Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea: changes over time and association to adherence

Ulander, Martin; Johansson, Malin; Ewaldh, Amanda Ekegren; Svanborg, Eva; Broström, Anders

doi:10.1007/s11325-014-0945-5

Cited by 62 publications

(61 citation statements)

References 25 publications

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“…Moreover, one of the side effects of the use of a continuous positive airway pressure device (common choice of therapy in treating pediatric OSA) is oral and nasal dryness. 16 Several studies have demonstrated that people who mouth breathe face increased risk of dental caries, gingivitis, and other oral infection. 39 Interestingly, adenotonsillar hypertrophy (reflected by Brodsky score of II or more) was a positive predictor for dental caries and gingival bleeding in our study.…”

Section: Discussionmentioning

confidence: 99%

“…15 Dry mouth can also occur during treatment of patients with OSA using continuous positive airway pressure devices. 16 Tsuda et al reported that 40% of adults on continuous positive airway pressure for OSA have poor oral health. 17 Moreover, recent studies have shown that OSA can activate various inflammatory processes, which when coupled with a dry mouth,…”

Section: Introductionmentioning

confidence: 99%

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Oral Health Status of Children With High Risk of Sleep-Disordered Breathing

Tamasas¹,

Godfrey²,

Nelson³

et al. 2018

JDSM

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JDSMStudy Objectives: To evaluate caries, gingival and periodontal status, and oral health-related quality of life (OHRQoL) in children with high risk of sleep-disordered breathing (SDB) in comparison to those with low risk of SDB. Methods:This cross-sectional study recruited consecutive children between the ages of 8 to 17 years from a university-based pediatric dental clinic. Caregivers completed the Pediatric Sleep Questionnaire (PSQ) to stratify risk of SDB. Children and their caregivers completed the Child Oral Health Impact Profile (COHIP) to measure OHRQoL. A dental examination blinded to the results of the PSQ and COHIP was conducted. Group characteristics were compared between those with high risk (SDB+) and low risk for SDB (SDB−). Results:One hundred twenty-three children were enrolled (11.5 ± 2.7 years, female = 48%). Forty-nine percent were classified as SDB+. COHIP scores were higher among the SDB+ group (24.5 versus 11.6, P < .001 as reported by caregivers, and 25.9 versus 10.3, P < .001 as reported by children). The incidence of dental caries present on examination was higher (60% versus 20%, P < .001) in the SDB+ group. In addition, the indices of periodontal diseases were higher among the SDB+ group when compared to the SDB− group (periodontal pocket depth was 2.0 ± 1.0 versus 0.0 ± 0.7, P < .0001, and bleeding on probing was 90% versus 20%, P < .001).Conclusions: This study suggests that caregiver reports of SDB symptoms in those seeking pediatric dental care are common. In addition, children in the SDB+ group had poorer OHRQoL, with increased incidence of caries lesion and periodontal disorders when compared to the SDB− group.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oral Health Status of Children With High Risk of Sleep-Disordered Breathing

Tamasas¹,

Godfrey²,

Nelson³

et al. 2018

JDSM

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“…Early side-effects related to CPAP such as increased number of awakenings and dry mouth after 1-2 weeks are significantly associated to treatment dropout during the first year and machine usage time after six months. [8] Other side-effects, such as blocked nose, skin irritations, mask leaks, [9] and claustrophobia [10] have also been shown to lower adherence. [11] CPAP-treated patients perceive that information about OSAS (e.g., about apneas and sequelae) and CPAP (e.g., side effects) affect adherence to treatment positively, while a lack of support from personnel at the CPAP initiation makes it more difficult for the patient to use CPAP.…”

Section: Introductionmentioning

confidence: 99%

Decisive situations influencing continuous positive airway pressure initiation in patients with obstructive sleep apnea syndrome – A critical incident technique analysis from the personnel’s perspective

