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Wang R, Mihaicuta S, Tiotiu A, Corlateanu A, Ioan IC, Bikov A. Asthma and obstructive sleep apnoea in adults and children - an up-to-date review. Sleep Med Rev 2022; 61:101564. [PMID: 34902822 DOI: 10.1016/j.smrv.2021.101564] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 02/05/2023]
Abstract
Obstructive sleep apnoea (OSA) and asthma are two common respiratory disorders in children and adults. Apart from common risk factors, such as obesity, gastroesophageal reflux disease and allergic rhinitis, emerging evidence suggest that the two diseases may complicate the clinical course of each other. On one hand, OSA modifies asthmatic airway inflammation and is associated with poor asthma control. On the other hand, asthma and its medications increase the collapsibility of the upper airways contributing to the development and worsening of OSA. The overnight respiratory symptoms of OSA and asthma are often similar, and an inpatient polysomnography is often necessary for a proper diagnosis, especially in children. Continuous positive pressure, the gold standard treatment for OSA can improve asthma control in patients suffering from both diseases. However, there is limited evidence how anti-asthma medications act in the same patients. Nevertheless, adenotonsillectomy seems to be effective in children with concomitant asthma and OSA. This review summarises the evidence for the bidirectional link between asthma and OSA, focuses on diagnostic and therapeutic challenges and highlights the need for further research.
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Affiliation(s)
- Ran Wang
- North West Lung Centre, Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, United Kingdom; Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Stefan Mihaicuta
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, Department of Pulmonology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.
| | - Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, France
| | - Alexandru Corlateanu
- Department of Respiratory Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Iulia Cristina Ioan
- Lung Function Testing Lab, University Children's Hospital of Nancy, France; DevAH, University of Lorraine, France
| | - Andras Bikov
- North West Lung Centre, Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, United Kingdom; Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom
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202
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Paternoster G, Sartini C, Pennacchio E, Lisanti F, Landoni G, Cabrini L. Awake pronation with helmet continuous positive airway pressure for COVID-19 acute respiratory distress syndrome patients outside the ICU: A case series. Med Intensiva 2022; 46:65-71. [PMID: 35115111 PMCID: PMC8802662 DOI: 10.1016/j.medine.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Continuous positive airway pressure (CPAP) is an important therapeutic tool in COVID-19 acute respiratory distress syndrome (ARDS) since it improves oxygenation, reduces respiratory rate and can prevent intubation and intensive care unit (ICU) admission. CPAP during pronation has seldom been described and never during sedation. DESIGN Case series. SETTING High dependency unit of San Carlo University Hospital (Potenza, Italy). PATIENTS Eleven consecutive patients with COVID-19 ARDS. INTERVENTION Helmet CPAP in prone position after failing a CPAP trial in the supine position. MAIN VARIABLE OF INTEREST Data collection at baseline and then after 24, 48 and 72h of pronation. We measured PaO2/FIO2, pH, lactate, PaCO2, SpO2, respiratory rate and the status of the patients at 28-day follow up. RESULTS Patients were treated with helmet CPAP for a mean±SD of 7±2.7 days. Prone positioning was feasible in all patients, but in 7 of them dexmedetomidine improved comfort. PaO2/FIO2 improved from 107.5±20.8 before starting pronation to 244.4±106.2 after 72h (p<.001). We also observed a significantly increase in Sp02 from 90.6±2.3 to 96±3.1 (p<.001) and a decrease in respiratory rate from 27.6±4.3 to 20.1±4.7 (p=.004). No difference was observed in PaCO2 or pH. At 28 days two patients died after ICU admission, one was discharged in the main ward after ICU admission and eight were discharged home after being successfully managed outside the ICU. CONCLUSIONS Helmet CPAP during pronation was feasible and safe in COVID-19 ARDS managed outside the ICU and sedation with dexmedetomidine safely improved comfort. We recorded an increase in PaO2/FIO2, SpO2 and a reduction in respiratory rate.
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Affiliation(s)
- G. Paternoster
- Cardiovascular Anesthesia and ICU, San Carlos Regional Hospital (San Carlo Azienda Ospedaliera Regionale), Potenza, Italy
| | - C. Sartini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy,Corresponding author
| | - E. Pennacchio
- Emergency Medicine San Carlo Hospital San Carlos Regional Hospital (San Carlo Azienda Ospedaliera Regionale), Potenza, Italy
| | - F. Lisanti
- Emergency Medicine San Carlo Hospital San Carlos Regional Hospital (San Carlo Azienda Ospedaliera Regionale), Potenza, Italy
| | - G. Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L. Cabrini
- Intensive Care and Anesthesia Unit, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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203
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Tooke L, Ehret DEY, Okolo A, Dlamini‐Nqeketo S, Joolay Y, Minto’o S, Pillay S, Abdallah Y, Naburi H, Ndour D, Brobby N, Stevenson AG. Limited resources restrict the provision of adequate neonatal respiratory care in the countries of Africa. Acta Paediatr 2022; 111:275-283. [PMID: 34328232 DOI: 10.1111/apa.16050] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/09/2021] [Accepted: 07/28/2021] [Indexed: 12/28/2022]
Abstract
AIM Over two thirds of newborn deaths occur in Africa and South Asia, and respiratory failure is a major contributor of these deaths. The exact availability of continuous positive airway pressure (CPAP) and surfactant in Africa is unknown. The aim of this study was to describe the availability of newborn respiratory care treatments in the countries of Africa. METHODS Surveys, in English, French and Portuguese, were sent to neonatal leaders in all 48 continental countries and the two islands with populations over 1 million. RESULTS Forty-nine (98%) countries responded. Twenty-one countries reported less than 50 paediatricians, and 12 countries had no neonatologists. Speciality neonatal nursing was recognised in 57% of countries. Most units were able to provide supplemental oxygen. CPAP was available in 63% and 67% of the most well-equipped government and private hospitals. Surfactant was available in 33% and 39% of the most well-equipped public and private hospitals, respectively. Availability of CPAP and surfactant was greatly reduced in smaller cities. Continuous oxygen saturation monitoring was only available in 33% of countries. CONCLUSION The availability of proven life-saving interventions in Africa is inadequate. There is a need to sustainably improve availability and use of these interventions.
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Affiliation(s)
- Lloyd Tooke
- Groote Schuur Hospital Cape Town South Africa
- Department of Paediatrics University of Cape Town South Africa
| | - Danielle E. Y. Ehret
- Vermont Oxford Network Burlington VT USA
- Department of Pediatrics Robert Larner MD College of MedicineUniversity of Vermont Burlington VT USA
| | | | | | - Yaseen Joolay
- Groote Schuur Hospital Cape Town South Africa
- Department of Paediatrics University of Cape Town South Africa
| | | | - Shakti Pillay
- Groote Schuur Hospital Cape Town South Africa
- Department of Paediatrics University of Cape Town South Africa
| | - Yaser Abdallah
- The Agakhan University Dar es Salaam Tanzania
- Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - Helga Naburi
- Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | | | - Naana Brobby
- Department of Child Health School of Medicine and Dentisty KNUST Kumasi Ghana
| | - Alexander G. Stevenson
- Mbuya Nehanda Maternity Hospital Harare Zimbabwe
- Department of Paediatrics University of Zimbabwe Harare Zimbabwe
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204
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Linz D, Norup Hertel J, Hendriks J, Saljic A, Dobrev D, Baumert M, Jespersen T, Linz D. Sleep apnea and atrial fibrillation: challenges in clinical and translational research. Expert Rev Cardiovasc Ther 2022; 20:101-109. [PMID: 35094618 DOI: 10.1080/14779072.2022.2036606] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Sleep-disordered breathing (SDB) is present in 21-74% of all patients with atrial fibrillation (AF). Treatment of SDB by positive airway pressure may help to prevent recurrence of AF after electrical cardioversion and help to improve AF ablation success rates in non-randomized studies. AREAS COVERED In this review, the current understanding of the atrial arrhythmogenic pathophysiology of SDB is summarized, and diagnostic and therapeutic challenges in AF patients are discussed. Current international recommendations are presented, and a comprehensive literature search is undertaken. EXPERT OPINION AF patients with SDB rarely report SDB-related symptoms such as daytime sleepiness. Therefore, systematic home sleep testing evaluation should be considered for all patients eligible for rhythm control strategy. A close interdisciplinary collaboration between the electrophysiologist/cardiologist, nurses and sleep-specialists are required for the management of SDB in AF patients. An arrhythmia-orientated assessment of SDB may better quantify SDB-related AF risk in an individual patient and may help to better guide targeted and personalized SDB treatment in AF patients as a component of rhythm and symptom control strategies. Finally, randomized controlled trials are needed to confirm the relationship between SDB and AF, and the benefits of routine testing and treatment of SDB in AF patients.
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Affiliation(s)
- Dominik Linz
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Norup Hertel
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeroen Hendriks
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, The Netherlands
| | - Arnela Saljic
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.,Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.,Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Mathias Baumert
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dominik Linz
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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205
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Luján M, Sayas J, Mediano O, Egea C. Non-invasive Respiratory Support in COVID-19: A Narrative Review. Front Med (Lausanne) 2022; 8:788190. [PMID: 35059415 PMCID: PMC8763700 DOI: 10.3389/fmed.2021.788190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022] Open
Abstract
Acute respiratory failure secondary to COVID-19 pneumonia may require a variety of non-pharmacological strategies in addition to oxygen therapy to avoid endotracheal intubation. The response to all these strategies, which include high nasal flow, continuous positive pressure, non-invasive ventilation, or even prone positioning in awake patients, can be highly variable depending on the predominant phenotypic involvement. Deciding when to replace conventional oxygen therapy with non-invasive respiratory support, which to choose, the role of combined methods, definitions, and attitudes toward treatment failure, and improved case improvement procedures are directly relevant clinical questions for the daily care of critically ill COVID-19 patients. The experience accumulated after more than a year of the pandemic should lead to developing recommendations that give answers to all these questions.
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Affiliation(s)
- Manel Luján
- Pneumology Service, Hospital Universitari Parc Taulí, Sabadell, Spain.,Centro de Investigacion Biomédica en Red (CIBERES), Madrid, Spain
| | - Javier Sayas
- Pneumology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Olga Mediano
- Pneumology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Carlos Egea
- Centro de Investigacion Biomédica en Red (CIBERES), Madrid, Spain.,Hospital Universitario de Araba, Universidad País Vasco, Vitoria Gasteiz, Spain
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206
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Kalkhoff SM, Lutgendorf MA, Morrison TC, Han T, Spence DL. A Randomized Controlled Trial of Sleep Study Surveillance with Targeted APAP Therapy for Obstructive Sleep Apnea in Pregnancy. Am J Obstet Gynecol MFM 2022; 4:100571. [PMID: 35051670 DOI: 10.1016/j.ajogmf.2022.100571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE(S) To determine effects of targeted autoregulated positive airway pressure (APAP) in women at risk for obstructive sleep apnea (OSA) on adverse pregnancy outcomes (APOs), cost, and natural history of OSA. STUDY DESIGN Pregnant women at high risk for OSA were randomized to a sleep study screening group with possible initiation of APAP compared to women not screened for OSA, receiving standard obstetric care (control). Women in the sleep study screened group received a sleep study at two points during pregnancy, early (6-16 weeks) and late (27-33 weeks), with initiation of APAP therapy if their apnea hypopnea index (AHI) indicated ≥ 5 events per hour. Women of both groups had a sleep study 3 months postpartum. The primary outcome was effect on APO, a composite of hypertension, preterm birth, low birthweight, stillbirth and diabetes. Secondary outcomes included OSA severity and hospital costs. RESULTS Among 193 women randomized (100 sleep study screened group; 93 control group; 6 lost to follow up), there were no significant differences in composite APO (46.4% screened vs. 43.3% control, p=0.77), hypertension (23.7% screened vs. 32% control, p=0.25), preterm birth (13.4% screened vs. 10% control, p=0.5), low birthweight (5.2% screened vs. 6.7% control, p=0.76), stillbirth (1% screened vs. 0% control, p=1), gestational diabetes (19.6% screened vs. 13.3% control, p=0.33), or mean cost ($12,185 screened vs. $12,607 control). The AHI increased over the course of pregnancy, peaking at 3 months postpartum (p<.001). There were 24 (25.8%) subjects who had a new diagnosis of OSA, with 6 in whom APAP was prescribed. APAP compliance rates were poor with usage rates ranging from 2% (1 of 64 days) to 43% (6 of 14 days). CONCLUSION Targeted APAP therapy for OSA in a sleep study screened high risk pregnancy group did not decrease composite adverse pregnancy outcomes or hospital costs compared to a group that received no OSA screening. However, a small sample size, low APAP prescription rates and poor compliance resulted in difficulty in drawing a definitive conclusion. The prevalence and severity of OSA worsened over the course of pregnancy, with the highest rates detected in the postpartum period. Large, multi-center clinical trials that are adequately powered are needed.
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Affiliation(s)
- Stephen M Kalkhoff
- Naval Medical Center San Diego, Department of Gynecologic Surgery and Obstetrics, 34800 Bob Wilson Dr., San Diego CA 92134.
| | - Monica A Lutgendorf
- Naval Medical Center San Diego, Department of Gynecologic Surgery and Obstetrics, 34800 Bob Wilson Dr., San Diego CA 92134
| | - Theodore C Morrison
- Naval Medical Center San Diego, Department of Gynecologic Surgery and Obstetrics, 34800 Bob Wilson Dr., San Diego CA 92134
| | - Tony Han
- Naval Medical Center San Diego, Department of Gynecologic Surgery and Obstetrics, 34800 Bob Wilson Dr., San Diego CA 92134
| | - Dennis L Spence
- Naval Medical Center San Diego, Department of Gynecologic Surgery and Obstetrics, 34800 Bob Wilson Dr., San Diego CA 92134
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207
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Pini L, Magri R, Perger E, Levi G, Zambelli L, Giordani J, Ciarfaglia M, Tantucci C. Phenotyping OSAH patients during wakefulness. Sleep Breath 2022; 26:1801-1807. [PMID: 35023036 DOI: 10.1007/s11325-021-02551-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Although currently there are simplified methods to measure the pathophysiological traits that stimulate the occurrence and maintenance of obstructive sleep apnea-hypopnea (OSAH), they remain difficult to implement in routine practice. This pilot study aimed to find a simpler daytime approach to obtain a meaningful, similar pathophysiological phenotypic profile in patients with OSAH. METHODS After obtaining diagnostic polygraphy from a group of consecutive patients with OSAH, we performed the dial-down CPAP technique during nocturnal polysomnography and used it as reference method. This allowed assessment of upper airway collapsibility, loop gain (LG), arousal threshold (AT), and upper airway muscle gain (UAG). We compared these results with a daytime protocol based on negative expiratory pressure (NEP) technique for evaluating upper airway collapsibility and UAG, on maximal voluntary apnea for LG, and on clinical predictors for AT. RESULTS Of 15 patients studied, 13 patients with OSAH accurately completed the two procedures. There were strong (all r2 > 0.75) and significant (all p < 0.001) correlations for each phenotypic trait between the measurements obtained through the reference method and those achieved during wakefulness. CONCLUSION It is possible to phenotype patients with OSAH from a pathophysiological point of view while they are awake. Using this approach, cutoff values corresponding to those usually adopted using the reference method can be identified to detect abnormal traits, achieving profiles similar to those obtained through the dial-down CPAP technique.
