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Fujita Y, Yamauchi M, Muro S. Assessment and management of continuous positive airway pressure therapy in patient with obstructive sleep apnea. Respir Investig 2024; 62:645-650. [PMID: 38759606 DOI: 10.1016/j.resinv.2024.05.004] [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: 12/27/2023] [Revised: 04/18/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024]
Abstract
Obstructive sleep apnea (OSA) causes excessive daytime sleepiness, impaired daytime functioning, and an increased risk of cardiovascular diseases. Continuous positive airway pressure (CPAP) is a highly effective therapy for moderate to severe OSA. Although CPAP adherence is commonly assessed using a 4-hthreshold, determining the optimal usage time based on clinical outcomes is crucial. While subjective sleepiness often improves with ≥4 h of CPAP usage, an extended duration (≥6 h) may be necessary to impact objective sleepiness. CPAP demonstrated a modest yet clinically meaningful dose-dependent effect on lowering blood pressure. For patients seeking antihypertensive benefits from CPAP therapy, the goal should extend beyond 4 h of use to maximize the therapeutic impact. Recognizing individual variations in sleep duration and responses to CPAP therapy is essential. The adoption of 'individualized goals for CPAP use,' outlining target times for specific outcomes, should also consider an individual's total sleep duration, including periods without CPAP. The impact of CPAP on clinical outcomes may vary, even with the same duration of CPAP use, depending on the period without CPAP use, particularly during the first or second half of sleep. Patients who remove or initiate CPAP midway or have a low CPAP usage frequency may require different forms of guidance. Tailoring patient education to address CPAP usage patterns may be necessary to enhanced satisfaction, self-efficacy, and adherence to therapy. Management of CPAP treatment should be personalized to meet individual needs and adapted based on specific response patterns for achieving treatment efficacy.
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Affiliation(s)
- Yukio Fujita
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan; Department of Clinical Pathophysiology of Nursing, Nara Medical University, Kashihara, Nara, 634-8522, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Jaspan VN, Greenberg GS, Parihar S, Park CM, Somers VK, Shapiro MD, Lavie CJ, Virani SS, Slipczuk L. The Role of Sleep in Cardiovascular Disease. Curr Atheroscler Rep 2024; 26:249-262. [PMID: 38795275 PMCID: PMC11192677 DOI: 10.1007/s11883-024-01207-5] [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] [Accepted: 05/01/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE OF REVIEW Sleep is an important component of cardiovascular (CV) health. This review summarizes the complex relationship between sleep and CV disease (CVD). Additionally, we describe the data supporting the treatment of sleep disturbances in preventing and treating CVD. RECENT FINDINGS Recent guidelines recommend screening for obstructive sleep apnea in patients with atrial fibrillation. New data continues to demonstrate the importance of sleep quality and duration for CV health. There is a complex bidirectional relationship between sleep health and CVD. Sleep disturbances have systemic effects that contribute to the development of CVD, including hypertension, coronary artery disease, heart failure, and arrhythmias. Additionally, CVD contributes to the development of sleep disturbances. However, more data are needed to support the role of screening for and treatment of sleep disorders for the prevention of CVD.
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Affiliation(s)
- Vita N Jaspan
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Garred S Greenberg
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Siddhant Parihar
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christine M Park
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael D Shapiro
- Center for Preventive Cardiology, Section On Cardiovascular Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Carl J Lavie
- Ochsner Clinical School, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Salim S Virani
- Office of the Vice Provost (Research), The Aga Khan University, Karachi, Pakistan
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA.
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Xiao Y, Li PJ, Guo MY, Cao Y, Liang ZA. Effect of obstructive sleep apnea on postoperative delirium: a system review and meta-analysis. Sleep Breath 2024:10.1007/s11325-024-03073-6. [PMID: 38861133 DOI: 10.1007/s11325-024-03073-6] [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: 01/12/2024] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE To investigate the impact of obstructive sleep apnea (OSA) on postoperative delirium (PD), and evaluate the effectiveness of positive airway pressure (PAP) therapy on PD among OSA patients. METHODS We systematically searched Embase, Cochrane Library and PubMed databases from their establishment to November 27, 2022. A random-effects approach was employed to determine aggregated results. Subgroup and sensitivity analyses were carried out to investigate heterogeneity. RESULTS Sixteen eligible studies were included in the analysis. Thirteen studies revealed that OSA significantly elevated the likelihood of developing PD (OR = 1.71; 95%CI = 1.17 to 2.49; p = 0.005). Subgroup analysis according to delirium assessment scales showed that OSA did not exhibit an association with the incidence of PD assessed by the Confusion Assessment Method-Intensive Care Unit (OR = 1.14; 95%CI = 0.77 to 1.67; p = 0.51) but enhanced the likelihood of developing PD evaluated with other measurement scales (OR = 2.15; 95%CI = 1.44 to 3.19; p = 0.0002). Three additional studies explored the impact of PAP treatment on PD among OSA individuals, indicating no significant reduction in PD incidence with PAP use (OR = 0.58; 95%CI = 0.13 to 2.47; p = 0.46). CONCLUSIONS OSA may not be a risk factor for PD in critically ill patients in the intensive care unit, but may increase the likelihood of developing PD among individuals receiving regular care in the ward postoperatively. The efficacy of PAP therapy in decreasing PD incidence among OSA patients remains debatable.
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Affiliation(s)
- Yao Xiao
- West China School of Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, PR China
| | - Pei-Jun Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, PR China.
| | - Meng-Yao Guo
- West China School of Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, PR China
| | - Yuan Cao
- West China School of Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, PR China
| | - Zong-An Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, PR China
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4
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Rozycki H, Fauroux B. Virtues of PEEP in the PICU and beyond. Paediatr Respir Rev 2024; 49:1. [PMID: 38184480 DOI: 10.1016/j.prrv.2023.12.003] [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: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Henry Rozycki
- Division of Neonatal Medicine, Vice Chair for Research, Director, Child Health Research Institute, Children's Hospital of Richmond at VCU, United States.
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Necker Enfants Malades University Hospital, 149 rue de Sèvres, 75015 Paris, Paris Cité University, EA 7330 VIFASOM, Paris, France.
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Hnatiak J, Galkova LZ, Winnige P, Batalik L, Dosbaba F, Ludka O, Krejci J. Comprehensive home-based telerehabilitation in a morbidly obese male patient with severe obstructive sleep apnea. A case report. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:390-394. [PMID: 37313735 DOI: 10.5507/bp.2023.022] [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: 03/21/2023] [Accepted: 05/19/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Rehabilitation may be an effective additional treatment method in patients with obstructive sleep apnea (OSA). Physical exercise, weight reduction, pulmonary rehabilitation, and myofunctional therapy (MT) represent beneficial components of rehabilitation recommended as a possible adjunct to standard OSA treatment. METHODS AND RESULTS A 54-year-old man with morbid obesity, long-lasting snoring, breathing pauses, frequent waking, as well as persistent drowsiness and fatigue during the day underwent polysomnography (PSG) to investigate suspected OSA. Severe OSA was confirmed by PSG and a 12-week comprehensive, home-based telerehabilitation program (tele-RHB program) along with continuous positive airway pressure (CPAP) therapy was implemented. The tele-RHB program included regular teleconsultations, aerobic-endurance training, MT, inspiratory and expiratory muscle training, as well as recommendations on proper nutrition, a healthy lifestyle, and behavioral changes. Following the treatment, the patient's quality of life (QoL), exercise capacity, lung function, and OSA severity significantly improved. The patient achieved an overall 19.9 kg reduction in weight, of which 16.2 kg was body fat, and his apnea-hypopnea index decreased by 42.6 episodes/hour. CONCLUSION Our case report suggests that the comprehensive home-based tele-RHB program adjunct to CPAP therapy may be a novel approach for improving OSA severity, a patient's QoL, exercise capacity, lung function and body composition. It is important to note that such a program should be optional, however it may be needed to achieve the highest possible overall improvement in a patient's life. Further clinical investigations are needed to determine the therapeutic efficacy and clinical potential of this tele-RHB program.
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Affiliation(s)
- Jakub Hnatiak
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lujza Zikmund Galkova
- 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Cardiovascular Sleep Center, 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Winnige
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Ondrej Ludka
- Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno, Brno, Czech Republic
| | - Jan Krejci
- 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Wu CS, Chen DHK, Ko YC, Bai CH, Chen PY, Liu WT, Lin YC. The firstly visited department affects the acceptance of CPAP in patients with obstructive sleep apnea: a cohort study. J Otolaryngol Head Neck Surg 2023; 52:71. [PMID: 37898803 PMCID: PMC10613393 DOI: 10.1186/s40463-023-00676-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: 11/03/2022] [Accepted: 10/18/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) therapy is the first-line treatment for obstructive sleep apnea (OSA). However, the low acceptance rate of CPAP remains a challenging clinical issue. This study aimed to determine the factors that influence the acceptance rate of CPAP. METHODS This retrospective cohort study was conducted at the sleep center of Shuang-Ho Hospital. Initially, 1186 OSA patients who received CPAP therapy between December 2013 and December 2017 were selected, and finally, 1016 patients were analyzed. All patients with OSA received CPAP therapy for at least 1 week, and their acceptance to treatment was subsequently recorded. Outcome measures included patients' demographic and clinical characteristics (sex, age, BMI, comorbidities, history of smoking, and the medical specialist who prescribed CPAP treatment), polysomnography (PSG) results, and OSA surgical records. RESULTS Patients with a lower CPAP acceptance rate were referred from otolaryngologists (acceptance rate of otolaryngology vs. others: 49.6% vs. 56.6%, p = .015), in addition to having a lower apnea-hypopnea index (AHI) (acceptance vs. non-acceptance: 55.83 vs. 40.79, p = .003), rapid eye movement AHI (REM-AHI) (acceptance vs. non-acceptance: 51.21 vs. 44.92, p = .014), and arousal index (acceptance vs. non-acceptance: 36.80 vs. 28.75, p = .011). The multiple logistic regression model showed that patients referred from otolaryngology had a lower CPAP acceptance rate (odds ratio 0.707, p = .0216) even after adjusting for age, sex, BMI, AHI, REM-AHI, arousal index, comorbidities, and smoking status. CONCLUSIONS Before their initial consultation, patients may already have their preferred treatment of choice, which is strongly linked to the type of medical specialists they visit, and consequently, affects their rate of acceptance to CPAP therapy. Therefore, physicians should provide personalized care to patients by exploring and abiding by their preferred treatment choices.
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Affiliation(s)
- Chung-Sheng Wu
- Department of Primary Care Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - David Hsin-Kuang Chen
- Department of Medical Education, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yuan-Chun Ko
- Department of Primary Care Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Po-Yueh Chen
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Otolaryngology, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Te Liu
- Sleep Center, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yi-Chih Lin
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Sleep Center, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Department of Otolaryngology, Shuang-Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan.
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Jiang W, Li W, Cheng J, Li W, Cheng F. Efficacy and safety of liraglutide in patients with type 2 diabetes mellitus and severe obstructive sleep apnea. Sleep Breath 2023; 27:1687-1694. [PMID: 36542275 PMCID: PMC10539428 DOI: 10.1007/s11325-022-02768-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To observe the efficacy and side effects of liraglutide in the treatment of type 2 diabetes mellitus (T2DM) patients with severe obstructive sleep apnea (OSA). METHODS The study conducted in an outpatient setting was a two-center, prospective randomized controlled study. T2DM patients with severe OSA were randomized to the control group (continuous positive airway pressure [CPAP] and drug treatment without liraglutide) or the liraglutide group (CPAP and drug treatment including liraglutide). Demographic and clinical characteristics, sleep-disordered breathing indices, cardiac function indices, and side effects were evaluated and compared between the two groups before and after 3 months. RESULTS Of 90 patients, 45 were randomized to the intervention arm (with liraglutide) and 45 to the control arm (without liraglutide). One patient in the liraglutide group dropped out of the study on day 8 after enrollment due to obvious gastrointestinal symptoms. No significant differences were found between the two groups in baseline demographics, clinical characteristics, cardiac function indicators, or sleep disorder respiratory indices (P > 0.05). After 3 months, the body mass index (BMI), apnea hypopnea index (AHI), and mean systolic blood pressure in the liraglutide treatment group were significantly lower than those in the control group (P < 0.05). The minimum oxygen saturation was significantly higher in the liraglutide group compared with that in the control group after 3 months of follow-up (P < 0.05). No difference was found between the two groups in the summary of side effects (P > 0.05). CONCLUSIONS Liraglutide combined with CPAP can effectively reduce BMI, lower mean systolic blood pressure, and improve AHI scores and hypoxia in T2DM patients with severe OSA. Liraglutide did not increase side effects.
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Affiliation(s)
- Wenlong Jiang
- Department of Cardiovascular, Shenzhen Yantian District People's Hospital, Shenzhen, China
| | - Weiguo Li
- Department of Cardiovascular, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, Fujian, China
| | - Jing Cheng
- Department of Cardiovascular, Shenzhen Yantian District People's Hospital, Shenzhen, China
| | - Wen Li
- Department of Cardiovascular, Shenzhen Yantian District People's Hospital, Shenzhen, China
| | - Fangzhou Cheng
- Department of Cardiovascular, Shenzhen Yantian District People's Hospital, Shenzhen, China.
