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A novel nasopharyngeal stent for the treatment of obstructive sleep apnea: a case series of nasopharyngeal stenting versus continuous positive airway pressure. Eur Arch Otorhinolaryngol 2015; 273:1307-12. [PMID: 26525882 DOI: 10.1007/s00405-015-3815-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/22/2015] [Indexed: 02/06/2023]
Abstract
The objective of the study was to investigate the first-night treatment success of a nasopharyngeal stent compared to standard nCPAP-titration. This is a case series and a single-center study. Eight participants (n = 8) were selected with untreated obstructive sleep apnea with a prestudy AHI ≥ 10. A newly developed nasopharyngeal stent was tested individually versus standard nCPAP-titration. Cardiorespiratory polysomnography was performed on two consecutive nights (random order: stent, nCPAP). The AHI, the number of obstructive apneas and hypopneas, the mean oxygen saturation, and the minimum oxygen saturation were compared before and after using the nasopharyngeal stent or standard nCPAP. The AHI value before treatment (AHIpre) was 31.1 ± 12.0 (mean ± standard deviation). After inserting the AlaxoStent, the mean AHIstent was 19 ± 12.0 compared to mean AHInCPAP 8.2 ± 11.9 with standard nCPAP-titration. Both nasopharyngeal stenting and nCPAP-titration could reduce the mean number of obstructive apneas by >94 %. Compared to responder rates of classic surgical interventions like uvulopalatopharyngoplasty or multi-level surgery, the nasopharyngeal stent seems to give a comparable responder rate of 50 %. There were no complications associated with the use of the stent and it was well tolerated by all subjects. Nasopharyngeal stenting widens the range of non-invasive mechanical treatment and seems to be an effective mechanical therapeutic alternative to surgery in nCPAP non-compliant patients with OSA. Careful selection of the patient population is a prerequisite of treatment and therefore it should be reserved for individual cases only.
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152
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Behavioral economics strategies for promoting adherence to sleep interventions. Sleep Med Rev 2015; 23:20-7. [DOI: 10.1016/j.smrv.2014.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 11/04/2014] [Accepted: 11/11/2014] [Indexed: 12/28/2022]
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153
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Puckrin R, Iqbal S, Zidulka A, Vasilevsky M, Barre P. Renoprotective effects of continuous positive airway pressure in chronic kidney disease patients with sleep apnea. Int Urol Nephrol 2015; 47:1839-45. [PMID: 26424500 DOI: 10.1007/s11255-015-1113-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 09/14/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Chronic kidney disease (CKD) is associated with a high incidence of obstructive sleep apnea (OSA). We assessed the effect of continuous positive airway pressure (CPAP) on renal function in patients with CKD and OSA. METHODS In this retrospective cohort study, 42 patients with Stage 3-5 CKD and OSA were stratified into two groups: patients who use CPAP more (average >4 h/night on >70 % of nights) and patients who use CPAP less (average ≤4 h/night on ≤70 % of nights). Median follow-up time was 2.3 (1.6-2.9) years for greater and 2.0 (0.6-3.5) years for lesser CPAP users. Chart reviews were carried out to record clinical characteristics, proteinuria measurements by urine dipstick, and eGFR values calculated by CKD-EPI equations. Univariate analyses were performed using Wilcoxon rank-sum and Kruskal-Wallis tests. Multivariate logistic regression models were applied to assess eGFR decline after CPAP prescription. RESULTS Twelve (29 %) of the 42 subjects used CPAP more. Groups were similar with respect to age, body mass index, blood pressure, Charlson Comorbidity Index, and baseline eGFR and proteinuria. The median rate of decline of eGFR was significantly slower at -0.07 mL/min/1.73 m(2)/year (range -30 to 13) in those who used more CPAP compared to those who used it less at -3.15 mL/min/1.73 m(2)/year (range -27 to 7) (p = 0.027).Greater use of CPAP was also associated with a significantly reduced level of proteinuria at 0.15 (range 0.0-3.0) versus 0.70 g/L (range 0.0-3.0) (p = 0.046). Less compliant CPAP users were more likely to have progressive decline of eGFR (decline >3 mL/min/1.73 m(2)/year), with unadjusted OR 5.0 (95 % CI 0.93-26.8) and adjusted OR 8.9 (95 % CI 1.1-72.8), adjusting for CCI and baseline eGFR. CONCLUSIONS Compliance to CPAP therapy is associated with a slower rate of progression of CKD in patients with CKD and OSA.
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Affiliation(s)
| | - Sameena Iqbal
- McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Paul Barre
- McGill University Health Centre, Montreal, QC, Canada
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Donovan LM, Boeder S, Malhotra A, Patel SR. New developments in the use of positive airway pressure for obstructive sleep apnea. J Thorac Dis 2015; 7:1323-42. [PMID: 26380760 DOI: 10.3978/j.issn.2072-1439.2015.07.30] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 07/03/2015] [Indexed: 12/14/2022]
Abstract
Obstructive sleep apnea (OSA) is a disorder which afflicts a large number of individuals around the world. OSA causes sleepiness and is a major cardiovascular risk factor. Since its inception in the early 1980's, continuous positive airway pressure (CPAP) has emerged as the major treatment of OSA, and it has been shown to improve sleepiness, hypertension, and a number of cardiovascular indices. Despite its successes, adherence with treatment remains a major limitation. Herein we will review the evidence behind the use of positive airway pressure (PAP) therapy, its various modes, and the methods employed to improve adherence. We will also discuss the future of PAP therapy in OSA and personalization of care.
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Affiliation(s)
- Lucas M Donovan
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA ; 2 Department of Medicine, 3 Department of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA, USA ; 4 Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Schafer Boeder
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA ; 2 Department of Medicine, 3 Department of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA, USA ; 4 Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Atul Malhotra
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA ; 2 Department of Medicine, 3 Department of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA, USA ; 4 Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sanjay R Patel
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA ; 2 Department of Medicine, 3 Department of Pulmonary and Critical Care Medicine, University of California San Diego, San Diego, CA, USA ; 4 Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Sharma SK, Katoch VM, Mohan A, Kadhiravan T, Elavarasi A, Ragesh R, Nischal N, Sethi P, Behera D, Bhatia M, Ghoshal AG, Gothi D, Joshi J, Kanwar MS, Kharbanda OP, Kumar S, Mohapatra PR, Mallick BN, Mehta R, Prasad R, Sharma SC, Sikka K, Aggarwal S, Shukla G, Suri JC, Vengamma B, Grover A, Vijayan VK, Ramakrishnan N, Gupta R. Consensus and evidence-based Indian initiative on obstructive sleep apnea guidelines 2014 (first edition). Lung India 2015; 32:422-34. [PMID: 26180408 PMCID: PMC4502224 DOI: 10.4103/0970-2113.159677] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Obstructive sleep apnea (OSA) and obstructive sleep apnea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences among the general public as well as the majority of primary care physicians across India is poor. This necessitated the development of the Indian initiative on obstructive sleep apnea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health and Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep-related symptoms or co-morbidities or ≥15 such episodes without any sleep-related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents, and high-risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers, and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography is the “gold standard” for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances (OA) are indicated for use in patients with mild to moderate OSA who prefer OA to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioral measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.
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Affiliation(s)
- Surendra K Sharma
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Vishwa Mohan Katoch
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, New Delhi, India
| | - Alladi Mohan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - T Kadhiravan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - A Elavarasi
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - R Ragesh
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Neeraj Nischal
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Prayas Sethi
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - D Behera
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manvir Bhatia
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Medanta Hospital, Gurgaon, Haryana, India
| | - A G Ghoshal
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - Dipti Gothi
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Employees' State Insurance Corporation, Post Graduate Institute of Medical Sciences and Research, New Delhi, India
| | - Jyotsna Joshi
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Topiwala National Medical College, Mumbai, Maharashtra, India
| | - M S Kanwar
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Apollo Hospitals, New Delhi, India
| | - O P Kharbanda
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Suresh Kumar
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Sree Balaji Medical College and Hospital, Bharath University, Chennai, Tamil Nadu, India
| | - P R Mohapatra
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - B N Mallick
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Ravindra Mehta
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Apollo Hospitals, Bengaluru, Karnataka, India
| | - Rajendra Prasad
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; VP Chest Institute, New Delhi, India
| | - S C Sharma
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Kapil Sikka
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Sandeep Aggarwal
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - Garima Shukla
- All India Institute of Medical Sciences, New Delhi, India ; Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group
| | - J C Suri
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Safdarjung Hospital, New Delhi, India
| | - B Vengamma
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Ashoo Grover
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, New Delhi, India
| | - V K Vijayan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, Bhopal, Madhya Pradesh, India
| | - N Ramakrishnan
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Rasik Gupta
- Writing Committee of the Indian Initiative on Obstructive Sleep Apnoea Guidelines Working Group ; Indian Council of Medical Research, New Delhi, India
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Zhu K, Roisman G, Aouf S, Escourrou P. All APAPs Are Not Equivalent for the Treatment of Sleep Disordered Breathing: A Bench Evaluation of Eleven Commercially Available Devices. J Clin Sleep Med 2015; 11:725-34. [PMID: 25766708 DOI: 10.5664/jcsm.4844] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 01/26/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study challenged on a bench-test the efficacy of auto-titrating positive airway pressure (APAP) devices for obstructive sleep disordered breathing treatment and evaluated the accuracy of the device reports. METHODS Our bench consisted of an active lung simulator and a Starling resistor. Eleven commercially available APAP devices were evaluated on their reactions to single-type SDB sequences (obstructive apnea and hypopnea, central apnea, and snoring), and to a long general breathing scenario (5.75 h) simulating various SDB during four sleep cycles and to a short scenario (95 min) simulating one sleep cycle. RESULTS In the single-type sequence of 30-minute repetitive obstructive apneas, only 5 devices normalized the airflow (> 70% of baseline breathing amplitude). Similarly, normalized breathing was recorded with 8 devices only for a 20-min obstructive hypopnea sequence. Five devices increased the pressure in response to snoring. Only 4 devices maintained a constant minimum pressure when subjected to repeated central apneas with an open upper airway. In the long general breathing scenario, the pressure responses and the treatment efficacy differed among devices: only 5 devices obtained a residual obstructive AHI < 5/h. During the short general breathing scenario, only 2 devices reached the same treatment efficacy (p < 0.001), and 3 devices underestimated the AHI by > 10% (p < 0.001). The long scenario led to more consistent device reports. CONCLUSION Large differences between APAP devices in the treatment efficacy and the accuracy of report were evidenced in the current study.
