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Meng F, Ang GY, Chang RRY, Lee CP, Tan KB, Abisheganaden JA. Cost-effectiveness analysis of continuous positive airway pressure treatment for obstructive sleep apnea in Singapore from a health system perspective. J Sleep Res 2024:e14326. [PMID: 39228120 DOI: 10.1111/jsr.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 08/02/2024] [Accepted: 08/13/2024] [Indexed: 09/05/2024]
Abstract
This study assessed the cost-effectiveness of continuous positive airway pressure treatment for obstructive sleep apnea in Singapore from a health system perspective. The analysis evaluated a 5-year care pathway using a Markov model, considering per-patient costs of treatment, health system cost savings of obstructive sleep apnea and attributed conditions, the effectiveness measured in disability-adjusted life years with a discount rate of 3% and a weighted 5-year continuous positive airway pressure adherence of 74.1% from Singapore studies. Per-patient costs of treatment were from a large public hospital in Singapore. Efficacy of continuous positive airway pressure treatment, health system costs and disability-adjusted life years were obtained from literature; costs are in US dollars. We conducted probabilistic sensitivity analysis, one-way sensitivity analysis and what-if analysis. Based on a willingness-to-pay threshold of US $50,000 per disability-adjusted life year in USA, continuous positive airway pressure therapy was highly cost-effective, with an incremental cost-effectiveness ratio of $13,822 per disability-adjusted life year averted. Compared with the annual total costs of $856 for patients with continuous positive airway pressure treatment diagnosed by an inpatient sleep study, the total costs for those diagnosed by a home sleep test were $625, resulting in a remarkable 27% reduction per patient per year. One-way sensitivity analysis indicated that costs of treatment, effectiveness of continuous positive airway pressure treatment and adherence had a higher impact on the cost-effectiveness of continuous positive airway pressure therapy. The what-if analysis suggested that for continuous positive airway pressure treatment to be cost-effective, adherence rate should be at least 16.1%. These findings provide valuable insights for policymakers in making informed decisions on funding diagnosis and continuous positive airway pressure therapy within Singapore's healthcare system.
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Affiliation(s)
- Fanwen Meng
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Gary Yee Ang
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | | | - Chuen Peng Lee
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kelvin Bryan Tan
- Chief Health Economist Office, Ministry of Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Centre of Regulatory Excellence, Duke-NUS Medical School, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - John Arputhan Abisheganaden
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Aalaei S, Tabesh H, Shahraki H, Rezaeitalab F, Amini M, Afsharisaleh L, Asadpour H, Eslami S. Remote monitoring system to support positive airway pressure therapy in patients with obstructive sleep apnea: a multi-center randomized controlled trial. Sleep Breath 2024:10.1007/s11325-024-03108-y. [PMID: 39196315 DOI: 10.1007/s11325-024-03108-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 05/29/2024] [Accepted: 07/12/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE To develop and evaluate an intervention tailored to patients' needs to increase the rate of positive airway pressure (PAP) adherence in patients afflicted with obstructive sleep apnea (OSA), who undergo PAP therapy. METHODS A multi-center, 3 parallel-arm, randomized, controlled trial was conducted. Participants with OSA who undergo a PAP therapy were randomized to one of three groups: control arm (usual care), educational booklet arm, and mobile-based application arm. PAP usage, the percentage of days using the device for more than 4 h, change in knowledge, risk perception, outcome expectancy, self-efficacy, and ESS were assessed before and one month after interventions in the three groups. Also, the application usage data were analyzed. RESULTS The result showed the change in average PAP usage, knowledge, risk perception, and self-efficacy in the application group was significantly higher than the control and booklet groups. Also, the change in use for more than 4 h in the application group was significantly higher than the control group. Comparing the actual and patients' self-report PAP use indicated patients' self-report about the use of the device is about 50 min (0.8 h) more than the actual amount of use. CONCLUSION The study results indicated that the improvement of primary and secondary outcomes in adherence to PAP was significantly higher in the application group than in other study groups. Given the increasingly penetrating influence of smartphone-based technologies, it seems that mobile-based applications could potentially be adopted in the population of patients with OSA. CLINICAL TRIALS REGISTRATION IRCT2017092236314N1; https://en.irct.ir/trial/27185.
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Affiliation(s)
- Shokoufeh Aalaei
- Department of Medical Informatics, School of Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 91779-48564, Iran
| | - Hamed Tabesh
- Department of Medical Informatics, School of Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 91779-48564, Iran
| | - Hadi Shahraki
- Department of Computer Engineering, Faculty of Industry and Mining, University of Sistan and Baluchestan, Zahedan, Iran
| | - Fariborz Rezaeitalab
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahnaz Amini
- Lung Diseases Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lahya Afsharisaleh
- Department of Occupational Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Asadpour
- Sleep Laboratory of Ibn-E-Sina Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeid Eslami
- Department of Medical Informatics, School of Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 91779-48564, Iran.
- Department of Medical Informatics, University of Amsterdam, Amsterdam, the Netherlands.
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Mosala P, Mpotje T, Abdel Aziz N, Ndlovu H, Musaigwa F, Nono JK, Brombacher F. Cysteinyl leukotriene receptor-1 as a potential target for host-directed therapy during chronic schistosomiasis in murine model. Front Immunol 2024; 15:1279043. [PMID: 38840916 PMCID: PMC11150569 DOI: 10.3389/fimmu.2024.1279043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/25/2024] [Indexed: 06/07/2024] Open
Abstract
Schistosomiasis remains the most devastating neglected tropical disease, affecting over 240 million people world-wide. The disease is caused by the eggs laid by mature female worms that are trapped in host's tissues, resulting in chronic Th2 driven fibrogranulmatous pathology. Although the disease can be treated with a relatively inexpensive drug, praziquantel (PZQ), re-infections remain a major problem in endemic areas. There is a need for new therapeutic drugs and alternative drug treatments for schistosomiasis. The current study hypothesized that cysteinyl leukotrienes (cysLTs) could mediate fibroproliferative pathology during schistosomiasis. Cysteinyl leukotrienes (cysLTs) are potent lipid mediators that are known to be key players in inflammatory diseases, such as asthma and allergic rhinitis. The present study aimed to investigate the role of cysLTR1 during experimental acute and chronic schistosomiasis using cysLTR1-/- mice, as well as the use of cysLTR1 inhibitor (Montelukast) to assess immune responses during chronic Schistosoma mansoni infection. Mice deficient of cysLTR1 and littermate control mice were infected with either high or low dose of Schistosoma mansoni to achieve chronic or acute schistosomiasis, respectively. Hepatic granulomatous inflammation, hepatic fibrosis and IL-4 production in the liver was significantly reduced in mice lacking cysLTR1 during chronic schistosomiasis, while reduced liver pathology was observed during acute schistosomiasis. Pharmacological blockade of cysLTR1 using montelukast in combination with PZQ reduced hepatic inflammation and parasite egg burden in chronically infected mice. Combination therapy led to the expansion of Tregs in chronically infected mice. We show that the disruption of cysLTR1 is dispensable for host survival during schistosomiasis, suggesting an important role cysLTR1 may play during early immunity against schistosomiasis. Our findings revealed that the combination of montelukast and PZQ could be a potential prophylactic treatment for chronic schistosomiasis by reducing fibrogranulomatous pathology in mice. In conclusion, the present study demonstrated that cysLTR1 is a potential target for host-directed therapy to ameliorate fibrogranulomatous pathology in the liver during chronic and acute schistosomiasis in mice.
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Affiliation(s)
- Paballo Mosala
- Institute of Infectious Diseases and Molecular Medicine (IDM), Department of Pathology, Division of Immunology and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Cape Town, South Africa
| | - Thabo Mpotje
- Institute of Infectious Diseases and Molecular Medicine (IDM), Department of Pathology, Division of Immunology and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Cape Town, South Africa
| | - Nada Abdel Aziz
- Institute of Infectious Diseases and Molecular Medicine (IDM), Department of Pathology, Division of Immunology and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Cape Town, South Africa
- Immuno-Biotechnology Lab, Biotechnology Department, Faculty of Science, Cairo University, Giza, Egypt
| | - Hlumani Ndlovu
- Division of Chemical and System Biology, Department of Integrative Biomedical Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Fungai Musaigwa
- Institute of Infectious Diseases and Molecular Medicine (IDM), Department of Pathology, Division of Immunology and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Cape Town, South Africa
| | - Justin Komguep Nono
- Institute of Infectious Diseases and Molecular Medicine (IDM), Department of Pathology, Division of Immunology and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Cape Town, South Africa
- Unit of Immunobiology and Helminth Infections, Laboratory of Molecular Biology and Biotechnology, Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Frank Brombacher
- Institute of Infectious Diseases and Molecular Medicine (IDM), Department of Pathology, Division of Immunology and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Cape Town Component, Cape Town, South Africa
- Welcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Study on Adherence to Positive Airway Pressure Treatment for Patients with Obstructive Sleep Apnea Using Real-world Big Data in a Telemedicine Management System. Methods 2022; 204:92-100. [DOI: 10.1016/j.ymeth.2022.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 12/22/2022] Open
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Yu CC, Huang CY, Hua CC, Wu HP. High-flow nasal cannula compared with continuous positive airway pressure in the treatment of obstructive sleep apnea. Sleep Breath 2021; 26:549-558. [PMID: 34145538 DOI: 10.1007/s11325-021-02413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/08/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Continuous positive airway pressure (CPAP) is a standard treatment for obstructive sleep apnea (OSA). However, CPAP has limitations. High-flow nasal cannula (HFNC) is already in use for various types of respiratory diseases. As HFNC generates positive airway pressure, it may be a potential candidate for OSA treatment. This prospective study compared the therapeutic effects of HFNC to CPAP in patients with OSA. METHODS Patients whose apnea-hypopnea index (AHI) was > 5 events/h were enrolled in this study. All participants were randomly divided into two groups. The first group underwent CPAP the first night and HFNC the second night. Conversely, the second group received HFNC the first night and CPAP the second night. Their respiratory events and sleep quality were compared using baseline polysomnography, CPAP, and HFNC. RESULTS In total, 28 participants completed this study. Median [interquartile range] AHI (35.0 [20.0-48.6] vs. 10.8 [5.5-20.6] events/h; p < 0.001) was significantly improved by the HFNC. However, sleep quality was not improved. When CPAP was compared directly with HFNC, CPAP demonstrated a more favorable effect for respiratory events (AHI 5.0 [2.0-7.0] vs. 10.8 [5.5-20.6] events/h; p < 0.001) and sleep efficiency (88.1 [79.9-92.5] vs. 77.9 [69.2-86.6] %; p = 0.001). CONCLUSION The efficacy of CPAP was superior to HFNC for both respiratory events and sleep quality. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03843372; URL: www.clinicaltrials.gov ; Date of registration: November 2, 2019.
