scholarly journals Canadian Thoracic Society 2011 Guideline Update: Diagnosis and Treatment of Sleep Disordered Breathing

2011 ◽  
Vol 18 (1) ◽  
pp. 25-47 ◽  
Author(s):  
John Fleetham ◽  
Najib Ayas ◽  
Douglas Bradley ◽  
Michael Fitzpatrick ◽  
Thomas K Oliver ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Sleep Apnea Syndrome ◽  
Central Sleep Apnea ◽  
Diagnosis And Treatment ◽  
Obstructive Sleep ◽  
Disordered Breathing

The Canadian Thoracic Society (CTS) published an executive summary of guidelines for the diagnosis and treatment of sleep disordered breathing in 2006/2007. These guidelines were developed during several meetings by a group of experts with evidence grading based on committee consensus. These guidelines were well received and the majority of the recommendations remain unchanged. The CTS embarked on a more rigorous process for the 2011 guideline update, and addressed eight areas that were believed to be controversial or in which new data emerged. The CTS Sleep Disordered Breathing Committee posed specific questions for each area. The recommendations regarding maximum assessment wait times, portable monitoring, treatment of asymptomatic adult obstructive sleep apnea patients, treatment with conventional continuous positive airway pressure compared with automatic continuous positive airway pressure, and treatment of central sleep apnea syndrome in heart failure patients replace the recommendations in the 2006/2007 guidelines. The recommendations on bariatric surgery, complex sleep apnea and optimum positive airway pressure technologies are new topics, which were not covered in the 2006/2007 guidelines.

Introduction to Sleep-Disordered Breathing and Treatment

2021 ◽  
pp. 509-528
Author(s):  
Joanne S. Martires ◽  
Reuben Ram ◽  
Jeanne Wallace
Keyword(s):  
Sleep Apnea ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Sleep Apnea Syndrome ◽  
Central Sleep Apnea ◽  
Sleep Related Breathing Disorders ◽  
Adaptive Servo Ventilation ◽  
Breathing Disorders ◽  
Disordered Breathing

Sleep-related breathing disorders encompass a wide range of problems that occur during sleep. The most common sleep-related breathing disorder is obstructive sleep apnea syndrome (OSAS). OSAS is increasingly prevalent, underdiagnosed and can lead to significant daytime sleepiness and disability. Continuous positive airway pressure (CPAP) is the treatment of choice for OSAS but lack of adherence to CPAP is rampant. Supportive care, education, and motivational enhancement programs do show promise in improving compliance. Alternatives to CPAP such as oral appliances, hypoglossal nerve stimulation, and myofunctional therapy have not been proved as efficacious but may provide some benefit. In the future, personalized treatment may be the best way to approach this condition. Central sleep apnea and hypoventilation are other forms of sleep-related breathing disorders. Treatment largely depends on the underlying condition but may require the use of advanced modes of noninvasive ventilation such as adaptive servo-ventilation, bilevel positive airway pressure, and volume-assured pressure support. Treatment of sleep-related breathing disorders is complex and includes seeking patient input, understanding barriers to treatment, and reevaluating patients after treatment is initiated. Successful treatment of sleep-disordered breathing can lead to improvements in daytime function, quality of life, and overall health.

scholarly journals Apnoea–hypopnoea indices determined via continuous positive airway pressure (AHI-CPAPflow) versus those determined by polysomnography (AHI-PSGgold): a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044499
Author(s):  
Fanny Bertelli ◽  
Carey Meredith Suehs ◽  
Jean Pierre Mallet ◽  
Marie Caroline Rotty ◽  
Jean Louis Pepin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

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