Continuous Positive Airway Pressure Device Research Articles

The Effect of Continuous Positive Airway Pressure (CPAP) Therapy on Serum Caspase-3 Level in Patients with Obstructive Sleep Apnea (OSA).

Intermittent hypoxemia has an important role in the physiopathogenesis of obstructive sleep apnea (OSA) complications. Increased apoptosis due to intermittent hypoxemia may be an important clinical entity in OSA. In this study, we aimed to evaluate caspase-3 enzyme level, which is an indirect marker of increased apoptosis in patients with OSA and to evaluate the effect of OSA treatment with continuous positive airway pressure on caspase-3 enzyme level. This study included 141 consecutive patients admitted to the sleep-disordered breathing laboratory within 6 months. Caspase-3 was measured in routine blood samples obtained on the morning of polysomnography (PSG) performed at night. The compliance of the patients to CPAP treatment was evaluated and caspase-3 levels were checked again after treatment. A total of 141 patients, 39 females (27,7%) and 102 males (72,3%) were included in the study. The mean age of the patients was 49 ± 12 years (min-17, max-77). According to PSG results, OSA was detected in 95.7% (135/141) of the cases. Mild OSA was 35 (24.8%), moderate OSA 39 (27.7%) and severe OSA 61 (43.3%) cases. Median caspase-3 enzyme levels were similar in men and women in the study group. There was no statistically significant difference in hemogram parameters and caspase-3 enzyme levels between the groups divided according to the presence and severity of OSA. It was determined that caspase-3 enzyme level did not change significantly after 3 months of CPAP treatment in OSA compared to pretreatment. Caspase-3 was found to have a negative correlation with both the percentage of daily use of CPAP therapy and the percentage of CPAP device use for more than 1 h per night. It was found that the control caspase-3 level decreased statistically significantly as the percentage of daily use of CPAP therapy increased (r = -0.397, p = 0.030). It was found that the control caspase-3 level decreased statistically significantly as the percentage of CPAP therapy use for more than 1 h per night increased (r = -0.411, p = 0.024). The results of this study did not reveal a relationship between the severity of OSA and caspase-3 levels. However, blood caspase-3 levels decreased as treatment compliance increased, suggesting that CPAP treatment may correct increased apoptosis in OSA. There is a need for more comprehensive studies on this issue.

Can the Use of Telemedicine in the Management of Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Reduce Clinical Time and Additional Appointments: A Randomized Controlled Trial.

Introduction: Obstructive sleep apnea (OSA) is a common sleep breathing disorder and is associated with increased cardiovascular risk and daytime sleepiness. Continuous positive airway pressure (CPAP) is a treatment for OSA, which splints the airway open. The introduction of telemedicine in CPAP devices offers clinical staff an alternative method of reviewing patients, monitoring treatment, and reducing clinical time. Materials and Methods: A randomized control trial was conducted with patients randomized to one of three arms: Arm 1 (standard care), Arm 2 (modem and a virtual appointment), and Arm 3 (modem, smart device application DreamMapper™, and a virtual appointment). Ninety participants requiring treatment with CPAP following a diagnosis of OSA were recruited and data collected at baseline, 14 days, and 180 days. Additional contacts or appointments were also recorded. Results: Ninety participants (n = 90) were recruited (68% males and 32% females) with an average age of 52.0 ± 13.13 years and apnea/hypopnea index (AHI) 43.5 ± 21.92 (events/h). There was a statistically significant difference between the three arms in the average clinical time taken for the first follow-up appointment (p = 0.001). There was a statistically significant difference between the three arms in the number of additional appointments or contacts required (p = 0.03). Discussion and Conclusion: Telemedicine reduced clinical time at first follow-up, and in patients who received standard care or a smart device application to monitor their own CPAP treatment, there were significantly less additional appointments required when compared with telemedicine support in the form of a modem alone.

