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Ruan B, Nagappa M, Rashid-Kolvear M, Zhang K, Waseem R, Englesakis M, Chung F. The effectiveness of supplemental oxygen and high-flow nasal cannula therapy in patients with obstructive sleep apnea in different clinical settings: A systematic review and meta-analysis. J Clin Anesth 2023; 88:111144. [PMID: 37172556 DOI: 10.1016/j.jclinane.2023.111144] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/13/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
STUDY OBJECTIVE To evaluate the effectiveness of supplemental oxygen therapy and high-flow nasal cannula (HFNC) therapy in patients with obstructive sleep apnea (OSA) in different clinical settings to assess its application to surgical patients in the postoperative setting. DESIGN A systematic search was conducted on MEDLINE and other databases from 1946 to December 16th, 2021. Title and abstract screening were conducted independently, and the lead investigators resolved conflicts. Meta-analyses were performed using a random-effects model and are presented as mean difference and standardized mean difference with 95% confidence intervals. These were calculated using RevMan 5.4. PATIENTS 1395 and 228 OSA patients underwent oxygen therapy and HFNC therapy respectively. INTERVENTIONS Oxygen therapy and HFNC therapy. MEASUREMENTS Apnea-hypopnea index (AHI), oxyhemoglobin saturation (SpO2), cumulative time with SPO2 < 90% (CT90). MAIN RESULTS Twenty-seven oxygen therapy studies were included in the review, with ten randomized controlled trials (RCT), seven randomized crossovers, seven non-randomized crossovers, and three prospective cohorts. Pooled analyses showed that oxygen therapy significantly reduced AHI by 31% and increased SpO2 by 5% versus baseline, and CPAP significantly reduced AHI by 84%, and increased SpO2 by 3% versus baseline. CPAP was 53% more effective in reducing AHI than oxygen therapy, but both treatments had similar effectiveness in increasing SpO2. Nine HFNC studies were included in the review, with five prospective cohorts, three randomized crossovers, and one RCT. Pooled analyses showed that HFNC therapy significantly reduced AHI by 36% but did not substantially increase SpO2. CONCLUSIONS Oxygen therapy effectively reduces AHI and increases SpO2 in patients with OSA. CPAP is more effective in reducing AHI than oxygen therapy. HFNC therapy is effective in reducing AHI. Although both oxygen therapy and HFNC therapy effectively reduce AHI, more research is needed to draw conclusions on clinical outcomes.
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Affiliation(s)
- Brandon Ruan
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Canada
| | - Mahesh Nagappa
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph Health Care, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Kevin Zhang
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Canada
| | - Rida Waseem
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Canada
| | | | - Frances Chung
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Canada.
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Yan H, Qinghua L, Mengyuan P, Yaoyu C, Long Z, Mengjie L, Xiaosong D, Fang H. High flow nasal cannula therapy for obstructive sleep apnea in adults. Sleep Breath 2021; 26:783-791. [PMID: 34383275 DOI: 10.1007/s11325-021-02453-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Obstructive sleep apnea hypopnea syndrome (OSAHS) is characterized by the aggravation of upper airway constriction or obstruction, and it is associated with high incidence of various metabolic diseases and high mortality. Continuous positive airway pressure (CPAP) is now recommended as the first-line therapy for OSAHS, but its application is limited by its unsatisfactory patient tolerance. Previous studies have showed that high flow nasal cannula (HFNC) may improve symptoms in some patients with OSAHS. Therefore, the aim of the present study was to evaluate the effect of HFNC on OSAHS in a larger cohort than in previous research and to study the details of its therapeutic characteristics. METHODS Polysomnography recording with and without HFNC was performed in 56 OSAHS patients with a wide spectrum of disease severity. Subgroups were divided by different treatment response criteria to identify the effect of this device. RESULTS Of 56 patients enrolled, 9 were of mild severity (AHI, 5 to <15 events/h), 30 were of moderate severity (AHI, 15 to <30 events/h), and 17 patients were severe (AHI ≥ 30 events/h); 34 patients were younger than 50 years old and 22 patients were older than 50 years old. AHI decreased significantly (from 26.9 ± 14.7 to 21.5 ± 17.0 events/h, p < 0.001) after HFNC treatment in general. The subjects of responder group accounted for 21%. There was a negative correlation between the difference of AI and the difference of HI in nonresponder group before and after HFNC treatment, and the negative correlation was strong (Pearson's test, r = - 0.804, p = 0.000). Of the patients with mild to moderate severity, 76% achieved any AHI reduction and 24% of patients achieved at least 50% reduction in AHI. Older patients (the age of responder group 52.6 ± 11.7 vs. nonresponder group 43.7 ± 12.1 years old, p < 0.05), especially patients older than 50 years, had a better response rate (≤ 50 years 9% vs. > 50 years 41%, p = 0.007). CONCLUSION HFNC may be useful in treating patients with OSAHS, especially older patients and those with mild to moderate severity. HFNC may be an alternative treatment when patients are intolerant of CPAP.
