0986 Positive Airway Pressure Care And Cleaning Practices In The Pediatric Home

Abstract Introduction The Sleep Clinic at Arkansas Children’s follows approximately 300 children who require positive airway pressure (PAP) at home. The clinic respiratory therapist provides oral and written cleaning instructions while some physicians choose to provide their own instructions. The home equipment company who supplies PAP in the home also gives cleaning instructions. The different routes of information given may result in inconsistent practices. It is extremely important to clean PAP equipment as directed as infection and illness may result from improper cleaning. Methods Caregivers of children who utilize home PAP devices were invited to complete an anonymous survey regarding cleaning practices during a Sleep clinic appointment. Data were collected electronically. Descriptive statistics were utilized to summarize results. Results There were 96 participants of whom 90% (87/96) were parents/caregivers. The mean age of the equipment user was 12 years and most were male (69%, 66/96). The mean length of time the equipment had been used was 2.6 years (SD 3.2). The majority of respondents, 67% (64/95), identified the parent/caregiver as responsible for cleaning. Only 25% (24/96) reported cleaning the mask daily as recommended; 43% (41/96) of participants reported cleaning tubing weekly; 27% (26/96) reported cleaning the water chamber daily by while most reported at least weekly (47%, 45/96). The majority, 58% (56/96) reported emptying the water chamber daily and using distilled water (81%, 74/96). Most respondents did not note respiratory symptoms starting/increasing with PAP (67%, 64/96). Of those with respiratory symptoms attributed to PAP, congestion was the most common (79%, 11/14). Conclusion There is a discrepancy between recommended and actual practices for cleaning PAP equipment. No significant association was found between the duration of PAP use and cleaning practices. However, a moderately low correlation between age and cleaning was identified. Increased age was associated with decreased cleaning practices. Support

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Continuous Positive Airway Pressure-Mandibular Advancement Device Combination Therapy for Moderate-to-Severe Obstructive Sleep Apnea: A Preliminary Study

European Journal of Dentistry ◽

10.1055/s-0040-1719220 ◽

2021 ◽

Author(s):

Thyagaseely Sheela Premaraj ◽

Jacob Stadiem ◽

Shyamaly Arya Premaraj ◽

Charles R. Davies ◽

Matthew Dennis ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Daytime Sleepiness ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Mandibular Advancement Device ◽

Mandibular Advancement ◽

Severe Obstructive Sleep Apnea ◽

Obstructive Sleep ◽

The Mean

Abstract Objectives The purpose of this pilot study was to determine whether compliance to auto-adjusting positive airway pressure (APAP) improves with the addition of a mandibular advancement device (MAD). Secondary outcome measures included were APAP pressure, subjective daytime sleepiness, apnea–hypopnea index (AHI), and mask leaks. Setting and Sample Population Participants included were diagnosed with moderate-to-severe obstructive sleep apnea (OSA) and became noncompliant to prescribed APAP. Thirteen participants with a mean age of 61.6 years were recruited for this study. Materials and Methods All participants were given a MAD to use with their APAP. Parameters measured included APAP pressure, AHI, mask leak reported via ResMed AirViewTM software, and self-reported daytime sleepiness (Epworth Sleepiness Scale [ESS]). A paired two-sample for mean t-test was performed to determine significance. Results The mean difference of pre- and postintervention APAP compliance was 23.1%, which was statistically significant (p = 0.015). The mean APAP air pressures were unchanged. The difference between pre- and postintervention mean ESS scores was 1.4 and was statistically significant (p = 0.027). The mean difference between pre- and postintervention AHI values and mask leak showed no significant difference. Conclusion This study showed that combination of APAP-MAD therapy, for patients with moderate-to-severe OSA who were noncompliant to APAP use, significantly increased compliance with APAP therapy, and significantly decreased the daytime sleepiness of participants.

