Obstructive Sleep Apnea Controls Research Articles

A mandibular advancement device associated with lingual control: a new treatment option for obstructive sleep apnea?

Oral appliances (OA) have become the main alternative to positive pressure airway devices (PAP) for the control of obstructive sleep apnea (OSA). Despite literature support, controversies about the mode of action and the effectiveness of these devices persist. The aim of this study was to evaluate the efficacy of modified mandibular advancement devices (MAD) in patients with OSA who failed treatment with MAD and toevaluate the role of the tongue as a factor in patients who failed treatment with MAD. Patients unable to control the apnea-hypopnea index (AHI) using a MAD were subsequently treated with a modified version that included a tongue trimming accessory. The objective was to stabilize the tongue by preventing it from sliding with the consequent collapse of the upper airway (UA). New polysomnography (PSG) was performed with the modified MAD in place. A total of 20 patients who failed MAD therapy were studied including15 men (75%) with mean age (±standard deviation) of 58.5±13.1 years and BMI 29.6± 5.0 Kg/m2.After installing the tongue trimmer, the number of patients who achieved complete success with the new MAD (AHI < 5) went from 0 to 30% and those who achieved partial success (5 < AHI < 10) went from 0 to 20%. The number of patient responders (AHI reduced by at least 50%) went from 20 to 75%. The results suggest that the tongue, even in the presence of a MAD, may be one of the contributing factors for the collapse of theUA and consequent device ineffectiveness. By stabilizing the tongue through the insertion of a tongue trimmer, theMAD became more effectivein many cases.

Anthropometric Determinants of Autonomic Control in Obstructive Sleep Apnea: A Large-Scale Study.

Autonomic dysfunction is an independent risk factor for cardiovascular disease (CVD). Both obesity and obstructive sleep apnea (OSA) are associated with heart rate variability (HRV) (a hall marker of sympathetic arousal) and increased risk of CVD. This study aims to investigate whether anthropometric parameters could predict reduced HRV in adult OSA during wakefulness. Cross-sectional study. Sleep center of Shanghai Jiao Tong University Affiliated Sixth Hospital from 2012 to 2017. Total of 2134 subjects (503 non-OSA and 1631 OSA) were included. Anthropometric parameters were recorded. HRV was recorded during a 5-minute wakefulness period and analyzed by using time-domain method and frequency-domain method. Multiple step-wise linear regressions were performed to determine significant predictors of HRV with and without adjustments. Multiplicative interactions between gender, OSA, and obesity on HRV were also determined and evaluated. Waist circumference (WC) was significant negative determinant of root mean square of successive NN intervals(β = -.116, p < .001) and high-frequency power (β = -.155, p < .001). Age was the strongest determining factor of HRV. Significant multiplicative interactions between obesity and OSA on HRV, gender, and obesity on cardiovascular parameters were observed. Anthropometric parameters could predict reduced HRV during wakefulness in patients with OSA, especially WC was the strongest influenceable factor. Obesity and OSA had significant multiplicative interaction on HRV. Gender and obesity had significant multiplicative interaction on cardiovascular parameters. Early intervention for obesity, especially centripetal obesity, may improve reduction of autonomic function and risk of CVD.

Development and validation of educational pamphlet to prevent sleepapnea

Background. Obstructive sleep apnea (OSA) is characterized by recurrent complete (apneas) and partial (hypopneas) upper airway obstructive. The Obstructive Sleep Apnea is one of the leading risk factor for coronary heart diseases and heart failure. Aim. The aim of the study was to develop and validate the educational pamphlet on Obstructive sleep apnea (OSA) Design. A mixed method research design with quantitative research approach was adopted in this study. Methods. Educational pamphlet was developed on prevention and control of Obstructive sleep apnea. The pamphlet was developed in three phases which includes review of content, design / layout of the pamphlet and validation with expert opinion. The pamphlet was validated using Item level content validity index (I-CVI) and Scale level Content Validity Index (S-CVI). individual items which ranged from 0.94 – 1. Scale level Content Validity Index (S-CVI) was 0.9120.

A Novel mHealth Approach for the Monitoring and Assisted Therapeutics of Obstructive Sleep Apnea

Obstructive sleep apnea is a respiratory problem that has serious consequences for physical and mental health, but also in monetary terms, since traffic accidents and poor work performance, among other direct consequences, are attributed to it. It is estimated that between 9% and 38% of the world’s population has this disease. This is a multifactorial disease, therefore, there are several methods of detection and treatment; however, all of them cause discomfort to the patient, or to those around them. In this article we propose a system for the detection and control of obstructive sleep apnea that promises to overcome the drawbacks of the existing therapies, therefore, potentially making it a practical and effective solution for this disease. The proof of concept presented in this paper makes use of an electromyography sensor to collect the myoelectric signal produced by the genioglossus muscle. Surface electrodes provide the electromyography signals to an ESP32 microcontroller, which has the function of analyzing and comparing the data obtained with a predefined value of the apnea threshold. After the detection of an apnea, the circuit is able to create a stimulus signal that is applied directly to the muscle, so that airway occlusion does not occur, and the user does not wake up. The data from each use are automatically sent to a database to be viewed and analyzed at a later point.

