Treatment Of Sleep-related Breathing Disorders Research Articles

Стоматологічна реабілітація дорослих пацієнтів із втратою зубів та обструктивним апное сну (огляд літератури)

Introduction. Dental sleep medicine is a branch of dental practice that deals with the treatment of sleep-related breathing disorders, including obstructive sleep apnea (OSA) in adults and children. However, daily practice shows that other sleep disorders also concern dentistry, including orofacial pain associated with sleep, xerostomia, hypersalivation, gastroesophageal reflux disease, temporomandibular joint dysfunction, and bruxism. Purpose: on the basis of a thorough analysis of literary sources, to study the main methods of dental rehabilitation of adult patients with obstructive sleep apnea and to compare their effectiveness. Materials and methods. Information search and analysis of scientific sources using scientometric databases Web of Science, PubMed, Google Scholar over the past 15 years. Conclusion. The analysis of the literature data of recent years has shown the wide spread of dental pathology in patients with OSA and the need to develop and implement modern multidisciplinary approaches to the treatment of this contingent with the involvement of practicing dentists in health care practice. Key words: obstructive sleep apnea, dental pathology, tooth loss, mandibular advancement devices.

Dental sleep medicine: Bridging gaps in sleep-related breathing disorder care: A short review

Sleep-related disorders, with a particular emphasis on obstructive sleep apnoea (OSA), exert a substantial impact on the overall well-being of affected individuals. Based on collaborative efforts across diverse disciplines, dental sleep medicine, orchestrated by dentists, assume a crucial role in the identification of these disorders through routine examinations, where they keenly discern indicative cues. The incorporation of dentistry into the realm of sleep medicine paves the way for fresh avenues in the diagnosis, management, and treatment of sleep-related breathing disorders. This multidisciplinary approach not only augments the quality of sleep but also bolsters overall well-being. As research continues to advance, dental sleep medicine is poised to assume a pivotal role in catering to the diverse needs of individuals grappling with these disorders.

Sleep-disordered breathing and dental sleep medicine: Implications for oral health and overall well-being

Sleep-disordered breathing (SDB) is a prevalent condition that encompasses a range of disorders, such as snoring, obstructive sleep apnea (OSA), and upper airway resistance syndrome. These disorders have significant implications for both oral health and overall well-being. Dental sleep medicine (DSM) plays a crucial role in the identification, diagnosis, and management of SDB, offering effective treatment options for patients. As awareness grows regarding the detrimental effects of airway disorders, particularly obstructive sleep apnea (OSA), as a sleep-related breathing disorder, it becomes important to recognize the potential role of dentists in offering solutions in this field. This recognition gives rise to a new aspect of dentistry known as Dental Sleep Medicine (DSM). DSM focuses on the practice of clinical dentistry with the goal of achieving an ideal jaw relationship and establishing normal oral function and performance. One crucial aspect of function and performance is the airway and breathing, which is among the most vital functions for human beings. Any alterations in the airway and breathing patterns can lead to changes in the posture of the tongue, jaws, and head, ultimately resulting in malocclusion. Early dental treatment not only has a positive impact on the teeth but also helps establish the best possible airway at an early age. Dentists now play a crucial and integral role as part of an interdisciplinary group involved in managing Sleep-Related Breathing Disorders (SRBDs). This review article aims to provide guidance to dentists in identifying children or adults who are suspected or at risk of SRBDs. Additionally, it will explain the roles of dentists and orthodontists in the management and treatment of SRBDs.

Acceptance of and adherence with long-term positive airway pressure treatment in adults with chronic obstructive pulmonary disease: A systematic review protocol.

