Urgent Need to Improve PAP Management: The Devil Is in Two (Fixable) Details

Thomas, Robert J.; Bianchi, Matt T.

doi:10.5664/jcsm.6574

Cited by 15 publications

(13 citation statements)

References 24 publications

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“…The timing and duration of the CPAP-off periods as well as the subjects' sleep should be documented to define and interpret the effectiveness of intervention. The residual apnea burden, including REM OSA, is directly influenced by the proportion and timing of CPAP-on and -off periods [ 148 - 150 ]. In future trials, a predefined secondary analysis of REM OSA should be performed, considering its significant cardiovascular effects and prevalence [ 158 ].…”

Section: Obstructive Sleep Apneamentioning

confidence: 99%

“…To summarize, we caution against discarding the benefit of CPAP therapy for the prevention of stroke and other cardiovascular events in OSA on the basis of results from the currently available RCTs. The overall findings suggest what really matters is the therapeutic effectiveness, which is determined by CPAP adherence, CPAP efficacy, apnea burden [ 148 - 150 ], and possibly disease phenotype [ 165 - 167 ]. Apnea burden is driven by residual or emergent sleep apnea during CPAP-on and-off periods along with the duration of CPAP-off periods [ 150 - 152 , 170 ].…”

Section: Obstructive Sleep Apneamentioning

confidence: 99%

“…The overall findings suggest what really matters is the therapeutic effectiveness, which is determined by CPAP adherence, CPAP efficacy, apnea burden [ 148 - 150 ], and possibly disease phenotype [ 165 - 167 ]. Apnea burden is driven by residual or emergent sleep apnea during CPAP-on and-off periods along with the duration of CPAP-off periods [ 150 - 152 , 170 ]. In future trials for primary and secondary prevention in OSA, we need to adopt methods to determine the therapeutic effectiveness by measuring apnea burden, and to test whether effective therapy (defined by minimal or sufficiently low apnea burden, e.g., measured average AHI <5 over the entire treatment period including both CPAP-on and -off state in sleep) reduces the risk of stroke and other cardiovascular events.…”

Section: Obstructive Sleep Apneamentioning

confidence: 99%

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Sleep Disturbances as a Risk Factor for Stroke

et al. 2018

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Sleep, a vital process of human being, is carefully orchestrated by the brain and consists of cyclic transitions between rapid eye movement (REM) and non-REM (NREM) sleep. Autonomic tranquility during NREM sleep is characterized by vagal dominance and stable breathing, providing an opportunity for the cardiovascular-neural axis to restore homeostasis, in response to use, distress or fatigue inflicted during wakefulness. Abrupt irregular swings in sympathovagal balance during REM sleep act as phasic loads on the resting cardiovascular system. Any causes of sleep curtailment or fragmentation such as sleep restriction, sleep apnea, insomnia, periodic limb movements during sleep, and shift work, not only impair cardiovascular restoration but also impose a stress on the cardiovascular system. Sleep disturbances have been reported to play a role in the development of stroke and other cardiovascular disorders. This review aims to provide updated information on the role of abnormal sleep in the development of stroke, to discuss the implications of recent research findings, and to help both stroke clinicians and researchers understand the importance of identification and management of sleep pathology for stroke prevention and care.

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Section: Obstructive Sleep Apneamentioning

confidence: 99%

Section: Obstructive Sleep Apneamentioning

confidence: 99%

Section: Obstructive Sleep Apneamentioning

confidence: 99%

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Sleep Disturbances as a Risk Factor for Stroke

et al. 2018

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“…real versus device-provided measures). For CPAP, it was underlined that AHI flow was not always correlated or concordant with PG/PSG measures, especially when a 3% versus a 4% threshold of oxygen desaturation is used (results were worse when a PSG was used because of the additive impact of arousals (which cannot be diagnosed by the device) on the scoring) [18, 25–27]. Equivalent, exhaustive data are lacking for ASV therapy, whereas preliminary [28] or final data [8, 29, 30] are in favour of a similar discrepancy between AHI flow and AHI PSG .…”

