Significant Decrease In Apnea-hypopnea Index Research Articles

The Efficacy of Twin-Block Appliances for the Treatment of Obstructive Sleep Apnea in Children: A Systematic Review and Meta-Analysis.

Objective To evaluate the efficacy of twin-block appliance in the treatment of children with obstructive sleep apnea (OSA). Methods Two independent reviewers conducted a systematic review of seven databases from database establishment until October 16, 2021. There were no language restrictions. The outcomes were changes in apnea-hypopnea index (AHI), oxyhemoglobin desaturation index (ODI), and lowest arterial oxygen saturation (lowest SaO2). National Institute for Health and Clinical Excellence (NICE) tool was used to assess the quality of the studies included. Results A total of 207 articles were screened for relevance, and 6 of them met the inclusion criteria for our meta-analysis. Four of the studies were case series, 1 was nonrandomized control trial, and 1 was a randomized crossover clinical trial. After twin-block therapy, there was a significant decrease in AHI (4.35 events/hour, 95% CI: 4.04, 4.66, p ≤ 0.001). The lowest SaO2 significantly increased by 9.17% (95% CI: 12.05, 6.28, p ≤ 0.001). Sensitivity analysis by excluding studies one by one showed stable and favorable results in lowest SaO2 and AHI. Conclusions Results from the meta-analysis showed that the use of twin-block appliance significantly decreased AHI and significantly increased lowest SaO2. Hence, twin-block appliance therapy may be an effective method for the treatment of pediatric OSA. Further large sample size randomized controlled trials are needed to assess this treatment efficacy in children with obstructive sleep apnea.

The effects of long-term continuous positive airway pressure on apnea-hypopnea index change following short-term that withdrawal in patients with obstructive sleep apnea.

The effect of long‐term continuous positive airway pressure (CPAP) treatment on apnea–hypopnea index (AHI) after CPAP withdrawal remains unclear, especially in obstructive sleep apnea (OSA) patients screened from the population. To examine that, 1241 civil servants who participated in the annual physical examination were screened for OSA between September and December 2017. Screened OSA firstly underwent 1‐week CPAP adherence assessment. Then, patients with good CPAP adherence would be freely provided CPAP to continued treatment. All OSA patients were followed for 2 years. At study end, all OSA patients underwent home sleep testing (HST) again within 1 week of CPAP withdrawal. The effect of 2‐year CPAP treatment on OSA severity was investigated by using linear regression and multinominal logistic regression. In total, 103 OSA patients were screened, including 41 cases (39.8%) in CPAP treatment group and 62 cases (60.2%) in non‐CPAP treatment group. At 2‐year follow‐up, compared with baseline, in CPAP treatment group, following CPAP withdrawal, a significant decrease in AHI was observed in patients with severe OSA (P = 0.014); in non‐CPAP treatment group, a significant increase in AHI was observed in patients with moderate OSA (P = 0.028). After adjustment for confounding factors, multivariate linear regression showed that △AHI was negatively associated with CPAP treatment (β = −4.930, 95% confidence interval [CI] [−9.361, −0.500], P = 0.030). Multinominal logistic regression showed that the AHI of patients not treated with CPAP tended to be unchanged or worsened with the AHI improvement group as a reference (OR [odds ration] [95% CI], 4.555 [1.307, 15.875], P = 0.017; 6.536 [1.171, 36.478], P = 0.032). In conclusion, active OSA screening and long‐term CPAP intervention may improve the severity of severe OSA patients following short‐term CPAP withdrawal in the general population.

Resistance Training of Inspiratory Muscles After Coronary Artery Disease May Improve Obstructive Sleep Apnea in Outpatient Cardiac Rehabilitation: RICAOS Study

