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Kong J, Liang C, Zhao Y, Chen Q, Xv H, Yan X, Zhang H, Zhang H. Relationship between social support and self-perceived burden in patients with obstructive sleep apnea: an analysis of chain-mediated effects. Sleep Med 2024; 119:27-33. [PMID: 38636212 DOI: 10.1016/j.sleep.2024.04.011] [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: 12/24/2023] [Revised: 03/13/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To estigate the relationship between social support, self-efficacy, coping style, and self-perceived burden and the mechanisms that underlie the action in Chinese OSA patients. METHODS Between October 2022 and June 2023,316 OSA patients from two hospitals were surveyed. Data were collected using the General Demographic Characteristics Questionnaire, Social Support Rating Scale (SSRS), Self-Efficacy for Chronic Disease Scale (SECD6), and Simple Coping Style Questionnaire (SCSQ). Correlation analysis was performed using Pearson correlation. Regression analysis was performed using multiple linear regression analysis. The mediation effect analysis was performed using the Process macro (version 3.4.1) in SPSS. RESULTS (1)This study confirmed that social support, self-efficacy, and coping styles had significant negative predictions regarding self-perceived burden. (2)The influence of social support on self-perceived burden in OSA patients is mainly through three indirect effects: single mediation effect of self-efficacy and coping style and interlocking mediation effect of self-efficacy→coping style. CONCLUSION Social support can indirectly predict self-efficacy in OSA patients through the single mediation effect of self-efficacy and coping style and indirectly predict the self-perception burden in OSA patients through the linked mediation effects of self-efficacy and coping style.
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Affiliation(s)
- Jie Kong
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, 121001, Jinzhou, PR China.
| | - Chunguang Liang
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, 121001, Jinzhou, PR China.
| | - Ying Zhao
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, 121001, Jinzhou, PR China.
| | - Qing Chen
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, 121001, Jinzhou, PR China.
| | - Huameng Xv
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, 121001, Jinzhou, PR China.
| | - Xiangru Yan
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, 121001, Jinzhou, PR China.
| | - Hui Zhang
- School of Nursing, Chongqing Medical University, Chongqing, PR China.
| | - Huiying Zhang
- Department of Otolaryngology Head & Neck Surgery, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, PR China.
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Pendharkar SR, Kaambwa B, Kapur VK. The Cost-Effectiveness of Sleep Apnea Management: A Critical Evaluation of the Impact of Therapy on Health Care Costs. Chest 2024:S0012-3692(24)00660-3. [PMID: 38815624 DOI: 10.1016/j.chest.2024.04.024] [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: 04/24/2023] [Revised: 04/01/2024] [Accepted: 04/11/2024] [Indexed: 06/01/2024] Open
Abstract
TOPIC IMPORTANCE OSA is a widespread condition that significantly affects both health and health-related quality of life (HRQoL). If left untreated, OSA can lead to accidents, decreased productivity, and medical complications, resulting in significant economic burdens including the direct costs of managing the disorder. Given the constraints on health care resources, understanding the cost-effectiveness of OSA management is crucial. A key factor in cost-effectiveness is whether OSA therapies reduce medical costs associated with OSA-related complications. REVIEW FINDINGS Treatments for OSA have been shown to enhance HRQoL, particularly for symptomatic patients with moderate or severe disease. Economic studies also have demonstrated that these treatments are highly cost-effective. However, although substantial empirical evidence shows that untreated OSA is associated with increased medical costs, uncertainty remains about the impact of OSA treatment on these costs. Randomized controlled trials of positive airway pressure (PAP) therapy have failed to demonstrate cost reductions, but the studies have had important limitations. Observational studies suggest that PAP therapy may temper increases in costs, but only among patients who are highly adherent to treatment. However, the healthy adherer effect is an important potential source of bias in these studies. SUMMARY OSA management is cost-effective, although uncertainties persist regarding the therapy's impact on medical costs. Future studies should focus on reducing bias, particularly the healthy adherer effect, and addressing other confounding factors to clarify potential medical cost savings. Promising avenues to further understanding include using quasiexperimental designs, incorporating more sophisticated characterization of OSA severity and symptoms, and leveraging newer technologies (eg, big data, wearables, and artificial intelligence).
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Affiliation(s)
- Sachin R Pendharkar
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Billingsley Kaambwa
- Health Economics, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, SA, Australia
| | - Vishesh K Kapur
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA.
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Tsalatsanis A, Dismuke-Greer C, Kumar A, Hoffman J, Monden KR, Magalang U, Schwartz D, Martin AM, Nakase-Richardson R. Cost-Effectiveness of Sleep Apnea Diagnosis and Treatment in Hospitalized Persons With Moderate to Severe Traumatic Brain Injury. J Head Trauma Rehabil 2024:00001199-990000000-00146. [PMID: 38652666 DOI: 10.1097/htr.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To assess the cost-effectiveness of alternative approaches to diagnose and treat obstructive sleep apnea (OSA) in patients with traumatic brain injury (TBI) during inpatient rehabilitation. SETTING Data collected during the Comparison of Sleep Apnea Assessment Strategies to Maximize TBI Rehabilitation Participation and Outcome (C-SAS) clinical trial (NCT03033901) on an inpatient rehabilitation TBI cohort were used in this study. STUDY DESIGN Decision tree analysis was used to determine the cost-effectiveness of approaches to diagnosing and treating sleep apnea. Costs were determined using 2021 Centers for Medicare and Medicaid Services reimbursement codes. Effectiveness was defined in terms of the appropriateness of treatment. Costs averted were extracted from the literature. A sensitivity analysis was performed to account for uncertainty. Analyses were performed for all severity levels of OSA and a subgroup of those with moderate to severe OSA. Six inpatient approaches using various phases of screening, testing, and treatment that conform to usual care or guideline-endorsed interventions were evaluated: (1) usual care; (2) portable diagnostic testing followed by laboratory-quality testing; (3) screening with the snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-Bang) questionnaire; (4) Multivariable Apnea Prediction Index (MAPI) followed by portable diagnostic testing and laboratory-quality testing; (5) laboratory-quality testing for all; and (6) treatment for all patients. MAIN MEASURES Cost, Effectiveness, and Incremental Cost-Effectiveness Ratio (ICER). RESULTS Phased approaches utilizing screening and diagnostic tools were more effective in diagnosing and allocating treatment for OSA than all alternatives in patients with mild to severe and moderate to severe OSA. Usual care was more costly and less effective than all other approaches for mild to severe and moderate to severe OSA. CONCLUSIONS Diagnosing and treating OSA in patients with TBI is a cost-effective strategy when compared with usual care.
