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Briand R, Lebouvier T, Lanvin L, Ramdane N, Skrobala E, Leroy M, Chenivesse C, Fry S, Le Rouzic O. Continuous positive airway pressure compliance in patients with mild cognitive impairment. Sleep Breath 2024; 28:1165-1172. [PMID: 38225442 DOI: 10.1007/s11325-024-02995-5] [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: 09/28/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/17/2024]
Abstract
PURPOSE Sleep apnoea (SA) is associated with accelerated cognitive decline in patients with mild cognitive impairment (MCI). Treatment of SA by continuous positive airway pressure (CPAP) may slow this decline if patients comply with the treatment. The aim of this study was to assess the rate of CPAP compliance in this population. METHODS In this single-centre retrospective study conducted in a tertiary care institution, patients with a diagnosis of MCI and SA initiating CPAP between January 2015 and August 2021 were included. Data from the initial sleep recording, the 3-month follow-up and compliance with at least 12 months of CPAP were analysed. Compliance was defined as an average CPAP use of at least 4 h per night. RESULTS 55 patients were included (49% women, age 70.7 ± 8.9 years, body mass index 28.9 ± 6.5 kg/m2). Aetiology of MCI was vascular (45.5%), psychiatric (12.7%) and related to Alzheimer's disease (7.3%), with 47.3% of amnesic disorders and 45.5% of dysexecutive disorders. The MiniMentalState score was 26.7 ± 3.1. SA was mostly obstructive (81.8%) with a mean apnoea-hypopnoea index of 41.1 ± 16.4/h. At 3 months, 38 patients were compliant (69%) with a CPAP median use of 5.9 h per night and 83% of nights. Self-reported tolerance was better in compliant patients (75.7% vs 38.5% p = 0.017). Thirty-four patients remained compliant at 12 months (62%). CONCLUSION Our results suggest a high rate of CPAP compliance in patients suffering from MCI. Compliance was related to the device tolerance, emphasizing the need to closely monitor and improve this factor.
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Affiliation(s)
- Raphaël Briand
- CHU Lille, Pneumology and Immuno-Allergology, 59000, Lille, France.
| | - Thibaud Lebouvier
- Univ. Lille, Inserm, CHU Lille, Lille Neuroscience & Cognition, CNRMAJ, LiCEND, DistAlz, 59000, Lille, France
| | - Lise Lanvin
- Clinical Neurophysiology, CHU Lille, 59000, Lille, France
| | - Nassima Ramdane
- Department of Biostatistics, CHU Lille, 59000, Lille, France
| | - Emilie Skrobala
- Univ. Lille, Inserm, CHU Lille, Lille Neuroscience & Cognition, CNRMAJ, LiCEND, DistAlz, 59000, Lille, France
| | - Mélanie Leroy
- Univ. Lille, Inserm, CHU Lille, Lille Neuroscience & Cognition, CNRMAJ, LiCEND, DistAlz, 59000, Lille, France
| | - Cécile Chenivesse
- CHU Lille, Pneumology and Immuno-Allergology, 59000, Lille, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U-1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, 59000, Lille, France
| | - Stéphanie Fry
- CHU Lille, Pneumology and Immuno-Allergology, 59000, Lille, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U-1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, 59000, Lille, France
| | - Olivier Le Rouzic
- CHU Lille, Pneumology and Immuno-Allergology, 59000, Lille, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U-1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, 59000, Lille, France
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Bottaz-Bosson G, Hamon A, Pépin JL, Bailly S, Samson A. Continuous positive airway pressure adherence trajectories in sleep apnea: Clustering with summed discrete Fréchet and dynamic time warping dissimilarities. Stat Med 2021; 40:5373-5396. [PMID: 34250615 DOI: 10.1002/sim.9130] [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: 06/15/2020] [Revised: 05/06/2021] [Accepted: 06/23/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a chronic disease characterized by recurrent pharyngeal collapses during sleep. In most severe cases, continuous positive airway pressure (CPAP) consists in keeping the airways open by administering mild air pressure. This treatment faces adherence issues. OBJECTIVES Eight hundred and forty-eight subjects were equipped with CPAP prescribed at the Grenoble University Hospital between 2016 and 2018. Their daily CPAP uses have been recorded during the first 3 months. Our aim is to cluster these adherence time series. With hierarchical agglomerative clustering, we focused on the choices of the dissimilarity measure and the internal cluster validation index (CVI). METHODS The Euclidean distance, the dynamic time warping (DTW) and the generalized summed discrete Fréchet dissimilarity were implemented with three linkage strategies ("average," "complete," and "Ward"). The performances of each method (dissimilarity and linkage) were evaluated on a simulation study through the adjusted Rand index (ARI). The Ward linkage with DTW dissimilarity provided the best ARI. Then six different internal CVIs (Silhouette, Calinski Harabasz, Davies Bouldin, Modified Davies Bouldin, Dunn, and COP) were compared on their ability to choose the best number of clusters. The Dunn index beat the others. RESULTS CPAP data were clustered with the Ward linkage, the DTW dissimilarity and the Dunn index. It identified six clusters, from a cluster of patients (N = 29 subjects) whose stopped the therapy early on to a cluster (N = 105) with increasing adherence over time. Other clusters were extremely good users (N = 151), good users (N = 150), moderate users (N = 235), and poor adherers (N = 178).
