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Ravesloot MJL. Positional Treatment of Obstructive Sleep Apnea. Otolaryngol Clin North Am 2024:S0030-6665(24)00002-1. [PMID: 38311472 DOI: 10.1016/j.otc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Positional sleep apnea (POSA), a distinctive subtype of obstructive sleep apnea, underscores the critical influence of a patient's sleeping position on the severity of their condition. In the management of POSA, compliance with positional therapy (PT) is paramount, as it wields a profound impact on the treatment's efficacy and the overall alleviation of the disease. The advent of new-generation PT devices offers a promising alternative to conventional methods like the tennis ball technique, boasting higher compliance rates and substantial disease alleviation.
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Lukachan GA, Yadollahi A, Auckley D, Gavrilovic B, Matelski J, Chung F, Singh M. The impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trial. BMC Anesthesiol 2023; 23:236. [PMID: 37443016 PMCID: PMC10339502 DOI: 10.1186/s12871-023-02193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The severity of sleep-disordered breathing is known to worsen postoperatively and is associated with increased cardio-pulmonary complications and increased resource implications. In the general population, the semi-upright position has been used in the management of OSA. We hypothesized that the use of a semi-upright position versus a non-elevated position will reduce postoperative worsening of OSA in patients undergoing non-cardiac surgeries. METHODS This study was conducted as a prospective randomized controlled trial of perioperative patients, undergoing elective non-cardiac inpatient surgeries. Patients underwent a preoperative sleep study using a portable polysomnography device. Patients with OSA (apnea hypopnea index (AHI) > 5 events/hr), underwent a sleep study on postoperative night 2 (N2) after being randomized into an intervention group (Group I): semi-upright position (30 to 45 degrees incline), or a control group (Group C) (zero degrees from horizontal). The primary outcome was postoperative AHI on N2. The secondary outcomes were obstructive apnea index (OAI), central apnea index (CAI), hypopnea index (HI), obstructive apnea hypopnea index (OAHI) and oxygenation parameters. RESULTS Thirty-five patients were included. Twenty-one patients were assigned to the Group 1 (females-14 (67%); mean age 65 ± 12) while there were fourteen patients in the Group C (females-5 (36%); mean age 63 ± 10). The semi-upright position resulted in a significant reduction in OAI in the intervention arm (Group C vs Group I postop AHI: 16.6 ± 19.0 vs 8.6 ± 11.2 events/hr; overall p = 0.01), but there were no significant differences in the overall AHI or other parameters between the two groups. Subgroup analysis of patients with "supine related OSA" revealed a decreasing trend in postoperative AHI with semi-upright position, but the sample size was too small to evaluate statistical significance. CONCLUSION In patients with newly diagnosed OSA, the semi-upright position resulted in improvement in obstructive apneas, but not the overall AHI. TRIAL REGISTRATION This trial was retrospectively registered in clinicaltrials.gov NCT02152202 on 02/06/2014.
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Affiliation(s)
- Gincy A Lukachan
- Department of Anesthesia, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
| | - Azadeh Yadollahi
- KITE - Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dennis Auckley
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Bojan Gavrilovic
- KITE - Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Frances Chung
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada
| | - Mandeep Singh
- Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, McL 2-405, Toronto, ON, M5T 2S8, Canada.
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Bosschieter PFN, Vonk PE, de Vries N. The predictive value of drug-induced sleep endoscopy for treatment success with a mandibular advancement device or positional therapy for patients with obstructive sleep apnea. Sleep Breath 2021; 26:1153-1160. [PMID: 34596877 DOI: 10.1007/s11325-021-02501-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE As drug-induced sleep endoscopy (DISE) can provide additional diagnostic information on collapse patterns of the upper-airway, it is widely used in patients with obstructive sleep apnea (OSA). Although more controversial, DISE may also predict the success of treatment with a mandibular advancement device (MAD) and/or positional therapy (PT). In 2018, we proposed a prediction model to investigate the predictive value of passive maneuvers during DISE - such as jaw thrust and changes in body position - on upper-airway patency. Based on the outcomes of various studies, we then adjusted our DISE protocol to better mimic the effect of a MAD, PT, or a combination of both. The aim of this study was to verify whether or not our adjustments would increase the value of DISE as a selection tool. METHODS This single-center retrospective cohort study involved a consecutive series of patients with OSA. Patients were included if a DISE had been performed in supine and non-supine sleeping position and with and without a boil-and-bite MAD in situ between December 2018 and February 2020. The VOTE scoring system was used to evaluate the obstruction at four levels of the upper-airway. RESULTS Among 94 patients included. the median apnea-hypopnea index (AHI) was 16.2 (events/h). As a temporary MAD during DISE reduced obstruction by 54% and jaw thrust by 57%, both mimicked the effect of the custom-made MADs referred to in the literature, which reduces the AHI by 60%. Head-and-trunk rotation reduced obstruction by 55% and thus mimicked the effect of PT, which is known to reduce the AHI by 50%. CONCLUSION A jaw thrust, a temporary MAD, and head-and-trunk rotation during DISE all seem to mimic the treatment effects of MAD and PT. These findings may be of added value when choosing OSA treatment. To prove the predictive value of these maneuvers during DISE, a prospective study should be performed.
