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Huang LL, Yang Y, Guo JH, Huang YL, Lin LX. The application of 5E rehabilitation management mode in the nursing of patients with aortic dissection complicated by obstructive sleep apnea. Sleep Breath 2023:10.1007/s11325-023-02977-z. [PMID: 38157125 DOI: 10.1007/s11325-023-02977-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/26/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study was designed to explore the effect of 5E rehabilitation mode (encouragement, education, exercise, employment, and evaluation) in patients with aortic dissection (AD) complicated by obstructive sleep apnea (OSA). METHODS Patients with Stanford type B AD (TBAD) complicated by OSA were admitted to Guangdong Provincial People's Hospital from January 2019 to December 2020. They were randomly divided into an experimental group and a control group. After discharge, patients in the control group were given routine nursing and follow-up education, whereas patients in the experimental group were given 5E rehabilitation management mode-based nursing and follow-up education. Upon the nursing intervention, the differences in polysomnography (PSG) parameters, medication adherence, quality of life, blood pressure, and heart rate of patients between the two groups were compared. Logistic regression analysis was performed to evaluate the risk factors for the occurrence of adverse aortic events. RESULTS A total of 89 patients were enrolled, 49 in the experimental group and 40 in the control group. After the intervention, the control of heart rate, systolic blood pressure, medication adherence, PSG parameters, and quality of life scores in the experimental group were significantly better than those in the control group (P<0.05). The incidence of adverse aortic events including aortic rupture and progressive aortic dilation in the experimental group was significantly lower than that in the control group (P < 0.05). Logistic regression analysis revealed that acute TBAD [odds ratio (OR) = 15.069; 95%confidence interval (CI), 1.738-130.652; P=0.014], history of chronic kidney disease (OR=10.342; 95%CI, 1.056-101.287; P=0.045), and apnea hypopnea index (AHI) ≥ 30 (OR=2.880; 95%CI, 1.081-9.51; P=0.036) were adverse factors affecting adverse aortic events; while 5E rehabilitation management mode (OR=0.063; 95%CI, 0.008-0.513; P=0.010) was a favorable factor for occurrence of adverse aortic events. CONCLUSION The findings suggest that continuous nursing based on information carrier 5E rehabilitation management significantly enhanced medication adherence, improved patients' overall quality of life, and decreased the incidence of adverse aortic events in patients TBAD patients and OSA.
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Affiliation(s)
- Li-Ling Huang
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, 510080, China
| | - Yi Yang
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, 510080, China
| | - Jin-Hua Guo
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, 510080, China
| | - Yi-Lin Huang
- Department of Rehabilitation, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, 510080, China
| | - Li-Xia Lin
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, 510080, China.
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Lukachan GA, Yadollahi A, Auckley D, Gavrilovic B, Matelski J, Chung F, Singh M. The impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trial. BMC Anesthesiol 2023; 23:236. [PMID: 37443016 PMCID: PMC10339502 DOI: 10.1186/s12871-023-02193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The severity of sleep-disordered breathing is known to worsen postoperatively and is associated with increased cardio-pulmonary complications and increased resource implications. In the general population, the semi-upright position has been used in the management of OSA. We hypothesized that the use of a semi-upright position versus a non-elevated position will reduce postoperative worsening of OSA in patients undergoing non-cardiac surgeries. METHODS This study was conducted as a prospective randomized controlled trial of perioperative patients, undergoing elective non-cardiac inpatient surgeries. Patients underwent a preoperative sleep study using a portable polysomnography device. Patients with OSA (apnea hypopnea index (AHI) > 5 events/hr), underwent a sleep study on postoperative night 2 (N2) after being randomized into an intervention group (Group I): semi-upright position (30 to 45 degrees incline), or a control group (Group C) (zero degrees from horizontal). The primary outcome was postoperative AHI on N2. The secondary outcomes were obstructive apnea index (OAI), central apnea index (CAI), hypopnea index (HI), obstructive apnea hypopnea index (OAHI) and oxygenation parameters. RESULTS Thirty-five patients were included. Twenty-one patients were assigned to the Group 1 (females-14 (67%); mean age 65 ± 12) while there were fourteen patients in the Group C (females-5 (36%); mean age 63 ± 10). The semi-upright position resulted in a significant reduction in OAI in the intervention arm (Group C vs Group I postop AHI: 16.6 ± 19.0 vs 8.6 ± 11.2 events/hr; overall p = 0.01), but there were no significant differences in the overall AHI or other parameters between the two groups. Subgroup analysis of patients with "supine related OSA" revealed a decreasing trend in postoperative AHI with semi-upright position, but the sample size was too small to evaluate statistical significance. CONCLUSION In patients with newly diagnosed OSA, the semi-upright position resulted in improvement in obstructive apneas, but not the overall AHI. TRIAL REGISTRATION This trial was retrospectively registered in clinicaltrials.gov NCT02152202 on 02/06/2014.
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Affiliation(s)
- Gincy A Lukachan
- Department of Anesthesia, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | - Azadeh Yadollahi
- KITE - Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dennis Auckley
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Bojan Gavrilovic
- KITE - Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Frances Chung
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada
| | - Mandeep Singh
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada.
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3
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Turnbull CD, Stradling JR. Endotyping, phenotyping and personalised therapy in obstructive sleep apnoea: are we there yet? Thorax 2023; 78:726-732. [PMID: 37217289 DOI: 10.1136/thorax-2023-220037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023]
Abstract
Obstructive sleep apnoea (OSA) was traditionally thought to be mainly caused by obesity and upper airway crowding, and hence OSA management was not personalised according to particular characteristics, with most symptomatic patients receiving continuous positive airway pressure therapy. Recent advances in our understanding have identified additional potential and distinct causes of OSA (endotypes), and subgroups of patients (phenotypes) with increased risk of cardiovascular complications. In this review, we discuss the evidence to date as to whether there are distinct clinically useful endotypes and phenotypes of OSA, and the challenges to the field in moving towards delivering personalised therapy in OSA.
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Affiliation(s)
- Chris D Turnbull
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford Centre for Respiratory Medicine, NIHR Oxford Biomedical Research Centre, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - John R Stradling
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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4
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Zhang X, Zhang N, Yang Y, Wang S, Yu P, Guan BY, Wang CX. Living alone and health-related quality of life among adults with obstructive sleep apnea in a single-center cohort study. Sleep Breath 2023; 27:221-227. [PMID: 35352266 PMCID: PMC8964248 DOI: 10.1007/s11325-022-02604-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/04/2022] [Accepted: 03/17/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the impact of a solitary lifestyle on health-related quality of life (HRQoL) in adults with obstructive sleep apnea (OSA). METHODS This was a prospective cohort study; patients diagnosed with OSA but not receiving continuous positive airway pressure (CPAP) therapy were enrolled in our study. These participants completed basic information and the Short Form-36 Health Survey (SF-36) at baseline and were divided into the living alone and living with others groups. Telephone follow-up was performed 1 year later to re-evaluate the SF-36. Differences in health status between and within groups were assessed. In addition, variables associated with changes in the health of the whole population were examined. RESULTS A total of 402 patients with OSA were enrolled, including 120 in the living alone group and the rest in the living with others group. After a year, mental health scores of the living alone group decreased (55.7 ± 21.5 versus 54.1 ± 22.7, p = 0.001), while physical functioning scores of the living with others group increased significantly (82.1 ± 24.7 versus 82.6 ± 24.2, p = 0.006). In the whole population, the determinants of mental health change after 1 year from baseline were alcohol drinking (beta coefficient - 1.169, 95% CI - 2.03 to - 0.309, p = 0.008) and solitary living (beta coefficient - 1.135, 95% CI - 2.072 to - 0.199, p = 0.018). CONCLUSION Regarding all initial variables, alcohol drinking and solitary living seem to be the predictors of mental health change of patients with OSA in China. We speculate that to improve the quality of life of such people, the medical staff could provide certain social support for them.
