Treatment Of Sleep Apnea Syndrome Research Articles

In Reply: Are Clinical Features and Severity Vital While Deciding the Treatment in Sleep Apnea Syndrome?

We appreciate your interest in our recently published study entitled “Five-Year Subjective Outcomes of Obstructive Sleep Apnea Surgery: A Multi-Institutional Study” [1]. We received 3 comments which we will address and are summarized as follows: (1) there were some insufficiencies in the clinical and demographic characteristics of the study population including sleep endoscopy; (2) the severity of obstructive sleep apnea (OSA) was not presented in the article; and (3) healthy control group was more suitable than untreated control group and follow-up polysomnographic tests were better than telephone inquiries. The objective of this research was to perform a retrospective, multi-institutional study to assess potential long-term effects of OSA surgery and positive airway pressure (PAP) on sleep disordered breathing (SDB) symptoms via a chart review and telephone survey. Being a retrospective study, we could not evaluate the effectiveness of specific treatments using broad patient selection criteria. Similar in design to our research, Goh et al. [2] evaluated long-term quality of life after uvulopalatopharyngoplasty. In their study and ours, surgical treatment was performed at the doctor’s discretion based on the patient’s clinical features, severity of disease, and preference. Because our data was accumulated from 10 different institutions, there was substantial heterogeneity in available demographic information, clinical features, and measured outcomes other than age, sex, body mass index, and baseline apnea-hypopnea index (AHI). We agree with the comment that sleep endoscopy and follow-up polysomnograms would have provided more important information. Unfortunately, postoperative polysomnograms were not routinely performed in our clinical setting and therefore could not be included in the analysis. Regarding the second comment, the mean AHI scores with ranges are provided in Table 1 [1]. Patients with the highest AHIs were included in the PAP group (mild:moderate:severe=2:15:51), followed by the surgery (mild:moderate:severe=16:30:41) and control (mild:moderate: severe=23:17:34) groups. The last comment warrants an interesting discussion on study design. We agree that healthy control patients would have provided additional information, including a reference to compare treatment success between PAP and surgery. However we designed this study to provide clinicians with long-term outcome data on the effects of upper airway surgery or PAP versus those patients with OSA that select no-treatment. We feel that this objective is also of value to the literature, as we demonstrated that patient-reported SDB symptoms were significantly improved after surgery or PAP, compared to those that had no intervention in a 5-year period.

Are Clinical Features and Severity Vital While Deciding the Treatment in Sleep Apnea Syndrome?

See the reply "In Reply: Are Clinical Features and Severity Vital While Deciding the Treatment in Sleep Apnea Syndrome?" in Volume 9 on page 183.

Compliance and Related Factors for Positive Airway Pressure (PAP) Treatment in Sleep Apnea Syndrome

Compliance and Related Factors for Positive Airway Pressure (PAP) Treatment in Sleep Apnea Syndrome

Effects of mandibular advancement devices for the treatment of sleep apnea syndrome based on cardiopulmonary coupling analysis

Effects of mandibular advancement devices for the treatment of sleep apnea syndrome based on cardiopulmonary coupling analysis

Phenotypes of comorbidity in OSAS patients: combining categorical principal component analysis with cluster analysis.

