Continuous positive airway pressure therapy in multidisciplinary treatment

We studied the acceptability of nasal continuous positive airway pressure (CPAP) therapy in 74 patients with obstructive sleep apnea-hypopnea (OSAH). CPAP was conducted in multidisciplinary treatment, combined with surgery and oral appliances. OSAH was defined by an apnea-hypopnea index > 20/h. Follow-up was 3 to 21 months. Automated titration during full polysomnography was conducted in the hospital using auto-CPAP devices (Autoset T, RESMED Co, Australia). CPAP alone was done in 37 (50%); CPAP with conservative nasal treatment in 25 (34%); CPAP with nasal surgery, endoscopic nose and/or sinus surgery in 10 (14%); and CPAP with uvulopalatopharyngoplasty and endoscopic nose and sinus surgery in 1 patient (1%). CPAP with an oral appliance was done in 1 (1%) to provide lower therapeutic pressure to avoid electroencephalography arousal caused by CPAP. Consequently CPAP with conservative nasal treatment and/or endoscopic nose and sinus surgery were conducted in 36 (49%). It was very important to improve nasal resistance to continue CPAP therapy. No statistically significant differences were seen between compliant and noncompliant patients in severity of OSAH, improvement of daytime somnolence, mask trouble, or nasal resistance. At the latest follow-up, 71 of 74 were still using CPAP. CPAP compliance by Kaplan-Meier evaluation was 96%. Multidisciplinary treatment involving CPAP combined with surgery and oral appliances thus improved the acceptability of CPAP therapy.     

Heated humidification during nasal continuous positive airway pressure for obstructive sleep apnea syndrome: objective evaluation of efficacy with nasal peak inspiratory flow measurements

BACKGROUND: Nasal obstruction is one of the most frequent and sometimes troublesome side effects of nasal continuous positive airway pressure (nCPAP) therapy for obstructive sleep apnea syndrome (OSAS). METHODS: We describe a 60-year-old man with allergic seasonal rhinitis and OSAS, with worsening nasal symptoms 1 week after beginning home nCPAP, making nCPAP use difficult (nasal peak inspiratory flow [nPIF], 80 L/minute [57% of his best]). RESULTS: No significant improvement was obtained with topical steroids or cold humidification. Heated humidification was then considered, achieving an improvement in mean nPIF and symptom scores. An acceptable compliance with CPAP could be obtained during the heated humidification period (3.9 hours of mean daily use). CONCLUSION: In this patient with moderately severe OSAS and allergic rhinitis, monitoring nasal symptoms and nasal PIF objectively showed the benefit of heated humidification to overcome nasal intolerance and increase compliance to nCPAP treatment.     

Morphologische und funktionelle Veränderungen der Nasenschleimhaut nach nCPAP-Therapie

BACKGROUND AND OBJECTIVE: The treatment success of nCPAP therapy (nasal continuous positive airway pressure) depends partly on the relief of symptoms and partly on long-term patient acceptance and the related avoidance of complications. Nasal complaints constitute the most frequently reported side effects and, together with problems of mask application, are among the primary factors causing an nCPAP-therapy to be prematurely discontinued. PATIENTS/METHODS: To assess the morphological changes of the nasal mucosa during nCPAP-therapy, we excised specimens of nasal mucosa tissue in twelve patients with obstructive sleep apnea syndrome (OSAS) both before and 3-10 months after establishing nCPAP-mask acceptance. The specimens were examined by electron microscopy. RESULTS: In all these patients, acceptance of the CPAP mask marked the initial part of therapy. In addition, mucociliary clearance was assessed by the saccharin test before and after therapy. In all patients, the nasal epithelium underwent fundamental changes upon CPAP therapy, which became manifest as modifications in the shape of epithelial cells, conglutination and clumping of the microvilli, and the appearance of immunocompetent cells. Once patients were nCPAP mask compliant, mucociliary clearance was distinctly prolonged in all cases. CONCLUSIONS: A successful therapeutic concept should provide normalization of room temperature and air humidity once nCPAP mask compliance has been achieved, and include regular assessment of the condition of the mucosa in the upper respiratory tract. Only by these measures can nasal complications be countered or therapy be applied at an early stage.     