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Vanek J, Prasko J, Genzor S, Belohradova K, Visnovsky J, Mizera J, Bocek J, Sova M, Ociskova M. Cognitive Functions, Depressive and Anxiety Symptoms After One Year of CPAP Treatment in Obstructive Sleep Apnea. Psychol Res Behav Manag 2023; 16:2253-2266. [PMID: 37366480 PMCID: PMC10290842 DOI: 10.2147/prbm.s411465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Objective The study worked with depressive symptoms, anxiety score and cognitive functions in obstructive sleep apnea (OSA) patients treated with CPAP. Methods Eighty-one subjects with OSA and without psychiatric comorbidity were treated with CPAP for one year and completed the following scales and cognitive tests: Trail Making Test, Verbal Fluency Test, d2 Test, Beck Depression Inventory-II and Beck Anxiety Inventory. MINI ruled out psychiatric disorder. At the two months check-up, subjects were re-evaluated for depressive and anxiety symptoms, and after one year of CPAP treatment, subjects repeated cognitive tests and scales. Data about therapy adherence and effectiveness were obtained from the patient's CPAP machines. Results The study was completed by 59 CPAP adherent patients and eight non-adherent patients. CPAP therapy effectiveness was verified in all patients by decreasing the apnea-hypopnoea index below 5 and/or 10% of baseline values. The adherent patients significantly improved depressive and anxiety symptoms. There was also an improvement in overall performance in the attention test; however, performance in many individual items did not change. The adherent patients also improved verbal fluency and in the Part B of the Trail making test. The non-adherent group significantly increased the number of mistakes made in the d2 test; other results were non-significant. Conclusion According to our results, OSA patients' mood, anxiety and certain cognitive domains improved during the one-year therapy with CPAP. Trial Registration Number NCT03866161.
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Affiliation(s)
- Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry of Palacky University, Olomouc, the Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry of Palacky University, Olomouc, the Czech Republic
- Institute for Postgraduate Education in Health Care, Prague, The Czech Republic
- Department of Psychology Sciences, Faculty of Social Science and Health Care of Constantine the Philosopher University, Nitra, the Slovak Republic
- Jessenia Inc. - Rehabilitation Hospital, Akeso Holding, Beroun, the Czech Republic
| | - Samuel Genzor
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry of Palacky University, Olomouc, the Czech Republic
| | - Kamila Belohradova
- Department of Psychiatry, Faculty of Medicine and Dentistry of Palacky University, Olomouc, the Czech Republic
| | - Jozef Visnovsky
- Department of Psychiatry, Faculty of Medicine and Dentistry of Palacky University, Olomouc, the Czech Republic
| | - Jan Mizera
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry of Palacky University, Olomouc, the Czech Republic
| | - Jonas Bocek
- Department of Psychiatry, Faculty of Medicine and Dentistry of Palacky University, Olomouc, the Czech Republic
| | - Milan Sova
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry of Palacky University, Olomouc, the Czech Republic
- Department of Respiratory Medicine, University Hospital and Faculty of Medicine of Masaryk University, Brno, the Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry of Palacky University, Olomouc, the Czech Republic
- Jessenia Inc. - Rehabilitation Hospital, Akeso Holding, Beroun, the Czech Republic
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Van de Perck E, Kazemeini E, Van den Bossche K, Willemen M, Verbraecken J, Vanderveken OM, Op de Beeck S. The effect of CPAP on the upper airway and ventilatory flow in patients with obstructive sleep apnea. Respir Res 2023; 24:143. [PMID: 37259138 DOI: 10.1186/s12931-023-02452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/14/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is the mainstay of treatment for obstructive sleep apnea (OSA). However, data about its effect on the upper airway, especially the epiglottis, are scarce. The aim of this study was to investigate the changes in upper airway dimensions and inspiratory flow in response to incremental pressure levels. METHODS This is a secondary analysis of a prospective clinical trial in which patients with moderate to severe OSA underwent drug-induced sleep endoscopy with simultaneous recordings of flow and mask pressure. CPAP was titrated in small increments. For each pressure level a representative 3-breath segment was selected to determine specific flow features. The corresponding endoscopic footage was reviewed to assess the degree of upper airway collapse in a semi-quantitative manner. RESULTS A total of 214 breath segments were obtained from 13 participants (median [Q1-Q3]; apnea-hypopnea index, 24.9 [20.1-43.9] events/h; body mass index 28.1 [25.1-31.7] kg/m²). CPAP significantly increased cross-sectional dimensions of the soft palate, lateral walls and tongue base, but not of the epiglottis, and induced epiglottis collapse in one subject. Increased pressure improved peak inspiratory flow and median ventilation in all patients, even in the presence of persistent epiglottis collapse. CONCLUSION CPAP does not effectively address epiglottis collapse in patients with OSA. However, it normalizes inspiratory flow regardless of its effect on the epiglottis. This clinical trial was registered on January 18th, 2020 on ClinicalTrials.gov with identifier NCT04232410.
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Affiliation(s)
- Eli Van de Perck
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 - D.T.494, Wilrijk, Belgium.
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
| | - Elahe Kazemeini
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 - D.T.494, Wilrijk, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Karlien Van den Bossche
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 - D.T.494, Wilrijk, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc Willemen
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Johan Verbraecken
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 - D.T.494, Wilrijk, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
- Department of Pulmonology, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 - D.T.494, Wilrijk, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Sara Op de Beeck
- Faculty of Medicine and Health Sciences, Department of Translational Neurosciences, University of Antwerp, Universiteitsplein 1 - D.T.494, Wilrijk, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
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10
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Lahaye C, Miolanne M, Farigon N, Pereira B, Dubray C, Beudin P, Greil A, Boirie Y. Enhanced pain sensitivity in obese patients with obstructive sleep apnoea syndrome is partially reverted by treatment: An exploratory study. Eur J Pain 2023; 27:624-635. [PMID: 36734594 DOI: 10.1002/ejp.2085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Obesity is frequently associated with obstructive sleep apnoea syndrome (OSA) and chronic pain. OSA as well as continuous positive airway pressure (CPAP) treatment may modulate the pain perception threshold (PT) in patients with obesity. METHODS In this prospective, longitudinal study, all patients admitted for obesity assessment were screened for OSA by nocturnal polygraphy (SOMNOcheck® , IAH ≥10) and performed mechanical (Von Frey electronic device) and electrical (PainMatcher® ) pain tests. Those with severe OSA were retested for PT 1 month after initiation of CPAP therapy. Newly diagnosed patients with severe OSA (hypopnea apnoea index >30) have been offered to start CPAP treatment. RESULTS Among 85 patients, there were 27 OSA patients, aged between 40 ± 13.2 years with a BMI of 42 ± 7.2 kg/m2 . Severe OSA patients (N = 11) showed a lower PT than non-OSA patients (N = 58) during mechanical (177 ± 120 vs. 328 ± 136 g, p < 0.01) and electrical methods (7.4 ± 6.4 vs. 12.9 ± 6.7 stimulation duration steps; p = 0.03). In the severe OSA group (N = 7), an increased PT was observed 1 month after CPAP treatment during mechanical pain testing (298 ± 69 vs. 259 ± 68 g, p < 0.05), but not during electrical pain testing (11.5 ± 3.0 vs. 12.4 ± 3.8 stimulation duration steps, p = 0.50). CONCLUSION In patients with obesity, this exploratory study showed that the presence of an OSA is associated with a decreased PT, whereas implantation of a CPAP device tends to normalize pain perception.
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Affiliation(s)
- Clément Lahaye
- Service de gériatrie, CHU Clermont-Ferrand, Clermont-Ferrand, France.,INRAE, Unité de Nutrition Humaine, CRNH Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Magalie Miolanne
- Service de nutrition clinique, CSO CALORIS, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas Farigon
- Service de nutrition clinique, CSO CALORIS, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Délégation Recherche Clinique et Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Claude Dubray
- Centre de Pharmacologie Clinique, INSERM CIC 501, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Patricia Beudin
- Service d'exploration fonctionnelle du système nerveux, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Annick Greil
- Service de pneumologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Yves Boirie
- INRAE, Unité de Nutrition Humaine, CRNH Auvergne, Université Clermont Auvergne, Clermont-Ferrand, France.,Service de nutrition clinique, CSO CALORIS, CHU Clermont-Ferrand, Clermont-Ferrand, France
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11
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Hanif U, Kiaer EK, Capasso R, Liu SY, Mignot EJM, Sorensen HBD, Jennum P. Automatic scoring of drug-induced sleep endoscopy for obstructive sleep apnea using deep learning. Sleep Med 2023; 102:19-29. [PMID: 36587544 DOI: 10.1016/j.sleep.2022.12.015] [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: 09/22/2022] [Revised: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatment of obstructive sleep apnea is crucial for long term health and reduced economic burden. For those considered for surgery, drug-induced sleep endoscopy (DISE) is a method to characterize location and pattern of sleep-related upper airway collapse. According to the VOTE classification system, four upper airway sites of collapse are characterized: velum (V), oropharynx (O), tongue (T), and epiglottis (E). The degree of obstruction per site is classified as 0 (no obstruction), 1 (partial obstruction), or 2 (complete obstruction). Here we propose a deep learning approach for automatic scoring of VOTE obstruction degrees from DISE videos. METHODS We included 281 DISE videos with varying durations (6 s-16 min) from two sleep clinics: Copenhagen University Hospital and Stanford University Hospital. Examinations were split into 5-s clips, each receiving annotations of 0, 1, 2, or X (site not visible) for each site (V, O, T, and E), which was used to train a deep learning model. Predicted VOTE obstruction degrees per examination was obtained by taking the highest predicted degree per site across 5-s clips, which was evaluated against VOTE degrees annotated by surgeons. RESULTS Mean F1 score of 70% was obtained across all DISE examinations (V: 85%, O: 72%, T: 57%, E: 65%). For each site, sensitivity was highest for degree 2 and lowest for degree 0. No bias in performance was observed between videos from different clinicians/hospitals. CONCLUSIONS This study demonstrates that automating scoring of DISE examinations show high validity and feasibility in degree of upper airway collapse.
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Affiliation(s)
- Umaer Hanif
- Biomedical Signal Processing & AI Research Group, Department of Health Technology, Technical University of Denmark, Oersteds Plads 345B, 2800, Kongens Lyngby, Denmark; Stanford University Center for Sleep and Circadian Sciences, Stanford University, 3165 Porter Dr., CA, 94304, Palo Alto, USA; Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark.
| | - Eva Kirkegaard Kiaer
- Danish Center for Sleep Surgery, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital (Rigshospitalet), Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.
| | - Robson Capasso
- Department of Otolaryngology/Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA, 94304, USA.
| | - Stanley Y Liu
- Department of Otolaryngology/Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Road, Palo Alto, CA, 94304, USA.
| | - Emmanuel J M Mignot
- Stanford University Center for Sleep and Circadian Sciences, Stanford University, 3165 Porter Dr., CA, 94304, Palo Alto, USA.
| | - Helge B D Sorensen
- Biomedical Signal Processing & AI Research Group, Department of Health Technology, Technical University of Denmark, Oersteds Plads 345B, 2800, Kongens Lyngby, Denmark.
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark.
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12
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The long-term results of modified maxillomandibular advancement in Asian OSA patients. Am J Otolaryngol 2023; 44:103677. [DOI: 10.1016/j.amjoto.2022.103677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
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13
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Rapelli G, Pietrabissa G, Angeli L, Manzoni GM, Tovaglieri I, Perger E, Garbarino S, Fanari P, Lombardi C, Castelnuovo G. Study protocol of a randomized controlled trial of motivational interviewing-based intervention to improve adherence to continuous positive airway pressure in patients with obstructive sleep apnea syndrome: The MotivAir study. Front Psychol 2022; 13:947296. [PMID: 36092104 PMCID: PMC9456614 DOI: 10.3389/fpsyg.2022.947296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Objective This study aims to evaluate the effectiveness of the MotivAir program-a phone-based intervention based on Motivational Interviewing (MI) principles and techniques-in enhancing adherence to Continuous Positive Airway Pressure (CPAP) therapy among patients with Obstructive Sleep Apnea Syndrome (OSAS). Methods A multicenter randomized controlled trial (RCT) design with random allocation at the level of the individual will be conducted to compare the impact of the experimental program (usual care plus MI) with a control group receiving usual care only in improving selected clinical and psychological parameters in the patients. A minimum sample of 80 participants (40 patients per group) will be recruited in each center according to the inclusion criteria. After the initial screening, participants will be randomly assigned to either the experimental group or the control condition. The program will last 180 days and will be delivered by a trained nurse. The impact of the MotivAir program on selected primary (adherence to CPAP in terms of average hours of usage per night and the Apnea-Hypopnea Index, AHI) and secondary (motivation, perceived competence, quality of life, sleepiness) outcomes will be measured at baseline, and after 1-, 3-, and 6-month from CPAP initiation. Discussion Participants are expected to show an increased level of adherence to CPAP and to acquire the skills and self-confidence necessary to deal with the psychological consequences of their chronic condition.
