Continuous Positive Airway Pressure Compliance Research Articles

An overview on the role of epiglottis in obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is common sleep disorder with its multimodal effect on health. OSA, if untreated can lead to various cardiovascular, cerebrovascular, psychological, cognitive as well as sexual morbidities. Continuous positive airway pressure (CPAP) device is considered as the gold standard in the treatment of OSA. Epiglottic collapse (EC) in OSA has evolved an important factor in the management of OSA as the CPAP may worsen the sleep apnoea. EC in itself is classified into primary or secondary, partial or complete, anteroposterior or lateral. Epiglottic collapse is considered as one of the causes for poor adherence to CPAP devices. There are newer diagnostic modalities to diagnose and distinguish primary and secondary epiglottic collapse of which interventional drug induced sleep endoscopy plays a viable and important role. CPAP still serves as a primary treatment modality for multilevel OSA with EC. Surgical treatment modalities for EC is aimed at improving the compliance of CPAP as well as for relieving the obstruction. Surgical options primarily include epiglottectomy, glossoepiglottopexy, epiglottis stiffening operations.

Positive Airway Pressure and Mask Factors Affecting Adherence in Patients with Obstructive Sleep Apnea

Purpose: Sleep apnea is a major risk factor for cardiovascular disorders. CPAP (Continuous Positive Airway Pressure) therapy is the main treatment for sleep apnea. However, adherence with CPAP remains a concern. Although there are various factors attributed to failure of CPAP therapy, mask related factors are not well studied. Methods: The study recruited patients with obstructive sleep apnea using CPAP from neurology outpatient clinic at Progressive Neurology and Sleep Center. An IRB (Institutional Review Board) approved questionnaire was administered to evaluate factors affecting CPAP compliance. Results: The study recruited 24 patients. It showed that almost 50% of the patients did not like using CPAP, 70.8% patients felt that the mask bothered them in sleep. Almost 67% of the patients felt sleepy at least on some days and 71% of the patients took naps, though occasionally. 87.5% of the patients had experienced dry mouth with CPAP. 91.8% of patients wanted to consider custom fit CPAP masks. Conclusion: The study showed that mask related factors play a major role in non-compliance with CPAP therapy. Designing a custom fit CPAP mask might help reduce the mask related factors further increasing CPAP adherence.

Quality of Life, Mental Health, and CPAP Compliance in Thai Patients with Obstructive Sleep Apnea during COVID-19 Pandemic.

This study is aimed at determining the quality of life, mental health, and adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) among Thai OSA patients during the coronavirus disease 2019 (COVID-19) pandemic as this data has been lacking. A cross-sectional study was conducted at a university hospital between September 2021 and April 2022. OSA patients aged 18 years or older who required home CPAP treatment were included. Sleep Apnea Quality of Life Index (SAQLI) and Depression Anxiety Stress Scales-21 (DASS-21) were used to assess quality of life and mental health, respectively. A total of 142 participants (62% male) were included, with a mean age of 54.4 ± 14.7 years and a body mass index of 29.9 ± 6.8 kg/m2. Polysomnographic data showed a mean apnea-hypopnea index of 48.0 ± 32.4 events/hour and a mean lowest oxygen saturation of 79.2 ± 12.2%. Severe OSA was observed in 66.9%. CPAP compliance was reported in 50.7%. The SAQLI score was 2.32 ± 1.12. Depression, anxiety, and stress scores in DASS-21 were 2.89 ± 3.31, 3.94 ± 3.67, and 4.82 ± 4.00, respectively. Compared to the CPAP compliance group, the CPAP noncompliance group had higher daily activity scores in SAQLI (2.98 ± 1.25 vs. 2.45 ± 1.33, P = 0.015). The quality of life for Thai OSA patients during the COVID-19 era was moderate degree. Poor CPAP compliance was significantly associated with limited daily activity. Enhancing CPAP compliance could improve the quality of life in these patients. This trial is registered with TCTR20211104004.

