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Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (25 February 2024) | Viewed by 18254

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Special Issue Editor

Prof. Dr. Yüksel Peker

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Guest Editor

1. Pulmonary Department, Koc University School of Medicine, 34010 Istanbul, Turkey
2. Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
3. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
4. Department of Clinical Sciences, Respiratory Medicine and Allergology, School of Medicine, Lund University, 22185 Lund, Sweden
Interests: obstructive sleep apnea; cardiovascular disease; cerebrovascular disease; phenotypes; biomarkers; drowsy driving; treatment modalities
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Special Issue Information

Dear Colleagues,

Obstructive sleep apnea (OSA) is a common disorder with strong associations with cardiovascular, cerebrovascular, metabolic, and cognitive consequences. Continuous positive airway pressure (CPAP) treatment is the first-line therapy for adults with OSA who are symptomatic. However, many individuals with comorbidities do not report symptoms associated with OSA, and adherence to CPAP is poor, especially in individuals with the non-sleepy OSA phenotype.

We have recently published a Special Issue, entitled “Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part I”, with a good collection of papers available online at: https://www.mdpi.com/journal/jcm/special_issues/Obstructive_Apnea

Based on the interest on treatment modalities other than CPAP, and the ongoing debate regarding different aspects of response to treatment, we are now happy to announce an extension of the Special Issue, entitled “Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II”.

This Special Issue aims to continue updating the current perspectives on the treatment of OSA in order to highlight multidisciplinary approaches, personalized treatment strategies, and identification of the predictors of response to treatment, both in the general population and in clinical cohorts. We particularly encourage the submission of papers that focus on drowsy driving and cost-benefit aspects of OSA treatment.

Prof. Dr. Yuksel Peker
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

obstructive sleep apnea
positive airway pressure
weight reduction
mandibular advancement devices
upper airway surgery
hypoglossal nerve stimulation
cardiovascular morbidity
phenotypes
biomarkers
cost-benefit
drowsy driving

Published Papers (13 papers)

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12 pages, 1233 KiB

Open AccessArticle

Association of TNF-α (-308G/A) Gene Polymorphism with Changes in Circulating TNF-α Levels in Response to CPAP Treatment in Adults with Coronary Artery Disease and Obstructive Sleep Apnea

by Yeliz Celik, Yüksel Peker, Tülay Yucel-Lindberg, Tilia Thelander and Afrouz Behboudi

J. Clin. Med. 2023, 12(16), 5325; https://doi.org/10.3390/jcm12165325 - 16 Aug 2023

Cited by 1 | Viewed by 1319

Abstract

Rationale: We recently demonstrated that patients with coronary artery disease (CAD) and obstructive sleep apnea (OSA) carrying the tumor necrosis factor-alpha (TNF-α) A allele had increased circulating TNF-α levels compared with the ones carrying the TNF-α G allele. In the current study, we addressed the effect of TNF-α (-308G/A) gene polymorphism on circulating TNF-α levels following continuous positive airway pressure (CPAP) therapy. Methods: This study was a secondary analysis of the RICCADSA trial (NCT00519597) conducted in Sweden. CAD patients with OSA (apnea–hypopnea index) of ≥15 events/h and an Epworth Sleepiness Scale (ESS) score of <10 were randomized to CPAP or no-CPAP groups, and OSA patients with an ESS score of ≥10 were offered CPAP treatment. Blood samples were obtained at baseline and 12-month follow-up visits. TNF-α was measured by immunoassay (Luminex, R&D Systems). Genotyping of TNF-α-308G/A (single nucleotide polymorphism Rs1800629) was performed by polymerase chain reaction–restriction fragment length polymorphism. Results: In all, 239 participants (206 men and 33 women; mean age 64.9 (SD 7.7) years) with polymorphism data and circulating levels of TNF-α at baseline and 1-year follow-up visits were included. The median circulating TNF-α values fell in both groups between baseline and 12 months with no significant within- or between-group differences. In a multivariate linear regression model, a significant change in circulating TNF-α levels from baseline across the genotypes from GA to GA and GA to AA (standardized β-coefficient −0.129, 95% confidence interval (CI) −1.82; −0.12; p = 0.025) was observed in the entire cohort. The association was more pronounced among the individuals who were using the device for at least 4 h/night (n = 86; standardized β-coefficient −2.979 (95% CI −6.11; −1.21); p = 0.004)), whereas no significant association was found among the patients who were non-adherent or randomized to no-CPAP. The participants carrying the TNF-α A allele were less responsive to CPAP treatment regarding the decline in circulating TNF-α despite CPAP adherence (standardized β-coefficient −0.212, (95% CI −5.66; −1.01); p = 0.005). Conclusions: Our results suggest that TNF-α (-308G/A) gene polymorphism is associated with changes in circulating TNF-α levels in response to CPAP treatment in adults with CAD and OSA. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