BackgroundObstructive sleep apnea (OSA) affects 5% of the adult population and its prevalence is up to 13 times higher in coronary artery disease (CAD) patients. However, OSA in this population is less symptomatic, leading to lower adherence to positive airway pressure (CPAP). While oropharyngeal exercise showed a significant decrease in apnea-hypopnea index (AHI) in patients with moderate OSA, there have been no studies testing the impact of specific inspiratory muscle training (IMT) for these patients. The aim of our study was to assess the effectiveness of IMT on AHI reduction in CAD patients with moderate OSA.MethodsWe included patients with CAD involved in a cardiac rehabilitation program and presenting an AHI between 15 and 30. Patients were randomized in a 1:1 allocation to a control group (CTL – classic training) or an IMT group (classic training + IMT). IMT consisted in 60 deep inspirations a day, 6 days a week, into a resistive load device set at 70% of the maximum inspiratory pressure (MIP). After 6 weeks, we compared AHI, neck circumference, Epworth Sleepiness Scale, Pittsburgh Sleep Quality index, and quality of life with the 12-item Short Form Survey before and after rehabilitation.ResultsWe studied 45 patient (60 ± 9 y, BMI = 27 ± 6 kg.m−2). The IMT group (n = 22) significantly improved MIP ( p < 0.05) and had a significant decrease in AHI by 25% (−6.5 ± 9.5, p = 0.02). In the CTL group (n = 23), AHI decreased only by 3.5% (−0.7 ± 13.1; p = 0.29). Between groups, we found a significant improvement in MIP ( p = 0.003) and neck circumference ( p = 0.01) in favor of the IMT group. However, we did not find any significant improvement of AHI in the IMT group compared to CTL ( p = 0.09).ConclusionA specific IMT during cardiac rehabilitation contributes to reduce significantly AHI in CAD patients with moderate OSA. Magnitude of the decrease in OSA severity could be enhanced according to implementation of specific IMT in this population.

Secondary Le Fort III after Early Fronto-Facial Monobloc Normalizes Sleep Apnea in Faciocraniosynostosis: A Cohort Study

This study aims to assess the improvement of sleep apnea after secondary Le Fort III facial advancement with distraction (LF3) in faciocraniosynostosis (FCS) patients with sleep apnea who have previously undergone fronto-facial monobloc advancement (FFMBA) with distraction. Patients having undergone secondary LF3 were selected from a cohort of FCS patients with documented sleep apnea who had previously undergone fronto-facial monobloc advancement. Patient charts and polysomnographic records were reviewed. Apnea-hypopnea index (AHI) was recorded before and at least 6 months after secondary LF3. The primary outcome was normalization of AHI (less than 5/h was considered normal). Hierarchical multilevel analysis was performed to predict postoperative AHI evolution. Seventeen patients underwent a secondary LF3, 7.0 ± 3.9 years after the primary FFMBA. The mean age was 9.6 ± 3.9 years. A total of 15 patients (88%) normalized their AHI. Two of four patients were decannulated (50%). There was a statistically significant decrease in AHI (preoperative AHI 21.5/h vs. 3.9/h postoperatively, p=0.003). Hierarchic multilevel modeling showed progressive AHI decrease postoperatively. Secondary LF3 improves residual or relapsing sleep apnea in FCS patients who have previously had FFMBA.

566 Persistent Sleep Apnea and Desaturation in Preterm Children at 18 Months of Age at High Altitude (2640 M)

Abstract Introduction Children born at term who live at high altitude (HA) (≥ 2500 m) have different respiratory patterns from those that live at sea level. It is essential to determine these patterns in preterm children due to their high risk of Sleep Apnea-Hypopnea Syndrome (SAHS). The evolution of the apnea hypopnea index (AHI), desaturation index (ODI), and oxygen saturation (SpO2) is unknown in this group at HA. The objective was to characterize the respiratory patterns during sleep of preterm children living at HA and compare it with those of healthy children born at term. Methods We conducted a cross-sectional study in Bogotá, Colombia (altitude: 2640 m). We included 302 children, 127 were preterm with an average of gestational age of 31weeks (SD: 2.9) and an average weight at birth of 1600 g (SD: 594) and 175 healthy full-term infants. Three groups were defined according to age: Group I: 3–4 months, Group II: 6–7 months,, Group III: 10–18 months. All children underwent nocturnal polysomnogram to evaluate their respiratory variables: AHI, average and minimum SpO2, ODI, and T90 during sleep and analyzed the data according to the parameters of the American Academy of Sleep Medicine Results 302 polysomnograms were performed, 54.3% were girls and were distributed by groups as follows: Group I:105 patients (34.8%), 16 preterm, Group II: 107 patients (35.4%), 46 preterm and Group III: 90 patients (29.8%), 65 preterm. We observed higher respiratory parameters within each age strata in premature infants compared to children born at term. Preterm infants had higher ODI, AHI, obstructive apnea hypopnea index (O-AHI), and Central Apnea hypopnea index (C-AHI). Although the effect decreases over time, we found a significant difference in the first age group. There was a high persistence index in children with a history of preterm birth living at high altitude. We also found a significant decrease in AHI, ODI across time in healthy and preterm children p&amp;lt;0.01 Conclusion Premature children living at HA persist with higher ODI and AHI compared to children of similar ages born at term. The high desaturation index indicates the presence of intermittent hypoxia that persists in these children over time Support (if any):

