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INTRODUCTION To assess the impact of nocturnal continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) on lower urinary tract (LUTS) symptoms. MATERIALS AND METHODS A prospective, monocentric study was conducted between June 2018 and August 2019. Patients with moderate to severe OSA with an indication for treatment with nocturnal CPAP in combination with SBAU were included. SBAUs and their impact were evaluated by completing two self-administered questionnaires (Urinary Symptom Profile (USP) and International Prostate Score Symptom (IPSS)) filled out during the night-time ventilatory polygraph or diagnostic polysomnography for OSA and after 4 months of CPAP treatment. RESULTS In 79 patients, after four months of CPAP treatment, USP scores for stress urinary incontinence and overactive bladder were significantly improved, respectively 0.65±1.38 vs 1.13±2.10 ; p

PurposeThe purpose is to assess the effectiveness of continuous positive airway pressure (CPAP) treatment on sleep quality, daytime sleepiness and daytime functioning among Thai obstructive sleep apnea (OSA) patients.Design/methodology/approachA repeated measures clinical intervention design was implemented. Participants were 50 patients first time diagnosed with OSA and prescribed CPAP treatment. The intervention composed of CPAP health education, and follow-up evaluation. Data on CPAP adherence were downloaded from Smartcards of the CPAP device. The Thai PSQI, ESS and FSAQ-10 questionnaires were administered at baseline, 1-month, and 3-months. Descriptive statistics and repeated measure analysis with multilevel mixed-effects modeling approach were used.FindingsThirty-nine participants completed the study. Approximately 53% (n = 25) and 71.1% (n = 27) of the patients adhered to CPAP treatment by the end of the 1- and 3-months, respectively. After controlling for patients’ adherence, at 1-month follow-up, the intervention improved quality of sleep (β = −2.65, 95% CI = −1.60, −4.13), daytime functioning (β = 3.24, 95% CI = 1.87, 4.61) and decreased daytime sleepiness (β = −3.29, 95% CI = −1.85, −4.73). At 3 months, the intervention still improved quality of sleep (β = −3.53, 95% CI = −2.05, −5.01), and daytime functioning (β = 4.34, 95% CI = 2.76, 5.92), and decreased daytime sleepiness (β = −4.82, 95% CI = −3.16, −6.49).Originality/valueAdherence to CPAP treatment is effective in improving sleep quality, daytime functioning and reducing daytime sleepiness. Patient-oriented strategies for enhancing CPAP adherence should be developed and implemented as a standard care in sleep clinics.

Continuous positive airway pressure (CPAP) is one of the most common therapies for Obstructive Sleep Apnea (OSA). We present a brief, patient-reported outcome measure used to assess patients' levels of adherence with CPAP treatment.A questionnaire was developed based on academic literature. We qualitatively tested a pool of 18 items. It was tested in a sample of 174 patients from the Hospital La Princesa. Next, 1021 patients from Catalonia were evaluated.5 items were removed. Nominal groups referred to three areas: general knowledge about OSA and its risks; CPAP treatment information and expectations; CPAP use, monitoring, and confidence with its use. The 13 retained items maintained the same meaning as the original questionnaire (r=.986; p.001) and the three proposed dimensions detected a significant increase in general knowledge of OSA (t[173]=8.097, p.001); CPAP treatment information (t[173]=15.170, p.001); and CPAP use (t[173]=14.642, p.001). The final 12-item version was reliable (CRI=.793) and its internal structure was adequate (χThe interview could help clinicians prevent some dropouts by targeting patients with lower adherence. It's a tool for assessing patient adherence to CPAP and to promote strategies through education and external motivational stimuli.

Although continuous positive airway pressure (CPAP) therapy is the most effective treatment for obstructive sleep apnea (OSA), it is not always easy to gain adherence to therapy. We aimed to evaluate how short-term CPAP application during the daytime before the titration night affects polysomnographic data and CPAP adherence in OSA. Patients with moderate to severe OSA for whom CPAP titration was recommended were prospectively randomized to daytime CPAP application (group 1) or usual care (group 2). For group 1, CPAP was applied for 30–60 min in daytime conditions to acclimate patients to the device. An appointment was then made to perform CPAP titration with PSG. In group 2 (usual care), the first CPAP application was performed on the titration night. PSG recordings and titration night recordings of both groups were compared. All subjects were evaluated 1 month after the initiation of CPAP treatment. Among 246 cases, first night data were similar in both groups. During the titration night, total sleep time, sleep efficiency, and time in stage N3 were significantly higher in patients who underwent the daytime CPAP trial. Adherence to CPAP treatment at first-month follow-up was significantly higher in the group 1 (5.7 ± 1.0 h/night) compared to the group 2 (3.9 ± 1.1 h/night, p < 0.001). A short-term daytime CPAP trial in patients before the titration night may provide longer and more efficient sleep on the titration night and better CPAP adherence at one month.

MOTIVATION: Studies have shown poor clinical effectiveness of the Epworth Sleepiness Scale (ESS) due to its ambiguity of items and cultural applicability. This study aimed to investigate the efficacy of a Visual Analog Scale (VAS) to assess sleepiness, compared to ESS. METHODS: Thirty-two obstructive sleep apnea (OSA) patients and 32 healthy participants completed two visits, 1 month apart, during which they completed both ESS and VAS. Patients diagnosed with OSA were treated with Continuous positive airway pressure (CPAP) between visits. The agreement between the ESS and VAS scores in both patients with OSA and healthy participants was investigated using Pearson correlation and Area Under the receiver operating characteristics. RESULTS: The (mean ± standard deviation) Oxygen Desaturation Index for patients with OSA was 18.5 ± 5.7 events/hour and 1.7 ± 1.0 events/hour in the healthy participants. A reduction in sleepiness, following CPAP treatment occurred in patients with OSA, using the ESS (11.2 ± 5.5–4.7 ± 5.0 points, P < 0.001) and the VAS (50.2 ± 3.0–21.9 ± 26.5 mm, P < 0.001). There was no significant change in sleepiness, in healthy participants using the ESS (3.91 ± 3.14–3.34 ± 3.27 points (P < 0.48) or the VAS (15.58 ± 21.21–12.05 ± 14.75 mm, (P < 0.44). A Likert scale showed that the VAS was easier to use compared to ESS in visit 1 (VAS: 8.7 ± 1.9 points, ESS: 7.7 ± 2.6 points, (P < 0.001), and visit 2 (VAS: 9.5 ± 1.4 points, ESS: 8.6 ± 1.5 points, P < 0.001). CONCLUSION: These preliminary results suggest that the VAS can detect a change in sleepiness after CPAP treatment in patients with OSA and that the VAS was also easier to use compared to ESS.

