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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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AL-Jahdali H, Ahmed A, AL-Harbi A, Khan A, ALGamedi M, Alyami S, Hayyan H, Al-Moamary M, Almuttari A. The most common pulmonary diseases length of stay, and characteristics of patients admitted to pulmonary service. Ann Thorac Med 2023; 18:124-131. [PMID: 37663882 PMCID: PMC10473058 DOI: 10.4103/atm.atm_348_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Although chronic respiratory diseases are prevalent in Saudi Arabia, there are limited data on the patient burden and associated factors. The aim of this study is to identify the chronic respiratory diseases frequently admitted to pulmonary services and to determine the patient's characteristics, associated comorbidities readmission rate, and reason for a more extended stay in hospital. METHODS A prospective study was conducted over a 5-year period at King Abdulaziz Medical City-Riyadh, Saudi Arabia, in the Pulmonary Division, between March 2015 and December 2019. Data on demographics, comorbidities, and chronic respiratory diseases were collected. RESULTS Total patients admitted were 1315 patients, female 54.2%, the mean age was 62.4 (SD±17.6), and the ages ranged from 14 to 98 years. Overall, chronic obstructive pulmonary disease was the most common respiratory disease requiring admission (17.9%), followed by interstitial lung disease (15.8%), bronchiectasis (11.9%), and obesity hypoventilation syndrome (10.8%). The most common comorbidities were obesity (42.5%), diabetes 49.1%, and hypertension 54.9%. Only 135 (10.3%) were readmitted within 30 days posthospital discharge. Among the patients who were readmitted, 103 (76.3%) were readmitted due to issues related to previous admission diagnosis, noncompliance 75 (55.5%), social reasons, and premature discharges in 51 (37.8%) and 29 (21.5%) of the cases, respectively. The respiratory disease varied significantly by gender, age, obesity status, comorbidities, length of stay (LOS), and admissions. CONCLUSION Chronic respiratory diseases are prevalent in our population and are mainly influenced by gender, age, obesity status, comorbidities, LOS, and admissions. Policymakers and health professionals need to recognize the burden of chronic respiratory diseases on patients and health systems and implement effective prevention programs.
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Affiliation(s)
- Hamdan AL-Jahdali
- Department of Medicine, Pulmonary Division, King Saud bin Abdulaziz University for Health Sciences, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Anwar Ahmed
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, MD, USA
- Department of Biostatistics, Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Abdullah AL-Harbi
- Department of Medicine, Pulmonary Division, King Saud bin Abdulaziz University for Health Sciences, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ayaz Khan
- Department of Medicine, Pulmonary Division, King Saud bin Abdulaziz University for Health Sciences, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Majed ALGamedi
- Department of Medicine, Pulmonary Division, King Saud bin Abdulaziz University for Health Sciences, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sami Alyami
- Department of Medicine, Pulmonary Division, King Saud bin Abdulaziz University for Health Sciences, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hajar Hayyan
- Department of Medicine, Pulmonary Division, King Saud bin Abdulaziz University for Health Sciences, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohamed Al-Moamary
- Department of Medicine, Pulmonary Division, King Saud bin Abdulaziz University for Health Sciences, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahmed Almuttari
- Department of Medicine, Pulmonary Division, King Saud bin Abdulaziz University for Health Sciences, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Jaritos V, Blanco M, Nogueira F, Giovini V, Borsini E. [Compliance with CPAP treatment in patients with obstructive sleep apneas during the COVID-19 pandemic in two hospitals in the Federal Capital]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2023; 80:106-111. [PMID: 37402304 PMCID: PMC10443417 DOI: 10.31053/1853.0605.v80.n2.37719] [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: 05/21/2022] [Accepted: 04/11/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction CPAP therapy is the first line treatment for sleep apnea and its effectiveness depends on adherence. Face to face control and follow-up was limited due to the fact that our country was immersed in social isolation due to the COVID-19 pandemic as of March 2020. In order to assess whether CPAP adherence was maintained in patients with obstructive sleep apnea (OSA), in two hospitals during the COVID-19 pandemic and compare it with the pre-pandemic situation on a historical control basis in the city of Buenos Aires. Methods Observational and retrospective study based on systematic data collection of adherence to CPAP and residual apnea-hypopnea index (AHI). For comparison, a historical control corresponding to the specular period (May to December of each year between 2016 and 2019) was used as a reference. Patients over 18 years ago with OSA on CPAP therapy more than 30 days of treatment were included. Patients with other chronic respiratory diseases requiring ventilation therapy (Bi-level, servo ventilation, volume-assured ventilation) were excluded. Results 151 pre-pandemic patients and 127 from the pandemic period, respectively, were evaluated. Men 98 (65%) vs. 50 (60.3%) p: 0.9, age: 65.4 ± 11.9 vs. 63.6 ± 12.6 p: 0.22, body mass index 31.5 ± 5.0 vs. 31.2 ± 5.3 kg/m2 p: 0.6, respectively. In both centers, the most used treatment was fixed CPAP; 90 (59.6%) vs. 96 (75.6%) p: 0.005. There was an increase in compliance with it compared to the pre-pandemic period in minutes/night [341.4 95% CI 292.4 - 340.6 vs. 274.3 95% CI 208.5 - 267.4, p: 0.001] and residual AHI reduction [3.3 IC 95% 2.0 - 3.05 vs. 6.3 IC 95% 2.6 - 4.3 p: 0.006]. Conclusions In the period of the COVID-19 pandemic, greater adherence to CPAP treatment was observed in patients with sleep apnea.
