CPAP compliance in patients with obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is characterized by repeated cessations of breathing during sleep. Major symptoms of this disease are excessive daytime sleepiness, snoring, and witnessed apnea. Most of the patients are treated with CPAP. In this study, we aimed to evaluate the factors affecting adherence to the CPAP treatment. Seventy-one patients were enrolled to this study. Patients were divided into three groups according to CPAP usage. Group I consisted of patients who had never used CPAP, group II consisted of patients who had used CPAP occasionally, and group-III patients had used CPAP treatment regularly. Group-III patients had higher apnea–hypopnea index (AHI) than groups I and II (respectively, 56.6 ± 27.7, 26.3 ± 7.5, and 32.3 ± 7.06; p < 0.000 for both). Oxygen desaturation index was significantly higher in group-III patients comparing to groups I and II (44.6 ± 22.3, 15.9 ± 8.3, and 25.6 ± 9.5; p < 0.000 for all). Our findings have shown that only very severe patients use the CPAP device regularly (mean AHI 56.6 ± 27.7). Compliance to CPAP treatment seemed to be poor in patients with moderate to severe, AHI about 30, OSAS. Considering the well-established benefits of CPAP treatment in patients with true indications, patients should be encouraged to use CPAP regularly, and complications of OSAS should be keynoted.     

持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者体内激素水平的影响

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)导致夜间低氧和正常睡眠节律的紊乱,引起体内激素分泌的改变和激素抵抗的增加。而持续气道正压通气(CPAP)治疗在改善夜间睡眠质量的同时也纠正了体内激素水平的紊乱,为CPAP在阻塞性睡眠呼吸暂停(OSA)方面的应用提供了更充分的依据。     

正压通气治疗睡眠呼吸暂停综合征并代谢综合征的研究

目的：研究持续气道内正压通气（CPAP）对睡眠呼吸暂停综合征（SAS）并代谢综合征（MS）的疗效。方法：158例SAS并MS患者被随机分成两组，即CPAP治疗组（治疗组）和药物治疗组（对照组），治疗组在药物组治疗基础上加用CPAP治疗。两组患者于治疗前、治疗4周后分别行呼吸睡眠监测：动脉血氧饱和度（SaO2）、呼吸参数，并测空腹血糖（FPG）、空腹胰岛素（FINS）、餐后2h血糖（2hPG）、餐后2h胰岛素（2hPINS）、胰岛素敏感性指数（ISI）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、体重指数（BMI）、收缩压（SBP）、舒张压（DBP）的变化。结果：与对照组比较，治疗组治疗后呼吸暂停和低通气均明显减少，打鼾消失，低氧发作次数减少，最低SaO2明显提高（P〈0．01）；同时血糖、胰岛素、TC、TG浓度，SBP、DBP均明显降低，HDL-C水平明显升高，与对照组比较有明显差异（P〈0．01）。结论：CPAP治疗SAS并MS除能改善SAS病情外，还能加强药物疗效，改善代谢参数，降低血压，降低心脑血管病危险因素的程度。     

Optimising CPAP accommodation time by feedback-supported training phases in patients with obstructive sleep apnea syndrome

Mask fitting and accommodation of CPAP-devices are of great importance. Only by accommodation over several hours, problems concerning mask size and fixation of mask are recognised and solved. Many patients overestimate the time they needed for achieving accommodation. We therefore asked whether by visualizing the time required for accommodation the accommodation time can be prolonged. Additionally we compared the subjective estimation on the time with the objectively measured time. We studied 20 patients with sleep apnoea syndrome, 13 men and 7 women, age 53 +/- 4 years, apnoea/hypopnoea index 32 +/- 16, lowest O2 saturation 83 +/- 6%. In a randomized cross-over study, a clock with a large 7 segment-display was either not visible in one setting, so that the patient had no control of the training-time, or the time was visible on the display. Thus the patient could possibly be motivated to increase his time of CPAP-accommodation during the day. The pressure-controlled clock counted only the time during which the pressure was above 4 HPa. In the setting with visible time-counter the accommodation time was 265.8 +/- 114 min, if the counter was not visible, time was only 210.8 +/- 91 min. If the patient cannot observe the time-counter he over-estimates the objectively measured time by half an hour (247.2 +/- 97.5 estimated vs. 210.8 +/- 91.0 actually). Thus the self-control of CPAP-accommodation by a visible clock leads to a significant prolongation of the exercise time. The estimation by the patient is only a limited means to evaluate the time of CPAP accommodation during the day.     