STUDY OBJECTIVES: Medium and long-term trials comparing continuous positive airway pressure (CPAP) with noninvasive ventilation in patients with obesity hypoventilation syndrome have shown no differences in outcomes. However, it remains unclear whether CPAP therapy should be prescribed if significant hypoxemia persists during CPAP titration, despite optimization of upper airway obstructive events or if maximum CPAP pressure is reached. We aimed to examine the effects of 6 weeks of home CPAP therapy on gas exchange in patients with obesity hypoventilation syndrome who failed CPAP titration due to persistent hypoxemia. METHODS: This case series is a substudy of a randomized-controlled trial evaluating efficacy of 3 different PAP modalities in obesity hypoventilation syndrome. Patients randomized to CPAP who failed titration and were prescribed CPAP are included. CPAP failure was defined as spending more than 20% of total sleep time with oxygen saturation below 90% despite adequate resolution of apneas and hypopneas. Follow-up data included in-laboratory polysomnogram on prescribed CPAP after 6 weeks of home CPAP therapy. RESULTS: Three of seven participants (43%) randomized to CPAP failed CPAP titration. All were morbidly obese, had severe OSA (apnea-hypopnea index > 90 events/h) and severe sleep hypoxemia (percentage of total sleep time with oxygen saturation < 90% [T90] = 60–89%). Hypoxemia (T90: 43–67%, T80: 0–31%, and T70: 0–11%) and hypercapnia (transcutaneous pressure of CO(2) levels > 50 mm Hg) persisted during CPAP titration polysomnogram. The final polysomnogram after 6 weeks of adherent home CPAP therapy showed effective control of obstructive sleep apnea. Hypoventilation and hypoxemia severity decreased significantly in all 3 participants. CONCLUSIONS: Our data suggest that CPAP titration failure does not equal CPAP treatment failure. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: AVAPS-AE Efficacy Study; URL: https://clinicaltrials.gov/ct2/show/NCT01368614; Identifier: NCT01368614. CITATION: Lastra AC, Masa JF, Mokhlesi B. CPAP titration failure is not equivalent to long-term CPAP treatment failure in patients with obesity hypoventilation syndrome: a case series. J Clin Sleep Med. 2020;16(11):1975–1981.

Obstructive sleep apnea (OSA) has been related to vascular inflammation and production of endothelial cell adhesion molecules (CAMs). We aimed to determine night-morning variation of CAMs in patients with OSA compared to controls and the effect of one-night continuous positive airway pressure (CPAP) treatment on them. Nonsmoking men went through a full-attended polysomnography (PSG) study. Participants with moderate to severe OSA went through another PSG study while being treated with CPAP. Participants who did not have OSA composed the control group. Serum levels of intercellular adhesion molecule-1 (ICAM-1), vascular adhesion molecule-1 (VCAM-1), and E-selectin were measured before and after sleep on both nights. Of 30 men, 20 had moderate to severe OSA while 10 did not. Night and morning ICAM-1 levels of patients with OSA were significantly higher than controls (p = 0.002 and p < 0.0001 respectively), while both night and morning VCAM-1 and E-selectin levels were not. Morning ICAM-1 levels of controls were significantly lower than night levels (p = 0.031), while morning ICAM-1, VCAM-1, and E-selectin levels of patients with OSA and morning VCAM-1 and E-selectin levels of controls were not. After CPAP treatment, the morning ICAM-1 levels, but not VCAM-1 levels, of patients with OSA were significantly lower than night levels (p = 0.006) and E-selectin levels showed a tendency for reduction (p = 0.06). OSA is associated with elevated night and morning ICAM-1 levels in adult men with OSA. Even one night of CPAP treatment restores the normal night-morning variation of ICAM-1 levels and may have an effect on E-selectin levels, as well.

Several studies propose that nocturia, which is common among obstructive sleep apnea (OSA) patients, might be benefited from continuous positive airway pressure (CPAP) treatment. However, related literature remains obscure and thus needs further consolidation and clarification. The present study aimed to provide further evidence regarding potent correlation between CPAP and nocturia in OSA patients. Five hundred and thirty publications were selected after a search in PubMed, Cochrane Library, ClinicalTrials.gov , Google Scholar databases, as well as in unpublished literature. Study eligibility criteria were fulfilled by 11 studies. A systematic review and meta-analysis with subgroup analyses and meta-regressions examined 11 means regarding nocturia rates before and after treatment with CPAP in a total of 830 patients. Mean differences (MD) and confidence intervals (CI) were estimated using random effects model. The study was registered to PROSPERO database (ID: 160600). Nocturia rates are diminished after CPAP treatment, when compared with nocturia rates before CPAP treatment: Overall MD = − 1.13, 95% CI: [− 1.48, − 0.78], P 27 mg/m2 BMI (P = 0.012). Nocturia is alleviated in CPAP-treated OSA patients; CPAP beneficial effect is independently correlated with younger age, increased BMI, and less severe cases.