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Affiliation(s)
| | - Magalí Blanco
- Unidad de Sueño y Ventilación. Hospital Británico de Buenos Aires..
| | - Facundo Nogueira
- Unidad de Sueño. Hospital de Clínicas José de San Martín. Universidad de Buenos Aires. Argentina.
| | - Vanina Giovini
- Unidad de Sueño. Hospital de Clínicas José de San Martín. Universidad de Buenos Aires. Argentina.
| | - Eduardo Borsini
- Unidad de Sueño y Ventilación. Hospital Británico de Buenos Aires..
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Tondo P, Scioscia G, Hoxhallari A, Sabato R, Sorangelo S, Mansueto G, Giuliani A, Foschino Barbaro MP, Lacedonia D. Clinical Evaluation and Management of Overlap Syndrome (OS) and Obesity Hypoventilation Syndrome (OHS). Clocks Sleep 2022; 4:735-744. [PMID: 36547106 PMCID: PMC9777142 DOI: 10.3390/clockssleep4040055] [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: 10/31/2022] [Revised: 11/22/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background and Aim: Sleep-disordered breathing (SDB) is an extremely common disorder with a high impact on morbidity and mortality. The purpose of this study was to compare overlap syndrome (OS) and obesity hypoventilation syndrome (OHS) and to highlight and understand the differences between them. Material and Methods: The study was conducted retrospectively on 132 subjects selected by consecutive sampling from those attending our unit for suspected SDB. After clinical evaluation as well as functional and sleep investigations, the population was divided according to diagnosis in OS and OHS; then, the clinical parameters of two groups were compared with different statistical analysis. Results: The subjects with OHS were younger and reported higher rated daytime sleepiness (p = 0.005). In addition, they presented more nocturnal respiratory events (apnea-hypopnea index (AHI) 63.61 ± 22.79 events·h−1 vs. AHIOS 42.21 ± 22.91 events·h−1, p < 0.0001) at the sleep investigation as worse gas exchange during sleep leading to a higher percentage of nocturnal hypoxemia (p < 0.0001). In contrast, subjects with OS had more an impaired respiratory function. With regard to night-time ventilatory therapy, more subjects with OS were effectively treated with continuous positive airway pressure (CPAP) (p = 0.011), while more OHS were treated with auto-adjusting PAP (APAP) (14% vs. 1%, p = 0.008). Conclusions: The present study tried to establish a framework for OS and OHS because proper management of the two disorders would reduce their burden on healthcare.
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Affiliation(s)
- Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Department of Specialistic Medicine, Respiratory and Intermediate Care Unit, Policlinico Foggia University Hospital, 71122 Foggia, Italy
- Correspondence: (P.T.); (G.S.)
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Department of Specialistic Medicine, Respiratory and Intermediate Care Unit, Policlinico Foggia University Hospital, 71122 Foggia, Italy
- Correspondence: (P.T.); (G.S.)