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Affiliation(s)
- Giada Rapelli
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Licia Angeli
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Ilaria Tovaglieri
- Department of Pulmonary Rehabilitation, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Elisa Perger
- Department of Cardiovascular, Neural and Metabolic Sciences, Sleep Disorders Center, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences, University of Genoa, Genoa, Italy
| | - Paolo Fanari
- Department of Pulmonary Rehabilitation, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Carolina Lombardi
- Department of Cardiovascular, Neural and Metabolic Sciences, Sleep Disorders Center, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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14
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Investigation of the Effectiveness of Traditional Breathing Therapy on Pulmonary Function in College Students with Obstructive Sleep Apnea. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:1674973. [PMID: 35909585 PMCID: PMC9307394 DOI: 10.1155/2022/1674973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 11/21/2022]
Abstract
Background Obstructive sleep apnea (OSA) is a problem that involves many body systems, but its impact on the respiratory system deserves special attention. While there are many studies investigating the use of continuous positive airway pressure (CPAP) to treat lung function in patients with sleep apnea, the lack of studies in the literature on the effects of traditional breathing therapy on lung function in patients with OSA prompted us to conduct such a study. Objective The present randomized trial aims to assess the effect of traditional breathing therapy on daytime sleepiness and pulmonary function in college students with OSA. Methods Forty college students (male) with OSA were randomly divided into two groups: the control group (CG) and the traditional breathing therapy group (TG). Daytime sleepiness symptoms in OSA are measured primarily by the Epworth Sleepiness Scale (ESS). Pulmonary function measurements included FVC, FEV1, PEE, and MEF50%. The changes in morning blood pressure (BP), including diastolic BP and systolic BP, were also recorded. Data were recorded before and after the experiment. Results A decrease in ESS at 12 weeks after intervention had statistical significance compared with values recorded before intervention (P < 0.05). A decrease in systolic and diastolic BP at 12 weeks after intervention had statistical significance compared with values recorded before intervention (P < 0.05). Comparisons made in terms of pulmonary functions demonstrated a statistically significant increase in 12-week postintervention values of FVC, FEV1, PEF, and MEF50% (P < 0.05). Conclusion Our study shows the positive effects of traditional breathing therapy on pulmonary function parameters. This suggests that traditional breathing therapy treatment in OSA patients is as effective as CPAP on pulmonary function, while there is an improvement in daytime sleepiness and a modest decline in the mean daytime systolic and diastolic BP.
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15
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Post-Operative Patients’ Satisfaction and Quality of Life Assessment in Adult Patients with Obstructive Sleep Apnea Syndrome (OSAS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106273. [PMID: 35627810 PMCID: PMC9141812 DOI: 10.3390/ijerph19106273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 01/27/2023]
Abstract
Background: The treatment for severe OSAS includes maxillomandibular advancement surgical option in selected cases. The aim of this study was to evaluate the post-operative impact of bimaxillary surgery on satisfaction and consequently the quality of life of these patients. Methods: This study included 18 patients with severe OSAS who received maxillomandibular advancement surgery. Patients were divided into Group A (operated by CAD/CAM) and Group B (conventional surgery). The impact of bimaxillary surgery on satisfaction and quality of life of these patients was evaluated by utilizing post-operative life quality and Rustemeyer’s patient-satisfaction-based survey. Results: A total of 18 adult OSAS patients (Group A: 11 patients, Group B: 7 patients) with a mean age of 44.39 years (SD ± 9.43) were included. Mean follow-up period was 32.64 months (SD ± 21.91). No intra-operative complications were seen in any patients. Post-operative complication was seen in one patient and the mandible did not integrate. According to the results, overall post-operative satisfaction score was 79.72% (SD ± 9.96). There was no significant difference among those in Group A and Group B. Conclusion: Maxillomandibular advancement surgery seems to be beneficial in terms of patients’ satisfaction in severe adult OSAS patients and can be considered as a valuable option in selected cases.
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16
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Berlin and Epworth Surveys to Predict Obstructive Sleep Apnea for Adults on Biomimetic Oral Appliance Therapy: A Nonrandomized Clinical Trial. Int J Dent 2022; 2022:5283406. [PMID: 35572355 PMCID: PMC9106488 DOI: 10.1155/2022/5283406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Two questionnaires (Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS)) are the widely used screening instruments for subjects suffering from sleep disorders. Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing. The biomimetic oral appliance therapy (BOAT) offers an alternative nonsurgical method, which can improve symptoms and indices of OSA on objective sleep testing. Aim To describe testing the ability of BQ and EES for prediction of BOAT outcomes during OSA. Methods Seventeen adults (9 males, 8 females; age, mean (SD): 45.76 (10.31), BMI mean (SD): 33.5(13.43)) who underwent an overnight sleep study were diagnosed by a sleep specialist physician. The BQ and EES were recorded before and after BOAT treatment. Subjects with mild-to-moderate OSA had 2 months of follow-up visits and underwent a final overnight sleep study to measure apnea-hypopnea index (AHI). The subjects were asked to wear the appliance for 10–12 hours/day and at night. Findings were analyzed statistically using paired t-tests. Result As per sleep test results, pre-BOAT AHI measures versus post-BOAT AHI measures showed significant improvement. Comparing the BQ before versus after treatment showed that at the pretreatment stage, 66.0% of patients had high-risk score, whereas 34% had low-risk score. After treatment, 66.0% of patient had low-risk scores, whereas 34% had high-risk scores. As for the ESS, treatment resulted in significant reduction of total score from 10.43 ± 6.32 to 5.00 ± 5.20 (P < 0.01, paired t-test). Finally, there was a mild negative correlation between AHI and each of the BQ and ESS scores that was not statistically significant (r = −0.420, N = 26, P > 0.05, and r = −0.41, N = 26, P > 0.05, respectively). Conclusion The BOAT device may provide a useful form of therapy to improve OSA-related PSG parameters such as AHI. Both BQ and ESS were predictive to improvements detected by the sleep study during BOAT device use.
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17
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Hamilton MJ, Atalaia A, McLean J, Cumming SA, Evans JJ, Ballantyne B, Jampana R, The Scottish Myotonic Dystrophy Consortium, Longman C, Livingston E, van der Plas E, Koscik T, Nopoulos P, Farrugia ME, Monckton DG. Clinical and neuroradiological correlates of sleep in myotonic dystrophy type 1. Neuromuscul Disord 2022; 32:377-389. [PMID: 35361525 DOI: 10.1016/j.nmd.2022.02.003] [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: 09/11/2021] [Revised: 01/15/2022] [Accepted: 02/09/2022] [Indexed: 10/19/2022]
Abstract
Abnormalities of sleep are common in myotonic dystrophy type 1 (DM1), but few previous studies have combined polysomnography with detailed clinical measures and brain imaging. In the present study, domiciliary polysomnography, symptom questionnaires and cognitive evaluation were undertaken in 39 DM1-affected individuals. Structural brain MRI was completed in those without contra-indication (n = 32). Polysomnograms were adequate for analysis in 36 participants. Sleep efficiency was reduced, and sleep architecture altered in keeping with previous studies. Twenty participants (56%) had moderate or severe sleep-disordered breathing (apnoea-hypopnoea index [AHI] ≥ 15). In linear modelling, apnoeas were positively associated with increasing age and male sex. AHI ≥ 15 was further associated with greater daytime pCO2 and self-reported physical impairment, somnolence and fatigue. Percentage REM sleep was inversely associated with cerebral grey matter volume, stage 1 sleep was positively associated with occipital lobe volume and stage 2 sleep with amygdala volume. Hippocampus volume was positively correlated with self-reported fatigue and somnolence. Linear relationships were also observed between measures of sleep architecture and cognitive performance. Findings broadly support the hypothesis that changes in sleep architecture and excessive somnolence in DM1 reflect the primary disease process in the central nervous system.
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Affiliation(s)
- Mark J Hamilton
- West of Scotland Clinical Genetics Service, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK; Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Antonio Atalaia
- Sorbonne Université, Inserm, Center of Research in Myology, UMRS 974, Institut de Myologie, G.H . Pitié-Salpêtrière, Paris, France
| | - John McLean
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Sarah A Cumming
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Jonathan J Evans
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK G12 0XH
| | - Bob Ballantyne
- West of Scotland Clinical Genetics Service, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Ravi Jampana
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | | | - Cheryl Longman
- West of Scotland Clinical Genetics Service, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Eric Livingston
- Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Timothy Koscik
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Peggy Nopoulos
- Department of Psychiatry, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Maria Elena Farrugia
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Darren G Monckton
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
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18
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Venema JAMU, Vries GEKD, van Goor H, Westra J, Hoekema A, Wijkstra PJ. Cardiovascular and metabolic effects of a mandibular advancement device and continuous positive airway pressure in moderate obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med 2022; 18:1547-1555. [PMID: 35088708 DOI: 10.5664/jcsm.9908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES It has been suggested that treatment for obstructive sleep apnea (OSA) reduces cardiovascular risk. So far, knowledge is limited about the difference in the reduction of this risk between mandibular advancement device (MAD) and continuous positive airway pressure (CPAP) therapy. The aim of this study was to compare the cardiovascular effects of MAD versus CPAP therapy in patients with moderate OSA. METHODS Patients with an apnea-hypopnea index (AHI) of 15-30 events/h were randomized to either MAD or CPAP therapy. At baseline and after 12-months follow-up, 24-hour ambulant blood pressure measurements (ABPM) and laboratory measurements were performed. ABPM consisted of 24-hour, daytime and night-time systolic (SBP) and diastolic blood pressure (DBP), and heart rate (HR) measurements. Laboratory measurements consisted of serum lipid values, creatinine, high-sensitivity c-reactive protein, plasma glucose, hemoglobin A1c (HbA1c), proinflammatory cytokines, soluble receptor for advanced glycation end products (sRAGE), chemokines and adhesion molecules. RESULTS Of the 85 randomized patients with moderate OSA, data were available for 54 patients (n=24 MAD, n=30 CPAP) at 12-month follow-up and showed that AHI significantly decreased with either therapy. In the MAD group, sRAGE and HbA1c were significantly higher after 12 months follow-up compared to baseline. No significant changes were found between MAD and CPAP treatment for all outcomes. CONCLUSIONS Treatment of patients with moderate OSA with either MAD or CPAP therapy had no profound effects on major cardiovascular risk factors after 12-months. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: MRA Therapy Versus CPAP Therapy in Moderate OSAS; Identifier: NCT01588275; URL: https://clinicaltrials.gov/ct2/show/NCT01588275.
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Affiliation(s)
- Julia A M Uniken Venema
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre, location Academic Medical Center (AMC), and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Grietje E Knol-de Vries
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, the Netherlands
| | - Johanna Westra
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands
| | - Aarnoud Hoekema
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre, location Academic Medical Center (AMC), and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, Tjongerschans Hospital, Heerenveen, The Netherlands
| | - Peter J Wijkstra
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Center for Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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19
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Major Abdominal Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00033-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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20
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Akashiba T, Inoue Y, Uchimura N, Ohi M, Kasai T, Kawana F, Sakurai S, Takegami M, Tachikawa R, Tanigawa T, Chiba S, Chin K, Tsuiki S, Tonogi M, Nakamura H, Nakayama T, Narui K, Yagi T, Yamauchi M, Yamashiro Y, Yoshida M, Oga T, Tomita Y, Hamada S, Murase K, Mori H, Wada H, Uchiyama M, Ogawa H, Sato K, Nakata S, Mishima K, Momomura SI. Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020. Sleep Biol Rhythms 2022; 20:5-37. [PMID: 38469064 PMCID: PMC10900032 DOI: 10.1007/s41105-021-00353-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 12/17/2022]
Abstract
The prevalence of sleep-disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the "Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults" was published in 2005, a new guideline was prepared to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the "Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension" Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Since sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.
