Prevalence of obstructive sleep apnea in venous thromboembolism: a systematic review and meta-analysis

Sleep and Breathing - Previous studies revealed that the concomitant prevalence of obstructive sleep apnea (OSA) and venous thromboembolism (VTE) was high, but the results were inconclusive due to...     

Diagnostic accuracy of screening questionnaires for obstructive sleep apnoea in adults in different clinical cohorts: a systematic review and meta-analysis

Sleep and Breathing - The majority of individuals with clinically significant obstructive sleep apnoea (OSA) are undiagnosed and untreated. A simple screening tool may support risk stratification,...     

Post-gastrointestinal endoscopy complications in patients with obstructive sleep apnea or at high risk for sleep apnea: a systematic review and meta-analysis

Background

Obstructive sleep apnea (OSA) is becoming increasingly more prevalent with the rise in obesity. Complications from gastrointestinal (GI) endoscopy in this patient population have been reported in several studies, but the modest complication rates from these procedures make it difficult to come to definitive conclusions based on single studies. The objective of our study was to systematically review these studies reporting the incidence of post-procedure complications in patients with OSA undergoing endoscopy to determine whether the presence of OSA increases post-procedure complications.

Methods

We conducted a systematic review using the Cochrane Collaboration Methodology. We searched Medline via Ovid, PubMed, Embase, and Evidence Based Medicine Reviews databases from 1950 to August 2013. We rated the quality of evidence for each outcome using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Meta-analysis was done using Review Manager Version 5.0.20.

Results

Our search resulted in seven eligible studies. There was no significant association between diagnosis of OSA and post-GI endoscopy complications including hypoxemia, respiratory distress, variations in blood pressure or heart rate, bradypnea, or need for significant interventions. Subgroup analysis based on the type of GI endoscopy or the type of anesthesia used did not show any significant associations either.

Conclusions

Obstructive sleep apnea patients and/or patients at high risk for obstructive sleep apnea do not appear to be at increased risk of adverse outcomes from GI endoscopy.

     

The prevalence of obstructive sleep apnea in interstitial lung disease: a systematic review and meta-analysis

Sleep and Breathing - To evaluate the overall prevalence of obstructive sleep apnea (OSA) in interstitial lung disease (ILD). We performed a systematic search of the academic literature while...     

Association between obstructive sleep apnea and non-alcoholic fatty liver disease: a systematic review and meta-analysis

Sleep and Breathing - The relationship between obstructive sleep apnea (OSA) and non-alcoholic fatty liver disease (NAFLD) has been an issue of great concern. The primary purpose of this study was...     

Diagnostic accuracy of echocardiography for pulmonary hypertension: a systematic review and meta-analysis

CONTEXT: Right heart catheterisation is the gold standard for the diagnosis of pulmonary hypertension. However, echocardiography is frequently used to screen for this disease and monitor progression over time because it is non-invasive, widely available and relatively inexpensive. OBJECTIVE: To perform a systematic review and quantitative meta-analysis to determine the correlation of pulmonary pressures obtained by echocardiography versus right heart catheterisation and to determine the diagnostic accuracy of echocardiography for pulmonary hypertension. DATA SOURCES: MEDLINE, EMBASE, Papers First, the Cochrane collaboration and the Cochrane Register of controlled trials were searched and were inclusive as of February 2010. STUDY SELECTION: Studies were only included if a correlation coefficient or the absolute number of true-positive, false-negative, true-negative and false-positive observations was available, and the 'reference standards' were described clearly. DATA EXTRACTION: Two reviewers independently extracted the data from each study. Quality was assessed with the quality assessment for diagnostic accuracy studies. A random effects model was used to obtain a summary correlation coefficient and the bivariate model for diagnostic meta-analysis was used to obtain summary sensitivity and specificity values. Results 29 studies were included in the meta-analysis.The summary correlation coefficient between systolic pulmonary arterial pressure estimated from echocardiography versus measured by right heart catheterisation was 0.70 (95% CI 0.67 to 0.73; n=27).The summary sensitivity and specificity for echocardiography for diagnosing pulmonary hypertension was 83% (95% CI 73 to 90) and 72% (95% CI 53 to 85;n=12), respectively. The summary diagnostic OR was 13(95% CI 5 to 31).Conclusions Echocardiography is a useful and noninvasive modality for initial measurement of pulmonary pressures but due to limitations, right heart catheterisation should be used for diagnosing and monitoring pulmonary hypertension.     

