Periodic limb movements and obstructive sleep apneas before and after continuous positive airway pressure treatment

Periodic limb movements during sleep (PLMS) and obstructive sleep apnea syndrome (OSAS) are two common sleep disorders. The similarity in periodicity of periodic limb movements (PLMs) and obstructive sleep apneas (OSAs) led us to hypothesize the existence of a common central generator responsible for the periodicity of both OSAs and PLMs. In order to test this hypothesis, we compared apnea periodicity before continuous positive airway pressure (CPAP) treatment with PLMs periodicity during CPAP treatment in 26 OSA patients, consecutively recorded and treated in our sleep laboratory. The investigation on CPAP was performed twice, once during the initial evaluation and once during a follow-up evaluation after 3 months of home treatment with CPAP. Our results showed that, in this sample, 16 patients out of 26 had an association of OSAS and PLMS, defined as the occurrence of at least 5 PLMs per hour of sleep. The mean apnea interval - measured as the time between the beginning of two successive apneas - was 43.1 s (+/-15.2, SD) and the mean PLM interval - calculated in the same way - was 29.6 s (+/-15.2) during the baseline night, 28.5 s (+/-15.7) during the first CPAP night, and 29.8 s (+/-14.8) during the second CPAP night. Thus, the periodicity of the two phenomena (apneas and PLMs) was different, both before and after CPAP treatment (P< 0.05). When considering the interval between the end of an event (apnea or PLM) and the beginning of the next one the mean apnea interval was 19.5 s (+/-11. 6), and the mean PLM interval was 28.1 s (+/-15.3) during the untreated night, 26.6 s (+/-16) during the first CPAP night and 27.9 s (+/-15) during the second CPAP night. The shortening of apnea intervals with this method of measuring intervals reflects the longer duration of apneas as compared to PLMs. Again the intervals between PLMs were not different between each other but the intervals between apneas were different from the intervals between PLMs (P< 0. 05) These results show that the periodicity of PLMs is different from that of OSAs, suggesting that sleep apneas and PLMs are not generated by a common central generator.     

Continuous positive airway pressure lowers blood pressure in hypertensive patients with obstructive sleep apnea

Summary Question of the study Obstructive sleep apnea (OSA) and hypertension are frequently associated and probably causally related. We investigated the influence of continuous positive airway pressure (CPAP) on blood pressure (BP) in OSA. Patients and Methods Fourty-four patients in whom CPAP-therapy had been successfully applied for treatment of OSA (median apnea-hypopopnea-index [AHI] 57.5/h) were included. Non-invasive 24-hour BP was measured at 15  min intervals before and with CPAP. Results After 1 – 3 days of CPAP, 24-hour systolic and diastolic BP in the hypertensive patients (n = 32) decreased from a median of 141 (129 – 173, 25 % – 75 % interquartile range) mmHg to 136 (118 – 157) mmHg (p = 0.004) and from 90 (80 – 107) mmHg to 88 (77 – 99) mmHg (p = 0.001), respectively, but was unchanged in the normotensives (n = 10). After 4 – 6 months of CPAP, 24-hour systolic and diastolic BP in a hypertensive subgroup (n = 19) decreased from a median of 140 (131 – 142) mmHg to 131 (122 – 143) mmHg (p = 0.01) and from 88 (86 – 94) mmHg to 84 (80 – 87) mmHg (p = 0.02), respectively, but was unchanged in a normotensive subgroup (n = 8). After long-term CPAP, there was a small weight reduction in the hypertensive patients. Subgroup analysis of 13 hypertensives with stable weight confirmed a significant BP-reduction. Conclusions In OSA with associated hypertension, CPAP has a specific BP-lowering effect. This suggests that both disorders are causally related.     

Efficacy of continuous positive airway pressure treatment on 5‐year survival in patients with ischaemic stroke and obstructive sleep apnea: a randomized controlled trial

The main purpose of the present analysis is to assess the influence of introducing early nasal continuous positive airway pressure (nCPAP) treatment on cardiovascular recurrences and mortality in patients with a first‐ever ischaemic stroke and moderate–severe obstructive sleep apnea (OSA) with an apnea–hypopnea index (AHI) ≥20 events h^?1 during a 5‐year follow‐up. Patients received conventional treatment for stroke and were assigned randomly to the nCPAP group (n = 71) or the control group (n = 69). Cardiovascular events and mortality were registered for all patients. Survival and cardiovascular event‐free survival analysis were performed after 5‐year follow‐up using the Kaplan–Meier test. Patients in the nCPAP group had significantly higher cardiovascular survival than the control group (100 versus 89.9%, log‐rank test 5.887; P = 0.015) However, and also despite a positive tendency, there were no significant differences in the cardiovascular event‐free survival at 68 months between the nCPAP and control groups (89.5 versus 75.4%, log‐rank test 3.565; P = 0.059). Early nCPAP therapy has a positive effect on long‐term survival in ischaemic stroke patients and moderate–severe OSA.     

