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1.
Behav Sleep Med ; 20(6): 695-705, 2022.
Article in English | MEDLINE | ID: mdl-34591739

ABSTRACT

BACKGROUND AND AIM: Existing interventions promoting positive airway pressure (PAP) adherence focus only on the diagnosed individual, despite the fact that partners are often the most impacted by obstructive sleep apnea (OSA), and are delivered mostly by health professionals, with limited success. The goal of this work is to develop a prototype of OurSleepKit, a couple-focused mobile health (mHealth) tool to coach mutual engagement and promote adherence to PAP treatment. METHODS: We used an iterative participatory approach working with future end users of OurSleepKit to support the development of this prototype. We conducted a total of 14 semi-structured in-depth open-ended dyadic interviews with OSA patients and their partners. Phase 1 of the development was to inform key functions of an engaging tool. Phase 2 focused on developing functions to engage positive conversation in the dyad and obtained feedback for this initial prototype. RESULTS: The OurSleepKit prototype was developed and demonstrated high acceptability and engagement. Three key functions included periodic assessments based on developmental stages of PAP treatment, a Coaching Board which provides customized and dynamically updated support content - primarily brief story-telling videos featuring real-life couples' experiences - and timely tailored prompts (for action, learning, and conversation) through push notifications in the evening to facilitate positive conversation in the dyad and offer in-the-moment support for PAP use. CONCLUSIONS: Going beyond the traditional and prevailing view of PAP use as an individual phenomenon, OurSleepKit is a novel mHealth intervention engaging both the patient and partner holding great promise to promote PAP adherence.


Subject(s)
Sleep Apnea, Obstructive , Telemedicine , Communication , Continuous Positive Airway Pressure , Humans , Motivation , Patient Compliance , Sleep Apnea, Obstructive/therapy
2.
J Clin Sleep Med ; 18(2): 597-607, 2022 Feb 01.
Article in English | MEDLINE | ID: mdl-34569926

ABSTRACT

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is a heterogeneous, complex disease. We aimed to identify OSA phenotypes through cluster analysis and to perform a long-term follow-up to validate the phenotypes. METHODS: We applied a partitioning around medioids technique in a cohort of 1,217 participants recently diagnosed with OSA. We performed a 5-year follow-up analyzing the incidence of comorbidities, chronic medication, hospital admissions, mortality, and the influence of continuous positive airway pressure treatment on mortality risk. RESULTS: We identified three phenotypes: two predominantly male clusters, one composed of middle-aged participants with overweight, moderate OSA, and cardiovascular risk factors and the other consisting of older, obese participants with severe OSA, cardiovascular risk factors, ischemic heart disease (18.4%), and atrial fibrillation (9.7%). The third cluster was composed of 77% female participants with moderate OSA; cardiovascular risk factors; the highest prevalence of depression (15.7%); and high prescription of antidepressants (55.1%), anxiolytics (40.0%), hypnotics, sedatives (11.1%), nonsteroidal anti-inflammatory drugs (67.9%), and weak opioids (15.1%). The baseline characteristics of each cluster maintained the same trend over time regarding the incidence of new comorbidities, medication intake, hospitalization rates, and reasons for admission. The absence of continuous positive airway pressure treatment was associated with a significantly higher risk of all-cause mortality (hazard ratio 5.84, confidence interval 2.9-11.8), especially in the older men (hazard ratio 7.7, confidence interval 4.06-14.63) and predominantly female clusters (hazard ratio 2.79, confidence interval 1.34-5.79). CONCLUSIONS: We identified three phenotypes with relevant clinical and prognostic implications in order to improve personalized strategies in OSA management. CITATION: Silveira MG, Sampol G, Mota-Foix M, Ferrer J, Lloberes P. Cluster-derived obstructive sleep apnea phenotypes and outcomes at 5-year follow-up. J Clin Sleep Med. 2022;18(2):597-607.


