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https://www.readbyqxmd.com/read/28651794/airflow-shape-is-associated-with-the-pharyngeal-structure-causing-obstructive-sleep-apnea
#1
Pedro R Genta, Scott A Sands, James P Butler, Stephen H Loring, Eliot S Katz, B Gail Demko, Eric J Kezirian, David P White, Andrew Wellman
BACKGROUND: Obstructive sleep apnea (OSA) results from the collapse of different pharyngeal structures (soft palate, tongue, lateral walls, epiglottis). The structure involved in collapse has been shown to impact non-CPAP OSA treatment. Different inspiratory airflow shapes are also observed among OSA patients. We hypothesized that inspiratory flow shape reflects the underlying pharyngeal structure involved in airway collapse. METHODS: Subjects with OSA were studied with a pediatric endoscope and simultaneous nasal flow and pharyngeal pressure recordings during natural sleep...
June 23, 2017: Chest
https://www.readbyqxmd.com/read/28419320/therapeutic-cpap-level-predicts-upper-airway-collapsibility-in-patients-with-obstructive-sleep-apnea
#2
Shane A Landry, Simon A Joosten, Danny J Eckert, Amy S Jordan, Scott A Sands, David P White, Atul Malhotra, Andrew Wellman, Garun S Hamilton, Bradley A Edwards
Study Objectives: Upper airway collapsibility is a key determinant of obstructive sleep apnea (OSA) which can influence the efficacy of certain non-continuous positive airway pressure (CPAP) treatments for OSA. However, there is no simple way to measure this variable clinically. The present study aimed to develop a clinically implementable tool to evaluate the collapsibility of a patient's upper airway. Methods: Collapsibility, as characterized by the passive pharyngeal critical closing pressure (Pcrit), was measured in 46 patients with OSA...
June 1, 2017: Sleep
https://www.readbyqxmd.com/read/28409851/response-to-a-combination-of-oxygen-and-a-hypnotic-as-treatment-for-obstructive-sleep-apnoea-is-predicted-by-a-patient-s-therapeutic-cpap-requirement
#3
Shane A Landry, Simon A Joosten, Scott A Sands, David P White, Atul Malhotra, Andrew Wellman, Garun S Hamilton, Bradley A Edwards
BACKGROUND AND OBJECTIVE: Upper airway collapsibility predicts the response to several non-continuous positive airway pressure (CPAP) interventions for obstructive sleep apnoea (OSA). Measures of upper airway collapsibility cannot be easily performed in a clinical context; however, a patient's therapeutic CPAP requirement may serve as a surrogate measure of collapsibility. The present work aimed to compare the predictive use of CPAP level with detailed physiological measures of collapsibility...
August 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/28387543/effect-of-4-aminopyridine-on-genioglossus-muscle-activity-during-sleep-in-healthy-adults
#4
Luigi Taranto-Montemurro, Scott A Sands, Ali Azarbarzin, Melania Marques, Camila M de Melo, Bradley A Edwards, Danny J Eckert, Ludovico Messineo, David P White, Andrew Wellman
RATIONALE: The reduction in upper airway muscle activity from wakefulness to sleep plays a key role in the development of obstructive sleep apnea. Potassium (K(+)) channels have been recently identified as the downstream mechanisms through which hypoglossal motoneuron membrane excitability is reduced both in non-rapid eye movement (NREM) sleep and REM sleep. In animal models, the administration of 4-aminopyridine (4-AP), a voltage-gated K(+) channel blocker, increased genioglossus activity during wakefulness and across all sleep stages...
July 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28364504/effects-of-tiagabine-on-slow-wave-sleep-and-arousal-threshold-in-patients-with-obstructive-sleep-apnea
#5
Luigi Taranto-Montemurro, Scott A Sands, Bradley A Edwards, Ali Azarbarzin, Melania Marques, Camila de Melo, Danny J Eckert, David P White, Andrew Wellman
Introduction: Obstructive sleep apnea (OSA) severity is markedly reduced during slow-wave sleep (SWS) even in patients with a severe disease. The reason for this improvement is uncertain but likely relates to non-anatomical factors (i.e. reduced arousability, chemosensitivity, and increased dilator muscle activity). The anticonvulsant tiagabine produces a dose-dependent increase in SWS in subjects without OSA. This study aimed to test the hypothesis that tiagabine would reduce OSA severity by raising the overall arousal threshold during sleep...