The role of telemedicine in CPAP compliance for patients with obstructive sleep apnea syndrome

The objective of this study was to compare continuous positive airway pressure (CPAP) use, functional status, and client satisfaction in obstructive sleep apnea syndrome (OSAS) patients randomized to either telemedicine support or traditional care. In our university-affiliated sleep disorders center, patients with OSAS who were initiating CPAP therapy were randomized to receive telemedicine support vs traditional follow-up care for 30 days. The telemedicine group received a “Health Buddy” computer that provided daily Internet-based informational support and feedback for problems experienced with CPAP use. At 30 days, there were no significant differences in the hours of CPAP use between groups receiving traditional care (M=4.22, SD±2.05) and telemedicine support (M=4.29, SD±2.15), p=0.87, or in the proportion of nights with CPAP use between the traditional (M=50%±33.8) and telemedicine groups (M=47%±34.2), p=0.61. No significant differences were found between groups in functional status (M=2.27±4.56 vs M=2.03±3.88, respectively, p=0.76) or client satisfaction (M=28.0±3.51 vs M=28.5±3.05, p=0.43). Patients in the telemedicine and traditional groups had similar CPAP use, functional status, and client satisfaction. The data suggest that telemedicine support as provided by our model compares favorably with traditional care. As a provider-extender, telemedicine support for patients initiating use of CPAP may allow for greater practice efficiency while maintaining quality of care. Disclosure Statement: Supported by the Telemedicine Directorate, Walter Reed Army Medical Center, Washington, DC.     

Evaluation of sleep fragmentation by EEG spectrography in patients with obstructive sleep apnea syndrome]

Sleep fragmentation is considered to have a central role in the pathophysiology of sleep-disordered breathing. However, the evaluation of sleep fragmentation can be very troublesome work. We sought to evaluate sleep fragmentation in 10 patients with obstructive sleep apnea syndrome by utilizing fast-fourier transforms to render their sleep encephalograms as spectrograms (horizontal axis: time, vertical axis: frequency, color: power). Detailed 5-minute spectrograms revealed relatively uniform patterns of change in EEG spectra during and after apnea episodes. In non-REM sleep, delta activity during apnea was followed by alpha and beta activity during resumed breathing. In REM sleep, flat and low-power spectral patterns during apnea were followed by relatively weak alpha and beta activity during resumed breathing. In compressed, 1-hour views of the spectrograms, repeated apnea events appeared as vertical striped patterns of spectral change. These patterns were thought to be representative of sleep fragmentation. The spectrographic display of EEGs may be a very simple and easy method for the evaluation of sleep-fragmentation in sleep disordered breathing.     

Nasopharyngeal symptoms in patients with obstructive sleep apnea syndrome. Effect of nasal CPAP treatment

BACKGROUND: Nasal side effects are often reported during nasal continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea syndrome (OSAS) and may make the use of nasal CPAP difficult. OBJECTIVE: The aim of this study was to evaluate the effect of nasal CPAP on nasopharyngeal symptoms in OSAS patients. METHODS: The frequency and severity of nasopharyngeal symptoms and signs were prospectively evaluated in 49 consecutive OSAS patients (37 men, 12 women, mean (SD) age 54 (7) years, body mass index 35 (6) kg/m2) immediately before and after 6 months' treatment with nasal CPAP. RESULTS: Nasopharyngeal symptoms were common already before starting nasal CPAP: 74% of patients reported dryness, 53% sneezing, 51% mucus in the throat, 45% blocked nose, and 37% rhinorrhea. During nasal CPAP treatment, severity and frequency of sneezing (75%) and rhinorrhea (57%) increased. This increase was related to the season when nasal CPAP was applied, and was more profound in winter than in summer. Mild abnormalities on rhinoscopy and paranasal sinus X-rays were common both at baseline and at follow-up with no significant change during treatment. CONCLUSIONS: Nasopharyngeal problems were found to be frequent in patients with OSAS before nasal CPAP treatment, and tended to increase during the treatment.     

Spousal involvement in CPAP adherence among patients with obstructive sleep apnea

Purpose  

To determine the effects of spousal involvement on continuous positive airway pressure (CPAP) adherence and response to CPAP problems in male patients with obstructive sleep apnea (OSA).     

