Predictors of CPAP compliance in different clinical settings: primary care versus sleep unit

Nadal, Núria; Batlle, Jordi de; Barbé, Ferrán; Marsal, Josep Ramón; Sánchez-de-la-Torre, Alicia; Tarraubella, Nuria; Lavega, M Mercé; Sánchez‐de‐la‐Torre, Manuel

doi:10.1007/s11325-017-1549-7

Cited by 24 publications

(8 citation statements)

References 27 publications

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“…3,4 The existing standard for adult OSA treatment is positive airway pressure (PAP) treatment, but a significant percentage of patients do not tolerate continuous or bilevel positive airway pressure (PAP) application, with some investigators reporting only 39% to 50% PAP treatment adherence. 5,6 Alternatives to PAP treatment in the form of soft tissue airway surgery, skeletal surgery, and hypoglossal nerve stimulation are utilized to reduce the disease burden associated with routine intolerance of standardof-care treatment. In the past, treatment success rates for non-PAP upper airway interventions have been relatively poor or at best inconsistent.…”

Section: Introductionmentioning

confidence: 99%

“…Untreated moderate and severe OSA in particular has significant comorbidities, ranging from daytime fatigue to cardiovascular morbidity and mortality as well as neurocognitive dysfunction 3,4 . The existing standard for adult OSA treatment is positive airway pressure (PAP) treatment, but a significant percentage of patients do not tolerate continuous or bilevel positive airway pressure (PAP) application, with some investigators reporting only 39% to 50% PAP treatment adherence 5,6 …”

Section: Introductionmentioning

confidence: 99%

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Patterns of Obstruction on DISE in Adults With Obstructive Sleep Apnea Change With BMI

2020

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Objectives We describe drug‐induced sleep endoscopy (DISE) obstruction patterns in adults with obstructive sleep apnea (OSA) based on body mass index (BMI). We also evaluate subgroups of patients with clinically significant obstruction patterns at the velopharynx and oropharynx. Study Design Retrospective chart review. Methods Single‐institution, retrospective chart review of adults with OSA who underwent DISE with dexmedetomidine sedation from 2016 to 2018. Endoscopic findings were graded using VOTE (Velum, Oropharynx, Tongue base, Epiglottis) classification. Oropharyngeal obstruction was additionally graded with the modifier T when due to palatine tonsil tissue. Findings in patients who had BMI < 25, 25 ≤ BMI < 30, and BMI ≥ 30 were compared. Results One hundred and eleven patients (1 underweight, 23 normal weight, 56 overweight, and 31 obese) were reviewed. Patients with lower BMI were more likely to have more severe obstruction at the level of the tongue base (χ2 = 11.52, P = .021) and epiglottis (χ 2 = 10.56, P = .032). Conversely, patients with higher BMI were more likely to have complete concentric (grade 2C) velum obstruction (χ 2 = 16.04, P < .001) and more severe oropharyngeal obstruction (χ 2= 9.65, P = .046). Patients with grade 2 oropharyngeal obstruction without tonsil obstruction had more severe concurrent velum obstruction compared to subjects with grade 2 T oropharyngeal obstruction (P = .009). Conclusion In adults with OSA, BMI categories have significantly distinct obstruction patterns at all airway levels on DISE, and there appear to be distinct subgroups associated with certain velum and oropharynx collapse patterns. These findings may have important implications for positive airway pressure–alternative treatment. Level of Evidence 3 Laryngoscope, 131:224–229, 2021

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patterns of Obstruction on DISE in Adults With Obstructive Sleep Apnea Change With BMI

2020

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“…Sex may potentially modify the association between response and adherence to PAP therapy. 56 The results of the current investigation add to the growing body of literature that suggests that OSA has heterogeneous manifestations, and that sleepiness in particular may be a marker of increased cardiometabolic risk. However, the results herein also extend the existing literature by demonstrating sex-specific differences and underscoring the need to examine sex-mediated differences in disease as OSA phenotyping emerges as a construct.…”

Section: Discussionmentioning

confidence: 57%

Obstructive Sleep Apnea, Sleepiness, and Glycemic Control in Type 2 Diabetes

Aurora

Punjabi

2019

Journal of Clinical Sleep Medicine

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Study Objectives: Self-reported sleepiness is common in patients with obstructive sleep apnea (OSA) and is being increasingly recognized as an effect modifier of the association between OSA and cardiovascular outcomes. However, data on whether sleepiness modifies the association between OSA and glycemic outcomes are lacking. The current study sought to characterize the association between glycemic control and sleepiness in people with OSA and type 2 diabetes. Methods: Adults with non-insulin requiring type 2 diabetes and undiagnosed moderate to severe OSA were recruited from the community. Demographic data, Epworth Sleepiness Scale (ESS), hemoglobin A1c (HbA1c), as well a type III home sleep test were obtained. The association between self-reported sleepiness and glycemic control was examined using quantile regression. Results: The study cohort included 311 participants with 56% of the sample being men. Stratified analyses by sex demonstrated that self-reported sleepiness was associated with a higher HbA1c level, but this association was present only in men with a body mass index (BMI) < 35 kg/m 2. Mean HbA1c levels were higher by 0.57% (95% confidence interval: 0.11, 1.02) in men with an ESS ≥ 11 compared to men with an ESS < 11. No such association was observed in men with a BMI ≥ 35 kg/m 2 or in women of any BMI category. Conclusions: The association between self-reported sleepiness and glycemic control in people with type 2 diabetes and moderate to severe OSA varies a function of BMI and sex. The noted differences in association should be considered when assessing possible treatment effects of therapy for OSA on metabolic outcomes.

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“…One possible explanation for the similar effectiveness is that OA tends to be used for longer sleep periods as compared with CPAP, according to the mean disease alleviation concept (Vanderveken et al 2013). OA is used for about 6 h per night versus about 4 to 5 h for CPAP (Phillips et al 2013; Vanderveken et al 2013; Nadal et al 2018; Schwartz et al 2018). It can be hypothesized that when patients wake in the middle of the night (to urinate or other reason), they may not reuse their CPAP, leaving more than half of the sleep period without treatment (Varga and Mokhlesi 2019).…”

Section: Osa Management: Diagnosis Treatment and Follow-upmentioning

confidence: 99%

Critical Issues in Dental and Medical Management of Obstructive Sleep Apnea

et al. 2019

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This critical review focuses on obstructive sleep apnea (OSA) and its management from a dental medicine perspective. OSA is characterized by ≥10-s cessation of breathing (apnea) or reduction in airflow (hypopnea) ≥5 times per hour with a drop in oxygen and/or rise in carbon dioxide. It can be associated with sleepiness and fatigue, impaired mood and cognition, cardiometabolic complications, and risk for transportation and work accidents. Although sleep apnea is diagnosed by a sleep physician, its management is interdisciplinary. The dentist’s role includes 1) screening patients for OSA risk factors (e.g., retrognathia, high arched palate, enlarged tonsils or tongue, enlarged tori, high Mallampati score, poor sleep, supine sleep position, obesity, hypertension, morning headache or orofacial pain, bruxism); 2) referring to an appropriate health professional as indicated; and 3) providing oral appliance therapy followed by regular dental and sleep medical follow-up. In addition to the device features and provider expertise, anatomic, behavioral, demographic, and neurophysiologic characteristics can influence oral appliance effectiveness in managing OSA. Therefore, OSA treatment should be tailored to each patient individually. This review highlights some of the putative action mechanisms related to oral appliance effectiveness and proposes future research directions.

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Predictors of CPAP compliance in different clinical settings: primary care versus sleep unit

Abstract: The predictors of adequate CPAP compliance vary between SU and PC settings. Detecting compliance predictors could help in the planning of early interventions to improve CPAP adherence.

Cited by 24 publications

References 27 publications

Patterns of Obstruction on DISE in Adults With Obstructive Sleep Apnea Change With BMI

Patterns of Obstruction on DISE in Adults With Obstructive Sleep Apnea Change With BMI

Obstructive Sleep Apnea, Sleepiness, and Glycemic Control in Type 2 Diabetes

Critical Issues in Dental and Medical Management of Obstructive Sleep Apnea

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