Pressure Compliance Research Articles

Association Between Severities of Obstructive Sleep Apnea and COVID-19 Outcomes.

Introduction Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse resulting in episodes of apnea and hypopnea. Studies have shown worsenedcoronavirus disease 2019 (COVID-19) severity due to coexisting respiratory conditionsand suggest increased severity of COVID-19 in patients with or at high risk of OSA.However, the extent of this correlation is unclear. This retrospective study aimed to evaluate the association between OSA severity and COVID-19 severity and assess the impact of continuous positive airway pressure (CPAP) compliance. Methods This single-center retrospective study was conducted at King Abdulaziz University Hospital (KAUH), a tertiary care center in Jeddah, Saudi Arabia. Data were collected from 62 adult patients with OSA who were diagnosed via polysomnography (PSG) and had a positive documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)polymerase chain reaction (PCR) test result. COVID-19 severity was categorized into mild, moderate, and severe. Results There was no significant correlation between OSA severity as measured by the apnea-hypopnea index (AHI), low oxyhemoglobin desaturation (LSAT), arousal index (AI), respiratory disturbance index (RDI), or the type of treatment used, including adherence to CPAP, and the outcomes of COVID-19. However, higher arousal with respiratory index (ARI) and a lower percentage of time with SpO2 < 90% (T90) values were linked to moderate COVID-19 severity with significant p-values of 0.046 and 0.007, respectively. Conclusion There was no significant correlation between the severity or types of OSA treatment and the severity of COVID-19. Further research including multicenter studies with bigger populations and extensive sleep study data is warranted. Understanding the OSA-COVID-19 link may improve risk stratification and patient management.

Elderly Self-Help Groups: A Community-Based Education and Peer Support Program for Hypertension Control, Supporting SDG 3 on Health and Well-being

The primary cause of death for people worldwide is hypertension. Heart disease, stroke, and even death can result from uncontrolled hypertension. Researchers are encouraged by this situation to create an integrated education model based on the Self-Help Group (SHG) method of instruction. This pressing global health issue aligns with the United Nations' Sustainable Development Goals (SDGs), particularly Goal 3, which seeks to ensure healthy lives and promote well-being for all at all ages. This study sought how community-based education and peer support, spearheaded by Eldery's SHG, could help manage hypertension. The design used a quasi-experiment design with quantitative research methods. The study's sample consisted of the elderly self-help group in Banyumas Regency, a rural district of Indonesia, in 2024. Sixty-eight respondents were gathered using a probability sampling technique combined with primary random sampling. This analysis included A control group in the quasi-experimental pre-post test paradigm. An SHG intervention was given for this investigation. The paired and independent t-tests were utilised in the analysis. According to the study's findings, the SHG significantly reduced older adults's blood pressure compliance for both the systole and diastole of their blood pressure (p = 0.004) and p = 0.003). The study's findings are anticipated to be used in community-based education and other subject areas.

Challenges of Positive Airway Pressure Treatment for Patients With Obstructive Sleep Apnea at a Veterans Medical Center.

Positive airway pressure (PAP) compliance is important in treating obstructive sleep apnea. Previous studies have suggested that patients with economic burdens, discomfort using machines, and insufficient education have difficulty tolerating PAP machines. This study explored the factors affecting short-term adherence to PAP in a veterans medical center. The medical records of patients who underwent polysomnography at the Veterans Health Service Medical Center, Seoul, Republic of Korea, between July 2018 and January 2021 were reviewed retrospectively. Patients with an apnea-hypopnea index (AHI) ≥15 were included (n=579). PAP adherence was defined as continuous use for ≥21 days for ≥4 hours daily for 30 consecutive days for 90 days from the date of PAP prescription. The PAP-adherent group (n=265, age 66.16±11.28 years) was younger and had more years of education, higher body mass indices, and lower scores in the Insomnia Severity Index and Beck Depression Inventory-II (BDI-II) than those of the PAP-nonadherent group (n=314, age 68.93±10.91 years). Patients who tolerated PAP had a higher AHI, longer duration of oxygen desaturation (less than 90%), and less dream enactment behavior (DEB) than that in those who did not. After adjusting for age, years of education, BDI-II, duration of oxygen desaturation, and presence of DEB, there were more patients with National Health Insurance (NHI) in the PAP-adherent group than in the PAP-nonadherent group (p<0.001). We showed that patients with NHI recorded significantly higher adherence compared to that in patients without NHI, among other factors.

