scholarly journals Effects of a Combined Community Exercise Program in Obstructive Sleep Apnea Syndrome: A Randomized Clinical Trial

2019 ◽  
Vol 8 (3) ◽  
pp. 361 ◽  
Author(s):  
Rodrigo Torres-Castro ◽  
Jordi Vilaró ◽  
Joan-Daniel Martí ◽  
Onintza Garmendia ◽  
Elena Gimeno-Santos ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Randomized Clinical Trial ◽  
Exercise Program ◽  
Walking Distance ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Severe Obstructive Sleep Apnea ◽  
Obstructive Sleep

Physical activity is associated with a decreased prevalence of obstructive sleep apnea and improved sleep efficiency. Studies on the effects of a comprehensive exercise program in a community setting remain limited. Our objective was to investigate the effects of a combined physical and oropharyngeal exercise program on the apnea-hypopnea index in patients with moderate to severe obstructive sleep apnea. This was a randomized clinical trial where the intervention group followed an eight-week urban-walking program, oropharyngeal exercises, and diet and sleep recommendations. The control group followed diet and sleep recommendations. A total of 33 patients were enrolled and randomized and, finally, 27 patients were included in the study (IG, 14; CG, 13) Obstructive sleep apnea patients were analyzed with a median age of 67 (52–74) and median apnea-hypopnea index of 32 events/h (25–41). The apnea-hypopnea index did not differ between groups pre- and post-intervention. However, in intervention patients younger than 60 (n = 6) a reduction of the apnea-hypopnea index from 29.5 (21.8–48.3) to 15.5 (11–34) events/h (p = 0.028) was observed. While a comprehensive multimodal program does not modify the apnea-hypopnea index, it could reduce body weight and increase the walking distance of patients with moderate to severe obstructive sleep apnea. Patients younger than 60 may also present a decreased apnea-hypopnea index after intervention.

scholarly journals Evaluation of the Effects of Different Rapid Maxillary Expansion Appliances on Obstructive Sleep Apnea: A randomized clinical trial

2021 ◽  
Author(s):  
Gokcenur Gokce ◽  
Ozen K Basoglu ◽  
Ilknur Veli
Keyword(s):  
Clinical Trial ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Randomized Clinical Trial ◽  
Rapid Maxillary Expansion ◽  
Secondary Outcome ◽  
Apnea Hypopnea Index ◽  
Maxillary Expansion ◽  
Obstructive Sleep ◽  
Tooth Tissue

Purpose The aim of this randomized clinical trial was to evaluate the effects of tooth tissue-borne (TTB), tooth-borne (TB), and bone-borne (BB) rapid maxillary expansion appliances on obstructive sleep apnea (OSA) severity. Trial design Three-arm parallel randomized controlled trial. Methods This study was designed in parallel with an allocation ratio of 1:1:1. Forty six patients with narrow maxilla and diagnosis of OSA recruited from the Department of Orthodontics, ### University were randomly assigned to three groups according to appliance used: tooth tissue-borne, tooth-borne and bone-borne expanders. The primary outcome of this study included polygraphic change in sleep parameters. Secondary outcome was the correction of posterior crossbite. Each subject underwent overnight sleep test with polygraphy at baseline and 3 month-follow-up of treatment. Randomization was performed using a computer-generated randomization program The outcome assessor was blinded to group assignment. For the statistical analysis, Kruskal-Wallis analysis and Dunn-Bonferroni tests were used for inter-group comparisons and Wilcoxon analysis was used for intra-group evalaution. p<0.05 was accepted statistically significant. Results The amount of expansion in maxillary width and upper intermolar width were similar in all goups (95% confidence interval [CI], p>0.05). The groups were similar in terms of apnea-hypopnea index (AHI) and oxygen saturation parameters at baseline (95% [CI], p>0.05). After 3 months of treatment, there was no significant decrease in AHI and oxygen desaturation index, and no increase in minimum and mean oxygen saturations (95% [CI], p>0.05). Supine AHI values were decreased by the tooth tissue-borne and tooth-borne appliances, but these changes were not significant (95% [CI], p>0.05). Harms No serious harm ocurred except mild gingivitis. Conclusions Similar skeletal and dental expansion of maxilla were observed after RME with all expanders. Although the decrease in AHI was not significant, RME can be used as an adjunct to the primary treatment in OSA patients.

