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Goosmann M, Williams AM, Springer K, Yaremchuk KL. The Impact of Marital Status and Race in Obstructive Sleep Apnea. EAR, NOSE & THROAT JOURNAL 2025; 104:NP381-NP387. [PMID: 35968832 DOI: 10.1177/01455613221120068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
ObjectivesTo examine the difference in survival of obstructive sleep apnea (OSA) based on marital status and race.MethodsA single academic institution with data collection from 2005 to 2015. Patients with a diagnosis of OSA based on polysomnogram were abstracted from electronic medical records. Patients were classified as "married" or "unmarried." Race was self-reported as White, Black, Asian American, Hispanic/Latinx, Middle Eastern descent, or unrecorded and gathered from the electronic medical record.ResultsThere were 6200 adults included. Of these, married patients composed 62.7% (n = 3890) of the patients. Patients were 51.3% White (n = 3182), 39.8% (n = 2467) were Black, and 8.9% (n = 551) were other/unrecorded. Married patients had better survival probabilities (p < .0001). Unmarried patients had 2.72 times the risk of death than those who were married (95% CI 1.78-4.20) when examining OSA survival. When examining survival of those on continuous positive airway pressure (CPAP) between married and unmarried patients, those who were unmarried had 2.00 (95% CI 1.58-2.54) times the risk of death than those who were married. Married Black patients demonstrated the best survival probabilities, followed by married White patients (p < .0001). Married patients had lower mean sleep efficiency than those that were unmarried (76.2% and 77.2%, respectively; p = .019).ConclusionMarried patients with OSA had increased survival compared to their single counterparts. Married Black patients had the highest survival.
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Affiliation(s)
- Madeline Goosmann
- Department of Otolaryngology - Head & Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Amy M Williams
- Department of Otolaryngology - Head & Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Kylie Springer
- Department of Otolaryngology - Head & Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Kathleen L Yaremchuk
- Department of Otolaryngology - Head & Neck Surgery, Henry Ford Health System, Detroit, MI, USA
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Goh LC, Chin EW, Tan BKJ, Gao EY, Goh SSL, Hisham Shunmugam R, Kulasegarah J, Abu Bakar MZ, Toh ST. Impact of surgical intervention on obstructive sleep apnea (OSA) and body-mass index: a scoping review. Postgrad Med 2025:1-8. [PMID: 40370213 DOI: 10.1080/00325481.2025.2506981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2025] [Revised: 05/03/2025] [Accepted: 05/06/2025] [Indexed: 05/16/2025]
Abstract
BACKGROUND Upper airway surgery for obstructive sleep apnea (OSA) offers an alternative to CPAP, but its impact on weight changes is poorly studied. PURPOSE To systematically review published literature on the relationship between surgical intervention for OSA and changes in body mass index (BMI). METHODS A literature search was conducted from 2013-2024 in five databases. Full-text English articles which examined BMI changes in adults with OSA pre- and post-surgery were included. The quality of each study was assessed independently by two researchers using the Newcastle-Ottawa Scale. This study was reported according to the PRISMA-ScR. RESULTS Eleven studies, involving 406 patients from six countries were included. Most patients were males (88.4%) with a mean age of 40 years old. The pre-operative BMI were higher [27.8 kg/m2 (SD = 2.6)] compared to a BMI of 27.7 kg/m2 (SD = 1.3) at 21.0 months post-operation. The pre-operative Epworth Sleepiness Score was 13.28 (SD = 6.36), while the apnea-hypopnea index was 41.2 (SD = 16.88), indicating that most patients were diagnosed with severe OSA. The average oxygen desaturation index was 35.63 (SD = 11.17). The meta-analysis showed no significant BMI changes after surgery (mean difference:-0.29; 95% CI:-0.80 to 0.21; I2 = 30%). Findings were consistent with no publication bias found. CONCLUSIONS Upper airway surgery for OSA does not significantly affect BMI. The authors propose closer monitoring of weight changes following upper airway surgery, as weight fluctuations can impact the outcomes of surgery. Unchanged weight post-surgery may be attributed to suboptimal OSA treatment.
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Affiliation(s)
- Liang Chye Goh
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ein Wan Chin
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Benjamin Kye Jyn Tan
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore
| | - Esther Yanxin Gao
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore
| | - Sheron Sir Loon Goh
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ranita Hisham Shunmugam
- Department of Library and Information Science, Faculty of Arts and Social Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jeyanthi Kulasegarah
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mohd Zulkiflee Abu Bakar
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Song Tar Toh
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore
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Rapelli G, Caloni C, Cattaneo F, Redaelli M, Cattivelli R, Landi G, Tossani E, Grandi S, Castelnuovo G, Pietrabissa G. Three in a Bed: Can Partner Support Improve CPAP Adherence? A Systematic Review and Intervention Recommendations. J Pers Med 2025; 15:192. [PMID: 40423062 DOI: 10.3390/jpm15050192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2025] [Revised: 04/27/2025] [Accepted: 04/29/2025] [Indexed: 05/28/2025] Open
Abstract
Background/Objectives: Continuous positive airway pressure (CPAP) is the standard approach for treating obstructive sleep apnea syndrome (OSAS), but patient adherence is often low due to various influencing factors. Recently, researchers have increasingly begun to explore the influence of partner support on adherence to CPAP therapy. This systematic review seeks to consolidate current evidence regarding the impact of partner support on CPAP adherence in individuals with OSAS. Methods: A comprehensive literature search was carried out across PubMed, Scopus, Medline, PsycINFO, and Web of Science databases under PRISMA guidelines. Stringent inclusion criteria were used, and at least two independent reviewers screened all studies. The mixed methods appraisal tool (MMAT) was used to assess selected articles for quality. Data relevant to the review's objectives were extracted and presented through narrative synthesis. The review protocol was preregistered (Prospero CRD420251016574). Results: Nine studies met the inclusion criteria. Findings highlighted the significant influence of adherence to CPAP. Partner support, relationship quality, and collaborative efforts emerged as facilitators of adherence, with partnered individuals exhibiting higher adherence to CPAP use. However, barriers such as anxiety, interruption in intimacy, and conflict in relationships were also identified. Conclusions: To the best of our knowledge, this is the first systematic review to synthesize evidence on the partner's role in CPAP adherence and inform clinicians on the importance of providing personalized care based on biopsychosocial characteristics of patients; for example, assessing the partner support in the management of the illness. Furthermore, the findings emphasize the need for further research-particularly randomized controlled trials and dyadic designs-to deepen understanding of how partner dynamics influence effects of CPAP treatment.
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Affiliation(s)
- Giada Rapelli
- Department of Psychology, University of Bologna, 40127 Bologna, Italy
| | - Carola Caloni
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
| | - Francesca Cattaneo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
| | - Marco Redaelli
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
| | | | - Giulia Landi
- Department of Psychology, University of Bologna, 40127 Bologna, Italy
| | - Eliana Tossani
- Department of Psychology, University of Bologna, 40127 Bologna, Italy
| | - Silvana Grandi
- Department of Psychology, University of Bologna, 40127 Bologna, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Clinical Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Clinical Psychology Research Laboratory, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
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Vanagas T, Lipskytė D, Tamošiūnaitė J, Petrikonis K, Pajėdienė E. Can We Reduce the Diagnostic Burden of Sleep Disorders? A Single-Centre Study of Subjective and Objective Sleep-Related Diagnostic Parameters. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:780. [PMID: 40428738 PMCID: PMC12113066 DOI: 10.3390/medicina61050780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2025] [Revised: 04/13/2025] [Accepted: 04/18/2025] [Indexed: 05/29/2025]
Abstract
Background and Objectives: Sleep disorders are highly prevalent in society and require focused attention within healthcare systems. While patient history, reported complaints, and subjective sleep questionnaires can provide initial insights into potential sleep issues, polysomnography (PSG) remains the gold standard for diagnosing various sleep disorders. However, long waiting times for PSG appointments in many healthcare facilities pose challenges for timely diagnosis and treatment. This study aimed to evaluate the diagnostic value of subjective measures, including patient-reported parameters, in comparison to the objective findings of PSG. Materials and Methods: In this study, we retrospectively analysed the data from 562 patients who underwent clinical evaluation and PSG testing at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics between 2018 and 2024. We report the diagnostic accuracy of different sleep questionnaires to detect various sleep disorders in our population. Results: We report the corresponding sensitivity and specificity values: the Epworth Sleepiness Scale (ESS)-73.2% and 44.1% for detecting severe obstructive sleep apnoea and 87.1% and 76.8% for detecting hypersomnia; the Insomnia Severity Index (ISI)-77.2% and 63.3% for detecting insomnia; the Berlin Questionnaire (BQ)-67.8% and 68.8% for detecting obstructive sleep apnoea; the Ullanlina Narcolepsy Scale (UNS)-84.4% and 58.9% for detecting hypersomnia; the Innsbruck REM Sleep Behaviour Disorder Inventory (RBD-I)-93.3% and 52.5% for detecting RBD; the REM Sleep Behaviour Disorder Single-Question Screen (RBD1Q)-73.3% and 81.0% for detecting RBD; and the Paris Arousal Disorder Severity Scale (PADSS)-57.5% and 90.5% for detecting parasomnia. Conclusions: When comparing our findings with the previous literature, we found that the screening tools generally demonstrated a slightly poorer performance in our population. However, our results suggest that certain individual questions from the comprehensive questionnaires may provide comparable diagnostic values, while reducing the patient burden. We propose a targeted screening approach that integrates fundamental clinical parameters, key screening questions, and selected validated questionnaires, enabling primary care and outpatient clinicians to more efficiently identify patients who may require referral for specialised sleep evaluation and treatment.
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Affiliation(s)
- Tadas Vanagas
- Neurology Department, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (K.P.); (E.P.)
| | - Domantė Lipskytė
- Medical Faculty, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.L.); (J.T.)
| | - Jovita Tamošiūnaitė
- Medical Faculty, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.L.); (J.T.)
| | - Kęstutis Petrikonis
- Neurology Department, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (K.P.); (E.P.)
| | - Evelina Pajėdienė
- Neurology Department, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (K.P.); (E.P.)
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Amendolara M, Di Lecce V, Santomasi C, Quaranta VN, Portacci A, Lazzaretti ID, Cuccaro LAS, Casparrini M, Spierto S, Picerno V, De Robertis C, Quaranta S, Dragonieri S, Carpagnano GE. The impact of PAP therapy first impression on short-term treatment adherence. Sleep Breath 2025; 29:152. [PMID: 40199775 PMCID: PMC11978682 DOI: 10.1007/s11325-025-03320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 03/26/2025] [Accepted: 03/26/2025] [Indexed: 04/10/2025]
Abstract
PURPOSE Positive airway pressure (PAP) treatment for obstructive sleep apnea syndrome (OSAS) is often burdened by lower adherence rates. Patients' perception and acceptance of PAP therapy play a crucial role in achieving acceptable adherence. METHOD We conducted a prospective cohort study to assess patients' initial impressions of PAP therapy using a six-item questionnaire. The questionnaire evaluated CPAP tolerance, interface comfort, titration pressure, likelihood of CPAP use, expected health benefits, and overall attitude toward PAP therapy. Patients underwent a baseline awake PAP therapy trial (T0) followed by titration with an automatic device (APAP). After one month of titration, a fixed CPAP value was set (T1). Follow-ups occurred at 1 (T2), 3 (T3), and 6 (T4) months after the start of treatment. Adherence to PAP therapy was considered sufficient if the mean device usage was ≥ 4 h/night at T4. RESULTS After six months, 77% of the enrolled patients achieved high PAP treatment adherence. Questionnaire scores generally improved from T0 to T4, particularly in CPAP tolerance, likelihood of treatment adherence, expected health benefits, and overall judgment of PAP therapy. Time-to-event analysis revealed that higher baseline scores in titration pressure comfort, likelihood of CPAP adherence, and overall judgment of PAP therapy were significantly associated with higher adherence likelihood. CONCLUSION Patients' first judgement on PAP therapy could significantly influence short-term adherence. Early identification and management of patients' complaints and discomforts could improve adherence rates and PAP perception over time.
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Affiliation(s)
- Monica Amendolara
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy
| | - Valentina Di Lecce
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy
| | - Carla Santomasi
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy
| | - Vitaliano Nicola Quaranta
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy
| | - Andrea Portacci
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy.
| | - Ilaria Dei Lazzaretti
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy
| | - Laura Anna Sara Cuccaro
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy
| | - Massimo Casparrini
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy
| | - Sebastiano Spierto
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy
| | - Vito Picerno
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy
| | - Cristina De Robertis
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy
| | - Sara Quaranta
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy
| | - Silvano Dragonieri
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy
| | - Giovanna Elisiana Carpagnano
- Institute of Respiratory Disease, Department of Translational Biomedicine and Neuroscience, University "Aldo Moro", 70124, Bari, Italy
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Emsellem HA, Colwell HH, Cronin J, Farkas RH, Mathias SD. Fatigue is distinct from sleepiness and negatively impacts individuals living with obstructive sleep apnea (OSA): results from qualitative research of individuals with OSA. Health Qual Life Outcomes 2025; 23:26. [PMID: 40128860 PMCID: PMC11934705 DOI: 10.1186/s12955-025-02355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Accepted: 03/09/2025] [Indexed: 03/26/2025] Open
Abstract
BACKGROUND We sought to identify important issues regarding symptoms and impacts of obstructive sleep apnea (OSA), to explore fatigue and sleepiness, and evaluate the content, clarity, and relevance of specific patient reported outcome (PRO) measures. METHODS Participants in the US with OSA and at least mild fatigue were studied. Individuals with positive airway pressure (PAP) therapy intolerance or current PAP refusal (non-PAP users) and those who initiated PAP within the past 12 months (PAP users) were identified and interviewed. Interviews included concept elicitation questions about symptoms and impacts of OSA. Participants then completed several PRO measures (the PRO Measurement Information System [PROMIS] Fatigue-8a, PROMIS Sleep-Related Impairment-8a, Epworth Sleepiness Scale [ESS], Patient-Global Impression of Severity of Fatigue [PGI-S Fatigue], and Patient Global Impression of Change in Fatigue [PGI-C Fatigue]) and were cognitively debriefed to evaluate their content, clarity, and relevance. RESULTS A total of 30 individuals with OSA (20 non-PAP and 10 PAP) were enrolled. In addition to fatigue (reported by 100%), sleepiness (75%), difficulty concentrating (85%), dry mouth/throat (60%), headaches (50%) and interrupted sleep (50%) were the most common symptoms reported by non-PAP users. Fifty-eight percent of non-PAP users rated fatigue as the most bothersome symptom; 5% rated sleepiness as the most bothersome. Among PAP users, the most common symptoms (prior to PAP use) in addition to fatigue (100%) were sleepiness (90%), difficulty concentrating (60%), dry mouth/throat (60%), headaches (50%), and interrupted sleep (50%). Fatigue was rated as most bothersome by 56% of PAP users; sleepiness was rated as the most bothersome by 22%. All participants mentioned fatigue and sleepiness separately, indicating they are considered distinct symptoms. In general, participants found the PRO measures to be relevant and clear, and results supported their content validity, clarity, and relevance. CONCLUSIONS Fatigue was the most bothersome symptom reported by non-PAP and PAP users. Participants described fatigue as a distinct and different concept from excessive daytime sleepiness. Participants reported that their OSA symptoms negatively impact daily activities, functioning, work, and relationships. The PRO measures are clear and relevant for individuals with OSA and appropriate for use in both clinical and research settings.