Effects of different treatment modalities on cardiovascular disease in ARR-positive hypertensive patients.

Data on the prognosis of clinically undiagnosed hypertensive patients who are aldosterone-to-renin ratio (ARR) positive are still scarce. Therefore, we investigated the clinical characteristics of clinically undiagnosed hypertensive patients who were ARR-positive and the influence of their different treatments on the occurrence and development of complications. A total of 285 hypertensive patients data with ARR ≥ 3.8 in the Second People's Hospital of Huai'an from January 2019 to December 2021 were collected, and 135 undiagnosed hypertensive patients were ultimately included in the analysis. According to their treatment strategy in various clinical departments, 135 patients were divided into the operation, spironolactone and control groups. Then, the clinical characteristics and the occurrence and development of complications in the three groups were compared. The results suggested that: (1) Only 34 (11.9%) of 285 hypertensive patients with ARR ≥ 3.8 were clearly diagnosed with Primary aldosteronism (PA) through functional tests, and the blood pressure (BP) compliance rate was only 50.30% during follow-up. (2) Based on exclusion criteria, 135 undiagnosed hypertensive patients were eventually included in the analysis. Patients in the surgery group had lower blood potassium levels and higher aldosterone levels than those in the other two groups, and their risk of new cerebrovascular complications was lower than that of the patients in the spironolactone group. (3) The risk of new cerebrovascular complications in the spironolactone group was 9.520 times higher than that of the control group, and this risk mainly occurred in patients with ARR values of 3.8-5.7. On the whole, surgery remains a good option for hypertensive patients with severe hyperaldosteronism and hypokalemia and those unable to undergo confirmatory tests; however, spironolactone therapy in patients with clinically undiagnosed hypertension, especially those with 3.8 ≤ ARR < 5.7, confered a higher risk of new cerebrovascular complications.

Evaluation of post-dilatation on longitudinal stent deformation and postprocedural stent malapposition in the left main artery by optical coherence tomography (OCT): an in vitro study

BackgroundThe diameter of the ostial and proximal left main coronary artery can be greater than 5.0 mm. However, the diameters of the mostly available coronary drug-eluting stents (DESs) are ≤ 4.0 mm. Whether high-pressure dilatation can increase the diameter of stents from 4.0 to 5.0 mm and whether post-dilatation leads to longitudinal stent deformation (LSD) of 4.0-mm-diameter stents have rarely been studied. Therefore, this study aims to evaluate LSD and stent malapposition of six types of commercially available 4.0-mm-diameter stents in China in a 5.0-mm-diameter artificial blood vessel model by optical coherence tomography (OCT) in vitro.MethodsThe left main coronary artery was simulated by a truncated cone-shaped silicone tube. The internal diameters were 4.0 mm at one end of the silicone tube and 5.0 mm at the other end. Six different types of coronary stents widely used in China were selected for this study. Each stent was respectively implanted into the simulated blood vessel and dilated to a diameter of 4.2 mm according to the stent-balloon pressure compliance table. The stents were subjected to post-dilatation with a 5.0 × 15-mm noncompliant balloon. The LSD ratio of the longitudinal axis of each stent and stent malapposition were measured through OCT, and any fractures of the stents were determined.ResultsNone of the six types of stents fractured following post-dilatation. The longitudinal axes of the BuMA and Excrossal stents were slightly shortened, while the other stents were elongated after high-pressure post-dilatation. All stents expanded to a diameter of 5.0 mm without incomplete stent apposition, except for the Nano Plus stent, which remained malapposed after high-pressure post-dilatation.ConclusionAll 4.0-mm-diameter stents can be expanded to a diameter of 5.0 mm by noncompliant balloon post-dilatation without stent strut fracture. Most stents were found to be well apposed after high-pressure post-dilatation. However, LSD was observed after post-balloon dilatation. Stent malapposition might be positively correlated with the percentage change in stent length.