Health and Wellness Coaching Can Improve Usage of Positive Airway Pressure Therapy in Participants With Obstructive Sleep Apnea and Obesity

Obstructive sleep apnea (OSA) has been tied to chronic conditions, such as obesity. Although continuous positive airway pressure (CPAP) device is an effective treatment, device discomfort impacts treatment adherence. Health and wellness coaching (HWC) can increase weight loss (WL) and adherence across other treatment types. This study aims to determine whether participants undergoing an HWC program improve CPAP device usage and WL compared to control group (CG). Participants were randomly selected to participate in the HWC group in conjunction with standard care. The HWC participants were gender, age, weight, CPAP usage (e.g., hours, days), and race matched to CG participants receiving standard care only. Variables collected include demographics (i.e., age, gender), CPAP device usage, and weight across four time points (baseline, 3-, 6-, and 9-months). Paired samples t-test and Pearson’s coefficient correlation were conducted to determine how outcomes differ between groups. Of 232 participants studied, those in the HWC group significantly increased CPAP usage over time ( P < .001) vs CG (6.5 ± 1.8, and 5.0 ± 2.3 hours, respectively). The HWC group had significantly more weight loss (11.0 ± 14.5 lbs.) than CG (5.7 ± 16.1 lbs.) across the 9-month timeline ( P < .001). This study provides evidence that HWC can improve CPAP adherence and weight loss.

Web Integrated Continuous Positive Airway Pressure System

Keywords: Continuous Positive Airway Pressure(CPAP) 1, Sleep Apnea 2, Neonatal 3, Respiratory Distress Syndrome (RDS) 4, Premature baby 5, Transpiration medical device 6, Internet of Things 7 CPAP, a non-invasive ventilation method crucial in neonatal care, has significant implications for the survival of very low birth weight preterm infants. However, its widespread adoption is hindered by cost constraints and the need for additional features like Apnea Hypopnea Index (AHI) monitoring. This study seeks to overcome these challenges by developing an affordable CPAP device for Neonatal Intensive Care Units (NICUs). By incorporating sensors for data collection and a microcontroller-based control system, this device aims to optimize CPAP function while minimizing energy consumption. Furthermore, the collected data will be securely stored on a cloud platform, potentially benefiting both neonatal care and sleep apnea management. Recognizing the vital role of sleep in human health, this innovation underscores the importance of restorative rest for physical and mental well-being. Highlights: · Web-integrated CPAP devices often come with remote monitoring capabilities. This allows healthcare providers to remotely monitor patients' CPAP usage data, including compliance and efficacy metrics, without requiring in-person visits. This feature facilitates better patient management and allows for timely intervention if issues arise. · These devices typically track and record various parameters such as usage hours, mask leaks, apnea-hypopnea index (AHI), and pressure settings. The data can be accessed by both patients and healthcare providers, providing insights into treatment progress and effectiveness over time. · Many web-integrated CPAP devices offer cloud connectivity, allowing users to sync their data to secure online platforms. This feature enables seamless access to CPAP usage data from multiple devices, such as smartphones, tablets, or computers, enhancing convenience and flexibility for users. · Some modern CPAP machines offer wireless connectivity options, such as Bluetooth or Wi-Fi, enabling users to connect their devices to compatible accessories or smartphone apps. This connectivity allows for features like remote control of device settings, automatic software updates, and integration with health tracking apps for a more comprehensive health management experience. · The integration of web-based CPAP platforms with telemedicine services allows for virtual consultations between patients and healthcare providers. This feature enhances access to care, particularly for patients in remote or underserved areas, and enables real-time adjustments to CPAP settings based on patient feedback and data analysis.

Level of Contamination of Positive Airway Pressure Devices Used in Obstructive Sleep Apnea.

