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Mansell SK, Devani N, Shah A, Schievano S, Main E, Mandal S. Current treatment strategies in managing side effects associated with domiciliary positive airway pressure (PAP) therapy for patients with sleep disordered breathing: A systematic review and meta-analysis. Sleep Med Rev 2023; 72:101850. [PMID: 37812972 DOI: 10.1016/j.smrv.2023.101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/25/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
Sleep disordered breathing is commonly treated with positive airway pressure therapy. Positive airway pressure therapy is delivered via a tight-fitting mask with common side effects including: leak, ineffective treatment, residual sleep disordered breathing, eye irritation, nasal congestion, pressure ulcers and poor concordance with therapy. This systematic review and meta-analysis aimed to identify the effectiveness of current treatment strategies for managing side effects associated with positive airway pressure therapy. Five databases were searched and 10,809 articles were screened, with 36 articles included in the review. Studies investigated: dressings, nasal spray/douche, chin straps, heated humidification and interfaces. No intervention either improved or detrimentally affected: positive airway pressure concordance, Epworth Sleepiness Score, residual apnoea hypopnea index or interface leak. The review was limited by study heterogeneity, particularly for outcome measures. Additionally, patient demographics were not reported, making it difficult to apply the findings to a broad clinical population. This review highlights the paucity of evidence supporting treatment strategies to manage side effects of positive airway pressure therapy.
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Affiliation(s)
| | | | - Amar Shah
- University College London, UK; Royal Free London NHS Foundation Trust, UK
| | | | | | - Swapna Mandal
- University College London, UK; Royal Free London NHS Foundation Trust, UK
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Deng B, Lai F, Zhang M, Xiong C, Chen F, Zhang H, Ma Y, Zhou D. Nasal pillow vs. standard nasal mask for treatment of OSA: a systematic review and meta-analysis. Sleep Breath 2023; 27:1217-1226. [PMID: 36214944 DOI: 10.1007/s11325-022-02721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE The purpose of this study was to compare the effectiveness of nasal pillows with standard nasal masks in the treatment of patients with obstructive sleep apnea (OSA). METHODS A digitalized search was carried out in four different databases including PubMed, Scopus, EMBASE, and CENTRAL using relevant keywords along with a manual search in relevant journals. All comparative studies comparing outcomes of using a nasal pillow with the use of standard nasal masks for continuous positive airway pressure (CPAP) treatment in patients with OSA were included. The qualitative analysis was carried out by tabulating the demographic data. The quantitative data were subjected to meta-analysis. The quality of comparative studies (both retrospective and prospective cohorts) was evaluated using New-castle Ottawa scale (NOS). RESULTS A total of 14 studies (eight prospective and six retrospective) were included in the review. Of them, five studies were randomized and were of cross-over study design. No significant differences were observed in achieved CPAP and residual apnea-hypopnea index (AHI) levels between the nasal pillow and nasal mask with SMD - 0.05 95% CI [- 0.18, 0.09], p = 0.50 and SMD - 0.13 95% CI [- 0.28, 0.03], p = 0.12, respectively. However, nasal pillow usage was associated with better CPAP adherence with a difference of only + 0.29 min/night as compared to a standard nasal mask, with SMD 0.29 95% CI [0.07, 0.50], p = 0.009. CONCLUSION Nasal pillow and standard nasal mask were equally effective in terms of residual AHI level and achieved similar therapeutic CPAP pressures. However, the difference in CPAP adherence between groups, though statistically significant, is of questionable clinical significance.
