Search

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) has been associated with cardiovascular events (CVEs), although recent randomized controlled trials have not demonstrated that long-term continuous positive airway pressure (CPAP) prevents CVEs. Our objective was to determine the effect of CPAP on older adults with moderate OSA regarding CVE reduction. METHODS: An observational and multicenter study of a cohort of older adults (> 70 years of age) diagnosed with moderate OSA (apnea-hypopnea index 15.0–29.9 events/h) was conducted. Two groups were formed: (1) CPAP treatment and (2) standard of care. The primary endpoint was CVE occurrence after OSA diagnosis. Association with CPAP treatment was assessed by propensity score matching and inverse weighting probability. Secondary endpoints were incidence of CVE separately and time to first CVE. RESULTS: A total of 614 patients were included. After matching, 236 older adults (111 men, mean age 75.9 ± 4.7 years) with a follow-up of 47 months (interquartile range: 29.6–64.0 months) were considered for primary and secondary endpoint evaluations. Forty-one patients presented at least 1 CVE (17.4%): 20 were in the standard-of-care group (16.9%) and 21 were in the CPAP group (17.8%), with a relative risk of 1.05 (95% confidence interval [CI], 0.60–1.83; P = .43) for CPAP treatment. Inverse probability weighting of the initial 614 patients determined an adjusted relative risk of 1.24 (95% CI, 0.79–1.96; P = .35) for CPAP treatment. No statistical differences were found in secondary endpoint analyses. CONCLUSIONS: CPAP should not be prescribed to reduce CVE probability in older adults with moderate OSA. CITATION: López-Padilla D, Terán-Tinedo J, Cerezo-Lajas A, et al. Moderate obstructive sleep apnea and cardiovascular outcomes in older adults: a propensity score–matched multicenter study (CPAGE-MODE study). J Clin Sleep Med. 2022;18(2):553–561.

Introduction : There is limited information describing features and outcomes of patients requiring Intermediate Respiratory Care Unit (IRCU) hospitalization for COVID19 disease and as of yet, no mechanical or medical treatments have clearly demonstrated efficacy in IRCU. Methods : Demographics and clinical variables on admission, as well as medical and mechanical therapeutic interventions, were extracted from Electronic Clinical Records in 274 SARS-CoV-2 infected patients attending a third level hospital IRCU. Using multivariate logistic regression analysis, variables that best discriminated mortality were obtained. Principal components analysis and a neural network (NN) algorithm were applied. Results : In relation to respiratory support, high-flow oxygen therapy and weaning procedures were associated with survival as were CPAP and non-invasive ventilation with low levels of support among the most severely affected. The IRCU achieved a survival rate of 87.6%, avoided 178 ICU admissions, successfully referred 35% to the ICU, and of these, 94% later survived the weaning phase. Higher mortality incidence was associated with cardiac and respiratory diseases and fever, heart rhythm and blood pressure disturbances. Following analysis of specific therapeutic options Corticoids and Anticoagulants were associated with better outcomes. Conclusions : The IRCU prevented the collapse of the ICU, allowed for recovered ICU patients to be quickly released from their unit, thus freeing up critical care beds and permitting them to function more effectively and in terms of mortality, achieved good results, that did not worsen due to a possible delay in intubation. In addition, we have generated an open-access NN capable of identifying severity predictors of SARS-CoV-2.

Introduction: Our Intermediate Respiratory Care Unit (IRCU) follows a mechanical ventilation weaning and decannulation protocol, in which a tracheal hemi-cannula is placed in most patients. The results of our protocol over a ten-year period (2007 to 2017) were analysed, demonstrating the benefits of tracheal hemi-cannula placement, avoiding reintubations and Intensive Care Unit (ICU) readmissions, thus achieving a decrease in mortality. Material and Methods: A retrospective study was conducted including all the tracheostomised patients discharged from the ICU that were admitted to our IRCU. Risk factors for tracheal hemi-cannula use were analysed, including variables such as: SAPS II, age, days of ICU stay, presence of polyneuropathy and the presence of multi-organic failure. Results: During the ten-year period, 307 patients were admitted to the IRCU. In 252 patients (82,1%), a tracheal hemi-cannula was placed, while 55 patients were decannulated without the use of this device. Overall mortality was 17.5% (54 patients). 41 patients (13% of the total) who underwent decannulation with a tracheal hemi-cannula required urgent recannulation. Of these recannulated patients, 36 (79%) survived and 5 (21%) died. Conclusions: The tracheal hemi-cannula is a useful tool in the weaning of complicated patients that allows recannulation if necessary, avoiding 13% of reintubations and re-admissions in the ICU. Mortality of tracheostomised patients in our IRCU weaning and decannulation program was 17.5%, which is lower than similar Spanish and European series.