CPAP Machines Research Articles

0582 Examining OSA Screening and Treatment for Individuals on a PTSD and Alcohol Disorder Residential Treatment Unit

Abstract Introduction Obstructive sleep apnea (OSA) is highly co-occurring with both alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) and has been shown to interfere with both PTSD and AUD outcomes. However, OSA often goes undiagnosed and untreated in residential treatment facilities. Our study aimed to assess the feasibility of incorporating OSA screening and treatment onto a substance abuse residential rehabilitation treatment program (SARRTP). Further, we examine the relationship between adherence rates of CPAP on PTSD outcomes. Methods Participants were 35 consecutive veterans admitted to the SARRTP PTSD track who consented to screening. Veterans were on the unit for 4-6 weeks. OSA was diagnosed using Nox T3 recorders, a Type-3 portable OSA screener (using Apnea Hypopnea Index >= 5). Insomnia Severity Index and PTSD checklist were given at pre- and post-treatment. Results 64.7% of Veterans screened positive for OSA. 11.8% were previously diagnosed with OSA, but did not use a CPAP machine; 17.6% were previously diagnosed and were using a CPAP machine; and 35.3% were newly diagnosed with OSA. Individuals with untreated OSA had significantly more days drinking in the last 30 days (M = 21.17 days, SD = 11.41) compared to no OSA/Treated OSA group (M = 8.82 days, SD = 10.92). There was no difference in change in PCL scores from baseline to post-treatment by the no-OSA/high compliance group and the low compliance group. Conclusion Taken together, OSA screening on the unit was accepted by the participants, feasible, and effective in diagnosing OSA. OSA screening and treatment should be considered as necessary on SUD and PTSD units. We did not find that OSA adherence predicted change in PTSD score, this is most likely due to veterans receiving their CPAP late into their stay on the unit. Future studies will need to examine OSA treatment on long term treatment outcomes. Support: Support This work is supported by UCSD Academic Senate Grant and a Veterans Affairs RR&D CDA (1lK2Rx002120-01) to Peter Colvonen.

FDA Reminds Patients that Devices Claiming to Clean, Disinfect or Sanitize CPAP Machines Using Ozone Gas or UV Light Have Not Been FDA Authorized

FDA Reminds Patients that Devices Claiming to Clean, Disinfect or Sanitize CPAP Machines Using Ozone Gas or UV Light Have Not Been FDA Authorized

Troubleshoot It: CPAP and BiPAP Machines: Similar Devices with Key Differences in Functionality.

Troubleshoot It: CPAP and BiPAP Machines: Similar Devices with Key Differences in Functionality.

1040 RESOLUTION OF EXFOLIATIVE DERMATITIS AND ALOPECIA AREATA OPHIASIS WITH THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA

The comorbidity of atopic dermatitis and obstructive sleep apnea can have a reciprocal improvement with the use of continuous positive airway pressure. Patient is a 17 year old African American female with a history of severe exfoliative dermatitis exacerbations secondary to uncontrolled atopic dermatitis (AD) with eczema herpeticum who presented with dermatopathic lymphadenitis, alopecia areata ophiasis, night sweats, nocturia, habitual snoring with hypertrophy of the tonsils to the sleep medicine department for her snoring and nocturnal sweating. Night time sweats produced an intense pruritic response. Nocturia occurred four times a night. Autoimmune and infectious disease work ups were negative. Skin and lymph node biopsies revealed dermatopathic lymphadenitis secondary to exfoliative dermatitis. Treatments included avoidance of suspected AD triggers, emollients, hypo-allergenic soaps and topical steroids. The application of topical steroids resulted in exfoliative dermatitis with eczema herpeticum and staph infections multiple times. Gabapentin improved her pruritic condition and a slight improvement in her skin and scalp was noted. A sleep study revealed the patient to have an Apnea-Hypopnea index of 16.4, excessive sweating and severe snoring were also noted on her sleep study. The mother of the patient declined the use of immune modulating therapies including topical steroids, methotrexate, cyclosporine, and tacrolimus as well as the recommendation for a tonsillectomy. Patient and mother agreed to the use of CPAP and photographing the progression of the disease. No change in the patient’s medications nor consistency were noted. After 10 months of excellent CPAP compliance, photographical evidence as well as physical examination revealed the patient’s hair returned as well as her an improvement in her skin was noted. Nocturia resolved after the use of CPAP. Patient reported two weeks of not using her CPAP machine and reported a new onset of hair loss and worsening of eczema. The use of continuous positive airway pressure has the potential for reducing inflammatory responses in the skin for patients suffering from atopic dermatitis as well as obstructive sleep apnea, reducing the need for immune modulating therapies.