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Affiliation(s)
- Bo Deng
- Department of Otolaryngology Head and Neck Surgery, Chengdu Longquanyi First People's Hospital, Chengdu, China
| | - Fei Lai
- Department of Otolaryngology Head and Neck Surgery, Chengdu Longquanyi First People's Hospital, Chengdu, China
| | - Manman Zhang
- Department of Otolaryngology Head and Neck Surgery, Chengdu Longquanyi First People's Hospital, Chengdu, China
| | - Chenyili Xiong
- Department of Otolaryngology Head and Neck Surgery, Chengdu Longquanyi First People's Hospital, Chengdu, China
| | - Feng Chen
- Department of Otolaryngology Head and Neck Surgery, Chengdu Longquanyi First People's Hospital, Chengdu, China
| | - Heng Zhang
- Department of Otolaryngology Head and Neck Surgery, Chengdu Longquanyi First People's Hospital, Chengdu, China.
| | - Yuanyuan Ma
- Department of Orthopedics, Chengdu Longquanyi First People's Hospital, Chengdu, China
| | - Daiying Zhou
- Department of Orthopedics, Chengdu Longquanyi First People's Hospital, Chengdu, China
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Chen L, Chen Y, Hu S, Lin M, Lee P, Chiang AA, Tu Y. In search of a better CPAP interface: A network meta-analysis comparing nasal masks, nasal pillows and oronasal masks. J Sleep Res 2022; 31:e13686. [PMID: 35821391 PMCID: PMC9787466 DOI: 10.1111/jsr.13686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/28/2022] [Accepted: 06/17/2022] [Indexed: 12/30/2022]
Abstract
Until now, no study has directly network meta-analysed the impact of nasal masks, nasal pillows and oronasal masks on continuous positive airway pressure therapy in patients with obstructive sleep apnea. This study aimed to meta-analyse the impact of three kinds of nasal interfaces with both network meta-analysis and pairwise comparison. PubMed, EMBASE, CENTRAL and ClinicalTrials.gov were systematically searched from inception to December 2020 for studies that compared the three types of nasal interfaces for treating obstructive sleep apnea with continuous positive airway pressure. The outcomes were residual apnea-hypopnea index, continuous positive airway pressure, and nightly average usage. The network meta-analysis was conducted using multivariate random-effects in a frequentist framework where three interfaces were ranked with the surface under the cumulative ranking probabilities. The pairwise comparison was conducted using random-effects meta-analysis. Twenty-nine articles comprising 6378 participants were included. The pairwise comparison showed both nasal masks and nasal pillows were associated with lower residual apnea-hypopnea index, lower continuous positive airway pressure, and higher continuous positive airway pressure adherence compared with oronasal masks. The surface under the cumulative ranking confirmed that nasal masks were associated with the lowest residual apnea-hypopnea index and highest adherence, while pillows were associated with the lowest continuous positive airway pressure. The meta-regression identified that lower pretreatment apnea-hypopnea index and continuous positive airway pressure determined during continuous positive airway pressure titration (versus determined during continuous positive airway pressure therapy) was associated with lower continuous positive airway pressure with nasal masks and nasal pillows. In conclusion, compared with oronasal masks, nasal masks and nasal pillows are better interfaces, especially in patients with lower pretreatment apnea-hypopnea index and those with the therapeutic pressure determined during continuous positive airway pressure titration.