February 1, 2017: Sleep
https://www.readbyqxmd.com/read/28364460/estimation-of-pharyngeal-collapsibility-during-sleep-by-peak-inspiratory-airflow
#6
Ali Azarbarzin, Scott A Sands, Luigi Taranto-Montemurro, Melania D Oliveira Marques, Pedro R Genta, Bradley A Edwards, James Butler, David P White, Andrew Wellman
Objectives: Pharyngeal critical closing pressure (Pcrit) or collapsibility is a major determinant of obstructive sleep apnea (OSA) and may be used to predict the success/failure of non-continuous positive airway pressure (CPAP) therapies. Since its assessment involves overnight manipulation of CPAP, we sought to validate the peak inspiratory flow during natural sleep (without CPAP) as a simple surrogate measurement of collapsibility. Methods: Fourteen patients with OSA attended overnight polysomnography with pneumotachograph airflow...
January 1, 2017: Sleep
https://www.readbyqxmd.com/read/28329099/effect-of-sleeping-position-on-upper-airway-patency-in-obstructive-sleep-apnea-is-determined-by-the-pharyngeal-structure-causing-collapse
#7
Melania Marques, Pedro R Genta, Scott A Sands, Ali Azarbazin, Camila de Melo, Luigi Taranto-Montemurro, David P White, Andrew Wellman
Objectives: In some patients, obstructive sleep apnea (OSA) can be resolved with improvement in pharyngeal patency by sleeping lateral rather than supine, possibly as gravitational effects on the tongue are relieved. Here we tested the hypothesis that the improvement in pharyngeal patency depends on the anatomical structure causing collapse, with patients with tongue-related obstruction and epiglottic collapse exhibiting preferential improvements. Methods: Twenty-four OSA patients underwent upper airway endoscopy during natural sleep to determine the pharyngeal structure associated with obstruction, with simultaneous recordings of airflow and pharyngeal pressure...
March 1, 2017: Sleep
https://www.readbyqxmd.com/read/28186830/reply-is-the-muscle-the-only-potential-target-of-desipramine-in-obstructive-sleep-apnea-syndrome
#8
Luigi Taranto-Montemurro, Scott A Sands, Bradley A Edwards, Danny J Eckert, David P White, Andrew Wellman
No abstract text is available yet for this article.
June 15, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27923429/effects-of-tiagabine-on-slow-wave-sleep-and-arousal-threshold-in-patients-with-obstructive-sleep-apnea
#9
Luigi Taranto-Montemurro, Scott A Sands, Bradley A Edwards, Ali Azarbarzin, Melania Marques, Camila de Melo, Danny J Eckert, David P White, Andrew Wellman
STUDY OBJECTIVES: Obstructive sleep apnea (OSA) severity is markedly reduced during slow wave sleep (SWS) even in patients with a severe disease. The reason for this improvement is uncertain but likely relates to non-anatomical factors (i.e. reduced arousability, chemosensitivity, and increased dilator muscle activity). The anticonvulsant tiagabine produces a dose-dependent increase in SWS in subjects without OSA. This study aimed to test the hypothesis that tiagabine would reduce OSA severity by raising the overall arousal threshold during sleep...
November 28, 2016: Sleep
https://www.readbyqxmd.com/read/27799387/desipramine-improves-upper-airway-collapsibility-and-reduces-osa-severity-in-patients-with-minimal-muscle-compensation
#10
Luigi Taranto-Montemurro, Scott A Sands, Bradley A Edwards, Ali Azarbarzin, Melania Marques, Camila de Melo, Danny J Eckert, David P White, Andrew Wellman
We recently demonstrated that desipramine reduces the sleep-related loss of upper airway dilator muscle activity and reduces pharyngeal collapsibility in healthy humans without obstructive sleep apnoea (OSA). The aim of the present physiological study was to determine the effects of desipramine on upper airway collapsibility and apnoea-hypopnea index (AHI) in OSA patients.A placebo-controlled, double-blind, randomised crossover trial in 14 OSA patients was performed. Participants received treatment or placebo in randomised order before sleep...
