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Sleep Apnea Syndromes: HELP
Articles by Winfried Johannes Randerath
Based on 53 articles published since 2010
(Why 53 articles?)
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Between 2010 and 2020, W. Randerath wrote the following 53 articles about Sleep Apnea Syndromes.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline Non-CPAP therapies in obstructive sleep apnoea. 2011

Randerath, W J / Verbraecken, J / Andreas, S / Bettega, G / Boudewyns, A / Hamans, E / Jalbert, F / Paoli, J R / Sanner, B / Smith, I / Stuck, B A / Lacassagne, L / Marklund, M / Maurer, J T / Pepin, J L / Valipour, A / Verse, T / Fietze, I / Anonymous2150689. ·Institute for Pneumology at the University Witten/Herdecke,Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany. randerath@klinik-bethanien.de ·Eur Respir J · Pubmed #21406515.

ABSTRACT: In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS. This report summarises the efficacy of alternative treatment options in OSAS. An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine. Evidence supports the use of mandibular advancement devices in mild to moderate OSAS. Maxillomandibular osteotomy seems to be as efficient as continuous positive airway pressure (CPAP) in patients who refuse conservative treatment. Distraction osteogenesis is usefully applied in congenital micrognathia or midface hypoplasia. There is a trend towards improvment after weight reduction. Positional therapy is clearly inferior to CPAP and long-term compliance is poor. Drugs, nasal dilators and apnoea triggered muscle stimulation cannot be recommended as effective treatments of OSAS at the moment. Nasal surgery, radiofrequency tonsil reduction, tongue base surgery, uvulopalatal flap, laser midline glossectomy, tongue suspension and genioglossus advancement cannot be recommended as single interventions. Uvulopalatopharyngoplasty, pillar implants and hyoid suspension should only be considered in selected patients and potential benefits should be weighed against the risk of long-term side-effects. Multilevel surgery is only a salvage procedure for OSA patients.

2 Editorial Central sleep apnea: the problem of diagnosis. 2017

Randerath, W. ·University of Cologne, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Aufderhöherstraße 169-175, 42699, Solingen, Germany. Electronic address: randerath@klinik-bethanien.de. ·Sleep Med · Pubmed #28153696.

ABSTRACT: -- No abstract --

3 Editorial Continuous Positive Airway Pressure and Airway Hyperreactivity in Asthma: Lessons for Patients with Obstructive Sleep Apnea? 2016

Randerath, Winfried J. ·University of Cologne, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany. ·Ann Am Thorac Soc · Pubmed #27831810.

ABSTRACT: -- No abstract --

4 Editorial New rules on driver licensing for patients with obstructive sleep apnoea: EU Directive 2014/85/EU. 2016

Bonsignore, Maria R / Randerath, Winfried / Riha, Renata / Smyth, Dan / Gratziou, Christina / Goncalves, Marta / McNicholas, Walter T. ·DiBiMIS, University of Palermo and Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy marisa@ibim.cnr.it. · Pneumologie und Allergologie Zentrum für Schlaf - und Beatmungsmedizin, Krankenhaus Bethanien, Solingen, Germany. · Sleep and Respiratory Medicine, University of Edinburgh, Edinburgh, UK. · European Lung Foundation Chair. · Medical School, Athens University, Athens, Greece. · Institute of Public Health - University of Porto (ISPUP), Porto, Portugal. · Dept of Respiratory and Sleep Medicine, St. Vincent's University Hospital, University College Dublin, Dublin, Ireland. ·Eur Respir J · Pubmed #26721963.

ABSTRACT: -- No abstract --

5 Editorial Missing links. 2015

Randerath, W / Khayat, R / Arzt, M / Javaheri, S. ·Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Aufderhöher Str. 169, 42699 Solingen, Germany. Electronic address: randerath@klinik-bethanien.de. · Sleep Heart Program, The Ohio State University, Columbus, OH, USA. · Department of Internal Medicine II, University Hospital Regensburg, Germany. · Bethesda North Hospital, Professor Emeritus, University of Cincinnati, Cincinnati, Ohio, USA. ·Sleep Med · Pubmed #26611946.

ABSTRACT: -- No abstract --

6 Editorial Time for screening? 2014

Randerath, Winfried. ·Clinic of Pneumology and Allergology Center for Sleep Medicine and Respiratory Care, Bethanien Hospital, Aufderhöher Straße 169-175, 42699 Solingen, Germany Tel.: 0049/212/63-6000; fax: 0049/212/63-6005.. Electronic address: randerath@klinik-bethanien.de. ·Sleep Med · Pubmed #25277662.

ABSTRACT: -- No abstract --

7 Editorial Sleep HERMES: a European training project for respiratory sleep medicine. 2011

De Backer, W / Simonds, A K / Horn, V / Andreas, S / Bonsignore, M / Calverley, P / Donic, V / Lévy, P / Mitchell, S / McNicholas, W T / Morrell, M / Randerath, W / Riha, R L / Trang, H / Verbraecken, J / Palange, P. · ·Eur Respir J · Pubmed #21885409.

