Continous Positive Airway Pressure Research Articles

Comparison of high flow nasal cannula therapy to nasal oxygen as a treatment for obstructive sleep apnea in infants.

Obstructive sleep apnea (OSA) in infants is treated with low flow oxygen via nasal cannula (NC), CPAP (continous positive airway pressure), or surgery. Literature supports the use of high flow NC (HFNC) in children in the outpatient setting, however there is limited data on the use of HFNC in infants. The purpose of this study was to compare HFNC and low-flow oxygen as treatments for OSA in infants. A prospective pilot study was performed at two institutions. Infants with primarily OSA underwent a 3-4 h sleep study with HFNC titration at 6-14 lpm for OSA, followed by clinical polysomnography (PSG) for oxygen titration (1/8-1 lpm). Infants with primarily central apnea were excluded. Nine infants were enrolled, with a mean age of 1.3 ± 1.7 months. Average apnea hypopnea index (AHI), average obstructive apnea hypopnea index (OAHI) and average central apnea index during the diagnostic PSG was 17.2 ± 7/h, 13.4 ± 5.4/h and 3.7 ± 4.8/h respectively. OSA improved in 44.4% of subjects with HFNC; the mean AHI and OAHI decreased from 15.6 ± 5.65/h and 12.8 ± 4.4/h on diagnostic PSG to 5.12 ± 2.5/h and 4.25 ± 2.5/h on titration PSG. OSA improved universally with low flow oxygen; the mean AHI decreased from 17.2 ± 7/h on diagnostic PSG to 4.44 ± 3.6/h on titration PSG. HFNC reduced OSA in some infants, though low flow oxygen reduced OSA in all subjects. Respiratory instability (high loop gain) in infants may explain why infants responded to low flow oxygen. More studies are needed to determine if HFNC is beneficial in selected groups of infants with OSA.

Effect of Clinical Pathway on Nurses' Performance and Neonates Outcomes regarding Noninvasive Continous Positive Airway Pressure

Noninvasive continuous positive airway pressure is a means of providingrespiratory support to neonates vulnerable to respiratory problem and complications. Clinicalpathway provide detailed guidance for each stage in the management of neonates with a specificcondition over a given time period and include progress and outcomes details

Predictors of optimum continous positive airway pressure level in obstructive sleep apnoea patients

Background: Obstructive sleep apnoea (OSA) is a breathing disorder during sleep which leads to life-threatening events. The recommended treatment for moderate to severe OSA is continuous positive pressure therapy (CPAP). Aim: To predict the optimal CPAP level in OSA. Methodology: This was a cross sectional observational study, carried out in pulmonary medicine department at a tertiary referral centre in South India. Twenty patients were recruited in the study over a period of 6 months. All patients in study group underwent CPAP titration with optimal or good titration over a full night polysomnography. Results: We correlated the optimal CPAP level with demographic, anthropometric and polysomnographic variables, which showed a trend of association between body mass index (BMI), neck circumference, apnoea hypopnoea index (AHI), oxygen desaturation index (ODI) and severity of OSA with optimal CPAP level Conclusion: No statistically significant association was observed between demographic, clinical, anthropometric and polysomnographic variables with optimal CPAP level.

