scholarly journals A randomized controlled trial of an ambulatory approach versus the hospital-based approach in managing suspected obstructive sleep apnea syndrome

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
David S. Hui ◽  
Susanna S. Ng ◽  
Kin-Wang To ◽  
Fanny W. Ko ◽  
Jenny Ngai ◽  
...  
Keyword(s):  
Waiting Time ◽  
Sleep Apnea Syndrome ◽  
Sleep Apnoea ◽  
Sleep Study ◽  
Cpap Treatment ◽  
Home Based ◽  
Obstructive Sleep ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Comparisons of home-based versus hospital-based approach in managing patients with suspected obstructive sleep apnoea syndrome(OSAS). A prospective, controlled CPAP parallel study of new referrals with suspected OSAS randomized into group A) home-based or B) hospital-based approach. Following detection of AHI ≥ 15/hr by Embletta sleep study (group A) or polysomnography (group B), patients received CPAP for 3 months after an overnight autoCPAP titration at home or in hospital respectively. Modified intention-to-treat analysis of those with AHI ≥ 15/hr on CPAP (n = 86 vs 86) showed no difference in Epworth sleepiness score, the primary endpoint, but greater improvement in Sleep-Apnoea-Quality-of-Life-Index[difference 0.3,(95%CI 0.02, 0.6), p = 0.033] at 3 months in group A. The mean costs for the patients in group A and group B were HK$8479(989) and HK$22,248(2407) respectively. The mean difference between groups was HK$-13,769(USD 1770 equivalent) per patient with 95% CI. (−14324, −13213), p < 0.001. The waiting time of patients with AHI ≥ 15/hr who were started on CPAP treatment from the first clinic consultation to the diagnostic sleep test, autoCPAP titration, and CPAP treatment was 189.6, 148.8 and 145.0 days shorter in group A than group B respectively. Home-based approach is non-inferior to hospital-based approach in managing patients with suspected OSAS, with shorter waiting time, and substantial cost savings.

Erythropoietin levels with treatment of obstructive sleep apnea

1995 ◽  
Vol 79 (4) ◽  
pp. 1278-1285 ◽  
Author(s):  
C. Cahan ◽  
M. J. Decker ◽  
J. L. Arnold ◽  
E. Goldwasser ◽  
K. P. Strohl
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Sleep Apnea Syndrome ◽  
Positive Pressure ◽  
Nasal Cpap ◽  
Cpap Treatment ◽  
Obstructive Sleep ◽  
The Mean ◽  
Continuous Positive Pressure

The effect of nasal continuous positive pressure (CPAP) treatment on erythropoietin (EPO) was examined by measuring diurnal serum EPO levels before and twice (over the 3rd day and over 1 day on recall after > or = 1 mo of therapy) after initiation of treatment in 12 obstructive sleep apnea syndrome patients with normal hemoglobin, hematocrit, creatinine, blood urea nitrogen, and albumin levels. Over each study day, oxygen saturation was measured by an ambulatory pulse oximetry system. Patients spent 27 +/- 9% (SE) of time below oxygen saturation of 88% vs. 2.1 +/- 0.6% after initiation of nasal CPAP treatment (P < 0.01). The number of desaturation events per hour of sleep before nasal CPAP treatment was 62 +/- 6 vs. 9 +/- 2 with nasal CPAP (P < 0.01). EPO levels measured by radioimmunoassay were drawn every hour before and at 3 days (n = 9) and before and at recall (n = 0) after initiation of CPAP therapy. The mean serum EPO level was higher before treatment (61 +/- 14 mU/ml) than that at 3 days (38 +/- 10 mU/ml, P < 0.01) or at recall (32 +/- 7 mU/ml, P < 0.01). We conclude that nasal CPAP treatment of sleep-disordered breathing will reduce diurnal levels of EPO.

scholarly journals Prospective Trial of CPAP in Community-Dwelling Adults with Down Syndrome and Obstructive Sleep Apnea Syndrome