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Affiliation(s)
- Kaixian Zhu
- Air Liquide Healthcare, Gentilly, France.,Sleep Disorders Center, AP-HP Antoine-Béclère Hospital, Clamart, France.,EA3544, Faculty of Pharmacy, Paris-Sud University, Châtenay-Malabry, France
| | - Gabriel Roisman
- Sleep Disorders Center, AP-HP Antoine-Béclère Hospital, Clamart, France
| | - Sami Aouf
- Air Liquide Healthcare, Gentilly, France
| | - Pierre Escourrou
- Sleep Disorders Center, AP-HP Antoine-Béclère Hospital, Clamart, France.,EA3544, Faculty of Pharmacy, Paris-Sud University, Châtenay-Malabry, France
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157
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Exhaled nitric oxide from the central airway and alveoli in OSAHS patients: the potential correlations and clinical implications. Sleep Breath 2015; 20:145-54. [PMID: 26084410 DOI: 10.1007/s11325-015-1198-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/02/2015] [Accepted: 05/15/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of the study was to evaluate exhaled nitric oxide (eNO) derived from different areas of airway in obstructive sleep apnea hypopnea syndrome (OSAHS) patients with NO exchange model and investigate the potential application and interpretation of eNO in clinical setting. METHODS This study was divided into two parts. Firstly, we performed a case control study in 32 OSAHS patients and 27 non-OSAHS participants. Fractional eNO (FeNO) and eNO from the central airway (J'awNO) and from alveoli (CANO) were compared in OSAHS and control groups. Also, correlation of eNO to severity of OSAHS was analyzed. Secondly, a prospective study was conducted in 30 severe OSAHS patients who received a short-term nasal continuous positive airway pressure (nCPAP) treatment. We evaluated eNO, plasma ET-1 concentration, and echocardiography during the treatment process and explored the potential relationship among them. RESULTS FeNO and J'awNO were higher in OSAHS and associated with disease severity, while CANO was relatively lower. After nCPAP treatment in severe OSAHS patients, FeNO and J'awNO decreased and CANO increased significantly. Substantial agreement was shown between the elevation of CANO and the decrease of plasma ET-1 concentration after nCPAP by Kappa analysis for consistency. Tei index, which is considered indicative of global right ventricular function, might be predicted by plasma ET-1 levels in severe OSAHS patients. CONCLUSIONS NO exchange model provides us with more information of eNO derived from different areas. eNO is not only confirmed to be an effective method for airway inflammation evaluation in the follow-up of OSAHS, CANO may also serve as a useful marker in monitoring endothelial function, resistance of pulmonary circulation, and right ventricular function for clinical implication.
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158
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Goel AK, Talwar D, Jain SK. Evaluation of short-term use of nocturnal nasal continuous positive airway pressure for a clinical profile and exercise capacity in adult patients with obstructive sleep apnea-hypopnea syndrome. Lung India 2015; 32:225-32. [PMID: 25983407 PMCID: PMC4429383 DOI: 10.4103/0970-2113.156226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIM The obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common chronic respiratory disease, characterized by repetitive complete or partial collapse of the upper airway during sleep. The clinical spectrum extends between stoppage of breathing, snoring, daytime somnolence, and fatigue, to serious cardiovascular disease, stroke, metabolic syndrome, increased morbidity, and mortality. We aim to evaluate the short-term use of nasal continuous positive airway pressure (nCPAP) therapy for the clinical profile and exercise capacity of patients with OSAHS. PATIENT SELECTION Twenty patients diagnosed with moderate-to-severe OSAHS were enrolled in the study (study group - 15; clinically and PSG-matched control group - 5). MATERIALS AND METHODS Each patient was clinically evaluated for sleep-related symptoms, and also assessed with spirometry, the six-minute walk test (6MWT), and a symptom-limited incremental cardiopulmonary exercise test (CPET). The study group patients were administered nCPAP therapy for eight hours each night for four weeks, while the control group patients were just observed. They were re-assessed after four weeks and the data were statistically analyzed between the two groups. RESULTS The study group patients showed a significant (P- < 0.05) improvement in the OSAHS symptoms-the Epworth sleepiness score, six-minute walk distance; duration of exercise, power output, peak oxygen uptake, anaerobic threshold, diastolic blood pressure, dyspnea, and fatigue-in comparison with the control group patients. The improvement in exercise capacity following nCPAP therapy was attributed to the relief of disabling the OSAHS symptoms and improved cardiovascular, ventilator, and musculoskeletal functions. CONCLUSION All OSAHS patients must be treated with nCPAP.
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Affiliation(s)
- Amrit K Goel
- Department of Respiratory, Sleep, Allergy, and Critical Care Medicine, Metro Centre for Respiratory Diseases, Metro Group of Hospitals, Noida, Uttar Pradesh, India
| | - Deepak Talwar
- Department of Respiratory, Sleep, Allergy, and Critical Care Medicine, Metro Centre for Respiratory Diseases, Metro Group of Hospitals, Noida, Uttar Pradesh, India
| | - Sushil K Jain
- Department of Respiratory, Sleep, Allergy, and Critical Care Medicine, Metro Centre for Respiratory Diseases, Metro Group of Hospitals, Noida, Uttar Pradesh, India
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159
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Sleep apnoea and the brain: a complex relationship. THE LANCET RESPIRATORY MEDICINE 2015; 3:404-14. [DOI: 10.1016/s2213-2600(15)00090-9] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 01/23/2023]
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160
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Minichbauer BC, Sheats RD, Wilder RS, Phillips CL, Essick GK. Sleep Medicine Content in Dental Hygiene Education. J Dent Educ 2015. [DOI: 10.1002/j.0022-0337.2015.79.5.tb05907.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Rose D. Sheats
- Department of Endodontics; Oral Facial Pain Group; Dental Sleep Medicine Unit; University of North Carolina at Chapel Hill School of Dentistry
| | | | - Ceib L. Phillips
- Department of Orthodontics; University of North Carolina at Chapel Hill School of Dentistry
| | - Gregory K. Essick
- Department of Prosthodontics and Center for Neurosensory Disorders; University of North Carolina at Chapel Hill School of Dentistry
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161
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Gonzaga C, Bertolami A, Bertolami M, Amodeo C, Calhoun D. Obstructive sleep apnea, hypertension and cardiovascular diseases. J Hum Hypertens 2015; 29:705-12. [DOI: 10.1038/jhh.2015.15] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 01/07/2015] [Accepted: 01/23/2015] [Indexed: 11/09/2022]
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162
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Abstract
Epidemiologic studies have shown that approximately 50% of older adults have sleep problems, many of which carry deleterious consequences that affect physical and mental health and also social functioning. However, sleep problems in late life are often unrecognized, and are inadequately treated in clinical practice. This article focuses on the diagnosis and treatment of the 2 most common sleep problems in older patients: sleep apnea and insomnia.
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Affiliation(s)
- Juan Carlos Rodriguez
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (IE), North Hills, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 405 Hilgard Avenue, CA 90095, USA; Department of Medicine, Pontificia Universidad Catolica de: Ave, Libertador Bernardo O'Higgins 340, Santiago, Chile.
| | - Joseph M Dzierzewski
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (IE), North Hills, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 405 Hilgard Avenue, CA 90095, USA
| | - Cathy A Alessi
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (IE), North Hills, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 405 Hilgard Avenue, CA 90095, USA
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163
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Djonlagic I, Guo M, Matteis P, Carusona A, Stickgold R, Malhotra A. First night of CPAP: impact on memory consolidation attention and subjective experience. Sleep Med 2015; 16:697-702. [PMID: 25953301 DOI: 10.1016/j.sleep.2015.01.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/23/2014] [Accepted: 01/23/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Neurocognitive deficits are common and serious consequences of obstructive sleep apnea (OSA). Currently, the gold standard treatment is continuous positive air pressure (CPAP) therapy, although the clinical responses to this intervention can be variable. This study examined the effect of one night of CPAP therapy on sleep-dependent memory consolidation, attention, and vigilance as well as subjective experience. METHODS Fifteen healthy controls and 29 patients with obstructive sleep apnea of whom 14 underwent a full-night CPAP titration completed the psychomotor vigilance test (PVT) and motor sequence learning task (MST) in the evening and the morning after undergoing overnight polysomnography. All participants also completed subjective evaluations of sleep quality. RESULTS Participants with OSA showed significantly less overnight improvement on the MST compared to controls without OSA, independent of whether or not they had received CPAP treatment, while there was no significant difference between the untreated OSA and CPAP-treated patients. Within the OSA group, only those receiving CPAP exhibited faster reaction times on the PVT in the morning. Compared to untreated OSA patients, they also felt subjectively more rested and reported that they slept better. CONCLUSION Our results demonstrate an instant augmentation of subjective experience and, based on PVT results, attention and vigilance after one night of CPAP, but a lack of an effect on offline sleep-dependent motor memory consolidation. This dissociation may be explained by different brain structures underlying these processes, some of which might require longer continued adherence to CPAP to generate an effect.
