scholarly journals European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea

2021 ◽  
Vol 30 (162) ◽  
pp. 210200
Author(s):  
Winfried Randerath ◽  
Johan Verbraecken ◽  
Christel A.L. de Raaff ◽  
Jan Hedner ◽  
Simon Herkenrath ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Gastric Bypass Surgery ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
European Respiratory Society ◽  
Obstructive Sleep ◽  
Custom Made ◽  
Clinical Questions

Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have been refined or reconsidered. In this European Respiratory Society (ERS) guideline on non-continuous positive airway pressure (CPAP) therapies for OSA, we present recommendations determined by a systematic review of the literature. It is an update of the 2011 ERS statement on non-CPAP therapies, advanced into a clinical guideline. A multidisciplinary group of experts, including pulmonary, surgical, dentistry and ear–nose–throat specialists, methodologists and patient representatives considered the most relevant clinical questions (for both clinicians and patients) relating to the management of OSA. Eight key clinical questions were generated and a systematic review was conducted to identify published randomised clinical trials that answered these questions. We used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the quality of the evidence and the strength of recommendations. The resulting guideline addresses gastric bypass surgery, custom-made dual-block mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillo-mandibular osteotomy, carbonic anhydrase inhibitors and positional therapy. These recommendations can be used to benchmark quality of care for people with OSA across Europe and to improve outcomes.

scholarly journals Comparison of titrable thermoplastic versus custom-made mandibular advancement device for the treatment of obstructive sleep apnoea

2017 ◽  
Vol 131 ◽  
pp. 35-42 ◽  
Author(s):  
Frédéric Gagnadoux ◽  
Xuan-Lan Nguyen ◽  
Marc Le Vaillant ◽  
Pascaline Priou ◽  
Nicole Meslier ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Obstructive Sleep ◽  
Custom Made

scholarly journals Weight loss surgery for obstructive sleep apnoea with obesity in adults: a systematic review and meta-analysis protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e020876 ◽  
Author(s):  
Zhiyong Dong ◽  
Brian Y Hong ◽  
Ashley M Yu ◽  
John Cathey ◽  
Sheikh Mohammed Shariful Islam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Obstructive Sleep Apnoea ◽  
Weight Loss Surgery ◽  
Meta Analysis ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Controlled Trials ◽  
Obstructive Sleep

IntroductionObstructive sleep apnoea (OSA) is caused by complete or partial obstruction of the upper airway resulting in repeated episodes of interrupted or shallow breaths. OSA is associated with significant morbidity and mortality. The prevalence is estimated to range from 3% to 7% in the general population but may be much higher. Several studies show that weight loss or bariatric surgery may have a role in treating OSA. The aim of this systematic review is to assess the safety and efficacy of randomised controlled trials (RCTs) of weight loss surgery for adults with OSA and comorbid obesity.Methods and analysisA search of the Cochrane Central Register of Controlled Trials, PubMed, EMBASE and two major Chinese biomedical databases will be performed to identify related trials published as of October 2018. This study will include RCTs, comparing different types of weight loss surgery for OSA with obesity or weight loss surgery for OSA with obesity with other upper airway surgeries. The primary outcomes that will be measured are apnoea–hypopnoea index, excess weight loss and in-hospital mortality. The secondary outcomes will include duration of hospital stay, neck circumference, reoperation, waist circumference, body mass index, Epworth Sleepiness Scale score, overt complications (eg, gastric fistula, bleeding, delayed gastric emptying, wound infection), quality of life, quality of sleep and/or functionality. The systematic review will be conducted according to the recommendations as outlined by the Cochrane collaboration.Ethics and disseminationThe systematic review and meta-analysis will include published data available online and thus ethics approval will not be required. The findings will be disseminated and published in a peer-reviewed journal. Review updates will be conducted if there is new evidence that may cause any change in review conclusions. Any changes to the study protocol will be updated in the PROSPERO trial registry accordingly.PROSPERO registration numberCRD42017081743.

scholarly journals Sudden death in individuals with obstructive sleep apnoea: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039774
Author(s):  
Emily Heilbrunn ◽  
Paddy Ssentongo ◽  
Vernon M Chinchilli ◽  
Anna E Ssentongo
Keyword(s):  
Systematic Review ◽  
Sudden Death ◽  
Obstructive Sleep Apnoea ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Sleep Apnoea ◽  
Primary Data ◽  
Obstructive Sleep ◽  
Increased Risk

