (iii) substantial heterogeneity was present across the cohorts that were evaluated; and (iv) insufficient information regarding confounding factors, such as snoring or timing of FeNO measurement [10].…”

Section: Introductionmentioning

confidence: 99%

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

Duarte

Rabahi

Sá

et al. 2019

Lung

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Purpose Obstructive sleep apnea (OSA) is a common condition characterized by repetitive collapse of the upper airways and intermittent oxygen desaturation, which may lead to airway inflammation. Here, we explored whether fractional exhaled nitric oxide (FeNO) levels provide a non-invasive screening tool of OSA. Methods Over a 3-month period, FeNO levels were measured in consecutive non-smoking patients referred for a sleep laboratory. All patients underwent full polysomnography. OSA severity was classified based on the apnea/hypopnea index: ≥ 5.0/h as any OSA, ≥ 15.0/h as moderate/severe OSA, and ≥ 30.0/h as severe OSA. FeNO was measured by a portable device (NIOX-MINO®; Aerocrine AB, Solna, Sweden) and expressed as parts per billion (ppb). Discrimination by area under the curve (AUC) and binary logistic regression were performed. Results A total of 229 subjects were evaluated. Mean FeNO values were similar among subjects without OSA or with OSA: 16.9 ± 10.6 ppb versus 20.2 ± 14.5 ppb, p = 0.221; respectively. FeNO was not an inclusionary parameter to predict any OSA, moderate/severe OSA, and severe OSA: odds ratio (OR) 1.023 (95% confidence interval [CI]: 0.986-1.062); OR 1.012 (95% CI: 0.991-1.034); and OR 0.999 (95% CI: 0.980-1.018), respectively. The AUC values for FeNO in the diagnosis of any OSA, moderate/severe OSA, and severe OSA showed no discriminatory properties: AUC: 0.567 (95% CI: 0.464-0.670), AUC: 0.541 (95% CI: 0.465-0.618), and AUC: 0.535 (95% CI: 0.459-0.610); respectively. Conclusions In a sleep-lab setting, our findings suggest that FeNO measurements are inconsequential in the screening of OSA in adults.

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Pulmonary dysfunction in overweight and obese children with obstructive sleep apnoea

Kasim

Golbabapour

Zaini

et al. 2023

Endocrino Diabet & Metabol

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Introduction Overweight and obese children are at risk of obstructive sleep apnoea (OSA) and abnormal pulmonary function (PF). Aim Investigate the relationship between body mass index (BMI), OSA on PF in children. Materials & Method Seventy‐four children were recruited. Mixed obstructive apnoea‐hypopnea index (MOAHI), BMI, oxygen saturation (SpO2), forced expiratory volume one second (FEV1), forced vital capacity (FVC) and fractionated exhaled nitric oxide (FeNO) were measured. Results Twenty‐four and thirty children had mild OSA and moderate‐to‐severe OSA respectively. BMI correlated negatively with SpO2 nadir (r = −.363, p = .001). FVC, FEV1 and nadir SpO2 values decreased with OSA severity (p < .001). The odds of a child with OSA having an abnormal spirometry was 3.16 (95% CI: 1.08, 9.22). There was significant association between FeNO and AHI (r = .497, <.001). Discussion Overweight and obese children with OSA have significant abnormalities in pulmonary function independent of BMI. OSA severity and elevated FeNO also correlated with diminishing lung function.

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Measurement of exhaled nitric oxide concentration in patients with obstructive sleep apnea

Abstract: Supplemental Digital Content is available in the text

Cited by 19 publications

References 44 publications

Snoring and nocturnal reflux: association with lung function decline and respiratory symptoms

Snoring and nocturnal reflux: association with lung function decline and respiratory symptoms

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

Pulmonary dysfunction in overweight and obese children with obstructive sleep apnoea

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