Treatment Of Sleep Apnea Syndrome Research Articles

Multiscale Bidirectional Temporal Convolutional Network for Sleep Apnea Detection Based on Wearable Photoplethysmography Bracelet.

Sleep apnea syndrome (SAS), which can lead to a range of Cardiopulmonary diseases, is a common chronic sleep disorder. The unobtrusive detection based on wearable devices is helpful for early diagnosis and treatment of SAS. To this end, this paper presents a method based on a one-dimensional multi-scale bidirectional temporal convolutional neural network (1D-MsBiTCNet) and two model performance optimization techniques, i.e., regularized dropout (RD) and logit adjustment (LA). Among them, 1D-MsBiTCNet has outstanding capabilities in both feature extraction and temporal dependence representation. RD and LA play an effective role in solving the overfitting problem of model training and the class imbalance problem of the dataset, respectively. The proposed model was trained and tested on a photoplethysmography (PPG) dataset (including data from 92 subjects) collected from commercial wearable bracelets. On this dataset, our method achieved accuracy, sensitivity and specificity of 82.76%, 71.58%, 86.74% for per-segment detection, and 97.83%, 88.89%, 100.00% for per-recording severe SAS detection. For the precise quantification of apnea-hypopnea index (AHI), our method achieved a mean absolute error of 5.44 between the predicted AHI and the ground truth AHI. The experimental results show that our proposed method has an outstanding performance and can provide a methodological reference for large-scale SAS automatic detection.

Efficiency of CPAP Therapy in the Treatment of Sleep Apnea Syndrome in Patients with Grade III-IV Obesity

Abstract: Obstructive sleep apnea syndrome (OSAS) and obesity are multifactorial and mutually aggravating diseases. Weight loss appears to be quite effective in controlling sleep disturbances, but the effect of OSAS treatment on body weight dynamics in obese patients remains poorly understood. A feature of the presented clinical case is a clinically significant decrease in body weight in a patient with morbid obesity complicated by severe obstructive sleep apnea syndrome using a standard approach to obesity therapy. Weight loss in this case was achieved due to the patient's high adherence to therapy and the absence of concomitant mental disorders. The high cost of CPAP therapy devices, their constant use during night sleep and the need for titration of therapeutic pressure make this therapy inaccessible. In this connection, in the complex treatment of obesity in patients with breathing disorders during sleep, in the absence of the possibility of CPAP therapy, individual therapeutic training should be provided to increase their medical motivation and compliance, more frequent visits to the endocrinologist, as well as correction of concomitant psychopathological disorders to achieve effective and long-term therapeutic success. Key words: obesity, obstructive sleep apnea syndrome, CPAP therapy, compliance.

Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020.

The prevalence of sleep disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the "Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults" was published in 2005, a new guideline was prepared in order to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the "Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension" Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Because sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.

Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020

The prevalence of sleep-disordered breathing (SDB) is reportedly very high. Among SDBs, the incidence of obstructive sleep apnea (OSA) is higher than previously believed, with patients having moderate-to-severe OSA accounting for approximately 20% of adult males and 10% of postmenopausal women not only in Western countries but also in Eastern countries, including Japan. Since 1998, when health insurance coverage became available, the number of patients using continuous positive airway pressure (CPAP) therapy for sleep apnea has increased sharply, with the number of patients about to exceed 500,000 in Japan. Although the “Guidelines for Diagnosis and Treatment of Sleep Apnea Syndrome (SAS) in Adults” was published in 2005, a new guideline was prepared to indicate the standard medical care based on the latest trends, as supervised by and in cooperation with the Japanese Respiratory Society and the “Survey and Research on Refractory Respiratory Diseases and Pulmonary Hypertension” Group, of Ministry of Health, Labor and Welfare and other related academic societies, including the Japanese Society of Sleep Research, in addition to referring to the previous guidelines. Since sleep apnea is an interdisciplinary field covering many areas, this guideline was prepared including 36 clinical questions (CQs). In the English version, therapies and managements for SAS, which were written from CQ16 to 36, were shown. The Japanese version was published in July 2020 and permitted as well as published as one of the Medical Information Network Distribution Service (Minds) clinical practice guidelines in Japan in July 2021.