Long-term noninvasive positive airway pressure (PAP) treatment is effective treatment for sleep-related breathing disorders and chronic hypercarbic respiratory failure secondary to chronic obstructive pulmonary disease (COPD). PAP treatment may be delivered as continuous positive airway pressure or noninvasive ventilation. Success in initiating PAP treatment and barriers to its use in adult patients with COPD are largely unknown. This systematic review aims to identify the acceptance of and adherence to PAP treatment prescribed for long-term use in adult patients with COPD and to summarize variables associated with these measures. Seven online electronic databases will be searched by an experienced medical librarian to identify records containing the concepts "obstructive airways disease" and "noninvasive positive airway pressure" and "acceptance" or "adherence". Randomized and non-randomized studies of interventions will be included. Citation lists from relevant articles will be reviewed, and experts will be contacted regarding unpublished studies. Abstracts from key conferences between 2018-2023 and Google Scholar search results will be reviewed for inclusion. Titles, abstracts and full texts will be reviewed independently for inclusion by two reviewers. Data extraction will be completed by one author using a pre-established form and primary outcomes confirmed by a second author. Methodological quality will be evaluated. If sufficient data are available for meta-analysis, a pooled summary statistic for the primary outcome will be calculated using a random-effects generic inverse-variance meta-analysis, weighted proportion or weighted medians-based approach. Subgroup analysis will explore clinically meaningful sources of heterogeneity. Variables that are associated with acceptance and adherence will be described. Long-term PAP treatment is a complex intervention prescribed to patients with COPD for several indications. Synthesis of the evidence on success with PAP treatment and variables associated with acceptance or adherence will inform program and policy development for supporting patients with COPD who are prescribed this therapy. Systematic review registration: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on July 13, 2021 (registration number CRD42021259262), with revisions submitted on April 17, 2023.

Sleep Position Detection for Closed-Loop Treatment of Sleep-Related Breathing Disorders.

Reliable detection of sleep positions is essential for the development of technical aids for patients with position-dependent sleep-related breathing disorders. We compare personalized and generalizable sleeping position classifiers using unobtrusive eight-channel pressure-sensing mats. Data of six male patients with confirmed position-dependent sleep apnea was recorded during three subsequent nights. Personalized position classifiers trained using leave-one-night-out cross-validation on average reached an F1-score of 61.3% for supine/non-supine and an F1-score of 46.2% for supine/lateral-left/lateral-right classification. The generalizable classifiers reached average F1-scores of 62.1% and 49.1% for supine/non-supine and supine/lateral-left/lateral-right classification, respectively. In-bed presence ("bed occupancy") could be detected with an average F1-score of 98.1%. This work shows that personalized sleep-position classifiers trained with data from two nights have comparable performance to classifiers trained with large interpatient datasets. Simple eight-channel sensor mattresses can be used to accurately detect in-bed presence required for closed-loop systems but their use to classify sleep-positions is limited.

Redefining our protocol of the orthognathic surgery-first approach after 10 years of experience

The objective of this study was to update and redefine some concepts of the surgery-first (SF) approach, regarding its indications and contraindications, virtual planning work-up, surgical tips, and postoperative orthodontic benefits, after 10 years of experience. A retrospective analysis was made of orthognathic surgical procedures following the SF protocol between January 2010 and December 2019 to review inclusion and exclusion criteria, diagnostic workflow, surgical tips, and postoperative outcomes. A total of 148 SF procedures were performed during this period, which corresponded to only 9.2% of the total orthognathic surgeries performed, which means that we have broadened the exclusion criteria instead of reducing them. Surgical tips include interdental corticotomies solely in cases of anterior crowding and leaving the intermaxillary fixation miniscrews in place postoperatively for orthodontic skeletal anchorage. The mean duration of postoperative orthodontic treatment was reduced in comparison to conventional surgery (36.8 vs 87.5 weeks). The overall degree of satisfaction was high not only for the patients, but also for the orthodontists and surgeon. SF is especially indicated for patients who desire an immediate aesthetic result, with short-term orthodontics, or for treatment of sleep-related breathing disorders, if they meet the established criteria.