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Accuracy of Positive Airway Pressure Device—Measured Apneas and Hypopneas: Role in Treatment Followup

Sleep Disorders ◽

10.1155/2013/314589 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Carl Stepnowsky ◽

Tania Zamora ◽

Robert Barker ◽

Lin Liu ◽

Kathleen Sarmiento

Keyword(s):

Home Environment ◽

Data Transmission ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Apnea Hypopnea Index ◽

Efficacy Data ◽

Treatment Progress ◽

Respiratory Events ◽

The Mean ◽

Efficacy Studies

Improved data transmission technologies have facilitated data collected from positive airway pressure (PAP) devices in the home environment. Although clinicians’ treatment decisions increasingly rely on autoscoring of respiratory events by the PAP device, few studies have specifically examined the accuracy of autoscored respiratory events in the home environment in ongoing PAP use. “PAP efficacy” studies were conducted in which participants wore PAP simultaneously with an Embletta sleep system (Embla, Inc., Broomfield, CO), which was directly connected to the ResMed AutoSet S8 (ResMed, Inc., San Diego, CA) via a specialized cable. Mean PAP-scored Apnea-Hypopnea Index (AHI) was 14.2 ± 11.8 (median: 11.7; range: 3.9–46.3) and mean manual-scored AHI was 9.4 ± 10.2 (median: 7.7; range: 1.2–39.3). Ratios between the mean indices were calculated. PAP-scored HI was 2.0 times higher than the manual-scored HI. PAP-scored AHI was 1.5 times higher than the manual-scored AHI, and PAP-scored AI was 1.04 of manual-scored AI. In this sample, PAP-scored HI was on average double the manual-scored HI. Given the importance of PAP efficacy data in tracking treatment progress, it is important to recognize the possible bias of PAP algorithms in overreporting hypopneas. The most likely cause of this discrepancy is the use of desaturations in manual hypopnea scoring.

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Comparative Analysis of Automatic versus Fixed Positive Airway Pressure Therapy for Severe Obstructive Sleep Apnea

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2019.00682 ◽

2020 ◽

Vol 63 (3) ◽

pp. 108-113

Author(s):

Ilyoung Cho ◽

Hwabin Kim ◽

Kuen-Ik Yi ◽

Sung-Dong Kim ◽

Sue Jean Mun ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Adherence Rate ◽

Severe Obstructive Sleep Apnea ◽

Obstructive Sleep ◽

Mean Pressure ◽

The Mean ◽

Purchase Rate

Background and Objectives The purposes of this study were to compare the purchase rate and adherence regarding the use of two machines, continuous positive airway pressure (CPAP) and automatic positive airway pressure (APAP), and to determine associated factors affecting the purchase rate and adherence of PAP in the treatment of severe obstructive sleep apnea (OSA).Subjects and Method From March 2016 to December 2017, 45 patients diagnosed with severe OSA by polysomnography were enrolled in this study. Patients were prescribed CPAP or APAP by one doctor and allowed to decide whether to purchase the machine after a one-month lease period, which was identified as the purchase rate. Adherence was identified as using the machine 4 h/night on 70% of nights following the PAP therapy of three months.Results The adherence rate of CPAP (84%) was statistically and significantly higher than APAP (55%) (p=0.033). However, there was no significant difference in the adherence rate between CPAP (76%) and APAP (63%). The mean pressure and 95th percentile leak were 8.62 cm H2O and 12.97 L/min in the CPAP and 10.55 cm H2O and 20.36 L/min in the APAP, respectively. The mean pressure and 95th percentile leak were significantly lower in CPAP than in APAP (p=0.010 and p=0.014, respectively).Conclusion Although adherence was not significantly different, the purchase rate was significantly higher in the fixed CPAP than in APAP, which may have been influenced by high pressure and leak patients experienced when using the particular PAP machine.

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Role of positive airway pressure on pulmonary acinar perfusion heterogeneity

Journal of Applied Physiology ◽

10.1152/jappl.2000.89.5.1943 ◽

2000 ◽

Vol 89 (5) ◽

pp. 1943-1948 ◽

Cited By ~ 1

Author(s):

Nobuhiro Tanabe ◽

Thomas M. Todoran ◽

Gerald M. Zenk ◽

Jun Aono ◽

Wiltz W. Wagner ◽

...

