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Rodenstein, Daniel, Philippe Collard, and Geneviève Aubert. "OSA Treatment." Chest 107, no. 2 (February 1995): 584–85. http://dx.doi.org/10.1378/chest.107.2.584.
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Alsaeed, Suliman, Farraj Albalawi, Abdulrahman A. Alghulikah, Ghadah Aldakheel, and Bassam Alalola. "Treatment of Obstructive Sleep Apnea Using Oral Appliances in Saudi Arabia: Are We following the Guidelines?" Healthcare 10, no. 11 (November 6, 2022): 2220. http://dx.doi.org/10.3390/healthcare10112220.
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Background: This study aimed to assess sleep medicine physicians’ knowledge and attitudes toward the role of oral appliances (OAs) in managing obstructive sleep apnea (OSA) in Saudi Arabia. Methods: An online questionnaire was administered to the registered physicians practicing sleep medicine (otolaryngology, internal medicine, pulmonology, and family medicine) in Saudi Arabia. The questionnaire included 26 questions under five domains. All the collected data were analyzed using descriptive statistics and Chi-square tests. Results: One hundred sleep physicians (43% Saudi, 75% male) from Saudi Arabia participated in this study. Almost 43% of participants reported inadequate knowledge of the treatment of OSA patients using OAs. Half of the participants were unaware of how OAs work in managing OSA. Most physicians (62%) never referred the patient for treatment of OSA using OAs, whereas 4% referred at least one patient every month. The majority (60%) believed that there are barriers to referring a case for OA treatment, mainly the lack of knowledge of the suitable cases (60%) and the lack of qualified dentists in this area (43%). Conclusion: Most sleep physicians reported poor knowledge of OA indications and mechanism of use, with most never referring a case for OA therapy.
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Talmant, Jacques, Jean-Claude Talmant, Joël Deniaud, and Philippe Amat. "Etiological treatment of OSA." Journal of Dentofacial Anomalies and Orthodontics 12, no. 3 (September 2009): 72–76. http://dx.doi.org/10.1051/odfen/2009032.
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Loube, Maj Daniel I. "Treatment Algorithm for OSA." Chest 111, no. 2 (February 1997): 528. http://dx.doi.org/10.1378/chest.111.2.528.
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Hudgel, David W. "Treatment Algorithm for OSA." Chest 111, no. 2 (February 1997): 528–29. http://dx.doi.org/10.1378/chest.111.2.528-a.
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Fleury Curado, Thomaz, Arie Oliven, Luiz U. Sennes, Vsevolod Y. Polotsky, David Eisele, and Alan R. Schwartz. "Neurostimulation Treatment of OSA." Chest 154, no. 6 (December 2018): 1435–47. http://dx.doi.org/10.1016/j.chest.2018.08.1070.
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Charčiūnaitė, Karolina, Rasa Gauronskaitė, Goda Šlekytė, Edvardas Danila, and Rolandas Zablockis. "Evaluation of Obstructive Sleep Apnea Phenotypes Treatment Effectiveness." Medicina 57, no. 4 (April 1, 2021): 335. http://dx.doi.org/10.3390/medicina57040335.
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Background and Objective: Obstructive sleep apnea (OSA) is a heterogeneous chronic sleep associated disorder. A common apnea-hypopnea index (AHI)-focused approach to OSA severity evaluation is not sufficient enough to capture the extent of OSA related risks, it limits our understanding of disease pathogenesis and may contribute to a modest response to conventional treatment. In order to resolve the heterogeneity issue, OSA patients can be divided into more homogenous therapeutically and prognostically significant groups–phenotypes. An improved understanding of OSA phenotype relationship to treatment effectiveness is required. Thus, in this study several clinical OSA phenotypes are identified and compared by their treatment effectiveness. Methods and materials: Retrospective data analysis of 233 adult patients with OSA treated with continuous positive airway pressure (CPAP) was performed. Statistical analysis of data relating to demographic and anthropometric characteristics, symptoms, arterial blood gas test results, polysomnografic and respiratory polygraphic tests and treatment, treatment results was performed. Results: 3 phenotypes have been identified: “Position dependent (supine) OSA” (Positional OSA), “Severe OSA in obese patients” (Severe OSA) and “OSA and periodic limb movements (PLM)” (OSA and PLM). The highest count of responders to treatment with CPAP was in the OSA and PLM phenotype, followed by the Positional OSA phenotype. Treatment with CPAP, despite the highest mean pressure administered was the least effective among Severe OSA phenotype. Conclusions: Different OSA phenotypes vary significantly and lead to differences in response to treatment. Thus, treatment effectiveness depends on OSA phenotypes and treatment techniques other than CPAP may be needed. This emphasizes the importance of a more individualized approach when treating OSA.
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Colvonen, P. J., G. Rivera, M. Haller, and S. Norman. "0582 Examining OSA Screening and Treatment for Individuals on a PTSD and Alcohol Disorder Residential Treatment Unit." Sleep 43, Supplement_1 (April 2020): A223. http://dx.doi.org/10.1093/sleep/zsaa056.579.
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Abstract Introduction Obstructive sleep apnea (OSA) is highly co-occurring with both alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) and has been shown to interfere with both PTSD and AUD outcomes. However, OSA often goes undiagnosed and untreated in residential treatment facilities. Our study aimed to assess the feasibility of incorporating OSA screening and treatment onto a substance abuse residential rehabilitation treatment program (SARRTP). Further, we examine the relationship between adherence rates of CPAP on PTSD outcomes. Methods Participants were 35 consecutive veterans admitted to the SARRTP PTSD track who consented to screening. Veterans were on the unit for 4-6 weeks. OSA was diagnosed using Nox T3 recorders, a Type-3 portable OSA screener (using Apnea Hypopnea Index >= 5). Insomnia Severity Index and PTSD checklist were given at pre- and post-treatment. Results 64.7% of Veterans screened positive for OSA. 11.8% were previously diagnosed with OSA, but did not use a CPAP machine; 17.6% were previously diagnosed and were using a CPAP machine; and 35.3% were newly diagnosed with OSA. Individuals with untreated OSA had significantly more days drinking in the last 30 days (M = 21.17 days, SD = 11.41) compared to no OSA/Treated OSA group (M = 8.82 days, SD = 10.92). There was no difference in change in PCL scores from baseline to post-treatment by the no-OSA/high compliance group and the low compliance group. Conclusion Taken together, OSA screening on the unit was accepted by the participants, feasible, and effective in diagnosing OSA. OSA screening and treatment should be considered as necessary on SUD and PTSD units. We did not find that OSA adherence predicted change in PTSD score, this is most likely due to veterans receiving their CPAP late into their stay on the unit. Future studies will need to examine OSA treatment on long term treatment outcomes. Support: Support This work is supported by UCSD Academic Senate Grant and a Veterans Affairs RR&D CDA (1lK2Rx002120-01) to Peter Colvonen.
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Srivastava, Palak. "Treatment with Oral Appliances in Obstructive Sleep Apnea." Journal of Dentistry and Oral Epidemiology 1, no. 2 (December 10, 2021): 1–6. http://dx.doi.org/10.54289/jdoe2100108.
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Obstructive sleep apnea (OSA) is a disorder caused by a number of factors like an obstruction of the upper airway during sleep because of insufficient motor tone of the tongue and/or airway dilator muscles or inadequate growth of the maxillary jaw bone etc. Oral appliances (OAs) are commonly used as a non-invasive treatment for obstructive sleep apnea syndrome. The primary oral appliance (OA) used in obstructive sleep apnea (OSA) treatment is the mandibular advancement device (MAD). Tongue-retaining devices or tongue-stabilizing devices (TSDs) are a second type of OA, which displace the tongue anteriorly and may be customized or come in different stock sizes. This review article aims to examine the best in class on this particular subject of treatment of OSA with oral appliances, explaining acceptability of an appliance in patients on the basis of its construction and results, while providing enough cognizance regarding the diagnosis, management and causes of discontinuation.
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Gauthier, Luc, Fernanda Almeida, Patrick Arcache, Catherine Ashton-McGregor, David Côté, Helen Driver, Kathleen Ferguson, et al. "Position Paper by Canadian Dental Sleep Medicine Professionals Regarding the Role of Different Health Care Professionals in Managing Obstructive Sleep Apnea and Snoring with Oral Appliances." Canadian Respiratory Journal 19, no. 5 (2012): 307–9. http://dx.doi.org/10.1155/2012/631803.
