Sleep Apnea Syndromes: Coleman J

Morgenthaler TI, Kapen S, Lee-Chiong T, Alessi C, Boehlecke B, Brown T, Coleman J, Friedman L, Kapur V, Owens J, Pancer J, Swick T, Anonymous00044, Anonymous00045. · Sleep Disorders Center, Pulm Crit Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. · Sleep. · Pubmed #16944671 No free full text.

Abstract: Therapies for obstructive sleep apnea other than positive airway pressure, oral appliances, and surgical modifications of the upper airway are reviewed in this practice parameter. Several of these therapies such as weight loss and positional therapy hold some promise. Others, such as serotonergic agents, may gain credibility in the future but lack well-designed clinical trials. No practice parameters could be developed for a number of possible therapeutic modalities that had little or no evidence-based data on which to form a conclusion. The role of an organized, targeted weight-loss program either as a single therapy or as a supplement to PAP needs to be clarified. Although bariatric surgery is increasingly performed for refractory medically complicated obesity, its long-term effectiveness in treatment of obstructive sleep apnea in morbidly obese patients is not yet demonstrated. Positional therapy, or methods for preventing sleep in the supine position, has probably been underutilized due to lack of easily measured predictive factors and randomized controlled trials.

Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, Boehlecke B, Brown TM, Coleman J, Friedman L, Kapen S, Kapur VK, Kramer M, Lee-Chiong T, Owens J, Pancer JP, Swick TJ, Wise MS, Anonymous00039. · Stanford University Center of Excellence for Sleep Disorders, Stanford, CA, USA. · Sleep. · Pubmed #16553024 No free full text.

Abstract: Positive airway pressure (PAP) devices are used to treat patients with sleep related breathing disorders (SRBD) including obstructive sleep apnea (OSA). Currently, PAP devices come in three forms: (1) continuous positive airway pressure (CPAP), (2) bilevel positive airway pressure (BPAP), and (3) automatic self-adjusting positive airway pressure (APAP). After a patient is diagnosed with OSA, the current standard of practice involves performing full, attended polysomnography during which positive pressure is adjusted to determine optimal pressure for maintaining airway patency. This titration is used to find a fixed single pressure for subsequent nightly usage. A task force of the Standards of Practice Committee of the American Academy of Sleep Medicine reviewed the available literature. Based on this review, the Standards of Practice Committee developed these practice parameters as a guideline for using CPAP and BPAP appropriately (an earlier review and practice parameters for APAP was published in 2002). Major conclusions and current recommendations are as follows: 1) A diagnosis of OSA must be established by an acceptable method. 2) CPAP is effective for treating OSA. 3) Full-night, attended studies performed in the laboratory are the preferred approach for titration to determine optimal pressure; however, split-night, diagnostic-titration studies are usually adequate. 4) CPAP usage should be monitored objectively to help assure utilization. 5) Initial CPAP follow-up is recommended during the first few weeks to establish utilization pattern and provide remediation if needed. 6) Longer-term follow-up is recommended yearly or as needed to address mask, machine, or usage problems. 7) Heated humidification and a systematic educational program are recommended to improve CPAP utilization. 8) Some functional outcomes such as subjective sleepiness improve with positive pressure treatment in patients with OSA. 9) CPAP and BPAP therapy are safe; side effects and adverse events are mainly minor and reversible. 10) BPAP may be useful in treating some forms of restrictive lung disease or hypoventilation syndromes associated with hypercapnia.

Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Owens J, Pancer JP, Anonymous00038. · Stanford University Center of Excellence for Sleep Disorders, CA, USA. · Sleep. · Pubmed #16494092 No free full text.

Abstract: These practice parameters are an update of the previously published recommendations regarding use of oral appliances in the treatment of snoring and Obstructive Sleep Apnea (OSA). Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OAs. Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures. Follow-up polysomnography or an attended cardiorespiratory (Type 3) sleep study is needed to verify efficacy, and may be needed when symptoms of OSA worsen or recur. Patients with OSA who are treated with oral appliances should return for follow-up office visits with the dental specialist at regular intervals to monitor patient adherence, evaluate device deterioration or maladjustment, and to evaluate the health of the oral structures and integrity of the occlusion. Regular follow up is also needed to assess the patient for signs and symptoms of worsening OSA. Research to define patient characteristics more clearly for OA acceptance, success, and adherence is needed.

Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M. · Stanford University Center of Excellence for Sleep Disorders, Stanford, CA, USA. · Sleep. · Pubmed #16171294 No free full text.

Abstract: These practice parameters are an update of the previously-published recommendations regarding the indications for polysomnography and related procedures in the diagnosis of sleep disorders. Diagnostic categories include the following: sleep related breathing disorders, other respiratory disorders, narcolepsy, parasomnias, sleep related seizure disorders, restless legs syndrome, periodic limb movement sleep disorder, depression with insomnia, and circadian rhythm sleep disorders. Polysomnography is routinely indicated for the diagnosis of sleep related breathing disorders; for continuous positive airway pressure (CPAP) titration in patients with sleep related breathing disorders; for the assessment of treatment results in some cases; with a multiple sleep latency test in the evaluation of suspected narcolepsy; in evaluating sleep related behaviors that are violent or otherwise potentially injurious to the patient or others; and in certain atypical or unusual parasomnias. Polysomnography may be indicated in patients with neuromuscular disorders and sleep related symptoms; to assist in the diagnosis of paroxysmal arousals or other sleep disruptions thought to be seizure related; in a presumed parasomnia or sleep related seizure disorder that does not respond to conventional therapy; or when there is a strong clinical suspicion of periodic limb movement sleep disorder. Polysomnography is not routinely indicated to diagnose chronic lung disease; in cases of typical, uncomplicated, and noninjurious parasomnias when the diagnosis is clearly delineated; for patients with seizures who have no specific complaints consistent with a sleep disorder; to diagnose or treat restless legs syndrome; for the diagnosis of circadian rhythm sleep disorders; or to establish a diagnosis of depression.

Coleman J, Bick PA. · Nashville Ear, Nose, and Throat Clinic, Nashville, Tennessee 37203-1632, USA. · Otolaryngol Clin North Am. · Pubmed #10385537 No free full text.

Abstract: Treatment of airway collapse in the retrolingual airway for obstructive sleep apnea syndrome and snoring has been a frequently frustrating exercise. There are several procedures that have been used with varying degrees of success for some time. These procedures include genioglossus advancement and hyoid suspension, as well as various forms of lingual plasty and lingual reduction. A new technique was introduced at the 1998 meeting of the American Academy of Otolaryngology-Head and Neck Surgery in San Antonio that consisted of using a suspension screw to support the hypopharyngeal soft tissues, specifically, the base of the tongue, to prevent its posterior displacement during sleep. Some of the initial results of these studies have been promising and are reviewed here.

Coleman J, Rathfoot C. · Nashville Ear, Nose, and Throat Clinic, Nashville, Tennessee 37203-1632, USA. · Otolaryngol Clin North Am. · Pubmed #10385536 No free full text.

Abstract: In the surgical management of snoring and sleep apnea, surgery to the oropharynx was the initial procedure used to treat sleep-related disorders. This article reviews both the various procedures available for this and the benefits and drawbacks of these procedures so the practitioner may be able to choose which type would be most beneficial for a particular patient.

Coleman J. · Nashville Ear, Nose, and Throat Clinic, Nashville, Tennessee 37203-1632, USA. · Otolaryngol Clin North Am. · Pubmed #10385534 No free full text.

Abstract: The initial reports of treating obstructive sleep apnea using the uvulopalatopharyngoplasty were encouraging; however, as further trials of this procedure were reported, it began to show disappointing results. It was found that the retropalatal airway was not the only site of obstruction and procedures would need to be developed that would address obstruction in the other portions of the airway involved, notably in the retrolingual or hypopharyngeal portion of the airway. It was first reported by oral surgeons that mandibular surgery could also improve sleep apnea and through their work and the work of others, techniques have been developed using skeletal surgery to enhance the patency of the airway during sleep. This article describes some of these techniques and their indications, complications, and results.