Impact of continuous positive airway pressure (CPAP) on quality of life in patients with obstructive sleep apnea (OSA)

Obstructive sleep apnea is a chronic illness with increasing prevalence. In addition to associated cardiovascular comorbidities, obstructive sleep apnea syndrome has been linked to poor quality of life, occupational accidents, and motor vehicle crashes secondary to excessive daytime sleepiness. Although continuous positive airway pressure is the gold standard for sleep apnea treatment, its effects on quality of life are not well defined. In the current study we investigated the effects of treatment on quality of life using the data from the Apnea Positive Pressure Long‐term Efficacy Study (APPLES), a randomized controlled trial of continuous positive airway pressure (CPAP) versus sham CPAP. The Calgary Sleep Apnea Quality of Life Index (SAQLI) was used to assess quality of life. Overall we found no significant improvement in quality of life among sleep apnea patients after CPAP treatment. However, after stratifying by OSA severity, it was found that long‐term improvement in quality of life might occur with the use of CPAP in people with severe and possibly moderate sleep apnea, and no demonstrable improvement in quality of life was noted among participants with mild obstructive sleep apnea.     

Effects of continuous positive airway pressure on blood pressure in obstructive sleep apnea patients: The Apnea Positive Pressure Long‐term Efficacy Study (APPLES)

Obstructive sleep apnea is associated with hypertension, and short‐term studies have demonstrated a modest reduction in blood pressure with continuous positive airway pressure therapy. We evaluated the effects of continuous positive airway pressure versus sham continuous positive airway pressure on blood pressure in 1,101 participants with obstructive sleep apnea from the Apnea Positive Pressure Long‐term Efficacy Study, a randomized, sham‐controlled double‐blinded study designed to assess the impact of continuous positive airway pressure on neurocognition. Participants with apnea?hypopnea index ≥ 10 were randomly assigned to continuous positive airway pressure or sham continuous positive airway pressure. Blood pressures measured in the morning and evening at baseline, 2 months and 6 months were analysed post hoc using a mixed‐model repeated‐measures analysis of variance. The largest magnitude reduction was approximately 2.4 mmHg in morning systolic pressure that occurred at 2 months in the continuous positive airway pressure arm as compared with an approximate 0.5 mmHg reduction in the sham group (continuous positive airway pressure effect ?1.9 mmHg, p = .008). At 6 months, the difference between groups was diminished and no longer statistically significant (continuous positive airway pressure effect ?0.9 mmHg, p = .12). Sensitivity analysis with use of multiple imputation approaches to account for missing data did not change the results. Treatment with continuous positive airway pressure for obstructive sleep apnea reduces morning but not evening blood pressure in a population with well‐controlled blood pressure. The effect was greater after 2 than after 6 months of treatment.     

Effects of continuous positive airway pressure treatment on glycaemic control and insulin sensitivity in patients with obstructive sleep apnoea and type 2 diabetes: a meta-analysis

Introduction

Obstructive sleep apnoea (OSA) is a prevalent disorder characterised by repetitive upper-airway obstruction during sleep, and it is associated with type 2 diabetes. Continuous positive airway pressure (CPAP) is the primary treatment for OSA. Prior studies investigating whether CPAP can improve insulin resistance or glucose control in OSA patients have resulted in conflicting findings. This meta-analysis investigated whether CPAP treatment could improve glucose metabolism and insulin resistance in patients with OSA and type 2 diabetes.

Material and methods

We performed a systematic literature search using Medline, Cochrane, EMBASE, and Google Scholar databases for randomised controlled prospective studies that investigated the effect of CPAP on glycaemic control or insulin sensitivity in subjects with type 2 diabetes.

Results

The combined standard (STD) paired difference in mean change in the levels of glycated haemoglobin (HbA_1c) was –0.073% (standard error (SE): 0.126), indicating that CPAP treatment did not alter HbA_1c levels. The combined STD paired difference in mean change of insulin sensitivity was observed as 0.552 µmol/kg • min (SE = 0.196) and indicated insulin sensitivity significantly increased with CPAP treatment (p = 0.005).

