Treatment Of Obstructive Sleep Apnea Research Articles

Case reports of oral appliance therapy on three young adults with Down syndrome and OSA.

Patients with Down syndrome (DS) have a high incidence of obstructive sleep apnea (OSA) due to hypotonia, weight, underdeveloped midface, and relative macroglossia. This article presents three cases of young adults with DS, who were diagnosed with mild to severe OSA and unable to tolerate positive airway pressure therapy. These patients have been successfully treated with a custom-made mandibular advancement device (MAD) or dual treatment with MAD and bi-level positive airway pressure (PAP) therapy. The baseline apnea-hypopnea index (AHI) of the three patients were 15.5/h, 31.8/h, and 41.3/h. The follow-up AHI after the application of MAD in three patients was 25/h (13 months after), 6/h (ODI 4%, 57 months after), and 21.8/h (21 months after), respectively. The application of MAD to treat OSA in patients with DS is a reasonable alternative when patients refuse PAP therapy. Although MAD might be less effective than PAP therapy, significant symptomatic improvement could be found in patients with DS after oral appliance therapy. The combination of MAD and PAP can decrease the PAP pressure and therefore improve adherence. This is the first case report to show that young adult patients with DS can successfully benefit from oral appliance therapy for OSA treatment.

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

Screening for obstructive sleep apnea in the memory clinic: A comparison of questionnaires, pulse oximetry, and polysomnography.

Obstructive sleep apnea (OSA) is highly prevalent among older adults and has been associated with cognitive decline and dementia risk. The suitability of screening tools for detecting OSA in memory clinic settings is unclear. To evaluate the utility and validity of the STOP-Bang questionnaire (SBQ) and pulse oximeter as a screening tool, compared to gold-standard polysomnography (PSG) in older adults attending a memory clinic. Participants aged over 50 with new onset cognitive/mood concerns attended a memory clinic, then completed the SBQ, oximetry, and PSG. The SBQ and oximetry's accuracy in detecting moderate-severe and severe OSA was evaluated using receiver operating curves. Intraclass correlation and Bland-Altman plots compared the oximeter's adjusted oxygen desaturation index (ODI-Ox) and PSG's apnea-hypopnea index (AHI-PSG). Of 194 participants (mean age = 65.6, 64 males) who completed PSG, 184 completed the SBQ, and 138 completed oximetry. SBQ demonstrated limited performance for moderate-severe OSA (sensitivity = 52%, specificity = 62%, AUC = 0.600) and severe OSA (sensitivity = 18%, specificity = 87%, AUC = 0.577). Oximetry was satisfactory for moderate-severe OSA (sensitivity = 67%, specificity = 73%, AUC = 0.769) and severe OSA (sensitivity = 50%, specificity = 88%, AUC = 0.730). The diagnostic performance was improved with new cut-offs at ODI-Ox ≥ 11 for AHI-PSG ≥ 15 and ODI-Ox ≥ 20 for AHI-PSG ≥ 30. Bland-Altman plots and intraclass correlation indicated acceptable agreement for oximetry. The findings suggest that while the SBQ may be unsuitable to detect moderate or severe OSA for older adults with cognitive impairment, oximetry may be a viable screening tool. Given OSA treatment can optimize sleep and may slow cognitive decline, routine screening for OSA should be part of memory clinic assessments.

No negative impact of a vibro-tactile supine-avoidance alarm on sleep onset latency following supine posture shifts during sleep.

It is unclear to what extent posture shifts during sleep are associated with prior arousal and full awakening, and if supine-avoidance alarms to discourage supine sleep promote more extended wake following supine alarms. Thus, this study sought to examine relationships between posture shifts, arousals and awakenings, and to establish if a vibro-tactile supine-avoidance alarm delays the return to sleep following supine posture shifts. Detailed posture shift and sleep data from a chest-worn device with an inactive or active supine-avoidance alarm, and in-home sleep study data were from 37 participants who completed a randomised controlled trial of supine-avoidance device treatment for supine-predominant obstructive sleep apnea. Posture shifts, sleep, arousal and awakening responses, and sleep onset latency following posture shifts were compared between baseline and supine-avoidance treatment nights. Compared to baseline, there was a marked reduction in overnight supine time with active supine-avoidance treatment. Around 90% of posture shifts were preceded by either wake, arousal or full awakening. Sleep onset latency was longer for posture shifts occurring from prior wake compared to those from prior sleep but was not different between baseline or supine-avoidance treatment nights or between shifts from non-supine to supine or vice-versa. Most overnight posture shifts are associated with either prior wake or brief arousal, which likely facilitates co-ordinated body movements needed for effective posture shifts. Thus, sleep is typically already interrupted around the time that supine-avoidance alarms are activated, and the alarm itself does not significantly delay the return to sleep.

