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Latest Advances in Sleep Medicine Obstructive Sleep Apnea

Chest (Impact Factor: 7.13). 12/2012; 142(6):1645-51. DOI: 10.1378/chest.12-2391
Source: PubMed

ABSTRACT This article is a review of the pertinent scientific data regarding obstructive sleep apnea (OSA) as presented in the medical literature. Attention regarding the diagnosis of OSA focused on the debate regarding home testing as compared with in-laboratory polysomnography (PSG), with a surprising result of possibly more cost benefit from PSG. New advances abound in the treatment of OSA, including those directed at preventing pharyngeal collapsibility. Multiple studies reviewed the comparative effects of oral appliances in conjunction with CPAP, with little difference between the two noted, especially for mild OSA. Finally, a number of studies evaluated both risks of OSA and outcomes from the use of CPAP, including functional outcomes, direct cardiac benefits, and overall cardiac mortality.

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    • "Obstructive sleep apnoea (OSA) is a disorder that consists of abnormal breathing pauses, irregular or superficial breathing that occurs during sleep [2] [11]. It has often been indicated as a serious, frequent but mostly underrated clinical problem. "
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    ABSTRACT: We present a complete technical solution for continuously monitoring vital signs required for observing sleep apnoea events, one of the major sleep respiratory disorders. Based on industry accepted medical devices, we developed a GSM-based remote data acquisition and transfer module that is integrated via a set of web services into the server side of the application. The back-end is responsible with aggregating all the data, and, based on machine learning techniques, it provides a first level of filtering in order to warn about possible abnormalities. The proposed solution is currently under the test phase at the "Victor Babes" Hospital in Timisoara, Romania.
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    ABSTRACT: Recently, portable sleep recording devices became an accepted alternative to polysomnography (PSG) for obstructive sleep apnoea (OSA) diagnosis in patients with a high pre-test probability of moderate to severe OSA but home polysomnography (H-PSG) was not recommended because there was insufficient data. The present review has analysed six prospective randomiszed cross-over studies comparing H-PSG to in-lab PSG. These studies convincingly showed that H-PSG allows complete sleep evaluation. The quality of patient's sleep tends to be better at home. H-PSG is accurate for OSA diagnosis and the failure rate is low despite the absence of supervision. In addition, it could offer a final and comprehensive diagnosis for many other sleep disorders. It is also likely that H-PSG can reduce PSG-related costs but complete cost-effectiveness analyses are not yet available. Recently, remotely attended H-PSG via telemonitoring has been tested and may reduce H-PSG failure rate. In conclusion, H-PSG can be used to rule-in and rule out OSA in suspected patients, even in the presence of co-morbidities and is an alternative when type 3 recording is negative. Future developments should target simplification of technical aspects of H-PSG, together with remote monitoring, in order to obtain good quality H-PSG performed in adequate conditions.
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    ABSTRACT: A high prevalence of obstructive sleep apnea syndrome (OSAS) has been reported in severely obese patients with nonalcoholic fatty liver disease (NAFLD), but few studies have evaluated OSAS in non-morbidly obese NAFLD patients. To determine the prevalence of risk for OSAS with or without daytime sleepiness in non-morbidly obese patients with NAFLD and evaluate the association with the severity of liver damage. We considered 159 consecutive patients with histological NAFLD and body mass index (BMI) <35 Kg/m2, and 80 controls without ultrasonographic steatosis matched for age, sex, and BMI. OSAS risk was determined by positivity for Berlin questionnaire (BQ), and daytime sleepiness by the Sleepness Epworth Scale (ESS). Liver damage was evaluated according to the NAFLD activity score. In NAFLD patients, BQ alone was positive in 39 (25%), ESS in 8 (5%), and both in 13 (8%, OSAS with sleepines); p = ns vs. controls without steatosis. In NAFLD patients at risk for OSAS with (but not in those without) sleepiness, we observed a higher prevalence of nonalcoholic steatohepatitis (NASH; 11/13, 85% vs. 72/146, 49%; p = 0.018), and of clinically significant fibrosis (stage>1; 9/13, 69% vs. 39/146, 27%; p = 0.003). At multivariate logistic regression analysis, OSAS with sleepiness was strongly associated with NASH and fibrosis>1 independently of known clinical risk factors such as age, gender, BMI, diabetes, and ALT levels (OR 7.1, 95% c.i. 1.7-51, p = 0.005 and OR 14.0, 95% c.i. 3.5-70, p = 0.0002, respectively). A proportion of NAFLD patients without severe obesity is at risk for OSAS with daytime sleepiness, which is associated with the severity of liver damage independently of body mass and other cofactors.
    PLoS ONE 04/2014; 9(4):e96349. DOI:10.1371/journal.pone.0096349 · 3.53 Impact Factor
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