New perspectives in the treatment of obstructive sleep apnea-hypopnea syndrome
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.
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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.
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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 Apr. 26];45(1):62-71. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/50
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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 Apr. 26];45(1):62-71. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/50
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