Hypoglossal nerve stimulation for obstructive sleep apnea: updated position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery.

Since the first statement of the German Society of Oto-Rhino-Laryngology, hypoglossal nerve stimulation (HNS) is meanwhile an established treatment option for obstructive sleep apnea (OSA). There are three HNS systems available in Germany which differ in their technical details of the underlying comparable basic principle. For the unilateral HNS with respiratory sensing, several comparative studies, high-volume register analysis and long-term reports exist.

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Hypoglossal nerve stimulation for obstructive sleep apnea - Updated position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Since the first statement of the German Society of Oto-Rhino-Laryngology, hypoglossal nerve stimulation (HNS) is meanwhile an established treatment option for obstructive sleep apnea (OSA). There are three HNS systems available in Germany which differ in their technical details of the underlying comparable basic principle.

Treatment of Cheyne-Stokes respiration with adaptive servoventilation-analysis of patients with regard to therapy restriction.

Purpose: The SERVE-HF study revealed no benefit of adaptive servoventilation (ASV) versus guideline-based medical treatment in patients with symptomatic heart failure, an ejection fraction (EF) ≤45% and a predominance of central events (apnoea-hypopnea Index [AHI] > 15/h). Because both all-cause and cardiovascular mortality were higher in the ASV group, an EF ≤ 45% in combination with AHI 15/h, central apnoea-hyponoea index [CAHI/AHI] > 50% and central apnoea index [CAI] > 10/h were subsequently listed as contraindications for ASV. The intention of our study was to analyse the clinical relevance of this limitation.

[Sleep in the intensive care unit].

Many patients are treated in intensive care units daily, often over a long period of time. Sleep plays a role that should not be underestimated for these patients. Sleep disorders are a relevant problem for intensive care patients and lead to a higher prevalence of delirium in these patients and thus to a longer length of stay in the intensive care unit and to a higher mortality.

Obesity hypoventilation syndrome treated with non-invasive ventilation: Is a switch to CPAP therapy feasible?

Background And Objective: Obesity hypoventilation syndrome (OHS) can be treated with either continuous positive airway pressure (CPAP) or non-invasive ventilation (NIV) therapy; the device choice has important economic and operational implications.

Methods: This multicentre interventional trial investigated the safety and short-term efficacy of switching stable OHS patients who were on successful NIV therapy for ≥3 months to CPAP therapy. Patients underwent an autotitrating CPAP night under polysomnography (PSG); if the ensuing parameters were acceptable, they were sent home on a fixed CPAP for a 4-6-week period.

Effects of continuous positive airway pressure therapy on daytime and nighttime arterial blood pressure in patients with severe obstructive sleep apnea and endothelial dysfunction.

Purpose: A nocturnal non-dipping or rise in blood pressure (BP) is associated with poor cardiovascular outcome. This study aimed to test whether continuous positive airway pressure (CPAP) therapy can reduce nocturnal BP and normalize the 24-h BP profile in patients with severe obstructive sleep apnea (OSA) and erectile dysfunction as a surrogate for endothelial dysfunction (ED).

Patients And Methods: Eighteen consecutive patients with OSA and ED on stable antihypertensive medication (age 55.

CPAP therapy improves erectile function in patients with severe obstructive sleep apnea.

Objectives: Erectile dysfunction (ED) is highly prevalent in obstructive sleep apnea (OSA), however, the effect of continuous positive airway pressure (CPAP) therapy on erectile function has not yet been thoroughly investigated in these patients.

Methods: Ninety-four men with severe OSA (ie, with an apnea-hypopnea-index ≥ 30/h of sleep) were prospectively evaluated for the presence and severity of ED before and after 6-12 months of CPAP therapy. The abbreviated version of the International Index of Erectile Function, (the IIEF-5) was used to rate erectile function.

Effects of respiratory muscle training (RMT) in patients with mild to moderate obstructive sleep apnea (OSA).

Purpose: Different forms of training focusing on the muscles of the upper airways showed limited effects on obstructive sleep apnea (OSA) and/or snoring. We investigated the effect of generalized respiratory muscle training (RMT) in lean patients with mild to moderate OSA.

Methods: Nine male subjects (52.

Effect of a Heated Breathing Tube on Efficacy, Adherence and Side Effects during Continuous Positive Airway Pressure Therapy in Obstructive Sleep Apnea.

Background: Heated breathing tubes were developed to improve heated humidification in continuous positive airway pressure (CPAP) therapy of patients with obstructive sleep apnea syndrome (OSAS).

Objectives: We wanted to investigate the influence of a heated breathing tube on patients' satisfaction with the treatment, the rate of side effects and the adherence to treatment.

Methods: Eighty-eight patients with primarily diagnosed OSAS were treated in a randomized, controlled, single-blind trial for 12 months either with a CPAP system plus conventional heated humidifier or with a CPAP system plus heated humidifier and an integrated heated breathing tube.

Anticyclic modulated ventilation versus continuous positive airway pressure in patients with coexisting obstructive sleep apnea and Cheyne-Stokes respiration: a randomized crossover trial.

Background: Although coexisting obstructive sleep apnea (OSA) and Cheyne-Stokes respiration (CSR) occur frequently in patients with heart diseases, optimal treatment remains unclear. Positive airway pressure (PAP) effectively treats OSA and adaptive servo-ventilation (ASV) has been shown to improve CSR. We compared a new treatment algorithm combining automatic continuous positive airway pressure (APAP) and ASV (anticyclic modulated ventilation, ACMV) versus continuous positive airway pressure (CPAP).

