Factors Affecting Long-Term Compliance of CPAP Treatment—A Single Centre Experience

Continuous positive airway pressure (CPAP) has been the standard treatment of obstructive sleep apnoea/hypopnoea syndrome (OSA) for almost four decades. Though usually effective, this treatment suffers from poor long-term compliance. Therefore, the aim of our one centre retrospective study was to assess factors responsible for treatment failure and long-term compliance. Four hundred subsequent patients diagnosed with OSA and qualified for CPAP treatment were chosen from our database and compliance data were obtained from medical charts. Many differing factors kept patients from starting CPAP or led to termination of treatment. Overall, almost half of patients ended treatment during the mean time of observation of 3.5 years. Survival analysis revealed that 25% of patients failed at a median time of 38.2 months. From several demographic and clinical covariates in Cox’s hazard model, only the presence of a mild OSA, i.e., AHI (apnoea/hypopnoea index) below 15/h was a factor strongly associated with long term CPAP failure. The compliance results of our study are in line with numerous studies addressing this issue. Contrary to them, some demographic or clinical variables that we used in our survival model were not related to CPAP adherence.

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Cost-effectiveness of positive airway pressure modalities in obesity hypoventilation syndrome with severe obstructive sleep apnoea

Thorax ◽

10.1136/thoraxjnl-2019-213622 ◽

2020 ◽

Vol 75 (6) ◽

pp. 459-467 ◽

Cited By ~ 4

Author(s):

Juan F Masa ◽

Babak Mokhlesi ◽

Iván Benítez ◽

Francisco Javier Gómez de Terreros Caro ◽

M-Ángeles Sánchez-Quiroga ◽

...

Keyword(s):

Cost Effectiveness ◽

Primary Outcome ◽

Cost Effective ◽

Sleep Apnoea ◽

Obesity Hypoventilation Syndrome ◽

Obstructive Sleep ◽

The Mean ◽

Hypoventilation Syndrome ◽

Obesity Hypoventilation

BackgroundObesity hypoventilation syndrome (OHS) is treated with either non-invasive ventilation (NIV) or CPAP, but there are no long-term cost-effectiveness studies comparing the two treatment modalities.ObjectivesWe performed a large, multicentre, randomised, open-label controlled study to determine the comparative long-term cost and effectiveness of NIV versus CPAP in patients with OHS with severe obstructive sleep apnoea (OSA) using hospitalisation days as the primary outcome measure.MethodsHospital resource utilisation and within trial costs were evaluated against the difference in effectiveness based on the primary outcome (hospitalisation days/year, transformed and non-transformed in monetary term). Costs and effectiveness were estimated from a log-normal distribution using a Bayesian approach. A secondary analysis by adherence subgroups was performed.ResultsIn total, 363 patients were selected, 215 were randomised and 202 were available for the analysis. The median (IQR) follow-up was 3.01 (2.91–3.14) years for NIV group and 3.00 (2.92–3.17) years for CPAP. The mean (SD) Bayesian estimated hospital days was 2.13 (0.73) for CPAP and 1.89 (0.78) for NIV. The mean (SD) Bayesian estimated cost per patient/year in the NIV arm, excluding hospitalisation costs, was €2075.98 (91.6), which was higher than the cost in the CPAP arm of €1219.06 (52.3); mean difference €857.6 (105.5). CPAP was more cost-effective than NIV (99.5% probability) because longer hospital stay in the CPAP arm was compensated for by its lower costs. Similar findings were observed in the high and low adherence subgroups.ConclusionCPAP is more cost-effective than NIV; therefore, CPAP should be the preferred treatment for patients with OHS with severe OSA.Trial registration numberNCT01405976

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A randomized controlled trial of an ambulatory approach versus the hospital-based approach in managing suspected obstructive sleep apnea syndrome

Scientific Reports ◽

10.1038/srep45901 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 10

Author(s):

David S. Hui ◽

Susanna S. Ng ◽

Kin-Wang To ◽

Fanny W. Ko ◽

Jenny Ngai ◽

...

Keyword(s):

Waiting Time ◽

Sleep Apnea Syndrome ◽

Sleep Apnoea ◽

Sleep Study ◽

Cpap Treatment ◽

Home Based ◽

Obstructive Sleep ◽

Group A ◽

The Mean ◽

Group B

Abstract Comparisons of home-based versus hospital-based approach in managing patients with suspected obstructive sleep apnoea syndrome(OSAS). A prospective, controlled CPAP parallel study of new referrals with suspected OSAS randomized into group A) home-based or B) hospital-based approach. Following detection of AHI ≥ 15/hr by Embletta sleep study (group A) or polysomnography (group B), patients received CPAP for 3 months after an overnight autoCPAP titration at home or in hospital respectively. Modified intention-to-treat analysis of those with AHI ≥ 15/hr on CPAP (n = 86 vs 86) showed no difference in Epworth sleepiness score, the primary endpoint, but greater improvement in Sleep-Apnoea-Quality-of-Life-Index[difference 0.3,(95%CI 0.02, 0.6), p = 0.033] at 3 months in group A. The mean costs for the patients in group A and group B were HK$8479(989) and HK$22,248(2407) respectively. The mean difference between groups was HK$-13,769(USD 1770 equivalent) per patient with 95% CI. (−14324, −13213), p < 0.001. The waiting time of patients with AHI ≥ 15/hr who were started on CPAP treatment from the first clinic consultation to the diagnostic sleep test, autoCPAP titration, and CPAP treatment was 189.6, 148.8 and 145.0 days shorter in group A than group B respectively. Home-based approach is non-inferior to hospital-based approach in managing patients with suspected OSAS, with shorter waiting time, and substantial cost savings.