No study has evaluated the degree of contamination after the total disassembly of continuous positive-airway pressure (CPAP) devices. We assessed the extent of contamination of the CPAP device by disassembling the system and identifying the factors that influence the degree of CPAP contamination, which is applied daily in patients with obstructive sleep apnea (OSA). Chart review of the medical records of patients with OSA who underwent disassembly and cleaning of the CPAP device was performed by two skilled technicians who photographed the levels of contamination of each component and scored them using a visual analog scale. Clinical characteristics and records of CPAP device usage were statistically analyzed to determine the characteristics that were significantly associated with the degree of CPAP device contamination. Among the 55 participants, not only the external components, including the mask and tube, but also the internal components, such as the humidifier and the interior of the main body, showed a substantial degree of contamination. The total and average daily duration of usage of the CPAP device were not significantly associated with the degree of contamination. Age was most frequently associated with the degree of contamination, such as in masks, humidifiers, and interior and exterior main parts. The degree of contamination of the internal components of the device was significantly correlated with the degree of contamination of the external components. Age-specific guidelines for hygiene management of the external and internal CPAP components should be prepared.

Lung ultrasound score predicts outcomes in patients with acute respiratory failure secondary to COVID-19 treated with non-invasive respiratory support: a prospective cohort study

BackgroundLung ultrasound has demonstrated its usefulness in several respiratory diseases management. One derived score, the Lung Ultrasound (LUS) score, is considered a good outcome predictor in patients with Acute Respiratory Failure (ARF). Nevertheless, it has not been tested in patients undergoing non-invasive respiratory support (NIRS). Taking this into account, the aim of this study is to evaluate LUS score as a predictor of 90-day mortality, ETI (Endotracheal intubation) and HFNC (High Flow Nasal Cannula) failure in patients with ARF due to COVID-19 admitted to a Respiratory Intermediate Care Unit (RICU) for NIRS management.ResultsOne hundred one patients were admitted to the RICU during the study period. Among these 76% were males and the median age was 55 (45–64) years. Initial ARF management started with HFNC, the next step was the use of Continuous Positive Airway Pressure (CPAP) devices and the last intervention was ETI and Intensive Care Unit (ICU) admission. Of the total study population, CPAP was required in 40%, ETI in 26%, while 15% died. By means of a ROC analysis, a LUS ≥ 25 points was identified as the cut-off point for mortality(AUC 0.81, OR 1.40, 95% CI 1.14 to 1.71; p < 0.001), ETI (AUC 0.83, OR 1.43, 95% CI 1.20 to 1.70; p < 0.001) and HFNC failure (AUC 0.75, OR 1.25, 95% CI 1.12 to 1.41; p < 0.001). Kaplan-Meier survival curves also identified LUS ≥ 25 as a predictor of 90-days mortality (HR 4.16, 95% CI 1.27–13.6) and 30 days ETI as well.ConclusionIn our study, a ≥ 25 point cut-off of the Lung Ultrasound Score was identified as a good outcome prediction factor for 90-days mortality, ETI and HFNC failure in a COVID-19 ARF patients cohort treated in a RICU. Considering that LUS score is easy to calculate, a multicenter study to confirm our findings should be performed.

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.

A Multivariate Study on the Adherence With Non-invasive Ventilation in People With Obstructive Sleep Apnea.

Obstructive Sleep Apnea (OSA) is a sleep disorder that affects a significant number of people worldwide. While Continuous Positive Airway Pressure (CPAP) devices have been proven to be effective in relieving symptoms, ensuring consistent use of those devices throughout the year can be challenging for a lot of patients. The present quantitative observational study in non-invasive ventilation for OSA patients explores adherence and attempts to identify independent predicting factors and year-round adherence differences in a large sample of OSA patients from Greece. Data from 1987 OSA patients using Continuous Positive Airway Pressure (CPAP) devices were collected in 2023. Factors evaluated in the study included the Apnea-Hypopnea Index (AHI), mask type, mask leaks and hours of CPAP device usage. The majority were males (77.2%), aged over 60 years (57.9%). CPAP use varied, with 14.0% in their first year, 44.2% for 2-4 years, and 41.7% for <4 years. Adherence was highest in more than 4 years users (54.9%) and nasal/pillow mask users (59.1%). Seasonal adherence varied, with summer having the most non-adherent patients (32.8%). Multinomial logistic regression showed BMI, mask type and seasonal severity influenced adherence. Full-face masks positively impacted adherence (OR=0.585, p=0.001). Non-adherence was associated with higher mask leaking in spring (OR=3.051, p=0.018) and usage of CPAP for < 4 years (OR=3.855, p=0.001). For 50% and 75% adherence, seasonal mask leaking and usage duration influenced adherence. CPAP device data can provide valuable insights to OSA therapy compliance. Seasonality plays an important role in adherence to the CPAP device use as is the type of mask with relation to air leaking.