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16 pages, 1298 KiB

Open AccessArticle

Development and Internal Validation of a Prediction Model for Surgical Success of Maxillomandibular Advancement for the Treatment of Moderate to Severe Obstructive Sleep Apnea

by Wouter P. Visscher, Jean-Pierre T. F. Ho, Ning Zhou, Madeline J. L. Ravesloot, Engelbert A. J. M. Schulten, Jan de Lange and Naichuan Su

J. Clin. Med. 2023, 12(2), 503; https://doi.org/10.3390/jcm12020503 - 7 Jan 2023

Viewed by 1615

Abstract

Background: Maxillomandibular advancement (MMA) has been shown to be the most effective surgical therapy for obstructive sleep apnea (OSA). Despite high success rates, there are patients who are considered as non-responders to MMA. In order to triage and inform these patients on their expected prognosis of MMA before the surgery, this study aimed to develop, internally validate, and calibrate a prediction model for the presence of surgical success for MMA in patients with OSA. Methods: A retrospective cohort study was conducted that included patients that had undergone MMA for moderate to severe OSA. Baseline clinical, polysomnographic, cephalometric, and drug-induced sleep endoscopy findings were recorded as potential predictors. Presence or absence of surgical success was recorded as outcome. Binary logistic regression analyses were conducted to develop the model. Performance and clinical values of the model were analyzed. Results: One hundred patients were included, of which sixty-seven (67%) patients reached surgical success. Anterior lower face height (ALFH) (OR: 0.93 [0.87–1.00], p = 0.05), superior posterior airway space (SPAS) (OR: 0.76 [0.62–0.92], p < 0.05), age (OR: 0.96 [0.91–1.01], p = 0.13), and a central apnea index (CAI) <5 events/hour sleep (OR: 0.16 [0.03–0.91], p < 0.05) were significant independent predictors in the model (significance level set at p = 0.20). The model showed acceptable discrimination with a shrunken area under the curve of 0.74, and acceptable calibration. The added predictive values for ruling in and out of surgical success were 0.21 and 0.32, respectively. Conclusions: Lower age at surgery, CAI < 5 events/hour, lower ALFH, and smaller SPAS were significant predictors for the surgical success of MMA. The discrimination, calibration, and clinical added values of the model were acceptable. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

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22 pages, 1136 KiB

Open AccessArticle

30-Day Postoperative Outcomes in Adults with Obstructive Sleep Apnea Undergoing Upper Airway Surgery

by Samuel Knoedler, Leonard Knoedler, Helena Baecher, Martin Kauke-Navarro, Doha Obed, Cosima C. Hoch, Yannick F. Diehm, Peter S. Vosler, Ulrich Harréus, Ulrich Kneser and Adriana C. Panayi