ABSTRACT: -- No abstract --

8 Review On the rise and fall of the apnea-hypopnea index: A historical review and critical appraisal. 2020

Pevernagie, Dirk A / Gnidovec-Strazisar, Barbara / Grote, Ludger / Heinzer, Raphael / McNicholas, Walter T / Penzel, Thomas / Randerath, Winfried / Schiza, Sophia / Verbraecken, Johan / Arnardottir, Erna S. ·Department of Lung Diseases, Ghent University Hospital, Gent, Belgium. · Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium. · Department of Paediatrics, General Hospital Celje and University of Ljubljana, Celje, Slovenia. · Department for Respiratory Disease, Sahlgrenska University Hospital, Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. · Pulmonary Department, Center for Investigation and Research in Sleep (CIRS), Lausanne University Hopital, Lausanne, Switzerland. · School of Medicine, University College Dublin, Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin, Ireland. · Interdisciplinary Sleep Medicine Center, Charité University Hospital Berlin, Berlin, Germany. · Russian Federation, Saratov State University, Saratov, Russia. · Institute of Pneumology at the University of Cologne, Solingen, Germany. · Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany. · Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Rethimno, Greece. · Department of Pulmonary Medicine, Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium. · Department of Engineering, Reykjavik University, Reykjavik, Iceland. · Internal Medicine Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. ·J Sleep Res · Pubmed #32406974.

ABSTRACT: The publication of "The Sleep Apnea Syndromes" by Guilleminault et al. in the 1970s hallmarked the discovery of a new disease entity involving serious health consequences. Obstructive sleep apnea was shown to be the most important disorder among the sleep apnea syndromes (SAS). In the course of time, it was found that the prevalence of obstructive sleep apnea reached the proportions of a global epidemic, with a major impact on public health, safety and the economy. Early on, a metric was introduced to gauge the seriousness of obstructive sleep apnea, based on the objective measurement of respiratory events during nocturnal sleep. The apnea index and later on the apnea-hypopnea index, being the total count of overnight respiratory events divided by the total sleep time in hours, were embraced as principle measures to establish the diagnosis of obstructive sleep apnea and to rate its severity. The current review summarises the historical evolution of the apnea-hypopnea index, which has been subject to many changes, and has been criticised for not capturing relevant clinical features of obstructive sleep apnea. In fact, the application of the apnea-hypopnea index as a continuous exposure variable is based on assumptions that it represents a disease state of obstructive sleep apnea and that evocative clinical manifestations are invariably caused by obstructive sleep apnea if the apnea-hypopnea index is above diagnostic threshold. A critical appraisal of the extensive literature shows that both assumptions are invalid. This conclusion prompts a reconsideration of the role of the apnea-hypopnea index as the prime diagnostic metric of clinically relevant obstructive sleep apnea.

9 Review Central sleep apnoea and periodic breathing in heart failure: prognostic significance and treatment options. 2019

Randerath, Winfried / Deleanu, Oana / Schiza, Sofia / Pepin, Jean-Louis. ·Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany randerath@klinik-bethanien.de. · University of Medicine and Pharmacy "Carol Davila" and Institute of Pneumology "Marius Nasta" Bucharest, Bucharest, Romania. · Sofia Schiza, University of Crete, Heraklion, Greece. · Laboratoire du sommeil explorations fonctionnelle Respire, Centre Hospitalier Universitaire Grenoble, Grenoble, France. ·Eur Respir Rev · Pubmed #31604817.

ABSTRACT: Central sleep apnoea (CSA) including periodic breathing is prevalent in more than one-third of patients with heart failure and is highly and independently associated with poor outcomes. Optimal treatment is still debated and well-conducted studies regarding efficacy and impact on outcomes of available treatment options are limited, particularly in cardiac failure with preserved ejection fraction. While continuous positive airway pressure and oxygen reduce breathing disturbances by 50%, adaptive servoventilation (ASV) normalises breathing disturbances by to controlling the underlying mechanism of CSA. Results are contradictory regarding impact of ASV on hard outcomes. Cohorts and registry studies show survival improvement under ASV, while secondary analyses of the large SERVE-HF randomised trial showed an excess mortality in cardiac failure with reduced ejection fraction. The current priority is to understand which phenotypes of cardiac failure patients may benefit from treatment guiding individualised and personalised management.

10 Review Obstructive sleep apnoea in acute coronary syndrome. 2019

Randerath, Winfried / Bonsignore, Maria R / Herkenrath, Simon. ·Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany randerath@klinik-bethanien.de. · DiBiMIS, University of Palermo, and CNR Institute of Biomedicine and Molecular Immunology (IBIM), Palermo, Italy. · Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany. ·Eur Respir Rev · Pubmed #31366458.

