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Ramírez Prieto MT, Lores Gutiérrez MAV, Moreno Zabaleta R, Rodríguez Pérez R. [Home CPAP Remote Monitoring as a System to Control Adaptation and Titration in Obstructive Sleep Apnoea and its Impact on the Management of this Pathology (T-CPAP Project)]. OPEN RESPIRATORY ARCHIVES 2024; 6:100332. [PMID: 38883210 PMCID: PMC11177187 DOI: 10.1016/j.opresp.2024.100332] [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: 11/06/2023] [Accepted: 04/25/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Continuous Positive Airway Pressure (CPAP) constitutes the most effective treatment for Obstructive Sleep Apnea (OSA). Automatic titration systems (ATS) are predominantly used to achieve adaptation to the equipment. Home CPAP devices allow telemonitoring (TM) of the same parameters as those provided by ATS but with access to continuous usage data. Under this premise, we conducted a study on the potential validity of TM for home CPAP devices as a titration system, its direct impact on proper adaptation (AD) to the equipment, and secondarily on the healthcare resources employed to achieve it. Material and methods An observational study involving 318 patients with OSA who were titrated using TM to achieve AD to CPAP. Patients with OSA were consecutively recruited and evaluated at 1, 3, and 6 months after initiating treatment. Results were compared with a historical group of 307 patients with OSA who achieved AD to CPAP using ATS. Additionally, we assessed the impact on required healthcare resources. Results Patients with OSA who initiated CPAP treatment with TM over the first six months showed a similar AD rate compared to the historical group titrated using ATS, with lower resource usage in the TM group. Conclusion Data provided by TM of home CPAP devices allow for titration and achieving similar AD as with ATS in non-complex patients.
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Affiliation(s)
| | - M A Vaneas Lores Gutiérrez
- Servicio de Neumología. Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Raul Moreno Zabaleta
- Servicio de Neumología. Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - Rocío Rodríguez Pérez
- Servicio de Neumología. Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
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Malhotra A, Heilmann CR, Banerjee KK, Dunn JP, Bunck MC, Bednarik J. Weight reduction and the impact on apnea-hypopnea index: A systematic meta-analysis. Sleep Med 2024; 121:26-31. [PMID: 38908268 DOI: 10.1016/j.sleep.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
Obstructive sleep apnea (OSA) is strongly associated with obesity. While the relationship between weight reduction and apnea-hypopnea index improvement has been documented, to our knowledge, it has not been quantified adequately. Therefore, this study aimed to quantify the relationship between weight reduction and AHI change. METHODS A systematic literature search was performed using meta-analyses (PRISMA) guidelines for studies reporting AHI and weight loss in people with obesity/overweight and OSA between 2000 and 2023. A linear and quadratic model (weighted by treatment arm sample size) predicted percent change from baseline AHI against mean percent change from baseline weight. The quadratic term was statistically significant (P < 0.05), so the quadratic model (with 95 % prediction interval) was used. RESULTS The literature search identified 27 studies/32 treatment arms: 15 using bariatric surgery and lifestyle intervention each and 2 using pharmacological interventions. Included studies were ≥3 months with weight intervention and participants had AHI ≥15/h. Weight reduction in people with OSA and obesity was associated with improvements in the severity of OSA. BMI reduction of 20 % was associated with AHI reduction of 57 %, while further weight reduction beyond 20 % in BMI was associated with a smaller effect on AHI. As the prediction intervals are relatively wide, a precise relationship could not be conclusively established. CONCLUSION The degree of AHI index improvement was associated with the magnitude of weight reduction. The model suggests that with progress in weight reduction beyond 20 %, the incremental decrease in BMI appeared to translate to a smaller additional effect on AHI.
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Parthasarathy S, Ayas NT, Bogan R, Hwang D, Kushida C, Lown JS, Ojile JM, Patel I, Prasad B, Rapoport DM, Strollo P, Vanderveken OM, Viviano J. Oral appliance therapy and hypoglossal nerve stimulation as non-positive airway pressure treatment alternatives for obstructive sleep apnea: a narrative expert review. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae035. [PMID: 38966620 PMCID: PMC11223066 DOI: 10.1093/sleepadvances/zpae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/13/2024] [Indexed: 07/06/2024]
Abstract
This perspective on alternatives to positive airway pressure (PAP) therapy for the treatment of obstructive sleep apnea (OSA) summarizes the proceedings of a focus group that was conducted by the Sleep Research Society Foundation. This perspective is from a multidisciplinary panel of experts from sleep medicine, dental sleep medicine, and otolaryngology that aims to identify the current role of oral appliance therapy and hypoglossal nerve stimulation for the treatment of OSA with emphasis on the US practice arena. A secondary aim is to identify-from an implementation science standpoint-the various barriers and facilitators for adoption of non-PAP treatment that includes access to care, multidisciplinary expertise, reimbursement, regulatory aspects, current treatment guidelines, health policies, and other factors related to the delivery of care. The panel has contextualized the review with recent events-such as a large-scale PAP device recall compounded by supply chain woes of the pandemic-and emerging science in the field of OSA and offers solutions for multidisciplinary approaches while identifying knowledge gaps and future research opportunities.
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Affiliation(s)
- Sairam Parthasarathy
- Department of Medicine, University of Arizona Health Sciences Center for Sleep and Circadian Sciences, University of Arizona, Tucson, AZ, USA
| | - Najib T Ayas
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Bogan
- Department of Psychaiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Dennis Hwang
- Division of Sleep Medicine, Kaiser Permanente Southern California, Fontana, CA, USA
| | - Clete Kushida
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | | | - Imran Patel
- Department of Medicine, University of Arizona Health Sciences Center for Sleep and Circadian Sciences, University of Arizona, Tucson, AZ, USA
- Dental Sleep Service Line, Banner University Medical Center - Tucson, Tucson, AZ, USA
| | - Bharati Prasad
- Department of Medicine, University of Illinois at Chicago and Jesse Brown VA Medical Center, Chicago, IL, USA
| | - David M Rapoport
- Mount Sinai Health System Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patrick Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Oliver M Vanderveken
- Department of ENT-HNS, Antwerp University Hospital, Edegem, Belgium and Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - John Viviano
- Sleep Disorders Dentistry Research and Learning Center, Mississauga, ON, Canada
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Xu L, Yi H, Pi M, Zhang C, Keenan BT, Glick HA, Dong X, Pack AI, Han F, Kuna ST. Telemedicine management of obstructive sleep apnea disorder in China: a randomized, controlled, non-inferiority trial. Sleep Breath 2024; 28:1173-1185. [PMID: 38225441 DOI: 10.1007/s11325-024-02994-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 01/17/2024]
Abstract
PURPOSE Previous studies assessed different components of telemedicine management pathway for OSA instead of the whole pathway. This randomized, controlled, and non-inferiority trial aimed to assess whether telemedicine management is clinically inferior to in-person care in China. METHODS Adults suspected of OSA were randomized to telemedicine (web-based questionnaires, self-administered home sleep apnea test [HSAT], automatically adjusting positive airway pressure [APAP], and video-conference visits) or in-person management (paper questionnaires, in-person HSAT set-up, APAP, and face-to-face visits). Participants with an apnea-hypopnea index (AHI) ≥ 15 events/hour received APAP for 3 months. The non-inferiority analysis was based on the change in Functional Outcomes of Sleep Questionnaire (FOSQ) score and APAP adherence. Cost-effectiveness analysis was performed. RESULTS In the modified intent-to-treat analysis set (n = 111 telemedicine, 111 in-person), FOSQ scores improved 1.73 (95% confidence interval [CI], 1.31-2.14) points with telemedicine and 2.05 (1.64-2.46) points with in-person care. The lower bound of the one-sided 95% non-inferiority CI for the difference in change between groups of - 0.812 was larger than the non-inferiority threshold of - 1. APAP adherence at 3 months was 243.3 (223.1-263.5) minutes/night for telemedicine and 241.6 (221.3-261.8) minutes/night for in-person care. The lower bound of the one-sided 95% non-inferiority CI of - 22.2 min/night was higher than the non-inferiority delta of - 45 min/night. Telemedicine had lower total costs than in-person management (CNY 1482.7 ± 377.2 vs. 1912.6 ± 681.3; p < 0.0001), driven by patient costs, but no significant difference in QALYs. CONCLUSIONS Functional outcomes and adherence were not clinically inferior in patients managed by a comprehensive telemedicine approach compared to those receiving in-person care in China. CLINICAL TRIAL REGISTRATION https://www.chictr.org.cn , Registration number ChiCTR2000030546. Retrospectively registered on March 06, 2020.
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Affiliation(s)
- Liyue Xu
- Department of Sleep Medicine, Peking University People's Hospital, No. 11, South Avenue, Beijing, China
| | - Huijie Yi
- Department of Sleep Medicine, Peking University People's Hospital, No. 11, South Avenue, Beijing, China
- Nursing School, Peking University, Beijing, China
| | - Mengyuan Pi
- Department of Sleep Medicine, Peking University People's Hospital, No. 11, South Avenue, Beijing, China
| | - Chi Zhang
- Department of Sleep Medicine, Peking University People's Hospital, No. 11, South Avenue, Beijing, China
| | - Brendan T Keenan
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Henry A Glick
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaosong Dong
- Department of Sleep Medicine, Peking University People's Hospital, No. 11, South Avenue, Beijing, China
| | - Allan I Pack
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Fang Han
- Department of Sleep Medicine, Peking University People's Hospital, No. 11, South Avenue, Beijing, China.
| | - Samuel T Kuna
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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Yu MWL, Au CT, Yuen HM, Chan NY, Chan JW, Wing YK, Li AM, Chan KCC. Effects of childhood obstructive sleep apnea with and without daytime sleepiness on behaviors and emotions. Sleep Med 2024; 115:93-99. [PMID: 38350308 DOI: 10.1016/j.sleep.2024.01.025] [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: 09/22/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To investigate the relationship between obstructive sleep apnea (OSA) with and without excessive daytime sleepiness (EDS) and behavioral and emotional outcomes in non-obese prepubertal children. METHODS This was a retrospective analysis of children aged 5-11 years who presented to our unit for assessment of their sleep-related complaints. All children underwent polysomnography (PSG). They also completed the Pediatric Daytime Sleepiness Scale (PDSS) and a sleep diary. OSA was diagnosed if the obstructive apnea-hypopnea index (OAHI) was ≥1 event/hour. EDS was defined as PDSS >15. Behavioral and emotional outcomes were assessed using the Child Behavioral Checklist (CBCL). RESULTS Data from 391 children (mean age of 8.6 ± 1.7 years; 67 % male) were analyzed. Seventy children did not have OSA or EDS, 137 had OSA, 50 had reported having EDS but without OSA, and 134 children had both OSA and EDS. There were significantly higher CBCL total problems score in the combined group (61 ± 9) compared to the non-OSA/EDS group (54 ± 10), and the OSA-only group (54 ± 10) (p < 0.001). The presence of EDS was significantly associated with higher CBCL T score and higher odds for clinically significant behavioral problems (T score ≥65) after adjusting for age, sex, BMI z-score and average sleep duration (p < 0.001). CONCLUSION Excessive daytime sleepiness is an important contributory factor associated with suboptimal behavioral and emotional outcomes in children with OSA.
