Table_1_Investigating associations between social determinants, self-efficacy measurement of sleep apnea and CPAP adherence: the SEMSA study.DOCX

Study objectivesThe prospective Self-Efficacy Measure for Sleep Apnea study (SEMSAS) is investigating thresholds for health literacy, self-efficacy and precariousness at obstructive sleep apnea (OSA) diagnosis to predict CPAP adherence. This paper describes the study protocol and presents baseline data from the ongoing study.MethodsEligible individuals had confirmed OSA and were referred to a homecare provider for continuous positive airway pressure (CPAP) therapy initiation. Data on patient characteristics and comorbidities were collected, along with baseline evaluations of self-efficacy [15-item Self-Efficacy Measure for Sleep Apnea tool (SEMSA-15)], precariousness [Deprivation in Primary Care Questionnaire (DipCareQ)], and health literacy (Health Literacy Questionnaire). CPAP adherence over 12 months of follow-up will be determined using remote monitoring of CPAP device data. The primary objective is to define an optimal SEMSA-15 score threshold to predict CPAP adherence at 3- and 12-month follow-up.ResultsEnrollment of 302 participants (71% male, median age 55 years, median body mass index 31.6 kg/m2) is complete. Low self-efficacy (SEMSA-15 score ≤ 2.78) was found in 93/302 participants (31%), and 38 (12.6%) reported precariousness (DipCareQ score > 1); precariousness did not differ significantly between individuals with a SEMSA-15 score ≤ 2.78 versus >2.78. Health literacy was generally good, but was significantly lower in individuals with versus without precariousness, and with low versus high self-efficacy.ConclusionSEMSAS is the first study using multidimensional baseline assessment of self-efficacy, health literacy and precariousness, plus other characteristics, to determine future adherence to CPAP, including CPAP adherence trajectories. Collection of follow-up data is underway.</p

sj-docx-1-eso-10.1177_23969873241227751 – Supplemental material for Trajectories of self-reported daytime sleepiness post-ischemic stroke and transient ischemic attack: A propensity score matching study versus non-stroke patients

Supplemental material, sj-docx-1-eso-10.1177_23969873241227751 for Trajectories of self-reported daytime sleepiness post-ischemic stroke and transient ischemic attack: A propensity score matching study versus non-stroke patients by Sébastien Baillieul, Renaud Tamisier, Bastien Gévaudan, Sarah Alexandre, Olivier Detante, Yves Dauvilliers, Claudio Bassetti, Jean-Louis Pépin and Sébastien Bailly in European Stroke Journal</p

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<p>A systematic review of English and French articles using Pubmed/Medline and Embase included studies assessing objective physical activity levels of obstructive sleep apnea (OSA) patients and exploring the effects of exercise training on OSA severity, body mass index (BMI), sleepiness, and cardiorespiratory fitness [peak oxygen consumption (VO2peak)]. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. For objective physical activity levels, eight studies were included. The mean number of steps per day across studies was 5,388 (95% CI: 3,831–6,945; p < 0.001), which was by far lower than the recommended threshold of 10,000 steps per day. For exercise training, six randomized trials were included. There was a significant decrease in apnea–hypopnea-index following exercise training (mean decrease of 8.9 events/h; 95% CI: −13.4 to −4.3; p < 0.01), which was accompanied by a reduction in subjective sleepiness, an increase in VO2peak and no change in BMI. OSA patients present low levels of physical activity and exercise training is associated with improved outcomes. Future interventions (including exercise training) focusing on increasing physical activity levels may have important clinical impacts on both OSA severity and the burden of associated co-morbidities. Objective measurement of physical activity in routine OSA management and well-designed clinical trials are recommended.</p><p>Registration # CRD42017057319 (Prospero).</p

Patients characteristics of the entire cohort and by clusters: Co-morbidities.

<p>Values in Numbers (%).</p

Conditional probabilities of BMI, age and risk factors to highlight the major differences among clusters.

<p>Cluster 1: the young symptomatic. Cluster 2: the old obese. Cluster 3: the multi-disease (MD) old obese. Cluster 4: the young snorers. Cluster 5: the drowsy obese. Cluster 6: the MD obese symptomatic</p

Conditional probabilities of symptoms to highlight the major differences among clusters.

<p>Cluster 1: the young symptomatic. Cluster 2: the old obese. Cluster 3: the multi-disease (MD) old obese. Cluster 4: the young snorers. Cluster 5: the drowsy obese. Cluster 6: the MD obese symptomatic</p

Conditional probabilities of co-morbidities to highlight the major differences among clusters.

<p>Cluster 4 was not represented in this figure because the probability to have cardiovascular and metabolic co-morbidities was near 0. Cluster 1: the young symptomatic. Cluster 2: the old obese. Cluster 3: the multi-disease (MD) old obese. Cluster 5: the drowsy obese. Cluster 6: the MD obese symptomatic</p

Representation of six clusters after ascending hierarchical clustering analysis.

<p>Axes correspond to individual coordinates for the two main dimensions of the multiple correspondence analysis. Cluster 1: the young symptomatic. Cluster 2: the old obese. Cluster 3: the multi-disease (MD) old obese. Cluster 4: the young snorers. Cluster 5: the drowsy obese. Cluster 6: the MD obese symptomatic.</p

data_sheet_1.docx

<p>A systematic review of English and French articles using Pubmed/Medline and Embase included studies assessing objective physical activity levels of obstructive sleep apnea (OSA) patients and exploring the effects of exercise training on OSA severity, body mass index (BMI), sleepiness, and cardiorespiratory fitness [peak oxygen consumption (VO2peak)]. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. For objective physical activity levels, eight studies were included. The mean number of steps per day across studies was 5,388 (95% CI: 3,831–6,945; p < 0.001), which was by far lower than the recommended threshold of 10,000 steps per day. For exercise training, six randomized trials were included. There was a significant decrease in apnea–hypopnea-index following exercise training (mean decrease of 8.9 events/h; 95% CI: −13.4 to −4.3; p < 0.01), which was accompanied by a reduction in subjective sleepiness, an increase in VO2peak and no change in BMI. OSA patients present low levels of physical activity and exercise training is associated with improved outcomes. Future interventions (including exercise training) focusing on increasing physical activity levels may have important clinical impacts on both OSA severity and the burden of associated co-morbidities. Objective measurement of physical activity in routine OSA management and well-designed clinical trials are recommended.</p><p>Registration # CRD42017057319 (Prospero).</p

Patients characteristics of the entire cohort and by clusters: Anthropometric and demographic characteristics.

<p>Values in Numbers (%) or median [IQR]. Body Mass Index (BMI). Cluster 1: the young symptomatic. Cluster 2: the old obese. Cluster 3: the multi-disease (MD) old obese. Cluster 4: the young snorers. Cluster 5: the drowsy obese. Cluster 6: the MD obese symptomatic.</p