BACKGROUND & AIMS: :Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side effects are common and long-term adherence low. The Type D (distressed) personality is defined as a combination of negative affectivity and social inhibition. The association of Type D personality with adherence has not been studied in CPAP-treated patients with OSAS. This study aimed to describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. A cross-sectional descriptive design was used. A total of 247 OSAS patients with a mean use of CPAP treatment for 55 months (6-182 months) were included. Data collection was achieved by two questionnaires; the Type D scale 14 (DS14) (Type D personality), SECI (side effects of CPAP), as well as from medical records (clinical variables and objective adherence to CPAP treatment). Type D personality occurred in 30% of the patients with OSAS and significantly (P < 0.05-0.001) increased the perceived frequency and severity of a broad range of side effects. The objective adherence was significantly lower (P < 0.001) for OSAS patients with Type D compared to OSAS patients without Type D, both with regard to a mean use of 4 h per night and 85% of the self-rated sleep time per night. The additional effect of a Type D personality on perceived side effects and adherence to CPAP treatment found in this study could be used by healthcare personnel when evaluating patients waiting for treatment.

背景与目标： : 持续气道正压通气 (CPAP) 是阻塞性睡眠呼吸暂停综合症 (OSAS) 的首选治疗方法，但副作用很常见，长期依从性低。D型 (苦恼) 人格被定义为消极情感和社会抑制的结合。尚未在CPAP治疗的oas患者中研究D型人格与依从性的关系。这项研究旨在描述CPAP治疗超过6个月的oas患者中D型人格的患病率以及与自我报告的副作用和依从性的关系。采用横断面描述性设计。共纳入平均使用CPAP治疗55个月 (6-182个月) 的247例OSAS患者。通过两份问卷进行数据收集; D型量表14 (DS14) (D型人格)，SECI (CPAP的副作用) 以及医疗记录 (临床变量和对CPAP治疗的客观依从性)。D型人格发生在30% oas患者中，并且显着 (P < 0.05-0.001) 增加了广泛副作用的感知频率和严重程度。与无D型oas患者相比，D型oas患者的客观依从性显着降低 (P <0.001)，无论是每晚平均使用4小时还是每晚自我评估的睡眠时间的85%。在本研究中发现的D型人格对感知到的副作用和对CPAP治疗的依从性的额外影响可由医护人员在评估等待治疗的患者时使用。

