Duration Of Continuous Positive Airway Pressure Research Articles

Comparison of nasal masks or binasal prongs for delivering continuous positive airway pressure in preterm neonates of gestational age less than 32 weeks

Background: Aim was to compare the efficacy and safety of continuous positive airway pressure (CPAP) delivered by nasal masks vs binasal prongs. Methods: This was observational trial where preterm infants less than 32 weeks of gestation with respiratory distress were enrolled after parental consent. Participants: 145 neonates less than 32 weeks gestation requiring nasal CPAP (NCPAP) as a primary mode for respiratory distress, who were treated with either nasal mask (n=45) or nasal prongs (n=99) as interface. Primary outcome: Was the incidence of CPAP failure (need for mechanical ventilation at less than 72 hours). Results: Failure rate in nasal mask group was 13% vs nasal prongs group was 39.4% and the difference was statistically significant. Secondary outcomes were mean FiO2 requirement at 6 hours, duration of CPAP therapy, hospital stay and nasal trauma. There was 3.7±5.78% reduction in oxygen requirement at 6 hours of CPAP initiation with nasal mask as compared to nasal prongs and the difference was statistically significant (p<0.05). the CPAP duration in nasal mask group was 3.4± 4.04 days vs nasal prongs group was 4.5±3.52 days and duration of hospital stay in nasal mask group was 15.4±14.19 vs in nasal prongs group was 20.2±13.86 and the both differences were also statistically significant(p<0.05). Nasal mask had no nasal injury (0%) as compared to infants on nasal prongs (23.2%) and the difference was statistically significant (p<0.05). Conclusions: NCPAP with mask as interface is as effective as prongs but causes less nasal trauma and less CPAP duration and hospital stay.

Influence of continuous positive airway pressure on lipid profiles of obstructive sleep apnea: A systematic review and meta-analysis.

Background:To investigate the influence of continuous positive airway pressure (CPAP) on lipid profiles of the patients with obstructive sleep apnea (OSA) in this meta-analysis.Methods:Relevant studies reporting the correlation between CPAP and lipid profiles of OSA patients were searched in Pubmed, Cochrane Library and Embase before January 1, 2021. Data of eligible studies were extracted and analyzed using the fixed-effect or random-effect model. Standard mean difference (SMD) and 95% confidence interval (95% CI) were calculated to assess such influence. Subgroup analysis based on CPAP duration was further performed. STATA 12.0 was used in this meta-analysis.Results:A total of 12 independent randomized controlled studies involved 1129 OSA patients were recruited in this meta-analysis. The analyzed lipid profiles included total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL). CPAP was not correlated to TC (SMD = –0.07, 95% CI = –0.33 to 0.19), TG (SMD = –0.01, 95% CI = –0.19 to 0.17), LDL (SMD = –0.01, 95% CI = –0.23 to 0.21) and HDL (SMD = 0.10, 95% CI = –0.03 to 0.22) in OSA patients. Moreover, CPAP duration (=12 weeks; >12 weeks; <12 weeks) also did not influence lipid profiles of OSA patients as well.Conclusions:Regardless of the treatment in CPAP duration, it doses does not influence lipid profiles of OSA patients, including TC, TG, LDL and HDL. The results are inconsistent with previous findings, which should be further validated in the multi-center, long-term randomized controlled trials.

Efficacy of CPAP duration and adherence for cognitive improvement in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials.

Obstructive sleep apnea (OSA) can impair cognition. Continuous positive airway pressure (CPAP) is a recommended treatment for OSA but its effectiveness on cognitive improvement is uncertain, a finding which may be biased by various durations and adherence to treatment with CPAP. In a meta-analysis assessing high-quality randomized controlled trials (RCTs), we estimated whether or not CPAP benefits cognition in patients with OSA. PRISMA criteria were followed in the performance of this meta-analysis. The weighted mean difference (WMD) and 95% confidence interval (CI) of six neuropsychological scores covering eight cognitive domains were used to evaluate the benefit between CPAP and non-CPAP interventions. Subgroups of different therapeutic durations and adherence, which were divided into short-term (< 8weeks) and long-term (≥ 12weeks) durations, and poor (nighttime < 4h/night) and good (nighttime ≥ 4h/night) adherence were also analyzed. Among 16 RCTs, 1529 participants with OSA were included. Comparing the CPAP group and the control group for all treatment durations and adherence, a mild improvement for digit span forward which reflected short-term memory was observed (WMD[95%CI] = 0.67[0.03,1.31], p = 0.04). Trail making test-part B, which reflected executive function was improved for participants with OSA who had good adherence to CPAP (WMD[95%CI] = - 6.24[- 12.60,0.12], p = 0.05). Patients with OSA who received short-term CPAP treatment (WMD[95%CI] = - 7.20[- 12.57, - 1.82], p = 0.009) had a significant improvement in executive function when compared with controls. There was no statistical difference for all scales between long-term (≥ 12weeks) CPAP treatment group and control group. The effectiveness of CPAP on cognitive improvement in patients with OSA is limited, although good adherence to CPAP can mildly benefit executive function with short-term effectiveness.