In patients with obstructive sleep apnea (OSA) and nasal obstruction does nasal surgery improve continuous positive airway pressure (CPAP) compliance?

In patients with obstructive sleep apnea (OSA) and nasal obstruction does nasal surgery improve continuous positive airway pressure (CPAP) compliance?

Continuous positive airway pressure compliance in patients with mild cognitive impairment.

Sleep apnoea (SA) is associated with accelerated cognitive decline in patients with mild cognitive impairment (MCI). Treatment of SA by continuous positive airway pressure (CPAP) may slow this decline if patients comply with the treatment. The aim of this study was to assess the rate of CPAP compliance in this population. In this single-centre retrospective study conducted in a tertiary care institution, patients with a diagnosis of MCI and SA initiating CPAP between January 2015 and August 2021 were included. Data from the initial sleep recording, the 3-month follow-up and compliance with at least 12months of CPAP were analysed. Compliance was defined as an average CPAP use of at least 4h per night. 55 patients were included (49% women, age 70.7 ± 8.9years, body mass index 28.9 ± 6.5kg/m2). Aetiology of MCI was vascular (45.5%), psychiatric (12.7%) and related to Alzheimer's disease (7.3%), with 47.3% of amnesic disorders and 45.5% of dysexecutive disorders. The MiniMentalState score was 26.7 ± 3.1. SA was mostly obstructive (81.8%) with a mean apnoea-hypopnoea index of 41.1 ± 16.4/h. At 3months, 38 patients were compliant (69%) with a CPAP median use of 5.9h per night and 83% of nights. Self-reported tolerance was better in compliant patients (75.7% vs 38.5% p = 0.017). Thirty-four patients remained compliant at 12months (62%). Our results suggest a high rate of CPAP compliance in patients suffering from MCI. Compliance was related to the device tolerance, emphasizing the need to closely monitor and improve this factor.

Application of E-coach chronic disease management model in rehabilitation management of patients with arteriosclerosis obliterans

ObjectiveTo explore the effect of a health (E)-coach chronic disease management model on the rehabilitation behaviour management of patients with arteriosclerosis obliterans (ASO).MethodsThe E-coach chronic disease management model was constructed based on a literature review and expert interviews. The effect of the E-coach model on patients with ASO during hospitalisation was analysed by comparing the compliance rates of blood glucose control, blood pressure control, drug compliance, ankle-brachial index, 6-min walking test (6MWT) and pain-free walking distance (PFWD) scores between the E-coach and control groups.ResultsIn total, 212 patients with ASO were included in this study. After the intervention, the blood pressure compliance rate (44.8% vs. 65.7%) and blood glucose compliance rate (48.6% vs. 66.8%) were higher in the E-coach group than in the control group (p < 0.05). After intervention, compared with the control group, the patients in the E-coach group had better drug compliance (6.8 ± 1.9 vs. 7.9 ± 1.0), and the difference was statistically significant (p < 0.05). The scores for the 6MWT (329.19 ± 5.58 vs. 353.00 ± 9.76; 412.65 ± 12.59 vs. 499.16 ± 18.43) and PFWD (219.15 ± 11.96 vs. 225.36 ± 16.13; 331.62 ± 51.36 vs. 369.42 ± 75.71) tests were significantly higher in the E-coach group than in the control group at 1 and 6 months after intervention (p < 0.05).ConclusionThe E-coach chronic disease management model can effectively improve the control rates of blood glucose and blood pressure and the behaviour management of patients with ASO and is thus worthy of clinical reference.

