Sleep Apnea: Difference between revisions
Irena Tran (talk | contribs) No edit summary |
Irena Tran (talk | contribs) No edit summary |
||
| Line 41: | Line 41: | ||
Healthcare practitioners have utilized a variety of methods to treat individuals with OSA due to upper airway obstruction, including: weight reduction, sleep positioning, pharmacological treatments, oral appliances (OA), and upper air reconstructive or bypass surgeries.<ref name="Management">Epstein L, Kristo D, Strollo Jr. P, Friedman N, Malhotra A, Patil S, et al. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults. Journal of Clinical Sleep Medication 2009; 5(3): 263-276. http://pharexmedics.com/wp-content/uploads/2015/11/sleepapnea_ebook.pdf (accessed 3 April 2016).</ref> Weight reduction via diet and exercise have shown to be beneficial, but it is not as effective when used by itself.<ref name="Management" /> Positional maneuvers can be used to adjust sleeping position and avoid laying in supine with the help of positional devices, such as pillows.<ref name="Management" /> The sleeping position can help increase airway size and opening.<ref name="Management" /> Pharmacological interventions are not the ideal method for treatment of OSA, but topical nasal corticosteroids have been shown to be useful adjuncts to other OSA interventions.<ref name="Management" /><sup> </sup> | Healthcare practitioners have utilized a variety of methods to treat individuals with OSA due to upper airway obstruction, including: weight reduction, sleep positioning, pharmacological treatments, oral appliances (OA), and upper air reconstructive or bypass surgeries.<ref name="Management">Epstein L, Kristo D, Strollo Jr. P, Friedman N, Malhotra A, Patil S, et al. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults. Journal of Clinical Sleep Medication 2009; 5(3): 263-276. http://pharexmedics.com/wp-content/uploads/2015/11/sleepapnea_ebook.pdf (accessed 3 April 2016).</ref> Weight reduction via diet and exercise have shown to be beneficial, but it is not as effective when used by itself.<ref name="Management" /> Positional maneuvers can be used to adjust sleeping position and avoid laying in supine with the help of positional devices, such as pillows.<ref name="Management" /> The sleeping position can help increase airway size and opening.<ref name="Management" /> Pharmacological interventions are not the ideal method for treatment of OSA, but topical nasal corticosteroids have been shown to be useful adjuncts to other OSA interventions.<ref name="Management" /><sup> </sup> | ||
Dental appliances that can be used for treatment are mandibular repositioning appliances (MRA) and tongue retaining devices (TRD).<ref name="Management" /> MRA holds the mandible in an advanced position, and the TRD holds the tongue in a forward position, both in an attempt to avoid blockage of the upper airways while sleeping.<ref name="Management" /> These oral appliances (OA) can be used for those with mild to moderate OSA, those who did not benefit from CPAP, and those who prefer OA.<ref name="Management" /> Positive airway pressure (PAP) is a common method of treatment for mild, moderate, and severe OSA.<ref name="Management" /> PAP provides pneumatic splinting to maintain the opening of the upper airway and effectively decreases AHI (Apnea Hypopnea Index), which is the number of apnea or hypopnea episodes per hour of sleep.<ref name="Management" />,<ref name="AHI">Healthy Sleep Med Harvard. Understanding the Results | Sleep Apnea. http://healthysleep.med.harvard.edu/sleep-apnea/diagnosing-osa/understanding-results (accessed 3 April 2016)</ref> Normal AHI is less than 5 per hour.<ref name="AHI" /> PAP can be provided in several ways: continuous (CPAP) (BPAP), and autotitrating (APAP) and via three interfaces: nasal, oral, or nasoral.<ref name="Management" /><sup> </sup> | Dental appliances that can be used for treatment are mandibular repositioning appliances (MRA) and tongue retaining devices (TRD).<ref name="Management" /> MRA holds the mandible in an advanced position, and the TRD holds the tongue in a forward position, both in an attempt to avoid blockage of the upper airways while sleeping.<ref name="Management" /> These oral appliances (OA) can be used for those with mild to moderate OSA, those who did not benefit from CPAP, and those who prefer OA.<ref name="Management" /> Positive airway pressure (PAP) is a common method of treatment for mild, moderate, and severe OSA.<ref name="Management" /> PAP provides pneumatic splinting to maintain the opening of the upper airway and effectively decreases AHI (Apnea Hypopnea Index), which is the number of apnea or hypopnea episodes per hour of sleep.<ref name="Management" />,<ref name="AHI">Healthy Sleep Med Harvard Edu. Understanding the Results | Sleep Apnea. http://healthysleep.med.harvard.edu/sleep-apnea/diagnosing-osa/understanding-results (accessed 3 April 2016)</ref> Normal AHI is less than 5 per hour.<ref name="AHI" /> PAP can be provided in several ways: continuous (CPAP) (BPAP), and autotitrating (APAP) and via three interfaces: nasal, oral, or nasoral.<ref name="Management" /><sup> </sup> | ||
