Ulm, Univ., Diss., 2007.

Univ., Diss., 2009--Marburg.

Zugl.: Marburg, University, Diss., 2005.

Ulm, Univ., Diss., 2008.

BACKGROUND: Treatment-emergent central sleep apnea (TECSA, formerly known as complex sleep apnea) is the conversion of obstructive sleep apnea (OSA) to central sleep apnea (CSA) and/or hypopnea while undergoing treatment, especially continuous positive air pressure (CPAP) therapy. Some research suggests prevalence of TECSA on CPAP could be as high as 20.3%, while other data reports prevalence as low as 0.56%. OBJECTIVES: The objective of this study is to elucidate the prevalence, as well as natural course, of TECSA with CPAP use which currently varies widely in different studies. METHODS: This is a prospective multicenter longitudinal study to be conducted with 3276 treatment-naïve OSA patients for 36 months each under a rolling enrollment model, with an estimated study run time of 5-6 years. After undergoing full-night CPAP titration, each patient will begin CPAP therapy at home using AirView or other ResMed PAP devices, which will record apnea-hypopnea index (AHI) and central apnea index (CAI) data into a U.S. PAP device telemonitoring database. Every six months, all patients will have a follow-up appointment, and a subset will receive full-night diagnostic polysomnography to confirm CPAP data. Patients will also self-assess and report habitual daytime sleepiness using the Epworth Sleepiness Scale upon diagnosis and at follow-up every 6 months. RESULTS: Prevalence of TECSA will be assessed for statistical significance using the Chi-squared test or Fisher’s exact test if expected cell counts are <5. Statistical significance is assumed for type I error <0.05. To measure the sensitivity and specificity of telemonitoring CPAP data, continuous variables for the accuracy and precision of the overlapping measures (AHI, apnea index, and hypopnea index) will be compared to PSG. Results from the Epsworth Sleepiness Scale will be measured by computing the mean score at each 6-month follow-up. DISCUSSION: This study will provide evidence as to the true prevalence of TECSA in the U.S. for OSA patients receiving CPAP therapy. Estimated TECSA prevalence while on CPAP therapy is anticipated to be higher than is currently shown in the literature, with a conservative estimate of 15%. As the largest study evaluating for TECSA prevalence to date, any results that are found will be more accurate than previous studies. This is expected to guide future treatment of OSA as a higher prevalence of TECSA while on CPAP therapy (the mainstay of OSA treatment) may impact clinical decision-making when considering treatment options for OSA.

Bubble CPAP (BCPAP) is used in the neonatal intensive care unit (NICU) as a form of non-invasive ventilation and is commonly employed in neonates demonstrating respiratory distress. BCPAP may be used to avoid the need for intubation and mechanical ventilation thereby reducing lung injury and other morbidities as well as decrease hospital stay. PURPOSE: The purpose of this study is to retrospectively investigate the length of stay on bubble CPAP (BCPAP) considering gestational age, birth weight, and surfactant delivery in the neonatal population born at an urban tertiary high load level three (NICU). METHODS: A retrospective study using existing data from an urban tertiary high load level three NICU was completed. DATA ANALYSIS: Data analysis was performed using SPSS 16.0. Descriptive statistics were run for each variable. Contingency tables were run to determine if gestational age at birth, birth weight, and length of time on BCPAP had significance compared to surfactant delivery. Intercorrelations were run to determine if gestational age at birth, birth weight, and length of time on BCPAP had an effect on each other. Davis conventions were used to analyze the results. RESULTS: Descriptive statistics indicated the mean gestational age at birth to be 32.263 weeks, SD = +2.978, mean neonatal weight to be 1.899 kg, SD = +0.728, and mean length of time on BCPAP to be 124.430 hours, SD = +185.474. Contingency statistics showed a substantial association (reta = 0.562) between the gestational age at birth and surfactant delivery, a very strong association (reta = 1.000) between the birth weight and surfactant delivery, and a very strong association (reta = 0.914) between the length of time the neonate was on BCPAP and surfactant delivery. Pearson product-moment correlation coefficients showed gestational age at birth had a very strong positive association with birth weight (r = 0.811, p < 0.01) and a moderate negative association with length of time on BCPAP (r = -0.439, p < 0.01). Intercorrelations also showed birth weight had a moderate negative association with length of time on BCPAP (r = -0.306, p < 0.01). CONCLUSIONS: The neonate was less likely to receive surfactant if, their gestational age was older at birth, they had a heavier birth weight, and their length of time on BCPCP was shorter. The data also demonstrated that the older the neonate’s gestational age at birth and the heavier the neonatal birth weight equated to a shorter length of time on BCPAP. Lastly the data demonstrated that the heavier the neonate’s birth weight, the shorter length of time on BCPAP.

