Background Obstructive sleep apnea (OSA) is a sleep disorder characterized as complete or partial upper airflow cessation during sleep Although it has been widely accepted that OSA is a risk factor for the development of hypertension, the studies focusing on this topic revealed inconsistent results We aimed to clarify the association between OSA and hypertension, including essential and medication-resistant hypertension Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed PubMed and Embase databases were used for searching the relevant studies published up to December 31, 2016 A quantitative approach of meta-analysis was performed to estimate the pooled odds ratio (OR) and 95% confidence interval (CI) Results Twenty-six studies with 51 623 participants (28 314 men, 23 309 women; mean age 518 years) met inclusion criteria and were included in this study Among them, six studies showed a significant association between OSA and resistant hypertension (pooled OR = 2842, 95% CI = 1703-3980, P < 005) Meanwhile, the combination of 20 original studies on the association of OSA with essential hypertension also presented significant results with the pooled ORs of 1184 (95% CI = 1093-1274, P < 005) for mild OSA, 1316 (95% CI = 1197-1433, P < 005) for moderate OSA and 1561 (95% CI = 1287-1835, P < 005) for severe OSA Conclusions Our findings indicated that OSA is related to an increased risk of resistant hypertension Mild, moderate and severe OSA are associated essential hypertension, as well a dose-response manner relationship is manifested The associations are relatively stronger among Caucasians and male OSA patients

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Association of obstructive sleep apnea with hypertension: A systematic review and meta-analysis.

Obstructive sleep apnea (OSA) is a common disease, affecting approximately 2% of women and 4% of men residing in Western communities. No systematically reviewed data are available about the prevalence of this disease in Asia, the most heavily populated continent. PubMed/Medline, Scopus and Google Scholar were searched for articles published from 1993 to May 2012 that reported the prevalence of OSA diagnosed via sleep monitoring and the prevalence of patients at risk for OSA as assessed by symptomatology and/or sleep questionnaires. We have also searched abstract database of major pulmonary and sleep scientific societies for relevant abstracts presented from 2010 to 2012. The following inclusion criteria were used: articles published in English, age ≥ 18 years, ≥ 100 participants in studies using sleep monitoring for the diagnosis of OSA, ≥ 300 participants in studies using questionnaires to detect patients at high risk for OSA. Exclusion criteria: duplicate publications, studies reporting the prevalence of central sleep apnea only, hospital based studies as well as studies assessing OSA prevalence among patients with resistant arterial hypertension, chronic kidney disease, heart failure and in patients with concomitant neurological disease. Twenty four articles were found to meet the inclusion criteria, covering 47,957 subjects (26,042 men and 21,915 women) and four relevant abstracts were noted. OSA prevalence ranged from 3.7% to 97.3%. Male gender, older age, a higher BMI and waist to hip ratio, greater neck circumference, arterial hypertension, smoking, snoring and daytime sleepiness were associated with OSA. Sample size, difference between the populations studied and the fact that some works included patients with a high pre-test probability of OSA explain the difference in prevalence rates. This systematic review highlights the lack of data regarding the prevalence of OSA in Asians. Only a few studies provide an approximate estimate of the OSA burden in some Asian communities.

https://link.springer.com/content/pdf/10.1186%2F1471-2466-13-10.pdf

Prevalence of obstructive sleep apnea in Asian adults: a systematic review of the literature

Background: The burden of obstructive sleep apnea among commercial drivers in Nigeria is not known. Aim: To assess the prevalence of high risk of obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) among intra-city commercial drivers. Setting and Design: A descriptive cross-sectional study in three major motor parks in Lagos metropolis. Materials and Methods: Demographic, anthropometric and historical data was obtained. The risk of OSA and EDS was assessed using the STOP BANG questionnaire and the Epworth Sleepiness Scale, respectively. Statistical Analysis: The relationship between the OSA risk, EDS risk and past road traffic accident (RTA) was explored using the Pearson's chi square. Independent determinants of OSA risk, EDS risk and past RTA, respectively, were assessed by multiple logistic regression models. Result: Five hundred male commercial drivers (mean age (years) ±SD = 42.36 ± 11.17 and mean BMI (kg/m 2 ) ±SD = 25.68 ± 3.79) were recruited. OSA risk was high in 244 (48.8%) drivers and 72 (14.4%) had EDS. There was a positive relationship between OSA risk and the risk of EDS (Pearson's X 2 = 28.2, P < 0.001). Sixty-one (12.2%) drivers had a past history of RTA but there was no significant relationship between a past RTA and either OSA risk (X 2 = 2.05, P = 0.15) or EDS risk (X 2 = 2.7, P = 0.1), respectively. Abdominal adiposity, regular alcohol use and EDS were independent determinants of OSA risk while the use of cannabis and OSA risk were independent determinants of EDS. No independent risk factor for past RTA was identified. Conclusion: A significant proportion of commercial drivers in Lagos metropolis are at high risk of OSA and EDS.

High-risk of obstructive sleep apnea and excessive daytime sleepiness among commercial intra-city drivers in Lagos metropolis.

