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Author: Nico de Vries
Publisher: Thieme
ISBN: 3132403660
Category : Medical
Languages : en
Pages : 442
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Book Description
The definitive resource on the innovative use of DISE for obstructive sleep apnea Obstructive sleep apnea is the most prevalent sleep-related breathing disorder, impacting an estimated 1.36 billion people worldwide. In the past, OSA was almost exclusively treated with Continuous Positive Airway Pressure (CPAP), however, dynamic assessment of upper airway obstruction with Drug-Induced Sleep Endoscopy (DISE) has been instrumental in developing efficacious alternatives. Drug-Induced Sleep Endoscopy: Diagnostic and Therapeutic Applications by Nico de Vries, Ottavio Piccin, Olivier Vanderveken, and Claudio Vicini is the first textbook on DISE written by world-renowned sleep medicine pioneers. Twenty-four chapters feature contributions from an impressive group of multidisciplinary international experts. Foundational chapters encompass indications, contraindications, informed consent, organization and logistics, patient preparation, and drugs used in DISE. Subsequent chapters focus on treatment outcomes, the role of DISE in therapeutic decision making and upper airway stimulation, pediatric sleep endoscopy, craniofacial syndromes, advanced techniques, and more. Key Highlights Comprehensive video library highlights common and rare DISE findings A full spectrum of sleep disordered breathing and OSA topics, from historic to future perspectives Insightful clinical pearls on preventing errors and managing complications including concentric and epiglottis collapse Discussion of controversial DISE applications including oral appliances and positional and combination therapies This unique book is essential reading for otolaryngology residents, fellows, and surgeons. Clinicians in other specialties involved in sleep medicine will also benefit from this reference, including pulmonologists, neurologists, neurophysiologists, maxillofacial surgeons, and anesthesiologists.
Author: Dan Jonas
Publisher:
ISBN:
Category :
Languages : en
Pages : 370
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Book Description
PURPOSE: To systematically review the evidence on screening and treating asymptomatic adults or those with unrecognized symptoms for obstructive sleep apnea (OSA). DATA SOURCES: PubMed/MEDLINE, the Cochrane Library, EMBASE, and trial registries through October 2015; reference lists of retrieved articles; outside experts; and reviewers, with surveillance of the literature through October 5, 2016. STUDY SELECTION: Two investigators independently selected English-language studies using a priori criteria. Eligible studies included randomized, controlled trials (RCTs) of screening for or treatment of OSA, studies evaluating accuracy of screening questionnaires or clinical prediction tools in asymptomatic adults or persons with unrecognized symptoms of OSA, systematic reviews (and studies published after eligible systematic reviews) evaluating diagnostic accuracy or reliability of portable monitors (PMs), and prospective cohort studies (e1 year) evaluating the association between apnea-hypopnea index (AHI) and health outcomes among community-based participants that adjusted for potential confounding through multivariable analyses. DATA EXTRACTION: One investigator extracted data and a second checked accuracy. Two reviewers independently rated quality for all included studies using predefined criteria. DATA SYNTHESIS: We included 110 studies. No RCTs compared screening with no screening. The only screening approach for which we found two eligible studies reporting accuracy was the Multivariable Apnea Prediction (MVAP) score followed by home PM testing; for detecting severe OSA syndrome (OSAS) (AHI e30 and Epworth Sleepiness Scale [ESS] score >10), areas under the curve were 0.799 (95% confidence interval [CI], 0.777 to 0.822) and 0.833 (95% CI, 0.765 to 0.902). However, both studies oversampled high-risk participants and those with OSA and OSAS. Studies reporting accuracy of PMs for diagnostic testing of persons with suspected OSA found wide ranges for sensitivity and specificity (Type II monitors: 85% to 94% and 77% to 95%; Type III monitors: 49% to 92% and 79% to 95%; Type IV monitors: 7% to 100% and 15% to 100%, respectively, for polysomnography AHI e15). Data were limited by imprecision and inconsistency for Type IV monitors. We found sparse data on reliability of PMs. Our meta-analyses of RCTs found that continuous positive airway pressure (CPAP) effectively reduced AHI to normal or near-normal levels (weighted mean difference [WMD], -33.8 [95% CI, -42.0 to -25.6]; 13 trials; 543 participants), reduced excessive sleepiness as measured by the ESS (WMD, -2.0 [95% CI, -2.6 to -1.4]; 22 trials; 2,721 participants), reduced diurnal systolic blood pressure (WMD, -2.4 [95% CI, -3.9 to -0.9]; 15 trials; 1,190 participants), and reduced diurnal diastolic blood pressure (WMD, -1.3 [95% CI, -2.2 to -0.4]; 15 trials; 1,190 participants) compared with sham. Trial evidence for most health outcomes was too limited to make conclusions (e.g., mortality, cardiovascular events, motor vehicle accidents). However, our meta-analysis for sleep-related quality of life found a significant benefit for CPAP, albeit with a small effect size (Cohen's d, 0.28 [95% CI, 0.14 to 0.42]; 13 trials; 2,325 participants). The effect size was slightly greater among those with excessive sleepiness at baseline but still small (0.33 [95% CI, 0.17 to 0.50]). Mandibular advancement devices (MADs) and weight loss programs also reduced AHI and excessive sleepiness; effect sizes were generally smaller than those for CPAP. Reporting of harms was suboptimal. Common adverse effects of CPAP included oral or nasal dryness, eye or skin irritation, rash, epistaxis, and pain; common adverse effects of MADs included oral dryness, excess salivation, mucosal erosions, or pain (mucosal, dental, or jaw). Consistent evidence from prospective cohort studies supports the association between AHI and all-cause mortality; persons with severe OSA die at about twice the rate of controls (pooled hazard ratio [HR], 2.07 [95% CI, 1.48 to 2.91]; 5 studies; 11,003 participants). Risk of cardiovascular mortality was also increased (HRs from 2.9 [95% CI, 1.1 to 7.3] to 5.9 [95% CI, 2.6 to 13.3]). LIMITATIONS: Data on screening accuracy for the MVAP followed by home PM testing were limited by risk of spectrum bias, which may substantially overestimate the accuracy that would be achieved in the general population of asymptomatic adults (or those with unrecognized symptoms). We found no studies that prospectively evaluated screening questionnaires or clinical prediction tools to report calibration or clinical utility for improving health outcomes. Treatment studies did not focus on screen-detected, asymptomatic patients (or those with unrecognized symptoms). Reporting on harms was scant; no studies evaluated overdiagnosis, overtreatment, or psychosocial harms (e.g., anxiety, labeling). CONCLUSIONS: There is uncertainty about the clinical utility of all potential screening tools. Although screening with MVAP followed by home PM testing may have promise for distinguishing persons in the general population who are more or less likely to have OSA, current evidence is limited. Multiple treatments for OSA reduce AHI, ESS, and blood pressure. Although good evidence has established that persons with severe OSA die at twice the rate of controls, trials of CPAP and other treatments have not established whether treatment reduces mortality or improves most other health outcomes, barring evidence of some possible benefit for sleep-related quality of life.