Subject(s)
Sleep Apnea, Obstructive , Aged , Continuous Positive Airway Pressure , Female , Follow-Up Studies , Humans , Male , Middle Aged , Phenotype , Proportional Hazards Models , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/therapy
3.
J Clin Sleep Med ; 18(2): 553-561, 2022 Feb 01.
Article in English | MEDLINE | ID: mdl-34534075

ABSTRACT

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) has been associated with cardiovascular events (CVEs), although recent randomized controlled trials have not demonstrated that long-term continuous positive airway pressure (CPAP) prevents CVEs. Our objective was to determine the effect of CPAP on older adults with moderate OSA regarding CVE reduction. METHODS: An observational and multicenter study of a cohort of older adults (> 70 years of age) diagnosed with moderate OSA (apnea-hypopnea index 15.0-29.9 events/h) was conducted. Two groups were formed: (1) CPAP treatment and (2) standard of care. The primary endpoint was CVE occurrence after OSA diagnosis. Association with CPAP treatment was assessed by propensity score matching and inverse weighting probability. Secondary endpoints were incidence of CVE separately and time to first CVE. RESULTS: A total of 614 patients were included. After matching, 236 older adults (111 men, mean age 75.9 ± 4.7 years) with a follow-up of 47 months (interquartile range: 29.6-64.0 months) were considered for primary and secondary endpoint evaluations. Forty-one patients presented at least 1 CVE (17.4%): 20 were in the standard-of-care group (16.9%) and 21 were in the CPAP group (17.8%), with a relative risk of 1.05 (95% confidence interval [CI], 0.60-1.83; P = .43) for CPAP treatment. Inverse probability weighting of the initial 614 patients determined an adjusted relative risk of 1.24 (95% CI, 0.79-1.96; P = .35) for CPAP treatment. No statistical differences were found in secondary endpoint analyses. CONCLUSIONS: CPAP should not be prescribed to reduce CVE probability in older adults with moderate OSA. CITATION: López-Padilla D, Terán-Tinedo J, Cerezo-Lajas A, et al. Moderate obstructive sleep apnea and cardiovascular outcomes in older adults: a propensity score-matched multicenter study (CPAGE-MODE study). J Clin Sleep Med. 2022;18(2):553-561.


Subject(s)
Sleep Apnea, Obstructive , Aged , Aged, 80 and over , Cohort Studies , Continuous Positive Airway Pressure , Heart , Humans , Male , Propensity Score , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/epidemiology , Sleep Apnea, Obstructive/therapy
5.
J Clin Sleep Med ; 18(1): 305-314, 2022 01 01.
Article in English | MEDLINE | ID: mdl-34596039

ABSTRACT

STUDY OBJECTIVES: To assess variable negative external pressure (vNEP) therapy using a range of pressures and varying collar sizes and shapes to identify combinations that improve the efficacy and comfort of this emerging therapy for obstructive sleep apnea (OSA). METHODS: This prospective, open-label pilot study included 28 eligible patients (71% men) having documented moderate OSA (apnea-hypopnea index [AHI] 15 events/h ≤ AHI ≤ 30 events/h) at 1 sleep clinic for an overnight, in-lab sleep trial. Each participant tested at least 2 of 6 available vNEP devices during sleep periods ≥ 2 hours. During the assessment of AHI by polysomnography, negative pressures of -20 cm H2O to -35 cm H2O were adjusted to improve each patient's response. Participants' therapeutic preferences were assessed by a questionnaire and interviews. RESULTS: Twenty (71%) of the participants responded to vNEP therapy: excellent response (AHI ≤ 5 events/h) was observed in 14 (50%); 6 (21%) achieved a partial response (AHI ≤ 50% baseline). For the 20 responders, the therapy reduced the fraction of total sleep time when peripheral oxygen saturation < 90% and improved minimum pulse oximetry oxygen saturation. Six patients experienced a minor, self-limited adverse event. Twenty-six participants (93%) stated that they would use vNEP nightly. CONCLUSIONS: In this pilot study, vNEP therapy markedly improved AHI and oxygenation in most patients with moderate OSA. The majority of participants found vNEP comfortable and preferable to prevailing OSA therapies. Further development and studies of vNEP are warranted. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Study of Variable Negative External Pressure (vNEP) in Reducing Respiratory Event in Individuals With OSA; URL: https://clinicaltrials.gov/ct2/show/NCT04718142; Identifier: NCT04718142. CITATION: Kram JA, Pelayo R. Variable negative external pressure-An alternative to continuous positive airway pressure for the treatment of obstructive sleep apnea: A pilot study. J Clin Sleep Med. 2022;18(1):305-314.