Effectiveness of a Uniquely Designed Oral Appliance on Obstructive Sleep Apnea Control: A Pilot Study.

Objectives Obstructive sleep apnea is an inflammatory, chronic, and evolutive disease often needing adequate treatment and follow-up. The oral appliance (OA) is an accepted alternative therapy for obstructive sleep apnea (OSA) control. Due to greater adherence, OA with mandibular advancement (OA m ) is being recommended treatment for patients who refuse or do not tolerate continuous positive airway pressure. The mode of action of OA m is to promote the advancement of the mandible or tongue with a subsequent increase in the tone of the pharyngeal muscles and the permeability of the upper airway, but most OA m use conventional models as reference, analogic, or digital, dissociating dental arches of the skull structures. Materials and Methods A retrospective longitudinal study of 33 OSA patient treated with a different OA m , that use Camper plane as reference with skull structures for dental arches disocclusion, where polysomnographic, cephalometric measures, and subjective data from questionnaires pre- and post-treatment were assessed and correlated. Descriptive analysis, correlated Chi-square tests, and basic statistics were used. Generalized linear mixed model for repeated measure and post hoc Tukey–Kramer test compares the variables pre- and post-treatment. Shapiro–Wilk test and Pearson's correlation coefficients were used. All statistical tests were set in 5% level of significance. Results Regarding polysomnography data, there was a significant association between apnea hypopnea index (AHI) with oxygen saturation, arousal index (AI) and the maximum heartbeats, and sleep improvement and health risk reduction. Additionally, from cephalometric data, it was found a significant association between the tongue posture with the soft palate, hioyd-C3 and, lower and posterior airway. When both parameters are correlated, there are a significant dependent association with hyoid bone position with AHI and AI. The limitation of this study was the two-dimensional image used without provide volumetric measurements, but this limitation was reduced with the follow-up polysomnography parameters. Conclusion In this pilot study, DIORS OA m as an uniquely designed device using Camper plane as a reference for disocclusion was effective in the control of OSA.

Glycolipid metabolism involved in the stage special association with nocturnal cardiac autonomic control in obstructive sleep apnea

Glycolipid metabolism involved in the stage special association with nocturnal cardiac autonomic control in obstructive sleep apnea

Hyperlipidemia Prevalence and Cholesterol Control in Obstructive Sleep Apnea: Data from the European Sleep Apnea Database (ESADA)

Hyperlipidemia Prevalence and Cholesterol Control in Obstructive Sleep Apnea: Data from the European Sleep Apnea Database (ESADA)

The effect of extended wakefulness on postural control in obstructive sleep apnea and healthy controls

The effect of extended wakefulness on postural control in obstructive sleep apnea and healthy controls

The effect of extended wakefulness on postural control in obstructive sleep apnea and healthy controls

The effect of extended wakefulness on postural control in obstructive sleep apnea and healthy controls

Treating Chronic Hypoventilation With Automatic Adjustable Versus Fixed EPAP Intelligent Volume-Assured Positive Airway Pressure Support (iVAPS): A Randomized Controlled Trial.

New noninvasive ventilation (NIV) modes can automatically adjust pressure support settings to deliver effective ventilation in response to varying ventilation demands. It is recommended that fixed expiratory positive airway pressure (FixedEPAP) is determined by attended laboratory polysomnographic (PSG) titration. This study investigated whether automatically determined EPAP (AutoEPAP) was noninferior to FixedEPAP for the control of obstructive sleep apnea (OSA) during intelligent volume-assured pressure support (iVAPS) treatment of chronic hypoventilation. In this randomized, double-blind, crossover study, patients with chronic hypoventilation and OSA used iVAPS with AutoEPAP or FixedEPAP over two separate nights of attended PSG. PSG recordings were scored by an independent scorer using American Academy of Sleep Medicine 2012 criteria. Twenty-five adults (14 male) with chronic hypoventilation secondary to obesity hypoventilation syndrome (n = 11), chronic obstructive pulmonary disease (n = 9), or neuromuscular disease (n = 5), all of whom were on established home NIV therapy, were included (age 57 ± 7 years, NIV for ≥3 months, apnea-hypopnea index [AHI] >5/hour). AutoEPAP was noninferior to FixedEPAP for the primary outcome measure (median [interquartile range] AHI 2.70 [1.70-6.05]/hour vs. 2.40 [0.25-5.95]/hour; p = .86). There were no significant between-mode differences in PSG sleep breathing and sleep quality, or self-reported sleep quality, device comfort, and patient preference. Mean EPAP with the Auto and Fixed modes was 10.8 ± 2.0 and 11.8 ± 3.9 cmH2O, respectively (p = .15). In patients with chronic hypoventilation using iVAPS, the AutoEPAP algorithm was noninferior to FixedEPAP over a single night's therapy.

