Continuous Positive Airway Pressure Tolerance Research Articles

Effect of continuous positive airway pressure helmet on respiratory function following surgical procedures in brachycephalic dogs: A randomized controlled trial.

To evaluate the effect of continuous positive airway pressure (CPAP) on respiratory function in the early postoperative period of brachycephalic dogs. Prospective, randomized clinical trial. A total of 32 dogs. Dogs were assigned to recover with or without CPAP (control) and assessed at specific time points over 1 h. Treatment was discontinued for dogs with a CPAP tolerance score of 3 or more (from a range of 0-4). The primary outcome was pulse oximetry (SpO2). Secondary outcomes were arterial O2 pressure (PaO2)/FiO2 ratio (PaO2/FiO2), arterial CO2 pressure (PaCO2), and rectal temperature. For dogs that reached a CPAP tolerance score of 3 or more, only the data collected up to the time point before discontinuation were included in the analysis.The treatment effect (β) was analyzed using random effects models and the results were reported with 95% confidence intervals. Dogs were assigned randomly to each protocol. Baseline characteristics in both groups were comparable. Arterial blood gases were obtained in seven control group dogs and nine CPAP group dogs. Treatment did not affect SpO2 (β = -0.1, -2.1 to 2.0) but affected the PaO2/FiO2 ratio (β = 58.1, 2.6 to 113.6), with no effects on PaCO2 (β = -4.3, -10.5 to 1.9) or temperature (β = 0.4, -0.8 to 1.6). In postoperative brachycephalic dogs, CPAP had no effect on SpO2 but improved the PaO2/FiO2 ratio in brachycephalic dogs postoperatively. Continuous positive airway pressure offers a valuable solution to improve gas exchange efficiency, a prevalent concern in postoperative brachycephalic dogs, with the potential to enhance overall outcomes.

Effect of CPAP on blood glucose fluctuation in patients with type 2 diabetes mellitus and obstructive sleep apnea

PurposeThis study aimed to investigate the effect of continuous positive airway pressure (CPAP) on blood glucose fluctuation in patients with type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA).MethodsPatients with T2DM and OSA were divided into an intervention group and a control group. All patients were treatment naïve. The intervention group was given CPAP therapy. The subjects were monitored using a continuous glucose monitoring system (CGMS) for 2 weeks.ResultsOf 60 patients, 30 were selected to receive CPAP intervention while 30 without CPAP served as controls. The CPAP tolerance of the intervention group was good, with average time on CPAP therapy of 55.2 ± 4.3 days, and average daily time on CPAP therapy of 8.3 ± 2.8 h. The postprandial blood glucose (PBG), fasting blood glucose (FBG), and HbA1c levels in the intervention group decreased significantly (P < 0.05). Significant variations in 24-h mean blood glucose and night-time mean blood glucose were significantly lower with CPAP therapy than without therapy (P < 0.05, respectively). The mean of daily differences and mean ambulatory glucose excursions were both considerably lower with treatment than without (P < 0.05, respectively). There was also a significant difference in time in range and time above range (P < 0.05, respectively).ConclusionCPAP treatment may significantly improve the blood glucose level and blood glucose stability in patients with T2DM and OSA. CPAP is an effective treatment method beyond lifestyle intervention and drug therapy.

Tolerance of Continuous Positive Airway Pressure After Sinonasal Surgery.

For patients with obstructive sleep apnea (OSA) undergoing sinonasal surgery, there is a lack of consensus on the risk and appropriate postoperative use of continuous positive airway pressure (CPAP). The aim of this study was to assess the tolerability of restarting CPAP on postoperative day one. Prospective cohort study. A prospective study on patients with OSA on CPAP who required a septoplasty/turbinectomy and/or functional endoscopic sinus surgery (FESS) was performed. Data from the memory card of a patient's CPAP machine and subjective information were obtained on the day of surgery and at scheduled follow-up visits. All subjects were instructed to restart CPAP on the first postoperative night. A total of 14 patients were analyzed; nine underwent FESS and five had a septoplasty/turbinectomy. There were no postoperative complications encountered. The only significant change in the first postoperative week was a reduction in the percentage of nights used over 4 hours (P < .05). By the third postoperative visit, average 22-item Sino-Nasal Outcome Test, Nasal Obstruction Symptom Evaluation, and CPAP tolerance scores improved from preoperative values. CPAP pressures, residual apnea-hypopnea index, and number of hours and mean percentage of nights used remained stable throughout the study period. Both quality-of-life and CPAP outcomes improved or remained the same when restarting CPAP immediately postoperatively. Combined with a lack of significant complications, this study suggests that CPAP is well-tolerated when restarted the day after a septoplasty/turbinectomy or FESS. 4 Laryngoscope, 131:E1013-E1018, 2021.

