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Sunwoo BY, Malhotra A. Mechanical Interactions Between the Upper Airway and the Lungs that Affect the Propensity to Obstructive Sleep Apnea in Health and Chronic Lung Disease. Sleep Med Clin 2024; 19:211-218. [PMID: 38692746 DOI: 10.1016/j.jsmc.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive narrowing and collapse of the upper airways during sleep. It is caused by multiple anatomic and nonanatomic factors but end-expiratory lung volume (EELV) is an important factor as increased EELV can stabilize the upper airway via caudal traction forces. EELV is impacted by changes in sleep stages, body position, weight, and chronic lung diseases, and this article reviews the mechanical interactions between the lungs and upper airway that affect the propensity to OSA. In doing so, it highlights the need for additional research in this area.
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Affiliation(s)
- Bernie Y Sunwoo
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA, USA.
| | - Atul Malhotra
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA, USA
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Owen GS, Talati VM, Zhang Y, LoSavio PS, Hutz MJ. The effect of head of bed elevation on upper airway collapsibility during drug-induced sleep endoscopy. J Clin Sleep Med 2024; 20:93-99. [PMID: 37707285 PMCID: PMC10758551 DOI: 10.5664/jcsm.10824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
STUDY OBJECTIVES Drug-induced sleep endoscopy with positive airway pressure evaluates the collapsibility of the upper airway. It is currently unknown whether body position affects this assessment. We sought to determine whether the collapsibility of the airway may change with head of bed elevation. METHODS A prospective, consecutive cohort study was performed by 2 sleep surgeons at a tertiary care center. Inclusion criteria included adults 18 years of age and older with obstructive sleep apnea who were intolerant to continuous positive airway pressure therapy. Patients underwent drug-induced sleep endoscopy with positive airway pressure to evaluate them for alternative treatment options. Patients were evaluated in supine position with the head of bed both level and elevated to 30°. The airway was evaluated using the standardized VOTE scoring system in both positions. RESULTS The 61 patients included in the study were predominantly male (70.5%), middle-aged (51.2 years), and obese (body mass index, 30.2 kg/m2) with moderate-to-severe obstructive sleep apnea (apnea-hypopnea index, 34.1 events/h). The cohort consisted of predominantly positional obstructive sleep apnea (mean supine apnea-hypopnea index 48.7 events/h, nonsupine apnea-hypopnea index 20.8 events/h). All 4 sites of the upper airway demonstrated a significant decrease in airway opening pressures with the head of bed elevated compared to level (P < .01 for all sites). There was no significant difference in VOTE scoring between level and upright positions. CONCLUSIONS Patients with the head of bed elevated to 30° have a significantly lower degree of airway collapsibility compared to patients in the level position but no significant change in VOTE scoring was observed. CITATION Owen GS, Talati VM, Zhang Y, LoSavio PS, Hutz MJ. The effect of head of bed elevation on upper airway collapsibility during drug-induced sleep endoscopy. J Clin Sleep Med. 2024;20(1):93-99.
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Affiliation(s)
- Grant S. Owen
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Vidit M. Talati
- Section of Sleep Surgery, Department of Otolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Yanyu Zhang
- Rush Informatics and Biostatistics Core, Rush University Medical Center, Chicago, Illinois
| | - Phillip S. LoSavio
- Section of Sleep Surgery, Department of Otolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
- Section of Sleep Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Michael J. Hutz
- Section of Sleep Surgery, Department of Otolaryngology – Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
- Section of Sleep Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
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He Y, Liu WT, Lin S, Li Z, Qiu H, Yim SHL, Chuang HC, Ho KF. The joint association of ambient air pollution and different sleep posture with mild obstructive sleep apnea: A study conducted at Taipei Sleep Center. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166531. [PMID: 37633386 DOI: 10.1016/j.scitotenv.2023.166531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Growing evidence suggests the detrimental impact of supine position and air pollution on obstructive sleep apnea (OSA), as well as the potential benefits of nonsupine positions. However, their interaction effects on OSA remain unclear. OBJECTIVES To evaluate the interaction effects of air pollution (NO2/PM2.5) and sleep position on OSA on additive and multiplicative scales. METHODS This study included 3330 individuals. Personal exposure to air pollution was assessed using a spatiotemporal model. OSA was diagnosed through polysomnography. The associations of supine and nonsupine positions and air pollutants with mild-OSA and their interaction effects on mild-OSA. were explored through generalized logistic regression. RESULTS Supine position and high NO2 level independently increased the risk of mild-OSA, while PM2.5 was not associated with mild-OSA. Significant interactions were observed between supine position and NO2 at different lag periods (0-7 days, 0-1 year, and 0-2 years) (P = 0.042, 0.013, and 0.010, respectively). The relative excess risks due to interactions on the additive scale for 1-week, 1-year, and 2-year NO2 exposure and supine position were 0.63 (95 % CI: 0.10-1.16), 0.56 (95 % CI: 0.13-0.99), and 0.64 (95 % CI: 0.18-1.10); the corresponding odds ratios for interactions on the multiplicative scale were 1.45 (95 % CI: 1.01-2.07), 1.55 (95 % CI: 1.09-2.22), and 1.60 (95 % CI: 1.12-2.28). The positive interactions persisted in men and participants with obesity. No interaction was observed between nonsupine position and NO2 levels; nevertheless, significant interactions were noted on both the negative additive and multiplicative scales in men. CONCLUSION Prolonged supine sleep significantly increased the risk of mild-OSA, particularly in men and individuals with obesity. Although the benefits of nonsupine position are considerably less than the risks of NO2 exposure, avoiding prolonged supine sleep may reduce the risk of mild-OSA caused by high levels of NO2 in men.
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Affiliation(s)
- Yansu He
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
| | - Wen-Te Liu
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shangyang Lin
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Zhiyuan Li
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China
| | - Hong Qiu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China
| | - Steve Hung Lam Yim
- The Asian School of the Environment, Nanyang Technological University, Singapore
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kin Fai Ho
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, HKSAR, China; Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, HKSAR, China.
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Lechat B, Scott H, Manners J, Adams R, Proctor S, Mukherjee S, Catcheside P, Eckert DJ, Vakulin A, Reynolds AC. Multi-night measurement for diagnosis and simplified monitoring of obstructive sleep apnoea. Sleep Med Rev 2023; 72:101843. [PMID: 37683555 DOI: 10.1016/j.smrv.2023.101843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/13/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023]
Abstract
Substantial night-to-night variability in obstructive sleep apnoea (OSA) severity has raised misdiagnosis and misdirected treatment concerns with the current prevailing single-night diagnostic approach. In-home, multi-night sleep monitoring technology may provide a feasible complimentary diagnostic pathway to improve both the speed and accuracy of OSA diagnosis and monitor treatment efficacy. This review describes the latest evidence on night-to-night variability in OSA severity, and its impact on OSA diagnostic misclassification. Emerging evidence for the potential impact of night-to-night variability in OSA severity to influence important health risk outcomes associated with OSA is considered. This review also characterises emerging diagnostic applications of wearable and non-wearable technologies that may provide an alternative, or complimentary, approach to traditional OSA diagnostic pathways. The required evidence to translate these devices into clinical care is also discussed. Appropriately sized randomised controlled trials are needed to determine the most appropriate and effective technologies for OSA diagnosis, as well as the optimal number of nights needed for accurate diagnosis and management. Potential risks versus benefits, patient perspectives, and cost-effectiveness of these novel approaches should be carefully considered in future trials.
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Affiliation(s)
- Bastien Lechat
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia.
| | - Hannah Scott
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Jack Manners
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Simon Proctor
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Sutapa Mukherjee
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Peter Catcheside
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute/Adelaide Institute for Sleep Health, Flinders University, Australia
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Messineo L, Joosten S, Perger E. Mechanisms relating to sleeping position to the endotypes of sleep disordered breathing. Curr Opin Pulm Med 2023; 29:543-549. [PMID: 37578380 DOI: 10.1097/mcp.0000000000001004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) severity varies considerably depending on the body position during sleep in certain subjects. Such variability may be underpinned by specific, body position-related changes in OSA pathophysiological determinants, or endotypes. Also head position relative to trunk may influence OSA endotypes. However, no studies to our knowledge have reviewed the endotype variations according to head or body position up to now. RECENT FINDINGS Several findings illustrate that supine OSA is mostly attributable to unfavorable upper airway anatomy compared to lateral position. However, a reduced lung volume, with consequent ventilatory instability (or elevated loop gain), may also play a role. Furthermore, preliminary findings suggest that prone and reclined positions may have a beneficial effect on collapsibility and loop gain. SUMMARY Sleeping supine induces many unfavorable pathophysiological changes, especially in certain predisposed OSA patients. Little is known on the influence of other sleep positions on key endotypic traits.
