Significant Reduction In Apnea-hypopnea Index Research Articles

Comparative efficacy of sleep positional therapy, oral appliance therapy, and CPAP in obstructive sleep apnea: a meta-analysis of mean changes in key outcomes

BackgroundObstructive sleep apnea (OSA) is commonly treated with continuous positive airway pressure (CPAP), though many patients struggle with adherence. Sleep positional therapy (SPT) offers a potential alternative, especially for positional OSA (POSA). This study aimed to compare the efficacy and safety of SPT with CPAP, oral appliance therapy (OAT), and placebo.MethodsNineteen randomized controlled trials (RCTs) with 1,231 participants were included. Data extraction focused on changes in key outcomes such as apnea-hypopnea index (AHI), total sleep time (TST), oxygen desaturation index (ODI), and sleep architecture from pre- to post-intervention. Random-effects meta-analyses were conducted to compare mean changes between SPT and control groups (placebo, OAT, CPAP), with sensitivity analyses to assess heterogeneity.ResultsSleep positional therapy (SPT) showed a significant reduction in AHI in the supine position compared to placebo (MD = −7.46, 95% CI: −11.42, −3.49), although no difference was observed in overall AHI between SPT and placebo or OAT. Compared to CPAP, SPT was less effective in reducing AHI, with a trend toward greater reductions in AHI favoring CPAP. SPT demonstrated a significant improvement in arousal index compared to OAT (MD = −7.11, 95% CI: −10.52, −3.71) and a lower risk of device-related complications compared to both OAT (OR = 0.54, 95% CI: 0.31, 0.95) and CPAP (OR = 0.29, 95% CI: 0.12, 0.72). However, SPT did not lead to significant improvements in TST or oxygen saturation parameters across comparisons.ConclusionSleep positional therapy (SPT) is a safe alternative for managing positional OSA, particularly for patients intolerant to CPAP, though it remains less effective than CPAP in reducing overall AHI and improving oxygenation.

Evaluating the effectiveness of mandibular advancement devices in treating very severe obstructive sleep apnea: a retrospective cohort study.

The repeated airway obstructions in the common disorder Obstructive Sleep Apnea (OSA) cause health risks. Continuous Positive Airway Pressure (CPAP), the standard treatment, faces adherence challenges. Mandibular Advancement Devices (MADs) have been used successfully for mild to moderate OSA, as a good alternative for these patients. to evaluate the effectiveness of MADs in reducing the Apnea-Hypopnea Index (AHI) and improving symptoms in patients with very severe OSA unable to tolerate CPAP. This retrospective study included 22 patients with very severe OSA (AHI ≥ 50) treated with MADs. Baseline characteristics, including: age, sex, BMI, and AHI, were recorded, and changes in AHI following treatment were assessed. Adherence was monitored using patient-reported data. Unlike previous studies, this research focuses exclusively on the efficacy of MADs in treating patients with very severe OSA, a population often excluded from similar inspections. median AHI significantly decreased from 60.0 (IQR: 57.0-65.0) to 15.0 (IQR: 10.0-24.0) after treatment (P < 0.001), with a mean reduction of 72.5% (± 14.3). Notably, 95.5% of patients achieved at least a 50% reduction in AHI. Symptom improvements, including reduced snoring and daytime tiredness, were reported by 72.7% of patients. BMI positively correlated with baseline AHI, and significant AHI reductions were observed across overweight and obese categories, although some patients remained in the severe AHI range post-treatment. Adherence varied, with 63.6% continuing to use the device. MADs are effective in managing very severe OSA, providing significant reductions in AHI and symptom improvements. MADs may be a viable alternative for patients unable to tolerate CPAP. Further investigations into the long-term efficacy and impact on quality of life are needed.

Can Auditory Stimulation Improve Sleep Apnea?

