Therapeutic alternatives with CPAP in obstructive sleep apnea

Journal of Mind and Medical Sciences Volume 6 | Issue 2 Article 2 2019 Therapeutic alternatives with CPAP in obstructive sleep apnea Corina E. Budin Lorena Ciumarnean Anca Maierean Ruxandra Rajnovean Bianca D. Gergely See next page for additional authors Follow this and additional works at: https://scholar.valpo.edu/jmms Part of the Internal Medicine Commons, Mental and Social Health Commons, and the Sleep Medicine Commons Recommended Citation Budin, Corina E.; Ciumarnean, Lorena; Maierean, Anca; Rajnovean, Ruxandra; Gergely, Bianca D.; Man, Milena; Aluas, Maria; Cozma, Angela; and Bordea, Roxana I. (2019) "Therapeutic alternatives with CPAP in obstructive sleep apnea," Journal of Mind and Medical Sciences: Vol. 6 : Iss. 2 , Article 2. DOI: 10.22543/7674.62.P181189 Available at: https://scholar.valpo.edu/jmms/vol6/iss2/2 This Review Article is brought to you for free and open access by ValpoScholar. It has been accepted for inclusion in Journal of Mind and Medical Sciences by an authorized administrator of ValpoScholar. For more information, please contact a ValpoScholar staff member at . Therapeutic alternatives with CPAP in obstructive sleep apnea Authors Corina E. Budin, Lorena Ciumarnean, Anca Maierean, Ruxandra Rajnovean, Bianca D. Gergely, Milena Man, Maria Aluas, Angela Cozma, and Roxana I. Bordea This review article is available in Journal of Mind and Medical Sciences: https://scholar.valpo.edu/jmms/vol6/iss2/2 https://scholar.valpo.edu/jmms/ https://proscholar.org/jmms/ ISSN: 2392-7674 J Mind Med Sci. 2019; 6(2): 181-189 doi: 10.22543/7674.62.P181189 Received for publication: June 11, 2019 Accepted: July 21, 2019 Review Therapeutic alternatives with CPAP in obstructive sleep apnea Corina Eugenia Budin1, Lorena Ciumarnean2, Anca Maierean1, Ruxandra Rajnovean3, Bianca Domokos Gergely3, Milena Man3, Maria Aluas4, Angela Cozma2, Roxana Ioana Bordea5 1 Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania Iuliu Hatieganu University of Medicine and Pharmacy, Department of Internal Medicine, Cluj Napoca 3 Iuliu Hatieganu University of Medicine and Pharmacy, Department of Pneumology, Cluj Napoca 4 Iuliu Hatieganu University of Medicine and Pharmacy, Department of Medical Education, Cluj Napoca 5 Iuliu Hatieganu University of Medicine and Pharmacy, Dentistry Faculty, Cluj Napoca, Romania 2 Abstract Obstructive Sleep Apnea (OSA), characterized by airflow cessation (apnea) or reduction (hypopnea) due to repeated pharyngeal obstructions during sleep, causes frequent disruption of sleep and hypoxic events. The condition is linked to many adverse health related consequences, such as neurocognitive and cardiovascular disorders, and metabolic syndrome. OSA is a chronic condition requiring long-term treatment, so treatment using continuous positive airway pressure (CPAP) has become the gold standard in cases of moderate or severe OSA. However, its effectiveness is influenced by patients’ adherence. Surgery for OSA or treatment with oral appliances can be successful in selected patients, but for the majority, lifestyle changes such as exercise and dietary control may prove useful. However, exercise training remains under-utilized by many clinicians as an alternative treatment for OSA. Other interventions such as oral appliance (OA), upper way stimulation, and oropharyngeal exercises are used in OSA. Because the benefit of all these techniques is heterogeneous, the major challenge is to associate specific OSA therapies with the maximum efficacy and the best patient compliance. Keywords  Highlights ✓ Even though the role of OA is similar to that of CPAP in clinical practice, clinicians may not achieve the abolition of all obstructive events during sleep by means of OA. OSA, oral appliance, upper way stimulation, oropharyngeal exercises, pulmonary rehabilitation ✓ There is currently an alternative therapy to CPAP or OA for subjects with mild to moderate OSA, consisting in the use of upper airway stimulation devices. To cite this article: Budin CE, Ciumarnean L, Maierean A, Rajnovean R, Gergely BD, Man M, Aluas M, Cozma A, Bordea RI. Therapeutic alternatives with CPAP in obstructive sleep apnea. J Mind Med Sci. 2019; 6(2): 181-189. DOI: 10.22543/7674.62.P181189 *Corresponding author: Anca Maierean, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania; Email: Corina Eugenia Budin et al. Introduction Obstructive sleep apnea is characterized by airflow cessation (apnea) or reduction (hypopnea) due to repeated pharyngeal obstructions during sleep, causing frequent disruption of sleep and hypoxic events. The pathophysiology of OSA varies and includes different underlying mechanisms, such as the effectiveness of the upper airway dilator muscles (genioglossus), the upper airway anatomy, the arousal threshold of the individual, and the inherent stability of the respiratory control system (1). It is well-know that obesity is the most significant risk factor, with other factors such as smoking, alcohol abuse, chronic nasal congestion, male gender, age, and the use of sedative medications playing a significant role in OSA development (2, 3). In addition, OSA is linked to many adverse health-related consequences, such as neurocognitive and cardiovascular disorders, and metabolic syndrome (4, 5, 6). OSA has become a chronic condition which requires long-term treatment, so treatment using continuous positive airway pressure (CPAP) has become the gold standard in cases of moderate or severe OSA, but its effectiveness is influenced by patients’ adherence. Surgery for OSA or treatment with oral appliances can be successful in selected patients (4), but for the majority, lifestyle changes such as exercise and dietary control may also prove useful. However, exercise training remains under-utilized by many clinicians as the alternative treatment for OSA (7). Other interventions such as oral appliance (OA), upper way stimulation, and oropharyngeal exercises are used in OSA. Discussion Prevalence OSA has been recognized as a very common pathology in recent years, but it still remains undiagnosed and untreated in many cases. Apnea-hypopnea index (AHI) quantifies both sleep apnea severity and the number of apneal or hypopneal obstructive events per hour of sleep. The prevalence of OSA was found to be 24% in men and 9% in women aged 30-60 years, thus defining OSA as an AHI greater than 5 events/hour in the Wisconsin Sleep Cohort in the United States of America. The values of prevalence worldwide do not vary significantly, thus confirming that OSA is as common in the developing world as in the occidental society (8). In Europe, the prevalence may be even greater, taking into account that modern diagnostic techniques are used. For example, in a Swiss study including over 2,000 subjects with the diagnosis of moderate-severe OSA, the prevalence was 23.4% in females and 49% in males (9). 182 Risk Factors The highest risk factor for OSA (...truncated)