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Sleep Apnea Syndromes: HELP
Articles from San Francisco Bay area
Based on 318 articles published since 2008
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These are the 318 published articles about Sleep Apnea Syndromes that originated from San Francisco Bay area during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13
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 Management of Obstructive Sleep Apnea in Commercial Motor Vehicle Operators: Recommendations of the AASM Sleep and Transportation Safety Awareness Task Force. 2017

Gurubhagavatula, Indira / Sullivan, Shannon / Meoli, Amy / Patil, Susheel / Olson, Ryan / Berneking, Michael / Watson, Nathaniel F. ·Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. · Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania. · Department of Psychiatry, Stanford University, Palo Alto, California. · Penn State Sleep Research and Treatment Center, Hummelstown, Pennsylvania. · Johns Hopkins School of Medicine, Baltimore, Maryland. · Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, Oregon. · Concentra, Inc., Grand Rapids, Michigan. · University of Washington Medicine Sleep Disorders Center and Department of Neurology, University of Washington, Seattle, Washington. ·J Clin Sleep Med · Pubmed #28356173.

ABSTRACT: ABSTRACT: The American Academy of Sleep Medicine Sleep and Transportation Safety Awareness Task Force responded to the Federal Motor Carrier Safety Administration and Federal Railroad Administration Advance Notice of Proposed Rulemaking and request for public comments regarding the evaluation of safety-sensitive personnel for moderate-to-severe obstructive sleep apnea (OSA). The following document represents this response. The most salient points provided in our comments are that (1) moderate-to-severe OSA is common among commercial motor vehicle operators (CMVOs) and contributes to an increased risk of crashes; (2) objective screening methods are available and preferred for identifying at-risk drivers, with the most commonly used indicator being body mass index; (3) treatment in the form of continuous positive airway pressure (CPAP) is effective and reduces crashes; (4) CPAP is economically viable; (5) guidelines are available to assist medical examiners in determining whether CMVOs with moderate-to-severe OSA should continue to work without restrictions, with conditional certification, or be disqualified from operating commercial motor vehicles.

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

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

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

4 Guideline Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. 2008

Kushida, Clete A / Chediak, Alejandro / Berry, Richard B / Brown, Lee K / Gozal, David / Iber, Conrad / Parthasarathy, Sairam / Quan, Stuart F / Rowley, James A / Anonymous6390598 / Anonymous6400598. ·Stanford University Center of Excellence for Sleep Disorders, 401 Quarry Road, Suite 3301, Stanford, CA 94305-5730, USA. ·J Clin Sleep Med · Pubmed #18468315.