ABSTRACT: Obstructive sleep apnoea (OSA) syndrome affects about 13% of the male and 7-9% of the female population. Hypoxia, oxidative stress and systemic inflammation link OSA and cardiovascular and metabolic consequences, including coronary artery disease. Current research has identified several clinical phenotypes, and the combination of breathing disturbances during sleep, systemic effects and end-organ damage might help to develop personalised therapeutic approaches. It is unclear whether OSA is a risk factor for acute coronary syndrome (ACS) and might affect its outcome. On the one hand, OSA in patients with ACS may worsen prognosis; on the other hand, OSA-related hypoxaemia could favour the development of coronary collaterals, thereby exerting a protective effect. It is unknown whether positive airway pressure treatment may influence adverse events and consequences of ACS. In non-sleepy patients with OSA and stable coronary artery disease, randomised controlled trials failed to show that continuous positive airway pressure (CPAP) treatment protected against cardiovascular events. Conversely, uncontrolled studies suggested positive effects of CPAP treatment in such patients. Fewer data are available in subjects with ACS and OSA, and results of randomised controlled studies on the effects of CPAP are expected shortly. Meanwhile, the search for reliable markers of risk continues. Recent studies suggest that daytime sleepiness may indicate a more severe OSA phenotype with regard to cardiovascular risk. Finally, some studies suggest sex-related differences. The picture is still incomplete, and the potential role of OSA in patients with ACS awaits confirmation, as well as clear definition of subgroups with different degrees of risk.

11 Review More than Heart Failure: Central Sleep Apnea and Sleep-Related Hypoventilation. 2019

Herkenrath, Simon Dominik / Randerath, Winfried Johannes. ·Institute for Pneumology at the University of Cologne, Bethanien Hospital, Solingen, Germany. · Institute for Pneumology at the University of Cologne, Bethanien Hospital, Solingen, Germany, randerath@klinik-bethanien.de. ·Respiration · Pubmed #31291632.

ABSTRACT: Central sleep apnea (CSA) comprises a variety of breathing patterns and clinical entities. They can be classified into 2 categories based on the partial pressure of carbon dioxide in the arterial blood. Nonhypercapnic CSA is usually characterized by a periodic breathing pattern, while hypercapnic CSA is based on hypoventilation. The latter CSA form is associated with central nervous, neuromuscular, and rib cage disorders as well as obesity and certain medication or substance intake. In contrast, nonhypercapnic CSA is typically accompanied by an overshoot of the ventilation and often associated with heart failure, cerebrovascular diseases, and stay in high altitude. CSA and hypoventilation syndromes are often considered separately, but pathophysiological aspects frequently overlap. An integrative approach helps to recognize underlying pathophysiological mechanisms and to choose adequate therapeutic strategies. Research in the last decades improved our insights; nevertheless, diagnostic tools are not always appropriately chosen to perform comprehensive sleep studies. This supports misinterpretation and misclassification of sleep disordered breathing. The purpose of this article is to highlight unresolved problems, raise awareness for different pathophysiological components and to discuss the evidence for targeted therapeutic strategies.

12 Review Servo-Ventilation Therapy for Sleep-Disordered Breathing. 2018

Somers, Virend / Arzt, Michael / Bradley, T Douglas / Randerath, Winfried / Tamisier, Renaud / Won, Christine. ·Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN. Electronic address: somers.virend@mayo.edu. · University Hospital, Regensburg, Germany. · University of Toronto, Toronto, ON, Canada. · Clinic of Pneumology and Allergology Center for Sleep Medicine and Respiratory Care, Bethanien Hospital, University of Cologne, Cologne, Germany. · Centre Hospitaliser Universitaire Michalon, Grenoble, France. · Yale University School of Medicine, New Haven, CT. ·Chest · Pubmed #29884256.

ABSTRACT: As seen in this CME online activity (available at http://journal.cme.chestnet.org/sv-sleep-disorder), central sleep apnea (CSA) is associated with increased mortality in patients with heart failure (HF), and it has been thought that treatment of CSA may improve underlying HF. Positive airway pressure therapy, specifically auto-servoventilation (ASV), can not only suppress abnormal breathing patterns but has been reported to improve cardiac function in HF patients with CSA. In patients with HF and with CSA unsuppressed with CPAP, newer ASV use has been associated with significant CSA improvement; in addition, several studies have reported efficacy of ASV in the treatment of underlying cardiac dysfunction in HF patients with CSA. However, results from the large randomized Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo-Ventilation in Patients with Heart Failure (SERVE-HF) trial (Cowie MR, Woehrle H, Wegscheider K, et al. Adaptive servo-ventilation for central sleep apnea in systolic heart failure. New Engl J Med. 2015;373[12]:1095-1105) showed no significant effect on the primary end point in patients with stable HF with reduced ejection fraction and predominantly CSA, but all-cause and cardiovascular mortality were both increased in the ASV arm. These results are surprising and inconsistent with earlier smaller studies reporting positive surrogate outcomes, and they require additional study and resolution. However, until this is done, there is an urgent educational need for review of the approved labeling and validated clinical use of ASV within the medical community. The purpose of this educational activity is to review the appropriate use of ASV for the treatment of sleep-disordered breathing, including Cheyne-Stokes respiration, treatment-emergent central apnea, and opioid-induced periodic breathing. Emphasis will be placed on proper patient and therapy selection, especially in patients with HF.