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Affiliation(s)
- Chung-Chieh Yu
- Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Yu Huang
- Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chung-Ching Hua
- Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Huang-Pin Wu
- Division of Pulmonary, Critical Care, and Sleep Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Keelung, Taiwan.
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Crew EC, Wohlgemuth WK, Sawyer AM, Williams NJ, Wallace DM. Socioeconomic Disparities in Positive Airway Pressure Adherence: An Integrative Review. Sleep Med Clin 2021; 16:23-41. [PMID: 33485530 DOI: 10.1016/j.jsmc.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nonadherence with positive airway pressure (PAP) therapy impedes the effectiveness of treatment and increases risk of mortality. Disparities in PAP adherence as a function of socioeconomic status (SES) are not well understood. A literature search identified 16 original publications meeting inclusion criteria that described effects of SES factors on objective PAP adherence; 69% of these articles found evidence of lower adherence as a function of SES. This integrative review provides a structured summary of the findings, highlights factors that may contribute to disparities among adult PAP users, and identifies future directions to improve equity in the management of OSA.
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Affiliation(s)
- Earl Charles Crew
- Behavioral Health Program, Mental Health Care Line, Michael E. DeBakey VA Medical Center, Building 108-A Room 224, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Psychology Division, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - William K Wohlgemuth
- Psychology Service, Bruce W. Carter Medical Center, Miami VA Healthcare system, Sleep Disorders Center, Room A212, 1201 NW 16th ST, Miami, FL 33125, USA; Neurology Service, Bruce W. Carter Medical Center, Miami VA Healthcare system, Sleep Disorders Center, Room A212, 1201 NW 16th ST, Miami, FL 33125, USA
| | - Amy M Sawyer
- University of Pennsylvania, School of Nursing, Clair Fagin Hall, Room 349, 418 Curie Boulevard, Philadelphia, PA 19104, USA; Perelman School of Medicine Center for Sleep and Circadian Neurobiology, Philadelphia, PA, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Natasha J Williams
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, New York University Grossman School of Medicine, 180 Madison Avenue, 7th Floor, New York, NY 10016, USA
| | - Douglas M Wallace
- Neurology Service, Bruce W. Carter Medical Center, Miami VA Healthcare system, Sleep Disorders Center, Room A212, 1201 NW 16th ST, Miami, FL 33125, USA; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
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Efficacy of a Smart Antisnore Pillow in Patients with Obstructive Sleep Apnea Syndrome. Behav Neurol 2021; 2021:8824011. [PMID: 33510821 PMCID: PMC7822707 DOI: 10.1155/2021/8824011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [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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Drakou T, Steiropoulos P, Saroglou M, Georgopoulou A, Kazis D, Papagiannopoulos S, Porpodis K, Tryfon S. The presence of insomnia and depression contributes to the acceptance of an initial treatment trial of continuous positive airway pressure therapy in patients with obstructive sleep apnea. Sleep Breath 2021; 25:1803-1812. [PMID: 33411189 DOI: 10.1007/s11325-020-02266-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/19/2020] [Accepted: 11/28/2020] [Indexed: 11/30/2022]
Abstract
The presence of comorbid insomnia and sleep apnea (COMISA) reduces the initial acceptance of continuous positive airway pressure (CPAP) therapy in 39-58% of patients with obstructive sleep apnea (OSA). Depressive disorders are reported in 5 to 63% of patients with OSA. Here we studied the co-occurrence of depression and insomnia in OSA patients and its impact on treatment acceptance in a real-life controlled trial. METHODS In this prospective, uncontrolled study, participants were recruited from January to December 2018, among adult patients who visited our sleep lab. Participants underwent polysomnography study and completed the Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), and Zung Depression Rating Scale (ZDRS). All subjects were categorized into 8 groups: no OSA/no depression (apnea-hypopnea index [AHI] < 5/h, n = 34), mild OSA/no depression (AHI = 5-14/h, n = 22), moderate OSA/no depression (AHI = 15-29/h, n = 44), severe OSA/no depression (AHI ≥ 30/h, n = 45), no OSA/mild depression (AHI < 5/h, n = 31), mild OSA/mild depression (AHI = 5-14/h, n = 24), moderate OSA/mild depression (AHI = 15-29/h, n = 31), and severe OSA/mild depression (AHI ≥ 30/h, n = 40). RESULTS Over the one-year period, 272 participants (200 men, mean age 52.9 ± 13.0 years, BMI 33.6 ± 7.2 kg/m2) were enrolled. When the above 8 groups were subcategorized into the presence or absence of insomnia, we found no differences in CPAP trial acceptance between subgroups except in patients from the mild depression/severe OSA/insomnia subgroup who denied CPAP therapy more frequently (chi-squared test p = 0.016). We found, with a moderate efficiency indicated by the ROC curve, that patients with AHI > 15/h, AIS ≥ 11, and ZDRS > 44 were more likely to refuse an initial trial of CPAP treatment because of COMISA and depression (ROC curve area = 0.710, p = 0.049). CONCLUSION This study demonstrates that it is important to recognize a depressive mood disorder in patients with moderate/severe OSA and COMISA as the coexistence of these comorbidities impairs the rate of initial acceptance of CPAP treatment. Additionally, our study suggests the cut-off values from the AIS and ZDRS questionnaires to help lead clinicians to an early diagnostic evaluation of COMISA patients for the presence of depressive mood disorder.
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Affiliation(s)
- Theodora Drakou
- Master Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupoli, Greece
| | - Pashalis Steiropoulos
- Master Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupoli, Greece
| | - Maria Saroglou
- Master Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupoli, Greece
| | | | - Dimitris Kazis
- Neurology Clinic, Aristotle University of Thessaloniki, General Hosp. "G. Papanikolaou", Thessaloniki, Greece
| | - Sotiris Papagiannopoulos
- Neurology Clinic, Aristotle University of Thessaloniki, General Hosp. "G. Papanikolaou", Thessaloniki, Greece
| | - Konstantinos Porpodis
- Master Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupoli, Greece.,Pulmonary Clinic, Aristotle University of Thessaloniki, General Hosp. "G. Papanikolaou", Thessaloniki, Greece
| | - Stavros Tryfon
- Pulmonary Clinic, NHS General Hosp. "G. Papanikolaou", Thessaloniki, Greece.
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Dhanda Patil R, Hong MP, Ishman SL. Hypoglossal Nerve Stimulation in Veterans With Comorbid Insomnia and Sleep Apnea. Otolaryngol Head Neck Surg 2021; 164:1345-1353. [PMID: 33399502 DOI: 10.1177/0194599820982638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Insomnia and sleep apnea frequently co-occur, with additive effects of both disorders presenting clinicians with unique treatment challenges compared to one disorder alone. The hypoglossal nerve stimulator (HNS) is a promising treatment for patients with comorbid insomnia and sleep apnea (COMISA), many of whom have positive airway pressure (PAP) intolerance. Our aim was to determine adherence to and efficacy of HNS in veterans with COMISA refractory to PAP therapy compared to those with obstructive sleep apnea alone (OSA only). STUDY DESIGN Retrospective case series. SETTING A single, academic Veterans Affairs medical center. METHODS Review of clinical records, pre- and postoperative polysomnography, and clinical measures of obstructive sleep apnea (OSA), sleepiness, and insomnia was conducted in 53 consecutive cases of veterans with OSA undergoing HNS implantation. HNS adherence was obtained at postoperative visits. HNS adherence and efficacy were compared between individuals with COMISA and OSA only. RESULTS COMISA was noted in 30 of 53 (56.6%) veterans studied. There was no significant difference between HNS adherence in patients with COMISA and OSA only (5.6 vs 6.4 h/night, P = .17). HNS implantation improved polysomnographic and clinical measures of OSA and sleepiness in both COMISA and OSA only, and 56.5% (13/23) of patients with COMISA self-reported improvement in insomnia after surgery. CONCLUSION HNS was successful in treating a complex veteran population with COMISA refractory to PAP when examining measures of treatment adherence and efficacy. Future studies of patients with COMISA undergoing HNS will examine effective combination therapy targeting insomnia and a multidisciplinary effort to optimize treatment adherence.
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Affiliation(s)
- Reena Dhanda Patil
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.,Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Michael P Hong
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stacey L Ishman
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.,Cincinnati Children's Hospital Medical Center, Divisions of Pediatric Otolaryngology and Pulmonary Medicine, Cincinnati, Ohio, USA
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Obstructive sleep apnea in people with intellectual disabilities: adherence to and effect of CPAP. Sleep Breath 2020; 25:1257-1265. [PMID: 33084987 DOI: 10.1007/s11325-020-02221-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is common in people with intellectual disabilities (ID), but in practice continuous positive airway pressure (CPAP) is often deemed unfeasible. We investigated adherence to and effect of CPAP in patients with ID and OSA. METHODS Patients with ID were started on CPAP using an intensive training program. Acceptable adherence was defined as use of ≥ 4 h/night during ≥ 70% of the nights. Treatment effect was measured with a patient global impression scale and customized questionnaires. Reasons for not starting CPAP, factors influencing treatment, and reasons for terminating CPAP were explored. RESULTS Of 39 patients with ID, 87% after 8-10 weeks and 70% at 8 months still used CPAP, of whom 74% and 77% showed acceptable adherence. Baseline apnea-hypopnea (AHI) index decreased from 41.2/h to 5.3/h after 8-10 weeks (p < 0.001), and 4.3/h after 8 months (p < 0.001). At 8-10 weeks and after 8 months, there was an improvement in the most restrictive reported complaint (both p < 0.0005), difficulty waking up (p < 0.01; p < 0.0005), handling behavior (p < 0.03; p < 0.02), presence of irritability (p < 0.01), and sleepiness (p < 0.05). The expectation that CPAP would not be tolerated was the main reason for not starting. CPAP use in the first 2 weeks predicted adherence at 8-10 weeks and 8 months (r = 0.51, p < 0.01; r = 0.69, p < 0.01). Of 13 patients who terminated CPAP, the reasons for termination included behavioral problems, comorbid insomnia, anxiety, discomfort, or other side effects. CONCLUSIONS With adequate guidance, CPAP is both feasible and effective in people with ID and OSA.