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Affiliation(s)
- L Pini
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy. .,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - R Magri
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - E Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - G Levi
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - L Zambelli
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - J Giordani
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - M Ciarfaglia
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - C Tantucci
- Respiratory Medicine Unit, ASST-Spedali Civili di Brescia, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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208
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McCoy AM, Morris D, Tanaka K, Wright A, Guyette FX, Martin-Gill C. Prehospital Noninvasive Ventilation: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:80-87. [PMID: 35001825 DOI: 10.1080/10903127.2021.1993392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Noninvasive ventilation (NIV), including bilevel positive airway pressure and continuous positive airway pressure, is a safe and important therapeutic option in the management of prehospital respiratory distress. NAEMSP recommends:NIV should be used in the management of prehospital patients with respiratory failure, such as those with chronic obstructive pulmonary disease, asthma, and pulmonary edema.NIV is a safe intervention for use by Emergency Medical Technicians.Medical directors must assure adequate training in NIV, including appropriate patient selection, NIV system operation, administration of adjunctive medications, and assessment of clinical response.Medical directors must implement quality assessment and improvement programs to assure optimal application of and outcomes from NIV.Novel NIV methods such as high-flow nasal cannula and helmet ventilation may have a role in prehospital care.
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209
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Guy EFS, Chase JG, Knopp JL, Shaw GM. Quantifying ventilator unloading in CPAP ventilation. Comput Biol Med 2022; 142:105225. [PMID: 35032739 DOI: 10.1016/j.compbiomed.2022.105225] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The intrinsic (muscular) patient effort driving inspiration in non-invasive ventilation modes, such as continuous positive airway pressure (CPAP) therapy, has not been identified from non-invasive data. Current CPAP settings are based on clinical judgment and assessment of symptoms of respiratory distress. Non-optimal settings, including too much positive end expiratory pressure (PEEP) can cause unintended lung injury and ventilator unloading, where patient effort drops and the CPAP device enables too much work being imposed on the injured lung. Currently, there is no non-invasive means of quantifying or identifying these effects. METHODS A novel model-based method of ascertaining intrinsic patient work of breathing (WOB) in CPAP is developed based on linear single compartment and 2nd order b-spline models previously used in invasive ventilation modes. Results are compared to current clinical indications, such as total Imposed WOB from the CPAP device and beak length, the latter of which is the clinical metric used to indicate alveolar overdistension. Intrinsic and Imposed WOB are compared. The hypothesis is that ventilator unloading can be assessed as a decrease in Intrinsic WOB relative to Imposed WOB, as PEEP and associated ventilator unloading rise. This hypothesis is tested using 14 subjects from a CPAP trial of several breathing rates at two PEEP levels. RESULTS The ratio of Intrinsic to Imposed WOB, normalised per unit tidal volume, decreased with increasing PEEP (4-7 cm H2O), capturing the expected trend of ventilator unloading. Ventilator unloading was observed across all breathing rates. Beak length measurements showed no conclusive evidence of capturing overdistension at higher PEEP or ventilator unloading. CONCLUSIONS Patient Intrinsic WOB in CPAP was non-invasively quantified using model-based methods, based on pressure and flow measurements. The ratio of Intrinsic to Imposed WOB per unit tidal volume clearly and consistently showed ventilator unloading across all patients and breathing rates, with Intrinsic WOB decreasing with increasing PEEP. This trend was not observed in the current clinical metric of beak length. Non-invasively quantifying Intrinsic WOB and ventilator unloading is the critical first step to objectively optimising clinical CPAP settings, patient care, and outcomes.
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210
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Celik Y, Balcan B, Peker Y. CPAP Intervention as an Add-On Treatment to Lipid-Lowering Medication in Coronary Artery Disease Patients with Obstructive Sleep Apnea in the RICCADSA Trial. J Clin Med 2022; 11:273. [PMID: 35012012 DOI: 10.3390/jcm11010273] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 02/01/2023] Open
Abstract
Dyslipidaemia is a well-known risk factor for coronary artery disease (CAD), and reducing lipid levels is essential for secondary prevention in management of these high-risk individuals. Dyslipidaemia is common also in patients with obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) is the first line treatment of OSA. However, evidence of a possible lipid-lowering effect of CPAP in CAD patients with OSA is scarce. We addressed the effect of CPAP as an add-on treatment to lipid-lowering medication in a CAD cohort with concomitant OSA. This study was a secondary analysis of the RICCADSA trial (Trial Registry: ClinicalTrials.gov; No: NCT00519597), that was conducted in Sweden between 2005 and 2013. In total, 244 revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index ≥ 15/h, Epworth Sleepiness Scale score < 10) were randomly assigned to CPAP or no-CPAP. Circulating triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels (all in mg/dL) were measured at baseline and 12 months after randomization. The desired TG levels were defined as circulating TG < 150 mg/dL, and LDL levels were targeted as <70 mg/dL according to the recent guidelines of the European Cardiology Society and the European Atherosclerosis Society. A total of 196 patients with available blood samples at baseline and 12-month follow-up were included (94 randomized to CPAP, 102 to no-CPAP). We found no significant between-group differences in circulating levels of TG, TC, HDL and LDL at baseline and after 12 months as well as in the amount of change from baseline. However, there was a significant decline regarding the proportion of patients with the desired TG levels from 87.2% to 77.2% in the CPAP group (p = 0.022), whereas there was an increase from 84.3% to 88.2% in the no-CPAP group (n.s.). The desired LDL levels remained low after 12 months in both groups (15.1% vs. 17.2% in CPAP group, and 20.8% vs. 18.8% in no-CPAP group; n.s.). In a multiple linear regression model, the increase in the TG levels was predicted by the increase in body-mass-index (β = 4.1; 95% confidence interval (1.0-7.1); p = 0.009) adjusted for age, sex and CPAP usage (hours/night). CPAP had no lipid-lowering effect in this revascularized cohort with OSA. An increase in body-mass-index predicted the increase in TG levels after 12 months, suggesting that lifestyle modifications should be given priority in adults with CAD and OSA, regardless of CPAP treatment.
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211
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BaHammam AS, Aleissi SA, Nashwan SZ, Olaish AH, Almeneessier AS. Results of CPAP Titration and Short-Term Adherence Rates in Patients with Obesity Hypoventilation Syndrome and Mild/Moderate Obstructive Sleep Apnea. Nat Sci Sleep 2022; 14:1137-1148. [PMID: 35733818 PMCID: PMC9207127 DOI: 10.2147/nss.s369316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE No study has assessed the titration success of CPAP therapy in patients with obesity hypoventilation syndrome (OHS) and an apnea-hypopnea index (AHI) <30 event/h. This study aimed to assess the titration success of CPAP therapy under polysomnography and subsequent short-term adherence (1 month) in patients with OHS and an AHI <30 event/h. METHODS Consecutive OHS patients with an AHI <30 events/h between 2010 and 2019 were included (n=54). All OHS patients were first started on CPAP during the therapeutic sleep-study. If the therapeutic-study showed that the SpO2 remained < 90% for 20% of the total sleep time, a second therapeutic study was arranged with bi-level PAP (BPAP). Thirty patients agreed to participate in the 1-month follow-up adherence study. We applied the American-Thoracic-Society criteria for PAP adherence. RESULTS The mean age was 54.8±14.6 years, and the mean BMI was 45.9±12.2 kg/m2. Successful titration on CPAP was attained in 36 (66.7%) patients, and 18 (33.3%) required BPAP. Patients who failed the CPAP trial had a significantly higher PaCO2 and bicarbonate, a more restrictive respiratory pattern on spirometry, and a significantly higher time with SpO2<90% (mins) during sleep. The only independent correlate of CPAP-titration success on the multivariable regression analysis was the desaturation index (OR: 1.33 [1.033-1.712]). More than 80% of the participants were using CPAP therapy after one-month with no differences in adherence between the CPAP and BPAP groups. CONCLUSIONS The current results suggest that CPAP therapy could be an acceptable alternative therapy to BPAP in patients with OHS without severe OSA.
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Affiliation(s)
- Ahmed S BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salih A Aleissi
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Samar Z Nashwan
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Awad H Olaish
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aljohara S Almeneessier
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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212
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Faria A, Laher I, Fasipe B, Ayas NT. Impact of Obstructive Sleep Apnea and Current Treatments on the Development and Progression of Type 2 Diabetes. Curr Diabetes Rev 2022; 18:e160222201169. [PMID: 35170415 DOI: 10.2174/1573399818666220216095848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/19/2021] [Accepted: 12/17/2021] [Indexed: 11/22/2022]
Abstract
Type 2 diabetes mellitus remains a growing health concern, affecting more than 420 million people globally. Preventing and treating diabetes require a better understanding of the associated risk factors. Sleep-disordered breathing, especially obstructive sleep apnea (OSA), is likely a contributor to the pathogenesis and aggravation of poor glycemic control. We review key epidemiological data that address the link between OSA and type 2 diabetes and present the current proposed pathophysiological mechanisms underlying this association. Several biological pathways are linking OSA and an increased propensity to diabetes. We review the impact of current treatment strategies for OSA based on the association between diabetes and sleep apnea.
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Affiliation(s)
- André Faria
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Babatunde Fasipe
- Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, Bowen University, Iwo, Nigeria
| | - Najib T Ayas
- Divisions of Critical Care and Respiratory Medicine, University of British Columbia, Vancouver, Canada
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213
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Abstract
Central apnea syndrome is a disorder with protean manifestations and concomitant conditions. It can occur as a distinct clinical entity or as part of another clinical syndrome. The pathogenesis of central sleep apnea (CSA) varies depending on the clinical condition. Sleep-related withdrawal of the ventilatory drive to breathe is the common denominator among all cases of central apnea, whereas hypocapnia is the final common pathway leading to apnea in the majority of central apnea. Medical conditions most closely associated with CSA include heart failure, stroke, spinal cord injury, and opioid use, among others. Nocturnal polysomnography is the standard diagnostic method, including measurement of sleep and respiration. The latter includes detection of flow, measurement of oxyhemoglobin saturation and detection of respiratory effort. Management strategy incorporates clinical presentation, associated conditions, and the polysomnographic findings in an individualized manner. The pathophysiologic heterogeneity may explain the protean clinical manifestations and the lack of a single effective therapy for all patients. While research has enhanced our understanding of the pathogenesis of central apnea, treatment options are extrapolated from treatment of obstructive sleep apnea. Co-morbid conditions and concomitant obstructive sleep apnea influence therapeutic approach significantly. Therapeutic options include positive pressure therapy, pharmacologic therapy, and supplemental Oxygen. Continuous positive airway pressure (CPAP) is the initial standard of care, although the utility of other modes of positive pressure therapy, as well as pharmacotherapy and device-based therapies, are currently being investigated.
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Affiliation(s)
- Geoffrey Ginter
- Department of Internal Medicine, University Health Center and John D. Dingell VA Medical Center, Wayne State University School of Medicine, Detroit, MI, United States
| | - M Safwan Badr
- Department of Internal Medicine, University Health Center and John D. Dingell VA Medical Center, Wayne State University School of Medicine, Detroit, MI, United States.
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214
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Nevola R, Russo A, Scuotto S, Imbriani S, Aprea C, Abitabile M, Beccia D, Brin C, Carusone C, Cinone F, Cirigliano G, Colantuoni S, Cozzolino D, Cuomo G, Del Core M, Gjeloshi K, Marrone A, Medicamento G, Meo LA, Nappo F, Padula A, Pafundi PC, Ranieri R, Ricozzi C, Rinaldi L, Romano CP, Ruocco R, Ruosi C, Salvati A, Sasso FC, Sellitto A, Sommese P, Villani A, Coppola N, Adinolfi LE. Non-invasive respiratory support in SARS-CoV-2 related acute respiratory distress syndrome: when is it most appropriate to start treatment? Respir Res 2022; 23:327. [PMID: 36463178 PMCID: PMC9719658 DOI: 10.1186/s12931-022-02258-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is one of the most severe complications of SARS-CoV-2 infection. Non-Invasive Respiratory Support (NRS) as Continuous Positive Airway Pressure (CPAP) and/or Non-Invasive Ventilation (NIV) has been proven as effective in the management of SARS-CoV-2-related ARDS. However, the most appropriate timing for start NRS is unknown. METHODS We conducted a prospective pilot study including all consecutive patients who developed moderate SARS-CoV-2-related ARDS during hospitalization. Patients were randomly divided into two intervention groups according to ARDS severity (assessed by PaO2/FiO2-P/F) at NRS beginning: group A started CPAP/NIV when P/F was ≤ 200 and group B started CPAP/NIV when P/F was ≤ 150. Eligible patients who did not give their consent to CPAP/NIV until the severe stage of ARDS and started non-invasive treatment when P/F ≤ 100 (group C) was added. The considered outcomes were in-hospital mortality, oro-tracheal intubation (OTI) and days of hospitalization. RESULTS Among 146 eligible patients, 29 underwent CPAP/NIV when P/F was ≤ 200 (Group A), 68 when P/F was ≤ 150 (Group B) and 31 patients agreed to non-invasive treatment only when P/F was ≤ 100 (Group C). Starting NRS at P/F level between 151 and 200 did not results in significant differences in the outcomes as compared to treatment starting with P/F ranging 101-150. Conversely, patients undergone CPAP/NIV in a moderate stage (P/F 101-200) had a significantly lower in-hospital mortality rate (13.4 vs. 29.0%, p = 0.044) and hospitalization length (14 vs. 15 days, p = 0.038) than those in the severe stage (P/F ≤ 100). Age and need for continuous ventilation were independent predictors of CPAP/NIV failure. CONCLUSIONS Starting CPAP/NIV in patients with SARS-CoV-2-related ARDS in moderate stage (100 > P/F ≤ 200) is associated to a reduction of both in-hospital mortality and hospitalization length compared to the severe stage (P/F ≤ 100). Starting CPAP/NIV with a P/F > 150 does not appear to be of clinical utility.
