Publisher: Karger Medical and Scientific Publishers
Category: Health & Fitness
This book aims to provide a comprehensive and clear review of the current knowledge of the relationship between obstructive sleep apnea (OSA) and cardiovascular and metabolic diseases, a subject of concern to a wide range of specialists and general practitioners. Separate chapters describe: the definition, symptoms and sequelae of OSA, and the diagnostic strategies and treatment options for adults with OSA according to the American Academy of Sleep Medicine; pathogenic mechanisms, by which OSA may contribute to the development and progression of cardiovascular and metabolic disorders, including inflammation, oxidative stress and thrombosis; links between OSA and obesity, alterations in glucose metabolism, metabolic syndrome and liver injury; relationships between OSA, endothelial dysfunction, autonomic dysfunction and cardiovascular disorders, and the results of studies investigating the effect of treatment for OSA on the concomitant cardiovascular disease. Each chapter summarizes the essential information and is illustrated by tables and figures, which will aid the readers in their understanding of the complex systemic interactions involved in this disease.Reviewed by internationally recognized experts, this publication will be of benefit to clinicians and scientists in the fields of pulmonology, cardiology, endocrinology and neurology as well as to sleep specialists and general practitioners.
Author: U. S. Department of Health and Human Services
Obstructive sleep apnea (OSA) is a relatively common disorder in the U.S. that affects people of all ages, but is most prevalent among the middle-aged and elderly. Affected individuals experience repeated collapse and obstruction of the upper airway during sleep, which results in reduced airflow (hypopnea) or complete airflow cessation (apnea), oxygen desaturation, and arousals from sleep. Adverse clinical outcomes associated with OSA include: cardiovascular disease, hypertension, non-insulin-dependent diabetes, and increased likelihood of motor vehicle and other accidents due to daytime hypersomnolence. Studies estimate the prevalence of OSA at approximately 10 to 20% of middle-aged and older adults. Evidence also indicates that these rates are rising, likely due to increasing rates of obesity. Based on the considerable mortality and morbidity associated with it and its attendant comorbidities, OSA is an important public health issue. Complicating diagnosis and treatment, however, is the great degree of clinical uncertainty that exists regarding the condition, due in large part to inconsistencies in its definition. Ongoing debate surrounds what type and level of respiratory abnormality should be used to define the disorder as well as what is the most appropriate diagnostic method for its detection. In addition, there is no current established threshold level for the apnea-hypopnea index (AHI) that would indicate the need for treatment. By consensus, people with relatively few apnea or hypopnea events per hour (often less than 5 or less than 15) are not formally diagnosed with OSA. Also of concern are the high rates of perioperative and postoperative complications among OSA patients, as are the numbers of asymptomatic and symptomatic individuals who remain undiagnosed and untreated. Three main categories of outcomes of interest in comparative effectiveness research are clinical (or health) outcomes, intermediate or surrogate outcomes, and adverse events. Objective clinical outcomes relevant to patients with OSA include comorbidities found to be associated with untreated sleep apnea, primarily cardiovascular disease and non-insulin-dependent diabetes. In addition, mortality due to cardiovascular disease, diabetes, motor vehicle accidents, and other causes represent important adverse outcomes of OSA. Intermediate outcomes of interest in the management of patients with OSA include sleep study measures, blood pressure, and hemoglobin A1c. Key Questions that are clinically relevant for the diagnosis and treatment of OSA were developed with input from domain experts and other stakeholders and from comments received in response to public review. Key Questions: 1. How do different available tests compare in their ability to diagnose sleep apnea in adults with symptoms suggestive of disordered sleep? How do these tests compare in different subgroups of patients, based on: race, sex, body mass index, existing non-insulin dependent diabetes mellitus, existing cardiovascular disease, existing hypertension, clinical symptoms, previous stroke, or airway characteristics? 2. How does phased testing (screening tests or battery followed by full test) compare to full testing alone? 3. What is the effect of preoperative screening for sleep apnea on surgical outcomes? 4. In adults being screened for obstructive sleep apnea, what are the relationships between apnea-hypopnea index or oxygen desaturation index and other patient characteristics with respect to long-term clinical and functional outcomes? 5. What is the comparative effect of different treatments for obstructive sleep apnea in adults? 6. In obstructive sleep apnea patients prescribed nonsurgical treatments, what are the associations of pretreatment patient-level characteristics with treatment compliance? 7. What is the effect of interventions to improve compliance with device use (positive airway pressure, oral appliances, positional therapy) on clinical and intermediate outcomes?
Completely updated, this volume is a practical, authoritative guide to the diagnosis and management of sleep-related breathing disorders. This Third Edition provides a more comprehensive treatment approach, focusing on surgical treatment but recognizing the growing importance of medical management of snoring/sleep disorders. Noted experts in the fields of otolaryngology, head and neck surgery, pulmonology, and sleep medicine examine the pathophysiology of these disorders, their clinical presentations in adults and children, the diagnostic workup, and the latest and most effective drugs, devices, oral appliances, and surgical procedures. An in-depth discussion of patient selection and treatment decisions is also included.
