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Sleep Apnea Syndromes: HELP
Articles from Virginia
Based on 107 articles published since 2008

These are the 107 published articles about Sleep Apnea Syndromes that originated from Virginia during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5
1 Editorial Some Cardiologists' Perspective on Past, Current, and Future of Sleep Medicine. 2018

Kwon, Younghoon / Surkin, Lee A / Lee, Chi-Hang. ·Department of Medicine, Cardiovascular Division, University of Virginia, Charlottesville, Virginia. Electronic address: yk2j@virginia.edu. · Carolina Clinic for Health and Wellness, Greenville, North Carolina. · Department of Cardiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. ·Am J Cardiol · Pubmed #29195826.

ABSTRACT: An accumulating body of evidence has highlighted the importance of sleep in cardiovascular health. Sleep apnea (SA) is a highly common condition in patients with cardiovascular comorbidities. Although awareness about the importance of diagnosis and treatment of SA among cardiologists has increased, incorporating it into daily practice has been challenging. We briefly review the current state of sleep medicine in the United States and provide views on how the cardiology community can more actively participate in SA care to deliver higher quality of care. We propose a cardiology-led patient-centered SA collaborative care model to effectively achieve this.

2 Review Mild Obstructive Sleep Apnea in Children: What is the Best Management Option? 2018

Baldassari, Cristina M / Choi, Sukgi. ·Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia, U.S.A. · Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A. · Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A. ·Laryngoscope · Pubmed #29521427.

ABSTRACT: -- No abstract --

3 Review Sleep and Cognition in Older Adults. 2018

Dzierzewski, Joseph M / Dautovich, Natalie / Ravyts, Scott. ·Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Room 306, Box 842018, Richmond, VA 23284-2018, USA. Electronic address: dzierzewski@vcu.edu. · Department of Psychology, Virginia Commonwealth University, 800 West Franklin Street, Room 203, Box 842018, Richmond, VA 23284-2018, USA. · Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA 23284-2018, USA. ·Sleep Med Clin · Pubmed #29412987.

ABSTRACT: Increased age is associated with normative declines in both sleep and cognitive functioning. Although there are some inconsistencies in the literature, negative sleep changes are associated with worse cognitive functioning. This negative relationship holds true across normal-sleeping older adults, older adults with insomnia, older adults with sleep disordered breathing, cognitively healthy older adults, and older adults with dementia. There are mixed results regarding potential benefits of sleep treatments on cognitive functions; however, this line of research deserves added attention because the potential mechanisms of action are likely distinct from other interventions to improve cognition.

4 Review Systematic Review of Drug-Induced Sleep Endoscopy Scoring Systems. 2018

Amos, Janine M / Durr, Megan L / Nardone, Heather C / Baldassari, Cristina M / Duggins, Angela / Ishman, Stacey L. ·1 Otolaryngology and Facial Plastic Surgery, McLaren Oakland Hospital, Pontiac, Michigan, USA. · 2 Department of Head and Neck Surgery, Kaiser Permanente, Oakland, California, USA. · 3 Division of Otolaryngology, Nemours/AI DuPont Hospital for Children, Wilmington, Delaware, USA. · 4 Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA. · 5 Division of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. · 6 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA. · 7 Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. ·Otolaryngol Head Neck Surg · Pubmed #29064308.

ABSTRACT: Objective To systematically review the scoring systems used to report findings during drug-induced sleep endoscopy (DISE) for adults and children with obstructive sleep apnea. Data Sources PubMed, CINAHL, EBM Reviews, Embase, and Scopus databases. Review Methods This is a systematic review of all indexed years of publications referring to scoring of DISE for children and adults with obstructive sleep apnea. The type of DISE scoring system utilized was the primary outcome. PRISMA guidelines were followed to carry out this review; articles were independently reviewed by 2 investigators. All pediatric and adult studies that utilized ≥1 DISE grading systems were included. Results Of 492 identified abstracts, 44 articles (combined population, N = 5784) were ultimately included; 6 reported on children, 35 on adults, and 1 on children and adults. Twenty-one reporting methods were used in these studies, with the most common being the VOTE system (velum, oropharynx, tongue base, and epiglottis; 38.6%) and the Pringle and Croft classification (15.9%). The sites of obstruction most commonly included in a scoring system were the tongue base (62%), lateral pharynx/oropharynx (57%), palate (57%), epiglottis/supraglottis (38%), and hypopharynx (38%). Less commonly included sites were the larynx (29%), velum (23%), nose (23%), tongue (14%), adenoids (10%), and nasopharynx (10%). Conclusion There is no consensus regarding which scoring system should be utilized to report findings during DISE. The VOTE system and the Pringle and Croft classification were the most frequent scoring systems reported for patients undergoing DISE. Standardization of the reporting of DISE findings would improve comparability among studies.