562 Adenoid Regrowth after Rapid Maxillary Expansion in Residual Pediatric OSA: Interim analysis of ERMES Randomized Clinical Trial

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A222-A222
Author(s):  
Marcos Fernández-Barriales ◽  
Montserrat López de Luzuriaga ◽  
Ainoa Álvarez ◽  
Lourdes Guerra ◽  
Jose Manuel Aguirre-Urizar ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oral Cavity ◽  
Randomized Clinical Trial ◽  
Population Based ◽  
Rapid Maxillary Expansion ◽  
Apnea Hypopnea Index ◽  
Maxillary Expansion ◽  
Obstructive Sleep

Abstract Introduction Residual pediatric Obstructive Sleep Apnea (OSA) after gold-standard treatment with adenotonsillectomy occurs in nearly 20% of the patients. Treatment alternatives are scarce and based upon low-level evidence. Rapid maxillary expansion is an orthodontic-orthopaedic treatment of maxillary transverse hypoplasia that has shown promising results in pediatric OSA based upon nasal and oral cavity enlargement. Revision adenoidectomy of all-purpose adenotonsillectomies in population-based studies is 4,9%, and a three-fold risk in OSA patients has been reported. We present data from an ongoing randomized clinical trial (ERMES) highlighting the importance of nasofibroscopic control of the adenoid tissue in residual pediatric OSA patients. Methods According to the study protocol of our ongoing randomized clinical trial (Rapid maxillary expansion for treatment of residual pediatric obstructive sleep apnea; Acronym: ERMES; NCT02947464) patients aged 4 to 9 years old with polysomnographic evidence of OSA persistence after adenotonsillectomy were randomized to either rapid maxillary expansion or wahtchful waiting. They underwent fiberoptic nasopharingoscopy in order to stablish the amount of adenoidal tissue present at the time of inclusion and at polysomnographic control twelve months later. The nasopharyngeal occupation was measured in a 1 to 4 scale. Patients that graded 3 or 4 at the initial nasofibroscopy were excluded from the study due to their surgical revision indication; if they developed grade 3 or 4 adenoid hypertrophy and persistence of symptoms at the final assesment they were offered re-adenoidectomy. Results A total of 5 patients developed an adenoid regrowth amenable for revision surgery: 4 of them within the rapid maxillary expansion group and one in the watchful waiting group. All of them had experienced either worsening or very mild improvement in their apnea hypopnea index (AHI). Conclusion Adenoid regrowth is a known risk factor for pediatric OSA persistence. The anatomical enlargement of the nasal and oral cavity provided by means of rapid maxillary expansion may trigger such overgrowth in otherwise predisposed residual OSA patients. Fiberoptic nasopharyngoscopy is therefore mandatory in the follow-up of such complex cases, since adenoid regrowth may hinder resolution of OSA and its associated symptoms. Support (if any) ERMES Randomized Clincal Trial (NCT02947464) is funded by Departamento de Salud del Gobierno Vasco.

scholarly journals Effect of a Graduated Walking Program on the Severity of Obstructive Sleep Apnea Syndrome. A Randomized Clinical Trial

2020 ◽  
Vol 17 (17) ◽  
pp. 6334
Author(s):  
Antonio Jurado-García ◽  
Guillermo Molina-Recio ◽  
Nuria Feu-Collado ◽  
Ana Palomares-Muriana ◽  
Adela María Gómez-González ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Intervention Group ◽  
Exercise Program ◽  
Density Lipoprotein ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Apnea Syndrome

Background: Obstructive sleep apnea syndrome (OSAS) is a common disease. The objective of this research was to determine the effectiveness of a graduated walking program in reducing the apnea–hypopnea index number in patients with obstructive sleep apnea syndrome (OSAS). Methods: A randomized controlled clinical trial with a two-arm parallel in three tertiary hospitals was carried out with seventy sedentary patients with moderate to severe OSAS. Twenty-nine subjects in each arm were analyzed by protocol. The control group received usual care, while usual care and an exercise program based on progressive walks without direct supervision for 6 months were offered to the intervention group. Results: The apnea–hypopnea index decreased by six points in the intervention group, and improvements in oxygen desaturation index, total cholesterol, and Low-Density Lipoprotein of Cholesterol (LDL-c) were observed. A higher decrease in sleep apnea–hypopnea index (45 ± 20.6 vs. 34 ± 26.3/h; p = 0.002) was found in patients with severe vs. moderate OSAS, as well as in oxygen desaturation index from baseline values (43.3 vs. 34.3/h; p = 0.046). Besides, High-Density Lipoprotein of Cholesterol (HDL-c) values showed a higher increase in the intervention group (45.3 vs. 49.5 mg/dL; p = 0.009) and also, a higher decrease in LDL-c was found in this group (141.2 vs. 127.5 mg/dL; p = 0.038). Conclusion: A home physical exercise program is a useful and viable therapeutic measure for the management of OSAS.

scholarly journals Endothelial Function and Arterial Stiffness Should Be Measured to Comprehensively Assess Obstructive Sleep Apnea in Clinical Practice

2021 ◽  
Vol 8 ◽  
Author(s):  
Jinmei Luo ◽  
Xiaona Wang ◽  
Zijian Guo ◽  
Yi Xiao ◽  
Wenhao Cao ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Arterial Stiffness ◽  
Endothelial Function ◽  
Augmentation Index ◽  
Reactive Hyperemia ◽  
Control Group ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Tnf Α

