Obstructive sleep apnea representations, self-efficacy and family coping regarding APAP adherence: a longitudinal study

Adherence is still an important issue considering new advances in Obstructive Sleep Apnea (OSA) treatment, as automatic positive airway pressure (APAP). The aim of the present study was to identify and explore relationships between identified predictors of adherence, over time. After overnight sleep study and OSA diagnosis and during a six-month APAP treatment period, a total of 153 patients underwent a three time psychological protocol evaluation. Generalized estimating equations were applied to analyzed repeated measurements in the same individuals. Results show that 40% of patients were poorly adherent and 60% were adherent after six months of treatment. The results confirmed a predictive value of age, self-efficacy, decisional balance index and health-related quality of life (HRQoL) in APAP adherence. Furthermore, the results revealed an interaction between time and illness cognitive representations, and self-efficacy and family coping, in explaining adherence patterns over time. Therefore, understanding the causality of theoretically derived constructs is crucial to predict the continuity of APAP adherence.Fundação para a Ciência e Tecnologia (FCT

Psychological morbidity, illness representations, and quality of life in female and male patients with obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder that affects both women and men. The aim of this study was to characterize and investigate the differences in terms of anxiety, depression, illness perception, and quality of life between female and male OSAS patients from a total of 111 patients (33 women and 78 men) who were recently diagnosed with OSAS in an outpatient clinic of a University Hospital in Portugal. They underwent a standardized protocol that included evaluation to assess of psychological morbidity (anxiety and depression – Hospital Anxiety and Depression Scale), illness representations (Brief Illness Perception Questionnaire), and quality of life (Sleep Apnea Quality of Life Index). The most significant differences between female and male OSAS patients result of apnea/hypopnea index (AHI), after controlling for body mass index (p 5 0.05); anxiety (p ¼ 0.000) and depression (p 5 0.005); consequences (p 5 0.005), identity (p ¼ 0.000), coherence (p 5 0.01), and emotional representation (p 5 0.005) of OSAS; and for daily functioning (p ¼ 0.000), emotional (p ¼ 0.001), and symptoms (p 5 0.05) domains of quality of life. Data suggest that women revealed more psychological morbidity associated with OSAS. Therefore, it seems extremely important to look at women as potential patients for sleep apnea and avoid looking up for a pattern of symptoms that rely on men as a norm to which women are compared.Fundação para a Ciência e a Tecnologia (FCT

Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema – a systematic review and meta-analysis

INTRODUCTION: Continuous positive airway pressure ventilation (CPAP) and non-invasive positive pressure ventilation (NPPV) are accepted treatments in acute cardiogenic pulmonary edema (ACPE). However, it remains unclear whether NPPV is better than CPAP in reducing the need for endotracheal intubation (NETI) rates, mortality and other adverse events. Our aim was to review the evidence about the efficacy and safety of these two methods in ACPE management. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials on the effect of CPAP and/or NIPV in the treatment of ACPE, considering the outcomes NETI, mortality and incidence of acute myocardial infarction (AMI). We searched six electronic databases up to May 2005 without language restrictions, reviewed references of relevant articles, hand searched conference proceedings and contacted experts. RESULTS: Of 790 articles identified, 17 were included. In a pooled analysis, 10 studies of CPAP compared to standard medical therapy (SMT) showed a significant 22% absolute risk reduction (ARR) in NETI (95% confidence interval (CI), -34% to -10%) and 13% in mortality (95%CI, -22% to -5%). Six studies of NPPV compared to SMT showed an 18% ARR in NETI (95%CI, -32% to -4%) and 7% in mortality (95%CI, -14% to 0%). Seven studies of NPPV compared to CPAP showed a non-significant 3% ARR in NETI (95%CI, -4% to 9%) and 2% in mortality (95%CI, -6% to 10%). None of these methods increased AMI risk. In a subgroup analysis, NPPV did not lead to better outcomes than CPAP in studies including more hypercapnic patients. CONCLUSION: Robust evidence now supports the use of CPAP and NPPV in ACPE. Both techniques decrease NETI and mortality compared to SMT and none shows increased AMI risk. CPAP should be considered a first line intervention as NPPV did not show a better efficacy, even in patients with more severe conditions, and CPAP is cheaper and easier to implement in clinical practice

