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Therapeutic Advances in Respiratory... Jan 2017Acetazolamide has been investigated for treating sleep apnea in newcomers ascending to high altitude. This study aimed to assess the effect of acetazolamide on sleep... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acetazolamide has been investigated for treating sleep apnea in newcomers ascending to high altitude. This study aimed to assess the effect of acetazolamide on sleep apnea at high altitude, determine the optimal therapeutic dose, and compare its effectiveness in healthy trekkers and obstructive sleep apnea (OSA) patients.
METHODS
PubMed, Embase, Scopus, Cochrane Library, and Airiti Library databases were searched up to July 2015 for randomized controlled trials (RCTs) performed above 2500 m in lowlanders and that used acetazolamide as intervention in sleep studies. Studies including participants with medical conditions other than OSA were excluded.
RESULTS
Eight studies of 190 adults were included. In healthy participants, the pooled mean effect sizes of acetazolamide on Apnea-Hypopnea Index (AHI), percentage of periodic breathing time, and nocturnal oxygenation were 34.66 [95% confidence interval (CI) 25.01-44.30] with low heterogeneity ( p = 0.7, I = 0%), 38.56% (95% CI 18.92-58.19%) with low heterogeneity ( p = 0.24, I = 28%), and 4.75% (95% CI 1.35-8.15%) with high heterogeneity ( p < 0.01, I = 87%), respectively. In OSA patients, the pooled mean effect sizes of acetazolamide on AHI and nocturnal oxygenation were 13.18 (95% CI 9.25-17.1) with low heterogeneity ( p = 0.33, I = 0%) and 1.85% (95% CI 1.08-2.62%) with low heterogeneity ( P = 0.56, I = 0%).
CONCLUSIONS
Acetazolamide improves sleep apnea at high altitude by decreasing AHI and percentage of periodic breathing time and increasing nocturnal oxygenation. Acetazolamide is more beneficial in healthy participants than in OSA patients, and a 250 mg daily dose may be as effective as higher daily doses for healthy trekkers.
Topics: Acetazolamide; Adult; Altitude; Carbonic Anhydrase Inhibitors; Dose-Response Relationship, Drug; Humans; Oxygen Consumption; Randomized Controlled Trials as Topic; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 28043212
DOI: 10.1177/1753465816677006 -
Sleep Medicine Reviews Feb 2014Reports on the association between obstructive sleep apnea (OSA) and risk of death, cardiovascular (CV) events, diabetes and depression have been inconsistent. (Review)
Review
BACKGROUND
Reports on the association between obstructive sleep apnea (OSA) and risk of death, cardiovascular (CV) events, diabetes and depression have been inconsistent.
METHODS
We conducted a systematic review of the prognostic value of clinical and polysomnographic (PSG) characteristics of OSA for adverse long-term outcomes of untreated OSA in adult patients. A comprehensive search strategy for prognosis studies, OSA, CV events, mortality, depression and diabetes was developed in collaboration with a medical information specialist. All English language studies, from Jan 1999 to Dec 2011, with longitudinal design in adults with OSA diagnosed by PSG recording, found through Medline, Embase and bibliographies of identified articles, were considered eligible. Quality was assessed using published guidelines.
RESULTS
Among 26 articles, ten evaluated the association of OSA with mortality, 9 with a composite CV outcome, 4 with stroke, 2 with diabetes and 1 with depression. Significant relationships between the apnea-hypopnea index (AHI) and outcomes of interest were reported in 18 studies: seven for all-cause mortality, six for composite CV events, three for stroke, one for diabetes and one for depression. The effect of AHI was attenuated by female gender, older age, absence of daytime sleepiness and higher body mass index. Due to clinical heterogeneity between studies, meta-analyses were not performed.
CONCLUSION
Evidence exists in men for a relationship between OSA and all-cause mortality and a composite CV outcome. Associations between OSA and other outcomes remain uncertain. Among OSA-specific markers, only AHI was a consistent predictor. Other consistent predictors were traditional CV risk factors. Research is required to identify effect modifiers and the predictive ability of various AHI threshold values and hypopnea definitions. An enhanced set of OSA-specific predictors will allow better risk stratification to guide OSA treatment.
