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Bentan MA, Moffatt D, Dawood E, Nord R. Addressing the gaps: What social media tells us about patient experiences with hypoglossal nerve stimulation. Am J Otolaryngol 2024; 45:104419. [PMID: 39053310 DOI: 10.1016/j.amjoto.2024.104419] [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: 05/30/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE Hypoglossal nerve stimulation (HNS) can be an effective treatment for moderate to severe obstructive sleep apnea (OSA) in positive airway pressure (PAP) intolerant patients. To better understand patient perceptions of HNS therapy, we explored three Facebook groups pertaining to HNS therapy. MATERIALS AND METHODS A retrospective analysis of Facebook posts from three HNS-related Facebook groups, from October 1, 2022 to October 1, 2023, was performed. Posts were analyzed for author attitude, content (adverse events, inquiries, or sharing information), and the inclusion of media within the post. RESULTS From 737 Facebook posts, 752 events were identified, predominantly authored by patients or family (99.5 %). Few posts included media attachments (7.3 %), primarily photos (85.5 %). Post tone was mainly neutral (79.4 %), rather than positive (12.9 %) or negative (7.7 %). Most posts (53.6 %) were queries to the Facebook group, as opposed to sharing information (28.9 %) or detailing adverse events (17.6 %). Notably queries posed by Facebook group members included those pertaining to the postoperative recovery course (10.17 %), physical activity restrictions (6.20 %), HNS therapy eligibility (4.71 %), financial considerations (4.22 %), and more. CONCLUSION Overall, Facebook group members reported a predominantly neutral tone, typically posting queries to the group rather than sharing information or detailing adverse events. These findings illustrate how diverse data sources, such as social media, can enhance our understanding of patient experiences and identify gaps in patient education with HNS therapy.
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Affiliation(s)
- Mihai A Bentan
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University School of Medicine, PO Box 980146, Richmond, VA 23298-0146, United States of America.
| | - David Moffatt
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University School of Medicine, PO Box 980146, Richmond, VA 23298-0146, United States of America
| | - Emaan Dawood
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University School of Medicine, PO Box 980146, Richmond, VA 23298-0146, United States of America
| | - Ryan Nord
- Department of Otolaryngology - Head & Neck Surgery, Virginia Commonwealth University School of Medicine, PO Box 980146, Richmond, VA 23298-0146, United States of America
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Wollny M, Heiser C, Sommer U, Schöbel C, Braun M. Adverse Events with Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea-A Systematic Review of Clinical Trials and Real-World Data. J Clin Med 2024; 13:4282. [PMID: 39124549 PMCID: PMC11313308 DOI: 10.3390/jcm13154282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/17/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Hypoglossal nerve stimulation (HNS) emerged as an alternative treatment for patients with obstructive sleep apnea (OSA) a decade ago. Long-term clinical trials and real-world data show that HNS treatment provides significant and sustained improvements in both OSA disease control and quality-of-life measures over time. Given the nature of HNS treatment, with the requirement of using an implantable neurostimulation system, patient safety is a critical domain in the assessment of this technology. The objective of this review was to evaluate adverse events (AEs) and complications with HNS therapy in a systematic review of published evidence. Methods: Medline, Cochrane, and Web of Science were systematically searched to identify randomized controlled and real-world observational studies reporting relevant outcomes with HNS therapy for treatment of OSA that included procedure-, device-, and treatment-related AEs. Results: Out of 418 articles screened, 27 were reviewed for eligibility, and 17 studies, the majority found to have low-to-moderate risk of bias, with data on 1962 patients were included for further analysis. Across included studies, reporting of AEs was heterogeneous with regard to the classifications used and the extent of reporting. Over an average follow-up duration of 17.5 ± 16.9 months, the pooled mortality rate was 0.01% (95% CI = 0.0 to 0.2%), with all reported deaths being unrelated to HNS treatment. The HNS system survival probability over the follow-up time of 60 months was 0.9834 (95% CI = 0.9768 to 0.9882), with infections and request for removal by patients being the most common indications. The pooled surgical revision rate was 0.08% (95% CI 0.0 to 0.2%). Most reported treatment-related side effects were transient stimulation-related discomfort (0.08%, 95% CI = 0.0 to 0.2%) and tongue abrasions (0.07%, 95% CI = 0.0 to 0.2%). Based on the systematic review, a standardized set of endpoints was defined, aiming to harmonize safety data relevant to HNS therapy. Conclusions: In this systematic review, HNS therapy for treatment of OSA is associated with a positive patient safety profile. AEs occur mainly at device implantation and during the treatment acclimatization period. Due to a lack of available evidence, partially implantable HNS systems are underrepresented in this review, which limits the generalizability of the results. Significant heterogeneity was found for adverse event reporting. A framework for reporting HNS outcomes that includes AEs and side effects is proposed to facilitate comparability of the reported data.
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Affiliation(s)
| | - Clemens Heiser
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, 80539 München, Germany
- ENT-Center Mangfall-Inn, 83043 Bad Aibling, Germany
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
| | - Ulrich Sommer
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, 80539 München, Germany
- ENT-Center Mangfall-Inn, 83043 Bad Aibling, Germany
| | - Christoph Schöbel
- Department of Pneumology, University Medicine Essen—Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, 45141 Essen, Germany
- Faculty of Sleep and Telemedicine, University Medicine Essen—Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, 45141 Essen, Germany
| | - Marcel Braun
- Department of Pneumology, University Medicine Essen—Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, 45141 Essen, Germany
- Faculty of Sleep and Telemedicine, University Medicine Essen—Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, 45141 Essen, Germany
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Wesson T, Rone V, Ramirez M, Manchanda S, Stahl S, Chernyak Y, Parker N. Outcome Reporting in Prospective Studies Evaluating Neurostimulation for Obstructive Sleep Apnea. Laryngoscope 2024. [PMID: 38994886 DOI: 10.1002/lary.31630] [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: 04/01/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE Due to the controversy surrounding the appropriate outcomes in neurostimulation, we sought to systematically describe ways in which polysomnography and apnea-hypopnea index are reported in prospective studies involving unilateral hypoglossal nerve stimulation. DATA SOURCES MEDLINE (Ovid), Embase (Ovid), Cochrane Library, and Scopus. REVIEW METHODS Following the Preferred Reporting items of Systematic Reviews and Meta-analysis (PRISMA) Statement guidelines, a systematic two-reviewer system was used for study screening and quality assessment. Articles that met inclusion criteria were included. Quality was evaluated with either the Newcastle-Ottawa Quality Assessment Scale or the Covidence risk-of-bias tool. RESULTS Fifteen studies met the inclusion criteria, which included 14 prospective cohort studies and one randomized controlled trial. Titration polysomnography was the primary sleep study used to acquire data in five of the studies compared to only three studies employing exclusively non-titration polysomnography to report outcomes. Three studies compiled data from two or more sleep studies to report a single apnea-hypopnea index. Within the 15 studies, non-titration apnea-hypopnea index was the most reported type (five studies). Titration apnea-hypopnea index was used to report outcomes in one study. Five studies did not specify what type of apnea-hypopnea index was employed to report treatment effectiveness. CONCLUSION The reported sleep studies and corresponding apnea-hypopnea indices were highly variable across the studies. Because of the high degree of heterogeneity, future research would benefit from consistent use of a standardized apnea-hypopnea index to report outcomes related to hypoglossal nerve stimulation. LEVEL OF EVIDENCE NA Laryngoscope, 2024.
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Affiliation(s)
- Troy Wesson
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Victoria Rone
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Mirian Ramirez
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Shalini Manchanda
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
- Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Stephanie Stahl
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Yelena Chernyak
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Noah Parker
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
- Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
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Habetha S, Sauermann S, Müller S, Gottschalk G. [Ten years of hypoglossal nerve stimulation in obstructive sleep apnea: a systematic literature review]. Pneumologie 2024. [PMID: 38914119 DOI: 10.1055/a-2331-8978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
OBJECTIVE To show the importance of hypoglossal nerve stimulation (HGNS) as a treatment method for obstructive sleep apnea (OSA) in the German healthcare context and to better assess the way patients who do not receive adequate care could benefit from HGNS. METHODS A systematic literature review in the Medline and Cochrane Library literature database was conducted, including publications using different stimulation technologies for HGNS. The efficacy of HGNS was assessed based on patient-relevant outcomes (daytime sleepiness, quality of life), treatment adherence and the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). The safety of the treatment method was assessed based on adverse events (AEs). RESULTS Inclusion and analysis of 33 publications: 2 randomized controlled trials (RCTs, level Ib), 1 level IIb trial (n = 1) and 30 level IV trials with a study duration of up to 60 months. The RCTs showed better values for daytime sleepiness and quality of life when using HGNS than in the control group. AHI and ODI showed a deterioration under placebo stimulation or therapy withdrawal in the RCTs. Consistently high adherence was also reported in the long-term course. Severe AEs under HGNS were rare and could usually be resolved by repositioning electrodes or replacing device components. Other AEs were mostly transient or could be resolved by non-invasive measures. All investigated parameters showed similar results in the evaluated studies. The results of different stimulation systems are comparable in type and extent. CONCLUSION The comprehensive review of the literature shows consistent data that highlight the importance of HGNS as an effective and safe treatment for OSA after unsuccessful CPAP treatment. The evaluation also shows that the different stimulation systems make it possible to better tailor the therapy to the patient's individual requirements. A future systematic evaluation of real-world data on the use of HGNS would help gain additional insights into the relevance of the method in routine clinical practice.
