Smart Anti-snore Pillow in the Management of Obstructive Sleep Apnea

1
Smart Anti-snore Pillow in the Management of
Obstructive Sleep Apnea Snoring

• Chang Bing Show-Chwan Memorial Hospital
• 1. Cheng-Yu Wei, 2. Ming-Chou Ku, 3. Tsung-Te
  Chung,
• 4. Chian-Fang Chung, 4. Ya-Ling Ko
• 1. Neurology Dep. 2. Orthology Dep. 3.
  Otolaryngology Dep. 4. Sleep Center

2
Abstract-1

• Background Obstructive sleep apnea (OSA)
  syndrome is risk factor for hypertension,
  coronary artery disease and stroke. In Taiwan,
  many of these individuals who are diagnosed,
  often refuse surgical treatment or exhibit poor
  compliance with nightly use of continuous
  positive airway pressure (CPAP). We assess the
  role of a special pillow in the treatment of OSA
  using polysomnography (PSG) data.
• Methods Thirty adult patients (15 men,
  59.3012.93 years of age, body mass index
  27.353.62 kg/m2) of OSA with snoring identified
  on a baseline PSG were studied. Patients were
  assigned to a night with Smart Anti-snore Pillow
  (Hong Jian Technology Co. Ltd., Taichung, Taiwan,
  Republic of China) under the assessment of
  secondary PSG.

3
Abstract-2

• Results The apnea-hypopnea index (AHI) decreased
  from 21.7615.69 events per hour to 16.4717.84
  events (p lt 0.001). The snore index decreased
  from 501.50235.07 events per hour to
  360.90218.10 events (p lt0.01). The mean oxygen
  saturation increased from 90.9517.31 to
  94.152.32 (p0.32). The desaturation index
  decreased from 15.8216.34 events per hour to
  7.842.50 events (p lt 0.01). Sleep efficiency and
  spontaneous arousal index were unchanged before
  and after therapies.
• Conclusion Smart Anti-snore Pillow therapy has
  the effects on AHI and snore. It may be a choice
  of treatment for the patients with OSA and
  snoring.

4
Introduction-1

• Many studies have produced convincing evidence
  that OSA is associated with an increased risk of
  cardiovascular morbidity and mortality. OSA may
  be independently associated with an increased
  risk for ischemic heart disease, stroke,
  arrhythmias and mortality. The treatments for
  adult OSA include positive airway pressure,
  surgery, oral appliances, weight loss,
  medications and other conservative treatment.
  CPAP is the standard form of therapy for treating
  OSA. Common difficulties associated with CPAP
  therapy include sense of dryness in the mouth,
  rhinorrhea, nasal congestion and dryness, mask
  discomfort, claustrophobia, irritation from
  device noise, aerophagia, chest discomfort and
  partner's intolerance. In Taiwan, many patients
  denied operation or are unable to comply with the
  use of CPAP. Searching a comfortable method for
  treating OSA is important subject.

5
Introduction-2

• We hypothesize that a Smart Anti-snore Pillow may
  relieve the symptoms for the patients of OSA with
  snore. We design a protocol to asses the effect
  of the special pillow in treating OSA and snore.

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Treatment for adult OSA

• Positive airway pressure
• CPAP
• Auto-CPAP
• Bilevel nasal ventilation
• Surgery
• Tracheotomy
• Uvulopalatopharyngoplasty
• Nasal/sinus surgery
• Genioglossal advancement/hyoid myotomy
• Maxillomandibular advancement
• Oral appliances
• Weight loss
• Medications
• Conservative treatment
• Positional therapy
• Treatment of nasal/allergic condition

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Subjects and Method-1

• The protocol of the study was approved by the
  Show-Chwan Memorial Hospital Research Ethics
  Review Committee (SCHM_IRB No991107). All
  patients provided informed consent before
  participation.

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Subjects and Method-2

• Patients
• Thirty OSA patients (15 male, 15 female), aged
  59.3012.93 years who took part in the research
  were randomly assigned from the Sleep Center in
  Chang Bing Show-Chwan Memorial Hospital. All
  patients had an initial baseline PSG study that
  identified the presence of OSA with snore in
  three months. The inclusion criteria were as
  follows (1) did not receive any management for
  OSA (2) age ?20 years and (3) provided informed
  consent. A second PSG study performed during
  using special pillow therapy for each patient.

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Subjects and Method-3

• Measurement of sleep quality
• Sleep quality in this study was measured by three
  sleep questionnaires (translated into Chinese)
  including Pittsburgh sleep quality index (PSQI),
  Athens insomnia scale (AIS) and Epworth
  sleepiness scale (ESS).

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Subjects and Method-4

• Smart Anti-snore Pillow Device
• The special pillow includes a base and a mobile
  seat (Hong Jian Technology Co. Ltd., Taichung,
  Taiwan, Republic of China ) (Figure 1). A shift
  control assembly shifts the mobile seat between
  positions and includes a motor, gear set and
  drive assembly. The head position happens through
  different positioning of the mobile seat after
  detecting continuous four snore (Figure 2).

