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Launois C, Bailly S, Sabil A, Goupil F, Pigeanne T, Hervé C, Masson P, Bizieux-Thaminy A, Meslier N, Kerbrat S, Trzepizur W, Gagnadoux F. Association Between Healthy Behaviors and Health Care Resource Use With Subsequent Positive Airway Pressure Therapy Adherence in OSA. Chest 2024; 166:845-856. [PMID: 38885897 DOI: 10.1016/j.chest.2024.05.024] [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: 11/30/2023] [Revised: 05/03/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The healthy adherer effect has gained increasing attention as a potential source of bias in observational studies examining the association of positive airway pressure (PAP) adherence with health outcomes in OSA. RESEARCH QUESTION Is adherence to PAP associated with healthy behaviors and health care resource use prior to device prescription? STUDY DESIGN AND METHODS Data from the Institut de Recherche en Santé Respiratoire (IRSR) des Pays de la Loire Sleep Cohort were linked to health administrative data to identify proxies of heathy behaviors, including adherence to cardiovascular (CV) drugs (medical possession ratio), cancer screening tests, influenza vaccination, alcohol and smoking consumption, and drowsiness-related road accidents during the 2 years preceding PAP onset in patients with OSA. Multivariable regression analyses were conducted to evaluate the association of heathy behaviors with subsequent PAP adherence. Health care resource use was evaluated according to subsequent PAP adherence. RESULTS We included 2,836 patients who had started PAP therapy between 2012 and 2018 (65% of whom were PAP adherent with mean daily use ≥ 4 h/night). Being adherent to CV active drugs (medical possession ratio ≥ 80%) and being a person who does not smoke were associated with a higher likelihood of PAP adherence (OR, 1.43; 95% CI, 1.15-1.77 and OR, 1.37; 95% CI, 1.10-1.71, respectively). Patients with no history of drowsiness-related road accidents were more likely to continue PAP (OR, 1.39; 95% CI, 1.04-1.87). Patients who were PAP adherent used less health care resources 2 years before PAP initiation than patients who were nonadherent (mean number of outpatient consultations: 19.0 vs 17.2, P = .003; hospitalization days: 5.7 vs 5.0; P = .04; ED visits: 30.7% vs 24.0%, P = .0002, respectively). INTERPRETATION This study indicated that patients who adhere to PAP therapy for OSA were more health-seeking and used less health care resources prior to device initiation than patients who were nonadherent. Until the healthy adherer effect associated with PAP adherence is better understood, caution is warranted when interpreting the association of PAP adherence with CV health outcomes and health care resource use in nonrandomized cohorts.
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Affiliation(s)
- Claire Launois
- Department of Respiratory and Sleep Medicine, Reims University Hospital, Reims, France; INSERM UMRS-1250, Université Reims Champagne-Ardenne, Reims, France.
| | - Sebastien Bailly
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
| | - Abdelkebir Sabil
- Pays de la Loire Respiratory Health Research Institute, Beaucouzé, Paris, France; Cloud Sleep Lab, Paris, France
| | - François Goupil
- Department of Respiratory Diseases, Le Mans General Hospital, Le Mans, France
| | - Thierry Pigeanne
- Respiratory Unit, Pôle santé des Olonnes, Olonne sur Mer, France
| | - Carole Hervé
- Department of Physiology and Sleep Medicine, Nantes University Hospital, Nantes, France
| | - Philippe Masson
- Department of Respiratory Diseases, Cholet General Hospital, Cholet, France
| | - Acya Bizieux-Thaminy
- Department of Respiratory Diseases, La Roche sur Yon General Hospital, La Roche sur Yon, France
| | - Nicole Meslier
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France; INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, France
| | | | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France; INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, France
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France; INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, France
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Grote L, Jonzon YA, Barta P, Murto T, Nilsson Z, Nygren A, Theorell-Haglöw J, Sunnergren O, Ulander M, Ekström M, Palm A, Hedner J. The Swedish sleep apnea registry (SESAR) cohort - "Real world data" on a national level. Sleep Med 2024; 124:362-370. [PMID: 39378545 DOI: 10.1016/j.sleep.2024.09.039] [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: 07/05/2024] [Revised: 09/12/2024] [Accepted: 09/28/2024] [Indexed: 10/10/2024]
Abstract
INTRODUCTION The Swedish Sleep Apnea Registry (SESAR) collects clinical data from individual obstructive sleep apnea (OSA) patients since 2010. SESAR has recently been integrated with additional national healthcare data. The current analysis presents the SESAR structure and representative clinical data of a national sleep apnea cohort. METHODS Clinical data from unselected patients with a diagnosis of OSA are submitted to the SESAR registry. 48 sleep centers report data from diagnosis, treatment starts with Continuous Positive Airway Pressure (CPAP), oral devices (OD), and Upper Airway Surgery (UAS). Data from follow-up are included. SESAR is linked to mandatory national healthcare data (mortality, comorbidities, procedures, prescriptions) and diagnosis-specific quality registries (e.g. stroke, heart failure, diabetes) within the DISCOVERY project. RESULTS 83,404 OSA patients have been reported during the diagnostic workup (age 55.4 ± 14.1 years, BMI 30.8 ± 6.5 kg/m2, AHI 25.8 ± 21.6n/h, respectively). At least one cardiometabolic and respiratory comorbidity is recognized in 57 % of female and 53 % of male OSA patients with a linear increase across OSA severity. In 54,468, 7,797, and 390 patients, start of CPAP, OD or UAS treatment is reported, respectively. OD patients have 4 units lower BMI and 10 units lower AHI compared to patients started on CPAP. UAS patients are characterized by 10 years lower age. The degree of daytime sleepiness is comparable between treatment groups with mean Epworth Sleepiness Scale Scores between 9 and 10. CONCLUSION SESAR is introduced as a large national registry of OSA patients. SESAR provides a useful tool to highlight OSA management and to perform relevant outcome research.
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Affiliation(s)
- Ludger Grote
- Center for Sleep and Wake Disorders, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | | | - Peter Barta
- Home Mechanical Ventilation Unit, Pulmonary Medicine, University Hospital, Örebro, Sweden.
| | - Tarmo Murto
- Sleep Apnea Unit, Respiratory Medicine, Umeå University Hospital, Umeå, Sweden.
| | - Zarita Nilsson
- Sleep Apnea Unit, ENT Department, Ystad Hospital, Ystad, Sweden.
| | - Anna Nygren
- Sleep Apnea Unit, Pulmonary Department, Central Hospital, Västerås, Sweden.
| | - Jenny Theorell-Haglöw
- Respiratory, Allergy and Sleep Research, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Ola Sunnergren
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Otorhinolaryngology- Head and Neck Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
| | - Martin Ulander
- Department for Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden; Division of Neurobiology, Department of Biomedicine and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Magnus Ekström
- Department of Clinical Sciences Lund, Respiratory Medicine, Lund University, Lund, Sweden.
| | - Andreas Palm
- Respiratory, Allergy and Sleep Research, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Jan Hedner
- Center for Sleep and Wake Disorders, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Vidal C, Bertelli F, Mallet JP, Gilson R, Borel JC, Gagnadoux F, Bourdin A, Molinari N, Jaffuel D. Mask side-effects are related to gender in long-term CPAP: results from the InterfaceVent real-life study. Respir Res 2024; 25:331. [PMID: 39243031 PMCID: PMC11380403 DOI: 10.1186/s12931-024-02965-1] [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: 07/04/2024] [Accepted: 08/31/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Over the past three decades, our understanding of sleep apnea in women has advanced, revealing disparities in pathophysiology, diagnosis, and treatment compared to men. However, no real-life study to date has explored the relationship between mask-related side effects (MRSEs) and gender in the context of long-term CPAP. METHODS The InterfaceVent-CPAP study is a prospective real-life cross-sectional study conducted in an apneic adult cohort undergoing at least 3 months of CPAP with unrestricted mask-access (34 different masks, no gender specific mask series). MRSE were assessed by the patient using visual analog scales (VAS). CPAP-non-adherence was defined as a mean CPAP-usage of less than 4 h per day. The primary objective of this ancillary study was to investigate the impact of gender on the prevalence of MRSEs reported by the patient. Secondary analyses assessed the impact of MRSEs on CPAP-usage and CPAP-non-adherence depending on the gender. RESULTS A total of 1484 patients treated for a median duration of 4.4 years (IQ25-75: 2.0-9.7) were included in the cohort, with women accounting for 27.8%. The prevalence of patient-reported mask injury, defined as a VAS score ≥ 5 (p = 0.021), was higher in women than in men (9.6% versus 5.3%). For nasal pillow masks, the median MRSE VAS score for dry mouth was higher in women (p = 0.039). For oronasal masks, the median MRSE VAS score for runny nose was higher in men (p = 0.039). Multivariable regression analyses revealed that, for both women and men, dry mouth was independently and negatively associated with CPAP-usage, and positively associated with CPAP-non-adherence. CONCLUSION In real-life patients treated with long-term CPAP, there are gender differences in patient reported MRSEs. In the context of personalized medicine, these results suggest that the design of future masks should consider these gender differences if masks specifically for women are developed. However, only dry mouth, a side effect not related to mask design, impacts CPAP-usage and non-adherence. TRIAL REGISTRATION INTERFACEVENT IS REGISTERED WITH CLINICALTRIALS.GOV (NCT03013283).FIRST REGISTRATION DATE IS 2016-12-23.
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Affiliation(s)
- Celia Vidal
- IDESP, INSERM, PreMEdical INRIA, CHU Montpellier, Montpellier University, Montpellier, France
- Groupe Adène, Montpellier, France
| | | | - Jean-Pierre Mallet
- Groupe Adène, Montpellier, France
- Department of Respiratory Diseases, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier University Hospital, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France
- PhyMedExp (INSERM U 1046, CNRS UMR9214), Montpellier University, Montpellier, France
| | | | | | - Frédéric Gagnadoux
- Departement of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
| | - Arnaud Bourdin
- Groupe Adène, Montpellier, France
- Department of Respiratory Diseases, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier University Hospital, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France
- PhyMedExp (INSERM U 1046, CNRS UMR9214), Montpellier University, Montpellier, France
| | - Nicolas Molinari
- IDESP, INSERM, PreMEdical INRIA, CHU Montpellier, Montpellier University, Montpellier, France
- Groupe Adène, Montpellier, France
| | - Dany Jaffuel
- Groupe Adène, Montpellier, France.
- Department of Respiratory Diseases, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier University Hospital, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France.
- PhyMedExp (INSERM U 1046, CNRS UMR9214), Montpellier University, Montpellier, France.
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Howard JJM, Capasso R, Ishman SL. Health Inequalities in the Diagnosis and Treatment of Obstructive Sleep Apnea in Children and Adults. Otolaryngol Clin North Am 2024; 57:353-362. [PMID: 38485537 DOI: 10.1016/j.otc.2024.02.004] [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] [Indexed: 04/30/2024]
Abstract
Our understanding of the prevalence of obstructive sleep apnea (OSA) in the United States is confounded by significant inequalities in diagnosis and treatment based on gender, race and socioeconomic status. Health literacy and cultural norms contribute to these inequities. Large gaps in data exist, as certain populations like Native Americans, Pacific Islanders, and sexual minorities have been sparsely studied, or not at all. Future research should aim to develop more inclusive diagnostic strategies to address OSA in diverse populations.
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Affiliation(s)
- Javier J M Howard
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Robson Capasso
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
| | - Stacey L Ishman
- Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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He J, Chen M, Huang N, Wang B. Fibromyalgia in obstructive sleep apnea-hypopnea syndrome: a systematic review and meta-analysis. Front Physiol 2024; 15:1394865. [PMID: 38831795 PMCID: PMC11144865 DOI: 10.3389/fphys.2024.1394865] [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: 03/02/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction: Fibromyalgia (FM) is a common condition in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). This meta-analysis aimed to evaluate differences in sleep monitoring indicators between patients with OSAHS and positive FM and patients with OSAHS and negative FM and to determine the incidence of FM in patients with OSAHS. Methods: An exhaustive literature review was conducted to analyze the incidence of FM in patients with OSAHS, using online databases, including PubMed, EMBASE, Web of Science, CNKI, and Wanfang, both in English and Chinese. The quality of the included studies was assessed by two researchers using the Newcastle-Ottawa Scale scores. The acquired data were analyzed using Stata 11.0 software. Continuous variables were combined and analyzed using the weighted mean difference as the effect size. Conjoint analyses were performed using random-effects (I2 > 50%) or fixed-effect (I2 ≤ 50%) models based on I2 values. Results: Fourteen studies met the inclusion criteria. This study showed that 21% of patients with OSAHS experienced FM. Subgroup analyses were performed based on race, age, sex, body mass index, and diagnostic criteria for patients with OSAHS. These findings indicate that obese patients with OSAHS have a higher risk of FM, similar to females with OSAHS. Regarding most sleep monitoring indicators, there were no discernible differences between patients with OSAHS with positive FM and those with negative FM. However, patients with positive FM had marginally lower minimum arterial oxygen saturation levels than those with negative FM. The current literature suggests that patients with OSAHS have a high incidence of FM (21%), and FM has little effect on polysomnographic indicators of OSAHS. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024510786, identifier CRD42024510786.
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Affiliation(s)
- Jie He
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Meifeng Chen
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Na Huang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Bo Wang
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
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Richard M, Jaffuel D, Mallet JP, Gilson R, Patout M, Fresnel E, Lebret M. General nomenclature of air leak patterns: A proposal. Sleep Med 2023; 112:188-190. [PMID: 37897963 DOI: 10.1016/j.sleep.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023]
Abstract
Leakage is a common issue with PAP therapy and may contribute to short-term non-compliance with treatment. PAP manufacturers use different methods to estimate and report air leaks (median, mean, p90, p95, % of important air leak, time spent on major leaks), which makes the analysis and comparisons challenging. Leak intensity is a well-known parameter of major importance as it can significantly affect the performance of PAP devices. However, there is a lack of knowledge regarding another leakage parameter, namely the leakage pattern. As of now, there is no standard classification for leak patterns in real-life settings. Our objective was to develop and propose a comprehensive nomenclature for leakage patterns observed during nasal auto-PAP therapy. We examined 50 ventilatory polygraphy recordings conducted with auto-PAP, based on data from a prior study in which the unintentional leak flow was precisely measured over time. We have categorized leaks into two main types: continuous leaks, which appear and persist for an extended period, and discontinuous leaks, which vanish more rapidly. Continuous leaks can have both abrupt or gradual apparitions and terminations. Their "shape" can be either interrupted or constant. Discontinuous leaks can have both abrupt or gradual apparitions and terminations. Due to the relatively short observation scale (less than 5 min minutes), this type of leakage is not characterized by a specific shape between apparition and termination. This nomenclature could be a valuable tool that facilitates comparative bench tests or clinical studies. This tool could support manufacturers in developing precise algorithms for leak compensation, residual AHI estimation and the accuracy of CPAP monitoring data. Lastly, establishing a standardized approach for describing and categorizing air leakage patterns could assist clinicians in identifying device-related issues, such as patient discomfort arising from specific types of leakage.
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Affiliation(s)
- Mathéo Richard
- KerNel Biomedical, 18 Rue Marie Curie Bâtiment ANIDER, Rouen, France
| | - Dany Jaffuel
- Department of Respiratory Diseases, CHU Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS, UMR 9214, Montpellier, France
| | - Jean-Pierre Mallet
- Department of Respiratory Diseases, CHU Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS, UMR 9214, Montpellier, France
| | - Raphael Gilson
- Groupe ADENE, Rue de Chambert, Parc Euromédecine 2, Montpellier, France
| | - Maxime Patout
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, France
| | - Emeline Fresnel
- KerNel Biomedical, 18 Rue Marie Curie Bâtiment ANIDER, Rouen, France
| | - Marius Lebret
- KerNel Biomedical, 18 Rue Marie Curie Bâtiment ANIDER, Rouen, France; Erphan Paris-Saclay University, Versailles, France.