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Affiliation(s)
- Li‐Yang Chen
- Department of Internal MedicineTainan Sin Lau HospitalTainanTaiwan
| | - Yung‐Hsuan Chen
- Center of Sleep DisorderNational Taiwan University HospitalTaipeiTaiwan,Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | | | - Ming‐Tzer Lin
- Center of Sleep DisorderNational Taiwan University HospitalTaipeiTaiwan,Department of Internal MedicineHsiao Chung‐Cheng HospitalNew TaipeiTaiwan
| | - Pei‐Lin Lee
- Center of Sleep DisorderNational Taiwan University HospitalTaipeiTaiwan,Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan,School of MedicineNational Taiwan UniversityTaipeiTaiwan,Center for Electronics Technology Integration, National Taiwan UniversityTaipeiTaiwan
| | - Ambrose A. Chiang
- Division of Sleep Medicine, Louis Stokes VA Medical Center; Department of MedicineCase Western Reserve UniversityClevelandOhioUSA
| | - Yu‐Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan UniversityTaipeiTaiwan
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Lima de Andrade Xavier J, Fernandes MD, Lorenzi-filho G, Genta PR. Clinical Decision-making for Continuous Positive Airway Pressure Mask Selection. Sleep Med Clin 2022; 17:569-576. [DOI: 10.1016/j.jsmc.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Kang YJ, Cho JH, Park CS. Analysis of risk factors for air leakage in auto-titrating positive airway pressure users: a single-center study. J Clin Sleep Med 2022; 18:75-88. [PMID: 34170231 PMCID: PMC8807919 DOI: 10.5664/jcsm.9504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES Because air leakage from masks is known as a common cause of low adherence to continuous positive airway pressure therapy, we analyzed the risk factors for air leakage related to parameters associated with auto-titrating positive airway pressure, polysomnography, InBody Test, and rhinomanometry. METHODS Usage data and medical records of 120 auto-titrating positive airway pressure users were reviewed retrospectively. All patients used a nasal or pillow mask and were carefully monitored at scheduled follow-ups. RESULTS Use of a pillow mask, sex (male), age, and abdominal fat percentage were significantly associated with high average air leakage. The higher the auto-titrating positive airway pressure average and mean pressure, the more likely patients exhibited high rates of air leakage. The percentage of patients with high average air leakage increased over time (up to 6 months of follow-up). CONCLUSIONS Older male patients using a pillow mask and those with a high abdominal fat percentage and high auto-titrating positive airway pressure may require close follow-up and continuous monitoring for air leakage. Because air leakage from a mask can change over time, mask-sealing capacity should be reassessed and masks should be changed regularly. CITATION Kang YJ, Cho J-H, Park C-S. Analysis of risk factors for air leakage in auto-titrating positive airway pressure users: a single-center study. J Clin Sleep Med. 2022;18(1):75-88.
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Affiliation(s)
- Yun Jin Kang
- Department of Otolaryngology-Head and Neck Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jin-Hee Cho
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan-Soon Park
- Department of Otolaryngology-Head and Neck Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea,Address correspondence to: Chan-Soon Park, MD, PhD, Department of Otorhinolaryngology-Head and Neck Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu Daero (Ji-dong), Suwon Si, Paldal-gu, Gyeonggi-Do, 16247, Republic of Korea; Tel: +82-31-249-8968; Fax: +82-31-257-3752;
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Abstract
This article reviews the evidence to date examining whether adherence to positive airway pressure (PAP) therapy is affected by any device modifications to pressure delivery. To date there is no robust evidence from systematic reviews and meta-analyses indicating that any modification to standard fixed-pressure PAP makes a clinically significant difference to patient adherence to therapy. The main modifications are reviewed in this article and whether improving pressure could drive adherence, in turn improving patient outcomes, is discussed.
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Affiliation(s)
- Roo Killick
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Pt Road, Glebe, Sydney, New South Wales 2037, Australia
| | - Nathaniel S Marshall
- Woolcock Institute of Medical Research, The University of Sydney, 431 Glebe Pt Road, Glebe, Sydney, New South Wales 2037, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
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Chung TT, Lee MT, Ku MC, Yang KC, Wei CY. Efficacy of a Smart Antisnore Pillow in Patients with Obstructive Sleep Apnea Syndrome. Behav Neurol 2021; 2021:8824011. [PMID: 33510821 DOI: 10.1155/2021/8824011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/08/2020] [Accepted: 01/02/2021] [Indexed: 12/14/2022] Open
Abstract
Objective Untreated obstructive sleep apnea syndrome (OSAS) increases the risk of cardiovascular, dementia, and motor vehicle accident events. However, continuous positive airway pressure (CPAP) which is the gold standard treatment is not acceptable for many patients with OSAS. Development of devices for the patients of nonadherence to CPAP is necessary. Materials and Methods We evaluated the effect of the smart antisnore pillow (SAP) in patients with OSAS in a prospective, noncontrolled, nonrandomized, pilot study. According to the apnea-hypopnea index (AHI), they were divided into two groups: mild-to-moderate OSAS group and severe OSAS group. Single-night polysomnography (PSG) with application of a SAP was performed. Thirty patients, 15 males and 15 females, 33–82 years old (mean age, 59.3 ± 12.9 years), completed the smart antisnore pillow therapy test. Among them, 23 patients had mild-to-moderate OSAS. Results The SAP significantly improved the snore number (p = 0.018), snore index (p = 0.013), oxygen denaturation index (p = 0.001), total AHI (p = 0.002), and supine AHI (p = 0.002) in the mild-to-moderate OSAS group, but there was no significant improvement in the severe OSAS group. Conclusions We concluded that the SAP is an effective positional therapy device for patients with OSAS of mild-to-moderate severity.
