CPAP Compliance Research Articles

0477 Impact of Socioeconomic Disparities on CPAP Compliance

0477 Impact of Socioeconomic Disparities on CPAP Compliance

0584 Influence of Comorbidities and Apnea-Hypopnea Index on CPAP Compliance in Patients with Obstructive Sleep Apnea

0584 Influence of Comorbidities and Apnea-Hypopnea Index on CPAP Compliance in Patients with Obstructive Sleep Apnea

1153 Many Reasons for Restless Legs, Not to Rest

Abstract Introduction Restless leg syndrome (RLS) involves an urge to move the legs that is exacerbated by rest, relieved by movement, and most prominent in the evening. While RLS is commonly associated with low ferritin, here we present a complex case in a patient requiring phlebotomy for symptom control related to elevated ferritin levels. Report of case(s) A 52 year-old male presented with uncontrolled RLS diagnosed 12 years prior. Sleep history included obstructive sleep apnea (OSA) on CPAP and hypersomnolence. Diagnostic polysomnogram was notable for an AHI 36.4 events/hr with associated hypoxia. Ferritin was 374ng/mL. He presented to our clinic on melatonin and wearing socks with bars of soap atop his feet. On exam, he was obese and plethoric with significant hypersomnolence despite excellent CPAP compliance. He was previously treated unsuccessfully with a combination of phenobarbital, trazodone, and ropinirole, which exacerbated his hypersomnia. He drank 4-5 liters (L) of soda daily. In the 5 years after initial presentation, he went through periods of total cessation to drinking up to 12L a day. He eventually developed uncontrolled diabetes, hypertension, hyperlipidemia, and NASH with advanced fibrosis. He was referred to Hematology and underwent therapeutic phlebotomy every 2-4 months. He was found to have HFE-C282Y Heterozygous mutation and NASH fibrosis without iron overload on MRI. His RLS was eventually controlled with a combination of pramipexole 1.5 mg, gabapentin 1800 mg, alprazolam 0.5 mg along with therapeutic phlebotomy to maintain a ferritin level less than 250 ng/mL. His hypersomnia was managed with amphetamine-dextroamphetamine. Conclusion RLS has been associated with high serum ferritin, iron, and saturation transferrin index levels with a low transferrin level due to impaired mobilization of stored iron. Iron deposits can be seen on MRI in the globus pallidus, dentate, red nuclei and substantia nigra. In this patient, soda cessation would help improve his diabetes, thereby decreasing chronic inflammation and lowering ferritin levels. Chronic liver disease, HFE C282Y mutations, and hypoxia from OSA can also contribute to increased ferritin levels. Abstaining from caffeine can likewise improve symptoms of RLS as caffeine is known to heighten proprioceptive awareness and increase neuromuscular reactivity which may include myoclonus. Support (if any)

0575 Parallel Comparison of Apnea Hypopnea Index with WatchPAT and CPAP Compliance Download

0575 Parallel Comparison of Apnea Hypopnea Index with WatchPAT and CPAP Compliance Download

Effect of Telemonitoring on CPAP compliance during CPAP initiation

Effect of Telemonitoring on CPAP compliance during CPAP initiation

Follow-up assessment of sleep-related symptoms in patients aftertreatment forcancer: responses to continuous positive airway pressure treatment for co-morbid obstructive sleep apnoea.