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Affiliation(s)
- P F N Bosschieter
- Department of Otorhinolaryngology, Head and Neck Surgery, OLVG, Jan Tooropstraat 164, 1061AE, Amsterdam, Netherlands.
| | - P E Vonk
- Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - N de Vries
- Department of Otorhinolaryngology, Head and Neck Surgery, OLVG, Jan Tooropstraat 164, 1061AE, Amsterdam, Netherlands.,Department of Oral Kinesiology, ACTA, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, University of Antwerp, Antwerp, Belgium
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Bosi M, Incerti Parenti S, Sanna A, Plazzi G, De Vito A, Alessandri-Bonetti G. Non-continuous positive airway pressure treatment options in obstructive sleep apnoea: A pathophysiological perspective. Sleep Med Rev 2021; 60:101521. [PMID: 34280847 DOI: 10.1016/j.smrv.2021.101521] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/02/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022]
Abstract
The phenotyping of the pathophysiology of obstructive sleep apnoea (OSA) lies at the core of tailored treatments and it is one of the most debated topics in sleep medicine research. Recent sophisticated techniques have broadened the horizon for gaining insight into the variability of the endotypic traits in patients with OSA which account for the heterogeneity in the clinical presentation of the disease and consequently, in the outcome of treatment. However, the implementation of these concepts into clinical practice is still a major challenge for both researchers and clinicians in order to develop tailored therapies targeted to specific endotypic traits that contribute to OSA in each individual patient. This review summarizes available scientific evidence in order to point out the links between endotypic traits (pharyngeal airway collapsibility, upper airway neuromuscular compensation, loop gain and arousal threshold) and the most common non-continuous positive airway pressure (CPAP) treatment options for OSA (mandibular advancement device, upper airway surgery, medication therapy, positional therapy) and to clarify to what extent endotypic traits could help to better predict the success of these therapies. A narrative guide is provided; current design limitations and future avenues of research are discussed, with clinical and research perspectives.
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Affiliation(s)
- Marcello Bosi
- Centro Disturbi del Sonno, Ospedali Privati Forlì, Forlì, Italy
| | - Serena Incerti Parenti
- Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Antonio Sanna
- Azienda USL Toscana Centro, Pneumology and Bronchial Endoscopy Unit, San Giuseppe Hospital, Empoli, FI, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Andrea De Vito
- Head & Neck Department, ENT Unit, Ravenna Hospital, Romagna Health Service, Italy
| | - Giulio Alessandri-Bonetti
- Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
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Goyal A, Pakhare A, Subhedar R, Khurana A, Chaudhary P. Combination of positional therapy with positive airway pressure for titration in patients with difficult to treat obstructive sleep apnea. Sleep Breath 2021. [PMID: 33486667 DOI: 10.1007/s11325-021-02291-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Positional therapy has been described as add-on therapy to a mandibular advancement device, but the efficacy of combination of positional therapy and positive airway pressure (PPAP) has not been documented. We have found PPAP therapy as an effective method of titration in patients with difficult to treat OSA (obstructive sleep apnea). METHODOLOGY This retrospective analysis was done in patients who had difficult to treat OSA, i.e., in whom titration in the supine position was unacceptable with any PAP device (CPAP or bilevel PAP) and could only be successfully titrated with a PAP device in the lateral position. This study describes our experience of PPAP therapy. Baseline characteristics and polysomnography data of patients who were successfully titrated in supine v/s lateral positions were compared. RESULTS Of 272 consecutive patients with OSA selected for analysis, 218 patients (191 and 27 with CPAP and bilevel PAP, respectively) could be successfully titrated in supine position. Further 54 (20%) patients in whom titration in supine position was unacceptable were titrated in lateral position. Patients titrated with PAP in the lateral position therapy group had higher BMI, higher neck and waist circumference, and lower awake sPO2 and nadir sPO2 during sleep, and spent more time in sleep with sPO2 < 90%. CONCLUSION Combination of positional therapy and PAP device is an effective way of titration for difficult to treat OSA patients. It can be tried in patients who fail titration in supine position.
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Ravesloot MJL, Vonk PE, Maurer JT, Oksenberg A, de Vries N. Standardized framework to report on the role of sleeping position in sleep apnea patients. Sleep Breath 2021. [PMID: 33426584 DOI: 10.1007/s11325-020-02255-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Sleep apnea is a multifactorial illness which can be differentiated in various physiological phenotypes as a result of both anatomical and non-anatomical contributors (e.g., low respiratory arousal threshold, high loop gain). In addition, the frequency and duration of apneas, in the majority of patients with OSA, are influenced by sleeping position. Differences in characteristics between non-positional patients (NPP) and positional patients (PP) suggest another crucial phenotype distinction, a clinical phenotype focusing on the role of sleeping position on sleep apnea. Since this clinical phenotype distinction has therapeutic implications, further research is necessary to better understand the pathophysiology behind this phenotypic trait and to improve management of PP. Therefore, we suggest a standardized framework that emphasizes the role of sleeping position when reporting clinical and research data on sleep apnea. METHODS We identified 5 key topics whereby a standardized framework to report on the role of sleeping position would be of added value: (1) sleep study data, (2) anatomical, morphological and physiological factors, (3) drug-induced sleep endoscopy (DISE) findings, (4) sleep apnea management, and (5) effectiveness versus efficacy of positional therapy in sleep apnea management. We performed a literature search to identify evidence to describe and support the rationale behind these 5 main recommendations. RESULTS In this paper, we present the rationale behind this construct and present specific recommendations such as reporting sleep study indices (disease severity) and sleep time spent in various sleeping positions. The same is suggested for DISE findings and effect of treatment. Sleep study indices (disease severity), anatomical, morphological, and physiological factors in sleep apnea patients should be reported separately for PP and NPP. CONCLUSION Applying these suggestions in future research will improve patient care, assist in better understanding of this dominant phenotype, and will enhance accurate comparisons across studies and future investigations.