Obstructive sleep apnea (OSA) is characterized by a narrowing and collapse of the upper airway during sleep. The prevalence of OSA is reported to be 15% in males and 5% in females. The major symptoms include snoring, unrefreshing sleep, excessive daytime sleepiness (EDS), lack of concentration, impaired memory, and lower quality of life. Aging, the male sex, and obesity are the main risk factors for OSA. Untreated OSA is associated with motor vehicle accidents, cardiovascular disease, stroke, hypertension, diabetes, cognitive dysfunction, and all-cause mortality. Given the range of clinical presentation, symptoms, and severity, recommending the most appropriate treatment for OSA patients can be challenging. To facilitate decision-making, CADTH conducted a health technology assessment (HTA) on the clinical effectiveness and costeffectiveness of interventions for the treatment of OSA in adults. Patient perspectives and experiences, ethical and implementation issues, and environmental factors related to therapy selection for OSA in adults were also considered in an evaluation of the appropriate use of OSA interventions.
Responding to the growing recognition of Obstructive Sleep Apnea (OSA) as a major medical condition and the emergence of exciting new therapies, this 2 volume source examines clinical features, characteristics, comorbidities, and impact of OSA on patient biological systems. Not to mention, diagnosis and treatment methods that include first-line and
As a follow-up to the overview of reviews conducted for Research Questions 1a and 1b in the main health technology assessment (HTA) protocol, and to address gaps within the published systematic review (SR) literature, an SR of relevant published primary studies on the clinical effectiveness, comparative clinical effectiveness, and safety of interventions for the treatment of obstructive sleep apnea (OSA) in adults will be conducted. Specifically, this SR will focus on addressing Research Questions 1a and 1b, in relation to certain combinations of interventions, comparators, and outcomes that are missing in the overview of reviews, as listed in Table 1.
The aim of this health technology assessment (HTA) was to assess the clinical effectiveness, cost-effectiveness, patient perspectives and experiences, ethical issues, implementation issues, and environmental impacts of positive airway pressure (PAP) devices, expiratory positive airway pressure (EPAP) valves, oral appliances (OAs), surgery, and lifestyle modifications for the treatment of OSA in adults.
Dental Management of Sleep Disorders focuses on the dentist’s role in treating patients with sleep problems, chiefly sleep disordered breathing and bruxism. A practical clinical book, Dental Management of Sleep Disorders highlights the background to these problems, discusses the dentist’s role in their diagnosis and treatment, and outlines clinical strategies and guidance. The book features a full discussion of the use of appliances, an overview of current treatment modalities, and investigates the relationship of sleep disorders to dental and orofacial causes.
The aim of this health technology assessment (HTA) is to assess the clinical effectiveness, cost-effectiveness, patient experiences and preferences, ethical issues, implementation issues, and environmental impacts of positive airway pressure (PAP) devices, oral appliances, surgical interventions, and lifestyle for the treatment of obstructive sleep apnea (OSA) in adults.
This issue of Sleep Medicine Clinics, edited by Song Tar Toh in collaboration with Consulting Editor, Teofilo Lee-Chiong, is devoted to the Preventing, Screening, and Treatments for Obstructive Sleep Apnea, beyond Positive Airway Pressure (PAP). Topics covered in this issue include: Prevention and Screening of Obstructive Sleep Apnea (OSA); Anatomical and Physiologic Considerations in Surgical Treatment for OSA; Medical and Surgical Options for Weight Management in OSA; Positional Therapy for OSA; Oral Appliances in Adults and Pediatrics; Myofunctional Therapy for OSA; Drug-induced Sleep Endoscopy in Treatment Options Selection; Establishing a Patent Nasal Passage in OSA; Palatal Surgery: From Ablation to Reconstruction; Volumetric Tongue Reduction Surgery in Clinical Practice; Transoral Robotic Surgery for OSA; Genioglossus Advancement and Hyoid Surgery; Maxillomandibular Rotational Advancement: Airway, Aesthetics, and Angle Considerations;
This issue of Sleep Medicine Clinics has been compiled by esteemed Consulting Editor, Teofilo Lee-Chiong, and brings together recent sleep medicine articles that will be useful for Primary Care Providers. Topics include: Internet-Delivered Cognitive Behavioral Therapy for Insomnia Tailoring Cognitive Behavioral Therapy for Insomnia for Patients with Chronic Insomnia; Prescription Drugs Used in Insomnia; Hypnotic Discontinuation in Chronic Insomnia; Evaluation of the Sleepy Patient Differential Diagnosis; Subjective and Objective Assessment of Hypersomnolence; Pharmacologic Management of Excessive Daytime Sleepiness; Nonpharmacologic Management of Excessive Daytime Sleepiness; Treatment of Obstructive Sleep Apnea Choosing the Best Positive Airway Pressure Device; Treatment of Obstructive Sleep Apnea Choosing the Best Interface; Treatment of Obstructive Sleep Apnea Achieving Adherence to Positive Airway Pressure Treatment and Dealing with Complications; Oral Appliances in the Management of Obstructive Sleep Apnea; Avoiding and Managing Oral Appliance Therapy Side Effects; Positional Therapy for Positional Obstructive Sleep Apnea; Pharmacologic and Nonpharmacologic Treatment of Restless Legs Syndrome; Drugs Used in Parasomnia; Drugs Used in Circadian Sleep-Wake Rhythm Disturbances; Sleep in the Aging Population; and Sleep, Health, and Society.