Positive airway pressure therapy for sleep apnea in adults : From CPAP initiation to follow-up

Obstructive sleep apnea (OSA) is highly prevalent worldwide; the incidence of OSA is increasing along with the increasing prevalence of obesity. The main symptoms of OSA are snoring and daytime somnolence. Continuous positive airway pressure (CPAP) therapy prevents sleep apneas and restores sleep. However, one third of patients abandon therapy within 1 year for several reasons, usually due to difficulties in falling asleep with the device, intolerance to pressure, and local disturbances related to the CPAP interface. Similar to many patients with other chronic diseases, OSA patients on CPAP therapy require regular follow up. The purpose of follow up is to ensure good adherence to treatment and amelioration of symptoms with therapy. There are no international guidelines on the frequency of CPAP follow up. The number of OSA patients is increasing faster than the available economic and medical resources. Accordingly, medical staff must adjust the frequency of follow up. We reviewed the reasons for patient contact between two routine visits for 1141 OSA patients. One third of these patients contacted our sleep unit between two routine appointments. The primary reason for an unscheduled contact was symptoms related to sleep apnea or CPAP treatment. The most common symptom was residual daytime somnolence while on CPAP therapy. With increasing knowledge of OSA, increasing numbers of elderly patients are screened and treated for OSA. However, the benefit of CPAP therapy and the effect of age on CPAP adherence has not fully been studied. We evaluated CPAP adherence in patients >70 years compared with younger patients (<50 years). At the 1-year follow up after CPAP initiation, we found no statistically significant difference either in the number of patients abandoning CPAP therapy during the follow-up period or in the daily CPAP use in hours between older and younger CPAP patients. One third of OSA patients abandon CPAP therapy within 1 year. As there is no good alternative treatment for OSA, patients are often referred for a new CPAP initiation trial. No data were available about the probability of success of CPAP therapy re-initiation after a previous failure. We therefore studied 224 subjects in the re-initiation group (reCPAP) and 228 subjects in a control group (CPAP virgin). At 1-year follow up, the success rate for the CPAP re-initiation group was 52%, which was significantly lower than that of the control group (67%). CPAP re-initiation therapy failed more often in women than in men (62% vs 40%). We observed that routine CPAP follow up do not sufficiently prevent additional visits to the sleep clinic, advanced age is not an obstacle to CPAP initiation, and that the success rate for CPAP re-initiation was significantly lower than that of the control group.Obstruktiivisen uniapnean (OSA) esiintyvyys on korkea maailmanlaajuisesti ja lisääntyy edelleen liikapainon lisääntyessä. Tavallisimmat oireet ovat kuorsaus ja päiväväsymys. Jatkuva ylipainehoito (CPAP) estää hengityskatkokset ja tekee unesta virkistävää. Ensimmäisen vuoden aikana kolmasosa potilaista lopettaa hoidon erilaisista syistä. Erityisesti hankaluudet nukahtaa laitteen kanssa, ongelmat hoitopaineen kanssa, sekä paikallisoireet liittyen CPAP maskeihin ovat syynä tähän. CPAP-hoidossa olevat uniapneapotilaat tarvitsevat säännöllistä seurantaa kuten yleensä muutkin kroonisia sairauksia sairastavat potilaat. Seurannan tarkoitus on varmistaa hoitoon sitoutuminen ja oireiden lievittyminen. Kansainvälisiä ohjeita seurannan taajuuden suhteen ei ole. Potilasmäärät lisääntyvät nopeammin kuin taloudelliset ja lääketieteelliset resurssit, mistä syystä seurantakäyntien järjestämistä joudutaan arvioimaan uudelleen Selvitimme 1141 CPAP-hoidossa olevalla uniapneapotilaalla syitä, miksi he ottivat yhteyttä hoitavaan yksikköön etukäteen ohjelmoitujen seurantakäyntien (rutiinikontrollien) välissä. Kolmasosa potilaista otti yhteyttä uniyksikköön kahden rutiinikontrollin välissä. Suurin syy tähän oli erilaiset uniapneaan tai CPAP-hoitoon liittyvät oireet. Tavallisin oire oli CPAP-hoidosta huolimatta esiintyvä päiväsaikainen jäännösväsymys. Yhä useammin myös ikääntyneitä henkilöitä tutkitaan ja hoidetaan uniapnean v uoksi. C PAP-hoitoon s itoutumista e i o le t utkittu i äkkäillä i hmisillä. Tämän vuoksi tutkimme CPAP-hoitoon sitoutumista > 70 vuotiailla potilailla, verrattuna nuorempiin potilaisiin (< 50 vuotiaisiin). Vuoden kuluttua CPAPhoidon aloituksesta emme havainneet tilastollisesti merkitsevää eroa CPAPhoidon keskeyttämisessä tai CPAP-laitteen käyttötunneissa vanhempien ja nuorempien potilaiden välillä. Kolmasosa potilaista keskeyttää CPAP-hoidon vuoden sisällä hoidon aloituksesta. Hoidon keskeyttäneitä potilaita lähetetään usein myöhemmin CPAPhoidon uudelleen aloitukseen. Tutkimustietoa CPAP-hoidon uudelleen aloituksen onnistumisesta aiemman keskeytyneen hoidon jälkeen ei ole käytettävissä. Selvitimme 224 CPAP-hoidon uudelleen aloittaneella potilaalla hoidon jatkumista vuoden seurannan jälkeen, kontrolliryhmässä oli 228 CPAP-hoitoa ensimmäistä kertaa aloittanutta potilasta. Vuoden kuluttua 52 % uudelleen aloittaneista ja 67% kontrolliryhmän potilaista jatkoi hoitoa. Ero oli tilastollisesti merkitsevä. CPAP-hoidon uudelleen aloitus epäonnistui useammin naisilla kun miehillä (62 % vs 40 %). 7 Totesimme tulosten perusteella että 1) huolimatta säännöllisistä etukäteen ohjelmoiduista CPAP-hoidon seurantakäynneistä, kolmasosa potilaista otti kuitenkin yhteyttä uniyksikköön seurantakäyntien välissä uniapneaan ja CPAP-hoitoon liittyvien ongelmien vuoksi 2) > 70 vuoden ikä ei vähennä CPAP-hoidon onnistumista, ja 3) että CPAP-hoidon aloittaminen uudelleen aiemmin keskeytyneen hoidon jälkeen onnistuu harvemmin kuin hoitoa ensimmäistä kerta aloitettaessa