Clinical usefulness of a cardiopulmonary sleep study in patients with sleep apnea syndrome]

Although polysomnography is indispensable in the diagnosis of sleep apnea syndrome (SAS), a common disease in Japan, it is a time-consuming procedure. We therefore assessed the clinical usefulness of a cardiopulmonary sleep study (CPSS), which monitors indices of respiratory and circulatory kinetics during sleep. Of ninety male patients (50 +/- 11 years old, BMI: 27 +/- 4), those with apnea indices (AI) > 5, as determined using an apnomonitor, underwent CPSS with a Night Watch System. Sixty-nine patients with indications for nasal CPAP (NCPAP) therapy underwent overnight CPSS and the optimum pressure was determined. AI was 31 +/- 17, whereas CPSS showed an apnea-hypopnea index of 49 +/- 24, a mean SaO2 of 93 +/- 3%, and a minimum SaO2 of 71 +/- 11%, indicating severe OSAS. The mean optimum pressure was 10 +/- 2 cm H2O, and the compliance was 86%, which was comparatively good. As CPSS can be performed on many patients in a short time, it may be useful for the early diagnosis and initial treatment of SAS.     

Sleepwalking precipitated by treatment of sleep apnea with nasal CPAP

A 33-year-old man with a long history of snoring, observed apneic episodes, and excessive daytime sleepiness, underwent all-night polysomnography, which demonstrated severe obstructive sleep apnea. During the nasal CPAP trial, two episodes of sleepwalking were observed during a period of delta sleep rebound.     

Measurement of mask leakage during CPAP in patients with obstructive sleep apnea

To improve the compliance of patients with obstructive sleep apnoea tight fitting nasal masks are necessary. It would be very useful to to measure the mask leakage during the recommended pressure for the treatment at home. We studied therefore the influence of different sizes and types of masks on the air leaks during the adaptation procedure. We investigated 20 patients, mean age 60.8 +/- 11.9 years, AHI 31 +/- 17, lowest oxygen saturation 81 +/- 10.3% mean CPAP-9.9 +/- 1.6. Randomized cross over we applied CPAP with different masks during wakefulness. The pressure was increased from 6 to 13 mbar by steps of 1 mbar. The mask leak was measured by Autoset. RESULTS: Using the best mask (selected from different sizes and different brands) the mask leak was 0.11 +/- 0.9 L/sec. If the patient used a mask (only one brand but selected from different sizes) or one standard mask the mask leak doubled respectively tripled. To reduce side effects and improve compliance we recommend therefore quantification of the mask leak to find the best fitting mask.     

Nasal CPAP reduces gastroesophageal reflux in obstructive sleep apnea syndrome.

Anecdotal reports suggest that obstructive sleep apnea syndrome (OSAS) patients may suffer from frequent nocturnal gastroesophageal reflux (GER) and that nasal continuous positive airway pressure may be an effective form of antireflux therapy in this population. To confirm these clinical impressions, we performed two consecutive days of 24-h esophageal pH monitoring, nocturnal esophageal pressure recording, and polysomnography on six OSAS patients complaining of regular nocturnal GER. On night one, the patients were untreated. Five of six subjects had abnormal amounts of nocturnal GER. Arousal, movement and swallowing were more frequent (p less than 0.043) and nadir intrathoracic pressure lower (p less than 0.005) in the 30 s prior to precipitous drops in esophageal pH (greater than or equal to 2 pH units) than during random control periods. A direct association between obstructive apneas and GER was not identified. On night two, nasal CPAP was administered and successfully treated apnea in five of six subjects. In these patients, there was also dramatic reduction in GER frequency and duration on CPAP. The mean percentage of time pH less than 4 dropped from 6.3 +/- 2.1 to 0.1 +/- 0.1 percent (p less than 0.025). We believe that OSAS may predispose to nocturnal GER by lowering intrathoracic pressure and increasing arousal and movement frequency. Nasal CPAP can correct these predisposing factors and reduce GER.     

无创呼吸机治疗睡眠呼吸暂停综合征伴严重心律失常一例

睡眠呼吸暂停综合征（obstruction sleep apnea syndrome,OSAS）是指各种原因导致睡眠状态下反复出现呼吸暂停,引起低氧血症、高碳酸血症、睡眠中断,从而使机体发生一系列病理生理改变的临床综合征,可分为中枢型、周围型及混合型.目前OSAS引起心律失常的报道愈来愈多.我们发现一例因OSAS导致的严重窦性停搏（10.8 s）,予以无创呼吸机睡眠时持续正压通气治疗后心律失常好转,现总结报道如下.     