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Affiliation(s)
- Michelle Wai-Ling Yu
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chun-Ting Au
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hoi-Man Yuen
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ngan-Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joey Wy Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yun-Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Albert Martin Li
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kate Ching-Ching Chan
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Franke C, Piezonna F, Schäfer R, Grimm A, Loris LM, Schwaibold M. Effect of a digital patient motivation and support tool on CPAP/APAP adherence and daytime sleepiness: a randomized controlled trial. Sleep Biol Rhythms 2024; 22:49-63. [PMID: 38469583 PMCID: PMC10899947 DOI: 10.1007/s41105-023-00479-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/22/2023] [Indexed: 03/13/2024]
Abstract
The purpose of this study was to assess the effect of a digital patient support (DPS) tool, complementary to standard care on continuous or automatic positive airway pressure (auto)CPAP adherence and daytime sleepiness after 12 weeks in patients diagnosed with severe obstructive sleep apnea (OSA). All patients with apnea-hypopnea index (AHI) ≥ 30 per hour were prospectively included and randomized to receive standard care (SC) or standard care with personalized DPS via a mobile app prototype version (SC + DPS). Patients in the SC + DPS arm received additionally automated feedback on their therapy, motivational messages and therapy recommendations. 100 patients completed the study (SC: 50, SC + DPS: 50). No differences were found in characteristics of SC vs. SC + DPS (mean ± SD) for age (53.9 ± 10.8 vs. 51.7 ± 12.3 years), initial diagnostic apnea-hypopnea index (51.1 ± 15.5 vs. 50.9 ± 17.7 events/h), BMI (33.8 ± 6.7 vs. 33.5 ± 4.5 kg/m), and Epworth Sleepiness Scale (ESS) baseline score (9.5 ± 4.2 vs. 9.1 ± 5.2). After 12 weeks, mean ESS score was significantly lower (SC: 7.6 ± 4.1 vs. SC + DPS: 5.5 ± 3.9; p = 0.006) in the SC + DPS group vs. standard care group. Therapy adherence was significantly higher (SC: 268.7 ± 122.1 vs. SC + DPS: 338.8 ± 106.8 min; p = 0.002) in the SC + DPS group compared to standard care group. No difference was found in the residual AHI between both groups. However, SC + DPS group showed a trend towards fewer phases with increased leakage compared to SC group. Intention-to-treat analysis (112 (56/56) patients) showed similar results. After 12 weeks, (auto)CPAP adherence and daytime sleepiness improved significantly in patients with severe OSA using the digital patient support tool. Clinical Trial Registration (retrospectively registered): Registry: NCT05440279; Title: Effects of Telemedical Support on Therapeutic Results of CPAP Patients; URL: https://clinicaltrials.gov/ct2/show/NCT05440279; Date of registration: June 30, 2022. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-023-00479-9.
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Affiliation(s)
- Christian Franke
- Medizinisches Versorgungszentrum GbR Sonneberg, 96515 Sonneberg, Germany
| | - Franziska Piezonna
- Medizinisches Versorgungszentrum GbR Sonneberg, 96515 Sonneberg, Germany
| | - Regina Schäfer
- Loewenstein Medical Technology GmbH+Co. KG, 76135 Karlsruhe, Germany
| | - Alexander Grimm
- Loewenstein Medical Technology GmbH+Co. KG, 76135 Karlsruhe, Germany
| | - Lisa-Marie Loris
- Loewenstein Medical Technology GmbH+Co. KG, 76135 Karlsruhe, Germany
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Kwak HH, Park JH, Lee DJ, Bae GH, Kim SD, Cho KS. Sleep time on back as a predictor of adherence to positive airway pressure therapy. Sci Rep 2023; 13:22415. [PMID: 38104214 PMCID: PMC10725441 DOI: 10.1038/s41598-023-49959-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/14/2023] [Indexed: 12/19/2023] Open
Abstract
Upper airway collapse can be effectively dealt with positive airway pressure (PAP), and patient adherence is considered as a major determining factor for success of PAP therapy. This study was performed to determine the potential factors affecting the adherence to PAP in patients with OSA by using polysomnography (PSG) parameters recorded for diagnosis of OSA. The data of 158 patients between December 2018 and July 2021 were collected. They were prescribed with PAP and used the device during the adaptation period for 90 days. They were categorized into adherent and non-adherent group according to the criteria of good adherence as use of PAP ≥ 4 h per night on 70% of nights. Demographic, clinical characteristics, and PSG results were reviewed. Among 158 patients engaged in PAP therapy, 121 patients (76.6%) met the criteria of good adherence. No significant differences were found in good adherence rate regarding demographic and clinical characteristics. None of the polysomnographic factors showed significant differences between adherent and non-adherent groups. However, the percentage of sleep time on back in the adherent group was significantly higher than non-adherent group (p = 0.041). The cut-off value was determined to be 41.45% (95% confidence interval 0.43 to 0.79) by receiver operating characteristic curve analysis and the odds ratio was calculated as 2.97. Only the percentage of sleep time on back appeared to be polysomnographic predictor for identifying good adherence to PAP therapy in OSA patients. However, the conclusions may be limited in generalization due to the small sample size.
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Affiliation(s)
- Hyun-Ho Kwak
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Ji-Hwan Park
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Dong-Joo Lee
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Gyo Han Bae
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Sung-Dong Kim
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea
| | - Kyu-Sup Cho
- Department of Otorhinolaryngology and Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, South Korea.
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Donovan LM, McDowell JA, Pannick AP, Pai J, Bais AF, Plumley R, Wai TH, Grunwald GK, Josey K, Sayre GG, Helfrich CD, Zeliadt SB, Hoerster KD, Ma J, Au DH. Protocol for a pragmatic trial testing a self-directed lifestyle program targeting weight loss among patients with obstructive sleep apnea (POWER Trial). Contemp Clin Trials 2023; 135:107378. [PMID: 37935303 DOI: 10.1016/j.cct.2023.107378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Obesity comprises the single greatest reversible risk factor for obstructive sleep apnea (OSA). Despite the potential of lifestyle-based weight loss services to improve OSA severity and symptoms, these programs have limited reach. POWER is a pragmatic trial of a remote self-directed weight loss care among patients with OSA. METHODS POWER randomizes 696 patients with obesity (BMI 30-45 kg/m2) and recent diagnosis or re-confirmation of OSA 1:1 to either a self-directed weight loss intervention or usual care. POWER tests whether such an intervention improves co-primary outcomes of weight and sleep-related quality of life at 12 months. Secondary outcomes include sleep symptoms, global ratings of change, and cardiovascular risk scores. Finally, consistent with a hybrid type 1 approach, the trial embeds an implementation process evaluation. We will use quantitative and qualitative methods including budget impact analyses and qualitative interviews to assess barriers to implementation. CONCLUSIONS The results of POWER will inform population health approaches to the delivery of weight loss care. A remote self-directed program has the potential to be disseminated widely with limited health system resources and likely low-cost.
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Affiliation(s)
- Lucas M Donovan
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA.
| | - Jennifer A McDowell
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Anna P Pannick
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - James Pai
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Tulane University, New Orleans, LA, USA
| | - Anthony F Bais
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Robert Plumley
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | | | | | | | - George G Sayre
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Christian D Helfrich
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Steven B Zeliadt
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Katherine D Hoerster
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Jun Ma
- University of Illinois Chicago, Chicago, IL, USA
| | - David H Au
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
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9
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Every JD, Mackay SG, Sideris AW, Do TQ, Jones A, Weaver EM. Mean disease alleviation between surgery and continuous positive airway pressure in matched adults with obstructive sleep apnea. Sleep 2023; 46:zsad176. [PMID: 37395677 DOI: 10.1093/sleep/zsad176] [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: 03/18/2023] [Revised: 05/19/2023] [Indexed: 07/04/2023] Open
Abstract
STUDY OBJECTIVES Polysomnography parameters measure treatment efficacy for obstructive sleep apnea (OSA), such as reduction in apnea-hypopnea index (AHI). However, for continuous positive airway pressure (CPAP) therapy, polysomnography measures do not factor in adherence and thus do not measure effectiveness. Mean disease alleviation (MDA) corrects polysomnography measures for CPAP adherence and was used to compare treatment effectiveness between CPAP and multilevel upper airway surgery. METHODS This retrospective cohort study consisted of a consecutive sample of 331 patients with OSA managed with multilevel airway surgery as second-line treatment (N = 97) or CPAP (N = 234). Therapeutic effectiveness (MDA as % change or as corrected change in AHI) was calculated as the product of therapeutic efficacy (% or absolute change in AHI) and adherence (% time on CPAP of average nightly sleep). Cardinality and propensity score matching was utilized to manage confounding variables. RESULTS Surgery patients achieved greater MDA % than CPAP users (67 ± 30% vs. 60 ± 28%, p = 0.04, difference 7 ± 3%, 95% confidence interval 4% to 14%) in an unmatched comparison, despite a lower therapeutic efficacy seen with surgery. Cardinality matching demonstrated comparable MDA % in surgery (64%) and CPAP (57%) groups (p = 0.14, difference 8 ± 5%, 95% confidence interval -18% to 3%). MDA measured as corrected change in AHI showed similar results. CONCLUSIONS In adult patients with OSA, multilevel upper airway surgery and CPAP provide comparable therapeutic effectiveness on polysomnography. For patients with inadequate CPAP use, surgery should be considered.
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Affiliation(s)
- James D Every
- Department of Otolaryngology, Head and Neck Surgery, The Wollongong Hospital, Wollongong, NSW. Australia
| | - Stuart G Mackay
- Department of Otolaryngology, Head and Neck Surgery, The Wollongong Hospital, Wollongong, NSW. Australia
- Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Anders W Sideris
- Department of Otolaryngology, Head and Neck Surgery, The Wollongong Hospital, Wollongong, NSW. Australia
| | - Timothy Q Do
- Department of Otolaryngology, Head and Neck Surgery, The Wollongong Hospital, Wollongong, NSW. Australia
| | - Andrew Jones
- Department of Respiratory Medicine, The Wollongong Hospital, Wollongong, NSW. Australia
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Edward M Weaver
- Department of Otolaryngology, University of Washington, Seattle, Washington, USA
- Surgery Service, Seattle Veterans Affairs Medical Center, Seattle, Washington, USA
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10
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Qiao M, Xie Y, Wolff A, Kwon J. Long term adherence to continuous positive Airway pressure in mild obstructive sleep apnea. BMC Pulm Med 2023; 23:320. [PMID: 37658304 PMCID: PMC10472589 DOI: 10.1186/s12890-023-02612-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Studies have shown that a significant percentage of patients with obstructive sleep apnea (OSA) do not tolerate continuous positive airway pressure (CPAP) therapy and long-term use may be as low as 30%. Given the lower levels of symptoms and health-related risks, patients with mild sleep apnea may be at even higher risk for non-adherence to long term CPAP. The purpose of our study was to investigate the prevalence and associations of long-term CPAP adherence in first time users with mild sleep apnea diagnosed by home sleep apnea testing (HSAT). METHODS We identified all the patients who were diagnosed with mild sleep apnea (5 = < AHI < 15) by home sleep apnea testing from 01/2013 to 06/2019 at a large, combined community and hospital-based sleep practice. Only first time CPAP users were included. Compliance was defined as CPAP usage ≥ 4 h per night on ≥ 70% of nights over 30 consecutive days. We defined long term adherence as compliance on the 12th month following CPAP set up. Patient demographics, comorbidities, and CPAP compliance at 1st, 3rd, 6th, 9th and 12th month after therapy initiation were collected. We compared and identified the factors that had significant difference (P < 0.1) between compliant and non-compliant groups at the 12th month. RESULTS 222 patients were included in the analysis. 57 (25.7%) patients were adherent with long term CPAP treatment. The following factors were associated with a greater likelihood for long-term CPAP adherence: older age, lower body mass index (BMI), presence of a bed partner, non-smoker, presence of Diabetes Mellitus (DM), presence of Heart Failure (CHF), lack of depression, and compliance at 1st, 3rd, 6th and 9th month. CONCLUSIONS Long term CPAP compliance in mild sleep apnea patients is low. Long term adherence to CPAP can be predicted based on CPAP adherence during the first three months.
