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Tselepi C, Tsirves G, Exarhos K, Chronis C, Kyriakopoulos C, Tatsis K, Kostikas K, Konstantinidis A. Educational video demonstrating collapsibility of the upper airway during sleep improves initial acceptance of CPAP in patients with severe obstructive sleep apnea: a retrospective study. J Clin Sleep Med 2024. [PMID: 38648113 DOI: 10.5664/jcsm.11166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
STUDY OBJECTIVES To investigate if an audio-visual educational video demonstrating collapsibility of the upper airway during sleep influences initial CPAP acceptance among patients with severe obstructive sleep apnea (OSA). METHODS Between January 2017 and December 2018, a single-center retrospective study was conducted. We implemented an educational video demonstrating upper airway collapsibility during sleep in February 2018. We analyzed the medical records from 145 consecutive patients diagnosed with severe OSA who underwent in-lab polysomnography (PSG) both before and after implementing the educational video. Among them, 76 patients received standard care before the video's introduction (standard care group), and another 69 patients were managed after its implementation (video group). RESULTS Baseline characteristics including age, BMI, educational level, occupation category, comorbidities, Mallampati score, Epworth Sleepiness Scale (ESS) score, apnea hypopnea index (AHI) and sleep time with SpO2 below 90% (T90%) were not significantly different between the two groups. Acceptance of CPAP following in-lab overnight titration study was significantly higher in the video group (80%) compared to the standard care group (57%), P= .004. Multivariate regression analyses revealed that watching the video was a strong predictor of initial CPAP acceptance (OR 4.162, 95%, CI 1.627-10.646; P= .004). Both T90% (OR 1.020 95% CI 1.002 to 1.038; P= .029) and sleep efficiency (OR 1.052 95% CI 1.023 to 1.083; P< .001) were weak predictors for initial CPAP acceptance. At 12 months, adherence among those who accepted the CPAP treatment was similar between the two groups (78% vs 74%, P= .662). However, within the initial cohorts, a significantly higher proportion of patients in the video group (62%) were using CPAP at 12 months compared to the standard care group (42%), P= .015. CONCLUSIONS Among patients with severe OSA, an educational video demonstrating upper airway collapsibility during sleep improved initial CPAP acceptance rates when compared to standard care.
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Affiliation(s)
- Charikleia Tselepi
- Sleep Disorders Unit, Department of Respiratory Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Georgios Tsirves
- Department of ENT, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Exarhos
- Department of Respiratory Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Christos Chronis
- Department of Respiratory Medicine, University Hospital of Ioannina, Ioannina, Greece
| | | | - Konstantinos Tatsis
- Department of Respiratory Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Kostikas
- Department of Respiratory Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Athanasios Konstantinidis
- Sleep Disorders Unit, Department of Respiratory Medicine, University Hospital of Ioannina, Ioannina, Greece
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Zheng Y, Yee BJ. Sleep well with home automation. Respirology 2023; 28:980-982. [PMID: 37699771 DOI: 10.1111/resp.14601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023]
Abstract
See related article
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Affiliation(s)
- Yizhong Zheng
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Brendon J Yee
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Human Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Yoshikawa A, Inoshita A, Sata N, Nakamura M, Suzuki Y, Ishimizu E, Suda S, Naito R, Kasai T, Matsumoto F. Impact of antiallergy agents on CPAP therapy and sleep quality with spring pollinosis in Japanese. Sleep Breath 2023; 27:1795-1803. [PMID: 36763255 PMCID: PMC9911947 DOI: 10.1007/s11325-023-02788-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/01/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Allergic rhinitis (AR) is associated with obstructive sleep apnea (OSA) and nasal obstruction causes decreased adherence to continuous positive airway pressure (CPAP). The purpose is to evaluate the effects of antiallergic agents on CPAP adherence and sleep quality. METHODS A longitudinal study was made of patients who use CPAP for OSA and treated with antiallergy agents for spring pollinosis. We compared the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), nasal symptoms scores (NSS), and data from CPAP before and after treatment. Then, we classified the subjects into two groups based on the baseline PSQI score: one group without a decreased sleep quality (PSQI < 6) and the other group with decreased sleep quality (PSQI ≥ 6). RESULTS Of 28 subjects enrolled, 13 had good sleep quality and 15 had poor sleep quality. PSQI showed significant improvements after medication (p = 0.046). ESS showed no significant differences after AR medication (p = 0.565). Significant improvement was observed after the prescription of antiallergy agents in all items of NSS (sneezing, p < 0.05; rhinorrhea, p < 0.01; nasal obstruction, p < 0.01; QOL, p < 0.01). The percentage of days with CPAP use more than 4 h increased significantly after the administration of rhinitis medication (p = 0.022). In the intragroup comparisons of PSQI ≥ 6 group, PSQI decreased significantly (p < 0.05). For the NSS in intragroup comparisons of PSQI ≥ 6 group, all parameters showed significant improvement (sneezing, p = 0.016; rhinorrhea, p = 0.005; nasal obstruction, p < 0.005; QOL, p < 0.005). CONCLUSION The use of antiallergy agents can improve CPAP adherence and sleep quality in patients with OSA on CPAP.
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Affiliation(s)
- Akihisa Yoshikawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-Ku, 113-8421, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
| | - Ayako Inoshita
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-Ku, 113-8421, Japan.
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan.
| | - Naoko Sata
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-Ku, 113-8421, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
| | - Masahiro Nakamura
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-Ku, 113-8421, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
| | - Yo Suzuki
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-Ku, 113-8421, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
| | - Erina Ishimizu
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-Ku, 113-8421, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
| | - Shoko Suda
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine , Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryo Naito
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine , Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Cardiovascular Biology and Medicine , Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, Bunkyo-Ku, 113-8421, Japan
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Qiao M, Xie Y, Wolff A, Kwon J. Long term adherence to continuous positive Airway pressure in mild obstructive sleep apnea. BMC Pulm Med 2023; 23:320. [PMID: 37658304 PMCID: PMC10472589 DOI: 10.1186/s12890-023-02612-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Studies have shown that a significant percentage of patients with obstructive sleep apnea (OSA) do not tolerate continuous positive airway pressure (CPAP) therapy and long-term use may be as low as 30%. Given the lower levels of symptoms and health-related risks, patients with mild sleep apnea may be at even higher risk for non-adherence to long term CPAP. The purpose of our study was to investigate the prevalence and associations of long-term CPAP adherence in first time users with mild sleep apnea diagnosed by home sleep apnea testing (HSAT). METHODS We identified all the patients who were diagnosed with mild sleep apnea (5 = < AHI < 15) by home sleep apnea testing from 01/2013 to 06/2019 at a large, combined community and hospital-based sleep practice. Only first time CPAP users were included. Compliance was defined as CPAP usage ≥ 4 h per night on ≥ 70% of nights over 30 consecutive days. We defined long term adherence as compliance on the 12th month following CPAP set up. Patient demographics, comorbidities, and CPAP compliance at 1st, 3rd, 6th, 9th and 12th month after therapy initiation were collected. We compared and identified the factors that had significant difference (P < 0.1) between compliant and non-compliant groups at the 12th month. RESULTS 222 patients were included in the analysis. 57 (25.7%) patients were adherent with long term CPAP treatment. The following factors were associated with a greater likelihood for long-term CPAP adherence: older age, lower body mass index (BMI), presence of a bed partner, non-smoker, presence of Diabetes Mellitus (DM), presence of Heart Failure (CHF), lack of depression, and compliance at 1st, 3rd, 6th and 9th month. CONCLUSIONS Long term CPAP compliance in mild sleep apnea patients is low. Long term adherence to CPAP can be predicted based on CPAP adherence during the first three months.
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Affiliation(s)
- Min Qiao
- Pulmonary and critical care medicine, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA.
| | - Yiyu Xie
- Medicine department, University of Massachusetts Chan Medical School, 55 Lake Ave, North Worcester, 01655, Worcester, MA, USA
| | - Armand Wolff
- Pulmonary disease, critical care and sleep medicine, 267 Grant St, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, 06610, USA
| | - Jeff Kwon
- Pulmonary disease, critical care and sleep medicine, 267 Grant St, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, 06610, USA
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Fashanu OS, Quan SF. Factors associated with treatment outcomes after use of auto-titrating CPAP therapy in adults with obstructive sleep apnea. Sleep Breath 2023; 27:165-172. [PMID: 35284979 DOI: 10.1007/s11325-022-02590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/18/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine factors that are associated with OSA therapy outcomes with auto-titrating positive airway pressure (APAP). METHODS We sequentially grouped patients from a retrospective cohort based on APAP efficacy (sufficiently vs. insufficiently treated; insufficiently treatment defined as residual AHI of ≥ 5), therapy adherence (adherent vs. non-adherent, non-adherence defined as < 70% usage for ≥ 4 h/night), and therapy outcomes (optimal vs. non-optimal and non-optimal outcomes defined as non-adherent and/or insufficiently treated). We subsequently compared each group. RESULTS The insufficiently treated were older (68.4 ± 12.5 vs. 60.4 ± 13.1 years, p < 0.01) and had lower BMI (31.9 ± 6.3 vs. 37.9 ± 9.1 kg/m2, p < 0.01). They had higher baseline central apnea indices (CAI), longer leaks, higher peak pressures, and were less compliant. The non-adherent were younger (61.1 ± 12.6 vs. 65.5 ± 13.2 years, p = 0.03) and comprised more females (56.1 vs. 43.9%, p = 0.04). The leak duration per usage hour was higher in the non-compliant (median: 1.5; IQR 7.9 vs. median: 0.3; IQR 1.9 min/h; p < 0.01). The non-optimally treated had lower BMI, longer leaks, and less nightly usage. Multivariate analyses showed that leak duration was the common factor associated with treatment effectiveness and optimal therapy outcomes. CONCLUSIONS Various demographic and clinical factors were associated with treatment efficacy and adherence. However, leak duration was the common factor related to treatment efficacy and overall optimal therapy outcomes.
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Affiliation(s)
- Olabimpe S Fashanu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA.
| | - Stuart F Quan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA
- Asthma and Airways Research Center, University of Arizona College of Medicine, Tucson, AZ, USA
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Chaiard J, Bhatarasakoon P. Effectiveness of behavioral and psychosocial interventions for continuous positive airway pressure adherence among patients with obstructive sleep apnea: A systematic review and meta-analysis. Appl Nurs Res 2023; 69:151654. [PMID: 36635010 DOI: 10.1016/j.apnr.2022.151654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/22/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) therapy is the treatment of choice for Obstructive Sleep Apnea (OSA) syndrome; however, interventions to improve CPAP adherence are still inconclusive. OBJECTIVE This study aimed to examine the effectiveness of behavioral and psychosocial interventions on CPAP adherence. METHODS The PRISMA guidelines and JBI approach for Systematic Review and Meta-analysis were used. Participants included 1) newly diagnosed patients with OSA, naive to CPAP treatment; 2) any type of behavioral and/or psychosocial intervention delivered via individual or group level; 3) CPAP adherence as an outcome. Two reviewers independently selected studies, evaluated their methodological quality, and extracted data. RESULTS Critical appraisal was conducted on 34 of the 1657 studies, with 18 RCTs included in the final review. Telemonitoring increased the mean nightly hour of CPAP use compared to standard care (WMD = 0.76, 95 % CI = 0.31-1.20, p = 0.001, I2 = 0 %, moderate certainty of evidence). Positive results were discovered in Motivational Enhancement Therapy (MET) (WMD = 1.22, 95 % CI = 0.28-2.16, p = 0.011, I2 = 65 %, very low degree of certainty of evidence). The combined effects of cognitive therapy and education on CPAP adherence were inconclusive. Behavioral/supportive interventions improved mean nightly CPAP use in both the short term (WMD = 1.49, 95 % CI = 0.16-2.81, p = 0.029, I2 = 30 %, very low certainty of evidence) and long-term follow-up (WMD = 1.67, 95 % CI = 1.55-1.79, p = 0, I2 = 0 %, very low certainty of evidence). CONCLUSIONS Telemonitoring improved the mean nightly hour of CPAP utilization compared with standard care. Motivational Enhancement Therapy (MET) had the most significant effect on long-term adherence.
