New perspectives in the treatment of obstructive sleep apnea-hypopnea syndrome

  • Edgar Cortés-Reyes Department of Human Body Movement, Institute of Clinical Research, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
  • Katherine Parrado-Bermúdez Department of Human Body Movement, Institute of Clinical Research, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
  • Franklin Escobar-Córdoba a. Department of Psychiatry, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia. b. Sueño Vigilia Colombiana Foundation, Bogotá, D.C., Colombia
Keywords: Sleep apnea syndromes, Obesity, Comorbidity, Therapeutics, Airway obstruction

Abstract

lntroduction: Obstructive sleep apnea-hypopnea syndrome (OSA) is an increasingly prevalent Received 2 February 2016 disorder in the population, which seriously compromises the quality of life of sufferers. Although continuous positive airway pressure remains the most commonly used treatment modality, its poor adhesion and relative failure have provoked several studies seeking to develop more convenient and effective alternatives for treating this condition.

Objective: To review the most effective, recent and innovative strategies that scientific evidence suggests for the treatment of OSA from anatomical and physiological mechanisms involved.

Materials and methods: A literature review was performed from items taken from PubMed, ScienceDirect, Springer, LILACS and PEDro databases, published between 2005 and 2015 in English.

Results: OSA is an intermittent and repetitive obstruction of the upper airway during sleep, caused mainly by an imbalance in respiratory muscle synergy. For treatment, the scientific literature has recently described methods such as oral devices, oral and nasal pressure therapies, Pillar, the Night Shift, bariatric surgery and stimulation of the hypoglossal nerve.

Conclusions: Although a fully effective treatment is not yet available, acombination of strategies from an interdisciplinary perspective can enhance the quality of life of patients. It is expected that in the coming years, the scientific and technological advances will allow for the implementation of a treatment protocol that is able to directly address the etiological processes to reduce their prevalence.

References

1. Escobar-Córdoba F, Liendo C. Trastornos respiratorios del sueño y alteraciones cardiovasculares. Rev Fac Med. 2012; 60:1-3.

2. Aguilar-Cordero MJ, Sánchez-López AM, Mur-Villar N, García-García I, Guisado-Barrilao R. Síndrome de apneas -hipoapneas del sueño y factores de riesgo. Nutr Hosp. 2013; 28:1781-91.

3. Marshall NS, Wong KH, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea and 20-year follow-up for all-cause mortality, stroke, cancer incidence and mortality in the Busselton Health Study cohort. J Clin Sleep Med. 2014; 10:355-62.

4. Fonseca-Pires MA, Pereira T, Caseiro P. Death and disability in patients with sleep apnea - a meta-analysis. Arq Bras Cardiol. 2015; 104:58-66.

5. Franklin KA, Anttila H, Axelsson S, Gislason T, Maasilta P, Myhre KI, et al. Effects and side-effects of surgery for snoring and obstructive sleep apnea - a systematic review. Sleep. 2009; 32:27-36.

6. Bachour A, Vitikainen P, Virkkula P, Maasilta P. CPAP interface: satisfaction and side effects. Sleep Breath. 2013; 17:667-73.

7. Marklund M. Predictors of long-term orthodontic side effects from mandibular advancement devices in patients with snoring and obstructive sleep apnea. Am J Orthod Dentofac Orthop 2006; 129:214-21.

8. Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of Obstructive Sleep Apnea in adults. J Clin Sleep Med. 2009; 5:263-76.

9. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med. 2012;8:597-619.

10. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, et al. Practice parameters for the indications for polysomnography and related procedures: an update for polysomnography and related procedures. Sleep. 2005; 28:499-521.

11. Eckert DJ, Malhotra A. Pathophysiology of adult obstructive sleep apnea. Am Thorac Soc. 2008;5:144-53.

12. Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of sleep apnea. Physiol Rev. 2010; 90:47-112.

13. Bachar G, Feinmesser R, Shpitzer T, Yaniv E, Nageris B, Eidelman L. Laryngeal and hypopharyngeal obstruction in sleep disordered breathing patients, evaluated by sleep endoscopy. Eur Arch Otorhinolaryngol. 2008; 265:1397-402.

14. Vroegop AV, Vanderveken OM, Boudewyns AN, Scholman J, Saldien V, Wouters K, et al. Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1,249 cases. Laryngoscope. 2014; 124:797-802.

15. Chebbo A, Tfail A, Ghamande S. Anatomy and physiology of obstructive sleep apnea. Sleep Med Clin. 2013; 8:425-31.

16. Lo YL, Jordan AS, Malhotra A, Heinzer RA, Eikermann M, Wellman A, et al. Influence of wakefulness on pharyngeal airway muscle activity. Thorax. 2007; 62:799-805.