Impact of CPAP Therapy on the Autonomic Nervous System.

Obstructive sleep apnea (OSA) is a significant risk factor for cardiovascular disease (CVD) with increasing prevalence. An important mechanism of CVD development is a dysregulation of the autonomic nervous system (ANS). This prospective and controlled cohort study aimed to investigate ANS function in OSA including the response to long-term continuous positive airway pressure (CPAP) therapy by analyzing 24 h Holter electrocardiogram and 24 h Holter ambulatory blood pressure recording parameters. The study enrolled 57 patients who were newly diagnosed with severe OSA. After 6 months of CPAP therapy, 37 patients had a good therapy adherence (usage of CPAP device >4 h per night), and their data were analyzed. The difference in nocturnal diastolic blood pressure values before and after CPAP therapy reached statistical significance (76 (68-84) vs. 74 (63-80) mmHg, p = 0.0439). Lower nocturnal values after CPAP therapy of SDNN (101.5 vs. 95 ms, p = 0.0492) and RMSSD (29.5 vs. 26 ms, p = 0.0193) were found. An increase in diurnal spectral power (1742 vs. 2112 ms2, p = 0.0282) and a decrease in nocturnal spectral power (3256 vs. 2124 ms2, p = 0.0097), nocturnal VLF band (2493 vs. 1485.4 ms2, p = 0.0176), nocturnal LF band (638.7 vs. 473 ms2, p = 0.0097), and nocturnal HF band (234.9 vs. 135.7 ms2, p = 0.0319) was found. The results showed an imbalance of the ANS with a sympathetic predominance, especially during the night hours and in those with arterial hypertension. The impact of CPAP therapy on the improvement in ANS parameters was more pronounced at night, in men, and those with arterial hypertension.

A pilot exploratory study examining the potential influence of continuous positive airway pressure devices on cranial molding trajectories in preterm infants.

The objective of this exploratory study was to assess the potential impacts of two different continuous positive airway pressure (CPAP) devices on preterm infant head shape and circumference. Twenty infants born at <32 weeks gestational age requiring CPAP support were enrolled. Ten infants used the Hudson RCI Nasal Prong CPAP device and 10 infants used the Fisher-Paykel CPAP device. Infant Cranial Index (CI) and head circumference (HC) were collected weekly as well as infant gestational age at birth, and total number of days on CPAP. At baseline, average total birthweight of infants was 1021 grams (SD = 227 grams), average gestational age was 26.9 weeks (SD = 1.80), mean CI was 79.7 cm (SD = 5.95), and HC was 10.2 cm (SD = 0.92). Days on CPAP ranged from 16 to 63 days, with an average of 40.7 (SD = 13.6) days. Neither CI nor HC differed by device type; however, the Fisher-Paykel device was associated with slightly greater HC growth rate. CPAP devices and the pressures they apply plausibly contribute to preterm infant cranial molding over time, with the greatest potential impact on infants who require CPAP support for longer periods; however, these findings must be validated in larger cohorts. Additionally, positioning practices should be further examined to determine how they may contribute to or prevent the development of cranial molding deformity.