Mandibular advancement device: prescription in adult dental sleep medicine — guideline of the German Society of Dental Sleep Medicine

PurposeObstructive sleep apnea (OSA) may result in severe health onditions, reduces quality of live, and affects high percentages of the adult population. Due to recent changes in the German health care regulations, mandibular advancement devices (MAD) will become available as a treatment option for OSA to a greater extent for general dentists and their patients.MethodsA guideline development group consisting of nine members representing four German dental and medical organizations was formed, in order to provide critical information and orientation to the main stakeholders (dentists and patients), regarding the use of MAD for the treatment of OSA within dental sleep medicine.ResultsThis guideline aims to inform physicians and dentists, particularly those with acquired qualification/specialization in sleep medicine (or in the diagnosis and treatment of sleep-related breathing disorders), as well as experts, payers, and patients. It delivers recommendations on technical requirements for MAD prescription and fabrication, clinical procedures, maintenance, and follow-up procedures.ConclusionA MAD should be designed for long-term therapy and must be a custom made, adjustable, bimaxillary retained two-splint system equipped with adjustable protrusive elements. The fabrication in a dental laboratory should be based on dental impressions or scans and three-dimensional registrations of the starting position taken with a bite gauge.

Sleep-related breathing disorders and pulmonary hypertension.

Sleep-related breathing disorders (SBDs) include obstructive apnoea, central apnoea and sleep-related hypoventilation. These nocturnal events have the potential to increase pulmonary arterial pressure (PAP) during sleep but also in the waking state. "Pure" obstructive sleep apnoea syndrome (OSAS) is responsible for a small increase in PAP whose clinical impact has not been demonstrated. By contrast, in obesity hypoventilation syndrome (OHS) or overlap syndrome (the association of chronic obstructive pulmonary disease (COPD) with obstructive sleep apnoea (OSA)), nocturnal respiratory events contribute to the development of pulmonary hypertension (PH), which is often severe. In the latter circumstances, treatment of SBDs is essential in order to improve pulmonary haemodynamics.Patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) are at risk of developing SBDs. Obstructive and central apnoea, as well as a worsening of ventilation-perfusion mismatch, can be observed during sleep. There should be a strong suspicion of SBDs in such a patient population; however, the precise indications for sleep studies and the type of recording remain to be specified. The diagnosis of OSAS in patients with PAH or CTEPH should encourage treatment with continuous positive airway pressure (CPAP). The presence of isolated nocturnal hypoxaemia should also prompt the initiation of long-term oxygen therapy. These treatments are likely to avoid worsening of PH; however, it is prudent not to treat central apnoea and Cheyne-Stokes respiration (CSR) with adaptive servo-ventilation in patients with chronic right-heart failure because of a potential risk of serious adverse effects from such treatment.In this review we will consider the current knowledge of the consequences of SBDs on pulmonary haemodynamics in patients with and without chronic respiratory disease (group 3 of the clinical classification of PH) and the effect of treatments of respiratory events during sleep on PH. The prevalence and consequences of SBDs in PAH and CTEPH (groups 1 and 4 of the clinical classification of PH, respectively), as well as therapeutic options, will also be discussed.

Cardiovascular effects of oral appliances in obstructive sleep apnea

Oral appliances (ОА) are one of the leading methods of effective treatment of sleep-related breathing disorders. Obstructive sleep apnea (OSA) is a widespread disturbance in the general population. It is closely associated with many cardiovascular diseases (hypertension, cardiac arrhythmias, chronic heart failure, ischemic heart disease). Timely detection and treatment of OSA is an important task in the process of reducing the number of cardiac complications. Modern devices for the treatment of OSA are custom-made devices which allow to change the position of the mandible and its extension providing personalized treatment of snoring and sleep apnea. Changing the degree of the mandible extension, the ОА retains the upper respiratory tract in open position and indirectly stimulates the muscles, determining their tone. The effectiveness of the ОА is evaluated by the complete elimination of all respiratory events (snoring, upper airway resistance syndrome, OSA and hypopnea), as well as the influence on the sleep structure and the wakefulness functioning (excessive daytime sleepiness). The effects of ОА on cardiovascular diseases are of great importance, as they showed a decrease in both systolic and diastolic blood pressure, as well as a positive effect on the impaired endothelial function. Among all the treatment options, ОА take the leading positions, only slightly inferior in effectiveness to noninvasive ventilation, so called CPAP therapy. Regarding the long-term adherence to therapy (which is especially important in the cardiovascular prevention) оral appliances exceed CPAP therapy. Thus, the OA therapy is one of the leading therapeutic directions in modern sleep medicine for obstructive sleep-related breathing disorders.