BACKGROUND & AIMS: STUDY OBJECTIVES:Medium and long-term trials comparing continuous positive airway pressure (CPAP) with noninvasive ventilation in patients with obesity hypoventilation syndrome have shown no differences in outcomes. However, it remains unclear whether CPAP therapy should be prescribed if significant hypoxemia persists during CPAP titration, despite optimization of upper airway obstructive events or if maximum CPAP pressure is reached. We aimed to examine the effects of 6 weeks of home CPAP therapy on gas exchange in patients with obesity hypoventilation syndrome who failed CPAP titration due to persistent hypoxemia. METHODS:This case series is a substudy of a randomized-controlled trial evaluating efficacy of 3 different PAP modalities in obesity hypoventilation syndrome. Patients randomized to CPAP who failed titration and were prescribed CPAP are included. CPAP failure was defined as spending more than 20% of total sleep time with oxygen saturation below 90% despite adequate resolution of apneas and hypopneas. Follow-up data included in-laboratory polysomnogram on prescribed CPAP after 6 weeks of home CPAP therapy. RESULTS:Three of seven participants (43%) randomized to CPAP failed CPAP titration. All were morbidly obese, had severe OSA (apnea-hypopnea index > 90 events/h) and severe sleep hypoxemia (percentage of total sleep time with oxygen saturation < 90% [T90] = 60-89%). Hypoxemia (T90: 43-67%, T80: 0-31%, and T70: 0-11%) and hypercapnia (transcutaneous pressure of CO₂ levels > 50 mm Hg) persisted during CPAP titration polysomnogram. The final polysomnogram after 6 weeks of adherent home CPAP therapy showed effective control of obstructive sleep apnea. Hypoventilation and hypoxemia severity decreased significantly in all 3 participants. CONCLUSIONS:Our data suggest that CPAP titration failure does not equal CPAP treatment failure. CLINICAL TRIAL REGISTRATION:Registry: ClinicalTrials.gov; Name: AVAPS-AE Efficacy Study; URL: https://clinicaltrials.gov/ct2/show/NCT01368614; Identifier: NCT01368614.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:CPAP is considered the therapy of choice for OSA, but the extent to which it can reduce BP is still under debate. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to quantify the effect size of the reduction of BP by CPAP therapy compared with other passive (sham CPAP, tablets of placebo drug, conservative measures) or active (oral appliance, antihypertensive drugs) treatments. METHODS:We searched four different databases (MEDLINE, EMBASE, Web of Science, and the Cochrane Library) with specific search terms and selection criteria. RESULTS:From 1,599 articles, we included 31 RCTs that compared CPAP with either passive or active treatment. In a random-effects meta-analysis vs passive treatment (29 RCTs, 1,820 subjects), we observed a mean±SEM net difference in systolic BP of 2.6±0.6 mm Hg and in diastolic BP of 2.0±0.4 mm Hg, favoring treatment with CPAP (P<.001). Among studies using 24-h ambulatory BP monitoring that presented data on daytime and nighttime periods, the mean difference in systolic and diastolic BP was, respectively, 2.2±0.7 and 1.9±0.6 mm Hg during daytime and 3.8±0.8 and 1.8±0.6 mm Hg during nighttime. In meta-regression analysis, a higher baseline apnea/hypopnea index was associated with a greater mean net decrease in systolic BP (beta±SE, 0.08±0.04). There was no evidence of publication bias, and heterogeneity was mild ( I2, 34%-36%). CONCLUSIONS:Therapy with CPAP significantly reduces BP in patients with OSA but with a low effect size. Patients with frequent apneic episodes may benefit the most from CPAP.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The optimal approach to initiate positive-pressure therapy in patients with obstructive sleep apnea is still debated. Current options are autotitrating positive airway pressure (APAP) or manual titration with continuous positive airway pressure (CPAP). Procedures differ by parameters and by algorithms used for adapting pressure. OBJECTIVES:To evaluate the efficacy of attended automatic titration in a randomized crossover study compared with manual titration over 2 nights where the sequence of the titration mode was changed. Therapy outcome was controlled after 6 weeks. METHODS:21 sleep apnea patients were treated using manual CPAP versus automatic APAP titration. The mode used during the 2nd night was continued for 6 weeks. Cardiorespiratory polysomnography, Epworth Sleepiness Scale (ESS), SF-36 score and compliance were assessed. RESULTS:Apnea-hypopnea index reduction was equally effective at similar effective pressure independent of the titration mode. If APAP was applied during the 1st night, total sleep time was longer (384 vs. 331 min, p < 0.01) and sleep efficacy was higher (91 vs. 81%, p < 0.01) than after starting with manual titration with CPAP. Compliance was comparable in both groups (4.6 +/- 1.9 h). The ESS improved in both groups (from 12.9 to 6.5). SF-36 scores and therapeutic pressure did not much change. CONCLUSIONS:Taking the sequence of titration into account, we found equal effectiveness of CPAP and APAP. Sleep quality was better with initial application of APAP - which favors attended automatic titration if only 1 titration night is possible. Both modes are comparable after 6 weeks regarding therapeutic pressure, efficacy, compliance and quality of life.

背景与目标：

BACKGROUND & AIMS: :The population pyramid is changing as a result of the ever-increasing life expectancy, which makes it crucial to acquire an in-depth understanding of the diseases that most often affect the elderly. Obstructive sleep apnoea (OSA) affects 15%-20% of the population aged over 65 years. Despite this prevalence, there have been very few specific studies on the management of OSA in this age group, even though over 60% of the patients aged over 65-70 years who attend sleep units with suspicion of OSA receive treatment with continuous positive airway pressure (CPAP), on the basis of an extrapolation of the positive results achieved by CPAP in clinical trials involving middle-aged males. However, the latter's form of presentation, evolution and, probably, prognosis comparing with OSA are not the same as those of elderly patients. Recent clinical trials performed on an exclusive series of elderly patients have shed light on the possible role of CPAP treatment in elderly patients with OSA, but there are still many questions that need to be answered. The physiological increase in the number of sleep-related disorders with the passing of years, and the lack of validated diagnostic and therapeutic tools for this age group are probably the greatest obstacles to define, diagnose and treat OSA in the elderly.

