Continuous Positive Airway Pressure Usage Research Articles

Comparative effectiveness of hypoglossal nerve stimulation and alternative treatments for obstructive sleep apnea: a systematic review and meta-analysis.

Continuous positive airway pressure (CPAP) is the primary therapeutic modality for obstructive sleep apnea (OSA) management. However, despite efforts to encourage patients to comply with CPAP usage, long-term adherence remains low. Consequently, surgical intervention for OSA is considered a secondary option for patients who exhibit non-compliance with CPAP. Therefore, we conducted systematic review and meta-analysis assessed the relative effectiveness of hypoglossal nerve stimulation (HNS) treatment and alternative surgical interventions for managing OSA. Five databases were searched. Studies were included if they measured polysomnography parameters and assessed sleep apnea-related quality of life (Epworth Sleepiness Scale [ESS]) both before and after HNS, and compared these outcomes with control, CPAP, or airway surgery (uvulopalatopharyngoplasty, expansion sphincter pharyngoplasty, or tongue base surgery) groups. A total of 10 studies (2209 patients) met the inclusion criteria. Compared to other airway surgeries, the rates of post-treatment apnea-hypopnea index (AHI) < 10 and < 15 events/h were significantly lower in the HNS group (odds ratio [OR] 5.33, 95% confidence interval [CI] 1.21-23.42; and 2.73, 95% CI 1.30-5.71, respectively). Additionally, postoperative AHI was significantly lower in the HNS group than in all other airway surgery groups (AHI: mean difference [MD] -8.00, 95% CI -12.03 to-3.97 events/h). However, there were no significant differences in the rate of post-treatment AHI < 5 events/h (OR 1.93, 95% CI 0.74-5.06) or postoperative ESS score (MD 0.40, 95% CI-1.52 to 2.32) between the two groups. HNS is an effective option for selected patients with moderate-to-severe OSA and CPAP intolerance.

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

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

Web Integrated Continuous Positive Airway Pressure System

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

Predictors of blood pressure response to continuous positive airway pressure treatment in patients with sleep apnea.

Sleep apnea is associated with hypertension. Metaanalyses indicate that treatment of sleep apnea by continuous positive airway pressure (CPAP) reduces blood pressure (BP) by a mean of 3 mmHg. To date, predictors of BP response to CPAP remain incompletely understood. We hypothesized that the magnitude of CPAP-induced BP reduction depends on baseline apnea-hypopnea index (AHI) and the extent of daytime sleepiness. We performed a retrospective study on the association of BP response to CPAP with polysomnographic readings, intensity of sleepiness (measured by Epworth Sleepiness Scale, ESS), and epidemiologic parameters in 2461 patients with obstructive sleep apnea. BP response was defined as the difference between office BP at polysomonography examinations before and after initiation of CPAP. Five hundred and fifty-five patients fulfilled all inclusion and exclusion criteria and were included in the analysis. Median monthly CPAP usage was 143.7 h (85.4-204.1 h). BP was significantly higher at baseline than at follow-up (129.9 ± 15.5 vs. 128.3 ± 15.2, P = 0.021) resulting in mean reduction of BP of -1.5 ± 19.2 mmHg. patients with a higher than median baseline AHI (median 21) showed a more pronounced reduction of BP than those with lower AHI (AHI ≥21: 130.5 ± 15.3 vs. 128.6 ± 14.6, P = 0.06; AHI <21: 129.5 ± 15.8 vs. 127.9 ± 15.8, P = 0.18). CPAP therapy led to a significant reduction in sleepiness (8.3 ± 4.8 vs. 6.6 ± 4.5, P < 0.0001). Those subjects with higher than median sleepiness score (ESS ≥8), however, did not show a significant difference in BP response compared with those with a lower sleepiness score. Receiver-operating characteristic (ROC) curve analyses investigating the accuracy of AHI and ESS to predict a BP reduction at least 5 mmHg revealed an AUC of 0.51 and 0.52, respectively. The study confirms that CPAP therapy for sleep apnea has a mild BP lowering effect. Although this effect is slightly higher in patients with above-average AHI, neither AHI nor ESS can be used to define threshold values predicting a BP decrease at least 5 mmHg.