Subject(s)
Continuous Positive Airway Pressure , Sleep Apnea, Obstructive , Female , Humans , Male , Pilot Projects , Polysomnography , Prospective Studies , Sleep Apnea, Obstructive/therapy , Treatment Outcome
6.
Int J Environ Res Public Health ; 20(2)2023 Jan 09.
Article in English | MEDLINE | ID: mdl-36673897

ABSTRACT

We read with great interest the article by Naranjo-Bonilla et al. concerning changes in retinal and choroidal thickness (ChT) in patients with obstructive sleep apnea (OSA) who underwent continuous positive airway pressure treatment (CPAP) [...].


Subject(s)
Continuous Positive Airway Pressure , Sleep Apnea, Obstructive , Humans , Continuous Positive Airway Pressure/methods , Public Health , Sleep Apnea, Obstructive/therapy
8.
Rev Med Suisse ; 19(N° 809-10): 58-61, 2023 Jan 18.
Article in French | MEDLINE | ID: mdl-36660839

ABSTRACT

Hypoglossal nerve stimulation is an alternative treatment for obstructive sleep apnea syndrome (OSAS) in patients intolerant to CPAP. The INSPIRE system (unilateral hypoglossal nerve stimulation) available since 2014 and the NYXOAH system (bilateral hypoglossal nerve stimulation) available since 2019 help to treat OSAS via activation of the genioglossus muscle causing protrusion of the tongue during sleep. We present in this article the two types of hypoglossal nerve stimulators through a recent review of the literature.


La stimulation du nerf hypoglosse est un traitement alternatif du syndrome d'apnées obstructives du sommeil (SAOS) chez des patients intolérants à la CPAP (Continuous Positive Airway Pressure). Le système INSPIRE (stimulation unilatérale du nerf hypoglosse) disponible depuis 2014, et le système NYXOAH (stimulation bilatérale du nerf hypoglosse), disponible depuis 2019, permettent de traiter le SAOS via une activation du muscle génioglosse, provoquant une protrusion de la langue pendant le sommeil. Nous présentons dans cet article les 2 types de stimulateur du nerf hypoglosse à travers une revue récente de la littérature.


Subject(s)
Electric Stimulation Therapy , Sleep Apnea, Obstructive , Humans , Hypoglossal Nerve/physiology , Sleep Apnea, Obstructive/therapy , Sleep/physiology , Continuous Positive Airway Pressure
9.
Intensive Crit Care Nurs ; 74: 103335, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36651655

ABSTRACT

BACKGROUND: The application of Continuous Positive Airway Pressure (CPAP) with a helmet is increasing around the world, both inside and outside of the intensive care unit. Current published literature focus's on indications, contraindications and efficiency of Helmet CPAP in differing clinical scenarios. Few reports, summarising the available knowledge concerning technical characteristics and nursing interventions to improve patient's comfort, are available. AIM: To identify the crucial technical aspects in managing patients undergoing Helmet-CPAP, and what nursing interventions may increase comfort. METHODS: A narrative literature review of primary research published 2002 onwards. The search strategy comprised an electronic search of three bibliographic databases (Pubmed, Embase, CINAHL). RESULTS: Twenty-three studies met the inclusion criteria and were included in the review. Research primarily originated from Italy. Nine key themes emerged from the review: gas flow management, noise reduction, impact of gas flow and HME filters on delivered FiO2, filtration of exhaled gas / environmental protection, PEEP monitoring, airway pressure monitoring, active humidification of gas flow, helmet fixation and tips to implement awake prone position during Helmet-CPAP. CONCLUSIONS: A Helmet-CPAP check-list has been made of nine key interventions based on the available evidence regarding system set up, monitoring and management. Implementation of this check-list may help nurses and physicians to increase the comfort of patients treated with Helmet CPAP and enhance their compliance with long-term treatment.


Subject(s)
Continuous Positive Airway Pressure , Intensive Care Units , Humans , Italy , Monitoring, Physiologic , Noise
10.
Semin Respir Crit Care Med ; 44(1): 91-99, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36646088

ABSTRACT

This paper discusses mechanisms of hypoxemia and interventions to oxygenate critically ill patients with COVID-19 which range from nasal cannula to noninvasive and mechanical ventilation. Noninvasive ventilation includes continuous positive airway pressure ventilation (CPAP) and high-flow nasal cannula (HFNC) with or without proning. The evidence for each of these modalities is discussed and thereafter, when to transition to mechanical ventilation (MV). Various techniques of MV, again with and without proning, and rescue strategies which would include extra corporeal membrane oxygenation (ECMO) when it is available and permissive hypoxemia where it is not, are discussed.