Mandibular advancement device: Effectiveness and dental side effects. A real-life study

ABSTRACT Objective: To investigate the effectiveness and adverse events of mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA) and to identify predictive clinical parameters for therapy success. Methods: A retrospective analysis of 318 patients indicated for MAD therapy, observed in a large teaching hospital in the Netherlands. Results: Ninety-seven patients (65.5%) achieved therapy success. A significant decrease in AHI (apnea–hypopnea index) and OSA-related symptoms was observed. None of the analyzed OSA-characteristics proved to be a significant predictive parameter for therapy success. Side-effects were reported in 54.4% of the patients, with temporomandibular dysfunction (27.0%) being the most frequent. Seventy-four patients (23.3%) discontinued treatment due to side-effects or therapy failure. Conclusion: MAD proved to be effective in the treatment of OSA and can be a viable alternative to CPAP in patients with severe OSA. Side-effects were relatively common and led to termination of therapy in 1 out of 10 cases.

Development and evaluation of myofunctional therapy support program(MTSP) based on self-efficacy theory for patients with obstructive sleep apnea.

The aim of this study is to determine the impact of myofunctional therapy support program (MTSP) based on self-efficacy theory compared to no support during myofunctional therapy (MT) in patients with obstructive sleep apnea (OSA). Thirty-one patients with OSA were randomized into two groups: 12 weeks of treatment with the MTSP developed in this study (experimental group) and one education session of MT (control group). Patients were evaluated at the beginning and the end of the study using questionnaires (self-efficacy scale, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, snoring intensity and frequency, dry mouth) and polysomnography. The control (n = 15) and experimental (n = 16) groups had similar results for all variables at study entry. The control group showed no significant change in any variables during the study period. In contrast, the experimental group showed a significant increase in self-efficacy 61.38 ± 9.50 to 65.56 ± 10.89 (p = 0.020) and a significant decrease in apnea-hypopnea index (AHI) 19.51 ± 11.41 to 14.11 ± 9.13 (p = 0.039), daytime sleepiness 9.88 ± 3.84 to 7.56 ± 3.42 (p = 0.028), snoring intensity 5.57 ± 3.13 to 4.44 ± 2.68 (p = 0.008), and dry mouth 6.44 ± 3.14 to 3.63 ± 2.33 (p = 0.005), compared to the baseline. No significant change in lowest SaO2 (p = 0.969), sleep quality (p = 0.307), and snoring frequency (p = 0.321) during the study period. The intensive and interactive intervention of MTSP improved the self-efficacy of OSA patients, and consequently, resulted in sign and symptom relief, such as AHI, daytime sleepiness, snoring and dry mouth. The MTSP was dedicated to the nurse practitioner to improve the way to dispense the MT. This research has implications for the successful treatment of OSA.

Development and evaluation of myofunctional therapy support program (MTSP) based on self-efficacy theory for patients with obstructive sleep apnea

The aim of this study is to determine the impact of myofunctional therapy support program (MTSP) based on self-efficacy theory compared to no support during myofunctional therapy (MT) in patients with obstructive sleep apnea (OSA). Thirty-one patients with OSA were randomized into two groups: 12 weeks of treatment with the MTSP developed in this study (experimental group) and one education session of MT (control group). Patients were evaluated at the beginning and the end of the study using questionnaires (self-efficacy scale, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, snoring intensity and frequency, dry mouth) and polysomnography. The control (n = 15) and experimental (n = 16) groups had similar results for all variables at study entry. The control group showed no significant change in any variables during the study period. In contrast, the experimental group showed a significant increase in self-efficacy 61.38 ± 9.50 to 65.56 ± 10.89 (p = 0.020) and a significant decrease in apnea-hypopnea index (AHI) 19.51 ± 11.41 to 14.11 ± 9.13 (p = 0.039), daytime sleepiness 9.88 ± 3.84 to 7.56 ± 3.42 (p = 0.028), snoring intensity 5.57 ± 3.13 to 4.44 ± 2.68 (p = 0.008), and dry mouth 6.44 ± 3.14 to 3.63 ± 2.33 (p = 0.005), compared to the baseline. No significant change in lowest SaO2 (p = 0.969), sleep quality (p = 0.307), and snoring frequency (p = 0.321) during the study period. The intensive and interactive intervention of MTSP improved the self-efficacy of OSA patients, and consequently, resulted in sign and symptom relief, such as AHI, daytime sleepiness, snoring and dry mouth. The MTSP was dedicated to the nurse practitioner to improve the way to dispense the MT. This research has implications for the successful treatment of OSA.