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Affiliation(s)
- Athanasios Tsalatsanis
- Author Affiliations: Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida (Dr Tsalatsanis and Dr Kumar); Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California (Dr Dismuke-Greer); Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington (Dr Hoffman); Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota (Dr Monden); The Ohio State University Wexner Medical Center, Columbus, Ohio (Dr Magalang); and Medicine Service (Dr Schwartz) Mental Health and Behavioral Science Service (Dr Martin), and Polytrauma TBI Rehabilitation (Dr Nakase-Richardson), James A. Haley Veterans' Hospital, Tampa, Florida
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Marquina C, Makarounas-Kirchmann K, Holden K, Sasse A, Ademi Z. The preventable productivity burden of sleep apnea in Australia: a lifetime modelling study. J Sleep Res 2023; 32:e13748. [PMID: 36303525 DOI: 10.1111/jsr.13748] [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: 08/07/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022]
Abstract
Obstructive sleep apnea (OSA) is a common disorder. OSA is associated with cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM) and depression, among other comorbidities. We aim to determine the productivity burden of OSA in Australia using productivity-adjusted life-years (PALYs). Using life table modelling, we built a multistate Markov model to estimate the impact of moderate to severe OSA on the whole working-age Australian population in 2021 (aged 20-65 years) with OSA until retirement (aged 66 years). The model also captured the impact of OSA on CVD, T2DM, depression, and vehicle-related accidents. Data for OSA and comorbidities and Australian specific labour data, were extracted from published sources. A second cohort was then modelled to test the effect of a hypothetical intervention, assuming a 10% reduction in OSA prevalence and a 10% reduction in comorbidities in patients with OSA. The primary outcome of interest were PALYs accrued. All outcomes were discounted 5% annually. Over a lifetime, the Australian population with OSA accrued 193,713,441 years of life lived and 182,737,644 PALYs. A reduction of 10% in OSA prevalence and comorbidities would result in 45,401 extra years of life lived and 150,950 extra PALYs. This resulted in more than AU$25 billion of gained gross domestic product over the lifetime of the working population. Our study highlights the substantial burden of OSA on the Australian population and the need to tailor interventions at the population level to reduce the health and economic impacts.
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Affiliation(s)
- Clara Marquina
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kelly Makarounas-Kirchmann
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Snoretox Ltd., Melbourne, Victoria, Australia
| | - Karen Holden
- Snoretox Ltd., Melbourne, Victoria, Australia.,School of Health Sciences, Bundoora West Campus, RMIT University, Melbourne, Victoria, Australia
| | - Anthony Sasse
- Snoretox Ltd., Melbourne, Victoria, Australia.,School of Health Sciences, Bundoora West Campus, RMIT University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
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May AM, Patel SR, Yamauchi M, Verma TK, Weaver TE, Chai-Coetzer CL, Thornton JD, Ewart G, Showers T, Ayas NT, Parthasarathy S, Mehra R, Billings ME. Moving toward Equitable Care for Sleep Apnea in the United States: Positive Airway Pressure Adherence Thresholds: An Official American Thoracic Society Policy Statement. Am J Respir Crit Care Med 2023; 207:244-254. [PMID: 36722719 PMCID: PMC9896653 DOI: 10.1164/rccm.202210-1846st] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Positive airway pressure (PAP) is a highly effective treatment for obstructive sleep apnea (OSA), but adherence limits its efficacy. In addition, coverage of PAP by CMS (Centers for Medicare & Medicaid Services) and other insurers in the United States depends on adherence. This leaves many beneficiaries without PAP, disproportionally impacting non-white and low socioeconomic position patients with OSA and exacerbating sleep health disparities. Methods: An inter-professional, multidisciplinary, international committee with various stakeholders was formed. Three working groups (the historical policy origins, impact of current policy, and international PAP coverage models) met and performed literature reviews and discussions. Using surveys and an iterative discussion-based consensus process, the policy statement recommendations were created. Results: In this position paper, we advocate for policy change to CMS PAP coverage requirements to reduce inequities and align with patient-centered goals. We specifically call for eradicating repeat polysomnography, eliminating the 4-hour rule, and focusing on patient-oriented outcomes such as improved sleepiness and sleep quality. Conclusions: Modifications to the current policies for PAP insurance coverage could improve health disparities.
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Fatima D, Tsai WH, Corrigan J, Ogah I, Ip-Buting A, Sharpe H, Laratta CR, Peller P, Pendharkar SR. Exploring patient-borne costs and wait times for obstructive sleep apnea (OSA) care among rural and urban adults. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2023. [DOI: 10.1080/24745332.2022.2156936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Duaa Fatima
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Willis H. Tsai
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Corrigan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Imhokhai Ogah
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Ada Ip-Buting
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Heather Sharpe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl R. Laratta
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Peller
- Spatial and Numeric Data Services, University of Calgary, Calgary, Alberta, Canada
| | - Sachin R. Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Zhang H, Liang C, Zhang X, Yu H, Yan X, Wang L, Tong T, Zhang H, Dai H, Tong H. Factors influencing patient delay in individuals with obstructive sleep apnoea: a study based on an integrated model. Ann Med 2022; 54:2828-2840. [PMID: 36259469 PMCID: PMC9586697 DOI: 10.1080/07853890.2022.2132417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder, yet it remains undiagnosed in a large proportion of adults. OBJECTIVE This study aims to investigate the status of patient delay and provider delay in OSA patients and examine related factors affecting patient delay in OSA individuals in China. METHODS A cross-sectional design was conducted on a sample of 309 OSA patients (aged from 18 to 76, median age of 47 years, 84.8% male) in Northeast China. Participants were required to complete the sociodemographic questionnaire, the symptom characteristics questionnaire, the help-seeking attitude scale (HSAS), the social support rating scale and the chronic disease self-efficacy scales (CDSES) to test the hypothesis. Binary logistic regression analysis was conducted to explore factors that account for the patient delay. RESULTS The median patient delay among OAS patients in this study was 22 months, the median provider delay was one month, and the median total delay was 26 months. As shown by multivariate analysis results, patients who have snored for over 6 years (OR = 3.377, 95%CI: 1.175-9.702) were more likely to experience prolonged patient delays. Per capita monthly family income above 3000 RMB (OR = 0.172, 95%CI: 0.052-0.571), taking up residence in cities or towns (OR = 0.484, 95%CI: 0.248-0.946), higher self-recognition of the disease (OR = 0.793, 95%CI: 0.647-0.972), higher objective support (OR = 0.825, 95%CI: 0.739-0.921) and stronger self-efficacy (OR = 0.674, 95%CI: 0.525-0.867) were significantly associated with shorter patient delays. CONCLUSION Patient delay is common in Chinese OSA patients. The upstream factors affecting the patient delay in individuals with OSA include income, place of residence, and objective support; midstream factors include self-recognition of the disease and self-efficacy; downstream factors include years of snoring.KEY MESSAGESDespite being a high-prevalence disease, many obstructive sleep apnoea (OSA) patients are not clearly diagnosed and treated.The factors affecting the delay in seeking medical treatment in individuals with OSA included income, place of residence, objective support, self-recognition of the disease, self-efficacy and years of snoring.Investigations into OSA patients' care-seeking behaviours can better reflect the secondary prevention of OSA, and it is crucial to pay attention to the delayed phase of patients.
