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Somnibel opens in the journal Medicina Respiratoria

01/03/2019
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The magazine dedicates a few pages to the alternatives to CPAP in the treatment of sleep apnea in volume number 11. You can learn more about positional treatments in positional OSA and more especially Somnibel (page 28).

Treatment of OSA. Beyond CPAP, FÉLIX DEL CAMPO, ANA CEREZO, Respiratory Medicine, vol. 11 nº 3, pages 25-33, editorial Neumologia y salud.

Summary (page 25)

The obstructive sleep apnea syndrome is a chronic, prevalent disease that is associated with significant morbidity, both in terms of quality of life and the cardiac and metabolic consequences. The reference treatment is still CPAP. However, a not inconsiderable number of patients are not adherent to the treatment; hence the need to search for other therapeutic options. In patients with obesity, calorie restriction and increased physical activity are recommended. The new positional devices allow to avoid the position of deconcept without affecting the quality of sleep. Mandibular advancement devices are an alternative to CPAP in patients with mild-moderate OSA, with an efficiency similar to that of CPAP. The identification of the patients and the correct dental follow-up are key aspects. Although there are a large number of devices, it is advisable to build them in a personalized way and to allow them to be graduates. Upper airway surgery and mandibular advancement surgery are indicated in patients with severe OSAS who do not accept treatment with CPAP. The stimulation of the hypoglossal nerve is a novel treatment that in a selected group of patients provides good short and long term results.

Introduction (Page 26)

Obstructive sleep apnea syndrome (OSAS) is a prevalent disease, characterized by the repetitive appearance during sleep of cessation or reduction of airflow due to the collapse of the upper airway (VAS). These episodes may be accompanied by clinical symptoms, changes in the quality of life and the appearance of cardio-metabolic diseases. In these patients it is indicated to start a treatment, with the aim of stabilizing the upper airway (VAS), to achieve the abolition or reduction of respiratory events, the disappearance of clinical symptoms and the long-term reduction of cardiovascular risk. and mortality (1). At present, a wide variety of therapeutic options are available, beyond CPAP, as shown in Table I. The aforementioned therapeutic modalities are not mutually exclusive, and very often in the same patient. You can combine any of these treatments. On the other hand, the indication of each of these therapeutic options is not well defined.

Since its introduction in the early 1980s, continuous positive airway pressure (CPAP) is still the reference treatment for OSA. Although it is an effective and cost-effective treatment, adherence to it is relatively modest, although it is similar to those achieved by various treatments in chronic diseases. However, this is the main argument used to question CPAP as the reference treatment (2).

Postural treatment (Page 28)

The number and duration of respiratory events are closely related to the position of the body. In the supine position, the snoring is more intense, the micro-awakenings are more frequent, the AHI increases and the desaturations are greater. Although there are different criteria, positional OSAS is defined as the presence of an AHI> 5, in addition to events in the supine position that are at least twice those present in the lateral decubitus position. Positional OSAS is relatively frequent, especially in younger patients, less obese and with mild / moderate OSAS.

Positional therapy in patients with OSAS would have the purpose of avoiding the position of supine decubitus during sleep. It is recommended in patients with positional OSAS, and its most appropriate profile would be: young patients, not obese, with mild / moderate OSAS. In the market there are very diverse devices to avoid the supine position such as tennis balls, vests, position alarms, pillows, etc. (16) These are passive devices that reduce or eliminate snoring and respiratory events. Its main limitation is long-term adherence, mainly because of its discomfort and because of the quality of sleep (17).

In recent years, several devices have been commercialized that produce a pulsating vibration when the patient is placed in decubitus. They try to force the patient to change position, without affecting the quality of sleep. This type of device applies the vibrating unit in different parts of the body: chest (Night balance ™), nape (Night shift ™) or forehead (SomniBel R) (18,19). It is important to highlight the importance of the position of the head in this type of treatment. The one applied on the forehead has been developed in our country jointly by the company SIBEL S.A.U. and the Sleep Functional Unit of OSI Araba (Figure 2). It has the advantage of providing data on adherence to treatment, as well as informing about postural changes. All these devices have been shown to reduce respiratory events and desires, presenting a good acceptance at least in the short term; It can be used alone or in combination with other treatment modalities. Its usefulness in positional OSS after mandibular advancement surgery has been described. There are not many comparative studies of its effectiveness.

Somnibel opens in the journal Medicina Respiratoria

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