CONGENITAL CYSTIC ADENOMATOID MALFORMATION OF THE LUNG: REPORT OF THREE CASES

TYPE: Late Breaking Abstract TOPIC: Pediatrics PURPOSE: Congenital cystic adenomatoid malformation (CCAM) is a rare abnormality of lung development. It is a benin lesion, typically discovered during a routine prenatal ultrasound. In low-middle income settings, the prenatal diagnosis is not always available, and these malformations are often revealed by respiratory distress during the neonatal period. METHODS: We report a series of three neonates admitted to our pediatric ICU for respiratory distress secondary to CCAM. RESULTS: Three neonates A, B and C were admitted to the pediatric ICU for respiratory distress. They were aged 18 , 21 and 90 days respectfully. Prenatal diagnosis of CCAM was available in one case. Thoracic CT-scan showed CCAM of the inferior left lobe in case A, of the superior and median right lobes in case B, and of the hole right lung in case C. Case A presented with pneumothorax, he underwent a needle aspiration before surgery. Left inferior lobectomy was performed. Case B presented with severe hemodynamic instability and surgery was not performed. He died 3days later. Case C underwent atypical resection of the cystic malformations. In both surgical cases, neonates were admitted to PICU, were extubated 4 hours post-operatively and put on continous positive airway pressure (CPAP) for 24 hours. Oxygen therapy weaning was successful after 48h.They were tranfered to the pediatric surgery ward. CONCLUSIONS: CCAM is a rare malformation causing respiratory distress in neonates. Surgical procedures such as lobectomy or atypical resections are usualy performed. Complications such as pneumothorax may occur before surgery. CLINICAL IMPLICATIONS: Prenatal diagnosis is essentiel to improve the outcome of CCAM. DISCLOSURE: Nothing to declare. KEYWORD: Congenital cystic adenomatoid malformation

Outcome of Locally Assembled Continous Positive Airway Pressure Device in Neonates with Respiratory Distress in Low Resource Setting

Respiratory distress is the most frequent cause of neonatal admission in neonatal intensive care unit (NICU). Continuous Positive Airway Pressure (CPAP) is an effective mode of treatment in newborn with respiratory distress. CPAP is the application of positive pressure to the airways of spontaneously breathing patient throughout the respiratory cycle. Low cost CPAP can be locally assembled and used in neonates with respiratory distress to reduce the mortality. This is a cross sectional descriptive study conducted in NICU of Nepal Medical College Teaching Hospital from the period of June 2021 to September 2021 to assess the outcome of locally assembled CPAP. A total of 96 newborns with respiratory distress were included in the study. Severity of respiratory distress was assessed by Downes score. Downes score before and after CPAP were recorded. Newborn with Downes score of ≥4 was started with locally assembled CPAP. Outcome was taken as improvement when the respiratory distress was decreased with Downes score<4. And it was taken as a failure when baby required mechanical ventilation. Mean Downes score before starting CPAP was 4.81 and after CPAP was 0.51. Mean CPAP pressure was 4.27cm of water. Outcome of study showed, 80 (83.3%) babies were improved, 7 (7.3%) had failed CPAP who required mechanical ventilation and 1 (1%) baby expired. In conclusion, locally assembled CPAP shown to be equally effective as standard CPAP device and can be used as an effective alternative to mechanical ventilator in developing country with limited resource setting.

EFFECT OF EzPAP DEVICE ON PULMONARY FUNCTION TESTS DURING PERIOPERATIVE PERIOD IN PATIENTS UNDERGOING GENERAL ANAESTHESIA FOR MORE THAN 2 HRS.

BACKGROUND-EzPAP is an option for treating and preventing atelectasis. It provides positive pressure that amplies an input ow of either air or oxygen approximately 4 times and this auguementation provides a larger ow with less effort than an unsupported inspiration and PEEP provided on expiration.So it clear secrections,increase lung volume and improve gas exchange.It provides positive pressure therapy independent of patient efforts;thus improve lung functions.EzPAP is an easily implemented ,disposable device that delievers continous positive airway pressure using ow from an oxygen ow meter via a mouthpiece or facemask .It provides a costeffective and easily utilized form of CPAP. OBJECTIVE-This study was carried out to compare the effects of EzPAP therapy on pulmonary function test after abdominal surgeries under general anaesthesia for more than 3 hrs and compare the postoperative volumetric spirometric values FVC,PEFR,FEV with preoperative baseline values. 1 Method-we conducted a prospective interventional study in 35 ASA I and II patients posted for elective abdominal surgeries .Various parameters such as age ,sex,surgeries ,time for surgery ,pulmonary spirometric values FVC,PEFR,FEV at preoperative 1 24 hrs and postoperative 48 hrs are noted.Quantitative analysis done. RESULTS-In this selected group of patients who are taken EzPAP therapy difference between preoperative and postoperative lung volumes was higher in postoperative conditions for parameters FVC,PEFR,FEV after EzPAP therapy.Medway NHS 1 foundation trust department based clinical study in their study ,EzPAP in relation to increasing or maintaining lung volumes and results in improvement in all physiological parameters. CONCLUSION- This prospective interventional study suggests that;EZPAP positive airway pressure device is a useful to improve respiratory functions and clinical improvements in lung volumes in the post operative patients undergoing general anaesthesia for more than 2 hrs , preventing atelectasis and postoperative hypoxemia .