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Affiliation(s)
- Jindarat Chaiard
- The Thailand Centre for Evidence-Based Health Care, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Patraporn Bhatarasakoon
- The Thailand Centre for Evidence-Based Health Care, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
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Pfammatter AF, Hughes BO, Tucker B, Whitmore H, Spring B, Tasali E. The Development of a Novel mHealth Tool for Obstructive Sleep Apnea: Tracking Continuous Positive Airway Pressure Adherence as a Percentage of Time in Bed. J Med Internet Res 2022; 24:e39489. [PMID: 36469406 DOI: 10.2196/39489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/07/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is the mainstay obstructive sleep apnea (OSA) treatment; however, poor adherence to CPAP is common. Current guidelines specify 4 hours of CPAP use per night as a target to define adequate treatment adherence. However, effective OSA treatment requires CPAP use during the entire time spent in bed to optimally treat respiratory events and prevent adverse health effects associated with the time spent sleeping without wearing a CPAP device. Nightly sleep patterns vary considerably, making it necessary to measure CPAP adherence relative to the time spent in bed. Weight loss is an important goal for patients with OSA. Tools are required to address these clinical challenges in patients with OSA. OBJECTIVE This study aimed to develop a mobile health tool that combined weight loss features with novel CPAP adherence tracking (ie, percentage of CPAP wear time relative to objectively assessed time spent in bed) for patients with OSA. METHODS We used an iterative, user-centered process to design a new CPAP adherence tracking module that integrated with an existing weight loss app. A total of 37 patients with OSA aged 20 to 65 years were recruited. In phase 1, patients with OSA who were receiving CPAP treatment (n=7) tested the weight loss app to track nutrition, activity, and weight for 10 days. Participants completed a usability and acceptability survey. In phase 2, patients with OSA who were receiving CPAP treatment (n=21) completed a web-based survey about their interpretations and preferences for wireframes of the CPAP tracking module. In phase 3, patients with recently diagnosed OSA who were CPAP naive (n=9) were prescribed a CPAP device (ResMed AirSense10 AutoSet) and tested the integrated app for 3 to 4 weeks. Participants completed a usability survey and provided feedback. RESULTS During phase 1, participants found the app to be mostly easy to use, except for some difficulty searching for specific foods. All participants found the connected devices (Fitbit activity tracker and Fitbit Aria scale) easy to use and helpful. During phase 2, participants correctly interpreted CPAP adherence success, expressed as percentage of wear time relative to time spent in bed, and preferred seeing a clearly stated percentage goal ("Goal: 100%"). In phase 3, participants found the integrated app easy to use and requested push notification reminders to wear CPAP before bedtime and to sync Fitbit in the morning. CONCLUSIONS We developed a mobile health tool that integrated a new CPAP adherence tracking module into an existing weight loss app. Novel features included addressing OSA-obesity comorbidity, CPAP adherence tracking via percentage of CPAP wear time relative to objectively assessed time spent in bed, and push notifications to foster adherence. Future research on the effectiveness of this tool in improving OSA treatment adherence is warranted.
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Affiliation(s)
- Angela Fidler Pfammatter
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | | | - Becky Tucker
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Harry Whitmore
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Bonnie Spring
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | - Esra Tasali
- Department of Medicine, University of Chicago, Chicago, IL, United States
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Ellender CM, Samaranayake C, Reid N, Duce B, Boyde M, Winter S, Hukins CA. Randomized controlled trial on the efficacy of audio-visual health educational materials on CPAP adherence: the AHEAD trial. J Clin Sleep Med 2022; 18:2617-2625. [PMID: 35924663 PMCID: PMC9622984 DOI: 10.5664/jcsm.10182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Educational interventions have been proposed to improve continuous positive airway pressure (CPAP) adherence; however, studies to date have not demonstrated robust effectiveness, due to methodological issues. Furthermore, these educational interventions have not specifically targeted low health literacy communication techniques, which have been demonstrated to improve outcomes in numerous other chronic diseases. We hypothesized that the addition of low-cost audio-visual educational videos (EVs) to usual standard-of-care (SC) education would improve CPAP adherence in adults with obstructive sleep apnea (OSA) syndrome. METHODS At CPAP initiation, treatment-naïve adults with OSA syndrome were randomized to (1) usual SC or (2) SC + 5 EVs showing a patient's journey, designed with low health literacy communication techniques to teach patients about OSA and CPAP therapy. The primary endpoint was CPAP usage at 2 months (hours/night) and secondary endpoints were CPAP usage at 12 months and percentage of patients with ≥ 4 hours/night use at 2 months and 12 months. RESULTS One hundred and ninety-five patients were randomized (SC 99, EV 96), with a mean age of 57 years (interquartile range [IQR] 44.1-64.8 years). There were no statistically significant differences in patient characteristics at baseline between the SC vs EV groups, with the diagnostic apnea-hypopnea index of 34 events/h (IQR 21-59 events/h) vs 30 events/h (IQR 20-50 events/h) and Epworth Sleepiness Scale score of 12.8 ± 6 vs 11.7 ± 5. At 2 months, there was no significant difference in hours of CPAP usage (SC: 3.45 hours/night [95% confidence interval (CI): 2.76 to 4.13] vs EV: 3.75 hours/night [95% CI: 3.14 to 4.37]) nor in proportion with adequate usage or overall commencement rate. However, at 12 months, there was a significant difference in hours of CPAP usage (SC: 2.50 hours/night [95% CI: 1.94 to 3.06] vs EV: 3.66 hours/night [95% CI: 2.92 to 4.40]). The probability of adequate CPAP usage at 12 months was higher in the intervention arm (odds ratio: 1.33; 95% CI: 1.04 to 1.7; P = .013). Patients with low education backgrounds benefitted substantially from the EV intervention compared with SC (mean difference at 12 months = 2.47 hours/night usage; 95% CI: 1.01 to 2.93; P < .01). CONCLUSIONS Low health literacy-designed EVs improve CPAP adherence at 12 months compared with SC, with the greatest impact in patients with a low educational background. CLINICAL TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Registry; Name: Randomised controlled trial on the efficacy of audio-visual health educational materials on sleep health literacy and continuous positive airway pressure (CPAP) adherence in Sleep Clinic patients; URL: https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619000523101; Identifier: ACTRN12619000523101. CITATION Ellender CM, Samaranayake C, Reid N, et al. Randomized controlled trial on the efficacy of audio-visual health educational materials on CPAP adherence: the AHEAD trial. J Clin Sleep Med. 2022;18(11):2617-2625.
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Affiliation(s)
- Claire M. Ellender
- Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Chinthaka Samaranayake
- Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Natasha Reid
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Brett Duce
- Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia
- Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Mary Boyde
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia
| | - Sara Winter
- Department of Psychology, The Prince Charles Hospital, Brisbane, Australia
| | - Craig A. Hukins
- Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Abstract
Treatment of OSA with CPAP is currently the recommended treatment and has the greatest evidence of efficacy on AHI, symptoms and comorbidities. Symptomatic patients with moderate-severe OSA generally have good adherence to CPAP therapy, while those with mild OSA, female, young and generally paucisymptomatic, have lower CPAP adherence, especially in the medium and long term. The recent identification of different clinical and pathophysiological phenotypes of OSA has paved the way for alternative treatments to CPAP, leading to an increasingly personalized therapy. Weight loss and lifestyle modifications are highly recommended in all obese or overweight patients. Mandibular advancement devices (MAD), positional therapy (PT) and hypoglossal nerve stimulation (HSN) are recent and personalized alternative therapies on which there is promising and encouraging data but with still little strong scientific evidence. The purpose of this review is to compare the efficacy, adherence and costs of various therapeutic options for OSA patients in the light of recent evidence and to provide useful guidance for specialists.
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Affiliation(s)
- Francesco Gambino
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Marta Maria Zammuto
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Alessandro Virzì
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Giosafat Conti
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Maria Rosaria Bonsignore
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy.
- PROMISE Department, University of Palermo, Palermo, Italy.
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Narang I, Kendzerska T, Heffernan A, Malik U, Carvalho CG, Ryan CM. Positive Airway Pressure Usage in Youth with Obstructive Sleep Apnea Following Transition to Adult Health Care. Nat Sci Sleep 2022; 14:153-163. [PMID: 35140537 PMCID: PMC8818969 DOI: 10.2147/nss.s345143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/14/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is increasing prevalence of moderate to severe obstructive sleep apnea (OSA) in adolescents, the majority of whom receive treatment with positive airway pressure (PAP). Adherence to PAP is sub-optimal in adolescents with OSA. Moreover, the impact of transition from pediatric to adult healthcare system on PAP adherence is unknown. This is relevant as the transition period is a time of increased stress for youth with chronic illnesses. RESEARCH QUESTION Does PAP adherence decrease during the 1-year transition period from pediatric to adult healthcare system in those with OSA? STUDY DESIGN AND METHODS Youth previously diagnosed with persistent OSA and treated with PAP in a large academic center (Toronto, Canada) between 2017 and 2019 were enrolled on transfer from the pediatric to adult sleep clinic and followed at 12 months. Mixed-effects linear regression models were used to investigate the effect of time since the transfer on objective PAP adherence with adjustment for confounders. RESULTS Among the 45 enrolled participants, 42.2% were female, the median age was 18 years (interquartile range [IQR]: 17-18), median BMI was 30.3 (IQR: 24.0-37.1), and the median apnea-hypopnea index (AHI) was 17.8 events/hour (11.8-30.7). In univariate analysis, we observed a significant reduction in the 12-month average PAP usage in days used at follow-up compared to PAP use at the time of enrolment: median of 5.0 hours/day (IQR: 1.3-8.0) vs 2.6 hours/day (0.0-6.4), p < 0.0001. Following adjustment for age, level of education, employment status and living arrangement, the 12-month average PAP usage in days remained significantly decreased at follow-up compared to at the time of enrolment: change in hours of -1.14; 95% CI -2.27 to -0.01. INTERPRETATION Among youth with OSA treated with PAP, there is a clinically significant reduction in PAP adherence over the first year during the transition from pediatric to adult health care.
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Affiliation(s)
- Indra Narang
- Department of Pediatrics, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
| | - Tetyana Kendzerska
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Uzair Malik
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Clodagh M Ryan
- Department of Medicine, University of Toronto, Toronto, Canada.,Sleep Research laboratory, KITE-UHN
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11
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Genzor S, Prasko J, Mizera J, Jakubec P, Sova M, Vanek J, Šurinová N, Langova K. Risk of Severe COVID-19 in Non-Adherent OSA Patients. Patient Prefer Adherence 2022; 16:3069-3079. [PMID: 36387050 PMCID: PMC9657257 DOI: 10.2147/ppa.s387657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with obstructive sleep apnoea (OSA) are at increased risk of severe course of COVID-19. Vaccination remains to be the most effective prevention of complicated courses of infection. The best contemporary conservative treatment of OSA is continuous positive airway pressure (CPAP) therapy. PURPOSE To compare vaccination acceptance and outcomes of COVID-19 infection between OSA patients adhering to the CPAP therapy and those who rejected CPAP and surgical therapy. PATIENTS AND METHODS Subjects were divided into two groups: group A (N = 167) were individuals with sufficient CPAP adherence (more than 4 hours per night on average) over the last 10 years. Group B (N = 106) were individuals who did not use the CPAP therapy at all and had no indications to surgical therapy. RESULTS Three patients in group B died, and one had a severe course of COVID-19. None of the patients in group A died or experienced a severe course of COVID-19. Group A had a significantly higher proportion of males (77.8% compared to 66% in group B) and all parameters of OSA severity. The vaccination status was similar among both groups, with a complete triple dose vaccination rate of 69.5% and 67.9% in groups A and B, respectively. CONCLUSION The results show that the patients with OSA adherent to CPAP therapy were less likely to experience a severe course of COVID-19 or death than the OSA patients non-compliant with therapy, despite the former group having more severe OSA. This result underlines the importance of adherence to CPAP therapy in OSA.
