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PubMed1999

Dental side effects of an oral device to treat snoring and obstructive sleep apnea.

STUDY OBJECTIVES: Snoring and obstructive sleep apnea (OSA) are common and related conditions--with major social and health implications--which can be treated successfully with dental devices that reposition the mandible. Despite wide use, side effects of these devices have not yet been systematically evaluated. The purpose of the study was to evaluate side effects of a mandibular advancement splint (MAS) previously described by the authors. DESIGN: Questionnaire survey and dental examination of a consecutive case series of patients treated with the MAS SETTING: Dental outpatient clinic PATIENTS: Attempts were made to contact all 191 patients treated over a 5-year period. All had snored loudly and habitually with or without OSA prior to treatment. MEASUREMENTS AND RESULTS: Of 191 patients treated, 132 agreed to complete the questionnaire. All were scheduled to attend for dental examination and 106 underwent examination. Of the 132 interviewed, patient and partner report indicated that the device was well tolerated and controlled snoring satisfactorily in 100 after 31 +/- 18 (mean +/- SD) months of use. Dental side effects were reported in 107 patients, although these were mostly minor, and only 10 patients ceased using the device because of them. Side effects included excess salivation (in 40), xerostomia (in 30), temporomandibular joint pain (in 35), dental discomfort (in 35), myofacial discomfort (in 33) and bite changes (in 16). Of 106 patients examined, 30 had increased maximal opening and 76 had no change compared with pretreatment records. Temporomandibular joint noises were found in 9 patients, and occlusal changes (12 m mylar strip and wax bite, relative to pretreatment) in 15. None of these effects could be related to degree of opening or protrusion produced by the MAS. CONCLUSION: Dental side effects occur in a significant proportion of patients using the MAS. In most cases these are minor and their importance must be balanced against the efficacy of the MAS in treating snoring and OSA.

Adult↗
PubMed1997

Management of obstructive sleep apnea in childhood.

The childhood obstructive sleep apnea syndrome is a common and serious problem. Adenotonsillectomy remains the mainstay of treatment. Nasal continuous positive airway pressure is effective and well tolerated in those who do not respond to adenotonsillectomy. In selected cases, additional surgery or supplemental oxygen (with careful monitoring) may play a role. New guidelines for pediatric polysomnography should help standardize methods, thus enabling a better comparison of outcomes. More research in this area is sorely needed.

Adenoidectomy↗
PubMed1996

Effects of NCPAP therapy on fibrinogen levels in obstructive sleep apnea syndrome.

In patients with obstructive sleep apnea syndrome (OSAS), the blood coagulation system may contribute to an increased risk of cardiovascular events, which occur most frequently in the morning. Nasal continuous positive airway pressure (NCPAP) treatment can improve the mortality of patients with OSAS. We measured the plasma fibrinogen concentration, which is an independent risk factor for cardiovascular events, in the afternoon (3:30 P.M.) and the next morning upon awakening (8:30 A.M.) in 11 patients with OSAS (apnea and hypopnea index > 20) before and after NCPAP therapy. We also measured the hematocrit, the C-reactive protein, and the total plasma protein at the same time. The plasma fibrinogen and hematocrit levels in the morning (298 +/- 16 mg/dl and 48.5 +/- 1.5%, mean +/- SEM) were significantly higher than on the previous afternoon (275 +/- 14 mg/dl and 46.6 +/- 1.3%) (fibrinogen, p < 0.02; hematocrit, p < 0.005). The whole blood viscosity (WBV) at a shear rate of 208 inverse seconds, which can be predicted based on the hematocrit and total plasma protein, was also significantly higher in the morning (4.98 +/- 0.20/s) than in the afternoon (4.73 +/- 0.17/s) (p < 0.005). These increases in the plasma fibrinogen concentration and the WBV in the morning disappeared after NCPAP treatment. The attenuation of morning increases in the plasma fibrinogen concentration and WBV induced by NCPAP treatment may contribute to an overall improvement in the mortality from cardiovascular events in patients with OSAS.

Adult↗
PubMed1993

Pharyngeal fat in obstructive sleep apnea.

Although most patients with obstructive sleep apnea (OSA) are obese, it is not known how obesity contributes to airway collapse during sleep. The purpose of this study was to determine whether the volume of adipose tissue adjacent to the pharyngeal airway in humans is related to the degree of OSA. We studied 30 subjects, nine without OSA and 21 with OSA; two subjects were studied before and after weight loss. Adipose tissue was detected with magnetic resonance imaging using T1-weighted spin echo sequences. The volume of adipose tissue adjacent to the upper airway was determined by measuring the volume of all pixels in the intensity range of adipose tissue within the region bounded by the ramus of the mandible, the spine, the anterior border of the soft palate, and the hard palate. Polysomnography was performed with conventional techniques. All subjects had a collection of adipose tissue adjacent to the upper airway; the volume of this adipose tissue correlated with the number of apneas plus hypopneas per hour of sleep (r = 0.59, p < 0.001). Both patients who lost weight and had fewer apneas and hypopneas had a marked decrease in the pharyngeal adipose tissue volume. We conclude that adipose tissue is deposited adjacent to the pharyngeal airway in patients with OSA and that the volume of this tissue is related to the presence and degree of OSA.