5 Review Sleep, sleep apnea and atrial fibrillation: Questions and answers. 2018

Kwon, Younghoon / Koene, Ryan J / Johnson, Alan R / Lin, Gen-Min / Ferguson, John D. ·Division of Cardiovascular Medicine, Department of Medicine and Department of Sleep Medicine, University of Virginia, Charlottesville, VA, USA. Electronic address: yk2j@hscmail.mcc.virginia.edu. · Department of Cardiovascular Medicine, Electrophysiology Section, Cleveland Clinic Foundation, Cleveland, OH, USA. · Division of Cardiovascular Medicine, Department of Medicine and Department of Sleep Medicine, University of Virginia, Charlottesville, VA, USA. · Department of Medicine, Hualien-Armed Forces General Hospital, Hualien 970, Taiwan; Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; College of Science and Engineering, National Dong Hwa University, Hualien 974, Taiwan. ·Sleep Med Rev · Pubmed #29029984.

ABSTRACT: Sleep apnea (SA) is a common sleep disorder increasingly recognized as a risk for cardiovascular disease. Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with significant morbidity and mortality. An increasing number of investigations in recent years have linked SA to AF. In this review, we aim to provide a critical overview of the existing evidence in a question and answer format by addressing the following: What is the prevalent association between the two conditions (separating nocturnally detected AF episodes from AF as a prevalent condition)? Is SA a risk factor for incident AF? Is SA a risk factor for recurrence of AF following cardioversion/catheter-based ablation? What is the association between SA and AF in patients with heart failure? Are there signature electrocardiographic markers of AF found in patients with SA? Are there electrophysiology-based studies supporting the link between SA and AF? What other sleep characteristics (beyond SA) are found in patients with AF? What is the impact of SA treatment on AF? What is the effect of AF treatment on sleep? Finally, we address unsolved questions and suggest future directions to enhance our understanding of the AF-SA relationship.

6 Review Update on pathophysiology and treatment of childhood obstructive sleep apnea syndrome. 2017

Brockbank, Justin C. ·Division of Pediatric Pulmonology, Pediatric Sleep Medicine, Children's Hospital of Richmond at VCU, Box 980315, Richmond, VA 23298-0315, USA. Electronic address: justin.brockbank@vcuhealth.org. ·Paediatr Respir Rev · Pubmed #28697968.

ABSTRACT: Obstructive sleep apnea syndrome (OSAS) is common in childhood and is characterized by recurrent upper airway obstructive events during sleep that produce significant neurocognitive and cardiovascular sequelae. The pathophysiology of childhood OSAS is complex and involves mechanical airway obstruction often secondary to adenotonsillar hypertrophy. However, neuromotor abnormalities and instability of central ventilatory control are also implicated. Several surgical and non-surgical treatment options for childhood OSAS are available, and will be discussed. Some of these include adenotonsillectomy, lingual tonsillectomy, supraglottoplasty, continuous positive airway pressure (CPAP), rapid maxillary expansion, oral appliance therapy, anti-inflammatory treatments, and supplemental oxygen.

7 Review The overlaps of asthma or COPD with OSA: A focused review. 2017

Owens, Robert L / Macrea, Madalina M / Teodorescu, Mihaela. ·Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, California, USA. · Division of Pulmonary, Critical Care and Sleep Medicine, Salem Veterans Affairs Medical Center, Salem, Virginia, USA. · Division of Allergy, Pulmonary and Critical Care Medicine, James B. Skatrud Pulmonary/Sleep Research Laboratory, William S. Middleton Memorial Veteran's Hospital, Madison, Wisconsin, USA. · Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. ·Respirology · Pubmed #28677827.

ABSTRACT: Asthma, chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) are the most common respiratory disorders worldwide. Given demographic and environmental changes, prevalence for each is likely to increase. Although exact numbers are not known, based on chance alone, many people will be affected by both lower airways obstruction and concomitant upper airway obstruction during sleep. Some recent studies suggest that there is a reciprocal interaction, with chronic lung disease predisposing to OSA, and OSA worsening control and outcomes from chronic lung disease. Thus, the combination of wake and sleep respiratory disorders can create an overlap syndrome with unique pathophysiological, diagnostic and therapeutic concerns. Although much work needs to be done, given the above, Respirologists, Sleep Medicine and Primary Care providers must be vigilant for overlap syndromes. Accurate diagnosis of, for example, OSA as a cause of nocturnal symptoms in a patient with asthma is likely to limit further ineffective titration of medications for asthma. Moreover, prompt treatment of OSA in the overlap syndromes will not only offer symptomatic benefit of OSA, but also improve symptoms and healthcare resource utilization attributable to obstructive lung disease, and in COPD, it may reduce mortality.

8 Review An obstructive sleep apnea primer: What the practicing allergist needs to know. 2017

Pasha, Sara / Kumar, Sandhya / Chatterjee, Arjun B / Krishnaswamy, Guha. ·Division of Neurology, Department of Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina. · Section on Sleep Medicine, Department of Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina. · Division of Pulmonary, Critical Care Medicine, Allergy and Immunology, Department of Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina; W. G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, North Carolina. Electronic address: gkrishna@wakehealth.edu. ·Ann Allergy Asthma Immunol · Pubmed #28284532.