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The present Canadian position paper contains recommendations for the management by dentists of sleep-disordered breathing in adults with the use of oral appliances (OAs) as a treatment option for snoring and obstructive sleep apnea (OSA). The recommendations are based on literature reviews and expert panel consensus. OAs offer an effective, first-line treatment option for patients with mild to moderate OSA who prefer an OA to continuous positive airway pressure (CPAP) therapy, or for severe OSA patients who cannot tolerate CPAP, are inappropriate candidates for CPAP or who have failed CPAP treatment attempts. The purpose of the present position paper is to guide interdisciplinary teamwork (sleep physicians and sleep dentists) and to clarify the role of each professional in the management of OA therapy. The diagnosis of OSA should always be made by a physician, and OAs should be fitted by a qualified dentist who is trained and experienced in dental sleep medicine. Follow-up assessment by the referring physician and polysomnography or sleep studies are required to verify treatment efficacy. The present article emphasizes the need for a team approach to OA therapy and provides treatment guidelines for dentists trained in dental sleep medicine. Many of the dentists and sleep physicians who contributed to the preparation of the present article are members of the Canadian Sleep Society and the authors reached a consensus based on the current literature.
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Narmada, Ida Bagus, Ervina R. Winoto, and Ailsa Marvalodya Hakim. "Orthodontic Interceptive Treatment on Obstructive Sleep Apnea Cases." Indonesian Journal of Dental Medicine 5, no. 1 (June 23, 2022): 12–17. http://dx.doi.org/10.20473/ijdm.v5i1.2022.12-17.
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Background: Obstructive sleep apnea (OSA) is a breathing disorder that occurs during sleep and results in decreased or complete cessation of airflow despite attempts to breathe. Specific populations, such as children with certain craniofacial or other genetic syndromes and who are obese have a higher prevalence of OSA than the general population. Craniofacial abnormalities are one of the causes of OSA in the upper airway. Craniofacial morphologies that may predispose to OSA include retrognathia, anterior open bite, midface deficiency, and lower hyoid position. Therefore, interceptive orthodontic treatment in children is needed as one of the treatment options that can be chosen. Purpose: this study aimed to describe the interceptive orthodontic treatments and their effects on OSA cases in children. Review: Interceptive orthodontic treatment has various types depending on how the dentocraniofacial abnormality occurs. Orthodontic treatment aims to reduce the severity of OSA through maxillary and mandibular expansion, thereby increasing air space and airflow. Conclusion: Interceptive orthodontic treatment in pediatric OSA cases include; Rapid Maxillary Expansion, Twin-block, Propulsor Universal Light appliance, Planas appliance modified, Fränkel-II appliance, and BioAJustax oral appliance.
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Pavwoski, Patrick, and Anita Valanju Shelgikar. "Treatment options for obstructive sleep apnea." Neurology: Clinical Practice 7, no. 1 (November 10, 2016): 77–85. http://dx.doi.org/10.1212/cpj.0000000000000320.
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AbstractPurpose of review:Obstructive sleep apnea (OSA) is a global problem with implications for general health and quality of life, and is often encountered in patients with neurologic disease. This review outlines treatment modalities to consider for management of OSA in patients with neurologic disease.Recent findings:New advances in positive airway pressure (PAP) devices, oral appliances, and surgical interventions offer a wide range of treatment options for patients with OSA.Summary:PAP therapy remains the gold standard treatment for OSA. Other treatment modalities may be considered for OSA patients who decline or cannot tolerate PAP therapy. Some OSA patients may benefit from multimodal treatment.
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Amaddeo, A., L. Griffon, B. Thierry, V. Couloigner, A. Joly, E. Galliani, E. Arnaud, S. Khirani, and B. Fauroux. "Obstructive sleep apnea syndrome (OSA) in adolescents: therapeutic management." Journal of Dentofacial Anomalies and Orthodontics 21, no. 1 (January 2018): 107. http://dx.doi.org/10.1051/odfen/2018045.
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Obstructive sleep apnea (OSA) in adolescents is characterized by a predominance of OSA type 2 which is associated with overweight/obesity. The treatment of OSA in adolescents depends on the cause of OSA and its risk and / or precipitating factors. Adenotonsillectomy is the cornerstone of OSA treatment in case of hypertrophy of the adenoids and/or tonsils. An anti-inflammatory treatment has proven its efficacy in mild to moderate or mild residual OSA after adenotonsillectomy. Orthodontic treatments such as rapid maxillary expansion or jaw positioning are indicated in case of dentofacial disharmonies. Continuous positive airway pressure (CPAP), is mainly indicated in type-3 OSA, which is associated with craniofacial or upper airway malformations or anomalies and should be performed by a pediatric multidisciplinary team having an expertise in sleep and OSA. Finally, maxillofacial or craniofacial surgery may be indicated in adolescents with type-3 OSA. In conclusion, the treatment of OSA in adolescents is based on the type of OSA, its severity and the medical characteristics of each patient.
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Fleetham, John A. "OSA Treatment: To the Editor." Chest 107, no. 2 (February 1995): 585. http://dx.doi.org/10.1378/chest.107.2.585.
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Kaplan, Robert. "Obstructive Sleep Apnoea and Depression — Diagnostic and Treatment Implications." Australian & New Zealand Journal of Psychiatry 26, no. 4 (December 1992): 586–91. http://dx.doi.org/10.3109/00048679209072093.
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Sleep apnoea (OSA), a common sleep disorder, is well recognised as a cause of morbidity including psychiatric disorders. There is increasing recognition of the link between OSA and depression. Sleep changes are intrinsic to depressive disorders, most notably disturbances of REM sleep; OSA causes predominantly REM sleep disturbances. The neuro-vegetative features of depression are similar or identical to the symptoms of OSA — an issue which has not achieved wide clinical recognition. A growing number of studies confirm the statistical link between the two conditions. The implications are twofold: OSA needs to be excluded in cases of chronic or resistant depression and treatment of OSA will make it easier to treat the primary depressive disorder. A new method of treatment for OSA, the Sullivan continuous positive airway pump (CPAP), raises the theoretical possibility of treating depression by this means as well.
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Ponkia, Jenee. "Obstructive Sleep Apnea- treatment methods, patient adherence, and newer techniques." International Journal of Dentistry Research 6, no. 2 (July 25, 2021): 65–67. http://dx.doi.org/10.31254/dentistry.2021.6208.
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The prevalence of OSA has been found to be high in people of different ages with males higher than 50 years of age being highly affects. The aim of this review is to cover the information regarding the prevalence of OSA and the treatment modalities for the management of OSA. In this review, we consider the pros and cons of each treatment modality for OSA. The review article also describes the patient perspective of the OSA treatment meaning the patient compliance and patient adherence with OSA treatment methods. Treatment methods for OSA such as Continuous Positive Airway Pressure, oral appliances, and relatively newer treatment modalities such as mini-screw assisted rapid palatal expansion have been reviewed in detail in this article. High quality randomized trials with different treatment options are required so that clinicians can get adequate knowledge for treatment of patients with OSA.
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Martinovic, Dinko, Daria Tokic, Ema Puizina-Mladinic, Sanja Kadic, Antonella Lesin, Slaven Lupi-Ferandin, Marko Kumric, and Josko Bozic. "Oromaxillofacial Surgery: Both a Treatment and a Possible Cause of Obstructive Sleep Apnea—A Narrative Review." Life 13, no. 1 (January 4, 2023): 142. http://dx.doi.org/10.3390/life13010142.
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Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder. It is characterized by a nocturnal periodic decrease or complete stop in airflow due to partial or total collapse of the oropharyngeal tract. Surgical treatment of OSA is constantly evolving and improving, especially with the implementation of new technologies, and this is needed because of the very heterogeneous reasons for OSA due to the multiple sites of potential airway obstruction. Moreover, all of these surgical methods have advantages and disadvantages; hence, patients should be approached individually, and surgical therapies should be chosen carefully. Furthermore, while it is well-established that oromaxillofacial surgery (OMFS) provides various surgical modalities for treating OSA both in adults and children, a new aspect is emerging regarding the possibility that some of the surgeries from the OMFS domain are also causing OSA. The latest studies are suggesting that surgical treatment in the head and neck region for causes other than OSA could possibly have a major impact on the emergence of newly developed OSA, and this issue is still very scarcely mentioned in the literature. Both oncology, traumatology, and orthognathic surgeries could be potential risk factors for developing OSA. This is an important subject, and this review will focus on both the possibilities of OMFS treatments for OSA and on the OMFS treatments for other causes that could possibly be triggering OSA.
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Ji, Xuan, Jing Du, Jiaying Gu, Jie Yang, Li Cheng, Zhaofeng Li, Caiming Li, and Yan Hong. "Structure and Menthone Encapsulation of Corn Starch Modified by Octenyl Succinic Anhydride and Enzymatic Treatment." Journal of Food Quality 2022 (March 7, 2022): 1–10. http://dx.doi.org/10.1155/2022/4556827.