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Affiliation(s)
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Motoharu Ohi
- Sleep Medical Center, Osaka Kaisei Hospital, Osaka, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fusae Kawana
- Department of Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeru Sakurai
- Division of Behavioral Sleep Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shintaro Chiba
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Kazuo Chin
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine, Nihon University of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610 Japan
- Department of Human Disease Genomics, Center for Genomic Medicine, Graduate School Medicine, Kyoto University, Kyoto, Japan
| | | | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | | | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Koji Narui
- Sleep Center, Toranomon Hospital, Tokyo, Japan
| | - Tomoko Yagi
- Ota Memorial Sleep Center, Ota General Hospital, Kanagawa, Japan
| | - Motoo Yamauchi
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | | | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasuhiro Tomita
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Mori
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroo Wada
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Makoto Uchiyama
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromasa Ogawa
- Department of Occupational Health, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazumichi Sato
- Department of Dental and Oral Surgery, International University of Health and Welfare, Chiba, Japan
| | - Seiichi Nakata
- Department of Otorhinolaryngology, Second Hospital, Fujita Health University School of Medicine, Aichi, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Tovichien P, Kulbun A, Udomittipong K. Comparing Adherence of Continuous and Automatic Positive Airway Pressure (CPAP and APAP) in Obstructive Sleep Apnea (OSA) Children. Front Pediatr 2022; 10:841705. [PMID: 35223704 PMCID: PMC8873574 DOI: 10.3389/fped.2022.841705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The treatment outcomes of pediatric obstructive sleep apnea (OSA) are affected by positive airway pressure (PAP) therapy adherence, which may be affected by the type of device used. Continuous PAP (CPAP) devices deliver a continuous and fixed air pressure level, whereas automatic PAP (APAP) devices automatically adjust the pressure to meet changing needs during sleep. The adherence, tolerance and consistency of OSA-children's use of CPAP and APAP devices were compared. STUDY DESIGN One-year, observational cohort study. METHODS Twenty-seven OSA-children were enrolled. Fourteen (52%) used CPAP, and 13 (48%) used APAP. The adherence, tolerance, and consistency of the PAP usage by the two groups were compared. RESULTS Overall, 11 of the 27 children (41%) showed good PAP adherence. The CPAP patients averaged 4.9 h of device usage on the days used, for 60% of days, with 6 of 14 (43%) demonstrating good adherence. In comparison, the APAP patients averaged 3.2 h for 55% of days, with 5 of 13 (38%) exhibiting good adherence. The 2 groups showed no differences in their adherence, tolerance, or consistency of device usage (P values, 0.816, 0.609, and 0.720, respectively). Although the adherence of both groups improved in the second 6 months, it was without statistical significance (P values, 0.400 and 0.724). Age, sex, baseline apnea-hypopnea index, comorbidities, prescribed period, device type, mask type, and caregiver education-level were not risk factors for poor PAP adherence. CONCLUSIONS No differences in the adherence, tolerance, or consistency of the children's use of CPAP and APAP were revealed in this small inhomogeneous cohort study with limited resources.
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Affiliation(s)
- Prakarn Tovichien
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Aunya Kulbun
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokporn Udomittipong
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Bindi I, Ori M, Marchegiani M, Morreale M, Gallucci L, Ricci G. Diagnosis of upper airways collapse in moderate-to-severe OSAHS patients: a comparison between drug-induced sleep endoscopy and the awake examination. Eur Arch Otorhinolaryngol 2021; 279:2167-2173. [PMID: 34839405 DOI: 10.1007/s00405-021-07184-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Compare awake evaluation (modified Mallampati score-MMs, Müller maneuver-MM) to drug-induced sleep endoscopy (DISE) findings according to NOHL (nose-oropharynx-hypopharynx-larynx) classification in moderate-to-severe OSAHS patients. METHODS 43 moderate-to-severe OSAHS patients referred to our ENT department were enrolled over a 2-year period. In this observational prospective study, each patient was evaluated by the same ENT team both in wakefulness and during pharmacologically induced sleep. Level and severity of the obstruction were described. RESULTS The comparison of degree of collapsibility was statistically significative only at hypopharyngeal level: 41.8% of the patients showed a hypopharyngeal obstruction in wakefulness whereas 88.3% in DISE (p = 0.000). Laryngeal level was found in 18.6% patients during awake examination, conversely DISE demonstrated laryngeal obstruction in 4.6%. DISE identified significantly higher incidence of multilevel collapses (p = 0.001). However, the incidence of oropharyngeal obstruction in patients classified as MMs I and II was significantly higher in DISE compared to MM (p = 0.021). CONCLUSION DISE is the best predictor of hypopharyngeal obstruction, whereas MM underestimates the severity of the collapse at this level. DISE is more reliable than MM to identify the obstruction in patients with MMs score I and II.
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Affiliation(s)
- Ilaria Bindi
- Department of Otorhinolaryngology, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
| | - Michele Ori
- Otolaryngology Department, University of Perugia, Sant'Andrea delle Fratte, 06129, Perugia, Italy
| | - Mauro Marchegiani
- Otolaryngology Department, University of Perugia, Sant'Andrea delle Fratte, 06129, Perugia, Italy
| | - Maddalena Morreale
- Otolaryngology Department, University of Perugia, Sant'Andrea delle Fratte, 06129, Perugia, Italy
| | - Luigi Gallucci
- Otolaryngology Department, University of Perugia, Sant'Andrea delle Fratte, 06129, Perugia, Italy
| | - Giampietro Ricci
- Otolaryngology Department, University of Perugia, Sant'Andrea delle Fratte, 06129, Perugia, Italy
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Burton JK, Craig L, Yong SQ, Siddiqi N, Teale EA, Woodhouse R, Barugh AJ, Shepherd AM, Brunton A, Freeman SC, Sutton AJ, Quinn TJ. Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev 2021; 11:CD013307. [PMID: 34826144 PMCID: PMC8623130 DOI: 10.1002/14651858.cd013307.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Delirium is an acute neuropsychological disorder that is common in hospitalised patients. It can be distressing to patients and carers and it is associated with serious adverse outcomes. Treatment options for established delirium are limited and so prevention of delirium is desirable. Non-pharmacological interventions are thought to be important in delirium prevention. OBJECTIVES: To assess the effectiveness of non-pharmacological interventions designed to prevent delirium in hospitalised patients outside intensive care units (ICU). SEARCH METHODS We searched ALOIS, the specialised register of the Cochrane Dementia and Cognitive Improvement Group, with additional searches conducted in MEDLINE, Embase, PsycINFO, CINAHL, LILACS, Web of Science Core Collection, ClinicalTrials.gov and the World Health Organization Portal/ICTRP to 16 September 2020. There were no language or date restrictions applied to the electronic searches, and no methodological filters were used to restrict the search. SELECTION CRITERIA We included randomised controlled trials (RCTs) of single and multicomponent non-pharmacological interventions for preventing delirium in hospitalised adults cared for outside intensive care or high dependency settings. We only included non-pharmacological interventions which were designed and implemented to prevent delirium. DATA COLLECTION AND ANALYSIS: Two review authors independently examined titles and abstracts identified by the search for eligibility and extracted data from full-text articles. Any disagreements on eligibility and inclusion were resolved by consensus. We used standard Cochrane methodological procedures. The primary outcomes were: incidence of delirium; inpatient and later mortality; and new diagnosis of dementia. We included secondary and adverse outcomes as pre-specified in the review protocol. We used risk ratios (RRs) as measures of treatment effect for dichotomous outcomes and between-group mean differences for continuous outcomes. The certainty of the evidence was assessed using GRADE. A complementary exploratory analysis was undertaker using a Bayesian component network meta-analysis fixed-effect model to evaluate the comparative effectiveness of the individual components of multicomponent interventions and describe which components were most strongly associated with reducing the incidence of delirium. MAIN RESULTS We included 22 RCTs that recruited a total of 5718 adult participants. Fourteen trials compared a multicomponent delirium prevention intervention with usual care. Two trials compared liberal and restrictive blood transfusion thresholds. The remaining six trials each investigated a different non-pharmacological intervention. Incidence of delirium was reported in all studies. Using the Cochrane risk of bias tool, we identified risks of bias in all included trials. All were at high risk of performance bias as participants and personnel were not blinded to the interventions. Nine trials were at high risk of detection bias due to lack of blinding of outcome assessors and three more were at unclear risk in this domain. Pooled data showed that multi-component non-pharmacological interventions probably reduce the incidence of delirium compared to usual care (10.5% incidence in the intervention group, compared to 18.4% in the control group, risk ratio (RR) 0.57, 95% confidence interval (CI) 0.46 to 0.71, I2 = 39%; 14 studies; 3693 participants; moderate-certainty evidence, downgraded due to risk of bias). There may be little or no effect of multicomponent interventions on inpatient mortality compared to usual care (5.2% in the intervention group, compared to 4.5% in the control group, RR 1.17, 95% CI 0.79 to 1.74, I2 = 15%; 10 studies; 2640 participants; low-certainty evidence downgraded due to inconsistency and imprecision). No studies of multicomponent interventions reported data on new diagnoses of dementia. Multicomponent interventions may result in a small reduction of around a day in the duration of a delirium episode (mean difference (MD) -0.93, 95% CI -2.01 to 0.14 days, I2 = 65%; 351 participants; low-certainty evidence downgraded due to risk of bias and imprecision). The evidence is very uncertain about the effect of multicomponent interventions on delirium severity (standardised mean difference (SMD) -0.49, 95% CI -1.13 to 0.14, I2=64%; 147 participants; very low-certainty evidence downgraded due to risk of bias and serious imprecision). Multicomponent interventions may result in a reduction in hospital length of stay compared to usual care (MD -1.30 days, 95% CI -2.56 to -0.04 days, I2=91%; 3351 participants; low-certainty evidence downgraded due to risk of bias and inconsistency), but little to no difference in new care home admission at the time of hospital discharge (RR 0.77, 95% CI 0.55 to 1.07; 536 participants; low-certainty evidence downgraded due to risk of bias and imprecision). Reporting of other adverse outcomes was limited. Our exploratory component network meta-analysis found that re-orientation (including use of familiar objects), cognitive stimulation and sleep hygiene were associated with reduced risk of incident delirium. Attention to nutrition and hydration, oxygenation, medication review, assessment of mood and bowel and bladder care were probably associated with a reduction in incident delirium but estimates included the possibility of no benefit or harm. Reducing sensory deprivation, identification of infection, mobilisation and pain control all had summary estimates that suggested potential increases in delirium incidence, but the uncertainty in the estimates was substantial. Evidence from two trials suggests that use of a liberal transfusion threshold over a restrictive transfusion threshold probably results in little to no difference in incident delirium (RR 0.92, 95% CI 0.62 to 1.36; I2 = 9%; 294 participants; moderate-certainty evidence downgraded due to risk of bias). Six other interventions were examined, but evidence for each was limited to single studies and we identified no evidence of delirium prevention. AUTHORS' CONCLUSIONS: There is moderate-certainty evidence regarding the benefit of multicomponent non-pharmacological interventions for the prevention of delirium in hospitalised adults, estimated to reduce incidence by 43% compared to usual care. We found no evidence of an effect on mortality. There is emerging evidence that these interventions may reduce hospital length of stay, with a trend towards reduced delirium duration, although the effect on delirium severity remains uncertain. Further research should focus on implementation and detailed analysis of the components of the interventions to support more effective, tailored practice recommendations.
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Affiliation(s)
- Jennifer K Burton
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Louise Craig
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Shun Qi Yong
- MVLS, College of Medicine and Veterinary Life Sciences, University of Glasgow, Glasgow, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Elizabeth A Teale
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
| | - Rebecca Woodhouse
- Department of Health Sciences, Hull York Medical School, University of York, York, UK
| | - Amanda J Barugh
- Department of Geriatric Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | - Suzanne C Freeman
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Imayama I, Balserak BI, Gupta A, Munoz T, Srimoragot M, Keenan BT, Kuna ST, Prasad B. Racial Differences in Functional and Sleep Outcomes with Positive Airway Pressure Treatment. Diagnostics (Basel) 2021; 11:diagnostics11122176. [PMID: 34943413 PMCID: PMC8700434 DOI: 10.3390/diagnostics11122176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022] Open
Abstract
It is unclear if the response to positive airway pressure (PAP) treatment is different between African American (AA) and European Americans (EA). We examined whether race modifies the effects of PAP on sleep and daytime function. We assessed Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire, Psychomotor Vigilance Task and actigraphy in 185 participants with moderate-to-severe obstructive sleep apnea before and 3–4 months after PAP treatment. The participants were middle-aged (mean, 55.1 years), 83.8% men and 60.5% AA. Linear regression models were used to examine the effect of race on outcomes. The AA had smaller reductions in ESS (mean change (95% confidence interval, CI) AA, −2.30 [−3.35, −1.25] vs. EA, −4.16 [−5.48, −2.84] and frequency of awakenings (AA, −0.73 [−4.92, 3.47] vs. EA, −9.35 [−15.20, −3.51]). A race × PAP usage interaction term was added to the model to examine if the change in outcomes per 1 h increase in PAP usage differed by race. AA exhibited greater improvement in wake after sleep onset (β (95% CI) AA, −8.89 [−16.40, −1.37] vs. EA, 2.49 [−4.15, 9.12]) and frequency of awakening (β (95% CI) AA, −2.59 [−4.44, −0.75] vs. EA, 1.71 [−1.08, 4.50]). The results indicate the importance of race in evaluating outcomes following PAP treatment.
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Affiliation(s)
- Ikuyo Imayama
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL 60612, USA
| | - Bilgay Izci Balserak
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Ahana Gupta
- Honors College, University of Illinois at Chicago, Chicago, IL 60607, USA;
| | - Tomas Munoz
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | | | - Brendan T. Keenan
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.T.K.); (S.T.K.)
| | - Samuel T. Kuna
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.T.K.); (S.T.K.)
