Treatment Of Obstructive Sleep Apnea Hypopnea Research Articles

Positive Airway Pressure Treatment of Obstructive Sleep Apnea-Hypopnea in Hypertensive Disorders of Pregnancy: A Pilot Randomized Proof-of-Concept Clinical Trial.

Rationale: Maternal obstructive sleep apnea-hypopnea (OSAH) is associated with hypertensive disorders of pregnancy (HDP). OSAH treatment with positive airway pressure (PAP) in the general population lowers blood pressure (BP). However, there are limited data on the effects of PAP therapy in maternal OSAH. Objectives: Our primary objective was to assess the feasibility of recruitment to a pilot randomized trial and adherence to PAP therapy for OSAH in women with HDP. Secondary objectives included assessment of PAP effects on 24-h BP, arterial stiffness, and maternal and fetal outcomes. Methods: Women with singleton pregnancies at ⩾12 weeks' gestation and hypertension underwent home level 2 polysomnography; those with mild to moderate OSAH (apnea-hypopnea index ⩾ 5 events/h; women with severe OSAH with apnea-hypopnea index > 30 events/h and oxygen desaturation index > 30 were excluded) were randomized to either PAP or nasal dilator strip (NDS; control) therapy. After PAP education, adherence was monitored online with episodic phone or in-person support by research personnel. Twenty-four-hour BP and arterial stiffness were assessed at baseline and before delivery. Maternal and fetal outcomes were also recorded. Results: Of 105 potentially eligible participants, 67 agreed to undergo screening for OSAH over 38 months; 48 women meeting OSAH inclusion criteria were randomized to PAP (n = 27) or NDS (n = 21) therapy. Of these, 14 PAP (52%) and 13 NDS (62%) participants completed all predelivery measurements, with lack of completion due to urgent delivery (19% in the PAP group, 14% in the NDS group), PAP intolerance at initiation (19%), or other factors. Mean PAP use was 3.1 ± 2.5 h/night, with use ⩾4 h/night on 38.4 ± 33.7% of nights during 9.6 ± 4.0 weeks of treatment. BP was controlled within the target range in most participants. There were no differences in mean change in 24-hour BP or arterial stiffness measurements or in adverse maternal and fetal outcomes between the PAP and NDS groups in either intention-to-treat or per-protocol analyses. Conclusions: PAP adherence was suboptimal in this HDP cohort despite education and troubleshooting. Further work is required to identify optimal OSAH treatment strategies during pregnancy. Clinical trial registered with www.clinicaltrials.gov (NCT03309826).

Effect of continuous positive airway pressure treatment of obstructive sleep apnea-hypopnea in multiple sclerosis: A randomized, double-blind, placebo-controlled trial (SAMS-PAP study)

Objective: The aim of this study was to evaluate the effect of continuous positive airway pressure (CPAP) treatment on the Fatigue Severity Scale (FSS, preplanned primary outcome), another fatigue measure, sleep quality, somnolence, pain, disability, and quality of life in multiple sclerosis (MS) patients with obstructive sleep apnea-hypopnea (OSAH). Methods: In a randomized, double-blind trial (NCT01746342), MS patients with fatigue, poor subjective sleep quality, and OSAH (apnea-hypopnea index of ⩾ 15 events per hour/sleep), but without severe OSAH (apnea-hypopnea index > 30, and 4% oxygen desaturation index > 15 events/hour or severe somnolence), were randomized to fixed CPAP or sham CPAP for 6 months. Outcome assessments were performed at 3 and 6 months. Results: Of 49 randomized patients, 34 completed the protocol. Among completers, FSS did not improve with CPAP compared to sham at 6 months. FSS tended to improve (p = 0.09), and sleepiness (Epworth Sleepiness Scale) improved significantly (p = 0.03) at 3 months with CPAP compared to sham, but there were no other improvements with CPAP at either study evaluation. Conclusion: In non-severe OSAH patients, CPAP did not significantly improve the primary outcome of FSS change at 6 months. In secondary analyses, we found a trend to improved FSS, and a significant reduction in somnolence with CPAP at 3 months.