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Affiliation(s)
- Helene A Emsellem
- Sleep Health Institute, 10221 River Road, PO Box 61324, Potomac, MD, 20859, USA.
| | - Hilary H Colwell
- Health Outcomes Solutions, 1149 Crystal Drive, Palm Beach Gardens, FL, 33418, USA
| | - John Cronin
- Apnimed, Inc., 39 John F. Kennedy St., 4th Floor, Cambridge, MA, 02138, USA
| | - Ronald H Farkas
- Apnimed, Inc., 39 John F. Kennedy St., 4th Floor, Cambridge, MA, 02138, USA
| | - Susan D Mathias
- Health Outcomes Solutions, 1149 Crystal Drive, Palm Beach Gardens, FL, 33418, USA
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Baran B, Lee EE. Age-Related Changes in Sleep and Its Implications for Cognitive Decline in Aging Persons With Schizophrenia: A Critical Review. Schizophr Bull 2025; 51:513-521. [PMID: 38713085 PMCID: PMC11908868 DOI: 10.1093/schbul/sbae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND AND HYPOTHESIS Cognitive impairment is a core feature of schizophrenia that worsens with aging and interferes with quality of life. Recent work identifies sleep as an actionable target to alleviate cognitive deficits. Cardinal non-rapid eye movement (NREM) sleep oscillations such as sleep spindles and slow oscillations are critical for cognition. People living with schizophrenia (PLWS) and their first-degree relatives have a specific reduction in sleep spindles and an abnormality in their temporal coordination with slow oscillations that predict impaired memory consolidation. While NREM oscillatory activity is reduced in typical aging, it is not known how further disruption in these oscillations contributes to cognitive decline in older PLWS. Another understudied risk factor for cognitive deficits among older PLWS is obstructive sleep apnea (OSA) which may contribute to cognitive decline. STUDY DESIGN We conducted a narrative review to examine the published literature on aging, OSA, and NREM sleep oscillations in PLWS. STUDY RESULTS Spindles are propagated via thalamocortical feedback loops, and this circuitry shows abnormal hyperconnectivity in schizophrenia as revealed by structural and functional MRI studies. While the risk and severity of OSA increase with age, older PLWS are particularly vulnerable to OSA-related cognitive deficits because OSA is often underdiagnosed and undertreated, and OSA adds further damage to the circuitry that generates NREM sleep oscillations. CONCLUSIONS We highlight the critical need to study NREM sleep in older PWLS and propose that identifying and treating OSA in older PLWS will provide an avenue to potentially mitigate and prevent cognitive decline.
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Affiliation(s)
- Bengi Baran
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Matsumura E, Grad GF, Madeiro F, Genta PR, Lorenzi-Filho G. Mouth Leak Is Associated with Sleep Fragmentation During Nasal Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea and May Be Detected by Leak Waveform Analysis. Ann Am Thorac Soc 2025; 22:430-437. [PMID: 39499768 DOI: 10.1513/annalsats.202404-425oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 10/31/2024] [Indexed: 11/07/2024] Open
Abstract
Rationale: Mouth air leak is a major cause of low adherence to nasal continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA). However, CPAP reports do not distinguish mouth leak from mask leak. We hypothesized that mouth air leak is terminated abruptly by an arousal from sleep and mouth closing that can be detected by CPAP leak waveform analysis. Objectives: To describe patterns of mouth air leak waveform during polysomnography (PSG) in patients with OSA treated with well-fitted nasal CPAP. Methods: PSG recordings with a jaw motion sensor to detect mouth opening were performed in patients with OSA treated with nasal CPAP with suspected mouth air leak. Careful mask fitting and visual inspection excluded mask leak. Mouth leak episodes were characterized by an increase (⩾20%) above the intentional leak. Leak episodes were classified as intermittent (<5 minutes) or continuous (⩾5 minutes). Results: Twenty patients (80% men; age, 63 ± 11 years; body mass index, 29.9 ± 6 kg/m2; baseline apnea-hypopnea index, 46.9 ± 19 events per hour) treated with nasal CPAP and documented mouth leak completed the study. All but one patient experienced an overlap of intermittent and continuous mouth leak. Most mouth leak episodes ended with mouth closure (97.7%) and an arousal (52.7%) or awakening (38.6%). Only 34.9% of the leak episodes were associated with respiratory events. Intermittent mouth air leak was more common in sleep stages N1 and N2 (P < 0.01), whereas continuous leak was more common in sleep stage N3 (P < 0.01). Continuous episodes of air leak were associated with a higher amplitude of mouth opening. The CPAP report waveform was able to detect only 29.6% of the leak episodes detected by PSG. Only 10 patients (50%) had a high unintentional leak according to the criteria adopted by ResMed, and only 2 patients (10%) presented large leak according to the Philips criteria. Conclusions: Intermittent and continuous mouth leak during nasal CPAP frequently coexist and contribute to sleep fragmentation. Identification of leak waveform patterns may help detect mouth air leak, which, in turn, is an important cause of poor CPAP adherence.
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Affiliation(s)
- Erika Matsumura
- Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gustavo F Grad
- Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda Madeiro
- Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Pedro R Genta
- Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Bègue L, Raoul G, Barry F, Nicot R. Effectiveness of orthognathic surgery by maxillomandibular advancement combined with soft tissue surgery as curative treatment for obstructive sleep apnea syndrome. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2025; 126:102075. [PMID: 39277137 DOI: 10.1016/j.jormas.2024.102075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 07/25/2024] [Accepted: 09/11/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE/BACKGROUND The aim of this study was to compare the efficacy of orthognathic surgery combined with soft tissue surgery with that of soft tissue surgery alone as curative treatments for moderate to severe obstructive sleep apnea (OSA) syndrome. PATIENTS/METHODS This retrospective cohort study included 50 patients aged ≥18 years who underwent orthognathic surgery combined with soft tissue surgery or soft tissue surgery alone for OSA syndrome (apnea-hypopnea index [AHI]: >15). The primary outcome was the improvement in AHI measured by overnight in-laboratory polysomnography before and at 6 months after the surgical treatment by. The secondary outcome was the postoperative AHI. RESULTS Twenty-eight (56 %) patients underwent orthognathic surgery combined with soft tissue surgery, while 22 (44 %) underwent soft tissue surgery only. There were no significant between-group differences in sex (p = 0.53), age (p = 0.08), body mass index (p = 0.42), and preoperative AHI (p = 0.17). The mean improvement in AHI at 6 months after surgery was significantly greater in the orthognathic surgery group than in the soft tissue surgery group (32.18 vs. 10.41; p < 0.0001). Similarly, the mean postoperative AHI was significantly lower in the orthognathic surgery group than in the soft tissue surgery group (8.46 vs. 29.62; p < 0.0001). CONCLUSION Compared with soft tissue surgery alone, orthognathic surgery combined with soft tissue surgery is more effective as curative treatment for OSA syndrome.
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Affiliation(s)
- Louis Bègue
- Univ. Lille, CHU Lille, Service de Chirurgie Maxillo-Faciale et Stomatologie, 59000 Lille, France.
| | - Gwénaël Raoul
- Univ. Lille, CHU Lille, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008 - Advanced Drug Delivery Systems, 59000 Lille, France
| | - Florent Barry
- Univ. Lille, CHU Lille, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008 - Advanced Drug Delivery Systems, 59000 Lille, France
| | - Romain Nicot
- Univ. Lille, CHU Lille, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008 - Advanced Drug Delivery Systems, 59000 Lille, France
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Yakdan S, Rahhal N, Al Chaar S, Alhaddad J, Al Akoum M, Chahine Y, Najem R, Chahine MN. Prevalence of Obstructive Sleep Apnea Among Lebanese Patients With Chronic Kidney Disease: Its Repercussion on Disease Trajectory and Its Effect on Patients' Quality of Life. Int J Nephrol 2025; 2025:1427467. [PMID: 40034190 PMCID: PMC11872291 DOI: 10.1155/ijne/1427467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 01/16/2025] [Indexed: 03/05/2025] Open
Abstract
Background and Objectives: Chronic kidney disease (CKD) remains a public health threat and a major cause of morbidity and mortality worldwide. A bidirectional relationship is found between sleep disorders and CKD worldwide. However, to our knowledge, this study is the first to assess the prevalence of obstructive sleep apnea (OSA) and to evaluate its impact on the progression of other comorbidities among Lebanese patients with CKD. Materials and Methods: The study is an observational cross-sectional study, carried out between September and November 2021. Lebanese patients with any stage of CKD were included. Patients' characteristics were collected via electronic health record and baseline questionnaires. We screened for obstructive sleep apnea using the STOP-Bang questionnaire. Results: We included 168 patients. The prevalence of OSA among our patients was 47.6%. The prevalence of OSA is higher in males compared with females (81.2% vs. 18.8%, p=0.002). Obesity was more prevalent in patients with OSA compared with patients without OSA (42.5% vs. 19.3%, p=0.002). Among the 168 patients, 69.6% had hypertension, with a significantly higher prevalence among those with OSA compared with those without OSA (81.2% vs. 59.1%, p=0.003). Patients with OSA reported significantly lower scores compared with those without OSA in several domains of physical and emotional health, including physical functioning (54.06 vs. 66.88, p=0.002), role limitations due to physical health (42.19 vs. 63.07, p=0.001), role limitations due to emotional problems (49.17 vs. 69.32, p=0.004), pain (61.31 vs. 70.45, p=0.019), and physical component score (52.53 vs. 69.53, p=0.002). All the abovementioned parameters were also examined in two subpopulations: patients with CKD and ESRD. Similarly, some comorbidities and a lower physical QOL score were observed more in patients with OSA in these two subpopulations. Conclusion: Patients with OSA in our study have higher probability of being male, obese, and hypertensive as well as poorer QOL compared with their counterparts without OSA. Implementing more effective screening and treatment of OSA in CKD patients is necessary.
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Affiliation(s)
- Salim Yakdan
- Department of Research, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Nazih Rahhal
- Department of Research, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Soltan Al Chaar
- Department of Research, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Juliano Alhaddad
- Department of Research, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Monifa Al Akoum
- Department of Research, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Yaacoub Chahine
- Department of Research, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Robert Najem
- Department of Research, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
- Internal Medicine Department, Nephrology Division, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
- Nephrology Department, The Lebanese Hospital Geitaoui-UMC, Beirut, Lebanon
| | - Mirna N. Chahine
- Department of Research, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
- Basic Sciences Department, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
- Department of Research, Foundation-Medical Research Institutes (F-MRI®), Beirut, Lebanon
- Department of Research, Foundation-Medical Research Institutes (F-MRI®), Geneva, Switzerland
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11
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An X, Zhou J, Xu Q, Zhao Z, Li W. Artificial intelligence in obstructive sleep apnea: A bibliometric analysis. Digit Health 2025; 11:20552076251324446. [PMID: 40123882 PMCID: PMC11930495 DOI: 10.1177/20552076251324446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 02/11/2025] [Indexed: 03/25/2025] Open
Abstract
Objective To conduct a bibliometric analysis using VOSviewer and Citespace to explore the current applications, trends, and future directions of artificial intelligence (AI) in obstructive sleep apnea (OSA). Methods On 13 September 2024, a computer search was conducted on the Web of Science Core Collection dataset published between 1 January 2011, and 30 August 2024, to identify literature related to the application of AI in OSA. Visualization analysis was performed on countries, institutions, journal sources, authors, co-cited authors, citations, and keywords using Vosviewer and Citespace, and descriptive analysis tables were created by using Microsoft Excel 2021 software. Results A total of 867 articles were included in this study. The number of publications was low and stable from 2011 to 2016, with a significant increase after 2017. China had the highest number of publications. Alvarez, Daniel, and Hornero, Roberto were the two most prolific authors. Universidad de Valladolid and the IEEE Journal of Biomedical and Health Informatics were the most productive institution and journal, respectively. The top three authors in terms of co-citation frequency are Hassan, Ar, Young, T, and Vicini, C. "Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis" was cited the most frequently. Keywords such as "OSA," "machine learning," "Electrocardiography," and "deep learning" were dominant. Conclusion AI's application in OSA research is expanding. This study indicates that AI, particularly deep learning, will continue to be a key research area, focusing on diagnosis, identification, personalized treatment, prognosis assessment, telemedicine, and management. Future efforts should enhance international cooperation and interdisciplinary communication to maximize the potential of AI in advancing OSA research, comprehensively empowering sleep health, bringing more precise, convenient, and personalized medical services to patients and ushering in a new era of sleep health.
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Affiliation(s)
- Xing An
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jie Zhou
- Clinical Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qiang Xu
- College of Intelligent Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhihui Zhao
- College of Intelligent Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Weihong Li
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Sichuan College of Traditional Chinese Medicine, Mianyang, Sichuan, China
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12
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Joskin A, Bruyneel M. Challenges in Obstructive Sleep Apnea Management in Elderly Patients. J Clin Med 2024; 13:7718. [PMID: 39768640 PMCID: PMC11676951 DOI: 10.3390/jcm13247718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 12/08/2024] [Accepted: 12/16/2024] [Indexed: 01/11/2025] Open
Abstract
With the aging of the population, obstructive sleep apnea (OSA) in elderly patients is now more commonly seen in clinical practice. In older people, sleepiness is less marked than in younger patients, but insomnia symptoms are more common. Comorbidities are numerous and related to cardiometabolic and cognitive conditions. Polygraphy can be used to establish the diagnosis in the vast majority of cases, but polysomnography is indicated in cases of comorbid sleep disorders. Continuous positive airway pressure (CPAP) remains the cornerstone of treatment, but compliance decreases with age, especially in those over 80, and when cognitive disorders are also present. In these patients, CPAP can be beneficial in terms of nighttime symptoms, sleepiness, mood, and cognition but can also prevent cardiovascular and cerebrovascular disorders, especially in severeOSA patients. For this reason, we should offer this treatment to elderly patients and devise strategies to support them with treatment difficulties (e.g., therapeutic education, adapted masks, and telemonitoring). In the future, we need prospective studies to help identify elderly patients who will gain the greatest long-term benefit from treatment. Dedicated sleep testing, OSA severity markers, and specific questionnaires need to be developed in this older, but large, OSA population.
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Affiliation(s)
- Aude Joskin
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Brussels, Belgium and Université Libre de Bruxelles, 1000 Brussels, Belgium;
| | - Marie Bruyneel
- Department of Pulmonary Medicine, Saint-Pierre University Hospital, Brussels, Belgium and Université Libre de Bruxelles, 1000 Brussels, Belgium;
- Department of Pulmonary Medicine, Brugmann University Hospital, Brussels, Belgium and Université Libre de Bruxelles, 1020 Brussels, Belgium
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13
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Couto Patriota TLG, Pedrosa RP. An Alternative In-Home Protocol to Diagnose and Treat Obstructive Sleep Apnea. Sleep Sci 2024; 17:e401-e406. [PMID: 39698182 PMCID: PMC11651865 DOI: 10.1055/s-0044-1782526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/20/2023] [Indexed: 12/20/2024] Open
Abstract
Objective Obstructive sleep apnea (OSA) is a major public health problem of pandemic proportions. In-laboratory OSA diagnosis and continuous positive airway pressure (CPAP) titration are insufficient, considering the number of patients affected. Finding alternative ways to diagnose and treat OSA is mandatory, especially in this era of the coronavirus disease 2019 (COVID-19) pandemic. The present study aims to describe an alternative in-home protocol to diagnose and treat OSA. Materials and Methods We enrolled consecutive patients aged ≥ 18 years with moderate/severe OSA, who underwent in-home type-III polysomnography and home-based titration with automatic CPAP, coupled with an oximetry sensor for 3 consecutive nights. Patients were remotely monitored for 90 days to evaluate CPAP compliance and the use of an engagement tool was encouraged. Results We included 86 participants. The median time until the diagnosis was of one day. The mean time from the baseline visit until the acquisition and initiation of the CPAP therapy was of 33 (range: 17 to 52) days. Telemonitoring ensured good compliance in the first 30 (79.2%), 60 (76.3%) and 90 (74.3%) days, with an average daily use of 6.2 ± 1.4 h, 6.0 ± 1.4 h, and 6.0 ± 1.3 h respectively. About 1/3 of the patients used the engagement tool, and CPAP compliance was significantly higher among these patients compared with those who did not used the tool: 89.9% versus 73.5% ( p < 0.002), 87.9% versus 70% ( p < 0.003), and 86.6% versus 67.6% ( p < 0.001) at 30, 60, and 90 days respectively. Conclusion We demonstrated that an alternative in-home protocol to diagnose and treat OSA is effective, ensuring good CPAP compliance after 90 days. Telemonitoring and engagement tools could be strategies to improve CPAP compliance.