J. Clin. Med. 2022, 11(24), 7371; https://doi.org/10.3390/jcm11247371 - 12 Dec 2022

Cited by 6 | Viewed by 1585

Abstract

Background: Obstructive sleep apnea (OSA) is a chronic disorder of the upper airway. OSA surgery has oftentimes been researched based on the outcomes of single-institutional facilities. We retrospectively analyzed a multi-institutional national database to investigate the outcomes of OSA surgery and identify risk factors for complications. Methods: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2008–2020) to identify patients who underwent OSA surgery. The postoperative outcomes of interest included 30-day surgical and medical complications, reoperation, readmission, and mortality. Additionally, we assessed risk-associated factors for complications, including comorbidities and preoperative blood values. Results: The study population included 4662 patients. Obesity (n = 2909; 63%) and hypertension (n = 1435; 31%) were the most frequent comorbidities. While two (0.04%) deaths were reported within the 30-day postoperative period, the total complication rate was 6.3% (n = 292). Increased BMI (p = 0.01), male sex (p = 0.03), history of diabetes (p = 0.002), hypertension requiring treatment (p = 0.03), inpatient setting (p < 0.0001), and American Society of Anesthesiology (ASA) physical status classification scores ≥ 4 (p < 0.0001) were identified as risk-associated factors for any postoperative complications. Increased alkaline phosphatase (ALP) was identified as a risk-associated factor for the occurrence of any complications (p = 0.02) and medical complications (p = 0.001). Conclusions: OSA surgery outcomes were analyzed at the national level, with complications shown to depend on AP levels, male gender, extreme BMI, and diabetes mellitus. While OSA surgery has demonstrated an overall positive safety profile, the implementation of these novel risk-associated variables into the perioperative workflow may further enhance patient care. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

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9 pages, 2016 KiB

Open AccessArticle

The Effect of Pharyngeal Surgery on Positive Airway Pressure Therapy in Obstructive Sleep Apnea: A Meta-Analysis

by Ki Hwan Kwak, Young Jeong Lee, Jae Yong Lee, Jae Hoon Cho and Ji Ho Choi

J. Clin. Med. 2022, 11(21), 6443; https://doi.org/10.3390/jcm11216443 - 30 Oct 2022

Cited by 2 | Viewed by 1455

Abstract

There is controversy about the effect of pharyngeal surgery for obstructive sleep apnea (OSA) on positive airway pressure (PAP) adherence, and the related results of meta-analysis have not yet been available. Therefore, the purpose of this meta-analysis was to assess the effect of pharyngeal OSA surgery on PAP therapy parameters such as optimal pressure levels and usage time. We selected studies investigating optimal PAP levels or usage time before and after pharyngeal OSA surgery, regardless of the study design. Pharyngeal OSA surgery included uvulopalatopharyngoplasty and its variants, tonsillectomy, Pillar implants, radiofrequency ablation, tongue base surgery and its variants, and genioglossus advancement. Studies in which isolated nasal surgery was performed were excluded. The random-effects model was used due to significant heterogeneity among the studies. Nine studies were included in the meta-analysis of optimal PAP levels, and five studies in the meta-analysis of PAP usage time. After pharyngeal OSA surgery, the summed optimal PAP level was significantly decreased (standardized mean difference (SMD), −1.113; 95% confidence interval (CI), −1.667 to −0.559)), and the summed usage time of PAP was significantly increased (SMD, 0.794; 95% CI, 0.259 to 1.329). This study illustrated that pharyngeal OSA surgery lowered optimal PAP levels and enhanced PAP usage time. The results of the meta-analysis contribute to our understanding of the role of pharyngeal OSA surgery in patients with PAP intolerance. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

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14 pages, 400 KiB

Open AccessArticle

Provider Perspectives on Sleep Apnea from Appalachia: A Mixed Methods Study

by Robert Stansbury, Toni Rudisill, Rachel Salyer, Brenna Kirk, Caterina De Fazio, Adam Baus, Shubekchha Aryal, Patrick J. Strollo, Sunil Sharma and Judith Feinberg