Caregiver-implemented intervention to increase use of positive airway pressure for adults with Down syndrome and sleep apnea.

Many individuals with Down syndrome are diagnosed with obstructive sleep apnea (OSA), a medical condition that substantially affects health and quality of life. The most common treatment for OSA is positive airway pressure (PAP) therapy. Few studies have examined interventions to improve PAP therapy adherence for adults with developmental disabilities or have recruited the assistance of caregivers to improve adherence with this therapy in the home. This study evaluated the efficacy of a caregiver-implemented behavioral intervention to increase PAP use for four adults with Down syndrome and OSA. The experimenters trained caregivers via telehealth to implement the intervention in their homes. The intervention consisted of graduated exposure, noncontingent reinforcement, and differential positive and negative reinforcement without escape extinction. The intervention increased the duration of PAP use for all four participants. These results provide preliminary support for the efficacy of this intervention and service-delivery model.

A randomised dose finding study of combination dronabinol and acetazolamide for the treatment of obstructive sleep apnoea.

Current treatments for obstructive sleep apnoea (OSA) are ineffective or not tolerated in a proportion of patients. Other therapeutic options are needed and pharmaceuticals may provide an alternative. This randomised, double-blind, placebo-controlled, cross-over study examined the effect of combination acetazolamide and dronabinol (IHL-42X) at low, medium and high doses on OSA severity. Participants with OSA (apnoea-hypopnoea index; AHI≥15events/hr) received 1-week of IHL-42X at each of 3 doses, and placebo, each separated by 1-week washout. The change from baseline in AHI, oxygen desaturation index (ODI), Epworth sleepiness score (ESS), and mood (profile of mood states) on the final night of each treatment arm relative to the change from baseline to placebo were the major endpoints. Adverse events (AEs) were monitored throughout. Ten of 11 participants completed the final night of at least one treatment arm. IHL-42X demonstrated a greater reduction in AHI from baseline compared with placebo (low, -19.7±27.1; medium, -17.5±23.3; high, -16.4±23.8 versus placebo, -2.8±21.0 events/hr; all p<0.05). The change from baseline in ODI3% was greater for the medium IHL-42X dose when compared with placebo (-15.4±19.0 versus placebo, -2.8±21.0 events/hr; p<0.05) but not the low or high doses (low, -15.2±24.8; high, -8.3±13.2 events/hr). IHL-42X did not change ESS or mood. No serious AEs occurred however 35 mild-moderate possibly, probably or treatment related AEs occurred during IHL-42X dosing and 5 occurred during placebo. One week of nightly IHL-42X at low, medium, and high doses was well tolerated, safe and associated with significant reductions in OSA severity.

Consumer sleep technology use in individuals with obstructive sleep apnea: does it have a role in monitoring treatment response?

Consumer sleep technology (CST) has an emerging role in monitoring sleep, including screening or surveillance of sleep disorders; however, few data are available on CST in patients with obstructive sleep apnea (OSA). We analyzed attitudes towards CST and patterns of CST use among individuals with OSA. Among 251 respondents (mean age 57.5 years; 58.2% female), 66.5% reported CST use, and 92.0% indicated that monitoring OSA treatment response would be a useful feature of CST. Individuals with a household income < $30,000 (OR 0.26; p=0.008) or identifying as a minority/other race (OR 0.15; p=0.021) were less likely to use CST. Older age (beta-coefficient 0.05; p<0.001), Medicare insurance (beta-coefficient 1.26; p=0.006), and positive airway pressure use (beta-coefficient; p=0.008) were associated with increased nights/week of CST use. These findings demonstrate a high perceived value of CST for monitoring treatment response among individuals with OSA, but disparate use by sociodemographic and clinical factors.

Obstructive Sleep Apnea and Chronic Rhinosinusitis: Understanding the Impact of OSA on CRSDisease Burden.

