nCPAP Treatment Research Articles

Efficacy of continuous positive airway pressure treatment on 5-year survival in patients with ischaemic stroke and obstructive sleep apnea: a randomized controlled trial.

The main purpose of the present analysis is to assess the influence of introducing early nasal continuous positive airway pressure (nCPAP) treatment on cardiovascular recurrences and mortality in patients with a first-ever ischaemic stroke and moderate-severe obstructive sleep apnea (OSA) with an apnea-hypopnea index (AHI) ≥20 events h(-1) during a 5-year follow-up. Patients received conventional treatment for stroke and were assigned randomly to the nCPAP group (n = 71) or the control group (n = 69). Cardiovascular events and mortality were registered for all patients. Survival and cardiovascular event-free survival analysis were performed after 5-year follow-up using the Kaplan-Meier test. Patients in the nCPAP group had significantly higher cardiovascular survival than the control group (100 versus 89.9%, log-rank test 5.887; P = 0.015) However, and also despite a positive tendency, there were no significant differences in the cardiovascular event-free survival at 68 months between the nCPAP and control groups (89.5 versus 75.4%, log-rank test 3.565; P = 0.059). Early nCPAP therapy has a positive effect on long-term survival in ischaemic stroke patients and moderate-severe OSA.

Nasal continuous positive airway pressure therapy in a non-tertiary neonatal unit: reduced need for up-transfers.

To evaluate the need for up-transfer after starting of nasal continuous positive airway pressure (n-CPAP) services in a Level II special newborn care unit (SNCU). Five hundred fifty infants admitted to Level II SNCU, 252 infants during one year prior to introduction of n-CPAP (retrospective data from case records and electronic data base) and 298 infants during one year after introduction of n-CPAP services (prospective data in predefined case reporting form) were evaluated in this before and after intervention trial. The primary outcome was proportion of infants needing up-transfers from Level II SNCU for any indication. Baseline demographic data like birth weight, gestation and other perinatal factors were similar between the two epochs. Among the infants admitted to Level II SNCU, up-transfer for any reason was significantly higher in the pre-CPAP epoch compared with CPAP epoch (n = 93, 36 % vs. n = 74, 24.8 %, p = 0.002, OR 0.56, 95 % CI 0.38 to 0.83). However parent desired up-transfers were similar between the two epochs (n = 9, 3 % vs. n = 16, 5 %, p = 0.40). Introduction of n-CPAP treatment modality reduced up-transfers in subgroups of very low birth weight infants (VLBW) (n = 20, 74 % vs. n = 15, 37 %, p = 0.003) and also in preterm infants (n = 50, 54 % vs. n = 34, 32 %, p = 0.002). Introduction of n-CPAP services in a non-tertiary care neonatal unit, significantly reduced the need for up-transfers, especially in VLBW and preterm infants.

ABSTRACT 398

Background and aims: Different respiratory support in preterm infants is applied. Aims: To realize the value of effects of two different models of respiratory support (invasive mechanic ventilation/surfactant therapy and non invasive mechanic ventilation/nCPAP) on evolution of necrotizing enterocolitis in very low birth premature neonates that were diagnosed as RDS. Methods: The neonates between January 2009 and June 2012, with the gestation weeks of 24–32 week and were divided into two groups according to the kind of mechanic ventilation. Infants were randomly assigned to intubation and surfactant treatment (within 1 hour after birth) or to nCPAP treatment initiated in the delivery room. In both two groups evolution of ≥ grade 2 NEC, duration of parenteral nutrition (PN) and the onset time of enteral nutrition were compared. Study approved by a local ethics committee. Results: 80 neonates given invasive mechanic ventilation support and 113 neonates given nCPAP support were included in the study. NEC was developed in 8 cases (%10) of first group and 9 cases (%8) of second group. The duration of PN therapy in invasive mechanic ventilation and nCPAP were found 15,4 ± 9 and 12,1 ± 9,5 days respectively. The attainment of full enteral nutrition in invasive mechanic ventilation and nCPAP was found 19,0 ± 9,5 and 15,1 ± 9,5 days respectively. In invasive MV group, both PN duration and onset time of full enteral nutrition were found significantly longer then the nCPAP (p=0,017), (p=0,006). Conclusions: nCPAP support had no adverse effect on evolution of NEC in premature neonates. In nCPAP group, duration of PN therapy and attainment of full enteral nutrition were found shorter.

