Mean Continuous Positive Airway Pressure Research Articles

The utility of various predictive equations in patients with severe Obstructive Sleep Apnea: a clinical practice viewpoint in settings with limited resources

BackgroundThe continuous positive airway pressure (CPAP) needed for the treatment of obstructive sleep apnea (OSA) can be determined after a manual titration study which is often expensive and time consuming. Hence, different predictive equations were suggested to simplify the treatment of OSA. The purpose of this work was to compare the CPAP identified with manual titration with that calculated using various equations in a cohort of patients with severe OSA.MethodsThis work was conducted on patients diagnosed with severe OSA. Data collected included full medical history, demographic and anthropometric measures, polysomnography results, and the CPAP pressure obtained after manual titration which was further compared to 15 predictive equations retrieved from the literature.ResultsA total of 166 patients [137 (82.5%) males and 29 (17.5%) females] with severe OSA were recruited in the study. Their mean age was 55.91 ± 12.64, and their baseline diagnostic apnea hypopnea index was 71.75 ± 23.70. The mean CPAP manual titration pressure was 11.31 ± 2.9 cmH2O. Non-significant statistical difference was found (p > 0.05) when the mean titration pressure was calculated by Eqs. 2 (11.36 ± 2), 3 (11.55 ± 1.68), 10 (11.51 ± 2.29), 11 (11.14 ± 2.04), and 14 (11.71 ± 2.06), whereas the mean titration pressure calculated by Eqs. 1, 4, 5, 6, 7, 8, 9, 12, 13, and 15 differed significantly from the manual titration pressure (p < 0.05).ConclusionPredictive equations suggested to calculate CPAP pressure, albeit simple and easy to apply, yielded variable results and should be investigated carefully before their use into clinical practice.

O004 The effect of treating OSA with CPAP on mood and sleepiness

Abstract Introduction Excessive sleepiness and symptoms of depression and anxiety are highly prevalent in individuals with obstructive sleep apnoea (OSA). The aim of this study was to determine the effect of treating OSA with continuous positive airway pressure (CPAP) on mood and daytime sleepiness. Methods Seventy-eight participants (mean age 51.3±12.2 years; 41% female) with previously diagnosed OSA were randomised to either treatment as usual (TAU CPAP, n=43) or to a waitlist control group (WL, n=35). Participants in the TAU CPAP group were implemented with CPAP via an in-laboratory sleep study at the Austin Health sleep laboratory. CPAP initiation was delayed for participants in the WL group by 4 months. Sleepiness and depression, anxiety and stress symptoms, were measured at baseline and 4 months follow-up and compared between groups. CPAP use was measured in the TAU CPAP group. Results Participants in both groups reported mild symptoms of depression at baseline. Daytime sleepiness (p&amp;lt;.001) improved in the TAU CPAP group compared to the WL group, but not symptoms of depression, anxiety and stress. Baseline stress symptoms in females improved in the TAU CPAP group compared to the WL group (p&amp;lt;.007). Mean CPAP use was 3.5(2.9) h/night in the TAU CPAP group. Discussion Daytime sleepiness was improved with 4 months of CPAP use compared to no treatment. Mood did not improve with 4 months of CPAP therapy. Developing an OSA-specific tool to measure mood symptoms may be beneficial, and future studies should carefully consider recruitment criteria to include participants with mood symptoms at baseline.

Effectiveness and feasibility of continuous positive airway pressure in patients with stroke and sleep apnea: a meta-analysis of randomized trials.