Autoadjusting-CPAP effect on serum Leptin concentrations in Obstructive Sleep Apnoea patients

© 2008 Drummond et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Types of Respiratory Intermediate Care Units

Respiratory intermediate care units (RICU) may be divided into three types, depending on staffing, monitoring levels and patients’ severity. In this chapter, we clearly define the different typologies of RICU, including the change and expansion due to the COVID-19 pandemic. There is a heterogeneity of RICU in terms of number, structure and model which largely vary in the different countries and locally within different hospitals. According to the European Respiratory Society (ERS) task force there are three main RICU levels: respiratory intensive care unit, respiratory intermediate care unit and respiratory monitoring units. To define the levels of the RICU, the expertise of the team, the nurse workload, and the capability of providing invasive as well non-invasive respiratory support are the crucial factors. RICU allow for a more efficient and cost-effective approach to respiratory care without decreasing the quality of care or adversely affecting the outcome. Respiratory medicine units should make strong efforts to lead and include such facilities under their own space

The Mediator Role of Illness Representations in Patients with Obstructive Sleep Apnea: A Preliminary Study

Background: This preliminary study examined the mediating role of illness representations on health-related quality of life (HRQoL) between adherent and poorly adherent obstructive sleep apnea patients (OSA) to the automatic positive airway pressure (APAP) therapy. Method: A total of 185 patients were assessed on determinants of APAP treatment, illness representations, family coping, and self-efficacy, at T1 (prior to APAP treatment) and T2 (1 to 2 months with APAP treatment). Results: Regarding the determinants of APAP, adherent patients showed higher self-efficacy, outcome expectations, and decisional balance index, compared to poorly adherent patients. Adherent patients also showed higher family coping and HRQoL, but less threatening cognitive representations compared to poorly adherent patients. Illness cognitive and emotional representations mediated the relationship between self-efficacy/family coping and HRQoL, in adherent patients. Only illness cognitive representations mediated the relationship between self-efficacy and HRQoL in poorly adherent patients. Conclusions: The results highlight the importance of illness representations during OSA treatment in the promotion of adherence to APAP

A new characterization of adherence patterns to auto-adjusting positive airway pressure in severe obstructive sleep apnea syndrome: clinical and psychological determinants

Purpose The aim of this study was to examine the joint role of demographic, clinical, psychological and family coping variables as predictors of adherence patterns to auto-adjusting positive airway pressure (APAP). Methods A total of 153 patients diagnosed with obstructive sleep apnea syndrome (OSAS) were assessed during a 6-months APAP treatment period. All patients underwent psychological evaluation prior to treatment (T1) and 1 to 3 months (T2) and 4 to 6 months (T3) post-APAP treatment. Of these, 107 patients maintained a stable adherence pattern to APAP during the treatment period. Results Forty-seven percent were poorly adherent, 27 % were moderately adherent and 26 % were optimally adherent OSAS patients. Several factors distinguished the three adherence patterns and some of these emerged as the main predictors. In T1, the first model included age, apnea–hypopnea index, outcome expectations and coping spiritual support, as main predictors to distinguish adherence patterns. In T2 and T3, two models emerged adjusted to the variables of model 1 that included leakage, self-efficacy, mobilizing family acquire/accept support and reframing in model 2 and self-efficacy in model 3. Generally, the areas under the ROC curve, presented a good discrimination. Conclusions Findings revealed an integrative heuristic model that accounted for the joint influence of demographic, clinical, psychological, and family coping factors on poor, moderate, and optimal adherence patterns.This work was supported by a grant (SFRH / BD / 38388 / 2007) from the Portuguese Foundation of Science and Technolog