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Affiliation(s)
- Ludovico Messineo
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Simon Joosten
- Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, Australia
- School of Clinical Sciences, Monash University, Victoria, Australia
- Epworth Partners
| | - Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
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Liu S, Huang X, Fu N, Li C, Su Z, Ostadabbas S. Simultaneously-Collected Multimodal Lying Pose Dataset: Enabling In-Bed Human Pose Monitoring. IEEE TRANSACTIONS ON PATTERN ANALYSIS AND MACHINE INTELLIGENCE 2023; 45:1106-1118. [PMID: 35239476 DOI: 10.1109/tpami.2022.3155712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Computer vision field has achieved great success in interpreting semantic meanings from images, yet its algorithms can be brittle for tasks with adverse vision conditions and the ones suffering from data/label pair limitation. Among these tasks is in-bed human pose monitoring with significant value in many healthcare applications. In-bed pose monitoring in natural settings involves pose estimation in complete darkness or full occlusion. The lack of publicly available in-bed pose datasets hinders the applicability of many successful human pose estimation algorithms for this task. In this paper, we introduce our Simultaneously-collected multimodal Lying Pose (SLP) dataset, which includes in-bed pose images from 109 participants captured using multiple imaging modalities including RGB, long wave infrared (LWIR), depth, and pressure map. We also present a physical hyper parameter tuning strategy for ground truth pose label generation under adverse vision conditions. The SLP design is compatible with the mainstream human pose datasets; therefore, the state-of-the-art 2D pose estimation models can be trained effectively with the SLP data with promising performance as high as 95% at PCKh@0.5 on a single modality. The pose estimation performance of these models can be further improved by including additional modalities through the proposed collaborative scheme.
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Muacevic A, Adler JR. Effects of Rapid Maxillary Expansion on Upper Airway Volume in Growing Children: A Three-Dimensional Cone-Beam Computed Tomography Study. Cureus 2023; 15:e34274. [PMID: 36855483 PMCID: PMC9968479 DOI: 10.7759/cureus.34274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
Background: Rapid maxillary expansion (RME) is a common orthodontic procedure that widens the maxillary arch to treat moderate to mild overcrowding and transverse skeletal and dental abnormalities. Orthodontic equipment applies lateral tension on posterior maxilla teeth or palate mucosa to the mid-palatal suture. The maxilla may grow transversely when force is applied at right angles to the mid-palatal suture, which is usually inactive in children and adolescents. This study used cone-beam computed tomography (CBCT) and an authorized upper respiratory airway volume measurement approach to compare RME cohort pharyngeal airway volume changes to healthy controls. Materials and Methods: This retrospective analysis included 52 RME patients and 52 healthy controls. The RME category's expansion regimen entailed twisting the screw of expansion on a tooth-attached Hyrax-type expansion equipment by 0.25 mm daily for at least 14 days. After six months, a few RME participants used fixed orthodontic gear. The comparison group used fixed orthodontic appliances for minor malocclusions without extractions (without RME). CBCT scans from 1021 orthodontic patients who visited a dental hospital between 2012 and 2022 were examined. The registry comprised only anonymized photographs. Volume, minimum cross-sectional area (MCA), molar width, and inter-molar width were measured before and after therapy. Results: The control group had 12227.12 mm3 at T0 and 15805.54 mm3 at T1. The control group's T0-T1 volume difference was statistically significant (p = 0.007). The RME group has 12884.84 mm3 at T0 and 17471.08 mm3 at T1. The RME group had a significant volume difference at T0 and T1 (p = 0.002). The volume RME effect was ±1011.92 and statistically insignificant. (p > 0.05). MCA in the control group was 126.04 mm2 at T0 and 170.61 mm2 at T1. MCA at T0 and T1 in the control group was statistically significant (p = 0.041). RME group MCA was 126.53 mm3 at T0 and 164.69 mm2 at T1. The RME group had a significant volume difference at T0 and T1 (p = 0.002). The MCA, RME effect was 5.92 and statistically insignificant (p > 0.05). Both the control and RME groups had statistically significant volume and MCA differences at T0 and T1. However, the intergroup analysis showed no significant differences across the groups. Conclusion: Tooth-borne RME does not affect upper airway or MCA volume in children compared to controls. Upper airway changes were better with younger skeletal ages before treatment. The findings may aid RME for young children.
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Affiliation(s)
- Alexander Muacevic
- Orthodontics Department of Preventive Dental Sciences, Albaha University College of Dentistry, Albaha, SAU
| | - John R Adler
- Orthodontics Department of Preventive Dental Sciences, Albaha University College of Dentistry, Albaha, SAU
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Iannella G, Cammaroto G, Meccariello G, Cannavicci A, Gobbi R, Lechien JR, Calvo-Henríquez C, Bahgat A, Di Prinzio G, Cerritelli L, Maniaci A, Cocuzza S, Polimeni A, Magliulo G, Greco A, de Vincentiis M, Ralli M, Pace A, Polimeni R, Lo Re F, Morciano L, Moffa A, Casale M, Vicini C. Head-Of-Bed Elevation (HOBE) for Improving Positional Obstructive Sleep Apnea (POSA): An Experimental Study. J Clin Med 2022; 11:jcm11195620. [PMID: 36233488 PMCID: PMC9571825 DOI: 10.3390/jcm11195620] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Evaluate the effectiveness of the head-of-bed elevation position (HOBE) with a 30° elevation of the head and trunk, in improving obstruction of the upper airways in obstructive sleep apnea (OSA) patients. A prospective trial simultaneously performing drug-induced sleep endoscopy (DISE) and polysomnography (PSG) tests was performed. Methods: Forty-five patients were included in the prospective study protocol. All patients enrolled in the study and underwent the following evaluations: (1) a drug-induced sleep endoscopy, with an evaluation of obstructions and collapse of the upper airways at 0° and in a HOBE position, with head and trunk elevation of 30°; (2) an overnight PSG assessment in the hospital with head and trunk elevation from 0° to 30° during the night; (3) a questionnaire to evaluate the feedback of patients to sleeping with head-of-bed elevation. Results: Velum (V) and oropharynx lateral wall (O) collapses were reduced in the 30° up position. There were no statistical differences that emerged in the obstruction of the tongue base and epiglottis between the 0° position and the 30° up position (p > 0.05). The average AHI score changed from 23.8 ± 13.3 (0° supine position) to 17.7 ± 12.4 (HOBE position), with a statistical difference (p = 0.03); the same statistical difference emerged in the percentage of apneas that decreased from 55 ± 28.1 to 44 ± 25.8 (p = 0.05). Conclusions: By adopting the HOBE position with 30° elevation of the head and trunk, it is possible to obtain a reduction of upper airways collapses and an improvement of apnea/hypopnea events and nightly respiratory outcomes.
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Affiliation(s)
- Giannicola Iannella
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini 34, 47121 Forlì, Italy
- Correspondence:
| | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini 34, 47121 Forlì, Italy
| | - Angelo Cannavicci
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini 34, 47121 Forlì, Italy
| | - Riccardo Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini 34, 47121 Forlì, Italy
| | - Jerome Rene Lechien
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons (UMONS), Avenue du Champ de Mars 6, B7000 Mons, Belgium
| | - Christian Calvo-Henríquez
- Clinic of Otolaryngology, Hospital Complex of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Ahmed Bahgat
- Department of Otorhinolaryngology, Alexandria University, Elazaritta, Alexandria 0020, Egypt
| | - Giuseppe Di Prinzio
- Department ENT & Audiology, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy
| | - Luca Cerritelli
- Department ENT & Audiology, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Via S. Sofia 78, 95125 Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Via S. Sofia 78, 95125 Catania, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillo Facial Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Giuseppe Magliulo
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy
| | - Antonio Greco
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy
| | - Marco de Vincentiis
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy
| | - Massimo Ralli
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy
| | - Annalisa Pace
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy
| | - Roberta Polimeni
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy
| | - Federica Lo Re
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy
| | - Laura Morciano
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy
| | - Antonio Moffa
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Manuele Casale
- School of Medicine, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini 34, 47121 Forlì, Italy
- Department ENT & Audiology, University of Ferrara, Via Savonarola 9, 44121 Ferrara, Italy
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Verbraecken J, Dieltjens M, Op de Beeck S, Vroegop A, Braem M, Vanderveken O, Randerath W. Non-CPAP therapy for obstructive sleep apnoea. Breathe (Sheff) 2022; 18:220164. [PMID: 36340820 PMCID: PMC9584565 DOI: 10.1183/20734735.0164-2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022] Open
Abstract
Treatment of obstructive sleep apnoea in adults is evolving, from a "one treatment fits all" to a more individualised approach. The spectrum of treatment options is broad and heterogeneous, including conservative, technological and pharmaceutical modalities. This raises the questions of which patients these modalities might be useful for, and if there are specific criteria for single or combined treatment. The most commonly used non-CPAP treatment is a mandibular advancement device. Furthermore, it appears from the available evidence that upper airway surgery, bariatric surgery, and maxillomandibular advancement can be effective in particular patient groups and should be indicated more readily in clinical practice. Technically, a tracheotomy is the most effective surgical treatment, but is not socially acceptable and is associated with major side-effects. Other treatment options are emerging, like positional therapy, hypoglossal nerve stimulation, and myofunctional exercises. Drug therapy is also promising when pathophysiological traits are considered. The range of currently available treatment options will be discussed in this review, with emphasis on the selection of appropriate patients, therapeutic efficacy and compliance, and reference to recent guidelines. In the selection process, routine application of drug-induced sleep endoscopy to assess the site(s) of collapse during sleep can increase the success rate of both surgical interventions and oral appliance therapy. Educational aims To outline recommendations concerning the proper management of obstructive sleep apnoea (OSA) patients that cannot be treated adequately with continuous positive airway pressure (CPAP) due to intolerance, poor adherence or compliance, or CPAP refusal.To provide information about the selection of appropriate patients for alternative non-CPAP treatment options.To better understand the different aspects of OSA treatment with noninvasive approaches, such as oral appliances, positional therapy, drug treatment and myofunctional therapy, including indications, contraindications, and expected short- and long-term results.To discuss the different surgical options for the treatment of OSA and to provide information on the important issue of proper patient selection for surgery, as most OSA surgical outcomes are associated with the pre-operative assessment of the level(s) of upper airway collapse.
