scholarly journals 0645 The Association of Hypoglossal Nerve Stimulator Adherence and Insomnia

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A246-A246
Author(s):  
M Sharma ◽  
A Chacko ◽  
M Rosenthal ◽  
M Khan
Keyword(s):  
Hypoglossal Nerve ◽  
Sleep Problems ◽  
Medical Center ◽  
Eligible Patient ◽  
Upper Airway ◽  
Severity Index ◽  
Nerve Stimulator ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Ohio State University

Abstract Introduction The gold standard for treatment of Obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). However, CPAP adherence is less than 50%. An alternative treatment is the hypoglossal nerve stimulator (HNS) which displaces the tongue anteriorly to treat upper airway obstruction. Difficulties tolerating HNS are related to stimulation discomfort. In this study, we investigated insomnia as a barrier to adherence. Methods Patients implanted and activated with HNS at The Ohio State University Wexner Medical Center between 2015 and 2019 were eligible. Patient usage data from the previous six months was obtained and subjects were asked to complete an Insomnia Severity Index (ISI). Participants were divided into adherent (defined as use ≥28 hours/week) and non-adherent (use <28 hours/week). Results 32 subjects were enrolled, 22 in the adherent group and 10 in the non-adherent group. There was a significant decrease in mean treatment AHI in both groups: 36.25 to 11.14 in the adherent group and 36.30 to 15.69 in the non-adherent group (p<0.0001). The mean ISI score in the adherent group was 6.84 which is consistent with no clinically significant insomnia and 8.67 in the non-adherent group consistent with subthreshold insomnia. However, there was not a statistically significant difference between the two groups (p=0.441). There was a statistically significant higher score for the question “Do you worry about your sleep problems?” in the non-adherent group (1.78, SD1.39 vs 0.74. SD 0.81) (p =0.018). Conclusion This study suggests that patients who have difficulty with sleep may have more difficulty with HNS adherence than those who do not. In particular the question stating “Do you worry about your sleep problems” had a statistically higher score in the non-adherent group. Prospective studies are needed to further explore a possible relationship between insomnia and HNS adherence. Support N/A

Adverse Events in Hypoglossal Nerve Stimulator Implantation: 5-Year Analysis of the FDA MAUDE Database

2020 ◽  
pp. 019459982096006
Author(s):  
Nikhil Bellamkonda ◽  
Travis Shiba ◽  
Abie H. Mendelsohn
Keyword(s):  
Adverse Events ◽  
Large Scale ◽  
Hypoglossal Nerve ◽  
Upper Airway ◽  
Perioperative Period ◽  
Nerve Stimulator ◽  
Upper Airway Stimulation ◽  
Patient Reports ◽  
Obstructive Sleep ◽  
National Patient

Objective Use of hypoglossal nerve stimulator implantation has dramatically improved the surgical treatment of multilevel airway collapse during obstructive sleep apnea (OSA). Understanding causes of adverse events and their impact on patients undergoing stimulator implantation will help improve patient preparation and surgical practices to avoid future complications. Study Design This study is a retrospective review of the US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database, a publicly available voluntary reporting system. Setting National patient event database. Methods The MAUDE database was searched for reports associated with the terms “hypoglossal nerve stimulator” and “Inspire,” being the only currently FDA-approved system for upper airway stimulation for OSA. All records were searched with the events limited in dates between May 2014 and September 2019. Results A total of 132 patient reports were identified over the 5-year inclusion period, containing 134 adverse events. The reported adverse events resulted in 32 device revision procedures as well as 17 explantations. Device migration and infection were 2 of the most commonly reported adverse events. Complications not witnessed in previous large-scale clinical trials included pneumothorax, pleural effusion, and lead migration into the pleural space. Conclusion Previous data have demonstrated hypoglossal nerve stimulator implantation results in reliable OSA improvement. However, a number of technical difficulties and complications still exist during the perioperative period, which should be communicated to patients during the surgical consent process.

Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽  
2021 ◽  
pp. 1-8
Author(s):  
Lifeng Li ◽  
Demin Han ◽  
Hongrui Zang ◽  
Nyall R. London
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Nasal Surgery ◽  
Subjective Sleep Quality ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

<b><i>Objective:</i></b> The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. <b><i>Methods:</i></b> Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. <b><i>Results:</i></b> By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (<i>p</i> &#x3c; 0.05), while the Apnea-Hypopnea Index (AHI) changed little (<i>p</i> = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all <i>p</i> &#x3c; 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (<i>p</i> &#x3c; 0.05), except with the AHI (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

Reduction in Obstructive Breathing Events During Body Rocking: A Controlled Polygraphic Study in Preterm and Full-Term Infants

PEDIATRICS ◽  
1995 ◽  
Vol 96 (1) ◽  
pp. 64-68
Author(s):  
J. Groswasser ◽  
M. Sottiaux ◽  
E. Rebuffat ◽  
T. Simon ◽  
M. Vandeweyer ◽  
...  
Keyword(s):  
Eye Movement ◽  
Preterm Infants ◽  
Upper Airway ◽  
Periodic Breathing ◽  
Full Term ◽  
Rapid Eye Movement ◽  
Term Infants ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Obstructive Sleep Apneas

Objective. To investigate the effect of body rocking on infant respiratory behavior during sleep. Methods. Eighteen infants with documented obstructive sleep apneas were studied. There were eight premature infants with persistent bradycardias and 10 infants born full-term, admitted after an idiopathic apparent life-threatening event. No cause for the obstructive apneas was found. The infants were recorded with polygraphic techniques during two successive nights. They were randomly assigned to a rocking or a nonrocking mattress. The conditions were reversed the following night, in a crossover design. Results. In both groups of infants, no significant difference was seen between the two consecutive nights for most of the variables studied: total sleep time, the proportion of non-rapid-eye-movement and rapid-eye-movement sleep, the number of arousals, the number and maximal duration of central apneas, the frequency of periodic breathing, the level of oxygen saturation, and heart rate. During the nonrocking nights, all infants had repeated obstructive breathing events. In seven of the eight preterm infants and in nine of the 10 full-term subjects, body rocking was associated with a significant decrease in the frequency of obstructive events. During rocking, in the preterm infants the obstructions fell from a median of 2.5 to 1.8 episodes per hour (P = .034). In the full-term infants, rocking reduced the obstructive events from a median of 1.5 obstructions per hour to 0.7 (P = .005). No difference was seen for the duration of the obstructive episodes. Conclusion. In preterm and full-term infants prone to obstructive sleep apneas, gentle side-to-side body rocking is associated with a significant decrease in the frequency of upper-airway obstructions.

scholarly journals O013 The pathogenesis of obstructive sleep apnea in individuals with comorbid insomnia and obstructive sleep apnoea (COMISA)

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A6-A7
Author(s):  
E Brooker ◽  
L Thomson ◽  
S Landry ◽  
B Edwards ◽  
S Drummond
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Severity Index ◽  
Loop Gain ◽  
Comorbid Insomnia ◽  
Arousal Threshold ◽  
Obstructive Sleep ◽  
High Loop ◽  
Insomnia Severity

Abstract Obstructive sleep apnea (OSA) and Insomnia are prevalent sleep disorders which are highly comorbid. This frequent co-occurrence suggests a shared etiology may exist. OSA is caused by the interaction of four pathophysiological traits: a highly collapsible upper airway, elevated loop gain, a low arousal threshold, and poor muscle compensation. No study has ascertained whether these traits are influenced by insomnia. We aimed to quantify the four traits which contribute to OSA in individuals diagnosed with comorbid insomnia and OSA (COMISA). We non-invasively determined these traits in 52 COMISA patients (Age: 56±14 years) with mild-to-severe OSA (AHI=21.2±10.63 events/h) using polysomnography. Our results indicated that 83% of COMISA patients had a low arousal threshold and only 2% of patients exhibited a highly collapsible airway using previously defined thresholds. Multiple linear regression revealed the arousal threshold (b=0.24, 95%CI[0.11, 0.37], β=0.47, p&lt;0.001) and loop gain (b=23.6, 95%CI[7.02, 40.18], β=0.33, p&lt;0.01) were the strongest predictors of OSA severity in our sample. There was no significant relationship between the arousal threshold and insomnia severity measured by the insomnia severity index (ISI). Further work is being performed to compare these findings with a matched sample of OSA only participants. Our preliminary findings demonstrate OSA in COMISA is characterized by a mildly collapsible airway/low arousal threshold phenotype and is largely driven by non-anatomical factors including a low arousal threshold and high loop gain. OSA treatments which are effective in patients with mild anatomical compromise and raise the arousal threshold may provide therapeutic benefit in COMISA patients.