13 Review Challenges and perspectives in obstructive sleep apnoea: Report by an 2018

Randerath, Winfried / Bassetti, Claudio L / Bonsignore, Maria R / Farre, Ramon / Ferini-Strambi, Luigi / Grote, Ludger / Hedner, Jan / Kohler, Malcolm / Martinez-Garcia, Miguel-Angel / Mihaicuta, Stefan / Montserrat, Josep / Pepin, Jean-Louis / Pevernagie, Dirk / Pizza, Fabio / Polo, Olli / Riha, Renata / Ryan, Silke / Verbraecken, Johan / McNicholas, Walter T. ·Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany. · Neurology Dept, Inselspital, Bern University Hospital, Bern, Switzerland. · DiBiMIS, University of Palermo and CNR Institute of Biomedicine and Molecular Immunology (IBIM), Palermo, Italy. · Unit of Biophysics and Bioengineering, School of Medicine and Health Sciences, University of Barcelona-IDIBAPS, Barcelona and CIBERES, Madrid, Spain. · Dept of Neurology OSR-Turro, Sleep Disorders Centre, Università Vita-Salute San Raffaele, Milan, Italy. · Dept of Sleep Medicine, Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden. · Dept of Pneumology, University Hospital of Zurich, Zurich, Switzerland. · Respiratory Dept, Polytechnic and University La Fe Hospital, Valencia, Spain. · Pulmonology Dept, CardioPrevent Foundation, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania. · Sleep Unit, Respiratory Dept, Hospital Clinic, University of Barcelona-IDIBAPS, Barcelona and CIBERES, Madrid, Spain. · HP2 Laboratory, INSERM U1042, Grenoble Alpes University and EFCR Laboratory, Thorax and Vessels Division, Grenoble Alpes University Hospital, Grenoble, France. · Sleep Medicine Centre, Kempenhaeghe Foundation, Heeze, The Netherlands. · Dept of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Belgium. · Dept of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna and IRCCS Institute of the Neurological Sciences, AUSL di Bologna, Bologna, Italy. · Unesta Ltd, Tampere, Finland. · Dept of Sleep Medicine, Royal Infirmary Edinburgh, Edinburgh, UK. · Dept of Respiratory and Sleep Medicine, St Vincent's University Hospital and School of Medicine, University College Dublin, Dublin, Ireland. · Dept of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium. · First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. ·Eur Respir J · Pubmed #29853491.

ABSTRACT: Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems throughout the world. The high prevalence and the impact on daily life of OSA oblige clinicians to offer effective and acceptable treatment options. However, recent evidence has raised questions about the benefits of positive airway pressure therapy in ameliorating comorbidities.An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field, and proposed topics for future research on epidemiology, phenotyping, underlying mechanisms, prognostic implications and optimal treatment of patients with OSA.The group concluded that a revision to the diagnostic criteria for OSA is required to include factors that reflect different clinical and pathophysiological phenotypes and relevant comorbidities (

14 Review Device Therapy for Sleep-Disordered Breathing in Patients with Cardiovascular Diseases and Heart Failure. 2017

Randerath, Winfried / Herkenrath, Simon. ·Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Institute of Pneumology, University of Cologne, Aufderhöher Str. 169, Solingen 42699, Germany. Electronic address: randerath@klinik-bethanien.de. · Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Institute of Pneumology, University of Cologne, Aufderhöher Str. 169, Solingen 42699, Germany. ·Sleep Med Clin · Pubmed #28477778.

ABSTRACT: Pathophysiologic components of upper airway obstruction, reduced tidal volume, and disturbed respiratory drive characterize sleep-disordered breathing. Positive airway pressure (PAP) devices address these components by stabilizing the upper airways (continuous PAP), applying air volumes and mandatory breaths (bilevel PAP), or counterbalancing ventilation (adaptive servoventilation). Although PAP therapies have been shown to improve breathing disturbances, daytime symptoms, and left ventricular function in obstructive sleep apnea and cardiovascular diseases, the effects on mortality are controversial, especially in heart failure and central sleep apnea. Optimal treatment is selected based on polysomnographic findings and symptoms, and applied based on the underlying pathophysiologic components.

15 Review Clinical applications of adaptive servoventilation devices: part 2. 2014

Javaheri, Shahrokh / Brown, Lee K / Randerath, Winfried J. ·College of Medicine, University of Cincinnati, Cincinnati, OH. Electronic address: shahrokhjavaheri@icloud.com. · Department of Internal Medicine, School of Medicine, The University of New Mexico, Albuquerque, NM. · Zentrum für Schlaf- und Beatmungsmedizin Aufderhöher, Institut für Pneumologie an der Universität Witten/Herdecke, Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien, Solingen, Germany. ·Chest · Pubmed #25180729.