Effect of positive airway pressure compliance on laryngopharyngeal reflux in obstructive sleep apnea patients

ObjectivesTo determine the effect of continuous positive airway pressure (CPAP) compliance on symptoms and signs of laryngopharyngeal reflux (LPR) in patients with obstructive sleep apnea (OSA).ResultsThirty patients were included. The participants were divided into good compliance (n = 21) and poor compliance (n = 9) groups. After 6-month CPAP treatment, the reflux symptom index score significantly decreased in both the good compliance group (20 (17,24) vs. 14 (10,18), p < 0.001) and the poor compliance group (21 (18,25) vs. 10 (5,16), p < 0.05). Reflux finding score was significantly reduced in both the good compliance group (8 (6,9) vs. 4 (3,5), p < 0.001) and the poor compliance group (6 (4,8) vs. 3 (2,4), p < 0.05). However, there were no statistically significant differences between the groups. CPAP treatment reduces the symptoms and signs of LPR. However, CPAP compliance does not correlate with improvement in LPR in patients with OSA.

EVALUATION ON CLINICAL APPLICATION OF LOW-DOSE TRADITIONAL QUADRUPLE ANTIHYPERTENSIVE COMPOUND PREPARATION IN CHINA

Objective: To evaluate whether a relatively old multi-drug SPC prescription can be adapted to current treatments of hypertension. Design and method: 1. In a retrospective, real-world study, 22148 patients with hypertension who visited 4 hospitals in China from 2011 to May 2016 were selected as the subjects. A comparison was conducted between treatment with compound reserpine and triamterene tablets (Reserpine/Triamterene CAS) and with four other single-pill combinations (SPCs) (losartan/hydrochlorothiazide, valsartan/hydrochlorothiazide, irbesartan/hydrochlorothiazide, and amlodipine/valsartan) for 20 days. The compliance rate was analyzed after patients’ propensity score matching analysis. 2. A meta-analysis of 7 randomized controlled trials on the safety and efficacy of compound reserpine and triamterene tablets published from 2000 to 2020 was conducted. Results: 1. Treatment with 1 compound reserpine and triamterene tablet daily (R/L) resulted in a blood pressure compliance rate (BP &lt; 140/90 mmHg) of 63 to 68%. Compared with valsartan/amlodipine, R/L achieved a compliance rate of 63% vs 50%; with valsartan/hydrochlorothiazide, of 64% vs 59%; with losartan/hydrochlorothiazide, of 67% vs 57%, and with irbesartan/hydrochlorothiazide, of 68% vs 59%. All P values were &lt; 0.05 (Figure 1). 2. Seven studies were included in the meta-analysis. In five studies, the overall response rate of hypotensive treatment with compound reserpine and triamterene tablets was higher in efficacy study compared with other hypotensive drugs (OR = 2.23, 95% CI: 1.32 ∼ 3.75) (Figure 2), and there was no significant difference in the incidence of adverse reaction with compound reserpine and triamterene tablets in the 6 trials included in the safety study (OR = 0.91, 95% CI: 0.68 ∼ 1.22) (Figure 3). Conclusions: China is faced with high prevalence of hypertension, low control rate, and scarce medical resources and economic resources in primary medical care, but ultra-low-dose SPC (R/L) can improve the antihypertensive effect and reduce the incidence of adverse reactions (Figure 4) through the synergistic effect among different components of the drug and has good patients’ compliance and low price. We confirmed that through systematic review and meta-analysis, ultra-low-dose SPC (R/L) is suitable for the treatment of hypertension, especially those with refractory hypertension.

0974 Limitations of Hypoglossal Nerve Stimulation in Patients with Down Syndrome

Abstract Introduction Obstructive sleep apnea (OSA) is a common sleep disorder affecting up to 80% of people with Down Syndrome (DS). Tonsillectomy and adenoidectomy (T&amp;A) are commonly utilized as the first line of treatment of OSA in patients with DS. However, even after T&amp;A, OSA can persist in up to 60% of patients. Positive airway pressure (PAP) compliance is low in patients with DS, limiting treatment efficacy. Hypoglossal nerve stimulation (HNS) is FDA-approved for the treatment of select adult patients with OSA. Limited research is available on HNS in people with DS; however, the limited data suggests that HNS may be a safe and effective treatment in this patient population. We describe two cases of patients with DS and HNS with unique challenges with treatment. Report of case(s) Case 1: A 36-year-old male with a history of DS presented for follow-up after activation of the HNS. The patient had been living part-time in a group home. While the patient’s mother thought he was using HNS every night, the download from the remote showed 41% usage over a three-week time frame. With further investigation, it was determined that the device was turned on the nights when the patient was at home with his parents, but not when he was at the group home despite detailed caregiver education. Case 2: A 19-year-old male with OSA and DS returned for a follow-up of his HNS. Upon exam, the patient’s HNS was already “on” in clinic, which the mother was unaware of. Download from the remote showed a usage time of 13+ hours, and the HNS was commonly “on” into the afternoon well after the patient had left for school in the morning, indicating that the HNS was commonly left on while the patient was awake. Despite significant education, the caregiver was not correctly turning the HNS off. Conclusion HNS offers a therapeutic alternative in patients with DS, who are refractory to T&amp;A and PAP. The success of the treatment is dependent on multiple factors, including therapy mechanics, patient tolerance, and caregiver education/compliance. Additional caregiver instruction may be necessary to ensure optimal use. Support (if any)