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Luo K, Zhang L, Zhang X, Han T, Li Y, Wang C. Acceptance of and six-month adherence to continuous positive airway pressure in patients with moderate to severe obstructive sleep apnea. CLINICAL RESPIRATORY JOURNAL 2020; 15:56-64. [PMID: 32939997 DOI: 10.1111/crj.13269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is the most effective treatment for moderate to severe obstructive sleep apnea (OSA). Acceptance of and adherence to CPAP are crucial for optimal treatment outcomes. The aim of this study was to investigate the factors influencing patients' acceptance of and adherence to CPAP treatment. METHODS One hundred eighty-eight patients with moderate to severe OSA who had received CPAP titration from October 2017 to September 2018 were recruited. They were interviewed at 2 weeks and at 6 months to assess CPAP use and barriers to acceptance and adherence. RESULTS One hundred fourteen patients (60.6%) accepted CPAP treatment. Disease severity, assessed by apnea-hypopnea index (AHI) (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.08), subjective satisfaction of titration (OR, 12.83; 95% CI, 3.83-42.99), initial intention of CPAP therapy (OR, 3.33; 95% CI, 1.05-10.51) and short-term home CPAP trial (OR, 9.40; 95% CI, 2.85-31.08) were associated with acceptance of CPAP treatment. Two-third of the 98 CPAP acceptors reported good CPAP adherence at 6 months follow-up. Average hours of CPAP use per day for the first 2 weeks (OR, 1.88; 95% CI, 1.28-3.04) and the global problems associated with CPAP use (OR, 0.82; 95% CI, 0.73-0.91) were independent predictors of the six-month CPAP adherence. CONCLUSIONS Nearly 40% of patients with moderate to severe OSA did not accept CPAP treatment, and one-third of those CPAP acceptors had poor adherence to CPAP treatment. Improvement in disease awareness, comfortable titration experience, short-term home CPAP trial may be of help to increase CPAP acceptance and early experience with CPAP is important for long-term adherence. The differences in predicting factors for CPAP acceptance and adherence highlight the importance of focusing on specific aspects during the whole process management of OSA.
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Affiliation(s)
- Kun Luo
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,First Hospital of Qinhuangdao, Beijing, China
| | - Li Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China
| | - Xiaolei Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China.,Capital Medical University, Beijing, China.,the Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Teng Han
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Yiming Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China.,Capital Medical University, Beijing, China.,the Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Landete P, Soriano JB, Aldave B, Zamora E, Acosta C, Erro M, López Riolobos C, Ramos MI, Moldenhauer F, Ancochea J. Obstructive sleep apnea in adults with Down syndrome. Am J Med Genet A 2020; 182:2832-2840. [PMID: 32909685 DOI: 10.1002/ajmg.a.61853] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/19/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023]
Abstract
Patients with Down syndrome (DS) often have a high occurrence of obstructive sleep apnea-hypopnea (OSA) syndrome. We studied a large cohort of adults with DS attended due to clinical suspicion of OSA. A standardized questionnaire and full medical assessment were conducted, including a sleep study. One hundred and fifty-seven DS individuals were studied, with a mean ± SD age of 36 ± 10 years, 40.7% women, BMI 29.4 ± 5.6 kg/m2 . The main clinical symptom was daytime sleepiness (64.9%). A sleep study was conducted in 114 patients. All 114 DS patients were diagnosed with OSA, with a predominance of obstructive and hypopnea events, (apnea-hypopnoea index, AHI, 35.0 ± 26.6), with an oxygen desaturation index of 32.9, and a Tc90% of 24.7%. Continuous positive airway pressure (CPAP) treatment was implemented in 75 (65.8%) of subjects. Tolerance was considered good in 75% of them, with a high compliance of 79.2% >4 hr/day (mean 7.1 hr/day), resulting in a symptomatic improvement in 58.7% of them. Obstructive sleep apnea is frequently confirmed in patients with DS when it clinically suspected. Treatment with CPAP in DS is feasible, and with higher adherence than in adults with normal cognitive functioning.
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Affiliation(s)
- Pedro Landete
- Department of Pneumology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Joan B Soriano
- Department of Pneumology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Beatriz Aldave
- Department of Pneumology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Enrique Zamora
- Department of Pneumology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Carmen Acosta
- Department of Pneumology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Marta Erro
- Department of Pneumology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | - Fernando Moldenhauer
- Adult Down Syndrome Outpatient Clinic, Department of Internal Medicine, Fundación de Investigación Biomédica, Hospital Universitario de La Princesa, Madrid, Spain
| | - Julio Ancochea
- Department of Pneumology, Hospital Universitario de La Princesa, Madrid, Spain
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Gates C, Ramadan J, Coutras S, Carr M. Adult Palatopharyngoplasty: Trends in Morbidity and Mortality from the NSQIP Database. Ann Otol Rhinol Laryngol 2020; 130:5-11. [PMID: 32567393 DOI: 10.1177/0003489420936711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Describe the postop morbidity of adults undergoing palatopharyngoplasty (PPP). METHOD Adults who underwent PPP were studied using ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database (2016-2017) via CPT code 42145. Analyzed outcomes included length of stay (LOS), readmission, reoperation, and postop complications. Predictive variables were age, gender, BMI, comorbidities. RESULTS A total of 1081 patients (73.7% male, mean age 42.0 years, range 18-79 years) were included. 95 (8.8%) were diabetic, 183 (16.9%) were smokers, 30 (2.8%) had preoperative dyspnea. 328 (30.3%) took medicine for hypertension. Concurrent procedures occurred in 646 (59.76%), 357 (33.02%) had nasal procedures, 320 (29.60%) had tonsil procedures, 66 (6.11%) had tongue procedures. Within 30 days postop, there were two (0.19%) mortalities. Complications included six wound infections, two dehiscences, four with pneumonia, two pulmonary embolisms, three myocardial infarctions, one DVT, three sepsis, one UTI, one who required CPR, and two who were ventilated for >48 hours. Five required reintubation. A total of 41 (3.79%) returned to OR for a related reason, at least 27 (65.90%) for bleeding. LOS ranged from 0 to 15 days, median 1 day. Overall 38 (3.52%) were readmitted for a related reason, 12 (31.58%) for bleeding and three (7.89%) for pain. Using a significance level of 0.002 (Bonferroni correction), LOS varied with presence of any concurrent procedure, BMI, and estimated probability of mortality and morbidity indices; readmission and reoperation had no significantly associated variables. CONCLUSION PPP is associated with low frequency but significant morbidity and mortality.
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Affiliation(s)
- Christopher Gates
- Department of Internal Medicine, West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, WV, USA
| | - Jad Ramadan
- West Virginia University Rockefeller Neuroscience Institute, Morgantown, WV, USA
| | - Steven Coutras
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, WV, USA
| | - Michele Carr
- Department of Otolaryngology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Kennedy B, Lasserson TJ, Wozniak DR, Smith I. Pressure modification or humidification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev 2019; 12:CD003531. [PMID: 31792939 PMCID: PMC6888022 DOI: 10.1002/14651858.cd003531.pub4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is the repetitive closure of the upper airway during sleep. This results in disturbed sleep and excessive daytime sleepiness. It is a risk factor for long-term cardiovascular morbidity. Continuous positive airway pressure (CPAP) machines can be applied during sleep. They deliver air pressure by a nasal or oronasal mask to prevent the airway from closing, reducing sleep disturbance and improving sleep quality. Some people find them difficult to tolerate because of high pressure levels and other symptoms such as a dry mouth. Switching to machines that vary the level of air pressure required to reduce sleep disturbance could increase comfort and promote more regular use. Humidification devices humidify the air that is delivered to the upper airway through the CPAP circuit. Humidification may reduce dryness of the throat and mouth and thus improve CPAP tolerability. This updated Cochrane Review looks at modifying the delivery of positive pressure and humidification on machine usage and other clinical outcomes in OSA. OBJECTIVES To determine the effects of positive pressure modification or humidification on increasing CPAP machine usage in adults with OSA. SEARCH METHODS We searched Cochrane Airways Specialised Register and clinical trials registries on 15 October 2018. SELECTION CRITERIA Randomised parallel group or cross-over trials in adults with OSA. We included studies that compared automatically adjusting CPAP (auto-CPAP), bilevel positive airway pressure (bi-PAP), CPAP with expiratory pressure relief (CPAPexp), heated humidification plus fixed CPAP, automatically adjusting CPAP with expiratory pressure relief, Bi-PAP with expiratory pressure relief, auto bi-PAP and CPAPexp with wakefulness detection with fixed pressure setting. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. We assessed the certainty of evidence using GRADE for the outcomes of machine usage, symptoms (measured by the Epworth Sleepiness Scale (ESS)), Apnoea Hypopnoea Index (AHI), quality of life measured by Functional Outcomes of Sleep Questionnaire (FOSQ), blood pressure, withdrawals and adverse events (e.g. nasal blockage or mask intolerance). The main comparison of interest in the review is auto-CPAP versus fixed CPAP. MAIN RESULTS We included 64 studies (3922 participants, 75% male). The main comparison of auto-CPAP with fixed CPAP is based on 36 studies with 2135 participants from Europe, USA, Hong Kong and Australia. The majority of studies recruited participants who were recently diagnosed with OSA and had not used CPAP previously. They had excessive sleepiness (ESS: 13), severe sleep disturbance (AHI ranged from 22 to 59), and average body mass index (BMI) of 35 kg/m2. Interventions were delivered at home and the duration of most studies was 12 weeks or less. We judged that studies at high or unclear risk of bias likely influenced the effect of auto-CPAP on machine usage, symptoms, quality of life and tolerability, but not for other outcomes. Primary outcome Compared with average usage of about five hours per night with fixed CPAP, people probably use auto-CPAP for 13 minutes longer per night at about six weeks (mean difference (MD) 0.21 hours/night, 95% confidence interval (CI) 0.11 to 0.31; 31 studies, 1452 participants; moderate-certainty evidence). We do not have enough data to determine whether auto-CPAP increases the number of people who use machines for more than four hours per night compared with fixed CPAP (odds ratio (OR) 1.16, 95% CI 0.75 to 1.81; 2 studies, 346 participants; low-certainty evidence). Secondary outcomes Auto-CPAP probably reduces daytime sleepiness compared with fixed CPAP at about six weeks by a small amount (MD -0.44 ESS units, 95% CI -0.72 to -0.16; 25 studies, 1285 participants; moderate-certainty evidence). AHI is slightly higher with auto-CPAP than with fixed CPAP (MD 0.48 events per hour, 95% CI 0.16 to 0.80; 26 studies, 1256 participants; high-certainty evidence), although it fell with both machine types from baseline values in the studies. Ten per cent of people in auto-CPAP and 11% in the fixed CPAP arms withdrew from the studies (OR 0.90, 95% CI 0.64 to 1.27; moderate-certainty evidence). Auto-CPAP and fixed CPAP may have similar effects on quality of life, as measured by the FOSQ but more evidence is needed to be confident in this result (MD 0.12, 95% CI -0.21 to 0.46; 3 studies, 352 participants; low-certainty evidence). Two studies (353 participants) provided data on clinic-measured blood pressure. Auto-CPAP may be slightly less effective at reducing diastolic blood pressure compared to fixed CPAP (MD 2.92 mmHg, 95% CI 1.06 to 4.77 mmHg; low-certainty evidence). The two modalities of CPAP probably do not differ in their effects on systolic blood pressure (MD 1.87 mmHg, 95% CI -1.08 to 4.82; moderate-certainty evidence). Nine studies (574 participants) provided information on adverse events such as nasal blockage, dry mouth, tolerance of treatment pressure and mask leak. They used different scales to capture these outcomes and due to variation in the direction and size of effect between the studies, the comparative effects on tolerability outcomes are uncertain (very low-certainty evidence). The evidence base for other interventions is smaller, and does not provide sufficient information to determine whether there are important differences between pressure modification strategies and fixed CPAP on machine usage outcomes, symptoms and quality of life. As with the evidence for the auto-CPAP, adverse events are measured disparately. AUTHORS' CONCLUSIONS In adults with moderate to severe sleep apnoea starting positive airway pressure therapy, auto-CPAP probably increases machine usage by about 13 minutes per night. The effects on daytime sleepiness scores with auto-CPAP are not clinically meaningful. AHI values are slightly lower with fixed CPAP. Use of validated quality of life instruments in the studies to date has been limited, although where they have been used the effect sizes have not exceeded proposed clinically important differences. The adoption of a standardised approach to measuring tolerability would help decision-makers to balance benefits with harms from the different treatment options available. The evidence available for other pressure modification strategies does not provide a reliable basis on which to draw firm conclusions. Future studies should look at the effects of pressure modification devices and humidification in people who have already used CPAP but are unable to persist with treatment.
