Selected Recommendations from International Guidelines on Obstructive Sleep Apnoea

2017 ◽  
Vol 2 (2) ◽  
pp. 19
Author(s):  
Nurul Yaqeen Mohd Esa ◽  
Ahmad Izuanuddin Ismail
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Asian Population ◽  
Diagnostic Procedures ◽  
Sleep Apnoea ◽  
Upper Airways ◽  
Specific Patient ◽  
Major Health ◽  
Asian Patients ◽  
Obstructive Sleep ◽  
Management Aspect

Obstructive sleep apnoea (OSA) is increasingly seen as a major health threat globally. However, it is still underdiagnosed mainly among Asian population partly due to lack of understanding on the pathophysiology, and limited access to the diagnostic and management aspect of the disease. Recurring complete and/or partial collapses of the upper airways define OSA. Based on the number of apnoeas and/or hypopnoeas per hour of sleep, OSA is categorized as mild, moderate and severe. Both the American Association of Sleep Medicine (AASM) and American College of Physicians (ACP) has published guidelines regarding the management of OSA in adults. Three recommendations have been suggested by the guidelines which can be used to tailor the management of OSA. The aim of this article is to select relevant recommendations from these guidelines in epidemiology, pathophysiology, diagnostic procedures and treatment for proper management of OSA, while considering specific patient populations, such as hypertensive, diabetic, obese and Asian patients.

scholarly journals Design of a study to investigate the mechanisms of obstructive sleep apnoea by means of drug-induced sleep endoscopy

2019 ◽  
Vol 57 (9) ◽  
pp. 1406-1413
Author(s):  
Valeria Bisogni ◽  
Giuseppe Maiolino ◽  
Giulio Ceolotto ◽  
Martino F. Pengo ◽  
Rosario Marchese Ragona ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Plasma Catecholamines ◽  
Sleep Apnoea ◽  
Sleep Endoscopy ◽  
Upper Airways ◽  
Drug Induced ◽  
Chromatography Method ◽  
Plasma Aldosterone Concentration ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep

Abstract Background Obstructive sleep apnoea (OSA) is an independent risk factor of hypertension and cardiovascular diseases. Recurrent episodes of upper airways collapse during sleep causing blood oxygen desaturation, hypercapnia, and micro-arousals, are known to activate the sympathetic nervous system (SNS). However, whether changes in the renin-angiotensin-aldosterone system and endothelial activation also occur remains contentious. Methods Based on routine use of drug-induced sleep endoscopy (DISE) for the work-up of OSA patients in our centre, we designed a prospective study to investigate the haemodynamic and humoral changes occurring during the apnoeic episodes reproduced in vivo in the course of DISE. Specifically, plasma aldosterone concentration and renin activity, C-terminal fragment of proendothelin-1, as a marker of endothelial damage, and free plasma catecholamines, will be measured at fixed times during DISE. The activity of catechol-O-methyltransferase (COMT), a key catecholamine-inactivating enzyme that has been scantly investigated thus far owing to the lack of commercially available kits, will be also determined by a newly developed high performance liquid chromatography method, which is herein described. Results and conclusions The aim of this study is to provide novel information on the haemodynamic, hormonal, and SNS changes, and also on COMT activity modification concomitantly occurring during apnoea, thus contributing substantively to the understanding of the pathophysiology of OSA.

scholarly journals Obstructive sleep apnoea in a patient with chronic lymphocytic leukaemia

2019 ◽  
Vol 12 (7) ◽  
pp. e228763
Author(s):  
Gregory Paul Stimac ◽  
Asefa Jejaw Mekonnen
Keyword(s):  
Chronic Lymphocytic Leukaemia ◽  
Obstructive Sleep Apnoea ◽  
Lymphocytic Leukaemia ◽  
Oral Appliance ◽  
Sleep Apnoea ◽  
Caucasian Woman ◽  
Upper Airways ◽  
Airway Narrowing ◽  
Obstructive Sleep ◽  
Structural Abnormalities

A 69-year-old Caucasian woman presented with chronic lymphocytic leukaemia (CLL; stage 1-Rai System), significant oropharyngeal lymphoid enlargement, snoring and fatigue. Overnight polysomnography revealed moderately severe obstructive sleep apnoea (OSA), which was managed successfully with oral appliance therapy with resolution of snoring and daytime fatigue. Structural abnormalities of the upper airways are known to cause OSA. Airway narrowing can result from bony structural abnormalities, nasopharyngeal growth, soft tissue redundancy, macroglossia, malignant and benign growth of the upper aero-digestive tract, and adenotonsilar enlargement. Clinicians should be encouraged to consider a diagnosis of OSA in patients with CLL when they present with symptoms of worsening fatigue.

scholarly journals Upper airways sarcoidosis presenting as obstructive sleep apnoea

Thorax ◽  
1998 ◽  
Vol 53 (3) ◽  
pp. 232-233 ◽  
Author(s):  
R N H Shah ◽  
P R Mills ◽  
P J M George ◽  
J A Wedzicha
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Upper Airways ◽  
Obstructive Sleep

Obstructive sleep apnoea

2021 ◽  
pp. 335-344
Author(s):  
Terry Robinson ◽  
Jane Scullion
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Nursing Care ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Diagnostic Procedures ◽  
Sleep Apnoea ◽  
Differential Diagnoses ◽  
Treatment Prevalence ◽  
Obstructive Sleep ◽  
Psychosocial History