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Affiliation(s)
- Xuan Zhang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Ning Zhang
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Clinical Psychology, Capital Medical University, Beijing, China
| | - Yang Yang
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Wang
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ping Yu
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Bo-Yuan Guan
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chun-Xue Wang
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Department of Clinical Psychology, Capital Medical University, Beijing, China.
- Beijing Institute of Brain Disorders, Beijing, China.
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Stuck BA, Arzt M, Fietze I, Galetke W, Hein H, Heiser C, Herkenrath SD, Hofauer B, Maurer JT, Mayer G, Orth M, Penzel T, Randerath W, Sommer JU, Steffen A, Wiater A. Partial update of the German S3 Guideline Sleep-Related Breathing Disorders in Adults: AWMF Registry No. 063-001—German Sleep Society (Deutsche Gesellschaft für Schlafforschung und Schlafmedizin – DGSM). Somnologie. [DOI: 10.1007/s11818-022-00349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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6
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Lin P, Ting H, Lu Y, Huang J, Lee T, Lee M, Wei JC. Risk of Infertility in Males with Obstructive Sleep Apnea: A Nationwide, Population-Based, Nested Case‒Control Study. J Pers Med 2022; 12:933. [PMID: 35743718 PMCID: PMC9224853 DOI: 10.3390/jpm12060933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 02/04/2023] Open
Abstract
Obstructive sleep apnea (OSA) yields intermittent hypoxia, hypercapnia, and sleep fragmentation. OSA is associated with chronic medical conditions such as cardiovascular diseases, metabolic syndrome, and neurocognitive dysfunction. However, the risk of infertility in OSA remains unclear due to limited data and lack of long-term population-based studies. The study aims to assess the risk of infertility in obstructive sleep apnea (OSA) by means of a population-based cohort study. The data was utilized from the Taiwan National Health Insurance Research Database (NHIRD) to conduct a population-based cohort study (1997–2013). Compared with the Non-OSA group, the male with OSA and surgery group has the OR (odds ratio) of infertility of 2.70 (95% CI, 1.46–4.98, p = 0.0015), but no significance exists in females with OSA. When the data was stratified according to age and gender, some associations in the specific subgroups were significant. Respectively, males aged 20–35 years old and aged 35–50 years old with a history of OSA and surgery both had a positive association with infertility. (aOR: 3.19; 95% CI, 1.18–8.66, p = 0.0227; aOR: 2.57; 95% CI, 1.18–5.62 p = 0.0176). Male patients with OSA suffer from reduced fertility, but no significant difference was noted in females with OSA. The identification of OSA as a risk factor for male infertility will aid clinicians to optimize long-term medical care. Furthermore, more studies will be encouraged to clarify the effect of OSA on female fertility.
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7
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Akashiba T, Inoue Y, Uchimura N, Ohi M, Kasai T, Kawana F, Sakurai S, Takegami M, Tachikawa R, Tanigawa T, Chiba S, Chin K, Tsuiki S, Tonogi M, Nakamura H, Nakayama T, Narui K, Yagi T, Yamauchi M, Yamashiro Y, Yoshida M, Oga T, Tomita Y, Hamada S, Murase K, Mori H, Wada H, Uchiyama M, Ogawa H, Sato K, Nakata S, Mishima K, Momomura SI. Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020. Respir Investig 2022; 60:3-32. [PMID: 34986992 DOI: 10.1016/j.resinv.2021.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
The prevalence of sleep disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the "Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults" was published in 2005, a new guideline was prepared in order to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the "Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension" Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Because sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.
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Affiliation(s)
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Motoharu Ohi
- Sleep Medical Center, Osaka Kaisei Hospital, Osaka, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fusae Kawana
- Department of Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeru Sakurai
- Division of Behavioral Sleep Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Rho Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shintaro Chiba
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Kazuo Chin
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University of Medicine, Tokyo, Japan; Department of Human Disease Genomics, Center for Genomic Medicine, Graduate School Medicine, Kyoto University, Japan.
| | | | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Koji Narui
- Sleep Center, Toranomon Hospital, Tokyo, Japan
| | - Tomoko Yagi
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | | | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasuhiro Tomita
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Mori
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroo Wada
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromasa Ogawa
- Department of Occupational Health, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazumichi Sato
- Department of Dental and Oral Surgery, International University of Health and Welfare, Chiba, Japan
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Second Hospital, Fujita Health University School of Medicine, Aichi, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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8
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Akashiba T, Inoue Y, Uchimura N, Ohi M, Kasai T, Kawana F, Sakurai S, Takegami M, Tachikawa R, Tanigawa T, Chiba S, Chin K, Tsuiki S, Tonogi M, Nakamura H, Nakayama T, Narui K, Yagi T, Yamauchi M, Yamashiro Y, Yoshida M, Oga T, Tomita Y, Hamada S, Murase K, Mori H, Wada H, Uchiyama M, Ogawa H, Sato K, Nakata S, Mishima K, Momomura SI. Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020. Sleep Biol Rhythms 2022; 20:5-37. [PMID: 38469064 PMCID: PMC10900032 DOI: 10.1007/s41105-021-00353-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 12/17/2022]
Abstract
The prevalence of sleep-disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the "Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults" was published in 2005, a new guideline was prepared to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the "Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension" Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Since sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.
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Affiliation(s)
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Motoharu Ohi
- Sleep Medical Center, Osaka Kaisei Hospital, Osaka, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fusae Kawana
- Department of Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeru Sakurai
- Division of Behavioral Sleep Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shintaro Chiba
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Kazuo Chin
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610 Japan
- Department of Human Disease Genomics, Center for Genomic Medicine, Graduate School Medicine, Kyoto University, Kyoto, Japan
| | | | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Koji Narui
- Sleep Center, Toranomon Hospital, Tokyo, Japan
| | - Tomoko Yagi
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | | | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasuhiro Tomita
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Mori
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroo Wada
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromasa Ogawa
- Department of Occupational Health, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazumichi Sato
- Department of Dental and Oral Surgery, International University of Health and Welfare, Chiba, Japan
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Second Hospital, Fujita Health University School of Medicine, Aichi, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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9
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De Corso E, Mastrapasqua RF, Fiorita A, Settimi S, Mele DA, Picciotti PM, Loperfido A, Marrone S, Rizzotto G, Paludetti G, Scarano E. Efficacy and long-term follow-up of positional therapy by vibrotactile neck-based device in the management of positional OSA. J Clin Sleep Med 2021; 16:1711-1719. [PMID: 32621579 DOI: 10.5664/jcsm.8664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Different therapeutic strategies have been investigated for the treatment of positional obstructive sleep apnea, but more evidence is needed about efficacy and compliance. The objective of this study was to describe the efficacy of vibrotactile neck-based treatment in patients with positional obstructive sleep apnea with different degrees of obstructive sleep apnea severity who were followed for 6 months. METHODS This is a retrospective study including 162 patients with positional obstructive sleep apnea undergoing vibrotactile neck-based positional therapy. We compared polysomnographic data obtained at baseline and during positional therapy after 1 month. We performed a subgroup analysis based on obstructive sleep apnea severity. Furthermore, we analyzed follow-up data in 84/162 (51.8%) patients with particular focus on discontinuation and complications related to the device. RESULTS We observed a significant difference between mean baseline obstructive apnea-hypopnea index (OAHI; 21.9 ± 9.9 events/h) and during positional therapy (12 ± 9.2 events/h; P < .01). Moreover, 87/162 (54.9%) patients showed a reduced baseline OAHI of at least 50% and 38/162 (23.4%) achieved complete disease control (OAHI < 5 events/h). At subgroup analysis, at least 50% reduction from baseline OAHI was observed in 56.8% of patients with mild, 55% with moderate, and 47.4% with severe OAHI, whereas complete control of disease was achieved in 50% of patients with mild, 22.5% with moderate, and 7.9% with severe OAHI. At a 6-month follow-up, only 35/84 patients (41.6%) were regularly using the device, with a mean of 5.9 ± 1.2 days per week. CONCLUSIONS Our results on the efficacy and long-term adherence to vibrotactile neck-based positional therapy showed that positional therapy can be an efficient first-line treatment option for mild positional obstructive sleep apnea and in selected cases of moderate disease. Long-term compliance is limited because of complications and low satisfaction in some patients.
