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Pordzik J, Ludwig K, Seifen C, Ruckes C, Huppertz T, Bahr-Hamm K, Hackenberg B, Matthias C, Gouveris H. Real-world data on polysomnography- and patient-reported outcomes in hypoglossal nerve stimulation and auto-titrating positive airway pressure therapy for obstructive sleep apnea. Respir Med 2024; 232:107750. [PMID: 39084269 DOI: 10.1016/j.rmed.2024.107750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/17/2024] [Accepted: 07/29/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Few data are available comparing first-line positive airway pressure (PAP) therapy of obstructive sleep apnea (OSA), especially auto-adjusting PAP (aPAP), with second-line hypoglossal nerve stimulation (HGNS) therapy. The aim of this study was to directly compare these therapeutic options by standard polysomnography (PSG)-related parameters and patient-reported outcomes in comparable groups. METHODS 20 patients (aged 57.30 ± 8.56 years; 6 female) were included in the HGNS and 35 patients (aged 56.83 ± 9.20 years; 9 female) were included in the aPAP group. In both groups participants had to fit the current guideline criteria for HGNS treatment. Groups were compared by analysis of covariance (ANCOVA) using inverse propensity score weighting. RESULTS Propensity scores did not differ between groups. Pre-therapeutic AHI (HGNS: 40.22 ± 12.78/h; aPAP: 39.23 ± 12.33/h) and ODI (HGNS: 37.9 ± 14.7/h, aPAP: 34.58 ± 14.74/h) were comparable between the groups. After 413.6 ± 116.66 days (HGNS) and 162.09 ± 140.58 days (aPAP) of treatment AHI (HGNS: 30.22 ± 17.65/h, aPAP group: 4.71 ± 3.42/h; p < 0.001) was significantly higher in the HGNS group compared to the aPAP group. However, epworth sleepiness scale (ESS) was post-interventionally significantly lower in the HGNS group compared to the aPAP group (pretherapeutic: HGNS: 13.32 ± 5.81 points, aPAP: 9.09 ± 4.71 points; posttherapeutic: HGNS: 7.17 ± 5.06 points; aPAP: 8.38 ± 5.41 points; p < 0.01). CONCLUSION These are novel real-world data. More research on the key parameters regarding titration of the HGNS neurostimulation parameter tuning and on the impact of factors influencing HGNS adherence is needed.
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Affiliation(s)
- Johannes Pordzik
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany.
| | - Katharina Ludwig
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
| | - Christopher Seifen
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center Mainz, 55131, Mainz, Germany
| | - Tilman Huppertz
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
| | - Katharina Bahr-Hamm
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
| | - Berit Hackenberg
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
| | - Christoph Matthias
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
| | - Haralampos Gouveris
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
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Kermelly SB, Lajoie AC, Boucher ME, Sériès F. Impact of continuous positive airway pressure mode on adherence to treatment in obstructive sleep apnea patients awaiting bariatric surgery. J Sleep Res 2021; 30:e13288. [PMID: 33547713 DOI: 10.1111/jsr.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 11/27/2022]
Abstract
Obstructive sleep apnea is prevalent in the bariatric population, and is associated with various complications. Despite increasing popularity, automatic positive airway pressure has not yet been studied in this population. The objective was to compare treatment adherence between automatic positive airway pressure and fixed positive airway pressure (continuous positive airway pressure) in obstructive sleep apnea patients awaiting bariatric surgery. This randomized controlled trial involved obese patients newly diagnosed with severe obstructive sleep apnea and awaiting bariatric surgery. The primary outcome was the difference in adherence between automatic positive airway pressure and continuous positive airway pressure pre-operatively. Secondary outcomes included positive airway pressure efficacy, adherence at 1 month, adverse effects, quality of life and peri-operative complications. Analyses were conducted using a modified intention-to-treat methodology. Fifty patients were randomized. Baseline characteristics and duration of positive airway pressure therapy were comparable between groups. At the time of surgery, the percentage of overall nights positive airway pressure used was 96.9% [95% confidence interval: 93.5-100] and 86.0% [95% confidence interval: 66.9-100] in the automatic positive airway pressure and continuous positive airway pressure groups, respectively (p = .047). Average use was 6.3 hr per night [95% confidence interval: 5.1-7.2] and 5.9 hr per night [95% confidence interval: 3.0-8.8], with a difference of 0.4 hr favouring automatic positive airway pressure (p = .75). Nightly use ≥ 4 hr per night was 86.4% and 74.0% in the automatic positive airway pressure and fixed continuous positive airway pressure groups, respectively (p = .22). There were no statistically significant differences regarding adherence at 1 month, efficacy parameters, adverse effects, quality of life and peri-operative complications. With no difference on the safety profile and efficiency parameters, treatment adherence is not improved with automatic positive airway pressure compared with fixed continuous positive airway pressure in obstructive sleep apnea patients awaiting bariatric surgery.
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Affiliation(s)
- Sophie B Kermelly
- Centre de Pneumologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Annie C Lajoie
- Centre de Pneumologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | | | - Frédéric Sériès
- Centre de Pneumologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
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Meurice JC, Antone E, Gilbert M, Watrin A, Bironneau V. [Continuous positive airway pressure in obstructive sleep apnea]. Presse Med 2017; 46:423-431. [PMID: 28434626 DOI: 10.1016/j.lpm.2017.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 02/25/2017] [Indexed: 12/18/2022] Open
Abstract
Continuous positive airway pressure (CPAP) is currently the most used and efficient therapy in OSAS. Efficiency of CPAP on sleep respiratory disorders is the same whether in fixed or automatic mode. Larger studies are required to evaluate their respective beneficial impact on cardiovascular or metabolic complications of OSAS. Close medical monitoring is necessary during the first weeks of CPAP therapy. Compliance to CPAP therapy is crucial for efficacy in preventing cardiovascular or metabolic complications of OSAS. As beneficial effects of CPAP in obese patients are modest, on blood pressure levels and metabolic disorders, its use has to be part of a comprehensive care of OSAS and related comorbidities.