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Bentan MA, Dawood E, Moffatt D, Suurna MV, Nord R. Are There Hidden Adverse Events in Hypoglossal Nerve Stimulation: Comparing Social Media and a Federal Database. Laryngoscope 2024. [PMID: 38888060 DOI: 10.1002/lary.31589] [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: 02/24/2024] [Revised: 05/21/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE Hypoglossal nerve stimulation (HNS) can be an effective treatment for moderate to severe obstructive sleep apnea (OSA) in positive airway pressure (PAP) intolerant patients. To better understand patient experiences with HNS therapy, we explored reported events from HNS-related Facebook groups and the Manufacturer and User Facility Device Experience (MAUDE) database. METHODS A retrospective analysis of HNS-related Facebook posts from three groups pertaining to HNS therapy, from October 1, 2022 to October 1, 2023, was performed. Posts were analyzed for patient-reported adverse events. Concurrently, the MAUDE database was reviewed for HNS-related events during the same timeframe. RESULTS From 737 Facebook posts, 132 (17.55%) adverse events were identified. Adverse events included pain (34.85%), stimulation discomfort (14.39%), lip weakness (6.82%) and issues related to lead tethering or tight leads around the neck (3.79%). Analysis of the MAUDE database found 428 adverse events, including pain (24.07%), lip weakness (0.44%), and lead tethering (1.64%). CONCLUSION Facebook group members reported higher rates of lip weakness and lead tethering than recorded in the MAUDE database. These findings illustrate how diverse data sources, such as social media, can enhance our understanding of patient experiences and identify gaps in patient education with HNS therapy. LEVEL OF EVIDENCE NA Laryngoscope, 2024.
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Affiliation(s)
- Mihai A Bentan
- Department of Otolaryngology-Head & Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Emaan Dawood
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A
| | - David Moffatt
- Department of Otolaryngology-Head & Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Maria V Suurna
- Department of Otolaryngology-Head & Neck Surgery, University of Miami, Miami, Florida, U.S.A
| | - Ryan Nord
- Department of Otolaryngology-Head & Neck Surgery, Virginia Commonwealth University, Richmond, Virginia, U.S.A
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Mackay SG, Every JD. Advances in Pharyngeal Surgery Over the Past 10 Years: New Techniques and Technology. Otolaryngol Clin North Am 2024; 57:501-510. [PMID: 38521723 DOI: 10.1016/j.otc.2024.02.009] [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] [Indexed: 03/25/2024]
Abstract
This article is a review of advances in pharyngeal surgery over the past 10 years regarding literature, surgical technique, assessment, collaboration, and future direction in the management of adult and pediatric obstructive sleep apnea.
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Affiliation(s)
- Stuart G Mackay
- Department of Otolaryngology, Head and Neck Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia; School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra ENT Head and Neck Clinic, 8-10 Victoria Street, Wollongong, New South Wales 2500, Australia
| | - James D Every
- Department of Otolaryngology, Head and Neck Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia; School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.
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Meisgeier A, Dürrschnabel F, Pienkohs S, Weiser A, Neff A. Cephalometric Screening Assessment for Superior Airway Space Narrowing-Added Value of Three-Dimensional Imaging. J Clin Med 2024; 13:2685. [PMID: 38731214 PMCID: PMC11084779 DOI: 10.3390/jcm13092685] [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: 03/23/2024] [Revised: 04/19/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Assessing the morphology of the superior airway space is a crucial diagnostic step in the treatment planning of patients with obstructive sleep apnea syndrome (OSAS) or prior to orthognathic surgery. The aim of this study is to evaluate the necessary scope of a two-dimensional cephalometric assessment and the necessity of three-dimensional imaging in the identification of superior airway space narrowing (SASN). Methods: The computed tomography studies of 100 non-obese, non-OSAS patients were evaluated and analyzed retrospectively. Multiplanar reconstructions were created and underwent cephalometric evaluation. The three-dimensional superior airway morphology was segmented and measured for the minimal cross-sectional area (Amin) and volume (V0). Patients were grouped according to Amin < 80 mm2 and V0 < 12 cm3. Cephalometric parameters (CPs) were analyzed according to Amin and V0 with an unpaired t-test, Pearson correlation, and ROC-curve analysis. Results: The CPs regarding sagittal airway space dimensions (IPAS, MPAS, SPAS) and mandibular body length (GoGn) show the strongest correlation to the three-dimensional minimal cross-sectional area (Amin). The ROC-curve analysis classifying for SASN led to an AUC of 0.86 for IPAS, 0.87 for MPAS, 0.88 for SPAS, and 0.63 for GoGn. Three-dimensional imaging may further improve the diagnostic accuracy in the identification of SASN for IPAS below 13.5 mm, MPAS below 10.2 mm, SPAS below 12.5 mm, and GoGn below 90.2 mm. Conclusions: Two-dimensional cephalometric sagittal airway space diameters and mandibular body length are useful initial screening parameters in the identification of superior airway space narrowing. Nevertheless, as the correlation of two-dimensional cephalometric parameters with three-dimensional upper airway space narrowing is varying and highly dependent on acquisition circumstances, indications for three-dimensional imaging, if possible, in the supine position to evaluate upper airway space morphology should be provided generously, especially in patients with low but normal airway space parameters in two-dimensional cephalometry.
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Affiliation(s)
- Axel Meisgeier
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
| | - Florian Dürrschnabel
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
| | - Simon Pienkohs
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
| | - Annabell Weiser
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, 35043 Marburg, Germany; (F.D.); (S.P.); (A.W.); (A.N.)
- Faculty of Medicine, Philipps University, 35043 Marburg, Germany
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Braun M, Wollny M, Schoebel C, Sommer JU, Heiser C. Patient-reported experience with hypoglossal nerve stimulation in the treatment of obstructive sleep apnea. Sleep Breath 2024; 28:221-230. [PMID: 37542679 PMCID: PMC10955022 DOI: 10.1007/s11325-023-02887-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Breathing-synchronized hypoglossal nerve stimulation (HNS) is routinely used as an alternative treatment for patients with obstructive sleep apnea (OSA). Significant and clinically relevant improvements in disease severity and OSA symptoms such as daytime sleepiness as well as overall quality of life have been reported in randomized-controlled trials and large real-world cohort studies. However, so far, few data exist on patient-reported experience with the treatment. METHODS A structured survey with 22 questions was constructed using five-level Likert scales (1 = no agreement, 5 = complete agreement) to evaluate patient experience with HNS and perception of the treatment in the domains "Overall experience with therapy," "Experience with treatment process," and "Side-effects from treatment." Additional data were collected on current symptom status, measured with Epworth sleepiness scale (ESS) questionnaire, and OSA disease history. Multiple linear regression analysis was conducted to test associations of medical variables and response behavior. Correlations between variables and domains, as well as individual items, were assessed using Spearman rank test. RESULTS A total of 75 patients from Germany who were treated with breathing-synchronized HNS were enrolled (mean age 57.3 years, 78% male), and 71 questionnaires with complete data were included for analysis. Two-thirds of participants (67%) had a history of OSA history for 5 years or longer. Of all patients, 76% had normalized OSA symptoms at time of the study (ESS: 6.4 ± 5.0) and 98% reported using stimulation therapy every night. Regression analysis revealed an association of current symptoms measured with ESS and response behavior. Hence, patients with normalized daytime sleepiness reported significantly more positive experience across all domains assessed, compared to patients with residual daytime sleepiness. Overall, only 2% of participants reported side effects that made them reduce or discontinue stimulation therapy. The rate of reported side effects was associated with current symptom control under therapy. CONCLUSIONS Overall patient-reported experience with breathing-synchronized HNS therapy was positive and high satisfaction with the treatment process was observed. Side effects occurred, but rarely affected subjective use of the therapy or satisfaction. Subjective experience and perception are influenced by residual daytime sleepiness with stimulation therapy.
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Affiliation(s)
- M Braun
- Department of Pneumology, University Medicine Essen - Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Duisburg, Germany.
- Faculty of Sleep and Telemedicine, University Medicine Essen - Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Duisburg, Germany.
| | - M Wollny
- MedImbursement, Tarmstedt, Germany
| | - C Schoebel
- Department of Pneumology, University Medicine Essen - Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Duisburg, Germany
- Faculty of Sleep and Telemedicine, University Medicine Essen - Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Duisburg, Germany
| | - J U Sommer
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- ENT-Center Mangfall-Inn, Bad Aibling, Germany
| | - C Heiser
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Freeman CG, Durgham R, Ren E, Conti KR, Yeakel H, Fan T, Brown DM, Ohlstein JF, Keeler JA. The Impact of Hypoglossal Nerve Stimulation on Secondary Health Outcomes. EAR, NOSE & THROAT JOURNAL 2024:1455613241235538. [PMID: 38424691 DOI: 10.1177/01455613241235538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep disorder that can increase the risk of hypertension, diabetes, obesity, and cardiovascular diseases. Hypoglossal nerve stimulation (HGNS) is an alternative therapy for OSA in patients who cannot tolerate continuous positive airway pressure. Understanding the impact of HGNS on blood pressure, hemoglobin A1C (A1C), and body mass index (BMI) currently remains limited. Methods: A retrospective review study of HGNS outcomes at a single practice from January 2020 to November 2022 was conducted. Inclusion/exclusion criteria were based on HGNS eligibility and postoperative titration study. Statistical analysis and data management were performed using statistical software, R (v.4.2.1; R Core Team). Paired Student's T test, Fisher's exact test, and McNemar's exact test were utilized for statistical analysis. P values less than .05 were considered statistically significant. Results: Sixty-three patients were included in this study. A significant decrease in mean apnea-hypopnea index was noted following HGNS (mean change -28; P < .0001). Similar significant decreases were also seen in mean arterial pressures (mean change -8.4, P < .0001). There was a significant change in overall antihypertensive medication requirements and in requirements ≥3 medications (P < .0005, P = .03). There was a trend toward reduction in A1C; however, there was no change in BMI or number of diabetes medications taken. Conclusions: Our results reinforce previous findings that HGNS is an effective treatment option for carefully selected patients with OSA. In addition, our findings suggest that HGNS may improve patients' quality of life while minimizing OSA associated morbidity.
