1.
[Obstructive sleep apnoea].
Thoonsen, H, van der Zeijden, J, Hoogeboom, PN, Copper, MP, Schure, PJCM, Teunissen, LL
Nederlands tijdschrift voor geneeskunde. 2019
Abstract
Obstructive sleep apnoea Obstructive sleep apnoea (OSA) is a complex condition with many different phenotypes. Historically, OSA has been defined using the apnoea-hypopnoea index (AHI). However, because there is no clear relationship between the AHI and the severity of symptoms and comorbidities the degree of hypoxia is increasingly being used to define OSA severity. To reach a diagnosis of obstructive sleep apnoea syndrome (OSAS), it has to be shown that symptoms improve with therapy. The treatment of first choice for patients with severe OSA is continuous positive airway pressure (CPAP) therapy. The indication for other therapies depends upon the patient's characteristics and preferences. Treatment with a position trainer and implantation of a hypoglossal nerve stimulator are relatively new therapies. OSA is a cardiovascular risk factor, but the effect of OSA treatment on cardiovascular outcome measures and mortality has not been shown in clinical trials.
2.
The Impact of Obstructive Sleep Apnea and Positive Airway Pressure Therapy on Metabolic Peptides Regulating Appetite, Food Intake, Energy Homeostasis, and Systemic Inflammation: A Literature Review.
Mashaqi, S, Badr, MS
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2019;(7):1037-1050
Abstract
INTRODUCTION Sleep-related breathing disorders are very common and highly associated with many comorbid diseases. They have many metabolic consequences that impact appetite, energy expenditure, and systemic inflammation. These consequences are mediated through peptides (eg, ghrelin, leptin, adiponectin, resistin, apelin, obestatin, and neuropeptide Y). METHODS We searched the literature (PubMed) for sleep-disordered breathing (SDB) and metabolic peptides and included 15, 22, 14, 4 and 2 articles for ghrelin, leptin, adiponectin, resistin, and apelin respectively. RESULTS Our review of the published literature suggests that leptin levels seem to correlate with body mass index and adiposity rather than obstructive sleep apnea. Conversely, levels of adiponectin and ghrelin are influenced by obstructive sleep apnea alone. Finally, resistin and apelin seem to be not correlated with obstructive sleep apnea. Regarding positive airway pressure (PAP) impact, it seems that PAP therapy affected the levels of these peptides (mainly ghrelin). CONCLUSIONS There is significant controversy in the literature regarding the impact of SDB and PAP therapy on these metabolic peptides. This could be due to the lack of randomized clinical trials and the variability of the methodology used in these studies. Further research is needed to assess the impact of SDB and PAP therapy on the levels of these peptides and whether this impact is also related to body mass index and body fat composition.
3.
Noninvasive positive pressure ventilation: effect on mortality in acute cardiogenic pulmonary edema: a pragmatic meta-analysis.
Potts, JM
Polskie Archiwum Medycyny Wewnetrznej. 2009;(6):349-53
Abstract
INTRODUCTION In contrast to a series of recent meta-analyses (MAs), the 3CPO (Three Interventions in Cardiogenic Pulmonary Oedema) randomized controlled trial (RCT) reported in 2008 did not find a significant mortality benefit of noninvasive positive pressure ventilation (NPPV) in acute cardiogenic pulmonary edema (ACPE). OBJECTIVES This paper combines data collected in the 3CPO trial together with data from recent MAs and calculates a revised risk ratio for NPPV in ACPE. Reasons for the discrepancy in mortality estimates are identified and discussed through contrasting the methodology and results of the 3CPO trial with previous RCTs. PATIENTS AND METHODS Patients included adults with ACPE secondary to a variety of insults such as hypertension, acute coronary syndromes, dietary indiscretion, arrhythmias and valvular lesions and assessed by clinical parameters (respiratory rate, crackles, oxygen saturation) and chest radiograph. Data was collected from MAs published after 2005 and their respective RCTs. As opinions regarding RCTs worthy of inclusion in the analyses were varied, 3 sets of RCTs were combined with the 3CPO data. The first set of data duplicated the RCTs chosen in the Cochrane; the second set, a comprehensive set, included all RCTs cited in any of the MAs reviewed; and the third set, a high quality RCT set, assessed data from only those RCTs included in at least 4 out of the 5 MAs reviewed. Data were analyzed with both fixed and variable effect modes using Revman software. RESULTS All combinations of RCTs and modes of analysis predict a significant mortality benefit. The combined data predicts a risk ratio for mortality using NPPV of 0.75 (95% CI: 0.61-0.92). CONCLUSIONS An analysis of the existing RCT data, inclusive of the 3CPO trial, predicts a continued and significant mortality benefit of NPPV in ACPE.
4.
Obstructive sleep apnoea syndrome: current status.
Berg, S
The clinical respiratory journal. 2008;(4):197-201
Abstract
INTRODUCTION Obstructive sleep apnoea syndrome (OSAS) is a prevalent condition that covaries with cardiovascular complications and most likely with arterial hypertension and diabetes mellitus. OBJECTIVE The present paper is a review of the current status of OSAS. RESULTS Definitions and diagnostic criteria as well as known risk factors, prevalence, symptoms, covariance with other diseases and consequences as traffic accidents are described. OSAS is characterised by daytime sleepiness symptoms that range from mild to severe. Risk factors such as anatomical upper airway abnormalities, overweight, smoking, excessive alcohol intake and use of muscle relaxants are related to the development of sleep apnoea. Various diagnostic procedures and treatment modalities are considered. Overnight polysomnography is the reference standard for sleep apnoea recording. Treatment modalities include mechanical [continuous positive airway pressure (CPAP), oral appliances], surgical, pharmacological and 'conservative' lifestyle modifications. Finally, Nordic accreditation guidelines for sleep medicine clinics and sleep medicine specialists are described. CONCLUSION The diagnosis of OSAS should be performed with a polygraph, and the first-line treatment of moderate to severe OSAS is CPAP. Lastly, compliance for this treatment should be optimised with regular clinical controls.