Physiological Traits and Adherence to Sleep Apnea Therapy in Individuals with Coronary Artery Disease

Zinchuk, Andrey; Chu, Jen-Hwa; Liang, Jiasheng; Çelik, Yeliz; Beeck, Sara Op de; Redeker, Nancy S.; Wellman, Andrew; Yaggi, H. Klar; Peker, Yüksel; Sands, Scott A.

doi:10.1164/rccm.202101-0055oc

Cited by 32 publications

(17 citation statements)

References 52 publications

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“…For example, detailed physiological studies in which the key OSA endotypes have been quantified and non-CPAP interventions delivered to improve one or more of the non-anatomical treatable traits can reduce OSA severity (Eckert et al, 2011;Edwards et al, 2012Edwards et al, , 2016bSands et al, 2018a;Aishah and Eckert, 2019;Taranto-Montemurro et al, 2019;Op de Beeck et al, 2021). Identification of patients with a low respiratory arousal threshold endotype may be an important physiological predictor of CPAP treatment failure (Gray et al, 2017;Zinchuk et al, 2021) and the presence of a low arousal threshold endotype is associated with mortality (Butler et al, 2019). Similarly, identification of patients impairment in endotypes such as high loop gain and highly collapsible pharyngeal airways may be important predictors for non-CPAP treatment failure including upper airway surgery, mandibular advancement splint therapy, hypoglossal nerve stimulation, pharmacotherapy (Edwards et al, 2016a;Li et al, 2017;Aishah and Eckert, 2019;Op de Beeck et al, 2021) and potentially positional therapy (Eckert, 2018b).…”

Section: Osa Endotypesmentioning

confidence: 99%

New and Emerging Approaches to Better Define Sleep Disruption and Its Consequences

et al. 2021

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Current approaches to quantify and diagnose sleep disorders and circadian rhythm disruption are imprecise, laborious, and often do not relate well to key clinical and health outcomes. Newer emerging approaches that aim to overcome the practical and technical constraints of current sleep metrics have considerable potential to better explain sleep disorder pathophysiology and thus to more precisely align diagnostic, treatment and management approaches to underlying pathology. These include more fine-grained and continuous EEG signal feature detection and novel oxygenation metrics to better encapsulate hypoxia duration, frequency, and magnitude readily possible via more advanced data acquisition and scoring algorithm approaches. Recent technological advances may also soon facilitate simple assessment of circadian rhythm physiology at home to enable sleep disorder diagnostics even for “non-circadian rhythm” sleep disorders, such as chronic insomnia and sleep apnea, which in many cases also include a circadian disruption component. Bringing these novel approaches into the clinic and the home settings should be a priority for the field. Modern sleep tracking technology can also further facilitate the transition of sleep diagnostics from the laboratory to the home, where environmental factors such as noise and light could usefully inform clinical decision-making. The “endpoint” of these new and emerging assessments will be better targeted therapies that directly address underlying sleep disorder pathophysiology via an individualized, precision medicine approach. This review outlines the current state-of-the-art in sleep and circadian monitoring and diagnostics and covers several new and emerging approaches to better define sleep disruption and its consequences.

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Section: Osa Endotypesmentioning

confidence: 99%

New and Emerging Approaches to Better Define Sleep Disruption and Its Consequences

et al. 2021

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“…Additionally, both high and low pharyngeal muscle compensation are linked to poor CPAP adherence. Therefore, identifying patients who are likely to benefit from genioglossus muscle strengthening, and future studies on more efficient genioglossus muscle strengthening protocols, might help the CPAP adherence in OSA patients [27].…”

Section: Discussionmentioning

confidence: 99%

A Pilot Randomized Controlled Trial of Effect of Genioglossus Muscle Strengthening on Obstructive Sleep Apnea Outcomes

Maghsoudipour

Nokes

Bosompra

et al. 2021

JCM

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The genioglossus is a major upper airway dilator muscle. Our goal was to assess the efficacy of upper airway muscle training on Obstructive Sleep Apnea (OSA) as an adjunct treatment. Sixty-eight participants with OSA (AHI > 10/h) were recruited from our clinic. They fall into the following categories: (a) Treated with Automatic Positive Airway Pressure (APAP), (n = 21), (b) Previously failed APAP therapy (Untreated), (n = 25), (c) Treated with Mandibular Advancement Splint (MAS), (n = 22). All subjects were given a custom-made tongue strengthening device. We conducted a prospective, randomized, controlled study examining the effect of upper airway muscle training. In each subgroup, subjects were randomized to muscle training (volitional protrusion against resistance) or sham group (negligible resistance), with a 1:1 ratio over 3 months of treatment. In the baseline and the final visit, subjects completed home sleep apnea testing, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), SF-36 (36-Item Short Form Survey), and Psychomotor Vigilance Test (PVT). Intervention (muscle training) did not affect the AHI (Apnea-Hypopnea Index), (p-values > 0.05). Based on PSQI, ESS, SF-36 scores, and PVT parameters, the changes between the intervention and sham groups were not significant, and the changes were not associated with the type of treatment (p-value > 0.05). The effectiveness of upper airway muscle training exercise as an adjunct treatment requires further study.

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“…In this issue of the Journal , Zinchuk and colleagues (pp. 703–712 ) present important findings that overcome these limitations and underscore the importance of physiologic traits in predicting PAP adherence ( 12 ). Greater understanding in this area may inform novel approaches to improve the effectiveness of PAP therapy.…”

mentioning

confidence: 99%

“…Indeed, a recent post hoc analysis of a randomized trial of eszopiclone suggests that those with a low arousal threshold who use PAP >1 month may derive more benefit from the hypnotic than those with a high arousal threshold ( 9 ). Several existing therapies such as acetazolamide and supplemental oxygen also have efficacy in alleviating loop gain ( 14 ), which Zinchuk and colleagues found may be a barrier in longer-term adherence ( 12 ). An underexplored approach is customizing PAP technology and settings to harmonize with physiologic traits.…”

mentioning

confidence: 99%

“…Here, Zinchuk and colleagues present important findings that overcome these limitations and underscore the importance of physiologic traits in predicting PAP adherence. 12 Greater understanding in this area may inform novel approaches to improve the effectiveness of PAP therapy. The researchers resourcefully analyzed physiologic traits on baseline polysomnograms (PSG) acquired from the Randomized Intervention with Continuous Positive Airway Pressure in CAD and OSA (RICCADSA) study.…”

mentioning

confidence: 99%

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Understanding Sleep Apnea Physiology: A Potential Path to Improving Positive Airway Pressure Effectiveness

Donovan

Kapur

2021

Am J Respir Crit Care Med

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Physiological Traits and Adherence to Sleep Apnea Therapy in Individuals with Coronary Artery Disease

Cited by 32 publications

References 52 publications

New and Emerging Approaches to Better Define Sleep Disruption and Its Consequences

New and Emerging Approaches to Better Define Sleep Disruption and Its Consequences

A Pilot Randomized Controlled Trial of Effect of Genioglossus Muscle Strengthening on Obstructive Sleep Apnea Outcomes

Understanding Sleep Apnea Physiology: A Potential Path to Improving Positive Airway Pressure Effectiveness

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