Effectiveness of Continuous Positive Airway Pressure in Alleviating Hypoxemia and Improving Exertional Capacity at Altitude.

Strickland, Brian, Elan Small, Mary Ryan, and Ryan Paterson. Effectiveness of continuous positive airway pressure in alleviating hypoxemia and improving exertional capacity at altitude. High Alt Med Biol. 00:000-000, 2024. Introduction: Decreased oxygen saturation and exercise tolerance are commonly experienced at high altitude. Continuous positive airway pressure (CPAP) devices have become increasingly portable and battery powered, providing a potentially unique new therapeutic modality for treatment of altitude-related illnesses. This study evaluated the potential use of CPAP devices to improve and maintain oxygen saturation at altitude, both at rest and with exertion, to evaluate the feasibility of using this device at altitude. Methods: Subjects were taken to Mount Blue Sky and monitored while they hiked to the summit (4,350 m), maintaining a consistent level of exertion. Subjects hiked for 0.7 km both with and without CPAP set to 10 cmH2O pressure. Continuous vital signs were collected during the hike and recovery period. Results: All subjects completed the hike wearing CPAP devices at a vigorous level of exertion. Mean oxygen saturation of the CPAP group (M = 83.8%, SD = 3.72) was significantly higher than that of the control group during exertion (M = 78.7%, SD = 2.97); p = 0.005. Recovery after exertion was quicker in the CPAP group than the control group. Three subjects experienced claustrophobia requiring a brief pause, but were able to complete their exercise trial without removing equipment or experiencing adverse events. When pauses from claustrophobia were excluded, there was no difference in completion time between the groups (p = 0.06). Conclusion: CPAP reliably improved oxygen saturation at rest and during vigorous exertion at high altitude. Its ability to correct hypoxemia, even with physical exertion, may prove useful after further study as a portable self-carried device to prevent and treat altitude-related illness, or to improve safety in high-altitude rescues.

Provision of bubble continuous positive airway pressure for the stabilisation of extremely and very preterm infants after birth: A single-centre experience.

AIM: To describe the effect of resuscitation with bubble CPAP (bCPAP) versus T-piece device at birth on early clinical parameters and hospital outcomes in infants born <32 weeks gestation. METHODS: This is a single-centre pre- and post-implementation study comparing outcomes in two epochs. In epoch 1 (1 July 2013-31 December 2014), infants were managed with non-humidified gas using Neopuff® T-piece devices to support breathing after birth. In epoch 2 (1 March 2020-31 December 2021), routine application of bCPAP with humidified gas was introduced at birth. RESULTS: Three hundred fifty-seven patients were included (176 epoch 1, 181 epoch 2). The mean gestational age was 28 ± 2 weeks. The demographics of the two epochs were comparable. There were significant improvements in outcomes of infants in epoch 2 with less infants intubated at delivery (16% vs. 4%, P ≤ 0.001), improved 5 min Apgar (7 vs. 8, P ≤ 0.001), reduced need for ventilation (21% vs. 8.8%, P ≤ 0.001), duration of ventilation in the first 72 h (9.6 vs. 4.6 h) and mortality (10.8% vs. 1.7%, P ≤ 0.001). There was, increased incidence of chronic lung disease (30% vs. 55%, P = 0.02) but no increase in infants discharged on oxygen (3.8% vs. 5%, P = 0.25). Similar findings were observed in a subgroup of infants born <25 weeks' gestation with no increase in the incidence of CLD. CONCLUSION: Introducing application of bCPAP from the first breaths in infants <32 weeks' gestation was associated with better short-term outcomes and mortality, albeit with increased incidence of CLD. The subgroup of infants born <25 weeks' gestation showed similar change in outcomes, with no increase in CLD.

The latest on positive airway pressure for pediatric obstructive sleep apnea.

INTRODUCTION: Obstructive sleep apnea (OSA) is an important and evolving area in the pediatric population, with significant sequelae when not adequately managed. The use of positive airway pressure (PAP) therapy is expanding rapidly and is being prescribed to patients with persistent OSA post adenotonsillectomy as well as those children who are not surgical candidates including those with medical complexity. AREAS DISCUSSED: This article provides a state-of-the-art review on the diagnosis of pediatric OSA and treatment with positive airway pressure (PAP). The initiation of PAP therapy, pediatric interface considerations, PAP mode selection, administration and potential complications of PAP therapy, factors influencing PAP adherence, the use of remote ventilation machine downloads, considerations surrounding follow-up of patients post PAP initiation and evaluation of weaning off PAP will be reviewed. The literature search was conducted via PubMed, Cochrane Library and Google Scholar databases through to March 2024. EXPERT OPINION: Further research is required to address barriers to adherence. Further innovation of home monitoring devices for both the diagnosis and assessment of OSA is required, given the limited pediatric sleep medicine resources in several countries worldwide.