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Affiliation(s)
- Cecilia G Freeman
- Department of Otolaryngology-Head and Neck Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Ryan Durgham
- Temple/St. Luke's School of Medicine, Bethlehem, PA, USA
| | - Emily Ren
- Temple/St. Luke's School of Medicine, Bethlehem, PA, USA
| | - Keith R Conti
- Department of Otolaryngology-Head and Neck Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Heather Yeakel
- Department of Otolaryngology-Head and Neck Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Timothy Fan
- Department of Otolaryngology-Head and Neck Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - David M Brown
- Department of Otolaryngology-Head and Neck Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
- Specialty Physician Associates, Bethlehem, PA, USA
| | - Jason F Ohlstein
- Department of Otolaryngology-Head and Neck Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
- Specialty Physician Associates, Bethlehem, PA, USA
| | - Jarrod A Keeler
- Department of Otolaryngology-Head and Neck Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
- Specialty Physician Associates, Bethlehem, PA, USA
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Ryan MT, Coulter M, Kim J, Noller M, Mack D, Huuki E, Riley CA, Tolisano AM. Hypoglossal Nerve Stimulator in the Active Duty Population: Military Readiness and Satisfaction. Mil Med 2024; 189:475-480. [PMID: 36892849 DOI: 10.1093/milmed/usad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/13/2023] [Accepted: 02/24/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Because inadequate sleep impairs mission performance, the U.S. Army regards sleep as a core pillar of soldier readiness. There is an increasing incidence of obstructive sleep apnea (OSA) among active duty (AD) service members, which is a disqualifying condition for initial enlistment. Moreover, a new diagnosis of OSA in the AD population often prompts a medical evaluation board, and if symptomatic OSA proves refractory to treatment, this may result in medical retirement. Hypoglossal nerve stimulator implantation (HNSI) is a newer implantable treatment option, which requires minimal ancillary equipment to function and may provide a useful treatment modality to support AD service members while maintaining readiness in appropriate candidates. Because of a perception among AD service members that HNSI results in mandatory medical discharge, we aimed to evaluate the impact of HNSI on military career progression, maintenance of deployment readiness, and patient satisfaction. METHODS The Department of Research Programs at the Walter Reed National Military Medical Center provided institutional review board approval for this project. This is a retrospective, observational study and telephonic survey of AD HNSI recipients. Military service information, demographics, surgical data, and postoperative sleep study results were collected from each patient.Additional survey questions assessed each service member's experience with the device. RESULTS Fifteen AD service members who underwent HNSI between 2016 and 2021 were identified. Thirteen subjects completed the survey. The mean age was 44.8 years (range 33-61), and all were men. Six subjects (46%) were officers. All subjects maintained AD status following HNSI yielding 14.5 person-years of continued AD service with the implant. One subject underwent formal assessment for medical retention. One subject transferred from a combat role to a support role. Six subjects have since voluntarily separated from AD service following HNSI. These subjects spent an average of 360 (37-1,039) days on AD service. Seven subjects currently remain on AD and have served for an average of 441 (243-882) days. Two subjects deployed following HNSI. Two subjects felt that HSNI negatively affected their career. Ten subjects would recommend HSNI to other AD personnel. Following HNSI, of the eight subjects with postoperative sleep study data, five achieved surgical success defined as >50% reduction of apnea-hypopnea index and absolute apnea-hypopnea index value of <20. CONCLUSIONS Hypoglossal nerve stimulator implantation for AD service members offers an effective treatment modality for OSA, which generally allows for the ability to maintain AD status, however: The impact on deployment readiness should be seriously considered and tailored to each service member based on their unique duties before implantation. Seventy-seven percent of HNSI patients would recommend it to other AD service members suffering from OSA.
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Affiliation(s)
- Matthew T Ryan
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Michael Coulter
- Department of Otolaryngology Head and Neck Surgery, Naval Medical Center, San Diego, CA 92134, USA
| | - Jeeho Kim
- N9 Medical, Navy Operation Support Center, Washington DC, Joint Base Andrews, MD 20762, USA
| | - Michael Noller
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Douglas Mack
- Department of Otolaryngology Head and Neck Surgery, Brook Army Medical Center, San Antonio, TX 78234, USA
| | - Elizabeth Huuki
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Charles A Riley
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Anthony M Tolisano
- Department of Otolaryngology Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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11
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Jacobowitz O, Afifi L, Alkan U, Penzel T, Poyares D, Kushida C. Endorsement of "European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea" by World Sleep Society. Sleep Med 2024; 113:293-298. [PMID: 38086250 DOI: 10.1016/j.sleep.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 01/07/2024]
Abstract
Guidelines for management of sleep disorders from national or regional societies provide recommendations that may be regionally appropriate but may not always be practical or relevant in other parts of the world. A task force of experts from the World Sleep Society's (WSS) International Sleep Medicine Guidelines Committee and Sleep and Breathing Disorders Task Force reviewed the European Respiratory Society's guideline on non-CPAP therapies for obstructive sleep apnea (OSA) with respect to its relevance and applicability to the practice of sleep medicine by sleep specialists in various regions of the world. The task force and the WSS guidelines committee endorsed the European Respiratory Society's guideline with respect to the utilization of bariatric surgery, mandibular advancement devices, positioning devices, myofunctional therapy, hypoglossal neurostimulation, maxilo-mandibular surgery, and carbonic anhydrase inhibitors for the treatment of OSA. The task force and the WSS guidelines committee noted that there is substantial new evidence for the role of soft tissue, upper airway surgery, not included in the guidelines paper.
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Affiliation(s)
- Ofer Jacobowitz
- Sleep Department, ENT and Allergy Associates, New York, NY, USA.
| | - Lamia Afifi
- Clinical Neurophysiology, School of Medicine, Cairo University, Egypt
| | - Uri Alkan
- Department of Otorhinolaryngology - Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charite Universitatsmedizin Berlin, Germany
| | - Dalva Poyares
- Psychobiology Department, Sleep Medicine Division, Universidade Federal de Sao Paulo, Brazil
| | - Clete Kushida
- Sleep Clinic and Center for Human Sleep Research, Stanford University School of Medicine, Redwood City, CA, USA
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12
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Gadodia R, Nandamuru D, Akberzie W, Kataria L. Sleep Disorders and Aging in Women. Sleep Med Clin 2023; 18:545-557. [PMID: 38501526 DOI: 10.1016/j.jsmc.2023.06.017] [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] [Indexed: 03/20/2024]
Abstract
Women of advancing age can suffer from an array of sleep disorders. We review the changes in sleep architecture, the impact of hormonal changes on sleep, and the various sleep disorders in women of advancing age. A focused history in this population should include the temporal relation to menopause and comorbid conditions. Treatment options should involve patient preference and review of current medications and comorbid conditions to optimize sleep in this population.
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Affiliation(s)
- Ritika Gadodia
- Department of Medicine, Medstar Washington Hospital Center, 110 Irving Street Northwest, Washington, DC 20010, USA
| | - Deepika Nandamuru
- Department of Neurology, George Washington University School of Medicine, GW Medical Faculty Associates, 2150 Pennsylvania Avenue Northwest, Washington, DC 20037, USA
| | - Wahida Akberzie
- Department of Primary Care Medicine, Primary Care Service, Martinsburg VA Medical Center, 510 Butler Avenue, Martinsburg, WV 25405, USA
| | - Lynn Kataria
- Sleep Laboratory, Washington DC VA Medical Center, George Washington University School of Medicine, 3rd Floor, 50 Irving Street Northwest, Washington, DC 20422, USA.
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13
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Hardin L. Hypoglossal nerve stimulation for adults with obstructive sleep apnea. JAAPA 2023; 36:24-29. [PMID: 37989167 DOI: 10.1097/01.jaa.0000991392.37494.b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
ABSTRACT Obstructive sleep apnea (OSA) is a common chronic condition in which upper airway collapse interferes with breathing during sleep, reducing sleep quality. Untreated OSA can impair a patient's health and quality of life. The recommended first-line treatment for OSA in adults is positive airway pressure, but difficulty tolerating this device limits adherence to treatment for many patients. Treatment with an implanted hypoglossal nerve stimulation (HNS) device is a relatively new second-line option for these patients, and is gaining more widespread use. Clinicians who treat OSA or provide other healthcare services to patients with HNS implants should be familiar with these devices. This article reviews HNS technology and relevant OSA pathophysiology, along with device candidacy criteria, efficacy, risks, and considerations related to use of other medical technologies for patients with HNS implants.
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Affiliation(s)
- Laura Hardin
- Laura Hardin practices in otolaryngology at Texas ENT Specialists in Houston, Tex. The author has disclosed no potential conflicts of interest, financial or otherwise
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14
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Braun M, Stoerzel M, Wollny M, Schoebel C, Ulrich Sommer J, Heiser C. Patient-reported outcomes with hypoglossal nerve stimulation for treatment of obstructive sleep apnea: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:4627-4639. [PMID: 37354340 PMCID: PMC10477259 DOI: 10.1007/s00405-023-08062-1] [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] [Received: 03/23/2023] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Hypoglossal nerve stimulation (HNS) has recently been introduced as an alternative treatment for patients with OSA. A large number of studies have demonstrated substantial changes in OSA with this therapy by reducing respiratory events and improving symptoms such as daytime sleepiness and quality of life. The objective of this review was to conduct a systematic review and meta-analysis to evaluate patient-reported outcomes and experience with HNS therapy. METHODS A systematic literature search of MEDLINE, Cochrane, and Web of Science was performed to identify randomized controlled and observational studies reporting subjective outcomes with different HNS systems in patients with OSA. Abstracts of 406 articles were screened and a subset of 55 articles were reviewed for eligibility. Risk of bias was assessed using the ROBINS-I tool. Meta-analysis using RevMan was performed when > 2 studies were identified that reported data on a specific outcome. RESULTS Thirty-four publications reporting data on 3785 patients with a mean follow-up of 11.8 ± 12.2 months were identified and included in the meta-analysis. The analysis revealed a pooled effect of 4.59 points improvement in daytime sleepiness as measured by the ESS questionnaire (Z = 42.82, p < .001), 2.84 points improvement in daytime functioning as measured by the FOSQ score (Z = 28.38, p < .001), and 1.77 points improvement in sleep quality as measured by the PSQI questionnaire (Z = 2.53, p = .010). Patient-reported experience was consistently positive and revealed additional relevant aspects from this perspective. CONCLUSION HNS therapy significantly improves quality of life in patients with OSA and reliably produces clinically meaningful effects on daytime sleepiness, daytime functioning, and sleep quality. Treatment regularly meets or exceeds the minimum clinically important differences defined for the respective instruments. Additional research is needed to further investigate effects on quality of life beyond improvements in daytime sleepiness and daytime functioning.
