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

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

Clinical Pathway for Coronary Atherosclerosis in Patients Without Conventional Modifiable Risk Factors JACC State-of-the-Art Review

Reducing the incidence and prevalence of standard modifiable cardiovascular risk factors (SMuRFs) is critical to tackling the global burden of coronary artery disease (CAD). However, a substantial number of individuals develop coronary atherosclerosis despite no SMuRFs. SMuRFless patients presenting with myocardial infarction have been observed to have an unexpected higher early mortality compared to their counterparts with at least 1 SMuRF. Evidence for optimal management of these patients is lacking. We assembled an international, multidisciplinary team to develop an evidence-based clinical pathway for SMuRFless CAD patients. A modified Delphi method was applied. The resulting pathway confirms underlying atherosclerosis and true SMuRFless status, ensures evidence-based secondary prevention, and considers additional tests and interventions for less typical contributors. This dedicated pathway for a previously overlooked CAD population, with an accompanying registry, aims to improve outcomes through enhanced adherence to evidence-based secondary prevention and additional diagnosis of modifiable risk factors observed

Oral appliance in sleep apnea treatment : respiratory and clinical effects and long-term adherence

PURPOSE: There is an increasing tendency to use oral appliance (OA) as an alternative treatment for sleep apnea. Here we report the long-term adherence and clinical effects of OA therapy. METHODS: All sleep apnea patients treated at the Department of Dentistry between the years 2006 and 2013 (n=1208) were reviewed. A questionnaire about OA adherence, asthma symptoms (Asthma Control Test™, ACT), and general health was sent to all patients who continued OA therapy after the 1-month follow-up visit (n=811). OA was adjusted to obtain at least 70 % of the maximal protrusion of the mandible. RESULTS: The response rate was 37.4 % (99 women, 204 men). The mean±SD age and BMI were 58.7±10.3 years and 27.3±4.0 kg/m(2), respectively. During the mean follow-up period of 3.3 years, there was no significant variation in BMI. Forty-one patients abandoned OA therapy yielding an adherence rate of 86 %. Ninety-seven percent of patients used OA ≥4 h/day, and the mean daily use was 7.2±1.1 h. The ACT score improved with OA use from 16.0±5.9 to 20.1±3.8 (p=0.004), indicating better asthma control. The apnea and hypopnea index decreased significantly from 27±19 at baseline to 10±10 with OA therapy (p=0.001). CONCLUSIONS: After a 1-month trial period, the long-term adherence to oral appliance was good. OA therapy decreased apneas and hypopneas significantly, and its long-term use was associated with an improvement in respiratory and asthma symptoms

Oral appliance in sleep apnea treatment : respiratory and clinical effects and long-term adherence

There is an increasing tendency to use oral appliance (OA) as an alternative treatment for sleep apnea. Here we report the long-term adherence and clinical effects of OA therapy. All sleep apnea patients treated at the Department of Dentistry between the years 2006 and 2013 (n = 1208) were reviewed. A questionnaire about OA adherence, asthma symptoms (Asthma Control Test (TM), ACT), and general health was sent to all patients who continued OA therapy after the 1-month follow-up visit (n = 811). OA was adjusted to obtain at least 70 % of the maximal protrusion of the mandible. The response rate was 37.4 % (99 women, 204 men). The mean +/- SD age and BMI were 58.7 +/- 10.3 years and 27.3 +/- 4.0 kg/m(2), respectively. During the mean follow-up period of 3.3 years, there was no significant variation in BMI. Forty-one patients abandoned OA therapy yielding an adherence rate of 86 %. Ninety-seven percent of patients used OA a parts per thousand yen4 h/day, and the mean daily use was 7.2 +/- 1.1 h. The ACT score improved with OA use from 16.0 +/- 5.9 to 20.1 +/- 3.8 (p = 0.004), indicating better asthma control. The apnea and hypopnea index decreased significantly from 27 +/- 19 at baseline to 10 +/- 10 with OA therapy (p = 0.001). After a 1-month trial period, the long-term adherence to oral appliance was good. OA therapy decreased apneas and hypopneas significantly, and its long-term use was associated with an improvement in respiratory and asthma symptoms.Peer reviewe

Provenancing East Mediterranean cedar wood with the 87Sr/86Sr strontium isotope ratio

Sr-87/Sr-86 isotope ratios of cedar wood from forests in the East Mediterranean have been compiled in order to investigate the feasibility of provenancing archaeological cedar wood finds. Cedrus sp. forests furnished a great amount of wood in antiquity, for purposes ranging from ship to temple construction, and for fashioning cult statues and sarcophagi. The Sr-87/Sr-86 signatures of archaeological cedar samples may be compared with the preliminary dataset presented here to help determine the geographic origin of wooden artifacts. Sample sites include two forest areas in the Troodos Massif of Cyprus, five in the Lebanon, and two in Turkey's Taurus Mountains. Sr ratios for wood varieties (i.e., early heartwood, late heartwood, sapwood, and twig wood) demonstrate relative uniformity between the xylem types frequently recovered from archaeological contexts. As such, this pilot study also assesses important issues of archaeological sampling and the geographical factors that influence Sr uptake in cedar trees of this region. While the regional signatures are distinct in most cases, small sample sizes and range overlap indicate the need for additional methods to make a case for a certain source forest. Alone, this method continues to be best used to disprove assumed wood provenances