This meta-analysis aimed to investigate the feasibility and effectiveness of continuous positive airway pressure (CPAP) treatment in stroke patients with sleep apnea. PubMed, EMBASE, and the Cochrane Library were searched from inception until July 28, 2022, for randomized controlled trials comparing the use of CPAP and usual treatment in patients with stroke or transient ischemic attack and sleep apnea. The primary outcome measures were the feasibility of CPAP therapy, neurological function, and functional status. After screening 5,747 studies, 14 studies with 1,065 patients were included in this meta-analysis. Overall, 8 of the 14 studies recorded CPAP use, and the mean CPAP use was 4.47 hours per night (95% confidence interval [CI]: 3.85-5.09). The risk ratio of discontinuing CPAP was 1.50 (95% CI: 0.76-2.94; P = .24). Analysis of the neurofunctional scales showed that CPAP treatment improved neurological function (standardized mean difference: 0.28; 95% CI: 0.02-0.53), but there was substantial heterogeneity (I2 = 57%, P = .03) across the studies. CPAP treatment had no significant effect on functional status vs the control (standardized mean difference: 0.25; 95% CI: -0.01 to 0.51), but the studies also had substantial heterogeneity (I2 = 55%, P = .06). CPAP treatment is feasible in patients with stroke and sleep apnea and may improve neurological outcomes in these patients. However, this finding should be interpreted with caution because of the substantial heterogeneity of current trials. Fu S, Peng X, Li Y, Yang L, Yu H. Effectiveness and feasibility of continuous positive airway pressure in patients with stroke and sleep apnea: a meta-analysis of randomized trials. J Clin Sleep Med. 2023;19(9):1685-1696.

Associations of self-efficacy and outcome expectancy with adherence to continuous positive airway pressure therapy in Japanese patients with obstructive sleep apnea.

To examine the associations of self-efficacy and outcome expectancy with adherence to continuous positive airway pressure (CPAP) therapy among Japanese men with obstructive sleep apnea (OSA) using objective adherence data for CPAP therapy. We conducted a retrospective study of 497 Japanese men with OSA who were receiving CPAP therapy. Good adherence was defined as CPAP use of ≥4 hours per night for ≥70% of nights. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of good adherence to CPAP therapy with self-efficacy and outcome expectancy (measured with the CPAP Self-Efficacy Questionnaire for Sleep Apnea in Japanese). The models were adjusted for age, duration of CPAP therapy, body mass index, apnea-hypopnea index, Epworth Sleepiness Scale score, and comorbidities (diabetes mellitus and hypertension). In total, 53.5% of participants had good adherence to CPAP therapy. The mean CPAP use was 5.18±1.53 hours/night. After adjusting for related factors, we found significant associations of good adherence to CPAP therapy with self-efficacy scores (OR, 1.10; 95% CI, 1.05-1.13; p<0.001) and outcome expectancy scores (OR, 1.10; 95% CI, 1.02-1.15; p=0.007). Our results indicate that self-efficacy and outcome expectancy are associated with good adherence to CPAP therapy among Japanese men with OSA.

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

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

Nasal polyposis is a risk factor for nonadherence to CPAP treatment in sleep apnea: the population-based DISCOVERY study.

The aim was to evaluate nasal polyposis as a risk factor for nonadherence to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). This was a population-based, longitudinal analysis of patients starting CPAP treatment for OSA in the Swedish quality registry Swedevox between 2010 and 2018. Data were cross-linked with national registries. The impact of nasal polyposis on CPAP adherence was analyzed using uni- and multivariable logistic and linear regression models. Relevant confounders (age, sex, usage of nasal and oral steroids) were identified using a direct acyclic graph. Of 20,521 patients with OSA on CPAP treatment (29.5% females), 331 (1.6%) had a diagnosis of nasal polyposis at baseline. At the 1-year follow-up, nasal polyposis was associated with an increased risk of CPAP usage < 4 hours/night (unadjusted odds ratio [OR] 1.21; 95% confidence interval [CI] 0.95-1.55); adjusted OR 1.38; 95% CI 1.08-1.77). In this group, unadjusted nocturnal mean CPAP usage was 15.4 minutes (95% CI -31.62 to 0.83) shorter and was an adjusted 24.1 minutes (95% CI -40.6 to -7.7) shorter compared with patients with OSA without nasal polyposis. Nasal polyposis is associated with reduced CPAP usage per night. These results highlight the importance of diagnosing nasal polyposis in patients with OSA before the start of CPAP treatment. Treatment of the condition may improve adherence, efficacy, and patient outcomes. Bengtsson C, Grote L, Ljunggren M, Ekström M, Palm A. Nasal polyposis is a risk factor for nonadherence to CPAP treatment in sleep apnea: the population-based DISCOVERY study. J Clin Sleep Med. 2023;19(3):573-579.

