scholarly journals A latent-class heteroskedastic hurdle trajectory model: patterns of adherence in obstructive sleep apnea patients on CPAP therapy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Niek G. P. Den Teuling ◽  
Edwin R. van den Heuvel ◽  
Mark S. Aloia ◽  
Steffen C. Pauws
Keyword(s):  
Sleep Apnea ◽  
Latent Class ◽  
Daily Basis ◽  
Cpap Therapy ◽  
Generalized Additive Modeling ◽  
Proposed Model ◽  
Obstructive Sleep ◽  
Number Of Patients ◽  
Additive Modeling ◽  
Over Time

Abstract Background Sleep apnea patients on CPAP therapy exhibit differences in how they adhere to the therapy. Previous studies have demonstrated the benefit of describing adherence in terms of discernible longitudinal patterns. However, these analyses have been done on a limited number of patients, and did not properly represent the temporal characteristics and heterogeneity of adherence. Methods We illustrate the potential of identifying patterns of adherence with a latent-class heteroskedastic hurdle trajectory approach using generalized additive modeling. The model represents the adherence trajectories on three aspects over time: the daily hurdle of using the therapy, the daily time spent on therapy, and the day-to-day variability. The combination of these three characteristics has not been studied before. Results Applying the proposed model to a dataset of 10,000 patients in their first three months of therapy resulted in nine adherence groups, among which 49% of patients exhibited a change in adherence over time. The identified group trajectories revealed a non-linear association between the change in the daily hurdle of using the therapy, and the average time on therapy. The largest difference between groups was observed in the patient motivation score. The adherence patterns were also associated with different levels of high residual AHI, and day-to-day variability in leakage. Conclusion The inclusion of the hurdle model and the heteroskedastic model into the mixture model enabled the discovery of additional adherence patterns, and a more descriptive representation of patient behavior over time. Therapy adherence was mostly affected by a lack of attempts over time, suggesting that encouraging these patients to attempt therapy on a daily basis, irrespective of the number of hours used, could drive adherence. We believe the methodology is applicable to other domains of therapy or medication adherence.

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.

scholarly journals The Worsening of Positional Mild Obstructive Sleep Apnea over Time Is Associated with an Increase in Body Weight: Impact on Blood Pressure and Autonomic Nervous System

Respiration ◽  
2021 ◽  
pp. 1-10
Author(s):  
Wei-Hsiu Chang ◽  
Hsien-Chang Wu ◽  
Chou-Chin Lan ◽  
Yao-Kuang Wu ◽  
Mei-Chen Yang
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Sleep Apnea ◽  
Obstructive Sleep ◽  
Mild Obstructive Sleep Apnea ◽  
Positional Dependency ◽  
Over Time

<b><i>Background:</i></b> Most patients with mild obstructive sleep apnea (OSA) are positional dependent. Although mild OSA worsens over time, no study has assessed the natural course of positional mild OSA. <b><i>Objectives:</i></b> The aim of this study was to evaluate the natural course of positional mild OSA, its most valuable progression predictor, and its impact on blood pressure (BP) and the autonomic nervous system (ANS). <b><i>Methods:</i></b> This retrospective observational cohort study enrolled 86 patients with positional mild OSA and 26 patients with nonpositional mild OSA, with a follow-up duration of 32.0 ± 27.6 months and 37.6 ± 27.8 months, respectively. Polysomnographic variables, BP, and ANS functions were compared between groups at baseline and after follow-up. <b><i>Results:</i></b> In patients with positional mild OSA after follow-up, the apnea/hypopnea index (AHI) increased (9.1 ± 3.3/h vs. 22.0 ± 13.2/h, <i>p</i> = 0.000), as did the morning systolic BP (126.4 ± 13.3 mm Hg vs. 130.4 ± 15.9 mm Hg, <i>p</i> = 0.011), and the sympathetic activity (49.4 ± 12.3% vs. 55.3 ± 13.1%, <i>p</i> = 0.000), while the parasympathetic activity decreased (50.6 ± 12.3% vs. 44.7 ± 13.1%, <i>p</i> = 0.000). The body mass index changes were the most important factor associated with AHI changes among patients with positional mild OSA (Beta = 0.259, adjust <i>R</i><sup>2</sup> = 0.056, <i>p</i> = 0.016, 95% confidence interval 0.425 and 3.990). The positional dependency disappeared over time in 66.3% of patients with positional mild OSA while 69.2% of patients with nonpositional mild OSA retained nonpositional. <b><i>Conclusions:</i></b> In patients with positional mild OSA, disease severity, BP, and ANS regulation worse over time. Increased weight was the best predictor for its progression and the loss of positional dependency. Better treatments addressing weight control and consistent follow-up are needed for positional mild OSA.

scholarly journals Obstructive sleep apnea and CPAP therapy alter distinct transcriptional programs in subcutaneous fat tissue

SLEEP ◽  
2019 ◽  
Vol 43 (6) ◽  
Author(s):  
Sina A Gharib ◽  
Amanda L Hurley ◽  
Michael J Rosen ◽  
James C Spilsbury ◽  
Amy E Schell ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Subcutaneous Adipose Tissue ◽  
Subcutaneous Fat ◽  
Study Group ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
Group 2 ◽  
Subcutaneous Adipose ◽  
Group 1

