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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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Pitre T, Mah J, Roberts S, Desai K, Gu Y, Ryan C, Busse JW, Zeraatkar D. Comparative Efficacy and Safety of Wakefulness-Promoting Agents for Excessive Daytime Sleepiness in Patients With Obstructive Sleep Apnea : A Systematic Review and Network Meta-analysis. Ann Intern Med 2023; 176:676-684. [PMID: 37155992 DOI: 10.7326/m22-3473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) is common among patients with obstructive sleep apnea (OSA). The comparative effectiveness of pharmacologic agents is unknown. PURPOSE To compare the effectiveness of drugs for EDS in OSA using network meta-analysis. DATA SOURCES MEDLINE, CENTRAL, EMBASE, and ClinicalTrials.gov to 7 November 2022. STUDY SELECTION Reviewers identified randomized trials that enrolled patients with EDS-associated OSA on or eligible for conventional therapy assigned to any pharmacologic intervention. DATA EXTRACTION Paired reviewers independently extracted data addressing effects of drugs on the Epworth Sleepiness Scale (ESS), Maintenance of Wakefulness Test (MWT), and adverse events at the longest reported follow-up. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. DATA SYNTHESIS Fourteen trials (3085 patients) were eligible. At 4 weeks, compared with placebo, solriamfetol improves ESS scores (mean difference [MD], -3.85 [95% CI, -5.24 to -2.50]; high certainty), and armodafinil-modafinil (MD, -2.25 [CI, -2.85 to -1.64]; moderate certainty) and pitolisant-H3-autoreceptor blockers (MD, -2.78 [CI, -4.03 to -1.51]; moderate certainty) probably improve ESS scores. At 4 weeks, compared with placebo, solriamfetol (standardized mean difference [SMD], 0.9 [CI, 0.64 to 1.17]) and armodafinil-modafinil (SMD, 0.41 [CI, 0.27 to 0.55]) improve MWT (both high certainty), whereas pitolisant-H3-autoreceptor blockers probably do not (moderate certainty). At 4 weeks, armodafinil-modafinil probably increases the risk for discontinuation due to adverse events (relative risk [RR], 2.01 [CI, 1.14 to 3.51]; moderate certainty); solriamfetol may increase the risk for discontinuation due to adverse events (RR, 2.07 [CI, 0.67 to 6.25]; low certainty). Low certainty evidence suggests these interventions may not increase the risk for serious adverse events. LIMITATIONS There is limited evidence on long term or effectiveness among patients nonadherent or with mixed adherence to conventional OSA therapies. CONCLUSION Solriamfetol, armodafinil-modafinil, and pitolisant reduce daytime sleepiness for patients with OSA already on conventional therapy, with solriamfetol likely superior. Adverse events probably increase the risk for discontinuation of armodafinil-modafinil and may increase the risk for discontinuation with solriamfetol. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Tyler Pitre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada (T.P.)
| | - Jasmine Mah
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (J.M., Y.G.)
| | - Sarah Roberts
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (S.R., K.D.)
| | - Kairavi Desai
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (S.R., K.D.)
| | - Yusing Gu
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (J.M., Y.G.)
| | - Clodagh Ryan
- Department of Respirology, University of Toronto, Toronto, Ontario, Canada (C.R.)
| | - Jason W Busse
- Departments of Anesthesiology and Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada (J.W.B., D.Z.)
| | - Dena Zeraatkar
- Departments of Anesthesiology and Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada (J.W.B., D.Z.)
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Liu R, Kong X. Study on the Changes of Liver and Kidney Function-Related Indicators and Clinical Significance in Patients with OSAHS. Emerg Med Int 2022; 2022:9536617. [PMID: 35757276 PMCID: PMC9225909 DOI: 10.1155/2022/9536617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To study the changes of liver and kidney function-related indexes in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and analyze their clinical significance. Method Ninety OSAHS patients treated in our hospital from April 2019 to April 2021 were selected. According to the apnea-hypopnea Index (AHI), they were divided into mild OSAHS group (5 ≤ AHI < 15 times/h, 35 people), moderate OSAHS group (15 ≤ AHI < 30 times/h, 35 people), and severe OSAHS group (AHI ≥ 30 times/h, 20 people). In addition, 50 healthy people who underwent physical examination in our hospital at the same time were selected as the control group, and the liver and kidney function and polysomnography (PSG)-related indexes of the above subjects were detected, and the comparison between the groups was carried out. Result The serum BUN and SCR levels of the severe group were significantly higher than those of the moderate group, the moderate group had significantly higher levels than the mild group, and the mild group had significantly higher levels than the control group (P < 0.05). The blood AST level of the severe group was significantly lower than that of the moderate group, the moderate group had a significantly lower level than the mild group, and the mild group had a significantly lower level than the control group (P < 0.05). The blood ALT level of the severe group was significantly higher than that of the moderate group, the moderate group had significantly a higher level than the mild group, and the mild group had a significantly higher level than the control group (P < 0.05). The proportions of abnormal liver and kidney function in the control group, mild group, moderate group, and severe group were significantly different (P < 0.05). The AHI of the severe group was significantly higher than that of the moderate group, the moderate group had a higher value than the mild group, and the mild group had a higher value than the control group (P < 0.05). The ASpO2 and MSpO2 of the severe group were significantly lower than those of the moderate group, the moderate group had significantly lower values than the mild group, and the mild group had significantly lower values than the control group (P < 0.05). Spearman correlation analysis showed that the liver and kidney function indexes of OSAHS patients were significantly correlated with PSG indexes (P < 0.05). Conclusion Patients with OSAHS will have obvious liver and kidney dysfunction, and the monitoring of liver and kidney function in such patients should be strengthened. If abnormality occurs, early intervention is recommended.