Control of OSA During Automatic Positive Airway Pressure Titration in a Clinical Case Series: Predictors and Accuracy of Device Download Data

To investigate the factors associated with physiologic control of obstructive sleep apnea (OSA) during automatic positive airway pressure (APAP) titration in a clinical series. To also assess the usefulness of apnea-hypopnea index (AHI) data downloaded from the APAP device (Dev AHI). Retrospective review of a consecutive series of patients with OSA who underwent APAP titration (Autoset Spirit, ResMed, Bella Vista, New South Wales, Australia ) with simultaneous polysomnographic (PSG) monitoring in the sleep laboratory. Tertiary sleep clinic. There were 190 consecutive patients with OSA referred for APAP titration. There were 58% of patients who achieved optimal or good control of OSA (titration PSG AHI < 10, or at least 50% reduction in AHI if diagnostic AHI < 15/hr) during APAP titration. The independent predictors of titration PSG AHI were a history of cardiac disease and elevated central apnea and arousal indices during the diagnostic study. Although the median and interquartile range (IQR) AHI from the device (7.0, 3.9-11.6 events/hr) was only slightly less than the PSG AHI (7.8, 3.9-14.4 events/hr, P = 0.04) during titration, case-by-case agreement between the two measures was poor (chi-square < 0.001). In a clinical sample control of OSA during APAP titration is often poor, and close clinical follow-up is particularly needed in patients with a history of cardiac disease or with high arousal or central apnea indices on the diagnostic study. Device AHI does not reliably assess control during APAP titration, and PSG assessment may be required if clinical response to treatment is poor. The findings relate to the ResMed AutoSet device and may not apply to other devices.

Effectiveness of Treatment Apnea-Hypopnea Index: A Mathematical Estimate of the True Apnea-Hypopnea Index in the Home Setting

To present a new measurement instrument, the Effectiveness of Treatment Apnea-Hypopnea Index (ET-AHI), which the authors developed to determine an estimate of the therapeutic control of obstructive sleep apnea (OSA). The authors retrospectively evaluated a cohort of patients with OSA who initially attempted to use continuous positive airway pressure (CPAP) therapy and subsequently underwent maxillomandibular advancement (MMA) surgery. The ET-AHI calculations were performed to estimate the level of CPAP adherence that would be necessary to achieve equivalence with the MMA surgical result and to reach effective AHIs of 5 and 15. The sample was composed of 37 adult patients (mean age, 44.2 ± 9.0 yr; 73% men) with moderate to severe OSA (baseline AHI, 56.3 ± 22.6). CPAP therapy was highly efficacious (CPAP titration AHI, 4.3 ± 5.9), but no patient could adequately adhere to treatment. MMA produced a significant decrease in OSA (AHI after MMA, 11.6 ± 7.4). The ET-AHI calculations predicted that an 86% adherence rate with CPAP would be necessary to achieve equivalence with MMA, whereas adherence rates of 99% and 79% may be required to achieve effective AHIs of 5 and 15, respectively. The ET-AHI has the potential to significantly affect the care of patients with OSA because it may provide the treating clinician with a valuable tool to estimate the control of OSA for any therapeutic intervention. How closely the ET-AHI predicts the true effective AHI in the home setting requires further validation.

Posthypoxic ventilatory decline during NREM sleep: influence of sleep apnea.

