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Sleep Medicine Clinics

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https://read.qxmd.com/read/30709540/prevention-screening-and-treatments-for-obstructive-sleep-apnea-beyond-positive-airway-pressure-pap
#1
EDITORIAL
Song Tar Toh
No abstract text is available yet for this article.
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709539/the-role-of-the-revised-stanford-protocol-in-today-s-precision-medicine
#2
REVIEW
Stanley Yung-Chuan Liu, Michael Awad, Robert Riley, Robson Capasso
Whereas the original Stanford protocol relied on a tiered approach to care to avoid unnecessary surgery, it did not address the issue of surgical relapse, a common concern among sleep medicine specialists. With 3 decades of experience since the original 2-tiered Powell-Riley protocol was introduced and the role of evolving skeletal techniques and upper airway stimulation, we are pleased to present our current protocol. This update includes emphasis on the facial skeletal development with impact on function including nasal breathing, and the incorporation of upper airway stimulation...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709538/addressing-the-tone-and-synchrony-issue-during-sleep-pacing-the-hypoglossal-nerve
#3
REVIEW
Clemens Heiser, Benedikt Hofauer
Upper airway stimulation is a novel therapy for patients suffering from obstructive sleep apnea who are incompliant toward continuous positive airway pressure therapy. Evidence supporting the effectiveness of this therapy with regard to the treatment of disordered breathing, subjective daytime impairment, and its effect on sleep characteristics has increased. Information on the subjective sensation of the stimulation of the hypoglossal nerve could be gathered as more patients are implanted and knowledge of different aspects of the therapy is increasing...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709537/maxillomandibular-rotational-advancement-airway-aesthetics-and-angle-s-considerations
#4
REVIEW
Clement Cheng-Hui Lin, Po-Fang Wang, Shaun Ray Han Loh, Hung Tuan Lau, Sam Sheng-Ping Hsu
Obstructive sleep apnea is a medical syndrome with multifactorial pathophysiology. Surgery can be the primary treatment option when anatomic factors are identified with narrowing at specific or general levels of pharyngeal airway. The surgeries are directed to the etiologic anatomic structure to achieve greatest effectiveness. Body weight, Mallampati scale, and tonsil grade are key evaluations to select effective surgical procedures. Surgical weight reduction, maxillomandibular advancement, and pharyngeal soft tissue surgeries are considered for the patient with obesity, maxillomandibular retrognathism, and tonsillar hypertrophy, respectively...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709536/genioglossus-advancement-and-hyoid-surgery
#5
REVIEW
Yau Hong Goh, Victor Abdullah, Sung Wan Kim
The structure and dimensions of the mandible, tongue, and hyoid complex are important variables in the pathophysiology of obstructive sleep apnea at the hypopharyngeal level. Genioglossus advancement is based on mandibular osteotomy, which brings the genioglossus muscle (GGM) forward and prevents posterior collapse during sleep. The genioglossus advancement technique has recently undergone several modifications; each has attempted to minimize surgical morbidity while improving the incorporation and advancement of the GGM...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709535/transoral-robotic-surgery-for-obstructive-sleep-apnea-past-present-and-future
#6
REVIEW
Claudio Vicini, Filippo Montevecchi
Nocturnal upper airway collapse often involves the obstruction at the tongue base. Several surgical procedures have been developed in recent years to address this area in continuous positive airway pressure-nonadherent patients and include hyolingual advancement, tongue suture suspension, and various lingual resection techniques. Traditional tongue base resection is generally done either via a transcervical technique or transorally with an endoscope for visualization. Each of these approaches has significant potential limitations...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709534/volumetric-tongue-reduction-for-obstructive-sleep-apnea
#7
REVIEW
Hsin-Ching Lin, Michael Friedman
Surgery for obstructive sleep apnea/hypopnea syndrome (OSA) is not a substitute for continuous positive airway pressure (CPAP) but is a salvage procedure for those who failed CPAP and other conservative therapies and therefore have no other options. The hypopharyngeal/tongue base procedures for the treatment of OSA are usually challenging to most sleep surgeons. In recent years, several procedures for OSA patients with hypopharyngeal obstructions have been developed to achieve higher response rates with decreased postoperative morbidities...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709533/palatal-surgery-for-obstructive-sleep-apnea-from-ablation-to-reconstruction
#8
REVIEW
Hsueh-Yu Li
Although continuous positive airway pressure is the first-line and gold-standard management for obstructive sleep apnea (OSA), surgery is the only mainstream treatment without the use of a device. Palatal surgery is the paragon and core value among various sleep surgeries in treating snoring and OSA. It has transformed from radical excision to functional reconstruction. The integrated treatment of palatal surgery includes reconstruction of airway, restoration of airflow and rehabilitation of muscle.