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - Bharati Prasad
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL 60612, USA
- Correspondence: ; Tel.: +1-312-996-8433
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25
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Laaka A, Hollmén M, Bachour A. Evaluation of CPAP mask performance during 3 years of mask usage: time for reconsideration of renewal policies? BMJ Open Respir Res 2021; 8:8/1/e001104. [PMID: 34799354 PMCID: PMC8606764 DOI: 10.1136/bmjresp-2021-001104] [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: 09/11/2021] [Accepted: 11/02/2021] [Indexed: 11/22/2022] Open
Abstract
Background Continuous positive airway pressure (CPAP) mask renewal policies vary inside and between countries. There are no independent studies on the optimal mask renewal frequency. We aimed to evaluate CPAP mask function over time in a real-life clinical setting, and to compare the results against current renewal policies. Methods Daily performance data of 1846 CPAP masks (65% nasal, 22% nasal pillows, 12% oronasal) were recorded from 450 participants (68% male, mean age 59 years) with obstructive sleep apnoea. The unintentional leak, Apnoea-Hypopnoea Index (CPAP-AHI) and usage data were exported from the CPAP device. Results Of 656 324 nights of CPAP usage, the mean renewal time was 497 days (SD 327), mean leak 5.7 L/min (SD 8.1) and CPAP-AHI 3.8 events/h (SD 3.6). The difference in mean leak between one (5.2 L/min, SD 7.5), 12 (6.0 L/min, SD 10.2) and 24 months (5.8 L/min, SD 7.5) was minimal (p=0.59). Mean CPAP-AHI remained normal and unchanged in nasal masks and pillows up to 30 months, and was highest in oronasal masks. Different mask manufacturers performed similarly. Masks’ daily or total usage did not affect the results. Shifting the mask renewal policy to 24 months could reduce the mask-related cost up to 50%–88%. Conclusions Nasal masks and pillows could be used at least 2 years without significant changes in unintentional leak and CPAP-AHI. We suggest updating the mask renewal policies of nasal masks and pillows; results on oronasal masks and other manufacturers CPAP devices need further verification.
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Affiliation(s)
- Atte Laaka
- Sleep Unit, Helsinki University Hospital Heart and Lung Center, Helsinki, Finland
| | - Maria Hollmén
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Sleep Unit, Helsinki University Hospital Heart and Lung Center, Helsinki, Finland
| | - Adel Bachour
- Sleep Unit, Helsinki University Hospital Heart and Lung Center, Helsinki, Finland
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26
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[Chronic obstructive pulmonary disease, sleep-disordered breathing and hypoventilation-Influence on the cardiorenal system]. Internist (Berl) 2021; 62:1166-1173. [PMID: 34623471 DOI: 10.1007/s00108-021-01169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Comorbidities are frequently observed in patients suffering from pulmonary diseases due to shared risk factors and intricate interactions between various organ systems. This article aims to characterize the effects of selected diseases of the respiratory system on the cardiovascular system and kidneys. Advanced chronic obstructive pulmonary disease (COPD) often leads to a prognostically unfavorable increased pressure in the pulmonary circulation. In this respect treatment of these patients is primarily aimed at the underlying pulmonary disease and targeted treatment of the pulmonary hypertension should only be carried out according to invasive diagnostics and in an individualized manner. So far, the fact that there is a substantial overlap between COPD and heart failure with preserved ejection fraction has been completely ignored, which should be considered in the diagnostic procedure. Obstructive sleep apnea (OSA) has several unfavorable effects on the cardiovascular system and has been identified as an independent risk factor for cardiovascular diseases. The established treatment of OSA with continuous positive airway pressure (CPAP) has been shown to improve daytime sleepiness and the quality of life; however, an effect of CPAP on the occurrence of cardiovascular events, especially in asymptomatic patients, has so far not been demonstrated in randomized trials. Peripheral edema is frequently observed in patients suffering from chronic hypercapnia, which can be explained by several pathophysiological mechanisms, including pulmonary vasoconstriction and a direct effect of the hypercapnia on renal blood flow. Apart from the administration of diuretics, recompensation of such patients always requires treatment of the hypercapnia by noninvasive ventilation.
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Maghsoudipour M, Nokes B, Bosompra NO, Jen R, Li Y, Moore S, DeYoung PN, Fine J, Edwards BA, Gilbertson D, Owens R, Morgan T, Malhotra A. A Pilot Randomized Controlled Trial of Effect of Genioglossus Muscle Strengthening on Obstructive Sleep Apnea Outcomes. J Clin Med 2021; 10:jcm10194554. [PMID: 34640575 PMCID: PMC8509668 DOI: 10.3390/jcm10194554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022] Open
Abstract
The genioglossus is a major upper airway dilator muscle. Our goal was to assess the efficacy of upper airway muscle training on Obstructive Sleep Apnea (OSA) as an adjunct treatment. Sixty-eight participants with OSA (AHI > 10/h) were recruited from our clinic. They fall into the following categories: (a) Treated with Automatic Positive Airway Pressure (APAP), (n = 21), (b) Previously failed APAP therapy (Untreated), (n = 25), (c) Treated with Mandibular Advancement Splint (MAS), (n = 22). All subjects were given a custom-made tongue strengthening device. We conducted a prospective, randomized, controlled study examining the effect of upper airway muscle training. In each subgroup, subjects were randomized to muscle training (volitional protrusion against resistance) or sham group (negligible resistance), with a 1:1 ratio over 3 months of treatment. In the baseline and the final visit, subjects completed home sleep apnea testing, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), SF-36 (36-Item Short Form Survey), and Psychomotor Vigilance Test (PVT). Intervention (muscle training) did not affect the AHI (Apnea-Hypopnea Index), (p-values > 0.05). Based on PSQI, ESS, SF-36 scores, and PVT parameters, the changes between the intervention and sham groups were not significant, and the changes were not associated with the type of treatment (p-value > 0.05). The effectiveness of upper airway muscle training exercise as an adjunct treatment requires further study.
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Affiliation(s)
- Maryam Maghsoudipour
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Brandon Nokes
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Naa-Oye Bosompra
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Rachel Jen
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Yanru Li
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China;
| | - Stacie Moore
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Pamela N. DeYoung
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Janelle Fine
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Bradley A. Edwards
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, VIC 3800, Australia;
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC 3800, Australia
| | - Dillon Gilbertson
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Robert Owens
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
| | - Todd Morgan
- Department of Dentistry, Scripps Encinitas Hospital, Encinitas, CA 92024, USA;
| | - Atul Malhotra
- Department of Medicine, University of California, La Jolla, San Diego, CA 92161, USA; (M.M.); (B.N.); (N.-O.B.); (S.M.); (P.N.D.); (J.F.); (D.G.); (R.O.)
- Correspondence:
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Zaccara G, Bartolini E, Tramacere L, Lattanzi S. Drugs for patients with epilepsy and excessive daytime sleepiness. Epilepsy Behav 2021; 124:108311. [PMID: 34534876 DOI: 10.1016/j.yebeh.2021.108311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
Excessive daytime sleepiness (EDS) and attentional deficits are often observed in people with epilepsy. They may be the consequence of seizures and subclinical discharges as well as of comorbid conditions as obstructive sleep apnea/hypopnea syndrome (OSAS), attention deficit hyperactivity disorder (ADHD), or other less frequent disorders. Excessive daytime sleepiness may also be caused or worsened by antiseizure medications (ASMs). Several meta-analyses suggested that lamotrigine, lacosamide, and perhaps eslicarbazepine are less sedative than other traditional and new ASMs and, in patients prone to somnolence, might be preferred over ASMs with more sedative properties. In patients with severe EDS and/or ADHD, advantages and risks of a treatment with a psychostimulant need to be considered. Methylphenidate, modafinil, armodafinil, pitolisant, and solriamfetol are authorized for use in ADHD and EDS in patients with narcolepsy and some of them also in OSAS. These agents are off-label for the treatment of EDS associated with epilepsy. They do not have proconvulsant effects, although there are several possible risks for patients with epilepsy. The risks of cardiovascular events and psychiatric symptoms should be carefully evaluated as such disorders can coexist with epilepsy and be triggered by these agents. Finally, combination of psychostimulants with ASMs may be associated with several pharmacokinetic drug-drug interactions.
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Affiliation(s)
| | - Emanuele Bartolini
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Prato, Italy
| | - Luciana Tramacere
- USL Centro Toscana, Neurology Unit, Ospedale San Giovanni di Dio, Firenze, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
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Soreca I. The role of circadian rhythms in Obstructive Sleep Apnea symptoms and novel targets for treatment. Chronobiol Int 2021; 38:1274-1282. [PMID: 34027758 DOI: 10.1080/07420528.2021.1929281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/09/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
Obstructive Sleep Apnea (OSA) is a common disorder that is associated with disability, premature mortality and lost quality of life. Excessive daytime sleepiness and depressive symptoms confer a great portion of the disability and lost quality of life associated with the disorder. While showing robust rates of response and symptoms resolutions, current treatments aimed at correcting the respiratory disturbances are not universally successful and a non-negligible proportion of patients who are correctly using available therapies do not experience symptomatic relief, suggesting that mechanisms beyond the respiratory disturbances may be involved in the pathogenesis of symptoms. A growing body of literature concerning animal and human models suggests that the sleep and respiratory disturbances commonly seen in OSA, namely sleep fragmentation, partial sleep deprivation, intermittent hypoxia, can promote shifts in circadian rhythms ultimately leading to misalignment between sleep-wake rhythms and the internal clock, as well as desynchrony amongst peripheral clocks and peripheral and central clock. This manuscript reviews the current evidence in support of a circadian disturbance underlying OSA symptomatology and proposes new applications for existing chronotherapeutic interventions with the potential for improving symptoms and quality of life for those patients that do not find symptomatic relief with currently available treatments.
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Affiliation(s)
- Isabella Soreca
- Department of Sleep Medicine, Mental Illness Research, Clinical, Education Centers of Excellence (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Bernardini A, Brunello A, Gigli GL, Montanari A, Saccomanno N. AIOSA: An approach to the automatic identification of obstructive sleep apnea events based on deep learning. Artif Intell Med 2021; 118:102133. [PMID: 34412849 DOI: 10.1016/j.artmed.2021.102133] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/31/2022]
Abstract
Obstructive Sleep Apnea Syndrome (OSAS) is the most common sleep-related breathing disorder. It is caused by an increased upper airway resistance during sleep, which determines episodes of partial or complete interruption of airflow. The detection and treatment of OSAS is particularly important in patients who suffered a stroke, because the presence of severe OSAS is associated with higher mortality, worse neurological deficits, worse functional outcome after rehabilitation, and a higher likelihood of uncontrolled hypertension. The gold standard test for diagnosing OSAS is polysomnography (PSG). Unfortunately, performing a PSG in an electrically hostile environment, like a stroke unit, on neurologically impaired patients is a difficult task; moreover, the number of strokes per day vastly outnumbers the availability of polysomnographs and dedicated healthcare professionals. Hence, a simple and automated recognition system to identify OSAS cases among acute stroke patients, relying on routinely recorded vital signs, is highly desirable. The vast majority of the work done so far focuses on data recorded in ideal conditions and highly selected patients, and thus it is hardly exploitable in real-life circumstances, where it would be of actual use. In this paper, we propose a novel convolutional deep learning architecture able to effectively reduce the temporal resolution of raw waveform data, like physiological signals, extracting key features that can be used for further processing. We exploit models based on such an architecture to detect OSAS events in stroke unit recordings obtained from the monitoring of unselected patients. Unlike existing approaches, annotations are performed at one-second granularity, allowing physicians to better interpret the model outcome. Results are considered to be satisfactory by the domain experts. Moreover, through tests run on a widely-used public OSAS dataset, we show that the proposed approach outperforms current state-of-the-art solutions.
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Affiliation(s)
- Andrea Bernardini
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy.
| | - Andrea Brunello
- Department of Mathematics, Computer Science, and Physics, University of Udine, Via delle Scienze 206, 33100 Udine, Italy.
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia, 15, 33100 Udine, Italy.
| | - Angelo Montanari
- Department of Mathematics, Computer Science, and Physics, University of Udine, Via delle Scienze 206, 33100 Udine, Italy.
| | - Nicola Saccomanno
- Department of Mathematics, Computer Science, and Physics, University of Udine, Via delle Scienze 206, 33100 Udine, Italy.
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Salzano G, Maglitto F, Bisogno A, Vaira LA, De Riu G, Cavaliere M, di Stadio A, Mesolella M, Motta G, Ionna F, Califano L, Salzano FA. Obstructive sleep apnoea/hypopnoea syndrome: relationship with obesity and management in obese patients. ACTA ACUST UNITED AC 2021; 41:120-130. [PMID: 34028456 PMCID: PMC8142730 DOI: 10.14639/0392-100x-n1100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023]
Abstract
Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is a disease characterised by upper airway obstruction during sleep, quite frequent in the general population, even if underestimated. Snoring, sleep apnoea and diurnal hypersomnia are common in these patients. Central obesity plays a key role: it reduces the size and changes the conformation of the upper airways, besides preventing lung expansion, with consequent reduction of lung volumes. Furthermore, obese people are also resistant to leptin, which physiologically stimulates ventilation; as a result, this causes scarce awakening during apnoea. OSAHS diagnosis is based on the combination of clinical parameters, such as apnoea/hypopnoea index (AHI), medical history, physical examination and Mallampati score. The first objective reference method to identify OSAHS is polysomnography followed by sleep endoscopy. Therapy provides in the first instance reduction of body weight, followed by continuous positive airway pressure (CPAP), which still remains the treatment of choice in most patients, mandibular advancement devices (MAD) and finally otolaryngology or maxillofacial surgery. Among surgical techniques, central is barbed reposition pharyngoplasty (BRP), used in the field of multilevel surgery.
