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Sleep Apnea Syndromes: HELP
Articles from Chicago
Based on 569 articles published since 2008
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These are the 569 published articles about Sleep Apnea Syndromes that originated from Chicago during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
151 Review Sleep, sleep disorders and inflammation in children. 2009

Gozal, David. ·Department of Pediatrics, Comer Children's Hospital, The University of Chicago, Chicago, IL 60637, USA. dgozal@peds.bsd.uchicago.edu ·Sleep Med · Pubmed #19647481.

ABSTRACT: Sleep-disordered breathing (SDB) and, more specifically, obstructive sleep apnea (OSA), can lead to significant morbidities including cardiovascular morbidity and neurocognitive dysfunction in children. Oxidative stress and increased inflammatory process activity are thought to be linked to the morbid consequences of OSA. Clinical and laboratory-based approaches have shown that oxidative stress and inflammation may be further modulated by genetic, lifestyle and environmental factors. Surgical treatment for OSA in children has been shown to be at least partially effective at normalizing endothelial function, reducing levels of inflammatory markers, and improving lipid profile, the apnea-hypopnea index and sleep fragmentation.

152 Review Determinants of hypercapnia in obese patients with obstructive sleep apnea: a systematic review and metaanalysis of cohort studies. 2009

Kaw, Roop / Hernandez, Adrian V / Walker, Esteban / Aboussouan, Loutfi / Mokhlesi, Babak. ·Department of Hospital Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH; Medicine Institute, the Department of Outcomes Research, Respiratory Institute, Cleveland Clinic, Cleveland, OH. Electronic address: kawr@ccf.org. · Anesthesiology Institute, the Department of Quantitative Health Sciences, Respiratory Institute, Cleveland Clinic, Cleveland, OH. · Lerner Research Institute, and the Department of Pulmonary, Critical Care, and Allergy, Respiratory Institute, Cleveland Clinic, Cleveland, OH. · Sleep Disorders Center, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL. ·Chest · Pubmed #19567489.

ABSTRACT: BACKGROUND: Inconsistent information exists about factors associated with daytime hypercapnia in obese patients with obstructive sleep apnea (OSA). We systematically evaluated these factors in this population. METHODS: We included studies evaluating the association between clinical and physiologic variables and daytime hypercapnia (Paco(2), >or= 45 mm Hg) in obese patients (body mass index [BMI], >or= 30 kg/m(2)) with OSA (apnea-hypopnea index [AHI], >or= 5) and with a < 15% prevalence of COPD. Two investigators conducted independent literature searches using Medline, Web of Science, and Scopus until July 31, 2008. The association between individual factors and hypercapnia was expressed as the mean difference (MD). Random effects models were used to account for heterogeneity. RESULTS: Fifteen studies (n = 4,250) fulfilled the selection criteria. Daytime hypercapnia was present in 788 patients (19%). Age and gender were not associated with hypercapnia. Patients with hypercapnia had higher BMI (MD, 3.1 kg/m(2); 95% confidence interval [CI], 1.9 to 4.4) and AHI (MD, 12.5; 95% CI, 6.6 to 18.4) than eucapnic patients. Patients with hypercapnia had lower percent predicted FEV(1) (MD, -11.2; 95% CI, -15.7 to -6.8), lower percent predicted vital capacity (MD, -8.1; 95% CI, -11.3 to -4.9), and lower percent predicted total lung capacity (MD, -6.4; 95% CI, -10.0 to -2.7). FEV(1)/FVC percent predicted was not different between hypercapnic and eucapnic patients (MD, -1.7; 95% CI, -4.1 to 0.8), but mean overnight pulse oximetric saturation was significantly lower in hypercapnic patients (MD, -4.9; 95% CI, -7.0 to -2.7). CONCLUSIONS: In obese patients with OSA and mostly without COPD, daytime hypercapnia was associated with severity of OSA, higher BMI levels, and degree of restrictive chest wall mechanics. A high index of suspicion should be maintained in patients with these factors, as early recognition and appropriate treatment can improve outcomes.

153 Review Clinical inquiries. Sleep apnea in adults: how accurate is clinical prediction? 2009

Jacobs, Christine K / Coffey, John. ·Advocate Illinois Masonic Family Medicine Residency, Chicago, IL, USA. ·J Fam Pract · Pubmed #19508847.

ABSTRACT: Moderately accurate, depending on which tool you use. Questionnaires, physical examination, and clinical prediction rules estimate the pretest probability of obstructive sleep apnea hypopnea syndrome (OSAHS), but are not specific enough to make the diagnosis. The Epworth Sleepiness Scale is a reliable measure of daytime sleepiness. The Berlin Questionnaire, Mallampati score, and truncal obesity can be used to assess pretest probability of OSAHS.

154 Review Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. 2009

Friedman, Michael / Wilson, Meghan / Lin, Hsin-Ching / Chang, Hsueh-Wen. ·Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA. hednnek@aol.com ·Otolaryngol Head Neck Surg · Pubmed #19467393.

