scholarly journals Positive Airway Pressure Therapy Adherence with Mask Resupply: A Propensity-Matched Analysis

2021 ◽  
Vol 10 (4) ◽  
pp. 720
Author(s):  
Adam Benjafield ◽  
Liesl Oldstone ◽  
Leslee Willes ◽  
Colleen Kelly ◽  
Carlos Nunez ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Group Versus ◽  
Control Group ◽  
Billing Data ◽  
Pressure Therapy ◽  
Therapy Termination ◽  
Few Data ◽  
And Control ◽  
The Impact

There are currently few data on the impact of mask resupply on longer-term adherence to positive airway pressure (PAP) therapy. This retrospective analysis investigated the effects of mask/mask cushion resupply on the adherence to PAP versus no resupply. Deidentified patient billing data for PAP supply items were merged with telemonitoring data from Cloud-connected AirSense 10/AirCurve 10 devices via AirViewTM (ResMed). Eligible patients started PAP between 1 July 2014 and 17 June 2016, had ≥360 days of PAP device data, and achieved initial U.S. Medicare adherence criteria. Patients who received a resupply of mask systems/cushions (resupply group) were propensity-score-matched with those not receiving any mask/cushion resupply (control group). A total of 100,370 patients were included. From days 91 to 360, the mean device usage was 5.6 and 4.5 h/night in the resupply and control groups, respectively (p < 0.0001). The proportion of patients with a mean device usage ≥4 h/night was significantly higher in the resupply group versus the control group (77% vs. 59%; p < 0.0001). The therapy termination rate was significantly lower in the resupply group versus the control group (14.7% vs. 31.9%; p < 0.0001); there was a trend toward lower therapy termination rates as the number of resupplies increased. The replacement of mask interface components was associated with better longer-term adherence to PAP therapy versus no resupply.

CPAP-Applikation bei der Thorakozentese: Pleuralen Druckabfall mindern und Komplikationen verhindern

2020 ◽  
Vol 8 (1) ◽  
pp. 28-29
Author(s):  
Thomas Lesser
Keyword(s):  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Controlled Study ◽  
Control Group ◽  
Clinical Implications ◽  
Control Groups ◽  
Column Pressure ◽  
And Control ◽  
The Impact ◽  
Prospective Controlled Study

Background: Excessive drop of pleural pressure (Ppl) during therapeutic thoracentesis may be related to adverse events and/or to repeated procedures due to incomplete drainage. Objective: This was a pilot study of the impact of the application of continuous positive airway pressure (CPAP) at +5 cm H2O upon the Ppl profile during thoracentesis. Methods: This was a prospective, controlled study of 49 consecutive adults who underwent thoracentesis. Enrollment was via alternation on a one-to-one basis. Pleural manometry was used to compare serial Ppl in patients using CPAP at +5 cm H2O (CPAP group) with Ppl in patients without CPAP (control group). Results: Mean volumes drained were comparable between CPAP and control groups (1,380 vs. 1,396 mL). Patients in the CPAP group had a significantly greater change in volume per centimeter water column pressure (p = 0.0231, 95% confidence interval 6.41-82.61). No patient in the CPAP group had a Ppl less than -20 cm H2O at termination of the procedure, while 8 (33%) control group patients developed a pressure lower than -20. No patient in either group developed re-expansion pulmonary edema. Conclusion: The application of CPAP at +5 cm H2O mitigates the decreases in Ppl caused by thoracentesis via an increase in pleural compliance. The clinical implications of this finding merit study.

scholarly journals Impact of Healthcare Non-Take-Up on Adherence to Long-Term Positive Airway Pressure Therapy

2021 ◽  
Vol 9 ◽  
Author(s):  
Najeh Daabek ◽  
Renaud Tamisier ◽  
Alison Foote ◽  
Hélèna Revil ◽  
Marie Joyeux-Jaure ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Research Question ◽  
Sleep Apnea Syndrome ◽  
Clinical Trial Registration ◽  
Pressure Therapy ◽  
Logistic Regression Models ◽  
Obstructive Sleep ◽  
Design And Methods ◽  
The Impact

