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Obstructive Sleep Apnea Syndrome Implications on Health and Adherence to CPAP Treatment  [PDF]
Jesús Moo Estrella, Paulino Dzib Aguilar, Ricardo Castillo Ayuso, Rossana Cuevas Ferrera
Health (Health) , 2015, DOI: 10.4236/health.2015.75076
Abstract: Respiratory disorders during sleep have as a general characteristic the alteration of the respiratory cycle while sleeping. The most outstanding characteristic of Obstructive Sleep Apnea Syndrome (OSA) is the partial (hypopnea) or total (apnea) obstruction of the upper airway that occurs repeatedly during sleep. The OSA is global public health issue. When it is not treated, OSA represents a cost two or three times higher of the institutional resources for health. Studies conducted in different countries indicate that the prevalence of the OSA goes from 2% to 10% in general population. The OSA is a serious sleep disorder that has negative implications on multiple systems of the organism. It is associated with hypertension, diabetes and the metabolic syndrome. When OSA coexists with a heart disease or ischemic heart disease, it significantly raises the probability of a heart failure. The use of Continuous Positive Airway Pressure (CPAP) is so far the most effective method for OSA treatment. Intervention at different levels (physiological, educational and psychological intervention) appears to be important in adherence to CPAP treatment.
Type of Mask May Impact on Continuous Positive Airway Pressure Adherence in Apneic Patients  [PDF]
Jean Christian Borel, Renaud Tamisier, Sonia Dias-Domingos, Marc Sapene, Francis Martin, Bruno Stach, Yves Grillet, Jean Fran?ois Muir, Patrick Levy, Frederic Series, Jean-Louis Pepin, on behalf of the Scientific Council of The Sleep Registry of the French Federation of Pneumology (OSFP)
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0064382
Abstract: Rationale In obstructive sleep apnea patients (OSA), continuous positive airway pressure (CPAP) adherence is crucial to improve symptoms and cardiometabolic outcomes. The choice of mask may influence CPAP adherence but this issue has never been addressed properly. Objective To evaluate the impact of nasal pillows, nasal and oronasal masks on CPAP adherence in a cohort of OSA. Methods Newly CPAP treated OSA participating in “Observatoire Sommeil de la Fédération de Pneumologie”, a French national prospective cohort, were included between March 2009 and December 2011. Anthropometric data, medical history, OSA severity, sleepiness, depressive status, treatment modalities (auto-CPAP versus fixed pressure, pressure level, interface type, use of humidifiers) and CPAP-related side effects were included in multivariate analysis to determine independent variables associated with CPAP adherence. Results 2311 OSA (age = 57(12) years, apnea+hypopnea index = 41(21)/h, 29% female) were included. Nasal masks, oronasal masks and nasal pillows were used by 62.4, 26.2 and 11.4% of the patients, respectively. In univariate analysis, oronasal masks and nasal pillows were associated with higher risk of CPAP non-adherence. CPAP non-adherence was also associated with younger age, female gender, mild OSA, gastroesophageal reflux, depression status, low effective pressure and CPAP-related side effects. In multivariate analysis, CPAP non-adherence was associated with the use of oronasal masks (OR = 2.0; 95%CI = 1.6; 2.5), depression, low effective pressure, and side effects. Conclusion As oronasal masks negatively impact on CPAP adherence, a nasal mask should be preferred as the first option. Patients on oronasal masks should be carefully followed.
