Stimulating therapy for obstructive sleep apnoea

Strollo, Patrick J.; Malhotra, Atul

doi:10.1136/thoraxjnl-2016-209077

Cited by 11 publications

(6 citation statements)

References 20 publications

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“…This RCT confirmed the observations from an earlier feasibility study (52). The strength of this study design was the measurement of sleep and sleep disruption during stimulation (56), although there are some limitations which include the length of stimulation being restricted to only one night before the primary outcome was assessed, a modest reduction of the 4% ODI in the whole group and a lack of impact of stimulation/intervention on the total group AHI during rapid-eye-movement sleep (57). The modest treatment effect could potentially be explained by the concept of different OSA patient phenotypes (58) with patients with an anterior pharyngeal collapse responding better to stimulation than patients who have multilevel or concentric obstructions; ongoing work suggests that only a portion of OSA patients have upper airway dilator muscle dysfunction (59,60).…”

Section: Transcutaneous Electrical Stimulation/hypoglossal Nerve Stimsupporting

confidence: 83%

Preface for the 3rd Clinical Update Sleep, 23rd February 2018, Royal College of Physicians, London, UK: year in review

Ratneswaran¹,

Sagoo²,

Steier³

2018

J. Thorac. Dis.

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Sleep medicine remains an exciting and fast-evolving field of medicine with insomnia, hypersomnia, parasomnia, sleepdisordered breathing and circadian rhythm disorders affecting significant proportions of the population. This update provides a selected overview about recent publications in the field. Sleep-disordered breathing and comorbidities The high prevalence of obstructive sleep apnoea (OSA) differs between genders, with male patients being more affected (1). In a US-nationwide study of 1,704,905 patients who had a diagnosis of OSA and 1,704,417 controls matched for age, sex and state of residence, the prevalence of co-morbidities [OR (95% CI)], such as type 2 diabetes [2.29 (2.28-2.31)], cardiac arrhythmia [3.26 (3.20-3.32)], ischaemic heart disease [2.54 (2.51-2.56)], stroke [3.51 (3.42-3.60)], hypertension [2.14 (2.13-2.15)], depression [4.99 (4.91-5.07)] and congestive heart failure [4.30 (4.21-4.39)] was increased (2). Non-communicable disease is important (3) and its link with comorbidities, predominantly its association with obesity (1), make OSA an important confounding factor that impacts on physical, social and mental health (4). Diagnostic criteria for sleep apnoea There have been ongoing discussions about the classification and diagnostic parameters of OSA. Study outcomes investigating OSA are dependent on accurate description, definition and comparisons of their patient groups. Heinzer et al. argue that the present International Classification of Sleep Disorders (ICSD-3) definition of sleep apnoea yields an unrealistically high prevalence of OSA (5), in part related to a low apnoea-hypopnoea index (AHI) threshold for normal subjects (5/h) and a high prevalence of coexisting symptoms and conditions such as fatigue, insomnia and hypertension which may not be related to the underlying OSA (6). In a group of 2,121 patients who underwent full home polysomnography (PSG) ['HypnoLaus' cohort; 48% male, median age 57, (interquartile range, IQR 49-68) years, mean body mass index (BMI) 25.6 kg/m 2 , standard deviation (SD) 4.1 kg/m 2 ], they applied the 2013 American Academy of Sleep Medicine (AASM) criteria for OSA: An apnoea was defined as ≥90% reduction in airflow from baseline, lasting for ≥10 seconds; a hypopnea was defined as ≥30% reduction in airflow from baseline, lasting for ≥10 seconds with either a ≥3% drop in oxygen saturation or an arousal (7,8). These criteria led to a diagnosis of moderate-to-severe OSA (sOSA) (AHI ≥15/h) in 23.4% (95% CI: 20.9-26.0) of women and 49.7% (95% CI: 46.6-52.8) of men (9). However, analysing the same cohort in 2016, but using the ICSD-3 criteria which are defined by an AHI ≥15/hour, or an AHI ≥5/hour associated with one or more symptoms of OSA or cardiovascular and metabolic comorbidities, the prevalence of OSA increased to 74.7% of men, and 52.1% of women (5,6,10). The authors suggested that a better definition of OSA should be sought using prospective and large cohort follow-up studies. Screening for OSA in a bariatric population OSA and obesity commonly co-exi...

