Purpose
The aim of this study is to determine parameters which influence 6-month compliance of continuous positive airway pressure therapy (CPAP) in patients with obstructive sleep apnea syndrome (OSAS).Methods
This prospective study investigated 73 patients (24 females) with OSAS and medical indication for CPAP therapy: age 55.1?±?11.5 years, body mass index (BMI) 30.8?±?5.0 kg/m2, Apnea–Hypopnea Index (AHI) 39.2?±?26.7/h, Oxygen Desaturation Index (ODI) 33.2?±?25.4/h, minimum O2 saturation 78.9?±?7.6%. The influence of baseline parameters (demographic and polysomnographic data, sleeping medication intakes, BMI, psychometrics [Epworth Sleepiness Scale, Regensburg Insomnia Scale, Vigilance test and Beck Depression Inventory]) on 6-month compliance was evaluated with a correlation and a linear regression analysis.Results
The baseline value of the Regensburg Insomnia Scale (RIS) predicts 6-month CPAP compliance (r?=??0.376, R 2?=?0.14, p?<?0.001), although no other baseline parameter correlates. Patients with a compliance of <4 h/night show higher RIS scores, i.e., more insomnia symptoms (17.6?±?8.8) compared to those with ≥4 h/night (12.6?±?6.9; p?<?0.05).Conclusions
Insomnia symptoms prior to the beginning of CPAP treatment show a negative influence on CPAP compliance. Further studies should clarify, if a treatment of insomnia symptoms leads to a benefit in compliance. 相似文献Moderate and severe obstructive sleep apnea (OSA) have been independently associated with dyslipidemia. The results of metabolic improvement with continuous positive airway pressure (CPAP) have been controversial. Less evidence exists regarding this issue in mild OSA. A current treatment for mild OSA is mandibular advancement device (MAD) therapy, but its effectiveness on the metabolic profile needs to be compared with CPAP. The purpose of this study was to compare MAD vs CPAP vs no treatment on the metabolic profile during 6 and 12 months of follow-up in patients with mild OSA.
MethodsThe inclusion criteria were patients with mild OSA, both genders, ages 18 to 65 years, and body mass index (BMI) of < 35 Kg/m2. Patients were randomized in 3 groups (CPAP, MAD, and control). The evaluations included physical examination, metabolic profile, and full polysomnography at baseline, 6 months, and 12 months of follow-up.
ResultsSeventy-nine patients with mild OSA were randomized in three treatment groups, with mean age (± SD) of 47?±?9 years, 54% men, and AHI 9.5?±?2.9 events/h. MAD and CPAP reduced AHI at 6 and 12 months compared to the control group. MAD adherence was higher than CPAP at 6 and 12 months. Despite lower adherence compared to MAD, CPAP was more effective in reducing total cholesterol over 12 months (baseline 189.3?±?60.2 mg/dl to 173.4?±?74.3 mg/dl) and low-density lipoprotein cholesterol (LDL-c, baseline 112.8?±?54.9 mg/dl to 94.5?±?67.4 mg/dl).
ConclusionsAfter 1 year of treatment, CPAP was superior to MAD in reducing total cholesterol and LDL-c in patients with mild OSA.
相似文献In children, the usual indications for continuous positive airway pressure (CPAP) are residual OSA after adenotonsillectomy and/or persistent OSA due to obesity. Data concerning adherence (hours/night) following ambulatory CPAP initiation are scarce.
MethodsAn observational cohort of 78 children was followed over 2 years. All exhibited sleep-disordered breathing (SDB) symptoms, were assessed by polysomnography, and prescribed CPAP. CPAP was initiated at hospital for 10 children.
ResultsOSA children, mean age 10.4?±?3.2 years, were mostly males (75.6%), with a mean body mass index of 21.2?±?7.3 kg/m2, and mean apnea+hypopnea index of 12.2?±?10.6 events/hour. Seventy-two children were still on CPAP at 3 months, 63 at 6 months, 55 at 1 year, and 34 at 2 years. CPAP was discontinued thanks to rehabilitation programs, dento-facial orthopedics, and/or weight loss. Mean CPAP adherence at 1, 3, 6, 12, and 24 months was respectively 6.1?±?2.8, 6.2?±?2.6, 6.2?±?2.8, 6.3?±?2.8, and 7.0?±?2.7 h/night. There was a trend towards higher CPAP adherence and younger age, primary versus middle/high school attendance, higher baseline apnea+hypopnea index, and neurocognitive disorders.