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Affiliation(s)
- Min Qiao
- Pulmonary and critical care medicine, University of Rochester Medical Center, 601 Elmwood Ave, 14642, Rochester, NY, USA.
| | - Yiyu Xie
- Medicine department, University of Massachusetts Chan Medical School, 55 Lake Ave, North Worcester, 01655, Worcester, MA, USA
| | - Armand Wolff
- Pulmonary disease, critical care and sleep medicine, 267 Grant St, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, 06610, USA
| | - Jeff Kwon
- Pulmonary disease, critical care and sleep medicine, 267 Grant St, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, 06610, USA
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11
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Roberts JM, King TL, Barton JR, Beck S, Bernstein IM, Buck TE, Forgues-Lackie MA, Facco FL, Gernand AD, Graves CR, Jeyabalan A, Hauspurg A, Manuck TA, Myers JE, Powell TM, Sutton EF, Tinker E, Tsigas E, Myatt L. Care plan for individuals at risk for preeclampsia: shared approach to education, strategies for prevention, surveillance, and follow-up. Am J Obstet Gynecol 2023; 229:193-213. [PMID: 37120055 DOI: 10.1016/j.ajog.2023.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/01/2023]
Abstract
Preeclampsia is a multisystemic disorder of pregnancy that affects 250,000 pregnant individuals in the United States and approximately 10 million worldwide per annum. Preeclampsia is associated with substantial immediate morbidity and mortality but also long-term morbidity for both mother and offspring. It is now clearly established that a low dose of aspirin given daily, beginning early in pregnancy modestly reduces the occurrence of preeclampsia. Low-dose aspirin seems safe, but because there is a paucity of information about long-term effects on the infant, it is not recommended for all pregnant individuals. Thus, several expert groups have identified clinical factors that indicate sufficient risk to recommend low-dose aspirin preventive therapy. These risk factors may be complemented by biochemical and/or biophysical tests that either indicate increased probability of preeclampsia in individuals with clinical risk factors, or more importantly, identify increased likelihood in those without other evident risk. In addition, the opportunity exists to provide this population with additional care that may prevent or mitigate the short- and long-term effects of preeclampsia. Patient and provider education, increased surveillance, behavioral modification, and other approaches to improve outcomes in these individuals can improve the chance of a healthy outcome. We assembled a group with diverse, relevant expertise (clinicians, investigators, advocates, and public and private stakeholders) to develop a care plan in which providers and pregnant individuals at risk can work together to reduce the risk of preeclampsia and associated morbidities. The plan is for care of individuals at moderate to high risk for developing preeclampsia, sufficient to receive low-dose aspirin therapy, as identified by clinical and/or laboratory findings. The recommendations are presented using the GRADE methodology with the quality of evidence upon which each is based. In addition, printable appendices with concise summaries of the care plan's recommendations for patients and healthcare providers are provided. We believe that this shared approach to care will facilitate prevention of preeclampsia and its attendant short- and long-term morbidity in patients identified as at risk for development of this disorder.
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Affiliation(s)
- James M Roberts
- Magee-Womens Research Institute and Clinical and Translational Science Institute, Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
| | - Tekoa L King
- School of Nursing, University of California, San Francisco, Oakland, CA
| | - John R Barton
- Maternal-Fetal Medicine, Baptist Health, Lexington, KY
| | - Stacy Beck
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Ira M Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT
| | | | | | - Francesca L Facco
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Alison D Gernand
- Nutritional Sciences, Pennsylvania State University, University Park, PA
| | - Cornelia R Graves
- Division of Maternal-Fetal Medicine, University of Tennessee College of Medicine, Nashville, TN
| | - Arundhati Jeyabalan
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Alisse Hauspurg
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Tracy A Manuck
- Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jenny E Myers
- Division of Developmental Biology and Medicine, University of Manchester, Manchester, United Kingdom
| | - Trashaun M Powell
- National Racial Disparity Taskforce, Preeclampsia Foundation and New Jersey Family Planning League, Somerset, NJ
| | | | | | | | - Leslie Myatt
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Morris JL, Scott PW, Magalang U, Keenan BT, Patel SR, Pack AI, Mazzotti DR. Five-year Transitions of Symptom Subtypes in Untreated Obstructive Sleep Apnea. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.18.23290191. [PMID: 37292667 PMCID: PMC10246122 DOI: 10.1101/2023.05.18.23290191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objectives It is unknown if symptom subtypes of obstructive sleep apnea (OSA) transition over time and what clinical factors may predict transitions. Methods Data from 2,643 participants of the Sleep Heart Health Study with complete baseline and 5-year follow-up visits were analyzed. Latent Class Analysis on 14 symptoms at baseline and follow up determined symptom subtypes. Individuals without OSA (AHI<5) were incorporated as a known class at each time point. Multinomial logistic regression assessed the effect of age, sex, body mass index (BMI) and AHI on specific class transitions. Results The sample consisted of 1,408 women (53.8%) and mean (SD) age 62.4 (10.5) years. We identified four OSA symptom subtypes at both baseline and follow-up visits: minimally symptomatic, disturbed sleep, moderately sleepy and excessively sleepy . Nearly half (44.2%) of the sample transitioned to a different subtype from baseline to follow-up visits; transitions to moderately sleepy were the most common (77% of all transitions). A five-year older age was associated with a 6% increase in odds to transit from excessively sleepy to moderately sleepy [OR (95% CI) = 1.06 (1.02, 1.12)]. Women had 2.35 times higher odds (95% CI: 1.27, 3.27) to transition from moderately sleepy to minimal symptoms . A 5-unit increase in BMI was associated with 2.29 greater odds (95% CI: 1.19, 4.38) to transition from minimal symptoms to excessively sleepy . Interpretation While over half of the sample did not transition their subtype over 5 years, among those who did, the likelihood of transitioning between subtypes was significantly associated with a higher baseline age, higher baseline BMI and with women, but was not predicted by AHI. Clinical Trials Sleep Heart Health Study (SHHS) Data Coordinating Center, (SHHS) https://clinicaltrials.gov/ct2/show/NCT00005275 , NCT00005275. Statement of significance There is very little research assessing symptom progression and its contributions to clinical heterogeneity in OSA. In a large sample with untreated OSA, we grouped common OSA symptoms into subtypes and assessed if age, sex, or BMI predicted transitions between the subtypes over 5 years. Approximately half the sample transitioned to a different symptom subtype and improvements in symptom subtype presentation were common. Women and older individuals were more likely to transition to less severe subtypes, while increased BMI predicted transition to more severe subtype. Determining whether common symptoms like disturbed sleep or excessive daytime sleepiness occur early in the course of the disease or as a result of untreated OSA over an extended period can improve clinical decisions concerning diagnosis and treatment.
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Gomase VG, Deshmukh P, Lekurwale VY. Obstructive Sleep Apnea and Its Management: A Narrative Review. Cureus 2023; 15:e37359. [PMID: 37182079 PMCID: PMC10174073 DOI: 10.7759/cureus.37359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a disorder in which there is repeated collapse of the upper airway when the person is in sleep, which causes oxygen desaturation and interrupted sleep. While asleep, airway blockages and collapse are accompanied by awakenings with or without oxygen desaturation. OSA is a prevalent disorder, especially in people with known risk factors and other illnesses. Pathogenesis is variable, and the risk factors include low chest volume, erratic respiratory regulation, and muscular dysfunction in the upper airway dilators. The high-risk factors include overweight, male sex, aging, adenotonsillar hypertrophy, interruption of the menstrual cycle, preservation of liquids, and smoking. The signs are snoring, drowsiness, and apneas. A sleep history, assessment of symptoms, and physical examination are all part of the screening process for OSA, and the data can help determine which people need to be tested for the condition. The results of the polysomnogram or at-home sleep apnea test assist in determining the presence and severity of OSA. Still, it is seen many times that the accuracy of home sleep apnea tests is significantly less, so one should take an expert opinion for the same. OSA results in systemic hypertension, drowsiness, and driving accidents. It is additionally related to diabetes mellitus, congestive heart failure (CHF), cerebral infarction, and myocardial infarction, but the exact mechanism is not known. The preferred treatment is continuous positive airway pressure with 60-70% adherence. Other management options include reducing weight, therapy of oral appliances, and correcting any anatomical obstruction (narrow pharyngeal airway, adenoid hypertrophy, and mass in the pharynx). OSA indirectly causes headaches just after awakening and daytime sleepiness. However, there are no age boundaries in OSA as it can occur in any age group. Still, more prevalence is seen in individuals of more than 60 years of age.
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Affiliation(s)
- Vrushabh G Gomase
- Otorhinolaryngology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prasad Deshmukh
- Otolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vedant Y Lekurwale
- Medical School, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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14
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Dupuy-McCauley K, Benzo R, Barwise A. Designing a program to support weight loss for patients attending the sleep medicine clinic: a qualitative study. J Clin Sleep Med 2023; 19:459-471. [PMID: 36458729 PMCID: PMC9978432 DOI: 10.5664/jcsm.10354] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 12/04/2022]
Abstract
STUDY OBJECTIVES Excess body weight is the most important risk factor in sleep-disordered breathing. Weight loss is a treatment alternative to positive airway pressure therapy, but there is a knowledge gap of what is feasible, acceptable, and sustainable in this population. We seek to add the voices of sleep medicine patients and providers to the medical literature to understand what makes this population unique when considering weight loss, and what we can do differently to create more sustainable weight loss interventions. METHODS We conducted one-on-one semistructured interviews with 12 patients with obstructive sleep apnea/obesity hypoventilation syndrome and obesity and with 9 sleep medicine providers regarding previous weight loss efforts, perceptions of barriers to and facilitators of weight loss, and potential components of a program to support those with sleep apnea and excess weight. RESULTS Patients indicated they appreciated direct conversation with their sleep physician regarding weight loss and providers felt the patient population was generally very receptive to weight loss conversations. Patients emphasized the most important aspects of a future weight loss program would be personalized diet, exercise, accountability, integration of technology, and an individualized approach to addressing the psychological aspects of eating. CONCLUSIONS This is a unique population of patients who are very receptive to conversations about weight loss. We plan to use this data to inform a future weight loss program based in health coaching to address the specific needs of this population. CITATION Dupuy-McCauley K, Benzo R, Barwise A. Designing a program to support weight loss for patients attending the sleep medicine clinic: a qualitative study. J Clin Sleep Med. 2023;19(3):459-471.
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Subjective HRQoL in Patients with Sleep Apnea Syndrome Who Underwent PAP Therapy in a Rehabilitation Setting: A Longitudinal Study. J Clin Med 2023; 12:jcm12051907. [PMID: 36902694 PMCID: PMC10003755 DOI: 10.3390/jcm12051907] [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: 01/18/2023] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is often associated with decreased health-related quality of life (HRQoL). The aims of this study were to evaluate HRQoL, the clinical and psychological profile of suspected or verified OSA patients, and the impact of PAP therapy at 1-year follow-up. METHODS At T0, OSA-suspected subjects underwent clinical, HRQoL, and psychological assessment. At T1, OSA patients underwent PAP therapy in a multidisciplinary rehabilitation setting. At 1 year follow-up, OSA patients were evaluated for the second time. RESULTS At T0, OSA patients (n = 283) and suspected OSA subjects (n = 187) differed for AHI, BMI, and ESS. At T0, the PAP-treatment group (n = 101) showed moderate-severe anxious (18.7%) and depressive (11.9%) symptoms. At 1 year follow-up (n = 59), the sleep breathing pattern had normalized and there was a reduction of ESS scores and anxious symptoms. There was also an improvement in HRQoL (0.6 ± 0.4 vs. 0.7 ± 0.5, p = 0.032; 70.4 ± 19.0 vs. 79.2 ± 20.3, p = 0.001) and in satisfaction with sleep quantity (52.3 ± 31.7 vs. 71.4 ± 26.2, p = 0.001), sleep quality (48.1 ± 29.7 vs. 70.9 ± 27.1, p = 0.001), mood (58.5 ± 24.9 vs. 71.0 ± 25.6, p = 0.001), and physical resistance (61.6 ± 28.4 vs. 67.8 ± 27.4, p = 0.039). CONCLUSION Considering the impact of PAP treatment on patients' psychological and HRQoL evaluations that we observed, our data are valuable for unveiling different profiles characterizing this clinical population.
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16
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Placebo response in objective and subjective measures of hypersomnia in randomized clinical trials on obstructive sleep apnea. A systematic review and meta-analysis. Sleep Med Rev 2023; 67:101720. [PMID: 36495752 DOI: 10.1016/j.smrv.2022.101720] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
Sleepiness is one of the outcomes most used in randomized clinical trials (RCT) on the effect of treatments for obstructive sleep apnea (OSA). Furthermore, it is known that there is a placebo effect, especially in subjective measures. Therefore, given that sleepiness is a subjective measure, the objective of this systematic review with meta-analysis and three-level meta-regression was to assess the response to different placebos (pills and sham-CPAP) used in RCTs in OSA, both on subjective (Epworth Sleepiness Scale [ESS]) and objective (Multiple Sleep Latency Test [MSLT], Maintenance Wake Test [MWT], the Osler test and the Psychomotor Vigilance Task [PVT]). We observed a statistically significant placebo effect in both subjective and objective measures of hypersomnia, and in both sham-CPAP and pills. This placebo effect was greater, even clinically significant, in subjective measures (ESS: -2.84 points) and in those RCTs that used pills as a placebo. In the meta-regression, only a higher baseline value of the ESS and Osler test was related to the placebo effect.
