Assessment of the clinical effectiveness of the treatment of positional obstructive sleep apnea and upper airway stimulation therapy for obstructive sleep apnea
13 June 2018
UAntwerp - Campus Drie Eiken - Building Q - Promotiezaal - Universiteitsplein 1 - 2610 WILRIJK (route: UAntwerpen, Campus Drie Eiken
Prof O. Vanderveken, Prof M. Dieltjens
PhD defence Jolien Beyers - Faculty of Medicine and Health Sciences
(Presentation in Dutch)
Sleep-disordered breathing is a pathophysiological spectrum of disorders ranging from intermittent snoring over the full-blown sleep apnea-hypopnea syndrome to the obesity-hypoventilation syndrome. Obstructive sleep apnea (OSA) patients are mainly referred to a sleep clinic because of complaints of loud snoring, excessive daytime sleepiness or the presence of witnessed apneas during sleep. When OSA is left untreated, patients are at higher risk for cardiovascular disease, stroke, motor vehicle accidents, and diminished quality of life, making adequate diagnosis and treatment of utmost importance. Several invasive and non-invasive treatment options are available. Research in the past taught us that efficacy as well as adherence plays an important role in treatment success in routine clinical practice. However, most treatment options have to deal with either adherence problems, either an inferior efficacy, resulting in low clinical effectiveness.
Because of the limitations of the currently existing treatment modalities for OSA, two new techniques that are aimed to overcome these limitations are evaluated in this doctoral thesis. Both, the sleep position trainer (SPT) and the upper airway stimulation (UAS) therapy, are described in different clinical contexts and both can be used in the everyday life of the patient.
Treatment with the SPT came with high adherence rates and was effective in reducing the respiratory event index and supine position on the short term of 1-month follow-up. The trial period that was described in this thesis is in the patients’ best interest, as it may prevent those who will not benefit from positional training from purchasing a SPT device. Long-term treatment with the SPT device was also found to be effective in reducing the time spent in supine sleeping position and apnea/hypopnea index. The time spent in supine sleeping position could be reduced to almost zero in the continuing users after 1 year of treatment. The patient satisfaction was high when using the SPT device and adherence rates remained acceptable.
UAS therapy might be beneficial after strict patient selection. The clinical pathway that was developed and described in this thesis, is used to optimize both the efficacy and the workflow of the UAS therapy for selected patients. In addition, the application of UAS therapy in adult Down syndrome OSA patients was found to be promising.
Overall, this thesis describes two new promising therapies for OSA. Both SPT and UAS showed a good efficacy and tolerance, implying these two treatment options should be considered when treating OSA.