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Abstract
Positional therapy appears to be an attractive strategy for many patients with positional obstructive sleep apnea (OSA). However, under the American Academy of Sleep Medicine OSA guidelines, positional therapy is considered as only an alternative therapy, because previous research has demonstrated poor treatment tolerance and adherence. Recent technological advances have renewed interest in positional therapy, with the invention of new sophisticated vibratory positional therapy devices. These devices have shown great promise with efficacy, markedly improved patient tolerance, and long-term adherence. We review the literature on positional therapy and explore the most current evidence on the new positional therapy devices.
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Affiliation(s)
- Mok Yingjuan
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | - Wong Hang Siang
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - Tan Kah Leong Alvin
- Department of Otorhinolaryngology, Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - Hsu Pon Poh
- Department of Otorhinolaryngology, Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889
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Maurer JT, Leitzbach S. [Conservative treatment of obstructive sleep apnea using non-PAP therapies]. HNO 2020; 68:791-800. [PMID: 32897392 DOI: 10.1007/s00106-020-00947-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In Germany about one third of adults aged between 30 and 69 years suffer from obstructive sleep apnea (OSA). Snoring, inspiratory flow limitations, hypopneas, and apneas occur, leading to disturbed sleep, reduced daytime performance, and increased cardiovascular morbidity and mortality. Positive airway pressure therapy (PAP therapy) can be successfully administered in every OSA severity. However, other conservative treatments have to be considered for some patients, particularly in PAP failure or intolerance. The individual treatment concept is based on poly(somno)graphic, morphological, and functional assessment, taking treatment acceptance, adherence, and compliance into account.
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Affiliation(s)
- Joachim T Maurer
- Sektion Schlafmedizin, Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Sarah Leitzbach
- Sektion Schlafmedizin, Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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Yaremchuk K. Why and When to Treat Snoring. Otolaryngol Clin North Am 2020; 53:351-365. [PMID: 32336469 DOI: 10.1016/j.otc.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
It is estimated that half of the adult population older than 60 years snores. This article discusses the many aspects of snoring, including impacts on bed partners, the individual who snores, and when and how to appropriately evaluate, diagnose, and treat the perpetrator. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of the phenomenon of snoring.It is estimated that half of the adult population over the age of 60 years of age snores. This chapter discusses snoring, including the impact on bed partners, the individual that snores and when and how to treat the snorer. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of patients who snores.
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Affiliation(s)
- Kathleen Yaremchuk
- Department of Otolaryngology/Head and Neck Surgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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Martínez Ruiz de Apodaca P, Carrasco Llatas M, Matarredona Quiles S, Dalmau Galofre J. Development of positional obstructive sleep apnea (POSA) after upper airway surgery in OSA patients. Sleep Breath 2020; 24:849-56. [PMID: 31410807 DOI: 10.1007/s11325-019-01910-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/17/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Positional therapy (PT) has become more reliable for obstructive sleep apnea (OSA) patients with the use of new devices. The objectives of this study were to determine the preoperative prevalence of positional OSA (POSA) in our population of surgically treated patients and the proportion of patients who developed POSA after surgery and might improve with additional positional therapy. METHODS This was a retrospective study of surgically treated OSA patients from 1999 to 2017. The Cartwright definition was used to define POSA. All patients completed a sleep study before and 6 months after surgery and a complete upper airway (UA) exploration (awake ± DISE). A total of 125 patients were included. RESULTS The global prevalence of POSA before surgery was 31.2%. In those who were cured by surgery, the preoperative prevalence of POSA was 38.3%. Having POSA was not related with surgical success outcome. For patients not cured by surgery, the proportion of POSA significantly increased from 25.64 to 53.85% after surgery. Eighteen patients of them (23.1%) achieved AHI < 5/h in a lateral position. In those patients, PT with Night-Shift™ was suggested, 50% of them accepted it and 88.9% of them experienced excellent satisfaction. Lateral velum collapse and the absence of concentric collapse at the tongue base had statistical relationships with the development of POSA. CONCLUSIONS The prevalence of POSA is increased after surgery in patients with persistent OSA after surgery. In these patients, the development of POSA gives an extra therapeutic chance as 23.1% of these cases can be successfully treated by using PT.
