Treatment Of Obstructive Sleep Apnea Research Articles

Age matters when improving symptoms of anxiety, depression, and sleepiness in patients with obstructive sleep apnea treated with continuous positive airway pressure.

Obstructive sleep apnea (OSA) is a prevalent sleep disorder linked to significant daytime sleepiness and mood disturbances. Continuous positive airway pressure (CPAP) therapy is the standard treatment for OSA, but its effects on mental health outcomes, are not well understood. This study aimed to evaluate the impact of CPAP on daytime sleepiness, depressive symptoms, and anxiety symptoms while assessing how improvements vary with age. A total of 98 participants diagnosed with OSA were included in this study. Pretreatment and posttreatment scores for daytime sleepiness [Epworth Sleepiness Scale (ESS)], depression [Patient Health Questionnaire (PHQ)], and anxiety [Generalized Anxiety Disorder (GAD)] were collected. Improvements were calculated as the difference between pretreatment and posttreatment scores. Age, sex, ethnicity, apnea-hypopnea index, and CPAP compliance, were analyzed. Significant improvements were observed across all age groups after CPAP treatment: ESS scores improved by a mean of 5.6 points (P < 0.001), PHQ scores improved by 6.3 points (P < 0.001), and GAD scores improved by 1.1 points (P = 0.002). CPAP therapy effectively reduced daytime sleepiness, depression, and anxiety in patients with OSA, with significant age-related differences in outcomes. Younger individuals benefited most from treatment.

Obstructive sleep apnea, the NLRP3 inflammasome and the potential effects of incretin therapies

Obstructive sleep apnea (OSA) is a common sleep disorder associated with serious neurological and cardiovascular complications. Intermittent hypoxia and reoxygenation, a key feature of OSA, produces molecular signals that activate various inflammatory pathways, notably the inflammasome—a multiprotein complex that promotes the release of pro-inflammatory cytokines including IL-18 and IL-1β. This results in systemic inflammation, which contributes to the development of the neurological and cardiovascular complications seen in OSA. In this review, we will first examine the pathways through which intermittent hypoxia induces inflammasome activation. Then, we will connect the inflammasome to the downstream neurological and cardiovascular effects of OSA. Finally, we will explore potential interactions between the inflammasome and OSA treatments including Continuous Positive Airway Pressure therapy and glucagon like peptide-1 receptor agonists (GLP-1RAs).

Adherence to oral appliance treatment for obstructive sleep apnea in patients with continuous positive airway pressure failure

The primary aim of this study was to determine the continuation and success rates of oral appliance (OA) therapy for patients in whom continuous positive airway pressure (CPAP) therapy failed. The secondary aim was to identify predictive factors for the long-term use of OA in patients with CPAP failure. A total of 81 patients who failed with CPAP use were included in this study. Patients who had been using OA for more than 1 year at follow-up visits were assigned to Group S, whereas those who discontinued OA or were lost to follow-up within 1 year were assigned to Group D. We investigated the continuation and success rates of OA therapy, as well as predictive factors for its long-term use for those with CPAP failure. Of the 81 patients, 60 were in Group S and 21 were in Group D; 74.0% of patients with CPAP failure continued OA therapy for more than 1 year. The apnea-hypopnea index was reduced from 41.3±21.7/h to 12.4±6.5/h with OA therapy. The only significant predictor of long-term OA use in patients with CPAP failure was awareness of the effectiveness of OA therapy after 1 month (P = 0.003, odds ratio: 9.731, 95% confidence interval: 2.146-44.119). Patients who recognized the effectiveness of OA treatment in the early stages were more likely to continue using OA therapy long-term.

Myofunctional Therapy for the Treatment of Obstructive Sleep Apnea: Systematic Review and Meta-Analysis.

Introduction Given the severity with which obstructive sleep apnea (OSA) syndrome can affect the patient's health, many therapies have been presented to minimize the occurrence of episodes of airway obstruction during sleep. Regarding non-invasive and effective methods, orofacial myofunctional therapy (OMT) is an important adjuvant in the clinical treatment. Objective To verify the effectiveness of OMT in the treatment of adult patients affected by OSA. Data Synthesis A search strategy was developed with terms adapted to the requirements of the main databases in the health field (PubMed, Cochrane, Embase and secondary databases) to designate the adult OSA population and the OMT intervention. The analysis of the records found was performed by two independent examiners and, at the end, we included five randomized clinical trials that presented the outcome of effectiveness of the OMT verified through the apnea-hypopnea index (AHI). Conclusion The effectiveness of the OMT in the treatment of adult OSA patients was verified, both alone and in association with other interventions, through the reduction in the AHI and the Epworth Sleepiness Scale.

