Continuous Positive Airway Pressure Research Articles

Exploring the impacts of daytime sleepiness on gait, physical balance, and the occurrence of orofacial trauma: a narrative review

Daytime sleepiness (DS) often accompanies obstructive sleep apnea (OSA), exacerbating its effects. DS can impair cognitive function, attention, reaction time, and motor coordination, increasing the risk of accidents. This study aimed to explore the relationship between DS, changes in gait and balance, and the occurrence of orofacial fractures. A narrative review was conducted using PubMed, Scopus, and Web of Science publications. The analysis revealed the impact of DS and OSA on gait and balance control in older individuals, emphasizing the need for interventions to address these issues and identify associated pathologies. Continuous Positive Airway Pressure (CPAP) therapy was recognized as a potential treatment, although further research is needed to understand DS triggers and treatment options in older populations. The study underscores the importance of analyzing interactions between the central nervous system, medications, balance, and mobility to prevent falls and related injuries. While the literature highlights the vulnerability of elderly individuals and those with OSA to falls, no established link between DS, gait, balance, and orofacial trauma necessitating medical and dental intervention was found. Thus, further research is warranted to address this gap and promote better understanding and management of these conditions.

The Emerging Role of Pharmacotherapy in Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a prevalent pathology with current modalities of treatment including continuous positive airway pressure (CPAP), surgery, weight loss, hypoglossal nerve stimulation, and pharmacotherapy. While CPAP is the current standard treatment for OSA, lack of tolerance and side effects necessitate alternative modalities of treatment. Various pharmacologic agents exist with mechanisms that may target OSA. Early trials have demonstrated efficacy of noradrenergic-antimuscarinic combinations to stimulate the airway, promote pharyngeal muscle tone, and prevent airway collapse. These agents, which we discuss in detail, have demonstrated significant reductions in apnea-hypopnea index (AHI) and lowest oxygen saturations based on preliminary studies. Glucagon-like peptide 1 receptor agonists (GLP-1RA), which stimulate endogenous insulin, reducing glucagon release, and decreasing gastric emptying, have shown positive results for OSA patients through weight loss with reductions in AHI. In this narrative review article, we highlight the mechanisms, current data, and future potential for multiple drug classes, including respiratory stimulants and GLP-1RAs.

Long-Term Management of Sleep Apnea-Hypopnea Syndrome: Efficacy and Challenges of Continuous Positive Airway Pressure Therapy

Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a prevalent condition characterized by intermittent upper airway obstruction during sleep, leading to significant health issues, including cardiovascular disease, metabolic syndrome, and neurodegenerative disorders. The primary treatment for OSAHS is Continuous Positive Airway Pressure (CPAP) therapy, which maintains airway patency through a continuous flow of air, effectively reducing apnea-hypopnea indices, improving sleep quality, and lowering cardiovascular risks.

Factors Affecting CPAP Adherence in an OSA Population during the First Two Years of the COVID-19 Pandemic.

Background: Obstructive sleep apnea (OSA) is a common disorder associated with major cardiovascular and neurocognitive sequelae. Continuous positive airway pressure (CPAP) is the standard treatment for OSA. The aim of this study was to investigate the prevalence and associations of long-term CPAP adherence in newly diagnosed OSA patients. Methods: We enrolled patients who were diagnosed with OSA during the COVID-19 pandemic. Adherence was defined as CPAP use ≥4 h per night on ≥70% of nights over 30 consecutive days. Patient demographics were retrieved from medical records, and CPAP adherence at 6 months and 1 year after initiation was monitored. Results: Overall, 107 patients were included in the analysis. A number of 73 (68%) and 63 (59%) patients were adherent to CPAP treatment at 6 months and 12 months accordingly. Among the factors examined and analyzed (age, gender, BMI, Apnea-Hypopnea Index (AHI)), no significant correlation was found. Further analysis revealed the potential role of comorbidities. CPAP compliance at 6 months was shown to be associated with better CPAP adherence at 12 months. Conclusions: CPAP adherence at 6 months is correlated to long-term adherence to treatment. Therefore, early close follow-up is important. Further prospective studies are needed to identify other potential predictors.