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Affiliation(s)
- Giovanni Salzano
- Maxillo-Facial and ENT Surgery Unit, INT- IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Fabio Maglitto
- Maxillo-Facial and ENT Surgery Unit, INT- IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Antonella Bisogno
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi (Salerno), Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Unit, University Hospital of Sassari, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Unit, University Hospital of Sassari, Sassari, Italy
| | - Matteo Cavaliere
- Department of Otolarhinolaryngology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Fisciano, Salerno, Italy
| | | | - Massimo Mesolella
- Department of Neuroscience, Reproductive and Odontostomatological Science, Ear Nose and Throat Unit, University of Naples "Federico II", Naples, Italy
| | - Gaetano Motta
- Clinic of Otorhinolaryngology, Head and Neck Surgery Unit, Department of Anesthesiology, Surgical and Emergency Science, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Franco Ionna
- Maxillo-Facial and ENT Surgery Unit, INT- IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Francesco Antonio Salzano
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi (Salerno), Italy
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Rapelli G, Pietrabissa G, Manzoni GM, Bastoni I, Scarpina F, Tovaglieri I, Perger E, Garbarino S, Fanari P, Lombardi C, Castelnuovo G. Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions. Front Psychol 2021; 12:705364. [PMID: 34475840 PMCID: PMC8406627 DOI: 10.3389/fpsyg.2021.705364] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/09/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: This scoping review aims to provide an accessible summary of available evidence on the efficacy of motivational interventions to increase adherence to Continuous Positive Airway Pressure (CPAP) among patients with Obstructive Sleep Apnea Syndrome (OSAS) and of their specific aspects and strategies by assessing adherence measures. Methods: A literature search was performed in PubMed, Scopus, Medline, PsycINFO, and Web of Science databases using the concepts of "obstructive sleep apnea syndrome," "continuous positive airway pressure," "motivational intervention," and "adherence." Rigorous inclusion criteria and screening by at least two reviewers were applied. Data were extracted to address the review aims and were presented as a narrative synthesis. Results: Search for databases produced 11 randomized controlled trials, all including naïve CPAP users. Findings showed that motivational interventions were more effective than usual care and educational programs in increasing adherence to CPAP, despite results were not always maintained over time across studies. Discussion: To our knowledge, this is the first scoping review of the literature aimed to explore the characteristics and impact of motivational interventions to promote adherence to CPAP in patients with OSAS. More research providing a detailed description of motivational strategies, and testing of their association with positive treatment outcomes via both direct and indirect measures are needed to increase awareness on active mechanisms of change.
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Affiliation(s)
- Giada Rapelli
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy,Faculty of Psychology, eCampus University, Novedrate, Italy
| | - Ilaria Bastoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Federica Scarpina
- U. O. di Neurologia e Neuroriabilitazione, Istituto Auxologico Italiano IRCCS, Verbania, Italy,“Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
| | - Ilaria Tovaglieri
- Pulmonary Rehabilitation Department, Istituto Auxologico Italiano IRCCS, Verbania, Italy
| | - Elisa Perger
- Department of Cardiovascular, Neural and Metabolic Sciences, Sleep Disorders Center, Instituto Auxologico Italiano IRCCS, Milan, Italy,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences, University of Genoa, Genoa, Italy
| | - Paolo Fanari
- Pulmonary Rehabilitation Department, Istituto Auxologico Italiano IRCCS, Verbania, Italy,*Correspondence: Paolo Fanari
| | - Carolina Lombardi
- Department of Cardiovascular, Neural and Metabolic Sciences, Sleep Disorders Center, Instituto Auxologico Italiano IRCCS, Milan, Italy,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
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Burton JK, Craig LE, Yong SQ, Siddiqi N, Teale EA, Woodhouse R, Barugh AJ, Shepherd AM, Brunton A, Freeman SC, Sutton AJ, Quinn TJ. Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev 2021; 7:CD013307. [PMID: 34280303 PMCID: PMC8407051 DOI: 10.1002/14651858.cd013307.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Delirium is an acute neuropsychological disorder that is common in hospitalised patients. It can be distressing to patients and carers and it is associated with serious adverse outcomes. Treatment options for established delirium are limited and so prevention of delirium is desirable. Non-pharmacological interventions are thought to be important in delirium prevention. OBJECTIVES: To assess the effectiveness of non-pharmacological interventions designed to prevent delirium in hospitalised patients outside intensive care units (ICU). SEARCH METHODS We searched ALOIS, the specialised register of the Cochrane Dementia and Cognitive Improvement Group, with additional searches conducted in MEDLINE, Embase, PsycINFO, CINAHL, LILACS, Web of Science Core Collection, ClinicalTrials.gov and the World Health Organization Portal/ICTRP to 16 September 2020. There were no language or date restrictions applied to the electronic searches, and no methodological filters were used to restrict the search. SELECTION CRITERIA We included randomised controlled trials (RCTs) of single and multicomponent non-pharmacological interventions for preventing delirium in hospitalised adults cared for outside intensive care or high dependency settings. We only included non-pharmacological interventions which were designed and implemented to prevent delirium. DATA COLLECTION AND ANALYSIS: Two review authors independently examined titles and abstracts identified by the search for eligibility and extracted data from full-text articles. Any disagreements on eligibility and inclusion were resolved by consensus. We used standard Cochrane methodological procedures. The primary outcomes were: incidence of delirium; inpatient and later mortality; and new diagnosis of dementia. We included secondary and adverse outcomes as pre-specified in the review protocol. We used risk ratios (RRs) as measures of treatment effect for dichotomous outcomes and between-group mean differences for continuous outcomes. The certainty of the evidence was assessed using GRADE. A complementary exploratory analysis was undertaker using a Bayesian component network meta-analysis fixed-effect model to evaluate the comparative effectiveness of the individual components of multicomponent interventions and describe which components were most strongly associated with reducing the incidence of delirium. MAIN RESULTS We included 22 RCTs that recruited a total of 5718 adult participants. Fourteen trials compared a multicomponent delirium prevention intervention with usual care. Two trials compared liberal and restrictive blood transfusion thresholds. The remaining six trials each investigated a different non-pharmacological intervention. Incidence of delirium was reported in all studies. Using the Cochrane risk of bias tool, we identified risks of bias in all included trials. All were at high risk of performance bias as participants and personnel were not blinded to the interventions. Nine trials were at high risk of detection bias due to lack of blinding of outcome assessors and three more were at unclear risk in this domain. Pooled data showed that multi-component non-pharmacological interventions probably reduce the incidence of delirium compared to usual care (10.5% incidence in the intervention group, compared to 18.4% in the control group, risk ratio (RR) 0.57, 95% confidence interval (CI) 0.46 to 0.71, I2 = 39%; 14 studies; 3693 participants; moderate-certainty evidence, downgraded due to risk of bias). There may be little or no effect of multicomponent interventions on inpatient mortality compared to usual care (5.2% in the intervention group, compared to 4.5% in the control group, RR 1.17, 95% CI 0.79 to 1.74, I2 = 15%; 10 studies; 2640 participants; low-certainty evidence downgraded due to inconsistency and imprecision). No studies of multicomponent interventions reported data on new diagnoses of dementia. Multicomponent interventions may result in a small reduction of around a day in the duration of a delirium episode (mean difference (MD) -0.93, 95% CI -2.01 to 0.14 days, I2 = 65%; 351 participants; low-certainty evidence downgraded due to risk of bias and imprecision). The evidence is very uncertain about the effect of multicomponent interventions on delirium severity (standardised mean difference (SMD) -0.49, 95% CI -1.13 to 0.14, I2=64%; 147 participants; very low-certainty evidence downgraded due to risk of bias and serious imprecision). Multicomponent interventions may result in a reduction in hospital length of stay compared to usual care (MD -1.30 days, 95% CI -2.56 to -0.04 days, I2=91%; 3351 participants; low-certainty evidence downgraded due to risk of bias and inconsistency), but little to no difference in new care home admission at the time of hospital discharge (RR 0.77, 95% CI 0.55 to 1.07; 536 participants; low-certainty evidence downgraded due to risk of bias and imprecision). Reporting of other adverse outcomes was limited. Our exploratory component network meta-analysis found that re-orientation (including use of familiar objects), cognitive stimulation and sleep hygiene were associated with reduced risk of incident delirium. Attention to nutrition and hydration, oxygenation, medication review, assessment of mood and bowel and bladder care were probably associated with a reduction in incident delirium but estimates included the possibility of no benefit or harm. Reducing sensory deprivation, identification of infection, mobilisation and pain control all had summary estimates that suggested potential increases in delirium incidence, but the uncertainty in the estimates was substantial. Evidence from two trials suggests that use of a liberal transfusion threshold over a restrictive transfusion threshold probably results in little to no difference in incident delirium (RR 0.92, 95% CI 0.62 to 1.36; I2 = 9%; 294 participants; moderate-certainty evidence downgraded due to risk of bias). Six other interventions were examined, but evidence for each was limited to single studies and we identified no evidence of delirium prevention. AUTHORS' CONCLUSIONS: There is moderate-certainty evidence regarding the benefit of multicomponent non-pharmacological interventions for the prevention of delirium in hospitalised adults, estimated to reduce incidence by 43% compared to usual care. We found no evidence of an effect on mortality. There is emerging evidence that these interventions may reduce hospital length of stay, with a trend towards reduced delirium duration, although the effect on delirium severity remains uncertain. Further research should focus on implementation and detailed analysis of the components of the interventions to support more effective, tailored practice recommendations.
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Affiliation(s)
- Jennifer K Burton
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Louise E Craig
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Shun Qi Yong
- MVLS, College of Medicine and Veterinary Life Sciences, University of Glasgow, Glasgow, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Elizabeth A Teale
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
| | - Rebecca Woodhouse
- Department of Health Sciences, Hull York Medical School, University of York, York, UK
| | - Amanda J Barugh
- Department of Geriatric Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | - Suzanne C Freeman
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alex J Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Brown A, Jones S, Perez-Algorta G. Experiences of Using Positive Airway Pressure for Treatment of Obstructive Sleep Apnoea: A Systematic Review and Thematic Synthesis. Sleep 2021; 44:6286002. [PMID: 34043010 DOI: 10.1093/sleep/zsab135] [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: 11/29/2020] [Revised: 04/28/2021] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES Sub-optimal use of positive airway pressure (PAP) to treat obstructive sleep apnoea (OSA) continues to be a major challenge to effective treatment. Meanwhile, the individual and societal impacts of untreated OSA make effective treatment a priority. Although extensive research has been conducted into factors that impact PAP use, it is estimated that at least half of users do not use it as prescribed. However, the voice of users is notably minimal in the literature. A systematic review and qualitative metasynthesis of PAP user experience was conducted to contribute to understandings of how PAP is experienced and to inform how usage could be improved. METHODS PsycINFO, MEDLINE, CINAHL and EMBASE databases were systematically searched. Primary research findings of adult experiences using PAP that had been inductively analysed were included. Papers were critically appraised using the CASP qualitative checklist to generate a "hierarchy of evidence". Thematic synthesis was then conducted to generate analytical themes. Results were presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). RESULTS 25 papers reporting on over 398 people's experiences were analysed to generate 4 themes: Journey to PAP, Discomfort from and around PAP, Adapting to and using PAP, and Benefits from PAP. Author reflexivity and vulnerability to bias is acknowledged. CONCLUSIONS The findings highlight the applicability of a biopsychosocial understanding to PAP use. This metasynthesis gave voice to user experiences, revealing barriers to PAP use at a healthcare service level across the world, and suggests ways services can address these barriers.
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L'Heureux F, Baril AA, Gagnon K, Soucy JP, Lafond C, Montplaisir J, Gosselin N. Longitudinal changes in regional cerebral blood flow in late middle-aged and older adults with treated and untreated obstructive sleep apnea. Hum Brain Mapp 2021; 42:3429-3439. [PMID: 33939243 PMCID: PMC8249886 DOI: 10.1002/hbm.25443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/03/2021] [Accepted: 03/29/2021] [Indexed: 12/31/2022] Open
Abstract
Obstructive sleep apnea (OSA) is associated with abnormal cerebral perfusion at wakefulness, but whether these anomalies evolve over time is unknown. Here, we examined longitudinal changes in regional cerebral blood flow (rCBF) distribution in late middle‐aged and older adults with treated or untreated OSA. Twelve controls (64.8 ± 8.0 years) and 23 participants with newly diagnosed OSA (67.8 ± 6.2 years) were evaluated with polysomnography and cerebral 99mTc‐HMPAO single‐photon emission computed tomography during wakeful rest. OSA participants were referred to a sleep apnea clinic and 13 of them decided to start continuous positive airway pressure (CPAP). Participants were tested again after 18 months. Voxel‐based analysis and extracted relative rCBF values were used to assess longitudinal changes. Untreated OSA participants showed decreased relative rCBF in the left hippocampus and the right parahippocampal gyrus over time, while treated participants showed trends for increased relative rCBF in the left hippocampus and the right parahippocampal gyrus. No changes were found over time in controls. Untreated OSA is associated with worsening relative rCBF in specific brain areas over time, while treated OSA shows the opposite. Considering that OSA possibly accelerates cognitive decline in older adults, CPAP treatment could help reduce risk for cognitive impairment.