Impact of an Extended Telemonitoring and Coaching Program on Continuous Positive Airway Pressure Adherence.

Rationale: The benefits of continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea are limited by adherence. Telemonitoring and coaching have been demonstrated to increase adherence, but the ideal duration of such support is unclear. Objectives: To compare the impact of a 12-month versus a 3-month behavioral support program on CPAP adherence. Methods: We evaluated real-world CPAP adherence data from all patients initiating CPAP between July 1, 2018, and April 1, 2020, by any durable medical equipment (DME) providers who had used a 12-month commercially available telemonitoring/coaching program (Long Term Adherence Management, Philips Respironics) in this timeframe. Patients receiving either 12 months or 3 months of support (Patient Adherence Management Service) were compared with those initiated on CPAP without support. Mean CPAP adherence was computed monthly over the initial 18 months. Missing usage was imputed as zero use. All analyses were adjusted for age, sex, and DME provider. Results: The nine DME providers using the 12-month telemonitoring/coaching service cared for a total of 26,489 patients (3,264 receiving 12-month support, 15,424 receiving 3-month support, and 7,801 receiving no support) in the timeframe under study. In adjusted analyses, mean CPAP use in the 3-month support group was greater than the no support group in Month 3 (4.6 h vs. 4.3 h; P < 0.001) but subsequently, usage declined to match the no support group at both Month 12 and Month 18. In contrast, mean CPAP use was greater in the 12-month support group than in the no support group at Month 3 (4.6 h vs. 4.3 h; P < 0.001), Month 12 (4.0 h vs. 3.6 h; P < 0.001), and Month 18 (3.3 h vs. 3.2 h; P = 0.02). Conclusions: A 3-month telemonitoring/coaching program increases CPAP use in the short term but does not lead to sustained improvements. In contrast, a 12-month program leads to sustained improvements but results still diminish once coaching ceases. Implementation of longer-term telemonitoring and coaching programs may be vital to obtaining long-term benefits from CPAP therapy.

Outcome of Locally Assembled Continous Positive Airway Pressure Device in Neonates with Respiratory Distress in Low Resource Setting

Respiratory distress is the most frequent cause of neonatal admission in neonatal intensive care unit (NICU). Continuous Positive Airway Pressure (CPAP) is an effective mode of treatment in newborn with respiratory distress. CPAP is the application of positive pressure to the airways of spontaneously breathing patient throughout the respiratory cycle. Low cost CPAP can be locally assembled and used in neonates with respiratory distress to reduce the mortality. This is a cross sectional descriptive study conducted in NICU of Nepal Medical College Teaching Hospital from the period of June 2021 to September 2021 to assess the outcome of locally assembled CPAP. A total of 96 newborns with respiratory distress were included in the study. Severity of respiratory distress was assessed by Downes score. Downes score before and after CPAP were recorded. Newborn with Downes score of ≥4 was started with locally assembled CPAP. Outcome was taken as improvement when the respiratory distress was decreased with Downes score&lt;4. And it was taken as a failure when baby required mechanical ventilation. Mean Downes score before starting CPAP was 4.81 and after CPAP was 0.51. Mean CPAP pressure was 4.27cm of water. Outcome of study showed, 80 (83.3%) babies were improved, 7 (7.3%) had failed CPAP who required mechanical ventilation and 1 (1%) baby expired. In conclusion, locally assembled CPAP shown to be equally effective as standard CPAP device and can be used as an effective alternative to mechanical ventilator in developing country with limited resource setting.

Treatment outcomes among rural and urban patients with obstructive sleep apnea: a prospective cohort study.

