Effect of mandibular advancement therapy on inflammatory and metabolic biomarkers in patients with severe obstructive sleep apnoea: a randomised controlled trial.

Systemic inflammation and metabolic disorders are among the mechanisms linking obstructive sleep apnoea (OSA) and cardiovascular disease (CVD). In 109 patients with severe OSA and no overt CVD, biomarkers of inflammation (C reactive protein, interleukin-6, tumour necrosis factor-α and its receptors, adiponectin, leptin and P-selectin), glucose and lipid metabolism, and N-terminal pro-brain natriuretic peptide, were measured before and after 2 months of treatment with a mandibular advancement device (MAD) (n=55) or a sham device (n=54). MAD reduced the Apnoea-Hypopnoea Index (p<0.001) but had no effect on circulating biomarkers compared with the sham device, despite high treatment adherence (6.6 hour/night). TRIAL REGISTRATION NUMBER: NCT01426607.

Impact of Mandibular Advancement Therapy on Endothelial Function in Severe Obstructive Sleep Apnea.

RATIONALE: Endothelial dysfunction, a major predictor of late cardiovascular events, is linked to the severity of obstructive sleep apnea (OSA). OBJECTIVES: To determine whether treatment with mandibular advancement device, the main alternative to continuous positive airway pressure, improves endothelial function in patients with severe OSA. METHODS: In this trial, we randomized patients with severe OSA and no overt cardiovascular disease to receive 2 months of treatment with either effective mandibular advancement device or a sham device. The primary outcome, change in reactive hyperemia index, a validated measurement of endothelial function, was assessed on an intention-to-treat basis. An embedded microsensor objectively measured treatment compliance. MEASUREMENTS AND MAIN RESULTS: A total of 150 patients (86% males; mean [SD] age, 54 [10] yr; median [interquartile range] apnea-hypopnea index, 41 [35-53]; mean [SD] Epworth sleepiness scale, 9.3 [4.2]) were randomized to effective mandibular advancement device (n = 75) or sham device (n = 75). On intention-to-treat analysis, effective mandibular advancement device therapy was not associated with improvement of endothelial function compared with the sham device. Office and ambulatory blood pressure outcomes did not differ between the two groups. Effective mandibular advancement device therapy was associated with significant improvements in apnea-hypopnea index (P < 0.001); microarousal index (P = 0.008); and symptoms of snoring, fatigue, and sleepiness (P < 0.001). Mean (SD) objective compliance was 6.6 (1.4) h/night with the effective mandibular advancement device versus 5.6 (2.3) h/night with the sham device (P = 0.006). CONCLUSIONS: In moderately sleepy patients with severe OSA, mandibular advancement therapy reduced OSA severity and related symptoms but had no effect on endothelial function and blood pressure despite high treatment compliance. Clinical trial registered with www.clinicaltrials.gov (NCT 01426607).

Effectiveness of intervention led by a community pharmacist for improving recognition of sleep apnea in primary care--a cohort study.

Despite its high prevalence and major public health ramifications, obstructive sleep apnea syndrome (OSAS) remains underdiagnosed. The aim of this study was to determine whether the involvement of a community pharmacist (CP) in the care pathway of a patient at risk of OSAS, through the implementation of a community pharmacist (CP) intervention, was effective, i.e. increased the use of diagnostic tests in this population. We compared a cohort of patients included in a research protocol (exposed to a CP intervention) with patients having the same characteristics taken from a general population database who did not receive the intervention (unexposed group). The aim of the CP intervention was to educate patients about the risk of untreated OSAS, encouraging them to consult their general practitioner, and urging the doctor to continue investigations. We included 782 patients at risk of OSAS, i.e. taking one or more anti-hypertensive drugs, being overweight (body mass index >25) and snoring almost every night (88 in the exposed group and 694 in the unexposed group). After a 6-month follow-up, the number of patients who underwent an OSAS diagnostic test was significantly higher in the exposed group compared to the unexposed group (22.7 versus 11.4%, P = 0.003). Being exposed to the pharmacist intervention was associated with a higher chance of undergoing a diagnostic test for OSAS, adjusted odds ratio: 2.24 (1.25-4.01). In conclusion, these findings provide arguments for the implementation of a CP OSAS screening intervention in CP routine practice.

