Automatic Positive Airway Pressure Therapy Research Articles

Evaluating the impact of automatic positive airway pressure therapy on cardiovascular risk index and vascular behavior in patients with obstructive sleep apnea: a study on heterogeneity in the therapeutic response.

This study investigated the impact of APAP therapy on vascular behavior and its potential to lower cardiovascular risk in patients with OSA, as well as differentiating APAP therapy heterogeneity. All participants were diagnosed with OSA by portable monitoring, and pulse wave parameters and cardiac risk composite parameter index (CRI) were obtained by photoplethysmography before and after APAP. Clustering analysis of pulse wave parameters before APAP in the high-risk population was performed using k-means clustering. Linear regression was used to assess the associations of changes in CRI and pulse wave parameters with clinical characteristics. Eighty-two patients with OSA underwent APAP therapy. The CRI after APAP was significantly lower than before APAP (0.38± 0.33 and 0.58 ± 0.31, respectively; p < 0.001). All pulse wave parameters (except irregular pulse) were significantly different (p < 0.001) in patients with OSA and in the high-risk responders group after versus before APAP. The differences in pulse wave parameters after versus before APAP were not significant in the high-risk non-responders group, except for RCRD and pulse rate variability. Four clusters were obtained from the clustering analysis of pulse wave parameters before APAP in the high-risk responders group. APAP reduces the CRI in patients with OSA by altering vascular behavior. Overnight photoplethysmography monitoring of pulse wave parameters can be used to assess whether patients with OSA will benefit from APAP.

Pneumothorax Induced by Automatic Positive Airway Pressure Therapy for Obstructive Sleep Apnea: A Rare Case Report and Review of the Literature

Positive airway pressure (PAP) therapy is known to be an effective treatment for obstructive sleep apnea (OSA) that does not generally have serious complications. However, pneumothorax following lung barotrauma with the use of PAP has rarely been reported. We recently experienced the case of a 72-year old male patient with chronic obstructive pulmonary disease who developed pneumothorax after the use of automatic PAP (APAP). After 4 months of APAP use with a pressure of 4–8 cm H&lt;sub&gt;2&lt;/sub&gt;O, he complained of sudden severe dyspnea at midnight. He eventually underwent surgical repair for pneumothorax. After 4 months, continuous PAP with low pressure of 5 cm H&lt;sub&gt;2&lt;/sub&gt;O was applied without any complications. In summary, we emphasize the risk of barotrauma when PAP is used by OSA patients with lung disease.

Characteristics of Patients With More Than 90% Adherence to Automatic Positive Airway Pressure

Background and Objective Among patients suffering from obstructive sleep apnea, there is a group with surprisingly high adherence (≥ 90%) to automatic positive airway pressure (APAP) treatment. This study aims to evaluate the characteristics of these patients.Methods Medical records of 4757 patients, who received APAP prescriptions between July 2018 and December 2019, were reviewed retrospectively. After the exclusion of patients not meeting the study criteria, a total of 103 patients were included in the study, and patients were divided into a very good adherence (VGA; adherence ≥ 90%) group and a poor adherence (PA; adherence &lt; 70%) group, based on nine months of APAP adherence. Patient demographics, medical history, body mass index, and pretreatment polysomnography (PSG) results, as well as APAP therapy adherence-related variables (percentage of total days of APAP usage, and the mean time of APAP usage), the 90th percentile pressure (P90), residual apnea-hypopnea index (AHI), and the type of devices or company managers were compared between the two groups.Results Median age was significantly higher in the VGA group than in the PA group (p = 0.032). The Beck Depression Inventory (BDI) also differed significantly (p = 0.017) between the two groups. There were significant differences in the total sleep time (p = 0.003): 309.04 ± 64.96 min in the VGA group and 345.47 ± 53.06 min in the PA group. Patient sleep efficiency was observed and differed significantly (p = 0.003) 74.46 ± 13.73% in the VGA group and 82.09 ± 10.82% in the PA group. Other parameters, such as a pretreatment PSG and sleep-related questionnaires, did not show significant differences between the two groups. The device-related data at 1, 3, and 9 months were similar, and there were significant differences in the mean usage time (p &lt; 0.001) and the number of days on which the device was used for more than 4 hours a day (p &lt; 0.001) between the two groups. However, the two groups had no significant differences in mean pressure, residual AHI, and the P90.Conclusions The total sleep time, sleep efficiency, and BDI were the main determinants of adherence in patients in the VGA group. To find additional factors which affect adherence, further studies will be needed.