| | - Anela Hoxhallari
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Department of Specialistic Medicine, Respiratory and Intermediate Care Unit, Policlinico Foggia University Hospital, 71122 Foggia, Italy
| | - Roberto Sabato
- Department of Specialistic Medicine, Respiratory and Intermediate Care Unit, Policlinico Foggia University Hospital, 71122 Foggia, Italy
| | - Simone Sorangelo
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Department of Specialistic Medicine, Respiratory and Intermediate Care Unit, Policlinico Foggia University Hospital, 71122 Foggia, Italy
| | - Giuseppe Mansueto
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Department of Specialistic Medicine, Respiratory and Intermediate Care Unit, Policlinico Foggia University Hospital, 71122 Foggia, Italy
| | - Antonella Giuliani
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Department of Specialistic Medicine, Respiratory and Intermediate Care Unit, Policlinico Foggia University Hospital, 71122 Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Department of Specialistic Medicine, Respiratory and Intermediate Care Unit, Policlinico Foggia University Hospital, 71122 Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Department of Specialistic Medicine, Respiratory and Intermediate Care Unit, Policlinico Foggia University Hospital, 71122 Foggia, Italy
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Chindamporn P, Wang L, Bena J, Zajichek A, Milinovic A, Kaw R, Kashyap SR, Cetin D, Aminian A, Kempke N, Foldvary-Schaefer N, Aboussouan LS, Mehra R. Obesity-associated sleep hypoventilation and increased adverse postoperative bariatric surgery outcomes in a large clinical retrospective cohort. J Clin Sleep Med 2022; 18:2793-2801. [PMID: 35959952 PMCID: PMC9713925 DOI: 10.5664/jcsm.10216] [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: 01/11/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Although obesity hypoventilation syndrome (OHS) is associated with increased morbidity and mortality, post-bariatric surgery OHS risk remains unclear due to often nonsystematic OHS assessments. METHODS We leverage a clinical cohort with nocturnal CO2 monitoring during polysomnography to address the hypothesis that patients with obesity-associated sleep hypoventilation (OaSH; ie, stage II OHS) have increased adverse postoperative bariatric surgery outcomes. We retrospectively analyzed data from patients undergoing pre-bariatric surgery polysomnography at the Cleveland Clinic from 2011-2018. OaSH was defined by body mass index ≥ 30 kg/m2 and either polysomnography-based end-tidal CO2 ≥ 45 mmHg or serum bicarbonate ≥ 27 mEq/L. Outcomes considered were as follows: intensive care unit stay, intubation, tracheostomy, discharge disposition other than home or 30-day readmission individually and as a composite, and all-cause mortality. Two-sample t test or Wilcoxon rank-sum test for continuous variables and chi-square or Fisher's exact test for categorical variables were used for OaSH vs non-OaSH comparisons. All-cause mortality was compared using Kaplan-Meier estimation and Cox proportional hazards models. RESULTS The analytic sample (n = 1,665) was aged 45.2 ± 12 years, 20.4% were male, had a body mass index of 48.7 ± 9 kg/m2, and 63.6% were White. OaSH prevalence was 68.5%. OaSH patients were older and more likely to be male with a higher BMI, apnea-hypopnea index, and glycated hemoglobin. The composite outcome was higher in OaSH vs non-OaSH patients (18.9% vs 14.3%, P = .021). Although some individual outcomes were respectively higher in OaSH vs non-OaSH patients, differences were not statistically significant: intubation (1.5% vs 1.3%, P = .81) and 30-day readmission (13.8% vs 11.3%, P = .16). Long-term mortality (median follow-up: 22.9 months) was not significantly different between groups, likely due to overall low event rate (hazard ratio = 1.39, 95% confidence interval: 0.56, 3.42). CONCLUSIONS In this largest sample to date of systematically phenotyped OaSH in a bariatric surgery cohort, we identify increased postoperative morbidity in those with sleep-related hypoventilation in stage II OHS when a composite outcome was considered, but individual contributors of intubation, intensive care unit admission, and hospital length of stay were not increased. Further study is needed to identify whether perioperative treatment of OaSH improves post-bariatric surgery outcomes. CITATION Chindamporn P, Wang L, Bena J, et al. Obesity-associated sleep hypoventilation and increased adverse postoperative bariatric surgery outcomes in a large clinical retrospective cohort. J Clin Sleep Med. 2022;18(12):2793-2801.
