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Fletcher HV, Cho PSP, Loong SL, Estrada-Petrocelli L, Patel AS, Birring SS, Lee KK. Effect of continuous positive airway pressure on maximal exercise capacity in patients with obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med 2020; 16:1847-1855. [PMID: 32662419 DOI: 10.5664/jcsm.8686] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
STUDY OBJECTIVES Exercise capacity is impaired in obstructive sleep apnea (OSA). There are conflicting reports on the effect of continuous positive airway pressure (CPAP) on maximal exercise capacity. The objective of this review was to determine if there is a change in exercise capacity and anaerobic threshold following CPAP treatment in OSA patients. METHODS We conducted a systematic review and meta-analyses to summarize the changes in peak rate of oxygen uptake (V̇O₂ peak) or maximum rate of oxygen uptake (V̇O2 max) and anaerobic threshold (AT) during cardiopulmonary exercise testing following CPAP intervention in patients with OSA. A systematic literature review was conducted to identify published literature on markers of V̇O₂ peak, V̇O₂ max, and AT pre- vs post-CPAP using a web-based literature search of PubMed/MEDLINE, Embase, CINAHL, and Cochrane review (CENTRAL) databases. Two independent reviewers screened the articles for data extraction and analysis. RESULTS The total search of all the databases returned 470 relevant citations. Following application of eligibility criteria, 6 studies were included in the final meta-analysis for V̇O₂ peak, 2 studies for V̇O₂ max, and five studies for AT. The meta-analysis showed a mean net difference in V̇O₂ peak between pre- and post-CPAP of 2.69 mL·kg-1·min-1, P = .02, favoring treatment with CPAP. There was no difference in V̇O₂ max or AT with CPAP treatment (mean net difference 0.66 mL·kg-1·min-1 [P = .78] and -144.98 mL·min-1 [P = .20] respectively). CONCLUSIONS There is a paucity of high-quality studies investigating the effect of CPAP on exercise capacity. Our meta-analysis shows that V̇O₂ peak increases following CPAP treatment in patients with OSA, but we did not observe any change in V̇O₂ max or AT. Our findings should be considered preliminary and we recommend further randomized controlled trials to confirm our findings and to clarify the peak and maximum rates of oxygen uptake adaptations with CPAP therapy.
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Affiliation(s)
- Hannah V Fletcher
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Peter S P Cho
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Stewart Lee Loong
- National Institute of Health Research/Wellcome King's Clinical Research Facility, London, United Kingdom
| | - Luis Estrada-Petrocelli
- Institut de Bioenginyeria de Catalunya (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona, Spain.,Universidad Latina de Panamá, Facultad de Ingeniería, Panama, Panama
| | - Amit S Patel
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Surinder S Birring
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom.,Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Kai K Lee
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom.,Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
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The effect of CPAP therapy on excessive daytime sleepiness and quality of life in subjects with obstructive sleep apnoea: an AB design study. Sleep Breath 2020; 25:1351-1357. [PMID: 33151498 DOI: 10.1007/s11325-020-02237-4] [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: 08/14/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a disorder characterized by apnoeas and hypopnoeas due to repetitive upper airway collapse during sleep. So far, there are no published data regarding quality of life (QoL) and adherence to CPAP among patients with OSA in India. This study aims to measure sleepiness and QoL of patients before and after effective CPAP use in patients with OSA. METHOD Newly diagnosed subjects with OSA were included, and socio-demographic risk factors and anthropomorphic measures were collected. Epworth sleepiness scale (ESS) and short sleep apnoea quality of life index (SAQLI) were administered before and after a minimum of 4 weeks of domiciliary CPAP use. While short SAQLI is a disease-specific questionnaire, ESS measures excessive daytime sleepiness. RESULTS In 92 subjects age range was 28-74 years, mean age 49.7 ± 11.3 years, and male:female ratio was 70:22. Mean BMI was 32.1 ± 6.4 kg/sq.m; mean neck circumference was 39.4 ± 3.4 cm; 56 subjects had Mallampati score of 3 or 4. One-month follow-up was completed by 34 subjects who reported a mean of 5.8 ± 1.1 hours/night usage of CPAP. Mean ESS score was 11.31 ± 5.6 at baseline vs 6.9 ± 3.3 after 1 month (p = 0.02), and baseline short SAQLI score was at 2.54 ± 1.26 vs 1.38 ± 0.87 after 1 month (p = 0.0001). CONCLUSIONS Subjects reported adequate compliance with CPAP at 1 month, and both ESS and short SAQLI showed a significant improvement in these patients. CPAP compliance improved both QoL and sleepiness in patients with OSA.