Impact of inspiratory muscle training on obstructive sleep apnea in coronary patients. The Ricaos Study: Preliminary results

Obstructive sleep apnea (OSA) syndrome affects 5% of the adult population and its prevalence is 13 times higher in coronary patients. However, OSA in coronary patients is less suggestive, leading to under diagnosis and lower adherence to continuous positive airway pressure (CPAP) treatment. While oropharyngeal exercises showed significant decrease in Apnea-Hypopnea Index (AHI) in patients with moderate OSA, there were no studies on specific inspiratory muscle training (IMT). The aim of our study was to assess the effectiveness of IMT on AHI reduction in coronary patients with moderate OSA and already engaged in a cardiac rehabilitation program post-infarction. We included coronary patients involving in a cardiac rehabilitation program after infarction, presenting an AHI between 15 and 30, and without clinical symptoms requiring CPAP. Patients were randomized in a 1:1 allocation in a control group (CTL - classic training) or in an IMT group (classic training + IMT). IMT consisted in a prolonged inspiration into a device allowing the air to pass during the inspiration only according to the force developed. The resistance applied was 70% of the maximum inspiratory pressure (Pi max ). Patients in the IMT group perform 2 sets of 30 breaths per day, 6 days a week for 2 months. We included 19 patients (59 ± 10 years; BMI = 27 ± 3 kg/m 2 ). All the patients showed a significant decrease in AHI after rehabilitation (21.5 ± 5.1 to 16.3 ± 7.8, P < 0.009). The IMT group ( n = 10) significantly improved Pi max ( P < 0.05) and had a significant decrease of AHI by 25% (−8.7, P = 0.02). In the CTL group ( n = 9), the AHI decreased by 23% (−5.2; P = 0.1). No significant differences were observed in anthropometric data. A specific IMT during a cardiac rehabilitation contributes to reduce significantly AHI in coronary patients with moderate OSA. Further research is needed to determine which patients benefit more of this alternative therapy.

Endoscopic Airway Findings in Infants with Obstructive Sleep Apnea

Objectives: This study describes the un-sedated endoscopic airway findings in infants with obstructive sleep apnea confirmed by polysomnography (PSG). Methods: A retrospective chart review was performed on infants who had undergone both a documented airway endoscopy and PSG from 2006 to 2015 at our center. Demographics, comorbidities, findings of airway endoscopy and findings on PSG were extracted from the electronic medical record. Regression analyses were performed to determine the relationship between AHI, endoscopic airway findings and gestational age. Results: We identified 39 patients with PSG in room air and confirmed obstructive sleep apnea (Apnea Hypopnea Index (AHI) >1/hour) who had undergone unsedated airway endoscopy. The median gestational age at time of PSG was 40 weeks and for endoscopy was 40 weeks. Median AHI on PSG was 17.2/hour. Laryngomalacia [87.2%], pharyngomalacia [33.3%] and tracheomalacia [10.3%] were the three most prevalent findings on endoscopy. Surgically correctable fixed airway obstruction was uncommon. Prevalence of pharyngomalacia decreased with increased gestational maturity (p=0.05). As the postmenstrual age at PSG completion increased, there was a trend towards a decline of the AHI (p=0.087). Twenty-two (56.4%) patients had a follow up PSG performed. Using paired t test, there was a significant decrease in AHI (Δ13.41: -40.9, 15.8, 15.8) from 23.4/hour (1.3-62) to 10.0/hour (0-32), despite no interim surgical intervention. Conclusions: Dynamic airway collapse, including laryngomalacia and pharyngomalacia, were the most common findings in obstructive sleep apnea during infancy. The decreased prevalence of pharyngomalcia and trend towards improvement of AHI with time suggests airway immaturity contributes to obstructive sleep apnea observed during infancy and improves with age.

