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Franke C, Piezonna F, Schäfer R, Grimm A, Loris LM, Schwaibold M. Effect of a digital patient motivation and support tool on CPAP/APAP adherence and daytime sleepiness: a randomized controlled trial. Sleep Biol Rhythms 2024; 22:49-63. [PMID: 38469583 PMCID: PMC10899947 DOI: 10.1007/s41105-023-00479-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/22/2023] [Indexed: 03/13/2024]
Abstract
The purpose of this study was to assess the effect of a digital patient support (DPS) tool, complementary to standard care on continuous or automatic positive airway pressure (auto)CPAP adherence and daytime sleepiness after 12 weeks in patients diagnosed with severe obstructive sleep apnea (OSA). All patients with apnea-hypopnea index (AHI) ≥ 30 per hour were prospectively included and randomized to receive standard care (SC) or standard care with personalized DPS via a mobile app prototype version (SC + DPS). Patients in the SC + DPS arm received additionally automated feedback on their therapy, motivational messages and therapy recommendations. 100 patients completed the study (SC: 50, SC + DPS: 50). No differences were found in characteristics of SC vs. SC + DPS (mean ± SD) for age (53.9 ± 10.8 vs. 51.7 ± 12.3 years), initial diagnostic apnea-hypopnea index (51.1 ± 15.5 vs. 50.9 ± 17.7 events/h), BMI (33.8 ± 6.7 vs. 33.5 ± 4.5 kg/m), and Epworth Sleepiness Scale (ESS) baseline score (9.5 ± 4.2 vs. 9.1 ± 5.2). After 12 weeks, mean ESS score was significantly lower (SC: 7.6 ± 4.1 vs. SC + DPS: 5.5 ± 3.9; p = 0.006) in the SC + DPS group vs. standard care group. Therapy adherence was significantly higher (SC: 268.7 ± 122.1 vs. SC + DPS: 338.8 ± 106.8 min; p = 0.002) in the SC + DPS group compared to standard care group. No difference was found in the residual AHI between both groups. However, SC + DPS group showed a trend towards fewer phases with increased leakage compared to SC group. Intention-to-treat analysis (112 (56/56) patients) showed similar results. After 12 weeks, (auto)CPAP adherence and daytime sleepiness improved significantly in patients with severe OSA using the digital patient support tool. Clinical Trial Registration (retrospectively registered): Registry: NCT05440279; Title: Effects of Telemedical Support on Therapeutic Results of CPAP Patients; URL: https://clinicaltrials.gov/ct2/show/NCT05440279; Date of registration: June 30, 2022. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-023-00479-9.
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Affiliation(s)
- Christian Franke
- Medizinisches Versorgungszentrum GbR Sonneberg, 96515 Sonneberg, Germany
| | - Franziska Piezonna
- Medizinisches Versorgungszentrum GbR Sonneberg, 96515 Sonneberg, Germany
| | - Regina Schäfer
- Loewenstein Medical Technology GmbH+Co. KG, 76135 Karlsruhe, Germany
| | - Alexander Grimm
- Loewenstein Medical Technology GmbH+Co. KG, 76135 Karlsruhe, Germany
| | - Lisa-Marie Loris
- Loewenstein Medical Technology GmbH+Co. KG, 76135 Karlsruhe, Germany
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Parmaksız ET. Can we enhance compliance to treatment by performing a continuous positive airway pressure trial in obstructive sleep apnea? Sleep Breath 2021; 25:2039-2043. [PMID: 33694035 DOI: 10.1007/s11325-021-02340-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although continuous positive airway pressure (CPAP) therapy is the most effective treatment for obstructive sleep apnea (OSA), it is not always easy to gain adherence to therapy. We aimed to evaluate how short-term CPAP application during the daytime before the titration night affects polysomnographic data and CPAP adherence in OSA. METHODS Patients with moderate to severe OSA for whom CPAP titration was recommended were prospectively randomized to daytime CPAP application (group 1) or usual care (group 2). For group 1, CPAP was applied for 30-60 min in daytime conditions to acclimate patients to the device. An appointment was then made to perform CPAP titration with PSG. In group 2 (usual care), the first CPAP application was performed on the titration night. PSG recordings and titration night recordings of both groups were compared. All subjects were evaluated 1 month after the initiation of CPAP treatment. RESULTS Among 246 cases, first night data were similar in both groups. During the titration night, total sleep time, sleep efficiency, and time in stage N3 were significantly higher in patients who underwent the daytime CPAP trial. Adherence to CPAP treatment at first-month follow-up was significantly higher in the group 1 (5.7 ± 1.0 h/night) compared to the group 2 (3.9 ± 1.1 h/night, p < 0.001). CONCLUSION A short-term daytime CPAP trial in patients before the titration night may provide longer and more efficient sleep on the titration night and better CPAP adherence at one month.
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Affiliation(s)
- Elif Torun Parmaksız
- Department of Chest Diseases, Health Sciences University, Kartal Dr Lutfi Kırdar City Hospital, Istanbul, Turkey.
