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Sleep Apnea Syndromes: HELP
Articles by David R. Hillman
Based on 56 articles published since 2008
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Between 2008 and 2019, D. Hillman wrote the following 56 articles about Sleep Apnea Syndromes.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline. 2017

de Raaff, Christel A L / Gorter-Stam, Marguerite A W / de Vries, Nico / Sinha, Ashish C / Jaap Bonjer, H / Chung, Frances / Coblijn, Usha K / Dahan, Albert / van den Helder, Rick S / Hilgevoord, Antonius A J / Hillman, David R / Margarson, Michael P / Mattar, Samer G / Mulier, Jan P / Ravesloot, Madeline J L / Reiber, Beata M M / van Rijswijk, Anne-Sophie / Singh, Preet Mohinder / Steenhuis, Roos / Tenhagen, Mark / Vanderveken, Olivier M / Verbraecken, Johan / White, David P / van der Wielen, Nicole / van Wagensveld, Bart A. ·Department of Surgery, OLVG West, Amsterdam, the Netherlands. Electronic address: c.deraaff@olvg.nl. · Department of Surgery, VU Medical Center, Amsterdam, the Netherlands. · Department of Oral Kinesiology, ACTA, Amsterdam, the Netherlands; Department of Otorhinolaryngology and Head and Neck Surgery, Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology, OLVG West, Amsterdam, the Netherlands. · Department of Anesthesiology and Perioperative Medicine, Temple University, Philadelphia, PA, USA. · Department of Anesthesiology, University Health Network, University of Toronto, Toronto, Canada. · Department of Anesthesiology, LUMC, Leiden, the Netherlands. · Department of Surgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands. · Department of Clinical Neurophysiology, OLVG West, Amsterdam, the Netherlands. · Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Australia. · Department of Anaesthesia, Saint Richard's Hospital, Chichester, United Kingdom. · Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA. · Department of Anesthesiology, AZ Sint Jan, Brugge, Belgium. · Department of Otorhinolaryngology, OLVG West, Amsterdam, the Netherlands. · Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands. · Department of Surgery, MC Slotervaart, Amsterdam, the Netherlands. · Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India. · Medical Library, OLVG West, Amsterdam, the Netherlands. · Department of Otorhinolaryngology and Head and Neck Surgery, Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. · Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem, Belgium. · Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA. · Department of Surgery, OLVG West, Amsterdam, the Netherlands. ·Surg Obes Relat Dis · Pubmed #28666588.

ABSTRACT: BACKGROUND: The frequency of metabolic and bariatric surgery (MBS) is increasing worldwide, with over 500,000 cases performed every year. Obstructive sleep apnea (OSA) is present in 35%-94% of MBS patients. Nevertheless, consensus regarding the perioperative management of OSA in MBS patients is not established. OBJECTIVES: To provide consensus based guidelines utilizing current literature and, when in the absence of supporting clinical data, expert opinion by organizing a consensus meeting of experts from relevant specialties. SETTING: The meeting was held in Amsterdam, the Netherlands. METHODS: A panel of 15 international experts identified 75 questions covering preoperative screening, treatment, postoperative monitoring, anesthetic care and follow-up. Six researchers reviewed the literature systematically. During this meeting, the "Amsterdam Delphi Method" was utilized including controlled acquisition of feedback, aggregation of responses and iteration. RESULTS: Recommendations or statements were provided for 58 questions. In the judgment of the experts, 17 questions provided no additional useful information and it was agreed to exclude them. With the exception of 3 recommendations (64%, 66%, and 66% respectively), consensus (>70%) was reached for 55 statements and recommendations. Several highlights: polysomnography is the gold standard for diagnosing OSA; continuous positive airway pressure is recommended for all patients with moderate and severe OSA; OSA patients should be continuously monitored with pulse oximetry in the early postoperative period; perioperative usage of sedatives and opioids should be minimized. CONCLUSION: This first international expert meeting provided 58 statements and recommendations for a clinical consensus guideline regarding the perioperative management of OSA patients undergoing MBS.

2 Guideline Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea. 2016

Chung, Frances / Memtsoudis, Stavros G / Ramachandran, Satya Krishna / Nagappa, Mahesh / Opperer, Mathias / Cozowicz, Crispiana / Patrawala, Sara / Lam, David / Kumar, Anjana / Joshi, Girish P / Fleetham, John / Ayas, Najib / Collop, Nancy / Doufas, Anthony G / Eikermann, Matthias / Englesakis, Marina / Gali, Bhargavi / Gay, Peter / Hernandez, Adrian V / Kaw, Roop / Kezirian, Eric J / Malhotra, Atul / Mokhlesi, Babak / Parthasarathy, Sairam / Stierer, Tracey / Wappler, Frank / Hillman, David R / Auckley, Dennis. ·From the *Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; †Department of Anesthesiology, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York; ‡Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan; §Department of Anesthesiology and Perioperative Medicine, University Hospital, St. Joseph's Hospital and Victoria Hospital, London Health Sciences Centre and St. Joseph's Health care, Western University, London, Ontario, Canada; ‖Paracelsus Medical University, Department of Anesthesiology, Perioperative Medicine and Intensive Care, Salzburg, Austria; ¶Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College New York, New York; #Department of Anesthesia, Perioperative Medicine and Intensive Care, Paracelsus Medical University, Salzburg, Austria; **Department of Medicine, University of California San Diego, San Diego, California; ††Sparrow Hospital, Lansing, Michigan; ‡‡Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Texas; §§Department of Medicine, Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada; ‖‖University of British Columbia, Vancouver, BC, Canada; ¶¶Department of Medicine, Emory University, Atlanta, Georgia; ##Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Palo Alto, California; ***Department of Anesthesia, Critical Care and Pain Medicine, Harvard University, Cambridge, Massachusetts; †††Library and Information Services, University Health Network, University of Toronto, Toronto, Ontario, Canada; ‡‡‡Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; §§§Department of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, Minnesota; ‖‖‖School of Medicine, Universidad Peruana de Ciencias Apl ·Anesth Analg · Pubmed #27442772.

ABSTRACT: The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients' conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence.

3 Editorial Sleep, pain, and breathing. 2015

Hillman, David R. ·From the Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Australia. ·Anesth Analg · Pubmed #25988626.

ABSTRACT: -- No abstract --

4 Editorial Anesthesia, sleep, and nasendoscopy. 2014

Hillman, David R. ·From the Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Australia. ·Anesth Analg · Pubmed #25232687.