Phenotyping obstructive sleep apnea syndrome's comorbidity has been attempted for the first time only recently. The aim of our study was to determine phenotypes of comorbidity in obstructive sleep apnea syndrome patients employing a data-driven approach. Data from 1472 consecutive patient records were recovered from our hospital's database. Categorical principal component analysis and two-step clustering were employed to detect distinct clusters in the data. Univariate comparisons between clusters included one-way analysis of variance with Bonferroni correction and chi-square tests. Predictors of pairwise cluster membership were determined via a binary logistic regression model. The analyses revealed six distinct clusters: A, 'healthy, reporting sleeping related symptoms'; B, 'mild obstructive sleep apnea syndrome without significant comorbidities'; C1: 'moderate obstructive sleep apnea syndrome, obesity, without significant comorbidities'; C2: 'moderate obstructive sleep apnea syndrome with severe comorbidity, obesity and the exclusive inclusion of stroke'; D1: 'severe obstructive sleep apnea syndrome and obesity without comorbidity and a 33.8% prevalence of hypertension'; and D2: 'severe obstructive sleep apnea syndrome with severe comorbidities, along with the highest Epworth Sleepiness Scale score and highest body mass index'. Clusters differed significantly in apnea-hypopnea index, oxygen desaturation index; arousal index; age, body mass index, minimum oxygen saturation and daytime oxygen saturation (one-way analysis of variance P < 0.0001). Binary logistic regression indicated that older age, greater body mass index, lower daytime oxygen saturation and hypertension were associated independently with an increased risk of belonging in a comorbid cluster. Six distinct phenotypes of obstructive sleep apnea syndrome and its comorbidities were identified. Mapping the heterogeneity of the obstructive sleep apnea syndrome may help the early identification of at-risk groups. Finally, determining predictors of comorbidity for the moderate and severe strata of these phenotypes implies a need to take these factors into account when considering obstructive sleep apnea syndrome treatment options.

Syndrome d’apnée du sommeil et troubles du rythme cardiaque

Arrhythmia is a major cause of morbidity and mortality in Europe and in the United States. The aim of this review article was to assess the results of the prospective studies that evaluated the risk of arrhythmia in patients with sleep apnea syndrome and discuss the management of this arrhythmia. Reports published with the following search terms were searched: sleep apnea syndrome, atrial flutter, supraventricular arrhythmia, ventricular arrhythmia, ventricular tachycardia, ventricular fibrillation, torsade de pointe, atrial fibrillation and sudden death. The investigation was restricted to reports published in English and French. The outcome of this analysis suggests that patients with untreated overt sleep apnea syndrome are at increased risk of arrhythmia. The timely recognition and effective treatment of sleep apnea syndrome in patients with arrhythmia are mandatory because the prognosis of arrhythmia may be improved with the appropriate treatment of sleep apnea syndrome.

Sleep apnea in the elderly.

Sleep apnea syndrome (SAS) in the elderly presents varied clinical symptoms and also has many complications. Moreover, there are many hospital departments related to these symptoms. This article uses literature to provide an outline on SAS observed in the elderly. SAS sufferers often have complications with so-called lifestyle-related diseases, such as hypertension, hyperlipidemia, diabetes mellitus and metabolic syndrome. These symptoms, along with SAS, recede as a result of continuous positive airway pressure treatment. Some have also reported recession of depression symptoms and delay in deterioration of cognitive functions. The elderly tends to develop SAS through coexistence of chronic respiratory organ disorders, increase in upper airway collapse, strokes, cardiovascular diseases, hypertension, diabetes mellitus and other physiological anatomical changes that accompany aging. However, judgment on the severity and effects regarding prognosis by each remedy used in the diagnosis and treatment of SAS in the elderly is still being developed, and it is considered necessary to accumulate more evidence and establish new standards.

Predictors of success in the treatment of obstructive sleep apnea syndrome with mandibular repositioning appliance: a systematic review.

Introduction Obstructive sleep apnea syndrome affects up to 4% of middle-aged men and 2% of adult women. It is associated with obesity. Objective The objective of this article is to review the literature to determine which factors best correlate with treatment success in patients with obstructive sleep apnea syndrome treated with a mandibular repositioning appliance. Data Synthesis A search was performed of the PubMed, Cochrane, Lilacs, Scielo, and Web of Science databases of articles published from January 1988 to January 2012. Two review authors independently collected data and assessed trial quality. Sixty-nine articles were selected from PubMed and 1 from Cochrane library. Of these, 42 were excluded based on the title and abstract, and 27 were retrieved for complete reading. A total of 13 articles and 1 systematic review were considered eligible for further review and inclusion in this study: 6 studies evaluated anthropomorphic and physiologic factors, 3 articles addressed cephalometric and anatomic factors, and 4 studies evaluated variables related to mandibular repositioning appliance design and activation. All the studies evaluated had low to moderate methodologic quality and were not able to support evidence on prediction of treatment success. Conclusion Based on this systematic review on obstructive sleep apnea syndrome treatment, it remains unclear which predictive factors can be used with confidence to select patients suitable for treatment with a mandibular repositioning appliance.

