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Goodridge D, Duncan B, Cowan K, Fang S, Fenton M, Parkalub D, Peters J, Skomro R, Skrapek C, Ulmer K. Top 10 research priorities for people with obstructive sleep apnoea, families and clinicians: James Lind Alliance Priority Setting Partnership. Thorax 2022; 77:511-513. [PMID: 35086914 PMCID: PMC9016253 DOI: 10.1136/thoraxjnl-2021-218154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/25/2021] [Indexed: 12/04/2022]
Abstract
Obstructive sleep apnoea (OSA) is associated with significant comorbidity, preventable accidents and reduced quality of life. Little is known about the research priorities of patients with OSA, family members and clinicians. A James Lind Alliance research priority setting partnership was conducted. An initial survey (690 respondents who generated 1110 questions), a prioritisation survey (250 respondents), and a final workshop were used to identify the top 10 research priorities. Consensus was achieved on the top-ranked research priorities. Our results will inform the efforts of funders, researchers and policy-makers to align directly with stakeholder priorities related to OSA.
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Affiliation(s)
- Donna Goodridge
- Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada .,Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Britney Duncan
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Sarah Fang
- Saskatchewan Centre for Patient-Oriented Research, Saskatoon, Saskatchewan, Canada
| | - Mark Fenton
- Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Dave Parkalub
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Lung Association of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jaimie Peters
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Lung Association of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert Skomro
- Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Candace Skrapek
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Saskatchewan Centre for Patient-Oriented Research, Saskatoon, Saskatchewan, Canada
| | - Kendra Ulmer
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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P. Den Teuling NG, van den Heuvel ER, Aloia MS, Pauws SC. A latent-class heteroskedastic hurdle trajectory model: patterns of adherence in obstructive sleep apnea patients on CPAP therapy. BMC Med Res Methodol 2021; 21:269. [PMID: 34852769 PMCID: PMC8638441 DOI: 10.1186/s12874-021-01407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Sleep apnea patients on CPAP therapy exhibit differences in how they adhere to the therapy. Previous studies have demonstrated the benefit of describing adherence in terms of discernible longitudinal patterns. However, these analyses have been done on a limited number of patients, and did not properly represent the temporal characteristics and heterogeneity of adherence. METHODS We illustrate the potential of identifying patterns of adherence with a latent-class heteroskedastic hurdle trajectory approach using generalized additive modeling. The model represents the adherence trajectories on three aspects over time: the daily hurdle of using the therapy, the daily time spent on therapy, and the day-to-day variability. The combination of these three characteristics has not been studied before. RESULTS Applying the proposed model to a dataset of 10,000 patients in their first three months of therapy resulted in nine adherence groups, among which 49% of patients exhibited a change in adherence over time. The identified group trajectories revealed a non-linear association between the change in the daily hurdle of using the therapy, and the average time on therapy. The largest difference between groups was observed in the patient motivation score. The adherence patterns were also associated with different levels of high residual AHI, and day-to-day variability in leakage. CONCLUSION The inclusion of the hurdle model and the heteroskedastic model into the mixture model enabled the discovery of additional adherence patterns, and a more descriptive representation of patient behavior over time. Therapy adherence was mostly affected by a lack of attempts over time, suggesting that encouraging these patients to attempt therapy on a daily basis, irrespective of the number of hours used, could drive adherence. We believe the methodology is applicable to other domains of therapy or medication adherence.
