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1.
Cas Lek Cesk ; 158(5): 170-174, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31703527

RESUMO

In the field of sleep disorders, otorhinolaryngology is mainly concerned with snoring and obstructive sleep apnea (OSA). Prevalence of OSA is suggested between 14-49 % of male and 5-30 % of female population, which makes it most common sleep disorder. The treatment of choice is positive airway pressure (PAP) therapy with excellent success rate of 90 %, however many patients dont tolerate it. Sleep surgery is usually used to get off snoring and for mild cases of OSA. Most of surgical approaches has much lower effectivity than PAP therapy; however, surgery benefit is present constantly, while PAP therapy demands patients cooperation, that is why many patients still prefer sleep surgery.


Assuntos
Otolaringologia , Apneia Obstrutiva do Sono , Feminino , Humanos , Masculino , Cooperação do Paciente , Apneia Obstrutiva do Sono/terapia , Ronco
2.
Rev Med Suisse ; 15(671): 2087-2089, 2019 Nov 13.
Artigo em Francês | MEDLINE | ID: mdl-31742939

RESUMO

Overlap syndrome (OVS) is defined by the co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in a same patient. This condition is associated with increased mortality and a higher risk of respiratory exacerbation, compared to patients with COPD or OSA alone. Nocturnal positive PAP treatment is effective to mitigate the additional risk related to OSA. Identification of OVS is a major challenge for clinicians because of the many phenotypes of OVS patients, with atypical OSA presentation, whose sleep quality is already impacted by COPD itself. Dedicated prospective studies are mandatory to improve our understanding of OVS patients and to optimize their medical care.


Assuntos
Doença Pulmonar Obstrutiva Crônica/complicações , Apneia Obstrutiva do Sono/complicações , Humanos , Doença Pulmonar Obstrutiva Crônica/terapia , Apneia Obstrutiva do Sono/terapia
3.
Rev Med Suisse ; 15(665): 1760-1764, 2019 Oct 02.
Artigo em Francês | MEDLINE | ID: mdl-31580020

RESUMO

Neurostimulation of the hypoglossal nerve is a new alternative treatment to CPAP (Continuous Positive Airway Pressure) for patients with moderate-to-severe OSAS (Obstructive Sleep Apnea Syndrome) with anteroposterior pharyngeal obstruction visualized during a Drug Induced Sleep Endoscopy (DISE). Implantation and follow-up are performed at the CHUV with the collaboration between the SAOS-ronchopathie unit, the maxillofacial and dental surgery division and the center for investigation and research on sleep (CIRS). In this article, we present the technique, its indication and the outcomes through a recent review of the literature. This new device has been used for five years, mainly in the United States and Europe.


Assuntos
Terapia por Estimulação Elétrica , Nervo Hipoglosso/fisiologia , Apneia Obstrutiva do Sono/terapia , Humanos
6.
HNO ; 67(9): 690-697, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31414154

RESUMO

BACKGROUND: Tongue motion patterns (TMP) can influence the outcome of upper airway stimulation (UAS) in the treatment of obstructive sleep apnea (OSA). As a postoperative control the cuff position of the stimulation lead is monitored via X­ray imaging. A multidimensional X­ray assessment system was established and the association between these positional assessments and TMP was investigated 1 year after implantation. MATERIAL AND METHODS: The study on TMP and the X­ray assessments were carried out at a German ear nose and throat clinic as an implantation center. The TMPs were assessed under bipolar electrode configuration and were categorized according to the currently available literature as right-sided protrusion (RP), left-sided protrusion (LP), bilateral protrusion (BP) and mixed activation (MA). The X­ray assessment was carried out in five dimensions: the position relative to the mandible and hyoid, cuff steepness in the lateral view of the neck, the cuff position based on the single electrode and the lead connection to the cuff in the anterior-posterior view. The analyses were performed by three raters with different medical backgrounds and knowledge regarding TMP. RESULTS: In approximately 60% of the patients the apnea-hypopnea index was reduced to below 15/h, 1 year after implantation. The most common TMPs were RP and BP (82.9%). The interrater variability of the X­ray assessment was good except for one category. Furthermore, no relevant associations were found apart from the correlation between a favorable TMP and the cuff position with respect to the lateral position of the stimulation cable. CONCLUSION: Despite good interrater variability and convenient usage of the suggested X­ray assessment system, this approach did not enable the identification of any associations, by which a TM and therefore a possible straightforward or complicated treatment pathway could be predicted. Attention should possibly be paid to a rotation of the cuff during implantation with a lateral position of the stimulation lead.