Factors Influencing Adherence to Auto-CPAP: An Observational Monocentric Study Comparing Patients With and Without Cardiovascular Diseases.

Introduction: Obstructive sleep apnea/hypopnea (OSAH) affects more than 15% of the general population and increases the occurrence of cardiovascular (CV) and metabolic events. Continuous positive airway pressure (CPAP) treatment is currently the gold standard treatment of OSAH and could prevent the occurrence of such events. However, long-term adherence to CPAP is a problem where a significant rate stop device treatment use. OSAH patients suffering CV disease could be less compliant due to less diurnal symptoms.Methods: We performed a prospective study of 408 non-CV or CV disease patients suffering severe OSAH syndrome and followed them during the first 5 months as well as a mean of 3 years of CPAP treatment use.Results: We demonstrated that in adult OSAH patients that two variables were associated with a low compliance (<5 h/night): age <60 y and lower maximal positive airway pressure level used. There was no significant impact of the presence of CV disease on compliance of 5 months. After 3 years of CPAP, age <60 y as well as diabetes were independent factors of low compliance. There was no significant association between gender, mask types, 90th centile positive airway pressure level, apnea/hypopnea index and short- or long-term compliance in our population.Conclusions: We did not find lower compliance of CPAP in CV OSAH patients. Most of our population (68–73%) demonstrated an optimal night treatment duration at 3 years of follow-up, allowing a reduction of CV occurrence or recurrence. We hypothesize that an early and short education of OSAH as we routinely proposed could allow a significant increase in the optimal observance of CPAP in at-risk populations.

Obstructive sleep apnoea-hypopnoea and arrhythmias: new updates.

Obstructive sleep apnoea-hypopnoea (OSAH) is a prevalent condition characterized by repetitive pharyngeal collapse during sleep, leading to hypoxemia, hypercapnia, and persistent inspiratory efforts against an occluded airway until arousal. Several studies demonstrated that OSAH exerts acute and chronic effects on the cardiovascular system. Thus, although being a respiratory problem, the most important consequences of OSAH are cardiovascular, among which there are arrhythmias. The purpose of this review is to systematically analyse what has been recently published about the relationship between OSAH and every cardiac arrhythmia separately. We searched Pubmed, Scopus, Web of Science and Cochrane Collaboration databases for 'OSAHS arrhythmias', 'OSAH arrhythmias' and 'OSA arrhythmias'. We analyse 1298 articles and meta-analyses, excluding already edited reviews. Arrhythmias, especially of ventricular origin, are frequent in OSAH. Ventricular premature beats, couplets and ventricular tachycardia runs are even more frequent in patients suffering from heart failure. They may be due to left heart remodelling, overwork and ischaemia and can explain at least some sudden deaths occurring between midnight and 6 a.m. Sinus pauses and atrioventricular blocks are increased according to the severity of the disturbance and may be reduced by continuous positive airway pressure therapy, preventing pace-maker implantation. Finally, atrial fibrillation, resistance against antiarrhythmic drugs and recurrences after surgical procedures are strongly related to OSAH. Arrhythmias are frequent in OSAH. Treatment of OSAH may reduce some of them. An implantable cardioverter-defibrillator and continuous positive airway pressure should be considered in some patients.