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Affiliation(s)
- Johan Verbraecken
- Department of Pulmonary Medicine, Antwerp University Hospital, Edegem (Antwerp), Belgium,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium,Corresponding author: Johan Verbraecken ()
| | - Marijke Dieltjens
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium,Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Sara Op de Beeck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Anneclaire Vroegop
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc Braem
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Olivier Vanderveken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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Lechat B, Catcheside P, Reynolds A, Adams RJ, McEvoy RD, Eckert DJ. Reply to Martinez-Garcia et al. and to Abreu and Punjabi. Am J Respir Crit Care Med 2022; 206:126-129. [PMID: 35476630 DOI: 10.1164/rccm.202201-0116le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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Combination therapy of high-flow nasal cannula and upper body elevation for postoperative sleep disordered breathing; randomized cross-over trial. Anesthesiology 2022; 137:15-27. [PMID: 35471655 DOI: 10.1097/aln.0000000000004254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Low acceptance rate of continuous positive airway pressure therapy in postoperative patients with untreated obstructive sleep apnea (OSA) indicates the necessity for development of an alternative postoperative airway management strategy. We considered whether the combination of high-flow nasal cannula and upper body elevation could improve postoperative OSA. METHODS This non-blinded randomized crossover study performed at a single university hospital investigated the effect on a modified apnea hypopnea index, based exclusively on the airflow signal without arterial oxygen saturation criteria (flow-based apnea hypopnea index, primary outcome), of high-flow nasal cannula (20 liter.minute-1 with 40% oxygen concentration) with and without upper body elevation in patients with moderate to severe OSA. Preoperative sleep studies were performed at home (control, no head-of-bed elevation) and in hospital (30-degree head-of-bed elevation). On the first and second postoperative nights, high-flow nasal cannula was applied with or without 30-degree head-of-bed elevation, assigned in random order to 23 eligible participants. RESULTS Twenty-two out of the 23 (96%) accepted high-flow nasal cannula. Four participants resigned from the study. Control flow-based apnea hypopnea index (mean±SD: 59.6 ± 12.0 events.hour-1, n=19) was reduced by 14.7 (95% CI: 5.5 to 30.0) events.hour-1 with head-of-bed elevation alone (p=0.002), 10.9 (1.2 to 20.6) events.hour-1 with high-flow nasal cannula alone (p=0.028), and 22.5 (13.1 to 31.9) events.hour-1 with combined head-of-bed elevation and high-flow nasal cannula (p<0.001). Compared to sole high-flow nasal cannula, additional intervention with head-of-bed elevation significantly decreased flow-based apnea hypopnea index by 11.5 events.hour-1 (1.7 to 21.4) (p=0.022). High-flow nasal cannula, alone or in combination with head-of-bed elevation also improved overnight oxygenation. No harmful events were observed. CONCLUSION The combination of high-flow nasal cannula and upper body elevation reduced OSA severity and nocturnal hypoxemia, suggesting a role for it as an alternate postoperative airway management strategy.
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Gumidyala R, Selzer A. Preoperative optimization of obstructive sleep apnea. Int Anesthesiol Clin 2022; 60:24-32. [PMID: 34897219 DOI: 10.1097/aia.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Baek S, Yu H, Roh J, Lee J, Sohn I, Kim S, Park C. Effect of a Recliner Chair with Rocking Motions on Sleep Efficiency. SENSORS (BASEL, SWITZERLAND) 2021; 21:8214. [PMID: 34960304 PMCID: PMC8706869 DOI: 10.3390/s21248214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
In this study, we analyze the effect of a recliner chair with rocking motions on sleep quality of naps using automated sleep scoring and spindle detection models. The quality of sleep corresponding to the two rocking motions was measured quantitatively and qualitatively. For the quantitative evaluation, we conducted a sleep parameter analysis based on the results of the estimated sleep stages obtained on the brainwave and spindle estimation, and a sleep survey assessment from the participants was analyzed for the qualitative evaluation. The analysis showed that sleep in the recliner chair with rocking motions positively increased the duration of the spindles and deep sleep stage, resulting in improved sleep quality.
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Affiliation(s)
- Suwhan Baek
- Department of Computer engineering, Kwangwoon University, Seoul 01897, Korea
| | - Hyunsoo Yu
- Department of Computer engineering, Kwangwoon University, Seoul 01897, Korea
| | - Jongryun Roh
- Digital Transformation RnD Department, Korea Institute of Industrial Technology, Ansan 15588, Korea
| | - Jungnyun Lee
- Digital Transformation RnD Department, Korea Institute of Industrial Technology, Ansan 15588, Korea
| | - Illsoo Sohn
- Department of Computer Science and Engineering, Seoul National University of Science and Technology, Seoul 01811, Korea
| | - Sayup Kim
- Digital Transformation RnD Department, Korea Institute of Industrial Technology, Ansan 15588, Korea
| | - Cheolsoo Park
- Department of Computer engineering, Kwangwoon University, Seoul 01897, Korea
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14
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Cozowicz C, Memtsoudis SG. Perioperative Management of the Patient With Obstructive Sleep Apnea: A Narrative Review. Anesth Analg 2021; 132:1231-1243. [PMID: 33857965 DOI: 10.1213/ane.0000000000005444] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The prevalence of obstructive sleep apnea (OSA) has reached 1 billion people worldwide, implying significant risk for the perioperative setting as patients are vulnerable to cardiopulmonary complications, critical care requirement, and unexpected death. This review summarizes main aspects and considerations for the perioperative management of OSA, a condition of public health concern. Critical determinants of perioperative risk include OSA-related changes in upper airway anatomy with augmented collapsibility, diminished capability of upper airway dilator muscles to respond to airway obstruction, disparities in hypoxemia and hypercarbia arousal thresholds, and instability of ventilatory control. Preoperative OSA screening to identify patients at increased risk has therefore been implemented in many institutions. Experts recommend that in the absence of severe symptoms or additional compounding health risks, patients may nevertheless proceed to surgery, while heightened awareness and the adjustment of postoperative care is required. Perioperative caregivers should anticipate difficult airway management in OSA and be prepared for airway complications. Anesthetic and sedative drug agents worsen upper airway collapsibility and depress central respiratory activity, while the risk for postoperative respiratory compromise is further increased with the utilization of neuromuscular blockade. Consistently, opioid analgesia has proven to be complex in OSA, as patients are particularly prone to opioid-induced respiratory depression. Moreover, basic features of OSA, including intermittent hypoxemia and repetitive sleep fragmentation, gradually precipitate a higher sensitivity to opioid analgesic potency along with an increased perception of pain. Hence, regional anesthesia by blockade of neural pathways directly at the site of surgical trauma as well as multimodal analgesia by facilitating additive and synergistic analgesic effects are both strongly supported in the literature as interventions that may reduce perioperative complication risk. Health care institutions are increasingly allocating resources, including those of postoperative enhanced monitoring, in an effort to increase patient safety. The implementation of evidence-based perioperative management strategies is however burdened by the rising prevalence of OSA, the large heterogeneity in disease severity, and the lack of evidence on the efficacy of costly perioperative measures. Screening and monitoring algorithms, as well as reliable risk predictors, are urgently needed to identify OSA patients that are truly in need of extended postoperative surveillance and care. The perioperative community is therefore challenged to develop feasible pathways and measures that can confer increased patient safety and prevent complications in patients with OSA.
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Affiliation(s)
- Crispiana Cozowicz
- From the Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Stavros G Memtsoudis
- From the Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.,Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York
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15
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Jeng PY, Wang LC, Hu CJ, Wu D. A Wrist Sensor Sleep Posture Monitoring System: An Automatic Labeling Approach. SENSORS 2021; 21:s21010258. [PMID: 33401750 PMCID: PMC7795231 DOI: 10.3390/s21010258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/12/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022]
Abstract
In the hospital, a sleep postures monitoring system is usually adopted to transform sensing signals into sleep behaviors. However, a home-care sleep posture monitoring system needs to be user friendly. In this paper, we present iSleePost—a user-friendly home-care intelligent sleep posture monitoring system. We address the labor-intensive labeling issue of traditional machine learning approaches in the training phase. Our proposed mobile health (mHealth) system leverages the communications and computation capabilities of mobile phones for provisioning a continuous sleep posture monitoring service. Our experiments show that iSleePost can achieve up to 85 percent accuracy in recognizing sleep postures. More importantly, iSleePost demonstrates that an easy-to-wear wrist sensor can accurately quantify sleep postures after our designed training phase. It is our hope that the design concept of iSleePost can shed some lights on quantifying human sleep postures in the future.
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Affiliation(s)
- Po-Yuan Jeng
- Department of Electrical and Computing Engineering, National Chiao Tung University, Hsinchu 30010, Taiwan;
| | - Li-Chun Wang
- Department of Electrical and Computing Engineering, National Chiao Tung University, Hsinchu 30010, Taiwan;
- Correspondence:
| | - Chaur-Jong Hu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (C.-J.H.); (D.W.)
- Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, New Taipei City 23561, Taiwan
- Sleep Center, Shuang-Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
| | - Dean Wu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; (C.-J.H.); (D.W.)
- Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, New Taipei City 23561, Taiwan
- Sleep Center, Shuang-Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
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Álvarez D, Arroyo CA, de Frutos JF, Crespo A, Cerezo-Hernández A, Gutiérrez-Tobal GC, Vaquerizo-Villar F, Barroso-García V, Moreno F, Ruiz T, Hornero R, del Campo F. Assessment of Nocturnal Autonomic Cardiac Imbalance in Positional Obstructive Sleep Apnea. A Multiscale Nonlinear Approach. ENTROPY (BASEL, SWITZERLAND) 2020; 22:E1404. [PMID: 33322747 PMCID: PMC7764670 DOI: 10.3390/e22121404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022]
Abstract
Positional obstructive sleep apnea (POSA) is a major phenotype of sleep apnea. Supine-predominant positional patients are frequently characterized by milder symptoms and less comorbidity due to a lower age, body mass index, and overall apnea-hypopnea index. However, the bradycardia-tachycardia pattern during apneic events is known to be more severe in the supine position, which could affect the cardiac regulation of positional patients. This study aims at characterizing nocturnal heart rate modulation in the presence of POSA in order to assess potential differences between positional and non-positional patients. Patients showing clinical symptoms of suffering from a sleep-related breathing disorder performed unsupervised portable polysomnography (PSG) and simultaneous nocturnal pulse oximetry (NPO) at home. Positional patients were identified according to the Amsterdam POSA classification (APOC) criteria. Pulse rate variability (PRV) recordings from the NPO readings were used to assess overnight cardiac modulation. Conventional cardiac indexes in the time and frequency domains were computed. Additionally, multiscale entropy (MSE) was used to investigate the nonlinear dynamics of the PRV recordings in POSA and non-POSA patients. A total of 129 patients (median age 56.0, interquartile range (IQR) 44.8-63.0 years, median body mass index (BMI) 27.7, IQR 26.0-31.3 kg/m2) were classified as POSA (37 APOC I, 77 APOC II, and 15 APOC III), while 104 subjects (median age 57.5, IQR 49.0-67.0 years, median BMI 29.8, IQR 26.6-34.7 kg/m2) comprised the non-POSA group. Overnight PRV recordings from positional patients showed significantly higher disorderliness than non-positional subjects in the smallest biological scales of the MSE profile (τ = 1: 0.25, IQR 0.20-0.31 vs. 0.22, IQR 0.18-0.27, p < 0.01) (τ = 2: 0.41, IQR 0.34-0.48 vs. 0.37, IQR 0.29-0.42, p < 0.01). According to our findings, nocturnal heart rate regulation is severely affected in POSA patients, suggesting increased cardiac imbalance due to predominant positional apneas.
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Affiliation(s)
- Daniel Álvarez
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 47011 Valladolid, Spain
| | - C. Ainhoa Arroyo
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
| | - Julio F. de Frutos
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
| | - Andrea Crespo
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
| | - Ana Cerezo-Hernández
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
| | - Gonzalo C. Gutiérrez-Tobal
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 47011 Valladolid, Spain
| | - Fernando Vaquerizo-Villar
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
| | - Verónica Barroso-García
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
| | - Fernando Moreno
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
| | - Tomás Ruiz
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
| | - Roberto Hornero
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 47011 Valladolid, Spain
| | - Félix del Campo
- Pneumology Department, Río Hortega University Hospital, 47012 Valladolid, Spain; (C.A.A.); (J.F.d.F.); (A.C.); (A.C.-H.); (F.M.); (T.R.)
- Biomedical Engineering Group, University of Valladolid, 47011 Valladolid, Spain; (G.C.G.-T.); (F.V.-V.); (V.B.-G.); (R.H.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 47011 Valladolid, Spain
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Riaz M, Ravula S, Obesso PD, Nigam G, Baran AS. The effect of torso elevation on minimum effective continuous positive airway pressure for treatment of obstructive sleep apnea. Sleep Breath 2020; 24:499-504. [PMID: 31286329 DOI: 10.1007/s11325-019-01880-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/02/2019] [Accepted: 06/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is considered the gold standard treatment of obstructive sleep apnea (OSA). However, it can be a challenge in some patients to find an effective CPAP setting that is well tolerated. A lower CPAP setting may improve patient tolerance of the treatment. The objective of this study was to evaluate the effect of approximately 30° torso elevation on minimum effective CPAP for the treatment of OSA. METHODS A retrospective chart review was performed to determine the effective CPAP setting required to treat OSA in patients who underwent CPAP titration with torso elevation using a wedge cushion, after having failed during the same titration study to achieve therapeutic results at CPAP of 20 cm H2O without torso elevation. RESULTS Thirty-nine patients who underwent CPAP titration with and without torso elevation utilizing a wedge cushion had statistically significant lowering of the minimum effective CPAP setting with torso elevation, with a mean CPAP reduction of 4.7 (p < 0.001) compared to ineffective treatment at CPAP of 20 cm H2O without torso elevation. Apnea hypopnea index (AHI), respiratory disturbance index (RDI), and lowest oxygen saturation (SpO2) were all improved with torso elevation, with a mean AHI difference of 4.4 (p = 0.03), mean RDI difference of 14.2 (p = 0.001), and mean SpO2 difference of 5.9% (p = 0.002). Age and BMI were inversely correlated, and gender had no correlation with therapeutic CPAP settings with use of torso elevation. CONCLUSION Torso elevation of approximately 30° resulted in effective CPAP treatment at settings significantly lower than 20 cm H2O in all reviewed OSA patients, who had been ineffectively treated without torso elevation at the maximum tested setting of 20 cm H2O. This intervention may be a useful adjunct during in-lab titration studies for patients who are not effectively treated at or cannot tolerate high CPAP settings.
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Affiliation(s)
- Muhammad Riaz
- Astria Health Center, 208 N. Euclid, Grandview, WA, 98930, USA
| | - Shantan Ravula
- St. Elizabeth Physicians, 2647 St. Elizabeth Blvd, Gonzales, LA, 70737, USA
| | - Peter Daniel Obesso
- University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA
| | - Gaurav Nigam
- Presbyterian Hospital, 1010 Spruce St, Espanola, NM, 87532, USA
| | - Alp Sinan Baran
- Sleep Disorders Center, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
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18
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Linz D, Baumert M, Desteghe L, Kadhim K, Vernooy K, Kalman JM, Dobrev D, Arzt M, Sastry M, Crijns HJ, Schotten U, Cowie MR, McEvoy RD, Heidbuchel H, Hendriks J, Sanders P, Lau DH. Nightly sleep apnea severity in patients with atrial fibrillation: Potential applications of long-term sleep apnea monitoring. IJC HEART & VASCULATURE 2019; 24:100424. [PMID: 31763438 PMCID: PMC6859526 DOI: 10.1016/j.ijcha.2019.100424] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In patients with atrial fibrillation (AF), the prevalence of moderate-to-severe sleep-disordered breathing (SDB) ranges between 21% and 72% and observational studies have demonstrated that SDB reduces the efficacy of rhythm control strategies, while treatment with continuous positive airway pressure lowers the rate of AF recurrence. Currently, the number of apneas and hypopneas per hour (apnea-hypopnea-index, AHI) determined during a single overnight sleep study is clinically used to assess the severity of SDB. However, recent studies suggest that SDB-severity in an individual patient is not stable over time but exhibits a considerable night-to-night variability which cannot be detected by only one overnight sleep assessment. Nightly SDB-severity assessment rather than the single-night diagnosis by one overnight sleep study may better reflect the exposure to SDB-related factors and yield a superior metric to determine SDB-severity in the management of AF. In this review we discuss mechanisms of night-to-night SDB variability, arrhythmogenic consequences of night-to-night SDB variability, strategies for longitudinal assessment of nightly SDB-severity and clinical implications for screening and management of SDB in AF patients.
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Affiliation(s)
- Dominik Linz
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Mathias Baumert
- University of Adelaide, School of Electrical and Electronic Engineering, Adelaide, Australia
| | - Lien Desteghe
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Kadhim Kadhim
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Jonathan M. Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Medical Centre Regensburg, Regensburg, Germany
| | - Manu Sastry
- Academic Sleep Centre (CIRO+), Horn, the Netherlands
| | - Harry J.G.M. Crijns
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Ulrich Schotten
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Martin R. Cowie
- National Heart and Lung Institute, Imperial College London (Royal Brompton Hospital), London, England, UK
| | - R. Doug McEvoy
- Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University and Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Hein Heidbuchel
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- University of Antwerp and Antwerp University Hospital, Edegem, Belgium
| | - Jeroen Hendriks
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H. Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Arias RS, Etienne B, Polotsky VY, Checkley W, Schwartz AR, Pham LV. Upright posture increases oxyhemoglobin saturation in Peruvian highlanders. Respir Physiol Neurobiol 2019; 266:138-143. [PMID: 31048020 DOI: 10.1016/j.resp.2019.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 02/02/2023]
Abstract
At high altitude, hypoxia amplifies oxyhemoglobin saturation (SPO2) swings with changes in respiratory mechanics. Our objective was to examine the effects of posture on SPO2 and determine predictors of postural SPO2 changes in highlanders. 50 native highlanders from Puno, Peru (3825 m) assumed supine and upright-seated postures, in rotating sequence, while undergoing continuous pulse-oximetry. We compared mean SpO2 in each posture with a paired t-test. We examined associations of BMI, age, sex and spirometry with postural SpO2 changes with mixed-effects linear regression. In highlanders, SpO2 was 84% in the supine posture and was 1.0% ± 1.1 (p < 0.0001) greater in the upright-seated posture. Greater postural changes in SpO2 were associated with older age (p = 0.01 for interaction) but not with sex, BMI, FVC or FEV1. In highlanders, SpO2 is higher in the upright-seated compared to supine posture, especially with older age. Because we generally sleep flat, posture may contribute significantly to highlanders' hypoxemic burden during sleep. Postural intervention during sleep may mitigate nocturnal hypoxemia.