To assess changes in sleep-related symptoms in patients withbreastcancer, endometrial cancer and melanoma previously examined for sleep-related symptoms and the presence of PSG (polysomnography)-determined OSA, ≥ 3years post-treatment; and to evaluate how CPAP treatment affects sleep-related symptoms in patients previously diagnosed with OSA. Patients initially recruited from breast cancer, endometrial cancer, and melanoma follow-up clinics at Westmead Hospital (Sydney, Australia) participated in this questionnaire-based study. Demographic and change in cancer status data were collected at follow-up. Patients completed the Pittsburgh Sleep Quality Index [poor sleep quality, PSQITOTAL ≥ 5au], Insomnia Severity Index, Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire; with ΔPSQITOTAL ≥ 3au indicating a clinically meaningful change in sleep quality over follow-up. PSG-determined OSA was confirmed using the apnoea-hypopnoea index. CPAP compliance was determinedvia self-report (CPAP compliant, CPAP; not compliant, non-CPAP). Logistic regression models determined if changes in cancer status, AHI, cancer subgroup or CPAP treatment was predictive of ΔPSQITOTAL ≥ 3 auand p < 0.05 indicated statistical significance. The 60 patients recruited had breast cancer (n = 22), endometrial cancer (n = 15), and melanoma (n = 23).Cancer subgroups were similarly aged, and all had median follow-up PSQITOTAL scores ≥ 5au; breast cancer patients scoring the highest (p < 0.05). TheCPAPgroup had significantly reduced PSQITOTAL scores (p = 0.02)at follow-up, unlike thenon-CPAP group. Cancer subgroups had similar median ISITOTAL, ESSTOTAL and FOSQ-10TOTAL scoresat follow-up, regardless of CPAP treatment. There were no significant predictors of ΔPSQITOTAL ≥ 3 au at follow-up. Sleep-related symptoms persist in patients withcancer ≥ 3years aftertreatment, although these symptoms improve with CPAP. Future studies should evaluate how CPAP affects survival outcomes in cancer patients with comorbid OSA.

P061 CPAP Investigation Results: Physician vs Scientist delivered. Is there a difference in CPAP compliance and uptake?

Abstract Introduction As standard practice in a tertiary public hospital, CPAP titration outcomes and recommendations are provided to patients by Sleep Physicians in a follow up consultation. To free up physician time, a new model of care was introduced where senior scientific staff would provide the results and recommendations after Sleep Physician reporting. The aim of this retrospective review was to determine if there were any differences in CPAP uptake and compliance between results and recommendations provided by Scientists, or Sleep Physicians. Method Retrospective review of uncomplicated CPAP naïve patients attending CPAP titration between 1/07/20 to 30/06/21. CPAP uptake, compliance, and Epworth at 2 and 12 months were compared between the groups receiving physician or scientist recommendations, using Student’s T-Tests for continuous or Chi-Square tests for categorical variables. Results 446 patients (55% Male) received titration outcomes and recommendations, 57% from Scientists and 43% from Physicians. Mean age was 57.6+/-14.5 years, BMI=37.6+/-8.8 kg/m2, Baseline Epworth=10.5+/-5.9 and AHI=37.6+/-26.8 events/hr with no significant differences between groups. CPAP uptake for Scientists=72% and Physician=68% (p=0.403). There was also no difference in either compliance or ESS at 2 month and 12 month follow up. Discussion In this retrospective audit, no differences in CPAP uptake, compliance or ESS were observed between CPAP titration results and recommendations provided by Scientist compared to Sleep Physicians. However patient selection was not randomised and may have influenced results. More robust evidence requires a randomised controlled trial design to confirm findings.

P107 Optimizing Obstructive Sleep Apnea Therapy in Patients with Acute Coronary Syndrome: A Pilot Randomised Controlled Trial