Elevated plasma levels of soluble (pro)renin receptor in patients with obstructive sleep apnea syndrome: Association with polysomnographic parameters

(Pro)renin receptor ((P)RR) is a specific receptor for both renin and its precursor prorenin. (P)RR was shown to be involved in pathophysiology of cardiovascular and renal diseases. Soluble (pro)renin receptor (s(P)RR), which is generated by furin from full length (P)RR, is present in blood. The aim of the present study is to clarify the association of plasma s(P)RR levels and the severity of OSAS. Plasma levels of s(P)RR were measured by ELISA in 58 male patients diagnosed as OSAS based on polysomnography, and 14 age-matched male control subjects. Blood samples were obtained at 6:00a.m. just after overnight polysomnography. Plasma s(P)RR levels were significantly higher in patients with OSAS (9.0±2.0ng/mL, mean±SD) than in control subjects (7.4±1.5ng/mL) (P=0.0026). Plasma s(P)RR levels showed a significant negative correlation with % stage rapid eye movement (REM) sleep (r=−0.377, p<0.005), and significant positive correlations with % stage 1 (r=0.374, p<0.005), arousal index (r=0.341, p<0.01), apnea hypopnea index (AHI) (r=0.352, p<0.01) and desaturation index (r=0.302, p<0. 05). In 12 OSAS patients with AHI ≥20, plasma levels of s(P)RR were studied after 3-month treatment with nasal continuous positive airway pressure (nCPAP). Plasma s(P)RR levels were significantly decreased after the nCPAP treatment (p=0.0016). The present study has shown for the first time elevated plasma s(P)RR levels in patients with OSAS. Plasma s(P)RR levels were associated with the severity of OSAS. Soluble (P)RR may serve as a plasma marker reflecting the severity of OSAS.

Nocturnal continuous positive airway pressure in severe non‐apneic asthma. A pilot study

It has been demonstrated that brief periods of nocturnal continuous positive airway pressure (nCPAP) reduce airway reactivity in animal models and in patients with asthma. The effects of nCPAP in severe uncontrolled non-apneic asthmatic patients are not well known. In this open pilot study, we aimed to assess the effect nCPAP on peak flow (PEF) variability and asthma control in this type of patients. CPAP was applied to 10 patients with severe long-standing asthma without obstructive sleep apnea for seven consecutive nights. CPAP was titrated in auto setting and applied to the patients. Daily PEF, was measured from 2 weeks before the intervention to 2 weeks after the end of nCPAP treatment. PEF amplitude and PEF morning dip (MD) over 24-h periods averaged over 1 week were calculated as indexes of PEF variability. Asthma control test (ACT) and European quality of life (EuroQol) questionnaire were measured at baseline and after 1 month, and at baseline and at the end of CPAP period, respectively. The PEF amplitude significantly decreased both during CPAP period and in the first week after nCPAP discontinuation as compared with the baseline (19.8 ± 7.5%, 23.9 ± 9.1% and 28.9 ± 11.5%, respectively, always P < 0.05). PEF MD significantly decreased during nCPAP in comparison with the baseline (P < 0.001). The ACT and EuroQol significantly improved after nCPAP in comparison with the basal value. In this preliminary report, brief period of nCPAP reduces PEF variability and improves control in severe non-apneic asthma at a short-term evaluation. Further studies with longer-term evaluation and larger number of patients are warranted.

The Impact of Obstructive Sleep Apnea and Nasal CPAP on Circulating Adiponectin Levels

Although obstructive sleep apnea syndrome (OSAS) is known to be an important risk factor for cardiovascular diseases, the mechanism behind this association has not been fully elucidated. Transendothelial migration of monocytes mediated by adhesion molecules is a crucial step in the pathogenesis of atherosclerosis. We investigated the effect of hypoxic stress on plasma adiponectin and tumor necrosis factor-α (TNF-α) levels and whether adiponectin and TNF-α modulate adhesion molecules in patients with OSAS. In 22 patients, plasma adiponectin and TNF-α levels and serum concentrations of soluble intercellular adhesion molecule-1 (sICAM-1) were determined early in the morning after polysomnography and after nasal continuous positive airway pressure (nCPAP) treatment. Plasma adiponectin levels were inversely correlated with the apnea-hypopnea index (AHI) (r=-0.582, p<0.005) and % time in SpO2 <90% (r=-0.539, p<0.01) but not with the body mass index (BMI). TNF-α levels were positively correlated with the AHI (r=0.462, p<0.05) and BMI (r=0.452, p<0.05). Serum sICAM-1 levels were inversely correlated with plasma adiponectin levels (r=-0.476, p<0.05) but not with TNF-α levels. Although plasma TNF-α levels decreased after overnight nCPAP treatment (p<0.05), plasma adiponectin levels increased after long-term nCPAP (3months) treatment (p<0.02) in ten patients. Our findings suggest that reduced adiponectin and elevated TNF-α levels in plasma are associated with OSAS-induced hypoxic stress. Decreased adiponectin levels are associated with sICAM-1 levels.