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Affiliation(s)
- Marcel Braun
- Department of Pneumology, University Medicine Essen - Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Duisburg, Germany.
- Faculty of Sleep and Telemedicine, University Medicine Essen - Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Tueschener Weg 40, 45239, Essen, Germany.
| | - Manuel Stoerzel
- German Cancer Research Center (DKFZ), Heidelberg, BW, Germany
| | | | - Christoph Schoebel
- Department of Pneumology, University Medicine Essen - Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Duisburg, Germany
- Faculty of Sleep and Telemedicine, University Medicine Essen - Ruhrlandklinik, West German Lung Center, University Duisburg-Essen, Tueschener Weg 40, 45239, Essen, Germany
| | - J Ulrich Sommer
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- ENT-Center Mangfall-Inn, Bad Aibling, Germany
| | - Clemens Heiser
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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15
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Colvin L, Collop N, Lorenz R, Morgenthaler T, Weaver TE. Examining the feasibility of adult quality-of-life measurement for obstructive sleep apnea in clinical settings: what is the path forward for sleep centers? J Clin Sleep Med 2023; 19:1145-1155. [PMID: 36692175 PMCID: PMC10235705 DOI: 10.5664/jcsm.10438] [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: 08/15/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 01/25/2023]
Abstract
Quality of life (QoL) is one of the outcomes that can be measured as a component of the required standards for sleep facility accreditation by the American Academy of Sleep Medicine. Utilization of a psychometrically robust QoL instrument is recommended; however, clinicians face a challenge balancing psychometric properties with questionnaire completion and scoring characteristics. This article provides an overview of common QoL instruments as a reference for clinicians when selecting a QoL tool for use in the clinical setting for adult patients with obstructive sleep apnea. CITATION Colvin L, Collop N, Lorenz R, Morgenthaler T, Weaver TE. Examining the feasibility of adult quality-of-life measurement for obstructive sleep apnea in clinical settings: what is the path forward for sleep centers? J Clin Sleep Med. 2023;19(6):1145-1155.
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Affiliation(s)
| | - Nancy Collop
- Emory Sleep Center, Emory University, Atlanta, Georgia
| | - Rebecca Lorenz
- University at Buffalo School of Nursing, Buffalo, New York
| | | | - Terri E. Weaver
- University of Illinois Chicago College of Nursing, Chicago, Illinois
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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17
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Hillman DR. Getting into shape: the tongue and hypoglossal nerve stimulation. J Clin Sleep Med 2023; 19:855. [PMID: 36856066 PMCID: PMC10152342 DOI: 10.5664/jcsm.10550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/02/2023]
Affiliation(s)
- David R. Hillman
- Centre for Sleep Science, School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
- West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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18
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Gusman E, Standlee J, Reid KJ, Wolfe LF. Work-Related Sleep Disorders: Causes and Impacts. Semin Respir Crit Care Med 2023; 44:385-395. [PMID: 37072022 DOI: 10.1055/s-0043-1767787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Insufficient sleep syndrome, shift work disorder, and obstructive sleep apnea (OSA) not only significantly impact the health of affected individuals, but also pose a threat to public safety. This article describes the clinical manifestations and impact of these sleep disorders, particularly as they pertain to workers' health and those with safety-sensitive positions. Sleep deprivation, circadian rhythm disruptions, and excessive daytime sleepiness-hallmarks of insufficient sleep, shift work disorder, and OSA, respectively-all lead to a series of cognitive deficits and impaired concentration that affect workers in a wide variety of fields. We describe the health consequences of these disorders along with treatment strategies, with a focus on current regulatory standards and the under-recognition of OSA in commercial drivers. Given its large scale, there is a need for improved guidelines and regulations for the screening, diagnosis, treatment, and long-term follow-up of OSA in commercial motor vehicle drivers. Increased recognition of the ways in which these sleep disorders impact workers will pave the way for significant improvements in occupational health and safety.
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Affiliation(s)
- Elen Gusman
- Department of Pulmonary and Critical Care Medicine, Northwestern Medicine, Chicago, Illinois
| | - Jordan Standlee
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Kathryn J Reid
- Department of Neurology, Division of Sleep Medicine, Northwestern Medicine, Chicago, Illinois
- Center for Circadian and Sleep Medicine, Northwestern Medicine, Chicago, Illinois
| | - Lisa F Wolfe
- Department of Pulmonary and Critical Care Medicine, Northwestern Medicine, Chicago, Illinois
- Department of Neurology, Division of Sleep Medicine, Northwestern Medicine, Chicago, Illinois
- Center for Circadian and Sleep Medicine, Northwestern Medicine, Chicago, Illinois
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19
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Brooks JK, Parsa A, Price JB. Hypoglossal nerve stimulator on extraoral radiography and cone beam computed tomography scan: Case report. Cranio 2023:1-4. [PMID: 36946617 DOI: 10.1080/08869634.2023.2188849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND The hypoglossal nerve stimulator (HNS) device has been employed in some patients with refractory or unsatisfactory outcomes to chronic obstructive sleep apnea management. The objective of this article is to increase recognition of the radiologic appearances of this device within the head and neck region, as seen on extraoral radiographic and cone beam computed tomography (CBCT) images. CLINICAL PRESENTATION A 55-year-old man, refractory to a multitude of apneic medical therapies, underwent a series of preorthognathic radiologic studies. Notably, an implanted HNS lead and ribbon electrodes appeared as hyperdense structures on the panoramic radiograph, lateral cephalogram, and CBCT scan. CONCLUSION This article provides various radiologic views of the primary components of an HNS. Clinicians should be able to recognize the presence of neurostimulator devices used for management of chronic sleep apnea within the radiologic field of view of examinations of the head and neck.
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Affiliation(s)
- John K Brooks
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Azin Parsa
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Jeffery B Price
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
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20
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Renslo B, Hobelmann K, Sagalow ES, Ananth A, Boon M, Huntley C. Palatal Coupling Maneuvers Do Not Predict Hypoglossal Nerve Stimulator Treatment Efficacy. Laryngoscope 2023; 133:431-436. [PMID: 36129159 DOI: 10.1002/lary.30397] [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: 04/16/2022] [Revised: 08/01/2022] [Accepted: 09/01/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE(S) Maneuvers during drug-induced sleep endoscopy (DISE), for patients with obstructive sleep apnea (OSA), have been used as predictors for success with oral appliances. Hypoglossal nerve stimulation (HGNS) promotes opening at the velum through palatoglossus coupling. In this study, we evaluate maneuvers during DISE as predictors for HGNS treatment efficacy. METHODS We evaluated patients undergoing HGNS between November, 2014 and February, 2021. We assessed maneuvers including jaw thrust and chin lift during preoperative DISE. The impact of tongue base and palatal opening during these maneuvers were rated from 1 to 4 (1: no improvement, 2: mild improvement, 3: moderate improvement, 4: significant improvement). Patients were grouped by a score of 1-2 (weak response) or 3-4 (strong response). Apnea hypopnea index (AHI) change was calculated from the difference between preoperative and postoperative sleep study. RESULTS One hundred and seventy one patients were included. With jaw thrust, there was no significant difference in AHI change between patients with weak or strong response at the palate (n = 68 vs. 94, 9.5 vs. 13.6, p = 0.21) or tongue base (n = 24 vs. 138, 16.6 vs. 11.3, p = 0.24). On chin lift, there was no significant difference at the palate (n = 82 vs. 18, 13.9 vs. 11.4, p = 0.63) or tongue base (n = 92 vs. 72, 10.8 vs. 14.6, p = 0.24). On multiple linear regression analysis, lower body mass index, higher preoperative AHI, and higher preoperative oxygen nadir were associated with a larger AHI change. CONCLUSION Palatal coupling maneuvers during DISE are not predictive of AHI change with HGNS. Findings using these maneuvers should not preclude HGNS candidacy. LEVEL OF EVIDENCE 3 Laryngoscope, 133:431-436, 2023.
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Affiliation(s)
- Bryan Renslo
- Department of Otolaryngology Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kealan Hobelmann
- Department of Otolaryngology Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emily S Sagalow
- Department of Otolaryngology Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ashwin Ananth
- Department of Otolaryngology Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Maurits Boon
- Department of Otolaryngology Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Colin Huntley
- Department of Otolaryngology Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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21
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Palomo JM, Piccoli VD, Menezes LMD. Obstructive sleep apnea: a review for the orthodontist. Dental Press J Orthod 2023; 28:e23spe1. [PMID: 37075419 PMCID: PMC10108585 DOI: 10.1590/2177-6709.28.1.e23spe1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/02/2023] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) affects an important part of the population and is characterized by recurrent total or partial obstruction of the upper airway (UA) during sleep, negatively affecting the quality of life of patients in the short and long terms, and constituting an important public health problem for the society. The field of expertise of orthodontists is closely related to the UA, placing them in a strategic position to diagnose air passage failures and intervene when necessary. Orthodontists, as health professionals, must know how to recognize respiratory problems and manage them appropriately, when indicated. OBJECTIVE Thus, this paper aims to review and critically evaluate the related literature, to provide orthodontists with updated knowledge on the diagnosis and therapy related to OSA. Science and technology are constantly evolving; thus, the literature was also reviewed considering new technologies available in consumer-targeted applications and devices for the diagnosis, monitoring, and treatment of sleep-disordered breathing.
