Therapeutic alternatives with CPAP in obstructive sleep apnea

Obstructive Sleep Apnea (OSA), characterized by airflow cessation (apnea) or reduction (hypopnea) due to repeated pharyngeal obstructions during sleep, causes frequent disruption of sleep and hypoxic events. The condition is linked to many adverse health related consequences, such as neurocognitive and cardiovascular disorders, and metabolic syndrome. OSA is a chronic condition requiring long-term treatment, so treatment using continuous positive airway pressure (CPAP) has become the gold standard in cases of moderate or severe OSA. However, its effectiveness is influenced by patients’ adherence. Surgery for OSA or treatment with oral appliances can be successful in selected patients, but for the majority, lifestyle changes such as exercise and dietary control may prove useful. However, exercise training remains under-utilized by many clinicians as an alternative treatment for OSA. Other interventions such as oral appliance (OA), upper way stimulation, and oropharyngeal exercises are used in OSA. Because the benefit of all these techniques is heterogeneous, the major challenge is to associate specific OSA therapies with the maximum efficacy and the best patient compliance

216 Jewish Hospital of St. Louis

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The effect of oral appliance therapy on glycemic control in Type II diabetic patients with obstructive sleep apnea : a pilot randomized controlled trial

Introduction : Le syndrome de l’apnée obstructive du sommeil (SAOS) est un trouble très prévalent chez les patients atteints du diabète de type 2 (DT2) et la littérature préconise un lien étroit entre le SAOS et la dysfonction glycémique. Cependant, les essais randomisés actuels évaluant le traitement du SAOS et les effets métaboliques chez les patients diabétiques sont limités au traitement par pression positive continue (PPC) – parcontre, une limitation majeure de ces études est une faible compliance. L’orthèse d’avancée mandibulaire (OAM) est une option de traitement alternative pour le SAOS qui est généralement mieux tolérée et acceptée par les patients que la PPC. Objectifs : L’objectif principal de cette étude est d’évaluer si un traitement de 3 mois avec une OAM améliore le contrôle glycémique chez les patients atteints du SAOS et le DT2 comparé à celui avec un appareil placébo. Les objectifs secondaires sont : 1) d’évaluer la faisabilité d’une OAM comme traitement du SAOS chez une population diabétique, 2) comparer les effets secondaires subjectifs ressentis lors du port de l’OAM ou de l’appareil placébo, 3) comparer les changements subjectifs dans la qualité de vie et sommeil avec les deux appareils, 4) comparer la compliance subjective et objective dans les deux groupes. Méthodes : 17 patients ont participé à cette étude pilote contrôlée et randomisée comparant le traitement du SAOS à l'aide d’une OAM (Somnodent®, n=7) et d'un appareil placébo (appareil Essix® mandibulaire, n=10). Des échantillons de sang mesurant le contrôle glycémique par les taux d'hémoglobine glyquée ont été prélevés avant et après le traitement. Trois polysomnographies ont été réalisées (au départ, après une période de titration de 2 mois et après une période de traitement de 3 mois). Tous les patients ont répondu à un questionnaire sur les effets indésirables après la période de titration. Les questionnaires suivants ont été comparés avant (V1), pendant (V4) et après (V6) le traitement : échelle de somnolence d’Epworth (ESS), questionnaire sur les résultats fonctionnels du sommeil (FOSQ), indice de qualité du sommeil de Pittsburg (PSQI), et l'échelle hospitalière d'anxiété et de dépression (HADS). Les patients ont rapporté leur compliance subjective dans un journal quotidien, et la compliance objective a été mesurée par une micropuce. Résultats : Aucune différence significative n'a été observée pour l’hémoglobine glycquée après 3-mois de traitement entre les deux groupes (p =0.75). L’OAM a présenté une diminution significative du SAOS mesurée par l'indice d'apnée-hypopnée (p =0.02) et l'indice de désaturation en oxygène (p =0.02). Aucune différence significative n'a été constatée lors de la comparaison des questionnaires sur les effets secondaires entre les groupes, plus précisément pour l'inconfort au niveau des mâchoires (p =0.15) et des changements occlusaux (p =0.41). La fréquence des complications était faible dans les deux groupes et n'a montré aucune différence significative (p =1.00). La satisfaction globale des patients était élevée dans les deux groupes et ne montrait aucune différence significative (p =1.00). Les deux groupes ont présenté des améliorations significatives des scores FOSQ (p =0.004 entre V1-4 et p =0.026 entre V1-6), des diminutions significatives pour ESS (p =0.023 entre V1-4), des diminutions significatives des scores d'anxiété (p =0.003 entre V1-4 et p =0.041 entre V1-6), ainsi qu’une diminution significative des