The 'Guideline for OSAS in children'

The obstructive sleep apnoea syndrome is a sleep-related disorder characterised by repetitive upper airway obstructions during sleep. In children this sleep-related disorder is associated with medical and developmentrelated disorders such as failure to thrive, cardiovascular complications and neurocognitive problems. Recently, the Dutch multidisciplinary guidelines for diagnosis and treatment of sleep apnoea syndrome in children were developed. In these guidelines adenotonsillectomy is considered to be the first-line treatment. Distraction surgery can be considered for children with severe sleep apnoea syndrome as a result of midfacial hypoplasia or micrognathia. The guidelines define a limited role for orthodontic treatment of dysgnathia. With mandibular repositioning appliances and rapid maxillary expansion, an increase of the upper airway volume can be produced. According to the new guidelines, orthodontic therapy may be considered as one of the secondary treatment options for sleep apnoea syndrome in children with specific disturbed jaw relations in selected cases.

Daytime sleepiness in Parkinson's disease: a reappraisal.

BackgroundExcessive daytime sleepiness is a frequent complaint in Parkinson’s disease (PD); however the frequency and risk factors for objective sleepiness remain mostly unknown. We investigated both the frequency and determinants of self-reported and objective daytime sleepiness in patients with Parkinson’s disease (PD) using a wide range of potential predictors.MethodsOne hundred and thirty four consecutive patients with PD, without selection bias for sleep complaint, underwent a semi-structured clinical interview and a one night polysomnography followed by a multiple sleep latency test (MSLT). Demographic characteristics, medical history, PD course and severity, daytime sleepiness, depressive and insomnia symptoms, treatment intake, pain, restless legs syndrome, REM sleep behaviour disorder, and nighttime sleep measures were collected. Self-reported daytime sleepiness was defined by an Epworth Sleepiness Scale (ESS) score above 10. A mean sleep latency on MSLT below 8 minutes defined objective daytime sleepiness.ResultsOf 134 patients with PD, 46.3% had subjective and only 13.4% had objective sleepiness with a weak negative correlation between ESS and MSLT latency. A high body mass index (BMI) was associated with both ESS and MSLT, a pain complaint with ESS, and a higher apnea/hypopnea index with MSLT. However, no associations were found between both objective and subjective sleepiness, and measures of motor disability, disease onset, medication (type and dose), depression, insomnia, restless legs syndrome, REM sleep behaviour disorder and nighttime sleep evaluation.ConclusionWe found a high frequency of self-reported EDS in PD, a finding which is however not confirmed by the gold standard neurophysiological evaluation. Current treatment options for EDS in PD are very limited; it thus remains to be determined whether decreasing pain and BMI in association with the treatment of sleep apnea syndrome would decrease significantly daytime sleepiness in PD.

Treatment of sleep apnoea syndrome decreases cognitive decline in patients with Alzheimer's disease

BackgroundIt is essential to detect and then treat factors that aggravate Alzheimer's disease (AD). Here, we sought to determine whether or not continuous positive airway pressure (CPAP) therapy for sleep...

Traitement du syndrome d’apnées du sommeil par pression positive nocturne

Traitement du syndrome d’apnées du sommeil par pression positive nocturne

Treatment of sleep apnoea syndrome

Treatment of patients with sleep disordered breathing and especially sleep apnea syndrome, involves a multidisciplinary approach. In all cases, it is necessary to implement adequate hygiene and diet lifestyle, as a prerequisite for active therapy. Non-invasive ventilation (NIV) is the gold standard for therapy, and it is carried predominantly by internists and pulmonologist. Dentists-orthodontists are involved in cases where a specially designed oral proven applications enable opening the airway in the throat. They are applied on the basis of preliminary estimates of clinical benefit, after the NIV refusal of treatment by patients with normal BMI. Surgical methods are primarily related to ENT interventions on the structures of the soft palate and mouth, with correction of nasal patency, with the aim of solving the mechanical obstruction of air flow. Extensive maxillofacial surgery is performed with significant craniofacial abnormalities and it is very demanding procedure, therefore strictly selective. In severe cases, tracheostomy is an option for emergency treatment of vitally endangered patients resistant to NIV treatment, often with very high BMI. Medical therapy is still inefficient. It is actually more important today to draw attention to the patient what medications should not be used (particularly sedatives), because they can worsen the degree of apnea during sleep and further disrupt the architecture of sleep.

