scholarly journals Prospective Trial of CPAP in Community-Dwelling Adults with Down Syndrome and Obstructive Sleep Apnea Syndrome

2020 ◽  
Vol 10 (11) ◽  
pp. 844
Author(s):  
Elizabeth A Hill ◽  
Donna M Fairley ◽  
Linda J Williams ◽  
Goffredina Spanò ◽  
Sally-Ann Cooper ◽  
...  
Keyword(s):  
Down Syndrome ◽  
General Health ◽  
Controlled Trial ◽  
Sleep Apnea Syndrome ◽  
Prospective Trial ◽  
Sleep Apnoea ◽  
Community Dwelling ◽  
Control Group ◽  
Sleep Study ◽  
Obstructive Sleep

Adults with Down syndrome (DS) are predisposed to obstructive sleep apnoea (OSA), but the effectiveness and acceptability of continuous positive airway pressure treatment (CPAP) in this group has rarely been formally assessed. This study was designed as a pilot randomised, parallel controlled trial for one month, continuing as an uncontrolled cohort study whereby the control group also received the intervention. Symptomatic, community-dwelling DS individuals exhibiting ≥10 apnoeas/hypopneas per hour in bed on a Type 3 home sleep study were invited to participate in this study, with follow-up at 1, 3, 6, and 12 months from baseline. Measurements of sleepiness, behaviour, cognitive function and general health were undertaken; the primary outcome was a change in the pictorial Epworth Sleepiness Scale (pESS) score. Twenty-eight participants (19 male) were enrolled: age 28 ± 9 year; body mass index 31.5 ± 7.9 kg/m2; 39.6 ± 32.2 apnoeas/hypopneas per hour in bed; pESS 11 ± 6/24. The pilot randomised controlled trial at one month demonstrated no change between the groups. At 12 months, participant (p = 0.001) pESS and Disruptive (p < 0.0001), Anxiety/Antisocial (p = 0.024), and Depressive (p = 0.008) behaviour scores were reduced compared to baseline. Improvement was noted in verbal (p = 0.001) and nonverbal intelligence scores (p = 0.011). General health scores also improved (p = 0.02). At the end of the trial, 19 participants continued on treatment. Use of CPAP in adults with DS and OSA led to a number of significant, sustained improvements in sleepiness and behavioural/emotional outcomes at 12 months.

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.

scholarly journals Comparing treatment effects of a convenient vibratory positional device to CPAP in positional OSA: a crossover randomised controlled trial

Thorax ◽  
2020 ◽  
Vol 75 (4) ◽  
pp. 331-337 ◽  
Author(s):  
Yingjuan Mok ◽  
Alvin Tan ◽  
Pon Poh Hsu ◽  
Audrey Seow ◽  
Yiong Huak Chan ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Sleep Apnoea ◽  
Treatment Preference ◽  
Patient Treatment ◽  
Published Data ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
Device Use ◽  
Randomised Controlled

ObjectivesUp to 77% of patients with obstructive sleep apnoea (OSA) have positional OSA (POSA) but traditional positional therapy (PT) methods have failed as they were poorly tolerated. New convenient vibratory PT devices have been invented but while recent studies suggest high treatment efficacy and adherence, there are no published data comparing these devices directly with continuous positive airway pressure (CPAP). Our objective is to evaluate if a convenient vibratory PT device is non-inferior to CPAP in POSA treatment.MethodsIn this crossover randomised controlled trial, we enrolled patients with POSA with significant daytime sleepiness (Epworth Sleepiness Scale (ESS)≥10). POSA diagnosis was based on: (1) total Apnoea/Hypopnoea Index (AHI)>10/hour and non-supine AHI<10/hour (2) supine AHI≥2 × non-supine AHI. Patients used their initial allocated devices (PT or CPAP) for 8 weeks before crossing to the alternative intervention after a 1 week washout. The primary aim is to measure changes in ESS between the two treatments. Secondary outcomes include sleep study parameters and patient treatment preference (ClinicalTrials.gov: NCT03125512).Results40 patients completed the trial between April 2017 and December 2018. Difference in ESS after 8 weeks of device use (PT minus CPAP) was 2.0 (95% CI 0.68 to 3.32), exceeding our predetermined non-inferiority margin of 1.5. AHI on CPAP was lower than with PT (4.0±3.2 vs 13.0±13.8 events/hour, respectively, p=0.001), although both were lower than at baseline. Time spent supine was significantly lower with PT than CPAP (p<0.001). 60% of patients preferred CPAP, 20% preferred PT, while 20% preferred neither device.ConclusionsThe non-inferiority ESS endpoint for PT compared with CPAP was not met and the results were inconclusive. Future trials with larger sample sizes or in less symptomatic patients are warranted to provide further insight into the role of these new vibratory PT devices.