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Choi W, Bae M, Chung Y. The impact of national health insurance on the compliance of positive airway pressure therapy in patients with obstructive sleep apnea. Clin Exp Otorhinolaryngol 2021; 15:100-106. [PMID: 33561916 PMCID: PMC8901945 DOI: 10.21053/ceo.2020.02362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/05/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Compliance with positive airway pressure (PAP) in patients with obstructive sleep apnea (OSA) directly affects its treatment efficacy. Since July 2018, polysomnography and PAP therapy have been covered by the national health insurance (NHI), which has reduced the price barrier and promoted PAP therapy in Korea. This study aimed to compare changes in PAP compliance before and after NHI implementation. Methods This study is a retrospective analysis in a tertiary hospital setting in Korea. From 2011 to 2019, patients with OSA (apnea-hypopnea index≥5) treated using a PAP device for ≥ 1 month were included. They were allocated to the pre-insurance (PI) (having started PAP before July 2018) and NHI groups (having received a PAP reimbursement by the NHI service). We collected and analyzed medical records and PAP use information for between-group comparisons of compliance. We defined compliance as (A) percentage of usage days, (B) percentage of days with usage for ≥ 4 night hours, and (C) average daily usage hours. Results We included 146 and 100 patients in the PI and NHI groups, respectively. Automatic positive airway pressure (APAP) mode and NHI were independent predictors of compliance B at the 3- and 9-month follow-up points. The NHI group showed significantly higher compliance A at 3, but not 9 months. For compliance B, the NHI group showed significantly higher compliance than the PI group at 1 month and 3 months, but not at 9 months. Compared with the PI group, the NHI group showed significantly higher compliance C only at 3 months. Conclusion The NHI has positively affected PAP therapy in patients with OSA. Insurance policy may affect compliance within the first 3 months.
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Affiliation(s)
- Woori Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Mirye Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoosam Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Carley DW, Prasad B, Reid KJ, Malkani R, Attarian H, Abbott SM, Vern B, Xie H, Yuan C, Zee PC. Pharmacotherapy of Apnea by Cannabimimetic Enhancement, the PACE Clinical Trial: Effects of Dronabinol in Obstructive Sleep Apnea. Sleep 2019; 41:4600041. [PMID: 29121334 DOI: 10.1093/sleep/zsx184] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Study Objectives There remains an important and unmet need for fully effective and acceptable treatments in obstructive sleep apnea (OSA). At present, there are no approved drug treatments. Dronabinol has shown promise for OSA pharmacotherapy in a small dose-escalation pilot study. Here, we present initial findings of the Phase II PACE (Pharmacotherapy of Apnea by Cannabimimetic Enhancement) trial, a fully blinded parallel groups, placebo-controlled randomized trial of dronabinol in people with moderate or severe OSA. Methods By random assignment, 73 adults with moderate or severe OSA received either placebo (N = 25), 2.5 mg dronabinol (N = 21), or 10 mg dronabinol (N = 27) daily, 1 hour before bedtime for up to 6 weeks. Results At baseline, overall apnea-hypopnea index (AHI) was 25.9 ± 11.3, Epworth Sleepiness Scale (ESS) score was 11.45 ± 3.8, maintenance of wakefulness test (MWT) mean latency was 19.2 ± 11.8 minutes, body mass index was 33.4 ± 5.4 kg/m2, and age was 53.6 ± 9.0 years. The number and severity of adverse events, and treatment adherence (0.3 ± 0.6 missed doses/week) were equivalent among all treatment groups. Participants receiving 10 mg/day of dronabinol expressed the highest overall satisfaction with treatment (p = .04). In comparison to placebo, dronabinol dose-dependently reduced AHI by 10.7 ± 4.4 (p = .02) and 12.9 ± 4.3 (p = .003) events/hour at doses of 2.5 and 10 mg/day, respectively. Dronabinol at 10 mg/day reduced ESS score by -3.8 ± 0.8 points from baseline (p < .0001) and by -2.3 ± 1.2 points in comparison to placebo (p = .05). MWT sleep latencies, gross sleep architecture, and overnight oxygenation parameters were unchanged from baseline in any treatment group. Conclusions These findings support the therapeutic potential of cannabinoids in people with OSA. In comparison to placebo, dronabinol was associated with lower AHI, improved self-reported sleepiness, and greater overall treatment satisfaction. Larger scale clinical trials will be necessary to clarify the best potential approach(es) to cannabinoid therapy in OSA.