ABSTRACT: OBJECTIVE: Perform an updated systematic review and meta-analysis to determine the cure rate of tonsillectomy and adenoidectomy (T&A) for pediatric obstructive sleep apnea/hypopnea syndrome (OSAHS). METHODS: A systematic review was performed to identify English-language studies that evaluate the treatment of pediatric (age < 20 years) OSAHS patients with T&A using polysomnography as a metric of cure. Twenty-three studies fit the inclusion criteria and a meta-analysis was performed to determine the overall success. Meta-analysis was also performed to determine the success in obese and comorbid populations vs cohorts of healthy children. RESULTS: The meta-analysis included 1079 subjects (mean sample size of 42 patients) with a mean age of 6.5 years. The effect measure was the percentage of pediatric patients with OSAHS who were successfully treated (k = 22 studies) with T&A based on preoperative and postoperative PSG data. Random-effects model estimated the treatment success of T&A was 66.3 percent, when cure was defined per each individual study. When "cure" was defined as an apnea-hypopnea index (AHI) of <1 (k = 9 studies), random-effects model estimate for OSAHS treatment success with T&A was 59.8 percent. Postoperative mean AHI was significantly decreased from preoperative levels. CONCLUSIONS: Contrary to popular belief, meta-analysis of current literature demonstrates that pediatric sleep apnea is often not cured by T&A. Although complete resolution is not achieved in most cases, T&A still offers significant improvements in AHI, making it a valuable first-line treatment for pediatric OSAHS.

155 Review Obstructive sleep apnea: a cardiopulmonary perspective and medical therapeutics. 2009

Jalandhara, Nishant B / Patel, Anil / Arora, Rohit R / Jalandhara, Priyanka. ·Rosalind Franklin University, North Chicago, IL, USA. ·Am J Ther · Pubmed #19454864.

ABSTRACT: The clinical importance of obstructive sleep apnea (OSA) is gradually rising to the extent that many clinicians now consider OSA as an underlying etiology or precipitating factor for many cardiovascular and pulmonary events. Although the incidence and pathophysiology underlying these cardiopulmonary structural and functional abnormalities are not well defined, various mechanisms are hypothesized. These include but are not limited to sympathetic activation, oxidative stress, inflammation, and endothelial dysfunction. Given the rising awareness of OSA, it is timely to review the effects of OSA on cardiovascular complications like arrhythmias and ventricular remodeling. In the later part of the review, we focused on the role of therapeutics in the management of patients with OSA. Although the role of medical therapeutics is not well defined, we reviewed the available literature focusing on the available options, supporting evidence and their role in specific subgroup of patients with OSA.

156 Review Congenital central hypoventilation syndrome from past to future: model for translational and transitional autonomic medicine. 2009

Weese-Mayer, Debra E / Rand, Casey M / Berry-Kravis, Elizabeth M / Jennings, Larry J / Loghmanee, Darius A / Patwari, Pallavi P / Ceccherini, Isabella. ·Department of Pediatrics, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60614, USA. dweese-mayer@childrensmemorial.org ·Pediatr Pulmonol · Pubmed #19422034.

ABSTRACT: The modern story of CCHS began in 1970 with the first description by Mellins et al., came most visibly to the public eye with the ATS Statement in 1999, and continues with increasingly fast paced advances in genetics. Affected individuals have diffuse autonomic nervous system dysregulation (ANSD). The paired-like homeobox gene PHOX2B is the disease-defining gene for CCHS; a mutation in the PHOX2B gene is requisite to the diagnosis of CCHS. Approximately 90% of individuals with the CCHS phenotype will be heterozygous for a polyalanine repeat expansion mutation (PARM); the normal allele will have 20 alanines and the affected allele will have 24-33 alanines (genotypes 20/24-20/33). The remaining approximately 10% of individuals with CCHS will have a non-PARM (NPARM), in the PHOX2B gene; these will be missense, nonsense, or frameshift. CCHS and PHOX2B are inherited in an autosomal dominant manner with a stable mutation. Approximately 8% of parents of a CCHS proband will be mosaic for the PHOX2B mutation. A growing number of cases of CCHS are identified after the newborn period, with presentation from infancy into adulthood. An improved understanding of the molecular basis of the PHOX2B mutations and of the PHOX2B genotype/CCHS phenotype relationship will allow physicians to anticipate the clinical phenotype for each affected individual. To best convey the remarkable history of CCHS, and to describe the value of recognizing CCHS as a model for translational and transitional autonomic medicine, we present this review article in the format of a chronological story, from 1970 to the present day.

157 Review Reduced sleep duration or quality: relationships with insulin resistance and type 2 diabetes. 2009

Tasali, Esra / Leproult, Rachel / Spiegel, Karine. ·Department of Medicine, University of Chicago, Chicago, IL 60637, USA. etasali@medicine.bsd.uchicago.edu ·Prog Cardiovasc Dis · Pubmed #19249444.

ABSTRACT: -- No abstract --

158 Review Preoperative screening, evaluation, and optimization of the patient's medical status before outpatient surgery. 2008

Sweitzer, Bobbie Jean. ·Anesthesia and Critical Care, University of Chicago, Anesthesia Perioperative Medicine Clinic, Chicago, Illinois, USA. ·Curr Opin Anaesthesiol · Pubmed #18997522.

ABSTRACT: PURPOSE OF THE REVIEW: Preoperative evaluation and optimization of a patient's medical condition are important components of anesthesia practice. With ever increasing numbers of patients with serious comorbidities having complex procedures as outpatients, the task of gathering information and properly preparing for their care is challenging. Improvements in assessment and management can potentially reduce adverse events, improve patient and caregiver satisfaction, and reduce costs. RECENT FINDINGS: A growing body of literature and evidence-based practices and guidelines can assist clinicians who work in the expanding field of preoperative medicine. Care providers from various specialties in medicine are developing innovative methods, tools, and knowledge to advance science and processes. Data-driven practices are beginning to close the information gap that has plagued this field of medical practice. SUMMARY: Preparation of patients before surgery is a necessary and vital component of perioperative medicine. Practices are developing to guide effective interventions that benefit patients and healthcare systems. Outpatients present special challenges to preoperative assessment.

