scholarly journals 0717 Peer-intervention Can Reduce Health Disparities In Patients With Obstructive Sleep Apnea

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A273-A273
Author(s):  
S I Patel ◽  
D Combs ◽  
N Provencio-Dean ◽  
S Mashaqi ◽  
S Bhattacharjee ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Health Disparities ◽  
Attention Control ◽  
Lower Income ◽  
Cpap Therapy ◽  
Sleep Study ◽  
Cpap Adherence ◽  
Obstructive Sleep ◽  
Peer Intervention ◽  
Peer Buddies

Abstract Introduction In patients with obstructive sleep apnea (OSA), adherence to continuous positive airway pressure (CPAP) therapy is a major problem. Moreover, up to 20% of patients with suspected OSA who are referred to sleep study testing do not adhere to such diagnostic work-up. Although, peer-driven intervention with an interactive voice response system (PDI-IVR) can improve CPAP adherence, whether such an intervention can improve adherence to sleep study testing is unknown. Also, there remain health disparities with greater levels of CPAP nonadherence disproportionately affecting individuals of lower socioeconomic status. We aimed to determine whether PDI-IVR can improve adherence to sleep study testing and CPAP adherence in a lower income population. Methods We performed a prospective, randomized, parallel group, controlled trial wherein patients with suspected OSA were randomly assigned to receive PDI-IVR or provided with educational information regarding OSA and CPAP therapy (attention-control group) while both groups received usual care. The PDI-IVR interactions aimed at promoting adherence to sleep study testing and in patients diagnosed with OSA the peer-intervention was focused on improving CPAP adherence. In the PDI-IVR group, trained peers (peer-buddies) with OSA were paired with randomized patients over a 6-month period combined with an ability to meet in-person, email, text message, or phone an inter-disciplinary team of providers. Results In this pilot study, there were 63 patients (48.4 ± 12.5 years; 30 men) who were randomized to intervention (n=31) and attention-control (n=32) arms. There were 36 peer-buddies who mentored the patients in the intervention group. Intention to treat analysis revealed that failure to undergo sleep study testing was 15.6% of patients in the attention-control arm and 9.7% in the PDI-IVR arm (P=0.7). Per protocol analysis revealed that failure to undergo sleep study testing was 18.4% of patients in the attention-control arm and 4% in the PDI-IVR arm (P=0.13). At 6 months, CPAP adherence was greater in PDI-IVR arm (290 ± 45 min [SE]) than attention-control arm (181 ± 43 min; P=0.01). Conclusion In a lower income population, PDI-IVR improved CPAP adherence with a tendency for better adherence to sleep-study testing. Peer-intervention can reduce sleep health disparities. Support HL138377

scholarly journals 0653 Positive Effects of Long Term Continuous Positive Airway Pressure Therapy on Blood Pressure in Obstructive Sleep Apnea Patients

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A249-A249
Author(s):  
R Shirahama ◽  
T Tanigawa ◽  
K Tomooka ◽  
L Fan Yun ◽  
A Ikeda ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Weight Loss ◽  
Obstructive Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Cpap Therapy ◽  
Significant Weight Loss ◽  
Cpap Adherence ◽  
Obstructive Sleep

Abstract Introduction Obstructive sleep apnea (OSA) is one of the common causes of hypertension. Therefore, we examine the longitudinal effect of continuous positive airway pressure (CPAP) therapy and its adherence on blood pressure among OSA patients. Methods One thousand two hundred ninety-three (male 1,130, female 163) patients, who were diagnosed with OSA and underwent CPAP therapy were investigated for longitudinal changes (24 months observation period) in the levels of blood pressure and body weight. The longitudinal analyses were performed by mixed effect model. Multiple Imputation with Chained Equations was also used to impute missing data. Good CPAP adherence is defined as more than 70% of the time using CPAP more than 4hours at all the measuring. Poor CPAP adherence is defined as less than 70% of the time using CPAP more than 4hours at all the measuring time points. Results The patient group with good CPAP adherences), compared to poor CPAP adherence, showed significant diastolic blood pressure reduction in 24 months follow-up period (β=-0.13, p=0.03) despite a lack of significant weight loss (β=-0.02, p=0.59). However, no significant associations were found between systolic blood pressure and CPAP adherence (β=-0.14, p=0.11). Conclusion CPAP therapy was found to have a longitudinal effect on diastolic blood pressure despite a lack of significant weight loss. Support  

scholarly journals 0632 The Correlation Between Severity of Obstructive Sleep Apnea and Patient Compliance

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A241-A241
Author(s):  
A C Roberts ◽  
G Bastin
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Patient Compliance ◽  
Compliance Rate ◽  
Newly Diagnosed ◽  
Cpap Therapy ◽  
Cpap Adherence ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Cpap Compliance