ABSTRACT: Positive airway pressure (PAP) devices are used to treat patients with sleep related breathing disorders (SRBDs), including obstructive sleep apnea (OSA). After a patient is diagnosed with OSA, the current standard of practice involves performing attended polysomnography (PSG), during which positive airway pressure is adjusted throughout the recording period to determine the optimal pressure for maintaining upper airway patency. Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP) represent the two forms of PAP that are manually titrated during PSG to determine the single fixed pressure of CPAP or the fixed inspiratory and expiratory positive airway pressures (IPAP and EPAP, respectively) of BPAP for subsequent nightly usage. A PAP Titration Task Force of the American Academy of Sleep Medicine reviewed the available literature. Based on this review, the Task Force developed these recommendations for conducting CPAP and BPAP titrations. Major recommendations are as follows: (1) All potential PAP titration candidates should receive adequate PAP education, hands-on demonstration, careful mask fitting, and acclimatization prior to titration. (2) CPAP (IPAP and/or EPAP for patients on BPAP) should be increased until the following obstructive respiratory events are eliminated (no specific order) or the recommended maximum CPAP (IPAP for patients on BPAP) is reached: apneas, hypopneas, respiratory effort-related arousals (RERAs), and snoring. (3) The recommended minimum starting CPAP should be 4 cm H2O for pediatric and adult patients, and the recommended minimum starting IPAP and EPAP should be 8 cm H2O and 4 cm H2O, respectively, for pediatric and adult patients on BPAP. (4) The recommended maximum CPAP should be 15 cm H2O (or recommended maximum IPAP of 20 cm H2O if on BPAP) for patients < 12 years, and 20 cm H2O (or recommended maximum IPAP of 30 cm H2O if on BPAP) for patients > or = 12 years. (5) The recommended minimum IPAP-EPAP differential is 4 cm H2O and the recommended maximum IPAP-EPAP differential is 10 cm H2O (6) CPAP (IPAP and/or EPAP for patients on BPAP depending on the type of event) should be increased by at least 1 cm H2O with an interval no shorter than 5 min, with the goal of eliminating obstructive respiratory events. (7) CPAP (IPAP and EPAP for patients on BPAP) should be increased from any CPAP (or IPAP) level if at least 1 obstructive apnea is observed for patients < 12 years, or if at least 2 obstructive apneas are observed for patients > or = 12 years. (8) CPAP (IPAP for patients on BPAP) should be increased from any CPAP (or IPAP) level if at least 1 hypopnea is observed for patients < 12 years, or if at least 3 hypopneas are observed for patients > or = 12 years. (9) CPAP (IPAP for patients on BPAP) should be increased from any CPAP (or IPAP) level if at least 3 RERAs are observed for patients < 12 years, or if at least 5 RERAs are observed for patients > or = 12 years. (10) CPAP (IPAP for patients on BPAP) may be increased from any CPAP (or IPAP) level if at least 1 min of loud or unambiguous snoring is observed for patients < 12 years, or if at least 3 min of loud or unambiguous snoring are observed for patients > or = 12 years. (11) The titration algorithm for split-night CPAP or BPAP titration studies should be identical to that of full-night CPAP or BPAP titration studies, respectively. (12) If the patient is uncomfortable or intolerant of high pressures on CPAP, the patient may be tried on BPAP. If there are continued obstructive respiratory events at 15 cm H2O of CPAP during the titration study, the patient may be switched to BPAP. (13) The pressure of CPAP or BPAP selected for patient use following the titration study should reflect control of the patient's obstructive respiration by a low (preferably < 5 per hour) respiratory disturbance index (RDI) at the selected pressure, a minimum sea level SpO2 above 90% at the pressure, and with a leak within acceptable parameters at the pressure.) (14) An optimal titration reduces RDI < 5 for at least a 15-min duration and should include supine REM sleep at the selected pressure that is not continually interrupted by spontaneous arousals or awakenings. (15) A good titration reduces RDI < or = 10 or by 50% if the baseline RDI < 15 and should include supine REM sleep that is not continually interrupted by spontaneous arousals or awakenings at the selected pressure. (16) An adequate titration does not reduce the RDI < or = 10 but reduces the RDI by 75% from baseline (especially in severe OSA patients), or one in which the titration grading criteria for optimal or good are met with the exception that supine REM sleep did not occur at the selected pressure. (17) An unacceptable titration is one that does not meet any one of the above grades. (18) A repeat PAP titration study should be considered if the initial titration does not achieve a grade of optimal or good and, if it is a split-night PSG study, it fails to meet AASM criteria (i.e., titration duration should be > 3 hr).

5 Editorial Orthostatic hypotension: does the heart rate matter? And other updates on recent autonomic research. 2018

Miglis, Mitchell G / Muppidi, Srikanth. ·Stanford Medical Center, Palo Alto, CA, USA. · Stanford Medical Center, Palo Alto, CA, USA. muppidis@stanford.edu. · Stanford Neurosciences Health Center, 213 Quarry Road, 2nd Floor, Palo Alto, CA, 94304, USA. muppidis@stanford.edu. ·Clin Auton Res · Pubmed #29779066.

