Clinical Significance of Sleep Desaturation in Hypoxemic Chronic Obstructive Pulmonary Disease: Studies in 130 Patients

We studied 130 patients with hypoxemic chronic obstructive lung disease to determine if nocturnal desaturation aggravates hypoxia-induced complications. All had tests of neuropsychological and physiological function known to be affected by chronic hypoxia. Of the 130 patients, 25 had complete polysomnography and 105 had their sleep judged visually and arterial oxygen saturation recorded continuously. Severe and mild desaturation groups were defined relative to the mean for both mean and maximal sleep desaturation, and the severity of waking complications were compared. No significant differences were noted between patients with mild and severe mean desaturation or maximal desaturation for hematocrit, neuropsychological tests, maximal exercise tolerance, or measures of quality of life. Waking pulmonary artery pressure did not differ significantly between patients with mild and severe mean desaturation or maximal desaturation, except in 20 patients with the most severe mean desaturation during sleep. We conclude that nocturnal desaturation does not aggravate hypoxia-induced complications in most patients who are chronically hypoxemic from chronic obstructive pulmonary disease

Consensus statement on the orofacial myofunctional assessment and therapy in patients with OSA: proposal of an international Delphi Method process

La rééducation myofonctionnelle orofaciale a été montrée efficace dans la prise en charge multidisciplinaire du syndrome d’apnées obstructives du sommeil chez l’enfant, l’adolescent et l’adulte, et elle est prescrite à plusieurs étapes de ces prises en charge. Cependant, compte tenu du manque d’homogénéité des protocoles de traitement et de mesures des résultats, du manque de recherches sur le type, la fréquence et la durée des exercices myofonctionnels et sur les phénotypes spécifiques qui peuvent en bénéficier, il apparait nécessaire de définir des recommandations de bonne pratique. Un consensus de recommandations Delphi consacré à l’évaluation et au traitement myofonctionnel orofacial pour les patients atteints de SAOS, a été mis en oeuvre à l’initiative de Marc Richard Moeller. Les deux premières étapes du consensus de recommandations Delphi sont achevées. La troisième étape, consacrée à l’élaboration du questionnaire aura lieu lors de la réunion conjointe de la World Sleep Society et de l’Academy of Applied Myofunctional Sciences, en mars 2022 à Rome. Les conclusions du consensus de recommandations Delphi seront publiées l’année suivante et largement diffusées.info:eu-repo/semantics/publishedVersio

Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome

Objective: To provide an overview of the healthcare and societal consequences and costs of untreated obstructive sleep apnea syndrome. Data sources: PubMed database for English-language studies with no start date restrictions and with an end date of September 2014. Methods: A comprehensive literature review was performed to identify all studies that discussed the physiologic, clinical and societal consequences of obstructive sleep apnea syndrome as well as the costs associated with these consequences. There were 106 studies that formed the basis of this analysis. Conclusions: Undiagnosed and untreated obstructive sleep apnea syndrome can lead to abnormal physiology that can have serious implications including increased cardiovascular disease, stroke, metabolic disease, excessive daytime sleepiness, work-place errors, traffic accidents and death. These consequences result in significant economic burden. Both, the health and societal consequences and their costs can be decreased with identification and treatment of sleep apnea. Implications for practice: Treatment of obstructive sleep apnea syndrome, despite its consequences, is limited by lack of diagnosis, poor patient acceptance, lack of access to effective therapies, and lack of a variety of effective therapies. Newer modes of therapy that are effective, cost efficient and more accepted by patients need to be developed. Keywords: Obstructive sleep apnea syndrome, Cost, Continuous positive airway pressure, Mandibular advancement devic

Principles and practice of sleep medicine

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Assessment and Management of Patients with Obesity Hypoventilation Syndrome

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