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Song Y, Choi SE, Papazyan A, Macey PM, Alessi CA, Fung CH, Josephson KR, Martin JL. Veterans' Experiences of Support in Managing Comorbid Sleep Apnea and Type 2 Diabetes. Nurs Res 2023; 72:495-501. [PMID: 37199499 PMCID: PMC10615660 DOI: 10.1097/nnr.0000000000000668] [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] [Indexed: 05/19/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is highly prevalent in patients with Type 2 diabetes, more so in veterans compared with nonveterans. Positive airway pressure is the recommended first-line treatment for OSA. However, adherence to both positive airway pressure and diabetes management regimens can be challenging for older adults. Support from family or friends may improve glucose control or sleep-apnea-related symptoms, yet the evidence is limited when both conditions coexist. OBJECTIVES This study aimed to describe veterans' experiences of support from family and friends with managing comorbid sleep apnea and Type 2 diabetes. METHODS We conducted a postal survey of older veterans with OSA and Type 2 diabetes from one healthcare system. Questions include demographic and health-related information, information about sleep apnea and diabetes treatment and education received, related support from family or a friend, perceived benefits of regular positive airway pressure device use on improving sleep health, and perceived benefits of education for family or a friend on sleep apnea and diabetes. Descriptive and bivariate analyses were performed. RESULTS Of 145 respondents (mean age = 72 years), 43% reported receiving help for Type 2 diabetes from family or a friend. Almost two thirds of the respondents were currently using a positive airway pressure device, of whom 27% received support with device use from family or friends. About one third of veterans perceived family and friends receiving education on treating sleep apnea and diabetes to be very or extremely helpful. Such perceived benefit was higher among those who were married or identified as non-White. Veterans using a positive airway pressure device had lower hemoglobin A1c levels than nonusers. DISCUSSION Veterans perceived that additional education for the individuals providing support would be beneficial. Future studies could address interventions to increase sleep apnea and Type 2 diabetes knowledge among families and friends of veterans with these comorbid conditions. In addition, patients' adherence to positive airway pressure may be enhanced by support from family and friends.
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Richards KC, Lozano AJ, Morris J, Moelter ST, Ji W, Vallabhaneni V, Wang Y, Chi L, Davis EM, Cheng C, Aguilar V, Khan S, Sankhavaram M, Hanlon AL, Wolk DA, Gooneratne N. Predictors of Adherence to Continuous Positive Airway Pressure in Older Adults With Apnea and Amnestic Mild Cognitive Impairment. J Gerontol A Biol Sci Med Sci 2023; 78:1861-1870. [PMID: 37021413 PMCID: PMC11007392 DOI: 10.1093/gerona/glad099] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Almost 60% of adults with amnestic mild cognitive impairment (aMCI) have obstructive sleep apnea (OSA). Treatment with continuous positive airway pressure (CPAP) may delay cognitive decline, but CPAP adherence is often suboptimal. In this study, we report predictors of CPAP adherence in older adults with aMCI who have increased odds of progressing to dementia, particularly due to Alzheimer's disease. METHODS The data are from Memories 2, "Changing the Trajectory of Mild Cognitive Impairment with CPAP Treatment of Obstructive Sleep Apnea." Participants had moderate to severe OSA, were CPAP naïve, and received a telehealth CPAP adherence intervention. Linear and logistic regression models examined predictors. RESULTS The 174 participants (mean age 67.08 years, 80 female, 38 Black persons) had a mean apnea-hypopnea index of 34.78, and 73.6% were adherent, defined as an average of ≥4 hours of CPAP use per night. Only 18 (47.4%) Black persons were CPAP adherent. In linear models, White race, moderate OSA, and participation in the tailored CPAP adherence intervention were significantly associated with higher CPAP use at 3 months. In logistic models, White persons had 9.94 times the odds of adhering to CPAP compared to Black persons. Age, sex, ethnicity, education, body mass index, nighttime sleep duration, daytime sleepiness, and cognitive status were not significant predictors. CONCLUSIONS Older patients with aMCI have high CPAP adherence, suggesting that age and cognitive impairment should not be a barrier to prescribing CPAP. Research is needed to improve adherence in Black patients, perhaps through culturally tailored interventions.
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Affiliation(s)
- Kathy C Richards
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Alicia J Lozano
- Department of Statistics, Center for Biostatistics and Health Data Science, Virginia Tech, Roanoke, Virginia, USA
| | - Jennifer Morris
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen T Moelter
- Department of Psychology, Saint Joseph’s University, Philadelphia, Pennsylvania, USA
| | - Wenyan Ji
- Department of Statistics, Center for Biostatistics and Health Data Science, Virginia Tech, Roanoke, Virginia, USA
| | | | - Yanyan Wang
- National Clinical Research Center for Geriatrics & Nursing Key Laboratory of Sichuan Province, West China Hospital & West China School of Medicine, Sichuan University, Chengdu, China
| | - Luqi Chi
- Department of Neurology, Washington University, St. Louis, Missouri, USA
- Department of Sleep Medicine, Washington University, St. Louis, Missouri, USA
| | - Eric M Davis
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Cindy Cheng
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Vanessa Aguilar
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Sneha Khan
- Department of Osteopathic Medicine, Arkansas State University, Jonesboro, Arkansas, USA
| | - Mira Sankhavaram
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Alexandra L Hanlon
- Department of Statistics, Center for Biostatistics and Health Data Science, Virginia Tech, Roanoke, Virginia, USA
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nalaka Gooneratne
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Cascais Costa C, Afreixo V, Cravo J. Impact of Obstructive Sleep Apnea Treatment on Marital Relationships: Sleeping Together Again? Cureus 2023; 15:e46513. [PMID: 37927636 PMCID: PMC10625457 DOI: 10.7759/cureus.46513] [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] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Objective We assess the impact of obstructive sleep apnea (OSA) treatment on the quality of marital relationships. Moreover, we evaluate the proportion of couples sleeping separately before treatment and whether there was any change after treatment began, which is still little explored in the literature. Methods A prospective study was conducted between April 2021 and April 2023, with users diagnosed with OSA in a level 2 hospital in Portugal. A questionnaire was applied before and after the start of treatment to both user and partner, which included questions on whether they slept together or separately, the disturbing factors of sleep quality, and satisfaction with the marital relationship. Statistical analysis was performed using R (version 4.2.2; R Development Core Team, Vienna, Austria). Results Seventy questionnaires were applied, 79% to male users. Forty-one percent of users reported that they slept at least once or twice a month separated from their spouse, and, of these, 41% always slept in separate rooms. The chief complaints of partners not sleeping together were snoring (86%), restless sleep (17%), and witnessed apnea (14%). After treatment, 72.4% started to sleep together again, with a statistically significant difference in the condition before and after intervention. Among all patients, 69% said that their personal lives had improved and, when asked the same question to their spouse, 74% recognized the benefit of therapy. Conclusion Starting treatment positively influenced the quality of the marital relationship of users and their partners, with a statistically significant proportion of couples sleeping together again.
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Affiliation(s)
| | - Vera Afreixo
- Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro, Aveiro, PRT
| | - João Cravo
- Department of Pulmonology, Centro Hospitalar do Baixo Vouga, Aveiro, PRT
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Prigent A, Blanloeil C, Serandour AL, Barlet F, Gagnadoux PF, Jaffuel D. A biphasic effect of age on CPAP adherence: a cross-sectional study of 26,343 patients. Respir Res 2023; 24:234. [PMID: 37759266 PMCID: PMC10537927 DOI: 10.1186/s12931-023-02543-x] [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: 04/12/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND As the prevalence of OSA increases in older patients, the proportion of elderly patients treated with CPAP is expected to become even higher. We studied CPAP-adherence in a real-life cohort involving a large population of elderly patients with OSA. METHODS eQUALISAS is a cross-sectional study of CPAP treated OSA patients for at least 4 months who received remote monitoring during 2021. CPAP adherence, device-reported residual AHI (AHICPAP) and 95th percentile non-intentional leaks were software collected during January 2021. Age and sex were also collected. RESULTS Data from 26,343 patients including 1656 patients aged [80-85] years and 639 patients aged ≥ 85 years were analysed. Median CPAP adherence increases from 6.3 h (< 50 years) to 7 h (75-80 years) and decreases after this age (p < 0.001). The decrease in CPAP adherence observed after the age of 80 was associated with an increase in the proportion of patients with a CPAP-adherence < 4 h/day (p < 0.001). Proportion of CPAP treated female, patients having AHICPAP mean ≥ 10 events per hour or 95th percentile non-intentional leaks mean over 24 l/min increase with aging of the population. However, for patients over 80 years old, Chi square test showed no association of adherence with gender, AHICPAP and leaks (p > 0.05). CONCLUSION This study demonstrates that adherence gradually increases with age until 80 years. The proportion of non-adherent patients grows with age after 80 years old. No significative relationship was found between adherence after 80 years old and gender, leaks and AHICPAP. TRIAL REGISTRATION The study is registered on Health Data Hub platform (No. F20220715144543).
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Affiliation(s)
- Arnaud Prigent
- Groupe Médical de Pneumologie, Polyclinique Saint-Laurent, 35000 Rennes, France
- Centre du Sommeil Polyclinique Saint Laurent, 35000 Rennes, France
| | | | | | | | - Pr Frédéric Gagnadoux
- Service de Pneumologie et Médecine du Sommeil, CHU d’Angers, Angers, France
- INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, Université d’Angers, Angers, France
| | - Dany Jaffuel
- Département de Pneumologie, Hôpital Arnaud de Villeneuve, CHRU de Montpellier, Montpellier, France
- Inserm U1046-CNRS 9214-Physiologie et Médecine Expérimentale Cœur et Muscle, Université de Montpellier, Montpellier, France
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11
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Locke BW, Sundar DJ, Ryujin D. Severity, comorbidities, and adherence to therapy in Native Hawaiians/Pacific Islanders with obstructive sleep apnea. J Clin Sleep Med 2023; 19:967-974. [PMID: 36727487 PMCID: PMC10152360 DOI: 10.5664/jcsm.10472] [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: 09/20/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Considerable disparities in the prevalence, diagnosis, and management of obstructive sleep apnea (OSA) exist for minority groups in the United States. However, the impact of OSA on Native Hawaiian/Pacific Islanders (NHPIs) has not been evaluated. METHODS We performed a retrospective review of patient records of NHPIs who underwent sleep apnea testing between 2014 and 2021 at a single center in Utah to characterize the distribution of comorbidities, disease severity, and treatment adherence. RESULTS 140 of 141 NHPI patients who underwent sleep testing had OSA. High rates of obesity (94%) and other relevant comorbidities were found. OSA was mostly severe (57%), particularly in males with higher obesity. Adherence to continuous positive airway pressure was low (41% using for 4 or more hours on 70% of nights), and medical factors predicted whether adherence targets were met with modest accuracy (area under the curve 0.699). CONCLUSIONS NHPIs at a single sleep center had a high prevalence of comorbidities in association with OSA, a skewed distribution toward severe disease suggestive of barriers to care or unique disease characteristics, and low adherence to continuous positive airway pressure. These findings suggest a high burden of OSA in this population, and further work to characterize barriers to identifying and treating OSA in NHPIs can improve chronic disease outcomes in NHPIs. CITATION Locke BW, Sundar DJ, Ryujin D. Severity, comorbidities, and adherence to therapy in Native Hawaiians/Pacific Islanders with obstructive sleep apnea. J Clin Sleep Med. 2023;19(5):967-974.
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Affiliation(s)
- Brian W. Locke
- University of Utah, Department of Internal Medicine, Division of Pulmonary and Critical Care, Salt Lake City, Utah
| | - Divya J. Sundar
- Division of Hematology, Department of Medicine, Salt Lake City, Utah
| | - Darin Ryujin
- University of Utah, Department of Family and Preventative Medicine, Salt Lake City, Utah
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12
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Sudarsan SS, Lohith Kumar MK, Bhumireddy Chalamaiahgari S, Kandaswamy S. Covid-19 and Obstructive Sleep Apnea: The Theatricals and Quality-of-Life Impact. Indian J Otolaryngol Head Neck Surg 2023:1-11. [PMID: 37362137 PMCID: PMC10115385 DOI: 10.1007/s12070-023-03730-4] [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: 12/10/2021] [Accepted: 03/21/2023] [Indexed: 06/28/2023] Open
Abstract
COVID-19 caused by SARS-CoV2 has reached pandemic proportions. The fear of Covid-19 has deterred many to abandon efforts for seeking timely medical help. In this setting, Obstructive sleep apnea (OSA)-like covid/non-covid cohorts have presented. Atypical pathologies can present like OSA and take the clinician unawares. With this series of misfits suffering silently, it would be unwise to underestimate its impact on quality-of-life (QOL). To determine the effect on quality-of-life by pathologies mimicking OSA and assess Covid-19 as a cause for delayed presentation. This was a prospective cross-sectional study. 127(N). Recent onset of symptoms of OSA. Study duration March 2020 to September 2021. Pittsburgh Sleep Quality Index (PSQI) screening done. Study criteria defined. Sleep parameters calculated. Primary surgical intervention given. Non-responders were put on CPAP therapy. QOL assessment done with sf-36 and SAQLI. Fear of Covid-19 scale (FCV-19S) quantified to study cause for temporal delay. Correlations computed. Level of Evidence-Level 3. 97 candidates completed study. Demographic and anthropometric details noted. Mean range was 43.85 ± 11.39 years. Male predominance. Overall AHI-19.73 ± 8.72. Moderate impact on QOL by sf-36/SAQLI. 78n Primary surgical candidates fared well. Polysomnography (PSG) and Continuous positive airway pressure (CPAP) titration/trial characteristics for 19n available. Statistically significant improvement in QOL after treatment completion. Correlations were meaningful. Body Mass Index (BMI) as a single factor was not influential on OSA-mimickers. Fear of Covid-19 significantly impacted emergency medical aid acquisition. OSA mimicking atypical airway pathologies may need emergent treatment not only from a surgical point-of-view but also from the QOL of the patient. On the contrary, these also unmask sub-clinical OSA, especially in patients with low/normal BMI. This category of recent onset OSA, if fortunately picked up at the earliest possible presentation, may hopefully not go through the significant QOL impact suffered by chronic OSA candidates.
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Affiliation(s)
- Shyam Sudhakar Sudarsan
- Department of ENT and Head and Neck Surgery, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
| | - Manoj Kumar Lohith Kumar
- Department of ENT and Head and Neck Surgery, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
| | - Surekha Bhumireddy Chalamaiahgari
- Department of ENT and Head and Neck Surgery, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
| | - Shoba Kandaswamy
- Department of ENT and Head and Neck Surgery, Saveetha Medical College and Hospital, No. 1, Saveetha Nagar, Thandalam, Chennai, Tamil Nadu 602105 India
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13
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Genzor S, Prasko J, Vanek J, Asswad AG, Nadjarpour S, Sova M. Adherence of obstructive sleep apnoea syndrome patients to positive airway pressure therapy - 10-year follow-up. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022; 166:441-446. [PMID: 34282803 DOI: 10.5507/bp.2021.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/15/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Continuous positive airway pressure (CPAP) is the most effective therapy for obstructive sleep apnoea syndrome (OSAS). Long-term adherence is necessary; however, it may be widely variable based on current literature, where the predicting factors are also not well defined. The aim of this study was to assess ten-year adherence to CPAP and to define factors influencing it. METHODS In total, 107 patients (91 males) were enrolled in this study, with an average age of 53.5 years (SD 10.1), with CPAP therapy being indicated (Apnoea-Hypopnoea Index - AHI > 15). Anthropometric and social status data have been obtained as well as the average use of CPAP through device memory. RESULTS Sufficient adherence (> 4 h per night) was found in 57% of patients in the first year with no subsequent significant change during the next 9 years. Adherence correlated significantly with the severity of OSAS - AHI (r = 0.321 over 5 years) and Epworth Sleepiness Scale (r = 0.317 over ten years) but did not correlate with the pressure used or the age of the patient. No statistically significant differences have been found between the sexes, the different mask groups, or the social status groups. CONCLUSION Good adherence to CPAP therapy in OSAS patients is essential. According to our results, patients with more severe OSAS or more severe sleepiness seem to have better adherence.
