scholarly journals Mood Predicts Response to Placebo CPAP

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Carl J. Stepnowsky ◽  
Wei-Chung Mao ◽  
Wayne A. Bardwell ◽  
José S. Loredo ◽  
Joel E. Dimsdale
Keyword(s):  
Positive Airway Pressure ◽  
Placebo Response ◽  
Hierarchical Regression ◽  
Apnea Hypopnea Index ◽  
Drug Trials ◽  
Factors Associated ◽  
Beneficial Effects ◽  
Cpap Treatment ◽  
Total Mood Disturbance ◽  
Obstructive Sleep

Study Objectives. Continuous positive airway pressure (CPAP) therapy is efficacious for treating obstructive sleep apnea (OSA), but recent studies with placebo CPAP (CPAP administered at subtherapeutic pressure) have revealed nonspecific (or placebo) responses to CPAP treatment. This study examined baseline psychological factors associated with beneficial effects from placebo CPAP treatment.Participants. Twenty-five participants were studied with polysomnography at baseline and after treatment with placebo CPAP.Design. Participants were randomized to either CPAP treatment or placebo CPAP. Baseline mood was assessed with the Profile of Mood States (POMS). Total mood disturbance (POMS-Total) was obtained by summing the six POMS subscale scores, with Vigor weighted negatively. The dependent variable was changed in apnea-hypopnea index (ΔAHI), calculated by subtracting pre- from post-CPAP AHI. Negative values implied improvement. Hierarchical regression analysis was performed, with pre-CPAP AHI added as a covariate to control for baseline OSA severity.Results. Baseline emotional distress predicted the drop in AHI in response to placebo CPAP. Highly distressed patients showed greater placebo response, with a 34% drop (i.e., improvement) in AHI.Conclusion. These findings underscore the importance of placebo-controlled studies of CPAP treatment. Whereas such trials are routinely included in drug trials, this paper argues for their importance even in mechanical-oriented sleep interventions.

scholarly journals Examining the Utility of a Novel Neurologic Test in Patients With Obstructive Sleep Apnea: A Pilot Study

2019 ◽  
Vol 10 ◽  
pp. 215013271988695
Author(s):  
Michael L. Grover ◽  
Lori Latowski Grover ◽  
Martina Mookadam ◽  
Lanyu Mi ◽  
Yu-Hui Chang ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Brain Function ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Apnea Hypopnea Index ◽  
Physical Measure ◽  
Cpap Treatment ◽  
Obstructive Sleep ◽  
Potential Improvement

Purpose: To test the association between participant King-Devick Test (KDT) times and obstructive sleep apnea (OSA) severity and evaluate for improvement after continuous positive airway pressure (CPAP) treatment. Methods: Study dates January 30 to July 31, 2018. Patients were referred for initial evaluation of sleep disordered breathing concerns. OSA severities were defined by Apnea Hypopnea Index (AHI) results, with ≥15 considered at least moderate OSA. The KDT is an objective physical measure of brain function. We estimated correlation between KDT time and AHI and compared mean KDT time between patients with and without moderate OSA. For the OSA subgroup, we evaluated for potential improvement in KDT after CPAP. Results: We enrolled 60 participants, of whom 35 (58.3%) had OSA with an AHI ≥15. Initial analyses noted no significant KDT time differences between patients based on OSA severity. However, after excluding 3 participants who had baseline neurologic illness, adjusted analyses demonstrated that mean KDT time was significantly prolonged for patients with moderate or greater OSA (AHI ≥15) as compared to those with mild or no sleep apnea (AHI <15); 63.4 seconds (95% CI 58.9-67.8) versus 55.7 seconds (95% CI 50.2-61.1), P = .03. CPAP-treated subjects demonstrated significantly improved KDT test times; 63.5 seconds mean pretreatment versus 55.6 posttreatment; −6.6 seconds mean difference, 95%CI (−12.0, −1.13), P = .02. Conclusion: Neurologic abnormalities in patients with OSA are potentially demonstrable utilizing this objective physical measure. Significant improvement is achieved in patients after CPAP treatment.

