Cervical positioning for reduction of sleep-disordered breathing in mild-to-moderate OSAS

Memory Foam Pillow as an Intervention in Obstructive Sleep Apnea Syndrome: A Preliminary Randomized Study

Specific pillow use is a seldom studied or controlled factor in the setting of sleep disordered breathing. The aim of this study was to investigate the effect of different pillows [own pillow (OP), memory foam pillow (MFP), generic laboratory pillow (LP)] on polysomnography (PSG)-derived parameters in patients with Obstructive Sleep Apnea Syndrome (OSAS). Thirty-two consecutive patients with OSAS were randomly allocated into two groups with randomized pillow usage [Group A: 3 h with LP and 3 h with OP (Age: 53.8 ± 12.5 years, BMI: 32.1 ± 4.6 kg/m²); Group B: 3 h with LP and 3 h with MFP (Age: 52.0 ± 6.3 years, BMI: 30.6 ± 2.2 kg/m²)]. Statistically significant differences between pillow types were detected in desaturation index and heart rate. In Group B (with MFP), a statistically significant decrease of 47.0 ± 15.9% was observed in snoring events (p < 0.05) and 10.6 ± 6.7% in their duration (p < 0.05) compared to LP. On the other hand, group A with OP recorded a decrease of 29.1 ± 32.1% in snoring events and 32.5 ± 33.1% in duration, but these values were not statistically significant (p > 0.05) compared to LP. These findings indicate that pillow type and usage, often uncontrolled in OSAS studies (contribution to the field), may impact several PSG parameters and are related to a snoring subtype of the syndrome. Secondly, they indicate that a focus on the treatment of the snoring OSAS subtype warrants further dedicated investigation.

Efficacy of a Smart Antisnore Pillow in Patients with Obstructive Sleep Apnea Syndrome

Objective

Untreated obstructive sleep apnea syndrome (OSAS) increases the risk of cardiovascular, dementia, and motor vehicle accident events. However, continuous positive airway pressure (CPAP) which is the gold standard treatment is not acceptable for many patients with OSAS. Development of devices for the patients of nonadherence to CPAP is necessary.

Materials and Methods

We evaluated the effect of the smart antisnore pillow (SAP) in patients with OSAS in a prospective, noncontrolled, nonrandomized, pilot study. According to the apnea-hypopnea index (AHI), they were divided into two groups: mild-to-moderate OSAS group and severe OSAS group. Single-night polysomnography (PSG) with application of a SAP was performed. Thirty patients, 15 males and 15 females, 33–82 years old (mean age, 59.3 ± 12.9 years), completed the smart antisnore pillow therapy test. Among them, 23 patients had mild-to-moderate OSAS.

Results

The SAP significantly improved the snore number (p = 0.018), snore index (p = 0.013), oxygen denaturation index (p = 0.001), total AHI (p = 0.002), and supine AHI (p = 0.002) in the mild-to-moderate OSAS group, but there was no significant improvement in the severe OSAS group.

Conclusions

We concluded that the SAP is an effective positional therapy device for patients with OSAS of mild-to-moderate severity.

Functional connectivity in default mode network correlates with severity of hypoxemia in obstructive sleep apnea

INTRODUCTION

Obstructive sleep apnea (OSA)-associated hypoxemia, sleep fragmentation, and cerebral vascular dysfunction are implicated in cognitive dysfunction. Functional connectivity within default mode network (DMN) is a possible mechanism underlying the cognitive impairment. The aim of this study was to investigate the impact of hypoxemia and sleep fragmentation on functional connectivity and on cognitive performance in patients with OSA.

METHODS

Twenty-eight patients with OSA were included (mean age = 58.0 ± 8.5 years). We correlated the functional connectivity in DMN with cognitive performances and further analyzed the relationship of functional connectivity in DMN with hypoxemia severity, as revealed by apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and nadir SaO₂ (%), and with degree of sleep fragmentation, as shown by sleep efficiency and wake after sleep onset.

RESULTS

Functional connectivity in DMN was associated with AHI, ODI, and nadir SaO₂ (%) (p < .05) and was not associated with sleep fragmentation measures (p > .05). Functional connectivity that was associated with AHI, ODI, and nadir SaO₂ (%) was in the areas of bilateral middle temporal gyri, bilateral frontal pole, and bilateral hippocampus and was positively correlated with Cognitive Abilities Screening Instrument (CASI) total score (ρ = 0.484; p = .012), CASI-List-generating, CASI-Attention, and composite score of CASI-List-generating plus CASI-Attention (p < .05).

CONCLUSION

Functional connectivity in DMN is implicated in impairment of global cognitive function and of attention in OSA patients. The functional connectivity in the DMN is associated with hypoxemia rather than with sleep fragmentation.