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Affiliation(s)
- Riccardo Nevola
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy ,Internal Medicine and Hepatology Unit, Betania Evangelical Hospital, Naples, Italy
| | - Antonio Russo
- grid.9841.40000 0001 2200 8888Infectious Diseases Unit, COVID Center, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Samuel Scuotto
- grid.9841.40000 0001 2200 8888Infectious Diseases Unit, COVID Center, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Simona Imbriani
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Concetta Aprea
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Marianna Abitabile
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Domenico Beccia
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Chiara Brin
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Caterina Carusone
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Francesca Cinone
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Giovanna Cirigliano
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Sara Colantuoni
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Domenico Cozzolino
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Giovanna Cuomo
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Micol Del Core
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Klodian Gjeloshi
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Aldo Marrone
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Giulia Medicamento
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Luciana Agnese Meo
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Francesco Nappo
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Andrea Padula
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Pia Clara Pafundi
- grid.411075.60000 0004 1760 4193GEMELLI GENERATOR-Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Roberta Ranieri
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Carmen Ricozzi
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Luca Rinaldi
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Ciro Pasquale Romano
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Rachele Ruocco
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Carolina Ruosi
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Annabella Salvati
- grid.9841.40000 0001 2200 8888Infectious Diseases Unit, COVID Center, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ferdinando Carlo Sasso
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Ausilia Sellitto
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Pino Sommese
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Angela Villani
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
| | - Nicola Coppola
- grid.9841.40000 0001 2200 8888Infectious Diseases Unit, COVID Center, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luigi Elio Adinolfi
- grid.9841.40000 0001 2200 8888Internal Medicine Unit, COVID Center, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy
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Tovichien P, Kulbun A, Udomittipong K. Comparing Adherence of Continuous and Automatic Positive Airway Pressure ( CPAP and APAP) in Obstructive Sleep Apnea (OSA) Children. Front Pediatr 2022; 10:841705. [PMID: 35223704 PMCID: PMC8873574 DOI: 10.3389/fped.2022.841705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The treatment outcomes of pediatric obstructive sleep apnea (OSA) are affected by positive airway pressure (PAP) therapy adherence, which may be affected by the type of device used. Continuous PAP (CPAP) devices deliver a continuous and fixed air pressure level, whereas automatic PAP (APAP) devices automatically adjust the pressure to meet changing needs during sleep. The adherence, tolerance and consistency of OSA-children's use of CPAP and APAP devices were compared. STUDY DESIGN One-year, observational cohort study. METHODS Twenty-seven OSA-children were enrolled. Fourteen (52%) used CPAP, and 13 (48%) used APAP. The adherence, tolerance, and consistency of the PAP usage by the two groups were compared. RESULTS Overall, 11 of the 27 children (41%) showed good PAP adherence. The CPAP patients averaged 4.9 h of device usage on the days used, for 60% of days, with 6 of 14 (43%) demonstrating good adherence. In comparison, the APAP patients averaged 3.2 h for 55% of days, with 5 of 13 (38%) exhibiting good adherence. The 2 groups showed no differences in their adherence, tolerance, or consistency of device usage (P values, 0.816, 0.609, and 0.720, respectively). Although the adherence of both groups improved in the second 6 months, it was without statistical significance (P values, 0.400 and 0.724). Age, sex, baseline apnea-hypopnea index, comorbidities, prescribed period, device type, mask type, and caregiver education-level were not risk factors for poor PAP adherence. CONCLUSIONS No differences in the adherence, tolerance, or consistency of the children's use of CPAP and APAP were revealed in this small inhomogeneous cohort study with limited resources.
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Affiliation(s)
- Prakarn Tovichien
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Aunya Kulbun
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokporn Udomittipong
- Division of Pulmonology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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216
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Peng Y, Dai B, Zhao HW, Wang W, Kang J, Hou HJ, Tan W. Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis. Ther Adv Respir Dis 2022; 16:17534666221113663. [PMID: 35861299 PMCID: PMC9340323 DOI: 10.1177/17534666221113663] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND High-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) are important treatment approaches for acute hypoxemic respiratory failure (AHRF) in coronavirus disease 2019 (COVID-19) patients. However, the differential impact of HFNC versus NIV on clinical outcomes of COVID-19 is uncertain. OBJECTIVES We assessed the effects of HFNC versus NIV (interface or mode) on clinical outcomes of COVID-19. METHODS We searched PubMed, EMBASE, Web of Science, Scopus, MedRxiv, and BioRxiv for randomized controlled trials (RCTs) and observational studies (with a control group) of HFNC and NIV in patients with COVID-19-related AHRF published in English before February 2022. The primary outcome of interest was the mortality rate, and the secondary outcomes were intubation rate, PaO2/FiO2, intensive care unit (ICU) length of stay (LOS), hospital LOS, and days free from invasive mechanical ventilation [ventilator-free day (VFD)]. RESULTS In all, 23 studies fulfilled the selection criteria, and 5354 patients were included. The mortality rate was higher in the NIV group than the HFNC group [odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.51-0.84, p = 0.0008, I2 = 60%]; however, in this subgroup, no significant difference in mortality was observed in the NIV-helmet group (OR = 1.21, 95% CI: 0.63-2.32, p = 0.57, I2 = 0%) or NIV-continuous positive airway pressure (CPAP) group (OR = 0.77, 95% CI: 0.51-1.17, p = 0.23, I2 = 65%) relative to the HFNC group. There were no differences in intubation rate, PaO2/FiO2, ICU LOS, hospital LOS, or days free from invasive mechanical ventilation (VFD) between the HFNC and NIV groups. CONCLUSION Although mortality was lower with HFNC than NIV, there was no difference in mortality between HFNC and NIV on a subgroup of helmet or CPAP group. Future large sample RCTs are necessary to prove our findings. REGISTRATION This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (no. CRD42022321997).
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Affiliation(s)
- Yun Peng
- Department of Intensive Care Medicine, The
Second Hospital of Jiaxing, Jiaxing, China
| | - Bing Dai
- Department of Respiratory and Critical Care
Medicine, The First Affiliated Hospital of China Medical University,
Shenyang, China
| | - Hong-wen Zhao
- Department of Respiratory and Critical Care
Medicine, The First Affiliated Hospital of China Medical University,
Shenyang, China
| | - Wei Wang
- Department of Respiratory and Critical Care
Medicine, The First Affiliated Hospital of China Medical University,
Shenyang, China
| | - Jian Kang
- Department of Respiratory and Critical Care
Medicine, The First Affiliated Hospital of China Medical University,
Shenyang, China
| | - Hai-jia Hou
- Department of Respiratory and Critical Care
Medicine, The First Affiliated Hospital of China Medical University,
Shenyang, China
| | - Wei Tan
- Department of Respiratory and Critical Care
Medicine, The First Affiliated Hospital of China Medical University, No.
155, Nanjing North Street, Heping District, Shenyang 110001, China
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217
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Wickwire EM, Bailey MD, Somers VK, Oldstone LM, Srivastava MC, Johnson AM, Scharf SM, Albrecht JS. CPAP adherence is associated with reduced inpatient utilization among older adult Medicare beneficiaries with pre-existing cardiovascular disease. J Clin Sleep Med 2022; 18:39-45. [PMID: 34170251 PMCID: PMC8807906 DOI: 10.5664/jcsm.9478] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To examine the impact of adherence to continuous positive airway pressure (CPAP) therapy on health care utilization among a nationally representative and sample of older adults with multiple morbidities and pre-existing cardiovascular disease and subsequently diagnosed with obstructive sleep apnea in the United States. METHODS Our data source was a random 5% sample of Medicare administrative claims data. All participants (n = 1,921) were of age ≥ 65 years, diagnosed with cardiovascular disease and obstructive sleep apnea, and subsequently began treatment with CPAP between 2009-2013. Based on the number of CPAP machine charges, individuals were categorized as low, partial, or high adherers (ie, < 4, 4-12, and > 12 CPAP charges, respectively). The impact of CPAP adherence status on health care utilization was assessed across multiple points of service, including outpatient encounters, inpatient stays, emergency department visits, and prescription fills over 24 months following CPAP initiation. RESULTS Significant differences in demographic and comorbid disease characteristics were observed between low adherers (n = 377), partial adherers (n = 236), and high adherers (n = 1,308). After adjusting for covariates and relative to low adherers, high adherers demonstrated reduced inpatient visits (hazard ratio 0.75; 95% confidence interval 0.57, 0.97). CONCLUSIONS In this nationally representative sample of older Medicare beneficiaries with multiple morbidities and relative to low adherers, high adherers demonstrated reduced inpatient utilization. CITATION Wickwire EM, Bailey MD, Somers VK, et al. CPAP adherence is associated with reduced inpatient utilization among older adult Medicare beneficiaries with pre-existing cardiovascular disease. J Clin Sleep Med. 2022;18(1):39-45.
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Affiliation(s)
- Emerson M. Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland,Address correspondence to: Emerson M. Wickwire, PhD, University of Maryland School of Medicine, Sleep Disorders Center, 100 N. Greene St., 2nd Floor, Baltimore, MD, 21201; Tel: (410) 706-4771; Fax: (410) 706-0345;
| | - M. Doyinsola Bailey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Virend K. Somers
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Mukta C. Srivastava
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Abree M. Johnson
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Steven M. Scharf
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer S. Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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218
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Ng SS, Tam WW, Lee RW, Chan TO, Yiu K, Yuen BT, Wong KT, Woo J, Ma RC, Chan KK, Ko FW, Cistulli PA, Hui DS. Effect of Weight Loss and CPAP on OSA and Metabolic Profile Stratified by Craniofacial Phenotype: A Randomized Clinical Trial. Am J Respir Crit Care Med 2021; 205:711-720. [PMID: 34936531 DOI: 10.1164/rccm.202106-1401oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Craniofacial structure is thought to modulate the effect of weight loss on OSA, but whether this affects metabolic profile after weight loss compared with continuous positive airway pressure(CPAP) is unknown among obese Chinese patients with obstructive sleep apnea(OSA). OBJECTIVES To compare the change in metabolic profile between lifestyle modification program(LMP), stratified by craniofacial phenotype, and CPAP therapy for 6 months. METHODS We randomly assigned 194 patients with BMI≥25kg/m2 and moderate-to-severe OSA to receive LMP or CPAP therapy for 6 months in a 2:1 ratio. Assessments included computed tomography for assessing maxillomandibular volume(MMV), high sensitivity C-reactive protein(hsCRP) and insulin sensitivity. Measurements and Main Results(mean±SD or median[interquartile range]): Among 128 and 66 subjects in LMP group and CPAP group, respectively, hsCRP reduced more in LMP group than the CPAP group (-0.7[-1.4 to -0.0]mg/L vs -0.3[-0.9 to 0.4]mg/L, p=0.012). More patients in LMP group achieved low hsCRP(<1mg/L) than the CPAP group(21.1% vs 9.1%, p=0.04). Insulin sensitivity improved only in LMP group with 3.1(95%CI 1.5-6.6) times more patients with normal glucose regulation after intervention. LMP group was stratified into LMP-small MMV(n=64) and LMP-large MMV(n=64) groups according to the median MMV value of 233.2cm3. There was no significant difference in hsCRP(-0.7[-1.3 to 0.1] vs -0.7[-1.5 to -0.2], p=0.884) and insulin sensitivity(0.5[-0.2 to 1.9] vs 0.6[0.1 to 2.0], p=0.4860) between LMP-small and LMP-large MMV groups. CONCLUSION Weight reduction improved subclinical inflammation and insulin sensitivity more than CPAP among obese Chinese patients with moderate to severe OSA, and this effect was not influenced by craniofacial structure. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT03287973.
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Affiliation(s)
- Susanna Ss Ng
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - Wilson Ws Tam
- National University of Singapore, 37580, Alice Lee Centre for Nursing Studies, Singapore, Singapore
| | - Richard Ww Lee
- Gosford Hospital, 90112, Department of Respiratory and Sleep Medicine, Gosford, New South Wales, Australia
| | - Tat-On Chan
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - Karen Yiu
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - Brian Ty Yuen
- Prince of Wales Hospital, 13621, Department of Imaging & Interventional Radiology, Hong Kong, Hong Kong
| | - Ka-Tak Wong
- Prince of Wales Hospital, 13621, Department of Imaging & Interventional Radiology, Hong Kong, Hong Kong
| | - Jean Woo
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong
| | - Ronald Cw Ma
- Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong.,The Chinese University of Hong Kong Hong Kong Institute of Diabetes and Obesity, 596882, Hong Kong, Hong Kong
| | - Ken Kp Chan
- The Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine and Therapeutics, Hong Kong, Hong Kong
| | - Fanny Ws Ko
- The Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine and Therapeutics, Hong Kong, Hong Kong
| | - Peter A Cistulli
- The University of Sydney Faculty of Medicine and Health, 522555, Charles Perkins Centre, Sydney, New South Wales, Australia
| | - David S Hui
- The Chinese University of Hong Kong Faculty of Medicine, 71024, Department of Medicine & Therapeutics, Hong Kong, Hong Kong;
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Kadafi KT, Yuliarto S, Monica C, Susanto WP. Clinical review of High Flow Nasal Cannula and Continuous Positive Airway Pressure in pediatric acute respiratory distress. Ann Med Surg (Lond) 2021; 73:103180. [PMID: 34931143 PMCID: PMC8674456 DOI: 10.1016/j.amsu.2021.103180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/06/2021] [Accepted: 12/11/2021] [Indexed: 11/26/2022] Open
Abstract
Acute Respiratory Distress Syndrome (ARDS) causes much morbidity and mortality in children. In mild to moderate ARDS, non-invasive ventilation (NIV) is the treatment of choice. Recently, there are 2 kinds of NIV used Continuous Positive Airway Pressure (CPAP) or High Flow Nasal Cannula (HFNC). Both of them can be used in various respiratory distress and have different physiological mechanisms. The effectiveness to improve the clinical parameter, morbidity, and mortality are similar between CPAP and HFNC. However, HFNC application is more tolerated in acute respiratory distress in children, with less nasal injury, lower heart rate inflicted, and better comfort index score. CPAP & HFNC widely used in pediatric acute respiratory distress. Both modalities have a different characteristics, beneficial in certain condition. The usage of each modalities depends on the causes of the respiratory distress.