Obstructive Sleep Syndrom in Patient with Plonjon Guatr: Case Report

A large number of predisposing factors (obesity, nasal obstruction, adenoid hypertrophy, macroglossia, etc.) are reported to be associated with obstructive sleep apnea syndrome (OUAS). In addition to these factors, the large goiter and hypothyroidism were reported to be associated with OSAS as well. However, this relationship could not yet be fully demonstrated. In our case related to plonjon goiter, we wanted to show the effect of hyroidectomy to OSAS –if there is- and the relationship between pressure and OSAS. Two years ago, a 72-year-old female with BMI: 26.8 kg/m2 patient was admitted to our clinic with complaints of respiratory standstill during sleep, snoring, morning headaches and drowsiness during daylight. In the chest X-ray, chest computed tomography and ultrasonography applied to the patient, it was detected that the trachea was deviated to the left due to euthyroid plonjon goiter and severe OSAS and polisomnografisi (PSG) was diagnosed for the patient. The patient's apnea-hypopnea index (AHI) was measured 63.1/h. With the aim of treatment, in 7cm H2O pressure, nasal continuous positive airway pressure (nCPAP) was applied to the patient and AHI decreased to the level of 11.4/h. Thyroidectomy was performed one month after the diagnosis. AHI was found 34.8 /h on the PSG applied for the purpose of 8 week-postoperative control. There were recovery on the levels of total sleep time, AHI, obstructive apnea index, hypopnea index, average desaturation index, stage 3 and REM as 16%, 44.8%, 84.7%, 19%, 38.3%, 52.4% and 28% respectively when compared the preoperative term with and postoperative term. It was demonstrated that there was no change of the in the degree of OSAS after thyroidectomy but only some partial improvement in the OSAS. The conclusion that there may be some improvements in nCPAP pressures after thyroidectomy and nCPAP treatment should not be stopped was reached. Also, it should be kept in mind that patients who apply to the primary care centers with the complaints of drowsiness, snorring and fatigue may be diagnosed as OSAS.

Effect of nasal CPAP therapy on functional respiratory parameters and cardiopulmonary exercise test in obstructive sleep apnea syndrome

Nasal CPAP treatment is an effective treatment modality for patients with OSAS. It can improve physical and mental functions by reducing daytime hypersomnolence, arousal index and sleep fragmentations. The purpose of this study was to evaluate whether pulmonary functions, exercise limitation confirmed with CPET, and quality of life can be improved after eight weeks of nCPAP treatment. We evaluated our case group with physical examination, SF-36 health survey, body composition analysis before and after nCPAP treatment for 8 weeks. Spirometric flow rates, PImax, PEmax, lung volumes and exercise capasities with CPET were measured. 31 of 40 patients (4 female, 27 male) completed the study. The mean age was 53.41 ± 1.46, 51.6% of cases had comorbidities and the smoking history rate was 54.8%. All of them had exercise limitation before treatment. After treatment there were increases in PImax–PEmax ( p < 0.05), VO2 peak ( p :0.001), load max ( p :0.000), maximal heart rates ( p :0.000), all SF-36 scores except pain ( p < 0.05) and a decrease in systolic blood pressure ( p :0.005). We did not see any changes in body compositions, spirometric flow rates except FEV1 and lung volumes. OSAS may lead to exercise limitation. nCPAP treatment is effective in reducing exercise limitation, can help to control blood pressure and improves respiratory muscle strength. nCPAP can also improve the quality of life scores in OSA patients without any comorbidity or with comorbidities under control. Our findings may suggest that these changes are the results of improvements in patients’ cardiac function, daytime somnolence and fitness. Thanks to my professors, patients and friends for helping me to continue this study.

