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Antunes J, Órfão J, Rito J, Adónis C, Freire F. Surgical treatment for obstructive sleep apnea: effect on sleep architecture. Eur Arch Otorhinolaryngol 2023; 280:5059-5065. [PMID: 37405452 DOI: 10.1007/s00405-023-08093-8] [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: 05/09/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE Investigate the effect of surgical treatment of obstructive sleep apnea syndrome (OSA) on sleep architecture. METHODS Observational retrospective analysis of polysomnographic data of adults diagnosed with OSA, submitted to surgical treatment. Median (25-75th percentile) was used to present the data. RESULTS Data were available for 76 adults, 55 men and 21 women, with median age of 49.0 years (41.0-62.0), body mass index of 27.3 kg/m2 (25.3-29.3) and AHI of 17.4 per hour (11.3-22.9) before surgeries. Preoperatively, 93.4% of patients had an abnormal distribution of at least one of the sleep phases. After surgical treatment, we found a significant increase in median N3 sleep percent from 16.9% (8.3-22-7) to 18.9% (15.5-25.4) (p = 0.003). Postoperatively, 18.6% patients that had an abnormal preoperative N1 sleep phase distribution had a normalization of this sleep phase, as also occurred to N2, N3 and REM sleep phases in 44.0%, 23.3% and 63.6% of patients, respectively. CONCLUSION This study aims to show the impact of OSA treatment, not only on respiratory events but also on other polysomnographic data often underestimated. Upper airway surgeries have shown to be effective in sleep architecture improvements. There is a trend for sleep distribution normalization, with increase of time spend in profound sleep.
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Affiliation(s)
- Joselina Antunes
- Department of Otorhinolaryngology, Head and Neck Surgery, Professor Doutor Fernando Fonseca Hospital, IC19, 2720-276, Amadora, Portugal.
| | - João Órfão
- Department of Otorhinolaryngology, Head and Neck Surgery, Professor Doutor Fernando Fonseca Hospital, IC19, 2720-276, Amadora, Portugal
| | - João Rito
- Department of Otorhinolaryngology, Head and Neck Surgery, Professor Doutor Fernando Fonseca Hospital, IC19, 2720-276, Amadora, Portugal
| | - Cristina Adónis
- Department of Otorhinolaryngology, Head and Neck Surgery, Professor Doutor Fernando Fonseca Hospital, IC19, 2720-276, Amadora, Portugal
| | - Filipe Freire
- Department of Otorhinolaryngology, Head and Neck Surgery, Professor Doutor Fernando Fonseca Hospital, IC19, 2720-276, Amadora, Portugal
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Shirahata T, Uchida Y, Uchida T, Shinomiya S, Sato H, Yamazaki S, Yogi S, Masaki K, Akagami T, Soma M, Ohmura K, Miyashita T, Kanazawa M, Nagata M, Nakamura H. Improvement of sleep parameters by titration polysomnography could predict adherence to positive airway pressure therapy in obstructive sleep apnea. J Clin Sleep Med 2023; 19:1465-1473. [PMID: 37082821 PMCID: PMC10394356 DOI: 10.5664/jcsm.10606] [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: 09/29/2022] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 04/22/2023]
Abstract
STUDY OBJECTIVES Poor adherence to continuous positive airway pressure (CPAP) has been a critical issue in treating obstructive sleep apnea. Because long-term CPAP adherence may be established shortly after treatment begins, early intervention is essential. This study aimed to identify the potential factors affecting CPAP therapy adherence during diagnostic polysomnography and auto CPAP titration polysomnography. METHODS This retrospective observational study included 463 patients with obstructive sleep apnea who underwent consecutive diagnostic polysomnography and titration polysomnography. We recorded their demographic, anthropometric, and lifestyle factors and obtained self-reported comments regarding their sleep status following both polysomnography evaluations. CPAP adherence was evaluated following 3 months of treatment. RESULTS A total of 312 patients (67.4%) fulfilled the criteria for good adherence. Each patient's CPAP adherence was categorized as "poor" (< 4 hours/night or <70% of nights), "good" (≥ 4 hours/night and ≥ 70% of nights), or "excellent" (≥ 6 hours/night and ≥ 80% of nights). There were no significant differences in arterial oxyhemoglobin saturation measured by pulse oximetry and apnea-hypopnea index during diagnostic polysomnography among 3 groups. The polysomnographic evaluations indicated that patients with better adherence displayed more significant improvements in sleep parameters, including apnea-hypopnea index, sleep efficacy, sleep latency, and sleep architecture, which were correlated with an improvement in self-reported sleep quality. CONCLUSIONS Polysomnographic evaluations enabled CPAP adherence prediction and a comparison of self-reported sleep quality with and without CPAP; CPAP adherence led to improvements in polysomnographic parameters. Our findings suggest that titration polysomnography and self-reported sleep improvement with CPAP could be used for adherence prediction in clinical practice. CITATION Shirahata T, Uchida Y, Uchida T, et al. Improvement of sleep parameters by titration polysomnography could predict adherence to positive airway pressure therapy in obstructive sleep apnea. J Clin Sleep Med. 2023;19(8):1465-1473.