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17
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Upper airway multilevel radiofrequency under local anesthesia can improve CPAP adherence for severe OSA patients. Am J Otolaryngol 2023; 44:103671. [DOI: 10.1016/j.amjoto.2022.103671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
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18
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Weaver TE. Best Predictors of Continuous Positive Airway Pressure Adherence. Sleep Med Clin 2022; 17:587-595. [DOI: 10.1016/j.jsmc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Feltner C, Wallace IF, Aymes S, Cook Middleton J, Hicks KL, Schwimmer M, Baker C, Balio CP, Moore D, Voisin CE, Jonas DE. Screening for Obstructive Sleep Apnea in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:1951-1971. [PMID: 36378203 DOI: 10.1001/jama.2022.18357] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
IMPORTANCE Obstructive sleep apnea (OSA) is associated with adverse health outcomes. OBJECTIVE To review the evidence on screening for OSA in asymptomatic adults or those with unrecognized OSA symptoms to inform the US Preventive Services Task Force. DATA SOURCES PubMed/MEDLINE, Cochrane Library, Embase, and trial registries through August 23, 2021; surveillance through September 23, 2022. STUDY SELECTION English-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or treatment of OSA reporting health outcomes or harms, and systematic reviews of treatment reporting changes in blood pressure and apnea-hypopnea index (AHI) scores. DATA EXTRACTION AND SYNTHESIS Dual review of abstracts, full-text articles, and study quality. Meta-analysis of intervention trials. MAIN OUTCOMES AND MEASURES Test accuracy, excessive daytime sleepiness, sleep-related and general health-related quality of life (QOL), and harms. RESULTS Eighty-six studies were included (N = 11 051). No study directly compared screening with no screening. Screening accuracy of the Multivariable Apnea Prediction score followed by unattended home sleep testing for detecting severe OSA syndrome (AHI ≥30 and Epworth Sleepiness Scale [ESS] score >10) measured as the area under the curve in 2 studies (n = 702) was 0.80 (95% CI, 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90). Five studies assessing the accuracy of other screening tools were heterogeneous and results were inconsistent. Compared with inactive control, positive airway pressure was associated with a significant improvement in ESS score from baseline (pooled mean difference, -2.33 [95% CI, -2.75 to -1.90]; 47 trials; n = 7024), sleep-related QOL (standardized mean difference, 0.30 [95% CI, 0.19 to 0.42]; 17 trials; n = 3083), and general health-related QOL measured by the 36-Item Short Form Health Survey (SF-36) mental health component summary score change (pooled mean difference, 2.20 [95% CI, 0.95 to 3.44]; 15 trials; n = 2345) and SF-36 physical health component summary score change (pooled mean difference, 1.53 [95% CI, 0.29 to 2.77]; 13 trials; n = 2031). Use of mandibular advancement devices was also associated with a significantly larger ESS score change compared with controls (pooled mean difference, -1.67 [95% CI, 2.09 to -1.25]; 10 trials; n = 1540). Reporting of other health outcomes was sparse; no included trial found significant benefit associated with treatment on mortality, cardiovascular events, or motor vehicle crashes. In 3 systematic reviews, positive airway pressure was significantly associated with reduced blood pressure; however, the difference was relatively small (2-3 mm Hg). CONCLUSIONS AND RELEVANCE The accuracy and clinical utility of OSA screening tools that could be used in primary care settings were uncertain. Positive airway pressure and mandibular advancement devices reduced ESS score. Trials of positive airway pressure found modest improvement in sleep-related and general health-related QOL but have not established whether treatment reduces mortality or improves most other health outcomes.
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Affiliation(s)
- Cynthia Feltner
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Medicine, University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Ina F Wallace
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Shannon Aymes
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Jennifer Cook Middleton
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Kelli L Hicks
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill
| | - Manny Schwimmer
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University, Columbus
| | - Claire Baker
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Casey P Balio
- Center for Rural Health Research, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City
| | - Daniel Moore
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Christiane E Voisin
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University, Columbus
| | - Daniel E Jonas
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University, Columbus
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Effect of CPAP vs. mandibular advancement device for excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life in patients with mild OSA. Sleep Breath 2022; 27:991-1003. [DOI: 10.1007/s11325-022-02694-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/31/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022]
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21
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Xanthopoulos MS, Williamson AA, Tapia IE. Positive airway pressure for the treatment of the childhood obstructive sleep apnea syndrome. Pediatr Pulmonol 2022; 57:1897-1903. [PMID: 33647183 PMCID: PMC8408267 DOI: 10.1002/ppul.25318] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/28/2022]
Abstract
In this review, we have summarized the benefits of treatment with positive airway pressure for the childhood obstructive sleep apnea syndrome and presented a socio-ecological framework to enhance our understanding of positive airway pressure adherence predictors and important targets of comprehensive positive airway pressure treatment models across different pediatric populations. Although positive airway pressure is clearly a beneficial treatment for pediatric obstructive sleep apnea syndrome, additional research is needed to evaluate how socio-ecological factors may interact to predict positive airway pressure adherence, with more attention to the impact of the broader healthcare setting and on treatment approaches and outcomes in special pediatric populations.
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Affiliation(s)
- Melissa S Xanthopoulos
- Division of Pulmonary and Sleep Medicine, Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ariel A Williamson
- Division of Pulmonary and Sleep Medicine, Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ignacio E Tapia
- Division of Pulmonary and Sleep Medicine, Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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22
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Common Sleep Disorders in Pregnancy. Obstet Gynecol 2022; 140:321-339. [DOI: 10.1097/aog.0000000000004866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
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Li Z, Cai S, Wang J, Chen R. Predictors of the Efficacy for Daytime Sleepiness in Patients With Obstructive Sleep Apnea With Continual Positive Airway Pressure Therapy: A Meta-Analysis of Randomized Controlled Trials. Front Neurol 2022; 13:911996. [PMID: 35832171 PMCID: PMC9271709 DOI: 10.3389/fneur.2022.911996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The main aim of this meta-analysis was to evaluate the predictors of the efficacy of continuous positive airway pressure (CPAP) in ameliorating excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea (OSA). Methods Randomized controlled trials (RCTs) published between January 1994 and October 2021 were searched in the PubMed, EMBASE, and Cochrane Library databases. The weighted mean differences (WMDs) for the Epworth Sleepiness Scale (ESS) scores, the Multiple Sleep Latency Test (MSLT), and the Maintenance of Wakefulness Test (MWT) were pooled in STATA. Results A total of 41 RCTs involving 7,332 patients were included. CPAP therapy was found to be significantly associated with changes in ESS (WMD = −2.14, P < 0.001), MSLT (WMD = 1.23, P < 0.001), and MWT (WMD = 1.6, P < 0.001). Meta-regression analysis and subgroup analysis indicated that in mild OSA, the efficacy of CPAP therapy for subjective EDS was limited to patients <50 years of age, with a baseline body mass index (BMI) of ≥30 kg/m2, baseline ESS score of ≥11, therapy adherence for ≥3 h/night, and treatment duration of ≥2 months. In moderate OSA, significant differences were observed in the changes in ESS among groups stratified by baseline ESS score (P = 0.005), adherence (P < 0.001), treatment duration (P = 0.009), and trial design type (P = 0.001). In severe OSA, this difference was observed among groups stratified by baseline BMI (P = 0.028), baseline ESS score (P = 0.001), and adherence (P = 0.047). Patients with moderate-severe OSA but not mild OSA showed significant improvements in MSLT. Patients with the age <50 years or BMI ≥33 kg/m2 had a more significant increase in MWT. Conclusion Continuous positive airway pressure therapy improved subjective and objective sleepiness in patients with OSA. Age, baseline BMI, baseline ESS score, adherence, and duration of treatment may predict the effects of CPAP on EDS in patients with OSA. Notably, the baseline ESS scores and adherence were stable predictors regardless of OSA severity.
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Affiliation(s)
- Zhiqiang Li
- Department of Respiratory and Critical Care Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Sijie Cai
- Department of Respiratory and Critical Care Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
- Department of Pulmonary and Critical Care Medicine Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China
| | - Jing Wang
- Department of Respiratory and Critical Care Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Rui Chen
- Department of Respiratory and Critical Care Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
- *Correspondence: Rui Chen
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Facco FL, Redline S, Hunter SM, Zee PC, Grobman WA, Silver RM, Louis JM, Pien GW, Mercer B, Chung JH, Bairey Merz CN, Haas DM, Nhan-Chang CL, Simhan HN, Schubert FP, Parry S, Reddy U, Saade GR, Hoffman MK, Levine LD, Wapner RJ, Catov JM, Parker CB. Sleep-disordered Breathing in Pregnancy and after Delivery: Associations with Cardiometabolic Health. Am J Respir Crit Care Med 2022; 205:1202-1213. [PMID: 35144521 PMCID: PMC9872809 DOI: 10.1164/rccm.202104-0971oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Rationale: Knowledge gaps exist regarding health implications of sleep-disordered breathing (SDB) identified in pregnancy and/or after delivery. Objectives: To determine whether SDB in pregnancy and/or after delivery is associated with hypertension (HTN) and metabolic syndrome (MS). Methods: nuMoM2b-HHS (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be Heart Health Study) (N = 4,508) followed participants initially recruited during their first pregnancy. Participants returned for a visit 2-7 years after pregnancy. This study examined a subgroup who underwent SDB assessments during their first pregnancy (n = 1,964) and a repeat SDB assessment after delivery (n = 1,222). Two SDB definitions were considered: 1) apnea-hypopnea index (AHI) ⩾ 5 and 2) oxygen desaturation index (ODI) ⩾ 5. Associations between SDB and incident HTN and MS were evaluated with adjusted risk ratios (aRRs). Measurements and Main Results: The aRR for MS given an AHI ⩾ 5 during pregnancy was 1.44 (95% confidence interval [CI], 1.08-1.93), but no association with HTN was found. ODI ⩾ 5 in pregnancy was associated with both an increased risk for HTN (aRR, 2.02; 95% CI, 1.30-3.14) and MS (aRR, 1.53; 95% CI, 1.19-1.97). Participants with an AHI ⩾ 5 in pregnancy that persisted after delivery were at higher risk for both HTN (aRR, 3.77; 95% CI, 1.84-7.73) and MS (aRR, 2.46; 95% CI, 1.59-3.76). Similar associations were observed for persistent ODI ⩾ 5 after delivery. Conclusions: An AHI ⩾ 5 in pregnancy was associated with an increased risk of MS. An ODI ⩾ 5 in pregnancy was significantly associated with both HTN and MS. Participants with persistent elevations in AHI and ODI during pregnancy and at 2-7 years after delivery were at the highest risk for HTN and MS. Clinical trial registered with www.clinicaltrials.gov (NCT02231398).