Increased the circulating levels of malondialdehyde in patients with obstructive sleep apnea: a systematic review and meta-analysis

Sleep and Breathing - Obstructive sleep apnea (OSA) is a prevalent sleep disorder associated with increased risk of cardiovascular disease. Several studies have demonstrated elevated...     

Efficacy and safety of montelukast for pediatric obstructive sleep apnea syndrome: A protocol for systematic review and meta-analysis

Background:Pediatric obstructive sleep apnea syndrome (OSAS) is significant public concern. Clinical practice indicates that montelukast has certain therapeutic advantages, while there is a lack of evidence-based medicine support. The aim of this study is to synthesize related data to explore efficacy and safety of montelukast for pediatric OSAS.Methods:Data in Pubmed, EMBASE, CENTRAL, CBM, CNKI, WanFang, VIP databases were comprehensively searched. All the randomized controlled trials (RCTs) in OSAS children were identified, in which the effects of montelukast on a range of outcomes were compared. The search had a deadline of January 1, 2020. Two investigators independently conducted data extraction and assessed the literature quality of the included studies. The Revman5.3 software was used for meta-analysis of the included literature.Results:The efficacy and safety of montelukast in the treatment of pediatric OSAS were evaluated in terms of apnea hypopnea index (AHI), the Pittsburgh Sleep Quality Index, the Epworth Sleep Scale (ESS), neck circumference, important index in Polysomnography: sleep efficiency, desaturation index, total sleep time.Conclusions:This study provides reliable evidence-based support for the clinical application of montelukast in the treatment of pediatric OSAS.PROSPERO registration number:CRD42020146940.     

Correction to: The prevalence of obstructive sleep apnea in interstitial lung disease: a systematic review and meta-analysis

Sleep and Breathing - A Correction to this paper has been published: https://doi.org/10.1007/s11325-021-02354-8     

Post-operative outcomes in adult obstructive sleep apnea patients undergoing non-upper airway surgery: a systematic review and meta-analysis

Background:

With the current obesity epidemic, obstructive sleep apnea (OSA) has become increasingly common. Several studies have reported on the risk of post-operative complications in OSA patients undergoing non-upper airway surgeries. The objective of our study was to systematically review the medical literature reporting the incidence of post-operative complications in patients with OSA.

Methods:

We conducted a systematic review using the Cochrane Collaboration Methodology. We searched Medline via Ovid, Pubmed, Embase, and Evidence-Based Medicine Reviews databases from 1950 to 2012. We rated the quality of evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Meta-analysis was done using Review Manager Version 5.0.20.

Results:

Our search resulted in 18 eligible studies. OSA was found to be associated with a significantly increased incidence of post-operative hypoxemia (odds ratio [OR]?=?3.06; 95 % confidence interval [CI] 2.35–3.97), respiratory complications (OR?=?2.77, 95 % CI 1.73–4.43), cardiac complications (OR?=?1.76 95 % CI 1.16–2.67), neurological complications (OR?=?2.65, 95 % CI 1.43–4.92), and unplanned intensive care unit (ICU) transfer (OR?=?2.97, 95 % CI 1.90–4.64). Re-intubation (OR?=?1.37, 95 % CI 0.65–2.91) was not significantly increased in patients with OSA. The association between OSA and post-operative outcomes remained unchanged with sub-group analysis including only studies that used polysomnography (PSG) for diagnosis.

Conclusions:

OSA patients are at increased risk of post-operative complications from non-upper airway surgeries. Early diagnosis and treatment of OSA might decrease post-operative complications in these patients. There is a need for further studies to assess the benefit of peri-operative treatment of OSA on post-operative outcomes.     

Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis

The purpose of this review is to conduct a systematic review and meta-analysis comparing the effects of continuous positive airway pressure (CPAP) with a mandibular advancement device (MAD) in improving the quality of life (sleepiness, cognitive, and functional outcomes) in patients diagnosed with obstructive sleep apnea (OSA). Authors identified randomized, placebo-controlled studies from MEDLINE through PubMed, Web of Science, and the Cochrane Library. Studies were assessed for inclusion and exclusion criteria, as well as risk of bias. Initial search yielded 240 unduplicated references, which the authors reduced to 12 relevant studies. Patients with CPAP therapy showed no statistically significant difference in the post-treatment quality of life measured with the SF-36 mental health component (p = .994), or the SF-36 physical functioning component (p = .827). There was no significant improvement in neither Functional Outcomes of Sleep Questionnaire (p = .788) nor cognitive performance (p = .395) compared to patients treated with oral appliances. However, the meta-analyses’ overall results showed a significant improvement in the post-treatment apnea–hypopnea index (AHI) in favor of CPAP therapy as compared with the oral appliance group (p < .001). Meta-analyses showed unclear results for sleepiness with no significant differences in average post-treatment Epworth Sleepiness Scale [ESS] (p = .203), but significant differences in change in ESS from baseline favorable to CPAP treatment (p = .047). Further studies are needed. Compliance with treatment was 1.1 h per night significantly lower with CPAP than MAD (p = .004), which could explain why though efficacy (AHI) is better with CPAP, no significant results are shown for quality of life, cognitive, and functional outcomes. Though CPAP is significantly more efficient in reducing AHI (moderate quality of evidence), it has a significantly lower compliance resulting in no differences with MAD in quality of life, cognitive, or functional outcomes. Sleep medicine professionals should monitor treatment compliance and offer patients non-compliant with CPAP an oral appliance for treatment of OSA.     

The prevalence of obstructive sleep apnea and its association with pregnancy-related health outcomes: a systematic review and meta-analysis

Purpose

Obstructive sleep apnea (OSA) is common during pregnancy. Nevertheless, prevalence estimates of OSA have varied widely due to variabilities in the assessment methods. This meta-analysis aimed to examine the prevalence of objectively assessed OSA and its association with pregnancy-related health outcomes in pregnant women.

Methods

This review was developed following the PRISMA guideline. A systematic search was conducted in major electronic databases to identify studies conducted from inception to January 2018. The pooled estimates with 95% confidence interval were calculated using the inverse variance method. Forest plots were used to present the results of individual studies and the pooled effect sizes.

Results

Thirty-three studies were included. The mean gestational age was between 21.2 (8.5) and 37.3 (2.1) weeks. The pooled worldwide prevalence of OSA was 15% (95% CI 12–18%). The prevalence estimates ranged from 5% in the European Region to 20% in the Region of Americas. The prevalence estimates for different trimesters ranged from 15 to 19%. OSA was related to an increased risk for gestational hypertension, gestational diabetes, pre-eclampsia, C-section, postoperative wound complication, and pulmonary edema. The pooled adjusted odds ratio (aOR) values were 1.97, 1.55, 2.35, 1.42, 1.87, and 6.35, respectively. OSA was also related to an increased risk for preterm birth (aOR?=?1.62) and neonatal intensive care unit admission (aOR?=?1.28).

Conclusions

OSA is a common health issue in pregnant women. OSA is associated with various pregnancy-related health outcomes. Routine screening, early diagnosis, and effective treatment of OSA are recommended in pregnant women, particularly during mid and late pregnancy.

     

Home-based diagnosis of obstructive sleep apnea by polysomnography type 2: accuracy,reliability, and feasibility

Purpose

Despite being used in large cohort studies, role of polysomnography (PSG) type 2 is still controversy. This study was aimed to determine its accuracy, reliability, and feasibility in diagnosis of obstructive sleep apnea (OSA) compared to gold standard.