Are symptoms of obstructive sleep apnoea related to good continuous positive airway pressure compliance?

Obstructive sleep apnoea (OSA) is a common disease that can be treated with continuous positive airway pressure (CPAP). CPAP tolerance may be associated with its compliance. Even though there are several predictors for good CPAP compliance, there are limited data available on the correlation between CPAP compliance and OSA symptoms. This study aimed to evaluate this correlation. We conducted a cross-sectional study and enrolled adult patients diagnosed with OSA through polysomnography who had experience using a CPAP machine. A self-report questionnaire was used to evaluate CPAP compliance and study variables. Predictors of CPAP compliance were analysed using stepwise multivariate logistic regression analysis. There were 68 patients with OSA who completed the questionnaire during the study period. Of those, 14 (20.59%) exhibited good CPAP compliance. Only fatigue as a symptom was an independent factor associated with good CPAP compliance, with an adjusted odds ratio of 5.380 (95% CI 1.274–22.719). In conclusion, fatigue was the only symptom associated with good CPAP compliance in patients with OSA.

Abstract TMP45: An Intensive Multidisciplinary Protocol for Improving Adherence to CPAP Therapy During Inpatient Rehabilitation May Improve Recovery in Stroke Patients

Introduction: Obstructive sleep apnea (OSA) is associated with worse outcome after stroke. Treatment with continuous positive airway pressure (CPAP) may improve recovery after stroke but has been limited by poor adherence. Methods: In a single-arm ongoing study, adults with stroke underwent an intensive CPAP adherence protocol during inpatient rehabilitation, including motivational interviewing and help with CPAP by nurses and respiratory therapists. A 3-night run-in period of auto-titrating CPAP was used to test for tolerance and to diagnose OSA, based upon the apnea-hypopnea index and flow resistance. Qualifying patients were asked to continue CPAP for 3 months. The outcomes included CPAP adherence, defined as ≥ 4 hours of use on ≥ 70% of nights, and stroke recovery, measured by change in NIH Stroke scale (NIHSS) and Functional Independence Measure (FIM) over 3 months. Results: During the run-in, 39 of 60 (65%) patients had presumed OSA, 5 (8%) had no evidence of OSA, 4 (7%) had evidence of central sleep apnea, and 12 (20%) were intolerant of CPAP. Among the 34 of 39 patients who chose to continue CPAP after the run-in, the median use per night was 5.3 hours (IQR 4.1, 6.0) with 56% (n=19) adherent during rehabilitation. The median CPAP use per night for the 22 who completed the study was 5.1 hours (IQR 2.5, 6.4) with 54% (n=12) adherent over the 3-month period. Unadjusted for baseline factors, there was a significant change in the NIHSS in adherent patients (n=10) vs. non-adherent patients (n=10) [5 (SD 3) vs. 2 (SD 2), p =0.02]. Comparing adherent (n=7) to non-adherent patients (n=5), the change for total FIM trended towards significant [42 (SD 18) vs. 30 (SD 11), p =0.20] and the change for cognitive component of the FIM was significant [10 (SD 7) vs. 2 (SD 3), p =0.05]. Conclusion: After an intensive adherence intervention, over half of stroke patients with presumed OSA and CPAP tolerance were adherent over 3 months. CPAP adherent patients had greater improvement in NIHSS and the cognitive component of the FIM, although the associations may be confounded by patients’ characteristics influencing both adherence and outcomes. Future studies are needed to evaluate in a randomized trial if the intensive intervention will lead to long-term CPAP adherence and improved stroke recovery.

The influence of multilevel upper airway surgery on CPAP tolerance in non-responders to obstructive sleep apnea surgery.