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Affiliation(s)
- Francesca L. Facco
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Susan Redline
- Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - William A. Grobman
- Department of Obstetrics, Gynecology-Maternal Fetal Medicine and Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Judette M. Louis
- University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Grace W. Pien
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brian Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve, MetroHealth, Cleveland, Ohio
| | - Judith H. Chung
- Department of Obstetrics and Gynecology, University of California, Irvine, Irvine, California
| | - C. Noel Bairey Merz
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - David M. Haas
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Chia-Ling Nhan-Chang
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Hyagriv N. Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Frank P. Schubert
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Uma Reddy
- Department of Obstetrics, Gynecology & Reproductive Services, Yale University, New Haven, Connecticut
| | - George R. Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, University of Texas, Galveston, Texas; and
| | - Matthew K. Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware
| | - Lisa D. Levine
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Janet M. Catov
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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25
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Comparison of Expiratory Pressures Generated by Four Different EPAP Devices in a Laboratory Bench Setting. Sleep Med 2022; 96:87-92. [DOI: 10.1016/j.sleep.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/04/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
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26
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Schmickl CN, Bosompra NO, DeYoung PN, Gilbertson D, Orr JE, Malhotra A, Grant I, Ancoli-Israel S, Young MK, Owens RL. Diagnostic performance of screening tools for the detection of obstructive sleep apnea in people living with HIV. J Clin Sleep Med 2022; 18:1797-1804. [PMID: 35383569 DOI: 10.5664/jcsm.9964] [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: 11/13/2022]
Abstract
STUDY OBJECTIVES Many people living with HIV (PLWH) have undiagnosed obstructive sleep apnea (OSA), which may contribute to commonly reported fatigue and the high cardiovascular disease burden in this population. Our objective was to assess the utility of traditional OSA screening tools (STOP-BANG, Berlin Questionnaire (BQ), and Epworth Sleepiness Scale (ESS)) for detecting OSA in PLWH. METHODS Adult PLWH were recruited from sleep/HIV clinics and the community into a larger clinical trial which included completion of these questionnaires before in-laboratory polysomnography. Discriminatory performance of these screening tools was assessed using area under receiver operating characteristic curves (AUC). The reference standard for the primary analysis was OSA based on an AHI≥5/h using recommended "1A"-criteria (hypopnea with 3%-desaturation and/or arousal). Secondary analyses explored acceptable "1B"-criteria (hypopnea with 4%-desaturation) and/or higher AHI cut-offs (≥15/h). RESULTS 120 PLWH were included (mean-age: 50±11 years; body mass index: 27±4 kg/m2, 84% male) and OSA was diagnosed in 75% using 1A-criteria. In the primary analysis, the discriminatory performance of the three screening tools was low (AUCs 0.58 to 0.70) and similar across the tools (P≥0.14). In secondary analyses, STOP-BANG showed moderate-high discriminatory ability (AUCs 0.77-0.80) and performed significantly better (P≤0.008) than the BQ or ESS (AUCs 0.53-0.62). CONCLUSIONS OSA was highly prevalent in our cohort of PLWH. Although STOP-BANG could reasonably identify moderate-severe OSA, the tools were not reliable for mild disease. Specifically, the questionnaires perform poorly for PLWH with mild OSA manifesting with arousals, yet such people may be at risk of fatigue/sleepiness and impaired memory consolidation. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Obstructive Sleep Apnea Endotypes and Impact on Phenotypes of People Living With HIV (PLWH/OSA); Identifier: NCT03575143; URL: https://clinicaltrials.gov/ct2/show/NCT03575143.
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Affiliation(s)
| | | | | | | | - Jeremy E Orr
- University of California San Diego, La Jolla, California
| | - Atul Malhotra
- University of California San Diego, La Jolla, California
| | - Igor Grant
- University of California San Diego, La Jolla, California
| | | | | | - Robert L Owens
- University of California San Diego, La Jolla, California
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Martin MJ, Khanna A, Srinivasan D, Sovani MP. Patient reported outcome measures (PROMS) following maxillomandibular advancement (MMA) surgery in patients with obstructive sleep apnoea syndrome. Br J Oral Maxillofac Surg 2022; 60:963-968. [DOI: 10.1016/j.bjoms.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
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28
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Bertrand M, Bastien C, Boutin I, Vallières A. A psychological view on the effectiveness of psychosocial interventions on positive airway pressure treatment adherence and sleep quality in patients with obstructive sleep apnea. Sleep Med 2022; 91:62-74. [DOI: 10.1016/j.sleep.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
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29
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El-Solh AA, Rudraraju A, Pasrija D, Bui H. Pharmacotherapy of residual excessive sleepiness among continuous positive airway pressure (CPAP) treated patients with sleep apnea. Expert Opin Pharmacother 2022; 23:507-516. [PMID: 35045769 DOI: 10.1080/14656566.2022.2029408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Patients with persistent sleepiness after adequate treatment of obstructive sleep apnea (OSA) with nasal continuous positive airway pressure (nCPAP) experience impaired cognition, reduced productivity, and worse quality of life. Although the mechanisms responsible for this phenomenon are not completely understood, neuroimaging studies have identified reduced gray matter in the frontal cortex and alterations in white matter integrity suggestive of axonal and myelin damage. The intermittent hypoxia with resulting oxidative injury is considered a prime culprit behind the loss of wake-promoting catecholaminergic neurons. AREAS COVERED This narrative review gives an overview of the pathophysiology and approaches to managing patients with residual sleepiness. The authors explore different targeted strategies aimed at improving selection of appropriate pharmacotherapy. EXPERT OPINION Wake-stimulant medications (modafinil and armodafinil) have demonstrated efficacy in reducing sleepiness in adequately treated OSA. The recent FDA approval of pitolisant and solriamfetol complements the use of modafinil by substituting for direct sympathomimetic agents. The distinctive pharmacologic profile and mode of action of each of these agents offer the opportunity of a personalized approach to the management of this disorder. Further studies should be conducted on the long-term effect of these agents alone or in combination on brain structural and functional changes.
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Affiliation(s)
- Ali A El-Solh
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.,Department of Epidemiology and Environmental Health; School of Public Health and Health Professions, University at Buffalo, USA
| | - Avantika Rudraraju
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Divij Pasrija
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, USA
| | - Hoang Bui
- Research and Development, The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA
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Abstract
Obstructive sleep apnea (OSA) is a disease that results from loss of upper airway muscle tone leading to upper airway collapse during sleep in anatomically susceptible persons, leading to recurrent periods of hypoventilation, hypoxia, and arousals from sleep. Significant clinical consequences of the disorder cover a wide spectrum and include daytime hypersomnolence, neurocognitive dysfunction, cardiovascular disease, metabolic dysfunction, respiratory failure, and pulmonary hypertension. With escalating rates of obesity a major risk factor for OSA, the public health burden from OSA and its sequalae are expected to increase, as well. In this chapter, we review the mechanisms responsible for the development of OSA and associated neurocognitive and cardiometabolic comorbidities. Emphasis is placed on the neural control of the striated muscles that control the pharyngeal passages, especially regulation of hypoglossal motoneuron activity throughout the sleep/wake cycle, the neurocognitive complications of OSA, and the therapeutic options available to treat OSA including recent pharmacotherapeutic developments.
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Affiliation(s)
- Luu V Pham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States.
| | - Jonathan Jun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Vsevolod Y Polotsky
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
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31
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Mediano O, González Mangado N, Montserrat JM, Alonso-Álvarez ML, Almendros I, Alonso-Fernández A, Barbé F, Borsini E, Caballero-Eraso C, Cano-Pumarega I, de Carlos Villafranca F, Carmona-Bernal C, Carrillo Alduenda JL, Chiner E, Cordero Guevara JA, de Manuel L, Durán-Cantolla J, Farré R, Franceschini C, Gaig C, Garcia Ramos P, García-Río F, Garmendia O, Gómez García T, González Pondal S, Hoyo Rodrigo MB, Lecube A, Antonio Madrid J, Maniegas Lozano L, Martínez Carrasco JL, Masa JF, Masdeu Margalef MJ, Mayos Pérez M, Mirabet Lis E, Monasterio C, Navarro Soriano N, Olea de la Fuente E, Plaza G, Puertas Cuesta FJ, Rabec C, Resano P, Rigau D, Roncero A, Ruiz C, Salord N, Saltijeral A, Sampol Rubio G, Sánchez Quiroga MÁ, Sans Capdevila Ó, Teixeira C, Tinahones Madueño F, Maria Togeiro S, Troncoso Acevedo MF, Vargas Ramírez LK, Winck J, Zabala Urionaguena N, Egea C. [Translated article] International consensus document on obstructive sleep apnea. Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2021.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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32
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Tavoian D, Ramos-Barrera LE, Craighead DH, Seals DR, Bedrick EJ, Alpert JS, Mashaqi S, Bailey EF. Six Months of Inspiratory Muscle Training to Lower Blood Pressure and Improve Endothelial Function in Middle-Aged and Older Adults With Above-Normal Blood Pressure and Obstructive Sleep Apnea: Protocol for the CHART Clinical Trial. Front Cardiovasc Med 2021; 8:760203. [PMID: 34901220 PMCID: PMC8652071 DOI: 10.3389/fcvm.2021.760203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/18/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Cardiovascular disease is a major global health concern and prevalence is high in adults with obstructive sleep apnea (OSA). Lowering blood pressure (BP) can greatly reduce cardiovascular disease risk and physical activity is routinely prescribed to achieve this goal. Unfortunately, many adults with OSA suffer from fatigue, daytime sleepiness, and exercise intolerance—due to poor sleep quality and nocturnal hypoxemia—and have difficulty initiating and maintaining an exercise program. High-resistance inspiratory muscle strength training (IMST) is a simple, time-efficient breathing exercise consistently reported to reduce BP in small, selective groups of both healthy and at-risk adults. Herein we present the study protocol for a randomized clinical trial to determine the long-term efficacy of IMST performed regularly for 24 weeks in middle-aged and older adults with OSA. The primary outcome is casual systolic BP. Secondary outcomes are 24-h systolic BP and circulating plasma norepinephrine concentration. Other outcomes include vascular endothelial function (endothelial-dependent and -independent dilation), aortic stiffness, casual and 24-h diastolic BP, and the influence of circulating factors on endothelial cell nitric oxide and reactive oxygen species production. Overall, this trial will establish efficacy of high-resistance IMST for lowering BP and improving cardiovascular health in middle-aged and older adults with OSA. Methods: This is a single-site, double-blind, randomized clinical trial. A minimum of 92 and maximum of 122 male and female adults aged 50–80 years with OSA and above-normal BP will be enrolled. After completion of baseline assessments, subjects will be randomized in a 1:1 ratio to participate in either high-resistance or sham (low-resistance) control IMST, performed at home, 5 min/day, 5 days/week, for 24 weeks. Repeat assessments will be taken after the 24-week intervention, and after 4 and 12 weeks of free living. Discussion: This study is designed to assess the effects of 24 weeks of IMST on BP and vascular function. The results will characterize the extent to which IMST can reduce BP when performed over longer periods (i.e., 6 months) than have been assessed previously. Additionally, this study will help to determine underlying mechanisms driving IMST-induced BP reductions that have been reported previously. Clinical Trial Registration: This trial is registered with ClinicalTrials.gov (Registration Number: NCT04932447; Date of registration June 21, 2021).
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Affiliation(s)
- Dallin Tavoian
- Arizona Respiratory Neurophysiology Laboratory, Department of Physiology, University of Arizona, Tucson, AZ, United States
| | - Lupita E Ramos-Barrera
- Arizona Respiratory Neurophysiology Laboratory, Department of Physiology, University of Arizona, Tucson, AZ, United States
| | - Daniel H Craighead
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Edward J Bedrick
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Joseph S Alpert
- College of Medicine, University of Arizona, Tucson, AZ, United States.,Division of Cardiology, Sarver Heart Center, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Saif Mashaqi
- College of Medicine, University of Arizona, Tucson, AZ, United States.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Banner - University Medical Center, Tucson, AZ, United States.,Sleep Disorders Center, Banner - University Medical Center, Tucson, AZ, United States
| | - E Fiona Bailey
- Arizona Respiratory Neurophysiology Laboratory, Department of Physiology, University of Arizona, Tucson, AZ, United States
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Imayama I, Balserak BI, Gupta A, Munoz T, Srimoragot M, Keenan BT, Kuna ST, Prasad B. Racial Differences in Functional and Sleep Outcomes with Positive Airway Pressure Treatment. Diagnostics (Basel) 2021; 11:diagnostics11122176. [PMID: 34943413 PMCID: PMC8700434 DOI: 10.3390/diagnostics11122176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022] Open
Abstract
It is unclear if the response to positive airway pressure (PAP) treatment is different between African American (AA) and European Americans (EA). We examined whether race modifies the effects of PAP on sleep and daytime function. We assessed Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire, Psychomotor Vigilance Task and actigraphy in 185 participants with moderate-to-severe obstructive sleep apnea before and 3–4 months after PAP treatment. The participants were middle-aged (mean, 55.1 years), 83.8% men and 60.5% AA. Linear regression models were used to examine the effect of race on outcomes. The AA had smaller reductions in ESS (mean change (95% confidence interval, CI) AA, −2.30 [−3.35, −1.25] vs. EA, −4.16 [−5.48, −2.84] and frequency of awakenings (AA, −0.73 [−4.92, 3.47] vs. EA, −9.35 [−15.20, −3.51]). A race × PAP usage interaction term was added to the model to examine if the change in outcomes per 1 h increase in PAP usage differed by race. AA exhibited greater improvement in wake after sleep onset (β (95% CI) AA, −8.89 [−16.40, −1.37] vs. EA, 2.49 [−4.15, 9.12]) and frequency of awakening (β (95% CI) AA, −2.59 [−4.44, −0.75] vs. EA, 1.71 [−1.08, 4.50]). The results indicate the importance of race in evaluating outcomes following PAP treatment.