Author: Nico de Vries
Publisher: Thieme
ISBN: 3132403660
Category : Medical
Languages : en
Pages : 442
Get Book Here
Book Description
The definitive resource on the innovative use of DISE for obstructive sleep apnea Obstructive sleep apnea is the most prevalent sleep-related breathing disorder, impacting an estimated 1.36 billion people worldwide. In the past, OSA was almost exclusively treated with Continuous Positive Airway Pressure (CPAP), however, dynamic assessment of upper airway obstruction with Drug-Induced Sleep Endoscopy (DISE) has been instrumental in developing efficacious alternatives. Drug-Induced Sleep Endoscopy: Diagnostic and Therapeutic Applications by Nico de Vries, Ottavio Piccin, Olivier Vanderveken, and Claudio Vicini is the first textbook on DISE written by world-renowned sleep medicine pioneers. Twenty-four chapters feature contributions from an impressive group of multidisciplinary international experts. Foundational chapters encompass indications, contraindications, informed consent, organization and logistics, patient preparation, and drugs used in DISE. Subsequent chapters focus on treatment outcomes, the role of DISE in therapeutic decision making and upper airway stimulation, pediatric sleep endoscopy, craniofacial syndromes, advanced techniques, and more. Key Highlights Comprehensive video library highlights common and rare DISE findings A full spectrum of sleep disordered breathing and OSA topics, from historic to future perspectives Insightful clinical pearls on preventing errors and managing complications including concentric and epiglottis collapse Discussion of controversial DISE applications including oral appliances and positional and combination therapies This unique book is essential reading for otolaryngology residents, fellows, and surgeons. Clinicians in other specialties involved in sleep medicine will also benefit from this reference, including pulmonologists, neurologists, neurophysiologists, maxillofacial surgeons, and anesthesiologists.
Author: Song Tar Toh
Publisher: Elsevier Health Sciences
ISBN: 0323655319
Category : Medical
Languages : en
Pages :
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Book Description
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;
Author: Cynthia Feltner
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Book Description
PURPOSE: To systematically review the evidence on screening and treating asymptomatic adults with obstructive sleep apnea (OSA) or those with unrecognized symptoms for OSA. DATA SOURCES: PubMed/MEDLINE, the Cochrane Library, Embase, and trial registries through August 23, 2021; reference lists of retrieved articles; outside experts; and reviewers, with surveillance of the literature through September 23, 2022. STUDY SELECTION: Two investigators independently selected English-language studies using a priori criteria. Eligible studies included randomized, controlled trials (RCTs) of screening for or treatment of OSA reporting on health outcomes, studies evaluating accuracy of screening questionnaires or clinical prediction tools in asymptomatic adults with OSA or persons with unrecognized symptoms of OSA, and systematic reviews of treatment reporting on changes in blood pressure (BP) and apnea-hypopnea index (AHI) scores. DATA EXTRACTION: One investigator extracted data and a second checked accuracy. Two reviewers independently rated data quality for all included studies using predefined criteria. DATA SYNTHESIS: No reviewed RCT directly compared screening with no screening. In two studies (702 total participants), the screening accuracy measured as AUC of the Multivariable Apnea Prediction (MVAP) score followed by unattended home sleep testing for detecting severe OSA syndrome (AHI ≥30 and Epworth Sleepiness Scale [ESS] score >10) was 0.80 (95% confidence interval [CI], 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90), respectively. Studies evaluating the Snoring, Tiredness, Observed apnea, blood Pressure, Body mass index, Age, Neck circumference, Gender (STOP-BANG) Questionnaire (k=4) and the Berlin Questionnaire (BQ) (k=2) enrolled different populations and used different criteria for a positive screening test. Recent systematic reviews of positive airway pressure (PAP) and mandibular advancement devices (MADs) show an association between PAP and MAD and reduction in BP and AHI, however reduction in BP outcomes versus inactive control is relatively small (2 to 3 mm Hg). Meta-analysis found that PAP compared with any control was associated with a significantly larger reduction in ESS score