251
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Schar MS, Omari TI, Woods CM, Ferris LF, Doeltgen SH, Lushington K, Kontos A, Athanasiadis T, Cock C, Chai Coetzer CL, Eckert DJ, Ooi EH. Altered swallowing biomechanics in people with moderate-severe obstructive sleep apnea. J Clin Sleep Med 2021; 17:1793-1803. [PMID: 33904392 DOI: 10.5664/jcsm.9286] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Dysphagia is a common but under-recognized complication of obstructive sleep apnea (OSA). However, the mechanisms remain poorly described. Accordingly, the aim of this study was to assess swallowing symptoms and use high-resolution pharyngeal manometry (HRPM) to quantify swallowing biomechanics in patients with moderate-severe OSA. METHODS Nineteen adults (4 female, mean age 46±26-68y) with moderate-severe OSA underwent HRPM testing with 5,10 & 20 ml volumes of thin and extremely thick liquids. Data were compared to 19 age- and sex-matched healthy controls (mean age 46±27-68y). Symptomatic dysphagia was assessed using the Sydney Swallow Questionnaire (SSQ). Swallow metrics were analyzed using the online application swallowgateway.com. General linear mixed model analysis was performed to investigate potential differences between people with moderate-severe OSA and controls. Data presented are means (95% CI). RESULTS 26% (5/19) of the OSA group but none of the controls reported symptomatic dysphagia (SSQ>234). Compared to healthy controls, the OSA group had increased upper esophageal sphincter (UES) relaxation pressure (-2 [-1] vs. 2 [1]mmHg, F = 32.1, p <0.0001), reduced UES opening (6 vs. 5mS, F = 23.6, p<0.0001) and increased hypopharyngeal intrabolus pressure (2 [1] vs 7 [1]mmHg, F= 19.0, p <0.05). Additionally, upper pharyngeal pressures were higher, particularly at the velopharynx (88 [12] vs. 144 [12]mmHg.cm.s, F = 69.6, p<0.0001). CONCLUSIONS HRPM identified altered swallowing biomechanics in people with moderate-severe OSA, which is consistent with a subclinical presentation. Potential contributing mechanisms include UES dysfunction with associated upstream changes of increased hypopharyngeal distension pressure and velopharyngeal contractility.
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Affiliation(s)
- Mistyka S Schar
- Department of Speech Pathology & Audiology, Flinders Medical Centre.,Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University
| | - Taher I Omari
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University
| | - Charmaine M Woods
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre
| | - Lara F Ferris
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University
| | - Sebastian H Doeltgen
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University
| | - Kurt Lushington
- Psychology, Justice & Society Academic Unit, University of South Australia
| | - Anna Kontos
- Department of Respiratory and Sleep Medicine, Women's and Children's Hospital
| | - Theodore Athanasiadis
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre
| | - Charles Cock
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Department of Gastroenterology & Hepatology, Flinders Medical Centre
| | - Ching-Li Chai Coetzer
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Respiratory & Sleep Services, Flinders Medical Centre
| | - Danny J Eckert
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University
| | - Eng H Ooi
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre
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252
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McEvoy RD, Sánchez-de-la-Torre M, Peker Y, Anderson CS, Redline S, Barbe F. Randomized clinical trials of cardiovascular disease in obstructive sleep apnea: understanding and overcoming bias. Sleep 2021; 44:6162685. [PMID: 33693919 DOI: 10.1093/sleep/zsab019] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Manuel Sánchez-de-la-Torre
- Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Yüksel Peker
- Department of Pulmonary Medicine, Koc University School of Medicine, Istanbul, Turkey.,Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden.,Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute China at Peking University Health Science Center, Beijing, PR China
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ferran Barbe
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Lleida, Spain
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253
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Rezaie L, Maazinezhad S, Fogelberg DJ, Khazaie H, Sadeghi-Bahmani D, Brand S. Compared to Individuals with Mild to Moderate Obstructive Sleep Apnea (OSA), Individuals with Severe OSA Had Higher BMI and Respiratory-Disturbance Scores. Life (Basel) 2021; 11:life11050368. [PMID: 33919250 PMCID: PMC8143081 DOI: 10.3390/life11050368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 12/25/2022] Open
Abstract
Objective: Individuals with obstructive sleep apnea (OSA) are at increased risk to suffer from further somatic and sleep-related complaints. To assess OSA, demographic, anthropometric, and subjective/objective sleep parameters are taken into consideration, but often separately. Here, we entered demographic, anthropometric, subjective, and objective sleep- and breathing-related dimensions in one model. Methods: We reviewed the demographic, anthropometric, subjective and objective sleep- and breathing-related data, and polysomnographic records of 251 individuals with diagnosed OSA. OSA was considered as a continuous and as categorical variable (mild, moderate, and severe OSA). A series of correlational computations, X2-tests, F-tests, and a multiple regression model were performed to investigate which demographic, anthropometric, and subjective and objective sleep dimensions were associated with and predicted dimensions of OSA. Results: Higher apnea/hypopnea index (AHI) scores were associated with higher BMI, higher daytime sleepiness, a higher respiratory disturbance index, and higher snoring. Compared to individuals with mild to moderate OSA, individuals with severe OSA had a higher BMI, a higher respiratory disturbance index (RDI) and a higher snoring index, while subjective sleep quality and daytime sleepiness did not differ. Results from the multiple regression analysis showed that an objectively shorter sleep duration, more N2 sleep, and a higher RDI predicted AHI scores. Conclusion: The pattern of results suggests that blending demographic, anthropometric, and subjective/objective sleep- and breathing-related data enabled more effective discrimination of individuals at higher risk for OSA. The results are of practical and clinical importance: demographic, anthropometric, and breathing-related issues derived from self-rating scales provide a quick and reliable identification of individuals at risk of OSA; objective assessments provide further certainty and reliability.
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Affiliation(s)
- Leeba Rezaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran; (L.R.); (S.M.); (D.S.-B.)
| | - Soroush Maazinezhad
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran; (L.R.); (S.M.); (D.S.-B.)
- School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran
| | - Donald J. Fogelberg
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA;
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran; (L.R.); (S.M.); (D.S.-B.)
- Correspondence: (H.K.); or (S.B.)
| | - Dena Sadeghi-Bahmani
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran; (L.R.); (S.M.); (D.S.-B.)
- Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35209, USA
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric University Hospital Basel, 4002 Basel, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Serge Brand
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran; (L.R.); (S.M.); (D.S.-B.)
- Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric University Hospital Basel, 4002 Basel, Switzerland
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran 25529, Iran
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland
- Correspondence: (H.K.); or (S.B.)
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254
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Kryger MA, Chehata VJ. Relationship Between Sleep-Disordered Breathing and Neurogenic Obesity in Adults With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:84-91. [PMID: 33814886 DOI: 10.46292/sci20-00044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Spinal cord injury (SCI) substantially increases the risk of neurogenic obesity, diabetes, and metabolic syndrome. Much like in the general population, a discussion of these syndromes in SCI would be incomplete without acknowledging the association of SCI with sleep-disordered breathing (SDB). This article will outline the interplay between obesity and obstructive sleep apnea (OSA), discussing the pathophysiology of obesity in OSA both for the general population and SCI population. The role of insulin resistance in SDB and SCI will also be examined. The epidemiology and pathophysiology of OSA and central sleep apnea in SCI are discussed through an examination of current evidence, followed by a review of central sleep apnea in SCI. Principles of diagnosis and management of SDB will also be discussed. Because sleep deprivation in itself can be a risk factor for developing obesity, the significance of comorbid insomnia in SCI is explored. Ultimately, a thorough sleep history, testing, and treatment are key to improving the sleep of individuals with SCI and to potentially reducing the impact of neurogenic obesity and metabolic syndrome.
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Affiliation(s)
- Michael A Kryger
- Department of Physical Medicine and Rehabilitation, Penn State University Milton Hershey Medical Center, Hershey, Pennsylvania
| | - Veronica J Chehata
- Department of Physical Medicine and Rehabilitation, Penn State University Milton Hershey Medical Center, Hershey, Pennsylvania
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255
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Carlier S, Bruyneel AV, Bruyneel M. Pressure adjustment is the most useful intervention for improving compliance in telemonitored patients treated with CPAP in the first 6 months of treatment. Sleep Breath 2021; 26:125-132. [PMID: 33846930 DOI: 10.1007/s11325-021-02367-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/14/2021] [Accepted: 04/01/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Telemonitoring (TMg) for patients treated with continuous positive airway pressure (CPAP) is now routine care in some sleep labs. The purpose of the present study was to identify technical interventions associated with improved CPAP compliance in a real-life cohort of newly telemonitored patients with obstructive sleep apnea (OSA) during the first 6 months of treatment. METHODS All patients with moderate-to-severe OSA (apnea-hypopnea index (AHI) ≥ 15/h) who were newly treated with CPAP were included in the study and telemonitored. A group educational session was scheduled after 1 month. Technical interventions were performed at the patient's request and during scheduled visits and the impact of each intervention on CPAP therapy compliance was collected. RESULTS Between May 2018 and Dec 2019, 349 patients newly diagnosed with OSA were hospitalized in the sleep lab for CPAP titration and 212 patients were included (mean age 54.6 ± 13.1 years, mean BMI 31.7 ± 5.8 kg/m2, mean AHI 42.8 ± 22.0). TMg acceptance rate was 87%. Mean 6-month compliance was 275 ± 154 min, 13% stopped CPAP, and 17% were non-compliant. Correlations were observed between BMI (r = 0.15, p = 0.029), median and 95th percentile leaks (r = -0.23 and -0.18, p = 0.016 and 0.002), and CPAP compliance. During follow-up, 92 interventions were required, mainly for mask change (n = 80). Pressure modification (n = 16) was the only intervention that increased CPAP use > 30 min/night, p = 0.021. CONCLUSION Pressure modification was the only adaptation that significantly increased CPAP compliance during the first 6 months. Remote TMg allows providing daily, accurate, and immediate feedback that could help clinicians to confirm that the CPAP treatment is effective.
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Affiliation(s)
- Sarah Carlier
- Department of Pulmonary Medicine, CHU Saint-Pierre, Brussels, Belgium.,Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Marie Bruyneel
- Department of Pulmonary Medicine, CHU Saint-Pierre, Brussels, Belgium. .,Université Libre de Bruxelles (ULB), Brussels, Belgium.
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256
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Alessi CA, Fung CH, Dzierzewski JM, Fiorentino L, Stepnowsky C, Rodriguez Tapia JC, Song Y, Zeidler MR, Josephson K, Mitchell MN, Jouldjian S, Martin JL. Randomized controlled trial of an integrated approach to treating insomnia and improving the use of positive airway pressure therapy in veterans with comorbid insomnia disorder and obstructive sleep apnea. Sleep 2021; 44:zsaa235. [PMID: 33221910 PMCID: PMC8033453 DOI: 10.1093/sleep/zsaa235] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/26/2020] [Indexed: 12/11/2022] Open
Abstract
STUDY OBJECTIVES Cognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway pressure (PAP) adherence program and tested effects on sleep and PAP use. METHODS 125 veterans (mean age 63.2, 96% men, 39% non-Hispanic white, 26% black/African American, 18% Hispanic/Latino) with comorbid insomnia and newly-diagnosed OSA (apnea-hypopnea index ≥ 15) were randomized to 5-weekly sessions integrating CBTI with a PAP adherence program provided by a "sleep coach" (with behavioral sleep medicine supervision), or 5-weekly sleep education control sessions. Participants and assessment staff were blinded to group assignment. Outcomes (baseline, 3 and 6 months) included Pittsburgh Sleep Quality Index (PSQI), 7-day sleep diary (sleep onset latency [SOL-D], wake after sleep onset [WASO-D], sleep efficiency [SE-D]), 7-day actigraphy (SE-A), and objective PAP use (hours/night and nights ≥ 4 h). Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) were also collected. RESULTS Compared to controls, intervention participants showed greater improvement (baseline to 3 and 6 months, respectively) in PSQI (-3.2 and -1.7), SOL-D (-16.2 and -15.5 minutes), SE-D (10.5% and 8.5%), SE-A (4.4% and 2.6%) and more 90-day PAP use (1.3 and 0.9 more hours/night, 17.4 and 11.3 more nights PAP ≥ 4 h). 90-day PAP use at 3 months was 3.2 and 1.9 h/night in intervention versus controls. Intervention participants also had greater improvements in ISI, ESS, and FOSQ-10 (all p < 0.05). CONCLUSIONS An intervention integrating CBTI with a PAP adherence program delivered by a supervised sleep coach improved sleep and PAP use in adults with comorbid insomnia and OSA. TRIAL REGISTRATION ClinicalTrials.govStudy name: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older VeteransURL: https://clinicaltrials.gov/ct2/results?cond=&term=NCT02027558&cntry=&state=&city=&dist=Registration: NCT02027558.
