Effects of One Night without Nasal CPAP Treatment on Sleep and Sleepiness in Patients with Obstructive Sleep Apnea

Kribbs, Nancy Barone; Pack, Allan I.; Kline, Lewis R.; Getsy, Joanne; Schuett, Jeanne S.; Henry, John N.; Maislin, Greg; Dinges, David F.

doi:10.1164/ajrccm/147.5.1162

Cited by 337 publications

(187 citation statements)

References 33 publications

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“…22 There is no clear predictive factor for compliance. Although use of nCPAP every night has been shown to be optimal, 29 the minimum number of hours per night that is actually required to ameliorate OSAS symptoms is not known. Engleman et al 23 reported significant improvement in daytime symptoms with nCPAP, despite a mean machine run time of only 3.7 hours.…”

Section: Long-term Compliance With Continuous Positive Airway Pressurementioning

confidence: 99%

Long-Term Compliance with Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Syndrome

Wali

1997

Ann Saudi Med

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Section: Long-term Compliance With Continuous Positive Airway Pressurementioning

confidence: 99%

Long-Term Compliance with Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Syndrome

Wali

1997

Ann Saudi Med

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“…The associated consequences include daytime sleepiness [3], decreased cognitive performance, decreased quality of life [4], increased risk of automobile and industrial accidents [5,6], and adverse cardiovascular sequelae [7][8][9][10]. Treatment of OSA leads to improvements in many of these adverse outcomes and may reduce healthcare costs [11][12][13]. Thus, diagnosis of this disorder is important.…”

Section: Introductionmentioning

confidence: 99%

Automated detection of sleep disordered breathing using a nasal pressure monitoring device

Grover

Pittman

2008

Sleep Breath

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To assess the accuracy of a single channel portable monitoring device (RUSleeping™ RTS, Respironics, Murrysville, PA) that measures nasal pressure (a surrogate for airflow) to detect sleep disordered breathing (SDB). Twenty-five adult patients referred to a community sleep laboratory with suspected obstructive sleep apnea (OSA) participated in this investigation. The portable monitoring device was used in the sleep laboratory to acquire data concurrently with a standard multi-channel polysomnogram (PSG) to assess SDB. Respiratory events were scored manually on the PSG using standard criteria for clinical research to quantify an apnea-hypopnea index (AHI) based on events during sleep. The portable monitoring device automatically calculated an unedited respiratory event index (REI) based on recording time. These data were then compared using the Pearson product-moment correlation coefficient, Bland-Altman analysis, receiver operating characteristic (ROC) curves, and likelihood ratios. All 25 subjects completed the study. Mean age of subjects was 42.4±12.9 years and mean body mass index was 31.0± 7.4 kg m −2 . There was good agreement between the REI and the AHI (R=0.77, p<0.001, mean difference 2.6 events per hour [2 SD: 39.8] using a Bland-Altman plot). The area under the ROC curve for detecting SDB (PSG AHI greater than or equal to five events per hour) with the REI was 0.94 (95% CI 0.84-1.0). For an REI >11.9 events per hour, the sensitivity was 0.89 (95% CI 0.65-0.99) and the specificity was 0.86 (95% CI 0.42-1.0) with a likelihood ratio of 6.2 for a positive test (LR+) and 0.13 for a negative test (LR−). Similar results were observed for detecting moderatesevere SDB (PSG AHI≥15 events h −1 ) using REI >15.2 events h −1 . In a population of subjects with suspected OSA, this portable monitoring device can automatically quantify an REI that compares well to the AHI scored manually on a concurrent PSG. Such a device may prove useful to assess SDB in high risk populations with self-administered testing in ambulatory settings such as the home.