Long-term auto-servoventilation or constant positive pressure in heart failure and coexisting central with obstructive sleep apnea.

Background: The coexistence of obstructive sleep apnea (OSA) and central sleep apnea (CSA) and Cheyne-Stokes respiration (CSR) is common in patients with heart failure (HF). While CPAP improves CSA/CSR by about 50%, maximal suppression is crucial in improving clinical outcomes. Auto-servoventilation (ASV) effectively suppresses CSA/CSR in HF, but few trials have been performed in patients with coexisting OSA and CSA/CSR.

Long-term therapy with continuous positive airway pressure in obstructive sleep apnea: adherence, side effects and predictors of withdrawal - a 'real-life' study.

Background: Long-term adherence to positive airway pressure (PAP) treatment is essential in patients with obstructive sleep apnea syndrome (OSAS).

Objectives: The aim of the present study was to analyze treatment adherence under real-life conditions and factors associated with discontinuation of PAP therapy.

Methods: Patients newly diagnosed with OSAS and started on PAP therapy were contacted by telephone after a minimum of 1 year.

Evaluation of a system for transcutaneous long-term capnometry.

Background: The measurement of CO(2) partial pressure (PCO(2)) is of great importance. Former systems of transcutaneous capnometry combining the measurement of oxygen partial pressure (PO(2)) and PCO(2) had their limitations due to skin irritations caused by the heating-up of the sensor and a short application time of 4 h.

Objectives: To evaluate for the first time combined monitoring of transcutaneous PCO(2) (tcPCO(2)) and oxygen saturation applying a lower temperature (sensor temperature 42 degrees C) and a new sensor technology in healthy individuals during sleep.

Esophageal pressure method and impulse oscillometry to assess mechanical properties of the respiratory system in healthy men.

Background: Lung elasticity can be assessed by pulmonary compliance using the esophageal pressure method, but this technique is invasive and time-consuming. Impulse oscillometry has been established as a non-invasive method to describe mechanical properties of the respiratory system and preliminary data suggest that it may be used as a marker of lung elasticity. Therefore we compared impulse oscillometry and pulmonary compliance in healthy subjects.

Combined adaptive servo-ventilation and automatic positive airway pressure (anticyclic modulated ventilation) in co-existing obstructive and central sleep apnea syndrome and periodic breathing.

Background: The co-existence of obstructive and central sleep apnea/hypopnea syndrome (OSAS) and periodic breathing is common in patients with and without underlying heart diseases. While automatic continuous positive airway pressure (APAP) has proven to effectively treat OSAS, the adaptive servo-ventilation (ASV) sufficiently improves periodic breathing. This is the first trial on a device which combines both treatment modes.

Comparison of manual titration and automatic titration based on forced oscillation technique, flow and snoring in obstructive sleep apnea.

Background: Continuous positive airway pressure (CPAP) treatment in obstructive sleep apnea syndrome (OSAS) requires pressure titration usually performed during attended in-hospital polysomnography. This manual titration procedure is not well standardized. The aim of the study was to ascertain whether a new automatic titration device is as effective as standard manual titration in determining constant CPAP pressure.

Adaptive servo-ventilation in patients with coexisting obstructive sleep apnoea/hypopnoea and Cheyne-Stokes respiration.

Objective: The coexistence of obstructive (OSAS) and central sleep apnoea (CSA) and Cheyne-Stokes respiration (CSR) is common in patients with and without underlying heart diseases. CPAP has been shown to improve CSA/CSR by about 50%, but recent data suggest maximal suppression of CSA is important in improving clinical outcomes in heart failure patients. Adaptive servo-ventilation (ASV) effectively suppresses CSA/CSR in heart failure, but only few trials have considered patients with coexisting OSAS and CSA/CSR.

Comparison of automatic and continuous positive airway pressure in a night-by-night analysis: a randomized, crossover study.

Background: Long-term compliance is suboptimal in the treatment of the obstructive sleep apnea syndrome (OSAS).

Objectives: We compared the efficacy of and the adherence to automatic continuous positive airway pressure (APAP) and constant continuous positive airway pressure (CPAP) based on a night-by-night analysis.

Methods: We performed a randomized, single-blind crossover study in 20 patients with moderate-to-severe OSAS.

Tongue-muscle training by intraoral electrical neurostimulation in patients with obstructive sleep apnea.

Study Objectives: To investigate the efficacy of tongue-muscle training by electrical neurostimulation of the upper-airway muscles as an alternative therapy option for obstructive sleep apnea syndrome.

Design: A randomized, placebo-controlled, double-blind study.

Setting: Department of pneumology and sleep laboratory, University of Witten/Herdecke, Germany.

Auto-adjusting CPAP based on impedance versus bilevel pressure in difficult-to-treat sleep apnea syndrome: a prospective randomized crossover study.

Background: Although continuous positive airway pressure therapy (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), there is a portion of patients in which CPAP is not usable. Bilevel treatment serves as an alternative for these patients. For uncomplicated OSAS, auto-adjusting CPAP based on the forced oscillation technique (APAPFOT) has proved to be equally as effective as constant CPAP, and is preferred by the patients.