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Oksenberg A, Gadoth N, Töyräs J, Leppänen T. Prevalence and characteristics of positional obstructive sleep apnea (POSA) in patients with severe OSA. Sleep Breath 2019; 24:551-559. [PMID: 31325020 DOI: 10.1007/s11325-019-01897-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/25/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE We assessed the prevalence of positional patients (PPs) and the main predictors of positional dependency in severe obstructive sleep apnea (OSA). A simulated effect of positional therapy (PT) vs. continuous positive airway pressure (CPAP) was also assessed. METHODS Polysomnographic recordings of 292 consecutive patients with severe OSA (Apnea-Hypopnea Index (AHI) ≥ 30) who slept > 4 h and had ≥ 30 min sleep in both supine and lateral positions were assessed. PPs were defined to have a supine AHI/lateral AHI ratio ≥ two and non-positional patients (NPPs) a supine AHI/lateral AHI ratio < two. RESULTS A total of 35.3% of the severe OSA patients were PPs. They were less obese and had less severe OSA (p < 0.001) compared with NPPs. The percentage of total apnea-hypopnea time from total sleep time (AHT%) was the most significant predictor for positional dependency. By sleeping in the lateral posture (i.e. after simulated PT), 78 (75.7%) PPs obtained significant improvement of their OSA severity and 9 (8.7%) of them became "non-OSA". Moreover, if CPAP was used only for 50% of total sleep time, 53 patients (18.2%) gained more benefit from avoiding the supine posture than from CPAP therapy. CONCLUSIONS More than a third of the studied severe OSA patients were PPs. These patients could achieve a significant decrease in the number and severity of apneas and hypopneas by adopting the lateral posture, suggesting that PT may be a valuable therapy for a significant portion of these severe OSA patients who for whatever reason are not being treated by CPAP. TRIAL REGISTRY ClinicalTrials.gov Identifier: NCT03232658.
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Affiliation(s)
- Arie Oksenberg
- Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana, Israel.
| | - Natan Gadoth
- Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana, Israel
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Timo Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Abstract
Positional therapy appears to be an attractive strategy for many patients with positional obstructive sleep apnea (OSA). However, under the American Academy of Sleep Medicine OSA guidelines, positional therapy is considered as only an alternative therapy, because previous research has demonstrated poor treatment tolerance and adherence. Recent technological advances have renewed interest in positional therapy, with the invention of new sophisticated vibratory positional therapy devices. These devices have shown great promise with efficacy, markedly improved patient tolerance, and long-term adherence. We review the literature on positional therapy and explore the most current evidence on the new positional therapy devices.
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Affiliation(s)
- Mok Yingjuan
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | - Wong Hang Siang
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - Tan Kah Leong Alvin
- Department of Otorhinolaryngology, Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - Hsu Pon Poh
- Department of Otorhinolaryngology, Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889
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13
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Benoist LBL, Beelen AMEH, Torensma B, de Vries N. Subjective effects of the sleep position trainer on snoring outcomes in position-dependent non-apneic snorers. Eur Arch Otorhinolaryngol 2018; 275:2169-2176. [PMID: 29948269 PMCID: PMC6060761 DOI: 10.1007/s00405-018-5036-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/08/2018] [Indexed: 01/01/2023]
Abstract
Purpose To evaluate the effect of a new-generation positional device, the sleep position trainer (SPT), in non-apneic position-dependent snorers. Methods Non-apneic position-dependent snorers with an apnea–hypopnea index (AHI) < 5 events/h were included between February 2015 and September 2016. After inclusion, study subjects used the SPT at home for 6 weeks. The Snore Outcome Survey (SOS) was filled out by the subjects at baseline and after 6 weeks, and at the same time, the Spouse/Bed Partner Survey (SBPS) was filled out by their bed partners. Results A total of 36 participants were included and 30 completed the study. SOS score improved significantly after 6 weeks from 35.0 ± 13.5 to 55.3 ± 18.6, p < 0.001. SBPS score also improved significantly after 6 weeks from 24.7 ± 16.0 versus 54.5 ± 25.2, p < 0.001. The severity of snoring assessed with a numeric visual analogue scale (VAS) by the bed partner decreased significantly from a median of 8.0 with an interquartile range (IQR) of [7.0–8.5] to 7.0 [3.8–8.0] after 6 weeks (p = 0.004). Conclusions Results of this study indicate that positional therapy with the SPT improved several snoring-related outcome measures in non-apneic position-dependent snorers. The results of this non-controlled study demonstrate that this SPT could be considered as an alternative therapeutic option to improve sleep-related health status of snorers and their bed partners.