Changes in Attitudes of Life Insurance Companies Towards Patients with Sleep Apnea Syndrome Undergoing Continuous Positive Airway Pressure in Japan.

Recent studies have revealed that sleep apnea syndrome (SAS) increases the risk of cardiovascular diseases and their risk factors, as well as the risk of traffic accidents. Although SAS screening and early treatment are important, truck drivers may avoid SAS screening to prevent the denial of their application for life insurance due to receiving continuous positive airway pressure (CPAP) treatment. Thus, this study investigated how life insurance companies handle patients on SAS treatment. We conducted a questionnaire survey on how they handle life insurance applications of patients with SAS on CPAP treatment for 46, 41, and 42 companies in 2009, 2015, and 2021, respectively, and analyzed the changes in their handling of life insurance applications of patients with SAS. The results revealed that while about 10 life insurance companies handle the application of life insurance of patients on CPAP treatment in the same way as healthy individuals, many life insurance companies handle them differently. This survey also revealed the differences in handling patients with SAS on CPAP treatment among companies and their policies regarding the reasons. The survey revealed that there are differences among life insurance companies in handling patients with SAS on CPAP treatment. It is important to provide information about the companies that would not give disadvantages to patients with SAS on CPAP treatment who purchase life insurance. It is also crucial to provide life insurance companies with evidence of reduced risk of traffic accidents in patients with SAS on CPAP treatment.

DOUBLE PRODUCT CAN BE REDUCED BY CPAP IN SLEEP APNEA SYNDROME PATIENTS

Objective: Sleep apnea syndrome (SAS) is associated with increased cardiovascular mortality mediated by intermittent hypoxia, oxidative stress, endothelial dysfunction, and sympathetic nerve activation. Continuous positive airway pressure (CPAP) therapy has been established as the treatment of SAS. Double product (W-P = systolic blood pressure x heart rate) was reported to be a good predictor for cardiovascular disease. This study was designed to test whether CPAP could reduce W-P in SAS patients. Design and method: Patients diagnosed as SAS by polisomnography (PSG) examined in our hospital from April 2016 to April 2018 were enrolled (N = 67, male 78.3%, 60.4 ± 14.3 years). 11 cases of the subjects had examined PSG under wearing CPAP. W-P was calculated by casual blood pressure and heart rate measured on the PSG enforcement day. The association between W-P and parameters including age, sex, BMI, abdominal circumference, blood tests date, urine albumin, and various SAS indexes were examined. Results: Casual blood pressure and heart rate were 124.8 ± 19.2/79.1 ± 15.9 mmHg and 78.6 ± 13.4 bpm. W-P in the group with CPAP (8786.7 ± 1451.7) was significantly decreased compared with the group without CPAP (10127.7 ± 2826.5, p < 0.05). The urine protein level (R = 0.43, p < 0.05) and the plasma BNP level (R = 0.45, p < 0.005) were related to W-P. Multivariate regression analysis adjusted for known risk factors also indicated that the urine protein level was independent factor to determine elevated W-P (beta = 0.57, p < 0.05). Conclusions: W-P was related to a hypertensive target organ damage in SAS patient. The CPAP therapy can decrease W-P and may reduce the risk of future cardiovascular disease.

The effect of treatment of obstructive sleep apnea syndrome on overactive bladder symptoms.

