Use Of Continuous Positive Airway Pressure Research Articles

Telephone follow-up as a substitute for standard out-clinic follow-up in CPAP therapy for obstructive sleep apnea patients: a randomized controlled trial.

This study assessed the feasibility of telephone follow-up consultations (TC) using an online data sharing and editing function (Airview™), as alternative to standard out-clinic follow-up consultations (SC) on adherence to continuous positive airway pressure (CPAP) in obstructive sleep apnea (OSA) patients. Furthermore, we investigated compliance to follow-up consultations and examined potential influencing factors, including baseline AHI (apnea-hypopnea-index), age, and distance from home to the hospital on consultation compliance. Two hundred OSA patients, with AHI 5 were randomly assigned (1:1) to receive TC or SC with follow-up after one month and 12month of CPAP initiation. Adherence goal was defined as achieving 4h of CPAP use daily in 70% of the days in a 365-days period. The proportion of participants achieving CPAP adherence was non-significantly lower in the TC group compared to the SC group (TC: 30% versus SC: 36%, adjusted OR 0.84, p = 0.59). Of participants who completed the study, the TC group had a significant average of 107min less use of CPAP compared to the SC group (p = 0.048). However, a higher proportion of participants was compliant to consultations in the TC group. The only influencing factor found was increasing baseline AHI, which might be a predictor for compliance to consultationsand adherence to CPAP therapy. TC might serve as substitute for SC in some part of the OSA population. If TC becomes a part of CPAP therapy management, it is important to consider patient characteristics and treatment-related issues to prevent decline in adherence.

Impact of positive airway pressure therapy on intraocular pressure in obstructive sleep apnea: A systematic review.

Positive airway pressure (PAP) therapy has been reported to have variable effect on intraocular pressure (IOP) in patients with obstructive sleep apnea (OSA) . The objective of this review is to present a qualitative assessment of available literature on impact of PAP on IOP in patients of OSA.Method: Online databases were searched for relevant articles up to September 2023. It included randomized control trial (RCT), prospective observational study, case control study, cross-sectional study, published abstract having relevant information. The comparator group consisted of OSA patients not receiving the PAP therapy or the pre-PAP IOP. Studies reporting change in IOP immediately after PAP use, at 1 month and at 1 year of PAP use were included. For quality assessment Cochrane Risk of Bias tool version 2 and NIH study quality assessment tool for Before-After (Pre-Post) Studies with No Control Group was used.Result: In this systematic review of ten clinical studies with 191 patients of OSA, use of continuous positive airway pressure (CPAP) therapy led to an immediate increase in IOP but it was not significantly different from non-CPAP users. One month and 1 year of CPAP use led to a significant increase in IOP from the baseline value. The available albeit limited evidence suggests that CPAP use, particularly at higher pressures, is linked to an elevation in IOP. However, high quality evidence from well-designed RCTs is needed to confirm or refute this findings.

Impacts of conservative treatment on the clinical manifestations of obstructive sleep apnea-systematic review and meta-analysis.

Obstructive sleep apnea (OSA) is a chronic disease with a high populational prevalence that is characterized as airway closure during sleep. Treatment is multidisciplinary and varies according to each case. Continuous positive airway pressure (CPAP), oral appliances, and surgery are the primary therapeutic options. Non-invasive conservative treatments such as sleep hygiene, positional therapy, physical exercises, and weight loss aim to reduce the worsening of the disease while being complementary to the invasive primary treatment. To analyze the impact of non-invasive conservative therapies on the clinical manifestations of OSA syndrome (OSA), compared with other interventions. This was a systematic review with meta-analysis. The searches were performed without filters for the time period, type of publication, or language. Randomized clinical trials on subjects over 18years of age diagnosed with untreated OSA were included. Responses to non-invasive conservative treatment were compared with responses to the primary intervention. Primary outcomes were assessed using the Epworth Sleepiness Scale and/or Functional Outcomes of Sleep Questionnaire (FOSQ). A total of eight studies were included in the review. The heterogeneity of the effect was estimated at 89.77%. Six studies compared conservative treatment with CPAP, one with oral appliances, and one with oropharyngeal exercises. Using the Epworth Sleepiness Scale measurements, the standardized difference in the estimated means, based on the random-effects model, was 0.457 (95% CI (1.082 to 0.169)) and the mean result did not differ significantly from zero (z = 1.43; p = 0.153). The conservative therapies assessed in this study improved the subjective quality of sleep, although the post-treatment ESE scores did not show significant results. The reduction in AHI and better outcomes in the evaluated domains, as well as in cognition and mood, were superior in the groups that received CPAP and IOD. The most commonly used treatments of choice for OSA are invasive, including the use of CPAP, oral appliances, and surgeries, being the most utilized options. This study demonstrated that non-invasive conservative treatments, such as sleep hygiene, yield results as effective as invasive treatments. Further studies are needed to confirm this result and to predict whether invasive treatment can be used as the primary treatment or only as a supplement.