Abstract Recent advancements in the field of acoustic stimulation have shown promising effects on the autonomic nervous system, influencing parameters such as heart rate [1] and cognitive performance [2]. In this study, we analyzed polygraphy data from patients with heart failure related central sleep apnea. We compared the Apnea-Hypopnea Index (AHI) during a baseline night with that during a night where acoustic stimulation was applied for 40 minutes before bedtime. Seven out of eight patients showed a significant reduction in AHI during the intervention night (p &lt; 0.01). These preliminary findings suggest that further investigation in a more controlled environment is warranted.

Effectiveness Of Oropharyngeal Exercises For Obstructive Sleep Apnea In Sedentary 45-Year-Old Adult: A Case Report

Background: Obstructive sleep apnea (OSA) is a common condition characterized by repeated episodes of airway obstruction during sleep. Traditional treatments include CPAP and lifestyle modifications. This case report explores the effectiveness of Oropharyngeal exercises in a sedentary 45-year-old adult with OSA. Case Presentation: A 45-year-old sedentary male with moderate OSA underwent a regimen of Oropharyngeal exercises over a 12-week period. Intervention: The patient performed daily Oropharyngeal exercises designed to strengthen the upper airway muscles. Outcome Measures: Improvement was assessed using the Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), and subjective sleep quality. Results: After 12 weeks, there was a significant reduction in AHI, improvement in ESS scores, and enhanced subjective sleep quality. Conclusion: Oropharyngeal exercises may be a viable adjunctive treatment for OSA, particularly in sedentary individuals. Further research with larger samples is needed to confirm these findings

The Emerging Role of Pharmacotherapy in Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a prevalent pathology with current modalities of treatment including continuous positive airway pressure (CPAP), surgery, weight loss, hypoglossal nerve stimulation, and pharmacotherapy. While CPAP is the current standard treatment for OSA, lack of tolerance and side effects necessitate alternative modalities of treatment. Various pharmacologic agents exist with mechanisms that may target OSA. Early trials have demonstrated efficacy of noradrenergic-antimuscarinic combinations to stimulate the airway, promote pharyngeal muscle tone, and prevent airway collapse. These agents, which we discuss in detail, have demonstrated significant reductions in apnea-hypopnea index (AHI) and lowest oxygen saturations based on preliminary studies. Glucagon-like peptide 1 receptor agonists (GLP-1RA), which stimulate endogenous insulin, reducing glucagon release, and decreasing gastric emptying, have shown positive results for OSA patients through weight loss with reductions in AHI. In this narrative review article, we highlight the mechanisms, current data, and future potential for multiple drug classes, including respiratory stimulants and GLP-1RAs.

Effectiveness of Mandibular Advancement Devices in Positional OSA Patients: A Retrospective Analysis of Predictive Variables in a Sample of Adult Patients.

Objectives To evaluate the efficacy of mandibular advancement devices (MADs) in improving apnea-hypopnea index (AHI) in positional obstructive sleep apnea (POSA), compared with a control group of nonpositional OSA (NPOSA) patients, from mild to very severe degree, in order to to find the main variables characterizing the examined group as potential predictors of treatment success. Materials and Methods In the present observational study, we retrospectively collected polysomnographic records of 39 positional adult patients, divided into 30 supine isolated OSA (siOSA) and 9 supine predominant OSA (spOSA) undergoing MADs from 2003 to 2019, and compared with those of a control group of 47 NPOSA patients. Demographics and anthropometrical data, home sleep apnea test (HSAT) records, drug-induced sleep endoscopy (DISE) results, and dental casts evaluation were analyzed pre- and post-treatment with MADs. Results A prevalence of the male sex (86%), mean age of 49,4 ± 14.98 years, and mean body mass index (BMI) of 26.74 ± 4.29 kg/m 2 were found among the OSA patients with significant differences between the three groups for sex and BMI. After MADs, the HSAT revealed significant reduction of AHI in all of the groups, with greater reduction of the supine AHI in POSA and significant reduction of the snore index for NPOSA. The hypopharynx section (H) of the NOHL Index, a fourth degree of hypopharyngeal collapse and an anteroposterior pattern was the most frequent to occur (19.9%) from DISE exam. No significant correlation between the initial total AHI and the dental variables was found, except for a reduced maxillary intermolar distance. Conclusion MADs are effective in reducing AHI in POSA and NPOSA patients from mild to very severe degree. Supine AHI decreased after treatment with MADs mainly in siOSA and spOSA patients compared with the NPOSA group. The snore index decreased significantly after treatment with MADs in all groups, showing the greater reduction in the NPOSA group. The tongue base (H) represented the most frequent anatomic area of collapse and there was a high prevalence of upper maxillary constriction.