The effectiveness of two types of MADS for OSA therapy

ObjectivesThe purpose of this study was to determine differences in effectiveness between two types of mandibular advancement device (MAD).Material and methodsIn this retrospective, cohort study, the two devices used were MAD type “Somnodent-Flex” (MAD 1) and MAD type “Herbst” (MAD 2). One hundred thirty-seven patients participated in this study, 67 patients were treated with MAD 1, and 70 patients with MAD 2. The indication MAD with obstructive sleep apnea (OSA) is based on a polysomnography test, in accordance with the CBO guidelines. The effectiveness of MAD therapy can be determined by a second polysomnography test (with the MAD in situ). The apnea-hypopnea index (AHI) is registered during the first and the second polysomnography test. Changes in these values determine the effectiveness.ResultsA significant decrease in AHI was found regarding T1 and T2 for both the MADs: F (1, 134) = 140,850, p < 0,001. The mean differences of both the MADs turned out to correlate to T1. After correcting for this covariance, there was no significant difference between the two MAD devices regarding the AHI value: F (1, 134) = 1160, p = 0,283.ConclusionsThe results of the present study show no significant difference in effectiveness between MAD 1 and MAD 2 in respect to the AHI value.Clinical relevanceSince 2012, healthcare insurance companies in the Netherlands refunds MAD type “Somnodent” used for treatment of sleep apnea. It is important to investigate if this type of MAD is as more effective or less effective as other types of MADs. If research points out that other MADs are more effective in reducing the sleep apnea, refund policies have to be adapted.

Electrical Stimulation of the Genioglossus in Patients with Residual Obstructive Sleep Apnea Post-UPPP Surgery

Objective: Genioglossus is a major upper-airway dilator muscle, which leads to upper-airway obstruction when its activity is decreased. We evaluated the effect and safety of genioglossus stimulation for patients with residual mild-to-moderate obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP). Methods: We enrolled 23 patients diagnosed with OSA by polysomnography (PSG) 6 months after UPPP, who underwent nightly transcutaneous genioglossus stimulation (TGS) therapy. Apnea hypopnea index (AHI), microarousal index (MAI), the ratio of duration of SpO2 < 90% to total sleep time (T90) and Epworth sleepiness scale (ESS) before and during TGS treatment were compared. We first observed the overall effect of TGS, and then compared its influence on patients with mild and moderate sleep apnea. Results: Compared with non-TGS therapy, there was a significant decrease in AHI, MAI, T90, and ESS (9.15 ± 4.21 vs. 17.90 ± 6.85, p < 0.0001; 6.33 ± 3.75 vs. 10.93 ± 4.90, p < 0.0001; 4.87 ± 4.02 vs. 9.13 ± 4.24, p < 0.0001; 8.65 ± 3.35 vs. 9.30 ± 3.10, p = 0.002, respectively), and a significant increase in mean SpO2 and minimal SpO2 (mini SpO2) (95.52% ± 0.95% vs. 94.43% ± 1.12%, p < 0.0001; 88.74% ± 2.94% vs. 85.17% ± 4.67%, p < 0.0001, respectively) during TGS treatment. Patients in the mild and moderate groups had the same variation trend between TGS and non-TGS therapy nights. However, the moderate group had a higher absolute value of changed AHI (△AHI; 11.12 ± 3.95 vs. 5.66 ± 1.70, p < 0.05) and MAI (△MAI; 5.8 (3.3, 8.6) vs. 2.5 (1.05, 5.6), p < 0.05) than the mild group. There were no significant differences in absolute changed mean SpO2 (△mean SpO2), absolute changed miniSpO2 (△miniSpO2), changed T90 (△T90) and absolute changed ESS (△ESS) between the two groups. Moreover, the percentage of △AHI was not different between the two groups (47.89% ± 13.79% vs. 51.04% ± 13.32%, p = 0.587). There was no perceived discomfort during TGS therapy and no procedure-related adverse events. Conclusion: Submental transcutaneous electrical stimulation of the genioglossus led to a significant reduction in AHI and improvement of daytime sleepiness for existing mild-to-moderate OSA patient’s post-UPPP surgery.