Topics: Aged; Female; Humans; Male; Middle Aged; Risk Factors; Sleep Apnea, Obstructive
PubMed: 23642349
DOI: 10.1016/j.smrv.2013.01.003 -
Journal of Oral Rehabilitation Mar 2022Sleep-disordered breathing (SDB) has negative influence on children's development and well-being. Malocclusion due to some craniofacial anatomical characteristics may be... (Review)
Review
BACKGROUND
Sleep-disordered breathing (SDB) has negative influence on children's development and well-being. Malocclusion due to some craniofacial anatomical characteristics may be associated with SDB.
OBJECTIVES
The aim of this paper is to ascertain whether SDB is associated with malocclusion in children/adolescents, aged 6-15 years compared to healthy controls.
METHODS
Prospero ID: CRD42021232103. A systematic electronic literature search following PRISMA was performed in PubMed, Embase and Cochrane Library. Inclusion criteria were as follows: Healthy children/adolescents aged 6-15 years with malocclusion undergoing polysomnography (PSG) or polygraphy (PG) and/or sleep questionnaire and orthodontic screening; compared to a healthy age-matched control group with neutral or minor deviation in the occlusion without requirement for orthodontic treatment; publications in English, Danish, Norwegian or Swedish published until 23 March 2021. JBI Critical Appraisal Tools and GRADE were used to evaluate the risk of bias and level of evidence.
RESULTS
The search resulted in 1996 records, 610 duplicates were removed, 1386 records were screened, and 1322 records were excluded. Sixty-four studies were selected for full-text reading, and four publications fulfilled the inclusion criteria. The included studies had moderate risk of bias, and the quality of evidence was low.
CONCLUSION
No firm conclusion can be drawn regarding an association between specific malocclusion traits and SDB. Thus, the studies found no association between molar relationship and crowding and SDB symptoms in children. It may be recommended that future studies include objective PSG or PG in diagnosis of SDB and compare groups of children with skeletal malocclusion and controls with neutral malocclusion.
Topics: Adolescent; Child; Humans; Malocclusion; Polysomnography; Sleep Apnea Syndromes; Surveys and Questionnaires
PubMed: 34779522
DOI: 10.1111/joor.13282 -
The Laryngoscope Jul 2017To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES/HYPOTHESIS
To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA).
DATA SOURCES
PubMed/MEDLINE and eight additional databases.
REVIEW METHODS
Three authors independently and systematically reviewed the international literature through February 21, 2016.
RESULTS
Seventeen studies reported outcomes for 314 children (7.6 ± 2.0 years old) with high-arched and/or narrow hard palates (transverse maxillary deficiency) and OSA. Data were analyzed based on follow-up duration: ≤3 years (314 patients) and >3 years (52 patients). For ≤3-year follow-up, the pre- and post-RME apnea-hypopnea index (AHI) decreased from a mean ± standard deviation (M ± SD) of 8.9 ± 7.0/hr to 2.7 ± 3.3/hr (70% reduction). The cure rate (AHI <1/hr) for 90 patients for whom it could be calculated was 25.6%. Random effects modeling for AHI standardized mean difference (SMD) is -1.54 (large effect). Lowest oxygen saturation (LSAT) improved from 87.0 ± 9.1% to 96.0 ± 2.7%. Random effects modeling for LSAT SMD is 1.74 (large effect). AHI improved more in children with previous adenotonsillectomy or small tonsils (73-95% reduction) than in children with large tonsils (61% reduction). For >3-year follow-up (range = 6.5-12 years), the AHI was reduced from an M ± SD of 7.1 ± 5.7/hr to 1.5 ± 1.8/hr (79% reduction).
CONCLUSIONS
Improvement in AHI and lowest oxygen saturation has consistently been seen in children undergoing RME, especially in the short term (<3-year follow-up). Randomized trials and more studies reporting long-term data (≥3-year follow-up) would help determine the effect of growth and spontaneous resolution of OSA. Laryngoscope, 2016 Laryngoscope, 127:1712-1719, 2017.
Topics: Adenoidectomy; Child; Child, Preschool; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Male; Oxygen; Palatal Expansion Technique; Postoperative Complications; Sleep Apnea, Obstructive; Tonsillectomy
PubMed: 27796040
DOI: 10.1002/lary.26352 -
Nicotine & Tobacco Research : Official... Feb 2023To systematically review the association between smoking behavior and obstructive sleep apnea (OSA). (Meta-Analysis)
Meta-Analysis
INTRODUCTION
To systematically review the association between smoking behavior and obstructive sleep apnea (OSA).
