-
Sleep Jan 2009Many patients undergo surgery for snoring and sleep apnea, although the efficacy and safety of such procedures have not been clearly established. Our aim was... (Review)
Review
STUDY OBJECTIVES
Many patients undergo surgery for snoring and sleep apnea, although the efficacy and safety of such procedures have not been clearly established. Our aim was systematically to review studies of the efficacy and adverse effects of surgery for snoring and obstructive sleep apnea.
DESIGN
Systematic review.
MEASUREMENTS
PubMed and Cochrane databases were searched in September 2007. Randomized controlled trials of surgery vs. sham surgery or conservative treatment in adults, with daytime sleepiness, quality of life, apnea-hypopnea index, and snoring as outcomes were included. Observational studies were also reviewed to assess adverse effects. Evidence of effect required at least two studies of medium and high quality reporting the same result.
RESULTS
Four studies of benefits and 45 studies of adverse effects were included. There was no significant effect on daytime sleepiness and quality of life after laser-assisted uvulopalatoplasty and radiofrequency ablation. The apnea-hypopnea index and snoring was reduced in one trial after laser-assisted uvulopalatoplasty but not in another trial. Subjective snoring was reduced in one trial after radiofrequency ablation. No trial investigating the effect of any other surgical modality met the inclusion criteria. Persistent side-effects occurred after uvulopalatopharyngoplasty and uvulopalatoplasty in about half the patients and difficulty in swallowing, globus sensation and voice changes were especially common.
CONCLUSIONS
Only a small number of randomized controlled trials with a limited number of patients assessing some surgical modalities for snoring or sleep apnea are available. These studies do not provide any evidence of effect from laser-assisted uvulopalatoplasty or radiofrequency ablation on daytime sleepiness, apnea reduction, quality of life or snoring. We call for research of randomized, controlled trials of surgery other than uvulopalatopharyngoplasty and uvulopalatoplasty, as they are related to a high risk of long-term side-effects, especially difficulty swallowing.
Topics: Adult; Disorders of Excessive Somnolence; Electrosurgery; Humans; Laser Therapy; Palate, Soft; Pharynx; Postoperative Complications; Quality of Life; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive; Snoring; Treatment Outcome; Uvula
PubMed: 19189776
DOI: No ID Found -
Lipids in Health and Disease Jun 2023One of the most prevalent sleep disorders affecting the individual's daily life is obstructive sleep apnea (OSA), for which obesity is a major risk factor. Several novel... (Meta-Analysis)
Meta-Analysis
BACKGROUND
One of the most prevalent sleep disorders affecting the individual's daily life is obstructive sleep apnea (OSA), for which obesity is a major risk factor. Several novel lipid indices have been suggested to have associations with OSA, among which visceral adiposity index (VAI), atherogenic index of plasma (AIP), and lipid accumulation product (LAP) are the most important ones. Herein, the current study aimed to systematically investigate the association between these indices and OSA.
METHODS
Four international databases, including PubMed, Scopus, the Web of Science, and Embase were searched in order to find relevant studies that investigated LAP, VAI, or AIP in OSA and compared them with non-OSA cases or within different severities of OSA. Random-effect meta-analysis was used to generate the standardized mean difference (SMD) and 95% confidence interval (CI) of the difference in lipid indices between OSA and non-OSA cases. Moreover, the pooled area under the receiver operating characteristic curves (AUCs) observed in individual studies for diagnosis of OSA based on these lipid indices were calculated by random-effect meta-analysis.
RESULTS
Totally 14 original studies were included, comprised of 14,943 cases. AIP, LAP, and VAI were assessed in eight, five, and five studies, respectively. Overall, these lipid indices had acceptable diagnostic ability (AUC 0.70, 95% CI 0.67 to 073). Meta-analysis revealed that AIP was significantly higher in patients with OSA (SMD 0.71, 95% CI 0.45 to 0.97, P < 0.01). Moreover, AIP also increased in higher severities of OSA. Regarding LAP, a higher LAP was observed in OSA/patients with high risk for OSA rather than in controls/low risk for OSA (SMD 0.53, 95% CI 0.25 to 0.81, P < 0.01). VAI was also increased in OSA based on results from two studies.
