Comparing CPAP masks during initial titration for Obstructive Sleep Apnea Syndrome: one-year experience

Abstract Objective: Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for OSA. A wide variety of masks are used during CPAP therapy. The aim of the study is to compare polysomnography outcomes during titration for different types of masks (oronasal, nasal and pillow) and assess the impact on PAP titration. Methods: We retrospectively analyzed all CPAP titration polysomnography for one year. Anthropometric data and baseline apnea severity were documented. Results: A total of 497 patients were evaluated. Nasal masks were used in 82.3% (n = 409), pillow in 14.1% (n = 70) and oronasal in 3.6% (n = 18). There was no difference according to body mass index and baseline apnea-hypopnea index among the groups. The oronasal group was older and had higher titrated CPAP pressure, higher residual apnea-hypopnea index, lower sleep efficiency, more superficial N1 sleep and longer wake time after sleep onset. All other polysomnography outcomes were similar among the groups. The mean CPAP level was 11.6 ± 2.1 cm H2O for the oronasal mask, 10.1 ± 2.1 cm H2O for the nasal mask and 9.8 ± 2.2 cm H2O for the pillow. The residual apnea-hypopnea index was 10.4 ± 7.9 for the oronasal mask, 5.49 ± 5.34 events/h for the nasal mask and 4.98 ± 5.48 events/h for the pillow. The baseline apnea-hypopnea index was correlated with of a higher CPAP pressure for all the groups (p< 0.001 for the nasal group, p = 0.001 for the pillow group and p = 0.049 for the oronasal group). Body mass index and residual AHI were correlated with of a higher CPAP pressure for the nasal and pillow groups only (p < 0.001). Conclusion: The interface can have a significant impact on the effectiveness of PAP titration. Patients with oronasal masks have higher CPAP pressure, higher residual apnea-hypopnea index, lower sleep efficiency and higher wake time after sleep onset. Oronasal masks should not be recommended as the first choice for apnea patients. Level of evidence: Level 3.

Assessment of SIBALERA Neck Pillow With Autonomous Sensory Meridian Response (ASMR) to Attention Function Among Medical Students in Indonesia

@#Introduction: The quality parameter of a country’s education is closely related with learning achievement, where attention plays an important role. In support of learning achievement, individuals often enforce their study time till induce stress or physical fatigue over a long term. Neck pillow is often used as a media at rest for body’s relaxation. The Autonomous Sensory Meridian Response (ASMR) can also provide relaxation and can trigger the release of dopamine hormone which functions as a neurotransmitter in the attention process. Based on these problems, we design a research on SIBALERA; a portable neck pillow with ASMR stimulation can improve attention function. Methods: This research used an experimental design of three parallel groups pre and post-test design. The participant (n=48) was randomly divided into three groups. The control group was not given any intervention (n=16), intervention group 1 was given regular neck pillow without ASMR stimulation (n=16), and intervention group 2 was given SIBALERA (n=16). ASMR stimulation was given by hearing twenty minutes before the participants went to sleep at night for two weeks.The attention function were measured used the Attention Network Test (ANT) the day before and after the intervention. Results: The result showed a significant difference scores of attention functions including alerting, orienting, and executive in the intervention group 2 (p<0.001) than the other two groups. Conclusion: In summary, SIBALERA with ASMR stimulation can effectively improve the attention function.

Effect of Variations in Neck Position on Peak Expiratory Flow Rate in Supine Posture in Young Healthy Adults - A Cross Sectional Study

