Evaluation of positive airway pressure treatment for sleep related breathing disorder in adults

Mayo Clinic, Rochester, MN 55905, USA.
Sleep (Impact Factor: 5.06). 04/2006; 29(3):381-401.
Source: PubMed

ABSTRACT Positive airway pressure (PAP) is used to treat obstructive sleep apnea (OSA), central sleep apnea (CSA), and chronic hypoventilation. This document provides a systematic analysis and grading of peer-reviewed, published clinical studies pertaining to application of PAP treatment in adults. The paper is divided into 5 sections, each addressing a series of questions. The first section deals with whether efficacy and/or effectiveness have been demonstrated for continuous PAP (CPAP) treatment based on a variety of parameters and the level of OSA severity. Next, CPAP titration conducted with full, attended polysomnography in a sleep laboratory is compared with titration done under various other conditions. The third section investigates what can be expected regarding adherence and compliance with CPAP treatment as measured by subjective and objective methods and what factors may influence these parameters. Side effects and the influence of other specific factors on efficacy, effectiveness and safety of CPAP therapy are evaluated in the fourth section. Finally, the use of bilevel PAP therapy is reviewed for both patients with OSA and those with other selected nocturnal breathing disorders. Each section also contains a brief summary and suggestions for future research.

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Available from: Terri E Weaver, Jun 30, 2014
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    • "In a cohort of 149 consecutive patients who were referred to the sleep laboratory and prescribed CPAP therapy, 18% of them rejected CPAP immediately after CPAP titration, and 16% dropped out after 2 weeks of therapy [25]. When defining adequate nightly use as at least 4 h per night, 29e83% of patients could be classified as nonadherent [1] [4]. Even when patients do not completely abandon CPAP, their adherence to recommended nightly use may be poor. "
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    ABSTRACT: Poor adherence to continuous positive airway pressure (CPAP) treatment is associated with substantial health care costs, morbidity and mortality, and has been a leading obstacle in the effective management of obstructive sleep apnea (OSA). Successful interventions to improve CPAP adherence may ultimately include a variety of components. For patients living with spouses (refers to all domestic partners), the spouse will likely be an integral component to any successful intervention. Developing understanding of the role of spouses in adherence to CPAP has been identified to be a critical research need. This review expands the investigation of CPAP adherence to a broader context, from an exclusive focus on individual patients to a dyadic perspective encompassing both patients and their spouses. A conceptual framework based on social support and social control theories is proposed to understand spousal involvement in CPAP adherence. Methodologies for future investigations are discussed, along with implications for developing interventions that engage both patients and their spouses to improve CPAP use.
    Sleep Medicine Reviews 05/2014; 19. DOI:10.1016/j.smrv.2014.04.005 · 9.14 Impact Factor
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    • "Effective treatment is important due to the identification of OSA as an independent risk factor for cardiovascular disease [2] [3] [4]. While continuous positive airway pressure (CPAP) therapy is effective at correcting sleep disordered breathing [5] [6] and improving daytime sleepiness [6] [7], adherence is poor [8– 10]. Although a number of factors are suggested to influence adherence, the importance of many of the determinants remains unclear [11] [12]. "
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    ABSTRACT: Purpose. We hypothesized that socioeconomic factors and a language barrier would impact adherence with continuous positive airway pressure (CPAP) among Hispanics with obstructive sleep apnea (OSA). Methods. Patients with OSA who were prescribed CPAP for at least 1 year and completed a questionnaire evaluating demographic data, socioeconomic status, and CPAP knowledge and adherence participated in the study. Results. Seventy-nine patients (26 males; 53 ± 11 yrs; body mass index (BMI) = 45 ± 9 kg/m(2)) with apnea-hypopnea index (AHI) 33 ± 30 events/hr completed the study. Included were 25 Hispanics, 39 African Americans, and 15 Caucasians, with no difference in age, AHI, CPAP use, or BMI between the groups. While there was a difference in educational level (P = 0.006), income level (P < 0.001), and employment status (P = 0.03) between the groups, these did not influence CPAP adherence. Instead, overall improvement in quality of life and health status and perceived benefit from CPAP influenced adherence, both for the group as a whole (P = 0.03, P = 0.004, and P = 0.001, resp.), as well as in Hispanics (P = 0.02, P = 0.02, P = 0.03, resp.). Conclusion. In Hispanic patients with OSA, perceived benefit with therapy, rather than socioeconomic status or a language barrier, appears to be the most important factor in determining CPAP adherence.
    02/2014; 2014:878213. DOI:10.1155/2014/878213
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    • "Positive airway pressure is the first-line treatment because it eliminates disordered breathing events (Gay et al., 2006); however, at least 30–40% of patients have low adherence (Kribbs et al., 1993; Weaver and Grunstein, 2008). "
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    ABSTRACT: Reduced upper airway muscle activity during sleep is a key contributor to obstructive sleep apnoea pathogenesis. Hypoglossal nerve stimulation activates upper airway dilator muscles, including the genioglossus, and has the potential to reduce obstructive sleep apnoea severity. The objective of this study was to examine the safety, feasibility and efficacy of a novel hypoglossal nerve stimulation system (HGNS(®) ; Apnex Medical, St Paul, MN, USA) in treating obstructive sleep apnoea at 12 months following implantation. Thirty-one subjects (35% female, age 52.4 ± 9.4 years) with moderate to severe obstructive sleep apnoea and unable to tolerate positive airway pressure underwent surgical implantation and activation of the hypoglossal nerve stimulation system in a prospective single-arm interventional trial. Primary outcomes were changes in obstructive sleep apnoea severity (apnoea-hypopnoea index, from in-laboratory polysomnogram) and sleep-related quality of life [Functional Outcomes of Sleep Questionnaire (FOSQ)]. Hypoglossal nerve stimulation was used on 86 ± 16% of nights for 5.4 ± 1.4 h per night. There was a significant improvement (P < 0.001) from baseline to 12 months in apnoea-hypopnoea index (45.4 ± 17.5 to 25.3 ± 20.6 events h(-1) ) and Functional Outcomes of Sleep Questionnaire score (14.2 ± 2.0 to 17.0 ± 2.4), as well as other polysomnogram and symptom measures. Outcomes were stable compared with 6 months following implantation. Three serious device-related adverse events occurred: an infection requiring device removal; and two stimulation lead cuff dislodgements requiring replacement. There were no significant adverse events with onset later than 6 months following implantation. Hypoglossal nerve stimulation demonstrated favourable safety, feasibility and efficacy.
    Journal of Sleep Research 09/2013; 23(1). DOI:10.1111/jsr.12079 · 2.95 Impact Factor
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