NEWS — SEPTEMBER/OCTOBER 2004
SLEEP DISORDERS
Food & Drug Administration Approves Sleep Apnea Implant...
Regulatory clearance was granted by the U.S. Food & Drug Administration (FDA) to Restore Medical (St. Paul MN) for its soft palate implant. The implant joins other treatments, such as dental appliances and surgery, as an alternative to continuous positive airway pressure (CPAP) for an unknown portion of patients with OSA.
Obstructive Sleep Apnea Research...
The American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNS; Alexandria VA; www.entnet.org) held its annual meeting the week of September 20th, 2004. Several interesting developments were announced at the meeting and summarized this month by Medical News Today (www.medicalnewstoday.com):
In recent years, surgical removal of adenoids and tonsils (adenotonsillectomy) has been successful in treating obstructive sleep apnea (OSA) in children. Along with cardio-respiratory complications, OSA in children is associated with behavioral disorders, developmental delay, and failure to thrive. In children under three years of age, however, adenotonsillectomy may put patients at high risk for complications.
A study conducted at the University of New Mexico Health Sciences Center (Albuquerque) included 20 subjects within this patient population (age range of 1.1 to 3.0 years), who were divided into four groups by weight and body mass index. Patients underwent surgery and were monitored for complications throughout their hospital stays.
Findings indicated that surgery significantly decreased the number of subjects who had severe OSA, but OSA was resolved in only seven patients (35%). Patients had concurrent unrelated conditions that can be detected and monitored during observed overnight hospital stays.
Relationship of laryngopharyngeal reflux (LPR) to obstructive sleep apnea (OSA), a condition in which breathing is repeatedly reduced or ceased during sleep:
Canadian researchers investigated the prevalence of LPR in patients with OSA and noted the severity of impairment. The prospective blinded study involved 34 patients who were analyzed with overnight sleep testing, as well as subsequent sensory testing and LPR assessments. There was an 93% prevalence of LPR in the group of participants with OSA. Based on reflex finding scores, the severity of LPR also correlated with OSA
Specialized oral appliances may help OSA patients:
The anterior mandibular positioning (AMP) dental device has recently been introduced as an alternative therapeutic approach to nasal continuous positive airway pressure (nCPAP), which is very effective but has very low compliance rates. Because overnight sleep testing is expensive and inconvenient, a clinical study involving Israeli and U.S. researchers used the Watch-PAT100 sleep diagnosis device for pre- and post-treatment assessments of participants, in dental clinics. Twenty OSA-diagnosed patients used either EMA2 or Silencer oral appliances. The results confirm that oral appliances offer successful treatment for patients with mild or moderate OSA and may also be beneficial in patients with severe OSA. The Watch-PAT 100 offers a convenient method of ambulatory monitoring and follow-up.
Testing For OSA At Home...
The Watch-PAT 100 is one ambulatory device that enables at-home sleep testing. Another option is the SNAP test, which was used in a study of 59 adult patients by researchers at Wilford Hall USAF Medical Center (San Antonio TX). Subjects initially underwent simultaneous polysomnography (PSG) and SNAP testing in the Wilford Hall Sleep Laboratory. [CPAP titration was performed subsequently on those diagnosed with OSA.]
Data were reviewed by independent groups of board-certified sleep physicians at three centers. Average recording times were close for PSG and SNAP (256 and 250 minutes, respectively). Several types of statistical analysis were used, and researchers attribute a solid correlation between PSG and SNAP for measuring the apnea/hypoxnia index (AHI). Take home SNAP tests may be a viable option to overnight PSG for diagnosis of OSA that can reduce diagnostic costs, decrease waiting times, and be more convenient for patients.