Targeted Stimulation of the Hypoglossal Nerve for Treatment of Obstructive Sleep Apnea

Objectives: Determine safety and effectiveness of targeted hypoglossal neurostimulation sleep therapy system for obstructive sleep apnea (OSA). Titration with multi-contact electrode and multi-channel pulse generator (IPG) allows stimulation of multiple areas of the proximal hypoglossal nerve permitting identification of optimal tongue position in each patient. Methods: A total of 105 adults were screened in this prospective, multicenter, single-arm study. Inclusion criteria were continuous positive airway pressure (CPAP) failure/intolerance, apnea hypopnea index (AHI) &gt; 20, and body mass index (BMI) &gt; 37. 56 patients meeting inclusion/exclusion criteria were surgically implanted with the unilateral hypoglossal nerve stimulator electrode and IPG (aura6000TM System, Imthera Medical, San Diego). Patients were evaluated at 1, 3, 6, and 12 months. Outcomes included AHI, oxygen desaturation index (ODI), Epworth Sleepiness Scale (ESS), Sleep Apnea Quality of Life Index, and EQ-5D quality of life questionnaire. Results: Postsurgical transient tongue paresis was observed in 5 out of 56 patients (8.9%); all resolved spontaneously. Four patients withdrew, leaving 52 subjects to complete the study by September 2014. All were male, with mean age of 54.8 ± 10.6 years, and mean BMI of 30.4 ± 3.6. Preliminary data at month 3 showed significant decrease in AHI by 43.7% from 50.5 ± 18.4 to 26.7 ± 19.8 ( P &lt; .001) and significant improvement in ESS from 12.4 ± 4.0 to 9.1 ± 4.5 ( P &lt; .001). Conclusions: Surgical implantation of targeted hypoglossal neurostimulation sleep therapy system appears to be a safe and practical treatment option for OSA. Preliminary data shows significant improvement in objective and subjective outcomes. Final safety and effectiveness will be determined.

Continuous Positive Airway Pressure Improves Sleep and Daytime Sleepiness in Patients with Parkinson Disease and Sleep Apnea

Obstructive sleep apnea (OSA), common in Parkinson disease (PD), contributes to sleep disturbances and daytime sleepiness. We assessed the effect of continuous positive airway pressure (CPAP) on OSA, sleep, and daytime sleepiness in patients with PD. This was a randomized placebo-controlled, crossover design. Patients with PD and OSA were randomized into 6 w of therapeutic treatment or 3 w of placebo followed by 3 w of therapeutic treatment. Patients were evaluated by polysomnography (PSG) and multiple sleep latency test (MSLT) pretreatment (baseline), after 3 w, and after 6 w of CPAP treatment. Analyses included mixed models, paired analysis, and within-group analyses comparing 3 w to 6 w of treatment. Sleep laboratory. Thirty-eight patients with PD (mean age = 67.2 ± 9.2 y; 12 females). Continuous positive airway pressure. PSG OUTCOME MEASURES: sleep efficiency, %sleep stages (N1, N2, N3, R), arousal index, apnea-hypopnea index (AHI), and % time oxygen saturation < 90% (%time SaO2 < 90%). MSLT outcome measures: mean sleep-onset latency (MSL). There were significant group-by-time interactions for AHI (P < 0.001), % time SaO2 < 90% (P = 0.02), %N2 (P = 0.015) and %N3 (P = 0.014). Subjects receiving therapeutic CPAP showed significant decrease in AHI, %time SaO2 < 90%, %N2, and significant increase in %N3 indicating effectiveness of CPAP in the treatment of OSA, improvement in nighttime oxygenation, and in deepening sleep. The paired sample analyses revealed that 3 w of therapeutic treatment resulted in significant decreases in arousal index (t = 3.4, P = 0.002). All improvements after 3 w were maintained at 6 w. Finally, 3 w of therapeutic CPAP also resulted in overall decreases in daytime sleepiness (P = 0.011). Therapeutic continuous positive airway pressure versus placebo was effective in reducing apnea events, improving oxygen saturation, and deepening sleep in patients with Parkinson disease and obstructive sleep apnea. Additionally, arousal index was reduced and effects were maintained at 6 weeks. Finally, 3 weeks of continuous positive airway pressure treatment resulted in reduced daytime sleepiness measured by multiple sleep latency test. These results emphasize the importance of identifying and treating obstructive sleep apnea in patients with Parkinson disease.