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Affiliation(s)
- Samuel Genzor
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jakub Vanek
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Amjad Ghazal Asswad
- Department of Respiratory Medicine West Middlesex University Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Shayan Nadjarpour
- Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Milan Sova
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
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14
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Gervès-Pinquié C, Bailly S, Goupil F, Pigeanne T, Launois S, Leclair-Visonneau L, Masson P, Bizieux-Thaminy A, Blanchard M, Sabil A, Jaffuel D, Racineux JL, Trzepizur W, Gagnadoux F. Positive Airway Pressure Adherence, Mortality, and Cardiovascular Events in Patients with Sleep Apnea. Am J Respir Crit Care Med 2022; 206:1393-1404. [PMID: 35816570 DOI: 10.1164/rccm.202202-0366oc] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Rationale: Randomized controlled trials showed no effect of positive airway pressure (PAP) therapy for obstructive sleep apnea (OSA) on cardiovascular (CV) risk. However, patient selection and low PAP adherence preclude the generalization of their data to clinical samples. Objectives: To evaluate the association between hours of PAP use, mortality, and CV morbidity in real-life conditions. Methods: Data from the Pays de la Loire Cohort were linked to health administrative data to identify incident major adverse cardiovascular events (MACEs; a composite outcome of mortality, stroke, and cardiac diseases) in patients with OSA who were prescribed PAP. Cox proportional hazards analyses were conducted to evaluate the association between MACEs and quartiles of average daily PAP use over the study period. Measurements and Main Results: After a median follow-up of 6.6 years, 961 of 5,138 patients experienced MACEs. Considering nonadherent patients (0-4 h/night) as the reference group, adjusted hazard ratios (95% confidence intervals) for MACEs were 0.87 (0.73-1.04) for the 4-6 h/night group, 0.75 (0.62-0.92) for the 6-7 h/night group, and 0.78 (0.65-0.93) for the ⩾7 h/night group (P = 0.0130). Sensitivity analyses using causal inference approaches confirmed the association of PAP use with MACEs. The association was stronger in male patients (P value for interaction = 0.0004), patients without overt CV disease at diagnosis (P < 0.0001), and those belonging to the excessively sleepy symptom subtype (P = 0.060). Conclusions: These real-life clinical data demonstrate a dose-response relationship between PAP adherence and incident MACEs in OSA. Patient support programs may help improve PAP adherence and CV outcomes in patients with OSA.
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Affiliation(s)
| | - Sebastien Bailly
- Hypoxia Physiopathology (HP2) Laboratory, Grenoble Alpes University, Grenoble, France
| | - François Goupil
- Department of Respiratory Diseases, Le Mans General Hospital, Le Mans, France
| | | | - Sandrine Launois
- Bioserenity Paris Jean-Jaurès, Hôpital Jean-Jaurès, Paris, France
| | | | - Philippe Masson
- Department of Respiratory Diseases, Cholet General Hospital, Cholet, France
| | - Acya Bizieux-Thaminy
- Department of Respiratory Diseases, La Roche sur Yon General Hospital, La Roche sur Yon, France
| | - Margaux Blanchard
- Ecole Supérieur D'Electronique de l'Ouest, Angers, France.,Laboratoire d'Acoustique de l'Université du Mans, Unité Mixte de Recherche, Centre National de la Recherche Scientifique 6613, Le Mans, France
| | - AbdelKebir Sabil
- Pays de la Loire Respiratory Health Research Institute, Beaucouzé, France.,Cloud Sleep Lab, Paris, France
| | - Dany Jaffuel
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | | | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France; and.,National Institute for Health and Medical Research (INSERM) Unit, Mitochondrial and Cardiovascular Physiopathology (MitoVasc), University of Angers, Angers, France
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France; and.,National Institute for Health and Medical Research (INSERM) Unit, Mitochondrial and Cardiovascular Physiopathology (MitoVasc), University of Angers, Angers, France
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15
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Genzor S, Prasko J, Mizera J, Jakubec P, Sova M, Vanek J, Šurinová N, Langova K. Risk of Severe COVID-19 in Non-Adherent OSA Patients. Patient Prefer Adherence 2022; 16:3069-3079. [PMID: 36387050 PMCID: PMC9657257 DOI: 10.2147/ppa.s387657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patients with obstructive sleep apnoea (OSA) are at increased risk of severe course of COVID-19. Vaccination remains to be the most effective prevention of complicated courses of infection. The best contemporary conservative treatment of OSA is continuous positive airway pressure (CPAP) therapy. Purpose To compare vaccination acceptance and outcomes of COVID-19 infection between OSA patients adhering to the CPAP therapy and those who rejected CPAP and surgical therapy. Patients and Methods Subjects were divided into two groups: group A (N = 167) were individuals with sufficient CPAP adherence (more than 4 hours per night on average) over the last 10 years. Group B (N = 106) were individuals who did not use the CPAP therapy at all and had no indications to surgical therapy. Results Three patients in group B died, and one had a severe course of COVID-19. None of the patients in group A died or experienced a severe course of COVID-19. Group A had a significantly higher proportion of males (77.8% compared to 66% in group B) and all parameters of OSA severity. The vaccination status was similar among both groups, with a complete triple dose vaccination rate of 69.5% and 67.9% in groups A and B, respectively. Conclusion The results show that the patients with OSA adherent to CPAP therapy were less likely to experience a severe course of COVID-19 or death than the OSA patients non-compliant with therapy, despite the former group having more severe OSA. This result underlines the importance of adherence to CPAP therapy in OSA.
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Affiliation(s)
- Samuel Genzor
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, OlomoucCzech Republic
| | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, OlomoucCzech Republic
- Institute for Postgraduate Education in Health Care, PragueCzech Republic
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, NitraThe Slovak Republic
| | - Jan Mizera
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, OlomoucCzech Republic
| | - Petr Jakubec
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, OlomoucCzech Republic
| | - Milan Sova
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, OlomoucCzech Republic
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Masaryk University Brno and University Hospital Brno, BrnoCzech Republic
| | - Jakub Vanek
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, OlomoucCzech Republic
| | | | - Katerina Langova
- Department of Biophysics, Palacky University Olomouc, OlomoucCzech Republic
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16
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Sabil A, Blanchard M, Annweiler C, Bailly S, Goupil F, Pigeanne T, Trzepizur W, Gervès-Pinquié C, Gagnadoux F. Overnight pulse rate variability and risk of major neurocognitive disorder in older patients with obstructive sleep apnea. J Am Geriatr Soc 2022; 70:3127-3137. [PMID: 35726128 DOI: 10.1111/jgs.17933] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Increasing evidence links obstructive sleep apnea (OSA) to cognitive decline. Autonomic dysfunction assessed by heart rate variability is a promising early biomarker of cognitive impairment in populations without major neurocognitive disorder (MND). We aimed to determine whether nocturnal pulse rate variability (PRV) extracted from oximetry signal and OSA severity could predict MND onset among older OSA patients. METHODS This study relied on data collected within the multicenter longitudinal Pays de la Loire Sleep Cohort, linked to health administrative data to identify new-onset MND. We included patients ≥60 years with newly diagnosed OSA, and no history of MND or atrial fibrillation. Cox proportional-hazards models were used to evaluate the association of MND with indices of PRV and OSA severity generated from sleep recordings. RESULTS After a median follow-up of 6.8 [4.7-9.4] years, 70 of 3283 patients (2.1%) had been diagnosed with MND. In multivariable Cox models, MND incidence was associated with age (p < 0.0001), depression (p = 0.013), and PRV assessed by the root mean square of the successive normal-to-normal (NN) beat interval differences (RMSSD; p = 0.008) and standard deviation of NN beat intervals (SDNN; p = 0.02). Patients with the highest quartile of RMSSD had a 2.3-fold [95%CI 1.11-4.92] higher risk of being diagnosed with MND. Indices of OSA and nocturnal hypoxia severity were not associated with MND. CONCLUSIONS Within a large clinic-based cohort of older patients with OSA, we found an association between oximetry-based indices of PRV and the onset of MND. Nocturnal oximetry-derived PRV indices could allow the early identification of OSA patients at higher risk of MND.
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Affiliation(s)
- AbdelKebir Sabil
- Institut de Recherche en Santé Respiratoires des Pays de la Loire (IRSR-PL), Beaucouzé, France.,Cloud Sleep Lab, Paris, France
| | | | - Cédric Annweiler
- Département de gériatrie et Centre mémoire ressources recherche, Centre de recherche sur l'autonomie et la longévité, Centre hospitalier universitaire, Angers, France.,UPRES EA 4638, Université d'Angers, Angers, France
| | - Sébastien Bailly
- Université Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
| | | | | | - Wojciech Trzepizur
- Université d'Angers, Département de Pneumologie et Médecine du Sommeil, Centre Hospitalier Universitaire d'Angers, Olonne sur Mer si, Angers, France
| | - Chloé Gervès-Pinquié
- Institut de Recherche en Santé Respiratoires des Pays de la Loire (IRSR-PL), Beaucouzé, France
| | - Frédéric Gagnadoux
- Université d'Angers, Département de Pneumologie et Médecine du Sommeil, Centre Hospitalier Universitaire d'Angers, Olonne sur Mer si, Angers, France
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Yu H, Gao Y, Tong T, Liang C, Zhang H, Yan X, Wang L, Zhang H, Dai H, Tong H. Self-management behavior, associated factors and its relationship with social support and health literacy in patients with obstructive sleep apnea–hypopnea syndrome. BMC Pulm Med 2022; 22:352. [PMID: 36115966 PMCID: PMC9482733 DOI: 10.1186/s12890-022-02153-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background The proportion of patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) is increasing year by year in China, which has become a major public health problem. Self-management of OSAHS and multiple support from caregivers are key to low hospital admissions and high quality of life for patients with OSAHS. Social support and health literacy are the main promoters of self-management behavior. However, their contributions have not been adequately studied. The purpose of this study is to investigate the level of self-management among patients with OSAHS and its relationship with general demographics, social support, and health literacy. Methods A total of 280 patients with OSAHS treated in two Classiii Grade A hospitals in Jinzhou City, Liaoning Province from October 2020 to July 2021 were selected as the study subjects. Patients were investigated by General Characteristics Questionnaire, Social Support Rating Scale (SSRS), Health Literacy Scale for Chronic Patients (HLSCP), and OSAHS Self-management Behavior Questionnaire, and the influencing factors of self-management of patients with OSAHS were analyzed. Results The average score of OSAHS self-management was 74.49(SD = 8.06), SSRS and HLSCP scores were positively correlated with total scores of self-management behavior. Furthermore, we found that disease duration, SSRS, and HLSCP scores were the main predictors of self-management behavior (R2 = 0.390, P < 0.001). Conclusion This study found that OSAHS patients with a longer duration of disease and higher SSRS or HLSCP scores also had higher levels of self-management. The factors discussed in this study may be helpful in developing individualized interventions in self-management for patients with OSAHS.
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18
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Goosmann M, Williams AM, Springer K, Yaremchuk KL. The Impact of Marital Status and Race in Obstructive Sleep Apnea. EAR, NOSE & THROAT JOURNAL 2022:1455613221120068. [PMID: 35968832 DOI: 10.1177/01455613221120068] [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: 12/22/2023] Open
Abstract
OBJECTIVES To examine the difference in survival of obstructive sleep apnea (OSA) based on marital status and race. METHODS A single academic institution with data collection from 2005 to 2015. Patients with a diagnosis of OSA based on polysomnogram were abstracted from electronic medical records. Patients were classified as "married" or "unmarried." Race was self-reported as White, Black, Asian American, Hispanic/Latinx, Middle Eastern descent, or unrecorded and gathered from the electronic medical record. RESULTS There were 6200 adults included. Of these, married patients composed 62.7% (n = 3890) of the patients. Patients were 51.3% White (n = 3182), 39.8% (n = 2467) were Black, and 8.9% (n = 551) were other/unrecorded. Married patients had better survival probabilities (p < .0001). Unmarried patients had 2.72 times the risk of death than those who were married (95% CI 1.78-4.20) when examining OSA survival. When examining survival of those on continuous positive airway pressure (CPAP) between married and unmarried patients, those who were unmarried had 2.00 (95% CI 1.58-2.54) times the risk of death than those who were married. Married Black patients demonstrated the best survival probabilities, followed by married White patients (p < .0001). Married patients had lower mean sleep efficiency than those that were unmarried (76.2% and 77.2%, respectively; p = .019). CONCLUSION Married patients with OSA had increased survival compared to their single counterparts. Married Black patients had the highest survival.