AIMS AND METHODS
PubMed, Medline, the Cochrane Library, EMBASE, and Scopus databases were used to conduct this review. The two researchers independently screened the literatures, conducted the quality assessment, and data extraction according to the inclusion and exclusion criteria. The RevMan 5.3 was used to analysis the apnea hypopnea index (AHI) index, min saturation of oxyhemoglobin (SaO2), Epworth Sleepiness Scale (ESS) score, and oxygen desaturation index (DOI) and publication bias analysis to assess the effect of smoking on OSA patients. Furthermore, we performed subgroup of the severity of OSA, different countries of sample origin (western countries or eastern countries), and pack-years (PYs < 10 or PYs ≥ 20) to analyze the heterogeneity.
RESULTS
Thirteen studies were included in this analysis that conformed to inclusion criteria and exclusion criteria. Totally 3654 smokers and 9796 non-smokers have participated. The meta-analysis of 13 studies demonstrated that AHI levels were significantly higher in smoker group compared with non-smoker, ESS scores were also significantly higher in smoker group compared with non-smoker, min SaO2 levels were obviously lower in smoker group compared with non-smoker, however, DOI levels hadn't significantly different between two groups. The subgroup analysis showed that there was an association between severe OSA, eastern countries, pack-years, and smoking.
CONCLUSIONS
Smoking behavior is a significant association with OSA. Heavy smokers with histories of more than 20 PYs were at a higher risk of OSA. Moreover, patient with severe OSA exhibited a significantly association with smoking compared with patients with mild or moderate OSA.
IMPLICATIONS
The relationship between smoking and OSA was controversial, especially, whether smoking increase or aggravate the risk of OSA. In our review and meta-analysis, we demonstrated that smoking behavior is a significant association with OSA. Heavy smokers with histories of more than 20 PYs were at a higher risk of OSA. Moreover, patient with severe OSA exhibited a significant association with smoking compared with patients with mild or moderate OSA. More prospective long-term follow-up studies about effect of quit smoking on OSA are recommended to establish the further relationship.
Topics: Humans; Smoking; Prospective Studies; Sleep Apnea, Obstructive; Tobacco Smoking; Non-Smokers
PubMed: 35922388
DOI: 10.1093/ntr/ntac126 -
Otolaryngology--head and Neck Surgery :... Mar 2018Objective The aim of this study was to determine the general outcomes and surgical success rates of anterior palatoplasty (AP) in patients with obstructive sleep apnea... (Meta-Analysis)
Meta-Analysis
Objective The aim of this study was to determine the general outcomes and surgical success rates of anterior palatoplasty (AP) in patients with obstructive sleep apnea (OSA). Data Sources A systematic review of the literature and meta-analysis of published data were performed by searching the Cochrane, SAGE, MEDLINE, and Google Scholar databases, from January 1, 2007, to March 27, 2017, using relevant keywords. Review Methods The search scanned for studies with patients who had undergone AP (with or without tonsillectomy) as a single-stage, single-level surgical intervention for treatment of OSA. Two independent reviewers (M.B. and O.K.) inspected titles and abstracts of the studies according to established criteria. The full texts were then reviewed to extract the clinical and polysomnographic data. The primary outcome was the surgical success rate, defined as a reduction in the apnea-hypopnea index (AHI) of 50% or greater and an AHI of less than 20 postoperatively. The PRISMA statement was followed. Results After systematic evaluation of potentially relevant articles, 14 studies were downloaded, and 6 studies, consisting of 170 patients, met the study criteria. A fixed effects model was used to analyze the data. The surgical success rate of AP was 60.6%. No serious complications were reported in the literature. Conclusion The results of the present meta-analysis support AP as a moderately effective surgical method for the treatment of OSA. Comparative and randomized controlled prospective studies showing long-term results, with pre- and postoperative data, should be conducted to demonstrate the exact outcomes and reliability of this surgical technique.
Topics: Humans; Palate; Sleep Apnea, Obstructive; Tonsillectomy
PubMed: 29086603
DOI: 10.1177/0194599817739857 -
Journal of Clinical Anesthesia Aug 2023Obstructive Sleep Apnea (OSA) is associated with increased perioperative cardiac, respiratory and neurological complications. Pre-operative OSA risk assessment is... (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVE
Obstructive Sleep Apnea (OSA) is associated with increased perioperative cardiac, respiratory and neurological complications. Pre-operative OSA risk assessment is currently done through screening questionnaires with high sensitivity but poor specificity. The objective of this study was to evaluate the validity and diagnostic accuracy of portable, non-contact devices in the diagnosis of OSA as compared with polysomnography.