159 Review Pharmacology of vagal afferent influences on disordered breathing during sleep. 2008

Carley, David W / Radulovacki, Miodrag. ·Center for Narcolepsy, Sleep and Health Research, University of Illinois, Chicago, IL 60612, USA. dwcarley@uic.edu ·Respir Physiol Neurobiol · Pubmed #18694851.

ABSTRACT: Sleep-related breathing disorders (SRBD) are a significant public health concern, with a prevalence in the US general population of approximately 2% of women and approximately 4% of men. Although significant strides have been made in our understanding of these disorders with respect to epidemiology, risk factors, pathogenesis and consequences, work to understand these factors in terms of the underlying cellular, molecular and neuromodulatory processes remains in its infancy. Current primary treatments are surgical or mechanical, with no drug treatments available. Basic investigations into the neurochemistry and neuropharmacology of sleep-related changes in respiratory pattern generation and modulation will be essential to clarify the pathogenic processes underlying SRBD and to identify rational and specific pharmacotherapeutic opportunities. Here we summarize emerging work suggesting the importance of vagal afferent feedback systems in sleep-related respiratory pattern disturbances and pointing toward a rich but complex array of neurochemical and neuromodulatory processes that may be involved.

160 Review Diagnosis and management of obesity hypoventilation syndrome in the ICU. 2008

Lee, Won Y / Mokhlesi, Babak. ·Section of Pulmonary and Critical Care Medicine, The University of Chicago Pritzker School of Medicine, 5841 South Maryland Avenue, Sleep Disorders Center W 4, Chicago, IL 60637, USA. ·Crit Care Clin · Pubmed #18538199.

ABSTRACT: Obesity hypoventilation syndrome (OHS) is characterized by obesity, daytime hypercapnia, and sleep-disordered breathing in the absence of other known causes of hypercapnia. Because of the global obesity epidemic and the high prevalence of obstructive sleep apnea in the general population, critical care physicians are likely to encounter patients who have acute-on-chronic respiratory failure attributable to OHS in their clinical practice. In this article we define the clinical characteristics of OHS, review its pathophysiology, and discuss the morbidity and mortality associated with OHS. Finally, we offer treatment strategies during ICU management using noninvasive positive pressure ventilation that may guide the physician in the care of these challenging patients.

161 Review Obstructive sleep apnea and type 2 diabetes: interacting epidemics. 2008

Tasali, Esra / Mokhlesi, Babak / Van Cauter, Eve. ·University of Chicago, Department of Medicine, 5841 S Maryland Ave, MC 6026, Chicago, IL 60637, USA. etasali@medicine.bsd.uchicago.edu ·Chest · Pubmed #18252916.

ABSTRACT: Type 2 diabetes is a major public health concern with high morbidity, mortality, and health-care costs. Recent reports have indicated that the majority of patients with type 2 diabetes also have obstructive sleep apnea (OSA). There is compelling evidence that OSA is a significant risk factor for cardiovascular disease and mortality. Rapidly accumulating data from both epidemiologic and clinical studies suggest that OSA is also independently associated with alterations in glucose metabolism and places patients at an increased risk of the development of type 2 diabetes. Experimental studies in humans and animals have demonstrated that intermittent hypoxia and reduced sleep duration due to sleep fragmentation, as occur in OSA, exert adverse effects on glucose metabolism. Based on the current evidence, clinicians need to address the risk of OSA in patients with type 2 diabetes and, conversely, evaluate the presence of type 2 diabetes in patients with OSA. Clearly, there is a need for further research, using well-designed studies and long-term follow-up, to fully demonstrate a causal role for OSA in the development and severity of type 2 diabetes. In particular, future studies must carefully consider the confounding effects of central obesity in examining the link between OSA and alterations in glucose metabolism. The interactions among the rising epidemics of obesity, OSA, and type 2 diabetes are likely to be complex and involve multiple pathways. A better understanding of the relationship between OSA and type 2 diabetes may have important public health implications.

162 Review Cardiometabolic features of polycystic ovary syndrome. 2008

Hoffman, Leslie K / Ehrmann, David A. ·Section of Endocrinology, Diabetes and Metabolism, The University of Chicago, 5841 S Maryland Avenue, Mail Code 1027, Chicago, IL 60637, USA. ·Nat Clin Pract Endocrinol Metab · Pubmed #18250636.

ABSTRACT: Polycystic ovary syndrome (PCOS) is a complex disorder comprising both hormonal and metabolic abnormalities that include impaired glucose tolerance, type 2 diabetes, vascular disease, dyslipidemia, and obstructive sleep apnea. Insulin resistance is a central pathogenetic factor in PCOS that seems to result from a post-receptor-binding defect in insulin action. Insulin resistance and the consequent development of hyperinsulinemia contribute to the constellation of cardiometabolic abnormalities noted above. Although there is a paucity of data in regard to cardiovascular event rates and mortality in PCOS, an increased prevalence of cardiovascular risk factors has been well documented. Attention to the metabolic risks associated with PCOS, starting as early as adolescence, is essential to the medical care of these patients.

163 Review Assessment and management of patients with obesity hypoventilation syndrome. 2008

Mokhlesi, Babak / Kryger, Meir H / Grunstein, Ronald R. ·Section of Pulmonary and Critical Care Medicine, and Sleep disorders Center, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA. bmokhles@medicine.bsd.uchicago.edu ·Proc Am Thorac Soc · Pubmed #18250215.