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Affiliation(s)
- David W Carley
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL.,Department of Medicine, University of Illinois at Chicago, Chicago, IL.,Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL
| | - Bharati Prasad
- Department of Medicine, University of Illinois at Chicago, Chicago, IL.,Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL.,Jesse Brown VA Medical Center, Chicago, IL
| | - Kathryn J Reid
- Northwestern University Department of Neurology, Division of Sleep Medicine, Chicago, IL.,Northwestern Medicine Center for Circadian and Sleep Medicine, Chicago, IL
| | - Roneil Malkani
- Northwestern University Department of Neurology, Division of Sleep Medicine, Chicago, IL.,Northwestern Medicine Center for Circadian and Sleep Medicine, Chicago, IL
| | - Hryar Attarian
- Northwestern University Department of Neurology, Division of Sleep Medicine, Chicago, IL.,Northwestern Medicine Center for Circadian and Sleep Medicine, Chicago, IL
| | - Sabra M Abbott
- Northwestern University Department of Neurology, Division of Sleep Medicine, Chicago, IL.,Northwestern Medicine Center for Circadian and Sleep Medicine, Chicago, IL
| | - Boris Vern
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL.,Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL
| | - Hui Xie
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL
| | - Chengbo Yuan
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL
| | - Phyllis C Zee
- Northwestern University Department of Neurology, Division of Sleep Medicine, Chicago, IL.,Northwestern Medicine Center for Circadian and Sleep Medicine, Chicago, IL
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Matsumoto H, Kasai T, Suda S, Yatsu S, Shitara J, Murata A, Kato T, Hiki M, Yanagisawa N, Fujibayashi K, Nojiri S, Nishizaki Y, Shinohara M, Daida H. Randomized controlled trial of an oral appliance (SomnoDent) for sleep-disordered breathing and cardiac function in patients with heart failure. Clin Cardiol 2018; 41:1009-1012. [PMID: 30014565 PMCID: PMC6490037 DOI: 10.1002/clc.23028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/10/2018] [Accepted: 07/12/2018] [Indexed: 12/28/2022] Open
Abstract
In patients with heart failure (HF), sleep-disordered breathing (SDB) is a common comorbidity and a risk factor for poor clinical outcomes. SDB can be ameliorated by continuous positive airway pressure; however, inadequate adherence remains a major cause of treatment failure. On the other hand, the efficacy of oral appliance (OA) has been proved in orthodontics and otolaryngology, although the efficacy of OA in patients with HF remains to be elucidated. This trial aims to determine the efficacy of OA for SDB in patients with HF. Patients with HF undergoing optimal medical therapy who were diagnosed as having SDB (apnea-hypopnea index [AHI] ≥ 10 and percentage of central AHI per total AHI ≤ 70%) by using polysomnography (PSG) will be enrolled in the present study. Either patients with HF with reduced ejection fraction (left ventricular ejection fraction [LVEF] ≤ 50%) or HF with preserved ejection fraction (history of hospitalization because of acute decompensated HF) or plasma B-type natriuretic peptide (BNP) level ≥ 100 pg/mL will be included. Each patient will be randomly assigned into active OA or sham OA. PSG, laboratory, and echocardiographic data will be obtained after 3 months of intervention. The main outcome measures are AHI, plasma BNP, and E/e' determined with echocardiography. Furthermore, overnight urinary catecholamine, 6-min walk distance, Epworth sleepiness scale, and health-related quality of life will be assessed simultaneously. This trial started on April 1, 2017, and the projected end date is March 31, 2019. This study was registered in the University Hospital Medical Information Network (UMIN000025731).
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Affiliation(s)
- Hiroki Matsumoto
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
- Cardiovascular Respiratory Sleep MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Takatoshi Kasai
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
- Cardiovascular Respiratory Sleep MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Shoko Suda
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
- Cardiovascular Respiratory Sleep MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Shoichiro Yatsu
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
| | - Jun Shitara
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
| | - Azusa Murata
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
| | - Takao Kato
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
| | - Masaru Hiki
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
| | - Naotake Yanagisawa
- Medical Technology Innovation Center, Juntendo UniversityTokyoJapan
- Clinical Research and Trial Center, Juntendo University HospitalTokyoJapan
| | - Kazutoshi Fujibayashi
- Medical Technology Innovation Center, Juntendo UniversityTokyoJapan
- Clinical Research and Trial Center, Juntendo University HospitalTokyoJapan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo UniversityTokyoJapan
- Clinical Research and Trial Center, Juntendo University HospitalTokyoJapan
| | - Yuji Nishizaki
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
- Medical Technology Innovation Center, Juntendo UniversityTokyoJapan
- Clinical Research and Trial Center, Juntendo University HospitalTokyoJapan
| | - Mitsuyo Shinohara
- Department of Oral and Maxillofacial SurgeryJuntendo University School of MedicineTokyoJapan
| | - Hiroyuki Daida
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
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Sökücü SN, Aydin Ş, İn E, Dalar L. Association Between Titration Method and Outcomes of First Night Satisfaction and CPAP Compliance. Noro Psikiyatr Ars 2018; 56:123-126. [PMID: 31223245 DOI: 10.5152/npa.2017.19467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/14/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The gold standard therapy for obstructive sleep apnoea syndrome (OSAS) is continuous positive airway pressure (CPAP). Our study evaluated the relationship between first night satisfaction and CPAP compliance, and the effect of using the titration method in this relationship. Methods Between January 2012 and December 2012, 40 patients with the diagnosis of OSAS and without comorbidities, who had undergone CPAP titration, were included. Of these, 20 patients had undergone manual titration (MT) with polysomnography, whereas 20 patients had undergone auto-adjusted CPAP (APAP) titration. Questionnaires were administered during the morning of the titration night. The first-year adherence to treatment and patient compliance were evaluated. Results Forty patients were randomised in two groups; 35 patients who could procure the CPAP and were available at the end of the first year completed the study. From the 35 patients, 20 (6 males; 40%) were in the MT group while 15 (6 males; 30%) were in the APAP group. No significant difference was detected between the mean titration pressure levels obtained with the MT or APAP group. There was no difference in terms of responses to the questions on the questionnaire between the two groups. At the first-year evaluation, no significant difference was detected between the groups. Conclusions The titration method used to detect CPAP pressure, MT, or APAP does not affect patient satisfaction on the day following the titration night, and does not affect first-year compliance.
