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Sleep Apnea Syndromes: HELP
Articles from Bethesda
Based on 136 articles published since 2009
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These are the 136 published articles about Sleep Apnea Syndromes that originated from Bethesda during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6
1 Guideline Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. 2019

Elmets, Craig A / Leonardi, Craig L / Davis, Dawn M R / Gelfand, Joel M / Lichten, Jason / Mehta, Nehal N / Armstrong, April W / Connor, Cody / Cordoro, Kelly M / Elewski, Boni E / Gordon, Kenneth B / Gottlieb, Alice B / Kaplan, Daniel H / Kavanaugh, Arthur / Kivelevitch, Dario / Kiselica, Matthew / Korman, Neil J / Kroshinsky, Daniela / Lebwohl, Mark / Lim, Henry W / Paller, Amy S / Parra, Sylvia L / Pathy, Arun L / Prater, Elizabeth Farley / Rupani, Reena / Siegel, Michael / Stoff, Benjamin / Strober, Bruce E / Wong, Emily B / Wu, Jashin J / Hariharan, Vidhya / Menter, Alan. ·University of Alabama, Birmingham, Alabama. · Central Dermatology, St. Louis, Missouri. · Mayo Clinic, Rochester, Minnesota. · University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · National Psoriasis Foundation, Portland, Oregon. · National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. · University of Southern California, Los Angeles, California. · Department of Dermatology, University of California San Francisco School of MedicineSan Francisco, California. · Medical College of Wisconsin, Milwaukee, Wisconsin. · Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York. · University of Pittsburgh, Pennsylvania. · University of California San Diego, San Diego, California. · Baylor Scott and White, Dallas, Texas. · University Hospitals Cleveland Medical Center, Cleveland, Ohio. · Massachusetts General Hospital, Boston, Massachusetts. · Department of Dermatology, Henry Ford Hospital, Detroit, Michigan. · Northwestern University Feinberg School of Medicine, Chicago, Illinois. · Dermatology and Skin Surgery, Sumter, South Carolina. · Colorado Permanente Medical Group, Centennial, Colorado. · University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. · Icahn School of Medicine at Mount Sinai, New York, New York. · Emory University School of Medicine, Atlanta, Georgia. · University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Canada. · San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas. · Dermatology Research and Education Foundation, Irvine, California. · American Academy of Dermatology, Rosemont, Illinois. Electronic address: vhariharan@aad.org. ·J Am Acad Dermatol · Pubmed #30772097.

ABSTRACT: Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.

2 Guideline [Guidelines in Practice: The New S3 Guideline "Sleeping Disorders - Sleep-Related Abnormal Breathing"]. 2017

Gerlach, M / Sanner, B. ·Medizinische Klinik, Agaplesion Bethesda Krankenhaus Wuppertal. ·Pneumologie · Pubmed #28558398.

ABSTRACT: Sleep related breathing disorders include central sleep apnea (CSA), obstructive sleep apnea (OSA), sleep-related hypoventilation, and sleep-related hypoxia. These disorders are frequent and growing in clinical relevance. The related chapter of the S3 guideline "Non-restorative sleep/Sleep disorders", published by the German Sleep Society (DGSM), has recently been updated in November 2016. Epidemiology, diagnostics, therapeutic procedures, and classification of sleep related disorders have been revised. Concerning epidemiology, a considerably higher mortality rate among pregnant women with OSA has been emphasized. With regards to diagnostics, the authors point out that respiratory polygraphy may be sufficient in diagnosing OSA, if a typical clinical condition is given. For CSA, recommendations were changed to diagnose CSA with low apnea rates present. Significant changes for treating CSA in patients with left ventricular dysfunction have been introduced. In addition, there is now to be differentiated between sleep-related hypoventilation and sleep-related hypoxaemia. Obesity hypoventilation syndrome is discussed in more detail. This article sums up and comments on the published changes.

3 Editorial Pro: continuous positive airway pressure and cardiovascular prevention. 2018

Martinez-Garcia, Miguel Angel / Campos-Rodriguez, Francisco / Javaheri, Shahrokh / Gozal, David. ·Pulmonary Dept, Polytechnic and University La Fe Hospital, Valencia, Spain. · Respiratory Dept, Valme University Hospital, Seville, Spain. · Pulmonary and Sleep Division, Bethesda North Hospital, Cincinnati, OH, USA. · Dept of Pediatrics, University of Chicago, Chicago, IL, USA. ·Eur Respir J · Pubmed #29748245.

ABSTRACT: -- No abstract --

4 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 --

5 Editorial Should you screen all your sleep apnea patients for thyroid disease? 2015

Holley, Aaron B. ·Walter Reed National Military Medical Center, Bethesda, MD, USA, aholley9@gmail.com. ·Sleep Breath · Pubmed #24840213.

ABSTRACT: -- No abstract --

6 Editorial A role for sleep disorders in pregnancy complications: challenges and opportunities. 2014

Romero, Roberto / Badr, M Safwan. ·Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI. Electronic address: romeror@mail.nih.gov. · Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Wayne State University, Detroit, MI. ·Am J Obstet Gynecol · Pubmed #24359866.

