Positive Airway Pressure Research Articles

Insomnia and Chronic Pain Mediate the Relationship Between Traumatic Brain Injury and Reduced Positive Airway Pressure Adherence Among Veterans.

To examine whether co-morbid insomnia, post-traumatic stress disorder (PTSD), depression, and chronic pain mediate the relationship between traumatic brain injury (TBI) and positive airway pressure (PAP) treatment adherence. One Veterans Health Administration (VHA) sleep medicine site. Veterans (n =8836) who were prescribed a modem-enabled PAP device. Secondary analysis of clinical data. We used path analysis to examine: (1) whether Veterans with a history of TBI were more likely to experience insomnia, PTSD, depression, and chronic pain; (2) in turn, whether Veterans with these co-morbid conditions exhibited lesser PAP adherence; and (3) whether Veterans with a history of TBI will exhibit lesser PAP adherence, even while accounting for such co-morbid conditions. Model estimates were adjusted for sociodemographic (eg, race/ethnicity) and clinical characteristics (eg, mask leakage). Health conditions were abstracted from the VHA medical record. PAP adherence was measured using average nightly use (hours). Among 8836 Veterans, 12% had a history of TBI. TBI history was not associated with PAP adherence when accounting for the presence of insomnia, PTSD, depression, and chronic pain. Indirect effect estimates indicated that a history of mild, moderate-severe, or unclassified TBI was associated with lesser PAP adherence, as mediated by the presence of co-morbid insomnia and chronic pain. Generally, TBI was associated with an increased likelihood of co-morbid insomnia, PTSD, depression, and chronic pain. In turn, insomnia and chronic pain, but not PTSD or depression, were associated with lesser PAP adherence. Our study offers empirical support for insomnia and chronic pain as potential explanatory mechanisms underlying the relationship between TBI history and suboptimal PAP adherence. While additional research is needed to confirm causality, findings offer preliminary evidence that can inform the development of tailored PAP adherence interventions for Veterans with TBI and obstructive sleep apnea.

Positive Airway Pressure Treatment Effects on the Serum Nod-like Receptor Protein 3 and Nitric Oxide Levels in Obstructive Sleep Apnea Syndrome

Positive Airway Pressure Treatment Effects on the Serum Nod-like Receptor Protein 3 and Nitric Oxide Levels in Obstructive Sleep Apnea Syndrome

Nasal Continuous Positive Airway Pressure Inhibits Gastroesophageal Refluxes in the Preterm Lamb.

Gastroesophageal refluxes (GERs) are universal in newborns and may induce deleterious consequences, especially in preemies. We have previously shown that nasal continuous positive airway pressure (nCPAP) inhibits GERs in full-term lambs, complementing similar results in adult humans. The effect of high-flow nasal cannula (HFNC) on GERs, however, remains unknown. This study aimed to assess the effects of nCPAP and HFNC on GERs in our preterm lamb model. Eleven preterm lambs born 14 days before full-term (~ 34 weeks of human gestation) were studied. Esophageal pH-impedancemetry and polysomnography recordings were performed simultaneously for six hours under three randomly ordered conditions: nCPAP 6 cmH2O, HFNC 7 L/min and no respiratory support (control). The indexes (/hour) of GERs and air-containing swallows were analyzed during each condition. The states of alertness and cardiorespiratory events were also analyzed during the identified GERs. nCPAP significantly decreased the GER index compared to control and HFNC during both quiet wakefulness and non-rapid eye movement sleep, whereas HFNC did not alter the GER index. In addition, nCPAP significantly increased the air-containing swallow index compared to control and HFNC. No significant differences were observed between the tested conditions for GER-related cardiorespiratory events, which were nevertheless rarely observed. Similar to full-term lambs, nCPAP strongly inhibited GERs in the preterm lamb, despite an increase in air-containing swallows. In contrast, HFNC did not impact GERs. Our results are clinically relevant when discussing the use of CPAP in preemies with GERs.