ABSTRACT: -- No abstract --

9 Review Effect of Sleep-Disordered Breathing on Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Heart Failure: A Systematic Review and Meta-Analysis. 2017

Kwon, Younghoon / Koene, Ryan J / Kwon, Osung / Kealhofer, Jessica V / Adabag, Selcuk / Duval, Sue. ·From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.) · Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.) · Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.) · and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.). ·Circ Arrhythm Electrophysiol · Pubmed #28213507.

ABSTRACT: BACKGROUND: Patients with heart failure and reduced ejection fraction are at increased risk of malignant ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD) is recommended to prevent sudden cardiac death in some of these patients. Sleep-disordered breathing (SDB) is highly prevalent in this population and may impact arrhythmogenicity. We performed a systematic review and meta-analysis of prospective studies that assessed the impact of SDB on ICD therapy. METHODS AND RESULTS: Relevant prospective studies were identified in the Ovid MEDLINE, EMBASE, and Google Scholar databases. Weighted risk ratios of the association between SDB and appropriate ICD therapies were estimated using random effects meta-analysis. Nine prospective cohort studies (n=1274) were included in this analysis. SDB was present in 52% of the participants. SDB was associated with a 55% higher risk of appropriate ICD therapies (45% versus 28%; risk ratio, 1.55; 95% confidence interval, 1.32-1.83). In a subgroup analysis based on the subtypes of SDB, the risk was higher in both central (risk ratio, 1.50; 95% confidence interval, 1.11-2.02) and obstructive (risk ratio, 1.43; 95% confidence interval, 1.01-2.03) sleep apnea. CONCLUSIONS: SDB is associated with an increased risk of appropriate ICD therapy in patients with heart failure and reduced ejection fraction.

10 Review Idiopathic pulmonary fibrosis: effects and optimal management of comorbidities. 2017

King, Christopher S / Nathan, Steven D. ·Advanced Lung Disease and Lung Transplant Clinic, Inova Fairfax Hospital, Falls Church, VA, USA. Electronic address: christopher.king@inova.org. · Advanced Lung Disease and Lung Transplant Clinic, Inova Fairfax Hospital, Falls Church, VA, USA. ·Lancet Respir Med · Pubmed #27599614.

ABSTRACT: Despite the development of pharmacological therapies that are effective in slowing the progression of idiopathic pulmonary fibrosis (IPF), it remains a debilitating and lethal condition. In addition to the adverse effects caused by pulmonary fibrosis, most patients with IPF have associated comorbid conditions, which might negatively affect functional status, quality of life, and survival. Comorbid conditions can be pulmonary or extrapulmonary. Pulmonary comorbidities include pulmonary hypertension, emphysema, and lung cancer, while non-pulmonary conditions include venous thromboembolism, coronary artery disease, congestive heart failure, sleep-disordered breathing, gastro-oesophageal reflux disease, and anxiety or depression. Although some of these comorbid conditions share risk factors with IPF, the likelihood for their presence or development in patients with IPF is still greater than expected. This might indicate that IPF fosters an environment for the development or perpetuation of comorbid conditions, or alternatively that they share causative factors. Optimal management of IPF therefore requires a comprehensive approach, which includes the identification and treatment of comorbid conditions to optimise patient outcomes.

11 Review Genial tubercle advancement and genioplasty for obstructive sleep apnea: A systematic review and meta-analysis. 2017

Song, Sungjin A / Chang, Edward T / Certal, Victor / Del Do, Michael / Zaghi, Soroush / Liu, Stanley Yung / Capasso, Robson / Camacho, Macario. ·Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii, U.S.A. · Department of Otorhinolaryngology, Sleep Medicine Centre-Hospital CUF, Porto, Portugal. · Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Porto, Portugal. · Virginia Commonwealth University School of Medicine, Richmond, Virginia, U.S.A. · Department of Otolaryngology-Head and Neck Surgery, Sleep Surgery Division, Stanford University Medical Center, Stanford, California, U.S.A. · Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, California, U.S.A. ·Laryngoscope · Pubmed #27546467.