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Affiliation(s)
- Eugenio De Corso
- Unit of Otorhinolaryngology and Head and Neck Surgery. Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy.,Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Antonella Fiorita
- Unit of Otorhinolaryngology and Head and Neck Surgery. Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy.,Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Settimi
- Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Antonio Mele
- Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Pasqualina Maria Picciotti
- Unit of Otorhinolaryngology and Head and Neck Surgery. Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy.,Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonella Loperfido
- Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Sabino Marrone
- Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Grazia Rizzotto
- Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy.,Unit of Neurophysiopathology. Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Unit of Otorhinolaryngology and Head and Neck Surgery. Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy.,Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Emanuele Scarano
- Unit of Otorhinolaryngology and Head and Neck Surgery. Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy.,Head and Neck Department, Catholic University of the Sacred Heart, Rome, Italy
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Sabil A, Blanchard M, Trzepizur W, Goupil F, Meslier N, Paris A, Pigeanne T, Priou P, Le Vaillant M, Gagnadoux F. Positional obstructive sleep apnea within a large multicenter French cohort: prevalence, characteristics, and treatment outcomes. J Clin Sleep Med 2021; 16:2037-2046. [PMID: 32804071 DOI: 10.5664/jcsm.8752] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVES To assess, in a large cohort of patients with obstructive sleep apnea, the factors that are independently associated with positional obstructive sleep apnea (POSA) and exclusive POSA (e-POSA) and determine their prevalence. The secondary objective was to evaluate the outcome of positive airway pressure (PAP) therapy for patients with POSA and e-POSA. METHODS This retrospective study included 6,437 patients with typical mild-to-severe OSA from the Pays de la Loire sleep cohort. Patients with POSA and e-POSA were compared to those with non-POSA for clinical and polysomnographic characteristics. In a subgroup of patients (n = 3,000) included in a PAP follow-up analysis, we determined whether POSA and e-POSA phenotypes were associated with treatment outcomes at 6 months. RESULTS POSA and e-POSA had a prevalence of 53.5% and 20.1%, respectively, and were independently associated with time in supine position, male sex, younger age, lower apnea-hypopnea index and lower body mass index. After adjustment for confounding factors, patients with POSA and e-POSA had a significantly lower likelihood of treatment adherence (PAP daily use ≥ 4 h) at 6 months and were at higher risk of PAP treatment withdrawal compared to those with non-POSA. CONCLUSIONS The prevalence and independent predictors of POSA and e-POSA were determined in this large clinical population. Patients with POSA and e-POSA have lower PAP therapy adherence, and this choice of treatment may not be optimal. Thus, there is a need to offer these patients an alternative therapy.
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Affiliation(s)
| | | | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France.,INSERM Unit 1063, Angers, France
| | - François Goupil
- Department of Respiratory Diseases, Le Mans General Hospital, Le Mans, France
| | - Nicole Meslier
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France.,INSERM Unit 1063, Angers, France
| | - Audrey Paris
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France.,INSERM Unit 1063, Angers, France
| | - Thierry Pigeanne
- Respiratory Unit, Pôle santé des Olonnes, Olonne sur Mer, France
| | - Pascaline Priou
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France.,INSERM Unit 1063, Angers, France
| | - Marc Le Vaillant
- Pays de la Loire Respiratory Health Research Institute, Beaucouzé, France
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France.,INSERM Unit 1063, Angers, France
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11
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Rizzo D, Libman E, Baltzan M, Fichten C, Bailes S. Impact of the COVID-19 pandemic on obstructive sleep apnea: recommendations for symptom management. J Clin Sleep Med 2021; 17:429-434. [PMID: 33100266 DOI: 10.5664/jcsm.8922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
STUDY OBJECTIVES In the context of the current COVID-19 pandemic situation, we address the following important questions: (1) How can patients be identified for possible OSA while sleep clinic testing is temporarily unavailable or limited? and (2) What measures can be suggested to improve sleep health until proper diagnosis and treatment become safe and available again? METHODS As a proxy for home or in-laboratory testing, validation of a symptom-based measure of OSA risk is presented, based on an ongoing larger prospective study of 156 family medicine patients with OSA (88 women, 68 men; mean age, 57 years) and 60 control participants (36 women, 24 men; mean age, 54 years) recruited from the community. Participants completed the Sleep Symptom Checklist (SSC) and a range of other self-report measures; primary care patients also underwent a polysomnographic sleep study. RESULTS Results showed that (1) individuals with OSA reported more symptoms on the SSC related to insomnia, daytime symptoms, sleep disorders, and psychological maladjustment than did the control group (all P < .001), and (2) their sleep-related symptoms were significantly more severe than those of the control patients. In addition, several polysomnographic indices in recently diagnosed untreated individuals with OSA were significantly correlated with SSC measured sleep disorder symptoms, and SSC scores significantly distinguished participants with OSA from control participants. CONCLUSIONS Our findings suggest that family practitioners can effectively prescreen patients for possible OSA by inquiring about 5 items that form the SSC sleep disorders subscale. If OSA is suspected, then we can recommend a range of behavioral techniques to improve symptoms. The current pandemic causes us to reflect that the provisional targeting of symptoms and guidance regarding mitigation strategies while waiting for specialist care could serve patients well at any time.
