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Apnea, sleep, obstructive [keywords]
- Transoral robotic lingual tonsillectomy in adults: preliminary results. [JOURNAL ARTICLE]
- Acta Otolaryngol 2014 Oct 30.:1-6.
Abstract Conclusion: Hypertrophy of lingual tonsils can be safely and effectively managed by transoral robotic surgery via a minimally invasive approach. The operating costs can be relatively high although the advantages to patients seem to justify the procedure. Transoral robotic surgery can represent the definitive treatment in hypertrophy of the lingual tonsils. Objective: The purpose of this work was to assess the feasibility, safety, and outcomes of transoral robotic surgery for lingual tonsillar hypertrophy in adults with obstructive sleep apnea. Methods: Retrospective medical records of six patients who underwent tongue base resection using the da Vinci Surgical Robotic System from September, 2012 through December, 2013 in a tertiary care hospital were evaluated. Demographic data, preoperative and postoperative polysomnography and Epworth Sleepiness Scale (ESS) scores, robot docking time, operative and postoperative aspects including surgical time, amount of bleeding, and early and late complications were collected and analyzed. Results: All patients successfully underwent lingual tonsillectomy using the da Vinci Surgical system. Transnasal endotracheal entubation was performed in all patients and they were all extubated before leaving the operation room. No tracheotomies were performed perioperatively for airway management. The patients were discharged on the fifth postoperative day. Operative time, estimated blood loss, and postoperative complication profiles were within the expected and acceptable limits for lingual tonsillectomy. There was a statistically significant decrease in apnea hypopnea index (AHI) (mean AHI from 27.5 to 6.3) and ESS scores (from 14.1 to 7.1).
- Long-term effects of continuous positive airway pressure treatment on sexuality in female patients with obstructive sleep apnea. [Journal Article]
- Sex Med 2013 Dec; 1(2):62-8.
Results from a previous study showed that sexuality was negatively affected in females with untreated obstructive sleep apnea (OSA). Data are sparse on the long-term effects of nocturnal continuous positive airway pressure (CPAP) treatment on sexual difficulties and sexual distress in female patients with OSA.The aim of the present study was to investigate the effects after 1 year of CPAP treatment on sexual difficulties, sexual distress, and manifest sexual dysfunction in female patients with OSA. The effect of CPAP on life satisfaction was also investigated.Fifty-four therapy-compliant, female patients (age 22-71) received a survey before and after 1 year of nocturnal CPAP treatment. The questions on this survey were drawn from three self-administered questionnaires: two on sexuality and one on life satisfaction. The results were compared with a population sample. The Epworth Sleepiness Scale was used for assessment of daytime sleepiness.The Female Sexual Function Index, Female Sexual Distress Scale, Manifest Female Sexual Dysfunction, four questions from Life Satisfaction 11, and the Epworth Sleepiness Scale were all used to measure outcome.In total, 44 patients responded to the survey (81% response rate). The results were a significant, positive change in manifest female sexual dysfunction, but no significant changes in isolated sexual difficulties or sexual distress. Daytime sleepiness significantly decreased after 1 year. The results from the Life Satisfaction 11 questionnaire remained unchanged after 1 year.After 1 year of CPAP treatment, female patients with OSA reported reduced manifest sexual dysfunction. However, it cannot be concluded if this result is due to CPAP treatment alone. Furthermore, reduced daytime tiredness was found in the surveyed population. CPAP treatment, per se, does not seem to affect partner relationships. Petersen M, Kristensen E, Berg S, and Midgren B. Long-term effects of continuous positive airway pressure treatment on sexuality in female patients with obstructive sleep apnea. Sex Med 2013;1:62-68.
- Apnea-induced rapid eye movement sleep disruption impairs human spatial navigational memory. [Journal Article]
- J Neurosci 2014 Oct 29; 34(44):14571-7.
Hippocampal electrophysiology and behavioral evidence support a role for sleep in spatial navigational memory, but the role of particular sleep stages is less clear. Although rodent models suggest the importance of rapid eye movement (REM) sleep in spatial navigational memory, a similar role for REM sleep has never been examined in humans. We recruited subjects with severe obstructive sleep apnea (OSA) who were well treated and adherent with continuous positive airway pressure (CPAP). Restricting CPAP withdrawal to REM through real-time monitoring of the polysomnogram provides a novel way of addressing the role of REM sleep in spatial navigational memory with a physiologically relevant stimulus. Individuals spent two different nights in the laboratory, during which subjects performed timed trials before and after sleep on one of two unique 3D spatial mazes. One night of sleep was normally consolidated with use of therapeutic CPAP throughout, whereas on the other night, CPAP was reduced only in REM sleep, allowing REM OSA to recur. REM disruption via this method caused REM sleep reduction and significantly fragmented any remaining REM sleep without affecting total sleep time, sleep efficiency, or slow-wave sleep. We observed improvements in maze performance after a night of normal sleep that were significantly attenuated after a night of REM disruption without changes in psychomotor vigilance. Furthermore, the improvement in maze completion time significantly positively correlated with the mean REM run duration across both sleep conditions. In conclusion, we demonstrate a novel role for REM sleep in human memory formation and highlight a significant cognitive consequence of OSA.