Effectiveness of High-Flow Nasal Cannula (RAM Cannula) With T-piece Resuscitator to Deliver Continuous Positive Airway Pressure (CPAP) During Neonatal Transport.

Background Newborns frequently experience respiratory distress (RD), necessitating preventive management during transportation. The use of Continuous Positive Airway Pressure (CPAP) is crucial in mitigating RD in neonates, particularly during transit. This study aims to assess the feasibility and efficacy of utilizing a RAM cannula (Neotech Products, Valencia, USA) with a T-piece resuscitator to deliver CPAP during neonatal transport. The objective is to evaluate the response of transported neonates to this intervention, including improvements in distress, surfactant requirements, ventilator dependency, and complications. Method and material Neonates with RD qualifying for CPAP support at birth and requiring transport to Neonatal Intensive Care Unit (NICU) care were included. The average duration of transport was 38 minutes (range 12 minutes to 2 hours). RAM cannula with a T-piece resuscitator was used for CPAP delivery during transportation. Vital parameters and interventions were monitored during transit, and outcomes were compared with inborn neonates receiving standard CPAP in the labor room. Results Out of 48 babies, nine babies required surfactant, and four needed invasive ventilation, with three developing a nasal injury. Compared to in-house preterm babies, these babies had more Positive End Expiratory Pressure (PEEP) knob adjustment, desaturation episodes, late surfactant administration, and intubation needs. Conclusion A high-flow nasal cannula combined with a T-piece resuscitator emerges as a promising modality for CPAP delivery during neonatal transportation, demonstrating efficacy with minimal complications.

Cardio-metabolic health effects of CPAP treatment for sleep apnoea during weight loss: A randomised controlled pilot trial.

BACKGROUND AND AIMS: This study assessed whether the addition of continuous positive airway pressure (CPAP) during weight loss would enhance cardiometabolic health improvements in patients with obesity and Obstructive Sleep Apnoea (OSA). METHODS AND RESULTS: Patients with overweight or obesity, pre-diabetes and moderatesevere OSA were randomised to receive CPAP therapy with a weight loss programme (CPAP+WL) or a weight loss programme alone (WL alone). PRIMARY OUTCOME: 2-hour glucose assessed by an oral glucose tolerance test. SECONDARY OUTCOMES: 24 hr blood pressure, body composition (DEXA) and fasting blood markers. 17 patients completed 3-month follow-up assessments (8 CPAP+WL and 9 WL alone). Overall, participants in both groups lost ∼12 kg which reduced polysomnography determined OSA severity by ∼45 %. In the CPAP+WL group, CPAP use (compliance 5.29 hrs/night) did not improve any outcome above WL alone. There was no improvement in 2-hour glucose in either group. However, in the pooled (n = 17) analysis there were overall improvements in most outcomes including insulin sensitivity (.000965 units, p = .008), sleep systolic BP (- 16.2 mmHg, p = .0003), sleep diastolic BP (-9.8 mmHg, p = 0.02), wake diastolic BP (- 4.3 mmHg, p = .03) and sleepiness (Epworth Sleepiness Score -3.2, p = .0003). In addition, there were reductions in glucose area under the curve (-230 units, p = .009), total (-0.86 mmol/L, p = 0.006) and LDL cholesterol (-0.58 mmol/L, p = 0.007), triglycerides (-0.75 mmol/L, p = 0.004), fat mass (-7.6 kg, p < .0001) and abdominal fat (-310 cm3, p < .0001). CONCLUSION: Weight loss reduced OSA and improved sleepiness and cardiometabolic health. These improvements were not further enhanced by using CPAP. Results suggest weight loss should be the primary focus of treatment for patients with OSA and obesity.

Knowledge and attitude regarding obstructive sleep apnoea among medical and dental practitioners working in North-Eastern Peninsular Malaysia: A comparative cross-sectional study.

