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Sleep related breathing disorders (SRBD) in patients with chiari type I malformation before and after posterior fossa decompression
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Abstracts / Sleep Medicine 14S (2013) e93–e164
decrease in sleep efficiency due to wake after sleep onset with preservation in normal range of sleep stages proportions. Fifty-three patients showed a pathological respiratory disturbance index (RDI Y5) and in 29.5% moderate to severe range (RDIY15). The respiratory alterations were predominantly obstructive hypopneas during the supine position. Twenty-two patients showed PLMs > 15. Conclusion: Patients with CM-I had an increased prevalence of fragmented sleep and sleep disordered breathing respect to normal population. These alterations may not be reported by patients and can only be detected by performing a specific sleep study. Its detection may help to screen patients and to establish surgical indications.. Acknowledgements: This work has been supported in part by the Fondo de Investigacio´n Sanitaria (Instituto de Salud Carlos III) with grant PI07/0681, co-financed by the European Regional Development Fund (ERDF) and awarded to Dr. M.A. Poca. http://dx.doi.org/10.1016/j.sleep.2013.11.272
Sleep related breathing disorders (SRBD) in patients with chiari type I malformation before and after posterior fossa decompression A. Ferre 1, M. Poca 2, M. De La Calzada 3, D. Moncho 4, O. Romero 1, J. Sahuquillo 2 1 Hospital Vall d’Hebron, Multidisciplinary Sleep Unit, Clinica Neurophsyiology, Spain 2 Hospital Vall d’Hebron, Neurosurgery Service, Investigation Unit of Neurosurgery and Neurotrauamtology, Spain 3 Hospital Vall d’Hebron, Investigation Unit of Neurosurgery and Neurotrauamtology, Spain 4 Hospital Vall d’Hebron, Clinical Neurophysiology, Spain
Introduction: The symptoms in Chiari malformation type I (CM-I) have different presentations, and depends on certain malformation components. Posterior Fosse Decompression (PFD) is certainly first line therapy in CM-I. There are a few case reports demonstrating that effective surgical treatment of CM leads to normalization of SRBD, and the recurrence of SRBD may be an early indicator of recurrence of CM. The aim of this study is to examine the occurrence of sleep apneas in patients with CM I and the impact of decompression surgery on sleep- disordered breathing. Materials and methods: Correlative 22 patients with CM-I (11 women and 10 men) with middle age of 39,214,2 years with pathological nocturnal polisomnography (PSG) (RDI > 5) underwent a new PSG 3 to 6 month after PFD. Results: When we compare sleepiness and Sleep architecture before and after surgery we did not obtain statistically significantly differences in the sleep parameters. Respiratory sleep disorders were predominantly obstructive hypopnea during the supine position. We observe a significant improvement of the total sleep time RDI after surgery (27.5 ± 21.9 & 13.2 ± 18.3), in REM-RDI (30.2 ± 24.9 & 14.1 ± 20.2), and NREM-RDI (22.5 ± 25.0 & 5.7 ± 10.6). After surgery we obtain normal values in RDI (<5) in 11 patients. Conclusion: Posterior decompression fosse in Patients with CM-I had a significant improvement of sleep and sleep disordered breathing. Acknowledgements: This work has been supported in part by the Fondo de Investigación Sanitaria (Instituto de Salud Carlos III) with grant PI07/0681, co-financed by the European Regional Development Fund (ERDF) and awarded to Dr. M.A. Poca. http://dx.doi.org/10.1016/j.sleep.2013.11.273
Positional sleep apnea therapy – Our experience A. Ferreira, A. Vale, D. Rocha, E. Matos, T. Calvo Centro Hospitalar de Trás-Os-Montes e Alto Douro (CHTMAD), Portugal
Introduction: In individuals with obstructive sleep apnea (SAOS), the body position during sleep can influence the obstructive events in 50–60% of patients. In these cases, the apnea-hypopnea index (AHI) is higher in the supine position than in the non-supine position. Some authors classify the duplication (or more) of obstructive events in supine position as positional sleep apnea. Studies are not enlightening, and positional therapy is controversial, with some authors advocating inefficiency. In the reviewed studies, the positional apnea patient is reported to be younger, with lower Body Mass Index (BMI), AHI and Respiratory Disturbance Index, with better sleep quality and less daytime sleepiness complaints, compared to non positional patients. Materials and methods: We perform a retrospective study, based on clinical process review, of