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Affiliation(s)
- Hui Zhang
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Chunguang Liang
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Xin Zhang
- Department of Respiratory Medicine, Zibo Central Hospital, Zibo, PR China
| | - Haitao Yu
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Xiangru Yan
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Liying Wang
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Tong Tong
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Huiying Zhang
- Department of Otolaryngology Head & Neck Surgery, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, PR China
| | - Hongliang Dai
- School of Nursing, Jinzhou Medical University, Jinzhou, PR China
| | - Huijuan Tong
- Department of Nursing, Shenyang Medical College, Shenyang, PR China
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Cost-Effectiveness of Continuous Positive Airway Pressure Therapy Versus Other Treatments of Obstructive Sleep Apnea. Sleep Med Clin 2022; 17:559-567. [DOI: 10.1016/j.jsmc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Newcomb P, Tadlock J, Nelson T, Urban R, Mullen H, Cordero R, Thinn S. Relationship between sleep apnea and hospital readmission in rural and urban populations. Public Health Nurs 2022; 39:1227-1234. [PMID: 35789117 DOI: 10.1111/phn.13114] [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: 02/22/2022] [Revised: 05/06/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate geographic differences in obstructive sleep apnea (OSA) prevalence, to determine if readmissions were more likely among rural patients with OSA than others, and to model predictors, including diagnosed OSA, of 30, 60, and 90-day acute-care readmissions. DESIGN This cohort study employed a secondary analysis of data extracted from the electronic health record shared by all hospitals in a north Texas healthcare system. SAMPLE The sample consisted of records associated with 472,503 adult patients admitted to any of the study system's acute-care facilities from 2016 through 2019. MEASUREMENTS Measurements consisted of case-level health information, including admissions, demographic variables, payors, diagnoses, screens, and physician orders. RESULTS OSA was significantly related to hospital readmission when considered in isolation but did not significantly predict readmission when modeled with plausible covariates. Screening rates for OSA did not vary by geography. Differences in rural/urban-suburban OSA prevalence were not statistically significant. CONCLUSIONS Findings contrast with previous suggestions that OSA plays an independent role in hospital readmissions or that rural resident may be disadvantaged regarding services that support the OSA diagnosis. Prevalence and screening rates were almost identical in urban and rural populations.
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Affiliation(s)
| | - Joell Tadlock
- Texas Health Stephenville Hospital, Stephenville, Texas, USA
| | | | - Regina Urban
- Texas Health Arlington Memorial Hospital, Arlington, Texas, USA
| | - Hannah Mullen
- Texas Health Cleburne Hospital, Cleburne, Texas, USA
| | - Rosette Cordero
- Texas Health Methodist Fort Worth Hospital, Fort Worth, Texas, USA
| | - Su Thinn
- Texas Health Methodist Fort Worth Hospital, Fort Worth, Texas, USA
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11
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Das AM, Chang JL, Berneking M, Hartenbaum NP, Rosekind M, Gurubhagavatula I. Obstructive sleep apnea screening, diagnosis, and treatment in the transportation industry. J Clin Sleep Med 2022; 18:2471-2479. [PMID: 34546916 PMCID: PMC9516581 DOI: 10.5664/jcsm.9672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022]
Abstract
Obstructive sleep apnea (OSA) is a common, identifiable, and treatable disorder with serious health, safety, and financial implications-including sleepiness- related crashes and incidents-in workers who perform safety-sensitive functions in the transportation industry. Up to one-third of crashes of large trucks are attributable to sleepiness, and large truck crashes result in more than 4,000 deaths annually. For each occupant of a truck who is killed, 6 to 7 occupants of other vehicles are killed. Treatment of OSA is cost-effective, lowers crash rates, and improves health and well-being. A large body of scientific evidence and expert consensus supports the identification and treatment of OSA in transportation operators. An Advanced Notice of Proposed Rulemaking regarding the diagnosis and treatment of OSA in commercial truck and rail operators was issued by the Federal Motor Carrier Safety Administration and Federal Railroad Administration, but it was later withdrawn. This reversal of the agencies' position has caused confusion among some, who have questioned whether efforts to identify and treat the disorder are warranted. In response, we urge key stakeholders, including employers, operators, legislators, payers, clinicians, and patients, to engage in a collaborative, patient-centered approach to address the disorder. At a minimum, stakeholders should follow the guidelines issued by a medical review board commissioned by the Federal Motor Carrier Safety Administration in 2016 alone, or in combination with the 2006 criteria, "Sleep Apnea and Commercial Motor Vehicle Operators," a Statement from the Joint Task Force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation developed by a joint task force. As research in this area continues to evolve, waiting is no longer an option, and the current standard of care demands action to mitigate the burden of serious health and safety risks due to this common, treatable disorder. CITATION Das AM, Chang JL, Berneking M, Hartenbaum NP, Rosekind M, Gurubhagavatula I. Obstructive sleep apnea screening, diagnosis, and treatment in the transportation industry. J Clin Sleep Med. 2022;18(10):2471-2479.
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Affiliation(s)
- Aneesa M. Das
- Division of Pulmonary, Critical Care and Sleep, The Ohio State University, Columbus, Ohio
| | - Judy L. Chang
- San Jose Military Entrance Processing Station, Mountain View, California
| | | | | | - Mark Rosekind
- Center for Injury Research and Policy Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Indira Gurubhagavatula
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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12
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Baillieul S, Shah NM, Dharmasena R, Schiza S, Testelmans D, Pataka A. CPAP for secondary cardiovascular prevention in obstructive sleep apnoea patients: not only one moon, but many stars. Breathe (Sheff) 2022; 18:220148. [PMID: 36865657 PMCID: PMC9973521 DOI: 10.1183/20734735.0148-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
While continuous positive airway pressure (CPAP) therapy has a strong evidence base for the treatment of obstructive sleep apnoea (OSA), its impact on cardiovascular comorbidity remains unclear. This journal club reviews three recent randomised controlled trials aimed to evaluate the impact of CPAP therapy in secondary prevention of cerebrovascular and coronary heart disease (SAVE trial), comorbid coronary heart disease (RICCADSA trial) and in patients admitted with acute coronary syndrome (ISAACC trial). All three trials included patients with moderate-to-severe OSA and excluded patients with severe daytime sleepiness. When CPAP was compared with usual care, they all reported no difference in a similar primary composite end-point including death from cardiovascular disease, cardiac events, and strokes. These trials faced the same methodological challenges, including a low primary end-point incidence, the exclusion of sleepy patients, and a low CPAP adherence. Therefore, caution must be taken when broadening their results to the wider OSA population. Although randomised controlled trials provide a high level of evidence, they may not be sufficient to capture the diversity of OSA. Large-scale, real-world data may be able to provide a more rounded and generalisable picture of the effects of routine clinical use of CPAP on cardiovascular morbimortality.