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Affiliation(s)
- Dorrie Rizzo
- Department of Family Medicine, McGill University, Montréal, Québec, Canada.,Centre Intégré Universitaire des Soins et Services Sociaux de l'ouest de l'île, Lady Davis Institute for Medical Research, Montréal, Québec, Canada
| | - Eva Libman
- Centre Intégré Universitaire des Soins et Services Sociaux de l'ouest de l'île, Lady Davis Institute for Medical Research, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Marc Baltzan
- Faculty of Medicine, Department of Epidemiology Biostatistics and Occupational Health, McGill University, Montréal, Canada.,Centre Intégré Universitaire des Soins et Services Sociaux du Nord de L'île de Montréal, Montréal, Canada.,Mount Sinai Hospital, Centre Intégré Universitaire des Soins et Services Sociaux du Centre-ouest de L'île de Montréal, Montréal, Canada.,Institut de Médecine du Sommeil, Montréal, Canada
| | - Catherine Fichten
- Centre Intégré Universitaire des Soins et Services Sociaux de l'ouest de l'île, Lady Davis Institute for Medical Research, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Sally Bailes
- Centre Intégré Universitaire des Soins et Services Sociaux de l'ouest de l'île, Lady Davis Institute for Medical Research, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
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Milicevic T, Katic J, Milovac SN, Matetic A, Aljinovic J, Dogas Z, Gunjaca G. Auto-adaptive positive airway pressure improves lung function and arterial stiffness parameters in patients with severe obstructive sleep apnea syndrome over a 1 year follow-up. Physiol Meas 2020; 41:125006. [PMID: 33382043 DOI: 10.1088/1361-6579/abcdf5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Auto-adaptive positive airway pressure (APAP) is an emerging therapeutic modality for obstructive sleep apnea (OSA) patients. However, their associated physiological effects have not been well-defined. Therefore, we aimed to investigate the impact of a 1 year APAP treatment on lung function and arterial stiffness parameters. APPROACH This study enrolled male patients with newly diagnosed severe OSA who have undergone APAP treatment. A total of 35 patients completed a 1 year follow up. Blood pressure, arterial stiffness (PWV, cAIx, pAIx, cSBP), and lung function readings (FEV1, FVC, FEV1/FVC, PEF) were obtained basally and after 1, 3, 6, and 12 months of treatment. MAIN RESULTS A gradual increase in FEV1 has been observed over the follow-up (2.92 ± 0.88 versus 3.07 ± 0.92 versus 3.18 ± 0.93 versus 3.28 ± 0.93 versus 3.41 ± 0.97 L), while PWV showed a gradual decrease over the follow-up (9.72 ± 1.64 versus 9.32 ± 1.73 versus 8.89 ± 1.65 versus 8.53 ± 1.61 versus 8.46 ± 1.60 m s-1), as measured by absolute values. Linear mixed effects model analysis revealed a statistically significantly higher FEV1 values (coefficient of 0.11, 0.20, and 0.33 for 3rd month, 6th month, and 12th month, respectively, P < 0.001) and lower PWV values (coefficient of -0.69, -0.63, and -0.34 for 3rd month, 6th month, and 12th month, respectively, P < 0.001), after the initiation of APAP treatment. SIGNIFICANCE We conclude that APAP treatment improves main lung function and arterial stiffness parameters in male patients with severe OSA over a 1 year follow-up.
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Affiliation(s)
- Tanja Milicevic
- Department of Endocrinology and Diabetology, University Hospital of Split, Split, Croatia
| | - Josip Katic
- Department of Cardiology, University Hospital of Split, Split, Croatia
| | | | - Andrija Matetic
- Department of Cardiology, University Hospital of Split, Split, Croatia.,Department of Pathophysiology, University of Split School of Medicine, Split, Croatia
| | - Jure Aljinovic
- Institute of Physical and Rehabilitation Medicine with Rheumatology, University Hospital of Split, Split, Croatia.,University Department for Health Studies, University of Split, Split, Croatia
| | - Zoran Dogas
- Department of Neuroscience, University of Split School of Medicine, Split, Croatia
| | - Grgo Gunjaca
- Community Health Center Split-Dalmatia County, Split, Croatia
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13
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Stuck BA, Arzt M, Fietze I, Galetke W, Hein H, Heiser C, Herkenrath SD, Hofauer B, Maurer JT, Mayer G, Orth M, Penzel T, Randerath W, Sommer JU, Steffen A, Wiater A. Teil-Aktualisierung S3-Leitlinie Schlafbezogene Atmungsstörungen bei Erwachsenen. Somnologie 2020. [DOI: 10.1007/s11818-020-00257-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Spielmanns M. [Are There Recommended Alternatives to Positive Airway Pressure Therapy in the Treatment of Sleep Apnea?]. Praxis (Bern 1994) 2020; 109:967-972. [PMID: 32933391 DOI: 10.1024/1661-8157/a003542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Are There Recommended Alternatives to Positive Airway Pressure Therapy in the Treatment of Sleep Apnea? Abstract. For decades, positive airway pressure (PAP) ventilation has been considered the gold standard in the therapy of obstructive sleep apnea (OSA). Although this is a very successful procedure with regard to the elimination of apnea, the long-term adherence of patients to PAP is only 60-80 % for various reasons. In the meantime, there are numerous options such as intraoral devices, spine sleep position avoidance or newer surgical procedures which are advertised as an alternative to PAP in the therapy of OSA. This raises questions about the significance and effectiveness. This article is intended to provide an up-to-date overview of the significance and possibilities of the therapy alternatives.
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Affiliation(s)
- Marc Spielmanns
- Pneumologie und Zentrum für Schlafmedizin Zürcher Oberland, Zürcher RehaZentren Klinik Wald, Schweiz
- Lehrstuhl für Pneumologie, Fakultät für Gesundheit, Universität Witten-Herdecke, Deutschland
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15
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Philippe C. [Non-surgical treatment of the sleep related breathing disorders in adults]. Orthod Fr 2019; 90:379-387. [PMID: 34643523 DOI: 10.1051/orthodfr/2019032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The treatment of obstructive sleep apnoea/hypopnoea syndrome (OSAHS) must allow for the suppression of symptoms and also prevent its immediate and long-term consequences. The evaluation of the effectiveness of treatments is now based on a normal apnea/hypopnea index, a normal oxygen saturation and the disappearance of sleep fragmentation. Clinical and biological follow-up of co-morbidities must be ensured. Compliance with treatment, a major element of success, must be monitored. Continuous Positive Airway Pressure (CPAP) is still the most effective and widely used treatment. However, mandibular advancement orthosis is now recommended as a first-line treatment in moderate forms in the absence of severe cardiovascular comorbidities (CV) and remains a therapeutic alternative in the event of refusal or intolerance to CPAP. Nutritional management in cases of obesity and a physical activity program must be systematically offered. A reduction in nocturnal breathing disorders can also be achieved by using a device in the event of positional OSAHS, or by limiting fluid movements. The contribution of myofunctional therapy is currently being evaluated. Very recently, a study testing the efficiency of pharmacological treatment on the severity of OSAHS and the reactivity of geniogloss appears to be promising. The evaluation of these different treatments and their combination should make it possible to evolve towards a personalised management adapted to each patient.