CONCLUSION
These findings suggest that composite lipid indices are increased in OSA. Also, these indices can have the potential beneficiary diagnostic and prognostic ability in OSA. Future studies can confirm these findings and enlighten the role of lipid indices in OSA.
Topics: Humans; Area Under Curve; Databases, Factual; Lipid Accumulation Product; Sleep Apnea, Obstructive; Lipids
PubMed: 37386562
DOI: 10.1186/s12944-023-01859-3 -
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 -
Journal of Global Health Jun 2018Obstructive sleep apnea (OSA) is a sleep disorder characterized as complete or partial upper airflow cessation during sleep. Although it has been widely accepted that... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Obstructive sleep apnea (OSA) is a sleep disorder characterized as complete or partial upper airflow cessation during sleep. Although it has been widely accepted that OSA is a risk factor for the development of hypertension, the studies focusing on this topic revealed inconsistent results. We aimed to clarify the association between OSA and hypertension, including essential and medication-resistant hypertension.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. PubMed and Embase databases were used for searching the relevant studies published up to December 31, 2016. A quantitative approach of meta-analysis was performed to estimate the pooled odds ratio (OR) and 95% confidence interval (CI).
RESULTS
Twenty-six studies with 51 623 participants (28 314 men, 23 309 women; mean age 51.8 years) met inclusion criteria and were included in this study. Among them, six studies showed a significant association between OSA and resistant hypertension (pooled OR = 2.842, 95% CI = 1.703-3.980, < 0.05). Meanwhile, the combination of 20 original studies on the association of OSA with essential hypertension also presented significant results with the pooled ORs of 1.184 (95% CI = 1.093-1.274, < 0.05) for mild OSA, 1.316 (95% CI = 1.197-1.433, < 0.05) for moderate OSA and 1.561 (95% CI = 1.287-1.835, < 0.05) for severe OSA.
CONCLUSIONS
Our findings indicated that OSA is related to an increased risk of resistant hypertension. Mild, moderate and severe OSA are associated essential hypertension, as well a dose-response manner relationship is manifested. The associations are relatively stronger among Caucasians and male OSA patients.
Topics: Humans; Hypertension; Risk Factors; Sleep Apnea, Obstructive
PubMed: 29497502
DOI: 10.7189/jogh.08.010405 -
Journal of Clinical Sleep Medicine :... May 2021Head and neck cancers (HNCs) may modify the upper airway anatomy and thereby increase the risk for obstructive sleep apnea (OSA). If untreated, OSA is associated with...
STUDY OBJECTIVES
Head and neck cancers (HNCs) may modify the upper airway anatomy and thereby increase the risk for obstructive sleep apnea (OSA). If untreated, OSA is associated with adverse outcomes. Identification of risk factors for OSA in patients with HNC is essential to promote proper evaluation, treatment, and improvement of sleep-related outcomes. In this review, we assessed associations between tumor stage, cancer treatment, and OSA in the population with HNC.
METHODS
A systematic search of PubMed, EMBASE (Embase.com), Cochrane Library (Cochranelibrary.com), Scopus, and Web of Science was conducted to identify articles related to OSA in patients with HNC. A total of 215 articles were identified, of which 14 were included in the qualitative synthesis. These studies included 387 participants.
RESULTS
The most common cancer type, tumor location, and cancer therapy were squamous cell carcinoma, oropharynx, and surgery, respectively. Three of six articles reported an association between surgical treatment and OSA. Conversely, associations between tumor stage, radiotherapy, and OSA were found in only a minority of studies (15%). The prevalence of OSA was between 57% and 76% pre-cancer therapy and 12% and 96% afterward.
CONCLUSIONS
This review suggests a potential association between HNC surgery and OSA. An association between tumor stage, radiotherapy to the head and neck, and OSA is inconclusive. Further research is needed to examine the relationship between HNC and OSA.
