Comparing efficacy of the mandibular advancement device after drug-induced sleep endoscopy and continuous positive airway pressure in patients with obstructive sleep apnea.

PURPOSE: The purpose of this study was to compare objective and self-reported outcomes of two treatments for managing mild, moderate, and severe obstructive sleep apnea (OSA) in adults: a mandibular advancement device (MAD) and continuous positive airway pressure (CPAP). METHODS: Patients diagnosed with OSA by means of polysomnography (PSG) included one group treated with a custom-made, two-piece, adjustable MAD and a second group treated with CPAP for 8 weeks. Before the initiation of the treatment, all patients assigned to MAD underwent drug-induced sleep endoscopy (DISE), and all CPAP group patients underwent manual titration of CPAP after PSG. Objective (PSG) and self-reported (Epworth Sleepiness Scale [ESS] and Short Form Health Survey [SF-36]) data were used to assess outcomes. Collected data included apnea-hypopnea index (AHI), mean capillary oxygen saturation (SpO2), oxygen desaturation index (ODI), arousal index (AI), degree of daytime sleepiness, and quality of life. A PSG follow-up after 8 weeks with MAD in situ, and data from the CPAP data card were used to assess the effect of the two treatments. RESULTS: A total of 59 patients included 30 treated with MAD and 29 treated with CPAP. Between baseline and the 8-week follow-up, the mean AHI score decreased significantly from 35.1 to 6.8 episodes/h (p < 0.001) in patients treated with MAD and from 35.2 to 3.0 episodes/h (p < 0.001) in patients treated with CPAP. The mean AHI score at the 8-week follow-up was significantly lower in CPAP group than in MAD group (p = 0.003). The two groups did not differ significantly at follow-up regarding SpO2 (p = 0.571), ODI (p = 0.273), AI (p = 0.100), ESS score (p = 0.648), and SF-36 score (p = 0.237). CONCLUSION: In the short term, patients on CPAP attained better PSG outcomes in terms of AHI reduction. Both MAD after DISE evaluation and CPAP resulted in similar improvements in clinical symptoms and health-related quality of life, even in patients with severe OSA.

Complex sleep apnea after full-night and split-night polysomnography: the Greek experience.

PURPOSE: Treatment-emergent central sleep apnea (TE-CSA) is defined as the emergence or persistence of central respiratory events during the initiation of positive airway pressure (PAP) without a back-up rate in obstructive sleep apnea (OSA) patients and after significant resolution of obstructive events. Previous studies have estimated a prevalence from 0.56 to 20.3%. The aim of this study was to establish the prevalence of TE-CSA in a Greek adult population. METHODS: One thousand fifty nine patients with newly diagnosed OSA, who were referred to the Sleep Disorders Center of Evangelismos Hospital of Athens over an 18-month period, were included in this study. A split-night polysomnography (PSG), or two formal overnight PSGs (diagnostic and continuous PAP (CPAP) titration study), were performed. RESULTS: Patients with OSA were divided in two groups; the first group included 277 patients, who underwent two separate studies (diagnostic and CPAP titration study), and the second group 782 patients, who underwent split-night studies. The prevalence of TE-CSA in the first group was 2.53% (7 patients), and in the second group was 5.63% (44 patients). CONCLUSIONS: The prevalence of TE-CSA in Greece was lower compared to most previous reported studies. The significant variation in the prevalence of TE-CSA between different centers throughout the world is mainly associated with the used diagnostic criteria as well as methodological and technical aspects.

Nasal steroids in snorers can decrease snoring frequency: a randomized placebo-controlled crossover trial.

