Obstructive Sleep Apnea and Oxygen Therapy: A Systematic Review of the Literature and Meta-Analysis

Mehta, Vanita; Vasu, Tajender S.; Phillips, Barbara; Chung, Frances

doi:10.5664/jcsm.2500

Cited by 99 publications

(79 citation statements)

References 62 publications

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“…In contrast to the findings of the current study and others, 30 Xie et al 31 reported that hyperoxia had no effect on mean AHI (room air vs. hyperoxia: 39 ± 6 vs. 34 ± 6 events/h, P = 0.25) and found there was no relationship between anatomy/collapsibility and the changes in AHI across participants. Apparent discrepancies are possibly explained by their greater average age (+10 y), more severe average collapsibility (Pcrit in the current study [ …”

Section: Altering Loop Gaincontrasting

confidence: 54%

“…However, it would appear, based on published effect sizes of the individual therapies, that the combination of oxygen and a hypnotic improves OSA more than either treatment alone. In a recent meta-analysis of the effects of oxygen therapy in over 300 OSA patients, Mehta et al 30 demonstrated that oxygen reduced the AHI by 20% (18% to 28% interquartile range). Similarly, our previous work 22 demonstrated that oxygen therapy reduced the AHI by 33%, with 2 of 12 patients (17%) being considered responders using the definition used in the current study.…”

Section: Combining Oxygen and A Hypnotic Has An Additive Effect In Rementioning

confidence: 99%

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The Combination of Supplemental Oxygen and a Hypnotic Markedly Improves Obstructive Sleep Apnea in Patients with a Mild to Moderate Upper Airway Collapsibility

Edwards

Sands

Owens

et al. 2016

Sleep

107

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Study Objectives: Obstructive sleep apnea (OSA) results from the interaction of several physiological traits; specifically a compromised upper airway anatomy and muscle function, and two key non-anatomical deficits: elevated loop gain and a low arousal threshold. Although continuous positive airway pressure (CPAP) is an efficacious treatment, it is often poorly tolerated. An alternative approach could involve administering therapies targeting the nonanatomic causes. However, therapies (oxygen or hypnotics) targeting these traits in isolation typically improve, but rarely resolve OSA. Therefore, our aim was to determine how the combination of oxygen and eszopiclone alters the phenotypic traits and OSA severity and to assess the baseline phenotypic characteristics of responders/nonresponders to combination therapy. Methods: In a single-blinded randomized crossover study, 20 OSA patients received combination therapy (3 mg eszopiclone and 40% oxygen) versus placebo/sham air, with 1 w between conditions. Under each condition, we assessed the effects on OSA severity (clinical polysomnography) and the phenotypic traits causing OSA using CPAP manipulations (research polysomnography). Results: Combination therapy reduced the apnea-hypopnea index (51.9 ± 6.2 vs. 29.5 ± 5.3 events/h; P < 0.001), lowered both the ventilation associated with arousal (5.7 ± 0.3 vs. 5.2 ± 0.3 L/min; P = 0.05) and loop gain (3.3 ± 0.5 vs. 2.2 ± 0.3; P = 0.025). Responders to therapy (apnea-hypopnea index reduced by > 50% to below 15 events/h; n = 9/20) had less severe OSA (P = 0.001), a less collapsible upper airway (P = 0.01) and greater upper airway muscle effectiveness (P = 0.002). Conclusions:The combination of lowering loop gain and raising the arousal threshold is an effective therapy in patients whose anatomy is not severely compromised. Our work demonstrates that combining therapies that target multiple traits can resolve OSA in selected individuals.

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Section: Altering Loop Gaincontrasting

confidence: 54%

Section: Combining Oxygen and A Hypnotic Has An Additive Effect In Rementioning

confidence: 99%

The Combination of Supplemental Oxygen and a Hypnotic Markedly Improves Obstructive Sleep Apnea in Patients with a Mild to Moderate Upper Airway Collapsibility

Edwards

Sands

Owens

et al. 2016

Sleep

107

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“…Breathing events and sleep fragmentation still occur in spite of the elevated oxygen saturation 27. Concerns regarding lengthened apnea duration and risk of hypercapnia have been raised 28, 29. Gottlieb and colleagues report that CPAP, rather than oxygen therapy, may reduce blood pressure in OSA patients, although patients with AHI >50 events/h or long duration of severe nocturnal hypoxemia (SaO 2 <85% for >10% of sleep) were excluded from the study 30.…”

Section: Discussionmentioning

confidence: 99%

Nocturnal Hypoxemia Due to Obstructive Sleep Apnea Is an Independent Predictor of Poor Prognosis After Myocardial Infarction