Ab. No. 125 Effect of Repetitive Transcranial Magnetic Stimulation Along With Conventional Physiotherapy Treatment on Sleep Parameters Using Polysomnography: A Sleep Study in Individuals With Sleep Apnea: A Single Case Study

Introduction: The purpose is to find the effectiveness of rTMS along with conventional physiotherapy on polysomnography (PSG)-sleep analysis in individuals with sleep apnea. The study attempts to widen the horizons of the physiotherapy profession in the field of sleep apnea. The improved quality of sleep may improve various domains of the quality of life of affected individuals. Methods: Study design is a case report of an individual with sleep apnea. A 45-year-old male has been diagnosed with sleep apnea for 4 years and has been using a CPAP device for the last 5 months. The patient had excessive daytime sleepiness, loud snoring, and difficulty wearing a CPAP mask at night. The physical examination showed obesity (BMI – 25.5 kg/m2), an inappropriate breathing pattern (more mouth breathing instead of nasal breathing), and tightness of accessory respiratory muscles (scalene, trapezius, pectoral, and sternocleidomastoid) on palpation. Then the patient was intervened with rTMS along with conventional physiotherapy for 5 sessions a week for the duration of 3 weeks. Pre- and post-objective assessment were done using polysomnography and subjective assessment were done using Pittsburgh Sleep Quality Index (PSQI). Results: Significant reduction in apnea-hypopnea index (AHI) was observed after the intervention. Sleep disturbance also decreased during the night and PSQI score also decreased from 8 to 6. Conclusion: The study concluded that rTMS, along with conventional physiotherapy, was found to be an effective treatment and can be used for management of sleep apnea.

The efficacy of a modified mandibular advancement device for OSA treatment in a group of adult patients

ABSTRACT Objective The Mandibular Advancement Device (MAD) is actually recommended for the treatment of Obstructive Sleep Apnea (OSA) with mild or moderate severity. The present study evaluated the effects of a fully customizable MAD-type device (It Makes You Sleep, IMYS), in patients with moderate-to-severe OSA. Methods Twenty-nine patients (15 men and 14 women; mean age 62, SD ±10 years) were retrospectively enrolled. Home Sleep Apnea Testing ;(HSAT) was performed for all patients at baseline (T0) and after three months (T1) of IMYS therapy. The analyzed respiratory parameters were: Apnea-Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), Minimum Oxygen Saturation (minSO2) and Medium Oxygen Saturation (medSO2). Results From T0 to T1, a significant reduction of AHI and ODI was reported, as well as a significant increase of minSO2 and medSO2. Conclusion The IMYS device could be an effective MAD appliance for treating moderate-to-severe OSA.

Virtual Surgical Planning for Patients with Skeletal-Dental and Obstructive Sleep Apnea Syndrome.