ABSTRACT: -- No abstract --

7 Review Cautery-assisted palatal stiffening operation for obstructive sleep apnea: A systematic review and meta-analysis. 2019

Llewellyn, Charles M / Noller, Michael W / Camacho, Macario. ·Madigan Army Medical Center, Department of Otolaryngology, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431, USA. · Walter Reed National Military Medical Center, Department of Otolaryngology, 4494 N Palmer Rd, Bethesda, MD 20889, USA. · Tripler Army Medical Center, Division of Otolaryngology, Sleep Surgery and Sleep Medicine, Tripler AMC, 1 Jarrett White Rd, HI 96859, USA. ·World J Otorhinolaryngol Head Neck Surg · Pubmed #30775702.

ABSTRACT: Objective: To systematically review outcomes for cautery-assisted palatal stiffening operation (CAPSO) as a treatment for adult obstructive sleep apnea (OSA). Methods: Five databases (including PubMed/MEDLINE) were searched through July 12, 2017. Results: Eight studies (307 patients) met criteria. Overall, CAPSO alone (80 patients) improved AHI from a mean ± standard deviation (M ± SD) of (16.8 ± 11.9) to (9.9 ± 10.9) events/h (41.1% decrease). Mixed CAPSO with/without tonsillectomy (92 patients) improved AHI from a M ± SD of (24.8 ± 12.6) to (10.6 ± 9.5) events/h (61.7% decrease). CAPSO with expansion pharyngoplasty (EP), (78 patients) improved AHI from a M ± SD of (26.3 ± 17.7) to (12.6 ± 5.8) events/h (52.1% decrease). CAPSO alone (90 patients) improved lowest oxygen saturation (LSAT) by 5.4 points. Mixed CAPSO with/without tonsillectomy (77 patients) improved LSAT by 10.6 points, and CAPSO with EP (78 patients) improved LSAT by 5.2 points. Sleepiness improved (182 patients) from an Epworth Sleepiness Scale score of 11.8 to 5.1, Conclusions: Apnea-hypopnea index has improved by 41.0% for CAPSO alone, 61.7% for CAPSO with tonsillectomy and 52.1% for CAPSO with expansion pharyngoplasty. Additionally, lowest oxygen saturation, sleepiness and snoring have also improved after CAPSO.

8 Review Skeletal Surgery for Obstructive Sleep Apnea. 2018

Barrera, José E. ·Department of Surgery, Uniformed Services University, Bethesda, MD, USA; Department of Otolaryngology, University of Texas Health Sciences Center, San Antonio, TX, USA; Texas Facial Plastic Surgery and ENT, 14603 Huebner Road, Building 1, San Antonio, TX 78209, USA. Electronic address: admin@drjosebarrera.com. ·Sleep Med Clin · Pubmed #30396448.

ABSTRACT: Multilevel surgery has been established as the mainstay of treatment for the surgical management of obstructive sleep apnea (OSA). Combined with uvulopalatopharyngoplasty, tongue-base surgeries, including the genioglossus advancement (GA), sliding genioplasty, and hyoid myotomy and suspension, have been developed to target hypopharyngeal obstruction. Total airway surgery consisting of maxillomandibular advancement (MMA) with/without GA has shown significant success. Skeletal procedures for OSA with or without a palatal procedure is a proven technique for relieving airway obstruction during sleep. A case study demonstrating the utility of virtual surgical planning for MMA surgery is presented.

9 Review Pediatric Considerations for Dental Sleep Medicine. 2018

Stark, Thomas R / Pozo-Alonso, Manuel / Daniels, Raj / Camacho, Macario. ·Uniformed Service Health Science University, Departments of Pediatric Dentistry and Orofacial Pain, Dental Health Activity Rheinland Pfalz, APO, AE 09005, Wiesbaden, Germany. Electronic address: trstark@gmail.com. · Uniformed Service Health Science University, Department of Orthodontics, Dental Health Activity Rheinland Pfalz, Landstuhl 09180, Germany. · Uniformed Service Health Science University, Department of Pediatrics, Division of Sleep Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu 96859, Hawaii. · Uniformed Service Health Science University, Division of Otolaryngology, Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu 96859, Hawaii. ·Sleep Med Clin · Pubmed #30396447.

ABSTRACT: Pediatric obstructive sleep apnea (OSA) is a serious medical condition with numerous health consequences. Dentists are well suited to recognize and provide medical referrals for pediatric patients at risk for OSA. Timely dental sleep medicine interventions may improve signs and symptoms of OSA in growing children. Orthodontic and dentofacial orthopedic treatment may decrease obstructive respiratory events in some pediatric patients. Palatal expansion may be part of a comprehensive orthodontic treatment plan to correct a malocclusion and treat OSA. Orthognathic surgery, mandibular advancement devices, and oropharyngeal exercises may have a role in the management of OSA in pediatric and adolescent patients.