Adenotonsillectomy and orthodontic therapy in pediatric obstructive sleep apnea

Rapid maxillary expansion (RME) is an additional treatment in pediatric obstructive sleep apnea (OSA). The aim of this study was to present data about the outcome of adenotonsillectomy (AT) and of RME in a clinical sample of pediatric OSA. We consecutively enrolled children with OSA to undergo RME or AT. The age and the severity of OSA are the main factors involved in the choice of treatment. A polysomnography was performed at the baseline (i.e., before treatment, T0) and 1 year after treatment (T1). A total of 52 subjects fulfilled the inclusion criteria. Twenty-five children underwent AT (group 1) and 22 children underwent RME (group 2). Five children underwent both treatments (group 3). Children in group 2 were older, had a longer disease duration, a higher body mass index (BMI), a lower apnea-hypopnea index (AHI), and a lower arousal index at T0 than children in group 1. After 1 year, BMI percentile and overnight mean saturation increased in group 1 while AHI and arousal index decreased. In group 2, mean overnight saturation increased while AHI decreased. Children in group 3 displayed a significant decrease in AHI from T0 to T1. Our data demonstrate that both treatments help to improve OSA, and a multidisciplinary approach to treatment is suggested.

Effectiveness of Lifestyle Interventions on Obstructive Sleep Apnea (OSA): Systematic Review and Meta-Analysis

Obstructive sleep apnea (OSA) is a common sleep disorder associated with several adverse health outcomes. Given the close association between OSA and obesity, lifestyle and dietary interventions are commonly recommended to patients, but the evidence for their impact on OSA has not been systematically examined. To conduct a systematic review and meta-analysis to assess the impact of weight loss through diet and physical activity on measures of OSA: apnea-hypopnea index (AHI) and oxygen desaturation index of 4% (ODI4). A systematic search was performed to identify publications using Medline (1948-2011 week 40), EMBASE (from 1988-2011 week 40), and CINAHL (from 1982-2011 week 40). The inverse variance method was used to weight studies and the random effects model was used to analyze data. Seven randomized controlled trials (519 participants) showed that weight reduction programs were associated with a decrease in AHI (-6.04 events/h [95% confidence interval -11.18, -0.90]) with substantial heterogeneity between studies (I(2) = 86%). Nine uncontrolled before-after studies (250 participants) showed a significant decrease in AHI (-12.26 events/h [95% confidence interval -18.51, -6.02]). Four uncontrolled before-after studies (97 participants) with ODI4 as outcome also showed a significant decrease in ODI4 (-18.91 episodes/h [95% confidence interval -23.40, -14.43]). Published evidence suggests that weight loss through lifestyle and dietary interventions results in improvements in obstructive sleep apnea parameters, but is insufficient to normalize them. The changes in obstructive sleep apnea parameters could, however, be clinically relevant in some patients by reducing obstructive sleep apnea severity. These promising preliminary results need confirmation through larger randomized studies including more intensive weight loss approaches.

Should cardiologist routinely screen and evaluate patients for sleep disordered breathing?

We report a case of a 61-year-old male patient who presented with reduced exercise capacity, dyspnea, lower limbs oedema,irregular heart rhythm, loud, irregular snoring, history of poorly controlled hypertension, nocturnal hypertension spikes, andmorning headaches. Patient underwent ECG Holter monitoring and polygraphy, which revealed severe obstructive sleepapnea. In ECG Holter monitoring atrial fibrillation with pauses to 6.5 s were observed. Patient was referred for continuouspositive airway pressure (CPAP) treatment. Three-months of CPAP therapy resulted in significant decrease in apnea-hypopneaindex (31.6/h vs. 5.1/h) and better control of hypertension and heart failure. CPAP treatment allowed us to reduce patient's cardiovascular risk. Cardiologist should routinely screen and evaluate patients for sleep disordered breathing, especially when patients are obese, have hypertension and/or arrhythmias.

Comparative Effectiveness of Maxillomandibular Advancement and Uvulopalatopharyngoplasty for the Treatment of Moderate to Severe Obstructive Sleep Apnea