Bidirectional interplay of sleep apnea syndrome and cardio-vascular disorders in diabetes.

Although often overlooked sleep apnea has emerged as a significant public health concern. Obstructive sleep apnea (OSA) and diabetes commonly co-exist with a vicious cycle worsening the incidence and severity of both conditions. OSA has many implications including cardiometabolic disorders and impaired cardiovascular (CV) prognosis. OSA combined with diabetes generates a cumulative effect on CV outcomes. The association of OSA with several comorbidities including CV disease and heart failure is bi-directional meaning that some of them are likely to contribute to OSA. In patients with diabetes, OSA treatment should be integrated in a holistic strategy of prevention of CV and microvascular complications. This article provides some clues to advance the understanding of the interplay between OSA and CV disorders in diabetes and to consider the role of some CV risk markers like cardiac autonomic neuropathy and artery stiffness and of novel metrics for hypoxic-related events in CV risk stratification, and offers a discussion on the effects of medical approaches including weight loss strategies, GLP1-receptor agonists and sodium-glucose cotransporter 2 inhibitors. It provides a guidance to improve screening and diagnosis of OSA, and adherence to OSA treatment in patients with diabetes.

Obstructive sleep apnea treatment is associated with reduction in myocardial extracellular volume (ECV): A cardiovascular magnetic resonance (CMR) study

Obstructive sleep apnea treatment is associated with reduction in myocardial extracellular volume (ECV): A cardiovascular magnetic resonance (CMR) study

The Impact of Tonsillectomy on Sleep Apnea and Quality of Life in Children and Adults

Tonsillectomy, performed with or without adenoidectomy, involves the complete removal of the tonsils and has long been a cornerstone in the management of obstructive sleep apnea (OSA) and related sleep-disordered breathing conditions. Sleep apnea is classified into obstructive, central, or mixed types, with mixed apnea combining obstructive and central features, often linked to severe OSA. Sleep apnea is associated with various risk factors and leads to significant consequences, including cardiovascular morbidity, neurobehavioral deficits, increased healthcare utilization, and reduced quality of life. A primary contributing factor, particularly in pediatric OSA, is the proliferation of the adenoids and tonsils, resulting in upper airway obstruction during sleep. Adenotonsillectomy is an established first-line treatment for pediatric OSA, effectively improving apnea indices and quality of life, though residual central sleep apnea may persist in some cases. In adults, tonsillectomy reduces apnea severity; however, its effectiveness is influenced by factors such as body mass index. The impact of tonsillectomy on the quality of life of adults with sleep apnea remains underexplored. This review aims to assess the impact of tonsillectomy on various types of sleep apnea in both children and adults, while identifying gaps in current research and future directions. Further studies are needed to investigate the long-term outcomes of surgical interventions and the role of obesity in determining surgical success, to optimize diagnostic, therapeutic, and management strategies for sleep apnea across diverse populations.

Association Between Severities of Obstructive Sleep Apnea and COVID-19 Outcomes.

Introduction Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse resulting in episodes of apnea and hypopnea. Studies have shown worsenedcoronavirus disease 2019 (COVID-19) severity due to coexisting respiratory conditionsand suggest increased severity of COVID-19 in patients with or at high risk of OSA.However, the extent of this correlation is unclear. This retrospective study aimed to evaluate the association between OSA severity and COVID-19 severity and assess the impact of continuous positive airway pressure (CPAP) compliance. Methods This single-center retrospective study was conducted at King Abdulaziz University Hospital (KAUH), a tertiary care center in Jeddah, Saudi Arabia. Data were collected from 62 adult patients with OSA who were diagnosed via polysomnography (PSG) and had a positive documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)polymerase chain reaction (PCR) test result. COVID-19 severity was categorized into mild, moderate, and severe. Results There was no significant correlation between OSA severity as measured by the apnea-hypopnea index (AHI), low oxyhemoglobin desaturation (LSAT), arousal index (AI), respiratory disturbance index (RDI), or the type of treatment used, including adherence to CPAP, and the outcomes of COVID-19. However, higher arousal with respiratory index (ARI) and a lower percentage of time with SpO2 < 90% (T90) values were linked to moderate COVID-19 severity with significant p-values of 0.046 and 0.007, respectively. Conclusion There was no significant correlation between the severity or types of OSA treatment and the severity of COVID-19. Further research including multicenter studies with bigger populations and extensive sleep study data is warranted. Understanding the OSA-COVID-19 link may improve risk stratification and patient management.