The integration of virtual surgical planning (VSP) for the treatment of skeletal, dental, and facial abnormalities and obstructive sleep apnea (OSA) with maxillofacial surgery has catapulted surgical planning. Although reported for treating skeletal dental abnormalities and dental implant surgery, a paucity of knowledge existed reporting the feasibility and resultant outcome measures when virtual surgical planning was employed for planning maxillary and mandibular surgery for OSA patients. The surgery first approach is at the forefront of advancing maxillofacial surgery. Case series reporting success with the surgery first approach for patients with skeletal-dental and sleep apnea patients have been reported. In sleep apnea patients, clinically significant reductions in AHI (apnea hypopnea index) and improvement of low oxyhemoglobin saturation have been achieved. More so, significant improvement in the posterior airway space at the occlusal and mandibular planes were achieved, while preserving aesthetic norms as measured by tooth to lip measurements. VSP is a feasible tool used for predicting surgical outcome measures in maxillomandibular advancement surgery for patients with skeletal, dental, facial and OSA derangements.

The Effects of Barbed Repositioning Pharyngoplasty in Positional and Non-Positional OSA Patients: A Retrospective Analysis.

The aim of our retrospective study is evaluating the effectiveness of barbed repositioning pharyngoplasty (BRP) in a consecutive cohort of patients and assessing its impact on positional indexes in order to potentially identify specific obstructive sleep apnea (OSA) phenotypes for patients who might benefit more significantly from this intervention. A single-center retrospective study with baseline and follow-up type III sleep tests evaluating the Apnea Hypopnea Index (AHI), supine AHI, non-supine AHI, oxygen desaturation index (ODI), mean SaO2, percentage of time spent at SaO2 below 90% (CT90), and lowest oxygen saturation (LOS) were performed. The patients were then divided into groups according to Sher's criteria and Amsterdam Positional OSA Classification (APOC). Parametric and non-parametric tests and univariate and multivariate analyses were conducted. The study finally included 47 patients. The statistical analysis showed significant improvement in AHI, supine AHI, non-supine AHI, and ODI after surgery. The linear regression showed that high values of baseline AHI, AHI supine, and AHI non supine predict more significant postoperative reductions in AHI, AHI supine, and AHI non supine, respectively. Therapeutic success was achieved in 22 patients out of 47. The logistic regression did not find any independent risk factors for success. The most significant reduction in AHI, supine AHI, and non-supine AHI was observed in the APOC 3 group while the APOC 1 patients experience a substantially lower improvement. BRP appears to be an effective surgical procedure for the treatment of OSA. The non-positional patients might benefit more from BRP in comparison with positional patients. Moreover, OSA severity should not be considered an absolute contra-indication for this surgical procedure.

Upper airway multilevel radiofrequency under local anesthesia can improve CPAP adherence for severe OSA patients

ObjectiveTo evaluate the effect of upper airway radiofrequency (RF) tissue reduction under local anesthesia (LA) in severe obstructive sleep apnea (OSA) patients using continuous positive airway pressure (CPAP) in order to improve their compliance and adherence. DesignThirty (30) patients were included in this randomized clinical trial, suffering from severe OSA seeking medical advice for better upper airway management while using CPAP. Multilevel RF tissue reduction at tongue base, soft palate and inferior nasal turbinates was done under LA in multiple sessions. The Apnea hypopnea index (AHI), arousal index, lowest SpO2, CPAP pressure, and CPAP using time were recorded pre-operatively and six months after the last RF session. ResultsPost-operatively, there were significant reduction in AHI (86.03 ± 20.5 vs. 54.65 ± 16.6 p < 0.001), arousal index (71.14 ± 17.7 vs. 35.90 ± 11.8 p < 0.001), and CPAP Pressure (17.13 ± 1.7 vs. 10.97 ± 1.5 p < 0.001). Also there was a significant increase in the lowest SpO2 (60.2 ± 0.2 vs. 75 ± 0.1 p < 0.001), and CPAP using time in hours (1.57 ± 0.56 vs. 3.75 ± 0.41 p < 0.001). Visual analogue scale (VAS) for pain was recorded showing that all patients reported throat pain mainly in the first five post-operative days which was well controlled on analgesia. Conclusion and relevanceUpper airway multilevel RF tissue reduction of tongue base, soft palate and inferior nasal turbinates under local anesthesia significantly improves the tolerance and adherence of severe OSA patients using CPAP.