BACKGROUND: Obstructive Sleep Apnea (OSA) is a temporary airflow obstruction during periods of sleep. Patients with OSA often suffer from poor work performance, compromised sleep quality, and low quality of life which may lead to a life-threatening event. Adequate knowledge and a positive attitude toward OSA among medical and dental practitioners are crucial to the initial diagnosis and treatment. OBJECTIVE: This study aimed to identify the differences in knowledge and attitude toward OSA between medical and dental practitioners working in North-Eastern Peninsular Malaysia. METHODS: A comparative cross-sectional study was performed from February 2020 to February 2021. A total of fifty-two medical practitioners and fifty-two dental practitioners working at university-based outpatient clinics, government health clinics, and oral health clinics located in Kelantan State of Malaysia participated in the study, and data were collected by the structured questionnaire including sociodemographic inquiry and OSAKA questionnaire by non-probability stratified random sampling. The Mann-Whitney U test was used to compare knowledge and attitude scores between the two groups. RESULTS: The mean age of the respondents was 34.6 years. The current study shows that 92.3% of medical doctors and 96.1% of dental doctors were able to correctly answer the question "Most of the patients with OSA snore" a significant finding in our study. Only 1% of medical professionals could answer seventeen questions correctly with a median score of 11, and only 1% of dental professionals could answer sixteen questions correctly with a median score of 9. None of them could provide an accurate answer to all the knowledge questions. Medical and dental practitioners exhibited different knowledge levels on OSA (z- statistics=-4.39, U = 827.00 with p <  0.05, and effect size, r = 0.61). However, no significant differences were found in total knowledge score by gender (p-value>0.05), ethnicity (p-value>0.05), total service years (p-value>0.05), and training attended. In addition, significant differences in attitude levels between medical and dental practitioners have been observed (z-statistics=-3.42, U = 725.00 with p <  0.05, and effect size, r = 0.47). Nevertheless, no significant differences have been seen in total attitude score by ethnicity (p-value >  0.05), total service years (p-value >  0.05), attending training on OSA (p-value >  0.05), and professional status (p-value >  0.05) except gender (p-value <  0.05). CONCLUSION: A Significant difference is evident concerning knowledge and attitude toward OSA diagnosis and management between medical and dental practitioners working in North-Eastern Peninsular Malaysia. Medical practitioners in this study recorded a higher knowledge and attitude score compared to dental practitioners.

[Home CPAP Remote Monitoring as a System to Control Adaptation and Titration in Obstructive Sleep Apnoea and its Impact on the Management of this Pathology (T-CPAP Project)]. / Impacto de la telemonitorización como sistema para una adecuada titulación y adaptación de la CPAP domiciliaria en la apnea obstructiva del sueño (proyecto T-CPAP).

Introduction: Continuous Positive Airway Pressure (CPAP) constitutes the most effective treatment for Obstructive Sleep Apnea (OSA). Automatic titration systems (ATS) are predominantly used to achieve adaptation to the equipment. Home CPAP devices allow telemonitoring (TM) of the same parameters as those provided by ATS but with access to continuous usage data. Under this premise, we conducted a study on the potential validity of TM for home CPAP devices as a titration system, its direct impact on proper adaptation (AD) to the equipment, and secondarily on the healthcare resources employed to achieve it. Material and methods: An observational study involving 318 patients with OSA who were titrated using TM to achieve AD to CPAP. Patients with OSA were consecutively recruited and evaluated at 1, 3, and 6 months after initiating treatment. Results were compared with a historical group of 307 patients with OSA who achieved AD to CPAP using ATS. Additionally, we assessed the impact on required healthcare resources. Results: Patients with OSA who initiated CPAP treatment with TM over the first six months showed a similar AD rate compared to the historical group titrated using ATS, with lower resource usage in the TM group. Conclusion: Data provided by TM of home CPAP devices allow for titration and achieving similar AD as with ATS in non-complex patients.

Real-life evaluation of NIV to CPAP switch in patients with chronic respiratory failure. A case control study.

