Multidisciplinary Alternatives to CPAP Program for CPAP-Intolerant Patients

Shelgikar, Anita Valanju; Aronovich, Sharon; Stanley, Jeffrey J.

doi:10.5664/jcsm.6508

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…Continuous positive airway pressure (CPAP) therapy can reduce the risk of cardiovascular comorbidity in OSA patients [3] and is considered the first therapeutic option for OSA patients. However, other therapeutic options, including surgery, are considered for CPAP-intolerant OSA patients [4].…”

Section: Introductionmentioning

confidence: 99%

Can drug-induced sleep endoscopy improve the success rates of tongue base surgery?

Lee

Nam

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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Background: The purpose of this study was to determine the therapeutic value of drug-induced sleep endoscopy (DISE) by comparing the outcomes of tongue base surgery based on Muller's maneuver (MM) and those based on DISE in obstructive sleep apnea (OSA) patients. Methods: Ninety-five patients who underwent the tongue base surgery in combination with palatal surgery for OSA at a tertiary referral hospital between March 2012 and March 2019 were enrolled in this retrospective comparative study. Forty-seven patients underwent MM for surgical decision and 48 patients underwent DISE in addition to MM for surgical decision. Surgical success was defined according to the Sher criteria (postoperative apnea-hypopnea index [AHI] < 20/h and ≥ 50% reduction in preoperative AHI), and AHI improvement (%) was defined as (preoperative AHI-postoperative AHI) × 100/preoperative AHI. For comparison between the MM and DISE groups, p-values were calculated using independent or paired t-tests for continuous variables and using chisquare test for categorical variables. Results: By comparing the results of MM and DISE, consensus on the tongue base level showed insignificant concordance (kappa = 0.017, p = 0.865), whereas that on the oropharynx level showed fair agreement (kappa = 0.241, p = 0.005). AHI, supine AHI, rapid eyeball movement (REM) AHI, non-REM AHI, and nadir oxygen saturation were all significantly improved after the tongue base surgery in both groups. The MM group showed a significant improvement in the Epworth sleepiness scale after the tongue base surgery (p = 0.014), whereas the DISE group did not (p = 0.165). However, there was no significant difference in the AHI improvement (MM group = 47.0 ± 32.0, DISE group = 48.3 ± 35.4, p = 0.852) and surgical success (MM group = 42.6%, DISE group = 45.8%, p = 0.748) between the groups. Tonsil grade (p < 0.05) and occlusion at the oropharynx lateral wall (p = 0.031) were significantly related to surgical success in the MM group. Conclusions: In the judgment of the tongue base surgery, MM and DISE findings showed poor agreement. DISE might affect the surgical decision on the tongue base surgery in OSA patients; however, there was a lack of evidence regarding the superiority of DISE over MM with respect to the surgical outcomes.

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Section: Introductionmentioning

confidence: 99%

Can drug-induced sleep endoscopy improve the success rates of tongue base surgery?

Lee

Nam

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

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“…Nasal surgery may be offered to CPAP-intolerant patients—adjunctive nasal surgery may facilitate improved postoperative CPAP adherence due to lower CPAP requirements (average of 2–3 cm H 2 O) or improved tolerance of nasal-type masks without the necessity of a chin strap [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Outcome of Continuous Positive Airway Pressure Adherence Based on Nasal Endoscopy and the Measurement of Nasal Patency—A Prospective Study

Knížek

Kotulek²,

Brothánková

et al. 2023

Life

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The gold standard for treating obstructive sleep apnea in adults is continuous positive airway pressure (CPAP). However, it can be difficult to convince patients to adhere to this therapy. The aim of this study was to determine the relationship between nasal endoscopy findings/nose patency and CPAP adherence. Material and methods: A cohort of 450 consecutive patients suspected of having OSA were prospectively enrolled. For further analyses, 47 OSA patients undergoing CPAP treatment were selected (13 females and 34 males, average age, 65.3 years, BMI 34.1, apnea-hypopnea index. AHI 51.0). The patients were divided into two groups: patients with good CPAP adherence (n = 35) and patients who did not adhere to CPAP therapy (n = 12). The influence of nasal endoscopy and flow measurement on CPAP adherence was explored. Results: We found a statistical independence between adherence to CPAP and AHI (p = 0.124), T90 (p = 0.502), endoscopic findings (p = 0.588) and nasal patency measured by a flowmeter (p = 0.498). Conclusions: In our studied sample, endoscopic findings and nasal patency measured by a flowmeter were not predictors of CPAP non-adherence in the first year of the treatment. Our data show that while an endoscopic finding in the nasal cavity could indicate that a patient has a severe obstruction, compliance with CPAP therapy is not reduced in these patients and neither is it reduced with a decrease in nasal flow, according to our observation.

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“…The value of engaging a multidisciplinary team in the diagnosis and management of OSA is well recognized [3]. However, the challenge has been translating this principle into clinical practice since clinicians have…”

Section: Multidisciplinary Approach To Successful Treatment Of Patients With Osa-case Examplesmentioning

confidence: 99%

A Comprehensive and Multidisciplinary Approach to Obstructive Sleep Apnea: Case Examples

Weber¹

2021

JCO

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Positive airway pressure (PAP) therapy is well established as the standard of care for most patients with obstructive sleep apnea (OSA), however, up to 50% are not successfully treated with this approach and their further care remains a challenge. The value of engaging a multidisciplinary team in the diagnosis and management of OSA has been well recognized for over 30 years; however, the difficulty has been translating this principle into clinical practice. We present a series of selected patients with a diagnosis of OSA who initially failed PAP therapy but were successfully treated using a multidisciplinary and evidence-based approach that is reproducible at other sleep centers.

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Multidisciplinary Alternatives to CPAP Program for CPAP-Intolerant Patients

Cited by 8 publications

References 26 publications

Can drug-induced sleep endoscopy improve the success rates of tongue base surgery?

Can drug-induced sleep endoscopy improve the success rates of tongue base surgery?

Outcome of Continuous Positive Airway Pressure Adherence Based on Nasal Endoscopy and the Measurement of Nasal Patency—A Prospective Study

A Comprehensive and Multidisciplinary Approach to Obstructive Sleep Apnea: Case Examples

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