ABSTRACT: OBJECTIVE: To perform a systematic review and meta-analysis for studies evaluating genioplasty alone, genial tubercle advancement (GTA) alone, and GTA with hyoid surgery (GTA-HS) to treat obstructive sleep apnea (OSA). DATA SOURCES: Ten databases. REVIEW METHODS: Three authors searched through November 15, 2015. RESULTS: 1,207 studies were screened; 69 were downloaded; and 13 studies met inclusion criteria. A total of 111 patients were included, with 27 standard genioplasty, 10 modified genioplasty, 24 GTA, and 50 GTA-HS patients. For standard genioplasty, the apnea-hypopnea index (AHI) reduced from a mean ± standard deviation (M ± SD) of 18.8 ± 3.8 (95% confidence interval [CI] 17.6, 20.0) to 10.8 ± 4.0 (95% CI 9.5, 12.1) events/hour (relative reduction 43.8%), P value = 0.0001. Genioplasty improved lowest oxygen saturation (LSAT) from 82.3 ± 7.3% (95% CI 80.0, 84.7) to 86.8 ± 5.2% (95% CI 85.1, 88.5), P value = 0.0032. For modified genioplasty AHI increased by 37.3%. For GTA, the AHI reduced from an M ± SD of 37.6 ± 24.2 (95% CI 27.9, 47.3) to 20.4 ± 15.1 (95% CI 14.4, 26.4) events/hour (relative reduction 45.7%), P value = 0.0049. GTA improved LSAT from 83.1 ± 8.3% (95% CI 79.8, 86.4) to 85.5 ± 6.8% (95% CI 82.8, 88.2), P value = 0.2789. For GTA-HS, the AHI reduced from an M ± SD of 34.5 ± 22.1 (95% CI 28.4, 40.6) to 15.3 ± 17.6 (95% CI 10.4, 20.2) events/hour (relative reduction 55.7%), P value < 0.0001; GTA-HS improved LSAT from 80.1 ± 16.6% (95% CI 75.5, 84.7) to 88.3 ± 6.9% (95% CI 86.4, 90.2), P value = 0.0017. CONCLUSION: Standard genioplasty, GTA and GTA-HS can improve OSA outcomes such as AHI and LSAT. Given the low number of studies, these procedures remain as an area for additional OSA research. Laryngoscope, 127:984-992, 2017.

12 Review Update on Obstructive Sleep Apnea: Implications for Neuropsychiatry. 2016

Baker, Christopher A / Hurley, Robin A / Taber, Katherine. ·Dr. Baker is affiliated with the Mental Health and Behavioral Sciences Service Line at the W.G. Hefner Veterans Affairs Medical Center in Salisbury, North Carolina. Drs. Hurley and Taber are affiliated with the Research and Academic Affairs Service Line and the Veterans Affairs Mid Atlantic Mental Illness Research, Education, and Clinical Center at the W.G. Hefner Veterans Affairs Medical Center in Salisbury, North Carolina. Dr. Hurley is affiliated with the Departments of Psychiatry and Radiology at Wake Forest School of Medicine in Winston-Salem, North Carolina, and the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston, Texas. Dr. Taber is affiliated with the Division of Biomedical Sciences at the Via College of Osteopathic Medicine in Blacksburg, Virginia, and the Department of Physical Medicine and Rehabilitation at Baylor College of Medicine in Houston, Texas. ·J Neuropsychiatry Clin Neurosci · Pubmed #27444053.

ABSTRACT: -- No abstract --

13 Review Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis. 2016

Camacho, Macario / Li, Dongcai / Kawai, Makoto / Zaghi, Soroush / Teixeira, Jeffrey / Senchak, Andrew J / Brietzke, Scott E / Frasier, Samuel / Certal, Victor. ·Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii. · Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford, California. · Shenzhen Key Laboratory of ENT, Institute of ENT & Longgang ENT hospital, Shenzhen, China, Stanford, California. · Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, California. · Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, California. · Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California. · Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland. · Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA. · Department of Otorhinolaryngology/Sleep Medicine Centre-Hospital CUF & CHEDV Porto, University of Porto, Porto, Portugal. · CINTESIS-Center for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal. ·Laryngoscope · Pubmed #27005314.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To determine if sleepiness and sleep study variables (e.g., Apnea-Hypopnea Index [AHI] and lowest oxygen saturation) improve following isolated tonsillectomy for adult obstructive sleep apnea (OSA). STUDY DESIGN: Systematic review and meta-analysis. METHODS: Nine databases (PubMed/MEDLINE included) were searched through November 24, 2015. RESULTS: Seventeen studies (n = 216 patients, 34.4 ± 10.0 years and body mass index: 29.0 ± 6.1 kg/m(2) ) met criteria. Tonsils sizes were hypertrophied, large, enlarged, extremely enlarged, or grades 2 to 4. Apnea-Hypopnea Index decreased by 65.2% (from 40.5 ± 28.9/hour to 14.1 ± 17.1/hour) (n = 203). The AHI mean difference (MD) was -30.2 per hour (95% confidence interval [CI] -39.3, -21.1) (P value < 0.00001). The AHI SMD was -1.37 (-1.65, -1.09) (large effect). Lowest oxygen saturation improved from 77.7 ± 11.9% to 85.5 ± 8.2% (n = 186). Lowest oxygen saturation MD was 8.5% (95% CI 5.2, 11.8) (P value < 0.00001). The Epworth Sleepiness Scale decreased from 11.6 ± 3.7 to 6.1 ± 3.9 (P value < 0.00001) (n = 125). Individual patient outcomes (n = 54) demonstrated an 85.2% success rate (AHI < 20/hour and ≥ 50% reduction) and a 57.4% cure rate. Individual patient data meta-analysis showed preoperative AHI < 30 per hour to be a significant predictor of surgical success (P value < 0.001) and cure (P value = 0.043); among patients with preoperative AHI < 30 per hour, tonsillectomy success rate was 100% (25 of 25) and cure rate was 84% (21 of 25) with a mean postoperative AHI of 2.4 ± 2.1 per hour; this compares to tonsillectomy success rate of 72.4% (21 of 29), cure rate of 10 of 29 (34.4%), and mean postoperative AHI of 14.3 ± 13.9 per hour for patients with preoperative AHI ≥ 30 per hour. CONCLUSION: Isolated tonsillectomy can be successful as treatment for adult OSA, especially among patients with large tonsils and mild to moderate OSA (AHI < 30/hour). Laryngoscope, 2016 Laryngoscope, 126:2176-2186, 2016.