Conclusions

We found that the CPAP treatment did not alter HbA_1c levels but did significantly improve insulin resistance, indicating treating OSA can positively impact the symptoms of type 2 diabetes.     

Effects of continuous positive airway pressure treatment on aortic stiffness in patients with resistant hypertension and obstructive sleep apnea: A randomized controlled trial

Resistant hypertension (RHT) is associated with obstructive sleep apnea (OSA) and increased aortic stiffness, measured by carotid‐femoral pulse wave velocity (cf‐PWV). We aimed to evaluate in a randomized controlled trial, the effect of Continuous positive airway pressure (CPAP) treatment on cf‐PWV in comparison with a control group in patients with RHT and moderate‐severe OSA. One‐hundred and sixteen patients were randomized to 6‐month CPAP treatment (56 patients) or no therapy (60 patients), while keeping their antihypertensive treatment unchanged. Carotid‐femoral pulse wave velocity was performed at the beginning and end of the 6‐month period. Intention‐to‐treat intergroup differences in cf‐PWV changes were assessed by a generalized mixed‐effects model with the allocation group as a fixed factor and adjusted for age, sex, changes in mean arterial pressure and the baseline cf‐PWV values. Subgroup sensitivity analyses were performed, excluding patients with low CPAP adherence and low cf‐PWV at baseline. CPAP and control groups had similar clinic‐laboratorial characteristics. Patients had a mean cf‐PWV of 9.4 ± 1.6 m/s and 33% presented cf‐PWV > 10 m/s. During treatment, the control group had a mean increase in cf‐PWV of +0.43 m/s (95% confidence interval [CI], +0.14 to +0.73 m/s; p = .005), whereas the CPAP group had a mean increase of +0.03 m/s (95% CI, ?0.33 to +0.39 m/s; p = .87), resulting in a mean difference in changes between CPAP and control of ?0.40 m/s (95% CI, ?0.82 to +0.02 m/s; p = .059). Subgroup analyses did not change the results. In conclusion, a 6‐month CPAP treatment did not reduce aortic stiffness, measured by cf‐PWV, in patients with RHT and moderate/severe OSA, but treatment may prevent its progression, in contrast to no‐CPAP therapy.     

Good long‐term adherence to continuous positive airway pressure therapy in patients with resistant hypertension and sleep apnea

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.     

双相气道正压无创机械通气时阻塞性睡眠呼吸暂停综合征患者上呼吸道影像分析

目的 应用多层螺旋CT对阻塞性睡眠呼吸暂停综合征(OSAS)患者不同通气状态下上呼吸道行放射学成像,分析在全身麻醉无自主呼吸条件下双相气道正压(BiPAP)无创机械通气是否能克服上呼吸道阻力达到有效的机械通气.方法 选择拟行咽腭成形术的OSAS患者10例,手术前常规实施麻醉诱导睡眠.分别对患者清醒状态下自主呼吸(清醒期)、睡眠诱导后意识消失(诱导期)、BiPAP无创机械通气后5 min(通气期)时头部正位和侧位作螺旋CT扫描,测量上呼吸道各软组织区[软腭后区(RP)、舌根后区(RG)、会厌区(EPG)]的最窄气道横截面左右径、前后径长度及相应横截面积,并监测扫描过程中的无创血压(NIBP)、脉搏血氧饱和度(SpO2)、心率(HR)、自主呼吸频率(RR).结果 头颈部正位扫描显示诱导期RP区和EPG区最窄气道横截面左右径、前后径线长度比清醒期明显缩短,各区横截面积明显缩小[RP区:0.00(0.00,0.60)mm2比38.34(10.57,72.76)mm2,RG区:145.16(0.00,183.72)mm2比177.79(111.05,216.27)mm2,EPG区:39.02(7.55,86.36)mm2比154.69(124.74,322.00)mm2,均P＜0.05].通气期各横截面径线和面积较清醒期仍明显缩小(均P＜0.05),但与诱导期差异无统计学意义(均P＞0.05).头部侧位诱导期除RG区左右径外,各区最窄气道横截面左右径、前后径线长度均短于清醒期,横截面积亦缩小[RP区:0.00(0.00,18.74)mm2比61.46(36.77,141.46)mm2,RG区:69.75(35.74,214.83)mm2比287.68(197.01,393.18)mm2,EPG区:17.28(4.37,65.45)mm2比293.76(254.63,374.83)mm2,均P＜0.05].BiPAP通气时各区横截面径线与清醒期比较尚明显缩短,横截面积虽缩小却较诱导期明显回升(均P＜0.05).各期正、侧位NIBP、HR无明显变化,诱导期RR明显受抑制,SpO2降低(均P＜0.05),通气期RR、SpO2与诱导期比较虽有所改善,但差异无统计学意义(均P＞0.05),仍未回复到清醒期水平(均P＜0.05).结论 OSAS患者睡眠诱导后上呼吸道通畅度明显下降,即使将头部侧位后仍未能改善上呼吸道的通畅度,无自主呼吸的状态下应用BiPAP无创机械通气不能克服上呼吸道阻力达到有效通气,需特殊处理保证安全.     