Early regular versus late selective poractant treatment in preterm infants born between 25 and 30 gestational weeks: a prospective randomized multicenter study

Objective: Surfactant treatment in the early hours of life significantly decreases the rates of death and air leak, and increases survival without bronchopulmonary dysplasia (BPD) in preterm infants. We aimed to compare the impact of early surfactant (ES) administration to late selective (LS) treatment on neonatal outcomes in preterm infants.Methods: All preterm infants between 25 and 30 wks gestational age and who were not entubated in the delivery room and did not have any major congenital malformation or perinatal asphyxia were randomized to ES treatment (200 mg/kg Curosurf® administration in 1 hour after birth) or LS treatment (200 mg/kg Curosurf®administration in the first 6 h of life if needed). The patients were treated by nasal continuous positive airway pressure (nCPAP) treatment regardless of the surfactant requirement. Outcomes were the necessity of mechanical ventilation, nCPAP duration, the oxygen requirement duration, the rates of BPD, retinopathy of prematurity (ROP) and mortality, and the assesment of the following situations; (pneumothorax, patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH) ≥ grade III).Results: Among 159 infants enrolled in the study, 79 were randomized to ES and 80 to LS treatment groups. Thirty-five patients (44%) in the LS treatment group needed surfactant administration. Necessity of second dose surfactant administration was 8.9% in the ES treatment group. Although necessity of mechanical ventilation, nCPAP duration, oxygen need duration, rates of PDA, NEC, BPD, ROP stage >3 and mortality did not show a significant difference between groups, the ES treatment group had lower rates of pneumothorax and IVH≥ grade III when compared to the LS treatment group.Conclusions: ES treatment decreases IVH (≥ grade III) and pneumothorax rates but does not have any effect on BPD when compared to LS.

First Outbreak with MRSA in a Danish Neonatal Intensive Care Unit: Risk Factors and Control Procedures

IntroductionThe purpose of the study was to describe demographic and clinical characteristics and outbreak handling of a large methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a neonatal intensive care unit (NICU) in Denmark June 25th–August 8th 2008, and to identify risk factors for MRSA transmission.MethodsData were collected retrospectively from medical records and the Danish Neobase database. All MRSA isolates obtained from neonates, relatives and NICU health care workers (HCW) as well as environmental cultures were typed.ResultsDuring the 46 day outbreak period, 102 neonates were admitted to the two neonatal wards. Ninety-nine neonates were subsequently sampled, and 32 neonates (32%) from 25 families were colonized with MRSA (spa-type t127, SCCmec V, PVL negative). Thirteen family members from 11 of those families (44%) and two of 161 HCWs (1%) were colonized with the same MRSA. No one was infected. Five environmental cultures were MRSA positive. In a multiple logistic regression analysis, nasal Continuous Positive Airway Pressure (nCPAP) treatment (p = 0.006) and Caesarean section (p = 0.016) were independent risk factors for MRSA acquisition, whereas days of exposure to MRSA was a risk factors in the unadjusted analysis (p = 0.04).ConclusionsMRSA transmission occurs with high frequency in the NICU during hospitalization with unidentified MRSA neonates. Caesarean section and nCPAP treatment were identified as risk factors for MRSA colonization. The MRSA outbreak was controlled through infection control procedures.

ARE ROAD TRAFFIC ACCIDENTS PREVENTABLE AMONG SLEEP APNOEA PATIENTS?

BackgroundDrowsiness and lack of concentration among obstructive sleep apnoea (OSA) patients may strongly contribute to road traffic accidents (RTAs).Aims/Objectives/PurposeA meta-analysis was conducted in order to estimate whether RTAs can be...

Oxidative stress mediated arterial dysfunction in patients with obstructive sleep apnoea and the effect of continuous positive airway pressure treatment