Serum copeptin is a new biomarker of continuous-positive-airway-pressure treatment in severe obstructive sleep apnea

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Sekiguchi ◽  
I Ishida ◽  
M Suzuki ◽  
M Hagiwara
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Statistical Significance ◽  
Sleep Apnea Syndrome ◽  
Apnea Hypopnea Index ◽  
Cpap Treatment ◽  
Obstructive Sleep

Abstract Introduction Copeptin, the C-terminal fragment of antidiuretic hormone (ADH), is a biomarker which has been reported to be increased in cardiovascular and cerebrovascular diseases, thus playing a role in predicting their prognosis. Patients with obstructive sleep apnea syndrome (OSA) have been demonstrated to have a high risk for developing these vascular diseases. However, there have been no authentic reports concerning the effect of continuous positive airway pressure (CPAP) on serum copeptin levels in OSA patients. Purpose We hypothesis that CPAP treatment substantially modifies copeptin levels in OSA patients. Methods A total of 60 OSA patients confirmed by polysomnographic examinations was divided into two groups: a mild-moderate OSA (apnea-hypopnea index: AHI &lt;30/h) group and a severe OSA (AHI ≥30/h) group. Blood samples were collected early in the morning after overnight fasting, and serum copeptin and ADH levels were measured with an enzyme immunoassay method. In patients initiated with CPAP, hormone levels were measured before and after CPAP treatment. Results Twenty-one patients (age: 54.7±12.4 y, male: 17, NT-proBNP: 45.3±44.2 pg/mL) were diagnosed as having mild-moderate OSA (AHI: 16.5±8.4/h), while 39 patients (age: 57.8±11.4y, male: 29, NT-proBNP: 73.7±87.3 pg/mL) were diagnosed as severe OSA (AHI: 49.5±21.1/h). As a whole, there were no significant differences in copeptin and ADH levels between mild-moderate OSA and severe OSA groups (copeptin: 2.1±1.4 pmol/L vs. 1.9±1.4, ADH: 2.3±2.6 pg/dL vs. 2.0±0.7). In 26 severe OSA patients (age: 55.9±12.9y, male: 23, NT-proBNP: 63.3±85.2 pg/mL), these hormones were again evaluated after CPAP initiation. AHI was significantly improved after CPAP treatment (45.5±20.8/h vs. 5.0±5.0, P&lt;0.01). Although the ADH level was changed from 1.85±0.77 pg/dL to 1.68±0.99, the difference did not reach the statistical significance. The copeptin level was certainly decreased after CPAP by 26% (2.29±2.63 pmol/L vs. 1.69±1.68, P&lt;0.01) (Figure 1). Conclusions Serum copeptin levels decreased after CPAP treatment in patients with severe OSA. Copeptin, but not ADH, can be considered as a new biomarker for predicting cardio/cerebrovascular events in severe OSA patients. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Prediction of optimal continuous positive airway pressure in Thai patients with obstructive sleep apnea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Narongkorn Saiphoklang ◽  
Kanyada Leelasittikul ◽  
Apiwat Pugongchai
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Linear Regression Analysis ◽  
Prediction Equation ◽  
Apnea Hypopnea Index ◽  
Predictive Equation ◽  
Obstructive Sleep

AbstractContinuous positive airway pressure (CPAP) is simple and effective treatment for obstructive sleep apnea (OSA) patients. However, the CPAP prediction equation in each country is different. This study aimed to predict CPAP in Thai patients with OSA. A retrospective study was conducted in Thai patients, who OSA was confirmed by polysomnography and CPAP titration from January 2015 to December 2018. Demographics, body mass index (BMI), neck circumference (NC), Epworth sleepiness scale, apnea–hypopnea index (AHI), respiratory disturbance index (RDI), mean and lowest pulse oxygen saturation (SpO2), and optimal pressure were recorded. A total of 180 subjects were included: 72.8% men, age 48.7 ± 12.7 years, BMI 31.0 ± 6.3 kg/m2, NC 40.7 ± 4.1 cm, AHI 42.5 ± 33.0 per hour, RDI 47.1 ± 32.8 per hour, and lowest SpO2 77.1 ± 11.0%. Multiple linear regression analysis identified NC, BMI, RDI, and lowest SpO2. A final CPAP predictive equation was: optimal CPAP (cmH2O) = 4.614 + (0.173 × NC) + (0.067 × BMI) + (0.030 × RDI) − (0.076 × lowest SpO2). This model accounted for 50.0% of the variance in the optimal pressure (R2 = 0.50). In conclusion, a CPAP prediction equation can be used to explain a moderate proportion of the titrated CPAP in Thai patients with OSA. However, the CPAP predictive equation in each country may be different due to differences of ethnicity and physiology.Trial registration: TCTR20200108003.

scholarly journals 0570 Apnea-Hypopnea Index is Positively Correlated with Mood Disturbance

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A218-A219
Author(s):  
K M Stubbers ◽  
S S Thosar ◽  
M P Butler ◽  
N P Bowles ◽  
A W McHill ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Mood State ◽  
Mood Disturbance ◽  
Apnea Hypopnea Index ◽  
Uncomplicated Hypertension ◽  
Total Mood Disturbance ◽  
Obstructive Sleep ◽  
Sleep Schedule ◽  
The Relationship ◽  
Larger Sample