Oxygen therapy in acute hypoxemic respiratory failure: guidelines from the SRLF-SFMU consensus conference

IntroductionAlthough largely used, the place of oxygen therapy and its devices in patients with acute hypoxemic respiratory failure (ARF) deserves to be clarified. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and the French Emergency Medicine Society (Société Française de Médecine d’Urgence, SFMU) organized a consensus conference on oxygen therapy in ARF (excluding acute cardiogenic pulmonary oedema and hypercapnic exacerbation of chronic obstructive diseases) in December 2023.MethodsA committee without any conflict of interest (CoI) with the subject defined 7 generic questions and drew up a list of sub questions according to the population, intervention, comparison and outcomes (PICO) model. An independent work group reviewed the literature using predefined keywords. The quality of the data was assessed using the GRADE methodology. Fifteen experts in the field from both societies proposed their own answers in a public session and answered questions from the jury (a panel of 16 critical-care and emergency medicine physicians, nurses and physiotherapists without any CoI) and the public. The jury then met alone for 48 h to write its recommendations.ResultsThe jury provided 22 statements answering 11 questions: in patients with ARF (1) What are the criteria for initiating oxygen therapy? (2) What are the targets of oxygen saturation? (3) What is the role of blood gas analysis? (4) When should an arterial catheter be inserted? (5) Should standard oxygen therapy, high-flow nasal cannula oxygen therapy (HFNC) or continuous positive airway pressure (CPAP) be preferred? (6) What are the indications for non-invasive ventilation (NIV)? (7) What are the indications for invasive mechanical ventilation? (8) Should awake prone position be used? (9) What is the role of physiotherapy? (10) Which criteria necessarily lead to ICU admission? (11) Which oxygenation device should be preferred for patients for whom a do-not-intubate decision has been made?ConclusionThese recommendations should optimize the use of oxygen during ARF.

Delayed sustained lung inflation for preterm neonates in neonatal intensive care unit: a randomized controlled trial

IntroductionSustained lung inflation (SLI) right after birth to decrease the use of mechanical ventilation of preterm infants is controversial because of potential harm. This randomized controlled trial was conducted to evaluate the effectiveness and safety of delayed SLI in neonatal intensive care unit (NICU).MethodsPreterm neonates requiring continuous positive airway pressure after birth were eligible for enrollment. In the experimental group, SLI with 20 cm H2O for 15 s was conducted by experienced staff in the NICU between 30 min and 24 h after birth.ResultsA total of 45 neonates were enrolled into this study, including 24 in the experimental group and 21 in the control group. There was no significant difference in the birth condition between the experimental and control groups, including gestational age (p = 0.151), birth weight (p = 0.692), and Apgar score at 1 min (p = 0.410) and 5 min (p = 0.518). The results showed the duration of respiratory support was shorter in the experimental group than the control group (p = 0.044). In addition, there was no significant difference in the other outcomes, such as pneumothorax, patent ductus arteriosus, and bronchopulmonary dysplasia.ConclusionOur findings indicate that sustained inflation conducted by experienced staff in the NICU is safe. The data suggest that SLI conducted by experienced staff in the NICU after stabilization could serve as an alternative management for preterm infants with respiratory distress. However, the reduction in use of respiratory support should be interpreted cautiously as a result of limited sample size.Trial registrationUniversity hospital Medical Information Network (UMIN) Clinical Trials Registry: UMIN000052797 (retrospectively registered).

The transition from children to young people living with home mechanical ventilation

ABSTRACT Purpose This study aimed to examine how young people living with Home Mechanical Ventilation experience the transition from childhood to young adulthood in relation to everyday life, perceived health and transition into adult professional healthcare. Methods Nine young adults (three females and six males aged 18–31) were interviewed, and data was primary analysed using phenomenological hermeneutics. In the actual study, data was reworked using secondary analysis as described by Beck. Two interviewees were ventilated invasively and six non-invasively, and one was treated with continuous positive airway pressure (CPAP). Results The results are presented in two main categories. First; moving towards adulthood; and second, To handle changes in health and healthcare contacts. The study highlights the importance of ongoing social relations and being part of a socializing and physically active community. The transfer from paediatric to adult healthcare was solid and worked out well but was a process in which the participants struggled to find their own voice. Conclusions The transition into adulthood is a sensitive and challenging time for young people with HMV, but stable, close relationships and a well-organized transfer can enable this group to feel safe and able to find and use their own voice.