Investigating the effect of a nasal decongestant on post-adenotonsillectomy respiratory complications in 25 paediatric patients with obstructive sleep apnoea: a pilot study

2019 ◽  
Vol 133 (2) ◽  
pp. 110-114 ◽  
Author(s):  
E Shamil ◽  
M J Rouhani ◽  
A C Panayi ◽  
J Lynch ◽  
J Tysome ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Obstructive Sleep Apnoea ◽  
Controlled Trial ◽  
Intervention Group ◽  
Sleep Apnoea ◽  
Respiratory Morbidity ◽  
Control Group ◽  
Respiratory Compromise ◽  
Paediatric Patients ◽  
Obstructive Sleep

AbstractObjectiveAdenotonsillectomy is frequently performed for obstructive sleep apnoea, but is associated with post-operative respiratory morbidity. This study assessed the effect of paediatric Otrivine (0.05 per cent xylometazoline hydrochloride) on post-operative respiratory compromise.MethodsPaediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea were included. The control group (n = 24) received no intervention and the intervention group (n = 25) received intra-operative paediatric Otrivine during induction using a nasal patty. Post-operative outcomes included pain, respiratory distress signs and medical intervention level required (simple, intermediate and major).ResultsPost-operative respiratory distress signs were exhibited by 4 per cent of the Otrivine group and 21 per cent of the control group. Sixty-eight per cent of the Otrivine group required simple medical interventions post-operatively, compared to 42 per cent of the control group. In the Otrivine group, 4 per cent required intermediate interventions; none required major interventions. In the control group, 12.5 per cent required both intermediate and major interventions. Fifty per cent of the control group reported pain post-operatively, compared with 40 per cent in the Otrivine group.ConclusionIntra-operative paediatric Otrivine may reduce post-operative respiratory compromise in paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea. A randomised controlled trial is required.

scholarly journals A randomized controlled trial of an ambulatory approach versus the hospital-based approach in managing suspected obstructive sleep apnea syndrome

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
David S. Hui ◽  
Susanna S. Ng ◽  
Kin-Wang To ◽  
Fanny W. Ko ◽  
Jenny Ngai ◽  
...  
Keyword(s):  
Waiting Time ◽  
Sleep Apnea Syndrome ◽  
Sleep Apnoea ◽  
Sleep Study ◽  
Cpap Treatment ◽  
Home Based ◽  
Obstructive Sleep ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract Comparisons of home-based versus hospital-based approach in managing patients with suspected obstructive sleep apnoea syndrome(OSAS). A prospective, controlled CPAP parallel study of new referrals with suspected OSAS randomized into group A) home-based or B) hospital-based approach. Following detection of AHI ≥ 15/hr by Embletta sleep study (group A) or polysomnography (group B), patients received CPAP for 3 months after an overnight autoCPAP titration at home or in hospital respectively. Modified intention-to-treat analysis of those with AHI ≥ 15/hr on CPAP (n = 86 vs 86) showed no difference in Epworth sleepiness score, the primary endpoint, but greater improvement in Sleep-Apnoea-Quality-of-Life-Index[difference 0.3,(95%CI 0.02, 0.6), p = 0.033] at 3 months in group A. The mean costs for the patients in group A and group B were HK$8479(989) and HK$22,248(2407) respectively. The mean difference between groups was HK$-13,769(USD 1770 equivalent) per patient with 95% CI. (−14324, −13213), p < 0.001. The waiting time of patients with AHI ≥ 15/hr who were started on CPAP treatment from the first clinic consultation to the diagnostic sleep test, autoCPAP titration, and CPAP treatment was 189.6, 148.8 and 145.0 days shorter in group A than group B respectively. Home-based approach is non-inferior to hospital-based approach in managing patients with suspected OSAS, with shorter waiting time, and substantial cost savings.

scholarly journals Comparison of different cephalometric variables in patients with and without history of snoring

2017 ◽  
Vol 5 (12) ◽  
pp. 5283
Author(s):  
Azhar Khan ◽  
Mohamad Imran ◽  
Mohammed Imran ◽  
Shoib N. Parkar ◽  
Mueed U. Islam ◽  
...  
Keyword(s):  
Hyoid Bone ◽  
Sleep Apnea Syndrome ◽  
Sleep Apnoea ◽  
Control Group ◽  
Mandibular Plane ◽  
Obstructive Sleep ◽  
High Prevalence ◽  
History Of ◽  
Group 2 ◽  
Group 1