Assess the impact of obstructive sleep apnea (OSA) on chronic rhinosinusitis (CRS) severeity. Retrospective database review. TriNetX US database. TriNetX US Collaborative Network database was queried for cohorts of patients with OSA, CRS, and CRS with comorbid OSA (CRS-OSA). Data included demographics, CRS severity was assessed via rates of endoscopic sinus surgery (ESS), antibiotic, and oral steroid use. Propensity score matching was performed to account for differences in demographics and clinical variables. The query identified 1,818,879 patients with CRS, 481144 with OSA, and 93,153 CRS-OSA patients. OSA-CRS patients had higher rates of hypertension, diabetes mellitus, obesity, and asthma than either CRS or OSA populations (P < 0.0001). CRS-OSA patients demonstrated higher rates of ESS (odds ratio [OR]: 1.91, 1.82-2.02, P < 0.0001), antibiotic (OR: 1.90, 1.81-1.96, P < 0.001), and oral steroid use (OR: 2.23, 2.16-2.28, P < 0.001) compared to CRS-only patients. CRS-OSA patients not on continuous positive airway pressure had higher utilization of antibiotics (OR: 3.24, 2.82-3.71, P < 0.0001) and steroids (OR: 2.28, 2.05-2.55, P < 0.0001) than nonutilizers. CRS-OSA patients with sleep-related surgical interventions required fewer antibiotic courses (OR: 1.93, 1.62-2.28, P < 0.0001). CRS-OSA patients experience higher rates of comorbidities associated with both diseases than those with CRS or OSA alone. OSA was associated with an increased risk of ESS, antibiotic, and steroid use in patients with CRS. There appears to be a correlation with treatment of OSA and CRS outcomes, however, further studies are required.

Three-dimensional mean disease alleviation (3D-MDA): The next step in measuring sleep apnea treatment effectiveness

Mean disease alleviation measures the effectiveness of Obstructive Sleep Apnea (OSA) treatments. It combines a patient's adherence to treatment normalized to their total sleep time and the treatment's efficacy as determined by the change in the apnea-hypopnea index. This metric fails to capture the patient's OSA-related symptoms, which are a key component and, in some cases, the primary component, of determining response to treatment.We propose an enhanced metric called three-dimensional mean disease alleviation (3D-MDA), which incorporates the symptom response to better reflect the true treatment impact. ResultsThe proposed 3D-MDA metric aims to provide a more comprehensive assessment of OSA treatment effectiveness by integrating the subjective impact, therapy adherence, and objective efficacy. Further, 3D-MDA is adaptable over time as the optimal metrics for these categories continue to evolve.

The efficacy and safety of dual orexin receptor antagonists in obstructive sleep apnea: A systematic review and meta-analysis of randomised controlled trials.

Dual orexin receptor antagonists (DORAs) are indicated for the treatment of insomnia disorder. However, DORAs may change sleep parameters, thus having adverse effects on patients with obstructive sleep apnea (OSA). This meta-analysis clarified the impact of DORAs in OSA treatment on sleep architecture and respiratory parameters. We systematically searched PubMed, Embase, and Cochrane Central databases for randomised control trials published up to May 2024. The search focussed on studies discussing the effects of DORAs on sleep architecture in patients with OSA. Nonrandomised studies were excluded. A meta-analysis using a random-effects model was performed. The patients were categorised into subgroups based on the treatment protocol (single or multiple dosages). The Cochrane risk of bias tool for randomised trials assessed the risk of bias. Our meta-analysis included four randomised placebo-controlled trials, encompassing 126 patients with a mean age of 49.1 years. The effects of DORAs on sleep architecture and respiratory parameters were examined. The main findings were as follows: DORAs significantly increased the total sleep time and improved sleep efficiency. However, they did not affect rapid eye movement sleep. DORAs also showed a trend towards decreased wake after sleep onset and did not increase the apnea-hypopnea index. DORAs did not increase the percentage of total sleep time with oxygen saturation lower than 90% and 85% compared with placebo, respectively. Furthermore, DORAs were not associated with significantly higher adverse effects compared with placebo. This meta-analysis demonstrated that DORAs improve sleep and do not impair nighttime respiratory function in patients with OSA.

