Continuous Positive Airway Pressure Machine Research Articles

Management of neonates with respiratory distress syndrome in resource-limited settings.

In South Africa, prematurity stands as one of the foremost causes of neonatal mortality. A significant proportion of these deaths occur because of respiratory distress syndrome of prematurity. The implementation of non-invasive respiratory support, such as continuous positive airway pressure (CPAP), has demonstrated both safety and efficacy in reducing mortality rates and decreasing the need for mechanical ventilation. Given the absence of blood gas analysers and limited radiological services in many district hospitals, the severity of respiratory distress is often assessed through observation of the infant's work of breathing and the utilisation of bedside scoring systems. Based on the work of breathing, non-invasive therapy can be commenced timeously. While evidence supporting the use of high-flow nasal cannula as a primary treatment for respiratory distress syndrome remains limited, it may be considered as an alternative, provided that CPAP machines are available. The purpose of this article is to advocate the use of non-invasive therapy in low resource-limited settings and describe the indications, contraindications, complications, and application of CPAP therapy. This would benefit healthcare workers, especially in low-care settings and district hospitals.

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.

Sleep Apnea is Not an Obstacle for Outpatient Hip and Knee Arthroplasty

BackgroundUp to 25% of patients requiring hip or knee arthroplasty have sleep apnea (SA), and these patients have historically been excluded from outpatient programs. The objectives of this study were to evaluate same-day discharge failure as well as 30-day complications, readmissions, and unexpected visits. MethodsA retrospective case-control study comparing patients who have and do not have SA matched for age, sex and arthroplasty type (total hip arthroplasty, total knee arthroplasty, unicompartimental knee arthroplasty) who underwent primary outpatient surgery between February 2019 and December 2022 in 2 academic hospitals was conducted. Cases with mild SA, moderate SA with a body mass index (BMI) <35, and SA of all severity treated by continuous positive airway pressure machines were eligible. There were 156 patients included (78 cases). Complications were assessed according to the Clavien-Dindo Classification and the Comprehensive Complication Index. Continuous variables were evaluated by Student's T or Mann-Whitney tests, while categorical data were analyzed by Chi-square or Fisher tests. Univariate analyses were performed to determine discharge failure risk factors. ResultsThere were 6 cases (7.7%) and 5 controls (6.4%) who failed to be discharged on surgery day (P = .754), with postoperative hypoxemia (6, [3.8%]) and apnea periods (3, [1.9%]) being the most common causes. Higher BMI (odds ratio = 1.19, P = .013) and general anesthesia (odds ratio = 11.97, P = .004) were found to be risk factors for discharge failure. No difference was observed on 30-day readmissions (P = .497), unexpected visits (P = 1.000), and complications on the Clavien-Dindo Classification (P > .269) and Comprehensive Complication Index (P > .334) scales. ConclusionsSelected patients who have SA can safely undergo outpatient hip or knee arthroplasty. Higher BMI and general anesthesia increased the odds of same-day discharge failure. Level of EvidenceLevel III, Case-control Study.

The Impact of Glucagon-like Peptide 1 Receptor Agonists on Obstructive Sleep Apnoea: A Scoping Review.