17. Jordan AS, White DP. Pharyngeal motor control and the pathogenesis of obstructive sleep apnea. Respir Physiol Neurobiol. 2008; 169:1-7.

18. Ryan CM, Bradley TD. Pathogenesis of obstructive sleep apnea. J Appl Physiol. 2005;99:2440-50.

19. Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest. 2007; 132:325-37.

20. McGinley BM, Schneider H, Schwartz AR, Kirkness JP, Smith PL, Patil SP. Upper airway neuromuscular compensation during sleep is defective in obstructive sleep apnea. J Appl Physiol. 2008; 105:197-205.

21. Cao Y, McGuire M, Liu C, Malhotra A, Ling L. Phasic respiratory modulation of pharyngeal collapsibility via neuromuscular mechanisms in rats. J Appl Physiol. 2012; 112:695-703.

22. White DP. Pathogenesis of obstructive and central sleep apnea. Am J Respir Care Med. 2005; 172:1363-70.

23. Jordan AS, Eckert DJ, Wellman A, Trinder JA, Malhotra A, White DP. Termination of respiratory events with and without cortical arousal in obstructive sleep apnea. Am J Respir Care Med. 2011; 184:1183-91.

24. Youbes M, Loewen S, Ostrowski M, Lapraire J, Maturino F, Hanly PJ. Genioglossus activity available via non-arousal mechanisms vs that required for opening the airway in obstructive apnea patients. J Appl Physiol. 2012; 112: 249-58.

25. Longbarddo GS, Evangelist CJ, Cherniack S. Influence of arousal threshol and depth of sleep on respiratory stability in man: analysis using a mathematical model. Exp Physiol. 2009; 94:1185-99.

26. Eckert DJ, Younes MK. Arousal from sleep: implications for obstructive sleep apnea pathogenesis and treatment. J Appl Physiol. 2014; 116:302-13.

27. Olzewska E, Sieskiewicz A, Rozycki J, Rogalewski M, Tarasow E, Rogowski M, et al. A comparison of cephalometric analysis using radiographs and craniofacial computed tomography in patients with obstructive sleep apnea syndrome: preliminary report. Eur Arch Otorhinolaryngol. 2009; 266:535-42.

28. Genta PR, Schorr F, Eckert DJ, Gebrim E, Kayamori F, Moriya HT, et al. Airway collapsibility is associated with obesity and hyoid position. Sleep 2014; 37:167-8.

29. Singhai P, Gupta R, Sharma R, Mishra P. Association of naso-oro-pharyngeal structures with the sleep architecture in suspected obstructive sleep apnea. Indian J Otolaryngol Head Neck Surg. 2014; 66:81-7.

30. Pop MA, Drugan TC, Urda A, Chatellain P, Galmace G, Pop CM. Obesity - important risk factor for sleep apnea síndrome. J Appl Med Inform. 2013; 33:22-32.

31. Mazzuca E, Battaglia S, Marrone O, Marotta AM, Castrogiovanni A, Esquinas C, et al. Gender-specific anthropometric markers of adiposity, metabolic syndrome and visceral adiposity index (VAI) in patients with obstructive sleep apnea. J Sleep Res. 2014; 23:13-21.

32. Wosu AC, Vélez JC, Barbosa C, Andrade A, Frye M, Chen X, et al. The relationship between high risk for obstructive sleep apnea and general and central obesity; findings from a simple of Chilean college students. Obesity. 2014; 871681:1-8.

33. Simpson L, Mukherjee S, Cooper MN, Ward KL, Palmer LJ, Kirkness J. Sex differences in the association of regional fat distribution with the severity of obstructive sleep apnea. Sleep. 2010; 33:467-74.

34. Martínez C, Abad J, Fiz JA, Rios J, Morera J. Usefulness of truncal obesity indices as predictive factors for obstructive sleep apnea syndrome. Obesity. 2008;16:113-8.

35. Inohana CHK. Obstructive sleep apnea of obese adults: pathophysiology and perioperative airway management. Anestesiology. 2009; 110:908-21.

36. Joosten SA, O'driscoll DM, Berger PJ, Hamilton GS. Supine position related obstructive sleep apnea in adults: pathogenesis and treatment. Sleep Med Rev. 2014; 18: 7-17.

37. Babb TG, Wyrick BL, Delorey DS, Chase PJ, Feng MY. Fat distribution and end-expiratory lung volume in lean and obese men and women. Chest. 2008; 134:704-11.