Adipose Tissue↗
PubMed1996

Treatment of obstructive sleep apnea. A review.

Treatment of obstructive sleep apnea (OSA) has developed over the last 25 years from tracheostomy to a variety of options, including weight loss, nasal continuous positive airway pressure (N-CPAP), pharyngeal surgery, and medications. None of these options is definitive or curative, except possibly weight loss. The most widely prescribed treatment is N-CPAP, but recently published studies using objective measurement of patient compliance show less than ideal compliance. Attempts have been made to design pharyngeal surgery according to the site of upper airway collapse or narrowing, as identified by various techniques in wakefulness. How representative these studies are of upper airway physiology in sleep is questionable. Recent studies have shown improved surgical success in correcting OSA. However, disturbing data are available in a limited number of patients that demonstrate worsening of the OSA months after a favorable response to surgery. More studies assessing the long-term outcome of pharyngeal surgery are needed. Several pharmacologic agents have been used to treat OSA. Results with any particular agent are not better than with N-CPAP or surgery. However, studies of subgroups of patients with OSA in which a particular pharmacologic agent may be specifically indicated, such as thyroxine in hypothyroidism, have not been conducted (to our knowledge). An algorithm for the approach to treatment recommendations is presented. Basic to this algorithm is an objective presentation of therapeutic options to the patient with OSA and a respect for the patient's preferences.

Humans↗
PubMed1997

[Laser assisted uvulopalptoplasty treatment for obstructive sleep apnea syndrome].

71 patients of obstructive sleep apnea symdrome (OSAS) were treated by Nd:YAG laser assisted uvulopalptoplasty (LAUP). According to the atonamic features of every patient, and type of operation which should be selected, the success rate of surgery would increase, and complications would be reduced. The effect rate is 97.2% by clinic, 90.0% by polysimnograph (PSG).

Adult↗
PubMed2000

[Malfunction of some immunologic functions in patients with obstructive sleep apnea].

Hypoxia and sleep disorders may result in an impairment of immune system in patients with obstructive sleep apnea (OSA). Therefore we studied mitogenic stimulation of peripheral blood lymphocytes by PHA (1 microgram/ml) by measurement of 3H-thymidine incorporation, metabolic activity of neutrophils measured by chemiluminescence (CL), immunoglobulins (IgG, IgA and IgM) concentration in serum (radial immunodiffusion) and TNF-alpha concentration in serum (ELISA), and E-rosette tests (with theophylline) in 57 obese patients with severe OSA. In OSA patients severe impairment of f-MLP-induced granulocyte chemiluminescent activity was observed.

Adult↗
PubMed1989

[Effectiveness of continuous positive airway pressure in the long-term treatment of the obstructive sleep apnea syndrome].

Eight patients with obstructive sleep apnea syndrome were treated with continuous positive airways pressure by nasal route. The treatment was carried out in the hospital during the initial days. If the procedure was effective and the tolerance was good, the patients were discharged to continue with treatment at home. Polygraphic sleep recordings carried out 2-4 months after the beginning of therapy showed normalization of the structure and the phases of sleep, apnea and desaturation being virtually absent. After a mean follow up of 18 months the patients are asymptomatic. The treatment has been well tolerated and significant side effects have not developed.

Adult↗
PubMedDate not supplied

Sleepless nights: obstructive sleep apnea in the pediatric patient.

Obstructive sleep apnea syndrome (OSAS) is a subtle but severe sleep disorder of early childhood. It occurs in 1.6%-3.4% of children between 6 months and 6 years of age. OSAS is often difficult to detect, and may have long-term consequences, including failure to thrive, behavioral disturbances, developmental delay, and cor pulmonale. Pediatric nurses are pivotal in assessing the clinical symptoms of OSAS so that prompt evaluation and treatment can be initiated. Early symptoms of OSAS include awakening with a startle or gasp, restlessness, retractions, inspiratory stridor, mouth breathing, and excessive sweating. Treatments vary, and include adenotonsilectomy, nasal continuous positive airway pressure (NCPAP), behavior modification, and tracheostomy.

Child↗
PubMed1994

[The use of the continuous positive air pressure method for treating the obstructive sleep apnea syndrome].