A new low-cost commercial bubble CPAP (bCPAP) machine compared with a traditional bCPAP device in Nigeria

ABSTRACTBackground: The bubble continuous positive airway pressure (bCPAP) technique is widely applied in neonatal respiratory support. Commercial bCPAP brands are expensive in Nigeria and this has driven Nigerian paediatricians to use potentially risky improvised devices (IbCPAP).Aim: This study aimed to design, produce and trial an appropriate low-cost bCPAP machine which is functionally effective and safe.Methods: Questionnaires were distributed to assess the need for a new bCPAP design for use in Nigeria, leading to the development of a new system (politeCPAP) which was functionally and clinically validated in three Nigerian hospitals. Six months of clinical data on the new device of sufficient comparative quality were generated from one of the hospitals and compared with control data on the IbCPAP. The hospitals (n = 3) submitted data on 71 patients on IbCPAP or politeCPAP; 14 were disqualified on the basis of the elimination criteria. The infants were classified into two birthweight categories: <1000 g (extremely low birthweight, ELBW, n = 15) and 1000 g (n = 42).Results: Six ELBW neonates on politeCPAP survived; there were no ELBW survivors in the IbCPAP group (n = 9). The IbCPAP device delivered an average 90% O2–gas ratio (FiO2) whereas the politeCPAP required only 47%. Many heavier neonates in the IbCPAP group survived (23 of 26); however, supplementary warming was required for all of them whereas none of the politeCPAP infants required warming. The politeCPAP costs around US$2000 whereas standard commercial CPAP brands in Nigeria range from US$5000 to US$18,000. High oxygen requirement and iatrogenic hypothermia were serious adverse features of IbCPAP.Conclusions: The study has narrowed the gap between relatively low-cost, risky devices (e.g. IbCPAP) and high-cost commercial machines. The politeCPAP is a feasible alternative to the IbCPAP in cost-constrained settings.Abbreviations: bCPAP: bubble continuous positive airway pressure; CPAP: continuous positive airway pressure; ELBW: extremely low birthweight; FiO2: ratio of oxygen content in gas flow (%); IbCPAP: improvised bubble continuous positive airway pressure device; LBW: low birthweight; NNU: neonatal unit; PEEP: positive end expiratory pressure; politeCPAP: the newly developed commercial bCPAP machine; RDS: respiratory distress syndrome; SpO2, oxygen saturation level (%).

Obstructive sleep apnea secondary to cervical spine chordoma

Abstract We present a rare case of obstructive sleep apnea (OSA) secondary to chordoma involving cervical spine with confirmative histopathological diagnosis following the suggestive findings of computed tomography and magnetic resonance imaging. The patient underwent en bloc removal of the tumour involving the vertebral body of C4 with preservation of the nerve roots and vertebral arteries involved, associated with postoperative radiation therapy. Clinicians should be aware that this is a very rare secondary cause of OSA caused by chordoma involving the spine and imaging of the cervical spine may be necessary to avoid incorrect treatment approaches such as CPAP or BiPAP machine in such cases.

The Impact of Physiological Factors on 30-day Unplanned Rehospitalization in Adults with Heart Failure

ABSTRACTHeart failure (HF) patients have high rates of 30-day unplanned rehospitalization. This study assessed the impact of physiological factors on 30-day HF unplanned rehospitalization. Methods: The cross-sectional study used secondary data from electronic medical records of 270 patients. Results: Findings revealed several factor types were related to 30-day HF unplanned rehospitalization such as chronic kidney disease (p = 0.001), the use of CPAP machine (p = 0.028), and B-type natriuretic peptide (p = 0.050). Conclusion: Many physiological factors were associated with 30-day HF unplanned rehospitalization. Identifying these factors will help health care providers to plan a variety of interventions that reduce 30-day HF unplanned rehospitalization.