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Affiliation(s)
- Rafael S Arias
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA
| | - Branden Etienne
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA; Department of Computer Science, University of Maryland, College Park, USA
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA
| | - William Checkley
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA; Division of Global Disease Epidemiology and Control, School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Alan R Schwartz
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA
| | - Luu V Pham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA.
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20
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Obstructive sleep apnoea in adults: peri-operative considerations: A narrative review. Eur J Anaesthesiol 2019; 35:245-255. [PMID: 29300271 DOI: 10.1097/eja.0000000000000765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
: Obstructive sleep apnoea (OSA) is a common breathing disorder of sleep with a prevalence increasing in parallel with the worldwide rise in obesity. Alterations in sleep duration and architecture, hypersomnolence, abnormal gas exchange and also associated comorbidities may all feature in affected patients.The peri-operative period poses a special challenge for surgical patients with OSA who are often undiagnosed, and are at an increased risk for complications including pulmonary and cardiovascular, during that time. In order to ensure the best peri-operative management, anaesthetists caring for these patients should have a thorough understanding of the disorder, and be aware of the individual's peri-operative risk constellation, which depends on the severity and phenotype of OSA, the invasiveness of the surgical procedure, anaesthesia and also the requirement for postoperative opioids.The objective of this review is to educate clinicians in the epidemiology, pathogenesis and diagnosis of OSA in adults and also to highlight specific tasks in the preoperative assessment, namely to select a suitable intra-operative anaesthesia regimen, and manage the extent and duration of postoperative care to facilitate the best peri-operative outcome.
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21
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Abdalla Y, Brown L, Sonnesen L. Effects of rapid maxillary expansion on upper airway volume: A three-dimensional cone-beam computed tomography study. Angle Orthod 2019; 89:917-923. [PMID: 30942607 DOI: 10.2319/101218-738.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare changes in pharyngeal airway volume and minimal cross-sectional area (MCA) between patients undergoing rapid maxillary expansion (RME) and a matched control group and to identify markers for predicting airway changes using cone-beam computed tomography (CBCT). MATERIALS AND METHODS Pre- and posttreatment CBCT scans were selected of children who had RME (14 girls and 12 boys; mean age, 12.4 years) along with scans of a control group (matched for chronological age, skeletal age, gender, mandibular inclination) who underwent orthodontic treatment for minor malocclusions without RME. Changes in airway volume and MCA were evaluated using a standardized, previously validated method and analyzed by a mixed-effects linear regression model. RESULTS Upper airway volume and MCA increased significantly over time for both the RME and matched control groups (P < .01 and P = .05, respectively). Although the RME group showed a greater increase when compared with the matched controls, this difference was not statistically significant. A reduced skeletal age before treatment was a significant marker for a positive effect on the upper airway volume and MCA changes (P < .01). CONCLUSIONS Tooth-borne RME is not associated with a significant change in upper airway volume or MCA in children when compared with controls. The younger the skeletal age before treatment, the more positive the effect on the upper airway changes. The results may prove valuable, especially in RME of young children.
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Fujita N, Grabitz SD, Shin CH, Hess PE, Mueller N, Bateman BT, Ecker JL, Takahashi O, Houle TT, Nagasaka Y, Eikermann M. Nocturnal desaturation early after delivery: impact of delivery type and the beneficial effects of Fowler's position. Br J Anaesth 2019; 122:e64-e66. [PMID: 30857611 DOI: 10.1016/j.bja.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/27/2018] [Accepted: 01/13/2019] [Indexed: 11/26/2022] Open
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The effect of head rotation on efficiency of face mask ventilation in anaesthetised apnoeic adults: A randomised, crossover study. Eur J Anaesthesiol 2018; 34:432-440. [PMID: 28009638 DOI: 10.1097/eja.0000000000000582] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Upper airway obstruction occurs commonly after induction of general anaesthesia. It is the major cause of difficult mask ventilation. OBJECTIVES The aim of this study was to determine whether head rotation improves the efficiency of mask ventilation of anaesthetised apnoeic adults. DESIGN A randomised, crossover study. SETTING Single university teaching hospital. PATIENTS Forty patients, aged 18 to 75 years with a BMI 18.5 to 35.0 kg m requiring general anaesthesia for elective surgery were recruited and randomised into two groups. INTERVENTIONS Once apnoeic after induction of general anaesthesia, face mask ventilation began with pressure controlled ventilation, at a peak inspiratory pressure of 15 cmH2O. Each patient was ventilated for three 1-min intervals with the head position alternated every minute: group A, mask ventilation was performed with a neutral head position for 1 min, followed by an axial head position rotated 45° to the right for 1 min and then returned to the neutral position for another 1 min. In group B, the sequence of head positioning was rotated → neutral → rotated. MAIN OUTCOME MEASURES Expiratory tidal volume, measured with a respiratory inductive plethysmograph. RESULTS Two patients were excluded due to protocol violation; thus, data from 38 patients were analysed. The mean expiratory tidal volume was significantly higher in the rotated head position than in the neutral position (612.6 vs. 544.0 ml: difference [95% confidence interval], 68.6 [46.8 to 90.4] ml, P < 0.0001). CONCLUSION Head rotation of 45° in anaesthetised apnoeic adults significantly increases the efficiency of mask ventilation compared with the neutral head position. Head rotation is an effective alternative to improve mask ventilation if airway obstruction is encountered. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02755077.
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An update on preoperative assessment and preparation of surgical patients with obstructive sleep apnea. Curr Opin Anaesthesiol 2018; 31:89-95. [DOI: 10.1097/aco.0000000000000539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Understanding Phenotypes of Obstructive Sleep Apnea: Applications in Anesthesia, Surgery, and Perioperative Medicine. Anesth Analg 2017; 124:179-191. [PMID: 27861433 DOI: 10.1213/ane.0000000000001546] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep-disordered breathing with potential long-term major neurocognitive and cardiovascular sequelae. The pathophysiology of OSA varies between individuals and is composed of different underlying mechanisms. Several components including the upper airway anatomy, effectiveness of the upper airway dilator muscles such as the genioglossus, arousal threshold of the individual, and inherent stability of the respiratory control system determine the pathogenesis of OSA. Their recognition may have implications for the perioperative health care team. For example, OSA patients with a high arousal threshold are likely to be sensitive to sedatives and narcotics with a higher risk of respiratory arrest in the perioperative period. Supplemental oxygen therapy can help to stabilize breathing in OSA patients with inherent respiratory instability. Avoidance of supine position can minimize airway obstruction in patients with a predisposition to upper airway collapse in this posture. In this review, the clinically relevant endotypes and phenotypes of OSA are described. Continuous positive airway pressure (CPAP) therapy is the treatment of choice for most patients with OSA but tolerance and adherence can be a problem. Patient-centered individualized approaches to OSA management will be the focus of future research into developing potential treatment options that will help decrease the disease burden and improve treatment effectiveness.
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Abstract
Purpose The purpose of this study is to test the effects of a mild degree of head-of-bed elevation (HOBE) (7.5°) on obstructive sleep apnea (OSA) severity and sleep quality. Methods OSA patients were recruited from a single sleep clinic (Criciúma, Santa Catarina, Brazil). Following a baseline polysomnography (PSG), all patients underwent a PSG with HOBE (within 2 weeks). In addition, a subset of patients performed a third PSG without HOBE. Results Fifty-two patients were included in the study (age 53.2 ± 9.1 years; BMI 29.6 ± 4.8 kg/m2, neck circumference 38.9 ± 3.8 cm, and Epworth Sleepiness Scale 15 ± 7). Compared to baseline, HOBE significantly decreased the apnea-hypopnea index (AHI) from 15.7 [11.3–22.5] to 10.7 [6.6–16.5] events/h; p < 0.001 and increased minimum oxygen saturation from 83.5 [77.5–87] to 87 [81–90]%; p = 0.003. The sleep architecture at baseline and HOBE were similar. However, sleep efficiency increased slightly but significantly with HOBE (87.2 [76.7–90.7] vs 88.8 [81.6–93.3]; p = 0.005). The AHI obtained at the third PSG without HOBE (n = 7) returned to baseline values. Conclusions Mild HOBE significantly improves OSA severity without interfering in sleep architecture and therefore is a simple alternative treatment to ameliorate OSA.
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Souza FJFDB, Evangelista AR, Silva JV, Périco GV, Madeira K. Cervical computed tomography in patients with obstructive sleep apnea: influence of head elevation on the assessment of upper airway volume. J Bras Pneumol 2016; 42:55-60. [PMID: 26982042 PMCID: PMC4805388 DOI: 10.1590/s1806-37562016000000092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 11/30/2015] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Obstructive sleep apnea syndrome (OSAS) has a high prevalence and carries significant cardiovascular risks. It is important to study new therapeutic approaches to this disease. Positional therapy might be beneficial in reducing the apnea-hypopnea index (AHI). Imaging methods have been employed in order to facilitate the evaluation of the airways of OSAS patients and can be used in order to determine the effectiveness of certain treatments. This study was aimed at determining the influence that upper airway volume, as measured by cervical CT, has in patients diagnosed with OSAS. METHODS This was a quantitative, observational, cross-sectional study. We evaluated 10 patients who had been diagnosed with OSAS by polysomnography and on the basis of the clinical evaluation. All of the patients underwent conventional cervical CT in the supine position. Scans were obtained with the head of the patient in two positions (neutral and at a 44° upward inclination), and the upper airway volume was compared between the two. RESULTS The mean age, BMI, and neck circumference were 48.9 ± 14.4 years, 30.5 ± 3.5 kg/m2, and 40.3 ± 3.4 cm, respectively. The mean AHI was 13.7 ± 10.6 events/h (range, 6.0-41.6 events/h). The OSAS was classified as mild, moderate, and severe in 70%, 20%, and 10% of the patients, respectively. The mean upper airway volume was 7.9 cm3 greater when the head was at a 44° upward inclination than when it was in the neutral position, and that difference (17.5 ± 11.0%) was statistically significant (p = 0.002). CONCLUSIONS Elevating the head appears to result in a significant increase in the caliber of the upper airways in OSAS patients.