Patients' with obstructive sleep apnoea syndrome (OSAS) preferences and demand for treatment: a discrete choice experiment.

RATIONALE: Despite its high level of effectiveness, initial acceptance of continuous positive airway pressure (CPAP) and regular use in patients with obstructive sleep apneoa syndrome (OSAS) are still an issue. Alternatively, oral appliances (OAs) can be recommended. To improve patient engagement in their treatment, physicians are advised to take into account patient preferences and to share the therapeutic decision. We aimed to determine patients' preferences for OSAS treatment-related attributes, and to predict patients' demand for both CPAP and OAs. METHODS: A discrete choice experiment (DCE) was performed in 121 newly diagnosed patients consecutively recruited in a sleep unit. RESULTS: Regression parameters were the highest for impact on daily life and effectiveness ahead of side effects. In the French context, the demanding probabilities for CPAP and OAs were 60.2% and 36.2%, respectively. They were sensitive to the variation in the amount of out-of-pocket expenses for both CPAP and OAs. CONCLUSIONS: This first DCE in OSAS emphasises the importance to communicate with patients before the implementation of treatment.

Insomnia related to sleep apnoea: effect of long-term auto-adjusting positive airway pressure treatment.

Insomnia related to sleep apnoea (IA) is highly prevalent, and its proper treatment is still debated. The aim of this study was to test the hypothesis that long-term auto-adjusting positive airway pressure (APAP) treatment improves IA symptoms. 80 patients (mean±sd age 54.9±10.6 yrs, respiratory disturbance index (RDI) 45.0±24.6 events·h(-1)) receiving APAP treatment were followed prospectively for 24 months. Somnolence and depression were assessed at baseline (T0) with the Epworth and the QD2A scales, respectively. Nightly APAP use was measured after 24 months of treatment (T24). The assessment of insomnia at T0 and T24 used the insomnia severity index (ISI). The combination of ISIT0 ≥15 and ISIT0-ISIT24 ≥9 defined the APAP-responding insomnia (APAP-RI) group. A logistic regression analysis identified the factors independently associated with the APAP-RI group. The ISI (13.7±5.7 versus 8.2±6.3) decreased significantly from T0 to T24 (p = 0.0001) for the patients as a whole, with a mean decrease of 13.5±2.9. Among the 39 insomniac subjects (T0), 20 belonged to the APAP-RI group (51%). The Epworth score (OR 1.536, 95% CI 1.093-2.159; p = 0.01) and the RDI (OR 1.080, 95% CI 1.010-1.154; p = 0.02) increased the risk of belonging to the APAP-RI group. IA symptoms improved with APAP treatment, and improvement was associated with the initial severity of the disease and somnolence in our population.

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

OBJECTIVE: The aim of this study was to investigate the efficacy of continuous positive airway pressure (CPAP) therapy following uvulopalatopharyngoplasty (UPPP) to prevent blood pressure (BP) elevation during sleep. METHODS: Sixteen normotensive patients with OSA were subjected to UPPP with or without septoplasty. These patients were instrumented for 24 h of ambulatory BP recording, polysomnography, nocturnal urinary catecholamine and pain evaluation using a visual analogue scale in the day prior to surgery (D-1), following the surgery (D+1) and 30 days later (D+30). For the D+1, the patients were divided into two groups: the without CPAP therapy group and the with CPAP therapy group. RESULTS: The apnoea-hypopnoea index (AHI) significantly increased in the patients without CPAP therapy compared with the D-1 (74 ± 23 vs. 35 ± 6 times/h, p < 0.05), and in the CPAP group, there was a significant reduction in the average AHI value to 14 ± 6 times/h, p < 0.01. During D+1, we observed an increase in the nocturnal systolic BP (10 %), diastolic BP (12 %) and heart rate (14 %) in the group without CPAP. These metrics were re-established in the CPAP group to values that were similar to those that were observed on the D-1. The absence of nocturnal dipping in the group without CPAP was followed by a significant increase in nocturnal norepinephrine (42 ± 12 µg/l/12 h) and epinephrine (8 ± 2 µg/l/12 h) levels compared with the D-1 (norepinephrine 17 ± 3; epinephrine 2 ± 0.3 µg/l/12 h, p < 0.001). In the patients who used the CPAP treatment, the nocturnal catecholamine levels were similar to D-1. The effectiveness of intravenous analgesic therapy was verified by a significant decrease in the pain scores in patients both with and without CPAP therapy. CONCLUSION: These data confirm an increase in the AHI on the night following UPPP with or without septoplasty. This increase promotes an absence of nocturnal dipping and a significant increase in urinary catecholamine levels. CPAP therapy was effective to prevent the transitory increase in BP.