14 Review Reducing cardiovascular risk through treatment of obstructive sleep apnea: 2 methodological approaches. 2016

Yaggi, Henry Klar / Mittleman, Murray A / Bravata, Dawn M / Concato, John / Ware, James / Stoney, Catherine M / Redline, Susan. ·Department of Medicine, Yale School of Medicine, New Haven, CT; VA Clinical Epidemiology Research Center, VA Connecticut HCS, West Haven, CT. Electronic address: henry.yaggi@yale.edu. · Department of Medicine, Beth Israel Deaconess, Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA. · VA Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, IN; Department of Medicine, Indiana School of Medicine, Indianapolis, IN; Department of Neurology, Indiana University School of Medicine, Indianapolis, IN. · Department of Medicine, Yale School of Medicine, New Haven, CT; VA Clinical Epidemiology Research Center, VA Connecticut HCS, West Haven, CT. · Department of Biostatistics, Harvard School of Public Health, Boston, MA. · National Heart, Lung, and Blood Institute, NIH, Bethesda, MD. · Department of Medicine, Harvard Medical School, Boston, MA; Division of Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA. ·Am Heart J · Pubmed #26856225.

ABSTRACT: Obstructive sleep apnea (OSA) significantly impacts cardiovascular health, demonstrated by observational investigations showing an independently increased risk of ischemic heart disease, diabetes, hypertension, congestive heart failure, acute coronary syndrome, stroke, cardiovascular mortality, and all-cause mortality. Positive airway pressure (PAP), a medical therapy for sleep apnea, reverses airway obstruction and may help reduce cardiovascular risk. Prior to planning large phase III randomized controlled trials to test the impact of PAP on cardiovascular outcomes, several gaps in knowledge need to be addressed. This article describes 2 independent studies that worked collaboratively to fill these gaps. The populations, design features, and relative benefits/challenges of the 2 studies (SleepTight and BestAIR) are described. Both studies were encouraged to have multidisciplinary teams with expertise in behavioral interventions to improve PAP compliance. Both studies provide key information that will be useful to the research community in future large-scale, event-driven, randomized trials to evaluate the efficacy and/or effectiveness of strategies to identify and treat significant OSA for decreasing risk of major adverse cardiovascular events in high-risk patients.

15 Review Sleep and Heart Failure. 2015

Nelson, Kimberly A / Trupp, Robin J. ·Virginia Commonwealth University Medical Center, 1250 E Marshal Street, Richmond, VA 23219, USA. · University of Illinois at Chicago, College of Nursing, 845 S Damien Street, Chicago, IL 60612, USA. Electronic address: rjtrupp@uic.edu. ·Crit Care Nurs Clin North Am · Pubmed #26567495.

ABSTRACT: Sleep deprivation occurs for many reasons but, when chronic in nature, has many consequences for optimal health and performance. Despite its high prevalence, sleep-disordered breathing is underrecognized and undertreated. This is especially true in the setting of heart failure, where sleep-disordered breathing affects more than 50% of patients. Although the optimal strategy to best identify patients is currently unknown, concerted and consistent efforts to support early recognition, diagnosis, and subsequent treatment should be encouraged. Optimization of guideline-directed medical therapy and concurrent treatment of sleep-disordered breathing are necessary to improve outcomes in this complex high-risk population.

16 Review Surgical History of Sleep Apnea in Pediatric Patients with Chiari Type 1 Malformation. 2015

Pomeraniec, Isaac Jonathan / Ksendzovsky, Alexander / Yu, Pearl L / Jane, John A. ·Department of Neurological Surgery, University of Virginia Health Science Center, 1215 Lee Street, Charlottesville, VA 22908, USA. · Department of Neurological Surgery, University of Virginia Health Science Center, 1215 Lee Street, Charlottesville, VA 22908, USA. Electronic address: jaj2k@virginia.edu. ·Neurosurg Clin N Am · Pubmed #26408064.

