scholarly journals Postoperative Continuous Positive Airway Pressure Use and Nasal Saline Rinses After Endonasal Endoscopic Skull Base Surgery in Patients With Obstructive Sleep Apnea: A Practice Pattern Survey

2018 ◽  
Vol 33 (1) ◽  
pp. 51-55 ◽  
Author(s):  
David L. Choi ◽  
Kesava Reddy ◽  
Erik K. Weitzel ◽  
Brian W. Rotenberg ◽  
Allan Vescan ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Standard Deviation ◽  
Skull Base ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Skull Base Surgery ◽  
Csf Leak ◽  
Cpap Therapy ◽  
Endoscopic Skull Base Surgery ◽  
Obstructive Sleep

Background Endoscopic skull base surgery continues to evolve in its indications, techniques, instrumentation, and postoperative care. As surgery of the skull base will often violate dura, intraoperative and postoperative cerebrospinal fluid (CSF) leak is not uncommon and represents a potential conduit for air and bacterial contamination. Patients with obstructive sleep apnea (OSA) requiring continuous positive airway pressure (CPAP) therapy undergoing skull base surgery represent a challenging group. However, there appears to be a paucity of consensus regarding the postoperative management of this patient population. The objective of this study is to examine practice patterns and expert opinion on the use of postoperative CPAP and nasal saline in patients with OSA. Methods A 14-item survey was generated by consensus among expert authors and distributed online to members of the North American Skull Base society and other international skull base community members. Data were analyzed for median, mean, and standard deviation variables. Subgroup analysis was completed between surgeons from different geographical locations and operative experience. SPSS22 was utilized for all complex statistical analysis and figures. Results Seventy-one responses were collected from skull base surgeons. In patients with OSA, respondents would resume patients’ CPAP therapy after a mean of 10.1 days (median, 7; standard deviation [SD], 10.2), without a CSF leak. In the presence of a small CSF leak, the mean duration would increase to 14.3 days (median, 14; SD, 9.8) and to 20.7 days (median, 21; SD, 11.8) in the presence of a larger leak. A surgeon’s choice to attribute the relationship between delaying the start of nasal saline and CPAP after the endoscopic skull base surgery with progressively more challenging skull base repair was found to be statistically significant ( P < .001). Conclusion Saline and CPAP therapies are initiated after the endoscopic skull base surgical repairs by surgeons at an increasing temporal delay in relation to the degree and complexity of the skull base defect repaired.

scholarly journals Timing of Postoperative CSF Leak after Endoscopic Skull Base Surgery in Patients with Obstructive Sleep Apnea

2018 ◽  
Vol 80 (04) ◽  
pp. 392-398 ◽  
Author(s):  
Terence M. Zimmermann ◽  
Chris R. Marcellino ◽  
Garret W. Choby ◽  
Jamie J. Van Gompel ◽  
Erin K. O'Brien ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Small Sample ◽  
Csf Leak ◽  
Positive Pressure ◽  
High Risk Population ◽  
Endoscopic Skull Base Surgery ◽  
Obstructive Sleep

Background There is little data regarding postoperative outcomes of patients with obstructive sleep apnea (OSA) undergoing skull base surgery. The purpose of this study is to determine an association between risk factors and proximity of cerebrospinal fluid (CSF) leak to surgery in patients with OSA undergoing endoscopic skull base surgery. Methods A retrospective review of neurosurgical inpatients, with and without OSA, at a tertiary care institution from 2002 to 2015 that experienced a postoperative CSF leak after undergoing endoscopic skull base surgery. Results Forty patients met inclusion criteria, 12 (30%) with OSA. OSA patients had significantly higher body mass index (BMI; median 39.4 vs. 31.7, p < 0.01) and were more likely to have diabetes (41.7 vs. 10.7%, p = 0.04) than non-OSA patients; otherwise there were no significant differences in clinical comorbidities. No patients restarted positive pressure ventilation (PPV) in the inpatient setting. The type of repair was not a significant predictor of the time from surgery to leak. Patients with OSA experienced postoperative CSF leak 49% sooner than non-OSA patients (Hazard Ratio 1.49, median 2 vs. 6 days, log-rank p = 0.20). Conclusion Patients with OSA trended toward leaking earlier than those without OSA, and no OSA patients repaired with a nasoseptal flap (NSF) had a leak after postoperative day 5. Due to a small sample size this trend did not reach significance. Future studies will help to determine the appropriate timing for restarting PPV in this high risk population. This is important given PPV's significant benefit to the patient's overall health and its ability to lower intracranial pressure.