An Alternative In-Home Protocol to Diagnose and Treat Obstructive Sleep Apnea

Abstract Objective Obstructive sleep apnea (OSA) is a major public health problem of pandemic proportions. In-laboratory OSA diagnosis and continuous positive airway pressure (CPAP) titration are insufficient, considering the number of patients affected. Finding alternative ways to diagnose and treat OSA is mandatory, especially in this era of the coronavirus disease 2019 (COVID-19) pandemic. The present study aims to describe an alternative in-home protocol to diagnose and treat OSA. Materials and Methods We enrolled consecutive patients aged ≥ 18 years with moderate/severe OSA, who underwent in-home type-III polysomnography and home-based titration with automatic CPAP, coupled with an oximetry sensor for 3 consecutive nights. Patients were remotely monitored for 90 days to evaluate CPAP compliance and the use of an engagement tool was encouraged. Results We included 86 participants. The median time until the diagnosis was of one day. The mean time from the baseline visit until the acquisition and initiation of the CPAP therapy was of 33 (range: 17 to 52) days. Telemonitoring ensured good compliance in the first 30 (79.2%), 60 (76.3%) and 90 (74.3%) days, with an average daily use of 6.2 ± 1.4 h, 6.0 ± 1.4 h, and 6.0 ± 1.3 h respectively. About 1/3 of the patients used the engagement tool, and CPAP compliance was significantly higher among these patients compared with those who did not used the tool: 89.9% versus 73.5% (p < 0.002), 87.9% versus 70% (p < 0.003), and 86.6% versus 67.6% (p < 0.001) at 30, 60, and 90 days respectively. Conclusion We demonstrated that an alternative in-home protocol to diagnose and treat OSA is effective, ensuring good CPAP compliance after 90 days. Telemonitoring and engagement tools could be strategies to improve CPAP compliance.

Effect of particulate matter on continuous positive airway pressure adherence in obstructive sleep apnea patients.

Sleep quality could be affected by air pollution, especially for particulate matter with a diameter of less than 10 microns (PM10) and particulate matter with a diameter of less than 2.5 microns (PM2.5). However, no direct study demonstrates the relationship and impact of air pollution especially PM10 and PM2.5 on continuous positive airway pressure (CPAP) adherence. Thus, we aimed to study the correlation between PM10, PM2.5, and low CPAP adherence in subjects with obstructive sleep apnea (OSA). We conducted a time-series study from August 2016 to May 2022 in Chiang Mai, Thailand. The data from 2,686 visits of CPAP compliance records from 839 OSA patients' electronic medical records at the Sleep Disorders Center, Center of Medical Excellence, Chiang Mai University, Chiang Mai, Thailand were reviewed. The level of adherence was determined utilizing the provided data. Low CPAP adherence was defined as using CPAP for less than 240 minutes per night or less than 70% of nights (i.e., <5 nights/week) in the previous month. The correlation between the monthly average of PM10 and PM2.5 and the rate of low CPAP adherence was analyzed using generalized linear mixed model (GLMM) after adjustment for confounding factors. There was no effect of an increase in PM10 and PM2.5 on low CPAP adherence [adjusted risk ratio (RR) =0.97; 95% confidence interval (CI): 0.87, 1.09; P value =0.624 and adjusted RR =0.93; 95% CI: 0.81, 1.08; P value =0.350 for PM10 and PM2.5, respectively]. There was no effect of particulate matter on CPAP adherence in OSA patients.

Predictors of Continuous Positive Airway Pressure Adherence and Comparison of Clinical Factors and Polysomnography Findings Between Compliant and Non-Compliant Korean Adults With Obstructive Sleep Apnea.