Factors Affecting Automatic Positive Airway Pressure Therapy Adherence in Patients Who had Completed the 3-Month Compliance Assessment for Korean National Health Insurance Coverage

Background and Objective The numbers of prescriptions for continuous positive airway pressure and automatic positive airway pressure (APAP) machines have increased dramatically since the Korean government changed national health insurance coverage. This study examined adherence to APAP therapy in patients with obstructive sleep apnea who completed the 3-month adaptation period required by the insurance service, and evaluated the factors predictive of good adherence.Methods We retrospectively reviewed the medical records of a total of 315 patients who received APAP prescriptions between July 2018 and December 2019. After screening, 189 patients were analyzed. Patients were divided into an adherent (AD) group and a non-adherent (NAD) group based on 9 months’ APAP adherence. Patient demographics, medical history, body mass index and pretreatment polysomnography results, as well as APAP therapy adherence-related variables, the 90th percentile pressure, residual apnea hypopnea status, and type of devices or managers were compared between the two groups.Results We found mean usage times, mean pressures, days with ≥ 4 hours of use a day, and 90th percentile pressures differed significantly between the AD and NAD groups. The device-related data at months 1 and 3 and 9 were similar. One type of device performed differently compared to the other devices, but this did not affect adherence.Conclusions The mean pressure and 90th percentile pressure were the main determinants of adherence in patients who passed a 3-month compliance assessment conducted by the Korean National Institute of Health. The data on adherence at months 1, 3 and 9 were similar.

Short term impact of antidepressants on the cardinal symptoms of depression in OSA patients with comorbid MDD who are APAP-adherent: A retrospective study in a veteran population.

• This study highlights the importance of continued assessment for depressive symptoms in veterans with OSA even after adequate treatment with automatic positive airway pressure (APAP). • Adding psychotropics to patients with depressive symptoms provides measurable benefit in reducing symptoms of depression, such as anhedonia, hopelessness and poor self-esteem, in patients with sleep apnea and comorbid major depressive disorder who are on APAP therapy. • If successful treatment of OSA does not alleviate the mood disturbance, the next step is to target the mood disorder. However, there are no supporting data for such an approach. Further studies are needed to analyze the connection between OSA and affective disorders, especially in the context of APAP treatment. Background: The purpose of the study is to determine whether the addition of antidepressants provides measurable benefit in diminishing symptoms of depression, such as anhedonia, hopelessness and poor self-esteem, in veterans with obstructive sleep apnea (OSA) and comorbid major depressive disorder (MDD) who are on automatic positive airway pressure (APAP) therapy. Methods: This is a retrospective study, involving veterans with MDD and treated OSA who were followed for 3 months. All veterans were compliant with APAP therapy for at least six months prior to their first mental health clinic appointment. The Clinically Useful Depression Outcome Scale (CUDOS) was administered during the first appointment and each subsequent visit with the respective psychiatrist to monitor mood symptoms. The CUDOS total scores were compared between the first visit, APAP pre- antidepressant period and after 3 months of treatment with an antidepressant. Results: The analysis was based on 47 participants, CUDOS scores decreased significantly from the initial score to month 3 with addition of antidepressants, as assessed using a Wilcoxon signed rank test for the paired observations within each participant ( p < 0.01), The median decrease was 21 points with an interquartile range of 14.5–26. Evaluation of the distribution of CUDOS cardinal symptoms of depression (anhedonia, poor self-esteem, and hopelessness) scores shows that scores for each item were reduced. Limitations: Our early work underscores the need for more definitive studies, these results are not ready for adoption to clinical care. Conclusion: Adding pharmacotherapy to patients with depressive symptoms on APAP has significant clinical benefits.

A Pilot Randomized Controlled Trial of Effect of Genioglossus Muscle Strengthening on Obstructive Sleep Apnea Outcomes.