Background: Obstructive sleep apnea syndrome has a high prevalence among adults. Cephalometric variables can be a valuable method for evaluating patients with this syndrome. The objective of this study is to evaluate and compare the craniofacial variables in subjects with and without snoring by cephalometric analysis.Methods: 40 patients were included in the study who were divided into two groups; group 1 of 20 snoring patients and group 2 control group of 20 non-snoring patients and were evaluated and compared for various cephalometric variables.Results: The distance from the hyoid bone to the mandibular plane (MP-H) was the only variable that showed a statistically significant correlation between two groups.Conclusions: Cephalometric variables are useful tools for evaluating the patients with snoring who are predisposed to obstructive sleep apnoea. The distance from the hyoid bone to the mandibular plane showed a statistically significant correlation between two groups.

scholarly journals O027 The combination of mandibular advancement devices (MAD) and supplemental oxygen dramatically improves OSA severity: preliminary results from the MADOX trial

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A12-A13
Author(s):  
B Edwards ◽  
D Vena ◽  
L Thomson ◽  
A Gikas ◽  
R Radmand ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Supplemental Oxygen ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Loop Gain ◽  
Eligibility Criteria ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
High Loop ◽  
Randomised Controlled

Abstract Introduction Patients with obstructive sleep apnoea (OSA) considered ‘non-responders’ to mandibular advancement device (MAD) therapy, typically have a high loop gain contributing to their OSA physiology. While MAD does not improve loop gain, other treatments such as supplemental oxygen can have a strong effect on this pathogenic trait. Therefore, we conducted a randomised controlled trial (RCT) to determine whether the administration of supplemental oxygen in combination with a MAD, was associated with greater improvements in OSA severity compared to MAD therapy alone. Methods Patients recently diagnosed with OSA underwent an initial screening sleep study to confirm the presence of moderate-severe OSA (Apnoea-hypopnoea index [AHI]&gt;20events/hr). Eligible patients were then enrolled in a randomised single-blind cross-over trial involving 4 sleep studies with the following treatments; MAD, oxygen (4L/min), MAD+oxygen and room-air/sham (control). The primary outcome was the reduction in AHI (%baseline). Results Of the 57 participants screened, 35 met the eligibility criteria (Baseline/Screening AHI = 52±22 events/hr). Compared to the sham night, all treatments significantly reduced the AHI; a 35% [CI: 18–48] was seen with oxygen (p&lt;0.0002), a 53% [CI: 40–64] was seen with MAD (p&lt;0.0001) and a 67% [CI: 56–76] was seen with MAD+oxygen (p&lt;0.0001). Importantly, the combination of MAD+oxygen was associated with a significant reduction in AHI relative to MAD alone (15% [CI:4–24] p=0.01). Discussion In a population with moderate-severe OSA, preliminary analyses from this trial suggests that the addition of supplemental oxygen in combination with MAD therapy provided greater reductions in OSA severity than either treatment alone.

scholarly journals Home oximetry to screen for obstructive sleep apnoea in Down syndrome

2018 ◽  
Vol 103 (10) ◽  
pp. 962-967 ◽  
Author(s):  
Catherine M Hill ◽  
Heather E Elphick ◽  
Michael Farquhar ◽  
Paul Gringras ◽  
Ruth M Pickering ◽  
...  
Keyword(s):  
Down Syndrome ◽  
High Risk ◽  
Obstructive Sleep Apnoea ◽  
Training Sample ◽  
Sleep Apnoea ◽  
Validation Sample ◽  
Sleep Study ◽  
Children With Down Syndrome ◽  
Sleep Studies ◽  
Obstructive Sleep