What is the availability of services for paediatric ENT surgery and paediatric surgery in Africa?

BackgroundChildren constitute 50% of Africa's population. Sub-Saharan Africa has the highest under-five mortality rates in the world. This study is the first to document the availability of paediatric ENT and paediatric surgery services in Africa. ObjectiveTo determine the availability of paediatric ENT services in Africa, as well as that of paediatric surgery that would complement paediatric ENT. MethodA descriptive observational study in the form of an online questionnaire was distributed by email to known ENT and paediatric surgeons based in Africa. ResultsSurgeons from twelve of 23 African countries responded to the survey. Seven countries had both ENT and paediatric surgery responses. In 8 of the 11 countries, the number of ENT surgeons per country was<6% of that of the UK, with 1 ENT surgeon per 414,000 people and 1 paediatric surgeon per 1,181,151 people. Ten of 11 countries reported hearing assessments in schools were poor/unavailable. Seventy-three percent responded positively for access to rigid laryngoscopes, bronchoscopes, cameras and fibre optic cables, tracheostomy, anaesthesia and nurse practitioners. Access was reported as poor/unavailable for balloon dilators 73% (8/11 countries); CPAP machines 73% (8/11) and sleep studies 82% (9/11 countries). Flexible endoscopes were available in 50% (4/8 countries), 75% (6/8 countries) had access to a camera, monitor and stack. Thirty-eight percent (3/9 countries) reported no ENT specialists with paediatric training. ConclusionsThere is a great shortage of paediatric ENT and paediatric surgery services in Africa. More regional training opportunities and health infrastructure for these surgical specialties are needed. Collaborative development of paediatric ENT, surgery and anaesthesia should be considered to improve ENT-related child health in Africa.

The Loneliest Moon

The Loneliest Moon Steven Schwartz (bio) Click for larger view View full resolution Photo by NASA 1 One of the most pernicious stages of insomnia is when it becomes an opponent. You want to outfox, outflank, out-smart it (lots of adversarial synonyms go through your head at three am). You spend much of your waking day plotting what tactics to use against it. In your head, you readjust your bedtime. If I wait until one am, I might sleep through the night. You calculate how much sleep you got [End Page 53] the night before as a prognostication of how much you’ll get tonight. It’s like an eating disorder, except the obsession is with hours slept instead of pounds lost. You strategize, you negotiate, you bargain to game an impenetrable system. And then, in the middle of the night when you’re wide awake, you realize that endeavoring to trick yourself back to sleep means the trick is on you. The insomnia has set a trap by making you believe it has a menacing existence outside your own conspiring mind. ________ I made an appointment for an overnight sleep study because, according to my wife, Emily, my snoring was becoming louder. Hooked up to a nest of wires running from head to toe, I took two hours and thirteen minutes to fall asleep. Eighty-two minutes later, the tech woke me up, found a mask that worked for me, and turned on the CPAP machine. I nodded off for another eighty minutes until the tech woke me at five am. She undid the belt monitor around my chest and peeled off the electrodes from my face and legs. “Did I sleep enough?” I asked her. She’d been understanding about my trouble getting to sleep, about my requests for an extra blanket and (I’m embarrassed to admit) a night-light. “Yes, we can get the data needed from even a few hours.” “How did I do?” “The doctor will let you know,” she said, smiling but noncommittal. A week later the results came back. I had moderate sleep apnea. Most of my score was made up of hypopneas—slow or shallow breathing due to partial obstruction—rather than apneas—a complete blockage of the breathing. But neither was good. My throat closed enough during sleep that breathing was compromised. The treatment: CPAP, the gold standard for preventing future cognitive impairment, high blood pressure, heart attacks, arrhythmia, diabetes, and strokes. ________ CPAP at work on my nightstand, I fall asleep but take off the mask after an hour. Wearing the CPAP mask has been compared to sticking your head out a car window at sixty miles an hour. Not exactly conducive to that floaty feeling of sleep, especially if, like me, you tend toward claustrophobia. When I explain that I’m having trouble adjusting to the machine, the doctor lowers the pressure. I also get fitted for a more comfortable mask. But that night, just as I’m drifting off, I jerk awake. It happens over and over, a sensation of being snapped back to consciousness by [End Page 54] the suspenders. Or being on the edge of a cliff and scaring yourself awake. In two weeks I’m scheduled to teach at a ten-day writing conference. I start to mull over how little sleep I’ve gotten at this conference in the past. What if I really can’t sleep? Not the usual poor-me whine of martyred sleeplessness, hyperbolic in its cri de coeur over forfeited hours, but an absolute inability to stop being awake. I listen to the whooshing of the CPAP mask—its battering ram of forced air to prevent the soft tissue in the back of my throat from collapsing. But I can’t stop thinking about going without sleep at the conference. Though I know it’s ridiculous to worry about it now, the worry grows tumid, feeding off some gathering force on the horizon that won’t let me fall asleep the remainder of the night. I decide to put off using the CPAP until I get back from the conference. I should have known the pressure of trying...