Abstract Introduction Obstructive sleep apnea (OSA) is a prevalent disorder affecting 9-38% of the global population and is linked to multiple health complications. Continuous Positive Airway Pressure (CPAP) is regarded as the gold standard treatment for OSA, but its efficacy is limited by poor patient compliance. Studies have linked many clinical and lifestyle factors to CPAP adherence, but have produced conflicting outcomes. Based on the current literature, it is assumed patients diagnosed with severe OSA are more likely to be compliant with CPAP due to a greater improvement in quality of life. The goal of this study is to compare the compliance rate of CPAP for patients with mild, moderate, and severe OSA, as well as identify other potential predictors of CPAP compliance. Methods This study is a retrospective chart review of 100 patients who were newly diagnosed with OSA and started on CPAP between January 1, 2017 and January 1, 2018. Baseline demographic data, past medical history, OSA severity, Epworth sleepiness scale, and compliance to CPAP therapy were recorded. Compliance was defined as CPAP usage greater than four hours per night for at least 21 days per month. Results Mean follow-up time after CPAP initiation was 3.19 months. Overall 77% of patients were compliant to CPAP therapy, of which 48% were males and 52% were females (P=0.48). CPAP compliance rates for mild OSA (79.3%), moderate OSA (73.7%), and severe OSA (78.8%) showed no significant difference for independence (P=0.83) or correlation with compliance (P=0.99). Only seasonal allergic rhinitis showed a positive association with CPAP adherence (P=0.031) and depression showed a negative association (P=0.027). Conclusion The level of OSA severity is not a significant predictor of short-term CPAP compliance among newly diagnosed patients. Support Parkview Physicians Group, Indiana School of Medicine - Fort Wayne, and the Dr. Luis and Anne B Schneider Foundation.

scholarly journals Recurrent Pneumothorax with CPAP Therapy for Obstructive Sleep Apnea

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Kartikeya Rajdev ◽  
Pretty Sara Idiculla ◽  
Shubham Sharma ◽  
Susanna G. Von Essen ◽  
Peter J. Murphy ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Diaphragmatic Hernia ◽  
Invasive Mechanical Ventilation ◽  
Positive Pressure ◽  
Cpap Therapy ◽  
Pulmonary Barotrauma ◽  
Sleep Study ◽  
Pressure Therapy ◽  
Obstructive Sleep

Pulmonary barotrauma such as pneumothorax (PTX) is a known complication of invasive mechanical ventilation. However, it is uncommonly reported with the use of noninvasive positive pressure ventilation (NPPV) and CPAP (continuous positive airway pressure) therapy. We present a case of a 66-year-old female who presented with chronic dyspnea on exertion secondary to right-sided diaphragmatic hernia. The patient also underwent a home sleep study which suggested obstructive sleep apnea (OSA) for which she was initiated on CPAP. She then underwent surgical repair of her right diaphragmatic hernia. The patient developed pneumothorax three times over the course of the following several months, once on the right side and twice on the left side. The patient’s incidences of PTX had a temporal association with the CPAP initiation. Her CPAP therapy was discontinued permanently after the third occurrence of PTX. With this case report, we highlight the risk of barotrauma with the use of CPAP for OSA. There are very few reported cases of PTX in association with NPPV therapy for OSA. The lung-protective ventilation strategies and limiting the positive airway pressures can help reduce the risk of pulmonary barotrauma with CPAP.

scholarly journals 0677 Patient Preferences On Initiating Treatment With Continuous Positive Airway Pressure

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A258-A258
Author(s):  
P V Borker ◽  
C Wyland ◽  
S R Patel
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Patient Preference ◽  
Airway Pressure ◽  
Treatment Initiation ◽  
Positive Airway Pressure ◽  
Cpap Therapy ◽  
Sleep Study ◽  
Cpap Adherence ◽  
Obstructive Sleep ◽  
At Home