RELATIONSHIPS BETWEEN CLINICAL RENAL PARAMETERS AND OSAS

SESSION TITLE: Sleep Disorders Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To assess the possible relationships between OSA and renal outcomes analysis. In OSAS, the sleep fragmentation and repetitive episodes of hypoxia/reoxygenation increase sympathetic activity, endothelial dysfunction, oxidative stress, lipid dysregulation and, systemic inflammation with direct effect on renal function. METHODS: We conducted a follow-up prospective study of 55 outpatients (mean aged 52.58±5.17 years) diagnosed with OSA and 26 healthy controls (mean aged 51.19±5.51 years), unselected for the presence of kidney disease. Demographic, anthropometric (weight, height), smoking history, blood pressure, plasma lipid profile: triglycerides (TG), total cholesterol (TC), Low Density Lipoprotein cholesterol (LDLc), High Density Lipoprotein cholesterol (HDLc), blood albumin and glycemia were assessed. Kidney function was determined by serum creatinine and urea, urine Albumin Excretion Rate (AER), Urinary Protein Excretion Estimation (UPEE), urinary Albumin/Creatinine Ratio (ACR), Urea/Creatinine Ratio (UCR), and creatinine clearance, as an estimate of Glomerular Filtration Rate (eGFR), calculated according to the Cockcroft and Gault and Modification of Diet in Renal Disease equation formulas. All subjects underwent cardiorespiratory poligraphy with VitalNight plus Sleep Diagnosis System according to the American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events, version 2.6 recommendations. Before testing, all participants were asked to complete the Epworth Sleepiness Scale (ESS) questionnaire. Statistical analysis included Spearman correlations tests, t test and one-way ANOVA test. RESULTS: In OSAS patients versus control, we found UPEE (p=0.04), ACR (p=0.0008), creatinine clearance (p=0.01), blood albumin (p= 0.01), TC (p=0.006), TG/albumin ratio (p= 0.0003) were significantly higher, meanwhile eGFR (p=0.01) and HDLc (p=0.04) were lower. In OSAS group, correlations are as follows: Apnea/Hypopnea Index (AHI) and TG/HDLc ratio (r=0.27;p=0.04), AHI and HDLc (r=-0.37;p=0.003); Oxygen Desaturation Index (ODI) and creatinine clearance (r=-0.29;p=0.02), ODI and UCR (r=0.37;p=0.004); eGFR and apneas number (r=0.30;p=0.02), the longest duration of oxygen saturation (minutes) (SpO2)£88% (r=-0.25;p=0.05); UPEE and glycemia (r=-0.40;p=0.002), UPEE and LDLc (r=0.41;p=0.001); TG and ACR (r=0.36;p=0.006), TG and AER (r=0.38;p=0.004). CONCLUSIONS: In OSAS patients, eGFR, UPEE, ACR may have predictive value of early stage kidney disease and, should consider screening in patients with OSA. CLINICAL IMPLICATIONS: A better understanding of pathophysiological mechanisms in this association may improve the role of treatment with continous positive airway pressure (CPAP) and reconsider the antioxidants that could attenuate intermittent hypoxia related to kidney disease. DISCLOSURES: No relevant relationships by Mihaela Gloria Martius, source=Web Response no disclosure on file for Roxana Maria Nemeș; No relevant relationships by Ancuta Petrovan, source=Web Response no disclosure on file for Carmen Monica Pop; No relevant relationships by Ligia Puiu, source=Web Response no disclosure on file for Emilia Tabacu

