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Treating Sleep Apnea: A Review of the Research for Adults

A doctor said you have mild, moderate, or severe “obstructive sleep apnea,” or OSA. People with OSA may snore and stop (or “pause”) their breathing a few or many times when they sleep.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: August 8, 2011

Lifestyle modification strategies for managing obstructive sleep apnoea

Obstructive sleep apnoea happens when breathing is either stopped or reduced during sleep because of a narrowing or blockage of the upper airway (passage to the lungs). It causes loud snoring and occasional apnoea (stopping breathing). It can lead to daytime sleepiness and may cause, hypertension, stroke and road accidents. Lifestyle modification, especially weight loss, sleep hygiene and exercise, are often recommended. These could help by relieving pressure on the upper airway, and increasing muscle tone in the airway. However, the review found no trials to assess the effects of these strategies, and more research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Does treating obstructive sleep apnoea in children who also have chronic cough improve their cough?

Sleep apnoea (a condition where breathing stops for short spells during sleep) and chronic cough in children are significant medical problems and cause a significant burden of distress to parents. Interventions for sleep apnoea are associated with risks of morbidity and mortality, in addition to substantial costs. This review aimed to examine the effect of the treatment of sleep apnoea in children with chronic cough, however no randomised controlled trials were found. Currently there is no evidence to support the use of interventions for sleep apnoea in children with chronic cough and a randomised controlled trial is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Oral appliances and functional orthopaedic appliances for obstructive sleep apnoea in children

Treatment of obstructive sleep apnoea syndrome (OSAS) in children appears to be possible with oral appliances or functional orthopaedic appliances. However this is only based on data from one small study.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Anti‐inflammatory drugs for the treatment of obstructive sleep apnea in children

Obstructive sleep apnea (OSA) is the partial or complete blockage of the upper airways during sleep and affects about 1% to 4% of children. The most common underlying reason for OSA in children is enlarged tonsils. Surgical removal of the enlarged tonsils is the therefore currently the treatment standard. In milder cases of OSA, treatment with anti‐inflammatory drugs to reduce the size of the tonsils is an alternative to surgery. The aim of this review was to evaluate the effectiveness of anti‐inflammatory drugs for the treatment of OSA in children between one and 16 years of age. A comprehensive literature search identified three relevant studies. Very limited evidence from these studies suggests that steroids inhaled through the nose may reduce symptoms of OSA in children. Further studies are needed to evaluate anti‐inflammatory drugs for OSA in children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Continuous positive airway pressure delivery interfaces for obstructive sleep apnoea in adults

Obstructive sleep apnoea (OSA) is a condition whereby patients experience obstruction of their airways and develop an irregular breathing pattern during their sleep. If untreated, OSA can cause a variety of health problems, including high blood pressure, heart problems, difficulty concentrating, excessive sleepiness and an increased risk of having a motor vehicle accident. One widely recommended form of treatment for OSA is CPAP (continuous positive airway pressure), which consists of a pump which blows air into a patient's nose and/or mouth during sleep to hold open the airways and stop obstructions from occurring. The pump is connected to the patient via a connecting hose and an "interface" which rests on the patient's face. There are many different types of interface available for CPAP use, including masks which cover the nose, the mouth, both the nose and mouth, and even the entire face. Unfortunately, patients will often experience side effects related to their interface, which may make them want to stop their CPAP treatment. This review compares the different interface options for CPAP in patients with OSA. Four trials involving 132 people were included. Two studies compared nasal masks with an oral mask called the Oracle, and there did not appear to any significant differences between the two in terms of compliance, sleep study recordings, sleepiness or other symptoms of OSA. One study assessing nasal masks versus nasal pillows (consisting of prongs that rest within the nostrils) showed that patients using the nasal pillows had fewer overall side effects and reported greater satisfaction. The nose mask performed better than the face mask (which covers both the nose and mouth) with one study showing greater compliance and less sleepiness, and was the preferred mask in almost all patients. The choice of interface for a particular person will need to be tailored to the individual. Further trials comparing the many interfaces for CPAP in the treatment of OSA are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Drug therapy for obstructive sleep apnoea in adults