Background: The effectiveness of positive airway pressure therapies (PAP) is contingent on treatment adherence. We hypothesized that forgoing healthcare may be a determinant of adherence to PAP therapy.Research Question: The objectives were: (i) to assess the impact of forgoing healthcare on adherence to PAP in patients with Chronic Respiratory Failure (CRF) and patients with Obstructive Sleep Apnea Syndrome (OSAS); (ii) to compare forgoing healthcare patterns in these two chronic conditions.Study design and methods: Prospective cohort of patients with OSAS or CRF, treated with PAP therapies at home for at least 12 months. At inclusion, patients were asked to fill-in questionnaires investigating (i) healthcare forgone, (ii) deprivation (EPICES score), (iii) socio-professional and familial status. Characteristics at inclusion were extracted from medical records. PAP adherence was collected from the device's built-in time counters. Multivariable logistic regression models were used to assess the associations between healthcare forgone and the risk of being non-adherent to CPAP treatment.Results: Among 298 patients included (294 analyzed); 33.7% reported forgoing healthcare. Deprivation (EPICES score &gt; 30) was independently associated with the risk of non-adherence (OR = 3.57, 95%CI [1.12; 11.37]). Forgoing healthcare had an additional effect on the risk of non-adherence among deprived patients (OR = 7.74, 95%CI [2.59; 23.12]). OSAS patients mainly forwent healthcare for financial reasons (49% vs. 12.5% in CRF group), whereas CRF patients forwent healthcare due to lack of mobility (25%, vs. 5.9 % in OSAS group).Interpretation: Forgoing healthcare contributes to the risk of PAP non-adherence particularly among deprived patients. Measures tailored to tackle forgoing healthcare may improve the overall quality of care in PAP therapies.Clinical Trial Registration: The study protocol was registered in ClinicalTrials.gov, identifier: NCT03591250.

scholarly journals 702 Patient Characteristics & Positive Airway Pressure Therapy Compliance During NYC’s 2020 COVID-19 Pandemic Stay-at-Home Orders

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A274-A274
Author(s):  
Sunil Nair ◽  
Alcibiades Rodriguez
Keyword(s):  
Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Sleep Problems ◽  
Control Period ◽  
Patient Characteristics ◽  
Pressure Therapy ◽  
And Control ◽  
At Home

Abstract Introduction During the first surge of the COVID-19 pandemic in New York City, as New Yorkers were enjoined by authorities to stay-at-home, patient encounters were transitioned from office visits to telemedicine consultations. It was thought that increased stress during the pandemic would worsen rates of insomnia, and concerns regarding use of positive airway pressure (PAP) therapy during a respiratory pandemic would affect compliance. We sought to describe telemedicine success rates, the distribution of sleep problems evaluated remotely by telemedicine, and PAP compliance in our patient population. Methods Telemedicine encounters from March 16th through May 31st, 2020, were reviewed for show-rates, patient characteristics and clinician impressions, and were compared to administrative data from the 2.5 months prior to the stay-at-home period (the “control period”). PAP compliance was analyzed for forty randomly selected patients established on PAP therapy between January 1st and October 1st, 2019, and whose machines transmitted data to a digital management system between October 1st and December 31st, 2019. Compliance reports and AHI were compared between the stay-at-home- and control- periods for this randomly selected group of patients. Results The telemedicine show rate was 89.37% (compared to a 91.91% in-office show-rate during the control period); all these encounters were successfully completed. Sleep apnea was the predominant diagnosis during the stay-at-home period (44.33% of encounters), followed by insomnia (23.16%). Insomnia complaints were significantly higher during the stay-at-home period compared to the control period (23.16% versus 14.6% of encounters; p &lt; .05), and among new- versus follow-up- patients (41.76% versus 35.99%). PAP compliance and AHI, however, were not statistically different for forty randomly selected patients between the control and stay-at-home periods. Conclusion Most stay-at-home period telemedicine encounters were successful. Sleep apnea, then insomnia, were common findings among new and follow-up patients during the stay-at-home period, and insomnia rates increased during the pandemic. PAP compliance and AHI were similar in a random cohort when compared between the stay-at-home and control periods. Support (if any):