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Affiliation(s)
- Sinem Nedime Sökücü
- Department of Pulmonary Medicine, Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, İstanbul, Turkey
| | - Şenay Aydin
- Department of Neurology, Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, İstanbul, Turkey
| | - Erdal İn
- Department of Pulmonary Medicine, Fırat University School of Medicine, Elazığ, Turkey
| | - Levent Dalar
- Department of Pulmonary Medicine, İstanbul Bilim University, School of Medicine, İstanbul, Turkey
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Copur AS, Erik Everhart D, Zhang C, Chen Z, Shekhani H, Mathevosian S, Loveless J, Watson E, Kadri I, Wallace L, Simon E, Fulambarker AM. Effect of personality traits on adherence with positive airway pressure therapy in obstructive sleep apnea patients. Sleep Breath 2017; 22:369-376. [PMID: 28856525 DOI: 10.1007/s11325-017-1559-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/14/2017] [Accepted: 08/22/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Patient adherence with positive airway pressure (PAP) therapy is a significant clinical problem in obstructive sleep apnea treatment. Personality traits may be a factor for non-adherence. The aim of this study is to investigate the relationship between PAP therapy adherence and patient personality traits. METHODS Patients were screened and recruited during their visit to a sleep clinic. Baseline data were collected from each patient's electronic chart. Behavioral inhibition system/behavioral activation system (BIS/BAS) scales, short measure of five-factor model personality traits (mini-IPIP), positive and negative affect score (PANAS), and appetitive motivation scores (AMS) tests were used to measure personality traits. Data from the PAP device were obtained following a minimum of an initial 30 days, with adherence defined as >4 h/night on 70% of nights. Univariate and multivariate logistic regression and Pearson correlation tests were used to analyze the data. RESULTS A total of 400 patients were recruited. Three hundred twenty-one patients had all the data and were included in the study. Behavioral activation system-fun seeking (BAS-FS) and, to a certain extent, negative affect were significantly associated with adherence. Intellect/imagination was marginally significant. Additionally, older age (>65 years), profession, PAP type, side effects, efficiency, apnea-hypopnea index (AHI), and residual AHI showed significant associations with patient adherence with PAP therapy. Multivariate analysis revealed that BAS-FS was still a significant predictor of adherence even after adjusting for other covariates. CONCLUSION BAS-FS, negative affect, and intellect/imagination are significant factors for adherence to PAP therapy in obstructive sleep apnea patients.
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Affiliation(s)
- Ahmet Sinan Copur
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA. .,, 424 Park Lane, Lake Bluff,, Shields Township,, IL, 60044, USA.
| | | | - Chao Zhang
- Biostatistics & Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Zhengjia Chen
- Biostatistics & Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Haris Shekhani
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Sipan Mathevosian
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Eric Watson
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Imtiazali Kadri
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Leandra Wallace
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Edwin Simon
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Ashok M Fulambarker
- Captain James Lovell Federal Health Care Center, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Lugo V, Villanueva JA, Garmendia O, Montserrat JM. The role of telemedicine in obstructive sleep apnea management. Expert Rev Respir Med 2017. [DOI: 10.1080/17476348.2017.1343147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Vera Lugo
- Unitat del Son Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
| | - Jair Asir Villanueva
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Onintza Garmendia
- Unitat del Son Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Josep M. Montserrat
- Unitat del Son Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Williams NJ, Jean-Louis G, Ravenell J, Seixas A, Islam N, Trinh-Shevrin C, Ogedegbe G. A community-oriented framework to increase screening and treatment of obstructive sleep apnea among blacks. Sleep Med 2016; 18:82-7. [PMID: 26652238 PMCID: PMC4908818 DOI: 10.1016/j.sleep.2015.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 07/22/2015] [Accepted: 07/31/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a leading sleep disorder that is disproportionately more prevalent in minority populations and is a major risk factor for cardiovascular disease (CVD) morbidity and mortality. OSA is associated with many chronic conditions including hypertension, diabetes, and obesity, all of which are disproportionately more prevalent among blacks (ie, peoples of African American, Caribbean, or African descent). METHODS This article reviews studies conducted in the United States (US) that investigated sleep screenings and adherence to treatment for OSA among blacks. In addition, guidelines are provided for implementing a practical framework to increase OSA screening and management among blacks. RESULTS Several studies have documented racial/ethnic disparities in adherence to treatment for OSA. However, despite its public health significance, there is a paucity of studies addressing these disparities. Further, there is a lack of health programs and policies to increase screening and treatment of OSA among blacks and other minority populations. A practical framework to increase the number of blacks who are screened for OSA and treated appropriately is warranted. Such a framework is timely and major importance, as early identification of OSA in this high-risk population could potentially lead to early treatment and prevention of CVD, thereby reducing racial and ethnic disparities in sleep-related CVD morbidity and mortality.
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Affiliation(s)
- Natasha J Williams
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA.