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Affiliation(s)
- Carole Philippe
- Unité des Pathologies du Sommeil, Service du Pr Arnulf, Groupe Hospitalier Pitié Salpêtrière, 47-83 boulevard de l'hôpital, 75651 Paris Cedex 13, France
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16
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Berry RB, Uhles ML, Abaluck BK, Winslow DH, Schweitzer PK, Gaskins RA, Doekel RC, Emsellem HA. NightBalance Sleep Position Treatment Device Versus Auto-Adjusting Positive Airway Pressure for Treatment of Positional Obstructive Sleep Apnea. J Clin Sleep Med 2019; 15:947-956. [PMID: 31383231 DOI: 10.5664/jcsm.7868] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 02/27/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Compare treatment efficacy and objective adherence between the NightBalance sleep position treatment (SPT) device and auto-adjusting positive airway pressure (APAP) in patients with exclusive positional obstructive sleep apnea (ePOSA) defined as a supine apnea-hypopnea index (sAHI) ≥ 2 times the nonsupine AHI (nsAHI) and a nsAHI < 10 events/h. METHODS This prospective multicenter randomized crossover trial enrolled treatment naive participants with ePOSA (AHI ≥ 15 events/h and nsAHI < 10 events/h) or (AHI > 10 and < 15 events/h with daytime sleepiness and nsAH < 5 events/h). Polysomnography and objective adherence determination (device data) were performed at the end of each 6-week treatment. Patient device preference was determined at the end of the study. RESULTS A total of 117 participants were randomized (58 SPT first, 59 APAP first). Of these, 112 started treatment with the second device (adherence cohort) and 110 completed the study (AHI cohort). The AHI on SPT was higher (mean ± standard deviation, 7.29 ± 6.8 versus 3.71 ± 5.1 events/h, P < .001). The mean AHI difference (SPT-APAP) was 3.58 events/h with a one sided 95% confidence interval upper bound of 4.96 events/h (< the prestudy noninferiority margin of 5 events/h). The average nightly adherence (all nights) was greater on SPT (345.3 ± 111.22 versus 286.98 ± 128.9 minutes, P < .0001). Participants found the SPT to be more comfortable and easier to use and 53% reported a preference for SPT assuming both devices were equally effective. CONCLUSIONS Treatment with SPT resulted in non-inferior treatment efficacy and greater adherence compared to APAP in ePOSA suggesting that SPT is an effective treatment for this group. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: The POSAtive Study: Study for the Treatment of Positional Obstructive Sleep Apnea; Identifier: NCT03061071; URL: https://clinicaltrials.gov/ct2/show/NCT03061071.
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Nguyen HT, Magalang U, Abduljalil A, Elias S, Schmalbrock P, Chandrasekaran P, Rojas S, Emmons K, Ribble D, Knopp MV. MRI-based methodology to monitor the impact of positional changes on the airway caliber in obstructive sleep apnea patients. Magn Reson Imaging 2019; 61:233-8. [PMID: 31150812 DOI: 10.1016/j.mri.2019.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To develop a non-invasive MRI-based methodology to visually and quantitatively assess the impact of head and chest rotations on the airway caliber. METHODS An MRI table set-up was developed for independent rotations of the head and chest along B0 field and tested for feasibility using phantom scans. The accuracy of the head and chest rotations was validated with ten volunteer scans. A 3T MRI protocol was optimized to image the regions of interest (ROIs) that were the retropalatal (RP) and retroglossal (RG) sections of the upper airway. A workflow for data analysis was developed to assess the changes of the airway caliber following the independent head and chest rotations. RESULTS A prototype MRI table setup was established with two separate plates each supporting and rotating the head or chest independently. Subject positioning and image acquisition were finished within seven minutes for each position. Thus, each subject MRI was set up with seven positions and completed for less than one hour. The implemented angles were within 0.3-degree deviation from the targeted angles. The data analysis workflow provided 2D and 3D visualization and quantification with the measurements of cross-sectional area, lateral and anterior-posterior distances of the ROIs. Sharp contrast of the airway and its surrounding tissues facilitated an automatic approach to ROI placement to minimize subjectivity. CONCLUSIONS The 3T MRI data acquisition and analysis methodology could reliably assess the impact of head and chest rotations on the upper airway caliber to identify the optimal position for obstructive sleep apnea patients.
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Abstract
BACKGROUND The modalities of therapy for obstructive sleep apnoea (OSA) include behavioural and lifestyle modifications, positional therapy, oral appliances, surgery and continuous positive airway pressure therapy (CPAP). Though CPAP has proven efficacy in treating OSA, adherence with CPAP therapy is suboptimal. Positional therapy (to keep people sleeping on their side) is less invasive and therefore expected to have better adherence. This review considered the efficacy of positional therapy compared to CPAP as well as positional therapy against no positional therapy. Devices designed for positional therapy include lumbar or abdominal binders, semi-rigid backpacks, full-length pillows, a tennis ball attached to the back of nightwear, and electrical sensors with alarms that indicate change in position. OBJECTIVES To compare the efficacy of positional therapy versus CPAP and positional therapy versus inactive control (sham intervention or no positional therapy intervention) in people with OSA. SEARCH METHODS We identified studies from the Cochrane Airways' Specialised Register (including CENTRAL, MEDLINE, Embase, CINAHL, AHMED and PsycINFO), ClinicalTrials.gov, and the World Health Organization trials portal (ICTRP). It also contains results derived from handsearching of respiratory journals and abstract books of major annual meetings. We searched all databases from their inception to September 2018, with no restrictions on language of publication or publication type. SELECTION CRITERIA We included randomised controlled trials comparing positional therapy with CPAP and positional therapy with inactive control. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and extracted the data. We used a random-effects model in the meta-analysis to estimate mean differences and confidence intervals. We assessed certainty of evidence using the GRADE approach. MAIN RESULTS We included eight studies. The studies randomised 323 participants into two types of interventions. The comparison between positional therapy and CPAP included 72 participants, while the comparison between positional therapy and inactive control included 251 participants. Three studies used supine vibration alarm devices, while five studies used physical positioning like specially designed pillows or semirigid backpacks.Positional therapy versus CPAPThe three studies included for this comparison were randomised cross-over trials. Two studies found that there was no difference in Epworth Sleepiness Scale (ESS) scores between CPAP and positional therapy. Two studies showed that CPAP produced a greater reduction in Apnoea-Hypopnoea Index (AHI) with a mean difference (MD) of 6.4 events per hour (95% CI 3.00 to 9.79; low-certainty evidence) compared to positional therapy. Subjective adherence, evaluated in one study, was found to be significantly greater with positional therapy (MD 2.5 hours per night, 95% CI 1.41 to 3.59; moderate-certainty evidence).In terms of secondary outcomes, one study each reported quality-of-life indices and quality-of-sleep indices with no significant difference between the two groups. One study reported cognitive outcomes using multiple parameters and found no difference between the groups. There were insufficient data to comment on other secondary outcomes like respiratory disturbance index (RDI), and frequency and duration of nocturnal desaturation. None of the studies clearly reported adverse effects.Positional therapy versus inactive controlThree studies of positional therapy versus no intervention were randomised cross-over trials, while two studies were parallel-arm studies. Data from two studies showed that positional therapy significantly improved ESS scores (MD -1.58, 95% CI -2.89 to -0.29; moderate-certainty evidence). Positional therapy showed a reduction in AHI compared with control (MD -7.38 events per hour, 95% CI -10.06 to -4.7; low-certainty evidence). One study reported adherence. The number of participants who continued to use the device at two months was no different between the two groups (odds ratio (OR) 0.80, 95% CI 0.33 to 1.94; low-certainty evidence). The same study reported adverse effects, the most common being pain in the back and chest, and sleep disturbance but there was no significant difference between the two groups in terms of device discontinuation (OR 1.25, 95% CI 0.5 to 3.03; low-certainty evidence). One study each reported quality-of-life indices and quality-of-sleep indices, with no significant difference between the two groups. One study reported cognitive outcome, and found no difference between the groups. There was insufficient evidence to comment on other secondary outcomes (RDI, frequency and duration of nocturnal desaturation). AUTHORS' CONCLUSIONS The review found that CPAP has a greater effect on improving AHI compared with positional therapy in positional OSA, while positional therapy was better than inactive control for improving ESS and AHI. Positional therapy may have better adherence than CPAP. There were no significant differences for other clinically relevant outcomes such as quality of life or cognitive function. All the studies were of short duration. We are unable to comment on the long-term effects of the therapies. This is important, as most of the quality-of-life outcomes will be evident only when the therapies are given over a longer period of time. The certainty of evidence was low to moderate.
