Optimal treatment of obstructive sleep apnea and excessive sleepiness

Rosenberg, Russell; Doghramji, Paul P.

doi:10.1007/s12325-009-0016-7

Cited by 28 publications

(16 citation statements)

References 113 publications

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“…The efficacy of CPAP depends upon an adequate interface, appropriate pressure settings, and adherence to use. 10,11 Despite efforts to promote use, CPAP adherence in children is generally poor.…”

Section: Introductionmentioning

confidence: 99%

Correlates of Pediatric CPAP Adherence

Hawkins

Jensen

Simon

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Obstructive sleep apnea (OSA) is a common pediatric condition characterized by recurrent partial or complete cessation of airflow during sleep, typically due to inadequate upper airway patency. Continuous positive airway pressure (CPAP) is a therapeutic option that reduces morbidity. Despite efforts to promote use, CPAP adherence is poor in both pediatric and adult populations. We sought to determine whether demographics, insurance status, OSA severity, therapeutic pressure, or comorbid conditions were associated with pediatric CPAP adherence. Methods: A retrospective review of adherence download data was performed on all pediatric patients with initiation or adjustment of CPAP treatment over a one-year period with documented in-laboratory CPAP titration. Patients were grouped as CPAP adherent or non-adherent, where adherence was defined as > 70% nightly use and average usage ≥ 4 hours per night. Differences between the groups were analyzed by χ 2 test. Results: Overall, nearly half of participants were CPAP adherent (49%, 69/140). Of the demographic data collected (age, ethnicity, sex, insurance status), only female sex was associated with better adherence (60.9% vs 39.5% of males adherent; odds ratio [OR] = 2.41, 95%CI = 1.20-4.85; p = 0.01). Severity of OSA (diagnostic apnea-hypopnea index [AHI] and degree of hypoxemia), therapeutic pressure, and residual AHI did not impact CPAP adherence (p > 0.05). Patients with developmental delay (DD) were more likely to be adherent with CPAP than those without a DD diagnosis (OR = 2.55, 95%CI = 1.27-5.13; p = 0.007). Female patients with trisomy 21 tended to be more adherent, but this did not reach significance or account for the overall increased adherence associated with female sex. Conclusions: Our study demonstrates that adherence to CPAP therapy is poor but suggests that female sex and developmental delay are associated with better adherence. These findings support efforts to understand the pathophysiology of and to develop adherence-promoting and alternative interventions for pediatric OSA.

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Section: Introductionmentioning

confidence: 99%

Correlates of Pediatric CPAP Adherence

Hawkins

Jensen

Simon

et al. 2016

Journal of Clinical Sleep Medicine

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“…CPAP acts to pneumatically splint open the upper airway, thereby eliminating obstructive events during sleep. 8 However, many patients find CPAP difficult to use on a consistent basis or at all. The compliance rate of CPAP is less than 50% in some studies.…”

Section: Introductionmentioning

confidence: 99%

Interventional Drug-Induced Sleep Endoscopy: A Novel Technique to Guide Surgical Planning for Obstructive Sleep Apnea

Victores

Olson

2017

Journal of Clinical Sleep Medicine

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Study Objective: One of the challenges of surgery for obstructive sleep apnea (OSA) is identifying the correct surgical site for each patient. The objective of this study was to use drug-induced sleep endoscopy (DISE) and nasopharyngeal tube (NPT) placement to determine the effect of eliminating palatal collapse on the obstruction seen on other segments of the upper airway. Methods: Forty-one OSA patients were enrolled in this prospective study. All patients had a polysomnogram followed by DISE. DISE findings were recorded and compared with and without placement of a NPT. Obstruction was graded with a scale that incorporates location, severity, and interval of obstruction. Results: Most patients (83%) demonstrated multilevel obstruction on initial DISE. With the nasopharyngeal airway in place, many patients with multilevel obstruction had at least a partial improvement (74%) and some a complete resolution (35%) of collapse (p < 0.05). Reduction in collapse was observed at the lateral walls (86%), epiglottis (55%), and tongue base (50%). NPT placement did not significantly alter upper airway morphology of patients with incomplete palatal obstruction or mild OSA. Conclusions: To our knowledge, this is the first study to evaluate the effect of soft palatal stenting on downstream pharyngeal obstruction during DISE. Our study provides evidence that reducing soft palatal collapse can reduce negative pharyngeal pressure and thereby alleviate other sites of upper airway obstruction. Taken together, these findings provide a means to identify appropriate candidates for isolated palatal surgery and better direct a minimally invasive approach to the surgical management of OSA. Keywords: obstructive sleep apnea, OSA, nasopharyngeal tube, drug-induced sleep endoscopy, DISE Citation: Victores AJ, Olson K, Takashima M. Interventional drug-induced sleep endoscopy: a novel technique to guide surgical planning for obstructive sleep apnea.

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“…Despite its effectiveness, adherence to its use is poor [2]. Reports of non-adherence to CPAP therapy range from 29% to 83% [3]. Pressure intolerance is a frequent complaint reported by CPAP-nonadherent users [4].…”

Section: Introductionmentioning

confidence: 99%