Association of soluble ST2 with heart failure and other comorbidities in patients with severe coronary heart disease

Abstract Background Circulating levels of soluble suppression of tumorigenicity-2 (sST2) reflect vascular congestion, inflammation, and fibrosis. sST2 has been proposed as a useful biomarker to predict the mortality and hospitalization due to heart failure. However, there is limited evidence regarding the relationship between sST2 and heart failure, as well as other comorbidities, in severe coronary heart disease (CAD). Purpose This study aims to measure the circulating levels of soluble ST2 (sST2) in a large population of patients with severe CAD to determine its association with heart failure, cardiac function, inflammation, and other important comorbidities. Methods This subanalysis is part of the ongoing perspective observational study. Available serum samples from 520 patients undergoing elective coronary artery bypass grafting (CABG) were analysed for sST2 levels. The inclusion criteria were written informed consent and age between 18-85 years. Exclusion criteria for this analysis were severe valvular disease, severe chronic obstructive pulmonary disease, oxygen therapy, nocturnal positive airway pressure support or mechanical ventilation, and the need for catecholamines or circulatory assist devices. The circulating levels of human sST2 were measured from frozen serum (-80°C) using commercially available ELISA kits. The plasma was diluted 100 times to detect sST2 levels (assay range of 31.2 - 2,000 pg/mL). Two measurements were taken to account as means for intra-assay variabilities. Logarithmic transformation was used to convert non-normal distributed data. Student t' test and linear regression were applied to categorical or continuous variables as appropriate. Results sST2 levels (median 20.4 ng/ml, [IQR 15.5 – 28.8]) significantly predict worse left ventricular ejection fraction (β = -0.164, p = 0.006), and significantly correlate with levels of NT-proBNP (β = 3.263, p < 0.001), hs-Troponin T (β = 3.391, p < 0.001), high-sensitivity C-reactive protein (β = 2.472, p = 0.014) and heart failure (p= 0.002). Interestingly, common comorbidities such as chronic kidney disease (estimated glomerular filtration rate < 60 mL/min/1.73 m2, p = 0.004), diabetes mellitus (p = 0.001) and higher levels of glycated haemoglobin (HbA1c, β = 3.615, p < 0.001) showed also a significant association with sST2 levels. No significant association of sST2 was observed with arterial hypertension (p = 0.190), atrial fibrillation (p = 0.289), obesity (BMI ≥ 30 kg/m2, p = 0.302), sleep apnoea (apnoea-hypopnoea index ≥ 15/h, p = 0.068), peripheral artery disease (p = 0.823), or previous stroke (p = 0.861). Conclusion(s) Circulating levels of sST2 significantly correlate with heart failure, NT-proBNP, hs-TnT, and hs-CRP in patients with severe CAD. Additionally, sST2 levels were found to be elevated in patients with diabetes mellitus and chronic kidney disease.

Treated obstructive sleep apnoea and incident arrhythmias

Abstract Background Obstructive sleep apnoea (OSA) is prevalent in approximately 15% of western populations. Cardiovascular disease and arrhythmia are extremely common in this group with significant morbidity overlap. Whilst treatment of OSA with continuous positive airways pressure (CPAP) appears to reduce hypertension, bradycardia and recurrence of atrial fibrillation (AF), large randomised control trials and meta-analyses do not demonstrate a significant reduction of incident tachyarrhythmias such as atrial fibrillation or sudden cardiac death. Some smaller studies suggest that AF may have up to 20% incidence. Analysis of these studies suggest that there may be significant heterogeneity in both CPAP usage and OSA phenotype, confounding the results. Furthermore, standard arrhythmia detection often underestimates paroxysmal arrhythmias. This on-going trial investigates a treated OSA population using CPAP monitoring and implantable loop recorders (ILR). Purpose This study aims to identify the incidence of arrhythmia in a treated OSA population with comprehensive arrhythmia monitoring and CPAP usage. It also explores the mechanisms linking OSA and arrhythmia such as heart rate variability and turbulence and cardiac biomarkers in order to identify at risk sub populations. Methods Continuous moderate-to-severe OSA patients were recruited from a major UK sleep centre after ECG and medical history confirmed the absence of arrhythmia. Each patient was then randomised to receive either standard-care or standard-care with an ILR with 24-hour heart rate variability/turbulence measurements, echocardiography (where possible) and cardiac biomarkers at baseline and 12 months. All patients had remote CPAP usage monitoring (where possible). The trial ended at 36 months after enrolment. Results 200 patients were recruited to the trial. Current mean average follow-up is 28 months in this on-going trial. Mean age and apnoea hypopnea index at enrolment was 53 years and 43.8 respectively. To date we have diagnosed atrial fibrillation in 15% of the ILR group compared to 2% in the standard care group. Other arrhythmias detected in the ILR group include two with supraventricular tachycardia and 2 with significant pauses but not requiring further treatment. Final analysis of arrhythmia incidence with CPAP usage and heart rate variability/turbulence, and cardiac biomarkers is ongoing with final results due by the time of final submission. Conclusion Arrhythmias, particularly AF, are highly incident in OSA despite CPAP treatment. This study may determine if heterogenous CPAP usage confounds the above observation and whether there may be predictors of arrhythmia that may indicate a need for arrhythmia screening in the OSA population.