The SomnuSeal Oral Mask Is Reasonably Tolerated by Otherwise CPAP Noncompliant Patients with OSA  [PDF]
N. Katz,Y. Adir,T. Etzioni,E. Kurtz,G. Pillar
Sleep Disorders , 2013, DOI: 10.1155/2013/840723
Abstract: Compliance with CPAP is the major limiting factor in treating patients with OSA. The novel SomnuSeal mask is an oral self-adaptable mask located between the teeth and the lips ensuring that there are no air leaks or skin abrasions. Fifty patients with , who failed previous CPAP trials, were asked to sleep with the mask for one month. In all patients, the mask was connected to an AutoPAP machine with a heated humidifier. Efficacy, convenience, and compliance (average usage for 4 or more hours per night) were monitored. Fifty patients (41?m and 9?f, mean age years, BMI ?kg/m2, and AHI /h) participated. Eleven were classified as compliant (average mask usage of 26 nights, 4.7 hours per night), five were only partially compliant (average usage of 13 nights, 2.9 hours per night), and 34 could not comply with it. In all patients who slept with it, the efficacy (assessed by residual AHI derived from the CPAP device) was good with an AHI of less than 8/hour. Interestingly, the required optimal pressure decreased from an average of 9.3?cmH2O to 4.6?cmH2O. The SomnuSeal oral interface is effective and may result in converting noncompliant untreated patients with OSA into well-treated ones. 1. Introduction Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent hypoxemia, hypercapnia, and arousal from sleep and is associated with adverse neurocognitive and cardiovascular sequelae [1–6]. Application of continuous positive airway pressure (CPAP) leads to improvements in many of these adverse parameters [7–9], although residual sleep disordered breathing may still persist [10, 11]. The major limiting factor of CPAP treatment is compliance [12–14]. Some of the most important factors that have been reported as limiting compliance are skin abrasions or eruptions due to the pressure exerted by the mask, mask pressure on the ridge of the nose, claustrophobia, aerophagia, air leaks (eye irritation), dry mouth, dry nose, nasal stuffiness, epistaxis, sinusitis, facial pain or a noisy device, or pressure intolerance [15–21]. Other factors that have been identified as affecting compliance consist of disease severity, daytime sleepiness, motivation, age, socioeconomic status, education, race, marital status, spouse support, and copayment [12–31]. Even with the advanced and newer devices (such as the “C-Flex” CPAP device, BPAP, or automatic CPAP), data are not convincing for improved compliance [32–35]. Since CPAP treatment has a dramatic beneficial impact on patients [7–9, 23, 36–39], it is of great importance to seek interfaces that can improve
Association between obstructive sleep apnea (OSA) and depression and the effect of continuous positive airway pressure (CPAP) treatment
El-Sherbini AM,Bediwy AS,El-Mitwalli A
Neuropsychiatric Disease and Treatment , 2011,
Abstract: Amr Makram El-Sherbini1, Adel Salah Bediwy2, Ashraf El-Mitwalli31Department of Psychiatry, Elminia University Hospital, Faculty of Medicine, Elminia, 2Chest Department, Faculty of Medicine, Tanta University, 3Department of Neurology, Mansoura School of Medicine, University of Mansoura, Mansoura, EgyptBackground: Obstructive sleep apnea (OSA) is a relatively common disorder which has a negative impact on the psychological well-being of affected individuals.Objective: To assess the association between OSA and depression as well as the effect of treatment with continuous positive airway pressure (CPAP).Methods: A total of 37 newly diagnosed individuals with OSA underwent an overnight polysomnography and were assessed using the Epworth Sleepiness Scale (ESS), the Hamilton Depression Rating Scale (HDRS), and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Patients were assessed before and after 2 months of CPAP use.Results: Of the 37 patients included in the study, 21 (56.7%) had clinically relevant depression as indicated by a score >10 on the HDRS and eleven patients (29.7%) met the diagnostic criteria for a major depressive episode using the Structured Clinical Interview. Scores on the HDRS were correlated with the Apnea Hypoxia Index, ESS scores, and oxygen saturation. Patients showed a significant reduction in depressive symptoms and improvement in ESS scores after CPAP treatment.Conclusion: Patients with OSA should be screened carefully for depressive disorders. CPAP should be tried first before starting other treatment modalities for depression.Keywords: obstructive sleep apnea, depression in OSA, CPAP and depression
