The effect of CPAP treatment for obstructive sleep apnea on asthma control-study limitations-author's response

Non peer reviewe

Long-term CPAP treatment improves asthma control in patients with asthma and obstructive sleep apnoea

Both asthma and obstructive sleep apnoea cause sleep disturbance, daytime sleepiness and diminished quality of life. Continuous positive airway pressure (CPAP) is efficient in reducing symptoms related to sleep apnoea. Here we report the impact of long-term use of CPAP on asthma symptoms. A survey questionnaire was distributed to all of our obstructive sleep apnoea patients with CPAP therapy in 2013. We used the Finnish version of the Asthma Control Test (TM) (ACT) and a visual analogue scale (0 = no symptoms, 100 = severe asthma symptoms). Asthma was defined as self-reported physician-diagnosed disease and a special reimbursement for asthma medication by the Social Insurance Institution. We sent 2577 questionnaires and received 1586 answers (61 %). One hundred ninety-seven patients were asthmatics with a prevalence of asthma among CPAP users of 13 %. We studied 152 patients (58 females) whose CPAP therapy was initiated after starting asthma medication. Their mean (SD) age was 62 (10) years, duration of CPAP 5.7 (4.7) years and their CPAP daily use was 6.3 (2.4) h. Self-reported asthma severity decreased significantly from 48.3 (29.6) to 33.1 (27.4) (p <0.001), and ACT score increased significantly from 15.35 (5.3) to 19.8 (4.6) (p <0.001) without a significant change in the body mass index (BMI). The percentage of patients using rescue medication daily reduced from 36 to 8 % with CPAP (P <0.001). We noticed a significant decrease in asthma symptoms with long-term use of CPAP in patients with both asthma and obstructive sleep apnoea.Peer reviewe

No changes in nocturnal respiration with hypoglossal neurostimulation therapy for obstructive sleep apnoea

Study objectives We initiated Hypoglossal Neurostimulation therapy (HGNS) at the Helsinki University Hospital in late 2014. Here, we report our experience. Methods We included all 15 HGNS patients. All patients had previously failed both CPAP and oral appliance therapy for sleep apnoea. Overnight polysomnography parameters were analysed before and at 1.5 years with HGNS. Results Mean +/- SD patient age was 53 +/- 6 years; 2 women and 13 men were included. Mean +/- SD efficient CPAP level was 11.4 +/- 3.4 cm H2O. Implantation technically succeeded in all patients. There were no significant changes of AHI and ODI4 after HGNS [median (quartile) 29.2/h (19.8-38.7) versus 30.1/h (15.6-52.6) and 15.0/h (5.9-20) versus 12.5/h (6.9-30.2) respectively]. Conclusion We did not observe significant changes in AHI and ODI4 indices with HGNS therapy. Larger multicentre randomised controlled trials are necessary before wider international use of HGNS.Peer reviewe

Bubbling test to recognize retrograde air escape via the nasolacrimal system during positive airway pressure therapy

Peer reviewe

Practical Aspects of Interface Application in CPAP Treatment

While continuous positive airway pressure (CPAP) is an effective first-line therapy for sleep apnea, CPAP fails in one third of patients mainly due to poor adherence to the CPAP device and masks. The role of the medical team is to guide the patient in choosing the best mask, thus insuring good CPAP therapy adherence. Once a suitable mask is found, the brand of the mask does not affect patient satisfaction or CPAP adherence. For the majority of patients, nasal masks are by far more suitable than oronasal masks. Orosanal masks are indicated in case of nasal stuffiness or when an air leak manifests through the mouth. Re-evaluation of the efficacy of CPAP therapy is recommended when switching to oronasal masks.Peer reviewe

Adherence to CPAP therapy for sleep apnea in patients aged over 70 years old

Purpose Adherence to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) syndrome has not been established in patients over 70 years of age, whereas several studies have reported adherence below that age. This trial was designed to address this evidence gap. Methods Consecutive senior (> 70 years) patients with OSA, mean respiratory event index (REI) 34/h, body mass index (BMI) 31 kg/m(2), and junior (< 50 years) patients (REI 37/h, BMI 31 kg/m(2)) were included. Results At year follow-up among 72 senior patients (35 women) and 71 junior patients (17 women), there was no difference in the percentage of patients abandoning CPAP (senior 47% vs. junior 43%) or in CPAP daily use (4:53 +/- 2:44 hh:min vs. 4:23 +/- 3:00 hh:min). Conclusions CPAP adherence in senior patients with OSA was not poorer than that of a younger group of OSA patients. Advanced age should not be an obstacle to CPAP initiation.Peer reviewe

The Effect of mandible advancement splints in mild, moderate, and severe obstructive sleep apnea-the need for sleep registrations during follow up