The genioglossus is a major upper airway dilator muscle. Our goal was to assess the efficacy of upper airway muscle training on Obstructive Sleep Apnea (OSA) as an adjunct treatment. Sixty-eight participants with OSA (AHI > 10/h) were recruited from our clinic. They fall into the following categories: (a) Treated with Automatic Positive Airway Pressure (APAP), (n = 21), (b) Previously failed APAP therapy (Untreated), (n = 25), (c) Treated with Mandibular Advancement Splint (MAS), (n = 22). All subjects were given a custom-made tongue strengthening device. We conducted a prospective, randomized, controlled study examining the effect of upper airway muscle training. In each subgroup, subjects were randomized to muscle training (volitional protrusion against resistance) or sham group (negligible resistance), with a 1:1 ratio over 3 months of treatment. In the baseline and the final visit, subjects completed home sleep apnea testing, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), SF-36 (36-Item Short Form Survey), and Psychomotor Vigilance Test (PVT). Intervention (muscle training) did not affect the AHI (Apnea-Hypopnea Index), (p-values > 0.05). Based on PSQI, ESS, SF-36 scores, and PVT parameters, the changes between the intervention and sham groups were not significant, and the changes were not associated with the type of treatment (p-value > 0.05). The effectiveness of upper airway muscle training exercise as an adjunct treatment requires further study.

Implementing a sleep technician-supervised and personalized APAP interface fitting session prior to initiation of home APAP therapy improves adherence in patients with obstructive sleep apnea.

Home automatic positive airway pressure (APAP) therapy is becoming a mainstay treatment of obstructive sleep apnea. It is typically prescribed without any prior supervised titration. Initial experience of APAP treatment dictates subsequent use. Discomfort related to the APAP interface contributes to poor APAP adherence. After obtaining institutional review board approval, 156 adult patients newly diagnosed with obstructive sleep apnea were prospectively randomized into 2 groups (group A and group B). Group A received a 30-minute personalized interface/mask fitting session supervised by a certified sleep technician, during which APAP therapy was simulated and patients were educated on proper use. Patients sampled different interfaces to address any issues with comfort. Group B received usual care where patients obtained an interface through durable medical equipment suppliers. Primary endpoints included percent APAP usage (number of days APAP was used for ≥ 4 hours divided by 30 days) and APAP usage (number of days APAP was used for any duration) during the initial 30 days of home APAP therapy. Interface-associated air leak served as the secondary endpoint. Mean percent APAP usage was higher in group A compared to group B (78.4% vs 67.8%; P = .04). On average, group A utilized the APAP machine on more days compared to group B (27 vs 24 days; P = .01). APAP interface associated air leak was lower in group A compared to group B (14.9 vs 21.1 l/min; P = .03). Our findings demonstrate that implementing a personalized interface fitting session supervised by a sleep technician improves APAP adherence. Syed Z, Mehta I, Hella JR, Barber K, Khorfan F. Implementing a sleep technician-supervised and personalized APAP interface fitting session prior to initiation of home APAP therapy improves adherence in patients with obstructive sleep apnea. J Clin Sleep Med. 2021;17(10):2057-2065.

Newly detected rapid eye movement\xa0associated sleep apnea after coronavirus disease 2019 as a possible cause for chronic fatigue: two case reports

BackgroundCoronavirus disease 2019 has become a health problem spreading worldwide with pandemic characteristics since March 2020. Post coronavirus disease 2019 symptoms are more frequent than initially expected, with fatigue as an often-mentioned issue.Case presentationsWe describe a 32-year-old white male and a 55-year-old white female who suffered from post coronavirus disease 2019 fatigue syndrome. On polysomnography, rapid eye movement associated sleep apnea with an increased hypopnea index during rapid eye movement phases of 36.8 and 19.5 events per hour was found. Based on the patients’ burdensome fatigue symptoms, we initiated automatic positive airway pressure therapy, which diminished sleep apnea (rapid eye movement index: 0.0 in both patients) and, consequently, also the fatigue symptoms.ConclusionsSince sleep apnea and coronavirus disease 2019 are both associated with fatigue, a screening for sleep apnea might be considered in coronavirus disease 2019 patients with fatigue syndrome.

