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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.

Dissertação de Mestrado em Gestão e Economia da Saúde apresentada à Faculdade de Economia A Síndrome de Apneia Obstrutiva do Sono (SAOS) é um distúrbio respiratório, de prevalência em crescendo. A SAOS está associada a elevado risco cardiovascular e a pobre Qualidade de Vida (QV). O tratamento gold-standard é o Continuous Positive Airway Pressure (CPAP), contudo os seus efeitos ao nível da QV ainda não se encontram completamente conhecidos.O objetivo do presente estudo foi avaliar a QV e a Sonolência Diurna Excessiva (SDE) em doentes com SAOS, sob tratamento com CPAP.O tipo de estudo foi observacional, descritivo e transversal. A amostra foi constituída por 158 doentes com diagnóstico de SAOS e sob tratamento desde o ano de 2019 no Centro Hospitalar de Leiria. Para avaliar o impacto do tratamento foi avaliada a SDE através da Escala de Sonolência de Epworth (ESE) e a QV através do questionário EQ-5D-5L.A amostra foi maioritariamente constituída por doentes do sexo masculino (67,7%) e com idade média de 63 anos. Tratou-se de uma população com múltiplos fatores de risco cardiovasculares, como a obesidade (IMC = 31,6 ± 4,6 kg/m2) e a hipertensão arterial (66,5%), e com várias patologias conhecidas. O Índice de Apneia-Hipopneia (IAH) médio prévio ao uso do CPAP era de 30,7 ± 19,1 eventos/hora. Todos os doentes se encontravam aderentes e bem-adaptados ao CPAP, com compliance de 88,9 ± 14,9% e utilização média de 6,1 ± 2,1 horas. Após o tratamento, a média da ESE passou de 9,1 ± 5,5 para 4,6 ± 4,2. A QV média avaliada foi de 0,78 ± 0,2, com mais problemas moderados a graves nas dimensões Mobilidade, Dor/Mal-Estar e Ansiedade/Depressão, e com as mulheres a apresentarem pior QV (p < 0,001). Verificou-se que quanto maior a idade pior a autoavaliação do estado de saúde (EQ-VAS), com p = 0,047. A QV encontrou-se negativamente associada às várias doenças conhecidas e aos fatores de risco cardiovasculares. A gravidade da SAOS, determinada pelo IAH e pelos restantes índices de PSG não se mostrou relacionada com a QV. A SDE e a QV encontram-se negativamente relacionadas (p = 0,01). A compliance ao CPAP encontra-se positivamente relacionada com a EQ-VAS (p = 0,05).Os doentes com SAOS, mesmo sob tratamento, apresentaram pobre QV. Tal deve-se ao impacto da SDE e ao fato de serem doentes com múltiplas patologias associadas. As mulheres apresentam pior QV, com mais SDE, e com possível associação a insónia e a ansiedade/depressão. A avaliação dos sintomas relativos à SAOS mostrou-se assim fundamental na apreciação dos resultados de um tratamento. Por fim, verificou-se que a QV não se apresentou relacionada com a gravidade da SAOS.Face aos nossos resultados a avaliação da QV mostrou-se essencial nesta população. Para tal, é necessários que os centros de medicina sono estejam sensibilizados para esta realidade e munidos dos instrumentos que permitem medir a QV, sejam eles questionários genéricos ou específicos da doença. Assim como a aplicação da ESE é uma medição fulcral nas várias fases da doença, mas em particular na avaliação da eficácia terapêutica.No início do tratamento com CPAP é fundamental desmistificar o ventilador e ter um acompanhamento apertado, para que o doente se sinta confortável, tanto a nível físico como psicológico. The Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory disorder, with increasing prevalence. OSAS is associated with high cardiovascular risk and poor Quality of Life (QoL). The gold-standard treatment is Continuous Positive Airway Pressure (CPAP), however its effects on QoL are not yet fully known.The aim of the present study was to evaluate QoL and Excessive Daytime Sleepiness (EDS) in patients with OSAS undergoing CPAP treatment.The type of study used was observational, descriptive and cross-sectional. The sample consisted of 158 patients diagnosed with OSAS and undergoing treatment since 2019 at the Leiria Hospital Center. To assess the impact of treatment, EDS was assessed using the Epworth Sleepiness Scale (ESS) and QoL using the EQ-5D-5L questionnaire.The sample consisted mostly by male patients (67.7%) with a average age of 63 years. It was a population with multiple cardiovascular risk factors, such as obesity (BMI = 31.6 ± 4.6 kg/m2) and arterial hypertension (66.5%), and with several known pathologies. The mean Apnea-Hypopnea Index (AHI) prior to the use of CPAP was 30.7 ± 19.1 events/hour. All patients were adherent and well-adapted to CPAP, with a compliance of 88.9 ± 14.9% and a mean use of 6.1 ± 2.1 hours. After treatment, the average ESS changed from 9.1 ± 5.5 to 4.6 ± 4.2. The mean QoL assessed was 0.78 ± 0.2, with more moderate to severe problems in the dimensions of Mobility, Pain/Illness and Anxiety/Depression, and women presenting worse QoL (p

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.