Subject(s)
COVID-19 , Noninvasive Ventilation , Respiratory Insufficiency , Humans , COVID-19/therapy , Respiration, Artificial , Continuous Positive Airway Pressure/methods , Noninvasive Ventilation/methods , Hypoxia/therapy , Oxygen Inhalation Therapy , Respiratory Insufficiency/therapy
11.
Appl Nurs Res ; 69: 151654, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36635010

ABSTRACT

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is the treatment of choice for Obstructive Sleep Apnea (OSA) syndrome; however, interventions to improve CPAP adherence are still inconclusive. OBJECTIVE: This study aimed to examine the effectiveness of behavioral and psychosocial interventions on CPAP adherence. METHODS: The PRISMA guidelines and JBI approach for Systematic Review and Meta-analysis were used. Participants included 1) newly diagnosed patients with OSA, naive to CPAP treatment; 2) any type of behavioral and/or psychosocial intervention delivered via individual or group level; 3) CPAP adherence as an outcome. Two reviewers independently selected studies, evaluated their methodological quality, and extracted data. RESULTS: Critical appraisal was conducted on 34 of the 1657 studies, with 18 RCTs included in the final review. Telemonitoring increased the mean nightly hour of CPAP use compared to standard care (WMD = 0.76, 95 % CI = 0.31-1.20, p = 0.001, I2 = 0 %, moderate certainty of evidence). Positive results were discovered in Motivational Enhancement Therapy (MET) (WMD = 1.22, 95 % CI = 0.28-2.16, p = 0.011, I2 = 65 %, very low degree of certainty of evidence). The combined effects of cognitive therapy and education on CPAP adherence were inconclusive. Behavioral/supportive interventions improved mean nightly CPAP use in both the short term (WMD = 1.49, 95 % CI = 0.16-2.81, p = 0.029, I2 = 30 %, very low certainty of evidence) and long-term follow-up (WMD = 1.67, 95 % CI = 1.55-1.79, p = 0, I2 = 0 %, very low certainty of evidence). CONCLUSIONS: Telemonitoring improved the mean nightly hour of CPAP utilization compared with standard care. Motivational Enhancement Therapy (MET) had the most significant effect on long-term adherence.


Subject(s)
Cognitive Behavioral Therapy , Sleep Apnea, Obstructive , Humans , Continuous Positive Airway Pressure , Psychosocial Intervention , Sleep Apnea, Obstructive/therapy , Cognitive Behavioral Therapy/methods , Patient Compliance
12.
BMJ Open ; 13(1): e060166, 2023 Jan 10.
Article in English | MEDLINE | ID: mdl-36627155

ABSTRACT

OBJECTIVE: To investigate the effect of continuous positive airway pressure (CPAP) treatment on cognitive function in stroke patients with obstructive sleep apnoea (OSA) by exploring randomised controlled trials (RCTs). METHODS: Published RCTs that assessed the therapeutic effects of CPAP on cognition in stroke patients with OSA, compared with controls or sham CPAP, were included. Electronic databases, including MEDLINE, Embase and Cochrane library, were searched in October 2020 and October 2021. Risk of bias was assessed using the Cochrane collaboration tools. A random effects or fixed effects model was used according to heterogeneity. The outcomes were global cognitive gain, improvement in cognitive domain and subjective sleepiness. RESULTS: 7 RCTs, including 327 participants, comparing CPAP with control or sham CPAP treatment were included. 6 RCTs with 270 participants reported results related to global cognition, and CPAP treatment had no significant effects on global cognitive gain in stroke patients with OSA (standardised mean difference (SMD), 0.18; 95% CI, -0.07 to 0.42; p=0.153). A subgroup analysis showed that an early start to (<2 weeks post stroke) CPAP treatment after stroke significantly improved global cognition (SMD, 0.66; 95% CI, 0.18 to 1.14; p=0.007), which was not found in the case of a delayed start to CPAP treatment. However, CPAP did not significantly help with memory, language, attention or executive function. Moreover, CPAP therapy significantly alleviated subjective sleepiness (SMD, -0.73; 95% CI, -1.15 to -0.32; p≤0.001). CONCLUSIONS: Early initiation of CPAP treatment might contribute to improvement in global cognition in stroke patients with OSA. This study had the following limitations: the sample size in each included study was relatively small; the scales related to cognitive assessment or subjective sleepiness were inconsistent; and the methodological quality was not high. Future trials should focus on including a greater number of stroke patients with OSA undergoing CPAP treatment. PROSPERO REGISTRATION NUMBER: CRD42020214709.