Obstructive sleep apnoea (OSA) is caused by collapse of the upper airway. The mainstay of medical treatment is continuous positive airways pressure (CPAP), delivered through a mask during sleep, aiming to keep the airway opened. Drug therapy has been proposed for individuals with mild OSA and those intolerant of CPAP.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Kinesthetic stimulation for preventing apnea in preterm infants

Lying preterm babies on oscillating mattresses has not been shown to help prevent apnea. Physical stimulation arouses babies experiencing apnea (episodes where breathing stops), and babies still in utero are naturally stimulated by their mothers' movements. Thus, it has been thought that keeping the baby moving might prevent apnea and promote growth and development. Oscillating (moving) mattresses have sometimes been used for babies born too early (preterm) who are at risk of apnea. However, the review found that this has not been shown to be effective.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Kinesthetic stimulation versus theophylline for apnea in preterm infants

There is some evidence that theophylline may be more effective for apnea in preterm babies than kinesthetic stimulation, but more research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Interventions for the management of submucous cleft palate

Cleft palate (a split in the roof of the mouth) is a common congenital anomaly which affects approximately 1 in 600 people. Submucous cleft palate (SMCP) is a small subgroup of cleft palate and most of the affected people are asymptomatic. However, some of the individuals with submucous cleft palate have certain speech and resonance problems like hypernasal speech and may undergo surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Co‐bedding premature twins to optimise their growth and brain development

Preterm twins are at high risk for growth and developmental problems. Co‐bedding (placement of twins in the same cot or incubator) has been proposed to benefit twins because it simulates the environment they share prior to birth, in which the twins support each other through a series of observed activities, termed "coregulation". These activities have been proposed to promote growth and brain development if they are allowed to continue after birth. However, there may be risks in placing twins in the same incubator or cot, including caregiver errors and infections. In this review, we planned to put together evidence on the benefits and risks of co‐bedding stable preterm twins.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Mechanical ventilation at night for people with nerve, muscle or chest wall disease who have persistent breathing problems

We reviewed the evidence about the effect of mechanical ventilation at night in people with chronic (i.e. persistent) difficulties with breathing spontaneously due to diseases of the nerves, muscles or chest wall.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Cisapride treatment for gastro‐oesophageal reflux in young children

Gastro‐oesophageal reflux is the movement of stomach contents back into the oesophagus. A ring of smooth muscle (sphincter) at the lower end of the oesophagus near the stomach usually prevents this regurgitation. Relaxation of the sphincter, ineffective clearance of food from the oesophagus into the stomach, and delayed emptying of the stomach can all contribute to reflux. The peak incidence of reflux is generally at around four months of age and resolves by one to two years. Parents may seek medical help for the reflux if they are anxious or find the symptoms of regurgitation, crying, irritability, vomiting and, gagging difficult to tolerate. Some young children experience associated respiratory problems of chronic cough, wheezing, hoarseness, recurring bronchitis, pneumonia, apnoea or breath holding; and back‐arching, refusal to feed and sleep disturbance. Inflammation of the oesophagus may be evident with endoscopy or the child may fail to thrive and surgery may be required. Scintigraphy or sonography are used to monitor oesophageal motility.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Topical steroids for nasal airway obstruction in children with moderately to severely enlarged adenoids

Adenoidal hypertrophy is generally considered a common condition of childhood and represents one of the most frequent indications for surgery in children. In less severe cases, non‐surgical interventions may be considered, however few medical alternatives are currently available. This review was conducted to assess the effectiveness of intranasal corticosteroids for improving nasal airway obstruction in children aged 0 to 12 years with moderate to severe adenoidal hypertrophy. Evidence derived from five of the six randomised controlled trials included in this review suggests that intranasal steroids may significantly improve symptoms of nasal obstruction in children with adenoidal hypertrophy and that this improvement may be associated with the reduction of adenoid size. One study did not find a significant improvement in nasal obstruction symptoms. Further large and high‐quality randomised controlled trials are warranted.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Non‐invasive ventilation for people with amyotrophic lateral sclerosis or motor neuron disease