Transvenous Phrenic Nerve Stimulation and Automatic Positive Airway Pressure Therapy for Treating Central Sleep Apnea and Residual Obstructive Sleep Apnea

Central sleep apnea (CSA) is a neurological breathing disorder resulting from intermittent disruptions in the neural drive to breath. CSA and obstructive sleep apnea (OSA), caused by partial or complete airway blockage, sometimes occur together. The remede System (Respicardia, Minnetonka, MN) is an implantable device that delivers transvenous phrenic nerve stimulation therapy (TPNS) to treat CSA. A patient who failed previous Positive Airway Pressure (PAP) therapies presented with severe CSA and OSA with a baseline Apnea Hypopnea Index (AHI) of 98.1 events/hour. The patient was implanted with a TPNS device and titrated to maximum effectiveness. His CSA improved, but still had persistent OSA. PAP therapy was added to supplement the TPNS. With TPNS off, PAP therapy treated obstructive events but not the central events. TPNS alone treated the central events but not the obstructive events. With both therapies on, CSA and OSA were controlled and breathing was normalized (AHI=3.8). ClinicalTrials.gov Identifier: NCT01816776.

0666 Implementing a Sleep Technician Supervised Mask/Interface Fitting Session Can Improve Adherence With Home Automatic Positive Airway Pressure Therapy

Abstract Introduction Obstructive sleep apnea (OSA) is a common disorder associated with increased risk of motor vehicle accidents in addition to cardiovascular and neurocognitive comorbidities. Home Automatic Positive Airway Pressure (APAP) therapy is becoming a mainstay treatment of OSA in the outpatient setting. It is typically prescribed without any prior supervised titration. Discomfort related to the APAP interface is thought to contribute to poor adherence with home APAP use. We examined whether implementing a dedicated and personalized interface fitting session improves APAP adherence. Methods After obtaining IRB approval, 132 adult patients newly diagnosed with OSA were prospectively randomized into two groups (Groups A and B). Group A received a personalized interface/mask fitting session supervised by a sleep technician prior to starting home APAP therapy. During this 30-minute session, patients were educated on APAP use and sampled different masks to address any issues with comfort, leaks, etc. Group B received the usual care where they obtained an interface through Durable Medical Equipment. APAP adherence and interface air leaks during the initial 30 days of home APAP use were compared between the two groups. Results Mean APAP adherence during the initial 30 days of APAP therapy was 12.9% higher in Group A compared to Group B; p=0.05. Fewer APAP interface air leaks were present in Group A (14.8 l/min) compared to Group B (21.2 l/min); p=0.04. Conclusion Discomfort related to the APAP interface can quickly lead to non-adherence with APAP therapy. Initial experience of APAP treatment is important in determining subsequent use. Our findings demonstrate that implementing a personalized interface fitting session supervised by a sleep technician can improve APAP adherence. Potential benefits of increased APAP adherence include improvement in quality of sleep and in turn improvement in quality of life. Support Prior studies have shown that the initial experience of APAP treatment was highly important in determining subsequent use. Patients establish a pattern of APAP adherence during the early days of treatment and maintain this pattern long-term. Early intervention with solutions may help improve APAP adherence.

P4520APAP therapy does not improve impaired sleep quality and sympatho-vagal balance: a randomized trial in patients with obstructive sleep apnea and systolic heart failure

Abstract Introduction and purpose In heart failure with reduced ejection fraction (HFrEF), the effects of automatic positive airway pressure therapy (APAP) for obstructive sleep apnea (OSA) on sleep quality and sympatho-vagal balance (SVB) are unknown. Methods In this randomized controlled trial, sleep quality and SVB in patients with HFrEF and OSA were monitored noninvasively across different breathing conditions (5-minute segments of OSA or normal breathing [NB]) during stable N2 sleep) at baseline (T0), during APAP initiation (T1) and after 6 months of successful APAP treatment (T2). Results 75 patients (61 male, 65±12 years, LVEF 31±9%) were enrolled. OSA was associated with a 17% increase in the low frequency/high frequency component ratio of heart rate variability (LF/HF) versus baseline, suggesting an increase in sympathetic drive (SVB) with OSA compared with normal breathing at baseline. Respiratory indices and oxygen saturation all significantly improved at both T1 and T2, but 6 months' APAP had no clinically relevant effect on objective sleep quality versus control. In HFrEF patients -suitable for HRV analysis (n=23)-, there was a trend (p=0.097) towards an increase in LF/HF at T2 in the therapy group (+17%), suggesting increased SVB. Conclusion Treatment of OSA in systolic HF patients improves respiratory indices but has no favorable effect on sleep quality. While OSA per se was associated with an increase in sympathetic drive, APAP treatment was not associated with a desired reduction in sympathetic drive. There was even a trend towards additional increases in sympathetic drive during the entire night and N2 sleep in particular. Acknowledgement/Funding This research (conductance of the APAP trial) has been supported by Resmed Germany (Martinsried, Germany).