BackgroundSeveral studies suggest an increase of oxidative stress and a reduction of endothelial function in obstructive sleep apnoea syndrome (OSAS). We assessed the association between OSAS, endothelial dysfunction and oxidative stress. Further aim was to evaluate the effect of nasal continuous positive airway pressure (nCPAP) on oxidative stress and arterial dysfunction.MethodsWe studied 138 consecutive patients with heavy snoring and possible OSAS. Patients underwent unattended overnight home polysomnography. Ten patients with severe OSAS were revaluated after 6 months of nCPAP therapy. To assess oxidative stress in vivo, we measured urinary 8-iso-PGF2α and serum levels of soluble NOX2-derived peptide (sNOX2-dp). Serum levels of nitrite/nitrate (NOx) were also determined. Flow-mediated brachial artery dilation (FMD) was measured to asses endothelial function.ResultsPatients with severe OSAS had higher urinary 8-iso-PGF2α (p<0.001) and serum NOX2 and lower NOx. A negative association was observed between FMD and OSA severity. Apnea/hypopnea index was significantly correlated with the indices of central obesity and with urinary 8-isoprostanes (r=0.298, p<0.001). The metabolic syndrome (t=-4.63, p<0.001) and urinary 8-isoprostanes (t=-2.02, p<0.05) were the only independent predictors of FMD. After 6-months nCPAP treatment, a significant decrease of serum NOX2, (p<0.005) and urinary 8-iso-PGF2α (p<0.01) was observed, while serum NOx showed only a minor increase. A statistically significant increase of FMD was observed (from 3.6% to 7.0%).ConclusionsThe results of our study indicate that patients with OSAS and cardiometabolic comorbidities have increased oxidative stress and arterial dysfunction that are partially reversed by nCPAP treatment.

P-1352 - Improvement of the link between cardiac vagal influence and delta sleep in sahs by long-term nCPAP treatment

Introduction Numerous cardiovascular events are related to sleep apnea-hypopnea syndrome (SAHS). Several studies reported, in SAHS patients, increased cardiac sympathic influence and altered link between cardiac vagal activity and delta sleep EEG. Nevertheless, short-term nasal CPAP (nCPAP) treatment regulates cardiac sympatho-vagal balance and sleep architecture. Objectives We tested that long-term nCPAP treatment improves the link between cardiac vagal influence and delta sleep EEG across the night. Aims Long-term nCPAP treatment could improve the link between heart rate variability (HRV) and sleep to prevent occurrence of cardiovascular events. Methods Cardiac activity and sleep of 8 middle-aged men suffering from SAHS were recorded before and after at least 6 months of nCPAP treatment. They were matched for sex, age, caffeine, nicotine and alcohol consumption with 14 healthy men. All subjects were free of somatic and psychiatric disorders as well as medication. Sleep architecture, spectral components of HRV and delta power band were calculated across the first three NREM-REM cycles as well as a coherence analysis between cardiac vagal influence and delta sleep EEG. Results AHI was 63.5 ± 22.9 vs 5.5 ± 4.4 events/hour after 47 ± 34 months of nCPAP treatment (mean± standard deviation). Awake, NREM and REM sleep durations were similar between groups as well as spectral HRV components. Coherence analysis revealed decreased gain value for untreated patients in comparison to controls while difference disappeared with nCPAP treatment. Conclusions Long-term nCPAP treatment improves the link between cardiac vagal influence and delta sleep even in the absence of altered HRV.

Transient Increase in Epileptiform Discharges after the Introduction of Nasal Continuous Positive Airway Pressure in a Patient with Obstructive Sleep Apnea and Epilepsy

In patients with obstructive sleep apnea (OSA) and epilepsy, the frequency of generalized spike and wave complexes (GSWCs) usually decreases after the initiation of nasal continuous positive airway pressure (nCPAP) therapy. However, we herein report a patient who had a transient increase in GSWCs following nCPAP treatment. A woman with epilepsy underwent polysomnography, who showed severe OSA and 30 GSWCs during the sleep study. Polysomnography at the introduction nCPAP showed that the GSWCs increased to 94 times during the monitoring period, despite improvement of her OSA. Polysomnography was again performed four months later, and the GSWCs had decreased to 23 times. Physicians should therefore be cautious regarding a possible increase in epileptiform discharges and seizures immediately after the introduction of nCPAP.