背景与目标： : 由于预期寿命的不断延长，人口金字塔正在发生变化，这使得深入了解最常影响老年人的疾病至关重要。阻塞性睡眠呼吸暂停 (OSA) 影响65岁以上人群的15%-20%。尽管这种流行，但在这一年龄组中很少有关于OSA管理的具体研究，尽管超过60% 的65-70岁以上患有OSA怀疑的睡眠单位的患者接受持续气道正压通气 (CPAP) 治疗，根据CPAP在涉及中年男性的临床试验中取得的积极结果进行外推。然而，与OSA相比，后者的表现形式，进化形式以及预后可能与老年患者不同。最近对一系列老年患者进行的临床试验揭示了CPAP治疗在老年OSA患者中的可能作用，但仍有许多问题需要回答。随着时间的流逝，与睡眠有关的疾病数量的生理增加，以及该年龄段缺乏经过验证的诊断和治疗工具，可能是定义，诊断和治疗老年人OSA的最大障碍。

BACKGROUND & AIMS: STUDY OBJECTIVES:To study the pattern of upper airway collapse in patients with CPAP failure by performing DISE while administering CPAP therapy and to determine the reason for CPAP failure accordingly. METHODS:This observational retrospective study comprised 30 patients diagnosed with OSA and CPAP failure, who underwent DISE while administering CPAP therapy. During DISE, the upper airway was assessed with and without CPAP therapy using the VOTE classification. Additionally, a jaw thrust maneuver was performed, in order to mimic the effect of an additional mandibular advancement device (MAD) in combination with CPAP therapy. Consequently, the outcome of DISE was translated into a clinically relevant categorization. RESULTS:Eleven patients (37%) had a persistent anteroposterior (AP) collapse, including a collapse at velum, tongue base, or epiglottis level and multilevel collapse. Eight patients (27%) had a floppy epiglottis. Five patients (17%) had a persistent complete concentric collapse (CCC) and three patients had a persistent laryngeal collapse (10%). In three patients (10%), no airway collapse was found after CPAP administration. CONCLUSIONS:Based on the results of the reported study, in most cases, the potential cause of CPAP failure can be determined by this new diagnostic method. Consequently, suggestions can be made for additional therapy.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:By including untreated obstructive sleep apnea-hypopnea syndrome (OSAHS) patients as the control group, this study explores the influence of minimally invasive surgical treatment and continuous positive airway pressure (CPAP) therapy on OSAHS patients, with the subjective and objective performance. The study also discusses their relationship, determines the effect factor, and provides a simple and practical method for evaluation of clinical efficacy. METHODS:A total of 90 OSAHS patients, who were diagnosed in the Sleep Disorders Diagnosis and Treatment Center of Sichuan Province from May 2014 to May 2016, were selected for the present study. These patients were divided into three groups: surgery group, CPAP group, and untreated group. These patients were followed up at six months, one year, and two years, respectively. The physiological indicators, clinical symptoms, degree of daytime sleepiness and quality of life were compared among these three groups. The daytime sleepiness and the quality of life before and after minimally invasive surgery and CPAP treatment were evaluated, and the subjective and objective efficacy of surgery and CPAP treatment was explored. RESULTS:Among these 90 patients, 11 (12.2%) patients had hypertension, while two (2.2%) patients had diabetes. The average AHI score was 50.53±23.39 per hour, and the mean minimum oxygen saturation and mean oxygen saturation was 71.25±14.16% and 90.13±5.90%, respectively. There were statistically significant differences in mouth breathing, morning sore throat and daytime sleepiness in the group having received surgery at 0.5 year and one year. In the CPAP group, there were statistically significant differences in mouth breathing, morning sore throat and daytime sleepiness at 0.5 year, one year and two years. Moreover, there were statistically significant differences in memory loss at one year and two years, and there were statistically significant differences in frequent nocturia at one year. The ESS value in the surgery group decreased at 0.5 year and one year, but increased at two years. The situation was the same in terms of the total points and in each dimension of the SF-36 paramter. The delta values of ESS among the three groups had statistical significance at 0.5 year, one year and two years, in which the CPAP group experienced the most changes, followed by the surgery group and the group received health education. CONCLUSION:For minimally invasive surgery, CPAP therapy and health education can improve daytime sleepiness and quality of life. CPAP therapy was found to be the most effective, followed by minimally invasive surgery and provision of health education. However, the treatment of OSAHS should be comprehensive.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To evaluate the performance of clinical criteria (CC) for diagnosis and initiation of empirical treatment with continuous positive airway pressure (CPAP) in patients with suspected obstructive sleep apnea (OSA) compared with the treatment decision based on sleep studies (polysomnography or respiratory polygraphy), guidelines, and experience of participating physicians. METHODS:This was a simulated intention-to-treat study in a retrospective (G1) and prospective (G2) cohort. Four observers (two per group) called CC1 and CC2 reviewed the sleep questionnaires and indicated CPAP if the patients presented snoring, frequent apneas (≥ 3-4/week), body mass index (BMI) > 25 kg/m2, sleepiness (Epworth > 11), or tiredness (at least 3-4 times per week) and some comorbidity (hypertension, coronary/cerebrovascular event, diabetes). Ten independent observers formed two groups of five (FD1 and FD2) and were blinded to each other's opinion. These observers in FD1 and FD2 decided CPAP treatment based on guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) or guidelines of the American Academy of Sleep Medicine (AASM) and factored in their own opinion. Sensitivity (S), specificity (Sp), and positive/negative likelihood ratios (LR+/-) were calculated with the test method: CC1/2, and the reference method: majority decision of FD1/2. RESULTS:A total of 653 patients (264 women, 40%) were studied. Median age was 54 years, BMI 28 kg/m2, and apnea hypopnea index (AHI) 16.5 events/h. S ranged from 21 to 25% (p 0.60), Sp 96.1 to 97.6% (p 0.39), and LR+ of clinical criteria 6.4 to 8.9 (p 0.52). CONCLUSION:CPAP indication without a previous sleep study showed a low sensitivity (≅ 22%) but a specificity greater than 95% in patients with high pretest probability for OSA (snoring, report of frequent apneas, BMI > 25 kg/m2 and sleepiness or tiredness plus comorbidity).