Obstructive sleep apnoea (OSA) and associated hypopnoea syndromes are chronic conditions of sleep-disordered breathing with significant sequelae if poorly managed, including hypertension, cardiovascular disease, metabolic syndrome and increased mortality. Glucagon-like peptide 1 receptor agonists (GLP-1RA) have recently garnered significant interest as a potential therapeutic, attributed to their durable effects in weight loss and glycaemic control in metabolic syndromes, such as obesity and type 2 diabetes mellitus. This has led to significant investment into companies that produce these medications and divestment from traditional gold standard methods of OSA management such as continuous positive airway pressure machines. Despite these sentiments, the impacts of these medications on OSA outcomes are poorly characterised, with no high-quality evidence at this stage to support this hypothesis. This scoping review therefore aims to address the research question of whether GLP-1RAs lead to a direct improvement in OSA and associated hypopnoea syndromes. A scoping review was performed following a computer-assisted search of Medline, Embase and Cochrane Central databases. Papers that evaluated the use of GLP-1RA medications related to sleep-disordered breathing, OSA or other sleep-related apnoeic or hypopnoeic syndromes were included. Literature search and evaluation identified 9 articles that were eligible for inclusion. Of these, 1 was a study protocol, 1 was a case report, 1 was an abstract of a randomised controlled trial (RCT), 1 was a non-randomised clinical trial and the remaining 5 were randomised clinical trials of variable rigour. All studies evaluated the outcomes of GLP-1RAs in patients with diagnosed OSA or symptoms suggestive of this condition. This scoping review identified early evidence to suggest that GLP-1RAs may improve OSA as defined by reduction in apnoea-hypopnoea index (AHI). This evidence is however conflicting due to contradicting results demonstrated from other studies. Overall, these medications were tolerated well, with minor gastrointestinal side-effects reported in some cases. Of all included studies, the quality of evidence was low, with short lengths of follow-up to identify durable effects of these medications on OSA outcomes and identify adverse events. More rigorous, RCTs with sufficient length of follow-up are required before consideration of formalising these medications into OSA treatment guidelines, frameworks and policies are warranted.

Digital forensics in healthcare: An analysis of data associated with a CPAP machine

The need for digital forensic services across all sectors is not a new concept, nor is the increasing demand seen globally. However, the devices on which we perform digital forensics have changed and continue to evolve. For each device new approaches need to be developed or adapted to facilitate the secure preservation and analysis of the data it contains. The healthcare sector has seen particular adoption of a range of devices, from traditional through to cutting edge. The Covid-19 pandemic facilitated the need for a more boundary-agnostic level of care for patients, and medical devices are becoming increasingly more interconnected to facilitate remote care. This presents challenges in that devices are no longer “secured” in medical premises and will often be found in patient's homes, making them more exposed to attack, but also in a position to record significant amounts of personal data. The integration of information technology in medical environments has influenced the need for the development of a digital forensic process to perform analysis on medical devices. One such device is a continuous positive airway pressure (CPAP) machine, used by patients who suffer from Obstructive Sleep Apnea (OSA). It is estimated that 3-9% of the world's population suffer from this disorder, the normal medical treatment is the use of some form of CPAP machine. The research undertaken focuses on the ResMed AirSense 10 CPAP machine and a complete forensic postmortem analysis of the data contained and recorded by the device. The application of digital forensics to a traditional medical device, such as a CPAP machine, requires an adapted version of digital forensics, but in general the same tools and processes can be used. Through the analysis conducted, all patient data was located on a removable FAT32 formatted SD card, allowing the recovery of specific medical information about the device and personally identifiable information about the patient. The recovered data was then visualised using a variety of tools and systems. Information that can be derived from the visualisations include a sequence of events, to some extent how the device was operating, and the clinical information recorded on the device.

A low-cost oxygen-air mixer device extends accessibility of safer neonatal respiratory support in a resource-poor setting

Background information: High cost of commercial-grade bubble continuous positive airway pressure (CPAP) machine has led to its limited availability for respiratory support of neonates in resource poor facilities. Most Nigeria facilities resorted to an improvised setup which supplies oxygen at 100% concentration exposing neonates to hyperoxia with possible ROP. PoliteO2blend® is a cheaper device that mixes supplied oxygen with atmospheric air, delivering variable fractions of inspired oxygen (FiO2) to neonates via tracheal tube or nasal prongs extended into a disposable PEEP water bottle as used in the improvised setup. The system microfilters and humidifies the blended gas unlike conventional improvised application. This study evaluated the PoliteO2blend as a standalone device as well as an upgraded version of improvised-CPAP. Methods: Four units of the politeO2blend were installed at the University Teaching Hospital Abakaliki for trialling and were operated by four designated staff after prior training on the modes of application of the device. Forty-five neonates, birthweight ≥1500g were treated following parental consents. The systems were operated as improved improvised-CPAP in 16 neonates of which 18.8% (3/16) were delivered preterm. All patients initially experienced respiratory distress with 75% (12/16) having pre-treatment respiratory rate &gt;60c/m and SPO2 as low as 43% in some. The neonatal impact analyses of continuing usage of the devices at the hospital was evaluated based on the fraction of the total number of needy neonates at the centre who necessarily got treated using the device. Results: The target SPO2 of 90-95% was achieved in all neonates using FiO2 that ranged from 0.21 to 0.6. Duration of improvised setup with PoliteO2blend before successful discharge ranged from 5hrs to 7days. Conclusion: Our target SPO2 was rapidly achieved at a safer FiO2 in most neonates that received respiratory support. Improvised-CPAP application via PoliteO2blend may reduce the incidence of oxygen toxicity owing to conventional use of improvised setup. PoliteO2blend is recommended as safer alternative for facilities lacking sufficient funds.