Study of Efficacy and Outcome of Nasal Cpap in Preterm Neonates with Hyaline Membrane Disease

Background: In the quest to bring down the neonatal mortality rate, the challenge is to develop low cost technology thatcan be used in remote settings. It is known that early use of continuous positive airway pressure (CPAP) reduces theincidence of respiratory distress and it may be used as an alternative to intubation and ventilation is some casesObjectives: To study the efficacy and outcome of Nasal CPAP in preterm neonates with Hyaline membrane disease.Methods: 50 preterm newborns with respiratory distress (Silverman"s score 3-6) admitted in NICU were included in thestudy. All study population were connected to CPAP variables like gestational age, birth weight, antenatal steroids,Downes Score, Age of start of CPAP, initial FiO2, initial PEEP , max FiO2, max PEEP, duration of CPAP, duration of O2administration, acute complications like sepsis, pneumothorax, septal damage and duration of hospital stay are comparedbetween CPAP success and CPAP failure groups.Results: Preterm New-borns between 31-34 wks of gestational age had a success of 96.5% as compared to gestationalage of 28-30 wks had success of 76.1% and p value 0.02. Preterm New-borns with birth weight &gt; 1000 gms had success of89% when compared to &lt;1000gms had success rate of 50% which is statistically significant. Preterms New-borns born tomothers who received antenatal steroids had better outcome (CPAP success rate of (87.7%) as compared to babies born tomothers who had not received antenatal steroidsConclusion: Early use of bubble CPAP is associated with lesser need for mechanical ventilation as well as reducedhospital stay. Bubble CPAP in pre-term neonates is efficient in decreasing respiratory distress, and associated with lessercomplications as well as mortality rate.

Surfactant Delivery Without Intubation in Preterm Infants

Surfactant Delivery Without Intubation in Preterm Infants

Changes of circulating biomarkers of inflammation and glycolipid metabolism by CPAP in OSA patients: a meta-analysis of time-dependent profiles.

Background:Continuous positive airway pressure (CPAP) is the first-line therapy for moderate-to-severe obstructive sleep apnea (OSA). Specifying timing of CPAP benefits on OSA-related biomarkers will help to assess the effectiveness of CPAP and to optimize the treatment strategies.Purpose:To explore the time-dependent changes of circulating biomarkers to CPAP treatment in patients with OSA, including inflammatory biomarkers [C-reactive protein (CRP) and tumor necrosis factor–α (TNF-α)] and glycolipid metabolic biomarkers [fasting blood glucose (FBG), fasting insulin (FINS), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglyceride (TG)].Methods:Searches of PubMed and Embase database were completed. Two independent reviewers extracted data from 68 included studies. A meta-analysis was conducted using a random-effect (or fixed-effect) model and standardized mean difference (SMD) model. The timing profiles of circulating biomarkers changes of inflammation and glycolipid metabolism were analyzed based on different CPAP duration, that is, short-term (<3 months), mid-term (3–6 months), and long-term (⩾6 months).Results:Those first improved by short-term treatment include CRP [SMD: 0.73, 95% confidence interval (CI): 0.15–1.31; p = 0.014], TNF-α [SMD: 0.48 (95% CI: 0.10–0.86; p = 0.014)], FBG [SMD: 0.32 (95% CI: 0.07–0.57; p = 0.011)], and LDL [SMD: 0.40 (95% CI: 0.18–0.62; p = 0.000)]. Those first improved by the mid-term or long-term treatment include HDL [SMD: –0.20 (95% CI: –0.36 to –0.03; p = 0.018)] and TC [SMD: 0.20 (95% CI: 0.05–0.34; p = 0.007)]. There were insignificant changes for TG and FINS after short or long CPAP.Conclusion:Our results imply that changes of circulating biomarkers for patients with OSA under CPAP treatment have a time-dependent profile.