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.

Abstract 3722: Multimodality Cardiovascular Imaging Detects Improvment Of Subclinical Microvascular Dysfunction With Continuous Positive Airway Pressure Therapy In Obstructive Sleep Apnea Patients: A Prospective, Randomized, Double-blinded Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Chandra Katikireddy ◽  
Patricia Nguyen ◽  
Christine Won ◽  
Chia-Yu Cardell ◽  
Deborah Nichols ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Obstructive Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Cardiovascular Imaging ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
Lv Mass ◽  
Subclinical Cardiovascular Disease ◽  
Double Blinded

Background: Several observational studies suggest that obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular disease. However, there is little data on early subclinical development of cardiovascular disease in OSA patients. Hypothesis: We tested the hypothesis that continuous positive airway pressure (CPAP) improves subclinical cardiovascular disease in OSA patients. Methods: Sixteen consecutive patients diagnosed with moderate to severe OSA were recruited into a double-blinded, prospective study. Multimodality cardiovascular imaging (CVI) studies (cardiac MRI, echocardiography, and vascular ultrasound) were performed to assess LV mass, LV and RV ejection fraction (EF), adenosine stress myocardial perfusion reserve (MPR), nitroglycerin mediated coronary vasoreactivity, and flow-mediated vasodilatation (FMD) of the brachial artery. Patients were randomized to either CPAP or sham CPAP therapy and monitored for compliance during the entire period of treatment. After 3 months of therapy, they underwent follow-up CVI studies to assess development of subclinical cardiovascular disease. Results: MPR significantly improved (p=0.02) in patients with CPAP therapy compared to those without. Similarly, FMD of brachial artery improved significantly (p=0.04) following CPAP therapy. No significant differences were observed in LV mass (p=0.31), LV EF (p=0.17), RV EF (p=0.09), LV diastolic function (E/A) (p=0.67), and coronary vasoreactivity (p=0.25) between the two groups. Conclusions: Impairment of endothelial dependent FMD, and MPR, surrogate markers of microvascualr function, has been shown to be the subclinical cardiovascular effects in OSA patients. Our findings suggest that CPAP therapy may prevent the progression of subclinical cardiovascular disease in OSA patients.

scholarly journals Comments on split-night polysomnography

2019 ◽  
Vol 67 (1) ◽  
pp. 7-8
Author(s):  
Alicia Liendo ◽  
César Liendo
Keyword(s):  
Obstructive Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Severe Obstructive Sleep Apnea ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
Therapeutic Study ◽  
Disordered Breathing

The need for speeding up the diagnosis and treatment of sleep-disordered breathing has increased in recent years. In order to achieve that, a split-night protocol has been implemented, in which the patient with suspected sleep-disordered breathing undergoes a diagnostic and therapeutic study in one night. Elshaug et al. (1), by using the split-night protocol, were able to reduce the time to initiate continuous positive airway pressure (CPAP) therapy by 15% in patients with severe obstructive sleep apnea. However, reviewing the limitations of said protocol is necessary to make it more streamline.

430 Outcome of Sleep-Wake Pattern in Obstructive Sleep Apnea Patients after Positive Airway Pressure Therapy using Actigraphy

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A170-A170
Author(s):  
Narumol Luekitinun ◽  
Kanlaya Panjapornpon ◽  
Pattharaphong Plurksathaporn ◽  
Rungaroon Tangsrikertikul ◽  
Wanlana Tongkien ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Quality ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Matched Pair ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
Before And After ◽  
Sleep Parameters