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Section: Transcutaneous Electrical Stimulation/hypoglossal Nerve Stimsupporting

confidence: 83%

Preface for the 3rd Clinical Update Sleep, 23rd February 2018, Royal College of Physicians, London, UK: year in review

Ratneswaran¹,

Sagoo²,

Steier³

2018

J. Thorac. Dis.

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“…Work schedules (in particular shift work), use of over-the-counter and prescribed sedating medications, and lifestyle factors also should be reviewed. Furthermore, healthcare providers should ensure that the underlying airway obstruction is being adequately treated with CPAP, an oral appliance, hypoglossal nerve stimulation, or other surgical interventions ( 48 – 51 ).…”

Section: Clinical Evaluation Of Eds In Osamentioning

confidence: 99%

Excessive Daytime Sleepiness in Obstructive Sleep Apnea. Mechanisms and Clinical Management

et al. 2021

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Many patients with obstructive sleep apnea (OSA) experience excessive daytime sleepiness (EDS), which can negatively affect daily functioning, cognition, mood, and other aspects of well-being. Although EDS can be reduced with primary OSA treatment, such as continuous positive airway pressure (CPAP) therapy, a significant proportion of patients continue to experience EDS despite receiving optimized therapy for OSA. This article reviews the pathophysiology and clinical evaluation and management of EDS in patients with OSA. The mechanisms underlying EDS in CPAP-treated patients remain unclear. Experimental risk factors include chronic intermittent hypoxia and sleep fragmentation, which lead to oxidative injury and changes in neurons and brain circuit connectedness involving noradrenergic and dopaminergic neurotransmission in wake-promoting regions of the brain. In addition, neuroimaging studies have shown alterations in the brain’s white matter and gray matter in patients with OSA and EDS. Clinical management of EDS begins with ruling out other potential causes of EDS and evaluating its severity. Tools to evaluate EDS include objective and self-reported assessments of sleepiness, as well as cognitive assessments. Patients who experience residual EDS despite primary OSA therapy may benefit from wake-promoting pharmacotherapy. Agents that inhibit reuptake of dopamine or of dopamine and norepinephrine (modafinil/armodafinil and solriamfetol, respectively) have demonstrated efficacy in reducing EDS and improving quality of life in patients with OSA. Additional research is needed on the effects of wake-promoting treatments on cognition in these patients and to identify individual or disorder-specific responses.

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“…These combinations of stimuli can activate the genioglossus during stable sleep, and may represent a therapeutic target to stabilize breathing in predisposed individuals. Methods of percutaneous stimulation of the hypoglossal nerve are now being studied in this context as well (32).…”

Section: Screening For Obstructive Sleep Apnea In Surgical Patientsmentioning

confidence: 99%

Knowledge Gaps in the Perioperative Management of Adults with Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome. An Official American Thoracic Society Workshop Report

Ayas¹,

Laratta²,

Coleman³

et al. 2018

Annals ATS

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The purpose of this workshop was to identify knowledge gaps in the perioperative management of obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). A single-day meeting was held at the American Thoracic Society Conference in May, 2016, with representation from many specialties, including anesthesiology, perioperative medicine, sleep, and respiratory medicine. Further research is urgently needed as we look to improve health outcomes for these patients and reduce health care costs. There is currently insufficient evidence to guide screening and optimization of OSA and OHS in the perioperative setting to achieve these objectives. Patients who are at greatest risk of respiratory or cardiac complications related to OSA and OHS are not well defined, and the effectiveness of monitoring and other interventions remains to be determined. Centers involved in sleep research need to develop collaborative networks to allow multicenter studies to address the knowledge gaps identified below.

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Stimulating therapy for obstructive sleep apnoea

Cited by 11 publications

References 20 publications

Preface for the 3rd Clinical Update Sleep, 23rd February 2018, Royal College of Physicians, London, UK: year in review

Preface for the 3rd Clinical Update Sleep, 23rd February 2018, Royal College of Physicians, London, UK: year in review

Excessive Daytime Sleepiness in Obstructive Sleep Apnea. Mechanisms and Clinical Management

Knowledge Gaps in the Perioperative Management of Adults with Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome. An Official American Thoracic Society Workshop Report

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