positional sleep apnea patients who realize positional therapy placing a tennis ball in their nightclothes, making supine position uncomfortable. For data analysis, we used IBM SPSS 20. Results: In our sleep laboratory, we analyzed 10 positional sleep apnea patients, treated with positional therapy. Most patients were male (n = 9), with mean age of 56 ± 14.5 years. The mean Body Mass Index of 27 ± 3.5 and mean Epworth Scale of 10.1 ± 4.7. Mean AHI was 19.3 ± 5.3 events/h and oxygen desaturation index of 19.1 ± 12.0 per hour. Snoring was the first clinical sign of disease, followed by daytime sleepiness. After 3 mounts of positional therapy treatment, all patients perform a home sleep study, witch showed a significant reduction in obstructive events, with mean AHI of 5.3 ± 2.7 events/h and oxygen desaturation index of 7.3 ± 5.3 per hour. Only 4 patients claim to use positional therapy daily; one refused therapy and another is currently using CPAP for keeping daytime sleepiness with positional technique. It was interesting to realize how positional therapy was performed, with different and imaginative solutions. Currently, there are marketed devices all over the world to improve positional therapy technique. In our opinion, the main disadvantage of this therapy is the lack of control over treatment adherence. Further, some patients think this therapy is embarrassing, discrediting its therapeutic potential. Conclusion: Despite the low number of patients involved in this study, the results were positive, with improvement of sleep events in patients with positional sleep apnea who fulfill the positional therapy. Acknowledgements: We thank all the team of the CHTMAD sleep lab, as well as the patients in this study. http://dx.doi.org/10.1016/j.sleep.2013.11.274
Mandibular advancement splint for the treatment of obstructive sleep apnea C. Ferreira, F. Teixeira, L. Vaz Rodrigues, F. Carvalho, J. Moutinho Dos Santos Centro de Medicina do Sono, Hospital Geral – Centro Hospitalar e Universitário de Coimbra, Portugal
Introduction: Mandibular Advancement Splint (MAS) is a simpler alternative to continuous positive airway pressure (CPAP) for the treatment of mild and moderate OSA. The aim of the study was to evaluate the effectiveness of MAS for the treatment of OSA and determine if sleep apnea symptoms, cephalometric measurements and sleep study data are associated with MAS treatment outcome.
Abstracts / Sleep Medicine 14S (2013) e93–e164
decrease in sleep efficiency due to wake after sleep onset with preservation in normal range of sleep stages proportions. Fifty-three patients showed a pathological respiratory disturbance index (RDI Y5) and in 29.5% moderate to severe range (RDIY15). The respiratory alterations were predominantly obstructive hypopneas during the supine position. Twenty-two patients showed PLMs > 15. Conclusion: Patients with CM-I had an increased prevalence of fragmented sleep and sleep disordered breathing respect to normal population. These alterations may not be reported by patients and can only be detected by performing a specific sleep study. Its detection may help to screen patients and to establish surgical indications.. Acknowledgements: This work has been supported in part by the Fondo de Investigacio´n Sanitaria (Instituto de Salud Carlos III) with grant PI07/0681, co-financed by the European Regional Development Fund (ERDF) and awarded to Dr. M.A. Poca. http://dx.doi.org/10.1016/j.sleep.2013.11.272
Sleep related breathing disorders (SRBD) in patients with chiari type I malformation before and after posterior fossa decompression A. Ferre 1, M. Poca 2, M. De La Calzada 3, D. Moncho 4, O. Romero 1, J. Sahuquillo 2 1 Hospital Vall d’Hebron, Multidisciplinary Sleep Unit, Clinica Neurophsyiology, Spain 2 Hospital Vall d’Hebron, Neurosurgery Service, Investigation Unit of Neurosurgery and Neurotrauamtology, Spain 3 Hospital Vall d’Hebron, Investigation Unit of Neurosurgery and Neurotrauamtology, Spain 4 Hospital Vall d’Hebron, Clinical Neurophysiology, Spain