The aim of this study was to evaluate the influence of multilevel upper airway surgery on subsequent continuous positive airway pressure (CPAP) use and tolerance in patients with moderate to severe obstructive sleep apnea (OSA). The study cohort enrolled 67 consecutive patients, who underwent septoplasty plus modified uvulopharyngopalatoplasty (mUPPP) with or without modified tongue base suspension (mTBS) due to CPAP intolerance, and who had residual OSA requiring CPAP therapy [non-responders to surgery, apnea-hypopnea index (AHI)>15 events/h] that had been confirmed by control polysomnography at the sixth month postoperatively. A questionnaire including questions on postoperative CPAP use, problems faced during CPAP use after the surgery, change in OSA symptoms, and satisfaction with the surgery was designed, and filled through interviews. Seventeen (25.4%) patients had septoplasty plus mUPPP and 50 (74.6%) had septoplasty plus mUPPP combined with mTBS. Postoperatively, mean AHI (45.00±19.76 vs. 36.60±18.34), Epworth sleepiness scale (ESS) score (18.00±4.45 vs. 13.00±4.72), oxygen desaturation index (ODI) (48.98±16.73 vs. 37.81±17.03), and optimal CPAP level (11.80±1.40 vs. 8.96±1.20) were decreased (p<0.001 for all parameters). Fifty-nine percent of patients reported that they fairly satisfied with the surgery and 49.2% reported that their symptoms were completely resolved. While none of the cases could tolerate CPAP before surgery, almost half (47.8%) of the cases used CPAP without problems postoperatively. Postoperative CPAP users had significantly higher postoperative AHI (p=0.001), supine AHI (p=0.009), ESS (p=0.019), and ODI (p=0.014), and significantly lower postoperative minimum O2 saturation (p=0.001) compared with non-users. Multilevel upper airway surgery with less invasive techniques may improve CPAP tolerance in well-selected patients.

Rehabilitación de músculos orofaríngeos con ejercicios y electroterapia para el síndrome de apnea-hipoapnea obstructiva del sueño

IntroductionObstructive sleep apnea syndrome (OSA) is associated with increased morbidity and mortality. Alternative interventions to continuous positive airway pressure (CPAP) lack efficacy and safety or are highly complex. ObjectiveTo describe the effects of an outpatient program of orofacial and extralaryngeal muscle re-education combined with electro-stimulation (TENS) of the same muscle groups in patients with OSA attending a tertiary level university hospital. DesignProspective, incident case series, with consecutively selected patients. MethodsParticipants consisted of 17 patients with mild, moderate or severe OSA who attended 24 thirty-minute sessions (three per week) of oropharyngeal exercises and electro-stimulation. The patients were evaluated at the beginning and end of the intervention by anthropometry, polysomnography, the Epworth sleepiness scale, and the Calgary Sleep Apnea Quality of Life (SAQLI) index. CPAP tolerance was evaluated by a visual scale rated from 1 to 10 (10 indicating maximum tolerance). Qualitative variables were described by frequencies, and quantitative variables by means and medians, depending on the type of distribution. ResultsAfter the intervention, the apnea - hypopnea index improved from 22 to 13 per hour, the SAQLI index improved from 4.65 to 5.33, and the Epworth scale from 7 to 5. CPAP tolerance increased from 3 to 9. The sessions were well tolerated with no adverse events of importance. Four patients reported facial muscular pain. ConclusionsElectrotherapy plus active exercises of the oropharyngeal muscles are easy, feasible, safe, and potentially beneficial for OSA, with minimal side effects.

Sleep differences in auto-adjustable CPAP devices and manual standard CPAP titration in a sleep laboratory

Continuous positive airway pressure (CPAP) and auto-adjusting positive airway pressure (APAP) devices are the mainstay of treatment for moderate to severe obstructive sleep apnea (OSA). The normalizing of sleep architecture may be one of the consequences of the treatment and may be related to treatment compliance and the relief of sleepiness. Determination the positive pressure required by a patient may be determined by standard CPAP (s-CPAP) or APAP, but there isn’t a universally accepted method to determine the optimal positive pressure value. Knowledge of the night sleep architecture in unselected OSAs patients by using s-CPAP or APAP devices during the determination the positive pressure by means of a full polysomnography (PSG) in the sleep lab attended by a sleep technician. 107 OSAS patients were one night full PSG controlees to titrated CPAP pressure, 63 of them (41 males and 22 females) by using APAP device and 44 patients (32 males and 12 females) by using s-CPAP. All patients were previously treated almost three months before (the pressure was calculated with a prediction formula). The groups were not different in their respective ages or BMIs. The PSG did not show differences in both groups in Total sleep time, sleep efficiency, sleep stage N1 or R, but the proportion of stage N3 was higher ( p = 0.035) and stage N2 was lower ( p = 0.022) in the APAP group. Other variables, such as taking hypnotics, CPAP tolerance, improving clinical manifestation with CPAP use, Epworth sleepiness scale, sleep position and previous randomized pressure did not show significant differences between groups. This is especially interesting taking into account that the APAP group had slept more hours the previous night. The mean CPAP pressure of the APAP group was higher (10.553 ± 1.78) than that of the s-CPAP group (9.250 ± 1.69) p = 0.000. The sleep structure was better on the APAP adjusted group than on the s-CPAP group, despite its mean CPAP pressure being higher. Only a minority of studies found in the bibliography are in agreement with this last observation. Both findings cannot be explained, but they could be a consequence of the slower increase of pressure in s-CPAP than in APAP. Therefore, it can be concluded that the use of APAP devices could be considered a good method for the adjustment of pressure levels and for normalizing sleep structure.