EVALUATION OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME UNDERGOING FUNCTIONAL EXPANSION PHARYNGOPLASTY, IN A HOSPITAL IN CURITIBA

Obstructive Sleep Apnea Syndrome (OSAS) has been increasingly recognized as a high prevalence condition and an independent risk factor for cardiac, metabolic, neurological, and perioperative morbidities, as well as erectile dysfunction, and traffic accidents, with non-standard surgical treatments and controversial results that do not seem to keep pace with the promising findings in the pathophysiology of the disease. The aim of this study was to evaluate the results of the Functional Expansion Pharyngoplasty technique in a group of patients with OSAS and small palatine tonsils. Preoperative and postoperative anthropometric and polysomnographic data from the medical records of 13 patients, of both sexes, in a renowned hospital in Curitiba (Brazil), were retrospectively analyzed. The 50% improvement in AHI (Apnea Hypopnea Index) and/or AHI below 20/h (Sher’s criteria) were considered surgical success. As a result, 84.6% of the patients achieved a significant AHI reduction (p=0.005), with 76.9% Sher’s success rate, and an also significant sleep time reduction, with oxyhemoglobin saturation below 90% (p=0.018). It can be concluded that the Functional Expansion Pharyngoplasty technique seems to be an effective alternative for the surgical treatment of patients with Obstructive Sleep Apnea Syndrome with small palatine tonsils.

A new design of mandibular advancement device (IMYS) in the treatment of obstructive sleep apnea

ABSTRACT Objective The mandibular advancement device (MAD) is currently suggested in patients with mild to moderate obstructive sleep apnea (OSA). This study investigated the effects of a new fully customizable MAD-type device called, “It Makes You Sleep” (IMYS), in patients with mild to moderate OSA. Methods Sixteen patients (14 men and 2 women; mean age 62; SD ± 11 years) were retrospectively enrolled. Each patient received home sleep apnea testing (HSAT) at baseline (T0) and after three months (T1) of IMYS treatment. The Apnea-Hypopnea Index (AHI), the Oxygen Desaturation Index (ODI), the Minimum Oxygen Saturation (minSO2) and the Medium Oxygen Saturation (medSO2) were analyzed. Results From T0 to T1, the IMYS treatment showed a significant reduction of AHI and ODI and a significant increase of minSO2 and medSO2. Conclusion The IMYS appliance is an effective device for treating mild or moderate OSA.

To compare different non-surgical treatment modalities on treatment of obstructive sleep apnea: A systematic review and meta-analysis.

The study aimed to assess the effect of mandibular advancement device (MAD) in patients with obstructive sleep apnea for reduction in 24-h mean blood pressure, sleep quality, Apnea Hypopnea Index (AHI), and patient compliance, compared to continuous positive airway pressure (CPAP), other interventions, or no treatment. Three different databases such as PubMed, EMBASE, and CENTRAL were searched using different search terms till July 2021 as per the inclusion and exclusion criteria. After inclusion of studies, data extraction including risk of bias assessment was done. For each study, we used odds ratio, mean difference, and 95% confidence interval to assess and synthesize the outcomes. The quality of evidence was evaluated as per the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Twenty-one randomized controlled trials were included: 497 patients in the MAD group, 239 patients in the CPAP group, and 274 patients in the sham group. In MAD-CPAP comparison, the results favored CPAP in the reduction of AHI of 3.48 (1.76-5.19). However, unclear results were found for sleep quality measured as Epworth Sleepiness Scale (ESS), patient compliance, and 24-h mean blood pressure. In MAD-sham comparison, the results favored MAD in the reduction of AHI of - 8.39 (-10.90--5.88] and ESS of - 0.91 (-1.70--0.12) and favored sham in terms of patient compliance while, unclear results for 24-h mean blood pressure. The GRADE score indicated that the quality of evidence is very low, low, and moderate for different outcomes. CPAP in comparison to MAD and MAD in comparison to sham showed a significant AHI reduction. However, patient compliance and 24-h mean blood pressure were not significantly different in MAD-CPAP or MAD-sham. Quality of evidence is very low and low when MAD was compared with CPAP and sham, respectively, for AHI.