Barriers to optimal use of continuous positive airway pressure machines in preterm babies with respiratory distress syndrome at a Tertiary Referral Hospital in Addis Ababa, Ethiopia

Background: Neonatal mortality is a significant contributor to under-five mortality in low-income countries like Ethiopia, carrying neonatal mortality of 30 per 1000 live births. Preterm newborns with respiratory distress can be effectively managed with a Continuous Positive Airway pressure machine. It is recommended as an essential lifesaving intervention by the World Health Organization. The study aimed to assess barriers to the optimal use of continuous positive airway pressure machines in preterm babies by Pediatrics residents at a tertiary referral hospital.&#x0D; Methods: A hospital-based cross-sectional study was carried out among pediatric residents at Tikur Anbessa Specialized Hospital from September to October 2021. The data were collected through a self-administered structured questionnaire and analyzed using SPSS version 25. A Pvalue &lt;0.05 was considered statistically significant.&#x0D; Results: One hundred twelve pediatrics residents were included; 41(36.6%) were females and 89 (79.5 %) were aged between 25-30 years and 106 (94.6%) had NICU experience of less than one year. Forty-one (36.6%) had a moderate level of practicing continuous positive airway pressure safety checklists. There was a statistically significant difference in the practice of CPAP safety checklist usage with the year of residency (P= 0.001). A majority, 90 (80.4%), of `pediatrics residents used locally-made improvised water bottle systems as bubble continuous positive airway pressure machines. The perceived barriers to continuous positive airway pressure machine use included lack of commercial bubble machine, 77 (85.5%), unavailability of oxygen, and lack of appropriately sized nasal prongs.&#x0D; Conclusion: Lack of commercial continuous positive airway pressure machines and essential equipment were the reported barriers. Tackling the perceived barriers would contribute to the national effort to decrease neonatal mortality and achieve Sustained Development-3

Continuous Positive Airway Pressure plus Mandibular Advancement Therapy (PAPMAT): study protocol for an adaptive randomised crossover trial comparing the benefits and costs of combining two established treatments for obstructive sleep apnoea

BackgroundObstructive sleep apnoea (OSA) involves repeated breathing pauses during sleep due to upper airway obstruction. It causes excessive daytime sleepiness and has other health impacts. Continuous positive airway pressure (CPAP) therapy is effective first line treatment for moderate to severe OSA. Unfortunately, many patients have difficulty tolerating CPAP and pressure intolerance is probably an important contributing factor. Mandibular advancement devices (MAD) are an alternative to CPAP. They are worn in the mouth during sleep to reduce airway obstruction. There is some evidence that, when used in combination with CPAP, MADs improve airway anatomy enough to reduce the CPAP pressure required to treat OSA and that this combination therapy could improve CPAP adherence.MethodsConsecutive patients starting on CPAP for moderate to severe OSA will be recruited at a regional NHS sleep service. Patients with high CPAP pressure requirements after initial titration, who satisfy all entry criteria and consent to participate, will undertake a 2-arm randomised crossover trial. The arms will be (i) standalone CPAP and (ii) CPAP + MAD therapy. Each arm will last 12 weeks, including 2 weeks acclimatisation. CPAP machines will be auto-titrating and with facility for data download, so the impact of MAD on CPAP pressure requirements and CPAP adherence can be easily measured. The primary outcome will be CPAP adherence. Secondary outcomes will include measures of OSA severity, patient-reported outcome measures including subjective daytime sleepiness, quality of life, and treatment preference at the trial exit and health service use. Cost-effectiveness analyses will be undertaken.DiscussionIf the intervention is shown to be effective and cost-effective in improving adherence in this standard CPAP-eligible OSA patient population it would be relatively straightforward to introduce into existing OSA treatment pathways, within the wider NHS and more widely. Both MAD and CPAP are already used by sleep services so their combination would require only minor adjustments to existing clinical pathways. It would be straightforward to disseminate the results of the study through regional, national, and international respiratory meetings. The health economics analysis would provide cost-effectiveness data to inform service planning and clinical guidelines through policy briefing papers, including those by NICE and SIGN.Trial registrationPAPMAT was registered with ISRCTN prior to recruitment beginning (ISRCTN Registry 2021): https://www.isrctn.com/ISRCTN33966032. Registered on 17th November 2021.