To determine whether adherence to continuous positive airway pressure (CPAP) in adults with uncomplicated obstructive sleep apnea differs by rural vs urban residential address. In this prospective cohort study, we recruited adults who initiated CPAP for uncomplicated obstructive sleep apnea that was diagnosed by a physician using sleep specialist-interpreted diagnostic testing. Participants were classified as urban (community size > 100,000) or rural (community size < 100,000) by translating residential postal code into geographic census area. The primary outcome was mean daily hours of CPAP use compared between rural and urban patients. Secondary outcomes included the proportion of patients who were adherent to CPAP, change in Epworth Sleepiness Scale score, change in EuroQOL-5D visual analog score, and Visit-Specific Satisfaction Instrument score. All outcomes were measured 3 months after CPAP initiation. We enrolled 242 patients (100 rural) with a mean (standard deviation) age of 51 (13) years and a respiratory event index of 24 (18) events/h. The mean (95% confidence interval) CPAP use was 3.19 (2.8-3.58) hours/night and 35% were CPAP-adherent, with no difference between urban and rural patients. Among the 65% of patients who were using CPAP at 3 months, the mean CPAP use was 4.89 (4.51-5.28) hours/night and was not different between rural and urban patients. Improvement in the Epworth Sleepiness Scale score and patient satisfaction was similar between groups, but the EuroQOL-5D score improved to a greater extent in rural patients. Urban or rural residence was not associated with CPAP adherence according to multivariable regression analysis. Rural vs urban residence was not associated with differences in CPAP adherence among patients with uncomplicated OSA diagnosed by a physician using specialist-interpreted sleep diagnostic testing. Corrigan J, Tsai WH, Ip-Buting A, etal. Treatment outcomes among rural and urban patients with obstructive sleep apnea: a prospective cohort study. J Clin Sleep Med. 2022;18(4):1013-1020.

Is bilevel PAP more effective than CPAP in treating hypercapnic obese patients with COPD and severe OSA?

Commentary on Zheng Y, Yee BJ, Wong K, Grunstein R, Piper A. A pilot randomized trial comparing CPAP versus bilevel PAP spontaneous mode in the treatment of hypoventilation disorder in patients with obesity and obstructive airway disease. J Clin Sleep Med. 20XX;XX(XX):XXX-XXX. doi:10.5664/jcsm.9506.

One-Year Adherence to Continuous Positive Airway Pressure With Telemonitoring in Sleep Apnea Hypopnea Syndrome: A Randomized Controlled Trial.

Study Objective: Telemedicine (TM) for continuous positive airway pressure (CPAP) treated patients may save health-care resources without compromising treatment effectiveness. We assessed the effect of TM (AirView Online System, ResMed) during the CPAP habituation phase on 3-month and 1-year treatment adherence and efficacy in patients with moderate-to-severe obstructive sleep apnea (OSA).Methods: At CPAP initiation, 120 patients diagnosed with OSA were randomized to either usual care (UC) or TM during the habituation phase (clinical registration: ISRCTN12865936). Both groups received a first face-to-face appointment with a sleep care giver at CPAP initiation. Within the following month, 2 other physical visits were scheduled in the UC group whereas two phone consultations were planned in the TM group, in which CPAP parameters were remotely adapted. Additional physical visits were programmed at the patient's request. Face-to-face consultations were scheduled at 3 and 12 months after CPAP initiation. The primary outcome was the mean CPAP daily use over the course of 12 months.Results: Twenty of 60 patients stopped CPAP therapy in the UC group vs. 14 of 60 in the TM group (p = 0.24). In per protocol analysis, mean [95% CI] daily CPAP use among 86 patients still using CPAP at 12 months was 279 [237; 321] min in the 38 patients on UC and 279 [247; 311] min in the 43 patients on TM, mean difference [95% CI]: 0 [−52; 52] min, P = 0.99. Total consultation time per patient was not different between groups, TM: 163 [147; 178] min, UC: 178 [159; 197] min, difference: −15 [−39; 9] min, p = 0.22.Conclusions: Telemedicine during the CPAP habituation phase did not alter daily CPAP use or treatment adherence and did not require more healthcare time. Telemedicine may support clinic attendance for CPAP titration.Clinical Trial Registration: [ISRCTN], identifier [ISRCTN12865936].