ABSTRACT: Sleep apnea represents a relative indication for posterior fossa decompression in pediatric patients with Chiari malformation type 1. Duraplasty was associated with improvement of sleep apnea in 100% of patients and dural splitting with improvement in 50% of patients. Duraplasty and dural splitting were associated with a similar reduction in tonsillar herniation on radiographic imaging of 58% (37% excluding tonsillectomy) and 35%, respectively. Longitudinal follow-up studies of patients with either neurologic deficits or severe symptoms will further elucidate the natural history of Chiari malformation type 1 and more appropriately gauge the risk-benefit tradeoff of surgical intervention.

17 Review Safe use of opioids in individuals with obstructive sleep apnea. 2015

Ward, Cynthia W. ·Carilion Roanoke Memorial Hospital, Roanoke, Virginia. Electronic address: cwward@carilionclinic.org. ·Pain Manag Nurs · Pubmed #25193164.

ABSTRACT: Obstructive sleep apnea (OSA) is a chronic breathing disorder that contributes to many other health problems (Epstein et al., 2009). It is present but undiagnosed in a large percentage of the population (Adesanya, Lee, Grilich, & Joshi, 2010). Pain is recognized as a public health problem in the United States, affecting millions of people of all ages (Committee on Advancing Pain Research, Care, and Education Board on Health Sciences Policy, 2011). Because of the high prevalence of both OSA and pain, it is very likely that an individual will have both conditions. Opioid analgesics used to treat pain may cause sedation and respiratory depression by themselves. When administered to individuals with OSA, the risk for harmful respiratory events increases. This article reviews the assessment and monitoring needed to administer opioids safely to individuals with OSA and identifies best practices from a review of the literature.

18 Review Aerobic exercise is associated with improved weight loss after laparoscopic adjustable gastric banding. 2013

Shada, Amber L / Hallowell, Peter T / Schirmer, Bruce D / Smith, Philip W. ·Department of Surgery, Healthsystem, PO Box 800709, Charlottesville, VA 22908, USA. ·Obes Surg · Pubmed #23196991.

ABSTRACT: BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is a common surgical treatment for obesity. Evidence for and against the association of aerobic exercise (AE) and weight loss after LAGB exists. We hypothesize that aerobic exercise is associated with improved weight loss and resolution of comorbidities after LAGB. METHODS: A review of a prospectively collected database identified patients who underwent LAGB over a 3-year period at a single institution. Body mass index (BMI), comorbidities, frequency, and duration of exercise were collected preoperatively and at 6, 12, 24, and 36 months postoperatively. Excess weight loss (EWL) was calculated. Groups were analyzed using Fisher's exact test and ANOVA. RESULTS: Of the 145 LAGB patients, 120 had adequate data for analysis. AE had no association with weight loss at 6 months. At 12, 24, and 36 months following LAGB, patients who reported 150 min or more per week of exercise had an EWL of 35.5, 47.3, and 54.1 %, respectively, while those reporting 0-59 min per week of AE had an EWL of 25.3, 32.1, and 33.0 % (p = 0.03, 0.03, and 0.02, respectively). BMI and age was not statistically different among groups. Diabetes and obstructive sleep apnea were significantly improved in patients exercising at least 60 min per week as compared to those exercising 0-59 min. CONCLUSIONS: AE is significantly associated with weight loss and comorbidity resolution after LAGB. We propose that patients who perform more AE will have higher levels of EWL.

19 Review Evaluation and pharmacologic approach to patients with resistant hypertension. 2012

Adams, Molly / Bellone, Jessica M / Wright, Bradley M / Rutecki, Gregory W. ·Department of Pharmacy, CJW Medical Center-Chippenham Campus, Richmond, VA 23225, USA. molly.adams@hcahealthcare.com ·Postgrad Med · Pubmed #22314117.

ABSTRACT: Patients are diagnosed as having resistant hypertension when they have blood pressure readings that remain above goal despite the concomitant use of 3 optimally dosed antihypertensive agents from different classes, with 1 of the agents being a diuretic. Prior to diagnosing a patient as having resistant hypertension, it is important to document adherence and exclude white-coat hypertension, inaccurate measurement of blood pressure, and secondary causes of hypertension (eg, aldosterone excess). After determining resistance, optimization of the medication regimen is essential. Combination strategies, which might include dual renin-angiotensin-aldosterone blockade with spironolactone as 1 agent, have been proven successful. This article focuses on the safety and efficacy of spironolactone when added to an optimized 3-drug regimen. Additionally, the use of spironolactone in chronic kidney disease and obstructive sleep apnea complicated by resistant hypertension is discussed. These 2 clinical entities are frequently accompanied by resistant hypertension and are indications for the use of spironolactone as well.