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Affiliation(s)
- Tarcya L G Couto Patriota
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico Universitário de Pernambuco (PROCAPE), Universidade de Pernambuco, Recife, PE, Brazil
| | - Rodrigo Pinto Pedrosa
- Sleep and Heart Laboratory, Pronto Socorro Cardiológico Universitário de Pernambuco (PROCAPE), Universidade de Pernambuco, Recife, PE, Brazil
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14
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Samà C, Longu S, Bergesio G, Samà F, Faioli A. Therapeutic adherence in patients with Obstructive Sleep Apnea Syndrome: a retrospective cohort study. Sleep Breath 2024; 28:2437-2443. [PMID: 39196316 DOI: 10.1007/s11325-024-03097-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/03/2024] [Accepted: 06/26/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory disorder characterized by repeated episodes of partial or complete airway obstruction. Continuous Positive Airway Pressure therapy (CPAP) is effective in improving sleep quality and daytime sleepiness. The aim of the study was to evaluate therapeutic adherence in a sample of patients with OSAS from the Pneumology ward of the "Cardinal Massaia" Hospital in Asti. MATERIALS AND METHODS A sample of 221 patients with OSAS were collected and retrospectively analyzed from January 2019 to December 2021. Ventilation hours during device titration (T1), possible second titration (T2) and one-year control (T3) were considered. The use of the CPAP device equal to or greater than 4 h/night was considered as therapeutic adherence. Age, gender, severity of OSAS, smoking, interface used and Epworth Sleepiness Scale (ESS) score were considered. RESULTS The analysis data showed that the percentage of adhesion during T1 was 84%. Only 9% needed T2, with 84% adherence. At T3 the adherence was 86%. Correlation studies showed that only smoking had a positive correlation with adherence, while OSAS severity, gender, ESS score, interface used and age had no statistically significant correlation. CONCLUSION It was important to understand that OSAS is a disease with prolonged treatment, which affects the life of the person and his family. Therefore, the concept of assistance network was born, which sees the healthcare operators, the person and his family as the main actors involved in a care process.
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Affiliation(s)
- Carmen Samà
- RN, Cardinal Massaia Hospital, Corso Dante Alighieri 202, Asti, 14100, Italy.
| | - Sandro Longu
- RN, Cardinal Massaia Hospital, Corso Dante Alighieri 202, Asti, 14100, Italy
| | - Giorgio Bergesio
- RN, MSN, Contract professors Nursing Degree University of Turin, Piazzale Fabrizio de Andrè, Asti, 14100, Italy
| | - Francesca Samà
- RN, Cardinal Massaia Hospital, Corso Dante Alighieri 202, Asti, 14100, Italy
| | - Alessia Faioli
- RN, Cardinal Massaia Hospital, Corso Dante Alighieri 202, Asti, 14100, Italy
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15
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Iannella G, Pace A, Magliulo G, Vicini C, Lugo R, Vanderveken OM, de Vries N, Pang K, Thuler E, Jacobowitz O, Cahali MB, Maurer JT, Casale M, Moffa A, Salamanca F, Leone F, Olszewska E, Reina CO, Zancanella E, Hoff PT, Baptista P, Bahgat AY, Ravesloot MJL, van Maanen P, Goldberg A, Carrasco M, Agrawal VK, Lechien JR, De Vito A, Cammaroto G, De Virgilio A, Greco A, Mancini P, Perrone T, Amado S, Alkan U, Cheong RCT, D'Ecclesia A, Galantai D, RajuAnand A, Calvo-Henriquez C, Cocuzza S, Arigliani M, Saibene AM, Aragona RM, Maniaci A. International expert consensus statement: surgical failure in obstructive sleep apnea. Sleep Breath 2024; 28:2601-2616. [PMID: 39307877 PMCID: PMC11567991 DOI: 10.1007/s11325-024-03162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/26/2024] [Accepted: 09/06/2024] [Indexed: 11/16/2024]
Abstract
PURPOSE Upper airway (UA) surgery is commonly employed in the treatment of patients with obstructive sleep apnea (OSA). The intricate pathophysiology of OSA, variability in sites and patterns of UA collapse, and the interaction between anatomical and non-anatomical factors in individual patients may contribute to possible surgical failures. This clinical consensus statement aims to identify areas of agreement among a development group comprising international experts in OSA surgery, regarding the appropriate definition, predictive factors in patients, and management of surgical failure in OSA treatment. METHODS A clinical consensus statement (CCS) was developed using the Delphi method by a panel of 35 contributors from various countries. A systematic literature review adhering to PRISMA guidelines was conducted. A survey consisting of 60 statements was then formulated and presented to the experts. RESULTS Following two rounds of the Delphi process, consensus or strong consensus was achieved on 36 items, while 24 items remained without consensus. Specifically, 5 out of 10 statements reached consensus regarding on the 'Definition of Surgical Success/Failure after OSA Surgery'. Regarding the 'Predictive Factors of Surgical Failure in OSA Surgery', consensus was reached on 10 out of 13 statements. In the context of the 'Diagnostic Workup in OSA Surgery', consensus was achieved on 9 out of 13 statements. Lastly, in 'Treatment in Surgical Failure Cases', consensus was reached on 12 out of 24 statements. CONCLUSION The management of OSA after surgical failure presents a significant clinical challenge for sleep specialists. This CCS provides valuable guidance for defining, preventing, and addressing surgical failures in the treatment of OSA syndrome.
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Affiliation(s)
- Giannicola Iannella
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00185, Rome, Italy.
| | - Annalisa Pace
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00185, Rome, Italy
| | - Giuseppe Magliulo
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00185, Rome, Italy
| | - Claudio Vicini
- Department ENT & Audiology, University of Ferrara, Ferrara, Italy
| | - Rodolfo Lugo
- Department of Otorhinolaryngology, Grupo Medico San Pedro, 64660, Monterrey, Mexico
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Antwerp, Belgium
- Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Nico de Vries
- Department of Orofacial Pain and Dysfunction, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | | | - Eric Thuler
- Division of Sleep Surgery, Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ofer Jacobowitz
- Sleep Department, ENT and Allergy Associates, New York, NY, USA
| | - Michel Burihan Cahali
- Departamento de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Joachim T Maurer
- Division of Sleep Medicine, Department of Otorhinolaryngology, University Hospital Mannheim, Mannheim, Germany
| | - Manuele Casale
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy
| | - Antonio Moffa
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy
| | | | - Federico Leone
- Otorhinolaryngology Unit, San Pio X Hospital, 20159, Milan, Italy
| | - Ewa Olszewska
- Department of Otolaryngology, Sleep Apnea Surgery Center, Medical University of Bialystok, 15-276, Bialystok, Poland
| | | | | | - Paul T Hoff
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Peter Baptista
- Otorhinolaryngology Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ahmed Yassin Bahgat
- Department of Otorhinolaryngology-Head & Neck Surgery, Alexandria University, Alexandria, 5424041, Egypt
| | - Madeline J L Ravesloot
- Department of Otorhinolaryngology-Head and Neck Surgery, OLVG, Amsterdam, The Netherlands
| | - Peter van Maanen
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Head and Neck Surgery, University of California, 2233 Post Street, Room 309, San Francisco, CA, 94115-1225, USA
| | - Andrew Goldberg
- Department of Otorhinolaryngology, Doctor Peset University Hospital, Valencia, Spain
| | - Marina Carrasco
- Department of Otorhinolaryngology, Doctor Peset University Hospital, Valencia, Spain
| | - Vikas K Agrawal
- Speciality ENT Hospital, Thakur Complex, Kandivali (E), Mumbai, Maharashtra, 400101, India
| | - Jerome R Lechien
- Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology-Head Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Andrea De Vito
- Department of Otolaryngology-Head and Neck Surgery, Forli Hospital, Forli, Italy
| | - Giovanni Cammaroto
- Department of Otolaryngology-Head and Neck Surgery, Forli Hospital, Forli, Italy
| | - Armando De Virgilio
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00185, Rome, Italy
| | - Antonio Greco
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00185, Rome, Italy
| | - Patrizia Mancini
- Department of 'Organi Di Senso', University "Sapienza", Viale Università 33, 00185, Rome, Italy
| | - Tiziano Perrone
- Otorhinolaryngology Unit, Civil Hospital of Alghero, Alghero, Italy
| | - Steve Amado
- Maple Respiratory, Universidad del Rosario, Bogotá, Colombia
| | - Uri Alkan
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Ryan Chin Taw Cheong
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals NHS, London, UK
| | | | - Dorina Galantai
- Department of Otorhinolaryngology, Head and Neck Surgery, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | | | - Christian Calvo-Henriquez
- Rhinology and Sleep Apnea Unit, Otolaryngology Department, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Salvatore Cocuzza
- Deparment of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, 95123, Catania, Italy
| | | | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo E Carlo Hospital, Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy
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Meads KL, Huettner S, Amata D, Johnson H, Devine JK, Warnakulasuriya S, Murphy KR, Good CH. Feasibility and acceptability of wearing a neuromodulation device at night in individuals in recovery from opioid use disorder. Front Psychiatry 2024; 15:1481795. [PMID: 39676914 PMCID: PMC11640868 DOI: 10.3389/fpsyt.2024.1481795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 11/14/2024] [Indexed: 12/17/2024] Open
Abstract
Introduction Opioid use disorder (OUD) is a serious and persistent problem in the United States with limited non-pharmacological treatment options, especially for the concomitant sleep disorders experienced by most individuals with addiction. While new, non-invasive interventions such as low-intensity focused ultrasound (LIFU) have shown promise in targeting the brain regions impacted throughout addiction and recovery, the devices used are not amenable to outpatient treatment in their current form factor and cannot be used at night during sleep. To bridge this gap and provide a much-needed treatment option for repeated, at-home use, we developed a wearable LIFU device out-of-clinic use. Methods This study evaluated the feasibility and acceptability of the portable treatment device among individuals recovering from OUD in an unsupervised, at-home setting. 31 subjects were recruited from a Baltimore, Maryland (USA) outpatient treatment facility and, along with a separate group of 14 healthy controls (HC), were asked to wear a prototype EEG-only (non-LIFU) device for 7 consecutive nights to assess their willingness and adherence to nightly use. Participants used a smartphone application, TrialKit (ePRO), to self-report nightly sleep data (e.g. duration, quality, possible disturbances, and device comfort). Results Of the 31 OUD participants recruited, 30 (97%) successfully completed the at-home study, and the majority responded that they would participate in future studies using the head wearable device (OUD, 87%; HC, 71%). OUD participants were statistically more likely than HCs to respond that they would consider using the device in the future to help them sleep (OUD, 70%; HC, 29%). Despite some participants facing technological issues (e.g. lack of reliable phone access or cellular data plans), the OUD group demonstrated high study compliance on par with the healthy control group. Discussion Participant's daily ePRO and exit interview results established that at-home use of advanced treatment technology is feasible in a population group challenged with recovering from OUD. Even more so, numerous participants noted strong willingness to participate in future LIFU-enabled intervention studies to address their persistent sleep issues during recovery.
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Affiliation(s)
| | | | - Dexter Amata
- Attune Neurosciences, Bel Air, MD, United States
| | - Hailey Johnson
- Attune Neurosciences, Bel Air, MD, United States
- Stevenson University, Owings Mills, MD, United States
| | - Jaime K. Devine
- Institutes for Behavior Resources, Baltimore, MD, United States
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17
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Lee JJ, Jang BJ, Kwon D, Kim H. Affecting factors and seasonal effects on the continuous positive airway pressure adherence of patients with obstructive sleep apnea. Heliyon 2024; 10:e39840. [PMID: 39524723 PMCID: PMC11550607 DOI: 10.1016/j.heliyon.2024.e39840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 09/30/2024] [Accepted: 10/24/2024] [Indexed: 11/16/2024] Open
Abstract
Continuous positive airway pressure (CPAP) is the preferred treatment for obstructive sleep apnea (OSA), but adherence remains challenging. This study identifies factors influencing CPAP adherence, including the impact of Korea's four distinct seasons. A retrospective study of 650 patients with OSA and prescribed with CPAP was conducted at a single institution from January 2018 to December 2020, and the patients' answers on various sleep questionnaires, demographic and polysomnographic data, and when and whether they returned the CPAP devices were collected and analyzed. The sample population was divided into when and whether the CPAP device was returned to the institution and the average daily use of the CPAP device. Results show that treatment failure is high in the first 12 weeks. Moreover, patients with more severe sleep apnea tended to have severe OSA-related clinical symptoms and are more likely to adhere to the treatment. In this study show that the seasons did not affect CPAP adherence because of indoor environmental factors. However, results show that other patient factors, such as BMI, AHI, RDI, daytime drowsiness, mood changes, and other OSA-related symptoms, have greater effects on CPAP adherence than seasonal change. Initial positive experience is important to adapt to the CPAP, and for this reason, more active intervention by sleep physicians during the initial CPAP adaptation is necessary.
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Affiliation(s)
- Jung Ju Lee
- Sleep Medicine Research Center, Department of Neurology, College of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon 22711, Republic of Korea
| | - Bong Jin Jang
- Department of Medical Business Administration, Daegu Haany University, 201, Daegudae-ro, Gyeongsan-si 38610, Republic of Korea
| | - Daeho Kwon
- Department of Microbiology, College of Medicine, Catholic Kwandong University, Gangneung 25601, Republic of Korea
| | - Hyeyun Kim
- Sleep Medicine Research Center, Department of Neurology, College of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon 22711, Republic of Korea
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18
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Tsalatsanis A, Dismuke-Greer C, Kumar A, Hoffman J, Monden KR, Magalang U, Schwartz D, Martin AM, Nakase-Richardson R. Cost-Effectiveness of Sleep Apnea Diagnosis and Treatment in Hospitalized Persons With Moderate to Severe Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:E498-E506. [PMID: 38652666 PMCID: PMC11486834 DOI: 10.1097/htr.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To assess the cost-effectiveness of alternative approaches to diagnose and treat obstructive sleep apnea (OSA) in patients with traumatic brain injury (TBI) during inpatient rehabilitation. SETTING Data collected during the Comparison of Sleep Apnea Assessment Strategies to Maximize TBI Rehabilitation Participation and Outcome (C-SAS) clinical trial (NCT03033901) on an inpatient rehabilitation TBI cohort were used in this study. STUDY DESIGN Decision tree analysis was used to determine the cost-effectiveness of approaches to diagnosing and treating sleep apnea. Costs were determined using 2021 Centers for Medicare and Medicaid Services reimbursement codes. Effectiveness was defined in terms of the appropriateness of treatment. Costs averted were extracted from the literature. A sensitivity analysis was performed to account for uncertainty. Analyses were performed for all severity levels of OSA and a subgroup of those with moderate to severe OSA. Six inpatient approaches using various phases of screening, testing, and treatment that conform to usual care or guideline-endorsed interventions were evaluated: (1) usual care; (2) portable diagnostic testing followed by laboratory-quality testing; (3) screening with the snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-Bang) questionnaire; (4) Multivariable Apnea Prediction Index (MAPI) followed by portable diagnostic testing and laboratory-quality testing; (5) laboratory-quality testing for all; and (6) treatment for all patients. MAIN MEASURES Cost, Effectiveness, and Incremental Cost-Effectiveness Ratio (ICER). RESULTS Phased approaches utilizing screening and diagnostic tools were more effective in diagnosing and allocating treatment for OSA than all alternatives in patients with mild to severe and moderate to severe OSA. Usual care was more costly and less effective than all other approaches for mild to severe and moderate to severe OSA. CONCLUSIONS Diagnosing and treating OSA in patients with TBI is a cost-effective strategy when compared with usual care.