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Affiliation(s)
- Madeline Goosmann
- Department of Otolaryngology - Head & Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Amy M Williams
- Department of Otolaryngology - Head & Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Kylie Springer
- Department of Otolaryngology - Head & Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Kathleen L Yaremchuk
- Department of Otolaryngology - Head & Neck Surgery, Henry Ford Health System, Detroit, MI, USA
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19
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Justeau G, Gervès-Pinquié C, Jouvenot M, Pigeanne T, Launois S, Leclair-Visonneau L, Masson P, Bizieux-Thaminy A, Bailly S, Meslier N, Sabil A, Racineux JL, Trzepizur W, Gagnadoux F. Cancer risk in adherent users of polyurethane foam-containing CPAP devices for sleep apnoea. Eur Respir J 2022; 60:13993003.00551-2022. [PMID: 35595314 PMCID: PMC9280448 DOI: 10.1183/13993003.00551-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/24/2022] [Indexed: 12/05/2022]
Abstract
On 14 June, 2021 Philipps Respironics (PR) emitted a voluntary recall notification for several sleep and respiratory care products, including continuous positive airway pressure (CPAP) devices used for obstructive sleep apnoea (OSA) therapy and ventilators. The polyester-based polyurethane (PE-PUR) sound abatement foam may break down into particles, which may enter the device's air tube and be inhaled or swallowed by the user. The volatile gas products (diethylene glycol, toluene di-isocyanate isomers, toluene diamine isomers) released during the degradation process have been suspected to present potential toxic and carcinogenic effects [1]. Whether prolonged exposure to these volatile compounds is associated with an increased risk of cancer in patients using PR devices for OSA is a crucial issue. Using clinical data from a retrospective longitudinal multicentre cohort linked with health administrative data, Kendzerskaet al. [2] reported no increased all-cancer risk in 1220 patients treated for OSA with a PR device over a median follow-up time of 7.5 years. However, the lack of therapy adherence data did not make it possible to evaluate cancer risk in CPAP-adherent patients. Using propensity score matching within a nationwide study of patients with OSA, Palmet al. [3] reported an increased all-cancer and lung cancer incidence in counties prescribing ≥80% of CPAP devices containing polyurethane foam (PUF-CPAP) compared to patients from counties prescribing <10% of PUF-CPAP. However, the association disappeared in the sensitivity analysis excluding a Swedish county with known higher smoking rates. Sustained and adherent CPAP therapy of obstructive sleep apnoea using Philips Respironics devices containing polyester-based polyurethane foam, was not associated with an increased risk of cancer after a median follow-up time of 7.2 yearshttps://bit.ly/3vBpUQE
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Affiliation(s)
- Grégoire Justeau
- Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France.,INSERM U955, Créteil, France.,Grégoire Justeau and Chloé Gervès-Pinquié contributed equally to this publication
| | - Chloé Gervès-Pinquié
- Institut de Recherche en Santé Respiratoire des Pays de le Loire (IRSR-PL), Beaucouzé, France.,Grégoire Justeau and Chloé Gervès-Pinquié contributed equally to this publication
| | - Marie Jouvenot
- Department of Respiratory Diseases, Le Mans General Hospital, Le Mans, France
| | - Thierry Pigeanne
- Respiratory Unit, Pôle santé des Olonnes, Olonne sur Mer, France
| | | | | | - Philippe Masson
- Department of Respiratory Diseases, Cholet General Hospital, Cholet, France
| | - Acya Bizieux-Thaminy
- Department of Respiratory Diseases, La Roche sur Yon General Hospital, La Roche sur Yon, France
| | - Sébastien Bailly
- University Grenoble Alpes, INSERM, CHU Grenoble Alpes, HP2, Grenoble, France
| | - Nicole Meslier
- Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France
| | - Abdelkebir Sabil
- Institut de Recherche en Santé Respiratoire des Pays de le Loire (IRSR-PL), Beaucouzé, France.,Cloud Sleep Lab, Paris, France
| | - Jean-Louis Racineux
- Institut de Recherche en Santé Respiratoire des Pays de le Loire (IRSR-PL), Beaucouzé, France
| | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France.,INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, France
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France .,INSERM, CNRS, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, France
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20
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Rosa D, Amigoni C, Rimoldi E, Ripa P, Ligorio A, Fracchiolla M, Lombardi C, Parati G, Perger E. Obstructive Sleep Apnea and Adherence to Continuous Positive Airway Pressure (CPAP) Treatment: Let's Talk about Partners! Healthcare (Basel) 2022; 10:943. [PMID: 35628081 PMCID: PMC9141202 DOI: 10.3390/healthcare10050943] [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: 04/12/2022] [Revised: 05/07/2022] [Accepted: 05/17/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA). The benefits of this therapy were studied and analyzed over time; patient adherence is often poor, as many factors negatively influence it. A topic that needs clarification is whether adherence to CPAP treatment in a patient with OSA is influenced by the behavior of a partner or spouse. METHODS A scoping review was conducted to evaluate the role of partner involvement in the CPAP treatment management in a patient with OSA. The research project was performed between August and September 2021 by consulting the main biomedical databases: CINHAL, Embase, PsycINFO, and PubMed. RESULTS Among 21 articles considered valid for our aim, 15 are qualitative studies, 5 are quantitative and 1 presents a mixed method. We identified several thematic areas and "key" elements, which are prevalent in the studies evaluated. CONCLUSIONS The presence of a partner promotes adherence to CPAP therapy in patients with OSA, resulting in ameliorating their overall quality of life. To increase CPAP adherence, a trained nurse could represent a reference figure to technically and emotionally support couples during the adaptation period and in the long term.
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Affiliation(s)
- Debora Rosa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, 20149 Milan, Italy
| | - Carla Amigoni
- Istituto Auxologico Italiano, IRCCS, SITR Lombardia, 20149 Milan, Italy;
| | - Elisa Rimoldi
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy; (E.R.); (P.R.); (A.L.)
| | - Paola Ripa
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy; (E.R.); (P.R.); (A.L.)
| | - Antonella Ligorio
- Ospedale San Giuseppe Gruppo Multimedica, Nursing Degree Course, University of Milan, 20122 Milan, Italy; (E.R.); (P.R.); (A.L.)
| | - Miriam Fracchiolla
- Multimedica, IRCCS, Emergency Department, 20099 Sesto San Giovanni, Italy;
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, 20149 Milan, Italy; (C.L.); (G.P.); (E.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, 20149 Milan, Italy; (C.L.); (G.P.); (E.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, 20149 Milan, Italy; (C.L.); (G.P.); (E.P.)
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
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21
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Pascoe M, Bena J, Andrews ND, Auckley D, Benca R, Billings ME, Kapur VK, Iber C, Zee PC, Redline S, Rosen CL, Foldvary-Schaefer N. Dose response relationship between positive airway pressure therapy and excessive daytime sleepiness: the HomePAP study. J Clin Sleep Med 2021; 18:1027-1034. [PMID: 34870587 DOI: 10.5664/jcsm.9792] [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 Clinical benefits of PAP therapy for OSA are assumed to require adherent PAP usage, as defined by CMS as ≥ 4 hours of use ≥ 70% of nights. However, this is based on early data and does not necessarily capture improvements at subthreshold adherence. We explored dose-response relationships between PAP adherence measures and EDS from the HomePAP RCT. METHODS Participants ≥18 years with apnea hypopnea index ≥ 15 and baseline sleepiness (Epworth Sleepiness Scale (ESS) ≥ 12) received PAP therapy. Data were collected at baseline, 1-month, and 3-months follow-up. Regression models and receiver operating characteristic curves evaluated PAP measures as predictors of ESS change and normalization (ESS < 10). RESULTS In 119 participants (age 49.4 ± 12.6 years, 66.4% male, 72.3% white), > 50% were PAP non-adherent per CMS criteria at 3 months. Percent of nights with PAP use ≥ 4 hours predicted ESS change (p = 0.023), but not when controlling for AHI. Percent of nights with ≥ 4 hours and average PAP use provided the best discrimination for predicting ESS normalization; each 10% increase in PAP use ≥ 4 hours increased the odds of ESS normalization by 22% (p = 0.007); those using PAP ≥ 4 hours had nearly 3-fold greater odds of ESS normalization (p = 0.025). At least 4 hours and 70% of nights provided the best balance between specificity (0.50) and sensitivity (0.73). CONCLUSIONS Although sub-adherent PAP usage may still confer some benefit for OSA patients, adherence to current criteria confers the highest likelihood for ESS change and normalization. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Portable Monitoring for Diagnosis and Management of Sleep Apnea (HomePAP); Identifier: NCT00642486; URL: http://clinicaltrials.gov/show/NCT00642486.
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Affiliation(s)
- Maeve Pascoe
- Cleveland Clinic Sleep Disorders Center, Cleveland, OH
| | - James Bena
- Cleveland Clinic Sleep Disorders Center, Cleveland, OH
| | | | - Dennis Auckley
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland OH
| | - Ruth Benca
- University of California Irvine, Irvine, CA
| | | | - Vishesh K Kapur
- Harborview Medical Center, University of Washington, Seattle, WA
| | | | - Phyllis C Zee
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Susan Redline
- Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Carol L Rosen
- Case Western Reserve University School of Medicine, Cleveland, OH
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22
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Daabek N, Tamisier R, Foote A, Revil H, Joyeux-Jaure M, Pépin JL, Bailly S, Borel JC. Impact of Healthcare Non-Take-Up on Adherence to Long-Term Positive Airway Pressure Therapy. Front Public Health 2021; 9:713313. [PMID: 34485235 PMCID: PMC8416102 DOI: 10.3389/fpubh.2021.713313] [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: 05/22/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022] Open
Abstract
Background: The effectiveness of positive airway pressure therapies (PAP) is contingent on treatment adherence. We hypothesized that forgoing healthcare may be a determinant of adherence to PAP therapy. Research Question: The objectives were: (i) to assess the impact of forgoing healthcare on adherence to PAP in patients with Chronic Respiratory Failure (CRF) and patients with Obstructive Sleep Apnea Syndrome (OSAS); (ii) to compare forgoing healthcare patterns in these two chronic conditions. Study design and methods: Prospective cohort of patients with OSAS or CRF, treated with PAP therapies at home for at least 12 months. At inclusion, patients were asked to fill-in questionnaires investigating (i) healthcare forgone, (ii) deprivation (EPICES score), (iii) socio-professional and familial status. Characteristics at inclusion were extracted from medical records. PAP adherence was collected from the device's built-in time counters. Multivariable logistic regression models were used to assess the associations between healthcare forgone and the risk of being non-adherent to CPAP treatment. Results: Among 298 patients included (294 analyzed); 33.7% reported forgoing healthcare. Deprivation (EPICES score > 30) was independently associated with the risk of non-adherence (OR = 3.57, 95%CI [1.12; 11.37]). Forgoing healthcare had an additional effect on the risk of non-adherence among deprived patients (OR = 7.74, 95%CI [2.59; 23.12]). OSAS patients mainly forwent healthcare for financial reasons (49% vs. 12.5% in CRF group), whereas CRF patients forwent healthcare due to lack of mobility (25%, vs. 5.9 % in OSAS group). Interpretation: Forgoing healthcare contributes to the risk of PAP non-adherence particularly among deprived patients. Measures tailored to tackle forgoing healthcare may improve the overall quality of care in PAP therapies. Clinical Trial Registration: The study protocol was registered in ClinicalTrials.gov, identifier: NCT03591250.
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Affiliation(s)
- Najeh Daabek
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,AGIR à dom. Homecare Charity, Meylan, France
| | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Alison Foote
- Research Division, Grenoble Alpes University Hospital, Grenoble, France
| | - Hélèna Revil
- Social Sciences Research - PACTE Laboratory, CNRS UMR 5194, University Grenoble Alpes, Grenoble, France
| | - Marie Joyeux-Jaure
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,AGIR à dom. Homecare Charity, Meylan, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Sébastien Bailly
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Christian Borel
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France.,AGIR à dom. Homecare Charity, Meylan, France
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23
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Justeau G, Bailly S, Gervès-Pinquié C, Trzepizur W, Meslier N, Goupil F, Pigeanne T, Launois S, Leclair-Visonneau L, Masson P, Bizieux-Thaminy A, Racineux JL, Gozal D, Gagnadoux F. Cancer risk in patients with sleep apnoea following adherent 5-year CPAP therapy. Eur Respir J 2021; 59:13993003.01935-2021. [PMID: 34475228 DOI: 10.1183/13993003.01935-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/10/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Increasing evidence suggests that obstructive sleep apnoea (OSA) contributes to cancer risk; however, limited data are available on the impact of continuous positive airway pressure (CPAP) therapy on cancer incidence. We aimed to determine whether adherence to CPAP therapy is associated with a reduction in all-cancer incidence compared to non-adherent patients with OSA. METHODS The study relied on the data collected by the multicentre study Pays de la Loire Sleep Cohort, linked to health administrative data, such as to identify new-onset cancer. We included patients who were prescribed CPAP for OSA, with no history of cancer before the diagnostic sleep study or during the first year of CPAP. Patients with documented CPAP use for at least 4 h per night were defined as adherent. Those who discontinued or used CPAP less than 4 h at night constituted the non-adherent group. A propensity-score inverse probability of treatment weighting analysis was performed to assess the effect of CPAP adherence on cancer risk. RESULTS After a median [inter-quartile range] follow-up of 5.4 [3.1-8.0] years, 437 (9.7%) of 4,499 patients developed cancer, 194 (10.7%) in the non-adherent group (n=1817) and 243 (9.1%) in adherent patients (n=2682). The final weighted model showed no significant impact of CPAP adherence on all-cause cancer risk (sub distribution hazard ratio [95% confidence interval]): 0.94 [0.78; 1.14]). CONCLUSIONS Adherence to CPAP therapy in OSA patients was not associated with a reduction in all-cancer incidence. Whether adherent CPAP therapy of OSA might reduce the risk of specific cancer sites should be further evaluated.
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Affiliation(s)
- Grégoire Justeau
- Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France.,INSERM Unit 1063, Angers, France
| | - Sebastien Bailly
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
| | | | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France.,INSERM Unit 1063, Angers, France
| | - Nicole Meslier
- Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France.,INSERM Unit 1063, Angers, France
| | - François Goupil
- Department of Respiratory Diseases, Le Mans General Hospital, Le Mans, France
| | - Thierry Pigeanne
- Respiratory Unit, Pôle santé des Olonnes, Olonne sur Mer, France
| | | | | | - Philippe Masson
- Department of Respiratory Diseases, Cholet General Hospital, Cholet, France
| | - Acya Bizieux-Thaminy
- Department of Respiratory Diseases, La Roche sur Yon General Hospital, La Roche sur Yon, France
| | | | - David Gozal
- ays de la Loire Respiratory Health Research Institute, Beaucouzé, France
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France .,INSERM Unit 1063, Angers, France
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24
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Vecchierini MF, Attali V, Collet JM, d'Ortho MP, Goutorbe F, Kerbrat JB, Leger D, Lavergne F, Monaca C, Monteyrol PJ, Mullens E, Pigearias B, Martin F, Khemliche H, Lerousseau L, Meurice JC. Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow-up data. J Clin Sleep Med 2021; 17:1695-1705. [PMID: 34165074 DOI: 10.5664/jcsm.9308] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVES Mandibular advancement devices (MADs) are an alternative to continuous positive airway pressure for the management of obstructive sleep apnea (OSA). The ORthèse d'avanCée mAndibulaire dans le traitement en DEuxième intention du SAHOS sévère (ORCADES) study is investigating the long-term effectiveness of MAD therapy in patients with OSA who refused or were intolerant of continuous positive airway pressure. Five-year follow-up data are presented. METHODS Data were available in 172 of 331 patients treated with a custom-made computer-aided design/computer-aided manufacturing biblock MAD (Narval CC; ResMed, Saint-Priest, France). The primary end point was treatment success (≥50% decrease in apnea-hypopnea index from baseline). RESULTS Five-year treatment success rates were 52% overall and 25%, 52%, and 63%, respectively, in patients with mild, moderate, or severe OSA. This reflects a decline over time vs 3-6 months (79% overall) and 2 years (68%). Rates declined in all patient subgroups but to the greatest extent in patients with mild OSA. The slight worsening of respiratory parameters over time was not associated with any relevant changes in sleepiness and symptoms. Moderate or severe OSA at baseline, treatment success at 3-6 months, and no previous continuous positive airway pressure use were significant independent predictors of 5-year treatment success on multivariate analysis. No new safety signals emerged during long-term follow-up. The proportion of patients using their MAD for ≥4 h/night on ≥4 days/wk was 93.3%; 91.3% of patients reported device use of ≥6 h/night at 5 years. At 5-year follow-up, 96.5% of patients reported that they wanted to continue MAD therapy. CONCLUSIONS Long-term MAD therapy remained effective after 5 years in >50% of patients, with good levels of patient satisfaction and adherence. CITATION Vecchierini MF, Attali V, Collet JM, et al. Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow-up data. J Clin Sleep Med. 2021;17(8):1695-1705.