ABSTRACT: -- No abstract --

5 Editorial A new pharmacological treatment to treat obstructive sleep apnea? 2013

Hillman, David. · ·Sleep · Pubmed #23633744.

ABSTRACT: -- No abstract --

6 Review Perioperative Implementation of Noninvasive Positive Airway Pressure Therapies. 2018

Hillman, David R / Jungquist, Carla R / Auckley, Dennis. ·Centre for Sleep Science, University of Western Australia, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Australia. · School of Nursing, University at Buffalo, Buffalo, NY. carlajun@buffalo.edu. · Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH. ·Respir Care · Pubmed #29339545.

ABSTRACT: Noninvasively applied positive airway pressure therapy (PAP) is available in 3 basic modes: continuous positive airway pressure (CPAP), bi-level positive airway pressure (BPAP), and adaptive servo-ventilation. These are in widespread use in home and hospital settings to treat a variety of disorders of ventilation or gas exchange, including obstructive sleep apnea, sleep-related hypoventilation, periodic breathing, acute and chronic hypercapnic respiratory failure, and acute respiratory failure. They are increasingly being used perioperatively to prevent or treat upper airway obstruction, hypoventilation, and periodic breathing, and they have been found to improve postoperative outcomes in the case of obstructive sleep apnea. An impediment to their use in this setting is a lack of familiarity with their application by hospital clinical staff. This review describes the modes of PAP therapy available, their indications, how therapy is initiated, how efficacy is assessed, common problems encountered with its use, and how these problems can be addressed.

7 Review Cognitive deficits in obstructive sleep apnea: Insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation. 2018

Olaithe, Michelle / Bucks, Romola S / Hillman, David R / Eastwood, Peter R. ·School of Psychological Science, University of Western Australia, Perth, Australia; Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, Perth, Australia. Electronic address: michelle.olaithe@uwa.edu.au. · School of Psychological Science, University of Western Australia, Perth, Australia. · Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, Perth, Australia. ·Sleep Med Rev · Pubmed #28760549.

ABSTRACT: Obstructive sleep apnea (OSA) is a nocturnal breathing disorder that is associated with cognitive impairment. The primary determinants of cognitive deficits in OSA are thought to be sleep disruption and blood gas abnormalities. Cognitive impairment is also seen in other disorders that are characterised primarily by sleep disturbance (e.g., sleep restriction/deprivation, insomnia) or hypoxia/hypercarbia (e.g., chronic obstructive pulmonary disease (COPD)). Assessment of the cognitive deficits observed in these other disorders could help better define the mechanisms underlying cognitive deficits in OSA. This study utilised meta-review methodology to examine the findings from systematic reviews and meta-analyses of the effects of untreated OSA, COPD, insomnia, and sleep deprivation on cognitive function in adults, compared with norms or controls. Eighteen papers met inclusion criteria: seven in OSA, two in insomnia, five in COPD, and four in sleep deprivation. OSA and COPD were both accompanied by deficits in attention, memory, executive function, psychomotor function, and language abilities, suggesting that hypoxia/hypercarbia may be an important determinant of deficits in these domains in OSA. Both OSA and sleep deprivation studies were accompanied by deficits in attention and memory, suggesting that short-term sleep disturbance in OSA may contribute to deficits in these domains. Visuospatial deficits were unique to OSA, suggesting the contribution of a mechanism other than sleep disturbance and hypoxia/hypercarbia to this problem. Our findings suggest that the cognitive deficits associated with untreated OSA are multidimensional, with different physiological disturbances responsible for differing cognitive problems.

8 Review Anaesthetic management of sleep-disordered breathing in adults. 2017

Hillman, David R / Chung, Frances. ·Centre for Sleep Science, University of Western Australia, Perth, Western Australia, Australia. · Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. · Department of Anesthesiology and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. ·Respirology · Pubmed #27988979.

ABSTRACT: Anaesthesia and sleep are different states of unconsciousness with considerable physiological common ground. Because of their shared depressant effects on muscle activation and ventilatory drive, patients with anatomically compromised airways will tend to obstruct in either state and those with impaired ventilatory capacity will tend to hypoventilate. Breathing behaviour in one state is predictive of that in the other. An essential difference is that while arousal responses are preserved during sleep, they are depressed during sedation and abolished by anaesthesia. This renders patients with sleep-related breathing disorders vulnerable to hypoventilation and asphyxia when deeply sedated. Addressing this vulnerability requires a systematic approach to identification of patients and circumstances that magnify this risk, and methods of managing it that seek to reconcile the need for safety with cost-effective use of resources.

9 Review Anesthesia, sleep, and upper airway collapsibility. 2010

Hillman, David R / Platt, Peter R / Eastwood, Peter R. ·West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Perth, Australia. David.Hillman@health.wa.gov.au ·Anesthesiol Clin · Pubmed #20850076.

ABSTRACT: Anesthesia and sleep both predispose to upper airway obstruction through state-induced reductions in pharyngeal dilator muscle activation and lung volume. The tendencies are related in patients with obstructive sleep apnea commonly presenting with difficulties in airway management in the perioperative period. This is a period of great potential vulnerability for such patients because of compromise of the arousal responses that protect against asphyxiation during natural sleep. Careful preoperative evaluation and insightful perioperative observation are likely to identify patients at risk. A significant proportion of patients will have previously undiagnosed obstructive sleep apnea and anesthesiologists are well placed to identify this potential. Patients with known or suspected obstructive sleep apnea need careful postoperative management, particularly while consciousness and arousal responses are impaired. Specific follow-up of suspected cases is needed to ensure that the sleep-related component of the problem receives appropriate care.

10 Review Obstructive Sleep Apnoea: From pathogenesis to treatment: Current controversies and future directions. 2010

Eastwood, Peter R / Malhotra, Atul / Palmer, Lyle J / Kezirian, Eric J / Horner, Richard L / Ip, Mary S / Thurnheer, Robert / Antic, Nick A / Hillman, David R. ·West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia. peter.eastwood@health.wa.gov.au ·Respirology · Pubmed #20136736.