ABSTRACT: Adaptive servoventilation (ASV) is an automated treatment modality used to treat many types of sleep-disordered breathing. Although default settings are available, clinician-specified settings determined in the sleep laboratory are preferred. Depending on the device, setting choices may include a fixed expiratory positive airway pressure (EPAP) level or a range for autotitrating EPAP; minimum and maximum inspiratory positive airway pressure or pressure support values; and type of backup rate algorithm or a selectable fixed backup rate. ASV was initially proposed for treatment of central sleep apnea and Hunter-Cheyne-Stokes breathing associated with congestive heart failure (CHF), and numerous observational studies have demonstrated value in this setting. Other studies have reported varying efficacy in patients with complex sleep apnea syndromes, including those with mixtures of obstructive and central sleep-disordered breathing associated with CHF, renal failure, or OSA with central apneas developing on conventional positive airway pressure therapy. Patients with opioid-induced sleep apnea, both obstructive and central, may also respond to ASV. The variability in response to ASV in a given patient along with the myriad choices of specific models and settings demand a high degree of expertise from the clinician. Finally, randomized controlled studies are needed to determine long-term clinical efficacy of these devices.

16 Review Positive airway pressure therapy with adaptive servoventilation: part 1: operational algorithms. 2014

Javaheri, Shahrokh / Brown, Lee K / Randerath, Winfried J. ·College of Medicine, University of Cincinnati, Cincinnati, OH. Electronic address: shahrokhjavaheri@icloud.com. · Department of Internal Medicine, School of Medicine, The University of New Mexico, Albuquerque, NM. · Zentrum für Schlaf- und Beatmungsmedizin Aufderhöher, Institut für Pneumologie an der Universität Witten/Herdecke, Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien, Solingen, Germany. ·Chest · Pubmed #25091757.

ABSTRACT: The beginning of the 21st century witnessed the advent of new positive airway pressure (PAP) technologies for the treatment of central and complex (mixtures of obstructive and central) sleep apnea syndromes. Adaptive servoventilation (ASV) devices applied noninvasively via mask that act to maintain a stable level of ventilation regardless of mechanism are now widely available. These PAP devices function by continually measuring either minute ventilation or airflow to calculate a target ventilation to be applied as needed. The apparatus changes inspiratory PAP on an ongoing basis to maintain the chosen parameter near the target level, effectively controlling hypopneas of any mechanism. In addition, by applying pressure support levels anticyclic to the patient's own respiratory pattern and a backup rate, this technology is able to suppress central sleep apnea, including that of Hunter-Cheyne-Stokes breathing. Moreover, ASV units have become available that incorporate autotitration of expiratory PAP to fully automate the treatment of all varieties of sleep-disordered breathing. Although extremely effective in many patients when used properly, these are complex devices that demand from the clinician a high degree of expertise in understanding how they work and how to determine the proper settings for any given patient. In part one of this series we detail the underlying technology, whereas in part two we will describe the application of ASV in the clinical setting.

17 Review [Sleep disorders in asthma and chronic obstructive pulmonary disease (COPD)]. 2014

Böing, Sebastian / Randerath, Winfried J. ·Institut für Pneumologie an der Universität Witten Herdecke. · Klinik für Pneumologie und Allergologie, Schlaf- und Beatmungsmedizin, Bethanien Krankenhaus, Solingen. ·Ther Umsch · Pubmed #24794341.

ABSTRACT: Sleep disturbances (SD) are a frequent finding in patients with asthma and chronic obstructive pulmonary disease (COPD) and have a negative impact on quality of life and the clinical course of the disease. The causes of SD are multiple and include for example respiratory symptoms and comorbidities. On the other hand sleep goes along with multiple physiological changes in respiration, so that sleep itself interacts with asthma and COPD. This interaction favors respiratory symptoms and may lead to hypoxemia and hypercapnia. A further complication of the respiratory situation and the clinical course can be found in asthma and COPD patients with coexisting obstructive sleep apnea syndrome (OSAS). Due to the heterogeneity of SD in asthma and COPD, a detailed patient survey is the most important diagnostical tool. Based on the survey further technical examinations should be considered. Treatment strategies for the reduction of SD in asthma and COPD include an optimized medication and treatment of comorbidities. If indicated oxygen therapy, positive pressure breathing and pulmonary rehabilitation can contribute.

18 Review [Non-CPAP therapies in obstructive sleep apnoea: an overview]. 2013

Keymel, S / Kelm, M / Randerath, W J. ·Heinrich-Heine Universität Düsseldorf, Medizinische Fakultät, Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf. ·Pneumologie · Pubmed #23247597.