Abstract Continuous positive airway pressure (CPAP) therapy and oral appliance therapy (OAT) are recommended therapies for obstructive sleep apnoea (OSA). Recent clinical trials, limited by suboptimal implementation of OSA therapy, have demonstrated neutral cardiovascular benefit. It remains unclear if optimised OSA therapy will improve cardiovascular health. Thus, we have designed a pilot interventional study to inform a future RCT with the aim to evaluate the effectiveness of optimised and personalised OSA therapy in patients with acute coronary syndrome(ACS). Patients diagnosed with ACS and OSA (ODI4≥10 events/h) were randomised to personalised OSA treatment (CPAP and/or OAT) versus usual medical care (UC). Patients receiving OSA therapy were allowed to acclimatise to therapy for 1-2 months, with the aim of optimising therapy. Patients were followed up monthly for 6 months to assess treatment effectiveness. Polysomnography and cardiovascular measures were conducted at baseline and 6 months post-therapy or usual care. To date, 9 patients (CPAP=4, OAT=1, UC=4) have completed the study. OSA severity reduced in both treatment groups (CPAP: 53±14 vs. 17±18events/h, OAT: 22.4 vs. 14.7events/h). CPAP compliance was 6.8±0.9hours/day, 90±6%days &amp;gt;4h. OAT subjective compliance was 7 hours/day daily. At completion, 3 patients on CPAP therapy reported they were ‘extremely-comfortable’ using CPAP for OSA treatment. The patient on OAT reported OAT was ‘very effective in reducing OSA symptoms’ and will continue therapy. This preliminary data suggests that it is feasible to personalise and optimise OSA therapy in patients with ACS. Whether this positively impacts on cardiovascular risk remains to be determined.

O053 Cardio-metabolic Health Effects of CPAP Treatment for Sleep Apnoea during Weight Loss: A Randomised Controlled Pilot Trial.

Abstract Introduction This study assessed whether the addition of CPAP during weight loss would enhance cardiometabolic health improvements in patients with obesity and OSA. Methods Patients with overweight or obesity, pre-diabetes and moderate-severe OSA were randomised to receive CPAP therapy with a weight loss programme (CPAP+WL) or a weight loss programme alone (WL alone). Primary outcome: 2-hour glucose assessed by OGTT. Trial registration: ANZCTRN 12617000823370. Results 17 patients completed 3-month follow-up assessments (8 CPAP+WL and 9 WL alone). Mean CPAP compliance was 5.29 hrs/night. Participants lost ~12 kg which reduced OSA severity by ~45%. The primary analysis showed no between group differences for any of the assessed outcomes. Despite this, most outcomes improved with weight loss including insulin sensitivity (.000965 units, p=.008), wake diastolic BP (-4.3mmHg, p=.03), sleep systolic BP (-16.2 mmHg, p=.0003), sleep diastolic BP (-9.8 mmHg, p=0.02), and sleepiness (Epworth Sleepiness Score -3.2, p=.0003). Two-hour glucose levels did not improve (p=0.33), but the glucose area under the curve (AUC) was reduced (-230 units, p=.009). In addition, total (-0.86mmol/L, p=0.006) and LDL cholesterol (-0.58mmol/L, p=0.007), triglycerides (-0.75mmol/L, p=0.004), fat mass (-7.6kg, p&amp;lt;.0001) and abdominal fat (-310cm3, p&amp;lt;.0001) were all reduced. Conclusions We did not establish any cardio-metabolic benefit from CPAP therapy during weight loss. In contrast, weight loss had a robust positive effect on cardio-metabolic health. The magnitude of weight loss improvements far exceeded those from trials assessing the impact of CPAP alone, suggesting that weight loss should be the primary focus of treatment for patients with OSA and obesity.

Mortality in obstructive sleep apnea syndrome (OSAS) and overlap syndrome (OS): The role of nocturnal hypoxemia and CPAP compliance

BackgroundObstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are two chronic diseases that afflict many individuals worldwide with negative effects on health that may overlap in Overlap Syndrome (OS). The aim of our study was to investigate the differences in mortality between OSAS alone and OS and the risk factors involved. MethodsThe study was conducted on patients with OSAS or OS diagnosis that completed 15-year follow-up between 2005 and 2023. Of these, the clinical, functional, sleep and survival data were registered and analysed. Risk factors were found by regression analysis. Results501 patients (428 OSAS and 73 OS) were enrolled. Patients with OS had higher mortality than OSAS (p < 0,001). The morality risk factors for the overall population found were age >65 years (odds ratio (OR) = 10.69 (95%CI 3,85–29,69), p < 0,001) and low forced-expiratory volume in 1-s (FEV1) (OR = 10.18 (95%CI 2,32–44,68), p = 0,002). In patients with OSAS, age and nocturnal hypoxemia (NH) (OR = 2.41 (95%CI 1,07–5,41), p = 0,03) were risk factors, while adherence to nighttime positive airway pressure (PAP) reduced mortality (OR = 0,36 (95%CI 0,15–0,83), p = 0,017). Multivariate analysis confirmed age and FEV1 as risk factors in OS. Conversely, the risk factors for the overall population under 65 years were NH, which is confirmed in patients with OSAS alone (OR = 4,72 (95%CI 1,07–20,77), p = 0,04) in whom, on the other hand, PAP compliance reduced the mortality risk. ConclusionsThe study suggests that NH is a risk factor for all-cause mortality in sleep disorders by excluding the age; conversely, nighttime PAP improves the survival.