J. Clin. Med. 2022, 11(15), 4449; https://doi.org/10.3390/jcm11154449 - 30 Jul 2022

Cited by 4 | Viewed by 1677

Abstract

West Virginia (WV) has the highest rates of obesity and cardiopulmonary disease in the United States (U.S.). Recent work has identified a significant care gap in WV for obstructive sleep apnea (OSA). This OSA care gap likely has significant health implications for the region given the high rates of obesity and cardiopulmonary disease. The purpose of this mix methods study was to identify barriers that contribute to the rural OSA care disparity previously identified in WV. Methods: This study used mixed methods to evaluate the barriers and facilitators to management of OSA at Federally Qualified Health Centers serving communities in southern WV. Focus groups were conducted at federally qualified health centers with providers serving Appalachian communities. Participants also completed the validated Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire to gain insight into provider knowledge and beliefs regarding OSA. EMR analysis using diagnostic codes was completed at the sites to assess OSA prevalence rates. The same individual served as the interviewer in all focus group sessions to minimize interviewer variability/bias. Our team checked to ensure that the professional transcriptions were correct and matched the audio via spot checks. Results: Themes identified from the focus groups fell into three broad categories: (1) barriers to OSA care delivery, (2) facilitators to OSA care delivery, and (3) community-based care needs to optimize management of OSA in the targeted rural areas. Questionnaire data demonstrated rural providers feel OSA is an important condition to identify but lack confidence to identify and treat OSA. Evaluation of the electronic medical record demonstrates an even larger OSA care gap in these rural communities than previously described. Conclusion: This study found a lack of provider confidence in the ability to diagnose and treat OSA effectively and identified specific themes that limit OSA care in the communities studied. Training directed toward the identified knowledge gaps and on new technologies would likely give rural primary care providers the confidence to take a more active role in OSA diagnosis and management. An integrated model of care that incorporates primary care providers, specialists and effective use of modern technologies will be essential to address the identified OSA care disparities in rural WV and similar communities across the U.S. Community engaged research such as the current study will be essential to the creation of feasible, practical, relevant and culturally competent care pathways for providers serving rural communities with OSA and other respiratory disease to achieve health equity. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

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Review

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10 pages, 528 KiB

Open AccessReview

The Future of Telemedicine for Obstructive Sleep Apnea Treatment: A Narrative Review

by Sébastien Bailly, Monique Mendelson, Sébastien Baillieul, Renaud Tamisier and Jean-Louis Pépin

J. Clin. Med. 2024, 13(9), 2700; https://doi.org/10.3390/jcm13092700 - 4 May 2024

Viewed by 324

Abstract

Obstructive sleep apnea is a common type of sleep-disordered breathing associated with multiple comorbidities. Nearly a billion people are estimated to have obstructive sleep apnea, which carries a substantial economic burden, but under-diagnosis is still a problem. Continuous positive airway pressure (CPAP) is the first-line treatment for OSAS. Telemedicine-based interventions (TM) have been evaluated to improve access to diagnosis, increase CPAP adherence, and contribute to easing the follow-up process, allowing healthcare facilities to provide patient-centered care. This narrative review summarizes the evidence available regarding the potential future of telemedicine in the management pathway of OSA. The potential of home sleep studies to improve OSA diagnosis and the importance of remote monitoring for tracking treatment adherence and failure and to contribute to developing patient engagement tools will be presented. Further studies are needed to explore the impact of shifting from teleconsultations to collaborative care models where patients are placed at the center of their care. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

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12 pages, 232 KiB

Open AccessReview

Potential Therapeutic Targets in Obesity, Sleep Apnea, Diabetes, and Fatty Liver Disease

by Christina Gu, Nicole Bernstein, Nikita Mittal, Soumya Kurnool, Hannah Schwartz, Rohit Loomba and Atul Malhotra

J. Clin. Med. 2024, 13(8), 2231; https://doi.org/10.3390/jcm13082231 - 12 Apr 2024

Viewed by 724

Abstract

Obesity and metabolic syndrome affect the majority of the US population. Patients with obesity are at increased risk of developing type 2 diabetes (T2DM), obstructive sleep apnea (OSA), and metabolic dysfunction-associated steatotic liver disease (MASLD), each of which carry the risk of further complications if left untreated and lead to adverse outcomes. The rising prevalence of obesity and its comorbidities has led to increased mortality, decreased quality of life, and rising healthcare expenditures. This phenomenon has resulted in the intensive investigation of exciting therapies for obesity over the past decade, including more treatments that are still in the pipeline. In our present report, we aim to solidify the relationships among obesity, T2DM, OSA, and MASLD through a comprehensive review of current research. We also provide an overview of the surgical and pharmacologic treatment classes that target these relationships, namely bariatric surgery, the glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon receptor agonists. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