Abstract 10203: Effect of Hydroxychloroquine on Endothelial Function in Older Adults with Moderate-Severe Sleep Apnea: A Randomized Clinical Trial

Introduction: Obstructive sleep apnea (OSA) is considered a low-grade chronic inflammatory disease. OSA impairs endothelial function and increases cardiovascular mortality. Hydroxychloroquine (HCQ), an anti-inflammatory drug, seems to reduce cardiovascular mortality. In animal and in vitro models, HCQ improved endothelial function. Its effects on endothelial function of patients with OSA is unknown. Hypothesis: Hydroxychloroquine can improve endothelial function in patients with OSA. Methods: Adults older than 65 years with an apnea-hypopnea index (AHI) greater than 15 events/hour were allocated to receive either 400mg of HCQ or placebo daily for eight-weeks. The randomization was computer-generated and pharmacy-controlled. Participants and outcome evaluators were blinded to the group allocation. Home sleep apnea test and measurements of flow-mediated dilation of brachial artery (FMD) and peripheral artery tonometry (PAT) were performed at baseline and follow-up in a research facility. The primary outcomes were the change in FMD (Δ%FMD) and change in PAT reactive-hyperemia index (ΔRHI). Change in AHI (ΔAHI) was a secondary outcome. Generalized estimating equations were used to verify time*group interaction. Results: Fourteen patients were assigned to the HCQ group and fifteen patients to the placebo group between April 2019 and May 2020 with no losses to follow-up. The recruitment was interrupted due to COVID-19 pandemic. Mean Δ%FMD was 0.35 (95% CI –4.26 to 4.97) in placebo group and 0.48 (95% CI –4.08 to 5.04) in HCQ group. Mean ΔRHI was 0.02 (95% CI -0.11 to 0.07) in placebo group and 0.05 (95% CI -0.24 to 0.13) in HCQ group. Mean ΔAHI was 7 (95% CI -1 to 15) in placebo group and -4 (95% CI -11 to 2) in HCQ group. P values for time*group interaction were 0.97, 0.74 and 0.04, respectively. No important adverse events have occurred. Conclusions: In this trial, HCQ did not improve endothelial function measured by FMD and PAT in older adults with OSA. A slight but significant reduction in AHI was observed in HCQ group, suggesting that some specific inflammatory mechanisms participate in OSA causation that could become a future therapeutic approach.

Myofunctional training with negative airway pressure for obstructive sleep apnea: a prospective non-randomized cohort feasibility study

Background: Orofacial myofunctional therapy (OMT), for obstructive sleep apnea (OSA) is emerging with recognition of specific phenotypes. Since many OSA sufferers are already familiar with positive airway pressure machines, we designed an OMT protocol involving the modification of such a machine to deliver negative airway pressure. We hypothesized that a three-month trial of using this protocol while awake would reduce the signs and symptoms of OSA. Methods: Fifteen adults with OSA enrolled for 30-minute sessions/three days a week for a three-month trial of “upper airway muscle physical therapy” while awake. Overnight sleep studies were performed before and after the intervention to determine each subject’s apnea hypopnea index (AHI), the primary outcome measure. Negative airway pressure application was determined by estimation of each subject’s one-repetition maximum (an exercise physiology measure of strength capacity). Exercise sessions consisted of subjects breathing against this pressure for a series of repetitions, and sets. Results: While the mean post study AHI was slightly improved (-4.3 ± 12.0 [ -10.9, 2.3], mean ± standard deviation, 95% confidence interval), it was not statistically significant. The results were similar when the AHI was divided by the sleep state (REM vs. non-REM). The nadir saturation was also essentially unchanged. The eight subjects with mild or moderate OSA (AHI &lt; 30) showed similar results. Conclusions: Though there was no significant reduction in AHI in this small cohort, the methods elucidate a new daytime use for a machine with which many OSA sufferers are familiar. Trial registration: ClinicalTrials.gov NCT02109731 (registered on April 10th 2015)