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Affiliation(s)
- Sébastien Baillieul
- Grenoble Alpes University, HP2 Laboratory, INSERM U1300 and Grenoble Alpes University Hospital, Grenoble, France,Corresponding author: Sébastien Baillieul ()
| | - Neeraj M. Shah
- Lane Fox Respiratory Research Centre, Guy's and St. Thomas’ NHS Foundation Trust, London, UK
| | | | - Sophia Schiza
- Sleep Disorders Centre, Dept of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Dries Testelmans
- KU Leuven – University of Leuven, University Hospitals Leuven, Department of Respiratory diseases, Leuven, Belgium
| | - Athanasia Pataka
- Aristotle University Thessaloniki and Respiratory Failure Unit, Aristotle University Thessaloniki, G. Papanikolaou Hospital Exohi, Thessaloniki, Greece
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13
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Peripheral Biomarkers to Diagnose Obstructive Sleep Apnea in Adults: A Systematic Review and Meta-Analysis. Sleep Med Rev 2022; 64:101659. [DOI: 10.1016/j.smrv.2022.101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
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14
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Krishnan S, Chai-Coetzer CL, Grivell N, Lovato N, Mukherjee S, Vakulin A, Adams RJ, Appleton SL. Comorbidities and quality of life in Australian men and women with diagnosed and undiagnosed high risk obstructive sleep apnea. J Clin Sleep Med 2022; 18:1757-1767. [PMID: 35332868 DOI: 10.5664/jcsm.9972] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES In a population-based survey, we determined sex-differences in health profiles and quality of life between individuals who have a confirmed diagnosis of obstructive sleep apnea (OSA) and those who are at high risk of OSA yet remain undiagnosed. METHODS An online survey of Australian adults ≥18 years (n= 3818) identified participants with self-reported diagnosed OSA (n=460) or high risk, undiagnosed OSA (OSA50 score ≥5, n=1015). Ever-diagnosed comorbidities, sociodemographic and quality of life (EQ-5D-5L, Functional Outcomes of Sleep Questionnaire-10) were assessed. RESULTS Females were more frequently represented in the high OSA risk group compared to diagnosed OSA (55.5%, n=563 cf 43%, n=198) p<0.001. In sex-specific logistic regression analyses, diagnosed OSA was associated with increased likelihoods of ≥1 cardiovascular condition (odds ratio:3.0, 95% CI:2.0-4.5), hypertension (1.9, 1.3-2.8), gout (1.8, 1.1-2.9) and COPD (3.8, 2.1-6.9) in males. In females an association with asthma (2.0, 1.3-3.0) was seen. Diabetes, arthritis, mental health conditions (ever-diagnosed) and all EQ-5D-5L dimensions were associated with an OSA diagnosis regardless of sex with the exception of EQ-5D-5L anxiety/depression which was only associated with an OSA diagnosis in females. A diagnosis of OSA was associated with sleepiness related impairment (lowest quartile of FOSQ-10) in males (1.6, 1.01-2.5) and females (2.2, 1.4-3.6). CONCLUSIONS Sex-specific health conditions may drive diagnosis of OSA however a clinical suspicion of OSA needs to be increased in men and women. The impaired quality of life and persistent sleepiness in participants with diagnosed OSA observed at a population level requires greater clinical attention.
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Affiliation(s)
- Sowmya Krishnan
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Ching Li Chai-Coetzer
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Nicole Grivell
- Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Sutapa Mukherjee
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Robert J Adams
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute-Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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15
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Pachito DV, Bagattini ÂM, Drager LF, Eckeli AL, Rocha A. Economic evaluation of CPAP therapy for obstructive sleep apnea: a scoping review and evidence map. Sleep Breath 2022; 26:17-30. [PMID: 33788132 DOI: 10.1007/s11325-021-02362-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To synthesize findings of economic evaluations investigating cost-effectiveness of continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) and of strategies of organization of care related to CPAP therapy. METHODS Scoping review with searches conducted in MEDLINE, CRD, LILACS, and Embase in August 2020. Eligible studies were economic evaluations comparing CPAP to other alternative or assessing strategies of care for CPAP therapy. Results were presented narratively, and incremental cost-effectiveness ratios (ICER) were presented in evidence maps. RESULTS Of 34 studies, 3 concluded that CPAP is less costly and more effective when compared to usual care. Most studies indicated that CPAP is associated with better health outcomes, but at higher prices. ICER ranged from USD 316 to 98,793 per quality-adjusted life years (QALY) gained (median 16,499; IQR 8267 to 33,119). One study concluded that CPAP is more costly and less effective, when treatment is applied to all patients, regardless of disease severity. Variability of ICER was mainly due to definition of population and applied time horizons. When CPAP was compared to mandibular advancement device, ICER ranged from USD 21,153 to 361,028 (median 89,671; IQR 26,829 to 295,983), which represents the investment in CPAP therapy required to obtain one extra QALY. Three studies assessed the effects of organizing CPAP therapy in primary care, which was cost-effective or cost-saving. CONCLUSIONS Compared to usual care, CPAP is cost-effective after the second year of treatment, when indicated for moderate-to-severe OSA. CPAP therapy may be even more cost-effective by using different strategies of organization of care. These findings may inform decision making related to CPAP reimbursement in health systems. CLINICAL TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Daniela V Pachito
- Department of Health Technology Assessment, Hospital Sírio-Libanês, Rua Barata Ribeiro 142, São Paulo, 01308-000, Brazil.
| | - Ângela M Bagattini
- Department of Health Technology Assessment, Hospital Sírio-Libanês, Rua Barata Ribeiro 142, São Paulo, 01308-000, Brazil
| | - Luciano F Drager
- Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
| | - Alan L Eckeli
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
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16
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Lajoie AC, Privé A, Roy-Hallé A, Pagé D, Simard S, Séries F. Diagnosis and management of sleep apnea by a clinical nurse: a noninferiority randomized clinical trial. J Clin Sleep Med 2022; 18:89-97. [PMID: 34170235 PMCID: PMC8807928 DOI: 10.5664/jcsm.9502] [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: 02/04/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES References for the evaluation of obstructive sleep apnea often exceed the sleep clinic's capacity. We aimed to assess the noninferiority of a nurse-communicated model compared with a traditional physician-led model for the initial management of uncomplicated obstructive sleep apnea in the sleep clinic. METHODS In this noninferiority, open-label randomized controlled trial, patients referred for the evaluation of uncomplicated obstructive sleep apnea (home sleep apnea test with respiratory event index ≥ 20 events/h) were randomized to a nurse-communicated or a physician-led management. The primary endpoint was noninferiority in the mean change from baseline of the Epworth Sleepiness Scale score at 3 and 6 months, assuming a noninferiority margin of -2.0 points. Secondary outcomes included quality of life (Quebec Sleep Questionnaire) and positive airway pressure adherence. RESULTS Two hundred participants were randomized to a nurse-communicated (n = 101) or physician-led management (n = 99). Overall, 48 participants were lost at follow-up (27.7% and 20.4% in the nurse-communicated and physician-led groups, respectively). Most participants were treated with positive airway pressure (78.2% and 80.6% in the nurse-communicated and physician-led management groups, respectively). There was substantial missing data for the Epworth Sleepiness Scale (33% and 58% at 3 and 6 months in the nurse-communicated group and 29% and 55% in the physician-led group) and Quebec Sleep Questionnaire (86% and 91% at 3 and 6 months and 79.6% and 85.7% in the physician-led group). The difference in mean change between groups for the Epworth Sleepiness Scale was -0.71 (95% confidence interval -2.25 to 0.83) at 3 months and -0.21 (95% confidence interval -1.85 to 1.45) at 6 months. For each domain of the Quebec Sleep Questionnaire at 3 and 6 months, the lower bound of the 95% confidence interval was greater than the prespecified noninferiority margin. Positive airway pressure adherence was similar between groups. CONCLUSIONS Among patients with uncomplicated obstructive sleep apnea, nurse-communicated management was noninferior to physician-led management in terms of sleepiness, quality of life, and positive airway pressure adherence at 6 months. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Management of Sleep Apnea Patients by a Clinical Nurse (Supernurse), URL: https://clinicaltrials.gov/ct2/show/NCT03455920; Identifier: NCT03455920. CITATION Lajoie AC, Privé A, Roy-Hallé A, Pagé D, Simard S, Séries F. Diagnosis and management of sleep apnea by a clinical nurse: a noninferiority randomized clinical trial. J Clin Sleep Med. 2022;18(1):89-97.