30-DAY AND 90-DAY OUTCOMES OF THE SURVIVORS OF COVID-19 PNEUMONIA TREATED EXCLUSIVELY WITH CPAP: RESULTS FROM A DISTRICT TEACHING HOSPITAL

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The recent two waves of the pandemic have caused over 127,000 deaths in the UK, with over 4.4 million cases and estimated global mortality of approximately 3 million when writing this abstract. Patients hospitalised with COVID-19 pneumonia have severe hypoxic respiratory failure, and it can be challenging to maintain adequate oxygenation with traditional oxygen supplementation. Continuous Positive Airway Pressure (CPAP) was used to avoid mechanical ventilation and rationalise oxygen stocks. CPAP is beneficial in studies globally. We studied the outcomes of the survivors of COVID 19 pneumonia treated exclusively with CPAP who belonged to the Not for ICU group, admitted exclusively to the ward-based CPAP unit. METHODS: Retrospective data were collected on the survivors of patients admitted to a ward-based CPAP in Suspected or confirmed COVID-19 with pneumonitis and type 1 Respiratory failure. Patients admitted for BIPAP were excluded. Patients on CPAP for OSA or Obesity Hypoventilation syndrome who required being in the unit for infection control purposes were also excluded. Data collected on basic demographics and specific information like comorbidities, status length of stay, CPAP duration, discharge prescription of oxygen were collected and analysed. RESULTS: 28 patients were identified who received CPAP only during both the first and second wave (March to July 2021 and January to March 2021) of the pandemic. 17 Males and 11 females, 60% and 40% respectively, received CPAP only—the average age was 63.5 years, range 37 to 86 years. Twenty-six out of survivors of CPAP only treatment group 28 are alive, at 30 days 60 days and 26 were alive at 90 days. The mean length of stay of this cohort was 23 days due to rehabilitation requirements. Further, twenty-seven out of twenty-eight patients (96% ) were COVID PCR positive, and one patient was COVID PCR negative but radiology consistent with COVID pneumonitis. Nine patients (31.2%) were discharged on home oxygen;4 of them had a respiratory morbidity -2 patients with ILD, two patients with COPD. At 90 days, 4 of these nine patients discharged on home oxygen were still on oxygen Duration CPAP ranged from and 3 to 14 days with an average of 6.33 days. Two patients were on CPAP at discharge due to a new diagnosis of Obesity hypoventilation /OSA, and 5 of them were on CPAP for OSA at admission. The most common comorbidities among this cohort were Hypertension 9/28, Diabetes mellitus 7/28, Asthma 4/28 and COPD 3 /28 patients CONCLUSIONS: Patients treated who received exclusive ward-based CPAP due to being not for ICU level of care had a good 60-day 90-day survival. Up to a third (31.2%) were still requiring oxygen at the time of discharge, indicating a prolonged recovery phase of the respiratory failure.15% still on oxygen at 90 days. CLINICAL IMPLICATIONS: CPAP for COVID pneumonia has favourable outcome even at 60 and 90 days post CPAP, with a third of patients requiring oxygen at discharge. DISCLOSURES: No relevant relationships by Wee Teck Lim, source=Web Response No relevant relationships by Farah Asyikin Mohamad Nasir, source=Web Response No relevant relationships by Ernest Okpo, source=Web Response No relevant relationships by Aravind Ponnuswamy, source=Web Response No relevant relationships by Tariq Trussell, source=Web Response

CPAP delivered outside critical care during the second wave of COVID-19: outcomes from a UK respiratory surge unit

BackgroundNHS England recommends non-invasive continuous positive airway pressure (CPAP) as a possible treatment for type 1 respiratory failure associated with COVID-19 pneumonitis, either to avoid intubation or as a ceiling...

Effect of continuous positive airway pressure on maximal exercise capacity in patients with obstructive sleep apnea: a systematic review and meta-analysis.