Effects of Chronic Opioid Use on Sleep and Wake.

Chronic use of opioids negatively affects sleep on 2 levels: sleep architecture and breathing. Patients suffer from a variety of daytime sequelae. There may be a bidirectional relationship between poor sleep quality, sleep-disordered breathing, and daytime function. Opioids are a potential cause of incident depression. The best therapeutic option is withdrawal of opioids, which proves difficult. Positive airway pressure devices are considered first-line treatment for sleep-related breathing disorders. New generation positive pressure servo ventilators are increasingly popular as a treatment option for opioid-induced sleep-disordered breathing. Treatments to improve sleep quality, sleep-related breathing disorders, and quality of life in patients who use opioids chronically are discussed.

Effect of cardiac pacing on sleep-related breathing disorders: a systematic review.

Sleep-related breathing disorders are commonly encountered in the middle-aged population, negatively affecting quality of life. Central sleep apnea is associated with congestive heart failure, whereas obstructive sleep apnea is related to different pathophysiologic mechanisms, such as the total or partial occlusion of upper airway tract. Both sleep-related disorders have been associated with increased morbidity, and hence, they have been a target of several treatment strategies. The aim of this systematic review is to evaluate the effect of different types of cardiac pacing on sleep-related breathing disorders in patients with or without heart failure. The PubMed and Cochrane Central Register of Controlled Trials were examined from April 2015 to January 2016. Of the initial 360 studies, 22 eligible trials were analyzed. The included studies were classified according to the type of sleep disorder and the intervention undertaken. The evidence shows that cardiac resynchronization therapy but not atrial overdrive pacing can reduce apneic events in central sleep apnea patients. However, their effect on obstructive sleep apnea is controversial. It can be assumed that pacing cannot be used alone as treatment of sleep-related breathing disorders. Further research is needed in order to elucidate the effect of these interventions in sleep apnea patients.

Sleep-related breathing disorders in stage II essential hypertension

Background Sleep-related breathing disorders (SRBDs) are reported to be common among patients with hypertension (HTN). Objective Our aim was to use polysomnography (PSG) to objectively study the frequency and types of SRBDs in essential stage II HTN. Patients and methods We used an attended full PSG recording in a group of 20 patients suffering from stage II HTN and in a group of 20 age-matched and sex-matched controls. The Berlin Questionnaire was also administered to the patients. The patients were assessed for a history of smoking, fasting blood sugar, and BMI. Results We found that 70% of HTN patients had SRBDs: 15% had mild, 30% had moderate, and 25% had severe SRBDs. As for the controls, we found that 40% of controls had SRBDs: 20% had mild, 15% had moderate, and 5% had severe SRBDs. The overweight patients with HTN had a significantly higher hypopnea index compared with normal weight patients. The diabetic hypertensive group showed a lower sleep efficiency. In addition, all the high-risk patients identified by the Berlin Questionnaire showed evidence of SRBDs, but not all SRBD patients were identified as high-risk patients by the Berlin Questionnaire. Conclusion SRBD is very common in stage II HTN. Clinicians should be aware of this high prevalence and make use of the Berlin Questionnaire and PSG, as treatment for SRBDs can have a profound impact on these patients.

Influence of Inspiratory Muscle Training on Changes in Sleep Architecture in Older Adult - Epidoso Projects

Background: Senescence is accompanied by changes in sleep parameters including fragmentation and increased abnormal respiratory events (apneas/hypopneas obstructive and central) with hypoxemia. Objective: This project aims to investigate the influence of inspiratory muscle training through the Threshold® on sleep disorders. Methods: The study involved the participation of 38 older adult volunteers of both genders with sleep disorders confirmed by polysomnography. Chosen patients underwent laboratory evaluation, cardiorespiratory assessment and evaluation of sleep, forming two groups: control group (Threshold® unloaded) and experimental groups (Threshold® loaded). The study lasted 8 weeks and frequency of 7 times per week, lasting 60 minutes each session. Results: Showed a decrease in the fragmentation sleep and apnea/hypopnea index. Conclusion: These results made us suggest that inspiratory muscle training can be a good help in the treatment of sleep-related breathing disorders.