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

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

6 The Role of CPAP Treatment on Associations Between Obstructive Sleep Apnea and Cognition Among Black and White Older Adults

Objective:Obstructive sleep apnea (OSA) may be a modifiable risk factor for late-life cognitive impairment. We previously demonstrated that non-Hispanic Black older adults are less likely to be diagnosed with OSA despite having equal or greater health risk for OSA compared to non-Hispanic White older adults, and this disparity in diagnosis was strongest among individuals with lower education. Here, we aimed to determine 1) whether there are racial differences in continuous positive airway pressure (CPAP) treatment, 2) how CPAP treatment may influence OSA-cognition associations, and 3) whether CPAP differentially influences OSA-cognition associations across racial groups.Participants and Methods:Cross-sectional data were obtained from 424 socioeconomically diverse community-dwelling adults ages 55-83 (63.4±3.2 years, 41.7% male, 53.5% Black) from the Michigan Cognitive Aging Project. Physician-diagnosed OSA and current CPAP use were self-reported. Global cognition was operationalized as a composite of five factor scores derived from a comprehensive neuropsychological battery. Racial group differences were investigated with chi-square and Fisher’s exact tests with statistical significance set at the .05 level. Associations between OSA and cognition (adjusted for age, gender, race, and years of education) were investigated with linear regressions. Subsequent models isolated effects of uncontrolled OSA by excluding individuals using CPAP. Racial differences in OSA-cognition associations were investigated with race-stratified models.Results:Fewer Black participants (9.2%) reported diagnosed OSA compared to White participants (12.3%; x2 (1, N=424) =5.314, p=.021, cp=.112). In the whole sample, 47.3% of participants with diagnosed OSA reported CPAP use, and this proportion did not differ across race (x2 [1, N=86] =.048, p=.826). In the whole sample, OSA diagnosis was only associated with cognition when CPAP users were excluded (excluding CPAP users: ß=-.085, SE=.037, p=.024; including CPAP users: ß=-.067, SE=.036, p=.062). In race-stratified models, diagnosed OSA was only associated with cognition among Black participants, and this association was stronger when CPAP users were excluded (excluding CPAP users: ß=-.142, SE=.060, p=.018; including CPAP users: ß=-.126, SE=.058, p=.030). Diagnosed OSA was not associated with cognition among White participants, irrespective of whether CPAP users were included (excluding CPAP users: ß=-.084,SE=.068, p=.215; including CPAP users: ß=-.056, SE=.064, p=.378).Conclusions:Our findings support CPAP treatment as a potential intervention to mitigate late-life cognitive impairment among those with OSA. Despite being less likely to receive a diagnosis of OSA, Black older adults were equally likely to engage in CPAP treatment as White older adults when diagnosed. The detrimental impact of OSA on cognition may be more salient among Black older adults, which may reflect racial disparities in cardiovascular risk and/or resources that promote cognitive reserve. However, CPAP appears to be an effective treatment to reduce OSA-related cognitive impairment for Black older adults, highlighting the critical importance of diagnosis and treatment in this group. Intervention efforts that abate racial inequalities in access to quality healthcare in order to facilitate acquisition of a formal OSA diagnosis and CPAP treatment may help to reduce preventable cognitive health disparities among older adults.

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

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

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

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

Effects of continuous positive airway pressure therapy on glucose metabolism in patients with obstructive sleep apnoea and type 2 diabetes: a systematic review and meta-analysis.

Obstructive sleep apnoea is a highly prevalent chronic disorder and has been shown to be associated with disturbed glucose metabolism and type 2 diabetes. However, the evidence from individual clinical trials on the effect of continuous positive airway pressure (CPAP) treatment on glycaemic control in patients with co-existing obstructive sleep apnoea and type 2 diabetes remains controversial. A systematic review of randomised controlled trials assessing the effect of CPAP on glycaemic control in patients with obstructive sleep apnoea and type 2 diabetes was conducted using the databases MEDLINE, Embase, Cochrane and Scopus up to December 2022. Meta-analysis using a random-effect model was performed for outcomes that were reported in at least two randomised controlled trials. From 3031 records screened, 11 RCTs with a total of 964 patients were included for analysis. CPAP treatment led to a significant reduction in haemoglobin A1c (HbA1c) (mean difference -0.24%, 95% CI -0.43- -0.06%, p=0.001) compared to inactive control groups. Meta-regression showed a significant association between reduction in HbA1c and hours of nightly CPAP usage. CPAP therapy seems to significantly improve HbA1c and thus long-term glycaemic control in patients with type 2 diabetes and obstructive sleep apnoea. The amount of improvement is dependent on the hours of usage of CPAP and thus optimal adherence to CPAP should be a primary goal in these patients.