Many individuals prefer using a pillow under their head when they sleep or read or use hand held electronic devices in recumbent position. Changes in position of the head with respect to the neck in supine posture may occur depending on the use of a pillow or height of the pillow used. This alteration of head and neck position might have an effect on pulmonary ventilation. The Peak Expiratory Flow Rate (PEFR) is one of the tests to assess pulmonary functions and PEFR can be performed easily and rapidly with the help of Wright’s Mini Peak Flowmeter. This study was undertaken to see the effect of variations in neck position on peak expiratory flow rate in supine posture in young healthy adults. METHODSA cross sectional study was carried out on 150 apparently healthy medical students of both sexes in the age group of 18 - 21 years. PEFR values were recorded using Wright’s Mini Peak Flow Meter. The subjects were asked to lie down in supine position on a wooden couch and recording of the peak expiratory flow rate was performed, initially by placing the subject’s head directly on the wooden couch and then by keeping the head on a pillow of 5 cm height. RESULTSData was analysed using paired ‘T’ Test and the p value of less than 0.05 was considered as statistically significant. We found that the mean PEFR value obtained using a pillow of 5 cm height under the head was more than the mean PEFR value obtained without using the pillow and the change in mean PEFR values was statistically significant (Table 1). CONCLUSIONSAfter comparing the mean PEFR values in the supine position with and without use of a pillow, we found that mean PEFR value was significantly higher when PEFR test was performed with use of a low height pillow (5 cm) under the head. From the result of this study, we conclude that pulmonary ventilation is better when the head and neck are supported with a low height pillow in supine posture.

The second stage of labour

The second stage of labor begins with full dilatation of cervix and ends with delivery of the fetus. In most of the cases the labor progresses uneventfully, without any need of an active intervention but in few cases complications may occur.  With passage of time there has been better understanding about second stage of labor, still there are several grey areas yet to be resolved. This review endeavours to scrutinize a variety of care practices including positions, time and type of pushing, use of epidural analgesia, and perineal support techniques etc and discuss evidence based management of second stage of labor. The review was carried out in the period of 1900-2019 by searching in Pub Med, Embase, Scopus, Google scholar, Web of sciences using relevant key words. Reports, articles, fact sheets and official publications of World health Organization (WHO), Ministry of health and family welfare-Govt of India and various other countries were also reviewed.

Comparison of Neck Pain, Shoulder Pain, and Comfort between Buckwheat and Latex Pillows

BACKGROUND: This study aimed to investigate differences in neck pain, shoulder pain, and comfort between buckwheat and latex pillows in elderly sanatorium residents. METHODS: The crossover experimental study was performed with 30 elderly patients in a convalescent hospital for seniors. The buckwheat and latex pillows were used for 2 weeks, the 7 day was assigned as the washout between each one week intervention, respectively. Pre- and posttest visual analog scale (VAS) scores for neck and shoulder pains and the neck disability index (NDI) were investigated. Data were analyzed using paired-samples t test, and their correlations were analyzed using SPSS/WIN 21.0 (IBM Corp., New York, NY, USA). RESULTS: After the 2-week intervention, results showed that the use of buckwheat pillows decreased the VAS scores for neck and shoulder pains and NDI. Further, the use of latex pillows decreased the VAS score for neck pain and NDI, but the VAS score for shoulder pain showed no statistically significant differences (t=1.887, P=0.069). CONCLUSION: In conclusion, using latex and buckwheat pillows is the best option for reducing neck pain. Between the buckwheat and latex pillows, the buckwheat pillow is a better option for decreasing neck and shoulder pains.

Comparative Study Of Pain Relief Between Using Traction And Pillow Support In Proximal Femur Fractures

INTRODUCTION: There is always confusion regarding preoperative stabilization modality for proximal femur fractures to achieve pain relief. Objectives: The aim of this study was to study the effects of skeletal traction and pillow support on pain in patients with proximal femur fractures. Patients and Methods: A total of 50 patients contributed in this randomized clinical trial. Patients were randomly allotted into two equal groups: the skeletal traction and pillow support groups. The severity of pain was recorded at admission and 30 minutes, 24, 48 hours after traction/pillow support application using Visual Analogue Scale (VAS). Results: The severity of pain was significantly decreased in skeletal traction group and pillow support group only at the end of the first day after traction application. The number of pain complaints which needs analgesics was the same between the two groups. Conclusions: even though skeletal traction and pillow support had no effect on analgesic consumption, both have significantly decreased the pain at the end of the first day. The application of skeletal traction and pillow support both are recommended in patients with proximal femur fractures.