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Affiliation(s)
- P R Srijithesh
- National Institute of Mental Health and Neuro Sciences (NIMHANS)Department of NeurologyHosur RoadBangaloreIndia
| | - Rajeswari Aghoram
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)Department of NeurologyD. NagarPuducherryPuducherryIndia605009
| | - Amit Goel
- Sanjay Gandhi Postgraduate Institute of Medical SciencesDepartment of GastroenterologyLucknowUttar PradeshIndia
| | - Jayaraj Dhanya
- Government Medical CollegeDepartment of PaediatricsCalicutKeralaIndia
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Gaines J, Vgontzas AN, Fernandez-Mendoza J, Bixler EO. Obstructive sleep apnea and the metabolic syndrome: The road to clinically-meaningful phenotyping, improved prognosis, and personalized treatment. Sleep Med Rev 2018; 42:211-9. [PMID: 30279095 DOI: 10.1016/j.smrv.2018.08.009] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 08/19/2018] [Accepted: 08/29/2018] [Indexed: 12/18/2022]
Abstract
Obstructive sleep apnea (OSA) is an increasingly prevalent sleep disorder characterized by upper airway obstruction during sleep, resulting in breathing pauses, intermittent hypoxia, and fragmented sleep. In parallel, the constellation of adverse health outcomes associated with prolonged obesity, such as insulin resistance, elevated blood pressure, triglycerides, and reduced high-density lipoprotein cholesterol - termed metabolic syndrome -raises the risk of cardiovascular morbidity and mortality, type 2 diabetes, and all-cause mortality. Affecting 35-40% of U.S. adults, risk factors for metabolic syndrome, including obesity, middle age, sedentary behavior, and genetics, share considerable overlap with those for OSA. Thus, it has been difficult to disentangle cause, effect, and whether certain treatments, such as CPAP, can improve these outcomes. In this paper, we provide an update to our 2005 review which explored the association between OSA and metabolic syndrome, highlighting visceral obesity as the common etiological factor of both conditions. This update includes (a) recent data on physiological and biochemical mechanisms, (b) new data in nonobese men and women as well as children and adolescents, (c) insight from the latest treatment studies, (d) the role of aging in understanding clinically-meaningful phenotypes of the disorder, and (e) the potential diagnostic/prognostic utility of biomarkers in identifying OSA patients with the strongest cardiometabolic risk.
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Doyle-McClam M, Shahid MH, Sethi JM, Koo P. Nocturia in Women With Obstructive Sleep Apnea. Am J Lifestyle Med 2018; 15:260-268. [PMID: 34025318 DOI: 10.1177/1559827618782657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/27/2018] [Accepted: 05/23/2018] [Indexed: 12/21/2022] Open
Abstract
Obstructive sleep apnea (OSA) is underdiagnosed in women compared with men. Women have a tendency to underreport or present with atypical symptoms such as behavior changes, insomnia, fatigue, and depression. Nocturia, waking up from sleep 2 times or more to void, has been shown to be associated with OSA, but it is not an included symptom in commonly used screening questionnaires in primary provider offices. About 50% of patients with OSA have nocturia, and treatment of OSA improves it. Recognition of nocturia as a relevant symptom of OSA is important for primary providers to provide timely referral for the diagnosis of OSA.
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Affiliation(s)
- Megan Doyle-McClam
- University of Tennessee College of Medicine Chattanooga, Erlanger Baroness Hospital, Chattanooga, Tennessee
| | - Muhammad H Shahid
- University of Tennessee College of Medicine Chattanooga, Erlanger Baroness Hospital, Chattanooga, Tennessee
| | - Jigme M Sethi
- University of Tennessee College of Medicine Chattanooga, Erlanger Baroness Hospital, Chattanooga, Tennessee
| | - Patrick Koo
- University of Tennessee College of Medicine Chattanooga, Erlanger Baroness Hospital, Chattanooga, Tennessee
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22
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Barnes H, Edwards BA, Joosten SA, Naughton MT, Hamilton GS, Dabscheck E. Positional modification techniques for supine obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2017; 36:107-15. [DOI: 10.1016/j.smrv.2016.11.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/25/2016] [Accepted: 11/10/2016] [Indexed: 11/24/2022]
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Abstract
Obstructive sleep apnea syndrome (OSAS), a pervasive disease, is closely associated with complications such as cardiovascular diseases, neurocognitive diseases, and metabolic syndromes. Continuous positive airway pressure (CPAP) is the standard treatment for OSAS, with low compliance due to multifarious factors. The two other modes of ventilation, bi-level positive airway pressure (BPAP) and autotitrating positive airway pressure (APAP), which were developed from CPAP, are slightly different from CPAP in specific groups, as well as the corresponding treatment effect and compliance. The compliance of traditional positional therapy is not high, but with the emergence of the neck-based position treatment device, its compliance and indications have changed. Although CPAP is superior to mandibular advancement device (MAD) in improving AHI, MAD seems to be comparable to CPAP in improving other indicators. Corticosteroids and leukotriene receptor antagonists are effective treatments for mild OSAS children. Whether corticosteroids can be used in other OSAS groups and their adjunctive functions to CPAP remains unclear. The combination of these two kinds of drugs appears to be more effective than single drug. Researches on transcutaneous electrical stimulation are still not enough. Its effectiveness and stimulation settings still need further study. This review summarized the various OSAS non-surgical treatments from indications, treatment outcomes, compliance, adverse reactions, and recent progress.
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Affiliation(s)
- Xu Tingting
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, People's Republic of China
| | - You Danming
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, People's Republic of China
| | - Chen Xin
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, People's Republic of China.
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Ferguson MS, Magill JC, Kotecha BT. Narrative review of contemporary treatment options in the care of patients with obstructive sleep apnoea. Ther Adv Respir Dis 2017; 11:411-423. [PMID: 29059008 DOI: 10.1177/1753465817736263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Snoring and obstructive sleep apnoea (OSA) are increasingly common conditions, and confer a significant health and socioeconomic burden. Furthermore, untreated OSA represents a significant mortality risk. Patients require careful assessment, including detailed clinical history and examination, sleep study and drug-induced sleep endoscopy (DISE). Although nasal continuous positive airway pressure (nCPAP) is the gold standard treatment for moderate and severe OSA, multidisciplinary team assessment is often required to develop the best treatment plan for an individual, especially when nasal CPAP is poorly tolerated. There is a wide range of medical and surgical treatment options, and following appropriate patient selection and assessment, a focused site-specific, often multilevel, intervention is indicated. There is an increasing body of evidence in the literature supporting these multilevel interventions and with agreement on standardized outcome measures more trials are likely to improve the robustness of these data further.
