Multidisciplinary Approach to Sleep Apnea Management
Main Article Content
Abstract
Obstructive sleep apnea (OSA) is one of the more common, yet least appreciated of the common chronic conditions in the United States. OSA is a syndrome with multifactorial pathophysiology, and is associated with increased morbidity and mortality, with many patients living with OSA for years before diagnosis. Because of the efficacy of CPAP, it has been considered a first-line therapy and OSA care has been primarily organized around it. However, several factors are converging that provide a sound argument for a multidisciplinary approach to OSA management. Over 35 therapeutic options exist for OSA, but they tend to be underutilized especially for patients with mild-to-moderate OSA. Most OSA care is provided by pulmonary physicians, without reference to the inclusion of other disciplines in the evaluation and therapeutic process. Finally, with increased recognition of both OSA phenotypes and non-anatomical causes of OSA, the field has now commenced in increasing the understanding of subgroups of OSA patients, and the new era of personalized, tailored treatment approach has begun. OSA healthcare services will need to either organize multidisciplinary clinics physically, virtually, or via some combination to care for the large number of OSA patients in the United. States.
Keywords:
behavioral sleep medicine, chronic illness, patient-centered, sleep apnea syndromes, therapies
Article Details
How to Cite
STEPNOWSKY, Carl.
Multidisciplinary Approach to Sleep Apnea Management.
Medical Research Archives, [S.l.], v. 7, n. 7, july 2019.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/1946>. Date accessed: 27 dec. 2024.
doi: https://doi.org/10.18103/mra.v7i7.1946.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O. Sleep-disordered breathing in community-dwelling elderly. Sleep. 1991;14(6):486-495.
3. Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med. 1998;157(1):144-148.
4. Sharafkhaneh A, Richardson P, Hirshkowitz M. Sleep apnea in a high risk population: a study of Veterans Health Administration beneficiaries. Sleep Med. 2004;5(4):345-350.
5. Ancoli-Israel S, Klauber MR, Stepnowsky C, Estline E, Chinn A, Fell R. Sleep-disordered breathing in African-American elderly. Am J Respir Crit Care Med. 1995;152(6 Pt 1):1946-1949.
6. Chen X, Wang R, Zee P, et al. Racial/Ethnic Differences in Sleep Disturbances: The Multi-Ethnic Study of Atherosclerosis (MESA). Sleep. 2015;38(6):877-888.
7. Global Surveillance, Prevention and Control of Chronic Respiratory Diseases: A Comprehensive Approach. Geneva, Switzerland: World Health Organization;2007.
8. Benjafield A, Valentine K, Ayas N, et al. Global Prevalence of Obstructive Sleep Apnea in Adults: Estimation Using Currently Available Data. American Journal of Respiratory and Critical Care Medicine. 2018;197.
9. Al Ghanim N, Comondore VR, Fleetham J, Marra CA, Ayas NT. The economic impact of obstructive sleep apnea. Lung. 2008;186(1):7-12.
10. Kapur V, Blough DK, Sandblom RE, et al. The medical cost of undiagnosed sleep apnea. Sleep. 1999;22(6):749-755.
11. Ronald J, Delaive K, Roos L, Manfreda J, Bahammam A, Kryger MH. Health care utilization in the 10 years prior to diagnosis in obstructive sleep apnea syndrome patients. Sleep. 1999;22(2):225-229.
12. Peker Y, Hedner J, Kraiczi H, Loth S. Respiratory disturbance index: an independent predictor of mortality in coronary artery disease. Am J Respir Crit Care Med. 2000;162(1):81-86.
13. Ancoli-Israel S, Kripke DF, Klauber MR, et al. Morbidity, mortality and sleep-disordered breathing in community dwelling elderly. Sleep. 1996;19(4):277-282.
14. Lavie P, Herer P, Peled R, et al. Mortality in sleep apnea patients: a multivariate analysis of risk factors. Sleep. 1995;18(3):149-157.