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

BackgroundStudies have shown that a significant percentage of patients with obstructive sleep apnea (OSA) do not tolerate continuous positive airway pressure (CPAP) therapy and long-term use may be as low as 30%. Given the lower levels of symptoms and health-related risks, patients with mild sleep apnea may be at even higher risk for non-adherence to long term CPAP. The purpose of our study was to investigate the prevalence and associations of long-term CPAP adherence in first time users with mild sleep apnea diagnosed by home sleep apnea testing (HSAT).MethodsWe identified all the patients who were diagnosed with mild sleep apnea (5 = < AHI < 15) by home sleep apnea testing from 01/2013 to 06/2019 at a large, combined community and hospital-based sleep practice. Only first time CPAP users were included. Compliance was defined as CPAP usage ≥ 4 h per night on ≥ 70% of nights over 30 consecutive days. We defined long term adherence as compliance on the 12th month following CPAP set up. Patient demographics, comorbidities, and CPAP compliance at 1st, 3rd, 6th, 9th and 12th month after therapy initiation were collected. We compared and identified the factors that had significant difference (P < 0.1) between compliant and non-compliant groups at the 12th month.Results222 patients were included in the analysis. 57 (25.7%) patients were adherent with long term CPAP treatment. The following factors were associated with a greater likelihood for long-term CPAP adherence: older age, lower body mass index (BMI), presence of a bed partner, non-smoker, presence of Diabetes Mellitus (DM), presence of Heart Failure (CHF), lack of depression, and compliance at 1st, 3rd, 6th and 9th month.ConclusionsLong term CPAP compliance in mild sleep apnea patients is low. Long term adherence to CPAP can be predicted based on CPAP adherence during the first three months.

Effectiveness of Continuous Positive Airway Pressure in Treating Hypertension in Obstructive Sleep Apnea: A Traditional Review.

Almost one billion individuals worldwide suffer from obstructive sleep apnea (OSA). The most widely used treatment for OSA has been continuous positive airway pressure (CPAP), but its effect on blood pressure (BP) has been challenged. Our review aims to evaluate the effects of treating OSA with CPAP on BP and BP-related morbidities in adult hypertensive patients. Medical subject headings (MeSH) terminology was used to search the PubMed Central, MEDLINE, and PubMed databases for articles on the use of CPAP in OSA patients with hypertension. We selected various forms of academic writing, encompassing complete texts that were published in the English language. The study included a total of 21 papers. OSA is a serious health concern associated with a higher risk of cardiovascular disease, kidney disease, pulmonary hypertension, and aortic stiffness, which is brought on by the periodic hypoxia caused by nocturnal respiratory episodes. For individuals with moderate-to-severe OSA, CPAP therapy has been shown to have a considerable long-term benefit with a median drop of 11 mm Hg, and high adherence results in a decrease in diastolic BP. CPAP therapy directly lowers BP in OSA patients with a body mass index (BMI) of more than 30 kg/m2 and has also demonstrated improvement in early signs of atherosclerosis with lower nocturnal systolic BP levels. OSA patients with resistant hypertension also experienced lower BP after using CPAP for a year. Therefore, our findings suggest that obesity, hypersomnolence, high nocturnal BP, prolonged CPAP usage, and resistant hypertension may all have a major impact on the BP response to CPAP therapy in individuals with severe OSA.

Mean disease alleviation between surgery and CPAP in matched adults with obstructive sleep apnea.