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Affiliation(s)
- Toru Shirahata
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Yoshitaka Uchida
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Takahiro Uchida
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Shun Shinomiya
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Hideaki Sato
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Susumu Yamazaki
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Sanehiro Yogi
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Kenji Masaki
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Tomoe Akagami
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Machika Soma
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Kazuyuki Ohmura
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
- School of Medical Technology, Faculty of Health and Medical Care, Saitama Medical University, Saitama, Japan
| | - Tatsuyuki Miyashita
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Minoru Kanazawa
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Makoto Nagata
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Hidetoshi Nakamura
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
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Cunningham TJ, Kishore D, Guo M, Igue M, Malhotra A, Stickgold R, Djonlagic I. The Effect of Obstructive Sleep Apnea on Sleep-dependent Emotional Memory Consolidation. Ann Am Thorac Soc 2023; 20:296-306. [PMID: 36250951 PMCID: PMC9989861 DOI: 10.1513/annalsats.202204-315oc] [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: 04/11/2022] [Accepted: 10/17/2022] [Indexed: 02/04/2023] Open
Abstract
Rationale: A growing body of evidence suggests that sleep is critical for the adaptive processing and consolidation of emotional information into long-term memory. Previous research has indicated that emotional components of scenes particularly benefit from sleep in healthy groups, yet sleep-dependent emotional memory processes remain unexplored in clinical cohorts, including those with obstructive sleep apnea (OSA). This line of research is important as it will add to the understanding of how disrupted sleep in OSA contributes to both impaired cognition and emotion dysregulation. Objectives: To test the hypothesis that individuals with OSA will have impaired sleep-dependent memory consolidation, with the greatest impact being on memory for emotional content. Methods: In this study, a group of newly diagnosed patients with OSA (n = 26; 10 female; average age, 42.5 years) and a matched group of healthy control subjects (n = 24; 13 female; average age, 37 years) were enrolled in the study at Beth Israel Deaconess Medical Center. Participants encoded scenes with negative or neutral foreground objects placed on neutral backgrounds before a night of polysomnographically recorded sleep. In the morning, they completed a recognition test in which old and new scene objects and backgrounds, presented separately and one at a time, were judged as old, new, or similar compared with what had been previously viewed. Results: Patients with OSA had a deficit in recognition memory for the scenes. Overall recognition (the ability to recognize old items as either old or similar) was impaired across all scene elements, both negative and neutral objects and backgrounds, whereas specific recognition (correctly identifying old items as old) was impaired only for negative objects. Across all participants, successful overall recognition correlated positively with sleep efficiency and rapid eye movement (REM) sleep, whereas successful specific memory recognition correlated only with REM sleep. Conclusions: Our findings indicate that fragmented sleep and reduced REM sleep, both hallmarks of OSA, are associated with disruptions in general memory impairment and veridical memory for emotional content, which could alter emotional regulation and contribute to comorbid emotional distress in OSA.