Impenetrable Abdomen: A Case Report of Endoscopic Sleeve Gastroplasty Performed in Patient with Huge Paramedian Laparocele.

Bariatric surgical techniques have demonstrated scientific efficacy and interventional safety; however, these approaches are not universally appropriate for all patients. The term "impenetrable abdomen" refers to the inability to achieve surgical access to the abdominal cavity, a condition that may arise from several underlying factors. Endoscopic sleeve gastroplasty (ESG) is proposed as a safe and effective technique in this subgroup of patients with obesity. A 56-year-old Caucasian woman with an impenetrable abdomen due to the presence of a large left paramedian laparocele underwent ESG (Fig. 1) to our unit. An abdominal computed tomography (CT) scan revealed a substantial laparocele in the left paramedian region, involving the tenuous loops, mesentery, and part of the transverse colon. The patient body mass index (BMI) at presentation was 47.15 kg/m2 (116 kg per 1.57 m). Comorbidities included obstructive sleep apnea syndrome (OSAS), requiring nocturnal continuous positive airway pressure (CPAP) therapy, hepatic steatosis, hypertension, hypertriglyceridemia, and hypovitaminosis D. The case was discussed with our multidisciplinary board team (MDT), who agreed to proceed with the ESG. The endoscopic procedure was performed in the supine position, using the Overstitch device and lasted 58 min. No intraprocedural or post-procedural complications/adverse events have been observed. The patient resumed a liquid diet on the first postoperative day and was discharged from the hospital 24 h after the procedure in good clinical condition. Regular outpatient follow-up visits showed significant reduction of the BMI at 6 months post-procedure with a value of 34.9 kg/m2 compared with the initial value of 47.1 kg/m2. Additionally, the patient's use of nocturnal CPAP for OSAS was successfully discontinued suggesting an improvement in her respiratory condition as a result of weight loss. Moreover, there was a notable reduction in the pharmacological management required for arterial hypertension. These outcomes underscore the positive impact of selecting the most appropriate therapeutic strategy for each patient with obesity through a multidisciplinary team approach. In our experience, we confirm that endoscopic sleeve gastroplasty is both feasible and safe in patients presenting with an impenetrable abdomen. Despite the minimally invasive approach, this technique has proven effective in terms of body weight loss and reduction of obesity related compared with bariatric surgery.

The Role of Oxidative Stress and the Potential Therapeutic Benefits of Aronia melanocarpa Supplementation in Obstructive Sleep Apnea Syndrome: A Comprehensive Literature Review

Obstructive sleep apnea (OSA) is a sleep disorder characterized by repeated episodes of apnea and hypopnea, leading to inflammation and oxidative stress that contribute to numerous health complications, including cardiovascular diseases. Continuous positive airway pressure (CPAP) is a standard for treating OSA and is effective in reducing inflammation and oxidative stress. Aronia melanocarpa (a black chokeberry), a deciduous shrub belonging to the Rosaceae family and native to eastern North America that is rich in polyphenols, has garnered attention for its therapeutic potential due to its ability to neutralize reactive oxygen species (ROS) and modulate inflammatory pathways, such as NF-κB. This review supports the hypothesis that combining CPAP with black chokeberry supplementation might provide a more comprehensive approach to treating OSA, reducing the risk of health complications by further reducing oxidative stress. In conclusion, Aronia melanocarpa has potential benefits as an adjunct therapy in the treatment of OSA, enhancing overall health and well-being. This review compiles the latest scientific findings on the benefits of black chokeberry supplementation, its application in OSA treatment, and its potential use in the treatment of other conditions linked to oxidative stress.