Although it is anecdotally known that nasal obstruction is associated with snoring, it remains unknown whether the application of nasal steroids could decrease oral/oro-nasal breathing and increase nasal breathing, and subsequently decrease snoring indices. This study evaluated the effect of nasal budesonide on breathing route pattern and snoring. Twenty-four snorers were enrolled in a randomized, double-blind, crossover trial of 1-week treatment with nasal budesonide compared with 1-week intervention with nasal placebo. At the start and end of each treatment period, patients underwent nasal resistance measurement and overnight polysomnography with concomitant measurement of breathing route pattern and snoring. Twelve patients were randomly assigned to a 1-week treatment with nasal budesonide, followed by 2-week washout period and a 1-week intervention with the nasal placebo; and 12 patients were randomly assigned to a 1-week intervention with nasal placebo, followed by 2-week washout period and a 1-week treatment with nasal budesonide. Nasal budesonide was associated with a decrease in oral/oro-nasal breathing epochs and concomitant increase in nasal breathing epochs, decrease of snoring frequency by [median (interquartile range)] 15.8% (11.2-18.8%), and an increase of rapid eye movement sleep; snoring intensity decreased only in patients with increased baseline nasal resistance by 10.6% (6.8-14.3%). The change in nasal breathing epochs was inversely related to the change in snoring frequency (Rs = 0.503; P < 0.001). Nasal budesonide in snorers can increase nasal breathing epochs, modestly decrease snoring frequency and increase rapid eye movement sleep.

The effect of nasal tramazoline with dexamethasone in obstructive sleep apnoea patients.

Although there is a strong correlation between oral/oro-nasal breathing and apnoea/hypopnoea index in patients with obstructive sleep apnoea and normal nasal resistance at wakefulness, it remains unknown whether the pharmacological prevention of potential nasal obstruction during sleep could decrease oral/oro-nasal breathing and increase nasal breathing and subsequently decrease the apnoea/hypopnoea index. This study evaluated the effect of a combination of a nasal decongestant with corticosteroid on breathing route pattern and apnoea/hypopnoea index. 21 patients with obstructive sleep apnoea (mean apnoea/hypopnoea index 31.1 events per hour) and normal nasal resistance at wakefulness were enrolled in a randomised crossover trial of 1 weeks' treatment with nasal tramazoline and dexamethasone compared with 1 weeks' treatment with nasal placebo. At the start and end of each treatment period, patients underwent nasal resistance measurement and overnight polysomnography with attendant measurement of breathing route pattern. Nasal tramazoline with dexamethasone was associated with decrease in oral/oro-nasal breathing epochs and concomitant increase in nasal breathing epochs, and mean decrease of apnoea/hypopnoea index by 21%. The change in nasal breathing epochs was inversely related to the change in apnoea/hypopnoea index (Rs=0.78; p<0.001). In conclusion, nasal tramazoline with dexamethasone in OSA patients with normal nasal resistance at wakefulness can restore the preponderance of nasal breathing epochs and modestly improve apnoea/hypopnoea index.

Clinical and polysomnographic determinants of snoring.

Snoring is considered one of the hallmarks of sleep-disordered breathing, but its determinants remain obscure in both obstructive sleep apnoea (apnoeic) and non-apnoeic snorers. We aimed to document positional dependency of snoring along with its association with clinical and polysomnographic variables. Seventy-seven apnoeic and 27 non-apnoeic snorers who complained for every-night loud snoring and slept in supine and lateral positions in all sleep stages during overnight polysomnography were included. Snoring (i.e. sound intensity > 40 dB) was quantified by measuring the mean and maximum sound intensity, and snoring frequency. In apnoeic and non-apnoeic snorers, mean snoring intensity and snoring frequency were higher in supine than in lateral positions irrespective of sleep stage, and were also usually higher in N3 in comparison to rapid eye movement and/or N2 sleep stage in any given position. Positional change in snoring intensity as expressed by the ratio of mean intensity in the supine to lateral positions was independently and positively correlated with body mass index, tonsils size and age in the total of patients. Snoring is more prominent in the supine position and in N3 sleep stage in apnoeic and non-apnoeic snorers. Snoring positional dependence is determined by body mass index, tonsils size and age.