Exercise capacity is impaired in obstructive sleep apnea (OSA). There are conflicting reports on the effect of continuous positive airway pressure (CPAP) on maximal exercise capacity. The objective of this review was to determine if there is a change in exercise capacity and anaerobic threshold following CPAP treatment in OSA patients. We conducted a systematic review and meta-analyses to summarize the changes in peak rate of oxygen uptake (V̇O₂ peak) or maximum rate of oxygen uptake (V̇O2 max) and anaerobic threshold (AT) during cardiopulmonary exercise testing following CPAP intervention in patients with OSA. A systematic literature review was conducted to identify published literature on markers of V̇O₂ peak, V̇O₂ max, and AT pre- vs post-CPAP using a web-based literature search of PubMed/MEDLINE, Embase, CINAHL, and Cochrane review (CENTRAL) databases. Two independent reviewers screened the articles for data extraction and analysis. The total search of all the databases returned 470 relevant citations. Following application of eligibility criteria, 6 studies were included in the final meta-analysis for V̇O₂ peak, 2 studies for V̇O₂ max, and five studies for AT. The meta-analysis showed a mean net difference in V̇O₂ peak between pre- and post-CPAP of 2.69 mL·kg-1·min-1, P = .02, favoring treatment with CPAP. There was no difference in V̇O₂ max or AT with CPAP treatment (mean net difference 0.66 mL·kg-1·min-1 [P = .78] and -144.98 mL·min-1 [P = .20] respectively). There is a paucity of high-quality studies investigating the effect of CPAP on exercise capacity. Our meta-analysis shows that V̇O₂ peak increases following CPAP treatment in patients with OSA, but we did not observe any change in V̇O₂ max or AT. Our findings should be considered preliminary and we recommend further randomized controlled trials to confirm our findings and to clarify the peak and maximum rates of oxygen uptake adaptations with CPAP therapy.

Outcomes of COVID-19 patients treated with continuous positive airway pressure outside the intensive care unit.

AimWe aimed to characterise a large population of coronavirus disease 2019 (COVID-19) patients with moderate-to-severe hypoxaemic acute respiratory failure (ARF) receiving continuous positive airway pressure (CPAP) outside the intensive care unit (ICU), and to ascertain whether the duration of CPAP application increased the risk of mortality for patients requiring intubation.MethodsIn this retrospective, multicentre cohort study, we included adult COVID-19 patients, treated with CPAP outside ICU for hypoxaemic ARF from 1 March to 15 April, 2020. We collected demographic and clinical data, including CPAP therapeutic goal, hospital length of stay and 60-day in-hospital mortality.ResultsThe study included 537 patients with a median (interquartile range (IQR) age of 69 (60–76) years. 391 (73%) were male. According to the pre-defined CPAP therapeutic goal, 397 (74%) patients were included in the full treatment subgroup, and 140 (26%) in the do not intubate (DNI) subgroup. Median (IQR) CPAP duration was 4 (1–8) days, while hospital length of stay was 16 (9–27) days. 60-day in-hospital mortality was 34% (95% CI 0.304–0.384%) overall, and 21% (95% CI 0.169–0.249%) and 73% (95% CI 0.648–0.787%) for full treatment and DNI subgroups, respectively. In the full treatment subgroup, in-hospital mortality was 42% (95% CI 0.345–0.488%) for 180 (45%) CPAP failures requiring intubation, and 2% (95% CI 0.008–0.035%) for the remaining 217 (55%) patients who succeeded. Delaying intubation was associated with increased mortality (hazard ratio 1.093, 95% CI 1.010–1.184).ConclusionsWe described a large population of COVID-19 patients treated with CPAP outside ICU. Intubation delay represents a risk factor for mortality. Further investigation is needed for early identification of CPAP failures.

Continuous Positive Airway Pressure (CPAP) face-mask ventilation is an easy and cheap option to manage a massive influx of patients presenting acute respiratory failure during the SARS-CoV-2 outbreak: A retrospective cohort study.