Affecting factors and seasonal effects on the continuous positive airway pressure adherence of patients with obstructive sleep apnea

Continuous positive airway pressure (CPAP) is the preferred treatment for obstructive sleep apnea (OSA), but adherence remains challenging. This study identifies factors influencing CPAP adherence, including the impact of Korea's four distinct seasons. A retrospective study of 650 patients with OSA and prescribed with CPAP was conducted at a single institution from January 2018 to December 2020, and the patients' answers on various sleep questionnaires, demographic and polysomnographic data, and when and whether they returned the CPAP devices were collected and analyzed. The sample population was divided into when and whether the CPAP device was returned to the institution and the average daily use of the CPAP device. Results show that treatment failure is high in the first 12 weeks. Moreover, patients with more severe sleep apnea tended to have severe OSA-related clinical symptoms and are more likely to adhere to the treatment. In this study show that the seasons did not affect CPAP adherence because of indoor environmental factors. However, results show that other patient factors, such as BMI, AHI, RDI, daytime drowsiness, mood changes, and other OSA-related symptoms, have greater effects on CPAP adherence than seasonal change. Initial positive experience is important to adapt to the CPAP, and for this reason, more active intervention by sleep physicians during the initial CPAP adaptation is necessary.

Reading aloud compared with positive expiratory pressure after abdominal surgery. a randomized controlled trial

Reading aloud compared with positive expiratory pressure after abdominal surgery. a randomized controlled trial

Continuous positive airway pressure in delivery room in extremely preterm infants: A single‐center retrospective study in China

AbstractTo assess the beneficial effects of delivery room continuous positive airway pressure (DRCPAP) in extremely preterm infants, a single‐center retrospective study was performed at the Women and Children's Hospital of Chongqing Medical University in China. Infants born between January 2016 and December 2018 were regarded as the control group, and those born between January 2019 and August 2022 were considered as the observation group (DRCPAP group). The primary outcome was tracheal intubation within 72 h after birth. Six hundred and seven patients were included in the study (control: 232; DRCPAP: 375). Compared with the control group, DRCPAP reduced the intubation rate (56.8% vs. 62.9%, OR 0.57, 95% CI 0.34–0.96, p = 0.035), including <28 weeks gestational age (GA) subgroup (61.5% vs. 84.7%, OR 0.12, 95% CI 0.02–0.78, p = 0.027). One‐to‐one propensity score matching (195:195) was used to match the baseline characteristics of patients in DRCPAP and control group. After matching, no significant differences were observed in intubation rate within 72 h between the two groups (20.5% [40 of 195] vs. 22.1% [43 of 195]; p = 0.711). Whether DRCPAP can reduce intubation rate within 72 h requires further investigation.

Role of surfactant therapy in reducing oxygen requirement and mortality among neonates suffering from respiratory distress syndrome: A Prospective study at Al – Batool teaching hospital in Diyala province

Background: Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality. It is a breathing disorder characterized by a deficiency or inactivity of surfactant in the lungs of preterm and term babies and if not treated, it leads to serious complications like pneumothorax, emphysema, bronchopulmonary dysplasia and death. Objective: To estimate the effect of surfactant therapy on oxygen requirement and neonatal mortality as well as the incidence of RDS in the special care neonatal unit (SCNU) in the AL Batool Teaching Hospital in Diyala Governorate. Patients and Methods: A sample of 2000 patients with signs and symptoms of RDS at the time of presentation was prospectively collected from the 1st of July 2022 until the 1st of March 2023 in SCNU at Al-Batool Teaching Hospital. Gestational age, body weight, the use of oxygen, surfactant therapy, and continuous positive airway pressure (CPAP) were taken into consideration in assessing the outcome of RDS neonates. Results: There was a significant relationship between surfactant administrations, the period of staying on CPAP, and oxygen demand as the p-value was < 0.001 for both. Neonates who received surfactant had a lower mortality rate, with an incidence of 2.5%; the p-value was < 0.001. Incidence of neonatal RDS was 694 (34.7%). Conclusion: Since the incidence of RDS was 34.7%, surfactant therapy should be routine in neonatal special and intensive care units. Proper use of surfactant (proper timing and mode of administration) reduces oxygen demand, the need for CPAP, hospitalization, and mortality among those neonates.

