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Pordzik J, Ludwig K, Seifen C, Ruckes C, Huppertz T, Bahr-Hamm K, Hackenberg B, Matthias C, Gouveris H. Real-world data on polysomnography- and patient-reported outcomes in hypoglossal nerve stimulation and auto-titrating positive airway pressure therapy for obstructive sleep apnea. Respir Med 2024; 232:107750. [PMID: 39084269 DOI: 10.1016/j.rmed.2024.107750] [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: 03/14/2024] [Revised: 07/17/2024] [Accepted: 07/29/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Few data are available comparing first-line positive airway pressure (PAP) therapy of obstructive sleep apnea (OSA), especially auto-adjusting PAP (aPAP), with second-line hypoglossal nerve stimulation (HGNS) therapy. The aim of this study was to directly compare these therapeutic options by standard polysomnography (PSG)-related parameters and patient-reported outcomes in comparable groups. METHODS 20 patients (aged 57.30 ± 8.56 years; 6 female) were included in the HGNS and 35 patients (aged 56.83 ± 9.20 years; 9 female) were included in the aPAP group. In both groups participants had to fit the current guideline criteria for HGNS treatment. Groups were compared by analysis of covariance (ANCOVA) using inverse propensity score weighting. RESULTS Propensity scores did not differ between groups. Pre-therapeutic AHI (HGNS: 40.22 ± 12.78/h; aPAP: 39.23 ± 12.33/h) and ODI (HGNS: 37.9 ± 14.7/h, aPAP: 34.58 ± 14.74/h) were comparable between the groups. After 413.6 ± 116.66 days (HGNS) and 162.09 ± 140.58 days (aPAP) of treatment AHI (HGNS: 30.22 ± 17.65/h, aPAP group: 4.71 ± 3.42/h; p < 0.001) was significantly higher in the HGNS group compared to the aPAP group. However, epworth sleepiness scale (ESS) was post-interventionally significantly lower in the HGNS group compared to the aPAP group (pretherapeutic: HGNS: 13.32 ± 5.81 points, aPAP: 9.09 ± 4.71 points; posttherapeutic: HGNS: 7.17 ± 5.06 points; aPAP: 8.38 ± 5.41 points; p < 0.01). CONCLUSION These are novel real-world data. More research on the key parameters regarding titration of the HGNS neurostimulation parameter tuning and on the impact of factors influencing HGNS adherence is needed.
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Affiliation(s)
- Johannes Pordzik
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany.
| | - Katharina Ludwig
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
| | - Christopher Seifen
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center Mainz, 55131, Mainz, Germany
| | - Tilman Huppertz
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
| | - Katharina Bahr-Hamm
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
| | - Berit Hackenberg
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
| | - Christoph Matthias
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
| | - Haralampos Gouveris
- Department of Otolaryngology, Head and Neck Surgery & Sleep Medicine Center, University Medical Center Mainz, 55131, Mainz, Germany
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Di Maria J, Hartley S, Levy J, Delord V, Vaugier I, Beghadi J, Ibrahim N, Bensmail D, Prigent H, Léotard A. Adherence to continuous positive airway pressure therapy in patients with spinal cord injury and obstructive sleep apnea: trajectories and predictors. Sleep Breath 2024; 28:753-762. [PMID: 38063994 DOI: 10.1007/s11325-023-02955-5] [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] [Received: 06/14/2023] [Revised: 10/06/2023] [Accepted: 11/20/2023] [Indexed: 05/31/2024]
Abstract
PURPOSE To identify specific determinants of non-adherence or cessation of continuous positive airway pressure (CPAP) therapy in a population of patients with spinal cord injuries (SCI). METHODS Retrospective analysis of data from patients with SCI who underwent a full night supervised polysomnography between 2015 and 2021 and presented with moderate to severe obstructive sleep apnea (OSA) and for whom CPAP was indicated. Adherence was studied at 1, 6, and 12 months. Univariate and multivariate analyses were performed to identify factors associated with non-adherence (< 4 h per night or CPAP cessation). Factors studied were demographic and disease-related data and both subjective and objective sleep parameters. RESULTS A total of 60 patients were included (40% cervical SCI). In univariate analysis, the only predictive parameters of non-adherence observed at 1, 6, and 12 months were the average use of CPAP on the 1st night (p = 0.02) and over the 1st week (p ≤ 0.001). A complete lesion (AIS-A) was predictive of non-adherence at 1 and 6 months (p = 0.02 at 6 months), while mask leakage was associated with non-adherence at 12 months (p = 0.02). Upper limb autonomy and the presence of family caregivers did not appear to be protective. In multivariate analysis, only the average use in the first week remained predictive of adherence (> 4 h) in the short, medium and long term. CONCLUSION In patients with SCI and OSA, the 1st week of CPAP treatment seems to be determinant of short-, medium-, and long-term CPAP adherence. Support for SCI patients from the start of treatment is essential and may help avoid treatment failures.