Polysomnography parameters measure treatment efficacy for obstructive sleep apnea, such as reduction in apnea hypopnea index. However, for continuous positive airway pressure (CPAP) therapy, polysomnography measures do not factor in adherence and thus do not measure effectiveness. Mean disease alleviation (MDA) corrects polysomnography measures for CPAP adherence and was used to compare treatment effectiveness between CPAP and multilevel upper airway surgery. This retrospective cohort study consisted of a consecutive sample of 331 patients with obstructive sleep apnea managed with multilevel airway surgery as second line treatment (N=97) or CPAP (N=234). Therapeutic effectiveness (MDA as % change or as corrected change in apnea hypopnea index) was calculated as the product of therapeutic efficacy (% or absolute change in apnea hypopnea index) and adherence (% time on CPAP of average nightly sleep). Cardinality and propensity score matching was utilised to manage confounding variables. Surgery patients achieved greater MDA % than CPAP users (67 ± 30% vs. 60 ± 28%, p=0.04, difference 7 ± 3%, 95% confidence interval 4% to 14%) in an unmatched comparison, despite a lower therapeutic efficacy seen with surgery. Cardinality matching demonstrated comparable MDA % in surgery (64%) and CPAP (57%) groups (p=0.14, difference 8 ± 5%, 95% confidence interval -18% to 3%). MDA measured as corrected change in apnea hypopnea index showed similar results. In adult patients with obstructive sleep apnea, multilevel upper airway surgery and CPAP provide comparable therapeutic effectiveness on polysomnography. For patients with inadequate CPAP use, surgery should be considered.

The use of continuous positive airway pressure in COPD-OSA overlap syndrome: A systematic review

BackgroundThe co-occurrence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), known as COPD-OSA overlap syndrome, increases morbidity and mortality. The effectiveness of continuous positive airway pressure (CPAP) therapy, a commonly used treatment for OSA, in this patient population remains uncertain. Therefore, we conducted a systematic review to evaluate the efficacy of CPAP therapy in improving clinical outcomes. MethodsWe conducted a comprehensive systematic review to identify studies that evaluated the impact of CPAP therapy on COPD exacerbation, hospitalization, and mortality in patients with COPD-OSA overlap syndrome. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement and assessed the quality of each study using the Newcastle-Ottawa quality scale. ResultsFrom the initial 3184 articles identified, we reviewed 365 and included five in the systematic review. Our findings revealed that CPAP therapy improved clinical outcomes, including COPD exacerbation, COPD related hospitalization, and mortality in patients with COPD-OSA overlap syndrome. However, the definition of COPD and OSA varied across studies, and the definition of CPAP usage was not consistent. ConclusionOur systematic review suggests that CPAP therapy is effective in improving outcomes in patients with COPD-OSA overlap syndrome. Nonetheless, further research is required to establish the efficacy of CPAP therapy by standardizing the definition of COPD, OSA, and CPAP usage.

0562 The characteristics of the older continuous positive airway pressure (CPAP) users in Japan: In comparison with the adult users

Abstract Introduction The characteristics of the older CPAP users have not been well studied, and accessibility to medical care and long-term follow up are the issues about their investigation of the older OSA patients. In this respect, Japan is in a unique position to look into reality of the situation, as virtually all the people have unlimited access to medical care and CPAP follow-up with one to three month interval is mandatory. Under this condition, the aim of this study is to reveal the characteristics of the older CPAP users compared to the adult users. Methods This is a retrospective study dealing with 340 obstructive sleep apnea patients who started CPAP therapy from May 2013 to Oct 2021 in our sleep laboratory. Two groups of CPAP users were extracted from these patients, older (n=44, with the age of 70 years or more, 75.8±4.4 years) and adult (n=26, with the age of 25-44 years old, 39.2±4.5 years) patients. We assessed the characteristics of demographic data, symptoms and comorbidity, diagnostic polysomnographic parameters, and CPAP adherence. Results The older CPAP users were leaner (BMI, older/adult, 24.9 [21.9-26.8]/31.3 [27.1-34.8], p&amp;lt; 0.0001) and less sleepy (Epworth Sleepiness Scale, older/adult, 8.0 [5.0-13.0]/15.5 [8.8-20.2], p&amp;lt; 0.0005). Apnea-hypopnea index (AHI) of two groups were not significantly different (older/adult, 38.6 [27.4-48.0]/49.5 [26.4-66.4]). Most of both older and adult patients continued to use CPAP more than one year (84.1 % and 92.3 %, respectively). CPAP adherence using more than one year in the older group was higher than that in the adult group (older/adult, 96.5 %/80.0 %). Conclusion Our study revealed that CPAP adherence in the older users was higher than that in the adult users, although the older CPAP users were leaner and less sleepy. Support (if any)