10 Review Tracheostomy for paediatric obstructive sleep apnoea: A systematic review. 2018

Fray, S / Biello, A / Kwan, J / Kram, Y A / Lu, K / Camacho, M. ·School of Medicine,Uniformed Services University of the Health Sciences,Bethesda,Maryland,USA. · Department of Surgery, Division of Otolaryngology,Tripler Army Medical Center,Hawaii,USA. · Department of Surgery, Division of Otolaryngology,San Antonio Military Medical Center,Texas,USA. ·J Laryngol Otol · Pubmed #30073941.

ABSTRACT: OBJECTIVE: To search the international literature (any language) for publications reporting outcomes of tracheostomy performed to treat obstructive sleep apnoea in children. METHOD: Data sources included: Google Scholar, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, and PubMed/Medline. Four authors searched systematically through to 20 January 2018. RESULTS: A total of 597 studies were screened; 64 were downloaded and 11 met criteria. A total of 196 patients underwent tracheostomy (mean age, 4.2 years; range, newborn to 18 years); 40 had detailed qualitative data and 6 had detailed quantitative data. Apnoea/hypopnoea index showed a 97 per cent reduction (n = 2) and apnoea index showed a 98 per cent reduction (n = 3). Lowest oxygen saturation showed a 34 oxygen saturation point improvement (n = 3). Several patients demonstrated significant improvement in breathing. All identified patients were syndromic, had significant co-morbidities or had severe obstructive sleep apnoea. CONCLUSION: Based on reports of children who have undergone a tracheostomy, for whom there are pre- and post-operative data, tracheostomy appears to be a successful treatment for obstructive sleep apnoea. However, additional research is recommended given the small number of patients in the literature.

11 Review Effects of Chronic Opioid Use on Sleep and Wake. 2018

Cao, Michelle / Javaheri, Shahrokh. ·Division of Sleep Medicine, Stanford University School of Medicine, 450 Broadway Street, Redwood City, CA 94063, USA. · Bethesda North Hospital, University of Cincinnati College of Medicine, 10535 Montgomery Road, Suite 200, Cincinnati, OH 45242, USA; Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, 181 Taylor Avenue, Columbus, OH 43203, USA. Electronic address: shahrokhjavaheri@icloud.com. ·Sleep Med Clin · Pubmed #29759277.

ABSTRACT: Chronic use of opioids negatively affects sleep on 2 levels: sleep architecture and breathing. Patients suffer from a variety of daytime sequelae. There may be a bidirectional relationship between poor sleep quality, sleep-disordered breathing, and daytime function. Opioids are a potential cause of incident depression. The best therapeutic option is withdrawal of opioids, which proves difficult. Positive airway pressure devices are considered first-line treatment for sleep-related breathing disorders. New generation positive pressure servo ventilators are increasingly popular as a treatment option for opioid-induced sleep-disordered breathing. Treatments to improve sleep quality, sleep-related breathing disorders, and quality of life in patients who use opioids chronically are discussed.

12 Review Female Sex and Gender in Lung/Sleep Health and Disease. Increased Understanding of Basic Biological, Pathophysiological, and Behavioral Mechanisms Leading to Better Health for Female Patients with Lung Disease. 2018

Han, MeiLan K / Arteaga-Solis, Emilio / Blenis, John / Bourjeily, Ghada / Clegg, Deborah J / DeMeo, Dawn / Duffy, Jeanne / Gaston, Ben / Heller, Nicola M / Hemnes, Anna / Henske, Elizabeth Petri / Jain, Raksha / Lahm, Tim / Lancaster, Lisa H / Lee, Joyce / Legato, Marianne J / McKee, Sherry / Mehra, Reena / Morris, Alison / Prakash, Y S / Stampfli, Martin R / Gopal-Srivastava, Rashmi / Laposky, Aaron D / Punturieri, Antonello / Reineck, Lora / Tigno, Xenia / Clayton, Janine. ·1 Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan. · 2 Division of Pediatric Pulmonology, Columbia University Medical Center, New York, New York. · 3 Pharmacology Ph.D. Program, Sandra and Edward Meyer Cancer Center, New York, New York. · 4 Department of Medicine, Brown University, Providence, Rhode Island. · 5 Department of Medicine, University of California Los Angeles, Los Angeles, California. · 6 Department of Medicine, Harvard Medical School, Boston, Massachusetts. · 7 Department of Medicine and. · 8 Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts. · 9 Pediatric Pulmonology, Case Western Reserve University, Cleveland, Ohio. · 10 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland. · 11 Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. · 12 Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts. · 13 Division of Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, Texas. · 14 Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana. · 15 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. · 16 Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver, Colorado. · 17 Department of Medicine, Columbia University, New York, New York. · 18 Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut. · 19 Neurologic Institute, Cleveland Clinic, Cleveland, Ohio. · 20 Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. · 21 Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota. · 22 Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada. · 23 Office of Rare Diseases Research, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland. · 24 Division of Lung Diseases, NHLBI/NIH, Bethesda, Maryland; and. · 25 Office of Research on Women's Health, NIH-Office of the Director, Bethesda, Maryland. ·Am J Respir Crit Care Med · Pubmed #29746147.

