scholarly journals 718 Investigating Decreased Positive Airway Pressure Compliance in a Veteran Affairs Sleep Medicine Clinic During the 2020 Pandemic

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A280-A280
Author(s):  
David Earl ◽  
Nicholas Cutrufello ◽  
Joseph Kern ◽  
Melissa Begay ◽  
Madeleine Grigg-Damberger ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Primary Outcome ◽  
Positive Airway Pressure ◽  
Sleep Medicine ◽  
Medicine Clinic ◽  
Time Period ◽  
Barriers And Challenges ◽  
Barriers To Use ◽  
Set Up ◽  
Machine Replacement

Abstract Introduction Positive airway pressure (PAP) compliance for the treatment of sleep apnea at the Albuquerque Veterans Affairs (VA) Sleep Medicine clinic has been observed to be lower in new setup patients after the onset of the COVID-19 pandemic. The reasons for decreased PAP compliance during the COVID-19 pandemic are unclear. The primary outcome will be to identify if there is a common reason that patients at the Albuquerque VA were less compliant with PAP after the onset of the COVID-19 pandemic. Methods Compliance data for 4/1/2020 through 9/30/2020 was compared to compliance data for 4/1/2019 through 9/30/2019. Compliance after PAP machine setup was confirmed to be lower during the 2020 time period. Noncompliant patients will be selected by setup type, new versus machine replacement, and surveyed for reasons for noncompliance. The survey will be conducted at the Albuquerque VA Sleep Center and will include questions regarding beliefs, barriers, and challenges with the use of PAP therapy during the coronavirus pandemic. The definition for initial PAP compliance will be the use of PAP therapy for greater than or equal to four hours per night on at least 70% of nights. Results For the 6-month time period of 4/1/2019 through 9/30/2019, there were 758 PAP setups at the Albuquerque VA. The 30-day compliance for the 758 setups was found to be 61.4%. Comparatively, for the six-month period of 4/1/2020 through 9/30/2020, there were 462 setups with a 30-day compliance result of 49.7%. A survey consisting of questions designed to elicit barriers to use as well as beliefs regarding PAP and COVID-19 will be administered to 20% (n = 46) of the non-compliant patients who were set up with a PAP machine during the 2020 study period. Conclusion PAP compliance after machine setup was lower at the Albuquerque VA sleep center in 2020 versus 2019 (49.7% versus 61.4%). The reasons for the lower observed compliance are attributed to the effects of the coronavirus pandemic. A random sampling of the non-compliant patients during the 2020 time period will be performed and the results will be presented once available. Support (if any) None

Nasal Intermittent Positive Pressure Ventilation versus Continuous Positive Airway Pressure and Apnea of Prematurity: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Bayane Sabsabi ◽  
Ava Harrison ◽  
Laura Banfield ◽  
Amit Mukerji
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Primary Outcome ◽  
Positive Pressure Ventilation ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Apnea Of Prematurity

Objective The study aimed to systematically review and analyze the impact of nasal intermittent positive pressure ventilation (NIPPV) versus continuous positive airway pressure (CPAP) on apnea of prematurity (AOP) in preterm neonates. Study Design In this systematic review and meta-analysis, experimental studies enrolling preterm infants comparing NIPPV (synchronized, nonsynchronized, and bi-level) and CPAP (all types) were searched in multiple databases and screened for the assessment of AOP. Primary outcome was AOP frequency per hour (as defined by authors of included studies). Results Out of 4,980 articles identified, 18 studies were included with eight studies contributing to the primary outcome. All studies had a high risk of bias, with significant heterogeneity in definition and measurement of AOP. There was no difference in AOPs per hour between NIPPV versus CPAP (weighted mean difference = −0.19; 95% confidence interval [CI]: −0.76 to 0.37; eight studies, 456 patients). However, in a post hoc analysis evaluating the presence of any AOP (over varying time periods), the pooled odds ratio (OR) was lower with NIPPV (OR: 0.46; 95% CI: 0.32–0.67; 10 studies, 872 patients). Conclusion NIPPV was not associated with decrease in AOP frequency, although demonstrated lower odds of developing any AOP. However, definite recommendations cannot be made based on the quality of the published evidence. Key Points

scholarly journals Effect of continuous positive airway pressure treatment of obstructive sleep apnea-hypopnea in multiple sclerosis: A randomized, double-blind, placebo-controlled trial (SAMS-PAP study)