Obstructive Sleep Apnea-Hypopnea and Cardiovascular Diseases in Adults

Cardiovascular diseases (CVD) are the main cause of death worldwide representing 30% of all global deaths. Obstructive sleep apnea hypopnea (OSAH) has been associated with several serious cardiovascular comorbidities. OSAH occurs in 17% to 24% of North American American adults that increase the risk of sudden cardiac deaths between 12 midnight and 6 a.m. OSAH is considered as an independent risk factor for CVD such as systemic hypertension, pulmonary arterial hypertension, coronary artery disease, stroke, cardiac arrhythmias, heart failure, which raise both cardiovascular morbidity and mortality and the increase demand for healthcare resources. Several mechanisms have been suggested to link OSAH and vascular diseases including increases in sympathetic activation, oxidative stress, inflammation, endothelial dysfunction, coagulation, and metabolic dysregulation. This review will provide insights on mechanisms by which OSAH might contribute to pathogenesis of cardiovascular disease. Continuous positive airway pressure (CPAP) is considered the gold standard in the treatment of OSAH with improved metabolic and CV endpoints. To a lesser extent oral appliance therapy and upper airway or mandibular advancement surgery are palliative measures that leave the patient with significant residual apnea hypopnea. There is increasing evidence that adequate CPAP therapy leads to a significant reduction in cardiovascular morbidity. Moderate to severe OSAH not treated with CPAP was an independent risk factor for relapse of a CVD event, and adequate CPAP treatment improved cardiovascular outcomes in elderly patients.

Analysis of the dynamic changes in the soft palate and uvula in obstructive sleep apnea-hypopnea using ultrafast magnetic resonance imaging

Apnea and the respiratory cycle are dynamic processes in obstructive sleep apnea-hypopnea (OSAH), which occur only during sleep. Our study aimed to observe the dynamic changes in the soft palate and the uvula during wakefulness and sleep using ultrafast magnetic resonance imaging (UMRI) to provide reference data for the pathogenesis and treatment of OSAH. The dynamic changes in the soft palate and uvular tip of 15 male patients (average age: 50.43 ± 9.82 years) with OSAH were evaluated using UMRI of the upper airway while asleep and awake after 1 night of sleep deprivation. A series of midline sagittal images of the upper airway were obtained. The distance from the center of the soft palate to the x-axis (an extended line from the anterior nasal spine to the posterior nasal spine), from the uvular tip to the x-axis, from the center of the soft palate to the y-axis (a perpendicular line from the center of the pituitary to the x-axis), and from the uvular tip to the y-axis (designated as PX, UX, PY, and UY, respectively) were measured during sleep and wakefulness. The minimum PX, PY, UX, and UY were shorter during sleep than during wakefulness, whereas the maxima were longer during sleep (P < 0.01), the differences between the maximum and minimum PX, PY, UX, and UY were larger during sleep (P < 0.01). The upward, downward, forward, and backward ranges of movement of the soft palate and the uvular tip were larger during sleep in OSAH patients. This increased compliance may trigger each airway obstructive event.

Awareness of, Opinions About, and Adherence to Evidence-Based Guidelines in Otorhinolaryngology

Guidelines may assist physicians and patients in decisions about effective and safe care. Little is known about the awareness of, opinions about, and adherence to evidence-based guidelines in otolaryngology. We performed a survey among 440 otorhinolaryngologists of the Dutch Society of Otolaryngology-Head and Neck Surgery. The questionnaire consisted of questions about the characteristics of the respondents, their knowledge and opinions of available evidence-based guidelines, and their adherence to them. Furthermore, 2 clinical scenarios were included to test their knowledge regarding the guideline for diagnosis and treatment of obstructive sleep apnea-hypopnea syndrome. The daily practice of most otorhinolaryngologists (70%) was influenced by evidence based guidelines: 62% stated that evidence-based guidelines supported their clinical practice; 32% stated that guidelines directed their clinical practice. The mean confidence in the evidence of recommendations stated in the guidelines was 77%. The mean percentage of nonadherence to guideline recommendations was 45%. The guideline adherence was higher in younger otorhinolaryngologists. Sex, type of hospital, and PhD grade did not affect the preferences of the responders. In general, surveyed otorhinolaryngologists treated patients in accordance with the guidelines. However, when disease characteristics were less distinct, on the one hand, the guidelines included a wider range of treatment options, and on the other hand, variation in chosen treatment by otorhinolaryngologists increased. Dutch otorhinolaryngologists are well aware of the available evidence-based guidelines, and many use these to support their clinical practice. The treatment by Dutch otorhinolaryngologists is in accordance with the Dutch guidelines. When guidelines, however, do not provide strict recommendations and allow flexibility in treatment, larger variations in chosen treatment occur. This may reflect that otorhinolaryngologists still may encounter difficulties when applying the current guidelines to an individual patient.