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Affiliation(s)
- Mark S Ferguson
- Department of Otolaryngology, Royal National Throat, Nose & Ear Hospital, London, UK
| | | | - Bhik T Kotecha
- Department of Otolaryngology, Royal National Throat, Nose & Ear Hospital, 330 Grays Inn Road, London WC1X 8DA, UK
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Abstract
Over the past few years, the diagnostic tools and therapeutic approaches for obstructive sleep apnea (OSA) have evolved further. Based on a review of the current literature and the personal experiences of the authors, the most relevant developments are summarized in this article and discussed with regard to their impact on the clinical management of the disease. In the third edition of the International Classification of Sleep Disorders, the classification of sleep-disordered breathing was modified. Notably, additional clinical criteria for the diagnosis of OSA were established and out-of-center sleep testing was introduced as an alternative to polysomnography. Recent technical advancements in diagnostic tools (e. g., peripheral arterial tonometry and pulse wave analysis) have further expanded the diagnostic possibilities. Drug-induced sleep endoscopy allows for a reliable assessment of the level and degree of upper airway obstruction. Whether this gain in diagnostic information leads to an improvement in surgical outcome is, however, still being discussed. The relevance of positional OSA has received increasing attention - the subgroup of patients in whom sleeping position significantly impacts their disease is reported to be above 50 %. For these patients, the introduction of the sleep position trainer offers a new therapeutic option. Further, hypoglossal nerve stimulation (upper airway stimulation) has substantially expanded the surgical spectrum for the treatment of OSA. In regard to the established surgical treatment options, randomized trials with superior methodology have been published, especially for bimaxillary advancement and tonsillectomy with uvulopalatopharyngoplasty. These developments are of particular interest for the otolaryngologist and will influence daily practice.
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Abstract
BACKGROUND Positional obstructive sleep apnea (POSA) is common in mild and moderate forms of obstructive sleep apnea (OSA). Two smartphone applications (apps) professing to avoid the supine position (SP) are available: for Android the "Apnea Sleep Position Trainer" and for iOS the "SomnoPose-Sleep Position Monitor". The smartphone needs to be attached to the chest to recognize SP, which then triggers a vibration alarm. This is intended to encourage the patient to change position and the vibration stops as soon as SP is left. These apps, however, have not yet undergone a systematic evaluation. METHODS Adult patients with polysomnographically diagnosed POSA were invited to participate in the study. POSA was defined as an apnea-hypopnea index (AHI) in SP >10, with AHI in a lateral position <10 and doubling of the AHI in SP. After 1 month, a control polysomnography (PSG) was performed and compliance (at least 4 h/night on 5 of 7 days) was evaluated after 6 months by phone. A sufficient therapy was defined as reduction in SP to <10% of the total sleep time and to an overall AHI <10. RESULTS Although 57 patients entered the study, 24 did not appear to the PSG control; therefore, 33 patients finished the study, of whom 25 were treated successfully. The overall AHI in 33 patients was reduced from 14.5 ± 9.0 to 9.5 ± 12.6 and the time in SP decreased significantly from 71.1 ± 50.5 to 25.4 ± 65.0 min. Compliance among the 25 continuously treated patients after 6 months was 79.2%. CONCLUSION Both smartphone apps have the capability to prevent PS in POSA patients and can potentially offer a cost-effective option in the treatment of POSA.
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Affiliation(s)
- D Haas
- Universitäts-HNO-Klinik Mannheim, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - R Birk
- Universitäts-HNO-Klinik Mannheim, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - J T Maurer
- Universitäts-HNO-Klinik Mannheim, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - K Hörmann
- Universitäts-HNO-Klinik Mannheim, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - B A Stuck
- Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - J U Sommer
- Universitäts-HNO-Klinik Mannheim, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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Liu T, Li W, Zhou H, Wang Z. Verifying the Relative Efficacy between Continuous Positive Airway Pressure Therapy and Its Alternatives for Obstructive Sleep Apnea: A Network Meta-analysis. Front Neurol 2017; 8:289. [PMID: 28701992 PMCID: PMC5487413 DOI: 10.3389/fneur.2017.00289] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/06/2017] [Indexed: 12/21/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a common breathing disorder, and continuous positive airway pressure (CPAP) therapy together with its alternatives has been developed to treat this disease. This network meta-analysis (NMA) was aimed to compare the efficacy of treatments for OSA. Cochrane Library, MEDLINE, and Embase were searched for eligible studies. A conventional and NMA was carried out to compare all therapies. Sleeping characteristics, including Apnea–Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), arterial oxygen saturation, and arousal index (AI), and changes of blood pressure were selected as outcomes. A total of 84 studies were finally included after rigorous screenings. For the primary outcomes of AHI and ESS, the value of auto-adjusting positive airway pressure (APAP), CPAP, and oral appliance (OA) all showed statistically reduction compared with inactive control (IC). Similar observation was obtained in AI, with treatments of the three active interventions. A lower effect of IC in SaO2 was exhibited when compared with APAP, CPAP, and OA. Similar statistically significant results were presented in 24 h systolic blood pressure and 24 h DBP when comparing with CPAP. Our NMA identified CPAP as the most efficacious treatment for OSA patients after the evaluation of sleeping characteristics and blood pressures. In addition, more clinical trials are needed for further investigation due to the existence of inconsistency observed in this study.
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Affiliation(s)
- Tingwei Liu
- Department of Respiratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wenyang Li
- Department of Respiratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Hui Zhou
- Department of Respiratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zanfeng Wang
- Department of Respiratory Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
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Troester N, Palfner M, Dominco M, Wohlkoenig C, Schmidberger E, Trinker M, Avian A. Positional therapy in sleep apnoea - one fits all? What determines success in positional therapy in sleep apnoea syndrome. PLoS One 2017; 12:e0174468. [PMID: 28406975 DOI: 10.1371/journal.pone.0174468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/09/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Positional therapy is a simple means of therapy in sleep apnoea syndrome, but due to controversial or lacking evidence, it is not widely accepted as appropriate treatment. In this study, we analysed data to positional therapy with regard to successful reduction of AHI and predictors of success. Methods All consecutive patients undergoing polysomnography between 2007 and 2011 were analysed. We used a strict definition of positional sleep apnoea syndrome (supine-exclusive sleep apnoea syndrome) and of therapy used. Patients underwent polysomnography initially and during follow-up. Results 1275 patients were evaluated, 112 of which had supine-exclusive sleep apnoea syndrome (AHI 5-66/h, median 13/h), 105 received positional therapy. With this treatment alone 75% (70/105) reached an AHI <5/h, in the follow-up 1 year later 37% (37/105) of these still had AHI<5/h, 46% (43/105) yielded an AHI between 5 and 10/h. Nine patient switched to APAP due to deterioration, 3 wanted to try APAP due to comfort reasons. At the last follow-up, 32% patients (34/105) were still on positional therapy with AHI <5/h. BMI was a predictor for successful reduction of AHI, but success was independent of sex, the presence of obstructive versus central sleep apnoea, severity of sleep apnoea syndrome or co-morbidities. Conclusion Positional therapy may be a promising therapy option for patients with positional sleep apnoea. With appropriate adherence it yields a reasonable success rate in the clinical routine.
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S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen – Kapitel „Schlafbezogene Atmungsstörungen“: Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM). Somnologie 2017; 20:97-180. [DOI: 10.1007/s11818-016-0093-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Snoring and obstructive sleep apnoea (OSA) are disorders within a wide spectrum of sleep-related breathing disorders (SRBD). Given the obesity epidemic, these conditions will become increasingly prevalent and continue to serve as a large economic burden. A thorough clinical evaluation and appropriate investigations will allow stratification of patients into appropriate treatment groups. A multidisciplinary team is required to manage these patients. Patient selection is critical in ensuring successful surgical and non-surgical outcomes. A wide range of options are available and further long term prospective studies, with standardised data capture and outcome goals, are required to evaluate the most appropriate techniques and long term success rates.