21 pages, 3058 KiB

Open AccessReview

The Present and Future of the Clinical Use of Physiological Traits for the Treatment of Patients with OSA: A Narrative Review

by Yvonne Chu and Andrey Zinchuk

J. Clin. Med. 2024, 13(6), 1636; https://doi.org/10.3390/jcm13061636 - 13 Mar 2024

Viewed by 1037

Abstract

People with obstructive sleep apnea (OSA) are a heterogeneous group. While many succeed in the treatment of their OSA, many others struggle with therapy. Herein, we discuss how anatomical and physiological factors that cause sleep apnea (OSA traits) impact treatment response and may offer an avenue for more precise care. These OSA traits, including anatomical (upper-airway collapsibility) and physiological (loop gain, airway muscle responsiveness, and arousal threshold) factors, may help determine who can succeed with continuous positive airway pressure, oral appliances, hypoglossal nerve stimulation, or pharmacotherapy. In the future, identifying OSA traits before initiating treatment may help guide the selection of the most effective and tolerable therapy modalities for each individual. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

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16 pages, 310 KiB

Open AccessFeature PaperReview

Achieving Better Understanding of Obstructive Sleep Apnea Treatment Effects on Cardiovascular Disease Outcomes through Machine Learning Approaches: A Narrative Review

by Oren Cohen, Vaishnavi Kundel, Philip Robson, Zainab Al-Taie, Mayte Suárez-Fariñas and Neomi A. Shah

J. Clin. Med. 2024, 13(5), 1415; https://doi.org/10.3390/jcm13051415 - 29 Feb 2024

Viewed by 968

Abstract

Obstructive sleep apnea (OSA) affects almost a billion people worldwide and is associated with a myriad of adverse health outcomes. Among the most prevalent and morbid are cardiovascular diseases (CVDs). Nonetheless, randomized controlled trials (RCTs) of OSA treatment have failed to show improvements in CVD outcomes. A major limitation in our field is the lack of precision in defining OSA and specifically subgroups with the potential to benefit from therapy. Further, this has called into question the validity of using the time-honored apnea–hypopnea index as the ultimate defining criteria for OSA. Recent applications of advanced statistical methods and machine learning have brought to light a variety of OSA endotypes and phenotypes. These methods also provide an opportunity to understand the interaction between OSA and comorbid diseases for better CVD risk stratification. Lastly, machine learning and specifically heterogeneous treatment effects modeling can help uncover subgroups with differential outcomes after treatment initiation. In an era of data sharing and big data, these techniques will be at the forefront of OSA research. Advanced data science methods, such as machine-learning analyses and artificial intelligence, will improve our ability to determine the unique influence of OSA on CVD outcomes and ultimately allow us to better determine precision medicine approaches in OSA patients for CVD risk reduction. In this narrative review, we will highlight how team science via machine learning and artificial intelligence applied to existing clinical data, polysomnography, proteomics, and imaging can do just that. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

17 pages, 313 KiB

Open AccessReview

Medical Treatment of Obstructive Sleep Apnea in Children

by Almala Pinar Ergenekon, Yasemin Gokdemir and Refika Ersu

J. Clin. Med. 2023, 12(15), 5022; https://doi.org/10.3390/jcm12155022 - 30 Jul 2023

Cited by 1 | Viewed by 1501

Abstract

Obstructive sleep apnea (OSA) is characterized by recurrent complete or partial obstruction of the upper airway. The prevalence is 1–4% in children aged between 2 and 8 years and rising due to the increase in obesity rates in children. Although persistent OSA following adenotonsillectomy is usually associated with obesity and underlying complex disorders, it can also affect otherwise healthy children. Medical treatment strategies are frequently required when adenotonsillectomy is not indicated in children with OSA or if OSA is persistent following adenotonsillectomy. Positive airway pressure treatment is a very effective modality for persistent OSA in childhood; however, adherence rates are low. The aim of this review article is to summarize medical treatment options for OSA in children. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

12 pages, 673 KiB

Open AccessReview

A Narrative Review of the Association of Obstructive Sleep Apnea with Hypertension: How to Treat Both When They Coexist?