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Joeseph Ravenell
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Azizi Seixas
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Nadia Islam
- Center for Health Equity, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Chau Trinh-Shevrin
- Center for Health Equity, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, NYU Medical Center, New York, NY 10016, USA
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Crawford MR, Espie CA, Bartlett DJ, Grunstein RR. Integrating psychology and medicine in CPAP adherence – New concepts? Sleep Med Rev 2014; 18:123-39. [DOI: 10.1016/j.smrv.2013.03.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 03/07/2013] [Accepted: 03/08/2013] [Indexed: 12/11/2022]
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Wickwire EM, Lettieri CJ, Cairns AA, Collop NA. Maximizing Positive Airway Pressure Adherence in Adults. Chest 2013; 144:680-693. [DOI: 10.1378/chest.12-2681] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Somiah M, Taxin Z, Keating J, Mooney AM, Norman RG, Rapoport DM, Ayappa I. Sleep quality, short-term and long-term CPAP adherence. J Clin Sleep Med 2012; 8:489-500. [PMID: 23066359 DOI: 10.5664/jcsm.2138] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Adherence to CPAP therapy is low in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). The purpose of the present study was to evaluate the utility of measures of sleep architecture and sleep continuity on the CPAP titration study as predictors of both short- and long-term CPAP adherence. METHODS 93 patients with OSAHS (RDI 42.8 ± 34.3/h) underwent in-laboratory diagnostic polysomnography, CPAP titration, and follow-up polysomnography (NPSG) on CPAP. Adherence to CPAP was objectively monitored. Short-term (ST) CPAP adherence was averaged over 14 days immediately following the titration study. Long-term (LT) CPAP adherence was obtained in 56/93 patients after approximately 2 months of CPAP use. Patients were grouped into CPAP adherence groups for ST (< 2 h, 2-4 h, and > 4 h) and LT adherence (< 4 h, > 4 h). Sleep architecture, sleep disordered breathing (SDB) indices, and daytime outcome variables from the diagnostic and titration NPSGs were compared between CPAP adherence groups. RESULTS There was a significant relationship between ST and LT CPAP adherence (r = 0.81, p < 0.001). Neither ST nor LT adherence were related to demographic variables, baseline severity of untreated SDB, sleep architecture, or measures of daytime impairment. Good CPAP adherence groups had significantly lower %N2 and greater %REM on the titration NPSG. A model combining change in sleep efficiency and change in sleep continuity between the diagnostic and titration NPSGs predicted 17% of the variance in LT adherence (p = 0.006). CONCLUSIONS These findings demonstrate that characteristics of sleep architecture, even on the titration NPSG, may predict some of the variance in CPAP adherence. Better sleep quality on the titration night was related to better CPAP adherence, suggesting that interventions to improve sleep on/prior to the CPAP titration study might be used as a therapeutic intervention to improve CPAP adherence.
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Affiliation(s)
- Manya Somiah
- NYU School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York, NY, USA
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Collop NA, Tracy SL, Kapur V, Mehra R, Kuhlmann D, Fleishman SA, Ojile JM. Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation. J Clin Sleep Med 2012; 7:531-48. [PMID: 22003351 DOI: 10.5664/jcsm.1328] [Citation(s) in RCA: 261] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Guidance is needed to help clinicians decide which out-of-center (OOC) testing devices are appropriate for diagnosing obstructive sleep apnea (OSA). A new classification system that details the type of signals measured by these devices is presented. This proposed system categorizes OOC devices based on measurements of Sleep, Cardiovascular, Oximetry, Position, Effort, and Respiratory (SCOPER) parameters.Criteria for evaluating the devices are also presented, which were generated from chosen pre-test and post-test probabilities. These criteria state that in patients with a high pretest probability of having OSA, the OOC testing device has a positive likelihood ratio (LR+) of 5 or greater coinciding with an in-lab-polysomnography (PSG)-generated apnea hypopnea index (AHI) ≥ 5, and an adequate sensitivity (at least 0.825).Since oximetry is a mandatory signal for scoring AHI using PSG, devices that do not incorporate oximetry were excluded. English peer-reviewed literature on FDA-approved devices utilizing more than 1 signal was reviewed according to the above criteria for 6 questions. These questions specifically addressed the adequacy of different respiratory and effort sensors and combinations thereof to diagnose OSA. In summary, the literature is currently inadequate to state with confidence that a thermistor alone without any effort sensor is adequate to diagnose OSA; if a thermal sensing device is used as the only measure of respiration, 2 effort belts are required as part of the montage and piezoelectric belts are acceptable in this context; nasal pressure can be an adequate measurement of respiration with no effort measure with the caveat that this may be device specific; nasal pressure may be used in combination with either 2 piezoelectric or respiratory inductance plethysmographic (RIP) belts (but not 1 piezoelectric belt); and there is insufficient evidence to state that both nasal pressure and thermistor are required to adequately diagnose OSA. With respect to alternative devices for diagnosing OSA, the data indicate that peripheral arterial tonometry (PAT) devices are adequate for the proposed use; the device based on cardiac signals shows promise, but more study is required as it has not been tested in the home setting; for the device based on end-tidal CO(2) (ETCO(2)), it appears to be adequate for a hospital population; and for devices utilizing acoustic signals, the data are insufficient to determine whether the use of acoustic signals with other signals as a substitute for airflow is adequate to diagnose OSA.Standardized research is needed on OOC devices that report LR+ at the appropriate AHI (≥ 5) and scored according to the recommended definitions, while using appropriate research reporting and methodology to minimize bias.