Assuntos
Terapia por Estimulação Elétrica , Apneia Obstrutiva do Sono , Humanos , Nariz , Polissonografia , Apneia Obstrutiva do Sono/terapia , Língua
7.
Artigo em Chinês | MEDLINE | ID: mdl-31434371

RESUMO

Objective: To compare the changes of genioglossus electromyography (GGEMG) with and without continuous positive airway pressure (CPAP) ventilation in moderate to severe obstructive sleep apnea (OSA) patients. Methods: Each of subjects, including male snorers and non-snorers, underwent polysomnography (PSG) with synchronous GGEMG recording with intra-oral bipolar silver ball electrodes at the Sleep Center of Beijing Tsinghua Changgung Hospital from August 2016 to Sepember 2017. Manual CPAP pressure titration and with GGEMG were performed in patients diagnosed moderate to severe OSA. T-test was used to compare the changes of GGEMG in OSA group (n=12, AHI (65.90+23.67) events/h) and control group (n=6, AHI(2.30+1.93) events/h) before and after CPAP treatment. Results: Variables of GGEMG (including tonic, peak and phasic GGEMG) were higher in OSA group than in control group during both wakefulness and non rapid eye movement(NREM) sleep. However, with CPAP treatment, the GGEMG variables were significantly decreased in OSA group during NREM sleep(tonic GGEMG: 1.23%±0.73% vs. 2.54%±1.12%, t=4.024, P=0.002; peak GGEMG: 12.37%±13.19% vs. 26.98%±15.52%, t=2.795, P=0.017; phasic GGEMG: 3.81%±2.47% vs. 8.82%±3.84%, t=5.113, P<0.001). Conclusions: CPAP treatment can eliminate respiratory events and maintain airway patency. It is helpful to normalize the excessive GGEMG response in OSA patients during sleep, which has therapeutic significance to alleviate and prevent genioglossal neuromuscular lesions.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono/terapia , Eletromiografia , Humanos , Masculino , Polissonografia , Respiração , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia , Língua
9.
Am J Orthod Dentofacial Orthop ; 156(1): 13-28.e1, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256826

RESUMO

The Board of Trustees of the American Association of Orthodontists asked a panel of medical and dental experts in sleep medicine and dental sleep medicine to create a document designed to offer guidance to practicing orthodontists on the suggested role of the specialty of orthodontics in the management of obstructive sleep apnea. This White Paper presents a summary of the Task Force's findings and recommendations.


Assuntos
Ortodontia/métodos , Ortodontia/normas , Ortodontistas , Apneia Obstrutiva do Sono/terapia , Academias e Institutos , Humanos , Aparelhos Ortodônticos , Médicos , Polissonografia/métodos , Prevalência , Radiografia Dentária , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Cirurgiões , Resultado do Tratamento , Estados Unidos
10.
Artigo em Chinês | MEDLINE | ID: mdl-31262104