To evaluate the effect of the treatment of obstructive sleep apnea syndrome on overactive bladder symptoms. All patients who applied to the outpatient clinic with complaints of snoring and apnea were evaluated by polysomnography between years 2017 and 2019. obstructive sleep apnea syndrome severity was evaluated according to the apnea-hypopnea-index. All patients were filled with questionnaire form as overactive bladder symptoms score, international quality of life, international consultation on incontinence questionnaire short-form, and 3-day bladder diary before polysomnography and three months after continuous positive airway pressure therapy and surgical treatment. A total of 125 patients, 34 (27.2%) patients with mild obstructive sleep apnea syndrome, 27 (21.6%) patients with moderate obstructive sleep apnea syndrome, and 64 (51.2) patients with severe obstructive sleep apnea syndrome were included in the study. The prevalence of overactive bladder symptoms in three obstructive sleep apnea syndrome groups were 67.6, 53.8, and 48.4%, respectively, and there was no statistical difference between the groups (p=0.190). obstructive sleep apnea syndrome treatment such as surgical treatment or continuous positive airway pressure therapy was applied to 45.5% (31 patients) patients with obstructive sleep apnea syndrome and overactive bladder. Three months after treatment, the overactive bladder symptoms score significantly decreased from 16.1±7.9-12.80±9.82, international quality of life was significantly increased from 105.0±23.2-110.4±22.2, and incontinence questionnaire short-form decreased from 11.9±4.0-10.4±5.6 (p=0.009, p=0.023, and p=0.248, respectively). There was a significant decrease between before and after treatment in terms of mean day-time frequency and mean urgency episodes of patients (p=0.007, p=0.002). Both surgery and continuous positive airway pressure treatment of obstructive sleep apnea syndrome improved overactive bladder symptoms, overactive bladder symptoms score, international quality of life, day-time frequency, and urgency episodes.

Management of sleep apnoea syndrome (SAS) in patients with vasovagal syncope (VVS): a protocol for the VVS-SAS cohort study.

IntroductionRecurrent vasovagal syncope (VVS) is associated with decreased quality-of-life and frequent use of emergency services. The evidence base for causality, diagnostic procedures and potential VVS treatments is poor. Scattered observations in the literature suggest a link between respiratory disturbances during sleep and VVS. Empirical observations lead us to further hypothesise that the appropriate management of sleep apnoea syndrome (SAS) may help resolve comorbid recurrent VVS in certain patients. We therefore designed this pilot study to provide a framework for the observation of changes in outcomes accompanying the deployment of SAS treatments in patients with VVS.Methods and analysisThis is a multicentre, registry-based study whose primary objective is to evaluate the effect of SAS management on the number of syncope/presyncope episodes in a population suffering from both VVS and SAS. To this effect, syncope rates prior to the treatment of SAS will be compared with those occurring after the initiation of the latter. In addition, yearly assessments will collect data for echocardiography, polysomnography, Holter monitoring, table tilt tests, multiple sleep latency tests, SAS management parameters and questionnaires describing fatigue, depression and quality-of-life. Sixty patients will be included with a minimum follow-up period of 12 months. The primary analysis will use comparisons of centrality for paired data to describe the changes in syncope rates before versus after the initiation of SAS management. Longitudinal data will be analysed using mixed models with patients set as a random effect. Subgroup analyses will be performed for SAS-treatment adherence and efficacy.Ethics and disseminationThe VVS-SAS registry was approved by an ethics committee (Comité pour la Protection des Personnes Ile-de-France VI, Reference number CPP/2-18) in accordance with French law. The princeps publication will present before–after SAS management results and longitudinal analyses.Trial registration numberNCT04294524. Pre-results.

Acceptance of virtual agents in a homecare context: Evaluation of excessive daytime sleepiness in apneic patients during interventions by continuous positive airway pressure (CPAP) providers.

