Continuous Positive Airway Pressure Treatment of Mild to Moderate Obstructive Sleep Apnea Reduces Cardiovascular Risk

Büchner, Nikolaus; Sanner, Bernd; Börgel, Jan; Rump, Lars Christian

doi:10.1164/rccm.200611-1588oc

Cited by 272 publications

(220 citation statements)

References 45 publications

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“…Continuous positive airway pressure (CPAP) is the primary treatment for obstructive sleep apnea (OSA) and has been proven to improve outcomes such as daytime sleepiness, cognitive performance, blood pressure, glucose control, cardiovascular status, quality of life and mortality [1][2][3][4][5][6] . Treatment efficacy is however limited by variable adherence.…”

Section: Introductionmentioning

confidence: 99%

Acceptance and Adherence to Continuous Positive Airway Pressure Therapy in patients with Obstructive Sleep Apnea (OSA) in a Southeast Asian privately funded healthcare system

Lee¹,

Leow²,

Song³

et al. 2017

Sleep Sci

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Background: There is limited data on long term Continuous Positive Airway Pressure (CPAP) adherence in Southeast Asian countries. This is a prospective study on CPAP adherence among Obstructive sleep apnea (OSA) patients in a Southeast Asian privately funded healthcare system. Methods: Patients with moderate-severe OSA who had been initiated on CPAP at least one year previously were contacted for a scripted telephone interview to assess compliance and factors associated with CPAP adherence. Results: Of 135 consecutive patients diagnosed to have moderate to severe OSA, 78 (57.8%) were initiated on CPAP treatment while 57 (42.2%) rejected CPAP upfront. 41 (52.6%) who initiated CPAP remained adherent at one year. OSA severity (AHI, ODI) and symptomatic improvement after CPAP were associated with better adherence. Presence of machine related side effects was associated with lower adherence. Inconvenience, cost and poor disease perception were reported as major barriers to uptake of CPAP therapy. Conclusions: In this Southeast Asian privately funded healthcare system, almost half of all patients with significant OSA rejected CPAP treatment upfront, but adherence among those who started CPAP is comparable to other reports. Challenges with CPAP acceptance as well as CPAP adherence need to be addressed to improve outcomes.

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Section: Introductionmentioning

confidence: 99%

Acceptance and Adherence to Continuous Positive Airway Pressure Therapy in patients with Obstructive Sleep Apnea (OSA) in a Southeast Asian privately funded healthcare system

Lee¹,

Leow²,

Song³

et al. 2017

Sleep Sci

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“…Continuous positive airway pressure (CPAP) is the treatment of choice for OSA (19)(20)(21)(22). CPAP has been shown to improve sleep architecture, decrease risk of MVAs (33)(34)(35), improve quality of life (23,36), and decrease neurocognitive and cardiovascular consequences associated with OSA (12,22,(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47). Several consensus statements have examined the efficacy of CPAP in the treatment of OSA (22,47,48).…”

Section: Introductionmentioning

confidence: 99%

An Official American Thoracic Society Statement: Continuous Positive Airway Pressure Adherence Tracking Systems. The Optimal Monitoring Strategies and Outcome Measures in Adults

Schwab

Badr

Epstein

et al. 2013

Am J Respir Crit Care Med

248

196

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Background: Continuous positive airway pressure (CPAP) is considered the treatment of choice for obstructive sleep apnea (OSA), and studies have shown that there is a correlation between patient adherence and treatment outcomes. Newer CPAP machines can track adherence, hours of use, mask leak, and residual apnea-hypopnea index (AHI). Such data provide a strong platform to examine OSA outcomes in a chronic disease management model. However, there are no standards for capturing CPAP adherence data, scoring flow signals, or measuring mask leak, or for how clinicians should use these data. Methods: American Thoracic Society (ATS) committee members were invited, based on their expertise in OSA and CPAP monitoring. Their conclusions were based on both empirical evidence identified by a comprehensive literature review and clinical experience. Results: CPAP usage can be reliably determined from CPAP tracking systems, but the residual events (apnea/hypopnea) and leak data are not as easy to interpret as CPAP usage and the definitions of these parameters differ among CPAP manufacturers. Nonetheless, ends of the spectrum (very high or low values for residual events or mask leak) appear to be clinically meaningful. Conclusions: Providers need to understand how to interpret CPAP adherence tracking data. CPAP tracking systems are able to reliably track CPAP adherence. Nomenclature on the CPAP adherence tracking reports needs to be standardized between manufacturers and AHI Flow should be used to describe residual events. Studies should be performed examining the usefulness of the CPAP tracking systems and how these systems affect OSA outcomes.Keywords: CPAP adherence; sleep apnea; CPAP tracking systems EXECUTIVE SUMMARYObstructive sleep apnea (OSA) is an extremely common condition and is associated with significant morbidity and mortality (1-18). Optimal treatment of sleep apnea is critical because sleepdisordered breathing is associated with the increased risk of vehicular crashes and cardiovascular morbidity and mortality (6, 9-18). Continuous positive airway pressure (CPAP) is the treatment of choice for sleep apnea (19)(20)(21)(22). Increased CPAP adherence has been shown to improve outcomes such as daytime sleepiness, quality of life, and mortality (23-25). OSA should be considered in a chronic disease management model in which CPAP adherence is tracked over time. To assess CPAP adherence and efficacy, tracking systems have been implemented. Such systems monitor CPAP efficacy (residual sleep-disordered breathing), hours of CPAP use, mask leak, and a number of different flow signals. However, there are no standards on how to use the data from these new CPAP tracking systems nor do we have evidence that these systems ultimately improve outcomes. See the online supplement for full discussion of the literature on the accuracy of the residual AHI and mask leak.The purpose of this document is to (1) review the data (adherence, leak, efficacy, flow signals) obtained from CPAP adherence tracking systems and the reliability of th...

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“…Buchner et al 13 for example, showed that CPAP treatment of patients with OSA had reduced risk of cardiovascular event (non-fatal MI, acute coronary syndrome with revascularization, death because of MI ) by 64% in a group of 449 patients independent of age and coincident co-morbidities. In a similar fashion, Marin et al 14 described an increase in fatal events (OD 2.87) and nonfatal events in patients with untreated OSA.…”

Section: Discussionmentioning

confidence: 99%

Complicated Course of Ischemic Heart Disease in a Patient With Obstructive Sleep Apnea

Sovová¹,

Sova²,

Hobzová³

et al. 2011

BIOMED PAP

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Continuous Positive Airway Pressure Treatment of Mild to Moderate Obstructive Sleep Apnea Reduces Cardiovascular Risk

Abstract: OSA treatment was associated with a cardiovascular risk reduction of 64% independent from age and preexisting cardiovascular comorbidities. OSA treatment should be considered for primary and secondary cardiovascular prevention, even in milder OSA.

Cited by 272 publications

References 45 publications

Acceptance and Adherence to Continuous Positive Airway Pressure Therapy in patients with Obstructive Sleep Apnea (OSA) in a Southeast Asian privately funded healthcare system

Acceptance and Adherence to Continuous Positive Airway Pressure Therapy in patients with Obstructive Sleep Apnea (OSA) in a Southeast Asian privately funded healthcare system

An Official American Thoracic Society Statement: Continuous Positive Airway Pressure Adherence Tracking Systems. The Optimal Monitoring Strategies and Outcome Measures in Adults

Complicated Course of Ischemic Heart Disease in a Patient With Obstructive Sleep Apnea

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