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Affiliation(s)
- Ina Djonlagic
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Center for Sleep and Cognition, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Sleep Medicine, Sleep Disorders Program Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Mengshuang Guo
- Center for Sleep and Cognition, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Sleep Medicine, Sleep Disorders Program Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Paul Matteis
- Center for Sleep and Cognition, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Sleep Medicine, Sleep Disorders Program Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Carusona
- Division of Sleep Medicine, Sleep Disorders Program Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Robert Stickgold
- Center for Sleep and Cognition, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Atul Malhotra
- Division of Sleep Medicine, Sleep Disorders Program Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA; Division of Pulmonary and Critical Care, University of California San Diego, La Jolla, CA, USA
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164
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Baba RY, Mohan A, Metta VVSR, Mador MJ. Temperature controlled radiofrequency ablation at different sites for treatment of obstructive sleep apnea syndrome: a systematic review and meta-analysis. Sleep Breath 2015; 19:891-910. [PMID: 25643764 DOI: 10.1007/s11325-015-1125-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/13/2014] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study seeks to determine the efficacy of temperature controlled radiofrequency tissue ablation (TCRFTA) to alleviate symptoms of obstructive sleep apnea (OSA) and reduce polysomnographic measures of OSA in the first year post-treatment. METHODS Systematic review and meta-analysis. Two independent searches of MEDLINE, EMBASE bibliographic databases, and Evidence Based Medicine Reviews to identify publications relevant to OSA and TCRFTA. Effectiveness of TCRFTA was measured separately for application of TCRFTA at the base of tongue and soft palate, and for multilevel intervention using the respiratory disturbance index (RDI), lowest oxygen saturation (LSAT), Epworth sleepiness scale (ESS), and bed partner's rating of snoring using a visual analogue scale (VAS snoring). The most recent search was conducted in April 2013. Statistical analysis was performed using Review Manager Version 5.2 using a relative measure of effect, i.e., ratio of means (RoM). RESULTS Our initial search resulted in 29 eligible studies, and subsequently, 20 studies were included in the meta-analysis. Substantial and consistent improvement in PSG and subjective outcomes were observed post-TCRFTA in the base of tongue (BOT) and multilevel surgery groups only. Application of TCRFTA at the BOT was associated with a significant reduction in RDI (RoM 0.60, CI 0.47-0.76), ESS (RoM 0.59, CI 0.51-0.67), and VAS snoring (RoM 0.48, CI 0.37-0.62) and increase in lowest oxygen saturation (RoM 1.05, CI 1.01-1.10). Similarly, a significant reduction in RDI (RoM 0.61, CI 0.47-0.80) and ESS (RoM 0.79, CI -0.71 to 0.88) was observed after multilevel TCRFTA, but substantial heterogeneity between these studies was observed. CONCLUSION TCRFTA is clinically effective in reducing RDI levels and symptoms of sleepiness in patients with OSA syndrome when directed at the base of tongue or as a multilevel procedure.
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Affiliation(s)
- Ridhwan Y Baba
- Department of Internal Medicine, University at Buffalo, Buffalo, NY, USA
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165
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Obstructive sleep apnea among hospitalized patients in Spain, analysis of hospital discharge data 2008-2012. Sleep Breath 2015; 19:841-8. [PMID: 25566944 DOI: 10.1007/s11325-014-1104-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/12/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study is to describe clinical characteristics, diagnostic and therapeutic procedure (polysomnography and continuous positive airway pressure (CPAP)/bi-level positive airway pressure (BPAP)), comorbidity, length of hospital stay (LOHS), discharge destination, and in-hospital mortality (IHM) of patients hospitalized for obstructive sleep apnea (OSA) in Spain over a 5-year study period. METHODS We included all patients who were hospitalized for OSA (ICD9-CM code 327.23) as primary or secondary diagnosis between 2008 and 2012. Data were collected from the National Hospital Discharge Database, covering the entire Spanish population. RESULTS We identified 196,769 discharges of patients admitted for OSA. The number of patients with OSA as primary or secondary diagnosis increased from 2008 to 2012 from 5358 to 7992 and 14,916 to 51,135 respectively. The mean age was 50.7 ± 20.3 years in patients admitted for OSA as primary diagnosis (n = 32,010) and 63.7 ± 17.6 years in patients admitted for OSA as secondary diagnosis (n = 164,759). The most common secondary diagnoses for patients discharged with a primary diagnosis of OSA was arterial hypertension (19.0%), obesity (16.9%), disorders of lipid metabolism (8.01%) and diabetes mellitus (6.48%). The most common primary diagnoses for patients discharged with a secondary diagnosis of OSA were obesity (12.5%), heart failure (9.6%), and chronic bronchitis (4.5%). The percentage of patients that received continuous positive airway pressure (CPAP)/bi-level positive airway pressure (BPAP) therapy was 11.3%. Patients who received this therapy had a higher length of stay compared with those who did not (10.4 ± 14.1 versus 7.3 ± 9.5 days, respectively, p < 0.05) and were less likely to be discharged to home (87.2 versus 91.1%, p < 0.05). The mortality was higher in the first group of patients (9 versus 5.6%, p < 0.05). Multivariate analysis showed that each year from 2008 to 2012, the mean probability of having OSA as primary diagnosis increased an average of 8%, and 33% as secondary diagnosis, after adjusting for other variables. CONCLUSIONS The results of this study reveal a national perspective on the characteristics and management of OSA in hospitalized patients in Spain during the period of 2008-2012. The burden of the disease seems to be increasing in Spain. Clinical studies are needed to provide a better knowledge of OSA in this subgroup of patients.
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Saito A, Kojima S, Sasaki F, Hayashi M, Mieno Y, Sakakibara H, Hashimoto S. Development and evaluation of a self-efficacy instrument for Japanese sleep apnea patients receiving continuous positive airway pressure treatment. Nat Sci Sleep 2015; 7:25-31. [PMID: 25678832 PMCID: PMC4319555 DOI: 10.2147/nss.s74268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to develop and evaluate a self-efficacy instrument for Japanese obstructive sleep apnea (OSA) patients treated with continuous positive airway pressure (CPAP). Analyzed subjects were 653 Japanese OSA patients (619 males and 34 females) treated with CPAP at a sleep laboratory in a respiratory clinic in a Japanese city. Based on Bandura's social cognitive theory, the CPAP Self-Efficacy Questionnaire for Sleep Apnea in Japanese (CSESA-J) was developed by a focus group of experts, using a group interview of OSA patients for the items of two previous self-efficacy scales for Western sleep apnea patients receiving CPAP treatment. CSESA-J has two subscales, one for self-efficacy and the other for outcome expectancy, and consists of a total of 15 items. Content validity was confirmed by the focus group. Confirmatory factor analysis showed that the factor loadings of self-efficacy and outcome expectancy were 0.47-0.76 and 0.41-0.92, respectively, for the corresponding items. CSESA-J had a significant but weak positive association with the General Self-Efficacy Scale, and a strong positive association with "Self-efficacy scale on health behavior in patients with chronic disease." Cronbach's alpha coefficient was 0.85 for the self-efficacy subscale and 0.89 for the outcome expectancy subscale. The intraclass correlation coefficient using data from the first and second measurements with CSESA-J for a subset of 130 subjects was 0.93 for the self-efficacy and outcome expectancy subscales. These results support CSESA-J as a reliable and valid instrument for measuring the self-efficacy of Japanese OSA patients treated with CPAP. Further studies are warranted to confirm validity for female OSA patients and generalizability.
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Affiliation(s)
- Ayako Saito
- Department of Hygiene, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shigeko Kojima
- Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, Handa, Japan
| | | | - Masamichi Hayashi
- Department of Internal Medicine, Division of Respiratory Medicine and Clinical Allergy, Fujita Health University, Toyoake, Japan
| | - Yuki Mieno
- Department of Internal Medicine, Division of Respiratory Medicine and Clinical Allergy, Fujita Health University, Toyoake, Japan
| | | | - Shuji Hashimoto
- Department of Hygiene, School of Medicine, Fujita Health University, Toyoake, Japan
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Corben LA, Lynch D, Pandolfo M, Schulz JB, Delatycki MB. Consensus clinical management guidelines for Friedreich ataxia. Orphanet J Rare Dis 2014; 9:184. [PMID: 25928624 PMCID: PMC4280001 DOI: 10.1186/s13023-014-0184-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/07/2014] [Indexed: 12/16/2022] Open
Abstract
Friedreich ataxia (FRDA), a multisystem autosomal recessive condition, is the most common inherited ataxia in Caucasians, affecting approximately 1 in 29,000 individuals. The hallmark clinical features of FRDA include progressive afferent and cerebellar ataxia, dysarthria, impaired vibration sense and proprioception, absent tendon reflexes in lower limbs, pyramidal weakness, scoliosis, foot deformity and cardiomyopathy. Despite significant progress in the search for disease modifying agents, the chronic progressive nature of FRDA continues to have a profound impact on the health and well-being of people with FRDA. At present there is no proven treatment that can slow the progression or eventual outcome of this life-shortening condition. Thirty-nine expert clinicians located in Europe, Australia, Canada and USA critically appraised the published evidence related to FRDA clinical care and provided this evidence in a concise manner. Where no published data specific to FRDA existed, recommendations were based on data related to similar conditions and/or expert consensus. There were 146 recommendations developed to ensure best practice in the delivery of health services to people with FRDA. Sixty-two percent of recommendations are based on expert opinion or good practice indicating the paucity of high-level quality clinical studies in this area. Whilst the development of these guidelines provides a critical first step in the provision of appropriate clinical care for people with FRDA, it also highlights the urgency of undertaking high-quality clinical studies that will ensure the delivery of optimum clinical management and intervention for people with FRDA.
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Affiliation(s)
- Louise A Corben
- Bruce Lefroy Centre, Murdoch Childrens Research Institute, Parkville, 3052, Victoria, Australia.