Elevated risk of sleepiness-related motor vehicle accidents in patients with obstructive sleep apnea syndrome: a case-control study.

The aim of this study was to assess the prevalence of Obstructive sleep apnoea syndrome (OSAS) in long-distance drivers located in the Zonguldak area and to show the correlation between OSAS and traffic accidents. In this study, 241 long-distance drivers who were residents of Zonguldak province were interviewed face-to-face and a questionnaire regarding OSAS symptoms, occupational histories, and numbers of accidents was administered. Body mass measurements were also taken from participants. Patients who exhibited evidence of OSAS underwent polysomnography (PSG). Snoring was detected in 56% out of all participants, daytime sleepiness was observed in 26.6% and apnoea in 11.6%. All-night PSG was applied to 42 participants who had a high probability of clinical OSAS. Among these, eight had an apnoea-hypopnoea index (AHI) < 5. The prevalence of OSAS was 14.1%. There was a significant relationship between the ratio of traffic accidents per professional years and AHI (r = 0.571; p < 0.005). OSAS prevalence was higher among long-distance drivers in the Zonguldak region. Disease severity was directly proportional to traffic-accident risk, and thus represents a serious social problem.

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Investigation of obstructive sleep apnoea syndrome prevalence among long-distance drivers from Zonguldak, Turkey

Obstructive sleep apnea among express bus drivers in Malaysia: important indicators for screening.

Metastatic renal cell carcinoma (RCC) presenting with multiple deposits in the head and neck region is unusual. It is not uncommon for a RCC to metastasise to a distant site after years of a tumour-free period, but most of it would be expected to have a single site of deposit. We report a rare case of a patient who had a nephrectomy 10 years earlier for RCC and presented with tumours in the frontal sinus and posterior pharyngeal wall. Radiological imaging and histology confirmed metastatic RCC at both sites.

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Multiple metastatic deposits in the head and neck region from a renal cell carcinoma.

Objective 
To evaluate the role of panendoscopy and biopsy in diagnosing occult primary site of cancer in the head and neck region.
 Methods 
A retrospective review of patient clinical notes, radiological, histological and intra-operative reports who underwent panendoscopy and biopsy of the upper aerodigestive tract. 
Results 
Out of 11 patients, six had undifferentiated carcinoma and five had squamous cell carcinoma (SCC) of the cervical lymph nodes. Nine underwent CT scan of the head and neck and one had a positron emission tomography scan. One patient had no radiological imaging. None of these studies were able to locate a primary tumor. Random biopsies from sites of possible origin of the primary tumor with tonsillectomies confirmed the primary site in 10 patients; three had nasopharyngeal carcinoma, four had SCC of the tonsils with three patients with unilateral and one with bilateral involvement, one each with SCC of the base of tongue, SCC of both vocal cord and non Hodgkin’s lymphoma of bilateral tonsils. In one patient, no site of origin of the primary tumor was identified in the head and neck region. 
Conclusion 
Panendoscopy and biopsies had significant role in arriving at a conclusive diagnosis as compared to imaging studies in cases of metastatic cervical lymph nodes with an occult primary. (Rawal Med J 2010;35: ).
Keyword 
Occult primary tumor, panendoscopy, head and neck cancer, aerodigestive tract
INTRODUCTION
Cervical lymph node metastasis from unknown primary is a relatively rare event constituting 3-9% of all head and neck cancers.1 The most frequent histopathological diagnosis is squamous cell carcinoma (SCC) accounting for 65-76% of all cervical metastases from unknown primary, followed by undifferentiated carcinoma (14%), adenocarcinoma (13%) and nasopharyngeal-type undifferentiated carcinoma (8%).2 The occult primary tumor is eventually found in approximately 10-40% of patients during the follow-up and the upper aerodigestive tract is the most common site. Proper and directed treatment strategies can then be carried out, limiting the extent of the treatment and thus reduce the unwanted side-effects. The purpose of this study was to compare the diagnostic management in our institution with those previously published. 
PATIENTS AND METHODS
We retrospectively reviewed the clinical records of patient with cervical lymph nodes metastasis with an unknown primary, who underwent panendoscopy and biopsy of the upper aerodigestive tract over 3 years from March 2005 to July 2008 at Universiti Kebangsaan Malaysia medical center. Patients’ demographics data, clinical presentation, examination findings of the neck and initial neck biopsy result were collected. We also reviewed the radiological findings, final histology and the modality of treatment conducted on each patient.

RESULTS

A total of 11 patients who had cervical metastasis with unknown primary tumor were seen in our center during the stu

Azlan Iskandar Ishak

Papers

Obstructive sleep apnea among express bus drivers in Malaysia: important indicators for screening.

Multiple metastatic deposits in the head and neck region from a renal cell carcinoma.

Role of panendoscopy and biopsy in cervical lymph node metastasis with unknown primary: a tertiary center experience

Primary Lymphoepithelial Carcinoma of the Submandibular Gland in A Young Patient: A Case Report