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Affiliation(s)
- Juan Martin Palomo
- Case Western Reserve University, School of Dental Medicine, Department of Orthodontics (Cleveland/OH, USA)
| | - Vicente Dias Piccoli
- Pontifícia Universidade Católica do Estado do Rio Grande do Sul, Faculdade de Odontologia (Porto Alegre/RS, Brazil)
| | - Luciane Macedo de Menezes
- Case Western Reserve University, School of Dental Medicine, Department of Orthodontics (Cleveland/OH, USA)
- Pontifícia Universidade Católica do Estado do Rio Grande do Sul, Faculdade de Odontologia (Porto Alegre/RS, Brazil)
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22
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Plawecki A, Tripathi N, Tovar Torres M, Yaremchuk K. Interference With Implanted Upper Airway Stimulation Device by Phones With Magnet Technology. Laryngoscope 2022; 132:2513-2515. [PMID: 35975894 DOI: 10.1002/lary.30348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 01/07/2023]
Abstract
Newer iPhone models with MagSafe magnetic technology can cause electromagnetic interference with the Inspire upper airway stimulator device (a surgical implant for the treatment of obstructive sleep apnea). Laryngoscope, 132:2513-2515, 2022.
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Affiliation(s)
- Andrea Plawecki
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Nitika Tripathi
- Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Maria Tovar Torres
- Division of Sleep Medicine, Department of Internal Medicine, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Kathleen Yaremchuk
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
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23
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Baptista P, Di Frisco IM, Urrestarazu E, Alcalde J, Alegre M, Sanchez I, O’Connor-Reina C, Plaza G. Quality of Life Impact of Hypoglossal Nerve Stimulation with Inspire ® Device in Patients with Obstructive Sleep Apnea Intolerant to Continuous Positive Airway Pressure Therapy. Life (Basel) 2022; 12:life12111737. [PMID: 36362892 PMCID: PMC9694893 DOI: 10.3390/life12111737] [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: 10/01/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with obstructive sleep apnea (OSA) that do not tolerate/accept continuous positive airway pressure (CPAP) are candidates for surgical alternatives. Hypoglossal nerve stimulation (HNS) through the implantation of the Inspire® device constitutes a minimally invasive operative option. The main objective of this study is to estimate, under real-world clinical practice conditions, the 3-month impact on the quality of life (IQoL) of the HNS in patients with moderate/severe OSA who do not tolerate or accept CPAP, compared to patients who did not receive HNS. As a baseline, the unadjusted EuroQol utility index was 0.764 (SD:0.190) in the intervention group (IGr) and 0.733 (SD:0.205) in the control group (CGr); three months later, the indexes were 0.935 (SD: 0.101) and 0.727 (SD:0.200), respectively. The positive impact on quality of life was estimated to be +0.177 (95% CI: 0.044−0.310; p = 0.010). All dimensions in the IGr improved compared to CGr, especially for usual activities (p < 0.001) and anxiety/depression (p > 0.001). At the end of the follow-up, there was no significant difference in the quality of life between the general Spanish population and the IGr (difference: 0.012; CI95%: −0.03 to −0.057; p = 0.0578) for the same age range; however, there was a difference concerning the CGr (difference: −0.196; CI95%: −0.257 to −0.135; p < 0.001). In conclusion, patients with moderate/severe OSA implanted with the Inspire® device showed a positive IQoL.
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Affiliation(s)
- Peter Baptista
- Otorhinolaryngology Department, University Clinic of Navarra, 31007 Pamplona, Spain
- Correspondence: or
| | | | - Elena Urrestarazu
- Otorhinolaryngology Department, University Clinic of Navarra, 31007 Pamplona, Spain
| | - Juan Alcalde
- Otorhinolaryngology Department, University Clinic of Navarra, 31007 Pamplona, Spain
| | - Manuel Alegre
- Otorhinolaryngology Department, University Clinic of Navarra, 31007 Pamplona, Spain
| | - Isabel Sanchez
- Otorhinolaryngology Department, University Clinic of Navarra, 31007 Pamplona, Spain
| | | | - Guillermo Plaza
- Otorhinolaryngology Department, University Hospital of Fuenlabrada, University Rey Juan Carlos, 28042 Madrid, Spain
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24
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Nord R, Fitzpatrick T, DeShazo JP, Reiter ER. Comparison of readmission and complication rates between traditional sleep surgery and hypoglossal nerve stimulation. Laryngoscope Investig Otolaryngol 2022; 7:1659-1666. [PMID: 36258877 PMCID: PMC9575102 DOI: 10.1002/lio2.883] [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: 06/03/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aims to compare readmission and complication rates between hypoglossal nerve stimulation (HNS) and traditional sleep surgery (TSS) in the 90-day postoperative period using a federated electronic health record (EHR) database. Methods We queried TriNetX, a global federated health research network providing access to EHR data from approximately 70 million patients in 49 large health care organizations to identify individuals who underwent either HNS or TSS for obstructive sleep apnea (OSA) from April 2014 to March 2021. Propensity scores based on demographics and obesity were used to balance groups. We compared the frequency of readmission/representation and surgical-related complication rates between cohorts. Results After propensity score matching of HNS versus palatal surgery (n = 1014 in each cohort) and HNS versus multilevel surgery (n = 374 in each cohort), we found palatal and multilevel surgery had a significantly higher risk of readmission versus HNS. (12% vs. 4%, p < .0001). Palatal surgery complication rate was also higher than HNS (21% vs. 2%, p < .0001). Multi-level surgery results were similarly higher (22% vs. 3%, p < .001). The most common diagnoses at ER readmission for TSS were procedural complications and pain, while common diagnoses for HNS readmission were general complaints such as malaise and headache. Conclusions Hypoglossal nerve stimulation has lower risk of readmission and postoperative complications than traditional sleep surgery as demonstrated in a large research network database analysis. Level of Evidence: 3.
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Affiliation(s)
- Ryan Nord
- Department of Otolaryngology—Head and Neck SurgeryVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Thomas Fitzpatrick
- Department of Otolaryngology—Head and Neck SurgeryVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Jonathan P. DeShazo
- Department of Health AdministrationVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Evan R. Reiter
- Department of Otolaryngology—Head and Neck SurgeryVirginia Commonwealth UniversityRichmondVirginiaUSA
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25
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Luyster FS, Ni Q, Lee K, Harrison C, Ramprasad VH, Soose RJ, Strollo PJ. Factors affecting obstructive sleep apnea patients' use of upper airway stimulation treatment. J Clin Sleep Med 2022; 18:2207-2215. [PMID: 35689597 PMCID: PMC9435328 DOI: 10.5664/jcsm.10086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Upper airway stimulation (UAS) is an alternative treatment for obstructive sleep apnea that must be activated nightly. Although the implanted device offsets the mask- or pressure-related side effects often associated with continuous positive airway pressure therapy, some UAS recipients do not use the therapy consistently. This study qualitatively explored factors associated with UAS usage in obstructive sleep apnea patients. METHODS Semistructured interviews were conducted with 24 obstructive sleep apnea patients who received UAS treatment. Twelve patients were categorized as high users with mean usage of ≥ 4 hours/night and 12 were categorized as low users with < 4 hours/night or nonuse. Interviews explored patients' experiences regarding barriers and facilitators to UAS use and their advice for new UAS recipients. Demographic and clinical data including the Insomnia Severity Index and Generalized Anxiety Disorder Scale were collected. RESULTS Compared to high users, low users had higher levels of insomnia (mean Insomnia Severity Index: 3.6 vs 15.2, respectively) and anxiety (mean Generalized Anxiety Disorder Scale: 3.4 vs 6.9). High users reported more positive experiences with UAS treatment, such as improvements in symptoms and convenience of treatment, as facilitators of use. Low users tended to focus on the negative aspects of treatment, particularly stimulation-related discomfort and associated sleep disturbance. CONCLUSIONS Insomnia with or without anxiety contributes to differing patient-reported experiences in high vs low user groups, with increased insomnia symptoms among low users. Improved understanding of the specific barrier and facilitators of UAS adherence may drive better long-term use and more personalized management strategies, including concomitant insomnia treatment. CLINICAL TRIALS REGISTRATION Registry: ClinicalTrials.gov; Name: Stimulation Therapy for Apnea: Reporting Thoughts (START); URL: https://clinicaltrials.gov/ct2/show/NCT04768543; Identifier: NCT04768543. CITATION Luyster FS, Ni Q, Lee K, et al. Factors affecting obstructive sleep apnea patients' use of upper airway stimulation treatment. J Clin Sleep Med. 2022;18(9):2207-2215.
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Affiliation(s)
- Faith S. Luyster
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Quan Ni
- Inspire Medical Systems, Inc., Minneapolis, Minnesota
| | - Kent Lee
- Inspire Medical Systems, Inc., Minneapolis, Minnesota
| | - Christine Harrison
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vaibhav H. Ramprasad
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ryan J. Soose
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patrick J. Strollo
- Department of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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26
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Gunta SP, Jakulla RS, Ubaid A, Mohamed K, Bhat A, López-Candales A, Norgard N. Obstructive Sleep Apnea and Cardiovascular Diseases: Sad Realities and Untold Truths regarding Care of Patients in 2022. Cardiovasc Ther 2022; 2022:6006127. [PMID: 36017216 PMCID: PMC9388301 DOI: 10.1155/2022/6006127] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/13/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022] Open
Abstract
Obstructive sleep apnea (OSA) is one of the most common and serious sleep-related breathing disorders with a high prevalence among patients with cardiovascular (CV) diseases. Despite its widespread presence, OSA remains severely undiagnosed and untreated. CV mortality and morbidity are significantly increased in the presence of OSA as it is associated with an increased risk of resistant hypertension, heart failure, arrhythmias, and coronary artery disease. Evaluation and treatment of OSA should focus on recognizing patients at risk of developing OSA. The use of screening questionnaires should be routine, but a formal polysomnography sleep study is fundamental in establishing and classifying OSA. Recognition of OSA patients will allow for the institution of appropriate therapy that should alleviate OSA-related symptoms with the intent of decreasing adverse CV risk. In this review, we focus on the impact OSA has on CV disease and evaluate contemporary OSA treatments. Our goal is to heighten awareness among CV practitioners.