Environmental Exposures, Characteristics, and Treatment Outcomes of Hypersensitivity Pneumonitis at a Rural Appalachian Academic Medical Center: A Cross-sectional Study

Purpose: Hypersensitivity pneumonitis (HP) is a form of interstitial lung disease (ILD) caused by inhalational exposure to an antigen. Little is known about the exposures, outcomes, and management of HP in rural Appalachian patients. Methods: A retrospective cross-sectional study was conducted from January 1, 2017, to June 30, 2022, at a tertiary academic medical center. Sixty-two patients were initially screened, and seven patients fulfilled the inclusion criteria. The primary outcome was the exposure leading to HP. Secondary outcomes included the disease stage at diagnosis, smoking rate, treatment modalities, ILD exacerbation rate, and mortality. Results: Birds and mold are the more common exposures attributed to HP (both n=2, 28.57%). Novel exposures to continuous positive airway pressure devices, vapor and/or fumes, and fiberglass were noted (each n=1, 14.28%). Three patients (42.85%) had fibrotic HP at presentation. Most patients were ever-smokers (n=4, 57.14%). All patients (n=7, 100%) received corticosteroids with a mean duration of use of 2.50 ± 0.65 months, and a mean dose of 37.14 ± 12.54 mg. One (14%) patient was compliant with antigen elimination. ILD exacerbation and mortality rate was high (both n=2, 28.57%). Conclusion: The exposures identified in rural Appalachian HP patients were similar to other rural and urban populations in the United States. Risk factors associated with poor outcomes, such as smoking, fibrotic HP subtype, and non-avoidance of antigen were higher in this cohort. The rate of ILD exacerbation and mortality were similarly higher. Larger studies are needed to investigate longitudinal trends of exposure, characteristics, and management of HP to improve outcomes in rural populations.

Comparison among three different follow-up models for obstructive sleep apnea syndrome patients: focus on the physiotherapist's role.

In obstructive sleep apnea syndrome (OSAS) subjects different follow-up modalities have been proposed to improve adherence to the continuous positive airway pressure (CPAP) device. This retrospective study compares three different health professional approaches dedicated to caring OSAS patients in three consecutive follow-up periods of 15 months each. The three different follow-up models are: i) physician-oriented follow-up (P-F); ii) physiotherapist-oriented follow-up (PT-F); and iii) tele-titration plus PT-oriented follow-up (TT-PT-F). Health personal visits and actions delivered, patients' adherence, CPAP efficacy, and problems under CPAP use were considered for comparison. Data from 122 OSAS patients with a new prescription of CPAP were analyzed: 39 (32.0%) in the P-F, 38 (31.1%) in the PT-F, and 45 (36.9%) in the TT-PT-F period. We found a reduction over time (from 40.9% in P-F to 8.2% in TT-PT-F, p<0.001) in patients missing the 1-year follow-up visit. The PT-F and TT-PT-F lead to a reduction in physician visits in comparison to P-F (5.2% and 8.9% vs 100%, p<0.001) with no differences in time to the first follow-up visit, CPAP efficacy, and patients' adherence among the three periods. More device-related problems were found in the PT-F (57.8%), compared with the PF (25.6%) period (p<0.001); the most common troubles were mask problems evaluated in 26.2% of cases. In conclusion, different follow-up models offer similar efficacy and short-term adherence for CPAP leading to a significant reduction in physician visits under the PT-F with or without tele-titration, being mask problems as the most commonly treated. Further analysis should be useful to define the best cost-efficacy follow-up intervention.

