Management Of Obstructive Sleep Apnea Research Articles

P034 An economic evaluation comparing the provision of sleep disorder services via a regional hub-and-spoke model of care to standard care in a metropolitan tertiary hospital

Abstract Introduction A new hub-and-spoke model of care (New-MOC) was introduced in a very remote Queensland region for the management of Obstructive Sleep Apnoea. Standard Care required travel and admission to a major metropolitan hospital. The aims were to increase access to services and ensure the New-MOC was cost-effective for sustainability. Method A cost-utility evaluation was performed from the health service perspective. Administrative and clinical data was collected in the 2-years prior and 1-year post implementation of the New-MOC to compare costs and outcomes. Base-case was modelled using decision tree analysis for a hypothetical cohort of 100 patients over a time horizon that captured 12-months of treatment. One-way sensitivity analyses were performed to evaluate uncertainty of inputs in which a) all costs were adjusted to upper bound b) set up costs were added and c) QALYs were reduced in the New-MOC. Results Under base-case the New-MOC was dominant and projected to save $226,511 of health service costs over 1.2 years and result 0.488 QALYs gained compared Standard Care. The New-MOC remained cost effective under all scenarios modelled. Discussion Whilst the New-MOC was cost effective, primary source data was only available up to diagnosis and therefore modelling relied on assumption around outcomes. Follow-up of patients in relation to treatment compliance would improve the accuracy of the model as would applying a lifetime horizon to capture all outcomes for a chronic condition. However, sufficient evidence exists to support the New-MOC as cost saving and cost-effective. Acknowledgement supported by a Metro North LINK Grant

Understanding obstructive sleep apnea

Obstructive sleep apnea (OSA) is defined by repeated episodes of partial or complete upper airway collapse, obstructing breathing during sleep. OSA is a dangerous health condition with high mortality and morbidity. Due to the rising prevalence of obesity, OSA is on the rise in developing countries. Nevertheless, the exact number of OSA prevalence among Indonesian people is unrecognized for several reasons; for instance, low awareness of sleep disorder issues, unawareness of the symptoms and impact of OSA, limited access to polysomnography examinations, and considering snoring as a common condition. Long-term health effects, decreased sleep quality, psychological issues, and cognitive impairment are all linked to untreated OSA. Nurses can contribute to the management of OSA by conducting screening and assessment, providing health promotion to patients, and coordinating with other healthcare providers. This paper explores the prevalence of OSA, society’s perception of OSA, diagnostic or screening procedures, and treatment options for the effective management of OSA.

Knowledge, attitude, and practices of Filipino adult neurologists on obstructive sleep apnea among stroke patients

ObjectivesThis study aimed to describe the knowledge, attitudes, and practices of Filipino adult neurologists in the recognition and treatment of obstructive sleep apnea (OSA) among patients presenting with acute stroke. MethodologyA prospective cross-sectional study was conducted using a web-based survey from April to June 2022 among active locally-practicing adult neurology fellows of the Philippine Neurological Association. The 18-item knowledge statements from the validated “Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) Questionnaire was used as survey instrument. There were also eight additional items assessing knowledge, six items assessing attitudes, and ten items assessing practices that were included. ResultsA total of 119 neurologists participated in the survey. Two-thirds of the respondents were females, and 70 % were between 31 and 40 years old. Majority of the respondents are General Neurologists (57.1 %) followed by Neurophysiologists (10 %) and Stroke Specialists (10 %). Forty-seven percent of neurologists got more than or equal to 75 % of the knowledge statements included in the OSAKA questionnaire correctly. Less than half of the respondents correctly answered the questions on (1) uvulopalatopharyngoplasty as curative for majority of patients with OSA (32.8 %), (2) continuous positive airway pressure (CPAP) therapy can cause nasal congestion (42.9 %), (3) laser-assisted uvuloplasty as treatment for severe OSA (16.8 %), and (4) less than 5 apneas is normal in adults (48.7 %). Majority (>80 %) of the respondents were able to correctly answer the statements relating OSA and stroke. Almost all agreed that OSA as a clinical disorder (95 %) is important and that acute stroke patients with possible OSA needs to be identified (94.1 %) and further evaluated (96.6 %). On the other hand, less than half of the respondents feel confident in: identifying patients at-risk for OSA (47.9 %), ability to manage acute stroke patients with OSA (34.5 %), and ability to manage acute stroke patients with OSA on CPAP therapy (21 %). Most neurologists would sometimes screen OSA among their patients with acute stroke (55.5 %). Most respondents would only educate their patients on OSA sometimes (43.7 %). With regards to the diagnosis (42 %), risk factors (42 %), and treatment options for OSA (40.3 %), most would discuss them with their patients. ConclusionLess than half of neurologists were able to get at least 75 % of the knowledge questions. Majority had difficulty with statements pertaining to surgery as cure for OSA, CPAP therapy causing nasal congestion, and OSA severity classification. Almost all has a positive attitude towards the importance of OSA diagnosis and management; however, there is low confidence among them with regards to their practice in identification and handling of these patients.