ABSTRACT: -- No abstract --

6 Editorial The link between sleep-disordered breathing and cognition in the elderly: New opportunities? 2017

Auerbach, Sanford / Yaffe, Kristine. ·From the Departments of Neurology, Psychiatry, and Behavioral Neurosciences (S.A.), Boston University School of Medicine and Sleep Disorders Center, Boston Medical Center, MA · and Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics (K.Y.), University of California, San Francisco, and San Francisco VA Medical Center. ·Neurology · Pubmed #28039313.

ABSTRACT: -- No abstract --

7 Editorial Introducing a new concept in obstructive sleep apnea: The continuum of treatment. 2017

Certal, Victor / Camacho, Macario / Song, Sungjin A / Capasso, Robson. ·a Department of Otorhinolaryngology/Sleep Medicine Centre , Hospital CUF Porto & CHEDV , Portugal. · b CINTESIS - Center for Research in Health Technologies and Information Systems, University of Porto , Porto , Portugal. · c Division of Sleep Surgery and Medicine, Department of Otolaryngology-Head and Neck Surgery , Tripler Army Medical Center , Honolulu , HI , USA. · d Sleep Surgery Division, Department of Otolaryngology-Head & Neck Surgery , Stanford University School of Medicine , Stanford , CA , USA. ·Cranio · Pubmed #27875929.

ABSTRACT: -- No abstract --

8 Editorial How Was Your Sleep? New Implications for Obstructive Sleep Apnea in Retinal Disease. 2016

Brodie, Frank L. ·Department of Ophthalmology, University of California San Francisco, San Francisco, California. ·Retina · Pubmed #26841214.

ABSTRACT: -- No abstract --

9 Editorial Screening for Sleep-Disordered Breathing in Patients Hospitalized for Heart Failure. 2015

Oldenburg, Olaf / Teerlink, John R. ·Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany. Electronic address: akleemeyer@hdz-nrw.de. · Section of Cardiology, San Francisco Veterans Affairs Medical Center, and School of Medicine, University of California San Francisco, San Francisco, California. ·JACC Heart Fail · Pubmed #26362450.

ABSTRACT: -- No abstract --

10 Editorial Oral appliances and sleep-disordered breathing. 2011

Ruoff, Chad M / Guilleminault, Christian. ·Sleep Medicine Division, Stanford University, Redwood City, CA. · Sleep Medicine Division, Stanford University, Redwood City, CA. Electronic address: cguil@stanford.edu. ·Chest · Pubmed #22045873.

ABSTRACT: -- No abstract --

11 Review The Role of the Revised Stanford Protocol in Today's Precision Medicine. 2019

Liu, Stanley Yung-Chuan / Awad, Michael / Riley, Robert / Capasso, Robson. ·Division of Sleep Surgery, Department of Otolaryngology, Stanford University School of Medicine, 801 Welch Road, Stanford, California 94304, USA. Electronic address: ycliu@stanford.edu. · Division of Sleep Surgery, Department of Otolaryngology, Stanford University School of Medicine, 801 Welch Road, Stanford, California 94304, USA. ·Sleep Med Clin · Pubmed #30709539.

ABSTRACT: Whereas the original Stanford protocol relied on a tiered approach to care to avoid unnecessary surgery, it did not address the issue of surgical relapse, a common concern among sleep medicine specialists. With 3 decades of experience since the original 2-tiered Powell-Riley protocol was introduced and the role of evolving skeletal techniques and upper airway stimulation, we are pleased to present our current protocol. This update includes emphasis on the facial skeletal development with impact on function including nasal breathing, and the incorporation of upper airway stimulation. The increased versatility of palatopharyngoplasty as an adjunctive procedure is also discussed.

12 Review Sleep-Disordered Breathing, Orofacial Growth, and Prevention of Obstructive Sleep Apnea. 2019

Guilleminault, Christian / Sullivan, Shannon S / Huang, Yu-Shu. ·Division of Sleep Medicine, Stanford University, 450 Broadway Pavillion C 2nd Floor, Redwood City, CA 94063, USA. Electronic address: cguil@stanford.edu. · Division of Sleep Medicine, Stanford University, 450 Broadway Pavillion C 2nd Floor, Redwood City, CA 94063, USA. · Division of Child-Psychiatry and Pediatric-Sleep laboratory, Department of Psychiatry, Chang Gung Memorial Hospital and Medical College, No. 5, Fuxing Street, Guishan, Taoyuan 333, Linkou, Taiwan. ·Sleep Med Clin · Pubmed #30709527.