ConclusionIn our population, mean CPAP adherence defined in hours per night was high and did not decrease during the 24-month follow-up. These findings support the feasibility of ambulatory CPAP initiation in non-syndromic OSA. The high CPAP adherence is expected to be associated with improvements in neurocognition, and in metabolic and cardiovascular parameters.
相似文献Mucopolysaccharidosis type I (MPS I) is an inherited lysosomal storage disorder characterized by severe multi-systemic organ manifestations including obstructive sleep apnea syndrome (OSAS). Hematopoietic stem cell transplantation (HSCT) is the treatment of choice in severe MPS I (MPS IH, Hurler syndrome). However, the effect of HSCT on OSAS in MPS IH still remains unclear. The purpose of this study was to analyze respiratory patterns during sleep following HSCT in MPS IH children and to relate these findings to craniofacial abnormalities.
MethodsOvernight polysomnographies of nine MPS IH children (mean age: 8.2 years) previously treated with HSCT were retrospectively analyzed. Magnetic resonance images of the head were assessed with regard to soft and hard tissue abnormalities of the upper respiratory tract.
ResultsThe mean apnea hypopnea index (AHI) was 5.3 events/h (range, 0.3–12.2), and the majority of apnea/hypopneas were obstructive. Whereas two patients had severe OSAS (AHI?>?10) and two moderate OSAS (5?>?AHI?<?10), five patients had no evidence of OSAS (AHI?<?2.0). Donor cell chimerism was significantly lower in MPS IH patients with OSAS as compared to patients without OSAS (p?<?0.001). The upper airway space and the maxilla were significantly smaller and the adenoids larger in MPS IH patients with OSAS as compared to those of non-OSAS patients.
ConclusionOSAS was only observed in MPS IH patients with graft failure or low donor cell chimerism. Conversely, successful HSCT seems to ameliorate adenoid hyperplasia and maxillary constriction in MPS IH patients and thereby minimizes the risk of OSAS at least at younger ages.
相似文献Telemonitoring (TMg) for patients treated with continuous positive airway pressure (CPAP) is now routine care in some sleep labs. The purpose of the present study was to identify technical interventions associated with improved CPAP compliance in a real-life cohort of newly telemonitored patients with obstructive sleep apnea (OSA) during the first 6 months of treatment.
MethodsAll patients with moderate-to-severe OSA (apnea-hypopnea index (AHI) ≥ 15/h) who were newly treated with CPAP were included in the study and telemonitored. A group educational session was scheduled after 1 month. Technical interventions were performed at the patient’s request and during scheduled visits and the impact of each intervention on CPAP therapy compliance was collected.
ResultsBetween May 2018 and Dec 2019, 349 patients newly diagnosed with OSA were hospitalized in the sleep lab for CPAP titration and 212 patients were included (mean age 54.6 ± 13.1 years, mean BMI 31.7 ± 5.8 kg/m2, mean AHI 42.8 ± 22.0). TMg acceptance rate was 87%. Mean 6-month compliance was 275 ± 154 min, 13% stopped CPAP, and 17% were non-compliant. Correlations were observed between BMI (r = 0.15, p = 0.029), median and 95th percentile leaks (r = ?0.23 and ?0.18, p = 0.016 and 0.002), and CPAP compliance.
During follow-up, 92 interventions were required, mainly for mask change (n = 80). Pressure modification (n = 16) was the only intervention that increased CPAP use > 30 min/night, p = 0.021.
ConclusionPressure modification was the only adaptation that significantly increased CPAP compliance during the first 6 months. Remote TMg allows providing daily, accurate, and immediate feedback that could help clinicians to confirm that the CPAP treatment is effective.