Xie

Kuniyoshi

Covassin

et al. 2016

JAHA

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BackgroundObstructive sleep apnea (OSA) is an important risk factor for the development of cardiovascular diseases including myocardial infarction (MI). The aim of this study was to investigate the effects of OSA on prognosis after MI, and to determine which specific measures of OSA severity best predicted outcomes.Methods and ResultsWe performed a prospective study, in which 112 patients without a prior diagnosis of sleep apnea underwent comprehensive polysomnography within a median of 7 days after MI. Patients were followed up at 6‐monthly intervals (±2 weeks) for a total of 48 months. Patients classified with central apnea (n=6) or those using continuous positive airway pressure (n=8) after polysomnography were excluded from analyses. The primary end point was major adverse cardiac events, including death from any cause, recurrent MI, unstable angina, heart failure, stroke, and significant arrhythmic events. Forty of 98 patients (41%) had OSA (apnea‐hypopnea index ≥15 events/h). OSA patients had higher major adverse cardiac event rates when compared to those without OSA (47.5% versus 24.1%; χ2=5.41, P=0.020). In a multivariate model that adjusted for clinically relevant variables including age, left ventricular ejection fraction, diabetes mellitus, oxygen desaturation index, and arousal index, significant hypoxemia, as defined by nocturnal nadir oxygen saturation ≤85%, was an independent risk factor for major adverse cardiac events (hazard ratio=6.05, P=0.004) in follow‐up 15 months after baseline.ConclusionsNocturnal hypoxemia in OSA is an important predictor of poor prognosis for patients after MI. These findings suggest that routine use of low‐cost nocturnal oximetry may be an economical and practical approach to stratify risk in post‐MI patients.

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“…OSA patients may also have an up-regulation of the central opioid receptors secondary to recurrent hypoxemia, and are therefore more susceptible to the respiratory depressant effects of opioids; thus, they may benefit from supplemental oxygen while on parenteral opioids [61]. However, it should also be kept in mind that oxygen therapy may prolong apneas in some individuals, and the use of supplemental oxygen therapy may also mask the development of hypercapnia, which may be seen in patients with known OSA who require supplemental oxygen added to home PAP therapy, as well as in patients with suspected OSA who require upward titration of oxygen supplementation [62]. While there is insufficient evidence to recommend a specific patient position postoperatively, the ASA guidelines states that the supine position should be avoided when possible during the recovery of patients who are at increased perioperative risk from OSA.…”

Section: Oxygenation and Positioningmentioning

confidence: 99%

“…Consider CPAP preoxygenation [62] Two-handed triple airway maneuvers Anticipate difficult airway. Personnel familiar with a specific difficult airway algorithm [61] Gastroesophageal reflux disease [64] Consider proton pump inhibitors, antacids, rapid sequence induction with cricoid pressure…”

Section: Adequate Preoxygenationmentioning

confidence: 99%

Perioperative Management of Obstructive Sleep Apnea

Abdullah

Chung

2013

Curr Anesthesiol Rep

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Obstructive sleep apnea (OSA) has been linked to a myriad of chronic diseases with physically serious and economically draining consequences. There has been a substantial increase in its prevalence over the last two decades and up to one-quarter of the elective surgical patients have been found to be at high risk for OSA. These patients are at an increased risk for perioperative adverse events such as cardiac and pulmonary complications as well as postoperative delirium. This review addresses the screening methods such as the STOP-Bang questionnaire for the undiagnosed and the preoperative management of the known and at-risk patients. Recommendations for the evaluation of the systemic complications and its management are included. Recent suggestions for the intraoperative management and risk mitigation methods are reviewed, such as the role of regional anesthesia and nonopioid analgesics. Special focuses on postoperative issues such as pain control, oxygenation, positioning, and patient disposition are also included.

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Obstructive Sleep Apnea and Oxygen Therapy: A Systematic Review of the Literature and Meta-Analysis

Cited by 99 publications

References 62 publications

The Combination of Supplemental Oxygen and a Hypnotic Markedly Improves Obstructive Sleep Apnea in Patients with a Mild to Moderate Upper Airway Collapsibility

The Combination of Supplemental Oxygen and a Hypnotic Markedly Improves Obstructive Sleep Apnea in Patients with a Mild to Moderate Upper Airway Collapsibility

Nocturnal Hypoxemia Due to Obstructive Sleep Apnea Is an Independent Predictor of Poor Prognosis After Myocardial Infarction

Perioperative Management of Obstructive Sleep Apnea

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