Multifunctional Cervical Health Care Pillow / 中国医疗器械杂志

Cervical spondylosis is due to degenerative cervical disc and its stimulation or oppression of the adjacent nerves, spinal cord, spinal artery and other tissue caused by clinical symptoms. The cervical spine is an anatomical structure with activity, while the pillow has a certain plastic fixation effect on the cervical spine anatomy. Therefore, the pillow not only plays a health role in the cervical spine, but also plays an important role in restoring the normal physiological curvature of the cervical spine. Based on this, a multi-functional cervical vertebra treatment pillow is designed, which not only has the functions of traction, maintaining different positions of the cervical spine, correcting the cervical curvature and equipment exercises, but also has the functions of voice broadcast and network data terminal.

Effects of Sagacious Confucius' Pillow Elixir on cognitive function in type 2 diabetic rats / 中国中药杂志

Type 2 diabetes mellitus (T2DM) is the leading threat to human health in China, and severe cognitive impairment often occurs in most T2DM patients. Although Sagacious Confucius' Pillow Elixir is a type of classical traditional Chinese medicine for cognitive impairment in clinic, the mechanism has not yet been completely defined. In this study, an experimental model of type 2 diabetes mellitus (T2DM) was established by injecting Sprague Dawley (SD) rats with streptozocin (STZ), so as to compare the learning and memory ability, hippocampal neurons pathological changes, beta amyloid protein (A beta) content, degree of Tau protein phosphorylation, blood glucose and insulin level. The results showed that the Sagacious Confucius' Pillow Elixir could improve the learning and memory ability of STZ injected rats, reduce the level of A beta content both in hippocampus and serum, effectively reduce Tau protein phosphorylation degree, and also significantly alleviate hippocampal pathological injury, blood glucose, insulin and other basic indicators. The results showed that Sagacious Confucius' Pillow Elixir can alleviate the hippocampal pathological damage caused by STZ, and is expected to provide a theoretical basis for human T2DM patients in clinical adjuvant therapy.

Using homemade polyhedral pillow in patients with endoscopic retrograde cholangiopancreatography operation / 中国实用护理杂志

Objective To observe the application effect of homemade polyhedral pillow in endoscopic retrograde cholangiopancreatography operation (ERCP). Methods Using the random number table method, the 160 cases of ERCP patients were divided into traditional group and improvement group on average. Common cotton pillow was used in the traditional group and homemade polyhedral pillow was used in the other. We observed the left facial ministry skin compression of postoperative patients, and a follow-up visit was made about the surgery physician satisfaction and patient comfort. Results The incidence of left facial ministry skin erythema and indentation in improved group patients was 12.50%(10/80), 15.00%(12/80), respectively. The corresponding rate in traditional group was 45.00%(36/80), 48.75%(39/80), respectively. Difference was statistically significant (χ2=20.63, P<0.01; χ2= 20.98, P<0.01). The degree of patient's comfort and Surgery physician satisfaction in improved group patients was 88.5 (70, 95) points, 90.00%(72/80),respectively, which higher than those in traditional group, for about 57.0(51, 83) points,70.00%(56/80), Difference was statistically significant (Z=-6.844, P<0.01; χ2=10.09, P=0.006). Conclusions Intraoperative use of homemade polyhedral pillow in ERCP, can ensure proper head position, reduce the pressure of left facial ministry skin and the occurrence of complications, thus improve the operator and shorten the operation time at the same time, which can also improve the patient′s comfort and the doctor′s degree of satisfaction.

The relationship between pillow height and cervical intervertebral disc stress in lateral decubitus position by three-dimensional finite element analysis / 国际生物医学工程杂志

Objective To analyze the relationship between pillow height and cervical intervertebral disc stress in lateral decubitus position of the human body using three-dimensional finite element method,and to provide the basis for appropriate pillow selection.Methods A cervical spine CT scan was performed on a normal male volunteer.The medical 3D image reconstruction software (Mimics),reverse engineering software (Geomagic Studio) and finite element software (MSC.Patran) were collectively used to establish three-dimensional finite element models of the whole cervical spine under three lateral decubitus conditions,includes pillow height of 10 cm (cervical spine leftward flexion),17 cm (cervical spine neutral),and 25 cm (cervical spine rightward flexion).Moreover,the finite element analysis and calculation of the three models were conducted.Results The Von-Mises stress,maximal principal stress and maximum shear stress of the model in cervical spine neutral (pillow height=17 cm) were all significantly lower than those of the cervical spine lateral model.Conclusions When the cervical coronal plane is in neutral position,the cervical discs can achieve the best stress distribution state.In lateral decubitus position of the human body,a appropriate pillow height should make the cervical vertebrae in neutral position.