Time to death and its predictors among neonates admitted with sepsis in neonatal intensive care unit at comprehensive specialized hospitals in Northeast Ethiopia.

In impoverished nations like Ethiopia, neonatal sepsis contributes significantly to neonatal mortality. Despite variations in the specific timing of death and predictors of neonatal mortality associated with sepsis across different settings, there's limited documented information in the Neonatal Intensive Care Units of northeastern Ethiopia. Consequently, the aim of this study was to determine time to death and its predictors among neonates with sepsis admitted to Neonatal Intensive Care Units in comprehensive specialized hospitals in northeastern Ethiopia. A prospective cohort study conducted at the institution level involved 306 neonates diagnosed with sepsis. Data collection utilized face-to-face interviews and chart reviews. Subsequently, the data were inputted into Epi-data version 4.6 and later analyzed using STATA version 17. The median time to death was determined, and both the Kaplan-Meier curve and log-rank test were applied. Furthermore, a Cox proportional hazard regression model was utilized to identify predictors of neonatal mortality associated with sepsis. The cumulative incidence of mortality among neonates admitted with sepsis was 34% (95% CI: 28.9%-39.5%). The neonatal mortality rate stood at 51 (95% CI: 42.1, 62) per 1,000 neonates admitted to the intensive care units with sepsis over a total of 1,854 person-days of observation. Additionally, the median time to death was 13 days (IQR = 5-23 days). Tachypnea [AHR 6.2 (95% CI: 1.5-9.7)], respiratory distress syndrome [AHR 2.1 (95% CI: 1.3-3.5)], lethargy [AHR 1.8 (95% CI: 1.2-2.6)], preterm birth [AHR 1.8 (95% CI: 1.2-2.7)], continuous positive airway pressure use [AHR 2.1 (95% CI: 1.3-3.4)], home delivery [AHR 2.63 (95% CI: 1.1-6.4)], Subgalea hemorrhage [AHR 1.8 (95% CI: 1.1-3.9)], and low platelet count [AHR 5.9 (95% CI: 2.3-8.6)] were found to be predictors of time to death in neonates with sepsis. The study revealed an alarmingly high neonatal mortality rate among septic neonates, underscoring the urgency for intervention. Enhancing the quality of care in neonatal intensive care units, bolstering infection prevention during procedures such as continuous positive airway pressure, exercising caution with locally made accessories, and reinforcing a culture of institutional delivery are critical in curbing neonatal sepsis-related mortalities.

Clinical Outcomes and Tau Pathology in Retired Football Players: Associations With Diagnosed and Witnessed Sleep Apnea.