November 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/27634790/the-combination-of-supplemental-oxygen-and-a-hypnotic-markedly-improves-obstructive-sleep-apnea-in-patients-with-a-mild-to-moderate-upper-airway-collapsibility
#11
Bradley A Edwards, Scott A Sands, Robert L Owens, Danny J Eckert, Shane Landry, David P White, Atul Malhotra, Andrew Wellman
STUDY OBJECTIVES: Obstructive sleep apnea (OSA) results from the interaction of several physiological traits; specifically a compromised upper airway anatomy and muscle function, and two key non-anatomical deficits: elevated loop gain and a low arousal threshold. Although continuous positive airway pressure (CPAP) is an efficacious treatment, it is often poorly tolerated. An alternative approach could involve administering therapies targeting the non-anatomic causes. However, therapies (oxygen or hypnotics) targeting these traits in isolation typically improve, but rarely resolve OSA...
November 1, 2016: Sleep
https://www.readbyqxmd.com/read/27634788/estimation-of-pharyngeal-collapsibility-during-sleep-by-peak-inspiratory-airflow
#12
Ali Azarbarzin, Scott A Sands, Luigi Taranto-Montemurro, Melania D Oliveira Marques, Pedro R Genta, Bradley A Edwards, James Butler, David P White, Andrew Wellman
OBJECTIVES: Pharyngeal critical closing pressure (Pcrit) or collapsibility is a major determinant of obstructive sleep apnea (OSA) and may be used to predict the success/failure of non-continuous positive airway pressure (CPAP) therapies. Since its assessment involves overnight manipulation of CPAP, we sought to validate the peak inspiratory flow during natural sleep (without CPAP) as a simple surrogate measurement of collapsibility. METHODS: Fourteen patients with OSA attended overnight polysomnography with pneumotachograph airflow...
September 9, 2016: Sleep
https://www.readbyqxmd.com/read/27181367/upper-airway-collapsibility-and-loop-gain-predict-the-response-to-oral-appliance-therapy-in-patients-with-obstructive-sleep-apnea
#13
RANDOMIZED CONTROLLED TRIAL
Bradley A Edwards, Christopher Andara, Shane Landry, Scott A Sands, Simon A Joosten, Robert L Owens, David P White, Garun S Hamilton, Andrew Wellman
RATIONALE: Oral appliances (OAs) are commonly used as an alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea (OSA). However, OAs have variable success at reducing the apnea-hypopnea index (AHI), and predicting responders is challenging. Understanding this variability may lie with the recognition that OSA is a multifactorial disorder and that OAs may affect more than just upper-airway anatomy/collapsibility. OBJECTIVES: The objectives of this study were to determine how OA alters AHI and four phenotypic traits (upper-airway anatomy/collapsibility and muscle function, loop gain, and arousal threshold), and baseline predictors of which patients gain the greatest benefit from therapy...
December 1, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/26967681/desipramine-increases-genioglossus-activity-and-reduces-upper-airway-collapsibility-during-non-rem-sleep-in-healthy-subjects
#14
Luigi Taranto-Montemurro, Bradley A Edwards, Scott A Sands, Melania Marques, Danny J Eckert, David P White, Andrew Wellman
RATIONALE: Obstructive sleep apnea is a state-dependent disease. One of the key factors that triggers upper airway collapse is decreased pharyngeal dilator muscle activity during sleep. To date, there have not been effective methods to reverse pharyngeal hypotonia pharmacologically in sleeping humans. OBJECTIVES: We tested the hypothesis that administration of desipramine 200 mg prevents the state-related reduction in genioglossus activity that occurs during sleep and thereby decreases pharyngeal collapsibility...
October 1, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/26446124/tube-law-of-the-pharyngeal-airway-in-sleeping-patients-with-obstructive-sleep-apnea
#15
Pedro R Genta, Bradley A Edwards, Scott A Sands, Robert L Owens, James P Butler, Stephen H Loring, David P White, Andrew Wellman
STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is characterized by repetitive pharyngeal collapse during sleep. However, the dynamics of pharyngeal narrowing and re-expansion during flow-limited breathing are not well described. The static pharyngeal tube law (end-expiratory area versus luminal pressure) has demonstrated increasing pharyngeal compliance as luminal pressure decreases, indicating that the airway would be sucked closed with sufficient inspiratory effort. On the contrary, the airway is rarely sucked closed during inspiratory flow limitation, suggesting that the airway is getting stiffer...