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Affiliation(s)
- Francis L'Heureux
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Neurosciences, Université de Montréal, Montreal, Quebec, Canada
| | - Andrée-Ann Baril
- The Framingham Heart Study, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Katia Gagnon
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université du Québec à Montreal, Montreal, Quebec, Canada
| | - Jean-Paul Soucy
- McConnel Brain Imaging Centre, McGill University, Montreal, Quebec, Canada
| | - Chantal Lafond
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
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Factors affecting CPAP compliance in patients with obstructive sleep apnea. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.897532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Haskell BS, Voor MJ, Roberts AM. A consideration of factors affecting palliative oral appliance effectiveness for obstructive sleep apnea: a scoping review. J Clin Sleep Med 2021; 17:833-848. [PMID: 33196434 PMCID: PMC8020709 DOI: 10.5664/jcsm.9018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This scoping review allows physicians, researchers, and others interested in obstructive sleep apnea to consider effectiveness of oral appliances (OAs). The intent is to improve understanding of OA effectiveness by considering morphologic interaction in patients with obstructive sleep apnea. METHODS Morphologic and biomechanical criteria for positional alterations of the mandible assessed success rates of OA appliances. Searches of databases (Medline, PubMed, The Cochrane Library, EBSCO) using terms: OA treatment effectiveness and positive and/or negative outcome predictors. Craniofacial predictors of OAs and obstructive sleep apnea biomechanical factors of anatomical traits associated with OA effectiveness were included. Databases searched radiographic cephalometric imaging for morphology/phenotypes and apnea-hypopnea index responses. Articles were excluded if title or abstract was not relevant or a case report. If the analysis did not report mean or standard deviation for apnea-hypoxia index, it was excluded. No language, age, or sex restrictions were applied. RESULTS Analysis of 135 articles included in searched literature indicated alterations in musculature and pharyngeal airway structure through OA use. These alterations were individually unpredictable with wide variability 61.81% ± 12.29 (apnea-hypoxia index mean ± standard deviation). Morphologic variations as predictors were typically weak and idiosyncratic. Biomechanical factors and wide variations in the metrics of appliance application were unclear, identifying gaps in knowledge and practice of OAs. CONCLUSIONS An integrated basis to identify morphologic and biomechanical elements of phenotypic expressions of sleep-disordered breathing in the design and application of OAs is needed. Current knowledge is heterogeneous and shows high variability. Identification of subgroups of patients with obstructive sleep apnea responding to OAs is needed.
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Affiliation(s)
- Bruce S. Haskell
- Division of Orthodontics, University of Kentucky College of Dentistry, Lexington Kentucky
- Department of Physiology, School of Medicine, University of Louisville, Louisville, Kentucky
- Comprehensive Dentistry, School of Dentistry, University of Louisville, Louisville, Kentucky
| | - Michael J. Voor
- Department of Orthopedics, School of Medicine, University of Louisville, Louisville, Kentucky
- Department of Biomedical Engineering, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Andrew M. Roberts
- Department of Physiology, School of Medicine, University of Louisville, Louisville, Kentucky
- Department of Pediatrics, School of Medicine, University of Louisville, Louisville, Kentucky
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The role of morphometric and respiratory factors in predicting the severity and evolution of urinary symptoms in patients with obstructive sleep apnea syndrome. Sleep Breath 2021; 26:907-914. [PMID: 33725289 DOI: 10.1007/s11325-021-02341-z] [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: 10/07/2020] [Revised: 01/16/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To assess the severity, evolution, and behaviour of several urinary symptoms in patients with obstructive sleep apnea syndrome (OSAS) before and after the treatment with continuous positive airway pressure (CPAP). METHODS A prospective study was performed on patients with a recent diagnosis of sleep apnea confirmed by nocturnal sleep polygraphy and absence of medical urological past history. The symptom incidence was analysed seeking predictive factors for initial nocturia, nocturnal polyuria (NP), and unfavourable International Prostate Symptoms Score (IPSS) before and after a 1-year period of treatment using a CPAP device. Morphometric variables (body mass index, BMI; neck and abdominal diameter) and functional respiratory variables (FEV1, FVC, and FEV1/FVC) were analysed. A multivariate analysis was performed with a calculation of Pearson's correlation coefficient to establish a linear relation between the variables. RESULTS A total of 43 patients completed the two-step study (IPSS and bladder diary before and after the CPAP treatment). IPSS decreased by 3.58 points. Nocturia decreased to once per night. Neck diameter, FEV1, and FEV1/FVC significantly predicted the initial severity of some lower urinary tract symptoms (LUTS), (p=0.015, p=0.029, p=0.008, respectively). Neck diameter, abdominal perimeter, and FEV1/FVC significantly predicted the LUTS evolution throughout the study (p=0.023, p=0.007, p=0.05, respectively). CONCLUSION Some pre-treatment morphometry and spirometry parameters such as abdominal or neck diameter, FEV1, and FEV1/FVC were predictive of the severity and evolution of LUTS in patients with OSAS.
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Bianco CL, Myers AL, Smagula S, Fortuna KL. Can Smartphone Apps Assist People with Serious Mental Illness in Taking Medications as Prescribed? Sleep Med Clin 2021; 16:213-222. [PMID: 33485529 PMCID: PMC8034491 DOI: 10.1016/j.jsmc.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adherence research commonly happens in a silo, focused on a particular disease state or type of therapy. Learning from outside disciplines can bring new insights and ideas. This article presents adherence research as related to people with a diagnosis of a serious mental illness (SMI) and medication adherence through smartphone applications (apps). Individuals with SMI have high rates of not taking medication, increasing risks of relapse and hospitalization. Advances in technology may be advantageous in promoting taking medication. Smartphones apps have been designed for people with SMI. Further research is needed to evaluate their efficacy on improving rates of taking medication.
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Affiliation(s)
- Cynthia L Bianco
- Department of Psychiatry Research, Dartmouth-Hitchcock, 2 Pillsbury Street, Suite 401, Concord, NH 03301, USA
| | - Amanda L Myers
- Department of Public Health, Rivier University, Nashua, NH, USA
| | - Stephen Smagula
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Room E-1120, Pittsburgh, PA 15213, USA
| | - Karen L Fortuna
- Department of Psychiatry, Dartmouth College, 2 Pillsbury Street, Suite 401, Concord, NH 03301, USA.
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Oh A, Grivell N, Chai-Coetzer CL. What is a Clinically Meaningful Target for Positive Airway Pressure Adherence? Sleep Med Clin 2021; 16:1-10. [PMID: 33485522 DOI: 10.1016/j.jsmc.2020.10.001] [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] [Indexed: 10/22/2022]
Abstract
Although good adherence to continuous positive airway pressure (PAP) traditionally is defined as greater than or equal to 4 hours/night, the origins and rationale for this remain unclear. Research studies report variation in optimal duration of PAP adherence, depending on outcome of interest. Evidence demonstrates benefit with PAP for daytime sleepiness, quality of life, neurocognitive outcomes, depression, and hypertension, predominantly in symptomatic, moderate-severe obstructive sleep apnea. Recent randomized controlled trials, however, have failed to demonstrate a reduction in cardiovascular and mortality risks. This review explores the question of what can be considered a clinically meaningful outcome for PAP adherence.
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Affiliation(s)
- Aaron Oh
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, South Australia 5042, Australia
| | - Nicole Grivell
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, South Australia 5042, Australia
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, South Australia 5042, Australia; Respiratory and Sleep Service, Southern Adelaide Local Health Network, SA Health, Flinders Drive, Bedford Park, South Australia 5042, Australia.
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Olson MD, Junna MR. Hypoglossal Nerve Stimulation Therapy for the Treatment of Obstructive Sleep Apnea. Neurotherapeutics 2021; 18:91-99. [PMID: 33559036 PMCID: PMC8116425 DOI: 10.1007/s13311-021-01012-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 11/30/2022] Open
Abstract
Hypoglossal nerve stimulation (HGNS) therapy was approved in 2014 for the treatment of obstructive sleep apnea in patients who are intolerant to continuous positive airway pressure (CPAP) therapy, which is reported in up to 40-60% of patients. This therapy works via direct neurostimulation of the hypoglossal nerve in synchrony with respiration, to open the airway via tongue stiffening and protrusion. Studies have demonstrated significant reductions in both respiratory parameters such as disordered breathing indices, as well as subjective sleep complaints, such as daytime sleepiness, with the use of this therapy. This has increased the repertoire of treatment options for sleep providers to recommend to those patients that are intolerant to CPAP therapy.
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Affiliation(s)
- Michael D Olson
- Department of Otolaryngology, Head and Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Mithri R Junna
- Center for Sleep Medicine, Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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Yenigun A, Tugrul S, Dogan R, Aksoy F, Ozturan O. A feasibility study in the treatment of obstructive sleep apnea syndrome and snoring: Nasopharyngeal stent. Am J Otolaryngol 2020; 41:102460. [PMID: 32247706 DOI: 10.1016/j.amjoto.2020.102460] [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: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objective of this study is to create a new choice of treatment with nasopharyngeal stent in isolated retro palatal obstruction and snoring for the treatment of obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHOD The study included five patients with mild OSAS and snoring. Nasopharyngeal stents were applied in these patients with drug-induced sedation endoscopy. RESULTS With the nasopharyngeal stents, we aimed to prevent the soft palate to fall backwards while sleeping, especially at supine position in order to prevent the occurrence of apnea and hypopnea, providing a way for the airway to remain open as well as a support behind the soft palate and thus prevent snoring based on the vibration created by draught. CONCLUSION We suggest a new alternative treatment approach to devices that need to be continuously used such as CPAP or intraoral devices or surgical methods that have many unwanted discomforts for the patients.
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Obstructive sleep apnea in people with intellectual disabilities: adherence to and effect of CPAP. Sleep Breath 2020; 25:1257-1265. [PMID: 33084987 DOI: 10.1007/s11325-020-02221-y] [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: 06/18/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is common in people with intellectual disabilities (ID), but in practice continuous positive airway pressure (CPAP) is often deemed unfeasible. We investigated adherence to and effect of CPAP in patients with ID and OSA. METHODS Patients with ID were started on CPAP using an intensive training program. Acceptable adherence was defined as use of ≥ 4 h/night during ≥ 70% of the nights. Treatment effect was measured with a patient global impression scale and customized questionnaires. Reasons for not starting CPAP, factors influencing treatment, and reasons for terminating CPAP were explored. RESULTS Of 39 patients with ID, 87% after 8-10 weeks and 70% at 8 months still used CPAP, of whom 74% and 77% showed acceptable adherence. Baseline apnea-hypopnea (AHI) index decreased from 41.2/h to 5.3/h after 8-10 weeks (p < 0.001), and 4.3/h after 8 months (p < 0.001). At 8-10 weeks and after 8 months, there was an improvement in the most restrictive reported complaint (both p < 0.0005), difficulty waking up (p < 0.01; p < 0.0005), handling behavior (p < 0.03; p < 0.02), presence of irritability (p < 0.01), and sleepiness (p < 0.05). The expectation that CPAP would not be tolerated was the main reason for not starting. CPAP use in the first 2 weeks predicted adherence at 8-10 weeks and 8 months (r = 0.51, p < 0.01; r = 0.69, p < 0.01). Of 13 patients who terminated CPAP, the reasons for termination included behavioral problems, comorbid insomnia, anxiety, discomfort, or other side effects. CONCLUSIONS With adequate guidance, CPAP is both feasible and effective in people with ID and OSA.
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van Veldhuisen SL, Kuppens K, de Raaff CAL, Wiezer MJ, de Castro SMM, van Veen RN, Swank DJ, Demirkiran A, Boerma EJG, Greve JWM, van Dielen FMH, Frederix GWJ, Hazebroek EJ. Protocol of a multicentre, prospective cohort study that evaluates cost-effectiveness of two perioperative care strategies for potential obstructive sleep apnoea in morbidly obese patients undergoing bariatric surgery. BMJ Open 2020; 10:e038830. [PMID: 33033026 PMCID: PMC7542938 DOI: 10.1136/bmjopen-2020-038830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Despite the high prevalence of obstructive sleep apnoea (OSA) in obese patients undergoing bariatric surgery, OSA is undiagnosed in the majority of patients and thus untreated. While untreated OSA is associated with an increased risk of preoperative and postoperative complications, no evidence-based guidelines on perioperative care for these patients are available. The aim of the POPCORN study (Post-Operative Pulse oximetry without OSA sCreening vs perioperative continuous positive airway pressure (CPAP) treatment following OSA scReeNing by polygraphy (PG)) is to evaluate which perioperative strategy is the most cost-effective for obese patients undergoing bariatric surgery without a history of OSA. METHODS AND ANALYSIS In this multicentre observational cohort study, data from 1380 patients who will undergo bariatric surgery will be collected. Patients will receive either postoperative care with pulse oximetry monitoring and supplemental oxygen during the first postoperative night, or care that includes preoperative PG and CPAP treatment in case of moderate or severe OSA. Local protocols for perioperative care in each participating hospital will determine into which cohort a patient is placed. The primary outcome is cost-effectiveness, which will be calculated by comparing all healthcare costs with the quality-adjusted life-years (QALYs, calculated using EQ-5D questionnaires). Secondary outcomes are mortality, complications within 30 days after surgery, readmissions, reoperations, length of stay, weight loss, generic quality of life (QOL), OSA-specific QOL, OSA symptoms and CPAP adherence. Patients will receive questionnaires before surgery and 1, 3, 6 and 12 months after surgery to report QALYs and other patient-reported outcomes. ETHICS AND DISSEMINATION Approval from the Medical Research Ethics Committees United was granted in accordance with the Dutch law for Medical Research Involving Human Subjects Act (WMO) (reference number W17.050). Results will be submitted for publication in peer-reviewed journals and presented at (inter)national conferences. TRIAL REGISTRATION NUMBER NTR6991.