change (pooled mean difference, −2.33 [95% CI, −2.75 to −1.90]; 47 trials, 7,024 participants), modest improvement in sleep-related quality of life (QOL) (standardized mean difference, 0.30 [95% CI, 0.19 to 0.42]; 18 trials, 3,083 participants), and improved general health-related QOL measured by the SF-36 mental health component summary score change (2.20 [95% CI, 0.95 to 3.44]; 15 trials, 2,345 participants) and SF-36 physical health component summary score change (pooled mean difference, 1.53 [95% CI, 0.29 to 2.77]; 13 trials, 2,031 participants). Meta-analysis also found that use of MADs was associated with a significantly larger ESS score change than controls (pooled mean difference, −1.67 [95% CI, −2.09 to −1.25]; 10 trials, 1,540 participants). Reporting of other health outcomes was sparse; no included trial found significant benefit associated with PAP or MAD on mortality, cardiovascular outcomes, stroke, or motor vehicle accidents. Common adverse effects of PAP and MADs included oral or nasal dryness, irritation, and pain, among others. LIMITATIONS: Two studies assessing the accuracy of the MVAP score oversampled participants at high risk of OSA and those with OSA syndrome. No study prospectively evaluated screening tools to report calibration or clinical utility for improving health outcomes. Three studies assessing the accuracy of the STOP-BANG and two assessing the BQ enrolled different populations and used different criteria for positive screening tests. Most included trials assessing the benefit of PAP and MADs reported outcomes over a relatively short duration (12 weeks or less), and most pooled estimates showing improvement in excessive sleepiness or QOL (except benefit of PAP for improving ESS scores) fell short of the range considered to be a minimal clinically important difference. Populations enrolled in trials of treatment were referred for treatment; no trial enrolled populations who were identified by screening in primary care. CONCLUSIONS: The accuracy and clinical utility of potential screening tools for OSA that could be used in primary care settings are uncertain. PAP and MADs reduce AHI, BP and ESS score. Trials of PAP have not established whether treatment reduces mortality or improves most other health outcomes, except for its modest improvement in sleep-related QOL and general health-related QOL.
Author: Clete A. Kushida
Publisher: CRC Press
ISBN: 142006181X
Category : Medical
Languages : en
Pages : 960
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Book Description
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
Author: Dan Jonas
Publisher:
ISBN:
Category : Sleep apnea syndromes
Languages : en
Pages : 0
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Book Description
PURPOSE: To systematically review the evidence on screening and treating asymptomatic adults or those with unrecognized symptoms for obstructive sleep apnea (OSA). DATA SOURCES: PubMed/MEDLINE, the Cochrane Library, EMBASE, and trial registries through October 2015; reference lists of retrieved articles; outside experts; and reviewers, with surveillance of the literature through October 5, 2016. STUDY SELECTION: Two investigators independently selected English-language studies using a priori criteria. Eligible studies included randomized, controlled trials (RCTs) of screening for or treatment of OSA, studies evaluating accuracy of screening questionnaires or clinical prediction tools in asymptomatic adults or persons with unrecognized symptoms of OSA, systematic reviews (and studies published after eligible systematic reviews) evaluating diagnostic accuracy or reliability of portable monitors (PMs), and prospective cohort studies (e1 year) evaluating the association between apnea-hypopnea index (AHI) and health outcomes among community-based participants that adjusted for potential confounding through multivariable analyses. DATA EXTRACTION: One investigator extracted data and a second checked accuracy. Two reviewers independently rated quality for all included studies using predefined criteria. DATA SYNTHESIS: We included 110 studies. No RCTs compared screening with no screening. The only screening approach for which we found two eligible studies reporting accuracy was the Multivariable Apnea Prediction (MVAP) score followed by home PM testing; for detecting severe OSA syndrome (OSAS) (AHI e30 and Epworth Sleepiness Scale [ESS] score >10), areas under the curve were 0.799 (95% confidence interval [CI], 0.777 to 0.822) and 0.833 (95% CI, 0.765 to 0.902). However, both studies oversampled high-risk