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Leelasittikul K, Pugongchai A, Tepwimonpetkun C, Saiphoklang N. Quality of Life, Mental Health, and CPAP Compliance in Thai Patients with Obstructive Sleep Apnea during COVID-19 Pandemic. SLEEP DISORDERS 2024; 2024:1373299. [PMID: 38695014 PMCID: PMC11060863 DOI: 10.1155/2024/1373299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/26/2024] [Accepted: 04/13/2024] [Indexed: 05/04/2024]
Abstract
Background This study is aimed at determining the quality of life, mental health, and adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) among Thai OSA patients during the coronavirus disease 2019 (COVID-19) pandemic as this data has been lacking. Methods A cross-sectional study was conducted at a university hospital between September 2021 and April 2022. OSA patients aged 18 years or older who required home CPAP treatment were included. Sleep Apnea Quality of Life Index (SAQLI) and Depression Anxiety Stress Scales-21 (DASS-21) were used to assess quality of life and mental health, respectively. Results A total of 142 participants (62% male) were included, with a mean age of 54.4 ± 14.7 years and a body mass index of 29.9 ± 6.8 kg/m2. Polysomnographic data showed a mean apnea-hypopnea index of 48.0 ± 32.4 events/hour and a mean lowest oxygen saturation of 79.2 ± 12.2%. Severe OSA was observed in 66.9%. CPAP compliance was reported in 50.7%. The SAQLI score was 2.32 ± 1.12. Depression, anxiety, and stress scores in DASS-21 were 2.89 ± 3.31, 3.94 ± 3.67, and 4.82 ± 4.00, respectively. Compared to the CPAP compliance group, the CPAP noncompliance group had higher daily activity scores in SAQLI (2.98 ± 1.25 vs. 2.45 ± 1.33, P = 0.015). Conclusions The quality of life for Thai OSA patients during the COVID-19 era was moderate degree. Poor CPAP compliance was significantly associated with limited daily activity. Enhancing CPAP compliance could improve the quality of life in these patients. This trial is registered with TCTR20211104004.
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Affiliation(s)
- Kanyada Leelasittikul
- Medical Diagnostics Unit, Thammasat University Hospital, Khlong Nueng, Pathum Thani, Thailand
- Sleep Center of Thammasat, Thammasat University Hospital, Khlong Nueng, Pathum Thani, Thailand
| | - Apiwat Pugongchai
- Medical Diagnostics Unit, Thammasat University Hospital, Khlong Nueng, Pathum Thani, Thailand
- Sleep Center of Thammasat, Thammasat University Hospital, Khlong Nueng, Pathum Thani, Thailand
| | - Chatkarin Tepwimonpetkun
- Sleep Center of Thammasat, Thammasat University Hospital, Khlong Nueng, Pathum Thani, Thailand
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Khlong Nueng, Pathum Thani, Thailand
| | - Narongkorn Saiphoklang
- Medical Diagnostics Unit, Thammasat University Hospital, Khlong Nueng, Pathum Thani, Thailand
- Sleep Center of Thammasat, Thammasat University Hospital, Khlong Nueng, Pathum Thani, Thailand
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Khlong Nueng, Pathum Thani, Thailand
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Prigent A, Blanloeil C, Jaffuel D, Serandour AL, Barlet F, Gagnadoux F. Seasonal changes in positive airway pressure adherence. Front Med (Lausanne) 2024; 11:1302431. [PMID: 38435388 PMCID: PMC10904632 DOI: 10.3389/fmed.2024.1302431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Through their effects on sleep duration, bedroom environments, and pollen allergies, seasonal variations may impact positive airway pressure (PAP) adherence. We analyzed daily PAP telemonitoring data from 25,846 adults (median age 64 years, 67.8% male) treated with PAP for at least 4 months [mean (standard deviation, SD) duration of PAP: 5.5 years (SD 4.1)] to examine seasonal changes in PAP adherence, leaks, and residual apnea-hypopnea index. We demonstrate a significant decrease in PAP adherence in June compared to January (mean (SD): 0.37 (1.54) h/night) that achieved the minimal clinically important difference (MCID) of 30 min in 13.9% of adults. Furthermore, we provide novel data supporting the association of rising temperatures with seasonal changes in PAP use. Indeed, the most pronounced decline in PAP adherence was observed during the hottest days, while PAP adherence was only slightly reduced during the coolest days of June. Clinicians should be aware of seasonal changes in PAP adherence that are likely to be exacerbated by climate change.
