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PubMed1986

[Therapy of obstructive sleep apnea syndrome].

Symptomatology and sequelae, as well as diagnosis and therapy of the obstructive sleep apnea syndrome are discussed. The Esmarch prosthesis, which we developed for the prosthetic treatment of obstructive sleep apnea syndrome, was tested in 7 patients. Patients were polysomnographically recorded during two sequential nights with and without Esmarch prosthesis. All apnea parameters improved significantly (apnea time by 78%, apnea index by 67% of baseline values). The mean duration of the remaining apnea phases diminished by 31%. Improvement of O2 saturation of haemoglobin and O2 partial pressure in the tissue paralleled that of the apnea parameters. The severely disturbed sleep profile of the patients showed a clear tendency towards normalization. The Esmarch prosthesis is an efficient method for the treatment of the obstructive sleep apnea syndrome.

Adult↗

PubMed2002

Obstructive sleep apnea in children: do intranasal corticosteroids help?

Obstructive sleep apnea (OSA) is a common condition of childhood, and is associated with significant morbidity. Prevalence of the condition peaks during early childhood, due in part to adenoidal and tonsillar enlargement within a small pharyngeal space. The lymphoid tissues regress after 10 years of age, in the context of ongoing bony growth, and there is an associated fall in the prevalence of OSA. Obstruction of the nasopharynx by adenoidal enlargement promotes pharyngeal airway collapse during sleep, and the presence of large tonsils contributes to airway obstruction. Administration of systemic corticosteroids leads to a reduction in the size of lymphoid tissues due to anti-inflammatory and lympholytic effects. However, a short course of systemic prednisone has been demonstrated not to have a significant effect on adenoidal size or the severity of OSA, and adverse effects preclude the long-term use of this therapy. Intranasal corticosteroids are effective in relieving nasal obstruction in allergic rhinitis, and allergic sensitization is more prevalent among children who snore than among those who do not snore. Intranasal corticosteroids have also been demonstrated to reduce adenoidal size, independent of the individual's atopic status. There is preliminary evidence of an improvement in the severity of OSA in children treated with intranasal corticosteroids, but further studies are needed before such therapy can be routinely recommended. Prescribing clinicians should take into account the potential benefits to the patient, the age of the child, the presence of comorbidities such as allergic rhinitis, the agent used, and the dose and duration of treatment when considering such therapy.

Administration, Intranasal↗

PubMed1997

Snoring and obstructive sleep apnea: does head posture play a role?

The aim of this article is to present scientific and clinical evidence to support the role of proper head and neck posture in the management of snoring and obstructive sleep apnea. Obstruction of the upper-airway during sleep is a serious medical condition often associated with severe daytime somnolence, morning headache, and a host of cardiopulmonary complications, including but not limited to systemic and pulmonary hypertension, nocturnal cardiac dysrhythmias, myocardial infarction, and stroke. Though anti-snoring pillows are occasionally mentioned in the literature, the role of proper head-neck support during sleep has been largely neglected. In this article the effect of head-neck position on upper-airway obstruction during sleep is discussed from the perspective of both causation and treatment. Based on the evidence presented by the author, it is recommended that the use of cervical-support pillows be considered as an adjunctive treatment modality in patients suffering from snoring and obstructive sleep apnea.

Aged↗

PubMed2000

High-flow transtracheal insufflation treats obstructive sleep apnea. A pilot study.