Factors of late respiratory support or oxygen weaning in infants with bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD) is the most common complication in preterm infants. This study aimed at identifying factors associated with early or with late or weaning failure from respiratory support or oxygen (O2) in preterm infants with BPD requiring respiratory support or O2 therapy after discharge from the neonatal intensive care unit (NICU). This retrospective study was conducted in the NICU of a tertiary hospital, in infants born before 32 weeks of gestation between 2012 and 2021, and discharged from the NICU with a respiratory support (tracheostomy [TT], invasive ventilation [IV], Non-IV [NIV], continuous positive airway pressure [CPAP], high flow nasal canula [HFNC]) or O2 therapy for BPD. Univariate and multivariate analyses were performed to identify factors associated with early weaning (before 6 months postmenstrual age [PMA]) or late (after 6 months PMA) and weaning failure. Among the 53 infants included (2% TT, 2% IV, 11% NIV, 25% CPAP or HFNC, 60% O2 at NICU discharge), 23 (43%) were weaned from respiratory support or O2 before 6 months PMA and 39 (73%) before 12 months PMA. IV duration during NICU stay and postnatal steroid treatment were identified as factors associated with a late or weaning failure (OR 1.03, p = .04 and OR 4.11, p = .023, respectively). In this study, nearly half of preterm infants with severe BPD were weaned from respiratory support or O2 before 6 months PMA. IV duration and postnatal steroid treatment during NICU stay were associated with a late or weaning failure.

Factors associated with the effectiveness of high-flow therapy in patients with acute hypoxemic respiratory failure: An observational study

BackwardThe COVID-19 pandemic has severely tested global health systems. Non-invasive respiratory support, especially combining high-flow nasal cannula (HFNC) and continuous positive airway pressure, has effectively treated COVID-19 induced Acute Hypoxemic Respiratory Failure and reduced mortality. However, HFNC alone is more comfortable, better tolerated, and less costly than non-invasive ventilation. Understanding which patients benefit from HFNC monotherapy versus combined therapies is essential. MethodsThis observational study included patients admitted to the intermediate respiratory care unit of a COVID-19 hospital between December 2020 and September 2021. All patients treated with HFNC were included (n = 1301). HFNC failure was defined as the need for escalated therapy (non-invasive ventilation, intubation) or death. Epidemiological, clinical, non-invasive respiratory support parameters, and laboratory data were collected, and a multivariable analysis identified key determinants. ResultsHFNC was successful in 39.9 % of patients. (n = 511) Risk factors for HFNC failure included increased age, male gender, obesity, obstructive sleep apnea, higher respiratory rate, initial SpO2/FiO2 ≤ 148, and initial PaO2/FiO2 ≤ 100. An increase in the ROX Index at 24 h and slower disease progression were associated with successful treatment. These findings led to the developmet of an index to identify patients who benefit most from HFNC monotherapy. ConclusionsHFNC monotherapy can be effective for a specific profile of patients with Acute Hypoxemic Respiratory Failure due to COVID-19. This tool may help manage these patients more appropriately. Further studies are needed to determine if these findings can be applied to Acute Hypoxemic Respiratory Failure caused by other pathologies. Implications for Clinical PracticeThis study underscores the importance of early identification and management of patients at risk of HFNC failure in intermediate respiratory care units. By recognizing factors such as age, comorbidities, and respiratory indices, healthcare providers can implement targeted strategies to enhance HFNC success. These strategies may include more stringent monitoring, tailored respiratory support, and timely escalation to more intensive therapies if needed. Our findings highlight the need for a comprehensive approach to managing severe respiratory failure in critical care settings, ultimately improving patient outcomes and reducing the burden on healthcare systems.

One Year Follow-Up Assessment of Impact of Rigorous Diet Regimen and Adequate C-PAP Therapy on Obese Patients with Obstructive Sleep Apnea Syndrome: A Retrospective Study.

Background/Objectives: This study evaluated the impact of continuous positive airway pressure (C-PAP) therapy combined with a rigorous diet regimen on obese patients with obstructive sleep apnea syndrome (OSAS). Methods: Sixty obese patients (BMI ≥ 30) diagnosed with severe OSAS were recruited in order to establish the evaluation of CPAP therapy with different extents of adherence to a rigorous diet regimen. After one year, significant improvements were observed. Results: BMI reduced by 12.32%, apnea-hypopnea index (AHI) by 22.04%, oxygen desaturation index (ODI) by 15.87%, total sleep time with oxygen saturation below 90% (TST90%) by 25.2%, and Epworth Sleepiness Scale (ESS) scores by 21.74%. Patients were, then, divided into three groups, based on adherence to the restricted diet, as well as to the correct use of the nocturnal C-PAP, showing different reductions in BMI, AHI, ODI, TST90%, and ESS, according to their adherence, based on the sum of % reduction in BMI + AHI into three groups. Conclusions: These findings underscore the effectiveness of combining C-PAP therapy with a strict diet in improving OSAS symptoms and overall health in obese patients. Future studies with larger cohorts and longer follow-up periods are needed to confirm these results and explore the long-term benefits of this integrated approach.