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Zaremba S, Mueller N, Heisig AM, Shin CH, Jung S, Leffert LR, Bateman BT, Pugsley LJ, Nagasaka Y, Duarte IM, Ecker JL, Eikermann M. Elevated upper body position improves pregnancy-related OSA without impairing sleep quality or sleep architecture early after delivery. Chest 2016; 148:936-944. [PMID: 25905714 DOI: 10.1378/chest.14-2973] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND During pregnancy, upper airway resistance is increased, predisposing vulnerable women to pregnancy-related OSA. Elevation of the upper body increases upper airway cross-sectional area (CSA) and improves severity of OSA in a subgroup of nonpregnant patients (positional-dependent sleep apnea). We tested the hypothesis that elevated position of the upper body improves OSA early after delivery. METHODS Following institutional review board approval, we conducted a randomized, crossover study on two postpartum units of Massachusetts General Hospital. Women during the first 48 h after delivery were included. Polysomnography was performed in nonelevated and 45° elevated upper body position. Upper airway CSA was measured by acoustic pharyngometry in nonelevated, 45° elevated, and sitting body position. RESULTS Fifty-five patients were enrolled, and measurements of airway CSA obtained. Thirty patients completed polysomnography in both body positions. Elevation of the upper body significantly reduced apnea-hypopnea index (AHI) from 7.7 ± 2.2/h in nonelevated to 4.5 ± 1.4/h in 45° elevated upper body position (P = .031) during sleep. Moderate to severe OSA (AHI > 15/h) was diagnosed in 20% of postpartum patients and successfully treated by elevated body position in one-half of them. Total sleep time and sleep architecture were not affected by upper body elevation. Change from nonelevated to sitting position increased inspiratory upper airway CSA from 1.35 ± 0.1 cm2 to 1.54 ± 0.1 cm2 during wakefulness. Position-dependent increase in CSA and decrease in AHI were correlated (r = 0.42, P = .022). CONCLUSIONS Among early postpartum women, 45° upper body elevation increased upper airway CSA and mitigated sleep apnea. Elevated body position might improve respiratory safety in women early after delivery. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01719224; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Sebastian Zaremba
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Sleep Medicine, Department of Neurology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Noomi Mueller
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Anne M Heisig
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Christina H Shin
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Stefanie Jung
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Pediatric Surgery, DRK-Kinderklinik Siegen, Teaching Hospital of Philipps University, Marburg, Germany; Department of Pediatric Urology, DRK-Kinderklinik Siegen, Teaching Hospital of Philipps University, Marburg, Germany
| | - Lisa R Leffert
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Brian T Bateman
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Lori J Pugsley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Yasuko Nagasaka
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ingrid Moreno Duarte
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jeffrey L Ecker
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Anesthesia and Critical Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
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Jackson M, Collins A, Berlowitz D, Howard M, O'Donoghue F, Barnes M. Efficacy of sleep position modification to treat positional obstructive sleep apnea. Sleep Med 2015; 16:545-52. [DOI: 10.1016/j.sleep.2015.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 12/09/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
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Afrashi A, Ucar ZZ. Effect of prone positioning in mild to moderate obstructive sleep apnea syndrome. Sleep Breath 2015; 19:1027-34. [PMID: 25618193 DOI: 10.1007/s11325-014-0985-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 04/08/2014] [Accepted: 04/11/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Sleeping in prone position could be effective in the management of obstructive sleep apnea (OSA) syndrome by reducing the gravity effect on the upper airway and hence collapsibility. Effect of pure prone positioning (PPP) treatment was investigated in mild to moderate OSA. PATIENTS AND METHODS Twenty-nine mild to moderate OSA patients (17 males, 12 females) who gave informed consent were tested with polysomnography at diagnostic and PPP nights. PPP device consisted of a pillow mounted on a table with a hole in the middle keeping the neck 180° extended in prone position. Mean ± SD of age and AHI were 48.4 ± 10.6 and 15.5 ± 6.2, respectively. Patients did not have abdominal and/or truncalobesity, or any condition that could interfere with prone sleeping. RESULTS AHI (mean difference: PPP treatment - diagnostic night: -5.2/h, 95% confidence interval [CI]: -0.1/h to -10.3/h, p = 0.04) and sleep oxygen saturation below 90% (mean difference: -1.80%, 95% CI: -0.22% to -3.37%, p = 0.02) and sleep efficiency (81.0 ± 21.2% and 88.1 ± 7.1 %, respectively, p = 0.02) were significantly lower in PPP than diagnostic night. Response to PPP treatment defined as AHI <5/h in the PPP night was observed in 15 (51.7%) patients, with a better rate in female than male patients (9/12 vs. 6/17, respectively, p = 0.03). CONCLUSIONS To our knowledge, this is the first study to examine the effect of prone positioning in the treatment of mild to moderate OSA. Application of PPP with a more comfortable design in a randomized clinical trial is required to investigate its long term effect in the treatment of mild to moderate OSA.
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Affiliation(s)
- Arman Afrashi
- Department of Otolaryngology - Head and Neck Surgery, Izmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey,
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Horner RL. Neural control of the upper airway: integrative physiological mechanisms and relevance for sleep disordered breathing. Compr Physiol 2013; 2:479-535. [PMID: 23728986 DOI: 10.1002/cphy.c110023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The various neural mechanisms affecting the control of the upper airway muscles are discussed in this review, with particular emphasis on structure-function relationships and integrative physiological motor-control processes. Particular foci of attention include the respiratory function of the upper airway muscles, and the various reflex mechanisms underlying their control, specifically the reflex responses to changes in airway pressure, reflexes from pulmonary receptors, chemoreceptor and baroreceptor reflexes, and postural effects on upper airway motor control. This article also addresses the determinants of upper airway collapsibility and the influence of neural drive to the upper airway muscles, and the influence of common drugs such as ethanol, sedative hypnotics, and opioids on upper airway motor control. In addition to an examination of these basic physiological mechanisms, consideration is given throughout this review as to how these mechanisms relate to integrative function in the intact normal upper airway in wakefulness and sleep, and how they may be involved in the pathogenesis of clinical problems such obstructive sleep apnea hypopnea.
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Mahmoud M, Jung D, Salisbury S, McAuliffe J, Gunter J, Patio M, Donnelly LF, Fleck R. Effect of increasing depth of dexmedetomidine and propofol anesthesia on upper airway morphology in children and adolescents with obstructive sleep apnea. J Clin Anesth 2013; 25:529-41. [DOI: 10.1016/j.jclinane.2013.04.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 02/26/2013] [Accepted: 04/01/2013] [Indexed: 11/30/2022]
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Menon A, Kumar M. Influence of body position on severity of obstructive sleep apnea: a systematic review. ISRN OTOLARYNGOLOGY 2013; 2013:670381. [PMID: 24223313 PMCID: PMC3817704 DOI: 10.1155/2013/670381] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/19/2013] [Indexed: 11/17/2022]
Abstract
Aim. The aim of this review is to determine the relationship between sleeping body posture and severity of obstructive sleep apnea. This relationship has been investigated in the past. However, the conclusions derived from some of these studies are conflicting with each other. This paper intends to summarize the reported relationships between sleep posture and various sleep indices in patients diagnosed with sleep apnea. Methods and Materials. A systematic review of the published English literature during a 25-year period from 1983 to 2008 was performed. Results. Published data concerning the sleep apnea severity and posture in adults are limited. Supine sleep posture is consistently associated with more severe obstructive sleep apnea indices in adults. However, relationship between sleep apnea severity indices and prone posture is inconsistent.