IoT Based Continuous Positive Airway Pressure for Sleep Apnea and Unhealthy Snoring Patient

The non-invasive mechanical breathing technique known as Continuous Positive Airway Pressure (CPAP) is frequently employed in neonatology. The survival of very low birth weight preterm newborns may be impacted by the use of new therapeutic and technological advancements. The exorbitant cost of this device and its multiple add-on features, like Apnea Hypopnea Index (AHI) and flow limiting, among others, present a challenge. As a proof of concept for use in a Neonatal Intensive Care Unit (NICU), the design and fabrication of a CPAP device are the focus of this study. Methods: Electro-pneumatic circuits and signal conditioning boards of sensors have been installed in order to design the experimental CPAP device with sensory instrumentation for supplying data to a micro-controlled system and achieve optimized CPAP performance with minimal energy consumption.The Cloud Platform would store the received data.At a proof of concept level, the same might likewise be used to Sleep Apnea Subject(s). Keywords: Continuous Positive Airway Pressure (CPAP), Sleep Apnea, Neonatal, Respiratory Distress Syndrome (RDS), Premature baby, Transpiration medical device, Internet of Things.

Investigating associations between social determinants, self-efficacy measurement of sleep apnea and CPAP adherence: the SEMSA study.

The prospective Self-Efficacy Measure for Sleep Apnea study (SEMSAS) is investigating thresholds for health literacy, self-efficacy and precariousness at obstructive sleep apnea (OSA) diagnosis to predict CPAP adherence. This paper describes the study protocol and presents baseline data from the ongoing study. Eligible individuals had confirmed OSA and were referred to a homecare provider for continuous positive airway pressure (CPAP) therapy initiation. Data on patient characteristics and comorbidities were collected, along with baseline evaluations of self-efficacy [15-item Self-Efficacy Measure for Sleep Apnea tool (SEMSA-15)], precariousness [Deprivation in Primary Care Questionnaire (DipCareQ)], and health literacy (Health Literacy Questionnaire). CPAP adherence over 12 months of follow-up will be determined using remote monitoring of CPAP device data. The primary objective is to define an optimal SEMSA-15 score threshold to predict CPAP adherence at 3- and 12-month follow-up. Enrollment of 302 participants (71% male, median age 55 years, median body mass index 31.6 kg/m2) is complete. Low self-efficacy (SEMSA-15 score ≤ 2.78) was found in 93/302 participants (31%), and 38 (12.6%) reported precariousness (DipCareQ score > 1); precariousness did not differ significantly between individuals with a SEMSA-15 score ≤ 2.78 versus >2.78. Health literacy was generally good, but was significantly lower in individuals with versus without precariousness, and with low versus high self-efficacy. SEMSAS is the first study using multidimensional baseline assessment of self-efficacy, health literacy and precariousness, plus other characteristics, to determine future adherence to CPAP, including CPAP adherence trajectories. Collection of follow-up data is underway.

The Effects of Changing Continuous Positive Airway Pressure Devices in Japanese Patients with Obstructive Sleep Apnea: A Case Series.

Objective The effects of continuous positive airway pressure (CPAP) devices on obstructive sleep apnea (OSA) in Japanese patients have not been reported. We assessed the effects of changing CPAP devices (from the Philips Respironics device to the ResMed device) on the control of OSA. Methods We retrospectively examined 13 patients with OSA who voluntarily changed from the Philips Respironics device to the ResMed device due to a Philips Respironics CPAP device recall. Data on the apnea-hypopnea index (AHI) were obtained from the CPAP devices for three months before and after changing the devices. Results The AHI obtained from the CPAP devices significantly decreased from 4.4 (3.1-10.7) events/h to 2.0 (0.8-3.6) events/h when patients changed devices (p=0.022). The AHI decreased to <5 events/h after changing devices in 4 patients, whereas it had been ≥5 events/h before changing devices in 6 patients. Conclusion Changing CPAP devices can decrease the AHI.

