Obstructive sleep apnoea syndrome (OSAS) is a common clinical condition in which the throat narrows or collapses repeatedly during sleep, causing obstructive sleep apnoea events. The syndrome is particularly prevalent in middle-aged and older adults. The mechanism by which the upper airway collapses is not fully understood but is multifactorial and includes obesity, craniofacial changes, alteration in upper airway muscle function, pharyngeal neuropathy and fluid shift towards the neck. The direct consequences of the collapse are intermittent hypoxia and hypercapnia, recurrent arousals and increase in respiratory efforts, leading to secondary sympathetic activation, oxidative stress and systemic inflammation. Excessive daytime sleepiness is a burden for the majority of patients. OSAS is also associated with cardiovascular co-morbidities, including hypertension, arrhythmias, stroke, coronary heart disease, atherosclerosis and overall increased cardiovascular mortality, as well as metabolic dysfunction. Whether treating sleep apnoea can fully reverse its chronic consequences remains to be established in adequately designed studies. Continuous positive airway pressure (CPAP) is the primary treatment modality in patients with severe OSAS, whereas oral appliances are also widely used in mild to moderate forms. Finally, combining different treatment modalities such as CPAP and weight control is beneficial, but need to be evaluated in randomized controlled trials. For an illustrated summary of this Primer, visit: http://go.nature.com/Lwc6te.

Obstructive sleep apnoea syndrome

Obstructive sleep apnea (OSA) is a breathing disorder during sleep that has implications beyond disrupted sleep. It is increasingly recognized as an independent risk factor for cardiac, neurologic, and perioperative morbidities. Yet this disorder remains undiagnosed in a substantial portion of our population. It is imperative for all physicians to remain vigilant in identifying patients with signs and symptoms consistent with OSA. This review focuses on updates in the areas of terminology and testing, complications of untreated OSA, perioperative considerations, treatment options, and new developments in this field.

https://www.mayoclinicproceedings.org/article/S0025-6196(11)60052-9/pdf

Updates on Definition, Consequences, and Management of Obstructive Sleep Apnea

Purpose Research during the past 10–20 years shows that positional therapy (PT) has a significant influence on the apnea–hypopnea index. These studies are predominantly performed as case series on a comparably small number of patients. Still, results have not found their way into the daily diagnostic and treatment routine. An average of 56% of patients with obstructive sleep apnea (OSA) have positiondependent OSA (POSA), commonly defined as a difference of 50% or more in apnea index between supine and nonsupine positions. A great deal could be gained in treating patients with POSA with PT. The aim of this paper was to perform a thorough review of the literature on positional sleep apnea and its therapy. Methods A broad search strategy was run electronically in the MEDLINE and EMBASE databases using synonyms for position and sleep apnea. Results Sixteen studies were found which examined the effect of PT on OSA. In this literature review, we discuss the various techniques, results, and compliance rates. Conclusion Long-term compliance for PT remains an issue, and although remarkable results have been shown using innovative treatment concepts for PT, there is room for both technical improvement of the devices and for further research.

/pdf/the-undervalued-potential-of-positional-therapy-in-position-5q4thpaokk.pdf

The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea—a review of the literature

Supine position related obstructive sleep apnea in adults: Pathogenesis and treatment

Study Objectives:Approximately 30% of obstructive sleep apnea (OSA) patients have supine-predominant OSA, and simply avoiding supine sleep should normalise respiratory disturbance event rates. Howe...

/pdf/accurate-position-monitoring-and-improved-supine-dependent-4ohogaww8j.pdf

Accurate position monitoring and improved supine-dependent obstructive sleep apnea with a new position recording and supine avoidance device

Study Objectives:Little is known regarding long-term patient compliance with the tennis ball technique (TBT), one of the original simple methods of positional therapy (i.e., avoiding the supine pos...

Poor long-term patient compliance with the tennis ball technique for treating positional obstructive sleep apnea.

Longitudinal audit of assessment and pharmaceutical intervention for cardiovascular risk in the Australasian Diabetes Data Network


 BACKGROUND
 Digital health interventions (DHIs) are efficacious in health-promoting behaviours (e.g., healthy eating and regular physical activity) that mitigate health risks and menopausal symptoms in midlife, however, integrated evidence-based knowledge about the mechanism of change in these interventions is unclear.
 
 
 OBJECTIVE
 This systematic review aims to evaluate studies on behaviour change techniques (BCTs) and mechanisms of change in DHIs aimed to promote health-enhancing behaviours in midlife women (aged 40-65 years).
 
 
 METHODS
 A systematic literature search of electronic databases MEDLINE/PubMed, Web of Science, PsycINFO and Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were conducted. Two independent reviewers selected studies for inclusion, extracted data, and completed BCT mapping of eligible studies. The mechanism of action and intervention functions of eligible studies were evaluated using the Behaviour Change Wheel (BCW) framework. Reporting of psychological theory use within these interventions were explored using the Theory Coding Scheme (TCS). Mode of delivery, psychological theory and BCTs were presented as descriptive statistics.
 
 
 RESULTS
 Thirteen interventions (including 1308 women) reviewed used 13 ± 4.30 (range 6–21) BCTs per intervention on average. ‘Shaping knowledge’ and ‘Repetition and substitution’ behaviour change categories (BCC) were used most frequently, with 12 interventions (92%) implementing at least one of these BCTs from these two categories. Only 14% (169/1209) of the 93 available BCTs were used, with ‘Instructions on behaviour’ most frequently utilised (12 of 13 studies). The BCW mapping suggests that half of the intervention content aimed to increase ‘Capability’ (50%; 49/98), 42% ‘Motivation’ (441/98), and 8% ‘Opportunity’ (8/98). ‘Behavioural Regulation’ was the most frequently used mechanism of action (15%; 15/98), followed by increasing ‘Knowledge’ (13%; 13/98) and ‘Cognitive and Interpersonal skills’ (10%; 10/98). Seven (78%; 7/9) intervention functions were used in the studies to change behaviour, primarily through ‘Enablement’ (36%; 60/169), while no study used ‘Restriction’ or ‘Modelling’ functions. Although 69% (9/13) of the studies mentioned a psychological theory or a model, the majority (77%; 10/13) stated or suggested rather than demonstrated use of a theoretical base, and none reported explicit links between all BCTs within the intervention and the targeted theoretical constructs. Technological components were primarily based on web-based (68%; 9/47) modes of delivery, followed by phone/text (62%; 8/47) and wearables (54%; 7/47).
 
 
 CONCLUSIONS
 The findings of this review indicate an overall weak use of theory, low levels of treatment fidelity, insignificant outcomes, and insufficient description of several interventions to support assessment of how specific BCTs were activated. Thus, the identified limitations in the current literature provide an opportunity to improve the design of lifestyle health-enhancing interventions with women in midlife.
 
 
 CLINICALTRIAL
 PROSPERO CRD42021259246
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021259246


Claire A. Robertson

Papers

Poor long-term patient compliance with the tennis ball technique for treating positional obstructive sleep apnea.

Longitudinal audit of assessment and pharmaceutical intervention for cardiovascular risk in the Australasian Diabetes Data Network

A Systematic Review of Behaviour Change Techniques in Digital Health Interventions with Midlife Women (Preprint)