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Affiliation(s)
- Kurniawan Taufiq Kadafi
- Pediatric Emergency and Intensive Care Department, Saiful Anwar General Hospital, Brawijaya University, Malang, Indonesia
| | - Saptadi Yuliarto
- Pediatric Emergency and Intensive Care Department, Saiful Anwar General Hospital, Brawijaya University, Malang, Indonesia
| | - Charity Monica
- Pediatric Emergency and Intensive Care Department, Saiful Anwar General Hospital, Brawijaya University, Malang, Indonesia
| | - William Prayogo Susanto
- Pediatric Emergency and Intensive Care Department, Saiful Anwar General Hospital, Brawijaya University, Malang, Indonesia
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Kusunoki M, Hisano F, Wakazono N, Tsutsumi K, Oshida Y, Miyata T. Effect of Treatment With Sodium-Glucose Cotransporter 2 Inhibitor on the Initiation of Continuous Positive Airway Pressure Therapy in Type 2 Diabetic Patients With Obstructive Sleep Apnea Syndrome. J Clin Med Res 2021; 13:497-501. [PMID: 34925660 PMCID: PMC8670768 DOI: 10.14740/jocmr4626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background Obese patients with type 2 diabetes mellitus often develop obstructive sleep apnea syndrome (OSAS). In this study, continuous positive airway pressure (CPAP) was initiated in Japanese patients with type 2 diabetes mellitus who developed OSAS during treatment with a sodium-glucose cotransporter 2 (SGLT2) inhibitor, and the effect of the SGLT2 inhibitor therapy on the patients was investigated. Methods The study was conducted in outpatients with type 2 diabetes mellitus with serum hemoglobin A1c (HbA1c) values of ≥ 6.5% who developed OSAS. The patients were divided into two groups according to whether they were receiving treatment with an SGLT2 inhibitor or with other oral hypoglycemic agents: the SGLT2 inhibitor group (n = 9) and non-SGLT2 inhibitor group (n = 7). The patients in the former group were under treatment with one of the following three SGLT2 inhibitors: luseogliflozin (2.5 mg/day), dapagliflozin (5 mg/day) and empagliflozin (10 mg/day). The patients took the drugs once daily, before or after breakfast. The patients were initiated on CPAP therapy for OSAS, and their weight, body mass index (BMI), serum HbA1c level, lipid profile, liver function parameters, serum uric acid, and apnea-hypopnea index (AHI) measured before the initiation of CPAP therapy (baseline) were compared with the values measured 3 months after the start of CPAP therapy. Results The AHI decreased significantly after 3 months of CPAP therapy, as compared to that at the baseline, in both the SGLT2 inhibitor and non-SGLT2 inhibitor groups. There was no significant change in the serum HbA1c value after 3 months of CPAP therapy as compared to that at the baseline in either group. The body weight and BMI increased significantly after 3 months of CPAP therapy in the SGLT2 inhibitor group, but not in the non-SGLT2 inhibitor group. Conclusion The body weight and BMI increased significantly after 3 months of CPAP therapy initiated for OSAS in the type 2 diabetic patients who were receiving SGLT2 inhibitor therapy. Thus, when CPAP therapy is adopted for an obese diabetic patient with OSAS, it should be borne in mind that the body weight may increase if the patient is receiving SGLT2 inhibitor treatment.
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Affiliation(s)
- Masataka Kusunoki
- Department of Diabetes, Motor Function and Metabolism, Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan
| | - Fumiya Hisano
- Graduate School of Medicine, Department of Integrated Health Sciences, Nagoya University, Nagoya, Japan
| | - Naomi Wakazono
- Department of Diabetes, Motor Function and Metabolism, Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan
| | | | | | - Tetsuro Miyata
- Office of Medical Education, School of Medicine, International University of Health and Welfare, Chiba, Japan
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Pollicina I, Maniaci A, Lechien JR, Iannella G, Vicini C, Cammaroto G, Cannavicci A, Magliulo G, Pace A, Cocuzza S, Di Luca M, Stilo G, Di Mauro P, Bianco MR, Murabito P, Bannò V, La Mantia I. Neurocognitive Performance Improvement after Obstructive Sleep Apnea Treatment: State of the Art. Behav Sci (Basel) 2021; 11:bs11120180. [PMID: 34940115 PMCID: PMC8698492 DOI: 10.3390/bs11120180] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete episodes of upper airway collapse with reduction or complete cessation of airflow. Although the connection remains debated, several mechanisms such as intermittent hypoxemia, sleep deprivation, hypercapnia disruption of the hypothalamic–pituitary–adrenal axis have been associated with poor neurocognitive performance. Different treatments have been proposed to treat OSAS patients as continuous positive airway pressure (CPAP), mandibular advancement devices (MAD), surgery; however, the effect on neurocognitive functions is still debated. This article presents the effect of OSAS treatments on neurocognitive performance by reviewing the literature. Methods: We performed a comprehensive review of the English language over the past 20 years using the following keywords: neurocognitive performance and sleep apnea, neurocognitive improvement and CPAP, OSAS, and cognitive dysfunction. We included in the analysis papers that correlated OSA treatment with neurocognitive performance improvement. All validated tests used to measure different neurocognitive performance improvements were considered. Results: Seventy papers reported neurocognitive Performance improvement in OSA patients after CPAP therapy. Eighty percent of studies found improved executive functions such as verbal fluency or working memory, with partial neural recovery at long-term follow-up. One article compared the effect of MAD, CPAP treatment on cognitive disorders, reporting better improvement of CPAP and MAD than placebo in cognitive function. Conclusions: CPAP treatment seems to improve cognitive defects associated with OSA. Limited studies have evaluated the effects of the other therapies on cognitive function.
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Affiliation(s)
- Isabella Pollicina
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Antonino Maniaci
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium; (A.M.); (J.R.L.)
| | - Jerome R. Lechien
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium; (A.M.); (J.R.L.)
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFRSimone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 91190 Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Giannicola Iannella
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
- Department of “Organi di Senso”, University “Sapienza”, 00185 Rome, Italy;
- Correspondence:
| | - Claudio Vicini
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
| | - Giovanni Cammaroto
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
| | - Angelo Cannavicci
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
| | - Giuseppe Magliulo
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
| | - Annalisa Pace
- Department of “Organi di Senso”, University “Sapienza”, 00185 Rome, Italy;
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Milena Di Luca
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Giovanna Stilo
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Paola Di Mauro
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Maria Rita Bianco
- Otolaryngology, Department of Health Science, University Magna Graecia of Catanzaro, Viale Europa, Germaneto, 88100 Catanzaro, Italy;
| | - Paolo Murabito
- Department of Surgery and Medical and Surgical Specialties—Section of Anaesthesiology and Intensive Care, University of Catania (Italy), 95123 Catania, Italy;
| | - Vittoria Bannò
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
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Prigent A, Pellen C, Texereau J, Bailly S, Coquerel N, Gervais R, Liegaux JM, Luraine R, Renaud JC, Serandour AL, Pépin JL. CPAP telemonitoring can track Cheyne-Stokes respiration and detect serious cardiac events: The AlertApnée Study. Respirology 2021; 27:161-169. [PMID: 34873795 DOI: 10.1111/resp.14192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/13/2021] [Accepted: 11/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Case reports have suggested that continuous positive airway pressure (CPAP) telemonitoring can detect the onset of acute cardiac events such as decompensated heart failure (HF) or atrial fibrillation through an increase in the apnoea-hypopnoea index (AHI) and onset of Cheyne-Stokes Respiration (CSR). This study addressed whether long-term remote CPAP treatment telemonitoring revealing CSR can help detect serious cardiac events (SCEs) in obstructive sleep apnoea (OSA) patients. METHODS This monocentric prospective cohort study included adults receiving CPAP therapy for OSA with daily telemonitoring. Any sudden increase in AHI generated an alert for the home healthcare provider to download CPAP data to identify CSR. A medical consultation was scheduled if CSR was detected. RESULTS We included 555 adults (412 men; 57% with known cardiovascular comorbidities). During the 1-year follow-up, 78 CSR episodes were detected in 74 patients (CSR+). The main conditions associated with incident CSR were HF (24 patients [30.8%]), ventilatory instability (21, 26.9%), leaks (13, 16.7%), medications inducing central apnoeas (baclofen, ticagrelor, opioids) (7, 9.0%), arrhythmias (6, 7.7%) and renal failure (2, 2.6%). Fifteen (20.3%) CSR+ patients had a confirmed SCE. In univariable analysis, a CSR episode increased the risk of an SCE by 13.8-fold (5.7-35.6) (p < 0.0001), with an adjusted OR of 5.7 (2.0-16.8) in multivariable analysis. CONCLUSION Long-term telemonitoring of patients on CPAP treatment can alert CSR episodes and allows early detection of SCEs in patients with or without known cardiac comorbidities.
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Affiliation(s)
- Arnaud Prigent
- Groupe Medical de Pneumologie, Polyclinique Saint-Laurent, Rennes, France.,Centre du sommeil, Polyclinique Saint-Laurent, Rennes, France
| | | | - Joëlle Texereau
- Respiratory Physiology Unit, Department of Respiratory Medicine, Cochin Hospital, AP-HP/Université de Paris, Paris, France.,Air Liquide Health Care, VitalAire France, Gentilly, France
| | - Sébastien Bailly
- HP2 Laboratory, Inserm U1300, Univ. Grenoble Alpes, Grenoble, France
| | - Nicolas Coquerel
- Service de cardiologie, Polyclinique Saint Laurent, Rennes, France
| | - Renaud Gervais
- Service de cardiologie, Polyclinique Saint Laurent, Rennes, France
| | - Jean-Marc Liegaux
- Groupe Medical de Pneumologie, Polyclinique Saint-Laurent, Rennes, France.,Centre du sommeil, Polyclinique Saint-Laurent, Rennes, France
| | - Régis Luraine
- Groupe Medical de Pneumologie, Polyclinique Saint-Laurent, Rennes, France.,Centre du sommeil, Polyclinique Saint-Laurent, Rennes, France
| | - Jean-Christophe Renaud
- Groupe Medical de Pneumologie, Polyclinique Saint-Laurent, Rennes, France.,Centre du sommeil, Polyclinique Saint-Laurent, Rennes, France
| | | | - Jean Louis Pépin
- HP2 Laboratory, Inserm U1300, Univ. Grenoble Alpes, Grenoble, France
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223
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Wang Z, He Y, Zhang X, Luo Z. Non-Invasive Ventilation Strategies in Children With Acute Lower Respiratory Infection: A Systematic Review and Bayesian Network Meta-Analysis. Front Pediatr 2021; 9:749975. [PMID: 34926341 PMCID: PMC8677331 DOI: 10.3389/fped.2021.749975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Multiple non-invasive ventilation (NIV) modalities have been identified that may improve the prognosis of pediatric patients with acute lower respiratory infection (ALRI). However, the effect of NIV in children with ALRI remains inconclusive. Hence, this study aimed to evaluate the efficacy of various NIV strategies including continuous positive airway pressure (CPAP), high flow nasal cannula (HFNC), bilevel positive airway pressure (BIPAP), and standard oxygen therapy in children with ALRI and the need for supplemental oxygen. Methods: Embase, PubMed, Cochrane Library, and Web of Science databases were searched from inception to July 2021. Randomized controlled trials (RCTs) that compared different NIV modalities for children with ALRI and the need for supplemental oxygen were included. Data were independently extracted by two reviewers. Primary outcomes were intubation and treatment failure rates. Secondary outcome was in-hospital mortality. Pairwise and Bayesian network meta-analyses within the random-effects model were used to synthesize data. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: A total of 21 RCTs involving 5,342 children were included. Compared with standard oxygen therapy, CPAP (OR: 0.40, 95% CrI: 0.16-0.90, moderate quality) was associated with a lower risk of intubation. Furthermore, both CPAP (OR: 0.42, 95% CrI: 0.19-0.81, low quality) and HFNC (OR: 0.51, 95% CrI: 0.29-0.81, low quality) reduced treatment failure compared with standard oxygen therapy. There were no significant differences among all interventions for in-hospital mortality. Network meta-regression showed that there were no statistically significant subgroup effects. Conclusion: Among children with ALRI and the need for supplemental oxygen, CPAP reduced the risk of intubation when compared to standard oxygen therapy. Both CPAP and HFNC were associated with a lower risk of treatment failure than standard oxygen therapy. However, evidence is still lacking to show benefits concerning mortality between different interventions. Further large-scale, multicenter studies are needed to confirm our results. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=172156, identifier: CRD42020172156.
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Affiliation(s)
- Zhili Wang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yu He
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaolong Zhang
- Department of Pediatrics, Jiangjin District Central Hospital, Chongqing, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Bonnesen B, Jensen JUS, Jeschke KN, Mathioudakis AG, Corlateanu A, Hansen EF, Weinreich UM, Hilberg O, Sivapalan P. Management of COVID-19-Associated Acute Respiratory Failure with Alternatives to Invasive Mechanical Ventilation: High-Flow Oxygen, Continuous Positive Airway Pressure, and Noninvasive Ventilation. Diagnostics (Basel) 2021; 11:diagnostics11122259. [PMID: 34943496 PMCID: PMC8700515 DOI: 10.3390/diagnostics11122259] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 02/05/2023] Open
Abstract
Patients admitted to hospital with coronavirus disease 2019 (COVID-19) may develop acute respiratory failure (ARF) with compromised gas exchange. These patients require oxygen and possibly ventilatory support, which can be delivered via different devices. Initially, oxygen therapy will often be administered through a conventional binasal oxygen catheter or air-entrainment mask. However, when higher rates of oxygen flow are needed, patients are often stepped up to high-flow nasal cannula oxygen therapy (HFNC), continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), or invasive mechanical ventilation (IMV). BiPAP, CPAP, and HFNC may be beneficial alternatives to IMV for COVID-19-associated ARF. Current evidence suggests that when nasal catheter oxygen therapy is insufficient for adequate oxygenation of patients with COVID-19-associated ARF, CPAP should be provided for prolonged periods. Subsequent escalation to IMV may be implemented if necessary.
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Affiliation(s)
- Barbara Bonnesen
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2200 Copenhagen, Denmark; (B.B.); (J.-U.S.J.)
| | - Jens-Ulrik Stæhr Jensen
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2200 Copenhagen, Denmark; (B.B.); (J.-U.S.J.)
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Klaus Nielsen Jeschke
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, 2650 Hvidovre, Denmark; (K.N.J.); (E.F.H.)
| | - Alexander G. Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester M23 9LT, UK;
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
| | - Alexandru Corlateanu
- Department of Respiratory Medicine, State University of Medicine and Pharmacy “Nicolae Testemitanu”, 2004 Chisinau, Moldova;
| | - Ejvind Frausing Hansen
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, 2650 Hvidovre, Denmark; (K.N.J.); (E.F.H.)
| | - Ulla Møller Weinreich
- Department of Respiratory Medicine, Aalborg University Hospital, University of Aalborg, 9100 Aalborg, Denmark;
- The Clinical Institute, Aalborg University, 9220 Aalborg, Denmark
| | - Ole Hilberg
- Department of Medicine, Little Belt Hospital, 7100 Vejle, Denmark;
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Pradeesh Sivapalan
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2200 Copenhagen, Denmark; (B.B.); (J.-U.S.J.)