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Affiliation(s)
- Guillaume Bottaz-Bosson
- Laboratoire HP2, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France.,LJK, Univ. Grenoble Alpes, CNRS, Grenoble, France
| | - Agnès Hamon
- LJK, Univ. Grenoble Alpes, CNRS, Grenoble, France
| | - Jean-Louis Pépin
- Laboratoire HP2, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Sébastien Bailly
- Laboratoire HP2, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
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Bulteel C, Le Bonniec A, Gounelle M, Schifano A, Jonquet O, Dupeyron A, Laffont I, Cousson-Gelie F, Gelis A. Factors influencing adherence to continuous positive airway pressure devices in individuals with spinal cord injury and sleep apnea: Results of a qualitative study. Ann Phys Rehabil Med 2019; 63:325-331. [PMID: 31302281 DOI: 10.1016/j.rehab.2019.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/24/2019] [Accepted: 06/30/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND In individuals with spinal cord injury (SCI) and sleep apnea (SA), adherence to continuous positive airway pressure (CPAP) therapy seems unsatisfactory despite technical and educational support implemented when starting treatment. OBJECTIVE We aimed to design comprehensive model of adherence to CPAP therapy in individuals with SCI and SA. METHODS This was a prospective qualitative study based on semi-directed interviews and using the grounded theory as an analytic method. The theoretical framework was the social cognitive theory of Bandura. Participants were recruited from an SCI referral centre. Individuals with SCI using or having used a CPAP device for SA were included. Data were collected by semi-directed interviews on the experience of individuals with SCI regarding SA and being fitted with a CPAP device and were coded and organized into categories of experience and category relationships. RESULTS Among the 17 individuals included; 9 had tetraplegia; the median age was 62 (Q1-Q3 47-66) years and median time since injury was 16 (Q1-Q3 1.75-21) years. Four categories of data were identified: 1) from symptoms to validation of SA diagnosis, 2) CPAP device fitting process, 3) representations of SA, and 4) level of adherence to the treatment. In addition to the factors already observed in the general population, the proposed model identified specific adherence factors in individuals with SCI, such as physical and relational dependence on a third party, increased daily care burden and increased presence of medical devices in the daily environment. CONCLUSION SA and its management present certain specificities in individuals with SCI that the physician must take into account to optimize therapeutic proposals, follow-up modalities and device adherence.
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Affiliation(s)
- Clémence Bulteel
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire Lapeyronie, 371, avenue du Doyen Gaston-Giraud, 34090 Montpellier, France
| | - Alice Le Bonniec
- Département Epidaure, Institut régional du Cancer Montpellier, 208, avenue des Apothicaires, 34298, Montpellier, France; Université Paul-Valery Montpellier 3, University Montpellier, Epsylon (EA4556), 34000 Montpellier, France
| | - Marion Gounelle
- Centre Mutualiste Neurologique Propara, 263, avenue du Caducée, 34090 Montpellier, France
| | - Annick Schifano
- Centre Mutualiste Neurologique Propara, 263, avenue du Caducée, 34090 Montpellier, France
| | - Olivier Jonquet
- Service de Réanimation médicale et Grands brulés, Centre Hospitalo-Universitaire Lapeyronie, 371, avenue du Doyen Gaston Giraud, 34090 Montpellier, France
| | - Arnaud Dupeyron
- Département de Médecine Physique et de Réadaptation, CHU Caremeau, Place du Pr Debré, 30000 Nîmes, France
| | - Isabelle Laffont
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire Lapeyronie, 371, avenue du Doyen Gaston-Giraud, 34090 Montpellier, France
| | - Florence Cousson-Gelie
- Département Epidaure, Institut régional du Cancer Montpellier, 208, avenue des Apothicaires, 34298, Montpellier, France; Université Paul-Valery Montpellier 3, University Montpellier, Epsylon (EA4556), 34000 Montpellier, France
| | - Anthony Gelis
- Service de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire Lapeyronie, 371, avenue du Doyen Gaston-Giraud, 34090 Montpellier, France; Université Paul-Valery Montpellier 3, University Montpellier, Epsylon (EA4556), 34000 Montpellier, France.
