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. There was no evidence from a single study that treatment of mild OSA reduces all-cause mortality. d The task force members identi?ed speci?c research gaps and made recommendations to address these gaps in knowledge. Introduction OSA is a major public health problem that is characterized by repetitive obstruction of the upper airway resulting in oxygen desaturation and/or arousals from sleep. The International Classi?cation of SleepDisorders (1) de?nes OSA as the occurrence of predominantly obstructiveapneas (...) (cessation of air?ow) and hypopneas (reduction in air?ow) denoted by either an apnea–hypopnea index (AHI; number of apneas and hypopneas per hour of sleep) of greater than or equal to 15/h or greater than or equal to 5/h accompanied by cardiovascular, neurocognitive, or metabolic consequences. General population-based studies indicate that the prevalence of OSA syndrome de?ned as AHI greater than or equal to 5/h with daytime sleepiness ranges from 3 to 7.5% in adult menandfrom2to3%inadultwomen (2–8
) Insomnia is a major health care problem in the United States. It is defined as dissatisfaction with sleep quantity or quality and is associated with difficulty initiating or maintaining sleep and early-morning waking with inability to return to sleep ( ). Approximately 6% to 10% of adults have insomnia that meets diagnostic criteria ( ). Insomnia is more common in women and older adults ( , ) and can occur independently or be caused by another disease. People with the disorder often experience fatigue (...) . Older adults are more likely to report problems with waking after sleep onset (difficulty maintaining sleep) than they are to report problems with sleep onset latency (time to fall asleep). The goal of treatment for insomnia is to improve sleep and alleviate distress or dysfunction caused by the disorder. Insomnia can be managed with psychological therapy, pharmacologic therapy, or a combination of both. Psychological therapy options include cognitive behavioral therapy for insomnia (CBT-I
, Khawaja IS, Ouellette J, Butler M, Kane RL, Wilt TJ. Management of insomniadisorder. Rockville: Agency for Healthcare Research and Quality (AHRQ). Comparative Effectiveness Review No. 159. 2015 Authors' objectives To assess the efficacy, comparative effectiveness, and harms of treatments for insomniadisorder in the general adult population and older adults. Authors' conclusions CBT-I or medical therapy with eszopiclone, zolpidem, and suvorexant improve global and sleep outcomes for insomniadisorder (...) Management of insomniadisorder Management of insomniadisorder Management of insomniadisorder Brasure M, MacDonald R, Fuchs E, Olson CM, Carlyle M, Diem S, Koffel E, Khawaja IS, Ouellette J, Butler M, Kane RL, Wilt TJ Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Brasure M, MacDonald R, Fuchs E, Olson CM, Carlyle M, Diem S, Koffel E
Factors that affect simulated driving in patients with obstructivesleepapnoea Objective data for advising sleepapnoea sufferers whether they are at increased risk of an accident when driving http://ow.ly/TWPgm.
CPAP vs Mandibular Advancement Devices and Blood Pressure in Patients With ObstructiveSleepApnea: A Systematic Review and Meta-analysis. Obstructivesleepapnea is associated with higher levels of blood pressure (BP), which can lead to increased cardiovascular risk.To compare the association of continuous positive airway pressure (CPAP), mandibular advancement devices (MADs), and inactive control groups (placebo or no treatment) with changes in systolic BP (SBP) and diastolic BP (DBP (...) ) in patients with obstructivesleep apnea.The databases of MEDLINE, EMBASE, and the Cochrane Library were searched up to the end of August 2015 and study bibliographies were reviewed.Randomized clinical trials comparing the effect of CPAP or MADs (vs each other or an inactive control) on BP in patients with obstructivesleepapnea were selected by consensus. Of 872 studies initially identified, 51 were selected for analysis.Data were extracted by one reviewer and checked by another reviewer. A network meta
efficacious. Specialty/Discipline (General Dentistry) (Oral Surgery) (Orthodontics) (Basic Science) Keywords maxillomandibular advancement; morbid obesity; obstructivesleepapnea; sleepapneasyndromes ID# 2929 Date of submission: 11/03/2015 E-mail Russelldk@uthscsa.edu Author Deborah Russell, DDS Co-author(s) Co-author(s) e-mail Faculty mentor/Co-author Ravikumar Anthony, BDS, MDS, MS Faculty mentor/Co-author e-mail ANTHONYR@uthscsa.edu Basic Science Rationale (Mechanisms that may account (...) Maxillomandibular Advancement (MMA) Surgery Is An Effective Second or Third-Line Treatment Modality For Morbidly Obese Patients with ObstructiveSleepApnea (OSA) UTCAT2929, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Maxillomandibular Advancement (MMA) Surgery Is An Effective Second or Third-Line Treatment Modality For Morbidly Obese Patients with ObstructiveSleepApnea (OSA) Clinical Question For morbidly obese