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Affiliation(s)
- Akshay Menon
- Cortland ENT and Sleep Lab, Cortland, NY 13045, USA
| | - Manoj Kumar
- Cortland ENT and Sleep Lab, Cortland, NY 13045, USA
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Low TT, Hong WZ, Tai BC, Hein T, Khoo SM, Tan AY, Chan MY, Richards M, Lee CH. The influence of timing of polysomnography on diagnosis of obstructive sleep apnea in patients presenting with acute myocardial infarction and stable coronary artery disease. Sleep Med 2013; 14:985-90. [DOI: 10.1016/j.sleep.2013.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 02/18/2013] [Accepted: 03/19/2013] [Indexed: 01/24/2023]
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Mollayeva T, Colantonio A, Mollayeva S, Shapiro CM. Screening for sleep dysfunction after traumatic brain injury. Sleep Med 2013; 14:1235-46. [PMID: 24211035 DOI: 10.1016/j.sleep.2013.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 07/12/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
Numerous studies on the high prevalence of sleep disorders in individuals with traumatic brain injury (TBI) have been conducted in the past few decades. These disorders can accentuate other consequences of TBI, negatively impacting mood, exacerbating pain, heightening irritability, and diminishing cognitive abilities and the potential for recovery. Nevertheless, sleep is not routinely assessed in this population. In our review, we examined the selective screening criteria and the scientific evidence regarding screening for post-TBI sleep disorders to identify gaps in our knowledge that are in need of resolution. We retrieved papers written in the English-language literature before June 2012 pertinent to the discussion on sleep after TBI found through a PubMed search. Within our research, we found that sleep dysfunction is highly burdensome after TBI, treatment interventions for some sleep disorders result in favorable outcomes, sensitive and specific tests to detect sleep disorders are available, and the cost-effectiveness and sustainability of screening have been determined from other populations. The evidence we reviewed supports screening for post-TBI sleep dysfunction. This approach could improve the outcomes and reduce the risks for post-TBI adverse health and nonhealth effects (e.g., secondary injuries). A joint sleep and brain injury collaboration focusing on outcomes is needed to improve our knowledge.
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Affiliation(s)
- Tatyana Mollayeva
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario M5G 2A2, Canada; University of Toronto, Toronto, Ontario M5G 1V7, Canada.
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Preoperative screening and perioperative care of the patient with sleep-disordered breathing. Curr Opin Pulm Med 2013; 18:588-95. [PMID: 22990655 DOI: 10.1097/mcp.0b013e3283589e6e] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Emerging data are raising concerns that patients with known or suspected obstructive sleep apnea (OSA) are at increased risk for a myriad of perioperative complications. Strategies to identify patients preoperatively with OSA, or at risk for OSA, are being advocated. In addition, approaches to identify patients most at risk for OSA-related postoperative complications have been described. While lacking solid evidence, a number of perioperative management strategies have been proposed for the care of these patients. RECENT FINDINGS Recent studies utilizing different methodologies have provided additional evidence regarding the impact that OSA can have on postoperative outcomes, including increased risk of difficult intubations, adverse pulmonary outcomes, and delirium. Tools, such as the STOP-Bang questionnaire and limited channel monitoring, have been investigated with regards to their utility to identify not only patients at risk for OSA but also those at risk for more severe OSA. Consensus-based guidelines for the perioperative care of OSA patients have recently been published. SUMMARY OSA is quite common in patients presenting for elective surgery and has been linked to increased perioperative complications. Attempts to identify these patients preoperatively appear prudent. Protocols on how best to manage these patients are available, although validation of their effectiveness is needed.
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Toh ST, Lin CH, Guilleminault C. Usage of four-phase high-resolution rhinomanometry and measurement of nasal resistance in sleep-disordered breathing. Laryngoscope 2012; 122:2343-9. [PMID: 22777838 DOI: 10.1002/lary.23441] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/16/2012] [Accepted: 04/26/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the ease of use of four-phase high-resolution rhinomanometry (HRR), a new way of measuring nasal resistance, in measuring change in nasal resistance from supine to inclined position in a clinical sleep laboratory setting, and to correlate findings with continuous positive airway pressure (CPAP) tolerance. STUDY DESIGN Retrospective review of clinical charts. METHODS Forty successively seen Caucasian subjects diagnosed with sleep-disordered breathing (SDB) with complete charts were analyzed. Using four-phase HRR and acoustic rhinometry, nasal resistance and minimal cross-sectional area of the nasal cavity were objectively measured with the patient in the supine position and repeated in the inclined position (30° from the horizontal plane), respectively. RESULTS From the supine to inclined position, reduction in total nasal resistance was observed in 87.5% (35 out of 40). There was a mean reduction of nasal resistance by 37.1 ± 21.6%. Five (12.5%) out of 40 subjects showed no change or mild increase in nasal resistance. Subjects with nasal resistance unresponsive to the inclined position change tended to have difficulty using nasal CPAP based on downloaded compliance card data. CONCLUSIONS Four-phase HRR and acoustic rhinometry are tests that can be easily performed by sleep specialists to characterize nasal resistance in SDB patients and determine changes in resistance with positional changes. In this study, we found that patients who did not demonstrate a decrease in nasal resistance with inclined position were more likely to be noncompliant with nasal CPAP. These measurements may help us objectively identify patients who might have trouble tolerating nasal CPAP.
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Affiliation(s)
- Song-Tar Toh
- Stanford University Sleep Medicine Division, Stanford University School of Medicine, Stanford, California 94063, USA
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Bignold JJ, Mercer JD, Antic NA, McEvoy RD, Catcheside PG. Accurate position monitoring and improved supine-dependent obstructive sleep apnea with a new position recording and supine avoidance device. J Clin Sleep Med 2012; 7:376-83. [PMID: 21897774 DOI: 10.5664/jcsm.1194] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Approximately 30% of obstructive sleep apnea (OSA) patients have supine-predominant OSA, and simply avoiding supine sleep should normalise respiratory disturbance event rates. However, traditional supine-avoidance therapies are inherently uncomfortable, and treatment adherence is poor and difficult to monitor objectively. This study evaluated the efficacy of a novel, potentially more acceptable position monitor and supine-avoidance device for managing supine-predominant OSA and snoring. DESIGN AND SETTING In-laboratory evaluation of position recording accuracy versus video recordings (validation study), and randomized controlled crossover trial of active versus inactive supine-avoidance therapy in the home setting (efficacy study). PATIENTS 17 patients undergoing in-laboratory sleep studies (validation) and 15 patients with supine-predominant OSA (efficacy). INTERVENTIONS EFFICACY STUDY: 1 week of inactive and 1 week of active treatment in randomized order, separated by 1 week. MEASUREMENTS AND RESULTS Agreement between 30-sec epoch-based posture classifications from device versus video records was high (median κ 0.95, interquartile range: 0.88-1.00), and there was good supine time agreement (bias 0.3%, 95%CI: -4.0% to 4.6%). In the efficacy study, apnea-hypopnea index (AHI) and snoring frequency were measured in-home using a nasal pressure and microphone based system during inactive and active treatment weeks. The position monitoring and supine alarm device markedly inhibited supine time (mean ± SEM 19.3% ± 4.3% to 0.4% ± 0.3%, p < 0.001) and reduced AHI (25.0 ± 1.7 to 13.7 ± 1.1 events/h, p = 0.030) but not snoring frequency. CONCLUSIONS This new position monitoring and supine alarm device records sleep position accurately and improves OSA but not snoring in patients with supine-predominant OSA.
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Affiliation(s)
- James J Bignold
- Adelaide Institute for Sleep Health, Repatriation General Hospital, Daw Park, Adelaide, South Australia
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Abstract
Obstructive sleep apnea (OSA) affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because of the individual's risk factors and symptoms. The vast majority remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences. Individuals with untreated OSA can stop breathing hundreds of times a night during their sleep. These apneic events can lead to fragmented sleep that is of poor quality, as the brain arouses briefly in order for the body to resume breathing. Untreated, sleep apnea can have dire health consequences and can increase the risk of hypertension, diabetes, heart disease, and heart failure. OSA management has also become important in a number of comorbid neurological conditions, including epilepsy, stroke, multiple sclerosis, and headache. Diagnosis typically involves use of screening questionnaires, physical exam, and an overnight polysomnography or a portable home study. Treatment options include changes in lifestyle, positive airway pressure, surgery, and dental appliances.
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Affiliation(s)
- Matthew L Ho
- UC Davis Department of Neurology, Davis Medical Center, University of California, California, USA
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Current medical management of sleep-related breathing disorders. Oral Maxillofac Surg Clin North Am 2009; 14:297-304. [PMID: 18088632 DOI: 10.1016/s1042-3699(02)00029-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Stadler DL, McEvoy RD, Sprecher KE, Thomson KJ, Ryan MK, Thompson CC, Catcheside PG. Abdominal compression increases upper airway collapsibility during sleep in obese male obstructive sleep apnea patients. Sleep 2009; 32:1579-87. [PMID: 20041593 PMCID: PMC2786041 DOI: 10.1093/sleep/32.12.1579] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY OBJECTIVES Abdominal obesity, particularly common in centrally obese males, may have a negative impact on upper airway (UA) function during sleep. For example, cranial displacement of the diaphragm with raised intra-abdominal pressure may reduce axial tension exerted on the UA by intrathoracic structures and increase UA collapsibility during sleep. DESIGN This study aimed to examine the effect of abdominal compression on UA function during sleep in obese male obstructive sleep apnea patients. SETTING Participants slept in a sound-insulated room with physiologic measurements controlled from an adjacent room. PARTICIPANTS Fifteen obese (body mass index: 34.5 +/- 1.1 kg/m2) male obstructive sleep apnea patients (apnea-hypopnea index: 58.1 +/- 6.8 events/h) aged 50 +/- 2.6 years participated. INTERVENTIONS Gastric (PGA) and transdiaphragmatic pressures (P(DI)), UA closing pressure (UACP), UA airflow resistance (R(UA)), and changes in end-expiratory lung volume (EELV) were determined during stable stage 2 sleep with and without abdominal compression, achieved via inflation of a pneumatic cuff placed around the abdomen. UACP was assessed during brief mask occlusions. MEASUREMENTS AND RESULTS Abdominal compression significantly decreased EELV by 0.53 +/- 0.24 L (P=0.045) and increased PGA (16.2 +/- 0.8 versus 10.8 +/- 0.7 cm H2O, P < 0.001), P(DI) (11.7 +/- 0.9 versus 7.6 +/- 1.2 cm H2O, P < 0.001) and UACP (1.4 +/- 0.8 versus 0.9 +/- 0.9 cm H2O, P = 0.039) but not R(UA)(6.5 +/- 1.4 versus 6.9 +/- 1.4 cm H2O x L/s, P=0.585). CONCLUSIONS Abdominal compression negatively impacts on UA collapsibility during sleep and this effect may help explain strong associations between central obesity and obstructive sleep apnea.