scholarly journals Treatment effect of selexipag on time to disease progression when initiated early in pulmonary arterial hypertension (PAH) patients: GRIPHON and TRITON pooled analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G J Coghlan ◽  
S Gaine ◽  
R N Channick ◽  
K M Chin ◽  
C Du Roure ◽  
...  
Keyword(s):  
Disease Progression ◽  
Oral Therapy ◽  
Group Versus ◽  
Pooled Analysis ◽  
Control Group ◽  
Placebo Control ◽  
Control Groups ◽  
Risk Of Disease ◽  
And Control ◽  
The Impact

Abstract Background In PAH clinical practice, drugs targeting the prostacyclin pathway, including the oral prostacyclin receptor agonist selexipag, are often initiated years after diagnosis. The GRIPHON (NCT01106014) and TRITON (NCT02558231) randomised controlled trials examined the impact of selexipag on disease progression, primary and secondary endpoints, respectively. In GRIPHON, selexipag significantly reduced the risk of disease progression (composite primary endpoint) in a PAH population (N=1156) with a mean time from diagnosis of 2.4 years, as part of an oral triple, double or monotherapy regimen versus placebo. In TRITON, a potential signal for reduced risk of disease progression was observed with initial triple oral therapy (selexipag, macitentan, tadalafil) versus initial double oral therapy (placebo, macitentan, tadalafil) in a population of 247 newly diagnosed, treatment naïve patients. Purpose To investigate the impact of initiating selexipag within 6 months of diagnosis on disease progression in a large PAH population. Methods We selected patients from GRIPHON and TRITON diagnosed within 6 months of randomization and compared those on active therapy with selexipag (selexipag group) versus those on control therapy with placebo (control group). Disease progression endpoints were defined as in the GRIPHON and TRITON studies, respectively. Hazard ratios (HR) and 95% CI for time to first disease progression event up to end of double-blind treatment (selexipag/placebo) + 7 days were estimated using a Cox regression model which included treatment as a factor, and baseline prognostic factors and study as covariates. Results Overall, 649 patients met the criteria (diagnosis ≤6 months) for these analyses: 329 in the selexipag group (207 from GRIPHON and 122 from TRITON) and 320 in the control group (197 from GRIPHON and 123 from TRITON). Patient characteristics at baseline and treatment regimens were balanced between the treatment groups. With respect to treatment regimen, selexipag/placebo was given as part of triple therapy in 44%, double therapy in 32% and monotherapy in 24% of patients. The median (range) exposure to study treatment was 510 (4–1280) and 409 (3–1318) days in the selexipag and control groups, respectively. There were 67 (20%) and 116 (36%) patients who experienced a disease progression event in the selexipag and control groups, respectively. Selexipag reduced the risk of disease progression (first event) by 52% compared to control (HR 0.48 [95% CI 0.35, 0.66]) (Figure). Conclusions This post-hoc pooled analysis of GRIPHON and TRITON patients diagnosed within 6 months suggests that targeting the prostacylin pathway with selexipag within a short time after diagnosis may reduce the risk of disease progression in a broad PAH population. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson

scholarly journals Low long-term mortality in patients with sleep apnoea and positive airway pressure therapy: analysis of a large German healthcare database

2020 ◽  
Vol 24 (3) ◽  
pp. 151-158
Author(s):  
H. Woehrle ◽  
C. Schoebel ◽  
O. Oldenburg ◽  
P. Young ◽  
I. Fietze ◽  
...  
Keyword(s):  
Cohort Study ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Average Length ◽  
Sleep Apnoea ◽  
Control Group ◽  
Healthcare Database ◽  
Pressure Therapy ◽  
Long Term Mortality