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Affiliation(s)
- Cathy A Alessi
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Constance H Fung
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | | | - Lavinia Fiorentino
- Department of Psychiatry, University of California, San Diego, San Diego, CA
| | - Carl Stepnowsky
- Department of Medicine, University of California, San Diego, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
| | | | - Yeonsu Song
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- School of Nursing, University of California Los Angeles, Los Angeles, CA
| | - Michelle R Zeidler
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Pulmonary, Critical Care and Sleep Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Karen Josephson
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, Los Angeles, CA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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257
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Farré R, Gozal D, Montserrat JM. Alternative Procedure to Individual Nasal Pressure Titration for Sleep Apnea. J Clin Med 2021; 10:jcm10071453. [PMID: 33916282 PMCID: PMC8037765 DOI: 10.3390/jcm10071453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
In the treatment of obstructive sleep apnea (OSA), the current standard of "CPAP titration" in the laboratory or at home is a resource demanding and costly approach that, in developed economies, markedly augments healthcare costs and in low resource economies precludes access to care altogether. Here, we discuss that current guidelines for titration of CPAP could be obviated by taking a different route that in many ways is similar to the institution of treatment in many other medical conditions. To this effect, we present novel population based data from 16,780 patients, showing that after individualized and labor-intensive and expensive CPAP titration, 86.4% of OSA patients are treated with nasal pressure settings within the range of 9 ± 2 cmH2O, and review the literature to justify the potential adoption of a standard therapeutic CPAP setting as the initial intervention which would be subsequently followed by any necessary adjustments in only a minority of patients who would not derive the necessary benefit from such standardized intervention. Assuming an 80-85% success rate as derived from our analyses, our personal view if extensively adopted could radically reduce healthcare costs and enable markedly improve access to diagnostics.
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Affiliation(s)
- Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain;
- Institut Investigacions Biomediques August Pi Sunyer, 08036 Barcelona, Spain
- Correspondence:
| | - David Gozal
- Department of Child Health, The University of Missouri School of Medicine, Columbia, MO 65212, USA;
| | - Josep M. Montserrat
- CIBER de Enfermedades Respiratorias, 28029 Madrid, Spain;
- Institut Investigacions Biomediques August Pi Sunyer, 08036 Barcelona, Spain
- Sleep Lab, Hospital Clinic, Universitat de Barcelona, 09036 Barcelona, Spain
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258
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Mediano O, González Mangado N, Montserrat JM, Alonso-Álvarez ML, Almendros I, Alonso-Fernández A, Barbé F, Borsini E, Caballero-Eraso C, Cano-Pumarega I, de Carlos Villafranca F, Carmona-Bernal C, Carrillo Alduenda JL, Chiner E, Cordero Guevara JA, de Manuel L, Durán-Cantolla J, Farré R, Franceschini C, Gaig C, Garcia Ramos P, García-Río F, Garmendia O, Gómez García T, González Pondal S, Hoyo Rodrigo MB, Lecube A, Madrid JA, Maniegas Lozano L, Martínez Carrasco JL, Masa JF, Masdeu Margalef MJ, Mayos Pérez M, Mirabet Lis E, Monasterio C, Navarro Soriano N, Olea de la Fuente E, Plaza G, Puertas Cuesta FJ, Rabec C, Resano P, Rigau D, Roncero A, Ruiz C, Salord N, Saltijeral A, Sampol Rubio G, Sánchez Quiroga MÁ, Sans Capdevila Ó, Teixeira C, Tinahones Madueño F, Maria Togeiro S, Troncos Acevedo MF, Vargas Ramírez LK, Winck J, Zabala Urionaguena N, Egea C. International Consensus Document on Obstructive Sleep Apnea. Arch Bronconeumol 2021; 58:52-68. [PMID: 33875282 DOI: 10.1016/j.arbres.2021.03.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023]
Abstract
The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 specialists from a wide geographical area (including the participation of 4 international societies), an expert in methodology, and a documentalist from the Iberoamerican Cochrane Center. The document consists of a main section containing the most significant innovations and a series of online manuscripts that report the systematic literature searches performed for each section of the international consensus document. This document does not discuss pediatric patients or the management of patients receiving chronic non-invasive mechanical ventilation (these topics will be addressed in separate consensus documents).
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Affiliation(s)
- Olga Mediano
- Unidad de Sueño, Departamento de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España; Departamento de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España.
| | - Nicolás González Mangado
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Neumología, Unidad Multidisciplinar de Sueño (UMS), Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, España
| | - Josep M Montserrat
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar de Patología del Sueño y VNID, Servei de Pneumologia, Institut Clínic Respiratori, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - M Luz Alonso-Álvarez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Dr. J. Terán Santos, Departamento de Neumología, Hospital Universitario de Burgos, Burgos, España
| | - Isaac Almendros
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, España
| | - Alberto Alonso-Fernández
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Servicio de Neumología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Baleares, España
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova y Santa Maria, Lleida, España
| | - Eduardo Borsini
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño y Ventilación, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Candelaria Caballero-Eraso
- Unidad de Trastornos Respiratorios del Sueño, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Irene Cano-Pumarega
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Departamento de Neumología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
| | - Felix de Carlos Villafranca
- Servicio de Estomatología, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Asturias, España
| | - Carmen Carmona-Bernal
- Unidad de Trastornos Respiratorios del Sueño, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Jose Luis Carrillo Alduenda
- Unidad de Medicina del Sueño, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, México
| | - Eusebi Chiner
- Unidad Multidisciplinar del Sueño, Servicio de Neumología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, España
| | - José Aurelio Cordero Guevara
- Grupo de Investigación en Epidemiología y Salud Pública, Unidad de Metodología y Estadística, Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Álava, España
| | - Luis de Manuel
- Corte del Ilustre Colegio de Abogados de Madrid, Madrid, España
| | - Joaquín Durán-Cantolla
- Servicio de Investigación, Instituto de Investigación, OSI Araba, Hospital Universitario de Araba, Vitoria-Gasteiz, Álava, España
| | - Ramón Farré
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, España
| | - Carlos Franceschini
- Unidad de Sueño y Ventilación Mecánica, Hospital Cosme Argerich, Buenos Aires, Argentina
| | - Carles Gaig
- Servicio de Neurología, Unidad Multidisciplinar de Sueño, Hospital Clínic de Barcelona, Barcelona, España
| | - Pedro Garcia Ramos
- Centro de Salud Don Benito Oeste, Servicio Extremeño de Salud, Don Benito, Badajoz, España
| | - Francisco García-Río
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Onintza Garmendia
- Unidad del Sueño, Servicio de Neumología, Hospital Clínic, Barcelona, España
| | - Teresa Gómez García
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Servicio de Odontología y Unidad Multidisciplinar del Sueño del Hospital Universitario Fundación Jiménez Díaz, Sociedad Española de Medicina Dental del Sueño (SEMDeS), Madrid, España
| | - Silvia González Pondal
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Servicio de Odontología y Unidad Multidisciplinar del Sueño del Hospital Universitario Fundación Jiménez Díaz, Sociedad Española de Medicina Dental del Sueño (SEMDeS), Madrid, España
| | | | - Albert Lecube
- Grupo de investigación en Obesidad, Diabetes y Metabolismo (ODIM), Servicio de Endocrinología y Nutrición, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, España
| | - Juan Antonio Madrid
- Laboratorio de Cronobiología, Universidad de Murcia, IMIB-Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, España
| | - Lourdes Maniegas Lozano
- Fundación Jiménez Díaz, Madrid, España; Neumología, Unidad Multidisciplinar de Sueño (UMS), Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, España
| | | | - Juan Fernando Masa
- Hospital San Pedro de Alcántara, Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), San Pedro de Alcántara, Cáceres, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - María José Masdeu Margalef
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar del Sueño, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Mercè Mayos Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - Carmen Monasterio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar del Sueño, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - Nieves Navarro Soriano
- Unidad de Sueño, Servicio de Neumología, Hospital Clínico Universitario, Valencia, España
| | - Erika Olea de la Fuente
- Servicio de Anestesiología y Reanimación, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
| | - Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, España; Hospital Universitario La Zarzuela, Madrid, España
| | - Francisco Javier Puertas Cuesta
- Unidad de Sueño, Servicio de Neurofisiología, Hospital Universitario de La Ribera, Facultad de Medicina y Ciencias de la Salud, Universidad Católica de Valencia, Alzira, Valencia, España
| | - Claudio Rabec
- Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier et Universitaire de Dijon, Dijon, Francia
| | - Pilar Resano
- Unidad de Sueño, Departamento de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España
| | - David Rigau
- Centro Cochrane Iberoamericano, Barcelona, España
| | - Alejandra Roncero
- Unidad Multidisciplinar del Sueño, Servicio de Neumología, Hospital San Pedro, Logroño, La Rioja, España
| | - Concepción Ruiz
- Servicio de Neurología, Unidad Multidisciplinar de Sueño, Hospital Clínic de Barcelona, Barcelona, España
| | - Neus Salord
- Unidad Multidisciplinar del Sueño, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - Adriana Saltijeral
- Servicio de Cardiología, Hospital Universitario del Tajo, Universidad Alfonso X El Sabio, Aranjuez, Madrid, España
| | - Gabriel Sampol Rubio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar del Sueño, Servicio de Neumología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - M Ángeles Sánchez Quiroga
- Hospital Virgen del Puerto, Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Plasencia, Cáceres, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Óscar Sans Capdevila
- Unidad del Sueño, Servicio de Neurología Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - Carlos Teixeira
- European Society of Sleep Technologists (EEST), Porto, Portugal
| | - Francisco Tinahones Madueño
- Sociedad Española para el Estudio de la Obesidad (SEEDO), Madrid, España; Servicio de Endocrinología, Hospital Virgen de la Victoria, (IBIMA), Centro de Investigación Biomédica en Red de Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain
| | - Sônia Maria Togeiro
- Disciplina de Pneumologia, Departamento de Medicina; Disciplina de Medicina y Biologia del Sueño - Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brasil
| | | | | | - Joao Winck
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | - Carlos Egea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Álava, España
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259
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Evaluation and Management of Adults with Obstructive Sleep Apnea Syndrome. Lung 2021; 199:87-101. [PMID: 33713177 DOI: 10.1007/s00408-021-00426-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common and underdiagnosed medical condition characterized by recurrent sleep-dependent pauses and reductions in airflow. While a narrow, collapsible oropharynx plays a central role in the pathophysiology of OSAS, there are other equally important nonanatomic factors including sleep-stage dependent muscle tone, arousal threshold, and loop gain that drive obstructive apneas and hypopneas. Through mechanisms of intermittent hypoxemia, arousal-related sleep fragmentation, and intrathoracic pressure changes, OSAS impacts multiple organ systems. Risk factors for OSAS include obesity, male sex, age, specific craniofacial features, and ethnicity. The prevalence of OSAS is rising due to increasing obesity rates and improved sensitivity in the tools used for diagnosis. Validated questionnaires have an important but limited role in the identification of patients that would benefit from formal testing for OSA. While an in-laboratory polysomnography remains the gold standard for diagnosis, the widespread availability and accuracy of home sleep apnea testing modalities increase access and ease of OSAS diagnosis for many patients. In adults, the most common treatment involves the application of positive airway pressure (PAP), but compliance continues to be a challenge. Alternative treatments including mandibular advancement device, hypoglossal nerve stimulator, positional therapies, and surgical options coupled with weight loss and exercise offer possibilities of an individualized personal approach to OSAS. Treatment of symptomatic patients with OSAS has been found to be beneficial with regard to sleep-related quality of life, sleepiness, and motor vehicle accidents. The benefit of treating asymptomatic OSA patients, particularly with regard to cardiovascular outcomes, is controversial and more data are needed.