- Correspondence: ; Tel.: +45-298-806-01
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Zonato AI, Rosa CFA, Oliveira L, Bittencourt L. Comparing CPAP masks during initial titration for Obstructive Sleep Apnea Syndrome: one-year experience. Braz J Otorhinolaryngol 2022; 88 Suppl 5:S63-8. [PMID: 34930686 DOI: 10.1016/j.bjorl.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/27/2021] [Accepted: 10/31/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for OSA. A wide variety of masks are used during CPAP therapy. The aim of the study is to compare polysomnography outcomes during titration for different types of masks (oronasal, nasal and pillow) and assess the impact on PAP titration. METHODS We retrospectively analyzed all CPAP titration polysomnography for one year. Anthropometric data and baseline apnea severity were documented. RESULTS A total of 497 patients were evaluated. Nasal masks were used in 82.3% (n = 409), pillow in 14.1% (n = 70) and oronasal in 3.6% (n = 18). There was no difference according to body mass index and baseline apnea-hypopnea index among the groups. The oronasal group was older and had higher titrated CPAP pressure, higher residual apnea-hypopnea index, lower sleep efficiency, more superficial N1 sleep and longer wake time after sleep onset. All other polysomnography outcomes were similar among the groups. The mean CPAP level was 11.6 ± 2.1 cm H2O for the oronasal mask, 10.1 ± 2.1 cm H2O for the nasal mask and 9.8 ± 2.2 cm H2O for the pillow. The residual apnea-hypopnea index was 10.4 ± 7.9 for the oronasal mask, 5.49 ± 5.34 events/h for the nasal mask and 4.98 ± 5.48 events/h for the pillow. The baseline apnea-hypopnea index was correlated with of a higher CPAP pressure for all the groups (p < 0.001 for the nasal group, p = 0.001 for the pillow group and p = 0.049 for the oronasal group). Body mass index and residual AHI were correlated with of a higher CPAP pressure for the nasal and pillow groups only (p < 0.001). CONCLUSION The interface can have a significant impact on the effectiveness of PAP titration. Patients with oronasal masks have higher CPAP pressure, higher residual apnea-hypopnea index, lower sleep efficiency and higher wake time after sleep onset. Oronasal masks should not be recommended as the first choice for apnea patients. LEVEL OF EVIDENCE Level 3.
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226
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Martinez-Garcia MA, Oscullo G, Ponce S, Pastor E, Orosa B, Catalán P, Martinez A, Hernandez L, Muriel A, Chiner E, Vigil L, Carmona C, Mayos M, Garcia-Ortega A, Gomez-Olivas JD, Beauperthuy T, Bekki A, Gozal D. Effect of continuous positive airway pressure in very elderly with moderate-to-severe obstructive sleep apnea pooled results from two multicenter randomized controlled trials. Sleep Med 2021; 89:71-77. [PMID: 34915264 DOI: 10.1016/j.sleep.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/31/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE There is very limited information about the effect of continuous positive airway pressure (CPAP) in the very elderly. Here we aimed to analysed the effect of CPAP on a clinical cohort of patients with obstructive sleep apnea (OSA) ≥80 years old. METHODS Post-hoc pooled analysis of two open-label, multicenter clinical trials aimed to determine the effect of CPAP in a consecutive clinical cohort of elderly (≥70 years old) with moderate-to-severe OSA (apnea-hipopnea index ≥15 events/hour) randomized to receive CPAP or no CPAP for three months. Those consecutive patients ≥80 years old were included in the study. The primary endpoint was the change in Epworth Sleepiness scale (ESS). Secondary outcomes included sleep-related symptoms, quality of life, neurocognitive and mood status as well as office blood pressure measurements. RESULTS From the initial 369 randomized individuals with ≥70 years, 97 (26.3%) with ≥80 years old were included (47 in the CPAP group and 50 in the no-CPAP group). The mean (SD) age was 81.5 (2.4) years. Average use of CPAP was 4.3 (2.6) hours/night (53% with good adherence) Patients in the CPAP group significantly improved snoring and witnessed apneas as well as AHI (from 41.9 to 4.9 events/hour). However no clinical improvements were seen in ESS (-1.2 points, 95%CI, 0.2 to -2.6), any domain of QSQ, any neurocognitive test, OSA-related symptoms, depression/anxiety or blood pressure levels. CONCLUSIONS The present study does not support the use of CPAP in very elderly patients with moderate-to-severe OSA.
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Affiliation(s)
- M A Martinez-Garcia
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - G Oscullo
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S Ponce
- Pneumology Department, Hospital Universitario Dr Peset, Valencia, Spain
| | - E Pastor
- Pneumology Department, Hospital Universitario San Juan, Alicante, Spain
| | - B Orosa
- Pneumology Department, Hospital Universitario Dr Peset, Valencia, Spain
| | - P Catalán
- Internal Medicine Department, Hospital General de Requena, Valencia, Spain
| | - A Martinez
- Pneumology Department, Hospital General Universitario de Castellón, Spain
| | - L Hernandez
- Pneumology Department, Hospital General Universitario de Alicante, Valencia, Spain
| | - A Muriel
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Nursing Department, Alcala University, Madrid, Spain
| | - E Chiner
- Pneumology Department, Hospital Universitario San Juan, Alicante, Spain
| | - L Vigil
- Pneumology Department, Hospital de Sabadell, Corporació Sanitaria Parc Tauli, Barcelona, Spain
| | - C Carmona
- Pneumology Department, Hospital Universitario Virgen Del Rocio, Sevilla, Spain
| | - M Mayos
- Pneumology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - A Garcia-Ortega
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J D Gomez-Olivas
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - T Beauperthuy
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - A Bekki
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - D Gozal
- University of Missouri School of Medicine, Department of Child Health, Columbia, MO, USA
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Pinilla L, Benítez ID, Santamaria-Martos F, Targa A, Moncusí-Moix A, Dalmases M, Mínguez O, Aguilà M, Jové M, Sol J, Pamplona R, Barbé F, Sánchez-de-la-Torre M. Plasma profiling reveals a blood-based metabolic fingerprint of obstructive sleep apnea. Biomed Pharmacother 2021; 145:112425. [PMID: 34800782 DOI: 10.1016/j.biopha.2021.112425] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/03/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a chronic, heterogeneous and multicomponent disorder with associated cardiovascular and metabolic alterations. Despite being the most common sleep-disordered breathing, it remains a significantly undiagnosed condition. OBJECTIVE We examined the plasma metabolome and lipidome of patients with suspected OSA, aiming to identify potential diagnosis biomarkers and to provide insights into the pathophysiological mechanisms underlying the disease. Additionally, we evaluated the impact of continuous positive airway pressure (CPAP) treatment on the circulating metabolomic and lipidomic profile. MATERIAL AND METHODS Observational-prospective-longitudinal study including 206 consecutive subjects referred to the sleep unit. OSA was defined as an apnea-hypopnoea index ≥ 15 events/h after polysomnography (PSG). Patients treated with CPAP were followed-up for 6 months. Untargeted plasma metabolomic and lipidomic profiling was performed using liquid chromatography coulpled to massspectrometry. RESULTS A plasma profile composed of 33 metabolites (mainly glycerophospholipids and bile acids) was identified in OSA vs. non-OSA patients. This profile correlated with specific PSG measures of OSA severity related to sleep fragmentation and hypoxemia. Machine learning analyses disclosed a 4-metabolites-signature that provided an accuracy (95% CI) of 0.98 (0.95-0.99) for OSA detection. CPAP treatment was associated with changes in 5 plasma metabolites previously altered by OSA. CONCLUSIONS This analysis of the circulating metabolome and lipidome reveals a molecular fingerprint of OSA, which was modulated after effective CPAP treatment. Our results suggest blood-based biomarker candidates with potential application in the personalized management of OSA and suggest the activation of adaptive mechanisms in response to OSA-derived hypoxia.
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Affiliation(s)
- Lucía Pinilla
- Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa María, IRBLleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Iván D Benítez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Group of Translational Research in Respiratory Medicine, Respiratory Department, University Hospital Arnau de Vilanova and Santa María, IRB Lleida, Lleida, Spain
| | - Fernando Santamaria-Martos
- Group of Translational Research in Respiratory Medicine, Respiratory Department, University Hospital Arnau de Vilanova and Santa María, IRB Lleida, Lleida, Spain
| | - Adriano Targa
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Group of Translational Research in Respiratory Medicine, Respiratory Department, University Hospital Arnau de Vilanova and Santa María, IRB Lleida, Lleida, Spain
| | - Anna Moncusí-Moix
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Group of Translational Research in Respiratory Medicine, Respiratory Department, University Hospital Arnau de Vilanova and Santa María, IRB Lleida, Lleida, Spain
| | - Mireia Dalmases
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Group of Translational Research in Respiratory Medicine, Respiratory Department, University Hospital Arnau de Vilanova and Santa María, IRB Lleida, Lleida, Spain
| | - Olga Mínguez
- Group of Translational Research in Respiratory Medicine, Respiratory Department, University Hospital Arnau de Vilanova and Santa María, IRB Lleida, Lleida, Spain
| | - Maria Aguilà
- Group of Translational Research in Respiratory Medicine, Respiratory Department, University Hospital Arnau de Vilanova and Santa María, IRB Lleida, Lleida, Spain
| | - Mariona Jové
- Department of Experimental Medicine, University of Lleida-Biomedical Research Institute of Lleida (UdL-IRBLleida), Lleida, Spain
| | - Joaquim Sol
- Department of Experimental Medicine, University of Lleida-Biomedical Research Institute of Lleida (UdL-IRBLleida), Lleida, Spain; Institut Català de la Salut, Atenció Primària, Lleida, Spain; Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain
| | - Reinald Pamplona
- Department of Experimental Medicine, University of Lleida-Biomedical Research Institute of Lleida (UdL-IRBLleida), Lleida, Spain
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Group of Translational Research in Respiratory Medicine, Respiratory Department, University Hospital Arnau de Vilanova and Santa María, IRB Lleida, Lleida, Spain
| | - Manuel Sánchez-de-la-Torre
- Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa María, IRBLleida, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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228
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Xavier JLDA, Madeiro Leite Viana Weaver F, Pinheiro GL, Sousa Fernandes PH, Genta PR, Lorenzi-Filho G. Patients with OSA on Oronasal CPAP Breathe Predominantly Through the Nose During Natural Sleep. Am J Respir Crit Care Med 2021; 205:250-252. [PMID: 34784495 DOI: 10.1164/rccm.202106-1502le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jeane Lima de Andrade Xavier
- Heart Institute (InCor), Hospital das Clinicas, University of São Paulo School of Medicine, Pulmonary Division, São Paulo, Brazil
| | | | - George Lago Pinheiro
- Heart Institute (InCor), Hospital das Clinicas, University of São Paulo School of Medicine, Pulmonary Division, São Paulo, Brazil
| | - Paulo Henrique Sousa Fernandes
- USP, 28133, Heart Institute (InCor), Hospital das Clinicas, University of São Paulo School of Medicine, Pulmonary Division São Paulo, Sao Paulo, Brazil
| | - Pedro R Genta
- Heart Institute (InCor), Hospital das Clinicas, University of São Paulo School of Medicine, Pulmonary Division, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Universidade de Sao Paulo, 28133, Heart Institute (InCor), LIM 63, Hospital das Clínicas, HCFMUSP, Pulmonary Division, Faculdade de Medicina, FMUSP, Sao Paulo, Brazil;
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229
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Masa JF, Benítez ID, Javaheri S, Mogollon MV, Sánchez-Quiroga MÁ, Terreros FJGD, Corral J, Gallego R, Romero A, Caballero-Eraso C, Ordax-Carbajo E, Gomez-Garcia T, González M, López-Martín S, Marin JM, Martí S, Díaz-Cambriles T, Chiner E, Egea C, Barca J, Barbé F, Mokhlesi B. Risk factors associated with pulmonary hypertension in obesity hypoventilation syndrome. J Clin Sleep Med 2021; 18:983-992. [PMID: 34755598 DOI: 10.5664/jcsm.9760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Pulmonary hypertension (PH) is prevalent in obesity hypoventilation syndrome (OHS). However, there is a paucity of data assessing pathogenic factors associated with PH. Our objective is to assess risk factors that may be involved in the pathogenesis of PH in untreated OHS. METHODS In a post-hoc analysis of the Pickwick trial, we performed a bivariate analysis of baseline characteristics between patients with and without PH. Variables with a p value ≤0.10 were defined as potential risk factors and were grouped by theoretical pathogenic mechanisms in several adjusted models. Similar analysis was carried out for the two OHS phenotypes, with and without severe concomitant obstructive sleep apnea (OSA). RESULTS Of 246 patients with OHS, 122 (50%) had echocardiographic evidence of PH defined as systolic pulmonary artery pressure ≥40 mmHg. Lower levels of awake PaO2 and higher body mass index (BMI) were independent risk factors in the multivariate model, with a negative and positive adjusted linear association, respectively (adjusted odds ratio 0.96; 95% CI 0.93 to 0.98; p = 0.003 for PaO2, and 1.07; 95% CI 1.03 to 1.12; p = 0.001 for BMI). In separate analyses, BMI and PaO2 were independent risk factors in the severe OSA phenotype, whereas BMI and peak in-flow velocity in early (E)/late diastole (A) ratio were independent risk factors in the non-severe OSA phenotype. CONCLUSIONS This study identifies obesity per se as a major independent risk factor for PH, regardless of OHS phenotype. Therapeutic interventions targeting weight loss may play a critical role in improving PH in this patient population. CLINICAL TRIALS REGISTRATION Registry: Clinicaltrial.gov; Identifier: NCT01405976.