Benefit of Atrial Overdrive Pacing in Patients with Sleep Apnea: A Meta-Analysis.

Background: Sleep apnea is one of the most common conditions around the world. This disorder can significantly impact cardiovascular morbidity and mortality. Atrial overdrive pacing (AOP) is a treatment modality that can potentially decrease respiratory events. There is currently a lack of evidence to confirm the benefits of AOP. We aimed to assess the impact of AOP in patients with obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed type. Methods: A literature search for studies that reported the impact on apnea–hypopnea index (AHI) by cardiac implantable electronic devices with different pacing modes was conducted using MEDLINE, Embase, and Cochrane Database from inception through July 2020. Pooled standard mean difference with 95%CI was calculated using a random-effects model. Results: Fifteen studies, including thirteen randomized studies and two observational studies containing 440 patients, were identified. The standard mean difference in apnea–hypopnea index of atrial overdrive pacing demonstrated less duration of apnea/hypopnea in patients with atrial overdrive pacing (AOP) (SMD −0.29, 95%CI: −0.48, −0.10, I2 = 57%). Additional analysis was performed to assess the effect of atrial overdrive pacing in patients with or without severe sleep apnea syndrome (mean AHI < 30 defined as non-severe). There was no statistically significant difference in standardized mean in AHI in both subgroups between AOP and control groups (SMD −0.25, severe sleep apnea syndrome SMD −0.03, I2 = 0.00%). Conclusions: AOP was associated with a statistically significant reduction in AHI, but the magnitude of reduction was small. AOP may potentially be used as an adjunctive treatment with other modalities in treating patients with sleep apnea.

A randomized controlled trial of oxygen therapy for patients who do not respond to upper airway surgery for obstructive sleep apnea.

We aimed to determine whether patients diagnosed with obstructive sleep apnea (OSA) who fail to respond to upper airway surgery may be successfully treated with supplemental oxygen and whether we could identify baseline physiologic endotypes (ie, collapsibility, loop gain, arousal threshold, and muscle compensation) that predict response to oxygen therapy. We conducted a single night, randomized double-blinded cross over trial in which patients with OSA who failed to respond to upper airway surgery were treated on separate nights with oxygen therapy (4 L/min) or placebo (medical air). Effect of oxygen/air on OSA on key polysomnography outcomes were assessed: apnea-hypopnea index (AHI), AHI without desaturation (ie, flow-based AHI), arousal index, and morning blood pressure. OSA endotypes were estimated from the polysomnography signals to determine whether baseline OSA physiology could be used to predict response to oxygen therapy. There was a statistically significant reduction in AHI and flow-based AHI on oxygen vs placebo (flow-based AHI: 42.4 ± 21.5 vs 30.5 ± 17.1 events/h, P = .008). Arousal index was also reduced on oxygen vs placebo (41.1 ± 19.5 vs 33.0 ± 15.3 events/h, P = .006). There was no significant difference in morning blood pressure between oxygen and placebo. Although 7 of 20 individuals experienced a 50% reduction or greater in flow-based AHI on oxygen (responders), there was no difference in the baseline OSA endotypes (or clinical characteristics) between responders and nonresponders. Our findings demonstrate that a proportion of patients who fail to respond to upper airway surgery for OSA respond acutely to treatment with supplemental oxygen. Registry: Australian New Zealand Clinical Trials Registry; Name: Oxygen therapy for treating patients with residual obstructive sleep apnea following upper airway surgery; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373566; Identifier: ACTRN12617001361392.