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260
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Clinical and Research Solutions to Manage Obstructive Sleep Apnea: A Review. SENSORS 2021; 21:s21051784. [PMID: 33806496 PMCID: PMC7961570 DOI: 10.3390/s21051784] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
Obstructive sleep apnea (OSA), a common sleep disorder disease, affects millions of people. Without appropriate treatment, this disease can provoke several health-related risks including stroke and sudden death. A variety of treatments have been introduced to relieve OSA. The main present clinical treatments and undertaken research activities to improve the success rate of OSA were covered in this paper. Additionally, guidelines on choosing a suitable treatment based on scientific evidence and objective comparison were provided. This review paper specifically elaborated the clinically offered managements as well as the research activities to better treat OSA. We analyzed the methodology of each diagnostic and treatment method, the success rate, and the economic burden on the world. This review paper provided an evidence-based comparison of each treatment to guide patients and physicians, but there are some limitations that would affect the comparison result. Future research should consider the consistent follow-up period and a sufficient number of samples. With the development of implantable medical devices, hypoglossal nerve stimulation systems will be designed to be smart and miniature and one of the potential upcoming research topics. The transcutaneous electrical stimulation as a non-invasive potential treatment would be further investigated in a clinical setting. Meanwhile, no treatment can cure OSA due to the complicated etiology. To maximize the treatment success of OSA, a multidisciplinary and integrated management would be considered in the future.
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261
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Ma EY, Kim JW, Lee Y, Cho SW, Kim H, Kim JK. Combined unsupervised-supervised machine learning for phenotyping complex diseases with its application to obstructive sleep apnea. Sci Rep 2021; 11:4457. [PMID: 33627761 PMCID: PMC7904925 DOI: 10.1038/s41598-021-84003-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/10/2021] [Indexed: 12/24/2022] Open
Abstract
Unsupervised clustering models have been widely used for multimetric phenotyping of complex and heterogeneous diseases such as diabetes and obstructive sleep apnea (OSA) to more precisely characterize the disease beyond simplistic conventional diagnosis standards. However, the number of clusters and key phenotypic features have been subjectively selected, reducing the reliability of the phenotyping results. Here, to minimize such subjective decisions for highly confident phenotyping, we develop a multimetric phenotyping framework by combining supervised and unsupervised machine learning. This clusters 2277 OSA patients to six phenotypes based on their multidimensional polysomnography (PSG) data. Importantly, these new phenotypes show statistically different comorbidity development for OSA-related cardio-neuro-metabolic diseases, unlike the conventional single-metric apnea-hypopnea index-based phenotypes. Furthermore, the key features of highly comorbid phenotypes were identified through supervised learning rather than subjective choice. These results can also be used to automatically phenotype new patients and predict their comorbidity risks solely based on their PSG data. The phenotyping framework based on the combination of unsupervised and supervised machine learning methods can also be applied to other complex, heterogeneous diseases for phenotyping patients and identifying important features for high-risk phenotypes.
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Affiliation(s)
- Eun-Yeol Ma
- Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Youngmin Lee
- Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sung-Woo Cho
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Heeyoung Kim
- Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
| | - Jae Kyoung Kim
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
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262
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Rotty MC, Suehs CM, Mallet JP, Martinez C, Borel JC, Rabec C, Bertelli F, Bourdin A, Molinari N, Jaffuel D. Mask side-effects in long-term CPAP-patients impact adherence and sleepiness: the InterfaceVent real-life study. Respir Res 2021; 22:17. [PMID: 33451313 PMCID: PMC7809735 DOI: 10.1186/s12931-021-01618-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
Background For some patients, Continuous Positive Airway Pressure (CPAP) remains an uncomfortable therapy despite the constant development of technological innovations. To date, no real life study has investigated the relationship between mask related side-effects (MRSEs) and CPAP-non-adherence (defined as < 4 h/day) or residual-excessive-sleepiness (RES, Epworth-Sleepiness-Scale (ESS) score ≥ 11) in the long-term. Methods The InterfaceVent-CPAP study is a prospective real-life cross-sectional study conducted in an apneic adult cohort undergoing at least 3 months of CPAP with unrestricted mask-access (34 different masks). MRSEs were evaluated using visual-analogue-scales, CPAP-data using CPAP-software, sleepiness using ESS. Results 1484 patients were included in the analysis (72.2% male, median age 67 years (IQ25–75: 60–74), initial Apnea–Hypopnea-Index (AHI) of 39 (31–56)/h, residual AHIflow was 1.9 (0.9–4) events/h), CPAP-treatment lasted 4.4 (2.0–9.7) years, CPAP-usage was 6.8 (5.5–7.8) h/day, the prevalence of CPAP-non-adherence was 8.6%, and the prevalence of RES was 16.17%. Leak-related side-effects were the most prevalent side-effects (patient-reported leaks concerned 75.4% of responders and had no correlation with CPAP-reported-leaks). Multivariable logistic regression analyses evaluating explanatory-variable (demographic data, device/mask data and MRSEs) effects on variables-of-interest (CPAP-non-adherence and RES), indicated for patient-MRSEs significant associations between: (i) CPAP-non-adherence and dry-mouth (p = 0.004); (ii) RES and patient-reported leaks (p = 0.007), noisy mask (p < 0.001), dry nose (p < 0.001) and harness pain (p = 0.043). Conclusion In long-term CPAP-treated patients, leak-related side-effects remain the most prevalent side-effects, but patient-reported leaks cannot be predicted by CPAP-reported-leaks. Patient-MRSEs can be independently associated with CPAP-non-adherence and RES, thus implying a complementary role for MRSE questionnaires alongside CPAP-device-reported-data for patient monitoring. Trial registration InterfaceVent is registered with ClinicalTrials.gov (NCT03013283).
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Affiliation(s)
- Marie-Caroline Rotty
- IMAG, CNRS, Montpellier University, Montpellier University Hospital, Montpellier, France.,Apard Groupe Adène, Montpellier, France
| | - Carey M Suehs
- Department of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, CHRU Montpellier, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France.,Department of Medical Information, Montpellier University Hospital, Montpellier, France
| | - Jean-Pierre Mallet
- Apard Groupe Adène, Montpellier, France.,Department of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, CHRU Montpellier, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France
| | | | - Jean-Christian Borel
- Inserm U1042, HP2 (Hypoxia PhysioPathology) LaboratoryCentre Hospitalier Universitaire Grenoble Alpes, Grenoble Alps University, Grenoble, France
| | - Claudio Rabec
- Pulmonary Department and Respiratory Critical Care Unit, University Hospital Dijon, Dijon, France
| | - Fanny Bertelli
- IMAG, CNRS, Montpellier University, Montpellier University Hospital, Montpellier, France.,Apard Groupe Adène, Montpellier, France
| | - Arnaud Bourdin
- Apard Groupe Adène, Montpellier, France.,Department of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, CHRU Montpellier, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France.,PhyMedExp (INSERM U 1046, CNRS UMR9214), Montpellier University, Montpellier, France
| | - Nicolas Molinari
- IMAG, CNRS, Montpellier University, Montpellier University Hospital, Montpellier, France.,Department of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, CHRU Montpellier, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France
| | - Dany Jaffuel
- Apard Groupe Adène, Montpellier, France. .,Department of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, CHRU Montpellier, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France. .,PhyMedExp (INSERM U 1046, CNRS UMR9214), Montpellier University, Montpellier, France. .,Pulmonary Disorders and Respiratory Sleep Disorders Unit, Polyclinic Saint-Privat, Boujan sur Libron, France.
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263
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Park DY, Gu G, Han JG, Park B, Kim HJ. Validating respiratory index of auto-titrating positive airway pressure device with polysomnography. Sleep Breath 2021; 25:1477-1485. [PMID: 33398794 DOI: 10.1007/s11325-020-02278-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Positive airway pressure (PAP) devices have been widely used as the first line of treatment in obstructive sleep apnea (OSA). Most advanced PAP devices support the estimation of respiratory index (RI) using the patient's mask airflow. In addition to the compliance factor for PAP device use, which is important for monitoring patient sleep health, RI is also becoming important for monitoring. However, there are few reports that validate RI of a PAP device with polysomnography. METHODS Between January 2015 and December 2017, 50 participants were enrolled who were diagnosed with OSA and prescribed auto-titration PAP (APAP) devices. The RIs of participants were measured at night using APAP devices, concurrently with electroencephalography, respiratory inductance plethysmography sensors, and other polysomnographic sensors in a sleep laboratory. The respiratory-related data of APAP were prospectively analyzed with the manually scored polysomnographic data. RESULTS The apnea-hypopnea index and apnea index showed a statistically close relationship between the auto-scored respiratory data from the APAP device and the manually scored respiratory data from polysomnographic sensors. Obstructive apnea and central apnea indices showed relatively low correlations. The differences between the auto-scored RI and manually scored RI were influenced by BMI, waist circumference, weight, oxygen saturation, and respiratory distress indices of diagnostic polysomnographic factors. CONCLUSIONS The RIs of APAP devices have a tendency to be underestimated or mismatched when compared with polysomnography. Sleep specialists are advised to consider additional anthropometric and diagnostic factors to account for these differences during PAP treatment.
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Affiliation(s)
- Do-Yang Park
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.,Sleep Center, Ajou University Hospital, Suwon, Republic of Korea
| | - Gayoung Gu
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Jang Gyu Han
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.,Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Hyun Jun Kim
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea. .,Sleep Center, Ajou University Hospital, Suwon, Republic of Korea.
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264
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Costanzo MR, Javaheri S, Ponikowski P, Oldenburg O, Augostini R, Goldberg LR, Stellbrink C, Fox H, Schwartz AR, Gupta S, McKane S, Meyer TE, Abraham WT. Transvenous Phrenic Nerve Stimulation for Treatment of Central Sleep Apnea: Five-Year Safety and Efficacy Outcomes. Nat Sci Sleep 2021; 13:515-526. [PMID: 33953626 PMCID: PMC8092633 DOI: 10.2147/nss.s300713] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/09/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The remedē System Pivotal Trial was a prospective, multi-center, randomized trial demonstrating transvenous phrenic nerve stimulation (TPNS) therapy is safe and effectively treats central sleep apnea (CSA) and improves sleep architecture and daytime sleepiness. Subsequently, the remedē System was approved by FDA in 2017. As a condition of approval, the Post Approval Study (PAS) collected clinical evidence regarding long-term safety and effectiveness in adults with moderate to severe CSA through five years post implant. METHODS Patients remaining in the Pivotal Trial at the time of FDA approval were invited to enroll in the PAS and consented to undergo sleep studies (scored by a central laboratory), complete the Epworth Sleepiness Scale (ESS) questionnaire to assess daytime sleepiness, and safety assessment. All subjects (treatment and former control group) receiving active therapy were pooled; data from both trials were combined for analysis. RESULTS Fifty-three of the original 151 Pivotal Trial patients consented to participate in the PAS and 52 completed the 5-year visit. Following TPNS therapy, the apnea-hypopnea index (AHI), central-apnea index (CAI), arousal index, oxygen desaturation index, and sleep architecture showed sustained improvements. Comparing 5 years to baseline, AHI and CAI decreased significantly (AHI baseline median 46 events/hour vs 17 at 5 years; CAI baseline median 23 events/hour vs 1 at 5 years), though residual hypopneas were present. In parallel, the arousal index, oxygen desaturation index and sleep architecture improved. The ESS improved by a statistically significant median reduction of 3 points at 5 years. Serious adverse events related to implant procedure, device or delivered therapy were reported by 14% of patients which include 16 (9%) patients who underwent a pulse generator reposition or lead revision (primarily in the first year). None of the events caused long-term harm. No unanticipated adverse device effects or related deaths occurred through 5 years. CONCLUSION Long-term TPNS safely improves CSA, sleep architecture and daytime sleepiness through 5 years post implant. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01816776.