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Many patients abandon continuous positive airway pressure (CPAP) treatment after initial acceptance. This may be for physical or psychological reasons. METHODS:We have carried out semi-structured interviews, constructed from the Health Belief Model (HBM) with a convenience sample of patients who had recently abandoned CPAP treatment after at least 6 months of use. We explored their understanding and experiences of their OSA and of the CPAP therapy and their reasons for stopping treatment. RESULTS:Nine patients were interviewed (age 32-70 years; 8 males). Four patients were not clear about the nature, severity, or consequences of sleep apnoea syndrome (SAS) and did not consider themselves to be ill. Three expected to be cured by the machine. Only one patient spoke of life-threatening risk. Eight of the nine patients had other health disorders. Seven stopped CPAP because of negative experiences, including problems with the mask and noise from the machine. Two patients felt 'liberated' on stopping treatment. CONCLUSIONS:Studies at the initiation stage of CPAP treatment are needed in order to identify factors impeding acceptance, which can be addressed early. The Health Belief Model, which emphasises subjective health experience and patients' beliefs about treatment, may be a useful tool for such investigations.

背景与目标：

BACKGROUND & AIMS: :We report an apparent solution to nasal dryness for patients with obstructive sleep apnea syndrome treated with nasal continuous positive airway pressure (CPAP) when a hygroscopic condenser humidifier is introduced into the CPAP circuit. Six patients underwent a 5-h test period of nasal CPAP therapy with a mask containing a hygroscopic humidifier. The water vapor showed a statistically significant increase in both inspired and expired gases. The relative humidity of the inspired gases increased significantly. The levels of O2 and CO2 in the respired gases did not change. When patients were asked about nasal dryness at the end of the test, all of them reported marked improvement.

