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The European Respiratory Journal Apr 2022Due in part to overall improvements in health, the population of elderly individuals is increasing rapidly. Similarly, obstructive sleep apnoea (OSA) is both gaining... (Review)
Review
Due in part to overall improvements in health, the population of elderly individuals is increasing rapidly. Similarly, obstructive sleep apnoea (OSA) is both gaining increased recognition and also increasing due to the worldwide obesity epidemic. The overlap of OSA and ageing is large, but there is strong plausibility for causation in both directions: OSA is associated with pathological processes that may accelerate ageing and ageing-related processes; ageing may cause physical and neurological changes that predispose to obstructive (and central) apnoea. In addition, the common symptoms ( excessive daytime sleepiness, and defects in memory and cognition), possible physiological consequences of OSA ( accelerated cardiovascular and cerebrovascular atherosclerosis), and changes in metabolic and inflammatory markers overlap with the symptoms and associated conditions seen in ageing. There is also the possibility of synergy in the effects of these symptoms and conditions on quality of life, as well as a need to separate treatable consequences of OSA from age-related complaints. Taken together, the aforementioned considerations make it essential to review the interaction of OSA and ageing, both proven and suspected. The present review examines some aspects of what is known and points to the need for further investigation of the relationships, given the large number of potentially affected subjects.
Topics: Aged; Disorders of Excessive Somnolence; Humans; Obesity; Quality of Life; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 34561285
DOI: 10.1183/13993003.01649-2021 -
Acta Otorhinolaryngologica Italica :... Feb 2022The aim of our study was to investigate the presence of dysphagia in patients with Obstructive Sleep Apnoea (OSA) and to correlate swallowing impairment with hypnologic...
OBJECTIVE
The aim of our study was to investigate the presence of dysphagia in patients with Obstructive Sleep Apnoea (OSA) and to correlate swallowing impairment with hypnologic and anatomic parameters.
METHODS
The study population includes 36 patients suffering from OSA. Patients were divided into two groups using the presence of dysphagia as a distinctive parameter. Group 1 included 27 OSA patients without signs of dysphagia and Group 2 included 9 OSA patients with signs of dysphagia.
RESULTS
The age of patients in Group 2 was higher compared with the age of patients in Group 1. Analysis of Continuous Positive Airway Pressure (CPAP), obtained in the titration phase, showed that OSA patients with signs of dysphagia required a higher level of CPAP pressure than those who were not affected by swallowing abnormalities (12.6 ± 1 10.5 ± 1.9 p = 0.003). No other differences in anthropometric, hypnologic, or arterial blood gas values were found between the two groups.
CONCLUSIONS
In clinical practice, all OSA patients should undergo a complete ENT exam, including assessment of swallowing, before CPAP therapy is started. This may predict the need for higher CPAP pressure settings to resolve apnoea episodes in the presence of dysphagia as well as guide the choice of CPAP interfaces (orofacial vs. nasal) in these patients.
Topics: Continuous Positive Airway Pressure; Deglutition; Deglutition Disorders; Humans; Nose; Sleep Apnea, Obstructive
PubMed: 35129539
DOI: 10.14639/0392-100X-N1578 -
Respirology (Carlton, Vic.) Oct 2022
Topics: Humans; Sleep; Sleep Apnea, Obstructive
PubMed: 35871771
DOI: 10.1111/resp.14332 -
Sleep apnea, "the Ugly Duckling of the Cinderellas" in cardiovascular prevention and rehabilitation.Panminerva Medica Jun 2021Cardiovascular diseases are the leading cause of death and account for the largest share of health expenditure worldwide, mainly invested in hospital and secondary care.... (Review)
Review
Cardiovascular diseases are the leading cause of death and account for the largest share of health expenditure worldwide, mainly invested in hospital and secondary care. Prevention and rehabilitation strategies are nearly neglected, therefore "the Cinderellas," in the health-care budget. The World Health Organization has proposed cost-effective interventions to reduce the impact of cardiovascular diseases that include polydrug treatment for hypertension and diabetes, counselling, diet, exercise, and others. Obstructive sleep apnea is not even mentioned among these interventions; consequently, it could be "the Ugly Duckling of the Cinderellas." Obstructive sleep apnea (OSA) is characterized by the presence of obstructive apneas or hypopneas during sleep, accompanied by hypoxia; and it is a highly prevalent but under-diagnosed condition. Although awareness of sleep apnea has recently increased most facts about it remains ignored by many. Robust evidence suggests that OSA is associated with, or is an independent risk factor for, hypertension, cerebrovascular disease, ischemic heart disease, heart failure and arrhythmias and that its prevalence among some of these cardiovascular diseases is higher than 80%. The efficacy of continuous positive airway pressure treatment for obstructive sleep apnea has been established. If obstructive sleep apnea plays a significant role in cardiovascular diseases, then screening and timely appropriate treatment could reduce morbidity and mortality. Thus, the public health and economic impact of these conditions could be included in the "best buy" list of interventions. This narrative review discusses the relationship between OSA and cardiovascular diseases and how neglected the link is.