ABSTRACT: Female sex/gender is an undercharacterized variable in studies related to lung development and disease. Notwithstanding, many aspects of lung and sleep biology and pathobiology are impacted by female sex and female reproductive transitions. These may manifest as differential gene expression or peculiar organ development. Some conditions are more prevalent in women, such as asthma and insomnia, or, in the case of lymphangioleiomyomatosis, are seen almost exclusively in women. In other diseases, presentation differs, such as the higher frequency of exacerbations experienced by women with chronic obstructive pulmonary disease or greater cardiac morbidity among women with sleep-disordered breathing. Recent advances in -omics and behavioral science provide an opportunity to specifically address sex-based differences and explore research needs and opportunities that will elucidate biochemical pathways, thus enabling more targeted/personalized therapies. To explore the status of and opportunities for research in this area, the NHLBI, in partnership with the NIH Office of Research on Women's Health and the Office of Rare Diseases Research, convened a workshop of investigators in Bethesda, Maryland on September 18 and 19, 2017. At the workshop, the participants reviewed the current understanding of the biological, behavioral, and clinical implications of female sex and gender on lung and sleep health and disease, and formulated recommendations that address research gaps, with a view to achieving better health outcomes through more precise management of female patients with nonneoplastic lung disease. This report summarizes those discussions.

13 Review Neuromuscular function of the soft palate and uvula in snoring and obstructive sleep apnea: A systematic review. 2018

Patel, Jagatkumar A / Ray, Bryan J / Fernandez-Salvador, Camilo / Gouveia, Christopher / Zaghi, Soroush / Camacho, Macario. ·F. Edward Hebert School of Medicine, Uniformed Services University (USU), Bethesda, MD, 20814, USA. Electronic address: jagatkumar.a.patel.mil@mail.mil. · F. Edward Hebert School of Medicine, Uniformed Services University (USU), Bethesda, MD, 20814, USA. · Tripler Army Medical Center, Division of Otolaryngology-Head and Neck Surgery, 1 Jarrett White Rd, Tripler AMC, HI 96859, USA. · Northwestern University, Feinberg School of Medicine, Department of Otolaryngology - Head and Neck Surgery, 676 N. St. Clair, Suite 1325, Chicago, IL 60611, USA. · UCLA Medical Center, Santa Monica, Santa Monica, CA 90404, USA. ·Am J Otolaryngol · Pubmed #29525140.

ABSTRACT: OBJECTIVE: A collapsible upper airway is a common cause of obstructive sleep apnea. The exact pathophysiology leading to a more collapsible airway is not well understood. A progressive neuropathy of the soft palate and pharyngeal dilators may be associated with the progression of snoring to OSA. The purpose of this study is to systematically review the international literature investigating the neurophysiologic changes in the soft palate and uvula that contribute to progression from snoring to OSA. METHODS: PubMed/MEDLINE and 4 other databases were systematically searched through July 4, 2017. Eligibility: (1) Patients: controls, snoring or OSA patients (2) Intervention: neuromuscular evaluation of the palate and/or uvula (3) Comparison: differences between controls, snoring and OSA patients (4) Outcomes: neuromuscular outcomes (5) Study design: Peer reviewed publications of any design. RESULTS: 845 studies were screened, 76 were downloaded in full text form and thirty-one studies met criteria. Histological studies of the soft palate demonstrated diffuse inflammatory changes, muscular changes consistent with neuropathy, and neural aberrancies. Sensory testing studies provided heterogeneous outcomes though the majority favored neuronal dysfunction. Studies have consistently demonstrated that increasing severity of snoring and sleep apnea is associated with worsening sensory nerve function of the palate in association with atrophic histological changes to the nerves and muscle fibers of the soft palate and uvula. CONCLUSIONS: Recent evidence highlighted in this systematic review implicates the role of neurogenic pathology underlying the loss of soft palate and/or uvular tone in the progression of snoring to sleep apnea.

14 Review Cardiometabolic risk in obese children. 2018

Chung, Stephanie T / Onuzuruike, Anthony U / Magge, Sheela N. ·Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland. · Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC. ·Ann N Y Acad Sci · Pubmed #29377201.

ABSTRACT: Obesity in childhood remains a significant and prevalent public health concern. Excess adiposity in youth is a marker of increased cardiometabolic risk (CMR) in adolescents and adults. Several longitudinal studies confirm the strong association of pediatric obesity with the persistence of adult obesity and the future development of cardiovascular disease, diabetes, and increased risk of death. The economic and social impact of childhood obesity is further exacerbated by the early onset of the chronic disease burden in young adults during their peak productivity years. Furthermore, rising prevalence rates of severe obesity in youth from disadvantaged and/or minority backgrounds have prompted the creation of additional classification schemes for severe obesity to improve CMR stratification. Current guidelines focus on primary obesity prevention efforts, as well as screening for clustering of multiple CMR factors to target interventions. This review summarizes the scope of the pediatric obesity epidemic, the new severe obesity classification scheme, and examines the association of excess adiposity with cardiovascular and metabolic risk. We will also discuss potential questions for future investigation.