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Delbarre A, Gagnadoux F, Gohier B, Pelletier-Fleury N. Continuous positive airway pressure therapy for obstructive sleep apnoea and psychotropic drug use: a retrospective observational matched-cohort study. Sci Rep 2018; 8:14134. [PMID: 30237498 PMCID: PMC6148046 DOI: 10.1038/s41598-018-32142-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 08/02/2018] [Indexed: 01/22/2023] Open
Abstract
Patients with obstructive sleep apnoea (OSA) frequently present symptoms of depression, anxiety and insomnia and continuous positive airway pressure (CPAP) can improve these symptoms. Using a real-world administrative database, we analysed the trend of psychotropic drug use (antidepressants, anxiolytics and hypnotics) on a long-term period in OSA individuals before-after CPAP initiation. A total of 869 OSA individuals to whom psychotropic drugs were prescribed were followed for 4 years. They were matched to 2,607 non-OSA individuals, who were similar in terms of demographics, chronic diseases and care consumption. Generalized estimating equations models were used to compare psychotropic drug defined daily doses (DDD). Results showed no significant differences in mean trends of psychotropic drug DDD between OSA individuals and non-OSA matched controls during the three years following CPAP initiation. Only time had a significant effect on DDD, which decreased in both groups: −9% in Y1 and −17% in Y3, compared to Y0 (p-values < 0.0001). Hence, CPAP therapy does not result in an earlier decrease of psychotropic drug use in OSA individuals compared to non-OSA matched controls. Further studies are needed to analyse long-term psychotropic drug use, particularly in non-adherent OSA individuals.
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Affiliation(s)
- Angélique Delbarre
- Center for research in Epidemiology and Population Health (CESP), Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France.
| | - Frédéric Gagnadoux
- Université Bretagne Loire, CHU d'Angers, Département de Pneumologie, Angers, France.,Inserm UMR, 1063 SOPAM, Angers, France
| | - Bénédicte Gohier
- Université Bretagne Loire, Laboratoire de Psychologie des Pays de Loire EA, 4638, Angers, France.,CHU d'Angers, Service de Psychiatrie et Addictologie, Angers, France
| | - Nathalie Pelletier-Fleury
- Center for research in Epidemiology and Population Health (CESP), Université Paris-Saclay, Université Paris-Sud, UVSQ, Villejuif, France
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Vanderperre G, Nguyen-Huy-Thui G, Marsan P, Desjeux G, Marcaillou M. [Impact of the obstructive sleep hypopnea-apnea syndrom treated on employment for military employment]. Rev Epidemiol Sante Publique 2018; 66:325-331. [PMID: 30017391 DOI: 10.1016/j.respe.2018.05.562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 11/03/2017] [Accepted: 05/07/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The diurnal hypersomnia associated with obstructive sleep apnea (OSA) affects soldier employment and deployability. In this study, we examined the impact of OSA on the employment of soldiers on continuous positive airways pressure (CPAP) therapy by measuring several items: work absenteeism using the Work Productivity and Activity Impairment (WPAI) questionnaire, diurnal hypersomnia, and career advancement. METHODS A questionnaire was sent by regular mail to 940 soldiers with OSA on CPAP therapy who are insured by the French Military Healthcare Fund (Caisse Nationale Militaire de Sécurité Sociale). RESULTS Questionnaires were returned by 439 soldiers: mean age 47 years; mean body mass index 29.8kg/m2. Absenteeism reached 0.45%, and work productivity impairment 8.7%. Hypersomnia was reported by 15.4% and was severe for 9.7%. The average daily working time was 6.5hours. Quality of life was improved for 91.1%. The military practitioner had diagnosed OSA in 19.6% of these soldiers and had prescribed treatment in 14.9%. DISCUSSION Residual OSA in these soldiers on CPAP therapy had little impact on work productivity impairment that was less than observed in populations with chronic diseases. In our study population, hypersomnia was less common than observed in the general population. An impact on career advancement could not be clearly demonstrated. Close medical follow-up is warranted in certain populations due to the persistence of severe somnolence in a significant number of patients.
