Archive for the ‘Obstructive Sleep Apnea’ Category

Long-Term Survival of Patients With Obstructive Sleep Apnea Treated by Uvulopalatopharyngoplasty or Nasal CPAP - CommentUvulopalatopharyngoplasty was proposed as a surgical treatment for OSA by Fujita and associates. The success of this operation varies considerably, and some of this variability has been accounted for by differences in patient selection or surgical technique. Both nasal CPAP and UPPP have been shown to reduce systemic blood pressure in patients with OSA. buy allegra

In contrast to our study, He and associates2 found improved survival in those patients with OSA treated by nasal CPAP or tracheostomy but not in those treated by UPPP when compared with untreated patients. However, there are major differences between the two studies. In the study by He and associates;x2 the patients had more severe OSA, and only 40 percent had a successful surgical outcome compared with 81 percent in our study, using similar criteria to define success. Furthermore, the proportion of patients who underwent follow-up polysomnography after UPPP differs. In the study by He and associates,2 79 percent of patients had follow-up polysomnography compared with 94 percent in our study.
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There is some support for this explanation in that we found no difference in survival between UPPP responders and nonresponders. In elderly patients the effect of OSA on longterm survival is less clear. Ancoli-Israel and colleagues showed an association between OSA and decreased survival in elderly women but not in men. Bliwise and coworkers demonstrated no difference in mortality in a group of treated and untreated elderly patients with OSA compared with controls.
The major cause of increased mortality in OSA appears to be cardiovascular in nature. Partinen and associates found an age-adjusted odds ratio of vascular mortality of 4.7. Long-term follow-up of the same patients has shown a relative risk of developing new vascular problems of 2.3 (95 percent confidence interval of 1.5 to 3.6). Obstructive sleep apnea is associated with significant cardiac arrhythmias and cyclical variation of systemic blood pressure during sleep. Both chronic snoring, which usually precedes the onset of florid OSA, and OSA have been shown to be significant risk factors for the development of cardiovascular and cerebrovascular disease. The combined effects of systemic hypertension, hypoxemia, and increased sympathetic activity during sleep are thought to promote the development of atherosclerosis. canadian healthcare mall

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Long-Term Survival of Patients With Obstructive Sleep Apnea Treated by Uvulopalatopharyngoplasty or Nasal CPAP - DiscussionOne hundred forty of the 149 UPPP patients (94 percent) had a follow-up polysomnogram. Eighty-nine of the 140 (63 percent) had a postoperative AI of less than 5 and a further 25 (18 percent) had a greater than 50 percent reduction in AI giving an overall 81 percent response rate. Patients who did not respond well to UPPP ( < 50 percent decrease in AI) tended to be older (mean± SD age, 55±10 years vs 50 ± 11 years, p < 0.02); however, their body mass index and preoperative AI were not significantly different (29.7 ± 4.6 kg/1112 for responders vs 30.8 ±5.7 kg/1112 for nonresponders and 25.6 ± 17.4/h vs 25.0 ± 14.0/h, respectively). All patients with nasal CPAP had an AI less than 5/h on follow-up polysomnography. There was 110 significant difference in posttherapy awake or asleep arterial oxygen saturation between survivors and nonsurvivors in either the patients with UPPP or nasal CPAP. In the UPPP patient group, 3 of the 9 patients (33 percent) without a follow-up polysomnogram died compared with 3 deaths in the 140 patients (2.1 percent) with a follow-up polysomnogram. The follow-up AIs of the 3 patients with UPPP who died and had a follow-up polysomnogram were 23/h, 5/h, and 1/h. The patients in both treatment groups who died were older (mean age, of 60 ±9.3 years, p < 0.001), but initial AI (mean of 34.3 ± 25/h) and body-mass indices (31.1 ± 9.2 kg/m2) were not significantly different from the survivors. my canadian pharmacy online

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One hundred fifty-four patients were treated with UPPP and 208 were treated with nasal CPAP during the 6-year period. Five of the 154 patients treated with UPPP were subsequently treated with nasal CPAP because of an unsuccessful response to surgery, and they were excluded from further analysis. Follow-up was complete in 137 of the remaining 149 patients. Twelve patients were unavailable for follow-up but were were included in the survival analysis. Six deaths occurred among the remaining 137. Eighty-two (40 percent) of the 208 patients initially treated with nasal CPAP were no longer using this form of treatment at the time of follow-up. Forty-four of these 82 elected to have a UPPP, 3 a tracheostomy, 6 an intraoral appliance, and 29 were not using any specific therapy. Thirty-two of the 44 patients going on to UPPP were included in our UPPP group, the other 12 had their surgery after conclusion of the study period or in another center. Only the 126 patients who were using nasal CPAP at the time of contact were included in the initial analysis. Nine were unavailable for follow-up but were included in the survival analysis. Three deaths occurred among patients treated with nasal CPAP.
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Long-Term Survival of Patients With Obstructive Sleep Apnea Treated by Uvulopalatopharyngoplasty or Nasal CPAP - MethodsObstructive sleep apnea (OSA) is a relatively common condition that may affect up to 2 percent of the adult population. There are limited data on the mortality associated with OSA, Ык most studies suggest a decreased long-term survival. Patients with OSA have an increased likelihood of cardiovascular-related death and may be more likely to die in their sleep. In the only study that examined different treatment modalities,2 mortality was decreased in patients treated with nasal continuous positive airway pressure (CPAP) and tracheostomy, but not in those patients treated with uvulopalatopharyngoplasty (UPPP), when compared with untreated patients. Although nasal CPAP is the primary treatment for OSA, some patients cannot tolerate nasal CPAP on a long-term basis.’ Uvulopalatopharyngoplasty continues to be widely performed and it is an effective treatment in selected patients. canadianfamilypharmacy

The primary objective of this retrospective study was to compare the long-term survival between patients with OSA treated with UPPP and nasal CPAP. Secondary objectives were to determine the most common cause of death in these patients, to establish whether there is an increased risk of dying during the night, and to examine the impact of follow-up polysomnography on long-term survival after UPPP.
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