1
|
Rubanenko AO, Dyachkov VA, Miroshnichenko AI. [Factors affecting adherence to CPAP therapy in patients with obstructive sleep apnea syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:58-65. [PMID: 38934667 DOI: 10.17116/jnevro202412405258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Analysis of factors affecting adherence to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA). MATERIAL AND METHODS The literature search was carried out using the databases PubMED, Google Scholar, E-library, Cyberleninka for the period 2013-2023 and included reviews and original articles. RESULTS The main groups of factors affecting adherence to CPAP therapy in patients with OSA have been established. These include sociodemographic and socioeconomic factors, the severity of OSA and the severity of clinical symptoms, and psychosocial factors. Strategies that can improve adherence were identified (educational technologies for patients, telemedicine technologies, behavioral therapy, modern technical interventions). CONCLUSION Factors that improve adherence to CPAP therapy are high levels of education and income, more severe OSA forms accompanied by daytime sleepiness, support from the patient's spouse and social support. Factors such as low levels of education and income, smoking, symptoms of depression and hypochondria, as well as side-effects worsen adherence to CPAP therapy, including refusal to continue treatment. It should be noted that all the identified factors are very closely associated with each other, so it is necessary to evaluate them comprehensively in each patient with OSA.
Collapse
Affiliation(s)
- A O Rubanenko
- Samara State Medical University of the Ministry of Healthcare of the Russia, Samara, Russia
| | - V A Dyachkov
- Samara State Medical University of the Ministry of Healthcare of the Russia, Samara, Russia
| | - A I Miroshnichenko
- Samara State Medical University of the Ministry of Healthcare of the Russia, Samara, Russia
| |
Collapse
|
2
|
MacLean JE, Fauroux B. Long-term non-invasive ventilation in children: Transition from hospital to home. Paediatr Respir Rev 2023; 47:3-10. [PMID: 36806331 DOI: 10.1016/j.prrv.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
Long-term non-invasive ventilation (NIV) is an accepted therapy for sleep-related respiratory disorders and respiratory insufficiency or failure. Increase in the use of long-term NIV may, in part, be driven by an increase in the number of children surviving critical illness with comorbidities. As a result, some children start on long-term NIV as part of transitioning from hospital to home. NIV may be used in acute illness to avoid intubation, facilitate extubation or support tracheostomy decannulation, and to avoid the need for a tracheostomy for long-term invasive ventilation. The decision about whether long-term NIV is appropriate for an individual child and their family needs to be made with care. Preparing for transition from the hospital to home involves understanding how NIV equipment is obtained and set-up, education and training for parents/caregivers, and arranging a plan for clinical follow-up. While planning for these transitions is challenging, the goals of a shorter time in hospital and a child living well at home with their family are important.
Collapse
Affiliation(s)
- Joanna E MacLean
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Canada; Women and Children's Health Research Institute, University of Alberta, Canada; Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, Necker University Hospital, AP-HP, Paris, France; Université de Paris, EA 7330 VIFASOM, F-75004 Paris, France
| |
Collapse
|
3
|
Htun ZM, McCullough L, Lastra AC. Ineffective CPAP Treatment After Effective CPAP Titration. Chest 2021; 158:e311-e315. [PMID: 33280775 DOI: 10.1016/j.chest.2020.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/27/2020] [Accepted: 07/12/2020] [Indexed: 11/16/2022] Open
Abstract
CASE PRESENTATION A 67-year-old woman was evaluated for snoring, frequent awakenings, excessive sleepiness, nocturia, headaches, witnessed apneas, and choking and gasping from sleep. Medical history included OSA, hypertension, type 2 diabetes, depression in remission, and mild intermittent asthma. Epworth sleepiness scale score was 22 (abnormal is ≥10, maximum score is 24; increasing scores represent increasing sleepiness). She had been prescribed CPAP therapy. She reported initial nasal mask discomfort (ResMed AirFit N20 nasal mask), which improved with change to an oronasal mask. Patient used nightly, with acceptable tolerance. Sleep onset and wake times remained consistent, with an average total sleep time of 7 hours. She denied alcohol intake, sedative medication use, or changes in weight.