IntroductionBecause of the COVID-19 pandemic, intensive care units (ICU) can be overwhelmed by the number of hypoxemic patients.Material and methodsThis single centre retrospective observational cohort study took place in a French hospital where the number of patients exceeded the ICU capacity despite an increase from 18 to 32 beds. Because of this, 59 (37%) of the 159 patients requiring ICU care were referred to other hospitals. From 27th March to 23rd April, consecutive patients who had respiratory failure or were unable to maintain an SpO2 > 90%, despite receiving 10–15 l/min of oxygen with a non-rebreather mask, were treated by continuous positive airway pressure (CPAP) unless the ICU physician judged that immediate intubation was indicated. We describe the characteristics, clinical course, and outcomes of these patients. The main outcome under study was CPAP discontinuation.ResultsCPAP was initiated in 49 patients and performed out of ICU in 41 (84%). Median age was 65 years (IQR = 54–71) and 36 (73%) were men. Median respiratory rate before CPAP was 36 (30–40) and median SpO2 was 92% (90–95) under 10 to 15 L/min oxygen flow. Median duration of CPAP was 3 days (IQR = 1–5). Reasons for discontinuation of CPAP were: intubation in 25 (51%), improvement in 16 (33%), poor tolerance in 6 (12%) and death in 2 (4%) patients. A decision not to intubate had been taken for 8 patients, including the 2 who died while on CPAP. Two patients underwent less than one hour CPAP for poor tolerance. In the end, 15 (38%) out of 39 evaluable patients recovered with only CPAP whereas 24 (62%) were intubated.ConclusionsCPAP is feasible in a non-ICU environment in the context of massive influx of patients. In our cohort up to 1/3 of the patients presenting with acute respiratory failure recovered without intubation.

Continuous positive pressure therapy usage and incident stroke in patients with obstructive sleep apnea: A nationwide population‐based cohort study

Continuous positive airway pressure (CPAP) is the main treatment for obstructive sleep apnea (OSA). To date, the link between CPAP usage and incident stroke has been inconsistent. This nationwide population study is designed to examine the effect of CPAP on stroke incidence in OSA patients. Using Taiwan's National Health Insurance Research Database (NHIRD), this study collected data from 4275 OSA patients diagnosed between 2000 and 2011 and divided them into two groups according to whether they received CPAP treatment. After matching baseline demographics and comorbidities, both cohorts contained 959 OSA patients and were followed to a newly diagnosed stroke or until the end of 2013. Cox regression analysis was performed to examine the incidence of stroke between patients with OSA receiving CPAP or no CPAP treatment. CPAP treatment for OSA patients predicted a lower incidence rate (3.41 vs 5.43 per 1000 person-years) and tended to protect against the development of stroke (hazard ratio (HR): 0.68, 95% confidence interval (95% CI): 0.38-1.23) compared to those without CPAP treatment, but the estimate was not statistically significant. Similar results were also observed by dividing stroke into ischemic (2.65 vs 4.30 per 1000 person-years; HR: 0.67, 95% CI: 0.35-1.31) or hemorrhagic origin (0.76 vs 1.12 per 1000 person-years; HR: 0.67, 95% CI: 0.19-2.40). It is possible that treatment with CPAP might be beneficial for protection against stroke, but this conclusion should be interpreted with caution. Future studies with satisfactory CPAP quality and duration are needed to validate this observation.

A randomized controlled trial of restricted versus standard fluid management in late preterm and term infants with transient tachypnea of the newborn.

Transient tachypnea of the newborn(TTNB) is the most common respiratory morbidity in late preterm and term babies and is pathophysiologically related to delayed lung fluid clearance after birth. Mimicking low physiological fluid intake in the initial period of life may accelerate the recovery from TTNB. In a randomized controlled trial, we compared the roles of restricted versus standard fluid management in babies with TTNB requiring respiratory support. This parallel group,non-blinded, stratified randomized controlled trial was conducted in a level III neonatal unit of eastern India. Late preterm and term babies with TTNB requiring continuous positive airway pressure (CPAP) were randomly allocated to standard and restricted fluid arms for the first 72 hours (hrs). Primary outcome was CPAP duration. In total, 100 babies were enrolled in this study with 50 babies in each arm. CPAP duration was significantly less in the restricted arm (48[42, 54] hrs vs 54[48,72] hrs, p = 0.002). However, no difference was observed in the incidence of CPAP failure between the two arms. In the subgroup analysis, the benefit of reduced CPAP duration persisted in late preterm but not in term infants. However, the effect was not significant in the late preterm babies exposed to antenatal steroid. This trial demonstrated the safety and effectiveness of restrictive fluid strategy in reducing CPAP duration in late preterm and term babies with TTNB. Late preterm babies, especially those not exposed to antenatal steroid were the most benefitted by this strategy.