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“…Airflow obstruction is thought to result from decreases in pharyngeal neuromuscular activity at sleep onset (2). These episodes lead to intermittent hypoxemia and recurrent arousals from sleep, accounting for the long-term neurocognitive (3,4), metabolic (5), and cardiovascular (6) sequelae of this disorder. Nasal continuous positive airway pressure remains the mainstay of treatment for moderate to severe obstructive sleep apnea (7).…”

mentioning

confidence: 99%

Acute Upper Airway Responses to Hypoglossal Nerve Stimulation during Sleep in Obstructive Sleep Apnea

Schwartz

Barnes

Hillman

et al. 2012

Am J Respir Crit Care Med

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Rationale: Hypoglossal nerve stimulation (HGNS) recruits lingual muscles, reduces pharyngeal collapsibility, and treats sleep apnea. Objectives: We hypothesized that graded increases in HGNS relieve pharyngeal obstruction progressively during sleep. Methods: Responses were examined in 30 patients with sleep apnea who were implanted with an HGNS system. Current (milliampere) was increased stepwise during non-REM sleep. Frequency and pulse width were fixed. At each current level, stimulation was applied on alternating breaths, and responses in maximal inspiratory airflow (V I max) and inspiratory airflow limitation (IFL) were assessed. Pharyngeal responses to HGNS were characterized by the current levels at which V I max first increased and peaked (flow capture and peak flow thresholds), and by the V I max increase from flow capture to peak (DV I max). Measurements and Main Results: HGNS produced linear increases in V I max from unstimulated levels at flow capture to peak flow thresholds (215 6 21 to 509 6 37 ml/s; mean 6 SE; P , 0.001) with increasing current from 1.05 6 0.09 to 1.46 6 0.11 mA. V I max increased in all patients and IFL was abolished in 57% of patients (non-IFL subgroup). In the non-IFL compared with IFL subgroup, the flow response slope was greater (1241 6 199 vs. 674 6 166 ml/s/mA; P , 0.05) and the stimulation amplitude at peak flow was lower (1.23 6 0.10 vs. 1.80 6 0.20 mA; P , 0.05) without differences in peak flow. Conclusions: HGNS produced marked dose-related increases in airflow without arousing patients from sleep. Increases in airflow were of sufficient magnitude to eliminate IFL in most patients and IFL and non-IFL subgroups achieved normal or near-normal levels of flow, suggesting potential HGNS efficacy across a broad range of sleep apnea severity.Keywords: obstructive sleep apnea; electrical hypoglossal nerve stimulation; pharynx; upper airway; titration Obstructive sleep apnea is characterized by recurrent episodes of upper airway obstruction during sleep (1). Airflow obstruction is thought to result from decreases in pharyngeal neuromuscular activity at sleep onset (2). These episodes lead to intermittent hypoxemia and recurrent arousals from sleep, accounting for the long-term neurocognitive (3, 4), metabolic (5), and cardiovascular (6) sequelae of this disorder. Nasal continuous positive airway pressure remains the mainstay of treatment for moderate to severe obstructive sleep apnea (7). Difficulties adhering to therapy can limit its effectiveness in the home setting (8, 9), and alternatives have been generally less effective in relieving upper airway obstruction during sleep (10-12).Hypoglossal nerve stimulation (HGNS) has been piloted as treatment for obstructive sleep apnea (13). Implantable HGNS systems have been developed to stimulate the hypoglossal nerve during inspiration, and recruit the lingual musculature, leading to decreases in pharyngeal collapsibility during sleep (14-17). Motor activity protrudes the tongue, and mitigates airflow obstruction during sleep (18,19)....

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Effects of One Night without Nasal CPAP Treatment on Sleep and Sleepiness in Patients with Obstructive Sleep Apnea

Cited by 337 publications

References 33 publications

Long-Term Compliance with Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Syndrome

Long-Term Compliance with Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Syndrome

Automated detection of sleep disordered breathing using a nasal pressure monitoring device

Acute Upper Airway Responses to Hypoglossal Nerve Stimulation during Sleep in Obstructive Sleep Apnea

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