背景与目标： : 我们报告了将吸湿冷凝器加湿器引入CPAP回路时，经鼻持续气道正压通气 (CPAP) 治疗的阻塞性睡眠呼吸暂停综合征患者的鼻干燥的明显解决方案。六名患者使用装有吸湿机的面罩进行了5小时的鼻CPAP治疗测试期。水蒸气在吸入和呼出气体中均显示出统计学上的显着增加。吸入气体的相对湿度显着增加。呼吸气体中O2和CO2的含量没有变化。当患者在测试结束时被问及鼻干燥时，所有患者均报告有明显改善。

BACKGROUND & AIMS: :OBJECTIVE: To non-invasively study the effects of continuous positive airway pressure breathing (CPAP) on renal vascular resistance in normal subjects and renal allograft recipients, in other words those with with denervated kidneys. We could then ascertain the influence of renal innervation on any resulting changes in renal haemodynamics. METHODS: Ten healthy volunteers and six renal transplant patients were studied. Using Doppler ultrasonography, the pulsatility index (PI), an index of renovascular resistance, was measured at incremental levels of CPAP (0, 2.5, 5.0 and 7.5 cmH2O). RESULTS: In both groups, the PI increased significantly between 0 and5.0 cmH2O CPAP, with a further increase at 7.5 cmH2O CPAP. CONCLUSIONS: We found that CPAP at 5.0 and 7.5 cmH2O caused a significant increase in renovascular resistance in both normal and renal transplant patients. There was no difference in the degree of rise in renovascular resistance between both groups, indicating that the renal nerves do not play a role in altering renal vascular resistance with the application of CPAP.

背景与目标： 目的: 非侵入性地研究持续气道正压呼吸 (CPAP) 对正常受试者和同种异体肾移植受者，即失神经肾受者的肾血管阻力的影响。然后，我们可以确定肾脏神经支配对肾脏血流动力学任何变化的影响。方法: 对10名健康志愿者和6名肾移植患者进行研究。使用多普勒超声检查，在CPAP (0、2.5、5.0和7.5 cmH2O) 的增量水平下测量搏动指数 (PI)，即肾血管阻力指数。结果: 在两组中，PI在0至5.0 cmH2O CPAP之间显着增加，在7.5 cmH2O CPAP时进一步增加。结论: 我们发现5.0和7.5 cmH2O的CPAP导致正常和肾移植患者的肾血管阻力显着增加。两组之间的肾血管阻力上升程度没有差异，表明使用CPAP时，肾神经在改变肾血管阻力方面不起作用。

BACKGROUND & AIMS: PURPOSE:This study aimed to perform a systematic review and meta-analysis of randomized trials investigating the effect of continuous positive airway pressure (CPAP) on non-invasive markers of arterial stiffness in patients with OSA. METHODS:The purpose of the study was to evaluate the effect of CPAP on markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix)) in patients with OSA. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically reviewed MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, and LILACS databases for randomized trials (RT) evaluating the changes in markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix) comparing CPAP vs. controls in patients with OSA. Reviewer Manager version 5.3 (R Foundation for Statistical Computing, Vienna, Austria) was used to perform meta-analysis. Risk of bias analysis was performed using the Cochrane tool. RESULTS:Of the 464 studies initially retrieved, 9 relevant studies with 685 participants were included in the analysis. The studies presented moderate risk of bias. CPAP did not significantly reduce Aix (mean difference, - 1.96 (95% confidence interval (CI) - 5.25 to 1.33), p = 0.24), whereas it significantly changed PWV (mean difference, - 0.44 (95% confidence interval (CI) - 0.76 to - 0.12), p = 0.00). CONCLUSION:CPAP treatment was effective in improving arterial stiffness by reducing PWV in patients with OSA. Additional randomized trials, however, should be performed to confirm these findings.