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Affiliation(s)
- Athanasios Tsalatsanis
- Author Affiliations: Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida (Dr Tsalatsanis and Dr Kumar); Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California (Dr Dismuke-Greer); Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington (Dr Hoffman); Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota (Dr Monden); The Ohio State University Wexner Medical Center, Columbus, Ohio (Dr Magalang); and Medicine Service (Dr Schwartz) Mental Health and Behavioral Science Service (Dr Martin), and Polytrauma TBI Rehabilitation (Dr Nakase-Richardson), James A. Haley Veterans' Hospital, Tampa, Florida
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Hu X, You Y, Wang H, Zheng Y, Wang Y. Development and Validation of a Nomogram for Predicting Non-Adherence to Continuous Positive Airway Pressure Therapy in Patients with Obstructive Sleep Apnea. Nat Sci Sleep 2024; 16:1737-1747. [PMID: 39493808 PMCID: PMC11529282 DOI: 10.2147/nss.s488208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 10/19/2024] [Indexed: 11/05/2024] Open
Abstract
Background Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA), but its long-term efficacy is limited by poor patient adherence. This study aimed to develop and validate a predictive nomogram for CPAP non-adherence in patients with OSA. Methods This is a secondary analysis of a retrospective study. A cohort of 695 Danish patients with OSA were followed for 3 years after initiating CPAP therapy. Independently associated factors were evaluated using multivariate Cox regression, and then nomogram predicting adherence to CPAP use were constructed. The discrimination of the nomogram was assessed using receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). Results Pulmonary disease, oxygen desaturation index (ODI), Epworth Sleepiness Score (ESS) and severity of OSA were identified as predictors and incorporated into the nomogram. The nomogram demonstrated good discrimination with concordance index in training dataset (0.73, 95% CI: 0.69-0.78) and validation dataset (0.72, 95% CI: 0.66-0.79). ROC curve, calibration curve, and DCA indicated the nomogram had good clinical utility. Conclusion This study provided an effective nomogram for predicting CPAP non-adherence in OSA patients.
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Affiliation(s)
- Xingjia Hu
- The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
- Department of Otolaryngology Head and Neck Surgery, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, People’s Republic of China
| | - Yating You
- Department of Otolaryngology Head and Neck Surgery, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, People’s Republic of China
| | - Hui Wang
- Department of Otolaryngology Head and Neck Surgery, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, People’s Republic of China
| | - Yiqing Zheng
- The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
- Department of Otolaryngology-HNS, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Ying Wang
- Department of Otolaryngology Head and Neck Surgery, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, People’s Republic of China
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20
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Cangur S, Balbay EG, Weaver TE. Factors Affecting Daily Functioning in Turkish Patients with Obstructive Sleep Apnea. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1652. [PMID: 39459439 PMCID: PMC11509515 DOI: 10.3390/medicina60101652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 09/03/2024] [Accepted: 10/08/2024] [Indexed: 10/28/2024]
Abstract
Background and Objectives: This study aims to examine the factors affecting the daily functioning of patients with obstructive sleep apnea (OSA). Materials and Methods: In addition to the polysomnography records of 361 patients, participants completed the Turkish FOSQ-10 (Functional Outcomes of Sleep-10), Medical Outcome Survey Short Form-12, Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). First, the psychometrics properties of the Turkish FOSQ-10 were evaluated. Then, factors affecting daily functioning were examined through univariate and multivariate analyses. Results: Of all participants, 68.7% (n = 248) were male, and the average age was 47.94 ± 11.08. According to the OSA category, 23% (n = 83) were mild, 22.7% (n = 82) were moderate, 45.2% (n = 163) were severe, and 9.1% (n = 33) were OSA negative. The Turkish FOSQ-10 was found to be a valid and reliable scale through validity and reliability analyses. The moderate and severe OSA patients had different FOSQ-10 Total scores compared to the negative OSA group. Daily functioning was positively associated with overall quality of life while inversely associated with depression, being anxious, and daytime sleepiness in OSA patients. In a multiple regression model, BDI, mental component summary-12, physical component summary-12, and ESS scores were significantly related to the FOSQ-10 Total score in OSA patients (p < 0.05). Conclusions: The daily functioning of moderate and severe OSA patients was worse than that of the negative OSA group. Depression, quality of life, and daytime sleepiness were simultaneously important variables associated with daily functioning in OSA patients.
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Affiliation(s)
- Sengul Cangur
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Duzce University, 81620 Duzce, Turkey
| | - Ege Gulec Balbay
- Department of Chest Diseases, Faculty of Medicine, Duzce University, 81620 Duzce, Turkey;
| | - Terri E. Weaver
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL 60612, USA;
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
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21
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Jiang Y, Samah NA, Zhou H. Assessing the Knowledge and Awareness of Obstructive Sleep Apnea among Patient Families in Saudi Arabia: A Qualitative Study [Letter]. Int J Gen Med 2024; 17:4537-4538. [PMID: 39398486 PMCID: PMC11471061 DOI: 10.2147/ijgm.s498630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Accepted: 10/08/2024] [Indexed: 10/15/2024] Open
Affiliation(s)
- Yilin Jiang
- School of Education, Universiti Teknologi Malaysia, Skudai, Johor, 81310, Malaysia
| | - Narina A Samah
- School of Education, Universiti Teknologi Malaysia, Skudai, Johor, 81310, Malaysia
| | - Heng Zhou
- Department of student Affairs, Chongqing Medical University, Chongqing, Yuzhong, 400016, People’s Republic of China
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22
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Patel SR, Sawyer AM, Gottlieb DJ. Con: can comparing adherent to non-adherent patients provide useful estimates of the effect of continuous positive airway pressure? Sleep 2024; 47:zsae063. [PMID: 38451903 DOI: 10.1093/sleep/zsae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/26/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Sanjay R Patel
- Division of Pulmonary Allergy, Critical Care and Sleep Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amy M Sawyer
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Daniel J Gottlieb
- Medical Service, VA Boston Healthcare System, and Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, MA, USA
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23
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Guichaoua C, Dugast S, Derrien A, Boudaud P, Chaux AG, Bertin H, Corre P. Evaluation of the efficacy of a custom-made monoblock mandibular advancement device in treatment of obstructive sleep apnea hypopnea syndrome. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101743. [PMID: 38128880 DOI: 10.1016/j.jormas.2023.101743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Mandibular advancement devices (MAD) are an alternative to continuous positive airway pressure for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). We aimed to evaluate the efficiency of a custom-made monoblock MAD for the treatment of OSAHS. MATERIALS AND METHODS We carried out a monocentric retrospective observational study including patients with OSAHS (mild, moderate or severe) or isolated ronchopathy from January 2005 to March 2023. The primary objective was to evaluate the overall efficiency of the MAD assessed by the percentage of patients successfully treated. The secondary objectives included the global efficiency of the device in the treatment of snoring, the report of side effects, and the identification of predictive factors for efficacy or failure. RESULTS The medical records of 586 patients were collected, and 293 patients (229 OSAHS and 64 isolated ronchopathy) were included in the analysis. After a mean 2.9 years follow-up, 72.5 % of patients were successfully treated by MAD. We observed a significant improvement in ronchopathy, both in terms of intensity and percentage of time per night. Regarding patients with isolated ronchopathy, 87.5 % reported an improvement in their symptoms and satisfaction with their treatment. Finally, 14.0 % of the patients declared side-effects, the dentoskeletal modifications being the most frequent (6.1 % of the patients). CONCLUSION This study confirmed the long-term efficacy and good tolerance of a custom-made monoblock orthosis in OSAHS.
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Affiliation(s)
- Camille Guichaoua
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, 1, place Alexis Ricordeau, F-44000, Nantes, France; Nantes Université, CHU Nantes, Service de chirurgie orale, 1, place Alexis Ricordeau, F-44000, Nantes, France.
| | - Sophie Dugast
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, 1, place Alexis Ricordeau, F-44000, Nantes, France
| | - Anthony Derrien
- Cabinet libéral PISB, 6, rue de Gouédic, F-22000, Saint-Brieuc, France
| | - Pascale Boudaud
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, 1, place Alexis Ricordeau, F-44000, Nantes, France
| | - Anne Gaelle Chaux
- Nantes Université, CHU Nantes, Service de chirurgie orale, 1, place Alexis Ricordeau, F-44000, Nantes, France
| | - Hélios Bertin
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, 1, place Alexis Ricordeau, F-44000, Nantes, France; Nantes Université, UnivAngers, CHU Nantes, INSERM, CNRS, CRCI2NA, 8, quai Moncousu, F-44000, Nantes, France
| | - Pierre Corre
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, 1, place Alexis Ricordeau, F-44000, Nantes, France; Nantes Université, Oniris, UnivAngers, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 1, place Alexis Ricordeau, F-44000, Nantes, France
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24
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Correa EJ, Conti DM, Moreno-Luna R, Sánchez-Gómez S, O'Connor Reina C. Role of Nasal Surgery in Adult Obstructive Sleep Apnea: A Systematic Review. Sleep Sci 2024; 17:e310-e321. [PMID: 39268344 PMCID: PMC11390176 DOI: 10.1055/s-0044-1782527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/27/2023] [Indexed: 09/15/2024] Open
Abstract
Objective To perform a systematic review to determine if isolated nasal surgery has any impact on subjective or objective parameters in adult obstructive sleep apnea (OSA) patients. Materials and Methods From December 2022 to March 2023, we conducted a search on the PubMed, Cochrane, Scopus, and Web of Science databases. Two independent investigators performed a study selection according to the established criteria, as well as data collection, including the study design, the subjective and objective parameters addressed, the type of intervention, and the outcomes, considering the methodological quality and risk of bias. Results In total, 25 studies met the selection criteria, and they showed that there is a significant improvement in sleep quality, sleepiness, nasal resistance, and snoring after isolated nasal surgery. Still, there is no relevant modification of other polysomnographic parameters. It also reduces the required titration pressures of continuous positive airway pressure (CPAP) and increases the duration of its use. Conclusion Isolated nasal surgery is not a primary treatment for OSA. Still, it improves the subjective parameters and can lead to CPAP therapy success by enhancing its effectiveness and long-term compliance.
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Affiliation(s)
- Eduardo J Correa
- Continuing Education Master's Program in Advanced Rhinology and Anterior Skull Base, Universidad Internacional de Andalucía, Sevilla, Spain
| | - Diego M Conti
- Scientific Expert Team, European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - Ramón Moreno-Luna
- Rhinology and Anterior Skull Base Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Serafín Sánchez-Gómez
- Rhinology and Anterior Skull Base Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Carlos O'Connor Reina
- Department of Otorhinolaryngology, Hospital Quirónsalud Marbella, Marbella, Málaga, Spain
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Laharnar N, Bailly S, Basoglu OK, Buskova J, Drummond M, Fanfulla F, Mihaicuta S, Pataka A, Riha RL, Bouloukaki I, Testelmans D, Trakada G, Verbraecken J, Zimmermann S, Penzel T, Fietze I. Bed partner perception of CPAP therapy on relationship satisfaction and intimacy-A European perspective from the ESADA network. J Sleep Res 2024; 33:e14125. [PMID: 38084019 DOI: 10.1111/jsr.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 07/17/2024]
Abstract
Obstructive sleep apnea increases morbidity and mortality risks. The most common treatment is continuous positive airway pressure, with nasal mask usage being important, but not always optimal. While most research on treatment adherence focuses on the patient, the bed partner's involvement may be detrimental. Our study aim is to obtain a European-wide picture of the bed partner's attitude and support towards continuous positive airway pressure therapy, including effects on relationship satisfaction and intimacy. The English translation of a German bed partner questionnaire, assessing relationship satisfaction and three major components (general attitude, perceived mask looks, intimacy effects) was distributed within the European Sleep Apnea Database Network and translated in participating countries' local language. Data were collected for 2 years. In total, 10 European countries (13 sleep centres) participated with 1546 questionnaires. Overall, 91% of bed partners had a positive attitude towards continuous positive airway pressure therapy, 86% perceived mask looks not negative, 64% stated no negative intimacy effects. More specifically, 71% mentioned improved sleep quality, 68% supported nightly device usage. For 41% of bed partners, relationship satisfaction increased (no change for 47%). These results were significantly more pronounced in Eastern/Southern Europe compared with Middle Europe, especially regarding intimacy effects. However, increased continuous positive airway pressure therapy length affected attitude negatively. These results provide necessary information to improve treatment strategies by including educational couple-focused approaches. Among others, we revealed that negative intimacy effects are not considered a barrier to continuous positive airway pressure adherence. These results may inspire more research identifying regional gaps with need for treatment adjustments.