The development and testing of a new communication tool to help clinicians inform patients with obstructive sleep apnoea syndrome about treatment options.

The objective of this study was to develop a tool to help clinicians inform patients about mechanical treatment options, continuous positive airway pressure and oral appliances for obstructive sleep apnoea syndrome, and to assess its validity, reliability and acceptability. Continuous positive airway pressure is always indicated as a first-line treatment in patients with severe obstructive sleep apnoea syndrome. However, oral appliances might be an effective treatment option in patients who fail treatment attempts, and also as a first-line treatment for patients with mild to moderate obstructive sleep apnoea. To help patients choose their initial treatment, we developed an electronic decision board to present information regarding the potential benefits and side effects of the two treatment options, using the best available evidence. In 34 healthy volunteers, to test validity we evaluated the extent to which the respondents' preferences for a treatment changed predictably when the rate of effectiveness and side effects were modified. Reliability was tested by readministering the decision board 2 weeks afterwards (kappa test). The decision-board acceptability was evaluated in 99 consecutive patients newly diagnosed with obstructive sleep apnoea syndrome. We found that the decision board was valid. Reliability was excellent (κ = 0.94). Concerning acceptability, 72% of the patients were satisfied with the information provided in the decision board and 71% indicated that it helped them to make a decision. The average score of true/false test of knowledge was 7.9 of 10 (range 3-10). The decision board we developed is a valid, reliable and acceptable tool to assess patients' preferences.

A multi-intervention protocol to improve sleep quality in a coronary care unit.

AIMS: Poor sleep is a frequent occurrence in the critical illness. Evaluate sleep quality and test the effect of a multi-intervention sleep care protocol in improving sleep quality in a coronary care unit (CCU). METHODS AND RESULTS: Quasi-experimental study, carried out in two phases. During the first phase, the control group (n = 58 patients) received usual care. Baseline sleep data were collected through the Richards-Campbell Sleep Questionnaire (RCSQ) and the Sleep in the Intensive Care Unit Questionnaire (SICUQ). During the second phase (n = 55 patients), a sleep care protocol was implemented. Interventions included actions to promote analgesia, reduce noise, brightness, and other general measures. Sleep data were collected again to assess the impact of these interventions. The intervention group had better scores in overall sleep depth [median (interquartile range)] [81 (65-96.7) vs. 69.7 (50-90); P = 0.046]; sleep fragmentation [90 (65-100) vs. 69 (42.2-92.7); P = 0.011]; return to sleep [90 (69.7-100) vs. 71.2 (40.7-96.5); P = 0.007]; sleep quality [85 (65-100) vs. 71.1 (49-98.1); P = 0.026]; and mean RCSQ score [83 (66-94) vs. 66.5 (45.7-87.2); P = 0.002] than the baseline group. The main barriers to sleep were pain [1 (1.0-5.5)], light [1 (1.0-5.0)], and noise [1 (1.0-5.0)]. The most rated sources of sleep-disturbing noise were heart monitor alarm [3 (1.0-5.25)], intravenous pump alarm [1.5 (1.0-5.00)]. and mechanical ventilator alarm [1 (1.0-5.0)]. All were significantly lower in the intervention group than in the baseline group. CONCLUSION: A multi-intervention protocol was feasible and effective in improving different sleep quality parameters and reducing some barriers to sleep in CCU patients.

Residual subjective daytime sleepiness under CPAP treatment in initially somnolent apnea patients: a pilot study using data mining methods.