ABSTRACT: Abnormal breathing during sleep is related to intrinsic and extrinsic factors that are present early in life. Investigation of fetal development and early-in-life orofacial growth allows recognition of risk factors that lead to change in upper airway patency, which leads to abnormal upper airway resistance, abnormal inspiratory efforts, and further increase in resistance and progressive narrowing of the collapsible upper airway. Such evolution can be recognized by appropriate clinical evaluation, specific polysomnographic patterns, and orofacial imaging. Recognition of the problems should lead to appropriate treatments and prevention of obstructive sleep apnea and its comorbidities.

13 Review Obstructive Sleep Apnea's Connections with Clinical Dentistry. 2018

Carstensen, Steve. ·Private Practice, Premier Sleep Associates, 636 120th Avenue NE A204, Bellevue, WA 98005, USA; Medmark Media, LLC, Dental Sleep Practice Magazine, 15720 N. Greenway Hayden Loop, Suite 9, Scottsdale, AZ 85260, USA; The Pankey Institute, One Crandon Boulevard Key Biscayne, FL 33149, USA; Louisiana State University Health Continuing Dental Education, 1100 Florida Avenue, New Orleans, LA 70119, USA; Department of Continuing Dental Education, The University of the Pacific, San Francisco, CA, USA; Spear Education, 7201 E Princess Boulevard, Scottsdale, AZ 85255, USA. Electronic address: SeattleSleepEd@gmail.com. ·Sleep Med Clin · Pubmed #30396446.

ABSTRACT: Adding airway services to a dental practice disrupts scheduling, examinations, treatment planning, billing, and team roles. Problems connected with the airway can be addressed with more precise therapy and better prognosis while building confidence between the patient and the dental team. Each team member must understand the connections between airway problems and patient health and be able to talk about it with confidence. If the entire team supports the inclusion of airway therapy into the service mix, patients will feel well cared for and rewards to the office will be plentiful.

14 Review Magnetic resonance imaging of obstructive sleep apnea in children. 2018

Fleck, Robert J / Shott, Sally R / Mahmoud, Mohamed / Ishman, Stacey L / Amin, Raouf S / Donnelly, Lane F. ·Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. Robert.Fleck@CCHMC.org. · Center for Pulmonary Imaging Research, Cincinnati Children's Hospital, Cincinnati, OH, USA. Robert.Fleck@CCHMC.org. · Imaging Research Center, Cincinnati Children's Hospital, Cincinnati, OH, USA. Robert.Fleck@CCHMC.org. · Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. · Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA. · Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. · Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. · Department of Radiology, Stanford University, Stanford, CA, USA. · Quality and Safety, Lucile Packard Children's Hospital, Stanford, CA, USA. ·Pediatr Radiol · Pubmed #30078047.

ABSTRACT: Sleep-disordered breathing has a spectrum of severity that spans from snoring and partial airway collapse with increased upper airway resistance, to complete upper airway obstruction with obstructive sleep apnea during sleeping. While snoring occurs in up to 20% of children, obstructive sleep apnea affects approximately 1-5% of children. The obstruction that occurs in obstructive sleep apnea is the result of the airway collapsing during sleep, which causes arousal and impairs restful sleep. Adenotonsillectomy is the first-line treatment of obstructive sleep apnea and is usually effective in otherwise healthy nonsyndromic children. However, there are subgroups in which this surgery is less effective. These subgroups include children with obesity, severe obstructive sleep apnea preoperatively, Down syndrome, craniofacial anomalies and polycystic ovarian disease. Continuous positive airway pressure (CPAP) is the first-line therapy for persistent obstructive sleep apnea despite previous adenotonsillectomy, but it is often poorly tolerated by children. When CPAP is not tolerated or preferred by the family, surgical options beyond adenotonsillectomy are discussed with the parent and child. Dynamic MRI of the airway provides a means to identify and localize the site or sites of obstruction for these children. In this review the authors address clinical indications for imaging, ideal team members to involve in an effective multidisciplinary program, basic anesthesia requirements, MRI protocol techniques and interpretation of the findings on MRI that help guide surgery.