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Affiliation(s)
- Julie Di Maria
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380, Garches, France
- « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France
| | - Sarah Hartley
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380, Garches, France
| | - Jonathan Levy
- « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France
- Service de médecine physique et de réadaptation, AP-HP, Hôpital Raymond Poincaré, Garches, France
- Sleep Lab Initiative In PMR group (SLIIP), Garches, France
| | | | - Isabelle Vaugier
- Centre d'investigation clinique 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Julien Beghadi
- ASV Santé, 125, Avenue Louis Roche, 92230, Gennevilliers, France
| | | | - Djamel Bensmail
- « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France
- Service de médecine physique et de réadaptation, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Hélène Prigent
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380, Garches, France
- « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France
| | - Antoine Léotard
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, 104 Boulevard Raymond Poincaré, 92380, Garches, France.
- « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France.
- Sleep Lab Initiative In PMR group (SLIIP), Garches, France.
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Stevens D, Title M, Spurr K, Morrison D. Positive airway pressure therapy adherence and outcomes in obstructive sleep apnea: An exploratory longitudinal retrospective randomized chart review. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2024; 60:28-36. [PMID: 38314346 PMCID: PMC10838662 DOI: 10.29390/001c.92080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/05/2024] [Indexed: 02/06/2024]
Abstract
Background Positive airway pressure (PAP) therapy is prescribed to patients with obstructive sleep apnea (OSA). A commonly used definition for PAP therapy adherence is based upon the minimum requirements to receive Medicare coverage in the US, defined as PAP usage of four or more hours per night on 70 percent of nights for at least 30 consecutive days. However, little evidence exists to support this definition for PAP therapy adherence. Therefore, the present study sought to determine the efficacy of the present definition of PAP therapy adherence on longitudinal outcomes in patients with OSA, using objectively measured PAP device usage time. Methods An exploratory longitudinal, retrospective, randomized chart review was done to assess clinical outcomes between patients with OSA who were defined as PAP therapy adherent (n=50) and non-adherent (n=50) during an eight-year observation period. Results No significant differences were shown between groups for mortality, hospitalizations, or development of co-morbidities during the observation period. However, logistic regression showed significantly higher odds of adherence in male patients compared to female patients (OR=8.519; 95%CI=1.301-55.756; p=0.025) and significantly lower odds of adherence in patients with higher normal (OR=0.039; 95%CI=0.005-0.392; p=0.003), mild excessive (OR=0.039; 95%CI=0.003-0.517; p=0.014), and severe excessive (OR=0.088; 95%CI=0.012-0.635; p=0.016) daytime sleepiness compared to patients with lower normal daytime sleepiness. An increasing number of hospitalizations also corresponded with a significant decrease in odds of being adherent (OR=0.741; 95%CI=0.551-0.995; p=0.046). Conclusion The present study supports a steadily growing body of literature calling for more consideration and evidence to support a definition of PAP therapy adherence that is clinically meaningful.
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Affiliation(s)
- Daniel Stevens
- School of Health and Human Performance Dalhousie University
| | - Michaela Title
- School of Health and Human Performance Dalhousie University
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Zhang G, Zhao X, Zhao F, Tan J, Zhang Q. Contribution of central sleep apnea to severe sleep apnea hypopnea syndrome. Sleep Breath 2023; 27:1839-1845. [PMID: 36849673 PMCID: PMC10539457 DOI: 10.1007/s11325-023-02776-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Central sleep apnea (CSA) is usually distinguished from obstructive sleep apnea (OSA). In fact, CSA is often a component of severe sleep apnea hypopnea syndrome (SAHS), rather than occurring alone. We investigated the clinical characteristics and polysomnography (PSG) parameters of CSA components in patients with severe SAHS. METHODS The clinical characteristics and PSG parameters were retrospectively analyzed. RESULTS Pure or dominant CSA was rare (5% of all patients). Of all patients with CSA, 72% also exhibited other apnea subtypes that contributed to severe SAHS. Among patients with severe SAHS, those with CSA were more likely than others to be older; thinner; exhibit higher prevalences of comorbid coronary heart disease, arrhythmia, and heart failure; a higher apnea/hypopnea index (AHI); mixed apnea index (MAI); an elevated oxygen desaturation index (ODI); and more nighttime oxygen saturation levels < 90%. Multivariate logistic regression analysis revealed that older age, comorbid arrhythmia or heart failure, and an elevated ODI were independently associated with CSA. CONCLUSION Patients who complain of snoring or apnea may be better evaluated by comprehensive PSG prior to treatment if they are old, show greater hypoxia, or suffer from arrhythmia and/or heart failure, because such patients are more likely than others to exhibit CSA.
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Affiliation(s)
- Guoxin Zhang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
- Chest Clinical College, Tianjin Medical University, Tianjin, 300222, China
- Respiratory and Critical Care Medicine Department and Sleep Center, Tianjin Chest Hospital, Tianjin, 300222, China
- Tianjin Medical University, Tianjin, China
| | - Xiaoyun Zhao
- Chest Clinical College, Tianjin Medical University, Tianjin, 300222, China
- Respiratory and Critical Care Medicine Department and Sleep Center, Tianjin Chest Hospital, Tianjin, 300222, China
| | - Fang Zhao
- Chest Clinical College, Tianjin Medical University, Tianjin, 300222, China
- Respiratory and Critical Care Medicine Department and Sleep Center, Tianjin Chest Hospital, Tianjin, 300222, China
| | - Jin Tan
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
| | - Qiang Zhang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China.
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