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Affiliation(s)
- Juan F Masa
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE)
| | - Iván D Benítez
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Institut de Recerca Biomédica de Lleida (IRBLLEIDA), Lleida, Spain
| | - Shahrokh Javaheri
- Division of Pulmonary and Sleep Medicine, Bethesda North Hospital, Cincinnati, Ohio
| | | | - Maria Á Sánchez-Quiroga
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE).,Respiratory Department, Virgen del Puerto Hospital, Plasencia, Cáceres, Spain
| | - Francisco J Gomez de Terreros
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE)
| | - Jaime Corral
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE)
| | - Rocio Gallego
- Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain.,CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE)
| | - Auxiliadora Romero
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Candela Caballero-Eraso
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Estrella Ordax-Carbajo
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, University Hospital, Burgos, Spain
| | - Teresa Gomez-Garcia
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, IIS Fundación Jiménez Díaz, Madrid, Spain
| | - Mónica González
- Respiratory Department, Valdecilla Hospital, Santander, Spain
| | | | - José M Marin
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, Miguel Servet Hospital, Zaragoza, Spain
| | - Sergi Martí
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Trinidad Díaz-Cambriles
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, Doce de Octubre Hospital, Madrid, Spain
| | - Eusebi Chiner
- Respiratory Department, San Juan Hospital, Alicante, Spain
| | - Carlos Egea
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Respiratory Department, Alava University Hospital IRB, Vitoria, Spain
| | - Javier Barca
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE).,Nursing Department, Extremadura University, Cáceres, Spain
| | - Ferrán Barbé
- CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain.,Institut de Recerca Biomédica de Lleida (IRBLLEIDA), Lleida, Spain
| | - Babak Mokhlesi
- Medicine/Pulmonary and Critical Care, University of Chicago, IL
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230
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Goyal A, Joshi A, Mitra A, Khurana A, Chaudhary P. Predictive factors for CPAP failure in obstructive sleep apnea patients. Lung India 2021; 38:540-544. [PMID: 34747736 PMCID: PMC8614613 DOI: 10.4103/lungindia.lungindia_867_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Some patients with obstructive sleep apnea (OSA) do not respond to Continuous Positive Airway Pressure (CPAP) and for these patients, Bi-level PAP is the next level modality. This study by a theory driven hierarchical approach, tries to identify the predictors for CPAP failure among OSA patients. Methodology: The potential predictors for the model were identified from a theoretical framework rooted in clinical examination, laboratory parameters, and polysomnographic variables pertaining to OSA patients. All patients of OSA who underwent manual titration with CPAP or Bi-level PAP (in case of CPAP Failure) between June 2015 and October 2017 were included in model building. This study compared five competitive models blocks deliberated by increasing order of diagnostic complexity and availability of resources. The fitting of the model was determined by both internal and external validation. Results: Among the five competitive models, the selected model has the significant deviance reduction (−2LL = 121.99, X2 = 25.55, P < 0.0001) from the baseline model (−2LL = 217.356). This logistic regression model consists of the following binary predictors – Age >60 years (odds ratio [OR] = 3.23 [1.27–8.23]), body mass index >35 Kg/m2 (OR = 4.25 [1.78–10.13]), forced expiratory volume <60% (OR = 7.33 [2.83–18.72]), apnea-hypopnea index >75 (OR = 4.31 [1.61–11.56]) and T90 > 30% (OR = 6.67 [2.57–17.36]). Conclusion: These five factors (acronym as BIPAP) may aid to the clinical decision-making by predicting failure of CPAP and therefore may assist in more vigilant clinical care.
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Affiliation(s)
- Abhishek Goyal
- Department of Pulmonary Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Ankur Joshi
- Department of Community and Family Medicine, Madhya Pradesh, India
| | - Arun Mitra
- Department of Community and Family Medicine, Madhya Pradesh, India
| | - Alkesh Khurana
- Department of Pulmonary Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Poonam Chaudhary
- Department of Biochemistry, AIIMS, Bhopal, Madhya Pradesh, India
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231
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Rabinowitz MR, Chaskes M, Choby G, Wang EW, Thorp B, Toskala E, Nyquist GG, Rosen MR, Evans JJ. Evolving concepts in the perioperative management of obstructive sleep apnea after endoscopic skull base surgery. Int Forum Allergy Rhinol 2021; 12:5-10. [PMID: 34747119 DOI: 10.1002/alr.22905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Mindy R Rabinowitz
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark Chaskes
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Garret Choby
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric W Wang
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brian Thorp
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Elina Toskala
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gurston G Nyquist
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Marc R Rosen
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James J Evans
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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232
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Adler AC, Chandrakantan A, Musso MF. Continuous Positive Airway Pressure Titration During Pediatric Drug Induced Sleep Endoscopy. Ann Otol Rhinol Laryngol 2021; 131:1085-1091. [PMID: 34706588 DOI: 10.1177/00034894211055527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To observe the degree of airway collapse at varying levels of continuous positive airway pressure (CPAP) during drug pediatric induced sleep endoscopy. METHODS Using our institutional anesthesia protocol for pediatric DISE procedures, patients were anesthetized followed by evaluation of the nasal airway, nasopharynx, velum, hypopharynx, arytenoids, tongue base, and epiglottis. CPAP titration was performed under vision to evaluate the degree of airway collapse at the level of the velum. Comparison was made with pre-operative polysomnography findings. RESULTS Twelve pediatric patients underwent DISE with intraoperative CPAP titration. In 7/12 patients, DISE observed CPAP titration was beneficial in elucidating areas of obstruction that were observed at pressures beyond those recommended during preoperative sleep study titrations. In 3 patients, DISE observations provided a basis for evaluation in children not compliant with sleep study CPAP titration testing. With regard to regions effected, airway collapse was observed at the velum and oropharynx to a greater degree when compared with the tongue base and epiglottis. CONCLUSION DISE evaluation of the pediatric patient with obstructive sleep apnea may present a source for further patient evaluation with respect to CPAP optimization and severity of OSA assessment, particularly in syndromic patients.
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Affiliation(s)
- Adam C Adler
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Arvind Chandrakantan
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Mary Frances Musso
- Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatric Otolaryngology, Texas Children's Hospital, Houston, TX, USA
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233
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Pradeep NP, Ayub II, Krishnaswamy M, Periakaruppan G. Bilevel positive airway pressure in tracheobronchomalacia. BMJ Case Rep 2021; 14:e246331. [PMID: 34686482 PMCID: PMC8543624 DOI: 10.1136/bcr-2021-246331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Nambron Prathyush Pradeep
- Department of Internal Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Irfan Ismail Ayub
- Department of Pulmonary Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Madhavan Krishnaswamy
- Department of Internal Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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234
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Jacobowitz O, Afifi L, Penzel T, Poyares D, Marklund M, Kushida C. Endorsement of: "treatment of adult obstructive sleep apnea with positive airway pressure: an American academy of Sleep Medicine Clinical Practice Guideline" by World Sleep Society. Sleep Med 2021; 89:19-22. [PMID: 34864508 DOI: 10.1016/j.sleep.2021.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Abstract
Guidelines for the evaluation and management of sleep disorders from national societies provide recommendations that may be regionally appropriate but may not always be practical or relevant in other parts of the world. A task force of experts from the World Sleep Society's (WSS) International Sleep Medicine Guidelines Committee and Sleep and Breathing Disorders Taskforce reviewed the American Academy of Sleep Medicine's Clinical Practice Guideline on the Treatment of Adult Obstructive Sleep Apnea (OSA) with Positive Airway Pressure with respect to its relevance and applicability to the practice of sleep medicine by sleep specialists in various regions of the world. To improve the evaluation of the guideline, surveys were sent by the senior author and the WSS to approximately 800 sleep doctors around the world to query the availability of OSA treatments in their respective region. The task force and the WSS guidelines committee endorsed the AASM's CPAP guidelines with respect to the indications for PAP therapy, utilization of different PAP modalities, and concurrent strategies to improve outcomes, noting appropriate caveats for universal applicability.
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Affiliation(s)
- Ofer Jacobowitz
- Sleep Department, ENT and Allergy Associates, New York, NY, USA.
| | - Lamia Afifi
- Clinical Neurophysiology, School of Medicine, Cairo University, Egypt
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charite Universitätsmedizin Berlin, Germany
| | - Dalva Poyares
- Psychobiology Department, Sleep Medicine Division, Universidade Federal de Sao Paulo, Brazil
| | | | - Clete Kushida
- Sleep Clinic and Center for Human Sleep Research, Stanford University School of Medicine, Redwood City, CA, USA
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Chetan IM, Maierean AD, Domokos Gergely B, Cabau G, Tomoaia R, Chis AF, Albu A, Stoia MA, Vesa SC, Blendea D, Todea DA. A Prospective Study of CPAP Therapy in Relation to Cardiovascular Outcome in a Cohort of Romanian Obstructive Sleep Apnea Patients. J Pers Med 2021; 11:1001. [PMID: 34683142 DOI: 10.3390/jpm11101001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Despite efforts at treatment, obstructive sleep apnea (OSA) remains a major health problem, especially with increasing evidence showing an association with cardiovascular morbidity and mortality. The treatment of choice for OSA patients is Continuous Positive Airway Pressure (CPAP), which has been proven in randomized controlled trials to be an effective therapy for this condition. The impact of CPAP on the cardiovascular pathology associated with OSA remains, however, unclear. Although the effect of CPAP has been previously studied in relation to cardiovascular outcome, follow-up of the treatment impact on cardiovascular risk factors at one year of therapy is lacking in a Romanian population. Thus, we aimed to evaluate the one-year effect of CPAP therapy on lipid profile, inflammatory state, blood pressure and cardiac function, assessed by echocardiography, on a cohort of Romanian OSA patients. Methods: We enrolled 163 participants and recorded their baseline demographic and clinical characteristics with a follow-up after 12 months. Inflammatory and cardiovascular risk factors were assessed at baseline and follow up. Results: Our results show that CPAP therapy leads to attenuation of cardiovascular risk factors including echocardiographic parameters, while having no effect on inflammatory markers. Conclusion: Treatment of OSA with CPAP proved to have beneficial effects on some of the cardiovascular risk factors while others remained unchanged, raising new questions for research into the treatment and management of OSA patients.
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Napolitano N, Roberts T, Nickel AJ, McDonough J, Sun H, Feng R, Jensen EA, Dysart K, Lin R. Performance Evaluation of Nasal Prong Interface for CPAP Delivery on a Critical Care Ventilator: A Bench Experiment. Respir Care 2021; 66:1514-1520. [PMID: 34230212 PMCID: PMC9993573 DOI: 10.4187/respcare.09018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The RAM cannula (Neotech, Valencia, CA) has become a commonly used interface for CPAP in neonatal intensive care. Performance characteristics of this interface used with a critical care ventilator are not well described. METHODS This was a bench study utilizing a lung simulator configured as an actively breathing infant (weights of 800 g, 1.5 kg, and 3 kg) with moderate lung disease and a critical care ventilator in CPAP mode with leak compensation on. Three sizes of the RAM cannulae (preemie, newborn, and infant) were compared to 3 BabyFlow nasal prongs (Dräger Medical, Lübeck, Germany) (medium, large, and extra-large). Fabricated nasal models produced a 70% occlusive fit for the RAM cannula and an occlusive fit with the Dräger prongs. Delivered flow and pressure levels were recorded at 9 CPAP levels between 5 and 20 cm H2O. RESULTS The Dräger prongs produced a mean airway pressure ([Formula: see text]) within 0.20 cm H2O (range -0.10 to 0.35) of the set CPAP across all evaluated prong sizes and CPAP levels. In contrast, the RAM cannula produced [Formula: see text] values that averaged 8.5 cm H2O (range -15 to -3.5) below the set CPAP levels. The deficit in delivered versus target CPAP level for the RAM cannula increased with greater set CPAP. Set CPAP of 5 cm H2O delivered [Formula: see text] values that ranged from 0.6 to 1.5 cm H2O (difference of 3.5-4.4 cm H2O). Set CPAP of 20 cm H2O delivered [Formula: see text] values that ranged from 5.0 to 8.4 cm H2O (difference of 11.7-15 cm H2O). Inspiratory flow required to achieve set CPAP levels did not differ between interfaces, suggesting high resistance in the RAM cannula device masks the delivered CPAP levels. CONCLUSIONS Use of the RAM cannula with a 30% leak on a critical care ventilator delivered [Formula: see text] values lower than set CPAP. This may be clinically meaningful and should be considered when choosing a nasal interface.
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Affiliation(s)
- Natalie Napolitano
- Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Tracey Roberts
- Department of Respiratory Therapy, Lucile Packard Children's Hospital, Stanford, California
| | - Amanda J Nickel
- Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph McDonough
- Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Haorui Sun
- Pennsylvania State College of Medicine, Hershey, Pennsylvania
| | - Rui Feng
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erik A Jensen
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kevin Dysart
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Richard Lin
- Division of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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237
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Tsang YP, To CY, Tsui CK, Leung SY, Kwok KL, Ng DKK. Feasibility of long-term home noninvasive ventilation program in a general pediatric unit: 21 years' experience in Hong Kong. Pediatr Pulmonol 2021; 56:3349-3357. [PMID: 34339596 DOI: 10.1002/ppul.25593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/19/2021] [Accepted: 07/20/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Long-term home noninvasive ventilation (NIV) is increasingly employed in children with sleep-disordered breathing and chronic respiratory failure. While studies suggest its successful implementation in tertiary care centers, little is known about the situation in a general care setting. Hence, we aim to evaluate the clinical profiles of these children in a general pediatric unit over the past two decades. METHODS Data collected retrospectively on patients younger than 18 years old receiving long-term home NIV from January 1, 1997 to December 31, 2017 in a Hong Kong regional general pediatric unit were reviewed. RESULTS The number of children on home NIV increased more than 10-fold over the past two decades. In total, 114 children were commenced on NIV during the 21-year period. Upper airway obstruction was the most common cause (77%), followed by neuromuscular diseases (16%), pulmonary disorders (4%), and abnormal ventilatory control (3%). Continuous positive airway pressure was the most common NIV type (59%). To date, 46% of the children remained in our NIV program, while 18% discontinued NIV support. NIV adherence increased significantly with follow-up (median of 78.6% and 82.5% at baseline and last follow-up, respectively). Sixty-five percent of the children used NIV for at least 4 h on 70% of the days monitored. Higher body mass index was associated with lower adherence. CONCLUSION Pediatric home NIV is feasible in the general care setting with good outcomes and adherence. As the demand for NIV service grows, input from local hospitals will be of increasing importance and should be considered upon healthcare planning.
