0982 Decide2Rest: A Program for Promoting Person-centered Obstructive Sleep Apnea (OSA) Treatment

Continuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea (OSA). Although CPAP was originally applied with a nasal mask, various interfaces are currently available. This study reviews theoretical concepts and questions the premise that all types of interfaces produce similar results. We revised the evidence in the literature about the impact that the type of CPAP interface has on the effectiveness of and adherence to OSA treatment. We searched the PubMed database using the search terms "CPAP", "mask", and "obstructive sleep apnea". Although we identified 91 studies, only 12 described the impact of the type of CPAP interface on treatment effectiveness (n = 6) or adherence (n = 6). Despite conflicting results, we found no consistent evidence that nasal pillows and oral masks alter OSA treatment effectiveness or adherence. In contrast, most studies showed that oronasal masks are less effective and are more often associated with lower adherence and higher CPAP abandonment than are nasal masks. We concluded that oronasal masks can compromise CPAP OSA treatment adherence and effectiveness. Further studies are needed in order to understand the exact mechanisms involved in this effect.

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Adenotonsillectomy for the Treatment of Obstructive Sleep Apnea in Children with Prader-Willi Syndrome: A Meta-analysis

Otolaryngology ◽

10.1177/0194599819893115 ◽

2019 ◽

Vol 162 (2) ◽

pp. 168-176

Author(s):

Chia-Hsuan Lee ◽

Wei-Chung Hsu ◽

Jenq-Yuh Ko ◽

Te-Huei Yeh ◽

Ming-Tzer Lin ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Success Rate ◽

Cochrane Review ◽

Velopharyngeal Insufficiency ◽

Apnea Hypopnea Index ◽

Prader Willi Syndrome ◽

Postoperative Changes ◽

Obstructive Sleep ◽

Osa Treatment

Objective Adenotonsillectomy outcomes in obstructive sleep apnea (OSA) treatment among children with Prader-Willi syndrome (PWS) remain unclear. This study aimed to elucidate the effectiveness of adenotonsillectomy in OSA treatment among children with PWS. Data Source PubMed, MEDLINE, Embase, and Cochrane Review up to February 2019. Review Methods The registry number of the protocol published on PROSPERO was CRD42015027053. Two authors independently searched the relevant database. Polysomnography outcomes in these children were examined, including net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum and mean oxygen saturation, the overall success rate for a postoperative AHI <1, and the overall success rate for a postoperative AHI <5. Results Six studies with 41 patients were analyzed (mean age, 5.0 years; 55% boys; mean sample size, 6.8 patients). All children had PWS and received adenotonsillectomy for the treatment of OSA. The AHI was 13.1 events per hour (95% CI, 11.0-15.1) before surgery and 4.6 events per hour (95% CI, 4.1-5.1) after surgery. The mean change in the AHI was a significant reduction of 8.0 events per hour (95% CI, −10.8 to −5.1). The overall success rate was 21% (95% CI, 11%-38%) for a postoperative AHI <1 and 71% (95% CI, 54%-83%) for a postoperative AHI <5. Some patients developed velopharyngeal insufficiency postoperatively. Conclusion Adenotonsillectomy was associated with OSA improvement among children with PWS. However, residual OSA was frequently observed postoperatively in these patients.

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The Impact of Obstructive Sleep Apnea on Balance, Gait, and Falls Risk: A Narrative Review of the Literature

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa014 ◽

2020 ◽

Vol 75 (12) ◽

pp. 2450-2460 ◽

Cited By ~ 1

Author(s):