Cardiovascular effects of continuous positive airway pressure in obstructive sleep apnea

The cardiovascular sequelae best shown to be associated with OSA are systemic hypertension and acute vascular events. The cardiovascular sequelae, including acute myocardial infarction or nocturnal angina may be contributed to by arterial vasospasm or clot formation in the area of an atheroma. Thus far there are no data showing that treatment of OSA eliminates vascular sequelae, but much evidence shows that chronic CPAP therapy may lower elevated blood pressure in some patients. However, for a variety of reasons mentioned above, CPAP does not correct hypertension in all OSA patients.     

Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine report

These practice parameters are an update of the previously published recommendations regarding the use of autotitrating positive airway pressure (APAP) devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome. Continuous positive airway pressure (CPAP) at an effective setting verified by attended polysomnography is a standard treatment for obstructive sleep apnea (OSA). APAP devices change the treatment pressure based on feedback from various patient measures such as airflow, pressure fluctuations, or measures of airway resistance. These devices may aid in the pressure titration process, address possible changes in pressure requirements throughout a given night and from night to night, aid in treatment of OSA when attended CPAP titration has not or cannot be accomplished, or improve patient comfort. A task force of the Standards of Practice Committee of the American Academy of Sleep Medicine has reviewed the literature published since the 2002 practice parameter on the use of APAP. Current recommendations follow: (1) APAP devices are not recommended to diagnose OSA; (2) patients with congestive heart failure, patients with significant lung disease such as chronic obstructive pulmonary disease; patients expected to have nocturnal arterial oxyhemoglobin desaturation due to conditions other than OSA (e.g., obesity hypoventilation syndrome); patients who do not snore (either naturally or as a result of palate surgery); and patients who have central sleep apnea syndromes are not currently candidates for APAP titration or treatment; (3) APAP devices are not currently recommended for split-night titration; (4) certain APAP devices may be used during attended titration with polysomnography to identify a single pressure for use with standard CPAP for treatment of moderate to severe OSA; (5) certain APAP devices may be initiated and used in the self-adjusting mode for unattended treatment of patients with moderate to severe OSA without significant comorbidities (CHF, COPD, central sleep apnea syndromes, or hypoventilation syndromes); (6) certain APAP devices may be used in an unattended way to determine a fixed CPAP treatment pressure for patients with moderate to severe OSA without significant comorbidities (CHF, COPD, central sleep apnea syndromes, or hypoventilation syndromes); (7) patients being treated with fixed CPAP on the basis of APAP titration or being treated with APAP must have close clinical follow-up to determine treatment effectiveness and safety; and (8) a reevaluation and, if necessary, a standard attended CPAP titration should be performed if symptoms do not resolve or the APAP treatment otherwise appears to lack efficacy.     

Effects of continuous positive airway pressure on neurocognitive and neuropsychiatric function in obstructive sleep apnea

The aim of this study was to determine the neurocognitive and neuropsychiatric effects of continuous positive airway pressure treatment on patients with obstructive sleep apnea. This cross‐sectional, prospective, observational study included 126 patients with sleep apnea. The following tests were performed: the Montreal Cognitive Assessment for the evaluation of cognitive impairment, the Beck Depression Inventory, and the State‐Trait Anxiety Inventory, together with the Epworth Sleepiness Scale for the evaluation of neuropsychiatric symptoms and a person's general level of daytime sleepiness. The first measurement did not show neurocognitive impairment or a higher level of depressive and anxiety symptoms in 126 patients with obstructive sleep apnea in comparison to normative standards. After the 3‐month treatment indicated for 43 patients with obstructive sleep apnea, we did not find any significant improvement in cognitive performance (p = .213). However, patients with sleep apnea with continuous positive airway pressure treatment did show significantly less daytime sleepiness, anxiety and depressive symptoms (all p < .001). In conclusion, short‐term (3 months) treatment of patients with obstructive sleep apnea can substantially alleviate their daytime sleepiness, as well as depressive and anxiety symptoms.     