Abstract 4134668: Title: Mandibular advancement device versus CPAP on cardiovascular health and quality of life in OSA a pre-specified 12 months follow up of outcomes

Background: Obstructive sleep apnoea (OSA) is a significant cause of hypertension. ACC/AHA Guidelines recommended screening and treatment of OSA in patients with hypertension; however, evidence comparing mandibular advancement devices (MAD) to continuous positive airway pressure (CPAP) on cardiovascular health is lacking. We present the complete 12 months follow-up data on the comparative effectiveness of MAD versus CPAP in ambulatory BP reduction, QoL, cardiac arrhythmia, and myocardial remodelling. Method: In a randomized, non-inferiority trial (margin 1.5 mmHg), 321 participants, aged over 40, with hypertension and high cardiovascular risk were recruited. Of these, 220 participants with OSA (apnoea–hypopnea index ≥15 events/h) were randomized to either MAD or CPAP (1:1). Pre-specified secondary outcomes include: ambulatory BP, quality of life (QoL) (sleep-specific: ESS, SAQLI, FOSQ; non-sleep-specific: SF-36, EQ-5D), ambulatory ECG monitoring, and cardiac MRI. Results: A total of 89 (80.9% of 110) participants from MAD, and 91 (82.7% of 110) participants from CPAP completed 12 months follow-up. The median daily usage was 5.5 hours for MAD and 4.9 hours for CPAP. The between-group difference in 24h mean BP from baseline to 12 months was - 0.57 mmHg (95% confidence interval: (-2.53 to 1.39, non-inferiority P &lt; 0.001). Compared with the CPAP group, MAD group demonstrated a larger reduction in all the 24h with the most pronounced differences observed in the asleep BP parameters (Table 1). Both the MAD and CPAP improved QoL (Table 2). CPAP had greater improvement in FOSQ from sleep-specific questionnaires (P=0.038), and social QoL in SF-36 from non-sleep-specificl questionnaires (P=0.013). The ambulatory ECG monitoring (MAD: 2.8 ± 1.0 days, CPAP: 2.3 ± 1.1 days) showed no between-group differences in % atrial fibrillation(P=0.209), % ventricular ectopic isolated count (P=0.790) and % supraventricular ectopic isolated count (P= 0.333). The cardiac MRI sub-study (101 participants : MAD= 45, CPAP= 56) showed CPAP had greater improvement in right ventricular stroke volume (P=0.023) and MAD had greater improvement in circumferential strain favours the MAD group (P=0.015) (Table 3). Conclusion: At 12 months , MAD was non-inferior to CPAP for reducing 24h mean arterial BP. MAD showed greater reduction in 24h BPs, especially during asleep. While both the MAD and CPAP are effective in improving QoL, CPAP is more effective in improving FOSQ and social QoL (SF-36).

The Great Controversy of Obstructive Sleep Apnea Treatment for Cardiovascular Risk Benefit: Advancing the Science Through Expert Consensus. An Official American Thoracic Society Workshop Report.

The prevalence of obstructive sleep apnea (OSA) is on the rise, driven by various factors including more sensitive diagnostic criteria, increased awareness, enhanced technology through at-home testing enabling easy and cost-effective diagnosis, and a growing incidence of comorbid conditions such as obesity. Treating symptomatic patients with OSA syndrome to enhance quality of life remains a cornerstone approach. However, there is a lack of consensus regarding treatment to improve cardiovascular disease (CVD) outcomes, particularly in light of overall negative results from several randomized controlled trials (RCT) indicating no benefit of positive airway pressure (PAP) therapy on primary and secondary CVD events. These RCTs were limited by suboptimal PAP adherence, use of composite CVD outcomes, and limited diversity and generalizability to Sleep Clinic patients. As such, this workshop assembled clinical experts, as well as researchers in basic and translational science, epidemiology, clinical trials, and population health to discuss the current state, and future research directions to guide personalized therapeutic strategies and future research directions in OSA. There was overall consensus among workshop participants that OSA represents a heterogeneous disease with variable endotypes and phenotypes, and heterogeneous responses to treatment. Future research should prioritize employing multi-modal therapeutic approaches within innovative and adaptive trial designs, focusing on specific subgroups of OSA patients hypothesized to benefit from a CVD perspective. Future work should also be inclusive of diverse populations and consider the life-course of OSA to better comprehend treatment strategies that can address the disproportionate impact of OSA on racially minoritized groups. Further, a more holistic approach to sleep must be adopted to include broader assessments of symptoms, sleep duration, and comorbid sleep and circadian disorders. Finally, it is imperative to establish a sleep research consortium dedicated to collecting raw data and biospecimens categorized by OSA subtypes. This will facilitate mechanistic determinations, foster collaborative research, and help bolster the pipeline of early-career researchers.

