The role of long-term continuous positive airway pressure in the progression of obstructive sleep apnoea: A longitudinal cohort study

Construction and Validation of a Nomogram Model for Predicting Pulmonary Hypertension in Patients with Obstructive Sleep Apnea

Purpose

Pulmonary hypertension (PH) is a common cardiovascular complication of obstructive sleep apnea (OSA), posing a significant threat to the health and life of patients with OSA. However, no clinical prediction model is currently available to evaluate the risk of PH in OSA patients. This study aimed to develop and validate a nomogram for predicting PH risk in OSA patients.

Patients and Methods

We collected medical records of OSA patients diagnosed by polysomnography (PSG) from January 2016 to June 2024. Transthoracic echocardiography (TTE) was performed to evaluate PH. A total of 511 OSA patients were randomly divided into training and validation sets for model development and validation. Potential predictive factors were initially screened using univariate logistic regression and Lasso regression. Independent predictive factors for PH risk were identified via multivariate logistic regression, and a nomogram model was constructed. Model performance was assessed in terms of discrimination, calibration, and clinical applicability.

Results

Eight independent predictive factors were identified: age, recent pulmonary infection, coronary atherosclerotic heart disease (CHD), apnea-hypopnea index (AHI), mean arterial oxygen saturation (MSaO2), lowest arterial oxygen saturation (LSaO2), alpha-hydroxybutyrate dehydrogenase (α-HBDH), and fibrinogen (FIB). The nomogram model demonstrated good discriminative ability (AUC = 0.867 in the training set, AUC = 0.849 in the validation set). Calibration curves and decision curve analysis (DCA) also indicated good performance. Based on this model, a web-based nomogram tool was developed.

Conclusion

We developed and validated a stable and practical web-based nomogram for predicting the probability of PH in OSA patients, aiding clinicians in identifying high-risk patients for early diagnosis and treatment.

Educational video demonstrating collapsibility of the upper airway during sleep improves initial acceptance of CPAP in patients with severe obstructive sleep apnea: a retrospective study

STUDY OBJECTIVES

We investigated whether an audiovisual educational video demonstrating collapsibility of the upper airway during sleep would influence initial continuous positive airway pressure (CPAP) acceptance among patients with severe obstructive sleep apnea.

METHODS

Between January 2017 and December 2018, a single-center retrospective study was conducted. We implemented an educational video demonstrating upper airway collapsibility during sleep in February 2018. We analyzed the medical records from 145 consecutive patients diagnosed with severe obstructive sleep apnea who underwent in-laboratory polysomnography both before and after implementing the educational video. Among them, 76 patients received standard care before the video's introduction (standard care group), and another 69 patients were managed after its implementation (video group).

RESULTS

Baseline characteristics including age, body mass index, educational level, occupation category, comorbidities, Mallampati score, Epworth Sleepiness Scale score, apnea-hypopnea index, and sleep time with SpO2 below 90% were not significantly different between the 2 groups. Acceptance of CPAP following an in-laboratory overnight titration study was significantly higher in the video group (80%) than in the standard care group (57%) (P = .003). Multivariate regression analyses revealed that watching the video was a strong predictor of initial CPAP acceptance (odds ratio, 4.162; 95% confidence interval, 1.627-10.646; P = .004). Both sleep time with SpO2 below 90% (odds ratio, 1.020; 95% confidence interval, 1.002-1.038; P = .029) and sleep efficiency (odds ratio, 1.052; 95% confidence interval, 1.023-1.083; P < .001) were weak predictors for initial CPAP acceptance. At 12 months, adherence among those who accepted the CPAP treatment was similar between the 2 groups (78% vs 74%; P = .662). However, within the initial cohorts, a significantly higher proportion of patients in the video group (62%) were using CPAP at 12 months compared with the standard care group (42%) (P = .015).

CONCLUSIONS

Among patients with severe obstructive sleep apnea, an educational video demonstrating upper airway collapsibility during sleep improved initial CPAP acceptance rates when compared with standard care.