ABSTRACT: Obesity hypoventilation syndrome (OHS) is characterized by obesity, daytime hypercapnia, and sleep-disordered breathing in the absence of significant lung or respiratory muscle disease. Compared with eucapnic morbidly obese patients and eucapnic patients with sleep-disordered breathing, patients with OHS have increased health care expenses and are at higher risk of developing serious cardiovascular disease leading to early mortality. Despite the significant morbidity and mortality associated with this syndrome, diagnosis and institution of effective treatment occur late in the course of the syndrome. Given that the prevalence of extreme obesity has increased considerably, it is likely that clinicians will encounter patients with OHS in their clinical practice. Therefore maintaining a high index of suspicion can lead to early recognition and treatment reducing the high burden of morbidity and mortality and related health care expenditure associated with undiagnosed and untreated OHS. In this review we define the clinical characteristics of the syndrome and review the pathophysiology, morbidity, and mortality associated with it. Last, we discuss currently available treatment modalities.

164 Review Obstructive sleep apnea and metabolic syndrome: alterations in glucose metabolism and inflammation. 2008

Tasali, Esra / Ip, Mary S M. ·Department of Medicine, University of Chicago, IL 60637, USA. etasali@medicine.bsd.uchicago.edu ·Proc Am Thorac Soc · Pubmed #18250214.

ABSTRACT: Metabolic syndrome (MS), the commonly used term for the clustering of obesity, insulin resistance, hypertension, and dyslipidemia, affects millions of people worldwide, and is associated with an increased risk of cardiovascular disease and type 2 diabetes. Recently, it has been suggested that obstructive sleep apnea (OSA), an increasingly prevalent condition, may contribute to the development of MS and diabetes. Despite substantial evidence from both clinical and population studies to suggest an independent link between OSA and metabolic abnormalities, the issue still remains controversial. Obesity, particularly visceral obesity, is an important factor in the assessment of adverse metabolic outcome in OSA. Further prospective and interventional studies, with adequate sample sizes and longer follow-up, rigorous control for adiposity, and, ideally, randomization and control for any therapeutic intervention, are clearly needed to address the direction of causality. There are multiple mechanistic pathways involved in the interaction between OSA, obesity, and metabolic derangements. Chronic intermittent hypoxia and sleep fragmentation with sleep loss in OSA are likely key triggers that initiate or contribute to the sustenance of inflammation as a prominent phenomenon, but their complex interplay remains to be elucidated. In summary, OSA may represent a novel risk factor for MS and diabetes, and thus clinicians should be encouraged to systematically evaluate the presence of metabolic abnormalities in OSA and vice versa.

165 Clinical Trial Differences in Dynamic Diurnal Blood Pressure Variability Between Japanese and American Treatment-Resistant Hypertensive Populations. 2017

Kario, Kazuomi / Bhatt, Deepak L / Brar, Sandeep / Bakris, George L. ·Department of Cardiovascular Medicine, Jichi Medical University School of Medicine. · Division of Cardiovascular Disease, Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School. · Cardiovascular Division, Medtronic. · ASH Comprehensive Hypertension Center, The University of Chicago Medicine. ·Circ J · Pubmed #28458378.

ABSTRACT: BACKGROUND: Dynamic diurnal changes in 24-h ambulatory systolic blood pressure (SBP) are associated with increased cardiovascular risk. We compared ambulatory BP dynamics in Japanese and American black and white populations with treatment-resistant hypertension.Methods and Results:Both HTN-Japan (n=41) and SYMPLICITY HTN-3 (n=384 white and n=140 black patients) enrolled patients with office SBP ≥160 mmHg and 24-h ambulatory SBP ≥135 mmHg while on ≥3 antihypertensive medications. Indices of circadian variation in ambulatory BP, including morning and nighttime dynamic surges, were retrospectively compared. All 3 cohorts had similar baseline office SBP. The Japanese cohort had significantly lower body mass index, less obstructive sleep apnea, and less hypercholesterolemia than the black and white cohorts, but significantly greater morning SBP levels, including moving peak morning SBP (183 vs. 169 vs. 169 mmHg, P<0.001), morning dynamic surge (37.9 vs. 28.6 vs. 24.2 mmHg, P<0.001) and nighttime dynamic surge (24.9 vs. 8.3 vs. 7.7 mmHg, P<0.001). These racial differences in SBP surge parameters persisted despite adjustment for baseline demographic population differences through multivariate regression. CONCLUSIONS: Greater diurnal BP variability, including dynamic surges, in Japanese compared with black and white patients may indicate ethnic differences in the underlying BP regulatory mechanism of resistant hypertension. These differences may be important to take into consideration for more specific drug and device-based therapy strategies based on ethnicity.

166 Clinical Trial The Accuracy of Portable Monitoring in Diagnosing Significant Sleep Disordered Breathing in Hospitalized Patients. 2016

Nagubadi, Swamy / Mehta, Rohit / Abdoh, Mamoun / Nagori, Mohammedumer / Littleton, Stephen / Gueret, Renaud / Tulaimat, Aiman. ·Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America. ·PLoS One · Pubmed #27992566.