20 Review Continuous positive airway pressure reduces risk of motor vehicle crash among drivers with obstructive sleep apnea: systematic review and meta-analysis. 2010

Tregear, Stephen / Reston, James / Schoelles, Karen / Phillips, Barbara. ·MANILA Consulting Group, McLean, VA, USA. ·Sleep · Pubmed #21061860.

ABSTRACT: CONTEXT: Obstructive sleep apnea (OSA) is associated with an increased risk of motor vehicle crash. OBJECTIVE: We performed a systematic review of the literature concerning the impact of continuous positive airway pressure (CPAP) treatment on motor vehicle crash risk among drivers with OSA. The primary objective was to determine whether CPAP use could reduce the risk of motor vehicle crash among drivers with OSA. A secondary objective involved determining the time on treatment required for CPAP to improve driver safety. DATA SOURCES: We searched seven electronic databases (MEDLINE, PubMed (PreMEDLINE), EMBASE, PsycINFO, CINAHL, TRIS, and the Cochrane library) and the reference lists of all obtained articles. STUDY SELECTION: We included studies (before-after, case-control, or cohort) that addressed the stated objectives. We evaluated the quality of each study and the interplay between the quality, quantity, robustness, and consistency of the evidence. We also tested for publication bias. DATA EXTRACTION: Data were extracted by two independent analysts. When appropriate, data were combined in a fixed or random effects meta-analysis. RESULTS: A meta-analysis of 9 observational studies examining crash risk of drivers with OSA pre- vs. post-CPAP found a significant risk reduction following treatment (risk ratio = 0.278, 95% CI: 0.22 to 0.35; P < 0.001). Although crash data are not available to assess the time course of change, daytime sleepiness improves significantly following a single night of treatment, and simulated driving performance improves significantly within 2 to 7 days of CPAP treatment. CONCLUSIONS: Observational studies indicate that CPAP reduces motor vehicle crash risk among drivers with OSA.

21 Review The future in paediatric respirology. 2010

Schmidt, H Joel / Bhandari, Vineet / Bhandari, Anita / Davies, Jane / Marshall, Bruce C / Praud, Jean-Paul / Zar, Heather J / Rubin, Bruce K. ·Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298, USA. ·Respirology · Pubmed #20409021.

ABSTRACT: The authors were given the charge of providing a vision of the future in paediatric respirology. Themes selected for being ripe for this visionary analysis include bronchopulmonary dysplasia (BPD), asthma, cystic fibrosis (CF), lung infections, obstructive sleep disordered breathing (OSDB) and pulmonary diagnostics and monitoring. A profound reduction or elimination of BPD is seen. Given the strong genetic component of this disease, genetic biomarkers will likely be identified that will permit much earlier recognition of BPD susceptibility and potentially the ability to modify disease course by altering gene expression. The ultimate prevention of BPD will be to prevent prematurity, but recognition of both the genetic basis of BPD and the inflammatory background should lead to improved prevention and therapy. A clear understanding and definition of asthma phenotypes will lead to more specific and targeted therapy, earlier detection and prevention, better monitoring of severity and adherence to therapy, lower mortality and decreased inappropriate diagnosis of asthma. The greatest opportunities in asthma care will likely come through tools to improve adherence to effective therapy. Also, areas are identified where better therapies are needed such as in patients with severe mucus hypersecretion (secretory hyperresponsiveness) especially in those with life-threatening asthma. The future of CF is easier to foresee with early successes seen in clinical trials. After the expected ability to correct the CF transmembrane regulator, care will need to change and additional research will be needed. Additionally, the face of CF is changing with more adults than children presently having the disease. This will necessitate changes to our approach to treating this disease in a fortunately aging population. If we are going to affect the worldwide lung health of children, we will need to address respiratory infections particularly pneumonia, tuberculosis and HIV-associated infections. Preventive, diagnostic and treatment strategies will shape the future face of these problems. The availability of inexpensive, readily available, and rapid molecular techniques to identify true infection (including HIV and tuberculosis) may permit earlier use of effective therapy while preventing the inappropriate use of antibiotics for common viral diseases. Sleep medicine will continue to be an important aspect of paediatric pulmonology. The evaluation of OSDB cannot rely on full-night attended polysomnography due to limited access. Identifying reliable markers of end organ dysfunction in children with OSDB may permit more rapid identification of patients in need of intervention like CPAP and assisted breathing. In addition, management options, as an alternative to adenotonsilectomy, are listed with a call for further research. Pulmonary diagnostics and monitoring will see the development and refinement of tools like the lung clearance index and the analysis of exhaled gases, volatiles and dissolved biomarkers of inflammation as techniques that might help clinicians identify both the initiation of inflammation while it is more amenable to therapy, and to identify more readily the early changes associated with chronic lung diseases in children. The authors hope that these visionary articles will generate comments, arguments, inspiration, and perhaps even motivate funding agencies.