38. Strohi KP, Butler J, Malhotra A. Mechanical properties of upper airway. Compr Physiol. 2013; 2:1853-72.

39. Kairaitis K, Byth K, Parikh R, Stavrinou R, Wheatley JR, Amis TC. Tracheal traction effects on upper airway patency in rabbits: the role of tissue pressure. Sleep. 2007; 30:179-86.

40. White DP. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med. 2015; 172:1363-70.

41. Kakkar RK, Berry RB. Positive Airway pressure treatment for obstructive sleep apnea. Chest. 2007; 132:1057-72.

42. Gay P, Weaver T, Loube D, Iber C. Evaluation of positive airway pressure treatmen for sleep related breathing disorders in adults. Sleep. 2006; 29:381-401.

43. Egoel AK, Talwar D, Jain SK. Evaluation of short-term use of nocturnal nasal continuous positive airway pressure for a clinical profile and exercise capacity in adult patients with obstructive sleep apnea-hypopnea síndrome. Lung India. 2015; 32:225-32.

44. Varounnis C, Kati V, Kallilkazaros IE, Tousoulis D, Stefanadis C, Parissis J, et al. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: a systematic review and meta-analysis. Int J Cardiol. 2014; 175:195-8.

45. Baessler A, Nadeem R, Harver E, Madbouly E, Younus A, Sijid H, et al. Treatment for sleep apnea by continuous positive airway pressure improves levels of inflammatory markers: a meta-analysis. J Inflamm. 2013; 10:2-10.

46. Yosuke N, Yoshifumi T, Yasuhiro U, Kota K, Tasuku Y, Kazuki S, et al. Continuous positive airway pressure treatment improves cardiovascular outcomes in elderly patients with cardiovascular disease and obstructive sleep apnea. Heart Vessels. 2015; 30:61-9.

47. Muñoz R, Vallejo A, Sánchez A, Moreno R, Caballero C, Macher H, et al. Obstructive sleep apnoea syndrome, endothelial function and markers of endothelialization. Changes after CPAP. PLOS ONE. 2015; 10:e0122091.

48. Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy. Am Thorac Soc. 2008; 5: 173-8.

49. Weaver TE, Maislin G, Dinges DF, Bloxham T, Greenberg H, Kander G. Relationship between hours of CPAP use and achieving normal levels of sleepiness and dail functioning. Sleep. 2007; 30:711-9.

50. Ming-Luo Y, Antic NA, Zang XL, Chen BY, Heeley EM, Huang SG. Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study. Sleep. 2013; 36:1929-37.

51. Broström A, Arestedt KF, Nilsen P, Strómberg A, Ulander M, Svanborg E. The side-effects to CPAP treatment inventory: the development and initial validatio of a new tool for the measurement of side-effects to CPAP treatment. J Sleep Res. 2010; 19:603-11.

52. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: Clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011; 15:343-56.

53. Fuchs FS, Pittarelli A, Hahn EG, Ficker JH. Adherence to continuous positive airway pressure therapy for obstructive sleep apnea: impact of patient education after a longer treatment period. Respiration. 2010; 80:32-7.

54. Deng T, Wang Y, Sun M, Chen B. Stage-matched intervention for adherence to CPAP in patients with obstructive sleep apnea: a randomized controlled trial. Sleep Breath. 2013; 17:791-801.

55. Wozniak DR, Lasserson TJ, Smith I. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2014, http://dx.doi.org/10.1002/14651858.CD007736.pub2.

56. Broström A, Strómberg A, Ulander A, Fridlund B, Svanborg E. Perceived informational needs, side-effects and their consequences on adherence-a comparison between CPAP treated patients with OSAS and healthcare personnel. PEC. 2009; 74:228-35.

57. Shapiro GK, Shapiro CM. Factors that influence CPAP adherence: an overview. Sleep Breath. 2010;14:323-33.

58. Berry RB, Kryger MH, Massie CA. A novel nasal expiratory positive airway pressure (EPAP) device for the treatment of obstructive sleep apnea: a randomized controlled trial. Sleep. 2011; 34:479-85.

59. Weaver TE, Calik MW, Farabi SS, Fink AM, Kapella MC, Carle DW, et al. Innovative treatments for adults with obstructive sleep apnea. Nat Sci Sleep. 2014; 6:137-47.

60. Olsén MF, Lannefors L, Westerdahi E. Positive expiratory pressure - common clinical applications and physiological effects. Respir Med. 2015; 109:297-307.