2021 ◽  
pp. 135245852110103
Author(s):  
Sulaiman Khadadah ◽  
R John Kimoff ◽  
Pierre Duquette ◽  
Vincent Jobin ◽  
Yves Lapierre ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Primary Outcome ◽  
Positive Airway Pressure ◽  
Apnea Hypopnea Index ◽  
Double Blind ◽  
Obstructive Sleep

Objective: The aim of this study was to evaluate the effect of continuous positive airway pressure (CPAP) treatment on the Fatigue Severity Scale (FSS, preplanned primary outcome), another fatigue measure, sleep quality, somnolence, pain, disability, and quality of life in multiple sclerosis (MS) patients with obstructive sleep apnea-hypopnea (OSAH). Methods: In a randomized, double-blind trial (NCT01746342), MS patients with fatigue, poor subjective sleep quality, and OSAH (apnea-hypopnea index of ⩾ 15 events per hour/sleep), but without severe OSAH (apnea-hypopnea index > 30, and 4% oxygen desaturation index > 15 events/hour or severe somnolence), were randomized to fixed CPAP or sham CPAP for 6 months. Outcome assessments were performed at 3 and 6 months. Results: Of 49 randomized patients, 34 completed the protocol. Among completers, FSS did not improve with CPAP compared to sham at 6 months. FSS tended to improve ( p = 0.09), and sleepiness (Epworth Sleepiness Scale) improved significantly ( p = 0.03) at 3 months with CPAP compared to sham, but there were no other improvements with CPAP at either study evaluation. Conclusion: In non-severe OSAH patients, CPAP did not significantly improve the primary outcome of FSS change at 6 months. In secondary analyses, we found a trend to improved FSS, and a significant reduction in somnolence with CPAP at 3 months.

scholarly journals 0883 Impact of Implementation of a Comprehensive Positive Airway Pressure Program

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A336-A336
Author(s):  
K Oppy ◽  
B Huffman ◽  
M Kalra
Keyword(s):  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Good Practice ◽  
Compliance Rate ◽  
Sleep Medicine ◽  
Clinic Visit ◽  
Obstructive Sleep ◽  
Number Of Patients ◽  
Tele Monitoring

Abstract Introduction The American Academy of Sleep Medicine (AASM) guidelines for treatment of Obstructive Sleep Apnea (OSA) with Positive Airway Pressure (PAP) state good practice standards involve adequate follow up with a clinician tele-monitoring efficacy through objective usage data to ensure acceptable treatment and compliance is met, and provide education, behavioral and/or troubleshooting interventions. In 2016, Dayton Children’s Hospital’s pap compliance was 29% due to limited staff support. Methods To efficiently implement the AASM guidelines, one dedicated Respiratory Therapist (RT) was assigned to help manage OSA patients at Dayton Children’s Sleep Medicine. The RT responsibilities include, PAP therapy education, arranging home PAP system, and a follow-up call within 7 days of setup. Through the tele-monitoring system, the RT assesses compliance and addresses equipment issues and mask fitting at the 4 to 6 week clinic visit. To enhance compliance, a welcome postcard and gift card were implemented. Monthly clinic visits occur until compliance is met, wearing device greater than 4 hours 60% of the time, then appointments are scheduled every 6 months to 1 year. Results Since 2016, compliance rate increased from 29% to 58%. There was a year over year growth of number of patients starting therapy from 2017 to 2019, 86 patients were added to the PAP program. In 2019, 60% of 6 to 12 years old met compliance and 51% of 13 to 18 years old. Conclusion A comprehensive PAP program resulted in improved compliance and substantial growth. Referring providers and families are more likely to accept PAP therapy when made aware of extensive education and follow up by RT staff. To further improve compliance, especially in the 13 to 18 age range, a desensitization program has recently been implemented. Support No support provided.