ABSTRACT: Optimal treatment of the obstructive sleep apnoea syndrome (OSAS) requires an individually designed and interdisciplinary approach. Continuous positive airway pressure (CPAP) is accepted as the first line therapy for patients with OSAS. However, non-CPAP therapies may be indicated as supportive therapeutical approach in CPAP failure or as an alternative approach in CPAP intolerance. Overall, the level of evidence for the majority of non-CPAP therapies is low. Mandibular advancement devices as a medical non-CPAP treatment have proven to reduce respiratory disturbances to a level which may be sufficient in mild to moderate sleep apnoea. Apnoea triggered neurostimulation of upper airway muscles is an innovative approach that has shown promising results in preclinical studies. Surgical treatment has previously been performed as single level surgery of the nasal, the oropharyngeal or hypopharyngeal level. However, only tonsillectomy in the presence of tonsillar hypertrophy and maxillomandibular advancement are recommended in carefully selected cases. Due to low success rates for single level surgery, multilevel surgery has been proposed as the surgical approach for the future.

19 Review Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy. 2012

Marklund, Marie / Verbraecken, Johan / Randerath, Winfried. ·Dept of Orthodontics, Faculty of Medicine, Umeå University, Umeå, Sweden. Marie.Marklund@odont.umu.se ·Eur Respir J · Pubmed #22075487.

ABSTRACT: Mandibular advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respiratory Society Task Force was to review the evidence in favour of MAD therapy. Effects of tongue-retaining devices are not included in this report. Custom-made MADs reduce apnoea/hypopnoea index (AHI) and daytime sleepiness compared with placebo devices. CPAP more effectively diminishes AHI, while increasing data suggest fairly similar outcomes in relation to symptoms and cardiovascular health from these treatments. Patients often prefer MADs to CPAP. Milder cases and patients with a proven increase in upper airway size as a result of mandibular advancement are most likely to experience treatment success with MADs. A custom-made device titrated from an initial 50% of maximum mandibular advancement has been recommended. More research is needed to define the patients who will benefit from MAD treatment compared with CPAP, in terms of the effects on sleep-disordered breathing and on other diseases related to OSA. In conclusion, MADs are recommended for patients with mild to moderate OSA (Recommendation Level A) and for those who do not tolerate CPAP. The treatment must be followed up and the device adjusted or exchanged in relation to the outcome.

20 Review [Sleep medicine in pneumology]. 2011

Randerath, W J. ·Institut für Pneumologie an der Universität Witten/Herdecke, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien. randerath@klinik-bethanien.de ·Dtsch Med Wochenschr · Pubmed #21448832.

ABSTRACT: Diagnosis and treatment of sleep related breathing disorders have become an essential challenge of internal medicine. They are highly important clinically because of the impairment of daytime performance, attention and concentration with elevated risk of accidents in workplace and traffic and because of their consequences on cardiovascular and metabolic disorders. The obstructive sleep apnoea syndrome (OSAS) has proven to be one of the most important risk factors for arteriosclerosis, especially in the cerebral vessels. OSAS induces arterial hypertention and increases mortality due to cardiovascular diseases. Sleep related breathing disorders induce hyperglycemia and dyslipidemia. OSAS and the metabolic syndrome increase the cardiovascular risk additively. Moreover, cardiac disorders, such as arterial hypertention, heart failure and arterial fibrillation, can induce central breathing disturbances. This impairs the prognosis of affected patients substantially. Atypical symptoms of obstructive sleep apnoea (daytime sleepiness, snoring, witnessed apnoea) are often absent in these patients. In contrast patients often suffer from fatigue, reduced daytime performance, and depression which is a major challenge to diagnosis. This review presents new data on these aspects. Moreover, the association of sleep apnoea and pulmonary embolism and the question of optimal sleep duration are addressed.

21 Clinical Trial Effects of respiratory muscle training (RMT) in patients with mild to moderate obstructive sleep apnea (OSA). 2018

Herkenrath, Simon Dominik / Treml, Marcel / Priegnitz, Christina / Galetke, Wolfgang / Randerath, Winfried J. ·Institute of Pneumology at the University of Cologne, Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Aufderhoeherstraße 169-175, 42699, Solingen, Germany. · Krankenhaus der Augustinerinnen, Jakobstraße 27, 50678, Cologne, Germany. · Institute of Pneumology at the University of Cologne, Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Aufderhoeherstraße 169-175, 42699, Solingen, Germany. randerath@klinik-bethanien.de. ·Sleep Breath · Pubmed #29080065.

ABSTRACT: PURPOSE: Different forms of training focusing on the muscles of the upper airways showed limited effects on obstructive sleep apnea (OSA) and/or snoring. We investigated the effect of generalized respiratory muscle training (RMT) in lean patients with mild to moderate OSA. METHODS: Nine male subjects (52.0 ± 10.8 years, BMI 29.1 ± 2.1 kg/m RESULTS: Patients trained effectively, seen by a significant (p < 0.01) increase of breathing frequency (23.3 ± 1.5 /min vs. 30.6 ± 2.9 /min) and minute volume (81.2 ± 13.7 L vs. 109.1 ± 21.9 L). AHI, snoring and ESS remained unchanged after training. QoL as measured by SF-36 significantly (p < 0.05) improved after the training in the subscales "bodily pain" (79 ± 21 vs. 90 ± 12) and "change of health" (3.1 ± 0.3 vs. 2.4 ± 0.5). CONCLUSIONS: There is no evidence that AHI, pulmonary function or daytime sleepiness are affected by 5 weeks of RMT. Nevertheless, there is an improvement of parameters of quality of life. TRIAL REGISTRATION: ClinicalTrials.gov , register no. NCT 00936286.