participants and those with OSA and OSAS. Studies reporting accuracy of PMs for diagnostic testing of persons with suspected OSA found wide ranges for sensitivity and specificity (Type II monitors: 85% to 94% and 77% to 95%; Type III monitors: 49% to 92% and 79% to 95%; Type IV monitors: 7% to 100% and 15% to 100%, respectively, for polysomnography AHI e15). Data were limited by imprecision and inconsistency for Type IV monitors. We found sparse data on reliability of PMs. Our meta-analyses of RCTs found that continuous positive airway pressure (CPAP) effectively reduced AHI to normal or near-normal levels (weighted mean difference [WMD], -33.8 [95% CI, -42.0 to -25.6]; 13 trials; 543 participants), reduced excessive sleepiness as measured by the ESS (WMD, -2.0 [95% CI, -2.6 to -1.4]; 22 trials; 2,721 participants), reduced diurnal systolic blood pressure (WMD, -2.4 [95% CI, -3.9 to -0.9]; 15 trials; 1,190 participants), and reduced diurnal diastolic blood pressure (WMD, -1.3 [95% CI, -2.2 to -0.4]; 15 trials; 1,190 participants) compared with sham. Trial evidence for most health outcomes was too limited to make conclusions (e.g., mortality, cardiovascular events, motor vehicle accidents). However, our meta-analysis for sleep-related quality of life found a significant benefit for CPAP, albeit with a small effect size (Cohen's d, 0.28 [95% CI, 0.14 to 0.42]; 13 trials; 2,325 participants). The effect size was slightly greater among those with excessive sleepiness at baseline but still small (0.33 [95% CI, 0.17 to 0.50]). Mandibular advancement devices (MADs) and weight loss programs also reduced AHI and excessive sleepiness; effect sizes were generally smaller than those for CPAP. Reporting of harms was suboptimal. Common adverse effects of CPAP included oral or nasal dryness, eye or skin irritation, rash, epistaxis, and pain; common adverse effects of MADs included oral dryness, excess salivation, mucosal erosions, or pain (mucosal, dental, or jaw). Consistent evidence from prospective cohort studies supports the association between AHI and all-cause mortality; persons with severe OSA die at about twice the rate of controls (pooled hazard ratio [HR], 2.07 [95% CI, 1.48 to 2.91]; 5 studies; 11,003 participants). Risk of cardiovascular mortality was also increased (HRs from 2.9 [95% CI, 1.1 to 7.3] to 5.9 [95% CI, 2.6 to 13.3]). LIMITATIONS: Data on screening accuracy for the MVAP followed by home PM testing were limited by risk of spectrum bias, which may substantially overestimate the accuracy that would be achieved in the general population of asymptomatic adults (or those with unrecognized symptoms). We found no studies that prospectively evaluated screening questionnaires or clinical prediction tools to report calibration or clinical utility for improving health outcomes. Treatment studies did not focus on screen-detected, asymptomatic patients (or those with unrecognized symptoms). Reporting on harms was scant; no studies evaluated overdiagnosis, overtreatment, or psychosocial harms (e.g., anxiety, labeling). CONCLUSIONS: There is uncertainty about the clinical utility of all potential screening tools. Although screening with MVAP followed by home PM testing may have promise for distinguishing persons in the general population who are more or less likely to have OSA, current evidence is limited. Multiple treatments for OSA reduce AHI, ESS, and blood pressure. Although good evidence has established that persons with severe OSA die at twice the rate of controls, trials of CPAP and other treatments have not established whether treatment reduces mortality or improves most other health outcomes, barring evidence of some possible benefit for sleep-related quality of life.
Author: Ferran Barbé
Publisher: European Respiratory Society
ISBN: 1849840601
Category : Medical
Languages : en
Pages : 342
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Book Description
Obstructive sleep apnoea (OSA) is a common and progressive chronic disease. It is responsible for a high number of comorbidities and is linked with increased mortality, including a rise in the rate of sudden cardiac death. It is widely acknowledged that OSA now affects millions of people worldwide. This Monograph considers this high-impact condition from four different perspectives: pathogenesis; at-risk populations; clinical scenarios; and treatment and management. Comprehensive and up-to-date chapters provide the reader with a concise overview of OSA, making this book a useful reference for pulmonologists concerned with the management of this disease.