Considerations Surrounding TENS Units and Patient-Used CPAP and BPAP Machines.

Considerations Surrounding TENS Units and Patient-Used CPAP and BPAP Machines.

Continuous Positive Airway Pressure: Is it a route for infection in those with Obstructive Sleep Apnoea?

IntroductionContinuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnoea (OSA), with limited data about the prevalence of respiratory infections and microbial colonization in these patients.ObjectivesThe aim of this study was to determine if CPAP use is associated with respiratory infections and to identify the organisms that colonize or infect these patients.MethodA retrospective, case-controlled study in patients diagnosed with OSA was carried out. 137 patients were recruited and interviewed using a questionnaire. A nasal swab was taken from each patient. Patients using CPAP machines had swabs taken from masks and humidifiers.Results66 (48.2%) patients received CPAP treatment with 60.6% of them having a heated humidifier. 78.8% were male, with the majority using a full face mask (63.6%). No significant difference was seen in the prevalence of rhinosinusitis, lower respiratory tract infections and hospital admissions for pneumonia between CPAP and non-CPAP treated patients. The presence of a humidifier did not influence the prevalence of infections. Commensal flora was predominantly cultured from nasal swabs from both patient groups. Coagulase Negative Staphylococci and Diphtheroids were the main organisms cultured from masks and humidifiers respectively.ConclusionsThis study shows that the use of CPAP, choice of mask and humidifier have no significant impact on the prevalence of infections and micro-organisms isolated. This is very reassuring to the physician prescribing CPAP therapy and users.

Chronic Rhinosinusitis and Obstructive Sleep Apnea: CPAP Reservoir Bacterial Colonization Is Not Associated with Sinus Culture Positivity

Chronic rhinosinusitis (CRS) and obstructive sleep apnea (OSA) are both highly prevalent chronic diseases in the United States. Association between culture positivity of CPAP machines and sinus samples has not been studied in patients with both disease states. Our objective was to compare the microbes present in the sinus cavities and CPAP reservoirs of patients with both CRS and OSA. Patients from an academic tertiary care Rhinology practice were identified with both CRS and OSA and enrolled prospectively. Inclusion criteria included age over 18 years; diagnosis of OSA by sleep study; regular CPAP use; and an active diagnosis of CRS. Exclusion criteria included treatment with antibiotics or cleaning of the CPAP reservoir in the month prior. Cultures were taken from participants’ sinus cavities and CPAP reservoirs and resulting microbial growth was compared. The most common organisms on CPAP culture were Enterobacter cloacae and Acinetobacter baumanii, whereas the most common on sinus culture were Staphyloccoccus aureus and Pseudomonas aeruginosa. Microbial growth from the sinus cavities and the CPAP reservoirs were not concordant in any of our patients. There is no association between bacterial colonization of the CPAP reservoir and the sinus cavities of those with CRS and OSA based on microbiologic cultures.