To determine the effect of transtracheal insufflation (TTI) on obstructive sleep apnea (OSA), we examined breathing patterns in five tracheostomized patients with OSA at varying TTI flow rates when breathing with a closed tracheostomy. The breathing patterns and polysomnographic responses to air insufflation were studied as TTI was increased from 0 to 15 L/min for brief periods of non-rapid eye movement (NREM) sleep (Experiment 1). The frequency of sleep-disordered breathing episodes remained high at 0 and 5 L/min (87.0 +/- 33.7 and 79.4 +/- 24.4 episodes per hour NREM) and decreased significantly to 41.3 +/- 31.5 and 43.4 +/- 31.4 episodes/h NREM sleep at rates of 10 and 15 L/min, respectively (p = 0.003). At high levels of TTI (10 and 15 L/min), obstructive apneas and hypopneas decreased but periodic laryngeal obstructions were induced during stage 1 NREM sleep. To prevent laryngeal obstructions, a servo-control system was used to briefly interrupt TTI during these events. When this system was implemented for more prolonged periods of sleep (Experiment 2, total sleep time 176.6 +/- 12.5 min), high-flow TTI (hf-TTI, 15 L/min) led to an overall reduction in the combined frequency of obstructive apneas and laryngeal obstructions from 63.8 +/- 21.8 to 10.7 +/- 9.1 (p < 0.03) and was associated with a marked reduction in arousal frequency from 60.0 +/- 26.0 to 8. 3 +/- 5.4/h in NREM sleep, and from 67.5 +/- 3.5 to 0 +/- 0/h in rapid eye movement (REM) sleep. Our findings demonstrate that hf-TTI stabilized breathing patterns in apneic patients, and was safe and efficacious for prolonged periods of sleep.

Adult↗

PubMedDate not supplied

Anesthetic management of obstructive sleep apnea patients.

Presented in an illustrative case report and a review of the anesthetic management of obstructive sleep apnea patients. Preoperative evaluation should include a thorough airway evaluation and a comprehensive cardiovascular and pulmonary evaluation. With polysomnography, identification of the severity of sleep apnea can be idenified. Although sleep centers vary in their definitions, severe obstructive sleep apnea is diagnosed if the patient demonstrates an apnea index greater than 70 and an oxygen (O2) desaturation less than 80% with cardiovascular sequelae. Severe sleep apnea patients are at extreme risk for general anesthesia. These risks should be discussed preoperatively with the patient. Unsupervised preoperative sedation should be avoided because of the extreme sensitivity of these patients to sedatives and airway obstruction. Intraoperative management of the obstructive sleep apnea patient varies depending on the severity of the sleep apnea. Invasive monitoring may be necessary if the patient demonstrates evidence of cardiopulmonary dysfunction. With the assistance of the otolaryngologist, the anesthesiologist can formulate an approach to establishing an airway. Intraoperative opioids and sedatives should be limited. The recovery of the sleep apnea patient is extremely important and is the time when most airway emergencies occur. Extubation of the patient should occur when appropriate surgical personnel and equipment are available in case of an airway emergency. Steroids may be used to decrease the amount of airway swelling. Supplemental O2 should be used in patients who demonstrate desaturation. Opioids and sedatives should be avoided, as should other drugs that have central and sedating effects. Postoperative pain is effectively controlled with acetaminophen and topical anesthetic sprays. Postoperative monitoring for apnea, desaturation, and dysrhythmias is a necessity in sleep apnea patients.

Adult↗

PubMed2001

[Obstructive sleep apnea in children. Our experience].

We expose our experience in obstructive sleep apnea syndrome (OSAS) in the pediatric population and review the literature. Forty-six nocturnal respiratory polygraphies were performed using a portable device (Eden Trace II Plus) that measures heart rate, chest wall impedance, nasal/oral airflow and oxygen saturation. Seven children have been studied before and six weeks after Adenotonsillectomy. All this children experienced an immediate and important improvement of their obstructive symptoms. After Adenotonsillectomy the number of obstructive sleep apneas disminished up to 87.25% and the number of hypoapneas disminished up to 73.3. The arterial oxygen saturation during the night normalized in the seven patients. The initial treatment of OSAS in children should be the Adenotonsillectomy, although the diagnostic criteria of OSAS in children have to be defined more precisely in the future.

Adenoidectomy↗

PubMed1990

Uvulopalatopharyngoplasty for treatment of obstructive sleep apnea.

