Objective Measurement of Patterns of Nasal CPAP Use by Patients with Obstructive Sleep Apnea

Kribbs, Nancy Barone; Pack, Allan I.; Kline, Lewis R.; Smith, Philip L.; Schwartz, Alan R.; Schubert, Norman; Redline, Susan; Henry, John N.; Getsy, Joanne; Dinges, David F.

doi:10.1164/ajrccm/147.4.887

Cited by 1,192 publications

(887 citation statements)

References 18 publications

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“…Despite improvements in nCPAP devices, long-term compliance in patients under nCPAP therapy has varied from 45 to 90% [15][16][17][18][19]. There are many reasons why patients may not tolerate nCPAP.…”

Section: Discussionmentioning

confidence: 99%

“…There are many reasons why patients may not tolerate nCPAP. A number of minor side-effects related to a fixed high level of nasal pressure [3] have been reported, including: discomfort due to the mask; rib cage discomfort; difficulty in breathing against the machine; soreness and/or dryness of the nose, mouth or throat; nasal congestion; and poor sleep due to mask leaks and noise generated by the device [15][16][17][18][19]. To reduce the overnight mean nasal pressure value, new nCPAP devices that automatically and rapidly adjust the pressure to the minimal effective level have recently been developed.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of an auto-nCPAP device based on snoring detection

Lofaso¹,

Lorino²,

Duizabo³

et al. 1996

Eur Respir J

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E Ev va al lu ua at ti io on n o of f a an n a au ut to o--n nC CP PA AP P d de ev vi ic ce e b ba as se ed d o onWe observed that a single night of auto-nCPAP improved the apnoea/hypnoea index (AHI) (12±21 vs 51±31 disordered breathing events·h -1 of sleep (mean±SD)), the awakening-arousal index (13±20 vs 40±26 arousals·h -1 of sleep), and duration of slow wave sleep (102±49 vs 71±56 min) but not of rapid eye movement (REM) sleep (55±31 vs 64±38 min). Auto-nCPAP was effective (apnoea/hypopnoea and arousal indices <10 events·h -1 ) in all but three patients. Auto-nCPAP was ineffective in one patient, whose obstructive respiratory events were not preceded by nasal mask pressure vibration detection, and in two patients who were quasi-permanent mouth breathers.Snoring detection may be effective in sleep apnoea syndrome with heavy snoring and without permanent mouth breathing, during the first night of nasal continuous positive airway pressure treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of an auto-nCPAP device based on snoring detection

Lofaso¹,

Lorino²,

Duizabo³

et al. 1996

Eur Respir J

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“…Nasal continuous positive airway pressure remains the mainstay of treatment for moderate to severe obstructive sleep apnea (7). Difficulties adhering to therapy can limit its effectiveness in the home setting (8,9), and alternatives have been generally less effective in relieving upper airway obstruction during sleep (10)(11)(12).…”

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confidence: 99%

Acute Upper Airway Responses to Hypoglossal Nerve Stimulation during Sleep in Obstructive Sleep Apnea