1025 Schizophrenic Patient with Large REM Rebound Following Treatment of Severe Obstructive Sleep Apnea

Abstract Introduction We present a case of uncontrolled schizophrenia with severe obstructive sleep apnea (OSA) and significant REM rebound after bilevel positive airway pressure (BPAP) therapy. Report of case(s) A 74-year-old female, with Schizophrenia on anti-psychotic therapy, presented to the sleep clinic due to excessive daytime sleepiness (EDS) and an Epworth score of 21/24. Diagnostic polysomnogram (PSG) reported an AHI of 162.1 events/hour with SaO2 nadir of 71% with sleep efficiency of 31.6% and no REM-sleep, consistent with severe OSA. The next morning, multiple sleep latency testing (MSLT) demonstrated mean sleep latency (MSL) of 3.6 minutes with 0 REM-onset sleep periods (SOREMPs). Patient underwent CPAP/BPAP titration which improved sleep efficiency to 88.6% and severe REM rebound at 61.7%. MSLT after the titration study demonstrated MSL of 4.0 minutes and 3 SOREMPs and was initiated on BPAP therapy at 20/13 cmH2O. A repeat PSG, 4 weeks later showed normalization of sleep architecture. After starting PAP therapy, the patient had a significant improvement in EDS but also energy and interest levels and denied feelings of sadness, racing or paranoid thoughts. Her social life improved and started exercising regularly and volunteering in the community. There was also improved blood pressure and blood sugar levels. She was followed up in the sleep clinic regularly and remained compliant with and benefiting from BPAP therapy and was continued on anti-psychotic therapy. Conclusion Untreated OSA often requires repetitive arousals to reopen the obstructed upper-airway that results in increased non-REM sleep at the expense of slow wave sleep and REM sleep. PAP therapy can cause a rebound increase in REM and SWS. OSA is under recognized in schizophrenic patients and other psychiatric disorders which results in development of significant comorbidities with greater severity of psychiatric symptoms. Elevated rates of OSA have been seen in the schizophrenic population. Treatment of OSA helps with not only physical but also psychotic symptoms. Many anti-psychotics, due to causing weight gain, may contribute to OSA. Studies also indicated that CPAP response to OSA, was as favorable in people with severe mental illness, compared to other patient groups. Support (if any) REM rebound and CPAP compliance; B. Koo, R. Wiggins, C. Molina

Effect of compliance to continuous positive airway pressure on exacerbations, lung function and symptoms in patients with chronic obstructive pulmonary disease and obstructive sleep apnea (overlap syndrome).