15 Review A review of the associations between obstructive sleep apnea and hypertensive disorders of pregnancy and possible mechanisms of disease. 2018

Dominguez, Jennifer E / Habib, Ashraf S / Krystal, Andrew D. ·Duke Department of Anesthesiology, Durham, NC, 27710, USA. Electronic address: Jennifer.dominguez@dm.duke.edu. · Duke Department of Anesthesiology, Durham, NC, 27710, USA. · Duke Department of Psychiatry and Behavioral Sciences, Durham, NC 27710, USA; University of California, San Francisco Department of Psychiatry, San Francisco, CA 94143, USA. ·Sleep Med Rev · Pubmed #29929840.

ABSTRACT: Obesity is prevalent among pregnant women in the United States; 15-20% of obese pregnant women have obstructive sleep apnea. The prevalence of obstructive sleep apnea increases along with body mass index, age and in the presence of other co-morbidities. Untreated obstructive sleep apnea in women is associated with a range of cardiovascular, pulmonary and metabolic co-morbidities; recent studies suggest that women with obstructive sleep apnea in pregnancy may be at significantly greater risk of entering pregnancy with chronic hypertension and/or of developing hypertensive disorders of pregnancy: gestational hypertension; preeclampsia; or eclampsia. This has serious public health implications; hypertensive disorders of pregnancy are a major cause of maternal and neonatal morbidity and mortality and are associated with a greater lifetime risk for cardiovascular disease. The mechanisms that associated obstructive sleep apnea with hypertensive disorders of pregnancy have not been defined, but several pathways are scientifically plausible. In this review, we will present a comprehensive literature review of the following: the associations between obstructive sleep apnea and hypertensive disorders of pregnancy; the proposed mechanisms that may connect obstructive sleep apnea and hypertensive disorders of pregnancy; and the effectiveness of treatment at mitigating these adverse outcomes.

16 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.

17 Review Sleep disordered breathing in pregnant women: maternal and fetal risk, treatment considerations, and future perspectives. 2018

Truong, Kimberly Kay / Guilleminault, Christian. ·a Division of Sleep Medicine, Stanford University School of Medicine , 450 Broadway MC 5704, Redwood City , CA 94063 , USA. ·Expert Rev Respir Med · Pubmed #29363362.

ABSTRACT: INTRODUCTION: Numerous physiologic and anatomic changes during pregnancy exacerbate or unmask obstructive sleep apnea in women. Left untreated, upper airway flow limitation during pregnancy may lead to dire maternal and fetal health consequences. Areas covered: This review outlines the relationship between sleep disordered breathing (SDB) and gestational hypertension, preeclampsia, and gestational diabetes. It also discusses the implications of SDB on fetal and maternal health and concludes with a review of the emerging literature of treatment options for SDB in pregnancy and its benefit. Expert commentary: Providers should screen, recognize, and treat SDB in pregnant women given its implicated risk on maternal and fetal health. This is particularly true in preeclampsia, a leading cause of maternal and fetal morbidity and mortality where SDB has been shown to add risk and severity. It is important to note that repetitive upper airway flow limitations in pregnancy are associated with surges in nocturnal blood pressure and poor maternal and fetal outcomes, and may be just as detrimental as frank apneas/hypopneas. Future large, prospective, randomized controlled studies on the effects of CPAP are still needed. The epidemiology of SDB in pregnant women needs to be further studied, as well as highlighting the need for systematic, long-term follow ups on mother and infant health post-delivery.