Implementation of a 10-meter radius centrifuge model into a simulator of the human cardiovascular system: Effect on heart rate, stroke volume, and aortic pressure

Greater interest in long term space travel is creating demand to develop artificial gravity systems that minimize the negative effects of long-term microgravity exposure. However, due to practical constraints of understanding the physiological effects of artificial gravity systems, we propose a cardiovascular simulation to better understand the physiological impacts of an artificial gravity gradient created through the centrifugal force of a rotating spacecraft. The purpose of these simulations is to understand the effects of artificial gravity systems during space travel. We hypothesized that an artificial gravity system will not have significant effects on the cardiovascular system if it induces the same gravity gradient in an upright human as exists on Earth. For this reason, a 10-meter radius, 1 radian/second centrifuge system was chosen to mimic the effect of the gravity gradient on Earth. We used a modified version of the CVSIM program developed to model cardiovascular responses to orthostatic challenges ( https://physionet.org/content/cvsim/1.0.0/ ). CVSIM is a 21-compartment, lumped parameter model with control systems for the cardiopulmonary and arterial baroreflexes. The existing tilt test simulation within the CVSIM program was modified to create a simulation of the centrifuge. A 500-second-long simulation resulted in an average heart rate of 79 beats/minute, an average stroke index of 46 mL/beat/m 2 , and average pressures in the ascending aorta of 99 mmHg during systole, and 72 mmHg during diastole. These values were achieved by 150 seconds into the 500-second simulation. In comparison, prior to the onset of the centrifugation, initial heart rate, stroke index, and ascending aortic pressure compliance were set at 70 beats/min, 46 mL/beat/m 2 , and 0.28 ml/mmHg, respectively, based on published norms in humans. These preliminary data suggests that this artificial gravity system may produce viable physiological conditions for the cardiovascular system. Further research, especially with longer simulations, is necessary to determine if a rotating spacecraft could ease the negative impacts of microgravity over an extended time. This work is supported by Iowa Space Grant Consortium/NASA BASE grant No.103428-19-20 (AP, MJL) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Predictive value of gut microbiota in long-term blood pressure control: a cross-sectional study

ObjectivesTo investigate the prediction of long-term blood pressure control using the intestinal flora of patients with hypertension.MethodsA total of 125 patients with primary grade-2 hypertension who attended the cardiovascular department of Hebei Province Hospital of Chinese Medicine between April 2021 and April 2022 were enrolled; these included 65 patients with substandard long-term blood pressure control (the uncontrolled group) and 60 patients with standard long-term blood pressure control (the controlled group). General clinical data and data on morning stools and diet were recorded for all the enrolled patients. The 16 s rDNA sequencing of faecal intestinal flora was also performed to analyse the differences in intestinal flora between the two groups of patients and to investigate the relationship between blood pressure compliance and the presence of flora.ResultsThe intestinal flora of the two groups of patients differed in terms of the Firmicutes–Bacteroidetes ratio (F/B), α-diversity analysis (Chao1, ACE and Shannon) results and β-diversity analysis results. At the genus level, the number of Streptococcus and Paraprevotella in patients in the uncontrolled group was greater than that of the controlled group, and the level of Akkermansia and Bifidobacterium was lower than that in the controlled group. A logistic regression analysis of the difference factors found differences in ACE, F/B, Streptococcus, Paraprevotella and Akkermansia in the two groups; these differences remained after correcting for age, gender and body mass index. The receiver operating characteristic curves revealed the following: ACE (area under the curve [AUC] = 85.282), Streptococcus (AUC = 82.705), Akkermansia (AUC = 77.333), Paraprevotella (AUC = 66.154) and F/B (AUC = 60.436).ConclusionsThere were significant differences in the intestinal flora of the patients in the controlled blood group compared with that of the uncontrolled group. Therefore, the ACE, genus levels of Streptococcus and Akkermansia could provide some prediction of late blood pressure compliance or non-compliance in patients with hypertension.