Acoustic rhinometry predicts tolerance of nasal continuous positive airway pressure: a pilot study

BACKGROUND: Nasal continuous positive airway pressure (nCPAP) is usually the first-line intervention for obstructive sleep apnea, but up to 50% of patients are unable to tolerate therapy because of discomfort-usually nasal complaints. No factors have been definitively correlated with nCPAP tolerance, although nasal cross-sectional area has been correlated with the level of CPAP pressure, and nasal surgery improves nCPAP compliance. This study examined the relationship between nasal cross-sectional area and nCPAP tolerance. METHODS: We performed acoustic rhinometry on 34 obstructive sleep apnea patients at the time of the initial sleep study. Patients titrated to nCPAP were interviewed 18 months after starting therapy to determine CPAP tolerance. Demographic, polysomnographic, and nasal cross-sectional area data were compared between CPAP-tolerant and -intolerant patients. RESULTS: Between 13 tolerant and 12 intolerant patients, there were no significant differences in age, gender, body mass index, CPAP level, respiratory disturbance index, or subjective nasal obstruction. Cross-sectional area at the inferior turbinate differed significantly between the two groups (p = 0.03). This remained significant after multivariate analysis for possibly confounding variables. A cross-sectional area cutoff of 0.6 cm2 at the head of the inferior turbinate carried a sensitivity of 75% and specificity of 77% for CPAP intolerance in this patient group. CONCLUSION: Nasal airway obstruction correlated with CPAP tolerance, supporting an important role for the nose in CPAP, and providing a physiological basis for improved CPAP compliance after nasal surgery. Objective nasal evaluation, but not the subjective report of nasal obstruction, may be helpful in the management of these patients.     

Adverse effects of continuous positive airway pressure therapy and its relation to the nose

The main problem in the treatment of obstructive sleep apnea syndrome (OSAS) with nasal continuous airway pressure (nCPAP) is the lack of compliance. One of the most important reasons for no compliance is the adverse effects of this treatment. We analyse, prospectively, 182 patients treated with nCPAP in order to show the relationship between previous nasal problems and adverse effects of nCPAP. Sixty percent of the population developed one o more side effects. Of this group, 69% showed nasal septum deviation at first examination in front of 31% that did not showed this problem (p = 0.001). In the group of patients with nasal side effects we observed an increase of compliance in 80% of patients treated medically and in 89% of those treated by a septoplasty. We demonstrate that the adverse effects of nCPAP are related to previous nasal problems and, also, that treatment of those problems can achieve an increase in compliance to nCPAP therapy.     

Nasopharyngeal Symptoms and Nasal Continuous Positive Airway Pressure Therapy in Obstructive Sleep Apnoea Syndrome

Nasal problems are often reported during the treatment of obstructive sleep apnoea syndrome (OSAS) with nasal continuous positive airway pressure (nCPAP) and may jeopardize the use of nCPAP. This retrospective study evaluated the frequency of nasopharyngeal symptoms in OSAS patients before and during nCPAP treatment. A questionnaire was sent to all patients (n=194) with OSAS for whom nCPAP had been prescribed during the years 1990-1995 at the authors' hospital, enquiring about nasopharyngeal symptoms both before and during treatment and nCPAP use. The study population consisted of the 151 patients [128 men and 23 women, median (range) age 54 (31-76) years and body-mass index 34 (17-54) kg/m²] who responded to the questionnaire. Seventy-one percent of patients were still using nCPAP after a median treatment duration of 30 months. The most commonly reported nasopharyngeal symptoms were nasal stuffiness, which was reported by 46% of patients before nCPAP and by 37% during nCPAP, dry nose (39% before and 46% during nCPAP), sneezing (36% and 35%) and rhinorrhoea (21% and 27%). The frequency of nasopharyngeal symptoms did not change with nCPAP treatment. The frequency of nasopharyngeal symptoms before and during nCPAP treatment was similar in those patients who discontinued the treatment (n=44, 29%) compared with those who continued with nCPAP (n=107, 71%). Skin problems caused by the mask (50%), airleak from mouth (44%), difficulty in exhaling (29%) and a sensation of suffocation (26%) were also problems associated with nCPAP treatment. Nasopharyngeal symptoms were common in patients with OSAS before nCPAP was started. There was no significant change in the frequency of these symptoms during nCPAP treatment. Nasopharyngeal symptoms did not seem to affect treatment continuation.     

