scholarly journals Accepting an Assisted Sleep - Addressing Barriers that Influence Engagement with Continuous Positive Air Pressure Therapy through Design.

2021 ◽  
Author(s):  
◽  
Katie O'Brien
Keyword(s):  
Product Information ◽  
Upper Airway ◽  
Early Death ◽  
Primary Treatment ◽  
The Body ◽  
Air Pressure ◽  
First Impressions ◽  
Cpap Therapy ◽  
Pressure Therapy ◽  
Obstructive Sleep

<p>This paper aims to answer the question ‘What are the initial experiences of people who use Continuous Positive Air Pressure (CPAP) therapy, and how can design address barriers that influence engagement within the first week of therapy?’  Obstructive Sleep Apnoea (OSA) is a respiratory sleep condition that is characterised by a repetitive collapse of the upper airway during sleep, causing a lack of oxygen and build up on carbon dioxide within the body. Left untreated, OSA can lead to serious medical conditions that may significantly reduce one’s quality of life and risk early death. The primary treatment for OSA is Continuous Positive Air Pressure (CPAP) therapy. This is a machine that pumps pressurised air through a facial mask to keep the airway open during sleep. Even though CPAP is the most effective treatment for OSA, it is known to be burdensome and adherence is problematic.  This thesis identifies the barriers that influence CPAP engagement through literature reviews, online surveys, cultural probes, and interviews with manufacturers, clinicians and CPAP users. The barriers identified include first impressions, product-related and social stigma, the ability to troubleshoot issues and the level of support, education and feedback present in the initial stages of therapy.  The outputs from this research focus on improving the user experience through design-based interventions. First, packaging solutions that focus on the interaction, the user’s first impressions, display of product information, and ease of assembly of the equipment. Second, a website that addresses education, support, customisation and the ability to troubleshoot issues. Third, customisable aspects that focus on personalisation of the CPAP equipment through 3D knitting processes that develop customised fabric hose covers. Lastly an application that addresses feedback, support and troubleshooting issues. Concepts are assessed against their relevance to the design criteria.</p>

scholarly journals Accepting an Assisted Sleep - Addressing Barriers that Influence Engagement with Continuous Positive Air Pressure Therapy through Design.

2021 ◽  
Author(s):  
◽  
Katie O'Brien
Keyword(s):  
Product Information ◽  
Upper Airway ◽  
Early Death ◽  
Primary Treatment ◽  
The Body ◽  
Air Pressure ◽  
First Impressions ◽  
Cpap Therapy ◽  
Pressure Therapy ◽  
Obstructive Sleep

<p>This paper aims to answer the question ‘What are the initial experiences of people who use Continuous Positive Air Pressure (CPAP) therapy, and how can design address barriers that influence engagement within the first week of therapy?’  Obstructive Sleep Apnoea (OSA) is a respiratory sleep condition that is characterised by a repetitive collapse of the upper airway during sleep, causing a lack of oxygen and build up on carbon dioxide within the body. Left untreated, OSA can lead to serious medical conditions that may significantly reduce one’s quality of life and risk early death. The primary treatment for OSA is Continuous Positive Air Pressure (CPAP) therapy. This is a machine that pumps pressurised air through a facial mask to keep the airway open during sleep. Even though CPAP is the most effective treatment for OSA, it is known to be burdensome and adherence is problematic.  This thesis identifies the barriers that influence CPAP engagement through literature reviews, online surveys, cultural probes, and interviews with manufacturers, clinicians and CPAP users. The barriers identified include first impressions, product-related and social stigma, the ability to troubleshoot issues and the level of support, education and feedback present in the initial stages of therapy.  The outputs from this research focus on improving the user experience through design-based interventions. First, packaging solutions that focus on the interaction, the user’s first impressions, display of product information, and ease of assembly of the equipment. Second, a website that addresses education, support, customisation and the ability to troubleshoot issues. Third, customisable aspects that focus on personalisation of the CPAP equipment through 3D knitting processes that develop customised fabric hose covers. Lastly an application that addresses feedback, support and troubleshooting issues. Concepts are assessed against their relevance to the design criteria.</p>

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.

