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

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

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

Local C-Reactive Protein Expression in Obliterative Lesions and the Bronchial Wall in Posttransplant Obliterative Bronchiolitis

The local immunoreactivity of C-reactive protein (CRP) was studied in a heterotopic porcine model of posttranplant obliterative bronchiolitis (OB). Bronchial allografts and control autografts were examined serially 2–28 days after subcutaneous transplantation. The autografts stayed patent. In the allografts, proliferation of inflammatory cells (P < .0001) and fibroblasts (P = .02) resulted in occlusion of the bronchial lumens (P < .01). Influx of CD4+ (P < .001) and CD8+ (P < .0001) cells demonstrated allograft immune response. CRP positivity simultaneously increased in the bronchial walls (P < .01), in macrophages, myofibroblasts, and endothelial cells. Local CRP was predictive of features characteristic of OB (R = 0.456–0.879, P < .05−P < .0001). Early obliterative lesions also showed CRP positivity, but not mature, collagen-rich obliterative plugs (P < .05). During OB development, CRP is localized in inflammatory cells, myofibroblasts and endothelial cells probably as a part of the local inflammatory response

Rates of initial acceptance of PAP masks and outcomes of mask switching

Recently, we noticed a considerable development in alleviating problems related to positive airway pressure (PAP) masks. In this study, we report on the initial PAP mask acceptance rates and the effects of mask switching on mask-related symptoms. We prospectively collected all cases of mask switching in our sleep unit for a period of 14 months. At the time of the study, we used ResMed (TM) CPAP devices and masks. Mask switching was defined as replacing a mask used for at least 1 day with another type of mask. Changing to a different size but keeping the same type of mask did not count as mask switching. Switching outcomes were considered failed if the initial problem persisted or reappeared during the year that followed switching. Our patient pool was 2768. We recorded 343 cases of mask switching among 267 patients. Of the 566 patients who began new PAP therapy, 108 (39 women) had switched masks, yielding an initial mask acceptance rate of 81 %. The reason for switching was poor-fit/uncomfortable mask in 39 %, leak-related in 30 %, outdated model in 25 %, and nasal stuffiness in 6 % of cases; mask switching resolved these problems in 61 %. Mask switching occurred significantly (p = 0.037) more often in women and in new PAP users. The odds ratio for abandoning PAP therapy within 1 year after mask switching was 7.2 times higher (interval 4.7-11.1) than not switching masks. The initial PAP mask acceptance rate was high. Patients who switched their masks are at greater risk for abandoning PAP therapy.Peer reviewe

Multi-drug resistant tuberculosis in Finland--a forecast

Since the collapse of the Soviet system, travel between the St Petersburg district and the Baltic states and Finland has increased substantially. Although it is difficult to obtain exact figures on the number of cases of tuberculosis (TB) and multi-drug resistant (MDR) TB in these countries, there is strong evidence of growing epidemics, bringing added epidemiological threat to Finland. The purpose of this study is to produce a short-term "worst case" forecast of the spatial development of a threatened MDR-TB epidemic in Finland. The method applied is a chorological multistep procedure using statistical and geographical methods and a simulation technique. Instead of focusing on populations of carriers and susceptibles, emphasis is placed on identifying the primary influences directing the epidemic as a spatial process. This was done by dividing Finland into small-area units and by assigning the risk of obtaining MDR-TB to each unit based on socioeconomic and structural characteristics of the population. The simulated 6 year cumulative distribution of new MDR-TB cases showed a marked concentration of cases in the capital region and in a cluster of municipalities along the west coast. Although socioeconomic factors are important in explaining the distribution of cases, frequent and widespread international contacts seemed to be equally important at the beginning of the epidemic.tuberculosis multi-drug resistance forecasting epidemiology Finland

Predicting Technical Success in Home Sleep Apnea Test

Peer reviewe