相似文献Purpose
Complex sleep apnea syndrome (CompSAS) is diagnosed after an elimination of obstructive events with continuous positive airway pressure (CPAP), when a central apnea index ??5/h or Cheyne?CStokes respiration pattern emerges in patients with obstructive sleep apnea syndrome (OSAS). However, the pathophysiology of CompSAS remains controversial.Methods
Of the 281 patients with suspected OSAS, all of whom underwent polysomnography conducted at Nagoya University Hospital, we enrolled 52 patients with apnea?Chypopnea index ??15/h (age 51.4?±?13.3?years). The polysomnographic findings, left ventricular ejection fraction (LVEF), and nasal resistance were compared between the CompSAS patients and OSAS patients.Results
Forty-three patients were diagnosed with OSAS and nine patients with central sleep apnea syndrome by natural sleep PSG. Furthermore, 43 OSAS patients were classified into the OSAS patients (OSAS group, n?=?38) and the CompSAS patients (CompSAS group, n?=?5) by the night on CPAP PSG. The nasal resistance was significantly higher in CompSAS group than in OSAS group (0.30?±?0.10 vs. 0.19?±?0.07?Pa/cm3/s, P?=?0.004). The arousal index, percentage of stage 1 sleep, and oxygen desaturation index were significantly decreased, and the percentage of stage REM sleep was significantly increased in the OSAS group with the initial CPAP treatment, but not in the CompSAS group. In addition, the patients with CompSAS showed normal LVEF.Conclusion
CPAP intolerance secondary to an elevated nasal resistance might relate to frequent arousals, which could presumably contribute to an increase in central sleep apnea. Further evaluation in a large study is needed to clarify the mechanism of CompSAS. 相似文献Purpose
Continuous positive airway pressure (CPAP) is the therapy of choice for the treatment of obstructive sleep apnea (OSA). Not all patients can use CPAP therapy with adequate compliance. There is a need to develop more comfortable modes. Auto bi-level Pressure Relief-Positive Airway Pressure (ABPR-PAP) can be an alternative. We conducted a prospective double-blind, randomised trial to evaluate the efficacy and compliance of ABPR-PAP compared with CPAP in OSA patients.Methods
We included 35 CPAP naive patients (age 53.3?±?10.3?years, BMI 31.0?±?5.0?kg/m2, ESS 10.0?±?4.2) diagnosed with moderate to severe OSA who underwent a successful CPAP titration. Patients were randomised into the CPAP or the ABPR-PAP treatment group. We used the same device (BIPAP? Auto, Philips Respironics) for CPAP or ABPR-PAP. Apnea?Chypopnea index (AHI) was determined using polysomnography before (AHI 40.6?±?18.3 per hour) and after treatment.Results
Eighteen patients received CPAP and the remaining 17 received APBR-PAP. Groups were similar in terms of demographics and OSA severity. There were no serious adverse events during the trial. CPAP was fixed by a sleep expert and ABPR-PAP varied (range 5?C15?cmH2O). AHI decreased in the CPAP group to 6.4?±?5.7 per hour and in the ABPR-PAP group to 4.8?±?3.6 per hour in the first night (N?=?35). After 3?months, the AHI decreased in the CPAP group to 4.4?±?5.3 per hour and in the ABPR-PAP group to 2.6?±?3.8 per hour (N?=?32). Differences between the groups were not statistically significant. There were no differences in compliance.Conclusions
ABPR-PAP is a promising new ventilation mode that enables effective treatment of OSA patients. 相似文献Patients with obstructive sleep apnea syndrome (OSAS) have been found to exhibit lower serum vitamin D levels, even when the control groups are matched for confounding conditions. However, contradictory studies are also present. This study aimed to compare serum 25-hydroxyvitamin D (25(OH)D) levels between adult patients with OSAS and non-apneic controls and to evaluate the changes in 25(OH)D levels after 3 and 12 months of continuous positive airway pressure (CPAP) therapy.
MethodsThe study was comprised of 30 patients with OSAS and 30 controls. Serum 25(OH)D levels were determined at baseline and after 3 and 12 months of CPAP therapy in all patients with OSAS. For analysis, patients with OSAS were divided into subgroups by adherence, with adherence defined as CPAP usage for > 4 h per night on at least 70% of nights.