Modifying effects of the R389G β1-adrenoceptor polymorphism on resting heart rate and blood pressure in patients with obstructive sleep apnoea

2005 ◽  
Vol 110 (1) ◽  
pp. 117-123 ◽  
Author(s):  
Jan Börgel ◽  
Tino Schulz ◽  
Nina K. Bartels ◽  
Jörg T. Epplen ◽  
Nikolaus Büchner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Obstructive Sleep Apnoea ◽  
Nervous Activity ◽  
Sleep Apnoea ◽  
Cpap Therapy ◽  
Pressure Therapy ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

OSA (obstructive sleep apnoea) stimulates sympathetic nervous activity and elevates resting HR (heart rate) and BP (blood pressure). In the present study in a cohort of 309 untreated OSA patients, the resting HR and BP during the daytime were correlated with AHI (apnoea/hypopnea index) and compared with patients with R389R (n=162), R389G (n=125) and G389G (n=22) genotypes of the β1-adrenoreceptor R389G polymorphism. We analysed the impact of the genotype on the decline of HR and BP in a subgroup of 148 patients (R389R, n=86; R389G, n=54; G389G, n=8) during a 6-month follow-up period under CPAP (continuous positive airway pressure) therapy during which cardiovascular medication remained unchanged. In untreated OSA patients, we found an independent relationship between AHI and resting HR (β=0.096, P<0.001), systolic BP (β=0.09, P=0.021) and diastolic BP (β=0.059, P=0.016). The resting HR/BP, however, did not differ among carriers with the R389R, R389G and G389G genotypes. CPAP therapy significantly reduced HR [−2.5 (−1.1 to −4.0) beats/min; values are mean difference (95% confidence intervals)] and diastolic BP [−3.2 (−1.5 to −5.0) mmHg]. The decline in HR was more significantly pronounced in the R389R group compared with the Gly389 carriers [−4.1 (−2.3 to −5.9) beats/min (P<0.001) compared with −0.2 (2.1 to −2.6) beats/min (P=0.854) respectively; Student's t test between groups, P=0.008]. Diastolic BP was decreased significantly (P<0.001) only in Gly389 carriers (R389G or G389G) compared with R389R carriers [−5.0 (−2.3 to −7.6) mmHg compared with −2.0 (0.4 to −4.3) mmHg respectively]. ANOVA revealed a significant difference (P=0.023) in HR reduction between the three genotypes [−4.1 (±8.4) beats/min for R389R, −0.5 (±9.3) beats/min for R389G and +1.9 (±7.2) beats/min for G389G]. In conclusion, although the R389G polymorphism of the β1-adrenoceptor gene did not influence resting HR or BP in untreated OSA patients, it may modify the beneficial effects of CPAP therapy on these parameters.

scholarly journals A Detection and Therapeutic Device to Overcome Sleep Apnea in Infants

2020 ◽  
Vol 2 (1) ◽  
pp. 35
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Pressure ◽  
Upper Airway ◽  
Periodic Breathing ◽  
Breathing Patterns ◽  
Efficient System ◽  
Pressure Therapy ◽  
Obstructive Sleep ◽  
Upper Airway Structure

Among the various sleep-disordered breathing patterns infant’s experience, like periodic breathing, premature apnea, obstructive sleep apnea, has been considered a major cause of concern. Upper airway structure, mechanics of the pulmonary system, etc., are a few reasons why the infants are vulnerable to obstructive sleep-disordered. An imbalance in the viscoelastic properties of the pharynx, dilators, and pressure can lead to airway collapse. A low level of oxygen in blood or hypoxemia is considered a characteristic in infants with severe OSA. Invasive treatments like nasopharyngeal tubes, continuous positive airway pressure (CPAP), or tracheostomy are found to be helpful in most cases where infants experience sleep apnea. This paper proposes an efficient system for monitoring obstructive sleep apnea in infants on a long-term basis, and if any anomaly is detected, the device provides Continuous Airway Pressure therapy until the abnormality is normalized.

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 Beyond Usual Care: A Multidisciplinary Approach Towards the Treatment of Obstructive Sleep Apnoea

2022 ◽  
Vol 8 ◽  
Author(s):  
Miuni Athauda Arachchige ◽  
Joerg Steier
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Team Approach ◽  
Cpap Therapy ◽  
Management Options ◽  
Airway Patency ◽  
Obstructive Sleep ◽  
Increased Risk