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Affiliation(s)
- Niek G. P. Den Teuling
- Dep. of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
- Philips Research, Eindhoven, The Netherlands
| | - Edwin R. van den Heuvel
- Dep. of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Mark S. Aloia
- Department of Medicine, National Jewish Health, Denver, CO USA
- Philips Respironics, Monroeville, PA USA
| | - Steffen C. Pauws
- Philips Research, Eindhoven, The Netherlands
- Department Communication and Cognition, Tilburg University, Tilburg, The Netherlands
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Brown A, Jones S, Perez-Algorta G. Experiences of Using Positive Airway Pressure for Treatment of Obstructive Sleep Apnoea: A Systematic Review and Thematic Synthesis. Sleep 2021; 44:6286002. [PMID: 34043010 DOI: 10.1093/sleep/zsab135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 04/28/2021] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES Sub-optimal use of positive airway pressure (PAP) to treat obstructive sleep apnoea (OSA) continues to be a major challenge to effective treatment. Meanwhile, the individual and societal impacts of untreated OSA make effective treatment a priority. Although extensive research has been conducted into factors that impact PAP use, it is estimated that at least half of users do not use it as prescribed. However, the voice of users is notably minimal in the literature. A systematic review and qualitative metasynthesis of PAP user experience was conducted to contribute to understandings of how PAP is experienced and to inform how usage could be improved. METHODS PsycINFO, MEDLINE, CINAHL and EMBASE databases were systematically searched. Primary research findings of adult experiences using PAP that had been inductively analysed were included. Papers were critically appraised using the CASP qualitative checklist to generate a "hierarchy of evidence". Thematic synthesis was then conducted to generate analytical themes. Results were presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). RESULTS 25 papers reporting on over 398 people's experiences were analysed to generate 4 themes: Journey to PAP, Discomfort from and around PAP, Adapting to and using PAP, and Benefits from PAP. Author reflexivity and vulnerability to bias is acknowledged. CONCLUSIONS The findings highlight the applicability of a biopsychosocial understanding to PAP use. This metasynthesis gave voice to user experiences, revealing barriers to PAP use at a healthcare service level across the world, and suggests ways services can address these barriers.
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Alcántara C, Giorgio Cosenzo L, McCullough E, Vogt T, Falzon AL, Perez Ibarra I. Cultural adaptations of psychological interventions for prevalent sleep disorders and sleep disturbances: A systematic review of randomized controlled trials in the United States. Sleep Med Rev 2021; 56:101455. [PMID: 33735638 DOI: 10.1016/j.smrv.2021.101455] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/16/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
Psychological interventions for sleep-wake disorders have medium-to-large effect sizes, however whether behavioral randomized controlled trials (RCTs) targeted underserved populations or addressed contextual and cultural factors is unknown. We conducted a systematic review to: (a) examine sociodemographic characteristics of behavioral RCTs for prevalent sleep-wake disorders and sleep disturbances that targeted undeserved adults, (b) identify types of cultural adaptations (surface-level, deep-level), and (c) describe intervention effectiveness on primary sleep outcomes. Overall, 6.97% of RCTs (56 studies) targeted underserved groups (veterans, women, racial/ethnic minorities, low socioeconomic status, disability status); 64.29% made surface-level and/or deep-level cultural adaptations. There was a lack of racial/ethnic, socioeconomic, sexual orientation, and linguistic diversity. Most cultural adaptations were made to behavioral therapies, and cognitive behavioral therapy for insomnia (CBT-I). Surface-level cultural adaptations to the delivery modality and setting were most common. Deep-level cultural adaptations of the content and core intervention components were also typical. Intervention effectiveness varied by type of adapted intervention and participant population. RCTs of adapted CBT-I interventions among participants with a definite sleep disorder or sleep disturbance showed consistent significant reductions in adverse sleep outcomes versus control. These findings have important implications for the use of cultural adaptations to address behavioral sleep medicine disparities.
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Affiliation(s)
- Carmela Alcántara
- School of Social Work, Columbia University, New York, NY, 10027, USA.
| | | | - Elliot McCullough
- School of Social Work, Columbia University, New York, NY, 10027, USA
| | - Tiffany Vogt
- School of Social Work, Columbia University, New York, NY, 10027, USA
| | - Andrea L Falzon
- Feinstein Institute for Medical Research, Northwell Health, New York, NY, USA
| | - Irene Perez Ibarra
- Aragonese Foundation for Research, Zaragoza, Spain; AgriFood Institute of Aragon, University of Zaragoza, Spain
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D'Rozario AL, Galgut Y, Crawford MR, Bartlett DJ. Summary and Update on Behavioral Interventions for Improving Adherence with Positive Airway Pressure Treatment in Adults. Sleep Med Clin 2021; 16:101-124. [PMID: 33485523 DOI: 10.1016/j.jsmc.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Continuous positive airway pressure (PAP) is still the most efficacious treatment for obstructive sleep apnea when used effectively. Since the availability of PAP 39 years ago there have been considerable technological advances, such as quieter, lighter and smaller machines with better humidification. However, adherence to treatment is still a major problem. This article reviews studies published on behavioral interventions aimed at improving the uptake and maintenance of PAP treatment (January 2016-February 2020). It discusses underlying factors in the poor uptake and discontinuation of treatment and the role of qualitative research to better understand the perspective of the patients.