Neighborhoods with Greater Prevalence of Minority Residents Have Lower Continuous Positive Airway Pressure Adherence.

Rationale: Limited data suggest racial disparities in continuous positive airway pressure (CPAP) adherence exist.Objectives: To assess whether CPAP adherence varies by neighborhood racial composition at a national scale.Methods: Telemonitoring data from a CPAP manufacturer database were used to assess adherence in adult patients initiating CPAP therapy between November 2015 and October 2018. Mapping ZIP code to ZIP code tabulation areas, age- and sex-adjusted CPAP adherence data at a neighborhood level was computed as a function of neighborhood racial composition. Secondary analyses adjusted for neighborhood education and poverty.Measurements and Main Results: Among 787,236 patients living in 26,180 ZIP code tabulation areas, the prevalence of CPAP adherence was 1.3% (95% confidence interval [CI], 1.0-1.6%) lower in neighborhoods with high (⩾25%) versus low (<1%) percentages of Black residents and 1.2% (95% CI, 0.9-1.5%) lower in neighborhoods with high versus low percentages of Hispanic residents (P < 0.001 for both), even after adjusting for neighborhood differences in poverty and education. Mean CPAP usage was similar across neighborhoods for the first 2 days, but by 90 days, differences in CPAP usage increased to 22 minutes (95% CI, 18-27 min) between neighborhoods with high versus low percentages of Black residents and 22 minutes (95% CI 17-27 min) between neighborhoods with high versus low percentages of Hispanic residents (P < 0.001 for both).Conclusions: CPAP adherence is lower in neighborhoods with greater proportions of Black and Hispanic residents, independent of education or poverty. These differences lead to a lower likelihood of meeting insurance coverage requirements for CPAP therapy, potentially exacerbating sleep health disparities.

Effects of CPAP treatment on cardiac structure and function in individuals with obstructive sleep apnea and cardiovascular disease: a prospective 6-month randomised control trial

Abstract Background Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular events. The influence of continuous positive airway pressure (CPAP) on cardiac function remains uncertain. Purpose To prospectively determine the effects of CPAP on cardiovascular function, as measured by cardiac magnetic resonance imaging (CMR) as a sub-study of the international SAVE trial (NCT00738179). Methods Participants with OSA and established cardiovascular disease were randomized to CPAP treatment plus usual cardiovascular care or Usual Care alone. Primary outcomes were defined as change in ventricular ejection fraction (EF) and stroke volume (SV) between baseline and 6-month follow-up both groups. Secondary outcomes included other ventricular parameters including volumes, mass, and strain, and atrial parameters. Results 140 participants were included; mean CPAP adherence in those allocated to receive the treatment was 4.31±2.45 hours per night. Most were male (91%) and had moderate-severe OSA with minimal daytime sleepiness. There were no significant differences in left or right ventricular EF between groups after 6 months of treatment. There was an 8.5 mL increase in LV SV (95% CI; [4.3–12.6], p&amp;lt;0.001) and a 7.7 mL increase in RV SV (95% CI; [3.4–12.0], p&amp;lt;0.001) in the CPAP group compared to Usual Care. CPAP also affected left and right ventricular EDV, RV strain, and atrial parameters. Conclusions In the first prospective CMR imaging study of patients with OSA and cardiovascular disease, CPAP treatment did not change EF after 6 months, but did have significant effects on other parameters of cardiac function. Funding Acknowledgement Type of funding source: Other. Main funding source(s): Respironics Foundation; Australian National Health and Medical Research; New Zealand Health Research Council

Continuous positive airway pressure effectively ameliorates arrhythmias in patients with obstructive sleep apnea-hypopnea via counteracting the inflammation.