- Monash Health, Clayton, 3168, Victoria, Australia.
| | - David Lynch
- Department of Neurology, Children's Hospital of Philadelphia, Pennsylvania, USA.
- Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania, USA.
- University of Pennsylvania, Pennsylvania, USA.
| | - Massimo Pandolfo
- Laboratory of Experimental Neurology, Université Libre de Bruxelles, Brussels, Belgium.
| | - Jörg B Schulz
- Department of Neurology, University Hospital, Aachen, Germany.
| | - Martin B Delatycki
- Bruce Lefroy Centre, Murdoch Childrens Research Institute, Parkville, 3052, Victoria, Australia.
- Department of Clinical Genetics, Austin Health, Heidelberg, 3084, Victoria, Australia.
- Department of Paediatrics, Melbourne University, Parkville, 3052, Victoria, Australia.
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Magyar MT. [Beneficial effect of continuous positive airway pressure therapy in obstructive sleep apnea syndrome]. Orv Hetil 2014; 155:1855-9. [PMID: 25403278 DOI: 10.1556/oh.2014.30040] [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: 11/19/2022]
Abstract
Continuous positive airway pressure therapy is an evidence based therapy of obstructive sleep apnea syndrome. The effective treatment of obstructive sleep apnea can decrease sympaticotonia and, consequently, blood pressure. Furthermore, it can improve inflammatory and metabolic parameters resulting in a decreased cardiovascular risk. This article summarizes the positive effects of continuous positive airway pressure therapy on cardiovascular risk factors in obstructive sleep apnea syndrome.
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Affiliation(s)
- Mária Tünde Magyar
- Debreceni Egyetem, Klinikai Központ, Általános Orvostudományi Kar Neurológiai Klinika Debrecen Móricz Zs. krt. 22 4032
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Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis. PLoS Med 2014; 11:e1001762. [PMID: 25423175 PMCID: PMC4244041 DOI: 10.1371/journal.pmed.1001762] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/17/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality, and decreased quality of life. Treatment with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is effective for many symptoms of OSA. However, it remains controversial whether treatment with CPAP or MAD also improves depressive symptoms. METHODS AND FINDINGS We performed a systematic review and meta-analysis of randomized controlled trials that examined the effect of CPAP or MADs on depressive symptoms in patients with OSA. We searched Medline, EMBASE, the Cochrane Central Registry of Controlled Trials, and PsycINFO from the inception of the databases until August 15, 2014, for relevant articles. In a random effects meta-analysis of 19 identified trials, CPAP treatment resulted in an improvement in depressive symptoms compared to control, but with significant heterogeneity between trials (Q statistic, p<0.001; I(2) = 71.3%, 95% CI: 54%, 82%). CPAP treatment resulted in significantly greater improvement in depressive symptoms in the two trials with a higher burden of depression at baseline (meta-regression, p<0.001). The pooled standardized mean difference (SMD) in depressive symptoms with CPAP treatment in these two trial populations with baseline depression was 2.004 (95% CI: 1.387, 2.621), compared to 0.197 (95% CI: 0.059, 0.334) for 15 trials of populations without depression at baseline. Pooled estimates of the treatment effect of CPAP were greater in parallel arm trials than in crossover trials (meta-regression, p = 0.076). Random effects meta-analysis of five trials of MADs showed a significant improvement in depressive symptoms with MADs versus controls: SMD = 0.214 (95% CI: 0.026, 0.401) without significant heterogeneity (I(2) = 0%, 95% CI: 0%, 79%). Studies were limited by the use of depressive symptom scales that have not been validated specifically in people with OSA. CONCLUSIONS CPAP and MADs may be useful components of treatment of depressive symptoms in individuals with OSA and depression. The efficacy of CPAP and MADs compared to standard therapies for depression is unknown. Please see later in the article for the Editors' Summary.
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170
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Strayer RJ, Caputo ND. Noninvasive ventilation during procedural sedation in the ED: a case series. Am J Emerg Med 2014; 33:116-20. [PMID: 25455053 DOI: 10.1016/j.ajem.2014.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 10/07/2014] [Accepted: 10/11/2014] [Indexed: 12/14/2022] Open
Affiliation(s)
- Reuben J Strayer
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA.
| | - Nicholas D Caputo
- Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY, USA
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Abstract
Sleep issues are common in people with psychiatric disorders, and the interaction is complex. Sleep disorders, particularly insomnia, can precede and predispose to psychiatric disorders, can be comorbid with and exacerbate psychiatric disorders, and can occur as part of psychiatric disorders. Sleep disorders can mimic psychiatric disorders or result from medication given for psychiatric disorders. Impairment of sleep and of mental health may be different manifestations of the same underlying neurobiological processes. For the primary care physician, key tools include recognition of potential sleep effects of psychiatric medications and familiarity with treatment approaches for insomnia in depression and anxiety.
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Affiliation(s)
- Eliza L Sutton
- Department of Medicine, University of Washington, 4245 Roosevelt Way Northeast, Box 354765, Seattle, WA 98105, USA.
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172
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Nannapaneni S, Morgenthaler TI, Ramar K. Assessing and predicting the likelihood of interventions during routine annual follow-up visits for management of obstructive sleep. J Clin Sleep Med 2014; 10:919-24. [PMID: 25126040 DOI: 10.5664/jcsm.3972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Patients with obstructive sleep apnea (OSA) on established positive airway pressure (PAP) treatment are often advised routine annual follow-up visits to assess ongoing effectiveness and address problems associated with therapy. This study evaluates the clinical utility of annual face-to-face follow-up visits. DESIGN We performed a retrospective chart review of OSA patients on PAP who had completed a routine annual follow-up visit. Demographics, polysomnography, PAP compliance, Epworth Sleepiness Scale (ESS), subjective complaints (efficacy and interface issues, equipment malfunction, prescription renewal), objective findings (efficacy or leak issues, equipment problems), and visit-specific interventions were recorded. We determined relationships between patient provided information and likelihood of therapeutic versus administrative interventions. SETTING Academic sleep center. MEASUREMENTS AND RESULTS Among 716 patients who met study criteria, we abstracted data on 180 randomly selected patients. On multivariate analyses, only subjective complaints or objective findings by providers were associated with a therapeutic intervention (p < 0.0001). Though most patients (55 of 63 patients, 87.3%) who required therapeutic interventions had objective findings, without subjective complaints, the odds of such findings were only 0.12 (95% CI = 0.06-0.24, p < 0.0001). Without subjective complaints, the likelihood of a therapeutic intervention was 0.07 (95% CI = 0.03-0.15, p < 0.001). CONCLUSION Our data suggests that in the absence of a subjective complaint, an annual follow-up is more likely to require administrative rather than face-to-face clinical intervention. Designing a clinic model to account for this might reduce resource utilization. However, the value and optimal timing of "routine" annual follow-up visits requires further evaluation.
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Affiliation(s)
| | - Timothy I Morgenthaler
- Division of Pulmonary and Critical Care Medicine and ; Center for Sleep Medicine, Mayo Clinic, Rochester, MN
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine and ; Center for Sleep Medicine, Mayo Clinic, Rochester, MN
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173
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Effects of a pragmatic lifestyle intervention for reducing body mass in obese adults with obstructive sleep apnoea: a randomised controlled trial. BIOMED RESEARCH INTERNATIONAL 2014; 2014:102164. [PMID: 25136550 PMCID: PMC4127266 DOI: 10.1155/2014/102164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 06/16/2014] [Accepted: 07/04/2014] [Indexed: 12/13/2022]
Abstract
This study investigated the effects of a pragmatic lifestyle intervention in obese adults with continuous positive airway pressure-treated obstructive sleep apnoea hypopnoea syndrome (OSAHS). Sixty patients were randomised 1 : 1 to either a 12-week lifestyle intervention or an advice-only control group. The intervention involved supervised exercise sessions, dietary advice, and the promotion of lifestyle behaviour change using cognitive-behavioural techniques. Outcomes were assessed at baseline (week 0), intervention end-point (week 13), and follow-up (week 26). The primary outcome was 13-week change in body mass. Secondary outcomes included anthropometry, blood-borne biomarkers, exercise capacity, and health-related quality of life. At end-point, the intervention group exhibited small reductions in body mass (−1.8 [−3.0, −0.5] kg; P = 0.007) and body fat percentage (−1 [−2, 0]%; P = 0.044) and moderate improvements in C-reactive protein (−1.3 [−2.4, −0.2] mg·L−1; P = 0.028) and exercise capacity (95 [50, 139] m; P < 0.001). At follow-up, changes in body mass (−2.0 [−3.5, −0.5] kg; P = 0.010), body fat percentage (−1 [−2, 0]%; P = 0.033), and C-reactive protein (−1.3 [−2.5, −0.1] mg·L−1; P = 0.037) were maintained and exercise capacity was further improved (132 [90, 175] m; P < 0.001). This trial is registered with ClinicalTrials.gov NCT01546792.
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Mitchell LJ, Davidson ZE, Bonham M, O'Driscoll DM, Hamilton GS, Truby H. Weight loss from lifestyle interventions and severity of sleep apnoea: a systematic review and meta-analysis. Sleep Med 2014; 15:1173-83. [PMID: 25192671 DOI: 10.1016/j.sleep.2014.05.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 03/27/2014] [Accepted: 05/28/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Excess body weight is a risk factor for obstructive sleep apnoea (OSA). The aim of the systematic review was to establish whether weight loss via lifestyle interventions such as diet and exercise are useful in the treatment of OSA. METHODS A literature search was conducted between 1980 and February 2012. Systematic reviews and randomised controlled trials (RCTs) with participants who had OSA, were overweight or obese, and who had undergone lifestyle interventions with the aim of improving sleep apnoea were included. Meta analyses were conducted for a subset of RCTs with appropriate data. RESULTS Two systematic reviews and eight RCTs were included. Meta-analyses were conducted for four RCTs comparing intensive lifestyle interventions to a control. The overall weighted mean differences for weight change, change in apnoea -hypopnoea index (AHI) and change in oxygen desaturation index of ≥4% were as follows: -13.76 kg (95% confidence interval (CI) -19.21, --8.32), -16.09 (95% CI -25.64, -6.54) and -14.18 (95% CI -24.23, -4.13), respectively. Although high heterogeneity within the meta analyses, all studies favoured the interventions. Long-term follow-up data from three RCTs suggest that improvements in weight and AHI are maintained for up to 60 months. CONCLUSIONS Intensive lifestyle interventions are effective in the treatment of OSA, resulting in significant weight loss and a reduction in sleep apnoea severity. Weight loss via intensive lifestyle interventions could be encouraged as a treatment for mild to moderate OSA.