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In order to improve the ability of starch to absorb menthone, corn starch was modified by enzymatic treatment (amyloglucosidase and α-amylase) combined with octenyl succinic anhydride (OSA) esterification. The oil absorption rate of starch modified by enzymatic treatment followed by OSA (P-OSA) reached 101.33%, whereas that of samples with reverse action sequences (OSA-P) was only 59.67%. The degree of substitution of OSA-P was also generally lower than that of P-OSA. At high OSA addition, OSA-P had a smaller specific surface area with fewer pores because octenyl succinic (OS) groups impeded the enzymatic treatment. Compared with OSA-P, the lamellar structure of P-OSA is sparser and less ordered. Owing to its pores, P-OSA was beneficial for the reaction to occur inside the granules, which was observed by Raman spectroscopy and laser confocal microscopy. At high OSA addition, the loading of P-OSA to menthone could reach 64.34 mg/g.
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Tarone, Lidia, Katia Mareschi, Elisa Tirtei, Davide Giacobino, Mariateresa Camerino, Paolo Buracco, Emanuela Morello, Federica Cavallo, and Federica Riccardo. "Improving Osteosarcoma Treatment: Comparative Oncology in Action." Life 12, no. 12 (December 14, 2022): 2099. http://dx.doi.org/10.3390/life12122099.
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Osteosarcoma (OSA) is the most common pediatric malignant bone tumor. Although surgery together with neoadjuvant/adjuvant chemotherapy has improved survival for localized OSA, most patients develop recurrent/metastatic disease with a dismally poor outcome. Therapeutic options have not improved for these OSA patients in recent decades. As OSA is a rare and “orphan” tumor, with no distinct targetable driver antigens, the development of new efficient therapies is still an unmet and challenging clinical need. Appropriate animal models are therefore critical for advancement in the field. Despite the undoubted relevance of pre-clinical mouse models in cancer research, they present some intrinsic limitations that may be responsible for the low translational success of novel therapies from the pre-clinical setting to the clinic. From this context emerges the concept of comparative oncology, which has spurred the study of pet dogs as a uniquely valuable model of spontaneous OSA that develops in an immune-competent system with high biological and clinical similarities to corresponding human tumors, including in its metastatic behavior and resistance to conventional therapies. For these reasons, the translational power of studies conducted on OSA-bearing dogs has seen increasing recognition. The most recent and relevant veterinary investigations of novel combinatorial approaches, with a focus on immune-based strategies, that can most likely benefit both canine and human OSA patients have been summarized in this commentary.
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Puravath, F. M., T. Ash, R. Rottapel, C. Spadola, S. Bandana, M. Schonberg, S. Redline, and S. Bertisch. "0624 Voice of the Patient: A Patient-Centered Exploration of Factors Influencing Obstructive Sleep Apnea Care." Sleep 43, Supplement_1 (April 2020): A238—A239. http://dx.doi.org/10.1093/sleep/zsaa056.621.
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Abstract Introduction Despite widely available efficacious treatments for obstructive sleep apnea (OSA), patients commonly report frustration in accessing and adhering to treatments. Sparse research has explored factors influencing OSA care from the patient perspective, which may limit provision of patient-centered care: care responsive to patient preferences, needs, and values. To this end, we conducted qualitative research to identify factors, voiced by patients, that influence OSA treatment initiation and adherence. Methods We performed semi-structured interviews with 15 patients previously diagnosed with OSA from Boston, MA and a national patient portal (MyApnea.Org). Patients were asked about barriers and facilitators to their diagnosis and treatment as well as about their preferences and values that informed their treatment decisions. Interviews were audio-recorded and transcribed. A qualitative content analysis was performed to identify themes. After developing a codebook, interviews were coded. Codes were then audited and finalized by study team consensus. Results Our sample was aged 25-74 years; 71% identified as female. Among participants, 57.1% identified as White, 14.3% Black, 14.3% Asian, and 14.3% Other. Major themes were broadly classified as (1) facilitators (provision of useful information on treatment options, participation in shared decision-making, continued clinician support); (2) barriers (inconvenience of treatment, difficulty of habit formation, treatment side effects, competing comorbid conditions); (3) motivators (value of improving chronic health, family support, positive treatment effects); (4) contextual factors (insufficient knowledge/awareness of OSA, navigating healthcare systems, access to informational resources). Awareness of OSA symptoms and treatments, and ongoing support were cited as the most common factors influencing the patient experience. Conclusion This formative research highlights that diverse factors impact the OSA evaluation and treatment patient experience. Further research should test interventions that promote effective patient-centered care for OSA, such as shared decision-making tools. Support Brigham and Women’s Hospital Research Institute Patient-Centered Comparative Effectiveness Research Center Grant
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Murphy, Mark, John Remmers, and Erin Mosca. "0751 The use of a Digitally Milled Oral Appliance in the Treatment of Severe Obstructive Sleep Apnea." Sleep 45, Supplement_1 (May 25, 2022): A327—A328. http://dx.doi.org/10.1093/sleep/zsac079.747.
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Abstract Introduction Oral appliances (OAs) that advance the mandible are commonly used for the treatment of mild to moderate obstructive sleep apnea (OSA) but are less accepted as a therapy for severe OSA, likely due to their supposed lower rate of therapeutic success in that population. However, the preference for OAT over CPAP and relative lack of other non-surgical treatment options highlights the need for acceptance of OAT for all severities of OSA. Data from two prospective studies that collected data on OAT efficacy were analyzed retrospectively to evaluate the success rate of OAT in severe OSA using a digitally milled OA. Methods Data from the severe OSA cohorts of two studies conducted for the validation of an in-home auto-titration test were evaluated. Study participants (n = 41 with severe OSA) received a precision iterative advancement OA (ProSomnus Sleep Technologies, Pleasanton, CA). The OAs used in the studies were CAD/CAM generated from digital intraoral scans and precision milled from control cured grade PMMA. The OAs consisted of sets of upper and lower trays that, when interfaced together, allowed for advancement of the mandible to a treated position. Oral appliances were set to the target protrusion provided by an in-home auto-titration test that predicts response to OAT (MATRx plus; Zephyr Sleep Technologies, Calgary, Alberta, Canada). Participants not predicted to respond to OAT were assigned a sham mandibular protrusion. Oral appliance therapy was initiated at the target protrusive position, sham position, or highest tolerated position for individuals who were unable to have their OA inserted at target. Once participants were habituated to OAT, a 2-night home sleep apnea test (HSAT) was conducted to assess treatment efficaciousness, and the mandible was advanced as necessary to lower the respiratory event index (REI). Results The study population included 36 male and 5 female participants with a mean age of 50.6 ± 8.4 years (range: 32-74 years), mean BMI of 32.1 ± 5.5 kg/m2 (range: 19.8-45.4 kg/m2), mean baseline REI of 49.5 ± 17.1 h-1 (range: 30.3-101.8 h-1), and median Epworth Sleepiness Scale (ESS) score of 10 (range: 0-23). Oral appliance therapy was well-tolerated in the study population. The majority of study participants achieved some level of therapeutic success, with 73.2% of participants achieving a decrease in REI from baseline of at least 50% and 68.3% achieving an REI < 15 h-1. Of the study participants who achieved an REI < 15 h-1, the average protrusive position of the OA was 86.7±15.3% (range: 54.8-100%). Conclusion The OAs used in the studies provided efficacious treatment for the majority of individuals with severe OSA, indicating that oral appliance therapy could be a suitable alternative to CPAP. The rate of therapeutic success was higher than that reported previously in the literature and might be a result of the precision of appliances generated from digital intraoral scans using a CAD/CAM approach. Support (If Any) Study data were collected by and used with the permission of Zephyr Sleep Technologies. ProSomnus Sleep Technologies provided the OAs used in the studies.
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Bruyneel, Marie. "Telemedicine in the diagnosis and treatment of sleep apnoea." European Respiratory Review 28, no. 151 (March 14, 2019): 180093. http://dx.doi.org/10.1183/16000617.0093-2018.
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Telemedicine (TM) is a current tool in the landscape of medicine. It helps to address public health challenges such as increases in chronic disease in an ageing society and the associated burden in healthcare costs. Sleep TM refers to patient data exchange with the purpose of enhancing disease management. Obstructive sleep apnoea (OSA) syndrome is a chronic disorder associated with a significant morbidity, mainly cardiometabolic, and mortality. Obtaining adequate compliance to continuous positive airway pressure (CPAP) remains the greatest challenge related to OSA treatment, and the adoption of TM to support OSA management makes sense. In addition, the prevalence of OSA is growing and OSA is associated with increased healthcare costs that could be streamlined by the application of TM. In OSA, multiple modalities of TM are utilised, such as telediagnostics, teleconsultation, teletherapy and telemonitoring of patients being treated with CPAP. In the present article, I aim to provide an overview of current practice and the recent developments in TM for OSA management. Concerns related to TM use will also be addressed.