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

Social engagement from childhood to middle age and the effect of childhood socio-economic status on middle age social engagement: results from the National Child Development study

Social engagement has powerful effects on wellbeing, but variation in individual engagement throughout the lifecourse is wide. The trajectories may differ by gender and be affected by socio-economic status (SES). However, long-term development of social engagement is little studied and the effect of childhood SES on later-life social engagement remains obscure. We aimed to describe the social engagement development from childhood to middle age by gender and test the effect of childhood SES on middle age social engagement. Data (N=16,440, 51.3% male) are drawn from the on-going National Child Development Study, following British babies born in 1958. Social engagement was measured by social activities, voluntary work and social contacts, with follow-ups at age 11, 16, 23 and 50. SES was measured by father's occupational social class and tenure status. Structural equation modelling suggested inter-individual stability in social engagement, showing that development of social engagement started in childhood and increased social engagement in middle age through adolescence and early adulthood. Longitudinal effects were detected within and across the social engagement domains. Lower childhood SES was significantly related to a lower level of voluntary work and social activity in middle age, but to higher levels of social contacts. Although stability in social engagement is moderate over the lifecourse, variation within and across the different social engagement domains is shaped by differences in childhood SES

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

Sediment properties, biota and local habitat structure explain variation in the erodibility of coastal sediments

Sediment resuspension is a frequent phenomenon in coastal areas and a key driver for many ecosystem functions. Sediment resuspension is often linked to biological and anthropogenic activities, which in combination with hydrodynamic forcing initiate sediment erosion and resuspension, if the erosion threshold (tau(c)) is exceeded. Despite its importance to ecosystem functions very few studies have provided measurements on natural assemblages for subtidal sediments. The aim of this study was to determinate key environmental variables regulating sediment resuspension potential across a sedimentary gradient in a subtidal coastal environment. In order to explore this, we sampled 16 sites encompassing a wide variety in environmental variables (e.g., grain size distribution, macrofaunal communities, vegetation) in the Gulf of Finland, Baltic Sea. A core-based erosion device (EROMES) was used to determine sediment resuspension potential measures of erosion threshold, erosion rate (ER), and erosion constant (m(e)). Based on abiotic and biotic properties sampled, sediments diverged into two distinct groups; cohesive (muddy) and noncohesive (sandy) sediments. Results showed that abiotic sediment properties explained 38-53% and 15-36% of the total variation in resuspension potential measures in muddy and sandy sediments, respectively. In cumulative models, biota accounted for 12-26% and 6-24% to the total variation in muddy and sandy sediments, respectively. Sediment erodibility and resuspension potential of natural sediments is highly variable from local habitats to a larger seascape scale. Our results underline the importance of biota to resuspension potential measures in spatially variable environments.Peer reviewe