Continuous positive airway pressure (CPAP) is the preferred treatment for obstructive sleep apnea (OSA). However, compliance with CPAP therapy varies among studies, and studies on its predictors are insufficient in Korea. This study aimed to identify factors that predict compliance with CPAP therapy in patients with OSA. We retrospectively reviewed medical records, polysomnography (PSG) records, and self-report questionnaires of patients w ith OSA. Criteria for compliance was the use of CPAP devices for ≥4 h per night for ≥70% of the consecutive 30 nights (i.e., 21 days) during the first 3 months of treatment initiation. The patients were classified into two groups: compliant and non-compliant. Logistic regression analyses were performed to identify the clinical factors and PSG parameters associated with CPAP compliance. Of the 188 participants, 80 were classified into the compliant group and 108 into the non-compliant group. The ratios of stage N1 (p=0.011) and health insurance coverage (p=0.007) were significantly associated with compliance with CPAP, with an explanatory power of 18.6% (R2=0.186, p<0.001). Stage N1 ratio and health insurance coverage were significant predictors of CPAP compliance. It is necessary to confirm whether the relationship between a high stage N1 ratio and compliance can be reproduced in a larger sample and in individuals from other countries.

Intervention Programmes among Obstructive Sleep Apnea Patients: A Systematic Review

Aims: To assess the effectiveness of intervention programs to improve functional outcomes, continuous positive airway pressure (CPAP) adherence, daytime sleepiness, and knowledge among obstructive sleep apnea (OSA) patients. Background: Oxygen desaturations, awakenings, and snoring are symptoms of OSA. Design: Through five databases such as Google Scholar, Science Direct, Web of Science, Medline, and Research Gate. Conclusions: Patients improved their knowledge; CPAP compliance was higher in the intervention group compared to the control group. Regular CPAP utilization can improve functional outcomes and reduce daytime sleepiness. Implication for practice: researchers need to develop educational initiatives appropriate for OSA patients in Malaysia.

The impact of obstructive sleep apnea treatment on microvascular complications in patients with type 2 diabetes: a feasibility randomized controlled trial.

Obstructive sleep apnea (OSA) is associated with an increased risk of diabetes-related complications. Hence, it is plausible that continuous positive airway pressure (CPAP) could have a favorable impact on these complications. We assessed the feasibility of conducting a randomized control trial in patients with type 2 diabetes and OSA over 2 years. We conducted an open-label multicenter feasibility randomized control trial of CPAP vs no CPAP in patients with type 2 diabetes and OSA. Patients with resting oxygen saturation < 90%, central apnea index > 15 events/h, or Epworth Sleepiness Scale ≥ 11 were excluded. OSA was diagnosed using a multichannel portable device (ApneaLink Air, ResMed). The primary outcome measures were related to feasibility and the secondary outcomes were changes in various clinical and biochemical parameters related to diabetes outcomes. Eighty-three (40 CPAP vs 43 no CPAP) patients were randomly assigned, with a median (interquartile range) follow-up of 645 (545, 861) days. CPAP compliance was inadequate, with a median usage of approximately 3.5 hours/night. Early CPAP use predicted longer-term compliance. The adjusted analysis showed a possible favorable association between being randomly assigned to CPAP and several diabetes-related end points (chronic kidney disease, neuropathy, and quality of life). It was feasible to recruit, randomly assign, and achieve a high follow-up rate over 2 years in patients with OSA and type 2 diabetes. CPAP compliance might improve by a run-in period before randomization. A full randomized control trial is necessary to assess the observed favorable association between CPAP and chronic kidney disease , neuropathy, and quality of life in patients with type 2 diabetes. Registry: ISRCTN; Name: The impact of sleep disorders in patients with type 2 diabetes; URL: https://www.isrctn.com/ISRCTN12361838; Identifier: ISRCTN12361838. Makhdom EA, Maher A, Ottridge R, etal. The impact of obstructive sleep apnea treatment on microvascular complications in patients with type 2 diabetes: a feasibility randomized controlled trial. J Clin Sleep Med. 2024;20(6):947-957.

In patients with obstructive sleep apnea (OSA) and nasal obstruction does nasal surgery improve continuous positive airway pressure (CPAP) compliance?

In patients with obstructive sleep apnea (OSA) and nasal obstruction does nasal surgery improve continuous positive airway pressure (CPAP) compliance?