Barbed Suspension Bridge Pharyngoplasty: Introducing a Novel Technique for Barbed Pharyngoplasty.

Surgical management of Obstructive Sleep Apnea (OSA) and Snoring has undergone many major and minor changes over a period of last decade. The most common surgical approach for OSA is uvulopalatopharyngoplasty (Stuck et al. in Sleep Med 50:152-165, 2018). The main goals of treatment of OSA are to decrease the risk of deleterious health effects and improve quality of sleep (Evans et al. in Otolaryngol Clin North Am 53: 319-328, 2020). Since bimanual surgical techniques in the depth of oral cavity have been tricky, search for a less demanding & easy to learn technique is always on. The surgical technique should also provide long term results with manageable complications. Barbed suture has been in sporadic use for the last decade amongst sleep apnea surgeons for its advantage of knotless application and distributed suture tension. However, the barbed suture which has been used is absorbable and is used only to close the surgical wound on the soft palate. In this paper we are describing our technique of using the 3-0 Polybutester non absorbable barbed suture to perform a novel technique of palatal surgery, in which we suspend the lower part of the soft palate permanently as a suspension bridge between the right and left Pterygomandibular raphae, so that the lower part of the soft palate cannot move posteriorly to touch the posterior pharyngeal wall preventing airway obstruction whereas it can still move superiorly freely while swallowing or during phonation. This technique can prove to be a technically less demanding one which provides excellent long-term results in snoring and OSA with manageable complications.

Chronic Rhinosinusitis After Maxillary Advancement Orthognathic Surgery.

Maxillomandibular advancement (MMA) remains an effective procedure for the management of obstructive sleep apnea (OSA). Maxillary advancement may lead to anatomical changes that impair paranasal sinus drainage, leading to chronic sinus inflammation. The aim of this study was to describe the clinical features and outcomes of patients suffering from chronic rhinosinusitis (CRS) following MMA. This is a retrospective case series study. Our study included subjects diagnosed with CRS following MMA from January 1992 to October 2018 at Stanford Hospital. We screened 730 patients undergoing MMA and identified a total of 57 with CRS after MMA. A descriptive analysis was performed using clinical data including patient demographics, comorbidities, prior surgical history, physical exam manifestations, CT findings, and quality of life outcomes (SNOT-22). Out of 730 patients undergoing MMA, 57(7.8%) were found to have CRS after orthognathic surgery. Presenting symptoms included facial pain (92.5%), nasal drainage (75%), nasal obstruction (67.5%), and hyposmia (20%). Endoscopic examination revealed recirculation (30.5%), purulent discharge (27.7%), polypoid changes (22.2%), and scarring (13.8%). Preoperative CT prior to undergoing endoscopic sinus surgery (ESS) demonstrated mucosal thickening in maxillary (64.2%), anterior ethmoid (39.2%), frontal (14.2%), posterior ethmoid (10.7%), sphenoid sinus (14.2%), and ostiomeatal complex (55.3%). Average Lund-Mackay score was 5.5(±3.8). Additional CT findings included secondary ostium in the inferior meatus (42.8%). Forty patients (70.1%) underwent ESS at a mean of 4.6 years after MMA. Patients undergoing ESS experienced significant improvement in SNOT-22 scores at 12-months post-surgery (P = .018). Patients undergoing maxillary advancement surgery are at risk of developing CRS postoperatively and should be advised of the risk of CRS associated with this procedure. Surgical treatment can be an option for medically refractory CRS related to MMA surgery.