by Servet Altay, Selma Fırat, Yüksel Peker and The TURCOSACT Collaborators

J. Clin. Med. 2023, 12(12), 4144; https://doi.org/10.3390/jcm12124144 - 20 Jun 2023

Cited by 2 | Viewed by 1480

Abstract

Hypertension (HT) is a worldwide public health issue and an essential risk factor for cardiovascular and cerebrovascular diseases. Obstructive sleep apnea (OSA) is a condition characterized by recurrent episodes of apnea and hypopnea as a consequence of partial or complete obstruction of the upper airways due to anatomic and/or functional disturbances. There is mounting evidence of a relationship between OSA and HT. In patients with OSA, HT is predominantly nocturnal and characterized by high diastolic blood pressure and usually by a nondipping pattern. Optimizing the blood pressure control is recommended in the current guidelines as the first treatment option in hypertensive patients with OSA. Continuous positive airway pressure (CPAP) therapy may reduce blood pressure, albeit only slightly as a stand-alone treatment. CPAP, as an add-on treatment to antihypertensive medication, appears to be an efficient treatment modality when both conditions coexist. This narrative review aims to summarize the current perspectives on the association of OSA with HT and the treatment options available for adults with OSA-related HT. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

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33 pages, 1796 KiB

Open AccessSystematic Review

Association between Obstructive Sleep Apnea and Heart Failure in Adults—A Systematic Review

by Agnieszka Polecka, Natalia Olszewska, Łukasz Danielski and Ewa Olszewska

J. Clin. Med. 2023, 12(19), 6139; https://doi.org/10.3390/jcm12196139 - 22 Sep 2023

Cited by 1 | Viewed by 1721

Abstract

Background: Heart failure (HF) patients commonly experience obstructive sleep apnea (OSA), which may worsen their condition. We reviewed a diverse range of studies to investigate the prevalence of OSA in HF patients, the effects of positive airway pressure (PAP) treatment, and the potential impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and sacubitril/valsartan on OSA outcomes. Methods: We analyzed case-control, observational studies, and randomized controlled trials. Prevalence rates, PAP treatment, and HF pharmacotherapy were assessed. Results: Numerous studies revealed a high prevalence of OSA in HF patients, particularly with preserved ejection fraction. PAP treatment consistently improved an apnea-hypopnea index, left ventricular ejection fraction, oxygen saturation, and overall quality of life. Emerging evidence suggests that SGLT2i and sacubitril/valsartan might influence OSA outcomes through weight loss, improved metabolic profiles, and potential direct effects on upper airway muscles. Conclusions: The complex interplay between OSA and HF necessitates a multifaceted approach. PAP treatment has shown promising results in improving OSA symptoms and HF parameters. Additionally, recent investigations into the effects of HF pharmacotherapy on OSA suggest their potential as adjunctive therapy. This review provides insights for clinicians and researchers, highlighting the importance of addressing OSA and HF in patient management strategies. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

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16 pages, 764 KiB

Open AccessSystematic Review

Maxillomandibular Advancement and Upper Airway Stimulation for Treatment of Obstructive Sleep Apnea: A Systematic Review

by Ning Zhou, Jean-Pierre T. F. Ho, René Spijker, Ghizlane Aarab, Nico de Vries, Madeline J. L. Ravesloot and Jan de Lange

J. Clin. Med. 2022, 11(22), 6782; https://doi.org/10.3390/jcm11226782 - 16 Nov 2022

Cited by 3 | Viewed by 1876

Abstract

This systematic review aimed to comparatively evaluate the efficacy and safety of maxillomandibular advancement (MMA) and upper airway stimulation (UAS) in obstructive sleep apnea (OSA) treatment. A MEDLINE and Embase database search of articles on MMA and/or UAS for OSA was conducted. Twenty-one MMA studies and nine UAS studies were included. All the MMA studies demonstrated a reduction in apnea hypopnea index (AHI) postoperatively, and success rates ranged from 41.1% to 100%. Ten MMA studies reported pre- and postoperative Epworth sleepiness scale (ESS), and all but one study demonstrated a reduction in ESS. In the UAS studies, all but one demonstrated a reduction in AHI, and success rates ranged from 26.7% to 77.8%. In the eight UAS studies reporting pre- and postoperative ESS, an ESS reduction was demonstrated. No studies reported any deaths related to MMA or UAS. The most common postoperative complications after MMA and UAS were facial paresthesia in the mandibular area and discomfort due to electrical stimulation, respectively. This systematic review suggests that both MMA and UAS are effective and generally safe therapies for OSA. However, due to the limitations of the included studies, there is no evidence yet to directly compare these two procedures in OSA treatment. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

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