A better understanding of Continuous Positive Airway Pressure (CPAP) adherence is a priority in improving patient care. To Identify adherence typology with a longitudinal approach, and explore the early determinants of lower adherence to CPAP. Obstructive sleep apnea patients ( N = 204). Prospective and longitudinal study.A classification into four profiles was observed: “ Regular Adherents,” “ Non-Regular Adherents,” “ Persistent Non-Adherents,” and “ Non-Persistent Non-Adherents.” Specific biopsychosocial factors make it possible to evaluate the risk of belonging to a lower adherence profile. We propose a novel approach of CPAP treatment adherence. Several pre-determinants have been identified.

Background This study aimed to explore the correlations between continuous positive airway pressure (CPAP) treatment-related self-efficacy and family support among patients with obstructive sleep apnoea (OSA) to provide a basis for improving patients' CPAP treatment compliance. Methods From May to Dec 2017, a cross-sectional study was conducted in the emergency wards, otorhinolaryngology wards, respiratory wards, and outpatient clinic of our hospital. A total of 112 patients with OSA treated with home ventilators were administered with the Self-efficacy Measure for Sleep Apnoea (SEMSA) and Perceived Social Support from Family (PSS-Fa) Scale. Results On the SEMSA, participants had a disease risk perception score of 2.61±0.31, an outcome expectation score of 2.44±0.17, and a self-efficacy score of 2.55±0.13. Mean total score on PSS-Fa was 10.15±2.73, with 10.7%, 45.5% and 43.8% of participants showing a low level, a medium level, and a high level of family support, respectively. Outcome expectation and self-efficacy were positively correlated with family support. Conclusions The self-efficacy and outcome expectation of patients with OSA are positively correlated with their level of family support.

Introduction There are many options available to patients who are placed on constant positive airway pressure (CPAP) for obstructive sleep apnea. Despite the success of CPAP in correcting apnea, a significant number of patients have difficulty with the therapy. A large number of those patients who have difficulty stop therapy and are often labeled as "CPAP Failure". Non-sleep specialists may view CPAP therapy as a singular course of treatment, but there are many ways CPAP may be ordered for a patient. Each patient experiences a unique set of options that constitute a unique order set. Methods In order to demonstrate the magnitude of the possible options, estimates of the number of unique order sets were calculated. The author chose individual order options and the number of selections possible within each option. The calculated sets included a "Generous, Limited and Minimal" number of selections for each option. Calculations were done separately for standard CPAP and for auto-adjusting CPAP. Additional calculations were performed using the number of commercially available masks in the United States. Results The maximum number of unique order sets was seen using a standard CPAP combined with commercially available masks: 49,152 unique order sets. The fewest number of unique order sets were seen with the auto-adjusting CPAP and the "Minimal" selections: 288 unique order sets. Discussion There are a large number of unique CPAP orders that a patient may experience. CPAP treatment is not a singular or simple therapy. When evaluating obstructive sleep apnea patients with histories of CPAP failure or prior difficulty with CPAP, paying close attention to the patient's treatment experiences may help explain a significant number of those patients' CPAP therapy problems.

STUDY OBJECTIVES: To determine whether an intensive weight-loss program (IWLP) is effective for reducing weight, the severity of obstructive sleep apnea (OSA), and metabolic variables in patients with obesity and severe OSA undergoing continuous positive airway pressure treatment. METHODS: Forty-two patients were randomized to the control (CG, n = 20) or the intervention group (IG, n = 22), who followed a 12-month IWLP. The primary outcome was a reduction in the apnea-hypopnea index (AHI) as measured at 3 and 12 months by full polysomnography. Metabolic variables, blood pressure, body fat composition by bioimpedance, carotid intima media thickness, and visceral fat by computed tomography were also assessed. RESULTS: Mean age was 49 (6.7) years, body mass index 35 (2.7) kg/m(2), and AHI 69 (20) events/h. Weight reduction was higher for the IG than the CG at 3 and 12 months, −10.5 versus −2.3 kg (P < .001), and −8.2 versus −0.1 kg (P < .001), respectively, as was loss of visceral fat at 12 months. AHI decreased more in the IG at 3 months (−23.72 versus −9 events/h) but the difference was not significant at 12 months, though 28% of patients from the IG had an AHI < 30 events/h compared to none in the CG (P = .046). At 12 months, the IG showed a reduction in C-reactive protein (P = .013), glycated hemoglobin (P = .031) and an increase in high density lipoprotein cholesterol (P = .027). CONCLUSIONS: An IWLP in patients with obesity and severe OSA is effective for reducing weight and OSA severity. It also results in an improvement in lipid profiles, glycemic control, and inflammatory markers. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Title: Effectiveness of an Intensive Weight Loss Program for Obstructive Sleep Apnea Syndrome (OSAS) Treatment; Identifier: NCT02832414; URL: https://clinicaltrials.gov/ct2/show/record/NCT02832414 CITATION: López-Padrós C, Salord N, Alves C, et al. Effectiveness of an intensive weight-loss program for severe OSA in patients undergoing CPAP treatment: a randomized controlled trial. J Clin Sleep Med. 2020;16(4):503–514.

International audience; Bruxism is a heterogeneous condition related to various underlying mechanisms, including the presence of OSA. This case report illustrates that sleep mandibular movement monitoring and analysis could provide a useful opportunity for detection of both sleep bruxism and respiratory effort. The current case suggests that tracking of respiratory effort could enable evaluation of bruxism and its potential interactions. Successful treatment of sleep-related respiratory effort may lead to improved or resolution of bruxism in cases where such a causal relationship does exist.

RATIONALE/OBJECTIVES: Due to a higher risk of postoperative complications in obstructive sleep apnea (OSA) patients, a systematic screening for OSA is recommended for patients undergoing bariatric ...

Continuous positive airway pressure (CPAP) remains the major treatment option for obstructive sleep apnea (OSA). The American Thoracic Society organized a workshop to discuss the importance of mask selection for OSA treatment with CPAP. In this workshop report, we summarize available evidence about the breathing route during nasal and oronasal CPAP and the importance of nasal symptoms for CPAP outcomes. We explore the mechanisms of air leaks during CPAP treatment and possible alternatives for leak control. The impact of nasal and oronasal CPAP on adherence, residual apnea-hypopnea index, unintentional leaks, and pressure requirements are also compared. Finally, recommendations for patient and partner involvement in mask selection are presented, and future directions to promote personalized mask selection are discussed.