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Affiliation(s)
- Tony J. Cunningham
- Center for Sleep and Cognition, Department of Psychiatry and
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, Massachusetts; and
| | - Divya Kishore
- Department of Neurology, Beth Israel Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meng Guo
- Department of Neurology, Beth Israel Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pulmonary, Critical Care, Sleep, and Physiology, University of California San Diego, La Jolla, California
| | - Moroké Igue
- Department of Neurology, Beth Israel Hospital and Harvard Medical School, Boston, Massachusetts
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, Sleep, and Physiology, University of California San Diego, La Jolla, California
| | | | - Ina Djonlagic
- Department of Neurology, Beth Israel Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pulmonary, Critical Care, Sleep, and Physiology, University of California San Diego, La Jolla, California
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Li Y, Li Q, Zou X, Zhong Z, Ouyang Q, Zeng Q, Hu Y, Wang M, Luo Y, Yao D. Effects of CPAP treatment on electroencephalographic activity in patients with obstructive sleep apnea syndrome during deep sleep: Preliminary findings of a cross-sectional study. Chron Respir Dis 2023; 20:14799731231215094. [PMID: 37967573 PMCID: PMC10655652 DOI: 10.1177/14799731231215094] [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: 12/04/2022] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
Study objectives: To investigate whether electroencephalographic (EEG) activities during non-rapid eye movement sleep stage 3 (N3) in obstructive sleep apnea syndrome (OSAS) patients were changed with continuous positive airway pressure (CPAP) treatment.Methods: A cross-sectional study of EEG activity during N3 sleep was conducted in 15 patients with moderate to severe OSAS without and with CPAP treatment compared to 15 normal controls. The amplitude, and absolute and relative power of delta, theta, alpha and beta waves as well as the absolute power ratio of slow to fast EEG waves (i.e., absolute power of delta and theta waves/absolute power of alpha and beta waves) and the spectral power density of 0-30 Hz EEG activities were analyzed.Results: CPAP significantly increased N3 sleep, the absolute and relative powers, amplitudes of delta and theta waves, and absolute power ratio of slow to fast EEG waves, but decreased relative alpha and beta powers during N3 sleep. However, there were no significant differences in those parameters between the OSAS patients with CPAP treatment and normal controls.Conclusions: CPAP prolongs N3 sleep and increases the power and amplitude of slow EEG waves during N3 sleep, which indicates an improvement in sleep quality and further provides evidence for recommendation of CPAP treatment for OSAS patients.
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Affiliation(s)
- Yiran Li
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People’s Hospital and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, China
| | - Qi Li
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People’s Hospital and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, China
| | - Xueliang Zou
- Jiangxi Mental Hospital, Nanchang University, Nanchang, China
| | - Zhijun Zhong
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People’s Hospital and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, China
| | - Qian Ouyang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People’s Hospital and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, China
| | - Qinghong Zeng
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People’s Hospital and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, China
| | - Yinyin Hu
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People’s Hospital and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, China
| | - Mengmeng Wang
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People’s Hospital and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, China
| | - Yaxing Luo
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People’s Hospital and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, China
| | - Dongyuan Yao
- Neurological Institute of Jiangxi Province and Department of Neurology, Jiangxi Provincial People’s Hospital and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Neurological Institute of Jiangxi Province and Department of Neurology, Xiangya Hospital of Central South University at Jiangxi, Nanchang, China
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Wilckens KA, Jeon B, Morris JL, Buysse DJ, Chasens ER. Effects of continuous positive airway pressure treatment on sleep architecture in adults with obstructive sleep apnea and type 2 diabetes. Front Hum Neurosci 2022; 16:924069. [PMID: 36177385 PMCID: PMC9513763 DOI: 10.3389/fnhum.2022.924069] [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: 04/20/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022] Open
Abstract