Inaccuracy of Apnea-Hypopnea Index Determination by CPAP Machines in Patients With Incompletely Treated Obstructive Sleep Apnea

Inaccuracy of Apnea-Hypopnea Index Determination by CPAP Machines in Patients With Incompletely Treated Obstructive Sleep Apnea

EPA-0113 – Cpap treatment compliance in combat veternas with obstructive sleep apnea and ptsd and how it affects their ptsd symptoms

As a Psychiatrist working at Veterans Affairs Hospital, I have seen many patients with co existence of Obstructive Sleep Apnea and PTSD. As we know sleep disturbances are very common in combat veterans with PTSD, most common of which are nightmares and insomnia. There have been studies showing that people with OSA can have worsening of PTSD but PTSD is not found to be deleterious for OSA. CPAP is the treatment of choice for OSA and it has been found that people who start using CPAP machine have less occurance of nightmares and they sleep better. There is considerable ratio of veterans seen in my practice who do not use CPAP despite being prescribed for it, I compared the veterans with OSA who use CPAP mahcine versus those who do not use CPAP machine. Patient's subjective reporting of improvement in PTSD symptoms in those who use CPAP machine will be compared to those who do not use CPAP machine and continued to have PTSD symptoms.

That’s one small book for a man, one gian leap for CPAP compliance. Association between patient education and CPAP comliance in an urban and a rural setting in Canada

Many patients and many physicians do not appreciate the health ramifications of sleep apnea or the economic impact of low treatment rates. Placing this information in an easily and repeatedly accessible form can have many benefits including education, personal relevance for those affected with CPAP compliance difficulties. Patient education can have long term positive impact of patient outcome. For example, a single enhanced patient education session delayed initiation of dialysis by 4.6 months (Devins et al., 1993). The objective of this study was to determine the association between patient education and CPAP compliance. 200 consecutive patients of an urban sleep clinic and 200 consecutive patients in a small rural facility were enrolled in the study. 100 patients in each location received the standard consultation with their physicians after the diagnosis of obstructive sleep apnea before receiving their CPAP machine. The other 100 patients in each location received an educational booklet (Sleep Apnea, CPAP and Me by Shapiro G, Zalai, D. Trajanovic N, & Mallea, J) on sleep apnea in addition to the standard consultation with their doctors. All patients had a one month and a one year follow up follow up with the consultant. CPAP compliance was assessed at the one year follow up visit. Compliance was defined as a regular CPAP use five or more nights per week and a minimum of 5 h each night. At one year follow-up 75% patients in the standard consultation group in the urban location were compliant CPAP users. The compliance rate of patients who received the booklet in addition to the consultation was 87% at follow up. There was a significant association between the receiving the booklet and CPAP compliance ( ÷ 2 = 4.68, p < .05) in this group. In the rural location the compliance rate of 89% in the special education group was not significantly higher than the compliance rate of 82% in the control group. Education clearly helps but this may be less so in an already highly compliant group. In a review we have previously showed very high compliance rates at the rural center. There may be several reasons for this and these should be explored. On the basis of “Bang for Buck” the provision of this $10 booklet appears to be valuable and has become a pattern for a number of CPAP suppliers when so asked by physicians running a sleep clinic. At this point in time there is the need to translate the book into other languages. Any takers?

Sleep architecture in patients with sleep apnea syndrome before CPAP therapy and at the background of CPAP