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Affiliation(s)
- Ikuyo Imayama
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL 60612, USA
| | - Bilgay Izci Balserak
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Ahana Gupta
- Honors College, University of Illinois at Chicago, Chicago, IL 60607, USA;
| | - Tomas Munoz
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | | | - Brendan T. Keenan
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.T.K.); (S.T.K.)
| | - Samuel T. Kuna
- Department of Medicine, Division of Sleep Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.T.K.); (S.T.K.)
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
| | - Bharati Prasad
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL 60612, USA
- Correspondence: ; Tel.: +1-312-996-8433
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34
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Giles JJ, Ling I, McArdle N, Bucks RS, Cadby G, Singh B, Morgan VA, Gabriel L, Waters F. Obstructive Sleep Apnea Is Treatable With Continuous Positive Airway Pressure in People With Schizophrenia and Other Psychotic Disorders. Schizophr Bull 2021; 48:437-446. [PMID: 34581411 PMCID: PMC8886585 DOI: 10.1093/schbul/sbab100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent condition in people living with schizophrenia or other psychotic disorder. Its treatment with continuous positive airway pressure therapy (CPAP) can dramatically improve daytime and physical health function. People with a psychotic disorder, however, are rarely diagnosed and treated and there are no large-scale studies showing evidence of successful treatment with CPAP. Using a retrospective case-control study approach (N = 554), we examined adherence to and effectiveness of a CPAP trial in individuals with comorbid psychotic disorder and OSA (psychosis group, n = 165) referred for a CPAP trial at the West Australian Sleep Disorders Research Institute. Given that antipsychotic medication is an important confounder, we included a psychiatric (non-psychosis) comparison group taking antipsychotic medication (antipsychotic group, n = 82), as well as a nonpsychiatric control group (OSA control group, n = 307) also diagnosed with OSA and referred for CPAP. Variables included OSA symptom response, CPAP engagement, and usage at 3 months. The Psychosis group had the most severe OSA at baseline and they attended fewer clinic appointments overall. However, there were no other group differences either in CPAP adherence or treatment response. CPAP was equally effective in normalizing OSA symptoms and daytime sleepiness in all groups. CPAP usage was longer per night in the Psychosis and Antipsychotic groups, perhaps suggesting a role of sedation from antipsychotic medications. In conclusion, OSA is treatable and CPAP feasible in people with severe mental illness and antipsychotic medications are not a barrier to treatment response.
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Affiliation(s)
- Jamilla J Giles
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Ivan Ling
- West Australian Sleep Disorders Research Institute, Perth, Australia,Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Perth, Australia,Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia,School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Gemma Cadby
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Perth, Australia,Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia,School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Perth, Australia,Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service-Mental Health, Perth, Australia,Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
| | - Laura Gabriel
- Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service-Mental Health, Perth, Australia
| | - Flavie Waters
- School of Psychological Science, University of Western Australia, Perth, Australia,Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service-Mental Health, Perth, Australia,To whom correspondence should be addressed; Clinical Research Centre, Gascoyne House, Graylands Hospital, North Metropolitan Health Service-Mental Health, Perth, 6019, Australia; tel: 61-8-9347-6420, fax: 61-8-9384-5128, e-mail: ;
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Lee MH, Lee SK, Thomas RJ, Yoon JE, Yun CH, Shin C. Deep Learning-Based Assessment of Brain Connectivity Related to Obstructive Sleep Apnea and Daytime Sleepiness. Nat Sci Sleep 2021; 13:1561-1572. [PMID: 34557049 PMCID: PMC8455296 DOI: 10.2147/nss.s327110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/04/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Obstructive sleep apnea (OSA) is associated with altered pairwise connections between brain regions, which might explain cognitive impairment and daytime sleepiness. By adopting a deep learning method, we investigated brain connectivity related to the severity of OSA and daytime sleepiness. PATIENTS AND METHODS A cross-sectional design applied a deep learning model on structural brain networks obtained from 553 subjects (age, 59.2 ± 7.4 years; men, 35.6%). The model performance was evaluated with the Pearson's correlation coefficient (R) and probability of absolute error less than standard deviation (PAE RESULTS We achieved a meaningful R (up to 0.74) and PAE CONCLUSION A deep learning method can assess the association of brain network characteristics with OSA severity and daytime sleepiness and specify the relevant brain connectivity.
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Affiliation(s)
- Min-Hee Lee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Seung Ku Lee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Robert J Thomas
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jee-Eun Yoon
- Department of Neurology, Uijeongbu Eulji Medical Center, Uijeongbu, Republic of Korea
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chol Shin
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
- Department of Pulmonary Sleep and Critical Care Medicine Disorder Center, College of Medicine, Korea University, Ansan, Republic of Korea
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Landzberg D, Bagai K. Prevalence of objective excessive daytime sleepiness in a cohort of patients with mild obstructive sleep apnea. Sleep Breath 2021; 26:1471-1477. [PMID: 34436710 DOI: 10.1007/s11325-021-02473-2] [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: 03/28/2021] [Revised: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is common, yet the relationship between mild OSA and excessive daytime sleepiness (EDS) is unclear. Our objective was to determine the prevalence of objective EDS in a population with mild OSA using the mean sleep latency (MSL) from the multiple sleep latency test (MSLT). METHODS We retrospectively analyzed 1205 consecutive patients who underwent a polysomnography and a following day MSLT at a single sleep center. Adult patients who met criteria for mild OSA with an apnea-hypopnea index of 5 to <15 events/h were identified, and the percentage of patients with a MSL ≤ 8 min was determined. Sleep study and demographic variables were examined to evaluate predictors of objective EDS. RESULTS Of 155 patients with mild OSA, objective EDS was found in 36% (56/155) with an average MSL of 5.6 ± 2.1 min in the objectively sleepy patients. Objectively sleepy patients with mild OSA had greater total sleep time (411.6 ± 48.9 vs. 384.5 ± 61.7 min, p = 0.004), increased sleep efficiency (84.9 ± 9.7 vs. 79.7 ± 12.7%, p = 0.01), and decreased wake after sleep onset time (53.0 ± 36.9 vs. 67.4 ± 46.1 min, p = 0.04) compared to patients with mild OSA but without objective EDS, with total sleep time being an independent predictor of MSL (p = 0.006). The Epworth Sleepiness Scale (ESS) weakly correlated with objective EDS (ρ = - 0.169, p = 0.03). CONCLUSIONS There is a large subgroup of patients with mild OSA patients who have objective sleepiness. This may represent an ideal subgroup to target for future studies examining the effect of treatment in mild OSA. Additionally, the ESS was a poor predictor of this subgroup with mild OSA and objective EDS.
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Affiliation(s)
- David Landzberg
- Vanderbilt School of Medicine, Vanderbilt University, Nashville, TN, USA. .,Sleep Disorders Center, Department of Neurology, Vanderbilt University Medical Center, A-0118 Medical Center North, 1161 21st Avenue South, Nashville, TN, 37232-2551, USA.
| | - Kanika Bagai
- Vanderbilt School of Medicine, Vanderbilt University, Nashville, TN, USA.,Vanderbilt Sleep Disorders Center and Department of Neurology, Vanderbilt University, Nashville, TN, USA
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Holley AB, Phillips B. POINT: Should Hypopneas Only Be Scored When Accompanied By Oxygen Desaturation? Yes. Chest 2021; 160:415-417. [PMID: 34366031 DOI: 10.1016/j.chest.2021.02.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/26/2021] [Accepted: 02/26/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Aaron B Holley
- Department of Pulmonary/Sleep and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
| | - Barbara Phillips
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, KY
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Pang KP, Pang EB, Rotenberg B. Holistic Treatment Outcomes in OSA: Clinical Evidence for the SLEEP GOAL. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00365-3] [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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Guimarães TM, Poyares D, Oliveira E Silva L, Luz G, Coelho G, Dal Fabbro C, Tufik S, Bittencourt L. The treatment of mild OSA with CPAP or mandibular advancement device and the effect on blood pressure and endothelial function after one year of treatment. J Clin Sleep Med 2021; 17:149-158. [PMID: 32964829 DOI: 10.5664/jcsm.8822] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVES To evaluate and compare the effects of continuous positive airway pressure (CPAP), use of a mandibular advancement device (MAD), and no treatment on 24-hour ambulatory blood pressure monitoring and peripheral arterial tonometry at 6 and 12 months follow-up in individuals with mild obstructive sleep apnea (OSA), and in a subgroup who had an apnea-hypopnea index of < 5 events/h and adherence of ≥ 4 hours per night (effective-treatment subgroups). METHODS The inclusion criteria were individuals with mild obstructive sleep apnea, any sex, age between 18 and 65 years, and a body mass index of ≤ 35 kg/m². Patients were randomized into CPAP, MAD, and no-treatment groups. The evaluations included physical examination, full polysomnography, 24-hour ambulatory blood pressure monitoring, and peripheral arterial tonometry at baseline and after 6 and 12 months. A generalized linear mixed model was used for comparisons. RESULTS The CPAP and MAD groups had lower apnea-hypopnea indexes than the control group at 6 and 12 months, and the CPAP group had higher blood oxygen levels (SpO₂) than the MAD group. The MAD group had more hours of treatment per night and better adaptation to treatment than the CPAP group (MAD: 5.7 ± 2.7 h/night; CPAP: 3.8 ± 3.4 h/night; MAD: 16% did not adapt; CPAP: 42% did not adapt). No differences were found in the total sample and effective treatment in relation to peripheral arterial tonometry or 24-hour ambulatory blood pressure monitoring outcomes. CONCLUSIONS Treatment of mild obstructive sleep apnea with CPAP or MAD did not improve blood pressure or endothelial function after 1 year, even in patients with effective treatment. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Continuous Positive Airway Pressure and Oral Appliances Treatments in Mild Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT01461486; Identifier: NCT01461486.
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Affiliation(s)
| | - Dalva Poyares
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | | | - Gabriela Luz
- Departamento de Pneumologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | - Glaury Coelho
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | - Cibele Dal Fabbro
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
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40
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Malhotra A, Nokes B, DeYoung P, Owens R. Why do we sometimes ignore the chief complaint in patients evaluated for obstructive sleep apnea? J Clin Sleep Med 2021; 16:657-659. [PMID: 32022681 DOI: 10.5664/jcsm.8310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Atul Malhotra
- Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla, California
| | - Brandon Nokes
- Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla, California
| | - Pamela DeYoung
- Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla, California
| | - Robert Owens
- Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, La Jolla, California
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Chou MSH, Ting NCH, El-Turk N, Harrington Z, Dobler CC. Treatment burden experienced by patients with obstructive sleep apnoea using continuous positive airway pressure therapy. PLoS One 2021; 16:e0252915. [PMID: 34097721 PMCID: PMC8183990 DOI: 10.1371/journal.pone.0252915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 05/25/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Little is known about the treatment burden experienced by patients with obstructive sleep apnoea (OSA) who use continuous positive airway pressure (CPAP) therapy. PARTICIPANTS 18 patients (33.3% males, mean age 59.7±11.8 years) with OSA who use CPAP therapy were interviewed. METHODS Patients treated with CPAP for OSA at a tertiary hospital outpatient clinic in Sydney, Australia, were invited to participate in an interview in person or via phone. Semi-structured interviews were used to explore the treatment burden associated with using CPAP. The interviews were recorded, transcribed, and analysed using NVivo 12 qualitative analysis software. RESULTS Four categories of OSA-specific treatment burden were identified: healthcare tasks, consequences of healthcare tasks, exacerbating and alleviating factors of treatment burden. Participants reported a significant burden associated with using CPAP, independently of how frequently they used their device. Common sources of their treatment burden included attending healthcare appointments, the financial cost of treatment, lifestyle changes, treatment-related side effects and general discomfort. CONCLUSIONS This study demonstrated that there is a significant treatment burden associated with the use of CPAP, and that treatment non-adherence is not the only consequence of treatment burden. Other consequences include relationship burden, stigma and financial burden. It is important for physicians to identify other negative impacts of treatment burden in order to optimise the patient experience.