Coleman J. · Nashville Ear, Nose, and Throat Clinic, Nashville, Tennessee 37203-1632, USA. · Otolaryngol Clin North Am. · Pubmed #10385533 No free full text.

Abstract: The complications of sleep-disordered breathing can be separated into two categories. First are those disorders that primarily are brought on by the sleep disorder itself. The second category is those pre-existing medical problems that are aggravated by the sleep disorder. This article examines the consequences of obstructive breathing disorders during sleep and reviews some of the current theories as to the pathophysiology of those problems directly resulting from the sleep disorder.

Coleman J. · Nashville Ear, Nose, and Throat Clinic, Nashville, Tennessee 37203-1632, USA. · Otolaryngol Clin North Am. · Pubmed #10385532 No free full text.

Abstract: Although the polysomnographic findings of sleep-disordered breathing in children are similar to those in adults, the underlying causes will vary significantly from adults, depending on whether one is dealing with a newborn, infant, or child. How they react to the disease process is also at times different than seen in the adult and subsequent testing and treatment will also vary considerably. These differences and similarities are reviewed in this article.

Coleman J. · Nashville Ear, Nose, and Throat Clinic, Nashville, Tennessee 37203-1632, USA. · Otolaryngol Clin North Am. · Pubmed #10385531 No free full text.

Abstract: Diagnosis of obstructive sleep apnea has been termed a laboratory diagnosis rather than a clinical diagnosis because one may not be able to make the diagnosis based on the history and physical examination alone. The polysomnogram was developed to give clinicians and researchers objective data on physiologic events occurring during the patient's sleep. From this, obstructive breathing patterns can be diagnosed and if pathologic, appropriate treatment can be instituted. Although the polysomnogram has been the gold standard for diagnosis for more than two decades, it is an expensive and time-consuming procedure. Current technologies for polysomnogram are reviewed, as well as proposals for alternatives that may be more cost and time effective.

Coleman J. · Nashville Ear, Nose, and Throat Clinic, Nashville, Tennessee 37203-1632, USA. · Otolaryngol Clin North Am. · Pubmed #10385530 No free full text.

Abstract: Otolaryngologists deal primarily with the disorders of obstructive sleep apnea and primary snoring. It is important to realize that although these two disorders are common in the general population, they make up only a small segment of the entire field of sleep disorders medicine. This article attempts to introduce the otolaryngologist to the complexity of this field, help to gain respect and understanding of those practitioners dealing with this entire field, and learn why there is such a broad appeal of this field of medicine to so many subspecialists. Also presented are a table describing the classification of sleep disorders and a short tribute to those individuals who founded this relatively new field of medicine.

Meoli AL, Rosen CL, Kristo D, Kohrman M, Gooneratne N, Aguillard RN, Fayle R, Troell R, Kramer R, Casey KR, Coleman J, Anonymous00019, Anonymous00020. · St. John's Regional Medical Center, Joplin, MO, USA. · Sleep. · Pubmed #14746392 No free full text.

Abstract: PURPOSE: To help practitioners avoid adverse perioperative events in patients with obstructive sleep-disordered breathing. REVIEWERS: Members of the American Academy of Sleep Medicine's Clinical Practice Review Committee. METHODS: A search of MEDLINE database using MeSH terms apnea, obstructive sleep apnea and anesthesia was conducted in October 2001. This review focuses on articles published in English between 1985 and 2001 that pertain to non-upper airway surgery in obstructive sleep apnea patients. RESULTS AND CONCLUSIONS: Scientific literature regarding the perioperative risk and best management techniques for OSAHS patients is scanty and of limited quality. There is insufficient information to develop an AASM standards of practice recommendation. Therefore, the Clinical Practice Review Committee (CPRC) used the available data to make this statement based upon a consensus of clinical experience and published peer-reviewed medical evidence. Important components of the perioperative management of OSAHS patients include a high degree of clinical suspicion, control of the airway throughout the perioperative period, judicious use of medications, and appropriate monitoring. Further research is needed to define the magnitude of risk and optimal perioperative care.