Comparing standard treatment of moderate to severe obstructive sleep apnoea to add-on acetazolamide treatment: An open-label randomised controlled trial.

Obstructive sleep apnea (OSA) is a common condition, featured by repetitive upper airway collapse during sleep manifested with poor quality of life and co-morbidities. Although continuous positive airway pressure (CPAP) is the recommended therapy, lack of patient compliance and persistent symptoms often preclude its success. The present study evaluates the effect of acetazolamide in combination with CPAP, and compares this treatment strategy to single therapy using CPAP in moderate to severe OSA. A parallel-group, open-label randomized controlled trial consisted of 95 subjects diagnosed with moderate to severe OSA. Subjects were randomly allocated in a 1:1 ratio to CPAP plus acetazolamide (C+D) and CPAP alone (C). The baseline characteristics and the apnea-hypopnea index (AHI) metrics were comparable. Following four weeks of intervention, the outcomes measured involved changes in AHI (apnea hypopnoea index), sleep architecture, ODI (oxygen desaturation Index), and other sleep parameters. The combination of CPAP and acetazolamide significantly reduced total AHI (34.69 ± 18.91 events/hour) compared to CPAP alone (45.47 ± 19.09 events/hour, p = 0.0044). AHI also observed significant improvements during non-REM sleep (p = 0.0014). Although no significant difference was found in AHI during REM sleep between the groups (p = 0.6284), the C+D group demonstrated a notable decrease in severe OSA cases and an increase in mild and moderate OSA classifications. Compliance-adjusted AHI was significantly lower in the C+D group (5.67 ± 3.45) compared to the C group (7.67 ± 3.41, p = 0.0034). The C+D group exhibited improved sleep architecture with lower percentages of N1 and N3 sleep stages, and a trend towards increased REM sleep percentage (p = 0.0704). Significant reductions in WASO (p = 0.0404) and ODI (p = 0.0301) were also observed. Both groups reported minimal and comparable side effects, indicating the safety and tolerability of the combination therapy. The addition of acetazolamide to CPAP therapy improves efficacy in OSA treatment parameters among moderate-to-severe OSA, reduces total and NREM AHI as well as ODI without an increase in adverse effects. With added pharmacotherapy, the combination therapy represents a potential adjunctive treatment for managing OSA.

Surgical treatment of obstructive sleep apnea in children. Literature review

The article presents current view on surgical treatment of obstructive sleep apnea syndrome in children. Publications concerning efficacy of different surgeries on lymphoid ring such as adenoidectomy, tonsillotomy, tonsillectomy, adenotonsillectomy combined with pharyngoplasty, tuboplasty, were studied. The role of sleependoscopy in case of small adenoid and tonsils or residual symptoms of sleep apnea after the primary surgery is discussed. Variants of surgical treatment for persistent sleep apnea after adenotonsillectomy, including septoplasty and turbinoplasty, tongue base surgery, supraglottoplasty and mandibular advancement, are analysed. В статье представлен современный взгляд на хирургическое лечение синдрома обструктивного апноэ сна у детей. Изучены публикации, посвященные различным операциям на лимфаденоидном глоточном кольце, оценена эффективность аденотомии, тонзиллотомиии, тонзиллэктомии, рассмотрены варианты фарингопластики при аденотонзиллэктомии. Обсуждается роль слипэндоскопии при отсутствии гипертрофии небных миндалин и сохранении обструктивного апноэ после первичной операции. Проанализированы варианты хирургического лечения при gерсистирующем апноэ после аденотонзиллэктомии, в т.ч. операции на перегородке носа и носовых раковинах, корне языка, гортани, нижней челюсти.

Classification of obstructive sleep apnea using bio-control feedback EEG biosensor device

Obstructive sleep apnea (OSA) is a common sleeping disorder that can result in shortness of breath due to the relaxation of upper respiratory tract muscles while the patient is asleep. This leads to low blood oxygen saturation and, hence, apnea. OSA is associated with higher risks of hypertension, coronary artery disease, arrhythmias, cardiac failure, and stroke, affecting 5% of the global human population. Thus, early detection and treatment of OSA are crucial. Nowadays, OSA is diagnosed by analyzing EEG signals. Electroencephalographic (EEG) signals are important for monitoring brain activity; this paper focuses on patients with OSA. Unfavorable spikes in the graph, such as head movements, electrical interferences, or even muscle spasms, may interfere with the general EEG frequencies being targeted. Our research was centered on designing a cost-effective electronic circuitry for this device that would efficiently acquire and process EEG signals. We used various methods to improve the device's functionality and accuracy, including rectifications in noise reduction, signal filtering, and structural correction through ICA decomposition. ⁤⁤Our system, theoretically, achieved a high accuracy rate of 97.14% using Support Vector Machines.

