This study aims to describe the pattern of home mechanical ventilation (HMV) usage in Australia and New Zealand.34 centres providing HMV in the region were identified and asked to complete a questionnaire regarding centre demographics, patient diagnoses, HMV equipment and settings, staffing levels and methods employed to implement and follow-up therapy.28 (82%) centres responded, providing data on 2,725 patients. The minimum prevalence of HMV usage was 9

Scientific inveStigAtionS introduction:Obstructive sleep apnea (OSA) is widely accepted to improve during slow wave sleep (SWS) compared to lighter stages of NREM sleep. However, supporting data to establish the magnitude and prevalence of this effect is lacking. Consequently, we examined this phenomenon, controlling for posture, in a large group of patients investigated for OSA at an academic clinical sleep service. Methods: A detailed retrospective analysis was conducted on data obtained from each 30-sec epoch of sleep in 253 consecutive fullnight diagnostic polysomnography studies performed over a 3-month period. Respiratory and arousal event rates were calculated within each stage of sleep, in the supine and lateral postures, and across the whole night, with OSA patients classified on the basis of an overall apnea-hypopnea index (AHI) ≥ 15 events/h. Central sleep apnea (CSA) patients were defined by a central apnea index ≥ 5/h. Sleep latency and time, and respiratory and arousal event rates in OSA, CSA, and non-OSA patients were compared between sleep stages and postures using linear mixed model analysis. The numbers of patients achieving reduced event rates in SWS and in the lateral posture were also examined.Results: There were 171 patients with OSA, 14 with CSA, and 68 non-OSA patients. OSA patients took significantly longer to achieve slow wave and REM sleep (p < 0.001) than non-OSA patients and had less stage 4 sleep (p = 0.037). There were striking improvements in AHI and arousal index (AI) from stage 1 to 4 NREM sleep (p < 0.001), with intermediate levels in REM sleep. AHI and AI were also markedly reduced in lateral versus supine sleep in all sleep stages (p < 0.001), with an effect size comparable to that of the slow wave sleep effect. The majority of OSA patients achieved low respiratory event rates in SWS. Eighty-two percent of patients achieved an AHI < 15 and 57% < 5 events/hour during stage 4 sleep. Conclusion:Although OSA patients demonstrate both a delayed and reduced proportion of SWS compared to non-OSA subjects, once they achieved SWS, AHI, and AI markedly improved in most patients.

IMPORTANCE Many adults with obstructive sleep apnea (OSA) use device treatments inadequately and remain untreated. OBJECTIVE To determine whether combined palatal and tongue surgery to enlarge or stabilize the upper airway is an effective treatment for patients with OSA when conventional device treatment failed. DESIGN, SETTING, AND PARTICIPANTS Multicenter, parallel-group, open-label randomized clinical trial of upper airway surgery vs ongoing medical management. Adults with symptomatic moderate or severe OSA in whom conventional treatments had failed were enrolled between November 2014 and October 2017, with follow-up until August 2018. INTERVENTIONS Multilevel surgery (modified uvulopalatopharyngoplasty and minimally invasive tongue volume reduction; n = 51) or ongoing medical management (eg, advice on sleep positioning, weight loss; n = 51). MAIN OUTCOMES AND MEASURES Primary outcome measures were the apnea-hypopnea index (AHI; ie, the number of apnea and hypopnea events/h; 15-30 indicates moderate and >30 indicates severe OSA) and the Epworth Sleepiness Scale (ESS; range, 0-24; >10 indicates pathological sleepiness). Baseline-adjusted differences between groups at 6 months were assessed. Minimal clinically important differences are 15 events per hour for AHI and 2 units for ESS. RESULTS Among 102 participants who were randomized (mean [SD] age, 44.6 [12.8] years; 18 [18%] women), 91 (89%) completed the trial. The mean AHI was 47.9 at baseline and 20.8 at 6 months for the surgery group and 45.3 at baseline and 34.5 at 6 months for the medical management group (mean baseline-adjusted between-group difference at 6 mo, −17.6 events/h [95% CI, −26.8 to −8.4]; P < .001). The mean ESS was 12.4 at baseline and 5.3 at 6 months in the surgery group and 11.1 at baseline and 10.5 at 6 months in the medical management group (mean baseline-adjusted between-group difference at 6 mo, −6.7 [95% CI, −8.2 to −5.2]; P < .001). Two participants (4%) in the surgery group had serious adverse events (1 had a myocardial infarction on postoperative day 5 and 1 was hospitalized for observation following hematemesis of old blood). CONCLUSIONS AND RELEVANCE In this preliminary study of adults with moderate or severe OSA in whom conventional therapy had failed, combined palatal and tongue surgery, compared with medical management, reduced the number of apnea and hypopnea events and patient-reported sleepiness at 6 months. Further research is needed to confirm these findings in additional populations and to understand clinical utility, long-term efficacy, and safety of multilevel upper airway surgery for treatment of patients with OSA.

National Health and Medical Research Council and Repat Foundation.