RESUMO

Objective: The severity of obstructive sleep apnea hypopnea syndrome (OSAHS) has a tendency to increase with age. The purpose of this study was to explore whether oral appliance (OA) treatment can block this age-related change. Methods: This study was a retrospective study. Fifteen patients (12 males,3 females) of OSAHS treated with OA were selected as treatment group,with an average age of (47.44±10.00) years and initial body mass index (BMI) of (26.31±3.33) kg/m(2). The follow-up length was 54 [22, 100] months. Nineteen patients (13 males,6 females) with untreated OSAHS served as controls, with an average age of (45.00±9.26) years and initial BMI of (25.53±2.58) kg/m(2),and the follow-up length was 35 [26,63] months. There were no significant differences in terms of gender,age,initial BMI, apnea hypopnea index(AHI), and follow-up length between the two groups. Polysomnography(PSG) data for the two groups were compared to observe the sleep respiratory function changes as aging by Wilcoxon test. Results: There was no significant difference in BMI of the treatment group and the control group at the time of follow-up, with BMI of treatment group from (26.31±3.33) kg/m(2) to (25.67±3.65) kg/m(2),Z=-1.223,P=0.221; and BMI of control group from (25.53±2.58) kg/m(2) to (25.12±2.72) kg/m(2),Z=-1.193,P=0.233. There was no significant difference in the change of AHI within the treatment group, from 26.20 [11.50, 52.98]/h to 23.10 [16.00, 45.00]/h, Z=-0.284, P=0.776; AHI in the control group was higher than that at the first visit, and the AHI increased from 15.00 [10.72, 28.90]/h to 31.10 [13.00, 41.80]/h, Z=-3.481, P<0.001. The longest apnea duration was not statistically different in the treatment group, from 60.00 [56.40, 74.00] s to 63.00 [52.00, 77.00] s, Z=-0.345, P=0.730; the longest apnea duration in the control group increased from 42.00 [34.00, 56.70] s to 46.00 [37.00,62.00] s,Z=-2.274,P=0.023. There was no significant difference in the lowest blood oxygen saturation of the treatment group and the control group, with the treatment group from 72.47%±12.69% to 72.73%±17.59%, Z=-0.597, P=0.550; and the control group from 78.21%±9.30% to 76.42%±12.17%, Z=-0.153, P=0.879. Conclusion: Symptoms of sleep apnea in OSAHS patients tend to increase with age,and oral appliance treatment may have the effect of slowing down this age-related worsening effect.


Assuntos
Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Adulto , Fatores Etários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aparelhos Ortodônticos Removíveis , Polissonografia , Respiração , Estudos Retrospectivos , Sono/fisiologia
11.
BMC Health Serv Res ; 19(1): 405, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226999

RESUMO

BACKGROUND: Clinical practice guidelines recommend further testing for people with tetraplegia and signs and symptoms of obstructive sleep apnoea (OSA), followed by treatment with positive airway pressure therapy. Little is known about how clinicians manage OSA in tetraplegia. The theoretical domains framework (TDF) is commonly used to identify determinants of clinical behaviours. This study aimed to describe OSA management practices in tetraplegia, and to explore factors influencing clinical practice. METHODS: Semi-structured interviews were conducted with 20 specialist doctors managing people with tetraplegia from spinal units in Europe, UK, Canada, USA, Australia and New Zealand. Interviews were audiotaped for verbatim transcription. OSA management was divided into screening, diagnosis and treatment components for inpatient and outpatient services, allowing common practices to be categorised. Data were thematically coded to the 12 constructs of the TDF. Common beliefs were identified and comparisons were made between participants reporting different practices. RESULTS: Routine screening for OSA signs and symptoms was reported by 10 (50%) doctors in inpatient settings and eight (40%) in outpatient clinics. Doctors commonly referred to sleep specialists for OSA diagnosis (9/20 in inpatients; 16/20 in outpatients), and treatment (12/20, 17/20). Three doctors reported their three spinal units were managing non-complicated OSA internally, without referral to sleep specialists. Ten belief statements representing six domains of the TDF were generated about screening. Lack of time and support staff (Environmental context and resources) and no prompts to screen for OSA (Memory, attention and decision processes) were commonly identified barriers to routine screening. Ten belief statements representing six TDF domains were generated for diagnosis and treatment behaviours. Common barriers to independent management practices were lack of skills (Skills), low confidence (Beliefs about capabilities), and the belief that OSA management was outside their scope of practice (Social/Professional role and identity). The three units independently managing OSA were well resourced with multidisciplinary involvement (Environmental context and resources), had 'clinical champions' to lead the program (Social influences). CONCLUSION: Clinical management of OSA in tetraplegia is highly varied. Several influences on OSA management within spinal units have been identified, facilitating the development of future interventions aiming to improve clinical practice.