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Affiliation(s)
- Marie-Françoise Vecchierini
- AP-HP, Hôpital Hôtel Dieu, Centre du Sommeil et de la Vigilance, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Valérie Attali
- AP-HP Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France.,Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Jean-Marc Collet
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Stomatologie et Chirurgie Maxillo-Faciale, Paris, France
| | - Marie-Pia d'Ortho
- Physiologie Clinique- Explorations Fonctionnelles et Centre du Sommeil, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France.,Université de Paris, INSERM, UMR 1141 NeuroDiderot, Paris, France
| | - Frederic Goutorbe
- Centre Médecine du Sommeil, Centre Hospitalier de Béziers, Béziers, France
| | - Jean-Baptiste Kerbrat
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Stomatologie et Chirurgie Maxillo-Faciale, Paris, France.,Hôpital Charles Nicolle, Stomatologie et Chirurgie Maxillo-Faciale, Rouen, France
| | - Damien Leger
- AP-HP, Hôpital Hôtel Dieu, Centre du Sommeil et de la Vigilance, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | | | | | - Eric Mullens
- Fondation Bon Sauveur, Laboratoire du Sommeil, Albi, France
| | | | - Francis Martin
- AP-HP Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil (Département "R3S"), Paris, France
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25
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Baldini N, Gagnadoux F, Trzepizur W, Meslier N, Dugas J, Gerves-Pinquie C, Chouet-Girard F, Kün-Darbois JD. Long-term dentoskeletal side effects of mandibular advancement therapy in patients with obstructive sleep apnea: data from the Pays de la Loire sleep cohort. Clin Oral Investig 2021; 26:863-874. [PMID: 34263409 DOI: 10.1007/s00784-021-04064-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Mandibular advancement devices (MADs) are the main therapeutic alternative to continuous positive airway pressure for obstructive sleep apnea. Our aim was to evaluate the long-term dentoskeletal side effects of MADs and to identify the predictive factors for these side effects. MATERIALS AND METHODS Patients from the Pays de la Loire cohort treated with a custom-made MAD for at least 1 year were included in this retrospective study. Digital cephalometric analyses were performed at baseline and at follow-up. RESULTS We included a total of 117 patients, treated with a MAD for a median [interquartile range] of 4.6 [2.6-6.6] years. The main significant side effects were a decrease in overbite (- 0.5 ± 1 mm), overjet (- 0.7 ± 1 mm) and maxillary incisor inclination (- 2.5 ± 2.8°) and an increase in mandibular incisor inclination (+ 2.2 ± 2.7°). Subjective side effects were not linked to the observed dentoskeletal changes. Current smokers were at higher risk of overjet modifications. A pre-existing anterior open-bite was associated with a greater decrease in overbite. Treatment duration was associated with a more pronounced mandibular incisor proclination. Propulsion was negatively associated with maxillary incisor retroclination. CONCLUSIONS Long-term dentoskeletal side effects were mainly moderate dental side effects. Some predictive factors were shown to be associated with more pronounced changes. Subjective side effects did not appear to be reliable tools to detect dentoskeletal side effects. CLINICAL RELEVANCE Regular follow-up with clinical examination and regular radiographs is mandatory. The predictive factors could be of interest for a better selection of patients and to individualize follow-up.
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Affiliation(s)
- Nicolas Baldini
- Department of Oral and Maxillofacial Surgery, Angers University Hospital Center, 4 rue Larrey, 49933, Angers Cedex, France.
| | - Frédéric Gagnadoux
- Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France.,Department of Respiratory and Sleep Medicine, Angers University Hospital, 4 rue Larrey, 49933, Angers Cedex, France
| | - Wojciech Trzepizur
- Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France.,Department of Respiratory and Sleep Medicine, Angers University Hospital, 4 rue Larrey, 49933, Angers Cedex, France
| | - Nicole Meslier
- Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France.,Department of Respiratory and Sleep Medicine, Angers University Hospital, 4 rue Larrey, 49933, Angers Cedex, France
| | - Julien Dugas
- Research Institute of Respiratory Health, Pays de La Loire, 9 rue du Landreau, BP 77132, 49071, Beaucouze Cedex, France
| | - Chloé Gerves-Pinquie
- Research Institute of Respiratory Health, Pays de La Loire, 9 rue du Landreau, BP 77132, 49071, Beaucouze Cedex, France
| | - Frédérique Chouet-Girard
- Department of Maxillofacial Surgery, Le Mans Hospital, 194 avenue Rubillard, 72037, Le Mans Cedex, France
| | - Jean-Daniel Kün-Darbois
- Department of Oral and Maxillofacial Surgery, Angers University Hospital Center, 4 rue Larrey, 49933, Angers Cedex, France.,Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France
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26
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Dunietz GL, Yu Y, Levine RS, Conceicao AS, Burke JF, Chervin RD, Braley TJ. Obstructive sleep apnea in older adults: geographic disparities in PAP treatment and adherence. J Clin Sleep Med 2021; 17:421-427. [PMID: 33094720 DOI: 10.5664/jcsm.8914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is prevalent among older adults. Although treatment with positive airway pressure (PAP) lowers subsequent morbidity, PAP adherence is inconsistent. Socioeconomic disparities have been observed in OSA treatment, but regional differences in OSA care are unknown. This study examined geographic variations in PAP treatment and adherence among older Americans. METHODS This study utilized a representative 5% sample of all Medicare fee-for-service beneficiaries aged 65+ years. An OSA diagnosis, treatment, and PAP adherence were confirmed with International Classification of Diseases, Ninth Revision, HCPCS (Health Care Common Procedure Coding System) codes, and ≥2 HCPCS claims for PAP supplies respectively. Descriptive statistics were used to examine proportions of Medicare beneficiaries who obtained and adhered to PAP. Maps described the proportion of treated and adherent beneficiaries by state and hospital referral region. RESULTS For state-level data, PAP treatment and adherence proportions among beneficiaries with an OSA diagnosis ranged between 54-87% and 59-81%, respectively. Proportions of treated patients were higher in Midwest states (>80%), in comparison to Northwest, Northeast, and Southern states (<73%). Southern states and California had lowest proportions of PAP adherence (<70%). Within-state variability in treatment patterns were apparent along the East and West coasts. Correlations of PAP treatment and adherence proportions were low in Washington, DC, New York, and New Jersey. Discordant treatment and adherence proportions were observed in Alabama and Mississippi. CONCLUSIONS Significant state-level and regional disparities of PAP treatment and adherence among Medicare beneficiaries with OSA suggest gaps in delivery of OSA care for older Americans.
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Affiliation(s)
- Galit Levi Dunietz
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Yue Yu
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Rivkah S Levine
- Department of Statistics, University of Michigan, Ann Arbor, Michigan
| | - Alan S Conceicao
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - James F Burke
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Ronald D Chervin
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Tiffany J Braley
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
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27
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Hsu N, Zeidler MR, Ryden AM, Fung CH. Racial disparities in positive airway pressure therapy adherence among veterans with obstructive sleep apnea. J Clin Sleep Med 2021; 16:1249-1254. [PMID: 32267221 DOI: 10.5664/jcsm.8476] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
STUDY OBJECTIVES Black individuals are disproportionately affected by diabetes, cardiovascular disease, obesity, and OSA. Adherence to PAP therapy has been reported to be lower among black individuals. This study seeks to examine associations between black race and PAP adherence among veterans with OSA. METHODS This was a retrospective study. Veterans newly diagnosed with OSA at a single Department of Veterans Affairs sleep center who were prescribed a modem-enabled PAP device between January 2015 and November 2017 were enrolled. PAP adherence was defined as ≥ 4 hours nightly usage for at least 70% of nights measured at 30 days from PAP setup. We examined the relationship between race and adherence, controlling for sex, marital status, age, socioeconomic status, residual apnea-hypopnea index), and mask leak. RESULTS Of 3013 patients identified with OSA, 2571 (85%) were newly started on PAP therapy (95% male, aged 59 years ± 14 years, 45% married, 8% with neighborhood socioeconomic disadvantage). Twenty-five percent of participants were black, and 57% were white. PAP adherence at 30 days was 50% overall (42% among blacks, 53% among nonblacks). Black race was associated with reduced 30-day PAP adherence in unadjusted (P < .001) and adjusted logistic regression models (odds ratio = 0.64; 95% CI, 0.53 - 0.78; P < .001). CONCLUSIONS Among veterans with OSA, black race was associated with reduced PAP adherence. These findings suggest health inequality among black individuals in the treatment of OSA.
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Affiliation(s)
- Nancy Hsu
- Scripps Health, San Diego, California.,Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California.,University of California Los Angeles, Los Angeles, California
| | - Michelle R Zeidler
- Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California.,University of California Los Angeles, Los Angeles, California
| | - Armand M Ryden
- Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California.,University of California Los Angeles, Los Angeles, California
| | - Constance H Fung
- Veterans Affairs Greater Los Angeles Healthcare, Los Angeles, California.,University of California Los Angeles, Los Angeles, California
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Sabil A, Blanchard M, Trzepizur W, Goupil F, Meslier N, Paris A, Pigeanne T, Priou P, Le Vaillant M, Gagnadoux F. Positional obstructive sleep apnea within a large multicenter French cohort: prevalence, characteristics, and treatment outcomes. J Clin Sleep Med 2021; 16:2037-2046. [PMID: 32804071 DOI: 10.5664/jcsm.8752] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVES To assess, in a large cohort of patients with obstructive sleep apnea, the factors that are independently associated with positional obstructive sleep apnea (POSA) and exclusive POSA (e-POSA) and determine their prevalence. The secondary objective was to evaluate the outcome of positive airway pressure (PAP) therapy for patients with POSA and e-POSA. METHODS This retrospective study included 6,437 patients with typical mild-to-severe OSA from the Pays de la Loire sleep cohort. Patients with POSA and e-POSA were compared to those with non-POSA for clinical and polysomnographic characteristics. In a subgroup of patients (n = 3,000) included in a PAP follow-up analysis, we determined whether POSA and e-POSA phenotypes were associated with treatment outcomes at 6 months. RESULTS POSA and e-POSA had a prevalence of 53.5% and 20.1%, respectively, and were independently associated with time in supine position, male sex, younger age, lower apnea-hypopnea index and lower body mass index. After adjustment for confounding factors, patients with POSA and e-POSA had a significantly lower likelihood of treatment adherence (PAP daily use ≥ 4 h) at 6 months and were at higher risk of PAP treatment withdrawal compared to those with non-POSA. CONCLUSIONS The prevalence and independent predictors of POSA and e-POSA were determined in this large clinical population. Patients with POSA and e-POSA have lower PAP therapy adherence, and this choice of treatment may not be optimal. Thus, there is a need to offer these patients an alternative therapy.
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Affiliation(s)
| | | | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France.,INSERM Unit 1063, Angers, France
| | - François Goupil
- Department of Respiratory Diseases, Le Mans General Hospital, Le Mans, France
| | - Nicole Meslier
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France.,INSERM Unit 1063, Angers, France
| | - Audrey Paris
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France.,INSERM Unit 1063, Angers, France
| | - Thierry Pigeanne
- Respiratory Unit, Pôle santé des Olonnes, Olonne sur Mer, France
| | - Pascaline Priou
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France.,INSERM Unit 1063, Angers, France
| | - Marc Le Vaillant
- Pays de la Loire Respiratory Health Research Institute, Beaucouzé, France
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France.,INSERM Unit 1063, Angers, France
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Brown A, Jones S, Perez-Algorta G. Experiences of Using Positive Airway Pressure for Treatment of Obstructive Sleep Apnoea: A Systematic Review and Thematic Synthesis. Sleep 2021; 44:6286002. [PMID: 34043010 DOI: 10.1093/sleep/zsab135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 04/28/2021] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES Sub-optimal use of positive airway pressure (PAP) to treat obstructive sleep apnoea (OSA) continues to be a major challenge to effective treatment. Meanwhile, the individual and societal impacts of untreated OSA make effective treatment a priority. Although extensive research has been conducted into factors that impact PAP use, it is estimated that at least half of users do not use it as prescribed. However, the voice of users is notably minimal in the literature. A systematic review and qualitative metasynthesis of PAP user experience was conducted to contribute to understandings of how PAP is experienced and to inform how usage could be improved. METHODS PsycINFO, MEDLINE, CINAHL and EMBASE databases were systematically searched. Primary research findings of adult experiences using PAP that had been inductively analysed were included. Papers were critically appraised using the CASP qualitative checklist to generate a "hierarchy of evidence". Thematic synthesis was then conducted to generate analytical themes. Results were presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). RESULTS 25 papers reporting on over 398 people's experiences were analysed to generate 4 themes: Journey to PAP, Discomfort from and around PAP, Adapting to and using PAP, and Benefits from PAP. Author reflexivity and vulnerability to bias is acknowledged. CONCLUSIONS The findings highlight the applicability of a biopsychosocial understanding to PAP use. This metasynthesis gave voice to user experiences, revealing barriers to PAP use at a healthcare service level across the world, and suggests ways services can address these barriers.
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Pelletier-Fleury N, Le Vaillant M, Goupil F, Paris A, Pigeane T, Gagnadoux F, Meslier N. Risk-seeking attitude in health and safety domain is associated with continuous positive airway pressure discontinuation in patients with obstructive sleep apnea-a multicenter prospective cohort study. Sleep 2021; 44:5896478. [PMID: 32832982 DOI: 10.1093/sleep/zsaa156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/03/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Many studies have already looked at factors that may influence adherence to continuous positive airway pressure (CPAP) (severity of obstructive sleep apnea (OSA), patients' age, technical aspects, socioeconomic factors, living conditions, psychological factors). Although it has been shown that individuals' preference for risky behaviors in daily life can influence the use of care or adherence to drug therapies in care settings, this has never been tested in OSA. This study aims to analyze the association between risk attitude in the health/safety domain and CPAP discontinuation in a cohort of OSA patients. METHODS In a prospective multicenter cohort study nested within the IRSR sleep cohort, consecutive patients who were prescribed CPAP were monitored for at least 6 months. In addition to the data usually collected in the IRSR sleep cohort at baseline, patients also completed a risk-taking questionnaire using the Domain-Specific Risk-Taking (DOSPERT) scale. Cox's proportional hazards regression was used to model the risk of CPAP discontinuation as a function of a linear combination of variables hypothetically related to this risk including health risk attitude. RESULTS Of the 489 patients under CPAP, 12.1% (n = 59) were risk-seeking, 87.9% (n = 430) were risk-neutral, and none were risk-averse. Cox's model indicated that a risk-seeking attitude (p = 0.04) and an AHI <30 (p < 0.01) were significantly associated with CPAP discontinuation. CONCLUSIONS Patients with risk-seeking behaviors in daily life have been shown to be more likely to discontinue CPAP. The DOSPERT scale can be a useful tool for screening this specific group of patients in clinical practice.
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Affiliation(s)
- Nathalie Pelletier-Fleury
- Institut National de la Santé Et de la Recherche Médicale (INSERM UMR 1018), Université Paris-Saclay, Centre de Recherche en Epidémiologie et Santé des Populations, Hôpital Paul Brousse, 16 av Paul Vaillant Couturier, Villejuif, France
| | - Marc Le Vaillant
- Institut de Recherche en Santé Respiratoire des Pays de la Loire, Beaucouzé, France
| | - François Goupil
- Département de pneumologie, Centre Hospitalier, Le Mans, France
| | - Audrey Paris
- Département de pneumologie, Centre Hospitalier, Le Mans, France
| | | | - Frédéric Gagnadoux
- Département de pneumologie, Centre hospitalier universitaire, Angers, France
| | - Nicole Meslier
- Département de pneumologie, Centre hospitalier universitaire, Angers, France
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31
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Trzepizur W, Adrian B, Le Vaillant M, Meslier N, Kün-Darbois JD, Gagnadoux F. Predicting treatment response to mandibular advancement therapy using a titratable thermoplastic device. Clin Oral Investig 2021; 25:5553-5561. [PMID: 33650081 DOI: 10.1007/s00784-021-03865-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/25/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Mandibular advancement device (MAD) therapy is the most commonly used second-line treatment for obstructive sleep apnea (OSA), but MAD may be ineffective in a subgroup of patients. We describe the use of a trial of a titratable thermoplastic MAD to predict treatment outcomes with a custom-made MAD. MATERIALS AND METHODS Patients treated with a thermoplastic MAD as a trial before custom-made MAD manufacturing were included in the study. Sleep recordings and clinical outcomes assessed after 6 months of treatment with each device were compared. Predictive utility of thermoplastic MAD to identify custom-made MAD treatment success defined as a reduction greater than 50% and final apnea-hypopnea index (AHI) less than 10 events/h was evaluated. RESULTS Thermoplastic MADs were installed in 111 patients, but only 36 patients were finally treated with both devices and were included in the analysis. A significant correlation was observed between the impact of the two devices on the AHI (r=0.85, p<0.0001), oxygen desaturation index (r=0.73, p<0.0001), snoring index (r=0.85, p<0.0001), and Epworth sleepiness scale (r=0.77, p<0.0001). A high positive predictive value (86%) but a low negative predictive value (46%) was observed regarding AHI decrease. CONCLUSIONS Similar impacts of both MADs were observed on major OSA severity markers and symptoms. The ability of thermoplastic MAD to indicate likelihood of success with custom-made MAD will require further controlled studies. CLINICAL RELEVANCE Thermoplastic MADs could represent a useful and easily implemented tool to predict the likelihood of success of a custom-made MAD as treatment for OSA.