Clinical application of flexible endoscope assisted by pillow-under-shoulder in patients with difficult airway / 吉林大学学报(医学版)

Objective:To observe the clinical application of flexible endoscope assisted by general versus pillow-under-shoulder supine position in nasotracheal intubation of the patients with difficult airway, and to explore the influence of intubation position in the intubation effect.Methods: A total of 168 patients with difficult airway who underwent nasotracheal intubation and oromaxillofacial surgery under general anesthesia were randomly divided into general supine position (control group) and pillow-under-shoulder supine position (experimental group) with 84 cases in each group.The first-time and the total success rate of intubation, the intubation time, and the rate of direct glottis exposure of the patients in two groups were recorded.The mean arterial pressure(MAP), heart rate (HR), and complications of intubation of the patients in two groups before induction, before tracheal intubation, during intubation, 1 and 5 min after intubation, were also recorded.Results:The first-time success rate of intubation in experimental group (94.0 %, 79/84) was significantly higher than that in control group (71.4%, 60/84) (P0.05);the intubation time (57 s±12 s) was significantly shorter than that in control group (146 s±29 s) (P0.05).There were no significant differences in the MAP and HR between different time points (P>0.05).The incidence rates of complications including pharyngalgia, hoarseness and epistaxis had no differences between two groups (P>0.05).Conclusion: Flexible endoscope assisted by pillow-under-shoulder in nasotracheal intubation has a higher intubation success rate, shorter intubation time and it is a superior procedure for the patients with difficult airway.

Anti-snoring Pillow in the Treatment of Obstructive Sleep Apnea with Heart Failure: an Efficacy Study / 医学研究杂志

Objective To investigate the effect of anti-snoring pillow for the treatment of obstructive sleep apnea in patients with heart failure.Methods Forty seven HF patients with OSAHS and 12 HF patients with simple snoring were enrolled.All the patients were divided into 3 groups:control group (n =12),mild-moderate OSAHS group (n =26) and severe OSAHS group (n =21).All the patients received the treatment of anti-snoring pillow and their sleep apnea parameters were evaluated by PSG at the same time.Results The sleep apnea parameters including AHI,OAI,ODI,mean SpO2％ and snore index were significantly improved in severe and mild moderate OSAHS group with anti-snoring pillow.Conclusion Anti-snoring pillow can reduce snoring index in all OSAHS patients and simple snorers.Sleep apnea and hypoxemia were greatly improved in mild-moderate OSAHS-HF patient while the anti-snoring pillow is not perfect in severe OSAHS patients with HF to replace PAP.

Continuous ozone disinfection contains bacterialcontamination of pillows for patients with head and neck burns / 现代临床护理

Objective To study the effect of continuous ozone disinfection on the bacterial contamination of the pillows for patients with head and neck burns. Methods Toally 40 patients with II-IIIo head and neck burnswere divided into the treatment and control groups:the former was treated with continuous ozone disinfection and the latter with traditional disinfection. They were compared in terms of the rates of bacterial detection and pillow bacterial contamination. Result The rates of bacterial detection and pillow bacterial contamination in the treatment group were both significantly lower than those the control group (P<0.05). Conclusions The rate of pillow bacterial contamination goes high as its use time is long. The ozone disinfection machine is effective in the reduction of bacterial detection and pillow bacterial contamination so as to lower the risk of wound infections.