Assuntos
Padrões de Prática Médica , Quadriplegia/complicações , Apneia Obstrutiva do Sono/terapia , Humanos , Pesquisa Qualitativa , Apneia Obstrutiva do Sono/complicações
12.
HNO ; 67(9): 663-669, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31190192

RESUMO

BACKGROUND: Many patients suffer from positional obstructive sleep apnea (POSA; 56%). In these cases, positional therapy may be an option. A sleep position trainer (SPT) is a small vibrating device that trains the patient to avoid sleeping in the supine position. This study aimed to compare the efficacy and tolerance of gradual and intensive training onset in POSA patients MATERIALS AND METHODS: Patients with mild to moderate POSA and incompliance with continuous positive airway pressure (CPAP) therapy were included in this prospective double-blind trail. Patients were randomized according to how training was initiated and the SPT was set to either a gradual or an intensive training program. Polygraphy was used to check respiratory parameters after 1 month, and subjective parameters and compliance were assessed prior to and after this time period using a questionnaire. RESULTS: A total of 38 patients were included (20 intensive; 18 gradual; 49 ± 13 years) of whom 31 completed the study protocol. After 1 month the apnea-hypopnea index (AHI) in both groups was significantly reduced, but there was no difference in AHI between the two training modalities (AHI intensive: 16.7 ± 6.3/h to 4.2 ± 3.2/h; AHI gradual: 18.9 ± 11.2/h to 8.4 ± 7.9/h). The same effect was observed for subjective sleepiness. CONCLUSION: The objective severity of OSA and the associated subjective daytime sleepiness was reduced in both groups. There was no difference in terms of clinical outcome or compliance between the gradual or intensive SPT therapy in POSA patients during the observation period. Both training modalities are highly successful and well tolerated.


Assuntos
Apneia Obstrutiva do Sono , Decúbito Dorsal , Pressão Positiva Contínua nas Vias Aéreas , Método Duplo-Cego , Humanos , Estudos Prospectivos , Apneia Obstrutiva do Sono/terapia
13.
Turk J Ophthalmol ; 49(3): 134-141, 2019 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-31245974

RESUMO

Objectives: To evaluate the frequency of glaucoma in patients with obstructive sleep apnea syndrome (OSAS) using and not using continuous positive airway pressure treatment. Materials and Methods: This prospective study included 59 patients diagnosed with OSAS based on the Apnea-Hypopnea Index (AHI). OSAS patients were divided into 3 groups according to their AHI scores: 5-15 was considered mild (19 patients), 16-30 was considered moderate (16 patients), and >30 (24 patients) was considered severe. Twenty-eight (47.5%) of the OSAS patients had been using continuous positive airway pressure treatment. The control group included 19 healthy subjects. Retinal nerve fiber layer and ganglion cell complex (GCC) thickness analyses were performed. Results: Average GCC thickness in left eyes was significantly lower in the mild OSAS group than in the control group (p=0.013). The GCC was significantly thinner in the inferior and inferonasal sectors of both eyes in the mild OSAS group compared to the control group (p=0.029, p=0.022, p=0.037, and p=0.019 respectively). Minimum GCC thickness in the left eyes of all OSAS groups was significantly lower than in the control group (p<0.05). Conclusion: In OSAS patients, there may be changes in retinal nerve fiber layer and ganglion cell complex thickness before alterations in the visual field emerge.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Glaucoma/diagnóstico , Pressão Intraocular/fisiologia , Células Ganglionares da Retina/patologia , Apneia Obstrutiva do Sono/complicações , Tomografia de Coerência Óptica/métodos , Campos Visuais , Feminino , Glaucoma/etiologia , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Polissonografia , Estudos Prospectivos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia
14.
J Laryngol Otol ; 133(7): 632-635, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31196251