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Affiliation(s)
| | - Shahrokh Javaheri
- Bethesda North Hospital, Cincinnati, OH, USA.,The Ohio State University, Columbus, OH, USA
| | - Piotr Ponikowski
- Department of Heart Diseases, Medical University, Military Hospital, Wroclaw, Poland
| | - Olaf Oldenburg
- Ludgerus-Kliniken Münster, Clemens Hospital, Münster, Germany
| | | | - Lee R Goldberg
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Henrik Fox
- Clinic for General and Interventional Cardiology Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Alan R Schwartz
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sanjaya Gupta
- University of Missouri-Kansas City School of Medicine, Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA
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265
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Watach AJ, Hwang D, Sawyer AM. Personalized and Patient-Centered Strategies to Improve Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Patient Prefer Adherence 2021; 15:1557-1570. [PMID: 34285474 PMCID: PMC8286071 DOI: 10.2147/ppa.s264927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/23/2021] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA), a common sleep disorder characterized by repeated pauses in breathing during sleep, is effectively treated with positive airway pressure (PAP) therapy. The magnitude of improvements in daily functioning and reduced negative health risks are dependent on maintaining PAP adherence, which is a significant challenge. Evidence-based interventions to improve PAP use are not easily translated to clinical practice because they are labor-intensive and require specialty expertise. Further, to date, individualized care, inclusive of personalized medicine and patient- and person-centered care have been marginally incorporated in the field's understanding of OSA and PAP adherence. This integrative review describes current PAP adherence assessment processes, interventions to improve adherence, and outlines future opportunities to advance the field, particularly as it relates to individualizing care and the use of implementation science to apply evidence to practice.
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Affiliation(s)
- Alexa J Watach
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Correspondence: Alexa J Watach University of Pennsylvania, School of Nursing, Claire Fagin Hall, Rm 349, 418 Curie Blvd, Philadelphia, PA, 19104, USATel +1-717-599-9908 Email
| | - Dennis Hwang
- Kaiser Permanente Southern California, Sleep Medicine and Department of Research and Evaluation, Fontana, CA, USA
| | - Amy M Sawyer
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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266
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Neruntarat C, Khuancharee K, Saengthong P. Barbed Reposition Pharyngoplasty versus Expansion Sphincter Pharyngoplasty: A Meta-Analysis. Laryngoscope 2020; 131:1420-1428. [PMID: 33368308 DOI: 10.1002/lary.29357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study was to compare barbed reposition pharyngoplasty (BRP) and expansion sphincter pharyngoplasty (ESP) in the treatment of obstructive sleep apnea (OSA). METHODS Relevant 907 articles were searched from various databases until August 2020, including PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science and Scopus, and reference lists. RESULTS Four studies with a total of 208 participants were included. The mean reduction of apnea-hypopnea index (AHI) in the BRP group was 74.03% and the mean reduction of AHI in the ESP group was 60.17%. The mean success rate in the BRP group and the ESP group was 84.96% and 79.87%, respectively. The mean difference (MD) of the change in AHI between groups was not significantly different (MD = -1.24 event/hr, 95% CI [-11.86, 9.36], P = .82). There was no significant difference in postoperative AHI, postoperative Epworth Sleepiness Scale, pain, hospital stay, time to oral diet, and the change in oxygen desaturation index in both groups whereas the analgesic requirement was lower in the BRP group. Operative time was lower in the BRP group (MD = 21.72 minutes, 95% CI [18.85, 24.60], P < .0001). CONCLUSION The outcomes in both procedures are comparable in the improvement of OSA with palatal collapse. BRP is superior to ESP in term of surgical time. However, randomized clinical controlled trials with multicenter cooperation and long-term follow-up are essential to further demonstrate the efficacy of these procedures. Laryngoscope, 131:1420-1428, 2021.
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Affiliation(s)
- Chairat Neruntarat
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Kitsarawut Khuancharee
- Department of Preventive and Social Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Petcharat Saengthong
- Department of Otorhinolaryngology Head and Neck Surgery, Police General Hospital, Bangkok, Thailand
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Donovan LM, Palen BN, Syed A, Blankenhorn R, Blanchard K, Feser WJ, Magid K, Gamache J, Spece LJ, Feemster LC, Fernandes L, Kirsh S, Au DH. Nurse-led triage of new sleep referrals is associated with lower risk of potentially contraindicated sleep testing: a retrospective cohort study. BMJ Qual Saf 2020; 30:599-607. [PMID: 33443226 DOI: 10.1136/bmjqs-2020-011817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/21/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The volume of specialty care referrals often outstrips specialists' capacity. The Department of Veterans Affairs launched a system of referral coordination to augment our workforce, empowering registered nurses to use decision support tools to triage specialty referrals. While task shifting may improve access, there is limited evidence regarding the relative quality of nurses' triage decisions to ensure such management is safe. OBJECTIVE Within the specialty of sleep medicine, we compared receipt of contraindicated testing for obstructive sleep apnoea (OSA) between patients triaged to sleep testing by nurses in the referral coordination system (RCS) relative to our traditional specialist-led system (TSS). METHODS Patients referred for OSA evaluation can be triaged to either home sleep apnoea testing (HSAT) or polysomnography, and existing guidelines specify patients for whom HSAT is contraindicated. In RCS, nurses used a decision support tool to make triage decisions for sleep testing but were instructed to seek specialist oversight in complex cases. In TSS, specialists made triage decisions themselves. We performed a single-centre retrospective cohort study of patients without OSA who were referred to sleep testing between September 2018 and August 2019. Patients were assigned to triage by RCS or TSS in quasirandom fashion based on triager availability at time of referral. We compared receipt of contraindicated sleep tests between groups using a generalised linear model adjusted for day of the week and time of day of referral. RESULTS RCS triaged 793 referrals for OSA evaluation relative to 1787 by TSS. Patients with RCS triages were at lower risk of receiving potentially contraindicated sleep tests relative risk 0.52 (95% CI 0.29 to 0.93). CONCLUSION Our results suggest that incorporating registered nurses into triage decision-making may improve the quality of diagnostic care for OSA.
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Affiliation(s)
- Lucas M Donovan
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA .,Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA
| | - Brian N Palen
- Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA
| | - Adnan Syed
- VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Richard Blankenhorn
- VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Kelly Blanchard
- VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - William J Feser
- VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Kate Magid
- VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Justina Gamache
- Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA
| | - Laura J Spece
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA
| | - Laura C Feemster
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA
| | | | - Susan Kirsh
- Office of Veterans Access to Care, Department of Veterans Affairs, Washington, DC, USA
| | - David H Au
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, Washington, USA
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268
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Gaspar LS, Sousa C, Álvaro AR, Cavadas C, Mendes AF. Common risk factors and therapeutic targets in obstructive sleep apnea and osteoarthritis: An unexpectable link? Pharmacol Res 2020; 164:105369. [PMID: 33352231 DOI: 10.1016/j.phrs.2020.105369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/11/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
Osteoarthritis (OA) and Obstructive Sleep Apnea (OSA) are two highly prevalent chronic diseases for which effective therapies are urgently needed. Recent epidemiologic studies, although scarce, suggest that the concomitant occurrence of OA and OSA is associated with more severe manifestations of both diseases. Moreover, OA and OSA share risk factors, such as aging and metabolic disturbances, and co-morbidities, including cardiovascular and metabolic diseases, sleep deprivation and depression. Whether this coincidental occurrence is fortuitous or involves cause-effect relationships is unknown. This review aims at collating and integrating present knowledge on both diseases by providing a brief overview of their epidemiology and pathophysiology, analyzing current evidences relating OA and OSA and discussing potential common mechanisms by which they can aggravate each other. Such mechanisms constitute potential therapeutic targets whose pharmacological modulation may provide more efficient ways of reducing the consequences of OA and OSA and, thus, lessen the huge individual and social burden that they impose.
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Affiliation(s)
- Laetitia S Gaspar
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal; Centre for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal; Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal; PhD Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - Cátia Sousa
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal; Centre for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Ana Rita Álvaro
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal; Centre for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal; Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal
| | - Cláudia Cavadas
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal; Centre for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal; Institute for Interdisciplinary Research (IIIUC), University of Coimbra, Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
| | - Alexandrina Ferreira Mendes
- Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal; Centre for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
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269
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Acupuncture for Obstructive Sleep Apnea (OSA) in Adults: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6972327. [PMID: 32258139 PMCID: PMC7079261 DOI: 10.1155/2020/6972327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/26/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Our aim was to assess the efficacy and safety of acupuncture for OSA patients with various severities of the disorder. METHODS Eight databases including PubMed, Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data, and Chinese Biomedical Literature Database (CBM) were comprehensively searched till July 2019. Randomized controlled trials (RCTs) testing acupuncture in the treatment of OSA were eligible for inclusion. Studies were selected for inclusion, and data were extracted by two authors independently. The Cochrane Collaboration's Risk of Bias Assessment Tool and RevMan software (version 5.3) were used to evaluate the quality of studies and conduct statistical analysis. RESULTS Nine RCTs with 584 participants were included. The trials covered acupuncture and electropuncture. Acupuncture caused clinically significant reductions in AHI (MD: -6.18; 95% CI: -9.58 to -2.78; Z = 3.56, P = 0.0004) as well as in ESS (MD: -2.84; 95% CI: -4.80 to -0.16, Z = 2.09, P = 0.04). AHI was reduced more in the subgroup analysis of moderate OSA patients (MD: -9.44; 95% CI: -12.44 to -6.45; Z = 6.18, P < 0.00001) and severe OSA patients (MD: -10.09; 95% CI: -12.47 to -7.71; Z = 8.31, P < 0.00001). ESS was also reduced more in the subgroup analysis of moderate OSA patients (MD: -2.40; 95% CI: -3.63 to -1.17; Z = 3.83, P = 0.0001) and severe OSA patients (MD: -4.64; 95% CI: -5.35 to -3.92; Z = 12.72, P < 0.00001). Besides, acupuncture had a beneficial effect on LSaO2 (MD: 5.29; 95% CI: 2.61 to 7.97; Z = 3.86, P = 0.0001). The outcome of AHI and LSaO2 yielded consistent results after sensitivity analysis, but the direction of the outcome of ESS was reversed. And the quality of evidence was mainly low to very low. CONCLUSIONS Acupuncture therapy is effective for OSA patients in reducing AHI and ESS and in improving the LSaO2 of various severities, especially in moderate and severe OSA patients. High-quality trials are urgently needed.
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270
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Where to Next for Optimizing Adherence in Large-Scale Trials of Continuous Positive Airway Pressure? Sleep Med Clin 2020; 16:125-144. [PMID: 33485525 DOI: 10.1016/j.jsmc.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Large-scale randomized trials of positive airway pressure (PAP) efficacy have been largely negative but PAP adherence was notably suboptimal across the trials. To address this limitation, evidence-based PAP adherence protocols embedded within the larger trial protocol are recommended. The complexity of such protocols depends on adequacy of resources, including funding and inclusion of behavioral scientist experts on the scientific team, and trial-specific considerations (eg, target population) and methods. Recommendations for optimizing PAP adherence in large-scale trials are set forth that address rigor and reproducibility.
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271
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Billings ME, Pendharkar SR. Alternative Care Pathways for Obstructive Sleep Apnea and the Impact on Positive Airway Pressure Adherence: Unraveling the Puzzle of Adherence. Sleep Med Clin 2020; 16:61-74. [PMID: 33485532 DOI: 10.1016/j.jsmc.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The high burden of obstructive sleep apnea (OSA), combined with inadequate supply of sleep specialists and constraints on polysomnography resources, has prompted interest in alternative models of care to improve access and treatment effectiveness. In appropriately selected patients, ambulatory clinical pathways and use of nonphysicians or primary care providers to manage OSA can improve timely access and costs without compromising adherence or other clinical outcomes. Although initial studies show promising results, there are several potential barriers that must be considered before broad implementation, and further implementation research and economic evaluation studies are required.
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Affiliation(s)
- Martha E Billings
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, UW Medicine Sleep Center at Harborview Medical Center, Box 359803, 325 Ninth Avenue, Seattle, WA 98104, USA.
| | - Sachin R Pendharkar
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building, Room 3E23, 3280 Hospital Drive Northwest, Calgary, Alberta T2N 4Z6, Canada
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272
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Rossi GP, Bisogni V, Rossitto G, Maiolino G, Cesari M, Zhu R, Seccia TM. Practice Recommendations for Diagnosis and Treatment of the Most Common Forms of Secondary Hypertension. High Blood Press Cardiovasc Prev 2020; 27:547-560. [PMID: 33159664 PMCID: PMC7661394 DOI: 10.1007/s40292-020-00415-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/10/2020] [Indexed: 12/14/2022] Open
Abstract
The vast majority of hypertensive patients are never sought for a cause of their high blood pressure, i.e. for a 'secondary' form of arterial hypertension. This under detection explains why only a tiny percentage of hypertensive patients are ultimately diagnosed with a secondary form of arterial hypertension. The prevalence of these forms is, therefore, markedly underestimated, although, they can involve as many as one-third of the cases among referred patients and up to half of those with difficult to treat hypertension. The early detection of a secondary form is crucial, because if diagnosed in a timely manner, these forms can be cured at long-term, and even when cure cannot be achieved, their diagnosis provides a better control of high blood pressure, and allows prevention of hypertension-mediated organ damage, and related cardiovascular complications. Enormous progress has been made in the understanding, diagnostic work-up, and management of secondary hypertension in the last decades. The aim of this minireview is, therefore, to provide updated concise information on the screening, diagnosis, and management of the most common forms, including primary aldosteronism, renovascular hypertension, pheochromocytoma and paraganglioma, Cushing's syndrome, and obstructive sleep apnea.