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Affiliation(s)
- Satya Preetham Gunta
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Roopesh Sai Jakulla
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Aamer Ubaid
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Kareem Mohamed
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Abid Bhat
- Department of Sleep Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Angel López-Candales
- Department of Cardiovascular Diseases, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Nicholas Norgard
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
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27
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Duarte RLDM, Togeiro SMGP, Palombini LDO, Rizzatti FPG, Fagondes SC, Magalhães-da-Silveira FJ, Cabral MM, Genta PR, Lorenzi-Filho G, Clímaco DCS, Drager LF, Codeço VM, Viegas CADA, Rabahi MF. Brazilian Thoracic Association Consensus on Sleep-disordered Breathing. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20220106. [PMID: 35830079 PMCID: PMC9262434 DOI: 10.36416/1806-3756/e20220106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 12/02/2022]
Abstract
Sleep is essential for the proper functioning of all individuals. Sleep-disordered breathing can occur at any age and is a common reason for medical visits. The objective of this consensus is to update knowledge about the main causes of sleep-disordered breathing in adult and pediatric populations, with an emphasis on obstructive sleep apnea. Obstructive sleep apnea is an extremely prevalent but often underdiagnosed disease. It is often accompanied by comorbidities, notably cardiovascular, metabolic, and neurocognitive disorders, which have a significant impact on quality of life and mortality rates. Therefore, to create this consensus, the Sleep-Disordered Breathing Department of the Brazilian Thoracic Association brought together 14 experts with recognized, proven experience in sleep-disordered breathing.
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Affiliation(s)
| | - Sonia Maria Guimarães Pereira Togeiro
- . Disciplina de Clínica Médica, Escola Paulista de Medicina - EPM - Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil.,. Instituto do Sono, São Paulo (SP) Brasil
| | | | | | - Simone Chaves Fagondes
- . Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | | | | | - Pedro Rodrigues Genta
- . Laboratório de Investigação Médica 63 - LIM 63 (Laboratório do Sono) - Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - HCFMUSP - São Paulo (SP) Brasil
| | - Geraldo Lorenzi-Filho
- . Laboratório de Investigação Médica 63 - LIM 63 (Laboratório do Sono) - Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - HCFMUSP - São Paulo (SP) Brasil
| | | | - Luciano Ferreira Drager
- . Unidade de Hipertensão, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - HCFMUSP - São Paulo (SP) Brasil
| | - Vitor Martins Codeço
- . Hospital Regional da Asa Norte, Secretaria de Estado de Saúde do Distrito Federal, Brasília (DF) Brasil
| | | | - Marcelo Fouad Rabahi
- . Faculdade de Medicina, Universidade Federal de Goiás - UFG - Goiânia (GO) Brasil
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28
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Partial update of the German S3 Guideline Sleep-Related Breathing Disorders in Adults. SOMNOLOGIE 2022. [DOI: 10.1007/s11818-022-00349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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29
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Baptista PM, Prieto-Matos C, Alegre-Esteban M, Urrestarazu-Bolumburu E, Alcade Navarrete J. Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea in Spain: Implementation Strategy and Early Results in a Tertiary Care Center. Indian J Otolaryngol Head Neck Surg 2022; 74:158-165. [DOI: 10.1007/s12070-021-02503-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/02/2021] [Indexed: 11/29/2022] Open
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30
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Steffen A, Baptista P, Ebner E, Jeschke S, König IR, Bruchhage K. Insomnia affects patient-reported outcome in sleep apnea treated with hypoglossal nerve stimulation. Laryngoscope Investig Otolaryngol 2022; 7:877-884. [PMID: 35734047 PMCID: PMC9195029 DOI: 10.1002/lio2.761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/04/2022] [Indexed: 01/03/2023] Open
Abstract
Objective Comorbid insomnia may impact outcomes of patients with obstructive sleep apnea (OSA) receiving hypoglossal nerve stimulation with respiratory sensing (HNS) therapy. To examine whether the presence of insomnia measured using the Insomnia Severity Index (ISI) is associated with patient-reported outcomes and objective OSA measures in patients receiving HNS therapy. Methods In this retrospective chart review, patients with an HNS implant and ISI score at follow-up assessment were categorized as having moderate/severe insomnia or no/subthreshold insomnia. OSA-related data (Apnea Hypopnea Index, AHI; Oxygen Desaturation Index, ODI), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), and overall patient satisfaction was compared between these patient categories. Correlations between ISI scores and each of these variables were examined. Results Of the 132 patients, 26% had moderate/severe insomnia at follow-up assessment. ESS and FOSQ scores were worse in the insomnia group at baseline, follow-up, and in the change from baseline, but AHI and ODI scores did not differ between patients with and without insomnia. Frequency of overall satisfaction at follow-up was lower in the insomnia group (58.8% vs. 92.8% with no insomnia, P < .001). Patients with insomnia were more likely to have depression (56% vs. 27% without insomnia, P < .002). Conclusions Insomnia is associated with worse patient-reported outcomes of daytime sleepiness and sleep-related quality of life in patients with OSA receiving HNS therapy. Depression is more prevalent in patients with comorbid insomnia. The ISI may help physicians to address comorbid insomnia and achieve high patient satisfaction and adherence to HNS therapy. Level of Evidence 4.
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Affiliation(s)
- Armin Steffen
- Department of OtorhinolaryngologyUniversity of LübeckLübeckGermany
| | - Peter Baptista
- Department of OtorhinolaryngologyClínica Universidad de NavarraPamplonaSpain
| | - Eva‐Maria Ebner
- Department of OtorhinolaryngologyUniversity of LübeckLübeckGermany
| | | | - Inke R. König
- Institute of Medical Biometry and StatisticsUniversity of LübeckLübeckGermany
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31
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Dzierzewski JM, Perez E, Ravyts SG, Dautovich N. Sleep and Cognition: A Narrative Review Focused on Older Adults. Sleep Med Clin 2022; 17:205-222. [PMID: 35659074 PMCID: PMC9177059 DOI: 10.1016/j.jsmc.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Little is known regarding sleep's association with the traditional developmental course of late-life cognitive functioning. As the number of older adults increases worldwide, an enhanced understanding of age-related changes in sleep and cognition is necessary to slow decline and promote optimal aging. This review synthesizes the extant literature on sleep and cognitive function in healthy older adults, older adults with insomnia, and older adults with sleep apnea, incorporating information on the potential promising effects of treating poor sleep on cognitive outcomes in older adults. Unifying theories of the sleep-cognition association, possible mechanisms of action, and important unanswered questions are identified.
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Affiliation(s)
- Joseph M Dzierzewski
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Room 306, Box 842018, Richmond, VA 23284-2018, USA.
| | - Elliottnell Perez
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA 23284-2018, USA
| | - Scott G Ravyts
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA 23284-2018, USA
| | - Natalie Dautovich
- Department of Psychology, Virginia Commonwealth University, 800 West Franklin Street, Room 203, Box 842018, Richmond, VA 23284-2018, USA
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32
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Sevcencu C. Single-interface bioelectronic medicines - concept, clinical applications and preclinical data. J Neural Eng 2022; 19. [PMID: 35533654 DOI: 10.1088/1741-2552/ac6e08] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/08/2022] [Indexed: 11/12/2022]
Abstract
Presently, large groups of patients with various diseases are either intolerant, or irresponsive to drug therapies and also intractable by surgery. For several diseases, one option which is available for such patients is the implantable neurostimulation therapy. However, lacking closed-loop control and selective stimulation capabilities, the present neurostimulation therapies are not optimal and are therefore used as only "third" therapeutic options when a disease cannot be treated by drugs or surgery. Addressing those limitations, a next generation class of closed-loop controlled and selective neurostimulators generically named bioelectronic medicines seems within reach. A sub-class of such devices is meant to monitor and treat impaired functions by intercepting, analyzing and modulating neural signals involved in the regulation of such functions using just one neural interface for those purposes. The primary objective of this review is to provide a first broad perspective on this type of single-interface devices for bioelectronic therapies. For this purpose, the concept, clinical applications and preclinical studies for further developments with such devices are here analyzed in a narrative manner.
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Affiliation(s)
- Cristian Sevcencu
- National Institute for Research and Development of Isotopic and Molecular Technologies, 67-103 Donat Street, Cluj-Napoca, 400293, ROMANIA
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33
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Rodriguez J, Kogan D. Comparison of Hypoglossal Nerve Stimulation with Bruxism on Polysomnography. Sleep Med 2022; 96:105-106. [DOI: 10.1016/j.sleep.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
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34
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Steffen A. Patient Related Outcome and Therapy Effects in Stimulation Treatment of Sleep-Related Breathing Disorders. Laryngorhinootologie 2022; 101:103-113. [PMID: 35605615 DOI: 10.1055/a-1647-8601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Several neurostimulation devices exist for the treatment of various sleep-related breathing diseases. The most data for hypoglossal nerve stimulation (HNS) in the therapy of obstructive sleep apnea (OSA) derive the HNS with respiratory sensing. Herewith, daytime sleepiness measured with the Epworth Sleepiness Scale (ESS) was improved in several publications by 5 points with a stability shown for up to several years. Sleep related quality of life, documented with the Functional Outcomes of Sleep Questionnaire, increased by 2 points. In many cohorts showed a mean usage of 5 to 6 hours per night. Under the consideration of shorter follow-ups and smaller group sizes, the ESS improved by 4 under unilateral continuous HNS and by 3 under bilateral HNS. Transvenous stimulation of the phrenic nerve is approved for the treatment in central sleep apnea. In a pivotal trial with 5 year follow-up data, an ESS reduction is documented by 3 points. There is one publication describing a usage of more than 5 hours. The daytime enoral neuromuscular electrical therapy improved ESS (2 points) and sleep-related quality of life of the snoring patients and the bed partner. The daytime training for the effects during the night adherence is given with 83%. For all described devices, there are running or announced studies and/or registry trials that consider patient related outcome.