Demographic and Clinical Characteristics Associated With Adherence to Guideline-Based Polysomnography in Children With Down Syndrome

2020 ◽  
pp. 019459982095483
Author(s):  
Philip D. Knollman ◽  
Christine H. Heubi ◽  
Susan Wiley ◽  
David F. Smith ◽  
Sally R. Shott ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Down Syndrome ◽  
Clinical Characteristics ◽  
Medical Center ◽  
Demographic Data ◽  
Children With Down Syndrome ◽  
Medical Need ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
History Of

Objectives To compare the demographic and clinical characteristics of children with Down syndrome who did and did not receive polysomnography to evaluate for obstructive sleep apnea after publication of the American Academy of Pediatrics’ guidelines recommending universal screening by age 4 years. Study Design Retrospective cohort study. Setting Single tertiary pediatric hospital. Methods Review was conducted of children with Down syndrome born between 2007 and 2012. Children who obtained polysomnography were compared with children who did not, regarding demographic data, socioeconomic status, and comorbidities. Results We included 460 children with Down syndrome; 273 (59.3%) received at least 1 polysomnogram, with a median age of 3.6 years (range, 0.1-8.9 years). There was no difference in the distribution of sex, insurance status, or socioeconomic status between children who received polysomnography and those who did not. There was a significant difference in race distribution ( P = .0004) and distance from home to the medical center ( P < .0001) between groups. Among multiple medical comorbidities, only children with a history of hypothyroidism ( P = .003) or pulmonary aspiration ( P = .01) were significantly more likely to have obtained polysomnography. Conclusions Overall, 60% of children with Down syndrome obtained a polysomnogram. There was no difference between groups by payer status or socioeconomic status. A significant difference in race distribution was noted. Proximity to the medical center and increased medical need appear to be associated with increased likelihood of obtaining a polysomnogram. This study illustrates the need for improvement initiatives to increase the proportion of patients receiving guideline-based screening.

scholarly journals 0674 Association Between Lateral Wall Collapse On Drug-induced Sleep Endoscopy And MRI Findings In Hypoglossal Nerve Stimulator Patients

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A257-A257
Author(s):  
Y Liu ◽  
A Wiemken ◽  
A Steffen ◽  
R Schwab ◽  
R Dedhia
Keyword(s):  
Hypoglossal Nerve ◽  
Lateral Wall ◽  
Inverse Association ◽  
Sleep Endoscopy ◽  
Nerve Stimulator ◽  
Mri Findings ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep ◽  
The Mean

Abstract Introduction Hypoglossal nerve stimulator (HNS) is an effective and safe alternative therapy for obstructive sleep apnea (OSA) in selected patients. Emerging evidence demonstrates that the outcome of HNS is variable, especially for patients with lateral wall collapse on drug-induced sleep endoscopy (DISE). Awake magnetic resonance imaging (MRI) offers detailed visualization of soft tissue. The aim of this study was to determine whether lateral wall collapse on DISE is associated with awake MRI findings in prospective HNS patients. Methods Patients from the ADHERE Registry, an international outcomes study for UAS were used for this study. At baseline, awake, supine MRI scans of each subject’s head and neck region were collected. The distance between the lateral walls was measured at the level of the hard palate, located by the appearance of the posterior nasal spine, using axial T2 turbo spin echo MRI. DISE assessments of the upper airway were recorded using the VOTE classification. All statistical analyses were performed using SPSS IBM 19.0 software program. Kendall’s Tau-b was performed to compare the association between VOTE scoring and MRI findings. Results Twenty-seven patients (N = 3 female, AHI = 28.8±10.5, BMI = 28.8 ±3.8 kg/m2, age = 53±9.9 years) were included in this study. The mean overall VOTE score and lateral wall score was 5.6±1.1 and 0.5±0.5, respectively. The mean lateral wall distance was 18.8±3.2 mm. A significant, inverse association was found between MRI lateral wall measurement and oropharyngeal lateral wall scoring on DISE (T=-.332,p=0.042) but not other anatomic subsites on DISE. Conclusion In our study, greater lateral wall collapse on DISE corresponded to narrower lateral airway distance on MRI. The utility of static imaging modalities such as MRI as patient selection tools for HNS warrants further study. Support Drs. Dedhia and Schwab receive related support for this project from the National Institutes of Health (NHBLI R01HL144859)

scholarly journals The Impact of Upper Airway Stimulation on Swallowing Function

2019 ◽  
Vol 98 (8) ◽  
pp. 496-499 ◽  
Author(s):  
Colin Huntley ◽  
Adam Vasconcellos ◽  
Michael Mullen ◽  
David W. Chou ◽  
Haley Geosits ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Swallowing Function ◽  
Upper Airway Stimulation ◽  
Obstructive Sleep ◽  
The Mean ◽  
The Impact

