The Comparison of CPAP and Oral Appliances in Treatment of Patients With OSA: A Systematic Review and Meta-analysis
ABSTRACT Background:A systematic review and meta-analysis was performed to compare the outcomes of oral appliances (OA) with those of continuous positive airway pressure (CPAP) in treatment of patients with obstructive sleep apnea (OSA).Methods:Relevant studies were retrieved from the following electronic databases up to and including Semptember 2012: MEDLINE, PubMed, EMBASE, and Central Register of Controlled Trials. Main outcomes were epworth sleepiness scale (ESS), health-related quality of life, cognitive performance, blood pressure, apnoea and hypopnoea index (AHI), arousal Index (AI), minimum saturation (Min SaO2), rapid eye movement sleep, % (REM%), treatment usage, side effects, treatment preference and withdrawals.Results:Fourteen trials were finally included in this review. Our results demonstrated that the effects on ESS (p=0.31 and 0.09 in cross-over and parallel-group trials), health-related quality of life, cognitive performance, and blood pressure of OA and CPAP were similar. Besides, pooled estimates of cross-over trials suggested a significant difference in favor of CPAP regarding AHI (p<0.00001), AI (p=0.001), and Min SaO2 (p<0.00001), while pooled estimates of parallel-group trials showed a significant difference in favor of CPAP regarding AHI (p<0.00001) and REM% (p=0.02). Moreover, OA and CPAP yielded fairly similar results in terms of treatment usage (p=0.26, hours/night in cross-over trials and p=0.14, hours/night; p=0.19, nights/week in parallel-group trials), treatment preference, side effects and withdrawals (p=0.34 in parallel- group trials).Conclusions:CPAP yielded better PSG outcomes especially in reducing AHI than OA, indicating that OA was less effective than CPAP in improving sleep disordered breathing. However, similar results from OA and CPAP in terms of clinical and other related outcomes were found, suggesting that it would appear proper to offer OA to patients who are unable or unwilling to persist with CPAP.
SourceAvailable from: Mary V. Seeman[Show abstract] [Hide abstract]
ABSTRACT: Abstract Background: Obstructive sleep apnoea (OSA) is often overlooked in the context of schizophrenia because its hallmark, daytime sleepiness, is so easily attributable to antipsychotic drugs. This is a special problem for women. Aims: To underscore the importance of diagnosing and treating OSA in women with schizophrenia. Methods: A review of the recent literature (search terms: Obstructive Sleep Apnoea; Schizophrenia; Women (or Gender); Obesity; Antipsychotics; Continuous Positive Airway Pressure (CPAP)) as it applies to a composite case vignette taken from the files of a specialty clinic that treats women with psychosis. Results: The rate of OSA in women who are both obese and postmenopausal is very similar to that of men. Family history, smoking, and the use of tobacco, alcohol and of antipsychotic medication increase the risk. Despite reluctance, patients with schizophrenia generally agree to undergo sleep studies. Compliance with CPAP is difficult, but can be aided by the physician and is, on the whole, relatively high in women. CPAP improves sleep parameters and may also improve cardiometabolic and cognitive indices, although this still needs to be more fully researched. Conclusion: Schizophrenia and untreated OSA are both associated with high mortality rates in women as well as men.Journal of Mental Health 01/2014; 23(4):191-196. DOI:10.3109/09638237.2013.869572 · 1.01 Impact Factor
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ABSTRACT: Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive sleep apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or co-morbidities or ≥ 15 such episodes without any sleep related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.The Indian Journal of Medical Research 09/2014; 140(3):451-68. · 1.66 Impact Factor
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ABSTRACT: While continuous positive airway pressure is the first-line treatment for obstructive sleep apnea, many patients find this form of therapy undesirable leading to treatment nonadherence. Both mandibular advancement devices and surgical therapy offer alternative solutions for such patients. This article serves to compare the types of surgical interventions and mandibular advancement devices available, their mechanisms of action, and expected side effects. Emphasis is made on the limitations and challenges in the interpretation of the available literature due to the varying definitions of curative success. The effects of mandibular advancement devices and surgical therapy on the apnea-hypopnea index and oxygen saturation are reviewed. Patient-centered outcomes of sleepiness, quality of life, treatment preference, adherence, and their effects on disease-related outcomes of hypertension are summarized. When available, comparative effectiveness trials between these therapies versus continuous positive airway pressure are emphasized. Patient selection criteria, practice parameters, and treatment limitations are discussed.Seminars in Respiratory and Critical Care Medicine 10/2014; 35(5):613-20. DOI:10.1055/s-0034-1390047 · 3.02 Impact Factor