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Affiliation(s)
- Wojciech Trzepizur
- INSERM U1063, SOPAM, Angers University, F-49045, Angers, France. .,Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France. .,Département de Pneumologie, CHU, 4 rue Larrey, 49100, Angers, France.
| | - Benjamin Adrian
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France
| | - Marc Le Vaillant
- Institut de Recherche en Santé Respiratoire des Pays de la Loire, Beaucouzé, France
| | - Nicole Meslier
- INSERM U1063, SOPAM, Angers University, F-49045, Angers, France.,Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France
| | | | - Frédéric Gagnadoux
- INSERM U1063, SOPAM, Angers University, F-49045, Angers, France.,Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France
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Crew EC, Wohlgemuth WK, Sawyer AM, Williams NJ, Wallace DM. Socioeconomic Disparities in Positive Airway Pressure Adherence: An Integrative Review. Sleep Med Clin 2021; 16:23-41. [PMID: 33485530 DOI: 10.1016/j.jsmc.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nonadherence with positive airway pressure (PAP) therapy impedes the effectiveness of treatment and increases risk of mortality. Disparities in PAP adherence as a function of socioeconomic status (SES) are not well understood. A literature search identified 16 original publications meeting inclusion criteria that described effects of SES factors on objective PAP adherence; 69% of these articles found evidence of lower adherence as a function of SES. This integrative review provides a structured summary of the findings, highlights factors that may contribute to disparities among adult PAP users, and identifies future directions to improve equity in the management of OSA.
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Affiliation(s)
- Earl Charles Crew
- Behavioral Health Program, Mental Health Care Line, Michael E. DeBakey VA Medical Center, Building 108-A Room 224, 2002 Holcombe Boulevard, Houston, TX 77030, USA; Psychology Division, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - William K Wohlgemuth
- Psychology Service, Bruce W. Carter Medical Center, Miami VA Healthcare system, Sleep Disorders Center, Room A212, 1201 NW 16th ST, Miami, FL 33125, USA; Neurology Service, Bruce W. Carter Medical Center, Miami VA Healthcare system, Sleep Disorders Center, Room A212, 1201 NW 16th ST, Miami, FL 33125, USA
| | - Amy M Sawyer
- University of Pennsylvania, School of Nursing, Clair Fagin Hall, Room 349, 418 Curie Boulevard, Philadelphia, PA 19104, USA; Perelman School of Medicine Center for Sleep and Circadian Neurobiology, Philadelphia, PA, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Natasha J Williams
- Department of Population Health, Division of Health and Behavior, Center for Healthful Behavior Change, New York University Grossman School of Medicine, 180 Madison Avenue, 7th Floor, New York, NY 10016, USA
| | - Douglas M Wallace
- Neurology Service, Bruce W. Carter Medical Center, Miami VA Healthcare system, Sleep Disorders Center, Room A212, 1201 NW 16th ST, Miami, FL 33125, USA; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
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33
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Sabil A, Bignard R, Gervès-Pinquié C, Philip P, Le Vaillant M, Trzepizur W, Meslier N, Gagnadoux F. Risk Factors for Sleepiness at the Wheel and Sleep-Related Car Accidents Among Patients with Obstructive Sleep Apnea: Data from the French Pays de la Loire Sleep Cohort. Nat Sci Sleep 2021; 13:1737-1746. [PMID: 34675722 PMCID: PMC8502051 DOI: 10.2147/nss.s328774] [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: 07/10/2021] [Accepted: 09/24/2021] [Indexed: 01/28/2023] Open
Abstract
PURPOSE We aimed to determine the risk factors of sleepiness at the wheel among patients with obstructive sleep apnea (OSA) and to determine factors that were independently associated with reported sleep-related near-miss accidents or car accidents. PATIENTS AND METHODS This retrospective study was conducted on 843 OSA patients from the French Pays de la Loire sleep cohort database. Each patient completed surveys including anthropometric data, medical history, professional status, and data on alcohol and tobacco use. Epworth sleepiness scale (ESS) and sleep quality questionnaires were administered. Regarding driving, data were collected on occurrence of sleepiness-related near-misses or car accidents, and on distance driven per year. The primary dependent variable of interest was reported sleepiness at the wheel. RESULTS On multivariable regression analysis, reported sleepiness at the wheel (n=298) was independently associated with younger age (p=0.02), male gender (p=0.009), marked nocturnal hypoxemia (p=0.006), lower BMI (p=0.03), absence of cardiovascular disease (p=0.022), executives or high degree jobs (p=0.003) and reported difficulty-maintaining sleep (p=0.03). Only past experience of sleepiness at the wheel (OR 12.18, [6.38-23.25]) and an ESS ≥11 (OR 4.75 [2.73-8.27]) were independently associated with reported car accidents (n=30) or near-miss accidents (n=137). CONCLUSION In patients newly diagnosed with OSA, the risk of car accident seems multifactorial, and its evaluation should include multiple parameters such as patient self-reported sleepiness at the wheel, occurrence of sleepiness-related accidents, anthropometry, professional status, and insomnia complaints. Thus, it is possible to evaluate this risk and advise patients as early as the first visit at the sleep medicine clinic without waiting for the results of the sleep study.
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Affiliation(s)
| | - Remi Bignard
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
| | - Chloé Gervès-Pinquié
- Biostatistics Department, Pays de la Loire Respiratory Health Research Institute, Beaucouzé, France
| | - Pierre Philip
- Sleep, Attention and Neuropsychiatry Unit, University of Bordeaux, CNRS, SANPSY USR 3413, and CHU Pellegrin, Bordeaux, France
| | - Marc Le Vaillant
- Biostatistics Department, Pays de la Loire Respiratory Health Research Institute, Beaucouzé, France
| | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
| | - Nicole Meslier
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
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Abstract
Long-term effective therapy is essential for obstructive sleep apnea (OSA) control and preventing comorbidity. OSA patients are often reported to be more receptive to oral appliance therapy over positive airway pressure (PAP). Oral appliance usage can now be objectively recorded by temperature microsensors. Studies using commercially available microsensor chips have reported data out to 1 year, with high rates of adherence (>80%), albeit in small samples. There is opportunity to further use this technology to understand individual adherence factors and patterns and in obtaining objective measures of treatment effectiveness, particularly for longer-term health outcomes and allowing comparison to PAP.
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Espinel P, Marshall N, Yee BJ, Hollis J, Smith K, D'Rozario AL, Gauthier G, Lambert T, Grunstein RR. Sleep-disordered breathing in severe mental illness: clinical evaluation of oximetry diagnosis and management limitations. Sleep Breath 2020; 25:1433-1440. [PMID: 33245500 DOI: 10.1007/s11325-020-02259-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/08/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND To describe the diagnosis and management pathway of sleep-disordered breathing (SDB) in a sample of patients with severe mental illness (SMI), and to assess the feasibility and patient acceptability of overnight oximetry as a first-step screening method for detecting severe SDB in this population. METHODS The study was a retrospective audit of patients with SMI seen at a Collaborative Centre for Cardiometabolic Health in Psychosis service who were invited for overnight oximetry between November 2015 and May 2018. The adjusted oxygen desaturation index (ODI) was calculated using 4% desaturation criteria. Results were discussed with a sleep specialist and categorized into a 4-level risk probability tool for SDB. RESULTS Of 91 adults consenting for overnight oximetry, 90 collected some oximetry data, though 11 of these 90 patients collected technically unsatisfactory oximetry. Thus 79/90 patients (88%) collected adequate oximetry data for at least one night. The oximetry traces suggested likely minimal obstructive sleep apnea (OSA) in 41 cases, moderate to severe OSA in 25 patients, severe OSA in 9 patients and possible obesity hypoventilation syndrome (OHS) in 4 cases. Full polysomnography was recommended for 39 patients but only one-third underwent testing. Nineteen patients were reviewed by a sleep specialist. Of the 10 patients who initiated CPAP, four were considered adherent to treatment. CONCLUSION Home oximetry may be a pragmatic option for SDB screening in patients with SMI but reliable full diagnostic and management pathways need to be developed.
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Affiliation(s)
- P Espinel
- CIRUS, Centre for Sleep and Chronobiology - NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, Level 4, 431 Glebe Point Road, Glebe, NSW, 2018, Australia.,Collaborative Centre for Cardiometabolic Health in Psychosis - Sydney Local Health District, Ground Floor, Clinical Sciences Building, Hospital Road, Concord, NSW, 2139, Australia
| | - N Marshall
- CIRUS, Centre for Sleep and Chronobiology - NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, Level 4, 431 Glebe Point Road, Glebe, NSW, 2018, Australia.,Susan Wakil School of Nursing and Midwifery, The University of Sydney, 88 Mallett Street, Camperdown, NSW, 2050, Australia
| | - B J Yee
- CIRUS, Centre for Sleep and Chronobiology - NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, Level 4, 431 Glebe Point Road, Glebe, NSW, 2018, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Level 11, 50 Missenden Road, Camperdown, NSW, 2050, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - J Hollis
- Collaborative Centre for Cardiometabolic Health in Psychosis - Sydney Local Health District, Ground Floor, Clinical Sciences Building, Hospital Road, Concord, NSW, 2139, Australia
| | - K Smith
- Collaborative Centre for Cardiometabolic Health in Psychosis - Sydney Local Health District, Ground Floor, Clinical Sciences Building, Hospital Road, Concord, NSW, 2139, Australia.,Concord Clinical School, Medical Education Centre, Concord Repatriation General Hospital, Hospital Road, Concord, NSW, 2139, Australia
| | - A L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology - NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, Level 4, 431 Glebe Point Road, Glebe, NSW, 2018, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - G Gauthier
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Level 11, 50 Missenden Road, Camperdown, NSW, 2050, Australia
| | - T Lambert
- Collaborative Centre for Cardiometabolic Health in Psychosis - Sydney Local Health District, Ground Floor, Clinical Sciences Building, Hospital Road, Concord, NSW, 2139, Australia.,Concord Clinical School, Medical Education Centre, Concord Repatriation General Hospital, Hospital Road, Concord, NSW, 2139, Australia.,RPA-Charles Perkins Centre, Royal Prince Alfred Hospital, John Hopkins Drive, Camperdown, NSW, 2050, Australia
| | - R R Grunstein
- CIRUS, Centre for Sleep and Chronobiology - NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, Level 4, 431 Glebe Point Road, Glebe, NSW, 2018, Australia. .,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia. .,RPA-Charles Perkins Centre, Royal Prince Alfred Hospital, John Hopkins Drive, Camperdown, NSW, 2050, Australia.
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Sabil A, Le Vaillant M, Stitt C, Goupil F, Pigeanne T, Leclair-Visonneau L, Masson P, Bizieux-Thaminy A, Humeau MP, Meslier N, Gagnadoux F. A CPAP data-based algorithm for automatic early prediction of therapy adherence. Sleep Breath 2020; 25:957-962. [PMID: 32974833 DOI: 10.1007/s11325-020-02186-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Adherence is a critical issue in the treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP). Approximately 40% of patients treated with CPAP are at risk of discontinuation or insufficient use (< 4 h/night). Assuming that the first few days on CPAP are critical for continued treatment, we tested the predictive value at day 14 (D14) of the Philips Adherence Profiler™ (AP) algorithm for adherence at 3 months (D90). METHOD The AP™ algorithm uses CPAP machine data hosted in the database of EncoreAnywhere™. This retrospective study involved 457 patients (66% men, 60.0 ± 11.9 years; BMI = 31.2 ± 5.9 kg/m2; AHI = 37.8 ± 19.2; Epworth score = 10.0 ± 4.8) from the Pays de la Loire Sleep Cohort. At D90, 88% of the patients were adherent as defined by a mean daily CPAP use of ≥ 4 h. RESULTS In a univariate analysis, the factors significantly associated with CPAP adherence at D90 were older age, lower BMI, CPAP adherence (≥ 4 h/night) at D14, and AP™ prediction at D14. In a multivariate analysis, only older age (OR 2.10 [1.29-3.41], p = 0.003) and the AP™ prediction at D14 (OR 16.99 [7.26-39.75], p < 0.0001) were significant predictors. CPAP adherence at D90 was not associated with device-derived residual events, nor with the levels of pressure or leakage except in the case of very significant leakage when it persisted for 90 days. CONCLUSION Automatic telemonitoring algorithms are relevant tools for early prediction of CPAP therapy adherence and may make it possible to focus therapeutic follow-up efforts on patients who are at risk of non-adherence.
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Affiliation(s)
| | - Marc Le Vaillant
- Pays de le Loire Respiratory Health Research Institute (IRSR-PL), Angers, France
| | | | - François Goupil
- Department of Respiratory Diseases, Le Mans General Hospital, Le Mans, France
| | - Thierry Pigeanne
- Respiratory Unit, Pôle santé des Olonnes, Olonne-sur-Mer, France
| | | | - Philippe Masson
- Department of Respiratory Diseases, Cholet General Hospital, Cholet, France
| | - Acya Bizieux-Thaminy
- Department of Respiratory Diseases, La Roche sur Yon General Hospital, La Roche-sur-Yon, France
| | | | - Nicole Meslier
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, INSERM Unit 1063, University of Angers, Angers, France
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, INSERM Unit 1063, University of Angers, Angers, France
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Sabil A, Marien C, LeVaillant M, Baffet G, Meslier N, Gagnadoux F. Diagnosis of sleep apnea without sensors on the patient's face. J Clin Sleep Med 2020; 16:1161-1169. [PMID: 32267226 DOI: 10.5664/jcsm.8460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Thermistors, nasal cannulas, and respiratory inductance plethysmography (RIP) are the recommended reference sensors of the American Academy of Sleep Medicine (AASM) for the detection and characterization of apneas and hypopneas; however, these sensors are not well tolerated by patients and have poor scorability. We evaluated the performance of an alternative method using a combination of tracheal sounds (TSs) and RIP signals. METHODS Consecutive recordings of 70 adult patients from the Pays de la Loire Sleep Cohort were manually scored in random order using the AASM standard signals and the combination TS and RIP signals, without respiratory sensors placed on the patient's face. The TS-RIP scoring used the TS and RIP-flow signals for detection of apneas and hypopneas, respectively, and the suprasternal pressure and RIP belt signals for the characterization of apneas. RESULTS Sensitivity and specificity of the TS-RIP combination were 96.21% and 91.34% for apnea detection and 89.94% and 93.25% for detecting hypopneas, respectively, with a kappa coefficient of 0.87. For the characterization of apneas, sensitivity and specificity were 98.67% and 96.17% for obstructive apneas, 92.66% and 99.36% for mixed apneas, and 96.14% and 98.89% for central apneas, respectively, with a kappa coefficient of 0.94. The TS-RIP scoring revealed a high agreement for classifying obstructive sleep apnea into severity classes (none, mild, moderate, and severe obstructive sleep apnea) with a Cohen's kappa coefficient of 0.96. CONCLUSIONS Compared with the AASM reference sensors, the TS-RIP combination allows reliable noninvasive detection and characterization of respiratory events with a high degree of sensitivity and specificity. TS-RIP combination could be used for diagnosis of obstructive sleep apnea in adults, either as an alternative to the AASM sensors or in combination with the recommended AASM sensors.