15 Review Mandibular advancement for adult obstructive sleep apnea: A systematic review and meta-analysis. 2017

Noller, Michael W / Guilleminault, Christian / Gouveia, Christopher J / Mack, Douglas / Vivian, Charles / Abdullatif, Jose / Mangili, Stefano / Liu, Stanley Yung / Zaghi, Soroush / Camacho, Macario. ·School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA. Electronic address: mnoller37@gmail.com. · Stanford Hospital and Clinics, Department of Psychiatry, Sleep Medicine Division, 450 Broadway, Redwood City, CA 94063, USA. · Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, CA 95304, USA. · School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA. · Instituto Ferrero de, Neurología y Sueño, División de Cirugía de Sueño, Junín 1120, Buenos Aires, Argentina. · Istituti Ospedalieri Bresciani, S. Anna Hospital, Department of Surgery, ENT, Head and Neck Surgery, Brescia, Lombardy 25100, Italy. · UCLA Medical Center, Santa Monica, Santa Monica, CA 90404, USA. · Tripler Army Medical Center, Division of Otolaryngology, Sleep Surgery, and Sleep Medicine, 1 Jarrett White Rd, Tripler AMC, HI 96859, USA. ·J Craniomaxillofac Surg · Pubmed #29113702.

ABSTRACT: OBJECTIVES: Patients with mandibular insufficiency can be predisposed to obstructive sleep apnea (OSA). The objective of this study was to systematically review the international literature for mandibular advancement surgeries (MAS) as treatment for adult OSA, and then to perform a meta-analysis. METHODS: Four authors searched five databases from the inception of each database through April 5, 2017. The PRISMA statement was followed. RESULTS: 972 studies were screened, 84 were downloaded, and 11 (57 patients) met criteria. In patients with mandibular insufficiency, MAS reduced apnea-hypopnea index (AHI) (50 patients) from 45.9 ± 24.7 to 6.2 ± 10.4 events/h (87% decrease). The lowest oxygen saturation (LSAT) (55 patients) increased from 71.9 ± 14.6% to 89.0 ± 11.0%. The AHI mean difference was -34.8 events/h [95% CI -43.9, -25.8]. The AHI standardized mean difference was -1.8 [95% CI -2.5, -1.2] (indicating a large magnitude of effect). Surgical cure was seen in 75% of those with >16 mm of mandibular advancement vs. 35% of those with <16 mm of advancement [Odds Ratio 5.5; 95% CI 1.06-28.4; Chi Square p = 0.035]. CONCLUSIONS: The current literature supports isolated mandibular advancement as an efficacious treatment modality for adult OSA in select patients with mandibular insufficiency.

16 Review Obesity Hypoventilation Syndrome: Choosing the Appropriate Treatment of a Heterogeneous Disorder. 2017

Piper, Amanda J / BaHammam, Ahmed S / Javaheri, Shahrokh. ·Sleep Unit, Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia; Central Medical School, University of Sydney, Sydney 2006, New South Wales, Australia. Electronic address: amanda.piper@sydney.edu.au. · The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11324, Saudi Arabia; National Plan for Science and Technology, King Saud University, Riyadh 11324, Saudi Arabia. · Montgomery Sleep Laboratory, Bethesda North Hospital, Cincinnati, OH 45242, USA; Pulmonary and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA; Division of Cardiology, Ohio State University, Columbus, OH, USA. ·Sleep Med Clin · Pubmed #29108613.

ABSTRACT: The obesity hypoventilation syndrome (OHS) is associated with significant morbidity and increased mortality compared with simple obesity and eucapnic obstructive sleep apnea. Accurate diagnosis and commencement of early and appropriate management is fundamental in reducing the significant personal and societal burdens this disorder poses. Sleep disordered breathing is a major contributor to the developmental of sleep and awake hypercapnia, which characterizes OHS, and is effectively addressed through the use of positive airway pressure (PAP) therapy. This article reviews the current evidence supporting different modes of PAP currently used in managing these individuals.

17 Review Positive Airway Pressure Therapy for Hyperventilatory Central Sleep Apnea: Idiopathic, Heart Failure, Cerebrovascular Disease, and High Altitude. 2017

Javaheri, Shahrokh / Brown, Lee K. ·Sleep Laboratory, Bethesda North Hospital, 10535 Montgomery Road, Suite 200, Cincinnati, OH 45242, USA; The University of Cincinnati, Cincinnati, OH, USA; The Ohio University Medical School, Columbus, OH, USA. Electronic address: shahrokhjavaheri@icloud.com. · Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, University of New Mexico Sleep Disorders Center, 1101 Medical Arts Avenue Northeast, Building #2, Albuquerque, NM 87102, USA; Department of Electrical and Computer Engineering, University of New Mexico School of Engineering, University of New Mexico Sleep Disorders Center, 1101 Medical Arts Avenue Northeast, Building #2, Albuquerque, NM 87102, USA. ·Sleep Med Clin · Pubmed #29108611.