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Affiliation(s)
- Jagdeep S Virk
- Department of Otolaryngology-Head and Neck Surgery, Royal National Throat, Nose and Ear Hospital, London, UK
| | - Bhik Kotecha
- Department of Otolaryngology-Head and Neck Surgery, Royal National Throat, Nose and Ear Hospital, London, UK
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Abstract
Depending on the subpopulation, obstructive sleep apnea (OSA) can affect more than 75% of surgical patients. An increasing body of evidence supports the association between OSA and perioperative complications, but some data indicate important perioperative outcomes do not differ between patients with and without OSA. In this review we will provide an overview of the pathophysiology of sleep apnea and the risk factors for perioperative complications related to sleep apnea. We also discuss a clinical algorithm for the identification and management of OSA patients facing surgery.
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Affiliation(s)
- Sebastian Zaremba
- Department of Anaesthesia Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, 02114, USA; Department of Neurology, Rheinische-Friedrich-Wilhelms-University, Bonn, D-53127, Germany; German Center for Neurodegenerative Diseases, Bonn, D-53127, Germany
| | - James E Mojica
- Department of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, 02114, USA
| | - Matthias Eikermann
- Department of Anaesthesia Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, 02114, USA; Department of Anaesthesia and Critical Care, University Hospital Essen, Essen, 45147, Germany
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Chen WC, Lee LA, Chen NH, Fang TJ, Huang CG, Cheng WN, Li HY. Treatment of snoring with positional therapy in patients with positional obstructive sleep apnea syndrome. Sci Rep 2015; 5:18188. [PMID: 26657174 DOI: 10.1038/srep18188] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/02/2015] [Indexed: 11/28/2022] Open
Abstract
Position therapy plays a role in treating snoring and obstructive sleep apnea syndrome (OSAS). The purpose of this study was to investigate whether position therapy using a head-positioning pillow (HPP) could reduce snoring sounds in patients with mild-to-moderate positional OSAS, taking into account the potential confounding effects of body weight. A total of 25 adults with positional OSAS (apnea-hypopnea index [AHI]supine:AHInon-supine ≥ 2) were prospectively enrolled. Patients were asked to use their own pillows at home during the first night (N0), and the HPP during the second (N1) and third (N2) nights. The primary outcome measures included the subjective snoring severity (SS, measured on a visual analogue scale ranging from 0 to 10) and the objective snoring index (SI, expressed as the number of snoring events per hour measured on an acoustic analytical program). Both endpoints were recorded over three consecutive nights. From N0 to N2, the median SS and SI values in the entire study cohort decreased significantly from 5.0 to 4.0 and from 218.0 events/h to 115.0 events/h, respectively. In the subgroup of overweight patients, SS showed a significant improvement, whereas SI did not. Both SS and SI were found to be significantly improved in normal-weight patients.
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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] [What about the content of this article? (0)] [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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Casey KR. Positional therapy is worth a try in patients with mild obstructive sleep apnea. Point-counterpoint: is avoidance of supine sleep an adequate treatment for OSA? J Clin Sleep Med 2015; 11:89-90. [PMID: 25580600 DOI: 10.5664/jcsm.4444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 11/13/2022]
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Kulkas A, Muraja-Murro A, Tiihonen P, Mervaala E, Töyräs J. Morbidity and mortality risk ratios are elevated in severe supine dominant OSA: a long-term follow-up study. Sleep Breath 2014; 19:653-60. [PMID: 25367548 DOI: 10.1007/s11325-014-1071-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 10/03/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Obstructive sleep apnoea (OSA) is a common public health problem. Sleeping position dependency has been related to OSA, and around half of OSA patients suffer from positional OSA where majority of the respiratory events occur in supine position. The consequences of supine dominant OSA have not been thoroughly investigated in long-term follow-up studies. The aim of the study was to retrospectively investigate the effects of supine dominant OSA on morbidity and mortality risk ratios during long-term follow-up and compare the findings with a non-supine OSA group at different OSA severities. METHODS Ambulatory polygraphic recordings of 793 patients with median follow-up time of 194.5 months were retrospectively analysed. The risk ratios of morbidity and mortality of supine dominant OSA and non-supine OSA patients were compared. RESULTS Supine dominant OSA patients, having majority of the obstruction events occurring in supine position, showed higher mortality and morbidity risk ratios in severe OSA category than the non-supine OSA patients. In severe category, the observed risk ratios were statistically significant. CONCLUSIONS The increased risk ratios of mortality and morbidity found further emphasises that supine OSA might have more severe health consequences than non-positional OSA especially in severe OSA. Severe OSA occurring in supine position was shown to be more deleterious than non-supine OSA based on long-term mortality and morbidity evidence.
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Affiliation(s)
- Antti Kulkas
- Department of Clinical Neurophysiology, Seinäjoki Central Hospital, 60220, Seinäjoki, Finland,
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Schiza SE, Mermigkis C, Bouloukaki I. The influence of a clinical classification system on the management of patients with positional dependent obstructive sleep apnoea. Sleep Breath 2014; 19:741-3. [DOI: 10.1007/s11325-014-1037-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/03/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
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Schiza SE, Mermigkis C, Bouloukaki I. The effect of weight loss on obstructive sleep apnea (OSA) severity and position dependence in the bariatric population. Sleep Breath 2014; 18:679-81. [PMID: 24638264 DOI: 10.1007/s11325-014-0973-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/03/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Sophia E Schiza
- Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, 71110, Heraklion, Crete, Greece,
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Morong S, Benoist LBL, Ravesloot MJL, Laman DM, de Vries N. The effect of weight loss on OSA severity and position dependence in the bariatric population. Sleep Breath 2014; 18:851-6. [PMID: 24584563 DOI: 10.1007/s11325-014-0955-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 02/02/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aims of this study were to determine the prevalence of positional obstructive sleep apnea (POSA) in patients undergoing bariatric surgery and to evaluate the effect of weight loss brought about by bariatric surgery on POSA. Furthermore, the authors investigated whether body mass index (BMI), neck circumference, apnea-hypopnea index (AHI), and age are predictors for POSA. METHOD A retrospective cohort study was conducted with data collected from patients who were screened for OSA pre-bariatric surgery and completed a follow-up polysomnography post bariatric surgery from August 2008 to November 2012. Descriptive statistics were used to characterize the prevalence of POSA patients, and the Mann-Whitney and Wilcoxon signed-rank tests were used to examine differences between the POSA and non-POSA groups. A logistic regression model was used to determine predictors for POSA. RESULTS Thirty-four percent of patients had POSA, which is significantly lower (p<0.001) than in the general population. BMI, neck circumference, and AHI were significantly lower in POSA patients. AHI was the only significant independent predictor for POSA. Of the 91 patients analyzed following bariatric surgery, 35.2% (n=32) no longer had OSA. CONCLUSION The prevalence of POSA in patients undergoing bariatric surgery is significantly lower than the prevalence noted in the general population. A low AHI was shown to be the only significant independent predictor for the presence of POSA.
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Affiliation(s)
- S Morong
- Department of Otolaryngology, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1006 AE, Amsterdam, The Netherlands,
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Oksenberg AS. Positional therapy for sleep apnea: a promising behavioral therapeutic option still waiting for qualified studies. Sleep Med Rev 2013; 18:3-5. [PMID: 24100064 DOI: 10.1016/j.smrv.2013.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 08/30/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Arie S Oksenberg
- Sleep Disorders Unit, Loewenstein Hospital - Rehabilitation Center, POB 3, Raanana, Israel.
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