Continuous positive airway pressure compliance in patients with mild cognitive impairment.

Sleep apnoea (SA) is associated with accelerated cognitive decline in patients with mild cognitive impairment (MCI). Treatment of SA by continuous positive airway pressure (CPAP) may slow this decline if patients comply with the treatment. The aim of this study was to assess the rate of CPAP compliance in this population. In this single-centre retrospective study conducted in a tertiary care institution, patients with a diagnosis of MCI and SA initiating CPAP between January 2015 and August 2021 were included. Data from the initial sleep recording, the 3-month follow-up and compliance with at least 12months of CPAP were analysed. Compliance was defined as an average CPAP use of at least 4h per night. 55 patients were included (49% women, age 70.7 ± 8.9years, body mass index 28.9 ± 6.5kg/m2). Aetiology of MCI was vascular (45.5%), psychiatric (12.7%) and related to Alzheimer's disease (7.3%), with 47.3% of amnesic disorders and 45.5% of dysexecutive disorders. The MiniMentalState score was 26.7 ± 3.1. SA was mostly obstructive (81.8%) with a mean apnoea-hypopnoea index of 41.1 ± 16.4/h. At 3months, 38 patients were compliant (69%) with a CPAP median use of 5.9h per night and 83% of nights. Self-reported tolerance was better in compliant patients (75.7% vs 38.5% p = 0.017). Thirty-four patients remained compliant at 12months (62%). Our results suggest a high rate of CPAP compliance in patients suffering from MCI. Compliance was related to the device tolerance, emphasizing the need to closely monitor and improve this factor.

THU413 Does Continuous Positive Airway Pressure Affect Bone Loss Process In The Population Of Sleep Apnea?

Abstract Disclosure: Y. Chen: None. A. Suresh: None. S. Haile: None. Z. Perciuleac: None. B. Soni: None. A. Cuevas Velazquez: None. A. Amirian: None. C. Udeh: None. L. Sangha: None. B. Ravichander: None. K. Aljassani: None. R. Joshi: None. A. Atrash: None. N. Ramesh: None. J. Sta. Cruz: None. S. Al-saadi: None. Introduction: Patients with obstructive sleep apnea (OSA) were reported to have higher risk of developing osteoporosis or increased bone loss. One of the theories suggested nocturnal hypoxia led to imbalanced osteoclastic activity and contributed to bone loss. Continuous Positive Airway Pressure (CPAP) is the first-line treatment for OSA, which improves airway obstruction and limits hypoxia. This study attempts to evaluate if compliant with CPAP therapy reduces bone loss. Methods: This retrospective study included patients who visited UPMC Central Pa. sleep medicine clinic from January 2010 to October 2022 with diagnosis of OSA and have at least two dual-energy X-ray absorptiometry (DEXA) after the OSA diagnosis. Patients’ records of CPAP usage on two databases, Respironics and Resmed, were used to assess the compliance of the therapy. The definition of compliance is average usage of 4hrs/night; frequency of use being 70% or above. Patient demographics, CPAP compliance, bone mineral density (BMD) and T-scores of two DEXAs were obtained. All data after diagnosis of active malignancy, hyperparathyroidism, end stage renal disease, or after patient received osteoporosis pharmacological treatment are excluded. Annual change of BMD was calculated with the difference of BMD between the two DEXA scans divided by the study interval. Two-sample t-test and chi-square test were used for analysis. Results: 265 patients were included for analysis, with 254 female (95.8%), 92.1% Caucasian, mean age 68.3 years old, mean BMI 36.7kg/m2. 165 patients were compliant and 100 were non-compliant. The two groups were identical on demographic data including age, sex, ethnicities. The median of annual BMD changes at L-spine, left femur neck, left femur total, and left radius were 0.003, −0.003, −0.002, −0.002 g/cm2 respectively in compliant group and 0.003, 0, −0.006, −0.002 g/ cm2 in non-compliant group. The annual changes of T-scores were 0, −0.043, 0, −0.036 for the compliant group and 0, 0, −0.051, −0.034 for non-compliant group. No significant within-group or between-group difference in annual bone density reduction on BMD or T-score was noted in our analysis. Discussions: Our study did not reveal the benefit of treating OSA on bone loss. Small sample size could be the leading factor for the limited effect size. Retrospective study design also restricted our study population to predominantly postmenopausal Caucasian female. Further adjustments for possible confounding factors including BMI and age might be beneficial. Future study with prospective design, larger sample size, and diverse population is encouraged to discover the effect of CPAP therapy on BMD preservation. Presentation: Thursday, June 15, 2023