Uso de almohadas de gel en recién nacidos de pretérmino se asocia a disminución de deformidad craneana / Using gel pillows in preterm infants is related to decreased cranial deformity

Introducción: la escafocefalia posicional, deformidad craneana típica del recién nacido prematuro, presumiblemente es debida a un inicio anticipado de presión sobre la calota, a un inadecuado control motor que determina un menor cambio de posición y un mayor tiempo de presión asimétrica sobre la calota. El descenso de la presión de puntos de apoyo asimétricos sobre el cráneo podría disminuir la escafocefalia. La superficie de gel puede bajar la presión localizada en el cráneo al disminuir la rigidez de la superficie de contacto. Los estudios existentes, escasos, no son concluyentes al respecto. Objetivo: Mostrar la relación entre el uso de almohadas de gel y la reducción de escafocefalia en recién nacidos de pretérmino. Método: Estudio longitudinal de pacientes prematuros hospitalizados en el servicios de neonatología de un hospital terciario, que utilizaron almohadas de gel por 5 semanas consecutivas, durante al menos el 90 por ciento del tiempo que permanecieron en decúbito. Se realizaron mediciones craneales, considerando el índice de deformidad craneana; la primera medición fue previo al uso de almohadas y luego semanalmente hasta completar 5 semanas. Resultados: 17 pacientes completaron las 5 semanas de protocolo. Edad promedio: 28,9 semanas de gestación (rango 28 a 34). Peso promedio: 1058 grs. (rango 720 a 2000). El índice de deformidad craneana varió desde 70,36 (DE 4,7) al inicio del estudio a 76,95 (DE 3,03) al término del estudio, con una diferencia significativa (p< 0,05). Conclusión: Este trabajo mostró una relación entre reducción del grado de escafocefalia, expresada en el IC, con el uso de almohadas de gel por un período de 5 semanas en RNPT.

Introduction: the positional scaphocephaly is the preterm infants’ typical cranial deformity. And probably is due to improper motor control, which determines minor change in position and longer asymmetric pressure on the skull. Decreasing the pressure of asymmetric support points on the skull, might decrease scaphocephaly. Gel’s surface may decrease localized pressure in the skull thus decreasing the stiffness of the contact surface. There are scarce reports about this issue and all are inconclusive. Objective: To show the relationship between the use of gel pillows and reduction of scaphocephaly in preterm infants. Method: Longitudinal study of preterm infants hospitalized in neonatology service of a tertiary hospital. They used gel pillows for 5 consecutive weeks, for at least 90 percent of the time in prone position. Cranial measurements were performed, considering the index of cranial deformity, the first measurement before to the use of pillows and then weekly until 5 weeks. Results: 17 patients completed the 5-week protocol. Average age 28.9 weeks of gestation (range 28-34), average weight 1058 g. (range 720-2000). The index of cranial deformity ranged from 70.36 (SD 4.7) at baseline to 76.95 (3.03) at the end of the study with a significant difference (p <0.05). Conclusions This study showed a relationship between the degree of reduction of scaphocephaly expressed in the IC, using gel pillows for a period of 5 weeks in preterm infants.

The Effect of Different Pillow Heights on the Parameters of Cervicothoracic Spine Segments

OBJECTIVE: To investigate the effect of different pillow heights on the slope of the cervicothoracic spine segments. METHODS: A prospective analysis of data from 16 asymptomatic adults (aged 20 to 30 years) was carried out. Exclusion criteria were history of injury or accident to the cervicothoracic spine, cervicothoracic spine surgery, or treatment for neck symptoms. We used three different pillow heights: flat (0 cm), 10-cm, and 20-cm pillows. Cervical sagittal parameters, measured with radiography, included; C2-7 Cobb's angle, T1 slope (T1S), thoracic inlet angle (TIA), and neck tilt (NT). Statistical analyses were performed using Spearman correlation coefficients. RESULTS: As the height of the pillow increased, the T1S & C2-7 Cobb's angle increased while the NT values tended to decrease. The TIA values, however, remained constant. Additionally, there was a statistically significant sex difference in T1S with the 0-cm pillow (p=0.01), and in NT with the 20-cm pillow (p=0.01). CONCLUSION: From the data obtained in this study, we recommend that the most suitable pillow height is 10 cm, considering the normal cervical lordosis.