A Survey of Koreans on Sleep Habits and Sleeping Symptoms Relating to Pillow Comfort and Support

The number of people who complain of sleep disturbances is steadily increasing. An understanding of sleep-related factors is required to address sleep problems. This survey study investigated the sleep habits and sleeping symptoms relating to the comfort and support characteristics of pillows and the relationship between sleep quality and pillow design factors. The study utilized data from 332 participating Korean adults aged 20–76 years (mean age ± SD: males, 40.4 ± 15.2; females, 42.9 ± 15.4). We developed a questionnaire that evaluated sleep habits (sleep duration, bedtime, wake-up time and sleeping position); sleeping symptoms (snoring or coughing, breathing and sleepiness during waking hours) based on the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K) questionnaire; and pillow-related factors (support, comfort, fatigue, height and shape) from existing pillow studies. The average sleep duration was 6.8 h, with more than half (52%) of participants sleeping in the supine position. The overall score for sleep quality was considered poor (4.84 points on a seven-point Likert scale), with some degree of sleepiness during waking hours (4.4 points on a seven-point Likert scale). Females went to bed earlier than males and were more likely to sleep in the lateral position compared to males. The number of toss and turn or waking events during sleep increased with age, and older individuals went to sleep earlier and woke up earlier. Among the symptoms of fatigue, pain, discomfort with changing position, snoring, coughing and breathing discomfort, participants reported their highest levels of discomfort due to sleepiness after waking, and they experienced the least head pain. Participants who used a regular-type pillow had poorer satisfaction on multiple comfort and support factors (support, comfort, height suitability, shape suitability) compared with those who used a functional-type pillow. Less head fatigue, less neck fatigue and less shoulder pain had significant effects on sleep quality. To reduce neck fatigue and shoulder pain, designers should consider the height for neck support in the lateral position. To reduce neck fatigue, it is desirable to use materials like latex or memory foam that provide neck support, which can improve sleep quality. The findings of this study contribute to a better understanding of sleep habits and characteristics of pillow comfort and provide practical guidelines for better pillow designs.

A Remote-Controlled Airbag Device Can Improve Upper Airway Collapsibility by Producing Head Elevation With Jaw Closure in Normal Subjects Under Propofol Anesthesia

Continuous maintenance of an appropriate position of the mandible and head purely by manual manipulation is difficult, although the maneuver can restore airway patency during sleep and anesthesia. The aim of this paper was to examine the effect of head elevation with jaw closure using a remote-controlled airbag device, such as the airbag system, on passive upper airway collapsibility during propofol anesthesia. Seven male subjects were studied. Propofol infusion was used for anesthesia induction and maintenance, with a target blood propofol concentration of 1.5–2 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}\(\mu \) \end{document}g/ml. Nasal mask pressure (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}\({P}_{\text {N}}\) \end{document}) was intermittently reduced to evaluate upper airway collapsibility (passive \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}\({P}_{_{\text {CRIT}}}\) \end{document}) and upstream resistance (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}\({R}_{_{\text {US}}}\) \end{document}) at three different head and jaw positions, jaw opening position in the supine position, jaw opening position in the sniffing position with 6-cm head elevation, and jaw closure at a 6-cm height sniffing position. The 6-cm height sniffing position with jaw closure was achieved by an airbag device that was attached to the subject’s head-like headgear. Patient demographics, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}\({P}_{_{\text {CRIT}}}\) \end{document} and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}\({R}_{_{\text {US}}}\) \end{document} in each condition were compared using one-way ANOVA with a post hoc Tukey test. \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}\({\rm P}<0.05\) \end{document} was considered significant. We also confirmed the effects of our airbag device on improvement of upper airway collapsibility in three obstructive sleep apnea patients in a clinical study. The combination of 6-cm head elevation with jaw closure using the air-inflatable robotic airbag system decreased upper airway collapsibility (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}\({P}_{_{\text {CRIT}}}\sim -3.4\) \end{document}-cm H\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}\(_{2}\) \end{document}O) compared with the baseline position (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}\({P}_{_{\text {CRIT}}}\sim -0.8\) \end{document}-cm H\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}\(_{2}\) \end{document}O, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}\({P} = 0.0001\) \end{document}). In the clinical study, there was improvement of upper airway obstruction in sleep apnea patients, including decreased apnea and hypopnea duration and increased the lowest level of oxygen saturation. We demonstrated that establishment of head elevation with jaw closure achieved by a remote-controlled airbag device using an inflatable airbag system can produce substantial decreases in upper airway collapsibility and maintain upper airway patency during propofol anesthesia and sleep.