[Ambulatory measuraments are better tolerated than in-hospital measuraments of sleepapnea.]. This study compares self reported measures of sleep quality between groups of patients undergoing ambulatory or in-hospital annual control of Continuous Positive Airway Pressure (CPAP) therapy.70 consecutive ObstructiveSleepApneaSyndrome (OSAS) patients scheduled for an annual control of CPAP therapy were randomly assigned to either ambulatory or in the hospital conditions. The same recording
Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructivesleep-disorderedbreathing in children. Obstructivesleep-disorderedbreathing (oSDB) is a condition that encompasses breathing problems when asleep, due to an obstruction of the upper airways, ranging in severity from simple snoring to obstructivesleepapnoeasyndrome (OSAS). It affects both children and adults. In children, hypertrophy of the tonsils and adenoid tissue is thought to be the commonest cause (...) and Goldstein.In the CHAT trial, at seven months, more children in the surgery group had normalisation of respiratory events during sleep as measured by PSG than those allocated to watchful waiting: 153/194 (79%) versus 93/203 (46%) (RD 33%, 95% CI 24% to 42%). In the Goldstein trial, at six months, PSG recordings were similar between groups and in the Sudarsan trial resolution of OSAS (Apnoea/Hypopnoea Index score below 1) did not significantly differ between the adenotonsillectomy and CPAP groups.In the CHAT
InsomniaDisorder. 26444730 2015 10 15 2018 12 02 1533-4406 373 15 2015 Oct 08 The New England journal of medicine N. Engl. J. Med. CLINICAL PRACTICE. InsomniaDisorder. 1437-44 10.1056/NEJMcp1412740 Winkelman John W JW eng Journal Article Review United States N Engl J Med 0255562 0028-4793 0 Antidepressive Agents 0 Hypnotics and Sedatives YBK48BXK30 Trazodone AIM IM Aged Antidepressive Agents therapeutic use Cognitive Behavioral Therapy Female Humans Hypnotics and Sedatives therapeutic use (...) Male Overweight complications Practice Guidelines as Topic Sleep Initiation and Maintenance Disorders diagnosis physiopathology therapy Trazodone therapeutic use 2015 10 8 6 0 2015 10 9 6 0 2015 10 16 6 0 ppublish 26444730 10.1056/NEJMcp1412740
No Relationship Between ObstructiveSleepApnea and Premolar Extraction UTCAT2917, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title No Relationship Between ObstructiveSleepApnea and Premolar Extraction Clinical Question In orthodontically treated patients, does extracting one premolar from each quadrant contribute to increased prevalence of obstructivesleepapnea as compared to patients with no extractions? Clinical (...) Bottom Line The evidence supports no relationship between premolar extractions and obstructivesleepapnea. Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) Larsen/2015 5,584 patients between 40 and 70 years old Retrospective medical records review Key results Key Results: 5,584 randomly selected subjects were divided into two equal groups of 2,792. One group had four missing premolars (one in each
fraction and predominantly central sleep apnea.We randomly assigned 1325 patients with a left ventricular ejection fraction of 45% or less, an apnea-hypopnea index (AHI) of 15 or more events (occurrences of apnea or hypopnea) per hour, and a predominance of central events to receive guideline-based medical treatment with adaptive servo-ventilation or guideline-based medical treatment alone (control). The primary end point in the time-to-event analysis was the first event of death from any cause (...) Adaptive Servo-Ventilation for Central SleepApnea in Systolic Heart Failure. Central sleepapnea is associated with poor prognosis and death in patients with heart failure. Adaptive servo-ventilation is a therapy that uses a noninvasive ventilator to treat central sleepapnea by delivering servo-controlled inspiratory pressure support on top of expiratory positive airway pressure. We investigated the effects of adaptive servo-ventilation in patients who had heart failure with reduced ejection
Heart Failure and Sleep-DisorderedBreathing - The Plot Thickens. 26323939 2015 09 30 2018 12 02 1533-4406 373 12 2015 Sep 17 The New England journal of medicine N. Engl. J. Med. Heart Failure and Sleep-DisorderedBreathing--The Plot Thickens. 1166-7 10.1056/NEJMe1510397 Magalang Ulysses J UJ From the Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus (U.J.M.); and the Center for Sleep and Circadian Neurobiology, Department (...) -Pressure Respiration methods SleepApnea, Central therapy 2015 9 2 6 0 2015 9 2 6 0 2015 10 1 6 0 ppublish 26323939 10.1056/NEJMe1510397
behavioral intervention (MCI) improved both insomnia and depressive symptoms in persons presenting with insomnia and high levels of depression. The sample consisted of 321 individuals with insomnia who participated in a trial of insomnia treatments; 106 participants had high levels of depression (score ≥ 16 on CES-D) at baseline. Participants either received the MCI or a control treatment (sleep education and hygiene booklet). At post-test, participants with high and low levels of depressive symptoms (...) Effects of a Multi-Component Behavioral Intervention (MCI) for Insomnia on Depressive and Insomnia Symptoms in Individuals with High and Low Depression. Insomnia and depression are prevalent and co-occurring conditions that are associated with significant impairment of life. Previous research indicates that cognitive-behavioral interventions for insomnia (CBT-I) can improve both insomnia and depressive symptoms. The aim of the authors in this study was to determine whether a multi-component