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Affiliation(s)
- Michael S. H. Chou
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Natasha C. H. Ting
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Nicole El-Turk
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Zinta Harrington
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Claudia C. Dobler
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
- Institute for Evidence-Based Healthcare, Bond University and Gold Coast University Hospital, Gold Coast, QLD, Australia
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42
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Walker A, Naughton MT, Shaw L, Jeklin AT, Martin C, Dabscheck E. Depression scores improve with continuous positive airway pressure in specialized sleep clinics: real-world data. J Clin Sleep Med 2021; 17:1201-1209. [PMID: 33590822 DOI: 10.5664/jcsm.9164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess changes in Hospital Anxiety and Depression Scale (HADS) scores after continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea. METHODS Consecutive patients attending the Alfred Health sleep clinic, diagnosed with obstructive sleep apnea, and prescribed CPAP were recruited. The primary outcome was a change in the HADS depression (HADS-D) and anxiety (HADS-A) subscales from the time of diagnosis to follow-up. Secondary analysis compared high (> 4 hours) and low (< 4 hours) CPAP adherence groups and change in depression cases, defined by HADS-D ≥ 8, and anxiety cases, defined by HADS-A ≥ 11. RESULTS We included 108 participants in the final analysis. Adherence groups were well matched in baseline mood, sleepiness, and apnea variables. Overall age (mean ± standard deviation) was 56.1 ± 12.8 years, and there was a median (interquartile ratio) apnea-hypopnea-index of 42.7 (27.5-58.1) or median (interquartile ratio) oxygen-desaturation-index of 43.0 (26.0-74.0). The median duration of CPAP therapy was 1.3 years. The HADS-D decreased after CPAP by -1.4 (adjusted 95% confidence interval, -2.1 to -0.6; P = .001). Patients with high-CPAP adherence (n = 84) had a tendency towards a greater reduction in HADS-D (-1.5) compared with those with low-CPAP adherence (n = 24; -0.3; adjusted P = .19). Depression cases (HADS-D ≥ 8) decreased by 13.1% in the high-CPAP-adherence group (P = .03) and increased by 4.1% in the low-CPAP-adherence group (P = .71). The HADS-A decreased after CPAP by -1.8 (adjusted 95% confidence interval, -1.8 to -0.4; P = .004). There was no significant difference between adherence groups or anxiety cases (HADS-A > 11). CONCLUSIONS Specialized obstructive sleep apnea treatment with CPAP reduces depression scores, with a trend toward greater reduction in those with high CPAP adherence.
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Affiliation(s)
- Anne Walker
- Department of Thoracic Medicine, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
| | - Matthew T Naughton
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia.,School of Medicine, Monash University, Victoria, Melbourne, Australia
| | - Lachlan Shaw
- School of Medicine, Monash University, Victoria, Melbourne, Australia
| | - Andrew T Jeklin
- School of Medicine, Monash University, Victoria, Melbourne, Australia
| | - Catherine Martin
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Eli Dabscheck
- Department of Respiratory Medicine, Alfred Health, Melbourne, Australia.,School of Medicine, Monash University, Victoria, Melbourne, Australia
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43
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Driendl S, Arzt M, Zimmermann CS, Jung B, Pukrop T, Böger CA, Haferkamp S, Zeman F, Heid IM, Stadler S. Sleep apnoea and incident malignancy in type 2 diabetes. ERJ Open Res 2021; 7:00036-2021. [PMID: 34007843 PMCID: PMC8093486 DOI: 10.1183/23120541.00036-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/07/2021] [Indexed: 12/04/2022] Open
Abstract
Background Sleep apnoea and type 2 diabetes (T2D) have been linked to malignancy. The aim of the present study was to evaluate the association between sleep apnoea and incidence of malignancy in patients with T2D. Methods The DIACORE (DIAbetes COhoRtE) study is a prospective, population-based cohort study in T2D patients. In the sleep disordered breathing substudy, the apnoea–hypopnoea index (AHI), oxygen desaturation index (ODI) and percentage of night-time spent with a peripheral oxygen saturation of <90% (tsat90%) were assessed using a two-channel ambulatory monitoring device. Malignancy diagnoses were gathered using self-reported medical history data validated by medical records. Hazard ratios (HRs) for incident malignancy were derived by Cox regression adjusting for sex, age, body mass index, smoking status, alcohol intake, socioeconomic status and HbA1c. Results Of 1239 patients with T2D (mean age 67 years, 41% female, mean body mass index 30.9 kg·m−2), 79 (6.4%) were first-time diagnosed with a malignancy within a median follow-up period of 2.7 years (interquartile range 2.2–4.5 years). AHI, ODI and tsat90% were not associated with incident malignancy. In subgroup analysis, females showed increased cancer risk per AHI unit (adjusted HR 1.03 per AHI unit, 95% CI 1.00–1.06; p=0.028) and severe sleep apnoea (defined as AHI ≥30 events·h−1; adjusted HR 4.19, 95% CI 1.39–12.77; p=0.012). This was not seen in males, and a significant interaction was observed (interaction terms p=0.048 and p=0.033, respectively). Conclusion Sleep apnoea was not associated with incident malignancy in T2D patients. However, stratified analysis revealed a significant association between sleep apnoea and incident malignancy in females, but not in males. In patients with type 2 diabetes, sleep apnoea is not associated with the incidence of malignancy. However, stratified analysis shows that sleep apnoea is associated with incident malignancy in females, but not in males.https://bit.ly/37RAK8V
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Affiliation(s)
- Sarah Driendl
- Dept of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.,These authors contributed equally
| | - Michael Arzt
- Dept of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.,These authors contributed equally
| | - Claudia S Zimmermann
- Dept of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Bettina Jung
- Dept of Nephrology, University Hospital Regensburg, Regensburg, Germany.,Dept of Nephrology, Traunstein, Germany
| | - Tobias Pukrop
- Dept of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Carsten A Böger
- Dept of Nephrology, University Hospital Regensburg, Regensburg, Germany.,Dept of Nephrology, Traunstein, Germany
| | | | - Florian Zeman
- Centre of Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Iris M Heid
- Dept of Genetic Epidemiology, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Stadler
- Dept of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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Pack AI, Magalang UJ, Singh B, Kuna ST, Keenan BT, Maislin G. Randomized clinical trials of cardiovascular disease in obstructive sleep apnea: understanding and overcoming bias. Sleep 2021; 44:5963957. [PMID: 33165616 DOI: 10.1093/sleep/zsaa229] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/28/2020] [Indexed: 12/11/2022] Open
Abstract
Three recent randomized control trials (RCTs) found that treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) did not reduce rates of future cardiovascular events. This article discusses the biases in these RCTs that may explain their negative results, and how to overcome these biases in future studies. First, sample selection bias affected each RCT. The subjects recruited were not patients typically presenting for treatment of OSA. In particular, subjects with excessive sleepiness were excluded due to ethical concerns. As recent data indicate that the excessively sleepy OSA subtype has increased cardiovascular risk, subjects most likely to benefit from treatment were excluded. Second, RCTs had low adherence to therapy. Reported adherence is lower than found clinically, suggesting it is in part related to selection bias. Each RCT showed a CPAP benefit consistent with epidemiological studies when restricting to adherent patients, but was underpowered. Future studies need to include sleepy individuals and maximize adherence. Since it is unethical and impractical to randomize very sleepy subjects to no therapy, alternative designs are required. Observational designs using propensity scores, which are accepted by FDA for studies of medical devices, provide an opportunity. The design needs to ensure covariate balance, including measures assessing healthy user and healthy adherer biases, between regular users of CPAP and non-users. Sensitivity analyses can evaluate the robustness of results to unmeasured confounding, thereby improving confidence in conclusions. Thus, these designs can robustly assess the cardiovascular benefit of CPAP in real-world patients, overcoming biases in RCTs.
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Affiliation(s)
- Allan I Pack
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Samuel T Kuna
- Sleep Medicine Section, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Brendan T Keenan
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Biostatistics Core, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Greg Maislin
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Biostatistics Core, Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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45
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Fitzpatrick J, Kerns ES, Kim ED, Sozio SM, Jaar BG, Estrella MM, Tereshchenko LG, Monroy-Trujillo JM, Parekh RS, Bourjeily G. Functional outcomes of sleep predict cardiovascular intermediary outcomes and all-cause mortality in incident hemodialysis patients. J Clin Sleep Med 2021; 17:1707-1715. [PMID: 33779539 DOI: 10.5664/jcsm.9304] [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: 11/13/2022]
Abstract
STUDY OBJECTIVES Patients with end-stage kidney disease (ESKD) commonly experience sleep disturbances. Sleep disturbance has been inconsistently associated with mortality risk in hemodialysis patients, but the burden of symptoms from sleep disturbances has emerged as a marker that may shed light on these discrepancies and guide treatment decisions. This study examines whether functional outcomes of sleep are associated with increased risk of intermediary CV outcomes or mortality among adults initiating hemodialysis. METHODS In 228 participants enrolled in the Predictors of Arrhythmic and Cardiovascular risk in ESRD (PACE) study, the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10), which assesses functional outcomes of daytime sleepiness, was administered within 6 months of enrollment. Intermediary CV outcomes included QTc [ms], heart rate variance [ms²], left ventricular mass index [g/m², LVMI], and left ventricular hypertrophy [LVH]. The association of FOSQ-10 score with all-cause mortality was examined using proportional hazards regression. Results: Mean age was 55 years, median BMI was 28 kg/m² (IQR 24,33), with 70% African Americans. Median FOSQ-10 score was 19.7 (IQR: 17.1,20.0). A 10% lower FOSQ-10 score was associated with increased mortality risk (HR 1.09, 95%CI 1.01-1.18). Lower FOSQ-10 scores were associated with longer QTc duration and lower heart rate variance, but not LVMI or LVH. CONCLUSIONS In adults initiating dialysis, sleep-related functional impairment is common and is associated with intermediary cardiovascular disease measures and increased mortality risk. Future studies should assess the impact of screening for sleep disturbances in ESKD patients to identify individuals at increased risk for cardiovascular complications and death.
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Affiliation(s)
- Jessica Fitzpatrick
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric S Kerns
- Lahey Hospital and Medical Center, Burlington, MA
| | - Esther D Kim
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
| | - Stephen M Sozio
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bernard G Jaar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Nephrology Center of Maryland, Baltimore, MD
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco and Department of Medicine, San Francisco VA Health Care System, San Francisco, CA
| | - Larisa G Tereshchenko
- Knight Cardiovascular Institute, Department of Medicine, Oregon Health and Science University, Portland, OR
| | | | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada
| | - Ghada Bourjeily
- Department of Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
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46
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Mediano O, González Mangado N, Montserrat JM, Alonso-Álvarez ML, Almendros I, Alonso-Fernández A, Barbé F, Borsini E, Caballero-Eraso C, Cano-Pumarega I, de Carlos Villafranca F, Carmona-Bernal C, Carrillo Alduenda JL, Chiner E, Cordero Guevara JA, de Manuel L, Durán-Cantolla J, Farré R, Franceschini C, Gaig C, Garcia Ramos P, García-Río F, Garmendia O, Gómez García T, González Pondal S, Hoyo Rodrigo MB, Lecube A, Madrid JA, Maniegas Lozano L, Martínez Carrasco JL, Masa JF, Masdeu Margalef MJ, Mayos Pérez M, Mirabet Lis E, Monasterio C, Navarro Soriano N, Olea de la Fuente E, Plaza G, Puertas Cuesta FJ, Rabec C, Resano P, Rigau D, Roncero A, Ruiz C, Salord N, Saltijeral A, Sampol Rubio G, Sánchez Quiroga MÁ, Sans Capdevila Ó, Teixeira C, Tinahones Madueño F, Maria Togeiro S, Troncos Acevedo MF, Vargas Ramírez LK, Winck J, Zabala Urionaguena N, Egea C. International Consensus Document on Obstructive Sleep Apnea. Arch Bronconeumol 2021; 58:52-68. [PMID: 33875282 DOI: 10.1016/j.arbres.2021.03.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023]
Abstract
The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 specialists from a wide geographical area (including the participation of 4 international societies), an expert in methodology, and a documentalist from the Iberoamerican Cochrane Center. The document consists of a main section containing the most significant innovations and a series of online manuscripts that report the systematic literature searches performed for each section of the international consensus document. This document does not discuss pediatric patients or the management of patients receiving chronic non-invasive mechanical ventilation (these topics will be addressed in separate consensus documents).
