- LITERATURE REVIEWSelect publications that you can relate to your AIM.Analyze—how does a study relate to your topic and what components don’t—service area, geography, age bands, ethnicity or how the variables studied are aligned with your aim. Don’t try to make your studies fit. Do read the articles carefully for content, applicability and strength—population size, inclusion criteria, control of variables, etc.Synthesize—several pubs will tell you the same thing—summarize those; cite each behind the statement and identify which ones said something different. Don’t be linear about the lit review. No meta-analysisAt least 25 current references—unless you are citing a seminal publication, i.e.—NIH, NAM, CDC, etc.No dot coms and very few select dot orgs—gov ok—and if dot orgs are representing scholarly work, such as professional orgs which employ double-blinded peer review. Think how these organizations might perpetuate their mission? —it helps to identify bias.
OBSTRUCTIVE SLEEP APNEA TREATMENT COMPLIANCE
Treatment Compliance for Obstructive Sleep Apnea Syndrome
Richard Williams
National University
HCA 692
Professor: Joann Harper
18 July2023
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OBSTRUCTIVE SLEEP APNEA TREATMENT COMPLIANCE
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Treatment Compliance for Obstructive Sleep Apnea Syndrome
Obstructive sleep apnea syndrome (OSAS) is a sleep disorder that affects the quality of
sleep and life for millions of people around the world. The respiratory disorder occurs with the
occlusion of upper airways causing interruptions in ventilation. This consequently causes oxygen
desaturation, an increased effort to breath, and arousal from sleep (McNicholas & Pevernagie,
2022). This is associated with snoring, poor sleep patterns, and the consequences of lethargy and
lack of adequate rest for the affected people. Research on OSAS has helped create an
understanding of the condition and the mechanisms that cause upper airway occlusion and the
pathophysiology and development of complications. This research has paved the way for the
development of different treatments for OSAS.
The most common symptom of OSAS is nighttime snoring. When accompanied with
episodes of apnea, excessive daytime sleepiness, and arousal from sleep, snoring may be
assessed as OSAS (McNicholas & Pevernagie, 2022). However, a diagnosis should be made
using overnight polysomnography which records nasal airflow, snoring sounds, oxygen
saturation, and respiratory efforts among other factors (Kapur et al., 2017). Apnea is the
complete cessation of airflow for at least 10 seconds and hypopnea is reduced airflow
(McNicholas & Pevernagie, 2022). OSAS is a hypopnea/apnea disorder and according to the
American Academy of Sleep Medicine, it can be diagnosed when the apnea-hypopnea index
(AHI) is more than 5 and accompanied by excessive daytime somnolence (Kapur et al., 2017).
This must be differentiated from habitual snoring whereby the latter is a person who always
snores, but their AHI is less than 5.
The effects of OSAS have received a lot of attention from researchers. The most obvious
effect is the quality of life that the individual with OSAS leads. Due to arousal from sleep and
OBSTRUCTIVE SLEEP APNEA TREATMENT COMPLIANCE
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sleep interruptions, somnolence and daytime fatigue and tiredness are common among people
with OSAS (Vogler et al., 2023). This is mainly because the frequent awakening makes
restorative sleep a challenge and the individual may suffer from daytime drowsiness, fatigue,
irritability, and trouble concentrating (Vanek et al., 2020). This has in turn been associated with
high risk of accidents due to lack of alertness as well as reduced academic and work performance
associated with poor concentration (Vogler et al., 2023). These effects make it necessary to
provide treatment to enhance the quality of life for people with OSAS.
It is well established that untreated OSAS is a major determinant of cardiovascular
morbidity. Epidemiological studies have established that 50% of people with OSAS also have
hypertension and more than 30% of people with hypertension have OSAS (Brown et al., 2022).
This indicates comorbidity which increases the disease burden for the patients. While the causal
link is not clear, some researchers have established that an increased diastolic blood pressure is
the first step in OSAS leading to hypertension (Cuspidi et al., 2019). In addition to hypertension,
studies have also established increased risk of arrhythmias, type 2 diabetes, ischemic heart
disease, and artherogenesis causing coronary artery disease in patients with uncontrolled OSAS
(Arnaud et al., 2020). People with untreated OSAS have a higher mortality rate than the general
population (Arnaud et al., 2020). These complications of OSAS present the need for treatment
for all people with OSAS. Cover any relationship between obesity and the OSAS.