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Affiliation(s)
- Naima Laharnar
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastien Bailly
- Grenoble Alpes University, Inserm, U1300, CHU Grenoble Alpes, Grenoble, France
| | - Ozen K Basoglu
- Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Jitka Buskova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Marta Drummond
- Sleep and Non-Invasive Ventilation Unit, Hospital São João, Porto Faculty of Medicine, Porto University, Porto, Portugal
| | - Francesco Fanfulla
- Respiratory Function and Sleep Unit, Clinical Scientific Institutes Maugeri IRCCS, Pavia, Italy
| | - Stefan Mihaicuta
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timișoara, Romania
| | - Athanasia Pataka
- Respiratory Failure Unit, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Renata L Riha
- Department of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Izolde Bouloukaki
- Sleep Disorders Unit, Department of Respiratory Medicine, School of Medicine, University of Crete, Rethymno, Greece
| | - Dries Testelmans
- Sleep Disorders Centre, University Hospital Gasthuisberg, Leuven, Belgium
| | - Georgia Trakada
- Department of Clinical Therapeutics, Division of Pulmonary Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Sandra Zimmermann
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Medicine, Southwest Medical University Affiliated Zigong Hospital, Zigong, China
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26
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Moura SP, McLaughlin MT, Gowda M, Shaffrey EC, Edalatpour A, Chu DY, Michelotti BF. The Impact of Neighborhood and Socioeconomic Disparities on Distal Radius Fracture Follow-Up Adherence. Plast Reconstr Surg 2024; 154:306e-316e. [PMID: 37566490 PMCID: PMC11584260 DOI: 10.1097/prs.0000000000010984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
BACKGROUND The aims of this retrospective cohort study were (1) to assess whether the Area Deprivation Index (ADI), a novel neighborhood-level socioeconomic disparities metric, is associated with follow-up nonadherence, and (2) to determine the individual-level socioeconomic factors associated with follow-up nonadherence after treatment of distal radius fractures (DRFs). METHODS The authors included all patients who underwent nonoperative or operative management of DRFs at an academic level I trauma center between 2019 and 2021. A manual chart review was performed to collect data on ADI, sociodemographic factors, injury characteristics, conservative and surgical interventions, and health care utilization. RESULTS There was a significant weak negative Spearman-ranked correlation between ADI state deciles and clinic attendance rates ( rs [220] = -0.144 [95% CI, -0.274 to -0.009]; P = 0.032). Socioeconomic factors associated with significant differences in clinic attendance rates were having a spouse or partner (protective) ( P = 0.007), Medicaid insurance ( P = 0.013), male sex ( P = 0.023), and current smoking ( P = 0.026). Factors associated with differences in no-show rates were having a spouse or partner (odds ratio [OR], 0.326 [95% CI, 0.123 to 0.867]; P = 0.025), Medicaid insurance (OR, 7.78 [95% CI, 2.15 to 28.2]; P = 0.002), male sex (OR, 4.09 [95% CI, 1.72 to 9.74]; P = 0.001), and cigarette use (OR, 5.07 [95% CI, 1.65 to 15.6]; P = 0.005). CONCLUSIONS ADI has a weak, negative correlation with clinic attendance rates after DRF treatment. Significant disparities in clinic follow-up adherence exist between patients on the basis of marital status, insurance, sex, and cigarette use. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Steven P. Moura
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
- Boston University School of Medicine
| | - Matthew T. McLaughlin
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
| | - Madhu Gowda
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
| | - Ellen C. Shaffrey
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
| | - Armin Edalatpour
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
| | - Daniel Y. Chu
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
| | - Brett F. Michelotti
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
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Chen Z, Shang Y, Ou Y, Shen C, Cao Y, Hu H, Yang R, Liu T, Liu Q, Song M, Zong D, Xiang X, Peng Y, Ouyang R. Obstructive Sleep Apnea Plasma-Derived Exosomes Mediate Cognitive Impairment Through Hippocampal Neuronal Cell Pyroptosis. Am J Geriatr Psychiatry 2024; 32:922-939. [PMID: 38290937 DOI: 10.1016/j.jagp.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/25/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is associated with impaired cognitive function. Exosomes are secreted by most cells and play a role in OSA-associated cognitive impairment (CI). The aim of this study was to investigate whether OSA plasma-derived exosomes cause CI through hippocampal neuronal cell pyroptosis, and to identify exosomal miRNAs in OSA plasma-derived. MATERIALS AND METHODS Plasma-derived exosomes were isolated from patients with severe OSA and healthy comparisons. Daytime sleepiness and cognitive function were assessed using the Epworth Sleepiness Scale (ESS) and the Beijing version of the Montreal Cognitive Assessment Scale (MoCA). Exosomes were coincubated with mouse hippocampal neurons (HT22) cells to evaluate the effect of exosomes on pyroptosis and inflammation of HT22 cells. Meanwhile, exosomes were injected into C57BL/6 male mice via caudal vein, and then morris water maze was used to evaluate the spatial learning and memory ability of the mice, so as to observe the effects of exosomes on the cognitive function of the mice. Western blot and qRT-PCR were used to detect the expressions of Gasdermin D (GSDMD) and Caspase-1 to evaluate the pyroptosis level. The expression of IL-1β, IL-6, IL-18 and TNF-α was detected by qRT-PCR to assess the level of inflammation. Correlations of GSDMD and Caspase-1 expression with clinical parameters were evaluated using Spearman's rank correlation analysis. In addition, plasma exosome miRNAs profile was identified, followed by Gene Ontology (GO) term and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. RESULTS Compared to healthy comparisons, body mass index (BMI), apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and ESS scores were increased in patients with severe OSA, while lowest oxygen saturation during sleep (LSaO2), mean oxygen saturation during sleep (MSaO2) and MoCA scores were decreased. Compared to the PBS group (NC) and the healthy comparison plasma-derived exosomes (NC-EXOS), the levels of GSDMD and Caspase-1 and IL-1β, IL-6, IL-18 and TNF-α were increased significantly in the severe OSA plasma-derived exosomes (OSA-EXOS) coincubated with HT22 cells. Compared to the NC and NC-EXOS groups, the learning and memory ability of mice injected with OSA-EXOS was decreased, and the expression of GSDMD and Caspase-1 in hippocampus were significantly increased, along with the levels of IL-1β, IL-6, IL-18 and TNF-α. Spearman correlation analysis found that clinical AHI in HCs and severe OSA patients was positively correlated with GSDMD and Caspase-1 in HT22 cells from NC-EXOS and OSA-EXOS groups, while negatively correlated with clinical MoCA. At the same time, clinical MoCA in HCs and severe OSA patients was negatively correlated with GSDMD and Caspase-1 in HT22 cells from NC-EXOS and OSA-EXOS groups. A unique exosomal miRNAs profile was identified in OSA-EXOS group compared to the NC-EXOS group, in which 28 miRNAs were regulated and several KEGG and GO pathways were identified. CONCLUSIONS The results of this study show a hypothesis that plasma-derived exosomes from severe OSA patients promote pyroptosis and increased expression of inflammatory factors in vivo and in vitro, and lead to impaired cognitive function in mice, suggesting that OSA-EXOS can mediate CI through pyroptosis of hippocampal neurons. In addition, exosome cargo from OSA-EXOS showed a unique miRNAs profile compared to NC-EXOS, suggesting that plasma exosome associated miRNAs may reflect the differential profile of OSA related diseases, such as CI.
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Affiliation(s)
- Zhifeng Chen
- Department of Respiratory Medicine (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China
| | - Yulin Shang
- Ophthalmology and Otorhinolaryngology (YS), Zigui County Traditional Chinese Medicine Hospital, Zigui, China
| | - Yanru Ou
- Department of Respiratory Medicine (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China
| | - Chong Shen
- Department of Respiratory Medicine (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China
| | - Ying Cao
- Department of Respiratory Medicine (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China
| | - Hui Hu
- Department of Respiratory Medicine (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China
| | - Ruibing Yang
- Department of Respiratory Medicine (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China
| | - Ting Liu
- Department of Respiratory Medicine (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China
| | - Qingqing Liu
- Department of Respiratory Medicine (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China
| | - Min Song
- Department of Respiratory Medicine (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China
| | - Dandan Zong
- Department of Respiratory Medicine (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China
| | - Xudong Xiang
- Department of Emergency (XX), The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yating Peng
- Department of Respiratory Medicine (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China.
| | - Ruoyun Ouyang
- Department of Respiratory Medicine (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Research Unit of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China; Clinical Medical Research Center for Pulmonary (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Critical Care Medicine in Hunan Province, Changsha, Hunan, China; Diagnosis and Treatment Center of Respiratory Disease (ZC, YO, CS, YC, HH, RY, TL, QL, MS, DZ, YP, RO), Central South University, Changsha, Hunan, China.
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Fujita Y, Yamauchi M, Muro S. Assessment and management of continuous positive airway pressure therapy in patient with obstructive sleep apnea. Respir Investig 2024; 62:645-650. [PMID: 38759606 DOI: 10.1016/j.resinv.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/18/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
Obstructive sleep apnea (OSA) causes excessive daytime sleepiness, impaired daytime functioning, and an increased risk of cardiovascular diseases. Continuous positive airway pressure (CPAP) is a highly effective therapy for moderate to severe OSA. Although CPAP adherence is commonly assessed using a 4-hthreshold, determining the optimal usage time based on clinical outcomes is crucial. While subjective sleepiness often improves with ≥4 h of CPAP usage, an extended duration (≥6 h) may be necessary to impact objective sleepiness. CPAP demonstrated a modest yet clinically meaningful dose-dependent effect on lowering blood pressure. For patients seeking antihypertensive benefits from CPAP therapy, the goal should extend beyond 4 h of use to maximize the therapeutic impact. Recognizing individual variations in sleep duration and responses to CPAP therapy is essential. The adoption of 'individualized goals for CPAP use,' outlining target times for specific outcomes, should also consider an individual's total sleep duration, including periods without CPAP. The impact of CPAP on clinical outcomes may vary, even with the same duration of CPAP use, depending on the period without CPAP use, particularly during the first or second half of sleep. Patients who remove or initiate CPAP midway or have a low CPAP usage frequency may require different forms of guidance. Tailoring patient education to address CPAP usage patterns may be necessary to enhanced satisfaction, self-efficacy, and adherence to therapy. Management of CPAP treatment should be personalized to meet individual needs and adapted based on specific response patterns for achieving treatment efficacy.
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Affiliation(s)
- Yukio Fujita
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan; Department of Clinical Pathophysiology of Nursing, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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29
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Jiang WJ, Jiang XF, Hu WM, Wang HF. Tao-Hong-Si-Wu-Tang Improves the Depressive-like Behaviors in Mice Experiencing Perimenopausal Depression Through Modulating Activity of the Hypothalamic-Pituitary-Adrenal-Ovary Axis and Activating the BDNF-TrkB-CREB Signaling Pathway. J Med Food 2024; 27:669-680. [PMID: 38682284 DOI: 10.1089/jmf.2023.k.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Tao-Hong-Si-Wu-Tang (THSWT), a traditional Chinese herbal remedy, is commonly utilized for the treatment of female perimenopausal depression through regulating menstruation, but the mechanism remains unknown. In this study, ICR mice were randomly divided into six groups: low, medium, and high dose of THSWT (0.5, 1.5, and 4.5 g/kg), soy isoflavone (250 mg/kg), ovariectomy group, and control group. All mice, except the control group, had ovaries removed and were exposed to hypoxic stimulation for 28 days to establish a perimenopausal depression mice model. The mice, having unrestricted access to food and water, were administered THSWT treatment for a duration of 14 days. The Western blotting and Enzyme linked immunosorbent assay kits were used to determine protein and hormone levels, respectively. Experimental results showed that THSWT reduced the immobility time of mice from 150.8 s to 104.9 s in the tail suspension test, and it decreased the immobility time of mice from 165.7 s to 119.0 s in the forced swimming test, outperforming the results obtained with soy isoflavones. In addition, THSWT upregulated the protein expression of follicle-stimulating hormone receptor and downregulated the protein expression of corticotropin-releasing hormone-receptor 1 in the hippocampus. Compared with the oophorectomized group, treatment with THSWT decreased the levels of corticosterone and adrenocorticotropic hormone in serum by 173.7 and 23.4 ng/mL, respectively. These findings showed that THSWT could stimulate the perimenopausal nerve tissue and regulate the level of serum hormones in mice. THSWT exhibited promising potential as a viable alternative drug for hormone treatment of perimenopause in clinical use.
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Affiliation(s)
- Wen-Jing Jiang
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
| | - Xue-Fan Jiang
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
| | - Wei-Ming Hu
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
| | - Hong-Fa Wang
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, P. R. China
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Shah RR, Mahmoud AF, Dedhia RC, Thaler ER. Characteristic Pressure Waveforms Can Distinguish Airway Collapse Patterns in Sleep Apnea Patients: A Pilot Study. OTO Open 2024; 8:e161. [PMID: 38974173 PMCID: PMC11225081 DOI: 10.1002/oto2.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/06/2024] [Accepted: 06/08/2024] [Indexed: 07/09/2024] Open
Abstract
Objective To use pharyngeal pressure recordings to distinguish different upper airway collapse patterns in obstructive sleep apnea (OSA) patients, and to assess whether these pressure recordings correlate with candidacy assessment for hypoglossal nerve stimulator (HGNS) implantation. Study Design Prospective case series. Setting Single tertiary-quaternary care academic center. Methods Subjects with OSA prospectively underwent simultaneous drug-induced sleep endoscopy (DISE) and transnasal pharyngeal pressure recording with a pressure-transducing catheter. Pressure was recorded in the nasopharynx and oropharynx, and endoscopic collapse patterns were classified based on site, extent, and direction of collapse. Pressure recordings were classified categorically by waveform shape as well as numerically by inspiratory and expiratory amplitudes and slopes. Waveform shape, amplitude, and slope were then compared with the endoscopic findings. Results Twenty-five subjects with OSA were included. Nasopharyngeal waveform shape was associated with the extent of collapse at the level of the palate (P = .001). Oropharyngeal waveform shape was associated with anatomical site of collapse (P < .001) and direction of collapse (P = .019) below the level of the palate. Pressure amplitudes and slopes were also associated with the extent of collapse at various sites. Waveform shape was also associated with favorable collapse pattern on endoscopy for HGNS implantation (P = .043), as well as surgical candidacy for HGNS (P = .004). Conclusion Characteristic pharyngeal pressure waveforms are associated with different airway collapse patterns. Pharyngeal pressure is a promising adjunct to DISE in the sleep surgery candidacy evaluation.
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Affiliation(s)
- Ravi R. Shah
- Department of Otolaryngology–Head and Neck SurgeryHenry Ford Health + Michigan State UniversityDetroitMichiganUSA
| | | | - Raj C. Dedhia
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Erica R. Thaler
- Department of Otorhinolaryngology–Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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31
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Alomri RM, Alghamdi Y. The Prevalence and Predictors of Sleep Disorders and Their Impact on Academic Performance Among Saudi University Students: A Cross-Sectional Study. Cureus 2024; 16:e61334. [PMID: 38947619 PMCID: PMC11213967 DOI: 10.7759/cureus.61334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND University students encounter a variety of sleep problems that have an impact on their health and academic performance. Therefore, the aim of this study was to evaluate the prevalence of sleep disorders and their impact on academic performance among Saudi university students. METHODS This is an online cross-sectional study that involved university students and was conducted between November 2022 and February 2023 in Saudi Arabia. Sleep disorders were examined among undergraduate students through online screening surveys including the Epworth Sleepiness Scale (ESS) to assess excessive daytime sleepiness, the Insomnia Severity Index (ISI) to measure insomnia, and the Berlin questionnaire to examine obstructive sleep apnea (OSA). Restless leg syndrome (RLS) was measured using the RLS rating. SPSS version 29.0 (IBM Corp., Armonk, NY, USA) was used for all statistical analyses. Binary logistic regression analysis was used to identify predictors of having excessive daytime sleepiness, insomnia, sleep-disordered breathing, and RLS. RESULTS The sample included 449 participants. According to the ESS, 56.6% (n=254) of students reported excessive daytime sleepiness. Using the ISI, 78.4% (n=352) of students were found to have insomnia. The Berlin questionnaire indicated that 6.7% (n=30) of students had sleep-disordered breathing. Additionally, 13.6% (n=61) of students reported having RLS. Male students had higher odds of sleep-disordered breathing compared to females (p<0.01), while marital status showed that married students had higher odds of sleep-disordered breathing (p<0.05). Students who reported nighttime sleeping had lower odds of insomnia and restless leg syndrome (p<0.05). Having regular sleeping times was associated with higher odds of insomnia (p<0.05). Napping sometimes was associated with higher odds of excessive daytime sleepiness and sleep-disordered breathing (p<0.05). Students working day and night shifts had higher odds of sleep-disordered breathing (p<0.01). Interestingly, students with comorbidities had lower odds of RLS (p<0.01). CONCLUSION This study established that sleep disturbances among students significantly reduce grade point averages (GPAs), where the most affected were male students and those who were married. The government should implement sleep education programs, provide resources for the management of sleep, encourage consistent sleep schedules, and come up with targeted interventions for at-risk groups. More research is also recommended on effective sleep interventions.
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Affiliation(s)
- Ridwan M Alomri
- Department of Psychology, College of Social Sciences and Media, University of Jeddah, Jeddah, SAU
| | - Yaser Alghamdi
- Department of Educational Psychology, College of Education, Taibah University, Madinah, SAU
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Kasetti P, Husain NF, Skinner TC, Asimakopoulou K, Steier J, Sathyapala SA. Personality traits and pre-treatment beliefs and cognitions predicting patient adherence to continuous positive airway pressure: A systematic review. Sleep Med Rev 2024; 74:101910. [PMID: 38471433 DOI: 10.1016/j.smrv.2024.101910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 01/09/2024] [Accepted: 02/12/2024] [Indexed: 03/14/2024]
Abstract
Adherence to Continuous Positive Airway Pressure (CPAP) for obstructive sleep apnoea (OSA) can be improved by behavioural interventions which modify patients' beliefs and cognitions about OSA, CPAP, and themselves. We have conducted the first systematic review of the literature on beliefs and cognitions held before starting treatment, and personality (which influences the former) that predict the decision to purchase or start CPAP, or CPAP adherence one month or more after CPAP initiation. A systematic search and screen of articles identified 21 eligible publications from an initial 1317. Quality assessment performed using an adapted Newcastle-Ottawa Scale demonstrated that 13 (62%) studies were poor quality and only seven (33%) were high quality. Eighteen factors, such as self-efficacy (confidence) in using CPAP and value placed on health predicted CPAP adherence; however, for only six (33%), utility as an intervention target is known, from calculation of individual predictive power. Studies did not use new behavioural frameworks effective at explaining adherence behaviours, nor did they interview patients to collect in-depth data on barriers and facilitators of CPAP use. Future studies cannot have these limitations if high quality evidence is to be generated for intervention development, which is currently sparse as highlighted by this review.
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Affiliation(s)
- P Kasetti
- Imperial College London, London, United Kingdom
| | - N F Husain
- Thames Valley Deanery, Oxford, United Kingdom
| | - T C Skinner
- La Trobe University, Melbourne, Australia; Copenhagen University, Denmark
| | | | - J Steier
- King's College London, London, United Kingdom; Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - S A Sathyapala
- Imperial College London, London, United Kingdom; Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom.