ABSTRACT: Obstructive sleep apnoea (OSA) is a common disease, recognized as an independent risk factor for a range of clinical conditions, such as hypertension, stroke, depression and diabetes. Despite extensive research over the past two decades, the mechanistic links between OSA and other associated clinical conditions, including metabolic disorders and cardiovascular disease, remain unclear. Indeed, the pathogenesis of OSA itself remains incompletely understood. This review provides opinions from a number of leading experts on issues related to OSA and its pathogenesis, interaction with anaesthesia, metabolic consequences and comorbidities, cardiovascular disease, genetics, measurement and diagnosis, surgical treatment and pharmacotherapeutic targets.

11 Review Obesity and the lung: 3. Obesity, respiration and intensive care. 2008

Malhotra, A / Hillman, D. ·Pulmonary and Critical Care and Sleep Medicine Divisions, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. amalhotra1@partners.org ·Thorax · Pubmed #18820119.

ABSTRACT: Obesity is a major problem from a public health perspective and a difficult practical matter for intensivists. The obesity pandemic has required treating clinicians to develop an appreciation of the substantial pathophysiological effects of obesity on the various organ systems. The important physiological concepts are illustrated by focusing on obstructive sleep apnoea, obesity hypoventilation syndrome, abdominal compartment syndrome and ventilatory management of the obese patient with acute respiratory distress syndrome.

12 Clinical Trial Effects on upper airway collapsibility of presence of a pharyngeal catheter. 2015

Maddison, Kathleen J / Shepherd, Kelly L / Baker, Vanessa A / Lawther, Bradley / Platt, Peter / Hillman, David R / Eastwood, Peter R / Walsh, Jennifer H. ·Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, WA, Australia; West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia. ·J Sleep Res · Pubmed #25131139.

ABSTRACT: Catheters that traverse the pharynx are often in place during clinical or research evaluations of upper airway function. The purpose of this study was to determine whether the presence of such catheters affects measures of upper airway collapsibility itself. To do so, pharyngeal critical closing pressure (Pcrit) and resistance upstream of the site of collapse Rus) were assessed in 24 propofol-anaesthetized subjects (14 men) with and without a multi-sensor oesophageal catheter (external diameter 2.7 mm) in place. Anaesthetic depth and posture were maintained constant throughout each study. Six subjects had polysomnography(PSG)-defined obstructive sleep apnea (OSA) and 18 either did not have or were at low risk of OSA. Airway patency was maintained with positive airway pressure. At intervals, pressure was reduced by varying amounts to induce varying degrees of inspiratory flow limitation. The slope of the pressure flow relationship for flow-limited breaths defined Rus. Pcrit was similar with the catheter in and out (-1.5 ± 5.4 cmH2 O and -2.1 ± 5.6 cmH2O, respectively, P = 0.14, n = 24). This remained the case both for those with PSG-defined OSA (3.9 ± 2.2 cmH2O and 2.6 ± 1.4 cmH2O, n = 6) and those at low risk/without OSA (-3.3 ± 4.9 cmH2O and -3.7 ± 5.6 cmH2O, respectively, n = 18). Rus was similar with the catheter in and out (20.0 ± 12.3 cmH2O mL(-1) s(-1) and 16.8 ± 10.1 cmH2O mL(-1) s(-1), P = 0.22, n = 24). In conclusion, the presence of a small catheter traversing the pharynx had no significant effect on upper airway collapsibility in these anaesthestized subjects, providing reassurance that such measures can be made reliably in their presence.

13 Clinical Trial Hypoglossal nerve stimulation improves obstructive sleep apnea: 12-month outcomes. 2014

Kezirian, Eric J / Goding, George S / Malhotra, Atul / O'Donoghue, Fergal J / Zammit, Gary / Wheatley, John R / Catcheside, Peter G / Smith, Philip L / Schwartz, Alan R / Walsh, Jennifer H / Maddison, Kathleen J / Claman, David M / Huntley, Tod / Park, Steven Y / Campbell, Matthew C / Palme, Carsten E / Iber, Conrad / Eastwood, Peter R / Hillman, David R / Barnes, Maree. ·Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. ·J Sleep Res · Pubmed #24033656.

ABSTRACT: Reduced upper airway muscle activity during sleep is a key contributor to obstructive sleep apnea pathogenesis. Hypoglossal nerve stimulation activates upper airway dilator muscles, including the genioglossus, and has the potential to reduce obstructive sleep apnea severity. The objective of this study was to examine the safety, feasibility and efficacy of a novel hypoglossal nerve stimulation system (HGNS; Apnex Medical, St Paul, MN, USA) in treating obstructive sleep apnea at 12 months following implantation. Thirty-one subjects (35% female, age 52.4 ± 9.4 years) with moderate to severe obstructive sleep apnea and unable to tolerate positive airway pressure underwent surgical implantation and activation of the hypoglossal nerve stimulation system in a prospective single-arm interventional trial. Primary outcomes were changes in obstructive sleep apnea severity (apnea-hypopnea index, from in-laboratory polysomnogram) and sleep-related quality of life [Functional Outcomes of Sleep Questionnaire (FOSQ)]. Hypoglossal nerve stimulation was used on 86 ± 16% of nights for 5.4 ± 1.4 h per night. There was a significant improvement (P < 0.001) from baseline to 12 months in apnea-hypopnea index (45.4 ± 17.5 to 25.3 ± 20.6 events h(-1) ) and Functional Outcomes of Sleep Questionnaire score (14.2 ± 2.0 to 17.0 ± 2.4), as well as other polysomnogram and symptom measures. Outcomes were stable compared with 6 months following implantation. Three serious device-related adverse events occurred: an infection requiring device removal; and two stimulation lead cuff dislodgements requiring replacement. There were no significant adverse events with onset later than 6 months following implantation. Hypoglossal nerve stimulation demonstrated favourable safety, feasibility and efficacy.

14 Clinical Trial Effect of continuous positive airway pressure therapy on cardiovascular risk factors in patients with type 2 diabetes and obstructive sleep apnea. 2012

Myhill, Paul C / Davis, Wendy A / Peters, Kirsten E / Chubb, S A Paul / Hillman, David / Davis, Timothy M E. ·University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, P.O. Box 480, Fremantle, Western Australia 6959, Australia. ·J Clin Endocrinol Metab · Pubmed #22962427.