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Affiliation(s)
- Samuel Genzor
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, OlomoucCzech Republic
| | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, OlomoucCzech Republic
- Institute for Postgraduate Education in Health Care, PragueCzech Republic
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, NitraThe Slovak Republic
- Correspondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital Olomouc, I. P. Pavlova 6, Olomouc, 775 20, Czech Republic, Email
| | - Jan Mizera
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, OlomoucCzech Republic
| | - Petr Jakubec
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, OlomoucCzech Republic
| | - Milan Sova
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, OlomoucCzech Republic
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Masaryk University Brno and University Hospital Brno, BrnoCzech Republic
| | - Jakub Vanek
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, OlomoucCzech Republic
| | | | - Katerina Langova
- Department of Biophysics, Palacky University Olomouc, OlomoucCzech Republic
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12
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Tovichien P, Kulbun A, Udomittipong K. Comparing Adherence of Continuous and Automatic Positive Airway Pressure (CPAP and APAP) in Obstructive Sleep Apnea (OSA) Children. Front Pediatr 2022; 10:841705. [PMID: 35223704 PMCID: PMC8873574 DOI: 10.3389/fped.2022.841705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The treatment outcomes of pediatric obstructive sleep apnea (OSA) are affected by positive airway pressure (PAP) therapy adherence, which may be affected by the type of device used. Continuous PAP (CPAP) devices deliver a continuous and fixed air pressure level, whereas automatic PAP (APAP) devices automatically adjust the pressure to meet changing needs during sleep. The adherence, tolerance and consistency of OSA-children's use of CPAP and APAP devices were compared. STUDY DESIGN One-year, observational cohort study. METHODS Twenty-seven OSA-children were enrolled. Fourteen (52%) used CPAP, and 13 (48%) used APAP. The adherence, tolerance, and consistency of the PAP usage by the two groups were compared. RESULTS Overall, 11 of the 27 children (41%) showed good PAP adherence. The CPAP patients averaged 4.9 h of device usage on the days used, for 60% of days, with 6 of 14 (43%) demonstrating good adherence. In comparison, the APAP patients averaged 3.2 h for 55% of days, with 5 of 13 (38%) exhibiting good adherence. The 2 groups showed no differences in their adherence, tolerance, or consistency of device usage (P values, 0.816, 0.609, and 0.720, respectively). Although the adherence of both groups improved in the second 6 months, it was without statistical significance (P values, 0.400 and 0.724). Age, sex, baseline apnea-hypopnea index, comorbidities, prescribed period, device type, mask type, and caregiver education-level were not risk factors for poor PAP adherence. CONCLUSIONS No differences in the adherence, tolerance, or consistency of the children's use of CPAP and APAP were revealed in this small inhomogeneous cohort study with limited resources.
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Affiliation(s)
- Prakarn Tovichien
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Aunya Kulbun
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokporn Udomittipong
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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13
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Ellender CM, Le Feuvre S, Boyde M, Duce B, Winter S, Hukins CA. Adequate health literacy is associated with adherence to continuous positive airway pressure in adults with obstructive sleep apnea. Sleep Adv 2021; 2:zpab013. [PMID: 37193568 PMCID: PMC10104391 DOI: 10.1093/sleepadvances/zpab013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/05/2021] [Indexed: 05/18/2023]
Abstract
Study Objectives Obstructive sleep apnea (OSA) is a chronic disease with significant health implications and adequate adherence to continuous positive airway pressure (CPAP) is essential for effective treatment. In many chronic diseases, health literacy has been found to predict treatment adherence and outcomes. In this study, the aim was to determine the health literacy of a sleep clinic population and evaluate the association between health literacy and CPAP adherence. Methods A prospective cohort study was undertaken, recruiting 104 consecutive patients with a variety of sleep diagnoses. The Short Form Rapid Estimate of Adult Literacy in Medicine (REALM-SF), a validated questionnaire, was administered to measure health literacy. In a sub-group of 91 patients prescribed CPAP for OSA, CPAP usage was measured, with adequate usage defined as greater than 4 h/night CPAP therapy. Results Seventy-one percent of the sleep clinic cohort was found to have adequate health literacy, as measured by the REALM-SF. In those prescribed CPAP for OSA, inadequate health literacy was associated with a twofold increased risk for inadequate CPAP usage (adjusted odds ratio [OR] 2.9, 95% CI: 1.1 to 8.22, p = 0.045). There was a 1.7 h/night difference in median CPAP usage comparing those with adequate to inadequate health literacy (4.6 h vs. 6.3 h/night). Conclusions The majority of this sleep disorders cohort had adequate health literacy as measured by the REALM-SF questionnaire. However, inadequate health literacy appears to be an independent predictor of treatment adherence and may represent a modifiable risk factor of poor treatment outcomes in OSA.
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Affiliation(s)
- Claire M Ellender
- Department of Respiratory & Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Sebastian Le Feuvre
- Department of Respiratory & Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia
| | - Mary Boyde
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
| | - Brett Duce
- Department of Respiratory & Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia
- Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Sara Winter
- Department of Psychology, The Prince Charles Hospital, Brisbane, Australia
| | - Craig A Hukins
- Department of Respiratory & Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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14
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Bonsignore MR, Pepin JL, Cibella F, Barbera CD, Marrone O, Verbraecken J, Saaresranta T, Basoglu OK, Trakada G, Bouloukaki I, McNicholas WT, Bailly S, Pataka A, Kvamme JA, Hein H, Mihaicuta S, Grote L, Fanfulla F. Excessive Daytime Sleepiness in Obstructive Sleep Apnea Patients Treated With Continuous Positive Airway Pressure: Data From the European Sleep Apnea Database. Front Neurol 2021; 12:690008. [PMID: 34434158 PMCID: PMC8381644 DOI: 10.3389/fneur.2021.690008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/31/2021] [Indexed: 12/17/2022] Open
Abstract
Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) that resolves under treatment with continuous positive airway pressure (CPAP). In some patients, sleepiness persists despite CPAP treatment. We retrospectively analyzed data on subjective residual EDS, assessed as an Epworth Sleepiness Scale score (ESS) >10, in patients from the European Sleep Apnea Database (n = 4,853, mean age ± SD 54.8 ± 11.8 years, 26.1% females), at baseline and at the first visit (median follow-up: 5 months, interquartile range 3–13). An ESS > 10 occurred in 56% of patients at baseline and in 28.2% of patients at follow-up. Residual EDS was analyzed in 2,190 patients (age: 55.1 ± 12.0 years, 26.1% females) with sleep monitoring data (median follow-up: 3 months, interquartile range 1–15). Sleep studies during CPAP use were obtained in 58% of these patients; EDS was reported by 47.2% of patients at baseline and by 30.3% at follow-up. Residual OSA, defined as an apnea–hypopnea index >10/h, and insufficient CPAP adherence, defined as nightly use <4 h, occurred with similar frequency in patients with and without EDS at follow-up. Prevalence of residual EDS was highest (40%) in patients with a first follow-up visit at 0–3 months, then it was 13–19% in patients with a first follow-up visit after 4 months to 2 years. The change in ESS (n = 2,190) was weakly correlated with CPAP use (R2 = 0.023, p < 0.0001). Logistic regression showed that an ESS score >10 at the first follow-up visit was associated directly with ESS at baseline and inversely with duration of follow-up, and CPAP use (R2 of the model: 0.417). EDS showed heterogeneity in different European countries both at baseline and at the first follow-up visit, suggesting modulation by cultural and lifestyle factors. In conclusion, residual EDS in CPAP-treated OSA occurred in approximately one in four patients at follow-up; its prevalence was highest (40%) in the first 3 months of treatment and subsequently decreased. The finding of residual EDS in a significant percentage of optimally treated OSA patients suggests that wake-promoting agents may be useful, but their indication should be evaluated after at least 3 months of treatment.
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Affiliation(s)
- Maria R Bonsignore
- Sleep Disordered Breathing Clinic, Pulmonary Division, PROMISE Department, University of Palermo, Palermo, Italy.,National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
| | - Jean L Pepin
- HP2 Laboratory, U1042, INSERM, Grenoble Alpes University, Grenoble, France
| | - Fabio Cibella
- National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
| | - Calogero D Barbera
- Sleep Disordered Breathing Clinic, Pulmonary Division, PROMISE Department, University of Palermo, Palermo, Italy
| | - Oreste Marrone
- National Research Council (CNR), Institute for Biomedical Research and Innovation (IRIB), Palermo, Italy
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University Hospital Antwerp, Antwerp, Belgium
| | - Tarja Saaresranta
- Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland.,Department of Pulmonary Diseases and Clinical Allergology, Sleep Research Centre, University of Turku, Turku, Finland
| | - Ozen K Basoglu
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | - Georgia Trakada
- Division of Pulmonology, Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Crete, Greece
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, School of Medicine, St. Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Sébastien Bailly
- HP2 Laboratory, U1042, INSERM, Grenoble Alpes University, Grenoble, France
| | - Athanasia Pataka
- Respiratory Failure Unit, G Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John A Kvamme
- Ear, Nose and Throat-Department, Foerde Central Hospital, Foerde, Norway
| | - Holger Hein
- Private Practice and Sleep Lab for Internal Medicine, Pulmonary Medicine and Sleep Medicine, Geesthacht, Germany
| | - Stefan Mihaicuta
- Victor Babes University of Medicine and Pharmacy, CardioPrevent Foundation, Timisoara, Romania
| | - Ludger Grote
- Sleep Disorders Centre, Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre for Sleep and Wake Disorders, Institute for Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Francesco Fanfulla
- Respiratory Function and Sleep Medicine Unit, Scientific Institutes of Pavia and Montescano, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Pavia, Italy
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15
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Borker PV, Carmona E, Essien UR, Saeed GJ, Nouraie SM, Bakker JP, Stitt CJ, Aloia MS, Patel SR. Neighborhoods with Greater Prevalence of Minority Residents Have Lower Continuous Positive Airway Pressure Adherence. Am J Respir Crit Care Med 2021; 204:339-346. [PMID: 33689593 DOI: 10.1164/rccm.202009-3685oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rationale: Limited data suggest racial disparities in continuous positive airway pressure (CPAP) adherence exist.Objectives: To assess whether CPAP adherence varies by neighborhood racial composition at a national scale.Methods: Telemonitoring data from a CPAP manufacturer database were used to assess adherence in adult patients initiating CPAP therapy between November 2015 and October 2018. Mapping ZIP code to ZIP code tabulation areas, age- and sex-adjusted CPAP adherence data at a neighborhood level was computed as a function of neighborhood racial composition. Secondary analyses adjusted for neighborhood education and poverty.Measurements and Main Results: Among 787,236 patients living in 26,180 ZIP code tabulation areas, the prevalence of CPAP adherence was 1.3% (95% confidence interval [CI], 1.0-1.6%) lower in neighborhoods with high (⩾25%) versus low (<1%) percentages of Black residents and 1.2% (95% CI, 0.9-1.5%) lower in neighborhoods with high versus low percentages of Hispanic residents (P < 0.001 for both), even after adjusting for neighborhood differences in poverty and education. Mean CPAP usage was similar across neighborhoods for the first 2 days, but by 90 days, differences in CPAP usage increased to 22 minutes (95% CI, 18-27 min) between neighborhoods with high versus low percentages of Black residents and 22 minutes (95% CI 17-27 min) between neighborhoods with high versus low percentages of Hispanic residents (P < 0.001 for both).Conclusions: CPAP adherence is lower in neighborhoods with greater proportions of Black and Hispanic residents, independent of education or poverty. These differences lead to a lower likelihood of meeting insurance coverage requirements for CPAP therapy, potentially exacerbating sleep health disparities.