Catastrophic implant failure after immediate loading of full arch implant prosthesis and its association with CPAP therapy: A case report.

Full arch implant-supported restorations are a common treatment modality for patients with a terminal dentition or an edentulous mouth. Several mechanical and biological factors that contribute to complications or failure are already extensively documented. Some patients receiving complex implant-based treatment plans also suffer from obstructive sleep apnea (OSA). The use of a continuous positive airway pressure (CPAP) mask in some of these patients is a lesser-known factor that could contribute to implant complications or failures. This article describes how the use of a CPAP machine may be a risk factor in implant dentistry and describes a patient whose use of a CPAP machine and mask led to a catastrophic failure of mandibular full arch dental implants.

Long-term sleep apnea CPAP via tracheostomy in children with tracheomalacia: 20-year experience.

Children with severe tracheobronchomalacia may need placements of tracheostomies and long-term mechanical ventilation. Due to financial constraints, continuous positive airway pressure (CPAP) machines commonly used to treat obstructive sleep apnea in adults have been utilized to deliver positive distending pressure to such children at our institution for more than 20 years with favorable outcomes. We, therefore, reported our experience with 15 children using this machine. This is a retrospective study during 2001-2021. Fifteen children, 9 boys, aged ranged 3 months-5.6 years, were discharged home with CPAP via tracheostomies. All had co-morbidities including gastroesophageal reflux (n = 9, 60%), neuromuscular disorders (n = 6, 40%), genetic abnormalities (n = 6, 40%), cardiac diseases (n = 4, 27%) and chronic lungs (n = 3, 20%). Eight (53%) children were aged less than 1 year old. The smallest child was aged 3 months old, weighing 4.9 kg. All caregivers were relatives and non-medical health professionals. The 1-month and 1-year readmission rates were 13% and 66% respectively. No factor-associated unfavorable outcomes were statistically identified. No complications related to CPAP malfunction were found. Five (33%) were weaned off CPAP, and 3 died (2 from sepsis and 1 from a sudden unknown cause). We first reported the use of sleep apnea CPAP via tracheostomy in children with severe tracheomalacia. In limited-resource countries, this simple device may be another option for long-term invasive ventilatory support. The CPAP use in children with tracheobronchomalacia requires adequately trained caregivers.

Obstructive Sleep Apnea, Psychotic Symptoms Common in Alzheimer’s Disease Patients

Obstructive Sleep Apnea, Psychotic Symptoms Common in Alzheimer’s Disease Patients

Marketing factors associated with a continuous positive airway pressure machine purchasing in patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is related with several cardiovascular diseases. It should be treated with a continuous positive airway pressure (CPAP) machine. There is limited data on marketing factors on a decision of CPAP machine purchasing in OSA patients. We enrolled adult patients aged over 18years with OSA who tried a CPAP. Marketing factors were evaluated for a decision of CPAP machine purchasing. There were 95 OSA patients participated in the study. Nice color CPAP machine and good knowledge and informative salesperson had adjusted odds ratio (aOR) of 4.480 and 9.478, the other two factors had aOR at0.102 and 0.217. Marketing factors related to CPAP machine purchasing in patients with OSA.