22 Article EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke. 2020

Bassetti, C L A / Randerath, W / Vignatelli, L / Ferini-Strambi, L / Brill, A-K / Bonsignore, M R / Grote, L / Jennum, P / Leys, D / Minnerup, J / Nobili, L / Tonia, T / Morgan, R / Kerry, J / Riha, R / McNicholas, W T / Papavasileiou, V. ·Neurology Department, Medical Faculty, University Hospital, Bern, Switzerland. · Department of Neurology, Sechenov First Moscow State Medical University, Moscow, Russia. · Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Bethanien Hospital, Institute of Pneumology at the University of Cologne, Solingen, Germany. · Servizio di Epidemiologia e Biostatistica IRCCS, Istituto delle Scienze Neurologiche di Bologna Ospedale Bellaria, Bologna, Italy. · Department of Neurology OSR-Turro, Sleep Disorder Center, Vita-Salute San Raffaele University, Milan, Italy. · Department of Pulmonary Medicine, University and University Hospital Bern, Bern, Switzerland. · PROMISE Department, Division of Respiratory Medicine, DiBiMIS, University of Palermo and IBIM-CNR, Palermo, Italy. · Sleep Disorders Center, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Göteborg, Sweden. · Danish Center for Sleep Medicine, Rigshospitalet, Copenhagen, Denmark. · Department of Neurology, University of Lille, Lille, France. · Department of Neurology and Institute for Translational Neurology, University of Muenster, Muenster, Germany. · Child Neuropsychiatry Unit, Gaslini Institute DINOGMI, University of Genova, Genoa, Italy. · Institute of Social and Preventive Medicine, Universtity of Bern, Bern, Switzerland. · Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. · Library and Information Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK. · Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. · Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK. · Department of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Ireland. · School of Medicine, University College Dublin, Dublin, Ireland. · First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. · Leeds Teaching Hospital NHS Trust, Leeds, UK. · Medical School, University of Leeds, Leeds, UK. ·Eur J Neurol · Pubmed #32314498.

ABSTRACT: BACKGROUND: Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality. AIM: Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology to critically evaluate the evidence regarding potential links and the impact of therapy. MATERIALS AND METHODS: Thirteen research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies post-dating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 were included. Statements were generated regarding current evidence and clinical practice. RESULTS: Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, whilst CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, whilst the pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, whilst treatment data are scarce. DISCUSSION/CONCLUSION: Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke.

23 Article Effects of continuous positive airway pressure therapy on daytime and nighttime arterial blood pressure in patients with severe obstructive sleep apnea and endothelial dysfunction. 2019

Bischof, Fabian / Egresits, Jozsef / Schulz, Richard / Randerath, Winfried J / Galetke, Wolfgang / Budweiser, Stephan / Nilius, Georg / Arzt, Michael / Hetzenecker, Andrea / Anonymous3751002. ·Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany. · Department of Pneumology, Hospital Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany. · Department of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany. · HELIOS-Klinik Hagen-Ambrock, University Hospital Witten/Herdecke, Solingen, Germany. · Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Clinical Center Rosenheim, Rosenheim, Germany. · Department of Pneumology and Allergology, Hospital Essen Mitte, Essen, Germany. · Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany. Andrea.Hetzenecker@klinik.uni-regensburg.de. ·Sleep Breath · Pubmed #31463779.

ABSTRACT: PURPOSE: A nocturnal non-dipping or rise in blood pressure (BP) is associated with poor cardiovascular outcome. This study aimed to test whether continuous positive airway pressure (CPAP) therapy can reduce nocturnal BP and normalize the 24-h BP profile in patients with severe obstructive sleep apnea (OSA) and erectile dysfunction as a surrogate for endothelial dysfunction (ED). PATIENTS AND METHODS: Eighteen consecutive patients with OSA and ED on stable antihypertensive medication (age 55.8 ± 9.5 years, body mass index 35.5 ± 3.8 kg/m RESULTS: Compared to baseline, nocturnal systolic and diastolic BP were significantly reduced after CPAP therapy (128.5 ± 14 to 122.9 ± 11 mmHg, p = 0.036; 76.2 ± 9 to 70.5 ± 5 mmHg, p = 0.007). The frequency of non-dipping and rising nocturnal systolic BP, as well as mean nocturnal heart rate, was reduced after CPAP treatment (73 to 27%, p = 0.039; 20 to 7%, p = 0.625; from 81.5 ± 10 to 74.8 ± 8 beats per minute p = 0.043). Serum levels of noradrenaline were significantly lower after CPAP therapy (398 ± 195 ng/l vs. 303 ± 135 ng/l, p = 0.032). CONCLUSION: In patients with severe OSA and clinically apparent ED, CPAP therapy was associated with a decrease in nocturnal BP and serum noradrenaline levels, as well as a normalization of the 24-h BP profile.