Section: Discussionmentioning

confidence: 99%

“…In the Silveira study, the Bland and Altman plot of the difference between PSG-AHI and ASV-AHI flow against the mean of both measurements, reports a mean difference of 11.9 ± 9.6 (95% limits of agreement − 6.90, 30.71) [30]. In a recent editorial, Thomas and Bianchi have underlined the existing concern that the efficacy of CPAP and ASV therapies can be overestimated by the reported AHI flow [27]. Future randomized ASV-studies must take into account these considerations by including several PSG controls for ASV quality in the study design.…”

Section: Discussionmentioning

confidence: 99%

What is the remaining status of adaptive servo-ventilation? The results of a real-life multicenter study (OTRLASV-study)

et al. 2019

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BackgroundsAs a consequence of the increased mortality observed in the SERVE-HF study, many questions concerning the safety and rational use of ASV in other indications emerged. The aim of this study was to describe the clinical characteristics of ASV-treated patients in real-life conditions.MethodsThe OTRLASV-study is a prospective, 5-centre study including patients who underwent ASV-treatment for at least 1 year. Patients were consecutively included in the study during the annual visit imposed for ASV-reimbursement renewal.Results177/214 patients were analysed (87.57% male) with a median (IQ25–75) age of 71 (65–77) years, an ASV-treatment duration of 2.88 (1.76–4.96) years, an ASV-usage of 6.52 (5.13–7.65) hours/day, and 54.8% were previously treated via continuous positive airway pressure (CPAP). The median Epworth Scale Score decreased from 10 (6–13.5) to 6 (3–9) (p < 0.001) with ASV-therapy, the apnea-hypopnea-index decreased from 50 (38–62)/h to a residual device index of 1.9 (0.7–3.8)/h (p < 0.001). The majority of patients were classified in a Central-Sleep-Apnea group (CSA; 59.3%), whereas the remaining are divided into an Obstructive-Sleep-Apnea group (OSA; 20.3%) and a Treatment-Emergent-Central-Sleep-Apnea group (TECSA; 20.3%). The Left Ventricular Ejection Fraction (LVEF) was > 45% in 92.7% of patients. Associated comorbidities/etiologies were cardiac in nature for 75.7% of patients (neurological for 12.4%, renal for 4.5%, opioid-treatment for 3.4%). 9.6% had idiopathic central-sleep-apnea. 6.2% of the patients were hospitalized the year preceding the study for cardiological reasons. In the 6 months preceding inclusion, night monitoring (i.e. polygraphy or oximetry during ASV usage) was performed in 34.4% of patients, 25.9% of whom required a subsequent setting change. According to multivariable, logistic regression, the variables that were independently associated with poor adherence (ASV-usage ≤4 h in duration) were TECSA group versus CSA group (p = 0.010), a higher Epworth score (p = 0.019) and lack of a night monitoring in the last 6 months (p < 0.05).ConclusionsIn real-life conditions, ASV-treatment is often associated with high cardiac comorbidities and high compliance. Future research should assess how regular night monitoring may optimize devices settings and patient management.Trial registrationThe OTRLASV study is registered on ClinicalTrials.gov (Identifier: NCT02429986) on 1 April 2015.

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APAP, BPAP, CPAP, and New Modes of Positive Airway Pressure Therapy

Johnson

2022

Advances in the Diagnosis and Treatment of Sleep Apnea

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Urgent Need to Improve PAP Management: The Devil Is in Two (Fixable) Details

Cited by 15 publications

References 24 publications

Sleep Disturbances as a Risk Factor for Stroke

Sleep Disturbances as a Risk Factor for Stroke

What is the remaining status of adaptive servo-ventilation? The results of a real-life multicenter study (OTRLASV-study)

APAP, BPAP, CPAP, and New Modes of Positive Airway Pressure Therapy

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