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Affiliation(s)
- Annie C. Lajoie
- Centre de Recherche de l’Institut de Cardiologie et de Pneumologie de Québec–Université Laval (CRIUCPQ-UL), Quebec City, Canada
| | - Alexis Privé
- Centre de Recherche de l’Institut de Cardiologie et de Pneumologie de Québec–Université Laval (CRIUCPQ-UL), Quebec City, Canada
| | - Annie Roy-Hallé
- Centre de Recherche de l’Institut de Cardiologie et de Pneumologie de Québec–Université Laval (CRIUCPQ-UL), Quebec City, Canada
| | - Diane Pagé
- Centre de Recherche de l’Institut de Cardiologie et de Pneumologie de Québec–Université Laval (CRIUCPQ-UL), Quebec City, Canada
| | - Serge Simard
- Centre de Recherche de l’Institut de Cardiologie et de Pneumologie de Québec–Université Laval (CRIUCPQ-UL), Quebec City, Canada
| | - Frédéric Séries
- Centre de Recherche de l’Institut de Cardiologie et de Pneumologie de Québec–Université Laval (CRIUCPQ-UL), Quebec City, Canada
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17
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Wu H, Fang F, Guo Y, Wu C, Wei Y. Independent Role of Nasal Congestion in Positive Airway Pressure Compliance for OSA Treatment. Otolaryngol Head Neck Surg 2021; 167:395-402. [PMID: 34905427 DOI: 10.1177/01945998211064577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the independent role of nasal congestion in positive airway pressure (PAP) therapy compliance and factors associated with an unfavorable shift of PAP compliance. STUDY DESIGN Prospective cohort study. SETTING Tertiary care center. METHODS This follow-up study comprised 174 patients with newly diagnosed obstructive sleep apnea (OSA) who accepted PAP therapy from January 2017 to June 2019. Information was collected on basic demographics, comorbidities, sleep-related symptoms, nasal symptoms, and upper airway assessment. PAP adherence data were collected at the end of the first week and the third month. RESULTS After 3 months of follow-up, 147 participants were included for final data analysis. The proportion of nasal congestion (29.2% vs 52.0%, P = .005) and its severity (mean rank, 58.5 vs 75.1; P = .007) were significantly higher in the noncompliance group as compared with the compliance group. After adjustment for basic demographics, comorbidities, sleep-related symptoms or sleep study parameters, and Friedman clinical staging, multinomial logistic regression models showed that nasal congestion (all odds ratios >2.0, P < .05) was independently associated with a higher odds of PAP noncompliance. Patients with an unfavorable shift of PAP compliance were younger (mean ± SD, 47.5 ± 10.6 vs 53.1 ± 12.6 years; P = .021) and had a lower body mass index (27.2 ± 3.7 vs 29.3 ± 5.0, P = .027) than those who consistently complied. OSA severity was associated with PAP compliance, initially and in the long term. CONCLUSION Nasal congestion is an independent predictor of PAP noncompliance. Younger patients with lower BMI were more likely to have an unfavorable shift of PAP compliance. Initial and long-term adherence to PAP therapy was affected by OSA severity.
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Affiliation(s)
- Hao Wu
- Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Fang Fang
- Beijing An Zhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Yaxin Guo
- Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Chan Wu
- Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Yongxiang Wei
- Beijing An Zhen Hospital, Capital Medical University, Beijing, China.,Capital Institute of Pediatrics, Beijing, China
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18
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Kim H, Kim JK, Cho JH. Cost-Effectiveness Analysis of Positive Airway Pressure in Patient with Obstructive Sleep Apnea. JOURNAL OF RHINOLOGY 2021. [DOI: 10.18787/jr.2021.00357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background and Objectives: Positive airway pressure (PAP) is effective at reducing the number of complications in patients with obstructive sleep apnea (OSA). To the best of our knowledge, no cost-effectiveness analysis of PAP has been conducted in Korea. Subjects and Method: We classified subjects into two groups, those with moderate-to-severe OSA who used PAP after polysomnography (PAP treatment group) and those who did not receive a diagnosis and treatment (control group), and compared their medical expenses over a period of 10 years. The incidence rate of common complications and accidents (coronary heart disease, heart failure, stroke, depression, diabetes, vehicular accidents, and work-related accidents) with or without PAP was adopted through a literature review. The average medical expenses for treating each complication and accident were found by searching several databases. The analysis consisted of a payer’s perspective and a societal perspective. Results: The incidence of all complications was higher in the control group than in the PAP treatment group. However, since the absolute incidence rate was not high in either group and medical expenses in Korea are low, the expected treatment cost was not high. In contrast, the PAP rental fee was relatively high. To obtain 1 unit of disability-adjusted life year, it costs 40,873,288 won from the payer’s perspective and 31,791,810 won from the societal perspective. Conclusion: PAP treatment reduces patient complications and extends their lifespan, but costs must be considered.
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19
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Streatfeild J, Smith J, Mansfield D, Pezzullo L, Hillman D. The Social And Economic Cost Of Sleep Disorders. Sleep 2021; 44:6279099. [PMID: 34015136 DOI: 10.1093/sleep/zsab132] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/14/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES To estimate economic cost of common sleep disorders in Australia for 2019-2020. METHODS Costs were estimated for obstructive sleep apnea (OSA), insomnia, and restless legs syndrome (RLS) using prevalence, financial, and nonfinancial data from national databases. These included: (1) financial costs associated with health care, informal care, productivity losses, non-medical accident costs, deadweight loss from taxation/welfare inefficiencies; and (2) nonfinancial costs associated with loss of well-being. They were expressed in US dollars ($). RESULTS Estimated overall cost of sleep disorders in Australia in 2019-2020 (population: 25.5 million) was $35.4 billion (OSA $13.1 billion; insomnia $13.3 billion, RLS $9.0 billion). Of this, the financial cost component was $10.0 billion, comprised of: health system costs $0.7 billion; productivity losses $7.7 billion; informal care $0.2 billion; other, mainly non-medical accident costs, $0.4 billion; and deadweight losses $1.0 billion. For moderate to severe OSA syndrome, insomnia unrelated to other conditions and RLS, financial costs represented $16,717, $21,982, and $16,624 per adult with the condition for the year, respectively. The nonfinancial cost was $25.4 billion. CONCLUSIONS The economic costs associated with sleep disorders are substantial. The financial component of $10.0 billion is equivalent to 0.73% of Australian gross domestic product. The nonfinancial cost of $25.4 billion represents 3.2% of total Australian burden of disease for the year. Health system costs of these disorders are low relative to those associated with their consequences, suggesting greater expenditure on detection, treatment and prevention is warranted.
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Affiliation(s)
- Jared Streatfeild
- Health Economics and Social Policy Team, Deloitte Access Economics, Canberra, Australia
| | - Jackson Smith
- Health Economics and Social Policy Team, Deloitte Access Economics, Canberra, Australia
| | - Darren Mansfield
- Monash Lung and Sleep Department, Monash Health, Melbourne, Australia
| | - Lynne Pezzullo
- Health Economics and Social Policy Team, Deloitte Access Economics, Canberra, Australia
| | - David Hillman
- Centre for Sleep Science, University of Western Australia, Perth, Australia.,West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Australia
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20
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Gonzalez-Vergara D, Marquez-Pelaez S, Alfonso-Arias JD, Perez-Ramos J, Rojas-Box JL, Aumesquet-Nosea M. An alternative model in the provision of CPAP in sleep apnea: a comparative cost analysis. BMC Health Serv Res 2021; 21:469. [PMID: 34006260 PMCID: PMC8130106 DOI: 10.1186/s12913-021-06474-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To conduct a pilot study on an alternative model for the provision of respiratory therapies in sleep apnea-hypopnea syndrome (SAHS) by internalizing the service with the purchase, monitoring and control of continuous positive airway pressure (CPAP) equipment by the hospital. METHODS An observational, prospective pilot study of comparative cost analysis by internalizing the service to include all patients up to a budget limit of 5000 euros. The cost of internalizing the service included the acquisition of CPAP equipment and all the necessary accessories in addition to the nursing days necessary to track the patients. Patient satisfaction was assessed by a survey of the hospital service. RESULTS Twenty-one patients with 23,046 patient-days of follow-up were included. The cost of the internalized system was 6825.11 €. The cost of the outsourced system over the same period would have been 22,781.18 €; thus, the direct saving was 15,956.07 €. The cost per device per day of the internalized system was 0.30 € versus the 0.99 € that the outsourced system would have cost during the study period. In the satisfaction survey, 12 (70.6%) patients indicated that they preferred the service of the hospital over that of the external company. No patient preferred the outsourced system. CONCLUSIONS The internalization of CPAP service represents significant cost savings from a hospital perspective and an improvement in patients' perceptions of the quality of service.