Obstructive sleep apnea (OSA) severely impacts sleep and has long-term health consequences. Treating sleep apnea with continuous positive airway pressure (CPAP) not only relieves obstructed breathing, but also improves sleep. CPAP improves sleep by reducing apnea-induced awakenings. CPAP may also improve sleep by enhancing features of sleep architecture assessed with electroencephalography (EEG) that maximize sleep depth and neuronal homeostasis, such as the slow oscillation and spindle EEG activity, and by reducing neurophysiological arousal during sleep (i.e., beta EEG activity). We examined cross-sectional differences in quantitative EEG characteristics of sleep, assessed with power spectral analysis, in 29 adults with type 2 diabetes treated with CPAP and 24 adults undergoing SHAM CPAP treatment (total n = 53). We then examined changes in spectral characteristics of sleep as the SHAM group crossed over to active CPAP treatment (n = 19). Polysomnography (PSG) from the CPAP titration night was used for the current analyses. Analyses focused on EEG frequencies associated with sleep maintenance and arousal. These included the slow oscillation (0.5–1 Hz), sigma activity (12–16 Hz, spindle activity), and beta activity (16–20 Hz) in F3, F4, C3, and C4 EEG channels. Whole night non-rapid eye movement (NREM) sleep and the first period of NREM spectral activity were examined. Age and sex were included as covariates. There were no group differences between CPAP and SHAM in spectral characteristics of sleep architecture. However, SHAM cross-over to active CPAP was associated with an increase in relative 12–16 Hz sigma activity across the whole night and a decrease in average beta activity across the whole night. Relative slow oscillation power within the first NREM period decreased with CPAP, particularly for frontal channels. Sigma and beta activity effects did not differ by channel. These findings suggest that CPAP may preferentially enhance spindle activity and mitigate neurophysiological arousal. These findings inform the neurophysiological mechanisms of improved sleep with CPAP and the utility of quantitative EEG measures of sleep as a treatment probe of improvements in neurological and physical health with CPAP.
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Affiliation(s)
- Kristine A Wilckens
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bomin Jeon
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jonna L Morris
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Daniel J Buysse
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Eileen R Chasens
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
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Tavoian D, Ramos-Barrera LE, Craighead DH, Seals DR, Bedrick EJ, Alpert JS, Mashaqi S, Bailey EF. Six Months of Inspiratory Muscle Training to Lower Blood Pressure and Improve Endothelial Function in Middle-Aged and Older Adults With Above-Normal Blood Pressure and Obstructive Sleep Apnea: Protocol for the CHART Clinical Trial. Front Cardiovasc Med 2021; 8:760203. [PMID: 34901220 PMCID: PMC8652071 DOI: 10.3389/fcvm.2021.760203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/18/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Cardiovascular disease is a major global health concern and prevalence is high in adults with obstructive sleep apnea (OSA). Lowering blood pressure (BP) can greatly reduce cardiovascular disease risk and physical activity is routinely prescribed to achieve this goal. Unfortunately, many adults with OSA suffer from fatigue, daytime sleepiness, and exercise intolerance—due to poor sleep quality and nocturnal hypoxemia—and have difficulty initiating and maintaining an exercise program. High-resistance inspiratory muscle strength training (IMST) is a simple, time-efficient breathing exercise consistently reported to reduce BP in small, selective groups of both healthy and at-risk adults. Herein we present the study protocol for a randomized clinical trial to determine the long-term efficacy of IMST performed regularly for 24 weeks in middle-aged and older adults with OSA. The primary outcome is casual systolic BP. Secondary outcomes are 24-h systolic BP and circulating plasma norepinephrine concentration. Other outcomes include vascular endothelial function (endothelial-dependent and -independent dilation), aortic stiffness, casual and 24-h diastolic BP, and the influence of circulating factors on endothelial cell nitric oxide and reactive oxygen species production. Overall, this trial will establish efficacy of high-resistance IMST for lowering BP and improving cardiovascular health in middle-aged and older adults with OSA. Methods: This is a single-site, double-blind, randomized clinical trial. A minimum of 92 and maximum of 122 male and female adults aged 50–80 years with OSA and above-normal BP will be enrolled. After completion of baseline assessments, subjects will be randomized in a 1:1 ratio to participate in either high-resistance or sham (low-resistance) control IMST, performed at home, 5 min/day, 5 days/week, for 24 weeks. Repeat assessments will be taken after the 24-week intervention, and after 4 and 12 weeks of free living. Discussion: This study is designed to assess the effects of 24 weeks of IMST on BP and vascular function. The results will characterize the extent to which IMST can reduce BP when performed over longer periods (i.e., 6 months) than have been assessed previously. Additionally, this study will help to determine underlying mechanisms driving IMST-induced BP reductions that have been reported previously. Clinical Trial Registration: This trial is registered with ClinicalTrials.gov (Registration Number: NCT04932447; Date of registration June 21, 2021).