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Affiliation(s)
- Olga Mediano
- Unidad de Sueño, Departamento de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España; Departamento de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España.
| | - Nicolás González Mangado
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Neumología, Unidad Multidisciplinar de Sueño (UMS), Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, España
| | - Josep M Montserrat
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar de Patología del Sueño y VNID, Servei de Pneumologia, Institut Clínic Respiratori, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - M Luz Alonso-Álvarez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Dr. J. Terán Santos, Departamento de Neumología, Hospital Universitario de Burgos, Burgos, España
| | - Isaac Almendros
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, España
| | - Alberto Alonso-Fernández
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Servicio de Neumología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma, Baleares, España
| | - Ferran Barbé
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova y Santa Maria, Lleida, España
| | - Eduardo Borsini
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño y Ventilación, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Candelaria Caballero-Eraso
- Unidad de Trastornos Respiratorios del Sueño, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Irene Cano-Pumarega
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Departamento de Neumología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
| | - Felix de Carlos Villafranca
- Servicio de Estomatología, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Asturias, España
| | - Carmen Carmona-Bernal
- Unidad de Trastornos Respiratorios del Sueño, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Jose Luis Carrillo Alduenda
- Unidad de Medicina del Sueño, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, México
| | - Eusebi Chiner
- Unidad Multidisciplinar del Sueño, Servicio de Neumología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, España
| | - José Aurelio Cordero Guevara
- Grupo de Investigación en Epidemiología y Salud Pública, Unidad de Metodología y Estadística, Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Álava, España
| | - Luis de Manuel
- Corte del Ilustre Colegio de Abogados de Madrid, Madrid, España
| | - Joaquín Durán-Cantolla
- Servicio de Investigación, Instituto de Investigación, OSI Araba, Hospital Universitario de Araba, Vitoria-Gasteiz, Álava, España
| | - Ramón Farré
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, España
| | - Carlos Franceschini
- Unidad de Sueño y Ventilación Mecánica, Hospital Cosme Argerich, Buenos Aires, Argentina
| | - Carles Gaig
- Servicio de Neurología, Unidad Multidisciplinar de Sueño, Hospital Clínic de Barcelona, Barcelona, España
| | - Pedro Garcia Ramos
- Centro de Salud Don Benito Oeste, Servicio Extremeño de Salud, Don Benito, Badajoz, España
| | - Francisco García-Río
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Onintza Garmendia
- Unidad del Sueño, Servicio de Neumología, Hospital Clínic, Barcelona, España
| | - Teresa Gómez García
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Servicio de Odontología y Unidad Multidisciplinar del Sueño del Hospital Universitario Fundación Jiménez Díaz, Sociedad Española de Medicina Dental del Sueño (SEMDeS), Madrid, España
| | - Silvia González Pondal
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Servicio de Odontología y Unidad Multidisciplinar del Sueño del Hospital Universitario Fundación Jiménez Díaz, Sociedad Española de Medicina Dental del Sueño (SEMDeS), Madrid, España
| | | | - Albert Lecube
- Grupo de investigación en Obesidad, Diabetes y Metabolismo (ODIM), Servicio de Endocrinología y Nutrición, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, España
| | - Juan Antonio Madrid
- Laboratorio de Cronobiología, Universidad de Murcia, IMIB-Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, España
| | - Lourdes Maniegas Lozano
- Fundación Jiménez Díaz, Madrid, España; Neumología, Unidad Multidisciplinar de Sueño (UMS), Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, España
| | | | - Juan Fernando Masa
- Hospital San Pedro de Alcántara, Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), San Pedro de Alcántara, Cáceres, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - María José Masdeu Margalef
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar del Sueño, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, España
| | - Mercè Mayos Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad de Sueño, Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - Carmen Monasterio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar del Sueño, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - Nieves Navarro Soriano
- Unidad de Sueño, Servicio de Neumología, Hospital Clínico Universitario, Valencia, España
| | - Erika Olea de la Fuente
- Servicio de Anestesiología y Reanimación, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
| | - Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, España; Hospital Universitario La Zarzuela, Madrid, España
| | - Francisco Javier Puertas Cuesta
- Unidad de Sueño, Servicio de Neurofisiología, Hospital Universitario de La Ribera, Facultad de Medicina y Ciencias de la Salud, Universidad Católica de Valencia, Alzira, Valencia, España
| | - Claudio Rabec
- Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier et Universitaire de Dijon, Dijon, Francia
| | - Pilar Resano
- Unidad de Sueño, Departamento de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España
| | - David Rigau
- Centro Cochrane Iberoamericano, Barcelona, España
| | - Alejandra Roncero
- Unidad Multidisciplinar del Sueño, Servicio de Neumología, Hospital San Pedro, Logroño, La Rioja, España
| | - Concepción Ruiz
- Servicio de Neurología, Unidad Multidisciplinar de Sueño, Hospital Clínic de Barcelona, Barcelona, España
| | - Neus Salord
- Unidad Multidisciplinar del Sueño, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - Adriana Saltijeral
- Servicio de Cardiología, Hospital Universitario del Tajo, Universidad Alfonso X El Sabio, Aranjuez, Madrid, España
| | - Gabriel Sampol Rubio
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Multidisciplinar del Sueño, Servicio de Neumología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - M Ángeles Sánchez Quiroga
- Hospital Virgen del Puerto, Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Plasencia, Cáceres, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Óscar Sans Capdevila
- Unidad del Sueño, Servicio de Neurología Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | - Carlos Teixeira
- European Society of Sleep Technologists (EEST), Porto, Portugal
| | - Francisco Tinahones Madueño
- Sociedad Española para el Estudio de la Obesidad (SEEDO), Madrid, España; Servicio de Endocrinología, Hospital Virgen de la Victoria, (IBIMA), Centro de Investigación Biomédica en Red de Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain
| | - Sônia Maria Togeiro
- Disciplina de Pneumologia, Departamento de Medicina; Disciplina de Medicina y Biologia del Sueño - Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brasil
| | | | | | - Joao Winck
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | - Carlos Egea
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España; Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Álava, España
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Facco F. Sleep Duration, Sleep Timing, and Sleep Disordered Breathing-Associations With Obesity and Gestational Diabetes in Pregnancy. Clin Obstet Gynecol 2021; 64:196-203. [PMID: 33481418 PMCID: PMC7839153 DOI: 10.1097/grf.0000000000000587] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pregnant individuals may come into pregnancy with underlying sleep abnormalities but are also predisposed to developing sleep issues such as obstructive sleep apnea, due to the physiologic changes associated with the gravid state. This article will review the epidemiology of sleep duration, sleep timing, and sleep disordered breathing in pregnancy with a focus on how the prevalence of these sleep conditions relate to body mass index. In addition, it will summarize the literature suggesting a link between these sleep disturbances and an increased risk for gestational diabetes.
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Affiliation(s)
- Francesca Facco
- Department of Obstetrics and Gynecology, University of Pittsburgh, Magee-Womens Hospital, Pittsburgh, Pennsylvania
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Positive Airway Pressure Therapy Adherence with Mask Resupply: A Propensity-Matched Analysis. J Clin Med 2021; 10:jcm10040720. [PMID: 33673066 PMCID: PMC7917762 DOI: 10.3390/jcm10040720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/31/2022] Open
Abstract
There are currently few data on the impact of mask resupply on longer-term adherence to positive airway pressure (PAP) therapy. This retrospective analysis investigated the effects of mask/mask cushion resupply on the adherence to PAP versus no resupply. Deidentified patient billing data for PAP supply items were merged with telemonitoring data from Cloud-connected AirSense 10/AirCurve 10 devices via AirViewTM (ResMed). Eligible patients started PAP between 1 July 2014 and 17 June 2016, had ≥360 days of PAP device data, and achieved initial U.S. Medicare adherence criteria. Patients who received a resupply of mask systems/cushions (resupply group) were propensity-score-matched with those not receiving any mask/cushion resupply (control group). A total of 100,370 patients were included. From days 91 to 360, the mean device usage was 5.6 and 4.5 h/night in the resupply and control groups, respectively (p < 0.0001). The proportion of patients with a mean device usage ≥4 h/night was significantly higher in the resupply group versus the control group (77% vs. 59%; p < 0.0001). The therapy termination rate was significantly lower in the resupply group versus the control group (14.7% vs. 31.9%; p < 0.0001); there was a trend toward lower therapy termination rates as the number of resupplies increased. The replacement of mask interface components was associated with better longer-term adherence to PAP therapy versus no resupply.
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Stevens D, Loffler KA, Buman MP, Dunstan DW, Luo Y, Lorenzi-Filho G, Barbe FE, Anderson CS, McEvoy RD. CPAP increases physical activity in obstructive sleep apnea with cardiovascular disease. J Clin Sleep Med 2021; 17:141-148. [PMID: 32951632 DOI: 10.5664/jcsm.8792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVES Uncertainty exists over whether continuous positive airway pressure (CPAP) treatment improves moderate to vigorous physical activity levels in those with obstructive sleep apnea. We aimed to determine effects of CPAP on moderate to vigorous physical activity among participants with co-occurring cardiovascular disease and obstructive sleep apnea. METHODS The Sleep Apnea cardioVascular Endpoints (SAVE) trial recruited participants with confirmed cardiovascular disease history and obstructive sleep apnea, 45-75 years old. The 2,687 participants (1,346 randomized to CPAP plus usual care and 1,341 to usual care alone) were followed up for a mean of 3.7 years. Self-reported physical activity was recorded at baseline, 6, 24, and 48 months using the Godin-Shepard Leisure Time Exercise Questionnaire (LTEQ). We also determined effects on any limitation of physical activity reported on the physical functioning subscale of the 36-item short form questionnaire (SF-36) and proportions of participants reaching guideline recommended physical activity levels. RESULTS Among 2,601 participants with available data, those in the CPAP group reported significantly more physical activity compared to the usual care group, with approximately 20% higher reported moderate activities on the LTEQ during follow-up (adjusted mean 95% confidence interval) scores: 8.7, 7.5-9.9 vs 7.3, 6.1-8.5; P = .003). Those in the CPAP group also reported less limitation in physical activity (adjusted between-group difference in SF-36 physical functioning subscale score 1.66, 95% confidence interval 0.87-2.45; P < 0.001), and more reported sufficient levels of physical activity to meet recommendations. CONCLUSIONS CPAP has positive effects on improving physical activity levels, consistent with long-term health benefits. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea to Prevent Cardiovascular Disease (SAVE); URL: https://clinicaltrials.gov/ct2/show/NCT00738179; Identifier: NCT00738179; and Registry: Australian New Zealand Clinical Trials Registry; Name: Sleep Apnea cardioVascular Endpoints study-An investigation of continuous positive airway pressure for the treatment of obstructive sleep apnea to prevent cardiovascular disease; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83062&isReview=true; Identifier: ACTRN12608000409370.
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Affiliation(s)
- David Stevens
- Adelaide Institute for Sleep Health - A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Kelly A Loffler
- Adelaide Institute for Sleep Health - A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - David W Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, Victoria, Australia
| | - Yuanming Luo
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, China
| | | | - Ferran E Barbe
- Respiratory Department, IRBLleida, Catalonia, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,The George Institute China, Health Science Center, Peking University, Beijing, China.,Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, New South Wales, Australia
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health - A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Sleep Health Service, Sleep and Respiratory Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
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50
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Cervenka T, Iber C. EHR Integration of PAP Devices in Sleep Medicine Implementation in the Clinical Setting. Sleep Med Clin 2020; 15:377-382. [PMID: 32762970 DOI: 10.1016/j.jsmc.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Positive airway pressure (PAP) therapy integration is a component of electronic health record (EHR) sleep medicine optimization. EHR optimization facilitates telehealth in continuous care population health. A coordinated care plan can leverage early telehealth interventions.
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Affiliation(s)
- Tereza Cervenka
- Department of Medicine, Pulmonary, Allergy, Critical Care and Sleep Medicine, M Health Fairview and University of Minnesota, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA
| | - Conrad Iber
- Department of Medicine, Pulmonary, Allergy, Critical Care and Sleep Medicine, M Health Fairview and University of Minnesota, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA.
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