Non-invasive ventilation in the treatment of sleep-related breathing disorders: A review and update

Non-invasive mechanical ventilation (NIV) was originally used in patients with acute respiratory compromises or exacerbations of chronic respiratory diseases as an alternative to intubation. Over the last thirty years NIV has been used during the night in patients with stable chronic lung diseases such as obstructive sleep apnea, the overlap syndrome (COPD and obstructive sleep apnea), neuromuscular disorders, obesity-hypoventilation syndrome and in other conditions such as sleep disorders associated with congestive heart failure.In this review we discuss the different types of NIV, the specific conditions in which they can be used as well as the indications, recommendations, and evidence supporting the efficacy of NIV.

Non-invasive ventilation in the treatment of sleep-related breathing disorders: A review and update

Non-invasive mechanical ventilation (NIV) was originally used in patients with acute respiratory compromises or exacerbations of chronic respiratory diseases as an alternative to intubation. Over the last thirty years NIV has been used during the night in patients with stable chronic lung diseases such as obstructive sleep apnea, the overlap syndrome (COPD and obstructive sleep apnea), neuromuscular disorders, obesity-hypoventilation syndrome and in other conditions such as sleep disorders associated with congestive heart failure.In this review we discuss the different types of NIV, the specific conditions in which they can be used as well as the indications, recommendations, and evidence supporting the efficacy of NIV.

Noninvasive ventilation in the treatment of sleep-related breathing disorders: concise clinical review

Non-invasive mechanical ventilation (NIV) was originally used in patients with acute respiratory compromises or exacerbations of chronic respiratory diseases, as an alternative to the endotracheal tube. Over the last thirty years NPPV has been also used during the night in patients with stable chronic lung disease such as obstructive sleep apnea, the overlap syndrome (COPD and obstructive sleep apnea), neuromuscular disorders, obesity-hypoventilation syndrome, and in other conditions such as sleep disorders associated with congestive heart failure (Cheyne-Stokes respiration). In this review we discuss the different types of NPPV, the specific conditions in which they can be used and the indications, recommendations and evidence supporting the efficacy of NIV. Obstructive sleep apnea syndrome (OSA) is characterized commonly by instability of upper airway during sleep, reduction or elimination of airflow, daytime hypersomnolence, sleep disruption. It is a risk factor for cardiovascular and cerebrovascular disorders including hypertension, myocardial infarction and stroke. Optimizing patient acceptance and adherence to non-invasive ventilation treatment is challenging. The treatment of sleep-related disorders is a life-threatening condition. The optimal level of treatment should be determinate in a sleep laboratory. Side effects directly affecting the patient’s adherence to treatment are known. The most common are nasopharyngeal symptoms including increased congestion and rhinorrhea; these effects are related to reduced humidity of inspired gas. Humidification of delivered gas may improve these symptoms. Sleep specialists should review the results of objective testing with the patient. Education of the patient concerning the nature of the disorder and treatment options is important. General education on the impact of weight loss, sleep position, alcohol avoidance, risk factor modification and medication effects should be discussed. The patient should be counseled on the risks and management of drowsy driving. Patient education should optimally be delivered as a part of a multidisciplinary chronic disease management team.

Positionspapier zur Diagnostik und Therapie schlafbezogener Atmungsstörungen bei Erwachsenen

Sleep related breathing disorders (SRBD) impair quality of live, morbidity and mortality of affected patients seriously. Moreover, due to their high prevalence, they have a huge impact on health care systems and national economics. The members of the German Respiratory Society, the German Society of Sleep Research and Sleep Medicine, the Association of Pneumological Clinics and the Association of Pneumologists focus strongly on the diagnosis and treatment of SRBD in their daily work. Prevailing developments in the provision of patients with SRBD, have strong impact on the quality of diagnosis and treatment, on the supply of devices, on the follow-up care and on the role and duties of the physician. Therefore, the societies estimate it essential, to publish this common position paper based on the evaluation and discussion of the scientific literature, the clinical practice and a consensus process of an expert group which is published in more detail (Randerath et al., Pneumologie 2/2014, Somnologie 1/2014).