BACKGROUND AND PURPOSE: Despite correct treatment with positive airway pressure (PAP), obstructive sleep apnea (OSA) patients sometimes remain subjectively somnolent. The reliability of the Epworth Sleepiness Scale (ESS) has been established for healthy subjects and patients under stable conditions; the ESS may eventually vary among treated OSA patients, biasing the results of a cross-sectional analysis of persisting sleepiness. The objective of this study was to depict the evolution of subjective vigilance under treatment using an index of ESS variability (DeltaESS). METHODS: In 80 OSA patients (apnea-hypopnea index [AHI]=54+/-26/h), initially somnolent (ESS=15+/-3) and treated with auto-titrating PAP (APAP) (oxyhaemoglobin desaturation index 3% [ODIapap]=3.4+/-2.2/h; daily APAP use=5.3+/-1.5 h) during 434+/-73 days, ESS scores were regularly collected four times every 109+/-36 days. DESS was calculated and data mining methods (Segmentation and Decision Tree) were used to determine homogeneous groups according to the evolution of ESS scores. RESULTS: When assessed cross-sectionally, 14-25% of the subjects were recognized as somnolent, depending on the moment when ESS was administered. Using data mining methods, three groups were clearly identifiable: two without residual somnolence - group 1, n=38 (47%), with high DeltaESS=-2.9+/-0.8, baseline ESS=16.3+/-3.3, AHI=58.5+/-26.1/h, mean ESSapap=5.1+/-2.4 and group 2, n=31 (39%), with low DeltaESS=-1.1+/-0.5, baseline ESS=13.2+/-1.4, AHI=53+/-27.3/h, mean ESSapap=8.8+/-1.9; and one with persisting sleepiness; group 3, n=11 (14%), with low DeltaESS=-0.3+/-0.8, baseline ESS=16.3+/-3, AHI=38.7+/-10.8/h, mean ESSapap=14.1+/-1.9. Compliance to PAP was high and comparable in the three groups. Age and body mass index (BMI) did not differ. CONCLUSION: Data mining methods helped to identify 14% of subjects with persisting sleepiness. Validation needs to be done on a larger population in order to determine predictive rules.

Performance characteristics of the French version of the severity hierarchy score for paediatric sleep apnoea screening in clinical settings.

BACKGROUND: Paediatric obstructive sleep apnoea syndrome (OSAS) is a highly prevalent condition carrying increased risk for impaired cognitive and cardiovascular function. The standard diagnosis consists of full-night polysomnography (PSG), but limited access to PSG leads to substantial under-diagnosis. The use of a validated and simple diagnostic screening tool to predict OSAS could prioritise night sleep recordings in children at risk of OSAS, and help in clinical decision-making. OBJECTIVE: This study aimed to prospectively assess the performance of the French version of the severity hierarchy score (SHS) in paediatric OSAS. This score consists of a discriminative subset of six respiratory items, and has already been validated in English for screening OSAS in the general paediatric population. METHODS: A total of 96 children (mean age 7.1 ± 2.4 years; BMI z-score: -0.03 ± 1.50) were recruited; they had been were referred to two academic sleep centres in France for the putative diagnosis of sleep-disordered breathing. The parents completed the SHS questionnaire prior to PSG. Sensitivity and specificity of the SHS for detecting moderate OSAS, defined by an apnoea-hypopnoea index (AHI) of ≥5/hours of total sleep time (TST), were assessed, and ROC analysis was performed. RESULTS: An SHS score of >2.75 exhibited an 82% sensitivity, 81% specificity, and 92% negative predictive value for detecting an AHI of ≥5/hour TST in the cohort. CONCLUSION: The French version of the SHS emerged as favourably suited for the screening for OSAS in children.

Effects of mandibular advancement on upper airway dynamics in awake normal subjects: a pilot study with phrenic nerve stimulation.

BACKGROUND: Mandibular advancement (MA) can be an alternative to continuous positive airway pressure (CPAP) in the treatment of obstructive sleep apnea syndrome. This study was designed to describe its effects on upper airway mechanics. METHODS: Six awake healthy subjects (four men, 31+/-8 years, body mass index (BMI) 25+/-2kg/m2) were studied supine. Phrenic stimulation was used to measure pressure-flow relationships in response to diaphragm contractions without pre-activation of upper airway dilators during progressive MA. RESULTS: Phrenic stimulation consistently induced flow limitation (initial peak V'-t1, corresponding to the limiting pressure; reduction to a nadir V'-t2; reincrease to a second peak V'-t3). The upper airway resistances were negatively correlated with MA. Their values at 4mm were significantly lower than at baseline. Further MA reduced resistances. CONCLUSIONS: As with CPAP, MA in normal subjects decreases the propensity of the upper airway to collapse in response to a negative pressure pulse.