Collapse
Affiliation(s)
- Zin Mar Htun
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago IL
| | - Lindsay McCullough
- Division of Pulmonary, Critical Care, and Sleep Medicine, Rush University Medical Center, Chicago, IL
| | - Alejandra C Lastra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Rush University Medical Center, Chicago, IL.
| |
Collapse
|
4
|
Ghadiri M, Grunstein RR. Clinical side effects of continuous positive airway pressure in patients with obstructive sleep apnoea. Respirology 2020; 25:593-602. [PMID: 32212210 DOI: 10.1111/resp.13808] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/05/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022]
Abstract
CPAP is considered the gold standard treatment in OSA and is highly efficacious in controlling OSA symptoms. However, treatment effectiveness is limited because of many factors including low adherence due to side effects. This review highlights the range of side effects associated with CPAP therapy in patients with OSA. This information is important for the initiation of patients onto CPAP as well as their continued care while on treatment, given the increase in non-medically supervised CPAP care models in use globally.
Collapse
Affiliation(s)
- Maliheh Ghadiri
- Woolcock Institute of Medical Research, Respiratory Technology Group, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, Respiratory Technology Group, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| |
Collapse
|
5
|
Castro-Codesal ML, Olmstead DL, MacLean JE. Mask interfaces for home non-invasive ventilation in infants and children. Paediatr Respir Rev 2019; 32:66-72. [PMID: 31130424 DOI: 10.1016/j.prrv.2019.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 12/25/2022]
Abstract
The selection of the mask interface for non-invasive ventilation (NIV) is recognized to be an essential part for therapy success. While nasal masks are the first recommended option in children and adults, there are indications for other mask types such as intolerance or complications from nasal masks. Evidence comparing performance, adherence and complication risk among mask interfaces in pediatrics is, however, scarce and information is often extrapolated from adult studies. Given this gap in knowledge and the lack of guidelines on NIV initiation in children, mask selection often relies on the clinicians' knowledge and expertise. Careful mask selection, a well-fitting headgear and time investment for mask desensitization are some important recommendations for adequate mask adaptation in children. Frequent mask-related complications include nasal symptoms, unintentional leak, mask displacement, skin injury, and midface hypoplasia. Close monitoring and a pro-active approach may help to minimize complications and promote the optimal use of home NIV.
Collapse
Affiliation(s)
- Maria L Castro-Codesal
- Department of Pediatrics, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada; Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada.
| | - Deborah L Olmstead
- Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada
| | - Joanna E MacLean
- Department of Pediatrics, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada; Stollery Children's Hospital, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada
| |
Collapse
|
6
|
Nascimento JA, Genta PR, Fernandes PHS, Barroso LP, Carvalho TS, Moriya HT, Madeiro F, Lorenzi-Filho G, Nakagawa NK. Predictors of oronasal breathing among obstructive sleep apnea patients and controls. J Appl Physiol (1985) 2019; 127:1579-1585. [PMID: 31465714 DOI: 10.1152/japplphysiol.00964.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Oronasal breathing may adversely impact obstructive sleep apnea (OSA) patients either by increasing upper airway collapsibility or by influencing continuous positive airway pressure (CPAP) treatment outcomes. Predicting a preferential breathing route would be helpful to guide CPAP interface prescription. We hypothesized that anthropometric measurements but not self-reported oronasal breathing are predictors of objectively measured oronasal breathing. Seventeen OSA patients and nine healthy subjects underwent overnight polysomnography with an oronasal mask with two sealed compartments attached to independent pneumotacographs. Subjects answered questionnaires about nasal symptoms and perceived breathing route. Oronasal breathing was more common (P = <0.001) among OSA patients than controls while awake (62 ± 44 vs. 5 ± 6%) and during sleep (59 ± 39 vs. 25 ± 21%, respectively). Oronasal breathing was associated with OSA severity (P = 0.009), age (P = 0.005), body mass index (P = 0.044), and neck circumference (P = 0.004). There was no agreement between objective measurement and self-reported breathing route among OSA patients while awake (κ = -0.12) and asleep (κ = -0.02). The breathing route remained unchanged after 92% of obstructive apneas. These results suggest that oronasal breathing is more common among OSA patients than controls during both wakefulness and sleep and is associated with OSA severity and anthropometric measures. Self-reporting is not a reliable predictor of oronasal breathing and should not be considered an indication for oronasal CPAP.NEW & NOTEWORTHY Continuous positive airway pressure (CPAP) interface choice for obstructive sleep apnea (OSA) patients is often guided by nasal symptoms and self-reported breathing route. We showed that oronasal breathing can be predicted by anthropometric measurements and OSA severity but not by self-reported oronasal breathing. Self-reported breathing and nasal symptoms should not be considered for CPAP interface choice.