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Affiliation(s)
- Dallin Tavoian
- Arizona Respiratory Neurophysiology Laboratory, Department of Physiology, University of Arizona, Tucson, AZ, United States
| | - Lupita E Ramos-Barrera
- Arizona Respiratory Neurophysiology Laboratory, Department of Physiology, University of Arizona, Tucson, AZ, United States
| | - Daniel H Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Edward J Bedrick
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Joseph S Alpert
- College of Medicine, University of Arizona, Tucson, AZ, United States.,Division of Cardiology, Sarver Heart Center, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Saif Mashaqi
- College of Medicine, University of Arizona, Tucson, AZ, United States.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Banner - University Medical Center, Tucson, AZ, United States.,Sleep Disorders Center, Banner - University Medical Center, Tucson, AZ, United States
| | - E Fiona Bailey
- Arizona Respiratory Neurophysiology Laboratory, Department of Physiology, University of Arizona, Tucson, AZ, United States
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Trzepizur W, Cistulli PA, Glos M, Vielle B, Sutherland K, Wijkstra PJ, Hoekema A, Gagnadoux F. Health outcomes of continuous positive airway pressure versus mandibular advancement device for the treatment of severe obstructive sleep apnea: an individual participant data meta-analysis. Sleep 2021; 44:6119670. [PMID: 33493338 DOI: 10.1093/sleep/zsab015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/12/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES The impact of therapy with continuous positive airway pressure (CPAP) and mandibular advancement device (MAD) has not been directly compared in patients with severe obstructive sleep apnea (OSA). The purpose of this individual participant data meta-analysis was to compare the treatment effects of CPAP and titratable MAD on sleepiness, quality of life, sleep-disordered breathing severity, and sleep structure in patients with severe OSA. METHODS Randomized controlled trials (RCTs) that included severe OSA patients were identified in order to compare the impact of the two treatments. Individual data from severe OSA patients were extracted from the databases and pooled for analysis. RESULTS Of the seven studies identified, three crossover RCT and one parallel-group RCT corresponding to 151 patients and 249 observations (125 in the CPAP treatment arm and 124 in the MAD treatment arm) were included in the analysis. Titratable MAD had a similar impact to CPAP on major patient-centered outcomes (sleepiness and quality of life). CPAP was more effective in reducing AHI and ODI. However, the two treatments had a similar impact on sleep structure with an increase of N3 and REM sleep. Finally, treatment adherence and preference were largely in favor of MAD. CONCLUSION This meta-analysis suggests that MAD represents an effective alternative treatment in severe OSA patients intolerant to CPAP or who prefer alternate therapy.