BACKGROUND: Non-invasive ventilation (NIV) is a standard of care for hypercapnic chronic respiratory failure (CRF). Obstructive sleep apnea syndrome (OSA) frequently contributes to hypoventilation in CRF patients. CPAP improves hypercapnia in selected COPD and obese patients, like NIV. We aimed to describe the profile of patients switching from NIV to CPAP in a cohort of patients on long-term ventilation and to identify the factors associated with a successful switch. METHODS: In this case-control study, 88 consecutive patients who were candidates for a NIV-CPAP switch were compared with 266 controls among 394 ventilated patients treated at the Dijon University Hospital between 2015 and 2020. They followed a standardized protocol including a poly(somno)graphy recorded after NIV withdrawal for three nights. CPAP trial was performed if severe OSA was confirmed. Patients were checked for recurrent hypoventilation after 1 and 23[14-46] nights under CPAP. RESULTS: Patients were 53% males, median age 65 [56-74] years, and median BMI 34 [25-38.5] kg/m2. Sixty four percent of patients were safely switched and remained on long-term CPAP. In multivariate analysis, the probability of a NIV-CPAP switch was correlated to older age (OR: 1.3 [1.01-1.06]), BMI (OR: 1.7 [1.03-1.12]), CRF etiology (OR for COPD: 20.37 [4.2-98,72], OR for obesity: 7.31 [1.58-33.74]), circumstances of NIV initiation (OR for acute exacerbation: 11.64 [2.03-66.62]), lower pressure support (OR: 0.90 [0.73-0.92]), lower baseline PaCO2 (OR: 0.85 [0.80-0.91]) and lower compliance (OR: 0.76 [0.64-0.90]). Among 72 patients who went home under CPAP, pressure support level was the only factor associated with the outcome of the NIV-CPAP switch, even after adjustment for BMI and age (p=0.01) with a non-linear correlation. Etiology of chronic respiratory failure, age, BMI, baseline PaCO2, circumstances of NIV initiation, time under home NIV or NIV compliance were not predictive of the outcome of the NIV-CPAP switch. CONCLUSIONS: A NIV-CPAP switch is possible in real life conditions in stable obese and COPD patients with underlying OSA.

Effect of CPAP Treatment on Cardiovascular Outcomes.

INTRODUCTION: Randomized controlled trials (RCT) have not demonstrated a role for continuous positive airway pressure (CPAP) on the secondary prevention of major cardiovascular events in obstructive sleep apnea (OSA) patients. However, participants in RCTs are substantially different from real-world patients. Therefore, we aimed to assess the effect of CPAP treatment on major cardiovascular events in real-world OSA patients. METHODS: Population-based longitudinal observational study including all OSA patients with an active CPAP prescription at the beginning of 2011 in Catalonia, Spain, that terminated CPAP treatment during 2011 and did not have CPAP prescriptions between 2012-2015; and propensity-score-matched OSA patients that continued CPAP treatment until the end of 2015 or death. Adjusted hazard ratios were used to assess the association between CPAP treatment and overall and cardiovascular mortality, cardiovascular hospitalizations, or major adverse cardiovascular events (MACEs). RESULTS: 3638 CPAP terminators and 10,914 propensity-score-matched continuators were included (median age 67 [57-77] years, 71.4% male). During a median follow-up of 47.9 months CPAP continuators showed a lower risk of cardiovascular death than terminators (hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.50-0.75) after adjusting by age, sex and key comorbidities. Similar results were found for cardiovascular hospitalizations (HR: 0.87; 95% CI: 0.76-0.99) and MACEs (HR: 0.84; 95% CI: 0.75-0.95). CONCLUSION: CPAP treatment continuation could be associated with a significantly lower risk of major cardiovascular events in real-world OSA patients. This result highlights the importance of including real-world patients in studies on OSA.

Continuous positive airway pressure is unsafe for radiofrequency ablation of lung cancer under sedation: a randomised controlled trial.