Subject(s)
Cognition , Continuous Positive Airway Pressure , Sleep Apnea, Obstructive , Stroke , Humans , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/therapy , Sleepiness , Randomized Controlled Trials as Topic , Stroke/complications , Stroke/psychology , Treatment Outcome
13.
Zhonghua Jie He He Hu Xi Za Zhi ; 46(1): 77-81, 2023 Jan 12.
Article in Chinese | MEDLINE | ID: mdl-36617934

ABSTRACT

In this article, we searched the research literatures related to clinical investigation of non-invasive positive pressure ventilation (NPPV) in acute respiratory failure(ARF)/chronic respiratory failure(CRF) between 1st October 2021 and 30th September 2022 through Medline, and reviewed the important advances. Three prospective randomized controlled studies related to the efficacy and safety of NPPV and/or high-flow nasal cannula oxygen therapy (HFNC) on patients with COVID-19 with ARF were reported, showing that NPPV (including continuous positive airway pressure and bilevel positive airway pressure) was able to reduce the intubation rate, but the efficacy of HFNC was contradictory. In addition, progress has been made in outcome prediction models for ARF treated with NPPV, NPPV-related cardiac arrest, and the impact of human-machine interface on NPPV treatment outcomes. The effects of NPPV as preoxygenation method before intubation was reported to be able to reduce severe desaturation during intubation, especially in obese population. The use of NPPV in extubated patients resulting in reduced reintubation rate was also studied. With regard to long-term home application of NPPV, five indicators of successful initiation were proposed, but the success rate was low in clinical practice. Some reports showed that psychological support could improve the adherence to NPPV. The results of these studies contributed to the rational selection and optimal application of NPPV in clinical practice.


Subject(s)
COVID-19 , Noninvasive Ventilation , Respiratory Insufficiency , Humans , Prospective Studies , COVID-19/therapy , Noninvasive Ventilation/methods , Continuous Positive Airway Pressure/adverse effects , Continuous Positive Airway Pressure/methods , Respiratory Insufficiency/therapy , Respiratory Insufficiency/etiology , Intubation, Intratracheal
14.
Cephalalgia ; 43(1): 3331024221128273, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36620891

ABSTRACT

BACKGROUND: Oxygen inhalation aborts cluster headache attacks, and case reports show the effect of continuous positive airway pressure. The aim of this study was to investigate the prophylactic effect of continuous positive airway pressure in chronic cluster headache. METHODS: This was a randomized placebo-controlled triple-blind crossover study using active and sham continuous positive airway pressure treatment for chronic cluster headache. Patients entered a one month's baseline period before randomly being assigned to two months' active continuous positive airway pressure treatment followed by a four weeks' washout period and two months' sham continuous positive airway pressure or vice versa. Primary outcome measure was number of cluster headache attacks/week. RESULTS: Of the 30 included participants (12 males, median age 49.5 years, min-max 20-66 years), 25 completed both treatment/sham cycles (two discontinued, three lost to follow-up). The median number of cluster headache attacks per week was reduced from 8.25 (0.75-89.75) attacks to 6.25 (0-56.00) attacks for active continuous positive airway pressure and to 7.50 (0.50-43.75) attacks for sham continuous positive airway pressure, but there was no difference in active versus sham (p = 0.904). One patient had a serious adverse event during active treatment, none occurred during sham treatment. CONCLUSIONS: Continuous positive airway pressure treatment did not reduce the number of cluster headache attacks compared to sham treatment in chronic cluster headache patients. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT03397563.