ABSTRACT: CONTEXT: Few prospective intervention studies have examined the effect of continuous positive airway pressure (CPAP) therapy on cardiovascular disease (CVD) risk factors in diabetes. OBJECTIVE: Our objective was to determine whether CPAP improves CVD risk factors in patients with type 2 diabetes and obstructive sleep apnea (OSA). DESIGN AND SETTING: This was a randomized parallel group intervention trial in an urban Australian community. PATIENTS: Fifty-nine participants of the Fremantle Diabetes Study Phase II at high risk for OSA consented to confirmatory polysomnography followed by randomization to a 3-month CPAP intervention initiated early (<1 wk) or late (1-2 months). MAIN OUTCOME MEASURES: Patients were assessed before and 1 and 3 months after CPAP started. Tests for repeated measures were used to compare variables of interest over time. RESULTS: Forty-four patients (75%) completed the study. Their mean ± sd age was 66.1 ± 8.8 yr, and 61.4% were male. Completers and noncompleters had similar age, sex, diabetes duration, apnea-hypopnea index, and Epworth Sleepiness Scale (P ≥ 0.29). There were no differences in outcome between early and late randomization, and the data were pooled. The Epworth Sleepiness Scale decreased between entry and 1 month [-4.8 (-6.5 to -3.1), P < 0.001]. Blood pressure improved between entry and 3 months (from 149 ± 23/80 ± 12 to 140 ± 18/73 ± 13 mm Hg; P ≤ 0.007). Pulse rate declined within the first month [-6 (-10 to -2) beats/min, P = 0.002]. Glycemic control and serum lipids, which were mostly within recommended target ranges at entry, did not change. CONCLUSIONS: Three months of CPAP in community-based people with type 2 diabetes significantly decreased blood pressure and pulse rate but did not influence metabolic control.

15 Clinical Trial Acute upper airway responses to hypoglossal nerve stimulation during sleep in obstructive sleep apnea. 2012

Schwartz, Alan R / Barnes, Maree / Hillman, David / Malhotra, Atul / Kezirian, Eric / Smith, Philip L / Hoegh, Thomas / Parrish, Daniel / Eastwood, Peter R. ·Johns Hopkins School of Medicine, Baltimore, MD 21224, USA. aschwar2@jhmi.edu ·Am J Respir Crit Care Med · Pubmed #22135343.

ABSTRACT: RATIONALE: Hypoglossal nerve stimulation (HGNS) recruits lingual muscles, reduces pharyngeal collapsibility, and treats sleep apnea. OBJECTIVES: We hypothesized that graded increases in HGNS relieve pharyngeal obstruction progressively during sleep. METHODS: Responses were examined in 30 patients with sleep apnea who were implanted with an HGNS system. Current (milliampere) was increased stepwise during non-REM sleep. Frequency and pulse width were fixed. At each current level, stimulation was applied on alternating breaths, and responses in maximal inspiratory airflow (V(I)max) and inspiratory airflow limitation (IFL) were assessed. Pharyngeal responses to HGNS were characterized by the current levels at which V(I)max first increased and peaked (flow capture and peak flow thresholds), and by the V(I)max increase from flow capture to peak (ΔV(I)max). MEASUREMENTS AND MAIN RESULTS: HGNS produced linear increases in V(I)max from unstimulated levels at flow capture to peak flow thresholds (215 ± 21 to 509 ± 37 ml/s; mean ± SE; P < 0.001) with increasing current from 1.05 ± 0.09 to 1.46 ± 0.11 mA. V(I)max increased in all patients and IFL was abolished in 57% of patients (non-IFL subgroup). In the non-IFL compared with IFL subgroup, the flow response slope was greater (1241 ± 199 vs. 674 ± 166 ml/s/mA; P < 0.05) and the stimulation amplitude at peak flow was lower (1.23 ± 0.10 vs. 1.80 ± 0.20 mA; P < 0.05) without differences in peak flow. CONCLUSIONS: HGNS produced marked dose-related increases in airflow without arousing patients from sleep. Increases in airflow were of sufficient magnitude to eliminate IFL in most patients and IFL and non-IFL subgroups achieved normal or near-normal levels of flow, suggesting potential HGNS efficacy across a broad range of sleep apnea severity.

16 Clinical Trial Treating obstructive sleep apnea with hypoglossal nerve stimulation. 2011

Eastwood, Peter R / Barnes, Maree / Walsh, Jennifer H / Maddison, Kathleen J / Hee, Geoffrey / Schwartz, Alan R / Smith, Philip L / Malhotra, Atul / McEvoy, R Douglas / Wheatley, John R / O'Donoghue, Fergal J / Rochford, Peter D / Churchward, Tom / Campbell, Matthew C / Palme, Carsten E / Robinson, Sam / Goding, George S / Eckert, Danny J / Jordan, Amy S / Catcheside, Peter G / Tyler, Louise / Antic, Nick A / Worsnop, Christopher J / Kezirian, Eric J / Hillman, David R. ·Sir Charles Gairdner Hospital, Perth, Australia. Peter.Eastwood@health.wa.gov.au ·Sleep · Pubmed #22043118.

ABSTRACT: BACKGROUND: Reduced upper airway muscle activity during sleep is fundamental to obstructive sleep apnea (OSA) pathogenesis. Hypoglossal nerve stimulation (HGNS) counteracts this problem, with potential to reduce OSA severity. STUDY OBJECTIVES: To examine safety and efficacy of a novel HGNS system (HGNS, Apnex Medical, Inc.) in treating OSA. PARTICIPANTS: Twenty-one patients, 67% male, age (mean ± SD) 53.6 ± 9.2 years, with moderate to severe OSA and unable to tolerate continuous positive airway pressure (CPAP). DESIGN: Each participant underwent surgical implantation of the HGNS system in a prospective single-arm interventional trial. OSA severity was defined by apnea-hypopnea index (AHI) during in-laboratory polysomnography (PSG) at baseline and 3 and 6 months post-implant. Therapy compliance was assessed by nightly hours of use. Symptoms were assessed using the Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Calgary Sleep Apnea Quality of Life Index (SAQLI), and the Beck Depression Inventory (BDI). RESULTS: HGNS was used on 89% ± 15% of nights (n = 21). On these nights, it was used for 5.8 ± 1.6 h per night. Nineteen of 21 participants had baseline and 6-month PSGs. There was a significant improvement (all P < 0.05) from baseline to 6 months in: AHI (43.1 ± 17.5 to 19.5 ± 16.7), ESS (12.1 ± 4.7 to 8.1 ± 4.4), FOSQ (14.4 ± 2.0 to 16.7 ± 2.2), SAQLI (3.2 ± 1.0 to 4.9 ± 1.3), and BDI (15.8 ± 9.0 to 9.7 ± 7.6). Two serious device-related adverse events occurred: an infection requiring device removal and a stimulation lead cuff dislodgement requiring replacement. CONCLUSIONS: HGNS demonstrated favorable safety, efficacy, and compliance. Participants experienced a significant decrease in OSA severity and OSA-associated symptoms. CLINICAL TRIAL INFORMATION: NAME: Australian Clinical Study of the Apnex Medical HGNS System to Treat Obstructive Sleep Apnea. REGISTRATION NUMBER: NCT01186926. URL: http://clinicaltrials.gov/ct2/show/NCT01186926.