阻塞性睡眠呼吸暂停综合征患者的血氧饱和度和肺功能变化

目的分析阻塞性睡眠呼吸暂停综合征（OSAHS）患者及OSAHS合并慢性阻塞性肺病（COPD）亦称重叠综合征患者的饱和度和肺功能变化特点。方法对经过多导睡眠图（PSG）、肺功能仪检查的60例患者进行回顾性分析。结果OSAHS患者与重叠综合征患者的呼吸暂停低通气指数（AHI）、最长呼吸暂停时间（LAT）、最低脉氧饱和度（LSaO2）、平均脉氧饱和度（MSaO2）与COPD患者均有明显差异;而且重叠综合征患者肺通气功能受损严重。结论重叠综合征患者的姐氧饱和度下降和肺通气功能受损比COPD患者显著,对夜间缺氧明显的COPD患者及时检测多导睡眠图,便于及早发现老年人OSAHS的发生。     

Alternatives to CPAP in the treatment of the obstructive sleep apnea syndrome

The obstructive sleep apnoea syndrome (OSAS) results in excessive daytime sleepiness, impaired quality of life, and is associated with an increased risk of traffic accidents and cardiovascular disease. Nasal continuous positive airway pressure (CPAP), the standard treatment for OSAS provides immediate relief of symptoms and has only minor side effects. Nevertheless, an alternative treatment is needed if CPAP is not feasible for medical or psychological reasons. Removable oral appliances that advance the mandible when fitted to the teeth during sleep also improve nocturnal breathing disturbances, symptoms, quality of life, vigilance and blood pressure in OSAS patients. Their long-term effectiveness and side effects require further study. In morbidly obese patients suffering from OSAS bariatric surgery should be considered as a treatment that reduces obesity and at the same time improves OSAS. In selected patients including those with adeno-tonsillar hypertrophy, and cranio-facial malformations various surgical techniques that enlarge the upper airway may be a treatment option for OSAS.     

持续气道正压通气治疗阻塞性睡眠呼吸暂停相关性高血压的疗效观察

目的:评估持续气道正压通气(CPAP)对严重阻塞性睡眠呼吸暂停(OSA)合并Ⅱ~Ⅲ级高血压患者的疗效。方法:32名高血压合并严重OSA的患者(呼吸暂停低通气指数30),予以3联抗高血压药物(缬沙坦160 mg+氨氯地平5~10 mg+氢氯噻嗪25 mg),3周后将患者随机分为2组,治疗组给予有效CPAP治疗(压力4~15cm H2O),每晚4 h;对照组给予安慰剂CPAP治疗(压力4 cm H2O),治疗3周。分别在降压药物治疗前、后及CPAP治疗3周后测量每位患者的诊室血压、动态血压、动态动脉硬化指数(AASI)、主动脉压、颈-股动脉脉搏波传导速度(cf PWV)、收缩波增强指数。结果:降压药物治疗3周之后,诊室血压及中心动脉压均有明显下降(P0.05),有效CPAP治疗3周后,两指标均有进一步的下降(P0.05)。降压药物治疗之前有94%的患者cf PWV超过正常范围(脉搏波传导速度12 ms),降压治疗后cf PWV下降了[(1.9±1.0)ms,P0.01],有效CPAP治疗后cf PWV进一步下降了0.7 ms(P0.05)。降压药物+有效CPAP组有37.5%的患者PWV超过正常,单纯降压药物治疗患者中有56%的患者PWV超过正常,降压药物+安慰剂CPAP组有53%的患者PWV超过正常。只有降压药物和CPAP联合治疗才能获得增强指数和AASI的显著下降以及主动脉和肱动脉血压的进一步降低。结论:OSA合并Ⅱ~Ⅲ级高血压患者给予有效CPAP治疗3周,患者诊室血压、动态血压、中心血压有了进一步下降,同时动脉硬化参数,如cf PWV、AASI和增强指数有显著改善。     

Effect of musculoskeletal pain on sleep architecture in patients with obstructive sleep apnea

Rationale

Obstructive sleep apnea and chronic musculoskeletal pain both affect sleep. Sleep architecture of patients suffering from both is largely unknown.