BLOOD PRESSURE AND ARTERIAL STIFFNESS DYNAMICS DEPENDING ON THE DURATION OF CPAP NIGHT SESSIONS IN PATIENTS WITH SEVERE OBSTRUCTIVE SLEEP APNEA

Background: Numerous studies on the pathophysiological mechanisms of obstructive sleep apnea discover the relationship between obstructive sleep apnea and cardiovascular diseases, its contribution to the development of resistant hypertension and endothelial remodeling. Continuous Positive Airway Pressure (CPAP) is the only reasonable pathogenetic therapy in these patients. This treatment regimen implies the creation of a “pneumatic stent” with a given level of positive pressure on the inhalation and exhalation of the patient, allowing to stabilize the lumen of the upper respiratory tract and prevent the pharyngeal collapse. However, the effects and the required duration of CPAP of night sessions to achieve the target values of blood pressure and restore arterial stiffness in patients with severe obstructive sleep apnea with resistant hypertension remain poorly understood. Objective: to study the dynamics of blood pressure, arterial stiffness and endothelial dysfunction in patients with severe obstructive sleep apnea with resistant hypertension, depending on the duration of auto-adjusting CPAP (A-Flex therapy). Methods: the prospective single-center study enrolled 168 patients with obstructive sleep apnea with resistant hypertension (139 males, 46,6 ± 9,0 y. o.) with apnea-hypopnea index &gt;30 events /hour. The night polygraphy study was performed to calculate AHI, oxygen desaturation index, mean nocturnal saturation (SpO2 ) according to the requirements of American Academy of Sleep Medicine. Endothelial function of blood vessels was assessed manually to peripheral arterial tone. The reactive hyperemia index and augmentation index was calculated. Blood pressure was monitored by office measurement, daily monitoring of blood pressure, and by individual patient diaries. Optimal level of CPAP-treatment was adjusted at home. Apnea-hypopnea index, the level of air leakage, average pressure and compliance to CPAP-therapy were established in accordance with international requirements. Results: In the group of patients, treated with night sessions of A-Flex &gt; 6 h/night, significant dynamics was observed by the 6th month of treatment. That is, a decrease in RHI by -1.33 (95% CI from -2.25 to -0.41; P = 0.002), a decrease in AI by -12.4% (95% CI from -18.42 to -6.38; P = 0.001), a decrease in mean SBP (24 h) by -33.6 mm Hg (95% CI from -44.1 to -23.2; P = 0.002) and decrease in mean DBP (24 h) by -20.2 mm Hg (95% CI from -29.4 to -11.1; P = 0.001), with a decrease in rate of morning rise of SPB by -22.4 mm Hg/h (95% CI from -24.7 to -20.1; P = 0.002) and a decrease in rate of morning rise of DPB by -17.4 mm Hg/h (95% CI from -19.5 to -15.3; P = 0.003). The best target values were achieved by the 12th month of treatment: a decrease in RHI by -2.11 (95% CI from -2.57 to -1.65; P = 0.001), a decrease in AI by -28.5% (95% CI from -37.06 to -19.94; P = 0.002), a decrease in mean SBP (24 h) by -39.7 mm Hg (95% CI from -48.9 to -30.5; P = 0.001) and decrease in mean DBP (24 h) by -26.8 mm Hg (95% CI from -36.1 to -17.5; P = 0.001), with a decrease in rate of morning rise of SPB by -22.5 mm Hg/h (95% CI from -23.6 to -21.4; P = 0.001) and a decrease in rate of morning rise of DPB by -19.4 mm Hg/h (95% CI from -20.7 to -18.1; P = 0.002). Conclusions: in patients with severe obstructive sleep apnea and resistant hypertension only CPAP-therapy in the A-Flex mode &gt; 6 h/night allows to achieve target blood pressure, restores endothelial function and arterial stiffness, therefore reducing the risks of cardiovascular complications.

Factors associated with improvements in subjective symptoms of obstructive sleep apnea syndrome after continuous positive airway pressure therapy.