To directly compare the clinical effectiveness of maxillomandibular advancement (MMA) and uvulopalatopharyngoplasty (UPPP)--performed alone and in combination--for the treatment of moderate to severe obstructive sleep apnea (OSA). The investigators designed and implemented a retrospective cohort study composed of patients with moderate to severe OSA (baseline AHI >15). The predictor variable was operative treatment and included MMA, UPPP, and UPPP followed by MMA (UPPP/MMA). The primary outcome variable was the apnea-hypopnea index (AHI) measured preoperatively and 3 months to 6 months postoperatively. Other variables were grouped into the following categories: demographic, respiratory, and sleep parameters. Descriptive and bivariate statistics were computed. The sample was composed of 106 patients grouped as follows: MMA (n = 37), UPPP (n = 34), and UPPP/MMA (n = 35) for treatment of OSA. There were no significant differences between the 3 groups for the study variables at baseline, except for AHI. Surgical treatment resulted in a significant decrease in AHI in each group: MMA (baseline AHI, 56.3 ± 22.6 vs AHI after MMA, 11.4 ± 9.8; P < .0001), UPPP/MMA (baseline AHI, 55.7 ± 49.2 vs AHI after UPPP/MMA, 11.6 ± 10.7; P < .0001), and UPPP (baseline AHI, 41.8 ± 28.0 vs AHI after UPPP, 30.1 ± 27.5; P = .0057). After adjusting for differences in baseline AHI, the estimated mean change in AHI was significantly larger for MMA compared with UPPP (MMA AHI, -40.5 vs UPPP AHI, -19.4; P = < .0001). UPPP/MMA was no more effective than MMA (P = .684). The results of this study suggest that MMA should be the surgical treatment option of choice for most patients with moderate to severe OSA who are unable to adequately adhere to CPAP.

Transvenous Phrenic Nerve Stimulation in Patients With Cheyne-Stokes Respiration and Congestive Heart Failure: A Safety and Proof-of-Concept Study

Cheyne-Stokes respiration (CSR), which often occurs in patients with congestive heart failure (CHF), may be a predictor for poor outcome. Phrenic nerve stimulation (PNS) may interrupt CSR in patients with CHF. We report the clinical use of transvenous PNS in patients with CHF and CSR. Nineteen patients with CHF and CSR were enrolled. A single stimulation lead was placed at the junction between the superior vena cava and brachiocephalic vein or in the left-side pericardiophrenic vein. PNS stimulation was performed using Eupnea System device (RespiCardia Inc). Respiratory properties were assessed before and during PNS. PNS was assessed at a maximum of 10 mA. Successful stimulation capture was achieved in 16 patients. Failure to capture occurred in three patients because of dislocation of leads. No adverse events were seen under maximum normal stimulation parameters for an overnight study. When PNS was applied following a series of central sleep apneic events, a trend toward stabilization of breathing and heart rate as well as improvement in oxygen saturation was seen. Compared with pre-PNS, during PNS there was a significant decrease in apnea-hypopnea index (33.8 ± 9.3 vs 8.1 ± 2.3, P = .00), an increase in mean and minimal oxygen saturation as measured by pulse oximetry (89.7% ± 1.6% vs 94.3% ± 0.9% and 80.3% ± 3.7% vs 88.5% ± 3.3%, respectively, all P = .00) and end-tidal CO2 (38.0 ± 4.3 mm Hg vs 40.3 ± 3.1 mm Hg, P = .02), but no significant difference in sleep efficiency (74.6% ± 4.1% vs 73.7% ± 5.4%, P = .36). The preliminary results showed that in a small group of patients with CHF and CSR, 1 night of unilateral transvenous PNS improved indices of CSR and was not associated with adverse events.

Clinical significance and intervention study of serum interleukin 18 in preeclampsia patients with coexisting obstructive sleep apnea

To investigate the role of IL-18 in the obstructive sleep apnea syndrome (OSAS)-induced preeclampsia (PE), by comparison of the changes of serum IL-18 levels among different groups as well as before and after continuous positive airway pressure (CPAP) treatment in pregnant women with both OSAS and PE. In control group there were 18 normal pregnant women with apnea hypopnea index (AHI) < 5. In simple PE group 18 pregnant PE patients with an AHI < 5 were recruited. In PE plus OSAS group 16 PE patients with coexisting OSAS were collected. CPAP treatment was performed for 1 week in 6 patients with AHI > 15 from PE plus OSAS group.Serum IL-18 levels were measured with ELISA. There was a significant difference in serum IL-18 levels among control group [(261 ± 95) ng/L], simple PE group [(382 ± 121) ng/L], and PE plus OSAS group [(601 ± 89) ng/L, all P < 0.001]. Following CPAP treatment, there was a significant decrease in AHI, systolic blood pressures, and serum IL-18 levels, but a significant increase in minimal SpO₂ (P < 0.01). Our study demonstrated that serum IL-18 levels in PE patients with OSAS were significantly elevated, which suggested that OSAS might increase the incidence of PE by enhancing inflammatory response, while CPAP treatment could effectively improve the pathological process.