ResultsThe 25(OH)D levels were not significantly different between OSAS and control groups at baseline. 25(OH)D levels did not change after 3 and 12 months of CPAP therapy. Patients who were CPAP-adherent showed less reduction in 25(OH)D levels compared with non-adherent ones (21.18 ± 9.3 vs. 12.13 ± 3.8 ng/mL, p = 0.022) after 1 year. The 25(OH)D levels were significantly correlated with higher daily CPAP usage at 3 and 12 months. Mean daily CPAP usage was a significant predictor of serum 25(OH)D levels at 12 months.
ConclusionsPatients with OSAS who demonstrated good CPAP adherence showed significantly higher 25(OH)D levels after 1 year compared with those not adequately using CPAP. Long-term good CPAP adherence and highly daily CPAP usage positively affected 25(OH)D levels in patients with OSAS.
相似文献Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent episodes of hypoxemia and hypercapnia during sleep. The aim of this study was to determine whether OSAS causes significant changes in corneal endothelium detectable by specular microscopy.
MethodsThis prospective, cross-sectional study compared the specular microscopic features of the corneal endothelium of patients with OSAS and age-and gender-matched controls. Patients diagnosed with OSAS by polysomnography in the sleep unit were classified using apnea-hypopnea indexes into two groups as mild-moderate OSAS group and severe OSAS group. All participants were divided into three age groups: 30–45, 46–60, and >?60 years. Corneal endothelial cell density (ECD), percentage of hexagonal cells (Hex), and coefficient of variation of cell area (CV) were obtained using a non-contact specular microscope. The measurements of each group were compared statistically.
ResultsA total of 66 patients (51.1?±?9.4 years) and 88 controls (49.2?±?10.5 years) were examined. The mild-moderate OSAS group and the severe OSAS group had no significant differences in measures of specular microscopy compared with the controls (ECD, p?=?0.84; Hex, p?= 0.18; CV, p?=?0.41). The mean values of ECD, Hex, and CV were 2552.56?±?302.49 cells/mm2, 54.13?±?8.13%, and 36.41?±?5.92, respectively, in the mild-moderate OSAS group; 2510.52?±?377.12 cells/mm2, 54.85?±?8.68%, and 34.77?±?5.02, respectively, in the severe OSAS group; 2543.37?±?286.94 cells/mm2, 51.89?±?9.09%, and 36.03?±?5.32, respectively, in the control group.
ConclusionsThere were no significant differences in corneal endothelial features between patients and controls. Although OSAS causes systemic hypoxia, its effects do not appear to result in corneal endothelial alterations detectable by specular microscopy.
相似文献Nasal continuous positive airway pressure (CPAP) alleviates sleepiness in patients with obstructive sleep apnoea syndrome (OSAS), but part of OSAS patients keep gaining weight. Leptin and insulin-like growth factor-1 (IGF-1) interact with energy balance, and CPAP therapy has been suggested to influence these endocrine factors. We hypothesised that leptin would decrease during long-term CPAP therapy, and weight gain would associate with OSAS severity, lower CPAP adherence, lower IGF-1, and leptin concentrations.
MethodsConsecutive patients (n?=?223) referred to sleep study with suspected OSAS were enrolled. Patients underwent cardiorespiratory polygraphy at baseline. Questionnaires were completed, and blood samples were drawn both at baseline and after 3 years. A total of 149 (67%; M 65, F 84) patients completed the follow-up. Plasma samples were available from 114 patients, 109 of which with CPAP adherence data (49 CPAP users, 60 non-users).
ResultsAt baseline, the CPAP users were more obese and had more severe OSAS than the non-users. Leptin concentrations did not differ. After follow-up, leptin concentrations were higher in CPAP users (30.2 ng/ml vs. 16.8 ng/ml; p?=?0.001). In regression analysis, increase in leptin concentrations was independent of age, baseline body mass index (BMI), or the change in BMI. Leptin concentrations increased among females (??8.9 vs. 12.7 ng/ml; p?<?0.001); whereas in men, CPAP did not have an effect, if not opposed the natural decrease in leptin observed in men not using CPAP. Change in IGF-1 levels did not differ.