Objective and design: Our aim was to evaluate the effect of mandible advancement splint (MAS) in mild, moderate, and severe obstructive sleep apnea (OSA). We also determined, if and in which OSA-groups the adequate forward movement in MAS could be quantified without sleep registration for different OSA levels. A retrospective study. Settings: The effect of MAS was measured with clinical methods and by sleep registration. Participants: The series consisted of 103 patients, 75 males and 28 females (mean age 52 years) suffering from mild (32 per cent), moderate (32 per cent), or severe (36 per cent) OSA, who were treated with MAS at Helsinki University Hospital, Finland during the years 2011-2012. Seventy per cent of the patients had tried continuous positive airway pressure (CPAP) before MAS. Results: The lower the body mass index (BMI) was the bigger the probability was to get apnea/hypopnea index (AHI) values <5 per hour with MAS (P <0.01). The total AHI decreased significantly from the baseline with MA (P <0.001). The mean oxygen desaturation index (ODI4%) improved significantly from 16 per hour (range 1-76) to 5.3 per hour (range 0.2-49), (P <0.01), and the minimum oxygen saturation improved significantly from 84 per cent (67-91) to 87 per cent (68-93), (P <0.01). The reduction of AHI with MAS was significantly bigger in patients with a previous CPAP experience (73 per cent) than those who did not tried CPAP therapy. The positive correlation was found between the decrease in AHI and the increase of the protrusion in MAS. Conclusion: Both sleep recordings and subjective indicators demonstrated that MAS therapy was successful in OSA based on ESS, total AHI, ODI4%, and minimum oxygen saturation values. It seems useful to increase the protrusion at its maximal clinical tolerance. An experienced dentist could make therapeutically decision concerning the follow up of MAS efficacy regardless of the result of sleep study. We suggest that MAS is a valuable treatment alternative for CPAP. However, the previous use of CPAP with MAS as well as lower baseline BMI seem to have a positive correlation with the success of MAS therapy.Peer reviewe

Sleep versus non-sleep-related fatal road accidents

Objective: To study different factors that are associated with fatal sleepiness-related motor vehicle accidents (FSMVA) and in other types of fatal motor vehicle accidents (FMVA) in Finland. Methods: All FMVA that were caused by falling asleep at the wheel (FSMVA) during the years 2005-2014 were investigated using OTI (Finnish Crash Data Institute) data. The control group consisted of 136 drivers who died in other types of FMVA in 2013. A total of 258 accidents were investigated. Results: The mean age of the 122 drivers in the FSMVA group was 44 (standard deviation 19) years; there were 100 men (82%) and 22 women. The mean age of the 136 control drivers was 45 (standard deviation 19) years; there were 116 men (85%) and 20 women. Short sleep time ( Conclusion: Short sleep is a major cause of fatal sleepiness-related motor vehicle accidents. Driver health factors such as sleep apnea or acute/chronic diseases as well as use of sedative medications and drugs are known risk factors for FSMVA, but these factors are associated also with other types of accidents. Healthy individuals are at risk for falling asleep while driving if they are sleep deprived. All drivers should be aware of the importance of adequate sleep. (C) 2018 Elsevier B.V. All rights reserved.Peer reviewe

Reasons for failure of mandibular advancement splint therapy in the treatment of obstructive sleep apnea

Objective: To investigate the reasons for poor adaptation to mandibular advancement splint (MAS) treatment. Methods: The study consisted of 44 patients with obstructive sleep apnea who had unsuccessful MAS treatment. Data were collected on age, body mass index, gender, general and mental diseases, continuous positive airway pressure (CPAP) tryout, usage of occlusal splint, dental overjet, temporomandibular disorders, shortened dental arch, sleep apnea severity, and Apnea-Hypopnea Index. Sixty patients who underwent successful MAS treatment were controls. Results: Patients with missing molars failed significantly more often in MAS therapy than the controls (p = 0.020). Patients with CPAP tryout prior to MAS treatment had a tendency to fail MAS treatment. MAS treatment was more likely to be successful in patients with prior occlusal splint experience (p = 0.050). Conclusion: The study could not identify a single reason for MAS failure.</div

A detection dog for obstructive sleep apnea : could it work in diagnostics?

Purpose We have previously demonstrated that dogs can be trained to distinguish the urine of patients with obstructive sleep apnea (OSA) from that of healthy controls based on olfaction. Encouraged by these promising results, we wanted to investigate if a detection dog could work as a screening tool for OSA. The objective of this study was to prospectively assess the dogs' ability to identify sleep apnea in patients with OSA suspicion. Methods Urine samples were collected from 50 patients suspected of having OSA. The urine sample was classified as positive for OSA when the patient had a respiratory event index of 5/h or more. The accuracy of two trained dogs in identifying OSA was tested in a prospective blinded setting. Results Both of the dogs correctly detected approximately half of the positive and negative samples. There were no statistically significant differences in the dogs' ability to recognize more severe cases of OSA, as compared to milder cases. Conclusion According to our study, dogs cannot be used to screen for OSA in clinical settings, most likely due to the heterogenic nature of OSA.Peer reviewe