17 Clinical Conference Knowledge Gaps in the Perioperative Management of Adults with Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome. An Official American Thoracic Society Workshop Report. 2018

Ayas, Najib T / Laratta, Cheryl R / Coleman, John M / Doufas, Anthony G / Eikermann, Matthias / Gay, Peter C / Gottlieb, Daniel J / Gurubhagavatula, Indira / Hillman, David R / Kaw, Roop / Malhotra, Atul / Mokhlesi, Babak / Morgenthaler, Timothy I / Parthasarathy, Sairam / Ramachandran, Satya Krishna / Strohl, Kingman P / Strollo, Patrick J / Twery, Michael J / Zee, Phyllis C / Chung, Frances F / Anonymous631114. · ·Ann Am Thorac Soc · Pubmed #29388810.

ABSTRACT: The purpose of this workshop was to identify knowledge gaps in the perioperative management of obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). A single-day meeting was held at the American Thoracic Society Conference in May, 2016, with representation from many specialties, including anesthesiology, perioperative medicine, sleep, and respiratory medicine. Further research is urgently needed as we look to improve health outcomes for these patients and reduce health care costs. There is currently insufficient evidence to guide screening and optimization of OSA and OHS in the perioperative setting to achieve these objectives. Patients who are at greatest risk of respiratory or cardiac complications related to OSA and OHS are not well defined, and the effectiveness of monitoring and other interventions remains to be determined. Centers involved in sleep research need to develop collaborative networks to allow multicenter studies to address the knowledge gaps identified below.

18 Article Associations of variants In the hexokinase 1 and interleukin 18 receptor regions with oxyhemoglobin saturation during sleep. 2019

Cade, Brian E / Chen, Han / Stilp, Adrienne M / Louie, Tin / Ancoli-Israel, Sonia / Arens, Raanan / Barfield, Richard / Below, Jennifer E / Cai, Jianwen / Conomos, Matthew P / Evans, Daniel S / Frazier-Wood, Alexis C / Gharib, Sina A / Gleason, Kevin J / Gottlieb, Daniel J / Hillman, David R / Johnson, W Craig / Lederer, David J / Lee, Jiwon / Loredo, Jose S / Mei, Hao / Mukherjee, Sutapa / Patel, Sanjay R / Post, Wendy S / Purcell, Shaun M / Ramos, Alberto R / Reid, Kathryn J / Rice, Ken / Shah, Neomi A / Sofer, Tamar / Taylor, Kent D / Thornton, Timothy A / Wang, Heming / Yaffe, Kristine / Zee, Phyllis C / Hanis, Craig L / Palmer, Lyle J / Rotter, Jerome I / Stone, Katie L / Tranah, Gregory J / Wilson, James G / Sunyaev, Shamil R / Laurie, Cathy C / Zhu, Xiaofeng / Saxena, Richa / Lin, Xihong / Redline, Susan. ·Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, United States of America. · Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States of America. · Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, United States of America. · Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX United States of America. · Center for Precision Health, School of Public Health and School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX United States of America. · Department of Biostatistics, University of Washington, Seattle, WA United States of America. · Department of Psychiatry, University of California, San Diego, CA, United States of America. · The Children's Hospital at Montefiore, Division of Respiratory and Sleep Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America. · Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America. · Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States of America. · Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America. · California Pacific Medical Center Research Institute, San Francisco, CA, United States of America. · USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States of America. · Computational Medicine Core, Center for Lung Biology, UW Medicine Sleep Center, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle WA, United States of America. · Department of Public Health Sciences, University of Chicago, Chicago, IL, United States of America. · VA Boston Healthcare System, Boston, MA, United States of America. · Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. · Departments of Medicine and Epidemiology, Columbia University, New York, NY, United States of America. · Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, UC San Diego School of Medicine, La Jolla, CA, United States of America. · Department of Data Science, University of Mississippi Medical Center, Jackson, MS, United States of America. · Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia. · Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia. · Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America. · Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States of America. · Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States of America. · Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America. · Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America. · The Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, United States of America. · Department of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, United States of America. · San Francisco VA Medical Center, San Francisco, CA, United States of America. · School of Public Health, University of Adelaide, South Australia, Australia. · Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson MS, United States of America. · Division of Genetics, Brigham and Women's Hospital, Boston, MA, United States of America. · Division of Medical Sciences, Harvard Medical School, Boston, MA, United States of America. · Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States of America. · Center for Genomic Medicine and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, United States of America. · Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America. ·PLoS Genet · Pubmed #30990817.

ABSTRACT: Sleep disordered breathing (SDB)-related overnight hypoxemia is associated with cardiometabolic disease and other comorbidities. Understanding the genetic bases for variations in nocturnal hypoxemia may help understand mechanisms influencing oxygenation and SDB-related mortality. We conducted genome-wide association tests across 10 cohorts and 4 populations to identify genetic variants associated with three correlated measures of overnight oxyhemoglobin saturation: average and minimum oxyhemoglobin saturation during sleep and the percent of sleep with oxyhemoglobin saturation under 90%. The discovery sample consisted of 8,326 individuals. Variants with p < 1 × 10(-6) were analyzed in a replication group of 14,410 individuals. We identified 3 significantly associated regions, including 2 regions in multi-ethnic analyses (2q12, 10q22). SNPs in the 2q12 region associated with minimum SpO2 (rs78136548 p = 2.70 × 10(-10)). SNPs at 10q22 were associated with all three traits including average SpO2 (rs72805692 p = 4.58 × 10(-8)). SNPs in both regions were associated in over 20,000 individuals and are supported by prior associations or functional evidence. Four additional significant regions were detected in secondary sex-stratified and combined discovery and replication analyses, including a region overlapping Reelin, a known marker of respiratory complex neurons.These are the first genome-wide significant findings reported for oxyhemoglobin saturation during sleep, a phenotype of high clinical interest. Our replicated associations with HK1 and IL18R1 suggest that variants in inflammatory pathways, such as the biologically-plausible NLRP3 inflammasome, may contribute to nocturnal hypoxemia.