- Vibration Signals of Snoring as a Simple Severity Predictor for Obstructive Sleep Apnea. [JOURNAL ARTICLE]
- Clin Respir J 2014 Oct 29.
Polysomnography (PSG), which involves simultaneous monitoring of various physiological monitors, is the current comprehensive tool for diagnosing obstructive sleep apnea (OSA).We aimed at validating vibrating signals of snoring as a single physiological parameter for screening and evaluating severity of OSA.Totally 111 subjects from the sleep center of a tertiary referral center were categorized into four groups according to the apnea hypopnea index (AHI) obtained from PSG: Simple snoring group (5>AHI, healthy subjects, n=11), mild OSA group (5≤AHI<15, n=11), moderate OSA group (15≤AHI<30, n=30), and severe OSA group (AHI≥30, n=59). Anthropometric parameters and sleep efficiency of all subjects were compared. Frequencies of amplitude changes of vibrating signals on anterior neck during sleep were analyzed to acquire a snoring burst index (SBI) using a novel algorithm. Data were compared with AHI and index of arterial oxygen saturation (Δ Index).There were no significant differences in age and sleep efficiency among all groups. Bland-Altman analysis showed better agreement between SBI and AHI (r = 0.906, P<0.001) than Δ Index and AHI (r=0.859, P <0.001). Additionally, receiver operating characteristic (ROC) showed substantially stronger sensitivity and specificity of SBI in distinguishing between patients with moderate and severe OSA compared to Δ Index (Sensitivity: 81.4% vs. 66.4%; Specificity: 96.7% vs. 86.7%, for SBI and Δ Index, respectively).SBI may serve as a portable tool for screening patients and assessing OSA severity in a non-hospital setting.
- Is Inconsistent Pre-Treatment Bedtime Related to CPAP Non-Adherence? [JOURNAL ARTICLE]
- Res Nurs Health 2014 Oct 29.
Lack of adherence to continuous positive airway pressure therapy (CPAP) limits the effectiveness of treatment of obstructive sleep apnea (OSA). We hypothesized that an irregular bedtime would be negatively related to regular use of CPAP treatment. If so, modifying bedtime schedule may address the persistent problem of inconsistent CPAP use in adults with OSA. In a prospective longitudinal study, we examined whether inconsistent self-reported bedtime before initiation of CPAP treatment, operationalized as bedtime variability, was (1) different among those adherent (≥4 hours per night) and non-adherent to CPAP treatment at 1 week and 1 month; and/or (2) was related to 1-week and 1-month CPAP use when other variables were accounted for. Consecutively recruited newly diagnosed OSA adults (n = 79) completed sleep diaries prior to CPAP treatment. One-week and 1-month objective CPAP use data were collected. Pre-treatment bedtime variability was different among CPAP non-adherers and adherers at 1 month and was a significant predictor of non-adherence at 1 month in multi-variable analyses. The odds of 1-month CPAP non-adherence were 3.5 times greater in those whose pre-treatment bedtimes varied by >75 minutes. Addressing sleep schedule prior to CPAP initiation may be an opportunity to improve CPAP adherence. © 2014 Wiley Periodicals, Inc.
- New Therapies for Obstructive Sleep Apnea. [JOURNAL ARTICLE]
- Semin Respir Crit Care Med 2014 Oct; 35(5):621-628.
A strong demand for new obstructive sleep apnea (OSA) therapies exists and several are emerging. Hypoglossal nerve stimulation is designed to activate upper airway muscles. The initial study from Inspire (Maple Grove, MN) suggests that the device will work well in a very selective group of OSA patients. However, it is likely to be quite expensive. The Winx device (ApniCure, Redwood City, CA) works by establishing a vacuum in the oral cavity, which pulls the uvula and soft palate forward and stabilizes the tongue position. The current device works in approximately 40% of patients and the early data suggest adherence may be quite good. The Provent device( Theravent, San Jose, CA) has been available for several years and is disposable. It is to be attached to the nares nightly and establishes substantial expiratory resistance. Multiple studies suggest that Provent can successfully treat OSA in about 35 to 50% of the patients. However, acceptance and adherence may be a problem. OSA phenotyping is not a therapy, but a way to determine exactly what causes airway collapse in each patient, which can vary substantially. This may allow for individualization of apnea therapy. New methods to prevent supine sleep and surgically implantable devices to treat OSA are also evolving.