[EN]: [Background]: Large variation in diagnostic procedures and treatment recommendations may hinder the management of obstructive sleep apnea (OSA) and also compromise correct interpretation of the results of multicenter clinical trials, especially in subjects with non-severe OSA. The aim of this study was to analyze the therapeutic decision-making between different sleep physicians in patients with AHI, [ES]: [Introducción]: La gran variedad de procedimientos diagnósticos y recomendaciones de tratamiento puede dificultar el manejo del síndrome de apnea obstructiva del sueño (SAHS), y del mismo modo comprometer la correcta interpretación de los resultados de ensayos clínicos multicéntricos, especialmente en pacientes con SAHS no grave. El objetivo de este estudio fue analizar la decisión terapéutica de distintos médicos expertos en sueño en pacientes con el índice de apnea hipopnea < 40 eventos/h. [Métodos]: Se pidió a seis especialistas con amplia experiencia en sueño de diferentes centros de España que tomaran una decisión terapéutica (terapia de presión positiva continua en las vías respiratorias o CPAP) basada en datos anónimos de los pacientes con sospecha de SAHS en los que previamente se había llevado a cabo un estudio del sueño. Los datos clínicos procedían de una base de datos online e incluían características antropométricas, cuestionarios clínicos, comorbilidades, examen físico y resultados del estudio del sueño. La concordancia intra- e interobservador de la toma de decisiones se analizó mediante el estadístico Fleiss’ Kappa (Kappa). [Resultados]: Se analizaron un total de 720 decisiones médicas para evaluar el consenso entre profesionales del sueño. De manera global, la fiabilidad de la evaluación intraobservador fue casi perfecta (Kappa = 0,83; 95% CI; 0,75 a 0,90, p < 0,001). Sin embargo, la concordancia global interobservador disminuyó hasta alcanzar un grado moderado de consenso (Kappa = 0,46; 95% CI; 0,42 a 0,51, p < 0,001), que fue especialmente bajo cuando se tuvo en cuenta un índice de apnea hipopnea

Background Previous studies have shown conflicting results on the effect of continuous positive airway pressure (CPAP) on quality of life (QoL) in obstructive sleep apnoea (OSA) patients. Objectives To evaluate the effect of CPAP on QoL in OSA patients compared to sham CPAP, placebo pills, and conservative treatment. Methods Studies were identified via Web of Knowledge, PubMed, PsychInfo, CINAHL, EMBASE, OpenGrey, and the Cochrane Library. Subgroup analyses and sensitivity analyses were conducted to assess the robustness of the findings. Results Meta-analysis of 13 randomised controlled trials showed no significant differences in overall and psychological QoL comparing values of CPAP treated patients with controls; however, physical QoL improved. CPAP significantly affected the overall QoL in studies with controls receiving sham CPAP, parallel design, low risk of bias, and mild OSA patients. Conclusion CPAP treatment may help to improve physical symptoms of OSA, whereas impaired psychological QoL still cannot be alleviated.

BackgroundThe COVID-19 pandemic has raised concern for healthcare workers getting infected via aerosol from non-invasive respiratory support of infants. Attaching filters that remove viral particles in air from the expiratory limb of continuous positive airway pressure (CPAP) devices should theoretically decrease the risk. However, adding filters to the expiratory limb could add to expiratory resistance and thereby increase the imposed work of breathing (WOB).ObjectiveTo evaluate the effects on imposed WOB when attaching filters to the expiratory limb of CPAP devices.MethodsTwo filters were tested on three CPAP systems at two levels of CPAP in a mechanical lung model. Main outcome was imposed WOB.ResultsThere was a minor increase in imposed WOB when attaching the filters. The differences between the two filters were small.ConclusionTo minimise contaminated aerosol generation during CPAP treatment, filters can be attached to expiratory tubing with only a minimal increase in imposed WOB in a non-humidified environment. Care has to be taken to avoid filter obstruction and replace filters as recommended.

While continuous positive airway pressure (CPAP) is an effective first-line therapy for sleep apnea, CPAP fails in one third of patients mainly due to poor adherence to the CPAP device and masks. The role of the medical team is to guide the patient in choosing the best mask, thus insuring good CPAP therapy adherence. Once a suitable mask is found, the brand of the mask does not affect patient satisfaction or CPAP adherence. For the majority of patients, nasal masks are by far more suitable than oronasal masks. Orosanal masks are indicated in case of nasal stuffiness or when an air leak manifests through the mouth. Re-evaluation of the efficacy of CPAP therapy is recommended when switching to oronasal masks.

STUDY OBJECTIVES: To evaluate continuous positive airway pressure (CPAP) treatment in patients with moderate to severe sleep-disordered breathing (SDB) after an ischemic stroke. METHODS: We identified patients included in the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) who underwent polysomnography after an ischemic stroke. We compared patients without significant SDB (apnea-hypopnea index [AHI] < 15 events/h: SDB−), with AHI ≥ 15 events/h who refused CPAP or with poor CPAP adherence (SDB+ CPAP−), and patients with SDB effectively treated by CPAP (SDB+ CPAP+). RESULTS: We analyzed data from 101 patients (age 68.5 ± 11.1 years, 84.1% men). In multivariate analysis the SDB+ CPAP+ group was associated with a significant reduction of stroke recurrence and mortality (odds ratio 0.13, 95% confidence interval 0.00–0.86, P = .031), whereas atrial fibrillation was independently associated with a higher risk (odds ratio 4.32, 95% confidence interval 1.51–12.33, P = .006). Event-free survival analysis (stroke recurrence and death) after 2-year follow-up showed that those in the SDB+ CPAP+ group had significantly higher cardiovascular survival, and Cox proportion hazard model identified CPAP treatment as significantly associated with survival time (P = .025). The AHI and the National Institutes of Health Stroke Scale subacute score were independently associated with CPAP adherence among patients with SDB. CONCLUSIONS: This observational study shows that CPAP treatment in stroke patients with moderate to severe SDB is associated with lower rates of stroke recurrence and death. CITATION: Haba-Rubio J, Vujica J, Franc Y, Michel P, Heinzer R. Effect of CPAP treatment of sleep apnea on clinical prognosis after ischemic stroke: an observational study. J Clin Sleep Med. 2019;15(6):839–847.

