Obstructive sleep apnea: current perspectives

Osman, A. Arnold; Carter, Sophie G.; Carberry, Jayne C.

doi:10.2147/nss.s124657

Cited by 311 publications

(242 citation statements)

References 168 publications

Supporting

Mentioning

185

Contrasting

Unclassified

Order By: Relevance

“…Alternatively, OSA is characterized by repetitive brief closure (apnea) or narrowing (hypopnea) of the pharyngeal airway during sleep which result in the cessation or reduction of airflow, reduced oxygen saturation, and commonly terminate in post-apneic arousals from sleep, increased sympathetic activity, and the resumption of airflow [1,14,15]. OSA is thought to result from a combination of anatomical (e.g., a narrow pharyngeal airway), and non-anatomical factors (e.g., impaired upper airway muscle function, low arousal threshold, and unstable control of breathing) [16]. The combination of frequent respiratory events and arousals from sleep throughout the night severely fragments sleep architecture, resulting in perceptions of chronically non-restorative sleep, reduced quality of life, excessive daytime sleepiness, and increased risk of motor-vehicle accidents [17][18][19].…”

Section: Insomnia and Obstructive Sleep Apneamentioning

confidence: 99%

“…Alternatively, insomnia disorder may be associated with a reduced respiratory arousal threshold, which may predispose patients to prematurely awaken to respiratory events [16,105]. Indeed, insomnia has been conceptualized as a disorder of chronic 'hyperarousal', including elevated cognitive (ruminations, anxiety, etc.)…”

Section: Bi-directional Relationships In Comisamentioning

confidence: 99%

See 1 more Smart Citation

Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials

2019

View full text Add to dashboard Cite

Co-morbid insomnia and sleep apnea (COMISA) is a highly prevalent and debilitating disorder, which results in additive impairments to patients' sleep, daytime functioning, and quality of life, and complex diagnostic and treatment decisions for clinicians. Although the presence of COMISA was first recognized by Christian Guilleminault and colleagues in 1973, it received very little research attention for almost three decades, until the publication of two articles in 1999 and 2001 which collectively reported a 30%-50% co-morbid prevalence rate, and re-ignited research interest in the field. Since 1999, there has been an exponential increase in research documenting the high prevalence, common characteristics, treatment complexities, and bi-directional relationships of COMISA. Recent trials indicate that co-morbid insomnia symptoms may be treated with cognitive and behavioral therapy for insomnia, to increase acceptance and use of continuous positive airway pressure therapy. Hence, the treatment of COMISA appears to require nuanced diagnostic considerations, and multi-faceted treatment approaches provided by multi-disciplinary teams of psychologists and physicians. In this narrative review, we present a brief overview of the history of COMISA research, describe the importance of measuring and managing insomnia symptoms in the presence of sleep apnea, discuss important methodological and diagnostic considerations for COMISA, and review several recent randomized controlled trials investigating the combination of CBTi and CPAP therapy. We aim to provide clinicians with pragmatic suggestions and tools to identify, and manage this prevalent COMISA disorder in clinical settings, and discuss future avenues of research to progress the field.

show abstract

Section: Insomnia and Obstructive Sleep Apneamentioning

confidence: 99%

Section: Bi-directional Relationships In Comisamentioning

confidence: 99%

Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials

2019

View full text Add to dashboard Cite

show abstract

“…OSA is a heterogeneous disorder (Osman et al 2018). Anatomical impairment of the upper airway (Bilston & Gandevia, 2014) coupled with a reduction in pharyngeal dilator muscle activity is key to OSA pathophysiology.…”

Section: Introductionmentioning

confidence: 99%

Changes in pharyngeal collapsibility and genioglossus reflex responses to negative pressure during the respiratory cycle in obstructive sleep apnoea