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Chen, Hsin-Yi, Yue-Cune Chang, Che-Chen Lin, Fung-Chang Sung, and Wen-Chi Chen. "Obstructive Sleep Apnea Patients Having Surgery Are Less Associated with Glaucoma." Journal of Ophthalmology 2014 (2014): 1–6. http://dx.doi.org/10.1155/2014/838912.
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Objective.To investigate if different treatment strategy of obstructive sleep apnea (OSA) was associated glaucoma risk in Taiwanese population.Methods.Population-based retrospective cohort study was conducted using data sourced from the Longitudinal Health Insurance Database 2000. We included 2528 OSA patients and randomly selected and matched 10112 subjects without OSA as the control cohort. The risk of glaucoma in OSA patients was investigated based on the managements of OSA (without treatment, with surgery, with continuous positive airway pressure (CPAP) treatment, and with multiple modalities). The multivariable Cox regression was used to estimate hazard ratio (HR) after adjusting for sex, age, hypertension, diabetes, hyperlipidemia, and coronary artery disease.Results.The adjusted HR of glaucoma for OSA patients was 1.88 (95% CI: 1.46–2.42), compared with controls. For patients without treatment, the adjusted HR was 2.15 (95% CI: 1.60–2.88). For patients with treatments, the adjusted HRs of glaucoma were not significantly different from controls, except for those with CPAP (adjusted HR = 1.65, 95% CI = 1.09–2.49).Conclusions.OSA is associated with an increased risk of glaucoma. However, surgery reduces slightly the glaucoma hazard for OSA patients.
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Gastelum, Erica, Marcus Cummins, Amitoj Singh, Michael Montoya, Gino Luis Urbano, and Mary Anne Tablizo. "Treatment Considerations for Obstructive Sleep Apnea in Pediatric Down Syndrome." Children 8, no. 11 (November 22, 2021): 1074. http://dx.doi.org/10.3390/children8111074.
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Children with Down syndrome (DS) are at high risk for developing obstructive sleep apnea (OSA) compared to children without DS. The negative impact of OSA on health, behavior, and cognitive development in children with DS highlights the importance of timely and effective treatment. Due to the higher prevalence of craniofacial and airway abnormalities, obesity, and hypotonia in patients with DS, residual OSA can still occur after exhausting first-line options. While treatment commonly includes adenotonsillectomy (AT) and continuous positive airway pressure (CPAP) therapy, additional therapy such as medical management and/or adjuvant surgical procedures need to be considered in refractory OSA. Given the significant comorbidities secondary to untreated OSA in children with DS, such as cardiovascular and neurobehavioral consequences, more robust randomized trials in this patient population are needed to produce treatment guidelines separate from those for the general pediatric population of otherwise healthy children with OSA. Further studies are also needed to look at desensitization and optimization of CPAP use in patients with DS and OSA.
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Salamah, Fahad Saleh Bin, Hiba Mohammed Al Alfayez, and Raghad Taha Melibary. "Diagnosis and treatment of obstructive sleep apnea." International Journal Of Community Medicine And Public Health 9, no. 2 (January 28, 2022): 987. http://dx.doi.org/10.18203/2394-6040.ijcmph20220016.
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Obstructive sleep apnea (OSA) has become a health issue of high prevalence. The prevalence is rising between 1990-2010 by approximately 30%, with absolute increases of 4.2% in women and 7.5% in men. This condition is characterized by a breathing disorder of partial or complete upper airway obstruction leading to increased resistance to airflow and potential cessation of breathing during sleep. Its multifactorial etiology Such etiologies involve obesity, craniofacial anatomy, and the use of stimulants and medications to reduce muscle tension. This review aims to summarize the recent diagnosis and treatment modalities of OSA. The database PubMed and google scholar were searched for relevant published records. A total of 39 articles were collected randomly limited to the English language. We placed no restrictions on the date of publication. Evidence from methodological studies indicate that undiagnosed OSA is associated with hypertension, cardiovascular disease, stroke, and daytime sleepiness. Thorough clinical and instrumental examinations should precede a proper diagnosis selection. The primary goal of treatment is reducing the Patient’s symptoms, depending on the severity of the patient’s condition. OSA can be treated in different ways, including behavioral therapy, medical device, surgery, and pharmacological therapies. There are limitations in dental school about education and training of OSA and oral appliances (OA). OSA teamwork must include both qualified sleep physicians and dentists. The Orthodontist plays a critical role in evaluating and treating OSA patients, choosing the right oral appliance, and assessing and adjusting the appliance.
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Pang, Kenny P., Raymond Tan, Puravi Puraviappan, and David J. Terris. "Anterior Palatoplasty for the Treatment of OSA." Otolaryngology–Head and Neck Surgery 141, no. 2 (August 2009): 253–56. http://dx.doi.org/10.1016/j.otohns.2009.04.020.
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OBJECTIVE: Review long-term results of the modified cautery-assisted palatoplasty (mod CAPSO)/anterior palatoplasty for the treatment of mild-moderate obstructive sleep apnea (OSA). STUDY DESIGN: Prospective series of 77 patients. All patients were >18 years old, type I Fujita, body mass index (BMI) < 33, Friedman clinical stage II, with apnea-hypopnea index (AHI) from 1.0 to 30.0. The mean follow-up time was 33.5 months. The procedure involved an anterior soft palatal advancement technique with or without removal of the tonsils. The procedure was done under general or local anesthesia. RESULTS: There were 69 men and eight women; the mean age was 39.3 years old; and mean BMI was 24.9 (range 20.7–26.8). There were 38 snorers and 39 OSA patients. The AHI improved in patients with OSA, 25.3 ± 12.6 to 11.0 ± 9.9 ( P < 0.05). The overall success rate for this OSA group was 71.8 percent (at mean 33.5 months). The mean snore scores (visual analog score) improved from 8.4 to 2.5 (for all 77 patients). Lowest oxygen saturation also improved in all OSA patients. Subjectively, all patients felt less tired. CONCLUSION: This technique has been shown to be effective in the management of patients with snoring and mild-moderate OSA.
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Fiz, J. A. F., J. Abad, J. Ruiz, M. Riera, J. Izquierdo, and J. Morera. "nCPAP treatment interruption in OSA patients." Respiratory Medicine 92, no. 1 (January 1998): 28–31. http://dx.doi.org/10.1016/s0954-6111(98)90028-2.
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Xia, Fen, and Mohamad Sawan. "Clinical and Research Solutions to Manage Obstructive Sleep Apnea: A Review." Sensors 21, no. 5 (March 4, 2021): 1784. http://dx.doi.org/10.3390/s21051784.
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Obstructive sleep apnea (OSA), a common sleep disorder disease, affects millions of people. Without appropriate treatment, this disease can provoke several health-related risks including stroke and sudden death. A variety of treatments have been introduced to relieve OSA. The main present clinical treatments and undertaken research activities to improve the success rate of OSA were covered in this paper. Additionally, guidelines on choosing a suitable treatment based on scientific evidence and objective comparison were provided. This review paper specifically elaborated the clinically offered managements as well as the research activities to better treat OSA. We analyzed the methodology of each diagnostic and treatment method, the success rate, and the economic burden on the world. This review paper provided an evidence-based comparison of each treatment to guide patients and physicians, but there are some limitations that would affect the comparison result. Future research should consider the consistent follow-up period and a sufficient number of samples. With the development of implantable medical devices, hypoglossal nerve stimulation systems will be designed to be smart and miniature and one of the potential upcoming research topics. The transcutaneous electrical stimulation as a non-invasive potential treatment would be further investigated in a clinical setting. Meanwhile, no treatment can cure OSA due to the complicated etiology. To maximize the treatment success of OSA, a multidisciplinary and integrated management would be considered in the future.
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White, Michelle, Elena Stuewe, Rajesh Zacharias, Aarti Grover, and Richard Wein. "461 Hypoglossal Nerve Stimulation: Effectiveness of Therapy for Treatment of Positional Obstructive Sleep Apnea." Sleep 44, Supplement_2 (May 1, 2021): A182. http://dx.doi.org/10.1093/sleep/zsab072.460.