Study Objectives : Although the full-night continuous positive airway pressure (CPAP) titration (fnPT) has been recognized as the gold standard for determining an optimal therapeutic pressure for obstructive sleep apnea (OSA) treatment, it is labor-intensive, time-consuming because it requires overnight polysomnography attended by well-experienced sleep technologists. The aim of this study is to develop a practical and feasible alternative titration method. Methods : We assessed demographic data and diagnostic polysomnographic parameters, time spent in CPAP titration, CPAP efficacy and long-term adherence of the two groups of our OSA patients who had received CPAP titration either by fnPT (n = 46) or by afternoon CPAP titration (aPT, n = 22). Main results : Mean total recording time of aPT was significantly shorter than that by fnPT (p < 0.0001). There was no significant difference in mean residual apnea hypopnea index (AHI) on treatment, percent days with device usage, cumulative device usage hours during the 360 days, average device usage hours per day (360 days, days used), and percent of days with device usage ≥ 4 hours during the 360 days after starting CPAP treatment between the two groups. Conclusions : Our study demonstrated that aPT was feasible procedure as an alternative to fnPT. J. Med. Invest. 68 : 170-174, February, 2021.

It is estimated that almost one-third of patients with COVID-19 develop delirium in the course of disease, actually it may be the only presenting symptom, especially in dementia patients. In COVID-19 patients delirium is associated with higher mortality rate, increased length of stay and a greater rate of admission in Intensive Care Unit and ventilator utilisation. We hypothesized a greater rate of delirium in Helmet CPAP COVID-19 ventilated patients because many known risk factors for delirium co-exist in these kind of patients (i.e. isolation, noise, dehydration). The first aim of our study is to investigate the incidence of delirium occurring during Helmet CPAP therapy in COVID-19 patients. Moreover, we wanted to verify if there are predictable risk factors for delirium and to determine if delirium increases the risk of adverse outcomes (need of endotracheal intubation and death). The cohort of CPAP ventilated COVID-19 patients were composed by 194 patients. Of them, 57 patients (29.3%) developed delirium during CPAP, more than two third in the first 48h. Age over 70 years, previous diagnosis of dementia or psychiatric condition, P/F < 150 after starting CPAP and Gr/Lys >8 resulted risk factors for delirium. Delirium group had a significantly higher mortality rate (47% vs 23%) and lower intubation rate (12% vs 26%) compared to non-delirious ones. Despite many potential predisposing factors are common in CPAP ventilated patients, delirium incidence in our population seems not to differ from what reported by other studies. Moreover, the occurrence of delirium seems not to be related to prolonged CPAP treatment, indeed no correlation between time spent in CPAP and delirium onset was found.

Introduction: Most of the patients with treatment-emergent central apnea syndrome (TECSA) experience resolution of central apneas after 2-3 months of CPAP treatment. For patients who do not respond to CPAP therapy, BPAP-ST or ASV modes are recommended. The aim of this case series is to show the efficacy of APAP (automatic positive airway pressure) devices in the management of TECSA. Methods: In this case series, the clinical features and treatment results of 5 male patients who started using APAP (automatic positive airway pressure) devices for TECSA treatment in our clinic during 2019 were retrospectively analyzed. Results: The clinical characteristics and treatment results of the patients are summarized in Tables 1 and 2. Two patients used an APAP device with a forced oscillation technique (FOT) and the others used APAP devices that could differentiate central apneas using the obstructive pressure peak (OPP) method. In Patient 1, even in the second week of the treatment, total regression of the central events was evident, while longer-term treatment results were also successful in the other patients. Discussion and Conclusion: APAP devices are constantly updated. The new algorithms including FOT / OPP differentiate central apneas more effectively and prevent unnecessary increases in pressure. APAP devices with these new algorithms can be a treatment option in TECSA.

Introduction: Obstructive Sleep Apnea (OSA), one of the most common sleep disorders worldwide has been suggested to promote aging by inducing cellular and molecular aging mechanisms (Gaspar, et al. 2017). Understanding OSA putative effect on aging might contribute to understand new strategies to improve OSA diagnosis and treatment but also to counteract aging. Aim: To investigate cellular senescence and senescent associate secretory phenotype (SASP), a hallmark of aging, in OSA patients and the impact of OSA treatment. Methods: A cohort of 9 adult male patients diagnosed with severe OSA was followed from the moment of diagnosis with polysomnography (PSG), up to 4 months and 24 months of treatment with continuous pressure positive mask (CPAP). SASP biomarkers were evaluated in OSA patients in comparison to age-matched controls and younger controls, both validated by PSG. Results: OSA patients show a deregulation of pro- and anti-inflammatory cytokine levels, in comparison with age-matched and young controls, an effect that is no longer observed after treatment. In addition, OSA patients show alterations in extracellular vesicles release that are not fully re-established upon CPAP treatment. Conclusion: These results suggest that OSA might induce SASP. CPAP treatment might partially re-stablish some alterations. Hence, OSA early diagnosis and specific treatment may constitute a new strategy to delay ageing.