Continuous positive airway pressure (CPAP) therapy improves subjective symptoms in obstructive sleep apnea syndrome (OSAS) patients; however, factors predicting symptom improvement post-CPAP therapy and the CPAP duration necessary for improving subjective symptoms are unclear. This study aimed to identify these factors and the appropriate nightly CPAP duration for improving subjective symptoms. We recruited 359 subjects who completed both overnight polysomnography and subjective symptom assessments using the Epworth Sleepiness Scale (ESS), Zung Self-Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). Firstly, we analyzed subject characteristics, and the associations between each assessment score and the Apnea-Hypopnea Index. These assessments were then repeated for 138 subjects who could continue for 3months after starting CPAP. Secondly, associations between changes in self-reported outcome measures and nightly CPAP duration were analyzed. We identified subjects with abnormal initial ESS, PSQI, and SDS scores and divided them into "improvement" and "non-improvement" groups to examine factors associated with a positive outcome after CPAP therapy. Subjective symptom scores and proportions of subjects exceeding the cutoff values of each symptom score were not significantly related to OSAS severity. ESS, SDS, and PSQI scores improved 3months after CPAP treatment, and factors involved in each improvement were found. Remarkably, longer CPAP nightly duration resulted in improvements in all subjective symptom scores. Furthermore, minimum durations between 4.75 and 5.40h were necessary for improvements in subjective symptoms based on ROC curve analysis. Longer nightly CPAP use significantly improved OSAS subjective symptoms.

Therapeutic effects of CPAP on cognitive impairments associated with OSA.

Obstructive sleep apnea (OSA) is the most common type of sleep apnea and caused by upper airway obstructions. Clinically, patients with OSA characteristically experience intermittent nocturnal hypoxemia and impaired sleep quality. Cognitive impairments are commonly seen in patients with an OSA diagnosis. A literature search on OSA, cognitive impairments and CPAP was performed with various electronic databases including Medline, EMBASE and Google Scholar. The chosen evidence was limited to human subject studies only, and reports on either central sleep apnea or non-classified sleep apnea were excluded. Available evidence has been systemically reviewed to ascertain what types of cognitive impairments are related to OSA as well as the pathological connections. In addition, effectiveness of continuous positive airway pressure (CPAP) was analyzed as a standard therapy for improving cognitive performance in patients with OSA. The review contributed in: (1) delineating OSA as a risk factor of cognitive impairments; (2) enumerating cognitive impairments seen in patients with OSA; (3) substantiating the relation between OSA and cognitive impairments from the pathological perspective of AD biomarkers; and (4) revealing duration of CPAP is crucial for its therapeutic effects on improving cognitive performance in patients with OSA.

A comparative study of outcomes of nasal prongs and nasal mask as CPAP interface in preterm neonates: A randomized control trial

Background: Nasal prongs are a common method of providing CPAP to newborn babies. They are the cause of mild to severe trauma to the nose and nasal septum and may result in CPAP failure. Nasal masks are now being used to try and mitigate the trauma.These are form fitting masks placed over the nose and are thought to cause less trauma than nasal prongs. Methods: A study was conducted on preterm neonates (28–34-week gestation) with respiratory distress within 24 h of life, admitted in a tertiary care center, Meerut. Babies were randomized and divided into two groups while being put on bubble continuous positive airway pressure (CPAP), using either nasal prongs (Group A) or nasal masks (Group B). The data generated were collected and analyzed for mean duration of CPAP, duration of hospital stay, CPAP failure, retinopathy of prematurity, necrotizing enterocolitis, patent ductus arteriosus, and nasal trauma among both groups. Results: Eighty neonates were analyzed in the study, of which the mean duration of CPAP was 4.53 days in Group A and 5.20 days in Group B; the mean duration of hospital stay was 21.36 days in Group A and 24.58 days in Group B; CPAP failure was observed in 21.95% cases in Group A and 23.07% cases in Group B; and nasal trauma was seen in 46.34% cases in Group A and 43.58% in Group B. Statistical analysis showed no significant difference among both groups. Conclusion: The outcomes of nasal mask as interface are as effective as nasal prongs in preterm infants on CPAP therapy.