Long-term adherence to CPAP treatment in patients with obstructive sleep apnea: importance of educational program  [cached]
La Piana GE,Scartabellati A,Chiesa L,Ronchi L
Patient Preference and Adherence , 2011,
Abstract: Giuseppe Emanuele La Piana1, Alessandro Scartabellati1, Lodovico Chiesa1, Luca Ronchi1, Paola Raimondi1, Miriam A Carro1, Silvia Zibetti1, Stefano Aiolfi2 1Pulmonary Rehabilitation Unit, S. Marta Hospital, Rivolta D'Adda; 2Unit of Pneumology, AO Ospedale Maggiore di Crema, Crema, Italy Background: Lack of adherence with continuous positive airway pressure (CPAP) therapy is the major cause of treatment failure in patients with obstructive sleep apnea syndrome. We evaluated the effectiveness of our intensive educational program on adherence in the short term and the long term. Methods: The educational program consisted of: intensive training, whereby each patient performed individual and collective sessions of three hours receiving information about obstructive sleep apnea syndrome, familiarizing themselves with CPAP tools, on six consecutive days; long-term training; and support meetings, with reassessment at three months and one year. Results: In 202 patients with obstructive sleep apnea syndrome, the mean (standard deviation) apnea/hypopnea index was 45 ± 22, the Epworth Sleepiness Scale score was 14 ± 5, and the average titration pressure was 10 ± 2 cm H2O. At three months, 166 patients (82%) used CPAP for an average of 7.3 hours per night. At one year, 162 (80%) used CPAP for about seven hours per night. At two years, 92 patients (43%) used CPAP for about five hours per night. The level of satisfaction remained higher in patients in ventilation. Conclusion: Our data show strong adherence to CPAP at three months and one year, with a decrease at two years. The initial educational program seems to play an important role in adherence. This effect is lost in the long term, suggesting that periodic reinforcement of educational support would be helpful. Keywords: adherence, continuous positive airway pressure, obstructive sleep apnea syndrome, educational program
Long-term adherence to CPAP treatment in patients with obstructive sleep apnea: importance of educational program
La Piana GE, Scartabellati A, Chiesa L, Ronchi L, Raimondi P, Carro MA, Zibetti S, Aiolfi S
Patient Preference and Adherence , 2011, DOI: http://dx.doi.org/10.2147/PPA.S24018
Abstract: ng-term adherence to CPAP treatment in patients with obstructive sleep apnea: importance of educational program Methodology (3300) Total Article Views Authors: La Piana GE, Scartabellati A, Chiesa L, Ronchi L, Raimondi P, Carro MA, Zibetti S, Aiolfi S Published Date November 2011 Volume 2011:5 Pages 555 - 562 DOI: http://dx.doi.org/10.2147/PPA.S24018 Giuseppe Emanuele La Piana1, Alessandro Scartabellati1, Lodovico Chiesa1, Luca Ronchi1, Paola Raimondi1, Miriam A Carro1, Silvia Zibetti1, Stefano Aiolfi2 1Pulmonary Rehabilitation Unit, S. Marta Hospital, Rivolta D'Adda; 2Unit of Pneumology, AO Ospedale Maggiore di Crema, Crema, Italy Background: Lack of adherence with continuous positive airway pressure (CPAP) therapy is the major cause of treatment failure in patients with obstructive sleep apnea syndrome. We evaluated the effectiveness of our intensive educational program on adherence in the short term and the long term. Methods: The educational program consisted of: intensive training, whereby each patient performed individual and collective sessions of three hours receiving information about obstructive sleep apnea syndrome, familiarizing themselves with CPAP tools, on six consecutive days; long-term training; and support meetings, with reassessment at three months and one year. Results: In 202 patients with obstructive sleep apnea syndrome, the mean (standard deviation) apnea/hypopnea index was 45 ± 22, the Epworth Sleepiness Scale score was 14 ± 5, and the average titration pressure was 10 ± 2 cm H2O. At three months, 166 patients (82%) used CPAP for an average of 7.3 hours per night. At one year, 162 (80%) used CPAP for about seven hours per night. At two years, 92 patients (43%) used CPAP for about five hours per night. The level of satisfaction remained higher in patients in ventilation. Conclusion: Our data show strong adherence to CPAP at three months and one year, with a decrease at two years. The initial educational program seems to play an important role in adherence. This effect is lost in the long term, suggesting that periodic reinforcement of educational support would be helpful.