Topics: Cardiac Rehabilitation; Cardiovascular Diseases; Continuous Positive Airway Pressure; Cost of Illness; Exercise; Humans; Hypertension; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 33709678
DOI: 10.23736/S0031-0808.21.04273-7 -
Sleep Medicine Dec 2023Excessive daytime sleepiness is common with obstructive sleep apnoea and can persist despite efforts to optimise primary airway therapy. The literature lacks... (Review)
Review
STUDY OBJECTIVE
Excessive daytime sleepiness is common with obstructive sleep apnoea and can persist despite efforts to optimise primary airway therapy. The literature lacks recommendations regarding differential diagnosis and management of excessive daytime sleepiness in obstructive sleep apnoea. This study sought to develop expert consensus statements to bridge the gap between existing literature/guidelines and clinical practice.
METHODS
A panel of 10 international experts was convened to undertake a modified Delphi process. Statements were developed based on available evidence identified through a scoping literature review, and expert opinion. Consensus was achieved through 3 rounds of iterative, blinded survey voting and revision to statements until a predetermined level of agreement was met (≥80 % voting "strongly agree" or "agree with reservation").
RESULTS
Consensus was achieved for 32 final statements. The panel agreed excessive daytime sleepiness is a patient-reported symptom. The importance of subjective/objective evaluation of excessive daytime sleepiness in the initial evaluation and serial management of obstructive sleep apnoea was recognised. The differential diagnosis of residual excessive daytime sleepiness in obstructive sleep apnoea was discussed. Optimizing airway therapy (eg, troubleshooting issues affecting effectiveness) was addressed. The panel recognised occurrence of residual excessive daytime sleepiness in obstructive sleep apnoea despite optimal airway therapy and the need to evaluate patients for underlying causes.
CONCLUSIONS
Excessive daytime sleepiness in patients with obstructive sleep apnoea is a public health issue requiring increased awareness, recognition, and attention. Implementation of these statements may improve patient care, long-term management, and clinical outcomes in patients with obstructive sleep apnoea.
Topics: Humans; Delphi Technique; Sleep Apnea, Obstructive; Disorders of Excessive Somnolence; Continuous Positive Airway Pressure; Surveys and Questionnaires
PubMed: 37839271
DOI: 10.1016/j.sleep.2023.10.001 -
European Respiratory Review : An... Jun 2023There is now widespread recognition within the world of sleep medicine of the increasing importance of dental sleep medicine and, in particular, the role of oral... (Review)
Review
There is now widespread recognition within the world of sleep medicine of the increasing importance of dental sleep medicine and, in particular, the role of oral appliance therapy (OAT) in the management of adults with obstructive sleep apnoea (OSA). For the purpose of this review, the term OAT refers to a custom-made intra-oral appliance, which acts to posture the mandible in a forward and downward direction, away from its natural resting position. Whilst nasally applied continuous positive airway pressure remains the "gold standard" in nonsurgical OSA management, OAT remains the recognised alternative treatment.This review of OAT aims to provide an evidence-based update on our current understanding of their mode of action, exploring the potential anatomical and physiological impact of their use in preventing collapse of the upper airway; the current clinical practice guidelines, including the recently published National Institute of Clinical Excellence 2021 guidance, in conjunction with the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine; optimal design features, comparing the role of custom-made noncustom OAT devices and the importance of titration in achieving a dose-dependent effect; patient predictors, preference and adherence to OAT; its impact on a range of both patient- and clinician-centred health outcomes, with a comparison with CPAP; the limitations and side-effects of providing OAT; and, finally, a look at future considerations to help optimise the delivery and outcomes of OAT.
Topics: Adult; Humans; Continuous Positive Airway Pressure; Sleep Apnea, Obstructive
PubMed: 37343962
DOI: 10.1183/16000617.0257-2022 -
Chinese Medical Journal Nov 2020Treatment-emergent central sleep apnea (TECSA) is a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during... (Review)
Review
Treatment-emergent central sleep apnea (TECSA) is a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during treatment for obstructive sleep apnea. The purpose of this review was to summarize the definition, epidemiology, potential mechanisms, clinical characteristics, and treatment of TECSA. We searched for relevant articles up to January 31, 2020, in the PubMed database. The prevalence of TECSA varied widely in different studies. The potential mechanisms leading to TECSA included ventilatory control instability, low arousal threshold, activation of lung stretch receptors, and prolonged circulation time. TECSA may be a self-limited disorder in some patients and could be resolved spontaneously over time with ongoing treatment of continuous positive airway pressure (CPAP). However, central apneas persist even with the regular CPAP therapy in some patients, and new treatment approaches such as adaptive servo-ventilation may be necessary. We concluded that several questions regarding TECSA remain, despite the findings of many studies, and it is necessary to carry out large surveys with basic scientific design and clinical trials for TECSA to clarify these irregularities. Further, it will be vital to evaluate the baseline demographic and polysomnographic data of TECSA patients more carefully and comprehensively.