Obstructive sleep apnea (SA) is common in older men and a contributor to negative cognitive, psychiatric, and brain health outcomes. Little is known about SA in those who played contact sports and are at increased risk of neurodegenerative disease(s) and other neuropathologies associated with repetitive head impacts (RHI). In this study, we investigated the frequency of diagnosed and witnessed SA and its contribution to clinical symptoms and tau pathology using PET imaging among male former college and former professional American football players. The sample included 120 former National Football League (NFL) players, 60 former college players, and 60 asymptomatic men without exposure to RHI (i.e., controls). Diagnosed SA was self-reported, and all participants completed the Mayo Sleep Questionnaire (MSQ, informant version), the Epworth Sleepiness Scale (ESS), neuropsychological testing, and tau (flortaucipir) PET imaging. Associations between sleep indices (diagnosed SA, MSQ items, and the ESS) and derived neuropsychological factor scores, self-reported depression (Beck Depression Inventory-II [BDI-II]), informant-reported neurobehavioral dysregulation (Behavior Rating Inventory of Executive Function-Adult Version [BRIEF-A] Behavioral Regulation Index [BRI]), and tau PET uptake, were tested. Approximately 36.7% of NFL players had diagnosed SA compared with 30% of the former college football players and 16.7% of the controls. Former NFL players and college football players also had higher ESS scores compared with the controls. Years of football play was not associated with any of the sleep metrics. Among the former NFL players, diagnosed SA was associated with worse Executive Function and Psychomotor Speed factor scores, greater BDI-II scores, and higher flortaucipir PET standard uptake value ratios, independent of age, race, body mass index, and APOE ε4 gene carrier status. Higher ESS scores correlated with higher BDI-II and BRIEF-A BRI scores. Continuous positive airway pressure use mitigated all of the abovementioned associations. Among the former college football players, witnessed apnea and higher ESS scores were associated with higher BRIEF-A BRI and BDI-II scores, respectively. No other associations were observed in this subgroup. Former elite American football players are at risk of SA. Our findings suggest that SA might contribute to cognitive, neuropsychiatric, and tau outcomes in this population. Like all neurodegenerative diseases, this study emphasizes the multifactorial contributions to negative brain health outcomes and the importance of sleep for optimal brain health.

Real-world impact of continuous positive airway pressure on sleepiness in patients with obstructive sleep apnea in a national registry

ObjectiveExcessive daytime sleepiness (EDS) persists in some patients with obstructive sleep apnea (OSA) despite continuous positive airway pressure (CPAP) treatment. This study characterized response to CPAP and factors associated with residual EDS. MethodsDanish National Patient Registry data were analyzed. Patients with OSA diagnosis (1994–2016), Epworth Sleepiness Scale (ESS) scores and apnea-hypopnea index recorded before beginning CPAP (baseline) and after 1–13 months of CPAP use, and CPAP adherence were included. Odds ratios (OR) for residual EDS after CPAP treatment were estimated using multivariate logistic regression. ResultsOf 1174 patients (mean age, 57 years; 75.5% male), 41.1% had baseline EDS (mild, 13.2%; moderate, 14.0%; severe, 13.9%); 58.9% did not. After CPAP treatment, follow-up mean ESS scores were normal (≤10) for all baseline EDS subgroups; however, 15.6% (n = 183) of patients had residual EDS (mild, 6.7%; moderate, 5.5%; severe, 3.4%). Odds of residual EDS were higher for patients with mild (OR, 5.2; 95% confidence interval [CI], 3.2–8.6), moderate (OR, 4.5; 95% CI, 2.7–7.4), and severe (OR, 13.0; 95% CI, 8.0–21.2) EDS at baseline compared with those with normal daytime sleepiness at baseline. Patients adherent with CPAP use were 38.2% less likely to have residual EDS compared with nonadherent patients (OR, 0.62; 95% CI, 0.43–0.88). ConclusionsEDS was common in this cohort of Danish patients with OSA. Baseline EDS severity predicted higher odds of residual EDS. After CPAP treatment, adherence was associated with reduced odds of residual EDS, but EDS persisted in a subgroup of patients.

Enlarging bullae and spontaneous pneumothorax associated with CPAP use: A case series of three patients

Objectives Spontaneous pneumothorax among patients with obstructive sleep apnea treated by nocturnal continuous positive airway pressure (CPAP) has not been well documented. Methods We present three cases of patients on chronic CPAP who experienced spontaneous pneumothorax without clear predisposing factors. Their personal and family medical histories, imaging characteristics, and CPAP settings are reviewed. Results In all three cases, the patients had bullae ipsilateral to the pneumothoraces that either formed (n = 1) or grew significantly (n = 2) after CPAP initiation. No other risk factors for pneumothorax or bullae were identified. Conclusions This case series demonstrates a need for further investigation into a possible connection between spontaneous pneumothorax, bullae development, and CPAP use. Keywords: obstructive sleep apnea, continuous positive airway pressure, bullae, complications of noninvasive mechanical ventilation, spontaneous pneumothorax

The Effectiveness of Continuous Positive Airway Pressure for Treating Obstructive Sleep Apnoea in Pregnancy: A Systematic Review