Cost-effectiveness analysis of continuous positive airway pressure treatment for obstructive sleep apnea in Singapore from a health system perspective.

This study assessed the cost-effectiveness of continuous positive airway pressure treatment for obstructive sleep apnea in Singapore from a health system perspective. The analysis evaluated a 5-year care pathway using a Markov model, considering per-patient costs of treatment, health system cost savings of obstructive sleep apnea and attributed conditions, the effectiveness measured in disability-adjusted life years with a discount rate of 3% and a weighted 5-year continuous positive airway pressure adherence of 74.1% from Singapore studies. Per-patient costs of treatment were from a large public hospital in Singapore. Efficacy of continuous positive airway pressure treatment, health system costs and disability-adjusted life years were obtained from literature; costs are in US dollars. We conducted probabilistic sensitivity analysis, one-way sensitivity analysis and what-if analysis. Based on a willingness-to-pay threshold of US $50,000 per disability-adjusted life year in USA, continuous positive airway pressure therapy was highly cost-effective, with an incremental cost-effectiveness ratio of $13,822 per disability-adjusted life year averted. Compared with the annual total costs of $856 for patients with continuous positive airway pressure treatment diagnosed by an inpatient sleep study, the total costs for those diagnosed by a home sleep test were $625, resulting in a remarkable 27% reduction per patient per year. One-way sensitivity analysis indicated that costs of treatment, effectiveness of continuous positive airway pressure treatment and adherence had a higher impact on the cost-effectiveness of continuous positive airway pressure therapy. The what-if analysis suggested that for continuous positive airway pressure treatment to be cost-effective, adherence rate should be at least 16.1%. These findings provide valuable insights for policymakers in making informed decisions on funding diagnosis and continuous positive airway pressure therapy within Singapore's healthcare system.

O50 EFFECT OF LONG-TERM USE OF CONTINUOUS POSITIVE AIRWAY PRESSURE ON BLOOD PRESSURE PATIENTS WITH RESISTANT HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA

Background and Objective: Obstructive Sleep Apnea (OSA) is strongly associated with Resistant Hypertension (RHT). Continuous positive airway pressure (CPAP) is the treatment of choice for moderate-severe OSA. Its benefit in terms of blood pressure (BP) control is still unclear. The objective of the study is to evaluate the effect of CPAP on BP in patients with RHT and moderate-severe OSA. Methods: This was a prospective intervention study that included 124 patients with RHT and moderate/severe OSA (AHI>15/hour) divided in 2 groups. Patients using CPAP uninterruptedly for a minimum period of 12 months (CPAP group) were compared with those who refused to use CPAP despite clinical indication (Control group). Office BP and 24-hour ABPM were obtained at baseline and after follow-up. Primary outcomes were changes in office and ambulatory BPs, and nocturnal BP reduction. Results: 124 individuals were included (37.9% male with a mean age of 60.7 ± 7.8 years), 65 in the CPAP group and 59 in the control group with a median [interquartile range] follow-up time of 68 [49-81] months. There was a reduction in office systolic BP (SBP) of -7.5 mmHg ([CI95%: -16.3 to -1.1],p=0.089), in nocturnal SBP and diastolic BP (DBP) of – 6.1 mmHg ([CI95%: -12.4 to 0.3],p=0.06) and -3.5 mmHg ([CI95%: -7.4 to 0.6],p=0.092), respectively, without reaching statistical significance. Otherwise, after excluding 9 patients of CPAP group with low adherence, we found a reduction in office SBP of -10.3 mmHg ([CI95%: -19.7 to 0.9],p=0.031), in 24-hour SBP and DBP of – 4.8 mmHg ([CI95%: -10.5 to 0.8],p=0.095) and -3.4 mmHg ([CI95%: -6.8 to 0.1],p=0.045), and in nocturnal SBP and DBP of – 8.1 mmHg ([CI95%: -14.7 to -1.5],p=0.017) and -5.3 mmHg ([CI95%: -9.6 to -1.1],p=0.014), respectively. Conclusion: Long term use of CPAP reduced office, 24-hour and nighttime SBP specially in resistant hypertensives with good CPAP adherence.