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Zonato AI, Rosa CFA, Oliveira L, Bittencourt LR. Efficacy of nasal masks versus nasal pillows masks during continuous positive airway pressure titration for patients with obstructive sleep apnea. Sleep Breath 2021; 25:1-8. [PMID: 33403598 DOI: 10.1007/s11325-020-02251-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Nasal masks are usually the first choice for CPAP therapy, but patients may experience side effects. There are limited data regarding the efficacy of nasal pillows masks during CPAP titration. This study aimed to compare the polysomnography outcomes during CPAP titration while comparing two types of masks (nasal and pillows) and to assess whether or not the patient characteristics differed between mask preferences. METHODS In a sleep-disorders clinic, we prospectively analyzed all patients undergoing CPAP titration for three consecutive months. CPAP pressures were manually titrated. Anthropometric data (age, sex, body mass index, and neck and waist circumferences) and OSA severity were documented. Patients completed a self-administered questionnaire that measured nasal obstruction (NOSE scale). Before titration, both types of masks were presented to patients, and each of them chose the one they preferred. RESULTS Of 157 patients, 55% (n = 86) used nasal masks, and 45% (n = 71) used nasal pillows masks. There was no difference according to mask type chosen by age, sex, body mass index, neck and waist circumferences, and NOSE scale. Polysomnography outcomes were similar between the mask groups. The mean CPAP level was 9.4 ± 1.8 cm H2O for nasal masks and 9.1 ± 2.0 cm H2O for nasal pillows (p = 0.61). Residual apnea-hypopnea index was 3.0 ± 2.8 events/h for nasal mask and 3.5 ± 4.1 events/h for pillow mask (p = 0.28). Baseline AHI, body mass index, neck and waist circumferences, and residual AHI were independent predictors of a higher CPAP pressure for both groups (p < 0.0001). CONCLUSIONS Nasal pillows masks seem to be as effective as nasal masks and may be considered to be an initial choice for CPAP titration.
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Zhou J, Wang C, Wu J, Fukunaga A, Cheng Z, Wang J, Yamauchi A, Yodoi J, Tian H. Anti-Allergic and Anti-Inflammatory Effects and Molecular Mechanisms of Thioredoxin on Respiratory System Diseases. Antioxid Redox Signal 2020; 32:785-801. [PMID: 31884805 DOI: 10.1089/ars.2019.7807] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Significance: The pathogenesis and progression of allergic inflammation in the respiratory system are closely linked to oxidative stress. Thioredoxin (TRX) is an essential redox balance regulator in organisms and is induced by various oxidative stress factors, including ultraviolet rays, radiation, oxidation, viral infections, ischemia reperfusion, and anticancer agents. Recent Advances: We demonstrated that systemic administration and transgenic overexpression of TRX is useful in a wide variety of in vivo inflammatory respiratory diseases models, such as viral pneumonia, interstitial lung disease, chronic obstructive pulmonary disease, asthma, acute respiratory distress syndrome, and obstructive sleep apnea syndrome, by removing reactive oxygen species, blocking production of inflammatory cytokines, inhibiting migration and activation of neutrophils and eosinophils, and regulating the cellular redox status. In addition, TRX's anti-inflammatory mechanism is different from the mechanisms associated with anti-inflammatory agents, such as glucocorticoids, which regulate the inflammatory reaction in association with suppressing immune responses. Critical Issues: Understanding the molecular mechanism of TRX is very helpful for understanding the role of TRX in respiratory diseases. In this review, we show the protective effect of TRX in various respiratory diseases. In addition, we discuss its anti-allergic and anti-inflammatory molecular mechanism in detail. Future Directions: The application of TRX may be useful for treating respiratory allergic inflammatory disorders. Antioxid. Redox Signal. 32, 785-801.