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Atilgan E, Kunter E, Algun ZC. Are oropharyngeal exercises effective in Obstructive Sleep Apnea Syndrome? J Back Musculoskelet Rehabil 2020; 33:209-216. [PMID: 31282395 DOI: 10.3233/bmr-171101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study has been conducted to examine the effects of posture, cervical region and oropharyngeal exercises in patients with Obstructive Sleep Apnea Syndrome (OSAS). METHOD Thirty patients with OSAS have been randomly divided into two groups. The first group received supervised exercise program including oropharyngeal, posture and cervical region exercises for 12 weeks. The patients in the control group have been informed about the posture but the exercise was not recommended. Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), Short Form 36 (SF-36), International Physical Activity Questionnaire-Short Form (IPAQ-SF) and 6 Minute Walk Test (6MWT) have been used in the evaluation of individuals participating in the study. Evaluations have been made at the beginning of the treatment and at the end of the 12-week exercise program. RESULTS Statistically significant improvements have been observed in the exercise group in PSQI total value, ESS score, SF-36 General Health Subscale and 6MWT (p< 0.05). Statistical significance could not be reached for other parameters. CONCLUSIONS Sleep quality, general health, and functional capacity have been found to improve in OSAS patients with oropharyngeal exercises.
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Affiliation(s)
- Esra Atilgan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Turkey
| | - Erdoğan Kunter
- Department of Chest Diseases, Faculty of Medicine, Istanbul Medipol University, Turkey
| | - Z Candan Algun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Medipol University, Turkey
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Dewez JE, Nangia S, Chellani H, White S, Mathai M, van den Broek N. Availability and use of continuous positive airway pressure (CPAP) for neonatal care in public health facilities in India: a cross-sectional cluster survey. BMJ Open 2020; 10:e031128. [PMID: 32114460 PMCID: PMC7053015 DOI: 10.1136/bmjopen-2019-031128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the availability of continuous positive airway pressure (CPAP) and to provide an overview of its use in neonatal units in government hospitals across India. SETTING Cross-sectional cluster survey of a nationally representative sample of government hospitals from across India. PRIMARY OUTCOMES Availability of CPAP in neonatal units. SECONDARY OUTCOMES Proportion of hospitals where infrastructure and processes to provide CPAP are available. Case fatality rates and complication rates of neonates treated with CPAP. RESULTS Among 661 of 694 government hospitals with neonatal units that provided information on availability of CPAP for neonatal care, 68.3% of medical college hospitals (MCH) and 36.6% of district hospitals (DH) used CPAP in neonates. Assessment of a representative sample of 142 hospitals (79 MCH and 63 DH) showed that air-oxygen blenders were available in 50.7% (95% CI 41.4% to 60.9%) and staff trained in the use of CPAP were present in 56.0% (45.8% to 65.8%) of hospitals. The nurse to patient ratio was 7.3 (6.4 to 8.5) in MCH and 6.6 (5.5 to 8.3) in DH. Clinical guidelines were available in 31.0% of hospitals (22.2% to 41.4%). Upper oxygen saturation limits of above 94% were used in 72% (59.8% to 81.6%) of MCH and 59.3% (44.6% to 72.5%) of DH. Respiratory circuits were reused in 53.8% (42.3% to 63.9%) of hospitals. Case fatality rate for neonates treated with CPAP was 21.4% (16.6% to 26.2%); complication rates were 0.7% (0.2% to 1.2%) for pneumothorax, 7.4% (0.9% to 13.9%) for retinopathy and 1.4% (0.7% to 2.1%) for bronchopulmonary dysplasia. CONCLUSIONS CPAP is used in neonatal units across government hospitals in India. Neonates may be overexposed to oxygen as the means to detect and treat consequences of oxygen toxicity are insufficient. Neonates may also be exposed to nosocomial infections by reuse of disposables. Case fatality rates for neonates receiving CPAP are high. Complications might be under-reported. Support to infrastructure, training, guidelines implementation and staffing are needed to improve CPAP use.