Topics: Head and Neck Neoplasms; Humans; Prevalence; Risk Factors; Sleep; Sleep Apnea, Obstructive
PubMed: 33560207
DOI: 10.5664/jcsm.9134 -
Journal of Clinical Medicine Nov 2022This systematic review aimed to comparatively evaluate the efficacy and safety of maxillomandibular advancement (MMA) and upper airway stimulation (UAS) in obstructive... (Review)
Review
This systematic review aimed to comparatively evaluate the efficacy and safety of maxillomandibular advancement (MMA) and upper airway stimulation (UAS) in obstructive sleep apnea (OSA) treatment. A MEDLINE and Embase database search of articles on MMA and/or UAS for OSA was conducted. Twenty-one MMA studies and nine UAS studies were included. All the MMA studies demonstrated a reduction in apnea hypopnea index (AHI) postoperatively, and success rates ranged from 41.1% to 100%. Ten MMA studies reported pre- and postoperative Epworth sleepiness scale (ESS), and all but one study demonstrated a reduction in ESS. In the UAS studies, all but one demonstrated a reduction in AHI, and success rates ranged from 26.7% to 77.8%. In the eight UAS studies reporting pre- and postoperative ESS, an ESS reduction was demonstrated. No studies reported any deaths related to MMA or UAS. The most common postoperative complications after MMA and UAS were facial paresthesia in the mandibular area and discomfort due to electrical stimulation, respectively. This systematic review suggests that both MMA and UAS are effective and generally safe therapies for OSA. However, due to the limitations of the included studies, there is no evidence yet to directly compare these two procedures in OSA treatment.
PubMed: 36431259
DOI: 10.3390/jcm11226782 -
European Archives of... Feb 2022The objective of this study is to systematically review the international literature for dynamic sleep magnetic resonance imaging (MRI) as a diagnostic tool in... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The objective of this study is to systematically review the international literature for dynamic sleep magnetic resonance imaging (MRI) as a diagnostic tool in obstructive sleep apnea (OSA), to perform meta-analysis on the quantitative data from the review, and to discuss its implications in future research and potential clinical applications.
STUDY DESIGN
A comprehensive review of the literature was performed, followed by a detailed analysis of the relevant data that has been published on the topic.
METHODS
Clinical key, Uptodate, Ovid, Ebscohost, Pubmed/MEDLINE, Scopus, Dynamed, Web of Science and The Cochrane Library were systematically searched. Once the search was completed, dynamic sleep MRI data were analyzed.
RESULTS
Nineteen articles reported on 410 OSA patients and 79 controls that underwent dynamic sleep MRI and were included in this review. For meta-analysis of dynamic sleep MRI data, eight articles presented relevant data on 160 OSA patients. Obstruction was reported as follows: retropalatal (RP) 98%, retroglossal (RG) 41% and hypopharyngeal (HP) in 5%. Lateral pharyngeal wall (LPW) collapse was found in 35/73 (48%) patients. The combinations of RP + RG were observed in 24% and RP + RG + LPW in 16%. If sedation was used, 98% of study participants fell asleep compared to 66% of unsedated participants.
CONCLUSIONS
Dynamic sleep MRI has demonstrated that nearly all patients have retropalatal obstruction, retroglossal obstruction is common and hypopharyngeal obstruction is rare. Nearly all patients (98%) who are sedated are able to fall asleep during the MRI. There is significant heterogeneity in the literature and standardization is needed.
Topics: Humans; Magnetic Resonance Imaging; Pharynx; Sleep; Sleep Apnea, Obstructive
PubMed: 34241671
DOI: 10.1007/s00405-021-06942-y -
Journal of Clinical Sleep Medicine :... Jan 2022Eye diseases are an important group of increasingly prevalent disorders that contribute very significantly to disability and represent a considerable health burden. Some... (Meta-Analysis)
Meta-Analysis
UNLABELLED
Eye diseases are an important group of increasingly prevalent disorders that contribute very significantly to disability and represent a considerable health burden. Some data suggest that several of these diseases may be associated with sleep-disordered breathing, mainly obstructive sleep apnea (OSA), due to intermediate mechanisms, such as intermittent hypoxia or sleep fragmentation. The aims of this systematic review were to identify and critically evaluate the current evidence supporting the existence of a possible relationship between OSA and the more relevant eye diseases as well as to evaluate the potential pathogenic mechanisms. There is a body of largely low-level evidence for the association of OSA with glaucoma, nonarteritic ischemic optic neuropathy, central serous chorioretinopathy, and diabetic retinopathy. Meta-analysis of available case-control studies shows that OSA increases the risk of glaucoma (pooled odds ratio: 1.50; 95% confidence interval: 1.25 to 1.80; < .001), nonarteritic ischemic optic neuropathy (3.62; 1.94 to 6.76; < .001), and diabetic retinopathy (1.57; 1.09 to 2.27; = .02). Moreover, several pathogenic pathways have been identified, mainly related to hypoxic damage, mechanical stress, systemic inflammation, oxidative stress, sympathetic tone, and endothelial dysfunction. In contrast, information about the effect of apnea-hypopnea suppression on the development and progression of eye damage is either nonexistent or of a very low level of evidence. In conclusion, OSA has emerged as an additional potential risk factor for many eye diseases, although their link is weak and contradictory, so further examination is required.