Introduction: The symptoms in Chiari malformation type I (CM-I) have different presentations, and depends on certain malformation components. Posterior Fosse Decompression (PFD) is certainly first line therapy in CM-I. There are a few case reports demonstrating that effective surgical treatment of CM leads to normalization of SRBD, and the recurrence of SRBD may be an early indicator of recurrence of CM. The aim of this study is to examine the occurrence of sleep apneas in patients with CM I and the impact of decompression surgery on sleep- disordered breathing. Materials and methods: Correlative 22 patients with CM-I (11 women and 10 men) with middle age of 39,214,2 years with pathological nocturnal polisomnography (PSG) (RDI > 5) underwent a new PSG 3 to 6 month after PFD. Results: When we compare sleepiness and Sleep architecture before and after surgery we did not obtain statistically significantly differences in the sleep parameters. Respiratory sleep disorders were predominantly obstructive hypopnea during the supine position. We observe a significant improvement of the total sleep time RDI after surgery (27.5 ± 21.9 & 13.2 ± 18.3), in REM-RDI (30.2 ± 24.9 & 14.1 ± 20.2), and NREM-RDI (22.5 ± 25.0 & 5.7 ± 10.6). After surgery we obtain normal values in RDI (<5) in 11 patients. Conclusion: Posterior decompression fosse in Patients with CM-I had a significant improvement of sleep and sleep disordered breathing. Acknowledgements: This work has been supported in part by the Fondo de Investigación Sanitaria (Instituto de Salud Carlos III) with grant PI07/0681, co-financed by the European Regional Development Fund (ERDF) and awarded to Dr. M.A. Poca. http://dx.doi.org/10.1016/j.sleep.2013.11.273
Positional sleep apnea therapy – Our experience A. Ferreira, A. Vale, D. Rocha, E. Matos, T. Calvo Centro Hospitalar de Trás-Os-Montes e Alto Douro (CHTMAD), Portugal
Introduction: In individuals with obstructive sleep apnea (SAOS), the body position during sleep can influence the obstructive events in 50–60% of patients. In these cases, the apnea-hypopnea index (AHI) is higher in the supine position than in the non-supine position. Some authors classify the duplication (or more) of obstructive events in supine position as positional sleep apnea. Studies are not enlightening, and positional therapy is controversial, with some authors advocating inefficiency. In the reviewed studies, the positional apnea patient is reported to be younger, with lower Body Mass Index (BMI), AHI and Respiratory Disturbance Index, with better sleep quality and less daytime sleepiness complaints, compared to non positional patients. Materials and methods: We perform a retrospective study, based on clinical process review, of positional sleep apnea patients who realize positional therapy placing a tennis ball in their nightclothes, making supine position uncomfortable. For data analysis, we used IBM SPSS 20. Results: In our sleep laboratory, we analyzed 10 positional sleep apnea patients, treated with positional therapy. Most patients were male (n = 9), with mean age of 56 ± 14.5 years. The mean Body Mass Index of 27 ± 3.5 and mean Epworth Scale of 10.1 ± 4.7. Mean AHI was 19.3 ± 5.3 events/h and oxygen desaturation index of 19.1 ± 12.0 per hour. Snoring was the first clinical sign of disease, followed by daytime sleepiness. After 3 mounts of positional therapy treatment, all patients perform a home sleep study, witch showed a significant reduction in obstructive events, with mean AHI of 5.3 ± 2.7 events/h and oxygen desaturation index of 7.3 ± 5.3 per hour. Only 4 patients claim to use positional therapy daily; one refused therapy and another is currently using CPAP for keeping daytime sleepiness with positional technique. It was interesting to realize how positional therapy was performed, with different and imaginative solutions. Currently, there are marketed devices all over the world to improve positional therapy technique. In our opinion, the main disadvantage of this therapy is the lack of control over treatment adherence. Further, some patients think this therapy is embarrassing, discrediting its therapeutic potential. Conclusion: Despite the low number of patients involved in this study, the results were positive, with improvement of sleep events in patients with positional sleep apnea who fulfill the positional therapy. Acknowledgements: We thank all the team of the CHTMAD sleep lab, as well as the patients in this study. http://dx.doi.org/10.1016/j.sleep.2013.11.274
Mandibular advancement splint for the treatment of obstructive sleep apnea C. Ferreira, F. Teixeira, L. Vaz Rodrigues, F. Carvalho, J. Moutinho Dos Santos Centro de Medicina do Sono, Hospital Geral – Centro Hospitalar e Universitário de Coimbra, Portugal
Introduction: Mandibular Advancement Splint (MAS) is a simpler alternative to continuous positive airway pressure (CPAP) for the treatment of mild and moderate OSA. The aim of the study was to evaluate the effectiveness of MAS for the treatment of OSA and determine if sleep apnea symptoms, cephalometric measurements and sleep study data are associated with MAS treatment outcome.