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Affiliation(s)
- Arnaud Prigent
- Groupe Médical de Pneumologie, Polyclinique Saint-Laurent, Rennes, France
- Centre du Sommeil Polyclinique Saint Laurent, Rennes, France
| | | | - Dany Jaffuel
- Département de Pneumologie, Hôpital Arnaud de Villeneuve, CHRU de Montpellier, Montpellier, France
- INSERM U1046 - CNRS 9214 - Physiologie et Médecine Expérimentale Cœur et Muscle, Université de Montpellier, Montpellier, France
| | | | - Franck Barlet
- i-GEIA 14 rue Pierre Grenier, Boulogne-Billancourt, France
| | - Frédéric Gagnadoux
- Service de Pneumologie, CHU d'Angers, Angers, France
- INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, Université d'Angers, Angers, France
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Bouloukaki I, Pataka A, Mauroudi E, Moniaki V, Fanaridis M, Schiza SE. Impact of the COVID-19 pandemic on positive airway pressure adherence and patients' perspectives in Greece: the role of telemedicine. J Clin Sleep Med 2023; 19:1743-1751. [PMID: 37218340 PMCID: PMC10545996 DOI: 10.5664/jcsm.10664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023]
Abstract
STUDY OBJECTIVES To analyze the impact of national lockdowns in Greece on positive airway pressure adherence, patients' perspectives regarding COVID-19 pandemic and the role of telemedicine. METHODS 872 obstructive sleep apnea patients from southern and 673 from northern Greece, under positive airway pressure treatment, were evaluated with adherence data available 12 months prior to and 3 months after the first and second lockdown. Telemedicine, locally available as part of a research protocol, was used for patient's follow-up in southern Greece and standard follow-up procedures were implemented in northern Greece. We analyzed the impact of COVID-19 lockdown on positive airway pressure adherence and patients' concerns regarding COVID-19 infection. RESULTS Significant difference was noted in positive airway pressure adherence as measured by the hours of use at 12 months prior to and at the 3 months after the first lockdown in southern (5.6 vs 6.6, P = .003) and northern Greece (5.3 vs 6.0, P = .03). The proportion of patients with optimal adherence (≥ 6 hours) increased by 18% (P = .004) in southern and by 9% (P = .20) in northern Greece after the first lockdown and remained steady after the second lockdown in both groups. In southern Greece, 23% of patients reported that they were concerned about getting COVID-19 due to obstructive sleep apnea diagnosis, while only 3% reported decreased sleep duration. Moreover, 9% were concerned that the presence of obstructive sleep apnea would make them more susceptible for worse outcome in case of COVID-19 infection. CONCLUSIONS Our results suggest that maintaining follow-up using telemedicine had a positive influence pointing out the potential role of digital health. CITATION Bouloukaki I, Pataka A, Mauroudi E, Moniaki V, Fanaridis M, Schiza SE. Impact of the COVID-19 pandemic on positive airway pressure adherence and patients' perspectives in Greece: the role of telemedicine. J Clin Sleep Med. 2023;19(10):1743-1751.
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Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Athanasia Pataka
- Department of Respiratory Medicine, G Papanikolaou Hospital, Respiratory Failure Unit, Aristotle University of Thessaloniki, Greece
| | - Eleni Mauroudi
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Violeta Moniaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Michalis Fanaridis
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Sophia E. Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Bottaz-Bosson G, Midelet A, Mendelson M, Borel JC, Martinot JB, Le Hy R, Schaeffer MC, Samson A, Hamon A, Tamisier R, Malhotra A, Pépin JL, Bailly S. Remote Monitoring of Positive Airway Pressure Data: Challenges, Pitfalls, and Strategies to Consider for Optimal Data Science Applications. Chest 2023; 163:1279-1291. [PMID: 36470417 PMCID: PMC10258439 DOI: 10.1016/j.chest.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/06/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
Over recent years, positive airway pressure (PAP) remote monitoring has transformed the management of OSA and produced a large amount of data. Accumulated PAP data provide valuable and objective information regarding patient treatment adherence and efficiency. However, the majority of studies that have analyzed longitudinal PAP remote monitoring have summarized data trajectories in static and simplistic metrics for PAP adherence and the residual apnea-hypopnea index by the use of mean or median values. The aims of this article are to suggest directions for improving data cleaning and processing and to address major concerns for the following data science applications: (1) conditions for residual apnea-hypopnea index reliability, (2) lack of standardization of indicators provided by different PAP models, (3) missing values, and (4) consideration of treatment interruptions. To allow fair comparison among studies and to avoid biases in computation, PAP data processing and management should be conducted rigorously with these points in mind. PAP remote monitoring data contain a wealth of information that currently is underused in the field of sleep research. Improving the quality and standardizing data handling could facilitate data sharing among specialists worldwide and enable artificial intelligence strategies to be applied in the field of sleep apnea.
