Browsing by Subject "Sleep Apnea Syndromes"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Auto-titrating continuous positive airway pressure for patients with acute transient ischemic attack: a randomized feasibility trial
    (Ovid Technologies Wolters Kluwer -American Heart Association, 2010-07) Bravata, Dawn M.; Concato, John; Fried, Terri; Ranjbar, Noshene; Sadarangani, Tanesh; McClain, Vincent; Struve, Frederick; Zygmunt, Lawrence; Knight, Herbert J.; Lo, Albert; Richerson, George B.; Gorman, Mark; Williams, Linda S.; Brass, Lawrence M.; Agostini, Joseph; Mohsenin, Vahid; Roux, Francoise; Klar Yaggi, H.; Department of Medicine, IU School of Medicine
    BACKGROUND AND PURPOSE: Transient ischemic attack (TIA) patients are at risk of recurrent vascular events. The primary objectives were to evaluate among TIA patients the prevalence of sleep apnea and among patients with sleep apnea auto-titrating continuous positive airway pressure (auto-CPAP) adherence. The secondary objective was to describe among TIA patients with sleep apnea the recurrent vascular event rate by auto-CPAP use category. METHODS: All intervention patients received auto-CPAP for 2 nights, but only intervention patients with evidence of sleep apnea received auto-CPAP for the remainder of the 90-day period. Intervention patients received polysomnography at 90 days after TIA. Control patients received polysomnography at baseline and at 90 days. Acceptable auto-CPAP adherence was defined as >or=4 hours per night for >or=75% of nights. Vascular events included recurrent TIA, stroke, hospitalization for congestive heart failure, myocardial infarction, or death. RESULTS: We enrolled 70 acute TIA patients: 45 intervention and 25 control. The majority of patients had sleep apnea: 57% at baseline and 59% at 90 days. Among the 30 intervention patients with airflow obstruction, 12 (40%) had acceptable auto-CPAP adherence, 18 (60%) had some use, and none had no use. Three intervention patients (12%) had recurrent events compared with 1 (2%;P=0.13) control patient. The vascular event rate was highest among sleep apnea patients with no CPAP use: none, 16%;some, 5%;acceptable adherence 0% (P=0.08). CONCLUSIONS: Sleep apnea is common among acute TIA patients. It appears feasible to provide auto-CPAP in the acute TIA period. Larger studies should evaluate whether a strategy of diagnosing and treating sleep apnea can reduce recurrent vascular events after TIA.
  • Thumbnail Image
    Item
    A Clinical Study Evaluating a Mandibular Repositioning Appliance to Treat Obstructive Sleep Apnea
    (1992) Coghlan, J. Kevin; Roberts, W. Eugene; Beiswanger, Bradley B.; Shanks, James C.; Garner, LaForrest D.; Hennon, David K.; Nelson, Charles L.
    The study evaluated the effects of a mandibular repositioning appliance (MRA) in patients with obstructive sleep apnea. The MRA was designed to hold the mandible anteriorly in an attempt to maintain a patent airway. Eleven subjects completed a full-night polysomnogram wherein their normal sleep was recorded half the night without the appliance (control) and the other half with the appliance (test). The sequencing of test and control halves was randomly assigned to avoid bias. After seven subjects were tested with the MRA, the MRA was modified for four additional patients by placing anterior vertical elastics (MRA*) to minimize the opening of the mandible. The skeletal and soft tissue changes with both appliances were analyzed using lateral cephalometric radiographs. The MRA was found to have no significant effect on the obstructive sleep apnea patients as a group. Individual response to the appliance varied from noticeably worse to marked improvement. Subject #2A exhibited the reduction of a moderate-to-severe apnea (Apnea-hypopnea index 55.92) to a clinically acceptable level (Apnea-hypopnea index 9.57) with appliance wear. The treatment was considered successful. Significant cephalometric changes with appliance wear were increased lower facial height, a superiorly positioned hyoid bone relative to the mandibular plane, and a decreased posterior airway space. No cephalometric measurement could accurately predict the outcome of the treatment, and posterior airway space, commonly measured in sleep research, was not reliable. The mandibular repositioning appliance was effective in treating a small percentage of individuals with obstructive sleep apnea. A polysomnogram was needed to quantitatively measure the effectiveness of treatment. Under no circumstance should a subjective evaluation by the patient or the clinician be used to assess treatment results. Further investigation is required to evaluate the long-term effectiveness of this treatment. Periodic follow-up sleep studies are required for any patient treated with this appliance until more long term studies are completed.