RESUMO

BACKGROUND: Obstructive sleep apnoea occurs consequent to partial or complete upper airway obstruction, caused mostly by the collapse of upper airway musculature. Drug-induced sleep endoscopy represents the 'gold standard' in identifying the obstruction site, from the palatal level to laryngeal entry. Breathing impairment in sleep caused by the collapse of cervical trachea after previous tracheostomy has not yet been described in the literature. METHODS: This report presents two patients with severe obstructive sleep apnoea, in whom pre-operative drug-induced sleep endoscopy revealed upper airway and cervical trachea collapse at the level of previous tracheostomy. RESULTS: The female patient was successfully treated with resection of hypertrophic tissue of the tongue base via lateral pharyngectomy, and resection of the collapsed segment of the trachea with primary reconstruction of the trachea by end-to-end anastomosis. The male patient was recommended continuous positive airway pressure therapy because of serious co-morbidities and high operative risk. CONCLUSION: Drug-induced sleep endoscopy should always be used for visualisation of anatomical structures below the vocal folds in patients with a history of cervical trachea surgery. These two cases demonstrate the importance of drug-induced sleep endoscopy in planning conservative and surgical treatments, contributing significantly to operative success.


Assuntos
Apneia Obstrutiva do Sono/terapia , Traqueostomia/efeitos adversos , Adulto , Idoso , Anastomose Cirúrgica , Comorbidade , Pressão Positiva Contínua nas Vias Aéreas , Endoscopia , Feminino , Humanos , Masculino , Apneia Obstrutiva do Sono/etiologia , Resultado do Tratamento
15.
Eur Arch Otorhinolaryngol ; 276(8): 2331-2338, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31197532

RESUMO

PURPOSE: Previous studies have shown an association between obstructive sleep apnoea syndrome (OSAS) and cardiovascular events. Whether this association is mediated by an impairment of endothelial function, which is itself a driver of elevated cardiovascular risk, has yet to be clarified, as it is the eventual protective role of several OSAS treatments. The aim of our meta-analysis is to evaluate the effect of various OSAS treatments on endothelial function calculated by means of flow-mediated dilatation (FMD). METHODS: We conducted a meta-analysis of prospective studies including patients affected by mild to severe OSAS treated with continuous positive airway pressure (CPAP), surgery, oral appliance and medical treatments. FMD was measured before and after treatment RESULTS: After pooling results from different treatment strategies, OSAS treatment showed a positive impact on endothelial function (Mean Difference [MD] = 2.58; 95% CI 1.95-3.20; p < 0.00001). CONCLUSIONS: Our study supports the hypothesis that several modalities of treatment for OSAS positively impact endothelial function. Whether this effect also associates with an improvement of clinical outcomes remains to be ascertained.


Assuntos
Endotélio Vascular/fisiopatologia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Adulto , Idoso , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Apneia Obstrutiva do Sono/terapia
16.
Int J Med Inform ; 127: 43-51, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31128831

RESUMO

CONTEXT: Disease management broke through in the early 1990s to counterbalance hyper-specialization with a more comprehensive approach. Its role became immediately relevant in chronic conditions and, consequently, in Obstructive Sleep Apnoea (OSA). This is a common chronic condition for which is important to organise services at the local level, taking into account organisational factors and the characteristics of the assisted population. OBJECTIVES: The aim of this work is to propose and apply, coherently with a disease management approach, a combination of healthcare process modelling and population analysis as a way to identify critical issues and explore shared solutions. METHODS: A multidisciplinary working group was created with scholars who are skilled in process analysis, statistics and medicine. Through semi-structured interviews and on-site meetings, healthcare processes were represented with a standard graphical language: Unified Modeling Language™. Population analysis was based on statistical analysis performed on a 5-year retrospective cohort assisted by a Community Pulmonary Service. RESULTS: A shared graphic presentation of the current healthcare process and the results of the statistical analyses constituted the knowledge base to identify critical issues and recommend corresponding solutions, which include: a) refine the local patient database with additional details on comorbidities and risk factors; b) support a greater involvement of "gate-keepers" in the screening phase; c) provide practical tools for the definition of strategies to increment the adherence to therapy; d) include recommendations for physical exercise and interdisciplinary cooperation; and e) define process indicators for measuring the quality of the screening and therapeutic phases. CONCLUSION: The concomitant analyses of formalised processes and critical risk factors represent a useful approach for systematically identifying areas of improvement in healthcare processes and allow us to discuss solutions. Moreover, the specific adoption of UML® for graphical modelling and representation of patient care processes allows us to formalise them by adopting a standard language that can be taken as the basis for implementing web services to support the execution of the modelled processes.