Association of incident obstructivesleepapnoea with outcomes in a large cohort of US veterans There is a paucity of large cohort studies examining the association of obstructivesleepapnoea (OSA) with clinical outcomes including all-cause mortality, coronary heart disease (CHD), strokes and chronic kidney disease (CKD).We hypothesised that a diagnosis of incident OSA is associated with higher risks of these adverse clinical outcomes.In a nationally representative cohort of over 3 million (n
, Gehrman P, Gurubhagavatula I, Al-Shehabi E, Marie E, Schwab R. Effectiveness of ramelteon for insomnia symptoms in older adults with obstructivesleepapnea: a randomized placebo-controlled pilot study. J Clin Sleep Med [Internet]. 2010 Dec 15 [cited 2015 Apr 15];6(6):572-80. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014244 PubMed: PM21206546 6. Walsh JK, Salkeld L, Knowles LJ, Tasker T, Hunneyball IM. Treatment of elderly primary insomnia patients with EVT 201 improves sleep (...) in the abstract. One RCT compared eszopiclone with placebo 4 and reported a significantly greater improvement in subjective sleep latency with eszopiclone as well as a significantly greater decrease in wake time after sleep onset. No rebound effect was noted and unpleasant taste was the only adverse event more frequently reported in the treatment group. 4 An RCT of ramelteon versus placebo 5 Treatment of Insomnia, Agitation or Delirium with Benzodiazepines 3 reported a statistically significant difference
% exhibited obstructivesleepapnea. However, in the group of patients diagnosed with sleep bruxism, that number rose to 4.8%, producing a p value of 95% confidence in the presence of obstructivesleepapnea being a significant factor in producing higher prevalence of sleep bruxism. #2) Hosoya/2014 67 patients with obstructivesleepapneasyndrome in whom sleepapnea occurred 5 or more times per hour Case Control Study Key results The prevalence of sleep bruxism was higher in the patients with obstructive (...) sleepapneasyndrome than it was in the control group. 47.8% of the obstructivesleepapneasyndrome patients were diagnosed with sleep bruxism. The frequency of sleep bruxism was significantly higher with an occurrence of 7.02 events per hour with a standard deviation of 10.1 while the control group exhibits 2.88 event per hour with a 1.47 standard deviation (p Evidence Search ("Sleep Bruxism"[Mesh]) AND "SleepApnea, Obstructive"[Mesh] Comments on The Evidence Validity: Groups were randomly
Continuous Positive Airway Pressure (CPAP) May Immediately Decrease Persistent Hypertension in Patients with ObstructiveSleepApnea (OSA) UTCAT2874, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Continuous Positive Airway Pressure (CPAP) May Immediately Decrease Persistent Hypertension in Patients with ObstructiveSleepApnea (OSA) Clinical Question In patients with obstructivesleepapnea with uncontrolled (...) hypertension that is not alleviated by medication, can the use of continuous positive airway pressure (CPAP) lower both diastolic and systolic blood pressure? Clinical Bottom Line In patients with obstructivesleepapnea and systemic hypertension that is not controlled by medication, the use of CPAP device can aid in decreasing blood pressure if obstructivesleepapnea is controlled. This is supported by two meta-analyses and a randomized controlled trial that showed clinically a decrease in both systolic
Occlusal Changes from ObstructiveSleepApnea Appliances Are Not Self-Limiting and Continue to Progress UTCAT2857, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Occlusal Changes from ObstructiveSleepApnea Appliances Are Not Self-Limiting and Continue to Progress Clinical Question In patients who use an obstructivesleepapnea appliance, are the occlusal changes that occur progressive and/or self-limiting? Clinical (...) Bottom Line Occlusal changes due to long-term use of an oral appliance to treat obstructivesleepapnea are not self-limiting and continue to progress. Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) Pliska/2014 77 adult patients with obstructivesleepapnea (OSA) treated with mandibular advancement splints (MAS). Cohort Study Key results After the study time period of an average 11 years, the authors
The Cardiovascular Health Benefits of Using Oral Appliance Therapy for ObstructiveSleepApnea Typically Outweigh the Risks of Tooth Movement and Malocclusion UTCAT2808, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title The Cardiovascular Health Benefits of Using Oral Appliance Therapy for ObstructiveSleepApnea Typically Outweigh the Risks of Tooth Movement and Malocclusion Clinical Question Do the cardiovascular (...) health benefits of using oral appliance therapy typically outweigh the risk of tooth movement and malocclusion in an overweight, elderly male with moderate obstructivesleepapnea? Clinical Bottom Line The cardiovascular health benefits of using oral appliance therapy (OAT) typically outweigh the risk of tooth movement and malocclusion in an overweight, elderly male with moderate obstructivesleepapnea (OSA). This is supported by a systematic review and a medical records review. The systematic