Outcome of Nasal continuous positive airway pressure in neonates: A cross-sectional study.

This study aimed to assess the efficacy of nasal continuous positive airway pressure (CPAP) in term and preterm neonates with respiratory distress by evaluating successful outcomes, identifying factors contributing to treatment failure, and documenting associated complications. A comparative cross-sectional study design was employed. The research was conducted at Combined Military Hospital (CMH) Rawalpindi from November 2022 to July 2023. All consecutive neonates admitted during the specified period with respiratory distress requiring CPAP treatment and meeting inclusion criteria were enrolled. Pre- and post-CPAP respiratory distress levels, relevant biochemical markers, as well as mortality and morbidity rates were documented. Both descriptive and inferential statistical analyses were employed. The mean age of the study cohort was 53.3±85.6 minutes. The average time to initiate CPAP was 82.4 ± 94.7 minutes. Mean gestational age stood at 34.68±2.8 weeks. CPAP was successful in 97% of babies. The low birth weight below 1200grams was the main factor related to failure of CPAP. The mean Downes score decreased from 5.8±1.3 before CPAP to 3.3±1.6 after 12 hours of CPAP and further to 1.85±2 after 24 hours. Significant improvements in Downes score were noted after 24 hours of CPAP usage (p < 0.05) using paired sample T-test. This study affirms the effectiveness of CPAP in addressing neonatal respiratory distress. The utilization of CPAP emerges as a valuable intervention that not only reduces the requirement for invasive ventilation but also exhibits the potential to alleviate morbidity and mortality rates among neonatal populations.

There is No Increased Pulmonary Risk Following Total Hip Arthroplasty in Patients Who Have Obstructive Sleep Apnea Without Underlying Lung Disease

BackgroundObstructive sleep apnea (OSA) is a frequent comorbidity. The current study evaluated whether there is a difference in the perioperative outcome after total hip arthroplasty (THA) in patients who had a low to moderate risk for OSA and high risk for OSA, respectively. MethodsAfter excluding patients who had concomitant lung disease (chronic obstructive pulmonary disease, asthma, or lung fibrosis) and those missing a STOP-Bang Score, 1,141 THA patients who had OSA were included in this retrospective study. Patients at low to moderate risk for OSA (STOP-Bang Score 0 to 4) and patients at high risk for OSA (STOP-Bang Score 5 to 8) were compared, and SpO2 (oxygen saturation) drops < 90% as well as readmission rates were compared between patients who did and did not use continuous positive airway pressure (CPAP). ResultsThere was no difference in the risk of SpO2 drop below 90% (1 versus 0%, P = 0.398) and readmission rate (2 versus 2%, P = 0.662) between patients who had low to moderate OSA risk (327 THA) and high OSA risk (814 THAs). There was no difference in SpO2 (P > 0.999) and a decrease in oxygen flow rate from the postanesthesia care unit to the morning of the first postoperative day. A CPAP device was used by 41% (467 of 1,141) of patients. There were no differences in SpO2 drop < 90% (0 versus 0%, P = 0.731) and readmission rate (2 versus 2%, P = 0.612) between patients who did and did not use a CPAP machine. ConclusionsThe current study showed no difference in perioperative outcomes between OSA patients undergoing THA who had a low STOP-Bang Score and patients who had a high STOP-Bang Score, regardless of the use of a CPAP machine. These data suggest that an elevated Stop-Bang Score does not indicate an increased perioperative risk for OSA patients when deciding on outpatient discharge.