Management of Obstructive Sleep Apnoea with Two Different Mandibular Advancement Devices

Management of Obstructive Sleep Apnoea with Two Different Mandibular Advancement Devices

The Transformative Role of Artificial Intelligence in Obstructive Sleep Apnea Management

The Transformative Role of Artificial Intelligence in Obstructive Sleep Apnea Management

Giving weight to incretin-based pharmacotherapy for obesity-related sleep apnea: a revolution or a pipe dream?

Obesity is a chronic disease affecting over 670 million adults globally, with multiple complications including obstructive sleep apnea (OSA). Substantial weight loss in patients with obesity-related OSA can reduce or even eliminate OSA as well as reduce sleepiness and improve cardio-metabolic health. Evidence suggests that these improvements exceed those that occur with device-based OSA therapies like continuous positive airway pressure which continue to be the first-line of therapy. Resistance to weight management as a first-line strategy to combat OSA could arise from the complexities in delivering and maintaining adequate weight management, particularly in sleep clinic settings. Recently, incretin-based pharmacotherapies including glucagon-like peptide 1 (GLP-1) receptor agonists alone or combined with glucose-dependent insulinotropic polypeptide (GIP) receptor agonists have been developed to target glycemic control in type 2 diabetes. These medications also slow gastric emptying and reduce energy intake. In randomized, placebo-controlled trials of these medications in diabetic and non-diabetic populations with obesity, participants on active medication lost up to 20% of their body weight, with corresponding improvements in blood pressure, lipid levels, physical functioning, and fat mass loss. Their adverse effects are predominantly gastrointestinal-related, mild, and transient. There are trials currently underway within individuals with obesity-related OSA, with a focus on reduction in weight, OSA severity, and cardio-metabolic outcomes. These medications have the potential to substantially disrupt the management of OSA. Pending coming data, we will need to consider pharmacological weight loss as a first-line therapy and how that influences training and management guidelines.

Anatomical Basis of Obstructive Sleep Apnoea: A Review of Randomized Controlled Trials.

Repeated obstruction and closure of the upper airway, sporadic hypoxic episodes, and sympathetic activity are symptoms of obstructive sleep apnea (OSA). Obstructive sleep apnoea is due to a combination of altered upper airway structure and muscular function, a low arousal threshold and increased loop gain.Although recurrent upper airway (UA) collapse during sleep is the most frequent clinical hallmark of OSA, the exact cause of this collapse is unknown. Furthermore, while continuous positive airway pressure aids in the management of OSA, many patients find it intolerable. As a result, a better knowledge of the causes of OSA may result in more effective treatments. We did a review of randomized controlled trials that were done in this regard in the last 10 years and whose full-text version is available on the PubMed database. A total of 20 articles were finalized for review after applying our criteria. The articles have proposed different theories regarding the anatomical basis responsible for obstructive sleep apnoea. The theories proposed by different studies in the last decade include reduced genioglossus and hypoglossal nerve activity, the pharyngeal muscles' failure to keep the airway open or tighten it, tonsils and adenoid hypertrophy, an oversensitive ventilatory control system and low respiratory arousal threshold, mandibular position, pharyngeal muscles' high sympathetic drive, cephalometric alterations such as mandibular and hyoid bone position and the length of the soft palate, obesity, and neck fat and fluid re-distribution in the body, from the lower to the upper parts while reclining. Given the diverse etiological characteristics of OSA patients and to increase our knowledge of the condition, additional study into this group is required. Filling any knowledge gaps that may exist in the anatomical basis of the onset of OSA is the main objective of this review paper.