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Affiliation(s)
- Priya V Borker
- Center for Sleep and Cardiovascular Outcomes Research.,Division of Pulmonary Allergy and Critical Care Medicine
| | - Emely Carmona
- Center for Sleep and Cardiovascular Outcomes Research
| | - Utibe R Essien
- Center for Health Equity and Promotion, and.,Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | | | | | | | | | | | - Sanjay R Patel
- Center for Sleep and Cardiovascular Outcomes Research.,Division of Pulmonary Allergy and Critical Care Medicine
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16
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Lundetræ RS, Saxvig IW, Aurlien H, Lehmann S, Bjorvatn B. Effect of Continuous Positive Airway Pressure on Symptoms and Prevalence of Insomnia in Patients With Obstructive Sleep Apnea: A Longitudinal Study. Front Psychol 2021; 12:691495. [PMID: 34367017 PMCID: PMC8339206 DOI: 10.3389/fpsyg.2021.691495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Obstructive sleep apnea (OSA) and insomnia are the two most common sleep disorders. Continuous positive airway pressure (CPAP) is considered first-line treatment for OSA. In the present study, we assess the effect of CPAP on symptoms and prevalence of insomnia in patients with OSA. We hypothesized a decrease in insomnia symptoms from CPAP initiation to follow-up, and that this decrease would depend on CPAP adherence. Materials and methods The sample included 442 patients diagnosed with OSA [mean age 54.9 years (SD = 12.1), 74.4% males] who started treatment with CPAP at a university hospital. OSA was diagnosed according to standard respiratory polygraphy. Mean apnea-hypopnea index (AHI) was 30.1 (SD = 21.1) at baseline. Insomnia was assessed prior to CPAP treatment (baseline) and at follow-up after a median of 19.9 weeks (range 6–52 weeks) with the Bergen Insomnia Scale (BIS). CPAP adherence was defined as an average use of ≥ 4 h per night, whereas non-adherence was defined as < 4 h per night. Results There was a significant decrease in BIS scores from baseline (mean = 18.8, SD = 9.8) to follow-up (mean = 12.9, SD = 9.9), p < 0.001. Cohen’s d(0.65) indicated a moderate effect size. The reduction in BIS scores was depending on CPAP adherence (interaction effect F(1,440) = 12.4, p < 0.001), with larger reduction in the adherent group than in the non-adherent group. The proportion of patients with chronic insomnia was significantly reduced from 51.1% at baseline to 33.0% at follow-up (p < 0.001). Conclusion Overall, there was a significant reduction in insomnia symptoms from baseline to follow-up. The improvement was significant in both adherence groups, but the degree of improvement was larger among patients who were adherent to CPAP. Furthermore, there was a significant reduction in the prevalence of chronic insomnia at follow-up compared to baseline. This suggests that CPAP effectively reduces both the presence of insomnia and the severity of insomnia symptoms in some patients with OSA.
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Affiliation(s)
- Ragnhild Stokke Lundetræ
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Centre for Sleep Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ingvild West Saxvig
- Centre for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Harald Aurlien
- Department of Clinical Neurophysiology, Haukeland University Hospital, Bergen, Norway
| | - Sverre Lehmann
- Centre for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Centre for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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17
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Mok EM, Greenough G, Pollack CC. Untreated obstructive sleep apnea is associated with increased hospitalization from influenza infection. J Clin Sleep Med 2021; 16:2003-2007. [PMID: 32780010 DOI: 10.5664/jcsm.8744] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVES There is evidence that sleep deprivation or diseases such as obstructive sleep apnea (OSA) that lead to sleep disruption may adversely impact immune system functioning. We hypothesized that individuals who have OSA who did not use continuous positive airway pressure (CPAP) would have higher rates of hospitalization and complications from influenza infection than patients with OSA who were adherent to treatment. METHODS Medical records of patients at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire who had both OSA and a new, laboratory-confirmed influenza infection between 2016 and 2018 were reviewed for results of polysomnography, CPAP usage, influenza vaccination records, confirmation of influenza infection, and influenza-related hospitalizations and complications. RESULTS Compared to the patients who were adherent to CPAP, patients who were either conservatively treated without CPAP or who were nonadherent to CPAP therapy had higher odds of hospitalization from influenza infections (odds ratio = 4.7, 95% confidence interval 1.3 to 19.5, P = .01) but no higher odds of complications from influenza. The patients who had untreated sleep apnea had a higher percentage of influenza vaccination for their season of illness (75% of patients) compared to patients who were adherent to CPAP (56% of patients), although the difference in vaccination was not statistically significant. CONCLUSIONS Patients with OSA who did not use CPAP appear to have greater rates of hospitalization from acute influenza infection, despite having a higher trend of influenza vaccination compared to patients who were adherent to CPAP.
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Affiliation(s)
- Eva M Mok
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Glen Greenough
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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18
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Abstract
Increasingly compelling data link chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) to cardiovascular complications independent of known comorbidities. It remains unclear whether the association is amplified in the presence of both conditions. The aims of this study are to assess the prevalence of atrial fibrillation (AF) in overlap syndrome (OS) and to identify risk factors predisposing to this atrial arrhythmia. We conducted a retrospective cohort study of 268 adults without past or current AF who were referred for an initial diagnostic polysomnogram from 2012 to 2019. A logistic regression analysis was performed to identify risk factors for incident AF. Incident AF occurred in 64 subjects [cumulative probability 24%, 95% confidence interval (CI) 19-29]. Independent predictors of incident AF were age-adjusted Charlson index [Odds ratio (OR) 1.62; 95% confidence interval (CI) 1.3-2.0], percentage of time spent with O2 saturation below 90% (CT90) (OR 3.72, 95% CI 1.18-11.71), and CPAP adherence (OR 0.32, 95% CI 0.13-0.71). OS patients with AF experienced higher hospitalization rates (OR 1.25, 95% CI 1.03-2.37) and worse mortality rates (OR 1.92, 95% CI 1.04-3.54). In multivariate Cox proportional regression, age-adjusted Charlson Index, severity of airflow obstruction, and CPAP adherence were independent predictors of mortality. The burden of hypoxemia and severity of comorbidities are independent factors for incident AF in individuals with OS. CPAP adherence may mitigate the risk of AF and reduce the rate of mortality in this population.
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Affiliation(s)
- Morohunfolu Akinnusi
- The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA
| | - Abdul Rahman El-Masri
- The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA
| | - Yolanda Lawson
- The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA
| | - Ali Albert El-Solh
- The Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215, USA.
- Department of Medicine, Jacob's School of Medicine, Buffalo, NY, USA.
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
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19
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Demirovic S, Lusic Kalcina L, Pavlinac Dodig I, Pecotic R, Valic M, Ivkovic N, Dogas Z. The COVID-19 Lockdown and CPAP Adherence: The More Vulnerable Ones Less Likely to Improve Adherence? Nat Sci Sleep 2021; 13:1097-1108. [PMID: 34290535 PMCID: PMC8287077 DOI: 10.2147/nss.s310257] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/05/2021] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Due to the possible interplay of factors predisposing to severe COVID-19 outcomes and negative health consequences of poorly controlled OSA, adherence to continuous positive airway pressure (CPAP) therapy among OSA patients might be crucial during COVID-19 pandemics. Lockdown-related changes in CPAP adherence were investigated in CPAP users willing to participate in this study. Pre-lockdown adherence, age, gender, comorbidities and anxiety were analyzed as predictors of COVID-19 lockdown adherence. PATIENTS AND METHODS A cross-sectional study performed at Split Sleep Medicine Center included 101 severe OSA patients (78.2% male). CPAP memory cards were assessed during 6 months of pre-lockdown and 40 days of lockdown (March/April 2020) period. A total of 81 patients in pre-lockdown met good CPAP adherence criteria (≥4 hours/night on 70% nights). RESULTS CPAP adherence improved during COVID-19 lockdown in the total sample of severe OSA patients. The percentage of adherent nights and CPAP usage hours per night increased during lockdown in good pre-lockdown CPAP adherers (p=0.011 and p=0.001, respectively), women (p=0.003 and p=0.001, respectively) and respondents younger than 58 years (p=0.007 and p<0.001, respectively). Out of 20/101 poor pre-lockdown CPAP adherers, 9 have shifted to good lockdown adherence. When comorbidities, BMI and anxiety were taken into account, older and male respondents were recognized as less likely to improve CPAP usage hours during lockdown (R2=9.4%; p=0.032). CONCLUSION The lockdown-related CPAP adherence improved in severe OSA patients, with a shift in almost half of poor pre-lockdown adherers towards good lockdown CPAP adherence. Women, younger and good pre-lockdown CPAP adherers were more adherent during lockdown. Despite being vulnerable groups for both OSA and COVID-19, no expected adherence improvements were observed in men and older patients.
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Affiliation(s)
- Sijana Demirovic
- Department of Neuroscience, University of Split School of Medicine, Split, Croatia.,Split Sleep Medicine Center, University Hospital Center Split, Split, Croatia
| | - Linda Lusic Kalcina
- Department of Neuroscience, University of Split School of Medicine, Split, Croatia.,Split Sleep Medicine Center, University Hospital Center Split, Split, Croatia
| | - Ivana Pavlinac Dodig
- Department of Neuroscience, University of Split School of Medicine, Split, Croatia.,Split Sleep Medicine Center, University Hospital Center Split, Split, Croatia
| | - Renata Pecotic
- Department of Neuroscience, University of Split School of Medicine, Split, Croatia.,Split Sleep Medicine Center, University Hospital Center Split, Split, Croatia
| | - Maja Valic
- Department of Neuroscience, University of Split School of Medicine, Split, Croatia.,Split Sleep Medicine Center, University Hospital Center Split, Split, Croatia
| | - Natalija Ivkovic
- Split Sleep Medicine Center, University Hospital Center Split, Split, Croatia
| | - Zoran Dogas
- Department of Neuroscience, University of Split School of Medicine, Split, Croatia.,Split Sleep Medicine Center, University Hospital Center Split, Split, Croatia
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20
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Abstract
Positive airway pressure (PAP) therapy integration is a component of electronic health record (EHR) sleep medicine optimization. EHR optimization facilitates telehealth in continuous care population health. A coordinated care plan can leverage early telehealth interventions.
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Affiliation(s)
- Tereza Cervenka
- Department of Medicine, Pulmonary, Allergy, Critical Care and Sleep Medicine, M Health Fairview and University of Minnesota, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA
| | - Conrad Iber
- Department of Medicine, Pulmonary, Allergy, Critical Care and Sleep Medicine, M Health Fairview and University of Minnesota, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA.