Overview on Sleep Bruxism for Sleep Medicine Clinicians.

Sleep bruxism (SB) is a common sleep-related jaw motor disorder observed in 8% of the adult population. SB diagnosis is based on history of tooth grinding and clenching and is confirmed by the polysomnographic recording of the electromyographic activity of jaw muscles during sleep. SB may be associated with orofacial pain, headaches, and sleep-disordered breathing. Managing SB cannot be done without a comprehensive clinical and, when indicated, polysomnographic differential diagnosis of other comorbidities, which need to be taken into account to select the best treatment approach.

Sleep in the intensive care unit.

Poor sleep quality is a consistently reported by patients in the ICU. In such a potentially hostile environment, sleep is extremely fragmented and sleep architecture is unconventional, with a predominance of superficial sleep stages and a limited amount of time spent in the restorative stages. Among the causes of sleep disruption in the ICU are factors intrinsic to the patients and the acute nature of their condition, as well as factors related to the ICU environment and the treatments administered, such as mechanical ventilation and drug therapy. Although the consequences of poor sleep quality for the recovery of ICU patients remain unknown, it seems to influence the immune, metabolic, cardiovascular, respiratory, and neurological systems. There is evidence that multifaceted interventions focused on minimizing nocturnal sleep disruptions improve sleep quality in ICU patients. In this article, we review the literature regarding normal sleep and sleep in the ICU. We also analyze sleep assessment methods; the causes of poor sleep quality and its potential implications for the recovery process of critically ill patients; and strategies for sleep promotion.

Left ventricular diastolic dysfunction in obstructive sleep apnoea syndrome by an echocardiographic standardized approach: An observational study.

BACKGROUND: The association between obstructive sleep apnoea syndrome (OSAS), left ventricular (LV) diastolic dysfunction and LV geometry remains controversial because of coexisting disorders. AIMS: To evaluate LV diastolic dysfunction and its independent predictors in a real-life cohort of OSAS patients, by a standardized approach. METHODS: We consecutively included 188 OSAS patients after an overnight polysomnography to undergo clinical evaluation, ambulatory blood pressure measurement and complete echocardiography, combining M-mode, two-dimensional Doppler and tissue Doppler imaging modes. Correlations between OSAS severity and clinical and echocardiographical variables were assessed, and logistic regression models were used to identify possible determining factors of LV diastolic dysfunction. RESULTS: Most patients were hypertensive (n=148, 78.7%) and already receiving treatment by continuous positive airway pressure (n=158, 84.5%). The prevalence of LV hypertrophy, defined by LV mass index (LVMi) normalized by height (2.7), was 12.4%, with a significant correlation with hypertension (P=0.004). The apnoea-hypopnoea index was correlated with body mass index (P<0.0001), 24-hour systolic blood pressure (P=0.01) and LVMi normalized by height (2.7) (P=0.03). Diastolic function assessed by a global approach was impaired for 70 patients (37.2%) and none of the OSAS severity variables was a determining factor after multivariable analysis with adjustment for age and sex. CONCLUSION: Diastolic dysfunction assessed by a standardized approach is common in OSAS and should be routinely evaluated; it is independently predicted by none of the respiratory severity variables.

Home unattended vs hospital telemonitored polysomnography in suspected obstructive sleep apnea syndrome: a randomized crossover trial.

