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Treatment effects of sleep apnoea: where are we now?

^* Dept of Pulmonology, Centre for Sleep Monitoring and Home Ventilation, University Hospital Gasthuisberg Leuven, Belgium, ^# Participants of working group 2 are listed in the Appendix.

CORRESPONDENCE: B. Buyse, Dept of Pulmonology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. Fax: 32 16346803. E-mail: Bertien.Buyse{at}uz.kuleuven.ac.be

The present article summarises some of the topics of discussion held during one of the workshops in preparation for the 7^th International Symposium of the Katholieke Universiteit Leuven on "Respiratory somnology: a clinical update; March 2006". Participants discussed the effectiveness of treatment in obstructive sleep apnoea/hypopnoea syndrome (OSAHS).

Of the topics discussed, the following are considered in the present article. 1) Sleepiness and attention deficit, as well as higher cognitive/executive defects in OSAHS, and the closely related clinical dilemma of "how to deal with the car-driving-ability problem in OSAHS". 2) Continuous positive airway pressure (CPAP) in post-stroke patients. The most important data discussed during the workshop for 1) and 2) are presented in the present article. 3) The effects of CPAP on metabolic outcome. One metabolic dysfunction of OSAHS is the change in leptin and ghrelin levels, which represent the "yin and yang" of an appetite regulatoion system that has developed to inform the brain about the current energy balance state. Data on the impact of sleep loss, either behavioural or OSAHS-related, on this neuroendocrine regulation of appetite are also presented.

The participants ended the workshop with a discussion session on the results of more "controversial" treatment strategies for obstructive sleep apnoea/hypopnoea syndrome, such as cardiac pacing, hyoid bone expansion (a preliminary surgical technique), drug treatment for obstructive sleep apnoea/hypopnoea syndrome, female hormone replacement therapy and the role of stimulants for refractory sleepiness in already treated obstructive sleep apnoea/hypopnoea syndrome patients.

KEYWORDS: Cardiac pacing, drug treatment, insulin resistance, sleep apnoea, sleepiness, stroke