ConclusionsOur results suggest increase in leptin concentrations during long-term CPAP therapy among females.
相似文献To determine the 1-year and 3-year adherence rates with Positive Airway Pressure (PAP) therapy in patients with schizophrenia compared to matched controls.
MethodsA case–control retrospective analysis was performed in a Veterans Affairs hospital. All symptomatic patients with schizophrenia ever started on PAP therapy between 2007 and 2015 were compared with controls matched for severity of sleep apnea based on AHI, BMI, and age at the time of diagnosis.
ResultsTotal number of subjects in both groups was 39. Mean AHI among cases and controls was 27.63 ± 22.16 and 33.59 ± 44.04 (p = 0.32), mean BMI was 34.91 ± 5.87 and 33.92 ± 5.21 (p = 0.43), and mean age at diagnosis was 53.6 ± 11.75 and 55.97 ± 11.92 (p = 0.36), respectively. There was no statistically significant difference in PAP use between patients with schizophrenia and controls at 1-year (percent days device use > 4 h—36.43% ± 31.41 vs. 49.09% ± 38.76; p = 0.17) and 3-year (percent days device use > 4 h—42.43 ± 35.50 vs. 60.53 ± 38.56; p = 0.089) visits
ConclusionsPAP adherence and usage is not significantly different among patients with schizophrenia compared to matched controls. Therefore, schizophrenia does not appear to influence CPAP compliance.
相似文献Obstructive sleep apnea-hypopnea syndrome (OSAHS) may affect cerebrovascular reactivity (CVR), representing cerebrovascular endothelial function, through complex cerebral functional changes. This study aimed to evaluate the change of CVR after 1-month and 6-month mandibular advancement device (MAD) treatment of patients with carotid atherosclerosis (CAS) combined with OSAHS.
MethodsPatients with carotid atherosclerosis combined with OSAHS who voluntarily accepted Silensor-IL MAD therapy were prospectively enrolled. All patients underwent polysomnographic (PSG) examinations and CVR evaluation by breath-holding test using transcranial Doppler ultrasound at baseline (T0), 1 month (T1), and 6 months (T2) of MAD treatment.
ResultsOf 46 patients (mean age 54.4 ± 12.4 years, mean body mass index [BMI] 27.5 ± 4.5 kg/m2), 41 patients (responsive group) responded to the 1-month and 6-month treatment of MAD, an effective treatment rate of 89%. The remaining 5 patients (non-responsive group) were younger (47.4?±?13.5 years) and had a higher BMI (35.8?±?1.8 kg/m2). The responsive group had an improvement of apnea-hypopnea index (AHI) (events/h) from 33.0?±?25.0 (T0) to 12.4?±?10.4 (T1) and 8.7?±?8.8 (T2), P?<?0.001; minimum arterial oxygen saturation (minSpO2) (%) increased from 79.8?±?9.1 (T0) to 81.8?±?9.4 (T1) and 85.2?±?5.4 (T2), P?<?0.01; longest apnea (LA) (s) decreased from 46.5?±?23.1 (T0) to 33.3?±?22.7 (T1) and 29.4?±?18.5 (T2), P?<?0.001; T90 (%) decreased from 10.3?±?14.9 (T0) to 6.1?±?11.8 (T1) and 3.3?±?7.5 (T2), P?<?0.05. Sleep architecture of these patients also improved significantly. The responsive group had a significant increase in left, right, and mean breath-holding index (BHI): left BHI(/s) from 0.52?±?0.42 (T0) to 0.94?±?0.56 (T1) and 1.04?±?0.64 (T2), P?<?0.01; right BHI(/s) from 0.60?±?0.38 (T0) to 1.01?±?0.58 (T1) and 1.11?±?0.60 (T2), P?<?0.01; mean BHI(/s) from 0.56?±?0.38 (T0) to 0.97?±?0.55 (T1) and 1.07?±?0.59 (T2), P?<?0.01), suggesting improved CVR.
ConclusionEffective MAD therapy is beneficial for restoring cerebrovascular endothelial function in patients with CAS and OSAHS in a short period (1 month and 6 months).
Trial registrationClinical trial registration number: NCT03665818. September 11, 2018.
相似文献