Dynamics of dissolved nutrients among different macrophyte stands in a shallow lake

Seasonally changing mechanisms affect the concentrations of dissolved inorganic nitrogen and soluble reactive phosphorus, which differ between the stands of different macrophyte life forms and open water in a eutrophic lake. Macrophytes that take nutrients up for their growth also shelter sediments from resuspension that brings nutrients back to the water and affect denitrification, which removes nitrogen from the water ecosystem. In this study the changes in nutrient concentrations were observed during the open-water period from April to November, and also denitrification rates were measured at different phases of the open-water season. The study was conducted at a shallow eutrophic lake where the effect of macrophytes on water quality is remarkable. The concentration changes of different nitrogen forms during the summer were very similar at the open-water and floating-leaved macrophyte (Nuphar lutea L.) stations. Nitrate was depleted faster among the submerged macrophytes (Myriophyllum verticillatum L.) than among floating-leaved plants or in open water. The decrease in the concentration of nitrate was so significant during the summer that it also affected the total nitrogen concentration in the water. Denitrification was highest in sediments among floating-leaved macrophytes (average 4.3 mg N m(-2) d(-1)) and lowest in sediments of submerged plants (average 1.5 mg N m(-2) d(-1)). Denitrification among submerged macrophytes was limited by low nitrate availability.Peer reviewe

Changes in the societal burden caused by sleep apnoea in Finland from 1996 to 2018 : A national registry study

Background In the current century, sleep apnoea has become a significant public health problem due to the obesity epidemic. To increase awareness, improve diagnostics, and improve treatment, Finland implemented a national sleep apnoea programme from 2002 to 2010. Here, we present changes in the societal burden caused by sleep apnoea from 1996 to 2018. Methods National register data were collected from the Care Register for Health Care, Statistics Finland, the Social Insurance Institution of Finland, and the Finnish Centre for Pensions. Disease prevalence, use of healthcare and social services, and societal costs were estimated. Findings The number of sleep apnoea patients increased in secondary care from 8 600 in 1996 to 61 000 in 2018. There was a continuous increase in outpatient visits in secondary care from 9 700 in 1996 to 122 000 in 2018 (1 160%) and in primary care from 10 000 in 2015 to 29 000 in 2018 (190%). Accordingly, the cumulative annual number of days off work for sleep apnoea increased from 1 100 to 46 000. However, disability pensions for sleep apnoea decreased from 820 to 550 (33%) during the observation period. Societal costs per patient decreased over 50% during the observation period ((sic) 2 800 to (sic)1 200). Interpretation The number of sleep apnoea patients in Finland increased remarkably during the observation period. To control this burden, diagnostic methods and treatment were revised and follow up was reorganised. Consequently, there was a significant decrease in societal costs per patient. The decrease in disability pensions suggests earlier diagnosis and improved treatment. The national sleep apnoea programme was one of the initiators for these improved outcomes. Funding The Finnish Institute for Health and Welfare and the Hospital District of Helsinki and Uusimaa (HUH), Helsinki, Finland. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Peer reviewe

FUNGI : FUsioN Gene Integration toolset

Motivation: Fusion genes are both useful cancer biomarkers and important drug targets. Finding relevant fusion genes is challenging due to genomic instability resulting in a high number of passenger events. To reveal and prioritize relevant gene fusion events we have developed FUsionN Gene Identification toolset (FUNGI) that uses an ensemble of fusion detection algorithms with prioritization and visualization modules. Results: We applied FUNGI to an ovarian cancer dataset of 107 tumor samples from 36 patients. Ten out of 11 detected and prioritized fusion genes were validated. Many of detected fusion genes affect the PI3K-AKT pathway with potential role in treatment resistance.Peer reviewe