ABSTRACT: BACKGROUND: Polysomnograms are not always feasible when sleep disordered breathing (SDB) is suspected in hospitalized patients. Portable monitoring is a practical alternative; however, it has not been recommended in patients with comorbidities. OBJECTIVE: We evaluated the accuracy of portable monitoring in hospitalized patients suspected of having SDB. DESIGN: Prospective observational study. SETTING: Large, public, urban, teaching hospital in the United States. PARTICIPANTS: Hospitalized patients suspected of having SDB. METHODS: Patients underwent portable monitoring combined with actigraphy during the hospitalization and then polysomnography after discharge. We determined the accuracy of portable monitoring in predicting moderate to severe SDB and the agreement between the apnea hypopnea index measured by portable monitor (AHIPM) and by polysomnogram (AHIPSG). RESULTS: Seventy-one symptomatic patients completed both tests. The median time between the two tests was 97 days (IQR 25-75: 24-109). Forty-five percent were hospitalized for cardiovascular disease. Mean age was 52±10 years, 41% were women, and the majority had symptoms of SDB. Based on AHIPSG, SDB was moderate in 9 patients and severe in 39. The area under the receiver operator characteristics curve for AHIPM was 0.8, and increased to 0.86 in patients without central sleep apnea; it was 0.88 in the 31 patients with hypercapnia. For predicting moderate to severe SDB, an AHIPM of 14 had a sensitivity of 90%, and an AHIPM of 36 had a specificity of 87%. The mean±SD difference between AHIPM and AHIPSG was 2±29 event/hr. CONCLUSION: In hospitalized, symptomatic patients, portable monitoring is reasonably accurate in detecting moderate to severe SDB.

167 Clinical Trial Obstructive Sleep Apnea and Circulating Potassium Channel Levels. 2016

Jiang, Ning / Zhou, Anyu / Prasad, Bharati / Zhou, Li / Doumit, Jimmy / Shi, Guangbin / Imran, Hafiz / Kaseer, Bahaa / Millman, Richard / Dudley, Samuel C. ·Lifespan Cardiovascular Institute, Brown University, Providence, RI. · University of Illinois at Chicago, IL. · Rhode Island Hospital, Brown University, Providence, RI. · Lifespan Cardiovascular Institute, Brown University, Providence, RI The Providence VA, Providence, RI samuel_dudley@brown.edu. ·J Am Heart Assoc · Pubmed #27543307.

ABSTRACT: BACKGROUND: Cardiac arrhythmias and sudden cardiac death are more frequent in patients with obstructive sleep apnea (OSA). OSA is associated with QT prolongation, and QT prolongation is an independent risk factor for sudden cardiac death. Because QT prolongation can be mediated by potassium channel loss of function, we tested whether OSA or continuous positive airway pressure therapy altered mRNA expression of circulating white blood cell potassium channels. METHODS AND RESULTS: In total, 28 patients with OSA newly diagnosed by polysomnogram and 6 participants without OSA were enrolled. Potassium channel levels in white blood cells at baseline and at a 4-week follow-up visit were compared. There was a significant inverse correlation between the severity of the OSA stratified by apnea-hypopnea index and mRNA expression of the main potassium channels assessed: KCNQ1 (r=-0.486, P=0.007), KCNH2 (r=-0.437, P=0.016), KCNE1 (r=-0.567, P=0.001), KCNJ2 (r=-0.442, P=0.015), and KCNA5 (r=-0.468, P=0.009). In addition, KCNQ1, KCNH2, and KCNE1 inversely correlated with the oxygen desaturation index 4. After 4 weeks of continuous positive airway pressure therapy, circulating KCNQ1 and KCNJ2 were increased 1.4±0.4-fold (P=0.040) and 2.1±1.4-fold (P=0.046) in the moderate OSA group. Compared with patients with mild or moderate OSA, patients with severe OSA had a persistently higher apnea-hypopnea index (mild 2.0±1.8, moderate 1.0±0.9, severe 5.8±5.6; P=0.015), perhaps explaining why the potassium channel changes were not seen in the severe OSA group. CONCLUSIONS: The mRNA expression of most potassium channels inversely correlates with the severity of OSA and hypoxemia. Continuous positive airway pressure therapy improves circulating KCNQ1 and KCNJ2 in patients with moderate OSA.

168 Clinical Trial Montelukast for Children with Obstructive Sleep Apnea: Results of a Double-Blind, Randomized, Placebo-Controlled Trial. 2016

Kheirandish-Gozal, Leila / Bandla, Hari P R / Gozal, David. ·Section of Pediatric Sleep Medicine, Department of Pediatrics, Biological Sciences Division, Pritzker School of Medicine, University of Chicago, Chicago, Illinois. ·Ann Am Thorac Soc · Pubmed #27439031.