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Pieh C, Bach M, Popp R, Jara C, Crönlein T, Hajak G, Geisler P. Insomnia symptoms influence CPAP compliance. Sleep Breath 2012; 17:99-104. [PMID: 22311553 DOI: 10.1007/s11325-012-0655-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 12/16/2011] [Accepted: 01/13/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE The aim of this study is to determine parameters which influence 6-month compliance of continuous positive airway pressure therapy (CPAP) in patients with obstructive sleep apnea syndrome (OSAS). METHODS This prospective study investigated 73 patients (24 females) with OSAS and medical indication for CPAP therapy: age 55.1 ± 11.5 years, body mass index (BMI) 30.8 ± 5.0 kg/m2, Apnea-Hypopnea Index (AHI) 39.2 ± 26.7/h, Oxygen Desaturation Index (ODI) 33.2 ± 25.4/h, minimum O(2) saturation 78.9 ± 7.6%. The influence of baseline parameters (demographic and polysomnographic data, sleeping medication intakes, BMI, psychometrics [Epworth Sleepiness Scale, Regensburg Insomnia Scale, Vigilance test and Beck Depression Inventory]) on 6-month compliance was evaluated with a correlation and a linear regression analysis. RESULTS The baseline value of the Regensburg Insomnia Scale (RIS) predicts 6-month CPAP compliance (r = -0.376, R (2) = 0.14, p < 0.001), although no other baseline parameter correlates. Patients with a compliance of <4 h/night show higher RIS scores, i.e., more insomnia symptoms (17.6 ± 8.8) compared to those with ≥4 h/night (12.6 ± 6.9; p < 0.05). CONCLUSIONS Insomnia symptoms prior to the beginning of CPAP treatment show a negative influence on CPAP compliance. Further studies should clarify, if a treatment of insomnia symptoms leads to a benefit in compliance.
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Affiliation(s)
- Christoph Pieh
- Department of Psychiatry and Psychotherapy, Sleep Disorder Center, University Medical Center Regensburg, Regensburg, Germany.
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Yu CC, Luo CM, Liu YC, Wu HP. The effects of heated humidifier in continuous positive airway pressure titration. Sleep Breath 2012; 17:133-8. [PMID: 22311554 PMCID: PMC3575558 DOI: 10.1007/s11325-012-0661-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 01/18/2012] [Accepted: 01/23/2012] [Indexed: 11/03/2022]
Abstract
BACKGROUND Previous studies have shown that routine heated humidifier (HH) do not provide any benefit during continuous positive airway pressure (CPAP) titration if there are no significant naso-pharyngeal symptoms. In clinical practice, nasal diseases and upper airway symptoms are very common. This study investigates the effects of HH during CPAP titration in subjects with or without naso-pharyngeal symptoms. METHODS Fifty-two patients who received polysomnography with CPAP titration were randomly assigned to HH and non-HH groups. Their nasal cavity, pharynx, and naso-pharynx were evaluated before CPAP titration, and a questionnaire on subjective sensation, including naso-pharyngeal symptoms, willingness to further use CPAP, and sleep improvement, was used. Objective (e.g., leak, apnea-hypopnea index (AHI) reduction, and optimal CPAP pressure level) and subjective data were analyzed between the two groups. RESULTS In subjective sensation, the HH group did not have any benefit in further willingness to use CPAP and in sleep improvement, but had improved naso-pharyngeal symptoms (p = 0.043). There were no significant differences in leak, AHI reduction, and optimal CPAP pressure, even in patients with significant naso-pharyngeal symptoms. CONCLUSION Routine use of HH is not necessary during CPAP titration regardless of naso-pharyngeal symptoms.
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Affiliation(s)
- Chung-Chieh Yu
- Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
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Lettieri CF, Lettieri CJ, Carter K. Does home sleep testing impair continuous positive airway pressure adherence in patients with obstructive sleep apnea? Chest 2011; 139:849-854. [PMID: 21292757 DOI: 10.1378/chest.10-1060] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The increasing recognition of obstructive sleep apnea (OSA) and demand for polysomnography has created a need for home sleep testing (HST) using unattended diagnostic and titration studies. Although these studies increase access to care and reduce cost, the limited interaction with sleep laboratories may negatively affect positive airway pressure (PAP) adherence. We sought to determine the difference in PAP use between HST and traditional in-laboratory studies. METHODS This observational cohort study included 210 patients with OSA classified into three equal groups. Following preestablished guidelines, group 1 underwent unattended, type III home diagnostic and unattended home auto-adjustable PAP (APAP) titrations; group 2 underwent in-laboratory, type I diagnostic and continuous PAP titration studies; group 3 underwent type I diagnostic and APAP titration studies. Group 1 was primarily managed and educated in a primary care clinic, whereas groups 2 and 3 received extensive education in an academic sleep medicine center. Objective measures of PAP use during the first 4 to 6 weeks of therapy were compared between groups. RESULTS Type of study and location of care did not affect PAP adherence. PAP was used for 70%, 73%, and 72% of nights in groups 1, 2, and 3, respectively (P = .94). Mean hours of nightly use (4.4 ± 2.0 h, 4.7 ± 1.5 h, and 4.6 ± 1.5 h; P = .98) was also similar. Regular use was observed in 54%, 51%, and 50% of subjects (P = .84). Discontinuation rates were similar between groups. CONCLUSIONS PAP usage did not differ between those undergoing HST vs in-laboratory studies. HST offers a more accessible and cost-effective alternative without compromising therapeutic adherence.