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Affiliation(s)
- Pornprapa Chindamporn
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Pulmonary and Critical Care Division, Phramongkutklao Hospital, Bangkok, Thailand
| | - Lu Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - James Bena
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Alexander Zajichek
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Alex Milinovic
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Roop Kaw
- Departments of Hospital Medicine and Anesthesiology Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | | | - Derrick Cetin
- Bariatric Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nancy Kempke
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Loutfi S. Aboussouan
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Reena Mehra
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
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Kotanen P, Brander P, Kreivi HR. The prevalence of non-invasive ventilation and long-term oxygen treatment in Helsinki University Hospital area, Finland. BMC Pulm Med 2022; 22:248. [PMID: 35752824 PMCID: PMC9233351 DOI: 10.1186/s12890-022-02044-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic respiratory failure (CRF) can be treated at home with non-invasive ventilation (NIV) and/or long-term oxygen (LTOT). The prevalence of these treatments is largely unknown. We aimed to clarify the prevalence and indications of the treatments, and the three-year mortality of the treated patients in the Helsinki University Hospital (HUH) area in Finland. METHODS In this retrospective study we analyzed the prevalence of adult CRF patients treated with NIV and/or LTOT on 1.1.2018 and followed these patients until 1.1.2021. Data collected included the underlying diagnosis, patient characteristics, information on treatment initiation and from the last follow-up visit, and mortality during the three-year follow-up. Patients with home invasive mechanical ventilation or sleep apnea were excluded. RESULTS On 1.1.2018, we had a total of 815 patients treated with NIV and/or LTOT in the Helsinki University Hospital (HUH) area, with a population of 1.4 million. The prevalence of NIV was 35.4 per 100,000, of LTOT 24.6 per 100,000 and of the treatments combined 60.0 per 100,000. Almost half, 44.5%, were treated with NIV, 41.0% with LTOT, and 14.4% underwent both. The most common diagnostic groups were chronic obstructive pulmonary disease (COPD) (33.3%) and obesity-hypoventilation syndrome (OHS) (26.6%). The three-year mortality in all patients was 45.2%. In the COPD and OHS groups the mortality was 61.3% and 21.2%. In NIV treated patients, the treatment durations varied from COPD patients 5.3 years to restrictive chest wall disease patients 11.4 years. The age-adjusted Charlson co-morbidity index (ACCI) median for all patients was 3.0. CONCLUSIONS NIV and LTOT are common treatments in CRF. The prevalence in HUH area was comparable to other western countries. As the ACCI index shows, the treated patients were fragile, with multiple co-morbidities, and their mortality was high. Treatment duration and survival vary greatly depending on the underlying diagnosis.
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Affiliation(s)
- Petra Kotanen
- HUH Heart and Lung Center, University of Helsinki and Helsinki University Hospital, (Haartmaninkatu 4), P.O. Box 372, 00029, Helsinki, Finland. .,Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland.
| | - Pirkko Brander
- HUH Heart and Lung Center, University of Helsinki and Helsinki University Hospital, (Haartmaninkatu 4), P.O. Box 372, 00029, Helsinki, Finland
| | - Hanna-Riikka Kreivi
- HUH Heart and Lung Center, University of Helsinki and Helsinki University Hospital, (Haartmaninkatu 4), P.O. Box 372, 00029, Helsinki, Finland
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Czajkowska-Malinowska M, Bartolik K, Nasiłowski J, Kania A. Development of Home Mechanical Ventilation in Poland in 2009–2019 Based on the Data of the National Health Fund. J Clin Med 2022; 11:jcm11082098. [PMID: 35456194 PMCID: PMC9032651 DOI: 10.3390/jcm11082098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Home mechanical ventilation (HMV) is a dynamically developing field of medicine driven by the increasing number of patients and technological advancements. In Poland, HMV has been financed from public funds since 2004. However, the organization of HMV is still evolving in search of the optimal model of care. The aim of this study was to analyze 11 years of HMV in terms of the number of patients, modes of ventilation, diagnosis and regional prevalence. In retrospective analysis of data reported to the National Health Fund by all health entities providing HMV in Poland in the period from 2009 to 2019, the following variables were included: age, sex, date of commencement, ventilation mode, diagnosis, and place of treatment. The diseases were identified according to the ICD-10 codes. A total of 12,616 patients receiving HMV were reported, including 1221 children (9.7%). The HMV prevalence increased from 2.8 in 2009 to 20/100,000 in 2019. In adults, the highest increase was reported for patients with chronic obstructive pulmonary disease, who accounted for 39% of all HMV users in 2019. The proportion of noninvasive ventilation (NIV) increased from 56% in 2014 to 73% in 2019. We identified significant regional variations in the prevalence of HMV between provinces. The main drivers for HMV development include full reimbursement, the development of hospital NIV centers and the involvement of respiratory physicians in the referral process for HMV.