11 patients with obstructive sleep apnea syndrome (OSAS) were treated by CPAP method for 10 nights. The principle of the method is the prevention of the upper airways closure episodes during sleep (the sleep apnea episodes) using continuous positive air pressure (CPAP) maintained in the patients' airways for the whole sleep time. After the treatment the basic symptoms disappeared in most of the patients who had also improved their general condition. It is shown that CPAP is more effective in patients with marked OSAS. The latter needs long-term CPAP therapy, because the symptoms may come back within 2-3 weeks after discontinuation of the treatment.

Adult↗
PubMed1994

[Brief polysomnographic studies in the diagnosis of the obstructive sleep apnea syndrome].

Firm diagnosis of obstructive sleep apnea syndrome (OSAS) is normally based on all-night-long polysomnograms, at considerable expenditure of time and money. Shorter studies have been proposed as an alternative. We have assessed the efficacy of polysomnograms recorded over the first three hours of nocturnal sleep (SN) for diagnosing OSAS and the results have been compared with those of polysomnograms recorded throughout the entire night (EN). Twenty-five male patients suspected of having OSAS were enrolled; 19 were diagnosed for OSAS by EN and 16 were diagnosed by SN, indicating 3 false negatives and a sensitivity of 84% for SS. No false positives were obtained by studying only the first three hours of sleep, indicating a specificity of 100%. Significant differences were found in minimum oxygen saturation (SatO2) and percent of total sleep time with intervals of SatO2 below 80%. We conclude that polysomnography during the first part of nocturnal sleep is a specific method for screening for OSAS and that, although this method's sensitivity is high, study should be continued throughout an entire night when results are negative. Desaturation levels may be underestimated in recordings lasting only the first half of the night.

Adult↗
PubMed1993

[Ambulatory blood pressure in obstructive sleep apnea syndrome].

38 patients with obstructive sleep apnea syndrome underwent automated ambulatory 24-hour blood pressure monitoring. Systolic, diastolic and mean pressure values were significantly correlated with the apnea index (AI) during sleep, as well as during wakefulness. A significant negative correlation was found between minimal arterial O2 saturation in sleep and diastolic blood pressure values during waking hours. The contribution of the AI to blood pressure during sleep and wakefulness was significant, while the contribution of body mass index (BMI) was negligible. These results support the causal relationship between the severity of sleep apnea syndrome and systemic hypertension, independent of BMI.

Blood Pressure↗
PubMedDate not supplied

Obstructive sleep apnea, nasal congestion, and snoring: their systemic effects and impact on quality of life.

A literature review was conducted to evaluate the available published data on sleep-related breathing disorders with a focus on obstructive sleep apnea (OSA) syndrome, nasal congestion, and snoring. The MEDLINE database was used to obtain pertinent reviews and articles. The pathophysiology of snoring, a partial blockage of the airway, and of apnea or total airway obstruction, is described. Contributing factors to the etiology of the OSA syndrome as well as current methods of diagnosis are discussed. Adverse systemic sequelae of the OSA syndrome, especially those pertaining to the cardiovascular and respiratory systems, are detailed. Treatment options, both nonsurgical and surgical, which are used to improve the quality of life of patients with these disorders, are presented also.

Disease Management↗
PubMed2000

Familial Aggregation and Segregation Analysis of Snoring and Symptoms of Obstructive Sleep Apnea.

To investigate possible modes of inheritance that would explain familial aggregation in obstructive sleep apnea (OSA), familial correlation and segregation analyses were performed on data derived from 584 pedigrees with 2019 cases enrolled in the Tucson Epidemiologic Study of Obstructive Airways Disease (TESOAD) who were at least 10 years of age and who had information pertaining to snoring and daytime sleepiness. Data were obtained from the 9th (May 1984 to October 1985) and 12th (February 1990 to October 1992) surveys of the TESOAD, which is a random, stratified sample of the non-Hispanic Caucasian population of Tucson, Arizona. A snoring phenotype was considered present if it occurred on at least some nights. A "sleep apnea" phenotype was constructed if participants snored and experienced daytime sleepiness. Familial correlations for snoring showed significant mother-child and sibling correlations but not father-child correlations. For sleep apnea, significant parent-daughter but not parent-son or sibling correlations were observed. Segregation analyses for snoring with regressive familial effects and sibling, age, and obesity covariates showed no evidence for mendelian transmission. However, additional familial effects were present that suggested phenotype aggregation from polygenic or environmental factors, or both. For the sleep apnea phenotype, similar segregation analyses indicated that mendelian dominant or codominant models were possible. However, the analyses also suggested that a nongenetic model fit the data as well. In addition, consistent with the familial correlations, specific maternal- and sibling-related effects remained even after inclusion of age, gender, and obesity covariates. These data support the concept that inheritable or shared environmental factors contribute to the development of OSA and that maternal components may be more important than paternal ones.