Advances in Physiological Research: Consideration on Arterial Hypercapnia in Acute Cardiogenic Pulmonary Edema (ACPE)

The causes of hypercapnia in Acute Cardiogenic Pulmonary Edema are still unknown. Our hypothesis recognizes an alteration of the ventilation-perfusion ratio in the apical areas of the lung as the major cause. The redistribution of blood to the apical lung zone in hypertensive pulmonary circulation determines an excess of perfusion compared to ventilation and consequently hypercapnia. Our suggestion might be in favor of Bilevel-PAP over Continuous Positive Airway Pressure (CPAP) as the first line of therapy.

Long-term mortality in patients with chronic obstructive pulmonary disease requiring acute non-invasive ventilation with and without obstructive sleep apnoea

IntroductionChronic obstructive pulmonary disease (COPD)/obstructive sleep apnoea (OSA) overlap syndrome (OVS) is associated with higher mortality compared with COPD alone in stable outpatients. However, the prognosis of patients hospitalised with...

Complications among assisted reproductive technique (ART) twin gestations versus spontaneously conceived twin gestations (SC): A retrospective outcome analysis among an Afro-Caribbean population at a university-based hospital in Jamaica

Aim: The aim of the study is to compare the frequency of maternal and neonatal complications among pregnant women with twin pregnancies conceived spontaneously versus conceived by assisted reproductive technique (ART). Methods: Univariate and bivariate analyses of maternal characteristics and neonatal outcomes were performed in this retrospective cohort study at a university-based hospital between 2006 and 2016 in Jamaica, a middle-income Caribbean country. Neonatal data were the primary outcomes: APGAR scores, gestational age, birth weight, admission to the neonatal intensive care unit (NICU), and the level of ventilatory support required. Maternal characteristics, comorbidities, and pregnancy complications were other outcomes studied. Results: There were 157 SC and 27 ART twin gestations. Women conceiving via ART were more likely to be advanced maternal age (p greater 0.001), have uterine fibroids (p greater 0.001), previous myomectomy (p=0.001), and incompetent cervix (p=0.003), delivery by cesarean section (p=0.007), and experience hemorrhage (p=0.017) than SC. There were no statistically significant differences in rates of preterm births, birth weight, APGAR scores, or NICU admissions. Assisted reproductive technique twins were more likely to require continuous positive airway pressure (CPAP) (p=0.025), with no differences observed between the two groups for neonatal respiratory distress. Conclusion: In our predominantly Afro-Caribbean population, ART mothers were observed to have more poor maternal outcomes than mothers who conceived spontaneously. Assisted reproductive technique and SC twins had similar neonatal outcomes; however, ART twins were more likely to require CPAP.

Peer-Driven Intervention for Care Coordination and Adherence Promotion for Obstructive Sleep Apnea: A Randomized, Parallel-Group Clinical Trial.

Obstructive sleep apnea (OSA) is a common condition that is usually treated by continuous positive airway pressure (CPAP) therapy, but poor adherence is common and is associated with worse patient outcomes and experiences. Patient satisfaction is increasingly adopted as a quality indicator by healthcare systems. We tested the hypothesis that peer-driven intervention effected through interactive voice-response(PDI-IVR) system leads to better patient satisfaction (primary outcome), care-coordination, and CPAP adherence when compared to active-control. We performed a 6-month randomized, parallel-group, controlled trial with CPAP naïve patients recruited from four centers and CPAP-adherent patients who were trained to be mentors delivering support through an IVR system. In 263 patients, intention-to-treat analysis global satisfaction for sleep-specific services was better in the intervention group (4.57+0.71 Likert scale score) than in the active-control group (4.10+1.13; P<0.001). CPAP adherence was greater in intervention group (4.5+0.2 hours/night; 62.0+3.0% of nights >4 hours usage) versus active-control group (3.7+0.2 hours/night; 51.4+3.0% of nights >4 hours usage; P=0.014 and P=0.023). When compared to active-control group, Patient Assessment of Chronic Illness Care ratings was moderately increased by an adjusted difference of 0.33+0.12 (P=0.009); Consumer Assessment of Healthcare Provider and Systems ratings was not different (adjusted difference of 0.46+0.26; P=0.076); and Client Perception of Coordination Questionnaire was mildly better in the intervention group (adjusted difference 0.15+0.07; P=0.035). Patient satisfaction with care delivery, CPAP adherence, and care-coordination was improved by peer-driven intervention through an IVR system. New payor policies compensating peer-support may enable implementation of this approach. Clinical trial registration available at www. gov, ID: NCT02056002.