Influence of the obstructive sleep apnea treatment in the glaucoma control

The information of the relationship between the obstructive Sleep Apnea Syndrome treatment (OSAS) with glaucoma and the importance of the approach to treatment of both together, is limited. Purpose: Formulate the association of Obstructive Sleep Apnea Syndrome (OSAS) and Glaucoma, through the presentation of a clinical case. A retrospective study in 41 patients with Glaucoma and OSAS was held over two years in joint management with Ophtalmology and Sleep Neuroly Service.The patients were controlled with applanation tonometry, Photo of the optic disc, Gonioscopy, Computerized Visual field, Optic disk OCT, in spite of the medical glaucoma treatment, there was Visual Field and RNFL defects progress. At the clinical control of the cardiovascular risk factors, OSAS was diagnosed by Polisomnography. A sample case of a male patient of 62 years of age with open angle glaucoma of 8 years of evolution under treatment with Timolol and Bimatoprost and 14 mmHg Intraocular Pressure) IOP with progression on the defects of the Visual Field and OCT will be discussed as an example. (became worse) Distant visual acuity with correction (sph + 2) was 20/20 in both eyes until December 2012 lowered to 20/25 in both eyes (macular epiretinal membrane was detected). Slit Lamp Biomicroscopy without any peculiarities (was normal). Both eyes with open angle and some mesodermal remnants at the trabecular meshwork at the gonioscopy. A Polisomnography for OSAS was performed successfully. The target IOP < 11 mmHg reached in all the control with Timolol and Dorzolamide and Bimatoprost (not advised in OSAS Brimonidine and had used without good tolerance when it was referred to). The patients began treatment with an air generator (CPAP) during the night well tolerated (something very difficult to achieve),stabilizing the visual fields (until December 2012 ) and RNFL OCT.In our series (n 41), the average age was 62.5, 39% did not know that they suffered from glaucoma and 56% did not know they had OSAS. The 35.8% patients had glaucoma associated with Plateau Iris, the 23% Pseudoexfoliation Glaucoma, 20.5% Open-angle glaucoma, 12.8% Low tension Glaucoma and 7.7% Primary angle-closure glaucoma. The OSA Index,was mild to moderate. In OSAS there’s an alteration of the optic nerve irrigation which is of great importance for the development and progression of the glaucoma. Most of our population don’t know Glaucoma–apnea Association. In a high percentage on the apnea/ hypopnea Index,was mild to moderate. That is why the emphasis must be put on its treatment. In the same way, in patients with OSAS, the focus must be on detection of glaucoma, as the prevalence in this group is higher, especially associated with Plateau Iris. Our results are different from literature reviewed. We must work in an interdisciplinary team with physicians in Neurology and Pneumonology to improve and/or stop the progression in these patients. Very low IOP Target is recommend for this group. Carolina Cuello Ortiz.

睡眠時無呼吸症候群に対する，鼻腔・咽頭の気道抵抗から考えた治療選択

睡眠時無呼吸症候群に対する，鼻腔・咽頭の気道抵抗から考えた治療選択

Reliability of Telemedicine in the Diagnosis and Treatment of Sleep Apnea Syndrome