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Affiliation(s)
- L B L Benoist
- Department of Otorhinolaryngology Head and Neck surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. .,Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - A M E H Beelen
- Department of Otorhinolaryngology Head and Neck surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - B Torensma
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - N de Vries
- Department of Otorhinolaryngology Head and Neck surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.,Department of Oral Kinesiology, ACTA, Amsterdam, The Netherlands.,Department of Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
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Levendowski DJ, Oksenberg A, Vicini C, Penzel T, Levi M, Westbrook PR. A systematic comparison of factors that could impact treatment recommendations for patients with Positional Obstructive Sleep Apnea (POSA). Sleep Med 2018; 50:145-151. [PMID: 30055481 DOI: 10.1016/j.sleep.2018.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/20/2018] [Accepted: 05/16/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE/BACKGROUND Systematically compare four criteria for Positional Obstructive Sleep Apnea (POSA) based on AASM 2007 and 2012 hypopnea scoring definitions. PATIENTS/METHODS 142 records acquired by in-home polysomnography (Sleep Profiler PSG2™) were retrospectively analyzed using AHI based on the American Academy Sleep Medicine 2007 and 2012 criteria (AHI2007 and AHI2012). Positional obstructive sleep apnea (POSA) was characterized using four criteria: Amsterdam Positional OSA Classification (APOC), supine AHI twice the non-supine AHI (Cartwright), Cartwright plus the non-supine AHI < 5 (Mador), and the overall AHI severity at least 1.4 times the non-supine severity (Overall/NS-AHI). RESULTS Correlations between the Cartwright and Overall/NS-AHI criteria increased with the inclusion of a more relaxed definition of hypopneas (AHI2007 = 0.79 and AHI2012 = 0.86, P < 0.00001). The prevalence of POSA based on the Cartwright and Overall/NS-AHI criteria was approximately 60% in those with at least mild OSA by AHI2007and AHI2012. A 16% reduction in POSA prevalence for AHI2012 vs. AHI2007 was attributed to the increased incident of mild OSA. For identification of those expected to have 25% or 35% reductions in SDB severity with positional therapy, Cartwright and Overall/NS-AHI exhibited the strongest sensitivity and Overall/NS-AHI and Mador the best specificity. CONCLUSIONS The four criteria used to identify POSA have similarities and differences. While there were similarities between the Cartwright and Overall/NS-AHI criteria in the detection of POSA prevalence across both scoring criteria, the Overall/NS-AHI provided the most consistent detection of those most likely to demonstrate important reductions in sleep disordered breathing severity if supine sleep is avoided.
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Affiliation(s)
| | - Arie Oksenberg
- Sleep Disorders Unit, Loewenstein Hospital - Rehabilitation Center, Raanana, Israel
| | - Claudio Vicini
- Ear-Nose-Throat Unit, Head and Neck Department, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Thomas Penzel
- Sleep Medicine Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mark Levi
- Levi's Sleep Clinic, West Gosford, Australia
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de Ruiter MHT, Benoist LBL, de Vries N, de Lange J. Durability of treatment effects of the Sleep Position Trainer versus oral appliance therapy in positional OSA: 12-month follow-up of a randomized controlled trial. Sleep Breath 2018; 22:441-450. [PMID: 28913630 PMCID: PMC5918490 DOI: 10.1007/s11325-017-1568-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/23/2017] [Accepted: 09/05/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The Sleep Position Trainer (SPT) is a new option for treating patients with positional obstructive sleep apnea (POSA). This study investigated long-term efficacy, adherence, and quality of life during use of the SPT device compared with oral appliance therapy (OAT) in patients with POSA. METHODS This prospective, multicenter trial randomized patients with mild to moderate POSA (apnea-hypopnea index [AHI] 5-30/h) to SPT or OAT. Polysomnography was performed at baseline and after 3 and 12 months' follow-up. The primary endpoint was OSA severity; adherence, quality of life, and adverse events were also assessed. RESULTS Ninety-nine patients were randomized and 58 completed the study (29 in each group). Median AHI in the SPT group decreased from 13.2/h at baseline to 7.1/h after 12 months (P < 0.001); corresponding values in the OAT group were 13.4/h and 5.0/h (P < 0.001), with no significant between-group difference (P = 1.000). Improvements throughout the study were maintained at 12 months. Long-term median adherence was also similar in the two treatment groups; the proportion of patients who used their device for ≥ 4 h for 5 days in a week was 100% in the SPT group and 97.0% in the OAT group (P = 0.598). CONCLUSIONS The efficacy of SPT therapy was maintained over 12 months and was comparable to that of OAT in patients with mild to moderate POSA. Adherence was relatively high, and similar in the two groups. TRIAL REGISTRATION www.clinicaltrials.gov (NCT02045576).
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Affiliation(s)
- Maurits H T de Ruiter
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Linda B L Benoist
- Department of Otorhinolaryngology Head and Neck Surgery, OLVG West, Jan Tooropstraat 164 1061 AE, Amsterdam, The Netherlands.