Subject(s)
Cluster Headache , Humans , Male , Middle Aged , Cluster Headache/therapy , Continuous Positive Airway Pressure , Cross-Over Studies , Double-Blind Method , Treatment Outcome
15.
J Clin Sleep Med ; 19(1): 111-117, 2023 Jan 01.
Article in English | MEDLINE | ID: mdl-36591793

ABSTRACT

STUDY OBJECTIVES: Physician-patient interactions influence the immediate encounter and leave lasting impressions for future health care encounters. We aimed to understand patient experiences and decision-making for considering sleep surgery, in terms of barriers and communication behaviors that facilitate or hinder referral for consideration of sleep surgery management of obstructive sleep apnea (OSA) when continuous positive airway pressure (CPAP) therapy has failed. METHODS: We employed qualitative methods, using semistructured interviews of adults with OSA who presented for sleep surgery consultation after unsatisfactory therapy with CPAP. Open-ended questions traced symptoms and progression of sleep apnea burden, trials of noninvasive OSA therapies, outcomes, and patient expectations and concerns. The interviews were audio-recorded, transcribed, and analyzed using content analysis to identify themes. RESULTS: Ten adult patients with OSA were enrolled March through April 2021 and reached predominant thematic saturation. Barriers to sleep surgery consultation included: (1) delays in OSA diagnosis due to limited OSA awareness among patients or primary providers and patients' perceived inconvenience of sleep testing, (2) patients faulted for slow progress, (3) patient-reported lack of urgency by providers in troubleshooting noninvasive management options, (4) scheduling delays and waitlists, and (5) cost. Patients were receptive to noninvasive treatment options, but inadequate improvement led to frustration after multiple encounters. Patients appreciated empathetic providers who shared information through transparent and understandable explanations and who presented multiple treatment options. CONCLUSIONS: Experiences of patients with OSA highlight the need for shared decision-making through improved communication of unresolved concerns and alternative management options, including timely referral for sleep surgery consultation when indicated. CITATION: Ikeda AK, McShay C, Marsh R, et al. Barriers and communication behaviors impacting referral to sleep surgery: qualitative patient perspectives. J Clin Sleep Med. 2023;19(1):111-117.


Subject(s)
Communication , Health Services Accessibility , Physician-Patient Relations , Referral and Consultation , Sleep Apnea, Obstructive , Adult , Humans , Continuous Positive Airway Pressure , Referral and Consultation/statistics & numerical data , Sleep Apnea, Obstructive/surgery , Sleep Apnea, Obstructive/therapy , Treatment Failure
17.
PLoS One ; 17(12): e0269147, 2022.
Article in English | MEDLINE | ID: mdl-36584229

ABSTRACT

OBJECTIVE: Continuous Positive Airway Pressure (CPAP) is recommended in the treatment of respiratory distress syndrome of premature newborns, however there are significant barriers to its implementation in low-resource settings. The objective of this study was to evaluate the feasibility of use and integration of Vayu bCPAP Systems into the newborn unit at Muhimbili National Hospital in Tanzania. STUDY DESIGN: A prospective qualitative study was conducted from April 6 to October 6 2021. Demographic and clinical characteristics of patients treated with Vayu bCPAP Systems were collected and analyzed. Healthcare workers were interviewed until thematic saturation. Interviews were transcribed, coded, and analyzed using a framework analysis. RESULTS: 370 patients were treated with Vayu bCPAP Systems during the study period. Mean birth weight was 1522 g (500-3800), mean duration of bCPAP treatment was 7.2 days (<1-39 d), and survival to wean was 81.4%. Twenty-four healthcare workers were interviewed and perceived Vayu bCPAP Systems as having become essential for treating neonatal respiratory distress at MNH. Key reasons were that Vayu bCPAP Systems improve patient outcomes, are easy to use, and more patients are now able to receive quality care. Barriers to integration included durability of oxygen tubing material and training. CONCLUSIONS: It was feasible to implement and integrate Vayu bCPAP Systems into the care of neonates at Muhimbili National Hospital.