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Affiliation(s)
- Barry Kennedy
- St. James's HospitalDepartment of Sleep MedicineDublinIreland
| | - Toby J Lasserson
- Cochrane Central ExecutiveEditorial & Methods DepartmentSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Dariusz R Wozniak
- Royal Papworth HospitalRespiratory Support and Sleep CentrePapworth EverardCambridgeUKCB23 3RE
| | - Ian Smith
- Royal Papworth HospitalRespiratory Support and Sleep CentrePapworth EverardCambridgeUKCB23 3RE
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Healthcare-seeking behaviour and utilization of treatment in a community-based screening study for obstructive sleep apnoea in Busselton, Western Australia. Sleep Health 2019; 5:91-100. [DOI: 10.1016/j.sleh.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 08/24/2018] [Accepted: 10/10/2018] [Indexed: 12/31/2022]
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da Silva Paulitsch F, Zhang L. Continuous positive airway pressure for adults with obstructive sleep apnea and cardiovascular disease: a meta-analysis of randomized trials. Sleep Med 2018; 54:28-34. [PMID: 30529774 DOI: 10.1016/j.sleep.2018.09.030] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/15/2018] [Accepted: 09/19/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND It remains uncertain whether continuous positive airway pressure (CPAP) therapy would significantly impact hard clinical outcomes in patients with obstructive sleep apnea (OSA). This meta-analysis aimed to assess the effects of CPAP in survival and secondary prevention of major cardiovascular events in patients with OSA and cardiovascular disease (CVD). METHODS PubMed, Cochrane CENTRAL, LILACS, and SciElo databases (up to January 2018) were searched for randomized trials that compared CPAP with no active treatment in adults with OSA and CVD. The primary outcomes were all-cause death, cardiovascular death, acute myocardial infarction, stroke, and any major cardiovascular event. We used risk ratios (RR) and 95% confidence interval (CI) as the effect measures for dichotomous data, and weighted mean difference (WMD) and 95% CI for continuous variables. We used the random-effects method for meta-analysis. RESULTS Nine trials involving 3314 patients contributed data for meta-analysis of at least one outcome. The duration (median) of CPAP treatment varied from one month to 56.9 months. The pooled RR (95% CI) was 0.86 (0.60-1.23, I2 = 0.0%) for all-cause death, 0.58 (0.19-1.74, I2 = 47%) for cardiovascular death, 1.11 (0.76-1.62, I2 = 0.0%) for myocardial infarction, 0.77 (0.46-1.28, I2 = 16%) for stroke, and 0.93 (0.70-1.24, I2 = 49%) for any major cardiovascular event. The quality of evidence for these outcomes was low. CONCLUSIONS Low-quality evidence suggests that CPAP therapy does not significantly improve survival or prevent major cardiovascular events in adults with OSA and cardiovascular disease.
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Affiliation(s)
- Felipe da Silva Paulitsch
- Hospital of Cardiology Santa Casa de Rio Grande, Postgraduate Program in Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Linjie Zhang
- Postgraduate Programs in Health Sciences and in Public Health, Respiratory Division, Federal University of Rio Grande, Rio Grande, Brazil.
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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] [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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Westlake K, Dostalova V, Plihalova A, Pretl M, Polak J. The Clinical Impact of Systematic Screening for Obstructive Sleep Apnea in a Type 2 Diabetes Population-Adherence to the Screening-Diagnostic Process and the Acceptance and Adherence to the CPAP Therapy Compared to Regular Sleep Clinic Patients. Front Endocrinol (Lausanne) 2018; 9:714. [PMID: 30555416 PMCID: PMC6282364 DOI: 10.3389/fendo.2018.00714] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/12/2018] [Indexed: 01/17/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common disorder in Type 2 diabetes (T2D) patients further increasing their already high cardiovascular risk. As T2D patients typically not report OSA symptoms, systematic screening for OSA in this population is warranted. We aimed to determine the readiness of T2D patients to undergo screening and to compare their adherence to continuous positive airway pressure (CPAP) therapy with "regular" sleep clinic patients who typically seek medical advice on their own initiative. We therefore recruited 494 consecutive T2D patients and offered them OSA screening using home sleep monitoring (type IV device). All participants in high risk of moderate-to-severe OSA were recommended home sleep apnea testing (HSAT) followed by CPAP therapy. Patients were followed-up for 12 months and outcomes compared to 228 consecutive sleep clinic patients undergoing HSAT. Among 307 screened T2D patients, 94 (31%) were identified at high risk of moderate-to-severe OSA. Subsequently, 54 patients underwent HSAT, 51 were recommended, and 38 patients initiated CPAP (acceptance 75%). Among 228 sleep clinic patients, 92 (40%) were recommended and 74 patients initiated CPAP (acceptance 80%). After 1 year, 15 (39%) T2D and 29 (39%) sleep clinic patients showed good CPAP adherence (use ≥ 4 h/night ≥ 70% nights). In conclusion, 20 T2D patients needed to be screened in order to obtain one successfully treated patient. OSA screening in T2D patients identified 31% with moderate-to-severe OSA. Once diagnosed, their CPAP acceptance and adherence did not differ from sleep clinic patients. However, the reasons for the high dropout during the screening-diagnostic process impacting the overall success of the screening program need to be identified and addressed.
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Affiliation(s)
- Katerina Westlake
- Second Internal Medicine Department, Vinohrady Teaching Hospital, Prague, Czechia
- Diabetology Practice Diabetologie Praha, Prague, Czechia
- Department of Pathophysiology, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Veronika Dostalova
- Neurology and Sleep Laboratory, INSPAMED Ltd., Prague, Czechia
- Institute of Sleep Medicine, Prague, Czechia
- Diamant Neuropsychology Laboratory, Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czechia
| | - Andrea Plihalova
- Second Internal Medicine Department, Vinohrady Teaching Hospital, Prague, Czechia
- Department of Pathophysiology, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Martin Pretl
- Neurology and Sleep Laboratory, INSPAMED Ltd., Prague, Czechia
- Institute of Sleep Medicine, Prague, Czechia
| | - Jan Polak
- Second Internal Medicine Department, Vinohrady Teaching Hospital, Prague, Czechia
- Department of Pathophysiology, Third Faculty of Medicine, Charles University, Prague, Czechia
- *Correspondence: Jan Polak
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Luijks KA, Vandenbussche NL, Pevernagie D, Overeem S, Pillen S. Adherence to continuous positive airway pressure in adults with an intellectual disability. Sleep Med 2017; 34:234-239. [DOI: 10.1016/j.sleep.2017.02.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/24/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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Lee CHK, Leow LC, Song PR, Li H, Ong TH. Acceptance and Adherence to Continuous Positive Airway Pressure Therapy in patients with Obstructive Sleep Apnea (OSA) in a Southeast Asian privately funded healthcare system. ACTA ACUST UNITED AC 2017; 10:57-63. [PMID: 28966740 DOI: 10.5935/1984-0063.20170010] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is limited data on long term Continuous Positive Airway Pressure (CPAP) adherence in Southeast Asian countries. This is a prospective study on CPAP adherence among Obstructive sleep apnea (OSA) patients in a Southeast Asian privately funded healthcare system. METHODS Patients with moderate-severe OSA who had been initiated on CPAP at least one year previously were contacted for a scripted telephone interview to assess compliance and factors associated with CPAP adherence. RESULTS Of 135 consecutive patients diagnosed to have moderate to severe OSA, 78 (57.8%) were initiated on CPAP treatment while 57 (42.2%) rejected CPAP upfront. 41 (52.6%) who initiated CPAP remained adherent at one year. OSA severity (AHI, ODI) and symptomatic improvement after CPAP were associated with better adherence. Presence of machine related side effects was associated with lower adherence. Inconvenience, cost and poor disease perception were reported as major barriers to uptake of CPAP therapy. CONCLUSIONS In this Southeast Asian privately funded healthcare system, almost half of all patients with significant OSA rejected CPAP treatment upfront, but adherence among those who started CPAP is comparable to other reports. Challenges with CPAP acceptance as well as CPAP adherence need to be addressed to improve outcomes.