Region-specific changes in brain activity and memory after continuous positive airway pressure therapy in obstructive sleep apnea: a pilot high-density electroencephalography study.

Limited channel electroencephalography (EEG) investigations in obstructive sleep apnea (OSA) have revealed deficits in slow wave activity (SWA) and spindles during sleep and increased EEG slowing during resting wakefulness. High-density EEG (Hd-EEG) has also detected local parietal deficits in SWA (delta power) during NREM. It is unclear whether effective continuous positive airway pressure (CPAP) treatment reverses regional SWA deficits, and other regional sleep and wake EEG abnormalities, and whether any recovery relates to improved overnight memory consolidation. A clinical sample of men with moderate-severe OSA underwent sleep and resting wake recordings with 256-channel Hd-EEG before and after 3 months of CPAP. Declarative and procedural memory tasks were administered pre- and post-sleep. Topographical spectral power maps and differences between baseline and treatment were compared using t-tests and statistical nonparametric mapping (SnPM). In 11 compliant CPAP users (5.2 ± 1.1 hours/night), total sleep time did not differ after CPAP but N1 and N2 sleep were lower and N3 was higher. Centro-parietal gamma power during N3 increased and fronto-central slow spindle activity during N2 decreased (SnPM < 0.05). No other significant differences in EEG power were observed. When averaged specifically within the parietal region, N3 delta power increased after CPAP (p = 0.0029) and was correlated with the change in overnight procedural memory consolidation (rho = 0.79, p = 0.03). During resting wakefulness, there were trends for reduced delta and theta power. Effective CPAP treatment of OSA may correct regional EEG abnormalities, and regional recovery of SWA may relate to procedural memory improvements in the short term.

Long term adherence to continuous positive Airway pressure in mild obstructive sleep apnea

BackgroundStudies 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).MethodsWe 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.Results222 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.ConclusionsLong 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.

Effect of positive airway pressure compliance on laryngopharyngeal reflux in obstructive sleep apnea patients

ObjectivesTo determine the effect of continuous positive airway pressure (CPAP) compliance on symptoms and signs of laryngopharyngeal reflux (LPR) in patients with obstructive sleep apnea (OSA).ResultsThirty patients were included. The participants were divided into good compliance (n = 21) and poor compliance (n = 9) groups. After 6-month CPAP treatment, the reflux symptom index score significantly decreased in both the good compliance group (20 (17,24) vs. 14 (10,18), p < 0.001) and the poor compliance group (21 (18,25) vs. 10 (5,16), p < 0.05). Reflux finding score was significantly reduced in both the good compliance group (8 (6,9) vs. 4 (3,5), p < 0.001) and the poor compliance group (6 (4,8) vs. 3 (2,4), p < 0.05). However, there were no statistically significant differences between the groups. CPAP treatment reduces the symptoms and signs of LPR. However, CPAP compliance does not correlate with improvement in LPR in patients with OSA.

The influence of obstructive sleep apnea and continuous positive airway pressure on the nasal microbiome.