Introdução: Apesar de o CPAP (Continuous Positive Airway Pressure) ser considerado padrão ouro no tratamento da Síndrome da Apneia Obstrutiva do Sono (SAOS), a taxa de adesão ao tratamento é baixa. A endoscopia do sono induzido por drogas (DISE) tem sido aplicada no topodiagnóstico do colapso da via aérea superior no paciente com SAOS, mas seu uso em pacientes com CPAP ainda é muito pouco explorado na literatura. O principal objetivo do presente estudo foi identificar, por meio da DISE, fatores anatômicos relacionados à má adaptação ao CPAP. Casuística e Métodos: Dezenove indivíduos com SAOS (13 mal-adaptados e seis bem-adaptados) foram submetidos à DISE durante a aplicação de um protocolo que envolveu o uso de CPAP com pressão em uso em casa, com máscara nasal e oronasal, ao estudo da pressão mais efetiva, de acordo com os achados da DISE, à realização de manobra de protrusão da mandíbula e associação das terapias (CPAP e manobra de protrusão da mandíbula). Os dados endoscópicos de cada etapa do exame foram classificados de acordo com a Classificação de VOTE (Velum Oropharynx Tongue base Epiglottis), e a soma dos graus obtidos por esta classificação resultou no \"escore VOTE total\". Foram comparados dados num mesmo momento de exame entre pacientes bem e mal-adaptados, e no mesmo grupo entre os diferentes momentos do exame. Resultados: Os dois grupos estudados apresentaram \"escore VOTE\" semelhante em cada um dos sítios analisados, assim como no escore \"VOTE total\". À manobra de protrusão de mandíbula, os indivíduos mal-adaptados apresentaram significativo pior \"escore VOTE\" em base da língua (mediana 4 para o grupo mal-adaptado e 2 para o grupo bem-adaptado; p<0,05); já durante o uso de CPAP na pressão em uso em casa, o \"escore VOTE\" foi pior em epiglote (mediana 1 no grupo mal-adaptado e zero no grupo bem-adaptado; p=0,02). O uso de máscara nasal foi capaz de promover melhora do \"escore \"VOTE total\" em relação ao exame sem efeito terapêutico (mediana 4,5 na condição basal e 2 com máscara nasal; p=0,003), efeito não observado quando o paciente foi submetido ao exame com a mesma pressão, mas com máscara oronasal. As pressões obtidas em polissonografia sugeridas pela DISE não revelaram diferença estatística em comparação às pressões sugeridas na polissonografia de titulação (p=0,19 no grupo mal-adaptado; p=0,17 no grupo bemadaptado), mas foram significativamente mais eficientes para melhora no escore \"VOTE total\" do que as pressões de CPAP em uso pelos pacientes (medianas de 2 e 3, respectivamente, p<0,05). A associação do CPAP à manobra de protrusão da mandíbula promoveu redução ainda mais importante do \"VOTE total\" em relação ao CPAP na pressão em uso em casa (mediana 3 versus 1, p<0,01). Conclusão: A persistência de colapso da epiglote durante o uso de CPAP pode ser uma das causas de má-adaptação. A DISE pode ser aplicada na avaliação do paciente com dificuldade de adaptação ao CPAP, assim como na avaliação do efeito de diversas modalidades terapêuticas clínicas, auxiliando na escolha da melhor delas. / Introduction: Although CPAP (Continuous Positive Airway Pressure) is considered the gold standard in the treatment of Obstructive Sleep Apnea (OSA), the rate of treatment adherence is very low. Drug Induced Sleep Endoscopy (DISE) has been used to evaluate collapse sites in upper airways on OSA patients, but its use in patients during CPAP therapy has been poorly explored in literature. In this study, we aimed to identify, through DISE, anatomical characteristics related to poor adherence to CPAP. Casuistic and Methods: Nineteen volunteers diagnosed with OSA underwent DISE (being 13 with poor and 6 with good adherence to CPAP). We analyzed the upper airway under the following conditions: during CPAP therapy, with pressure previously used, during the use of both nasal and oronasal masks, with the pressure titrated by CPAP, the chin lift maneuver, and the association of both CPAP and chin lift maneuver. The endoscopic findings were scored using VOTE, and the sum of VOTE in each site was considered as \"total VOTE\". The data obtained in each moment of the study were compared between patients with good and bad adherence to CPAP. Also, a comparison was performed between the different moments of the exam. Results: The \"total VOTE\" score was similar between the two groups in each site analyzed, as for \"total VOTE\" score. During chin lift maneuver, the patients with poor adherence had a worse \"VOTE score\" at the tongue base (median 4 for the group with poor adherence and 2 for the good adherence, p<0.05); during CPAP therapy, with the previously determined and used pressure, \"VOTE score\" was worse at epiglottis (median 1 for the group with poor adherence and 0 for the group with good adherence, p=0.02). The nasal mask promoted a significantly improved \"Total VOTE\" score in comparison with the baseline condition (median 4.5 for the baseline condition and 2 with the nasal mask, p=0.003), and such an effect was not observed when the same pressure was applied through an oronasal mask. The pressure suggested by DISE did not present statistical difference from that suggested by CPAP titration polysomnogram (p=0.19 for the group with poor adherence and p=0.17 for the group with good adherence), but they were significantly more effective to improve \"total VOTE\" score than previously used pressure (medians respectively 2 and 3, p<0.05). The association between chin lift maneuver and CPAP promoted a \"total VOTE score\" reduction when compared to previously used pressure (median 3 versus 1, p < 0.01). Conclusion: The persistence of epiglottis collapse under the use of CPAP might contribute to a poor adherence to CPAP. DISE may be useful in the investigation of factors leading to non-adherence to CPAP, as well as in the evaluation of the different clinical modalities. This exam could even be important in choosing the best therapy for each patient.

