RationaleIn obstructive sleep apnea patients (OSA), continuous positive airway pressure (CPAP) adherence is crucial to improve symptoms and cardiometabolic outcomes. The choice of mask may influence CPAP adherence but this issue has never been addressed properly.ObjectiveTo evaluate the impact of nasal pillows, nasal and oronasal masks on CPAP adherence in a cohort of OSA.MethodsNewly CPAP treated OSA participating in “Observatoire Sommeil de la Fédération de Pneumologie”, a French national prospective cohort, were included between March 2009 and December 2011. Anthropometric data, medical history, OSA severity, sleepiness, depressive status, treatment modalities (auto-CPAP versus fixed pressure, pressure level, interface type, use of humidifiers) and CPAP-related side effects were included in multivariate analysis to determine independent variables associated with CPAP adherence.Results2311 OSA (age = 57(12) years, apnea+hypopnea index = 41(21)/h, 29% female) were included. Nasal masks, oronasal masks and nasal pillows were used by 62.4, 26.2 and 11.4% of the patients, respectively. In univariate analysis, oronasal masks and nasal pillows were associated with higher risk of CPAP non-adherence. CPAP non-adherence was also associated with younger age, female gender, mild OSA, gastroesophageal reflux, depression status, low effective pressure and CPAP-related side effects. In multivariate analysis, CPAP non-adherence was associated with the use of oronasal masks (OR = 2.0; 95%CI = 1.6; 2.5), depression, low effective pressure, and side effects.ConclusionAs oronasal masks negatively impact on CPAP adherence, a nasal mask should be preferred as the first option. Patients on oronasal masks should be carefully followed.
BackgroundThe classification of obstructive sleep apnea is on the basis of sleep study criteria that may not adequately capture disease heterogeneity. Improved phenotyping may improve prognosis prediction and help select therapeutic strategies. Objectives: This study used cluster analysis to investigate the clinical clusters of obstructive sleep apnea.MethodsAn ascending hierarchical cluster analysis was performed on baseline symptoms, physical examination, risk factor exposure and co-morbidities from 18,263 participants in the OSFP (French national registry of sleep apnea). The probability for criteria to be associated with a given cluster was assessed using odds ratios, determined by univariate logistic regression. Results: Six clusters were identified, in which patients varied considerably in age, sex, symptoms, obesity, co-morbidities and environmental risk factors. The main significant differences between clusters were minimally symptomatic versus sleepy obstructive sleep apnea patients, lean versus obese, and among obese patients different combinations of co-morbidities and environmental risk factors.ConclusionsOur cluster analysis identified six distinct clusters of obstructive sleep apnea. Our findings underscore the high degree of heterogeneity that exists within obstructive sleep apnea patients regarding clinical presentation, risk factors and consequences. This may help in both research and clinical practice for validating new prevention programs, in diagnosis and in decisions regarding therapeutic strategies.
Characterization of the interaction of water with the highly ordered mesoporous solid MCM-41 (pore diameter -2.5 nm) is undertaken with the aid of several techniques (adsorption gravimetry, X-ray diffraction, Fourier transform infrared spectroscopy, and controlled rate-evolved gas analysis). The relatively complex water-MCM-41 interactions are characterized by a type V isotherm indicating an initial repulsive character followed by a capillary condensation step of the adsorbate. This highlights both hydrophobic and hydrophilic properties of this potential model mesoporous adsorbent
Methane and krypton adsorption measured on single-walled nanotubes at 78.7 and 77.3 K, respectively, give rise to stepwise isotherms, representative of the adsorption on two types of comparatively uniform patches during the first stages of the adsorbate condensation. The values of the methane isosteric heat of adsorption on these two fractions of quasi-uniform surface, determined from the dependence of the equilibrium pressure on temperature between 78 and 110 K, are in very good agreement with those measured at 77.3 K by means of isothermal microcalorimetry in quasi-equilibrium. Their respective mean values (18.3 ± 1 and 11.2 ± 0.5 kJ mol-1) enclose that of methane adsorption on graphite in the monolayer range (14.9 kJ mol-1). A phase transition occurring in the adsorbed film on the less attractive quasi-uniform part of the surface can be predicted from volumetric measurements.
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