This work is aimed at evaluating the therapeutic effect of continuous positive airway pressure (CPAP) in treatment of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) combined with arrhythmias as well as clarifying the possible mechanism underpinning such an intervention. Through exclusions, a total of 108 OSAHS patients combined with arrhythmias were enrolled from June 2017 to June 2019 with full clinical information in this work. A computerized permuted block design with varying block stratification and size according to age, sex, AHI and type of arrhythmia was used to randomize 108 patients to CPAP versus sham CPAP for a period of 12-week. All were subjected to unchanged pharmacological anti-arrhythmia therapy combined with CPAP. Before and after CPAP treatment, the improvement of various arrhythmias was compared between the CPAP group and the sham-CPAP group. The levels of CRP, IL-6 and TNF-ɑ were measured simultaneously. During follow-up, the mean (±SD) CPAP pressure used in the CPAP group was 12.3 (±3.1) cm H2O. The use of CPAP and sham CPAP was on average of 5.2±0.56 and 5.1±0.63h/night, respectively. After 12weeks of CPAP therapy, the AHI was significantly decreased and the lowest blood oxygen saturation was notably elevated in the CPAP group compared to the sham-CPAP group, P<0.05. The CPAP therapy, compared with the sham-CPAP group, significantly reduced the incidence of all types of arrhythmia in patients with OSAHS. The level of the c-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) was significantly lower in the CPAP group than in the sham-CPAP group (P<0.05). Pearson correlation analysis showed that the reduction in the incidence of total arrhythmias was positively correlated with the decrease of CRP, IL-6 and TNF-ɑ levels, respectively. Findings from this work suggest that proper use of CPAP significantly benefits to OSAHS patients combined with arrhythmias, possibly via counteracting the inflammation.

0627 Cognitive Perceptions Impact Short-Term CPAP Adherence in Asian Patients with Obstructive Sleep Apnea

Abstract Introduction Adherence for the gold standard Continuous Positive Airway Pressure (CPAP) treatment for obstructive sleep apnea (OSA) is poor worldwide. Studies have explored factors impacting CPAP adherence but data is limited for Asian patients where cultural and social norms differ. This study aimed to examine the role of disease and treatment-related perceptions in short-term CPAP adherence among patients from a multi-ethnic Southeast Asian country. Methods 34 patients with newly diagnosed OSA were recruited from Changi General Hospital, a 1000-bed tertiary hospital in Singapore between September 2018 and February 2019. Psychological factors of self-efficacy, risk-perception and outcome expectancies were assessed with the Self-Efficacy Measure for Sleep Apnea (SEMSA) questionnaire. The SEMSA questionnaire has been previously validated for the evaluation of adherence-related cognitions. Patients were administered the SEMSA questionnaire before commencement of CPAP treatment and 1 month after. Results 73.5% (25/34) of the patients were male (82.4% Chinese, 11.8% Malays, 2.9% Indians, 2.9% others). Mean age was 43.3 ± 11.8 years, mean apnea hypopnea index (AHI) was 45.2 ± 29.6 events/hr and mean CPAP usage at one month was 3.6±2.0 hours. 47% were adherent to CPAP, defined as average device use &amp;gt; 4 hrs/day. Pre-treatment self-efficacy was significantly correlated with CPAP adherence (r = 0.498, P&amp;lt;0.01). Outcome expectancies and self-efficacy measured after one-month CPAP use were significantly correlated with CPAP adherence (r = 0.702, P&amp;lt;0.01; r = 0.467, P&amp;lt;0.01, respectively). However, no association between risk perception and CPAP adherence was noted at either time points. Conclusion Consistent with previous literature in Western population, our study demonstrated that patients’ cognitive perceptions of outcome expectancies and sense of self-efficacy have an impact on CPAP adherence in a Southeast Asian population. Strategies targeting these aspects would be important in designing patient education programs. Support