PS-C19-6: STUDY ON THE EFFICACY AND SAFETY OF TENG FU JIANGYA TABLET IN THE TREATMENT OF HYPERTENSION

Background: At present, the most important task of cardiovascular disease health management that is to improving the blood pressure compliance rate of Hypertensive Patients. Traditional Chinese medicine (TCM) is an important part of complementary and alternative medicine. Research shows that traditional Chinese medicine has antihypertensive effect from multiple pathways and multiple targets. However, lack of clinical evidence-based medical evidence of TCM in the treatment of hypertension. The purpose of this study was to investigate the efficacy and safety of Teng Fu Jiangya tablet (TJT) in the treatment of hypertension. Methods: A prospective, randomized, single-blind, placebo-controlled clinical trial was conducted in order to evaluating the effectiveness and safety of TJT in the treatment of grade 1 hypertension (N = 130). On this basis, a multicenter, randomized, double-blind, placebo-controlled clinical trial was conducted on the treatment of grade 2 hypertension with TJT combined with valsartan / amlodipine (N = 288). During the experiment, the efficacy index of the subjects were recorded for effectiveness evaluation, and the safety index and adverse reaction events of the subjects were recorded for safety evaluation. Results: 1. After 4 weeks of intervention in patients with grade 1 hypertension, there were significantly difference in the SBP and DBP compared with placebo group. The compliance rate of blood pressure of TJT group is 67.19% and in placebo group is 43.08%. TJT can improve the standard rate of blood pressure. There were also significantly difference in the level of Arachidonic acid, the thromboxaneB2 and the Prostaglandin E2 between the two groups. And there was no serious adverse event reported. 2. After 4 weeks of intervention in patients with grade 2 hypertension, in accordance blood pressure compliance rate, the systolic blood pressure compliance rate of the treatment group was 61.65%, and the placebo group was 37.68%. The treatment group could more effectively reduce the levels of arachidonic acid and thromboxane B2 and increase the level of prostaglandin E2, reduce inflammatory factors, so as to reduce the inflammatory. Conclusion: TJT tablet has good effectiveness and safety in the clinical treatment of hypertension. TJT also can effectively reduce the damage of vascular endothelium in the treatment of hypertension. Therefore, TJT play a key role in reducing blood pressure and protecting target organ damage. This is an innovative method for the treatment of hypertension.

The use of topical nasal steroids to improve continuous positive airway pressure compliance in patients with obstructive sleep apnea: An updated systematic review and meta-analysis of randomized control trials.

Nasal steroids are commonly prescribed to reduce nasal side effects, which are the primary cause of continuous positive airway pressure (CPAP) intolerance in obstructive sleep apnea (OSA) patients. We conducted a systematic review and meta-analysis of OSA patients to assess the effect of nasal steroids on CPAP compliance and nasal symptoms. PubMed, Scopus, Ovid, and Cochrane Library were searched through March 2022. Randomized controlled trials (RCTs) evaluating the effects of nasal steroids on CPAP compliance in adult patients, which reported quantitative data on CPAP use and nasal symptoms, were included. Three RCTs (224 patients) were eligible for the meta-analysis. At the 4-week follow-up, the study did not demonstrate a statistically significant difference in CPAP compliance (average hours of CPAP use per night: mean difference 0.45; 95% confident interval (CI) (-0.01, 0.90); P = 0.06, percentage of nights device used: mean difference 1.79; 95%CI (-2.59, 6.17); P = 0.42). There was also no difference in overall nasal symptoms (mean difference 0.47, 95%CI (-0.00, 0.94); P = 0.05), with significantly more sneezing and rhinorrhea among patients with nasal steroids (sneezing: mean difference 0.64, 95%CI (0.23, 1.05); P = 0.002, rhinorrhea: mean difference 0.78, 95%CI (0.24, 1.31); P = 0.005). At the 4-week follow-up, the pooled results did not demonstrate significant benefits of nasal steroids on CPAP compliance. There was also no significant benefit for relieving nasal symptoms. To further explore the benefit of nasal steroids on CPAP use, additional, longer-term studies are required.