61. Patel AV, Hwang D, Masdeu M, Chen GM, Rapoport DM, Ayappa I. Predictors of response to a nasal expiratory resistor device and its potential mechanisms of action for treatment of obstructive sleep apnea. J Clin Sleep Med. 2011; 7: 13-22.

62. Kryger MH, Berry RB, Massie C. Long-term use of a nasal expiratory positive airway pressure (EPAP) device as a treatment for obstructive sleep apnea (OSA). J Clin Sleep Med. 2011; 7:449-53.

63. Walsh JK, Griffin KS, Forts EH. A convenient expiratory positive airway pressure nasal device for the treatment of sleep apnea in patients non-adherent with continuous positive airway pressure. J Clin Sleep Med. 2011; 12: 147-52.

64. Rosenthal L, Massie CA, Dolan DC. A multicenter, prospective study of a novel nasal EPAP device in the treatment of obstructive sleep apnea: efficacy and 30-day adherence. J Clin Sleep Med. 2009; 5:532-7.

65. Moayer MF, Siegerl LC, Black J. A feasibility evaluation of oral pressure therapy for the treatment of obstructive sleep apnea. Ther Adv Respir Dis. 2013; 7:3-12.

66. Black J, Sieger LC, Bogan RK, Becker PM, Goldberg R, Malhotra A, et al. A multicenter evaluation of oral pressure therapy for the treatment of obstructive sleep apnea. Sleep Med. 2013; 14:830-7.

67. Moayer MF, Siegel LC, Black J. Oral pressure therapy for treatment of obstructive sleep apnea: clinical feasibility. Nat Sci Sleep. 2013; 5:53-9.

68. Sutherland K, Vanderveken OM, Tsuda H, Marklund M, Gagnadoux F. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med. 2014; 10:215-27.

69. Chan AS, Sutherland K, Schwab RJ, Zeng B, Petocz P, Lee RW, et al. The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax. 2010; 65: 726-32.

70. Brown EC, Cheng S, Mckenzie DK, Butler JE, Gandevia SC, Bilston LE. Tongue and lateral upper airway movement with mandibular advancement. Sleep. 2013; 36:397-404.

71. Cossellu G, Sarcina BR, Mortellaro C, Farronto G. Three-dimensional evaluation of upper airway in patients with obstructive sleep apnea syndrome during oral appliance therapy. J Craniofac Surg. 2015; 26:745-8.

72. Almeida FR, Henrich N, Lynd LD, Lowe AA, Tsuda H, Fleetham JA, et al. Patient preferences and experiences of CPAP and oral appliances for the treatment of obstructive sleep apnea a qualitative analysis. Sleep Breath. 2013; 17:659-66.

73. Correa LP. Overview of oral appliance therapy for the management of obstructive sleep apnea. Sleep Med Clin. 2013;8:505-16.

74. Doff MHJ, Finnema KJ, Hoekema A, Wijkstra PJ, Stengenga B. Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects. Clin Oral Investig. 2013; 17:475-82.

75. Ngiam J, Kyung HM. Microimplant-based mandibular advancement therap for the treatment of snoring and obstructive sleep apnea: a prospective study. Angle Orthod. 2012; 82:978-84.

76. Gillespie MB, Smith JE, Clarke J, Nguyen SA. Effectiveness of Pillar palatal implants for snoring management. Otolaryngol Head Neck Surg. 2009;140:363-8.

77. Lin HC, Friedman M, Chang HW, Lai CC, Chin CH, Samuelson C, et al. Effects of Pillar implants for sleep-related breathing disorders on middle ear function. Eur Arch Otorhinolaryngol. 2013;270:2339-43.

78. Choi JH, Kim SN. Efficacy of the pillar implant in the treatment of snoring and mild-to-moderate obstructive sleep apnea: a meta-analysis. Laryngoscope. 2013; 123: 269-76.

79. Haytoglu S, Kayabasoglu G, Sezen OS. Comparison of two techniques in simple snoring and obstructive sleep apnea syndrome patients: palatal implant or uvulopalatal flap. Eur J Gen Med. 2014; 11:179-86.

80. Friedman M, Schalch P, Lin HC, Kakodkar KA, Mazllom N. Palatal implants for the treatment of snoring and obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2008; 138:209-16.

81. Steward DL, Huntley TC, Woodson BT, Surdulescu V. Palate implants for obstructive sleep apnea: multi-institution, randomized, placebo-controlled study. Otolaryngol Head Neck Surg. 2008; 139:506-10.