CPAP Therapy for 4 Months Improves Sleep Quality, Daytime Alertness, Fatigue, and Mental Health in People with Chronic Spinal Cord Injury and Moderate-to-Severe Sleep-Related Breathing Disorder: The Preliminary Results of an Ongoing Prospective Study. (S38.002)

<h3>Objective:</h3> To examine the cognitive and psychological effects of continuous positive airway pressure (CPAP) therapy in people with chronic spinal cord injury (SCI) and moderate-to-severe sleep-related breathing disorder (SRBD). <h3>Background:</h3> SRBDs are common but under-recognized after SCI. <h3>Design/Methods:</h3> An ongoing single-arm clinical trial (NCT04007380) aims to evaluate the effects of 4 months of CPAP therapy on cognition and mental health in people with SCI who were diagnosed with moderate-to-severe SRBD. Outcomes included the Epworth Sleepiness Scale, Medical Outcomes Study Sleep Scale, Fatigue Severity Scale, Depression, Anxiety &amp; Stress Scale-21, and Montreal Cognitive Assessment (MoCA). The participants shared their experience in a 1-hour semi-structured interview (qualitative analysis). <h3>Results:</h3> By September 2022, we screened 31 individuals (10 females, 21 males; ages range: 37–79 years; mean age: 58.4 years) with complete motor (n=14) or incomplete SCI at cervical (n=20) or thoracic level. Time from SCI onset varied from 4 to 793 months (mean time: 190.5 months). Of the 31 screened participants, the apnea-hypopnea index (AHI) varied from 2.6 to 83.7 events per hour (mean AHI: 23.0). Of the 24 individuals who initiated CPAP therapy, 11 individuals have completed it, whereas three individuals withdrew from the study. The overall mean adherence rate to CPAP was 78.6%; mean nighttime CPAP usage was approximately 5 hours. Daytime sleepiness (p=0.003) and sleep quality (p&lt;0.001) significantly improved with CPAP therapy. Fatigue significantly decreased with CPAP therapy (p=0.048). Mental health indicators improved with CPAP therapy (p=0.049). There was a numeric increase in MoCA scores, but this did not reach significance yet (p=0.160). All 11 participants confirmed that CPAP therapy had a positive impact in their lives. <h3>Conclusions:</h3> Our preliminary results suggest that 4 months of CPAP therapy significantly improves sleep quality, and reduces daytime sleepiness, fatigue, stress, anxiety and mood in people with chronic SCI. The participants’ adherence to CPAP therapy was high (78.6%). <b>Disclosure:</b> The institution of Dr. Furlan has received research support from Wings for Life Spinal Cord Research Foundation. The institution of Dr. Furlan has received research support from Craig H Neilsen Foundation. The institution of Dr. Furlan has received research support from Ontario Neurotrauma Foundation. The institution of Dr. Furlan has received research support from Cervical Spine Research Society. The institution of Dr. Furlan has received research support from J P Bickell Foundation. The institution of Dr. Furlan has received research support from Praxis Spinal Cord Institute. The institution of Dr. Furlan has received research support from Cervical Spine Research Society. Dr. Hitzig has nothing to disclose. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jazz Pharmaceuticals. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Paladin Labs. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Boulos has received research support from Interaxon. The institution of Dr. Boulos has received research support from The Mahaffy Family Research Fund. The institution of Dr. Boulos has received research support from Canadian Institutes of Health Research. The institution of Dr. Boulos has received research support from Slamen-Fast New Initiatives in Neurology Award. The institution of Dr. Boulos has received research support from Green Mountain . Dr. Boulos has received personal compensation in the range of $5,000-$9,999 for serving as a speaker with Jazz Pharmaceuticals.

The relationship between adherence to continuous positive airway pressure and nasal resistance measured by rhinomanometry in patients with obstructive sleep apnea syndrome.

