Sleep medicine
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Randomized Controlled Trial Clinical Trial
A prospective 8 week trial of nasal interfaces vs. a novel oral interface (Oracle) for treatment of obstructive sleep apnea hypopnea syndrome.
To compare efficacy, compliance rates, and side effects of a new strapless oral interface, the Oracle, with available nasal masks over 8 weeks of use for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). ⋯ Oral delivery of CPAP with the Oracle is an effective and suitable alternative for patients with OSAHS.
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(a) To determine if self-reported diabetes mellitus is independently associated with sleep-disordered breathing (SDB); (b) to determine if diabetes mellitus is specifically associated with central sleep apnea including periodic breathing (Cheyne-Stokes breathing pattern) during sleep. ⋯ The authors concluded that diabetes mellitus is associated with sleep apnea but that this association is largely explained by risk factors in common for both disorders, most notably obesity. After adjusting for confounding factors there was no difference between diabetic and non-diabetic participants with regard to obstructive events. However, even after adjusting for potential confounders, there was a greater prevalence of periodic breathing in diabetic subjects. Although not reaching statistical significance, there was a suggestion of an increased prevalence of central events in the diabetic population, particularly when the sample included participants with known CVD. The investigators believed it unlikely that the findings were attributable to underlying congestive heart failure in as much as the diabetic subjects without prevalent CVD exhibited increased prevalence of periodic breathing and possibly increased central events. The authors proposed that diabetes mellitus might be a cause of SDB, mediated through autonomic neuropathy that may alter ventilatory control mechanisms. In this context, the authors commented that autonomic neuropathy may cause perturbations in ventilatory control by altering chemoreceptor gain or altering cardiovascular function (although the authors discounted underlying congestive heart failure as an explanation for the higher prevalence of periodic breathing in diabetic participants). To reinforce their conclusions, the authors cited the literature indicating increased prevalence of sleep apnea in diabetic patients with autonomic dysfunction, as well as the association between Shy--Drager syndrome, in which autonomic insufficiency is a constitutive element, and central sleep apnea.