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Affiliation(s)
- Christine F Lettieri
- Department of Family Medicine, DeWitt Army Community Hospital, Fort Belvoir, VA; Department of Family Medicine, Uniformed Services University, Bethesda, MD.
| | - Christopher J Lettieri
- Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington DC; Department of Medicine, Uniformed Services University, Bethesda, MD
| | - Kevin Carter
- Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington DC
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Buchanan PR, Grunstein RR. Positive-pressure treatment of obstructive sleep apnea syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2011; 98:421-439. [PMID: 21056203 DOI: 10.1016/b978-0-444-52006-7.00028-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Peter R Buchanan
- Woolcock Institute of Medical Research, University of Sydney, Department of Respiratory Medicine, Liverpool Hospital and Sleep Medicine Consultative Service, St. Vincent's Clinic, Sydney, Australia.
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The need for pressure changes in CPAP therapy 2-3 months after initial treatment: a prospective trial in 905 patients with sleep-disordered breathing. Sleep Breath 2010; 15:107-12. [PMID: 20204534 DOI: 10.1007/s11325-010-0332-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 01/19/2010] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the need for pressure change in patients with sleep-disordered breathing (SDB) several weeks after therapy initiation. We prospectively studied 905 consecutive patients (740 men and 165 women) with SDB and therapeutic intervention with continuous positive airway pressure (CPAP)/bilevel PAP. METHODS Several weeks after therapy initiation, patients were restudied for control, and pressure was optimized if it was necessary. The differences in CPAP pressure from initial treatment and control night were assessed. Anthropometric data, polysomnography data, Epworth sleepiness scale, and Berlin questionnaire scores were correlated to pressure differences from the first and control titration nights. RESULTS Pressure change was needed in 511 patients (58.2%). Pressure increase was more frequent than pressure reduction (41.7% vs. 11.7%). Mean pressure increase in CPAP was 1.3 mbar, and mean decrease, 1.6 mbar. In the bilevel PAP group, the mean increase in inspiratory pressure was 1.2 mbar, and in expiratory pressure, 0.8 mbar; the mean decrease in inspiratory pressure was 1.9 mbar, and in expiratory pressure, 1.4 mbar. No correlation was found between anthropometric data, sleep efficacy, the amount of rapid eye movement sleep per night, or questionnaire scores and pressure change. CONCLUSION Our results show that pressure changes are necessary in the majority of patients several weeks after therapy initiation. Therefore, re-evaluation of therapy pressure is useful.
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Weaver TE, Sawyer A. Management of obstructive sleep apnea by continuous positive airway pressure. Oral Maxillofac Surg Clin North Am 2010; 21:403-12. [PMID: 19944340 DOI: 10.1016/j.coms.2009.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Obstructive sleep apnea (OSA) is a common problem, with 9% to 28% of women and 24% to 26% of males having apneic events at a treatable level, making this syndrome a serious public health issue. This article describes the outcomes associated with continuous positive airway pressure treatment, significance of the issue of poor adherence in OSA, discusses evidence regarding the optimal duration of nightly use, describes the nature and predictors of nonadherence, and reviews interventions that have been tested to increase nightly use and suggests management strategies.
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Affiliation(s)
- Terri E Weaver
- Biobehavioral and Health Sciences Division, University of Pennsylvania School of Nursing, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA.
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Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Ann Am Thorac Soc 2008; 5:173-8. [PMID: 18250209 DOI: 10.1513/pats.200708-119mg] [Citation(s) in RCA: 1043] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Despite the high efficacy of continuous positive airway pressure (CPAP) to reverse upper airway obstruction in sleep apnea, treatment effectiveness is limited by variable adherence to prescribed therapy. When adherence is defined as greater than 4 hours of nightly use, 46 to 83% of patients with obstructive sleep apnea have been reported to be nonadherent to treatment. Evidence suggests that use of CPAP for longer than 6 hours decreases sleepiness, improves daily functioning, and restores memory to normal levels. The decision to embrace CPAP occurs during the first few days of treatment. Although many strategies in patient interface with CPAP or machine modality are marketed to improve CPAP usage, there are few data to support this. No single factor has been consistently identified as predictive of adherence. Patient perception of symptoms and improvement in sleepiness and daily functioning may be more important in determining patterns of use than physiologic aspects of disease severity. Emerging data suggest that various behavioral interventions may be effective in improving CPAP adherence.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the nature of adherence to continuous positive airway pressure (CPAP), identify measurement modalities, consider factors that have been identified in the literature associated with nonadherence and present interventions that may promote use. RECENT FINDINGS Patient characteristics associated with CPAP adherence include self-reported daytime sleepiness, level of disease severity, nasal resistance and perception of symptomatic benefit. Heated humidification and flexible pressure also promote use. Feelings of claustrophobia affect adherence in a small proportion of patients. Adherence was better with nasal mask than nasal pillows and full face mask and equal to oral interface. Patients who employed an active coping style and those with perceived self-efficacy, especially following exposure to treatment, had higher levels of adherence. A videotape targeted to improve self-efficacy and other interventions to enhance cognitions related to CPAP has generated greater use. Intensive support utilizing several days of titration, education and home visits also improves adherence. SUMMARY Adherence to CPAP treatment is an important clinical issue that needs to be routinely assessed and addressed. Frequent patient contact to troubleshoot problems will contribute to adherence. Further study is needed to identify factors that affect adherence and cost-effective interventions.