ABSTRACT: Central sleep apnea (CSA) and Hunter-Cheyne-Stokes breathing (HCSB) are caused by failure of the pontomedullary pacemaker generating breathing rhythm. CSA/HCSB may complicate several disorders causing recurrent arousals and desaturations. Common causes of CSA in adults are congestive heart failure, stroke, and chronic use of opioids; opioids have hypoventilatory effects. Diagnosis and treatment of hyperventilatory CSA may improve quality of life, and, when associated with heart failure or cerebrovascular disease, reduce morbidity and perhaps mortality.

18 Review Treatment of Obstructive Sleep Apnea: Achieving Adherence to Positive Airway Pressure Treatment and Dealing with Complications. 2017

Lettieri, Christopher J / Williams, Scott G / Collen, Jacob F / Wickwire, Emerson M. ·Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA. Electronic address: christopher.j.lettieri.mil@mail.mil. · Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA. · Department of Psychiatry, University of Maryland School of Medicine, 100 North Greene Street, 2nd Floor, Baltimore, MD 21201, USA; Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 100 North Greene Street, 2nd Floor, Baltimore, MD 21201, USA. ·Sleep Med Clin · Pubmed #29108610.

ABSTRACT: Obstructive sleep apnea is a common and treatable condition, but therapeutic adherence is limited by numerous factors. Despite advances in positive airway pressure (PAP) technology and a multitude of effective pharmacologic and behavioral therapeutic interventions to overcome the most common barriers to PAP, adherence has not increased significantly over the past 30 years. This review aims to identify the most important factors that impact adherence, common barriers to treatment, and evidence-based treatment strategies to maximize the effectiveness of PAP treatment. Complications of PAP treatment and mitigation techniques are also discussed.

19 Review Positive Airway Pressure Device Technology Past and Present: What's in the "Black Box"? 2017

Brown, Lee K / Javaheri, Shahrokh. ·Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, University of New Mexico Sleep Disorders Center, 1101 Medical Arts Avenue NE, Building #2, Albuquerque, NM 87102, USA; Department of Electrical and Computer Engineering, University of New Mexico School of Engineering, University of New Mexico Sleep Disorders Center, 1101 Medical Arts Avenue NE, Building #2, Albuquerque, NM 87102, USA. Electronic address: lkbrown@alum.mit.edu. · Sleep Laboratory, Bethesda North Hospital, 10475 Montgomery Road, Cincinnati, OH 45242, USA; TriHealth Sleep Center, Pulmonary and Sleep Division, Bethesda North Hospital, University of Cincinnati College of Medicine, 10500 Montgomery Road, Cincinnati, OH 45242, USA; The Ohio State University College of Medicine, 473 West 12th Avenue, Columbus, OH 43210, USA. ·Sleep Med Clin · Pubmed #29108606.

ABSTRACT: Since the introduction of continuous positive airway pressure (PAP) for the treatment of obstructive sleep apnea (OSA) in 1981, PAP technology has diversified exponentially. Compact and quiet fixed continuous PAP flow generators, autotitrating PAP devices, and bilevel PAP devices that can treat multiple sleep-disordered breathing phenotypes including OSA, central sleep apnea (CSA), combinations of OSA and CSA, and hypoventilation are available. Adaptive servo-ventilators can suppress Hunter-Cheyne-Stokes breathing and CSA and treat coexisting obstructive events. Volume-assured pressure support PAP apparatus purports to provide a targeted degree of ventilatory assistance while also treating cooccurring OSA and/or CSA.

20 Review [Obstructive sleep apnea and hypertension]. 2017

Balanis, Thomas / Sanner, Bernd. ·Agaplesion Bethesda Krankenhaus, Wuppertal, Deutschland. · Medizinische Klinik, Agaplesion Bethesda Krankenhaus gGmbH, Hainstr. 35, D-42109, Wuppertal, Deutschland. bernd.sanner@bethesda-wuppertal.de. ·MMW Fortschr Med · Pubmed #28718114.

ABSTRACT: -- No abstract --

21 Review Polysomnography results versus clinical factors to predict post-operative respiratory complications following pediatric adenotonsillectomy. 2017

Saur, John S / Brietzke, Scott E. ·Walter Reed National Military Medical Center, USA. · Walter Reed National Military Medical Center, USA; Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, USA. Electronic address: SEBrietzke@msn.com. ·Int J Pediatr Otorhinolaryngol · Pubmed #28583490.