15. Young T, Peppard P, Palta M, et al. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med. 1997;157(15):1746-1752.
16. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378-1384.
17. Strohl KP, Redline S. Recognition of obstructive sleep apnea. Am J Respir Crit Care Med. 1996;154(2 Pt 1):279-289.
18. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. Jama. 2003;289(19):2560-2572.
19. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283(14):1829-1836.
20. Shepard JW, Jr. Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. Clin Chest Med. 1992;13(3):437-458.
21. Logan AG, Perlikowski SM, Mente A, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens. 2001;19(12):2271-2277.
22. Loredo JS, Ancoli-Israel S, Kim EJ, Lim WJ, Dimsdale JE. Effect of continuous positive airway pressure versus supplemental oxygen on sleep quality in obstructive sleep apnea: a placebo-CPAP-controlled study. Sleep. 2006;29(4):564-571.
23. McArdle N, Douglas NJ. Effect of continuous positive airway pressure on sleep architecture in the sleep apnea-hypopnea syndrome: a randomized controlled trial. Am J Respir Crit Care Med. 2001;164(8 Pt 1):1459-1463.
24. Stepnowsky C, Johnson S, Dimsdale J, Ancoli-Israel S. Sleep apnea and health-related quality of life in African-American elderly. Ann Behav Med. 2000;22(2):116-120.
25. Beebe DW, Groesz L, Wells C, Nichols A, McGee K. The neuropsychological effects of obstructive sleep apnea: a meta-analysis of norm-referenced and case-controlled data. Sleep. 2003;26(3):298-307.
26. Findley LJ, Suratt PM, Dinges DF. Time-on-task decrements in "steer clear" performance of patients with sleep apnea and narcolepsy. Sleep. 1999;22(6):804-809.
27. Aikens JE, Caruana-Montaldo B, Vanable PA, Tadimeti L, Mendelson WB. MMPI correlates of sleep and respiratory disturbance in obstructive sleep apnea. Sleep. 1999;22(3):362-369.
28. Grunstein RR, Stenlof K, Hedner JA, Sjostrom L. Impact of self-reported sleep-breathing disturbances on psychosocial performance in the Swedish Obese Subjects (SOS) Study. Sleep. 1995;18(8):635-643.
29. Parish JM, Lyng PJ. Quality of life in bed partners of patients with obstructive sleep apnea or hypopnea after treatment with continuous positive airway pressure. Chest. 2003;124(3):942-947.
30. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230-1235.
31. Kales A, Cadieux RJ, Bixler EO, et al. Severe obstructive sleep apnea--I: Onset, clinical course, and characteristics. J Chronic Dis. 1985;38(5):419-425.
32. Davidson TM, Sedgh J, Tran D, Stepnowsky CJ. The anatomic basis for the acquisition of speech and obstructive sleep apnea: evidence from cephalometric analysis supports The Great Leap Forward hypothesis. Sleep Med. 2005;6(6):497-505.
33. Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013;188(8):996-1004.
34. Zinchuk A, Edwards BA, Jeon S, et al. Prevalence, Associated Clinical Features, and Impact on Continuous Positive Airway Pressure Use of a Low Respiratory Arousal Threshold Among Male United States Veterans With Obstructive Sleep Apnea. J Clin Sleep Med. 2018;14(5):809-817.
35. Holley AB, Walter RJ. Does a Low Arousal Threshold Equal Low PAP Adherence? J Clin Sleep Med. 2018;14(5):713-714.
36. Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981;1(8225):862-865.
37. Loube DI, Gay PC, Strohl KP, Pack AI, White DP, Collop NA. Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement. Chest. 1999;115(3):863-866.
38. Liu T, Li W, Zhou H, Wang Z. Verifying the Relative Efficacy between Continuous Positive Airway Pressure Therapy and Its Alternatives for Obstructive Sleep Apnea: A Network Meta-analysis. Front Neurol. 2017;8:289.
39. Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT. Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis. Arch Intern Med. 2003;163(5):565-571.
40. Wright J, Johns R, Watt I, Melville A, Sheldon T. Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence. Bmj. 1997;314(7084):851-860.
41. Stepnowsky CJ, Jr., Moore PJ. Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med Rev. 2003;7(5):445-446.
42. Boyd SB, Upender R, Walters AS, et al. Effective Apnea-Hypopnea Index ("Effective AHI"): A New Measure of Effectiveness for Positive Airway Pressure Therapy. Sleep. 2016;39(11):1961-1972.
43. Dedhia RC, Strollo PJ, Soose RJ. Upper Airway Stimulation for Obstructive Sleep Apnea: Past, Present, and Future. Sleep. 2015;38(6):899-906.
44. Jacobowitz O. Advances in Oral Appliances for Obstructive Sleep Apnea. Adv Otorhinolaryngol. 2017;80:57-65.
45. Johal A, Agha B. Ready-made versus custom-made mandibular advancement appliances in obstructive sleep apnea: A systematic review and meta-analysis. J Sleep Res. 2018.
46. Strollo PJ, Jr., Soose RJ, Maurer JT, et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014;370(2):139-149.
47. Woodson BT, Soose RJ, Gillespie MB, et al. Three-Year Outcomes of Cranial Nerve Stimulation for Obstructive Sleep Apnea: The STAR Trial. Otolaryngol Head Neck Surg. 2016;154(1):181-188.
48. Gillespie MB, Soose RJ, Woodson BT, et al. Upper Airway Stimulation for Obstructive Sleep Apnea: Patient-Reported Outcomes after 48 Months of Follow-up. Otolaryngol Head Neck Surg. 2017;156(4):765-771.
49. Camacho M, Riaz M, Capasso R, et al. The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment pressures: a systematic review and meta-analysis. Sleep. 2015;38(2):279-286.
50. MacKay SG, Chan L. Surgical Approaches to Obstructive Sleep Apnea. Sleep Med Clin. 2016;11(3):331-341.
51. Young T, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol (1985). 2005;99(4):1592-1599.
52. Tuomilehto H, Seppa J, Uusitupa M. Obesity and obstructive sleep apnea--clinical significance of weight loss. Sleep Med Rev. 2013;17(5):321-329.
53. Ravesloot MJL, White D, Heinzer R, Oksenberg A, Pepin JL. Efficacy of the New Generation of Devices for Positional Therapy for Patients With Positional Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis. J Clin Sleep Med. 2017;13(6):813-824.
54. Walsh JH, Maddison KJ, Platt PR, Hillman DR, Eastwood PR. Influence of head extension, flexion, and rotation on collapsibility of the passive upper airway. Sleep. 2008;31(10):1440-1447.
55. Epstein LJ, Kristo D, Strollo PJ, Jr., et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-276.
56. Camacho M, Chang ET, Neighbors CLP, et al. Thirty-five alternatives to positive airway pressure therapy for obstructive sleep apnea: an overview of meta-analyses. Expert Rev Respir Med. 2018;12(11):919-929.
57. Certal V, Camacho M, Song SA, Capasso R. Introducing a new concept in obstructive sleep apnea: The continuum of treatment. Cranio. 2017;35(1):1-2.
58. Edwards BA, Redline S, Sands SA, Owens RL. More than the Sum of the Respiratory Events: Personalized Medicine Approaches for Obstructive Sleep Apnea. Am J Respir Crit Care Med. 2019.
59. Hirotsu C, Haba-Rubio J, Andries D, et al. Effect of Three Hypopnea Scoring Criteria on OSA Prevalence and Associated Comorbidities in the General Population. J Clin Sleep Med. 2019;15(2):183-194.
60. Weaver EM, Woodson BT, Steward DL. Polysomnography indexes are discordant with quality of life, symptoms, and reaction times in sleep apnea patients. Otolaryngol Head Neck Surg. 2005;132(2):255-262.
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