Are noradrenergics combined with antimuscarinics the future pharmacologic treatment for obstructive sleep apnea? A systematic review and meta-analysis of randomized controlled trials.

Noradrenergics and antimuscarinics have been proposed as future pharmacotherapy for obstructive sleep apnea (OSA). However, the available randomized controlled trials (RCTs) showed heterogeneous results regarding the safety and efficacy of the combined regimen in OSA. Therefore, we performed this meta-analysis from the published RCTs to clarify this conflicting evidence. A systematic search of four electronic databases was done till December 2023. Thirteen RCTs (n = 345) were systematically reviewed and meta-analyzed. The combined regimen significantly reduced apnea-hypopnea index (AHI): AHI 3% [events/h; Mean difference (MD): - 6.30; 95% Confidence interval (CI) (- 9.74, - 2.87); P = 0.0003], AHI 4% [events/h; MD: - 6.50; 95% CI (- 8.74, - 4.26 events/h); P < 0.00001]. All gasometric measures significantly improved in the combined regimen group except mean SpO2. No difference was found in total sleep time between the treatment and placebo. However, compared to placebo, the combined regimen altered sleep architecture and decreased sleep efficiency. Regarding OSA endotypes, the combined regimen significantly improved loop gain, pharyngeal muscle compensation, pharyngeal muscle recruitment, and respiratory arousal threshold. The combined regimen effectively reduces AHI and OSA severity with improvement in almost all OSA endotypes. However, this regimen decreased sleep efficiency and altered sleep architecture. Short-term side effects can be confined to increased heart rate, dry mouth and urinary hesitancy. Therefore, noradrenergics and anti-muscarinics is a promising regimen for treating OSA, yet this optimism must be titrated by the lack of long-term effects of the regimen. Future RCTs with focus on the long-term efficacy of the regimen and cardiovascular outcomes is recommended.

Clinical study of two mandibular advancement devices in the treatment of Obstructive Sleep Apnea: a pilot randomized controlled trial

ObjectiveA preliminary clinical evaluation of the efficacy, comfort, and adverse reactions of two mandibular advancement devices (MADs) in the treatment of Obstructive Sleep Apnea (OSA).MethodsForty patients with mild-to-severe OSA were recruited and randomly divided into two groups. They were treated with Shark-fin or Silensor MAD, respectively. Treatment efficacy was evaluated by home sleep apnea tests, the snoring scale, Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). A comfort scale questionnaire was applied. Cone beam computed tomography (CBCT), cephalometric radiography, and intraoral scanning were made before and after 3-month treatment to detect temporomandibular joints (TMJ), dental and skeletal changes. All data were assessed as normal distributed and analyzed by t test. The significance level was defined as α = 0.05.ResultsThe effective rate, defined as a decrease in Respiratory Event Index (REI) to less than 5 events per hour or a decrease of more than 50%, was 70% in the Shark-fin MAD group and 50% in the Silensor MAD group. REI, lowest oxygen saturation and maximum apnea and hypoventilation time were significantly improved in Shark-fin MAD group (P < 0.01), and the proportion of non-rapid eye movement (REM) sleep stage 3 was higher than before use (P < 0.05), while only REI and lowest oxygen saturation were significantly improved in Silensor MAD group (P < 0.05). The loudness of snoring was significantly decreased after one day using Shark-fin MAD (P < 0.05), and further decreased after one month (P < 0.01). Conversely, Silensor MAD exhibited inferior efficacy in mitigating snoring compared to Shark-fin MAD. Upon wearing the Shark-fin MAD, ESS were significantly improved after one month and three months (P < 0.05), and PSQI improved after three months (P < 0.05). Additionally, the Shark-fin MAD group had a significantly better comfort score compared to the Silensor MAD group (P < 0.05). There was no significant difference in TMJ, dental and skeletal structures in the two groups before and after treatment (P > 0.05).ConclusionBoth two MADs were effective in reducing REI and increasing lowest oxygen saturation on OSA patients, and Shark-fin MAD has better improvement effect and faster onset of action. In addition, Shark-fin MAD was superior to Silensor MAD in improving snoring loudness, daytime sleepiness, sleep quality and wearing comfort. There were no significant dental or skeletal changes, and no alterations in occlusion or temporomandibular joint function in the short term.Trial registrationClinical Trials.gov Registration ID ChiCTR2400086628. Registered 08/07/ 2024-Retrospectively registered, https://register.clinicaltrials.gov.

