Beyond Usual Care: A Multidisciplinary Approach Towards the Treatment of Obstructive Sleep Apnoea

Upper Airway ◽

Sleep Apnoea ◽

Team Approach ◽

Cpap Therapy ◽

Management Options ◽

Airway Patency ◽

Obstructive Sleep ◽

Increased Risk

Obstructive Sleep Apnoea (OSA) is common and characterised by repeated apnoeas and hypopnoeas while asleep due to collapse of the upper airway. OSA can have a significant impact on physical and mental health and, when left untreated, is associated with increased risk of developing cardiovascular ill health. Besides cardiorespiratory implications excessive daytime sleepiness, morning headaches, limited memory function and lack of concentration are some further symptoms caused by OSA. Continuous Positive Airway Pressure (CPAP) therapy is the evidence-based treatment to maintain upper airway patency in patients with moderate to severe OSA. Proper adherence to CPAP therapy successfully abolishes nocturnal apnoeas and hypopnoeas, and diminishes consequences of uncontrolled OSA, such as treatment resistant hypertension. However, long term adherence to CPAP remains an unresolved limitation of this method. Although alternatives to CPAP therapy may be less efficacious, there is a variety of non-CPAP treatments that includes conventional lifestyle advice, postural advice, the use of mandibular advancement devices (MADs), surgical treatment options, such as uvulopalatopharyngoplasty, tonsillectomy, or maxillomandibular advancement, and the use of electrical stimulation of the upper airway dilator muscles. Hypoglossal Nerve Stimulation is available as an invasive (HNS) and a transcutaneous (TESLA) approach. For the management of “difficult-to-treat” patients with OSA, particularly in those in whom first line therapy proved to be unsuccessful, a multidisciplinary team approach may be helpful to incorporate the available options of non-CPAP therapy and provide appropriate choices. Symptom control, patient-related outcome measures and long-term cardiovascular health should be prioritised when choosing long-term therapies to treat OSA. The inclusion of patients in the choice of successful management options of their condition will facilitate better long-term adherence. Advancing clinical trials in the field will further help to resolve the relative lack of evidence for effective non-CPAP methods.

New frontiers in obstructive sleep apnoea

Clinical Science ◽

10.1042/cs20140070 ◽

2014 ◽

Vol 127 (4) ◽

pp. 209-216 ◽

Cited By ~ 31

Author(s):

Najib T. Ayas ◽

Allen A. J. Hirsch ◽

Ismail Laher ◽

T. Douglas Bradley ◽

Atul Malhotra ◽

...

Keyword(s):

Animal Models ◽

Upper Airway ◽

Sleep Apnoea ◽

Sleep Fragmentation ◽

Current Evidence ◽

Respiratory Disorder ◽

Negative Consequences ◽

Obstructive Sleep ◽

Increased Risk

OSA (obstructive sleep apnoea), the most common respiratory disorder of sleep, is caused by the loss of upper airway dilating muscle activity during sleep superimposed on a narrow upper airway. This results in recurrent nocturnal asphyxia. Termination of these events usually requires arousal from sleep and results in sleep fragmentation and hypoxaemia, which leads to poor quality sleep, excessive daytime sleepiness, reduced quality of life and numerous other serious health consequences. Furthermore, patients with untreated sleep apnoea are at an increased risk of hypertension, stroke, heart failure and atrial fibrillation. Although there are many predisposing risk factors for OSA, including male gender, endocrine disorders, use of muscle relaxants, smoking, fluid retention and increased age, the strongest risk factor is obesity. The aim of the present review is to focus on three cutting-edge topics with respect to OSA. The section on animal models covers various strategies used to simulate the physiology or the effects of OSA in animals, and how these have helped to understand some of the underlying mechanisms of OSA. The section on diabetes discusses current evidence in both humans and animal models demonstrating that intermittent hypoxia and sleep fragmentation has a negative impact on glucose tolerance. Finally, the section on cardiovascular biomarkers reviews the evidence supporting the use of these biomarkers to both measure some of the negative consequences of OSA, as well as the potential benefits of OSA therapies.

CPAP therapy prevents increase in blood pressure after upper airway surgery for obstructive sleep apnoea

Sleep And Breathing ◽

10.1007/s11325-013-0837-0 ◽

2013 ◽

Vol 17 (4) ◽

pp. 1289-1299 ◽

Cited By ~ 5

Author(s):

Maria Teresa Martins de Araújo ◽

Nazaré Sousa Bissoli ◽

Sônia Alves Gouvêa ◽

Maria Christina Thomé Pacheco ◽

Bernard Meyer ◽

...

Keyword(s):

Blood Pressure ◽

Upper Airway ◽

Sleep Apnoea ◽

Cpap Therapy ◽

Upper Airway Surgery ◽

Airway Surgery ◽

From diagnosis to long-term management: the experiences of older New Zealanders with obstructive sleep apnoea

Journal of Primary Health Care ◽

10.1071/hc17072 ◽

2018 ◽

Vol 10 (2) ◽

pp. 140 ◽

Cited By ~ 2

Author(s):

Rosemary Gibson ◽

Angela Campbell ◽

Shelley Mather ◽

Alister Neill

Keyword(s):

