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Stevens D, Title M, Spurr K, Morrison D. Positive airway pressure therapy adherence and outcomes in obstructive sleep apnea: An exploratory longitudinal retrospective randomized chart review. Can J Respir Ther 2024; 60:28-36. [PMID: 38314346 PMCID: PMC10838662 DOI: 10.29390/001c.92080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/05/2024] [Indexed: 02/06/2024]
Abstract
Background Positive airway pressure (PAP) therapy is prescribed to patients with obstructive sleep apnea (OSA). A commonly used definition for PAP therapy adherence is based upon the minimum requirements to receive Medicare coverage in the US, defined as PAP usage of four or more hours per night on 70 percent of nights for at least 30 consecutive days. However, little evidence exists to support this definition for PAP therapy adherence. Therefore, the present study sought to determine the efficacy of the present definition of PAP therapy adherence on longitudinal outcomes in patients with OSA, using objectively measured PAP device usage time. Methods An exploratory longitudinal, retrospective, randomized chart review was done to assess clinical outcomes between patients with OSA who were defined as PAP therapy adherent (n=50) and non-adherent (n=50) during an eight-year observation period. Results No significant differences were shown between groups for mortality, hospitalizations, or development of co-morbidities during the observation period. However, logistic regression showed significantly higher odds of adherence in male patients compared to female patients (OR=8.519; 95%CI=1.301-55.756; p=0.025) and significantly lower odds of adherence in patients with higher normal (OR=0.039; 95%CI=0.005-0.392; p=0.003), mild excessive (OR=0.039; 95%CI=0.003-0.517; p=0.014), and severe excessive (OR=0.088; 95%CI=0.012-0.635; p=0.016) daytime sleepiness compared to patients with lower normal daytime sleepiness. An increasing number of hospitalizations also corresponded with a significant decrease in odds of being adherent (OR=0.741; 95%CI=0.551-0.995; p=0.046). Conclusion The present study supports a steadily growing body of literature calling for more consideration and evidence to support a definition of PAP therapy adherence that is clinically meaningful.
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Affiliation(s)
- Daniel Stevens
- School of Health and Human Performance Dalhousie University
| | - Michaela Title
- School of Health and Human Performance Dalhousie University
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2
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Patil SP, Billings ME, Bourjeily G, Collop NA, Gottlieb DJ, Johnson KG, Kimoff RJ, Pack AI. Long-term health outcomes for patients with obstructive sleep apnea: placing the Agency for Healthcare Research and Quality report in context-a multisociety commentary. J Clin Sleep Med 2024; 20:135-149. [PMID: 37904571 PMCID: PMC10758567 DOI: 10.5664/jcsm.10832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 11/01/2023]
Abstract
This multisociety commentary critically examines the Agency for Healthcare Research and Quality (AHRQ) final report and systematic review on long-term health outcomes in obstructive sleep apnea. The AHRQ report was commissioned by the Centers for Medicare & Medicaid Services and particularly focused on the long-term patient-centered outcomes of continuous positive airway pressure, the variability of sleep-disordered breathing metrics, and the validity of these metrics as surrogate outcomes. This commentary raises concerns regarding the AHRQ report conclusions and their potential implications for policy decisions. A major concern expressed in this commentary is that the AHRQ report inadequately acknowledges the benefits of continuous positive airway pressure for several established, long-term clinically important outcomes including excessive sleepiness, motor vehicle accidents, and blood pressure. While acknowledging the limited evidence for the long-term benefits of continuous positive airway pressure treatment, especially cardiovascular outcomes, as summarized by the AHRQ report, this commentary reviews the limitations of recent randomized controlled trials and nonrandomized controlled studies and the challenges of conducting future randomized controlled trials. A research agenda to address these challenges is proposed including study designs that may include both high quality randomized controlled trials and nonrandomized controlled studies. This commentary concludes by highlighting implications for the safety and quality of life for the millions of people living with obstructive sleep apnea if the AHRQ report alone was used by payers to limit coverage for the treatment of obstructive sleep apnea while not considering the totality of available evidence. CITATION Patil SP, Billings ME, Bourjeily G, et al. Long-term health outcomes for patients with obstructive sleep apnea: placing the Agency for Healthcare Research and Quality report in context-a multisociety commentary. J Clin Sleep Med. 2024;20(1):135-149.
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Affiliation(s)
- Susheel P. Patil
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- University Hospitals of Cleveland, Cleveland, Ohio
| | | | - Ghada Bourjeily
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Daniel J. Gottlieb
- VA Boston Healthcare System, Boston, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
| | - Karin G. Johnson
- University of Massachusetts Chan School of Medicine-Baystate, Springfield, Massachusetts
| | - R. John Kimoff
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania
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Park DY, Cho JH, Jung YG, Choi JH, Kim DK, Kim SW, Kim HJ, Kim HY, Park SK, Park CS, Yang HC, Lee SH, Cho HJ. Clinical Practice Guideline: Clinical Efficacy of Nasal Surgery in the Treatment of Obstructive Sleep Apnea. Clin Exp Otorhinolaryngol 2023; 16:201-216. [PMID: 36791806 PMCID: PMC10471902 DOI: 10.21053/ceo.2022.01361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 02/16/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway obstruction during sleep. To reduce the morbidity of OSA, sleep specialists have explored various methods of managing the condition, including manifold positive airway pressure (PAP) techniques and surgical procedures. Nasal obstruction can cause significant discomfort during sleep, and it is likely that improving nasal obstruction would enhance the quality of life and PAP compliance of OSA patients. Many reliable studies have offered evidence to support this assumption. However, few comprehensive guidelines for managing OSA through nasal surgery encompass all this evidence. In order to address this gap, the Korean Society of Otorhinolaryngology-Head and Neck Surgery (KORL-HNS) and the Korean Society of Sleep and Breathing designated a guideline development group (GDG) to develop recommendations for nasal surgery in OSA patients. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. The types of nasal surgery included septoplasty, turbinate surgery, nasal valve surgery, septorhinoplasty, and endoscopic sinus surgery. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians' grading system. The GDG developed 10 key action statements with supporting text to support them. Three statements are ranked as strong recommendations, three are only recommendations, and four can be considered options. The GDG hopes that this clinical practice guideline will help physicians make optimal decisions when caring for OSA patients. Conversely, the statements in this guideline are not intended to limit or restrict physicians' care based on their experience and assessment of individual patients.