Assuntos
Apneia Obstrutiva do Sono , Adulto , Idoso , Doença Crônica , Comorbidade , Assistência à Saúde , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapia
17.
Cochrane Database Syst Rev ; 5: CD010990, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31041813

RESUMO

BACKGROUND: The modalities of therapy for obstructive sleep apnoea (OSA) include behavioural and lifestyle modifications, positional therapy, oral appliances, surgery and continuous positive airway pressure therapy (CPAP). Though CPAP has proven efficacy in treating OSA, adherence with CPAP therapy is suboptimal. Positional therapy (to keep people sleeping on their side) is less invasive and therefore expected to have better adherence. This review considered the efficacy of positional therapy compared to CPAP as well as positional therapy against no positional therapy. Devices designed for positional therapy include lumbar or abdominal binders, semi-rigid backpacks, full-length pillows, a tennis ball attached to the back of nightwear, and electrical sensors with alarms that indicate change in position. OBJECTIVES: To compare the efficacy of positional therapy versus CPAP and positional therapy versus inactive control (sham intervention or no positional therapy intervention) in people with OSA. SEARCH METHODS: We identified studies from the Cochrane Airways' Specialised Register (including CENTRAL, MEDLINE, Embase, CINAHL, AHMED and PsycINFO), ClinicalTrials.gov, and the World Health Organization trials portal (ICTRP). It also contains results derived from handsearching of respiratory journals and abstract books of major annual meetings. We searched all databases from their inception to September 2018, with no restrictions on language of publication or publication type. SELECTION CRITERIA: We included randomised controlled trials comparing positional therapy with CPAP and positional therapy with inactive control. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies and extracted the data. We used a random-effects model in the meta-analysis to estimate mean differences and confidence intervals. We assessed certainty of evidence using the GRADE approach. MAIN RESULTS: We included eight studies. The studies randomised 323 participants into two types of interventions. The comparison between positional therapy and CPAP included 72 participants, while the comparison between positional therapy and inactive control included 251 participants. Three studies used supine vibration alarm devices, while five studies used physical positioning like specially designed pillows or semirigid backpacks.Positional therapy versus CPAPThe three studies included for this comparison were randomised cross-over trials. Two studies found that there was no difference in Epworth Sleepiness Scale (ESS) scores between CPAP and positional therapy. Two studies showed that CPAP produced a greater reduction in Apnoea-Hypopnoea Index (AHI) with a mean difference (MD) of 6.4 events per hour (95% CI 3.00 to 9.79; low-certainty evidence) compared to positional therapy. Subjective adherence, evaluated in one study, was found to be significantly greater with positional therapy (MD 2.5 hours per night, 95% CI 1.41 to 3.59; moderate-certainty evidence).In terms of secondary outcomes, one study each reported quality-of-life indices and quality-of-sleep indices with no significant difference between the two groups. One study reported cognitive outcomes using multiple parameters and found no difference between the groups. There were insufficient data to comment on other secondary outcomes like respiratory disturbance index (RDI), and frequency and duration of nocturnal desaturation. None of the studies clearly reported adverse effects.Positional therapy versus inactive controlThree studies of positional therapy versus no intervention were randomised cross-over trials, while two studies were parallel-arm studies. Data from two studies showed that positional therapy significantly improved ESS scores (MD -1.58, 95% CI -2.89 to -0.29; moderate-certainty evidence). Positional therapy showed a reduction in AHI compared with control (MD -7.38 events per hour, 95% CI -10.06 to -4.7; low-certainty evidence). One study reported adherence. The number of participants who continued to use the device at two months was no different between the two groups (odds ratio (OR) 0.80, 95% CI 0.33 to 1.94; low-certainty evidence). The same study reported adverse effects, the most common being pain in the back and chest, and sleep disturbance but there was no significant difference between the two groups in terms of device discontinuation (OR 1.25, 95% CI 0.5 to 3.03; low-certainty evidence). One study each reported quality-of-life indices and quality-of-sleep indices, with no significant difference between the two groups. One study reported cognitive outcome, and found no difference between the groups. There was insufficient evidence to comment on other secondary outcomes (RDI, frequency and duration of nocturnal desaturation). AUTHORS' CONCLUSIONS: The review found that CPAP has a greater effect on improving AHI compared with positional therapy in positional OSA, while positional therapy was better than inactive control for improving ESS and AHI. Positional therapy may have better adherence than CPAP. There were no significant differences for other clinically relevant outcomes such as quality of life or cognitive function. All the studies were of short duration. We are unable to comment on the long-term effects of the therapies. This is important, as most of the quality-of-life outcomes will be evident only when the therapies are given over a longer period of time. The certainty of evidence was low to moderate.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono/terapia , Decúbito Dorsal , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Adv Exp Med Biol ; 1176: 25-33, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31073928