Phrenic Nerve Stimulation and Automatic Positive Airway Pressure Therapy for Treating Central Sleep Apnea and Residual Obstructive Sleep Apnea: A Case Study

Introduction Central sleep apnea (CSA) is a neurological breathing disorder resulting from intermittent disruptions in the neural drive to breath. CSA and obstructive sleep apnea (OSA), caused by partial or complete blockage of the airway, frequently occur together. The remedē System (Respicardia, Minnetonka, MN) is an implantable device that delivers phrenic nerve stimulation therapy (PNS) to treat moderate to severe CSA. A remedē System pivotal trial patient presented following failure with mask-based therapies with baseline (BL) Apnea Hypopnea Index (AHI) 98.1 events/hour; Central Apnea Index (CAI)=60.8/Obstructive Apnea Index (OAI)=13.4/Mixed Apnea Index (MAI)=5.4/Hypopnea Index (HI)=18.4). The patient has a complex cardiovascular history including heart failure and classic sleep apnea symptoms. Hypothesis The combination of PNS and APAP for patients with CSA and residual OSA is feasible. Methods Patient was implanted with the PNS device and titrated to maximum effectiveness. Follow-up polysomnograms (PSG) were completed every 6 months. Results At the 6 month PSG, the patient transitioned from CSA into an OSA/OSA hypopnea pattern; Central Sleep Apnea Index (CAI)=1.4/Obstructive Apnea Index (OAI)=28.3/Mixed Apnea Index (MAI)=0.1/ Hypopnea Index (HI)=44.1 with Obstructive Hypopnea Index (OHI)=43.7 and this continued at the 12 month PSG. Mask-based therapy (APAP) was then added to supplement the PNS and the combination therapy was assessed during a routine PSG. Final APAP pressures of 6cmH2O-12cmH2O were well tolerated. The PSG demonstrated that with PNS off, APAP therapy treated the obstructive (apnea/hypopnea) events but did not treat the central events. PNS alone treated the CSA but did not resolve OSA (apnea/hypopnea) events. With both PNS and PAP therapy on, CSA and OSA were controlled and breathing was normalized (AHI 3.8). PSG testing at 18 months with PNS and APAP showed the AHI was reduced by 90% including a reduction in all AHI components; Central Apnea Index (CAI)=0.0/Obstructive Apnea Index (OAI)=3.9/Mixed Apnea Index (MAI)=0.0/Hypopnea Index (HI)=6.1). Epworth Sleepiness Scale improved (BL=14/6mo=4/9mo=5/12mo=6). PSG testing at 24 months with PNS on and APAP therapy off showed residual presence of hypopnic OSA and continued successful treatment of CSA; Central Apnea Index (CAI)=0.4/Obstructive Apnea Index (OAI)=0.8/Mixed Apnea Index (MAI)=0.0/Hypopnea Index (HI)=47.5 with Obstructive Hypopnea Index (OHI)=39.9). Patient remains treated with both PNS and APAP and sleeping well. Conclusion PNS effectively treated CSA. APAP therapy alone did not treat the CSA but did resolve obstructive apnea/hypopnea. Combination PNS and APAP safely and successfully treated both CSA and OSA.

APAP therapy does not improve impaired sleep quality and sympatho-vagal balance: a randomized trial in patients with obstructive sleep apnea and systolic heart failure.