OBJECTIVE: To evaluate the safety of a minimum continuous positive airway pressure of 4 cmH2O (CPAP + 4) during computed tomography (CT)-guided radiofrequency ablation (RFA) for lung malignancies under procedural sedation and analgesia (PSA). METHODS: This was a prospective, randomised, single-blind, parallel-group, placebo-controlled trial with an open-label medical device conducted at a single tertiary university hospital in Barcelona, Spain. Forty-six patients over 18 years of age scheduled for CT-guided RFA of a malignant pulmonary tumour under PSA were randomised to receive either CPAP + 4 or a modified mask for placebo CPAP (Sham-CPAP). Exclusion criteria included contraindications for RFA, refusal to participate, inability to understand the procedure or tolerate the CPAP test, lung biopsy just prior to RFA, intercurrent diseases, or previous randomisation for additional pulmonary RFA. Primary outcomes were the percentage of patients reporting at least one serious adverse event (SAE), classification for complications from the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and Clavien-Dindo classifications for complications, hospital stay, and readmissions. Secondary outcomes included adverse events (AEs), respiratory parameters, airway management, and the local radiological efficacy of pulmonary ablation. RESULTS: CPAP + 4 prolonged hospital stay (1.5 ± 1.1 vs. 1.0 ± 0 inpatient nights, p = 0.022) and increased the risk of AE post-RFA (odds ratio (95% CI): 4.250 (1.234 to 14.637), p = 0.021 with more pneumothorax cases (n = 5/22, 22.7% vs. n = 0/24, 0%, p = 0.019). Per-protocol analysis revealed more SAEs and CIRSE grade 3 complications in the CPAP + 4 group (23.5% vs. 0%, p = 0.036). No significant differences were found in the effectiveness of oxygenation, ventilation, or pulmonary ablation. CONCLUSION: CPAP is unsafe during CT-guided RFA for lung cancer under PSA even at the lowest pressure setting. TRIAL REGISTRATION: ClinicalTrials.Gov, ClinicalTrials.gov ID NCT02117908, Registered 11 April 2014, https://www. CLINICALTRIALS: gov/study/NCT02117908 CRITICAL RELEVANCE STATEMENT: This study highlights the hazards of continuous positive airway pressure during radiofrequency ablation of lung cancer, even at minimal pressures, deeming it unsafe under procedural sedation and analgesia in pulmonary interventional procedures. Findings provide crucial insights to prioritise patient safety. KEY POINTS: No prior randomised controlled trials on CPAP safety in percutaneous lung thermo-ablation. Standardised outcome measures are crucial for radiology research. CPAP during lung RFA raises hospital stay and the risk of complications. CPAP is unsafe during CT-guided RFA of lung cancer under procedural sedoanalgesia.

Effectiveness of continuous positive airway pressure therapy on romantic relationships and intimacy among individuals with obstructive sleep apnea: A systematic review and a meta-analysis.

Obstructive sleep apnea is a common yet often overlooked chronic sleep disorder with significant health implications globally. Bedpartners play a vital role in motivating individuals with obstructive sleep apnea to seek medical help, though their sleep quality may suffer, straining the couple's relationship. From September 2023 to January 2024, utilizing PubMed, Scopus, BioMed Central, Cochrane Library, ScienceDirect and www.clinicaltrials.gov databases, this systematic review meticulously examined data from 27 studies to investigate how continuous positive airway pressure therapy, recognized as the gold-standard for treating obstructive sleep apnea, may positively influence psychological dynamics within couples. Additionally, a meta-analysis was conducted on nine studies, to assess the effect of continuous positive airway pressure on erectile function, which is often compromised in patients with obstructive sleep apnea. The PRISMA checklist and specific quality assessments were followed to ensure methodological rigour and transparency. Findings reveal positive changes in conflict resolution for patients with obstructive sleep apnea post- continuous positive airway pressure adaptation (p < 0.05). Emotional functioning (p = 0.002) and social relationships (p < 0.001) also show improvements in bedpartners. While six subjective assessments indicate enhancements in sexual quality of life for patients with obstructive sleep apnea, challenges related to continuous positive airway pressure use as a barrier to intimacy are acknowledged. Focusing on male patients with obstructive sleep apnea, findings demonstrated a substantial improvement in erectile function post-continuous positive airway pressure utilization, with a Z-score of 4.84 (p < 0.00001). Female patients with obstructive sleep apnea using continuous positive airway pressure show no significant improvements in sexual functioning, while female bedpartners report positive changes. These insights emphasize the importance of holistic approaches in addressing the impact of obstructive sleep apnea on both individuals and their relationships.

Combination Therapies with an Oral Appliance in the Management of Obstructive Sleep Apnea.

Combination therapy (CT) with a mandibular advancement device (MAD) and positive airway pressure (PAP) has been advocated for patients for whom neither MAD nor PAP alone provides an efficacious and tolerated therapy. This article reviews the small and limited, but growing body of evidence in support of CT and highlights details in its implementation. In most studies, CT was found to be preferred by many, but not all PAP-intolerant patients. CT can be more efficacious than either MAD or PAP alone.