Patients with overlap syndrome (OS), that is obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD), are at increased risk of acute exacerbations related to COPD (AECOPD). We assessed the effect of CPAP compliance on AECOPD, symptoms and pulmonary function in OS patients. Consecutive OS patients underwent assessment at baseline and at 12 months under treatment with CPAP of: AECOPD and hospitalizations, COPD Assessment Test (CAT) and modified British Medical Research Council (mMRC) questionnaires, pulmonary function testing and 6-min walking test (6MWT). In total, 59 patients(54 males) with OS were followed for 12 months and divided post hoc according to CPAP compliance into: group A with good (≥4 h CPAP use/night, n = 29) and group B with poor (<4 h CPAP use/night, n = 30) CPAP compliance. At 12 months, group A showed improvements in FEV1 (p = 0.024), total lung capacity (p = 0.024), RV/TLC (p = 0.003), 6MWT (p < 0.001) and CAT (p < 0.001). COPD exacerbations decreased in patients with good CPAP compliance from baseline to 12 months (17 before vs. 5 after, p = 0.001), but not in those with poor compliance (15 before vs. 15 after, p = 1). At multivariate regression analysis, COPD exacerbations were associated with poor CPAP compliance (β = 0.362, 95% CI: 0.075-0.649, p = 0.015). When compared to poorly compliant patients, OS patients with good CPAP compliance had a lower number of AECOPD and showed improved lung function and COPD related symptoms.

Improving CPAP Compliance: Transcutaneous Nasal Valve Stabilization

Improving CPAP Compliance: Transcutaneous Nasal Valve Stabilization

Telemedicine home CPAP titration and follow-up in the COVID-19 scenario.

IntroductionContinuous positive airway pressure (CPAP) titration was dramatically affected by the coronavirus disease 2019 (COVID-19) pandemic due to increased biological risk. This study aimed to compare successful CPAP adaptation and compliance with home telemedicine CPAP titration with the usual method based on face-to-face visits.MethodologyA prospective cohort using telemedicine home CPAP titration and follow-up during the COVID-19 pandemic (TC) was compared with a retrospective cohort receiving face-to-face pre-pandemic home titration (RC). The TC included a subgroup with a smartphone application (TC-APP). Successful CPAP adaptation and compliance at 1 month of follow-up were the main endpoints, while patient satisfaction and costs were secondary endpoints.Results210 consecutive patients were evaluated (80 RC and 130 TC). 36 patients were in the TC-APP subgroup. CPAP titration was successful in 90% in RC versus 95% in TC and 100% in TC-APP. No compliance differences between groups were found at 1 month (4.79 h·night−1 RC, 4.33 h·night−1 TC and 4.59 h·night−1 TC-APP). Mean±sd patient satisfaction out of 10 was 7.69±2.05 in RC versus 9.02±0.64 in TC (p<0.001). 64% of the TC-APP subgroup reported that their telemedicine strategy influenced an increase in CPAP use (p=0.011). CPAP adaptation with follow-up had an estimated direct staff cost per patient of EUR 19.61±8.61 in TC with no smartphone application used versus EUR 23.79±9.94 in TC-APP (p=0.048).ConclusionsTelemedicine in CPAP titration and early follow-up is equivalent to the usual care in terms of successful adaptation and compliance, while achieving greater patient satisfaction.

0859 AVAPS to the rescue: A case of severe obstructive sleep apnea with treatment resistant to UPPP and CPAP in a pediatric patient with Prader-Willi syndrome

Abstract Introduction Prader-Willi syndrome (PWS) has a prevalence of 1/10,000 to 1/30000 and is the most common syndromic form of obesity. Prader-Willi syndrome is defined by a multitude of features that develop from early childhood to adolescents, but one of the primary developments is obesity in the setting of hyperphagia during early childhood. Due to the development of obesity, there is a high prevalence of obstructive sleep apnea (OSA) among PWS patients. Report of Cases: A 6-year-old boy with PWS with a 2-year history of loud snoring underwent polysomnography (PSG) which showed severe OSA with Apnea-Hypopnea Index (AHI, events/h) 133.7. The patient underwent surgical intervention with a combined uvulopalatopharyngoplasty and adenotonsillectomy and a follow up PSG showed a residual AHI of 37. On CPAP titration the AHI improved to 1.2 with CPAP 14 cm H2O and the patient was discharged on home nasal CPAP. Over the next several years, the patient had suboptimal CPAP compliance. At 11 years of age, the patient was admitted to the intensive care unit (ICU) with volume overload –with a normal cardiac workup- and respiratory failure requiring high flow nasal cannula oxygen. Venous blood gas (VBG) showed pH 7.34 and severe hypercapnia with pCO2 73 mmHg c/w obesity hypoventilation syndrome (OHS). The patient was started on CPAP then changed to bilevel PAP ST with supplemental oxygen. Due to persistent hypercapnia in the high 60s noninvasive ventilation (NIV) was switched to Average Volume-assured Pressure Support with auto titrating EPAP (AVAPS-AE) with significant improvement in hypercapnia and overall tolerance. Discharge VBG showed pH 7.35 and PCO2 56 mm Hg. The patient was discharged home, is doing well and has avoided readmission for at least 6 months. Conclusion This case highlights the potential for newer modes of noninvasive ventilation with autotitrating EPAP to treat severe OSA with OHS and hypercapnic respiratory failure in patients with PWS and other conditions. With the growing obesity epidemic, rates of treatment failures with CPAP and traditional bilevel PAP therapy may increase and consideration of alternative modes of NIV therapy should be considered. Support (If Any)