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Affiliation(s)
| | - Kim Kuppens
- Department of Pulmonary Medicine, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | - Marinus J Wiezer
- Department of Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | - Ruben N van Veen
- Department of Surgery, OLVG, location West, Amsterdam, The Netherlands
| | - Dingeman J Swank
- Department of Surgery, Dutch Obesity Clinic (Nederlandse Obesitas Kliniek), The Hague, The Netherlands
| | - Ahmet Demirkiran
- Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - Evert-Jan G Boerma
- Department of Surgery, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - Jan-Willem M Greve
- Department of Surgery, Zuyderland Medisch Centrum, Heerlen, The Netherlands
- Department of Surger / Nutrim, Maastricht University, Maastricht, The Netherlands
| | | | - Geert W J Frederix
- Department of Public Health, Julius Center Research Program Methodology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Eric J Hazebroek
- Department of Surgery / Vitalys Clinic, Rijnstate Ziekenhuis, Arnhem, The Netherlands
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Gelderland, The Netherlands
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Pandi-Perumal SR, Monti JM, Burman D, Karthikeyan R, BaHammam AS, Spence DW, Brown GM, Narashimhan M. Clarifying the role of sleep in depression: A narrative review. Psychiatry Res 2020; 291:113239. [PMID: 32593854 DOI: 10.1016/j.psychres.2020.113239] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/14/2020] [Accepted: 06/14/2020] [Indexed: 01/13/2023]
Abstract
It has been established that 4.4 to 20% of the general population suffers from a major depressive disorder (MDD), which is frequently associated with a dysregulation of normal sleep-wake mechanisms. Disturbances of circadian rhythms are a cardinal feature of psychiatric dysfunctions, including MDD, which tends to indicate that biological clocks may play a role in their pathophysiology. Thus, episodes of depression and mania or hypomania can arise as a consequence of the disruption of zeitgebers (time cues). In addition, the habit of sleeping at a time that is out of phase with the body's other biological rhythms is a common finding in depressed patients. In this review, we have covered a vast area, emerging from human and animal studies, which supports the link between sleep and depression. In doing so, this paper covers a broad range of distinct mechanisms that may underlie the link between sleep and depression. This review further highlights the mechanisms that may underlie such link (e.g. circadian rhythm alterations, melatonin, and neuroinflammatory dysregulation), as well as evidence for a link between sleep and depression (e.g. objective findings of sleep during depressive episodes, effects of pharmacotherapy, chronotherapy, comorbidity of obstructive sleep apnea and depression), are presented.
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Affiliation(s)
| | - Jaime M Monti
- Department of Pharmacology and Therapeutics, School of Medicine Clinics Hospital, University of the Republic, Montevideo 11600, Uruguay
| | - Deepa Burman
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Palestine, State of, United States
| | | | - Ahmed S BaHammam
- University of Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia; The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation, Saudi Arabia
| | | | - Gregory M Brown
- Centre for Addiction and Mental Health, University of Toronto, 250 College St, Toronto, ON, Canada
| | - Meera Narashimhan
- Department of Medicine, University of South Carolina, Columbia, SC, United States; Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC, United States
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 989] [Impact Index Per Article: 247.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Bros J, Poulet C, Methni JE, Deschaux C, Gandit M, Pauwels PJ, Charavel M. Determination of risks of lower adherence to CPAP treatment before their first use by patients. J Health Psychol 2020; 27:223-235. [PMID: 32783470 DOI: 10.1177/1359105320942862] [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: 11/16/2022] Open
Abstract
A better understanding of Continuous Positive Airway Pressure (CPAP) adherence is a priority in improving patient care. To Identify adherence typology with a longitudinal approach, and explore the early determinants of lower adherence to CPAP. Obstructive sleep apnea patients (N = 204). Prospective and longitudinal study.A classification into four profiles was observed: "Regular Adherents," "Non-Regular Adherents," "Persistent Non-Adherents," and "Non-Persistent Non-Adherents." Specific biopsychosocial factors make it possible to evaluate the risk of belonging to a lower adherence profile. We propose a novel approach of CPAP treatment adherence. Several pre-determinants have been identified.
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Affiliation(s)
- Julie Bros
- Université Grenoble Alpes, LIP/PC2S, Grenoble, Saint-Martin-d'Hères, France
| | - Caroline Poulet
- Université Grenoble Alpes, LIP/PC2S, Grenoble, Saint-Martin-d'Hères, France
| | - Jonathan El Methni
- Université Paris Descartes, Sorbonne Paris Cité, Laboratoire MAP 5, UMR CNRS 8145., Paris, France
| | | | - Marc Gandit
- Université Grenoble Alpes, LIP/PC2S, Grenoble, Saint-Martin-d'Hères, France
| | | | - Marie Charavel
- Université Grenoble Alpes, LIP/PC2S, Grenoble, Saint-Martin-d'Hères, France
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Chakrabarti B, Lewis-Burke N, Pearson M, Craig S, Davies L, Sheridan K, England P, McKnight E, Angus R. Implementation of a computer-guided consultation in the assessment of suspected obstructive sleep apnoea syndrome. ERJ Open Res 2020; 6:00362-2019. [PMID: 32743003 PMCID: PMC7383049 DOI: 10.1183/23120541.00362-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/08/2020] [Indexed: 12/26/2022] Open
Abstract
Background We describe implementation of a clinical decision support system, a computer-guided consultation (CGC), in the assessment of subjects referred with suspected obstructive sleep apnoea syndrome (OSAS). Methods Two cohorts of patients were assessed. The first 100 cases had data collected with the CGC by a specialist sleep physician (stage1). A further 100 cases were assessed by a nonspecialist using the CGC (stage 2). For each case, the diagnosis suggested by the CGC was compared with the final diagnosis made by a second specialist sleep physician blinded to the CGC diagnosis. Results Stage 1: of 100 people evaluated, a final diagnosis of OSAS was made by both the sleep specialist and CGC in 88% of cases. In 7 of the remaining 12 cases, both agreed there was “No evidence of OSAS”; in 5 cases the CGC did not reach a final diagnosis instead prompting specialist referral. Stage 2: 100 people were evaluated; 95% were evaluable. Both CGC and the sleep specialist made a diagnosis of OSAS in 83 cases (87%), in 5 cases both agreed there was no OSAS, whereas in 7 cases the CGC prompted a specialist review due to unexplained symptoms. The CGC was concordant with the final diagnosis in 95% and 93% of cases in the two cohorts, respectively and where there was doubt, prompted for clinical review. No OSAS cases were overlooked by the CGC. Conclusion An intelligent CGC program creates opportunities in sleep medicine management pathways to safely yet effectively utilise nonspecialists working under specialist supervision. A clinical decision support system may be used safely to assess subjects with suspected obstructive sleep apnoea syndrome when used by specialists and nonspecialists alikehttps://bit.ly/2AFPD0r
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Affiliation(s)
| | | | - Mike Pearson
- Aintree Chest Centre, University Hospital Aintree, Liverpool, UK.,LungHealth Ltd, Swaffham, UK
| | - Sonya Craig
- Aintree Chest Centre, University Hospital Aintree, Liverpool, UK
| | - Lisa Davies
- Aintree Chest Centre, University Hospital Aintree, Liverpool, UK.,LungHealth Ltd, Swaffham, UK
| | - Kim Sheridan
- National Services for Health Improvement, Swaffham, UK
| | | | - Eddie McKnight
- LungHealth Ltd, Swaffham, UK.,National Services for Health Improvement, Swaffham, UK
| | - Robert Angus
- Aintree Chest Centre, University Hospital Aintree, Liverpool, UK.,LungHealth Ltd, Swaffham, UK
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Sprung VS, Kemp GJ, Wilding JP, Adams V, Murphy K, Burgess M, Emegbo S, Thomas M, Needham AJ, Weimken A, Schwab RJ, Manuel A, Craig SE, Cuthbertson DJ. Randomised, cOntrolled Multicentre trial of 26 weeks subcutaneous liraglutide (a glucagon-like peptide-1 receptor Agonist), with or without contiNuous positive airway pressure (CPAP), in patients with type 2 diabetes mellitus (T2DM) and obstructive sleep apnoEa (OSA) (ROMANCE): study protocol assessing the effects of weight loss on the apnea-hypnoea index (AHI). BMJ Open 2020; 10:e038856. [PMID: 32699168 PMCID: PMC7380950 DOI: 10.1136/bmjopen-2020-038856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) and type 2 diabetes mellitus (T2DM) often occur concurrently, and untreated OSA may potentially amplify the high risk of cardiovascular disease in T2DM. Compliance with continuous positive airway pressure (CPAP), the conventional treatment for OSA, can be poor and considering weight loss is the most effective treatment for OSA. This trial examines whether the glucagon-like peptide-1 receptor agonist liraglutide, a glucose-lowering therapy associated with significant weight loss used in T2DM, can improve the severity and symptoms of OSA. METHODS AND ANALYSIS This is an outpatient, single-centred, open-labelled, prospective, phase IV randomised controlled trial in a two-by-two factorial design. One hundred and thirty-two patients with newly diagnosed OSA (apnoea-hypopnoea index (AHI) ≥15 events/hour), and existing obesity and T2DM (glycated haemoglobin (HbA1c) ≥47 mmol/mol), will be recruited from diabetes and sleep medicine outpatient clinics in primary and secondary care settings across Liverpool. Patients will be allocated equally, using computer-generated random, permuted blocks of unequal sizes, to each of the four treatment arms for 26 weeks: (i) liraglutide (1.8 mg once per day) alone, (ii) liraglutide 1.8 mg once per day with CPAP, (iii) CPAP alone (conventional care) or (iv) no treatment (control). The primary outcome measure is change in OSA severity, determined by AHI. Secondary outcome measures include effects on glycaemic control (glycated haemoglobin (HbA1c)), body weight and quality of life measures. Exploratory measures include measures of physical activity, MRI-derived measures of regional body composition including fat mass (abdominal subcutaneous, visceral, neck and liver fat) and skeletal muscle mass (cross-sectional analysis of thigh), indices of cardiac function (using transthoracic echocardiography) and endothelial function. ETHICAL APPROVAL The study has been approved by the North West Liverpool Central Research Ethics Committee (14/NW/1019) and it is being conducted in accordance with the Declaration of Helsinki and Good Clinical Practice. TRIAL REGISTRATION NUMBERS ISRCTN16250774. EUDRACT No. 2014-000988-41. UTN U1111-1139-0677.
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Affiliation(s)
- Victoria S Sprung
- Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Graham J Kemp
- Department of Musculoskeletal & Ageing Science, University of Liverpool, Liverpool, Merseyside, UK
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
| | - John Ph Wilding
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Valerie Adams
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
| | - Kieran Murphy
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
| | - Malcolm Burgess
- Department of Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Stephen Emegbo
- Liverpool Sleep & Ventilation Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Matthew Thomas
- Liverpool Sleep & Ventilation Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Andrew Weimken
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard J Schwab
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ari Manuel
- Liverpool Sleep & Ventilation Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sonya E Craig
- Liverpool Sleep & Ventilation Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
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Awareness of obstructive sleep apnea among critical care physicians in Sharkia Governorate, Egypt. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00005-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patients with symptoms of obstructive sleep apnea (OSA) present to nearly all physicians irrespective of their specialties. A basic knowledge of OSA is considered essential to identify those patients for appropriate referral and treatment. This study aimed to assess the knowledge and attitude of Sharkia Governorate Critical Care physicians regarding OSA using a standard validated questionnaire.
Results
This cross-sectional survey study was performed on a sample of Sharkia Governorate physicians, from all critical care units in tertiary and secondary hospitals including the following specialties: chest, internal medicine, neurology, cardiology, pediatric, and anesthesia. The OSA knowledge and attitudes (OSAKA) questionnaire that consists of 18 knowledge assessment questions and the OSA attitude questionnaire that consists of 6 attitude assessment questions were used. A total of 231, out of 296 invited physicians, completed the given questionnaire with a response rate of 78%. The mean score for knowledge assessment was 10.05 ± 2.3 with a 33.3% adequate response, while the mean score for attitude assessment was 3.75 ± 1.22 with a 59.3% adequate response. The mean OSA knowledge (12.5 ± 2.42) and attitude (5 ± 0.78) scores were highest among chest physicians when compared to physicians from other specialties (p < 0.001). A significant positive correlation between knowledge and attitude scores was found among Sharkia Governorate critical care physicians (r = 0.55, p < 0.001).
Conclusions
The level of knowledge of OSA among Sharkia Governorate critical care physicians was far from optimal whereas the attitude regarding OSA was acceptable.
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