- Departments of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Nico de Vries
- Department of Otorhinolaryngology Head and Neck Surgery, OLVG West, Jan Tooropstraat 164 1061 AE, Amsterdam, The Netherlands
- Department of Oral Kinesiology of the Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
- Departments of Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Department of Oral Kinesiology of the Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
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Newell J, Mairesse O, Neu D. Can positional therapy be simple, effective and well tolerated all together? A prospective study on treatment response and compliance in positional sleep apnea with a positioning pillow. Sleep Breath 2018; 22:1143-51. [PMID: 29516264 DOI: 10.1007/s11325-018-1650-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE Until now, there is no clear consensus on optimal care for mild sleep-related breathing disorders (SRBD) in general or for positional obstructive sleep apnea (POSA) in particular. Most proposed treatment options are either invasive and/or expensive. Positional therapy (PT) may therefore present as a valuable first-line intervention in POSA. METHODS Twenty-eight patients presenting with POSA were enrolled in a prospective cohort study. The protocol consisted of three nights of polysomnography (PSG) in an academic sleep lab. Inclusion was based on the first PSG. During a consecutive PSG, PT was provided by means of a sleep-positioning pillow (Posiform®). The third PSG was performed after 1 month of PT. Sleepiness, fatigue, and sleep quality were assessed with the Epworth Sleepiness Scale (ESS), the fatigue severity scale (FSS), the Pittsburgh Sleep Quality Index (PSQI), and the Function Outcomes of Sleep Questionnaire (FOSQ) at baseline, and after 1 and at 6 months of PT alongside satisfaction and compliance ratings. RESULTS Significant immediate treatment effects after one night and sustained after 1 month were observed by significant reductions of sleep in supine position (p < .001), sleep fragmentation (p < .05), apnea-hypopnea (p < .001), respiratory disturbance (p < .001), and oxygen desaturation (p < .001) indices. PSQI (p < .001), ESS (p < .005), and FOSQ (p < .001) also showed significant and persistent improvements. CONCLUSIONS Combined effects on sleep-related respiration and clinical symptoms were observed after PT initiation as well as after 1 month using the sleep-positioning pillow. Furthermore, reported compliance and overall satisfaction appeared to be highly concordant both at 1 month and 6 months follow-up.
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Deppe M, Lebiedz P. [Extreme obesity-particular aspect of invasive and noninvasive ventilation]. Med Klin Intensivmed Notfmed 2019; 114:533-40. [PMID: 28875324 DOI: 10.1007/s00063-017-0332-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 06/27/2017] [Accepted: 07/19/2017] [Indexed: 10/18/2022]
Abstract
The obesity rate is increasing worldwide and the percentage of obese patients in the intensive care unit (ICU) is rising concomitantly. Ventilatory support strategies in obese patients must take into account the altered pathophysiological conditions. Unfortunately, prospective randomized multicenter trials on this subject are lacking. Therefore, current strategies are based on the individual experiences of ICU physicians and single-center studies. Noninvasive ventilation (NIV) in critically ill patients with acute respiratory failure and obesity hypoventilation syndrome (OHS) is an efficient treatment option and should be provided as early as possible is an effort to avoid intubation. Patient positioning is also crucial: half-sitting positions (>45°) improve lung compliance and functional residual capacity in patients with respiratory failure. Transpulmonary pressure measurements or the Acute Respiratory Distress Syndrome (ARDS) Network tables may help to adjust the optimal positive end-expiratory pressure (PEEP). The tidal volume should be adapted to the ideal and not the actual bodyweight (Vt = 6 ml/kg of ideal bodyweight) to avoid lung damage and (additional) right ventricular stress. Under particular conditions, inspiratory pressures >30 cmH2O may be tolerated for a limited duration. Early tracheostomy combined with termination/reduction of sedation and relaxation is controversy discussed in the literature as a therapeutic option during invasive ventilation of morbidly obese patients. However, data on early tracheotomy in obese respiratory failure patients are rare and this should be regarded as an individual treatment attempt only. In cases of refractory lung failure, venovenous extracorporeal membrane oxygenation (vv-ECMO) is an option despite anatomic changes in morbid obesity.
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Benoist L, de Ruiter M, de Lange J, de Vries N. A randomized, controlled trial of positional therapy versus oral appliance therapy for position-dependent sleep apnea. Sleep Med 2017; 34:109-117. [PMID: 28522078 DOI: 10.1016/j.sleep.2017.01.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the effectiveness of positional therapy (PT) with the sleep position trainer (SPT) to oral appliance therapy (OAT) in patients with mild-to-moderate positional obstructive sleep apnea (POSA). METHODS Multicenter, prospective, randomized, controlled trial. Patients with mild-to-moderate POSA (apnea-hypopnea index (AHI) ≥5 ≤ 30/hour sleep) were randomized for PT or OAT. Polysomnography was repeated after 3 months. Efficacy, adherence, mean disease alleviation (MDA), quality of life, dropouts and adverse events were evaluated. RESULTS A total of 177 patients were screened for the study; 99 underwent randomization and 81 completed the study. Intention-to-treat (ITT) analysis of median [IQR] AHI showed a reduction in the PT group from 13.0 [9.7-18.5] to 7.0 [3.8-12.8], p < 0.001 and in the OAT group from 11.7 [9.0-16.2] to 9.1 [4.9-11.7], p < 0.001. Mean adherence (≥4 h/night, ≥5 days/week) was 89.3 ± 22.4% for SPT versus 81.3 ± 30.0% in OAT patients, p = 0.208. CONCLUSIONS Oral appliance therapy and positional therapy were equally effective in reducing the median AHI in patients with mild-to-moderate POSA. The results of this study have important implications for future OSA treatment guidelines and daily clinical practice. CLINICALTRIALS. GOV NUMBER NCT02045576.