The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea-a review of the literature

Purpose

Research during the past 10–20 years shows that positional therapy (PT) has a significant influence on the apnea–hypopnea index. These studies are predominantly performed as case series on a comparably small number of patients. Still, results have not found their way into the daily diagnostic and treatment routine. An average of 56 % of patients with obstructive sleep apnea (OSA) have position-dependent OSA (POSA), commonly defined as a difference of 50 % or more in apnea index between supine and non-supine positions. A great deal could be gained in treating patients with POSA with PT. The aim of this paper was to perform a thorough review of the literature on positional sleep apnea and its therapy.

Methods

A broad search strategy was run electronically in the MEDLINE and EMBASE databases using synonyms for position and sleep apnea.

Results

Sixteen studies were found which examined the effect of PT on OSA. In this literature review, we discuss the various techniques, results, and compliance rates.

Conclusion

Long-term compliance for PT remains an issue, and although remarkable results have been shown using innovative treatment concepts for PT, there is room for both technical improvement of the devices and for further research.

Shape design of an optimal comfortable pillow based on the analytic hierarchy process method

OBJECTIVE

Few studies have analyzed the shapes of pillows. The purpose of this study was to investigate the relationship between the pillow shape design and subjective comfort level for asymptomatic subjects.

METHODS

Four basic pillow designs factors were selected on the basis of literature review and recombined into 8 configurations for testing the rank of degrees of comfort. The data were analyzed by the analytic hierarchy process method to determine the most comfortable pillow.

RESULTS

Pillow number 4 was the most comfortable pillow in terms of head, neck, shoulder, height, and overall comfort. The design factors of pillow number 4 were using a combination of standard, cervical, and shoulder pillows. A prototype of this pillow was developed on the basis of the study results for designing future pillow shapes.

CONCLUSIONS

This study investigated the comfort level of particular users and redesign features of a pillow. A deconstruction analysis would simplify the process of determining the most comfortable pillow design and aid designers in designing pillows for groups.

Effect of head elevation on passive upper airway collapsibility in normal subjects during propofol anesthesia

BACKGROUND

Head elevation can restore airway patency during anesthesia, although its effect may be offset by concomitant bite opening or accidental neck flexion. The aim of this study is to examine the effect of head elevation on the passive upper airway collapsibility during propofol anesthesia.

METHOD

Twenty male subjects were studied, randomized to one of two experimental groups: fixed-jaw or free-jaw. Propofol infusion was used for induction and to maintain blood at a constant target concentration between 1.5 and 2.0 μg/ml. Nasal mask pressure (PN) was intermittently reduced to evaluate the upper airway collapsibility (passive PCRIT) and upstream resistance (RUS) at each level of head elevation (0, 3, 6, and 9 cm). The authors measured the Frankfort plane (head flexion) and the mandible plane (jaw opening) angles at each level of head elevation. Analysis of variance was used to determine the effect of head elevation on PCRIT, head flexion, and jaw opening within each group.

RESULTS

In both groups the Frankfort plane and mandible plane angles increased with head elevation (P < 0.05), although the mandible plane angle was smaller in the free-jaw group (i.e., increased jaw opening). In the fixed-jaw group, head elevation decreased upper airway collapsibility (PCRIT ~ -7 cm H₂O at greater than 6 cm elevation) compared with the baseline position (PCRIT ~ -3 cm H₂O at 0 cm elevation; P < 0.05).

CONCLUSION

: Elevating the head position by 6 cm while ensuring mouth closure (centric occlusion) produces substantial decreases in upper airway collapsibility and maintains upper airway patency during anesthesia.

Sleep apnea avoidance pillow effects on obstructive sleep apnea syndrome and snoring

The study was performed to determine the ability of a new inclined pillow to treat snoring and obstructive sleep apnea syndrome. The SONA Pillow is a triangular pillow with space to place your arm under the head while sleeping on the side. Twenty-two patients with nocturnal polysomnogram (NPSG)-proven obstructive sleep apnea syndrome were included in this study; the group included 11 mild, 8 moderate, and 3 severe sleep apnea patients. All patients had a second attended NPSG performed while utilizing this specific inclined pillow. The pillow was found to be an effective and easily used treatment for mild (respiratory disturbance index [RDI] 5 to 19) and moderate (RDI 20 to 40) obstructive sleep apnea and snoring. In this group, RDI ranged from 5.1 to 35.2 and decreased on the average from 17 events per hour to fewer than 5 events per hour while utilizing the inclined pillow (<0.0001). Also, a statistically significant difference was noted in rapid eye movement (REM) RDI decrement in all patients with mild to moderate sleep apnea (p=0.001) and the increase in SaO2 was also significant (p=0.004). Overall, snoring was decreased or eliminated (p=0.017).

CONCLUSION

A uniquely designed pillow (SONA Pillow) is effective in reducing the number of events in patients with mild to moderate obstructive sleep apnea. Using this pillow also reduces snoring.