Exploring Heterogeneity in the Cost-Effectiveness of High-Flow Nasal Cannula Therapy in Acutely Ill Children—Insights From the Step-Up First-line Support for Assistance in Breathing in Children Trial Using a Machine Learning Method

ObjectivesTo investigate heterogeneity in the cost-effectiveness of high-flow nasal cannula (HFNC) therapy compared with continuous positive airway pressure (CPAP) for acutely ill children requiring noninvasive respiratory support. MethodsUsing data from the First-line Support for Assistance in Breathing in Children trial, we explore heterogeneity at the patient and subgroup levels using 2 causal forest approaches and a seemingly unrelated regression approach for comparison. First-line Support for Assistance in Breathing in Children is a noninferiority randomized controlled trial (ISRCTN60048867) involving 24 UK pediatric intensive care units. The Step-up trial focuses on acutely ill children aged 0 to 15 years, requiring noninvasive respiratory support. A total of 600 children were randomly assigned to HFNC and CPAP groups in a 1:1 allocation ratio, with 94 patients excluded because of data unavailability. ResultsThe primary outcome is the incremental net monetary benefit (INB) of HFNC compared with CPAP, using a willingness-to-pay threshold of £20 000 per quality-adjusted life year gain. INB is derived from total costs and quality-adjusted life years at 6 months. Subgroup analysis showed that some subgroups, such as male children, those aged less than 12 months, and those without severe respiratory distress at randomization, had more favorable INB results. Patient-level analysis revealed heterogeneity in INB estimates, particularly driven by the cost component, with greater uncertainty for those with higher INBs. ConclusionsThe estimated overall INB of HFNC is significantly larger for specific patient subgroups, suggesting that the cost-effectiveness of HFNC can be heterogeneous, which highlights the importance of considering patient characteristics in evaluating the cost-effectiveness of HFNC.

Evolution of treated obstructive sleep apneas syndrome after bariatric surgery: an observational retrospective study

BackgroundThe resolution of obstructive sleep apneas syndrome (OSAS) following bariatric surgery appears to be promising for the majority of patients although this resolution does not necessarily exhibit a linear correlation with weight loss. Previous small-scale studies have pinpointed a younger age and preoperative weight under 100kg as predictive factors of OSAS improvement ObjectivesThe primary objective was to evaluate the evolution of OSAS in patients treated with continuous positive airway pressure (CPAP). Additionally, we tried to identify potential predictive factors for OSAS improvement postsurgery. SettingBrest Hospital, France, University Hospital. MethodsIn this retrospective, observational study we analyzed a cohort of 44 patients who underwent bariatric surgery, between January 2015 and December 2021. Each patient underwent respiratory polygraphy (RP) or polysomnography (PSG) before and after the surgical procedure. We collected CPAP data (including effective pressure and adherence) before and during the 6 months following the intervention. ResultsWithin the study population, 68.18% of patients exhibited improved OSAS, as defined as an apnea-hypopnea index of less than 15 per hour. A higher mean oxygen saturation prior to surgery emerged as the sole predictive factor for OSAS improvement. CPAP adherence and therapeutic pressure value, 2 rarely studied parameters, did not show significant difference between improved and nonimproved patients. ConclusionsThe rate of OSAS resolution after surgery is 68.18%, with only a higher mean oxygen saturation before surgery identified as a predictive factor for OSAS resolution.

A Predictive Nomogram of In-Hospital Mortality After 48 h for Atrial Fibrillation Patients in the Coronary Care Unit.

Patients with atrial fibrillation (AF) suffer a higher risk of death, and it is necessary to develop prediction tools for mortality risk in critically ill patients with AF. This study aimed to develop a novel predictive nomogram of in-hospital mortality after 48 h in the coronary care unit (CCU) for patients with AF. We collected information on CCU patients with AF from the "Medical Information Mart for Intensive Care-III" database and developed a nomogram model for predicting the all-cause mortality risk after 48 h in the hospital. Key variables were selected by univariate logistic and least absolute shrinkage and selection operator regression. The independent predictors with p < 0.05 were screened out by multivariate logistic regression. A predictive nomogram was constructed using these independent predictors, and the model calibration and discrimination were evaluated. This study finally enrolled 1248 CCU patients with AF, and the in-hospital mortality was 17% (209/1248). The predictive nomogram was constructed by 13 selected independent predictors, including age, smoking status, acute kidney injury, chronic obstructive pulmonary disease, ventricular arrhythmia, shock, urea, red cell distribution width, leucocytosis, continuous renal replacement therapy, continuous positive airway pressure, anticoagulation, and heart rate. The area under the curve of the nomogram was 0.803 (95% confidence interval 0.771-0.835). The nomogram was verified to have good accuracy and calibration. This study developed a novel nomogram containing age, acute kidney injury, and heart rate that can be a good predictor of potential in-hospital mortality after 48 h in CCU patients with AF.