Association between elevated homocysteine levels and obstructive sleep apnea hypopnea syndrome: a systematic review and updated meta-analysis.

Objective: This study aimed to distinguish between healthy controls and patients with OSAHS regarding homocysteine (HCY) levels and investigate how individuals with OSAHS respond to continuous positive airway pressure ventilation (CPAP) in terms of serum and plasma HCY levels. Methods: To ascertain published articles about OSAHS, an exhaustive search was performed across medical databases, encompassing PubMed, Web of Science, EMBASE, CNKI, and Cochrane Library, until January 2, 2024. This study reviewed the literature regarding HCY levels in individuals with OSAHS and control groups, HCY levels under pre- and post-CPAP treatment, the Pearson/Spearman correlation coefficients between HCY levels and apnea-hypopnea index (AHI), and the hazard ratio (HR) of HCY levels concerning the occurrence of major adverse cerebrocardiovascular events (MACCEs) in patients with OSAHS. Meta-analyses were performed using weighted mean difference (WMD), correlation coefficients, and HR as effect variables. The statistical analysis was conducted using the R 4.1.2 and STATA 11.0 software packages. Results: In total, 33 articles were selected for the final analysis. The OSAHS group exhibited significantly higher serum/plasma HCY levels than the control group (WMD = 4.25 µmol/L, 95% CI: 2.60-5.91, P< 0.001), particularly among individuals with moderate and severe OSAHS. Additionally, subgroup analysis using mean age, ethnicity, mean body mass index, and study design type unveiled significantly elevated levels of HCY in the serum/plasma of the OSAHS group compared to the control group. CPAP treatment can significantly decrease serum/plasma HCY levels in patients with OSAHS. Moreover, elevated HCY levels in individuals with OSAHS could be one of the risk factors for MACCEs (adjusted HR = 1.68, 95% CI = 1.10-2.58, P = 0.017). AHI scores show a positive correlation with serum/plasma HCY levels. Conclusion: Patients with OSAHS had elevated serum/plasma HCY levels compared to healthy controls; however, CPAP therapy dramatically decreased HCY levels in patients with OSAHS. In patients with OSAHS, elevated HCY levels were linked with an increased risk of MACCEs, and HCY was positively connected with AHI values. HCY levels may serve as a useful clinical indicator for determining the severity and efficacy of OSAHS treatments. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024498806.

Association between a composite measure of sleep health and depressive symptoms in patients with obstructive sleep apnea treated with CPAP therapy: Real-world data.

OBJECTIVE: Sleep health is known to be multidimensional, and there is increasing clinical interest in composite sleep health scores that capture the number of adverse sleep characteristics. We investigated whether a composite sleep health score was associated with depressive symptoms in patients with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). METHODS: Participants were OSA patients using CPAP (n = 1768, (92.1 % men, age 52.7 ± 10.7 years) attending sleep clinics in Japan. A cross-sectional survey conducted in 2020 assessed self-reported sleep and depressive symptoms. Sleep health was categorized as "good' or "poor' on five dimensions: satisfaction, daytime sleepiness, mid-sleep time, efficiency, and duration. A composite sleep health score was calculated by summing the "poor' dimensions. Depressive symptoms were assessed using two items from the Patient Health Questionnaire (PHQ-2). Associations between sleep health and depressive symptoms were assessed using multivariable logistic regression analysis. RESULTS: Individual sleep health symptoms of poor satisfaction and efficiency were significantly associated with depressed mood; poor satisfaction, daytime sleepiness, and duration were significantly associated with loss of interest; and poor satisfaction, efficiency, and duration were significantly associated with depressive symptoms. Composite sleep health scores were associated with greater odds of depressive symptoms in a graded manner. CONCLUSIONS: Individual and composite sleep health scores were associated with depressive symptoms. Measures of multidimensional sleep health may provide a better understanding of the association between poor sleep and depressive symptoms among patients with OSA using CPAP, accounting for CPAP adherence, leading to improved intervention strategies.

The Curious Role of PAI-1 in Severe Obstructive Sleep Apnea.