Ventilation may limit exercise. Wearing a gas mask may further compromise ventilation. Continuous positive airway pressure (CPAP) improves ventilation by reducing airway resistance and thus the work of breathing. We investigated the effects of wearing a gas mask with and without CPAP on the work of breathing (WOB) during resting and exercise conditions to determine (a) whether wearing a gas mask increases the WOB and (b) whether the application of CPAP to a gas mask will mitigate (reduce) said increase to the WOB. Ten healthy males completed two test protocols with three stages each, and in three mask conditions. Physiological and dyspnea parameters were measured. Wearing a gas mask increased the metabolic cost and work of breathing. When the portable CPAP device was applied, there was no change in the calculated work of breathing, but metabolic cost of breathing was significantly reduced. CPAP also significantly reduced the sensation of dyspnea.

Ventilation may limit exercise. Wearing a gas mask may further compromise ventilation. Continuous positive airway pressure (CPAP) improves ventilation by reducing airway resistance and thus the work of breathing. We investigated the effects of wearing a gas mask with and without CPAP on the work of breathing (WOB) during resting and exercise conditions to determine (a) whether wearing a gas mask increases the WOB and (b) whether the application of CPAP to a gas mask will mitigate (reduce) said increase to the WOB. Ten healthy males completed two test protocols with three stages each, and in three mask conditions. Physiological and dyspnea parameters were measured. Wearing a gas mask increased the metabolic cost and work of breathing. When the portable CPAP device was applied, there was no change in the calculated work of breathing, but metabolic cost of breathing was significantly reduced. CPAP also significantly reduced the sensation of dyspnea.

<p>Obstruktivt sömnapnésyndrom (OSAS) innebär upprepade andningsuppehåll under natten tillsammans med extrem dagen efter-trötthet. Fortfarande finns det många personer med ett odiagnostiserat OSAS. Syftet med litteraturstudien var att belysa hur personer med obstruktivt sömnapnésyndrom upplever sin livskvalitet. I metoden har 18 artiklar bearbetats. Resultatet visar på en försämrad livskvalitet hos personer med OSAS. Livskvaliteten påverkas av fysiska, psykiska och sociala aspekter. Personer med OSAS påverkades i sitt vardagliga liv då tröttheten begränsar deras livsstil. En efterfrågan av relevant information kan upptäckas i denna patientgrupp. Genom CPAP-behandling kan livskvaliteten öka. Sjuksköterskan kan genom extra stöd och undervisning i samband med diagnostisering och behandling, ytterligare öka patientens livskvalitet. Mer kunskap behövs hos sjukvårds¬personalen om OSAS och CPAP-behandlingar. Detta för att kunna ge undervisning och stöd till patient och anhöriga. Genom en utvecklad sömnanamnes skulle fler patienter med OSAS kunna upptäckas och få hjälp. Det finns ett behov av mer forskning om OSAS ur ett sjuksköterskeperspektiv samt om patienters upplevelser av OSAS.</p>