2020 ◽  
Vol 10 (11) ◽  
pp. 844
Author(s):  
Elizabeth A Hill ◽  
Donna M Fairley ◽  
Linda J Williams ◽  
Goffredina Spanò ◽  
Sally-Ann Cooper ◽  
...  
Keyword(s):  
Down Syndrome ◽  
General Health ◽  
Controlled Trial ◽  
Sleep Apnea Syndrome ◽  
Prospective Trial ◽  
Sleep Apnoea ◽  
Community Dwelling ◽  
Control Group ◽  
Sleep Study ◽  
Obstructive Sleep

Adults with Down syndrome (DS) are predisposed to obstructive sleep apnoea (OSA), but the effectiveness and acceptability of continuous positive airway pressure treatment (CPAP) in this group has rarely been formally assessed. This study was designed as a pilot randomised, parallel controlled trial for one month, continuing as an uncontrolled cohort study whereby the control group also received the intervention. Symptomatic, community-dwelling DS individuals exhibiting ≥10 apnoeas/hypopneas per hour in bed on a Type 3 home sleep study were invited to participate in this study, with follow-up at 1, 3, 6, and 12 months from baseline. Measurements of sleepiness, behaviour, cognitive function and general health were undertaken; the primary outcome was a change in the pictorial Epworth Sleepiness Scale (pESS) score. Twenty-eight participants (19 male) were enrolled: age 28 ± 9 year; body mass index 31.5 ± 7.9 kg/m2; 39.6 ± 32.2 apnoeas/hypopneas per hour in bed; pESS 11 ± 6/24. The pilot randomised controlled trial at one month demonstrated no change between the groups. At 12 months, participant (p = 0.001) pESS and Disruptive (p < 0.0001), Anxiety/Antisocial (p = 0.024), and Depressive (p = 0.008) behaviour scores were reduced compared to baseline. Improvement was noted in verbal (p = 0.001) and nonverbal intelligence scores (p = 0.011). General health scores also improved (p = 0.02). At the end of the trial, 19 participants continued on treatment. Use of CPAP in adults with DS and OSA led to a number of significant, sustained improvements in sleepiness and behavioural/emotional outcomes at 12 months.

scholarly journals Factors Affecting Long-Term Compliance of CPAP Treatment—A Single Centre Experience

2021 ◽  
Vol 11 (1) ◽  
pp. 139
Author(s):  
Agata Gabryelska ◽  
Marcin Sochal ◽  
Bartosz Wasik ◽  
Przemysław Szczepanowski ◽  
Piotr Białasiewicz
Keyword(s):  
Sleep Apnoea ◽  
Factors Affecting ◽  
Cpap Treatment ◽  
Obstructive Sleep ◽  
Clinical Covariates ◽  
Single Centre Experience ◽  
The Mean ◽  
Mean Time ◽  
Cpap Failure

Continuous positive airway pressure (CPAP) has been the standard treatment of obstructive sleep apnoea/hypopnoea syndrome (OSA) for almost four decades. Though usually effective, this treatment suffers from poor long-term compliance. Therefore, the aim of our one centre retrospective study was to assess factors responsible for treatment failure and long-term compliance. Four hundred subsequent patients diagnosed with OSA and qualified for CPAP treatment were chosen from our database and compliance data were obtained from medical charts. Many differing factors kept patients from starting CPAP or led to termination of treatment. Overall, almost half of patients ended treatment during the mean time of observation of 3.5 years. Survival analysis revealed that 25% of patients failed at a median time of 38.2 months. From several demographic and clinical covariates in Cox’s hazard model, only the presence of a mild OSA, i.e., AHI (apnoea/hypopnoea index) below 15/h was a factor strongly associated with long term CPAP failure. The compliance results of our study are in line with numerous studies addressing this issue. Contrary to them, some demographic or clinical variables that we used in our survival model were not related to CPAP adherence.

scholarly journals Obstructive sleep apnea syndrome should be considered as a cause of nocturia in younger patients without other voiding symptoms

2016 ◽  
Vol 10 (7-8) ◽  
pp. 241 ◽  
Author(s):  
Takahiro Maeda ◽  
Koichi Fukunaga ◽  
Hirohiko Nagata ◽  
Mizuha Haraguchi ◽  
Eiji Kikuchi ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Old Patients ◽  
Voiding Symptoms ◽  
Obstructive Sleep ◽  
Group A ◽  
Apnea Syndrome ◽  
Group B