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Abstract Introduction Hypoglossal nerve stimulation (HGNS) therapy is highly effective treatment for patients with moderate-severe obstructive sleep apnea (OSA). Positional OSA is considered when the apnea-hypopnea index (AHI) is at least twice as high in supine position compared with non-supine position. There are few studies in the literature investigating response to HGNS in patients with positional OSA. Methods Pre- and post-implant polysomnography (PSG) data was retrospectively reviewed in 46 patients who underwent HGNS at a large tertiary care center from November 2017 to March 2020. Supine and non-supine AHI were used to diagnose positional OSA on pre- and post-implant PSG. Pre-implant AHI was recorded from both in-lab PSG as well as home sleep tests, while post-implant AHI was based on in-lab hypoglossal nerve stimulator titration performed three months after device activation. Overall AHI pre- and post-implantation and absolute AHI reduction (pre-implant AHI – post-implant AHI) were evaluated. Basic demographic information including age, sex and BMI were also recorded. Results 25/46 patients (54%) were diagnosed with positional OSA on pre-implant PSG. Patients with positional OSA had lower pre-implant overall AHI than patients without positional OSA (AHI 29.6 and 38.9, respectively, p<0.05) and lower absolute AHI reduction than patients without positional OSA (18.2 and 26.7, respectively, p<0.05). There were no statistically significant differences in BMI and post-implant overall AHI between these groups. 19/25 patients (76%) with pre-implant positional OSA had persistent positional OSA on post-implant PSG. Conclusion Patients with positional OSA prior to HGNS had lower pre-implant overall AHI and absolute AHI reduction than patients without positional OSA. However, post-implant overall AHI was comparable, suggesting similar benefit in HGNS therapy regardless of positional OSA diagnosis. HGNS does not appear to resolve positional OSA, given that 76% of patients with positional OSA pre-implantation had persistent positional OSA post-implantation. Positional OSA after HGNS should be recognized in patients with persistent symptoms or inability to tolerate higher device amplitudes, and treatment with combination therapy with positional device can be considered. Support (if any):
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Libman, E., S. Bailes, C. S. Fichten, D. Rizzo, L. Creti, M. Baltzan, R. Grad, et al. "CPAP Treatment Adherence in Women with Obstructive Sleep Apnea." Sleep Disorders 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/2760650.
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Untreated obstructive sleep apnea (OSA) has numerous negative health-related consequences. Continuous positive airway pressure (CPAP) is generally considered the treatment of choice for OSA, but rates of nonadherence are high. It is believed that OSA is more prevalent among men; therefore understanding how OSA presents among women is limited and treatment adherence has received little research attention. For this study, 29 women were recruited from primary care offices. They completed a questionnaire battery and underwent a night of nocturnal polysomnography (PSG) followed by a visit with a sleep specialist. Women diagnosed with OSA were prescribed CPAP; 2 years later CPAP adherence was evaluated. Results show that approximately half the sample was adherent. There were no significant differences between adherent and nonadherent women on OSA severity; however CPAP adherent women had worse nocturnal and daytime functioning scores at the time of diagnosis. Moreover, when the seven nocturnal and daytime variables were used as predictors in a discriminant analysis, they could predict 87% of adherent and 93% of the nonadherent women. The single most important predictor was nonrefreshing sleep. We discuss the implications of the findings for identifying women in primary care with potential OSA and offer suggestions for enhancing treatment adherence.
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Duong-Quy, Sy, Hoang Nguyen-Huu, Dinh Hoang-Chau-Bao, Si Tran-Duc, Lien Nguyen-Thi-Hong, Thai Nguyen-Duy, Tram Tang-Thi-Thao, et al. "Personalized Medicine and Obstructive Sleep Apnea." Journal of Personalized Medicine 12, no. 12 (December 8, 2022): 2034. http://dx.doi.org/10.3390/jpm12122034.
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Obstructive sleep apnea (OSA) is a common disease that is often under-diagnosed and under-treated in all ages. This is due to differences in morphology, diversity in clinical phenotypes, and differences in diagnosis and treatment of OSA in children and adults, even among individuals of the same age. Therefore, a personalized medicine approach to diagnosis and treatment of OSA is necessary for physicians in clinical practice. In children and adults without serious underlying medical conditions, polysomnography at sleep labs may be an inappropriate and inconvenient testing modality compared to home sleep apnea testing. In addition, the apnea–hypopnea index should not be considered as a single parameter for making treatment decisions. Thus, the treatment of OSA should be personalized and based on individual tolerance to sleep-quality-related parameters measured by the microarousal index, harmful effects of OSA on the cardiovascular system related to severe hypoxia, and patients’ comorbidities. The current treatment options for OSA include lifestyle modification, continuous positive airway pressure (CPAP) therapy, oral appliance, surgery, and other alternative treatments. CPAP therapy has been recommended as a cornerstone treatment for moderate-to-severe OSA in adults. However, not all patients can afford or tolerate CPAP therapy. This narrative review seeks to describe the current concepts and relevant approaches towards personalized management of patients with OSA, according to pathophysiology, cluster analysis of clinical characteristics, adequate combined therapy, and the consideration of patients’ expectations.
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Panahi, Ladan, George Udeani, Steven Ho, Brett Knox, and Jason Maille. "Review of the Management of Obstructive Sleep Apnea and Pharmacological Symptom Management." Medicina 57, no. 11 (October 28, 2021): 1173. http://dx.doi.org/10.3390/medicina57111173.
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Nearly a billion adults around the world are affected by a disease that is characterized by upper airway collapse while sleeping called obstructive sleep apnea or OSA. The progression and lasting effects of untreated OSA include an increased risk of diabetes mellitus, hypertension, stroke, and heart failure. There is often a decrease in quality-of-life scores and an increased rate of mortality in these patients. The most common and effective treatments for OSA include continuous positive airway pressure (CPAP), surgical treatment, behavior modification, changes in lifestyle, and mandibular advancement devices. There are currently no pharmacological options approved for the standard treatment of OSA. There are, however, some pharmacological treatments for daytime sleepiness caused by OSA. Identifying and treating obstructive sleep apnea early is important to reduce the risks of future complications.
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Morrison, Krystal I., Deborah C. Beidel, and Amie R. Newins. "When Traumatic Memories Affect Your Health: A Clinical Case Study." Clinical Case Studies 19, no. 3 (March 20, 2020): 222–35. http://dx.doi.org/10.1177/1534650120912328.
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Obstructive sleep apnea hypopnea (OSA) is the most common breathing-related sleep disorder and affects more than 20% of older individuals. Furthermore, risk of OSA increases in postmenopausal women. OSA is effectively treated using continuous positive airway pressure (CPAP). However, Mary, a 74-year-old White woman with OSA, severe, refused to obtain a CPAP machine because the sound of the machine elicited memories of her late husband’s suicide. Intervention focused on reducing Mary’s fear of CPAP sounds. Treatment involved imaginal exposure, in vivo exposure, sleep hygiene strategies, and relaxation strategies. Although evidence-based treatments for OSA and trauma separately exist, there are no treatment protocols designed to address the specific combination of the conditions. Treatment gains included a reduction in trauma-related symptoms and an increase in CPAP compliance. Quantity and quality of patient’s sleep did not improve despite sleep hygiene and CPAP use. At 3-week follow-up, treatment gains and CPAP compliance were maintained.
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Kinoshita, L., E. Blank, M. Chen, K. Doudell, Y. Day, V. Alipio Jocson, L. Lazzeroni, et al. "0652 A Novel Cognitive-Behavioral Therapy to Increase PAP Adherence in Veterans With Posttraumatic Stress Disorder: Preliminary Results." Sleep 43, Supplement_1 (April 2020): A249. http://dx.doi.org/10.1093/sleep/zsaa056.648.
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Abstract Introduction The occurrence of obstructive sleep apnea (OSA) is high in veterans with posttraumatic stress disorder (PTSD). Our previous research on OSA in Vietnam-era veterans found that 69% had an AHI≥10 (Yesavage, 2012). Efficacious treatments are available for OSA, PAP therapy; however, veterans with OSA frequently fail to use them (Yesavage, 2012; Kuna, 2011). Of the veterans diagnosed with OSA, 63% were not using their prescribed PAP device. The reasons for low PAP adherence include discomfort using PAP and psychological barriers. We developed a novel cognitive-behavioral therapy (CBT) intervention to increase PAP adherence in veterans with PTSD and OSA, called CBT-OSA. Methods Participants included 37 veterans age 18+ from clinics at VA Palo Alto. Participants were randomly assigned to CBT-OSA or an education arm. All participants received treatment as usual in VA Pulmonary Service or a community-based Sleep Medicine Center. Participants in CBT-OSA received therapy from a Clinical Psychologist. The other veterans received education sessions. All participants received weekly, individual sessions during the first four weeks of PAP treatment. Average mask on time was calculated for each participant during week 1-4 of PAP use. Results An independent samples t-test was conducted to compare average mask on time in the CBT-OSA and education conditions. There was a significant difference in the average mask on time for CBT-OSA (M=235.33, SD=139.22) and education (M=136.68; SD=149.19); t(35)=-2.08, p=0.045. These results suggest that veterans who received the CBT treatment increased their PAP use compared to the veterans in the education condition. Conclusion CBT-OSA has shown early efficacy. CBT-OSA increased PAP adherence in veterans with PTSD compared to veterans in the education condition. Veterans receiving CBT-OSA demonstrated a longer average mask on time compared to veterans in the education condition. We are following the participants for one year to examine if CBT-OSA fosters long-term PAP adherence. Support This research is supported by the Research Service of the Department of Veterans Affairs (Grant Number 1I01RX001799-01A2).