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Affiliation(s)
- Yuk-Ping Tsang
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR.,Department of Paediatrics & Adolescent Medicine, United Christian Hospital, Kowloon, Hong Kong SAR
| | - Ching-Yee To
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR.,Ambulatory Care Center, Hong Kong Children's Hospital, Hong Kong, Hong Kong SAR
| | - Cheuk-Kiu Tsui
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR
| | - Shuk-Yu Leung
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR
| | - Ka-Li Kwok
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, Hong Kong SAR
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Harańczyk M, Konieczyńska M, Płazak W. Influence of obstructive sleep apnea on right heart structure and function. Adv Respir Med 2021; 89:493-500. [PMID: 34569612 DOI: 10.5603/arm.a2021.0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep disorder associated with increased cardiovascular morbidity and mortality. This study aimed to investigate heart structure and function and their correlation with the degree of OSAS and sleep indexes in patients diagnosed with OSAS. MATERIALS AND METHODS A cohort of 77patients (48 males, aged 58.1 ± 11.0 years, body mass index [BMI] = 32.4 ± 6.2) admitted to the hospital due to suspected OSAS was examined using echocardiography and polysomnography. RESULTS Patients with moderate-to-severe OSAS compared to patients without diagnosed OSAS or with mild OSAS had greater right ventricular outflow tract (RVOT) dimensions (32.6 ± 3.6 vs 30.9 ± 2.4 mm; p < 0.05), larger right atrial area (RAA; 21.1 ± 4.8 vs 17.2 ± 3.2 mm; p = 0.002), greater right ventricular mid-cavity diameter (RVD; 35.5 ± 7.0 vs 32.2 ± 4.7 mm; p = 0.02), and diminished tricuspid annular plane systolic excursion (TAPSE, 21.9 ± 4.5 vs 25.8 ± 4.4 mm; p = 0.04), while there were no significant differences in tissue doppler imaging (TDI) parameters (S' and E') and in valvular regurgitation gradient for both groups. Moreover, significantly greater RVOT dimensions (31.6 ± 2.6 vs 30.9 ± 3.0 mm, p = 0.04), RVD (39.3 ± 7.0 vs 32.7 ± 5.2 mm, p = 0.003), and RAA (21.4 ± 4.4 vs 18.1 ± 4.2 mm, p = 0.02) as well as reduction in TAPSE (20.9 ± 5.3 vs 25.0 ± 4.3 mm, p = 0.01) were observed in patients having ≥ 10 episodes of obstructive apnea (OA) per hour. CONCLUSIONS In moderate-to-severe OSAS patients, right ventricular (RV) enlargement was observed together with RV dysfunction as measured by TAPSE. Examination using TDI is not superior to standard echocardiography for the detection of heart pathology in OSAS patients. Right heart pathology is present predominantly in patients with obstructive apnea.
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Affiliation(s)
- Michał Harańczyk
- Department of Diagnostic Medicine, John Paul II Hospital, Kraków, Poland.
| | | | - Wojciech Płazak
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Kraków, Poland
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239
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Pleil JD, Wallace MAG, Davis MD, Matty CM. The physics of human breathing: flow, timing, volume, and pressure parameters for normal, on-demand, and ventilator respiration. J Breath Res 2021; 15:10.1088/1752-7163/ac2589. [PMID: 34507310 PMCID: PMC8672270 DOI: 10.1088/1752-7163/ac2589] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/10/2021] [Indexed: 11/12/2022]
Abstract
Normal breathing for healthy humans is taken for granted; it occurs without conscious effort using ambient (1-atmosphere) pressure with 21% oxygen (O2) concentration. The body automatically adjusts for stress, exercise, altitude, and mild disease by increasing the volume and frequency of breathing. Longer term adaptations for exercise and altitude include increases in red blood cell counts and higher concentrations of capillaries in muscle tissue. When more challenging external environmental conditions or pulmonary illnesses exceed the capability for these adaptations, the human system requires technology to maintain sufficient ventilation to preserve life. On the environmental side there are two conditions to be addressed: toxicity of the surrounding atmosphere and changes in external pressure and O2concentration. On the medical side, mechanisms for assisting breathing include O2supplementation at ambient pressure, positive pressure/flow without additional O2, or a combination of both. This overview describes the various technologies applied to maintaining a safe breathing environment. Topics for environmental intervention include filter-based and flowing air-supply masks for toxic environments (occupational and laboratory protection), and on-demand gas supply systems for firefighters, self-contained underwater breathing apparatus divers, and altitude (high performance aircraft, spacecraft) applications. The topics for medical intervention include nasal cannula, continuous positive airway pressure, and medical ventilators. The primary purpose of this article is to provide a basic understanding of normal human breathing and the adaptation of breathing in different environments using available technologies.
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Affiliation(s)
- Joachim D. Pleil
- Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - M. Ariel Geer Wallace
- Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Michael D. Davis
- Herman B. Wells Center for Pediatrics Research, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christopher M. Matty
- Johnson Space Center, National Aeronautics and Space Administration, Houston, TX, USA
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240
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Khalyfa A, Trzepizur W, Gileles-Hillel A, Qiao Z, Sanz-Rubio D, Marin JM, Martinez-Garcia MA, Campos-Rodriguez F, Almendros I, Farre R, Sanchez-de-la-Torre M, García-Río F, Gozal D. Heterogeneity of Melanoma Cell Responses to Sleep Apnea-Derived Plasma Exosomes and to Intermittent Hypoxia. Cancers (Basel) 2021; 13:4781. [PMID: 34638272 DOI: 10.3390/cancers13194781] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnea (OSA) is associated with increased cutaneous melanoma incidence and adverse outcomes. Exosomes are secreted by most cells, and play a role in OSA-associated tumor progression and metastasis. We aimed to study the effects of plasma exosomes from OSA patients before and after adherent treatment with continuous positive airway pressure (CPAP) on melanoma cells lines, and also to identify exosomal miRNAs from melanoma cells exposed to intermittent hypoxia (IH) or normoxia. Plasma-derived exosomes were isolated from moderate-to-severe OSA patients before (V1) and after (V2) adherent CPAP treatment for one year. Exosomes were co-incubated with three3 different melanoma cell lines (CRL 1424; CRL 1619; CRL 1675) that are characterized by genotypes involving different mutations in BRAF, STK11, CDKN2A, and PTEN genes to assess the effect of exosomes on cell proliferation and migration, as well as on pAMK activity in the presence or absence of a chemical activator. Subsequently, CRL-1424 and CRL-1675 cells were exposed to intermittent hypoxia (IH) and normoxia, and exosomal miRNAs were identified followed by GO and KEG pathways and gene networks. The exosomes from these IH-exposed melanoma cells were also administered to THP1 macrophages to examine changes in M1 and M2 polarity markers. Plasma exosomes from V1 increased CRL-1424 melanoma cell proliferation and migration compared to V2, but not the other two cell lines. Exposure to CRL-1424 exosomes reduced pAMPK/tAMPK in V1 compared to V2, and treatment with AMPK activator reversed the effects. Unique exosomal miRNAs profiles were identified for CRL-1424 and CRL-1675 in IH compared to normoxia, with six miRNAs being regulated and several KEGG pathways were identified. Two M1 markers (CXCL10 and IL6) were significantly increased in monocytes when treated with exosomes from IH-exposed CRL-1424 and CRL-1625 cells. Our findings suggest that exosomes from untreated OSA patients increase CRL-1424 melanoma malignant properties, an effect that is not observed in two other melanoma cell lines. Exosomal cargo from CRL-1424 cells showed a unique miRNA signature compared to CRL-1675 cells after IH exposures, suggesting that melanoma cells are differentially susceptible to IH, even if they retain similar effects on immune cell polarity. It is postulated that mutations in STK-11 gene encoding for the serine/threonine kinase family that acts as a tumor suppressor may underlie susceptibility to IH-induced metabolic dysfunction, as illustrated by CRL-1424 cells.
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241
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Pleil JD, Christensen LE. Rationale for developing tunable laser spectroscopy (TLS) technology for high resolution real-time carbon dioxide monitoring (capnography) in human breath. J Breath Res 2021; 15. [PMID: 34525465 DOI: 10.1088/1752-7163/ac2723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/15/2021] [Indexed: 12/18/2022]
Abstract
Real-time monitoring of exhaled carbon dioxide (CO2), also known as capnography, is a valuable hospital tool for assessing patient health during anesthesia and in both the emergency department and critical care units. The fundamental measurement is referred to as end-tidal carbon dioxide concentration that reflects pulmonary gas exchange of CO2representing systemic metabolism. The shape of the exhaled CO2concentration for individual inhalation/exhalation breath cycles can offer additional information regarding lung function, airway obstruction, alveolar ventilation, and worsening disease. The most frequent use is to indicate appropriate placement of an endotracheal tube but and it is also employed in the assessment of disease severity and response to treatment (e.g. asthma). Other applications include outpatient monitoring with oxygen supplementation (nasal cannula) and continuous positive airway pressure control for sleep apnea. As technology has evolved, CO2measurements have become more mobile; capnography systems are now used by emergency medical services personnel for verifying proper placement of airway devices in 'pre-hospital' environments. The use of CO2diagnostics has evolved to identify breathing system disruptions in 'on-demand' regulator/masks equipment, both in medical and occupational settings. Most recently, miniaturized tunable laser spectroscopy sensors have been implemented for assessing pilot breathing in high-performance military aircraft. This editorial describes the use of CO2breath sensors and proposes some new applications based on miniaturized sensors that can be directly inserted into breathing masks.
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Affiliation(s)
- Joachim D Pleil
- Gillings School of Public Health, University of North Carolina, Chapel Hill, NC 27599, United States of America
| | - Lance E Christensen
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, United States of America
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242
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Rauseo M, Mirabella L, Laforgia D, Lamanna A, Vetuschi P, Soriano E, Ugliola D, Casiello E, Tullo L, Cinnella G. A Pilot Study on Electrical Impedance Tomography During CPAP Trial in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: The Bright Side of Non-invasive Ventilation. Front Physiol 2021; 12:728243. [PMID: 34566690 PMCID: PMC8458834 DOI: 10.3389/fphys.2021.728243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia phenotypes were described that match with different lung compliance and level of oxygenation, thus requiring a personalized ventilator setting. The burden of so many patients and the lack of intensive care unit (ICU) beds often force physicians to choose non-invasive ventilation (NIV) as the first approach, even if no consent has still been reached to discriminate whether it is safer to choose straightforward intubation, paralysis, and protective ventilation. Under such conditions, electrical impedance tomography (EIT), a non-invasive bedside tool to monitor lung ventilation and perfusion defects, could be useful to assess the response of patients to NIV and choose rapidly the right ventilatory strategy. Objective: The rationale behind this study is that derecruitment is a more efficient measure of positive end expiratory pressure (PEEP)-dependency of patients than recruitment. We hypothesized that patients who derecruit significantly when PEEP is reduced are the ones that do not need early intubation while small end-expiratory lung volume (ΔEELV) variations after a single step of PEEP de-escalation could be predictive of NIV failure. Materials and Methods: Consecutive patients admitted to ICU with confirmed SARS-CoV-2 pneumonia ventilated in NIV were enrolled. Exclusion criteria were former intubation or NIV lasting > 72 h. A trial of continuos positive airway pressure (CPAP) 12 was applied in every patient for at least 15 min, followed by the second period of CPAP 6, either in the supine or prone position. Besides standard monitoring, ventilation of patients was assessed by EIT, and end-expiratory lung impedance (ΔEELI) (%) was calculated as the difference in EELI between CPAP12 and CPAP6. Tidal volume (Vt), Ve, respiratory rate (RR), and FiO2 were recorded, and ABGs were measured. Data were analyzed offline using the dedicated software. The decision to intubate or continue NIV was in charge of treating physicians, independently from study results. Outcomes of patients in terms of intubation rate and ICU mortality were recorded. Results: We enrolled 10 male patients, with a mean age of 67 years. Six patients (60%) were successfully treated by NIV until ICU discharge (Group S), and four patients failed NIV and were intubated and switched to MV (Group F). All these patients died in ICU. During the supine CPAP decremental trial, all patients experienced an increase in RR and Ve. ΔEELI was < 40% in Group F and > 50% in Group S. In the prone trial, ΔEELI was > 50% in all patients, while RR decreased in Group S and remained unchanged in Group F. Conclusion: ΔEELI < 40% after a single PEEP de-escalation step in supine position seems to be a good predictor of poor recruitment and CPAP failure.
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Affiliation(s)
- Michela Rauseo
- Department of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy
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243
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Daabek N, Tamisier R, Foote A, Revil H, Joyeux-Jaure M, Pépin JL, Bailly S, Borel JC. Impact of Healthcare Non-Take-Up on Adherence to Long-Term Positive Airway Pressure Therapy. Front Public Health 2021; 9:713313. [PMID: 34485235 PMCID: PMC8416102 DOI: 10.3389/fpubh.2021.713313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022] Open
Abstract
Background: The effectiveness of positive airway pressure therapies (PAP) is contingent on treatment adherence. We hypothesized that forgoing healthcare may be a determinant of adherence to PAP therapy. Research Question: The objectives were: (i) to assess the impact of forgoing healthcare on adherence to PAP in patients with Chronic Respiratory Failure (CRF) and patients with Obstructive Sleep Apnea Syndrome (OSAS); (ii) to compare forgoing healthcare patterns in these two chronic conditions. Study design and methods: Prospective cohort of patients with OSAS or CRF, treated with PAP therapies at home for at least 12 months. At inclusion, patients were asked to fill-in questionnaires investigating (i) healthcare forgone, (ii) deprivation (EPICES score), (iii) socio-professional and familial status. Characteristics at inclusion were extracted from medical records. PAP adherence was collected from the device's built-in time counters. Multivariable logistic regression models were used to assess the associations between healthcare forgone and the risk of being non-adherent to CPAP treatment. Results: Among 298 patients included (294 analyzed); 33.7% reported forgoing healthcare. Deprivation (EPICES score > 30) was independently associated with the risk of non-adherence (OR = 3.57, 95%CI [1.12; 11.37]). Forgoing healthcare had an additional effect on the risk of non-adherence among deprived patients (OR = 7.74, 95%CI [2.59; 23.12]). OSAS patients mainly forwent healthcare for financial reasons (49% vs. 12.5% in CRF group), whereas CRF patients forwent healthcare due to lack of mobility (25%, vs. 5.9 % in OSAS group). Interpretation: Forgoing healthcare contributes to the risk of PAP non-adherence particularly among deprived patients. Measures tailored to tackle forgoing healthcare may improve the overall quality of care in PAP therapies. Clinical Trial Registration: The study protocol was registered in ClinicalTrials.gov, identifier: NCT03591250.