CITATION
García-Sánchez A, Villalaín I, Asencio M, García J, García-Rio F. Sleep apnea and eye diseases: evidence of association and potential pathogenic mechanisms. . 2022;18(1):265-278.
Topics: Glaucoma; Humans; Hypoxia; Optic Neuropathy, Ischemic; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 34283018
DOI: 10.5664/jcsm.9552 -
Journal of Community Hospital Internal... Jun 2020Obstructive sleep apnea (OSA) is an established risk factor for poor cardiovascular outcomes and coronary artery disease, but its influence on the development of... (Review)
Review
INTRODUCTION
Obstructive sleep apnea (OSA) is an established risk factor for poor cardiovascular outcomes and coronary artery disease, but its influence on the development of peripheral artery disease (PAD) is not well established. The aim of our study was to understand the mutual prevalence of OSA and PAD and any reported statistical association between the two conditions.
METHODS
PubMed, Ovid Embase, Web of Science, Cochrane library and clinicaltrials.gov databases were systematically searched up to 29 November 2018. A total of 844 articles were identified and 744 articles were screened for relevance.
RESULTS AND CONCLUSION
Eleven prospective cohorts qualified for inclusion with = 63,642 ( = 28,062, = 35,494). All studies evaluated OSA severity primarily with apnea-hypopnea index (AHI) values. The overall prevalence of PAD was 20.5% ( = 13,068). Except for two studies, all studies reported an increased prevalence of OSA in patients with PAD. OSA severity was not found to have an association with poor ankle brachial index values or increasing daytime sleepiness as measured by Epworth sleepiness scale. Further prospective clinical trials are required to further delineate this finding.
PubMed: 32850063
DOI: 10.1080/20009666.2020.1764276 -
Journal of Clinical Sleep Medicine :... Dec 2009We performed a systematic review of the OSA-related risk of crash in commercial motor vehicle (CMV) drivers. The primary objective involved determining whether... (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVES
We performed a systematic review of the OSA-related risk of crash in commercial motor vehicle (CMV) drivers. The primary objective involved determining whether individuals with obstructive sleep apnea (OSA) are at an increased risk for a motor vehicle crash when compared to comparable individuals who do not have the disorder. A secondary objective involved determining what factors are associated with an increased motor vehicle crash risk among individuals with OSA.
DESIGN/SETTING
Seven electronic databases (MEDLINE, PubMed (PreMEDLINE), EMBASE, PsycINFO, CINAHL, TRIS, and the Cochrane library) were searched (through May 27, 2009), as well as the reference lists of all obtained articles. We included controlled studies (case-control or cohort) that evaluated crash risk in individuals with OSA. We evaluated the quality of each study and the interplay between the quality, quantity, robustness, and consistency of the body of evidence, and tested for publication bias. Data were extracted by 2 independent analysts. When appropriate, data from different studies were combined in a fixed- or random-effects meta-analysis.
RESULTS
Individuals with OSA are clearly at increased risk for crash. The mean crash-rate ratio associated with OSA is likely to fall within the range of 1.21 to 4.89. Characteristics that may predict crash in drivers with OSA include BMI, apnea plus hypopnea index, oxygen saturation, and possibly daytime sleepiness.
CONCLUSIONS
Untreated sleep apnea is a significant contributor to motor vehicle crashes.
Topics: Accidents, Traffic; Body Mass Index; Cognition; Disorders of Excessive Somnolence; Health Status; Humans; Obesity; Odds Ratio; Psychomotor Performance; Risk Factors; Severity of Illness Index; Sleep Apnea, Obstructive
PubMed: 20465027
DOI: No ID Found