双相气道正压无创机械通气时阻塞性睡眠呼吸暂停综合征患者上呼吸道影像分析

Objective Multislice spiral CT scanning was used for radiological imaging of upper airway under various ventilation in obstructive sleep apnea syndrome (OSAS) patients in order to study whether bi-level positive airway pressure (BiPAP) noninvasive mechanical vetilation can overcome upper airway resistance and provide effective ventilation under general anesthesia and non-spontenuous breathing.Methods Ten OSAS patients scheduled for uvulopalatopharyngoplasty were enrolled in the study. General anesthesia inducing sleep was routinely performed before operation. Computer tomography of cephal-neck in orthophofic and lateral position was performed under spontaneous respiration (lucid interval) , nonconsciousness after sleep induction (induction period), and noninvasively ventilation with BiPAP for 5 min (ventilation period). Narrowest transverse and anteroposterior diameters of transverse section, and correlative cross section areas over each soft tissue region of upper respiratory tract [retropalatal (RP) ,retroglossal (RG) and epiglottal (EPG) region] were tested. Noninvasive blood pressure (NIBP), oxygen saturation by pulse oximeter (SpO2) , heart rate (HR) and spontaneous respiratory rate (RR) during scanning were monitored. Results In orthophoric position, transverse diameter and anteroposterior diameter of RP and EPG regions shortened during anesthesia induction. Cross section area of all regions decreased during anesthesia induction [RP region: 0.00(0.00, 0.60) mm2 vs 38.34(10.57, 72.76) mm2, RG region:145.16(0.00, 183.72) mm2 vs 177.79(111.05, 216.27) mm2, EPG region: 39.02(7.55, 86.36) mm2 vs 154.69 (124.74, 322.00) mm2, all P＜0.05]. The diameters shortened and area decreased as well under BiPAP ventilation when comparing with those in spontaneous respiration (all P＞0.05) , however, no statistical significance was found when comparing with those in induction period (all P＞0.05). In lateral position, diameters and areas under BiPAP ventilation were smaller than those during spontaneous respiration except for transverse diameter of RG region[areas, BP region: 0.00(0.00, 18.74) mm2 vs 61.46(36.77, 141.46) mm2, RG region: 69.75 (35.74, 214.83) mm2 vs 287.68 (197.01, 393.18) mm2, EPG region: 17.28 (4.37, 65.45) mm2 vs 293.76(254.63, 374.83) mm2, all P＜0.05] The transverse diameter,anteroposterior diameter and transverse section area during BiPAP ventilation decreased also when comparing with those in spontaneous respiration, however, transverse section area increased significantly during induction period (all P＞0.05). Neither NIBP nor HR changed both in orthophoric and lateral position. RR at induction period was obviously inhibited and SpO2 decreased (all P＜0.05). Though RR and SpO2 during ventilation period improved as compared to induction period, however no statistical significance was observed (all P＞0.05), none of them returned to normal range (all P＜0.05). Conclusion The ventilation of upper airway is not smooth after sleep induction in OSAS patients, though their heads are in lateral postion. By BiPAP noninvasive ventilation, effective ventilation still can not be achieved since airway resistance is not relieved, so special handling is advised to ensure safety.     

Determinants of depressive mood in coronary artery disease patients with obstructive sleep apnea and response to continuous positive airway pressure treatment in non‐sleepy and sleepy phenotypes in the RICCADSA cohort