David Stevens ◽

Brianna Jackson ◽

Jayne Carberry ◽

James McLoughlin ◽

Chris Barr ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Disturbances ◽

Large Scale ◽

Falls Risk ◽

Obstructive Sleep ◽

Increased Risk ◽

Risk Of Falls ◽

Osa Treatment ◽

The Impact

Abstract Falls-related hospitalization and injury rates are steadily increasing globally due to a growth in the aging population, and the associated health problems that increase risk of falls. One such associated health problem is sleep disturbances and disorders. Recent cohort studies have shown that subjectively reported poor quality sleep is associated with an increased risk of falls. Obstructive sleep apnea (OSA) is a common sleep disorder characterized by the repetitive reductions, or cessation, of airflow. Some studies have shown that OSA impairs posture/balance and gait with nocturnal hypoxemia the likely main cause. Emerging evidence suggests that treating OSA by continuous positive airway pressure (CPAP) can improve gait, but no studies to date have examined the effect of CPAP on posture/balance. The overall control of balance relies on a complex interaction between several physiological functions including vestibular, muscle, visual, and cognitive functions. We postulate that OSA impacts balance by affecting these different systems to various degrees, with the nocturnal hypoxic burden likely playing an important role. Importantly, these impairments in balance/posture and possible falls risk may be alleviated by OSA treatment. Larger mechanistic studies are needed to properly elucidate how OSA affects falls risk and future large-scale randomized control trials are needed to determine the effectiveness of OSA treatment in reducing the risk of falls.

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Polysomnographic Outcomes Before and After Skeletal Surgeries for the Treatment of Obstructive Sleep Apnea

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.03.11906 ◽

2021 ◽

Vol 104 (3) ◽

pp. 445-452

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Apnea Hypopnea Index ◽

Success Rates ◽

Maxillomandibular Advancement ◽

Obstructive Sleep ◽

Before And After ◽

Hyoid Suspension ◽

Group 2 ◽

Osa Treatment

Objective: To evaluate polysomnographic (PSG) outcomes after common skeletal surgeries for the treatment of obstructive sleep apnea (OSA) in Thai patients. Materials and Methods: The retrospective study included OSA patients aged 18 years and older treated by hyoid suspension (HS) plus uvulopalatopharyngoplasty (UPPP) (Group 1), genioglossus advancement (GA) plus tongue base radiofrequency (TBRF) (Group 2), and maxillomandibular advancement (MMA) (Group 3) at Siriraj Hospital between January 2007 and October 2018. Those with incomplete PSG data were excluded. The primary outcome was the apnea-hypopnea index (AHI). Secondary outcomes were other PSG parameters and postoperative complications. Results: Twenty-four patients including 22 males and 2 females were included. Group1 (n=11), median AHI decreased from 45.4 to 24.1 events/hour (p=0.17), while lowest oxygen saturation (LSAT) changed from 72.0% to 71.0% (p=0.11). Group2 (n=3) median AHI decreased from 64.7 to 51.4 events/hour (p=0.11), LSAT increased from 76.0% to 79.0% (p=1.0), and rapid eye movement (REM) sleep increased from 0.0% to 12.4% (p=0.11). Group3 (n=12) median AHI decreased from 68.5 to 7.8 events/hour (p<0.002), LSAT increased from 75.5% to 88.0% (p=0.04), and REM increased from 0.0% to 21.5% (p=0.01). Surgical success rates as defined by Sher’s criteria or a postoperative AHI of less than five events/hour were 44.4%, 33.3%, and 66.6% in patients in groups 1, 2, and 3, respectively. Common surgical complications included bleeding, mental or perioral paresthesia, and malocclusion after MMA. Conclusion: The skeletal surgeries significantly improved some PSG parameters, and thus may be viable options for OSA treatment in Thai patients. Keywords: Obstructive sleep apnea, Skeletal surgery, Hyoid suspension, Genioglossus advancement, Maxillomandibular advancement, Thai

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Obstructive Sleep Apnea in Women: Specific Issues and Interventions

BioMed Research International ◽

10.1155/2016/1764837 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 30

Author(s):