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Affiliation(s)
- Do-Yang Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Hoon Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Sang-Wook Kim
- Department of Otorhinolaryngology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyun Jun Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chan Soon Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Chae Yang
- 9Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Aguilar H, Kahanowitch R, Weiss M, Ortiz-Vergara MC, Lew J, Rodriguez O, Nino G. Real-world data evaluation of PAP responsiveness in pediatric obstructive sleep apnea. J Clin Sleep Med 2023; 19:1313-1319. [PMID: 37032622 PMCID: PMC10315588 DOI: 10.5664/jcsm.10578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 04/11/2023]
Abstract
STUDY OBJECTIVES The use of positive airway pressure (PAP) in children is a complex process determined by multiple factors. There are limited data on the response of the pediatric population to PAP therapy at home. The goal of the study was to examine real-world responses using PAP home monitoring in children with obstructive sleep apnea. METHODS The study included PAP therapy data for 195 children aged between 1 month and 18 years with obstructive sleep apnea and polysomnogram baseline study. We collected demographics, clinical variables, and polysomnogram parameters in all study participants. The individual response to PAP therapy was calculated comparing the apnea-hypopnea index (AHI) in the initial polysomnogram with the mean AHI provided by the download of PAP devices. Multivariate models (logistic regression) were used to examine the predictors of positive PAP response defined as a reduction in AHI ≥ 75%. RESULTS We found excellent responses to PAP therapy in children (median 85% AHI reduction). However, there was substantial heterogeneity in AHI reductions while on PAP therapy. The best PAP responses were linked to more severe obstructive sleep apnea and higher PAP levels. We also identified that the response to PAP was higher in obese children and lower in males. The best predictive model for individual PAP response was biological sex, obesity, and obstructive AHI ≥ 20 events/h (area under the receiver operating characteristic curve of 0.791). CONCLUSIONS Real-world data show that PAP is overall an effective therapy in children but the response is heterogeneous. Obstructive sleep apnea parameters and individual factors can be used to predict individual AHI reductions while on PAP and optimize PAP responses at home. CITATION Aguilar H, Kahanowitch R, Weiss M, et al. Real-world data evaluation of PAP responsiveness in pediatric obstructive sleep apnea. J Clin Sleep Med. 2023;19(7):1313-1319.
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Affiliation(s)
- Hector Aguilar
- Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Hospital, Washington, DC
| | - Ryan Kahanowitch
- Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Hospital, Washington, DC
| | - Miriam Weiss
- Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Hospital, Washington, DC
| | | | - Jenny Lew
- Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Hospital, Washington, DC
- Department of Pediatrics, George Washington University, Washington, DC
| | - Oscar Rodriguez
- Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Hospital, Washington, DC
- Department of Pediatrics, George Washington University, Washington, DC
| | - Gustavo Nino
- Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Hospital, Washington, DC
- Department of Pediatrics, George Washington University, Washington, DC
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Locke BW, Sundar DJ, Ryujin D. Severity, comorbidities, and adherence to therapy in Native Hawaiians/Pacific Islanders with obstructive sleep apnea. J Clin Sleep Med 2023; 19:967-974. [PMID: 36727487 PMCID: PMC10152360 DOI: 10.5664/jcsm.10472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Considerable disparities in the prevalence, diagnosis, and management of obstructive sleep apnea (OSA) exist for minority groups in the United States. However, the impact of OSA on Native Hawaiian/Pacific Islanders (NHPIs) has not been evaluated. METHODS We performed a retrospective review of patient records of NHPIs who underwent sleep apnea testing between 2014 and 2021 at a single center in Utah to characterize the distribution of comorbidities, disease severity, and treatment adherence. RESULTS 140 of 141 NHPI patients who underwent sleep testing had OSA. High rates of obesity (94%) and other relevant comorbidities were found. OSA was mostly severe (57%), particularly in males with higher obesity. Adherence to continuous positive airway pressure was low (41% using for 4 or more hours on 70% of nights), and medical factors predicted whether adherence targets were met with modest accuracy (area under the curve 0.699). CONCLUSIONS NHPIs at a single sleep center had a high prevalence of comorbidities in association with OSA, a skewed distribution toward severe disease suggestive of barriers to care or unique disease characteristics, and low adherence to continuous positive airway pressure. These findings suggest a high burden of OSA in this population, and further work to characterize barriers to identifying and treating OSA in NHPIs can improve chronic disease outcomes in NHPIs. CITATION Locke BW, Sundar DJ, Ryujin D. Severity, comorbidities, and adherence to therapy in Native Hawaiians/Pacific Islanders with obstructive sleep apnea. J Clin Sleep Med. 2023;19(5):967-974.
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Affiliation(s)
- Brian W. Locke
- University of Utah, Department of Internal Medicine, Division of Pulmonary and Critical Care, Salt Lake City, Utah
| | - Divya J. Sundar
- Division of Hematology, Department of Medicine, Salt Lake City, Utah
| | - Darin Ryujin
- University of Utah, Department of Family and Preventative Medicine, Salt Lake City, Utah
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Jo S, Cho J. Impact of the COVID-19 pandemic on adherence to positive airway pressure treatment in patients with obstructive sleep apnea: systematic review and meta-analysis. Ther Adv Respir Dis 2023; 17:17534666231214040. [PMID: 38146255 PMCID: PMC10752124 DOI: 10.1177/17534666231214040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/19/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND The adverse effects of the COVID-19 pandemic on sleep have been well studied. However, whether the COVID-19 pandemic impacted positive airway pressure (PAP) adherence in patients with obstructive sleep apnea (OSA) remains unclear. OBJECTIVES To evaluate the impact of the COVID-19 pandemic on adherence to PAP therapy in patients with OSA. DESIGN A retrospective cohort study, systematic review, and meta-analysis. DATA SOURCES AND METHODS The retrospective study included adults with OSA who received PAP prescriptions within the year before and the year after the start date of COVID-19 social distancing (22 March 2020) in South Korea. The threshold of clinical significance for PAP adherence was defined as 0.5 h/day. We also searched for relevant studies published up to 15 January 2023 using the MEDLINE and Embase databases. We performed a random-effects meta-analysis of our findings with the identified studies regarding the standardized mean change (SMC) with a 95% CI of PAP adherence. RESULTS Our study included a total of 306 patients (mean age, 59.7 years; men, 73.5%). The average daily PAP usage was 5.10 ± 1.63 h before the COVID-19 pandemic and 4.79 ± 1.96 h during the pandemic (mean difference, -0.31 h/day; 95% CI, -0.46 to -0.15 h/day; p < 0.001 using paired t-test). After identifying 10 observational before-and-after studies through a systematic review, we conducted a meta-analysis that included our original data and showed that adherence to PAP treatment was not different before and during the COVID-19 pandemic (SMC, 0.01; 95% CI, -0.18 to 0.19; p = 0.952). CONCLUSION Although the COVID-19 pandemic had a statistically negative impact on adherence to PAP treatment in South Korea, the effect was not clinically relevant in patients with OSA. According to our meta-analysis, adherence to PAP treatment was not different before and during the COVID-19 pandemic in patients with OSA. TRIAL REGISTRATION PROSPERO database; No.: CRD42023414268; URL: https://www.crd.york.ac.uk/PROSPERO.