24 Article Extended evaluation of the efficacy of a proactive forced oscillation technique-based auto-CPAP algorithm. 2019

Herkenrath, S D / Treml, M / Anduleit, N / Richter, K / Pietzke-Calcagnile, A / Schwaibold, M / Schäfer, R / Alshut, R / Grimm, A / Hagmeyer, L / Randerath, W J. ·Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Aufderhoeher Str. 169-175, 42699, Solingen, Germany. · Löwenstein Medical Technology GmbH + Co. KG, Karlsruhe, Germany. · Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Aufderhoeher Str. 169-175, 42699, Solingen, Germany. randerath@klinik-bethanien.de. ·Sleep Breath · Pubmed #31388800.

ABSTRACT: PURPOSE: Previous studies revealed substantially varying therapy efficacy of automatic continuous positive airway pressure (APAP) devices in the treatment of obstructive sleep apnea (OSA). We evaluated the efficacy of a new APAP device using the forced oscillation technique (FOT) to evaluate upper airway obstruction during apneas and flow contour analyses during hypopneas. METHODS: Forty-six initially diagnosed OSA patients were included and the pressure range was set from 5 to 20 hPa. Therapy efficacy was assessed based on the reduction of apnea-hypopnea index (AHI), improvement of objective sleep quality parameters, and the appropriateness of the device's pressure regulation. RESULTS: AHI and arousal index significantly decreased during APAP therapy (median [interquartile range]: AHI 36 [23-55] vs. 2 [1-6]/h, arousal index 30 [22-45] vs. 15 [10-19]/h, both p < 0.001). The amount of slow wave sleep (SWS) and rapid-eye-movement (REM) sleep significantly increased (SWS 20 [14-29] vs. 29 [19-34]%, REM 16 [11-21] vs. 24 [14-30]%, both p < 0.01). Most residual respiratory events during therapy were of central etiology and attributable to five patients, who presented with treatment-emergent central sleep apnea. The device's pressure regulation abolished most obstructive respiratory events (n = 6.7 residual obstructive events per patient). Of central respiratory events, 534/646 (83%) did not lead to pressure increases. CONCLUSION: This pilot study provides a proof of concept that the APAP device combining FOT and evaluation of flow contour allows for the suppression of obstructive events without relevant false reactions.

25 Article Clinical and Economic Benefits of Upper Airway Stimulation for Obstructive Sleep Apnea in a European Setting. 2019

Pietzsch, Jan Benjamin / Richter, Ann-Kathrin / Randerath, Winfried / Steffen, Armin / Liu, Shan / Geisler, Benjamin P / Wasem, Jürgen / Biermann-Stallwitz, Janine. ·Wing Tech Inc., Menlo Park, California, USA, jpietzsch@wing-tech.com. · Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany. · Department of Pneumology and Allergology, Bethanien Hospital, Solingen, Germany. · Department of Otorhinolaryngology, University of Lübeck, Lübeck, Germany. · Wing Tech Inc., Menlo Park, California, USA. · College of Engineering, University of Washington, Seattle, Washington, USA. · Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA. · Essener Forschungsinstitut für Medizinmanagement - EsFoMed GmbH, Essen, Germany. ·Respiration · Pubmed #30923287.

ABSTRACT: BACKGROUND: Upper airway stimulation (UAS) is a treatment approach for patients with moderate-to-severe obstructive sleep apnea who cannot adhere to continuous positive airway pressure therapy. OBJECTIVE: The objective was to evaluate added patient benefit and cost-effectiveness of UAS in the German health care system. METHODS: We used a decision-analytic Markov model to project major adverse cardiovascular or cerebrovascular events (myocardial infarction [MI] or stroke), motor vehicle collision (MVC), mortality, quality-adjusted life years (QALYs), and costs. The assumed reduction in the apnea-hypopnea index with UAS compared to no treatment is based on German real-world data. Other input data were derived from the literature, public statistics, and multivariate regression. Cost-effectiveness was evaluated in Euros per QALY gained, both discounted at 3%. RESULTS: UAS was projected to reduce event risks (10-year relative risk for stroke, MI, cardiovascular death, and MVC: 0.76, 0.64, 0.65, and 0.34, respectively), and to increase survival by 1.27 years. While the UAS strategy incurred an additional 1.02 QALYs within the patient lifetime, there were also additional costs of EUR 45,196, resulting in an incremental cost-effectiveness ratio of EUR 44,446 per QALY gained. -Conclusions: In the present model-based analysis, UAS therapy provides meaningful benefit to patient-relevant endpoints and is a cost-effective therapy in the German setting.

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