Currently, uvulopalatopharyngoplasty (UPPP) is the most common surgical procedure used for the treatment of obstructive sleep apnea. Patients with clinically significant obstructive sleep apnea in whom medical treatment has failed or who are unwilling to comply with medical therapy are considered candidates for UPPP. The initial surgical results obtained in nonselected patients with obstructive sleep apnea were highly variable, approximately half of the patients experiencing more than a 50% reduction in the frequency of disordered breathing events postoperatively. Although differences in surgical technique likely account for some of the variability, preoperative differences in the site (or sites) of upper airway collapse are also thought to influence the surgical results. Because UPPP involves resection of the uvula, distal margin of the soft palate, palatine tonsils, and any excessive lateral pharyngeal tissue, patients with anatomic narrowing and collapse confined to the velopharyngeal or retropalatal region of the upper airway are considered optimal surgical candidates. Fiberoptic pharyngoscopy, cephalometric roentgenography, computed tomography, and somnofluoroscopy are procedures that can be used preoperatively to help select optimal candidates for UPPP. The results suggest that the success rate of UPPP can approach 66% with careful preoperative selection of patients.

Evaluation Studies as Topic↗

PubMed1983

Obstructive sleep apnea and its therapy: clinical and polysomnographic manifestations.

Obstructive sleep apnea syndrome was studied in 32 children, aged 2 to 14 years, in the sleep-wake disorders center at Montefiore Hospital and Medical Center during the years 1977 to 1980. All children underwent all-night polysomnograms; 17 of these children had surgery to relieve airway obstruction and seven had a repeat polysomnographic study 4 to 6 weeks following the surgery. There was a significant improvement in the number of obstructive apneas and in other apnea indices following surgery. There was no significant effect on the durations and the proportions of the various sleep stages, on sleep efficiency, or on the number of awakenings.

Adenoidectomy↗

PubMed2001

Association between polysomnographic sleep measures and health-related quality of life in obstructive sleep apnea.

Many facets of health-related quality of life are diminished in obstructive sleep apnea (OSA) as they are in other chronic medical conditions. We speculated that impairment in health-related quality of life (HRQoL) might result from the fatigue and daytime somnolence associated with the sleep disorder, as an indirect result from the fragmentation of night-time sleep in OSA. Our hypothesis was that sleep fragmentation measures would correlate with poorer HRQoL measured by medical outcomes study (MOS) subscales. Thirty-nine patients with polysomnographically-confirmed OSA participated in this study. Pearson's correlations were performed with the following sleep architecture variables: wake after sleep onset, the total number of brief arousals, the number of respiratory-related arousals, the rate of respiratory events per hour, and total sleep time. To our surprise, although the total number of arousals was associated with health distress (r=-0.481, P < 0.005), it did not correlate with any other subscales indicating poorer physical and mental health. The relatively insensitive measure of total sleep time (TST) correlated in the expected direction with most subscales. However, after controlling for age and gender, respiratory disturbance indices (RDI) and/or number of arousals emerged as significantly associated with mobility, cognitive functioning, social functioning, energy and fatigue, and health distress. Our findings suggest that polysomnographic indicators of sleep quality and sleep continuity may be an important influence determining many aspects of HRQoL in OSA patients.

Adult↗

PubMed2000

[Pharyngolaryngoscopic findings in patients with obstructive sleep apnea syndrome and primary snoring].