Objective: An effective clinical tool to assess endothelial function and arterial stiffness in patients with obstructive sleep apnea (OSA) is lacking. This study evaluated the clinical significance of subclinical markers for OSA management in males without serious complications.Patients/Methods: Males without serious complications were consecutively recruited. Clinical data, biomarker tests, reactive hyperemia index (RHI), and augmentation index at 75 beats/min (AIx75) measured by peripheral arterial tonometry were collected. An apnea hypopnea index (AHI) cutoff of ≥15 events/h divided the patients into two groups.Results: Of the 75 subjects, 42 had an AHI ≥15 events/h. Patients with an AHI ≥15 events/h had higher high-sensitivity C-reactive protein, tumor necrosis factor-alpha (TNF-α), vascular endothelial growth factor, and AIx75 values than the control group but no statistical difference in RHI was observed. After controlling for confounders, TNF-α was negatively correlated with the average oxygen saturation (r = −0.258, P = 0.043). RHI was correlated with the rapid eye movement (REM) stage percentage (r = 0.306, P = 0.016) but not with AHI (P &gt; 0.05). AIx75 was positively correlated with the arousal index (r = 0.289, P = 0.023) but not with AHI (r = 0.248, P = 0.052).Conclusions: In males with OSA without severe complications, TNF-α and AIx75 are independently related to OSA. The role of RHI in OSA management requires further elucidation. These markers combined can comprehensively evaluate OSA patients to provide more evidence for the primary prevention of coronary heart disease and treatment response assessment.

scholarly journals A Comparison of Uvulopalatopharyngoplasty and Modified Radiofrequency Tissue Ablation in Mild to Moderate Obstructive Sleep Apnea: A Randomized Clinical Trial

2017 ◽  
Vol 13 (09) ◽  
pp. 1089-1096 ◽  
Author(s):  
Amin Amali ◽  
Maziar Motiee-Langroudi ◽  
Babak Saedi ◽  
Sara Rahavi-Ezabadi ◽  
Ali Karimian ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Randomized Clinical Trial ◽  
Tissue Ablation ◽  
Obstructive Sleep

scholarly journals Multilevel Surgery in Moderate to Severe Obstructive Sleep Apnea Patients

2014 ◽  
Vol 6 (3) ◽  
pp. 87-91
Author(s):  
Jumroon Tungkeeratichai ◽  
Navarat Apirakkittikul ◽  
Somyos Kunachak
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Wound Dehiscence ◽  
Velopharyngeal Insufficiency ◽  
Apnea Hypopnea Index ◽  
Severe Obstructive Sleep Apnea ◽  
Multilevel Surgery ◽  
Obstructive Sleep ◽  
Lateral Pharyngoplasty ◽  
Results Of Surgery

ABSTRACT Objective The aim of this study was to investigate the objective and subjective effectiveness of multilevel surgery, i.e. combined lingualplasty with new technique of partial posterior glossectomy (PPG) and uvulopalatopharyngoplasty in moderate to severe obstructive sleep apnea (OSA) patients. Study design and setting Retrospective study of 60 OSA patients undergoing multilevel surgery for the treatment of moderate to severe OSA. Results Preoperative mean apnea hypopnea index (AHI) was 57.5 events/h and preoperative mean lowest SpO2 was 79.1%. After multilevel surgery, postoperative mean AHI significantly decreased to 29.7 events/h (p < 0.001) and postoperative mean lowest SpO2 increased to 84.4% (p < 0.001). Patients had postoperative followup assessments for 1 to 3 years. Results of surgery was classified as curative in 35/60 (58.3%) of patients, and as effective, i.e. postoperative AHI less than preoperative AHI in 52/60 patients (86.7 %). Surgery was ineffective in 8/60 (13.3%) patients. Early postoperative complications comprised early velopharyngeal insufficiency (VPI) 20% (12/60), dysarthria 20% (12/60) and wound dehiscence 3.33% (2/60) but without serious complications after 1 year. Conclusion Combined lingualplasty (with new PPG) and uvulopalatopharyngoplasty (UPPP) as multilevel surgery can be an effective treatment of choice for patients with moderate to severe OSA. No mediumterm serious complication was found. Keywords Apnea hypopnea index, Glossectomy, Lateral pharyngoplasty, Multilevel surgery in obstructive sleep apnea, Obstructive sleep apnea, Uvulopalatoplasty. How to cite this article Tungkeeratichai J, Apirakkittikul N, Kunachak S. Multilevel Surgery in Moderate to Severe Obstructive Sleep Apnea Patients. Int J Otorhinolaryngol Clin 2014;6(3):8791.

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