Subject(s)
Continuous Positive Airway Pressure , Respiratory Distress Syndrome, Newborn , Infant, Newborn , Humans , Tanzania , Prospective Studies , Feasibility Studies , Treatment Outcome , Respiratory Distress Syndrome, Newborn/therapy , Hospitals
19.
Sleep Med ; 101: 543-549, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36577225

ABSTRACT

BACKGROUND: Sleep-disordered breathing (SDB) is a risk factor for recurrent adverse events in patients with coronary artery disease (CAD). However, the prognosis of continuous positive alveolar pressure (CPAP) treatment for SDB with CAD remains unknown. METHODS: A total of 281 consecutive patients with stable CAD requiring percutaneous coronary intervention (PCI) were included and classified into three groups according to the concomitance of SDB and CPAP treatment (untreated SDB group, n = 61; CPAP-SDB group, n = 24; and non-SDB group, n = 138). The incidence of major adverse cardiac and cerebrovascular events (MACCEs) within a year after PCI was compared between the three groups. The characteristics of the culprit plaques, including macrophage accumulation, were further assessed using optical coherence tomography. RESULTS: The incidence of MACCEs was significantly different among the three groups (p = 0.037), with the highest incidence in the untreated-SDB group (22.9%) and 8.3% and 10.1% in the CPAP-SDB and non-SDB groups, respectively. The incidence of MACCEs at 1 year was significantly lower in patients with appropriate CPAP use than that in inadequately treated patients with SDB (0.0 vs. 22.5%, p = 0.048). Macrophage accumulation differed significantly among the three groups, with the highest accumulation in the untreated SDB group. CONCLUSIONS: CPAP treatment for SDB may be associated with a lower incidence of MACCEs following PCI and a lower prevalence of macrophages in the culprit plaques.


Subject(s)
Coronary Artery Disease , Percutaneous Coronary Intervention , Sleep Apnea Syndromes , Humans , Coronary Artery Disease/complications , Coronary Artery Disease/therapy , Continuous Positive Airway Pressure/adverse effects , Percutaneous Coronary Intervention/adverse effects , Sleep Apnea Syndromes/complications , Sleep Apnea Syndromes/therapy , Prognosis
20.
J Med Case Rep ; 16(1): 486, 2022 Dec 27.
Article in English | MEDLINE | ID: mdl-36575498

ABSTRACT

BACKGROUND: Coronavirus disease 2019 is a highly transmissible and pathogenic viral infection caused by severe acute respiratory syndrome coronavirus 2, a novel coronavirus that was identified in early January 2020 in Wuhan, China, and has become a pandemic disease worldwide. The symptoms of coronavirus disease 2019 range from asymptomatic to severe respiratory failure. In moderate and severe cases, oxygen therapy is needed. In severe cases, high-flow nasal cannula, noninvasive ventilation, and invasive mechanical ventilation are needed. Many ventilation methods in mechanical ventilation can be used, but not all are suitable for coronavirus disease 2019 patients. Airway pressure release ventilation, which is one of the mechanical ventilation methods, can be considered for patients with moderate-to-severe acute respiratory distress syndrome. It was found that oxygenation in the airway pressure release ventilation method was better than in the conventional method. How about airway pressure release ventilation in coronavirus disease 2019 patients? We report a case of confirmed coronavirus disease 2019 in which airway pressure release ventilation mode was used. CASE PRESENTATION: In this case study, we report a 74-year-old Chinese with a history of hypertension and uncontrolled diabetes mellitus type 2. He came to our hospital with the chief complaint of difficulty in breathing. He was fully awake with an oxygen saturation of 82% on room air. The patient was admitted and diagnosed with severe coronavirus disease 2019, and he was given a nonrebreathing mask at 15 L per minute, and oxygen saturation went back to 95%. After a few hours with a nonrebreathing mask, his condition worsened. On the third day after admission, saturation went down despite using noninvasive ventilation. We decided to intubate the patient and used airway pressure release ventilation mode. Finally, after 14 days of being intubated, the patient could be extubated and discharged after 45 days of hospitalization. CONCLUSION: Early use of airway pressure release ventilation may be considered as one of the ventilation strategies to treat severe coronavirus disease 2019 acute respiratory distress syndrome. Although reports on airway pressure release ventilation and protocols on its initiation and titration methods are limited, it may be worthwhile to consider, given its known ability to maximize alveolar recruitment, preserve alveolar epithelial integrity, and surfactant, all of which are crucial for handling the "fragile" lungs of coronavirus disease 2019 patients.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Male , Humans , Aged , Continuous Positive Airway Pressure/adverse effects , Continuous Positive Airway Pressure/methods , COVID-19/complications , COVID-19/therapy , Lung , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Respiration, Artificial , SARS-CoV-2
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