Treatment of obstructive sleep apnea-hypopnea with refractory epilepsy in children

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与癫痫都是儿科常见病，根据不同的文献报道，OSAHS在普通儿童中患病率约为2%～4%，而在癫痫患者中患病率高达5%-63%，在难治性癫痫患者中患病率更高。OSAHS与癫痫在发病机制、临床表现及治疗效果等方面存在复杂的联系，但具体机制尚不明确，相关文献报道甚少。广州市儿童医院耳鼻咽喉科2002年11月至2007年11月共收治3例OSAHS伴难治性癫痫患儿，以下介绍其临床资料，以探讨此类患儿的治疗方案。

Cost-effectiveness of oral appliances in the treatment of obstructive sleep apnoea–hypopnoea

Oral appliances (OA) are commonly prescribed for the treatment of obstructive sleep apnoea-hypopnoea (OSAH), but there is limited evidence on their cost-effectiveness. A model was designed to simulate the costs and benefits of treatment of OSAH with OA or continuous positive airway pressure (CPAP) based on their effects on quality of life, motor vehicle crashes, and cardiovascular effects. The primary outcome was the incremental cost-effectiveness ratio (ICER) in terms of costs per one quality-adjusted life year (QALY) gained 5 years after treatment. Compared with no treatment, OA results in $268 higher costs and an incremental QALY of 0.0899 per patient (ICER = $2,984/QALY). Compared with OA, CPAP resulted in $1,917 more costs and 0.0696 additional QALYs (ICER = $27,540/QALY). For the most part in the sensitivity analyses, CPAP remained cost-effective compared to OA, and OA remained cost-effective with respect to no treatment in almost all scenarios. OAs are less economically attractive than CPAP but remain a cost-effective treatment for patients who are unwilling or unable to adhere to CPAP therapy.

Oral appliances for obstructive sleep apnoea

Obstructive sleep apnoea-hypopnoea (OSAH) is a syndrome characterised by recurrent episodes of partial or complete upper airway obstruction during sleep that are usually terminated by an arousal. Nasal continuous positive airway pressure (CPAP) is the primary treatment for OSAH , but many patients are unable or unwilling to comply with this treatment. Oral appliances (OA) are an alternative treatment for OSAH. The objective was to review the effects of OA in the treatment of OSAH in adults. We searched the Cochrane Airways Group Specialised Register. Searches were current as of June 2005. Reference lists of articles were also searched. Randomised trials comparing OA with control or other treatments in adults with OSAH . Two authors independently extracted data and assessed trial quality. Study authors were contacted for missing information. Sixteen studies (745 participants) met the inclusion criteria. All the studies had some shortcomings, such as small sample size, under-reporting of methods and data, and lack of blinding. OA versus control appliances (six studies): OA reduced daytime sleepiness in two crossover trials (WMD -1.81;95%CI -2.72 to -0.90), and improved apnoea-hypopnoea index (AHI) (-10.78; 95% CI-15.53 to -6.03 parallel group data - five studies). OA versus CPAP (nine studies): OA were less effective than CPAP in reducing apnoea-hypopnoea index (parallel group studies: WMD 13 (95% CI 7.63 to 18.36), two trials; crossover studies: WMD 7.97; (95% CI 6.38 to 9.56, seven trials). However, no significant difference was observed on symptom scores. CPAP was more effective at improving minimum arterial oxygen saturation during sleep compared with OA. In two small crossover studies, participants preferred OA therapy to CPAP. OA versus corrective upper airway surgery (one study): Symptoms of daytime sleepiness were initially lower with surgery, but this difference disappeared at 12 months. AHI did not differ significantly initially, but did so after 12 months in favour of OA. There is increasing evidence suggesting that OA improves subjective sleepiness and sleep disordered breathing compared with a control. CPAP appears to be more effective in improving sleep disordered breathing than OA. The difference in symptomatic response between these two treatments is not significant, although it is not possible to exclude an effect in favour of either therapy. Until there is more definitive evidence on the effectiveness of OA in relation to CPAP, with regard to symptoms and long-term complications, it would appear to be appropriate to recommend OA therapy to patients with mild symptomatic OSAH, and those patients who are unwilling or unable to tolerate CPAP therapy. Future research should recruit patients with more severe symptoms of sleepiness, to establish whether the response to therapy differs between subgroups in terms of quality of life, symptoms and persistence with usage. Long-term data on cardiovascular health are required.