Journal Article↗
PubMed2004

Auto-titrating versus standard continuous positive airway pressure for the treatment of obstructive sleep apnea: results of a meta-analysis.

STUDY OBJECTIVE: To compare the effectiveness of auto-titrating continuous positive airway pressure (APAP) versus conventional continuous positive airway pressure (CPAP) in reducing the apnea-hypopnea index (AHI), reducing the mean airway pressure, improving subjective sleepiness, and improving treatment adherence in patients with obstructive sleep apnea (OSA). DESIGN: Meta-analysis and metaregression of published randomized trials comparing APAP to CPAP. SETTING: N/A. PARTICIPANTS: N/A. INTERVENTIONS: N/A. RESULTS: We identified 9 randomized trials studying a total of 282 patients. Compared to CPAP, there was no significant advantage of APAP in reducing AHI or sleepiness (pooled APAP-CPAP posttreatment AHI and Epworth Sleepiness Scale score = -0.20 events per hour, 95% confidence interval:[-0.74,0.35], and -0.56 [-1.4,0.3] respectively). The use of APAP reduced the mean applied pressure across the night by 2.2 cm water [1.9,2.5] compared to CPAP. Adherence with therapy was not substantially improved with APAP; pooled estimate of improvement was 0.20 hours per night ([-0.16,0.57], P = .28) using a random-effects model. CONCLUSIONS: Compared to standard CPAP, APAP is associated with a reduction in mean pressure. However, APAP and standard CPAP were similar in adherence and their ability to eliminate respiratory events and to improve subjective sleepiness. Given that APAP is more costly than standard CPAP, APAP should not be considered first-line chronic therapy in all patients with OSA. However, APAP may be useful in other situations (eg, home titrations, detection of mouth leak) or in certain subgroups of patients with OSA. Identifying circumstances in which APAP is a definite improvement over CPAP in terms of costs or effects should be the focus of future studies.

Humans↗
PubMed2004

Update for nurse anesthetists. The Starling resistor: a model for explaining and treating obstructive sleep apnea.

Recent epidemiological research places the incidence of obstructive sleep apnea as high as 16% in the general population. Serious postoperative respiratory complications and death have been reported in this population. Anesthetic drugs contribute to these complications secondary to acute and residual influences on the complex orchestration of airway muscles and reflexes involved in airway patency. The Starling resistor model is a theoretical model that has application in explaining upper airway dynamics and the treatment and management of obstructive sleep apnea. The model postulates the oropharynx as a collapsible tube. The oropharynx remains open or partially or completely closed as a result of pressure upstream at the nose and mouth, pressure downstream at the trachea and below, or tissue pressure surrounding the oropharynx. This AANA Journal course provides an overview of the Starling resistor model, its application to obstructive sleep apnea, and preoperative and postoperative anesthetic considerations.

Airway Resistance↗
PubMed2006

Concurrent presence of metabolic syndrome in obstructive sleep apnea syndrome exacerbates the cardiovascular risk: a sleep clinic cohort study.

This cross-sectional study was conducted to examine whether the obstructive sleep apnea syndrome (OSAS) is associated with elevation of the pulse wave velocity (PWV) and increase in the plasma levels of C-reactive protein (CRP), both of which are known markers of cardiovascular risk, and also to determine if the concurrent presence of the metabolic syndrome might exacerbate this elevation in the levels of these cardiovascular risk markers in subjects with OSAS. With these objectives, the PWV and serum CRP were measured in 184 subjects attending a sleep clinic. It was found that the PWV and CRP were higher in the subjects with OSAS (n=94) than in those without OSAS (n=90). Furthermore, among the subjects with OSAS, the PWV and CRP were higher in those with the concurrent presence of the metabolic syndrome (n= 41; PWV=1,562+/-19 cm/s; CRP=1.8+/-0.2 mg/l) than in those without metabolic syndrome (n=53; PWV=1,432+/-21 cm/s; CRP=1.2+/-0.1 mg/l) (p<0.05). A general linear model analysis demonstrated that OSAS and metabolic syndrome were independently associated with elevated PWV and increase of the plasma levels of CRP. OSAS appears to be associated with increased cardiovascular risk, as reflected by both elevated PWV and increase of the plasma CRP. The concurrent presence of metabolic syndrome may exacerbate this increase in cardiovascular risk in subjects with OSAS. Therefore, the concurrent presence of metabolic syndrome may constitute an additive cardiovascular risk factor in subjects with OSAS.

Adult↗