In heart failure with reduced ejection fraction (HFrEF), the effects of automatic positive airway pressure therapy (APAP) for obstructive sleep apnea (OSA) on sleep quality and sympatho-vagal balance (SVB) are unknown. In this randomized controlled trial (6months of APAP vs. nasal strips as control), sleep quality and SVB in patients with HFrEF and OSA were monitored. The distinction was made between different breathing conditions (5-min segments of OSA or normal breathing [NB] during stable N2 sleep) at baseline (T0), APAP initiation (T1), and 6months of successful APAP treatment (T2). Of 75 patients enrolled, 61 were men with average age of 65 ± 12years and LVEF of 31 ± 9%; 37 patients were randomized into the APAP and 38 into the control (nasal strips only) group. At T0, OSA was associated with a 17% increase in the low-frequency/high-frequency component ratio of heart rate variability (LF/HF) versus baseline, suggesting an increase in sympathetic drive (SVB) with OSA compared with normal breathing. Respiratory indices and oxygen saturation all significantly improved at both T1 and T2, but at 6months, APAP had no clinically relevant effect on objective sleep quality versus control. In fact, in patients with HFrEF (n = 23 with data suitable for HRV analysis), there was even a trend (p = 0.097) towards an additional 17% increase in LF/HF at T2 in the therapy group, suggesting (undesired) increased SVB in the APAP group. Treatment of OSA in patients with systolic HF improves respiratory indices but does not have a favorable effect on sleep quality. While OSA per se was associated with an increase in sympathetic drive, APAP treatment was not associated with a reduction in sympathetic drive. After 6months of treatment, there was even a trend towards additional increases in sympathetic drive in the APAP group.

Therapeutic Outcome of Primary Snoring and Mild Obstructive Sleep Apnea and Clinical Suggestion for Treatment Approaches

Background and Objectives The clinical significance and need for the treatment of primary snoring and mild obstructive sleep apnea have been recently questioned. In this study, we analyzed therapeutic outcome and the methods of treatment of such diseases. Subjects and Method A retrospective review was conducted using the medical records of patients diagnosed with primary snoring or mild obstructive sleep apnea at a single institution from 2013 to 2015 through polysomnography or WATCHPAT. Results Of the 18 patients (37%) with primary snoring, 13 patients (72.2%) underwent surgery, four patients (22.2%) were treated with surgery and mandibular advancement device, and one patient (5.6%) underwent automatic positive airway pressure therapy. Of the 78 patients (61%) with mild obstructive sleep apnea, 35 patients (44.8%) had surgery, 24 patients (30.8%) were treated with mandibular advancement device, 13 patients (16.7%) were treated with surgery and mandibular advancement device and 6 patients (7.7%) received automatic positive airway pressure therapy. For primary snoring, while Epworth Sleepiness Scale and Pittsburg Sleep Quality Index did not improve, the snoring visual analog scale decreased significantly. In patients with mild obstructive sleep apnea, Apnea-Hypopnea Index, snoring decibel, Epworth Sleepiness Scale, and Pittsburg Sleep Quality Index were significantly decreased after treatment and the lowest oxygen saturation was significantly increased after treatment. Conclusion For primary snoring, the direction of treatment should be determined in accordance with the presence of associated diseases related to sleep disturbance breathing. For mild obstructive sleep apnea, active treatment may be helpful. Key words: Mild obstructive sleep apnea ㆍ Outcome ㆍ Primary snoring

IMPACT OF POSITIVE AIRWAY PRESSURE THERAPY ON CARDIAC FUNCTION IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION AND OBSTRUCTIVE SLEEP APNEA: A RANDOMIZED, CONTROLLED TRIAL

The Automatic Positive Airway Pressure (APAP) trial investigated the effects of nocturnal APAP therapy on cardiopulmonary function in heart failure with reduced ejection fraction (HF-REF) patients (pts) with moderate-to-severe obstructive sleep apnea (OSA). Aim of this sub-study was to investigate

Fixed versus automatic positive airway pressure therapy for positional obstructive sleep apnoea ‐ a double‐blind, randomised trial

Fixed versus automatic positive airway pressure therapy for positional obstructive sleep apnoea ‐ a double‐blind, randomised trial

Automatic positive airway pressure for treatment of obstructive sleep apnea in heart failure