(Aust N Z J Obstet Gynaecol 2023. 2023;63(3):290–300) Obstructive sleep apnea (OSA) is characterized by recurrent pauses in breathing during sleep due to upper airway collapse, resulting in decreased oxygen levels. OSA affects around 10.5% of parturients during early pregnancy and up to 30% at term. In pregnancy, OSA is associated with an increased risk for gestational hypertension, pre-eclampsia, and gestational diabetes. Infants born to mothers with OSA may have a lower birth weight and are at increased risk for premature delivery and neonatal intensive care unit admission. Baseline obesity increases the risk of OSA during pregnancy, with lifestyle modifications being the standard treatment, though their influence on maternal outcomes is limited. Continuous positive airway pressure (CPAP) is an effective OSA treatment; however, little research exists on the impact of CPAP on either maternal or fetal outcomes. This systematic review sought to investigate if the use of CPAP improved outcomes for pregnant women with or at risk of OSA.

Erectile dysfunction in patient with obstructive sleep apnea: effects of continuous positive airway pressure

Background Obstructive sleep apnea (OSA) is linked to various health complications, including erectile dysfunction (ED), which is more prevalent in individuals with OSA. This study explored ED in Korean OSA patients and assessed the impact of continuous positive airway pressure (CPAP) therapy on ED. Methods A total of 87 male patients with OSA from four different sleep centers underwent physical measurements and completed sleep and mental health (MH) questionnaires, including the Korean version of the International index of erectile function (IIEF), before and three months after initiating CPAP therapy. Results After three months of CPAP therapy, the patients demonstrated a significant improvement in ED as measured on the IIEF. However, the study found no significant correlation between the duration of CPAP use and the improvement in IIEF score. It did identify the SF36 quality of life assessment as a significant factor influencing ED improvement after CPAP. Conclusions ED is a prevalent issue that escalates with age and is associated with OSA. CPAP therapy has shown potential in alleviating ED symptoms, particularly in those with underlying psychological conditions, although further research is required to confirm these findings and understand the underlying mechanisms.

The impact of obstructive sleep apnea treatment on microvascular complications in patients with type 2 diabetes: a feasibility randomized controlled trial.

Obstructive sleep apnea (OSA) is associated with an increased risk of diabetes-related complications. Hence, it is plausible that Continuous Positive Airway Pressure (CPAP) could have a favorable impact on these complications. To assess the feasibility of conducting a randomized control trial (RCT) in patients with type 2 diabetes (T2D) and OSA over 2 years. An open-label multicenter feasibility RCT of CPAP vs no CPAP in patients with T2D and OSA. Patients with resting oxygen saturation <90%, central apnea index >15/hour or Epworth Sleepiness Scale (ESS) ≥11 were excluded. OSA was diagnosed using a multichannel portable device (ApneaLink Air, ResMed). The primary outcome measures were related to feasibility, and the secondary outcomes were changes in various clinical and biochemical parameters related to diabetes outcomes. Eighty-three (40 CPAP vs 43 no CPAP) patients were randomized, with a median (IQR) follow-up of 645 [545, 861] days. CPAP compliance was inadequate, with a median usage of approximately 3.5 hours/night. Early CPAP use predicted longer-term compliance. The adjusted analysis showed a possible favorable association between being randomized to CPAP and several diabetes-related endpoints (chronic kidney disease (CKD), neuropathy, and quality of life (QoL)). It was feasible to recruit, randomize, and achieve a high follow-up rate over 2 years in patients with OSA and T2D. CPAP compliance might improve by a run-in period before randomization. A full RCT is necessary to assess the observed favorable association between CPAP and CKD, neuropathy, and QoL in patients with T2D. Registry: ISRCTN; URL: https://www.isrctn.com/ISRCTN12361838; Title: The impact of sleep disorders in patients with type 2 diabetes; Identifier: ISRCTN12361838.

Snoring Survivors: the impact of obstructive sleep apnoea and continuous positive airway pressure use on in-hospital mortality, length of stay and costs among patients hospitalised with acute cardiovascular disease – A retrospective analysis of 2016–2019 National Inpatient Sample Data

BackgroundThe routine administration of supplemental oxygen to non-hypoxic patients with acute myocardial infarction (AMI) has been abandoned for lack of mortality benefit. However, the benefits of continuous positive airway pressure...

Long-term effects on clinical event, mental health, and related outcomes of CPAP for obstructive sleep apnea: a systematic review.

