Long-term Positive Airway Pressure Treatment Research Articles

Acceptance of and adherence with long-term positive airway pressure treatment in adults with chronic obstructive pulmonary disease: A systematic review protocol.

Long-term noninvasive positive airway pressure (PAP) treatment is effective treatment for sleep-related breathing disorders and chronic hypercarbic respiratory failure secondary to chronic obstructive pulmonary disease (COPD). PAP treatment may be delivered as continuous positive airway pressure or noninvasive ventilation. Success in initiating PAP treatment and barriers to its use in adult patients with COPD are largely unknown. This systematic review aims to identify the acceptance of and adherence to PAP treatment prescribed for long-term use in adult patients with COPD and to summarize variables associated with these measures. Seven online electronic databases will be searched by an experienced medical librarian to identify records containing the concepts "obstructive airways disease" and "noninvasive positive airway pressure" and "acceptance" or "adherence". Randomized and non-randomized studies of interventions will be included. Citation lists from relevant articles will be reviewed, and experts will be contacted regarding unpublished studies. Abstracts from key conferences between 2018-2023 and Google Scholar search results will be reviewed for inclusion. Titles, abstracts and full texts will be reviewed independently for inclusion by two reviewers. Data extraction will be completed by one author using a pre-established form and primary outcomes confirmed by a second author. Methodological quality will be evaluated. If sufficient data are available for meta-analysis, a pooled summary statistic for the primary outcome will be calculated using a random-effects generic inverse-variance meta-analysis, weighted proportion or weighted medians-based approach. Subgroup analysis will explore clinically meaningful sources of heterogeneity. Variables that are associated with acceptance and adherence will be described. Long-term PAP treatment is a complex intervention prescribed to patients with COPD for several indications. Synthesis of the evidence on success with PAP treatment and variables associated with acceptance or adherence will inform program and policy development for supporting patients with COPD who are prescribed this therapy. Systematic review registration: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on July 13, 2021 (registration number CRD42021259262), with revisions submitted on April 17, 2023.

Long-Term Effects of Positive Airway Pressure Treatment on Restless Legs Syndrome Severity in Obstructive Sleep Apnea Syndrome

To research how long-term positive airway pressure (PAP) therapy affects the severity of restless legs syndrome in patients with obstructive sleep apnea syndrome (OSASThe study included 320 individuals that were diagnosed with moderate and severe OSAS using polysomnography (PSG) and under PAP treatment. Among these patients, the demographic data of 72 patients who met the diagnostic criteria of restless legs syndrome (RLS) were analyzed. The patients were evaluated with the International RLS Study Group rating scale (IRLS) before and at the 12th month after PAP in the treatment of OSAS. The mean body mass index of the 72 patients with OSAS and RLS was 31.2 (±5.8), and their mean apnea-hypopnea index was 44.9±27.7. The prevalence of RLS in moderate and severe OSAS was 24%. There was a negative correlation between the IRLS score and mean oxygen saturation all night (r: -0.075), minimum oxygen saturation all night (r: -0.125), time spent below <90% saturation (r: -0.172), and sleep efficiency (r: 0.087) on PSG performed before PAP treatment, as well as a negative correlation between the IRLS score and weekly PAP use hours at the 12th month after PAP treatment (r: -0.316; p<0.001). The data obtained from this study suggest that the coexistence of OSAS and RLS is common and should not be overlooked in the diagnosis of comorbid diseases. Long-term PAP treatment is effective in reducing RLS symptoms. Further studies are needed on this subject.

Long-term positive airway pressure therapy is associated with reduced total cholesterol levels in patients with obstructive sleep apnea: data from the European Sleep Apnea Database (ESADA)

Background and aimObstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia. The current study examined the effects of positive airway pressure (PAP) treatment on lipid status in the European Sleep Apnea Database (ESADA). MethodsThe prospective cohort study enrolled 1564 OSA subjects (74% male, mean age 54 ± 11y, body mass index (BMI) 32.7 ± 6.6 kg/m2 and apnea-hypopnea index (AHI) 40.3 ± 24.4 n/h) undergoing PAP therapy for at least three months (mean 377.6 ± 419.5 days). Baseline and follow-up total cholesterol (TC) from nine centers were analyzed. Repeated measures and logistic regression tests (adjusted for age, sex, weight changes, lipid lowering medication, PAP compliance, and treatment duration) were used to compare changes in TC concentration. Incident risk for a coronary heart disease event (CHD) was used to compute a Framingham CHD risk score (estimated from age, BMI, blood pressure, and TC). ResultsAdjusted means of TC decreased from 194.2 mg/dl to 189.3 mg/dl during follow-up (p = 0.019). A clinically significant (10%) reduction of TC at PAP follow-up was observed in 422 patients (27%). Duration of PAP therapy was identified as independent predictor for TC reduction, which implies an approximately 10% risk reduction for incident CHD events (from 26.7% to 24.1% in men and from 11.2% to 10.1% in women, p < 0.001 respectively). ConclusionThis observational study demonstrates a reduction of TC after long-term PAP treatment. The close association between TC concentration and cardiovascular (CV) mortality suggests that identification and treatment of OSA may have a beneficial effect on overall CV risk due to this mechanism. This possibility needs to be evaluated in prospective randomized studies.