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Friedman, Michael, Roee Landsberg, and Jessica Ascher-Landsberg. "Treatment of Hypoxemia in Obstructive Sleep Apnea." American Journal of Rhinology 15, no. 5 (September 2001): 311–13. http://dx.doi.org/10.1177/194589240101500505.
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Many patients suffering from obstructive sleep apnea (OSA) have intermittent oxygen desaturation associated with periods of apnea or hypopnea. Oxygen saturation levels below 90% are considered harmful.1 Usually, treatment is directed at correcting the apnea, which will in turn prevent hypoxemia. Unfortunately, many patients fail or are not candidates for nasal continuous positive airway pressure (CPAP) or surgical correction of their OSA. Forty-three patients with persistent OSA and nocturnal hypoxemia below 90% who were not candidates for additional surgical or CPAP therapy were treated with nocturnal oxygen supplementation. Standard symptoms associated with OSA and the Epworth Sleepiness Scale (ESS) were recorded before treatment and 30 days after the start of the treatment. In 21 patients, polysomnography studies were performed to compare the Respiratory Disturbance Index (RDI) score and minimum oxygen saturation levels when the patients were breathing room air or breathing 4 L/minute of oxygen by nasal cannula. Subjective symptoms of obstructive sleep apnea improved, and the ESS score significantly decreased after a 30-night treatment with oxygen. Split-night polysomnography showed a significant increase in minimum oxygen saturation during oxygen administration. The RDI did not significantly change with treatment. Oxygen administration for the correction of OSA-related nocturnal hypoxemia was both safe and effective in alleviation of OSA-related symptoms. It also appeared to have a beneficial effect on minimum oxygen saturation levels. Thus, oxygen therapy may be considered a treatment option in patients who fail to comply with CPAP and are not candidates for a surgical procedure.
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Sonsuwan, Nuntigar, Kongsak Rujimethabhas, and Kittisak Sawanyawisuth. "Factors Associated with Successful Treatment by Radiofrequency Treatment of the Soft Palate in Obstructive Sleep Apnea as the First-Line Treatment." Sleep Disorders 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/690425.
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Background. Radiofrequency ablation (RFA) is recommended as the second-line treatment for obstructive sleep apnea (OSA). This study aims to study the factors associated with successful treatment by RFA in OSA patients as the first-line treatment.Methods. All patients diagnosed as mild to moderate OSA were enrolled prospectively and treated with RFA. Three points of soft palate were ablated: midline, left, and right paramedian sites. Baseline characteristics and clinical factors including snoring score (SS), Epworth Sleepiness Scale (ESS), and apnea-hypopnea index (AHI), with minimal oxygen saturation, were recorded at baseline and three months after treatment.Results. During the study period, there were 51 patients who met the study criteria and received RFA treatment. At three months, the SS, ESS, and AHI were significantly lower than baseline values, while the minimal oxygenation was significantly increased from the baseline values. There were 16 patients (31.37%) who had an AHI of < 5 times/h. Only baseline AHI was significantly associated with an AHI of < 5 times/h at three months after RFA treatment. The adjusted odds ratio was 0.804 (95% CI: 0.699, 0.924).Conclusion. Transoral RFA treatment may be effective in mild to moderate OSA as the first-line treatment. Baseline AHI is associated with preferable outcome by RFA treatment.
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Bikova, O. V., L. M. Kusenkova, O. I. Maslova, and A. N. Boyko. "Acetazolamide in the treatment of sleep apnea m adults and childi en." "Arterial’naya Gipertenziya" ("Arterial Hypertension") 12, no. 4 (August 28, 2006): 365–68. http://dx.doi.org/10.18705/1607-419x-2006-12-4-365-368.
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Obstructive sleep apnea syndrome (OSA) is life-threatening condition in adults and children. Prevalence of OSA in adult and pediatric population is not well-established as not all patients have clear clinical picture. In Britain prevalence of OSA syndrome is comparable to asthma disease. Acetazolamide can cause metabolic acidosis, which can stimulate pulmonary ventilation and proposed to be effective in treatment of sleep breathing disturbances. Acetazolamide is widely used to therapeutic treatment of central OSA in adults and children. In adults administration of this drug can have problems of tolerance if administrated chronically. Alternatively, in children, OSA is usually transitory condition is early childhood what allow to treat it with acetazolamide effectively.
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Parolin, Matteo, Francesca Dassie, Luigi Alessio, Alexandra Wennberg, Marco Rossato, Roberto Vettor, Pietro Maffei, and Claudio Pagano. "Obstructive Sleep Apnea in Acromegaly and the Effect of Treatment: A Systematic Review and Meta-Analysis." Journal of Clinical Endocrinology & Metabolism 105, no. 3 (November 13, 2019): e23-e31. http://dx.doi.org/10.1210/clinem/dgz116.
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Abstract Background Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway collapse requiring nocturnal ventilatory assistance. Multiple studies have investigated the relationship between acromegaly and OSA, reporting discordant results. Aim To conduct a meta-analysis on the risk for OSA in acromegaly, and in particular to assess the role of disease activity and the effect of treatments. Methods and Study Selection A search through literature databases retrieved 21 articles for a total of 24 studies (n = 734). Selected outcomes were OSA prevalence and apnea-hypopnea index (AHI) in studies comparing acromegalic patients with active (ACT) vs inactive (INACT) disease and pretreatment and posttreatment measures. Factors used for moderator and meta-regression analysis included the percentage of patients with severe OSA, patient sex, age, body mass index, levels of insulin-like growth factor 1, disease duration and follow-up, and therapy. Results OSA prevalence was similar in patients with acromegaly who had ACT and INACT disease (ES = −0.16; 95% CI, −0.47 to 0.15; number of studies [k] = 10; P = 0.32). In addition, AHI was similar in ACT and INACT acromegaly patients (ES = −0.03; 95% CI, −0.49 to 0.43; k = 6; P = 0.89). When AHI was compared before and after treatment in patients with acromegaly (median follow-up of 6 months), a significant improvement was observed after treatment (ES = −0.36; 95% CI, −0.49 to −0.23; k = 10; P < 0.0001). In moderator analysis, the percentage of patients with severe OSA in the populations significantly influenced the difference in OSA prevalence (P = 0.038) and AHI (P = 0.04) in ACT vs INACT patients. Conclusion Prevalence of OSA and AHI is similar in ACT and INACT patients in cross-sectional studies. However, when AHI was measured longitudinally before and after treatment, a significant improvement was observed after treatment.
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Suarez-Giron, Monique, Maria R. Bonsignore, and Josep M. Montserrat. "New organisation for follow-up and assessment of treatment efficacy in sleep apnoea." European Respiratory Review 28, no. 153 (September 11, 2019): 190059. http://dx.doi.org/10.1183/16000617.0059-2019.
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Obstructive sleep apnoea (OSA) is a highly prevalent disease, and there is an increased demand for OSA diagnosis and treatment. However, resources are limited compared with the growing needs for OSA diagnosis and management, and alternative strategies need to be developed to optimise the OSA clinical pathway. In this review, we propose a management strategy for OSA, and in general for sleep-disordered breathing, to be implemented from diagnosis to follow-up. For this purpose, the best current options seem to be: 1) networking at different levels of care, from primary physicians to specialised sleep laboratories; and 2) use of telemedicine. Telemedicine can contribute to the improved cost-effectiveness of OSA management during both the diagnostic and therapeutic phases. However, although the technology is already in place and different commercial platforms are in use, it is still unclear how to use telemedicine effectively in the sleep field. Application of telemedicine for titration of positive airway pressure treatment, follow-up to improve compliance to treatment through early identification and solution of problems, and teleconsultation all appear to be promising areas for improved OSA management.
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Deacon-Diaz, Naomi Louise, Scott A. Sands, R. Doug McEvoy, and Peter G. Catcheside. "Daytime loop gain is elevated in obstructive sleep apnea but not reduced by CPAP treatment." Journal of Applied Physiology 125, no. 5 (November 1, 2018): 1490–97. http://dx.doi.org/10.1152/japplphysiol.00175.2018.