Can the OSA patient be managed within an ERAS protocol? A narrative review

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder among surgical patients and is associated with an increased risk of perioperative cardiopulmonary complications leading to increased health expenses. Therefore, preoperative OSA screening should be instituted to inform patients of their increased perioperative risk and measures can be taken in to decrease this risk. Meanwhile ERAS (Enhanced recovery after surgery) guidelines are becoming standard of care and being widely implemented. The purpose of these recovery programs is to standardize medical care, enhance outcomes and decrease health care expenses using evidence-based protocols. According to the current evidence it is unclear if OSA patients could benefit from these protocols. The first part of this narrative review states the current evidence on OSA definition, classification, pathophysiology and risk factors, postoperative complications, endotypes and their relevance for the anesthesiologist. The second part investigated the feasibility of ERAS measures within the OSA-population. Preoperatively there are many parallels to be drawn between the ERAS measures and Society of Anesthesia and Sleep Medicine (SASM) guidelines on OSA management: Risk stratification by OSA-screening, information counselling on the increased perioperative risk and optimization of preoperative health conditions by initiation of CPAP-therapy. Perioperatively the use short acting anesthetics allows for both early mobilization and avoid postoperative respiratory compromise by sustained drug effect. ERAS measures to maintain the patient in the zone of normovolaemia are advantageous for OSA patients as excessive fluid administration can worsen OSA. The use of multimodal analgesia sparing opioids might be the most important element beneficial for OSA patients they are more prone to develop opioid induced respiratory depression (OIRD). As OSA patients are at risk for venous thromboembolism appropriate thromboprophylaxis should be applied. Postoperatively OSA patients should be closely monitored in the prevention of OIRD. In conclusion many ERAS measures seem to be applicable or of benefit for OSA patients. However, large prospective randomized controlled trials are needed to evaluate if these patients can be managed within an ERAS protocol.

Impact of Obstructive Sleep Apnea on Disease Severity and Adverse Outcomes in Patients with Acute Pulmonary Embolism.

Acute pulmonary embolism (PE) poses a life-threatening risk with high mortality rates. While the coexistence of PE and obstructive sleep apnea (OSA) is gaining recognition, its influence on PE severity and prognosis remains uncertain. This study aims to investigate the associations between OSA and disease severity, as well as outcomes, in patients with acute PE. We conducted a retrospective cohort study on patients diagnosed with acute PE who had undergone previous cardiorespiratory polygraphy. OSA severity was assessed using the apnea-hypopnea index (AHI) derived from cardiorespiratory polygraphy. The severity of acute PE was evaluated using the simplified Pulmonary Embolism Severity Index (sPESI) score. Logistic regression analysis was performed to investigate the associations between AHI and the risk of belonging to the sPESI≥1 group. Cox regression analysis was used to examine the relationship between AHI and long-term adverse events, defined as a composite of all-cause mortality and non-fatal cardiovascular events. Among 145 acute PE patients (mean age 62.2 years, 49.7% male), 94 (64.8%) had OSA. Patients with OSA had a significantly higher proportion of sPESI≥1 (89.4% vs 68.6%, p=0.002) than non-OSA patients. Each unit increase in AHI was associated with a 15% increased risk of severe PE (sPESI≥1) (odds ratio: 1.15, 95% CI 1.05-1.26, p=0.002) after adjusting for confounders. During a median follow-up of 15.2 months, 27 (18.6%) patients experienced adverse events. Increased AHI independently predicted a higher risk of adverse events (hazard ratio: 1.03, 95% CI: 1.00-1.05, p=0.026), even after adjusting for potential confounders. AHI ≥8 events/h was associated with a significantly higher adjusted hazard ratio of 2.56 (95% CI: 1.15-5.72, p=0.022) for adverse events compared to AHI <8 events. OSA is common in acute PE patients and is linked to increased disease severity and adverse outcomes. Implementing routine OSA screening and management may aid risk stratification and improve outcomes in acute PE patients.

Integrative Approach to Managing Obstructive Sleep Apnea.

Conventional therapies for obstructive sleep apnea (OSA), including CPAP and oral appliances, offer the best opportunity for symptomatic improvement and reduction in OSA overall health impact. Integrative medicine brings conventional and complementary approaches together in a coordinated way. With rising obesity rates, weight loss and lifestyle programs seem to be the most favorable integrative methods to combine with conventional OSA therapies. Complementary and integrative approaches to OSA management are varied and, in conjunction with conventional methods, may offer some reduction in the apnea-hypopnea index.

Perioperative management of Obstructive Sleep Apnoea: Present themes and future directions.

Obstructive sleep apnoea (OSA) is an increasingly common pathology that all those involved in perioperative care will come across. Patients with the condition present a challenge at many stages along the perioperative journey, not least because many patients living with OSA are unaware of their diagnosis.Key interventions can be made pre, intra-, and postoperatively to improve outcomes. Knowledge of screening tools, diagnostic tests, and the raft of treatment options are important for anyone caring for these patients. Recent literature has highlighted the increasing complexity of surgical patients and significant underdiagnosis of OSA in this patient population. Work has demonstrated how and why patients with OSA are at a higher perioperative risk and that effective positive airways pressure (PAP) therapy can reduce these risks, alongside evidencing how best to optimise adherence to therapy, a key issue in OSA. OSA, and particularly undiagnosed OSA, presents a huge problem in the perioperative period. Perioperative PAP reduces the risk of postoperative complications but adherence remains an issue. Bespoke perioperative pathways should be developed to identify and optimise high risk patients, although at present evidence on how best to achieve this is lacking.