Effectiveness of Hypoglossal Nerve Stimulation in the Treatment of Obstructive Sleep Apnea (Meta-analytic Study)

Abstract Background Obstructive sleep apnea (OSA) is a serious, potentially life-threatening disorder. There are many treatment modalities are being used, but none of them gained consensus. Continuous positive airway pressure considered the most widely accepted treatment of OSA but very poor adherence limits its effectiveness, thus was the need for alternative therapy of high compliance and effective for long term. Aim of the Work To perform a meta-analysis of the available studies included outcomes of hypoglossal nerve stimulation to evaluate its effectiveness as a choice of treatment of obstructive sleep apnea. Patients and Methods The study included published medical articles that evaluated the efficacy of hypoglossal nerve stimulation as treatment of obstructive sleep apnea with outcomes for primary outcome measures apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and for secondary outcome measures Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ) before and after implantation. Results Eight prospective studies with 329 patients were included in this met analysis. At 12 months, statistical analysis demonstrated significant reductions in AHI, ODI with standardized mean difference of -1.3940 (95% CI: -1.7745 to -1.0136; P = 0.0042), -0.9188 (95% CI: -1.3040 to -0.5337; p = 0.0002) respectively, and -not significant- reduction in ESS, FOSQ with standardized mean difference of -1.0365 (95% CI: -1.1889 to -0.8841; p = 0.2290), 1.0545 (95% CI: 0.8867 to 1.2223; p = 0.4922), respectively. Similar were observed at 6 months. Conclusion Hypoglossal nerve stimulation results in significant improvement of primary outcome measures of OSA with significant reduction of apnea episodes. It could be considered as an effective -but still of high cost- alternative for OSA patients. Further studies comparing HNS to other therapies are needed.

Long-term obstructive sleep apnea therapy: a 10-year follow-up of mandibular advancement device and continuous positive airway pressure

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder, commonly managed by either continuous positive airway pressure (CPAP) or a mandibular advancement device (MAD). Long-term follow-up and comparison regarding efficacy of these therapies is scarce. In this study the results of treatment, patient adherence, and satisfaction over a 10-year follow-up of these therapies are reported. This is a longitudinal follow-up study taken from a subset of patients initially enrolled in a randomized controlled clinical trial of 103 patients with OSA (51 and 52 patients randomized for MAD and CPAP, respectively). After a 10-year follow-up period, 14 patients using MAD and 17 patients using CPAP could be evaluated for this longitudinal follow-up study. Data were analyzed at baseline, after 3 months and at 1-, 2-, and 10-year follow-up. All 31 patients with OSA underwent polysomnography and self-reported measurements. Polysomnography results showed a favorable outcome of both therapies at 10-year follow-up. At baseline, included patients in both groups did not significantly differ in apnea-hypopnea index (AHI) values. At 10-year follow-up, both the MAD and CPAP groups showed a significant reduction in AHI. At baseline the mean AHI in the MAD group was 31.7 ± 20.6 events/h whereas in the CPAP group it was 49.2 ± 26.1 events/h. At 10-year follow-up the mean AHI in the MAD group was 9.9 ± 10.3 events/h and in the CPAP group it was 3.4 ± 5.4 events/h. Both therapies resulted in a substantial improvement in self-reported neurobehavioral outcomes at 10-year follow-up. Both CPAP and MAD therapy demonstrate good and stable treatment effects after a 10-year follow-up period. Therefore, when indicated, both therapies are appropriate modalities for the long-term management of OSA. Registry: Netherlands Trial Register; Name: Management of the Obstructive Sleep Apnea-Hypopnea Syndrome: Oral Appliance versus Continuous Positive Airway Pressure Therapy; Identifier: NL75; URL: https://www.trialregister.nl/trial/75.