- Noncontinuous Positive Airway Pressure Therapies for Obstructive Sleep Apnea. [JOURNAL ARTICLE]
- Semin Respir Crit Care Med 2014 Oct; 35(5):613-620.
While continuous positive airway pressure is the first-line treatment for obstructive sleep apnea, many patients find this form of therapy undesirable leading to treatment nonadherence. Both mandibular advancement devices and surgical therapy offer alternative solutions for such patients. This article serves to compare the types of surgical interventions and mandibular advancement devices available, their mechanisms of action, and expected side effects. Emphasis is made on the limitations and challenges in the interpretation of the available literature due to the varying definitions of curative success. The effects of mandibular advancement devices and surgical therapy on the apnea-hypopnea index and oxygen saturation are reviewed. Patient-centered outcomes of sleepiness, quality of life, treatment preference, adherence, and their effects on disease-related outcomes of hypertension are summarized. When available, comparative effectiveness trials between these therapies versus continuous positive airway pressure are emphasized. Patient selection criteria, practice parameters, and treatment limitations are discussed.
- Enhancing Adherence to Positive Airway Pressure Therapy for Sleep Disordered Breathing. [JOURNAL ARTICLE]
- Semin Respir Crit Care Med 2014 Oct; 35(5):604-612.
Sleep disordered breathing is made up of a group of conditions that include obstructive sleep apnea, central sleep apnea, complex sleep apnea, and sleep-related hypoventilation. Continuous positive airway pressure (CPAP) is the first-line therapy for obstructive sleep apnea. The other forms of sleep disordered breathing require different types of positive airway pressure (PAP). Adherence to PAP can be challenging and affected by multiple factors. Educating the patient regarding the consequences of untreated sleep disordered breathing and the benefits of PAP is the first step in improving adherence. Attention to social, psychological, and demographic factors that may contribute to difficulty complying is important. Addressing side effects such as nasal symptoms and equipment usability issues is also beneficial. Compliance can be monitored by the data download cards present in PAP machines, but clinicians must be aware of the limitations of the data obtained. The challenges of improving adherence occur along with the increasing need to demonstrate to payers a patient's adherence to and benefit from PAP therapy.
- Auto-adjusting and Advanced Positive Airway Pressure Therapeutic Modalities. [JOURNAL ARTICLE]
- Semin Respir Crit Care Med 2014 Oct; 35(5):593-603.
Continuous positive airway pressure (CPAP) therapy is the first-line treatment for obstructive sleep apnea (OSA). Although the gold standard for the treatment of OSA, CPAP may not be the optimal modality to treat more complex sleep disordered breathing such as Cheyne-Stokes respirations, opioid-induced central apnea, and complex sleep disordered breathing related to chronic hypoventilation syndromes (obesity-hypoventilation syndrome, restrictive thoracic disease due to neuromuscular or thoracic cage disease, chronic obstructive pulmonary disease). Newer generation auto-adjusting PAP devices are increasingly being used to treat OSA. Advanced positive airway pressure modalities have been developed in an effort to improve treatment of the more complex sleep disordered breathing syndromes including automated servo ventilation and volume-targeted pressure-limited ventilation. This article is intended to provide the clinician reader with a description of newer PAP modalities, a review of evidence-supported indications for use, as well as to provide a framework for managing patients with advanced positive airway pressure therapy.
- Diagnosis and Management of Obstructive Sleep Apnea in the Perioperative Setting. [JOURNAL ARTICLE]
- Semin Respir Crit Care Med 2014 Oct; 35(5):571-581.
Obstructive sleep apnea (OSA) is a chronic prevalent condition which may be under-recognized in surgical populations. Patients with OSA may be at increased perioperative risk, in part due to the effects sedatives and anesthetics have on upper airway tone and respiratory drive. A growing amount of data suggests that OSA patients have increased odds for adverse postoperative outcomes including intensive care unit transfer, respiratory failure, arrhythmias, and cardiac ischemia. Several screening tools have been developed to identify patients at risk for OSA preoperatively, but it remains to be seen whether routine implementation of these tools improves outcomes. In this review, we discuss the perioperative complications of OSA, the tools with which physicians can screen surgical patients, and the perioperative management of these patients.