Abstract Background There are limited data on long-term mortality in sleep apnoea (SA) patients with and without positive airway pressure (PAP) therapy. This retrospective cohort study investigated long-term hospitalisation and mortality rates in SA patients from a German statutory health insurance (SHI) database who did versus did not receive PAP therapy. Methods Patients had continuous insurance coverage from 01 January 2008 to 31 December 2013, complete medical records and ≥1 SA-related diagnosis in 2009. Those receiving PAP were matched with a control group not treated with PAP. Outcomes (hospitalisations including stays in the sleep laboratory) were compared between groups the year prior to and the 4 years after SA diagnosis. Mortality was assessed in the 4 years after SA diagnosis. Results 2176 PAP therapy recipients were matched with 2176 controls. The PAP group had a higher rate of hospitalisation in the year before SA diagnosis than the control group (80.2% vs. 26.6%; p = 0.0016). After diagnosis, the PAP group had a higher hospitalisation rate only in year 1 (p < 0.05), and average length of stay per hospitalisation was lower in the PAP group (p < 0.05 vs. control at years 1, 2 and 4). Cumulative all-cause mortality after year 3 (3.4% vs. 4.6%; p = 0.0287) and after year 4 (4.8% vs. 6.5%; p = 0.0175) was significantly lower in SA patients receiving PAP versus controls (relative risk reduction for death after 4 years: 25.5%). Conclusion This real-world cohort study showed an association between long-term PAP therapy use and lower mortality, a higher rate of hospitalisations before and shorter hospital stays after treatment initiation.

scholarly journals What is the Impact of Positive Airway Pressure in Nasal Polyposis? An Experimental Study

2019 ◽  
Vol 23 (02) ◽  
pp. 147-151
Author(s):  
Leonardo Balsalobre ◽  
Rogerio Pezato ◽  
Joao Mangussi-Gomes ◽  
Luciano Gregorio ◽  
Fernanda Louise Martinho Haddad ◽  
...  
Keyword(s):  
Nasal Obstruction ◽  
Airway Pressure ◽  
Nasal Polyps ◽  
Nasal Polyposis ◽  
Positive Airway Pressure ◽  
Positive Pressure ◽  
Control Group ◽  
Nasal Patency ◽  
Control Subjects ◽  
The Impact

Introduction It has been hypothesized that increasing the interstitial hydrostatic pressure within the sinonasal mucosa of patients with nasal polyposis (NP) might decrease the size of nasal polyps. Objective To evaluate the effects of positive airway pressure, delivered by a continuous positive airway pressure (CPAP) device, in patients with NP and in control subjects. Methods Twelve patients with NP and 27 healthy subjects were exposed to CPAP (20 cm H2O) for 2 hours. Visual analog scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE) scale, acoustic rhinometry (AR), peak nasal inspiratory flow (PNIF) and nasal endoscopy (NE—Meltzer polyp grading system) were performed before and after the intervention, for all patients. Results The control group showed a significant worsening in nasal obstruction symptoms, as measured by VAS and NOSE (p < 0.01), and a significant decrease in nasal patency, as measured by the PNIF and AR (p < 0.01). For the NP group, VAS, NOSE, and AR did not differ significantly (p = 0.72, p = 0.73, and p = 0.17, respectively), but PNIF values worsened (p = 0.04) after exposure to CPAP. There was a statistically significant reduction in the nasal polyps' size (p = 0.04). Conclusions Positive pressure worsened the nasal obstruction symptoms and decreased objective parameters of nasal patency in control subjects. In patients with NP, exposure to CPAP reduced the nasal polyps' size, and the nasal patency, as measured by PNIF. However, it had no significant effects in AR and in nasal obstruction symptoms.

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