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Affiliation(s)
- Guillaume Bottaz-Bosson
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France; Jean Kuntzmann Laboratory, University Grenoble Alpes, Grenoble, France
| | - Alphanie Midelet
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France; Probayes, Montbonnot-Saint-Martin, France
| | - Monique Mendelson
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France
| | - Jean-Christian Borel
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France; AGIR à dom HomeCare Charity, Meylan, France
| | - Jean-Benoît Martinot
- Sleep Laboratory, CHU UCL Namur Site Sainte-Elisabeth, Namur, Belgium; Institute of Experimental and Clinical Research, UCL, Bruxelles Woluwe, Belgium
| | | | | | - Adeline Samson
- Jean Kuntzmann Laboratory, University Grenoble Alpes, Grenoble, France
| | - Agnès Hamon
- Jean Kuntzmann Laboratory, University Grenoble Alpes, Grenoble, France
| | - Renaud Tamisier
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, CA
| | - Jean-Louis Pépin
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France
| | - Sébastien Bailly
- Laboratoire HP2, U1300 Inserm, University Grenoble Alpes, Grenoble, France.
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Mendelson M, Duval J, Bettega F, Tamisier R, Baillieul S, Bailly S, Pépin JL. The individual and societal price of non-adherence to continuous positive airway pressure, contributors and strategies for improvement. Expert Rev Respir Med 2023; 17:305-317. [PMID: 37045746 DOI: 10.1080/17476348.2023.2202853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Continuous positive airway pressure (CPAP) is the first line therapy for obstructive sleep apnea (OSA). CPAP is highly effective for improving symptoms and quality of life but the major issue is adherence, with up to 50% of OSA discontinuing CPAP in the first 3 years after CPAP initiation. AREAS COVERED We present the individual and societal cost of non-adherence to CPAP, factors associated with non-adherence to CPAP, as well as current strategies for improving adherence including telehealth, couples-based interventions and behavioral interventions. We also report on challenges and pitfalls for the visualization and analysis of CPAP remote monitoring platforms. EXPERT OPINION CPAP termination rates and adherence to therapy remain major issues despite technical improvements in CPAP devices. The individual and societal price of non-adherence to CPAP for OSA patients goes beyond excessive sleepiness and includes cardiovascular events, all-cause mortality, and increased health costs. Strategies for improving CPAP adherence should be individually tailored and aim to also improve lifestyle habits including physical activity and nutrition. Access to these strategies should be supported by refining visualization dashboards of CPAP remote monitoring platforms, and by disseminating telehealth and innovative analytics, including artificial intelligence.
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Affiliation(s)
- Monique Mendelson
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, Grenoble, France
| | - Jeremy Duval
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, Grenoble, France
- LVL Médical, 44 Quai Charles de Gaulle Lyon, France
| | - François Bettega
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, Grenoble, France
| | | | - Sébastien Bailly
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, Grenoble, France
| | - Jean-Louis Pépin
- HP2 Laboratory, Inserm U1300, Grenoble Alps University, Grenoble, France
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Jo S, Cho J. Impact of the COVID-19 pandemic on adherence to positive airway pressure treatment in patients with obstructive sleep apnea: systematic review and meta-analysis. Ther Adv Respir Dis 2023; 17:17534666231214040. [PMID: 38146255 PMCID: PMC10752124 DOI: 10.1177/17534666231214040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/19/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND The adverse effects of the COVID-19 pandemic on sleep have been well studied. However, whether the COVID-19 pandemic impacted positive airway pressure (PAP) adherence in patients with obstructive sleep apnea (OSA) remains unclear. OBJECTIVES To evaluate the impact of the COVID-19 pandemic on adherence to PAP therapy in patients with OSA. DESIGN A retrospective cohort study, systematic review, and meta-analysis. DATA SOURCES AND METHODS The retrospective study included adults with OSA who received PAP prescriptions within the year before and the year after the start date of COVID-19 social distancing (22 March 2020) in South Korea. The threshold of clinical significance for PAP adherence was defined as 0.5 h/day. We also searched for relevant studies published up to 15 January 2023 using the MEDLINE and Embase databases. We performed a random-effects meta-analysis of our findings with the identified studies regarding the standardized mean change (SMC) with a 95% CI of PAP adherence. RESULTS Our study included a total of 306 patients (mean age, 59.7 years; men, 73.5%). The average daily PAP usage was 5.10 ± 1.63 h before the COVID-19 pandemic and 4.79 ± 1.96 h during the pandemic (mean difference, -0.31 h/day; 95% CI, -0.46 to -0.15 h/day; p < 0.001 using paired t-test). After identifying 10 observational before-and-after studies through a systematic review, we conducted a meta-analysis that included our original data and showed that adherence to PAP treatment was not different before and during the COVID-19 pandemic (SMC, 0.01; 95% CI, -0.18 to 0.19; p = 0.952). CONCLUSION Although the COVID-19 pandemic had a statistically negative impact on adherence to PAP treatment in South Korea, the effect was not clinically relevant in patients with OSA. According to our meta-analysis, adherence to PAP treatment was not different before and during the COVID-19 pandemic in patients with OSA. TRIAL REGISTRATION PROSPERO database; No.: CRD42023414268; URL: https://www.crd.york.ac.uk/PROSPERO.