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Affiliation(s)
- Jean Claude Meurice
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France; Groupe ALIVE, CIC Inserm 1402, 86000 Poitiers, France.
| | - Elise Antone
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France
| | - Mylene Gilbert
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France
| | - Audrey Watrin
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France
| | - Vanessa Bironneau
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France; Groupe ALIVE, CIC Inserm 1402, 86000 Poitiers, France
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Antone E, Gilbert M, Bironneau V, Meurice JC. [Continuous positive airways pressure treatment for obstructive sleep apnoea]. Rev Mal Respir 2015; 32:447-60. [PMID: 25823935 DOI: 10.1016/j.rmr.2014.11.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/07/2014] [Indexed: 11/16/2022]
Abstract
Continuous positive airway pressure (CPAP) still remains the most frequently used and the most efficient treatment for obstructive sleep apnea syndrome. However, its efficiency is conditioned by healthcare quality depending on many factors such as medical specificities of the patients as well as the severity of sleep-related breathing disorders. In order to optimize CPAP efficiency, it is necessary to be aware of the functional abilities of the different devices, and to perform a close monitoring of the patients, particularly during the first weeks of treatment, by maximally using the data provided by the CPAP apparatus. Some questions remain unsolved, such as the impact of nasal CPAP on glucose metabolism or cardiovascular prognosis. Furthermore, the strategy of CPAP use should be improved according to future results of studies dedicated to the interest of home telemonitoring and taking into account the validated mode of CPAP initiation.
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Affiliation(s)
- E Antone
- Service de pneumologie, CHU de Poitiers, université de Poitiers, 2, rue de la Miletrie, 86000 Poitiers, France.
| | - M Gilbert
- Service de pneumologie, CHU de Poitiers, université de Poitiers, 2, rue de la Miletrie, 86000 Poitiers, France
| | - V Bironneau
- Service de pneumologie, CHU de Poitiers, université de Poitiers, 2, rue de la Miletrie, 86000 Poitiers, France
| | - J C Meurice
- Service de pneumologie, CHU de Poitiers, université de Poitiers, 2, rue de la Miletrie, 86000 Poitiers, France
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Arora A, Kotecha J, Acharya A, Garas G, Darzi A, Davies DC, Tolley N. Determination of biometric measures to evaluate patient suitability for transoral robotic surgery. Head Neck 2014; 37:1254-60. [DOI: 10.1002/hed.23739] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Asit Arora
- Department of Otorhinolaryngology and Head and Neck Surgery; St. Mary's Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
| | - Jalpa Kotecha
- Department of Otorhinolaryngology and Head and Neck Surgery; St. Mary's Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
| | - Amish Acharya
- Department of Otorhinolaryngology and Head and Neck Surgery; St. Mary's Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
| | - George Garas
- Department of Otorhinolaryngology and Head and Neck Surgery; St. Mary's Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer; Imperial College London; St. Mary's Hospital Campus London United Kingdom
| | - D. Ceri Davies
- Human Anatomy Unit; Department of Surgery and Cancer; Imperial College London; Charing Cross Hospital Campus London United Kingdom
| | - Neil Tolley
- Department of Otorhinolaryngology and Head and Neck Surgery; St. Mary's Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
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Xu T, Li T, Wei D, Feng Y, Xian L, Wu H, Xu J. Effect of automatic versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: an up-to-date meta-analysis. Sleep Breath 2011; 16:1017-26. [DOI: 10.1007/s11325-011-0626-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 11/20/2011] [Accepted: 11/22/2011] [Indexed: 11/30/2022]
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Abstract
Obstructive Sleep Apnoea (OSA) is increasingly recognised as a condition that not only causes excessive daytime sleepiness, but is also an important cardiovascular risk factor. Treatment of OSA should include conservative measures such as weight loss and positional therapy, the nuances of which are discussed in this article. However this in itself is not sufficient treatment for most patients. The first line of treatment for OSA that is recommended across the entire spectrum of disease is continuous positive airway pressure (CPAP) therapy. Indications for initiating CPAP are discussed, as well as possible alternatives to CPAP such as surgery or dental devices. In initiating CPAP treatment, machine-patient interface needs to be carefully considered, as there is a wide range of masks available. Factors to be considered in the choice of CPAP machine and mode are discussed. Finally, patient-specific factors such as patient acceptance of treatment, common problems encountered in CPAP follow-up and the importance of patient education are addressed.
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Affiliation(s)
- Thun How Ong
- Department of Respiratory and Critical Care Medicine, Sleep Disorders Unit, Singapore General Hospital
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Ball N, Gordon N, Casal E, Parish J. Evaluation of auto bi-level algorithm to treat pressure intolerance in obstructive sleep apnea. Sleep Breath 2010; 15:301-9. [DOI: 10.1007/s11325-010-0381-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 06/04/2010] [Accepted: 06/09/2010] [Indexed: 10/19/2022]
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Current World Literature. Curr Opin Pulm Med 2009; 15:638-44. [DOI: 10.1097/mcp.0b013e3283328a80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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