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Affiliation(s)
- Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy.
| | - Valeria Bisogni
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy
| | - Giacomo Rossitto
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy
| | - Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy
| | - Maurizio Cesari
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy
| | - Rui Zhu
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy
| | - Teresa Maria Seccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, University Hospital, via Giustiniani, 2, 35126, Padova, Italy
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273
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Choi JH. Positive Airway Pressure Prescription and Management for Patients with Obstructive Sleep Apnea. JOURNAL OF RHINOLOGY 2020. [DOI: 10.18787/jr.2020.00319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by repeated events of complete or partial upper airway obstruction during sleep and is a chronic sleep disorder that requires long-term comprehensive management. Positive airway pressure (PAP) is recommended for treatment of OSA in adults with excessive daytime sleepiness, decreased sleep-related quality of life, and comorbid hypertension. During PAP therapy, regular follow-up is continuously necessary to evaluate side effects or complications, compliance, and treatment effects such as OSA-related symptoms, quality of life, and consequences. This review provides knowledge about PAP-related background information, indications for PAP prescription including the Korean National Health Insurance criteria, optimal pressure, PAP modes, patient education and support, short-term and long-term management, interpretation of PAP uses, and alternative therapies.
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274
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Schöbel C, Werther S, Teschler H, Taube C. Telemedicine in respiratory sleep medicine: COVID-19 pandemic unmasks the need for a process-oriented, replicable approach for implementation in clinical routine. J Thorac Dis 2020; 12:S261-S263. [PMID: 33214929 PMCID: PMC7642636 DOI: 10.21037/jtd-cus-2020-011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Christoph Schöbel
- Department for Pneumology, University Medicine Essen, Ruhrlandklinik - West German Lung Center, Essen, Germany.,Center for Sleep- and Telemedicine, University Medicine Essen, Ruhrlandklinik - West German Lung Center, Essen, Germany
| | - Stefanie Werther
- Department for Pneumology, University Medicine Essen, Ruhrlandklinik - West German Lung Center, Essen, Germany
| | | | - Christian Taube
- Department for Pneumology, University Medicine Essen, Ruhrlandklinik - West German Lung Center, Essen, Germany
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275
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Hill EA, Fairley DM, Williams LJ, Spanò G, Cooper SA, Riha RL. Prospective Trial of CPAP in Community-Dwelling Adults with Down Syndrome and Obstructive Sleep Apnea Syndrome. Brain Sci 2020; 10:E844. [PMID: 33198148 PMCID: PMC7696635 DOI: 10.3390/brainsci10110844] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022] Open
Abstract
Adults with Down syndrome (DS) are predisposed to obstructive sleep apnoea (OSA), but the effectiveness and acceptability of continuous positive airway pressure treatment (CPAP) in this group has rarely been formally assessed. This study was designed as a pilot randomised, parallel controlled trial for one month, continuing as an uncontrolled cohort study whereby the control group also received the intervention. Symptomatic, community-dwelling DS individuals exhibiting ≥10 apnoeas/hypopneas per hour in bed on a Type 3 home sleep study were invited to participate in this study, with follow-up at 1, 3, 6, and 12 months from baseline. Measurements of sleepiness, behaviour, cognitive function and general health were undertaken; the primary outcome was a change in the pictorial Epworth Sleepiness Scale (pESS) score. Twenty-eight participants (19 male) were enrolled: age 28 ± 9 year; body mass index 31.5 ± 7.9 kg/m2; 39.6 ± 32.2 apnoeas/hypopneas per hour in bed; pESS 11 ± 6/24. The pilot randomised controlled trial at one month demonstrated no change between the groups. At 12 months, participant (p = 0.001) pESS and Disruptive (p < 0.0001), Anxiety/Antisocial (p = 0.024), and Depressive (p = 0.008) behaviour scores were reduced compared to baseline. Improvement was noted in verbal (p = 0.001) and nonverbal intelligence scores (p = 0.011). General health scores also improved (p = 0.02). At the end of the trial, 19 participants continued on treatment. Use of CPAP in adults with DS and OSA led to a number of significant, sustained improvements in sleepiness and behavioural/emotional outcomes at 12 months.
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Affiliation(s)
- Elizabeth A Hill
- Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK; (E.A.H.); (D.M.F.)
| | - Donna M Fairley
- Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK; (E.A.H.); (D.M.F.)
| | - Linda J Williams
- Centre for Population Health Sciences, Usher Institute, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK;
| | - Goffredina Spanò
- Down Syndrome Research Group, Department of Psychology, University of Arizona, Tucson, AZ 85721, USA;
| | - Sally-Ann Cooper
- Mental Health and Wellbeing Research Group, Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 0XH, UK;
| | - Renata L Riha
- Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK; (E.A.H.); (D.M.F.)
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276
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Use of Wake-Promoting Agents in OSA: When Patients Do Not Achieve a Minimum of 6 Hours of PAP Usage per Night? CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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277
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Lundetræ RS, Saxvig IW, Lehmann S, Bjorvatn B. Effect of continuous positive airway pressure on symptoms of anxiety and depression in patients with obstructive sleep apnea. Sleep Breath 2020; 25:1277-1283. [PMID: 33098538 PMCID: PMC8376719 DOI: 10.1007/s11325-020-02234-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 12/16/2022]
Abstract
Purpose The objective was to assess the effect of continuous positive airway pressure (CPAP) on symptoms of anxiety and depression in patients with obstructive sleep apnea (OSA). We hypothesized a decrease in symptoms at follow-up, but that improvement relied on CPAP adherence. Methods The sample comprised 468 patients (mean age 55.5 years (SD = 12.0), 72% men) with OSA who received CPAP at a Norwegian hospital. OSA was diagnosed according to standard respiratory polygraphy. Mean baseline respiratory event index (REI) was 28.4 (SD = 20.6). Symptoms of anxiety and depression were assessed prior to CPAP treatment and at follow-up after a median of 20 weeks, range 6–52 weeks, with the Hospital Anxiety and Depression Scale (HADS). Patients were classified as CPAP adherent (≥ 4 h per night) or non-adherent (< 4 h per night). Results There was a significant decrease in anxiety scores from baseline (mean = 5.16, SD = 3.94) to follow-up (mean = 4.76, SD = 3.81), p < 0.001. Similarly, depression scores decreased from baseline (mean = 4.31, SD = 3.66) to follow-up (mean = 3.89, SD = 3.69), p < 0.001. Cohen’s d (0.19 and 0.18, respectively) indicated small effect sizes. The reduction in anxiety scores did not depend on CPAP adherence (no interaction effect F(1, 466) = 0.422, p = 0.516), whereas the reduction in depression scores were seen only in the CPAP adherent group (interaction effect F(1, 466) = 7.738, p = 0.006). Conclusions We found a decrease in symptoms of anxiety and depression from baseline to follow-up of CPAP treatment. The improvement in symptoms of depression was depending on CPAP adherence. This underlines the importance of adherence for optimal effect of CPAP treatment.
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Affiliation(s)
- Ragnhild Stokke Lundetræ
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway. .,Centre for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Ingvild West Saxvig
- Centre for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Sverre Lehmann
- Centre for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.,Centre for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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278
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Arikawa T, Nakajima T, Yazawa H, Kaneda H, Haruyama A, Obi S, Amano H, Sakuma M, Toyoda S, Abe S, Tsutsumi T, Matsui T, Nakata A, Shinozaki R, Miyamoto M, Inoue T. Clinical Usefulness of New R-R Interval Analysis Using the Wearable Heart Rate Sensor WHS-1 to Identify Obstructive Sleep Apnea: OSA and RRI Analysis Using a Wearable Heartbeat Sensor. J Clin Med 2020; 9:E3359. [PMID: 33092145 PMCID: PMC7589311 DOI: 10.3390/jcm9103359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/11/2020] [Accepted: 10/16/2020] [Indexed: 01/20/2023] Open
Abstract
Obstructive sleep apnea (OSA) is highly associated with cardiovascular diseases, but most patients remain undiagnosed. Cyclic variation of heart rate (CVHR) occurs during the night, and R-R interval (RRI) analysis using a Holter electrocardiogram has been reported to be useful in screening for OSA. We investigated the usefulness of RRI analysis to identify OSA using the wearable heart rate sensor WHS-1 and newly developed algorithm. WHS-1 and polysomnography simultaneously applied to 30 cases of OSA. By using the RRI averages calculated for each time series, tachycardia with CVHR was identified. The ratio of integrated RRIs determined by integrated RRIs during CVHR and over all sleep time were calculated by our newly developed method. The patient was diagnosed as OSA according to the predetermined criteria. It correlated with the apnea hypopnea index and 3% oxygen desaturation index. In the multivariate analysis, it was extracted as a factor defining the apnea hypopnea index (r = 0.663, p = 0.003) and 3% oxygen saturation index (r = 0.637, p = 0.008). Twenty-five patients could be identified as OSA. We developed the RRI analysis using the wearable heart rate sensor WHS-1 and a new algorithm, which may become an expeditious and cost-effective screening tool for identifying OSA.
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Affiliation(s)
- Takuo Arikawa
- Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan; (T.A.); (H.Y.); (H.K.); (A.H.); (S.O.); (H.A.); (M.S.); (S.T.); (S.A.); (T.I.)
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan; (T.A.); (H.Y.); (H.K.); (A.H.); (S.O.); (H.A.); (M.S.); (S.T.); (S.A.); (T.I.)
| | - Hiroko Yazawa
- Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan; (T.A.); (H.Y.); (H.K.); (A.H.); (S.O.); (H.A.); (M.S.); (S.T.); (S.A.); (T.I.)
| | - Hiroyuki Kaneda
- Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan; (T.A.); (H.Y.); (H.K.); (A.H.); (S.O.); (H.A.); (M.S.); (S.T.); (S.A.); (T.I.)
| | - Akiko Haruyama
- Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan; (T.A.); (H.Y.); (H.K.); (A.H.); (S.O.); (H.A.); (M.S.); (S.T.); (S.A.); (T.I.)
| | - Syotaro Obi
- Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan; (T.A.); (H.Y.); (H.K.); (A.H.); (S.O.); (H.A.); (M.S.); (S.T.); (S.A.); (T.I.)
| | - Hirohisa Amano
- Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan; (T.A.); (H.Y.); (H.K.); (A.H.); (S.O.); (H.A.); (M.S.); (S.T.); (S.A.); (T.I.)
| | - Masashi Sakuma
- Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan; (T.A.); (H.Y.); (H.K.); (A.H.); (S.O.); (H.A.); (M.S.); (S.T.); (S.A.); (T.I.)
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan; (T.A.); (H.Y.); (H.K.); (A.H.); (S.O.); (H.A.); (M.S.); (S.T.); (S.A.); (T.I.)
| | - Shichiro Abe
- Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan; (T.A.); (H.Y.); (H.K.); (A.H.); (S.O.); (H.A.); (M.S.); (S.T.); (S.A.); (T.I.)
| | - Takeshi Tsutsumi
- Division of Cardiology, Eda Memorial Hospital, Kanagawa 225-0012, Japan;
| | - Taishi Matsui
- Union Tool Co. Ltd., Tokyo 140-0013, Japan; (T.M.); (A.N.); (R.S.)
| | - Akio Nakata
- Union Tool Co. Ltd., Tokyo 140-0013, Japan; (T.M.); (A.N.); (R.S.)
| | - Ryo Shinozaki
- Union Tool Co. Ltd., Tokyo 140-0013, Japan; (T.M.); (A.N.); (R.S.)
| | - Masayuki Miyamoto
- Center of Sleep Medicine, Dokkyo Medical University Hospital, Tochigi 321-0293, Japan;
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan; (T.A.); (H.Y.); (H.K.); (A.H.); (S.O.); (H.A.); (M.S.); (S.T.); (S.A.); (T.I.)