Prediction of Optimal CPAP Pressure in Patients with OSAS in Turkish Population

The most effective therapy defined for the patients with obstructive sleep apnea syndrome (OSAS) is the continuous positive airway pressure (CPAP). In this study, we aimed to construct a CPAP prediction formula in Turkish population in order to decrease the requirements for polysomnography (PSG) laboratories. The demographic features, age, gender, weight and height of the participants were recorded at the first visit, together with the neck, waist and hip circumferences. Epworth Sleepiness Scale (ESS) was used to evaluate the levels of daytime sleepiness. All patients underwent at least two PSG studies. In a total of 269 patients with a mean age of 53.42 ±13.32 years were included in the study. In step-wise multiple regression analysis; BMI, AHI, ARI, and neck circumference were the independent predictors of CPAP. A new formula was developed using these values: CPAP pred: (BMI X 0.138) + (AHI X 0.044) + (ARI X 0.056) +(NECK X 0.151) -6.180. The mean CPAP was 7.70 ±2.48 and the mean CPAP pred was 7.71 ±1.53. When the mean CPAP and CPAP pred values were compared, there was not a significant difference with a p value of 0.846. There was a significant correlation between CPAP and CPAP pred values (p:0.001 and r:0.613). We determined that, predicting CPAP with high accuracy may be possible with formulations. These formulations are important in order to reduce the requirements for repeated PSG. Further, larger, prospective studies are required to increase the accuracy of CPAP predicting formulas.

The effect of torso elevation on minimum effective continuous positive airway pressure for treatment of obstructive sleep apnea

Continuous positive airway pressure (CPAP) is considered the gold standard treatment of obstructive sleep apnea (OSA). However, it can be a challenge in some patients to find an effective CPAP setting that is well tolerated. A lower CPAP setting may improve patient tolerance of the treatment. The objective of this study was to evaluate the effect of approximately 30° torso elevation on minimum effective CPAP for the treatment of OSA. A retrospective chart review was performed to determine the effective CPAP setting required to treat OSA in patients who underwent CPAP titration with torso elevation using a wedge cushion, after having failed during the same titration study to achieve therapeutic results at CPAP of 20cm H2O without torso elevation. Thirty-nine patients who underwent CPAP titration with and without torso elevation utilizing a wedge cushion had statistically significant lowering of the minimum effective CPAP setting with torso elevation, with a mean CPAP reduction of 4.7 (p< 0.001) compared to ineffective treatment at CPAP of 20cm H2O without torso elevation. Apnea hypopnea index (AHI), respiratory disturbance index (RDI), and lowest oxygen saturation (SpO2) were all improved with torso elevation, with a mean AHI difference of 4.4 (p= 0.03), mean RDI difference of 14.2 (p= 0.001), and mean SpO2 difference of 5.9% (p= 0.002). Age and BMI were inversely correlated, and gender had no correlation with therapeutic CPAP settings with use of torso elevation. Torso elevation of approximately 30° resulted in effective CPAP treatment at settings significantly lower than 20cm H2O in all reviewed OSA patients, who had been ineffectively treated without torso elevation at the maximum tested setting of 20cm H2O. This intervention may be a useful adjunct during in-lab titration studies for patients who are not effectively treated at or cannot tolerate high CPAP settings.

Mindfulness may be a novel factor associated with CPAP adherence in OSAHS patients.

Poor adherence to continuous positive airway pressure (CPAP) remains the greatest obstacle to effective treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS). The purpose of the present study was to identify if mindfulness is associated with CPAP adherence of OSAHS patients. Newly diagnosed patients with OSAHS completed questionnaires including the Epworth Sleepiness Scale (ESS), the Mindful Attention Awareness Scale (MAAS), and the Hospital Anxiety and Depression Scale (HADS) and had experienced an overnight CPAP titration. Participants returned to the sleep center for a scheduled research visit after 30-day CPAP treatment at home. Demographics, disease severity, and device-related variables were collected. Multiple linear regression analysis was performed to build a multivariate predictive model for the outcome variable, mean daily CPAP use over 30days. Mean CPAP use was 4.7 ±2.4h/night for the study sample of 100 patients and 67% were classified as CPAP adherent. MAAS scale was 45.2 ± 18.8, whereas only 13% of patients expressed anxiety or depression. MAAS scales were significantly higher in the CPAP adherent group compared to the non-adherent group (49.5 ± 14.5 vs 40.8 ± 14.2, p< 0.001) with mean hours of daily CPAP use over 30days for the adherent group (5.7 ±1.4h/night) compared to the non-adherence group (3.0 ±1.7h/night). There were differences between the two groups in HADS depression, AHI, lowest SaO2, optimal CPAP pressure, residual AHI, mean days over 30days, and mean daily CPAP use in the first week. Univariate analyses identified an unadjusted association between mean daily CPAP use over 30days and HADS depression, MAAS, AHI, lowest SaO2, optimal pressure, and mean daily CPAP use in the first week. Multiple linear regression analysis demonstrated only MAAS and AHI were associated (p< 0.05) with mean daily CPAP use. MAAS and AHI uniquely explained 10.1% (p< 0.001) and 8.7% (p< 0.001) of mean daily CPAP use respectively. This study found a significant independent association of dispositional mindfulness with CPAP adherence. As a novel factor, mindfulness may play an important role in CPAP adherence.

