Selma Firat Guven

The prevalence of obstructive sleep apnea in patients with difficult-to-treat asthma

OBJECTIVES Obstructive sleep apnea (OSA) occurs more commonly in asthma patients than in the general population and can complicate asthma management. The aim of this study was to evaluate the presence of OSA in patients with difficult-to-treat asthma (DTA) and to investigate the sleep quality in these patients. METHODS Patients with DTA were recruited from the adult allergy clinic of a tertiary care hospital. After completing the Sleep Questionnaire and Epworth Sleepiness Scale, all participants underwent overnight polysomnography. The demographic and asthma severity assessments included the following measures: the age at diagnosis, duration of illness, smoking and atopy status, results of pulmonary function tests, number of asthma control medications used, and number of hospitalizations and emergency room visits because of asthma and analgesic hypersensitivity according to apnea-hypopnea index (AHI) scores. RESULTS We analyzed 47 (M:9/F:38) DTA patients with a mean age of 48.74±9.45 years. The mean duration of asthma was 9.17±6.5 years. Twenty-four (51.1%) patients were atopic. The analgesic hypersensitivity rate was 27.7%. Fourteen patients (29.8%) were former smokers and 2 patients were current smokers. Sleep quality was impaired in all patients. Thirty-five patients (74.5%) had OSA, 11 of whom had mild OSA, and 24 patients had moderate-severe OSA. The presence of OSA was not statistically correlated with asthma characteristics. CONCLUSION The study showed that there is a remarkably high prevalence of OSA in DTA. Although no statistically significant relationship between the presence of OSA and clinical asthma characteristics was identified, all DTA patients should be assessed for OSA.

Management of Obstructive Sleep Apnea in an Edentulous Lower Jaw Patient with a Mandibular Advancement Device

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with periodic reduction or cessation of airflow during sleep. It is associated with loud snoring, disrupted sleep, and witnessed apneas. Treatment of OSA varies from simple measures such as oral appliances and nasal continuous positive airway pressure (CPAP) to surgical procedures like uvulopalatopharyngoplasty and tracheostomy. Oral appliances are a viable nonsurgical treatment alternative in patients with OSA, of which mandibular advancement devices are most common. Edentulism which contributes to the worsening of OSA reduces the number of available therapeutic strategies and is considered a contraindication to oral appliance therapy. This clinical report describes the treatment of a 63-year-old edentulous OSA patient for whom a mandibular advancement device was designed.

Split-Night Versus Full-Night Polysomnography: Comparison of the First and Second Parts of the Night

BACKGROUND AND OBJECTIVE In a split-night study, the first part consists of standard polysomnography (PSG) for the diagnosis of obstructive sleep apnea syndrome while the second part is used to establish a suitable level of continuous positive airway pressure. The aim of our study was to compare the sleep and respiratory parameters during the first 3 hours of the night with the values found during the remainder of sleep and during the whole night. PATIENTS AND METHODS Forty-five patients were included in the study. Each patient underwent a standard full-night PSG and the PSG data for each patient were divided into 2 periods: PSG1, defined as the initial 3 hours of the total sleep time and PSG2, defined as the remaining period. Sleep and breathing data from PSG1 and PSG2 were then separately computed and compared with each other and with data for the total sleep time (PSGt). RESULTS The percentage of total sleep time in stage III-IV and the apnea-hypopnea index (AHI) were significantly higher and the percentage of time in rapid eye movement (REM) sleep was significantly lower during PSG1 than during PSG2 (P< .001). Similarly, the percentage of time in stage III-IV sleep was significantly higher and the percentage of REM sleep was significantly lower during PSG1 than during PSGt (P< .001), but there was no significant difference in the AHI between PSG1 and PSGt. CONCLUSION The diagnosis for the first 3 hours of the night will give a reliable reflection of the whole night. In addition, optimal positive airway pressure titrated during the second half of the night is also optimal for the first half of the night.

Alternative technique to transfer jaw relations for custom mandibular advancement devices: A case report

Abstract Background: Oral appliance therapy for obstructive sleep apnea can be helpful in mild and moderate cases. This clinical report evaluates the efficacy of a protocol that predicts an optimal jaw position and describes the response of a young OSA patient to treatment. Clinical Presentation: A 27-year-old woman was diagnosed with moderate OSA and had an apnea–hypopnea index (AHI) of 25.8/hr. In order to fabricate a custom device, an alternative procedure to determine the optimal protrusion and vertical positioning of the jaw was applied. After a follow-up period of 14 months, her apnea-hypopnea index (AHI) significantly decreased from 25.8 to 1.0 per hr with the appliance. The total number of respiratory events decreased from 211 to 8. Conclusion: Improved polysomnographic parameters showed that the oral device was efficient in treatment. The advantages of the device in this study are that it is comfortable, economical, and simple to fabricate.