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Affiliation(s)
- Cheah Hooi Ken Lee
- Singapore General Hospital, Respiratory and Critical Care Medicine - Singapore - Singapore - Singapura
| | - Leong Chai Leow
- Singapore General Hospital, Respiratory and Critical Care Medicine - Singapore - Singapore - Singapura
| | - Pei Rong Song
- Singapore General Hospital, Respiratory and Critical Care Medicine - Singapore - Singapore - Singapura
| | - HuiHua Li
- Singapore General Hospital, Health Services Research - Singapore - Singapore - Singapura
| | - Thun How Ong
- Singapore General Hospital, Respiratory and Critical Care Medicine - Singapore - Singapore - Singapura
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Weiss P, Kryger M. Positive Airway Pressure Therapy for Obstructive Sleep Apnea. Otolaryngol Clin North Am 2016; 49:1331-1341. [PMID: 27720457 DOI: 10.1016/j.otc.2016.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Positive airway pressure (PAP) is considered first-line therapy for moderate to severe obstructive sleep apnea and may also be considered for mild obstructive sleep apnea, particularly if it is symptomatic or there are concomitant cardiovascular disorders. Continuous PAP is most commonly used. Other modes, such as bilevel airway pressure, autotitrating positive airway pressure, average volume assured pressure support, and adaptive support ventilation, play important roles in the management of sleep-related breathing disorders. This article outlines the indications, description, and comfort features of each mode. Despite the proven efficacy of PAP in treating obstructive sleep apnea syndrome and its sequelae, adherence to therapy is low. Close follow-up of patients for evaluation of adherence to and effectiveness of treatment is important.
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Affiliation(s)
- Pnina Weiss
- Pediatric Respiratory Medicine and Medical Education, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Meir Kryger
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
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22
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Fietze I, Herrala J, Polo O, Glos M, Blau A, Penzel T. Comparison of CPAP adherence in two European sleep centres. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0057-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Ng SSS, Chan RSM, Woo J, Chan TO, Cheung BHK, Sea MMM, To KW, Chan KKP, Ngai J, Yip WH, Ko FWS, Hui DSC. A Randomized Controlled Study to Examine the Effect of a Lifestyle Modification Program in OSA. Chest 2016; 148:1193-1203. [PMID: 25763792 DOI: 10.1378/chest.14-3016] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Obesity is an important risk factor for OSA. This study aimed to assess the effect of weight reduction through a lifestyle modification program (LMP) on patients with moderate to severe OSA. METHODS This was a parallel group, randomized controlled trial. Altogether, 104 patients with moderate to severe OSA diagnosed on portable home sleep monitoring were randomized to receive a dietician-led LMP or usual care for 12 months. The primary outcome was reduction of apnea-hypopnea index (AHI) at 12 months as assessed by portable home sleep monitoring. RESULTS In the intention-to-treat analysis (ITT), LMP (n = 61) was more effective in reducing AHI from baseline (16.9% fewer events in the LMP group vs 0.6% more events in the control group, P = .011). LMP was more effective in reducing BMI (-1.8 kg/m2, 6.0% of the initial BMI; -0.6 kg/m2, 2.0% of the initial BMI in control group; P < .001). The reduction in daytime sleepiness as assessed by Epworth Sleepiness Scale was not significant in ITT but was more in the LMP group (-3.5 in the LMP group vs -1.1 in the control group, P = .004) by treatment per protocol analysis. There was modest improvement in mental health in the Short Form Health Survey. Eating behavior was improved with increased intake of protein and fiber. These changes were observed 4 months after the initial intensive diet counseling and persisted at 12 months. CONCLUSIONS LMP was effective in reducing the severity of OSA and daytime sleepiness. The beneficial effect was sustained in 12 months. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01384760; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Susanna S S Ng
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Ruth S M Chan
- Centre for Nutritional Studies, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Jean Woo
- Centre for Nutritional Studies, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Tat-On Chan
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Bernice H K Cheung
- Centre for Nutritional Studies, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Mandy M M Sea
- Centre for Nutritional Studies, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Kin-Wang To
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Ken K P Chan
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Jenny Ngai
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Wing-Ho Yip
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - Fanny W S Ko
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - David S C Hui
- Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
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24
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Frasnelli M, Baty F, Niedermann J, Brutsche MH, Schoch OD. Effect of telemetric monitoring in the first 30 days of continuous positive airway pressure adaptation for obstructive sleep apnoea syndrome – a controlled pilot study. J Telemed Telecare 2015; 22:209-14. [DOI: 10.1177/1357633x15598053] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/07/2015] [Indexed: 11/16/2022]
Abstract
Obstructive sleep apnoea syndrome (OSAS) is characterised by repetitive collapse of the upper airway during sleep. Continuous positive airway pressure (CPAP) applied via a mask is the standard treatment for OSAS. CPAP adherence is crucial in therapy to prevent the deleterious consequences of OSAS. We hypothesised that a combination of supervision by telemetry together with targeted telephone support in the first month of CPAP would increase CPAP adherence and treatment success. A total of 113 OSAS patients followed by telemetry-triggered interventions used the device for 5.3 h/night on 28/30 nights, significantly more than the 110 OSAS patients in the control group with 4.6 h/night and 27/30 nights. Telemetry-triggered interventions have a significant impact on adherence rate in early CPAP treatment. These results can be reached with an acceptable additional effort.
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Affiliation(s)
- Matthias Frasnelli
- Klinik für Pneumologie und Schlafmedizin, Zentrum für Schlafmedizin, Kantonsspital St Gallen, Switzerland
| | - Florent Baty
- Klinik für Pneumologie und Schlafmedizin, Zentrum für Schlafmedizin, Kantonsspital St Gallen, Switzerland
| | - Jolanda Niedermann
- Klinik für Pneumologie und Schlafmedizin, Zentrum für Schlafmedizin, Kantonsspital St Gallen, Switzerland
| | - Martin H Brutsche
- Klinik für Pneumologie und Schlafmedizin, Zentrum für Schlafmedizin, Kantonsspital St Gallen, Switzerland
| | - Otto D Schoch
- Klinik für Pneumologie und Schlafmedizin, Zentrum für Schlafmedizin, Kantonsspital St Gallen, Switzerland
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25
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Fung CH, Martin JL, Hays RD, Rodriguez JC, Igodan U, Jouldjian S, Dzierzewski JM, Kramer BJ, Josephson K, Alessi C. Development of the Usability of Sleep Apnea Equipment-Positive Airway Pressure (USE-PAP) questionnaire. Sleep Med 2015; 16:645-51. [PMID: 25890783 DOI: 10.1016/j.sleep.2015.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 01/28/2015] [Accepted: 01/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND A growing number of positive airway pressure (PAP) device users will develop physical/sensory impairments such as arthritis. For these individuals, the usability of their PAP devices (e.g., efficiency and satisfaction) may impact the frequency and safety of device usage. Questionnaires to assess PAP usability are unavailable; therefore, we developed the Usability of Sleep Apnea Equipment-Positive Airway Pressure (USE-PAP) questionnaire. METHODS Questionnaire development included in-depth interviews to identify relevant content areas, a technical advisory panel to review/edit items, cognitive interviews to refine items, and a cross-sectional survey of Veterans Affairs sleep clinic patients assessing PAP device usability overall (one multi-item scale), usability of PAP components (multi-item scales for machine controls, mask/headgear, tubing, and humidifier), frequency of usability-related issues (one multi-item scale), PAP device characteristics, and demographics. RESULTS After conducting 19 in-depth interviews, a panel meeting, and 10 cognitive interviews, we administered the survey to 100 PAP device users (67% ≥60 years; 90% male). The items assessing machine control usability received the least favorable ratings. Twenty percent of respondents reported difficulty getting equipment ready for use, and 33 percent had difficulty cleaning equipment. The six multi-item scales had excellent internal consistency reliability (alpha ≥0.84) and item-rest correlations (≥0.39). CONCLUSIONS This study provides initial support for the USE-PAP for measuring PAP device usability. Studies that include large samples are needed to further evaluate the psychometric properties of the USE-PAP. In addition, comparisons of USE-PAP responses with direct observations of PAP-related tasks and objectively measured PAP adherence are needed to fully evaluate the questionnaire.
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Affiliation(s)
- Constance H Fung
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Jennifer L Martin
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ron D Hays
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Juan Carlos Rodriguez
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Medicine Department, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Uyi Igodan
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Stella Jouldjian
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Joseph M Dzierzewski
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - B Josea Kramer
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Karen Josephson
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Cathy Alessi
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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26
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Ng SSS, Chan TO, To KW, Chan KKP, Ngai J, Tung A, Ko FWS, Hui DSC. Prevalence of obstructive sleep apnea syndrome and CPAP adherence in the elderly Chinese population. PLoS One 2015; 10:e0119829. [PMID: 25774657 PMCID: PMC4361659 DOI: 10.1371/journal.pone.0119829] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study assessed the prevalence of obstructive sleep apnea syndrome (OSAS) and CPAP adherence in the elderly Chinese in Hong Kong. METHODS We conducted a sleep questionnaire survey among the elders aged ≥60 years in the community centres followed by level 3 home sleep study (Embletta). Subjects with an apnea hypopnea index (AHI) ≥ 15/hr alone and those with AHI ≥ 5/hr plus either cardiovascular risk factors or Epworth Sleepiness Score (ESS) ≥ 10 were offered CPAP treatment. RESULTS Altogether 819 subjects were interviewed with mean (SD) age of 73.9 (7.5) years, BMI 24.2 (3.6) kg/m2, neck circumference 34.9 (3.4) cm and ESS 6.6 (5.2). Daytime sleepiness was reported by 72.4%, snoring loudly 5.1% and witnessed apnea 4%. Among 234 subjects who underwent home sleep study, 156 (66.7%), 102 (43.6%), 70 (29.9%) and 45 (19.2%) had AHI ≥ 5, ≥ 10, ≥ 15 and ≥ 20/hr respectively, with the prevalence increasing with age and BMI. In the sample, 149 subjects (63.7%) were classified as having OSAS, as defined by an AHI ≥ 5/hr with associated symptoms, involving 81 men (74.3%) and 68 women (54.4%). Neck circumference and snoring frequency were the only positive independent factors associated with the AHI and the diagnosis of OSAS. Among 141 subjects who were offered CPAP treatment, 30 accepted CPAP prescription with improvement of ESS and cognitive function over 12 months with CPAP usage of 4.2 (2.2) h/night. CONCLUSION This study showed a high prevalence of OSAS among the community elders in Hong Kong. Home CPAP acceptance was low but there was significant improvement of subjective sleepiness and cognitive function among those on CPAP treatment.