The syndrome of sleep apnea appears to be one of the most prevalent forms of sleep disorders. The goal of the research was to study the peculiarities of sleep architecture in patients with the syndrome of sleep apnea before CPAP therapy and at the background of CPA. The investigations were carried out at P. Sarajishvili Institute of Neurology. A total of 17 patients, ages 28–65, with sleep apnea were examined, including 15 men and 2 women. All patients completed the a questionnaire for their Epworth Sleepness Score and their MBI was determined. For differential diagnostics of sleep apnea a polysomnography investigations (PSG) was carried out using Dr. Sagura Medizintechnik P59 polygraph accompanied by full video synchronized recording. For CPAP therapy the IntelliPAP AutoAdjust Travel CPAP Machine with SmartFlex (Manufactured by DeVilbiss) was used. According to the questionnaire all the patients have a high rate of night sleep disorders. Epworth Sleepness Score (20–22, maximum 24) and body mass index (BMI) overall maximum (31–45 > 31). The patients were characterized by night sleep disorder, loud snoring, headache, apathy, problems concentrating, excess daytime sleep. PSG investigation has shown that the patients with both obstructive sleep apnea (OSA) (14) and central sleep apnea (3) are characterized by significant decrease in sleep architecture, which results in full absence of the II stage of sleep (superficial sleep), the increase of REM stage, frequent EEG and EMG awakenings, and by the fragmentation of sleep as a whole. It should be noted that a separate part of OSA patients (both women and men) was characterized by clearly expressed REM behavioral disorders. Central sleep apnea was characterized by relatively low index of snoring (SI) (80–120) and relatively high indices of the saturation (SP02) (87–93) in cases of obstructive sleep apnea (SI>200, SP02-(36–91). At the background of CPAP therapy the first significant effect was received after 2 h resulting in the regulation of respiration and snore index. The progressive increase of SP02 was within the limits of 92–95%. Sleep architecture considerably changed, EEG and EMG awakenings sharply decreased, NREM stages increased, in rare cases when NREM3 stage was noted, sleep fragmentation significantly decreased. Thus, SA (both CSA and OSA) is characterized by significant disorder of sleep architecture. At the background of CPAP therapy a significant improvement of sleep architecture and the regulation of symptomocomplex characteristics of sleep apnea take place. Dr. Sagura Medizintechnik.

Proper method for preoperative chest preparation of patients listed for cardiac surgery

Postoperative pulmonary complication (PCCs) after cardiac surgery are a major source of morbidity and mortality, and increase length of hospital stay and resource utilization. The preoperative including prehospitlization period before CARDIAC surgery maybe used to improve a patients pulmonary condition. The efficacy of preoperative non-invasive CPAP and BIPAP machine use, chest physiotherapy (CPT) and postural drainage, frequent nebulization plus inspiratory muscle training (IMT) in reducing the incidence of PPCs in high-risk patients undergoing CARDIAC surgery has not yet been determined. To evaluate the prophylactic efficacy of our new preoperative chest preparation strategy (strategy A) on the incidence of PPCs in high risk patients scheduled for elective CARDIAC surgery compared with classic routinely used one (Strategy B). A single blind, randomized clinical trial conducted at the Cardiac Center of Kind Fahad Armed forces Hospital, Jeddah, Saudi Arabia, with the enrollment between November 2011 and October 2012. Of 500 patients referred for elective CARDIAC surgery, 100 (20%) met criteria for high risk of developing PPCs, of whom were enrolled and followed up until discharge from hospital after dividing him to two groups, our new preoperative chest preparation strategy group (group A) and classic routinely used group (group B). Patients were randomly assigned to receive either preoperative strategy (n = 50) or usual care B strategy (n = 50). Both groups received the postoperative physical therapy. Incidence of PPCs especially pneumonia, duration of postoperative intubation and invasive ventilation, Intensive Care Unit (ICU) stay and hospitalization incidence of requiring re-intubation and impact of both strategies on postoperative patient compliance to respiratory therapy. Both groups were comparable at baseline. After CARDIAC surgery, PPCs were present in 10 (20%) of patients in the A group and 25 (50%) of patients B group. Pneumonia occurred in 5 (10%) of patients in the A group and in 7 (14%) of patients in the B (OR 95% CI). Median days range 6–18 days in the B group. Finally, postoperative patients compliance to respiratory therapy was significantly improved. Preoperative A strategy reduced the incidence of PPCs an duration of postoperative hospitalization in patients at high risk of developing pulmonary complication undergoing CARDIAC surgery. Also, postoperative patient compliance to respirartory therapy was significantly improved.

An innovative nasal continuous positive airway pressure assembly

Continuous positive airway pressure is required by patients of obstructive sleep apnea to prevent any obstruction of airways. This requires CPAP machines which are costly, have electrical dependence and are not readily available. The nasal CPAP assembly devised by us overcomes most of these limitations and can be made from easily available materials.

Health Disparities in Sleep Medicine: Responses to the American Sleep Medicine Foundation Humanitarian Projects Award Program

Health Disparities in Sleep Medicine: Responses to the American Sleep Medicine Foundation Humanitarian Projects Award Program

Healthcare “Practice”–Is it Misguided?

Healthcare “Practice”–Is it Misguided?