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279
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Falkenstein M, Karthaus M, Brüne-Cohrs U. Age-Related Diseases and Driving Safety. Geriatrics (Basel) 2020; 5:E80. [PMID: 33086572 PMCID: PMC7709672 DOI: 10.3390/geriatrics5040080] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Due to demographic changes, the number of older drivers is steadily increasing. Mobility is highly relevant for leading an independent life in the elderly. It largely depends on car driving, which is a complex task requiring a multitude of cognitive and motor skills vulnerable to age- related functional deterioration. The almost inevitable effects of senescence may be potentiated by age-related diseases, such as stroke or diabetes mellitus. Respective pharmacological treatment may cause side effects, additionally affecting driving safety. The present article reviews the impact of age-related diseases and drug treatment of these conditions on driving fitness in elderly drivers. In essence, we focus on diseases of the visual and auditory systems, diseases of the central nervous system (i.e., stroke, depression, dementia and mild cognitive disorder, and Parkinson's disease), sleep disorders, as well as cardiovascular diseases, diabetes mellitus, musculoskeletal disorders, and frailty. We will outline the role of functional tests and the assessment of driving behavior (by a driving simulator or in real traffic), as well as the clinical interview including questions about frequency of (near) accidents, etc. in the evaluation of driving fitness of the elderly. We also address the impact of polypharmacy on driving fitness and end up with recommendations for physicians caring for older patients.
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Affiliation(s)
- Michael Falkenstein
- Institute for Work Learning and Aging (ALA), Hiltroper Landwehr 136, 44805 Bochum, Germany
| | - Melanie Karthaus
- Leibniz Institute for Working Environment and Human Factors (IfADo), 44139 Dortmund, Germany;
| | - Ute Brüne-Cohrs
- LWL University Hospital, Clinic for Psychiatry, Psychotherapy and Preventive Medicine, 44791 Bochum, Germany;
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280
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Elfimova EM, Mikhailova OO, Khachatryan NT, Litvin AY, Chazova IE, Laiovich LY, Malkina TA, Pevzner AV, Golitsyn SP. [Adherence and efficacy of long-term PAP therapy in patients with sleep-related breathing disorders associated with cardiac conduction disorders]. TERAPEVT ARKH 2020; 92:39-43. [PMID: 33346429 DOI: 10.26442/00403660.2020.09.000730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
AIM To study the effectiveness of prolonged use of PAP therapy (positive airway pressure therapy) in eliminating sleep respiratory disorders and associated cardiac conduction disturbances. MATERIALS AND METHODS We included 21 patients who were examined at the Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology, regarding cardiac rhythm and conduction disturbances, as well as obstructive sleep apnea and who have been on PAP therapy for more than 12 months. The average age was 66.5 [63.5; 73.2] years, body mass index 33.0 [30.2; 38.5] kg/m2, apnea-hypopnea index 65.0 [59.0; 86.3]/h. At the time of analysis, 15 patients continued to use PAP therapy (mean time of use: 6.0 years [4.7; 9.2]) and 6 patients refused long-term use of PAP therapy, mean time to use PAP therapy until failure amounted to 2.82.1 years. RESULTS PAP therapy lead to a persistent decrease in apnea-hypopnea index of 63.6/h to 3.7/h was (p=0.0002). 86% of patients met the criteria for adherence to PAP therapy (use 4 hours/night, more than 70% of nights). Initially, before the use of PAP therapy, all cardiac conduction disorders were during sleep and exceeded 3 seconds, with fluctuations from 3.1 to 10.6 seconds. PAP therapy appeared to be effective in all patients: no asystoles, duration of more than 3 seconds, were detected. CONCLUSION In obstructive sleep apnea patients with concomitant nighttime cardiac conduction disturbances, the long-term use of PAP therapy is effective and with good adherence.
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Affiliation(s)
- E M Elfimova
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology
| | - O O Mikhailova
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology
| | - N T Khachatryan
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology
| | - A Y Litvin
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology.,Pirogov Russian National Research Medical University
| | - I E Chazova
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology
| | - L Y Laiovich
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology
| | - T A Malkina
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology
| | - A V Pevzner
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology
| | - S P Golitsyn
- Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology
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281
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Corrigan J, Ogah I, Ip-Buting A, Sharpe H, Laratta CR, Peller P, Tsai WH, Pendharkar SR. An evaluation of rural-urban disparities in treatment outcomes for obstructive sleep apnoea: study protocol for a prospective cohort study. ERJ Open Res 2020; 6:00141-2020. [PMID: 33043058 PMCID: PMC7534578 DOI: 10.1183/23120541.00141-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/03/2020] [Indexed: 11/05/2022] Open
Abstract
Background Obstructive sleep apnoea (OSA) is a common and treatable chronic condition that is associated with significant morbidity and economic cost. Geography is increasingly being recognised as a barrier to diagnosis and treatment of many chronic diseases; however, no study to date has investigated the impact of place of residence on health outcomes in OSA. Objective The purpose of this study is to determine whether treatment outcomes for patients initiating continuous positive airway pressure (CPAP) for OSA differ between those who live in urban versus rural settings. Methods A prospective cohort design will be used. Participants will be recruited through community-based CPAP providers and assigned to either the rural or urban cohort based on residential postal code. The primary outcome will be the difference in nightly hours of CPAP use between the two groups, measured 3 months after initiation of therapy. Secondary outcomes will include symptoms, quality of life, patient satisfaction and patient-borne costs. Anticipated results This study will determine whether there are differences in CPAP adherence or patient-reported outcomes between rural and urban patients with OSA. These results will highlight potential challenges with providing OSA care in rural populations and may inform health interventions to reduce urban-rural inequities.
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Affiliation(s)
- Jennifer Corrigan
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Imhokhai Ogah
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ada Ip-Buting
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Heather Sharpe
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Cheryl R Laratta
- Dept of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Peter Peller
- Spatial and Numeric Data Services, University of Calgary, Calgary, Canada
| | - Willis H Tsai
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Dept of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sachin R Pendharkar
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Dept of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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282
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Treatment of Obstructive Sleep Apnea-Hypopnea Syndrome With a Mandible Advanced Device Increases Nitric Oxide Release and Ameliorates Pulmonary Hypertension in Rabbits. J Oral Maxillofac Surg 2020; 79:694.e1-694.e12. [PMID: 33259783 DOI: 10.1016/j.joms.2020.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the effects of mandible advanced device (MAD) therapy for obstructive sleep apnea-hypopnea syndrome (OSAHS) on nitric oxide (NO) release and changes in pulmonary artery pressure and structure. METHODS Thirty male New Zealand white rabbits were randomly divided into OSAHS, MAD, and control groups (n = 10 per group). The soft palate of rabbits in the OSAHS and MAD groups was injected with hydrophilic polyacrylamide gel to induce OSAHS. The MAD group wore a MAD, and the control group was not treated. Cone-beam computed tomography scans and polysomnography recordings were performed to confirm successful model establishment. All rabbits slept in a supine position for 4 to 6 hours daily and were observed for 8 consecutive weeks. The pulmonary artery pressure was measured by right heart catheterization. Pulmonary artery morphometry was analyzed by hematoxylin and eosin staining. NO levels in plasma and lung homogenate supernatants were detected by Griess reaction assay kits. RESULTS The OSAHS group exhibited higher pulmonary artery pressure (57.74 ± 1.79 mm Hg) than the MAD (19.99 ± 2.04 mm Hg) and control (14.49 ± 0.54 mm Hg) groups. The media thickness percentage of the pulmonary artery was higher in the OSAHS group (46.89 ± 2.72%) than the control group (15.87 ± 1.18%) and was markedly reduced by MAD (21.64 ± 1.45%). Blood oxygen saturation was positively correlated with the NO concentration in both the lung and plasma, and the NO concentration was negatively correlated with the media thickness percentage and media section percentage. CONCLUSIONS OSAHS induced a decrease in NO and pulmonary hypertension, which was relieved by MAD therapy.
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283
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Low arousal threshold is associated with unfavorable shift of PAP compliance over time in patients with OSA. Sleep Breath 2020; 25:887-895. [PMID: 33011910 DOI: 10.1007/s11325-020-02197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/28/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the predictive factors of initial and long-term adherence to positive airway pressure (PAP) therapy and factors leading to an unfavorable shift of PAP compliance. METHODS This follow-up study was comprised of newly diagnosed patients with obstructive sleep apnea (OSA) amenable to PAP therapy from January 2017 to April 2019. Information on basic demographics, comorbidities, and sleep-related symptoms were collected. PAP adherence data were collected at the end of the first week and the third month. RESULTS Of 166 patients enrolled, data from 142 (86%) were in the final analysis. Overall PAP usage was worse at 3 months declining from the first week. After adjusting for age and gender, multinomial logistic regression analysis showed that a small number of sleep-related symptoms (OR, 0.69; 95% CI, 0.52-0.91) and low arousal threshold (ArTH) (OR, 4.44; 95% CI, 1.52-12.98) were associated with higher odds of noncompliance. Low ArTH (OR, 2.87; 95% CI, 1.09-7.57) and lower body mass index (BMI) (OR, 0.88; 95% CI, 0.78-0.99) increased the risk of compliance-to-noncompliance shift. Sixty-two patients with polysomnography were analyzed separately. After adjustment for age and gender, poor sleep efficiency (OR, 0.80; 95% CI, 0.68-0.94) was associated with higher odds of consistent noncompliance. Low ArTH (OR, 15.36; 95% CI, 1.44-164.24) increased the risk of compliance-to-noncompliance shift in this subgroup. CONCLUSIONS Lower BMI and low ArTH were associated with an unfavorable shift of PAP compliance over time in patients with OSA, which was different from the predictors of consistent PAP noncompliance of patients with OSA.
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284
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Shah NM, D'Cruz RF, Murphy PB. Novel modes of non-invasive ventilation in chronic respiratory failure: a narrative review. J Thorac Dis 2020; 12:S217-S224. [PMID: 33214925 PMCID: PMC7642641 DOI: 10.21037/jtd-cus-2020-013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Home non-invasive ventilation (NIV) is central in the management of chronic hypercapnic respiratory failure and is associated with improvements in clinically relevant outcomes. Home NIV typically involves delivery of fixed positive inspiratory and expiratory airway pressures. These pressures do not reflect physiological changes to respiratory mechanics and airway calibre during sleep, which may impact on physiological efficacy, subsequent clinical outcomes, and therapy adherence. Novel ventilator modes have been designed in an attempt to address these issues. Volume-assured pressure support modes aim to automatically adjust inspiratory pressure to achieve a pre-set target tidal volume. The addition of auto-titrating expiratory pressure to maintain upper airway calibre is designed for patients at risk of upper airway collapse, such as obese patients and those with obstructive sleep apnoea complicating their hypercapnic failure. Heterogeneity in setup protocols, patient selection and trial design limit firm conclusions to be drawn on the clinical efficacy of these modes. However, there are data to suggest that compared to fixed-pressure NIV, volume-assured modes may improve nocturnal carbon dioxide, sleep quality and ventilator adherence in select patients. The use of the forced oscillation technique to identify expiratory flow limitation and adjust expiratory pressure to eliminate it is the most recent addition to these advanced modes and is yet to be assessed in formal clinical trials.
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Affiliation(s)
- Neeraj Mukesh Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Rebecca F D'Cruz
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Patrick B Murphy
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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285
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Abstract
Sleep disorders, such as sleep-disordered breathing (SDB), insomnia or restless legs syndrome (RLS), are common in the general population and after stroke. In some cases, sleep disturbances are pre-existing, but can also appear de novo as a direct consequence of brain damage or due to stroke-related complications. Furthermore, some sleep conditions may act as a risk factor of stroke. This review explores the available evidence of the two-way relationship between sleep and stroke. Cardiovascular physiological changes during sleep are described, as well as the evidence on the relationship between stroke and sleep duration, SDB, RLS, insomnia, excessive daytime sleepiness (EDS), and circadian rhythm alterations. Potential changes on sleep architecture, and the links that may exist between sleep and functional outcomes after stroke are also discussed. Importantly, sleep-related disturbances may be associated with worse stroke recovery outcomes and increased cerebrovascular morbidity. It is therefore relevant that the bidirectional association between stroke and sleep is taken into consideration by clinicians taking care of these patients. Future research may focus on this mutual relationship for a better understanding of the impact of stroke on sleep, the importance of sleep in stroke incidence and recovery, and have further evidence on treatment strategies that may improve functional outcome after stroke.