Preliminary efficacy of individualized genioglossus advancement with 3D printing in the treatment of obstructive sleep apnea with micrognathia

Objective: To investigate the preliminary efficacy of 3D printed individualized genioglossus advancement (GA) for the treatment of obstructive sleep apnea (OSA) in adults with micrognathia. Methods: The OSA patients with retropalatal and retroglossal collapses due to micrognathia underwent 3D printed individualized GA combined with Uvulopalatopharyngoplasty(UPPP) in Department of Otolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Clinical data including pre-and post-operative polysomnography (PSG), cephalometric measurements of genioglossus advancement, patient-reported symptom and surgical complications were collected. A comparison of pre-and post-operative data was conducted using paired t-tests. Results: Nineteen OSA patients with micrognathia successfully underwent 3D printed individualized GA combined with UPPP, and achieved an actual mean genioglossus advancement distance of (9.0±1.4) mm compared to the planned distance of (9.4±1.0) mm preoperatively (t=0.81, P=0.427). Among the 14 patients followed up for more than 6 months, the mean AHI reduced by 60.4% at 6 months postoperatively, with 5 cases (5/14) cured and 5 cases (5/14) showing significant improvement, resulting in an overall surgical response rate of 10/14. All patients expressed satisfaction with their postoperative facial appearance, with 13 cases perceiving an improvement in attractiveness. Two patients reported temporary genial numbness, and one patient experienced temporary mandibular occlusal asthenia. Conclusion: The 3D printed individualized GA combined with UPPP effectively reduces AHI in adult OSA patients with micrognathia, accompanied by a low incidence of surgical complications and high patient satisfaction regarding postoperative facial appearance.

Shared genetic associations and etiology between obstructive sleep apnea and CVDs: A genome-wide cross-trait analysis and bidirectional Mendelian randomization analysis.

To investigate the genetic correlations and potential causal relationships between obstructive sleep apnea (OSA) and various cardiovascular diseases (CVDs), aiming to enhance understanding of shared genetic mechanisms and improve recognition and treatment of OSA in patients with CVDs. Utilizing genome-wide association study (GWAS) data, we analyzed shared genetics between OSA and CVDs using linkage disequilibrium score regression (LDSC), multi-trait analysis of GWAS (MTAG), and genotype-tissue expression analysis (GTEx TSEA). We further investigated causal relationships using Bayesian colocalization tests, bidirectional Mendelian randomization (MR), and latent causal variable (LCV) analysis. We found strong associations between OSA and multiple CVDs: coronary artery disease (CAD), heart failure (HF), myocardial infarction (MI), stroke, and atrial fibrillation (AF). Novel SNPs related to CVDs were identified during single-trait MTAG analysis. By applying cross-trait MTAG, we identified 15 shared loci between OSA and CAD, 25 shared loci between OSA and MI, and 7 shared loci between OSA and HF. Shared genes are primarily expressed in the blood, heart, kidney, liver, muscle, and pancreas. MR analysis indicated a significant causal effect of OSA on HF and AF as a causal factor for OSA. LCV analysis suggested that AF was causally associated with OSA, while HF showed partial causality. Our study suggests strong genetic correlations between OSA and several CVDs. Further research is needed on the associations between OSA and CVDs, as well as the mechanisms of the identified loci.

Cannabinoids for obstructive sleep apnea: A systematic review.

Cannabinoids have emerged as a potential treatment for obstructive sleep apnea (OSA). This systematic review aimed to summarize the efficacy and safety of cannabinoids to treat OSA. Databases including Ovid MEDLINE, EMBASE, Scopus, PsycINFO, and International Pharmaceutical Abstracts were searched; experimental and observational studies were eligible for inclusion. One-hundred seventy unique records were screened, and nine studies included: five full-text studies and four published abstracts. The five full-text studies were judged for quality appraisal: two studies deemed at low risk for bias, one study deemed to have some concerns for bias, and two studies deemed to have high risk for bias. Seven of nine total studies were experimental designs and evaluated dronabinol, and the other two studies were observational designs evaluating cannabis. The range of cannabinoid therapy duration spanned from 1 to 6 weeks, and the median duration was 3 weeks. Eight of nine total studies reported statistically significant, positive OSA outcomes due to cannabinoid therapy including reductions in the apnea hypopnea index and improvements in patient-reported daytime sleepiness scales. Between 70% and 80% of study participants reported neuropsychiatric and gastrointestinal adverse events attributable to cannabinoids. The American Academy of Sleep Medicine does not recommend using cannabinoids to treat OSA due to a lack of long-term safety and efficacy data. This systematic review found similar limitations, with the median cannabinoid treatment duration being only 3 weeks. Adequately powered experimental trials over longer time frames are necessary to more completely assess the long-term efficacy and safety of cannabinoids in the treatment of OSA and its effects on common comorbid conditions, such as obesity and cardiovascular disease.