scores de dépression (p =0.025 entre V1-6). Les patients du groupe avec OAM ont sur-rapporté de façon significative leur compliance subjective par rapport à la compliance objective mesurée par les micropuces (p =0.02). Conclusion : L’OAM est un traitement faisable pour le traitement du SAOS chez les patients atteints du DT2 et a démontré des effets secondaires minimes et un taux de satisfaction élevé. Un « effet placébo » important a été observé avec l’appareil placébo, ce qui souligne l’importance des études randomisées et contrôlées dans le domaine du traitement du SAOS. Les micropuces utilisées pour mesurer la compliance objective offrent des données plus fiables que les rapports subjectifs des patients. D'autres essais randomisés et contrôlés à grande échelle sont nécessaires, et des analyses futures d’un système de mesure de glucose en continue pourrait être plus précis pour évaluer les effets de l’OAM sur le contrôle glycémique ; l’investigation de phénotypes métaboliques chez certains patients qui pourraient mieux répondre au traitement de leur SAOS serait aussi important.Introduction: Obstructive sleep apnea (OSA) is a disorder that is highly prevalent among patients with type 2 diabetes mellitus (T2DM) and the literature supports a strong link between OSA and glucose dysregulation. However, current randomized trials assessing the effect of OSA treatment on metabolic outcomes have been limited to continuous positive airway pressure (CPAP) therapy, and one of the main limitations of these studies is poor compliance. A mandibular advancement device (MAD) is an alternative treatment option for OSA that is generally better tolerated and accepted by patients than CPAP. Objectives: The main objective of this study is to evaluate if 3 months of treatment with a MAD will improve glycemic control in patients with OSA and T2DM as compared to a Placebo Device. Secondary objectives will be: 1) to evaluate the feasibility of a MAD to treat sleep apnea in a diabetic population, 2) to compare subjective side effects of the MAD and Placebo Device, 3) to compare subjective changes in quality of life and sleep with both devices, and 4) to compare subjective and objective compliance in both groups. Methods: 17 patients participated in this randomized controlled pilot study, comparing treatment of OSA using a MAD (Somnodent, n=7) and a placebo device (mandibular Essix, n=10). Blood samples measuring glycemic control by glycated hemoglobin levels were collected before and after treatment. Three polysomnographies were performed (at baseline, after a 2-month titration period and after a 3-month treatment period). All patients answered a side-effects questionnaire after the titration period, and the following questionnaires were compared before (V1), during (V4) and after treatment (V6): Epworth Sleepiness Scale (ESS), the Functional Outcomes of Sleep Questionnaire (FOSQ), the Pittsburg Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale. Patients recorded subjective compliance in a daily journal, and objective compliance was measured by a microchip. Results: No significant difference was found in glycated hemoglobin levels between groups (p=0.75). The MAD group showed a significant decrease in OSA as measured by the Apnea-Hypopnea Index (p=0.02) and the Oxygen Desaturation Index (p=0.02). No significant difference was found when comparing Side Effects Questionnaires between groups, more specifically for discomfort in jaws (p=0.15) and changes in occlusion (p=0.41). Frequency of complications were low in both groups and showed no significant differences (p=1.00). Overall patient satisfaction was high in both groups and showed no significant differences (p=1.00). Both groups showed significant improvements in FOSQ scores (p=0.004 between V1-4, and p=0.026 between V1-6), significant decreases in ESS (p= 0.023 between V1-4), significant decreases in Anxiety scores (p=0.003 between V1-4, and p=0.041 between V1-6), as well as a significant decrease in Depression scores (p=0.025 between V1-6). Patients in the MAD group significantly over-reported their subjective compliance as compared to the objective compliance measured by a microchip (p=0.02). Conclusion: MAD is a feasible treatment for OSA in patients with T2DM as it was able to significantly improve OSA while demonstrating high overall satisfaction and minimal complications. A strong “placebo effect” was noted with the Placebo Device and reinforces the importance of randomized and controlled studies in the field of OSA treatment. Microchips to measure objective compliance should be used as they offer more reliable data than subjective records. Further large-scale randomized and controlled trials are required, as well as future analyses of Continuous Glucose Monitoring Systems which may allow for more precise evaluation of glycemic outcomes; investigating possible metabolic phenotypes in patients which may respond better to OSA treatment will be important

