13.05.2014
Symptoms may be present for years, even decades without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep deprivation. For example, the hormone adiponectin is decreased in concentration in the serum in patients with sleep apnea. The availability of an effective treatment stimulated an aggressive search for affected individuals and led to the establishment of hundreds of specialized clinics dedicated to the diagnosis and treatment of sleep disorders.
Sleep apnea is a condition in which people have one or more pauses in breathing or shallow breaths while they sleep. According to the National Institutes of Health (NIH), about 12 million Americans suffer from sleep apnea. Recently, Inspire Medical Systems has developed an implanted device, Upper Airway Stimulation (UAS) Therapy, for the treatment of sleep apnea. Sleep apnea may seem like a simple problem of interruption of sleep, but can lead to fatal health conditions. Provent Therapy is an easy-to-use, discreet nasal device proven to significantly reduce AHI (Apnea Hypopnea Index), ODI (Oxygen Desaturation Index), and OSA-related snoring. Provent Sleep Apnea Therapy is indicated for the treatment of obstructive sleep apnea (OSA). The safety and effectiveness of Provent Therapy in pregnant women, children under the age of 18, and patients with central sleep apnea have not been established.
Sleep Review's webinar "Insourcing Versus Outsourcing Home Sleep Testing" is now available for on-demand viewing. How it works: Oral appliance therapy (OAT) helps prevent the collapse of the tongue and soft tissues in the back of the throat by supporting the jaw in a forward position, keeping the airway open during sleep.
Other considerations: Patients with lower BMI and lower AHI have higher success rates with oral appliances. Bennett: It is important for sleep physicians to collaborate with a dentist who can conduct a thorough intraoral examination to assess candidacy for an oral appliance. How it works: Worn on the back of the neck, Night Shift (by Advanced Brain Monitoring) begins to vibrate when users begin to sleep on their back and slowly increases in intensity until a position change occurs. Other considerations: While positional therapy can reduce the overall AHI to the nonsupine severity, its effect on snoring is more variable. Concern: I can advise the patient to sleep on two tennis balls in a sock to stay off his back for a much cheaper price. Concern: Night Shift will wake my patient up due to the vibration, thereby still interrupting his sleep. White: A single night sleep study either in the lab or in the home can easily determine if the Winx device will work in a given patient. How it works: During inhalation, the proprietary microvalve technology in Provent (by Theravent) opens, allowing the user to breathe in freely. New developments in 2014: The FDA approved a lower resistance version of EPAP, Theravent, which is an over-the-counter product indicated only for primary snoring. Williams: The Provent Nasal Cannula is a diagnostic tool to be used with the Provent Sleep Apnea Therapy device during sleep studies, enabling practitioners to confirm product efficacy. New developments in 2014: More and more surgeons are opting to perform a drug-induced sleep endoscopy (DISE) prior to oropharyngeal surgery in order to find out exactly where the blockage is and help determine the responders versus the nonresponders. How it works: Gastric banding, sleeve gastrectomy, and gastric bypass surgery lead to significant weight loss, including lessening the buildup of fat tissue in the upper thorax and neck.