Osman

Carberry

Gandevia

et al. 2020

The Journal of Physiology

Self Cite

View full text Add to dashboard Cite

Key pointsr Impaired pharyngeal anatomy and increased airway collapsibility is a major cause of obstructive sleep apnoea (OSA) and a mediator of its severity.r Upper airway reflexes to changes in airway pressure provide important protection against airway closure. r This study shows increased pharyngeal collapsibility and attenuated genioglossus reflex responses during expiration in people with OSA.Abstract Upper airway collapse contributes to obstructive sleep apnoea (OSA) pathogenesis. Pharyngeal dilator muscle activity varies throughout the respiratory cycle and may contribute to dynamic changes in pharyngeal collapsibility. However, whether upper airway collapsibility and reflex responses to changes in airway pressure vary throughout the respiratory cycle in OSA is unclear. Thus, this study quantified differences in upper airway collapsibility and genioglossus electromyographic (EMG) activity and reflex responses during different phases of the respiratory cycle. Twelve middle-aged people with OSA (2 female) were fitted with standard polysomnography equipment: a nasal mask, pneumotachograph, two fine-wire intramuscular electrodes into the genioglossus, and a pressure catheter positioned at the epiglottis and a second at the choanae (the collapsible portion of the upper airway). At least 20 brief (ß250 ms) pressure pulses (ß−11 cmH 2 O at the mask) were delivered every 2-10 breaths during four conditions: (1) early inspiration, (2) mid-inspiration, (3) early expiration, and (4) mid-expiration. Mean baseline genioglossus EMG activity 100 ms prior to pulse delivery Amal Osman is a Research Associate at the Adelaide Institute for Sleep Health, Flinders University. She completed her PhD at the University of New South Wales and Neuroscience Research Australia. She is investigating development of simple clinical tools to measure upper airway collapsibility in obstructive sleep apnoea, a critical component in the pathogenesis of this common sleep-related breathing disorder. Current interests include understanding the mechanisms that contribute to airway closure in sleep apnoea. The hope is that this work brings us closer to developing new clinical tools to predict and optimize responses to targeted and novel treatments. J Physiol 598.3 and genioglossus reflex responses were quantified for each condition. The upper airway collapsibility index (UACI), quantified as 100 × (nadir choanal − epiglottic pressure)/nadir choanal pressure during negative pressure pulses, varied throughout the respiratory cycle (early inspiration = 43 ± 25%, mid-inspiration = 29 ± 19%, early expiration = 83 ± 19% and mid-expiration = 95 ± 11% (mean ± SD) P < 0.01). Genioglossus EMG activity was lower during expiration (e.g. mid-expiration vs. mid-inspiration = 76 ± 23 vs. 127 ± 41% of early-inspiration, P < 0.001). Similarly, genioglossus reflex excitation was delayed (39 ± 11 vs. 23 ± 7 ms, P < 0.001) and reflex excitation amplitude attenuated during mid-expiration versus early inspiration (209 ± 36 vs. 286 ± 80%, P = 0.009). These findings ...

show abstract

“…Mandibular advancement devices (MAD) and surgery are generally reserved for patients with mild to moderate OSA or CPAP failure. 6,7 Maxillomandibular advancement (MMA) is the most successful surgical intervention for OSA aside from tracheostomy. 8 MMA involves advancement of both jaws following a Le Fort 1 maxillary osteotomy in conjunction with a bilateral sagittal split osteotomy of the mandible.…”

Section: Introductionmentioning

confidence: 99%

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

et al. 2019

View full text Add to dashboard Cite

Objectives/Hypothesis To evaluate upper airway (UA) collapse patterns during drug‐induced sleep endoscopy (DISE) and maxillomandibular advancement (MMA) surgery outcome, paying particular attention to the DISE phenotype complete concentric collapse at the level of the palate (CCCp). Study Design Prospective case series. Methods Nineteen patients diagnosed with obstructive sleep apnea (OSA) prospectively underwent mandibular advancement device (MAD) treatment followed by MMA surgery. UA collapse patterns were evaluated before and after MMA surgery. Baseline apnea‐hypopnea index (AHI) was compared with AHI during MAD treatment and after MMA surgery. UA collapse patterns and the presence of baseline CCCp were assessed. AHI differences between patients with and without CCCp after MMA surgery were compared. Results In 14 patients, a full dataset was obtained: 8/6 (male/female), mean age = 51 ± 7 years, body mass index (BMI) = 25.6 ± 3.7 kg/m2, and baseline AHI = 40.2 ± 25.6 per hour of sleep. MMA surgery reduced AHI to 9.9 ± 7.2 per hour of sleep (P = .0001). Eight patients benefited from additional AHI reduction compared to MAD treatment (P = .0113). Six out of 14 (43%) patients showed baseline CCCp. Baseline patient characteristics (age, BMI, and AHI) did not significantly differ between patients with and without CCCp. AHI was equally reduced after MMA, whether (P = .0145) or not (P = .0075) CCCp was present at baseline. All patients showed resolution of CCCp (P = .0159) during postoperative DISE. Conclusions CCCp seems not to be a negative predictor for MMA surgery outcome measured by AHI reduction. Furthermore, MMA is likely to eliminate CCCp. Therefore, MMA might be a solution for OSA patients showing CCCp and broadens the perspective for personalized medicine and combination therapy. However, a large sample is required for definitive results. Level of Evidence 4 Laryngoscope, 130:E268–E274, 2020

show abstract

Obstructive sleep apnea: current perspectives

Cited by 311 publications

References 168 publications

Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials

Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials

Changes in pharyngeal collapsibility and genioglossus reflex responses to negative pressure during the respiratory cycle in obstructive sleep apnoea

Drug‐Induced Sleep Endoscopy Upper Airway Collapse Patterns and Maxillomandibular Advancement

Contact Info

Product

Resources

About