IntroductionObstructive sleep apnoea (OSA) is a form of sleep-disordered breathing, characterised by blockage of the airway, snoring, gasping for air during sleep, daytime sleepiness and fatigue. OSA is associated with increased risk of cardiovascular and cerebrovascular morbidity and mortality, and sudden cardiac death (SCD). The magnitude of this risk varies in the literature and therefore we aim to systematically assess this risk. This study protocol proposes a meta-analysis and systematic review aimed to estimate the magnitude of the association between OSA, ‘sudden death’ and cardiovascular death.MethodsWe will conduct a systematic review and meta-analysis of studies published from the inception of each database, which report the risk of ‘sudden death’ or cardiovascular death (including SCD) in individuals diagnosed with OSA versus persons without OSA. The primary outcome of interest in this study will be the relative risk of ‘sudden death’ in patients diagnosed with OSA in comparison to those without an OSA diagnosis. We will search the following electronic research databases: PubMed (MEDLINE), Cochrane, OVID (Healthstar), OVID (Medline), Scopus and Joana Briggs Institute EBP Database. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. The checklist for this document is included in the supplemental material. Two reviewers will screen articles for inclusion criteria, extracting appropriate data and evaluating the quality of the included studies. The methodological quality of studies will be appraised using an appropriate tool. Funnel plots and the Egger’s test will be employed to evaluate potential publication bias. We will fit random-effects model with inverse-variance methods for the pooling effect estimates. We will conduct a meta-regression analysis, using numerous variables of interest including age, gender, race, body mass index, hypertension and diabetes, to explore sources of study heterogeneity.PROSPERO registration numberCRD42020164941.Ethics and disseminationNo ethics clearance was required for this protocol, for no primary data are being collected on research subjects. Only secondary analysis of pre-existing data in scientific databases will be evaluated. The findings of this meta-analysis will be published in a peer-reviewed journal and presented at scientific conferences. These results may assist professionals in the prevention and management of OSA and SCD.

scholarly journals Heat-moulded versus custom-made mandibular advancement devices for obstructive sleep apnoea: a randomised non-inferiority trial

Thorax ◽  
2019 ◽  
Vol 74 (7) ◽  
pp. 667-674 ◽  
Author(s):  
Jean Louis Pépin ◽  
Nathalie Raymond ◽  
Olivier Lacaze ◽  
Nathalie Aisenberg ◽  
Jérôme Forcioli ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Primary Outcome ◽  
Protocol Analysis ◽  
Blood Pressure Reduction ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Absolute Difference ◽  
Obstructive Sleep ◽  
Custom Made ◽  
Mandibular Advancement Devices

RationaleCustom-made mandibular advancement devices (MADs) are reported as providing higher efficacy rates compared with thermoplastic heat-moulded MADs but at the price of higher costs and treatment delays.ObjectiveTo determine whether a thermoplastic heat-moulded titratable MAD (ONIRIS; ONIRIS SAS, Rueil Malmaison, France) is non-inferior to a custom-made acrylic titratable MAD (TALI; ONIRIS SAS, Rueil Malmaison, France) for obstructive sleep apnoea (OSA).MethodsWe conducted a multicentre, open, randomised controlled trial of patients with OSA refusing or not tolerating continuous positive airway pressure (CPAP). Participants were randomly assigned to a thermoplastic heat-moulded titratable device or a custom-made acrylic device for 2 months with stratification by centre and OSA severity. The non-inferiority primary outcome was a ≥50% reduction in apnoea–hypopnoea index (AHI) or achieving AHI <10 events/hour at 2 months. The non-inferiority margin was preset as a difference between groups of 20% for the primary outcome in the per-protocol analysis.Main resultsOf 198 patients (mean age 51 [SD, 12] years; 138 [72.6%] men; mean body mass index 26 [SD, 2.7] kg/m2; mean AHI 26.6/hour [SD, 10.4]), 100 received TALI and 98 ONIRIS. In per-protocol analysis, the response rate was 51.7% in the TALI group versus 53.6% in the ONIRIS group (absolute difference 1.9%; 90% CI: 11% to 15%, within the non-inferiority margin). Effectiveness was the same for severity, symptoms, quality of life and blood pressure reduction. Patients in ONIRIS group reported more side effects and adherence was slightly better with TALI.ConclusionIn patients with OSA refusing or not tolerating CPAP, the thermoplastic heat-moulded titratable MAD was non-inferior in the short-term to the custom-made acrylic MAD.Trial registration numberNCT02348970.

scholarly journals Obstructive sleep apnoea treatment and blood pressure: which phenotypes predict a response? A systematic review and meta-analysis

2020 ◽  
Vol 55 (5) ◽  
pp. 1901945 ◽  
Author(s):  
Martino F. Pengo ◽  
Davide Soranna ◽  
Alice Giontella ◽  
Elisa Perger ◽  
Paola Mattaliano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Obstructive Sleep Apnoea ◽  
Meta Analysis ◽  
Arterial Oxygen Saturation ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Arterial Oxygen ◽  
Obstructive Sleep ◽  
Randomised Controlled