Compliance After Re-Prescription for Positive Airway Pressure in Obstructive Sleep Apnea Patients Who Failed Positive Airway Pressure Therapy.

Little is known about studies evaluating positive airway pressure (PAP) compliance after re-prescription. Therefore, the aim of this study was to investigate PAP compliance after re-prescription in obstructive sleep apnea (OSA) patients who failed initial PAP therapy. We retrospectively reviewed OSA patients who had received a re-prescription for PAP from March 2020 to June 2021. We compared the compliance rate between initial prescription and re-prescription for PAP and investigated the reasons for PAP failure after the first prescription. A total of 10 consecutive OSA patients (mean age=45.6±13.7 years and male:female=8:2) who received a re-prescription for PAP were included. Of them, 8 patients (80%) met the compliance criteria (i.e., Korean National Health Insurance criteria) for PAP after re-prescription. The compliance rate increased from 36.3±18.2% (initial prescription) to 61.3±28.8% (re-prescription); this was not of statistical significance (p=0.074). PAP/mask-related discomfort was the most common reason for PAP failure, followed by nasal obstruction, unintentional mask removal, and pressure-related discomfort. Even if initial PAP therapy fails, the proportion of patients who meet the compliance criteria may be improved through various forms of clinical aid and support after re-prescription of PAP.

Determination of level of self-reported adherence of antihypertensive drug(s) and its associated factors among patient with hypertension at a tertiary care center.

The study aimed to determine the level of self-reported adherence to antihypertensive drug(s) and its associated factors among patient with hypertension at a tertiary care center. The authors performed hospital based observational cross-sectional study using semi-structured questionnaires, WHO STEP tool and Hill and Bone high blood pressure compliance scale from December 1, 2021 to February 28, 2022. Descriptive statistics, Chi-square/Fisher's exact test and non-parametric tests were used for statistical analysis. Among 150 cases included in the study, majority (94, 62.67%) had good adherence based on Hill and Bone high blood pressure compliance scale with adherence level labelled as "good adherence" (score 3) and "not good adherence" (score<3). The adherence to drug therapy was significantly better in females compared to males (50 [71.43%] vs. 44 [55.00%], p=.038). Among the factors related to hypertension and anti-hypertensive therapy, people with higher body mass index (ρ=-.324, n=56, p=.015) and taking three or more pills (6, 1.71%, p=.017) had lower adherence to therapy. Likewise, forgetfulness (30, 53.57%), ineffective counseling (7, 12.50%), and missed follow-up (13, 23.21%) were the factors associated with lower adherence to anti-hypertensive therapy. This study finds good adherence among the patients taking anti-hypertensive medications. However, with the improved education, lesser number of pills and physical fitness help to adhere with the anti-hypertensive therapy.

The Role of Isolated Nasal Surgery in Obstructive Sleep Apnea Therapy-A Systematic Review.