Long-term adherence to ambulatory initiated continuous positive airway pressure in non-syndromic OSA children.

In children, the usual indications for continuous positive airway pressure (CPAP) are residual OSA after adenotonsillectomy and/or persistent OSA due to obesity. Data concerning adherence (hours/night) following ambulatory CPAP initiation are scarce. An observational cohort of 78 children was followed over 2years. All exhibited sleep-disordered breathing (SDB) symptoms, were assessed by polysomnography, and prescribed CPAP. CPAP was initiated at hospital for 10 children. OSA children, mean age 10.4 ± 3.2years, were mostly males (75.6%), with a mean body mass index of 21.2 ± 7.3kg/m2, and mean apnea+hypopnea index of 12.2 ± 10.6 events/hour. Seventy-two children were still on CPAP at 3months, 63 at 6months, 55 at 1year, and 34 at 2years. CPAP was discontinued thanks to rehabilitation programs, dento-facial orthopedics, and/or weight loss. Mean CPAP adherence at 1, 3, 6, 12, and 24months was respectively 6.1 ± 2.8, 6.2 ± 2.6, 6.2 ± 2.8, 6.3 ± 2.8, and 7.0 ± 2.7h/night. There was a trend towards higher CPAP adherence and younger age, primary versus middle/high school attendance, higher baseline apnea+hypopnea index, and neurocognitive disorders. In our population, mean CPAP adherence defined in hours per night was high and did not decrease during the 24-month follow-up. These findings support the feasibility of ambulatory CPAP initiation in non-syndromic OSA. The high CPAP adherence is expected to be associated with improvements in neurocognition, and in metabolic and cardiovascular parameters.

Evaluation of the efficacy of a dedicated table to improve CPAP adherence in children: a pilot study

ObjectiveOnly a few studies have addressed strategies to improve continuous positive airway pressure (CPAP) adherence in children with obstructive sleep apnea. The aim of our study was to assess the efficacy of a table based on token economy to improve CPAP adherence. MethodsA table was proposed to children nonadherent to CPAP (<3 h per night of CPAP use), eight days after CPAP initiation (D8). The child has to fill the table on a daily basis with green (I used my CPAP this night) or red (I did not use my CPAP) tokens. Objectives of CPAP use and rewards were decided between the child and their parents. An assessment of CPAP adherence was performed one month after initiation of table filling (M1) and compared to CPAP adherence at D8, and to data of adherent children. ResultsData of six nonadherent and nine adherent children were gathered (age 5 ± 5 vs. 5 ± 3 years, p = 0.953; apnea−hypopnea index 20 ± 15 vs. 25 ± 16 events/h, p = 0.550, respectively). Mean CPAP adherence at D8 was 4.7 ± 1.6 nights/wk and 1h00 ± 0h33 in the nonadherent children, vs. 6.9 ± 0.4 nights/wk and 7h16 ± 1h51 in the adherent group (p < 0.01). The mean number of nights per week at M1 was 6.4 ± 0.6 nights in nonadherent children (p = 0.086), and was equivalent to that in adherent children (6.8 ± 0.6 nights, p = 0.126). Mean adherence at M1 increased to 4h31 ± 1h12 in non-adherent children (p < 0.001), but was still lower when compared to that in adherent children (7h27 ± 2h00, p = 0.007). ConclusionThe study findings imply that use of a simple table by a child appears to be effective in improving CPAP adherence at one month.