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Affiliation(s)
- Hu Yan
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Li Qinghua
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Pi Mengyuan
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Chen Yaoyu
- Department of Pulmonary Diseases and Oncology, Pu'er Hospital of Traditional Chinese Medicine, Pu'er, Yunnan Province, People's Republic of China
| | - Zhao Long
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Li Mengjie
- PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, People's Republic of China
| | - Dong Xiaosong
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China
| | - Han Fang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China.
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Ho CH, Chen CL, Yu CC, Yang YH, Chen CY. High-flow nasal cannula ventilation therapy for obstructive sleep apnea in ischemic stroke patients requiring nasogastric tube feeding: a preliminary study. Sci Rep 2020; 10:8524. [PMID: 32444630 PMCID: PMC7244586 DOI: 10.1038/s41598-020-65335-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/01/2020] [Indexed: 01/14/2023] Open
Abstract
Obstructive sleep apnea (OSA) is associated with increasing risk of recurrent stroke and mortality. Nasogastric tubes used by dysphagic stroke patients may interfere with nasal continuous positive airway pressure (CPAP) due to air leakage. This study was evaluated the effects and short-term tolerability of high-flow nasal cannula (HFNC) therapy for OSA in stroke patients with nasogastric intubation. The HFNC titration study was performed in post-acute ischemic stroke patients with nasogastric intubation and OSA. Then, participants were treated with HFNC therapy in the ward for one week. Eleven participants (eight males) who were all elderly with a median age of 72 (IQR 67-82) years and a body mass index of 23.5 (IQR 22.0-26.6) completed the titration study. The HFNC therapy at a flow rate up to 50~60 L/min significantly decreased the apnea-hypopnea index from 52.0 events/h (IQR 29.9-61.9) to 26.5 events/h (IQR 3.3-34.6) and the total arousal index from 34.6 (IQR 18.6-42.3) to 15.0 (IQR 10.3-25.4). The oxygen desaturation index was also significantly decreased from 53.0 events/h (IQR 37.0-72.8) to 16.2 events/h (IQR 0.8-20.1), accompanied by a significant improvement in the minimum SpO2 level. Finally, only three participants tolerated flow rates of 50~60 L/minute in one-week treatment period. Conclusively, HFNC therapy at therapeutic flow rate is effective at reducing the OSA severity in post-acute ischemic stroke patients with nasogastric intubation. Owing to the suboptimal acceptance, HFNC might be a temporary treatment option, and CPAP therapy is suggested after the nasogastric tube is removed.
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Affiliation(s)
- Chien-Hui Ho
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Chieh Yu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yao-Hung Yang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chung-Yao Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan.
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Obstructive sleep apnoea in adults: peri-operative considerations: A narrative review. Eur J Anaesthesiol 2019; 35:245-255. [PMID: 29300271 DOI: 10.1097/eja.0000000000000765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
: Obstructive sleep apnoea (OSA) is a common breathing disorder of sleep with a prevalence increasing in parallel with the worldwide rise in obesity. Alterations in sleep duration and architecture, hypersomnolence, abnormal gas exchange and also associated comorbidities may all feature in affected patients.The peri-operative period poses a special challenge for surgical patients with OSA who are often undiagnosed, and are at an increased risk for complications including pulmonary and cardiovascular, during that time. In order to ensure the best peri-operative management, anaesthetists caring for these patients should have a thorough understanding of the disorder, and be aware of the individual's peri-operative risk constellation, which depends on the severity and phenotype of OSA, the invasiveness of the surgical procedure, anaesthesia and also the requirement for postoperative opioids.The objective of this review is to educate clinicians in the epidemiology, pathogenesis and diagnosis of OSA in adults and also to highlight specific tasks in the preoperative assessment, namely to select a suitable intra-operative anaesthesia regimen, and manage the extent and duration of postoperative care to facilitate the best peri-operative outcome.