ABSTRACT: RATIONALE: Obstructive sleep apnea (OSA) is highly prevalent in children and is usually treated by adenotonsillectomy. Nonsurgical therapies for OSA consist primarily of antiinflammatory approaches and have gained popularity, but their efficacy remains to be critically examined. OBJECTIVES: To determine the effect of montelukast on pediatric OSA. METHODS: A prospective randomized double-blind controlled trial of polysomnographically diagnosed OSA in children ages 2-10 years who were treated with either oral montelukast (4 or 5 mg daily) or placebo for 16 weeks. Adherence to the medication was ascertained using automated timed pill dispensers along with weekly telephonic reminders. MEASUREMENTS AND MAIN RESULTS: Ninety-two children diagnosed with OSA were approached, and 64 (69.6%) agreed to participate. Of these, 57 (89.0%) completed the 16-week trial, 28 in the montelukast group and 29 in the placebo group. Age, sex, and percentage of obesity were similar in the two groups, as were initial apnea-hypopnea index (AHI) scores. Overall, intention-to-treat analyses revealed that beneficial effects occurred in 20 children receiving montelukast (71.4%), whereas only 2 (6.9%) of the children receiving placebo showed reductions in AHI score (P < 0.001). Indeed, AHI decreased from 9.2 ± 4.1/hour total sleep time (TST) to 4.2 ± 2.8/hour TST (P < 0.0001) in montelukast-treated children, whereas in children receiving placebo, the AHI did not change (from 8.2 ± 5.0/h TST before to 8.7 ± 4.9/h TST at completion of the trial). CONCLUSIONS: When compared with placebo, montelukast for 16 weeks effectively reduced the severity of obstructive sleep apnea in children 2-10 years of age. These results support a therapeutic role for leukotriene modifiers in pediatric OSA provided that long-term trials confirm current findings. Clinical trial registered with www.clinicaltrials.gov (NCT 00599534).

169 Clinical Trial Using the STOP-BANG questionnaire to predict hypoxaemia in patients recovering from noncardiac surgery: a prospective cohort analysis. 2016

Khanna, A K / Sessler, D I / Sun, Z / Naylor, A J / You, J / Hesler, B D / Kurz, A / Devereaux, P J / Saager, L. ·Center for Critical Care Department of Outcomes Research Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA khannaa@ccf.org. · Department of Outcomes Research. · Department of Outcomes Research Anesthesiology and Perioperative Medicine, Georgia Regents University, Augusta, Georgia, USA. · Department of Outcomes Research Department of Quantitative Health Sciences, Cleveland, Ohio, USA. · Department of Outcomes Research Department of Psychiatry, Rush University, Chicago, IL, USA. · Department of Outcomes Research Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA. · Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada Department of Clinical Epidemiology Department of Biostatistics Department of Medicine, McMaster University, Hamilton, Canada. ·Br J Anaesth · Pubmed #27106966.

ABSTRACT: BACKGROUND: The STOP-BANG questionnaire is a validated, eight-point dichotomized scale used to screen preoperative patients for obstructive sleep apnoea. Sleep apnoea causes hypoxaemia, and nocturnal oxygen desaturation is diagnostic in these patients. We tested the hypothesis that STOP-BANG score is associated with hypoxaemia after noncardiac surgery. METHODS: This analysis was a sub-study of VISION, a prospective cohort study of perioperative cardiovascular events. With institutional review board approval, we included 630 patients in the final analysis. We assessed the association between the STOP-BANG score and postoperative hypoxaemia, defined as integrated area under the curve of [Formula: see text] saturation of 90% per h using median quantile regression. Secondarily, we selected a subset of STOP-BANG questions that best predicts postoperative hypoxaemia using 'Least Absolute Shrinkage and Selection Operator' method, and then assessed the association between the new score based on the selected questions and the primary outcome using quantile regression. RESULTS: The median [q1, q3] area under [Formula: see text] of 90% per h was 0.09 [0.02, 0.39] %-h. The STOP-BANG score was not associated with hypoxaemia, with a multivariable slope coefficient of 0.002 (95% CI: -0.01, 0.01) %-h for a unit increase in the score (P=0.76). Secondarily, no association was found between the new score based on the two retained STOP-BANG questions, treatment for hypertension and neck circumference >40 cm, and the primary outcome with a multivariable slope coefficient of 0.03 (98.3% CI: -0.01, 0.06) %-h/score (P=0.07). CONCLUSIONS: The STOP-BANG score does not predict hypoxaemia in adults recovering from noncardiac surgery. CLINICAL TRIAL REGISTRATION: NCT00512109.

170 Clinical Trial Targeted hypoglossal nerve stimulation for the treatment of obstructive sleep apnea: Six-month results. 2016

Friedman, Michael / Jacobowitz, Ofer / Hwang, Michelle S / Bergler, Wolfgang / Fietze, Ingo / Rombaux, Philippe / Mwenge, Gimbada B / Yalamanchali, Sreeya / Campana, John / Maurer, Joachim T. ·Rush University Medical Center and Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, U.S.A.. mfriedman@chicagoent.com. · ENT and Allergy Associates, Orange Regional Medical Center, Middletown, New York, U.S.A. · Rush University Medical Center and Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, U.S.A. · Head and Neck Department, St. Joseph Hospital, Bremen, Germany. · Department of Cardiology, Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany. · Saint Luc University Clinics, Department of Oto-Rhino-Laryngology, Institute of Neurosciences, University of Louvain, Brussels, Belgium. · Colorado Head and Neck Specialists, Denver, Colorado, U.S.A. · Mannheim University ENT Clinic, Mannheim, Germany. ·Laryngoscope · Pubmed #27010361.