<sup></sup><sup></sup><sup></sup>There are also surgical interventions to improve passages via nasal, oral, oropharyngeal, nasopharyngeal, hypopharyngeal, laryngeal, and global airways.<ref name="Management" /> Surgeries are beneficial for those with severely obstructive anatomy and unsuccessful treatments with CPAPs or OAs.<ref name="Management" />These methods have shown varying degrees of success, so there is no consistent best treatment plan for all, but the combination of several of these therapies have proved to be effective.<ref name="Management" /><br> | <sup></sup><sup></sup><sup></sup>There are also surgical interventions to improve passages via nasal, oral, oropharyngeal, nasopharyngeal, hypopharyngeal, laryngeal, and global airways.<ref name="Management" /> Surgeries are beneficial for those with severely obstructive anatomy and unsuccessful treatments with CPAPs or OAs.<ref name="Management" />These methods have shown varying degrees of success, so there is no consistent best treatment plan for all, but the combination of several of these therapies have proved to be effective.<ref name="Management" /><br> | ||
Revision as of 23:41, 3 April 2016
Original Editors - Ylice Bridges and Irena Tran
Top Contributors - Irena Tran, Ylice Bridges, Lucinda hampton, Venugopal Pawar, Kim Jackson, 127.0.0.1, Elaine Lonnemann, WikiSysop, Adam Vallely Farrell, Lilian Ashraf and Admin
Definition/Description[edit | edit source]
add text here
Prevalence[edit | edit source]
Studies have shown that OSA appears to be more prevalent (2.5x increase) in the African-American population than the Caucasian population while the correlations of risk factors and OSA have been stronger between different races.[1] For example, a study had shown a stronger correlation between BMI in younger individuals and OSA in the Caucasian population than the African-American population.[1]Population-based studies have also shown that men have a 2-3x increased risk of developing OSA than women as well as the fact that a women's risk of OSA increases during pregnancy.[1] Additionally, several studies have indicated that OSA can occur in childhood and adolescence, but is more common after mid-age (40-60 years old).[1] However, it has been found that after the age of 65, the occurrence of OSA plateaus, and it is unclear as to whether this is due to an "increase in mortality rate from OSA or a remission of OSA with aging."[1](p1221) Studies have also shown that genetics may play a factor in the likelihood of developing OSA.[2] Individuals with first-degree relatives who have OSA are 1.5-2 times more likely to have OSA, and genetics may also play a role in the craniofacial morphology and prescence of conditions that affect these structures.[2] OSA has also been found to be common in individuals who spend long periods of time sitting and driving, such as commercial trunk drivers.[3]
Characteristics/Clinical Presentation[edit | edit source]
add text here
Associated Co-morbidities[edit | edit source]
It has been shown that individuals with Hypertension (HTN) had a higher incidence of OSA as well as the possibility of a causal relationship between HTN and OSA where treatment of OSA had lead to a decrease in HTN, specifically with middle-aged individuals.[4] Obesity has also been found to be commonly associated with OSA in which the excessive body weight affects the individual's breathing ability via increasing the amount of adipose around the airway structures, and the overall body.[1][2] Those with congested heart failure (CHF), Type II Diabetes, pulmonary hypertension, and stroke have also been found to be at higher risk for OSA.[3]
Medications[edit | edit source]
add text here
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
add text here
Etiology/Causes[edit | edit source]
add text here
Systemic Involvement[edit | edit source]
add text here
Medical Management (current best evidence)[edit | edit source]
Healthcare practitioners have utilized a variety of methods to treat individuals with OSA due to upper airway obstruction, including: weight reduction, sleep positioning, pharmacological treatments, oral appliances (OA), and upper air reconstructive or bypass surgeries.[3] Weight reduction via diet and exercise have shown to be beneficial, but it is not as effective when used by itself.[3] Positional maneuvers can be used to adjust sleeping position and avoid laying in supine with the help of positional devices, such as pillows.[3] The sleeping position can help increase airway size and opening.[3] Pharmacological interventions are not the ideal method for treatment of OSA, but topical nasal corticosteroids have been shown to be useful adjuncts to other OSA interventions.[3]