Introduction: The aims of this research are to describe the characteristics of patients under CPAP treatment (telematic (TG) and conventional (CG) follow-up), to compare the adherence and to evaluate the perceived satisfaction. Methods: Prospective single-blind randomized study.Patients who started using a CPAP were randomized to conventional o telematic follow-up. The inclusion period was a year and the follow up, 6 months. Adherence was monitored and patients were asked about perceived satisfaction using the CSQ 8. Results: 84 patients were recruited (53 men) whose characteristics are shown in Table.The number of hours per night that patients used CPAP was higher than 6 in both groups and the two different monitoring methods resulted in a similar final pressure and residual apnea-hypopnea index. We found improvement in terms of perceived daytime sleepiness in both groups and they reported a similar degree of satisfaction related to the improvement in quality of life and with the service provided in the Sleep Unit.Patient satisfaction was measured using the CSQ-8 questionnaire (average score in both groups was 29.1). Conclusions: Patients in TG also have perception of satisfaction and a good adherence (as those with face-to-face visit)

Introduction Prior to October 2018 our sleep service was offering oximetry sleep study and consultant appointment for all sleep referrals. GP referrals have increased by up to 13%. As a result of a quality improvement project we changed our pathway to incorporate a sleep symptom questionnaire at the time of study, then consultant reporting and restricting clinic appointments to those with definite sleep apnoea. Repeat studies were arranged for equivocal cases depending on the symptom questionnaire. Method 376 patients (GP referral=279) attended for home sleep study over a 6 month period were included in the analysis. Studies were either screening overnight pulse oximetry (n =310) or multi-channel respiratory tracings (n=36). An additional sleep symptom questionnaire was completed prior to performing the studies. After consultant review of the study and questionnaire, patients were either offered treatment, further investigation or discharged with advice. Results 49% of patients who attended for sleep studies required doctor follow up and CPAP treatment. 43% of patients attending for sleep studies did not require clinic appointment or CPAP. 8% of the individuals attended clinic but did not have CPAP after consultation – the majority of this group were advised lifestyle changes and/or use of MAD (CPAP not required/lifestyle advice n = 14, MAD= 10, CPAP offered but declined = 3, neurology referral =2, CBT = 2). Conclusion and Discussion Around half of patients referred to the sleep clinic have normal overnight oximetry readings and do not require clinic consultation if a symptom questionnaire is also completed. Implementation of a sleep symptom questionnaire into the sleep apnoea pathway helps preserve appointment capacity. Individuals with mild sleep apnoea may still require clinic appointment to discuss symptoms and treatments.

Objectives: Serum uric acid (UA) and arterial lactate acid (LA) are markers of oxidative stress and tissue hypoxia that are present in patients with obstructive sleep apnea syndrome (OSAS). The aim...

We explored the relationship between obstructive sleep apnea (OSA) patients&rsquo, anthropometric measures and the CPAP treatment response. To that end, we processed three non-overlapping cohorts (D1, D2, D3) with 1046 patients from four sleep laboratories in Western Romania, including 145 subjects (D1) with one-night CPAP therapy. Using D1 data, we created a CPAP-response network of patients, and found neck circumference (NC) as the most significant qualitative indicator for apnea&ndash, hypopnea index (AHI) improvement. We also investigated a quantitative NC cutoff value for OSA screening on cohorts D2 (OSA-diagnosed) and D3 (control), using the area under the curve. As such, we confirmed the correlation between NC and AHI (&rho, =0.35, p&lt, 0.001) and showed that 71% of diagnosed male subjects had bigger NC values than subjects with no OSA (area under the curve is 0.71, with 95% CI 0.63&ndash, 0.79, p&lt, 0.001), the optimal NC cutoff is 41 cm, with a sensitivity of 0.8099, a specificity of 0.5185, positive predicted value (PPV) = 0.9588, negative predicted value (NPV) = 0.1647, and positive likelihood ratio (LR+) = 1.68. Our NC =41 cm threshold classified the D1 patients&rsquo, CPAP responses&mdash, measured as the difference in AHI prior to and after the one-night use of CPAP&mdash, with a sensitivity of 0.913 and a specificity of 0.859.

Background During COVID-19 outbreak, with the increasing number of patients presenting with acute respiratory failure (ARF), a large use of non-invasive positive pressure ventilation (NIPPV) was done in the Emergency Departments (EDs) and medical wards despite the lack of recommendations. We aimed to assess the use of continuous positive airway pressure (CPAP) in the ED. The primary endpoint was the rate of CPAP failure and the need of endotracheal intubation (ETI). Secondary endpoints were in-hospital mortality and intensive care unit (ICU) and in-hospital length of stay. Methods A retrospective observational study enrolling adult patients admitted to the ED of Niguarda Hospital, Milan, Italy, with ARF due to COVID-19 pneumonia from March 18th to April 18th 2020, was conducted. Only patients who strictly followed a local CPAP protocol were enrolled. Results A total of 52 patients were included in this study. 38 patients (73%) were judged eligible for ETI. 18 (34.6%) were intubated. 16 (30.8%) patients died: 7 (38.9%) and 9 (26.5%) in the ETI and non-ETI group respectively. The median hospital length of stay was different in ETI and non-ETI patients: 26 days [IQR 16–37] vs 15 days [IQR 9–17] (p = 0.005). The median invasive mechanical ventilation time was 11 days [IQR 7–21] with an ICU length of stay of 14.5 days [IQR 10–28]. During the CPAP trial, variations between ETI and non-ETI patients over time were found for positive end-expiratory pressure (PEEP) (p = 0.003) and respiratory rate (RR) (p = 0.059). Conclusionss A short closed monitored CPAP trial could be considered for ARF due to COVID-19 pneumonia before considering ETI. A progressive PEEP titration should target patient’s RR reduction. More studies are needed to evaluate the efficacy and predictors of failure of CPAP and NIPPV in patients with ARF due to COVID-19 pneumonia.