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Affiliation(s)
| | - Caroline Marien
- Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France
| | - Marc LeVaillant
- Institut de Recherche en Santé Respiratoire des Pays de la Loire, Beaucouzé, France
| | | | - Nicole Meslier
- Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France.,Inserm UMR 1063, Université d'Angers, Angers, France; *Contributed equally
| | - Frédéric Gagnadoux
- Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France.,Inserm UMR 1063, Université d'Angers, Angers, France; *Contributed equally
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Justeau G, Gervès-Pinquié C, Le Vaillant M, Trzepizur W, Meslier N, Goupil F, Pigeanne T, Launois S, Leclair-Visonneau L, Masson P, Bizieux-Thaminy A, Humeau MP, Gosselin C, Blanchard M, Urban T, Gagnadoux F. Association Between Nocturnal Hypoxemia and Cancer Incidence in Patients Investigated for OSA: Data From a Large Multicenter French Cohort. Chest 2020; 158:2610-2620. [PMID: 32629036 DOI: 10.1016/j.chest.2020.06.055] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous studies have yielded inconsistent findings regarding the association between OSA and cancer in humans. RESEARCH QUESTION Is there an association between indexes of sleep-disordered breathing severity and cancer incidence in patients investigated for suspected OSA? STUDY DESIGN AND METHODS Data from a large multicenter cohort of cancer-free patients investigated for OSA were linked to health administrative data to identify new-onset cancer. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate the association of cancer incidence with OSA severity and nocturnal hypoxemia. RESULTS After a median follow-up period of 5.8 years (interquartile range, 3.8-7.8), 718 of 8,748 patients (8.2%) had received a diagnosis of cancer. On unadjusted Kaplan-Meier survival analyses, cancer incidence was associated with increasing severity of OSA (log-rank test, P < .0005) and nocturnal hypoxemia (log-rank test, P < .0001 for both oxygen desaturation index and percent night time with oxygen saturation < 90% [T90]). After adjustment for anthropomorphic data, smoking and alcohol consumption, comorbid cardiac, metabolic, and respiratory diseases, marital status, type of sleep study, and study site, only T90 was associated with cancer incidence (adjusted hazard ratio, 1.33; 95% CI, 1.05-1.68 for T90 ≥ 13% vs < 0.01%; P = .02). On stratified analyses, the association between T90 and cancer appeared stronger in older patients with obesity and no adequate OSA therapy. Among the most frequent cancer sites, nocturnal hypoxemia was associated with lung and breast malignancies. INTERPRETATION Nocturnal hypoxemia was associated with all-cancer incidence in patients investigated for OSA. Whether OSA therapy might reduce the risk of cancer needs further evaluation.
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Affiliation(s)
- Grégoire Justeau
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers
| | | | - Marc Le Vaillant
- Pays de la Loire Respiratory Health Research Institute, Beaucouzé
| | - Wojciech Trzepizur
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers; INSERM Unit 1063, Angers
| | - Nicole Meslier
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers; INSERM Unit 1063, Angers
| | - François Goupil
- Department of Respiratory Diseases, Le Mans General Hospital, Le Mans
| | | | | | | | - Philippe Masson
- Department of Respiratory Diseases, Cholet General Hospital, Cholet
| | - Acya Bizieux-Thaminy
- Department of Respiratory Diseases, La Roche sur Yon General Hospital, La Roche sur Yon
| | | | | | | | - Thierry Urban
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers; INSERM Unit 1063, Angers.
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Seo MY, Lee SH. Compliance with Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea. SLEEP MEDICINE RESEARCH 2020. [DOI: 10.17241/smr.2020.00563] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Lebret M, Jaffuel D, Suehs CM, Mallet JP, Lambert L, Rotty MC, Pépin JL, Matzner-Lober E, Molinari N, Borel JC. Feasibility of Type 3 Polygraphy for Evaluating Leak Determinants in CPAP-Treated OSA Patients: A Step Toward Personalized Leak Management. Chest 2020; 158:2165-2171. [PMID: 32544491 DOI: 10.1016/j.chest.2020.05.593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/01/2020] [Accepted: 05/17/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Unintentional leaks (ULs) are frequent adverse effects in CPAP-treated patients. We previously published a novel methodology for analyzing the determinants of UL using polysomnography. We now propose a simplified recording system using a type 3 polygraphic device (Somnolter; Nomics S.A.). RESEARCH QUESTION (1) To describe individual UL determinants provided by the Somnolter software in automatic-CPAP-treated OSA patients; (2) To subsequently describe the clinical consensus of four physicians on how to manage each individual UL situation. STUDY DESIGN AND METHODS Somnoler recordings performed under nasal automatic-CPAP were automatically analyzed with APIOS software. For each polygraphic recording, APIOS provided the OR and the CIs for potential determinants of UL: mouth opening, CPAP pressure, body position, and mandibular oscillation. Based on these results, each of four physicians was asked to choose one of four strategies: (1) increase or decrease therapeutic pressure; (2) change nasal mask for oro-nasal mask/chinstrap; (3) favor a nonsupine or supine position; (4) no action for individual leak management. Subsequently, a meeting was held to determine a consensus choice for each individual case. RESULTS Seventy-eight consecutive patients underwent home-polygraphy with Somnolter. Fifty recordings were analyzed (16 females; 65 [57-75] years of age; BMI = 31.1 [27.4-35.3]). Individual diagnosis of UL was routinely feasible. The determinants of UL were heterogeneous in the population, and diagnosis of UL was not feasible in 10 patients. Based on the results from this analysis, we established consensus leak management strategies at the individual level. The average Cohen κ coefficient for the four raters was 0.58. Pressure modification was proposed in 36% of patients, no action in 24%, installation of a facial mask/chinstrap in 22%, and positional treatment in 18%. INTERPRETATION The use of type 3 polygraphy for characterizing leak determinants in patients treated with nasal automatic-CPAP is feasible in routine practice. Leak determinants are patient specific. Interrater concordance for determining individual leak management strategies demonstrated a "fair" level of agreement. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03381508; URL: www.clinicaltrials.gov).
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Affiliation(s)
- Marius Lebret
- University of Grenoble Alpes, Grenoble, France; AGIR à dom. Association, Meylan, France.
| | - Dany Jaffuel
- APARD, groupe Adène, Montpellier, France; Department of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, Montpellier, France; Pulmonary Disorders and Respiratory Sleep Disorders Unit, Polyclinic Saint-Privat, Boujan sur Libron, France
| | - Carey M Suehs
- Department of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Jean-Pierre Mallet
- Department of Respiratory Diseases, Montpellier University Hospital, Arnaud de Villeneuve Hospital, Montpellier, France
| | | | - Marie-Caroline Rotty
- APARD, groupe Adène, Montpellier, France; IMAG, CNRS, Montpellier University, Montpellier University Hospital, Montpellier, France
| | - Jean-Louis Pépin
- University of Grenoble Alpes, Grenoble, France; Sleep Laboratory, Thorax and Vessels Division, Grenoble Alpes University Hospital, France
| | | | - Nicolas Molinari
- IMAG, CNRS, Montpellier University, Montpellier University Hospital, Montpellier, France
| | - Jean-Christian Borel
- University of Grenoble Alpes, Grenoble, France; AGIR à dom. Association, Meylan, France; Sleep Laboratory, Thorax and Vessels Division, Grenoble Alpes University Hospital, France
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Zhou J, Li DH, Zhu PF, Yi CY, Chang L, Zhang Y, Yang XH. Effect of mandibular advancement device on the stomatognathic system in patients with mild-to-moderate obstructive sleep apnoea-hypopnoea syndrome. J Oral Rehabil 2020; 47:889-901. [PMID: 32306424 PMCID: PMC7318685 DOI: 10.1111/joor.12982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/13/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
Objective This study was conducted to evaluate the changes of temporomandibular joints (TMJs) through magnetic resonance imaging (MRI) scanning and the electrical changes in mandibular movement and masticatory muscle surface of mild‐to‐moderate obstructive sleep apnoea‐hypopnoea syndrome (OSAHS) patients before and after treatment with mandibular advancement device (MAD). Methods This was a single‐centre, prospective study recruiting OSAHS patients undergoing treatment with MAD in Department of Stomatology, Yannan Hospital, Kunming, China. Patients were recruited from February 2015 to October 2015, and TMJ changes were observed in MRI scanning before and after 18 months of treatment with MAD in cohort 1. The second cohort of the patients were recruited from January 2014 to September 2015 and electrical changes in mandibular movement and masticatory muscle surface of patients before and after 6 months of treatment with MAD. Results In the cohort 1, TMJ changes analysed through MRI scanning, before and after 18‐month treatment with MAD, there was no significant deviation in the angle of joint disc position. A minor change in the position relationship between condylar process, articular disc and articular fossa but not significant was observed. There was no significant difference in the shape and magnitude of mandibular incision edge movement, percussion movement, masticatory movement and condylar central trajectory among the recruited OSAHS patients, before and after 6 months of MAD treatment as analysed through electromyography. Conclusion In this study, from the results it was evident that the effect of MAD on the stomatognathic system of OSAHS patients is minimal.
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Affiliation(s)
- Jing Zhou
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
| | - De-Hong Li
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
| | - Peng-Fei Zhu
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
| | - Chun-Yan Yi
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
| | - Lin Chang
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
| | - Yanan Zhang
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
| | - Xiang-Hong Yang
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
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Barewal RM. Obstructive Sleep Apnea: The Role of Gender in Prevalence, Symptoms, and Treatment Success. Dent Clin North Am 2019; 63:297-308. [PMID: 30825992 DOI: 10.1016/j.cden.2018.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this article is to provide an overview of known similarities and differences between genders relative to presenting symptoms, demographics, and severity of obstructive sleep apnea. There is a relationship of risk of disease occurrence relative to stages of reproductive life of a woman, indicating that chronologic age might not be as important as timing of pregnancy and menopausal transition. The current understanding of gender differences in treatment success and compliance with oral appliance therapy is limited and requires further investigation.
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Affiliation(s)
- Reva Malhotra Barewal
- Department of Pulmonology and Critical Care, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098, USA.
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Van Ryswyk E, Anderson CS, Antic NA, Barbe F, Bittencourt L, Freed R, Heeley E, Liu Z, Loffler KA, Lorenzi-Filho G, Luo Y, Margalef MJM, McEvoy RD, Mediano O, Mukherjee S, Ou Q, Woodman R, Zhang X, Chai-Coetzer CL. Predictors of long-term adherence to continuous positive airway pressure in patients with obstructive sleep apnea and cardiovascular disease. Sleep 2019; 42:5581969. [DOI: 10.1093/sleep/zsz152] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 05/12/2019] [Indexed: 11/12/2022] Open
Abstract
AbstractStudy ObjectivesPoor adherence to continuous positive airway pressure (CPAP) commonly affects therapeutic response in obstructive sleep apnea (OSA). We aimed to determine predictors of adherence to CPAP among participants of the Sleep Apnea and cardioVascular Endpoints (SAVE) trial.MethodsSAVE was an international, randomized, open trial of CPAP plus usual care versus usual care (UC) alone in participants (45–75 years) with co-occurring moderate-to-severe OSA (≥12 episodes/h of ≥4% oxygen desaturation) and established cardiovascular (CV) disease. Baseline sociodemographic, health and lifestyle factors, OSA symptoms, and 1-month change in daytime sleepiness, as well as CPAP side effects and adherence (during sham screening, titration week, and in the first month), were entered in univariate linear regression analyses to identify predictors of CPAP adherence at 24 months. Variables with p <0.2 were assessed for inclusion in a multivariate linear mixed model with country, age, and sex included a priori and site as a random effect.ResultsSignificant univariate predictors of adherence at 24 months in 1,121 participants included: early adherence measures, improvement in daytime sleepiness at 1 month, fixed CPAP pressure, some measures of OSA severity, cardiovascular disease history, breathing pauses, and very loud snoring. While observed adherence varied between countries, adherence during sham screening, initial titration, and the first month of treatment retained independent predictive value in the multivariate model along with fixed CPAP pressure and very loud snoring.ConclusionsEarly CPAP adherence had the greatest predictive value for identifying those at highest risk of non-adherence to long-term CPAP therapy.Clinical Trial RegistrationSAVE is registered with clinicaltrials.gov (NCT00738179).
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Affiliation(s)
- Emer Van Ryswyk
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- The George Institute China at Peking University Health Science Center, Beijing, China
| | - Nicholas A Antic
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, Australia
| | - Ferran Barbe
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Lleida, Spain
- CIBERES, Madrid, Spain
| | - Lia Bittencourt
- Instituto do Sono, AFIP, Sao Paulo, Brazil
- Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Ruth Freed
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Emma Heeley
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Zhihong Liu
- Department of Cardiology, Fuwai Hospital, Beijing, China
| | - Kelly A Loffler
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, Australia
| | | | - Yuanming Luo
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Maria J Masdeu Margalef
- Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Olga Mediano
- University Hospital of Guadalajara, Guadalajara, Spain
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Qiong Ou
- Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
| | - Xilong Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ching Li Chai-Coetzer
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Adelaide, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
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Borel AL, Tamisier R, Böhme P, Priou P, Avignon A, Benhamou PY, Hanaire H, Pépin JL, Kessler L, Valensi P, Darmon P, Gagnadoux F. Obstructive sleep apnoea syndrome in patients living with diabetes: Which patients should be screened? DIABETES & METABOLISM 2019; 45:91-101. [DOI: 10.1016/j.diabet.2018.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/16/2018] [Accepted: 08/11/2018] [Indexed: 12/27/2022]
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Richards KC, Gooneratne N, Dicicco B, Hanlon A, Moelter S, Onen F, Wang Y, Sawyer A, Weaver T, Lozano A, Carter P, Johnson J. CPAP Adherence May Slow 1-Year Cognitive Decline in Older Adults with Mild Cognitive Impairment and Apnea. J Am Geriatr Soc 2019; 67:558-564. [PMID: 30724333 DOI: 10.1111/jgs.15758] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES Obstructive sleep apnea (OSA) has been linked to an increased risk for Alzheimer's disease (AD), but little prospective evidence exists on the effects of OSA treatment in preclinical AD. The objective was to determine if continuous positive airway pressure (CPAP) treatment adherence, controlling for baseline differences, predicts cognitive and everyday function after 1 year in older adults with mild cognitive impairment (MCI) and to determine effect sizes for a larger trial. DESIGN Quasi-experimental pilot clinical trial with CPAP adherence defined as CPAP use 4 hours or more per night over 1 year. SETTING Sleep and geriatric clinics and community. PARTICIPANTS Older adults, aged 55 to 89 years, with an apnea-hypopnea index of 10 or higher participated: (1) MCI, OSA, and CPAP adherent (MCI +CPAP), n = 29; and (2) MCI, OSA, CPAP nonadherent (MCI -CPAP), n = 25. INTERVENTION CPAP. MEASUREMENTS The primary cognitive outcome was memory (Hopkins Verbal Learning Test-Revised), and the secondary cognitive outcome was psychomotor/cognitive processing speed (Digit Symbol subtest from the Wechsler Adult Intelligence Scale Substitution Test). Secondary function and progression measures were the Everyday Cognition, Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale, and Clinical Dementia Rating. RESULTS Statistically significant improvements in psychomotor/cognitive processing speed in the MCI +CPAP group vs the MCI -CPAP group were observed at 1 year after adjustment for age, race, and marital status (parameter estimate = 1.68; standard error = 0.47; 95% confidence interval = 0.73-2.62), with a 6-month effect size (ES) of 0.46 and a 1-year ES of 1.25. There were small to moderate ESs for memory (ES 0.20, 6 mo), attention (ES 0.25, 1 y), daytime sleepiness (ES 0.33, 6 mo and ES 0.22, 1 y), and everyday function (ES 0.50, 6 mo) favoring the MCI +CPAP group vs the MCI -CPAP group. CONCLUSION Controlling for baseline differences, 1 year of CPAP adherence in MCI +OSA significantly improved cognition, compared with a nonadherent control group, and may slow the trajectory of cognitive decline. TRIAL REGISTRATION NUMBER Memories; NCT01482351; https://clinicaltrials.gov/ct2/show/NCT01482351?cond=MCI+and+OSA&rank=1 J Am Geriatr Soc 67:558-564, 2019.