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Affiliation(s)
- Soomin Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jaeyoung Cho
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Hsieh YH, Schell AE, Yeh E, Strohl MP, Curado TF, Strohl KP. Neurostimulation in the Management of Obstructive Sleep Apnea. Curr Sleep Medicine Rep 2022. [DOI: 10.1007/s40675-022-00233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yi H, Dong X, Shang S, Zhang C, Xu L, Han F. Identifying longitudinal patterns of CPAP treatment in OSA using growth mixture modeling: Disease characteristics and psychological determinants. Front Neurol 2022; 13:1063461. [DOI: 10.3389/fneur.2022.1063461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
In this study, we aim to identify the distinct subtypes of continuous positive airway pressure (CPAP) user profiles based on the telemedicine management platform and to determine clinical and psychological predictors of various patterns of adherence. A total of 301 patients used auto-CPAP (Autoset 10, Resmed Inc.) during the treatment period. Four categories of potential predictors for CPAP adherence were examined: (1) demographic and clinical characteristics, (2) disease severity and comorbidities, (3) sleep-related health issues, and (4) psychological evaluation. Then, growth mixture modeling was conducted using Mplus 8.0 to identify the unique trajectories of adherence over time. Adherence data were collected from the telemedicine management platform (Airview, Resmed Inc.) during the treatment. Three novel subgroups were identified and labeled “adherers” (53.8% of samples, intercept = 385, slope = −51, high mean value, negative slope and moderate decline), “Improvers” (18.6%, intercept = 256, slope = 50, moderate mean value, positive slope and moderate growth) and “non-adherers” (27.6%, intercept = 176, slope = −31, low mean value, negative slope and slight decline). The comorbidities associated with OSA and the apnea–hypopnea index (AHI), which reflects the objective severity of the disease, did not differ significantly among the subgroups. However, “improvers” showed higher levels of daytime sleepiness (8.1 ± 6.0 vs. 12.1 ± 7.0 vs. 8.0 ± 6.1 in SWIFT, p = 0.01), reduced daytime function (4.6 ± 1.6 vs. 3.8 ± 1.6 vs. 4.2 ± 1.8 in QSQ daytime symptoms, p = 0.02), and characteristics of positive coping style (1.8 ± 0.5 vs. 1.9 ± 0.5 vs. 1.7 ± 0.5 in SCSQ positive coping index, p = 0.02). Negative emotion was more pronounced in patients with “non-adherers” (12.9 ± 3.8 vs. 13.7 ± 3.3 vs. 14.6 ± 3.5, p = 0.02 in the HADS depression dimension; 9.0 ± 6.1 vs. 9.8 ± 5.1 vs. 11.5 ± 6.3, p = 0.01 with Negative Affectivity in DS14, and 9.3 ± 6.1 vs. 10.3 ± 5.1 vs. 11.7 ± 6.5, p = 0.01 with Social Inhibition in DS14). Overall, our study demonstrated that CPAP therapy may present distinct trajectories of adherence over time in addition to the traditional binary classification. Self-reported sleep health issues (diurnal sleepiness and daytime dysfunction) as well as psychological characteristics (negative emotions and coping style) were predictors of different adherence subtypes in patients with OSA. Understanding CPAP use profiles and their predictors enable the identification of those who may require additional intervention to improve adherence and further enhance the therapeutic effect in OSA patients.
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Yi H, Shang S, Zhang Y, Zhang C, Xu L, Wang J, He X, Dong X, Han F. Study on Adherence to Positive Airway Pressure Treatment for Patients with Obstructive Sleep Apnea Using Real-world Big Data in a Telemedicine Management System. Methods 2022. [DOI: 10.1016/j.ymeth.2022.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 12/22/2022] Open
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Naughton MT. The importance of being apnoeic (on CPAP). Respirology 2022; 27:105-106. [PMID: 34989085 DOI: 10.1111/resp.14200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew T Naughton
- Department of Respiratory Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
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Maley JH, Alba GA, Barry JT, Bartels MN, Fleming TK, Oleson CV, Rydberg L, Sampsel S, Silver JK, Sipes S, Verduzco Gutierrez M, Wood J, Zibrak JD, Whiteson J. Multi-Disciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Breathing Discomfort and Respiratory Sequelae in Patients with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC). PM R 2021; 14:77-95. [PMID: 34902224 DOI: 10.1002/pmrj.12744] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Jason H Maley
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - George A Alba
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - John T Barry
- Good Shepherd Penn Partners, Penn Therapy & Fitness - University City, Philadelphia, PA
| | - Matthew N Bartels
- Department of Rehabilitation Medicine, Montefiore Health System, Albert Einstein College of Medicine, New York
| | - Talya K Fleming
- JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, NJ
| | - Christina V Oleson
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Case Western Reserve University, Cleveland, OH
| | - Leslie Rydberg
- Department of Physical Medicine and Rehabilitation, Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Julie K Silver
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Sabrina Sipes
- Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, TX
| | | | - Jamie Wood
- Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joseph D Zibrak
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jonathan Whiteson
- Department of Rehabilitation Medicine and Department of Medicine, Rusk Rehabilitation, NYU Langone Health, New York, NY
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Dissanayake HU, Colpani JT, Sutherland K, Loke W, Mohammadieh A, Ou YH, de Chazal P, Cistulli PA, Lee CH. Obstructive sleep apnea therapy for cardiovascular risk reduction-Time for a rethink? Clin Cardiol 2021; 44:1729-1738. [PMID: 34791676 PMCID: PMC8715402 DOI: 10.1002/clc.23747] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 01/14/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent and underdiagnosed medical condition, which is associated with various cardiovascular and metabolic diseases. The current mainstay of therapy is continuous positive airway pressure (CPAP); however, CPAP is known to be poorly accepted and tolerated by patients. In randomized controlled trials evaluating CPAP in cardiovascular outcomes, the average usage was less than 3.5 hours, which is below the 4 hours per night recommended to achieve a clinical benefit. This low adherence may have resulted in poor effectiveness and failure to show cardiovascular risk reduction. The mandibular advancement device (MAD) is an intraoral device designed to advance the mandible during sleep. It functions primarily through alteration of the jaw and/or tongue position, which results in improved upper airway patency and reduced upper airway collapsibility. The MAD is an approved alternative therapy that has been consistently shown to be the preferred option by patients who are affected by OSA. Although the MAD is less efficacious than CPAP in abolishing apnea and hypopnea events in some patients, its greater usage results in comparable improvements in quality-of-life and cardiovascular measures, including blood pressure reduction. This review summarizes the impact of OSA on cardiovascular health, the limitations of CPAP, and the potential of OSA treatment using MADs in cardiovascular risk reduction.