A new reservoir-based CPAP with low oxygen consumption: the Bag-CPAP

BackgroundSeveral noninvasive ventilatory supports rely in their design on high oxygen consumption which may precipitate oxygen shortage, as experienced during the COVID-19 pandemic. In this bench-to-bedside study, we assessed the performance of a new continuous positive airway pressure (CPAP) device integrating a large reservoir (“Bag-CPAP”) designed to minimize oxygen consumption, and compared it with other CPAP devices.MethodsFirst, a bench study compared the performances of Bag-CPAP and four CPAP devices with an intensive care unit ventilator. Two FiO2 targets (40–60% and 80–100%) at a predefined positive end expiratory pressure (PEEP) level between 5 and 10 cm H2O were tested and fraction of inspired oxygen (FiO2) and oxygen consumption were measured. Device-imposed work of breathing (WOB) was also evaluated. Second, an observational clinical study evaluated the new CPAP in 20 adult patients with acute respiratory failure in two hospitals in France. Actual FiO2, PEEP, peripheral oxygen saturation, respiratory rate, and dyspnea score were assessed.ResultsAll six systems tested in the bench study reached the minimal FiO2 target of 40% and four reached at least 80% FiO2 while maintaining PEEP in the predefined range. Device-delivered FiO2/consumed oxygen ratio was the highest with the new reservoir-based CPAP irrespective of FiO2 target. WOB induced by the device was higher with Bag-CPAP. In the clinical study, Bag-CPAP was well tolerated and could reach high (> 90%) and moderate (> 50%) FiO2 with an oxygen flow rate of 15 [15–16] and 8 [7–9] L/min, respectively. Dyspnea score improved significantly after introduction of Bag-CPAP, and SpO2 increased.ConclusionsIn vitro, Bag-CPAP exhibited the highest oxygen saving properties albeit had increased WOB. It was well accepted clinically and reduced dyspnea. Bag-CPAP may be useful to treat patients with acute respiratory failure in the field, especially when facing constraints in oxygen delivery.

Continuous positive airway pressure increases CSF flow and glymphatic transport.

Respiration can positively influence cerebrospinal fluid (CSF) flow in the brain, yet its effects on central nervous system (CNS) fluid homeostasis, including waste clearance function via glymphatic and meningeal lymphatic systems, remain unclear. Here, we investigated the effect of supporting respiratory function via continuous positive airway pressure (CPAP) on glymphatic-lymphatic function in spontaneously breathing anesthetized rodents. To do this, we used a systems approach combining engineering, MRI, computational fluid dynamics analysis, and physiological testing. We first designed a nasal CPAP device for use in the rat and demonstrated that it functioned similarly to clinical devices, as evidenced by its ability to open the upper airway, augment end-expiratory lung volume, and improve arterial oxygenation. We further showed that CPAP increased CSF flow speed at the skull base and augmented glymphatic transport regionally. The CPAP-induced augmented CSF flow speed was associated with an increase in intracranial pressure (ICP), including the ICP waveform pulse amplitude. We suggest that the augmented pulse amplitude with CPAP underlies the increase in CSF bulk flow and glymphatic transport. Our results provide insights into the functional crosstalk at the pulmonary-CSF interface and suggest that CPAP might have therapeutic benefit for sustaining glymphatic-lymphatic function.

Self-reported oral moistening disorders in obstructive sleep apnoea: A scoping review.

Obstructive sleep apnoea (OSA) is a highly prevalent problem with significant consequences. Continuous positive airway pressure (CPAP) and oral mandibular advancement device (MAD) are considered the standard treatments for OSA. Patients may experience self-reported oral moistening disorders (OMDs) (i.e. xerostomia or drooling) at the beginning, throughout and after treatment. This affects oral health, quality of life and treatment effectiveness. The exact nature of the associations between OSA and self-reported OMD is still unknown. We aimed to provide an overview of the associations between self-reported OMD on the one hand and OSA and its treatment (namely CPAP and MAD) on the other hand. In addition, we sought to determine whether OMD affects treatment adherence. A literature search in PubMed was performed up to 27 September 2022. Two researchers independently assessed studies for eligibility. In total, 48 studies were included. Thirteen papers investigated the association between OSA and self-reported OMD. They all suggested an association between OSA and xerostomia but not between OSA and drooling. The association between CPAP and OMD was addressed in 20 articles. The majority of studies have indicated xerostomia as a CPAP side effect; however, some have observed that xerostomia diminishes with CPAP therapy. In 15 papers, the association between MAD and OMD was investigated. In most publications, both xerostomia and drooling have been described as common side effects of MADs. These side effects are often mild and transient, and they improve as patients continue to use their appliance. Most studies found that these OMDs do not cause or are not a strong predictor of non-compliance. Xerostomia is a common side effect of CPAP and MAD, as well as a significant symptom of OSA. It may be regarded as one of the indicators of sleep apnoea. Moreover, MAD therapy can be associated with OMD. However, it seems that OMD may be mitigated by being adherent to the therapy.