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Affiliation(s)
- Susanna S. S. Ng
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Tat-On Chan
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Kin-Wang To
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Ken K. P. Chan
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Jenny Ngai
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Alvin Tung
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - Fanny W. S. Ko
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | - David S. C. Hui
- Division of Respiratory Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
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27
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Dudley KA, Patel SR. Disparities and genetic risk factors in obstructive sleep apnea. Sleep Med 2015; 18:96-102. [PMID: 26428843 DOI: 10.1016/j.sleep.2015.01.015] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/29/2014] [Accepted: 01/14/2015] [Indexed: 01/02/2023]
Abstract
Obstructive sleep apnea (OSA) is an increasingly prevalent condition. A growing body of literature supports substantial racial disparities in the prevalence, risk factors, presentation, diagnosis, and treatment of this disease. Craniofacial structure among Asians appears to confer an elevated risk of OSA despite lower rates of obesity. Among African Americans, Native Americans, and Hispanics, OSA prevalence is increased, likely due in part to obesity. The burden of symptoms, particularly excessive daytime sleepiness, is higher among African Americans, although Hispanics more often report snoring. Limited data suggest that African Americans may be more susceptible to hypertension in the setting of OSA. While differences in genetic risk factors may explain disparities in OSA burden, no definitive genetic differences have yet been identified. In addition to disparities in OSA development, disparities in OSA diagnosis and treatment have also been identified. Increased severity of disease at diagnosis among African Americans suggests a delay in diagnosis. Treatment outcomes are also suboptimal among African Americans. In children, tonsillectomy is less likely to cure OSA and more commonly associated with complications in this group. Among adults, adherence to continuous positive airway pressure (CPAP) is substantially lower in African Americans. The reasons for these disparities, particularly in outcomes, are not well understood and should be a research priority.
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Affiliation(s)
- Katherine A Dudley
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.
| | - Sanjay R Patel
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
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28
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Hussain SF, Irfan M, Waheed Z, Alam N, Mansoor S, Islam M. Compliance with continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea among privately paying patients- a cross sectional study. BMC Pulm Med 2014; 14:188. [PMID: 25433468 PMCID: PMC4258250 DOI: 10.1186/1471-2466-14-188] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 11/24/2014] [Indexed: 11/19/2022] Open
Abstract
Background To evaluate the compliance, benefits and side effects associated with continuous positive airway pressure (CPAP) therapy among Pakistani patients treated for obstructive sleep apnea (OSA) in private sector. Methods Patients diagnosed to have OSA based on overnight study who were recommended for CPAP therapy, between 1998 and 2003, were evaluated by telephonic survey and review of hospital notes. Compliance, benefits and side effects associated with CPAP therapy were assessed. Results Out of 135 patients who were prescribed CPAP therapy, 75 could be contacted. Sixty (80%) started using CPAP within one month of diagnosis and 46 (61%) continued to use it long-term (beyond one year). Compliance with CPAP therapy was associated with higher body mass index, higher Epworth sleepiness scale score, history of witnessed apnea, and reduction in daytime sleepiness with CPAP therapy. OSA severity as assessed by apnea-hypopnea index did not affect compliance with CPAP therapy. Use of anti-depressants and CPAP induced sleep disturbances were associated with poor compliance with CPAP therapy. Conclusions Obesity, excessive daytime sleepiness, witnessed apnea and improvement of daytime symptoms following use of CPAP were predictors of improved compliance. Use of antidepressants and CPAP induced sleep disturbances were predictors of poor compliance.
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Affiliation(s)
| | - Muhammad Irfan
- Department of Medicine, The Aga Khan University Hospital, PO Box 3500, Stadium Road, Karachi 74800, Pakistan.
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29
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Chai-Coetzer CL, Luo YM, Antic NA, Zhang XL, Chen BY, He QY, Heeley E, Huang SG, Anderson C, Zhong NS, McEvoy RD. Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study. Sleep 2013; 36:1929-37. [PMID: 24293768 DOI: 10.5665/sleep.3232] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To determine the clinical variables that best predict long- term continuous positive airway pressure (CPAP) adherence among patients with cardiovascular disease who have obstructive sleep apnea (OSA). DESIGN 12-mo prospective within-trial observational study. SETTING Centers in China, Australia, and New Zealand participating in the Sleep Apnea cardioVascular Endpoints (SAVE) study. PATIENTS There were 275 patients age 45-70 y with cardiovascular disease (i.e., previously documented transient ischemic attack, stroke, or coronary artery disease) and OSA (4% oxygen desaturation index (ODI) > 12) who were randomized into the CPAP arm of the SAVE trial prior to July 1, 2010. METHODS Age, sex, country of residence, type of cardiovascular disease, baseline ODI, severity of sleepiness, and Hospital Anxiety and Depression Scale (HADS) scores plus CPAP side effects and adherence at 1 mo were entered in univariate analyses in an attempt to identify factors predictive of CPAP adherence at 12 mo. Variables with P < 0.2 were then included in a multivariate analysis using a linear mixed model with sites as a random effect and 12-mo CPAP use as the dependent outcome variable. MEASUREMENTS AND RESULTS CPAP adherence at 1, 6, and 12 mo was (mean ± standard deviation) 4.4 ± 2.0, 3.8 ± 2.3, and 3.3 ± 2.4 h/night, respectively. CPAP use at 1 mo (effect estimate ± standard error, 0.65 ± 0.07 per h increase, P < 0.001) and side effects at 1 mo (-0.24 ± 0.092 per additional side effect, P = 0.009) were the only independent predictors of 12- mo CPAP adherence. CONCLUSION Continuous positive airway pressure use in patients with coexisting cardiovascular disease and moderate to severe obstructive sleep apnea decreases significantly over 12 months. This decline can be predicted by early patient experiences with continuous positive airway pressure (i.e., adherence and side effects at 1 month), raising the possibility that intensive early interventions could improve long-term continuous positive airway pressure compliance in this patient population. CLINICAL TRIALS REGISTER Clinical Trials, http://www.clinicaltrials.gov, NCT00738179.
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Affiliation(s)
- Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health, Repatriation General Hospital, Adelaide, Australia ; Flinders University, Adelaide, Australia
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30
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Aloia MS, Arnedt JT, Strand M, Millman RP, Borrelli B. Motivational enhancement to improve adherence to positive airway pressure in patients with obstructive sleep apnea: a randomized controlled trial. Sleep 2013; 36:1655-62. [PMID: 24179298 DOI: 10.5665/sleep.3120] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with a variety of medical conditions. Positive airway pressure (PAP) is an effective treatment for improving sleep, yet adherence rates are low. The aim of the current study is to test two treatments versus standard care in improving adherence to PAP. METHOD Two hundred twenty-seven patients with OSA were randomized to standard care (SC), education (ED) and motivational enhancement therapy (MET). Adherence was measured objectively and the first week of adherence (prior to the intervention) was used as an a priori moderator of the effect of the various interventions. Mediators of treatment response were also examined using theory-based measures of decisional balance and self-efficacy. RESULTS Adherence declined over time for all three groups. There was a significant interaction between level of adherence during the first week of treatment and treatment group. Those who had moderate levels of adherence during their first week of PAP were more likely to adhere to treatment at follow-up if they had MET; those who had high levels of adherence during their first week of PAP were more likely to adhere to treatment at follow-up if they had ED. MET treatment increased the perception of the positive aspects of PAP, but ED did not. CONCLUSIONS Initial adherence to positive airway pressure could help guide subsequent treatment plans. The results also support social cognitive theory in that educational approaches might be best suited for those who are ready for change whereas more motivational approaches might be best for those who are ambivalent about change.
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Affiliation(s)
- Mark S Aloia
- Department of Medicine, National Jewish Health, Denver, CO
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31
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Long-term adherence to nasal continuous positive airway pressure therapy by hypertensive patients with preexisting sleep apnea. J Cardiol 2013; 63:281-5. [PMID: 24148860 DOI: 10.1016/j.jjcc.2013.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/23/2013] [Accepted: 08/18/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Although positive screening for and treatment of obstructive sleep apnea (OSA) have been recommended for patients with cardiovascular problems, patient adherence to nasal continuous positive airway pressure (CPAP) therapy primarily for a cardiovascular concern is unknown. Therefore, this study aimed to determine the adherence to CPAP therapy by hypertensive patients with OSA after a screening test performed regardless of OSA-related symptoms. SUBJECTS AND METHODS CPAP therapy was administered to 194 of the 1365 hypertensive patients who underwent the screening. The monthly dropout from CPAP therapy and the adequate use level (4h every night, 70% days in a month) were assessed using the Kaplan-Meier analysis over a 3-year follow-up period. RESULTS Of the patients, 106 (55%) refused or abandoned the therapy by the end of the follow-up period (adherence, 45%). An adequate use level was maintained by 76 patients (39%). Most of the patients' background characteristics, including age, sex, Epworth sleepiness scale scores, and parameters obtained on polysomnography, were not related to adherence or adequate use level. The good-compliance level on the first visit after CPAP therapy introduction was most strongly related to adherence (95% CI, 0.05-0.32; p<0.001) and adequate use level (95% CI, 0.06-0.33; p<0.05). Fourth quartile of apnea hypopnea index value (greater than 67/h) was also related to adherence (95% CI, 0.21-0.98; p<0.02) and adequate use level (95% CI, 0.19-0.88; p<0.05). CONCLUSIONS The adherence and use level in this population may not be satisfactory but are comparable with those in previous sleep center reports treating symptomatic OSA patients. Thus, the present results would encourage hypertensive patients to undergo positive screening for OSA, regardless of OSA-related symptoms. However, an outcomes study with the same cohort is needed.