The aim of this study was to investigate the influence of obstructive sleep apnea and continuous positive airway pressure on the nasal microbiome. Endonasal swabs from the olfactory groove of 22 patients with moderate and severe obstructive sleep apnea (OSA) and a control group of 17 healthy controls were obtained at the Department of Otorhinolaryngology of the Friedrich-Alexander-Universität Erlangen-Nürnberg. 16S rRNA gene sequencing was performed to further evaluate the endonasal microbiome. In a second step, the longitudinal influence of continuous positive airway pressure (CPAP) therapy on the nasal microbiome was investigated (3-6 and 6-9 months). Analysis of the bacterial load and β-diversity showed no significant differences between the groups, although patients with severe OSA showed increased α-diversity compared to the control group, while those with moderate OSA showed decreased α-diversity. The evaluation of longitudinal changes in the nasal microbiota during CPAP treatment showed no significant difference in α- or β-diversity. However, the number of bacteria for which a significant difference between moderate and severe OSA was found in the linear discriminant analysis decreased during CPAP treatment. Long-term CPAP treatment showed an alignment of the composition of the nasal microbiome in patients with moderate and severe OSA as well as an alignment of biodiversity with that of the healthy control group. This change in the composition of the microbiome could be both part of the therapeutic effect in CPAP therapy and a promoting factor of the adverse side effects of the therapy. Further studies are needed to investigate whether the endonasal microbiome is related to CPAP compliance and whether CPAP compliance can be positively influenced in the future by therapeutic modification of the microbiome.

Adherence to CPAP Treatment: Can Mindfulness Play a Role?

Obstructive sleep apnea (OSA) is considered a chronic disease that requires long-term multidisciplinary management for effective treatment. Continuous Positive Airway Pressure (CPAP) is still considered the gold standard of therapy. However, CPAP effectiveness is limited due to poor patients' adherence, as almost 50% of patients discontinue treatment after a year. Several interventions have been used in order to increase CPAP adherence. Mindfulness-based therapies have been applied in other sleep disorders such as insomnia but little evidence exists for their application on OSA patients. This review aims to focus on the current data on whether mindfulness interventions may be used in order to increase CPAP adherence and improve the sleep quality of OSA patients. Even though controlled trials of mindfulness and CPAP compliance remain to be performed, this review supports the hypothesis that mindfulness may be used as an adjunct method in order to increase CPAP adherence in OSA patients.

The use of topical nasal steroids to improve continuous positive airway pressure compliance in patients with obstructive sleep apnea: An updated systematic review and meta-analysis of randomized control trials.

Nasal steroids are commonly prescribed to reduce nasal side effects, which are the primary cause of continuous positive airway pressure (CPAP) intolerance in obstructive sleep apnea (OSA) patients. We conducted a systematic review and meta-analysis of OSA patients to assess the effect of nasal steroids on CPAP compliance and nasal symptoms. PubMed, Scopus, Ovid, and Cochrane Library were searched through March 2022. Randomized controlled trials (RCTs) evaluating the effects of nasal steroids on CPAP compliance in adult patients, which reported quantitative data on CPAP use and nasal symptoms, were included. Three RCTs (224 patients) were eligible for the meta-analysis. At the 4-week follow-up, the study did not demonstrate a statistically significant difference in CPAP compliance (average hours of CPAP use per night: mean difference 0.45; 95% confident interval (CI) (-0.01, 0.90); P = 0.06, percentage of nights device used: mean difference 1.79; 95%CI (-2.59, 6.17); P = 0.42). There was also no difference in overall nasal symptoms (mean difference 0.47, 95%CI (-0.00, 0.94); P = 0.05), with significantly more sneezing and rhinorrhea among patients with nasal steroids (sneezing: mean difference 0.64, 95%CI (0.23, 1.05); P = 0.002, rhinorrhea: mean difference 0.78, 95%CI (0.24, 1.31); P = 0.005). At the 4-week follow-up, the pooled results did not demonstrate significant benefits of nasal steroids on CPAP compliance. There was also no significant benefit for relieving nasal symptoms. To further explore the benefit of nasal steroids on CPAP use, additional, longer-term studies are required.