BACKGROUND AND OBJECTIVE: The localization of an upper airway collapse in snorers and patients suffering from obstructive sleep apnea was a subject frequently discussed in the last few years. Pharyngolaryngoscopy during sleep or drug-induced sleep allows evaluation of upper airway conditions. PATIENTS/METHODS: A total of 324 patients suffering from snoring or obstructive sleep apnea underwent flexible pharyngolaryngoscopy while awake and under propofol-induced sedation in the course of routine diagnostic procedures in the sleeping lab. In this study, the results of pharyngolaryngoscopy are compared to results of the Müller maneuver and polysomnographic recordings. The therapeutic consequences of this additional investigation are discussed. RESULTS: In 95% of cases snoring was observed during drug-induced sleep. A significant discrepancy was seen between results of the endoscopy while being awake (Müller maneuver) and during drug-induced sleep. The degree of collapse differed significantly in the area of the base of the tongue. Severe collapse was seen much more often with pharyngoscopy during drug-induced sleep compared to the results during the Müller maneuver. CONCLUSIONS: The collapsibility in the area of the base of the tongue correlated with higher results in the RDI (respiratory disturbance index) registered with standard polysomnography. Snoring and upper airway collapse were easily surveyed, and the pharyngolaryngoscopy during propofol-induced sleep proved to be a simple, safe, readily controllable and effective supplementary diagnostic device for the diagnosis and treatment of obstructive sleep apnea and snoring.

Adolescent↗

PubMed1998

Fluoroscopic MR of the pharynx in patients with obstructive sleep apnea.

PURPOSE: The purpose of our study was to introduce an ultrafast MR imaging technique of the pharynx as a diagnostic tool for viewing the mechanism of obstruction in patients with obstructive sleep apnea. METHODS: Six healthy volunteers and 16 patients with obstructive sleep apnea were examined on a 1.5-T whole-body imager using a circular polarized head coil. Ultrafast two-dimensional fast low-angle shot sequences were obtained in midsagittal and axial projections during transnasal shallow respiration at rest, during simulation of snoring, and during performance of the Müller maneuver. All patients underwent physical examination, transnasal fiberoptic endoscopy, and polysomnography. RESULTS: Five to six images were obtained per second with an in-plane resolution of 2.67 x 1.8 mm and 2.68 x 2.34 mm, allowing visualization of motion of the tongue, soft palate, uvula, and posterior pharyngeal surface. MR findings correlated well with results of clinical examination. The length of obstruction in the oropharynx, which cannot be ascertained by transnasal endoscopy of the pharynx, was clearly visible MR images. Differences between patients with obstructive sleep apnea and healthy subjects in terms of the degree of obstruction in the velopharynx and oropharynx depicted on MR images during the Müller maneuver were highly significant. CONCLUSION: We believe that ultrafast MR imaging is a reliable noninvasive method for use in the evaluation of obstructive sleep apnea.

Airway Obstruction↗

PubMed1991

Peripheral chemoreceptor reflex in obstructive sleep apnea patients; a relationship between ventilatory response to hypoxia and nocturnal bradycardia during apnea events.

15 patients with obstructive sleep apnea syndrome and arterial hypertension (H-OSAS), 25 normotensive patients with sleep apnea syndrome (N-OSAS) and 20 healthy age-matched controls (C) were included in this study. Ventilatory responses to activation (hypoxia) and inactivation (hyperoxia) of carotid chemoreceptors were studied in all subjects. Relationship between hypoxic ventilatory reactivity and nocturnal bradycardia during apnea-phases was analysed in both groups of patients. Results and conclusions. 1. We found an impairment of ventilatory response to hypoxia in H-OSAS and N-OSAS patients. However, the increase in ventilation in response to hypoxia was significantly greater in H-OSAS as compared to N-OSAS patients. 2. An augmented ventilatory response to inactivation of carotid chemoreceptors (the decrease in ventilation), observed in H-OSAS patients, indicates an increase in resting peripheral chemoreceptors drive in this group of patients. 3. The relationship between ventilatory response to hypoxia and nocturnal bradycaria in obstructive sleep apnea patients suggests, that hypoxic reactivity of arterial chemoreceptors might be involved in the origin of bradycardia during apnea events.

Bradycardia↗

PubMed2003

Development of the obstructive sleep apnea knowledge and attitudes (OSAKA) questionnaire.