Moderate-to-severe obstructive sleep apnea (OSA) has been documented in about 20% of patients with heart failure and reduced ejection fraction (HF-REF). Continuous positive airway pressure (CPAP) is the gold standard for OSA treatment, but very few studies have investigated the effects of CPAP on quality of life, cardiac function, and outcome in HF-REF patients. The Automatic Positive Airway Pressure (APAP) trial is investigating the effects of automatically-adjusting CPAP on cardiopulmonary exercise capacity, OSA parameters, HF status, and quality of life in HF-REF patients with moderate-to-severe OSA. This prospective, single-center trial (DRKS00000446) randomized HF-REF patients (NYHA ≥ II, ejection fraction ≤45%) with moderate-to-severe OSA (apnea–hypopnea index ≥15/h) to 6 months of treatment with APAP (AutoSet™, ResMed) or nasal strips (control). The primary endpoint is change in cardiopulmonary exercise (CPX) capacity parameters in HF-REF patients treated with nasal strips (control group) or APAP from baseline to 6 months. These parameters include peak oxygen uptake (VO2 peak), predicted peak oxygen uptake (predicted VO2 peak), and oxygen uptake at the individual aerobic–anaerobic threshold (VO2-AT) during a standardized testing protocol. Secondary endpoints include changes in sleep apnea parameters, quality of life, sleepiness, laboratory (including natriuretic peptides) and echocardiographic (ejection fraction, dimensions) measurements, and 6‑min walk distance. The APAP trial was designed to assess the efficacy of APAP therapy for OSA on cardiopulmonary exercise capacity in HF-REF patients after 6 months. Secondary endpoints will reveal its effects on quality of life, sleepiness, and metrics of cardiac morphology and function.

Obstructive sleep apnea symptoms beyond sleepiness and snoring: effects of nasal APAP therapy

The purpose of this study was to evaluate the prevalence and assess the response to nasal automatic positive airway pressure (APAP) therapy of less typical symptoms in patients diagnosed with obstructive sleep apnea (OSA), like fatigue, gasping, nocturia, nocturnal sweating, morning headaches, heartburn, and erectile dysfunction. Ninety-eight male patients with moderate to severe OSA were included in the study (n = 98). In the beginning of the study, an overnight sleep study was performed to all subjects using a five-channel recording device. Patients started APAP therapy with pre-determined minimum and maximum pressures of 4 and 15cmH(2)0, respectively. The total Sleep Disorders Questionnaire was answered by all subjects before and 6months after APAP therapy. Questions 4, 18, 23, 25, 58, 88, and 148 were used in this study. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) 17.0 software. Subjects had a mean (SD) age of 55.1 (10.8) years and an average of 52.2 (21.4) apnea-hypopnea events per hour of sleep. At baseline, nocturia was the most prevalent symptom (38%), followed by nocturnal sweating (34%), gasping (30%), erectile dysfunction (25%), fatigue (23%), heartburn (15%), and morning headaches (10%). After 6months of APAP therapy, a statistically significant reduction on the prevalence of all symptoms was observed, except for erectile dysfunction and morning headaches. The findings suggest that APAP therapy is effective in controlling the majority of OSA symptoms beyond sleepiness and snoring.

Impacto da umidificação aquecida com pressão positiva automática em vias aéreas na terapia do síndroma de apneia obstrutiva do sono

To study the impact that heated humidification instituted in the beginning of automatic positive airway pressure (APAP) therapy has on compliance with and the side effects of the treatment. Thirty-nine treatment-naïve patients with obstructive sleep apnea were randomized into two groups to receive APAP using one of two modalities: with heated humidification (APAPwith group); and without heated humidification (APAPw/o group).Patients were evaluated at 7 and 30 days after APAP initiation. The following parameters were analyzed: compliance with treatment (mean number of hours/night); side effects (dry nose or mouth, nasal obstruction and rhinorrhea); daytime sleepiness (Epworth sleepiness scale score) and subjective comfort (visual analog scale score). Patients were also evaluated in terms of residual apnea-hypopnea index (AHI), as well as mean pressures and leaks registered in the ventilators. There were no differences between the two groups in terms of mean age (APAPwith: 57.4 +/- 9.2; APAPw/o: 56.5 +/- 10.7 years), AHI (APAPwith: 28.1 +/- 14.0; APAPw/o: 28.8 +/- 20.5 events/hour of sleep), baseline Epworth score (APAPwith: 11.2 +/- 5.8; APAPw/o: 11.9 +/- 6.3) and initial nasal symptoms. Compliance was similar in both groups (APAPwith: 5.3 +/- 2.4; APAPw/o: 5.2 +/- 2.3 h/night). There were no differences in any of the other parameters analyzed. The introduction of heated humidification at the beginning of APAP therapy provided no advantage in terms of treatment compliance or side effects of treatment.