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Affiliation(s)
- Lana J Mitchell
- Department of Nutrition and Dietetics, Monash University, Melbourne, Vic, Australia
| | - Zoe E Davidson
- Department of Nutrition and Dietetics, Monash University, Melbourne, Vic, Australia.
| | - Maxine Bonham
- Department of Nutrition and Dietetics, Monash University, Melbourne, Vic, Australia
| | - Denise M O'Driscoll
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Vic, Australia; Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Vic, Australia
| | - Garun S Hamilton
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Vic, Australia; Monash Lung and Sleep, Monash Health, Melbourne, Vic, Australia
| | - Helen Truby
- Department of Nutrition and Dietetics, Monash University, Melbourne, Vic, Australia
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Abstract
One of the less well-documented, potentially modifiable stroke risk factor is the obstructive sleep apnea. Obstructive sleep apnea increases cardiovascular morbidity and mortality, including stroke risk. The article summarizes the pathophysiological factors in sleep apnea syndrome which can increase stroke risk.
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Affiliation(s)
- Mária Tünde Magyar
- Debreceni Egyetem, Klinikai Központ Neurológiai Klinika Debrecen Móricz Zs. krt. 22. 4032
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176
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Clinical services for obstructive sleep apnea patients in pharmacies: the Australian experience. Int J Clin Pharm 2014; 36:460-8. [PMID: 24562977 DOI: 10.1007/s11096-014-9926-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 02/11/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND In Australia, certain pharmacies have undertaken a role in the management of the chronic sleep disorder, obstructive sleep apnea. The perspectives of pharmacy staff involved in this niche clinical service have never been formally collated on a national scale. The experiences of Australian pharmacies could provide a template for pharmacies in other health systems to adopt similar roles. OBJECTIVE To provide an overview of the perspectives of pharmacy staff involved in Continuous Positive Airway Pressure (CPAP) and sleep apnea-related services. Specifically, to describe clinical and structural elements, explore benefits and barriers, investigate viability, and gauge perspectives on future directions. SETTING Australian community pharmacies involved in CPAP and sleep apnea-related services. METHOD Cross-sectional mail survey. A questionnaire designed to meet the study objectives was developed by the researchers and mailed to all pharmacies in Australia providing CPAP services during the period of study recruitment. Pharmacies were identified through the distributor lists of the major CPAP manufacturers and a comprehensive Internet search. Non-responders were contacted in two subsequent recruitment rounds. MAIN OUTCOME MEASURE Self-reported sleep apnea service specifics. RESULTS A response rate of 55 % was achieved (n = 106 questionnaires valid for data entry). Benefits of providing a CPAP service included meeting patient and community needs, and professional satisfaction. Barriers included the cost of CPAP equipment to patients and lack of time. A majority of pharmacies (71 %) reported the service was financially viable despite most (63 %) not charging a 'fee for service.' Respondents expressed the view that CPAP provision should remain a specialist area of practice within the pharmacy profession. Key areas identified for improvement within the service were: (1) Staff training and knowledge (2) Promotion of the service and increasing public awareness (3) Infrastructure and expansion (4) Inter-professional collaboration and communication (5) Patient follow-up. CONCLUSION The provision of CPAP and sleep apnea-related services can be a viable and rewarding experience for pharmacists. The role may need to remain a specialised area for those willing to invest significantly in the service--in time, staff, resources and finances.
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Law M, Naughton M, Ho S, Roebuck T, Dabscheck E. Depression may reduce adherence during CPAP titration trial. J Clin Sleep Med 2014; 10:163-9. [PMID: 24532999 DOI: 10.5664/jcsm.3444] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVES Depression is a risk factor for medication non-compliance. We aimed to identify if depression is associated with poorer adherence during home-based autotitrating continuous positive airway pressure (autoPAP) titration. DESIGN Mixed retrospective-observational study. SETTING Academic center. PARTICIPANTS Two-hundred forty continuous positive airway pressure-naïve obstructive sleep apnea (OSA) patients. MEASUREMENTS Patients underwent approximately 1 week of home-based autoPAP titration with adherence data downloaded from the device. Electronic hospital records were reviewed in a consecutive manner for inclusion. Three areas of potential predictors were examined: (i) demographics and clinical factors, (ii) disease severity, and (iii) device-related variables. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). Scores on the subscales were categorized as normal or clinical diagnoses of depression (≥ 8) and anxiety (≥ 11). The primary outcome variable was the mean hours of autoPAP used per night. RESULTS Patients were diagnosed with OSA by either attended polysomnography (n = 73, AHI 25.5[15.1-41.5]) or unattended home oximetry (n = 167, ODI3 34.0[22.4-57.4]) and had home-based autoPAP titration over 6.2 ± 1.2 nights. Mean autoPAP use was 4.5 ± 2.4 hours per night. Multiple linear regression analysis revealed that depression and lower 95(th) percentile pressures significantly predicted lesser hours of autoPAP use (R(2) = 0.19, p < 0.001). Significantly milder OSA in those requiring lower pressures may have confounded the relationship between 95(th) percentile pressure and autoPAP use. CONCLUSION Depression was independently associated with poorer adherence during home-based autoPAP titration. Depression may be a potential target for clinicians and future research aimed at enhancing adherence to autoPAP therapy.
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Affiliation(s)
- Mandy Law
- Alfred Hospital, Prahran, Melbourne, Victoria, Australia and Monash University, Clayton, Victoria, Australia
| | - Matthew Naughton
- Alfred Hospital, Prahran, Melbourne, Victoria, Australia and Monash University, Clayton, Victoria, Australia
| | - Sally Ho
- Alfred Hospital, Prahran, Melbourne, Victoria, Australia and Monash University, Clayton, Victoria, Australia
| | - Teanau Roebuck
- Alfred Hospital, Prahran, Melbourne, Victoria, Australia and Monash University, Clayton, Victoria, Australia
| | - Eli Dabscheck
- Alfred Hospital, Prahran, Melbourne, Victoria, Australia and Monash University, Clayton, Victoria, Australia
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Veer V, Yang WY, Green R, Kotecha B. Long-term safety and efficacy of radiofrequency ablation in the treatment of sleep disordered breathing: a meta-analysis. Eur Arch Otorhinolaryngol 2014; 271:2863-70. [PMID: 24510179 DOI: 10.1007/s00405-014-2909-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 01/22/2014] [Indexed: 01/10/2023]
Abstract
Radiofrequency ablation (RFA) is used in the treatment of sleep disordered breathing (SDB), particularly in the alleviation of snoring. The literature provides evidence that the short-term results are promising; however, the long-term efficacy is a matter of contention. In this article, we present the results of a literature search of studies that use RFA in the treatment of SDB which have a follow-up time of greater than a year. RFA was found to be a safe technique with minimal morbidity. The overall Visual Analogue score from six studies showed the overall mean improvement to be 4.3 (confidence intervals 3.4-5.12). Apnea Hypopnea Index (AHI), improved significantly in five of the studies analysed. Epworth Sleepiness Score (ESS), improved significantly in six of the studies analysed. In conclusion, the evidence suggests that RFA for SDB results in a significant improvement in follow-up times of at least a year. Since RFA can be applied in a clinic setting and leads to minimal disruption to daily life, this treatment option can be considered for those unwilling to participate in the more traditional surgical options for SDB.
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Affiliation(s)
- Vik Veer
- James Cook University Hospital, Middlesbrough, England,
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Schoch OD, Baty F, Niedermann J, Rüdiger JJ, Brutsche MH. Baseline Predictors of Adherence to Positive Airway Pressure Therapy for Sleep Apnea: A 10-Year Single-Center Observational Cohort Study. Respiration 2014; 87:121-8. [DOI: 10.1159/000354186] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/29/2013] [Indexed: 11/19/2022] Open
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Barewal RM, Hagen CC. Management of snoring and obstructive sleep apnea with mandibular repositioning appliances: a prosthodontic approach. Dent Clin North Am 2014; 58:159-180. [PMID: 24286651 DOI: 10.1016/j.cden.2013.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Dentists are becoming increasingly aware of the importance of the detection and management of obstructive sleep apnea. The anatomic and neuromuscular risk factors in the pathogenesis of obstructive sleep apnea are reviewed with particular emphasis on oral findings. Mandibular repositioning appliances hold an important role in the treatment of this condition; however, knowledge of indications and contraindications for treatment, potential areas of oropharyngeal obstruction, appliance design, and treatment steps are vital to ensure maximum treatment success. A review of the steps involved in treatment and management with particular emphasis on collaborative care with physicians is presented.