18 Review From oral facial dysfunction to dysmorphism and the onset of pediatric OSA. 2018

Guilleminault, Christian / Huang, Yu-Shu. ·Stanford University Sleep Medicine Division, CA, USA; Pediatric Sleep Laboratory Division of Child Psychiatry Chang Gung Memorial Hospital and Medical College, Linkou, Taiwan. ·Sleep Med Rev · Pubmed #29103943.

ABSTRACT: The upper airway is a collapsible tube, and its collapsibility increases during sleep. Extrinsic factors such as atypical craniofacial features may increase the risks of airway collapse. We review early development of oral-facial structures and the anatomical variants that may be present at birth and can impact nasal breathing. After birth, there is a continuous interaction between orofacial functions and growth of anatomic features. We review the dysfunctions identified to date that may impact orofacial development leading to sleep-disordered-breathing through changes in the orofacial growth. The identification of risk-factors, ultimately leading to full-blown obstructive sleep apnea, may allow early recognition of these factors and the development of treatments to eliminate early problems or at least decrease their impact.

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

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

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

20 Review Chronic organ failure in adult sickle cell disease. 2017

Vichinsky, Elliott. ·UCSF Benioff Children's Hospital Oakland, Oakland, CA. ·Hematology Am Soc Hematol Educ Program · Pubmed #29222290.

ABSTRACT: Sickle cell disease is now a chronic adult illness characterized by progressive multiorgan failure, particularly involving the brain and kidney. The etiology is multifactorial; it includes hemolysis and nitric oxide deficiency. As patients age, most experience neurologic insult. Twenty-five percent of older adults have had a clinical stroke and at least half of the population have had a silent infarct, cortical atrophy, and neurocognitive impairment. Periodic screening with neuroimaging and neurocognitive testing is recommended. Identification and correction of modifiable risk factors such as nocturnal hypoxemia, obstructive sleep apnea, and physical exercise programs should be implemented. Patients with neurocognitive impairment require cognitive remediation and educational accommodations. Chronic renal disease occurs in 25% of older adults and results in 50% of their deaths. Renal failure often develops insidiously. It can be prevented or minimized by early screening and treatment of modifiable risk factors including hypertension and microalbuminuria. There is an increasing number of therapeutic options, including inhibitors of the renin angiotensin system, angiotensin-II receptor blockers, endothelin-1 receptor antagonist, and haptoglobin therapy. Patients with sickle cell disease have increased mortality rates from renal failure compared with nonsickle cell patients, in part from a lack of access to early multidisciplinary care, including timely initiation of dialysis and renal transplantation.

21 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.

22 Review Lingual Tonsillectomy for Pediatric Persistent Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. 2017

Rivero, Alexander / Durr, Megan. ·1 Kaiser Permanente, Oakland, California, USA. ·Otolaryngol Head Neck Surg · Pubmed #28871840.

ABSTRACT: Objective To determine the role of lingual tonsillectomy (LT) in pediatric patients with persistent obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy (T&A). Data Sources PubMed, OVID-MEDLINE, and Cochrane Central from 2006 to 2017. Review Methods Inclusion criteria included English-language studies containing original data on LT in pediatric patients with persistent OSA. Exclusion criteria included case reports and studies without outcome measures. Two investigators independently reviewed all manuscripts and performed quality assessment using validated tools. Meta-analysis was performed. Results Of the 866 abstracts identified, 5 studies met inclusion criteria. All studies were case series (level of evidence 4). Outcome measures included apnea-hypopnea index (AHI), minimum oxygen saturation (minSaO

23 Review Association of Sleep-Disordered Breathing With Cognitive Function and Risk of Cognitive Impairment: A Systematic Review and Meta-analysis. 2017

Leng, Yue / McEvoy, Claire T / Allen, Isabel E / Yaffe, Kristine. ·Department of Psychiatry, University of California, San Francisco. · School of Medicine, Dentistry, and Biomedical Sciences, Queen's University, Belfast, United Kingdom. · Department of Epidemiology and Biostatistics, University of California, San Francisco. · Department of Neurology, University of California, San Francisco. · Department of Epidemiology, University of California, San Francisco. · San Francisco VA Medical Center, San Francisco, California. ·JAMA Neurol · Pubmed #28846764.