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Affiliation(s)
- Linda Benoist
- Department of Otorhinolaryngology Head and Neck Surgery, OLVG West, Amsterdam, The Netherlands; Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Maurits de Ruiter
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Oral Kinesiology, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Oral Kinesiology, Amsterdam, The Netherlands
| | - Nico de Vries
- Department of Otorhinolaryngology Head and Neck Surgery, OLVG West, Amsterdam, The Netherlands; Department of Oral Kinesiology, Amsterdam, The Netherlands; Department of Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
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Abstract
Central sleep apnea (CSA) and obstructive sleep apnea (OSA) are prevalent in heart failure (HF) and associated with a worse prognosis. Nocturnal oxygen therapy may decrease CSA events, sympathetic tone, and improve left ventricular ejection fraction, although mortality benefit is unknown. Although treatment of OSA in patients with HF is recommended, therapy for CSA remains controversial. Continuous positive airway pressure use in HF-CSA may improve respiratory events, hemodynamics, and exercise capacity, but not mortality. Adaptive servo ventilation is contraindicated in patients with symptomatic HF with predominant central sleep-disordered events. The role of phrenic nerve stimulation in CSA therapy is promising.
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Affiliation(s)
- Bernardo J Selim
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Center for Sleep Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Center for Sleep Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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20
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Benoist LBL, Verhagen M, Torensma B, van Maanen JP, de Vries N. Positional therapy in patients with residual positional obstructive sleep apnea after upper airway surgery. Sleep Breath 2016; 21:279-288. [PMID: 27535072 DOI: 10.1007/s11325-016-1397-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/30/2016] [Accepted: 08/04/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE/BACKGROUND A considerable portion of patients has residual positional obstructive sleep apnea (POSA) after upper airway surgery. Those patients could benefit from additional treatment with positional therapy (PT). The objective of this prospective study was to assess the additional effect of PT in patients with residual POSA after upper airway surgery for sleep apnea. METHODS A polysomnography (PSG) was used to diagnose a patient with residual POSA after surgery. After informed consent, patients were treated with PT for 3 months and underwent a follow-up PSG while using the sleep position trainer (SPT). Changes in apnea-hypopnea index (AHI) and sleep position parameters were analyzed. Compliance rates and mean disease alleviation (MDA) were determined. RESULTS Thirty-three patients with a median postoperative AHI of 18.3/h sleep were included. With the SPT median AHI dropped to 12.5/h sleep and the Epworth Sleepiness Scale (ESS) improved from 10.0 to 7.0. After 3 months, 37.5 % patients were considered responders of whom 31.3 % had treatment success. The compliance rate with SPT was 89.0 %. MDA was 44.7 % for SPT alone. With the combination of both surgery and SPT, MDA was 65.6 %. CONCLUSIONS The results of this study indicate that additional PT in a complex OSA patient population with residual POSA after surgery can increase overall therapeutic effectiveness by improving the median MDA from 39.5 % (effect of surgery alone) to 65.6 % (effect of combining surgery and PT).
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Affiliation(s)
- L B L Benoist
- Department of Otolaryngology Head and Neck Surgery, OLVG west, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. .,Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - M Verhagen
- Department of Otolaryngology Head and Neck Surgery, OLVG west, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - B Torensma
- Department of Epidemiology and Biostatistics, OLVG west, Amsterdam, The Netherlands
| | - J P van Maanen
- Department of Otolaryngology Head and Neck Surgery, OLVG west, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - N de Vries
- Department of Otolaryngology Head and Neck Surgery, OLVG west, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, OLVG west, Amsterdam, The Netherlands.,Department of Oral Kinesiology ACTA, Amsterdam, The Netherlands.,Department of Otolaryngology Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
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Abstract
In the last several years, a variety of novel approaches to the treatment of sleep-disordered breathing have emerged. This new technology holds promise in serving to re-engage with patients who have previously been lost to follow-up due to continuous positive airway pressure intolerance. With more tools at our disposal, in turn more options can be offered to patients' growing demand for alternatives that are tailored to their individual needs. The key to proper deployment of alternative therapies will often depend on identification of certain phenotypic traits that trend toward a reasonable response to a given therapy.
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22
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Ravesloot MJ, Frank MH, van Maanen JP, Verhagen EA, de Lange J, de Vries N. Positional OSA part 2: retrospective cohort analysis with a new classification system (APOC). Sleep Breath 2016; 20:881-8. [PMID: 26084413 DOI: 10.1007/s11325-015-1206-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/08/2015] [Accepted: 05/25/2015] [Indexed: 11/01/2022]
Abstract
BACKGROUND In Part 1 of this two-part article, the Amsterdam Positional Obstructive Sleep Apnoea Classification (APOC) was recently introduced, a classification system aimed at facilitating the identification of suitable candidates for positional therapy (PT): patients who will benefit from a clinically significant improvement of their obstructive sleep apnoea (OSA) with PT. APOC was developed with new generation PT devices in mind rather than conventional PT (tennis ball technique). New generation PT can be defined as a well-tolerated device which prevents a patient from adopting the worst sleeping position (WSP) without negatively influencing sleep efficiency, as objectified by a full night polysomnography (PSG). PT is rapidly gaining momentum in the scope of OSA treatment. The objective of this manuscript is to measure the prevalence of position-dependent obstructive sleep apnoea (POSA) according to the APOC, in a consecutive series of patients referred for PSG as well as an investigation of associations between POSA and certain patient characteristics. METHODS We performed a retrospective, single-centre cohort study including a consecutive series of patients who underwent a PSG during the period of April 2010 until October 2010. RESULTS Within this OSA-cohort (n = 253), a prevalence of POSA of 69 % when applying APOC is measured, compared to 64 % when applying Cartwright's classification. An inverse relation between POSA and BMI was observed, likewise between POSA and apnoea hypopnoea index (AHI). CONCLUSION We are of opinion that APOC is a suitable tool to identify patients who will or will not benefit from PT, thus resulting in more cost-efficient treatment.