Schwartz

Barnes

Hillman

et al. 2012

Am J Respir Crit Care Med

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Rationale: Hypoglossal nerve stimulation (HGNS) recruits lingual muscles, reduces pharyngeal collapsibility, and treats sleep apnea. Objectives: We hypothesized that graded increases in HGNS relieve pharyngeal obstruction progressively during sleep. Methods: Responses were examined in 30 patients with sleep apnea who were implanted with an HGNS system. Current (milliampere) was increased stepwise during non-REM sleep. Frequency and pulse width were fixed. At each current level, stimulation was applied on alternating breaths, and responses in maximal inspiratory airflow (V I max) and inspiratory airflow limitation (IFL) were assessed. Pharyngeal responses to HGNS were characterized by the current levels at which V I max first increased and peaked (flow capture and peak flow thresholds), and by the V I max increase from flow capture to peak (DV I max). Measurements and Main Results: HGNS produced linear increases in V I max from unstimulated levels at flow capture to peak flow thresholds (215 6 21 to 509 6 37 ml/s; mean 6 SE; P , 0.001) with increasing current from 1.05 6 0.09 to 1.46 6 0.11 mA. V I max increased in all patients and IFL was abolished in 57% of patients (non-IFL subgroup). In the non-IFL compared with IFL subgroup, the flow response slope was greater (1241 6 199 vs. 674 6 166 ml/s/mA; P , 0.05) and the stimulation amplitude at peak flow was lower (1.23 6 0.10 vs. 1.80 6 0.20 mA; P , 0.05) without differences in peak flow. Conclusions: HGNS produced marked dose-related increases in airflow without arousing patients from sleep. Increases in airflow were of sufficient magnitude to eliminate IFL in most patients and IFL and non-IFL subgroups achieved normal or near-normal levels of flow, suggesting potential HGNS efficacy across a broad range of sleep apnea severity.Keywords: obstructive sleep apnea; electrical hypoglossal nerve stimulation; pharynx; upper airway; titration Obstructive sleep apnea is characterized by recurrent episodes of upper airway obstruction during sleep (1). Airflow obstruction is thought to result from decreases in pharyngeal neuromuscular activity at sleep onset (2). These episodes lead to intermittent hypoxemia and recurrent arousals from sleep, accounting for the long-term neurocognitive (3, 4), metabolic (5), and cardiovascular (6) sequelae of this disorder. Nasal continuous positive airway pressure remains the mainstay of treatment for moderate to severe obstructive sleep apnea (7). Difficulties adhering to therapy can limit its effectiveness in the home setting (8, 9), and alternatives have been generally less effective in relieving upper airway obstruction during sleep (10-12).Hypoglossal nerve stimulation (HGNS) has been piloted as treatment for obstructive sleep apnea (13). Implantable HGNS systems have been developed to stimulate the hypoglossal nerve during inspiration, and recruit the lingual musculature, leading to decreases in pharyngeal collapsibility during sleep (14-17). Motor activity protrudes the tongue, and mitigates airflow obstruction during sleep (18,19)....

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“…Although treatment of OSA with nCPAP is effective when the prescribed pressures are tolerated and present throughout the night, sub-optimal adherence and effectiveness are common 4, 5 . In this context, a pharmacotherapy for OSA may be viewed in the first instance as a useful adjunct to help improve upper airway stability and/or stabilize breathing.…”

Section: Introductionmentioning

confidence: 99%

A resource of potential drug targets and strategic decision‐making for obstructive sleep apnoea pharmacotherapy

2017

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There is currently no pharmacotherapy for OSA, but there is no principled a-priori reason why there shouldn’t be one. This review identifies a rational decision-making strategy with the necessary logical underpinnings that any reasonable approach would be expected to navigate to develop a viable pharmacotherapy for OSA. The process first involves phenotyping an individual to quantify and characterize the critical predisposing factor(s) to their OSA pathogenesis and identify, a-priori, if the patient is likely to benefit from a pharmacotherapy that targets those factors. We then identify rational strategies to manipulate those critical predisposing factor(s), and the barriers that have to be overcome for success of any OSA pharmacotherapy. A new analysis then identifies candidate drug targets to manipulate the upper airway motor circuitry for OSA pharmacotherapy. The first conclusion is that there are two general pharmacological approaches for OSA treatment that are of most potential benefit and are practically realistic, one being fairly intuitive but the second perhaps less so. The second conclusion is that after identifying the critical physiological obstacles to OSA pharmacotherapy, there are current therapeutic targets of high interest for future development. The final analysis provides a tabulated resource of “druggable” targets that are relatively restricted to the circuitry controlling the upper airway musculature, with these candidate targets being of high priority for screening and further study. We also emphasize that a pharmacotherapy may not cure OSA per se, but may still be a useful adjunct to improve the effectiveness of, and adherence to, other treatment mainstays.

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Objective Measurement of Patterns of Nasal CPAP Use by Patients with Obstructive Sleep Apnea

Cited by 1,192 publications

References 18 publications

Evaluation of an auto-nCPAP device based on snoring detection

Evaluation of an auto-nCPAP device based on snoring detection

Acute Upper Airway Responses to Hypoglossal Nerve Stimulation during Sleep in Obstructive Sleep Apnea

A resource of potential drug targets and strategic decision‐making for obstructive sleep apnoea pharmacotherapy

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