Poor versus good sleepers in patients under treatment for sleep-related breathing disorders: better is not good enough

Dear editor Recently we published a retrospective study in this journal which reported the significant relationship between nocturnal awakening, respectively high arousal index, and fatigue in 410 patients with sleep disorders admitted to our sleep laboratory.1 In this study we noticed that Pittsburgh Sleep Quality Index (PSQI) mean values2 were lower in patients who have been treated for sleep-related breathing disorders (SRBD) compared with either treatment-naive SRBD patients, or with patients with periodic limb movement disorder (PLMD), restless legs syndrome (RLS), or insomnia. However, this study was not focused on PSQI values and we did not classify the patients into good and poor sleepers according to the established PSQI cut-off (less than or equal to versus greater than five). The PSQI was initially developed to screen impaired subjective sleep quality in patients with insomnia and depression, but today it is widely used in sleep medicine in general. We now report the results of a classification of our patients into good and poor sleepers according to their PSQI values, using the PSQI-cut-off of ≤ or >5 that we performed subsequent to our original study. To our knowledge, there have been to date only a few studies in this issue that have investigated the use of PSQI in obstructive sleep apnea (OSA) patients. These studies had inconsistent findings and small sample sizes. Macey et al3 did not find a significant relationship between the apnea-hypopnea-index per hour of sleep (AHI) and PSQI values in 49 untreated OSA patients. Chihara et al4 reported a significant improvement of PSQI values after auto-adjusting positive airway pressure (APAP) with flexible positive airway pressure (C-Flex) (n=29), but not with APAP alone (n=28) or APAP in combination with fixed inspiration/expiration pressure difference (A-Flex) (n=28). Mermigkis et al5 found no significant improvement of PSQI values before and after continuous positive airway pressure (CPAP) in a small sample of 12 patients.

Non-Invasive Ventilation in the Treatment of Sleep-Related Breathing Disorders: Concise Clinical Review

Non-invasive mechanical ventilation (NIV) was originally used in patients with acute respiratory compromises or exacerbations of chronic respiratory diseases, as an alternative to the endotracheal tube. Over the last thirty years NPPV has been also used during the night in patients with stable chronic lung disease such as obstructive sleep apnea, the overlap syndrome (COPD and obstructive sleep apnea), neuromuscular disorders, obesity-hypoventilation syndrome, and in other conditions such as sleep disorders associated with congestive heart failure (Cheyne-Stokes respiration). In this review we discuss the different types of NPPV, the specific conditions in which they can be used and the indications, recommendations and evidence supporting the efficacy of NIV. Obstructive sleep apnea syndrome (OSA) is characterized commonly by instability of upper airway during sleep, reduction or elimination of airflow, daytime hypersomnolence, sleep disruption. It is a risk factor for cardiovascular and cerebrovascular disorders including hypertension, myocardial infarction and stroke. Optimizing patient acceptance and adherence to non-invasive ventilation treatment is challenging. The treatment of sleep-related disorders is a life-threatening condition. The optimal level of treatment should be determinate in a sleep laboratory. Side effects directly affecting the patient’s adherence to treatment are known. The most common are nasopharyngeal symptoms including increased congestion and rhinorrhea; these effects are related to reduced humidity of inspired gas. Humidification of delivered gas may improve these symptoms. Sleep specialists should review the results of objective testing with the patient. Education of the patient concerning the nature of the disorder and treatment options is important. General education on the impact of weight loss, sleep position, alcohol avoidance, risk factor modification and medication effects should be discussed. The patient should be counseled on the risks and management of drowsy driving. Patient education should optimally be delivered as a part of a multidisciplinary chronic disease management team.

Oral appliance therapy for sleep-related breathing disorders

Oral appliances that advance the mandible in relationship to the maxilla offer a relatively simple and viable option in the treatment of sleep-related breathing disorders. Oral appliances are indicated for the treatment of snoring and mild to moderate sleep apnea or for those who prefer this type of therapy to positive airway pressure therapies. This article will describe the different appliance types, the proposed mechanisms of action, fabrication, and management of adverse events that may occasionally occur with oral appliance therapy.