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181
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Hanes CA, Wong KK, Saini B. An overview of service quality of continuous positive airway pressure services in Australian pharmacies. Respirology 2013; 19:85-91. [DOI: 10.1111/resp.12160] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/19/2013] [Accepted: 07/03/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Carissa A. Hanes
- Faculty of Pharmacy; The University of Sydney; Sydney
- The NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS); Glebe
- Woolcock Institute of Medical Research; Glebe
| | - Keith K.H. Wong
- Faculty of Medicine; The University of Sydney; Sydney
- The NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS); Glebe
- Woolcock Institute of Medical Research; Glebe
- Royal Prince Alfred Hospital; Camperdown New South Wales Australia
| | - Bandana Saini
- Faculty of Pharmacy; The University of Sydney; Sydney
- The NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS); Glebe
- Woolcock Institute of Medical Research; Glebe
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Chai-Coetzer CL, Luo YM, Antic NA, Zhang XL, Chen BY, He QY, Heeley E, Huang SG, Anderson C, Zhong NS, McEvoy RD. Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study. Sleep 2013; 36:1929-37. [PMID: 24293768 DOI: 10.5665/sleep.3232] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To determine the clinical variables that best predict long- term continuous positive airway pressure (CPAP) adherence among patients with cardiovascular disease who have obstructive sleep apnea (OSA). DESIGN 12-mo prospective within-trial observational study. SETTING Centers in China, Australia, and New Zealand participating in the Sleep Apnea cardioVascular Endpoints (SAVE) study. PATIENTS There were 275 patients age 45-70 y with cardiovascular disease (i.e., previously documented transient ischemic attack, stroke, or coronary artery disease) and OSA (4% oxygen desaturation index (ODI) > 12) who were randomized into the CPAP arm of the SAVE trial prior to July 1, 2010. METHODS Age, sex, country of residence, type of cardiovascular disease, baseline ODI, severity of sleepiness, and Hospital Anxiety and Depression Scale (HADS) scores plus CPAP side effects and adherence at 1 mo were entered in univariate analyses in an attempt to identify factors predictive of CPAP adherence at 12 mo. Variables with P < 0.2 were then included in a multivariate analysis using a linear mixed model with sites as a random effect and 12-mo CPAP use as the dependent outcome variable. MEASUREMENTS AND RESULTS CPAP adherence at 1, 6, and 12 mo was (mean ± standard deviation) 4.4 ± 2.0, 3.8 ± 2.3, and 3.3 ± 2.4 h/night, respectively. CPAP use at 1 mo (effect estimate ± standard error, 0.65 ± 0.07 per h increase, P < 0.001) and side effects at 1 mo (-0.24 ± 0.092 per additional side effect, P = 0.009) were the only independent predictors of 12- mo CPAP adherence. CONCLUSION Continuous positive airway pressure use in patients with coexisting cardiovascular disease and moderate to severe obstructive sleep apnea decreases significantly over 12 months. This decline can be predicted by early patient experiences with continuous positive airway pressure (i.e., adherence and side effects at 1 month), raising the possibility that intensive early interventions could improve long-term continuous positive airway pressure compliance in this patient population. CLINICAL TRIALS REGISTER Clinical Trials, http://www.clinicaltrials.gov, NCT00738179.
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Affiliation(s)
- Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, Repatriation General Hospital, Adelaide, Australia ; Flinders University, Adelaide, Australia
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183
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Kallweit U, Baumann CR, Harzheim M, Hidalgo H, Pöhlau D, Bassetti CL, Linnebank M, Valko PO. Fatigue and sleep-disordered breathing in multiple sclerosis: a clinically relevant association? Mult Scler Int 2013; 2013:286581. [PMID: 24251039 PMCID: PMC3819751 DOI: 10.1155/2013/286581] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 08/30/2013] [Accepted: 09/11/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Fatigue in patients with multiple sclerosis (MS) is highly prevalent and severely impacts quality of life. Recent studies suggested that sleep-disordered breathing (SDB) significantly contributes to fatigue in MS. Study Objective. To evaluate the importance of routine respirography in MS patients with severe fatigue and to explore the effects of treatment with continuous positive airway pressure (CPAP). Patients and Methods. We prospectively assessed the presence of severe fatigue, as defined by a score of ≥5.0 on the Fatigue Severity Scale (FSS), in 258 consecutive MS patients. Ninety-seven patients (38%) suffered from severe fatigue, whereof 69 underwent overnight respirography. Results. We diagnosed SDB in 28 patients (41%). Male sex was the only independent associate of SDB severity (P = 0.003). CPAP therapy in 6 patients was associated with a significant reduction of FSS scores (5.8 ± 0.5 versus 4.8 ± 0.6, P = 0.04), but the scores remained pathological (≥4.0) in all patients. Conclusion. Respirography in MS patients with severe fatigue should be considered in daily medical practice, because SDB frequency is high and CPAP therapy reduces fatigue severity. However, future work is needed to understand the real impact of CPAP therapy on quality of life in this patient group.
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Affiliation(s)
- Ulf Kallweit
- Department of Neurology, University Hospital Zurich, Frauenklinikstraße 26, 8091 Zurich, Switzerland
- Department of Neurology, Kamillus-Klinik, Hospitalstrasse 6, 53567 Asbach, Germany
| | - Christian R. Baumann
- Department of Neurology, University Hospital Zurich, Frauenklinikstraße 26, 8091 Zurich, Switzerland
| | - Michael Harzheim
- Department of Neurology, Kamillus-Klinik, Hospitalstrasse 6, 53567 Asbach, Germany
| | - Hildegard Hidalgo
- Department of Neurology, Kamillus-Klinik, Hospitalstrasse 6, 53567 Asbach, Germany
| | - Dieter Pöhlau
- Department of Neurology, Kamillus-Klinik, Hospitalstrasse 6, 53567 Asbach, Germany
| | - Claudio L. Bassetti
- Department of Neurology, University of Bern, Inselspital, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Michael Linnebank
- Department of Neurology, University Hospital Zurich, Frauenklinikstraße 26, 8091 Zurich, Switzerland
| | - Philipp O. Valko
- Department of Neurology, University Hospital Zurich, Frauenklinikstraße 26, 8091 Zurich, Switzerland
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Heatley EM, Harris M, Battersby M, McEvoy RD, Chai-Coetzer CL, Antic NA. Obstructive sleep apnoea in adults: A common chronic condition in need of a comprehensive chronic condition management approach. Sleep Med Rev 2013; 17:349-55. [DOI: 10.1016/j.smrv.2012.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 09/20/2012] [Accepted: 09/21/2012] [Indexed: 12/21/2022]
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185
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Theoretical approach towards increasing effectiveness of palatal surgery in obstructive sleep apnea: role for concomitant positional therapy? Sleep Breath 2013; 18:341-9. [PMID: 24014179 DOI: 10.1007/s11325-013-0891-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aims of this study are to evaluate the effect of palatal surgery (uvulopalatopharyngoplasty (UPPP) or Z-palatoplasty (ZPP)) with or without (+/-) concomitant radiofrequent ablation of the base of the tongue (RFTB) on body position-specific apnea-hypopnea index (AHI) values in patients with obstructive sleep apnea (OSA) and to compare this treatment outcome to the theoretical effect of (addition of) positional therapy (PT). METHODS Retrospective analysis of pre- and posttreatment polysomnographies in 139 patients who had undergone UPPP/ZPP +/- RFTB was performed. Hypothetical evaluation of the effects of (addition of) ideal PT on AHI in positional OSA (POSA) patients was carried out. RESULTS Median AHI significantly decreased from 18.0 to 11.2 (p < 0.001). Median AHI in all separate positions decreased significantly as well. Sixty-eight patients suffered from POSA and showed a significant decrease in median AHI from 15.5 to 11.5 (p = 0.002). In the 71 non-positional OSA (NPOSA) patients, the significant AHI decrease was more outspoken, from 23.0 to 11.0 (p < 0.001). Our hypothetical model to treat POSA patients with an ideal PT (as monotherapy or in addition to surgery) resulted in a significant median AHI decrease from 18.0 to 4.5 (p < 0.0001). CONCLUSIONS UPPP/ZPP +/- RFTB significantly reduces AHI and all body position-specific AHI values. This reduction is significantly higher in NPOSA than in POSA patients. When considering UPPP/ZPP +/- RFTB, the effect of body position needs to be taken into account. PT, either as monotherapy or in addition to surgery, theoretically has shown to improve treatment results dramatically in POSA patients. Prospective, controlled trials focusing on the effects of this combination of treatments should further evaluate this hypothetical conclusion.
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186
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Influencing factors on the effect of mandibular advancement device in obstructive sleep apnea patients: analysis on cephalometric and polysomnographic parameters. Sleep Breath 2013; 18:305-11. [DOI: 10.1007/s11325-013-0885-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/01/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
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187
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High cardiovascular risk profile in patients with sleep apnea. Laryngoscope 2013; 124:306-10. [DOI: 10.1002/lary.24304] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/21/2013] [Accepted: 06/21/2013] [Indexed: 11/07/2022]
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188
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Esquinas C, Sánchez-de-la Torre M, Aldomá A, Florés M, Martínez M, Barceló A, Barbé F. Rationale and methodology of the impact of continuous positive airway pressure on patients with ACS and nonsleepy OSA: the ISAACC Trial. Clin Cardiol 2013; 36:495-501. [PMID: 23843147 DOI: 10.1002/clc.22166] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/24/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is common in acute coronary syndrome (ACS) and a possible cause of increased morbidity and mortality. OBJECTIVES The main objective is to determine in patients with ACS and OSA if CPAP treatment reduces the incidence of cardiovascular events (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, and hospitalization for unstable angina or transient ischemic attack). The secondary objectives are to determine the prevalence of nonsleepy OSA in patients with ACS; assess the effect of CPAP on the incidence of newly diagnosed diabetes mellitus, symptoms, and quality of life; identify biomarkers of risk involved in cardiovascular complications in these patients; and conduct a cost-effectiveness analysis of diagnosis and treatment. POPULATION AND METHODOLOGY Multicenter, prospective, randomized and controlled study. Patients are admitted to the coronary care unit with diagnosis of ACS and without daytime sleepiness (Epworth Sleepiness Scale ≤10) at 15 teaching hospitals in Spain. All patients undergo a sleep study by cardiorespiratory polygraphy. Patients with an apnea-hypopnea index ≥15/hour will be randomized to treatment with CPAP (group 1, 632 patients) or conservative treatment (group 2, 632 patients). Patients with an apnea-hypopnea index <15/hour (group 3, 600 patients) will be followed as a reference group. Patients will be monitored at baseline (T0), 1 month (T1), 3 months (T2), 6 months (T3), 12 months (T4), and every 6 months thereafter (where applicable) during the follow-up period. CONCLUSIONS The ISAACC trial will contribute to evaluating the effect of CPAP treatment on cardiovascular events in patients with ACS and OSA.