Early Vs Delayed C-Pap in RDS in Newborns

Background- Early versus delayed initiation of nasal continous positive airway pressure for treatment of respiratory distress syndrome in premature newborns. Aims- The prospective study was aimed to compare between early continuous positive airway pressure and late continuous positive airway pressure in premature newborns in case of respiratory distress syndrome. Methods and Materials- This was a randomized controlled trial where data of 72 preterm neonates with 28-37 weeks were admitted in NICU of Muzaffarnagar Medical College between January 2019- December 2019 were collected and analyzed. Infants were randomly assigned to early CPAP (initiated at half an hour after birth) or to the late CPAP (initiated after half an hour after birth) treatment groups. The primary outcome were need for surfactant administration and need for ventilator support after birth and secondary outcomes was intraventricular haemorrhage and death. Results- There was no significant difference between the two groups with regard to intraventricular haemorrhage and death. But the need for surfactant administration was significantly reduced in the early CPAP group (P=0.04). Infants in the early CPAP group less frequently required mechanical ventilation. Conclusion- Early CPAP is more effective than late CPAP for the treatment of respiratory distress syndrome and can be helpful in reducing the need for some invasive procedures such as intubation and mechanical ventilation.

Prone and Lateral Positioning in Spontaneously Breathing Patients With COVID-19 Pneumonia Undergoing Noninvasive Helmet CPAP Treatment

Prone and Lateral Positioning in Spontaneously Breathing Patients With COVID-19 Pneumonia Undergoing Noninvasive Helmet CPAP Treatment

Nasal high-frequency percussive ventilation vs nasal continuous positive airway pressure in newborn infants respiratory distress: A cross over clinical trial.

To determine if nasal high-frequency percussive ventilation (nHFPV) to manage neonatal respiratory distress decreases the regional cerebral oxygen saturation (rScO2 ) compared to nasal continous positive airway pressure (nCPAP). A prospective, randomized, monocentric, open-label, noninferiority crossover trial. Newborns of gestational age (GA) ≥ 33 weeks exhibiting persistent respiratory distress after 10 minutes of life were treated with nHFPV and nCPAP, in succession and in random order. The primary endpoint was the mean rScO2 , as revealed by near-infrared spectroscopy (NIRS). Forty-nine newborns were randomized; the mean GA and birth weight was 36.4 ± 1.9 weeks and 2718 ± 497 g. The mean rScO2 difference during the last 5 minutes of each ventilation mode (nHFPV minus nCPAP) was -0.7 ± 5.4% (95% confidence interval (CI) -2.25; 0.95%). In our study on newborns of GA ≥33 weeks treated for respiratory distress, cerebral oxygenation via nHFPV was not inferior to nCPAP.

Efficacy of bubble continous positive airway pressure in newborns with respiratory distress and its outcome in tertiary care hospital, Tirupathi

Background: Respiratory distress is one of the commonest emergency occurring mostly within the first 48-72 hours of life. Bubble continuous positive airway pressure (bCPAP) is essential to manage acute respiratory distress in neonates. Method: A Hospital based prospective observational study was done at SNCU at Department of Pediatrics, Sri Venkateswara Ramnarayan Ruia Government General Hospital, Tirupati from October 2017 to September 2018. Efficacy of bCPAP was judged based on Downe /SAS scoring. Results: Out of 171 babies who were managed with bCPAP, it proved effective in 118 babies (69%). The results analyzed based on gender and gestational age were found statistically significant difference (p 0.05). The mean age for initiation of treatment is 9.39±15.022 hours. Overall Mean duration on bCPAP was 24.24±18.22. The success rate was more in babies with RDS 68.2%. There was a significant improvement in Downe/SAS scores in babies with RDS, Pneumonia, MAS and TTNB. The complications were more in failure group. Study of mortality rate was more in the failure group 81%and the survival rate was more in success group 100%. Conclusion: CPAP appears to be the best option to manage infants with respiratory distress at SNCUs of peripheral levels.