ABSTRACT: OBJECTIVES/HYPOTHESIS: This feasibility study was designed to show the preliminary safety and efficacy of targeted hypoglossal neurostimulation (THN), and to identify baseline predictors of successful therapy. STUDY DESIGN: Open-label, prospective, multicenter, single-arm cohort study, conducted at seven centers in the U.S.A. and Europe. METHODS: Forty-six participants with moderate to severe obstructive sleep apnea (OSA), failing or intolerant of continuous positive airway pressure, were implanted. Primary (Apnea-Hypopnea Index [AHI], Oxygen Desaturation Index [ODI]) and secondary (Arousal Index, Epworth Sleepiness Scale Index, Sleep Apnea Quality of Life Index) outcomes were measured at baseline and compared at 6 months. Data were analyzed to identify participant characteristics that would predict success with therapy. RESULTS: Sixty-seven adverse events (AEs) were observed among 36 participants; most of the AEs were related to the implant procedure and resolved without sequelae; one device replacement was necessary. Forty-three participants showed significant (P < .01) decreases in both AHI and ODI at 6 months; 35% (15 of 43) met criteria for AHI responders and 40% (17 of 43) for ODI responders. Significant improvement was observed in all the secondary endpoints. Predictors-of-success selection criteria were identified as baseline AHI < 65/hr, baseline apnea index ≤ 30, baseline body mass index < 35, and <15 events/hr of SpO CONCLUSIONS: This feasibility study suggests that THN therapy is likely to be safe and effective in selected patients. LEVEL OF EVIDENCE: 2b Laryngoscope, 126:2618-2623, 2016.

171 Clinical Trial Can upper airway surgery for OSA protect against cardiovascular sequelae via effects on coagulation? 2016

Zhan, Xiaojun / Li, Li / Wang, Ningyu / Ge, Xiaohui / Pinto, Jayant M / Wu, Xiaofan / Wei, Yongxiang. ·a Department of Otolaryngology Head & Neck Surgery , Beijing Anzhen Hospital, Capital Medical University , Beijing , PR China ; · b Department of Otolaryngology Head & Neck Surgery , Beijing Chaoyang Hospital, Capital Medical University , Beijing , PR China ; · c Section of Otolaryngology-Head and Neck Surgery, Department of Surgery , the University of Chicago , Chicago , IL , USA ; · d Department of Cardiology , Beijing Anzhen Hospital, Capital Medical University , Beijing , PR China. ·Acta Otolaryngol · Pubmed #26595664.

ABSTRACT: CONCLUSION: Upper airway surgery is associated with salutary effects on the blood coagulation characteristics of OSA patients, a benefit that may be protective against cardiac and cerebrovascular morbidity and mortality. OBJECTIVE: Increased blood coagulation is an important factor linking OSA and cardiovascular complications. Surgery is an important method to treat OSA, but the effect of surgery on blood coagulation in OSA patients is unknown. METHODS: the authors performed a prospective clinical trial of adult OSA patients who underwent surgery from 2012-2014. Pre-operative and post-operative blood coagulation parameters and polysomnography (PSG) results were compared. RESULT: There were 61 subjects. The total rate of success in curing OSA was 11.5%. The rate of response after surgery was 40.8%. Overall, the Apnea-Hypopnea Index (AHI) improved after surgery (from 39.8 3 ± 24.49 to 25.9 7 ± 18.53, p < 0.01). After surgery, serum platelet counts (PLT) decreased (from 242.5 ± 52.6 to 230.9 ± 40.7, p=0.01), and Fibrinogen (FIB) levels declined (from 262.5 ± 52.5 to 247.3 ± 44.4, p = 0.02). Other blood coagulation parameters also improved: prothrombin time (PT) (from 10.6 2 ± 0.62 to 10.8 6 ± 0.70, p=0.01), activated partial thromboplastin time (APTT) (from 26.9 8 ± 4.94 to 27.7 8 ± 3.02, p = 0.06), and Thrombin time (TT) (from 19.5 3 ± 0.84 to 20.1 1 ± 1.31, p < 0.01).

172 Clinical Trial Dietary self-monitoring in patients with obstructive sleep apnea. 2014

Hood, Megan M / Nackers, Lisa M / Kleinman, Brighid / Corsica, Joyce / Katterman, Shawn N. ·a Rush University Medical Center. ·Behav Med · Pubmed #24274238.

ABSTRACT: Self-monitoring of food intake is a cornerstone of behavioral weight loss interventions, but its use has not been evaluated in the treatment of obese patients with obstructive sleep apnea (OSA). This pilot study described patterns of adherence to dietary self-monitoring in obese patients with OSA and determined associations between self-monitoring and weight loss, psychosocial functioning, and adherence to continuous positive airway pressure treatment. Participants completed a 6-week behavioral weight loss intervention focused on dietary self-monitoring. Approximately one-third of participants were adherent to self-monitoring throughout the course of the intervention and experienced more weight loss than those who did not self-monitor regularly. More frequent dietary self-monitoring also appeared to be associated with adherence to other health behaviors. These preliminary data suggest that use of dietary self-monitoring may be beneficial for promoting weight loss and adherence to other important health behaviors in OSA patients.

173 Clinical Trial Otolaryngology office-based treatment of obstructive sleep apnea-hypopnea syndrome with titratable and nontitratable thermoplastic mandibular advancement devices. 2010

Friedman, Michael / Pulver, Tanya / Wilson, Meghan N / Golbin, Dina / Leesman, Christopher / Lee, George / Joseph, Ninos J. ·Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL 60602, USA. hednnek@aol.com ·Otolaryngol Head Neck Surg · Pubmed #20620623.