Application of waist pillow in defecation of bedridden patients in emergency department / 中国实用护理杂志

Objective To explore the efficacy of self-designed waist pillow combined with plastic toilet in bedridden patients in emergency department.Methods From August 2013 to February 2014,90 bedridden patients in emergency department were divided into the observation group 1,the observation group 2 and the control group by random digits table with 30 cases in each group.Patients in the observation group 1 lied in the suprine position,and elevating head of bed 15 to 30 degrees,with pillow under the waist,and plastic toilet under the buttocks.Patients in the observation group 2 used the same method as that of the observation group 1,except that they did not use waist pillow.The control group lied in the suprine position,only used plastic toilet.The defecation and other related items were compared between the three groups.Results The observation group 1 was better than those of the observation group 2 and the control group in preventing pressure ulcers,urine leakage and backflow,comfort degree,worrying degree,defecation difficulty degree.Conclusions Application of waist pillow and plastic toilet in bedridden patients in emergency department could reduce the skin damage,and let patients defecate smoothly,which was in accordance with the connotation of comfort nursing.

Design and application of self-made water pillow / 现代临床护理

Objective To explore the effect of self-made water pillow on absolute bed rest patients.Methods Eight-eight patients were randomly allocated into observation group(n=46)and control group(n=42).The patients in the control group received daily care with conventional cotton pillows which were placed at the compression part, while those in the observation group were treated with newly designed water pillows.Both groups received constant turn-over to avoid pressure sores.The two groups were compared in terms of times of daily turn-over,degree of comfort and rate of skin pressuring red.Results The time of daily turn-over in the observation group was less than that of the control group and the degree of comfort was higher and the rate of skin pressuring red smaller all with statistically significant differences(P<0.05).Conclusion The application of the self-made water pillow can effectively prevent pressure sore,enhance comfort degree of absolute bed rest patients and reduce the workload of nursery.It is simple, economical,convenient and safe.

Comparative study on the effects of suspension and pillow elevation on limb swelling after elbow surgery / 现代临床护理

Objective To compare the clinic effects of suspension and pillow elevation on limb swelling after elbow surgery. Methods One hundred patients receiving operations on elbow fracture were randomly divided into experiment group(suspension elevation)and the control group(pillow elevation)to eliminate limb swelling,50 cases in each group.The forearm circumference(10 cm below elbow)were measured 1-5d after operation,the circumferences on the first day and the fifth day recorded for comparing effects of the limb swelling elimination.Results The circumferences on the 1st day and 5th day of the suspension elevation group and the pillow elevation group were(2?53±0?76)cm,and(4?19±2?36)cm,respectively.The differences in circumference between the two groups were statistically significant(P<0?05).Conclusion The suspension elevation is more effective in promoting venous circulation and eliminating swelling,so it is conducive for the elbow fracture patients in early functional exercise?

Research in prevention of pressure ulcer for bed-ridden patients by simple turn-over pillow and turn-over mattress / 中国实用护理杂志

Objective To study the prevention of pressure ulcer for bed-ridden patients by simple turn-over pillow and turn-over mattress.Methods Self-made simple turn-over pillow and turnover mattress were used in 1300 patients who had high risk of pressure ulcer,and the application effect was observed.Results No pressure ulcer occurred in 1300 patients when they were discharged.Conclusions Simple turn-over pillow and turn-over mattress showed definite effect to prevent pressure ulcer,they have application value,and are worthy of wide spread.

Manufacture of double-deck pillow and its application during thyroma operation / 中国实用护理杂志

Objective To approach the preoperative exercise of body position and the comfortable post operative body position of thyroma patients,to elevate the degree of comfort and satisfaction of patients,reduce the complication and promote the rehabilitation of patients.Methods 60 thyroma patients(all underwent operation and with drainage tube)in general surgery department of our hospital from January 2004 to February 2006 were randomly divided into the experimental group and the control group.Before the operation the double deck pillows were used in the experimental group and the ordinary pillows were used in the control group.The therapeutic result was observed in both groups.Results The degree of comfort,the first-class healing rate of incision and the postoperative complications rate were significantly different between the two groups(P＜0.05).Condusiom The application of the double-deck pillow in thyroma patients could augment the degree of comfort of the preoperative exercise and postoperative body position,and could degrade the postoperative complications of thyroma patients and shorten the length of hospital stay.