Oksigenasi dengan Bag and Mask 10 LPM Memperbaiki Asidosis Respiratorik

Introduction: ALO (Acute Lung Oedema) is the most common and remarkably life threatening medical emergency. It is not unusual that clients come to the hospital in critical condition. ALO occurs due to fluid accumulation in the alveoly, thereby impairing gas exchange and the client will experience respiratory acidosis and hypoxemia. The ALO management that must be urgently carried out is high concentration oxygenation with PEEP (Positive End Expiratory Pressure) to prevent alveolar collapse by means of Bag and Mask oxygenation, CPAP (Continous Positive Airway Pressure) mask and mechanical ventilation. The objective of this study was to explain the effect of oxygenation by using 10 lpm (liters per minute) bag and mask on respiratory acidosis improvement in ALO client. Method: A pre-experimental one group pre post test design was used in this study. The population were all ALO clients in ICU (Intensive Care Unit), Adi Husada Kapasari Hospital. There were 12 respondents which taken by using total sampling. Data were collected by using observation on the blood gas analyze (pH, PaCO2 and PaO2) then analyzed by using Paired t-Test with significance level a≤0.05. Result: The result showed that 12 respondents experienced respiratory acidosis and hypoxemia before intervention with 10 lpm bag and mask oxygenation was gave to them. After intervention for 1 hour, the result showed that pH increased (p=0.003), PaCO2 reduced (p=0.004) and PaO2 increased (p=0.005). Discussion: It can be concluded that 10 lpm bag and mask oxygenation had significance effect on the improvement of respiratory acidosis in ALO clients. Further studies should involve more respondents and more reliable measurement tools to obtain better accuracy.

Obstructive Sleep Apnea: Update and Future.

Obstructive sleep apnea (OSA) is a worldwide disease whose prevalence is increasing as obesity rates increase. The link between obesity and OSA is likely to be the deposition of fat in the tongue, compromising upper airway size. The role of obesity varies in different ethnic groups, with Chinese being particularly sensitive to increases in weight. OSA lends itself to a personalized approach to diagnosis and therapy. For example, different clinical OSA subtypes likely benefit from therapy in different ways. Hypoglossal nerve stimulation is a useful second-line therapy in patients who cannot tolerate continous positive airway pressure (CPAP) machines or intraoral devices. Technological advances allow patients to participate in their own care, and doing so improves CPAP compliance. We are entering a future where we can focus efforts to predict and prevent OSA on an individual level.

Îmbunătăţirea calităţii vieţii la pacienţii cu sindrom de apnee în somn şi accident vascular cerebral

Introduction. Obstructive sleep apnea syndrome (OSAS) is the most frequent pathology among respiratory disorders during sleep and determines multiple sleep fragmentations causing excessive daytime sleepiness. The stroke represents an important death cause worldwide and the most frequent cause of disability on long term. This study shows the improvement of the quality of life in patients with sleep apnea syndrome and stroke, who follow the continous positive airway pressure (CPAP) treatment, in comparison with those who refused this therapy. Material and method. I conducted a study on 262 patients between 18 and 83 years old, admitted in the „Bagdasar Arseni” Clinical Emergency Hospital and the „Marius Nasta” Pneumology Institute between 01.01.2014 – 25.05.2015 and diagnosed with obstructive sleep apnea syndrome, with or without CPAP treatment, 12 of these patients having a stroke in their medical history. Results. All of the patients with history of stroke, regardless of the CPAP therapy use, were asked to complete the quality of life questionnaire SF-36. In the group of patients who were following the CPAP treatment it was registered an improvement on the quality of life. Conclusions. Present data show that OSAS can be a predisposing risk factor for stroke. At the moment there aren’t any guidelines to state if patients with stroke should be commonly investigated for sleep apnea syndrome.