Preoperative continuous positive airway pressure compliance in children with obstructive sleep apnea syndrome: assessed by a simplified approach

INTRODUCTION: The frequency of diagnoses of obstructive sleep apnea syndrome (OSAS) in children is increasing and more and more adenotonsillectomies (A&T) are being performed on severely ill children who have a higher perioperatory risk. The objective of the present study was to describe preoperative compliance in the use of continuous positive airway pressure (CPAP) in children with OSAS, when this treatment was prescribed as a means of preventing complications. PATIENTS AND METHODS: We describe data from children with severe OSAS caused by hypertrophy of the adenoids and tonsils, but with no craniofacial abnormalities. CPAP pressure was adjusted either during diurnal polysomnography with sleep deprivation or by self-adjusting devices. Follow-up was conducted through weekly interviews and the downloading of data recorded by the equipment. RESULTS: 48 children were included; 73% of them used a CPAP machine > or =3h per night, and 31% used it for > or =6h per night. The variables associated with good equipment compliance included higher BMI, higher pressure levels in the devices, and a higher number of episodes of apneas and hypopneas. Children who weighed > or =30kg used CPAP for > or =3h per night more often (OR 16, 95% CI 1.9-137). Compliance levels with fixed and self-adjusting CPAP were similar, and side effects in both cases were slight and limited to those caused by the pressure of the masks on patients' skin. One case of excessive bleeding was the only complication reported during A&T. CONCLUSIONS: The mean preoperative use of CPAP equipment by children with severe OSAS was 4.5+/-2.6h. Seventy-three percent of subjects used the equipment for >/=3h.     

阻塞性睡眠呼吸暂停综合征450例疗效分析

目的：比较手术，等离子体消融及持续经鼻正压通气对阻塞性睡眠呼吸暂停综合征（OSAS）的疗效。探讨最佳治疗途径。方法：将450例OSAS患者分为3组，其中手术组368例[包括悬雍垂腭咽成形术（UPPP）302例，UPPP加舌根部分切除术（PERT）49例，UPPP加下鼻甲部分切除术（PIT）11例，UPPP加PERT和PIT6例]；等离子体消融（CPS）组65例；鼻腔持续正压通气（nCPAP)组25例，其中17例为首选治疗，8例为手术失败后治疗。结果：nCPAP组的近远期疗效（95．23％及83．33％）均高于手术组吸CPS组，手术组与CPS组的近期疗效相近，分别为86．39％及78．04％。手术组的远期（1－3年）疗效尚达不到50％，并随时间延长而继续下降，且具有一定的危险性和并发症。CPS组和nCPAP组的副作用小，无明显并发症。结论：OSAS的治疗应趋向于安全、简单、有效，并易于患者接受，重度患者应接受nCPAP或较简单安全的手术治疗，UPPP、CPS及nCPAP均对中轻度患者有较好的疗效，可由患者与医生根据具体情况作出适当的选择。CPS的远期疗效有待进一步观察。     

Fine-structural investigations of the effect of nCPAP-mask application on the nasal mucosa