Clinical and Polysomnographic Predictors of Short-Term Continuous Positive Airway Pressure Compliance

Poor compliance and initial intolerance limit the effectiveness of continuous positive airway pressure (CPAP) in obstructive sleep apnea. Short-term compliance has been shown to predict long-term use. Unfortunately, few identified variables reliably predict initial CPAP tolerance and use. We sought to identify potential pretreatment variables that would predict short-term use of CPAP. We performed a retrospective review assessing short-term CPAP compliance after 4 to 6 weeks of treatment. Consecutive patients initiating CPAP therapy were included. Demographic and polysomnographic variables were correlated with objective measures of CPAP use. The average hours per night and percentage of nights of CPAP use were correlated with each variable. Variables were also associated with good vs poor compliance, which we defined as > 4 h per night > 70% of nights. We included 400 consecutive patients (78% male; mean age, 47 +/- 8 years). Of the measured variables, only age (48 +/- 8 years vs 46 +/- 7 years, p = 0.02) and use of a sedative/hypnotic during CPAP titration (77% vs 57.6%, p < 0.0005) were associated with better compliance. Those receiving a sedative/hypnotic had longer sleep times (345 +/- 42 min vs 314 +/- 51 min, p < 0.0005) and greater sleep efficiency (84 +/- 9% vs 78 +/- 11%, p < 0.0005) during polysomnography. CPAP titrations were improved in those receiving sedative/hypnotics, achieving lower respiratory disturbance index on the final CPAP pressure (6 +/- 7 vs 10 +/- 11, p = 0.04). Of the measured variables, only age and a one-time use of sedative/hypnotics during polysomnography correlated with greater short-term CPAP compliance. Hypnotics facilitated better quality CPAP titrations. Reliable predictors of short-term CPAP use could help identify measures to improve long-term compliance.

Continuous Positive Airway Pressure for Obstructive Sleep Apnea

A 48-year-old man reports that he snores loudly and falls asleep when sedentary. A diagnosis of obstructive sleep apnea is made, and treatment with continuous positive airway pressure (CPAP) is recommended. CPAP has been shown to improve cognitive function and sleep quality, although beneficial effects on survival have not been clearly documented. The patient's tolerance of CPAP is often a limiting factor.

Rhinoplastic techniques for the nasal valve for the patient with sleep apnea

Treatment of nasal blockage is necessary to facilitate therapy of obstructive sleep apnea and improve continuous positive airway pressure tolerance. The importance of the nasal valve in controlling inspiratory airflow has been well documented. Defining the nasal valve region and correlating physiology with its anatomic and surgical findings can be confusing. Reliable interpretation of the different types of nasal valve dysfunction can be correlated with effective surgical repair to reduce nasal airway resistance. A simplified approach to standardizing surgical treatment of nasal valve problems is presented.

Effects of nasal obstruction on continuous positive airway pressure treatments in obstructive sleep apnea syndrome

The purpose of this study was to assess the effectiveness of nasal surgery for continuous positive airway pressure (CPAP) failure in patients with both severe obstructive sleep apnea syndrome (OSAS) and nasal obstruction. Seventy-six male patients diagnosed with OSAS were prescribed CPAP for treatment. Sleep parameters and nasal resistance were evaluated by using standard polysomnography and rinomanometry before and after nasal surgery, respectively. Four of the 76 patients who were refractory to CPAP treatment underwent nasal surgery. However, they were able to use CPAP after surgery. In conclusion, nasal surgery may improve the tolerance of CPAP in patients with OSAS.