Methods

Adult patients with stable medical conditions who complained of snoring or excessive sleepiness and lived around Bangkok were recruited from a sleep clinic. All were asked to fill questionnaires and have PSG done in laboratory (in-Lab PSG) and at home (Home PSG) on separate nights within 2–4 weeks interval.

Results

Eighty-six patients, 48 males and 38 females, were included. Mean of total sleep time, sleep efficiency, and stage R were significantly greater in Home PSG than in-Lab PSG (p?p?=?0.04), but with excellent reliability, intra-class correlation coefficients of 0.96 (95 % CI; 0.93–0.97), and good agreements (κ?=?0.59–0.70) between both tests. The sensitivity, specificity, and accuracy of Home PSG at cut-off point of AHI ≥5, were 0.97, 0.56, and 0.85, respectively, and at AHI ≥15 were 0.95, 0.76, and 0.85, respectively. Sixty-four patients (74.4 %) preferred home-PSG but four patients (4.7 %) needed repeated tests due to significant data loss.

Conclusions

This is the first report in Asia demonstrating that home-based diagnosis of OSA by PSG type 2 was feasible performing with good reliability, high accuracy, and a low failure rate. However, further studies focusing on its cost-effectiveness are required.     

Socioeconomic disparities in obstructive sleep apnea: a systematic review of empirical research

Background

Considering socioeconomic status (SES) in the diagnosis of obstructive sleep apnea (OSA) will enhance our understanding of socioeconomic disparities in clinical practice of sleep medicine. This systematic review analyzes the relations between SES and OSA measures.

Methodology

Eleven articles were identified through the Pubmed database. The National Institute of Health’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to rate the quality of these studies.

Results

This systematic review revealed that associations between socioeconomic status and OSA measures are similar for both adults, children, and adolescents. Our findings showed that: (1) A lower SES is associated with an increased risk of OSA, both in adults and children/adolescents as well as for men and women. (2) Several studies assessed sleep outcomes with a single question, an approach that is unable to capture the multi-dimensionality and day-to-day variability of sleep in general or OSA in particular, (3) Low SES has detrimental effects on sleep health. (4) Sleep questionnaires are more commonly used than objective measure to assess OSA.

Conclusions

Interaction between SES and OSA must be better understood to improve current clinical guidelines. Living conditions influence the trajectory of OSA with unknown speed and for an, undetermined period, pointing to the need for more studies on this topic. Future work should identify the effect of SES on the development and progression of OSA, determine the effect of behavioral intervention and local public health programs to reduce social inequalities associated with OSA.

     

Phenotyping the pathophysiology of obstructive sleep apnea using polygraphy/polysomnography: a review of the literature

Continuous positive airway pressure (CPAP) is the first-line treatment for the majority of patients affected by obstructive sleep apnea syndrome (OSA). However, long-term compliance with CPAP therapy may result limited and alternatives to CPAP therapy are required to address the increasing need to provide tailored therapeutic options. Understanding the pathophysiological traits (PTs) of OSA patients [upper airway (UA) anatomical collapsibility, loop gain (LG), arousal threshold (AT), and UA gain (UAG)] lies at the heart of the customized OSA treatment. However, sleep research laboratories capable to phenotype OSA patients are sparse and the diagnostic procedures time-consuming, costly, and requiring significant expertise. The question arises whether the use of routine clinical polysomnography or nocturnal portable multi-channel monitoring (PSG/PM) can provide sufficient information to characterize the above traits. The aim of the present review is to deduce if the information obtainable from the clinical PSG/PM analysis, independently of the scope and context of the original studies, is clinically useful to define qualitatively the PTs of individual OSA patients. In summary, it is possible to identify four patterns using PSG/PM that are consistent with an altered UA collapsibility, three that are consistent with altered LG, two with altered AT, and three consistent with flow limitation/UA muscle response. Furthermore, some PSG/PM indexes and patterns, useful for the suitable management of OSA patient, have been discussed. The delivery of this clinical approach to phenotype pathophysiological traits will allow patients to benefit in a wider range of sleep services by facilitating tailored therapeutic options.