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35
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Peracaula M, Torres D, Poyatos P, Luque N, Rojas E, Obrador A, Orriols R, Tura-Ceide O. Endothelial Dysfunction and Cardiovascular Risk in Obstructive Sleep Apnea: A Review Article. Life (Basel) 2022; 12:537. [PMID: 35455027 PMCID: PMC9025914 DOI: 10.3390/life12040537] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a respiratory condition during sleep caused by repeated pauses in breathing due to upper airway obstruction. It is estimated that OSA affects 30% of the population, but only 10% are well diagnosed due to the absence of a well-defined symptomatology and poor screening tools for early diagnosis. OSA is associated to an endothelial dysfunction inducing several biological responses such as hypoxia, hypercapnia and oxidative stress, among others. OSA also triggers respiratory, nervous, metabolic, humoral and immunity system activations that increase the possibility of suffering a cardiovascular (CV) disease. In this review, we expose different studies that show the relationship between OSA and endothelial dysfunction and its association with CV pathologies like hypertension, and we define the most well-known treatments and their limitations. Additionally, we describe the potential future directions in OSA research, and we report clinical features such as endothelial progenitor cell alterations that could act as biomarkers for the development of new diagnostic tools and target therapies.
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Affiliation(s)
- Miriam Peracaula
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Daniela Torres
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Paula Poyatos
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Neus Luque
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Eric Rojas
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Anton Obrador
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Ramon Orriols
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
| | - Olga Tura-Ceide
- Department of Pulmonary Medicine, Dr. Josep Trueta University Hospital of Girona, Santa Caterina Hospital de Salt and the Girona Biomedical Research Institute (IDIBGI), 17190 Girona, Spain; (M.P.); (D.T.); (P.P.); (N.L.); (E.R.); (A.O.)
- Biomedical Research Networking Centre on Respiratory Diseases (CIBERES), 28029 Madrid, Spain
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Leone F, De Santi S, Costantino A, Marciante GA, Bianchi A, Colombo G, Salamanca F. Barbed pharyngoplasty for the treatment of obstructive sleep apnea: the surgical learning curve. Sleep Breath 2022; 26:1869-1874. [DOI: 10.1007/s11325-022-02579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/04/2022] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
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Soberon JR, Murray Casanova I, Wright J. Anesthetic Implications for Patients With Implanted Hypoglossal Nerve Stimulators: A Case Report. Cureus 2022; 14:e21424. [PMID: 35198329 PMCID: PMC8856631 DOI: 10.7759/cureus.21424] [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] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
Obstructive sleep apnea is a serious health issue affecting more than one billion people worldwide. Although continuous positive airway pressure is the mainstay for the treatment of obstructive sleep apnea, hypoglossal nerve stimulation is a surgical option for patients who are unable to tolerate or adhere to this therapy. As more hypoglossal nerve stimulators are implanted, these patients will present with increasing frequency for medical procedures requiring general anesthesia or deep sedation. We describe our experience with one such patient and hope this information can be used to develop future guidelines to aid in the anesthetic management of these patients.
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Arens P, Hänsel T, Wang Y. Hypoglossal Nerve Stimulation Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:351-372. [PMID: 36217095 DOI: 10.1007/978-3-031-06413-5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hypoglossal nerve stimulation (HNS) has been shown to be a safe alternative in the treatment of moderate-to-severe obstructive sleep apnea (OSA). A recent meta-analysis of 12 studies by Costantino et al. indicated the surgical success rates at 55-75%, a reduction of the apnea hypopnea index (AHI) of 18 events/h, and a reduction of the Epworth Sleepiness Scale (ESS) of 2.9-5.3. After animal studies in the 1970s, the first trial on humans to decrease upper airway resistance by transcutaneous electrical stimulation of the genioglossus was reported in 1989. A separate stimulation of protruding and retracting muscles was realized in 1995 by fine-wire electrodes that were placed into the tongue transoral. Over the next years, several companies developed implantable devices for hypoglossal stimulation in OSA. Initially, devices were developed that used unilateral stimulation of the hypoglossal nerve. In 2014, a device for unilateral respiratory frequency-controlled hypoglossal stimulation finally received FDA approval after a successful phase III trial. In recent years, a device for bilateral breath rate-independent stimulation of the hypoglossal nerve has been added to these approaches as a new development. Accordingly, hypoglossal nerve stimulation, on the one hand, is now an established tool for patients with OSA when standard treatments are not satisfactory. Beyond that, hypoglossal stimulation is undergoing a continuous and impressive development like hardly any other field of surgical therapy for OSA.
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Affiliation(s)
- Philipp Arens
- Department of Otorhinolaryngology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Toni Hänsel
- Department of Otorhinolaryngology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Yan Wang
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Interdisciplinary Sleep Medicine Center, Berlin, Germany
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Mediano O, González Mangado N, Montserrat JM, Alonso-Álvarez ML, Almendros I, Alonso-Fernández A, Barbé F, Borsini E, Caballero-Eraso C, Cano-Pumarega I, de Carlos Villafranca F, Carmona-Bernal C, Carrillo Alduenda JL, Chiner E, Cordero Guevara JA, de Manuel L, Durán-Cantolla J, Farré R, Franceschini C, Gaig C, Garcia Ramos P, García-Río F, Garmendia O, Gómez García T, González Pondal S, Hoyo Rodrigo MB, Lecube A, Antonio Madrid J, Maniegas Lozano L, Martínez Carrasco JL, Masa JF, Masdeu Margalef MJ, Mayos Pérez M, Mirabet Lis E, Monasterio C, Navarro Soriano N, Olea de la Fuente E, Plaza G, Puertas Cuesta FJ, Rabec C, Resano P, Rigau D, Roncero A, Ruiz C, Salord N, Saltijeral A, Sampol Rubio G, Sánchez Quiroga MÁ, Sans Capdevila Ó, Teixeira C, Tinahones Madueño F, Maria Togeiro S, Troncoso Acevedo MF, Vargas Ramírez LK, Winck J, Zabala Urionaguena N, Egea C. [Translated article] International consensus document on obstructive sleep apnea. Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2021.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Gastelum E, Cummins M, Singh A, Montoya M, Urbano GL, Tablizo MA. Treatment Considerations for Obstructive Sleep Apnea in Pediatric Down Syndrome. CHILDREN 2021; 8:children8111074. [PMID: 34828787 PMCID: PMC8619133 DOI: 10.3390/children8111074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/25/2022]
Abstract
Children with Down syndrome (DS) are at high risk for developing obstructive sleep apnea (OSA) compared to children without DS. The negative impact of OSA on health, behavior, and cognitive development in children with DS highlights the importance of timely and effective treatment. Due to the higher prevalence of craniofacial and airway abnormalities, obesity, and hypotonia in patients with DS, residual OSA can still occur after exhausting first-line options. While treatment commonly includes adenotonsillectomy (AT) and continuous positive airway pressure (CPAP) therapy, additional therapy such as medical management and/or adjuvant surgical procedures need to be considered in refractory OSA. Given the significant comorbidities secondary to untreated OSA in children with DS, such as cardiovascular and neurobehavioral consequences, more robust randomized trials in this patient population are needed to produce treatment guidelines separate from those for the general pediatric population of otherwise healthy children with OSA. Further studies are also needed to look at desensitization and optimization of CPAP use in patients with DS and OSA.
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Affiliation(s)
- Erica Gastelum
- School of Medicine, University of California San Francisco, Fresno, CA 94143, USA; (M.C.); (A.S.)
- Department of Pediatrics, Undergraduate Medical Education, University of California San Francisco, Fresno, CA 93721, USA;
- Correspondence: ; Tel.: +1-(559)-4594300
| | - Marcus Cummins
- School of Medicine, University of California San Francisco, Fresno, CA 94143, USA; (M.C.); (A.S.)
- Department of Pediatrics, Undergraduate Medical Education, University of California San Francisco, Fresno, CA 93721, USA;
| | - Amitoj Singh
- School of Medicine, University of California San Francisco, Fresno, CA 94143, USA; (M.C.); (A.S.)
- Department of Pediatrics, Undergraduate Medical Education, University of California San Francisco, Fresno, CA 93721, USA;
| | - Michael Montoya
- Department of Pediatrics, Undergraduate Medical Education, University of California San Francisco, Fresno, CA 93721, USA;
- School of Medicine, University of California Davis, Sacramento, Fresno, CA 95817, USA
| | - Gino Luis Urbano
- School of Medicine and Public Health, Ateneo de Manila University, Pasig 1604, Philippines;
| | - Mary Anne Tablizo
- Department of Pulmonology, Valley Children’s Hospital, Madera, CA 93720, USA;
- Department of Pulmonology, Stanford Children’s Health, Lucille Packard Children’s Hospital, Palo Alto, CA 94304, USA
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Abstract
What are the effects of sleep disturbance and changes of sleep on aging women in the short and long term? Most research that has been done in recent years evaluates how sleep disorders and sleep disturbance may change mortality and outcomes of this population. Many confounding factors may be playing a role, including comorbid conditions. This article reviews sleep disorders including insomnia, circadian sleep-wake rhythm disorders, restless legs syndrome, disorders of hypersomnia, and sleep-disordered breathing in women aged 65 and older; prevalence of these disorders; and recommended treatment options.