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Affiliation(s)
- Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Juliana T Colpani
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Weiqiang Loke
- Faculty of Dentistry, National University of Singapore, Singapore
| | - Anna Mohammadieh
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Yi-Hui Ou
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Philip de Chazal
- Sleep Research Group, Charles Perkins Centre, Faculty of Engineering, University of Sydney, Camperdown, New South Wales, Australia
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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14
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Kwon JS, Jung HJ, Yu JH, Bae SY, Park Y, Cha JY, Ahn HJ. Effectiveness of remote monitoring and feedback on objective compliance with a mandibular advancement device for treatment of obstructive sleep apnea. J Sleep Res 2021; 31:e13508. [PMID: 34693583 DOI: 10.1111/jsr.13508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
Compliance with a mandibular advancement device is important for the optimal treatment of obstructive sleep apnea. Recent advances in information and communication technology-based monitoring and intervention for chronic diseases have enabled continuous monitoring and personalized management. Self-evaluation and self-regulation through objective monitoring and feedback may improve compliance. The aim of this study was to evaluate the effects of information and communication technology-based remote monitoring and feedback services, using a smartphone application, on the objective compliance with a mandibular advancement device in patients with obstructive sleep apnea. Forty individuals who were diagnosed with obstructive sleep apnea by polysomnography were randomly assigned to groups A and B. During an initial 6-week evaluation period, the mandibular advancement device-wearing time was monitored with the smartphone application in group B, but not in group A. The two groups then switched the monitoring procedures during the second 6-week period (the smartphone application was then used by group B, but not by group A). If no input data were indicated on the cloud server of the smartphone application during the monitored period, push notifications were provided twice daily. Objective compliance, monitored by a micro-recorder within the mandibular advancement device, was noted and compared based on whether the monitoring service was provided. The number of mandibular advancement device-wearing days was significantly higher in the monitored period than in the unmonitored period. The mandibular advancement device-wearing time did not differ significantly between the two groups. In conclusion, information and communication technology-based remote monitoring and feedback services demonstrated a potential to increase the objective measures of compliance with mandibular advancement devices.
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Affiliation(s)
- Jeong-Seung Kwon
- Department of Orofacial Pain and Oral Medicine, Dental Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyo-Jung Jung
- Department of Orofacial Pain and Oral Medicine, Dental Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Jae-Hun Yu
- Department of Orthodontics, Institute of Craniofacial Deformities, Yonsei University College of Dentistry, Seoul, Korea.,BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
| | - So-Yeon Bae
- Department of Orthodontics, Institute of Craniofacial Deformities, Yonsei University College of Dentistry, Seoul, Korea.,Department of Dental Laboratory Science and Engineering, College of Health Science, Korea University, Seoul, Republic of Korea
| | - YounJung Park
- Department of Orofacial Pain and Oral Medicine, Dental Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Jung Yul Cha
- Department of Orthodontics, Institute of Craniofacial Deformities, Yonsei University College of Dentistry, Seoul, Korea.,BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Hyung-Joon Ahn
- Department of Orofacial Pain and Oral Medicine, Dental Hospital, Yonsei University College of Dentistry, Seoul, Korea
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15
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Labarca G, Schmidt A, Dreyse J, Jorquera J, Barbe F. Telemedicine interventions for CPAP adherence in obstructive sleep apnea patients: Systematic review and meta-analysis. Sleep Med Rev 2021; 60:101543. [PMID: 34537668 DOI: 10.1016/j.smrv.2021.101543] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/07/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022]
Abstract
Continuous positive airway pressure (CPAP) is the preferred therapy in patients with obstructive sleep apnea (OSA). However, data suggests treatment adherence is low. In recent years, telemedicine-based intervention (TM) has been evaluated to increase adherence. In this systematic review and meta-analysis of randomized controlled trials (RCTs), we evaluated the efficacy of TM on CPAP adherence in patients with OSA. Two independent reviewers explored five databases; the risk of bias (RoB) was evaluated using the Cochrane tool. Outcomes were defined as the mean difference (MD) in CPAP use per night and the proportion of patients with increased CPAP adherence of ≥4 h/night. The meta-analysis was conducted following the DerSimonian-Laird method, and the certainty of the evidence was rated according to GRADE. We included 16 RCTs including 3039 participants. The RoB was low in 12/16 studies. TM was associated with an increase in CPAP adherence of 29.2 min/night, I2 =75% (p < 0.01), and CPAP adherence ≧4 h/night, RR: 1.09 (1.02-1.17), I2 =22%. Subgroup analyses reported better results between three and 6 months, in the sleepy subgroup. Finally, based on the results obtained in this systematic review, there is favorable evidence regarding the treatment with TM in patients with OSA using CPAP. REVIEW REGISTRATION NUMBER: CRD42020165367.
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Affiliation(s)
- Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepcion, Chile.
| | - Alexia Schmidt
- Faculty of Medicine, University of Concepcion, Concepcion, Chile
| | - Jorge Dreyse
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios Del Sueño (GETRS) Clínica Las Condes, Santiago, Chile
| | - Jorge Jorquera
- Centro de Enfermedades Respiratorias y Grupo de Estudio Trastornos Respiratorios Del Sueño (GETRS) Clínica Las Condes, Santiago, Chile
| | - Ferran Barbe
- Respiratory Department. Hospital Univ Arnau de Vilanova, IRBLleida. and CIBERES, Madrid, Spain
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16
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Abstract
Interest in telemedicine has increased exponentially. There is a growing body of published evidence on the use of telemedicine for patients using continuous positive airway pressure. Telemedicine-ready devices can support the transmission on use time, apnea-hypopnea index, and leakage. This approach enables early activation of troubleshooting. Automated, personalized feedback for patients and patient access to their own data provide unprecedented opportunities for integrating comanagement approaches, multiactor interactions, and patient empowerment. Telemedicine is likely cost effective, but requires better evidence. Notwithstanding barriers for implementation that remain, telemedicine has to be embraced, leaving the physician and patient to accept it or not.