19 Article Healthcare-seeking behaviour and utilization of treatment in a community-based screening study for obstructive sleep apnoea in Busselton, Western Australia. 2019

Munks, Rhian / Knuiman, Matthew / Hunter, Michael / Hillman, David / Divitini, Mark / James, Alan. ·Faculty of Health and Medical Sciences, University of Western Australia, Nedlands, WA 6009, Australia. · School of Population and Global Health, University of Western Australia, Nedlands, WA 6009, Australia. Electronic address: matthew.knuiman@uwa.edu.au. · School of Population and Global Health, University of Western Australia, Nedlands, WA 6009, Australia; Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia. · Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia. · School of Population and Global Health, University of Western Australia, Nedlands, WA 6009, Australia. ·Sleep Health · Pubmed #30670173.

ABSTRACT: OBJECTIVES: To investigate whether in-home screening for obstructive sleep apnoea (OSA) promotes healthcare-seeking or lifestyle modification behaviour. We also examined the uptake and adherence rates to different treatment options, the factors affecting adherence, and the impact of treatment on health-related quality of life. DESIGN: Follow-up survey of adults at high risk of OSA. SETTING: Community-based sample. PARTICIPANTS: Adults who completed an in-home sleep study in the 2005-07 or 2010-15 Busselton surveys of adults with apnoea-hypopnoea index (AHI) > 15 (n = 192). MEASUREMENTS: The follow-up questionnaire was administered in 2016 and assessed healthcare-seeking and lifestyle modification behaviour, treatment utilization and adherence, and health-related quality of life. RESULTS: Of the 159 that recalled receiving a result from their in-home sleep study, 65% (n = 103) sought help and/or made lifestyle changes, 49% (n = 78) discussed the results with their GP, 21% (n = 33) underwent a confirmatory study and 33% (n = 53) started treatment. The most common treatment used was continuous positive airway pressure (CPAP) (72%) and adherence rates were high (84%). Self-reported snoring, breathing pauses, daytime tiredness and AHI were identified as predictors of whether people displayed healthcare-seeking behaviour. CONCLUSIONS: This study provides promising evidence that in-home screening for OSA could contribute towards relieving the associated morbidity, especially if health promotion strategies including education are implemented.

20 Article Multiethnic Meta-Analysis Identifies RAI1 as a Possible Obstructive Sleep Apnea-related Quantitative Trait Locus in Men. 2018

Chen, Han / Cade, Brian E / Gleason, Kevin J / Bjonnes, Andrew C / Stilp, Adrienne M / Sofer, Tamar / Conomos, Matthew P / Ancoli-Israel, Sonia / Arens, Raanan / Azarbarzin, Ali / Bell, Graeme I / Below, Jennifer E / Chun, Sung / Evans, Daniel S / Ewert, Ralf / Frazier-Wood, Alexis C / Gharib, Sina A / Haba-Rubio, José / Hagen, Erika W / Heinzer, Raphael / Hillman, David R / Johnson, W Craig / Kutalik, Zoltan / Lane, Jacqueline M / Larkin, Emma K / Lee, Seung Ku / Liang, Jingjing / Loredo, Jose S / Mukherjee, Sutapa / Palmer, Lyle J / Papanicolaou, George J / Penzel, Thomas / Peppard, Paul E / Post, Wendy S / Ramos, Alberto R / Rice, Ken / Rotter, Jerome I / Sands, Scott A / Shah, Neomi A / Shin, Chol / Stone, Katie L / Stubbe, Beate / Sul, Jae Hoon / Tafti, Mehdi / Taylor, Kent D / Teumer, Alexander / Thornton, Timothy A / Tranah, Gregory J / Wang, Chaolong / Wang, Heming / Warby, Simon C / Wellman, D Andrew / Zee, Phyllis C / Hanis, Craig L / Laurie, Cathy C / Gottlieb, Daniel J / Patel, Sanjay R / Zhu, Xiaofeng / Sunyaev, Shamil R / Saxena, Richa / Lin, Xihong / Redline, Susan. ·1 Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. · 2 Human Genetics Center, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health and. · 3 Center for Precision Health, School of Public Health & School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas. · 4 Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts. · 5 Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts. · 6 Department of Public Health Sciences, University of Chicago, Chicago, Illinois. · 7 Division of Genetics, Brigham and Women's Hospital, Boston, Massachusetts. · 8 Center for Genomic Medicine and Department of Anesthesia, Pain, and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts. · 9 Department of Biostatistics, University of Washington, Seattle, Washington. · 10 Departments of Medicine and Psychiatry, University of California, San Diego, California. · 11 the Children's Hospital at Montefiore, Division of Respiratory and Sleep Medicine, Albert Einstein College of Medicine, Bronx, New York. · 12 Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, the University of Chicago, Chicago, Illinois. · 13 Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee. · 14 Division of Medical Sciences, Harvard Medical School, Boston, Massachusetts. · 15 California Pacific Medical Center Research Institute, San Francisco, California. · 16 Internal Medicine B, University Medicine Greifswald, Greifswald, Germany. · 17 Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas. · 18 Computational Medicine Core, Center for Lung Biology, University of Washington Medicine Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington. · 19 Center of Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland. · 20 Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin. · 21 Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. · 22 Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland. · 23 Swiss Institute of Bioinformatics, Lausanne, Switzerland. · 24 Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts. · 25 Department of Medicine, Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee. · 26 Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Jeokgum-ro, Danwon-gu, Ansan-si, Gyeonggi-Do, Republic of Korea. · 27 Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio. · 28 Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California. · 29 Adelaide Institute for Sleep Health, Flinders Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia. · 30 School of Public Health, University of Adelaide, Adelaide, South Australia, Australia. · 31 Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland. · 32 University Hospital Charité Berlin, Sleep Center, Berlin, Germany. · 33 Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. · 34 Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida. · 35 Institute for Translational Genomics and Population Sciences, Los Angeles BioMedical Research Institute and Department of Pediatrics at Harbor-University of California Los Angeles Medical Center, Torrance, California. · 36 Division of Pulmonary, Critical Care, and Sleep, Icahn School of Medicine at Mount Sinai, New York, New York. · 37 Department of Pulmonary, Sleep, and Critical Care Medicine, College of Medicine, Korea University Ansan Hospital, Jeokgum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Republic of Korea. · 38 Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California. · 39 Department of Physiology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. · 40 Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany. · 41 Computational and Systems Biology, Genome Institute of Singapore, Singapore. · 42 Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada. · 43 Department of Neurology and Sleep Medicine Center, Northwestern University, Chicago, Illinois. · 44 Veterans Affairs Boston Healthcare System, Boston, Massachusetts. · 45 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. · 46 Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts; and. · 47 Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. ·Am J Respir Cell Mol Biol · Pubmed #29077507.