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Long-term CPAP treatment improves asthma control in patients with asthma and obstructive sleep apnoea

Sleep And Breathing ◽

10.1007/s11325-016-1340-1 ◽

2016 ◽

Vol 20 (4) ◽

pp. 1217-1224 ◽

Cited By ~ 17

Author(s):

Paula Kauppi ◽

Patrick Bachour ◽

Paula Maasilta ◽

Adel Bachour

Keyword(s):

Asthma Control ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Cpap Treatment ◽

Obstructive Sleep

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Genioglossus advancement and hyoid myotomy: short-term and long-term results

The Journal of Laryngology & Otology ◽

10.1258/002221503321892343 ◽

2003 ◽

Vol 117 (6) ◽

pp. 482-486 ◽

Cited By ~ 46

Author(s):

C. Neruntarat

Keyword(s):

Body Mass Index ◽

Weight Gain ◽

Clinical Success ◽

Sleep Apnoea ◽

Long Term Results ◽

Short Term ◽

Obstructive Sleep ◽

The Mean

Successful results of genioglossus advancement and hyoid myotomy with suspension (GAHM) in the treatment of obstructive sleep apnoea (OSA) have been reported. However, there have been few studies of long-term results. Forty-six patients with hypopharyngeal obstruction underwent GAHM. Patients had a mean age of 40.1 ± 4.2 years and a mean body mass index (BMI) of 28.9 ± 2.1 kg/m2. The mean follow-up was 39.4 ± 5.7 monthswith a range of 37 to 46 months. The mean pre-operative RDI, short-term RDI, and long-term RDI were 47.9 ± 8.4, 14.2 ± 3.9, 18.6 ± 4.1, respectively. The mean post-operative LSAT, short-term LSAT, and long-term LSAT were 81.2 per cent ± 2.9 per cent, 88.8 per cent ± 2.7 per cent and 87.2 per cent ± 3.1 per cent, respectively. The changein BMI was significantly different in the patients with, and without, recurrence (2.1 ± 0.3 vs 0.4 ± 0.2.kg/m2, <0.05). Thirty (65.2 per cent) patientshad long-term clinical success, and six (16.7 per cent) patients with short-term success failedlong-term. GAHM appears to be an effective procedure and results in long-term success. However,patients with weight gain are at risk of recurrence.

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Faculty Opinions recommendation of Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.719900217.793506792 ◽

2015 ◽

Author(s):

Martica Hall

Keyword(s):

Continuous Positive Airway Pressure ◽

Observational Study ◽

Obstructive Sleep Apnoea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Sleep Apnoea ◽

Cardiovascular Outcomes ◽

Obstructive Sleep

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Surveillance System in Smart Cities: A Dependability Evaluation Based on Stochastic Models

Electronics ◽

10.3390/electronics10080876 ◽

2021 ◽

Vol 10 (8) ◽

pp. 876

Author(s):

Igor Gonçalves ◽

Laécio Rodrigues ◽

Francisco Airton Silva ◽

Tuan Anh Nguyen ◽

Dugki Min ◽

...

Keyword(s):

Surveillance System ◽

Smart Cities ◽

Heterogeneous Data ◽

Time To Failure ◽

Video Streams ◽

Dependability Evaluation ◽

The Mean ◽

Mean Time ◽

The Internet Of Things

Surveillance monitoring systems are highly necessary, aiming to prevent many social problems in smart cities. The internet of things (IoT) nowadays offers a variety of technologies to capture and process massive and heterogeneous data. Due to the fact that (i) advanced analyses of video streams are performed on powerful recording devices; while (ii) surveillance monitoring services require high availability levels in the way that the service must remain connected, for example, to a connection network that offers higher speed than conventional connections; and that (iii) the trust-worthy dependability of a surveillance system depends on various factors, it is not easy to identify which components/devices in a system architecture have the most impact on the dependability for a specific surveillance system in smart cities. In this paper, we developed stochastic Petri net models for a surveillance monitoring system with regard to varying several parameters to obtain the highest dependability. Two main metrics of interest in the dependability of a surveillance system including reliability and availability were analyzed in a comprehensive manner. The analysis results show that the variation in the number of long-term evolution (LTE)-based stations contributes to a number of nines (#9s) increase in availability. The obtained results show that the variation of the mean time to failure (MTTF) of surveillance cameras exposes a high impact on the reliability of the system. The findings of this work have the potential of assisting system architects in planning more optimized systems in this field based on the proposed models.

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