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Affiliation(s)
- Johan Verbraecken
- Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, Edegem, Antwerp 2650, Belgium.
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17
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Weiss MR, Allen ML, Landeo-Gutierrez JS, Lew JP, Aziz JK, Mintz SS, Lawlor CM, Becerra BJ, Preciado DA, Nino G. Defining the patterns of PAP adherence in pediatric obstructive sleep apnea: a clustering analysis using real-world data. J Clin Sleep Med 2021; 17:1005-1013. [PMID: 33538691 DOI: 10.5664/jcsm.9100] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVES The implementation of positive airway pressure (PAP) therapy to treat obstructive sleep apnea in children is a complex process. PAP therapy data are highly heterogeneous in pediatrics, and the clinical management cannot be generalized. We hypothesize that pediatric PAP users can be subgrouped via clustering analysis to guide tailored interventions. METHODS PAP therapy data for 250 children with obstructive sleep apnea were retrospectively examined using unsupervised hierarchical cluster analysis based on (1) PAP tolerance (average hours on days used) and (2) consistency of PAP use (percentage of days used). Clinical features in each cluster were defined, and a tree decision analysis was generated for clinical implementation. RESULTS We were able to subclassify all 250 children (median age = 11.5 years) into five clusters: A (13.6%), B (29.6%), C (17.6%), D (16.4%), and E (22.8%). The clusters showed significant differences in PAP use patterns (Kruskal-Wallis P value < 1e-16). The most consistent PAP use patterns were seen in clusters A, B, and C. Major differences across clusters included the prevalence of obesity, PAP setting, developmental delay, and adenotonsillectomy. We also identified important differences in mask acceptance, OSA severity, and individual responses to PAP therapy based on objective apnea-hypopnea reductions in PAP downloads. CONCLUSIONS A simple method to subset PAP use patterns in children can be implemented by analyzing cloud-based PAP therapy data. This novel approach may contribute to optimization of PAP therapy in children of all ages based on real-world evidence at the individual level.
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Affiliation(s)
- Miriam R Weiss
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC
| | - Michelle L Allen
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC
| | - Jeremy S Landeo-Gutierrez
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC.,Department of Pediatrics, George Washington University, Washington, DC
| | - Jenny P Lew
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC.,Department of Pediatrics, George Washington University, Washington, DC
| | - Julia K Aziz
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC.,Department of Pediatrics, George Washington University, Washington, DC
| | - Sylvan S Mintz
- Department of Pediatrics, George Washington University, Washington, DC
| | - Claire M Lawlor
- Department of Pediatrics, George Washington University, Washington, DC.,Division of Pediatric Otorhinolaryngology, Children's National Hospital, George Washington University, Washington, DC
| | - Benjamin J Becerra
- Department of Information and Decision Sciences, California State University, San Bernardino, California
| | - Diego A Preciado
- Department of Pediatrics, George Washington University, Washington, DC.,Division of Pediatric Otorhinolaryngology, Children's National Hospital, George Washington University, Washington, DC
| | - Gustavo Nino
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC.,Department of Pediatrics, George Washington University, Washington, DC
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18
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Pelletier-Fleury N, Le Vaillant M, Goupil F, Paris A, Pigeane T, Gagnadoux F, Meslier N. Risk-seeking attitude in health and safety domain is associated with continuous positive airway pressure discontinuation in patients with obstructive sleep apnea-a multicenter prospective cohort study. Sleep 2021; 44:5896478. [PMID: 32832982 DOI: 10.1093/sleep/zsaa156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/03/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Many studies have already looked at factors that may influence adherence to continuous positive airway pressure (CPAP) (severity of obstructive sleep apnea (OSA), patients' age, technical aspects, socioeconomic factors, living conditions, psychological factors). Although it has been shown that individuals' preference for risky behaviors in daily life can influence the use of care or adherence to drug therapies in care settings, this has never been tested in OSA. This study aims to analyze the association between risk attitude in the health/safety domain and CPAP discontinuation in a cohort of OSA patients. METHODS In a prospective multicenter cohort study nested within the IRSR sleep cohort, consecutive patients who were prescribed CPAP were monitored for at least 6 months. In addition to the data usually collected in the IRSR sleep cohort at baseline, patients also completed a risk-taking questionnaire using the Domain-Specific Risk-Taking (DOSPERT) scale. Cox's proportional hazards regression was used to model the risk of CPAP discontinuation as a function of a linear combination of variables hypothetically related to this risk including health risk attitude. RESULTS Of the 489 patients under CPAP, 12.1% (n = 59) were risk-seeking, 87.9% (n = 430) were risk-neutral, and none were risk-averse. Cox's model indicated that a risk-seeking attitude (p = 0.04) and an AHI <30 (p < 0.01) were significantly associated with CPAP discontinuation. CONCLUSIONS Patients with risk-seeking behaviors in daily life have been shown to be more likely to discontinue CPAP. The DOSPERT scale can be a useful tool for screening this specific group of patients in clinical practice.