Management of amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), has evolved rapidly in the last ten years and although still incurable, ALS is not untreatable. In this updated review we examined the evidence from two randomised trials, involving 54 participants in total, of non‐invasive ventilation (using a face or nasal mask and a small portable ventilator) in people with ALS. Complete data were only available from a single trial of 41 participants. The results of this trial indicate that non‐invasive ventilation significantly prolongs survival and improves or maintains quality of life compared to standard care. Average survival was increased by 48 days from 171 to 219 days (estimated 95% CI 12 to 91 days). The survival benefit from non‐invasive ventilation was shown to be much greater in those people with ALS who had normal or only moderately impaired bulbar function (impairments to the muscles used for speaking, chewing and swallowing). Among these 20 participants, the average survival for those treated with non‐invasive ventilation was increased by 205 days (survival was 216 days with non‐invasive ventilation, compared to 11 days with standard care). The quality of life was also maintained in participants with mild to moderate bulbar impairment. In the 21 participants with severe bulbar impairment, non‐invasive ventilation significantly improved sleep‐related symptoms compared to standard care but did not prolong survival. Neither trial reported on adverse effects due to the intervention. Future studies should examine the health economics of non‐invasive ventilation and factors that influence access to non‐invasive ventilation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Sound reduction management in the neonatal intensive care unit for preterm or very low birthweight infants

Background: Infants in the neonatal intensive care unit (NICU) are subjected to stress, including high intensity sound. The sound environment in the NICU is louder than most home or office environments and contains disturbing noises of short duration and at irregular intervals. There are competing sound signals that frequently challenge preterm infants, staff, and parents. The sound levels in NICUs range from 7 dB to 120 dB, often exceeding the maximum acceptable level of 45 dB, recommended by the American Academy of Pediatrics. Hearing impairment is diagnosed in 2% to 10% of preterm infants versus 0.1% of the general paediatric population. Noise may cause apnoea, hypoxaemia, alternation in oxygen saturation, and increased oxygen consumption secondary to elevated heart and respiratory rates and may, therefore, decrease the amount of calories available for growth. Elevated levels of speech are needed to overcome the noisy environment in the NICU, thereby increasing the negative impacts on staff, newborns, and their families. High noise levels are associated with an increased rate of errors and accidents, leading to decreased performance among staff. The aim of all interventions considered for inclusion in this review is to reduce the sound levels that reach the individual neonate to 45 dB or less. This can be achieved by lowering the sound levels in an entire unit, treating the infant in a section of a NICU or in a 'private' room, or in incubators in which the sound levels are controlled, or reducing the sound levels that reaches the individual infant by using earmuffs or earplugs. By lowering the sound levels that reach the neonate, the resulting stress can be diminished, thereby promoting growth and reducing adverse neonatal outcomes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Opioids for the treatment of chronic low‐back pain

We reviewed the evidence about the effect of opioids on pain and function among people with chronic low‐back pain (CLBP).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Testing Treatments: Better Research for Better Healthcare. 2nd edition

How do we know whether a particular treatment really works? How reliable is the evidence? And how do we ensure that research into medical treatments best meets the needs of patients? These are just a few of the questions addressed in a lively and informative way in Testing Treatments. Brimming with vivid examples, Testing Treatments will inspire both patients and professionals.

Pinter & Martin.

Version: 2011

Medical Encyclopedia

  • Sleep Apnea
    Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
  • Drug Class Review: Newer Antihistamines: Final Report Update 2 [Internet]
    Antihistamines inhibit the effects of histamine at H1 receptors. They have a number of clinical indications including allergic conditions (e.g., rhinitis, dermatoses, atopic dermatitis, contact dermatitis, allergic conjunctivitis, hypersensitivity reactions to drugs, mild transfusion reactions, and urticaria), chronic idiopathic urticaria (CIU), motion sickness, vertigo, and insomnia.
  • CPAP
    CPAP, or continuous positive airway pressure, is a treatment that uses mild air pressure to keep your airways open while you sleep.
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Systematic Reviews in PubMed

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