<p><strong>Introduction:</strong> This study aimed to evaluate urination frequency among patients with obstructive sleep apnea syndrome (OSAS) and the effect of continuous positive airway pressure (CPAP) treatment.</p><p><strong>Methods:</strong> We evaluated 138 men with moderate-to-severe OSAS by using polysomnography. Urination status was assessed at baseline and three months using the International Prostate Symptom Score and Overactive Bladder Symptom Score. Nocturia was defined as ≥2 nighttime urinations and patients were classified into Group A (&lt;50 years old with nocturia), Group B (≥50 years old with nocturia), and Group C (patients without nocturia). OSAS severity and other urinary symptoms were also evaluated.</p><p><strong>Results:</strong> Patients with nocturia exhibited more severe OSAS, compared to patients without nocturia (apnea-hypopnea index [AHI]: 52.0 vs. 44.7; p=0.021). Group A had the worst AHI, but did not have additional voiding symptoms, compared to Group B (p&lt;0.001). The number of urinations was significantly correlated with OSAS severity in &lt;50-year-old patients (p=0.013). CPAP reduced the number of urinations in Group A (75% of patients) and Group B (90% of patients). Patients with and without improved nocturia exhibited significant differences in their baseline OSAS severity (AHI: 53.7 vs. 37.3; p=0.042).</p><p><strong>Conclusions:</strong> OSAS severity was associated with the number of urinations in &lt;50-year-old patients. CPAP decreased the nocturia frequency in 85% of patients with nocturia and was most effective in patients with severe AHI. However, additional studies should evaluate voiding volume in order to elucidate the mechanism of nocturia in patients with OSAS.</p>

Craniofacial Cephalometric Evaluation in Habitual Snorers with and without Obstructive Sleep Apnea

1993 ◽  
Vol 109 (6) ◽  
pp. 1007-1013 ◽  
Author(s):  
Marco Zucconi ◽  
Luigi Ferini-Strambi ◽  
Stefano Palazzi ◽  
Chiara Curci ◽  
Emanuele Cucchi ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Mandibular Bone ◽  
Habitual Snoring ◽  
Facial Height ◽  
Obstructive Sleep ◽  
Group A ◽  
Group B

Cephalometry has been used to evaluate soft tissue and craniofacial dimensions in moderate-to-severe obstructive sleep apnea syndrome (OSA), but rarely in habitual snoring, the preclinical stage of OSA. This study deals with craniofacial bone measurements in a sample of 28 male habitual snorers with and without OSA, and 10 healthy non-snorers. Habitual snorers showed a significant decrease in sagittal dimensions of the cranial base and mandibular bone; there was also a shorter maxilla in group B (apnea plus hypopnea index more than 10) with respect to group A (apnea plus hypopnea index less or equal to 10). Facial height and angle dimensions were not different between snorers and non-snorers. These findings indicate that some habitual snorers may have some anatomic disposition to upper airway obstruction during sleep.

scholarly journals Effects of adenoidectomy and adenotonsillectomy on the components of Waldeyer ring

2017 ◽  
Vol 3 (2) ◽  
pp. 290 ◽  
Author(s):  
Vikram K. Bhat ◽  
Deekshith Shetty ◽  
Preetham H. Nagaiah
Keyword(s):  
Clinical Trial ◽  
High Risk ◽  
Recurrence Risk ◽  
Sleep Apnoea ◽  
Chronic Infections ◽  
Palatine Tonsils ◽  
Lingual Tonsil ◽  
Obstructive Sleep ◽  
Group A ◽  
Group B

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The consolidated effects of adenoidectomy alone and adenotonsillectomy on the Waldeyer ring need to be studied in children. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This was a clinical trial with a sample size of 100 in each of the two arms [Group A: adenoidectomy alone, Group B: adenotonsillectomy].  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">It was found that the association between adenoid recurrence (Risk 3 times) and palatine tonsil hypertrophy (Risk 11 times) in Group A patients at 3 and 6 months was extremely significant. Whereas lingual tonsil hypertrophy was found to be highly associated with Group B. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">If adenoidectomy alone is performed, there are high chances of hypertrophy of palatine tonsils, lateral pharyngeal bands and a high risk of adenoid recurrence. If adenoidectomy and tonsillectomy are performed together there is some chance of lingual tonsil hypertrophy. Hence it would be prudent to perform both the surgeries simultaneously in most children for better control of chronic infections and obstructive sleep apnoea </span>symptoms<span lang="EN-IN">.</span></p>

Sleep nasendoscopy: what benefit to the management of snorers?