ABSTRACT: Obstructive sleep apnea (OSA) is a common heritable disorder displaying marked sexual dimorphism in disease prevalence and progression. Previous genetic association studies have identified a few genetic loci associated with OSA and related quantitative traits, but they have only focused on single ethnic groups, and a large proportion of the heritability remains unexplained. The apnea-hypopnea index (AHI) is a commonly used quantitative measure characterizing OSA severity. Because OSA differs by sex, and the pathophysiology of obstructive events differ in rapid eye movement (REM) and non-REM (NREM) sleep, we hypothesized that additional genetic association signals would be identified by analyzing the NREM/REM-specific AHI and by conducting sex-specific analyses in multiethnic samples. We performed genome-wide association tests for up to 19,733 participants of African, Asian, European, and Hispanic/Latino American ancestry in 7 studies. We identified rs12936587 on chromosome 17 as a possible quantitative trait locus for NREM AHI in men (N = 6,737; P = 1.7 × 10

21 Article Treating Chronic Hypoventilation With Automatic Adjustable Versus Fixed EPAP Intelligent Volume-Assured Positive Airway Pressure Support (iVAPS): A Randomized Controlled Trial. 2017

McArdle, Nigel / Rea, Clare / King, Stuart / Maddison, Kathleen / Ramanan, Dinesh / Ketheeswaran, Sahisha / Erikli, Lisa / Baker, Vanessa / Armitstead, Jeff / Richards, Glenn / Singh, Bhajan / Hillman, David / Eastwood, Peter. ·Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, University of Western Australia, Nedlands, Australia. · West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia. · ResMed Science Centre, Bella Vista, Sydney, Australia. ·Sleep · Pubmed #28958052.

ABSTRACT: Objectives: New noninvasive ventilation (NIV) modes can automatically adjust pressure support settings to deliver effective ventilation in response to varying ventilation demands. It is recommended that fixed expiratory positive airway pressure (FixedEPAP) is determined by attended laboratory polysomnographic (PSG) titration. This study investigated whether automatically determined EPAP (AutoEPAP) was noninferior to FixedEPAP for the control of obstructive sleep apnea (OSA) during intelligent volume-assured pressure support (iVAPS) treatment of chronic hypoventilation. Methods: In this randomized, double-blind, crossover study, patients with chronic hypoventilation and OSA used iVAPS with AutoEPAP or FixedEPAP over two separate nights of attended PSG. PSG recordings were scored by an independent scorer using American Academy of Sleep Medicine 2012 criteria. Results: Twenty-five adults (14 male) with chronic hypoventilation secondary to obesity hypoventilation syndrome (n = 11), chronic obstructive pulmonary disease (n = 9), or neuromuscular disease (n = 5), all of whom were on established home NIV therapy, were included (age 57 ± 7 years, NIV for ≥3 months, apnea-hypopnea index [AHI] >5/hour). AutoEPAP was noninferior to FixedEPAP for the primary outcome measure (median [interquartile range] AHI 2.70 [1.70-6.05]/hour vs. 2.40 [0.25-5.95]/hour; p = .86). There were no significant between-mode differences in PSG sleep breathing and sleep quality, or self-reported sleep quality, device comfort, and patient preference. Mean EPAP with the Auto and Fixed modes was 10.8 ± 2.0 and 11.8 ± 3.9 cmH2O, respectively (p = .15). Conclusions: In patients with chronic hypoventilation using iVAPS, the AutoEPAP algorithm was noninferior to FixedEPAP over a single night's therapy.

22 Article Assessment of the Depression, Anxiety, and Stress Scale (DASS-21) in untreated obstructive sleep apnea (OSA). 2017

Nanthakumar, Shenooka / Bucks, Romola S / Skinner, Timothy C / Starkstein, Sergio / Hillman, David / James, Alan / Hunter, Michael. ·School of Psychology, University of Western Australia. · School of Psychological and Clinical Sciences, Charles Darwin University. · School of Psychiatry and Clinical Neurosciences, University of Western Australia. · West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital. · School of Medicine and Pharmacology, University of Western Australia. · School of Population Health, University of Western Australia. ·Psychol Assess · Pubmed #27936819.

ABSTRACT: The assessment of depression in obstructive sleep apnea (OSA) is confounded by symptom overlap. The Depression, Anxiety, and Stress Scale-short form (DASS-21) is a commonly used measure of negative affect, but it not known whether the DASS-21 is suitable for use in an OSA sample. This study compared the fit of Lovibond and Lovibond's (1995) correlated 3-factor structure of the DASS-21 and measurement invariance between a non-OSA and an OSA sample using confirmatory factor analysis. As measurement invariance was not found, to determine the source of non-invariance differential item functioning (DIF) was examined using dMACS. The correlated 3-factor structure (with correlated errors) of the DASS-21 was a better fit in the non-OSA sample. dMACS indicated that there was a degree of DIF for each of the subscales, especially for the Anxiety subscale, in which 2 symptoms (that are also physiological symptoms of OSA) produced lower severity scores in the OSA sample compared with the non-OSA sample. However, the degree of DIF for each of the subscales is not sufficient to cause concern when using the DASS-21; therefore, the total DASS-21 is suitable for use in an OSA sample. Interestingly, the impact of symptom overlap in anxiety symptoms may be reducing anxiety scores because of DIF, which contrasts with the proposed effect of symptom overlap in depression, where it leads to the inflation of depression scores in OSA. This deserves greater consideration in relation to OSA and other clinical disorders or chronic illness conditions with different patterns of overlapping symptoms. (PsycINFO Database Record