Objectives

This study seeks to define the sleep architecture of patients with chronic musculoskeletal pain and obstructive sleep apnea.

Methods

Patients with obstructive sleep apnea diagnosed by sleep study during the past 3 years were included. Patients with clinical documentation of chronic musculoskeletal pain constituted cases, while others were classified as controls.

Measurements

Demographics, clinical factors affecting sleep, medications affecting sleep, Epworth sleepiness scores, and polysomnographic parameters; total sleep time, sleep efficiency, sleep stages, rapid eye movement (REM) sleep onset, apnea–hypopnea index, arousal index, and periodic leg movements were recorded.

Results

There were 393 subjects: 200 cases (obstructive sleep apnea and chronic musculoskeletal pain) and 193 controls (obstructive sleep apnea alone). There was significant difference in total sleep time (274.5?±?62.5 vs. 302.2?±?60.1 min, p?=?0.0001), sleep efficiency (73.54?±?15.8 vs. 78.76?±?14.3 %, p?=?0.0003), and REM sleep onset (148.18?±?80.5 vs. 124.8?±?70.9 min, p?=?0.006). Subgroup analysis within the obstructive sleep apnea with chronic musculoskeletal pain group revealed that subjects had better total sleep time and sleep efficiency if they were on REM sleep affecting medications (suppressants and stimulants). Those on REM sleep suppressants slept 25.7 min longer and had 6.4 % more efficient sleep than those not on REM suppressants (p?=?0.0034 and p?=?0.0037).

Conclusion

Patients with obstructive sleep apnea and chronic musculoskeletal pain sleep not only significantly less but also with inferior sleep quality. Their REM sleep is also less in duration and its onset is delayed. Despite low TST and SE, these patients may not exhibit sleepiness.     

阻塞性睡眠呼吸暂停综合征的睡眠结构改变

目的研究阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）病情严重程度及持续气道内正压（ＣＰＡＰ）治疗对睡眠结构的影响。方法通过分析多导睡眠图，分析了３１例非ＯＳＡＳ者和１４７例ＯＳＡＳ患者的睡眠结构及ＣＰＡＰ治疗对１１例ＯＳＡＳ患者睡眠结构的影响。结果与对照组相比ＯＳＡＳ组的睡眠结构存在如下异常：（１）睡眠期转换次数（ＯＳＡＳ组：１２０±７１，对照组：９２±６０，Ｐ＝０．０１０６）、快波睡眠次数（ＯＳＡＳ组：８８±５４，对照组：６５±４５，Ｐ＝０．００７５）、醒觉次数（ＯＳＡＳ组：２７±２８，对照组：１９±１８，Ｐ＝０．０１７）差异有显著性；（２）慢波睡眠次数（ＯＳＡＳ组：５±９，对照组：８±８，Ｐ＝０．００３５）、占总睡眠时间的比例（ＯＳＡＳ组：５％±８％，对照组：８％±９％，Ｐ＝０．００６２）及慢波睡眠的缺乏率（ＯＳＡＳ组：４８％，对照组：２６％，Ｐ＜０．０５）亦明显不同；（３）睡眠呼吸紊乱指数低于２５的ＯＳＡＳ者与对照组比较睡眠各参数相差不大；（４）ＣＰＡＰ治疗能使上述参数得到不同程度的改善。结论ＯＳＡＳ主要引起睡眠的破碎、深睡减少及浅睡增加，且与病情的严重程度有一定关系。ＣＰＡＰ治疗能够改善这些紊乱。     

Systemic hypertension in sleep apnea syndrome. Relationship with sleep architecture and breathing abnormalities

To examine the possible relationship between systemic HT and SAS we compared 21 hypertensive (HT+) and 29 normotensive (HT-) patients for morphologic characteristics, sleep disturbances and respiratory events monitored during a full night polysomnography. There was no significant difference between HT+ and HT- patients with respect to age, weight, BMI, sleep stage distribution and disorganization, apnea-hypopnea index (number of episodes per hour of sleep) and duration (minutes per hour of sleep) nor O2 saturation indices: mean nocturnal and minimum O2 saturation. We conclude therefore that HT in SAS patients is not directly related to morphologic characteristics, sleep disturbances and breathing abnormalities.