ABSTRACT: OBJECTIVE: 1) Share our experiences treating patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) with titratable and nontitratable thermoplastic mandibular advancement devices (MADs) fitted in our otolaryngology clinic. 2) Compare these devices in terms of objective response (OR), as defined by a > or = 50 percent decrease in baseline apnea-hypopnea index (AHI) and an AHI < 20, and subjective parameters, including adherence. 3) Determine overall success, as defined by OR plus adherence at two months follow-up. STUDY DESIGN: Cohort study. SETTING: Tertiary care center. SUBJECTS AND METHODS: Patients with OSAHS who tried and failed or refused both continuous positive airway pressure (CPAP) and surgical therapy were fitted with a nontitratable Snore Guard (n = 38), nontitratable SomnoGuard 2.0 (n = 8), or titratable SomnoGuard AP (n = 41). Pre- and post-treatment assessment included: 1) Epworth Sleepiness Scale, 2) snoring level, 3) polysomnogram. Patients were contacted at two months follow-up to assess adherence and subjective parameters. RESULTS: OR was achieved in 62.1 percent of patients. Overall mean reduction in AHI was from 39.96 +/- 23.70 to 14.86 +/- 13.46 (P = 0.000). Adherence at two months was 58.5 percent. No significant differences were observed in OR or adherence according to MAD type, though improvements in AHI and minimum oxygen saturation were significantly better for the SomnoGuard AP than for the nontitratable devices. Overall success was 38.6 percent. CONCLUSION: Thermoplastic MADs are a relatively inexpensive treatment alternative for patients with OSAHS who fail/refuse CPAP and upper airway surgery. They can be easily fitted in the otolaryngology clinic. Long-term compliance, efficacy, and safety are unknown at this time.

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

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

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

175 Article Long-term clinical effectiveness of continuous positive airway pressure therapy versus non-invasive ventilation therapy in patients with obesity hypoventilation syndrome: a multicentre, open-label, randomised controlled trial. 2019

Masa, Juan F / Mokhlesi, Babak / Benítez, Iván / Gomez de Terreros, Francisco Javier / Sánchez-Quiroga, Maria Ángeles / Romero, Auxiliadora / Caballero-Eraso, Candela / Terán-Santos, Joaquin / Alonso-Álvarez, Maria Luz / Troncoso, Maria F / González, Mónica / López-Martín, Soledad / Marin, José M / Martí, Sergi / Díaz-Cambriles, Trinidad / Chiner, Eusebi / Egea, Carlos / Barca, Javier / Vázquez-Polo, Francisco-José / Negrín, Miguel A / Martel-Escobar, María / Barbe, Ferran / Corral, Jaime / Anonymous1421199. ·Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain. Electronic address: fmasa@separ.es. · Department of Medicine, University of Chicago, Chicago, IL, USA. · Respiratory Department, Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain. · Respiratory Department, Virgen del Puerto Hospital, Plasencia, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, University Hospital, Burgos, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, IIS Fundación Jiménez Díaz, Madrid, Spain. · Respiratory Department, Valdecilla Hospital, Santander, Spain. · Respiratory Department, Gregorio Marañon Hospital, Madrid, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Miguel Servet Hospital, Zaragoza, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Valld'Hebron Hospital, Barcelona, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Doce de Octubre Hospital, Madrid, Spain. · Respiratory Department, San Juan Hospital, Alicante, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Alava University Hospital IRB, Vitoria, Spain. · Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain; Nursing Department, Extremadura University, Cáceres, Spain. · Department of Quantitative Methods, Las Palmas de Gran Canarias University Canary Islands, Spain. ·Lancet · Pubmed #30935737.

ABSTRACT: BACKGROUND: Obesity hypoventilation syndrome is commonly treated with continuous positive airway pressure or non-invasive ventilation during sleep. Non-invasive ventilation is more complex and costly than continuous positive airway pressure but might be advantageous because it provides ventilatory support. To date there have been no long-term trials comparing these treatment modalities. We therefore aimed to determine the long-term comparative effectiveness of both treatment modalities. METHODS: We did a multicentre, open-label, randomised controlled trial at 16 clinical sites in Spain. We included patients aged 15-80 years with untreated obesity hypoventilation syndrome and an apnoea-hypopnoea index of 30 or more events per h. We randomly assigned patients, using simple randomisation through an electronic database, to receive treatment with either non-invasive ventilation or continuous positive airway pressure. Both investigators and patients were aware of the treatment allocation. The research team was not involved in deciding hospital treatment, duration of treatment in the hospital, and adjustment of medications, as well as adjudicating cardiovascular events or cause of mortality. Treating clinicians from the routine care team were not aware of the treatment allocation. The primary outcome was the number of hospitalisation days per year. The analysis was done according to the intention-to-treat principle. This study is registered with ClinicalTrials.gov, number NCT01405976. FINDINGS: From May 4, 2009, to March 25, 2013, 100 patients were randomly assigned to the non-invasive ventilation group and 115 to the continuous positive airway pressure group, of which 97 patients in the non-invasive ventilation group and 107 in the continuous positive airway pressure group were included in the analysis. The median follow-up was 5·44 years (IQR 4·45-6·37) for all patients, 5·37 years (4·36-6·32) in the continuous positive airway pressure group, and 5·55 years (4·53-6·50) in the non-invasive ventilation group. The mean hospitalisation days per patient-year were 1·63 (SD 3·74) in the continuous positive airway pressure group and 1·44 (3·07) in the non-invasive ventilation group (adjusted rate ratio 0·78, 95% CI 0·34-1·77; p=0·561). Adverse events were similar between both groups. INTERPRETATION: In stable patients with obesity hypoventilation syndrome and severe obstructive sleep apnoea, non-invasive ventilation and continuous positive airway pressure have similar long-term effectiveness. Given that continuous positive airway pressure has lower complexity and cost, continuous positive airway pressure might be the preferred first-line positive airway pressure treatment modality until more studies become available. FUNDING: Instituto de Salud Carlos III, Spanish Respiratory Foundation, and Air Liquide Spain.

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