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Affiliation(s)
- Małgorzata Czajkowska-Malinowska
- Department of Lung Diseases and Respiratory Failure, Centre of Sleep Medicine and Respiratory Care, Kuyavian-Pomeranian Pulmonology Centre, 85-326 Bydgoszcz, Poland
- Correspondence:
| | - Kinga Bartolik
- Department of Analysis and Strategy, Ministry of Health, 00-952 Warsaw, Poland;
| | - Jacek Nasiłowski
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland;
- VitalAire Home Mechanical Ventilation Centre, 00-180 Warsaw, Poland
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, 01-938 Warsaw, Poland
| | - Aleksander Kania
- 2nd Department of Medicine, Department of Pulmonology, Faculty of Medicine, Jagiellonian University Medical College, 30-688 Cracow, Poland;
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8
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Johnson KG, Rastegar V, Scuderi N, Johnson DC, Visintainer P. PAP therapy and readmission rates after in-hospital laboratory titration polysomnography in patients with hypoventilation. J Clin Sleep Med 2022; 18:1739-1748. [PMID: 35332871 DOI: 10.5664/jcsm.9962] [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 Hypoventilation associated with sleep disordered breathing in inpatients is associated with higher risk of morbidity, hospitalizations and death. In-hospital titration polysomnography qualifies patients for positive airway pressure (PAP) therapy and optimizes settings, but impact is unknown. This study describes a process for in-hospital sleep testing and evaluates subsequent PAP adherence and readmission. METHODS A retrospective cohort of patients with hypoventilation and in-hospital titration polysomnography with available PAP data were analyzed to determine whether PAP adherence was associated with 90-day readmission. Absolute differences were obtained using logistic regression models. Models were adjusted for body mass index, age and Elixhauser Index. PAP adherence and nonadherence were defined as ≥ 4 and < 4 hours daily average use prior to readmission or first 90-days post-discharge. RESULTS 81 patients, 50.6% male, age (mean ± SD) 61.1 ± 13.5 years were included. Comorbid sleep disorders included 91.4% with OSA and 23.5% with central sleep apnea. 28/52 (53.8%) nonadherent and 6/29 (20.7%) adherent patients had 90-day readmissions. 11 (13.6%) patients (all nonadherent) were readmitted within 2 weeks of discharge. Adjusted model showed a 35.6% (95% CI 15.9%-55.2%) reduction in 90-day readmission in adherent group compared to nonadherent (p=0.004). Similar reductions in readmission were found with adherence ≥ 50% and ≥ 70% days ≥ 4 hours. Male sex, treatment with iVAPS, and highest CO2 ≥ 60 mmHg on polysomnography were associated with largest differences in readmission rates between adherent and nonadherent patients. CONCLUSIONS Adherence to optimized PAP therapy after in-hospital titration polysomnography in patients with hypoventilation may decrease readmissions.
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Affiliation(s)
- Karin G Johnson
- Department of Neurology, Baystate Medical Center, University of Massachusetts Medical School-Baystate, Springfield, MA.,Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Vida Rastegar
- Department of Medicine, Baystate Medical Center, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Nicholas Scuderi
- Department of Neurology, Baystate Medical Center, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Douglas C Johnson
- Department of Medicine, Baystate Medical Center, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Paul Visintainer
- Department of Medicine, Baystate Medical Center, University of Massachusetts Medical School-Baystate, Springfield, MA
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9
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Sleep and Hypoventilation. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Sivam S, Wang D, Wong KKH, Piper AJ, Zheng YZ, Gauthier G, Hockings C, McGuinness O, Menadue C, Melehan K, Cooper S, Hilmisson H, Phillips CL, Thomas RJ, Yee BJ, Grunstein RR. Cardiopulmonary coupling and serum cardiac biomarkers in obesity hypoventilation syndrome and obstructive sleep apnea with morbid obesity. J Clin Sleep Med 2021; 18:1063-1071. [PMID: 34879904 DOI: 10.5664/jcsm.9804] [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 The main cause of death in patients with obesity hypoventilation syndrome (OHS) is cardiac rather than respiratory failure. Here, we investigated autonomic-respiratory coupling and serum cardiac biomarkers in patients with OHS and obstructive sleep apnea (OSA) with comparable body mass index (BMI) and apnea-hypopnea index (AHI). METHODS Cardiopulmonary coupling (CPC) and cyclic variation of heart rate (CVHR) analysis was performed on the electrocardiogram signal from the overnight polysomnogram. Cardiac serum biomarkers were obtained in patients with OHS and OSA with a BMI > 40kg/m2. Samples were obtained at baseline and after 3 months of positive airway pressure (PAP) therapy in both groups. RESULTS Patients with OHS (n=15) and OSA (n=36) were recruited. No group differences in CPC, CVHR and serum biomarkers were observed at baseline and after 3 months of PAP therapy. An improvement in several CPC metrics, including the sleep apnea index, unstable sleep (low frequency coupling and elevated low frequency coupling narrow band [e-LFCNB]) and CVHR were observed in both groups with PAP use. However, distinct differences in response characteristics were noted. e-LFCNB coupling correlated with highly sensitive troponin (hs-troponin-T, p<0.05) in the combined cohort. Baseline hs-troponin-T inversely correlated with awake oxygen saturation in the OHS group (p<0.05). CONCLUSIONS PAP therapy can significantly improve CPC stability in obese patients with OSA or OHS, with key differences. e-LFCNB may function as a surrogate biomarker for early subclinical cardiac disease. Low awake oxygen saturation could also increase this biomarker in OHS. CLINICAL TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Registry; Name: Obesity Hypoventilation Syndrome and Neurocognitive Dysfunction; URL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367492; Identifier: ACTRN12615000122550.