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Affiliation(s)
- G Vanderperre
- École du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France.
| | - G Nguyen-Huy-Thui
- Caisse nationale militaire de sécurité sociale, 83000 Toulon, France
| | - P Marsan
- Caisse nationale militaire de sécurité sociale, 83000 Toulon, France
| | - G Desjeux
- Caisse nationale militaire de sécurité sociale, 83000 Toulon, France
| | - M Marcaillou
- École du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France
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[Sleepiness, continuous positive airway pressure and the obstructive sleep apnea hypopnea syndrome]. Rev Mal Respir 2018; 35:116-133. [PMID: 29454715 DOI: 10.1016/j.rmr.2017.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/01/2017] [Indexed: 12/23/2022]
Abstract
Excessive daytime sleepiness is a major symptom in cases of the obstructive sleep apnea-hypopnea syndrome. Most often, it is vastly improved by treatment with continuous positive airway pressure (CPAP). The most effective way to confirm its disappearance is through wakefulness maintenance testing. If residual sleepiness remains, despite CPAP, further diagnostic investigation must be carried out. Firstly, it must be assessed whether the treatment is fully effective (apnea hypopnea index<10/h) by examining flow limitations under treatment (polysomnography) and whether it is sufficiently used (>6h/night). If this is the case, the possibility of other situations responsible for excessive daytime sleepiness must be reviewed and eliminated, whether they are depression, sleep insufficiency, use of intoxicants, obesity, restless legs syndrome, or circadian sleep-wake cycle disorder. If not, the multiple sleep latency tests make it possible to assess sleepiness (latency<8min) and can lead to a diagnosis of central hypersomnia (narcolepsy, idiopathic hypersomnia, hypersomnia due to a medical pathology). In some rare cases (about 6% of patients) investigations will reveal central hypersomnia due to the obstructive sleep apnea-hypopnea syndrome or "lesional" hypersomnia due to intermittent hypoxia. Since 2011, medications treating excessive sleepiness have had marketing authorization only for narcolepsy in France. However, they can be administered by way of derogation to other neurological hypersomnias on prescription by a reference centre or a centre with expertise in hypersomnia.
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Meurice JC, Antone E, Gilbert M, Watrin A, Bironneau V. [Continuous positive airway pressure in obstructive sleep apnea]. Presse Med 2017; 46:423-431. [PMID: 28434626 DOI: 10.1016/j.lpm.2017.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 02/25/2017] [Indexed: 12/18/2022] Open
Abstract
Continuous positive airway pressure (CPAP) is currently the most used and efficient therapy in OSAS. Efficiency of CPAP on sleep respiratory disorders is the same whether in fixed or automatic mode. Larger studies are required to evaluate their respective beneficial impact on cardiovascular or metabolic complications of OSAS. Close medical monitoring is necessary during the first weeks of CPAP therapy. Compliance to CPAP therapy is crucial for efficacy in preventing cardiovascular or metabolic complications of OSAS. As beneficial effects of CPAP in obese patients are modest, on blood pressure levels and metabolic disorders, its use has to be part of a comprehensive care of OSAS and related comorbidities.
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Affiliation(s)
- Jean Claude Meurice
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France; Groupe ALIVE, CIC Inserm 1402, 86000 Poitiers, France.