As we live and breathe – the use of simulated education in the management of patients on continuous positive airway pressure (CPAP) with COVID-19 using both a high-fidelity manikin and a real person

Continuous Positive Airway Pressure (CPAP) was being used on patients within designated wards to help reduce pressures on the Intensive Care Unit [1] and the number of intubated patients. Those patients presenting with COVID-19 associated respiratory failure within 48 hours of diagnosis were placed on CPAP [2]. The aim was to reduce mortality from hypoxaemia and promote patient safety. Those eligible for CPAP showed deterioration in oxygenation on arterial gas sampling or were showing increased work of breathing including an unsustainably high respiratory rate [3]. The simulated education sessions were to upskill registered intermediate care nurses in the use of CPAP, our most advanced airway procedure outside of the intensive care unit, and support redeployed nurses rostered onto the COVID-19 wards from other non-COVID-19 clinical areas. The aim was to empower nurses to feel more confident in the management of patients requiring CPAP and for them to be able to troubleshoot common problems giving patients the best care and chance of survival. Methods included coordinating exposure for each nurse to a CPAP preloading session following Trust policy, proformas and competency, then ensuring clinicians attended a dedicated two-hour practical simulation-based session using a mixture of high-fidelity manikins and real persons as simulated patients. Scenarios were developed based on issues that had previously happened or could occur in clinical practice. This created both a progressive simulation or shorter sessions followed by a debriefing depending on the experience of the nurse and how they performed on the day. Staff were asked to complete a feedback form about how they found the session and then assessment was made in clinical practice with the signing off of the CPAP clinical competency Within two months the team delivered training to all nurses rostered onto the COVID-19 ward and 95% had the clinical competency signed off. The feedback following the debriefing sessions stated that they felt more confident in managing the CPAP machine and the patient. They felt that the educational processes now in place facilitated patient safety and improved the quality of care delivered. Simulation-based education with the CPAP machine improved not only theoretical but also practical knowledge to help staff feel more empowered and confident when in clinical practice. Using a real person for several of the scenarios instead of the manikins meant staff could experience and respond appropriately to situations as they developed. This not only improved realism but enabled more immersive experiences for all involved. 1. Vaschetto R, Barone-Adesi F, Racca F, Pissaia C, Maestrone C, Colombo D, Olivieri C, De Vita N, Santangelo E, Scotti L, Castello L. Outcomes of COVID-19 patients treated with continuous positive airway pressure outside the intensive care unit. ERJ Open Research. 2021;7(1). 2. Ashish A, Unsworth A, Martindale J, Sundar R, Kavuri K, Sedda L, Farrier M. CPAP management of COVID-19 respiratory failure: a first quantitative analysis from an inpatient service evaluation. BMJ open respiratory research. 2020;7(1):e000692. 3. Talbot-Ponsonby J, Shrestha A, Vijayasingam A, Breck S, Motazed R, Raste Y. Adaptation of a respiratory service to provide CPAP for patients with COVID-19 pneumonia, outside of a critical care setting, in a district general hospital. Future Healthcare Journal. 2021;8(2):302–306.

Sensing Error in Respironics Continuous Positive Airway Pressure Machine Risks Compromising Patient Compliance

We report a continuous positive airway pressure (CPAP) machine malfunction that may compromise patient compliance. A patient's Respironics DreamStation machine (Philips Respironics) was observed to sense “vibratory snore” events incorrectly, resulting in pressure increases that led to poor mask fit, large air leaks, and patient discomfort. A replacement machine developed the same problem. Once aware of the defect, we observed it in 2 other patients. The manufacturer acknowledges receiving a few similar reports, but our experience suggests that this may be an underreported defect. The resulting increased pressures reduce patient tolerance for CPAP. This may be an unrecognized cause for patients abandoning CPAP therapy.

CPAP setup by mail: we're not there yet.

CPAP setup by mail: we're not there yet.