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Finger 1
12
Finger 2
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Subjects and Method-5-1

• PSG
• PSG were performed while the patients were
  breathing room air and consisted of a recording
  of rib cage and abdominal motion, with air flow
  measured using a pressure transducer. Snoring was
  monitored using a snore microphone. The patients
  wore a position sensor on their chests.
  Synchronized digital video recordings were also
  obtained on all patients and reviewed during the
  scoring process to confirm body position. Other
  recordings included pulse oximetry,
  electrocardiogram, electrooculogram, digastric
  electromyogram, and electroencephalogram. All
  variables were continuously recorded and stored
  in a computerized system.

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Subjects and Method-5-2

• Sleep was staged, and arousals were defined using
  established criteria. Obstructive apneas were
  defined by the lack of airflow for more than 10
  seconds, associated with the presence of ribcage
  and abdominal movement. Obstructive hypopneas
  were defined by a 30 decrease in airflow for
  more than 10 seconds, associated with the
  presence of ribcage and abdominal movement, and
  accompanied by an oxygen desaturation of at least
  4 or a 50 decrease in airflow associated with a
  3 or greater decrease in oxygen saturation or an
  arousal. Apneas were defined as central if there
  was a lack of respiratory effort during the
  period of absent airflow. The AHI was calculated
  as the number of apneic and hypopneic events per
  hour of sleep.

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Subjects and Method-5-3

• An arousal was defined as an abrupt shift of
  electroencephalographic frequency, including
  alpha, theta, or frequencies greater than 16 Hz
  (but not spindles) that lasted at least 3
  seconds, with at least 10 seconds of stable sleep
  preceding the change. Other calculated variables
  included total sleep time, sleep efficiency
  (total sleep time divided by time in bed),
  arousal index, desaturation index, AHI, and the
  percentage of total sleep time with an arterial
  oxygen saturation (SaO2) of less than 90. All of
  the PSG studies were initially scored by a single
  senior technologist.

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Subjects and Method-6

• Statistical analysis
• Continuous data were expressed as the mean
  standard deviation categorical data were
  expressed as numbers with percentages.
  Categorical data were compared by using the
  Fisher's exact test in two independent groups. T
  or Wilcoxon test for paired samples was used to
  assess changes in the variables over time within
  each group. The relationship of mean differences
  between groups ( AHI and snore index improved or
  not ) were analyzed with wilcoxon rank sum test.
  A two tailed p value lt 0.05 was considered
  statistically significant. All data were analyzed
  using the statistical package SAS for Windows,
  version 9.2 (SAS Institute Inc., Cary, NC, USA).

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Results-1
Table 1. Sociodemographic and clinical
characteristics of the OSA patients
Variables N() /meanSD  
Female / Male 15(50)/15(50)  
Age (years) 59.3012.93 59.3012.93
BMI (kg/m2) 27.353.62 27.353.62
ESS 7.533.53 7.533.53
PSQI 9.103.93 9.103.93
AIS 7.504.84 7.504.84
Neck circumference 37.033.32 37.033.32
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Results-2

• Table 2 Comparison of PSG study between baseline
  and pillow therapy in all patients

Variable N Baseline PSG Secondary PSG p valuea
s1 30 36.9020.12 45.8623.99 0.0374
s2 30 49.0120.62 43.1422.14 0.1573
s3 30 0.842.29 0.200.42 0.1425
s4 30 0.231.04 0.000.00 0.2363
REM 30 13.027.65 10.815.30 0.0859
TST/min 30 292.3546.77 270.7958.70 0.1400
Sleep efficiency/ 30 77.7612.12 75.6813.78 0.4732
Sleep latency/min 30 17.5121.95 14.9018.70 0.5529
REM latency/min 30 121.7178.24 142.0679.66 0.3167
Total arousal/index 30 30.0219.68 32.9113.21 0.3460
Snore number 30 2406.671173.47 1693.771071.40 0.0038
Snore index 30 501.50235.07 360.90218.10 0.0025
PLM index 30 10.9634.82 4.026.69 0.2558
Mean O2 30 90.9517.31 94.152.32 0.3219
Denaturation index 30 15.8216.34 7.842.50 0.0070
AHI 30 21.7615.69 16.4717.84 0.0008
a paired_t test
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• Fig. 3. Comparison of PSG parameter between
  baseline and pillow therapy in all patients

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Conclusion

• Our findings have important clinical
  applications. Smart Anti-snore Pillow therapy has
  the effects which decrease AHI and snore. It may
  be a choice of treatment for the patients with
  OSA and snoring. Future studies will be directed
  towards understanding the mechanism of Smart
  Anti-snore Pillow how to effect the respiratory
  tract in OSA patients.