The treatment success of nasal continuous positive airway pressure (nCPAP)-therapy is dependent, on the one hand, on the achieved relief of complaints and, on the other hand, on long-term patient compliance and avoidance of compliance-related complaints. Next to the problem of mask application, nasal complaints comprise the most frequently reported side-effects and are among the primary factors causing nCPAP-therapy to be discontinued prematurely. To assess the morphological changes in the nasal mucosa during nCPAP-therapy, we excised specimens of nasal mucosa tissue from 10 patients with obstructive sleep apnoea syndrome (OSAS) before and 3-10 months after establishing nCPAP-mask compliance. The specimens were examined by electron microscopy. In all these patients compliance with the CPAP-mask marked the initial part of therapy. In addition, mucociliary clearance was assessed by the saccharin test before and after therapy. In all patients the nasal epithelium underwent fundamental changes upon CPAP-therapy, which became manifest as modifications in the shape of epithelial cells, conglutination and clumping of the microvilli, and the appearance of immunocompetent cells. Once patients were nCPAP-mask compliant, mucociliary clearance was distinctly prolonged in all cases. A successful therapeutic concept should provide normalization of room temperature and air humidity once nCPAP-mask compliance has been achieved and include regular assessment of the condition of the mucosa in the upper respiratory tract. Only by these measures can nasal complications be countered or given therapy at an early stage.     

Obstructive sleep apnea syndrome after reconstructive laryngectomy for glottic carcinoma

Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep. The obstruction predominantly occurs along the pharyngeal airway but other sites of obstruction have occasionally been described. We report our experience with three patients suffering from OSAS suspected to be of laryngeal origin. OSAS developed after reconstructive laryngectomy for glottic carcinoma and upper airway obstruction seemed to be located in the reconstructed laryngeal area. The three patients were given nCPAP (nasal-continuous positive airway pressure) treatment associated with peroral endoscopic CO₂ laser vaporization of the laryngeal edema. After CO₂ laser treatment, one patient was able to stop nCPAP treatment. The other two have remained on nCPAP therapy. OSAS may arise in the post-operative period of reconstructive laryngectomy for glottic carcinoma and can be managed by CO₂ laser vaporization (laryngeal edema in the reconstructed area) in association with nCPAP treatment. Received: 28 April 2000 / Accepted: 27 June 2000     

Nasopharyngeal symptoms and nasal continuous positive airway pressure therapy in obstructive sleep apnoea syndrome.

Nasal problems are often reported during the treatment of obstructive sleep apnoea syndrome (OSAS) with nasal continuous positive airway pressure (nCPAP) and may jeopardize the use of nCPAP. This retrospective study evaluated the frequency of nasopharyngeal symptoms in OSAS patients before and during nCPAP treatment. A questionnaire was sent to all patients (n = 194) with OSAS for whom nCPAP had been prescribed during the years 1990-1995 at the authors' hospital, enquiring about nasopharyngeal symptoms both before and during treatment and nCPAP use. The study population consisted of the 151 patients [128 men and 23 women, median (range) age 54 (31-76) years and body-mass index 34 (17-54) kg/m2] who responded to the questionnaire. Seventy-one percent of patients were still using nCPAP after a median treatment duration of 30 months. The most commonly reported nasopharyngeal symptoms were nasal stuffiness, which was reported by 46% of patients before nCPAP and by 37% during nCPAP, dry nose (39% before and 46% during nCPAP), sneezing (36% and 35%) and rhinorrhoea (21% and 27%). The frequency of nasopharyngeal symptoms did not change with nCPAP treatment. The frequency of nasopharyngeal symptoms before and during nCPAP treatment was similar in those patients who discontinued the treatment (n = 44, 29%) compared with those who continued with nCPAP (n = 107, 71%). Skin problems caused by the mask (50%), airleak from mouth (44%), difficulty in exhaling (29%) and a sensation of suffocation (26%) were also problems associated with nCPAP treatment. Nasopharyngeal symptoms were common in patients with OSAS before nCPAP was started. There was no significant change in the frequency of these symptoms during nCPAP treatment. Nasopharyngeal symptoms did not seem to affect treatment continuation.     