Nurses' Knowledge Toward Continuous Positive Airway Pressure Machine at Respiratory Isolation Unit

Background: For patients with coronavirus disease(COVID-19), continuous positive airway pressure (CPAP) has been considered as a useful treatment. The goal of CPAP therapy is to enhance oxygenation, relieve breathing muscle strain, and maybe avoid intubation. If applied in a medical ward with a multidisciplinary approach, CPAP has the potential to reduce the burden on intensive care units. Methods: Cross-sectional design was conducted in the ALSHEFAA center for crises in Baghdad. Questionnaire filled by 80 nurses who work in Respiratory Isolation Unit who had chosen by non-probability (purposive) selection collected the data. Then the researcher used an observational checklist to evaluate nurses’ practice. The data was analyzed using descriptive statistics and SPSS. Results: the study found a deficit in nurses’ knowledge and practices regarding using of continues positive airway pressure machine for COVID patients Conclusion: The nurses in this study lacked sufficient knowledge and had a low practice regarding using of continues positive airway pressure machine for COVID patients Recommendations: Special education programs should be carried out for the medical staff and specifically for the nurses who are working in the RCU, to raise their awareness toward using of CPAP machine during infecting with COVID and prevent its complication and how to prevent and manage it. Practice guidelines should be defined and implemented. Keywords: Continuous Positive Airway Pressure\ Knowledge\ Respiratory Isolation Unit

Reduction in medical emergency team activation among postoperative surgical patients at risk for undiagnosed obstructive sleep apnea.

Obstructive sleep apnea (OSA) is an under-recognized condition that results in morbidity and mortality. Postoperative complications, including medical emergency team activation (META), are disproportionally increased among surgical patients at risk for OSA. A systematic approach is needed to improve provider recognition and treatment, but protocols that demonstrate improvement in META are lacking. As part of a multidisciplinary quality improvement project, DOISNORE50 (DIS), a sleep apnea questionnaire and proactive safety measure, was algorithmically applied to all perioperative patients. Consecutive sleep screening was conducted among perioperative patients. Of the 49,567 surgical navigation center patients, 11,932 had previous diagnosis of OSA. Of the 37,572 (96%) patients screened with DIS, 25,171 (66.9%) were Low Risk (DIS < 4), 9,211 (24.5%) were At Risk (DIS ≥ 4), and 3,190 (8.5%) were High Risk (DIS ≥ 6) for OSA, respectively. High Risk patients received same-day sleep consultation. On the day of surgery, patients with Known OSA, At Risk, and High Risk for OSA received an "OSA Precaution Band." An electronic chart reminder alerted admission providers to order postoperative continuous positive airway pressure (CPAP) machine and sleep consult for patients High Risk for OSA. Implementation of a comprehensive program was associated with increased sleep consultation, sleep testing, and inpatient CPAP use (P < .001). For every 1,000 surgical patients screened, 30 fewer META, including rapid responses, reintubation, code blues, and code strokes, were observed. However, inpatient sleep consultation and inpatient CPAP use were not independently associated with reduced META. In the subgroup of patients hospitalized longer than 3 days, inpatient CPAP use was independently associated with reduced META. In this single-center, institution-wide, multidisciplinary-approach, quality improvement project, a comprehensive OSA screening process and treatment algorithm with appropriate postoperative inpatient CPAP therapy and inpatient sleep consultations was associated with increased CPAP use and reduced META. Further prospective studies are needed to assess cost, feasibility, and generalizability of these findings. Namen AM, Forest D, Saha AK, etal. Reduction in medical emergency team activation among postoperative surgical patients at risk for undiagnosed obstructive sleep apnea. J Clin Sleep Med. 2022;18(8):1953-1965.