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Affiliation(s)
- Cristina Esquinas
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain; Respiratory Medicine Research Group, IRBLleida, Lleida, Spain
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189
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Kreivi HR, Maasilta P, Bachour A. Willingness score obtained after a short CPAP trial predicts CPAP use at 1 year. Sleep Breath 2013; 18:207-13. [PMID: 23812639 DOI: 10.1007/s11325-013-0872-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/03/2013] [Accepted: 06/15/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE To predict continuous positive airway pressure (CPAP) adherence at 1 year. METHODS We followed consecutive OSA patients scheduled for CPAP initiation for 1 year. Patients completed a self-efficacy questionnaire (5 = low, 25 = high score) before CPAP initiation. After CPAP initiation, we enquired about patients' satisfaction in CPAP trial and their eagerness and willingness to continue CPAP therapy (0 = unsatisfied, uneager, or refused CPAP; 100 = satisfied, eager, or willing to continue CPAP treatment). RESULTS Of the 580 patients we followed, 377 continued CPAP therapy beyond 1 year. A low willingness score (<50) was expressed by 77 patients but only 7 of them used CPAP >4 h daily at 1 year, yielding a specificity of 97 % in predicting CPAP failure. At 1 year, patients with a self-efficacy score >20, expressed prior to CPAP initiation, used CPAP more often than the patients with a score <20 (average use 4.4 ± 2.2 h vs. 3.7 ± 2.3 h, p<0.001). CONCLUSIONS A low score of willingness to continue CPAP therapy after a short trial predicts CPAP failure and poor CPAP adherence at 1 year.
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Affiliation(s)
- Hanna-Riikka Kreivi
- Sleep Unit, Division of Pulmonary Medicine, Department of Medicine, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 372, FIN-00029 HUS, Helsinki, Finland,
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Douglas N, Young A, Roebuck T, Ho S, Miller BR, Kee K, Dabscheck EJ, Naughton MT. Prevalence of depression in patients referred with snoring and obstructive sleep apnoea. Intern Med J 2013; 43:630-4. [PMID: 23461358 DOI: 10.1111/imj.12108] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 12/19/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - T. Roebuck
- Department of Allergy; Immunology and Respiratory Medicine; Alfred Hospital; Australia
| | - S. Ho
- Department of Allergy; Immunology and Respiratory Medicine; Alfred Hospital; Australia
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191
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Bhalla G, Arya D, Chand P, Singh K, Tripathi S. Management of obstructive sleep apnea with a palatal lift prosthesis. INTERNATIONAL JOURNAL OF STOMATOLOGY & OCCLUSION MEDICINE 2013. [DOI: 10.1007/s12548-013-0088-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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192
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Borel JC, Tamisier R, Dias-Domingos S, Sapene M, Martin F, Stach B, Grillet Y, Muir JF, Levy P, Series F, Pepin JL. Type of mask may impact on continuous positive airway pressure adherence in apneic patients. PLoS One 2013; 8:e64382. [PMID: 23691209 PMCID: PMC3654912 DOI: 10.1371/journal.pone.0064382] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 04/12/2013] [Indexed: 11/19/2022] Open
Abstract
RATIONALE In obstructive sleep apnea patients (OSA), continuous positive airway pressure (CPAP) adherence is crucial to improve symptoms and cardiometabolic outcomes. The choice of mask may influence CPAP adherence but this issue has never been addressed properly. OBJECTIVE To evaluate the impact of nasal pillows, nasal and oronasal masks on CPAP adherence in a cohort of OSA. METHODS Newly CPAP treated OSA participating in "Observatoire Sommeil de la Fédération de Pneumologie", a French national prospective cohort, were included between March 2009 and December 2011. Anthropometric data, medical history, OSA severity, sleepiness, depressive status, treatment modalities (auto-CPAP versus fixed pressure, pressure level, interface type, use of humidifiers) and CPAP-related side effects were included in multivariate analysis to determine independent variables associated with CPAP adherence. RESULTS 2311 OSA (age = 57(12) years, apnea+hypopnea index = 41(21)/h, 29% female) were included. Nasal masks, oronasal masks and nasal pillows were used by 62.4, 26.2 and 11.4% of the patients, respectively. In univariate analysis, oronasal masks and nasal pillows were associated with higher risk of CPAP non-adherence. CPAP non-adherence was also associated with younger age, female gender, mild OSA, gastroesophageal reflux, depression status, low effective pressure and CPAP-related side effects. In multivariate analysis, CPAP non-adherence was associated with the use of oronasal masks (OR = 2.0; 95%CI = 1.6; 2.5), depression, low effective pressure, and side effects. CONCLUSION As oronasal masks negatively impact on CPAP adherence, a nasal mask should be preferred as the first option. Patients on oronasal masks should be carefully followed.
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Affiliation(s)
| | - Renaud Tamisier
- HP2 Laboratory INSERM U 1042, University Grenoble Alpes, Grenoble, France
- Pôle Locomotion, Rééducation et Physiologie, Hôpital Albert Michallon, Grenoble, France
| | - Sonia Dias-Domingos
- HP2 Laboratory INSERM U 1042, University Grenoble Alpes, Grenoble, France
- Pôle Locomotion, Rééducation et Physiologie, Hôpital Albert Michallon, Grenoble, France
| | - Marc Sapene
- Unité Sommeil et Vigilance, Polyclinique Bordeaux Cauderan, Bordeaux, France
| | - Francis Martin
- Unité des pathologies du sommeil, Centre hospitalier de Compiègne, Compiègne, France
| | - Bruno Stach
- Pneumologie, Cabinet Médical Saint Michel, Valenciennes, France
| | | | - Jean François Muir
- Pneumology and Respiratory Intensive Care U, Rouen University Hospital, Rouen, France
| | - Patrick Levy
- HP2 Laboratory INSERM U 1042, University Grenoble Alpes, Grenoble, France
- Pôle Locomotion, Rééducation et Physiologie, Hôpital Albert Michallon, Grenoble, France
| | - Frederic Series
- Institut Universitaire de Pneumologie et Cardiologie de Québec, Université Laval, Québec, Canada
| | - Jean-Louis Pepin
- HP2 Laboratory INSERM U 1042, University Grenoble Alpes, Grenoble, France
- Pôle Locomotion, Rééducation et Physiologie, Hôpital Albert Michallon, Grenoble, France
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Cipolli C, Mazzetti M, Plazzi G. Sleep-dependent memory consolidation in patients with sleep disorders. Sleep Med Rev 2013; 17:91-103. [DOI: 10.1016/j.smrv.2012.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 01/13/2012] [Accepted: 01/14/2012] [Indexed: 11/26/2022]
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Obstructive sleep apnea and cardiovascular disease in blacks: a call to action from the Association of Black Cardiologists. Am Heart J 2013; 165:468-76. [PMID: 23537962 DOI: 10.1016/j.ahj.2012.12.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 12/21/2012] [Indexed: 11/24/2022]
Abstract
Obstructive sleep apnea (OSA) has emerged as a new and important risk factor for cardiovascular disease (CVD). Over the last decade, epidemiologic and clinical research has consistently supported the association of OSA with increased cardiovascular (CV) morbidity and mortality. Such evidence prompted the American Heart Association to issue a scientific statement describing the need to recognize OSA as an important target for therapy in reducing CV risk. Emerging facts suggest that marked racial differences exist in the association of OSA with CVD. Although both conditions are more prevalent in blacks, almost all National Institutes of Health-funded research projects evaluating the relationship between OSA and CV risk have been conducted in predominantly white populations. There is an urgent need for research studies investigating the CV impact of OSA among high-risk minorities, especially blacks. This article first examines the evidence supporting the association between OSA and CVD and reviews the influence of ethnic/racial differences on this association. Public health implications of OSA and future directions, especially regarding minority populations, are discussed.
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195
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Mehta V, Vasu TS, Phillips B, Chung F. Obstructive sleep apnea and oxygen therapy: a systematic review of the literature and meta-analysis. J Clin Sleep Med 2013; 9:271-9. [PMID: 23493498 DOI: 10.5664/jcsm.2500] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Hypoxemia is an immediate consequence of obstructive sleep apnea. Oxygen (O2) administration has been used as an alternative treatment in patients with obstructive sleep apnea (OSA) who do not adhere to continuous positive airway pressure (CPAP) in order to reduce the deleterious effects of intermittent hypoxemia during sleep. This systematic review aims to investigate the effects of O2 therapy on patients with OSA. METHOD We conducted a systematic search of the databases Medline, Embase, Cochrane Central Register of Controlled Trials (1(st) Quarter 2011), Cochrane Database of Systematic Reviews (from 1950 to February 2011). Our search strategy yielded 4,793 citations. Irrelevant papers were excluded by title and abstract review, leaving 105 manuscripts. We reviewed all prospective studies that included: (1) a target population with obstructive sleep apnea, (2) O2 therapy and/or CPAP as a study intervention, (3) the effects of O2 on the apnea-hypopnea index (AHI), nocturnal hypoxemia, or apnea duration. RESULTS We identified 14 studies including a total of 359 patients. Nine studies were of single cohort design, while 5 studies were randomized control trials with 3 groups (CPAP, oxygen, and placebo/sham CPAP). When CPAP was compared to O2 therapy, all but one showed a significant improvement in AHI. Ten studies demonstrated that O2 therapy improved oxygen saturation vs. placebo. However, the average duration of apnea and hypopnea episodes were longer in patients receiving O2 therapy than those receiving placebo. CONCLUSION This review shows that O2 therapy significantly improves oxygen saturation in patients with OSA. However, it may also increase the duration of apnea-hypopnea events.