Plasminogen activator inhibitor-1 (PAI-1) has a significant role in fibrinolysis, atherogenesis, cellular senescence, and chronic inflammation. OSA (obstructive sleep apnea) leads to increased PAI-1 levels and the development of cardiovascular disease (CVD). The aim of this study was to determine the effects of CPAP therapy on coagulation parameters and PAI-1 in patients with severe OSA. This prospective, controlled study enrolled 57 patients who were newly diagnosed with severe OSA, 37 of whom had had good CPAP adherence after 6 months of therapy (usage of the device for at least 4 h per night), and their data were analyzed. The analysis showed a statistically significant increase in D-dimer values before CPAP therapy (415 (316.5-537.5)) vs. after therapy (499 (327-652)), p = 0.0282, and a decrease in fibrinogen values (3.665 ± 0.752 before CPAP therapy vs. 3.365 ± 0.771 after therapy, p = 0.0075)). PAI-1 concentration values before and after CPAP therapy did not differ significantly (17.35 ± 7.01 ng/mL before CPAP therapy vs. 17.42 ± 6.99 ng/mL after therapy, p = 0.9367). This study shows a tendency for fibrinolytic capacity to improve in patients with OSA after CPAP therapy, although PAI-1 levels did not differ significantly.

Association between obstructive sleep apnea (OSA) and COVID-19 severity.

Obstructive sleep apnea and sleep-related hypoxia have been associated with higher rates of hospitalization and mortality among patients with Coronavirus disease 2019 (COVID-19). We further explored the association between obstructive sleep apnea, COVID-19 severity and related mortality. In addition, we examined the effects of clinical and demographic parameters on COVID-19. In this retrospective study, we included adult patients who were diagnosed with COVID-19 prior to the Omicron variant identification. We compared the severity of COVID-19 and mortality with the diagnosis of obstructive sleep apnea. The study population included 44,275 patients who tested positive for COVID-19. Of these, 97% had mild or asymptomatic disease, 1.2% had moderate disease, and 1.8% had severe disease. Obstructive sleep apnea was diagnosed in 980 (2.2%) patients. In a multivariate analysis, obstructive sleep apnea diagnosis increased the risk of severe COVID-19 by 1.6 (95% confidence interval: 1.1-2.4) compared with mild disease. However, no increase in mortality was associated with obstructive sleep apnea. Interestingly, patients with moderate and high socioeconomic status had a 1.6 times higher risk for severe COVID-19 than patients from the low socioeconomic status group (95% confidence interval: 1.2-2.1 and 95% confidence interval: 1.1-2.3, respectively). The risk of dying due to COVID-19 was 1.6 (95% confidence interval: 1.1-2.5) and 3.1 (95% confidence interval: 1.8-5.3) times higher in patients with medium and high socioeconomic status, respectively, compared with patients with low socioeconomic status. Diagnosis of obstructive sleep apnea was found to be an independent risk factor for severe COVID-19. The higher the socioeconomic status, the higher the risk of severe COVID-19 morbidity and mortality.

The Relationship between Leptin Levels and Continuous Positive Airway Pressure Treatment: A Cluster Analysis.

Objective Leptin is an appetite-suppressing hormone released by adipose tissue that plays an important role in severe obstructive sleep apnea syndrome (OSAS). However, it is unclear whether leptin levels are a useful biomarker for this syndrome. The present study aimed to assess the effect of continuous positive airway pressure (CPAP) treatment on the syndrome according to leptin levels, using a cluster classification based on clinical features of the syndrome. Materials and Methods We performed a hierarchical cluster analysis of data from 97 OSAS patients diagnosed via polysomnography. We also evaluated the effect after 6 months of CPAP administration. Results Clusters 1 (49 patients; 50.5%) and 2 (6 patients; 6.2%) presented normal leptin levels, and clusters 3 (11 patients; 11.3%) and 4 (31 patients; 32%) presented high leptin levels. Clusters 3 and 4 presented different leptin levels, but the same degree of obesity. After treatment, the levels of excessive daytime sleepiness improved in all clusters. In Cluster 3, leptin levels were significantly reduced after treatment. Conclusion Using the conventional diagnostic method of the apnea-hypopnea index, it was not clear whether leptin is a useful biomarker for the CPAP treatment. However, it may be helpful for particular clusters, including obese women, and where particular populations require CPAP treatment.

Microstructural Changes in the Cerebral White Matter After 12 Months of CPAP Treatment for Moderate to Severe Obstructive Sleep Apnoea: A TBSS Study.