Sleep apnea syndrome treatment relies primarily on continuous positive airway pressure, which requires a homecare follow-up. Excessive daytime sleepiness is a key symptom to be measured during follow-up, and there is a need for more easy-to-administer, ecological and engaging tools to assess it. Virtual agents have shown their effectiveness in performing clinical evaluation in a medical environment. A virtual agent assessing excessive daytime sleepiness via the Epworth Sleepiness Scale has been tested at home by 102 patients treated by continuous positive airway pressure (CPAP) and their homecare providers. Acceptance and trustworthiness of the agent, as well as the influence of demographics and clinical characteristics of patients, were investigated. Results showed that both patients and homecare providers reported a positive attitude towards the virtual agent, which was found to be usable, satisfactory, credible and benevolent. Homecare providers reported that it was not a burden to their working routine. Positive regression coefficients were found between patients' and homecare providers' attitudes towards the virtual agent. We found no influence of patients' demographics and clinical characteristics on their acceptance of the virtual agent. This shows that virtual agents are well accepted by patients and homecare providers, independently of their demographics and clinical characteristics. Positive regression coefficients observed between patients' and homecare providers' perceptions of the agent indicate that the opinions of both influence acceptance of the virtual agent in a homecare context. Virtual agents are new innovative digital solutions to be considered in homecare follow-up of apneic patients treated by CPAP.

Identification of Sleep Apnea Syndrome by Analyzing Sleep Sound Data Using a Clustering Method

Sleep Apnea Syndrome (SAS) has attracted considerable attention in recent years because it is known to cause catastrophes when people suffering from it fall asleep while driving. In addition, approximately 70% of SAS patients have other lifestyle-related diseases, which are further complicated owing to SAS; therefore, its early detection is important. Moreover, the detection of pre-SAS, which is likely to turn into SAS in the future, may help in the early detection of SAS. In this study, a method to identify SAS and pre-SAS using only sound data has been proposed. In the proposed method, peculiar breathing sound patterns in SAS are analyzed using the k-means clustering method and perform discriminant analysis using quantification theory based on the results. Because respiratory sound data is extensive and non-uniform during sleep, an efficient analysis method is required. The presented analysis method focuses on the features of SAS sounds, and performs the analysis almost automatically; therefore, the time required for analysis is reduced and the uniformity of the analysis results is guaranteed. Using this method, it is possible to distinguish between non-SAS and SAS symptoms including pre-SAS symptoms, which is difficult to perform using the Apnea-Hypopnea Index, which is a measure of SAS that employs breathing sound data only. Thus, this method, which also analyzes pre-SAS, is convenient for the early detection and treatment of SAS and can also be expected to contribute toward the early detection of preliminary lifestyle-related diseases.

Long-Term Subjective Outcomes of Barbed Reposition Pharyngoplasty for Obstructive Sleep Apnea Syndrome Treatment.

Background: The purpose of this study was to evaluate long-term subjective outcomes of barbed reposition pharyngoplasty for obstructive sleep apnea syndrome (OSAS) treatment using a specific questionnaire, the Palate Postoperative Problem Score (PPOPS). Methods: 140 patients who underwent barbed reposition pharyngoplasty (BRP) surgery in the Morgagni Pierantoni Hospital of Forlì, Italy were enrolled in the study. Postoperative outcomes were evaluated in a short- and long-term follow-up using the PPOPS questionnaire. The average period of follow-up was 26 months. All patients received the PPOPS questionnaire by telephone in a period between April and August 2019. Results: 51% of patients complained of swallowing problems after surgery. In 91% of cases, the problem cleared up spontaneously. At the time of the interview, only 9% of patients had a residual swallowing difficult. At the time of PPOPS evaluation, rhinolalia was observed in 8% of patients, whereas nose regurgitation was present in 2% of patients. In 20% of patients, the foreign body sensation was present during follow-up. The value of apnea–hypopnea index (AHI) reduced from the preoperative value of 31.5 to the postoperative value of 11.4. Conclusions: BRP surgery proved to be an effective technique, appreciated by the majority of patients. Use of the PPOPS questionnaire has demonstrated that the BRP technique seems to ensure efficacy and lower morbidity, with few complications after surgery.