Topics: Continuous Positive Airway Pressure; Humans; Lung; Respiration; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 33009018
DOI: 10.1097/CM9.0000000000001125 -
Minerva Medica Feb 2023Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is an extremely common sleep-related breathing disorder (SRBD) characterised by complete or partial collapse of the... (Review)
Review
Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is an extremely common sleep-related breathing disorder (SRBD) characterised by complete or partial collapse of the upper airways. These nocturnal phenomena cause high-frequency hypoxemic desaturations (or intermittent hypoxia, IH) during sleep and alterations in gas exchange. The result of IH is the development or worsening of cerebro-cardio-vascular, metabolic and other diseases, which cause a high risk of death. Hence, OSAHS is a multifactorial disease affecting several organs and systems and presenting with various clinical manifestations involving different medical branches. Although it has been estimated that about one billion individuals worldwide are affected by OSAHS, this SRBD remains underestimated also due to misinformation regarding both patients and physicians. Therefore, this review aims to provide information on the main symptoms and risk factors for the detection of individuals at risk of OSAHS, as well as to present the diagnostic investigations to be performed and the different therapeutic approaches. The scientific evidence reported suggest that OSAHS is an extremely common and complex disorder that has a large impact on the health and quality of life of individuals, as well as on healthcare expenditure. Moreover, given its multifactorial nature, the design and implementation of diagnostic and therapeutic programmes through a multidisciplinary approach are necessary for a tailor-made therapy for each patient.
Topics: Humans; Quality of Life; Sleep Apnea, Obstructive; Syndrome; Respiration; Sleep
PubMed: 35766549
DOI: 10.23736/S0026-4806.22.08190-3 -
Heart (British Cardiac Society) Oct 2022Excessive daytime sleepiness (EDS) is classically viewed as a consequence of insufficient sleep or a symptom of sleep disorders. Epidemiological and clinical evidence... (Review)
Review
Excessive daytime sleepiness (EDS) is classically viewed as a consequence of insufficient sleep or a symptom of sleep disorders. Epidemiological and clinical evidence have shown that patients reporting EDS in tandem with sleep disorders (e.g., obstructive sleep apnoea) are at greater cardiovascular risk than non-sleepy patients. While this may simply be attributable to EDS being present in patients with a more severe condition, treatment of sleep disorders does not consistently alleviate EDS, indicating potential aetiological differences. Moreover, not all patients with sleep disorders report EDS, and daytime sleepiness may be present even in the absence of any identifiable sleep disorder; thus, EDS could represent an independent pathophysiology. The purpose of this review is twofold: first, to highlight evidence that EDS increases cardiovascular risk in the presence of sleep disorders such as obstructive sleep apnoea, narcolepsy and idiopathic hypersomnia and second, to propose the notion that EDS may also increase cardiovascular risk in the absence of known sleep disorders, as supported by some epidemiological and observational data. We further highlight preliminary evidence suggesting systemic inflammation, which could be attributable to dysfunction of the gut microbiome and adipose tissue, as well as deleterious epigenetic changes, may promote EDS while also increasing cardiovascular risk; however, these pathways may be reciprocal and/or circumstantial. Additionally, gaps within the literature are noted followed by directions for future research.
Topics: Humans; Cardiovascular Diseases; Risk Factors; Disorders of Excessive Somnolence; Sleep Apnea, Obstructive; Sleep Wake Disorders; Biomarkers; Heart Disease Risk Factors
PubMed: 35102000
DOI: 10.1136/heartjnl-2021-319596 -
Neurocritical Care Apr 2021Apnea is one of the three cardinal findings in brain death (BD). Apnea testing (AT) is physiologically and practically complex. We sought to review described... (Review)
Review
Apnea is one of the three cardinal findings in brain death (BD). Apnea testing (AT) is physiologically and practically complex. We sought to review described modifications of AT, safety and complication rates, monitoring techniques, performance of AT on extracorporeal membrane oxygenation (ECMO), and other relevant considerations regarding AT. We conducted a systematic scoping review to answer these questions by searching the literature on AT in English language available in PubMed or EMBASE since 1980. Pediatric or animal studies were excluded. A total of 87 articles matched our inclusion criteria and were qualitatively synthesized in this review. A large body of the literature on AT since its inception addresses a variety of modifications, monitoring techniques, complication rates, ways to perform AT on ECMO, and other considerations such as variability in protocols, lack of uniform awareness, and legal considerations. Only some modifications are widely used, especially methods to maintain oxygenation, and most are not standardized or endorsed by brain death guidelines. Future updates to AT protocols and strive for unification of such protocols are desirable.
Topics: Apnea; Brain Death; Extracorporeal Membrane Oxygenation; Humans
PubMed: 32524528
DOI: 10.1007/s12028-020-01015-0