94 The effect of continuous positive airway pressure (CPAP) on airway problems in pediatrics's subglottic stenosis patients who underwent balloon dilatation

94 The effect of continuous positive airway pressure (CPAP) on airway problems in pediatrics's subglottic stenosis patients who underwent balloon dilatation

Lung Ultrasound Score for Prediction of Surfactant Administration in Preterm Infants with Respiratory Failure.

We investigated the predictive value of a lung ultrasound score (LUS) for surfactant administration in a United States Level 4 Neonatal Intensive Care Unit. Thirty infants born at <37 weeks gestational age with respiratory distress syndrome associated respiratory failure requiring continuous positive airway pressure were included. A LUS was obtained within six hours of life. Surfactant administration in the first five days of life was recorded. Receiver operating characteristic (ROC) analysis for LUS and surfactant administration was performed. Median completed gestational age was 33 weeks (31-34 weeks interquartile range) and median birth weight was 2.0 kg (1.5-2.3 kg). LUS for predicting an initial surfactant dose had an area under the ROC curve of 0.97. A score >9 provided 100% sensitivity and 91% specificity for predicting administration of an initial surfactant dose. A LUS > 9 provided excellent sensitivity and specificity for predicting which infants will receive surfactant for associated respiratory failure.

Prevalence of continuous positive airway pressure-related aerophagia in obstructive sleep apnea: an observational study of 753 cases undergoing CPAP/BiPAP treatment in a sleep clinic - part one of a two-part series.

Aerophagia occurring during continuous positive airway pressure (C-aerophagia in CPAP) in patients with obstructive sleep apnea (OSA) disturbs CPAP therapy. However, the diagnostic criteria and exact prevalence of C-aerophagia are not well documented; therefore, this study aimed to evaluate them. Newly developed criteria (flatulence, eructation, and abdominal bloating, with quantitative evaluation of these symptoms and a clear timing of onset) were used to diagnose C-aerophagia. The study included 753 adults with OSA who underwent follow-up visits for positive airway pressure treatment (including CPAP and bilevel positive airway pressure). The observation period ranged from 6 months to 3 years past the survey date (between May 1 and July 31, 2023). Medical records of patients were retrospectively analyzed. Discomfort associated with C-aerophagia was examined using a visual analog scale (VAS); a score ≥ 7 was associated with definite discomfort. Association of patient demographics and CPAP parameters with occurrence of C-aerophagia was analyzed using multivariate analysis. The prevalence of C-aerophagia was 7.2%. Although more than half of these patients reported discomfort associated with aerophagia, only 44.4% reported to their physician. The multivariate analysis showed that increased CPAP pressure level (odds ratio [OR] = 1.24) and comorbid gastroesophageal reflux disease (GERD; OR = 2.52) promote C-aerophagia, while increased age (OR = 0.76) and body mass index (BMI; OR = 0.88) inhibit it. The prevalence of C-aerophagia was 7.2%. Most patients with C-aerophagia experience discomfort, but may not report these symptoms. High CPAP pressure and GERD promoted C-aerophagia, while aging and increased BMI prevented it.

970: Continuous positive airway pressure as a method of diaphragmal motion management in SBRT

970: Continuous positive airway pressure as a method of diaphragmal motion management in SBRT

CPAP-induced sphenoid sinus pressures after endoscopic sinus surgery.

Positive pressure transmitted from continuous positive airway pressure (CPAP) to the sinuses and skull base in the early post-operative period has not been studied in live subjects and controversy exists in when to restart this post-operatively. This study found that approximately 32.76% and 13.52% of the delivered CPAP pressures reached the post-surgical sphenoid sinus and the mid-nasal cavity, respectively, suggesting that surgical factors such as tissue edema, nasal packing, blood, and nasal secretions may provide a protective effect.

2879: Continuous Positive Airway Pressure in Radiotherapy in Breast Cancer: A Prospective Trial

2879: Continuous Positive Airway Pressure in Radiotherapy in Breast Cancer: A Prospective Trial