Obstructive Sleep Apnoea (OSA) is common and characterised by repeated apnoeas and hypopnoeas while asleep due to collapse of the upper airway. OSA can have a significant impact on physical and mental health and, when left untreated, is associated with increased risk of developing cardiovascular ill health. Besides cardiorespiratory implications excessive daytime sleepiness, morning headaches, limited memory function and lack of concentration are some further symptoms caused by OSA. Continuous Positive Airway Pressure (CPAP) therapy is the evidence-based treatment to maintain upper airway patency in patients with moderate to severe OSA. Proper adherence to CPAP therapy successfully abolishes nocturnal apnoeas and hypopnoeas, and diminishes consequences of uncontrolled OSA, such as treatment resistant hypertension. However, long term adherence to CPAP remains an unresolved limitation of this method. Although alternatives to CPAP therapy may be less efficacious, there is a variety of non-CPAP treatments that includes conventional lifestyle advice, postural advice, the use of mandibular advancement devices (MADs), surgical treatment options, such as uvulopalatopharyngoplasty, tonsillectomy, or maxillomandibular advancement, and the use of electrical stimulation of the upper airway dilator muscles. Hypoglossal Nerve Stimulation is available as an invasive (HNS) and a transcutaneous (TESLA) approach. For the management of “difficult-to-treat” patients with OSA, particularly in those in whom first line therapy proved to be unsuccessful, a multidisciplinary team approach may be helpful to incorporate the available options of non-CPAP therapy and provide appropriate choices. Symptom control, patient-related outcome measures and long-term cardiovascular health should be prioritised when choosing long-term therapies to treat OSA. The inclusion of patients in the choice of successful management options of their condition will facilitate better long-term adherence. Advancing clinical trials in the field will further help to resolve the relative lack of evidence for effective non-CPAP methods.

Positive airway pressure therapy

2017 ◽  
Author(s):  
Dirk Pevernagie
Keyword(s):  
Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Central Sleep Apnea ◽  
Upper Airway ◽  
Therapeutic Success ◽  
Pressure Therapy ◽  
Cardiovascular Comorbidity ◽  
Adaptive Servo Ventilation ◽  
Obstructive Sleep

This chapter describes positive airway pressure (PAP) therapy for sleep disordered breathing. Continuous PAP (CPAP) acts as a mechanical splint on the upper airway and is the treatment of choice for moderate to severe obstructive sleep apnea (OSA). Autotitrating CPAP may be used when the pressure demand for stabilizing the upper airway is quite variable. In other cases, fixed CPAP is sufficient. There is robust evidence that CPAP reduces the symptomatic burden and risk of cardiovascular comorbidity in patients with moderate to severe OSA. Bilevel PAP is indicated for treatment of respiratory diseases characterized by chronic alveolar hypoventilation, which typically deteriorates during sleep. Adaptive servo-ventilation is a mode of bilevel PAP used to treat Cheyne–Stokes respiration with central sleep apnea . It is crucial that caregivers help patients get used to and be compliant with PAP therapy. Education, support, and resolution of adverse effects are mandatory for therapeutic success.

scholarly journals Threshold of the upper airway cross-section for hypopnea onset during sleep and its identification under waking condition

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hongyi Lin ◽  
Cunting Wang ◽  
Han Zhang ◽  
Huahui Xiong ◽  
Zheng Li ◽  
...  
Keyword(s):  
Cross Section ◽  
Airway Resistance ◽  
Upper Airway ◽  
The Body ◽  
Sigmoid Function ◽  
Fluid Accumulation ◽  
Normal Breathing ◽  
Obstructive Sleep ◽  
The Cross ◽  
Shape Changes

Abstract Background There is currently no method that can predict whether or under what condition hypopnea, even obstructive sleep apnea (OSA), will occur during sleep for individuals based on credible parameters measured under waking condition. We propose a threshold concept based on the narrowest cross-sectional area of the upper airway (CSA-UA) and aim to prove our hypothesis on the threshold of the area for hypopnea onset (TAHO), which can be used as an indicator of hypopnea onset during sleep and measured while awake. Methods We performed magnetic resonance imaging for 20 OSA patients to observe CSA-UA changes during fluid accumulation in the neck caused by elevating their legs, and identified TAHO by capturing the sudden enlargement in CSA-UA. Correlation analyses between TAHO and the body mass index (BMI), and between the reduction in CSA-UA and the increase in the neck circumference (NC) with fluid accumulation were performed. Logistic regression analysis was performed for identifying OSA patients based on the behaviors of their CSA-UA changes during leg raising. Shape changes of airway cross-section were also investigated. Results Four CSA-UA change patterns after fluid redistribution were identified. Six patients had similar CSA-UA variation behaviors observed in healthy subjects. From the other three change patterns involving 14 patients, a threshold value of CSA-UA 0.63 ± 0.21 cm2 was identified for normal breathing. Data showed a positive correlation between TAHO and BMI (r = 0.681, p = 0.0007), and a negative correlation between the reduction in CSA-UA and the increase in NC (r = − 0.513, p = 0.051) with fluid accumulation. A sigmoid function for the probability of being a OSA patient p = 1/[1 + exp. (4.836 + 3.850 t-8.4 h)] was obtained to effectively separate OSA patients from normal subjects. The upper airway narrowing occurred in anteroposterior, lateral, or both directions, suggesting different tendencies of upper airway collapse in patients. Three types of shape changes in the cross-section of the upper airway, which had different effects on airway resistance, were measured. Conclusions Our findings prove TAHO hypothesis. The threshold measured while awake for normal breathing can be used clinically as the indicator of hypopnea onset during sleep, and therefore to identify OSA patients under waking condition and design effective personalized treatments for OSA patients. Both shape and size changes in the cross-section of the upper airway affect airway resistance significantly. Shape change in the cross-section of the upper airway can provide key clinical information on the collapse patterns of the upper airway for individuals.