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Affiliation(s)
- Demetrio Gonzalez-Vergara
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot, s/n, 41013, Seville, Spain.
| | | | | | - Julia Perez-Ramos
- Agencia Sanitaria Bajo Guadalquivir, Hospital de Alta Resolución de Constantina, Seville, Spain
| | - Jose Luis Rojas-Box
- Agencia Sanitaria Bajo Guadalquivir, Hospital de Alta Resolución de Constantina, Seville, Spain
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21
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Bertelli F, Suehs CM, Mallet JP, Rotty MC, Pepin JL, Gagnadoux F, Matzner-Lober E, Bourdin A, Molinari N, Jaffuel D. Apnoea-hypopnoea indices determined via continuous positive airway pressure (AHI-CPAP flow) versus those determined by polysomnography (AHI-PSG gold): a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e044499. [PMID: 33972338 PMCID: PMC8112393 DOI: 10.1136/bmjopen-2020-044499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea-hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. METHODS AND ANALYSIS No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. ETHICS AND DISSEMINATION This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/TRIAL REGISTRATION NUMBERS CRD42020159914/NCT04526366; Pre-results.
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Affiliation(s)
- Fanny Bertelli
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France
- Association pour l'assistance et la réhabilitation à domicile (Apard) groupe Adène, Montpellier, France
| | - Carey Meredith Suehs
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- Department of Medical Information, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Jean Pierre Mallet
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- PhyMedExp (INSERM U 1046, CNRS UMR9214), Montpellier University, Montpellier, France
| | - Marie Caroline Rotty
- Association pour l'assistance et la réhabilitation à domicile (Apard) groupe Adène, Montpellier, France
| | - Jean Louis Pepin
- Department of Physiology, Sleep and Exercise, Univ Grenoble Alpes, CHU Grenoble, Grenoble, France
| | | | | | - A Bourdin
- Association pour l'assistance et la réhabilitation à domicile (Apard) groupe Adène, Montpellier, France
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- PhyMedExp (INSERM U 1046, CNRS UMR9214), Montpellier University, Montpellier, France
| | - Nicolas Molinari
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France
- Department of Medical Information, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Dany Jaffuel
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- PhyMedExp (INSERM U 1046, CNRS UMR9214), Montpellier University, Montpellier, France
- Pulmonary Disorders and Respiratory Sleep Disorders Unit, Polyclinic Saint-Privat, Boujan sur Libron, France
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22
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Darden M, Espie CA, Carl JR, Henry AL, Kanady JC, Krystal AD, Miller CB. Cost-effectiveness of digital cognitive behavioral therapy (Sleepio) for insomnia: a Markov simulation model in the United States. Sleep 2021; 44:5957088. [PMID: 33151330 DOI: 10.1093/sleep/zsaa223] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
STUDY OBJECTIVES To examine the cost-effectiveness and potential net monetary benefit (NMB) of a fully automated digital cognitive behavioral therapy (CBT) intervention for insomnia compared with no insomnia treatment in the United States (US). Similar relative comparisons were made for pharmacotherapy and clinician-delivered CBT (individual and group). METHODS We simulated a Markov model of 100,000 individuals using parameters calibrated from the literature including direct (treatment) and indirect costs (e.g. insomnia-related healthcare expenditure and lost workplace productivity). Health utility estimates were converted into quality-adjusted life years (QALYs) and one QALY was worth $50,000. Simulated individuals were randomized equally to one of five arms (digital CBT, pharmacotherapy, individual CBT, group CBT, or no insomnia treatment). Sensitivity was assessed by bootstrapping the calibrated parameters. Cost estimates were expressed in 2019 US dollars. RESULTS Digital CBT was cost beneficial when compared with no insomnia treatment and had a positive NMB of $681.06 (per individual over 6 months). Bootstrap sensitivity analysis demonstrated that the NMB was positive in 94.7% of simulations. Relative to other insomnia treatments, digital CBT was the most cost-effective treatment because it generated the smallest incremental cost-effectiveness ratio (-$3,124.73). CONCLUSIONS Digital CBT was the most cost-effective insomnia treatment followed by group CBT, pharmacotherapy, and individual CBT. It is financially prudent and beneficial from a societal perspective to utilize automated digital CBT to treat insomnia at a population scale.
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Affiliation(s)
- Michael Darden
- Carey Business School, Johns Hopkins University, Baltimore, MD
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Inc., London, UK.,Big Health Inc., San Francisco, CA
| | - Jenna R Carl
- Big Health Inc., London, UK.,Big Health Inc., San Francisco, CA
| | - Alasdair L Henry
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Inc., London, UK.,Big Health Inc., San Francisco, CA
| | | | - Andrew D Krystal
- Department of Psychiatry, School of Medicine, University of California San Francisco, San Francisco, CA.,Department of Neurology, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Christopher B Miller
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Inc., London, UK.,Big Health Inc., San Francisco, CA
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23
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Crew EC, Wohlgemuth WK, Sawyer AM, Williams NJ, Wallace DM. Socioeconomic Disparities in Positive Airway Pressure Adherence: An Integrative Review. Sleep Med Clin 2021; 16:23-41. [PMID: 33485530 DOI: 10.1016/j.jsmc.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nonadherence with positive airway pressure (PAP) therapy impedes the effectiveness of treatment and increases risk of mortality. Disparities in PAP adherence as a function of socioeconomic status (SES) are not well understood. A literature search identified 16 original publications meeting inclusion criteria that described effects of SES factors on objective PAP adherence; 69% of these articles found evidence of lower adherence as a function of SES. This integrative review provides a structured summary of the findings, highlights factors that may contribute to disparities among adult PAP users, and identifies future directions to improve equity in the management of OSA.