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Affiliation(s)
- Terri E Weaver
- Biobehavioral and Health Science Division, School of Nursing, Center for Sleep and Respiratory Neurobiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-6096, USA.
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Abstract
Obstructive sleep apnea (OSA) is a highly significant condition based both on the high prevalence in community and significant consequences. Obstructive sleep apnea syndrome (OSAS), OSA together with hypersomnolence, is seen in 4% of middle-aged men and 2% of middle-aged women. OSA is associated with impaired quality of life and increased risks of motor vehicle accidents, cardiovascular disease (including hypertension and coronary artery disease), and metabolic syndrome. There is some evidence for the use of conservative interventions such as weight loss and position modification. CPAP remains the mainstay of treatment in this condition with high-level evidence supporting its efficacy. Continuous positive airway pressure (CPAP) is an intrusive therapy, with long-term adherence rates of less than 70%. Dental appliances have been shown to be effective therapy in some subjects but are limited by the inability to predict treatment responders. Alternative treatments are discussed but there is little role for upper airway surgery (except in a select few experienced institutions) or pharmacological treatment. The current levels of evidence for the different treatment regimens are reviewed.
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Affiliation(s)
- Craig A Hukins
- Sleep Disorders Centre, Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Woolloongabba, Australia.
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Abstract
AIM This paper reports a successful transformation of clinical practice from inpatient diagnosis and initiation of treatment for obstructive sleep apnoea syndrome to a nurse-led domiciliary model increasing patient access and choice. BACKGROUND Obstructive sleep apnoea syndrome is common, affecting globally 2-4% of the adult population. It is characterized by periodic complete or partial collapse of the upper airway, leading to hypoxaemia and sleep fragmentation, resulting in daytime sleepiness and impaired quality of life. It can be treated successfully with nocturnal continuous positive airway pressure. Strategies for diagnosis and initiation of treatment have traditionally been inpatient-based, but limited facilities and increasing demand in many countries have necessitated alternative strategies. METHODS As an extension to our current inpatient provision, we have established nurse-led domiciliary investigation and treatment. Patients meeting predefined criteria undergo a limited sleep study followed by therapy initiation at home. Confirmation of investigation findings, evaluation of treatment, education and long-term review are carried out in nurse-led clinics. RESULTS We evaluated outcome in the first 150 patients managed in this way between August 2002 and December 2003. In our highly selected patient group, 79% of those who undertook a trial of treatment continued at 3 months, with average compliance >5 hours per night, a figure which compares favourably with our overall patient population. Statistically significant sustained improvement in sleepiness was seen. Independent predictors of long-term acceptability of continuous positive airway pressure were disease severity and magnitude of improvement in sleepiness. CONCLUSION A nurse-led service for domiciliary diagnosis, treatment initiation and on-going management of selected patients with obstructive sleep apnoea syndrome is feasible and cost-effective, with outcomes comparable with conventional inpatient services. This approach is applicable in most countries where increasing demand for investigations greatly exceeds the availability of traditional facilities.
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Affiliation(s)
- Mark Tomlinson
- Department of Respiratory Medicine, Freeman Hospital, Newcastle upon Tyne, UK.
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Meurice JC. Faut-il traiter le SAS par PPC autopilotée ? Arguments contre. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)72483-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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d'Ortho MP. Auto-titrating continuous positive airway pressure for treating adult patients with sleep apnea syndrome. Curr Opin Pulm Med 2004; 10:495-9. [PMID: 15510056 DOI: 10.1097/01.mcp.0000144438.73152.4a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The treatment of sleep apnea syndrome (SAS) is continuous positive airway pressure (CPAP) as the first line of therapy. The current standard is for an attendant technician to titrate CPAP by means of an in-laboratory polysomnography to obtain a fixed single pressure. Over the past decade and a half, some devices able to modify the pressure delivered to the patient overnight and from night to night have become available. The efficacy of such devices to manage SAS has been demonstrated, however the question of their use either as unattended APAP to determine pressures for fixed CPAP or for self-adjusting APAP treatment on a long-term basis is still matter of debate. RECENT FINDINGS However, if cost considerations may render reluctant to APAP, off note, using APAP could allow initiation of treatment more quickly, reduce in-laboratory time, and reduce healthcare costs. SUMMARY Auto-titrating continuous positive airway pressure and CPAP are to date equivalent in terms of efficacy to treat SAS, but APAP could allow quick initiation of treatment and therefore reduce healthcare costs.
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Affiliation(s)
- M-P d'Ortho
- Service de Physiologie, Explorations Fonctionnelles Hôpital Henri Mondor Assistance Publique, Hôpitaux de Paris, Créteil, France.
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