We explored determinants of depressive mood in adults with coronary artery disease and obstructive sleep apnea and response to positive airway pressure treatment in sleepy and non‐sleepy phenotypes. In this secondary analysis of the RICCADSA trial conducted in Sweden, 493 cardiac patients with obstructive sleep apnea (n = 386) or no obstructive sleep apnea (n = 107) with complete Epworth Sleepiness Scale and Zung Self‐rating Depression Scale questionnaires were included. Sleepy (Epworth Sleepiness Scale ≥10) versus non‐sleepy (Epworth Sleepiness Scale <10) patients with depressive mood (Zung Self‐rating Depression Scale score ≥50) were evaluated after 3 and 12 months of positive airway pressure treatment. In all, 133 patients (27.0%) had depressive mood (29.3% of obstructive sleep apnea versus 18.7% of no obstructive sleep apnea; p = 0.029), with a higher percentage among the sleepy phenotype (36.9% versus 24.5%; p = 0.009). In multivariate analysis, depressive mood was significantly associated with female sex, body mass index and Epworth Sleepiness Scale. Among 97 obstructive sleep apnea patients with depressive mood at baseline, there was a significant reduction in the scores at follow‐up both in the sleepy and non‐sleepy patients allocated to positive airway pressure treatment, whereas no significant changes were observed in the untreated group (p = 0.033). The device use (hr/night) predicted improvement in mood (odds ratio, 1.33; 95% confidence interval, 1.10–1.61; p = 0.003) adjusted for age, female sex, body mass index, left ventricular ejection fraction, apnea–hypopnea index and delta Epworth Sleepiness Scale score. We conclude that obstructive sleep apnea was associated with depressive mood in adults with coronary artery disease. Treatment with positive airway pressure improved mood in both phenotypes, independent of the confounding factors.     

Predictors of continuous positive airway pressure use during the first week of treatment

This study aimed to identify pre‐treatment and immediate early treatment factors predicting continuous positive airway pressure (CPAP) use during the first week of therapy, when the pattern of non‐adherence is established. Four domains of potential predictors were examined: pre‐treatment demographic and clinical factors, patients’ perceived self‐efficacy, treatment delivery (mask leak and bothering side effects) and immediate disease reduction (residual respiratory events and flow limitation). The Autoset? Clinical System objectively documented daily CPAP use, mask leak, residual respiratory events and flow limitation. Ninety‐one CPAP‐naive patients with newly diagnosed obstructive sleep apnea were followed for 1 week after treatment initiation. Mean CPAP daily use during the first week was 3.4 ± 2.7 h, with significantly lower use observed in black than non‐black participants (2.7 versus 4.4 h, respectively, P = 0.002). Less intimacy with partners caused by CPAP was the only treatment side effect correlated with CPAP use (r = ?0.300, P = 0.025). Reduced CPAP use during the first week was associated simultaneously with being black, higher residual apnea–hypopnea index and the treatment side effect of less intimacy with partners. The three factors together accounted for 25.4% of the variance in the CPAP use (R² = 0.254, P < 0.01). These data suggest the need to assess the impact of CPAP on intimacy and troubleshooting aspects of the treatment that interfere with sexual relationships. Assessing the presence of residual respiratory events may be important in promoting CPAP adherence. The association of race and CPAP use needs to be explored further by including more socioeconomic information.     

Nasal pillows as an alternative interface in patients with obstructive sleep apnoea syndrome initiating continuous positive airway pressure therapy

Side‐effects directly due to the nasal mask are common in patients with obstructive sleep apnoea syndrome (OSAS) commencing continuous positive airway pressure (CPAP). Recently, nasal pillows have been designed to overcome these issues. Limited evidence exists of the benefits and effectiveness of these devices. Twenty‐one patients (19 male, 49 ± 10 years) with the established diagnosis of OSAS [apnoea/hypopnoea index (AHI): 52 ± 22] and who had a successful CPAP titration were commenced on CPAP therapy (10 ± 2 cmH2O), and randomized to 4 weeks of a nasal pillow (P) and a standard nasal mask (M) in a crossover design. Outcome measures were objective compliance, AHI, quality of life, Epworth Sleepiness Score (ESS) and CPAP side‐effects. There was no difference in compliance (M versus P: 5.1 ± 1.9 h versus 5.0 ± 1.7 h; P = 0.701) and AHI (2.6 ± 2.7 versus 3.0 ± 2.9; P = 0.509). Quality of life and ESS improved with CPAP, but there was no difference in the extent of improvement between both devices. Usage of nasal pillows resulted in less reported pressure on the face and more subjects found the nasal pillow the more comfortable device. However, there was no clear overall preference for either device at the end of the study (mask = 57%, pillow = 43%; P = 0.513). The applied CPAP pressure did not correlate with compliance, AHI and ESS. Furthermore, no differences in outcome parameters were noted comparing groups with CPAP pressure <10 and ≥10 cm H₂O. Nasal pillows are equally effective in CPAP therapy, but do not generally lead to improved compliance.