This chapter covers the causes, signs, and symptoms of obstructive sleep apnoea (OSA). It explains the process of diagnosis, from a history, medications, family, and psychosocial history, occupation, and diagnostic procedures. Differential diagnoses that should be excluded are listed. The prevalence of OSA is estimated to be around 4% of the population. It is quite a common disorder, although this figure may be an underestimate as many people may not seek treatment. Prevalence figures also vary according to the chosen threshold for defining a significant sleep abnormality and symptoms. Treatment options are also outlined, and the specific aspects of nursing care are listed.

scholarly journals Adipose tissue as a key player in obstructive sleep apnoea

2019 ◽  
Vol 28 (152) ◽  
pp. 190006 ◽  
Author(s):  
Silke Ryan ◽  
Claire Arnaud ◽  
Susan F. Fitzpatrick ◽  
Jonathan Gaucher ◽  
Renaud Tamisier ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Experimental Models ◽  
Complex Interaction ◽  
Health Concern ◽  
Metabolic Dysfunction ◽  
Major Health ◽  
Multiple Organs ◽  
Obstructive Sleep

Obstructive sleep apnoea (OSA) is a major health concern worldwide and adversely affects multiple organs and systems. OSA is associated with obesity in >60% of cases and is independently linked with the development of numerous comorbidities including hypertension, arrhythmia, stroke, coronary heart disease and metabolic dysfunction. The complex interaction between these conditions has a significant impact on patient care and mortality. The pathophysiology of cardiometabolic complications in OSA is still incompletely understood; however, the particular form of intermittent hypoxia (IH) observed in OSA, with repetitive short cycles of desaturation and re-oxygenation, probably plays a pivotal role. There is fast growing evidence that IH mediates some of its detrimental effects through adipose tissue inflammation and dysfunction. This article aims to summarise the effects of IH on adipose tissue in experimental models in a comprehensive way. Data from well-designed controlled trials are also reported with the final goal of proposing new avenues for improving phenotyping and personalised care in OSA.

scholarly journals Drug-Induced Sleep Endoscopy Changes the Treatment Concept in Patients with Obstructive Sleep Apnoea

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Jaroslava Hybášková ◽  
Ondřej Jor ◽  
Vilém Novák ◽  
Karol Zeleník ◽  
Petr Matoušek ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Sleep Apnoea ◽  
Treatment Concept ◽  
Sleep Endoscopy ◽  
Upper Airways ◽  
Drug Induced ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep

The present study evaluated whether drug-induced sleep endoscopy (DISE) helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA). A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP) treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%). The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse (n=17, 33.3%), followed by palatal and oropharyngeal collapse (n=12, 23.5%). Pathology of the larynx (epiglottis) was observed in 16 patients (31.4%). The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3%) patients. After DISE, the surgical plan was changed in 31 patients (60.8%). The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA.

scholarly journals Osteopathic Manipulation of the Sphenopalatine Ganglia Versus Sham Manipulation, in Obstructive Sleep Apnoea Syndrom: A Randomised Controlled Trial

2021 ◽  
Vol 11 (1) ◽  
pp. 99
Author(s):  
Valérie Attali ◽  
Olivier Jacq ◽  
Karine Martin ◽  
Isabelle Arnulf ◽  
Thomas Similowski
Keyword(s):  
Adverse Events ◽  
Nasal Obstruction ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Obstructive Sleep Apnoea Syndrome ◽  
Upper Airways ◽  
Osteopathic Manipulation ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Randomised Controlled

(1) Background: osteopathic manipulation of the sphenopalatine ganglia (SPG) blocks the action of postganglionic sensory fibres. This neuromodulation can reduce nasal obstruction and enhance upper airway stability. We investigated the manipulation of the SPG in 31 patients with obstructive sleep apnoea syndrome (OSAS); (2) Methods: Randomised, controlled, double-blind, crossover study. Participants received active (AM), then sham manipulation (SM), or vice versa. The primary endpoint was apnoea-hypopnoea index (AHI). Secondary endpoints were variation of nasal obstruction evaluated by peak nasal inspiratory flow (PNIF) and upper airways stability evaluated by awake critical closing pressure [awake Pcrit]), at 30 min and 24 h. Schirmer’s test and pain were assessed immediately post-manipulation. Tactile/gustatory/olfactory/auditory/nociceptive/visual sensations were recorded. Adverse events were collected throughout. (3) Results: SPG manipulation did not reduce AHI (p = 0.670). PNIF increased post-AM but not post-SM at 30 min (AM-SM: 18 [10; 38] L/min, p = 0.0001) and 24 h (23 [10; 30] L/min, p = 0.001). There was no significant difference on awake Pcrit (AM-SM) at 30 min or 24 h). Sensations were more commonly reported post-AM (100% of patients) than post-SM (37%). Few adverse events and no serious adverse events were reported. (4) Conclusions: SPG manipulation is not supported as a treatment for OSAS but reduced nasal obstruction. This effect remains to be confirmed in a larger sample before using this approach to reduce nasal congestion in CPAP-treated patients or in mild OSAS.

Resistance in upper airways: a simple tool in the management of obstructive sleep apnoea

2019 ◽  
Author(s):  
Julia Herrero Huertas ◽  
Ramón Fernández ◽  
Gemma Rubinos ◽  
Marta Íscar ◽  
María José Vázquez ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Upper Airways ◽  
Simple Tool ◽  
Obstructive Sleep
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