1995 ◽  
Vol 109 (12) ◽  
pp. 1163-1165 ◽  
Author(s):  
Andrew E. Camilleri ◽  
Laxmi Ramamurthy ◽  
Philip H. Jones
Keyword(s):  
Success Rate ◽  
Obstructive Sleep Apnoea ◽  
Predictive Power ◽  
Sleep Apnoea ◽  
Grading System ◽  
Operative Results ◽  
Obstructive Sleep ◽  
Group A ◽  
Group B ◽  
Sleep Nasendoscopy

AbstractIt has been proposed that sleep nasendoscopy (SN) will improve the success rate of the uvulopalatopharyngoplasty operation by identifying those patients with palatal snoring. The aim of this study was to test the efficacy of SN in the management of snorers who do not have obstructive sleep apnoea. This study compared a group of 26 snorers managed without SN (group A) to a group of 27 snorers managed with SN (group B). The post-operative results of group A were 61 per cent cured, 27 per cent better and 8 per cent unchanged. Group B results were 76 per cent cured, 19 per cent better and 5 per cent unchanged. However, if patients with only palatal snoring had surgery, the results for group B would have been 94 per cent cured, 6 per cent better and 0 per cent unchanged (95 per cent C.I. of difference +0.14,+0.54, p = 0.017). The results confirm the predictive power of SN in identifying success following uvulopalatopharyngoplasty. A simple grading system is suggested to aid in treatment planning. Patients are divided into three categories on SN: palatal snorers, mixed snorers and non-palatal (tongue base) snorers. It is proposed that uvulopalatopharyngoplasty may cure palatal snorers but mixed snorers will need additional therapies to eliminate their snoring although uvulopalatopharyngoplasty may improve the symptoms.

Comparative Study of effectiveness of mobilization with movement (MWM) and End range mobilization (ERM) techniques in frozen shoulder

2018 ◽  
Vol 4 (4) ◽  
pp. 519-522
Author(s):  
Jeyakumar S ◽  
Jagatheesan Alagesan ◽  
T.S. Muthukumar
Keyword(s):  
Range Of Motion ◽  
Frozen Shoulder ◽  
Type I ◽  
Mean Values ◽  
Functional Activities ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Frozen shoulder is disorder of the connective tissue that limits the normal Range of motion of the shoulder in diabetes, frozen shoulder is thought to be caused by changes to the collagen in the shoulder joint as a result of long term Hypoglycemia. Mobilization is a therapeutic movement of the joint. The goal is to restore normal joint motion and rhythm. The use of mobilization with movement for peripheral joints was developed by mulligan. This technique combines a sustained application of manual technique “gliding” force to the joint with concurrent physiologic motion of joint, either actively or passively. This study aims to find out the effects of mobilization with movement and end range mobilization in frozen shoulder in Type I diabetics. Materials and Methods: 30 subjects both male and female, suffering with shoulder pain and clinically diagnosed with frozen shoulder was recruited for the study and divided into two groups with 15 patients each based on convenient sampling method. Group A patients received mobilization with movement and Group B patients received end range mobilization for three weeks. The outcome measurements were SPADI, Functional hand to back scale, abduction range of motion using goniometer and VAS. Results: The mean values of all parameters showed significant differences in group A as compared to group B in terms of decreased pain, increased abduction range and other outcome measures. Conclusion: Based on the results it has been concluded that treating the type 1 diabetic patient with frozen shoulder, mobilization with movement exercise shows better results than end range mobilization in reducing pain and increase functional activities and mobility in frozen shoulder.