Sleep apnea Syndrome and cardiac dysfunction: correlations and therapeutic aspects

Almost half of patients with sleep apnea syndrome (SAS) have asymptomatic left ventricular (LV) dysfunction, this incidence may vary depending on the criteria used. Along with metabolic syndrome, dyslipidemia, smoking status and lack of exercise, obstructive sleep apnea increases cardiovascular risk. SAS has a high incidence in patients with high cardiovascular risk profile and asymptomatic left ventricular dysfunction. The first phase of evaluating the cardiac dysfunction in an SAS patient is to identify patients with multiple cardiovascular risk factors who will be asked to answer the Berlin and Epworth Questionnaires. Those patients with high scores and clinical suspicion of SAS should be referred to a clinic for further evaluation. This will include polysomnography and screening echocardiography for all the patients. Patients diagnosed by polysomnography with SAS will perform an ENT examination that assesses the presence of obstructive disorders that may contribute to the onset or worsening of SAS. This examination will also indicate whether the surgery to remove the obstacle will be performed. Where considered appropriate there should be initiated specific therapy with ventilator assistance devices during sleep. Therapy consists in SAS treatment and cardiac treatment as well.

Clinical research of comprehensive treatment of sleep apnea syndrome with traditional Chinese medicine

Objective To evaluate the efficacy of TCM comprehensive therapy in the treatment of sleep apnea syndrome (SAS). Methods Eighty-two SAS patients who met the inclusion criteria were randomly divided into two groups, 41 in each group. The control group was treated with continuous positive airway pressure (CPAP). The observation group was treated with traditional Chinese medicine, oral Chinese medicine, acupuncture, massage, and acupuncture points. Both groups were treated for 2 weeks. Polysomnography (PSG) was used to evaluate the various stages of sleep, including total sleep time, hypopnea time, <90% oxygen saturation time. Results The total effective rate was 90.2% (37/41) of the observation group and 70.7% (29/41) of the control group. The difference between the two groups was statistically significant (χ2=4.970, P=0.026). After treatment, the sleep time (5.5 ± 0.7 h vs. 5.0 ± 0.6 h, t=3.556) of the treatment group was significantly longer than that of the control group (P<0.01). The hypoventilation time (45.1 ± 9.5 min vs. 50.2 ± 10.1 min, t=2.412), <90% oxygen saturation time (19.8 ± 9.6 min vs. 25.4 ± 10.1 min, t=2.635) was significantly lower than those of the control group (P<0.05). Conclusions Then comprehensive TCM therapy can alleviate the clinical symptoms of SAS patients, increase sleep time, and improve sleep quality. Key words: Sleep apnea syndromes; Acupuncture therapy; Tui Na therapy; Auricular plastertherapy; Continuous positive airway pressure

VI. Diagnosis and Treatment of Sleep Apnea Syndrome from a Viewpoint of Endocrine Hypertension

VI. Diagnosis and Treatment of Sleep Apnea Syndrome from a Viewpoint of Endocrine Hypertension

Mandibular Advancement Devices: Tailoring New Treatments for Sleep Apnea Syndrome

Mandibular Advancement Devices: Tailoring New Treatments for Sleep Apnea Syndrome

Analysis of points selection pattern in acupuncture treatment of sleep apnea syndrome based on data mining

To explore the points selection pattern of acupuncture for sleep apnea syndromes by data mining technique. Clinical literature about acupuncture therapy for sleep apnea syndromes was derived from China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing VIP Database (CQVIP), PubMed and Science Direct between the time that databases were created and March 25th,2017. Relevant excel database was established and descriptive studies and association rules were analyzed. The most frequently used point was Lianquan (CV 23) and the most frequently used meridian was the Stomach Meridian. The analysis of association rules showed that the clinical choice of acupuncture points was highly correlated, among which the combination of the highest degree of confidence and the highest degree of support was Shenmen (HT 7) and Sishencong (EX-HN 1); Lieque (LU 7), lianquan (CV 23) and Zhaohai (KI 6). Acupuncture treatment of sleep apnea syndromes has specific selection rules of points, providing certain references for clinical and scientific research.

