Translation of obstructive sleep apnea pathophysiology and phenotypes to personalized treatment: a narrative review DOI Creative Commons
Walter T. McNicholas, Henri Korkalainen

Frontiers in Neurology, Год журнала: 2023, Номер 14

Опубликована: Авг. 24, 2023

Obstructive Sleep Apnea (OSA) arises due to periodic blockage of the upper airway (UA) during sleep, as negative pressure generated inspiration overcomes force exerted by UA dilator muscles maintain patency. This imbalance is primarily seen in individuals with a narrowed UA, attributable factors such inherent craniofacial anatomy, neck fat accumulation, and rostral fluid shifts supine posture. Sleep-induced attenuation dilating muscle responsiveness, respiratory instability, high loop gain further exacerbate obstruction. The widespread comorbidity profile OSA, encompassing cardiovascular, metabolic, neuropsychiatric domains, suggests complex bidirectional relationships conditions like heart failure, stroke, metabolic syndrome. Recent advances have delineated distinct OSA phenotypes beyond mere obstruction frequency, showing links specific symptomatic manifestations. It vital bridge gap between measurable patient characteristics, phenotypes, underlying pathophysiological traits enhance our understanding its interplay related outcomes. knowledge could stimulate development tailored therapies targeting phenotypic endotypes. review aims elucidate multifaceted pathophysiology focusing on functional traits, clinical manifestations, comorbidities. ultimate objective pave way for more personalized treatment paradigm offering alternatives continuous positive therapy selected patients thereby optimizing efficacy adherence. There an urgent need strategies ever-evolving field sleep medicine, we progress from ‘one-size-fits-all’ ‘tailored-therapy’ approach.

Язык: Английский

Metrics of sleep apnea severity: beyond the apnea-hypopnea index DOI Creative Commons
Atul Malhotra, Indu Ayappa, Najib Ayas

и другие.

SLEEP, Год журнала: 2021, Номер 44(7)

Опубликована: Март 9, 2021

Obstructive sleep apnea (OSA) is thought to affect almost 1 billion people worldwide. OSA has well established cardiovascular and neurocognitive sequelae, although the optimal metric assess its severity and/or potential response therapy remains unclear. The apnea-hypopnea index (AHI) established; thus, we review history predictive value in various different clinical contexts. Although AHI often criticized for limitations, it best studied of severity, albeit imperfect. We further alternative metrics including hypoxic burden, arousal intensity, odds ratio product, cardiopulmonary coupling. conclude with possible future directions capture clinically meaningful endophenotypes use genetics, blood biomarkers, machine/deep learning wearable technologies. Further research should be directed towards providing diagnostic prognostic information make diagnosis more accessible improving regarding consequences, order guide patient care help design trials.

Язык: Английский

Процитировано

293
Evaluation and Management of Adults with Obstructive Sleep Apnea Syndrome DOI

Janet J. Lee,

Krishna M. Sundar

Lung, Год журнала: 2021, Номер 199(2), С. 87 - 101

Опубликована: Март 13, 2021

Язык: Английский

Процитировано

149
European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea DOI Creative Commons
Winfried Randerath, Johan Verbraecken, Christel A.L. de Raaff

и другие.

European Respiratory Review, Год журнала: 2021, Номер 30(162), С. 210200 - 210200

Опубликована: Ноя. 30, 2021

Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced clinical practice, while other approaches refined or reconsidered. In this European Respiratory Society (ERS) guideline on non-continuous positive airway pressure (CPAP) for OSA, we present recommendations determined by a systematic review the literature. It an update 2011 ERS statement non-CPAP therapies, advanced into guideline. A multidisciplinary group experts, including pulmonary, surgical, dentistry ear–nose–throat specialists, methodologists patient representatives considered most relevant questions (for both clinicians patients) relating to management OSA. Eight key were generated was conducted identify published randomised trials that answered these questions. We used GRADE (Grading Recommendations Assessment, Development Evaluation) approach assess quality evidence strength recommendations. The resulting addresses gastric bypass surgery, custom-made dual-block mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillo-mandibular osteotomy, carbonic anhydrase inhibitors positional therapy. These can be benchmark care people with OSA across Europe improve outcomes.

Язык: Английский

Процитировано

135
The Sleep Apnea–Specific Pulse-Rate Response Predicts Cardiovascular Morbidity and Mortality DOI
Ali Azarbarzin, Scott A. Sands, Magdy Younes

и другие.

American Journal of Respiratory and Critical Care Medicine, Год журнала: 2021, Номер 203(12), С. 1546 - 1555

Опубликована: Янв. 6, 2021

Rationale: Randomized controlled trials have been unable to detect a cardiovascular benefit of continuous positive airway pressure in unselected patients with obstructive sleep apnea (OSA). We hypothesize that deleterious outcomes are concentrated subgroup heightened pulse-rate response apneas and hypopneas (ΔHR). Methods: measured the ΔHR MESA (Multi-Ethnic Study Atherosclerosis) (N = 1,395) SHHS (Sleep Heart Health Study) 4,575). data were used determine functional form association between subclinical biomarkers, whereas primary analyses tested nonfatal or fatal disease (CVD) all-cause mortality longitudinal from SHHS. Measurements Main Results: In MESA, U-shaped relationships observed CVD biomarkers (coronary artery calcium, NT-proBNP [N-terminal prohormone BNP], Framingham risk score) ΔHR; notably, high (upper quartile) was associated elevated biomarker scores compared midrange (25th-75th centiles). SHHS, individuals at increased (nonfatal adjusted hazard ratio [95% confidence interval (CI)], 1.60 [1.28-2.00]; CI], 1.68 [1.22-2.30]; 1.29 [1.07-1.55]). The particularly those substantial hypoxic burden (nonfatal, 1.93 [1.36-2.73]; fatal, 3.50 [2.15-5.71]; all-cause, 1.84 [1.40-2.40]) exclusively nonsleepy individuals. Conclusions: Individuals OSA who demonstrate an morbidity mortality. This study identifies prognostic for appears useful stratification patient selection future clinical trials.