ABSTRACT: Importance: Growing evidence suggests an association between sleep-disordered breathing (SDB) and cognitive decline in elderly persons. However, results from population-based studies have been conflicting, possibly owing to different methods to assess SDB or cognitive domains, making it difficult to draw conclusions on this association. Objective: To provide a quantitative synthesis of population-based studies on the relationship between SDB and risk of cognitive impairment. Data Sources: PubMed, EMBASE, and PsychINFO were systematically searched to identify peer-reviewed articles published in English before January 2017 that reported on the association between SDB and cognitive function. Study Selection: We included cross-sectional and prospective studies with at least 200 participants with a mean participant age of 40 years or older. Data Extraction and Synthesis: Data were extracted independently by 2 investigators. We extracted and pooled adjusted risk ratios from prospective studies and standard mean differences from cross-sectional studies, using random-effect models. This meta-analysis followed the PRISMA guidelines and also adhered to the MOOSE guidelines. Main Outcomes and Measures: Cognitive outcomes were based on standard tests or diagnosis of cognitive impairment. Sleep-disordered breathing was ascertained by apnea-hypopnea index or clinical diagnosis. Results: We included 14 studies, 6 of which were prospective, covering a total of 4 288 419 men and women. Pooled analysis of the 6 prospective studies indicated that those with SDB were 26% (risk ratio, 1.26; 95% CI, 1.05-1.50) more likely to develop cognitive impairment, with no evidence of publication bias but significant heterogeneity between studies. After removing 1 study that introduced significant heterogeneity, the pooled risk ratio was 1.35 (95% CI, 1.11-1.65). Pooled analysis of the 7 cross-sectional studies suggested that those with SDB had slightly worse executive function (standard mean difference, -0.05; 95% CI, -0.09 to 0.00), with no evidence of heterogeneity or publication bias. Sleep-disordered breathing was not associated with global cognition or memory. Conclusions and Relevance: Sleep-disordered breathing is associated with an increased risk of cognitive impairment and a small worsening in executive function. Further studies are required to determine the mechanisms linking these common conditions and whether treatment of SDB might reduce risk of cognitive impairment.

24 Review Occupation and Obstructive Sleep Apnea: A Meta-Analysis. 2017

Schwartz, Daniel A / Vinnikov, Denis / Blanc, Paul D. ·UC Berkeley-UCSF Joint Medical Program, School of Public Health, University of California, Berkeley, Berkeley (Mr Schwartz) · Department of Internal Medicine, Occupational Disease and Hematology, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan, and School of Public Health, Al-Farabi Kazakh National University, Almaty, Kazakhstan (Dr Vinnikov) · Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, San Francisco (Dr Blanc), California. ·J Occup Environ Med · Pubmed #28598928.

ABSTRACT: OBJECTIVE: Obstructive sleep apnea (OSA) remains a prevalent condition, but its occupational burden is unclear. We carried out a systematic review to characterize the consistency and magnitude of occupational associations with OSA. METHODS: We studied OSA within three occupational categories: commercial drivers, organic solvent-exposed workers, other selected occupations. We performed a meta-analysis on the prevalence of OSA among drivers and the risk of OSA associated with solvent exposure. RESULTS: The pooled OSA prevalence in drivers was 41% (95% confidence interval [CI] 26% to 56%) for apnea hypopnea-index (AHI) is greater than 5, and 15% (95% CI 12% to 19%) for AHI is greater than 15. Exposure to solvents was associated with increased but non-statistically significant risk of OSA: summary relative risk, 2.38 (95% CI 0.89 to 6.32). Evidence of occupational association was inconsistent for other factors. CONCLUSIONS: OSA is common among commercial drivers and potentially associated with occupations involving likely solvent exposure.

25 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

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