Introduction: Continuous positive airway pressure (CPAP) therapy improves clinical symptoms in patients with obstructive sleep apnea (OSA); however, the mechanism of this clinical improvement and how it may be associated with the restoration of white matter (WM) structures in the brain is unclear. Therefore, this study investigated the relationship between the structural recovery of brain WM and improvements in cognitive function and emotion after long-term (12 months) CPAP treatment in patients with OSA. Methods: We collected data from 17 patients with OSA before and 12 months after CPAP treatment, including sleep monitoring, clinical assessment, and diffusion tensor imaging (DTI) magnetic resonance imaging. Results: We observed a partial reversible recovery of brain WM (mean and radial diffusion coefficients) after treatment. This recovery involved the commissural fibers (cingulum, body of corpus callosum), projection fibers (retrolenticular part of the internal capsule, posterior thalamic radiation, posterior limb of the internal capsule, superior corona radiata, posterior corona radiata), association fibers (external capsule, superior longitudinal fasciculus, inferior longitudinal fasciculus), and other regions. In addition, the improvements in WM fibers in one part of the brain significantly were correlated with the Hamilton Anxiety Scale and Hamilton Depression Scale scores. Discussion: Our results suggest that reversible recovery of reduced brain WM integrity due to OSA may require longer CPAP treatment. Moreover, changes in the integrity of the commissural fibers were associated with emotion regulation. These restored WM areas may explain the cognitive and mood improvements observed after OSA treatment.

Management of sleep-disordered breathing in patients with syndromic hemifacial macrosomia.

PURPOSE: Patients with syndromic hemifacial microsomia (SHFM) are at risk of obstructive sleep apnea (OSA). The aim of the study was to describe the prevalence of OSA and its management, especially in patients with Goldenhar syndrome (GS). METHODS: The respiratory polygraphies and clinical management of 15 patients, aged 2 to 23 years, evaluated at a national reference center, were analyzed. RESULTS: Four (27%) patients had no OSA, 4 (27%) had mild OSA, and 7 (46%), of whom 5 were ≤ 2 years old, had severe OSA. None of the patients had central apneas. Only one patient had alveolar hypoventilation, and another one had nocturnal hypoxemia. Two patients had severe OSA despite prior adenoidectomy or mandibular distraction osteogenesis. Median duration of follow-up was 3.5 years (range 0.5-9 years). None of the patients without OSA or with mild OSA at baseline respiratory polygraphy developed OSA during the follow up. Among the 7 patients with severe OSA, 3 required continuous positive airway pressure or noninvasive ventilation, and one patient required a tracheostomy. CONCLUSION: In conclusion, patients with SHFM are at high risk of severe OSA at any age, underlining the importance of systematic sleep studies to diagnose and evaluate the severity of OSA. Individualized treatment should be privileged, based on a careful examination of the entire upper airway, taking in account potential associated risk factors. All patients with SHFM should be managed by a pediatric expert multidisciplinary medical/surgical team until the end of post pubertal growth.

Patient experience of the use of continuous positive airway pressure for the treatment of obstructive sleep apnea with or without telemedicine during COVID-19: a qualitative approach.

STUDY OBJECTIVES: Continuous positive airway pressure (CPAP) is considered effective treatment for moderate-severe obstructive sleep apnea (OSA). Clinicians measure compliance to treatment by the number of hours CPAP is used per 24 hours. There have been very few studies examining the patients' lived experience of CPAP and the barriers to use. This study examined the patients' experience of OSA, CPAP use and treatment during COVID-19. METHODS: This CPAP patient experience qualitative study was part of a larger project. The overarching study was a three-armed nonblinded randomized controlled trial of patients on CPAP for treatment of OSA using standard care or one of two telemedicine interventions. Patients who had completed the RCT study were invited to be interviewed via telephone, about their OSA diagnosis, CPAP experiences, their experience of using telemedicine and the impact of SARS-CoV-2 (COVID-19). RESULTS: Fifteen patients (five from each arm of the trial) took part in a semi-structured interview. Thematic analysis identified three themes: day to day living, standard hospital care versus telemedicine management and living though COVID-19 with CPAP. CONCLUSIONS: All participants described significant symptoms caused by their OSA before diagnosis. While CPAP treatment was often described as challenging, patients discussed the improvement in their symptoms with treatment. There were differing opinions on virtual appointments, however the consensus was the use of telemedicine to support CPAP treatment was well received. COVID-19 appeared to have little effect on the patient experience.