Abstract Introduction The prevalence of mood disorders such as depression is higher in individuals with obstructive sleep apnea (OSA). Previous studies have found no significant correlation between the apnea-hypopnea index (AHI) and measures of mood and have only included participants who met diagnostic criteria for OSA. The current analysis sought to determine whether mood correlated with AHI in individuals with any AHI values including those that did not meet diagnostic criteria for OSA. Methods 31 volunteers were studied (BMI=29.2±1.0 kg/m2, mean±SE), free from medication and without psychiatric illness or chronic medical conditions with the exception of untreated OSA, uncomplicated hypertension (BP&lt;160/100), or obesity. Following 1-3 weeks of an 8h habitual at home sleep schedule, participants completed the POMS-Brief questionnaire (POMS-B) to assess mood after undergoing overnight polysomnography to determine AHI. Total mood disturbance (TMD) scores were calculated by adding the scores on the POMS-B for each mood state subscale and subtracting the score for vigor-activity. Results The average AHI was 15.3±3.1 (range of 1.1-74.1) events per hour. The average POMS-B TMD score was 21±1.5 (range of 4-46). There was a significant correlation between the POMS-B TMD score and AHI (p=0.037, r2=0.14). This result was also seen in only those individuals with AHI scores &gt;5 (p=0.002, r2=0.4). Conclusion In this sample, individuals with higher AHI values displayed higher TMD scores. These results differ from previous data that showed no significant correlation between AHI and TMD. This is the first analysis to demonstrate a correlation between TMD and AHI while including individuals who didn’t meet diagnostic criteria for OSA. However, the relationship between AHI and TMD was also significant in those with AHI&gt;5. More data on these measures with larger sample sizes and a more equal representation of AHI values should be gathered to provide additional evidence for this relationship. Support: Support NIH R01-HL125893; CTSA UL1TR000128, R21HL140377

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 Randomized controlled trial of an integrated approach to treating insomnia and improving the use of positive airway pressure therapy in veterans with comorbid insomnia disorder and obstructive sleep apnea

SLEEP ◽  
2020 ◽  
Author(s):  
Cathy A Alessi ◽  
Constance H Fung ◽  
Joseph M Dzierzewski ◽  
Lavinia Fiorentino ◽  
Carl Stepnowsky ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Sleep Onset ◽  
Apnea Hypopnea Index ◽  
Sleep Onset Latency ◽  
Pressure Therapy ◽  
Comorbid Insomnia ◽  
Obstructive Sleep

Abstract Study Objectives Cognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway pressure (PAP) adherence program and tested effects on sleep and PAP use. Methods 125 veterans (mean age 63.2, 96% men, 39% non-Hispanic white, 26% black/African American, 18% Hispanic/Latino) with comorbid insomnia and newly-diagnosed OSA (apnea-hypopnea index ≥ 15) were randomized to 5-weekly sessions integrating CBTI with a PAP adherence program provided by a “sleep coach” (with behavioral sleep medicine supervision), or 5-weekly sleep education control sessions. Participants and assessment staff were blinded to group assignment. Outcomes (baseline, 3 and 6 months) included Pittsburgh Sleep Quality Index (PSQI), 7-day sleep diary (sleep onset latency [SOL-D], wake after sleep onset [WASO-D], sleep efficiency [SE-D]), 7-day actigraphy (SE-A), and objective PAP use (hours/night and nights ≥ 4 h). Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) were also collected. Results Compared to controls, intervention participants showed greater improvement (baseline to 3 and 6 months, respectively) in PSQI (−3.2 and −1.7), SOL-D (−16.2 and −15.5 minutes), SE-D (10.5% and 8.5%), SE-A (4.4% and 2.6%) and more 90-day PAP use (1.3 and 0.9 more hours/night, 17.4 and 11.3 more nights PAP ≥ 4 h). 90-day PAP use at 3 months was 3.2 and 1.9 h/night in intervention versus controls. Intervention participants also had greater improvements in ISI, ESS, and FOSQ-10 (all p &lt; 0.05). Conclusions An intervention integrating CBTI with a PAP adherence program delivered by a supervised sleep coach improved sleep and PAP use in adults with comorbid insomnia and OSA. Trial Registration ClinicalTrials.gov Study name: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older Veterans URL: https://clinicaltrials.gov/ct2/results?cond=&term=NCT02027558&cntry=&state=&city=&dist= Registration: NCT02027558