Язык: Английский

Процитировано

132
Obstructive sleep apnea: transition from pathophysiology to an integrative disease model DOI
Walter T. McNicholas, Dirk Pevernagie

Journal of Sleep Research, Год журнала: 2022, Номер 31(4)

Опубликована: Май 24, 2022

Summary Obstructive sleep apnea (OSA) is characterised by recurring episodes of upper airway obstruction during and the fundamental abnormality reflects inability dilating muscles to withstand negative forces generated within inspiration. Factors that result in narrowing oropharynx such as abnormal craniofacial anatomy, soft tissue accumulation neck, rostral fluid shift recumbent position increase collapsing airway. The counteracting muscles, especially genioglossus, are negatively influenced onset, inadequacy genioglossus responsiveness, ventilatory instability, post arousal, loop gain. OSA frequently associated with comorbidities include metabolic, cardiovascular, renal, pulmonary, neuropsychiatric, there growing evidence bidirectional relationships between comorbidity, for heart failure, metabolic syndrome, stroke. A detailed understanding complex pathophysiology encourages development therapies targeted at pathophysiological endotypes facilitates a move towards precision medicine potential alternative continuous positive pressure therapy selected patients.

Язык: Английский

Процитировано

79
Pulse Wave Amplitude Drops Index: A Biomarker of Cardiovascular Risk in Obstructive Sleep Apnea DOI Creative Commons
Geoffroy Solelhac, Manuel Sánchez‐de‐la‐Torre, Margaux Blanchard

и другие.

American Journal of Respiratory and Critical Care Medicine, Год журнала: 2023, Номер 207(12), С. 1620 - 1632

Опубликована: Апрель 5, 2023

It is currently unclear which patients with obstructive sleep apnea (OSA) are at increased cardiovascular risk.

Язык: Английский

Процитировано

47
REM sleep obstructive sleep apnoea DOI Creative Commons
Maria R. Bonsignore,

Emilia Mazzuca,

Pierpaolo Baiamonte

и другие.

European Respiratory Review, Год журнала: 2024, Номер 33(171), С. 230166 - 230166

Опубликована: Янв. 31, 2024

Obstructive sleep apnoea (OSA) can occur in both rapid eye movement (REM) and non-REM or be limited to REM sleep, when the upper airway is most prone collapse due atonia. Respiratory events are usually longer more desaturating than NREM sleep. The prevalence of OSA higher women men occurs context mild–moderate based on apnoea–hypopnoea index calculated for entire study. Studies have highlighted some detrimental consequences OSA; example, its frequent association with systemic hypertension a degree excessive daytime sleepiness similar that found nonsleep-stage-dependent OSA. Moreover, could increase cardiometabolic risk. Continuous positive pressure (CPAP) treatment aimed at preventing should 4 h considered as good compliance, since mostly during second half night. Unfortunately, patients show poor adherence CPAP. Alternative non-CPAP treatments might choice OSA, but data lacking. This review summarises available critically examines weaknesses strengths existing literature.

Язык: Английский

Процитировано

21
Sleep bruxism and temporomandibular disorders: A scoping review of the literature DOI
Daniele Manfredini, Frank Lobbezoo

Journal of Dentistry, Год журнала: 2021, Номер 111, С. 103711 - 103711

Опубликована: Июнь 6, 2021

Язык: Английский

Процитировано

94
Sleep apnoea and ischaemic stroke: current knowledge and future directions DOI
Sébastien Baillieul, Martijn Dekkers, Anne‐Kathrin Brill

и другие.

The Lancet Neurology, Год журнала: 2021, Номер 21(1), С. 78 - 88

Опубликована: Дек. 20, 2021

Язык: Английский

Процитировано

88
Associations between sleep bruxism and other sleep-related disorders in adults: a systematic review DOI Creative Commons
Boyuan Kuang, Deshui Li, Frank Lobbezoo

и другие.

Sleep Medicine, Год журнала: 2021, Номер 89, С. 31 - 47

Опубликована: Ноя. 19, 2021

Systematic reviews on sleep bruxism (SB) as a comorbid condition of other sleep-related disorders are lacking. Such would contribute to the insight clinicians into occurrence SB in patients with disorders, and underlying mechanisms such associations. This systematic review aimed: 1. determine prevalence adults disorders; 2. associations between explain these associations.A search was performed PubMed, Embase, Cochrane Library, Web Science identify eligible studies published until May 15, 2020. Quality assessment using Risk Bias Assessment tool for Non-randomized Studies.Of 1539 unique retrieved studies, 37 articles were included this review. The adult obstructive apnea, restless leg syndrome, periodic limb movement during sleep, gastroesophageal reflux disease, REM behavior disorder (RBD), epilepsy higher than that general population. specific behind positive could not be identified.SB is more prevalent previously mentioned Sleep arousal may common factor which all identified associated, except RBD Parkinson's disease. call screening abovementioned disorders.

Язык: Английский

Процитировано

72