Systematic review of long-term health outcomes of continuous positive airway pressure (CPAP) use in adults with obstructive sleep apnea. We updated prior systematic reviews with searches in multiple databases through January 3, 2023. We included randomized controlled trials (RCTs) and adjusted nonrandomized comparative studies (NRCSs) that reported specified long-term (mostly >1 year) health outcomes. We assessed risk of bias, conducted meta-analyses, and evaluated strength of evidence. We found 38 eligible studies (16 trials, 28 observational). All conclusions were of low strength of evidence given study and data limitations. RCTs found no evidence of effect of CPAP on mortality (summary effect size [ES] 0.89; 95% CI 0.66, 1.21); inclusion of adjusted NRCSs yields an association with reduced risk of death (ES 0.57; 95% CI 0.44, 0.73). RCTs found no evidence of effects of CPAP for cardiovascular death (ES 0.99; 95% CI 0.64, 1.53), stroke (ES 0.99; 95% CI 0.73, 1.35), myocardial infarction (ES 1.05; 95% CI 0.78, 1.41), incident atrial fibrillation (ES 0.89; 95% CI 0.48, 1.63), and composite cardiovascular outcomes (all statistically nonsignificant). RCTs found no evidence of effects for incident diabetes (ES 1.02; 95% CI 0.69, 1.51) and accidents (all nonsignificant), and no clinically significant effects on depressive symptoms, anxiety symptoms, or cognitive function. Whether CPAP use for obstructive sleep apnea affects long-term health outcomes remains largely unanswered. RCTs and NRCSs are inconsistent regarding the effect of CPAP on mortality. Current studies are underpowered, with relatively short duration follow-up and methodological limitations.

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.

Nasal Tip Vascularization and Its Application for Columellar Reconstruction.

Many studies have been published about the vascular anatomy of the nose and its utility for nasal reconstruction. Anatomic variations of the main arteries and their perforators are well described in the literature. A nasal tip perforator, not well described in the published studies, is analyzed in the present study and its utility for columellar reconstruction. This paper presents an anatomic study of the nasal tip artery and its clinical applications for columellar repair. This study investigated the nasal tip perforator artery during nasal tip flap surgery for columellar repair in patients with sequels after nasal continuous positive airway pressure use. A descriptive anatomic study was conducted using intraoperative vascular dissection of patients operated on for nasal columellar defects by the author between 2013 and 2018. An observational study of a group of patients operated on for columellar repair using the axial nasal tip flap is presented here. The nasal tip artery was found in all the intraoperative dissections. Location and trajectory are described. Observed columellar length and width in operated patients have been nonstatistical and significantly different than controls in this study. The presence and trajectory of the nasal tip artery have been consistent in all the studied cases. The nasal tip flap based on this perforator has been a useful method for columellar repair in the studied group of patients. The presence of this vessel may augment blood supply to the nasal tip skin. By confirming the preservation of this artery, the surgeon may elevate the nasal tip flap safely.

Relación entre la apnea obstructiva del sueño y la diabetes mellitus tipo 2

IntroductionThe association between obstructive sleep apnea (OSA) and glucose metabolism remains controversial. This study investigates the relationship between OSA and incident type 2 diabetes (DM) and prediabetes (preDM), as well as the effect of long-term CPAP (continuous positive airway pressure) treatment. MethodsFollow-up study in a retrospective clinical cohort of patients with OSA and randomly selected controls. Data on incident DM and preDM as well as CPAP were obtained from hospital records. The relationship between baseline OSA and incident DM was examined using COX regression models. ResultsThree hundred and fifty-six patients, 169 with OSA and 187 controls were followed for a median of 98 months; 47 patients (13.2%) developed DM and 43 (12.1%) developed preDM. The 5-year cumulative incidence of DM was 10.7% (6.5–13.9%). 87% of subjects with preDM in the baseline sample progressed to incident DM. It is shown that body mass index (BMI), nocturnal hypoxia and apnea hypopnea index (AHI) are risk factors for the development of DM and that CPAP reduces this risk. ConclusionsPatients with OSA have a higher risk of developing DM. The risk factors involved are BMI, nocturnal hypoxia and AHI. Regular long-term CPAP use was associated with a decreased risk.