Abstract Obstructive sleep apnea (OSA) has been linked to dysregulated metabolic states, and treatment of sleep apnea may improve these conditions. Subcutaneous adipose tissue is a readily samplable fat depot that plays an important role in regulating metabolism. However, neither the pathophysiologic consequences of OSA nor the effects of continuous positive airway pressure (CPAP) in altering this compartment’s molecular pathways are understood. This study aimed to systematically identify subcutaneous adipose tissue transcriptional programs modulated in OSA and in response to its effective treatment with CPAP. Two subject groups were investigated: Study Group 1 was comprised of 10 OSA and 8 controls; Study Group 2 included 24 individuals with OSA studied at baseline and following CPAP. For each subject, genome-wide gene expression measurement of subcutaneous fat was performed. Differentially activated pathways elicited by OSA (Group 1) and in response to its treatment (Group 2) were determined using network and Gene Set Enrichment Analysis (GSEA). In Group 2, treatment of OSA with CPAP improved apnea-hypopnea index, daytime sleepiness, and blood pressure, but not anthropometric measures. In Group 1, GSEA revealed many up-regulated gene sets in OSA subjects, most of which were involved in immuno-inflammatory (e.g. interferon-γ signaling), transcription, and metabolic processes such as adipogenesis. Unexpectedly, CPAP therapy in Group 2 subjects was also associated with up-regulation of several immune pathways as well as cholesterol biosynthesis. Collectively, our findings demonstrate that OSA alters distinct inflammatory and metabolic programs in subcutaneous fat, but these transcriptional signatures are not reversed with short-term effective therapy.

Cardiovascular outcomes of CPAP therapy in obstructive sleep apnea syndrome

2007 ◽  
Vol 293 (4) ◽  
pp. R1666-R1670 ◽  
Author(s):  
Walter T. McNicholas
Keyword(s):  
Cardiovascular Disease ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Cpap Therapy ◽  
Obstructive Sleep ◽  
Cardiovascular Morbidity And Mortality ◽  
Apnea Syndrome ◽  
The Impact

Considerable evidence is now available of an independent association between obstructive sleep apnea syndrome (OSAS) and cardiovascular disease. The association is particularly strong for systemic arterial hypertension, but there is growing evidence of an association with ischemic heart disease and stroke. The mechanisms underlying cardiovascular disease in patients with OSAS are still poorly understood. However, the pathogenesis is likely to be a multifactorial process involving a diverse range of mechanisms, including sympathetic overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormal coagulation, and metabolic dysregulation, the latter particularly involving insulin resistance and disordered lipid metabolism. Therapy with continuous positive airway pressure (CPAP) has been associated with significant benefits to cardiovascular morbidity and mortality, both in short-term studies addressing specific aspects of morbidity, such as hypertension, and more recently in long-term studies that have evaluated major outcomes of cardiovascular morbidity and mortality. However, there is a clear need for further studies evaluating the impact of CPAP therapy on cardiovascular outcomes. Furthermore, studies on the impact of CPAP therapy have provided useful information concerning the role of basic cell and molecular mechanisms in the pathophysiology of OSAS.

scholarly journals Pain Intensity and Opioid Utilization in Response to CPAP Therapy in Veterans with Obstructive Sleep Apnea on Chronic Opioid Treatment

2016 ◽  
Vol 12 (08) ◽  
pp. 1105-1111 ◽  
Author(s):  
Philippe Jaoude ◽  
Ashima Lal ◽  
Leah Vermont ◽  
Jahan Porhomayon ◽  
Ali A. El-Solh
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pain Intensity ◽  
Cpap Therapy ◽  
Opioid Treatment ◽  
Obstructive Sleep

scholarly journals CPAP treatment, glycemia and diabetes risk in obstructive sleep apnea and comorbid cardiovascular disease

2020 ◽  
Author(s):  
Kelly A. Loffler ◽  
Emma Heeley ◽  
Ruth Freed ◽  
Rosie Meng ◽  
Lia R. Bittencourt ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Glycemic Control ◽  
Usual Care ◽  
Serum Glucose ◽  
Cpap Therapy ◽  
Cpap Treatment ◽  
Obstructive Sleep

Objective: Despite evidence of a relationship between obstructive sleep apnea (OSA), metabolic dysregulation and diabetes mellitus (DM), it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and DM risk in patients with cardiovascular disease (CVD) and OSA. <strong>Research Design and Methods: </strong>Blood, medical history, and personal data were collected in a <strong>substudy of 888 participants in the </strong>Sleep Apnea Cardiovascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were r<strong>andomized</strong> to receive CPAP plus Usual Care, or Usual Care alone. Serum glucose and glycated hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) were measured at baseline, and six months, two- and four years, and incident diabetes diagnoses recorded. Results: Median follow-up was 4.3 years. In those with pre-existing DM (n=274), there was no significant difference between CPAP and Usual Care groups in serum glucose, HbA<sub>1c</sub> or anti-diabetic medications during follow-up. There were also no significant between-group differences in participants with pre-diabetes (n=452), nor in new diagnoses of DM. Interaction testing suggested that women with diabetes did poorly in the Usual Care group while their counterparts on CPAP therapy remained stable. <strong>Conclusions</strong><b>:</b> Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affected glycemic control in those with diabetes or pre-diabetes, or DM risk over standard of care treatment. The potential differential effect according to sex deserves further investigation.

Sign in / Sign up

Export Citation Format

Share Document