We wished to determine the severity of posthypoxic ventilatory decline in patients with sleep apnea relative to normal subjects during sleep. We studied 11 men with sleep apnea/hypopnea syndrome and 11 normal men during non-rapid eye movement sleep. We measured EEG, electrooculogram, arterial O(2) saturation, and end-tidal P(CO2). To maintain upper airway patency in patients with sleep apnea, nasal continuous positive pressure was applied at a level sufficient to eliminate apneas and hypopneas. We compared the prehypoxic control (C) with posthypoxic recovery breaths. Nadir minute ventilation in normal subjects was 6.3 +/- 0.5 l/min (83.8 +/- 5.7% of room air control) vs. 6.7 +/- 0.9 l/min, 69.1 +/- 8.5% of room air control in obstructive sleep apnea (OSA) patients; nadir minute ventilation (% of control) was lower in patients with OSA relative to normal subjects (P < 0.05). Nadir tidal volume was 0.55 +/- 0.05 liter (80.0 +/- 6.6% of room air control) in OSA patients vs. 0.42 +/- 0.03 liter, 86.5 +/- 5.2% of room air control in normal subjects. In addition, prolongation of expiratory time (Te) occurred in the recovery period. There was a significant difference in Te prolongation between normal subjects (2.61 +/- 0.3 s, 120 +/- 11.2% of C) and OSA patients (5.6 +/- 1.5 s, 292 +/- 127.6% of C) (P < 0.006). In conclusion, 1) posthypoxic ventilatory decline occurred after termination of hypocapnic hypoxia in normal subjects and patients with sleep apnea and manifested as decreased tidal volume and prolongation of Te; and 2) posthypoxic ventilatory prolongation of Te was more pronounced in patients with sleep apnea relative to normal subjects.

Assessment of closed-loop ventilatory stability in obstructive sleep apnea.

Previous studies on ventilatory control in obstructive sleep apnea (OSA) have generally indicated depressed chemosensitivity, implying greater stability of the chemical control of breathing in these subjects. However, these results were based on tests involving steady-state or quasi-steady measurements obtained in wakefulness. We have developed a method for assessing the dynamic stability characteristics of chemoreflex control in OSA patients during sleep. While continuous positive airway pressure was applied to stabilize the upper airways, acoustically stimulated arousals were used to perturb the respiratory system during sleep. The fluctuations in esophageal pressure that ensued were analyzed, using a closed-loop minimal model, to estimate the chemoreflex loop impulse response (CLIR). Tests using simulated data confirmed the validity of our estimation algorithm. Application of the method to arousal responses measured in six OSA and five normal subjects revealed no statistically significant differences in gain margins and loop gain magnitudes between the two groups. However, the CLIR in the OSA subjects exhibited faster and more oscillatory dynamics. This result implies that, in addition to unstable upper airway mechanics, an underdamped chemoreflex control system may be another important factor that promotes the occurrence of periodic obstructive apneas during sleep.

Cardiac autonomic control in obstructive sleep apnea: effects of long-term CPAP therapy.

To determine how long-term treatment with continuous positive airway pressure (CPAP) affects cardiac autonomic function, we measured R-R interval (RRI), respiration, and blood pressure in 13 awake patients with moderate-to-severe obstructive sleep apnea (OSA) in both supine and standing postures, before and after 3 to 9 mo of home therapy. Using visual feedback, the subjects controlled their respiration to track a randomized breathing pattern. From the RRI spectrum, we computed high-frequency power and the ratio of low-frequency to high-frequency power (LHR). To correct for differences in breathing, the average transfer gain relating respiration to RRI changes (G(RSA)) and the modified low-frequency to high-frequency ratio (MLHR) were also derived. CPAP therapy did not change the conventional spectral indices of heart rate variability (HRV). However, G(RSA) increased with average nightly CPAP use in supine (p < 0.01) and standing (p < 0.03) postures, whereas MLHR decreased with CPAP compliance during standing (p < 0.03). Supine mean heart rate decreased with compliance (p < 0.03). None of the estimated parameters was correlated with duration of therapy when actual CPAP use was not taken into account. These results suggest that CPAP treatment improves vagal heart rate control in patients with OSA and that the degree of improvement varies directly with compliance level.

Dynamics of heart rate control in obstructive sleep apnea: a minimal model.

Recent studies indicate that cardiovascular regulation is impaired and sympathetic activity is abnormally elevated in patients with obstructive sleep apnea (OSA) during both wakefulness and sleep1,2. Heart rate variability (HRV) has been found to be substantially reduced in OSA3. Spectral analysis shows an increase in the proportion of low-frequency (0.04 to 0.15 Hz) content relative to high-frequency (0.15 to 0.4 Hz) content of heart rate oscillations in awake OSA subjects, suggesting increased sympathetic modulation along with decreased vagal cardiac activity. Although statistical and spectral analyses of HRV offer a simple and non-intrusive means of assessing cardiovascular autonomic function in these subjects, the measures derived can be confounded significantly by intra-and inter-subject differences in ventilation level and breathing pattern4,5. To circumvent this limitation, we have introduced a minimal modeling approach that allows a clear delineation of the respiratory-related influences on HRV from the effects that are intrinsically circulatory in nature.KeywordsObstructive Sleep ApneaHeart Rate VariabilityImpulse ResponseMinimal ModelBreathing PatternThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.