Spartan Daily, March 30, 1977

Volume 68, Issue 39https://scholarworks.sjsu.edu/spartandaily/6193/thumbnail.jp

Developing Ostomy Educational Tools To Decrease Hospital Length Of Stay

A quality improvement project “Developing Ostomy Educational Tools To Decrease Hospital Length Of Stay” is aimed at reducing length of stay (LOS) for patients undergoing elective ostomy surgery from the current twelve days (Kirkland-Kyhn, 2017), to less than five days. Methods included use of a Pre-Ostomy Survey, which was distributed and completed by the nursing staff. Pre-survey analysis identified the need for three ostomy educational tools which were developed using a set of evidenced based patient care “milestones” and included: a Colostomy and Ileostomy Nursing Resource Binder, Patient Milestone Checklist, and the R.N. Postoperative Process For Ostomy Patients. The evidenced based tools will enable the nurses to partner with patients in addressing the psychosocial and educational needs related to ostomy acceptance and management. The timeline for this project is pending administrative review and approval. On approval, the project begins with three months of staff education regarding purpose and use of ostomy educational tools followed by six-months of implementation. When complete, an analysis will be done to evaluate the impact of these tools on reduction of length of stay, as well as nurse and patient satisfaction with the process

Assessment of the Awareness of Dental Professionals Regarding Identification and Basic Management of Dental Patients with Systemic/Parafunctional conditions in a Routine SPT appointment\u2026 A Survey

This study examined what New Mexico dentists have reported regarding the knowledge and confidence levels of dental hygienists in providing patient education on oral/systemic periodontal risk factors. Further examined were New Mexico dentists views are on structured SPT protocols that include dentist/dental hygienist patient education on major risk factors for oral/systemic disease, and referrals and consultation with primary physicians. Members of the New Mexico Dental Association (n-700) were asked to participate in a 20-question online survey. Survey questions focused primarily on the level of risk assessment for periodontal disease that New Mexico dentists report dental hygienists discussing with periodontal patients. It was predicted that New Mexico dentists do not believe that dental hygienists are lacking in knowledge or confidence when it comes to providing patient education on major risk factors for periodontal disease. Most of the New Mexico dentists who responded to this survey (76%) reported satisfaction with the knowledge of and patient education provided by a dental hygienist on all four of the risk factors studied (diabetes, cardiovascular disease [CVD], cigarette smoking, and parafunctional habits). Results indicated that parafunctional habits (bruxism) and occlusal appliance fabrication appear to be increasingly common links to supporting periodontal maintenance. No significant relationships were found in chi-square tests performed on demographic data—such as age and area of practice (rural vs. urban)—as being related to their experience and views on dental hygienist knowledge and structure in SPT protocols. Overall, New Mexico dentists support increasing education on periodontal risk factors and structured SPT protocols would be beneficial for a dental hygienist. Survey results reveal that 33% of New Mexico dentists witness dental hygienists with a 4-year degree have increased knowledge and confidence in discussing risk factors with periodontal patients, while 27% response said dental hygienist graduates from 4-year and 2-year study programs had equal amounts of knowledge and confidence. Positively, results showed New Mexico dentists\u27 satisfaction with their dental hygienists\u27 patient education, and support a team approach between dentist and dental hygienist for periodontal patient assessment

Barnes Hospital Bulletin

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The Value of Information Technology-Enabled Diabetes Management

Reviews different technologies used in diabetes disease management, as well as the costs, benefits, and quality implications of technology-enabled diabetes management programs in the United States

216 Jewish Hospital of St. Louis

https://digitalcommons.wustl.edu/bjc_216/1155/thumbnail.jp

Obstructive sleep apnea as a risk factor for type 2 diabetes mellitus

Preethi Rajan, Harly Greenberg Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Hofstra-North Shore LIJ School of Medicine, New Hyde Park, NY, USA Abstract: Obstructive sleep apnea (OSA) is independently associated with cardiovascular and cardiometabolic risk in several large epidemiologic studies. OSA leads to several physiologic disturbances such as intermittent hypoxia, sleep fragmentation, and increase in autonomic tone. These disturbances have been associated with insulin resistance and type 2 diabetes mellitus (T2DM) in animal and human studies. Studies also suggest a bidirectional relationship between OSA and T2DM whereby T2DM itself might contribute to the features of OSA. Moreover, successful treatment of OSA may reduce these risks, although this is controversial. The purpose of this article is to review 1) the links and bidirectional associations between OSA and T2DM; 2) the pathogenic mechanisms that might link these two disease states; 3) the role of continuous positive airway pressure therapy in improving glucose tolerance, sensitivity, and resistance; and 4) the implications for clinical practice. Keywords: Insulin resistance, metabolic syndrome, sleep disordered breathing, intermittent hypoxi