STUDY OBJECTIVES: To develop and validate a questionnaire that assesses physicians' knowledge and attitudes about obstructive sleep apnea (OSA): the Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire. DESIGN: Questionnaire study. SETTING: Physicians associated with the Washington University Physicians Network. PARTICIPANTS: Twenty physicians in the pilot testing and 115 physicians in the final testing of the instrument. INTERVENTIONS: Physicians completed the OSAKA questionnaire containing sections regarding knowledge about OSA (18 items), attitudes about OSA (five items), and demographics of the study participants. MEASUREMENTS AND RESULTS: Knowledge scores ranged from 0 to 18 (mean+/-SD=13.3+/-2.8). Individual knowledge items did not differ significantly by gender or by whether or not respondents had completed subspecialty training. The five attitude items were significantly correlated with one another. Knowledge scores correlated with the 5-item attitude scale. There was a negative correlation between age and knowledge (r=-0.368, P<0.001) and between age and the single attitude item pertaining to physicians' confidence in managing patients with OSA (r=-0.198, P=0.036); thus, the older the respondent, the lower the knowledge score and the less confident they were in managing patients with OSA. CONCLUSIONS: The OSAKA appears to be a useful instrument to measure physicians' knowledge about OSA, their views on its importance as a clinical disorder, and their confidence in identifying and managing patients with this disorder.

Adult↗

PubMed2026

One in three patients with positional obstructive sleep apnea does not benefit from positional therapy: Insights from a home-based trial.

PURPOSE: Positional obstructive sleep apnea (POSA) is the most common phenotype of obstructive sleep apnea, yet patient selection for positional therapy (PT) remains suboptimal. With this analysis we aimed to clarify how many patients with POSA may not require PT because they do not habitually sleep supine at home, and how many fail vibrotactile PT despite appropriate indication. METHODS: We conducted a retrospective observational study of consecutive adults with POSA evaluated at a tertiary sleep center between 2021 and 2024. All patients underwent a home-based trial with a neck-based vibrotactile positional therapy device (Night Shift™), consisting of monitoring mode followed by therapy mode. Outcomes included the proportion of non-supine sleepers at home, failure rate of vibrotactile PT, device compliance and differences in supine sleep time between diagnostic testing and home monitoring. RESULTS: Of 92 screened patients, 74 met inclusion criteria (mean age 60.3 ± 13.2 years; mean AHI 22.9 ± 13.3 events/h). Fifteen percent (11/74) did not habitually sleep supine at home, indicating no clinical need for PT, and an additional 14.8% (11/74) failed vibrotactile PT. Overall, 30% of patients were either unlikely to benefit from PT or failed therapy. Non-response was frequently associated with psychotropic or sedative medication use and neurological or sleep-related comorbidities. CONCLUSION: A substantial proportion of patients diagnosed with POSA either do not require or fail vibrotactile treatment in real-world conditions. Incorporating a brief home monitoring and therapy trial into routine clinical practice may optimize patient selection, reduce unnecessary costs, and improve personalized management of POSA.

Humans↗

PubMed2001

Cephalometric and polysomnographic analyses of functional magnetic system therapy in patients with obstructive sleep apnea.