The role of the WatchPAT device in the diagnosis and management of obstructive sleep apnea

Obstructive sleep apnea (OSA) is a common condition affecting an estimated 936 million individuals worldwide, leading to a considerable demand for diagnostic services. Polysomnography, the current gold standard for diagnosis, is resource intensive and inconvenient for patients and healthcare providers. The WatchPAT is an unobtrusive device for home OSA diagnosis. It utilizes peripheral arterial tomography in conjunction with heart rate, oximetry, actingraphy, and respiratory movements for the diagnosis of OSA. It has good correlation with polysomnography for OSA diagnosis and also reports sleep time and sleep staging. The WatchPAT device has reported sensitivities of 81–95%, specificities of 66–100%, positive predictive values of 79–96%, and negative predictive values of 92% for the determination of the apnea–hypopnea index (AHI). It has also been studied and its use validated in a variety of patient populations, including children, older adults, pregnant women, and those with comorbid medical conditions. The device has also been adopted for use in screening for cardiac arrhythmia and central sleep apnea, although neither use has become widespread. With the emergence of telemedicine and an increasing demand for sleep services, the WatchPAT device can be a useful aid in OSA diagnostics.

Oral appliance therapy for the management of obstructive sleep apnea in adults: an umbrella review protocol.

The objective of this review is to summarize the evidence on the effectiveness of oral appliance therapy compared with other therapeutic approaches (continuous positive airway pressure, maxillomandibular and upper airway surgeries, behavioral techniques) for the management of obstructive sleep apnea in adults. For primary snoring, mild to moderate obstructive sleep apnea, and patients with a severe condition who are intolerant of continuous positive airway pressure therapy, an oral appliance is the treatment of choice among conservative procedures. The effectiveness of these appliances is largely determined by a variety of parameters, including the severity of sleep apnea (mild, moderate, severe), materials and methods used to fabricate the appliance, and the degree of mandibular protrusion. Thus, it is important to evaluate the effectiveness of oral appliances in the reduction of sleep apnea. This review will include systematic reviews of quantitative studies reporting on the effectiveness of oral appliances for the treatment of obstructive sleep apnea of any severity, confirmed using polysomnography. The primary outcome will be measured by reduction in the apnea-hypopnea index. A search will be conducted of MEDLINE, Cochrane Database of Systematic Reviews, Scopus, Web of Science, CINAHL, Epistemonikos, Embase, ProQuest Dissertations and Theses, and Shodhganga Dissertations and Theses from database inception until the present, with no language restrictions. Google Scholar will be searched manually. Two independent reviewers will screen titles, abstracts, and full-text articles and perform data extraction. Quality assessment will be conducted using the standard JBI critical appraisal tool. Data will be extracted from systematic reviews and a synthesis of the findings will be presented. The certainty will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). PROSPERO CRD42021258515.

Factors associated with the diagnosis and treatment of obstructive sleep apnoea in chronic heart failure: a mixed methods study