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Affiliation(s)
- Juan Emmanuel Dewez
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Sushma Nangia
- Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Hospital, New Delhi, Delhi, India
| | - Harish Chellani
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Sarah White
- Department of International Public Health, Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Matthews Mathai
- Department of International Public Health, Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nynke van den Broek
- Department of International Public Health, Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Mendelson M, Marillier M, Bailly S, Flore P, Borel JC, Vivodtzev I, Doutreleau S, Tamisier R, Pépin JL, Verges S. Maximal exercise capacity in patients with obstructive sleep apnoea syndrome: a systematic review and meta-analysis. Eur Respir J 2018; 51:13993003.02697-2017. [PMID: 29700103 DOI: 10.1183/13993003.02697-2017] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 04/13/2018] [Indexed: 01/27/2023]
Abstract
Maximal aerobic capacity is a strong health predictor and peak oxygen consumption (V'O2peak) is considered a reflection of total body health. No systematic reviews or meta-analyses to date have synthesised the existing data regarding V'O2peak in patients with obstructive sleep apnoea (OSA).A systematic review of English and French articles using PubMed/MEDLINE and Embase included studies assessing V'O2peak in OSA patients either in mL·kg-1·min-1 compared with controls or in % predicted. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence.Mean V'O2peak expressed in mL·kg-1·min-1 was significantly lower in patients with OSA than in controls (mean difference -2.7 mL·kg-1·min-1; p<0.001; n=850). This reduction in V'O2peak was found to be larger in non-obese patients (body mass index <30 kg·m-2). Mean V'O2peak % pred was 89.9% in OSA patients (n=643).OSA patients have reduced maximal aerobic capacity, which can be associated with increased cardiovascular risks and reduced survival in certain patient subgroups. Maximal exercise testing can be useful to characterise functional limitation and to evaluate health status in OSA patients.
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Affiliation(s)
- Monique Mendelson
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France.,Both authors contributed equally and share the first authorship
| | - Mathieu Marillier
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France.,Both authors contributed equally and share the first authorship
| | - Sébastien Bailly
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Patrice Flore
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Christian Borel
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Isabelle Vivodtzev
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Stéphane Doutreleau
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France.,Both authors share senior authorship
| | - Samuel Verges
- HP2 Laboratory, University Grenoble Alpes, Grenoble, France.,Inserm U1042, Grenoble, France.,Grenoble Alps University Hospital, Grenoble, France.,Both authors share senior authorship
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New perspectives in the treatment of obstructive sleep apnea-hypopnea syndrome☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201701000-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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New perspectives in the treatment of obstructive sleep apnea–hypopnea syndrome. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Cortés-Reyes E, Parrado-Bermúdez K, Escobar-Córdoba F. Nuevas perspectivas en el tratamiento del síndrome de apnea-hipopnea obstructiva del sueño. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Battan G, Kumar S, Panwar A, Atam V, Kumar P, Gangwar A, Roy U. Effect of CPAP Therapy in Improving Daytime Sleepiness in Indian Patients with Moderate and Severe OSA. J Clin Diagn Res 2016; 10:OC14-OC16. [PMID: 28050420 DOI: 10.7860/jcdr/2016/23800.8876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/15/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Obstructive Sleep Apnoea (OSA) is a highly prevalent disease and a major public health issue in India. Excessive daytime sleepiness is an almost ubiquitous symptom of OSA. Epworth Sleepiness Scale (ESS) score is a validated objective score to measure the degree of daytime sleepiness. Continuous Positive Airway Pressure (CPAP) therapy has been established as the gold standard treatment modality for OSA patients. A few Indian studies have reported the effectiveness of CPAP therapy in improving ESS scores after 1st month of CPAP use. AIM To observe both, short-term (one month) and long-term (three month) effects of CPAP therapy on ESS scores in moderate to severe OSA patients. MATERIALS AND METHODS The patients complaining of excessive day-time sleepiness, snoring and choking episodes during sleep, consecutively presenting to medicine OPD over a period of 2 years, were subjected to Polysomnography (PSG). Seventy-three patients with apnoea-hypopnea index (AHI) ≥15 were categorised as having moderate to severe forms of OSA (moderate OSA with AHI=15-30 and severe OSA with AHI >30), and were scheduled for an initial trial of CPAP therapy. Forty-seven patients reported good tolerance to CPAP therapy after a trial period of 2 weeks and comprised the final study group. ESS scores in these patients were recorded at the baseline, and after 1st and 3rd month of CPAP therapy, and statistically analysed for significance. RESULTS Mean ESS score at the baseline among moderate and severe OSA patients were 13.67±2.29 and 16.56 ±1.87, respectively. ESS score in both these subgroups improved significantly to 11.63±3.79, p=0.022, CI (0.3293-4.0106)} and 14.13 ±3.74, p < 0.001, CI (1.2991-4.5408), respectively after one month of CPAP therapy. Likewise, mean ESS scores among moderate and severe OSA patients improved significantly to 9.84 ±2.97, p = 0.022, CI (0.3293-4.0106) and 12.29 ±3.97, p <0.001, CI (2.9414-6.1385), respectively after three months of CPAP therapy. CONCLUSION The result of the present study shows that CPAP therapy is significantly effective in improving ESS scores in Indian patients having moderate to severe OSA. Benefits in daytime sleepiness were observed after short-term as well as long-term use of CPAP therapy.
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Affiliation(s)
- Gulshan Battan
- Senior Resident, Department of Cardiology, Sarvodaya Hospital and Research Center , Faridabad, Haryana, India
| | - Sanjeev Kumar
- Senior Resident, Department of Medicine, King George's Medical University , Lucknow, UP, India
| | - Ajay Panwar
- Consultant Neurologist, Department of Neurology, Aditya Hospital , Warangal, Telangana, India
| | - Virendra Atam
- Professor, Department of Medicine, King George's Medical University , Lucknow, UP, India
| | - Pradeep Kumar
- Professor, Department of Physiology, King George's Medical University , Lucknow, UP, India
| | - Anil Gangwar
- Senior Resident, Department of Physiology, King George's Medical University , Lucknow, UP, India
| | - Ujjawal Roy
- Resident, Department of Neurology, IPGMER, Bangur Institute of Neurosciences , Kolkata, West Bengal, India
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Treatment of Obstructive Sleep Apnea. Prospects for Personalized Combined Modality Therapy. Ann Am Thorac Soc 2016; 13:101-8. [PMID: 26569377 DOI: 10.1513/annalsats.201508-537fr] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder with serious associated morbidities. Although several treatment options are currently available, variable efficacy and adherence result in many patients either not being treated or receiving inadequate treatment long term. Personalized treatment based on relevant patient characteristics may improve adherence to treatment and long-term clinical outcomes. Four key traits of upper airway anatomy and neuromuscular control interact to varying degrees within individuals to cause OSA. These are: (1) the pharyngeal critical closing pressure, (2) the stability of ventilator chemoreflex feedback control (loop gain), (3) the negative intraesophageal pressure that triggers arousal (arousal threshold), and (4) the level of stimulus required to activated upper airway dilator muscles (upper airway recruitment threshold). Simplified diagnostic methods are being developed to assess these pathophysiological traits, potentially allowing prediction of which treatment would best suit each patient. In contrast to current practice of using various treatment modes alone, model predictions and pilot clinical trials show improved outcomes by combining several treatments targeted to each patient's pathophysiology profile. These developments could theoretically improve efficacy and adherence to treatment and in turn reduce the social and economic health burden of OSA and the associated life-threatening morbidities. This article reviews OSA pathophysiology and identifies currently available and investigational treatments that may be combined in the future to optimize therapy based on individual profiles of key patient pathophysiological traits.
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Affiliation(s)
- Anjali Mahajan
- Department of Community Medicine, Indira Gandhi Medical College (IGMC), Shimla, Himachal Pradesh, India E-mail:
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