Nasal obstruction is believed to play a significant role in the pathophysiology and management of obstructive sleep apnea (OSA). However, controversy remains about the ability of isolated nasal surgery to improve OSA. The objective of this systematic review is to give an updated overview of the literature on whether isolated nasal surgery can improve OSA subjectively (Epworth Sleepiness Scale (ESS)) and/or objectively (polysomnography (PSG)). Methods: A systematic review was performed searching the electronic databases PubMed, Embase.com (accessed on 20 June 2022) Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL) up to 20 June 2022. Eligible studies were reviewed for methodological quality using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Twenty-one studies met the inclusion criteria. The majority of the included studies reported no significant reduction in the apnea-hypopnea index (AHI) after isolated nasal surgery in patients with OSA. The meta-analysis suggests that the AHI slightly decreases after nasal surgery. The ESS was significantly lower after nasal surgery in eighteen studies. Conclusion: Based on the present analysis of objective outcomes, isolated nasal surgery did not improve the AHI significantly in the majority of the studies. The meta-analysis suggests a slight decrease in AHI after nasal surgery, but this reduction is not clinically relevant in terms of treatment success. Isolated nasal surgery should therefore not be recommended as a first-line treatment for OSA. Because of high study heterogeneity, these results should be interpreted with caution. Isolated nasal surgery can possibly improve OSA subjectively. Perhaps only OSA patients with complaints of nasal obstruction or OSA patients experiencing difficulty with continuous positive airway pressure (CPAP) compliance would benefit from isolated nasal surgery.

Effect of combined use of home blood pressure monitoring and nifedipine on blood pressure compliance and quality of life of patients with essential hypertension

Purpose: To investigate the effect of combination of home blood pressure monitoring (HBPM) and nifedipine on blood pressure compliance and quality of life in patients with essential hypertension.&#x0D; Methods: One hundred and twenty essential hypertension patients admitted to Jiaozuo Coal Industry (Group) Co. Ltd Central Hospital from February 2020 to February 2021 were retrospectively studied. They were equally divided into study group (SG) and control group (COG) according to the order of admission. All patients were treated with nifedipine. Blood pressure was regularly measured in COG patients in the consulting room, while for SG patients, blood pressure was measured at home. Treatment compliance, blood pressure-related indices and quality of life of the two groups were determined.&#x0D; Results: Treatment compliance values of patients in SG at 6 weeks (T2) and 12 weeks (T3) were significantly better than the corresponding values for patients in COG (p &lt; 0.05). The related indices of blood pressure at T2 and T3 were significantly better in SG than in COG (p &lt; 0.05), with higher blood pressure compliance at T2 and T3 in SG (60 and 70 %, respectively) than in COG (p &lt; 0.05). The quality-of-life scores at T3 in SG were significantly higher than those in COG (p &lt; 0.05).&#x0D; Conclusion: The combined use of HBPM and nifedipine improves treatment compliance, enhances the levels of related indices of blood pressure, increases blood pressure compliance, and quality of life of patients with essential hypertension. Therefore, the combined therapy merits further investigation on a larger scale.

Factors Analysis of the Compliance Rate of Hypertension Detection Control and Self-Assessment Control in Community Outpatient Clinics.

Objective To understand the related influencing factors of outpatient hypertension detection and control and self-test control compliance rate. Methods A total of 637 hypertensive patients who visited the outpatient clinic of our hospital from January 2021 to December 2021 were selected for investigation and research, and the relevant information such as blood pressure, treatment detection, and other related information of the patients were counted, and the detection and control of outpatient hypertension were explored through regression analysis and the related factors of the self-test control compliance rate. Results There was no statistically significant difference in the number of patients who met the standard or not under the gender difference (P > 0.05), and it can be found that there was no statistically significant difference in the age of patients who met the standard and those who did not (P > 0.05). The proportion of patients with self-test hypertension control at home was 64.68%, and the compliance rate of self-test blood pressure was 42.54%. The compliance rate of blood pressure control in outpatient testing was 61.85%. Heart rate, exercise, smoking, medication compliance, and other factors are important factors affecting the control of hypertension. Knowing hypertension-related knowledge, regular follow-up, office blood pressure compliance, smoking, excessive salt intake, and hypertension complications are important factors affecting the self-test control of hypertension in the family. Conclusion By urging patients to do daily physical exercise, admonishing patients to quit smoking, and improving patients' medication compliance, the control rate of hypertension in outpatient clinics can be effectively improved. Understanding the knowledge of hypertension, controlling the salt content in the diet, and receiving regular follow-up surveys from doctors can effectively improve the effect of self-measurement and control of blood pressure at home and further improve the control rate of hypertension.