82. Dixon JB, Schachter LM, O'brein PE, Grima M, Naughton MT. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea. JAMA. 2012; 308:1142-9.

83. Sarkhosh K, Switzer NJ, EL-Hadi M, Birch DW, Shi X, Karmali S. The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg. 2013; 23:414-23.

84. Lawrence J, Kristo D, Susheel P, Weinstein MD, Weaver E. Guideline for the evaluation management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2010;5:263-76.

85. Aguilar IC, Santos IR, Apostolico N, Nacif SR, Kassab P, Malheiros CA, et al. Obstructive sleep apnea and pulmonary function in patients with severe obesity before and after bariatric surgery: a randomized clinical trial. Multidiscip Respir Med. 2014; 9:43-51.

86. Karakóse F, Bozkert S, Yakar F, Bayram M, Sezer M, Kart L. The role of bariatric surgery in obstructive sleep apnea syndrome. Turk Thorac J. 2014; 15:150-4.

87. Millichamp KA, Cooper V, Syed AA. Immediate changes in continuous positive airway pressure after bariatric surgery in obese people with obstructive sleep apnoea. Euro J Inl Med. 2014; 25:e33-4.

88. Lettier CJ, Eliasson AH, Greenburg DL. Persistence of obstructive sleep apnea after surgical weight loss. J Clin Sleep Med. 2008; 4:333-8.

89. Maanen JP, Richard W, Van-Kesteren ER, Ravesloot MJ, Lama DM, Hilgevoord AA, et al. Evaluation of a new simple treatment for positional sleep apnoea patients. J Sleep Res. 2012; 21:322-9.

90. Levendowsli DJ, Seagraves S, Popovic D, Westbrook PR. Assessment of a neck-based treatment and monitoring device for positional obstructive sleep apnea. J Clin Sleep Med. 2014; 10:863-71.

91. Jackson M, Collins A, Berlowitz D, Howard M, O'Donoghue F, Barnes M. Efficacy of sleep position modification to treat positional obstructive sleep apnea. Sleep Med. 2015;16: 545-52.

92. Levendowski DJ, Veljkovic B, Seagraves S, Westbrook PR. Capability of a neck worn device to measure sleep/wake, airway position, and differentiate benign snoring from obstructive sleep apnea. J Clin Monit Comput. 2015; 29:53-64.

93. Eastwood PR, Barnes M, Walsh JH, Maddison KJ, Hee G, Schwartz AR, et al. Treating obstructive sleep apnea with hypoglossal nerve stimulation. Sleep. 2011; 34:1479-86.

94. Akinnusi M, Saliba R, El-Solth AA. Emerging therapies for obstructive sleep apnea. Lung. 2012;190:365-71.

95. Kezirian EJ, Goding GS, Malhotra A, Zammit G, Wheatley JR, Smith PL, et al. Hypoglossal nerve stimulation improves obstructive sleep apnea: 12-month outcomes. J Sleep Res. 2014; 23:7-83.

96. Baskin JZ, Cramer MA, Dotan Y, Hohenhorst W, Knaack L, Odland RM, et al. Implanted upper airwa stimulation device for obstructive sleep apnea. Laryngoscope. 2012;122:1626-33.

97. Kezirian EJ, Boudewyns A, Eisele DW, Schwartz AR, Smith PL, DeBaker WA, et al. Electrical stimulation of the hypoglossal nerve in the treatment of obstructive sleep apnea. Sleep Med Rev. 2010; 14:299-305.

98. Goding GS, Tesfayesus W, Keziran EJ. Hypoglossal nerve stimulation and airway changes under fluoroscopy. Otolaryngol Head Neck Surg 2012;146:1017-22.

99. Schwartz AR, Smith PL, Oliven A. Electrica stimulation of the hypoglossal nerve: a potential therapy. J Appl Physiol. 2014; 116:337-44.
How to Cite
1.
Cortés-Reyes E, Parrado-Bermúdez K, Escobar-Córdoba F. New perspectives in the treatment of obstructive sleep apnea-hypopnea syndrome. Colomb. J. Anesthesiol. [Internet]. 2017 Jan. 1 [cited 2024 May 30];45(1):62-71. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/50

Downloads

Download data is not yet available.
Published
2017-01-01
How to Cite
1.
Cortés-Reyes E, Parrado-Bermúdez K, Escobar-Córdoba F. New perspectives in the treatment of obstructive sleep apnea-hypopnea syndrome. Colomb. J. Anesthesiol. [Internet]. 2017 Jan. 1 [cited 2024 May 30];45(1):62-71. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/50
Section
Narrative review

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code

Some similar items: