Pressure Reduction During Exhalation in Sleep Apnea Patients Treated by Continuous Positive Airway Pressure

Pépin, Jean‐Louis; Muir, Jean-François; Gentina, Thibaut; Dauvilliers, Yves; Tamisier, Renaud; Sapène, Marc; Escourrou, P.; Fleury, Bernard; Philip-Joët, F.; Philip, Pierre; d’Ortho, Marie-Pia

doi:10.1378/chest.08-2646

Cited by 35 publications

(30 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although these values are slightly lower than average adherence in some studies 27,28 they are in the same range as most studies reporting CPAP adherence.…”

Section: Discussionmentioning

confidence: 59%

Sleep Quality, Short-Term and Long-Term CPAP Adherence

Somiah

Taxin

Keating

et al. 2012

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

S C I E N T I F I C I N V E S T I G A T I O N SU ntreated obstructive sleep apnea/hypopnea syndrome (OSAHS) signifi cantly affects quality of life and cardiovascular/cerebrovascular morbidities and mortality.1-4 CPAP therapy has been shown to be effective in treating sleep disordered breathing (SDB) by reducing the apnea/hypopnea index (AHI) 5 and by reducing excessive daytime somnolence (EDS). 6Despite this, CPAP acceptance and adherence are disappointingly low. A signifi cant number of patients (ranging from 30% to 80% in various studies) demonstrate an average CPAP usage of less than 4 hours per night. 7,8 Several reviews have emphasized the need to identify patients who are at the greatest risk for non-adherence, with the goal of developing techniques to maximize overall adherence. 9,10Studies have suggested that CPAP adherence can be correlated to characteristics of patients at baseline, such as the severity of OSAHS, 11-13 the level of EDS, 14 and anatomical factors (smaller nasal cross-sectional area, reduced nasal volume, and high nasal resistance 15,16 ), but the strength of these correlations has been weak. Drake et al. showed that patients whose sleep effi ciency on the CPAP titration night improved most had the greatest CPAP compliance at 47 days.17 More recently, studies using social cognitive theory 18-20 and health BRIEF SUMMARYCurrent knowledge/Study Rationale: Despite its efficacy, adherence to CPAP therapy is highly variable amongst patients with obstructive sleep apnea with large numbers of patients demonstrating inadequate adherence to CPAP. The present study is aimed at identifying early predictors of CPAP adherence from variables obtained at the time of diagnosis and titration of CPAP, thereby providing potential for early intervention. Study Impact: Our data show that better sleep quality (greater % REM) was seen in patients with higher CPAP adherence and confi rm that long term adherence was largely predicted by short term adherence. This suggests that interventions that improve sleep during or prior to the CPAP titration study may be useful in improving CPAP adherence.

show abstract

“…Although these values are slightly lower than average adherence in some studies 27,28 they are in the same range as most studies reporting CPAP adherence.…”

Section: Discussionmentioning

confidence: 59%

Sleep Quality, Short-Term and Long-Term CPAP Adherence

Somiah

Taxin

Keating

et al. 2012

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

show abstract

“…Some studies in adults have shown improved comfort or adherence with C-Flex or Bi-Flex, 7,8 whereas other studies have not shown signifi cant improvements. [9][10][11][12] In children, factors infl uencing PAP adherence are likely different from those in adults. Furthermore, as children have lower tidal volumes and faster respiratory rates than adults; they do not always have adequate triggering and cycling of noninvasive ventilation.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Randomized, Double-Blind Clinical Trial of Two Different Modes of Positive Airway Pressure Therapy on Adherence and Efficacy in Children

Marcus

Beck

Traylor

et al. 2012

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objectives:To determine the effects of bilevel positive airway pressure with pressure release technology (Bi-Flex) on adherence and effi cacy in children and adolescents compared to standard continuous positive airway pressure (CPAP) therapy. We hypothesized that Bi-Flex would result in improved adherence but similar effi cacy to CPAP. Methods: This was a randomized, double-blinded clinical trial. Patients with obstructive sleep apnea were randomized to CPAP or Bi-Flex. Repeat polysomnography was performed on pressure at 3 months. Objective adherence data were obtained at 1 and 3 months. Results: 56 children and adolescents were evaluated. There were no signifi cant differences in the number of nights the device was turned on, or the mean number of minutes used at pressure per night for CPAP vs Bi-Flex (24 ± 6 vs 22 ± 9 nights, and 201 ± 135 vs 185 ± 165 min, respectively, for Month 1). The apnea hypopnea index decreased signifi cantly from 22 ± 21/h to 2 ± 3/h on CPAP (p = 0.005), and 18 ± 15/h to 2 ± 2/h on Bi-Flex (p < 0.0005), but there was no signifi cant difference between groups (p = 0.82 for CPAP vs Bi-Flex). The Epworth Sleepiness Scale decreased from 8 ± 5 to 6 ± 3 on CPAP (p = 0.14), and 10 ± 6 to 5 ± 5 on Bi-Flex (p < 0.0005; p = 0.12 for CPAP vs Bi-Flex). Conclusions: Both CPAP and Bi-Flex are effi cacious in treating children and adolescents with OSAS. However, adherence is suboptimal with both methods. Further research is required to determine ways to improve adherence in the pediatric population. keywords: CPAP, obstructive sleep apnea, Bi-Flex Citation: Marcus CL; Beck SE; Traylor J; Cornaglia MA; Meltzer LJ; DiFeo N; Karamessinis LR; Samuel J; Falvo J; DiMaria M; Gallagher PR; Beris H; Menello MK. Randomized, double-blind clinical trial of two different modes of positive airway pressure therapy on adherence and effi cacy in children.

show abstract

“…However, for C-Flex, better adherence has not been proved consistently in clinical studies, 4,8,9,[11][12][13][14]16,17 and the majority reported similar adherence 4,9,14,17 and treatment efficacy 9 between CPAP with and without C-Flex. Adherence and treatment efficacy are not reported in the literature for the other pressurerelief features.…”

Section: Discussionmentioning

confidence: 95%

“…In addition, most studies on such therapy feature are restricted to C-Flex (Philips Respironics, Murrysville, PA, USA), and the literature does not consistently support its usefulness. [8][9][10][11][12][13][14][15][16] For other pressure-relief features available on the market, the additional benefits still remain unclear.…”

Section: Introductionmentioning

confidence: 99%