A meta-analysis to identify factors associated with CPAP machine purchasing in patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a common disease and related to several cardiovascular diseases. Treatment with a continuous positive airway pressure (CPAP) machine is effective. However, not all patients with OSA purchase a CPAP machine for personal use. Previous studies showed different predictors of CPAP machine purchasing in patients with OSA. The present study aimed to summarize and identify predictors of CPAP purchasing using meta-analysis. The study was conducted using factors associated with CPAP purchasing in patients with OSA. The types of studies conducted in adult patients with OSA included: Randomized controlled trials, observational studies or descriptive studies comparing factors between those who purchased CPAP and those who did not. A total of five databases, including PubMed, Central database, Scopus, CINAHL Plus and Web of Science, were searched, and the final search was performed on February 8, 2021. Predictors for CPAP purchasing were determined. There were 598 articles from five databases, which met the inclusion criteria. After duplicated article removal, 390 articles were included in the screening process. There were 12 eligible articles for full text evaluation, and of those, eight studies met the study criteria with 1,605 patients from four countries. There were 11 variables that were available for a comparison between those who purchased the CPAP machine and those who did not, and six factors were different between the two groups: Age, years of education, income, smoking, Epworth Sleepiness Scale (ESS) score and apnea hypopnea index/respiratory disturbance index (AHI/RDI). The AHI/RDI was significantly different between the two groups, with the highest mean difference of 10.40 events/h (95% CI, 4.95-15.86). Patients who purchased CPAP were older (1.11 years), had more years of education (0.93 years), smoked more (1.15 pack/year), and had both higher ESS (0.61) and AHI/RDI (10.40) than those who did not purchase CPAP. Additionally, those who purchased CPAP had a 1.47 times higher income than those who did not. In conclusion, specific personal customer and clinical factors were related to the decision of CPAP purchase in patients with OSA.

Medicare Durable Medical Equipment Competitive Bidding Program: An Evaluation.

The Centers for Medicare and Medicaid Services (CMS) implemented the Medicare durable medical equipment (DME) Competitive Bidding Program (CBP) in 2011. Since then, concerns have been raised regarding access to equipment and adverse health outcomes. The aim was to evaluate whether the CBP was associated with changes in spending, utilization, and adverse health events (emergency department visits, hospitalizations, and falls). A comparative interrupted time series over 8 years was used to compare Round1 and Round2 bidding to nonbidding areas. Medicare fee for services claims were aggregated at the quarterly Metropolitan Statistical Area (MSA) level from 2009 to 2016. For the 3 evaluated DME (continuous positive airway pressure machines, oxygen supplies, and walkers), we found that implementation of the Medicare CBP was associated with reductions in per capita spending without changes in DME utilization or adverse health outcomes in CBP areas compared with nonbidding areas. For example, the slope change in the proportion of oxygen supplies purchasers in Round1 areas after implementation of Round1 was similar to the slope change in nonbidding areas (-0.0002; 95% CI: -0.0004, 0.0001; P=0.189). The difference in slope changes of emergency department visits and hospitalization in Round1 areas for oxygen supplies were (-0.0004; 95% CI: -0.0016, 0.0008; P=0.514) and (0.0002; 95% CI: -0.0010, 0.0014; P=0.757), respectively. Findings in Round2 areas after implementation of Round2 were similar to findings in Round1 areas. The Medicare DME CBP lowered Medicare expenditures while not reducing beneficiary access or increasing adverse outcomes.

Evaluating the diagnosis and intervention of a sleepwalking disorder associated with violence: A case study

This study aimed to investigate a case of sleep problems associated with violence (non-REM parasomnias) and obstructive sleep apnea (OSA) besides related therapeutic approaches. The studied case in the present study was a 60-year-old man with a family history of this sleep disorder. The treatment plan in the present study was as follows: Execution of the principles of sleep hygiene by the patient, use of the continuous positive airway pressure machine (CPAP), and eight sessions of weekly biofeedback therapy. Before the intervention, the subject suffered from anxiety, minor depression, moderate quality of life, some degree of PTSD, obstructive sleep apnea, and periodic limb undesirable movements. After the intervention, there was a relative improvement in all indicators, especially obstructive sleep apnea and limb movements. Practical Implications. Given the prevalence and complexity of non-REM parasomnias, insufficient knowledge of the involved causes and mechanisms, and the failure of many pharmacological therapies, the present study can help discover the possible causes and alternative treatments based on physical and psychological factors.