68 Feasibility of applying synchronized and proportional negative pressure ventilation in preterm infants with respiratory distress (NeoVest)

Abstract Background In preterm infants, application of negative pressure ventilation (NPV) may offer advantages to traditional methods of nasal continuous positive airway pressure (nCPAP). In a pre-clinical model, we recently described the “NeoVest”, a system consisting of a sealed abdominal interface and a ventilator that applies NPV in synchrony and in proportion to the diaphragm electrical activity (Edi) (Beck 2022). In animals with loaded breathing, the Neovest allowed a 50% reduction in Edi, and demonstrated specific diaphragm unloading, without hemodynamic effects. The NeoVest system, and its interface, have yet to be evaluated in human infants. Objectives The aim of the study was to evaluate the feasibility of applying synchronized and proportional NPV with an abdominal interface in infants with respiratory distress. Design/Methods This is a prospective feasibility trial. The inclusion criteria were admission to the Neonatal Intensive Care Unit with respiratory distress, birthweight&amp;gt;1.5kg, &amp;lt;6 weeks of age, FiO2 &amp;lt;0.35, clinically stable with no recent apneas and bradycardias, nCPAP &amp;lt;8 cm H2O and at least 48 hrs old, or post-extubation. After parental consent, the feeding tube was exchanged for a 6F “Edi catheter” (for feeding and measuring Edi), and sensors were placed (heart rate, oxygen saturation, transcutaneous CO2, and non-invasive blood pressure (BP)). Figure 1 shows the Neovest interface on a manikin. The five protocol steps were: nCPAP ON/NeoVest OFF (10 min), nCPAP ON/NeoVest ON (10 min), NO ASSIST (1 min), NeoVest only medium (10 min), NeoVest high (5 min), NeoVest low (5 min). Results Eight babies have been included to this point. The principal diagnoses were Respiratory Distress Syndrome and/or Transient Tachypnea of the Newborn. Mean weight was 2186±480g and age 10±8 days old. All babies tolerated the physical application of the vest. As shown in Figure 2, there was no significant difference in Edipk when the vest was placed (12.4±5.5 vs. 11.1±3.5 uV). During the period of no assist, Edipk was higher (18.8 ±7.3 uV) than nCPAP or NeoVest periods (p= 0.012), which were not significantly different from each other. Neural respiratory rate was the same for all periods tested. As per its design, the Neovest system delivered negative pressure in synchrony and in proportion to the Edi. Negative pressures applied (□PVEST) were -9±4, -11±4, and -7±5 cmH2O (Figure 2) for the three NeoVest periods. All infants were clinically stable with no disruptions to vital signs. Conclusion Applying synchronized and proportional negative pressure with the NeoVest system was feasible and showed promise with regards to diaphragm unloading. Future studies are required to evaluate the NeoVest utility for longer periods and compared to other methods of respiratory support.

Treatment of OSA beyond adenotonsillectomy.

Pediatric obstructive sleep apnea (OSA) is a common syndrome in children. While an adenotonsillectomy is effective for most, it may not be the treatment of choice for all, and possible alternative treatment options are briefly discussed herein. In obese children, in whom OSA is more prevalent, and has high rates of persistence after surgery, weight loss interventions may be recommended. Anti-inflammatory therapies, such as nasal steroids and montelukast, reduce the size of the adenoids and tonsils and are considered part of the stepwise treatment approach. Functional orthodontic therapies may improve OSA as well as orthopedic interventions in children in whom orthodontic indications exist. Positive airway pressure and high flow nasal cannula, stent the airway open and alleviate the obstruction, but adherence may be challenging. Tongue surgery, as well as several additional interventions are further discussed. In conclusion, multiple therapeutic options are available for pediatric OSA. Further studies are required to better identify the children most likely to benefit from these therapies.