The influence of obesity and obstructive sleep apnea on metabolic hormones

Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by excessive daytime sleepiness and repetitive upper airway obstruction episodes during sleep. Clinically, obesity is a major risk factor for developing OSAS. However, OSAS has been associated with hormonal and metabolic alterations that could predispose patients to obesity. The aim of this study was to investigate the independent role of apneas and obesity on plasma levels of metabolic hormones (adiponectin, ghrelin, and leptin) in patients with OSAS. We have studied patients with OSAS and controls with and without obesity. All patients were male, had an apnea-hypopnea index of 20/h or greater, and were eligible for nasal continuous positive airway pressure (nCPAP) treatment. Patients were considered obese (n = 28) when their BMI was higher than 30 kg/m(2) and non-obese (n = 21) when it was lower than 27 kg/m(2). Non-obese control subjects (n = 20) were non-snorers with a normal cardiorespiratory sleep study, while obese control subjects (n = 10) were recruited from those obese subjects who were visited in our sleep unit and for whom OSAS was excluded by full polysomnography. A single blood sample was obtained from an antecubital vein in all participants after the completion of the nocturnal sleep laboratory recording. Plasma leptin, adiponectin, and ghrelin levels were determined by radioimmunoassay. The adiponectin, ghrelin, and leptin plasma levels were similar in both patients and controls. There were differences in leptin and adiponectin plasma levels between the obese and non-obese in both patient and control groups. In the case of ghrelin, differences between obese and non-obese subjects were only seen in patients. There were no significant differences in hormone levels between the obese controls and obese patients or between non-obese controls and non-obese patients. After 3 months of nCPAP treatment, adiponectin levels decreased significantly both in obese and non-obese patients, and leptin levels decreased in obese patients. Finally, nCPAP did not reduce ghrelin in either obese or non-obese patients. The basal levels of leptin, adiponectin, and ghrelin were mostly associated with obesity. We found that sleep apnea was not a determinant factor in leptin, adiponectin, and ghrelin hormonal levels. Interestingly, nCPAP treatment diminishes leptin in obese OSA patients and adiponectin levels in obese and non-obese patients with OSAS.

Continuous positive air pressure treatment reduces serum advanced glycation end products in patients with obstructive sleep apnoea syndrome: a pilot study

Nasal continuous positive air pressure (nCPAP) treatment may favourably affect serum levels of advanced glycation end products (AGEs) in patients with obstructive sleep apnoea syndrome (OSAS). At baseline, OSAS patients had significantly higher levels of AGEs than controls. Six months after nCPAP initiation, AGEs decreased significantly. nCPAP treatment could lower AGEs in patients with OSAS.

Decreased Free Water Clearance Is Associated with Worse Respiratory Outcomes in Premature Infants

ObjectiveThe goal was to elucidate predictors of decreased free water clearance (DFWC) in very low birth weight (VLBW) infants. We hypothesized that DFWC and fluid retention are linked to the severity of pulmonary problems and prolonged respiratory support, especially to nCPAP treatment.MethodsThe investigation was carried out at Tampere University Hospital between 2001 and 2006. The study population comprised 74 VLBW infants born at 29.21 (24.57–34.14) weeks of gestation. Median birth weight was 1175 (575–1490) grams. We measured plasma and urine osmolality and 24-hour urine volume to calculate free water clearance (FWC) for each infant. If FWC was less than 30 ml/kg/day the infant was classified as having DFWC.ResultsThere were 38 (51.4%) infants with DFWC in the study population. The median duration of the observed DFT period was 14 (4–44) days. The gestational age at birth was lower for DFWC infants compared to infants with normal FWC (NFWC), 28.29 (24.57–32.86) vs. 30.00 (25.57–34.14) weeks (p = 0.001). DFWC infants also needed longer ventilator treatment, 2 (0–23) vs. 0.50 (0–23) days (p = 0.046), nCPAP treatment 30 (0–100) vs. 3 (0–41) days (p<0.0001) and longer oxygen supplementation 47 (0–163) vs. 22 (0–74) days (p = 0.011) than NFWC infants. All values presented here are medians with ranges.ConclusionsDFWC appears to be frequently connected with exacerbation and prolongation of pulmonary problems in VLBW infants. Cautious fluid administration seems to be indicated in VLBW infants with prolonged respiratory problems and DFWC.

Nasal continuous positive airway pressure (nCPAP) treatment for obstructive sleep apnea, road traffic accidents and driving simulator performance: A meta-analysis