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Affiliation(s)
- Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, Angers University hospital, INSERM U1063, SOPAM, Angers University, Angers, France
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
| | - Martin Glos
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bruno Vielle
- Centre de Recherche Clinique, CHU d'Angers, Angers, France
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
| | - Peter J Wijkstra
- Department of Pulmonary Diseases/Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Aarnoud Hoekema
- Department of Orofacial pain and dysfunction, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre, location Academic Medical Center (AMC), and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University hospital, INSERM U1063, SOPAM, Angers University, Angers, France
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Djonlagic IE, Guo M, Igue M, Kishore D, Stickgold R, Malhotra A. Continuous Positive Airway Pressure Restores Declarative Memory Deficit in Obstructive Sleep Apnea. Am J Respir Crit Care Med 2021; 203:1188-1190. [PMID: 33347378 DOI: 10.1164/rccm.202011-4253le] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ina E Djonlagic
- Beth Israel Hospital and Harvard Medical School Boston, Massachusetts
| | - Meng Guo
- Beth Israel Hospital and Harvard Medical School Boston, Massachusetts.,Medical College of Wisconsin Milwaukee, Wisconsin and
| | - Moroke Igue
- Beth Israel Hospital and Harvard Medical School Boston, Massachusetts
| | - Divya Kishore
- Beth Israel Hospital and Harvard Medical School Boston, Massachusetts
| | - Robert Stickgold
- Beth Israel Hospital and Harvard Medical School Boston, Massachusetts
| | - Atul Malhotra
- University of California San Diego La Jolla, California
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9
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Morrison KI, Beidel DC, Newins AR. When Traumatic Memories Affect Your Health: A Clinical Case Study. Clin Case Stud 2020. [DOI: 10.1177/1534650120912328] [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: 11/15/2022]
Abstract
Obstructive sleep apnea hypopnea (OSA) is the most common breathing-related sleep disorder and affects more than 20% of older individuals. Furthermore, risk of OSA increases in postmenopausal women. OSA is effectively treated using continuous positive airway pressure (CPAP). However, Mary, a 74-year-old White woman with OSA, severe, refused to obtain a CPAP machine because the sound of the machine elicited memories of her late husband’s suicide. Intervention focused on reducing Mary’s fear of CPAP sounds. Treatment involved imaginal exposure, in vivo exposure, sleep hygiene strategies, and relaxation strategies. Although evidence-based treatments for OSA and trauma separately exist, there are no treatment protocols designed to address the specific combination of the conditions. Treatment gains included a reduction in trauma-related symptoms and an increase in CPAP compliance. Quantity and quality of patient’s sleep did not improve despite sleep hygiene and CPAP use. At 3-week follow-up, treatment gains and CPAP compliance were maintained.
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Şahin Duyar S, Fırat S, Kara T, Çelik D. Practical and rapidly-implemented parameters for assessing APAP titration failure. Sleep Breath 2020; 25:49-55. [PMID: 32193843 DOI: 10.1007/s11325-020-02052-x] [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: 12/30/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to show the predictive value of simple polysomnographic parameters including latency of deep sleep (nREM3), latency of rapid eye movement sleep (REM), and minimum oxygen saturation (SpO2) for predicting failure of autoadjusting positive airway pressure (APAP) titration. METHODS Out of 1470 patients with moderate to severe obstructive sleep apnea syndrome (OSAS) who underwent APAP titration between July 1, 2016, and December 31, 2017, 22 patients with titration failure were enrolled in the study. The demographic and polysomnographic characteristics of this group were compared with 44 patients with an adequate APAP titration who were matched with the titration failure group by age, sex, and OSAS severity. The periods between the start of sleep and the start of REM and nREM3 stages were noted as REM latency and nREM3 latency, respectively. RESULTS The between group differences in the parameters including nREM3 latency, REM latency, and minimum SpO2 during the titration test were statistically significant (p = 0.004, p = 0.008, p <0.001 respectively). Possible threshold values to predict failure of APAP titration were found as 40 min and 135 min for nREM3 and REM latencies, respectively. The best threshold for minimum SpO2 was 86% with an 86.4% of sensitivity. Despite the high negative predictive values (81% for nREM3 latency, 75% for REM latency), the sensitivities (63.6% for nREM3 latency, 54.5% for REM latency) of the prior parameters in determining titration failure were relatively low. CONCLUSION The minimum SpO2 < 86% can be used as a readily available indicator of APAP titration failure. nREM3 and REM latencies may be regarded as supplementary indicators in detecting the patients who may need an advanced PAP device.
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Affiliation(s)
- Sezgi Şahin Duyar
- Sleep Disorders Center, University of Health Sciences Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, 06280, Keçiören, Ankara, Turkey. .,Sleep Disorders Center, University of Health Sciences Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara, Turkey.
| | - Selma Fırat
- Sleep Disorders Center, University of Health Sciences Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
| | - Türkan Kara
- Sleep Disorders Center, University of Health Sciences Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
| | - Deniz Çelik
- Pulmonology, University of Health Sciences Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara, Turkey
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