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This study was co-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East Midlands (CLAHRC EM), now recommissioned as NIHR Applied Research Collaboration East Midlands (ARC EM) and Leicestershire Partnership NHS Trust - Raising Health Charitable Funds Award and supported by the NIHR Leicester Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Background Heart Failure (HF) is associated with a considerable burden of disability that includes frequent hospitalisation and high risk of mortality. Despite advances in HF treatment, many patients continue to experience symptoms and will die from progressive HF, often exacerbated by the presence of co-morbidities, such as obstructive sleep apnea (OSA). Despite the high prevalence of OSA in chronic HF and the association with the development and progression of chronic HF, OSA remains largely under diagnosed and under treated. Purpose To explore factors associated with the diagnosis and treatment of OSA in CHF. Methods A convergent parallel mixed methods research design was utilised. Quantitative methods included a systematic review and meta-analysis, diagnostic validation study and a survey study, whilst semi-structured interviews and reflexive thematic analysis was utilised for the qualitative component. Data collection and data analysis were conducted simultaneously with the integration of the findings in the discussion. Results The systematic review and meta-analysis showed that the STOP-Bang screening questionnaire had a high sensitivity to detect OSA in the sleep clinic and surgical populations but lacked adequate specificity. The diagnostic validation study indicated a high sensitivity of the STOP-Bang questionnaire, but due to differences in prevalence, risk of selection bias and spectrum effect, validation in a sleep clinic population is unlikely to reflect the true performance of the STOP-Bang questionnaire in a stable CHF population. The survey study demonstrated a knowledge deficit in the diagnosis and treatment of OSA, and variable practice among HF clinicians in the UK. Findings from the qualitative component identified several key barriers and enablers across the OSA diagnostic pathway from both patients’ and clinicians’ accounts. Conclusion Due to a lack of typical OSA symptoms, there is currently no real evidence of cardiovascular hospitalisation and mortality benefit for OSA treatment in CHF. This contributed to a paucity of guidance on the management of OSA in CHF clinical guidelines. Due to a lack of typical OSA symptoms, screening questionnaires that rely on patient symptoms may be less effective. Although clinicians felt that OSA was an important clinical condition, findings demonstrated a disconnect between the stated level of clinical importance and clinicians’ actual level of knowledge. The current absence of evidence to support the treatment of OSA in CHF and paucity of CHF guidelines to inform the management of OSA in CHF, are likely to contribute to clinicians not prioritising the recognition and treatment of OSA in CHF.

Sociodemographic disparities and healthcare utilization in pediatric obstructive sleep apnea management

ObjectivesWe examined (1) disparities in obstructive sleep apnea (OSA) care by insurance coverage, and by child race and ethnicity among Medicaid-insured children (MIC), and (2) healthcare utilization changes after OSA care. MethodsIBM MarketScan insurance claims were used to index OSA care 1-year before and after initial OSA diagnosis in 2017 among 2-17-year-old children (n = 31,787, MIC: 59%). OSA care and healthcare utilization analyses adjusted for child age, sex, obesity, and complex chronic conditions. ResultsWe identified 8 OSA care pathways, including no care, which occurred in 34.4% of the overall sample. MIC had 13% higher odds of no OSA care compared to commercially-insured children (CIC). MIC had 32–48% lower odds of any treatment pathway involving specialty care, but a 13–46% higher likelihood of receiving surgical care without polysomnogram (PSG) and PSG only. In MIC, non-Latinx Black/African American (Black) and Hispanic/Latinx children were 1.3–2.2 times more likely than White children to receive treatment involving specialty care and/or PSG, while Black children were 31% less likely than White youth to undergo surgery. In the full sample, surgical care was associated with less outpatient and emergency healthcare utilization compared to those untreated or not surgically treated. ConclusionsVaried OSA management by insurance coverage suggests disparities in access to and engagement in care and potentially greater disease burden among MIC. Surgical care is associated with reduced healthcare utilization. The lower odds of surgery in Black MIC should be further evaluated in the context of OSA severity, healthcare biases, and family preferences.

Obesity, Bariatric Surgery and Obstructive Sleep Apnea-A Narrative Literature Review.

The purpose of this review was to analyze the available literature on the subject of obesity and obstructive sleep apnea. We searched for available articles for the time period from 2013 to 2023. Obesity is listed as one of the most important health issues. Complications of obesity, with obstructive sleep apnea (OSA) listed among them, are common problems in clinical practice. Obesity is a well-recognized risk factor for OSA, but OSA itself may contribute to worsening obesity. Bariatric surgery is a treatment of choice for severely obese patients, especially with present complications, and remains the only causative treatment for patients with OSA. Though improvement in OSA control in patients after bariatric surgery is well-established knowledge, the complete resolution of OSA is achieved in less than half of them. The determination of subpopulations of patients in whom bariatric surgery would be especially advantageous is an important issue of OSA management. Increasing the potential of non-invasive strategies in obesity treatment requires studies that assess the efficacy and safety of combined methods.

AKT answer relating to management of obstructive sleep apnoea

AKT answer relating to management of obstructive sleep apnoea

AKT question relating to management of obstructive sleep apnoea

AKT question relating to management of obstructive sleep apnoea