The impact of effective continuous positive airway pressure on homeostasis model assessment insulin resistance in non-diabetic patients with moderate to severe obstructive sleep apnea

Abstract Objectives The purpose of this pilot study was to determine whether compliance to auto-adjusting positive airway pressure (APAP) improves with the addition of a mandibular advancement device (MAD). Secondary outcome measures included were APAP pressure, subjective daytime sleepiness, apnea–hypopnea index (AHI), and mask leaks. Setting and Sample Population Participants included were diagnosed with moderate-to-severe obstructive sleep apnea (OSA) and became noncompliant to prescribed APAP. Thirteen participants with a mean age of 61.6 years were recruited for this study. Materials and Methods All participants were given a MAD to use with their APAP. Parameters measured included APAP pressure, AHI, mask leak reported via ResMed AirViewTM software, and self-reported daytime sleepiness (Epworth Sleepiness Scale [ESS]). A paired two-sample for mean t-test was performed to determine significance. Results The mean difference of pre- and postintervention APAP compliance was 23.1%, which was statistically significant (p = 0.015). The mean APAP air pressures were unchanged. The difference between pre- and postintervention mean ESS scores was 1.4 and was statistically significant (p = 0.027). The mean difference between pre- and postintervention AHI values and mask leak showed no significant difference. Conclusion This study showed that combination of APAP-MAD therapy, for patients with moderate-to-severe OSA who were noncompliant to APAP use, significantly increased compliance with APAP therapy, and significantly decreased the daytime sleepiness of participants.

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Continuous Positive Airway Pressure Therapy Improves Hypoadiponectinemia in Severe Obese Men With Obstructive Sleep Apnea Without Changes in Insulin Resistance

Metabolic Syndrome and Related Disorders ◽

10.1089/met.2009.0019 ◽

2009 ◽

Vol 7 (6) ◽

pp. 537-542 ◽

Cited By ~ 37

Author(s):

Gláucia Carneiro ◽

Sônia Maria Togeiro ◽

Fernando Flexa Ribeiro-Filho ◽

Eveli Truksinas ◽

Artur Beltrame Ribeiro ◽

...

Keyword(s):

Insulin Resistance ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Pressure Therapy ◽

Positive Airway Pressure Therapy ◽

Obstructive Sleep

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Association between sleep disordered breathing in early pregnancy and glucose metabolism

SLEEP ◽

10.1093/sleep/zsab281 ◽

2022 ◽

Author(s):

Laura Sanapo ◽

Margaret H Bublitz ◽

Alice Bai ◽

Niharika Mehta ◽

Geralyn M Messerlian ◽

...

Keyword(s):

Insulin Resistance ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Glucose Metabolism ◽

Early Pregnancy ◽

Airway Pressure ◽

Sleep Disordered Breathing ◽

Positive Airway Pressure ◽

Obstructive Sleep ◽

Respiratory Event

Abstract Study Objectives To examine the association between maternal sleep disordered breathing (SDB) and glucose metabolism in early gestation. Methods Women with body mass index (BMI) ≥27 kg/m2 and singleton pregnancies underwent in-home sleep study (HSAT) and homeostatic model assessment (HOMA) in early pregnancy. Insulin resistance (HOMA-IR) and β-cell function (HOMA %B) were derived. Exclusion criteria included pregestational diabetes, use of continuous positive airway pressure and chronic steroid therapy. We performed linear regression analyses to evaluate the association between continuous measures of SDB (respiratory event index (REI), and oxygen desaturation index (ODI)) and glucose metabolism parameters (HOMA-IR and HOMA %B). Analyses were adjusted for a set of a priori selected variables which included gestational age, maternal age, BMI, ethnicity, race, and parity. Results One hundred and ninety-two pregnant women with median (interquartile range) BMI of 35.14 (8.30) kg/m2 underwent HSAT and HOMA assessment at 11.14 (3) and 15.35 (4.14) gestational weeks, respectively. REI and ODI, as continuous values, were associated with HOMA-IR after adjusting for covariates. OSA (obstructive sleep apnea) diagnosis (REI > 5 events per hour) was not associated with HOMA-IR after adjusting for BMI (p ≥ 0.05). None of the parameters were associated with HOMA %B (p > 0.07). Conclusions SDB and insulin resistance are associated in early pregnancy, with a dose response association between respiratory event index severity and insulin resistance. Further studies are needed to establish if pregnant women with overweight and obesity may benefit from early SDB screening to improve glucose metabolic outcome. Clinical trials: NCT02412696, Positive Airway Pressure, Sleep Apnea, and the Placenta (PAP-SAP) https://clinicaltrials.gov/ct2/show/NCT02412696?term=Bourjeily&draw=2&rank=2 and NCT02917876, Predictors of De-novo Development of Obstructive Sleep Apnea in Pregnancy (Predictors) https://clinicaltrials.gov/ct2/show/NCT02917876?term=Bourjeily&draw=2&rank=1

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Impact of the type of mask on the effectiveness of and adherence to continuous positive airway pressure treatment for obstructive sleep apnea

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132014000600010 ◽

2014 ◽

Vol 40 (6) ◽

pp. 658-668 ◽

Cited By ~ 17

Author(s):

Rafaela Garcia Santos de Andrade ◽

Vivien Schmeling Piccin ◽

Juliana Araújo Nascimento ◽

Fernanda Madeiro Leite Viana ◽

Pedro Rodrigues Genta ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Treatment Effectiveness ◽

Obstructive Sleep ◽

Pubmed Database ◽

Osa Treatment ◽

The Impact

Continuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea (OSA). Although CPAP was originally applied with a nasal mask, various interfaces are currently available. This study reviews theoretical concepts and questions the premise that all types of interfaces produce similar results. We revised the evidence in the literature about the impact that the type of CPAP interface has on the effectiveness of and adherence to OSA treatment. We searched the PubMed database using the search terms "CPAP", "mask", and "obstructive sleep apnea". Although we identified 91 studies, only 12 described the impact of the type of CPAP interface on treatment effectiveness (n = 6) or adherence (n = 6). Despite conflicting results, we found no consistent evidence that nasal pillows and oral masks alter OSA treatment effectiveness or adherence. In contrast, most studies showed that oronasal masks are less effective and are more often associated with lower adherence and higher CPAP abandonment than are nasal masks. We concluded that oronasal masks can compromise CPAP OSA treatment adherence and effectiveness. Further studies are needed in order to understand the exact mechanisms involved in this effect.

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