Alison Wimms ◽

Holger Woehrle ◽

Sahisha Ketheeswaran ◽

Dinesh Ramanan ◽

Jeffery Armitstead

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Correct Diagnosis ◽

Upper Airway ◽

Fat Distribution ◽

Apnea Hypopnea Index ◽

Optimal Care ◽

Obstructive Sleep ◽

Osa Treatment ◽

Degrees Of Severity

Obstructive sleep apnea (OSA) has traditionally been seen as a male disease. However, the importance of OSA in women is increasingly being recognized, along with a number of significant gender-related differences in the symptoms, diagnosis, consequences, and treatment of OSA. Women tend to have less severe OSA than males, with a lower apnea-hypopnea index (AHI) and shorter apneas and hypopneas. Episodes of upper airway resistance that do not meet the criteria for apneas are more common in women. Prevalence rates are lower in women, and proportionally fewer women receive a correct diagnosis. Research has also documented sex differences in the upper airway, fat distribution, and respiratory stability in OSA. Hormones are implicated in some gender-related variations, with differences between men and women in the prevalence of OSA decreasing as age increases. The limited data available suggest that although the prevalence and severity of OSA may be lower in women than in men, the consequences of the disease are at least the same, if not worse for comparable degrees of severity. Few studies have investigated gender differences in the effects of OSA treatment. However, given the differences in physiology and presentation, it is possible that personalized therapy may provide more optimal care.

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Hypoglossal nerve stimulation [HGNS] for Obstructive Sleep Apnea [OSA] treatment – a review

Polski Przegląd Otorynolaryngologiczny ◽

10.5604/01.3001.0010.5196 ◽

2017 ◽

Vol 6 (3) ◽

pp. 66-71

Author(s):

Małgorzata Bilińska ◽

Kazimierz Niemczyk

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Hypoglossal Nerve ◽

Muscle Tone ◽

Upper Airway ◽

Western Society ◽

Obstructive Sleep ◽

Increased Risk ◽

Osa Treatment ◽

Oncologic Diseases

Obstructive sleep apnea (OSA) is characterized by recurrent periods of upper airway obstruction (hypopneas and apneas) during sleep. It leads to repeated oxyhemoglobin desaturations, nocturnal hypercapnia, and arousals. Common symptoms include loud snoring with breathing interruptions. Excessive daytime sleepiness and cognitive impairment occur. Obstructive sleep apnea is a major cause of morbidity and mortality in Western society. Its association with an increased risk of development and progression of neurocognitive, metabolic, cardiovascular and oncologic diseases and complications is well described. The significant factor in OSA pathogenesis is reduced muscle tone in the tongue and upper airway. In the recent years, devices providing neurostimulation of the hypoglossal nerve (HGNS) were developed as an alternative for noncompliant CPAP (continuous positive airway pressure) patients. Clinical trials suggest that electrical stimulation of the hypoglossal nerve is effective. This is considered to be one of the targets of neurostimulation in the treatment of obstructive sleep apnea (OSA).

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Association between the degree of obstructive sleep apnea and the severity of COVID-19: An explorative retrospective cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0257483 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257483

Author(s):