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Affiliation(s)
- Wahida Akberzie
- Department of Neurology, George Washington University School of Medicine, Washington DC VA Medical Center, 3B-103, 50 Irving Street Northwest, Washington, DC 20422, USA
| | - Lynn Kataria
- Sleep Laboratory, Department of Neurology, George Washington University School of Medicine, Washington DC VA Medical Center, 3B-103, 50 Irving Street Northwest, Washington, DC 20422, USA.
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Nazar G, Astorquiza C, Cabezón R. El paciente roncador: evaluación y alternativas terapéuticas. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Xiao K, Campbell D, Mastrolonardo E, Boon M, Huntley C. Evaluating YouTube Videos on Hypoglossal Nerve Stimulation as a Resource for Patients. Laryngoscope 2021; 131:E2827-E2832. [PMID: 34363396 DOI: 10.1002/lary.29809] [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: 06/02/2021] [Revised: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study evaluated the quality and comprehensiveness of YouTube videos on hypoglossal nerve stimulation (HNS) for patients. This study also investigated the relationship between video content, video metrics, and popularity. STUDY DESIGN Cross-sectional study. METHODS We identified 150 videos using three search terms: "inspire sleep apnea," "hypoglossal nerve stimulation," and "upper airway stimulation." Videos that were unrelated to the use of HNS for obstructive sleep apnea in adults, operating room recordings, lectures for medical professionals, non-English, or non-audio were excluded. Video quality and comprehensiveness were assessed using modified DISCERN criterion (range: 5-25) and novel content criterion (range: 0-12), respectively. Secondary outcomes included video metrics (views, likes, dislikes, comments, and days since upload) and Video Power Index to measure popularity. Outcomes were stratified by video uploader source (medical institutions, medical companies, individual users, other). RESULTS Users searched YouTube for "inspire sleep apnea" 2.48 times more in 2020 than in 2018. We identified 67 videos for review, with the majority coming from medical institutions (70.2%). Overall, the average-modified DISCERN (13.65 ± 4.88) and novel content (3.87 ± 2.09) scores were low and did not differ between medical institutions or other uploader sources. Higher quality and more comprehensive video content did not correlate with popularity. CONCLUSION Overall quality and comprehensiveness of information of HNS YouTube videos was low. Given the high demand for information on HNS, there is opportunity for medical institutions to implement new strategies to improve both video content and visibility to patients. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Kevin Xiao
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel Campbell
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eric Mastrolonardo
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Maurits Boon
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Colin Huntley
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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OSA Upper Airways Surgery: A Targeted Approach. ACTA ACUST UNITED AC 2021; 57:medicina57070690. [PMID: 34356971 PMCID: PMC8305825 DOI: 10.3390/medicina57070690] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 01/12/2023]
Abstract
Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients' in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.
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Choi JH. Treatments for Adult Obstructive Sleep Apnea. SLEEP MEDICINE RESEARCH 2021. [DOI: 10.17241/smr.2021.00913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lou B, Hahn S, Korotun M, Quintero L, Shikowitz M, Greenberg H. Space invader: pleural penetration of a hypoglossal nerve stimulator sensor lead. J Clin Sleep Med 2021; 17:2329-2332. [PMID: 34170242 DOI: 10.5664/jcsm.9492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The mainstay of treatment for obstructive sleep apnea (OSA) is positive airway pressure (PAP). PAP therapy may be difficult to tolerate for some patients which may compromise adherence, requiring alternative therapies. Hypoglossal nerve stimulation (HGNS) has become an option for those who meet implantation criteria. Implantation of the device is an ambulatory surgical procedure and is generally well-tolerated, though rare adverse events have been reported. We report an unusual complication of HGNS in a patient who had initial success with this therapy. After three years of treatment, the sensor lead penetrated into the pleural space. Components of the HGNS were explanted, and a new sensor lead and generator were reimplanted. The new device was activated, and therapy was successfully resumed. This case demonstrates that there is a potential for a delayed complication of sensor lead penetration into the pleural space which has only rarely been reported.
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Affiliation(s)
- Becky Lou
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, New Hyde Park, NY
| | - Stella Hahn
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, New Hyde Park, NY
| | - Maksim Korotun
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, New Hyde Park, NY
| | - Luis Quintero
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, New Hyde Park, NY
| | - Mark Shikowitz
- Department of Otolaryngology, Head and Neck Center of Surgery, Zucker Sinus Center - Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, New Hyde Park, NY
| | - Harly Greenberg
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, New Hyde Park, NY
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Baptista PM, Garaycochea O, O’Connor C, Plaza G. Tongue Surgery That Works in OSA. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Neruntarat C, Wanichakorntrakul P, Khuancharee K, Saengthong P, Tangngekkee M. Upper airway stimulation vs other upper airway surgical procedures for OSA: a meta-analysis. Sleep Breath 2021; 26:407-418. [PMID: 33999362 DOI: 10.1007/s11325-021-02402-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim was to compare the outcomes of upper airway stimulation (Stim) and other upper airway surgical procedures (Surg) in the treatment of obstructive sleep apnea (OSA). METHODS Data sources included PubMed, Ovid MEDLINE, Cochrane Library, Web of Science, Scopus, and reference lists. Relevant articles were identified from various databases according to the PRISMA guidelines. RESULTS Five articles with a total of 990 patients were included. The mean cure rates in the Stim group and the Surg group was 63% and 22%, and the mean success rates was 86% and 51% which were higher in the Stim group (p < 0.001). The apnea-hypopnea index reduction was -23.9 events/ hour (MD, 95% CI -25.53, -22.29) in the Stim group and -15.5 events/hour (MD, 95% CI -17.50, -13.45) in the Surg group which was greater in the Stim group (P < 0.001). Epworth Sleepiness Scale decreased -4.9 (MD, 95% CI -5.45, -4.32) in the Stim group and -5.1 (MD 95% CI -5.88, -4.37) in the Surg group without significant difference between the groups (P = 0.62). Oxygen saturation nadir improvement was 8.5% (MD 95% CI 7.05%, 9.92%) in the Stim group and 2.2% (MD 95% CI-0.22%, 4.58%) in the Surg group which was higher in the Stim group (P < 0.001). Hospital stay and readmission rate were lower in the Stim group. The timing of follow-up ranged from 2 to 13 months. CONCLUSION Upper airway stimulation provides improved objective and similar subjective outcomes compared to other upper airway surgical procedures for selected patients with moderate to severe OSA with difficulty adhering to CPAP treatment. However, further studies are essential to confirm outcomes in the long term.
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Affiliation(s)
- Chairat Neruntarat
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, Thailand.
| | - Pisit Wanichakorntrakul
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, Thailand
| | - Kitsarawut Khuancharee
- Department of Preventive and Social Medicine, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, Thailand
| | - Petcharat Saengthong
- Department of Otorhinolaryngology Head and Neck Surgery, Police General Hospital, 492/1 Rama 1 Road, Patumwan, Bangkok, Thailand
| | - Mongkol Tangngekkee
- Department of Otolaryngology, Faculty of Medicine, Thammasat University, 99/209 Moo 2, Klong Luang, Rasit, Prathumthani, Thailand
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Paul M. The Impact of Obstructive Sleep Apnea on the Sleep of Critically Ill Patients. Crit Care Nurs Clin North Am 2021; 33:173-192. [PMID: 34023084 DOI: 10.1016/j.cnc.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Obstructive sleep apnea is becoming increasingly prevalent in society and thus critical care practitioners need to be prepared to care for these patients in the intensive care unit. Preparation begins with equipping the critical care nurse with the knowledge necessary to provide interventions which can enhance patient outcomes and mitigate complications.
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Affiliation(s)
- Michaelynn Paul
- Walla Walla University, School of Nursing, 10345 Southeast Market Street, Portland, OR 97216, USA.
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Martínez-Ruíz de Apodaca P, Carrasco-Llatas M, Matarredona-Quiles S, Valenzuela-Gras M, Dalmau-Galofre J. Long-term stability of results following surgery for obstructive sleep apnea (OSA). Eur Arch Otorhinolaryngol 2021; 279:373-380. [PMID: 33797601 DOI: 10.1007/s00405-021-06781-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Although upper airway surgery in selected patients with obstructive sleep apnea (OSA) has been shown to be beneficial, its long-term effects have been questioned. The main objective was to evaluate whether results following surgery remain stable over time, both in objective and subjective terms. As a secondary aim, such stability was also measured in relation with the type of surgery performed. METHODS This work constitutes a retrospective study of OSA adult patients subjected to the following surgical procedures: different types of pharyngoplasties, tongue-base surgery, partial epiglottectomy or hyoid suspension. Those who exclusively underwent tonsillectomy or nasal surgery were excluded. Before surgery, a sleep study, and an assessment of the patients' sleepiness and quality of life were performed, which were repeated at 8, 34, and 48 months after surgery. A total of 153 patients was included. RESULTS Following surgery, the apnea-hypopnea index decreased from 34.84/h to 14.54/h and did not vary more than one point in subsequent controls (p = 0.01). The oxygen desaturation index changed from 31.02/h to 14.0/h and remained stable in the second (15.34/h) and third (11.43/h) controls (p = 0.01). Parameters measuring sleepiness and well-being demonstrated the maintenance of long-term benefits. New pharyngoplasties were observed to be more stable than classic pharyngoplasties in the long term (p = 0.04). Single-level surgeries were found to be more stable than multilevel surgeries, although a statistically significant difference was not observed (p = 0.07). CONCLUSION The benefits obtained remained stable in the long term. In our sample, modern pharyngoplasty techniques showed superiority over the classic ones regarding long-term stability.
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Affiliation(s)
| | | | | | | | - José Dalmau-Galofre
- Hospital Universitario Dr. Peset, Avenida Gaspar Aguilar 90, 46017, Valencia, Spain
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