| 1. |
- Dieltjens, Marijke, et al.
(författare)
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Use of the Clinical Global Impression scale in sleep apnea patients-Results from the ESADA database.
- 2019
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Ingår i: Sleep medicine. - : Elsevier BV. - 1878-5506 .- 1389-9457. ; 59, s. 56-65
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Tidskriftsartikel (refereegranskat)abstract
- The Clinical Global Impression scale (CGI) reflects the clinician's assessment of the disease impact on patient's global functioning. We assessed predictors of CGI scale rating in patients with obstructive sleep apnea (OSA).Consecutive patients with suspected OSA (n=7581) were identified in the European Sleep Apnea Database (ESADA). Anthropometrics, comorbidities, apnea severity obtained by polygraphy or polysomnography, and daytime sleepiness [Epworth Sleepiness Scale (ESS)] were assessed. The CGI 7-point scale was completed at the end of the diagnostic process (CGI-severity, ie, CGI-S) and, in a subpopulation, at treatment follow-up (CGI-Improvement).CGI-S was rated mild to moderate in 44% of patients. CGI rating at any given apnea intensity was worse in women than in men (p<0.01). Patients undergoing polygraphy (n=5075) were more frequently rated as severely ill compared to those studied with polysomnography (19.0% vs 13.0%, p<0.001). In patients aged ≤65 years, CGI scoring was generally better than in the elderly despite a similar degree of OSA (eg, 'normal, not ill' 24.2% vs 15.3%, p<0.01, respectively). Independent predictors of CGI rating included age, BMI, AHI, ESS, cardio-metabolic comorbidities, and diagnosis based on polygraphy. CGI-improvement rating (Beta=-0.406, p<0.01) was superior to sleep apnea severity or ESS-score (Beta=0.052 and-0.021, p=0.154 and 0.538 respectively) at baseline for prediction of good CPAP compliance at follow-up.CGI rating is confounded by gender, age class and the type of sleep diagnostic method. As OSA phenotypes differ, CGI may contribute as a clinical tool to reflect the significance of clinical disease.
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| 2. |
- Marrone, Oreste, et al.
(författare)
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Chronic kidney disease in European patients with obstructive sleep apnea: the ESADA cohort study
- 2016
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Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 25, s. 739-745
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Tidskriftsartikel (refereegranskat)abstract
- © 2016 European Sleep Research Society The cross-sectional relationship of obstructive sleep apnea with moderate to severe chronic kidney disease, defined as an estimated glomerular filtration rate <60mLmin−1∙1.73m−2, was investigated in a large cohort of patients with suspected obstructive sleep apnea studied by nocturnal polysomnography or cardiorespiratory polygraphy. Data were obtained from the European Sleep Apnea Database, where information from unselected adult patients with suspected obstructive sleep apnea afferent to 26 European sleep centres had been prospectively collected. Both the Modification of Diet in Renal Disease and the Chronic Kidney Disease-Epidemiology Collaboration equations were used for the assessment of estimated glomerular filtration rate. The analysed sample included 7700 subjects, 71% male, aged 51.9±12.5years. Severe obstructive sleep apnea (apnea–hypopnea index ≥30) was found in 34% of subjects. The lowest nocturnal oxygen saturation was 81±10.2%. Chronic kidney disease prevalence in the whole sample was 8.7% or 6.1%, according to the Modification of Diet in Renal Disease or the Chronic Kidney Disease-Epidemiology Collaboration equations, respectively. Subjects with lower estimated glomerular filtration rate were older, more obese, more often female, had worse obstructive sleep apnea and more co-morbidities (P<0.001, each). With both equations, independent predictors of estimated glomerular filtration rate <60 were: chronic heart failure; female gender; systemic hypertension; older age; higher body mass index; and worse lowest nocturnal oxygen saturation. It was concluded that in obstructive sleep apnea, chronic kidney disease is largely predicted by co-morbidities and anthropometric characteristics. In addition, severe nocturnal hypoxaemia, even for only a small part of the night, may play an important role as a risk factor for kidney dysfunction.
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| 3. |
- Randerath, Winfried, et al.
(författare)
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European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea
- 2021
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Ingår i: European Respiratory Review. - : ERS Publications. - 0905-9180 .- 1600-0617. ; 30:162
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Tidskriftsartikel (refereegranskat)abstract
- Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have been refined or reconsidered. In this European Respiratory Society (ERS) guideline on non-continuous positive airway pressure (CPAP) therapies for OSA, we present recommendations determined by a systematic review of the literature. It is an update of the 2011 ERS statement on non-CPAP therapies, advanced into a clinical guideline. A multidisciplinary group of experts, including pulmonary, surgical, dentistry and ear-nose-throat specialists, methodologists and patient representatives considered the most relevant clinical questions (for both clinicians and patients) relating to the management of OSA. Eight key clinical questions were generated and a systematic review was conducted to identify published randomised clinical trials that answered these questions. We used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the quality of the evidence and the strength of recommendations. The resulting guideline addresses gastric bypass surgery, custom-made dual-block mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillo-mandibular osteotomy, carbonic anhydrase inhibitors and positional therapy. These recommendations can be used to benchmark quality of care for people with OSA across Europe and to improve outcomes.
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| 4. |
- RODENSTEIN, DANIEL, et al.
(författare)
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Driving in Europe: the need of a common policy for drivers with obstructive sleep apnoea syndrome
- 2008
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Ingår i: Journal of sleep research. - : Wiley. - 1365-2869 .- 0962-1105. ; 17:3, s. 281-284
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Tidskriftsartikel (refereegranskat)abstract
- Obstructive sleep apnoea syndrome (OSA) increases the risk of motor vehicle crashes, and of all medical disorders, has greatest risk in this respect. There is no consistency in the way OSA is considered by the national 'Physical Fitness to Drive' legislations within the 27 member countries of the European Union (EU), and most ignore OSA. This is further reflected by the absence of any reference to OSA in Annex III of the Directive 91/439/EEC, harmonizing Driving License regulations in the EU. A recent meeting brought together experts from several European and other countries, together with a representative of the European Commission. They discussed the best way to design and implement a uniform policy within Europe, for OSA and driving. It was agreed that: (i) other forms of pathological sleepiness be included, (ii) it covers both private and professional drivers, (iii) police accident report forms should explicitly consider sleepiness as a potential cause, (iv) sleep-wake education should be incorporated into the mandatory program of continuous education for professional drivers, ideally from 2010, (v) driver screening methods should contain questions on sleepiness at the wheel, habitual snoring and witnessed apneas during sleep, as well as the Epworth Sleepiness Score and Body Mass Index and (vi) following effective and efficient treatment, patients should be permitted to drive. In the light of medical, scientific and technical progress, EU procedures exist to enable the rapid modification of existing legislation. If such a procedure could be enacted for these aspects of driver sleepiness, then roads would be safer for 400 million people.
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