J. P. T. F. Ho ◽

H. C. M. Donders ◽

N. Zhou ◽

K. Schipper ◽

N. Su ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Obstructive Sleep Apnea ◽

Regression Analysis ◽

Sleep Apnea ◽

Patient Data ◽

Sleep Study ◽

Icu Admission ◽

Obstructive Sleep ◽

Osa Treatment

Obstructive sleep apnea (OSA) on its own, as well as its risk factors, have been found to be associated with the outcome of Coronavirus disease 2019 (COVID-19). However, the association between the degree of OSA and COVID-19 severity is unclear. Therefore, the aim of the study was to evaluate whether or not parameters to clinically evaluate OSA severity and the type of OSA treatment are associated with COVID-19 severity. Patient data from OSA patients diagnosed with COVID-19 were reviewed from outpatients from the Isala Hospital and patients admitted to the Isala Hospital, starting from March until December 2020. Baseline patient data, sleep study parameters, OSA treatment information and hospital admission data were collected. Apnea hypopnea index (AHI), low oxyhemoglobin desaturation (LSAT), oxygen desaturation index (ODI), respiratory disturbance index (RDI), and the type of OSA treatment were regarded as the independent variables. COVID-19 severity–based on hospital or intensive care unit (ICU) admission, the number of days of hospitalization, and number of intubation and mechanical ventilation days–were regarded as the outcome variables. Multinomial regression analysis, binary logistic regression analysis, and zero-inflated negative binomial regression analysis were used to assess the association between the parameters to clinically evaluate OSA severity and COVID-19 severity. A total of 137 patients were included. Only LSAT was found to be significantly associated with the COVID-19 severity (p<0.05) when COVID-19 severity was dichotomized as non-hospitalized or hospitalized and ICU admission or death. Therefore, our findings showed that LSAT seems to be a significant risk factor for COVID-19 severity. However, the degree of OSA–based on AHI, ODI, and RDI–and OSA treatment were not found to be risk factors for COVID-19 severity when looking at hospital or ICU admission, the number of days of hospitalization, and number of intubation and mechanical ventilation days.

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Orthodontic Management of Adult Sleep Apnea: Clinical Case Reports

10.5772/intechopen.101193 ◽

2021 ◽

Author(s):

Lahcen Ousehal ◽

Soukaina Sahim ◽

Hajar Bouzid ◽

Hakima Aghoutan ◽

Asmaa El Mabrak ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Case Reports ◽

Upper Airway ◽

Public Health Problem ◽

Airway Collapse ◽

Upper Airway Collapse ◽

Obstructive Sleep ◽

Potential Risks ◽

Osa Treatment

Obstructive sleep apnea (OSA) is a serious public health problem that has important impacts on the quality and life expectancy of affected individuals. It is characterized by repetitive upper airway collapse during sleep. OSA requires a multidisciplinary plan of treatment. There is increasing interest in the role of the orthodontist both in screening for adult obstructive sleep apnea and its management. Dental appliances and orthognathic surgery are two strategies that are currently used in the treatment of sleep apnea. This chapter focuses on the orthodontic management of sleep apnea in adults through three clinical cases with varying degrees of severity of sleep apnea. It provides a background on OSA treatment approaches and discusses the potential risks and benefits of each.

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Obstructive sleep apnea: A sharp increase in the prevalence of patients treated with nasal CPAP over the last decade in France

PLoS ONE ◽

10.1371/journal.pone.0245392 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245392

Author(s):

Laurence Mandereau-Bruno ◽

Damien Léger ◽

Marie-Christine Delmas

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Time Trends ◽

Sharp Increase ◽

Traffic Accidents ◽

Negative Binomial ◽

Incidence Rates ◽

Mandibular Advancement ◽

Obstructive Sleep ◽

Osa Treatment

Introduction Obstructive sleep apnea (OSA) is a frequent condition. In the absence of treatment, OSA is associated with a higher risk of traffic accidents and a large variety of diseases. The objectives of this study were to describe the characteristics of patients treated for OSA in France and assess the time trends in treatment. Methods The French National Health Data System is an individual database with data on all healthcare reimbursements for the entire French population. Based on this database, we included all patients aged 20 years or over who were treated with continuous positive airway pressure (CPAP) or mandibular advancement splint (MAS) between 2009 and 2018. Negative binomial models, adjusted for age, were used to assess time trends in treatment prevalence and incidence rates. Results In 2017, 2.3% of French adults aged ≥20 years were treated with CPAP (men: 3.3%; women: 1.3%). The highest prevalence was observed in people aged 70–74 years (5.0%). From 2009 to 2018, the annual prevalence of CPAP increased 3-fold and the annual incidence 1.9-fold. During the same period, the rate of patients reimbursed for MAS (first prescription or renewal) was multiplied by 7.6. The proportion of patients treated with CPAP in 2017 who were no longer treated in the subsequent year was 6.9%. Discussion The sharp increase in the incidence of OSA treatment probably reflects a better recognition of the disease in France. However, the prevalence of OSA treatment remains lower than expected based on the international literature. Further studies are needed to identify the obstacles to an optimal management of individuals with OSA in France.

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