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21
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Al-Halawani M, Kyung C, Liang F, Kaplan I, Moon J, Clerger G, Sabin B, Barnes A, Al-Ajam M. Treatment of obstructive sleep apnea with CPAP improves chronic inflammation measured by neutrophil-to-lymphocyte ratio. J Clin Sleep Med 2020; 16:251-257. [PMID: 31992409 DOI: 10.5664/jcsm.8176] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is associated with chronic inflammation likely triggered by nocturnal, intermittent hypoxemia and increased adrenergic tone. The neutrophil-to-lymphocyte ratio (NLR) was recently described as a measure of subclinical systemic inflammation. Studies on the effect of continuous positive airway pressure (CPAP) therapy in OSA on subclinical inflammation measured by NLR are lacking. We hypothesize that NLR levels would improve as chronic inflammation diminishes in patients with OSA treated with CPAP. METHODS We retrospectively reviewed patients in whom OSA was diagnosed and who were treated with CPAP therapy. Complete blood count (CBC) were obtained pretreatment and posttreatment for calculation of NLR, which was calculated by dividing the number of neutrophils by the number of lymphocytes. Patients with conditions known to affect NLR such as chronic infections, inflammatory diseases, active cardiovascular disease, and malignancies were excluded from the study. CPAP adherence downloads were obtained for all patients. RESULTS Out of 184 patients in whom OSA was diagnosed and who were treated with CPAP, 109 met our study criteria, including baseline polysomnogram, baseline and posttreatment CBC, and available adherence download. We compared the NLR before and after treatment with CPAP. There was a significant difference in NLR before and after treatment with CPAP (P < .0001). There was also a significant difference in apnea-hypopnea index before and after treatment (P < .0001). We also assessed the relationship between CPAP adherence (percentage of days used for > 4 hours) and the change in NLR. NLR decreased significantly in both the adherent (CPAP use ≥ 70% of days; P = .014) and nonadherent groups (CPAP use < 70% of days; P = .0003). Finally, we noticed a significant direct correlation between CPAP adherence beyond 70% and the change in NLR (ΔNLR) (P = .046) in patients who had ≥ 70% adherence with CPAP, which was not observed in patients with < 70% adherence. CONCLUSIONS The NLR may be a useful marker for monitoring improvement, as CPAP had a desirable effect on the chronic inflammation induced by OSA when measured by NLR in this study. Our results specifically suggest that the NLR values decrease significantly in patients using CPAP regardless of adherence, but with a more direct relationship in those who use it beyond 70% of days, at least 4 hours a day.
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Affiliation(s)
- Moh'd Al-Halawani
- Division of Pulmonary and Critical Care Medicine, State University of New York Downstate Medical Center, Brooklyn, New York.,Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs New York Harbor Health Care System, Brooklyn, New York
| | - Christian Kyung
- Division of Pulmonary and Critical Care Medicine, State University of New York Downstate Medical Center, Brooklyn, New York.,Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs New York Harbor Health Care System, Brooklyn, New York
| | - Fei Liang
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Ian Kaplan
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Jane Moon
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Guerrier Clerger
- Department of Internal Medicine, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Bruce Sabin
- Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs New York Harbor Health Care System, Brooklyn, New York
| | - Andrea Barnes
- Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs New York Harbor Health Care System, Brooklyn, New York
| | - Mohammad Al-Ajam
- Division of Pulmonary and Critical Care Medicine, State University of New York Downstate Medical Center, Brooklyn, New York.,Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs New York Harbor Health Care System, Brooklyn, New York
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22
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Holley A, Shaha D, Costan-Toth C, Slowik J, Robertson BD, Williams SG, Terry S, Golden D, Andrada T, Skeete S, Sheikh K, Butler G, Collen JF. A randomized, placebo-controlled trial using a novel PAP delivery platform to treat patients with OSA and comorbid PTSD. Sleep Breath 2020; 24:1001-9. [PMID: 31691105 DOI: 10.1007/s11325-019-01936-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/16/2019] [Accepted: 09/07/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Positive airway pressure (PAP) adherence is poor in comorbid OSA/PTSD. SensAwake™ (SA) is a wake-sensing PAP algorithm that lowers pressure when wake is detected. We compared auto-PAP (aPAP) with and without SA for comorbid OSA/PTSD. METHODS Prospective, randomized crossover study comparing aPAP to aPAP + SA. We enrolled patients with OSA/PTSD who were PAP naïve. Four weeks after randomization, the patients were crossed over to the alternate treatment group, with final follow-up at eight weeks. Sleep questionnaires (ESS, ISI, FSS, and FOSQ-10) were assessed at baseline and follow-up. RESULTS We enrolled 85 patients with OSA/PTSD. aPAP reduced AHI to < 5/h in both groups. Our primary endpoint, average hours of aPAP adherence (total) after 4 weeks, was significantly increased in the SA group in our intention-to-treat (ITT) analysis (ß = 1.13 (95% CI 0.16-2.1); p = 0.02), after adjustment for ESS differences at baseline. After adjustment for ESS, SA (ITT analysis) also showed significant improvement in percentage of nights used for ≥ 4 h (ß = 14.9 (95% CI 1.02-28.9); p = 0.04). There were trends toward an increase in percentage nights used total (ß = 17.4 (95% CI - 0.1 to 34.9); p = 0.05), average hours of aPAP adherence (nights used) (ß = 1.04 (95% CI - 0.07 to 2.1); p = 0.07), and regular use (OR = 7.5 (95% CI 0.9-64.7); p = 0.07) after adjustment for ESS at baseline. After adjustment for ESS and days to cross over, SA by actual assignment did not show any effect on adherence variables. The ESS, ISI, FSS, and FOSQ-10 all showed significant improvements with PAP, but there were no differences in the magnitude of improvement in any score between groups. CONCLUSIONS Adherence to aPAP may be improved with the addition of SA and deserves further study. SA is as effective as standard aPAP for normalizing the AHI and improving sleep-related symptoms. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02549508 https://clinicaltrials.gov/ct2/show/NCT02549508?term=NCT02549508&rank=1 "Comparison Study Using APAP With and Without SensAwake in Patients With OSA and PTSD".
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23
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Abstract
Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing. Continuous positive airway pressure (CPAP) is the treatment of choice, but adherence is poor, contributing to a myriad of comorbidities that increase health burden. The study purpose was to examine the effect of the CPAP-SAVER intervention on adherence among adults with newly diagnosed OSA. Sixty-six participants were randomly assigned to intervention or standard care groups. Data were analyzed using chi-square, t-tests, and correlations. At one month, there was no significant difference in adherence between groups; CPAP beliefs and attitude were significantly higher and attitude significantly increased for the intervention group. Focus on CPAP beliefs and attitude by practitioners may impact CPAP adherence. With further research and replication of this study in larger samples to determine generalizability, the CPAP-SAVER intervention may provide underpinnings for the eventual development of an OSA-CPAP adherence management protocol.
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Lo Bue A, Salvaggio A, Iacono Isidoro S, Romano S, Insalaco G. OSA and CPAP therapy: effect of gender, somnolence, and treatment adherence on health-related quality of life. Sleep Breath 2019; 24:533-540. [PMID: 31309464 DOI: 10.1007/s11325-019-01895-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) often has a significant impact on health-related quality of life (HRQoL) with social and psychological implications. For most OSA patients, a reduction in their HRQoL is due to symptoms such as poor sleep quality, excessive daytime somnolence, and fatigue with differences between gender. PURPOSE This study explores the CPAP treatment effect on self-perceived HRQoL related to gender, somnolence, and CPAP adherence. METHODS Out of 1082 consecutive Italian outpatients, 125 (82 M) (60.3 ± 9.6 years) completed the prospective observational study and were evaluated at the first visit (T0), and the follow-up visit (T1). Two self-reported HRQoL questionnaires were administered: six subscales Psychological General Well-Being Index (PGWBI) and 12-Item Short-Form Health Survey (SF-12). RESULTS Scores of PGWBI and SF-12 MCS improved from T0 to T1. Patients with CPAP use ≥ 4 h/night showed a significant improvement in all dimensions evaluated, except for SF-12 PCS. At T1, participants with ESS > 10 improved in all scores, except SF-12 PCS. Gender comparison shows better-perceived HRQoL in males at first visit and CPAP follow-up visit. Variation of PGWBI was significantly correlated with CPAP use, ESS at T0 and T1 (p < 0.0001; r2 = 0.26). CONCLUSIONS This study provides evidence on the effectiveness of CPAP treatment on perceived HRQoL. Participants with greater adherence to therapy, greater sleepiness, and greater improvement of daytime sleepiness with CPAP therapy, reported a higher quality of life improvement. Gender comparison shows better-perceived HRQoL in males at first visit and CPAP follow-up, despite a more considerable improvement in females.
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Affiliation(s)
- Anna Lo Bue
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
| | - Adriana Salvaggio
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy.
| | - Serena Iacono Isidoro
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
| | - Salvatore Romano
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
| | - Giuseppe Insalaco
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Via Ugo La Malfa, 153, 90146, Palermo, Italy
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25
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Perriol MP, Jullian-Desayes I, Joyeux-Faure M, Bailly S, Andrieux A, Ellaffi M, Jounieaux F, Pépin JL, Lamblin C. Long-term adherence to ambulatory initiated continuous positive airway pressure in non-syndromic OSA children. Sleep Breath 2019; 23:575-8. [PMID: 30685850 DOI: 10.1007/s11325-018-01775-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/11/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE In children, the usual indications for continuous positive airway pressure (CPAP) are residual OSA after adenotonsillectomy and/or persistent OSA due to obesity. Data concerning adherence (hours/night) following ambulatory CPAP initiation are scarce. METHODS An observational cohort of 78 children was followed over 2 years. All exhibited sleep-disordered breathing (SDB) symptoms, were assessed by polysomnography, and prescribed CPAP. CPAP was initiated at hospital for 10 children. RESULTS OSA children, mean age 10.4 ± 3.2 years, were mostly males (75.6%), with a mean body mass index of 21.2 ± 7.3 kg/m2, and mean apnea+hypopnea index of 12.2 ± 10.6 events/hour. Seventy-two children were still on CPAP at 3 months, 63 at 6 months, 55 at 1 year, and 34 at 2 years. CPAP was discontinued thanks to rehabilitation programs, dento-facial orthopedics, and/or weight loss. Mean CPAP adherence at 1, 3, 6, 12, and 24 months was respectively 6.1 ± 2.8, 6.2 ± 2.6, 6.2 ± 2.8, 6.3 ± 2.8, and 7.0 ± 2.7 h/night. There was a trend towards higher CPAP adherence and younger age, primary versus middle/high school attendance, higher baseline apnea+hypopnea index, and neurocognitive disorders. CONCLUSION In our population, mean CPAP adherence defined in hours per night was high and did not decrease during the 24-month follow-up. These findings support the feasibility of ambulatory CPAP initiation in non-syndromic OSA. The high CPAP adherence is expected to be associated with improvements in neurocognition, and in metabolic and cardiovascular parameters.
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26
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Mehrtash M, Bakker JP, Ayas N. Predictors of Continuous Positive Airway Pressure Adherence in Patients with Obstructive Sleep Apnea. Lung 2019; 197:115-121. [PMID: 30617618 DOI: 10.1007/s00408-018-00193-1] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/29/2018] [Indexed: 01/23/2023]
Abstract
Obstructive sleep apnea (OSA) is a common disease which impacts quality of life, mood, cardiovascular morbidity, and mortality. Continuous positive airway pressure (CPAP) is the first-line treatment for patients with moderate to severe OSA. CPAP ameliorates respiratory disturbances, leading to improvements in daytime sleepiness, quality of life, blood pressure, and cognition. However, despite the high efficacy of this device, CPAP adherence is often sub-optimal. Factors including: socio-demographic/economic characteristics, disease severity, psychological factors, and side-effects are thought to affect CPAP adherence in OSA patients. Intervention studies have suggested that augmented support/education, behavioral therapy, telemedicine and technological interventions may improve CPAP adherence. In this paper, we will extensively review the most common factors including age, gender, race/ethnicity, socioeconomic status, smoking status, severity of OSA, severity of OSA symptoms, psychological variables, social support, marital status/bed partner involvement, dry nose and mouth, mask leak, and nasal congestion that may predict CPAP adherence. We will also extensively review interventions that may increase adherence to CPAP.