Objective: To evaluate the impact of upper airway stimulation therapy (UAS) on swallowing function in patients with obstructive sleep apnea. Study Design: Prospective cohort study. Setting: Academic medical center. Participants and Outcome Measures: We recorded demographic, preoperative polysomnogram (PSG), operative, and postoperative PSG data. We assessed the patients swallowing function using the Eating Assessment Tool (EAT-10) dysphagia questionnaire. This was administered both pre- and postoperatively. The postoperative EAT-10 survey was administered at least 3 months after UAS implantation. Results: During the study period, 27 patients underwent UAS implantation, completed the pre- and postoperative EAT-10 questionnaire, met inclusion/exclusion criteria, and were included in the study. The cohort consisted of 16 men and 11 women with a mean age of 63.63 years. The mean preoperative BMI, Epworth Sleepiness Scale (ESS), and Apnea Hypopnea Index (AHI) were 29.37, 10.33, and 34.90, respectively. The mean postoperative ESS and AHI were 5.25 and 7.59, respectively. These were both significantly lower than the preoperative values ( P = .026 and P < .001). The mean pre- and postoperative EAT-10 scores were 0.37 and 0.22, respectively ( P = .461). Conclusion: Our data suggest that UAS likely does not lead to postoperative dysphagia.

Assessment of the Relationship between Sleep Disorders and Circadian Type in Nurses with Shift and Daytime Work

2020 ◽  
Author(s):  
Lahya Afshari Saleh ◽  
Amir Rezaei Ardani ◽  
Ehsan Rafeemanesh ◽  
Pegah Kheradmand
Keyword(s):  
Circadian Rhythms ◽  
Sleep Disorders ◽  
Shift Work ◽  
Sleep Problems ◽  
Work Group ◽  
Severity Index ◽  
Teaching Hospitals ◽  
Cross Sectional ◽  
Significant Difference ◽  
Circadian Type

Background and Objective: Chronotypes vary in different people, and the daily function outside of the framework of this rhythm can affect the quality of work. This study aimed to investigate the association between sleep disorders and chronotypes among the shift and day work nurses. Materials and Methods: This cross-sectional study was performed among nurses in two teaching hospitals in Mash-had, Iran, during 2016-2017. A total of 180 randomly-selected nurses were divided into shift work and day work groups. Participants completed demographic information form, Circadian Type Inventory (CTI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). Results: A total of 180 female nurses (90 participants in each group) with a mean age of 35.62 ± 4.07 years were stud-ied. The prevalence of rigid circadian rhythm in the day work group (93.3%) was significantly (P = 0.004) higher than shift work group (78.9%). However, the groups did not show any significant difference regarding the languid/vigorous (LV) index of the CTI (P = 0.080). There was a significant difference in the mean score of CTI between individuals with rigid and flexible circadian rhythms in the shift work group (P = 0.021). Conclusion: In the present study, although there was no association between circadian type and sleep problems includ-ing insomnia and daytime sleepiness in shift work nurses, we observed the capability of coping with working in the rotating shifts in nurses with flexible circadian rhythms.  

Investigation of smell and taste function in patients with obstructive sleep apnoea syndrome

2019 ◽  
Vol 133 (05) ◽  
pp. 376-379 ◽  
Author(s):  
A Yenigun ◽  
N Degirmenci ◽  
S S Goktas ◽  
R Dogan ◽  
O Ozturan
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Obstructive Sleep Apnoea Syndrome ◽  
Upper Respiratory Tract ◽  
Taste Test ◽  
Sleep Apnoea Syndrome ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Taste And Smell

AbstractObjectiveThis study investigated the relationship between disease severity and taste and smell functions in patients with obstructive sleep apnoea syndrome.MethodsA total of 65 patients with recurrent upper airway obstruction during sleep were included. Participants were divided into four groups according to apnoea-hypopnoea index, obtained on polysomnography. Smell and taste tests were performed on these patients.ResultsA significant difference was observed between the smell thresholds of the groups for the identification test (p = 0.016). In the taste test, significant differences were observed between the groups in terms of sweet, sour, salty and bitter taste test thresholds (p = 0.029, p = 0.0005, p = 0.001 and p = 0.017, respectively).ConclusionAs sleep apnoea severity increased (according to the apnoea-hypopnoea index) in obstructive sleep apnoea syndrome patients, the taste and smell thresholds decreased due to the effect of neuropathy and inflammation in the upper respiratory tract.

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