Effective comparison of two auto-CPAP devices for treatment of obstructive sleep apnea based on polysomnographic evaluation

BACKGROUND: Automatic continuous positive airway pressure (auto-CPAP) machines differ mainly in algorithms used for respiratory event detection and pressure control. The auto-CPAP machines operated by novel algorithms are expected to have better performance than the earlier ones in the treatment of obstructive sleep apnea syndrome (OSAS). OBJECTIVES: The purpose of this study was to determine the therapeutic characteristics between two different auto-CPAP devices, i.e., the third-generation flow-based (f-APAP) and the second-generation vibration-based (v-APAP) machines, during the first night treatment of OSAS. METHODS: We retrospectively reviewed the polysomnography (PSG) recordings of 43 OSAS patients who were initially performed an overnight diagnostic PSG to confirm the disease and afterwards received the first night auto-CPAP treatment with using either the f-APAP (n=22) or v-APAP (n=21) device under another PSG evaluation. RESULTS: There were 13.6% and 61.9% patients who remained a residual apnea/hypopnea index more than 5 during the f-APAP and v-APAP application, respectively (P<0.005). The f-APAP was more effective than the v-APAP in reducing apnea/hypopnea index (P=0.003), hypopnea index (P=0.023) and apnea index (P=0.007), improving the lowest oxygen saturation index (P=0.007) and shortening stage 1 sleep (P=0.016). However, the f-APAP was less sufficient than the v-APAP in reducing arousal/awakening index (P=0.02). CONCLUSION: These findings suggest that the f-APAP works better than the v-APAP in abolishing breathing abnormities in the treatment of OSAS; however, the f-APAP device might still have some potential limitations in the clinical application.     

Adherence of obstructive sleep apnea syndrome patients to continuous positive airway pressure in a public service,

IntroductionThe standard therapy for obstructive sleep apnea syndrome (OSAS) is continuous positive airway pressure (CPAP), but its correct and frequent use is essential to control the disease.PurposeTo analyze adherence to CPAP among patients with OSAS treated in a multidisciplinary outpatient clinic of a public tertiary hospital.MethodsThis was a retrospective study evaluating 156 patients with OSAS who underwent polysomnography for CPAP titration from 2008 to 2011. The patients were divided into two groups, those with good adherence to CPAP (a mean use of four or more hours per night) and those with poor adherence. The groups were compared regarding the following data: gender, age, body mass index, associated diseases, AHI at diagnostic polysomnography, and pressure (cmH₂O) suggested by titration polysomnography.Results125 patients were analyzed, and it was observed that 82 of the patients (65%) had good adherence, whereas 43 (35%) showed poor adherence. Comparison between groups revealed that patients with a higher apnea-hypopnea index (AHI) were those who better adhered to treatment with CPAP.Conclusionsthe rate of adherence to CPAP among OSAS patients undergoing clinical monitoring at a public service was 65%. Patients with a higher AHI were those who adhered better to treatment with CPAP.© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.     

Schnarchen / Schlafapnoe—chirurgisch heilbar ?

INTRODUCTION: Obstructive sleep apnea (OSA) is characterized by nocturnal collapsing of the upper airways. Nasal continuous positive airway pressure (nCPAP) ventilation is the gold standard in the treatment of obstructive sleep apnea syndrome (OSAS). Long-term compliance rates do not exceed more than 60 to 70%. Alternative multi-level surgeries are of interest, combining procedures at the level of the base of tongue and the soft palate in order to stabilize the airway. Preliminary results suggested the hyoid suspension as one part of the multi-level surgery concept to be of high effectiveness. Therefore this study investigated the outcome of the hyoid suspension and compared it with the CPAP therapy. METHODS: Between March 2001 and February 2003, 66 patients with OSA were treated with a hyoid suspension in combination with surgeries at the base of tongue, the soft palate or the nose (always performed by the same surgeon). All patients underwent a pre- and postoperative polysomnography in the sleep lab. Daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Mean age was 52,1 years, the mean body mass index (BMI) was 28,04 kg/m(2). RESULTS: The mean apnea-hypopnea-index (AHI) was 38,9121,10/h before operation and 19,25+/-19,64/h after operation (p<0,0001). More statistically significant changes were found for the arousal index, the oxygen saturation and the ESS (p<0,05). After surgery 57,6% of the subjects (38/66) were regarded as cured (reduction of AHI > or =50% and below 15/h). Another 21,2% (14/66) improved (reduction of AHI >20%). Altogether 78,8% of the patients were counted as responders. CONCLUSION: Multi-level surgeries based on the hyoid suspension show the effectiveness of this concept. This surgical strategy could be equal to the CPAP mask, especially in cases of CPAP intolerance.     