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Reduced ventilatory control stability (elevated loop gain) is a key nonanatomical, pathological trait contributing to obstructive sleep apnea (OSA), yet the mechanisms responsible remain unclear. We sought to identify the key factors contributing to elevated loop gain in OSA (controller vs. plant contributions) and to examine whether abnormalities in these factors persist after OSA treatment. In 15 males (8 OSA, 7 height, weight- and age -matched controls), we measured loop gain, controller gain, and plant gain using a pseudorandom binary CO2 stimulation method during wakefulness. Factors potentially influencing plant gain were also assessed (supine lung volume via helium dilution and spirometry). Measures were repeated 2 and 6 wk after initiating continuous positive airway pressure treatment. Loop gain (LG) was higher in OSA versus controls (LG at 1 cycle/min 0.28 ± 0.04 vs. 0.16 ± 0.04, P = 0.046, respectively), and the controller exhibited a greater peak response to CO2 and faster roll-off in OSA. OSA patients also exhibited reduced forced expiratory volume in the first second and forced vital capacity compared with controls (92.2 ± 1.7 vs. 102.9 ± 3.5% predicted, P = 0.021; 93.4 ± 3.1 vs. 106.6 ± 3.6% predicted, P = 0.015, respectively). There was no effect of treatment on any variable. These findings confirm loop gain is higher in untreated OSA patients than in matched controls; however, this was not affected by treatment. NEW & NOTEWORTHY Elevated loop gain contributes to obstructive sleep apnea (OSA) pathophysiology. However, whether loop gain is inherently elevated in OSA or induced by OSA itself, whether it is elevated due to increased chemoreflex sensitivity or obesity-dependent reduced lung volume, and whether it is treatment reversible, are all currently uncertain. This study found loop gain was elevated in OSA versus age-, sex-, height-, and weight-matched controls. However, this was not altered by 6-wk continuous positive airway pressure treatment.
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Urbano, Gino Luis, Bea Janine Tablizo, Youmna Moufarrej, Mary Anne Tablizo, Maida Lynn Chen, and Manisha Witmans. "The Link between Pediatric Obstructive Sleep Apnea (OSA) and Attention Deficit Hyperactivity Disorder (ADHD)." Children 8, no. 9 (September 19, 2021): 824. http://dx.doi.org/10.3390/children8090824.
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Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing that affects up to 9.5% of the pediatric population. Untreated OSA is associated with several complications, including neurobehavioral sequelae, growth and developmental delay, cardiovascular dysfunction, and insulin resistance. Attention-deficit/hyperactivity disorder (ADHD) is among the neurobehavioral sequelae associated with OSA. This review aims to summarize the research on the relationship between OSA and ADHD and investigate the impacts of OSA treatment on ADHD symptoms. A literature search was conducted on electronic databases with the key terms: “attention deficit hyperactivity disorder” or “ADHD”, “obstructive sleep apnea” or “OSA”, “sleep disordered breathing”, and “pediatric” or “children”. Review of relevant studies showed adenotonsillectomy to be effective in the short-term treatment of ADHD symptoms. The success of other treatment options, including continuous positive airway pressure (CPAP), in treating ADHD symptoms in pediatric OSA patients has not been adequately evaluated. Further studies are needed to evaluate the long-term benefits of surgical intervention, patient factors that may influence treatment success, and the potential benefits of other OSA treatment methods for pediatric ADHD patients.
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Gunta, Satya Preetham, Roopesh Sai Jakulla, Aamer Ubaid, Kareem Mohamed, Abid Bhat, Angel López-Candales, and Nicholas Norgard. "Obstructive Sleep Apnea and Cardiovascular Diseases: Sad Realities and Untold Truths regarding Care of Patients in 2022." Cardiovascular Therapeutics 2022 (August 11, 2022): 1–10. http://dx.doi.org/10.1155/2022/6006127.
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Obstructive sleep apnea (OSA) is one of the most common and serious sleep-related breathing disorders with a high prevalence among patients with cardiovascular (CV) diseases. Despite its widespread presence, OSA remains severely undiagnosed and untreated. CV mortality and morbidity are significantly increased in the presence of OSA as it is associated with an increased risk of resistant hypertension, heart failure, arrhythmias, and coronary artery disease. Evaluation and treatment of OSA should focus on recognizing patients at risk of developing OSA. The use of screening questionnaires should be routine, but a formal polysomnography sleep study is fundamental in establishing and classifying OSA. Recognition of OSA patients will allow for the institution of appropriate therapy that should alleviate OSA-related symptoms with the intent of decreasing adverse CV risk. In this review, we focus on the impact OSA has on CV disease and evaluate contemporary OSA treatments. Our goal is to heighten awareness among CV practitioners.
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Luo, Binyu, Yiwen Li, Mengmeng Zhu, Jing Cui, Yanfei Liu, and Yue Liu. "Intermittent Hypoxia and Atherosclerosis: From Molecular Mechanisms to the Therapeutic Treatment." Oxidative Medicine and Cellular Longevity 2022 (August 3, 2022): 1–16. http://dx.doi.org/10.1155/2022/1438470.
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Intermittent hypoxia (IH) has a dual nature. On the one hand, chronic IH (CIH) is an important pathologic feature of obstructive sleep apnea (OSA) syndrome (OSAS), and many studies have confirmed that OSA-related CIH (OSA-CIH) has atherogenic effects involving complex and interacting mechanisms. Limited preventive and treatment methods are currently available for this condition. On the other hand, non-OSA-related IH has beneficial or detrimental effects on the body, depending on the degree, duration, and cyclic cycle of hypoxia. It includes two main states: intermittent hypoxia in a simulated plateau environment and intermittent hypoxia in a normobaric environment. In this paper, we compare the two types of IH and summarizes the pathologic mechanisms and research advances in the treatment of OSA-CIH-induced atherosclerosis (AS), to provide evidence for the systematic prevention and treatment of OSAS-related AS.
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Oliveira, Joana Correia, Filipa Costa Sousa, Inês Gante, and Margarida Figueiredo Dias. "Awareness of the Causes Leading to Surgical Ablation of Ovarian Function in Premenopausal Breast Cancer—A Single-Center Analysis." Medicina 57, no. 4 (April 16, 2021): 385. http://dx.doi.org/10.3390/medicina57040385.
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Background and Objectives: Ovarian surgical ablation (OSA) in estrogen receptor-positive (ER+) breast cancer is usually performed to halt ovarian function in premenopausal patients. Since alternative pharmacological therapy exists and few studies have investigated why surgery is still performed, we aimed to analyze the reasons for the use of OSA despite the remaining controversy. Materials and Methods: Premenopausal ER+ breast cancer patients treated at a tertiary center (2005–2011) were selected, and patients with germline mutations were excluded. Results: Seventy-nine patients met the inclusion criteria. Globally, the main reasons for OSA included: continued menstruation despite hormone therapy with or without ovarian medical ablation (OMA) (34.2%), patient informed choice (31.6%), disease progression (16.5%), gynecological disease requiring surgery (13.9%), and tamoxifen intolerance/contraindication (3.8%). In women aged ≥45 years, patient choice was significantly more frequently the reason for OSA (47.4% versus 17.1% (p = 0.004)). For those aged <45 years, salvation attempts were significantly more frequent as compared to older women (26.8% versus 5.3% (p = 0.01)). In 77.8% of women undergoing OSA with menstrual cycle maintenance, surgery was performed 1–5 years after diagnosis, while surgery was performed earlier (0–3 months after diagnosis) in patients undergoing OSA as an informed choice (56.0%), as a salvation attempt (53.8%), or due to gynecological disease (63.6%). The leading reason for OSA in women previously undergoing OMA was continued menstruation (60.0%). Conclusions: This study suggests a possible failure of pharmacological ovarian suppression and reinforces the need for shared decision-making with patients when discussing treatment strategies, although validation by further studies is warranted due to our limited sample size.
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Nishio, Yoshitomo, Tetsuro Hoshino, Kenta Murotani, Akifumi Furuhashi, Masayo Baku, Ryujiro Sasanabe, Yoshiaki Kazaoka, and Toshiaki Shiomi. "Treatment outcome of oral appliance in patients with REM-related obstructive sleep apnea." Sleep and Breathing 24, no. 4 (November 25, 2019): 1339–47. http://dx.doi.org/10.1007/s11325-019-01966-5.
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Abstract Purpose Oral appliances (OA) are used to treat patients with obstructive sleep apnea (OSA). The purpose of this study is to evaluate the efficacy of OA treatment in patients with rapid eye movement (REM)–related OSA. Methods Forty-six patients with REM-related OSA and 107 with non-stage-specific OSA were prescribed OA treatment after diagnosis by polysomnography (PSG) and a follow-up sleep test by PSG was conducted. Efficacy and treatment outcome predictors were evaluated according to the following criteria for treatment success: #1, reduction of the apnea-hypopnea index (AHI) to less than 5 and > 50% compared with baseline; #2, AHI reduction to less than 10 and > 50% compared with baseline; and #3, > 50% AHI reduction compared with baseline. Results Success rates according to criteria #1, #2, and #3 were 45.7%, 50.0%, and 50.0% in REM-related OSA and 36.4%, 52.3%, and 63.6% in non-stage-specific OSA, respectively. No significant differences in success rate were found between the two groups. In multivariate logistic regression analysis with each criterion as the response variable, only BMI was extracted as a significant predictor. The BMI cutoff values defined based on the maximum Youden index according to the three criteria were 26.2 kg/m2, 25.6 kg/m2, and 26.2 kg/m2, respectively. Conclusions No significant differences in success rate of OA treatment were found between REM-related OSA and non-stage-specific OSA. BMI has greater impact on treatment outcome of OA in patients with REM-related OSA.