Effect of Continous Positive Airway Pressure Treatment on Depression, Anxiety and Percieved Stress Levels in Patients with Obstructive Sleep Apnea Syndrome

The aim of this study is to determine the effects of continuous positive airway pressure (CPAP) treatment on depression, anxiety, and perceived stress levels and to identify factors predictive of treatment efficacy in patients with obstructive sleep apnea syndrome (OSAS). This study included 51 patients admitted to the Adiyaman University Medical School Otorhinolaryngology Department or Eskisehir Yunus Emre State Hospital between January and September 2014 with one or more complaints including snoring, excessive daytime sleepiness, or apnea witnessed by the partner. Diagnosis of OSAS was made by polysomnography and CPAP treatment was initiated. Depression levels were assessed in all study subjects using the Hospital Anxiety and Depression Scale (HADS) at the start of treatment and at 3 months. Anxiety levels were assessed using both the HADS and the State and Trait Anxiety Inventory (STAI), and perceived stress level was assessed using the Perceived Stress Questionnaire (PSQ). After CPAP treatment, we observed significant decreases in both the Depression and Anxiety Subscales of the HADS, in the Trait Anxiety subscale of the STAI, and in the PSQ. An evaluation of the initial parameters that predict improvements in these scales revealed that snoring time predicted decreases in all scale scores. In OSAS patients CPAP treatment has positive effects on psychological parameters like depression, anxiety, and perceived stress. We suggest that possible psychogenic benefits should be considered when deciding to start CPAP treatment, particularly in patients with pronounced and extended snoring who may also have social problems.

P95. REM sleep without atonia and REM sleep behavioral disorder in patients with amytrophic lateral sclerosis

REM sleep behavioral disorder (RBD) is characterized by dream-enacting behavior arising from REM sleep. On polysomnography (PSG), physiological muscle atonia is absent during phasic REM sleep in patients with RBD. RBD reflects disinhibition of cortical motor impulses on the brainstem level during REM sleep. RBD comprises a prodromal or concomitant condition in neurodegenerative diseases characterized by α-synuclein deposition. In patients with amyotrophic lateral sclerosis (ALS) RBD has not been systematically been investigated. Since neurodegeneration in ALS spreads from the motor cortex to the bulbar reticular formation we retrospectively studied the presence of REM sleep without atonia (RSWA) and RBD in patients with ALS. Patients with possible, probable or definite ALS according to the revised El Escorial criteria were included in the study. Occurrence of nocturnal behavioral abnormalities was assessed by a standardized physician interview. Exlusion criteria were tetraplegia, home ventilatory support, continous positive airway pressure support for obstructive sleep apnea, concomitant PD or MSA, dementia, and medication with either benzodiazepines or tricyclic antidepressants. Video polysomnography was performed according to standard recommendations, and PSG records were validated manually by two independent scorers according to the AASM criteria. Tonic muscle activity during REM sleep was scored when 50% ore more of a single 30 s epoch showed an EMG amplitude higher than the smallest EMG amplitude during non-REM sleep. Phasic muscle activity during REM sleep was scored when 5 out of 10 3 s mini-epochs showed transient muscle activity for 0.5–1.0 s with an EMG amplitude at least 4-fold above background activity. Classification of behavioral abnormalities during REM sleep was performed based on the widely used RBD severity scale (RBD-SS). Video-polysomnography records of 12 patients underwent detailed analysis. Three patients were female. Mean age was 48.8 years. One patient was diagnosed to have familial ALS with a proven mutation in the FUS gene. Two patients had bulbar onset of ALS symptoms. Behavioral abnormalities or increased motor acitivity during sleep clearly not associated with nocturnal dyspnea were reported by two patients and their bed partners. Subtle clinical signs of parkinsonism were present in only one of these patients on admission (mild hyposmia, distal rigor). Both patients showed dream-enacting behavior in combination with RSWA on video-PSG confirming RBD. Four patients without self-reported symptoms of possible RBD exhibited non-physiologic motor activity during REM sleep including jerks and vocalisations. Violent behavior or vigorous movements did not occur. 9 out of 12 patients showed tonic or phasic musle activity on surface EMG reflecting RSWA. It is not known whether ALS predisposes to the development of RBD. In accordance to very few case reports in the literature our study suggests that both RSWA and mild RBD may be encountered in patients with ALS. Further studies in larger patient samples are necessary to elucidate the prevalence of RBD in patients with ALS.