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Eijsvogel MM, Ubbink R, Dekker J, Oppersma E, de Jongh FH, van der Palen J, Brusse-Keizer MG. Sleep position trainer versus tennis ball technique in positional obstructive sleep apnea syndrome. J Clin Sleep Med 2015; 11:139-47. [PMID: 25515276 PMCID: PMC4298771 DOI: 10.5664/jcsm.4460] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 11/09/2014] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVE Positional therapy (PT) is an effective therapy in positional obstructive sleep apnea syndrome (POSAS) when used, but the compliance of PT is low. The objective of this study was to investigate whether a new kind of PT is effective and can improve compliance. METHODS 29 patients were treated with the Sleep Position Trainer (SPT), 26 patients with the Tennis Ball Technique (TBT). At baseline and 1 month polysomnography, Epworth Sleepiness Scale (ESS) and the Quebec Sleep Questionnaire (QSQ) were taken. Daily compliance was objectively measured in both groups. RESULTS Both therapies prevent supine sleep position to a median of 0% (min-max: SPT 0.0% to 67%, TBT 0.0% to 38.9%), resulting in a treatment success (AHI <5) in 68.0% of the SPT and 42.9% of the TBT patients. The ESS at baseline was <10 in both groups. Sleep quality parameters as wake after sleep onset (WASO; p = 0.001) and awakenings (p = 0.006) improved more in the SPT group. Total QSQ scores (0.4±0.2, p = 0.03) and the QSQ domains nocturnal symptoms (0.7±0.2, p = 0.01) and social interactions (0.8±0.3, p = 0.02) changed in favor of the SPT group. Effective compliance (≥4 h/night + ≥5 days/week) was 75.9% for the SPT and 42.3% for the TBT users (p = 0.01). CONCLUSION In mild POSAS with normal EES the new SPT device and the standard TBT are equally effective in reducing respiratory indices. However, compared to the TBT, sleep quality, quality of life, and compliance improved significantly more in the SPT group.
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Affiliation(s)
- Michiel M. Eijsvogel
- Department of Pulmonology and Sleep Medicine, Medisch Spectrum Twente Hospital, Enschede, The Netherlands
| | - Rinse Ubbink
- MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Janita Dekker
- MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Eline Oppersma
- MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Frans H. de Jongh
- Department of Pulmonology and Sleep Medicine, Medisch Spectrum Twente Hospital, Enschede, The Netherlands
- Department of Mechanical Engineering, Engineering Fluid Dynamics, University of Twente, Enschede, The Netherlands
- Academic Medical Centre, Department of Neonatal Intensive Care, Amsterdam, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente Hospital, Enschede, The Netherlands
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
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Ha SCN, Hirai HW, Tsoi KKF. Comparison of positional therapy versus continuous positive airway pressure in patients with positional obstructive sleep apnea: a meta-analysis of randomized trials. Sleep Med Rev 2013; 18:19-24. [PMID: 23831268 DOI: 10.1016/j.smrv.2013.05.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 05/04/2013] [Accepted: 05/06/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA), caused by the obstruction of the upper airway, is the most common type of sleep apnea. Continuous positive airway pressure (CPAP) and positional therapy have been shown to be effective to improve positional OSA. AIM To compare the effectiveness of positional therapy versus CPAP on positional OSA. METHODS Prospective randomized trials were systematically searched from the OVID databases. The trials comparing positional therapy versus CPAP in patients with positional OSA were included. Apnea-hypopnea index (AHI), mean oxygen saturation level, arousal index, sleep efficiency, and sleep time were the outcomes of this meta-analysis. RESULTS Three crossover trials were identified from Canada, New Zealand, and United States from 1999 to 2010. A total of 71 patients were randomly assigned to receive CPAP or positional therapy and the mean age of patients was 51 y. Positional therapy showed higher AHI (mean difference, MD: 4.28, 95% CI: 0.72-7.83) and lower oxygen saturation level (MD: -1.04, 95% CI: -1.63 to -0.46) than CPAP. It showed no distinct advantage over CPAP in terms of arousal index, sleep efficiency, and total sleep time, but CPAP reduced sleep time in the supine position. CONCLUSION CPAP is superior to positional therapy in reducing the severity of sleep apnea and increasing the oxygen saturation level in patients with positional OSA.
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Affiliation(s)
- Stanley C N Ha
- Department of Otorhinolaryngology, Head & Neck Surgery, United Christian Hospital, Hong Kong; School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Hoyee W Hirai
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Kelvin K F Tsoi
- Hong Kong Branch of the Chinese Cochrane Centre, The Chinese University of Hong Kong, Hong Kong; School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
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