Fine-structural Investigations of the Effect of nCPAP-mask Application on the Nasal Mucosa

The treatment success of nasal continuous positive airway pressure (nCPAP)-therapy is dependent, on the one hand, on the achieved relief of complaints and, on the other hand, on long-term patient compliance and avoidance of compliance-related complaints. Next to the problem of mask application, nasal complaints comprise the most frequently reported side-effects and are among the primary factors causing nCPAP-therapy to be discontinued prematurely. To assess the morphological changes in the nasal mucosa during nCPAP-therapy, we excised specimens of nasal mucosa tissue from 10 patients with obstructive sleep apnoea syndrome (OSAS) before and 3-10 months after establishing nCPAP-mask compliance. The specimens were examined by electron microscopy. In all these patients compliance with the CPAP-mask marked the initial part of therapy. In addition, mucociliary clearance was assessed by the saccharin test before and after therapy. In all patients the nasal epithelium underwent fundamental changes upon CPAP-therapy, which became manifest as modifications in the shape of epithelial cells, conglutination and clumping of the microvilli, and the appearance of immunocompetent cells. Once patients were nCPAP-mask compliant, mucociliary clearance was distinctly prolonged in all cases. A successful therapeutic concept should provide normalization of room temperature and air humidity once nCPAP-mask compliance has been achieved and include regular assessment of the condition of the mucosa in the upper respiratory tract. Only by these measures can nasal complications be countered or given therapy at an early stage.     

悬雍垂腭咽成形术后持续正压通气治疗

观察悬雍垂腭咽成形术（ｕｖｕｌｏｐｌａｔｏｐｈａｒｙｇｏｐｌａｓｔｙ,ＵＰＰＰ）后疗效不佳的阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅｓｌｅｅｐａｐｎｅａｓｙｎｄｒｏｍｅ,ＯＳＡＳ）患者为手术组行持续正压通气（ｃｏｎｔｎｕｏｕｓｐｏｓｉｔｉｖｅａｉｒｗａｙｐｒｅｓｓｕｒｅ,ＣＰＡＰ）治疗的效果。方法１５例ＵＰＰＰ术后呼吸暂停低通气指数（ａｐｎｏｅａ－ｈｙｐｏｎｏｅａｉｎｄｅｘ,ＡＨＩ）仍大于     

羟甲唑啉鼻喷剂改善伴鼻阻塞OSAHS患者行nCPAP顺应性

目的 探讨羟甲唑啉鼻喷剂对伴鼻阻塞的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者行经鼻持续气道正压通气(nCPAP)的疗效,明确伴鼻阻塞OSAHS患者改善鼻腔阻力提高nCPAP顺应性的意义。方法 将确诊存在鼻阻塞性病变的OSAHS患者随机分为试验组30例(nCPAP治疗前使用羟甲唑啉喷雾剂)和对照组30例(常规使用nCPAP治疗),采用嗜睡评价量表(Epworth)、治疗压力滴定对nCPAP治疗前后睡眠情况进行分析。结果 伴鼻阻塞的OSAHS患者羟甲唑啉喷雾后nCPAP治疗过程中的睡眠情况均较对照组改善,顺应性、依从性差异有统计学意义。结论 羟甲唑啉鼻喷剂提高伴鼻阻塞的OSAHS患者nCPAP治疗顺应性,通过治疗有望获得患者对nCPAP治疗依从性的提高。     