Age related volume of cadaver-prostates in Bangladesh

1970 ◽  
Vol 4 (2) ◽  
pp. 74-77
Author(s):  
Rukshana Ahmed ◽  
Shamim Ara
Keyword(s):  
Prostate Gland ◽  
Age Groups ◽  
Clinical Settings ◽  
Cross Sectional ◽  
Medical College ◽  
Age Related ◽  
Group A ◽  
Key Words Prostate ◽  
The Mean ◽  
Group B

Pathological changes in the prostate gland occur commonly with advancing age including inflammation, atrophy, hyperplasia and carcinoma and a change in volume is also evident. Estimation of volume of prostate may be useful in a variety of clinical settings. A cross-sectional descriptive study was designed to see the changes in volume of the prostate with advancing age and done in the Department of Anatomy, Dhaka Medical College, Dhaka from August 2006 to June 2007. The study was performed on 70 post-mortem human prostates collected from the unclaimed dead bodies that were under examination in the Department of Forensic Medicine, Dhaka Medical College, Dhaka. The samples were divided into three age groups; group A (10-20 years), group B (21-40 years) and group C (41-70 years). Volume of the sample was measured by using the ellipsoid formula. The mean ± SD volume of prostate was 7.68 ± 3.64 cm3 in group A, 10.61 ± 3.99 cm3 in group B and 15.40 ± 6.31 cm3 in group C. Mean difference in volume between group A and group C, group B and group C were statistically significant (p<0.001). Statistically significant positive correlation was found between age and volume of prostate (r = + 0.579, p < 0.001). Key Words: Prostate; volume; Bangladeshi. DOI: 10.3329/imcj.v4i2.6501Ibrahim Med. Coll. J. 2010; 4(2): 74-77

Efficacy and Safety of Oral Ivermectin and Topical Permethrin in the Treatment of Scabies

2020 ◽  
Vol 33 (1) ◽  
pp. 41-47
Author(s):  
Mohsena Akhter ◽  
Ishrat Bhuiyan ◽  
Zulfiqer Hossain Khan ◽  
Mahfuza Akhter ◽  
Gulam Kazem Ali Ahmad ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Close Contact ◽  
Randomized Study ◽  
Sarcoptes Scabiei ◽  
Efficacy And Safety ◽  
Common Skin ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B

Background: Scabies is one of the most common skin diseases in our country. It is caused by the mite Sarcoptes scabiei var hominis, which is an ecto-parasite infesting the epidermis. Scabies is highly contagious. Prevalence is high in congested or densely populated areas. Individuals with close contact with an affected person should be treated with scabicidal which is available in both oral and topical formulations. The only oral but highly effective scabicidal known to date is Ivermectin. Amongst topical preparations, Permethrin 5 % cream is the treatment of choice. Objective: To evaluate the efficacy & safety of oral Ivermectin compared to topical Permethrin in the treatment of scabies. Methodology: This prospective, non-randomized study was conducted at the out-patient department of Dermatology and Venereology of Shaheed Suhrawardy Medical College & Hospital over a period of 6 months, from August 2016 to January 2017. The study population consisted of one hundred patients having scabies, enrolled according to inclusion criteria. They were divided into two groups. group A was subjected to oral Ivermectin and the group B to Permethrin 5% cream. Patients were followed up on day 7 and 14 for assessment of efficacy and safety. Result: The mean scoring with SD in group A (Ivermectin) and group B (Permethrin) were 8.26 ± 2.22 and 7.59 ± 2.01 respectively at the time of observation. The difference between the mean score of the two group is not significant (p=0.117) the mean scoring with SD in group A and group B were 4.54 ± 2.05 and 1.64 ± 1.84 respectively at 7thdays. The difference between the mean score of the two group is significant (p<0.001). The mean scoring with SD in group A and group B were 2.68± 2.35 and .36± 1.10 respectively at 14th day difference between the mean score of the group is significant (p<0.001). Conclusion: Topical application of permethrin 5% cream is more effective and safer than oral Ivermectin in the treatment of scabies. TAJ 2020; 33(1): 41-47

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