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33
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Gabada R, Yadav V, Nikhade D. Transformative Physiotherapy Approach in an 80-Year-Old Female: A Case Report of Managing Obstructive Sleep Apnea for Improved Quality of Life. Cureus 2024; 16:e57481. [PMID: 38707025 PMCID: PMC11066711 DOI: 10.7759/cureus.57481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Obstructive sleep apnea (OSA) presents a significant challenge to patients' overall health and well-being, characterized by upper airway collapse during sleep leading to fragmented and non-restorative sleep patterns. This case report describes an 80-year-old female patient presenting with breathlessness, obesity (BMI: 43 kg/m2), sleep disturbances, fatigue, attention deficits, reduced chest compliance, and a history of type 2 diabetes mellitus. Clinical findings revealed ongoing sleep disruptions, worsening breathlessness, progressive weakness, and decreased oxygen saturation levels. The therapeutic intervention involved a comprehensive physiotherapy program targeting respiratory muscle training, lung function improvement, peripheral muscle strengthening, and relaxation exercises. The discussion highlights studies supporting physiotherapeutic interventions such as thoracic extension exercises, neuromuscular stimulation, and oropharyngeal exercises for managing OSA symptoms. Overall, this case underscores the importance of tailored physiotherapy interventions in addressing the multifaceted challenges of OSA, aiming to improve patient outcomes and quality of life.
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Affiliation(s)
- Rishika Gabada
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Vaishnavi Yadav
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Dhanshri Nikhade
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Sforza M, Salibba A, Carollo G, Scarpellino A, Bertone JM, Zucconi M, Casoni F, Castronovo V, Galbiati A, Ferini-Strambi L. Boosting obstructive sleep apnea therapy by non-pharmacological approaches: A network meta-analysis. Sleep Med 2024; 115:235-245. [PMID: 38382310 DOI: 10.1016/j.sleep.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is the most common breathing-related sleep disorder with a considerable economic burden, low diagnosis and treatment rates. Continuous positive airway pressure (CPAP/PAP) is the principal therapy for OSA treatment; nevertheless, effectiveness is often limited by suboptimal adherence. The present network meta-analysis aims to systematically summarize and quantify different interventions' effects on CPAP/PAP adherence (such as mean usage CPAP or PAP in hours per night) in OSA patients, comparing Behavioral, Educational, Supportive and Mixed interventions in Randomized Control Trials (RCT). METHODS We conducted a computer-based search using the electronic databases of Pubmed, Psycinfo, Scopus, Embase, Chinal and Medline until August 2022, selecting 50 RCT. RESULTS By means of a random effect model network meta-analysis, results suggested that the most effective treatment in improving CPAP/PAP adherence was the Supportive approach followed by Behavioral Therapy focused on OSA treatment adherence. CONCLUSION This network meta-analysis might encourage the most experienced clinicians and researchers in the field to collaborate and implement treatments for improving CPAP/PAP treatment adherence. Moreover, these results support the importance of multidisciplinary approaches for OSA treatment, which should be framed within a biopsychological model.
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Affiliation(s)
- Marco Sforza
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.
| | - Andrea Salibba
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Giacomo Carollo
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Alessandro Scarpellino
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - John Matteo Bertone
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Francesca Casoni
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Vincenza Castronovo
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Andrea Galbiati
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Luigi Ferini-Strambi
- Vita-Salute San Raffaele University Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
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35
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Furundarena-Padrones L, Cabriada-Nuño V, Brunsó-Casellas J, Garcia-Fernandez RI, Castro-Quintas S, Santos-Zorrozúa B, González-Zapico G, Calvo-Guirado JL, De-Carlos-Villafranca F. Correlation between polysomnographic parameters and volumetric changes generated by maxillomandibular advancement surgery in patients with obstructive sleep apnea: a fluid dynamics study. J Clin Sleep Med 2024; 20:371-379. [PMID: 37861401 PMCID: PMC11019223 DOI: 10.5664/jcsm.10874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
STUDY OBJECTIVES Maxillomandibular advancement surgery (MMA) is a therapeutic option for obstructive sleep apnea (OSA). The main objective of this study was to determine the impact of MMA on the physical and airflow characteristics of the upper airway based on data obtained by computational fluid dynamics (CFD) and to correlate these data with polysomnography parameters. Other objectives included the identification of presurgical variables that could help avoid surgeries likely to have a low success rate. METHODS This was a retrospective observational study of 18 patients with moderate-severe OSA who underwent MMA. Polysomnography and computed axial tomography imaging were performed before and after the surgery. Three-dimensional models for CFD study were made based on the images obtained. RESULTS MMA achieved an average increase in airway volume of 43.75%, with a mean decrease in the maximum airway velocity of 40.3%. We found significant correlations between improved apnea-hypopnea index values and both the increase in airway volume and decrease in maximum airway speed. Patients with a maximum velocity of less than 7.2 m/s before the intervention had a high rate of surgical failure (43%). CONCLUSIONS MMA generates a significant increase in the volume of the upper airway, which was associated with improved flow conditions in the CFD simulation. These findings also correlated with improved polysomnography parameters. Thus, CFD simulation on three-dimensional anatomical models of patients with OSA could contribute to the better selection of candidates for MMA. CITATION Furundarena-Padrones L, Cabriada-Nuño V, Brunsó-Casellas J, et al. Correlation between polysomnographic parameters and volumetric changes generated by maxillomandibular advancement surgery in patients with obstructive sleep apnea: a fluid dynamics study. J Clin Sleep Med. 2024;20(3):371-379.
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Affiliation(s)
| | - Valentín Cabriada-Nuño
- Pneumology Service, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Medicine Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Bizkaia, Spain
| | - Joan Brunsó-Casellas
- Maxillofacial Surgery Department, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Ruben Israel Garcia-Fernandez
- 3D Printing and Bioprinting Laboratory, Biocruces Bizkaia Health Research Institute, Innovation and Quality Department, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Sonia Castro-Quintas
- Pneumology Service, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain
- Medicine Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Bizkaia, Spain
| | - Borja Santos-Zorrozúa
- Scientific Coordination Unit, Cruces University Hospital, Osakidetza, Barakaldo, Bizkaia, Spain
| | | | | | - Felix De-Carlos-Villafranca
- Surgery and Medical-Surgical Specialties Department, Area of Orthodontics, Faculty of Medicine, University of Oviedo, Oviedo, Spain
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Williams NJ, Grant AB, Butler M, Ebben M, Belisova-Gyure Z, Bubu OM, Jean-Louis G, Wallace DM. The effects of social support and support types on continuous positive airway pressure use after 1month of therapy among adults with obstructive sleep apnea. Sleep Health 2024; 10:69-74. [PMID: 38007302 PMCID: PMC11938104 DOI: 10.1016/j.sleh.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND The relationship between perceived social support and continuous positive airway pressure remains understudied among individuals with obstructive sleep apnea. The aim of this prospective cohort study was to determine if baseline perceived social support and subtypes predict regular continuous positive airway pressure use after 1month of therapy. METHODS Adults with obstructive sleep apnea initiating continuous positive airway pressure therapy were recruited from sleep clinics in New York City. Demographics, medical history, and comorbidities were obtained from patient interview and review of medical records. Objective continuous positive airway pressure adherence data was collected at the first clinical follow-up. RESULTS Seventy-five participants (32% female; non-Hispanic Black 41%; mean age of 56 ± 14years) provided data. In adjusted analyses, poorer levels of overall social support, and subtypes including informational/emotional support, and positive social interactions were associated with lower continuous positive airway pressure use at 1month. Relative to patients reporting higher levels of support, participants endorsing lower levels of overall social support, positive social interaction and emotional/informational support had 1.6 hours (95% CI: 0.5,2.7, hours; p = .007), 1.3 hours (95% CI: 0.2,2.4; p = .026), and 1.2 hours (95% CI: 0.05,2.4; p = .041) lower mean daily continuous positive airway pressure use at 1month, respectively. CONCLUSION Focusing on social support overall and positive social interaction particularly, could be an effective approach to improve continuous positive airway pressure adherence in patients at risk of suboptimal adherence.
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Affiliation(s)
- Natasha J Williams
- NYU Grossman School of Medicine, Institute for Excellence in Health Equity, Department of Population Health, New York, New York, USA.
| | - Andrea Barnes Grant
- VA: Department of Veterans Affairs: New York Harbor HealthCare System, Brooklyn Campus, Brooklyn, New York, USA
| | - Mark Butler
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Matthew Ebben
- Weill Cornell Medicine, Center for Sleep Medicine, New York, New York, USA
| | - Zuzana Belisova-Gyure
- VA: Department of Veterans Affairs: New York Harbor HealthCare System, New York Campus, New York, New York, USA
| | - Omonigho M Bubu
- NYU Grossman School of Medicine, Department of Psychiatry, New York, New York, USA
| | - Girardin Jean-Louis
- NYU Grossman School of Medicine, Department of Psychiatry, New York, New York, USA
| | - Douglas M Wallace
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA; Psychiatry and Behavioral Sciences, Neurology, Psychology and Public Health, University of Miami Miller School of Medicine, Miami, Florida, USA
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Rodriguez Alcala C, Rodriguez Alcala L, Ignacio Garcia JM, Plaza G, Baptista P, Lujan G, Mazzei P, Ibañez-Rodriguez JA, O’Connor-Reina C. Use of Ultrasound to Verify the Impact of Telemedicine Myofunctional Therapy on Sleep Apnea Syndrome: Study Protocol Proposal. Life (Basel) 2024; 14:197. [PMID: 38398705 PMCID: PMC10890081 DOI: 10.3390/life14020197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/03/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
The anatomy of the upper airways influences the risk of obstructive sleep apnea (OSA). The size of soft tissue structures, such as the tongue, soft palate, and lateral walls of the pharynx, contributes to the pathogenesis of OSA. New lines of treatment for sleep apnea, such as myofunctional therapy (MT), aim to strengthen the oropharyngeal musculature to improve the defining parameters of apnea. The present protocol uses ultrasound imaging to measure the size of the lingual musculature non-invasively and cost-effectively and evaluates the changes in its morphology. Eligible patients include those with OSA who have undergone submental cervical ultrasound and drug-induced sleep endoscopy before starting MT with the AirwayGym app. Follow-up evaluations are conducted at 3 months after beginning treatment. Patients diagnosed with OSA via questionnaires and polysomnography or respiratory polygraphy are evaluated anatomically and functionally using the Iowa Oral Performance Instrument, a tongue digital spoon, somnoscopy, and submental cervical ultrasound to assess their responses to the AirwayGym app. The lingual thickness (mm) and volume (cm3) and the distance between both lingual arteries (mm) are measured. The AirwayGym app helps users and therapists monitor the patient performance of MT. Incorporating submental ultrasound can be a useful non-invasive tool to evaluate OSA and MT.
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Affiliation(s)
| | - Laura Rodriguez Alcala
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680 Marbella, Spain; (L.R.A.); (P.M.); (J.A.I.-R.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | | | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28943 Madrid, Spain;
- Otorhinolaryngology Department, Hospital Sanitas la Zarzuela, 28023 Madrid, Spain
| | - Peter Baptista
- Otorhinolaryngology Department, Clínica Universitaria de Navarra, 31008 Pamplona, Spain
| | - Guillermina Lujan
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680 Marbella, Spain; (L.R.A.); (P.M.); (J.A.I.-R.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Paula Mazzei
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680 Marbella, Spain; (L.R.A.); (P.M.); (J.A.I.-R.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Juan Antonio Ibañez-Rodriguez
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680 Marbella, Spain; (L.R.A.); (P.M.); (J.A.I.-R.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Carlos O’Connor-Reina
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680 Marbella, Spain; (L.R.A.); (P.M.); (J.A.I.-R.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
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Miller JN, Kupzyk K, Zheng C, Wichman C, Schutte-Rodin S, Gehrman P, Sawyer A, Berger AM, Balas MC. Nurse practitioner-led, virtually delivered, motivational enhancement and device support intervention to improve CPAP adherence: A feasibility randomized control trial. Heart Lung 2024; 63:119-127. [PMID: 37879189 DOI: 10.1016/j.hrtlng.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Evidence indicates continuous positive airway pressure (CPAP) therapy improves several important patient-centered outcomes. However, adherence to this safe and effective intervention remains poor. OBJECTIVES Assess nine feasibility outcomes of a nurse practitioner-led, virtually delivered motivational enhancement and device support (MENDS) intervention to improve CPAP adherence in adults with Obstructive Sleep Apnea (OSA). Secondary aims compared the changes in CPAP adherence to patient-reported outcomes, patient activation, and perceived self-efficacy. METHODS This two-group feasibility randomized controlled trial included 29 patients newly diagnosed with OSA and prescribed CPAP therapy. The study was conducted from July 2020 through December 2021 at a midwestern sleep/pulmonary clinic. Participants were randomized to the MENDS intervention group (n=14) (30-45 minute interactive tele-discussions on weeks 2, 4, 6, and 8) or to the usual care (n=15) group. Feasibility, patient-reported outcomes, and behavioral constructs were measured at baseline and 12 weeks. CPAP adherence was measured weekly. RESULTS Feasibility of the MENDS sessions was demonstrated (56 sessions offered, 52 completed remotely without technical difficulties) with minimal participant attrition and no missing CPAP data. Generalized linear mixed models showed no statistically significant time-by-group interactions on adherence or patient-reported outcomes. Higher adherence and lower CPAP apnea-hypopnea index (AHI) scores were associated with declines in pre- to post-changes in fatigue and sleep disturbance. Lower CPAP AHI scores were associated with pre- to post-decreases in PROMIS Anxiety scores (r=.532, p=.005). CONCLUSION The virtual MENDS intervention was feasible. Higher CPAP adherence and lower AHI levels led to positive improvements in fatigue, sleep disturbance, and anxiety.
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Affiliation(s)
- Jennifer N Miller
- The University of Nebraska Medical Center College of Nursing, 4111 Dewey Ave, Omaha, NE 68198; Nebraska Pulmonary Specialties, LLC, 1500 S. 48(th) St. #800, Lincoln, NE 68506.
| | - Kevin Kupzyk
- The University of Nebraska Medical Center College of Nursing, 4111 Dewey Ave, Omaha, NE 68198
| | - Cheng Zheng
- The University of Nebraska Medical Center College of Public Health, 40th and Dewey Ave, Omaha, NE 68198
| | - Chris Wichman
- The University of Nebraska Medical Center College of Public Health, 40th and Dewey Ave, Omaha, NE 68198
| | - Sharon Schutte-Rodin
- Perelman School of Medicine at The University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104
| | - Philip Gehrman
- Perelman School of Medicine at The University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104
| | - Amy Sawyer
- Perelman School of Medicine at The University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104; The University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA 19104
| | - Ann M Berger
- The University of Nebraska Medical Center College of Nursing, 4111 Dewey Ave, Omaha, NE 68198
| | - Michele C Balas
- The University of Nebraska Medical Center College of Nursing, 4111 Dewey Ave, Omaha, NE 68198
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Rubanenko AO, Dyachkov VA, Miroshnichenko AI. [Factors affecting adherence to CPAP therapy in patients with obstructive sleep apnea syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:58-65. [PMID: 38934667 DOI: 10.17116/jnevro202412405258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Analysis of factors affecting adherence to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA). MATERIAL AND METHODS The literature search was carried out using the databases PubMED, Google Scholar, E-library, Cyberleninka for the period 2013-2023 and included reviews and original articles. RESULTS The main groups of factors affecting adherence to CPAP therapy in patients with OSA have been established. These include sociodemographic and socioeconomic factors, the severity of OSA and the severity of clinical symptoms, and psychosocial factors. Strategies that can improve adherence were identified (educational technologies for patients, telemedicine technologies, behavioral therapy, modern technical interventions). CONCLUSION Factors that improve adherence to CPAP therapy are high levels of education and income, more severe OSA forms accompanied by daytime sleepiness, support from the patient's spouse and social support. Factors such as low levels of education and income, smoking, symptoms of depression and hypochondria, as well as side-effects worsen adherence to CPAP therapy, including refusal to continue treatment. It should be noted that all the identified factors are very closely associated with each other, so it is necessary to evaluate them comprehensively in each patient with OSA.