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Affiliation(s)
- Sheila Sivam
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - David Wang
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Keith K H Wong
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Amanda J Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Yi Zhong Zheng
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Gislaine Gauthier
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Christine Hockings
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Olivia McGuinness
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Collette Menadue
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kerri Melehan
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Sara Cooper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | | | - Craig L Phillips
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Robert J Thomas
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Brendon J Yee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
| | - Ronald R Grunstein
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, Australia
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11
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Zheng Y, Phillips CL, Sivam S, Wong K, Grunstein RR, Piper AJ, Yee BJ. Cardiovascular disease in obesity hypoventilation syndrome - A review of potential mechanisms and effects of therapy. Sleep Med Rev 2021; 60:101530. [PMID: 34425490 DOI: 10.1016/j.smrv.2021.101530] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
Cardiovascular disease is common in patients with obesity hypoventilation syndrome (OHS) and accounts in part for their poor prognosis. This narrative review article examines the epidemiology of cardiovascular disease in obesity hypoventilation syndrome, explores possible contributing factors and the effects of therapy. All studies that included cardiovascular outcomes and biomarkers were included. Overall, there is a higher burden of cardiovascular disease and cardiovascular risk factors among patients with obesity hypoventilation syndrome. In addition to obesity and sleep-disordered breathing, there are several other pathophysiological mechanisms that contribute to higher cardiovascular morbidity and mortality in OHS. There is evidence emerging that positive airway pressure therapy and weight loss have beneficial effects on the cardiovascular system in obesity hypoventilation syndrome patients, but further research is needed to clarify whether this translates to clinically important outcomes.
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Affiliation(s)
- Yizhong Zheng
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia; Department of Respiratory and Sleep Medicine, St George Hospital, Australia.
| | - Craig L Phillips
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Sheila Sivam
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
| | - Keith Wong
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
| | - Ronald R Grunstein
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia
| | - Amanda J Piper
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
| | - Brendon J Yee
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Australia
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12
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Orbea CP, Jenad H, Kassab LL, St Louis EK, Olson EJ, Shaughnessy GF, Peng LT, Morgenthaler TI. Does testing for sleep-disordered breathing pre-discharge versus post-discharge result in different treatment outcomes? J Clin Sleep Med 2021; 17:2451-2460. [PMID: 34216199 DOI: 10.5664/jcsm.9450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Treatment of sleep-disordered breathing (SDB) may improve health related outcomes post-discharge. However timely definitive sleep testing and provision of ongoing therapy has been a challenge. Little is known about how the time of testing-during hospitalization vs. after discharge-affects important outcomes such as treatment adherence. METHODS We conducted a 10-year retrospective study of hospitalized adults who received an inpatient sleep medicine consultation for SDB and subsequent sleep testing. We divided them into inpatient and outpatient sleep testing cohorts and studied their clinical characteristics, follow-up and PAP adherence, and hospital readmission. RESULTS Of 485 patients, 226 (47%) underwent inpatient sleep testing and 259 (53%) had outpatient sleep testing. The median age was 68 years old (IQR=57-78), and 29.6% were females. The inpatient cohort had a higher Charlson Comorbidity Index (CCI) (4 [3-6] vs 3[2-5], p=<0.0004). A higher CCI (HR=1.14, 95%CI:1.03-1.25, p=0.001), BMI (HR=1.03, 95%CI:1.0-1.05, p=0.008) and stroke (HR=2.22, 95%CI:1.0-4.9, p=0.049) were associated with inpatient sleep testing. The inpatient cohort kept fewer follow-up appointments (39.90% vs 50.62%, p=0.03) however PAP adherence was high among those keeping follow-up appointments (88.9% [inpatient] vs 85.71% [outpatient], p=0.55). The inpatient group had an increased risk for death (HR: 1.82 95%CI 1.28-2.59, p=<0.001) but readmission rates did not differ. CONCLUSIONS Medically complex patient were more likely to receive inpatient sleep testing but less likely to keep follow-up, which could impact adherence and effectiveness of therapy. Novel therapeutic interventions are needed to increase sleep medicine follow-up post-discharge which may result in improvement in health outcomes in hospitalized patients with SDB.