Continuous positive airway pressure improved daytime sleepiness and memory function in patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a sleep disorder which results in daytime sleepiness and impaired memory function. The aim of this study was to investigate the effect of continuous positive airway pressure (CPAP) on daytime sleepiness and memory function in OSA patients. We also investigated whether CPAP compliance impacted the effect of this treatment. The nonrandomized, nonblinded clinical trial enrolled 66 patients with moderate-to-severe OSA subjects. All subjects completed a polysomnographic study, daytime sleepiness questionnaires (the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index), and four memory function tests (working memory; processing speed [PS]; logical memory [LM]; face memory [FM]). Before CPAP treatment, no significant differences (P < 0.05) were noted in the demographic data, daytime sleepiness, or memory function between two groups (with/without CPAP). However, OSA patients treated with CPAP for 2 months showed significant improvements in daytime sleepiness, PS, mostly of LM, and FM comparing to 2 months ago. As compared to those who did not receive CPAP treatment, CPAP can improve only parts of LM (delayed LM [DLM] and LM percentage [LMP]). In addition, compared to control group, a significant improvement of daytime sleepiness and LM (LM learning, DLM, and LMP) in good compliance with CPAP treatment group and of DLM and LMP in the low compliance with CPAP treatment group was found. CPAP treatment for 2 months could improve some of LM in OSA patients, especially in patients exhibiting good CPAP compliance.

Surgical Treatment Options for Epiglottic Collapse in Adult Obstructive Sleep Apnoea: A Systematic Review.

The critical role of epiglottis in airway narrowing contributing to obstructive sleep apnoea (OSA) and continuous positive airway pressure (CPAP) intolerance has recently been revealed. This systematic review was conducted to evaluate available surgical treatment options for epiglottic collapse in adult patients with OSA. The Pubmed and Scopus databases were searched for relevant articles up to and including March 2022 and sixteen studies were selected. Overall, six different surgical techniques were described, including partial epiglottectomy, epiglottis stiffening operation, glossoepiglottopexy, supraglottoplasty, transoral robotic surgery, maxillomandibular advancement and hypoglossal nerve stimulation. All surgical methods were reported to be safe and effective in managing selected OSA patients with airway narrowing at the level of epiglottis. The surgical management of epiglottic collapse can improve OSA severity or even cure OSA, but can also improve CPAP compliance. The selection of the appropriate surgical technique should be part of an individualised, patient-specific therapeutic approach. However, there are not enough data to make definitive conclusions and additional high-quality studies are required.

P039 A novel mean disease alleviation outcome measure in the management of adult obstructive sleep apnoea

Abstract Introduction Current methods assessing device and surgical treatment efficacy for OSA, such as apnoea hypopnea index (AHI), do not factor in compliance. Clinical effectiveness may be better represented when long-term compliance is incorporated into a mean disease alleviation score (MDA). Here, MDA scores between surgery and device are compared in a high-volume adult OSA clinic. Methods Three hundred and forty-five patients seen over a 13-year period in a high-volume adult OSA clinic staffed by an experienced sleep-trained otolaryngologist and sleep physician were included. Patients were managed with device (Continuous Positive Airway Pressure (CPAP), Mandibular Advancement Splint (MAS) or underwent multilevel airway surgery. Mean disease alleviation was calculated as the product of therapeutic efficacy (change in AHI) and adjusted compliance. Surgical compliance was assumed as one hundred percent. Cardinality matching was utilised to account for differences in patient and disease factors between subgroups. Results Surgically treated patients demonstrated higher MDA than device users (67.3 ± 29.9% vs. 59.4 ± 31.1%, p=0.039), despite higher therapeutic efficacy seen in device users (85.0±24.4% vs. 67.0±29.9%, p&amp;lt;0.001). Surgical patients were younger, had lower comorbidity scores, lower BMI, and suffered worse daytime sleepiness than device users. Cardinality matching for these factors demonstrated similar mean MDA between groups (66% vs 58%, p=0.11). Device users had to utilise &amp;gt;8hrs per night of compliant use to reach a similar MDA to matched surgical patients. Discussion In Adult OSA patients with less-than-ideal CPAP compliance, multilevel airway surgery is an equivalent and effective alternative, based on novel MDA measures.