Nasal breathing disorders are associated with obstructive sleep apnea (OSA) syndrome and influence the availability of continuous positive airway pressure (CPAP) therapy. However, information is scarce about the impact of nasal resistance assessed by rhinomanometry on CPAP therapy. This study aimed to examine the relationship between CPAP adherence and nasal resistance evaluated by rhinomanometry, and to identify clinical findings that can affect adherence to CPAP therapy for patients with OSA. This study included 260 patients (199 men, 61 women; age 58 [interquartile ranges (IQR) 50-66] years) with a new diagnosis of OSA who underwent rhinomanometry (before, and 1 and 3 months after CPAP introduction) between January 2011 and December 2018. CPAP use was recorded, and the good and poor CPAP adherence groups at the time of patient registration were compared. Furthermore, those with improved and unimproved pre-CPAP high rhinomanometry values were also compared. Their apnea-hypopnea index (AHI) by polysomnography at diagnosis was 45.6 (IQR 33.7-61.6)/hour, but the residual respiratory event (estimated AHI) at enrollment was 2.5 (IQR 1.4-3.9)/hour and the usage time was 318 (IQR 226-397) minutes, indicating that CPAP was effective and adherence was good. CPAP adherence was negatively correlated with nasal resistance (r = -0.188, p = 0.002). The participants were divided into good (n = 153) and poor (n = 107) CPAP adherence groups. In the poor adherence group, rhinomanometry values before CPAP introduction were worse (inspiration, p = 0.003; expiration, p = 0.006). There was no significant difference in patient background when comparing those with improved (n = 16) and unimproved (n = 12) pre-CPAP high rhinomanometry values. However, CPAP usage time was significantly longer in the improved group 1 month (p = 0.002) and 3 months (p = 0.026) after CPAP introduction. The results suggest that nasal resistance evaluated by rhinomanometry is a useful predictor of CPAP adherence, and that improved rhinomanometry values may contribute to extending the duration of CPAP use.

Use of historical remote monitoring data to determine predictors of CPAP non-compliance in patients with OSA.

Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnoea. This study aimed to use complete usage data collected remotely from modern CPAP devices to identify compliance trends and clinical predictors of CPAP usage. Group usage data were analysed for a large cohort at a single tertiary sleep-centre before a detailed review of a 90-day reporting window for each patient was conducted. Individual data were collected for a smaller cohort of patients including demographics, past medical history and diagnostic sleep study results. A zero-inflated negative binomial regression model was used to determine associations between patient characteristics and usage days. Of 6450 patients who wereprescribed CPAP and included in the initial service analysis, 476 patients wereincluded in the sub-group. Complete usage data revealed that 46% of patients were fully compliant with CPAP therapy. Compliance fell from 55 to 46% by day 90 and remained at this rate going forward. Significant predictors of CPAP non-compliance included being in the lowest quartile of Index of Multiple Deprivation scores (most deprived) compared with the highest quartile (least deprived) (p = .005), and less severe oxygen desaturation index (ODI) on diagnosis (p = .03). Complete usage data show that compliance at day 90 appears to be a good indicator of future CPAP usage. Predictors of CPAP non-compliance may include lower socioeconomic status, and lower ODI.

The Management of Obstructive Sleep Apnea Patients during the COVID-19 Pandemic as a Public Health Problem—Interactions with Sleep Efficacy and Mental Health

With the onset of the COVID-19 outbreak, it was stipulated that patients with obstructive sleep apnea (OSA) may have a greater risk of morbidity and mortality and may even experience changes in their mental health. The aim of the current study is to evaluate how patients managed their disease (sleep apnea) during the COVID-19 pandemic, to determine if continuous positive airway pressure (CPAP) usage changed after the beginning of the pandemic, to compare the stress level with the baseline, and to observe if any modifications are related to their individual characteristics. The present studies highlight the level of anxiety, which was high among patients with OSA during the COVID-19 pandemic (p < 0.05), with its influence on weight control (62.5% of patients with high levels of stress gained weight) and sleep schedule (82.6% reported a change in sleep schedule). Patients with severe OSA and high levels of stress increased their CPAP usage (354.5 min/night vs. 399.5 min/night during the pandemic, p < 0.05). To conclude, in OSA patients, the presence of the pandemic led to a greater level of anxiety, changes in sleep schedule and weight gain because of job loss, isolation, and emotional changes, influencing mental health. A possible solution, telemedicine, could become a cornerstone in the management of these patients.

