In patients with minimally symptomatic OSA can baseline characteristics and early patterns of CPAP usage predict those who are likely to be longer-term users of CPAP

Background

Long-term continuous positive airway pressure (CPAP) usage varies between individuals. It would be of value to be able to identify those who are likely to benefit from CPAP (and use it long term), versus those who would not, and might therefore benefit from additional help early on. First, we explored whether baseline characteristics predicted CPAP usage in minimally symptomatic obstructive sleep apnoea (OSA) patients, a group who would be expected to have low usage. Second, we explored if early CPAP usage was predictive of longer-term usage, as has been shown in more symptomatic OSA patients.

Methods

The MOSAIC trial was a multi-centre randomised controlled trial where minimally symptomatic OSA patients were randomised to CPAP, or standard care, for 6 months. Here we have studied only those patients randomised to CPAP treatment. Baseline characteristics including symptoms, questionnaires [including the Epworth sleepiness score (ESS)] and sleep study parameters were recorded. CPAP usage was recorded at 2–4 weeks after initiation and after 6 months. The correlation and association between baseline characteristics and 6 months CPAP usage was assessed, as was the correlation between 2 and 4 weeks CPAP usage and 6 months CPAP usage.

Results

One hundred and ninety-five patients randomised to CPAP therapy had median [interquartile range (IQR)] CPAP usage of 2:49 (0:44, 5:13) h:min/night (h/n) at the 2–4 weeks visit, and 2:17 (0:08, 4:54) h/n at the 6 months follow-up visit. Only male gender was associated with increased long-term CPAP use (male usage 2:56 h/n, female 1:57 h/n; P=0.02). There was a moderate correlation between the usage of CPAP at 2–4 weeks and 6 months, with about 50% of the variability in long-term use being predicted by the short-term use.

Conclusions

In patients with minimally symptomatic OSA, our study has shown that male gender (and not OSA severity or symptom burden) is associated with increased long-term use of CPAP at 6 months. Although, in general, early patterns of CPAP usage predicted longer term use, there are patients in whom this is not the case, and patients with low initial usage may need to extend their CPAP trial before a decision about longer-term use is made.     

Sexual compulsivity among men in a decentralized MSM community of the Midwestern United States

Among men who have sex with men (MSM), sexual compulsivity has been associated with higher frequencies of sexual behaviors that may increase risk for transmission of HIV and other sexually transmitted infections (STI). In a Midwestern region where social and community resources for MSM are relatively diffuse, the patterns of partner-seeking and sexual behavior, and their relations to sexual compulsivity, may be different than findings from most other assessments of men in large urban areas. Using a community-based participatory approach (CBPR) and a cross-sectional survey, quantitative data were collected between November 2006 and January 2007 from 504 men related to sexual compulsivity, sexual partner-seeking, and sexual behavior. We sought to explore sexual behaviors in venues where men reported meeting sexual partners, based on their level of compulsivity. Venues that could be characterized as "sexualized" were better predictors of higher sexual compulsivity scores among men than those that are "social" in nature. Men who were higher in compulsivity reported patterns of saturating sexualized venues in order to find sexual partners. Given the unique patterns of sexual partner-seeking in this area, interventions to decrease sexual risk-taking should take into account that men who have a higher propensity for sexual compulsivity are visiting multiple venues, and prevention messages need to be tailored to be consistent across these contexts. In addition, these may need to be differentially designed based on the specific environment in which they are to be delivered.     

From the Cover: Accumulation and enhanced cycling of polyphosphate by Sargasso Sea plankton in response to low phosphorus

Phytoplankton alter their biochemical composition according to nutrient availability, such that their bulk elemental composition varies across oceanic provinces. However, the links between plankton biochemical composition and variation in biogeochemical cycling of nutrients remain largely unknown. In a survey of phytoplankton phosphorus stress in the western North Atlantic, we found that phytoplankton in the phosphorus-depleted subtropical Sargasso Sea were enriched in the biochemical polyphosphate (polyP) compared with nutrient-rich temperate waters, contradicting the canonical oceanographic view of polyP as a luxury phosphorus storage molecule. The enrichment in polyP coincided with enhanced alkaline phosphatase activity and substitution of sulfolipids for phospholipids, which are both indicators of phosphorus stress. Further, polyP appeared to be liberated preferentially over bulk phosphorus from sinking particles in the Sargasso Sea, thereby retaining phosphorus in shallow waters. Thus, polyP cycling may form a feedback loop that attenuates the export of phosphorus when it becomes scarce, contributes bioavailable P for primary production, and supports the export of carbon and nitrogen via sinking particles.Phosphorus (P) is an essential element for all living organisms. However, P can be extremely scarce in open-ocean surface waters such as in the subtropical western North Atlantic (the Sargasso Sea), where soluble reactive P (SRP) concentrations are routinely <10 nmol⋅L⁻¹ and turnover rates are on the order of hours (1). Despite this scarcity, primary production by phytoplankton in the Sargasso Sea does not appear to be limited primarily by P (2, 3), reflecting the intensity of P recycling by the microbial community (4, 5) and the exquisite adaptations of marine phytoplankton to low P conditions, which remain to be fully characterized.Phytoplankton respond to low P by producing enzymes such as alkaline phosphatase to hydrolyze extracellular dissolved organic P molecules (4, 6, 7), increasing the affinity and rate of P uptake (8, 9) and reducing their inventory of P-containing biochemicals (1, 10). In contrast, when P is abundant, phytoplankton take up excess P and store it as a luxury reserve that is generally thought to be composed of polyphosphate (polyP) (10–12). This modulation of P-containing biochemicals results in basin-scale relationships between P availability and biomass carbon-to-phosphorus (C:P) ratios (13). Presently, the only class of molecules known to consistently contribute to these gradients in cellular P are lipids because P stress in phytoplankton triggers substitution of non–P-membrane lipids for phospholipids, such as the sulfolipid sulfoquinovosyldiacylglycerol (SQDG) for the phospholipid phosphatidylglycerol (PG) (1, 14). However, lipid substitution alone probably cannot account for the full range of C:P observed in the ocean, and yet an understanding of other biochemical drivers of the C:P gradient remains elusive. Further, it is unknown how changes in plankton biochemical composition influence the recycling of nutrients.Polyphosphate (polyP), a ubiquitous inorganic P polymer of three to hundreds of residues, has diverse physiological roles and complex dynamics in microbes. It is critical for surviving nutritional stress and stationary phase (15–17) but is also important for P homeostasis: microbes produce polyP when P is more abundant than required for growth, so-called luxury uptake, and break down this polyP store upon P stress (18). Moreover, if P-stressed cells experience a spike in P availability, they overproduce polyP in excess of luxury uptake levels, the so-called “overplus” response (19). Given these complex dynamics, it has been hypothesized that polyP might be either virtually absent, or particularly abundant, in oligotrophic marine systems (20).