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Van Daele M, Smolders Y, Van Loo D, Bultynck C, Verbraecken J, Vroegop A, Lapperre T, Op de Beeck S, Dieltjens M, Vanderveken OM. Personalized Treatment for Obstructive Sleep Apnea: Beyond CPAP. Life (Basel) 2024; 14:1007. [PMID: 39202749 PMCID: PMC11355307 DOI: 10.3390/life14081007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/22/2024] [Accepted: 08/05/2024] [Indexed: 09/03/2024] Open
Abstract
Obstructive sleep apnea (OSA) is a sleep disorder characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep. Continuous positive airway pressure (CPAP) is a method used as a first-line treatment for obstructive sleep apnea (OSA). However, intolerance and resistance to CPAP can limit its long-term effectiveness. Alternative treatments are available, such as Mandibular Advancement Devices (MADs), positional therapy, upper airway surgery, and maxillomandibular osteotomy. However, often less efficient in reducing the apnea-hypopnea index, the higher tolerance of and compliance to alternative treatment has resulted in the adequate treatment of OSA in CPAP-intolerant patients. This paper describes the protocol of a prospective single-center cohort study including adult patients with moderate to severe OSA (15 events/h ≤ apnea-hypopnea index (AHI) < 65 events/h) that failed to comply with CPAP therapy. Selected patients will be invited to the clinic to explore alternative treatment options where DISE will be a first step in further identifying upper airway collapse during sleep. By exploring alternative treatment options in CPAP-intolerant patients and systematically documenting their treatment paths, an algorithm can be defined to better guide patients towards personalized treatment for OSA. The follow-up is aimed at 5 years with an inclusion of 170 patients per year, including a drop-out rate of 15%. By leveraging a real-world database, this study aims to bridge the gap between research and clinical practice, facilitating the development of evidence-based guidelines and personalized treatment algorithms for CPAP-intolerant patients.
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Affiliation(s)
- Margot Van Daele
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Yannick Smolders
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Dorine Van Loo
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Charlotte Bultynck
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Respiratory Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Anneclaire Vroegop
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Thérèse Lapperre
- Department of Respiratory Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, 2000 Antwerp, Belgium
| | - Sara Op de Beeck
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Marijke Dieltjens
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Olivier M. Vanderveken
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, 2650 Edegem, Belgium
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Vena D, Gell L, Messineo L, Mann D, Azarbarzin A, Calianese N, Wang TY, Yang H, Alex R, Labarca G, Hu WH, Sumner J, White DP, Wellman A, Sands SA. Physiological Determinants of Snore Loudness. Ann Am Thorac Soc 2024; 21:114-121. [PMID: 37879037 PMCID: PMC10867912 DOI: 10.1513/annalsats.202305-438oc] [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: 05/12/2023] [Accepted: 10/24/2023] [Indexed: 10/27/2023] Open
Abstract
Rationale: The physiological factors modulating the severity of snoring have not been adequately described. Airway collapse or obstruction is generally the leading determinant of snore sound generation; however, we suspect that ventilatory drive is of equal importance. Objective: To determine the relationship between airway obstruction and ventilatory drive on snore loudness. Methods: In 40 patients with suspected or diagnosed obstructive sleep apnea (1-98 events/hr), airflow was recorded via a pneumotachometer attached to an oronasal mask, ventilatory drive was recorded using calibrated intraesophageal diaphragm electromyography, and snore loudness was recorded using a calibrated microphone attached over the trachea. "Obstruction" was taken as the ratio of ventilation to ventilatory drive and termed flow:drive, i.e., actual ventilation as a percentage of intended ventilation. Lower values reflect increased flow resistance. Using 165,063 breaths, mixed model analysis (quadratic regression) quantified snore loudness as a function of obstruction, ventilatory drive, and the presence of extreme obstruction (i.e., apneic occlusion). Results: In the presence of obstruction (flow:drive = 50%, i.e., doubled resistance), snore loudness increased markedly with increased drive (+3.4 [95% confidence interval, 3.3-3.5] dB per standard deviation [SD] change in ventilatory drive). However, the effect of drive was profoundly attenuated without obstruction (at flow:drive = 100%: +0.23 [0.08-0.39] dB per SD change in drive). Similarly, snore loudness increased with increasing obstruction exclusively in the presence of increased drive (at drive = 200% of eupnea: +2.1 [2.0-2.2] dB per SD change in obstruction; at eupneic drive: +0.14 [-0.08 to 0.28] dB per SD change). Further, snore loudness decreased substantially with extreme obstruction, defined as flow:drive <20% (-9.9 [-3.3 to -6.6] dB vs. unobstructed eupneic breathing). Conclusions: This study highlights that ventilatory drive, and not simply pharyngeal obstruction, modulates snore loudness. This new framework for characterizing the severity of snoring helps better understand the physiology of snoring and is important for the development of technologies that use snore sounds to characterize sleep-disordered breathing.