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709532/establishing-a-patent-nasal-passage-in-obstructive-sleep-apnea
#9
REVIEW
Chiba Shintaro, Chan-Soon Park
The role of the nose in the pathophysiology and treatment of sleep-disordered breathing (SDB) has not been fully understood and might have been underestimated. In the Staring resistor model, the nose is regarded as a passive and noncollapsible tube, but recent studies have shown that the nose might participate more in the pathophysiology of SDB as anatomic, neuromuscular, and respiratory factors than previously reported, which might imply the nose is an active noncollapsible tube. The roles of nasal treatments for OSA are not only the reduction of AHI, but also the improvement of subjective symptoms, sleep quality, and CPAP adherence...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709531/drug-induced-sleep-endoscopy-in-treatment-options-selection
#10
REVIEW
Khai Beng Chong, Andrea De Vito, Claudio Vicini
Drug-induced sleep endoscopy is a safe and practical technique to evaluate the dynamic upper airway collapse during sleep. We review drug-induced sleep endoscopy in adults, including its indications, technique, evaluation of upper airway collapse, and clinical application. Drug-induced sleep endoscopy is useful to improve treatment options selection for patients with obstructive sleep apnea, especially for those who are unable to accept or tolerate continuous positive airway pressure therapy. Owing to a lack of standardization for drug-induced sleep endoscopy, it is difficult to compare the published literature from different sleep centers across the world...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709530/anatomic-and-pathophysiologic-considerations-in-surgical-treatment-of-obstructive-sleep-apnea
#11
REVIEW
Srinivas Kishore Sistla, Vijaya Krishnan Paramasivan, Vikas Agrawal
Evaluation of the upper airway is key for a successful surgical management. Proper evaluation can be done only with a good understanding of the anatomy and pathophysiology of the upper airway. The authors discuss surgical anatomy from a soft tissue and bony perspective in detail along with its clinical implications. The complex interaction among pharyngeal dilator tone, arousal threshold, respiratory control instability, and changes in lung volume during sleep play an important role in obstructive sleep apnea...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709529/weight-management-in-obstructive-sleep-apnea-medical-and-surgical-options
#12
REVIEW
Kwang Wei Tham, Phong Ching Lee, Chin Hong Lim
Obesity plays a pivotal role in the pathogenesis of obstructive sleep apnea (OSA) and as an exacerbating factor of OSA. Given the interlinking relationship of obesity and OSA, treatment of obesity is fundamental in the management of OSA. Weight loss of 7% to 11% significantly improves OSA with remission seen with greater weight loss. Weight loss also ameliorates the constellation of other obesity-related metabolic conditions, reducing the overall cardiovascular risk in an obese person with OSA. This article discusses specific weight loss interventions effective in improving OSA, including lifestyle interventions with dietary modification and physical activity, pharmacotherapy, and bariatric surgery...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709528/myofunctional-therapy-role-in-pediatric-osa
#13
REVIEW
Yu-Shu Huang, Shih-Chieh Hsu, Christian Guilleminault, Li-Chuan Chuang
Myofunctional therapy (MFT) has been reported to be an alternative treatment to obstructive sleep apnea (OSA), but compliance and long-term outcome in the children were considered as an issue. A prospective study was performed on age-matched children submitted to MFT or to a functional oral device used during sleep (passive MFT) and compared with no-treatment control group. Compliance is a major problem of MFT, and MFT will have to take into consideration the absolute need to have continuous parental involvement in the procedure for pediatric OSA...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709527/sleep-disordered-breathing-orofacial-growth-and-prevention-of-obstructive-sleep-apnea
#14
REVIEW
Christian Guilleminault, Shannon S Sullivan, Yu-Shu Huang