Treatment outcomes and compliance according to obesity in patients with obstructive sleep apnea

The objective of this study was to assess treatment outcomes and compliance according to obesity among groups of patients with obstructive sleep apnea (OSA) receiving different treatments. A total of 297 patients with OSA treated between 2006 and 2009 underwent pre- and post-treatment polysomnography. One hundred and fifty-one patients were treated with continuous airway positive pressure (CPAP), 76 with mandible advancement device (MAD), and 70 with oropharyngeal surgery. All patients were classified according to obesity. Treatment success rate and compliance of CPAP were analyzed according to obesity. For each treatment modality, the overall treatment success rate was not significantly different between obese and non-obese patients. However, the oxygen desaturation index was different in patients who were treated with MAD and surgery. Additionally, obese patients with severe OSA showed an unfavorable response to CPAP treatment. For CPAP compliance, obese patients showed a tendency to be highly compliant with CPAP treatment at 12 months than non-obese patients. This study showed that obesity might be a factor in determining the success or failure of treatment. Additionally, obesity may be a predictive factor to determine CPAP compliance.     

Long-term compliance with nasal continuous positive airway pressure therapy for sleep apnea syndrome in an otorhinolaryngological office

Continuous positive airway pressure (CPAP) is effective for patients with SAS. CPAP therapy requires long-term usage to prevent recurrence of symptoms. It is, thus, important to examine the level of long-term CPAP use and the factors influencing compliance with CPAP therapy for SAS. Compliance with CPAP therapy was examined in 204 patients in whom such therapy was started between 2003 and 2009. The median follow-up duration was 19 months (IQR = 6.8?37.5). Although the subjective and objective curative effects were significant, 18 patients (8.9 %) refused CPAP therapy. Survival analysis showed that the patients’ adherence to CPAP after 5 years was 89.8 %. Multivariate analysis, including gender, age, BMI, AHI, arousal index, minSpO₂, ESS, sleep stage, and LMI, indicated that the degree of improvement of AHI, percentage of deep sleep stage, and LMI were clinical variables independently associated with long-term adherence to CPAP. Furthermore, use of appropriate drugs for the patients with nasal congestion resulted in better satisfaction and adherence to CPAP therapy. We have shown that the rate of compliance and the subjective and objective curative effects of CPAP therapy were high, and detected the independent clinical factors associated with continued CPAP therapy.     

The efficacy of nasal surgery in obstructive sleep apnea syndrome: a prospective clinical study

The aim of this study was to investigate the effects of surgical intervention for nasal pathologies on obstructive sleep apnea syndrome (OSAS) and continuous positive airway pressure (CPAP) titrations in patients with OSAS. The study was designed as a prospective case control study. Between December 2007 and June 2010, 31 patients (26 men and 5 women) who were diagnosed with OSAS with polysomnography and confirmed to have obstructive nasal pathology were enrolled in the study. The average age of the patients was 53 ± 9.6 (range 33–68 years) and the body mass index ranged from 22 to 40.6 kg/m² with an average of 30.3 ± 4.1. The patients were evaluated with Epworth Sleepiness Scale, OSAS Complaints Questionnaire, visual analog scale, and CPAP titration before and 3 months after nasal surgery. As three patients did not attend the control polysomnography, data analysis was performed on 28 patients. Although there was a significant improvement in the nasal passage and subjective complaints, namely, snoring frequency, apnea and daytime sleepiness, the difference between preoperative and postoperative AHI values was not statistically significant. Postoperative CPAP titration results indicated a decrease both in pressures and in AHI in comparison to preoperative values. These reductions were not statistically significant, although the decrease in CPAP pressures was close to significance (p = 0.062). Nasal pathologies should be treated in all patients with OSAS, particularly those undergoing CPAP treatment. However, patients should be counseled that favorable results might not be achieved after nasal surgery.