Alterations in Gut Microbiota Composition Are Associated with Changes in Emotional Distress in Children with Obstructive Sleep Apnea.

Emerging evidence underscores the pivotal role of the gut microbiota in regulating emotional and behavioral responses via the microbiota-gut-brain axis. This study explores associations between pediatric obstructive sleep apnea (OSA), emotional distress (ED), and gut microbiome alterations before and after OSA treatment. Sixty-six children diagnosed with OSA via polysomnography participated, undergoing adenotonsillectomy alongside routine educational sessions. ED was assessed using the OSA-18 questionnaire, categorizing participants into high ED (scores ≥ 11, 52%) and low ED (scores < 11, 48%) groups. Gut microbiome analysis revealed significant diversity differences, with high ED linked to a reduced Shannon index (p = 0.03) and increased beta diversity (p = 0.01). Three months post-treatment, significant improvements were observed in OSA symptoms, ED scores, and gut microbiome alpha diversity metrics among 55 participants (all p < 0.04). Moreover, changes in the relative abundances of Veillonella, Bifidobacterium, Flavonifractor, and Agathobacter, as well as ultra-low frequency power and low frequency power of sleep heart rate variability, were independently associated with ED score alterations. These findings underscore the gut microbiome's critical role in the emotional and behavioral symptoms associated with pediatric OSA, suggesting that microbiome-targeted interventions could complement traditional treatments for ED reduction and emphasizing the need for further research.

Demographic profile of surgical approaches to obstructive sleep apnea in the United States from 2004 to 2020: a descriptive study

ObjectivesThis study aims to evaluate the quantity, types, and trends of surgical procedures used to treat obstructive sleep apnea (OSA) within a diverse national population, utilizing a comprehensive proprietary healthcare database.MethodsThis descriptive observational study analyzed longitudinal data from the Optum Clinformatics® Data Mart databases, covering the period from January 2004 to December 2020. The study included patients aged 18 to 89 years, both male and female, with a confirmed diagnosis of OSA. These patients were either treated with continuous positive airway pressure (CPAP) or underwent surgical interventions.ResultsThroughout the study period, 1,250,273 individuals were diagnosed with OSA. The average age at diagnosis was 62 years (SD = 16), with a male predominance of 62.3%, and 75% of the patients were identified as Caucasian. The most frequently performed surgical procedure for OSA was Uvulopalatopharyngoplasty (UPPP). However, the implantable hypoglossal nerve stimulator was more commonly utilized among older patients.ConclusionsThis study provides essential insights into the prevalence and characteristics of surgical procedures used in OSA treatment across a diverse national population. The findings underscore the significance of understanding surgical intervention patterns and trends to enhance patient care and outcomes.

Hypnotics on Obstructive Sleep Apnea Severity and Endotypes: A Systematic Review and Meta-Analysis.

Rationale: Low arousal threshold and poor muscle responsiveness are common determinants of obstructive sleep apnea (OSA). Hypnotics were hypothesized as an alternative OSA treatment via raising the arousal threshold and possibly genioglossus responsiveness. Objectives: To examine the effect of common hypnotics on arousal threshold, OSA severity, and genioglossus responsiveness. Methods: We searched MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov for randomized clinical trials, and we ran meta-analyses to determine the effect of oral hypnotics on arousal threshold, OSA severity, and genioglossus responsiveness. The Grades of Recommendation Assessment, Development and Evaluation was used to rate the quality of evidence (QoE). The association between post-treatment apnea-hypopnea index (AHI) and arousal threshold percentage reductions was explored in individual patient data meta-analyses (overall sample and low arousal threshold subgroups). Measurements and Main Results: On the basis of our analysis (27 studies; 25 for AHI, 11 for arousal threshold, 4 for genioglossus responsiveness), hypnotics minimally raised arousal threshold (mean difference [95% confidence interval], 2.7 [1.5, 3.8] cm H2O epiglottic pressure swings; moderate QoE) but did not change OSA severity (-1.4 [-3.5, 0.7] events/h; moderate QoE). Individual patient data meta-analysis (N = 114) showed no association between changes in arousal threshold and AHI, independent of arousal threshold subgrouping. However, people with very low arousal threshold or those who exhibited a 0-25% arousal threshold increase from placebo experienced the greatest, yet still modest, post-treatment AHI reductions (∼10%). Hypnotics did not affect genioglossus responsiveness (high QoE). Conclusions: Further research testing or clinical use of hypnotics as OSA alternative treatments should be discouraged, unless in the presence of comorbid insomnia or as part of combination therapy in individuals with very low arousal threshold.