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32
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Esquinas AM, Cistulli P. Is prediction of CPAP adherence in obstructive sleep apnea in the perioperative setting feasible? J Clin Sleep Med 2013; 9:731. [PMID: 23853571 DOI: 10.5664/jcsm.2856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ghosh D, Allgar V, Elliott MW. Identifying poor compliance with CPAP in obstructive sleep apnoea: A simple prediction equation using data after a two week trial. Respir Med 2013; 107:936-42. [DOI: 10.1016/j.rmed.2012.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 10/14/2012] [Accepted: 10/15/2012] [Indexed: 11/30/2022]
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Skinner T, McNeil L, Olaithe M, Eastwood P, Hillman D, Phang J, de Regt T, Bucks RS. Predicting uptake of continuous positive airway pressure (CPAP) therapy in obstructive sleep apnoea (OSA): a belief-based theoretical approach. Sleep Breath 2013; 17:1229-40. [PMID: 23516025 DOI: 10.1007/s11325-013-0828-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 02/06/2013] [Accepted: 03/04/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Obstructive sleep apnoea (OSA) is a common disorder, for which continuous positive airway pressure (CPAP) therapy is a standard treatment. Despite its well-established efficacy, many patients choose not to initiate CPAP treatment. The present study investigated the degree to which biological measures (e.g. Apnoea-Hypopnoea Index [AHI]), symptom experiences (e.g. fatigue) and illness representations (e.g. perceived consequences) predict the decision of individuals newly diagnosed with OSA to undergo a trial of CPAP therapy. METHODS Four hundred forty-nine individuals (316 males) newly diagnosed with OSA. Epworth sleepiness scale (ESS), Fatigue Severity Scale, Depression Anxiety Stress Scale and Illness Perception Questionnaire-Revised (IPQ-R) were administered at time of sleep study. These, patient demographics and sleep study variables were used to determine factors predicting patient decision to proceed with a trial of CPAP. RESULTS The participants were most likely to attribute their OSA to unchangeable and psychological factors. For those with moderate OSA (AHI, 15 to 30) IPQ-R illness consequence was predictive of decision to initiate CPAP (p = 0.002). For severe OSA (AHI >30) age, ESS and IPQ illness causal beliefs were predictive of decision to initiate CPAP (p < 0.001). CONCLUSIONS Illness beliefs are important determinants of the choice of recently diagnosed OSA patients whether or not to undertake a trial of CPAP therapy. Concerns about illness consequences were important in those with moderate OSA. In severe OSA, sleepiness symptoms are more prominent and a more significant determinant of CPAP uptake along with age and causal beliefs.
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Affiliation(s)
- Timothy Skinner
- Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, 0909, Australia,
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35
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Sampaio R, Graça Pereira M, Winck JC. Obstructive sleep apnea representations, self-efficacy and family coping regarding APAP adherence: a longitudinal study. PSYCHOL HEALTH MED 2013; 19:59-69. [PMID: 23484461 DOI: 10.1080/13548506.2013.774430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Adherence is still an important issue considering new advances in Obstructive Sleep Apnea (OSA) treatment, as automatic positive airway pressure (APAP). The aim of the present study was to identify and explore relationships between identified predictors of adherence, over time. After overnight sleep study and OSA diagnosis and during a six-month APAP treatment period, a total of 153 patients underwent a three time psychological protocol evaluation. Generalized estimating equations were applied to analyzed repeated measurements in the same individuals. Results show that 40% of patients were poorly adherent and 60% were adherent after six months of treatment. The results confirmed a predictive value of age, self-efficacy, decisional balance index and health-related quality of life (HRQoL) in APAP adherence. Furthermore, the results revealed an interaction between time and illness cognitive representations, and self-efficacy and family coping, in explaining adherence patterns over time. Therefore, understanding the causality of theoretically derived constructs is crucial to predict the continuity of APAP adherence.
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Affiliation(s)
- Rute Sampaio
- a School of Psychology , Minho University , Braga , Portugal
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Billings ME, Auckley D, Benca R, Foldvary-Schaefer N, Iber C, Redline S, Rosen CL, Zee P, Kapur VK. Race and residential socioeconomics as predictors of CPAP adherence. Sleep 2011; 34:1653-8. [PMID: 22131602 DOI: 10.5665/sleep.1428] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES There are few established predictors of CPAP adherence; poor adherence limits its effectiveness. We investigated whether race, education level, and residential economic status predict CPAP adherence in participants enrolled in a trial with standard access to treatment. DESIGN A multi-center randomized trial of home vs. lab-based evaluation and treatment of OSA assessing adherence to CPAP at 1 and 3 months. SETTING Seven AASM-accredited sleep centers in 5 U.S. cities. PARTICIPANTS Subjects with moderate to severe OSA (AHI ≥ 15 and Epworth Sleepiness Scale score > 12) who completed follow-up at 1 and/or 3 months (n = 135). MEASUREMENTS AND RESULTS Subjects' demographic data were collected upon enrollment; CPAP use at 1 and 3 months was assessed at clinic follow-up. In unadjusted analyses, CPAP adherence (average minutes per night of CPAP use) at 3 months was lower in black subjects and in subjects from lower socioeconomic status ZIP codes. In adjusted analyses using multivariate linear regression, black race was predictive of CPAP adherence at one month (P = 0.03). At 3 months, black race was predictive in analyses only when ZIP code SES was not adjusted for. CONCLUSION Black race and lower socioeconomic residential areas are associated with poorer adherence to CPAP in subjects with standardized access to care and treatment. Disparities remain despite provision of standardized care in a clinical trial setting. Future research is needed to identify barriers to adherence and to develop interventions tailored to improve CPAP adherence in at risk populations. Portable Monitoring for Diagnosis and Management of Sleep Apnea (HomePAP) CLINICAL TRIAL INFORMATION: NIH CLINICAL TRIALS REGISTRY NUMBER: NCT00642486. URL: http://clinicaltrials.gov/show/NCT00642486.
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Affiliation(s)
- Martha E Billings
- Health Services Research & Development, Department of Veterans Affairs, Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA.
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Abstract
Obstructive Sleep Apnoea (OSA) is increasingly recognised as a condition that not only causes excessive daytime sleepiness, but is also an important cardiovascular risk factor. Treatment of OSA should include conservative measures such as weight loss and positional therapy, the nuances of which are discussed in this article. However this in itself is not sufficient treatment for most patients. The first line of treatment for OSA that is recommended across the entire spectrum of disease is continuous positive airway pressure (CPAP) therapy. Indications for initiating CPAP are discussed, as well as possible alternatives to CPAP such as surgery or dental devices. In initiating CPAP treatment, machine-patient interface needs to be carefully considered, as there is a wide range of masks available. Factors to be considered in the choice of CPAP machine and mode are discussed. Finally, patient-specific factors such as patient acceptance of treatment, common problems encountered in CPAP follow-up and the importance of patient education are addressed.
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Affiliation(s)
- Thun How Ong
- Department of Respiratory and Critical Care Medicine, Sleep Disorders Unit, Singapore General Hospital
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Avlonitou E, Kapsimalis F, Varouchakis G, Vardavas CI, Behrakis P. Adherence to CPAP therapy improves quality of life and reduces symptoms among obstructive sleep apnea syndrome patients. Sleep Breath 2011; 16:563-9. [PMID: 21667216 DOI: 10.1007/s11325-011-0543-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 06/01/2011] [Accepted: 06/06/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the study was to asses quality of life and symptoms of obstructive sleep apnea syndrome (OSAS) patients after adhering to 6 months of continuous positive airway pressure (CPAP) treatment. METHODS A group of 50 patients (41 men and 9 women) were diagnosed by polysomnography and treated with CPAP therapy for 6 months. Their symptoms and health-related quality of life were assessed by administering a validated and translated version of the sleep apnea quality of life index (SAQLI). Sleepiness was measured using the Epworth Sleepiness Scale (ESS) and through electronic monitoring of CPAP usage per night of sleep. RESULTS Mean CPAP usage was 4.5 ± 0.5 h per night. Comparisons between quality of life indexes before and after CPAP treatment showed an improvement in the total SAQLI score (3.8 ± 0.9 vs. 5.8 ± 0.8 after CPAP, p < 0.01), in daily functioning (4.2 ± 1.4 vs. 6.0 ± 0.9, p < 0.01), social interactions (4.8 ± 1.3 vs.6.3 ± 0.7, p < 0.01), emotional functioning (4.4 ± 1.4 vs. 5.7 ± 1.0, p < 0.01), symptoms (1.6 ± 0.8 vs. 5.8 ± 1.2, p < 0.01), and in the ESS (13.7 ± 6.5 vs. 3.9 ± 3.8, p < 0.01). Regarding the patients' symptoms, improvement was noticed for "sleepiness while watching a spectacle" (96%), "reading" (95%), "carrying on a conversation" (95%), "driving" (92.9%), "restless sleep" (87.8%), and "urinating more than once per night" (84.8%). Smaller improvements were observed for the reported "dry mouth-throat upon awakening" (36.1%),"excessive fatigue" (54.5%), and "decreased energy" (55.3%). CONCLUSION We conclude that OSAS patients who adhere to nighttime CPAP therapy show significant improvement of their quality of life, daytime sleepiness, and other symptoms after 6 months of treatment with CPAP.
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El-Solh AA, Ayyar L, Akinnusi M, Relia S, Akinnusi O. Positive airway pressure adherence in veterans with posttraumatic stress disorder. Sleep 2011; 33:1495-500. [PMID: 21102991 DOI: 10.1093/sleep/33.11.1495] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES to determine the short-term positive airway pressure (PAP) adherence rates and to identify non-mask-related risk factors associated with 30-day nonadherence to PAP in a population of veterans with obstructive sleep apnea (OSA) and posttraumatic stress disorder (PTSD). DESIGN a retrospective study. SETTINGS a Veterans Affairs hospital. PATIENTS one hundred forty-eight PTSD veterans newly diagnosed with OSA and a control group of OSA without PTSD matched for age, gender, BMI, and severity of OSA. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS at 30-day follow-up, adherence to PAP was significantly lower in the PTSD group compared to the control group (41% versus 70%, respectively; P < 0.001). Veterans with adequate PAP adherence were more likely to experience sleepiness at baseline compared to nonadherent subjects (ESS 14.4 ± 5.3 versus 12.3 ± 5.9, respectively; P = 0.04). Nightmares were more frequently reported in those who were PAP nonadherent (P = 0.002). Mask discomfort, claustrophobia, and air hunger were the reported reasons for PAP nonadherence in the PTSD group. CONCLUSION PAP usage and adherence were lower in PTSD veterans with OSA than veterans without PTSD. Excessive sleepiness predicted PAP adherence while frequent nightmares were correlated with poor adherence to PAP therapy.
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Affiliation(s)
- Ali A El-Solh
- The Veterans Affairs Western New York Healthcare System, Buffalo, NY 14215, USA.