Mouth Leak is Associated with Sleep Fragmentation During Nasal CPAP Treatment of OSA and May Be Detected by Leak Waveform Analysis.

Mouth air leak is a major cause of low adherence to nasal CPAP in patients with obstructive sleep apnea (OSA). However, CPAP reports do not distinguish mouth from mask leak. We hypothesized that mouth air leak is terminated abruptly by an arousal from sleep and mouth closing that can be detected by CPAP leak waveform analysis. Describe patterns of mouth air leak waveform during polysomnography (PSG) in patients with OSA treated with well-fitted nasal CPAP. PSG recordings with a jaw motion sensor to detect mouth opening were performed in OSA patients treated with nasal CPAP with suspected mouth air leak. Careful mask fitting and visual inspection excluded mask leak. Mouth leak episodes were characterized by an increase (≥ 20%) above the intentional leak. Leak episodes were classified as intermittent (< 5 minutes) or continuous (≥ 5 minutes). Twenty patients (80% men; age: 63±11 years; body mass index: 29.9±6 kg/m2; baseline apnea hypopnea index: 46.9±19 events/h) treated with nasal CPAP and documented mouth leak completed the study. All but one patient experienced an overlap of intermittent and continuous mouth leak. Most mouth leak episodes ended with mouth closure (97.7%) and an arousal (52.7%) or awakening (38.6%). Only 34.9% of the leak episodes were associated with respiratory events. Intermittent mouth air leak was more common in sleep stages N1+ N2 (P<0.01), while continuous leak was more common in sleep stage N3 (P<0.01). Continuous episodes of air leak were associated with a higher amplitude of mouth opening. CPAP report waveform was able to detect only 29.6% of the leak episodes detected by PSG. Only 10 patients (50%) had a high unintentional leak according to the criterion adopted by ResMed and only 2 patients (10%) presented large leak according to the Philips criterion. Intermittent and continuous mouth leak during nasal CPAP frequently co-exist and contribute to sleep fragmentation. Identification of leak waveform patterns may help detect mouth air leak which in turn is an important cause of poor CPAP adherence.

A PhD completed. Issues related to indication, surgery, and outcome of maxillomandibular advancement in obstructive sleep apnea

Obstructive sleep apnea is a common sleep-related breathing disorder. Although maxillomandibular advancement is widely recognized for its proven effectiveness, there are still uncertainties surrounding this procedure. This research therefore focused on the indication, surgical techniques, and outcomes of maxillomandibular advancement in patients with obstructive sleep apnea. A systematic review and meta-analysis showed that maxillomandibular advancement is more effective than multilevel surgery for the treatment of obstructive sleep apnea. Both maxillomandibular advancement and hypoglossal nerve stimulation were identified as effective and safe treatment methods for obstructive sleep apnea. Various retrospective studies also indicated that patients with hypopnea-dominant obstructive sleep apnea are better candidates for maxillomandibular advancement, in contrast to patients with cardiovascular diseases or a higher central apnea index. Furthermore, it was demonstrated that maxillomandibular advancement is effective in patients with a high percentage of central and mixed apneas, despite the potential surgical inaccuracies of maxillomandibular advancement, highlighting the broad applicability of this treatment method.