Karlsson

Elfström

Sunnergren

et al. 2014

JHA

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This is the published version of a paper published in Journal of Hospital Administration. Citation for the original published paper (version of record):Karlsson, S., Elfström, M., Sunnergren, O., Fridlund, B., Broström, A. (2015) Decisive situations influencing continuous positive airway pressure initiation in patients with obstructive sleep apnea syndrome -A critical incident technique analysis from the personnel' s perspective. Journal of Hospital AbstractBackground: Continuous positive airway pressure is an effective treatment of obstructive sleep apnea syndrome, but adherence to treatment is low. Interventions such as encouragement, education and cognitive behavioural therapy have affected adherence to continuous positive airway pressure treatment positively. Currently there are no studies regarding the situation for personnel during the initiation process of treatment. Purpose: The purpose was to describe situations influencing the initiation of continuous positive airway pressure in patients with obstructive sleep apnea syndrome from a personnel perspective. Materials and methods: A qualitative approach using critical incident technique was used. Data were collected through semistructured interviews. Thirty one informants were strategically selected from sixteen centres in Sweden.Results: Motivation, a prepared patient, communicational aspects and participation of family were described as pedagogical circumstances. External conditions, practical experience, the patient's state of health and adaption to the mask were described as practical circumstances. The personnel handled the situations in a theoretical, practical and/or an emotional way. Conclusions: A better understanding of situations creating barriers or being facilitators, as well as ways to handle these situations, can be used to develop the role of personnel during the initiation process in order to increase continuous positive airway pressure adherence.

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We would like to thank Akar et al for their interest in our study [1], and for their comments on it.Side effect data were collected using SECI (Side Effects to Continuous Positive Airway Pressure (CPAP) Inventory), which is a self-report instrument for CPAP side effects that was developed by our group for a previous study [2]. That is, eye irritation as well as other side effects were reported by the patients, and were not based on an ophthalmological examination.

…”

mentioning

confidence: 96%

“…We would like to thank Akar et al for their interest in our study [1], and for their comments on it.…”

mentioning

confidence: 96%

Response to Akar et al., regarding our study “Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea”

Ulander

Broström

2015

Sleep Breath

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We would like to thank Akar et al. for their interest in our study [1], and for their comments on it.Side effect data were collected using SECI (Side Effects to Continuous Positive Airway Pressure (CPAP) Inventory), which is a self-report instrument for CPAP side effects that was developed by our group for a previous study [2]. That is, eye irritation as well as other side effects were reported by the patients, and were not based on an ophthalmological examination. We did not use the Ocular Surface Disease Index as our study did not focus specifically on eye-related side effects. In the interest of reducing the number of items (SECI itself in the version used in the study contains 45 items), it was deemed inappropriate to include specific questionnaires for each particular side effect. We agree that it would be valuable to assess the correlation between item 5 in SECI (i.e. irritated eyes) and the results of an ophthalmological examination, but that was not part of the aim of the study in question. Our main interest in self-reported CPAP side effects stems from the fact that they may affect treatment adherence, which is documented to be suboptimal in many studies [3]. Although there may be an association between objective findings and subjective reports with regard to those side effects that can be assessed objectively (e.g. eye irritation, but not, for example anxiety), selfreported CPAP side effects are more complex, as other factors (e.g. personality, see ref.2) may affect the perceived prevalence and severity of side effects. If side effects are of importance for adherence, it is more likely that a patient's perception of irritated eyes, for example, is associated with adherence rather than the tear film break-up time, although objective ophthalmological findings are likely to be related to perceived subjective symptoms. What medical, psychological and treatment-related factors that may lead to certain side effects is of course an important and interesting research question in its own right, but not what our study aimed at investigating. In conclusion, we do not think that our findings contradict the findings reported by you, especially as our aims, and therefore, our study design differ from yours. Conflicts of interest

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Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea: changes over time and association to adherence

Abstract: While some side effects are related to adherence, most are not. Not all side effects are stable over time. This, together with differences in methodology between studies, might explain the conflicting findings in earlier research.

Cited by 62 publications

References 25 publications

Oral Health Status of Children With High Risk of Sleep-Disordered Breathing

Oral Health Status of Children With High Risk of Sleep-Disordered Breathing

Decisive situations influencing continuous positive airway pressure initiation in patients with obstructive sleep apnea syndrome – A critical incident technique analysis from the personnel’s perspective

Response to Akar et al., regarding our study “Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea”

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