Mood Predicts Response to Placebo CPAP  [PDF]
Carl J. Stepnowsky,Wei-Chung Mao,Wayne A. Bardwell,José S. Loredo,Joel E. Dimsdale
Sleep Disorders , 2012, DOI: 10.1155/2012/404196
Abstract: Study Objectives. Continuous positive airway pressure (CPAP) therapy is efficacious for treating obstructive sleep apnea (OSA), but recent studies with placebo CPAP (CPAP administered at subtherapeutic pressure) have revealed nonspecific (or placebo) responses to CPAP treatment. This study examined baseline psychological factors associated with beneficial effects from placebo CPAP treatment. Participants. Twenty-five participants were studied with polysomnography at baseline and after treatment with placebo CPAP. Design. Participants were randomized to either CPAP treatment or placebo CPAP. Baseline mood was assessed with the Profile of Mood States (POMS). Total mood disturbance (POMS-Total) was obtained by summing the six POMS subscale scores, with Vigor weighted negatively. The dependent variable was changed in apnea-hypopnea index (ΔAHI), calculated by subtracting pre- from post-CPAP AHI. Negative values implied improvement. Hierarchical regression analysis was performed, with pre-CPAP AHI added as a covariate to control for baseline OSA severity. Results. Baseline emotional distress predicted the drop in AHI in response to placebo CPAP. Highly distressed patients showed greater placebo response, with a 34% drop (i.e., improvement) in AHI. Conclusion. These findings underscore the importance of placebo-controlled studies of CPAP treatment. Whereas such trials are routinely included in drug trials, this paper argues for their importance even in mechanical-oriented sleep interventions. 1. Introduction Placebo responses remain one of the great mysteries of medicine. While a clinical benefit of treatment (any treatment) is always a “plus” for the patient, such placebo responses can complicate clinical trials. This paper examines some placebo response characteristics in patients being treated with continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA). OSA is a potentially devastating illness that involves sleep fragmentation and associated hypoxia, affecting up to 9% of middle-aged adults and higher percentages in the elderly [1–3]. The pathological consequences of upper airway obstruction during sleep may lead to cardiovascular complications, marked psychological distress, and impairment in daytime performance and cognitive functioning [4–9]. The most commonly used treatment is nasal CPAP [10, 11]. CPAP has been efficacious in improving many outcome measurements, especially in patients with severe OSA [12–15]. However, some researchers have reported inconsistencies in improvement, for example, a nonspecific (or placebo) effect of
Changes in the Heart Rate Variability in Patients with Obstructive Sleep Apnea and Its Response to Acute CPAP Treatment  [PDF]
Ernesto Kufoy, Jose-Alberto Palma, Jon Lopez, Manuel Alegre, Elena Urrestarazu, Julio Artieda, Jorge Iriarte
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0033769
Abstract: Introduction Obstructive Sleep Apnea (OSA) is a major risk factor for cardiovascular disease. The goal of this study was to demonstrate whether the use of CPAP produces significant changes in the heart rate or in the heart rate variability of patients with OSA in the first night of treatment and whether gender and obesity play a role in these differences. Methods Single-center transversal study including patients with severe OSA corrected with CPAP. Only patients with total correction after CPAP were included. Patients underwent two sleep studies on consecutive nights: the first night a basal study, and the second with CPAP. We also analyzed the heart rate changes and their relationship with CPAP treatment, sleep stages, sex and body mass index. Twenty-minute segments of the ECG were selected from the sleep periods of REM, no-REM and awake. Heart rate (HR) and heart rate variability (HRV) were studied by comparing the R-R interval in the different conditions. We also compared samples from the basal study and CPAP nights. Results 39 patients (15 females, 24 males) were studied. The mean age was 50.67 years old, the mean AHI was 48.54, and mean body mass index was 33.41 kg/m2 (31.83 males, 35.95 females). Our results showed that HRV (SDNN) decreased after the use of CPAP during the first night of treatment, especially in non-REM sleep. Gender and obesity did not have any influence on our results. Conclusions These findings support that cardiac variability improves as an acute effect, independently of gender or weight, in the first night of CPAP use in severe OSA patients, supporting the idea of continuous use and emphasizing that noncompliance of CPAP treatment should be avoided even if it is just once.