STUDY OBJECTIVE: To compare home unattended polysomnography (H-PSG) with polysomnography performed in a local hospital and telemonitored by a sleep laboratory (T-PSG) in the diagnosis of obstructive sleep apnea syndrome (OSAS). DESIGN: Randomized crossover trial. PATIENTS: Ninety-nine patients with suspected OSAS who underwent H-PSG and T-PSG on 2 consecutive nights, according to a randomized order. MEASUREMENTS: H-PSG and T-PSG were compared in terms of (1) effectiveness, only recordings providing interpretable signals from at least one EEG, the electro-oculograph, the electromyograph, air flow, thoracic or abdominal movements, and arterial oxygen saturation for 180 min of sleep were considered to be effective; (2) patient preference assessed by a questionnaire; and (3) polysomnographic indexes and final interpretative results in patients for whom both recordings were legible. RESULTS: Recordings were considered to be ineffective in 11.2% of T-PSG (95% confidence interval [CI], 4.9 to 17.4%) and in 23.4% of H-PSG (95% CI, 19.12 to 27.68%). Thermistor problems were the main cause of failure of H-PSG. Forty-one percent of patients preferred H-PSG, and 55% preferred T-PSG. H-PSG and T-PSG did not differ in terms of sleep and respiratory indexes in the 65 patients in whom both recordings were legible. H-PSG and T-PSG were concordant in 58 of 65 patients using a 10-event-per-hour apnea-hypopnea index cutoff value for the diagnosis of OSAS. CONCLUSIONS: T-PSG is clearly superior to H-PSG from a technical point of view and tends to be preferred by patients. The site of recording (home vs hospital) has no influence on polysomnographic indexes.

Mandibular advancement titration for obstructive sleep apnea: optimization of the procedure by combining clinical and oximetric parameters.

BACKGROUND: Oral appliances (OAs) have been used for the treatment of obstructive sleep apnea syndrome (OSAS), with different degrees of effectiveness having been shown in previous studies. But, in the absence of a consensual recommendation, the method of the determination of effective mandibular advancement varies from one study to another. STUDY OBJECTIVE: We prospectively evaluated an OA titration protocol based on a combined analysis of symptomatic benefit and oximetric recording to guide the progressive mandibular advancement. SETTING: University hospital sleep disorders center. PATIENTS: Forty patients with OSAS (mean [+/-SD] apnea-hypopnea index [AHI], 46 +/- 21 events per hour) found on baseline polysomnography, who were intolerant of nasal continuous positive airway pressure, completed all aspects of the study. METHODS: Two acrylic appliances connected by Herbst attachments were constructed. The mandible was advanced 1 mm every week until there was a resolution of the symptoms and a reduction in the oxygen desaturation index (ie, the number of desaturations yielding a > 3% fall in pulse oximetric saturation per hour of recording) [ODI] of <10 events per hour of recording or a maximum comfortable limit of advancement was obtained. The final response to OA was evaluated by full polysomnography recording. RESULTS: A complete response (ie, mean AHI, 5 +/- 3 events per hour; mean snoring reduction [SR], 91 +/- 13%; mean Epworth sleepiness scale [ESS] score, 5 +/- 3) was obtained in 63.6% of patients, and a limited response (ie, mean AHI, 21 +/- 11 events per hour; mean SR, 88 +/- 15%; mean ESS, 6 +/- 3) was obtained in 18.2% of patients. Twenty-five percent of mandibular advancements were motivated by an abnormal ODI (ie, 21 +/- 10 events per hour) despite resolution of the symptoms, while 20% were motivated by persistent symptoms with a normal ODI (ie, 6 +/- 2 events per hour). After a mean duration of 17 +/- 4 months, 34 patients declared that they had used the OA 5 +/- 2 days a week for 89 +/- 19% of their sleep time. CONCLUSIONS: A combination of the patient's subjective evaluation and oximetric score improves the effectiveness of the OA titration procedure.

Radiofrequency ablation for the treatment of mild to moderate obstructive sleep apnea.