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Affiliation(s)
- A O Rubanenko
- Samara State Medical University of the Ministry of Healthcare of the Russia, Samara, Russia
| | - V A Dyachkov
- Samara State Medical University of the Ministry of Healthcare of the Russia, Samara, Russia
| | - A I Miroshnichenko
- Samara State Medical University of the Ministry of Healthcare of the Russia, Samara, Russia
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Suzgun MA, Kabeloglu V, Senel GB, Karadeniz D. Smoking Disturbs the Beneficial Effects of Continuous Positive Airway Pressure Therapy on Leptin Level in Obstructive Sleep Apnea. J Obes Metab Syndr 2023; 32:338-345. [PMID: 38156370 PMCID: PMC10786207 DOI: 10.7570/jomes23030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/31/2023] [Accepted: 10/11/2023] [Indexed: 12/30/2023] Open
Abstract
Background This study aimed to determine how smoking alters the effect of positive airway pressure (PAP) therapy on metabolic syndrome in obstructive sleep apnea (OSA). Methods In this clinical trial, morphometric measures, metabolic syndrome parameters, and apnea-hypopnea index (AHI) in OSA patients were recorded and compared between active smokers and non-smokers. The mean change in metabolic syndrome parameters measured before and after 3 months of PAP therapy was determined. The study included 72 males and 43 females. Results Morphometric values and mean AHI did not differ between active smokers and non-smokers. When the percentage of unchanged, increased, or decreased metabolic parameters measured before and after treatment was analyzed, leptin level tended to increase in active smokers with OSA after PAP therapy compared with non-smokers (P=0.034, adjusted for confounders). Conclusion Serum leptin level was stable or decreased in non-smokers, while 40% of active smokers had increased leptin level. Therefore, smoking plays a predisposing role in leptin resistance despite PAP therapy in OSA patients.
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Affiliation(s)
- Merve Aktan Suzgun
- Neurology Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Vasfiye Kabeloglu
- Department of Neurology, Bakirkoy Mazhar Osman Research and Training Hospital, Istanbul, Turkey
| | - Gülcin Benbir Senel
- Neurology Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Derya Karadeniz
- Neurology Department, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Fietze I, Rosenblum L, Ossadnik S, Gogarten JH, Zimmermann S, Penzel T, Laharnar N. Nocturnal positive pressure ventilation improves relationship satisfaction of patients with OSA and their partners. Sleep Med 2023; 111:191-198. [PMID: 37797413 DOI: 10.1016/j.sleep.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/26/2023] [Accepted: 08/26/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Continuous positive airway pressure (CPAP) ventilation is considered the therapeutic standard for obstructed sleep apnea (OSA). Therapy success may also be affected by the patient's bed partner. A questionnaire was developed and tested that measures the attitude of the bed partner towards CPAP therapy and relationship effects. METHODS A new questionnaire to capture bed partners' attitude towards CPAP mask therapy was used with an anonymous sample of 508 bed partners. Possible constructs underlying the attitude of the bed partner towards mask appearance have been investigated by means of a Principal Components Analysis. RESULTS The survey revealed bed partners' positive attitude towards their partner's CPAP therapy (over 90% of bed partners were happy with the therapy, over 75% would recommend the therapy). Importantly, the bed partners' satisfaction with the relationship increased significantly during CPAP therapy (before therapy: 49% were satisfied, after therapy initiation: 70%; p<.001). There was a strong correlation between support for CPAP therapy and improved sleep quality of bed partners (r = 0.352, p>.001). Furthermore, the validation of the questionnaire through principal components analysis revealed three major factors: Attitude (of the bed partner towards CPAP therapy), Looks (of the mask perceived by the bed partner), Intimacy (effect of CPAP therapy on relationship and intimacy). CONCLUSION Both, the OSA patient and the bed partner benefit from CPAP therapy. This is the first bed partner questionnaire - interviewing the bed partner alone and anonymously - that showed that CPAP therapy also positively influences the relationship. We recommend that the bed partner be involved in the CPAP treatment from the start of therapy.
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Affiliation(s)
- Ingo Fietze
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Lisa Rosenblum
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany.
| | - Sarah Ossadnik
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Jacob Henry Gogarten
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Sandra Zimmermann
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Thomas Penzel
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Naima Laharnar
- Department of Internal Medicine and Dermatology, Interdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Germany
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Kuroda T, Ichikawa K, Hinata S, Chiba K, Okabayashi K, Asato Y, Aono H, Marumo K. Educating patients with upper limb dysfunction on self-adjustment of the CPAP/NPPV mask: A case series. Respirol Case Rep 2023; 11:e01232. [PMID: 37840601 PMCID: PMC10568380 DOI: 10.1002/rcr2.1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023] Open
Abstract
We share our experiences of instructing three patients with severe upper limb dysfunction on how to self-adjust CPAP/NPPV masks. In Case 1, we simplified the procedure by suturing a part of the headband as the left forearm was amputated. In Case 2, the patient had congenitally short limbs with short stature; thus, we provided an additional belt to the headband to maintain the headband's configuration while wearing the mask. In Case 3, the patient had left hemiplegia due to stroke and, repetitive coaching was conducted during the recovery phase rehabilitation program. Difficulties with self-adjusting NPPV/CPAP masks can occur whenever there is limited hand mobility above the head, including upper limb dysfunction. Simplifying procedures and providing sufficient time for instruction could help achieve independence. There have been no previous reports describing similar training details. We believe that sharing this knowledge will be helpful to both patients and healthcare professionals.
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Affiliation(s)
- Tomoko Kuroda
- Nursing DepartmentTokyo Metropolitan Police HospitalTokyoJapan
| | | | - Satoshi Hinata
- Respirology Division, Department of Internal MedicineTokyo Metropolitan Police HospitalTokyoJapan
| | - Kaoru Chiba
- Respirology Division, Department of Internal MedicineTokyo Metropolitan Police HospitalTokyoJapan
| | - Ken Okabayashi
- Respirology Division, Department of Internal MedicineTokyo Metropolitan Police HospitalTokyoJapan
| | - Yuko Asato
- Respirology Division, Department of Internal MedicineTokyo Metropolitan Police HospitalTokyoJapan
| | - Hiromi Aono
- Respirology Division, Department of Internal MedicineTokyo Metropolitan Police HospitalTokyoJapan
| | - Kazuyoshi Marumo
- Respirology Division, Department of Internal MedicineTokyo Metropolitan Police HospitalTokyoJapan
- Hoken Kaikan ClinicTokyo Health Service AssociationTokyoJapan
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Wu CS, Chen DHK, Ko YC, Bai CH, Chen PY, Liu WT, Lin YC. The firstly visited department affects the acceptance of CPAP in patients with obstructive sleep apnea: a cohort study. J Otolaryngol Head Neck Surg 2023; 52:71. [PMID: 37898803 PMCID: PMC10613393 DOI: 10.1186/s40463-023-00676-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 10/18/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) therapy is the first-line treatment for obstructive sleep apnea (OSA). However, the low acceptance rate of CPAP remains a challenging clinical issue. This study aimed to determine the factors that influence the acceptance rate of CPAP. METHODS This retrospective cohort study was conducted at the sleep center of Shuang-Ho Hospital. Initially, 1186 OSA patients who received CPAP therapy between December 2013 and December 2017 were selected, and finally, 1016 patients were analyzed. All patients with OSA received CPAP therapy for at least 1 week, and their acceptance to treatment was subsequently recorded. Outcome measures included patients' demographic and clinical characteristics (sex, age, BMI, comorbidities, history of smoking, and the medical specialist who prescribed CPAP treatment), polysomnography (PSG) results, and OSA surgical records. RESULTS Patients with a lower CPAP acceptance rate were referred from otolaryngologists (acceptance rate of otolaryngology vs. others: 49.6% vs. 56.6%, p = .015), in addition to having a lower apnea-hypopnea index (AHI) (acceptance vs. non-acceptance: 55.83 vs. 40.79, p = .003), rapid eye movement AHI (REM-AHI) (acceptance vs. non-acceptance: 51.21 vs. 44.92, p = .014), and arousal index (acceptance vs. non-acceptance: 36.80 vs. 28.75, p = .011). The multiple logistic regression model showed that patients referred from otolaryngology had a lower CPAP acceptance rate (odds ratio 0.707, p = .0216) even after adjusting for age, sex, BMI, AHI, REM-AHI, arousal index, comorbidities, and smoking status. CONCLUSIONS Before their initial consultation, patients may already have their preferred treatment of choice, which is strongly linked to the type of medical specialists they visit, and consequently, affects their rate of acceptance to CPAP therapy. Therefore, physicians should provide personalized care to patients by exploring and abiding by their preferred treatment choices.
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Affiliation(s)
- Chung-Sheng Wu
- Department of Primary Care Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - David Hsin-Kuang Chen
- Department of Medical Education, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yuan-Chun Ko
- Department of Primary Care Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Po-Yueh Chen
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Otolaryngology, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Te Liu
- Sleep Center, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yi-Chih Lin
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Sleep Center, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Department of Otolaryngology, Shuang-Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan.
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Sánchez-de-la-Torre M, Gracia-Lavedan E, Benitez ID, Sánchez-de-la-Torre A, Moncusí-Moix A, Torres G, Loffler K, Woodman R, Adams R, Labarca G, Dreyse J, Eulenburg C, Thunström E, Glantz H, Peker Y, Anderson C, McEvoy D, Barbé F. Adherence to CPAP Treatment and the Risk of Recurrent Cardiovascular Events: A Meta-Analysis. JAMA 2023; 330:1255-1265. [PMID: 37787793 PMCID: PMC10548300 DOI: 10.1001/jama.2023.17465] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/20/2023] [Indexed: 10/04/2023]
Abstract
Importance The effect of continuous positive airway pressure (CPAP) on secondary cardiovascular disease prevention is highly debated. Objective To assess the effect of CPAP treatment for obstructive sleep apnea (OSA) on the risk of adverse cardiovascular events in randomized clinical trials. Data Sources PubMed (MEDLINE), EMBASE, Current Controlled Trials: metaRegister of Controlled Trials, ISRCTN Registry, European Union clinical trials database, CENTRAL (Cochrane Central Register of Controlled Trials), and ClinicalTrials.gov databases were systematically searched through June 22, 2023. Study Selection For qualitative and individual participant data (IPD) meta-analysis, randomized clinical trials addressing the therapeutic effect of CPAP on cardiovascular outcomes and mortality in adults with cardiovascular disease and OSA were included. Data Extraction and Synthesis Two reviewers independently screened records, evaluated potentially eligible primary studies in full text, extracted data, and cross-checked errors. IPD were requested from authors of the selected studies (SAVE [NCT00738179], ISAACC [NCT01335087], and RICCADSA [NCT00519597]). Main Outcomes and Measures One-stage and 2-stage IPD meta-analyses were completed to estimate the effect of CPAP treatment on risk of recurrent major adverse cardiac and cerebrovascular events (MACCEs) using mixed-effect Cox regression models. Additionally, an on-treatment analysis with marginal structural Cox models using inverse probability of treatment weighting was fitted to assess the effect of good adherence to CPAP (≥4 hours per day). Results A total of 4186 individual participants were evaluated (82.1% men; mean [SD] body mass index, 28.9 [4.5]; mean [SD] age, 61.2 [8.7] years; mean [SD] apnea-hypopnea index, 31.2 [17] events per hour; 71% with hypertension; 50.1% receiving CPAP [mean {SD} adherence, 3.1 {2.4} hours per day]; 49.9% not receiving CPAP [usual care], mean [SD] follow-up, 3.25 [1.8] years). The main outcome was defined as the first MACCE, which was similar for the CPAP and no CPAP groups (hazard ratio, 1.01 [95% CI, 0.87-1.17]). However, an on-treatment analysis by marginal structural model revealed a reduced risk of MACCEs associated with good adherence to CPAP (hazard ratio, 0.69 [95% CI, 0.52-0.92]). Conclusions and Relevance Adherence to CPAP was associated with a reduced MACCE recurrence risk, suggesting that treatment adherence is a key factor in secondary cardiovascular prevention in patients with OSA.
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Affiliation(s)
- Manuel Sánchez-de-la-Torre
- Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Esther Gracia-Lavedan
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
| | - Ivan D. Benitez
- Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Alicia Sánchez-de-la-Torre
- Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Anna Moncusí-Moix
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
| | - Gerard Torres
- Precision Medicine in Chronic Diseases, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Kelly Loffler
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Richard Woodman
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Gonzalo Labarca
- Laboratorio de Inmunología Traslacional, Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Christine Eulenburg
- Department for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Erik Thunström
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helena Glantz
- Department of Internal Medicine, Skarabrg Hospital, Lidköping, Sweden
| | - Yüksel Peker
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pulmonary Medicine, Koç University School of Medicine, Istanbul, Turkey
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Clinical Sciences, Respiratory Medicine, and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Craig Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Doug McEvoy
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
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Lajoie AC, Gu Y, Lim A, Benedetti A, Kaminska M. Adherence to continuous positive airway pressure for the treatment of obstructive sleep apnea in neurodegenerative diseases: A systematic review. Sleep Med Rev 2023; 71:101836. [PMID: 37586145 DOI: 10.1016/j.smrv.2023.101836] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 07/26/2023] [Accepted: 08/06/2023] [Indexed: 08/18/2023]
Abstract
Obstructive sleep apnea (OSA) is prevalent in patients with neurodegenerative diseases and is associated with worse outcomes. Positive airway pressure therapy has the potential to benefit these patients but can be challenging in this population. Our primary aim was to describe positive pressure therapy adherence. Secondarily, we aimed at identifying identify predictors of adherence to treatment in adults with neurodegenerative diseases and OSA, and report the effect of PAP adherence on outcomes such as cognitive function, quality of life and patient/caregiver satisfaction. We performed a systematic review of the literature and identified seventeen studies, eight reporting on adults with obstructive sleep apnea and mild cognitive impairment (MCI) and/or Alzheimer's disease (AD), 6 with Parkinson's disease (PD), and 3 with multiple system atrophy (MSA). Meta-analyses were not performed due to lack of systematic and standardized reporting of the primary outcome. Study duration ranged from 6 weeks to an average of 3.3 years. PAP adherence definition was widely variable between studies. Attrition rates ranged from 12% to 75%. In MCI/AD, adherence rates ranged from 28% to 61% (study duration range: 3 weeks to 3.3 years). Younger age, race (white) and better CPAP confidence scores at 1 week were associated with more CPAP use while APOE4 positive and unmarried individuals were more likely to abandon CPAP. In most studies, adherent patients had improvement in excessive daytime sleepiness, depressive symptoms, sleep quality, ability to manage daily activities and certain aspects of cognition (composite score or global cognition, psychomotor speed, executive function), as well as less cognitive decline over time. Caregiver satisfaction was also better in PAP adherent patients in one study. In PD, 15-25% of individuals refused treatment with PAP upfront, and attrition ranged from 8 to 75%. Adherent patients used their device for an average of 3h27 to 5h12 per night (study duration range: 6 weeks to 12 months). Longer disease duration, worse motor symptoms or sleep quality and lower % of REM sleep were identified as predictors of lower PAP adherence in a preliminary study, while race (non-white) and sex (women) were linked to lower adherence in a large retrospective study. In the study reporting the highest attrition rate (75%), individuals had lower educational levels. PAP adherence improved daytime sleepiness, anxiety symptoms, sleep architecture and quality and global non-motor symptoms. However, in one short-term (3 weeks) study, there was no improvement in neuropsychological testing composite score. Three studies on MSA patients suffering from sleep-disordered breathing showed that most patients are accepting of PAP (69-72%) with an average nightly use of 4h42 to 6h18. Floppy epiglottis was more frequently seen in patients discontinuing PAP in one study. In one study, four adults with MSA and long-term PAP use reported better sleep and improved vigilance. Survival time was no different between treated and untreated individuals. In conclusion, PAP therapy is challenging in patients with OSA and NDD, as evidenced by the considerable attrition and low adherence rates reported in this systematic review. There is emerging evidence proposing OSA a treatable target to prevent clinical and functional deterioration in patients with neurodegenerative diseases and addressing potential barriers to PAP adherence is paramount to maximize adherence. Our systematic review outlines several of these potential barriers, underscoring the need for future studies to standardize the definition of and explore long-term adherence to PAP therapy and assess interventions that can optimize adherence in this patient population.