ObjectiveChildren with Down syndrome are at high risk of obstructive sleep apnoea (OSA) and screening is recommended. Diagnosis of OSA should be confirmed with multichannel sleep studies. We aimed to determine whether home pulse oximetry (HPO) discriminates children at high risk of OSA, who need further diagnostic multichannel sleep studies.DesignCross-sectional prospective study in a training sample recruited through three UK centres. Validation sample used single-centre retrospective analysis of clinical data.PatientsChildren with Down syndrome aged 0.5–6 years.InterventionDiagnostic multichannel sleep study and HPO.Main outcome measuresSensitivity and specificity of HPO to predict moderate-to-severe OSA.Results161/202 children with Down syndrome met quality criteria for inclusion and 25 had OSA. In this training sample, the best HPO parameter predictors of OSA were the delta 12 s index >0.555 (sensitivity 92%, specificity 65%) and 3% oxyhaemoglobin (SpO2) desaturation index (3% ODI)>6.15 dips/hour (sensitivity 92%, specificity 63%). Combining variables (delta 12 s index, 3% ODI, mean and minimum SpO2) achieved sensitivity of 96% but reduced specificity to 52%. All predictors retained or improved sensitivity in a clinical validation sample of 50 children with variable loss of specificity, best overall was the delta 12 s index, a measure of baseline SpO2 variability (sensitivity 92%; specificity 63%).ConclusionsHPO screening could halve the number of children with Down syndrome needing multichannel sleep studies and reduce the burden on children, families and health services alike. This approach offers a practical universal screening approach for OSA in Down syndrome that is accessible to the non-specialist paediatrician.

CARDIOVASCULAR RISKS IN OBSTRUCTIVE SLEEP APNEA SYNDROME WITH IMPROVED SASD07 COMPARE TO STARDUST II

2014 ◽  
pp. 77-86
Author(s):  
Anh Tien Hoang ◽  
Thi Y Nhi Nguyen ◽  
Luu Trinh Nguyen ◽  
Thi Hong Diep Phan ◽  
Huu Cat Nguyen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Hdl Cholesterol ◽  
Control Group ◽  
Positive Correlation ◽  
Obstructive Sleep ◽  
Apnea Syndrome

Background : Sleep Apnea Syndrome (SAS) is a cause of hypertension, increasingcardiovascular risk and cardiovascular disease such as stroke, coronary artery disease, myocardial infarction, arrhythmias, heart failure, increasing the risk of death in patients with heart disease, independent of other causative factors. So far, in Vietnam there are very few studies on Obstructive Sleep Apnea Syndrome (OSAS) and cardiovascular risk factors . Self-making SASD07 is trustly for detecting OSAS with statistical significiant in comparision with StarDustII (gold criteria). Subjects and Methods: Cross sectional study, comparision with control group: 136 peoples (68 in disease group and 68 in control group). Patients were parallelly measured with StarDustII and SASD07 to detect OSAS and find the corellation with cardiovascular risk factors. Results: There is a positive correlation between SBP with the severity of OSAS (r = 0.459, p < 0.001), positive correlation between DBP with the severity of OSAS (r = 0.352, p < 0.003). No statistically significant differences between severe OSAS and fasting blood glucose, cholesterol, HDL Cholesterol, Non - HDL Cholesterol, LDL Cholesterol and TG median (p > 0.05). There is a positive correlation between AHI and neck circumference (r = 0.511, p < 0.001), waist circumference (r = 0.585, p < 0.001), BMI (r = 0.380, p < 0.01). SASD07 diagnostic value of detecting OSAS compared with StarDustII have Kappa = 0.72, (standard error 0.06, p <0.001). Conclusion: The risk factors related to OSAS in our study is neck circumference, waist circumference, systolic blood pressure, diastolic blood pressure. SASD07 have a good value in diagnosing of OSAS compared with polysomnography StarDustII. Key words: Sleep Apnea Syndrome, cardiovascular risk factor, SASD07.

Increasing Life-Space Mobility in Community-Dwelling Older Persons With Cognitive Impairment Following Rehabilitation: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Phoebe Ullrich ◽  
Christian Werner ◽  
Martin Bongartz ◽  
Tobias Eckert ◽  
Bastian Abel ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Older Persons ◽  
Controlled Trial ◽  
Intervention Group ◽  
Community Dwelling ◽  
Control Group ◽  
Life Space ◽  
Home Based ◽  
Independent Life

Abstract Background Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk of losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The aim of this study was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM. Methods Older persons with mild-to-moderate CI (Mini-Mental State Examination: 17–26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group received a CI-specific, home-based strength, balance, and walking training supported by tailored motivational strategies. The control group received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment, including a composite score for LSM and 3 subscores for maximal, equipment-assisted, and independent life space. Mixed-model repeated-measures analyses were used. Results One hundred eighteen participants (82.3 ± 6.0 years) with CI (Mini-Mental State Examination: 23.3 ± 2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the Life-Space Assessment in Persons with Cognitive Impairment composite scores (b = 8.15; 95% confidence interval: 2.89–13.41; p = .003) and independent life-space subscores (b = 0.39; 95% confidence interval: 0.00–0.78; p = .048) in the intervention group (n = 63) compared to control group (n = 55). Other subscores and follow-up results were not significantly different. Conclusions The home-based training program improved LSM and independent life space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction.

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