DESIGN
This study is a systematic review of English observational cohort studies with meta-analysis and risk of bias assessment.
SETTING
Pre-operative, including in the hospital and clinic setting.
PATIENTS
Adult patients undergoing sleep apnea assessment using polysomnography and an experimental non-contact tool.
INTERVENTIONS
A novel non-contact device, which does not utilize any monitor that makes direct contact with the patient's body, in conjunction with polysomnography.
MEASUREMENTS
Primary outcomes included pooled sensitivity and specificity of the experimental device in the diagnosis of obstructive sleep apnea, in comparison to gold-standard polysomnography.
RESULTS
Twenty-eight of 4929 screened studies were included in the meta-analysis. A total of 2653 patients were included with the majority being patients referred to a sleep clinic (88.8%). Average age was 49.7(SD±6.1) years, female sex (31%), average body mass index of 29.5(SD±3.2) kg/m, average apnea-hypopnea index (AHI) of 24.7(SD±5.6) events/h, and pooled OSA prevalence of 72%. Non-contact technology used was mainly video, sound, or bio-motion analysis. Pooled sensitivity and specificity of non-contact methods in moderate to severe OSA diagnosis (AHI > 15) was 0.871 (95% CI 0.841,0.896, I 0%) and 0.8 (95% CI 0.719,0.862), respectively (AUC 0.902). Risk of bias assessment showed an overall low risk of bias across all domains except for applicability concerns (none were conducted in the perioperative setting).
CONCLUSION
Available data indicate contactless methods have high pooled sensitivity and specificity for OSA diagnosis with moderate to high level of evidence. Future research is needed to evaluate these tools in the perioperative setting.
Topics: Adult; Humans; Female; Middle Aged; Sleep Apnea, Obstructive; Sleep; Polysomnography; Sensitivity and Specificity; Cohort Studies; Observational Studies as Topic
PubMed: 36868010
DOI: 10.1016/j.jclinane.2023.111087 -
The Laryngoscope Apr 2017To perform a systematic review and meta-analysis for studies evaluating genioplasty alone, genial tubercle advancement (GTA) alone, and GTA with hyoid surgery (GTA-HS)... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To perform a systematic review and meta-analysis for studies evaluating genioplasty alone, genial tubercle advancement (GTA) alone, and GTA with hyoid surgery (GTA-HS) to treat obstructive sleep apnea (OSA).
DATA SOURCES
Ten databases.
REVIEW METHODS
Three authors searched through November 15, 2015.
RESULTS
1,207 studies were screened; 69 were downloaded; and 13 studies met inclusion criteria. A total of 111 patients were included, with 27 standard genioplasty, 10 modified genioplasty, 24 GTA, and 50 GTA-HS patients. For standard genioplasty, the apnea-hypopnea index (AHI) reduced from a mean ± standard deviation (M ± SD) of 18.8 ± 3.8 (95% confidence interval [CI] 17.6, 20.0) to 10.8 ± 4.0 (95% CI 9.5, 12.1) events/hour (relative reduction 43.8%), P value = 0.0001. Genioplasty improved lowest oxygen saturation (LSAT) from 82.3 ± 7.3% (95% CI 80.0, 84.7) to 86.8 ± 5.2% (95% CI 85.1, 88.5), P value = 0.0032. For modified genioplasty AHI increased by 37.3%. For GTA, the AHI reduced from an M ± SD of 37.6 ± 24.2 (95% CI 27.9, 47.3) to 20.4 ± 15.1 (95% CI 14.4, 26.4) events/hour (relative reduction 45.7%), P value = 0.0049. GTA improved LSAT from 83.1 ± 8.3% (95% CI 79.8, 86.4) to 85.5 ± 6.8% (95% CI 82.8, 88.2), P value = 0.2789. For GTA-HS, the AHI reduced from an M ± SD of 34.5 ± 22.1 (95% CI 28.4, 40.6) to 15.3 ± 17.6 (95% CI 10.4, 20.2) events/hour (relative reduction 55.7%), P value < 0.0001; GTA-HS improved LSAT from 80.1 ± 16.6% (95% CI 75.5, 84.7) to 88.3 ± 6.9% (95% CI 86.4, 90.2), P value = 0.0017.