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Affiliation(s)
- M Mehrtash
- Experimental Medicine Program, Department of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- Sleep Disorders Program, UBC Hospital, Vancouver, BC, Canada
| | - J P Bakker
- Division of Sleep & Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - N Ayas
- Sleep Disorders Program, UBC Hospital, Vancouver, BC, Canada.
- Respiratory and Critical Care Divisions, Department of Medicine, UBC, Vancouver, BC, Canada.
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27
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Gentina T, Bailly S, Jounieaux F, Verkindre C, Broussier PM, Guffroy D, Prigent A, Gres JJ, Kabbani J, Kedziora L, Tamisier R, Gentina E, Pépin JL. Marital quality, partner's engagement and continuous positive airway pressure adherence in obstructive sleep apnea. Sleep Med 2018; 55:56-61. [PMID: 30771736 DOI: 10.1016/j.sleep.2018.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/23/2018] [Accepted: 12/05/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is the first line therapy for obstructive sleep apnea (OSA) but its effectiveness requires high adherence. We aimed to assess the impacts of the spouse's/partner's involvement and the quality of the couple's relationship on CPAP adherence. METHODS In a multicenter prospective study conducted in France, patients reported their subjective views regarding their partner's engagement in their CPAP treatment and the quality of their marital relationship using the Quality of Marriage Index. A hierarchical linear model was built to assess the predictors of CPAP adherence at day 120. Structural equation modeling was performed to evaluate the direct and indirect effects of the spouse's/partner's engagement and the quality of the couple's relationship on CPAP adherence. RESULTS The 290 OSA patients were predominantly male (77%), with a median age of 53 years IQR: [46; 62], median BMI: 32 kg/m2 [28.6; 35.9] and median apnea + hypopnea index: 43/per hour [33; 58]. Independent factors for CPAP adherence at day 120 were the partner's encouragement of CPAP usage and a stable relationship exceeding 30 years, although emotional support or collaboration were not associated with CPAP adherence. Structural equation modeling demonstrated that spouse's/partner's engagement is directly related to CPAP adherence and improvement of symptoms, and that CPAP adherence is a mediator of disease-specific health-related quality of life. Marital quality was a significant moderator of these interactions meaning that a spouse's/partner's engagement improved adherence only when the quality of marriage index was high. CONCLUSION Future research and integrated OSA management should systematically include and document the role of the spouse/partner in CPAP adherence.
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Affiliation(s)
- Thibaut Gentina
- Ramsey General Healthcare La Louviere Hospital, Lille, France.
| | - Sébastien Bailly
- HP2 Laboratory, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France; EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
| | | | | | | | | | | | | | | | | | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France; EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
| | - Elodie Gentina
- IESEG School of Management, LEM-CNRS (UMR 9221), Lille, France.
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France; EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
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28
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Tan B, Tan A, Chan YH, Mok Y, Wong HS, Hsu PP. Adherence to Continuous Positive Airway Pressure therapy in Singaporean patients with Obstructive Sleep Apnea. Am J Otolaryngol 2018; 39:501-506. [PMID: 29929863 DOI: 10.1016/j.amjoto.2018.05.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/22/2018] [Accepted: 05/26/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the rates of Continuous Positive Airway Pressure (CPAP) uptake and adherence amongst Singaporean patients diagnosed with Obstructive Sleep Apnea (OSA), and to evaluate factors correlated with CPAP uptake and adherence. STUDY DESIGN Retrospective review of medical records. METHODS Medical records were reviewed for baseline demographics, daytime sleepiness, presence of nasal symptoms and OSA severity, initial treatment choice, the rate of CPAP treatment uptake and CPAP adherence at 1 and 12 months. RESULTS 2160 patients were diagnosed with OSA within the 5-year period (2011-2015). 463 (21.4%) had mild OSA, 583 (27.0%) had moderate OSA and 1114 (51.6%) had severe OSA. For initial therapy, 751 (34.8%) patients opted for a 1-month CPAP trial, 288 (13.3%) patients chose surgery upfront, 291 (13.5%) patients chose adjunctive treatments (weight loss, positional therapy, dental appliance, intranasal steroid spray for allergic rhinitis) and 830 (38.4%) patients rejected all forms of treatment. 337 out of 751 patients (44.9%) were adherent to CPAP therapy during the 1 month trial. 381 out of 751 (50.7%) patients took up CPAP therapy following the trial period, of which 299 out of 381 (78.5%) patients were adherent to CPAP therapy at 1 year. CPAP adherence during the 1-month trial was a predictor for eventual CPAP treatment uptake and CPAP adherence at 1 year (p < 0.001). Age (p < 0.001), BMI (p < 0.001) and normal ESS (p = 0.01) were predictors of treatment rejection. 24 patients underwent upper airway surgery during their first year of using CPAP. 21 out of the 24 patients (87.5%) were adherent to CPAP at 1 year after undergoing surgery. These patients had a higher rate of CPAP adherence compared to the overall cohort (87.5% versus 78.5%), but this was not statistically significant (p > 0.05). CONCLUSION Singaporean patients who accept CPAP therapy after an initial 1-month CPAP trial will generally be adherent to CPAP therapy. Initial patterns of CPAP usage are predictive of long term CPAP adherence. However, there is a high rate of CPAP treatment rejection both at the time of diagnosis and after the CPAP trial. Upper airway surgery in selected patients may improve CPAP adherence.
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Affiliation(s)
- Bernard Tan
- Department of Otolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore.
| | - Alvin Tan
- Department of Otolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yingjuan Mok
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Hang Siang Wong
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Pon Poh Hsu
- Department of Otolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore University of Technology and Design, Singapore
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29
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Andrade L, Paiva T. Ambulatory Versus Laboratory Polysomnography in Obstructive Sleep Apnea: Comparative Assessment of Quality, Clinical Efficacy, Treatment Compliance, and Quality of Life. J Clin Sleep Med 2018; 14:1323-1331. [PMID: 30092885 DOI: 10.5664/jcsm.7264] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 04/05/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study has as its primary objective to evaluate the quality and effectiveness of type II ambulatory polysomnography (Amb-PSG) versus type I attended laboratory polysomnography (Lab-PSG) in diagnosing obstructive sleep apnea (OSA). Its secondary objective is to evaluate the clinical efficacy, quality of life (QoL), and treatment adherence after diagnosis. METHODS An observational study of patients with OSA (n = 225) in whom diagnosis was made via Amb-PSG (n = 114) or Lab-PSG (n = 111). Patients' clinical data were retrospectively assessed (including general demographic and clinical data, Epworth Sleepiness Scale, blood pressure, indices from polysomnography, and treatment adherence. Cross-sectional assessment (patient questionnaire) was used to evaluate clinical efficacy indicators, comorbidities, current treatment, and QoL. RESULTS Polysomnography indices were comparable between Amb-PSG and Lab-PSG (apnea-hypopnea index: 38.9 ± 22.5 versus 35.8 ± 23.1 events/h; P > .05), except for an elevation of total sleep time (510 ± 54.7 versus 476.3 ± 79.4 minutes; P < .01) and loss of oximetry signal (9.8% versus 0.0%; P < .05). Based on polysomnography parameters, OSA was severe in 119 patients (52.9%), moderate in 88 (39.1%), and mild in 18 (8.0%). Diagnostic effect of Amb-PSG in clinical (body mass index, blood pressure, Epworth Sleepiness Scale) and treatment follow-up (CPAP adherence and QoL) indicators was comparable to that of Lab-PSG. CONCLUSIONS Amb-PSG showed an OSA diagnostic capacity comparable to Lab-PSG. Secondary analyses (diagnostic quality, clinical efficacy, treatment compliance, QoL) underline the value of Amb-PSG as an emerging alternative to improve accessibility to care.
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Affiliation(s)
- Lília Andrade
- Pulmonology Department, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Teresa Paiva
- CENC - Sleep Medicine Center, Campolide, Lisbon, Portugal.,Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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30
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Liguori C, Placidi F, Palmieri MG, Izzi F, Ludovisi R, Mercuri NB, Pierantozzi M. Continuous Positive Airway Pressure Treatment May Improve Optic Nerve Function in Obstructive Sleep Apnea: An Electrophysiological Study. J Clin Sleep Med 2018; 14:953-958. [PMID: 29852910 DOI: 10.5664/jcsm.7158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/20/2018] [Indexed: 01/21/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a sleep disorder frequently associated with optic nerve diseases. Moreover, untreated patients with severe OSA may show optic nerve dysfunction as documented by electrophysiological studies using visual evoked potentials (VEP). Because continuous positive airway pressure (CPAP) treatment has proved to restore the physiologic nocturnal breathing, thus preventing nocturnal hypoxemia and reducing inflammation, in this study we tested whether 1-year CPAP treatment may modify VEP responses in patients with severe OSA. METHODS VEP were recorded at baseline and after 1 year of CPAP treatment in 20 patients with severe OSA, divided in two groups on the basis of CPAP adherence, and compared to a healthy control group. RESULTS Patients with good adherence to CPAP therapy (CPAP+; n = 10) showed VEP P100 amplitude significantly higher than patients with poor adherence to CPAP therapy (CPAP-; n = 10). Moreover, the CPAP+ group showed VEP responses similar to those in the control group (n = 26). Considering the mean difference of VEP responses between baseline and follow-up, the CPAP+ group showed a significant increase in VEP P100 amplitude and a significant decrease in VEP P100 latency compared to the CPAP- group. CONCLUSIONS This study documented that CPAP therapy significantly improves VEP in patients with OSA who are adherent to the treatment. We hypothesize that CPAP treatment, minimizing the metabolic, inflammatory and ischemic consequences of OSA, may normalize the altered VEP responses in patients with OSA by restoring and preserving optic nerve function.
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Affiliation(s)
- Claudio Liguori
- Sleep Medicine Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Fabio Placidi
- Sleep Medicine Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Maria Giuseppina Palmieri
- Sleep Medicine Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Francesca Izzi
- Sleep Medicine Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Raffaella Ludovisi
- Sleep Medicine Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Nicola Biagio Mercuri
- Sleep Medicine Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy.,Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy.,Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Mariangela Pierantozzi
- Neurology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Swieca J, Hamilton GS, Meaklim H. The management, privacy and medico-legal issues of electronic CPAP data in Australia and New Zealand: Electronic CPAP data management in Australia and New Zealand. Sleep Med 2017. [PMID: 28648227 DOI: 10.1016/j.sleep.2017.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE Continuous Positive Airway Pressure (CPAP) is considered to be the gold standard treatment for obstructive sleep apnoea (OSA). CPAP monitoring systems allow tracking of patient CPAP adherence and treatment efficacy, by measuring residual sleep-disordered breathing, hours of CPAP use, and mask leak etc. The American Thoracic Society (ATS) published a position paper in 2013 highlighting issues of interpreting CPAP data such as a lack of consistency between CPAP manufacturers data algorithms, legal implications of CPAP data and implications for CPAP adherence. This paper extends on this work by investigating these issues in an Australasian context. METHOD A review of current literature on CPAP monitoring systems, privacy and security of CPAP data for major Australasian CPAP providers, and CPAP adherence was undertaken. A legal review was also commissioned for issues related to privacy and security of CPAP data. RESULTS CPAP manufacturers' utilize different algorithms for respiratory event detection and clinicians need to be aware the implications for interpreting CPAP data. Australasian CPAP manufacturers have created security/privacy policies with the intent to follow relevant legislation to protect patients' CPAP data, however they do need to be constantly reviewed and updated to avoid data breaches and changes to agreements. No guarantees can be provided by the Australasian Sleep Association on CPAP manufacturers' compliance with these policies and there is the potential for some degree of liability for physicians and CPAP providers associated with CPAP data. Lastly, providing patients with feedback on their CPAP usage and OSA management appears to have positive influence CPAP adherence. CONCLUSIONS CPAP data provides many opportunities to increase OSA patient care and to help patients self-manage this chronic condition. However, issues relating to lack of standardization of CPAP parameters, privacy, security, and legal implications will need to be managed in this changing technologic and clinical environment.