We used meta-analysis to synthesize current evidence regarding the effect of nasal continuous positive airway pressure (nCPAP) on road traffic accidents in patients with obstructive sleep apnea (OSA) as well as on their performance in driving simulator. The primary outcomes were real accidents, near miss accidents, and accident-related events in the driving simulator. Pooled odds ratios (ORs), incidence rate ratios (IRRs) and standardized mean differences (SMDs) were appropriately calculated through fixed or random effects models after assessing between-study heterogeneity. Furthermore, risk differences (RDs) and numbers needed to treat (NNTs) were estimated for real and near miss accidents. Meta-regression analysis was performed to examine the effect of moderator variables and publication bias was also evaluated. Ten studies on real accidents (1221 patients), five studies on near miss accidents (769 patients) and six studies on the performance in driving simulator (110 patients) were included. A statistically significant reduction in real accidents (OR=0.21, 95% CI=0.12-0.35, random effects model; IRR=0.45, 95% CI=0.34-0.59, fixed effects model) and near miss accidents (OR=0.09, 95% CI=0.04-0.21, random effects model; IRR=0.23, 95% CI=0.08-0.67, random effects model) was observed. Likewise, a significant reduction in accident-related events was observed in the driving simulator (SMD=-1.20, 95% CI=-1.75 to -0.64, random effects). The RD for real accidents was -0.22 (95% CI=-0.32 to -0.13, random effects), with NNT equal to five patients (95% CI=3-8), whereas for near miss accidents the RD was -0.47 (95% CI=-0.69 to -0.25, random effects), with NNT equal to two patients (95% CI=1-4). For near miss accidents, meta-regression analysis suggested that nCPAP seemed more effective among patients entering the studies with higher baseline accident rates. In conclusion, all three meta-analyses demonstrated a sizeable protective effect of nCPAP on road traffic accidents, both in real life and virtual environment.

431 Predictors of Decreased Fluid Tolerance in Vlbw Infants

Objective: The goal was to elucidate predictors of decreased fluid tolerance (DFT) in very low birth weight (VLBW) infants. We hypothesized that the fluid retention is linked to severity of pulmonary problems and prolonged respiratory support, especially to nCPAP treatment. Methods: The investigation was carried out at Tampere University Hospital between years 2001 and 2006. The study population comprised 74 very low birth weight (VLBW) infants born at 29.21 (24.57-34.14) weeks of gestation. Median of birth weight was 1175 (575-1490) grams. We measured plasma and urine osmolality and 24 hour urine volume to calculate free water clearance (FWC) for each infant. If FWC was less than 30 ml/kg/day the infant was classified as having a DFT. Results: There were 38 (51.4%) infants with an abnormal FWC (AFWC) in the study population. The median duration of observed DFT period was 14 (4-44) days. The gestational age at birth was lower for AFWC infants compared to infants with normal FWC (NFWC), 28.29 (24.57-32.86) vs. 30.00 (25.57-34.14) weeks (p=0.001). AFWC infants also needed longer ventilator treatment, 2 (0-23) vs. 0.50 (0-23) days (p=0.046), nCPAP treatment 30 (0-100) vs. 3 (0-41) days (p< 0.0001) and longer oxygen supplementation 22 (0-74) vs. 47 (0-163) days (p=0.011) than NFWC infants. Conclusions: Decreased fluid tolerance seems to be frequently connected with exacerbation and prolongation of pulmonary problems in VLBW infants. Fluid restriction might be a more beneficial treatment than diuretics in VLBW infants with prolonged respiratory problems and DFT.

1351 Five Years Experience with Ncpap as the Standard of Practice in Poland

Objective: We hypothesized that nCPAP could be applied successfully across our country and that gathering of relevant data would identify factors associated with successful treatment. Methods: We implemented a program in 2003 to establish general use of nCPAP as the standard of practice. The variable flow Infant Flow was selected as the system of choice. A registry of the baseline, course of treatment and outcome of all infants treated with nCPAP was established. In this analysis we present our experience with 11,476 neonates treated with nCPAP over the first 5 year period. Results: 41% of the infants were between 1000- 2000 grams, 14% below and 45% above. Most of the infants were treated to avoid intubation (67% RDS, 12% other, 5% apnea), and the balance to avoid reintubation when weaning from mechanical ventilation. The percentage of infants in the weaning category decreased as elective intubation decreased. nCPAP treatment successfully avoided intubation or reintubation 84% of the time. Multivariate analysis revealed that treatment success was not only associated with diagnostic category, weight and EGA, but also Apgar score at 5 minutes, pH>7.25 and PaO2/FiO2>150. The incidence of pneumothorax was highest in infants larger than 1000 grams being treated to avoid intubation, but still only 2.2%. Multivariate analysis revealed that pneumothorax in this group was associated with Apgar score at 5 minutes, pH< 7.25 and PaO2/FiO2< 150. Conclusions: We successfully established nCPAP as a standard of practice in Poland. We identified baseline factors associated with bad outcomes.