A case of severe obstructive sleep apnoea in Madelung's disease treated by lateral pharyngoplasty

2017 ◽  
Vol 131 (9) ◽  
pp. 834-837 ◽  
Author(s):  
V Pinto ◽  
P G Morselli ◽  
D Tassone ◽  
O Piccin
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Obstructive Sleep Apnoea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Pressure Therapy ◽  
Madelung's Disease ◽  
Madelung’S Disease ◽  
Obstructive Sleep

AbstractBackground:Madelung's disease is a rare disorder characterised by the presence of multiple, symmetric, non-capsulated fat masses in the face, neck and other areas of upper extremities. In some cases, severe clinical complications such as upper airway compression can occur.Case report:A 56-year-old man affected by Madelung's disease complained of snoring and severe daytime sleepiness. Polysomnography revealed severe obstructive sleep apnoea. An attempt to treat sleep apnoea by continuous positive airway pressure failed because of poor compliance. Functional expansion pharyngoplasty was carried out as an initial treatment. Marked improvement of neck movements and normalisation of somnographic parameters were observed at six months’ follow up.Conclusion:Patients with Madelung's disease should be examined carefully for potential obstructive sleep apnoea. Although continuous positive airway pressure remains the treatment of choice, specific surgery can be used in those patients who cannot tolerate continuous positive airway pressure therapy.

Upper Airway Stimulation for OSA

2016 ◽  
Vol 155 (1) ◽  
pp. 188-193 ◽  
Author(s):  
David T. Kent ◽  
Jake J. Lee ◽  
Patrick J. Strollo ◽  
Ryan J. Soose
Keyword(s):  
Outcome Measures ◽  
Case Series ◽  
Upper Airway ◽  
Positive Pressure ◽  
Apnea Hypopnea Index ◽  
Upper Airway Stimulation ◽  
Pressure Therapy ◽  
Early Results ◽  
Obstructive Sleep ◽  
Adherence Monitoring

Objective To review outcome measures and objective adherence data for patients treated with hypoglossal nerve stimulation (HNS) therapy for moderate to severe obstructive sleep apnea (OSA). Study Design Case series with chart review. Setting Academic sleep medicine center. Subjects and Methods The first 20 implanted patients to complete postoperative sleep laboratory testing were assessed. All patients had moderate to severe OSA, were unable to adhere to positive pressure therapy, and met previously published inclusion criteria for the commercially available implantable HNS system. Data included demographics, body mass index (BMI), apnea-hypopnea index (AHI), Epworth Sleepiness Score (ESS), nightly hours of device usage, and procedure- and therapy-related complications. Results Mean age was 64.8 ± 12.0 years, with 50% female. Mean BMI was unchanged postoperatively (26.5 ± 4.2 to 26.8 ± 4.5 kg/m2; P > .05). Mean AHI (33.3 ± 13.0 to 5.1 ± 4.3; P < .0001) and mean ESS (10.3 ± 5.2 to 6.0 ± 4.4; P < .01) decreased significantly. Seventy percent (14/20) of patients achieved a treatment AHI <5, 85% (17/20) an AHI <10, and 95% (19/20) an AHI <15. Average stimulation amplitude was 1.89 ± 0.50 V after titration. Adherence monitoring via device interrogation showed high rates of voluntary device use (mean 7.0 ± 2.2 h/night). Conclusion For a clinical and anatomical subset of patients with OSA, HNS therapy is associated with good objective adherence, low morbidity, and improved OSA outcome measures. Early results at one institution suggest that HNS therapy can be implemented successfully into routine clinical practice, outside of a trial setting.

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