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Affiliation(s)
- Vanita Mehta
- Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
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196
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Cerebral hemodynamic changes in obstructive sleep apnea syndrome after continuous positive airway pressure treatment. Sleep Breath 2013; 17:1103-8. [PMID: 23386369 DOI: 10.1007/s11325-013-0810-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/11/2013] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients with obstructive sleep apnea syndrome (OSAS) are at increased risk for cerebrovascular diseases. The underlying mechanisms remain obscure. It may occur through a reduction in cerebral vascular reactivity. Continuous positive airway pressure (CPAP) is effective in reducing the occurrence of apneas. We hypothesized that treatment with CPAP improves cerebral vascular reactivity. METHODS This is a prospective study with OSAS patients. The apnea test (ApT) was calculated as an increase of mean artery velocity during apnea: [Artery velocity in apnea minus Resting artery velocity]/Resting artery velocity expressed as percentage. After 2 years of CPAP treatment, the test was repeated. RESULTS Seventy-six patients represented the study pool. After 2 years of treatment with CPAP, we were able to conduct a reassessment in 65 patients. Of the 65 patients who finished the clinical study, 56 were men, and 9 were women, with an average age of 48.1 ± 10.4 years. There was an improvement in the ApT after CPAP treatment (30.8 ± 12.1 vs 39.8 ± 15.1; p:0.000). The values of cerebral blood flow velocities, diastolic blood pressure in apnea, and basal heart rate decreased. CONCLUSIONS Cerebral vascular reactivity in OSAS patients measured by ApT improved after 2 years of CPAP.
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197
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Iftikhar IH, Hays ER, Iverson MA, Magalang UJ, Maas AK. Effect of oral appliances on blood pressure in obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med 2013; 9:165-74. [PMID: 23372472 PMCID: PMC3544387 DOI: 10.5664/jcsm.2420] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is an independent risk factor for the development of hypertension. However the effect of continuous positive airway pressure (CPAP) on lowering systemic blood pressure (BP) in OSA patients has been conflicting. Oral appliance (OA) therapy is an important alternative therapy to CPAP for patients with mild to moderate OSA. OBJECTIVE To conduct a meta-analysis of studies which have evaluated the effect of OAs on BP in patients with OSA. DATA SOURCES Studies were retrieved by searching PubMed (all studies that were published until December 15, 2011) STUDY SELECTION Three independent reviewers screened citations to identify trials of the effect of OA on BP. DATA EXTRACTION Data from observational and randomized controlled trial (RCT) studies was extracted for pre- and post-treatment systolic, diastolic, and mean arterial blood pressure (SBP, DBP, and MAP). DATA SYNTHESIS A total of 7 studies that enrolled 399 participants met the inclusion criteria. The pooled estimate of mean changes and the corresponding 95% CIs for SBP, DBP, and MAP from each trial are -2.7 mm Hg (95% CI: -0.8 to -4.6), p-value 0.04; -2.7 mm Hg (95% CI: -0.9 to -4.6), p-value 0.004; and -2.40 mm Hg (95% CI: -4.01 to -0.80), p-value 0.003 (Figures 2-4). The pooled estimate of mean changes and the corresponding 95% CIs for nocturnal SBP, DBP, and MAP from each trial are -2.0 mm Hg (95% CI: 1.1 to -5.3), p-value 0.212; -1.7 mm Hg (95% CI: -0.1 to -3.2), p-value 0.03; and -1.9 mm Hg (95% CI: 1.3 to -5.1), p-value 0.255 (Figures 5-7) respectively. CONCLUSIONS The pooled estimate shows a favorable effect of OAs on SBP, MAP, and DBP. Most of the studies were observational. Therefore, more RCTs are warranted involving a larger number of patients and longer treatment periods to confirm the effects of OA on BP.
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Affiliation(s)
- Imran H Iftikhar
- University of South Carolina, School of Medicine, Columbia, SC, USA.
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Jennum P, Ibsen R, Kjellberg J. Morbidity prior to a diagnosis of sleep-disordered breathing: a controlled national study. J Clin Sleep Med 2013; 9:103-8. [PMID: 23372461 DOI: 10.5664/jcsm.2398] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) causes burden to the sufferer, the healthcare system, and society. Most studies have focused on cardiovascular diseases (CVDs) after a diagnosis of obstructive sleep apnea (OSA) or obesity hypoventilation syndrome (OHS); however, the overall morbidity prior to an SDB diagnosis has not been evaluated. The aim of this study was to identify morbidity prior to a SDB diagnosis to identify patients at risk for having/developing SDB. METHODS Using data from the Danish National Patient Registry (1998-2006), we identified all patients nationwide given a diagnosis of OSA (19,438) or OHS (755) in all hospitals and clinics. For each patient, we randomly selected 4 citizens matched for age, sex, and socioeconomic status from the Danish Civil Registration System Statistics. RESULTS Patients with OSA or OHS presented with increased morbidity at least 3 years prior to their SDB diagnosis. The most common contacts with the health system (odds ratio [OR]/confidence interval [CI]) for OSA/OHS were due to musculoskeletal system (1.36[1.29-1.42]/1.35[1.05-1.74]); CVD (1.38[1.30-1.46]/1.80[1.38-2.34]); endocrine, nutritional, and metabolic diseases (1.62[1.50-1.76]/4.10[2.90-5.78]); diseases of the nervous system (1.62[1.0-1.76]/3.54[2.56-4.88]); respiratory system (1.84[1.73-1.96]/2.83[2.07-3.89]); skin and subcutaneous tissue (1.18[1.07-1.30]/2.12[1.33-3.38]); gastrointestinal (1.17[1.10-1.24]/NS); infections (1.20[1.08-1.33]/NS); genitourinary system (1.21[1.13-1.30]/NS); and ear, nose, and throat (1.44[1.32-1.56]/NS). CONCLUSIONS Patients with SDB show significant morbidities several years prior to a diagnosis of OSA or OHS. OSA should be considered in all medical specialties as an important comorbidity. In our study, evidence points to particular emphasis for considering this diagnosis in endocrinology and metabolic specialties.
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Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark.
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Alam A, Chengappa KNR, Ghinassi F. Screening for obstructive sleep apnea among individuals with severe mental illness at a primary care clinic. Gen Hosp Psychiatry 2012; 34:660-4. [PMID: 22832135 DOI: 10.1016/j.genhosppsych.2012.06.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/19/2012] [Accepted: 06/19/2012] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is linked to significant morbidity and mortality. OSA has received more attention recently, but the literature on OSA is scant in patients with severe mental illness (SMI). This project was undertaken to improve clinician knowledge and screening of OSA in persons with SMI. METHOD One hundred SMI patients attending a primary care clinic were screened for symptoms and risk factors associated with OSA. The Epworth Sleepiness Scale was used to assess daytime sleepiness, and the STOP-Bang score was used to classify those at high risk for OSA. RESULTS Sixty-nine percent of patients were found to be at high risk for OSA. Sixteen percent had a previously confirmed diagnosis of OSA. Most patients reported that OSA was never discussed with them, and 71% of those at high risk were willing to be referred for a sleep evaluation. CONCLUSIONS Patients with SMI are at high risk for OSA, and screening for OSA appears to be inadequate. This screening can be done easily, seems acceptable to patients and may prove very beneficial as OSA diagnosis and treatment can improve mental and physical health outcomes in SMI patients.
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Affiliation(s)
- Abdulkader Alam
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213-2593, USA.
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Boyd SB, Walters AS. Effectiveness of treatment apnea-hypopnea index: a mathematical estimate of the true apnea-hypopnea index in the home setting. J Oral Maxillofac Surg 2012; 71:351-7. [PMID: 22771095 DOI: 10.1016/j.joms.2012.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 04/19/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To present a new measurement instrument, the Effectiveness of Treatment Apnea-Hypopnea Index (ET-AHI), which the authors developed to determine an estimate of the therapeutic control of obstructive sleep apnea (OSA). MATERIALS AND METHODS The authors retrospectively evaluated a cohort of patients with OSA who initially attempted to use continuous positive airway pressure (CPAP) therapy and subsequently underwent maxillomandibular advancement (MMA) surgery. The ET-AHI calculations were performed to estimate the level of CPAP adherence that would be necessary to achieve equivalence with the MMA surgical result and to reach effective AHIs of 5 and 15. RESULTS The sample was composed of 37 adult patients (mean age, 44.2 ± 9.0 yr; 73% men) with moderate to severe OSA (baseline AHI, 56.3 ± 22.6). CPAP therapy was highly efficacious (CPAP titration AHI, 4.3 ± 5.9), but no patient could adequately adhere to treatment. MMA produced a significant decrease in OSA (AHI after MMA, 11.6 ± 7.4). The ET-AHI calculations predicted that an 86% adherence rate with CPAP would be necessary to achieve equivalence with MMA, whereas adherence rates of 99% and 79% may be required to achieve effective AHIs of 5 and 15, respectively. CONCLUSIONS The ET-AHI has the potential to significantly affect the care of patients with OSA because it may provide the treating clinician with a valuable tool to estimate the control of OSA for any therapeutic intervention. How closely the ET-AHI predicts the true effective AHI in the home setting requires further validation.
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Affiliation(s)
- Scott B Boyd
- Department of Oral and Maxillofacial Surgery, Vanderbilt University School of Medicine, Nashville, TN 37232-2103, USA.
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