scholarly journals Dynamic Characteristics of Mechanical Ventilation System of Double Lungs with Bi-Level Positive Airway Pressure Model

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Dongkai Shen ◽  
Qian Zhang ◽  
Yan Shi
Keyword(s):  
Mathematical Model ◽  
Mechanical Ventilation ◽  
Dynamic Characteristics ◽  
Airway Pressure ◽  
Life Support ◽  
Positive Airway Pressure ◽  
Coupling Effect ◽  
Ventilation System ◽  
System A ◽  
Set Up

In recent studies on the dynamic characteristics of ventilation system, it was considered that human had only one lung, and the coupling effect of double lungs on the air flow can not be illustrated, which has been in regard to be vital to life support of patients. In this article, to illustrate coupling effect of double lungs on flow dynamics of mechanical ventilation system, a mathematical model of a mechanical ventilation system, which consists of double lungs and a bi-level positive airway pressure (BIPAP) controlled ventilator, was proposed. To verify the mathematical model, a prototype of BIPAP system with a double-lung simulators and a BIPAP ventilator was set up for experimental study. Lastly, the study on the influences of key parameters of BIPAP system on dynamic characteristics was carried out. The study can be referred to in the development of research on BIPAP ventilation treatment and real respiratory diagnostics.

Effectiveness of preoxygenation with positive airway pressure in non-obese healthy patient: a comparison of the supine and 25° head up position

2019 ◽  
Author(s):  
Yogesh Dhakal ◽  
Balkrishna Bhattarai ◽  
Sindhu Khatiwada ◽  
Asish Subedi
Keyword(s):  
Supine Position ◽  
Airway Pressure ◽  
Primary Outcome ◽  
Positive Airway Pressure ◽  
Controlled Trial ◽  
Conventional Technique ◽  
Randomized Controlled ◽  
Head Up Tilt ◽  
The Difference ◽  
Made In

Abstract Background Though conventional preoxygenation provides extended safe apnoeic period during endotracheal intubation, it is associated with atelectasis of lungs immediately after induction. Therefore, alternatives such as positive airway pressure and head-up tilt during preoxygenation have been explored but uniform recommendations have not yet been made. In the present study we aimed to find out the effect of combination of 5 cmH2O CPAP and 25° head up position during preoxygenation on non-hypoxic apnea period. Methods In this randomized controlled trial, 60 non-obese healthy adult patients were randomly divided into three groups; Group C receiving preoxygenation in conventional technique, Group S receiving preoxygenation in supine position with 5 cmH2O CPAP and Group H receiving preoxygenation in 25° head-up position with 5 cmH2O CPAP. After 3 min of preoxygenation, anesthesia was induced and trachea intubated. After confirming the tracheal intubation by direct visualization, all patients were administered vecuronium to maintain neuromuscular blockade and midazolam to prevent awareness. Post-induction, patients in all groups were left apneic in supine position with the tracheal tube exposed to atmosphere till the SpO2 dropped to 92%. The primary outcome compared between the groups was the non-hypoxic apnoeic period (time to fall SpO2 to 92%). Results The duration of non-hypoxic apnea period was longer (p<0.05) in Group H patients (405.90±106.69 s) as compared to the Group C (296.90±99.01 s) and Group S (319.65±71.54 s). Although the duration of non-hypoxic apnea was clinically longer in the Group S as compared to Group C the difference was not statistically significant. There were no remarkable adverse events observed in any group. Conclusion Preoxygenation in 25° head-up position with 5 cmH2O CPAP significantly prolongs non-hypoxic apnea period in non-obese healthy adults compared to supine position, with or without 5 cmH2O CPAP.

scholarly journals Long-Term Compliance to Continuous Positive Airway Pressure Therapy (nCPAP) Set Up During a Split-Night Polysomnography

SLEEP ◽  
1994 ◽  
Vol 17 (6) ◽  
pp. 512-515 ◽  
Author(s):  
Bernard Fleury ◽  
Dominique Rakotonanahary ◽  
Alain D. Tehindrazanarivelo ◽  
Chantal Hausser-Hauw ◽  
Bemard Lebeau
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Pressure Therapy ◽  
Positive Airway Pressure Therapy ◽  
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