Prevalence of central sleep apnea during continous positive airway pressure (CPAP) titration in subjects with obstructive sleep apnea syndrome at an altitude of 2640 m

BackgroundThe occurrence of central apneas when applying positive pressure (CPAP) to patients with obstructive sleep apnea syndrome (OSAS) is called complex sleep apnea (CompSA). This causes poor adherence to CPAP and persistence of symptoms. In Bogota, a city located at an altitude of 2640 m above sea level, chronic hypoxemia can generate certain instability of the respiratory system during sleep which could increase the presence of central apnea. The aim was to establish the prevalence of central apnea (central apnea index >5/h) in adults with moderate or severe OSAS during CPAP titration, and the factors associated with this. MethodPatients over 18 years old with OSAS were referred to the Fundacion Neumologica Colombiana Sleep Center, from January 2008 to June 2010. Polysomnogram (PSG) for CPAP titration was performed according to the American Academy of Sleep Medicine criteria. The prevalence was calculated and the clinical and baseline PSG factors associated with the CompSA were analyzed. ResultsWe included 988 patients, 58% men. CompSA prevalence was 11.6%. Factors associated with CompSA were: central apneas in the baseline PSG (OR: 5.34 [3.49–8.16]), history of heart failure (OR: 2.53 [1.58–4.07]), and male sex (OR: 1.68 [1.06–2.69]). ConclusionThe prevalence of complex sleep apnea in Bogota (11.6%) was intermediate compared to the reported in lower altitudes. The factors associated with the development of CompSA were male sex, heart failure, and the presence of central apnea in the baseline PSG.

Obstruktif uyku apne sendromu olan erektil disfonksiyonlu erkek hastalarda polisomnografik bulguların analizi ve nazal CPAP tedavisinin erektil disfonksiyon üzerine etkisi

Objective: We aimed to investigate the relationship between polysomnographic (PSG) findings and sexual functions of men with erectile dysfunction (ED) caused by obstructive sleep apnea (OSA) syndrome. and point out the alteration in the sexual functions after continous positive airway pressure (CPAP) theraphy. Materials and Methods: Patients referred to Yunus Emre State Hospital sleep laboratory between May 2013 and October 2013 with a complaints of snoring and apnea during sleep and have apnea hypopnea index (AHI)>15 were the subjects of this prospective clinical study. All patients were asked to fill IIEF (International Index of Erectile Function) test before and after 12 weeks of CPAP theraphy. Results: As well as total IIEF-15 scores, each score of five questions (erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction) were significantly increased after nasal CPAP therapy (p

Allergic contact dermatitis due to use of a continous positive airway pressure mask - A rare case report

Nasal continuous positive airway pressure (CPAP) is commonly used to treat various respiratory conditions including obstructive sleep apnea (OSA). It is now the treatment of choice for patients with sleep apnea syndrome (SAS). Several side effects related to the use of nasal CPAP are described in the literature. Mask interface related issues can be an important determinant of adherence to continuous positive airway pressure (CPAP) therapy and the side effects can cause patients to discontinue this effective therapy. We report a case of 72 year old man who used nasal CPAP for 6 months for the treatment of OSA and developed allergic contact dermatitis (ACD) from a CPAP nasal mask.

Nailfold Capillaroscopy: An Important Clinical Tool for the Vascular Surgeon

The current practice of neonatal medicine has been carved with recent findings based on studies and prospective or follow-up studies of potentially very severe patients who, at birth, are more likely to not survive than grow and develop normally. Thanks to a better understanding of the pathophysiology of specific diseases of the immature newborn and technical and scientific improvements in the care and treatment of these patients. Especially the introduction of antenatal corticosteroids, parenteral nutrition, synchronized mode of ventilations which are patient triggered and non-invasive ventilation, like CPAP (Continous Positive Airway Pressure) for newborns. The better resuscitation care, the knowledge about the golden hour approach and the exogenous surfactant was a dramatic reduction in mortality of these patients over the past 3 decades. Having reached a low neonatal mortality, the focus of Perinatology now also addressing the quality of life in the medium and long-term patients discharged from the Maternity Hospital.