Sleep Apnoea ◽

Cpap Therapy ◽

Group Discussions ◽

Health Value ◽

Treatment Services ◽

Obstructive Sleep ◽

Term Management

ABSTRACT INTRODUCTION In New Zealand (NZ), access to public sleep services is limited to people deemed with the highest need. The prevalence of obstructive sleep apnoea (OSA) increases with age, but the symptoms and the treatment pathway is expected to differ for older compared to younger patients. This study explored the experience of older people regarding diagnosis and treatment services for OSA in order to inform considerations required in primary health and sleep services. METHODS Patients who were initiated on Continuous Positive Airway Pressure (CPAP) therapy at the age of 65 years or older were invited to one of three 1.5-h focus group discussions. In total, 16 patients attended; nine were accompanied by their spouse or partner. Discussions were semi-structured and explored experiences with the OSA pathway, from diagnosis through to long-term management. RESULTS Thematic analysis highlights the key symptoms of OSA. Patients’ experiences with diagnostic and treatment services were generally positive. However, there was an overarching need for greater knowledge and follow up regarding OSA and CPAP therapy. Most patients were happy with CPAP treatment. Issues associated with long-term use, comfort and daily management were highlighted, and strategies used to overcome them discussed. DISCUSSION Focus groups reported similar experiences, positively endorsing the health value of OSA diagnosis and CPAP therapy. Mechanisms and resources are required at a primary healthcare level in order to raise awareness around sleep and aging, OSA and CPAP. This would aid earlier and more appropriate diagnosis and management of OSA and help overcome some of the gaps identified in this study.

Faculty Opinions recommendation of Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.719900217.793506792 ◽

2015 ◽

Author(s):

Martica Hall

Keyword(s):

Continuous Positive Airway Pressure ◽

Observational Study ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Sleep Apnoea ◽

Cardiovascular Outcomes ◽

Changes in the calibre of the upper airway and the surrounding structures after maxillomandibular advancement for obstructive sleep apnoea

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2014.02.006 ◽

2014 ◽

Vol 52 (5) ◽

pp. 445-451 ◽

Cited By ~ 32

Author(s):

Yuh-Jia Hsieh ◽

Yu-Fang Liao ◽

Ning-Hung Chen ◽

Yu-Ray Chen

Keyword(s):

Upper Airway ◽

Sleep Apnoea ◽

Maxillomandibular Advancement ◽

Long-term outcomes in childhood obstructive sleep apnoea

Paediatric Respiratory Reviews ◽

10.1016/s1526-0542(12)70042-8 ◽

2012 ◽

Vol 13 ◽

pp. S41-S42

Author(s):

A. Li

Keyword(s):

Sleep Apnoea ◽

Long Term Outcomes ◽

Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study

The Lancet ◽

10.1016/s0140-6736(05)71141-7 ◽

2005 ◽

Vol 365 (9464) ◽

pp. 1046-1053 ◽

Cited By ~ 1047

Author(s):

Jose M Marin ◽

Santiago J Carrizo ◽

Eugenio Vicente ◽

Alvar GN Agusti

Keyword(s):

Continuous Positive Airway Pressure ◽

Observational Study ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Sleep Apnoea ◽

Cardiovascular Outcomes ◽

Modifying effects of the R389G β1-adrenoceptor polymorphism on resting heart rate and blood pressure in patients with obstructive sleep apnoea

Clinical Science ◽

10.1042/cs20050244 ◽

2005 ◽

Vol 110 (1) ◽

pp. 117-123 ◽

Cited By ~ 10

Author(s):

Jan Börgel ◽

Tino Schulz ◽

Nina K. Bartels ◽

Jörg T. Epplen ◽

Nikolaus Büchner ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Nervous Activity ◽

Sleep Apnoea ◽

Cpap Therapy ◽

Pressure Therapy ◽

Obstructive Sleep ◽

Significant Difference ◽

The Impact

OSA (obstructive sleep apnoea) stimulates sympathetic nervous activity and elevates resting HR (heart rate) and BP (blood pressure). In the present study in a cohort of 309 untreated OSA patients, the resting HR and BP during the daytime were correlated with AHI (apnoea/hypopnea index) and compared with patients with R389R (n=162), R389G (n=125) and G389G (n=22) genotypes of the β1-adrenoreceptor R389G polymorphism. We analysed the impact of the genotype on the decline of HR and BP in a subgroup of 148 patients (R389R, n=86; R389G, n=54; G389G, n=8) during a 6-month follow-up period under CPAP (continuous positive airway pressure) therapy during which cardiovascular medication remained unchanged. In untreated OSA patients, we found an independent relationship between AHI and resting HR (β=0.096, P<0.001), systolic BP (β=0.09, P=0.021) and diastolic BP (β=0.059, P=0.016). The resting HR/BP, however, did not differ among carriers with the R389R, R389G and G389G genotypes. CPAP therapy significantly reduced HR [−2.5 (−1.1 to −4.0) beats/min; values are mean difference (95% confidence intervals)] and diastolic BP [−3.2 (−1.5 to −5.0) mmHg]. The decline in HR was more significantly pronounced in the R389R group compared with the Gly389 carriers [−4.1 (−2.3 to −5.9) beats/min (P<0.001) compared with −0.2 (2.1 to −2.6) beats/min (P=0.854) respectively; Student's t test between groups, P=0.008]. Diastolic BP was decreased significantly (P<0.001) only in Gly389 carriers (R389G or G389G) compared with R389R carriers [−5.0 (−2.3 to −7.6) mmHg compared with −2.0 (0.4 to −4.3) mmHg respectively]. ANOVA revealed a significant difference (P=0.023) in HR reduction between the three genotypes [−4.1 (±8.4) beats/min for R389R, −0.5 (±9.3) beats/min for R389G and +1.9 (±7.2) beats/min for G389G]. In conclusion, although the R389G polymorphism of the β1-adrenoceptor gene did not influence resting HR or BP in untreated OSA patients, it may modify the beneficial effects of CPAP therapy on these parameters.