scholarly journals The Management of Co-Morbidities in Patients with Heart Failure – Obstructive Sleep Apnoea

2017 ◽  
Vol 10 ◽  
Author(s):  
Andrew Coats
Keyword(s):  
Heart Failure ◽  
Obstructive Sleep Apnoea ◽  
Adult Population ◽  
Treatment Options ◽  
Sleep Apnoea ◽  
Response To Treatment ◽  
Consensus Recommendation ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
Artery Disease

Heart failure (HF) patients are older and frequently present with multiple co-morbidities. Co- morbidities worsen patient symptoms and may contribute to the progression of heart failure, increase mortality or limit the therapeutic response to treatment. Obstructive sleep apnoea (OSA) affects 2–4% of the adult population world-wide and is associated with similar risk factors to HF, meaning it is a frequent finding in HF patients, including HFrEF, HFmrEF and HFpEF. OSA has consistently been shown to be associated with hypertension, coronary artery disease, arrhythmias, heart failure, and stroke. A thorough understanding of the diagnosis and treatment options of OSA is of paramount importance to the practising HF clinician. Patients may present to the HF specialist having been diagnosed by a formal sleep study or may be suspected of OSA because of symptoms of snoring, reports of obstructed breathing by the sleep partner or day-time sleepiness. The mainstay of treatment for OSA is a positive airway pressure mask which can be used in mild moderate and severe OSA. The need for therapy should be discussed with the patient and if the AHI is above 15/hr then treatment is indicated to reduce this to below 15. This is a consensus recommendation and no adequately powered clinical trials have shown this improves either mortality or the risk of disease progression. Other options are discussed

scholarly journals P101 Economic evaluation of diagnostic sleep studies for obstructive sleep apnoea in the adult population: a systematic review

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A53-A54
Author(s):  
A Natsky ◽  
A Vakulin ◽  
C Chai Coetzer ◽  
B Kaambwa
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Diagnostic Tests ◽  
Science Studies ◽  
Adult Population ◽  
Public Health Problem ◽  
Sleep Apnoea ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
Level 3

Abstract Background Obstructive sleep apnoea (OSA) is a significant public health problem with large health and economic burden. Despite the existence of effective treatment, undiagnosed OSA remains a challenge. The gold standard diagnostic tool is polysomnography (PSG), yet this test is expensive, labour intensive, and time-consuming. Home-based, limited channel sleep study testing (Level 3 and 4) can advance and widen access to diagnostic services. This systematic review aims to summarise available evidence regarding the cost-effectiveness of limited channel tests compared to laboratory and home PSG in diagnosing OSA. Method Eligible studies were identified across the following databases: MEDLINE, Psychinfo, Proquest, Scopus, CINAHL, Cochrane, Emcare and Web of Science. Studies were screened, critically appraised and eligible data were extracted using a standardised template. Relevant findings were summarised using a qualitative approach adhering to economic reporting standards. Results 915 non-duplicate abstracts were identified, 82 full-text articles were retrieved for review. 32 studies met the inclusion criteria and were included in the final analysis: 28 studies investigated Level 3 and four assessed Level 4 OSA diagnostic tests. Using a dominance ranking framework to compare cost and outcomes, both Level 3 and Level 4 OSA diagnostic tests were cost-effective compared to PSG. Discussion Although study designs and methodologies differ broadly, findings indicate that using limited channel diagnostic sleep tests for OSA is associated with lower cost and non-inferior health outcomes relative to PSG. Limited channel tests also resulted in shorter waiting times and improvements in access to diagnostic services for patients with OSA.

scholarly journals Narrative review of contemporary treatment options in the care of patients with obstructive sleep apnoea

2017 ◽  
Vol 11 (11) ◽  
pp. 411-423 ◽  
Author(s):  
Mark S. Ferguson ◽  
Jennifer Claire Magill ◽  
Bhik T. Kotecha
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Treatment Plan ◽  
Treatment Options ◽  
Clinical History ◽  
Sleep Apnoea ◽  
Drug Induced ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
Wide Range ◽  
Detailed Clinical History

Snoring and obstructive sleep apnoea (OSA) are increasingly common conditions, and confer a significant health and socioeconomic burden. Furthermore, untreated OSA represents a significant mortality risk. Patients require careful assessment, including detailed clinical history and examination, sleep study and drug-induced sleep endoscopy (DISE). Although nasal continuous positive airway pressure (nCPAP) is the gold standard treatment for moderate and severe OSA, multidisciplinary team assessment is often required to develop the best treatment plan for an individual, especially when nasal CPAP is poorly tolerated. There is a wide range of medical and surgical treatment options, and following appropriate patient selection and assessment, a focused site-specific, often multilevel, intervention is indicated. There is an increasing body of evidence in the literature supporting these multilevel interventions and with agreement on standardized outcome measures more trials are likely to improve the robustness of these data further.

Effect of a 1-week intense myofunctional training on obstructive sleep apnoea in children with Down syndrome

2018 ◽  
Vol 104 (3) ◽  
pp. 275-279 ◽  
Author(s):  
Magnus von Lukowicz ◽  
Nina Herzog ◽  
Sebastian Ruthardt ◽  
Mirja Quante ◽  
Gabriele Iven ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Marginal Effect ◽  
Sleep Study ◽  
Desaturation Index ◽  
Intensive Training ◽  
Children With Down Syndrome ◽  
Training Camp ◽  
Obstructive Sleep

BackgroundObstructive sleep apnoea (OSA) is common in children with Down syndrome (DS), yet difficult to treat. As muscular hypotonia of the upper airway may cause OSA and is also common in DS, we tested whether intense myofunctional therapy improves OSA in children with DS.Patients and methodsForty-two children underwent cardiorespiratory sleep studies immediately before and after a 1-week intensive training camp consisting of three daily 45 min sessions of myofunctional exercises according to Padovan. Primary outcome was the mixed-obstructive-apnoea/hypopnoea index (MOAHI), secondary outcomes the ≤3% oxygen desaturation index (DI3), the ≤90% desaturation index (DI90) and the lowest pulse oximeter saturation (SpO2nadir).ResultsEighteen recordings had ≥3 hours of artefact-free recording in both the pretreatment and post-treatment sleep study and were therefore included in the analysis. Mean age was 6.3 years (SD 2.5); 83% had OSA prior to intervention. Mean MOAHI was 6.4 (SD 8.6) before and 6.4 (SD 10.8) after the intervention (p>0.05); the DI3 and SpO2nadir also did not change. Only the DI90 decreased significantly from 2.7 (SD 4.5) to 2.1 (SD 3.7) (p<0.05).ConclusionThe 1-week intense myofunctional training camp evaluated here in children with DS had only a marginal effect on OSA. Whether a longer follow-up period or duration of intervention would yield stronger effects remains to be determined.

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