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Affiliation(s)
- Cinthya Pena Orbea
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland OH
| | - Hussam Jenad
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN
| | | | - Erik K St Louis
- Department of Neurology, Mayo Clinic, Rochester, MN.,Center for Sleep Medicine, Mayo Clinic, Rochester MN
| | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN.,Center for Sleep Medicine, Mayo Clinic, Rochester MN
| | - Gaja F Shaughnessy
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN
| | | | - Timothy I Morgenthaler
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN.,Center for Sleep Medicine, Mayo Clinic, Rochester MN
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13
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Strausz S, Kiiskinen T, Broberg M, Ruotsalainen S, Koskela J, Bachour A, Palotie A, Palotie T, Ripatti S, Ollila HM. Sleep apnoea is a risk factor for severe COVID-19. BMJ Open Respir Res 2021; 8:8/1/e000845. [PMID: 33436406 PMCID: PMC7804843 DOI: 10.1136/bmjresp-2020-000845] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 12/19/2022] Open
Abstract
Background Obstructive sleep apnoea (OSA) is associated with higher body mass index (BMI), diabetes, older age and male gender, which are all risk factors for severe COVID-19. We aimed to study if OSA is an independent risk factor for COVID-19 infection or for severe COVID-19. Methods OSA diagnosis and COVID-19 infection were extracted from the hospital discharge, causes of death and infectious diseases registries in individuals who participated in the FinnGen study (n=260 405). Severe COVID-19 was defined as COVID-19 requiring hospitalisation. Multivariate logistic regression model was used to examine association. Comorbidities for either COVID-19 or OSA were selected as covariates. We performed a meta-analysis with previous studies. Results We identified 445 individuals with COVID-19, and 38 (8.5%) of them with OSA of whom 19 out of 91 (20.9%) were hospitalised. OSA associated with COVID-19 hospitalisation independent from age, sex, BMI and comorbidities (p-unadjusted=5.13×10−5, OR-adjusted=2.93 (95% CI 1.02 to 8.39), p-adjusted=0.045). OSA was not associated with the risk of contracting COVID-19 (p=0.25). A meta-analysis of OSA and severe COVID-19 showed association across 15 835 COVID-19 positive controls, and n=1294 patients with OSA with severe COVID-19 (OR=2.37 (95% 1.14 to 4.95), p=0.021). Conclusion Risk for contracting COVID-19 was the same for patients with OSA and those without OSA. In contrast, among COVID-19 positive patients, OSA was associated with higher risk for hospitalisation. Our findings are in line with earlier works and suggest OSA as an independent risk factor for severe COVID-19.
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Affiliation(s)
- Satu Strausz
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Oral and Maxillofacial Diseases, Helsinki University Hospital (HUH), Helsinki, Finland
| | - Tuomo Kiiskinen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Martin Broberg
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Sanni Ruotsalainen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Jukka Koskela
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Adel Bachour
- Sleep Unit, Heart and Lung Center, Helsinki University Hospital (HUH), Helsinki, Finland
| | | | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Analytic and Translational Genetics Unit (ATGU), Department of Medicine, Department of Neurology and Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tuula Palotie
- Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Oral and Maxillofacial Diseases, Helsinki University Hospital (HUH), Helsinki, Finland
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Hanna M Ollila
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland .,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Stanford University School of Medicine, Palo Alto, CA, USA
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14
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Overlooking Obesity Hypoventilation Syndrome: The Need for Obesity Hypoventilation Syndrome Staging and Risk Stratification. Ann Am Thorac Soc 2020; 17:1211-1212. [PMID: 33000959 PMCID: PMC7640632 DOI: 10.1513/annalsats.202006-683ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Payen F, Greil A, Caillaud D. [Obesity hypoventilation syndrome and initial compliance with non-invasive ventilation]. Rev Mal Respir 2020; 37:783-789. [PMID: 33071059 DOI: 10.1016/j.rmr.2020.09.003] [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: 05/07/2020] [Accepted: 08/06/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The obesity hypoventilation syndrome (OHS) has an increasing prevalence. Compliance with first-line non-invasive ventilation has not been evaluated, taking into account patients' initial comorbidities. This study consisted of identification of the factors associated with compliance with non-invasive ventilation during the first six months of use. METHODS A monocentric retrospective study, gathering patients from the pneumology department of Gabriel-Montpied hospital in Clermont-Ferrand, from April 2010 to October 2019. The analysis was carried-out through the collection of computerised medical records (age, mode of entry, patient comorbidities) and compliance reports (average daily hours of use) provided by the regional service provider for the Auvergne area (AIRRA). RESULTS Being hospitalized for an acute exacerbation and being older than seventy-five years were factors associated with an improved compliance to non-invasive ventilation, with an increase of 1.47h/d and 2.73h/d (P value: 0.018 and 0.02, respectively). Moreover, patients with obstructive sleep apnea hypopnea syndrome and recipients of therapeutic education may prove more compliant over time. CONCLUSION Age greater than seventy-five years and being hospitalized for an acute exacerbation are predictors of better use of non-invasive ventilation in OHS.