OBJECTIVES/HYPOTHESIS: Obstructive sleep apnea syndrome is due to pharyngeal obstructions, which can take place at the level of the soft palate. Temperature-controlled radiofrequency ablation has been introduced as being capable of reducing soft tissue volume and excessive compliance. The aim of the study was to evaluate prospectively the possible efficacy of temperature-controlled radiofrequency ablation applied to the soft palate in subjects with mild to moderate obstructive sleep apnea syndrome. STUDY DESIGN: Twenty-nine patients with a respiratory disturbance index between 10 and 30 events per hour, body mass index equal to or less than 30 kg/m2, and obstruction at the level of the soft palate were included in a pilot, prospective nonrandomized study. METHODS: Snoring and daytime sleepiness were evaluated subjectively. Treatment (maximum of three sessions) was discontinued when the bed partner was satisfied with the snoring level. A full night recording was performed at least 4 months after the last treatment. RESULTS: Mean snoring level decreased significantly from 8.6 +/- 1.3 to 3.3 +/- 2.5 on a visual analogue scale (0-10). Daytime sleepiness decreased nonsignificantly. Mean respiratory disturbance index decreased significantly from 19.0 +/- 6.1 events per hour to 9.8 +/- 8.6 events per hour. Mean lowest oxygen saturation value increased nonsignificantly from 85.3% +/- 4.1% to 86.4% +/- 4.4%. Of the patients, 65.5% were cured of their disease. CONCLUSIONS: Temperature-controlled radiofrequency ablation was effective in selected patients with mild to moderate obstructive sleep apnea syndrome. A full-night polysomnography is required after completion of treatment to rule out residual disease.

Changes in facial profile after maxillomandibular advancement surgery for obstructive sleep apnea syndrome.

UNLABELLED: The aim of this study was to assess changes in the profile of adult male patients treated for obstructive sleep apnea syndrome (OSAS) with maxillomandibular advancement (MMA) surgery and to measure patient perception of changes compared with that of different panels. MATERIALS AND METHODS: Fifteen consecutive apneic patients displaying a wide variety of morphological types, mean age 42 years (20-59), a BMI of 26.60 kg/m(2) (22-29), a mean initial Apnea Hypopnea Index (AHI) of 50.9 (19-85), underwent MMA. Assessment was done by facial photography, lateral cephalographs (Tweed analysis modified by Riley and Delaire architectural analysis), polysomnographic records and a validated self-assessment questionnaire. Patients' pre- and postoperative profiles were taken from photographs using Photoshop 7™ software. Their darkened outlines were shown randomly in positions A or B (pre- and postoperative) to panels composed of orthodontists (n=40), fine arts students (n=50) and lay persons (n=50) who were requested to choose the most attractive profiles. RESULTS: The MMA success rate for OSAS was 80% (12/15) for an AHI less than 15, with no surgical complications. All patients reported a reduction of their symptoms and 14 out of 15 were satisfied with the esthetic outcome. Mean advancement was 8.4mm (3.0-10.0) for the maxilla and 10.8mm (10.0-13.0) for the mandible. Following MMA, 12 out of 15 exhibited maxillary protrusion and six out of 15 mandibular protrusion. The mean change in the nasolabial angle was -5.7° (-27°; 14°). The postoperative profiles were preferred by 85% of the combined panels (P=<0.001), showing no significant difference from one panel to another. No skeletal characteristic could be correlated with the esthetic preference. Upper lip retrusion, open nasolabial angle and dolichofacial type emerged as positive preoperative predictors of esthetic preference. CONCLUSION: The profile changes following MMA were favorably perceived in the majority of cases. However, specific orthodontic preparation could be offered to patients with pronounced preoperative protrusion.

Symptoms of sleep apnea syndrome: high prevalence and underdiagnosis in the French population.

OBJECTIVE: To determine the prevalence of symptoms evocative of obstructive sleep apnea (SE-OSA) and the magnitude of obstructive sleep apnea (OSA) underdiagnosis. METHODS: We used data from a cross-sectional survey conducted in 2008 in a representative sample of the French general population. Data were collected through interviews and self-administrated questionnaires and were complete for 12,203 adults (≥16 years old). SE-OSA was defined by snoring almost every night plus witnessed apneas or excessive daytime sleepiness (Epworth sleepiness scale score>10). RESULTS: The prevalence of SE-OSA was 4.9% (95% CI: 4.5-5.3), and that of self-reported OSA diagnosis was 2.4% (2.1-2.7). The prevalence of SE-OSA was 8% among people with hypertension and 11% among obese people. A previous sleep monitoring session was reported by 2.7% (2.4-3.0) of the participants and by 15.1% of people with SE-OSA. This latter proportion increased with age (24% in people with SE-OSA aged 60 years or over) and was higher in obese people (26%) and in those with chronic diseases (27% among people with hypertension). CONCLUSION: The prevalence of SE-OSA is high in France and OSA remains underdiagnosed, even in people with obesity or hypertension. Further efforts are needed to improve the diagnosis of OSA.