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Affiliation(s)
- Annie C Lajoie
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre - Montreal, Quebec, Canada.
| | - Yusing Gu
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Lim
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto- Toronto Ontario, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre - Montreal, Quebec, Canada; Dept. of Epidemiology, Biostatistics & Occupational Health, McGill University - Montreal, Quebec, Canada
| | - Marta Kaminska
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre - Montreal, Quebec, Canada; Respiratory Division & Sleep Laboratory, McGill University Health Centre - Montreal, Quebec, Canada
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Trindade A, Custódio C, Cabral J, Lopes T, Martins V, Aguiar M, Gonçalves I, Furtado S. Influence of excessive daytime sleepiness on the treatment adherence of obstructive sleep apnea. Sleep Med 2023; 109:50-55. [PMID: 37418827 DOI: 10.1016/j.sleep.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/22/2023] [Accepted: 06/16/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES To compare positive airway pressure (PAP) adherence between patients with or without excessive daytime sleepiness (EDS) in mild, moderate and severe obstructive sleep apnea (OSA). METHODS Patients ≥18 years diagnosed with OSA in 2018 and 2019, without previous history of PAP usage and with adherence registration in the first medical consultation after treatment initiation, were included. EDS was defined as a score of ≥10 on the Epworth Scale. Patients were divided into two groups according to the adherence to PAP: "Adherent" if using the device for ≥4 h for ≥70% of the nights and "Nonadherent" otherwise. Simple and multiple logistic regression models for adherence were determined. RESULTS 321 patients were included, most male (64.2%), with mean age 56.56 years. Most patients had severe OSA (n = 159; 49.5%), and median AHI was 29.3/h [16.8; 47.5]. Being older or having a severe OSA resulted in an increased adherence (OR = 1.020, CI95% = [1.002; 1.039] and OR = 2.299, CI95% = [1.273; 4.191], respectively). In patients without EDS a statistically significant difference was found in adherence between those with severe OSA and both mild and moderate OSA categories (OR = 0.285, p = 0.023 and OR = 0.387, p = 0.026, respectively), with patients with severe OSA being adherent. There was no statistical difference in adherence between patients with or without EDS (OR 1.083; p = 0.876), nor in the different degrees of severity in those with EDS. CONCLUSION In our study there were no differences in PAP therapy adherence between patients with or without excessive daytime sleepiness. Older age and higher OSA severity resulted in higher adherence rates.
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Affiliation(s)
- Anatilde Trindade
- Pulmonology Department, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276, Amadora, Lisboa, Portugal.
| | - Catarina Custódio
- Pulmonology Department, Hospital Beatriz Ângelo, Avenida Carlos Teixeira 3, 2674-514, Loures, Lisboa, Portugal.
| | - Jorge Cabral
- Centre for Research & Development in Mathematics and Applications, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal.
| | - Telma Lopes
- Pulmonology Department, Hospital Beatriz Ângelo, Avenida Carlos Teixeira 3, 2674-514, Loures, Lisboa, Portugal.
| | - Vera Martins
- Pulmonology Department, Hospital Beatriz Ângelo, Avenida Carlos Teixeira 3, 2674-514, Loures, Lisboa, Portugal.
| | - Margarida Aguiar
- Pulmonology Department, Hospital Beatriz Ângelo, Avenida Carlos Teixeira 3, 2674-514, Loures, Lisboa, Portugal.
| | - Inês Gonçalves
- Pulmonology Department, Hospital Beatriz Ângelo, Avenida Carlos Teixeira 3, 2674-514, Loures, Lisboa, Portugal.
| | - Sofia Furtado
- Pulmonology Department, Hospital Beatriz Ângelo, Avenida Carlos Teixeira 3, 2674-514, Loures, Lisboa, Portugal.
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Marciuc D, Morarasu S, Morarasu BC, Marciuc EA, Dobrovat BI, Pintiliciuc-Serban V, Popescu RM, Bida FC, Munteanu V, Haba D. Dental Appliances for the Treatment of Obstructive Sleep Apnea in Children: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1447. [PMID: 37629737 PMCID: PMC10456847 DOI: 10.3390/medicina59081447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Abstract
Background and objectives: Obstructive sleep apnea (OSA) in children is a debilitating disease, difficult to treat. Dental appliances have been proposed as a valid therapy for improving functional outcomes with good compliance rates. Herein, we aimed to perform a meta-analysis comparing clinical outcomes between OSA children treated with dental appliances versus controls. Materials Methods: The study was registered with PROSPERO. A systematic search was performed for all comparative studies examining outcomes in pediatric patients who underwent treatment of OSA with oral appliances versus controls. Data was extracted and analyzed using a random effects model via Rev Man 5.3. Results: Six studies including 180 patients were analyzed split into two groups: patients treated with dental appliances (n = 123) and the controls (n = 119). Therapy with dental appliances was shown to significantly improve the apnea-hypopnea index (p = 0.009) and enlarge the superior posterior airway space (p = 0.02). Maxilla-to-mandible measurements were not significantly different between the two groups, nor was the mean SO2 (p = 0.80). Conclusions: This is the most updated meta-analysis assessing the role of dental appliances for OSA in children; it shows that such devices can improve functional outcomes by decreasing the apnea-hypopnea index.
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Affiliation(s)
- Daniel Marciuc
- Surgery Department, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.); (V.P.-S.); (R.M.P.)
| | - Stefan Morarasu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Bianca Codrina Morarasu
- Department of Internal Medicine and Toxicology, “Saint Spiridon” University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Emilia Adriana Marciuc
- Department of Radiology, Emergency Hospital “Prof. Dr. Nicolae Oblu”, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.I.D.); (D.H.)
| | - Bogdan Ionut Dobrovat
- Department of Radiology, Emergency Hospital “Prof. Dr. Nicolae Oblu”, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.I.D.); (D.H.)
| | - Veronica Pintiliciuc-Serban
- Surgery Department, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.); (V.P.-S.); (R.M.P.)
| | - Roxana Mihaela Popescu
- Surgery Department, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.); (V.P.-S.); (R.M.P.)
| | - Florinel Cosmin Bida
- Department of Implantology, Removable Prostheses, Dental Prostheses Technology, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Valentin Munteanu
- Department of Intensive Care Unit, “Saint Mary” Emergency Children Hospital, 700309, Faculty of Medical Bioengineering, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Danisia Haba
- Department of Radiology, Emergency Hospital “Prof. Dr. Nicolae Oblu”, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.I.D.); (D.H.)
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Cistulli PA, Armitstead JP, Malhotra A, Yan Y, Vuong V, Sterling KL, Barrett MA, Nunez CM, Pépin JL, Benjafield AV. Relationship between Self-reported Sleepiness and Positive Airway Pressure Treatment Adherence in Obstructive Sleep Apnea. Ann Am Thorac Soc 2023; 20:1201-1209. [PMID: 37126852 PMCID: PMC10405605 DOI: 10.1513/annalsats.202206-482oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 05/01/2023] [Indexed: 05/03/2023] Open
Abstract
Rationale: Positive airway pressure (PAP) is the first-choice treatment for obstructive sleep apnea (OSA). However, its real-world effectiveness is often questioned because of usage issues. The relationship between patient sleepiness and PAP usage has been assessed in relatively small and selected populations within the research context. Objectives: To assess the impact of patient-reported sleep outcomes, particularly self-reported sleepiness and its change during therapy, on PAP usage in the real-world setting. Methods: Deidentified data for U.S.-based patients receiving PAP therapy were examined. Eligible patients were registered in the myAir app and provided self-reported sleepiness at baseline and after 7, 14, 21, and 28 days of PAP between November 2019 and April 2020. Results: A total of 95,397 registered patients met all eligibility criteria and were included in the analysis (mean age, 49.6 ± 13.0 yr; 61.6% male). Daytime sleepiness was the most common reason for PAP therapy initiation (57.1% of patients), and 42.2% of all patients had self-reported moderate to severe OSA. Self-reported sleepiness improved with PAP therapy in most patients over the assessment period, with 62.1% of patients reporting "no" or "slight" sleepiness at Day 28. There was a dose-dependent association between improvement in self-reported sleepiness at Day 28 and PAP usage, and this finding was maintained at Day 360. Self-reported sleepiness at Day 28 was associated with achieving U.S. Centers for Medicare & Medicaid Services compliance at 90 days (approximately 90% for those with no or slight sleepiness vs. <70% for those with residual very or extreme sleepiness); average daily PAP usage over 360 days was ⩾5.0 and ⩽3.7 hours, respectively, for those with no or slight versus very or extreme sleepiness. Conclusions: This study demonstrates the feasibility of capturing patient-reported outcomes via a digital platform. Patient-reported outcomes appear to be associated with PAP usage, especially self-reported sleepiness and its response to therapy. Capturing patient-reported outcomes using digital solutions during the course of treatment has the potential to enhance patient outcomes by providing actionable insights.
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Affiliation(s)
- Peter A. Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Atul Malhotra
- University of California, San Diego, La Jolla, California
| | - Yang Yan
- ResMed Science Center, Singapore, Singapore
| | - Vy Vuong
- ResMed Science Center, San Francisco, California
| | | | | | | | - Jean-Louis Pépin
- HP2 Laboratory, University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
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Šiarnik P, Jurík M, Valovičová K, Klobučníková K, Kollár B, Poddaný M, Rovňák M, Turčáni P, Sýkora M. Adherence to positive airway pressure therapy initiated in the early subacute phase of ischemic stroke: a PRESS study follow-up. Sleep Breath 2023; 27:1279-1286. [PMID: 36198999 PMCID: PMC9534463 DOI: 10.1007/s11325-022-02722-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/05/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is frequent in stroke patients and negatively affects stroke outcomes. Positive airway pressure (PAP) is the standard first-line treatment for patients with moderate-to-severe SDB. Despite a strong link between PAP adherence and therapeutic response, rates of post-stroke PAP adherence remain underexplored. Our study aimed to determine PAP adherence in patients undergoing comprehensive sleep apnea assessment and in-lab PAP titration in the early subacute phase of stroke. METHODS In-hospital screening pulse oximetry was performed in consecutive patients with imaging-confirmed acute ischemic stroke. Subjects with desaturation index ≥ 15.3/h were selected as PAP candidates, and polysomnography was recommended. In a sleep laboratory setting, subjects underwent a diagnostic night followed by a titration night, and PAP therapy was initiated in subjects with apnea-hypopnea index ≥ 15/h. Adherence to PAP therapy was assessed at a 6-month follow-up visit. RESULTS Of 225 consecutive patients with acute ischemic stroke, 116 were PAP candidates and 52 were able to undergo polysomnography. PAP therapy was initiated in 35 subjects. At a 6-month follow-up visit, out of 34 stroke survivors, PAP adherence (PAP use of > 4 h per night) was present in 47%. Except for the significantly lower minimal nocturnal O2 saturation determined from the polysomnography (74.6 ± 11.7% vs. 81.8 ± 5.2%, p = 0.025), no other significant difference in characteristics of the groups with PAP adherence and PAP non-adherence was found. CONCLUSIONS Less than half of the stroke subjects remained adherent to PAP therapy at 6 months post-PAP initiation. Special attention to support adaptation and adherence to PAP treatment is needed in this group of patients.
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Affiliation(s)
- Pavel Šiarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Matúš Jurík
- 1st Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Katarína Valovičová
- 1st Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Katarína Klobučníková
- 1st Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Branislav Kollár
- 1st Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Michal Poddaný
- Department of Neurology, General Hospital, Liptovsky Mikulas, Slovakia
| | - Marek Rovňák
- Jessenius Faculty of Medicine, Comenius University in Bratislava, University Hospital in Martin, Martin, Slovakia
| | - Peter Turčáni
- 1st Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Marek Sýkora
- 1st Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
- Department of Neurology, St. John’s Hospital, Medical Faculty, Sigmund Freud University Vienna, Vienna, Austria
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50
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Park JS, Kwon B, Kang HS, Yun SJ, Han SJ, Choi Y, Kang SH, Lee MY, Lee KC, Hong SJ. Craniofacial Phenotype in Obstructive Sleep Apnea and Its Impact on Positive Airway Pressure (PAP) Adherence. J Pers Med 2023; 13:1196. [PMID: 37623447 PMCID: PMC10455729 DOI: 10.3390/jpm13081196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Positive airway pressure (PAP) is an important treatment tool for patients with moderate and severe obstructive sleep apnea (OSA), and adherence to PAP significantly affects treatment outcomes. Disease severity, adverse effects, and psychosocial factors are known to predict medication adherence. Cephalometric parameters have been reported to positively correlate with upper airway collapse. However, research on the correlation between these cephalometric parameters and PAP adherence remains insufficient. This study aimed to identify this relationship. This study included 185 patients with OSA who were prescribed PAP. Polysomnography (PSG) was performed to diagnose OSA, and paranasal sinus computed tomography (PNS CT) was performed to check for comorbidities of the upper airway. In addition, cephalometric parameters such as the hyoid-posterior nasal spine (H-PNS), posterior nasal spine-mandibular plane (PNS-MP), and hyoid-mandibular plane (H-MP) were measured in the midsagittal and axial CT views. Adherence was evaluated 3-12 months after the PAP prescription. A total of 136 patients were PAP-adherent, and 49 were nonadherent. There were more males in the adherent group and a higher average height in the adherent group. The PSG results showed that the apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), arousal index (AI), rapid eye movement (REM) AHI, and supine AHI were significantly higher, and the lowest oxygen saturation was lower in the adherent group. In the analysis of covariance (ANCOVA) model adjusted for sex and height, among the cephalometric parameters, H-MP was significantly longer in the adherent group (p = 0.027), and H-PNS showed a longer tendency (p = 0.074). In the logistic regression analysis model, the odds ratio (OR) and 95% confidence intervals (95% CI) of adherence and severe OSA in the third tertile compared to the first tertile of H-MP were 2.93 (1.25-6.86) and 4.00 (1.87-8.56). In the case of H-PNS, they were 2.58 (1.14-5.81) and 4.86 (2.24-10.54), respectively. This study concluded that an inferiorly placed hyoid bone in adult patients is associated with PAP adherence and disease severity.
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Affiliation(s)
- Jae-Seon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (J.-S.P.); (H.-S.K.); (S.-J.Y.); (S.-H.K.); (K.-C.L.)
| | - Bin Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea; (B.K.); (S.-J.H.); (Y.C.)
| | - Hyun-Seok Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (J.-S.P.); (H.-S.K.); (S.-J.Y.); (S.-H.K.); (K.-C.L.)
| | - Seong-Jin Yun
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (J.-S.P.); (H.-S.K.); (S.-J.Y.); (S.-H.K.); (K.-C.L.)
| | - Sung-Jun Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea; (B.K.); (S.-J.H.); (Y.C.)
| | - Yeso Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea; (B.K.); (S.-J.H.); (Y.C.)
| | - Sung-Hun Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (J.-S.P.); (H.-S.K.); (S.-J.Y.); (S.-H.K.); (K.-C.L.)
| | - Mi-Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea;
| | - Kyung-Chul Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (J.-S.P.); (H.-S.K.); (S.-J.Y.); (S.-H.K.); (K.-C.L.)
| | - Seok-Jin Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (J.-S.P.); (H.-S.K.); (S.-J.Y.); (S.-H.K.); (K.-C.L.)
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