Dental appliances that can be used for treatment are mandibular repositioning appliances (MRA) and tongue retaining devices (TRD).[3] MRA holds the mandible in an advanced position, and the TRD holds the tongue in a forward position, both in an attempt to avoid blockage of the upper airways while sleeping.[3] These oral appliances (OA) can be used for those with mild to moderate OSA, those who did not benefit from CPAP, and those who prefer OA.[3] Positive airway pressure (PAP) is a common method of treatment for mild, moderate, and severe OSA.[3] PAP provides pneumatic splinting to maintain the opening of the upper airway and effectively decreases AHI (Apnea Hypopnea Index), which is the number of apnea or hypopnea episodes per hour of sleep.[3],[5] Normal AHI is less than 5 per hour.[5] PAP can be provided in several ways: continuous (CPAP) (BPAP), and autotitrating (APAP) and via three interfaces: nasal, oral, or nasoral.[3]
There are also surgical interventions to improve passages via nasal, oral, oropharyngeal, nasopharyngeal, hypopharyngeal, laryngeal, and global airways.[3] Surgeries are beneficial for those with severely obstructive anatomy and unsuccessful treatments with CPAPs or OAs.[3]These methods have shown varying degrees of success, so there is no consistent best treatment plan for all, but the combination of several of these therapies have proved to be effective.[3]
There is a new treatment option, the insertion of the Hypoglossal Nerve-Stimulating System (HGNS), that is currently being studied.[6] The Hypoglossal Nerve is the cranial nerve that innervates the tongue, especially the genioglossus muscle, and it plays a large role in maintaining airway patency.[6] Specifically, the genioglossus "protrudes the tongue, dilates the pharynx, and mitigates airflow obstruction during sleep."[6](p337)The study focused on HGNS via submental transcutaneous stimulation, direct fine wire stimulation, and direct hypoglossal stimulation.[6]Studies showed that submental transcutaneous stimulation aroused patients from sleep without clear improvements in the "airflow dynamics," but it is now being re-evaluated for the potential use of "prolonged, low-intensity transcutaneous stimulation" to increase lingual muscle tone and improve airway patency.[6](p338) In regards to the use of direct fine wire stimulation, it produced effective contractions of the genioglossus that improved pharyngeal patency as shown with and without simultaneous contractions of the lingual muslces.[6] Finally, the use of direct hypoglossal stimulation via implantation of "hypoglossal cuff electrodes" around the proximal and distal nerve trunk was able to increase pharyngeal patency and decrease pharyngeal collapsibility without arousing the patients.[6](p338) The implanted cuff electrodes had to be manually applied during sleep, but with the significant findings from the studies, there are currently "efforts to develop a fully implantable therapeutic HGNS system."[6](p338)
Physical Therapy Management (current best evidence)[edit | edit source]
add text here
Differential Diagnosis[edit | edit source]
add text here
Case Reports/ Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Recent Related Research (from Pubmed)[edit | edit source]
Failed to load RSS feed from http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1FQ_Hz0ueKYwijOqRSpDrvKPkj7DwaSTRhFksqCUpgE17Q9Y3H|charset=UTF-8|short|max=10: Error parsing XML for RSS
References[edit | edit source]
see adding references tutorial.
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Young T, Peppard P, Gottlieb D. Epidemiology of Obstructive Sleep Apnea. Am J Respir Crit Care Med 2002;165(9):1217-1239. http://www.atsjournals.org/doi/full/10.1164/rccm.2109080#.Vu73OZMrKYU (accessed 20 March 2016).
- ↑ 2.0 2.1 2.2 Lam J, Sharma S, Lam B. Obstructive sleep apnea: Definitions, epidemiology & natural history. Indian J Med Res 2010;131:165-170. http://pharexmedics.com/wp-content/uploads/2015/11/sleepapnea_ebook.pdf (accessed 3 April 2016).
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 Epstein L, Kristo D, Strollo Jr. P, Friedman N, Malhotra A, Patil S, et al. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults. Journal of Clinical Sleep Medication 2009; 5(3): 263-276. http://pharexmedics.com/wp-content/uploads/2015/11/sleepapnea_ebook.pdf (accessed 3 April 2016).
- ↑ Nieto F, Young T, Lind B, Shahar E, Samet J, Redline S, et al. Association of Sleep-Disordered Breathing, Sleep Apnea, and Hypertension in a Large Community-Based Study. JAMA 2000; 283(14): 1829-1836. http://jama.jamanetwork.com/article.aspx?articleid=192578&amp;amp;resultclick=1 (accessed 20 March 2016).
- ↑ 5.0 5.1 Healthy Sleep Med Harvard Edu. Understanding the Results | Sleep Apnea. http://healthysleep.med.harvard.edu/sleep-apnea/diagnosing-osa/understanding-results (accessed 3 April 2016)
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 Schwartz A, Smith P, Oliven A. Electrical stimulation of the hypoglossal nerve: a potential therapy. Journal of Applied Physiology 2013;116(3):337-344. http://jap.physiology.org/content/116/3/337.full (accessed 3 April 2016).