CITATION

Tselepi C, Tsirves G, Exarchos K, et al. Educational video demonstrating collapsibility of the upper airway during sleep improves initial acceptance of CPAP in patients with severe obstructive sleep apnea: a retrospective study. J Clin Sleep Med. 2024;20(9):1423-1433.

Improved Quality of Life After Mandibular Advancement by Bilateral Internal Ramus Distraction

BACKGROUND

Obstructive Sleep Apnea (OSA) is a significant health issue due to noncompliance with continuous positive airway pressure treatment. Therefore, evaluating alternative treatments is crucial.

PURPOSE

Analyze the impact of maxillomandibular advancement using bilateral internal ramus distraction (BIRD) on quality of life (QOL) in OSA patients.

STUDY DESIGN, SETTING, AND SAMPLE

A prospective cohort study was conducted at the Oral and Maxillofacial Surgery Department of the University Hospital "La Princesa." The study included patients with moderate to severe OSA who were treated with the BIRD approach.

PREDICTOR VARIABLE

Changes in measured variables were analyzed at three time points: before surgery (T1), after mandibular advancement (T2), and after maxillary advancement (T3).

MAIN OUTCOME VARIABLE(S)

QOL changes measured by Quebec Sleep Questionnaire and the Epworth Sleepiness Scale. Secondary outcomes included: apnea-hypopnea index (AHI), oxygen desaturation index, and percentage of time with saturation below 90%.

COVARIATES

Age, sex, continuous positive airway pressure treatment, cephalometric variables and cardiovascular risk parameters were considered.

ANALYSES

Statistical analysis employed the Friedman test and χ2 test, with a significance level of P ≤ .05.

RESULTS

The study included 32 patients (22% with moderate OSA, 78% with severe OSA). Epworth Sleepiness Scale scores significantly decreased between T1 (13.4 ± 4.4) and T2 (5.8 ± 3.6) and T3 (1.9 ± 1.8) (P < .001). QOL improvements were observed in all domains: daytime sleepiness T1 (3.0 ± 1.3) T2 (5.4 ± 1.4) T3 (6.3 ± 1.0); diurnal symptoms T1 (2.5 ± 1.4) T2 (5.2 ± 1.3) T3 (6.2 ± 1.1); nocturnal symptoms T1 (2.5 ± 1.1) T2 (5.6 ± 1.1) T3 (6.5 ± 0.8); emotions T1 (2.6 ± 1.6) T2 (5.3 ± 1.4) T3 (6.5 ± 0.9); and social interaction T1 (2.5 ± 1.6) T2 (5.4 ± 1.6) T3 (6.3 ± 1.2) (P < .001). AHI decreased between T1 (47.9 ± 23.1) and T2 (14.4 ± 14.3) and T3 (4.7 ± 5.6) h-1 (P < .001), with a final cure rate of 81.2% (defined as final AHI<5 h-1). Oxygen desaturation index and percentage of time with saturation below 90% also showed significant reductions (P < .001).

CONCLUSIONS AND RELEVANCE

BIRD approach for OSA demonstrated a high cure rate and significant QOL improvements. It shows promise as an effective surgical option. Further research and long-term follow-up are needed.

Effect of positive airway pressure compliance on laryngopharyngeal reflux in obstructive sleep apnea patients

OBJECTIVES

To determine the effect of continuous positive airway pressure (CPAP) compliance on symptoms and signs of laryngopharyngeal reflux (LPR) in patients with obstructive sleep apnea (OSA).

RESULTS

Thirty patients were included. The participants were divided into good compliance (n = 21) and poor compliance (n = 9) groups. After 6-month CPAP treatment, the reflux symptom index score significantly decreased in both the good compliance group (20 (17,24) vs. 14 (10,18), p < 0.001) and the poor compliance group (21 (18,25) vs. 10 (5,16), p < 0.05). Reflux finding score was significantly reduced in both the good compliance group (8 (6,9) vs. 4 (3,5), p < 0.001) and the poor compliance group (6 (4,8) vs. 3 (2,4), p < 0.05). However, there were no statistically significant differences between the groups. CPAP treatment reduces the symptoms and signs of LPR. However, CPAP compliance does not correlate with improvement in LPR in patients with OSA.