RESUMO

Obstructive sleep apnea (OSA) is the most common manifestation of sleep-related breathing disorders that are often accompanied by dysfunction of the autonomic nervous system. The main objective of the study was to assess the usefulness of heart rate variability (HRV) analysis in the diagnosis of patients with severe OSA and in the assessment of the effects of 3-month treatment with continuous positive airway pressure (CPAP). There were 54 patients enrolled in the study. The OSA group consisted of 39 patients suffering from severe OSA (apnea/hypopnea index >30/h), and the control group included 15 non-OSA patients with matched demographic characteristics and comorbidities. All patients underwent 24-h Holter electrocardiographic monitoring. HRV was analyzed using the time- and frequency-domains. We found that OSA patients had decreases in time-domains and increases in frequency-domains of HRV, compared to non-OSA controls, which strongly suggested a clinically disadvantageous shift in the balance of parasympathetic/sympathetic activity toward the latter. Further, CPAP treatment, partly, albeit significantly, reversed the OSA-induced changes in HRV. We conclude that HRV analysis may be of help in the diagnosis of OSA and in the monitoring of the effectiveness of treatment.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Frequência Cardíaca , Apneia Obstrutiva do Sono , Sistema Nervoso Autônomo/patologia , Estudos de Casos e Controles , Humanos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia
20.
Sleep Health ; 5(2): 161-165, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30928116

RESUMO

INTRODUCTION: Treatment with positive airway pressure (PAP) therapy reduces injury risk among adults with obstructive sleep apnea syndrome (OSAS), but the effect of PAP therapy on children's injury risk is unknown. This study investigated whether treatment of OSAS with PAP reduces children's pedestrian injury risk in a virtual reality pedestrian environment. METHODS: Forty-two children ages 8-16 years with OSAS were enrolled upon diagnosis by polysomnography. Children crossed a simulated street several times upon enrollment, prior to PAP treatment, and again after 3 months of PAP therapy. Children underwent sleep studies at all time points. RESULTS: Children adherent with PAP had a significant reduction in hits by a virtual vehicle (P < .01) and less time to contact with oncoming vehicles (P < .01) following treatment. Those who were nonadherent did not show improved safety. There was no change in attention to oncoming traffic. CONCLUSIONS: OSAS may have significant consequences on children's daytime functioning in a critical domain of personal safety: pedestrian skills. In pedestrian simulation, children with OSAS adherent to PAP therapy showed improvement in pedestrian safety and had fewer collisions with a virtual vehicle following treatment. Results highlight need for heightened awareness of the real-world benefits of treatment for pediatric sleep disorders. LEVEL OF EVIDENCE: Level II Therapeutic Study.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Pedestres/psicologia , Respiração com Pressão Positiva , Apneia Obstrutiva do Sono/terapia , Ferimentos e Lesões/prevenção & controle , Adolescente , Criança , Feminino , Humanos , Masculino , Pedestres/estatística & dados numéricos , Medição de Risco , Resultado do Tratamento
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