背景与目标：

BACKGROUND & AIMS: RATIONALE:Obstructive sleep apnoea (OSA) is common in coronary artery disease (CAD) and a possible cause of increased mortality. To date, there is a lack of randomized controlled trials to draw the conclusion that all CAD patients should be investigated for OSA and subsequently be treated with continuous positive airway pressure (CPAP). OBJECTIVE:The Randomized Intervention with CPAP in CAD and OSA (RICCADSA) trial is designed to address if CPAP treatment reduces the combined rate of new revascularization, myocardial infarction, stroke and cardiovascular mortality over a 3-year period in CAD patients with OSA. Secondary outcomes include cardiovascular biomarkers, cardiac function and maximal exercise capacity at 3-month- and 1-year follow-ups. PATIENTS AND METHODS:A sample of 400 CAD patients (100 non-sleepy OSA patients randomized to CPAP, 100 to non-CPAP; 100 sleepy OSA patients on CPAP, and 100 CAD patients without OSA) will be included. So far, 240 patients have been enrolled in the trial since December 31, 2005. CONCLUSION:The RICCADSA trial will contribute to defining the impact of CPAP on prognosis of CAD patients with OSA.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Obstructive sleep apnea (OSA) is prevalent among bariatric surgery candidates and is associated with numerous adverse health conditions, both pre- and postoperatively. Continuous positive airway pressure therapy (CPAP) is the first-line treatment for OSA, but it requires significant behavioral changes. As such, CPAP adherence is a significant problem in OSA treatment. Information from the preoperative psychological evaluation may be used to identify psychosocial risk factors associated with CPAP nonadherence and inform the implementation of more specific and appropriate interventions. OBJECTIVES:Examine the utility of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) behavioral/externalizing dysfunction scale scores to determine personality and psychopathology associations with, and risk for, CPAP nonadherence. SETTING:Academic medical center. METHODS:Patients who underwent a preoperative psychological evaluation and were diagnosed with OSA (n = 358) were divided into 2 groups: CPAP adherent (n = 271) and CPAP nonadherent (n = 87). Independent samples t tests were computed to examine differences in average MMPI-2-RF scale scores between these groups. Relative risk ratios were computed using multiple MMPI-2-RF substantive scale score cut-offs to determine which MMPI-2-RF scales were associated with increased risk of CPAP nonadherence. RESULTS:Higher scores on scales measuring behavioral/externalizing dysfunction and family problems were associated with and indicative of risk for CPAP nonadherence. CONCLUSIONS:CPAP nonadherence is related to and may be affected by generally higher levels of behavioral/externalizing dysfunction. Using a broadband measure of personality and psychopathology, like the MMPI-2-RF, during the preoperative evaluation can provide important information about co-morbid symptoms that may interfere with CPAP adherence. Considering this information during preoperative treatment planning could increase the likelihood of preoperative CPAP adherence and reduce the likelihood of adverse postoperative outcomes.

背景与目标：

BACKGROUND & AIMS: None:A middle-aged man with obstructive sleep apnea who had been treated with continuous positive airway pressure (CPAP) developed COVID-19. An analysis of airflow records from the CPAP machine revealed a rise in his respiratory rate on the night before the onset of COVID-19-related symptoms, while his nocturnal respiratory rate had been stable during the 18-month period prior to the presently reported episode. The present case suggests that a rise in respiratory rate detected using CPAP machine data could be an important sign of impending acute illness, such as COVID-19. Studies to elucidate the usefulness of this method are warranted.

背景与目标： 无: 一名患有阻塞性睡眠呼吸暂停的中年男子，接受持续气道正压通气 (CPAP) 治疗，并发新型冠状病毒肺炎。对CPAP机器的气流记录进行的分析显示，在COVID-19-related症状发作前的晚上，他的呼吸频率有所上升，而在目前报道的发作之前的18个月内，他的夜间呼吸频率一直稳定。目前的病例表明，使用CPAP机器数据检测到的呼吸频率上升可能是即将发生的急性疾病 (新型冠状病毒肺炎) 的重要迹象。有必要进行研究以阐明该方法的有用性。