Abstract Introduction Clinical guidelines recommend continuous positive airway pressure (CPAP) therapy be initiated in patients with obstructive sleep apnea (OSA) either at home using an auto-titrating device or following manual titration in the sleep laboratory. Patient preference between these two options is unknown. Methods Patients newly prescribed CPAP therapy for the treatment of OSA at an academic sleep medicine clinic were surveyed by telephone within one month of initiating treatment. Data on demographics, disease severity and CPAP adherence were obtained from the medical record. Results A total of 75 participants (56% male, mean age 52±15 yrs, 48% moderate to severe OSA) were surveyed. Physicians prescribed home initiation of CPAP in 51%, lab initiation in 23%, and allowed the patient to choose in 27% of cases. Overall, 67% of participants (95% CI [56%-77%]) reported preference for home initiation. Preference for home initiation did not vary by age, sex, AHI, degree of sleepiness, or type of diagnostic study (home vs. lab sleep study) performed (p>0.10 for all). Convenience (44%) and starting treatment faster (44%) were the most common reasons provided for those favoring home initiation, while sleep technician availability (40%), optimization of pressure settings (32%), and ability to try multiple masks (28%) were cited by those favoring lab initiation. The prevalence of CPAP adherence at 90 days tended to be higher in those whose treatment was initiated aligned to preference (79% in those whose treatment initiation was concordant with preference vs. 64% in those whose treatment initiation was discordant, p=0.16). Conclusion Overall, two-thirds of patients with OSA prefer initiation of CPAP be done at home. This preference does not vary by demographics, OSA severity or diagnostic modality. Initiating treatment concordant with patient preference may lead to greater adherence. Support American Thoracic Society Academic Sleep Pulmonary Integrated Research/Clinical (ASPIRE) Fellowship, K24 HL127307

scholarly journals VAMONOS (Veterans Affairs' Metabolism, Obstructed and Non-Obstructed Sleep) Study: Effects of CPAP Therapy on Glucose Metabolism in Patients with Obstructive Sleep Apnea

2017 ◽  
Vol 13 (03) ◽  
pp. 455-466 ◽  
Author(s):  
Octavian C. Ioachimescu ◽  
Jeremy Anthony ◽  
Tina Constantin ◽  
Mary-Margaret Ciavatta ◽  
Kandace McCarver ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Glucose Metabolism ◽  
Veterans Affairs ◽  
Cpap Therapy ◽  
Sleep Study ◽  
Obstructive Sleep

Cancer risk in patients with sleep apnoea following adherent 5-year CPAP therapy

2021 ◽  
pp. 2101935
Author(s):  
Grégoire Justeau ◽  
Sebastien Bailly ◽  
Chloé Gervès-Pinquié ◽  
Wojciech Trzepizur ◽  
Nicole Meslier ◽  
...  
Keyword(s):  
Cancer Risk ◽  
Cancer Incidence ◽  
Sleep Apnoea ◽  
First Year ◽  
Cpap Therapy ◽  
Sleep Study ◽  
Cpap Adherence ◽  
Obstructive Sleep ◽  
History Of ◽  
The Impact

BackgroundIncreasing evidence suggests that obstructive sleep apnoea (OSA) contributes to cancer risk; however, limited data are available on the impact of continuous positive airway pressure (CPAP) therapy on cancer incidence. We aimed to determine whether adherence to CPAP therapy is associated with a reduction in all-cancer incidence compared to non-adherent patients with OSA.MethodsThe study relied on the data collected by the multicentre study Pays de la Loire Sleep Cohort, linked to health administrative data, such as to identify new-onset cancer. We included patients who were prescribed CPAP for OSA, with no history of cancer before the diagnostic sleep study or during the first year of CPAP. Patients with documented CPAP use for at least 4 h per night were defined as adherent. Those who discontinued or used CPAP less than 4 h at night constituted the non-adherent group. A propensity-score inverse probability of treatment weighting analysis was performed to assess the effect of CPAP adherence on cancer risk.ResultsAfter a median [inter-quartile range] follow-up of 5.4 [3.1–8.0] years, 437 (9.7%) of 4,499 patients developed cancer, 194 (10.7%) in the non-adherent group (n=1817) and 243 (9.1%) in adherent patients (n=2682). The final weighted model showed no significant impact of CPAP adherence on all-cause cancer risk (sub distribution hazard ratio [95% confidence interval]): 0.94 [0.78; 1.14]).ConclusionsAdherence to CPAP therapy in OSA patients was not associated with a reduction in all-cancer incidence. Whether adherent CPAP therapy of OSA might reduce the risk of specific cancer sites should be further evaluated.

scholarly journals Long-term effect of continuous positive airway pressure therapy on blood pressure in patients with obstructive sleep apnea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryutaro Shirahama ◽  
Takeshi Tanigawa ◽  
Yoshifumi Ida ◽  
Kento Fukuhisa ◽  
Rika Tanaka ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Weight Loss ◽  
Obstructive Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Cpap Therapy ◽  
Cpap Adherence ◽  
Obstructive Sleep