Comparison of radiofrequency and transoral robotic surgery in obstructive sleep apnea syndrome treatment

Introduction: Radiofrequency tissue ablation (RFTA) and transoral robotic surgery (TORS) are the methods used in OSAS surgery. We also aimed to compare the advantages and disadvantages of RF and TORS as treatment methods applied in OSAS patients in terms of many parameters, especially apnea hypopnea index (AHI).Materials and methods: Patients were classified by performing a detailed examination and evaluation before surgery. 20 patients treated with anterior palatoplasty and uvulectomy −/+ tonsillectomy + RFTA (17 males, 3 females) and 20 patients treated with anterior palatoplasty and uvulectomy −/+ tonsillectomy + TORS (16 males, 4 females) were included in the study. PSG was performed preoperatively and postoperatively in all patients and Epworth sleepiness questionnaire was applied. All operations were performed by the same surgeon and these surgical methods -RF and TORS- were compared in terms of many parameters.Results: When the patients treated with RF and TORS were compared in operation time, length of hospitalization and duration of transition to oral feeding; all parameters were significantly greater in the patients treated with TORS.Conclusions: TORS technique was found to be more successful than RF in terms of reduction of AHI value, correcting minimum arterial oxygen saturation value and decreasing Epworth Sleepiness Scale score.

Treatment of sleep apnea syndrome by electrical auricle stimulation using miniaturized system of second generation

Treatment of sleep apnea syndrome by electrical auricle stimulation using miniaturized system of second generation

The urge to move and breathe – the impact of obstructive sleep apnea syndrome treatment in patients with previously diagnosed, clinically significant restless legs syndrome

ObjectiveThe association between restless legs syndrome (RLS) and obstructive sleep apnea syndrome (OSAS) has seldom been reported. There is one study reporting improvement of RLS symptoms severity in patients naive of treatment after initiation of continuous positive airway pressure (CPAP) for OSAS. The aim of this study was to evaluate the impact of the OSAS treatment in patients with previously diagnosed, clinically significant RLS in a usual clinical setting. MethodsThis was a retrospective study of RLS patients from a sleep clinic with a concomitant or subsequent diagnosis of OSAS. All patients who started treatment for OSAS and had a follow-up of ≥3 months were selected. Exclusion criteria included noncompliance, absence of sufficient information on clinical records, and RLS improvement following treatment of secondary causes. The primary outcome variable was clinical status of RLS symptoms following OSA treatment. Other variables included demographics, RLS treatment and outcome, OSA diagnosis, treatment, compliance, outcome, and PSG characteristics. ResultsFrom a database of 97 RLS patients, 56 patients had both OSA and RLS. Of these patients, 28 met the criteria for the study. In all, 17 patients (60.9%) were female, with a mean age 60 years. A total of 16 patients (57.1%) were diagnosed with idiopathic RLS. OSAS was diagnosed, on average, 21 months after the RLS diagnosis. A total of 19 (70.4%) patients were overweight or obese, 26 (92.9%) reported snoring, and 10 (35.7%) witnessed apneas. A total of 16 patients (57.1%) had excessive daytime sleepiness and 23 (84.1%) had insomnia. The mean apnea–hypopnea index was 19. Patients were mostly treated with dopamine agonists (19 patients, 67.9%) for the RLS, and nine patients were treated with more than two drugs for RLS. A total of 20 patients (71.4%) had improvement of symptoms of RLS after therapy for OSAS, of whom nine stopped drug therapy and eight reduced the dose. ConclusionsIn patients with clinically significant RLS, treatment of concomitant OSAS significantly improved RLS symptoms, enabling drug therapy reduction in more than half of the patients. These data reinforce the need to actively diagnose OSAS in RLS patients.

Significance of Early Detection and Treatment of Sleep Apnea Syndrome

Significance of Early Detection and Treatment of Sleep Apnea Syndrome