Author: Kristi Thornton
Publisher:
ISBN:
Category : Primary care (Medicine)
Languages : en
Pages : 158
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Book Description
Author: Ki Beom Kim
Publisher: Springer Nature
ISBN: 3030541460
Category : Medical
Languages : en
Pages : 646
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Book Description
This book provides comprehensive information on the etiology, pathophysiology, medical implications, diagnosis, and surgical and nonsurgical treatment of obstructive sleep apnea (OSA). Divided into five parts, the book begins with principles and fundamentals of OSA and its diagnostic considerations. Subsequent parts then address non-surgical management, surgical management, and maxillomandibular advancements for OSA. Chapters seek to approach this common disorder from the viewpoint of multiple specialties, thereby promoting the development of a broad strategy for the evaluation and management of OSA patients that draws on each of them. An invaluable reference, Management of Obstructive Sleep Apnea: An Evidence-Based, Multidisciplinary Textbook meets the needs of advanced dental and medical students, orthodontic, maxillofacial, ENT, neurology, and plastic surgery residents, and sleep medicine and pulmonary physicians.
Author: Azmeh Shahid
Publisher: Springer Science & Business Media
ISBN: 1441998926
Category : Medical
Languages : en
Pages : 403
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Book Description
There are at least four reasons why a sleep clinician should be familiar with rating scales that evaluate different facets of sleep. First, the use of scales facilitates a quick and accurate assessment of a complex clinical problem. In three or four minutes (the time to review ten standard scales), a clinician can come to a broad understanding of the patient in question. For example, a selection of scales might indicate that an individual is sleepy but not fatigued; lacking alertness with no insomnia; presenting with no symptoms of narcolepsy or restless legs but showing clear features of apnea; exhibiting depression and a history of significant alcohol problems. This information can be used to direct the consultation to those issues perceived as most relevant, and can even provide a springboard for explaining the benefits of certain treatment approaches or the potential corollaries of allowing the status quo to continue. Second, rating scales can provide a clinician with an enhanced vocabulary or language, improving his or her understanding of each patient. In the case of the sleep specialist, a scale can help him to distinguish fatigue from sleepiness in a patient, or elucidate the differences between sleepiness and alertness (which is not merely the inverse of the former). Sleep scales are developed by researchers and clinicians who have spent years in their field, carefully honing their preferred methods for assessing certain brain states or characteristic features of a condition. Thus, scales provide clinicians with a repertoire of questions, allowing them to draw upon the extensive experience of their colleagues when attempting to tease apart nuanced problems. Third, some scales are helpful for tracking a patient’s progress. A particular patient may not remember how alert he felt on a series of different stimulant medications. Scale assessments administered periodically over the course of treatment provide an objective record of the intervention, allowing the clinician to examine and possibly reassess her approach to the patient. Finally, for individuals conducting a double-blind crossover trial or a straightforward clinical practice audit, those who are interested in research will find that their own clinics become a source of great discovery. Scales provide standardized measures that allow colleagues across cities and countries to coordinate their practices. They enable the replication of previous studies and facilitate the organization and dissemination of new research in a way that is accessible and rapid. As the emphasis placed on evidence-based care grows, a clinician’s ability to assess his or her own practice and its relation to the wider medical community becomes invaluable. Scales make this kind of standardization possible, just as they enable the research efforts that help to formulate those standards. The majority of Rating Scales in Sleep and Sleep Disorders:100 Scales for Clinical Practice is devoted to briefly discussing individual scales. When possible, an example of the scale is provided so that readers may gain a sense of the instrument’s content. Groundbreaking and the first of its kind to conceptualize and organize the essential scales used in sleep medicine, Rating Scales in Sleep and Sleep Disorders:100 Scales for Clinical Practice is an invaluable resource for all clinicians and researchers interested in sleep disorders.