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Affiliation(s)
- Soomin Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jaeyoung Cho
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Grote L. Lessons for sleep medicine learned from the COVID-19 pandemic. Breathe (Sheff) 2022; 18:220146. [PMID: 36340821 PMCID: PMC9584547 DOI: 10.1183/20734735.0146-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/30/2022] [Indexed: 11/19/2022] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, sleep medicine services were dramatically reduced worldwide. Implementation of mitigation strategies was suggested by expert organisations and helped to restart sleep medicine services. Distance communication and monitoring during diagnosis, treatment initiation, and treatment follow-up have been used widely, in particular for patients with sleep apnoea. Follow-up studies demonstrate both advantages and potential disadvantages with the use of these new technologies. Emerging epidemiological evidence suggests that obstructive sleep apnoea may be an independent risk factor for adverse outcome in COVID-19, including an increased risk for hospitalisation and elevated mortality. Experimental studies explaining the underlying mechanisms behind these findings are warranted.
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Affiliation(s)
- Ludger Grote
- Sleep Disorders Centre, Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden,Centre for Sleep and Wake Disorders, Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden,Corresponding author: Ludger Grote ()
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Turnbull CD, Allen M, Appleby J, Brown R, Bryan N, Cooper A, Cooper BG, Gillooly C, Davidson J, Farley H, Gaspar A, Gibbons G, Gray B, Hill G, Kendrick A, Marsh B, McMillan A, Page J, Pepperell JCT, Quinnell T, Rogers C, Sexton J, Sheperd N, Steier J, Stockley J, Stradling J, Woroszyl A, West S, Wright S, Nickol A. COVID-19-related changes in outpatient CPAP setup pathways for OSA are linked with decreased 30-day CPAP usage. Thorax 2022; 77:thoraxjnl-2021-218635. [PMID: 35534153 DOI: 10.1136/thoraxjnl-2021-218635] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/13/2022] [Indexed: 11/04/2022]
Abstract
The COVID-19 pandemic changed continuous positive airway pressure (CPAP) setup pathways. We evaluated patients commenced on CPAP in 2019 (prepandemic) and 2020 (post-first UK wave). Face-to-face (F2F) setup numbers, with CPAP turned on, decreased from 613 patients (98.9%) in 2019, to 6 (1.1%) in 2020. In 2020, setups were F2F without CPAP turned on (403 (71.1%)), or remote (158 (27.9%)). Prepandemic median CPAP usage at first follow-up was 5.4 (2.7-6.9) hours/night and fell by 0.9 hours/night (95% CI 0.5 to 1.2, p<0.0001) in 2020. We found clinically relevant reductions in CPAP usage with pathway changes post-COVID-19.
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Affiliation(s)
- Chris D Turnbull
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Martin Allen
- Sleep and Ventilation Service, University Hospital North Midlands, Stoke on Trent, UK
| | | | - Richard Brown
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Nathalie Bryan
- Sleep and Ventilation Service, University Hospital North Midlands, Stoke on Trent, UK
| | - Ann Cooper
- Sleep and Ventilation Service, University Hospital North Midlands, Stoke on Trent, UK
| | - Brendan G Cooper
- Lung Function & Sleep (QEHB Site), University Hospital Birmingham, Birmingham, UK
| | - Cathie Gillooly
- Respiratory Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - James Davidson
- Respiratory Medicine, Musgrove Park Hospital, Taunton, UK
| | - Hannah Farley
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ana Gaspar
- Respiratory Medicine, The Lister Hospital Sleep Service, East and North Hertfordshire NHS Trust, Stevenage, UK
| | | | - Beverley Gray
- Respiratory Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | | | - Adrian Kendrick
- University Hospitals Bristol and Weston NHS Foundation Trust & Department of Physiology, University of Bristol, Bristol, UK
| | - Blake Marsh
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alison McMillan
- Respiratory Medicine, The Lister Hospital Sleep Service, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Joseph Page
- Respiratory Medicine, Musgrove Park Hospital, Taunton, UK
| | | | - Tim Quinnell
- Respiratory Support and Sleep Centre, Royal Papworth Hospital, Cambridge, UK
| | | | - Jane Sexton
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Naomi Sheperd
- Respiratory Medicine, Musgrove Park Hospital, Taunton, UK
| | - Joerg Steier
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- CHAPS, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - James Stockley
- Lung Function & Sleep (QEHB Site), University Hospital Birmingham, Birmingham, UK
| | - John Stradling
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Asia Woroszyl
- Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Sophie West
- Newcastle Regional Sleep Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Susan Wright
- Respiratory Medicine, Musgrove Park Hospital, Taunton, UK
| | - Annabel Nickol
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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