The demographic profile, clinical spectrum, and outcome of term neonates requiring continuous positive airway pressure in a tertiary care teaching hospital

Background: Respiratory distress is the major cause of neonatal intensive care unit (NICU) admission of full-term neonates for which they require different levels of mode of ventilation. Aims and Objectives: The objective of this study was to determine the demographic profile, clinical spectrum, and outcome of term neonates, requiring continuous positive airway pressure (CPAP) in tertiary care teaching hospitals. Materials and Methods: The study was a prospective observational study conducted from December 2020 to November 2022 in the neonatal section of the department of pediatrics. Results: A total of 261 neonates were included in the study. The male-to-female ratio was 1.7:1, the range of birth weight was between 2.1 kg and 3 kg (60.91%), the gestation age was 38 weeks (59.2%), and 73.6% were lower-segment cesarean section born. The age of starting CPAP in most of the newborns was at admission to NICU (in 69.73% of cases). The success rate of CPAP therapy was high (60.9%) and the rest 39.08% of patients did not settle with CPAP and required higher modes of respiratory support such as nasalintermittent positive pressure ventilation (IPPV) (5.89%) and IPPV (94.11%). Conclusion: In the resource-limiting settings, due to the non-availability of higher levels of ventilatory gadgets, the early use of CPAP as a mode of ventilation in full-term babies with transient tachypnea of newborns is well-documented and it can be safely used in other common neonatal conditions which can cause respiratory distress in full-term neonates. The low-middle-income countries are facing challenges to improve comprehensive neonatal care; there is a dire need for simple and cost-effective methods of respiratory support. Bubble CPAP is one such promising ventilatory support intervention, which may reduce the need for costly mechanical ventilators.

A Multivariate Study on the Adherence With Non-invasive Ventilation in People With Obstructive Sleep Apnea.

Obstructive Sleep Apnea (OSA) is a sleep disorder that affects a significant number of people worldwide. While Continuous Positive Airway Pressure (CPAP) devices have been proven to be effective in relieving symptoms, ensuring consistent use of those devices throughout the year can be challenging for a lot of patients. The present quantitative observational study in non-invasive ventilation for OSA patients explores adherence and attempts to identify independent predicting factors and year-round adherence differences in a large sample of OSA patients from Greece. Data from 1987 OSA patients using Continuous Positive Airway Pressure (CPAP) devices were collected in 2023. Factors evaluated in the study included the Apnea-Hypopnea Index (AHI), mask type, mask leaks and hours of CPAP device usage. The majority were males (77.2%), aged over 60 years (57.9%). CPAP use varied, with 14.0% in their first year, 44.2% for 2-4 years, and 41.7% for <4 years. Adherence was highest in more than 4 years users (54.9%) and nasal/pillow mask users (59.1%). Seasonal adherence varied, with summer having the most non-adherent patients (32.8%). Multinomial logistic regression showed BMI, mask type and seasonal severity influenced adherence. Full-face masks positively impacted adherence (OR=0.585, p=0.001). Non-adherence was associated with higher mask leaking in spring (OR=3.051, p=0.018) and usage of CPAP for < 4 years (OR=3.855, p=0.001). For 50% and 75% adherence, seasonal mask leaking and usage duration influenced adherence. CPAP device data can provide valuable insights to OSA therapy compliance. Seasonality plays an important role in adherence to the CPAP device use as is the type of mask with relation to air leaking.

The use of preoperative continuous positive airway pressure in patients with obstructive sleep apnea following total hip arthroplasty: A propensity score matched analysis

IntroductionObstructive sleep apnea (OSA) impacts approximately 936 million individuals globally and is known to complicate post-surgical recovery, particularly after total hip arthroplasty (THA). While continuous positive airway pressure (CPAP) is commonly recommended for managing OSA, its effect on THA recovery remains uncertain. The study aimed to assess the impact of CPAP use on post-THA outcomes in patients with OSA, focusing on medical complications and periprosthetic joint infection (PJI) at 90 days and 1 year. MethodsA national, all-payer database was utilized to identify patients undergoing primary THA between 2010 and 2021. Patients with OSA were stratified based on CPAP use through propensity score matching. Three matched groups were formed: OSA without CPAP, OSA with CPAP, and no OSA. Medical and surgical complications were assessed at 90 days and 1 year post-THA. ResultsPatients with OSA using CPAP exhibited more baseline comorbidities than those without CPAP. CPAP use was associated with inferior outcomes, including higher odds of PJI, wound complications, and venous thromboembolism at 90 days and 1 year post-THA. These trends were consistent even after adjusting for confounders. ConclusionCPAP use, indicative of severe OSA, was linked to worse post-THA outcomes, emphasizing the importance of recognizing OSA severity preoperatively. The study does not advocate for or against CPAP use but underscores the heightened risk in this patient population, guiding clinicians in tailoring perioperative strategies and counseling patients about potential risks.

