Beyond CPAP: modifying upper airway output for the treatment of OSA

Gruenberg, Eli; Cooper, Jessica; Zamora, Tania; Stepnowsky, Carl; Vahabzadeh‐Hagh, Andrew M.; Malhotra, Atul; Nokes, Brandon

doi:10.3389/fneur.2023.1202271

Cited by 4 publications

(1 citation statement)

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“…Positive airway pressure (PAP), the gold standard treatment for OSAHS [13], stents the upper airway allowing for unrestricted airflow [14]. This treatment method maintains oxygen levels during sleep and improves quality of sleep.…”

Section: Figure 1amentioning

confidence: 99%

Positive airway pressure improves amnestic mild cognitive impairment in patients diagnosed with obstructive sleep apnoea hypopnoea syndrome. A review of the evidence

Parsons

2024

IJCCR

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There is growing clinical evidence showing the impact of sleep disturbance on the development of Alzheimer’s disease (AD). It has been proposed that intermittent hypoxia and sleep fragmentation, which are hallmarks of obstructive sleep apnoea hypopnoea syndrome (OSAHS), are physiological changes that may contribute to cognitive impairment. Sleep fragmentation reduces slow-wave sleep duration affecting the efficiency of the brain clearance system, allowing metabolic proteins to accumulate. These proteins contribute to neurodegeneration, brain atrophy, and cognitive impairment. Improvements in fluid diffusion which leads to the reduction in the accumulation of metabolic proteins, have been observed after positive airway pressure (PAP) treatment. Treating OSAHS may be effective in reducing the risk of neuronal damage and improve cognitive function. This review outlines the current knowledge associating OSAHS and AD and discusses the effect of PAP treatment on cognitive function, AD biomarkers, and the brain clearance system.

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Section: Figure 1amentioning

confidence: 99%

Positive airway pressure improves amnestic mild cognitive impairment in patients diagnosed with obstructive sleep apnoea hypopnoea syndrome. A review of the evidence

Parsons

2024

IJCCR

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Phenotypic differences in airway obstruction as determined by VOTE score

Franklin,

Putnam,

Chanamolu

et al. 2024

World j. otorhinolaryngol.-head neck surg.

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ObjectiveThe objective if this study was to investigate phenotypic differences in airway obstruction, as determined by VOTE score, in a cohort of patients with obstructive sleep apnea (OSA) undergoing drug‐induced sleep endoscopy (DISE).MethodsPatients older than 18 years of age scheduled for DISE by one surgeon at a tertiary care center from July 2016 to July 2022 were included in a single‐center retrospective cohort study. Patient demographics, body mass index (BMI), apnea‐hypopnea index (AHI), and VOTE scores were extracted. Spearman correlation tests were utilized to determine the relationship between variables, and statistical analyses were performed using R.ResultsThe study included 165 patients (61.24 years, SD 11.57; BMI 31.04 kg/m2, SD 6.05). Due to several significant relationships between VOTE scores and patient demographics, a cluster analysis was performed, in which two distinct clusters (phenotype 1 and phenotype 2) arose. Phenotype 1 patients had lower overall VOTE scores (p < 0.001), less obstruction at the velum (p < 0.001) and oropharynx (p < 0.001), significantly more tongue obstruction (p = 0.031), and a significantly lower BMI (p = 0.001). Though not reaching significance, phenotype 1 patients also had more epiglottic obstruction (p = 0.0841) and were older (p = 0.2775).ConclusionsPatients suffering from OSA may be categorized into one of two distinct phenotypes of clinical significance. Phenotype 1 patients who are nonobese and have less significant obstruction overall, with increased obstruction at the tongue, may benefit greatly from targeted surgical modalities. Conversely, phenotype 2 patients with worse obstruction on DISE and increased velum and oropharynx obstruction may represent a phenotype of OSA that is increasingly difficult to treat surgically, due to body habitus and severe, multi‐level obstruction.

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