The treatment for obstructive sleep apnoea (OSA) with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is associated with blood pressure (BP) reduction; however, the overall effect is modest. The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) comparing the effect of such treatments on BP was to identify subgroups of patients who respond best to treatment.The article search was performed in three different databases with specific search terms and selection criteria. From 2289 articles, we included 68 RCTs that compared CPAP or MADs with either passive or active treatment. When all the studies were pooled together, CPAP and MADs were associated with a mean BP reduction of −2.09 (95% CI −2.78– −1.40) mmHg for systolic BP and −1.92 (95% CI −2.40– −1.43) mmHg for diastolic BP and −1.27 (95% CI −2.34– −0.20) mmHg for systolic BP and −1.11 (95% CI −1.82– −0.41) mmHg for diastolic BP, respectively. The subgroups of patients who showed a greater response were those aged <60 years (systolic BP −2.93 mmHg), with uncontrolled BP at baseline (systolic BP −4.14 mmHg) and with severe oxygen desaturations (minimum arterial oxygen saturation measured by pulse oximetry <77%) at baseline (24-h systolic BP −7.57 mmHg).Although this meta-analysis shows that the expected reduction of BP by CPAP/MADs is modest, it identifies specific characteristics that may predict a pronounced benefit from CPAP in terms of BP control. These findings should be interpreted with caution; however, they are particularly important in identifying potential phenotypes associated with BP reduction in patients treated for OSA.

The effectiveness of mandibular advancement devices in the treatment of obstructive sleep apnoea in adults: a methodological quality assessment of systematic reviews

2019 ◽  
Vol 42 (5) ◽  
pp. 483-493 ◽  
Author(s):  
Serena Incerti Parenti ◽  
Elena Aroni ◽  
Laura Laffranchi ◽  
Corrado Paganelli ◽  
Giulio Alessandri-Bonetti
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Clinical Decision Making ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Measurement Tool ◽  
Obstructive Sleep ◽  
Mandibular Advancement Devices

Summary Background and objectives There is growing interest in the use of mandibular advancement devices (MADs) for the treatment of obstructive sleep apnoea (OSA). Many systematic reviews (SRs) have investigated their effectiveness, but the applicability of SR results is affected by their methodological quality. This study critically appraises the methodological quality of SRs on this topic using a more detailed and updated version of A MeaSurement Tool to Assess systematic Reviews (AMSTAR). Materials and methods The literature was searched for SRs on MAD effectiveness in adults (≥18 years of age) for OSA treatment as compared with other non-surgical or surgical interventions or no intervention. Any objective or subjective measures of treatment outcome were considered eligible. AMSTAR2 was used to assess methodological quality. Results The literature search yielded 64 potential reports; 10 met the eligibility criteria. All SRs had more than one critical flaw in AMSTAR2, so their methodological quality was rated as critically low. The most common issues included non-registration of study protocol, absence of list of excluded studies, no acknowledgment of fundings of included studies, no impact of risk of bias on SR results or interpretation and discussion of results, and data extraction not in duplicate. Limitations If a SR was not clearly identified by title or abstract as a SR or meta-analysis, it may have been missed during the screening process. Conclusions The methodological quality of SRs was suboptimal and warrants further improvement in order to provide strong evidence of MAD effectiveness and increase applicability of SR results for clinical decision-making.

scholarly journals Sudden death in individuals with obstructive sleep apnoea: a systematic review and meta-analysis

2021 ◽  
Vol 8 (1) ◽  
pp. e000656
Author(s):  
Emily S Heilbrunn ◽  
Paddy Ssentongo ◽  
Vernon M Chinchilli ◽  
John Oh ◽  
Anna E Ssentongo
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Sudden Death ◽  
Obstructive Sleep Apnoea ◽  
Cardiovascular Mortality ◽  
Observational Studies ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep

ObjectivesOver 1 billion individuals worldwide experience some form of sleep apnoea, and this number is steadily rising. Obstructive sleep apnoea (OSA) can negatively influence one’s quality of life and potentially increase mortality risk. However, the association between OSA and mortality has not been reliably estimated. This meta-analysis estimates the risk of all-cause and cardiovascular mortality in individuals with OSA.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Cochrane Library, Scopus and Joanna Briggs Institute Evidence-Based Practice databases were searched from inception through 1 January 2020.Eligibility criteria for selecting studiesWe included observational studies assessing the association of sudden deaths in individuals with and without OSA.Data extraction and synthesisTwo independent reviewers (AES and ESH) extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale quality assessment tool. Data were pooled using the random-effects models and reported as risk ratios (RRs) with 95% CIs. Heterogeneity was quantified with I2 statistic.ResultsWe identified 22 observational studies (n=42 099 participants). The mean age was 62 years and 64% were men. OSA was associated with all-cause sudden death (RR=1.74, 95% CI: 1.44 to 2.10, I2=72%) and cardiovascular mortality (RR=1.94, 95% CI: 1.39 to 2.70, I2=32%). A marginally significant dose–response relationship between severity of OSA and the risk of death was observed (p for interaction=0.05): mild OSA (RR=1.16, 95% CI: 0.70 to 1.93), moderate OSA (RR=1.72, 95% CI: 1.11 to 2.67) and severe OSA (RR=2.87, 95% CI: 1.70 to 4.85). Meta-regression analysis showed that older age was a significant contributing factor in the relationship between OSA and mortality. The median study methodological quality was considered high.ConclusionsOSA is a significant risk factor for all-cause mortality and cardiac mortality. Prevention and treatment strategies to optimise survival and quality of life in individuals with OSA are urgently needed.PROSPERO registration numberCRD42020164941.

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