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Affiliation(s)
- Nathalie Pelletier-Fleury
- Institut National de la Santé Et de la Recherche Médicale (INSERM UMR 1018), Université Paris-Saclay, Centre de Recherche en Epidémiologie et Santé des Populations, Hôpital Paul Brousse, 16 av Paul Vaillant Couturier, Villejuif, France
| | - Marc Le Vaillant
- Institut de Recherche en Santé Respiratoire des Pays de la Loire, Beaucouzé, France
| | - François Goupil
- Département de pneumologie, Centre Hospitalier, Le Mans, France
| | - Audrey Paris
- Département de pneumologie, Centre Hospitalier, Le Mans, France
| | | | - Frédéric Gagnadoux
- Département de pneumologie, Centre hospitalier universitaire, Angers, France
| | - Nicole Meslier
- Département de pneumologie, Centre hospitalier universitaire, Angers, France
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19
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Shapiro AL, Olson J, Shafique S, Piamjariyakul U. CPAP-SAVER follow-up study to determine long-term adherence and associated factors. J Am Assoc Nurse Pract 2021; 34:261-269. [PMID: 33927159 DOI: 10.1097/jxx.0000000000000605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many factors contribute to continuous positive airway pressure (CPAP) nonadherence, affecting health care burden. The original CPAP-SAVER study enrolled 66 CPAP-naive participants and showed high 1-month adherence and significantly higher apnea beliefs and CPAP attitude for the intervention group. PURPOSE AND METHODS Thirty-three participants from the original CPAP-SAVER study were recruited for a 3-year follow-up to determine adherence, examine the intervention effect, and identify adherence-associated factors. RESULTS Adherence rates dropped to 54.5% at 3 years, with a significant decrease in CPAP use hours (t = -2.37, p = .024) and nights (t = -4.05, p < .001). Group differences in beliefs and attitude were not sustained; however, beliefs (r = 0.57) and attitude (r = 0.44) were significant factors associated with adherence. Life satisfaction was significantly higher at present compared with before wearing CPAP (t = 5.17, p < .001). IMPLICATIONS FOR PRACTICE The authors recommend intervention with a focus on apnea beliefs, CPAP attitude, and long-term support to promote CPAP adherence. Focus on CPAP attitude and beliefs and enhanced support early in the obstructive sleep apnea (OSA) treatment trajectory may promote long-term adherence and subsequently reduce the health care burden of OSA disease.
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Affiliation(s)
- April L Shapiro
- School of Nursing, West Virginia University, Keyser, West Virginia
| | - Joeli Olson
- Mountaineer Home Medical, Morgantown, West Virginia
| | - Saima Shafique
- School of Nursing, West Virginia University, Morgantown, West Virginia
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20
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Farré R, Gozal D, Montserrat JM. Alternative Procedure to Individual Nasal Pressure Titration for Sleep Apnea. J Clin Med 2021; 10:jcm10071453. [PMID: 33916282 PMCID: PMC8037765 DOI: 10.3390/jcm10071453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
In the treatment of obstructive sleep apnea (OSA), the current standard of "CPAP titration" in the laboratory or at home is a resource demanding and costly approach that, in developed economies, markedly augments healthcare costs and in low resource economies precludes access to care altogether. Here, we discuss that current guidelines for titration of CPAP could be obviated by taking a different route that in many ways is similar to the institution of treatment in many other medical conditions. To this effect, we present novel population based data from 16,780 patients, showing that after individualized and labor-intensive and expensive CPAP titration, 86.4% of OSA patients are treated with nasal pressure settings within the range of 9 ± 2 cmH2O, and review the literature to justify the potential adoption of a standard therapeutic CPAP setting as the initial intervention which would be subsequently followed by any necessary adjustments in only a minority of patients who would not derive the necessary benefit from such standardized intervention. Assuming an 80-85% success rate as derived from our analyses, our personal view if extensively adopted could radically reduce healthcare costs and enable markedly improve access to diagnostics.
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Affiliation(s)
- Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain;
- Institut Investigacions Biomediques August Pi Sunyer, 08036 Barcelona, Spain
- Correspondence:
| | - David Gozal
- Department of Child Health, The University of Missouri School of Medicine, Columbia, MO 65212, USA;
| | - Josep M. Montserrat
- CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain;
- Institut Investigacions Biomediques August Pi Sunyer, 08036 Barcelona, Spain
- Sleep Lab, Hospital Clinic, Universitat de Barcelona, 09036 Barcelona, Spain
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21
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Almeneessier AS, Aleissi S, Olaish AH, BaHammam AS. Long-Term Adherence to Positive Airway Pressure Therapy in Saudi Ambulatory Patients with Obesity Hypoventilation Syndrome and Severe Obstructive Sleep Apnea: A One-Year Follow-Up Prospective Observational Study. Nat Sci Sleep 2021; 13:63-74. [PMID: 33469401 PMCID: PMC7813470 DOI: 10.2147/nss.s290349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Long-term studies assessing positive airway pressure (PAP) therapy adherence in patients with obesity hypoventilation (OHS) are limited. The aim of this study was to assess PAP therapy adherence in Arab (Saudi) patients with OHS and an apnea-hypopnea index (AHI) >30/h. METHODS A prospective cohort study of consecutive adult patients diagnosed with OHS between March 2010 and September 2019 was conducted. During the therapeutic sleep study, all OHS patients were started on continuous PAP (CPAP). Patients who failed to maintain oxygen saturation ≥88% despite the elimination of obstructive respiratory events were shifted to bi-level PAP (BPAP). Objective assessment of adherence was performed at 1, 6, and 12 months after initiating PAP therapy. We adopted the American-Thoracic-Society criteria for PAP adherence. RESULTS The study included 101 patients (women = 65 patients) with OHS, an AHI ≥30/h, and a mean age of 54.9 ± 12.7 years. Successful titration on CPAP was achieved in 64.4% of the patients and BPAP was required for 35.6% of the patients who failed CPAP titration. At the end of the study, 43.6% of the patients used PAP therapy in an acceptable manner. Adherence after 1 and 6 months was the only independent predictors of adherence at 12 months. CONCLUSION PAP adherence among Saudi patients with OHS and severe obstructive sleep apnea was relatively low. Almost two-thirds of patients tolerated CPAP titration with the elimination of respiratory events and desaturation. Early adherence to PAP therapy was the only predictor of PAP therapy adherence at the end of the study.
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Affiliation(s)
- Aljohara S Almeneessier
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salih Aleissi
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Awad H Olaish
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed S BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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22
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Jamil SM, Owens RL, Lipford MC, Shafazand S, Marron RM, Vega Sanchez ME, Lam MT, Sunwoo BY, Schmickl C, Orr JE, Sharma S, Sankari A, Javaheri S, Bertisch S, Dupuy-McCauley K, Kolla B, Imayama I, Prasad B, Guzman E, Hayes MM, Wang T. ATS Core Curriculum 2020. Adult Sleep Medicine. ATS Sch 2020; 1:476-94. [PMID: 33870314 DOI: 10.34197/ats-scholar.2020-0017RE] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The American Thoracic Society Core Curriculum updates clinicians annually in adult and pediatric pulmonary disease, medical critical care, and sleep medicine, in a 3–4-year recurring cycle of topics. These topics will be presented at the 2020 Virtual Conference. Below is the adult sleep medicine core that includes topics pertinent to sleep-disordered breathing and insomnia.