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Affiliation(s)
- Rongyue Liu
- Department of Otolaryngology, The First People's Hospital of Fuyang Hangzhou, Hangzhou 311400, Zhejiang, China
| | - Xiangdong Kong
- Department of Nephrology, The First People's Hospital of Fuyang Hangzhou, Hangzhou 311400, Zhejiang, China
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Gauld C, Lopez R, Morin C, Geoffroy PA, Maquet J, Desvergnes P, McGonigal A, Dauvilliers Y, Philip P, Dumas G, Micoulaud-Franchi JA. Symptom network analysis of the sleep disorders diagnostic criteria based on the clinical text of the ICSD-3. J Sleep Res 2021; 31:e13435. [PMID: 34269498 DOI: 10.1111/jsr.13435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/08/2021] [Accepted: 06/24/2021] [Indexed: 01/04/2023]
Abstract
The third edition of the International Classification of Sleep Disorders (ICSD-3) is the authoritative clinical text for the diagnosis of sleep disorders. An important issue of sleep nosology is to better understand the relationship between symptoms found in conventional diagnostic manuals and to compare classifications. Nevertheless, to our knowledge, there is no specific exhaustive work on the general structure of the networks of symptoms of sleep disorders as described in diagnostic manuals. The general aim of the present study was to use symptom network analysis to explore the diagnostic criteria in the ICSD-3 manual. The ICSD-3 diagnostic criteria related to clinical manifestations were systematically identified, and the units of analysis (symptoms) were labelled from these clinical manifestation diagnostic criteria using three rules ("Conservation", "Splitting", "Lumping"). A total of 37 of the 43 main sleep disorders with 160 units of analysis from 114 clinical manifestations in the ICSD-3 were analysed. A symptom network representing all individual ICSD-3 criteria and connections between them was constructed graphically (network estimation), quantified with classical metrics (network inference with global and local measures) and tested for robustness. The global measure of the sleep symptoms network shows that it can be considered as a small world, suggesting a strong interconnection between symptoms in the ICSD-3. Local measures show the central role of three kinds of bridge sleep symptoms: daytime sleepiness, insomnia, and behaviour during sleep symptoms. Such a symptom network analysis of the ICSD-3 structure could provide a framework for better systematising and organising symptomatology in sleep medicine.
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Affiliation(s)
- Christophe Gauld
- Department of Psychiatry, University of Grenoble, Grenoble, France.,UMR CNRS 8590 IHPST, Sorbonne University, Paris 1, France
| | - Régis Lopez
- Department of Neurology, Sleep Disorders Center, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France.,Inserm, Université Montpellier 1, Montpellier, U1061, France
| | - Charles Morin
- École de psychologie, Université Laval, Québec City, Québec, Canada.,Centre d'étude des troubles du sommeil, Institut Universitaire en Santé Mentale de Québec, Quebec City, Canada
| | - Pierre A Geoffroy
- Département de Psychiatrie et d'Addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hospital Bichat - Claude Bernard, Paris, France.,GHU Paris - Psychiatry and Neurosciences, Paris, France.,NeuroDiderot, Université de Paris, Paris, Inserm, France.,CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
| | - Julien Maquet
- Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Centre d'investigation clinique 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Pierre Desvergnes
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, Bordeaux, France
| | - Aileen McGonigal
- Epileptology Department, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Aix Marseille University, Marseille, France
| | - Yves Dauvilliers
- Department of Neurology, Sleep Disorders Center, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France.,Inserm, Université Montpellier 1, Montpellier, U1061, France
| | - Pierre Philip
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, Bordeaux, France.,USR CNRS 3413 SANPSY, University Hospital of Bordeaux, Bordeaux, France
| | - Guillaume Dumas
- Center for Complex Systems and Brain Sciences, Florida Atlantic University, Boca Raton, Florida, USA.,Centre de recherche du Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Jean-Arthur Micoulaud-Franchi
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, Bordeaux, France.,USR CNRS 3413 SANPSY, University Hospital of Bordeaux, Bordeaux, France
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