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Affiliation(s)
- JieDong Zhou
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, China
| | - CuiXue Wang
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, China
| | - JiaLin Wu
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, China
| | - Atsushi Fukunaga
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - ZuSheng Cheng
- Department of Radiology, Shaoxing Seventh People's Hospital, Shaoxing, China
| | - JinQuan Wang
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, China
| | - Akira Yamauchi
- Department of Breast Surgery, Nara Prefectural General Medical Center, Nara, Japan
| | - Junji Yodoi
- Laboratory of Infection and Prevention, Department of Biological Response, Institute for Virus Research, Kyoto University, Kyoto, Japan
| | - Hai Tian
- Department of Basic Medicine, Medical College, Shaoxing University, Shaoxing, China.,Jiaozhimei Biotechnology (Shaoxing) Co., Ltd., Shaoxing, China
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Abstract
The selection of the mask interface for non-invasive ventilation (NIV) is recognized to be an essential part for therapy success. While nasal masks are the first recommended option in children and adults, there are indications for other mask types such as intolerance or complications from nasal masks. Evidence comparing performance, adherence and complication risk among mask interfaces in pediatrics is, however, scarce and information is often extrapolated from adult studies. Given this gap in knowledge and the lack of guidelines on NIV initiation in children, mask selection often relies on the clinicians' knowledge and expertise. Careful mask selection, a well-fitting headgear and time investment for mask desensitization are some important recommendations for adequate mask adaptation in children. Frequent mask-related complications include nasal symptoms, unintentional leak, mask displacement, skin injury, and midface hypoplasia. Close monitoring and a pro-active approach may help to minimize complications and promote the optimal use of home NIV.
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Affiliation(s)
- Maria L Castro-Codesal
- Department of Pediatrics, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada; Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada.
| | - Deborah L Olmstead
- Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada
| | - Joanna E MacLean
- Department of Pediatrics, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada; Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada
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Affiliation(s)
- Stefano Marra
- Department of Neuroscience, IRCCS, G. Gaslini Institute, Genoa, Italy
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
| | - Dario Arnaldi
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
- Neurology Unit, IRCCS San Martino Hospital, Genoa, Italy
| | - Lino Nobili
- Department of Neuroscience, IRCCS, G. Gaslini Institute, Genoa, Italy
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
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Blanco M, Ernst G, Salvado A, Borsini E. Impact of Mask Type on the Effectiveness of and Adherence to Unattended Home-Based CPAP Titration. Sleep Disord 2019; 2019:4592462. [PMID: 31019811 PMCID: PMC6452566 DOI: 10.1155/2019/4592462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/28/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare interfaces performance during home-based automatic titration (APAP). METHODS Retrospective study based on APAP titration from Obstructive Sleep Apnea Syndrome (OSA) patients. RESULTS 707 patients, 513 men (70.6%), were titrated. Masks were 104 pillows (14.7%), group I (GI); 532 nasal (75.2%), group II (GII); and 71 oronasal masks (10%), group III (GIII). We found differences in effective pressure to the device (P90/P95) (GI: 7.13±1.9 vs. GII: 8.3±2.1 vs. GIII: 9.3±2.6 cmH2O, p <0.001) but not in final pressure titrated manually (GI: 7.9±1.4 vs. GII: 8.6±1.6 vs. GIII: 9.2±1.9 cm of H2O, p >0.5), where lower residual AHI for pillows was p <0.001 and leaks for nasal were p <0.001. No differences were found in compliance (hours) (GI: 6.3±1.2 vs. GII: 6.2±1.1 vs. GIII: 6.1±1.0, p <0.4). CONCLUSION During auto-adjusting titration by CPAP-naïve patients, nasal masks had lower leak rates and nasal pillows presented a similar performance.
