Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Oct 2014
Review Comparative StudyNoncontinuous positive airway pressure therapies for obstructive sleep apnea.
While continuous positive airway pressure is the first-line treatment for obstructive sleep apnea, many patients find this form of therapy undesirable leading to treatment nonadherence. Both mandibular advancement devices and surgical therapy offer alternative solutions for such patients. This article serves to compare the types of surgical interventions and mandibular advancement devices available, their mechanisms of action, and expected side effects. ⋯ Patient-centered outcomes of sleepiness, quality of life, treatment preference, adherence, and their effects on disease-related outcomes of hypertension are summarized. When available, comparative effectiveness trials between these therapies versus continuous positive airway pressure are emphasized. Patient selection criteria, practice parameters, and treatment limitations are discussed.
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Semin Respir Crit Care Med · Oct 2014
ReviewAmbulatory management strategies for obstructive sleep apnea.
The prevalence of obstructive sleep apnea (OSA) has been steadily rising over recent decades and patient access to laboratory-based sleep services and specialist consultations have become increasingly limited, resulting in potential delays in treatment. As a result, there has been growing interest in the use of non-sleep laboratory methods for diagnosing and managing OSA, including the use of screening questionnaires, portable sleep monitoring devices, and home autotitrating continuous positive airway pressure. ⋯ In this review, we compare the different types of home monitoring devices, discuss the limitations of portable monitoring compared with full laboratory polysomnography, and summarize the results from published comparative effectiveness studies which have evaluated ambulatory models of care for the management of OSA. We also consider how future models of care that may be needed to deal with the burden of disease will evolve and some of the issues that prevent the translation of such models of care in many countries.
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Semin Respir Crit Care Med · Oct 2014
ReviewDiagnosis and management of obstructive sleep apnea in the perioperative setting.
Obstructive sleep apnea (OSA) is a chronic prevalent condition which may be under-recognized in surgical populations. Patients with OSA may be at increased perioperative risk, in part due to the effects sedatives and anesthetics have on upper airway tone and respiratory drive. ⋯ Several screening tools have been developed to identify patients at risk for OSA preoperatively, but it remains to be seen whether routine implementation of these tools improves outcomes. In this review, we discuss the perioperative complications of OSA, the tools with which physicians can screen surgical patients, and the perioperative management of these patients.
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Semin Respir Crit Care Med · Oct 2014
ReviewObstructive sleep apnea: role of intermittent hypoxia and inflammation.
Obstructive sleep apnea results in intermittent hypoxia via repetitive upper airway obstruction leading to partial or complete upper airway closure, apneas and hypopneas, respectively. Intermittent hypoxia leads to sympathetic nervous system activation and oxidative stress with a resultant systemic inflammatory cascade. The putative mechanism by which obstructive sleep apnea has been linked to numerous pathologic conditions including stoke, cardiovascular disease, hypertension, and metabolic derangements is through these systemic effects. Treatment of obstructive sleep apnea appears to reduce systemic markers of inflammation and ameliorates the adverse sequelae of this disease.
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Semin Respir Crit Care Med · Oct 2014
A telemedicine program for diagnosis and management of sleep-disordered breathing: the fast-track for sleep apnea tele-sleep program.
The objective of this study was to facilitate access to sleep health care for veterans. We designed and implemented a Telehealth program for diagnosing and treating sleep-related breathing disorders (SRBDs). Building on our ongoing out-of-laboratory "Fast Track for Sleep Apnea" program, procedures were modified to accommodate remote operations. ⋯ Over the past year, we have updated and refined our procedures to optimize program performance and efficiency. To achieve the next step, that is, increasing program scale beyond its current state (e.g., to region-wide), we will need to further develop and formalize quality control indicators to more efficiently monitor operations. The program has helped relieve clinical load at the central sleep program, improved local access to sleep care for veterans, and improved patient satisfaction with health care for SRBDs.