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Affiliation(s)
- Earl Charles Crew
- Behavioral Health Program, Mental Health Care Line, Michael E. DeBakey VA Medical Center, Building 108-A Room 224, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Psychology Division, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - William K Wohlgemuth
- Psychology Service, Bruce W. Carter Medical Center, Miami VA Healthcare system, Sleep Disorders Center, Room A212, 1201 NW 16th ST, Miami, FL 33125, USA; Neurology Service, Bruce W. Carter Medical Center, Miami VA Healthcare system, Sleep Disorders Center, Room A212, 1201 NW 16th ST, Miami, FL 33125, USA
| | - Amy M Sawyer
- University of Pennsylvania, School of Nursing, Clair Fagin Hall, Room 349, 418 Curie Boulevard, Philadelphia, PA 19104, USA; Perelman School of Medicine Center for Sleep and Circadian Neurobiology, Philadelphia, PA, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Natasha J Williams
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, New York University Grossman School of Medicine, 180 Madison Avenue, 7th Floor, New York, NY 10016, USA
| | - Douglas M Wallace
- Neurology Service, Bruce W. Carter Medical Center, Miami VA Healthcare system, Sleep Disorders Center, Room A212, 1201 NW 16th ST, Miami, FL 33125, USA; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
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24
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Mansfield DR. Obstructive sleep apnoea phenotypes: The many faces of a public health monolith. Respirology 2020; 26:294-295. [PMID: 33289249 DOI: 10.1111/resp.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
See related article
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Affiliation(s)
- Darren R Mansfield
- Monash Lung and Sleep Department, Monash Health and Monash University, Melbourne, VIC, Australia
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25
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Corrigan J, Ogah I, Ip-Buting A, Sharpe H, Laratta CR, Peller P, Tsai WH, Pendharkar SR. An evaluation of rural-urban disparities in treatment outcomes for obstructive sleep apnoea: study protocol for a prospective cohort study. ERJ Open Res 2020; 6:00141-2020. [PMID: 33043058 PMCID: PMC7534578 DOI: 10.1183/23120541.00141-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/03/2020] [Indexed: 11/05/2022] Open
Abstract
Background Obstructive sleep apnoea (OSA) is a common and treatable chronic condition that is associated with significant morbidity and economic cost. Geography is increasingly being recognised as a barrier to diagnosis and treatment of many chronic diseases; however, no study to date has investigated the impact of place of residence on health outcomes in OSA. Objective The purpose of this study is to determine whether treatment outcomes for patients initiating continuous positive airway pressure (CPAP) for OSA differ between those who live in urban versus rural settings. Methods A prospective cohort design will be used. Participants will be recruited through community-based CPAP providers and assigned to either the rural or urban cohort based on residential postal code. The primary outcome will be the difference in nightly hours of CPAP use between the two groups, measured 3 months after initiation of therapy. Secondary outcomes will include symptoms, quality of life, patient satisfaction and patient-borne costs. Anticipated results This study will determine whether there are differences in CPAP adherence or patient-reported outcomes between rural and urban patients with OSA. These results will highlight potential challenges with providing OSA care in rural populations and may inform health interventions to reduce urban-rural inequities.
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Affiliation(s)
- Jennifer Corrigan
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Imhokhai Ogah
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ada Ip-Buting
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Heather Sharpe
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Cheryl R Laratta
- Dept of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Peter Peller
- Spatial and Numeric Data Services, University of Calgary, Calgary, Canada
| | - Willis H Tsai
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Dept of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sachin R Pendharkar
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Dept of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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26
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Low arousal threshold is associated with unfavorable shift of PAP compliance over time in patients with OSA. Sleep Breath 2020; 25:887-895. [PMID: 33011910 DOI: 10.1007/s11325-020-02197-9] [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: 06/04/2020] [Revised: 08/28/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the predictive factors of initial and long-term adherence to positive airway pressure (PAP) therapy and factors leading to an unfavorable shift of PAP compliance. METHODS This follow-up study was comprised of newly diagnosed patients with obstructive sleep apnea (OSA) amenable to PAP therapy from January 2017 to April 2019. Information on basic demographics, comorbidities, and sleep-related symptoms were collected. PAP adherence data were collected at the end of the first week and the third month. RESULTS Of 166 patients enrolled, data from 142 (86%) were in the final analysis. Overall PAP usage was worse at 3 months declining from the first week. After adjusting for age and gender, multinomial logistic regression analysis showed that a small number of sleep-related symptoms (OR, 0.69; 95% CI, 0.52-0.91) and low arousal threshold (ArTH) (OR, 4.44; 95% CI, 1.52-12.98) were associated with higher odds of noncompliance. Low ArTH (OR, 2.87; 95% CI, 1.09-7.57) and lower body mass index (BMI) (OR, 0.88; 95% CI, 0.78-0.99) increased the risk of compliance-to-noncompliance shift. Sixty-two patients with polysomnography were analyzed separately. After adjustment for age and gender, poor sleep efficiency (OR, 0.80; 95% CI, 0.68-0.94) was associated with higher odds of consistent noncompliance. Low ArTH (OR, 15.36; 95% CI, 1.44-164.24) increased the risk of compliance-to-noncompliance shift in this subgroup. CONCLUSIONS Lower BMI and low ArTH were associated with an unfavorable shift of PAP compliance over time in patients with OSA, which was different from the predictors of consistent PAP noncompliance of patients with OSA.
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27
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Heraganahally SS, Zaw KK, Tip S, Jing X, Mingi JJ, Howarth T, Roy A, Falhammar H, Sajkov D. Obstructive sleep apnoea and adherence to continuous positive airway therapy among Australian women. Intern Med J 2020; 52:440-450. [PMID: 33012105 DOI: 10.1111/imj.15076] [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: 07/18/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Clinical characteristics of women with different obstructive sleep apnoea (OSA) severity and adherence to Continuous Positive Airway Pressure (CPAP) therapy have not been previously explored. Therefore, in this retrospective study we assessed OSA prevalence. predictors, clinical and polysomnographic (PSG) characteristics and adherence to CPAP therapy among adult Australian women. METHODS All female patients who underwent a diagnostic PSG between 2014/2015 were included. CPAP adherence was assessed during the study period between 2018/2019 using multiple regression model. RESULTS Among a total of 591 females included in this study (Aboriginal n=86), OSA was diagnosed in 458/591 (78%) patients; mild, moderate and severe OSA was present in 44%, 27% and 29% respectively. Older age, higher BMI and hypertension predicted the presence and severity of OSA. The Epworth Sleepiness Scale (ESS) score was not significantly different with [10 (5, 13)] or without [8 (5, 12)] OSA. PSG showed rapid eye movement (REM) sleep associated apnoea hypopnea index (AHI) was higher with all severity of OSA. Adherence to CPAP therapy was noted in 171 (57%) patients; 47% mild, 57% moderate and 63% with severe OSA respectively. Three multiple regression models [clinical, PSG parameters, OSA severity, combined (clinical and PSG)] showed combined model had strongest predictive value and demonstrated that higher ESS and more severe oxygen desaturation were associated with CPAP adherence irrespective of OSA severity. CONCLUSION Older age, higher BMI and presence of hypertension predicted the presence of OSA. REM sleep related AHI was higher. Adherence to CPAP was associated with symptomatic OSA and severe oxygen desaturation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Subash S Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia and Northern Territory Medical Program, Darwin, Northern Territory, Australia.,Darwin Respiratory and Sleep Health, Darwin private Hospital, Darwin, Northern Territory, Australia.,Australian Respiratory and Sleep Medicine Institute, Adelaide, Australia
| | - Kyi K Zaw
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sai Tip
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Department of General Practice, Northern Territory, Darwin, Australia
| | - Xinlin Jing
- Health Information Services, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Joy J Mingi
- Darwin Respiratory and Sleep Health, Darwin private Hospital, Darwin, Northern Territory, Australia.,Department of Public Health, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Timothy Howarth
- Darwin Respiratory and Sleep Health, Darwin private Hospital, Darwin, Northern Territory, Australia.,College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anil Roy
- Department of Respiratory and Sleep Medicine, The Queen Elizabeth Hospital, South Australia, Australia
| | - Henrik Falhammar
- Departments of General Medicine and Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden and Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Dimitar Sajkov
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia and Northern Territory Medical Program, Darwin, Northern Territory, Australia.,Australian Respiratory and Sleep Medicine Institute, Adelaide, Australia.,Respiratory and Sleep Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
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28
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Global Risk Factor Evaluation of Obstructive Sleep Apnea in Relation to Research Activity and Socioeconomic Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186785. [PMID: 32957715 PMCID: PMC7559375 DOI: 10.3390/ijerph17186785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022]
Abstract
Obstructive Sleep Apnea is emerging as a global health epidemic, particularly due to the obesity pandemic. However, comprehensive prevalence data are still lacking and global OSA research has not yet been structurally evaluated. Using the latest comprehensive age/gender-specific BMI and obesity data, a global landscape estimating the risk/burden of OSA was created. Results were presented in relation to an in-depth analysis of OSA research and countries’ socioeconomic/scientific background. While the USA, Canada, and Japan are the highest publishing countries on OSA, Iceland, Greece, and Israel appeared at the forefront when relating the scientific output to socioeconomic parameters. Conversely, China, India, and Russia showed relatively low performances in these relations. Analysis of the estimated population at risk (EPR) of OSA showed the USA, China, India, and Brazil as the leading countries. Although the EPR and OSA research correlated strongly, major regional discrepancies between the estimated demand and actual research performances were identified, mainly in, but not limited to, developing nations. Our study highlights regional challenges/imbalances in the global activity on OSA and allows targeted measures to mitigate the burden of undiagnosed/untreated OSA. Furthermore, the inclusion of disadvantaged countries in international collaborations could stimulate local research efforts and provide valuable insights into the regional epidemiology of OSA.