Long-term outcomes of extracapsular tonsillectomy in the treatment of obstructive sleep apnoea in adults

Background Tonsillectomy is an effective treatment option for obstructive sleep apnoea in selected adult patients, but there has been a lack of long-term follow-up data. Objectives To analyse the long-term outcomes of extracapsular tonsillectomy in the treatment of obstructive sleep apnoea in adults, with the longest follow-up periods to date. Materials and methods We recruited adults who had undergone extracapsular tonsillectomy because of obstructive sleep apnoea between 2004 and 2018 in the Hospital District of Southwest Finland. A new home sleep study, questionnaires, and a structured phone interview were conducted on these patients 4–17 years after surgical treatment. The primary outcome was the change in the apnoea-hypopnoea index. Results The mean apnoea-hypopnoea index was reduced from 27.1 preoperatively to 14.1 after the long-term follow-up (mean 12 years), and the mean Epworth Sleepiness Scale score decreased from 9.2 to 4.6. The long-term surgical success rate was 38.5%. Four out of five patients would choose the surgery again according to the phone interview. Conclusions and significance This study supports the notion that extracapsular tonsillectomy alone can be considered as a surgical treatment option for selected adults with obstructive sleep apnoea and tonsillar hypertrophy. For most of the patients, the obstructive sleep apnoea is alleviated.

Role of polysomnography in the management of obstructive sleep apnea during the first year of life in Robin sequence: a prospective and longitudinal study

ObjectivesTo prospectively assess, using polysomnography (PSG), the evolution in obstructive sleep apnea (OSA) in infants with Robin Sequence (RS) during their first year of life and to evaluate the role of PSG in OSA treatment. MethodsProspective and longitudinal study conducted in 2 tertiary hospitals (2018-2021). Data from 2 PSG (PSG1 0-3 months of life, PSG2 6-10 months of life) performed in RS infants in different sleep positions/conditions (without treatment: supine [SP]; with treatment: lateral [LP], prone [PP], respiratory support) were analyzed. OSA treatment type were compared before and after both PSG. ResultsAmong the 45 RS infants included (median [IQR] age 2[1-2] months at PSG1 and 8[6-8] months at PSG2), 27 had available data from both PSG1/PSG2. Sleep efficacy without treatment (SP) tended to be lower at PSG1 than PSG2 (77%[66-84] versus 88%[78-96], p=0.0048). At PSG1 without treatment, 77% of infants had a severe OSA; OAHI significantly decreased between PSG1 and PSG2 (17/h[10-36 versus 5/h[3-7], p<0.0001). At PSG1 under treatment, despite an improvement in OAHI, OSA remained severe for 81% of infants in LP, 47% in PP, and 85% with respiratory support (16/h[11-21],10/h[6-17],18/h[11-20], respectively). PSG1 led to a change in treatment for 40% of infants (de-escalation 18%; escalation 22%). ConclusionSleep and OSA improved spontaneously during the first months of life in RS infants, approaching near-normal at 8 months of age. Early PSG led to a change in management strategy in nearly half the RS infants, highlighting that PSG represents a precious tool to optimize OSA treatment. Clinical Trial RegistrationNot applicable

Impact of Obstructive Sleep Apnea in Patients with Acute Heart Failure: A Nationwide Cohort Study

Background/Objectives: Heart failure presents a significant public health challenge, affecting millions in the US, with projections of increasing prevalence and economic burdens. Obstructive sleep apnea (OSA) is highly prevalent among HF patients. This study analyzes the impact of OSA on the outcomes in patients admitted with acute decompensated heart failure. Methods: We conducted a retrospective cohort study using the National Inpatient Sample database (NIS) 2020, focusing on patients admitted with acute heart failure. Patient outcomes were compared between those with and without a secondary diagnosis of OSA, identified via validated ICD-10 codes. Subgroup analysis was conducted between heart failure patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). Results: Among 65,649 patients with acute heart failure, 4595 (7%) patients were found to have OSA. The patients with OSA were more likely to be male, older in age and had a higher burden of comorbidities. No significant differences were observed in mortality between heart failure patients with and without OSA. In HFrEF patients, OSA was associated with longer hospital stays (6.45 days vs. 5.79 days, p &lt; 0.001), higher rates of acute kidney injury (AKI) (adjusted odds ratio 1.28, 95% CI: 1.07–1.54, p = 0.007), and atrial fibrillation (adjusted odds ratio 1.35, 95% CI: 1.13–1.61, p = 0.001). In HFpEF patients, an association between OSA and AF was observed (adjusted odds ratio 1.20, 95% CI: 1.01–1.42, p = 0.03). Conclusions: OSA is associated with poor in-hospital outcomes in patients admitted with acute heart failure. HFrEF subgroup is especially vulnerable, with OSA leading to a significant increase in healthcare utilization and complication rates in these patients. This nationwide study underscores the importance of timely identification and treatment of OSA in heart failure to alleviate healthcare burdens and improve patient outcomes.