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Affiliation(s)
- John Swieca
- Melbourne Sleep Disorders Centre, East Melbourne, VIC, Australia.
| | - Garun S Hamilton
- Monash Health, Department of Lung and Sleep, Monash Medical Centre, Clayton VIC, Australia; School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Hailey Meaklim
- Melbourne Sleep Disorders Centre, East Melbourne, VIC, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
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Metta RVVS, Zaka A, Lee VC, Mador MJ. Continuous Positive Airway Pressure Adherence In Patients with Obstructive Sleep Apnea & Symptomatic BPH. Lung 2017; 195:255-261. [PMID: 28204876 DOI: 10.1007/s00408-017-9981-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/29/2017] [Indexed: 10/20/2022]
Abstract
Purpose To determine the short-term and long-term adherence rates with continuous positive airway pressure (CPAP) therapy in sleep apnea patients with benign prostatic hyperplasia (BPH) compared to matched controls. Methods A case-control retrospective analysis was performed in a veterans affairs hospital. All symptomatic patients with BPH (n = 107) ever started on CPAP therapy between 2006 and 2012 were compared with controls matched for severity of sleep apnea (AHI). Adherence measures were obtained at the third and twelfth month visits. The cases included symptomatic BPH patients on active medical therapy. Diuretic use among cases and controls, and severity of nocturia among the cases were also analyzed. Results The mean AHI among cases and controls was 35.6 ± 27.3 and 35.5 ± 31 (p = 0.96). The population was male and predominantly Caucasian. There was no statistically significant difference in percent days CPAP device use ≥4 h. between symptomatic BPH patients and controls at 3-month (51.6 ± 38 vs. 47.2 ± 36; p = 0.43) and 1-year (64 ± 40.5 vs. 64.7 ± 31.3; p = 0.90) visits. The use of diuretics in the cases and controls, and the severity of nocturia in the cases did not influence adherence with CPAP therapy. Conclusions BPH or diuretic use did not affect adherence with CPAP therapy in obstructive sleep apnea. Severity of nocturia did not have any influence on adherence among the cases. BPH, regardless of the severity of nocturia, and diuretic use does not influence CPAP adherence in patients with OSA.
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Affiliation(s)
- Ramesh V V S Metta
- The Veterans Affairs Western New York Healthcare System, University at Buffalo, 3495 Bailey Avenue, Buffalo, NY, 14215, USA. .,Division of Pulmonary, Critical Care, and Sleep Medicine, University at Buffalo, 3495 Bailey Avenue, Buffalo, NY, 14215, USA.
| | - Awais Zaka
- Department of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Vincent C Lee
- Department of Medicine, University at Buffalo, Buffalo, NY, USA
| | - M Jeffery Mador
- The Veterans Affairs Western New York Healthcare System, University at Buffalo, 3495 Bailey Avenue, Buffalo, NY, 14215, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, University at Buffalo, 3495 Bailey Avenue, Buffalo, NY, 14215, USA
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Hwang D. Monitoring Progress and Adherence with Positive Airway Pressure Therapy for Obstructive Sleep Apnea: The Roles of Telemedicine and Mobile Health Applications. Sleep Med Clin 2016; 11:161-71. [PMID: 27236054 DOI: 10.1016/j.jsmc.2016.01.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Technology is changing the way health care is delivered and how patients are approaching their own health. Given the challenge within sleep medicine of optimizing adherence to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA), implementation of telemedicine-based mechanisms is a critical component toward developing a comprehensive and cost-effective solution for OSA management. Key elements include the use of electronic messaging, remote monitoring, automated care mechanisms, and patient self-management platforms. Current practical sleep-related telemedicine platforms include Web-based educational programs, automated CPAP follow-up platforms that promote self-management, and peer-based patient-driven Internet support forums.
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Affiliation(s)
- Dennis Hwang
- Sleep Medicine, Southern California Permanente Medical Group, Kaiser Permanente Fontana Sleep Disorders Center, 9961 Sierra Avenue, Fontana, CA 92335, USA.
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35
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Schwartz SW, Sebastião Y, Rosas J, Iannacone MR, Foulis PR, Anderson WM. Racial disparity in adherence to positive airway pressure among US veterans. Sleep Breath 2016; 20:947-55. [PMID: 26810493 DOI: 10.1007/s11325-016-1316-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite advances in continuous positive airway pressure (CPAP) technology, compliance with CPAP therapy remains suboptimal. Studies conducted since the advent of objective CPAP recording have noted that African Americans (AA) may use CPAP less than Whites. We sought to confirm this finding among a large sample of veterans and examine effect modifiers of the differential usage. METHODS A retrospective cohort of 233 AA and 1939 White Veterans Administration (VA) patients who had a sleep study between January 2003 and October 2006 and received CPAP therapy by the end of 2007. CPAP compliance was summarized at 2 weeks and 6 months post CPAP receipt. RESULTS AAs were significantly less adherent than Whites even when controlling for age, gender, marital status, median household income for zip code, BMI, comorbidities, and obstructive sleep apnea (OSA) severity. AAs with severe OSA were 3 times more likely to use CPAP than AAs with mild/moderate OSA (p ≤ 0.001); a much smaller but still statistically significant difference was seen for Whites. CONCLUSIONS CPAP compliance is considerably lower in AAs than in Whites, though severity of OSA modifies this association. These findings are not readily explained by differences in demographics or comorbidity.
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Affiliation(s)
- Skai W Schwartz
- Department of Epidemiology and Biostatistics, College of Public Health MDC-56, University of South Florida, Tampa, FL, 33612, USA.
| | - Yuri Sebastião
- Department of Epidemiology and Biostatistics, College of Public Health MDC-56, University of South Florida, Tampa, FL, 33612, USA
| | - Julie Rosas
- Medical Service, James A. Haley VA Hospital, Tampa, FL, USA
| | - Michelle R Iannacone
- Department of Epidemiology and Biostatistics, College of Public Health MDC-56, University of South Florida, Tampa, FL, 33612, USA
| | - Philip R Foulis
- Laboratory Service, James A. Haley VA Hospital, Tampa, FL, USA
- Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA
| | - W McDowell Anderson
- Medical Service, James A. Haley VA Hospital, Tampa, FL, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, University of South Florida, Tampa, FL, USA
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Lettieri CJ, Williams SG, Collen JF. OSA Syndrome and Posttraumatic Stress Disorder: Clinical Outcomes and Impact of Positive Airway Pressure Therapy. Chest 2016; 149:483-490. [PMID: 26291560 DOI: 10.1378/chest.15-0693] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We sought to determine the impact of OSA syndrome (OSAS) on symptoms and quality of life (QoL) among patients with posttraumatic stress disorder (PTSD). In addition, we assessed adherence and response to positive airway pressure (PAP) therapy in this population. METHODS This was a case-controlled observational cohort study at the Sleep Disorders Center of an academic military medical center. Two hundred consecutive patients with PTSD underwent sleep evaluations. Patients with PTSD with and without OSAS were compared with 50 consecutive age-matched patients with OSAS without PTSD and 50 age-matched normal control subjects. Polysomnographic data, sleep-related symptoms and QoL measures, and objective PAP usage were obtained. RESULTS Among patients with PTSD, more than one-half (56.6%) received a diagnosis of OSAS. Patients with PTSD and OSAS had lower QoL and more somnolence compared with the other groups. Patients with PTSD demonstrated significantly lower adherence and response to PAP therapy. Resolution of sleepiness occurred in 82% of patients with OSAS alone, compared with 62.5% of PAP-adherent and 21.4% of nonadherent patients with PTSD and OSAS (P < .001). Similarly, posttreatment Functional Outcomes of Sleep Questionnaire ≥ 17.9 was achieved in 72% of patients with OSAS, compared with only 56.3% of patients with PTSD and OSA who were PAP adherent and 26.2% who were nonadherent (P < .03). CONCLUSIONS In patients with PTSD, comorbid OSAS is associated with worsened symptoms, QoL, and adherence and response to PAP. Given the negative impact on outcomes, the possibility of OSAS should be considered carefully in patients with PTSD. Close follow-up is needed to optimize PAP adherence and efficacy in this at-risk population.
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Affiliation(s)
- Christopher J Lettieri
- Department of Medicine, Uniformed Services University, Bethesda, MD; Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD
| | - Scott G Williams
- Department of Medicine, Uniformed Services University, Bethesda, MD; Department of Pulmonary, Critical Care, and Sleep Medicine, Womack Army Medical Center, Fort Bragg, NC
| | - Jacob F Collen
- Department of Medicine, Uniformed Services University, Bethesda, MD; Department of Pulmonary, Critical Care, and Sleep Medicine, Brooke Army Medical Center, Fort Sam Houston, TX.
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Lai AYK, Ip MSM, Lam JCM, Weaver TE, Fong DYT. A pathway underlying the impact of CPAP adherence on intimate relationship with bed partner in men with obstructive sleep apnea. Sleep Breath 2015; 20:543-51. [PMID: 26265560 DOI: 10.1007/s11325-015-1235-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/25/2015] [Accepted: 07/18/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Our aim was to determine the pathway underlying the effects of continuous positive airway pressure (CPAP) adherence on intimate relationship with bed partner in men with obstructive sleep apnea (OSA). We hypothesized that CPAP with good adherence affected the intimate relationship with bed partner directly and indirectly, and it was mediated through daytime sleepiness and activity level in men with OSA. METHODS Data were obtained from an education program for enhancing CPAP adherence. Men who were newly diagnosed of OSA and CPAP therapy naïve were recruited in a tertiary teaching hospital. RESULTS Self-reported quality of life [Functional Outcomes of Sleep Questionnaire], daytime sleepiness [Epworth Sleepiness Scale (ESS)], and negative emotion symptoms [depression, anxiety, stress scale] were assessed before and after CPAP treatment at 1-year assessment. Seventy-three men were included in the data analysis, with a mean ± SD age of 52 ± 10 years, body mass index of 29.0 ± 5.2 kg/m(2), ESS of 9.5 ± 5.6, and median [interquartile range(IR)] apnea and hypopnea index of 31 (21, 56) events/h. The median (IR) CPAP daily usage was 4.3(0, 6.1) h/day. From the path analysis, CPAP therapy was shown to improve intimate relationship directly (ß = 0.185) and indirectly (ß = 0.050) by reducing daytime sleepiness and increasing activity level. However, negative emotion symptoms were not the mediators between CPAP adherence and the intimate relationship. CONCLUSIONS CPAP therapy with good adherence is related directly and indirectly to a better intimate relationship with bed partner in men with OSA. It was possibly attributed to reduced daytime sleepiness and increased activity level.