Health-related quality of life in patients with obstructive sleep apnea: effects of long-term positive airway pressure treatment

The aim of the present study was to determine the effect of middle and long-term positive airway pressure (CPAP) treatment on the health-related quality of life in patients with obstructive sleep apnea. We prospectively studied two groups of patients with this disease; a group of 42 patients (33 men and 9 women) with a mean age of 55.2±7.4 years and a body mass index of 33.5±6.4kg/m2 treated with CPAP for 6-months, and another group of 42 patients (34 men and 8 women) with a mean age of 54.4±10.5 years and a body mass index of 33.2±4.0kg/m2 treated with CPAP for 18-months. The health related quality of life was assessed by administering a Medical Outcomes Study Short Form-36 (SF-36) questionnaire before and after CPAP therapy.Patients treated with CPAP for 6 months only improved significantly in the vitality dimension and this change was clinically relevant (standard error of the measurement=1.43 SEmeas). In contrast, those treated with CPAP for a long period (18-month) showed statistically significant improvement at post-treatment in five SF-36 dimensions: physical functioning (P<0.001), role physical (P<0.01), social functioning (P<0.01), vitality (P<0.001), and general health perception (P<0.001). In four of these dimensions the improvement was clinically relevant: role physical (1.16 SEmeas), social functioning (1.35 SEmeas), vitality (1.35 SEmeas), and general health perception (2.05 SEmeas). Using two different global rating of change (independent measures or anchors), the minimal change important difference for patients treated with CPAP for 6 months ranged from 20.7 to 24.2 points on the vitality dimension; and for patients with CPAP for 18-months it ranged from 2.5 to 7.5 points on the physical role, 5.5–6.6 points on social functioning, 7.5–8.7 on vitality, and 13.5–15.5 on general health perception dimension.We conclude that health-related quality of life of obstructive sleep apnea patients improves with long term CPAP treatment and these changes are clinically relevant in several health dimensions.

Factors associated with sleep apnea in men with spinal cord injury: a population-based case-control study.

To characterize a population of spinal cord injury (SCI) patients with sleep apnea, and to determine associated factors and comorbidities. Population-based retrospective case-control study. 584 male patients served by a Veterans Affairs SCI service. Medical records were reviewed for sleep apnea diagnosis, demographic information, neurologic characteristics, and treatments received. Sleep study reports were not available to determine the nature of abnormal respiratory events (ie central, obstructive, hypoventilation). For each case with tetraplegia, a control tetraplegic subject without sleep apnea diagnosis was selected. We identified 53 subjects with diagnosed sleep apnea: 42 tetraplegic, 11 paraplegic. This represented 14.9% of all tetraplegic and 3.7% of all paraplegic patients in the population (P<0.0001 for comparison of tetraplegic and paraplegic proportions). In tetraplegic subjects, sleep apnea was associated with obesity and more rostral motor level, but not with ASIA Impairment Scale. Medical comorbidities associated with sleep apnea in non-SCI patients, such as hypertension, were more common in case subjects. Less than half of case subjects were receiving some form of treatment. For motor-complete tetraplegics, long-term positive airway pressure treatment was less common with motor level C5 and above compared to C6 and below. In this population, sleep apnea has been frequently diagnosed, particularly in tetraplegic subjects. The true prevalence is likely to be considerably higher, since this study considered only previously diagnosed cases. Sleep apnea was associated with obesity and higher neurologic level, but not ASIA Impairment Scale. Medical comorbidities were more frequent in this group, and treatment acceptance was poor with higher level motor-complete injuries. Since the type of sleep apnea (central or obstructive) was not distinguished, we cannot comment on the prevalence and associations based on specific types of sleep apnea.