Aim Premature ejaculation (PE) is a common problem in male sexual health that significantly affects the quality of life. We aimed to evaluate the association of PE with obstructive sleep apnoea syndrome (OSAS), which is characterised by chronic oxidative stress, and to assess the effects of continuous positive airway pressure (CPAP) therapy on PE. Material and methods Sexually active men between the ages of 20 and 50 who were newly diagnosed with PE, and diagnosed with moderate or severe OSAS were included in the study. Arabic Premature Ejaculation Index (AIPE) and Intravaginal Ejection Delay Time (IELT) were questioned for the diagnosis of PE. Patients with OSAS who accepted to participate in the study were given 1 year of CPAP treatment, and AIPE and IELT were questioned again, after the treatment. The results are compared with the results of the control group. Results In total, 80 control subjects without OSAS, 85 patients with moderate OSAS and 82 patients with severe OSAS were included in the study. There were no significant differences between the groups in terms of age, BMI or thyroid function test results. Initial IELT and AIPE scores were significantly higher in the control group compared with the OSAS groups (for the IELT, 155.63 ± 98.78 vs 96.23 ± 60.60 and 62.86 ± 40.49; for the AIPE 26.18 ± 3.88 vs 18.71 ± 3.43 and 17.85 ± 3.83). Compared with initial (pretreatment) values, both scores improved significantly in both OSAS groups after 1 year of CPAP therapy (in moderate OSAS group, 96.23 ± 60.60 vs 134.17 ± 83.43 and 18.71 ± 3.43 vs 23.25 ± 3.43 and severe OSAS group 62.86 ± 40.49 vs 112.25 ± 71.58 and 17.85 ± 3.83 vs 24.18 ± 3.53). Conclusion For the first time in literature, we determined that the presence of OSAS was associated with significantly worse IELT and AIPE scores in males with PE, and the treatment of OSAS was related to the significant improvements in both scores, in the absence of any specific treatments for PE.

Background Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular events. The influence of continuous positive airway pressure (CPAP) on cardiac function remains uncertain. Purpose To prospectively determine the effects of CPAP on cardiovascular function, as measured by cardiac magnetic resonance imaging (CMR) as a sub-study of the international SAVE trial (NCT00738179). Methods Participants with OSA and established cardiovascular disease were randomized to CPAP treatment plus usual cardiovascular care or Usual Care alone. Primary outcomes were defined as change in ventricular ejection fraction (EF) and stroke volume (SV) between baseline and 6-month follow-up both groups. Secondary outcomes included other ventricular parameters including volumes, mass, and strain, and atrial parameters. Results 140 participants were included; mean CPAP adherence in those allocated to receive the treatment was 4.31±2.45 hours per night. Most were male (91%) and had moderate-severe OSA with minimal daytime sleepiness. There were no significant differences in left or right ventricular EF between groups after 6 months of treatment. There was an 8.5 mL increase in LV SV (95% CI; [4.3–12.6], p Conclusions In the first prospective CMR imaging study of patients with OSA and cardiovascular disease, CPAP treatment did not change EF after 6 months, but did have significant effects on other parameters of cardiac function. Funding Acknowledgement Type of funding source: Other. Main funding source(s): Respironics Foundation; Australian National Health and Medical Research; New Zealand Health Research Council

Background: The efficacy of CPAP at the mildest end of the OSA spectrum is unclear. The MERGE trial investigated the effect of CPAP on quality of life in patients with mild OSA (Wimms et al. 2019). This subset analysis aimed to determine the effectiveness of CPAP in a subset of patients with ‘very9 mild OSA, defined as having mild OSA according to the sensitive AASM 2012 criteria, but no OSA using the earlier AASM 2007 criteria (i.e. AHI >5 to Methods: The MERGE trial randomised patients with mild OSA (AHI >5 to ≤15 events/hr, AASM 2007 or 2012) in parallel to receive either CPAP plus Standard Care or Standard Care alone for 3 months. A subset of 95 of 301 patients were identified as having ‘very9 mild OSA. Results: The subset of 95 ‘very9 mild OSA patients had a median (IQR) AHI 6.80(5.7, 8.8) events/hr, and were symptomatic (Vitality 41.9(10.9); ESS 10.3(4.7)). 50 of 95 were allocated to CPAP, and 45 to Standard Care. ‘Very9 mild OSA patients had significantly improved Vitality after 3 months of CPAP, compared to Standard Care (+9.2 points, 95% CI +5.6 to +12.7; p Conclusions: This subset analysis has shown the clinical effectiveness of CPAP treatment in patients at the mildest end of the disease spectrum, with 9very9 mild but symptomatic OSA. The results were similar to those observed in the primary analysis of the MERGE trial.

Introduction: Obstructive sleep apnea (OSA) seems to be associated with an increased rate of cardiovascular events and greater mortality. The objective of this study was to assess the effect of OSA and its treatment with continuous positive airway pressure (CPAP) on cardio and cerebrovascular morbimortality. Methods: Prospective study between 1993 and 1995 in which 1050 men aged 30 to 70 years old of the general population from Vitoria-Gasteiz were included. Clinical data were collected and a respiratory poligraphy was performed at the beginning and end of the study. Kaplan-Meier and Cox regression models were used. Results: Of the 1050 subjects [median age 48.0 (17.0), BMI 25.9 (4.0), AHI 6.0 (10.0)] follow-up data were obtained in 1014 men after a median of 269,0 (10,0) months [median age 69.0 (16.4), BMI 27.5 (3.9), AHI 19.0 (18.0)]. 59,2% of them had an AHI ≥ 5/h at baseline, and up to 95,8% of them at the end of the study. At the end there had been 196 (19.3%) deaths, 57 (6.0%) episodes of cerebrovascular disease and 220 (23.0%) of cardiovascular disease. Analysis showed no significant association between cardio-cerebrovascular events and OSA detected in the baseline study (p=0,212). Mortality was significantly increased in the OSA at baseline group compared with non OSA/CPAP treated patients, both in mild [HR 1,61 (1,14-2,27), p=0,007)] and in moderate-severe [HR 1,82 (1,23-2,68), p=0,003] OSA groups. Main mortality cause was cancer (50%). Conclusion: OSA prevalence significantly increases after 20 years of follow up. Non-treated OSA is associated with greater mortality.