ABSTRACT: OBJECTIVE: Systematically review the published literature comparing the presence of clinical features (age, BMI, co-morbidities, etc.) versus polysomnogram (PSG) results in the prediction of major post-operative respiratory complications following pediatric adenotonsillectomy (T/A) for the treatment of Obstructive Sleep Apnea Syndrome (OSAS). METHODS: A systematic review of the PUBMED and EMBASE databases was performed to identify studies containing both clinical and PSG data predicting major post-operative respiratory complications following T/A. Inclusion criteria included English language and extractable data. Major respiratory complications were defined as events that required significant intervention (intubation, CPAP,etc.) and/or altered patient disposition. Random effect modeling was performed and study quality was assessed using the Newcastle-Ottawa Scale. RESULTS: Twenty-two studies met the inclusion criteria with a median sample size of 157 (range 26-1735) and published between 1992 and 2015. The most common study design was a case series. Most studies included multiple patients at high risk for respiratory complications (Syndromic, obese, etc.). The summary estimate of the major respiratory complication rate following T/A was only 5.8% (95% CI = 4.2-7.4%, p < 0.001, I CONCLUSION: The major respiratory complication rate following pediatric T/A for OSAS is low even amongst series of high risk patients. The majority of the published literature report that readily identified clinical factors predict the large majority of post-operative respiratory complications following T/A.

22 Review Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis. 2017

Camacho, Macario / Noller, Michael W / Zaghi, Soroush / Reckley, Lauren K / Fernandez-Salvador, Camilo / Ho, Erika / Dunn, Brandyn / Chan, Dylan. ·Division of Otolaryngology, Sleep Surgery and Sleep Medicine, Tripler Army Medical Center, Tripler AMC, 1 Jarrett White Rd, Honolulu, HI, 96859, USA. drcamachoent@yahoo.com. · School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA. · Division of Sleep Surgery and Medicine, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, CA, USA. · Division of Otolaryngology and Sleep Medicine, Tripler Army Medical Center, Tripler AMC, Honolulu, HI, USA. · John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, 96813, USA. · University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868, USA. · Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, 94158, USA. ·Eur Arch Otorhinolaryngol · Pubmed #28378061.

ABSTRACT: OBJECTIVES: To evaluate the international literature for studies reporting outcomes for obstructive sleep apnea (OSA) in children undergoing isolated tongue surgeries. METHODS: Two authors searched from inception through November 14, 2016 in four databases including PubMed/MEDLINE. RESULTS: 351 studies were screened. Eleven studies (116 children) met criteria. Most children were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Surgeries included base-of-tongue (BOT) reduction (n = 114), tongue suspension (n = 1), and hypoglossal nerve stimulation (n = 1). The pre- and post-BOT reduction surgeries decreased apnea-hypopnea index (AHI) from a mean (M) and standard deviation (SD) of 16.9 ± 12.2/h to 8.7 ± 10.6/h (48.5% reduction) in 114 patients. Random effects modeling (109 patients) demonstrated a standardized mean difference for AHI of -0.78 (large magnitude of effect) [95% CI -1.06, -0.51], p value <0.00001. For BOT surgery in 53 non-syndromic children, the AHI decreased 59.2% from 14.0 ± 11.4 to 5.7 ± 6.7/h, while in 55 syndromic children, the AHI decreased 40.0% from 20.5 ± 19.1 to 12.3 ± 18.2/h. BOT reduction improved lowest oxygen saturation from M ± SD of 84.7 ± 7.4-87.9 ± 6.5% in 113 patients. Hypoglossal nerve stimulation and tongue-base suspension are limited to case reports. CONCLUSIONS: Most children undergoing tongue surgeries in the literature were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Children with a body mass index <25 kg/m

23 Review Tongue retaining devices for obstructive sleep apnea: A systematic review and meta-analysis. 2017

Chang, Edward T / Fernandez-Salvador, Camilo / Giambo, Jeremy / Nesbitt, Blaine / Liu, Stanley Yung-Chuan / Capasso, Robson / Kushida, Clete A / Camacho, Macario. ·Department of Otolaryngology, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, HI, USA. Electronic address: etchan78@gmail.com. · Department of Otolaryngology, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, HI, USA. Electronic address: cferna25@gmail.com. · Uniformed Services University of the Health Sciences, School of Medicine, Bethesda,MD 20814, USA. Electronic address: jeremy.giambo@usuhs.edu. · Uniformed Services University of the Health Sciences, School of Medicine, Bethesda,MD 20814, USA. Electronic address: nicholas.nesbitt@usuhs.edu. · Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA. Electronic address: stanley.yung.liu@gmail.com. · Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA. Electronic address: rcapasso@stanford.edu. · Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine,Stanford Hospital and Clinics, 450 Broadway St. 2nd Floor, Redwood City, CA 94063, USA. Electronic address: clete@standford.edu. · Department of Otolaryngology, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, HI, USA; Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine,Stanford Hospital and Clinics, 450 Broadway St. 2nd Floor, Redwood City, CA 94063, USA. Electronic address: drcamachoent@yahoo.com. ·Am J Otolaryngol · Pubmed #28237516.