Collapse
Affiliation(s)
- Juliana A Nascimento
- Department of Physiotherapy, LIM-54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Pedro R Genta
- Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo H S Fernandes
- Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lucia P Barroso
- Departament of Statistics, Instituto de Matemática e Estatística da Universidade de São Paulo, São Paulo, Brazil
| | - Tômas S Carvalho
- Department of Physiotherapy, LIM-54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Henrique T Moriya
- Biomedical Engineering Laboratory, Telecommunication and Control Engineering Department, Escola Politécnica da Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda Madeiro
- Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Naomi Kondo Nakagawa
- Department of Physiotherapy, LIM-54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Sleep Laboratory, Pulmonary Division, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
7
|
Foellner S, Guth P, Jorde I, Lücke E, Ganzert C, Stegemann-Koniszewski S, Schreiber J. Prevention of leakage due to mouth opening through applying an oral shield device (Sominpax™) during nasal CPAP therapy of patients with obstructive sleep apnea. Sleep Med 2019; 66:168-173. [PMID: 31884409 DOI: 10.1016/j.sleep.2019.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND/OBJECTIVE The first line treatment for obstructive sleep apnea (OSA) is nasal continuous positive airway pressure (nCPAP), for which a variety of masks are available. While nasal masks (NM) are the first choice; oronasal masks (ONM) are also frequently used to prevent mouth dryness resulting from mouth opening. Our cross-sectional, prospective, randomized, un-blinded study addressed the efficacy of wearing an oral shield in addition to NM in preventing mouth leakage METHODS: Patients with OSA and established therapy using NM and complaining about mouth dryness (n = 29) underwent three polysomnographies (PSGs) using NM, ONM or a nose mask in combination with an oral shield (NMS). Mask leakage was continuously documented and objective sleep quality was assessed. RESULTS There were significant differences in the apnea-hypopnea-index (AHI) between ONM (8.5/h; SD 6,7) and NM/nasal mask combined with oral shield device (NMS) (2.6/h; SD 2,3; 2.7/h; SD 2,6) (p < 0,05) as well as in leakage [ONM (39.7 l/min SD 12,4); NM (34.6 l/min SD 9,4); NMS (33.1 l/min SD 9,6)] (p = 0.011). Furthermore, analysis of sleep quality (NREM3) favored NM and NMS over ONM (p = 0.02). There were no significant differences between NM and NMS in any objective outcome. CONCLUSIONS Our data consistently confirmed the NM as the first choice for continuous positive airway pressure (CPAP) therapy of OSA. Notably, we demonstrated a high potential of the oral shield for patients with mouth opening to achieve additional comfort and thereby possibly compliance, without affecting nCPAP therapy effectiveness.
Collapse
Affiliation(s)
- Sebastian Foellner
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany.
| | - Patricia Guth
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany
| | - Ilka Jorde
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany
| | - Eva Lücke
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany
| | - Christine Ganzert
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany
| | - Sabine Stegemann-Koniszewski
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany
| | - Jens Schreiber
- Otto - von - Guericke University Magdeburg, Dept. of Pneumonology, Centre for Sleep Medicine, Magdeburg, Germany
| |
Collapse
|
8
|
|
9
|
Nasal vs Oronasal CPAP for OSA Treatment. Chest 2018; 153:665-674. [DOI: 10.1016/j.chest.2017.10.044] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/17/2017] [Accepted: 10/20/2017] [Indexed: 01/11/2023] Open
|
10
|
Upper airway obstruction induced by non-invasive ventilation using an oronasal interface. Sleep Breath 2018; 22:781-788. [DOI: 10.1007/s11325-018-1640-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/15/2018] [Accepted: 02/06/2018] [Indexed: 12/14/2022]
|
11
|
Need for positive airway pressure re-titration with changes in mask style. Sleep Med 2018; 41:100-101. [DOI: 10.1016/j.sleep.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 11/18/2022]
|