0505 3-Year follow-up of patients with OSA on telemonitoring

Abstract Introduction Obstructive Sleep Apnea (OSA) is a highly prevalent respiratory disease. In the subgroup of OSA patients on Positive Airway Pressure (PAP), telemonitoring for CPAP (Continuous Positive Airway Pressure) have emerged as follow-up option to monitor and detect poor compliance to treatment. We aimed to understand whether telemonitoring is an independent factor in the therapeutic adherence of OSAS patients. Methods A retrospective assessment was carried out in patients followed in the Sleep Medicine consultation between March 2019 and June 2022. A total of 312 patients with Resmed® model S10 CPAP devices with residual apnea detection algorithm, mean therapy pressure, and the number of hours of daily use ware included. After placement of the PAP patients were reassessed by consultation at 3, 6, 12, 24 and 36 months of therapy. Results A total of 312 patients were evaluated, 203 men and 109 women, with a mean daily use of 6 hours and 43 minutes, with a standard deviation of 1 hour and 52 minutes. The residual AHI of averaged 2.58/hour. In June 2022, 30 patients were included at 3 months, 30 at 6 months, 41 at 12 months, 84 at 24 months and 127 at 36 months, with a mean daily use of respectively: 4.29 (median 5.17), 4.33 (median 4.44), 3.52 (median 4.45), 5.05 ( median 5.59) and 4.40 hours (median (5.28), with no statistical significance and adherence being similar from the first trimester, as well as in the divisions of patients per group. This analysis shows that adherence did not decrease over the months of telemonitoring, which may mean that patients felt permanently monitored. The mean Residual AHI was respectively: 4.64, 2.08, 2.33, 2.33 and 2.37/hour, we found that the disease remained controlled and without much variation. We obtained an excellent adaptation to therapy in 262 patients (84%), and 16% (50 patients) abandoned therapy. Conclusion In patients with a confirmed diagnosis of OSA treated by PAP, telemonitoring has proven to be a helpful tool for a better follow-up and therapeutic adjustment, promoting ideal compliance to therapy, which is effective as early as the first three months. Support (if any)

Retrospective Analysis of Real-World Data for the Treatment of Obstructive Sleep Apnea with Slow Maxillary Expansion Using a Unique Expansion Dental Appliance (DNA).

In addition to mandibular advancement devices, dental expansion appliances are an important clinical approach for achieving an increased intra-oral space that promotes airflow and lessens the frequency or severity of apneic events in patients diagnosed with obstructive sleep apnea (OSA). It has been thought that dental expansion in adults must be preceded by oral surgery; however, in this paper, we examine the results of a new technique for slow maxillary expansion without any surgical procedures. The palatal expansion device, DNA (Daytime-Nighttime Appliance), was reviewed in this retrospective study, particularly regarding its effects on measurements of transpalatal width, airway volume, and apnea-hypopnea indices (AHI) as well as its common modalities and complications. The DNA effectively reduced AHI by 46% (p = 0.00001) and significantly increased both airway volume and transpalatal width (p < 0.00001). After DNA treatment, 80% of patients showed some improvement in AHI scores with 28% of patients having their OSA symptoms completely resolved. Compared to the use of mandibular appliances, this approach is intended to create a sustained improvement in airway management that can reduce or eliminate dependence on continuous positive airway pressure (CPAP) or other OSA treatment devices.