ABSTRACT: OBJECTIVE: Tongue Retaining Devices (TRD) anteriorly displace the tongue with suction forces while patients sleep. TRD provide a non-surgical treatment option for patients with Obstructive Sleep Apnea (OSA). Our objective was to conduct a systematic review of the international literature for TRD outcomes as treatment for OSA. METHODS: Three authors independently and systematically searched four databases (including PubMed/MEDLINE) through June 26, 2016. We followed guidelines set within the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS: Sixteen studies with 242 patients met criteria. The overall means±standard deviations (M±SD) for apnea-hypopnea index (AHI) decreased from 33.6±21.1/h to 15.8±16.0/h (53% reduction). Seven studies (81 patients) reported lowest oxygen saturation (LSAT), which improved from 79.8±17.5% to 83.9±8.6%. Four studies (93 patients) reported Epworth sleepiness scale (ESS), which decreased from 10.8±4.8 to 8.2±4.5, p <0.0001. Four studies (31 patients) reported Oxygen Desaturation Index (ODI) which decreased from 29.6±32.1 to 12.9±8.7, a 56.4% reduction. CONCLUSION: Current international literature demonstrates that tongue retaining devices reduce apnea-hypopnea index by 53%, increase lowest oxygen saturation by 4.1 oxygen saturation points, decrease oxygen desaturation index by 56% and decrease Epworth sleepiness scale scores by 2.8 points. Tongue retaining devices provide a statistically effective alternative treatment option for obstructive sleep apnea.

24 Review Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. 2017

Javaheri, Shahrokh / Barbe, Ferran / Campos-Rodriguez, Francisco / Dempsey, Jerome A / Khayat, Rami / Javaheri, Sogol / Malhotra, Atul / Martinez-Garcia, Miguel A / Mehra, Reena / Pack, Allan I / Polotsky, Vsevolod Y / Redline, Susan / Somers, Virend K. ·Pulmonary and Sleep Division, Bethesda North Hospital, Cincinnati, Ohio. Electronic address: shahrokhjavaheri@icloud.com. · Respiratory Department, Institut Ricerca Biomèdica de Lleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain. · Respiratory Department, Hospital Universitario de Valme, Sevilla, Spain. · Department of Population Health Sciences and John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, Wisconsin. · Sleep Heart Program, the Ohio State University, Columbus, Ohio. · Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts. · Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, California. · Respiratory Department, Hospital Universitario de Politecnico La Fe, Valencia, Spain. · Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio. · Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. · Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. ·J Am Coll Cardiol · Pubmed #28209226.

ABSTRACT: Sleep apnea is highly prevalent in patients with cardiovascular disease. These disordered breathing events are associated with a profile of perturbations that include intermittent hypoxia, oxidative stress, sympathetic activation, and endothelial dysfunction, all of which are critical mediators of cardiovascular disease. Evidence supports a causal association of sleep apnea with the incidence and morbidity of hypertension, coronary heart disease, arrhythmia, heart failure, and stroke. Several discoveries in the pathogenesis, along with developments in the treatment of sleep apnea, have accumulated in recent years. In this review, we discuss the mechanisms of sleep apnea, the evidence that addresses the links between sleep apnea and cardiovascular disease, and research that has addressed the effect of sleep apnea treatment on cardiovascular disease and clinical endpoints. Finally, we review the recent development in sleep apnea treatment options, with special consideration of treating patients with heart disease. Future directions for selective areas are suggested.

25 Review Laser-Assisted Uvulopalatoplasty for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. 2017

Camacho, Macario / Nesbitt, N Blaine / Lambert, Evan / Song, Sungjin A / Chang, Edward T / Liu, Stanley Y / Kushida, Clete A / Zaghi, Soroush. ·Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, HI. · Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, CA. · F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD. · Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, HI. · Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, CA. ·Sleep · Pubmed #28201808.

ABSTRACT: Study Objectives: Laser-assisted uvulopalatoplasty (LAUP) has been used as treatment for obstructive sleep apnea (OSA). The objective of this study was to perform a systematic review and meta-analysis for LAUP alone as treatment for OSA in adults. Methods: Three authors searched five databases (including PubMed/MEDLINE) from inception through October 30, 2016 for peer-reviewed studies, with any design/language. A study quality assessment tool was used. The PRISMA statement was followed. A meta-analysis was performed. Results: Twenty-three adult studies (717 patients) reported outcomes (age: 50 ± 9 years, body mass index: 29 ± 4 kg/m2). The pre- and post-LAUP means (M) ± standard deviations (SDs) for apnea-hypopnea index (AHI) were 28 ± 13 and 19 ± 12 events/h (32% reduction). Random effects modeling for 519 patients demonstrated an AHI mean difference (MD) of -6.56 [95% CI -10.14, -2.97] events/h. Individual patient data analyses demonstrate a 23% success rate (≥50% reduction in AHI and <20 events/h) and an 8% cure rate. Additionally, 44% of patients had worsening of their AHI after LAUP. Lowest oxygen saturation (LSAT) improved from a M ± SD of 80 ± 8% to 82 ± 7%. A limitation is that most studies were case series studies and only two were randomized controlled trials. Conclusions: In this meta-analysis, LAUP reduced AHI by 32% among all patients; while the LSAT only changed minimally. Individual data demonstrated a success rate of 23%, cure rate of 8%, and worsening of the AHI among 44% of patients. We recommend that LAUP be performed with caution or not performed at all given the unfavorable results of currently published studies.

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