22 Review Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. 2009

Tregear, Stephen / Reston, James / Schoelles, Karen / Phillips, Barbara. ·MANILA Consulting Group, McLean, VA, USA. ·J Clin Sleep Med · Pubmed #20465027.

ABSTRACT: STUDY OBJECTIVES: We performed a systematic review of the OSA-related risk of crash in commercial motor vehicle (CMV) drivers. The primary objective involved determining whether individuals with obstructive sleep apnea (OSA) are at an increased risk for a motor vehicle crash when compared to comparable individuals who do not have the disorder. A secondary objective involved determining what factors are associated with an increased motor vehicle crash risk among individuals with OSA. DESIGN/SETTING: Seven electronic databases (MEDLINE, PubMed (PreMEDLINE), EMBASE, PsycINFO, CINAHL, TRIS, and the Cochrane library) were searched (through May 27, 2009), as well as the reference lists of all obtained articles. We included controlled studies (case-control or cohort) that evaluated crash risk in individuals with OSA. We evaluated the quality of each study and the interplay between the quality, quantity, robustness, and consistency of the body of evidence, and tested for publication bias. Data were extracted by 2 independent analysts. When appropriate, data from different studies were combined in a fixed- or random-effects meta-analysis. RESULTS: Individuals with OSA are clearly at increased risk for crash. The mean crash-rate ratio associated with OSA is likely to fall within the range of 1.21 to 4.89. Characteristics that may predict crash in drivers with OSA include BMI, apnea plus hypopnea index, oxygen saturation, and possibly daytime sleepiness. CONCLUSIONS: Untreated sleep apnea is a significant contributor to motor vehicle crashes.

23 Review Evaluation of the obstructive sleep apnea patient and management of snoring. 2009

Lee, N Ray. ·Department of Oral and Maxillofacial Surgery, Medical College of Virginia, Virginia Commonwealth University, 520 North 12th Street, Richmond, VA 23298, USA. reyzor1@aol.com ·Oral Maxillofac Surg Clin North Am · Pubmed #19944338.

ABSTRACT: This article provides a practical strategy for the systematic evaluation of the obstructive sleep apnea patient. The management of snoring is also discussed. The presented strategy is based upon review of the current literature, the principles set forth in the American Academy of Sleep Medicine clinical guideline publication, and the author's personal experience.

24 Review Potential clinical use of cardiopulmonary exercise testing in obstructive sleep apnea hypopnea syndrome. 2009

Aron, Adrian / Zedalis, Donald / Gregg, John M / Gwazdauskas, Francis C / Herbert, William G. ·Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States. aaron@radford.edu ·Int J Cardiol · Pubmed #19042045.

ABSTRACT: There is growing evidence linking obstructive sleep apnea hypopnea syndrome (OSAHS) with multiple cardiovascular and metabolic diseases. Exercise testing is generally available and routinely used to provide valuable information on cardiopulmonary function in healthy and diseased populations. This review summarizes and integrates recent findings on exercise testing in OSAHS and discusses the potential mechanisms that may contribute to the responses that seem to differentiate these patients from apparently healthy subjects and patients with other cardiopulmonary diseases. Although exercise testing is widely used in the evaluation and diagnosis of coronary artery disease patients, recent studies showed distinctive cardiopulmonary responses in OSAHS that raise the possibility of similar applications in this disorder, as well. Several studies illustrated in this review found that OSAHS patients have a reduced exercise capacity, as shown by low peak oxygen uptake achieved. Also, their exercise HR response was reported as significantly lower than in healthy peers, suggesting chronotropic incompetence. Exercise blood pressure response were atypical as well. OSAHS patients had increased systolic and diastolic BP during exercise and a persistently elevated systolic BP during the early post-exercise recovery period. Possible explanations for these responses include cardiac dysfunction, impaired muscle metabolism, chronic sympathetic over-activation, and endothelial dysfunction. Early identification of OSAHS using cardiopulmonary exercise testing (CPXT) shows promise for selecting patients at risk for this disorder in the clinical setting. A uniform definition and measurement of OSAHS together with more rigorous trials are necessary to establish the utility of exercise responses in clinical settings.

25 Review Comorbidities in polycystic ovary syndrome: their relationship to insulin resistance. 2008

Bethea, S W / Nestler, J E. ·Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, VA, USA. jnestler@mc vhvcu.edu ·Panminerva Med · Pubmed #19078870.

ABSTRACT: The polycystic ovary syndrome (PCOS) affects 5-10% of women of child-bearing age, and the diagnosis carries with it associated metabolic and cardiovascular risk factors that are likely linked to insulin resistance. Consequently, women affected by PCOS are at significant risk for developing type 2 diabetes mellitus, cardiovascular disease, and obstructive sleep apnea. Aggressive screening for glucose intolerance and cardiovascular risk factors should be performed in all PCOS patients, and, when indicated by symptomatology, affected women should be screened for sleep apnea. Long-term goals of therapy should focus on prevention of these comorbidities.