Indication of CPAP in Patients with Suspected Obstructive Sleep Apnea, Based on Clinical Parameters and a Novel Two-Channel Recording Device (ApneaLink): A Pilot Study  [PDF]
Carlos Alberto Nigro,Eduardo Dibur,Sofía Grandval,Facundo Nogueira
Sleep Disorders , 2012, DOI: 10.1155/2012/346181
Abstract: Objective. To evaluate the accuracy and reliability of the medical decision based on the results of the hand scoring from a two-channel recording device (ApneaLink) plus clinical data for the prescription of a CPAP assay in patients with suspected OSA. Methods. 39 subjects were assessed in the sleep laboratory with polysomnography and ApneaLink. The patients completed the Epworth sleepiness scale and a clinical history. Two blinded independent observers decided to prescribe CPAP according to the results of the PSG (gold standard, observer A), ApneaLink (alternative method, observer B), and the clinical parameters. Sensitivity and specificity of observer B on the indication of CPAP were calculated. The interobserver agreement for the indication of CPAP was assessed using kappa statistics. Results. 38 subjects were included (26 men, mean age 47.5, mean RDI 28.7, mean BMI 31.4?kg/m2). The prevalence of OSA was 84%. The sensitivity and specificity of observer B to initiate a CPAP trial were 90.6% and 100%, respectively. The interrater agreement for the prescription of CPAP was good (kappa: 0.75). Conclusion. This study has shown that the use of ApneaLink plus clinical data has made it possible to indicate CPAP reliably in most patients with high-clinical pretest for OSA. 1. Introduction Obstructive sleep apnea (OSA) is a major health problem due to its prevalence rates of 2–4% in middle-aged people [1] and significant morbidity [2, 3] and mortality [4] reported in patients with this condition. Continuous positive airway pressure (CPAP) is an effective treatment commonly prescribed for symptomatic patients with obstructive sleep apnea. It is costeffective [5] and reduces daytime sleepiness [6], rates of motor vehicle accidents [7], and blood pressure [8]. The American Thoracic Society [9] and the American Academy of Sleep Medicine [10] recommend supervised polysomnography (PSG) in the sleep laboratory over two nights for the diagnosis of obstructive sleep apnea and initiation of CPAP. This approach to a highly prevalent condition results in inevitable discrepancies between the demand for services and the current capacity of sleep laboratories [11]. Because the treatment of sleep apnea provides many benefits to patients and society, it is imperative to develop strategies that are less complex than the traditional approach based on PSG to expedite the diagnosis and treatment of patients with OSA. The ApneaLink is a two-channel screening tool for sleep apnea. The device consists of a nasal cannula attached to a small case that houses a pressure transducer and a
Patient Perspective on Use of an Interactive Website for Sleep Apnea  [PDF]
Carl Stepnowsky,Christine Edwards,Tania Zamora,Robert Barker,Zia Agha
International Journal of Telemedicine and Applications , 2013, DOI: 10.1155/2013/239382
Abstract: Incomplete patient adherence with nasal continuous positive airway pressure (CPAP) limits the effectiveness of treatment and results in suboptimal obstructive sleep apnea (OSA) outcomes. An interactive website specifically designed for patients with OSA was designed and utilized in a randomized clinical trial to test its effect on increasing CPAP adherence. The goal of this paper is to report on CPAP adherence, internet use, privacy concerns and user satisfaction in using the website. The original project was designed as a randomized, controlled clinical trial of Usual Care (UC, control) versus MyCPAP group (intervention). Questionnaires were administered to evaluate the patient perspective of using the MyCPAP website. Participation in the MyCPAP intervention resulted in higher CPAP adherence at the two-month time point relative to participation in the UC group (3.4??±??2.4 and 4.1??±??2.3?hrs/nt; ; mean??±??SD). Participants randomized to the MyCPAP website increased their use of the internet to obtain OSA related information, but did not increase their use of the internet to get information on general health or medical conditions. Users had very little concern about their CPAP data being viewed daily or being sent over the internet. Future studies should consider the use of newer evaluation criteria for collaborative adaptive interactive technologies. 1. Introduction Obstructive sleep apnea (OSA) is a disorder characterized by repeated cessations of breathing during sleep, which can result in a number of potentially serious consequences affecting cardiovascular, physiological, neurocognitive, emotional, and psychosocial functioning [1]. OSA is the most common sleep disorder, affecting about 4% of men and 2% of women aged from 30 to 70 years old in the USA [2]. OSA is a chronic disease that is estimated to contribute 3 billion in additional medical costs in the USA, with a total economic burden greater than 100 billion when including loss of workplace productivity, occupational injury, and greater health care utilization [3]. In addition to its economic burden, OSA is associated with serious long-term adverse health consequences such as hypertension [4], metabolic dysfunction [5], cardiovascular disease [6], neurocognitive deficits [7], and motor vehicle accidents [8]. Nasal continuous positive airway pressure (CPAP) [9] is the treatment of choice for OSA [10], with meta-analytic reports of numerous randomized controlled trials showing that CPAP improves both objectively and subjectively measured daytime sleepiness [11] as well as health-related
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