462 Redefining Positive Airway Pressure Adherence Phenotypes Utilizing Deep Neural Networks and Unsupervised Clustering

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A182-A182
Author(s):  
Yoav Nygate ◽  
Sam Rusk ◽  
Chris Fernandez ◽  
Nick Glattard ◽  
Nathaniel Watson ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Clustering Algorithm ◽  
Positive Airway Pressure ◽  
Treatment Success ◽  
Unsupervised Clustering ◽  
Additional Patient ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Usage Patterns ◽  
Usage Data

Abstract Introduction Improving positive airway pressure (PAP) adherence is crucial to obstructive sleep apnea (OSA) treatment success. We have previously shown the potential of utilizing Deep Neural Network (DNN) models to accurately predict future PAP usage, based on predefined compliance phenotypes, to enable early patient outreach and interventions. These phenotypes were limited, based solely on usage patterns. We propose an unsupervised learning methodology for redefining these adherence phenotypes in order to assist with the creation of more precise and personalized patient categorization. Methods We trained a DNN model to predict PAP compliance based on daily usage patterns, where compliance was defined as the requirement for 4 hours of PAP usage a night on over 70% of the recorded nights. The DNN model was trained on N=14,000 patients with 455 days of daily PAP usage data. The latent dimension of the trained DNN model was used as a feature vector containing rich usage pattern information content associated with overall PAP compliance. Along with the 455 days of daily PAP usage data, our dataset included additional patient demographics such as age, sex, apnea-hypopnea index, and BMI. These parameters, along with the extracted usage patterns, were applied together as inputs to an unsupervised clustering algorithm. The clusters that emerged from the algorithm were then used as indicators for new PAP compliance phenotypes. Results Two main clusters emerged: highly compliant and highly non-compliant. Furthermore, in the transition between the two main clusters, a sparse cluster of struggling patients emerged. This method allows for the continuous monitoring of patients as they transition from one cluster to the other. Conclusion In this research, we have shown that by utilizing historical PAP usage patterns along with additional patient information we can identify PAP specific adherence phenotypes. Clinically, this allows focus of PAP adherence program resources to be targeted early on to patients susceptible to treatment non-adherence. Furthermore, the transition between the two main phenotypes can also indicate when personalized intervention is necessary to maximize treatment success and outcomes. Lastly, providers can transition patients in the highly non-compliant group more quickly to alternative therapies. Support (if any):

scholarly journals Sleep quality, daytime sleepiness and daytime functioning among Thai obstructive sleep apnea patients receiving continuous positive airway pressure therapy

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Theerakorn Theerakittikul ◽  
Jindarat Chaiard ◽  
Jirawan Deeluea
Keyword(s):  
Sleep Quality ◽  
Daytime Sleepiness ◽  
Positive Airway Pressure ◽  
Quality Of Sleep ◽  
Daytime Functioning ◽  
Content Type ◽  
Cpap Treatment ◽  
Obstructive Sleep

PurposeThe purpose is to assess the effectiveness of continuous positive airway pressure (CPAP) treatment on sleep quality, daytime sleepiness and daytime functioning among Thai obstructive sleep apnea (OSA) patients.Design/methodology/approachA repeated measures clinical intervention design was implemented. Participants were 50 patients first time diagnosed with OSA and prescribed CPAP treatment. The intervention composed of CPAP health education, and follow-up evaluation. Data on CPAP adherence were downloaded from Smartcards of the CPAP device. The Thai PSQI, ESS and FSAQ-10 questionnaires were administered at baseline, 1-month, and 3-months. Descriptive statistics and repeated measure analysis with multilevel mixed-effects modeling approach were used.FindingsThirty-nine participants completed the study. Approximately 53% (n = 25) and 71.1% (n = 27) of the patients adhered to CPAP treatment by the end of the 1- and 3-months, respectively. After controlling for patients’ adherence, at 1-month follow-up, the intervention improved quality of sleep (β = −2.65, 95% CI = −1.60, −4.13), daytime functioning (β = 3.24, 95% CI = 1.87, 4.61) and decreased daytime sleepiness (β = −3.29, 95% CI = −1.85, −4.73). At 3 months, the intervention still improved quality of sleep (β = −3.53, 95% CI = −2.05, −5.01), and daytime functioning (β = 4.34, 95% CI = 2.76, 5.92), and decreased daytime sleepiness (β = −4.82, 95% CI = −3.16, −6.49).Originality/valueAdherence to CPAP treatment is effective in improving sleep quality, daytime functioning and reducing daytime sleepiness. Patient-oriented strategies for enhancing CPAP adherence should be developed and implemented as a standard care in sleep clinics.

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