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Affiliation(s)
- Najeh Daabek
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,AGIR à dom. Homecare Charity, Meylan, France
| | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Alison Foote
- Research Division, Grenoble Alpes University Hospital, Grenoble, France
| | - Hélèna Revil
- Social Sciences Research - PACTE Laboratory, CNRS UMR 5194, University Grenoble Alpes, Grenoble, France
| | - Marie Joyeux-Jaure
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,AGIR à dom. Homecare Charity, Meylan, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Sébastien Bailly
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Christian Borel
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,AGIR à dom. Homecare Charity, Meylan, France
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244
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Pun M, Beaudin AE, Raneri JK, Anderson TJ, Hanly PJ, Poulin MJ. Impact of nocturnal oxygen and CPAP on the ventilatory response to hypoxia in OSA patients free of overt cardiovascular disease. Exp Neurol 2021; 346:113852. [PMID: 34461058 DOI: 10.1016/j.expneurol.2021.113852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 08/17/2021] [Accepted: 08/24/2021] [Indexed: 11/20/2022]
Abstract
A primary characteristic of obstructive sleep apnea (OSA) is chronic exposure to intermittent hypoxia (IH) due to repeated upper airway obstruction. Chronic IH exposure is believed to increase OSA severity over time by enhancing the acute ventilatory response to hypoxia (AHVR), thus promoting ventilatory overshoot when apnea ends and perpetuation of apnea during sleep. Continuous positive airway pressure (CPAP), the gold-standard treatment of OSA, reduces the AHVR, believed to result from correction of IH. However, CPAP also corrects ancillary features of OSA such as intermittent hypercapnia, negative intrathoracic pressure and surges in sympathetic activity, which may also contribute to the reduction in AHVR. Therefore, the objective of this study was to investigate the impact of nocturnal oxygen therapy (to remove IH only) and CPAP (to correct IH and ancillary features of OSA) on AHVR in newly diagnosed OSA patients. Fifty-two OSA patients and twenty-two controls were recruited. The AHVR was assessed using a 5 min iscopanic-hypoxic challenge before, and after, treatment of OSA by nocturnal oxygen therapy and CPAP. Following baseline measurements, OSA patients were randomly assigned to nocturnal oxygen therapy (Oxygen, n = 26) or no treatment (Air; n = 26). The AHVR was re-assessed following two weeks of oxygen therapy or no treatment, after which all patients were treated with CPAP. The AHVR was quantified following ~4 weeks of adherent CPAP therapy (n = 40). Both nocturnal oxygen and CPAP treatments improved hypoxemia (p < 0.05), and, as expected, nocturnal oxygen therapy did not completely abolish respiratory events (i.e., apneas/hypopneas). Averaged across all OSA patients, nocturnal oxygen therapy did not change AHVR from baseline to post-oxygen therapy. Similarly, the AHVR was not altered pre- and post-CPAP (p > 0.05). However, there was a significant decrease in AHVR with both nocturnal oxygen therapy and CPAP in patients in the highest OSA severity quartile (p < 0.05). Nocturnal oxygen therapy and CPAP both reduce the AHVR in patients with the most severe OSA. Therefore, IH appears to be the primary mechanism producing ventilatory instability in patients with severe OSA via enhancement of the AHVR.
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Affiliation(s)
- Matiram Pun
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew E Beaudin
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jill K Raneri
- Sleep Centre, Foothills Medical Centre, Calgary, AB, Canada
| | - Todd J Anderson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Patrick J Hanly
- Sleep Centre, Foothills Medical Centre, Calgary, AB, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Marc J Poulin
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
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245
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Simioli F, Nicoletta C, Valentino MR, Martino M, Annunziata A, Carannante N, Di Micco P, Fiorentino G. Remdesivir in Severe COVID-19 and Non-Invasive Ventilation: A Real-Life Experience. Healthcare (Basel) 2021; 9:1108. [PMID: 34574882 DOI: 10.3390/healthcare9091108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Antiviral treatment is a hot topic regarding therapy for COVID-19. Several antiviral drugs have been tested in the months since the pandemic began. Yet only Remdesivir obtained approval after first trials. The best time to administer Remdesivir is still a matter for discussion and this could also depend upon the severity of lung damage and the staging of the infection. Methods: We performed a real-life study of patients hospitalized forCOVID-19 and receiving non-invasive ventilation (NIV). In this single-center study, a 5 day course of Remdesivir was administered as compassionate use. Further therapeutic supports included antibiotics, low molecular weight heparin and steroids. Data collection included clinical signs and symptoms, gas exchange, laboratory markers of inflammation, and radiological findings. Major outcomes were de-escalation of oxygen-support requirements, clinical improvement defined by weaning from ventilation to oxygen therapy or discharge, and mortality. Adverse drug reactions were also recorded. All data were collected during hospitalization and during a 20-day follow up after treatment. Results: 51 patients were enrolled. A global clinical improvement was recorded in 22 patients (43%) at 12 days, and 36 (71%) at 20 days; in particular, at 12 days, 27 patients (53%) also had a de-escalation of oxygen-support class from a therapeutic point of view. Remdesivir use was associated with a lower hazard ratio for clinical improvement in the elderly (older than 70 years) and in subjects with more extensive lung involvement (total severity score at HRCT of more than 14). The 20-day mortality was 13%. Conclusions: Results demonstrated that Remdesivir is associated with an improvement in clinical, laboratory and radiological parameters in patients with severe COVID-19 and showed an overall mortality of 13%. We conclude that, in this cohort, Remdesivir was a beneficial add-on therapy for severe COVID-19, especially in adults with moderate lung involvement at HRCT.
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246
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Culmer P, Davis Birch W, Waters I, Keeling A, Osnes C, Jones D, de Boer G, Hetherington R, Ashton S, Latham M, Beacon T, Royston T, Miller R, Littlejohns A, Parmar J, Lawton T, Murdoch S, Brettle D, Musasizi R, Nampiina G, Namulema E, Kapur N. The LeVe CPAP System for Oxygen-Efficient CPAP Respiratory Support: Development and Pilot Evaluation. Front Med Technol 2021; 3:715969. [PMID: 35047948 PMCID: PMC8757765 DOI: 10.3389/fmedt.2021.715969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/29/2021] [Indexed: 12/04/2022] Open
Abstract
Background: The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has placed a significant demand on healthcare providers (HCPs) to provide respiratory support for patients with moderate to severe symptoms. Continuous Positive Airway Pressure (CPAP) non-invasive ventilation can help patients with moderate symptoms to avoid the need for invasive ventilation in intensive care. However, existing CPAP systems can be complex (and thus expensive) or require high levels of oxygen, limiting their use in resource-stretched environments. Technical Development + Testing: The LeVe ("Light") CPAP system was developed using principles of frugal innovation to produce a solution of low complexity and high resource efficiency. The LeVe system exploits the air flow dynamics of electric fan blowers which are inherently suited to delivery of positive pressure at appropriate flow rates for CPAP. Laboratory evaluation demonstrated that performance of the LeVe system was equivalent to other commercially available systems used to deliver CPAP, achieving a 10 cm H2O target pressure within 2.4% RMS error and 50-70% FiO2 dependent with 10 L/min oxygen from a commercial concentrator. Pilot Evaluation: The LeVe CPAP system was tested to evaluate safety and acceptability in a group of ten healthy volunteers at Mengo Hospital in Kampala, Uganda. The study demonstrated that the system can be used safely without inducing hypoxia or hypercapnia and that its use was well-tolerated by users, with no adverse events reported. Conclusions: To provide respiratory support for the high patient numbers associated with the COVID-19 pandemic, healthcare providers require resource efficient solutions. We have shown that this can be achieved through frugal engineering of a CPAP ventilation system, in a system which is safe for use and well-tolerated in healthy volunteers. This approach may also benefit other respiratory conditions which often go unaddressed in Low and Middle Income Countries (LMICs) for want of context-appropriate technology designed for the limited oxygen resources available.
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Affiliation(s)
- Pete Culmer
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - W. Davis Birch
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - I. Waters
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - A. Keeling
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - C. Osnes
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - D. Jones
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - G. de Boer
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - R. Hetherington
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
| | - S. Ashton
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - M. Latham
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - T. Beacon
- Medical Aid International Ltd., Bedford, United Kingdom
| | - T. Royston
- Medical Aid International Ltd., Bedford, United Kingdom
| | - R. Miller
- Medical Aid International Ltd., Bedford, United Kingdom
| | | | - J. Parmar
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - Tom Lawton
- Bradford Teaching Hospitals National Health Service (NHS) Foundation Trust, Bradford, United Kingdom
| | - S. Murdoch
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - D. Brettle
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | | | | | | | - N. Kapur
- School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
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247
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Garland H, Stoll S, Patel S, Mogal R. A case of Bartonellosis presenting as a puzzling multisystem disorder complicated by nosocomial COVID-19 infection. BMJ Case Rep 2021; 14:14/8/e244002. [PMID: 34413042 PMCID: PMC8378352 DOI: 10.1136/bcr-2021-244002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The most commonly considered infection with a Bartonella species is cat-scratch disease caused by Bartonella henselae Here, we discuss a unique case of a 60-year-old man who presented with Bartonella infection complicated by nosocomial COVID-19. He was admitted with a history of chest pain, persistent fever, rash and influenza-like symptoms. Positive Bartonella serology confirmed diagnosis and the patient developed complications of pericardial effusion in addition to COVID-19 infection, requiring non-invasive ventilation and admission to the intensive care unit. We discuss his symptoms, investigations, treatment and outcomes, while also highlighting the challenges of assessing patients presenting with fever of unknown origin during the COVID-19 pandemic.
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Affiliation(s)
| | - Sarah Stoll
- West Hertfordshire Hospitals NHS Trust, Watford, Hertfordshire, UK
| | - Shalinee Patel
- West Hertfordshire Hospitals NHS Trust, Watford, Hertfordshire, UK
| | - Rahul Mogal
- Department of Respiratory Medicine, Watford General Hospital, Watford, Hertfordshire, UK
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248
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Salzano G, Maglitto F, Bisogno A, Vaira LA, De Riu G, Cavaliere M, di Stadio A, Mesolella M, Motta G, Ionna F, Califano L, Salzano FA. Obstructive sleep apnoea/hypopnoea syndrome: relationship with obesity and management in obese patients. ACTA ACUST UNITED AC 2021; 41:120-130. [PMID: 34028456 PMCID: PMC8142730 DOI: 10.14639/0392-100x-n1100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/28/2020] [Indexed: 02/07/2023]
Abstract
Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is a disease characterised by upper airway obstruction during sleep, quite frequent in the general population, even if underestimated. Snoring, sleep apnoea and diurnal hypersomnia are common in these patients. Central obesity plays a key role: it reduces the size and changes the conformation of the upper airways, besides preventing lung expansion, with consequent reduction of lung volumes. Furthermore, obese people are also resistant to leptin, which physiologically stimulates ventilation; as a result, this causes scarce awakening during apnoea. OSAHS diagnosis is based on the combination of clinical parameters, such as apnoea/hypopnoea index (AHI), medical history, physical examination and Mallampati score. The first objective reference method to identify OSAHS is polysomnography followed by sleep endoscopy. Therapy provides in the first instance reduction of body weight, followed by continuous positive airway pressure (CPAP), which still remains the treatment of choice in most patients, mandibular advancement devices (MAD) and finally otolaryngology or maxillofacial surgery. Among surgical techniques, central is barbed reposition pharyngoplasty (BRP), used in the field of multilevel surgery.
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Affiliation(s)
- Giovanni Salzano
- Maxillo-Facial and ENT Surgery Unit, INT- IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Fabio Maglitto
- Maxillo-Facial and ENT Surgery Unit, INT- IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Antonella Bisogno
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi (Salerno), Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Unit, University Hospital of Sassari, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Unit, University Hospital of Sassari, Sassari, Italy
| | - Matteo Cavaliere
- Department of Otolarhinolaryngology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Fisciano, Salerno, Italy
| | | | - Massimo Mesolella
- Department of Neuroscience, Reproductive and Odontostomatological Science, Ear Nose and Throat Unit, University of Naples "Federico II", Naples, Italy
| | - Gaetano Motta
- Clinic of Otorhinolaryngology, Head and Neck Surgery Unit, Department of Anesthesiology, Surgical and Emergency Science, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Franco Ionna
- Maxillo-Facial and ENT Surgery Unit, INT- IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Francesco Antonio Salzano
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi (Salerno), Italy
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249
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O'Halloran D, O'Boyle C, Doherty L. Poor Sleep Associated with Clinically Severe Obesity Is Independent of OSA Status. Obes Surg 2021; 31:4734-4740. [PMID: 34386907 DOI: 10.1007/s11695-021-05588-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Obesity has been reported to be associated with short sleep duration. It follows that patients with a BMI >35kg/m2 could be expected to have the poorest sleep. This poor sleep could be explained by the presence of obstructive sleep apnoea (OSA), although treatment with positive airway pressure (PAP) may modify this. The purpose of this study is to determine if patients attending for bariatric surgery have poor sleep independent of OSA status. MATERIALS AND METHODS Sleep duration and quality, using the Pittsburgh Sleep Quality Index (PSQI), was analysed in 203 patients undergoing bariatric surgery between June 2016 and May 2019 in a single centre. Anthropometric data on all patients were recorded as well as presence of OSA and PAP usage. RESULTS The bariatric population reported an average (standard deviation) sleep duration of 6.5 (1.6) h, and 67.9% of patients had a documented poor sleep quality (PSQI>5). The presence of OSA did not significantly influence either sleep duration (p=0.23) or sleep quality (p=0.5). On logistic regression, there was no significant relationship between sleep duration or sleep quality and the following variables: age, sex, and AHI. There was however a significant association between BMI and sleep quality (p= 0.007). PSQI was inversely associated with BMI. This equated to 1 kg/m2 weight gain being associated with 0.097 decrease in PSQI score. CONCLUSIONS The presence of OSA does not influence either sleep duration or sleep quality in the bariatric surgical population. This suggests that clinically severe obesity itself may cause poor sleep.
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Affiliation(s)
- David O'Halloran
- Department of Respiratory Medicine, Bon Secours Hospital, College Rd, Cork, Ireland.
| | - Colm O'Boyle
- Department of Surgery, Bon Secours Hospital, College Rd, Cork, Ireland
| | - Liam Doherty
- Department of Respiratory Medicine, Bon Secours Hospital, College Rd, Cork, Ireland
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250
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Cervera Gil O, Sanabria Carretero P, Castro L, Reinoso Barbero F, Polo López L, Andrés de la Torre C. Original and minimally invasive approach to a left-lung refractory atelectasis after reparation of an aortic recoarctation in a lactant: Selective endobronchial CPAP. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:420-423. [PMID: 34389274 DOI: 10.1016/j.redare.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 10/15/2020] [Indexed: 11/27/2022]
Abstract
Atelectasis is one of the most common respiratory complications in pediatric patients after open-heart surgery, and may lead to weaning failure and increased morbidity. We report the use of an original, minimally invasive approach to refractory left lung atelectasis after repair of an aortic coarctation in a 2 month-old infant, in which a CPAP system connected to a flexible endobronchial tube resolved the atelectasis.
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Affiliation(s)
- O Cervera Gil
- Servicio Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain.
| | - P Sanabria Carretero
- Sección de Anestesia y Reanimación Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | - L Castro
- Servicio Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - F Reinoso Barbero
- Servicio de Anestesia y Reanimación Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | - L Polo López
- Servicio de Cirugía Cardiovascular Infantil, Hospital Universitario La Paz, Madrid, Spain
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