Advances in information technology and telecommunications have provided the option of making it easier to diagnose and treat obstructive sleep apnea syndrome (OSAS) using telemedicine techniques. This study assessed the feasibility and reliability of respiratory polygraphy and prescription of treatment by pressure adjustment with auto-continuous positive airway pressure (CPAP) systems, both being transmitted telematically to the Sleep Unit, with teleconsultation as a support method. Forty patients were studied from a population 80 km from the Sleep Unit using respiratory polygraphy transmitted in real time. They were divided into two groups: one was seen by conventional consultation, and the other was seen using teleconsultation. We also estimated satisfaction with this system and its costs. The mean patient age was 53 ± 10.3 years, with a body mass index of 31 ± 6.2 kg/m(2) and an Epworth score of 12 ± 5.3. In total, 35 patients were diagnosed with OSAS, with an Apnea-Hypopnea Index of ≥10, and CPAP treatment was started in 16 of them. The agreement in the Apnea-Hypopnea Index, total apneas and hypopneas, mean oxygen saturation, and time with an oxygen saturation <90% was greater than 90% between the studies transmitted in real time and those stored in the polygraph. The level of compliance with CPAP treatment was 85% for the patients who were seen in a conventional clinic and 75% in those seen by teleconsultation. The use of telematic techniques is useful to establish a diagnostic and therapeutic strategy for OSAS with the creation of a Wide Core Sleep Laboratory as a process controller.

P4‐215: Treatment of sleep apnea syndrome slows cognitive decline in mild‐to‐moderate Alzheimer's disease

P4‐215: Treatment of sleep apnea syndrome slows cognitive decline in mild‐to‐moderate Alzheimer's disease

Effects of Sleep Apnea Syndrome on Delayed Memory and Executive Function in Elderly Adults

To identify differences in cognitive function between elderly adults with sleep apnea syndrome (SAS) and healthy controls. Cross-sectional. Sleep laboratory at Seoul National University Bundang Hospital. Sixty-three elderly adults (26 female; mean age 68.2 ± 4.8) without cognitive disorders. Sleep-laboratory polysomnography findings and cognitive function results determined using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery. When the control group (apnea-hypopnea index (AHI) < 15) was compared with the groups with mild to moderate (15 ≤ AHI < 30) and severe (AHI ≥ 30) SAS, significant differences in delayed recall (P = .003) and errors on the Trail-Making Test Part B (TMT B; P = .009) were observed, with participants with severe SAS showing greater impairment on both tests than controls (P = .02 and P = .01, respectively). Stepwise multiple regression showed that oxygen desaturation index (β = -0.37, P = .003) and educational level (β = 0.24, P = .04) determined delayed recall impairment (adjusted coefficient of determination (R (2)) = 17.8%, P = .003). TMT B errors were independently associated with educational level (β = -0.41, P = .001) and AHI (β = 0.31, P = .007; adjusted R (2) = 25.7%, P = .001). Severe SAS is associated with measures of delayed recall and executive function in cognitively healthy older adults. Although further study is needed, this evidence may provide further rationale for the treatment of SAS in older adults. Moreover, the role of SAS as a risk factor for cognitive disorders needs to be determined.

Noninvasive positive pressure ventilation treatment for sleep apnea syndrome involving clinical engineering technologists in our hospital

Noninvasive positive pressure ventilation treatment for sleep apnea syndrome involving clinical engineering technologists in our hospital

The Syndrome of Sleep Apnea in the Elderly Suffering from COPD and Live in the County of Attica, Greece.

Introduction:Chronic Obstructive Pulmonary Disease (COPD) and obstructive sleep apnea syndrome are two diseases, which often coexist in one person. The sleep apnea is often caused by an interruption to breath when sleeping, due to an obstruction of the upper airway during inhalation, causing chronic snoring, morning headaches, increased body weight, blood pressure and sleepiness during the day.Aim:The purpose of this study is to investigate the extend of this problem among a large group of elderly people living in the Attica Basin.Material and Methods:Material of the study was 500 people aged 70 and above years old, including 274 men and 226 women. Data collection was facilitated with the use of an anonymous questionnaire with the purpose to identify patients with apnea, after a personal interview with the researcher. Data analysis was performed with the use of the statistical package SPSS 17.Results:Based on their responses to the questionnaires, it was found that 98.0% of the participants have abnormal sleepiness during the day. The 35.4% of them show no apnea, while 36.0% of the sample suffer from mild sleep apnea. It is important though, the fact that about one out of three seniors, 28.6%, shows sleep apnea in a high risk level.Conclusions:COPD is a complex disease that occurs in a large proportion of the elderly. Emphasis should be given on early diagnosis and treatment of sleep apnea syndrome, in order to improve the quality of the elderly life.