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Affiliation(s)
- Agnes Y K Lai
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China.
| | - Mary S M Ip
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China.,Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Hong Kong, SAR, China
| | - Jamie C M Lam
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China
| | - Terri E Weaver
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Daniel Y T Fong
- School of Nursing, The University of Hong Kong, Hong Kong, SAR, China
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Collen J, Lettieri CJ, Eliasson A. Postoperative CPAP use impacts long-term weight loss following bariatric surgery. J Clin Sleep Med 2015; 11:213-7. [PMID: 25515283 DOI: 10.5664/jcsm.4528] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/31/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is common among bariatric surgery candidates. After surgical weight loss, OSA frequently persists and untreated OSA can lead to weight gain. Long-term continuous positive airway pressure (CPAP) adherence is unclear and poor adherence may worsen weight loss outcomes. We sought to determine the impact of CPAP use on long-term weight-loss outcomes in a cohort of bariatric patients. METHODS Long-term observational study of bariatric surgery patients with OSA. Patients were evaluated with polysomnography preoperatively and one-year postoperatively. The cohort was again evaluated a mean of 7.2 years later to determine the relationship between long-term CPAP use and subsequent regain of weight. RESULTS Twenty-four consecutive patients (aged 48.5 ± 9.4 years at time of surgery; 73% female) were included in the initial assessment, and long-term outcome data were available on 22 subjects. Persistent OSA was documented in 21 of 22 subjects (95%) one year postoperatively. Final evaluation occurred 7.2 ± 2.3 years following surgery. Weight (213.3 ± 39.1 to 235.3 ± 47.1 lb, p = 0.10) and BMI (32.5 ± 5.4 to 37.3 ± 8.2 kg/m(2), p = 0.03) increased in most (n = 19, 86.4%) from postoperative to final evaluation. CPAP use declined from 83.3% (preoperatively) to 38.1% (one year) and to 23.8% (final evaluation). BMI increased among those not using CPAP at long-term follow-up compared to those with continued CPAP use (6.8% v -1.8%, p = 0.05). CONCLUSIONS In our cohort of bariatric patients with OSA, long-term adherence to CPAP therapy was poor, and non-adherence was associated with weight gain. Ongoing follow-up of OSA in this population may help to preserve initial achievements after surgical weight loss.
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Affiliation(s)
- Jacob Collen
- Pulmonary, Critical Care, and Sleep Medicine, San Antonio Military Medical Center, Fort Sam Houston, TX.,Department of Medicine, Uniformed Services University, Bethesda, MD
| | - Christopher J Lettieri
- Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD.,Department of Medicine, Uniformed Services University, Bethesda, MD
| | - Arn Eliasson
- Department of Medicine, Uniformed Services University, Bethesda, MD.,Integrative Cardiac Health Project, Walter Reed National Military Medical Center, Bethesda, MD
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Mello-Fujita L, Kim LJ, Palombini LDO, Rizzi C, Tufik S, Andersen ML, Coelho FM. Treatment of obstructive sleep apnea syndrome associated with stroke. Sleep Med 2015; 16:691-6. [PMID: 25953300 DOI: 10.1016/j.sleep.2014.12.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/20/2014] [Accepted: 12/04/2014] [Indexed: 11/25/2022]
Abstract
The association between sleep-disordered breathing and stroke has been a subject of increased interest and research. Obstructive sleep apnea (OSA) is an important risk factor for stroke incidence and mortality. Moreover, OSA is a common clinical outcome after stroke, directly influencing the patient's recovery. The treatment of choice for OSA is positive airway pressure (PAP) support and the PAP appliance is considered the most recommended clinical management for the treatment of patients with cardiovascular complications. However, the implementation of PAP in stroke patients remains a challenge, considering the increased frequency of motor and language impairments associated with the cerebrovascular event. In the present study, we reviewed the main findings describing the association between stroke and OSA treatment with continuous positive airway pressure. We also discussed the types of OSA treatment, the different options and indications of PAP treatment, PAP adherence and the clinical outcomes after treatment.
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Affiliation(s)
- Luciane Mello-Fujita
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lenise Jihe Kim
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Camila Rizzi
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Fernando Morgadinho Coelho
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, Brazil.
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40
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Prashad PS, Marcus CL, Maggs J, Stettler N, Cornaglia MA, Costa P, Puzino K, Xanthopoulos M, Bradford R, Barg FK. Investigating reasons for CPAP adherence in adolescents: a qualitative approach. J Clin Sleep Med 2013; 9:1303-13. [PMID: 24340293 DOI: 10.5664/jcsm.3276] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Adolescents with obstructive sleep apnea syndrome (OSAS) represent an important but understudied subgroup of long-term continuous positive airway pressure (CPAP) users. The purpose of this qualitative study was to identify factors related to adherence from the perspective of adolescents and their caregivers. METHODS Individual open-ended, semi-structured interviews were conducted with adolescents (n = 21) and caregivers (n = 20). Objective adherence data from the adolescents' CPAP machines during the previous month was obtained. Adolescents with different adherence levels and their caregivers were asked their views on CPAP. Using a modified grounded theory approach, we identified themes and developed theories that explained the adolescents' adherence patterns. RESULTS Adolescent participants (n = 21) were aged 12-18 years, predominantly male (n = 15), African American (n = 16), users of CPAP for at least one month. Caregivers were mainly mothers (n = 17). Seven adolescents had high use (mean use 381 ± 80 min per night), 7 had low use (mean use 30 ± 24 min per night), and 7 had no use during the month prior to being interviewed. Degree of structure in the home, social reactions, mode of communication among family members, and perception of benefits were issues that played a role in CPAP adherence. CONCLUSIONS Understanding the adolescent and family experience of using CPAP may be key to increasing adolescent CPAP adherence. As a result of our findings, we speculate that health education, peer support groups, and developmentally appropriate individualized support strategies may be important in promoting adherence. Future studies should examine these theories of CPAP adherence.
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Affiliation(s)
- Priya S Prashad
- Sleep Center, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Schwartz SW, Rosas J, Iannacone MR, Foulis PR, Anderson WM. Correlates of a prescription for Bilevel positive airway pressure for treatment of obstructive sleep apnea among veterans. J Clin Sleep Med 2013; 9:327-35. [PMID: 23585747 DOI: 10.5664/jcsm.2580] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The acceptance of portable home-based polysomnography together with auto-titrating CPAP has bypassed the need for a laboratory polysomnography. Since bilevel airway pressure (BPAP) is titrated in the sleep lab, patients diagnosed using portable home-based polysomnography may not have the opportunity to receive BPAP. It is unknown whether the patients who would have ordinarily received a BPAP would benefit from it. We determine correlates of receiving BPAP and of being switched from BPAP to CPAP. We examine whether patients with these correlates have better adherence to BPAP versus CPAP. METHODS Retrospective Cohort Study (Correlates at baseline) of 2,513 VA patients with a sleep study between January 2003 and October 2006 and receiving continuous or bilevel positive airway pressure (CPAP [N = 2,251]) or BPAP [N = 262]) by the end of 2007. PAP adherence up to 30 months was assessed. RESULTS Significant correlates of BPAP were older age (p < 0.001), higher BMI and CHF (p < 0.01), COPD (p < 0.001), higher blood CO₂ (p < 0.05), higher AHI and OSA severity (p < 0.001), lower nadir SpO₂ (p < 0.001), and greater sleepiness (ESS) (p < 0.01). Patients on BPAP were more adherent to PAP therapy (p < 0.01), but the association largely disappeared following adjustment for BPAP correlates. There was preliminary evidence that these correlates predict long-term adherence to PAP therapy regardless of mode. CONCLUSIONS We identified baseline factors that can help clinicians decide whether to prescribe an auto-BPAP as first-line therapy and that predict good long-term PAP adherence.
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Affiliation(s)
- Skai W Schwartz
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33612, USA.
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Balachandran JS, Yu X, Wroblewski K, Mokhlesi B. A brief survey of patients' first impression after CPAP titration predicts future CPAP adherence: a pilot study. J Clin Sleep Med 2013; 9:199-205. [PMID: 23493772 DOI: 10.5664/jcsm.2476] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND CPAP adherence patterns are often established very early in the course of therapy. Our objective was to quantify patients' perception of CPAP therapy using a 6-item questionnaire administered in the morning following CPAP titration. We hypothesized that questionnaire responses would independently predict CPAP adherence during the first 30 days of therapy. METHODS We retrospectively reviewed the CPAP perception questionnaires of 403 CPAP-naïve adults who underwent in-laboratory titration and who had daily CPAP adherence data available for the first 30 days of therapy. Responses to the CPAP perception questionnaire were analyzed for their association with mean CPAP adherence and with changes in daily CPAP adherence over 30 days. RESULTS Patients were aged 52 ± 14 years, 53% were women, 54% were African American, the mean body mass index (BMI) was 36.3 ± 9.1 kg/m(2), and most patients had moderate-severe OSA. Four of 6 items from the CPAP perception questionnaire- regarding difficulty tolerating CPAP, discomfort with CPAP pressure, likelihood of wearing CPAP, and perceived health benefit-were significantly correlated with mean 30-day CPAP adherence, and a composite score from these 4 questions was found to be internally consistent. Stepwise linear regression modeling demonstrated that 3 variables were significant and independent predictors of reduced mean CPAP adherence: worse score on the 4-item questionnaire, African American race, and non-sleep specialist ordering polysomnogram and CPAP therapy. Furthermore, a worse score on the 4-item CPAP perception questionnaire was consistently associated with decreased mean daily CPAP adherence over the first 30 days of therapy. CONCLUSIONS In this pilot study, responses to a 4-item CPAP perception questionnaire administered to patients immediately following CPAP titration independently predicted mean CPAP adherence during the first 30 days. Further prospective validation of this questionnaire in different patient populations is warranted.
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Affiliation(s)
- Jay S Balachandran
- Sleep Disorders Center, Section of Pulmonary and Critical Care, Department of Medicine, Chicago, IL, USA
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Abstract
STUDY OBJECTIVES Adherence to CPAP therapy is low in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). The purpose of the present study was to evaluate the utility of measures of sleep architecture and sleep continuity on the CPAP titration study as predictors of both short- and long-term CPAP adherence. METHODS 93 patients with OSAHS (RDI 42.8 ± 34.3/h) underwent in-laboratory diagnostic polysomnography, CPAP titration, and follow-up polysomnography (NPSG) on CPAP. Adherence to CPAP was objectively monitored. Short-term (ST) CPAP adherence was averaged over 14 days immediately following the titration study. Long-term (LT) CPAP adherence was obtained in 56/93 patients after approximately 2 months of CPAP use. Patients were grouped into CPAP adherence groups for ST (< 2 h, 2-4 h, and > 4 h) and LT adherence (< 4 h, > 4 h). Sleep architecture, sleep disordered breathing (SDB) indices, and daytime outcome variables from the diagnostic and titration NPSGs were compared between CPAP adherence groups. RESULTS There was a significant relationship between ST and LT CPAP adherence (r = 0.81, p < 0.001). Neither ST nor LT adherence were related to demographic variables, baseline severity of untreated SDB, sleep architecture, or measures of daytime impairment. Good CPAP adherence groups had significantly lower %N2 and greater %REM on the titration NPSG. A model combining change in sleep efficiency and change in sleep continuity between the diagnostic and titration NPSGs predicted 17% of the variance in LT adherence (p = 0.006). CONCLUSIONS These findings demonstrate that characteristics of sleep architecture, even on the titration NPSG, may predict some of the variance in CPAP adherence. Better sleep quality on the titration night was related to better CPAP adherence, suggesting that interventions to improve sleep on/prior to the CPAP titration study might be used as a therapeutic intervention to improve CPAP adherence.
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Affiliation(s)
- Manya Somiah
- NYU School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, NY, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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