Effect of Bubble and Ventilator-derived Continuous Positive Airway Pressure on the Management of Respiratory Distress Syndrome in Premature Neonates

Background: In this study, we aimed to compare ventilator-derived and bubble continuous positive airway pressure (CPAP) in neonates with respiratory distress syndrome admitted to Neonatal Intensive Care Unit of Vali-e-Asr Hospital, Birjand, Iran, in 2014. Methods: This cohort study was conducted among 68 patients assigned into two groups. The neonates in group A (32 infants) were treated with bubble CPAP and those in group B (36 infants) were treated with a ventilator-derived CPAP. The protocol of treatment was applying CPAP with the positive end-expiratory pressure (PEEP) of 5-6 cm H2O and fraction of inspired oxygen equivalent to 30-40%, depending on the gestational age. In case of need for higher oxygen levels to maintain oxygen saturation of arterial blood (SpO2) (90-95%), surfactant was administered and additional PEEP was applied (up to 8 cm H2O). Data analysis was performed using independent t-test and Chi-squared in the SPSS software, version 18. Results: The duration of CPAP and oxygen therapy was 1.67±1.22 days and 3.57±2.67 days in group A and 2.09±1.53 days (P=0.21) and 4.67±3.74 days (P=0.16) in group B, respectively. There was a significant difference between the groups in terms of discharge weight and surfactant dosage (P=0.042 and P=0.007, respectively). Moreover, although the length of stay in hospital in the ventilation group was almost 4 days longer than the other group, there was no significant difference between the groups in this regard. Conclusion: There was no significant difference between bubble CPAP and ventilator-derived CPAP. Moreover, further studies with larger sample size are recommended.

Does Continuous Positive Airway Pressure (CPAP) treatment of obstructive sleep apnoea (OSA) improve asthma-related clinical outcomes in patients with co-existing conditions?- A systematic review.

A high prevalence of OSA has been observed in asthma populations, with detrimental impact on clinical outcomes. To determine if CPAP treatment of co-existing OSA improves asthma-related symptoms and quality of life. Literature review of EMBASE and MEDLINE databases prior to July 2017. Study populations included asthmatics with co-existing OSA treated with CPAP, and ≥1 asthma-related clinical outcome measure. 12 studies; 8 prospective quasi-experimental and 4 observational. Mean CPAP duration; 19.5 (2-100) weeks. Meta-analysis demonstrated significant improvement in mean Asthma Quality of Life Questionnaire scores (AQLQ and mini-AQLQ); 0.59 (95%CI; 0.25, 0.92), p = 0.0006. No significant improvement was demonstrated in forced expiratory volume in 1 s (FEV1)% predicted; 0.32 (95%CI; -2.84, 3.47), p = 0.84. Asthma Control Test/Asthma Control Questionnaire improved in 2 studies, with no improvement in 1 study. 4 studies demonstrated improvement in asthma daytime/night-time symptoms, and 3 studies showed improved asthma severity. Asthmatics with co-existing OSA can experience improved quality of life with CPAP treatment. This effect appears more pronounced in severe OSA or poorly controlled asthma.

Effectiveness and safety of nasal mask versus binasal prongs for providing continuous positive airway pressure in preterm infants-A systematic review and meta-analysis.

Continuous positive airway pressure (CPAP) delivered via binasal prongs has been the cornerstone of respiratory management in preterm infants. Though effective, the use of binasal prongs is associated with nasal trauma, and CPAP failure. To overcome these issues, nasal masks are increasingly used to deliver CPAP in preterm infants. The aim was to conduct a systematic review of randomized controlled trials (RCTs) comparing nasal mask versus binasal prongs to deliver CPAP in preterm infants. Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing, and Allied Health Literature, and E-abstracts from the Pediatric Academic Society meetings were searched in May 2017. All RCTs comparing nasal mask versus binasal prongs for delivering CPAP in preterm infants were included. Primary outcome was CPAP failure (need for mechanical ventilation within 72 h of initiating CPAP). Secondary outcomes included duration of CPAP, moderate to severe nasal trauma, any nasal trauma, pneumothorax, severe IVH, bronchopulmonary dysplasia at 36 weeks postmenstrual age, and mortality. Five RCTs with low risk of bias were included. Nasal mask significantly decreased the risk of CPAP failure (4 RCTs [N = 459]; relative risk [RR]: 0.63; 95% confidence interval [CI]: 0.45-0.88; P=.007; I2 = 0%, NNT: 9), and the incidence of moderate to severe nasal trauma (3 RCTs [N = 275], RR: 0.41; 95%CI, 0.24-0.72; P = 0.002; I2 = 74%, NNT: 6). Other outcomes did not differ significantly between the groups. Compared to binasal prongs, nasal mask may provide a safe and effective alternative by minimizing the risk of CPAP failure in preterm infants needing CPAP support.