How it works: Inspire therapy is an implanted system that senses breathing patterns and delivers mild stimulation to key airway muscles, which keeps the airway open during sleep. Sleep medicine pioneer David Rapoport, MD, had his doubts when he first saw the nasal EPAP (expiratory positive airway pressure) device, but first impressions can be deceiving. You have been involved with clinical research in sleep medicine since 1979, and co-founded the NYU Sleep Disorders Center in 1989. David Rapoport MD, director of the Sleep Medicine Program at the New York University (NYU) School of Medicine states; Provent Therapy is not another way to deliver CPAP.
It has been shown in other studies that giving CO2 externally does increase the stiffness of the upper airway, and the tone in the muscles, and may have a small effect on sleep apnea by itself. In the first paper in the Journal of Clinical Sleep Medicine2, we had hoped to identify some factors to help us predict that, and we were not successful in finding these factors. However, chronic, severe obstructive sleep apnea requires treatment to prevent sleep deprivation and other medical complications, including death. A bed partner may lose an hour or more of sleep each night from sleeping next to a person with sleep apnea.
Drastic problems can result from the oxygen deprivation of sleep apnea, including premature death.
The real difficulty in obstructive sleep apnea is identifying the level of obstruction in the pharynx during sleep.
An oral appliance is a custom made mouthpiece that shifts the jaw forward to help keep the pharynx open during sleep.
The most common type of sleep apnea (that affects almost 90% of people) is Obstructive Sleep Apnea (OSA). The company is planning to start its clinical trial with 100 sleep apnea patients in January to evaluate the potential of device therapy. We profile the spectrum of FDA-approved therapies, including when to try them, considerations for each, and new developments. For patients with an elevated supine apnea index, overall snoring may increase with positional therapy because supine apneas are replaced with snoring.
In our study, the number of arousals due to sleep disorder breathing exceeded the number of supine attempts resulting in positional feedback by a factor of 15. Assessment of a neck-based treatment and monitoring device for positional obstructive sleep apnea. A multicenter evaluation of oral pressure therapy for the treatment of obstructive sleep apnea.
The cannula allows transmission of pressure signals from the nose to a pressure transducer of a physiologic recorder with a standard interface designed to attach the nasal cannula to standard pressure transducers, and a custom connection to the Provent Therapy device. A novel nasal expiratory positive airway pressure (EPAP) device for the treatment of obstructive sleep apnea: a randomized controlled trial. Efficacy of the Pillar implant in the treatment of snoring and mild-to-moderate obstructive sleep apnea: a meta-analysis. Obstructive sleep apnea and pulmonary function in patients with severe obesity before and after bariatric surgery: a randomized clinical trial.
Ventus continues the deliberate process of building evidence and educating sleep physicians, with the most influential study to date involving 19 centers, 250 subjects, a placebo control, and a 3-month follow-up, with results appearing in a 2011 issue of the journal Sleep1. There are also those who have mild sleep apnea, and those who may have reversible conditions, and only wear CPAP for 3 to 6 months.


The reason that works is that when the majority of people go to sleep, they spontaneously revert to breathing through their nose. Along with the apnea episodes, the person afflicted with sleep apnea may have additional trouble sleeping caused by side effects of the condition, including a frequent need to get up and urinate during the night, and excessive nighttime sweating. Oral appliance therapy is usually successful in patients with mild to moderate obstructive sleep apnea.
People with CSA seldom snore, which makes it even harder to diagnose as they do not fit the "normal" profile of a sleep apnea sufferer.
The exact mechanism of the loss of central respiratory drive during sleep in obstructive sleep apnea is unknown. Current treatments for OSA include weight loss, oral appliances, surgery and continuous positive airway pressure therapy (CPAP). Sleep apnea patients who are interested to be a part of the trial can participate in a survey on the Inspire Medical Systems website to see if they qualify for the trial. Use of Night Shift resulted in significant reductions in stage N1 and increased in N2, while REM and sleep efficiency increase and arousals and awakenings were significantly reduced.
Objective measurement of compliance during oral appliance therapy for sleep-disordered breathing.
Remotely controlled mandibular protrusion during sleep predicts therapeutic success with oral appliances in patients with obstructive sleep apnea. Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. We used to think that sleep apnea was a disorder primarily treated during inspiration, and that pressure during inspiration served to hold the airway open.
If it turns out that Provent helps, and these people are benefitting, it will then become the ideal therapy for these types of people. In obstructive sleep apnea, breathing is interrupted by a physical block to airflow despite contraction of the hemi- diaphragms. That a tracheotomy can effectively treat even severe obstructive sleep apnea implies that the anatomic site or sites of obstruction of the airway during sleep are above or superior to the level of the trachea.
However, while the causes of the breathing cessation are different in central sleep apnea and obstructive sleep apnea, the symptoms and results are much the same. The interesting part is most people who have sleep apnea don’t know, if they have it because it only occurs during sleep.
It is important to tailor the treatment to the individual needs of each patient to promote long-term therapeutic success. In mixed sleep apnea, there is a transition from central to obstructive features during the apneic events themselves.
An adhesive flange can alternatively be used to retain the nasal-pharyngeal tube in place during sleep so that it does not back out of its desired position.



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