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Affiliation(s)
| | - Saima Bashir
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, IDIBGI, Girona, Spain
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286
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Shah S, Smotherman C, Louis M. Determinants of bilevel therapy in the management of obstructive sleep apnea. Sleep Breath 2020; 25:1181-1186. [PMID: 32965586 DOI: 10.1007/s11325-020-02193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/28/2020] [Accepted: 09/12/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to investigate potential patient or polysomnogram (PSG) characteristics that can help determine who might benefit from bilevel positive airway pressure (BPAP) in the treatment of uncomplicated OSA. STUDY DESIGN This was a single center, retrospective, observational study in which 19 patients who met our inclusion criteria for BPAP were matched to 40 patients in the control group. Data on patient baseline characteristics as well as PSG results were analyzed. RESULTS Baseline patient and PSG characteristics were similar with the exception of shorter sleep time in the BPAP group, 290 min compared with 351 min (p = 0.005). Analysis of oxygen saturations revealed that the percent of total sleep time (TST) spent below 90% (SpO2 < 90%) was statistically higher in BPAP group (mean 21.4% ± 23.6%) compared with CPAP (mean 9.1% ± 11.1%, p = 0.045). For every 5% increase in TST at SpO2 < 90%, there is a 28% increase in the odds of BPAP prescription (OR = 1.276, 95%CI 1.029, 1.582, p = 0.027), and for every 10% increase, there is an increase of 63% (OR 1.627, 95%CI 1.058-2.502). The Hosmer-Lemeshow goodness-of-fit test revealed a good fit (p = 0.23). The AUC was 0.7. CONCLUSION There is an association between duration of hypoxemia on the PSG and the likelihood of requiring BPAP for the treatment of uncomplicated OSA. More research is needed to understand the best patient-centered therapy when initiating PAP in the management of OSA.
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Affiliation(s)
- Stuart Shah
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Jacksonville Suite 7-088, C-54 UF Health Clinical Center, 655 west 8th Street, Jacksonville, FL, 32209, USA
| | - Carmen Smotherman
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Jacksonville Suite 7-088, C-54 UF Health Clinical Center, 655 west 8th Street, Jacksonville, FL, 32209, USA
| | - Mariam Louis
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Jacksonville Suite 7-088, C-54 UF Health Clinical Center, 655 west 8th Street, Jacksonville, FL, 32209, USA.
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287
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Affiliation(s)
| | - Eric J Olson
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sean M Caples
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
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288
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Luo K, Zhang L, Zhang X, Han T, Li Y, Wang C. Acceptance of and six-month adherence to continuous positive airway pressure in patients with moderate to severe obstructive sleep apnea. CLINICAL RESPIRATORY JOURNAL 2020; 15:56-64. [PMID: 32939997 DOI: 10.1111/crj.13269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is the most effective treatment for moderate to severe obstructive sleep apnea (OSA). Acceptance of and adherence to CPAP are crucial for optimal treatment outcomes. The aim of this study was to investigate the factors influencing patients' acceptance of and adherence to CPAP treatment. METHODS One hundred eighty-eight patients with moderate to severe OSA who had received CPAP titration from October 2017 to September 2018 were recruited. They were interviewed at 2 weeks and at 6 months to assess CPAP use and barriers to acceptance and adherence. RESULTS One hundred fourteen patients (60.6%) accepted CPAP treatment. Disease severity, assessed by apnea-hypopnea index (AHI) (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.08), subjective satisfaction of titration (OR, 12.83; 95% CI, 3.83-42.99), initial intention of CPAP therapy (OR, 3.33; 95% CI, 1.05-10.51) and short-term home CPAP trial (OR, 9.40; 95% CI, 2.85-31.08) were associated with acceptance of CPAP treatment. Two-third of the 98 CPAP acceptors reported good CPAP adherence at 6 months follow-up. Average hours of CPAP use per day for the first 2 weeks (OR, 1.88; 95% CI, 1.28-3.04) and the global problems associated with CPAP use (OR, 0.82; 95% CI, 0.73-0.91) were independent predictors of the six-month CPAP adherence. CONCLUSIONS Nearly 40% of patients with moderate to severe OSA did not accept CPAP treatment, and one-third of those CPAP acceptors had poor adherence to CPAP treatment. Improvement in disease awareness, comfortable titration experience, short-term home CPAP trial may be of help to increase CPAP acceptance and early experience with CPAP is important for long-term adherence. The differences in predicting factors for CPAP acceptance and adherence highlight the importance of focusing on specific aspects during the whole process management of OSA.
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Affiliation(s)
- Kun Luo
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,First Hospital of Qinhuangdao, Beijing, China
| | - Li Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China
| | - Xiaolei Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China.,Capital Medical University, Beijing, China.,the Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Teng Han
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Yiming Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China.,Capital Medical University, Beijing, China.,the Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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289
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MacKay S, Carney AS, Catcheside PG, Chai-Coetzer CL, Chia M, Cistulli PA, Hodge JC, Jones A, Kaambwa B, Lewis R, Ooi EH, Pinczel AJ, McArdle N, Rees G, Singh B, Stow N, Weaver EM, Woodman RJ, Woods CM, Yeo A, McEvoy RD. Effect of Multilevel Upper Airway Surgery vs Medical Management on the Apnea-Hypopnea Index and Patient-Reported Daytime Sleepiness Among Patients With Moderate or Severe Obstructive Sleep Apnea: The SAMS Randomized Clinical Trial. JAMA 2020; 324:1168-1179. [PMID: 32886102 PMCID: PMC7489419 DOI: 10.1001/jama.2020.14265] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Many adults with obstructive sleep apnea (OSA) use device treatments inadequately and remain untreated. OBJECTIVE To determine whether combined palatal and tongue surgery to enlarge or stabilize the upper airway is an effective treatment for patients with OSA when conventional device treatment failed. DESIGN, SETTING, AND PARTICIPANTS Multicenter, parallel-group, open-label randomized clinical trial of upper airway surgery vs ongoing medical management. Adults with symptomatic moderate or severe OSA in whom conventional treatments had failed were enrolled between November 2014 and October 2017, with follow-up until August 2018. INTERVENTIONS Multilevel surgery (modified uvulopalatopharyngoplasty and minimally invasive tongue volume reduction; n = 51) or ongoing medical management (eg, advice on sleep positioning, weight loss; n = 51). MAIN OUTCOMES AND MEASURES Primary outcome measures were the apnea-hypopnea index (AHI; ie, the number of apnea and hypopnea events/h; 15-30 indicates moderate and >30 indicates severe OSA) and the Epworth Sleepiness Scale (ESS; range, 0-24; >10 indicates pathological sleepiness). Baseline-adjusted differences between groups at 6 months were assessed. Minimal clinically important differences are 15 events per hour for AHI and 2 units for ESS. RESULTS Among 102 participants who were randomized (mean [SD] age, 44.6 [12.8] years; 18 [18%] women), 91 (89%) completed the trial. The mean AHI was 47.9 at baseline and 20.8 at 6 months for the surgery group and 45.3 at baseline and 34.5 at 6 months for the medical management group (mean baseline-adjusted between-group difference at 6 mo, -17.6 events/h [95% CI, -26.8 to -8.4]; P < .001). The mean ESS was 12.4 at baseline and 5.3 at 6 months in the surgery group and 11.1 at baseline and 10.5 at 6 months in the medical management group (mean baseline-adjusted between-group difference at 6 mo, -6.7 [95% CI, -8.2 to -5.2]; P < .001). Two participants (4%) in the surgery group had serious adverse events (1 had a myocardial infarction on postoperative day 5 and 1 was hospitalized for observation following hematemesis of old blood). CONCLUSIONS AND RELEVANCE In this preliminary study of adults with moderate or severe OSA in whom conventional therapy had failed, combined palatal and tongue surgery, compared with medical management, reduced the number of apnea and hypopnea events and patient-reported sleepiness at 6 months. Further research is needed to confirm these findings in additional populations and to understand clinical utility, long-term efficacy, and safety of multilevel upper airway surgery for treatment of patients with OSA. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12614000338662.
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Affiliation(s)
- Stuart MacKay
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
- University of Wollongong, NSW, Australia
- Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia
| | - A. Simon Carney
- Southern ENT & Adelaide Sinus Centre, Flinders Private Hospital, Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Peter G. Catcheside
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Michael Chia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Peter A. Cistulli
- Charles Perkins Centre, Faculty for Medicine and Health, University of Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - John-Charles Hodge
- Ear Nose and Throat Department, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Andrew Jones
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
- University of Wollongong, NSW, Australia
- Illawarra Sleep Medicine Centre, Wollongong, NSW, Australia
| | - Billingsley Kaambwa
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Richard Lewis
- Hollywood Medical Centre, Perth, WA, Australia
- Department of Otolaryngology, Head & Neck Surgery, Royal Perth Hospital, Perth, WA, Australia
| | - Eng H. Ooi
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Alison J. Pinczel
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Perth, WA, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Guy Rees
- The Memorial Hospital, Adelaide, SA, Australia
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Perth, WA, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- Faculty of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Nicholas Stow
- The Woolcock Clinic, University of Sydney, NSW, Australia
| | - Edward M. Weaver
- Department of Otolaryngology/Head and Neck Surgery, University of Washington, Seattle
- Staff Surgeon, Seattle Veterans Affairs Medical Center, Seattle, Washington
| | - Richard J. Woodman
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Charmaine M. Woods
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Aeneas Yeo
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - R. Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Respiratory and Sleep Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia
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Global Risk Factor Evaluation of Obstructive Sleep Apnea in Relation to Research Activity and Socioeconomic Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186785. [PMID: 32957715 PMCID: PMC7559375 DOI: 10.3390/ijerph17186785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022]
Abstract
Obstructive Sleep Apnea is emerging as a global health epidemic, particularly due to the obesity pandemic. However, comprehensive prevalence data are still lacking and global OSA research has not yet been structurally evaluated. Using the latest comprehensive age/gender-specific BMI and obesity data, a global landscape estimating the risk/burden of OSA was created. Results were presented in relation to an in-depth analysis of OSA research and countries’ socioeconomic/scientific background. While the USA, Canada, and Japan are the highest publishing countries on OSA, Iceland, Greece, and Israel appeared at the forefront when relating the scientific output to socioeconomic parameters. Conversely, China, India, and Russia showed relatively low performances in these relations. Analysis of the estimated population at risk (EPR) of OSA showed the USA, China, India, and Brazil as the leading countries. Although the EPR and OSA research correlated strongly, major regional discrepancies between the estimated demand and actual research performances were identified, mainly in, but not limited to, developing nations. Our study highlights regional challenges/imbalances in the global activity on OSA and allows targeted measures to mitigate the burden of undiagnosed/untreated OSA. Furthermore, the inclusion of disadvantaged countries in international collaborations could stimulate local research efforts and provide valuable insights into the regional epidemiology of OSA.
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291
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Are the International Classification of Functioning, Disability and Health (ICF) domains considered in the obstructive sleep apnea instruments? An integrative review. Sleep Breath 2020; 25:1089-1100. [PMID: 32865728 DOI: 10.1007/s11325-020-02173-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Obstructive Sleep Apnea (OSA) is related to cardiovascular, metabolic, and neurocognitive diseases. Furthermore, OSA symptoms, such as excessive sleepiness, fatigue, and mood disorders, may interfere in functioning. The assessment of this aspect in patients with OSA is not frequent and no specific instrument is available in the literature. Our aim is to identify if the International Classification of Functioning, Disability and Health (ICF) domains are considered in the validated instruments used to assess patients with OSA. METHODS In this integrative literature review, three databases were searched: Pubmed, Embase, and LILACS. Bibliographic survey was carried out in 2020, between March and July. Articles published in English, Portuguese, and Spanish with validated tools to assess OSA in adults were included. RESULTS Thirty instruments have undergone a process of concept extraction and coding according to the ICF, generating a total of 769 significant concepts. It was observed that the function domain was the most prevalent, making 42% (n = 323) of the concepts, followed by domains of activity (16%), participation (10%), environmental factors (5%), personal factor (5%), and structure (1%). Only one instrument, the "Sleep Apnea Quality of Life Index (SAQLI)," encompasses all domains of the ICF in its constructs. CONCLUSION In the analyzed instruments, the function domain prevails, with most concepts related to sleep functions. Only one validated instrument included in this research covered all the ICF domains. This instrument closely matched the recommended way of assessing functioning, though it approached the domains in an unbalanced way.
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292
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Bonsignore MR, Barbera CDG, Clini E. Obstructive sleep apnea and blood pressure in young hypertensives: does it matter? Intern Emerg Med 2020; 15:921-923. [PMID: 32189237 DOI: 10.1007/s11739-020-02308-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/29/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Maria Rosaria Bonsignore
- PROMISE Department, Sleep and Respiratory Failure Clinic, University of Palermo, Palermo, Italy.
- IRIB-CNR, Palermo, Italy.
| | | | - Enrico Clini
- Department of Medical and Surgical Science SMECHIMAI, University of Modena Reggio Emilia, Modena, Italy
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293
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Gerdung C, Rodriguez-Lopez S, Palkowski S, Keto-Lambert D, Sebastianski M, Castro Codesal ML. Does non-invasive ventilation change metabolic markers in children with obstructive sleep apnoea? A systematic review and meta-analysis study protocol. BMJ Open 2020; 10:e039655. [PMID: 32830118 PMCID: PMC7445331 DOI: 10.1136/bmjopen-2020-039655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is not only common within paediatrics but is associated with critical childhood metabolic morbidity such as obesity, cardiovascular disease and glucose tolerance impairment. Increasing evidence suggests an association between childhood OSA and metabolic syndrome such as markers of cardiovascular disease, systemic hypertension, glucose intoleranceand increased lipid profile. Recent studies have targeted changes in metabolic markers in children using non-invasive ventilation (NIV) but no systematic reviews are available to summarise this emerging evidence. The purpose of this systematic review is to provide systematic synthesis of the evidence on the effect of NIV use on metabolic markers in children with OSA. METHODS AND ANALYSIS A systematic search of electronic databases and grey literature will include paediatric interventional studies (random controlled trials, cohort studies) with and without a comparison group. Two reviewers will independently undertake the two step process of title/abstract and full-text screening. Data will be extracted and assessed, with aggregate data being reported. When the data allow, meta-analysis will be performed. ETHICS AND DISSEMINATION There are no ethical concerns with this systematic review, as data have previously been published. This review will inform clinicians taking care of children with OSA and obesity/metabolic syndrome about the potential effects of NIV therapies on metabolic markers and has the potential to change the approach to childhood OSA and obesity. Results of this systematic review will be submitted for dissemination in abstract and manuscript form.
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Affiliation(s)
- Christopher Gerdung
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Sara Rodriguez-Lopez
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Stefan Palkowski
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Diana Keto-Lambert
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
- University of Alberta Faculty of Medicine and Dentistry Department of Pediatrics, Edmonton, Alberta, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
- University of Alberta Faculty of Medicine and Dentistry Department of Pediatrics, Edmonton, Alberta, Canada
| | - Maria Luisa Castro Codesal
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
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294
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Martin JL, Mysliwiec V, Chowdhuri S, Ulmer CS. The Veterans Administration and Department of Defense clinical practice guidelines for the diagnosis and management of sleep disorders: what does this mean for the practice of sleep medicine? J Clin Sleep Med 2020; 16:1377-1381. [PMID: 32807296 DOI: 10.5664/jcsm.8486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
None In 2017 the Veterans Administration (VA) and Department of Defense (DOD) launched development of clinical practice guidelines (CPGs) for the diagnosis and treatment of sleep disorders, with the goal of informing and improving patient care. The guideline development process followed GRADE methodology, considering studies and systematic reviews published over the 10-year period prior to guideline development. A total of 41 recommendations were made,18 related to the diagnosis and treatment of obstructive sleep apnea (OSA) and 23 regarding chronic insomnia disorder. In contrast to other published guidelines, the VA DoD CPGs provide a comprehensive approach to diagnosis and management of the two most common sleep disorders, including a discussion of the sequencing of diagnostic approaches and treatment options. Regarding OSA, strong recommendations were made for follow-up evaluation after non-diagnostic home sleep apnea tests, positive airway pressure therapy as first-line treatment, and the incorporation of supportive, educational and behavioral interventions for patients at high risk for PAP therapy non-adherence due to comorbid conditions. Strong recommendations were also made for the use of cognitive-behavioral therapy for insomnia and against the use of kava (an herbal supplement) in the treatment of chronic insomnia disorder. These guidelines, while intended to directly inform care within VA and DOD, are broadly relevant to the practice of sleep medicine. The majority of scientific evidence was based on studies of non-military, non-veteran populations. The CPG is a major milestone for the VA and DOD in recognizing the importance of evidence-based treatments for sleep disorders in military personnel and veterans.
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Affiliation(s)
- Jennifer L Martin
- Veterans Administration Greater Los Angeles Healthcare System and David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, California
| | - Vincent Mysliwiec
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Susmita Chowdhuri
- John D. Dingell Veterans Administration Sleep Wake Disorders Center and Wayne State University, Detroit, Michigan
| | - Christi S Ulmer
- Durham Veterans Administration Healthcare System and Duke University School of Medicine, Durham, North Carolina
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295
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Patel SR, Donovan LM. The COVID-19 Pandemic Presents an Opportunity to Reassess the Value of Polysomnography. Am J Respir Crit Care Med 2020; 202:309-310. [PMID: 32510968 PMCID: PMC7397790 DOI: 10.1164/rccm.202005-1546ed] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Sanjay R Patel
- Division of Pulmonary, Allergy, and Critical Care MedicineUniversity of PittsburghPittsburgh, Pennsylvania
| | - Lucas M Donovan
- Center of Innovation for Veteran-Centered and Value-Driven CareVA Health Services Research and DevelopmentSeattle, Washingtonand.,Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of WashingtonSeattle, Washington
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296
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Hooper RG. CPAP Therapeutic Options for Obstructive Sleep Apnea. Pragmat Obs Res 2020; 11:67-76. [PMID: 32765155 PMCID: PMC7381796 DOI: 10.2147/por.s258632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/12/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction There are many options available to patients who are placed on constant positive airway pressure (CPAP) for obstructive sleep apnea. Despite the success of CPAP in correcting apnea, a significant number of patients have difficulty with the therapy. A large number of those patients who have difficulty stop therapy and are often labeled as "CPAP Failure". Non-sleep specialists may view CPAP therapy as a singular course of treatment, but there are many ways CPAP may be ordered for a patient. Each patient experiences a unique set of options that constitute a unique order set. Methods In order to demonstrate the magnitude of the possible options, estimates of the number of unique order sets were calculated. The author chose individual order options and the number of selections possible within each option. The calculated sets included a "Generous, Limited and Minimal" number of selections for each option. Calculations were done separately for standard CPAP and for auto-adjusting CPAP. Additional calculations were performed using the number of commercially available masks in the United States. Results The maximum number of unique order sets was seen using a standard CPAP combined with commercially available masks: 49,152 unique order sets. The fewest number of unique order sets were seen with the auto-adjusting CPAP and the "Minimal" selections: 288 unique order sets. Discussion There are a large number of unique CPAP orders that a patient may experience. CPAP treatment is not a singular or simple therapy. When evaluating obstructive sleep apnea patients with histories of CPAP failure or prior difficulty with CPAP, paying close attention to the patient's treatment experiences may help explain a significant number of those patients' CPAP therapy problems.
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Affiliation(s)
- Robert G Hooper
- Center for Sleep Medicine, Mayo Clinic, Phoenix, Arizona, USA
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297
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Ryan S, Cummins EP, Farre R, Gileles-Hillel A, Jun JC, Oster H, Pepin JL, Ray DW, Reutrakul S, Sanchez-de-la-Torre M, Tamisier R, Almendros I. Understanding the pathophysiological mechanisms of cardiometabolic complications in obstructive sleep apnoea: towards personalised treatment approaches. Eur Respir J 2020; 56:13993003.02295-2019. [PMID: 32265303 DOI: 10.1183/13993003.02295-2019] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/15/2020] [Indexed: 12/19/2022]
Abstract
In January 2019, a European Respiratory Society research seminar entitled "Targeting the detrimental effects of sleep disturbances and disorders" was held in Dublin, Ireland. It provided the opportunity to critically review the current evidence of pathophysiological responses of sleep disturbances, such as sleep deprivation, sleep fragmentation or circadian misalignment and of abnormalities in physiological gases such as oxygen and carbon dioxide, which occur frequently in respiratory conditions during sleep. A specific emphasis of the seminar was placed on the evaluation of the current state of knowledge of the pathophysiology of cardiovascular and metabolic diseases in obstructive sleep apnoea (OSA). Identification of the detailed mechanisms of these processes is of major importance to the field and this seminar offered an ideal platform to exchange knowledge, and to discuss pitfalls of current models and the design of future collaborative studies. In addition, we debated the limitations of current treatment strategies for cardiometabolic complications in OSA and discussed potentially valuable alternative approaches.
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Affiliation(s)
- Silke Ryan
- Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Dublin, Ireland .,School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Eoin P Cummins
- School of Medicine, Conway Institute, University College Dublin, Dublin, Ireland
| | - Ramon Farre
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona-IDIBAPS, and CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Alex Gileles-Hillel
- Pediatric Pulmonology and Sleep Unit, Dept of Pediatrics, and The Wohl Institute for Translational Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jonathan C Jun
- Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Henrik Oster
- Institute of Neurobiology, University of Lübeck, Lübeck, Germany
| | | | - David W Ray
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.,Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Sirimon Reutrakul
- Division of Endocrinology, Diabetes, and Metabolism, Dept of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Manuel Sanchez-de-la-Torre
- Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Renaud Tamisier
- HP2 INSERM U1042, Université Grenoble Alpes, Grenoble, France
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona-IDIBAPS, and CIBER Enfermedades Respiratorias, Barcelona, Spain
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298
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299
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Loffler KA, Heeley E, Freed R, Meng R, Bittencourt LR, Gonzaga Carvalho CC, Chen R, Hlavac M, Liu Z, Lorenzi-Filho G, Luo Y, McArdle N, Mukherjee S, Yap HS, Zhang X, Palmer LJ, Anderson CS, McEvoy RD, Drager LF. Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease. Diabetes Care 2020; 43:1859-1867. [PMID: 32291275 DOI: 10.2337/dc19-2006] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/15/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Despite evidence of a relationship among obstructive sleep apnea (OSA), metabolic dysregulation, and diabetes, it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and diabetes risk in patients with cardiovascular disease (CVD) and OSA. RESEARCH DESIGN AND METHODS Blood, medical history, and personal data were collected in a substudy of 888 participants in the Sleep Apnea cardioVascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were randomized to receive CPAP plus usual care, or usual care alone. Serum glucose and glycated hemoglobin A1c (HbA1c) were measured at baseline, 6 months, and 2 and 4 years and incident diabetes diagnoses recorded. RESULTS Median follow-up was 4.3 years. In those with preexisting diabetes (n = 274), there was no significant difference between the CPAP and usual care groups in serum glucose, HbA1c, or antidiabetic medications during follow-up. There were also no significant between-group differences in participants with prediabetes (n = 452) or new diagnoses of diabetes. Interaction testing suggested that women with diabetes did poorly in the usual care group, while their counterparts on CPAP therapy remained stable. CONCLUSIONS Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affects glycemic control in those with diabetes or prediabetes or diabetes risk over standard-of-care treatment. The potential differential effect according to sex deserves further investigation.
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Affiliation(s)
- Kelly A Loffler
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Emma Heeley
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ruth Freed
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rosie Meng
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Lia R Bittencourt
- Instituto do Sono, Associação Fundo de Incentivo a Pesquisa, São Paulo, Brazil
| | | | - Rui Chen
- The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | | | | | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Instituto do Coração, University of São Paulo, São Paulo, Brazil
| | - Yuanming Luo
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, Guangdong, China
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Hooi Shan Yap
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Xilong Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lyle J Palmer
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health China at Peking University Health Science Center, Beijing, China
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia .,Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
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300
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Trotti LM. Treat the Symptom, Not the Cause? Pitolisant for Sleepiness in Obstructive Sleep Apnea. Am J Respir Crit Care Med 2020; 201:1033-1035. [PMID: 31990205 PMCID: PMC7193852 DOI: 10.1164/rccm.202001-0104ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Lynn Marie Trotti
- Department of Neurology and Emory Sleep CenterEmory University School of MedicineAtlanta, Georgia
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