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Petitto, L., and M. Musso. "0904 Rapid Eye Movement Related Obstructive Sleep Apnea In The Pediatric Population: Case Series And Considerations." Sleep 43, Supplement_1 (April 2020): A344. http://dx.doi.org/10.1093/sleep/zsaa056.900.
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Abstract Introduction Rapid Eye Movement (REM) related Obstructive Sleep Apnea (OSA) can impact sleep quality and result in negative clinical consequences. There are limited pediatric studies evaluating potential consequences, looking at optimal decision making, and discussing best treatment options. Aims: 1: Describe clinical impact and potential negative consequences; 2: Discuss treatment management of REM related OSA; 3: Evaluate clinical effectiveness of treatment. Methods Case series: Retrospective review of 22 pediatric patients with REM related OSA at a tertiary care center. Clinical analysis of implemented treatment modality vs. observation was reviewed. Symptomatic response to treatment modality vs. observation including alteration of quality of life was examined. Results REM related OSA lead to negative clinical daytime symptoms which warranted consideration and implementation of further treatment. Conclusion Treatment considerations for REM related OSA include tonsillectomy and adenoidectomy, positive airway pressure, medical management, and watchful waiting. Further research is necessary to increase knowledge of clinical impact of REM related OSA and treatment. Support N/A
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Berg, Lars M., Torun K. S. Ankjell, Yi-Qian Sun, Tordis A. Trovik, Anders Sjögren, Oddveig G. Rikardsen, Ketil Moen, Sølve Hellem, and Vegard Bugten. "Friedman Score in Relation to Compliance and Treatment Response in Nonsevere Obstructive Sleep Apnea." International Journal of Otolaryngology 2020 (March 19, 2020): 1–8. http://dx.doi.org/10.1155/2020/6459276.
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Nonsevere obstructive sleep apnea (OSA) is most often treated with a continuous positive airway pressure (CPAP) device or a mandibular advancement splint (MAS). However, patient compliance with these treatments is difficult to predict. Improvement in apnea-hypopnea index (AHI) is also somewhat unpredictable in MAS treatment. In this study, we investigated the association between Friedman tongue position score (Friedman score) and both treatment compliance and AHI improvement in patients with nonsevere OSA receiving CPAP or MAS treatment. 104 patients with nonsevere OSA were randomly allocated to CPAP or MAS treatment and followed for 12 months. Data were collected through a medical examination, questionnaires, sleep recordings from ambulatory type 3 polygraphic sleep recording devices, and CPAP recordings. Associations between Friedman score, treatment compliance, and AHI improvement were analysed with logistic regression analyses. Friedman score was not associated with treatment compliance (odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.59–1.23), or AHI improvement (OR: 1.05, 95% CI: 0.62–1.76) in the overall study sample, the CPAP treatment group, or the MAS treatment group. Adjustment for socioeconomic factors, body mass index, and tonsil size did not significantly impact the results. Although Friedman score may predict OSA severity and contribute to the prediction of success in uvulopalatopharyngoplasty, we found no association between Friedman score and treatment compliance in patients with nonsevere OSA receiving CPAP or MAS treatment, nor did we find any association between Friedman score and AHI improvement. Factors other than Friedman score should be considered when deciding whether a patient with nonsevere OSA should be treated with CPAP or MAS.
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Posadas, Tomas, Grace Oscullo, Enrique Zaldívar, Alberto Garcia-Ortega, José Daniel Gómez-Olivas, Manuela Monteagudo, and Miguel Angel Martínez-García. "Treatment with CPAP in Elderly Patients with Obstructive Sleep Apnoea." Journal of Clinical Medicine 9, no. 2 (February 17, 2020): 546. http://dx.doi.org/10.3390/jcm9020546.
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The population pyramid is changing as a result of the ever-increasing life expectancy, which makes it crucial to acquire an in-depth understanding of the diseases that most often affect the elderly. Obstructive sleep apnoea (OSA) affects 15%–20% of the population aged over 65 years. Despite this prevalence, there have been very few specific studies on the management of OSA in this age group, even though over 60% of the patients aged over 65-70 years who attend sleep units with suspicion of OSA receive treatment with continuous positive airway pressure (CPAP), on the basis of an extrapolation of the positive results achieved by CPAP in clinical trials involving middle-aged males. However, the latter’s form of presentation, evolution and, probably, prognosis comparing with OSA are not the same as those of elderly patients. Recent clinical trials performed on an exclusive series of elderly patients have shed light on the possible role of CPAP treatment in elderly patients with OSA, but there are still many questions that need to be answered. The physiological increase in the number of sleep-related disorders with the passing of years, and the lack of validated diagnostic and therapeutic tools for this age group are probably the greatest obstacles to define, diagnose and treat OSA in the elderly.
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Saw, S. S., Shariffa N.Y., Ruri A.S., and Uthumporn U. "Physicochemical and emulsifying properties of pre-treated octenyl succinic anhydride (OSA) sago starch in simple emulsion system." Food Research 4, no. 4 (April 24, 2020): 1326–32. http://dx.doi.org/10.26656/fr.2017.4(4).426.
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A study was carried out to determine the physicochemical and emulsifying properties of pre-treated octenyl succinic anhydride (OSA) sago starch in simple emulsion. Sago starch was pre-treated with STARGEN enzyme (EN OSA: single pre-treatment), heat moisture treatment followed by STARGEN enzyme (HMT EN OSA: dual pre-treatment) before being esterified with OSA. The ability of the pre-treated OSA sago starch to stabilize emulsion was then investigated. Dual pre-treated starch, HMT EN OSA, had significantly highest degree of substitution (DS), (DS = 0.0179) compared to single pre-treated starch, EN OSA, (DS = 0.0159) and native OSA, N-OSA (DS = 0.0057). As compared to emulsions prepared by N-OSA and HMT EN OSA, EN OSA had significantly highest emulsifying activity throughout all starch concentrations and it produced a thick viscous emulsion layer directly after emulsification. This might be due to enzymatic pretreatments may retained granule’s original shape and smooth appearance which allow having a better fit during the emulsification process. The highest emulsion stability was observed with the emulsion index values of EN OSA stabilized emulsions was the most stable for all starch concentrations throughout storage study. After the 8th week of storage study, the EN OSA remains the highest emulsion index from 0.37 to 0.56 for 200 mg/mL oil to 500 mg/mL oil starch concentration. Light micrograph of EN OSA showed that starch particles accumulated at the oil-water interface and cover the oil droplets with higher degree of coverage than the HMT EN OSA and control. No spaces were observed in the EN OSA stabilized emulsion which indicated that EN OSA modified sago starch can effectively stabilize oil in water emulsion.
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Maghsoudipour, M., N. Bosompra, R. Jen, Y. Li, S. Moore, P. DeYoung, J. Fine, et al. "0690 An Evaluation Of Genioglossus Strengthening On Obstructive Sleep Apnea Treatment Outcomes." Sleep 43, Supplement_1 (April 2020): A263. http://dx.doi.org/10.1093/sleep/zsaa056.686.
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Abstract Introduction Obstructive sleep apnea (OSA) is characterized by repetitive episodes of pharyngeal collapse. The genioglossus is a major upper airway dilator muscle thought to be important in OSA pathogenesis. Upper airway (UA) muscle training has reported benefits in some OSA patients. Our goal was to assess the effect of upper airway muscle training on OSA outcomes. Methods Sixty five patients with OSA (AHI>10/h) were divided in three subgroups: 1) Treated with auto-CPAP (n=21), 2) Previously failed or refused CPAP therapy (no treatment), (n=24), 3) Currently treated with an oral appliance who still have residual OSA (AHI>10/h), (n=20). All subjects were given a custom-made tongue strengthening device. Within each group we conducted a prospective, randomized, controlled study examining the effect of upper airway muscle training. In each subgroup, subjects were randomized to UA muscle training (volitional protrusion against resistance) or sham group (negligible resistance), with 1:1 ratio over 6 weeks of treatment (twice daily for 20 min/session). In the baseline and the final visit, subjects completed home sleep testing, questionnaires (ESS, PSQI), acoustic pharynogometry, Iowa Oral Performance Instrument (IOPI), and Psychomotor Vigilance Test (PVT). Results Results remain blinded; 33 patients received treatment Y and 32 patients received treatment Z. To date, we have not observed a main effect of treatment group on several measures of OSA severity. Some changes in subjective measures over time were observed but difficult to interpret until unblinding occurs. Conclusion Treatment of OSA using upper airway muscle training exercises requires further study. Whether muscle training is a viable approach for a definable subset of OSA patients remains unclear. Support R01HL085188-05A1 (U.S. NIH Grant/Contract)