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Affiliation(s)
- F Payen
- Service de pneumologie, CHU Gabriel-Montpied, université Clermont-Auvergne, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - A Greil
- Service de pneumologie, CHU Gabriel-Montpied, université Clermont-Auvergne, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - D Caillaud
- Service de pneumologie, CHU Gabriel-Montpied, université Clermont-Auvergne, 58, rue Montalembert, 63000 Clermont-Ferrand, France
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16
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Masoud O, Ramsay M, Suh ES, Kaltsakas G, Srivastava S, Pattani H, Marino P, Murphy PB, Hart N, Steier J. Long-term adherence to home mechanical ventilation: a 10-year retrospective, single-centre cohort study. J Thorac Dis 2020; 12:S120-S128. [PMID: 33214917 PMCID: PMC7642640 DOI: 10.21037/jtd-cus-2020-003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Sleep-disordered breathing (SBD) can be associated with hypercapnic respiratory failure (HRF). Home Mechanical Ventilation (HMV) is the preferred long-term treatment for patients with chronic HRF. We reviewed the database of a large tertiary referral centre for HMV to study the long-term adherence to HMV in chronic hypercapnic patients. Methods Data on adherence and characteristics of patients who received HMV for the treatment of SDB were collected over a decade using electronic patient records. The primary outcome parameter in this study was annual non-adherence rate (patients with HMV usage of <4 hours/night in the service divided by the number of all new patients of the same year), secondary outcomes were patients’ characteristics and reasons for low adherence. HMV adherence clinics were established to improve uptake. Results Two thousand and two hundred twenty-eight patients with HRF were under active follow-up on HMV at the end of the recording period. In contrast, a total of 1,900 patients had their HMV contracts terminated over the course of a decade (due to non-adherence, transfer to other services or death). Out of those, 222 patients {62 [52–72] years, body-mass index, BMI 40 [35–43] kg/m2, 58.1% male, Epworth Sleepiness Scale, ESS 9 [4–15] points, 4% oxygen desaturation index, 4%ODI 32 [20–71] × hour−1, TcCO2 6.6 [6.0–7.2] kPa} met the non-adherence criteria (nocturnal usage 0–4 hours). The annual non-adherence rate was 25.5% of all new setups in 2010, and declined to 3.4% in 2019 (relative reduction of 86%, P<0.001). Patients with Obstructive Sleep Apnoea/Obesity Hypoventilation Syndrome (58.2%), Neuromuscular Diseases (NMD) (26.8%) and COPD (13.6%) accounted for most cases of this non-adherent cohort. The vast majority of the patients (96.1%) were established on full-face masks. In 23.4% of patients, substantial weight loss (>10%) was the most common reason for low adherence; general displeasure (21.3%), uncontrolled symptoms (12.8%), claustrophobia (6.7%), mood (4.8%) and mask intolerance (4.3%) caused problems as well. Conclusions Non-adherence to HMV in patients with chronic HRF can affect significant proportions of patients. However, the non-adherent rate substantially decreases when individual treatment solutions are offered in multi-disciplinary clinics.
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Affiliation(s)
- Omar Masoud
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Michelle Ramsay
- Lane Fox Unit, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Eui-Sik Suh
- Lane Fox Unit, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Georgios Kaltsakas
- Faculty of Life Sciences and Medicine, King's College London, London, UK.,Lane Fox Unit, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Hina Pattani
- Lane Fox Unit, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Philip Marino
- Lane Fox Unit, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Patrick B Murphy
- Lane Fox Unit, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas Hart
- Lane Fox Unit, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Joerg Steier
- Faculty of Life Sciences and Medicine, King's College London, London, UK.,Lane Fox Unit, Guy's & St Thomas' NHS Foundation Trust, London, UK
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