Abnormal breathing during sleep is related to intrinsic and extrinsic factors that are present early in life. Investigation of fetal development and early-in-life orofacial growth allows recognition of risk factors that lead to change in upper airway patency, which leads to abnormal upper airway resistance, abnormal inspiratory efforts, and further increase in resistance and progressive narrowing of the collapsible upper airway. Such evolution can be recognized by appropriate clinical evaluation, specific polysomnographic patterns, and orofacial imaging...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709526/positional-therapy-for-positional-obstructive-sleep-apnea
#15
REVIEW
Mok Yingjuan, Wong Hang Siang, Tan Kah Leong Alvin, Hsu Pon Poh
Positional therapy appears to be an attractive strategy for many patients with positional obstructive sleep apnea (OSA). However, under the American Academy of Sleep Medicine OSA guidelines, positional therapy is considered as only an alternative therapy, because previous research has demonstrated poor treatment tolerance and adherence. Recent technological advances have renewed interest in positional therapy, with the invention of new sophisticated vibratory positional therapy devices. These devices have shown great promise with efficacy, markedly improved patient tolerance, and long-term adherence...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709525/oral-appliances-in-the-management-of-obstructive-sleep-apnea
#16
REVIEW
Jing Hao Ng, Mimi Yow
Obstructive sleep apnea (OSA) is a multifactorial condition, and an interdisciplinary approach to diagnosis forms the basis for effective treatment planning. Craniofacial structure and attached soft tissues and muscles play a central role in OSA. Evidence-based studies demonstrate the effectiveness of oral appliances for mandibular advancement and tongue stabilization in managing OSA, and current clinical standards of practice recommend the use of oral appliances to treat OSA when patients cannot tolerate continuous positive airway pressure (CPAP)...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30709524/holistic-management-of-obstructive-sleep-apnea-translating-academic-research-to-patient-care
#17
REVIEW
Song Tar Toh, Chu Qin Phua, Shaun Loh
A holistic approach is pertinent in managing obstructive sleep apnea (OSA). It goes beyond integrated multidisciplinary assessment and management in the hospital setting. Although clinicians should be aware of different treatment modalities and adjunctive measures, proactive management of OSA is as important. The future of OSA management lies in identifying patients at risk of developing OSA and developing strategy to prevent OSA from taking root. It involves active screening of patients with OSA and treating them and identifying patients with OSA with high risk of preventable serious morbidity and death and intervening early to prevent these from happening...
March 2019: Sleep Medicine Clinics
https://read.qxmd.com/read/30396451/beyond-blowing-oral-appliance-therapy-surgery-and-transcranial-magnetic-stimulation
#18
EDITORIAL
Jamison R Spencer
No abstract text is available yet for this article.
December 2018: Sleep Medicine Clinics
https://read.qxmd.com/read/30396450/transcranial-magnetic-stimulation-potential-use-in-obstructive-sleep-apnea-and-sleep-bruxism
#19
REVIEW
Herrero Babiloni A, Louis De Beaumont, Gilles J Lavigne
The aim of this article is to introduce transcranial magnetic stimulation (TMS) to dental practitioners and to explain its use in obstructive sleep apnea (OSA) and sleep bruxism (SB). In these 2 sleep disorders, TMS has proven to be a useful tool to explore pathophysiological pathways and disease mechanisms, and in a more limited way, to recruit upper airway muscles in OSA and reduce muscle activity and pain intensity in SB. Although promising, research using TMS in these conditions is still very limited and future investigations should be conducted before its clinical application can be considered...
December 2018: Sleep Medicine Clinics
https://read.qxmd.com/read/30396449/controversies-in-obstructive-sleep-apnea-surgery
#20
REVIEW
Carolyn C Dicus Brookes, Scott B Boyd
Obstructive sleep apnea (OSA) is a common chronic disease characterized by repetitive pharyngeal collapse during sleep. OSA is associated with cardiovascular disease and increased mortality, among other issues. Continuous positive airway pressure (CPAP) is considered first line therapy for OSA, but is not always tolerated. Both non-surgical and surgical alternative management strategies are available for the CPAP intolerant patient. This article explores controversies surrounding airway evaluation, definition of successful treatment, and surgical management of the CPAP intolerant patient with moderate to severe OSA...
December 2018: Sleep Medicine Clinics
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