Abstract Introduction The initial phase of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) may affect sleep parameters and PAP compliance. Actigraphy is a validated method using accelerometer to objectively measure sleep parameters in patients with a range of sleep disorders, including OSA, particularly to follow-up after treatment. We compare sleep parameters from actigraphy, sleep log, sleep diary, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), heart rate and blood pressure in OSA patients before and after CPAP therapy for 1 week. Methods This pilot study have been prospectively performed at Central Chest Institute of Thailand (CCIT) since June to November 2020. Adult OSA patients, diagnosed by ICSD-3 criteria and achieved optimal or good CPAP pressure titration from split-night polysomnography (PSG), were informed and consent to wear actigraphy before and after CPAP therapy each for 1 week. Clinical and sleep parameters were recorded and analyzed using Wilcoxon matched-pair signed-rank and Mann Whitney U test. P-value &lt; 0.05 was considered to have statistical significance. Results All 11 OSA patients participated in this study. Most patients were male (63.6%), hypertension (54.5%) and dyslipidemia (45.4%). Means of age, body mass index (BMI), ESS, PSQI, apnea hypopnea index (AHI), nadir SpO2, and CPAP usage were 45.5 ± 15.9 years, 29.1 ± 5.2 kg/m2, 10.8 ± 3.9, 7.7 ± 2.9, 65.2 ± 37.7 events/h, 82.3 ± 10.8 % and 9.5 ± 3.1 cmH2O, respectively. Comparing before and after 1-week CPAP therapy, an average number of wake bouts ((NWB), 48.4 vs 38 events, p=0.010), ESS (11 vs 9, p=0.035) and PSQI (8 vs 4, p=0.005) were significantly decrease. Additionally, when comparing between poor and good CPAP compliance group, NWB (55.1 vs 36.3 events, p=0.036) and the difference of wake after sleep onset (WASO, 10.5 vs -0.11 min, p=0.035) were significantly decrease. Conclusion OSA patients treated with CPAP for 1-week experienced marked improvement in sleepiness, sleep quality and nighttime awakening. Support (if any):

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 Effect of continuous positive airway pressure on inflammatory, antioxidant, and depression biomarkers in women with obstructive sleep apnea: a randomized controlled trial

SLEEP ◽  
2019 ◽  
Vol 42 (10) ◽  
Author(s):  
Francisco Campos-Rodriguez ◽  
Maria Isabel Asensio-Cruz ◽  
Jose Cordero-Guevara ◽  
Bernabe Jurado-Gamez ◽  
Carmen Carmona-Bernal ◽  
...  
Keyword(s):  
Antioxidant Activity ◽  
Randomized Controlled Trial ◽  
Obstructive Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Controlled Trial ◽  
Cpap Therapy ◽  
Randomized Controlled ◽  
Obstructive Sleep

AbstractStudy ObjectivesThe effect of continuous positive airway pressure (CPAP) on mediators of cardiovascular disease and depression in women with obstructive sleep apnea (OSA) is unknown. We aimed to assess the effect of CPAP therapy on a variety of biomarkers of inflammation, antioxidant activity, and depression in women with OSA.MethodsWe conducted a multicenter, randomized controlled trial in 247 women diagnosed with moderate-to-severe OSA (apnea–hypopnea index [AHI] ≥ 15). Women were randomized to CPAP (n = 120) or conservative treatment (n = 127) for 12 weeks. Changes in tumor necrosis factor α (TNFα), interleukin 6 (IL-6), C-reactive protein (CRP), intercellular adhesion molecule 1 (ICAM-1), catalase (CAT), superoxide dismutase (SOD), and brain-derived neurotrophic factor (BDNF) were assessed. Additional analyses were conducted in subgroups of clinical interest.ResultsWomen had a median (25th–75th percentiles) age of 58 (51–65) years, body mass index 33.5 (29.0–38.3) kg/m2, and AHI 33.3 (22.8–49.3). No differences were found between groups in the baseline levels of the biomarkers. After 12 weeks of follow-up, there were no changes between groups in any of the biomarkers assessed. These results did not change when the analyses were restricted to sleepy women or to those with severe OSA. In women with CPAP use at least 5 hours per night, only TNFα levels decreased compared to the control group (−0.29 ± 1.1 vs −0.06 ± 0.53, intergroup difference −0.23 [95% CI = −0.03 to −0.50]; p = 0.043).ConclusionsTwelve weeks of CPAP therapy does not improve biomarkers of inflammation, antioxidant activity, or depression compared to conservative treatment in women with moderate-to-severe OSA.Trial RegistrationNCT02047071.

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