Cancer Risk Associated with Continuous Positive Airway Pressure: A National Study.

In 2021 the U.S. FDA issued a Class 1 safety recall notice for specific devices due to a risk of carcinogen exposure. The objective of this study was to evaluate reports of cancer linked to CPAP devices to understand implications for the field of sleep medicine. Cases of cancer involving CPAP devices were retrieved from the MAUDE database from 2014 to 2021 and analyzed with descriptive statistics. A total of 2571 patient injuries were associated with CPAP. Reports of cancer (n=209; 4.62%) were the second most commonly documented patient problem associated with CPAP, although 1950 (43.13%) patients had a device problem without an associated injury. Of the 209 cancer cases associated with CPAP, 200 (95.7%) of the adverse event reports were received by the FDA in 2021. There were 174 (9.15%) descriptions of the CPAP polyurethane sound abatement foam degrading in association with a cancer diagnosis, but degradation was more commonly not associated with malignancy (n=1728; 90.85%). Other frequently documented CPAP device problems included broken devices (n=279; 6.92%), fire (n=182; 4.51%), and patient-device incompatibility (n=144; 3.57%). Malignancy associated with CPAP devices has been reported; however, future studies are required to establish causation. Given 95.7% of those documented cases were reported in 2021, otolaryngologists should be prepared to discuss the risks of carcinogenesis associated with CPAP. The otolaryngology community should also be aware of the potential bandwagon effect and the implications for CPAP compliance. 4 Laryngoscope, 132:2270-2274, 2022.

Compliance to Continuous Positive Airway Pressure therapy in patients with obstructive sleep apnea - long-term assessment.

IntroductionTo assess CPAP acquirement, compliance, and dropout rates among OSA patients three years after the prescription.Material and MethodsWe assessed CPAP acquirement (Acq), compliance (Comp), and dropout (Dout) through a telephone survey. We interviewed 156 patients; ESS: 9.9±5.7, AHI>15ev/hour in 96.4%. 92 patients had accessed CPAP therapy (58.9%) and 67 (72.8%) were still using it. Dropout was reported by 25 (27.2%). The Comp group was older (p<0.01), had more men (p<0.001), higher ESS scores (p<0.03) and a higher level of specialist follow-up (p<0.001). Multivariate analysis adjusted showed; follow-up by experts (OR: 4.39; p<0.05) and ESS>10 (OR: 1.25; p<0.05) increased CPAP compliance.ConclusionThere is a high number of patients without CPAP therapy acquirement. Long-term compliance was found in ¾ of the study population in symptomatic patients followed up by specialists. Finally, 43% had effective treatment.

Management and Treatment of Patients With Obstructive Sleep Apnea Using an Intelligent Monitoring System Based on Machine Learning Aiming to Improve Continuous Positive Airway Pressure Treatment Compliance: Randomized Controlled Trial.

BackgroundContinuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA), but treatment compliance is often unsatisfactory.ObjectiveThe aim of this study was to assess the effectiveness and cost-effectiveness of an intelligent monitoring system for improving CPAP compliance.MethodsThis is a prospective, open label, parallel, randomized controlled trial including 60 newly diagnosed patients with OSA requiring CPAP (Apnea–Hypopnea Index [AHI] >15) from Lleida, Spain. Participants were randomized (1:1) to standard management or the MiSAOS intelligent monitoring system, involving (1) early compliance detection, thus providing measures of patient’s CPAP compliance from the very first days of usage; (2) machine learning–based prediction of midterm future CPAP compliance; and (3) rule-based recommendations for the patient (app) and care team. Clinical and anthropometric variables, daytime sleepiness, and quality of life were recorded at baseline and after 6 months, together with patient’s compliance, satisfaction, and health care costs.ResultsRandomized patients had a mean age of 57 (SD 11) years, mean AHI of 50 (SD 27), and 13% (8/60) were women. Patients in the intervention arm had a mean (95% CI) of 1.14 (0.04-2.23) hours/day higher adjusted CPAP compliance than controls (P=.047). Patients’ satisfaction was excellent in both arms, and up to 88% (15/17) of intervention patients reported willingness to keep using the MiSAOS app in the future. No significant differences were found in costs (control: mean €90.2 (SD 53.14) (US $105.76 [SD 62.31]); intervention: mean €96.2 (SD 62.13) (US $112.70 [SD 72.85]); P=.70; €1=US $1.17 was considered throughout). Overall costs combined with results on compliance demonstrated cost-effectiveness in a bootstrap-based simulation analysis.ConclusionsA machine learning–based intelligent monitoring system increased daily compliance, reported excellent patient satisfaction similar to that reported in usual care, and did not incur in a substantial increase in costs, thus proving cost-effectiveness. This study supports the implementation of intelligent eHealth frameworks for the management of patients with CPAP-treated OSA and confirms the value of patients’ empowerment in the management of chronic diseases.Trial RegistrationClinicalTrials.gov NCT03116958; https://clinicaltrials.gov/ct2/show/NCT03116958

CPAP - The choice of the mask does matter

We present a case of a patient with uncorrected Obstructive Sleep Apnea (OSA) despite good CPAP compliance with an oronasal mask who was referred to our tertiary care multidisciplinary sleep unit. We present here our systematic and comprehensive re-evaluation of the case, accompanied by an image of the polysomnography recordings that exemplify each step in the process, which concludes with a change to nasal CPAP and a transition to BPAP treatment. Keywords: obstructive sleep apnea; CPAP; BPAP; oronasal mask; nasal mask.

Nasal function and CPAP use in patients with obstructive sleep apnoea: a systematic review.

This systematic review was conducted to answer the following 3 questions: 'Does nasal pathology affect CPAP use?', 'What is the effect of CPAP on the nose?'and 'Does treatment of nasal pathology affect CPAP use?'. Pubmed and Scopus databases were searched for articles relevant to the study questions up to October 2020. Sixty-three articles were selected, of which a majority were observational studies. Most studies identified a correlation between larger nasal cross-sectional area or lower nasal resistance and higher CPAP compliance or lower CPAP pressures; however, nasal symptoms at baseline did not appear to affect CPAP use. The effect of CPAP on the nose remains uncertain: while most studies suggested increased mucosal inflammation with CPAP, those investigating symptoms presented contradictory results, with some reporting an increase and others an improvement in nasal symptoms. Evidence is clearer for nasal surgery leading to an increase in CPAP compliance and a decrease in CPAP pressures, whereas there is little evidence available for the use of topical nasal steroids. There appears to be a link between nasal volumes or nasal resistance and CPAP compliance, an increase in nasal inflammation caused by CPAP and a beneficial effect of nasal surgery on CPAP usage, but no significant effect of CPAP on nasal patency or effect of topical steroids on CPAP compliance. Results are more mitigated with regard to the effect of nasal symptoms on CPAP use and vice versa, and further research in this area would help identify patients who may benefit from additional support or treatment alongside CPAP.