Defining the impact of continuous positive airway pressure therapy on diastolic function in adults with moderate-to-severe obstructive sleep apnea.

Although studies have shown that continuous positive airway pressure (CPAP) therapy to treat obstructive sleep apnea improves left ventricular diastolic function, modifiers of improvement are unknown. We explored race and pre-treatment 24-h non-dipping blood pressure status as modifiers of improved diastolic function. Participants (N=220) with obstructive sleep apnea (apnea-hypopnea index ≥15 events/h) and hypertension were recruited to a cohort study that examined effects of 3-month CPAP therapy on 24-h blood pressure. Those who completed echocardiogram at baseline and follow-up were included in this analysis. Diastolic function parameters (E, A, e', E/A, E/e') were assessed. Race was categorised to African American versus others. Participants were categorised as nocturnal dippers (night-time blood pressure decrease by ≥10%) versus non-dippers. We compared changes in parameters of diastolic function by race and nocturnal dipping status. A total of 92 participants were included. They were men (86%), African American (67.4%), and current smoker (29.5%). Mean apnea-hypopnea index was 32.9 events/h. Mean CPAP usage was 3.15 h/day. After 3 months of CPAP treatment, there were significant improvements in measures of diastolic function: a median (interquartile range [IQR]) increase in E velocity by 4.00(-5.75 to 13.75)cm/s, an increase in e' by 2.00(0-4.00)cm/s, and a decrease in the E/e' ratio by 1.74(-4.27 to 0.00) at follow-up (p < 0.05). These changes did not differ by race or nocturnal dipping status. Improvements in diastolic function after CPAP therapy did not differ by race or nocturnal dipping status. Further studies are needed to understand predictors of CPAP effects on diastolic function.

Cardiovascular Outcomes in Adults with Coronary Artery Disease and Obstructive Sleep Apnea with versus without Excessive Daytime Sleepiness in the RICCADSA Cinical Trial.

Rationale: Recent randomized controlled trials did not show cardiovascular benefits of continuous positive airway pressure (CPAP) in adults with coronary artery disease (CAD) and obstructive sleep apnea (OSA) in intention-to-treat analyses. It has been argued that exclusion of patients with OSA with excessive daytime sleepiness (EDS), who may be most likely to benefit from CPAP treatment, may be a reason for the null results. Objectives: We addressed 1) the effect of concomitant EDS on adverse outcomes in patients with CAD and OSA; and 2) whether the cardiovascular benefit of CPAP adherence differs between individuals with versus without EDS. Methods: This was a secondary analysis of the RICCADSA (Randomized Intervention with CPAP in CAD and Obstructive Sleep Apnea) trial, conducted in Sweden between 2005 and 2013. Data were analyzed from 155 patients with CAD with OSA (apnea-hypopnea index ⩾ 15/h) and EDS (Epworth Sleepiness Scale score ⩾ 10), who were allocated to CPAP and 244 patients without EDS (ESS < 10), who were randomized to CPAP or no CPAP. Patients who were allocated to no CPAP or were nonadherent (CPAP usage < 4 h/night) were compared with adherent patients (CPAP usage ⩾ 4 h/night) at 1-year follow-up. Inverse probability of treatment weighting was applied to mimic randomization of EDS. The primary endpoint was the first event of repeat revascularization, myocardial infarction, stroke, or cardiovascular mortality. Results: The median follow-up was 52.2 months. The incidence of the primary endpoint did not differ significantly between the EDS versus no-EDS groups in the entire cohort. Within the adherent group, patients without EDS had a significantly decreased risk compared with patients with EDS (adjusted hazard ratio, 0.41; 95% confidence interval, 0.20-0.85; P = 0.02). Conclusions: Adverse cardiovascular outcomes did not differ by degrees of EDS for patients with CAD with OSA who were untreated or nonadherent to treatment. CPAP use, at least 4 h/night, was associated with reduced adverse outcomes in participants without EDS. Clinical trial registered with www.clinicaltrials.gov (NCT00519597).