| | - Elise Antone
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France
| | - Mylene Gilbert
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France
| | - Audrey Watrin
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France
| | - Vanessa Bironneau
- CHU de Poitiers, université de Poitiers, service de pneumologie, 86000 Poitiers, France; Groupe ALIVE, CIC Inserm 1402, 86000 Poitiers, France
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Sedkaoui K, Leseux L, Pontier S, Rossin N, Leophonte P, Fraysse JL, Didier A. Efficiency of a phone coaching program on adherence to continuous positive airway pressure in sleep apnea hypopnea syndrome: a randomized trial. BMC Pulm Med 2015; 15:102. [PMID: 26370444 PMCID: PMC4570038 DOI: 10.1186/s12890-015-0099-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 09/08/2015] [Indexed: 11/21/2022] Open
Abstract
Background Continuous Positive Airway Pressure (CPAP) remains the reference treatment for moderate to severe forms of the Sleep Apnea/Hypopnea Syndrome (SAHS). Compliance to the treatment appears to be a key factor to improving health status of these patients. Methods We conducted a multicenter, prospective, randomized, controlled, parallel group trial of standard support completed or not within 3 months of coaching sessions for newly diagnosed SAHS patients starting CPAP therapy. This study has been recorded by AFSSAPS with the RCB number: 2009-A01127-50 and received favourably by the Human Studies Committee in France. The coaching session consisted of 5 sessions of telephone-based counselling by competent staff. The primary outcome was the proportion of patients using CPAP more than 3 h per night for 4 months; the secondary outcome was mean hours of CPAP usage in the 2 groups. Results Three hundred and seventy-nine patients fulfilled the inclusion criteria and were randomized. The percentage of patients using CPAP more than 3 h per night for 4 months was 65 % for the standard support group and 75 % for the coached group. This difference reached a statistical significance (χ2 = 3.97). The mean CPAP usage was increased in the coached group versus standard group. A difference of 26 min was observed (4 h34+/−2 h17 and 4 h08+/−2 h25 respectively, p = 0.04). Conclusion This study shows that SAHS patients who benefit from phone coaching are statistically more compliant to CPAP than a standard support group is. A simple phone coaching procedure based on knowledge of the disease and reinforcement messages about treatment benefits helps to improve CPAP adherence in SAHS patients. Trial registration NCT02435355
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Affiliation(s)
- Kamila Sedkaoui
- Service de pneumologie - allergologie, hôpital Larrey, CHU de Toulouse, chemin de Pouvourville, 31059, Toulouse, France.
| | - Ludivine Leseux
- SADIR association, oncopole, 2 place Pierre Potier, CS 40623, 31106, Toulouse cedex 1, France.
| | - Sandrine Pontier
- Service de pneumologie - allergologie, hôpital Larrey, CHU de Toulouse, chemin de Pouvourville, 31059, Toulouse, France.
| | - Nicole Rossin
- SADIR assistance, oncopole, 2 place Pierre Potier, CS 40623, 31106, Toulouse cedex 1, France.
| | - Paul Leophonte
- SADIR association, oncopole, 2 place Pierre Potier, CS 40623, 31106, Toulouse cedex 1, France.
| | - Jean-Louis Fraysse
- SADIR assistance, oncopole, 2 place Pierre Potier, CS 40623, 31106, Toulouse cedex 1, France.
| | - Alain Didier
- Service de pneumologie - allergologie, hôpital Larrey, CHU de Toulouse, chemin de Pouvourville, 31059, Toulouse, France.
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Antone E, Gilbert M, Bironneau V, Meurice JC. [Continuous positive airways pressure treatment for obstructive sleep apnoea]. Rev Mal Respir 2015; 32:447-60. [PMID: 25823935 DOI: 10.1016/j.rmr.2014.11.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/07/2014] [Indexed: 11/16/2022]
Abstract
Continuous positive airway pressure (CPAP) still remains the most frequently used and the most efficient treatment for obstructive sleep apnea syndrome. However, its efficiency is conditioned by healthcare quality depending on many factors such as medical specificities of the patients as well as the severity of sleep-related breathing disorders. In order to optimize CPAP efficiency, it is necessary to be aware of the functional abilities of the different devices, and to perform a close monitoring of the patients, particularly during the first weeks of treatment, by maximally using the data provided by the CPAP apparatus. Some questions remain unsolved, such as the impact of nasal CPAP on glucose metabolism or cardiovascular prognosis. Furthermore, the strategy of CPAP use should be improved according to future results of studies dedicated to the interest of home telemonitoring and taking into account the validated mode of CPAP initiation.
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Affiliation(s)
- E Antone
- Service de pneumologie, CHU de Poitiers, université de Poitiers, 2, rue de la Miletrie, 86000 Poitiers, France.
| | - M Gilbert
- Service de pneumologie, CHU de Poitiers, université de Poitiers, 2, rue de la Miletrie, 86000 Poitiers, France
| | - V Bironneau
- Service de pneumologie, CHU de Poitiers, université de Poitiers, 2, rue de la Miletrie, 86000 Poitiers, France
| | - J C Meurice
- Service de pneumologie, CHU de Poitiers, université de Poitiers, 2, rue de la Miletrie, 86000 Poitiers, France
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Meurice JC. Comment améliorer l’observance vis-à-vis de la PPC dans le syndrome d’apnées du sommeil : du « coaching » à la télémédecine. Rev Mal Respir 2012; 29:7-10. [DOI: 10.1016/j.rmr.2011.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 12/09/2011] [Indexed: 11/16/2022]
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