AbstractObstructive sleep apnea (OSA) is a common cause of hypertension. Previous studies have demonstrated beneficial short-term effects of continuous positive airway pressure (CPAP) therapy on blood pressure. However, long-term antihypertensive effects of CPAP have not been properly verified. This study examined the longitudinal effect of CPAP therapy adherence on blood pressure among OSA patients. All patients diagnosed with OSA and undergoing subsequent CPAP therapy at a Kanagawa-area sleep clinic were clinically followed for 24 months to examine CPAP adherence, as well as longitudinal changes in blood pressure and body weight because it may become a confound factor for changes in blood pressure. The hours of CPAP usage were collected over the course of 30 nights prior to each follow-up visit (1st, 3rd, 6th, 12th, and 24th month). The relationship between CPAP adherence and blood pressure was analyzed using mixed-effect logistic regression models. A total of 918 OSA patients were enrolled in the study. We found a significant reduction in diastolic blood pressure among patients with good CPAP adherence during the 24-month follow-up period (β = − 0.13, p = 0.03), when compared to the group with poor CPAP adherence. No significant association was found between CPAP adherence and weight loss (β = − 0.02, p = 0.59). Long-term, good CPAP therapy adherence was associated with lower diastolic blood pressure without significant weight loss.

scholarly journals The Effect of Continuous Positive Airway Pressure Therapy on Obstructive Sleep Apnea-Related Hypertension

2021 ◽  
Vol 22 (5) ◽  
pp. 2300
Author(s):  
Ronni Baran ◽  
Daniela Grimm ◽  
Manfred Infanger ◽  
Markus Wehland
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Common Disease ◽  
Cpap Therapy ◽  
Pressure Therapy ◽  
Airway Patency ◽  
Obstructive Sleep

Obstructive sleep apnea (OSA) is a common disease, with approximately 3–7% of men and 2–5% of women worldwide suffering from symptomatic OSA. If OSA is left untreated, hypoxia, microarousals and increased chemoreceptor stimulation can lead to complications like hypertension (HT). Continuous positive airway pressure (CPAP) is the most common treatment for OSA, and it works by generating airway patency, which will counteract the apnea or hypopnea. More than one billion people in the world suffer from HT, and the usual treatment is pharmacological with antihypertensive medication (AHM). The focus of this review will be to investigate whether the CPAP therapy for OSA affects HT.

Rationale and design of remotely-supervised cardiac rehabilitation study in patients with obstructive sleep apnea

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Hnatiak ◽  
O Ludka ◽  
L Batalik ◽  
P Winnige ◽  
F Dosbaba
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiac Rehabilitation ◽  
Public Institution ◽  
Moderate Intensity ◽  
Newly Diagnosed ◽  
Cpap Therapy ◽  
Phone Calls ◽  
Obstructive Sleep ◽  
Home Conditions

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Ministry of Health Czech Republic; identification of organization 65269705 Background Although continuous positive airway pressure (CPAP) is currently still the gold standard for therapy of moderate to severe obstructive sleep apnea (OSA), another alternative or adjunct effective therapeutic options exist. Lifestyle intervention focused on nutrition and weight reduction, regular exercise, sleep hygiene, smoking and alcohol restriction represents a recommended therapeutic strategy for OSA. Though this intervention represents an effective tool for improving objective and subjective parameters of OSA, it’s effectivity depends on components of the intervention, OSA severity and gender. Comprehensive remotely-supervised cardiac rehabilitation (CR) represents possible training intervention in home conditions using elements of telemedicine. Purpose This prospective study aims to investigate the feasibility and effect of a remotely-supervised CR in patients with newly diagnosed OSA with Apnea-Hypopnea Index greater than 15 episodes per hour. Methods This monocentric study is designed as a prospective, parallel, randomised, controlled trial of remotely-supervised 12-week CR in male patients between 40-60 years old with newly diagnosed OSA indicated to CPAP therapy. The sample size is calculated by 0,05 level of significance and 80% statistical power on 25 participants in each group. The Intervention group will undergo comprehensive remotely-supervised CR in home conditions with teleconsultation (contains telecoaching, telemonitoring) via regular phone calls and e-mails at least 1-2 times a week. The intervention will include nutrition, health-related lifestyle and behavioral changes recommendations, and at least 5 times a week 30 minutes of moderate-intensity aerobic training, 10 minutes of inspiratory and expiratory muscle training with breathing device and 10 minutes of oropharyngeal exercise along with individually titrated CPAP therapy. The control group will undergo individually titrated CPAP therapy only. The participants in both groups will go through the following assessments before and after this study: polysomnography, spirometry, anthropometry and body composition examination, laboratory values examination, quality of life questionnaires, Epworth sleepiness scale, 6-min walking test. Conclusions: Comprehensive remotely-supervised CR, as mentioned in this study, may represent an adjunct therapy with a promising future in patients with OSA. The study is occupied with a current issue and can also bring new possibilities and experiences in remote rehabilitation.

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