Identifying longitudinal patterns of CPAP treatment in OSA using growth mixture modeling: Disease characteristics and psychological determinants

In this study, we aim to identify the distinct subtypes of continuous positive airway pressure (CPAP) user profiles based on the telemedicine management platform and to determine clinical and psychological predictors of various patterns of adherence. A total of 301 patients used auto-CPAP (Autoset 10, Resmed Inc.) during the treatment period. Four categories of potential predictors for CPAP adherence were examined: (1) demographic and clinical characteristics, (2) disease severity and comorbidities, (3) sleep-related health issues, and (4) psychological evaluation. Then, growth mixture modeling was conducted using Mplus 8.0 to identify the unique trajectories of adherence over time. Adherence data were collected from the telemedicine management platform (Airview, Resmed Inc.) during the treatment. Three novel subgroups were identified and labeled "adherers" (53.8% of samples, intercept = 385, slope = -51, high mean value, negative slope and moderate decline), "Improvers" (18.6%, intercept = 256, slope = 50, moderate mean value, positive slope and moderate growth) and "non-adherers" (27.6%, intercept = 176, slope = -31, low mean value, negative slope and slight decline). The comorbidities associated with OSA and the apnea-hypopnea index (AHI), which reflects the objective severity of the disease, did not differ significantly among the subgroups. However, "improvers" showed higher levels of daytime sleepiness (8.1 ± 6.0 vs. 12.1 ± 7.0 vs. 8.0 ± 6.1 in SWIFT, p = 0.01), reduced daytime function (4.6 ± 1.6 vs. 3.8 ± 1.6 vs. 4.2 ± 1.8 in QSQ daytime symptoms, p = 0.02), and characteristics of positive coping style (1.8 ± 0.5 vs. 1.9 ± 0.5 vs. 1.7 ± 0.5 in SCSQ positive coping index, p = 0.02). Negative emotion was more pronounced in patients with "non-adherers" (12.9 ± 3.8 vs. 13.7 ± 3.3 vs. 14.6 ± 3.5, p = 0.02 in the HADS depression dimension; 9.0 ± 6.1 vs. 9.8 ± 5.1 vs. 11.5 ± 6.3, p = 0.01 with Negative Affectivity in DS14, and 9.3 ± 6.1 vs. 10.3 ± 5.1 vs. 11.7 ± 6.5, p = 0.01 with Social Inhibition in DS14). Overall, our study demonstrated that CPAP therapy may present distinct trajectories of adherence over time in addition to the traditional binary classification. Self-reported sleep health issues (diurnal sleepiness and daytime dysfunction) as well as psychological characteristics (negative emotions and coping style) were predictors of different adherence subtypes in patients with OSA. Understanding CPAP use profiles and their predictors enable the identification of those who may require additional intervention to improve adherence and further enhance the therapeutic effect in OSA patients.

Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions

Objective: This scoping review aims to provide an accessible summary of available evidence on the efficacy of motivational interventions to increase adherence to Continuous Positive Airway Pressure (CPAP) among patients with Obstructive Sleep Apnea Syndrome (OSAS) and of their specific aspects and strategies by assessing adherence measures. Methods: A literature search was performed in PubMed, Scopus, Medline, PsycINFO, and Web of Science databases using the concepts of "obstructive sleep apnea syndrome," "continuous positive airway pressure," "motivational intervention," and "adherence." Rigorous inclusion criteria and screening by at least two reviewers were applied. Data were extracted to address the review aims and were presented as a narrative synthesis. Results: Search for databases produced 11 randomized controlled trials, all including naïve CPAP users. Findings showed that motivational interventions were more effective than usual care and educational programs in increasing adherence to CPAP, despite results were not always maintained over time across studies. Discussion: To our knowledge, this is the first scoping review of the literature aimed to explore the characteristics and impact of motivational interventions to promote adherence to CPAP in patients with OSAS. More research providing a detailed description of motivational strategies, and testing of their association with positive treatment outcomes via both direct and indirect measures are needed to increase awareness on active mechanisms of change.