Examining the impact of obstructive sleep apnea on cognitive function in severe COPD

PurposeThis study aimed to examine the association between obstructive sleep apnea (OSA) and cognitive function in patients with severe chronic obstructive pulmonary disease (COPD).MethodsPatients with severe COPD, who had not previously been diagnosed with OSA, were recruited between January 2021 and January 2023. To evaluate cognitive function, the Montreal Cognitive Assessment (MoCA), a continuous reaction time test (CRT) and a driving simulator were used. OSA was identified using a CardioRespiratory Monitor (CRM). Cognitive tests were repeated for patients who were identified with and received treatment for OSA, to determine whether treatment improved cognitive function.ResultsIn total, 80 patients participated in the study and 50 patients (63%) were diagnosed with OSA, with or without nocturnal desaturation (ND), and six patients (8%) with ND only. Thirty-two patients (40%) had mild OSA and 18 (23%) had moderate/severe OSA. We found no statistically significant difference in the prevalence of cognitive impairment (CI) between patients with and without OSA and/or ND. However, a multiple regression analysis showed that patients with moderate/severe OSA had a significant lower CRT-index, indicating a decrease in attention and reaction time, compared to patients with mild OSA.ConclusionIn patients with COPD and OSA, the degree of CI may depend on the severity of OSA. The 23% prevalence of moderate/severe OSA emphasizes the importance of OSA screening in severe COPD.The study was registered at www.clinicaltrials.gov in March 2020, with the identification number NCT04458038.

Chinese herbal medicine for obstructive sleep apnoea: a systematic review with meta-analysis.

Chinese Herbal Medicine (CHM) may have a place in the treatment of obstructive sleep apnoea (OSA), but the evidence has not been systematically assessed. The objective of this study is to evaluate the evidence for the effectiveness of CHM for OSA. CENTRAL, EMBase, PubMed, CINAHL, CNKI, Wanfang and Chongqing VIP were searched from database inception to the 13th of August 2023. Randomised-controlled trials in which the effect of CHM on sleep variables was tested in the treatment of OSA were selected. The primary outcomes of this review and meta-analysis were the apnoea hypopnoea index (AHI) measured with polysomnography. A total of 58 studies, involving 4,590 participants, were included. The meta-analysis showed that CHM reduced AHI more significantly than placebo (mean difference = -7.10 events/hour, 95% CI = -11.95, -2.25, P < 0.01, 7 studies, 583 participants) and the combination of CHM and Continuous Positive Airway Pressure (CPAP) more effective than CPAP alone (mean difference = -4.71 events/hour, 95% CI = -5.62, -3.80, P < 0.001, 28 studies, 2,267 participants). CHM improved sleepiness, quality of life, body weight, oxidative biomarkers, inflammatory biomarkers, cognitive function, blood pressure and respiratory function. Our results suggest that CHM, alone and as an adjunct treatment, can improve various aspects of OSA and its comorbidities and is therefore a viable therapeutic option for OSA.

Optimal treatment of obstructive sleep apnea guided by physiological characteristics

Obstructive sleep apnea (OSA) is a common and heterogeneous disorder. Most patients can be successfully treated, but some have poor treatment outcomes. This review first presented four physiological OSA characteristics, including upper airway collapsibility, loop gain, airway muscle responsiveness, and arousal threshold, which are associated with the efficacy of OSA therapy. Then, we presented how to select the most effective therapy modality for each individual based on OSA characteristics, with the purpose of providing a basis for individualized treatment of OSA.

Images: Combined positive air way pressure and atomoxetine-oxybutynin for the treatment of severe obstructive sleep apnea.

Obstructive sleep apnea (OSA) is one of the most common sleep disorders. Positive airway pressure therapy (PAP) is considered the gold standard for treating OSA. Yet, optimal therapy might not be achieved in some cases of severe OSA, despite using maximum settings. In this case report, we describe the successful combination of PAP therapy and atomoxetine-oxybutynin in reducing the apnea-hypopnea index from the severe range to the mild to moderate range. This was also associated with significant improvement in several symptoms including excessive daytime sleepiness and drowsiness while driving.