Efficacy and co-morbidity of oral appliances in the treatment of obstructive sleep apnea-hypopnea: a systematic review.

The Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a common sleep-related breathing disorder characterized by repetitive obstructions of the upper airway during sleep. Modification of pharyngeal patency by Oral Appliance (OA) therapy has been suggested as an alternative to various treatment modalities for OSAHS. To determine the evidence base with respect to the efficacy and co-morbidity of OA therapy in OSAHS, we conducted a systematic review of the available literature. Primary outcome measures were the reduction in number of upper-airway obstructions and co-morbidity related to the craniomandibular or craniofacial complex, respectively. Eligible studies regarding efficacy were independently assessed by two assessors using a quality assessment scale. Effect sizes of methodologically sound studies were calculated. In identical interventions, effect sizes were pooled with the use of a random-effects model. Given the scarcity of controlled studies related to co-morbidity, appraisal was confined to a description of eligible studies. Sixteen controlled trials related to efficacy were identified. With respect to the primary outcome measure, OA therapy was clearly more effective than control therapy (pooled effect size, -0.96; 95% confidence interval [CI], -1.49 to -0.42) and possibly more effective than uvulopalatopharyngoplasty. Although patients generally preferred OA therapy, improvement of respiratory variables, such as the number of upper-airway obstructions, was usually better in Continuous Positive Airway Pressure (CPAP) therapy (pooled effect size, 0.83; 95% CI, 0.59 to 1.06). Moreover, specific aspects related to OA design may influence patient-perceived efficacy and preference. Twelve patient-series and one controlled trial related to co-morbidity were identified. Analysis of the data suggests that OA therapy may have adverse effects on the craniomandibular and craniofacial complex. Although CPAP is apparently more effective and adverse effects of OA treatment have been described, it can be concluded that OA therapy is a viable treatment for, especially, mild to moderate OSAHS. Controlled studies addressing the specific indication and co-morbidity of OA therapy are warranted.

A randomized trial of auto-titrating CPAP and fixed CPAP in the treatment of obstructive sleep Apnea–Hypopnea

Background: Continuous positive airway pressure (CPAP) remains the treatment of choice for obstructive sleep apnea–hypopnea (OSAH). Auto-titrating CPAP (APAP) devices automatically adjust pressure and may improve treatment compliance compared to fixed CPAP (F-CPAP). Methods: Randomized, prospective, single-blind, crossover trial to compare efficacy, side effects, compliance, patient satisfaction and preference between APAP and F-CPAP therapy in patients with moderate to severe OSAH. There were two treatment periods of 4 weeks each (APAP and F-CPAP), separated by a 2-week washout period. Results: Ten CPAP-naı̈ve OSAH patients (9 males) completed the study. They had Mean ± sd age of 44.9±9.7 years; body mass index of 35.9±12.9 kg/m 2 and apnea/hypopnea index (AHI) of 47.2±35.6. Both forms of therapy were equally effective in improving the symptoms and in reducing the AHI. Both forms of therapy were associated with frequent side effects and had similar patient compliance. At the end of the study, more patients (6–1) preferred F-CPAP to A-CPAP therapy. Conclusion: A-PAP was as effective as F-CPAP in the treatment of OSAH but was not associated with fewer side effects, better compliance, better satisfaction or increased patient preference.