February 1, 2016: Sleep
https://www.readbyqxmd.com/read/25515107/an-integrative-model-of-physiological-traits-can-be-used-to-predict-obstructive-sleep-apnea-and-response-to-non-positive-airway-pressure-therapy
#16
Robert L Owens, Bradley A Edwards, Danny J Eckert, Amy S Jordan, Scott A Sands, Atul Malhotra, David P White, Stephen H Loring, James P Butler, Andrew Wellman
STUDY OBJECTIVES: Both anatomical and nonanatomical traits are important in obstructive sleep apnea (OSA) pathogenesis. We have previously described a model combining these traits, but have not determined its diagnostic accuracy to predict OSA. A valid model, and knowledge of the published effect sizes of trait manipulation, would also allow us to predict the number of patients with OSA who might be effectively treated without using positive airway pressure (PAP). DESIGN, PARTICIPANTS AND INTERVENTION: Fifty-seven subjects with and without OSA underwent standard clinical and research sleep studies to measure OSA severity and the physiological traits important for OSA pathogenesis, respectively...
June 1, 2015: Sleep
https://www.readbyqxmd.com/read/25324514/test-of-the-starling-resistor-model-in-the-human-upper-airway-during-sleep
#17
Andrew Wellman, Pedro R Genta, Robert L Owens, Bradley A Edwards, Scott A Sands, Stephen H Loring, David P White, Andrew C Jackson, Ole F Pedersen, James P Butler
The human pharyngeal airway during sleep is conventionally modeled as a Starling resistor. However, inspiratory flow often decreases with increasing effort (negative effort dependence, NED) rather than remaining fixed as predicted by the Starling resistor model. In this study, we tested a major prediction of the Starling resistor model--that the resistance of the airway upstream from the site of collapse remains fixed during flow limitation. During flow limitation in 24 patients with sleep apnea, resistance at several points along the pharyngeal airway was measured using a pressure catheter with multiple sensors...
December 15, 2014: Journal of Applied Physiology
https://www.readbyqxmd.com/read/25323235/quantifying-the-ventilatory-control-contribution-to-sleep-apnoea-using-polysomnography
#18
Philip I Terrill, Bradley A Edwards, Shamim Nemati, James P Butler, Robert L Owens, Danny J Eckert, David P White, Atul Malhotra, Andrew Wellman, Scott A Sands
Elevated loop gain, consequent to hypersensitive ventilatory control, is a primary nonanatomical cause of obstructive sleep apnoea (OSA) but it is not possible to quantify this in the clinic. Here we provide a novel method to estimate loop gain in OSA patients using routine clinical polysomnography alone. We use the concept that spontaneous ventilatory fluctuations due to apnoeas/hypopnoeas (disturbance) result in opposing changes in ventilatory drive (response) as determined by loop gain (response/disturbance)...
February 2015: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/25321848/clinical-predictors-of-the-respiratory-arousal-threshold-in-patients-with-obstructive-sleep-apnea
#19
Bradley A Edwards, Danny J Eckert, David G McSharry, Scott A Sands, Amar Desai, Geoffrey Kehlmann, Jessie P Bakker, Pedro R Genta, Robert L Owens, David P White, Andrew Wellman, Atul Malhotra
RATIONALE: A low respiratory arousal threshold (ArTH) is one of several traits involved in obstructive sleep apnea pathogenesis and may be a therapeutic target; however, there is no simple way to identify patients without invasive measurements. OBJECTIVES: To determine the physiologic determinates of the ArTH and develop a clinical tool that can identify patients with low ArTH. METHODS: Anthropometric data were collected in 146 participants who underwent overnight polysomnography with an epiglottic catheter to measure the ArTH (nadir epiglottic pressure before arousal)...
December 1, 2014: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/25191791/enhanced-upper-airway-muscle-responsiveness-is-a-distinct-feature-of-overweight-obese-individuals-without-sleep-apnea
#20
Scott A Sands, Danny J Eckert, Amy S Jordan, Bradley A Edwards, Robert L Owens, James P Butler, Richard J Schwab, Stephen H Loring, Atul Malhotra, David P White, Andrew Wellman
RATIONALE: Body habitus is a major determinant of obstructive sleep apnea (OSA). However, many individuals do not have OSA despite being overweight/obese (body mass index > 25 kg/m(2)) for reasons that are not fully elucidated. OBJECTIVES: To determine the key physiologic traits (upper-airway anatomy/collapsibility, upper-airway muscle responsiveness, chemoreflex control of ventilation, arousability from sleep) responsible for the absence of OSA in overweight/obese individuals...
October 15, 2014: American Journal of Respiratory and Critical Care Medicine
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