CONCLUSION
Standard genioplasty, GTA and GTA-HS can improve OSA outcomes such as AHI and LSAT. Given the low number of studies, these procedures remain as an area for additional OSA research. Laryngoscope, 127:984-992, 2017.
Topics: Female; Follow-Up Studies; Genioplasty; Humans; Male; Mandibular Advancement; Polysomnography; Quality of Life; Severity of Illness Index; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 27546467
DOI: 10.1002/lary.26218 -
Computer Methods and Programs in... Mar 2017Sleep apnea syndrome (SAS), which can significantly decrease the quality of life is associated with a major risk factor of health implications such as increased... (Review)
Review
BACKGROUND AND OBJECTIVE
Sleep apnea syndrome (SAS), which can significantly decrease the quality of life is associated with a major risk factor of health implications such as increased cardiovascular disease, sudden death, depression, irritability, hypertension, and learning difficulties. Thus, it is relevant and timely to present a systematic review describing significant applications in the framework of computational intelligence-based SAS, including its performance, beneficial and challenging effects, and modeling for the decision-making on multiple scenarios.
METHODS
This study aims to systematically review the literature on systems for the detection and/or prediction of apnea events using a classification model.
RESULTS
Forty-five included studies revealed a combination of classification techniques for the diagnosis of apnea, such as threshold-based (14.75%) and machine learning (ML) models (85.25%). In addition, the ML models, were clustered in a mind map, include neural networks (44.26%), regression (4.91%), instance-based (11.47%), Bayesian algorithms (1.63%), reinforcement learning (4.91%), dimensionality reduction (8.19%), ensemble learning (6.55%), and decision trees (3.27%).
CONCLUSIONS
A classification model should provide an auto-adaptive and no external-human action dependency. In addition, the accuracy of the classification models is related with the effective features selection. New high-quality studies based on randomized controlled trials and validation of models using a large and multiple sample of data are recommended.
Topics: Algorithms; Diagnosis, Computer-Assisted; Humans; Polysomnography; Sleep Apnea Syndromes
PubMed: 28254083
DOI: 10.1016/j.cmpb.2017.01.001 -
European Archives of... Aug 2017To evaluate the international literature for studies reporting outcomes for obstructive sleep apnea (OSA) in children undergoing isolated tongue surgeries. (Review)
Review
OBJECTIVES
To evaluate the international literature for studies reporting outcomes for obstructive sleep apnea (OSA) in children undergoing isolated tongue surgeries.
METHODS
Two authors searched from inception through November 14, 2016 in four databases including PubMed/MEDLINE.
RESULTS
351 studies were screened. Eleven studies (116 children) met criteria. Most children were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Surgeries included base-of-tongue (BOT) reduction (n = 114), tongue suspension (n = 1), and hypoglossal nerve stimulation (n = 1). The pre- and post-BOT reduction surgeries decreased apnea-hypopnea index (AHI) from a mean (M) and standard deviation (SD) of 16.9 ± 12.2/h to 8.7 ± 10.6/h (48.5% reduction) in 114 patients. Random effects modeling (109 patients) demonstrated a standardized mean difference for AHI of -0.78 (large magnitude of effect) [95% CI -1.06, -0.51], p value <0.00001. For BOT surgery in 53 non-syndromic children, the AHI decreased 59.2% from 14.0 ± 11.4 to 5.7 ± 6.7/h, while in 55 syndromic children, the AHI decreased 40.0% from 20.5 ± 19.1 to 12.3 ± 18.2/h. BOT reduction improved lowest oxygen saturation from M ± SD of 84.7 ± 7.4-87.9 ± 6.5% in 113 patients. Hypoglossal nerve stimulation and tongue-base suspension are limited to case reports.
CONCLUSIONS
Most children undergoing tongue surgeries in the literature were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Children with a body mass index <25 kg/m and non-syndromic children have had the most improvement in AHI. The specific type of surgery must be tailored to the patient. Patients with co-morbidities should undergo treatment in centers that are equipped to provide appropriate perioperative care.
Topics: Child; Humans; Otorhinolaryngologic Surgical Procedures; Patient Selection; Sleep Apnea, Obstructive; Tongue
PubMed: 28378061
DOI: 10.1007/s00405-017-4545-4