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Affiliation(s)
- Daniel Vena
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laura Gell
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ludovico Messineo
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dwayne Mann
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Queensland, Australia; and
| | - Ali Azarbarzin
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicole Calianese
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsai-Yu Wang
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hyungchae Yang
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Otorhinolaryngology–Head and Neck Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Raichel Alex
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gonzalo Labarca
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wen-Hsin Hu
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey Sumner
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - David P. White
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott A. Sands
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Neagos A, Dumitru M, Neagos CM, Mitroi M, Vrinceanu D. Correlations between Morphology, the Functional Properties of Upper Airways, and the Severity of Sleep Apnea. J Clin Med 2022; 11:jcm11185347. [PMID: 36142994 PMCID: PMC9502432 DOI: 10.3390/jcm11185347] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is considered the silent killer pathology of the new millennium. This is due to increased risk factors such as obesity. Healthcare systems face an increasing burden from severe cases of OSA. We performed a study on a group of 152 Romanian patients with OSA recording data obtained through polysomnography and cephalometric variables, recorded in lateral plain X-rays. The results confirmed some of the data available from previous studies worldwide, but some of the variables presented a positive statistical correlation specific to our study group. For example, the apnea-hypopnea index (AHI) correlated with the uvula length but surprisingly did not correlate with body mass index (BMI) because obesity tends to become endemic in Romania. To our knowledge, this is one of the first studies focusing on cephalometric data in Romanian OSA patients. The results obtained through this study will be further analyzed in research on larger groups of Romanian OSA patients.
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Affiliation(s)
- Adriana Neagos
- ENT Department, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Tirgu Mures, Romania
- Correspondence: (A.N.); (M.D.)
| | - Mihai Dumitru
- ENT Department, Carol Davila University of Medicine and Pharmacy, 010271 Bucharest, Romania
- Correspondence: (A.N.); (M.D.)
| | - Cristian Mircea Neagos
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 010271 Bucharest, Romania
| | - Mihaela Mitroi
- ENT Department, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Daniela Vrinceanu
- ENT Department, Carol Davila University of Medicine and Pharmacy, 010271 Bucharest, Romania
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Leoncini S, Signorini C, Boasiako L, Scandurra V, Hayek J, Ciccoli L, Rossi M, Canitano R, De Felice C. Breathing Abnormalities During Sleep and Wakefulness in Rett Syndrome: Clinical Relevance and Paradoxical Relationship With Circulating Pro-oxidant Markers. Front Neurol 2022; 13:833239. [PMID: 35422749 PMCID: PMC9001904 DOI: 10.3389/fneur.2022.833239] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBreathing abnormalities are common in Rett syndrome (RTT), a pervasive neurodevelopmental disorder almost exclusively affecting females. RTT is linked to mutations in the methyl-CpG-binding protein 2 (MeCP2) gene. Our aim was to assess the clinical relevance of apneas during sleep-wakefulness cycle in a population with RTT and the possible impact of apneas on circulating oxidative stress markers.MethodsFemale patients with a clinical diagnosis of typical RTT (n = 66), MECP2 gene mutation, and apneas were enrolled (mean age: 12.5 years). Baseline clinical severity, arterial blood gas analysis, and red blood cell count were assessed. Breathing was monitored during the wakefulness and sleep states (average recording time: 13 ± 0.5 h) with a portable polygraphic screening device. According to prevalence of breath holdings, the population was categorized into the wakefulness apnea (WA) and sleep apnea (SA) groups, and apnea-hypopnea index (AHI) was calculated. The impact of respiratory events on oxidative stress was assessed by plasma and intra-erythrocyte non-protein-bound iron (P-NPBI and IE-NPBI, respectively), and plasma F2-isoprostane (F2-IsoP) assays.ResultsSignificant prevalence of obstructive apneas with values of AHI > 15 was present in 69.7% of the population with RTT. The group with SA showed significantly increased AHI values > 15 (p = 0.0032), total breath holding episodes (p = 0.007), and average SpO2 (p = 0.0001) as well as lower nadir SpO2 (p = 0.0004) compared with the patients with WAs. The subgroups of patients with WA and SA showed no significant differences in arterial blood gas analysis variables (p > 0.089). Decreased mean cell hemoglobin (MCH) (p = 0.038) was observed in the group with WAs. P-NPBI levels were significantly higher in the group with WA than in that with SAs (p = 0.0001). Stepwise multiple linear regression models showed WA being related to nadir SpO2, average SpO2, and P-NPBI (adjusted R2 = 0.613, multiple correlation coefficient = 0.795 p < 0.0001), and P-NPBI being related to average SpO2, blood PaCO2, red blood cell mean corpuscular volume (MCV), age, and topiramate treatment (adjusted R2 = 0.551, multiple correlation coefficient = 0.765, p < 0.0001).ConclusionOur findings indicate that the impact of apneas in RTT is uneven according to the sleep-wakefulness cycle, and that plasma redox active iron represents a potential novel therapeutic target.
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Affiliation(s)
- Silvia Leoncini
- Rett Syndrome Trial Center, Child Neuropsychiatry Unit, University Hospital Azienda Ospedaliera Universitaria Senese, Siena, Italy
- Neonatal Intensive Care Unit, University Hospital Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Cinzia Signorini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Lidia Boasiako
- Rett Syndrome Trial Center, Child Neuropsychiatry Unit, University Hospital Azienda Ospedaliera Universitaria Senese, Siena, Italy
- Neonatal Intensive Care Unit, University Hospital Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Valeria Scandurra
- Child Neuropsychiatry Unit, University Hospital, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Joussef Hayek
- Child Neuropsychiatry Unit, University Hospital, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Lucia Ciccoli
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Marcello Rossi
- Respiratory Pathophysiology and Rehabilitation Unit, University Hospital, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Roberto Canitano
- Child Neuropsychiatry Unit, University Hospital, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Claudio De Felice
- Rett Syndrome Trial Center, Child Neuropsychiatry Unit, University Hospital Azienda Ospedaliera Universitaria Senese, Siena, Italy
- Neonatal Intensive Care Unit, University Hospital Azienda Ospedaliera Universitaria Senese, Siena, Italy
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