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Affiliation(s)
| | - Nalaka Gooneratne
- Division of Sleep Medicine, Center for Sleep and Circadian Neurobiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Barry Dicicco
- School of Medicine, Virginia Commonwealth University & Pulmonary and Critical Care Specialists of Northern Virginia, Richmond, Virginia
| | - Alexandra Hanlon
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen Moelter
- Department of Psychology, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania
| | - Fannie Onen
- Division of Sleep Medicine, Center for Sleep and Circadian Neurobiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Geriatrics, CHU Bichat Claude Bernard, APHP, Paris, France.,INSERM 1178 & CESP, University of Paris Sud, Chatenay-Malabry, France
| | - Yanyan Wang
- School of Nursing, University of Texas at Austin, Texas, Austin.,National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Amy Sawyer
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Terri Weaver
- Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois.,Division of Pulmonary, Critical Care and Sleep, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Alicia Lozano
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patricia Carter
- School of Nursing, University of Texas at Austin, Texas, Austin
| | - Jerry Johnson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Campos-Rodriguez F, Navarro-Soriano C, Reyes-Nuñez N, Torres G, Caballero-Eraso C, Lloberes P, Diaz-Cambriles T, Somoza M, Masa JF, Gonzalez M, Mañas E, de la Peña M, Barbe F, Garcia-Rio F, Montserrat JM, Muriel A, Garcia-Ortega A, Selma MJ, Martinez-Garcia MA. Good long-term adherence to continuous positive airway pressure therapy in patients with resistant hypertension and sleep apnea. J Sleep Res 2019; 28:e12805. [PMID: 30604577 DOI: 10.1111/jsr.12805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 11/29/2022]
Abstract
Although adequate adherence is paramount in achieving the beneficial effects of continuous positive airway pressure therapy in patients with obstructive sleep apnea, long-term adherence and the variables involved in continuous positive airway pressure compliance in patients with resistant hypertension and obstructive sleep apnea are yet unknown. We conducted a prospective, multicentre, observational study in 177 patients recruited from hypertensive units with resistant hypertension confirmed by means of 24-hr blood pressure monitoring (blood pressure ≥ 130 and/or ≥ 80 mmHg, despite taking at least three antihypertensive drugs or < 130/80 mmHg with > 3 drugs) and obstructive sleep apnea (apnea-hypopnea index ≥ 5 in a respiratory polygraph) who were prescribed continuous positive airway pressure treatment. Good adherence was defined as an average cumulative continuous positive airway pressure use of ≥ 4 hr per night at the end of the follow-up. A multivariate Cox regression analysis was performed to identify independent predictors of continuous positive airway pressure adherence. Patients were followed for a median of 57.6 (42-72) months after initiating continuous positive airway pressure therapy. At the end of the follow-up, the median continuous positive airway pressure use was 5.7 (inter-quartile range 3.9-6.6) hr per night, and 132 patients (74.5%) showed good continuous positive airway pressure adherence. The only baseline variable associated with poor adherence was the presence of previous stroke (hazard ratio 4.00, 95% confidence interval 1.92-8.31). Adequate adherence at 1 month also predicted good adherence at the end of the follow-up (hazard ratio 14.4, 95% confidence interval 4.94-56). Both variables also predicted adherence at a threshold of 6 hr per night. Our results show that good continuous positive airway pressure adherence is an achievable and feasible goal in patients with resistant hypertension and obstructive sleep apnea. Previous stroke and short-term adherence predicted long-term adherence.
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Affiliation(s)
- Francisco Campos-Rodriguez
- Respiratory Department, Hospital Universitario de Valme, Sevilla, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla, Sevilla, Spain.,CIBERes, CIBER de enfermedades Respiratorias, Madrid, Spain
| | | | - Nuria Reyes-Nuñez
- Respiratory Department, Hospital Universitario de Valme, Sevilla, Spain
| | - Gerard Torres
- Internal Medicine Service, Hospital Universitari de Santa María, Lleida, Spain
| | | | - Patricia Lloberes
- Respiratory Department, Hospital Universitario Vall Hebron, Barcelona, Spain
| | | | - Maria Somoza
- Respiratory Department, Consorcio Sanitario de Terrassa, Barcelona, Spain
| | - Juan F Masa
- CIBERes, CIBER de enfermedades Respiratorias, Madrid, Spain.,Respiratory Department, Hospital Universitario San Pedro de Alcantara, Caceres, Spain
| | - Monica Gonzalez
- Respiratory Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Eva Mañas
- Respiratory Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Monica de la Peña
- Respiratory Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Ferran Barbe
- CIBERes, CIBER de enfermedades Respiratorias, Madrid, Spain.,Institut de Recerca Biomédica, IRB Lleida, Lleida, Spain
| | - Francisco Garcia-Rio
- CIBERes, CIBER de enfermedades Respiratorias, Madrid, Spain.,Respiratory Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | - Alfonso Muriel
- CIBERes, CIBER de enfermedades Respiratorias, Madrid, Spain.,Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, Madrid, Spain.,IRYCIS, Madrid, Spain.,Departamento de Enfermería, Universidad de Alcalá, Madrid, Spain
| | | | - Maria J Selma
- Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Gentina T, Bailly S, Jounieaux F, Verkindre C, Broussier PM, Guffroy D, Prigent A, Gres JJ, Kabbani J, Kedziora L, Tamisier R, Gentina E, Pépin JL. Marital quality, partner's engagement and continuous positive airway pressure adherence in obstructive sleep apnea. Sleep Med 2018; 55:56-61. [PMID: 30771736 DOI: 10.1016/j.sleep.2018.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/23/2018] [Accepted: 12/05/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is the first line therapy for obstructive sleep apnea (OSA) but its effectiveness requires high adherence. We aimed to assess the impacts of the spouse's/partner's involvement and the quality of the couple's relationship on CPAP adherence. METHODS In a multicenter prospective study conducted in France, patients reported their subjective views regarding their partner's engagement in their CPAP treatment and the quality of their marital relationship using the Quality of Marriage Index. A hierarchical linear model was built to assess the predictors of CPAP adherence at day 120. Structural equation modeling was performed to evaluate the direct and indirect effects of the spouse's/partner's engagement and the quality of the couple's relationship on CPAP adherence. RESULTS The 290 OSA patients were predominantly male (77%), with a median age of 53 years IQR: [46; 62], median BMI: 32 kg/m2 [28.6; 35.9] and median apnea + hypopnea index: 43/per hour [33; 58]. Independent factors for CPAP adherence at day 120 were the partner's encouragement of CPAP usage and a stable relationship exceeding 30 years, although emotional support or collaboration were not associated with CPAP adherence. Structural equation modeling demonstrated that spouse's/partner's engagement is directly related to CPAP adherence and improvement of symptoms, and that CPAP adherence is a mediator of disease-specific health-related quality of life. Marital quality was a significant moderator of these interactions meaning that a spouse's/partner's engagement improved adherence only when the quality of marriage index was high. CONCLUSION Future research and integrated OSA management should systematically include and document the role of the spouse/partner in CPAP adherence.
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Affiliation(s)
- Thibaut Gentina
- Ramsey General Healthcare La Louviere Hospital, Lille, France.
| | - Sébastien Bailly
- HP2 Laboratory, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France; EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
| | | | | | | | | | | | | | | | | | - Renaud Tamisier
- HP2 Laboratory, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France; EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
| | - Elodie Gentina
- IESEG School of Management, LEM-CNRS (UMR 9221), Lille, France.
| | - Jean-Louis Pépin
- HP2 Laboratory, INSERM U1042, Univ. Grenoble Alpes, Grenoble, France; EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France.
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48
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Predictors of positive airway pressure therapy termination in the first year: analysis of big data from a German homecare provider. BMC Pulm Med 2018; 18:186. [PMID: 30518372 PMCID: PMC6280473 DOI: 10.1186/s12890-018-0748-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/20/2018] [Indexed: 11/28/2022] Open
Abstract
Background There is a lack of robust data about factors predicting continuation (or termination) of positive airway pressure therapy (PAP) for sleep apnea. This analysis of big data from a German homecare provider describes patients treated with PAP, analyzes the therapy termination rate over the first year, and investigates predictive factors for therapy termination. Methods Data from a German homecare service provider were analyzed retrospectively. Patients who had started their first PAP therapy between September 2009 and April 2014 were eligible. Patient demographics, therapy start date, and the date of and reason for therapy termination were obtained. At 1 year, patients were classified as having compliance-related therapy termination or remaining on therapy. These groups were compared, and significant predictors of therapy termination determined. Results Of 98,329 patients included in the analysis, 11,702 (12%) terminated PAP therapy within the first year (after mean 171 ± 91 days). There was a U-shaped relationship between therapy termination and age; therapy termination was higher in the youngest (< 30 years, 15.5%) and oldest (≥ 80 years, 19.8%) patients, and lower in those aged 50–59 years (9.9%). Therapy termination was significantly more likely in females versus males (hazard ratio 1.48, 95% confidence interval 1.42–1.54), in those with public versus private insurance (1.75, 1.64–1.86) and in patients whose first device was automatically adjusting or fixed-level continuous positive airway pressure versus bilevel or adaptive servo-ventilation (1.28, 1.2–1.38). Conclusions This analysis of the largest dataset investigating PAP therapy termination identified a number of predictive factors. These can help health care providers chose the most appropriate PAP modality, identify specific patient phenotypes at higher risk of stopping PAP and target interventions to support ongoing therapy to these groups, as well as allow them to develop a risk stratification tool.
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49
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Sabil A, Vanbuis J, Baffet G, Feuilloy M, Le Vaillant M, Meslier N, Gagnadoux F. Automatic identification of sleep and wakefulness using single-channel EEG and respiratory polygraphy signals for the diagnosis of obstructive sleep apnea. J Sleep Res 2018; 28:e12795. [PMID: 30478923 DOI: 10.1111/jsr.12795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022]
Abstract
Polysomnography (PSG) is necessary for the accurate estimation of total sleep time (TST) and the calculation of the apnea-hypopnea index (AHI). In type III home sleep apnea testing (HSAT), TST is overestimated because of the lack of electrophysiological sleep recordings. The aim of this study was to evaluate the accuracy and reliability of a novel automated sleep/wake scoring algorithm combining a single electroencephalogram (EEG) channel with actimetry and HSAT signals. The study included 160 patients investigated by PSG for suspected obstructive sleep apnea (OSA). Each PSG was recorded and scored manually using American Academy of Sleep Medicine (AASM) rules. The automatic sleep/wake-scoring algorithm was based on a single-channel EEG (FP2-A1) and the variability analysis of HSAT signals (airflow, snoring, actimetry, light and respiratory inductive plethysmography). Optimal detection thresholds were derived for each signal using a training set. Automatic and manual scorings were then compared epoch by epoch considering two states (sleep and wake). Cohen's kappa coefficient between the manual scoring and the proposed automatic algorithm was substantial, 0.74 ± 0.18, in separating wakefulness and sleep. The sensitivity, specificity and the positive and negative predictive values for the detection of wakefulness were 76.51% ± 21.67%, 95.48% ± 5.27%, 81.84% ± 15.42% and 93.85% ± 6.23% respectively. Compared with HSAT signals alone, AHI increased by 22.12% and 27 patients changed categories of OSA severity with the automatic sleep/wake-scoring algorithm. Automatic sleep/wake detection using a single-channel EEG combined with HSAT signals was a reliable method for TST estimation and improved AHI calculation compared with HSAT.
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Affiliation(s)
| | - Jade Vanbuis
- Ecole Supérieure d'Electronique de l'Ouest, Angers, France
| | | | - Mathieu Feuilloy
- Ecole Supérieure d'Electronique de l'Ouest, Angers, France.,Laboratoire d'Acoustique, Université du Maine, Le Mans, France
| | - Marc Le Vaillant
- Institut de Recherche en, Santé Respiratoire des Pays de la Loire, Beaucouzé, France
| | - Nicole Meslier
- Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France.,INSERM, UMR 1063, Université d'Angers, Angers, France
| | - Frédéric Gagnadoux
- Département de Pneumologie, Centre Hospitalier Universitaire, Angers, France.,INSERM, UMR 1063, Université d'Angers, Angers, France
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50
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Borel AL, Tamisier R, Böhme P, Priou P, Avignon A, Benhamou PY, Hanaire H, Pépin JL, Kessler L, Valensi P, Darmon P, Gagnadoux F. [Reprint of : Management of obstructive sleep apnea syndrome in people living with diabetes: context, screening, indications and treatment modalities: context, screening, indications and treatment modalities: a French position statement]. Rev Mal Respir 2018; 35:1067-1089. [PMID: 30429090 DOI: 10.1016/j.rmr.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- A-L Borel
- Hôpital universitaire Grenoble Alpes, Département d'Endocrinologie, Diabétologie, Nutrition, 38043 Grenoble cedex 9, France; Université Grenoble Alpes, laboratoire "Hypoxie physiopahologie" INSERM U1042, Grenoble, France.
| | - R Tamisier
- Université Grenoble Alpes, laboratoire "Hypoxie physiopahologie" INSERM U1042, Grenoble, France; Hôpital universitaire Grenoble Alpes, Pôle "Thorax et Vaisseaux", clinique de physiologie, sommeil et exercice, Grenoble, France
| | - P Böhme
- Hôpital universitaire de Nancy, Département d'Endocrinologie, Diabétologie, Nutrition, Nancy, France; Université de Lorraine, EA4360 APEMAC, Nancy, France
| | - P Priou
- Hôpital universitaire d'Angers, Département des maladies respiratoires, Angers, France; Université d'Angers, INSERM UMR 1063, Angers, France
| | - A Avignon
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France; Hôpital universitaire de Montpellier, département de Nutrition, Montpellier, France
| | - P-Y Benhamou
- Hôpital universitaire Grenoble Alpes, Département d'Endocrinologie, Diabétologie, Nutrition, 38043 Grenoble cedex 9, France
| | - H Hanaire
- Hôpital universitaire de Toulouse, Université de Toulouse, Toulouse, France
| | - J-L Pépin
- Université Grenoble Alpes, laboratoire "Hypoxie physiopahologie" INSERM U1042, Grenoble, France; Hôpital universitaire Grenoble Alpes, Pôle "Thorax et Vaisseaux", clinique de physiologie, sommeil et exercice, Grenoble, France
| | - L Kessler
- Hôpital universitaire de Strasbourg, département de diabétologie, INSERM UMR 1260, Strasbourg, France
| | - P Valensi
- Departement d'Endocrinologie Diabétologie Nutrition, APHP, Hôpital Jean Verdier, Université Paris Nord, CRNH-IdF, CINFO, Bondy, France
| | - P Darmon
- Hôpital universitaire de Marseille, département d'Endocrinologie, et Université de France & Aix Marseille, INSERM, INRA, C2VN, Marseille, France
| | - F Gagnadoux
- Hôpital universitaire d'Angers, Département des maladies respiratoires, Angers, France; Université d'Angers, INSERM UMR 1063, Angers, France
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