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Affiliation(s)
- Angela L D'Rozario
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Level 2, Building D17, Johns Hopkins Drive, Camperdown, New South Wales 2050, Australia; Sleep and Circadian Research Group, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia; Sydney Medical School, The University of Sydney.
| | - Yael Galgut
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia
| | - Megan R Crawford
- The University of Strathclyde, Graham Hills Building, 50 George Street, Glasgow G1 1QE, UK
| | - Delwyn J Bartlett
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, The University of Sydney, PO Box M77, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia; Sydney Medical School, The University of Sydney
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Salman LA, Shulman R, Cohen JB. Obstructive Sleep Apnea, Hypertension, and Cardiovascular Risk: Epidemiology, Pathophysiology, and Management. Curr Cardiol Rep 2020; 22:6. [PMID: 31955254 DOI: 10.1007/s11886-020-1257-y] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Given the rising prevalence of obstructive sleep apnea (OSA), we aimed to review the epidemiologic and pathophysiologic relationship of OSA, hypertension, and cardiovascular disease, and to summarize recent advances in the treatment of OSA. RECENT FINDINGS OSA is associated with an elevated risk of hypertension and cardiovascular disease. Several pathophysiologic factors contribute to the relationship between OSA and vascular risk, including neurohormonal dysregulation, endothelial dysfunction, and inflammation. While CPAP reduces blood pressure, it has not been demonstrated to reduce cardiovascular risk. The combination of CPAP and weight loss has a synergistic effect on blood pressure and several metabolic parameters. Adherence to CPAP is poor across studies, potentially contributing to the attenuation of perceived cardiovascular benefit from CPAP therapy. A greater emphasis on adherence to CPAP and the combination of CPAP and weight loss are central to reducing cardiovascular risk among individuals with OSA.
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Affiliation(s)
- Liann Abu Salman
- Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA
| | - Rachel Shulman
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 831 Blockley, Philadelphia, PA, 19104, USA.
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Varga AW, Mokhlesi B. REM obstructive sleep apnea: risk for adverse health outcomes and novel treatments. Sleep Breath 2019; 23:413-423. [PMID: 30232681 PMCID: PMC6424642 DOI: 10.1007/s11325-018-1727-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/04/2018] [Accepted: 09/14/2018] [Indexed: 02/07/2023]
Abstract
Rapid eye movement (REM) sleep was discovered nearly 60 years ago. This stage of sleep accounts for approximately a quarter of total sleep time in healthy adults, and it is mostly concentrated in the second half of the sleep period. The majority of research on REM sleep has focused on neurocognition. More recently, however, there has been a growing interest in understanding whether obstructive sleep apnea (OSA) during the two main stages of sleep (REM and non-REM sleep) leads to different cardiometabolic and neurocognitive risk. In this review, we discuss the growing evidence indicating that OSA during REM sleep is a prevalent disorder that is independently associated with adverse cardiovascular, metabolic, and neurocognitive outcomes. From a therapeutic standpoint, we discuss limitations of continuous positive airway pressure (CPAP) therapy given that 3 or 4 h of CPAP use from the beginning of the sleep period would leave 75% or 60% of obstructive events during REM sleep untreated. We also review potential pharmacologic approaches to treating OSA during REM sleep. Undoubtedly, further research is needed to establish best treatment strategies in order to effectively treat REM OSA. Moreover, it is critical to understand whether treatment of REM OSA will translate into better patient outcomes.
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Affiliation(s)
- Andrew W Varga
- Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, Annenberg 21-44, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Babak Mokhlesi
- Section of Pulmonary and Critical Care Medicine, Sleep Disorders Center, University of Chicago, Chicago, IL, USA
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