The therapeutic effect of a functional magnetic system on obstructive sleep apnea and the system's operating mechanism have not been examined. Two hypotheses are postulated: a functional magnetic system increases the size of the oral cavity airway passage, or it increases the pharyngeal space. Twenty-eight patients with mild-to-moderate obstructive sleep apnea were examined; 10 patients (9 men and 1 woman; aged, 50.5 +/- 2.6 years) met the study criteria. After baseline nocturnal polysomnography and daytime tiredness self-evaluation, a functional magnetic system was inserted. The functional magnetic system is a mandibular repositioning appliance that uses a pair of attractive magnets (Sm2Co17), placed opposite each other in the jaws, which results in an advancement-to-opening ratio of 1:2. After 8 weeks of functional magnetic system treatment, polysomnography, daytime tiredness, and nighttime snoring were evaluated, and cephalogram radiographs with and without the appliance were taken. It was found that the respiratory disturbance index decreased significantly; minimal oxygen saturation increased significantly, reaching a normal value; day time tiredness improved; snoring declined; the oral cavity anterior region increased significantly, and the pharyngeal airway passages did not change. Reduction in the respiratory disturbance index and enlargement of the anterior oral cavity area were highly and significantly correlated. In conclusion, the functional magnetic system is a reliable mandibular repositioning appliance that has no apparent adverse effects. A functional magnetic system operates by increasing the anterior region of the oral cavity, mainly vertically, with no change in the posterior oral cavity region and pharyngeal airway passages.

Adult↗

PubMed2006

A prospective study to determine the incidence of atopy in children undergoing adenotonsillectomy for obstructive sleep apnea.

OBJECTIVES: To investigate the relationship between adenotonsillar hypertrophy seen in pediatric obstructive sleep apnea and upper airway allergy to airborne allergens. METHODS: A prospective study of Radioallergosorbent (RAST) tests to common airborne allergens in children (<16 years old) undergoing adenotonsillectomy for obstructive sleep apnea in a London Teaching Hospital. RESULTS: 20.9% of patients had a positive RAST result to house dust mite, 2.8% to cat hair, 0% to mixed feather, 7.8% to mixed grass pollen and 3.8% to dog hair. CONCLUSIONS: This study does not support the hypothesis that the adenotonsillar hypertrophy seen in pediatric patients with obstructive sleep apnea is contributed to by allergy to airborne allergens. It is possible that there is a localized allergic reaction in the upper respiratory tract mucosa which is not apparent on an assay of systemic IgE.

Adenoidectomy↗

PubMed2002

Effects of obstructive sleep apnea on circulating ICAM-1, IL-8, and MCP-1.

Obstructive sleep apnea syndrome (OSAS) is one of the most important risk factors of cardiovascular disorders. In the treatment of OSAS, nasal continuous positive airway pressure (nCPAP) has been widely used and found to be effective. In the present study, we hypothesized that the hypoxic stress caused by obstructive sleep apnea would increase circulating intercellular adhesion molecule-1 (ICAM-1), interleukin-8 (IL-8), and monocyte chemoattractant protein-1 (MCP-1) in untreated OSAS patients compared with an age-matched control group. In addition, we hypothesized that nCPAP may decrease OSAS-induced hypoxic stress and mediators. To examine these hypotheses, we measured circulating ICAM-1 and IL-8 before and after nCPAP therapy in OSAS patients. We observed that nCPAP decreased apnea, desaturation, and the circulating ICAM-1 and IL-8 levels in OSAS patients. The circulating levels of ICAM-1, IL-8, and MCP-1 in untreated OSAS patients were significantly greater than those in the controls. These observations suggest that nCPAP therapy could reduce OSAS-induced hypoxia and generation of inflammatory mediators. Treatment of OSAS using nCPAP can be, therefore, a potential approach to decrease risk of the progression of OSAS-associated disorders.

Chemokine CCL2↗

PubMed1987

Uvulopalatopharyngoplasty as a treatment of obstructive sleep apnea precipitated by uvular prolapse.

Two patients are discussed in whom obstructive sleep apnea was precipitated by uvular prolapse into the larynx and successfully treated by uvulopalatopharyngoplasty. Although tracheostomy has been the definitive treatment for obstructive sleep apnea, uvulopalatopharyngoplasty has also been used as an alternative surgical procedure. However, indications for its successful use have not been clearly defined. Our experience illustrates that the surgical approach to obstructive sleep apnea is dependent on a thorough diagnostic evaluation that includes a sleep history, head and neck examination, hypnopolygraphic recording and, if indicated, nocturnal fiberoptic endoscopy.

Endoscopy↗