Sleep apnea is a growing public health problem. Among men, OSAS is diagnosed in
approximately 13% of the population and in 6% of female population (Santili et al., 2021).
However, it is estimated that more than 80% of sleep apnea cases are undiagnosed (Santili et al.,
2021). People with obesity are also more likely to be diagnosed with OSAS than the general
public (Lyons et al., 2020). Due to the increasing obesity pandemic in the past few decades, there
OBSTRUCTIVE SLEEP APNEA TREATMENT COMPLIANCE
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has also been a sharp increase in OSAS cases with the current estimates being 26% of Americans
have OSAS (Lyons et al., 2020). These statistics indicate that the target issue is a priority in
public health and must be addressed effectively. Delete my statement above now.
The most widely used treatment approach for OSAS is the Continuous Positive Airway
Pressure (CPAP). It is mostly used for moderate to severe OSAS treatment. This method
provides pressurized air which keeps the upper airway open to maintain patency during
inspiration and expiration (Pavwoski & Shelgikar, 2017). An alternative to CPAP is an
autotitrating positive airway pressure (APAP) device. Unlike the CPAP which provides a
constant stream of pressurized air, the APAP will adjust the pressure of that air depending on the
detected airway resistance (Johnson, 2022). Bilevel positive airway pressure (BPAP) is another
option which provides a preset amount of pressure when breathing in and a different amount
when breathing out (Johnson, 2022). CPAP is the most commonly used because it has been
widely studied and determined to effectively control OSAS (Pavwoski & Shelgikar, 2017).
Alternatives to positive airway pressure treatment include oral devices, surgical
interventions, and adjunct treatments. Oral devices are used to maintain upper airway patency
and decrease collapsibility of the airway (Tserenpil et al., 2020). Surgical interventions may
include tissue removal, maxillomandibular advancement, and tracheostomy for other approaches
that have failed and the patient is in a severe life-threatening condition (Tserenpil et al., 2020;
Johnson, 2022). Adjunct treatment may include weight loss, repositioning, nasal expiratory
positive airway pressure, and oral pressure therapy (Johnson, 2022). Each of these interventions
are indicated depending on the severity of the patient’s condition and their tolerance and
adherence to specific treatment options.
OBSTRUCTIVE SLEEP APNEA TREATMENT COMPLIANCE
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The main challenge in OSAS treatment is that the response to treatment varies from one
patient to another. For instance, Sánchez-de-la-Torre et al. (2015) found that while some patients
have huge improvements with CPAP, others do not improve and clinicians have no way of
distinguishing likely responders from non-responders beforehand. Other than failure to predict
response to treatment, another challenge for CPAP and other treatment is the poor adherence and
tolerance by some patients (Rapelli et al., 2021). Many patients may not adhere to treatment due
to the discomfort associated with the devices, including oral devices. This creates a challenge in
achieving the desired outcomes.
Moreover, despite relieving symptoms of OSAS, there is limited evidence that most of
the treatments reduce cardiometabolic risks. CPAP, for instance, has been identified as having
little efficacy in reducing cardiovascular and metabolic syndrome comorbidities (Randerath et
al., 2018). However, this is also closely associated with poor adherence and compliance with
treatment (Rapelli et al., 2021). People with OSAS generally have poor compliance and
adherence to device-related treatment and this has led to a challenge in the effective management
of the condition.
Despite the extensive research on OSAS treatment, compliance with treatment remains
the major challenge still being researched today. With the established poor compliance with
treatment of OSAS, researchers strive to create more effective treatment approaches and methods
to increase adherence. The general problem of adherence to OSAS treatment has not received
adequate attention from researchers. Poor adherence to treatment means poor health outcomes
and quality of life for people with OSAS. More specifically, there is need for further research on
the factors and interventions that affect adherence to OSAS treatment.
OBSTRUCTIVE SLEEP APNEA TREATMENT COMPLIANCE
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To overcome this gap, the purpose of this study will be to conduct a systematic review of
the literature to establish the factors affecting compliance with OSAS treatment. This study will
investigate OSAS treatment compliance and interventions that are effective in promoting
treatment compliance. This analysis will focus on patients newly-diagnosed with OSAS to
determine factors that affect their treatment compliance and methods that can be used to increase
compliance.
OBSTRUCTIVE SLEEP APNEA TREATMENT COMPLIANCE
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