23 Article A randomised controlled trial of CPAP versus non-invasive ventilation for initial treatment of obesity hypoventilation syndrome. 2017

Howard, Mark E / Piper, Amanda J / Stevens, Bronwyn / Holland, Anne E / Yee, Brendon J / Dabscheck, Eli / Mortimer, Duncan / Burge, Angela T / Flunt, Daniel / Buchan, Catherine / Rautela, Linda / Sheers, Nicole / Hillman, David / Berlowitz, David J. ·Institute for Breathing and Sleep, Heidelberg, Australia. · Austin Health, Heidelberg, Australia. · University of Melbourne, Parkville, Australia. · Monash University, Clayton, Australia. · Royal Prince Alfred Hospital, Camperdown, Australia. · Alfred Health, Melbourne, Australia. · La Trobe University, Melbourne, Australia. · Sir Charles Gairdner Hospital, Nedlands, Australia. ·Thorax · Pubmed #27852952.

ABSTRACT: BACKGROUND: Obesity hypoventilation syndrome (OHS) is the most common indication for home ventilation, although the optimal therapy remains unclear, particularly for severe disease. We compared Bi-level and continuous positive airways pressure (Bi-level positive airway pressure (PAP); CPAP) for treatment of severe OHS. METHODS: We conducted a multicentre, parallel, double-blind trial for initial treatment of OHS, with participants randomised to nocturnal Bi-level PAP or CPAP for 3 months. The primary outcome was frequency of treatment failure (hospital admission, persistent ventilatory failure or non-adherence); secondary outcomes included health-related quality of life (HRQoL) and sleepiness. RESULTS: Sixty participants were randomised; 57 completed follow-up and were included in analysis (mean age 53 years, body mass index 55 kg/m CONCLUSIONS: In newly diagnosed severe OHS, Bi-level PAP and CPAP resulted in similar improvements in ventilatory failure, HRQoL and adherence. Baseline PaCO TRIAL REGISTRATION NUMBER: ACTRN12611000874910, results.

24 Article Predictive value of craniofacial and anthropometric measures in obstructive sleep apnea (OSA). 2017

Remya, Krishnan Jyothi / Mathangi, Krishnakumar / Mathangi, Damal Chandrasekhar / Sriteja, Yerlagadda / Srihari, Ramamoorthy / Govindaraju, Soundararajan / Hillman, David R / Eastwood, Peter R. ·a Department of Physiology , Chettinad Hospital & Research Institute , Kelambakkam , India. · b Department of Allied Health Sciences , Chettinad Hospital & Research Institute , Kelambakkam , India. · c West Australian Sleep Disorders Research Institute , University of Western Australia , Perth , Australia. ·Cranio · Pubmed #27425257.

ABSTRACT: BACKGROUND: Most individuals with OSA remain undiagnosed, mainly due to limited access to effective screening tools and diagnostic facilities. Therefore, the objective of this study was to identify craniofacial and anthropometric measurements that predict OSA in an Indian population. METHODS AND FINDINGS: Male subjects (n = 76) between 25 and 50 years of age were recruited for the study from the general population. The study measures consisted of home-based type IV polysomnography and a total of 40 anthropometric and craniofacial measurements. Key measures were identified, and a model was developed with these variables, which predicted the presence of OSA with a sensitivity, specificity and overall accuracy of 93.1, 20.0 and 74.4%, respectively. CONCLUSION: This preliminary study shows the utility of craniofacial and anthropometric variables in the identification of individuals at risk of OSA. These findings need to be further validated against the results of overnight polysomnography in a large independent population.

25 Article Physical Inactivity Is Associated with Moderate-Severe Obstructive Sleep Apnea. 2015

Simpson, Laila / McArdle, Nigel / Eastwood, Peter R / Ward, Kim L / Cooper, Matthew N / Wilson, Annette C / Hillman, David R / Palmer, Lyle J / Mukherjee, Sutapa. ·Centre for Genetic Origins of Health and Disease, University of Western Australia, Perth, Western Australia, Australia. · Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, Faculty Science, The University of Western Australia, Perth, Western Australia, Australia. · Western Australian Sleep Disorders Research Institute, Queen Elizabeth Medical Centre II, Perth, Western Australia, Australia. · Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Western Australia, Australia. · School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. · School of Population Health, University of Western Australia, Perth, Western Australia, Australia. · Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia. · School of Mathematics and Statistics, University of Western Australia, Perth, Western Australia, Australia. · The Joanna Briggs Institute and School for Translational Health Sciences, University of Adelaide, Adelaide, SA, Australia. · Adelaide Institute for Sleep Health, Adelaide, Australia. ·J Clin Sleep Med · Pubmed #26285117.

ABSTRACT: STUDY OBJECTIVE: To investigate whether low levels of physical activity were associated with an increased occurrence of obstructive sleep apnea (OSA), OSA-related symptoms, and cardiometabolic risk. METHODS: A case-control study design was used. OSA cases were patients referred to a sleep clinic for suspected OSA (n = 2,340). Controls comprised participants from the Busselton community (n = 1,931). Exercise and occupational activity were derived from questionnaire data. Associations were modelled using logistic and linear regression and adjusted for confounders. RESULTS: In comparison with moderate exercise, the high, low, and nil exercise groups had an odds ratio (OR) for moderate-severe OSA of 0.6 (95% CI 0.5-0.8), 1.6 (95% CI 1.2-2.0), and 2.7 (95% CI 1.9-3.7), respectively. Relative to men in heavy activity occupations, men in medium, light and sedentary occupations had an OR for moderate-severe OSA of 1.7 (95% CI 1.1-2.5), 2.1 (95% CI 1.4-3.2), and 1.8 (95% CI 1.2-2.8), respectively. Relative to women in medium activity occupations, women in light and sedentary occupations had an OR for moderate-severe OSA of 4.2 (95% CI 2.6-7.2) and 3.5 (2.0-6.0). OSA patients who adequately exercised had lower: levels of doctor-diagnosed depression (p = 0.047); symptoms of fatigue (p < 0.0001); systolic (p = 0.015) and diastolic blood pressure (p = 0.015); and C-reactive protein (CRP) (p = 0.003). CONCLUSIONS: Low levels of physical activity were associated with moderate-severe OSA. Exercise in individuals with OSA is associated with lower levels of depression, fatigue, blood pressure and CRP.

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