Predicting sleep apnea responses to oral appliance therapy using polysomnographic airflow

Vena, Daniel; Azarbarzin, Ali; Marques, Melania; Beeck, Sara Op de; Vanderveken, Olivier M.; Edwards, Bradley A.; Calianese, N.; Hess, L; Radmand, Reza; Hamilton, Garun S.; Joosten, Simon A.; Taranto‐Montemurro, Luigi; Kim, Sang Wook; Verbraecken, Johan; Braem, M; White, David P.; Sands, Scott A.; Wellman, Andrew

doi:10.1093/sleep/zsaa004

Cited by 42 publications

(23 citation statements)

References 39 publications

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“…9 Our findings confirm the results obtained with NSE showing that inspiratory discontinuity, quantified as high NED, characterizes epiglottic collapse. 4,10 The distinction between tongue base and other collapse types shown with NSE 4 was absent in the current dataset. It is important to note, however, the difference in tongue base collapse scoring between the NSE studies and the current DISE study.…”

Section: Chestjournalorgmentioning

confidence: 66%

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Flow-Identified Site of Collapse During Drug-Induced Sleep Endoscopy

Beeck

Perck

Vena

et al. 2021

Chest

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Section: Chestjournalorgmentioning

confidence: 66%

“… 9 Our findings confirm the results obtained with NSE showing that inspiratory discontinuity, quantified as high NED, characterizes epiglottic collapse. 4 , 10 …”

Section: Discussionmentioning

confidence: 99%

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Flow-Identified Site of Collapse During Drug-Induced Sleep Endoscopy

Beeck

Perck

Vena

et al. 2021

Chest

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“…Primary analysis of respiratory events were based on the ensemble-averaging method1 30 31: within a patient, flow and drive signals from each event were aligned at event termination, overlaid and mean-averaged. Flow-drive correlation ( R ), flow:drive and Δdrive/Δflow were determined from the ensemble event.…”

Section: Methodsmentioning

confidence: 99%

Neural ventilatory drive decline as a predominant mechanism of obstructive sleep apnoea events

Gell

Vena

Alex

et al. 2022

Thorax

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BackgroundIn the classic model of obstructive sleep apnoea (OSA), respiratory events occur with sleep-related dilator muscle hypotonia, precipitating increased neural ventilatory ‘drive’. By contrast, a drive-dependent model has been proposed, whereby falling drive promotes dilator muscle hypotonia to precipitate respiratory events. Here we determine the extent to which the classic versus drive-dependent models of OSA are best supported by direct physiological measurements.MethodsIn 50 OSA patients (5–91 events/hour), we recorded ventilation (‘flow’, oronasal mask and pneumotach) and ventilatory drive (calibrated intraoesophageal diaphragm electromyography, EMG) overnight. Flow and drive during events were ensemble averaged; patients were classified as drive dependent if flow fell/rose simultaneously with drive. Overnight effects of lower drive on flow, genioglossus muscle activity (EMGgg) and event risk were quantified (mixed models).ResultsOn average, ventilatory drive fell (rather than rose) during events (−20 (−42 to 3)%baseline, median (IQR)) and was strongly correlated with flow (R=0.78 (0.24 to 0.94)). Most patients (30/50, 60%) were classified as exhibiting drive-dependent event pathophysiology. Lower drive during sleep was associated with lower flow (−17 (−20 to –14)%/drive) and EMGgg (−3.5 (−3.8 to –3.3)%max/drive) and greater event risk (OR: 2.2 (1.8 to 2.5) per drive reduction of 100%eupnoea); associations were concentrated in patients with drive-dependent OSA (ie, flow: −37 (−40 to –34)%/drive, OR: 6.8 (5.3 to 8.7)). Oesophageal pressure—without tidal volume correction—falsely suggested rising drive during events (classic model).ConclusionsIn contrast to the prevailing view, patients with OSA predominantly exhibit drive-dependent event pathophysiology, whereby flow is lowest at nadir drive, and lower drive raises event risk. Preventing ventilatory drive decline is therefore considered a target for OSA intervention.

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“…The same research group also identified expiratory flow limitation (recognizable as pinching of the airflow signal) as the hallmark of palatal prolapse ( 29 ). According to recent evidence, this pinching feature is associated with a negative response to mandibular advancement device treatment, indicating the potential of this non-invasive assessment ( 32 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Drug-Induced Sleep Endoscopy and Natural Sleep Endoscopy in the Assessment of Upper Airway Pathophysiology During Sleep: Protocol and Study Design

et al. 2021

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Study Objectives: Obstructive sleep apnea (OSA) is increasingly recognized as a complex and heterogenous disorder. As a result, a “one-size-fits-all” management approach should be avoided. Therefore, evaluation of pathophysiological endotyping in OSA patients is emphasized, with upper airway collapse during sleep as one of the main features. To assess the site(s) and pattern(s) of upper airway collapse, natural sleep endoscopy (NSE) is defined as the gold standard. As NSE is labor-intensive and time-consuming, it is not feasible in routine practice. Instead, drug-induced sleep endoscopy (DISE) is the most frequently used technique and can be considered as the clinical standard. Flow shape and snoring analysis are non-invasive measurement techniques, yet are still evolving. Although DISE is used as the clinical alternative to assess upper airway collapse, associations between DISE and NSE observations, and associated flow and snoring signals, have not been quantified satisfactorily. In the current project we aim to compare upper airway collapse identified in patients with OSA using endoscopic techniques as well as flow shape analysis and analysis of tracheal snoring sounds between natural and drug-induced sleep.Methods: This study is a blinded prospective comparative multicenter cohort study. The study population will consist of adult patients with a recent diagnosis of OSA. Eligible patients will undergo a polysomnography (PSG) with NSE overnight and a DISE within 3 months. During DISE the upper airway is assessed under sedation by an experienced ear, nose, throat (ENT) surgeon using a flexible fiberoptic endoscope in the operating theater. In contrast to DISE, NSE is performed during natural sleep using a pediatric bronchoscope. During research DISE and NSE, the standard set-up is expanded with additional PSG measurements, including gold standard flow and analysis of tracheal snoring sounds.Conclusions: This project will be one of the first studies to formally compare collapse patterns during natural and drug-induced sleep. Moreover, this will be, to the authors' best knowledge, the first comparative research in airflow shape and tracheal snoring sounds analysis between DISE and NSE. These novel and non-invasive diagnostic methods studying upper airway mechanics during sleep will be simultaneously validated against DISE and NSE.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04729478.

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Predicting sleep apnea responses to oral appliance therapy using polysomnographic airflow

Cited by 42 publications

References 39 publications

Flow-Identified Site of Collapse During Drug-Induced Sleep Endoscopy

Flow-Identified Site of Collapse During Drug-Induced Sleep Endoscopy

Neural ventilatory drive decline as a predominant mechanism of obstructive sleep apnoea events

Comparison of Drug-Induced Sleep Endoscopy and Natural Sleep Endoscopy in the Assessment of Upper Airway Pathophysiology During Sleep: Protocol and Study Design

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