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Affiliation(s)
- Daniel L Stadler
- Adelaide Institute for Sleep Health, The Repatriation General Hospital, Daw Park, South Australia 5041, Australia.
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Mahmoud M, Gunter J, Donnelly LF, Wang Y, Nick TG, Sadhasivam S. A Comparison of Dexmedetomidine with Propofol for Magnetic Resonance Imaging Sleep Studies in Children. Anesth Analg 2009; 109:745-53. [DOI: 10.1213/ane.0b013e3181adc506] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Walsh JH, Leigh MS, Paduch A, Maddison KJ, Armstrong JJ, Sampson DD, Hillman DR, Eastwood PR. Effect of body posture on pharyngeal shape and size in adults with and without obstructive sleep apnea. Sleep 2009; 31:1543-9. [PMID: 19014074 DOI: 10.1093/sleep/31.11.1543] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
STUDY OBJECTIVES In patients with obstructive sleep apnea (OSA), the severity and frequency of respiratory events is increased in the supine body posture compared with the lateral recumbent posture. The mechanism responsible is not clear but may relate to the effect of posture on upper airway shape and size. This study compared the effect of body posture on upper airway shape and size in individuals with OSA with control subjects matched for age, BMI, and gender. PARTICIPANTS 11 males with OSA and 11 age- and BMI-matched male control subjects. RESULTS Anatomical optical coherence tomography was used to scan the upper airway of all subjects while awake and breathing quietly, initially when supine, and then in the lateral recumbent posture. A standard head, neck, and tongue position was maintained during scanning. Airway cross-sectional area (CSA) and anteroposterior (A-P) and lateral diameters were obtained in the oropharyngeal and velopharyngeal regions in both postures. A-P to lateral diameter ratios provided an index of regional airway shape. In equivalent postures, the ratio of A-P to lateral diameter in the velopharynx was similar in OSA and control subjects. In both groups, this ratio was significantly less for the supine than for the lateral recumbent posture. CSA was smaller in OSA subjects than in controls but was unaffected by posture. CONCLUSIONS The upper airway changes from a more transversely oriented elliptical shape when supine to a more circular shape when in the lateral recumbent posture but without altering CSA. Increased circularity decreases propensity to tube collapse and may account for the postural dependency of OSA.
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Affiliation(s)
- Jennifer H Walsh
- West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Nedlands, Western Australia.
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Chung SA, Yuan H, Chung F. A Systemic Review of Obstructive Sleep Apnea and Its Implications for Anesthesiologists. Anesth Analg 2008; 107:1543-63. [DOI: 10.1213/ane.0b013e318187c83a] [Citation(s) in RCA: 229] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol 2008; 52:686-717. [PMID: 18702977 DOI: 10.1016/j.jacc.2008.05.002] [Citation(s) in RCA: 595] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
MESH Headings
- Adult
- Arrhythmias, Cardiac/epidemiology
- Cardiovascular Diseases/epidemiology
- Cardiovascular Diseases/physiopathology
- Child
- Comorbidity
- Continuous Positive Airway Pressure
- Death, Sudden, Cardiac
- Disease Progression
- Endothelium, Vascular/physiopathology
- Heart Failure/epidemiology
- Heart Rate/physiology
- Humans
- Hypertension/physiopathology
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/physiopathology
- Hypertrophy, Left Ventricular/epidemiology
- Hypoxia/physiopathology
- Insulin Resistance/physiology
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/physiopathology
- Myocardial Ischemia/epidemiology
- Myocardial Ischemia/physiopathology
- Obesity/epidemiology
- Oxidative Stress/physiology
- Polysomnography
- Sleep Apnea, Central/diagnosis
- Sleep Apnea, Central/epidemiology
- Sleep Apnea, Central/physiopathology
- Sleep Apnea, Obstructive/diagnosis
- Sleep Apnea, Obstructive/epidemiology
- Sleep Apnea, Obstructive/physiopathology
- Sleep Apnea, Obstructive/therapy
- Stroke/epidemiology
- Sympathetic Nervous System/physiopathology
- Ventricular Dysfunction, Left/epidemiology
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Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T. Sleep apnea and cardiovascular disease: an American Heart Association/american College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation 2008. [PMID: 18725495 DOI: 10.1161/circulationaha.107.189420] [Citation(s) in RCA: 801] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Soga T, Nakata S, Yasuma F, Noda A, Sugiura T, Yatsuya H, Koike Y, Ozaki N, Nakashima T. Upper airway morphology in patients with obstructive sleep apnea syndrome: effects of lateral positioning. Auris Nasus Larynx 2008; 36:305-9. [PMID: 18606511 DOI: 10.1016/j.anl.2008.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Revised: 02/20/2008] [Accepted: 04/01/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to clarify the interaction of lateral and supine sleeping positions with upper airway morphology in patients with obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS Thirty-one patients with OSAS, whose apnea/hypopnea index (AHI: number of episodes of apnea or hypopnea per hour) was over 15, were enrolled in this study. Subjects were divided in two groups according to positional effects on their AHI. In six patients, a lateral posture decreased the AHI by 50% and more (responders); in the remaining 25, lateral positioning decreased the AHI by less than 50% or even increased the AHI (nonresponders). AHI and body mass index (BMI) of the responders tended to be lower and their mean age was younger than those of nonresponders, but these differences were not statistically significant. We compared the upper airway morphology between the responders and the nonresponders regarding the tonsil size, tongue position (modified Mallanpati grade, reflecting the space between the tongue and soft palate) and the width of the fauces and retroglossal space. In addition, we compared nasal resistance between the groups using active rhinomanometry. RESULTS The width of the fauces was significantly greater (P=0.041) among the responders than among the nonresponders. However, the other parameters were not consistently different between the two, and these differences were not statistically significant either. CONCLUSIONS The distance between the fauces was the sole morphological feature to distinguish the responders and the nonresponders to the positional therapy in patients with OSAS. Lateral positioning during sleep might be a recommended sleep hygiene for OSAS patients with wide fauces.
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Affiliation(s)
- Taro Soga
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya 466-8550, Japan
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SKINNER MA, KINGSHOTT RN, FILSELL S, TAYLOR DR. Efficacy of the tennis ball technique versus nCPAP in the management of position-dependent obstructive sleep apnoea syndrome. Respirology 2008; 13:708-15. [DOI: 10.1111/j.1440-1843.2008.01328.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kaw R, Aboussouan L, Auckley D, Bae C, Gugliotti D, Grant P, Jaber W, Schauer P, Sessler D. Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients. Obes Surg 2007; 18:134-8. [PMID: 18008109 DOI: 10.1007/s11695-007-9282-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 08/05/2007] [Indexed: 11/26/2022]
Abstract
Bariatric surgery has serious associated medical comorbidity and procedure-related risks and is, thus, considered an intermediate-to-high-risk non-cardiac surgery. Altered respiratory mechanics, obstructive sleep apnea (OSA), and less often, pulmonary hypertension and postoperative pulmonary embolism are the major contributors to poor pulmonary outcomes in obese patients. Attention to posture and positioning is critical in patients with OSA. Suspected OSA patients requiring intravenous narcotics should be kept in a monitored setting with frequent assessments and naloxone kept at the bedside. Use of reverse Tredelenburg position, preinduction, maintenance of positive end-expiratory pressure, and use of continuous positive airway pressure can help improve oxygenation in the perioperative period.
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Affiliation(s)
- Roop Kaw
- Department of Hospital Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue-S70, Cleveland, OH 44195, USA.
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Abstract
Positive airway pressure (PAP) is the treatment of choice for patients with moderate-to-severe obstructive sleep apnea (OSA). Randomized controlled trials have demonstrated that PAP can effectively reduce the apnea-hypopnea index and improve subjective and objective sleepiness. Some studies have also demonstrated benefits in sleep quality and quality of life for both the patient and bed partner. Observational studies have shown a reduction in the risk of cardiovascular events in OSA patients treated with PAP compared to untreated patients. Since continuous PAP (CPAP) treatment of OSA was described, additional modes of pressure delivery have been developed (bilevel PAP, autoadjusting PAP, flexible PAP). While none of the variants of PAP improves adherence in unselected patients compared to CPAP, individual patients may respond to a change in pressure mode. Attended PAP titration remains the standard of practice for selecting a treatment pressure. However, use of autotitrating PAP devices in the unattended setting can provide an effective titration alternative with careful patient selection and review of titration results. More choices of mask interface are now available to improve comfort and intervene for mask or mouth leaks. However, despite the increase in PAP treatment options, lack of acceptance and inadequate adherence to PAP therapy remain the major causes of treatment failure. Some studies suggest that heated humidification can improve PAP adherence, especially in patients with nasal congestion or dryness. A systematic approach to PAP treatment including education, objective adherence monitoring, early intervention for side effects, and telephone and clinic support is essential to optimize adherence.
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Affiliation(s)
- Rahul K Kakkar
- Malcom Randall Veterans Affairs Medical Center 111A, 1601 S Archer Rd, Gainesville, FL 32608, USA
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