The effects of social support and support types on continuous positive airway pressure use after 1 month of therapy among adults with obstructive sleep apnea

BackgroundThe relationship between perceived social support and continuous positive airway pressure remains understudied among individuals with obstructive sleep apnea. The aim of this prospective cohort study was to determine if baseline perceived social support and subtypes predict regular continuous positive airway pressure use after 1month of therapy. MethodsAdults with obstructive sleep apnea initiating continuous positive airway pressure therapy were recruited from sleep clinics in New York City. Demographics, medical history, and comorbidities were obtained from patient interview and review of medical records. Objective continuous positive airway pressure adherence data was collected at the first clinical follow-up. ResultsSeventy-five participants (32% female; non-Hispanic Black 41%; mean age of 56 ± 14years) provided data. In adjusted analyses, poorer levels of overall social support, and subtypes including informational/emotional support, and positive social interactions were associated with lower continuous positive airway pressure use at 1month. Relative to patients reporting higher levels of support, participants endorsing lower levels of overall social support, positive social interaction and emotional/informational support had 1.6 hours (95% CI: 0.5,2.7, hours; p = .007), 1.3 hours (95% CI: 0.2,2.4; p = .026), and 1.2 hours (95% CI: 0.05,2.4; p = .041) lower mean daily continuous positive airway pressure use at 1month, respectively. ConclusionFocusing on social support overall and positive social interaction particularly, could be an effective approach to improve continuous positive airway pressure adherence in patients at risk of suboptimal adherence.

Long term effects of continuous positive airway pressure treatment of obstructive sleep apnea-hypopnea syndrome in multiple sclerosis patients

BackgroundObstructive sleep apnea-hypopnea (OSAH) is common in MS patients and is associated with fatigue. We recently published a randomized, controlled trial (RCT) of active vs sham continuous positive airway pressure (CPAP) treatment in MS patients with fatigue, poor sleep quality, and (OSAH) (Mult Scl J 2022;28:82–92). Our aim was to evaluate the long-term effects of CPAP treatment on fatigue (Fatigue Severity Scale, FSS, primary outcome) and other clinical outcomes in MS patients with OSAH. MethodsFollowing the RCT, participants were offered treatment with CPAP and participation in an open label study. Patients were re-evaluated with RCT outcome measures at least 6 months after completion of the RCT. ResultsTwenty-eight of 34 (82 %) RCT-completers participated in this study a mean of 2.7 years after the RCT. Sixteen (57 %) patients were treated with CPAP (mean use 5.4 ± 1.0 h/night during the 6 months prior to follow-up visit), while the other 12 patients declined CPAP use and received no other OSAH treatments. Baseline clinical characteristics, including MS related disability and sleep outcomes, were not significantly different between CPAP-treated vs non-CPAP treated patients. Patients using CPAP at follow-up (n = 16) demonstrated significant improvements from RCT baseline in FSS (p = 0.005), Fatigue Scale for Motor and Cognitive Functions (p = 0.008, p = 0.012), Pittsburgh Sleep Quality Index (p = 0.016), Center of Epidemiological Studies-Depression Scale (p = 0.05), and Multiple Sclerosis Quality of Life-54 (MSQOL-54) physical and mental component scores (p = 0.012, p = 0.023), but no improvements in Epworth Sleepiness Scale, Pain Visual Analog Scale, or Expanded Disability Status Scale. Patients not using CPAP (n = 12) had no significant improvements in outcome measures. Using a linear mixed model, FSS (p = 0.03), morning fatigue (p = 0.048), and MSQOL-54 physical component score (p = 0.02) improved significantly in CPAP treated patients compared with non-CPAP treated patients from RCT baseline. ConclusionIn this post-RCT open label study, long-term CPAP use was associated with improved fatigue (FSS, our primary outcome) and physical quality of life in MS patients with OSAH.