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23
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Abstract
Elderly adults demonstrate increased propensity for breathing instability during sleep compared with younger adults, and this may contribute to increased prevalence of sleep-disordered breathing (SDB) in this population. Hence, in older adults with SDB, we examined whether addition of supplemental oxygen (O2) will stabilize breathing during sleep and alleviate SDB. We hypothesized that exposure to supplemental O2 during non-rapid eye movement (NREM) sleep will stabilize breathing and will alleviate SDB by reducing ventilatory chemoresponsiveness and by widening the carbon dioxide (CO2) reserve. We studied 10 older adults with mild-to-moderate SDB who were randomized to undergo noninvasive bilevel mechanical ventilation with exposure to room air or supplemental O2 (Oxy) to determine the CO2 reserve, apneic threshold (AT), and controller and plant gains. Supplemental O2 was introduced during sleep to achieve a steady-state O2 saturation ≥95% and fraction of inspired O2 at 40%-50%. The CO2 reserve increased significantly during Oxy versus room air (-4.2 ± 0.5 mmHg vs. -3.2 ± 0.5 mmHg, P = 0.03). Compared with room air, Oxy was associated with a significant decline in the controller gain (1.9 ± 0.4 L/min/mmHg vs. 2.5 ± 0.5 L/min/mmHg, P = 0.04), with reductions in the apnea-hypopnea index (11.8 ± 2.0/h vs. 24.4 ± 5.6/h, P = 0.006) and central apnea-hypopnea index (1.7 ± 0.6/h vs. 6.9 ± 3.9/h, P = 0.03). The AT and plant gain were unchanged. Thus, a reduced slope of CO2 response resulted in an increased CO2 reserve. In conclusion, supplemental O2 reduced SDB in older adults during NREM sleep via reduction in chemoresponsiveness and central respiratory events.NEW & NOTEWORTHY This study demonstrates for the first time in elderly adults without heart disease that intervention with supplemental oxygen in the clinical range will ameliorate central apneas and hypopneas by decreasing the propensity to central apnea through decreased chemoreflex sensitivity, even in the absence of a reduction in the plant gain. Thus, the study provides physiological evidence for use of supplemental oxygen as therapy for mild-to-moderate SDB in this vulnerable population.
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Affiliation(s)
- Ruchi Rastogi
- Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan.,Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - M S Badr
- Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan.,Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - A Ahmed
- Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - S Chowdhuri
- Medical Service, Sleep Medicine Section, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan.,Division of Pulmonary/Critical Care and Sleep Medicine, Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
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24
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Kasai T. Who will desire upper airway stimulation as a treatment of obstructive sleep apnea in the Japanese patient population? Sleep Biol Rhythms 2020; 18:281-2. [DOI: 10.1007/s41105-020-00281-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Abstract
Obstructive sleep apnea (OSA) telehealth management may improve initial and chronic care access, time to diagnosis and treatment, between-visit care, e-communications and e-education, workflows, costs, and therapy outcomes. OSA telehealth options may be used to replace or supplement none, some, or all steps in the evaluation, testing, treatments, and management of OSA. All telehealth steps must adhere to OSA guidelines. OSA telehealth may be adapted for continuous positive airway pressure (CPAP) and non-CPAP treatments. E-data collection enhances uses for individual and group analytics, phenotyping, testing and treatment selections, high-risk identification and targeted support, and comparative and multispecialty therapy studies.
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de Chazal P, Cistulli PA, Naughton MT. The future of sleep-disordered breathing: A public health crisis. Respirology 2020; 25:688-689. [PMID: 32410274 DOI: 10.1111/resp.13839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/27/2020] [Indexed: 11/27/2022]
Abstract
Find the whole series here https://onlinelibrary.wiley.com/doi/toc/10.1111/(ISSN)1440-1843.new-frontiers-in-sleep-disordered-breathing See cover image.
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Affiliation(s)
- Philip de Chazal
- Charles Perkins Centre and School of Biomedical Engineering, The University of Sydney, Sydney, NSW, Australia
| | - Peter A Cistulli
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Matthew T Naughton
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, VIC, Australia
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Sunwoo BY, Schmickl CN, Malhotra A. Contemporary Concise Review 2019: Sleep and ventilation. Respirology 2020; 25:552-558. [PMID: 32048407 PMCID: PMC7162714 DOI: 10.1111/resp.13781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Bernie Y Sunwoo
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Christopher N Schmickl
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego (UCSD), La Jolla, CA, USA
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Katsumata Y, Terada J, Matsumura T, Koshikawa K, Sakao S, Tomiyoshi G, Shinmen N, Nakamura R, Kuroda H, Nagashima K, Kobayashi Y, Kobayashi E, Iwadate Y, Zhang XM, Hiwasa T, Tatsumi K. Circulating Anti-Sorting Nexins 16 Antibodies as an Emerging Biomarker of Coronary Artery Disease in Patients with Obstructive Sleep Apnea. Diagnostics (Basel) 2020; 10:E71. [PMID: 32012743 DOI: 10.3390/diagnostics10020071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/17/2020] [Accepted: 01/25/2020] [Indexed: 12/21/2022] Open
Abstract
Biomarkers are not available for monitoring the onset and progression of coronary artery disease (CAD) in patients with obstructive sleep apnea (OSA), a major risk factor for arteriosclerotic cardiovascular diseases. This study aimed to test for correlation between circulating anti-Sorting Nexins 16 antibody (SNX16-Ab) levels, CAD history and clinical parameters of patients with OSA. Sixty-four healthy donors, 82 adults with OSA, and 96 with acute coronary syndrome (ACS) were studied. Serum samples were collected at diagnostic polysomnography in the OSA group or at the disease onset in the ACS group. Serum SNX16-Ab levels were measured by amplified luminescence proximity homogeneous assay (AlphaLISA), and correlation between SNX16-Ab levels and clinical parameters was analyzed. SNX16-Ab levels and apnea-hypopnea index (AHI) were weakly correlated. Additionally, logistic regression analyses of OSA group identified that elevated SNX16-Ab level associated with the history of CAD. Circulating SNX16-Ab could increase during CAD pathogenesis in patients with OSA. Further prospective studies are required to prove the predictive potential of SNX16-Ab level in CAD onset of patients with OSA.