Introduction: Telemonitoring systems could play an important role in the treatment of the Obstructive Sleep Apnea Syndrome. The principal aim of this research is to describe the characteristics of patients under CPAP treatment (telematic and conventional follow-up) and to compare the satisfaction in both groups. The second aim is to evaluate the patient's dropout Methods: Prospective single-blind randomized study. Patients who started using a CPAP were randomized to conventional o telematic treatment. The inclusion period was a year and the follow up, 6 months. Patients were asked about symptomatic and quality of life improvement using the CSQ 8 questionnaire. Results: 84 patients were recruited. 53 were men(63%) and 31 women(37%). Characteristics of the analyzed population are shown in Table 1. In the conventional group 95% patients completed the follow up period, while in the telematic one 85%. Patient satisfaction was measured using the CSQ8 questionnaire and the average score in both groups was 28.6. 95% and 91% of the patients in the conventional and telematic group found an improvement in their symptoms respectively. 85% in both groups described an improvement in their quality of life and almost 50% in social relationship Conclusions: Patients undergoing treatment with telematic follow-up also have perception of satisfaction and overall improvement of symptoms (as those with face-to-face visits) Sin financiación 16.671 JCR (2020) Q1, 3/64 Respiratory System 4.021 SJR (2020) Q1, 46/2446 Medicine (miscellaneous) No data IDR 2020 UEM

Background: Enhanced levels of vascular adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) have been associated with obstructive sleep apnoea (OSA). Impact of continuous positive airway pressure (CPAP) treatment on VCAM-1 and ICAM-1 levels in coronary artery disease (CAD) patients with OSA is unclear. Aims and Objectives: We aimed to evaluate whether CPAP therapy would reduce VCAM-1 and ICAM-1 after one year in a revascularized CAD cohort. Methods: This was one of the secondary outcomes of the RICCADSA trial, conducted in Sweden between 2005 and 2013. In all, 210 adults with nonsleepy OSA (apnea-hypopnea index ≥15/h, and Epworth Sleepiness Scale Results: Median VCAM-1 decreased from 1055 to 979 ng/ml (p=0.02) in CPAP group, and from 1062 to 1034 ng/ml (p=0.95) in no-CPAP group. Similarly, median ICAM-1 reduced from 152 to 115 ng/ml (p Conclusions: There was a natural decrease in the VCAM-1 and ICAM-1 values after one year in this CAD cohort with OSA. The magnitude of the decline was associated with increasing CPAP usage. Clinical trial registrationNCT00519597

This review will focus on non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP) therapy in children with obstructive sleep apnea (OSA) due to obesity and underlying syndromes. These children have a high prevalence of OSA and residual OSA after adenotonsillectomy. Therefore, a high proportion of these children are treated with CPAP or NIV. This review will focus on treatment selection tools and will subsequently cover specific issues on CPAP treatment in obese and syndromic children with a major focus on Down syndrome.

Weight loss, continuous positive airway pressure (CPAP) and positional therapy (PT) are important treatments in obstructive sleep apnea (OSA). Although all of these reduce the apnea-hypopnea index (AHI) effectively, the benefits of these treatments have not been thoroughly investigated in a patient-specific manner. Therefore, clinicians do not have objective means to choose an optimal treatment for each patient. We aim to provide clinicians the possibility for treatment optimization in a patient-specific manner by introducing a computational simulation approach. The effect of actual weight change, computationally simulated CPAP treatment and PT and their combinations on the AHI were compared in 54 OSA patients divided into three equally sized groups (weight loss 7%, weight loss 0%-7%, and weight gain) after a 5-year follow-up with lifestyle intervention. Weight loss reduced the AHI by 43.5% (p .05) and 18%, simulated CPAP treatment with 3.3-hr adherence by 42.4% (p .05) and 35.5% (p .05), and simulated PT by 13.5% (p .05) and 30.7% (p .05) in 7% and 0%-7% weight loss groups, respectively. Simulated CPAP treatment and PT were able to compensate for the increase in the AHI caused by weight gain. A developed simulation approach could help clinicians to estimate treatment success in advance in order to prescribe the most optimal patient-specific treatment to reduce OSA-related health risks.

This work is aimed at evaluating the therapeutic effect of continuous positive airway pressure (CPAP) in treatment of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) combined with arrhythmias as well as clarifying the possible mechanism underpinning such an intervention.Through exclusions, a total of 108 OSAHS patients combined with arrhythmias were enrolled from June 2017 to June 2019 with full clinical information in this work. A computerized permuted block design with varying block stratification and size according to age, sex, AHI and type of arrhythmia was used to randomize 108 patients to CPAP versus sham CPAP for a period of 12-week. All were subjected to unchanged pharmacological anti-arrhythmia therapy combined with CPAP. Before and after CPAP treatment, the improvement of various arrhythmias was compared between the CPAP group and the sham-CPAP group. The levels of CRP, IL-6 and TNF-ɑ were measured simultaneously.During follow-up, the mean (±SD) CPAP pressure used in the CPAP group was 12.3 (±3.1) cm H2O. The use of CPAP and sham CPAP was on average of 5.2 ± 0.56 and 5.1 ± 0.63 h/night, respectively. After 12 weeks of CPAP therapy, the AHI was significantly decreased and the lowest blood oxygen saturation was notably elevated in the CPAP group compared to the sham-CPAP group, P 0.05. The CPAP therapy, compared with the sham-CPAP group, significantly reduced the incidence of all types of arrhythmia in patients with OSAHS. The level of the c-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) was significantly lower in the CPAP group than in the sham-CPAP group (P 0.05). Pearson correlation analysis showed that the reduction in the incidence of total arrhythmias was positively correlated with the decrease of CRP, IL-6 and TNF-ɑ levels, respectively.Findings from this work suggest that proper use of CPAP significantly benefits to OSAHS patients combined with arrhythmias, possibly via counteracting the inflammation.