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29
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30
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Lyons MM, Bhatt NY, Pack AI, Magalang UJ. Global burden of sleep-disordered breathing and its implications. Respirology 2020; 25:690-702. [PMID: 32436658 DOI: 10.1111/resp.13838] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/01/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Abstract
One-seventh of the world's adult population, or approximately one billion people, are estimated to have OSA. Over the past four decades, obesity, the main risk factor for OSA, has risen in striking proportion worldwide. In the past 5 years, the WHO estimates global obesity to affect almost two billion adults. A second major risk factor for OSA is advanced age. As the prevalence of the ageing population and obesity increases, the vulnerability towards having OSA increases. In addition to these traditional OSA risk factors, studies of the global population reveal select contributing features and phenotypes, including extreme phenotypes and symptom clusters that deserve further examination. Untreated OSA is associated with significant comorbidities and mortality. These represent a tremendous threat to the individual and global health. Beyond the personal toll, the economic costs of OSA are far-reaching, affecting the individual, family and society directly and indirectly, in terms of productivity and public safety. A better understanding of the pathophysiology, individual and ethnic similarities and differences is needed to better facilitate management of this chronic disease. In some countries, measures of the OSA disease burden are sparse. As the global burden of OSA and its associated comorbidities are projected to further increase, the infrastructure to diagnose and manage OSA will need to adapt. The use of novel approaches (electronic health records and artificial intelligence) to stratify risk, diagnose and affect treatment are necessary. Together, a unified multi-disciplinary, multi-organizational, global approach will be needed to manage this disease.
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Affiliation(s)
- M Melanie Lyons
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Nitin Y Bhatt
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Allan I Pack
- Division of Sleep Medicine/Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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31
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Garg H, Er XY, Howarth T, Heraganahally SS. Positional Sleep Apnea Among Regional and Remote Australian Population and Simulated Positional Treatment Effects. Nat Sci Sleep 2020; 12:1123-1135. [PMID: 33304112 PMCID: PMC7723233 DOI: 10.2147/nss.s286403] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/19/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To assess the prevalence of positional sleep apnea (POSA) and its predictors in patients diagnosed to have obstructive sleep apnea (OSA) in the regional and remote population of the Northern Territory of Australia over a two-year study period (2018 and 2019). PATIENTS AND METHODS Of the total 1463 adult patients who underwent a diagnostic polysomnography (PSG), 946 patients were eligible to be included in the study, of them, 810 consecutive patients with OSA (Apnea-Hypopnea Index (AHI) ≥ 5) who slept >4 h and had ≥30 min sleep in both supine and lateral positions were assessed. Patients were considered to have POSA if supine AHI to lateral AHI ratio ≥2. The likely comparative impact of use of continuous positive airway therapy (CPAP) or positional therapy (PT) on disease severity was evaluated using model simulation. RESULTS A total of 495/810 (61%) patients had POSA, the majority were males (68% vs 60%, p=0.013) and non-Indigenous Australians (93% vs 87%, p=0.004). POSA patients were younger (mean difference 2.23 years (95% CI 0.27, 4.19)), less obese (BMI mean difference 3.06 (95% CI 2.11, 4.01)), demonstrated less severe OSA (p < 0.001) and a greater proportion reported alcohol consumption (72% vs 62%, p=0.001) as compared to those with non-POSA. Using the simulation model, if patients with POSA use PT two-thirds (323/495, 65%) would obtain significant improvement of their OSA severity, with one in five (92/495, 19%) displaying complete resolution. Comparing this to simulated CPAP therapy, where the majority (444/495, 90%) will show significant improvement, and one-third (162/495, 33%) will display complete resolution. CONCLUSION POSA needs to be routinely recognised and positional therapy integrated in practice especially in the remote regions and in the developing world when effective methods are in place to monitor positional therapy.
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Affiliation(s)
- Himanshu Garg
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Xin Yi Er
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Timothy Howarth
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Tiwi, Darwin, Northern Territory, Australia
| | - Subash S Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Tiwi, Darwin, Northern Territory, Australia.,Flinders University - College of Medicine and Public Health, Adelaide, South Australia
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32
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Heffernan A, Malik U, Cheng R, Yo S, Narang I, Ryan CM. Transition to Adult Care for Obstructive Sleep Apnea. J Clin Med 2019; 8:jcm8122120. [PMID: 31810317 PMCID: PMC6947540 DOI: 10.3390/jcm8122120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 01/10/2023] Open
Abstract
Obstructive sleep apnea may occur throughout the lifespan, with peak occurrences in early childhood and during middle and older age. Onset in childhood is overwhelmingly due to adeno-tonsillar hypertrophy, while in adulthood, contributors include risk factors, such as obesity, male sex, and aging. More recently, there has been a precipitous increase in the prevalence of obstructive sleep apnea in youth. Drivers of this phenomenon include both increasing obesity and the survival of children with complex medical conditions into adulthood. Appropriate treatment and long-term management of obstructive sleep apnea is critical to ensure that these youth maintain well-being unfettered by secondary comorbidities. To this end, patient engagement and seamless transition of care from pediatric to adult health care systems is of paramount importance. To date, this is an unacknowledged and unmet need in most sleep programs. This article highlights the need for guideline-driven sleep disorder transition processes and illustrates the authors’ experience with the development of a program for sleep apnea.
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Affiliation(s)
- Austin Heffernan
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
| | - Uzair Malik
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
| | - Russell Cheng
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
| | - Shaun Yo
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
| | - Indra Narang
- Department of Pediatrics, Division of Respirology, University of Toronto, Toronto, ON M5G1X8, Canada;
- Sleep Laboratory, Hospital for Sick Children, Toronto, ON M5G1X8, Canada
| | - Clodagh M. Ryan
- Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G2A2, Canada; (A.H.); (U.M.); (R.C.)
- Department of Medicine, Division of Respirology, University of Toronto, Toronto, ON M5G2N2, Canada
- Correspondence:
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