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Fleury Curado T, Oliven A, Sennes LU, Polotsky VY, Eisele D, Schwartz AR. Neurostimulation Treatment of OSA. Chest 2018; 154:1435-1447. [PMID: 30222959 DOI: 10.1016/j.chest.2018.08.1070] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/02/2018] [Accepted: 08/30/2018] [Indexed: 01/04/2023] Open
Abstract
Over the past 30 years, hypoglossal nerve stimulation has moved through a development pathway to become a viable treatment modality for patients with OSA. Initial pilot studies in animals and humans laid the conceptual foundation for this approach, leading to the development of fully implantable stimulating systems for therapeutic purposes. These devices were then shown to be both safe and efficacious in feasibility studies. One such closed-loop stimulating device was found to be effective in treating a limited spectrum of apneic patients and is currently approved by the US Food and Drug Administration for this purpose. Another open-loop stimulating system is currently being rigorously tested in a pivotal trial. Collectively, clinical trials of hypoglossal nerve stimulating systems have yielded important insights that can help optimize therapeutic responses to hypoglossal nerve stimulation. These insights include specific patient selection criteria and methods for delivering stimulation to specific portions of the hypoglossal nerve and/or genioglossus muscle. New approaches for activating efferent and afferent motor pathways are currently in early-stage laboratory development and hold some long-term promise as a novel therapy.
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Affiliation(s)
- Thomaz Fleury Curado
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Otorhinolaryngology, University of São Paulo Medical School, São Paulo, Brazil.
| | - Arie Oliven
- Department of Medicine, Bnai Zion Medical Center, Technion, Haifa, Israel
| | - Luiz U Sennes
- Department of Otorhinolaryngology, University of São Paulo Medical School, São Paulo, Brazil
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Eisele
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, MD
| | - Alan R Schwartz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
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Lee CP, Holmes T, Neri E, Kushida CA. Deception in clinical trials and its impact on recruitment and adherence of study participants. Contemp Clin Trials 2018; 72:146-157. [PMID: 30138717 DOI: 10.1016/j.cct.2018.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/27/2018] [Accepted: 08/14/2018] [Indexed: 11/27/2022]
Abstract
Deceptive practices by participants in clinical research are prevalent. It has been shown that as high as 75% of participants withheld information to avoid exclusion from studies. Self-reported adherence has been found to be largely inaccurate. Overcoming deception is a critical issue, since the safety of study participants, the integrity of research data and research resources are at risk. In this review article, we examine deception from the perspective of investigators conducting clinical trials; we describe the types (concealment, fabrication, drug holidays and collusion), prevalence, risks, and predictors of deception, and propose an approach to reduce the impact of deception, especially on adherence, in clinical trials.
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Affiliation(s)
- Chuen Peng Lee
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.
| | - Tyson Holmes
- Stanford University Human Immune Monitoring Center, Institute for Immunity Transplantation and Infection, Stanford University School of Medicine, Stanford, United States
| | - Eric Neri
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Clete A Kushida
- Stanford Sleep Medicine Center, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 450 Broadway Street, MC 5704, Pavilion C, 2nd Floor, Redwood City, CA 94063-5704, United States
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Kirkness JP, Sowho M, Murano E. The interplay between tongue tissue volume, hyoid position, and airway patency. Sleep 2014; 37:1585-6. [PMID: 25197803 DOI: 10.5665/sleep.4060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 12/23/2022] Open
Affiliation(s)
- Jason P Kirkness
- Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mudiaga Sowho
- Johns Hopkins Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Emi Murano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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