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Affiliation(s)
- Magalí Blanco
- Sleep and Ventilation Unit, Hospital Británico de Buenos Aires, Argentina
| | - Glenda Ernst
- Center for Respiratory Medicine, Hospital Británico de Buenos Aires, Argentina
| | - Alejandro Salvado
- Center for Respiratory Medicine, Hospital Británico de Buenos Aires, Argentina
| | - Eduardo Borsini
- Sleep and Ventilation Unit, Hospital Británico de Buenos Aires, Argentina
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Tan B, Tan A, Chan YH, Mok Y, Wong HS, Hsu PP. Adherence to Continuous Positive Airway Pressure therapy in Singaporean patients with Obstructive Sleep Apnea. Am J Otolaryngol 2018; 39:501-506. [PMID: 29929863 DOI: 10.1016/j.amjoto.2018.05.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/22/2018] [Accepted: 05/26/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the rates of Continuous Positive Airway Pressure (CPAP) uptake and adherence amongst Singaporean patients diagnosed with Obstructive Sleep Apnea (OSA), and to evaluate factors correlated with CPAP uptake and adherence. STUDY DESIGN Retrospective review of medical records. METHODS Medical records were reviewed for baseline demographics, daytime sleepiness, presence of nasal symptoms and OSA severity, initial treatment choice, the rate of CPAP treatment uptake and CPAP adherence at 1 and 12 months. RESULTS 2160 patients were diagnosed with OSA within the 5-year period (2011-2015). 463 (21.4%) had mild OSA, 583 (27.0%) had moderate OSA and 1114 (51.6%) had severe OSA. For initial therapy, 751 (34.8%) patients opted for a 1-month CPAP trial, 288 (13.3%) patients chose surgery upfront, 291 (13.5%) patients chose adjunctive treatments (weight loss, positional therapy, dental appliance, intranasal steroid spray for allergic rhinitis) and 830 (38.4%) patients rejected all forms of treatment. 337 out of 751 patients (44.9%) were adherent to CPAP therapy during the 1 month trial. 381 out of 751 (50.7%) patients took up CPAP therapy following the trial period, of which 299 out of 381 (78.5%) patients were adherent to CPAP therapy at 1 year. CPAP adherence during the 1-month trial was a predictor for eventual CPAP treatment uptake and CPAP adherence at 1 year (p < 0.001). Age (p < 0.001), BMI (p < 0.001) and normal ESS (p = 0.01) were predictors of treatment rejection. 24 patients underwent upper airway surgery during their first year of using CPAP. 21 out of the 24 patients (87.5%) were adherent to CPAP at 1 year after undergoing surgery. These patients had a higher rate of CPAP adherence compared to the overall cohort (87.5% versus 78.5%), but this was not statistically significant (p > 0.05). CONCLUSION Singaporean patients who accept CPAP therapy after an initial 1-month CPAP trial will generally be adherent to CPAP therapy. Initial patterns of CPAP usage are predictive of long term CPAP adherence. However, there is a high rate of CPAP treatment rejection both at the time of diagnosis and after the CPAP trial. Upper airway surgery in selected patients may improve CPAP adherence.
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Affiliation(s)
- Bernard Tan
- Department of Otolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore.
| | - Alvin Tan
- Department of Otolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yingjuan Mok
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Hang Siang Wong
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Pon Poh Hsu
- Department of Otolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore University of Technology and Design, Singapore
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