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Eastwood PR, Barnes M, MacKay SG, Wheatley JR, Hillman DR, Nguyên XL, Lewis R, Campbell MC, Pételle B, Walsh JH, Jones AC, Palme CE, Bizon A, Meslier N, Bertolus C, Maddison KJ, Laccourreye L, Raux G, Denoncin K, Attali V, Gagnadoux F, Launois SH. Bilateral hypoglossal nerve stimulation for treatment of adult obstructive sleep apnoea. Eur Respir J 2020; 55:13993003.01320-2019. [PMID: 31601716 PMCID: PMC6949509 DOI: 10.1183/13993003.01320-2019] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/21/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIM Hypoglossal nerve stimulation (HNS) decreases obstructive sleep apnoea (OSA) severity via genioglossus muscle activation and decreased upper airway collapsibility. This study assessed the safety and effectiveness at 6 months post-implantation of a novel device delivering bilateral HNS via a small implanted electrode activated by a unit worn externally, to treat OSA: the Genio™ system. METHODS This prospective, open-label, non-randomised, single-arm treatment study was conducted at eight centres in three countries (Australia, France and the UK). Primary outcomes were incidence of device-related serious adverse events and change in the apnoea-hypopnoea index (AHI). The secondary outcome was the change in the 4% oxygen desaturation index (ODI). Additional outcomes included measures of sleepiness, quality of life, snoring and device use. This trial was registered with ClinicalTrials.gov, number NCT03048604. RESULTS 22 out of 27 implanted participants (63% male, aged 55.9±12.0 years, body mass index (BMI) 27.4±3.0 kg·m-2) completed the protocol. At 6 months BMI was unchanged (p=0.85); AHI decreased from 23.7±12.2 to 12.9±10.1 events·h-1, a mean change of 10.8 events·h-1 (p<0.001); and ODI decreased from 19.1±11.2 to 9.8±6.9 events·h-1, a mean change of 9.3 events·h-1 (p<0.001). Daytime sleepiness (Epworth Sleepiness Scale; p=0.01) and sleep-related quality of life (Functional Outcomes of Sleep Questionnaire-10; p=0.02) both improved significantly. The number of bed partners reporting loud, very intense snoring, or leaving the bedroom due to participant snoring decreased from 96% to 35%. 91% of participants reported device use >5 days per week, and 77% reported use for >5 h per night. No device-related serious adverse events occurred during the 6-month post-implantation period. CONCLUSIONS Bilateral HNS using the Genio™ system reduces OSA severity and improves quality of life without device-related complications. The results are comparable with previously published HNS systems despite minimal implanted components and a simple stimulation algorithm.
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Affiliation(s)
- Peter R Eastwood
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Australia .,West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Australia.,University of Melbourne, Parkville, Australia
| | - Stuart G MacKay
- Illawarra ENT Head and Neck Clinic, Wollongong, Australia.,Wollongong Hospital, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, Australia.,Woolcock Institute of Medical Research, Glebe, Australia
| | - John R Wheatley
- Dept of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Australia.,University of Sydney at Westmead Hospital, Westmead, Australia.,Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, Australia
| | - David R Hillman
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Australia.,West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, Australia
| | - Xuân-Lan Nguyên
- Unité de Somnologie et Fonction Respiratoire, Hopital St Antoine, Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Richard Lewis
- Dept Otolaryngology, Head and Neck Surgery, Royal Perth Hospital, Perth, Australia.,Hollywood Private Hospital, Perth, Australia
| | - Matthew C Campbell
- Institute for Breathing and Sleep, Austin Hospital, Heidelberg, Australia.,University of Melbourne, Parkville, Australia
| | - Boris Pételle
- Service ORL Chirurgie de la Face et du Cou, Hôpital Tenon, AP-HP, Paris, Sorbonne Université, Paris, France
| | - Jennifer H Walsh
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Australia.,West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, Australia
| | - Andrew C Jones
- Illawarra ENT Head and Neck Clinic, Wollongong, Australia.,Wollongong Hospital, Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, Australia
| | - Carsten E Palme
- University of Sydney at Westmead Hospital, Westmead, Australia.,The Dept of Otolaryngology Head Neck Surgery, Westmead Hospital, Westmead, Australia
| | - Alain Bizon
- Dept Otolaryngology, Head and Neck Surgery, University Hospital of Angers, Angers, France
| | - Nicole Meslier
- Dept of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France.,INSERM UMR 1063 "SOPAM", University of Angers, Angers, France
| | - Chloé Bertolus
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Stomatologie et Chirurgie Maxillo-faciale, Paris, France
| | - Kathleen J Maddison
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Australia.,West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, Australia
| | - Laurent Laccourreye
- Dept Otolaryngology, Head and Neck Surgery, University Hospital of Angers, Angers, France
| | | | | | - Valérie Attali
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
| | - Frédéric Gagnadoux
- Dept of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France.,INSERM UMR 1063 "SOPAM", University of Angers, Angers, France
| | - Sandrine H Launois
- Unité de Somnologie et Fonction Respiratoire, Hopital St Antoine, Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Yamauchi M, Satoh M, Kitahara T, Ota I, Strohl K. Nerve Stimulation for the Treatment of Obstructive Sleep Apnea. Sleep Biol Rhythms 2020; 18:77-87. [PMID: 38031560 PMCID: PMC10686243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Purpose This review will trace the elements of neurostimulation for obstructive sleep apnea and details on its implementation, efficacy and safety, immediate clinical outcomes, and future prospects. Methods The literature on upper airway neurostimulation was surveyed from July, 2013, to July 2019, with a focus on the components of devices, evidence for clinical utility, and adverse events. Results Current technology is focused on the hypoglossal nerve stimulation (HNS). The most long-term experience is with the Inspire Medical System (Maple Grove, MN USA) which has both FDA and European regulatory approval. Given the inclusion criteria (BMI <35, ideally <32), AHI 15-65/h, and a favorable anterior-posterior velopharyngeal collapse pattern on DISE), across many centers ~65% of patients who are intolerant to primary therapy achieve clinical success (AHI <20/h with a reduction of <50% in AHI), and more have symptomatic relief. Adverse events are generally mild, often self-limited, with occasional need for uncomplicated surgical adjustments or replacement of the implantable generator. Three other devices are in various phases of development, each with a differences in nerve electrodes, implantable components, power sources, proprietary programming, and activation patterns. Conclusions HNS is not considered a first-line treatment option. HNS therapy, however, should be considered as one alternative therapeutic option for patients meeting the inclusion criteria when more traditional therapeutic options have been considered.
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Affiliation(s)
- Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Makoto Satoh
- University of Tsukuba, International Institute for Integrative Sleep Medicine, Tsukuba, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Ichiro Ota
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Kingman Strohl
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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