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Galetke W, Puzzo L, Priegnitz C, Anduleit N, Randerath WJ. Long-Term Therapy with Continuous Positive Airway Pressure in Obstructive Sleep Apnea: Adherence, Side Effects and Predictors of Withdrawal – A ‘Real-Life’ Study. Respiration 2011; 82:155-61. [DOI: 10.1159/000322838] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 11/16/2010] [Indexed: 11/19/2022] Open
Affiliation(s)
- Wolfgang Galetke
- Clinic for Pneumology, Cardiology, Allergology, Sleep Medicine and Respiratory Care, Krankenhaus der Augustinerinnen, Cologne, Germany.
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Effects of continuous positive airway pressure therapy on hypertension control in patients with sleep-related breathing disorders: available evidence and unresolved issues. J Hypertens 2010; 28:2012-5. [DOI: 10.1097/hjh.0b013e32833f0e7e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baron KG, Berg CA, Czajkowski LA, Smith TW, Gunn HE, Jones CR. Self-efficacy contributes to individual differences in subjective improvements using CPAP. Sleep Breath 2010; 15:599-606. [DOI: 10.1007/s11325-010-0409-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 07/26/2010] [Accepted: 08/23/2010] [Indexed: 10/19/2022]
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Arfoosh R, Rowley JA. Adherence to Positive Airway Pressure Therapy. Sleep Med Clin 2010. [DOI: 10.1016/j.jsmc.2010.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Broström A, Ulander M, Nilsen P, Svanborg E, Arestedt KF. The attitudes to CPAP treatment inventory: development and initial validation of a new tool for measuring attitudes to CPAP treatment. J Sleep Res 2010; 20:460-71. [PMID: 20819143 DOI: 10.1111/j.1365-2869.2010.00885.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but low adherence rates are common. The aim was to develop the attitudes to CPAP treatment inventory (ACTI), and to investigate the validity and reliability of the instrument among patients with OSAS. ACTI was developed on the basis of: (i) in-depth interviews with 23 patients; (ii) examination of the scientific literature; and (iii) consensus agreement of a multi-professional expert panel. This yielded five different types of attitudes to CPAP treatment. A prospective longitudinal design was used. Two-hundred and eighty-nine patients with OSAS were recruited at three different CPAP centres. Data were collected with ACTI and obtained from medical records. The homogeneity and internal consistency reliability were satisfactorily reflected by the item-total correlations (0.59-0.81) and Cronbach's alpha (0.89), respectively. Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation; PCF). The PCF based on baseline data resulted in a one single-factor solution explaining 69% of the total variance. A confirmatory factor analysis was performed 2 weeks after CPAP initiation, resulting in the same factor solution. No indication of uniform differential item functioning was found. The predictive validity was tested with receiver operating characteristic analyses, and a cut-off of 10 on the ACTI gave a sensitivity of 93% and a specificity of 44% for CPAP termination within 6 months. The satisfactory measurement properties of this new pragmatic instrument are promising and indicate that ACTI can be useful in clinical practice to reliably measure attitudes to CPAP treatment.
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Affiliation(s)
- Anders Broström
- Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
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Sawyer AM, Deatrick JA, Kuna ST, Weaver TE. Differences in perceptions of the diagnosis and treatment of obstructive sleep apnea and continuous positive airway pressure therapy among adherers and nonadherers. QUALITATIVE HEALTH RESEARCH 2010; 20:873-892. [PMID: 20354236 PMCID: PMC2978511 DOI: 10.1177/1049732310365502] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Obstructive sleep apnea (OSA) patients' consistent use of continuous positive airway pressure (CPAP) therapy is critical to realizing improved functional outcomes and reducing untoward health risks associated with OSA. We conducted a mixed methods, concurrent, nested study to explore OSA patients' beliefs and perceptions of the diagnosis and CPAP treatment that differentiate adherent from nonadherent patients prior to and after the first week of treatment, when the pattern of CPAP use is established. Guided by social cognitive theory, themes were derived from 30 interviews conducted postdiagnosis and after 1 week of CPAP use. Directed content analysis, followed by categorization of participants as adherent/nonadherent from objectively measured CPAP use, preceded across-case analysis among 15 participants with severe OSA. Beliefs and perceptions that differed between adherers and nonadherers included OSA risk perception, symptom recognition, self-efficacy, outcome expectations, treatment goals, and treatment facilitators/ barriers. Our findings suggest opportunities for developing and testing tailored interventions to promote CPAP use.
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Affiliation(s)
- Amy M. Sawyer
- Biobehavioral Health Sciences Division, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Philadelphia Veterans Affairs Medical Center, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Sleep & Respiratory Neurobiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Janet A. Deatrick
- Center for Health Equities Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Samuel T. Kuna
- Philadelphia Veterans Affairs Medical Center, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Sleep & Respiratory Neurobiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Terri E. Weaver
- Biobehavioral Health Sciences Division, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Sleep & Respiratory Neurobiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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BROSTRÖM ANDERS, ÅRESTEDT KRISTOFERFRANZÉN, NILSEN PER, STRÖMBERG ANNA, ULANDER MARTIN, SVANBORG EVA. The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment. J Sleep Res 2010; 19:603-11. [DOI: 10.1111/j.1365-2869.2010.00825.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Weaver TE, Sawyer A. Management of obstructive sleep apnea by continuous positive airway pressure. Oral Maxillofac Surg Clin North Am 2010; 21:403-12. [PMID: 19944340 DOI: 10.1016/j.coms.2009.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Obstructive sleep apnea (OSA) is a common problem, with 9% to 28% of women and 24% to 26% of males having apneic events at a treatable level, making this syndrome a serious public health issue. This article describes the outcomes associated with continuous positive airway pressure treatment, significance of the issue of poor adherence in OSA, discusses evidence regarding the optimal duration of nightly use, describes the nature and predictors of nonadherence, and reviews interventions that have been tested to increase nightly use and suggests management strategies.
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Affiliation(s)
- Terri E Weaver
- Biobehavioral and Health Sciences Division, University of Pennsylvania School of Nursing, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA.
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Broström A, Nilsen P, Johansson P, Ulander M, Strömberg A, Svanborg E, Fridlund B. Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: a qualitative content analysis. Sleep Med 2009; 11:126-30. [PMID: 20004615 DOI: 10.1016/j.sleep.2009.04.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 04/02/2009] [Accepted: 04/29/2009] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Effective treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) can reduce morbidity and mortality, but adherence rates are low without a clear consensus of causes. OBJECTIVE To explore the experiences of adherence to CPAP treatment in patients with OSAS. METHODS A qualitative content analysis was employed. Data were collected by in-depth interviews with 23 purposively selected patients. RESULTS Adherence to CPAP treatment was summarized according to "facilitators" and "barriers" to CPAP treatment. Facilitators for adherence, as described by the patients were a desire to avoid symptoms, knowledge about the risk for medical consequences, fear of negative social consequences and disturbing the sleep of significant others. Other facilitators were a positive attitude to CPAP treatment, trust in healthcare personnel, a sense of engagement from the spouse and a feeling of physical improvement. Barriers included experiencing practical problems, negative psychological effects of the equipment, and negative attitudes to the treatment. Other barriers were side-effects as well as insufficient support from healthcare personnel and the spouse. CONCLUSION Adherence to CPAP treatment is a multifaceted problem including patient, treatment, condition, social and healthcare related factors. Knowledge about facilitators and barriers for adherence to CPAP treatment can be used in interventional strategies.
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Affiliation(s)
- Anders Broström
- Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden.
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Matthews EE, Aloia MS. Continuous Positive Airway Pressure Treatment and Adherence in Obstructive Sleep Apnea. Sleep Med Clin 2009. [DOI: 10.1016/j.jsmc.2009.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sopkova Z, Dorkova Z, Tkacova R. Predictors of compliance with continuous positive airway pressure treatment in patients with obstructive sleep apnea and metabolic syndrome. Wien Klin Wochenschr 2009; 121:398-404. [PMID: 19626298 DOI: 10.1007/s00508-009-1181-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 02/18/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Continuous positive airway pressure (CPAP) applied via a tight-fitting mask is the most effective treatment for obstructive sleep apnea (OSA) and has potential to improve the cardiovascular prognosis in such patients. Adequate compliance with the use of CPAP is essential for achieving the cardiovascular and metabolic benefits of this treatment. This prospective study aimed to assess factors related to objective compliance with CPAP treatment in Slovakian patients with metabolic syndrome and newly diagnosed OSA. PATIENTS AND METHODS Fifty-one patients (42 men) with metabolic syndrome and OSA (mean age, 54.5 +/- 1.5 years; mean apnea-hypopnea index 59.0 +/- 3.9 events/h of sleep; mean lowest sleep transcutaneous oxygen saturation [SpO(2)] 66.0 +/- 2.7%) underwent pressure titration during overnight polysomnography using the Autoset self-adjusting CPAP device. Metabolic syndrome was diagnosed according to the recent definition of the International Diabetes Federation. Objective compliance was assessed electronically at the 8-week follow-up visit. RESULTS Obesity was present in all (100%) the patients and arterial hypertension in 48 (94%); fasting plasma glucose levels were increased in 27 (55%) patients and serum triglycerides in 36 (71%); serum HDL cholesterol was reduced in 30 (59%) patients. Two patients did not use CPAP at all and were excluded from further analyses. The remaining 49 patients were divided into two groups: CPAP compliant (>or=4 h/night, mean use 5.52 +/- 0.19 h/night, n = 30) and CPAP non-compliant (< 4 h/night; mean use 1.94 +/- 0.27 h/night, n = 19). Mask leak was significantly higher in the non-compliant patients (43.0 +/- 4.4 vs. 31.9 +/- 2.7 l/min, P = 0.027). No relationships were observed between CPAP compliance and age, apnea-hypopnea index, arousal index or variables of sleep architecture. In contrast, CPAP compliance was significantly related to mean sleep SpO(2) (r = 0.314, P = 0.028), the lowest sleep SpO(2) (r = 0.297, P = 0.038) and mask leak (r = -0.376, P = 0.008). A close relationship between BMI and mask leak was also observed (r = 0.579, P < 0.001). In multiple linear regression analyses with CPAP compliance as an independent variable, and age, sex, mask leak, BMI and mean sleep SpO(2) as dependent variables, mask leak was the only independent predictor of CPAP compliance (R(2) = 0.382, P = 0.009). CONCLUSION The study demonstrates the relationship between reductions in mask leak and good compliance with CPAP treatment in central European patients with OSA and concurrent metabolic syndrome. Strategies to maintain low leakage of the CPAP mask are warranted, particularly in grossly overweight patients.
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Affiliation(s)
- Zuzana Sopkova
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P. J. Safarik University and L. Pasteur Teaching Hospital, Kosice, Slovakia
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