Keyword(s):

Airway Pressure ◽

Positive Airway Pressure ◽

Appearance Time ◽

Capillary Networks ◽

Pulmonary Acinus ◽

Capillary Resistance ◽

The Mean ◽

Lung Lobes ◽

Dilution Curves

Perfusion of the pulmonary acinus has been shown to be generally homogeneous, but there is a significant component that is heterogeneous. To investigate the contribution of the alveolar septal capillary network to acinar perfusion heterogeneity, the passage of fluorescent dye boluses through the subpleural microcirculation of isolated dog lung lobes was videotaped using fluorescence microscopy. As the videotapes were replayed, dye-dilution curves were recorded from each of the tributary branches of Y-shaped venules that drained single acini. For each Y-shaped venule, the mean appearance time difference between the pair of tributary branches was calculated from the dye curves. When the complex septal capillary networks were derecruited by high positive airway pressure, venular perfusion became proportionally more homogeneous. This result shows that septal capillary resistance and pathlength differences are important contributors to intra-acinar perfusion heterogeneity.

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0902 The Use Of Auto-titrating Continuous Positive Airway Pressure (auto Cpap) For Obstructive Sleep Apnea In Children With Neurological Disorder

SLEEP ◽

10.1093/sleep/zsaa056.898 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A343-A343

Author(s):

L Platter ◽

G Urbano ◽

L Roberto ◽

R Sudhakar ◽

M Tablizo

Keyword(s):

Obstructive Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Neurological Disorder ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Pediatric Population ◽

Adverse Outcomes ◽

Good Compliance ◽

Obstructive Sleep ◽

The Mean

Abstract Introduction Multiple studies have demonstrated the effectiveness of auto-titrating continuous positive airway pressure (auto CPAP) in the adult population, but there is limited literature on the use of auto CPAP in the pediatric population. Specifically, the use of auto CPAP in children with neurological disorder(s) has not been established. Thus, we conducted a study to review the use of auto CPAP in children ages 18 years old and younger with Obstructive Sleep Apnea Syndrome (OSAS) and associated neurological disorder to document its effectiveness, adverse events and outcomes of its use. Methods A retrospective chart review was performed on patients 18 yo and younger diagnosed with OSAS and associated neurological disorder(s) who have good compliance with auto CPAP use. Good compliance was defined as >4 hours/night and >20/30 days of auto CPAP use. Compliance from the most recent 30 days was downloaded. Results 5 children met our criteria for inclusion, with a mean age of 11 years (6-18 years old). All had initial baseline sleep studies performed without PAP titration polysomnography. Associated neurological disorders were cerebral palsy, Arnold Chiari Malformation, seizure disorder and intellectual disability. The average length of use of auto CPAP was 4 months. Auto CPAP was used on average of 24/30 nights, with a mean of 7.35 hours/night. The mean baseline obstructive apnea-hypopnea (OAHI) index was 42 (8.2-94.4). The mean AHI on a 30 day download report showed a mean decrease in AHI to 2.9 (0.5-5.2) while on auto CPAP. Review of patient charts did not reveal any adverse outcomes associated with the use of auto CPAP in these patients. Conclusion This study showed that auto CPAP significantly improved the AHI in pediatric patients treated for OSA with associated neurological disorder. There were no reported adverse outcomes. Further research is needed to establish the effectiveness and safety of auto CPAP use in the pediatric population, specifically those with neurological disorder. The use of auto CPAP will help decrease the wait time for treatment in children with OSA. These patients can use auto CPAP while waiting for a titration study and for long term use. Support none

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Surgery and Obstructive Sleep Apnea: Long-Term Clinical Outcomes

Otolaryngology ◽

10.1016/s0194-5998(00)70058-1 ◽

2000 ◽

Vol 122 (3) ◽

pp. 415-421 ◽

Cited By ~ 69

Author(s):

Robert W. Riley ◽

Nelson B. Powell ◽

Kasey K. Li ◽

Robert J. Troell ◽

Christian Guilleminault

Keyword(s):

Body Mass Index ◽

Obstructive Sleep Apnea ◽

Surgical Treatment ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Obstructive Sleep ◽

The Mean

OBJECTIVE: Outcome data on the surgical treatment of obstructive sleep apnea are, in general, based on short-term follow-up (<6–9 months). This examination was undertaken to assess long-term results. METHODS: Forty patients who underwent soft tissue and skeletal surgery were the subjects of this review. Methods of evaluation included polysomnographic variables (respiratory disturbance index [RDI], low oxyhemoglobin desaturation [LSATT]), body mass index, quality-of-life assessments, roentgenographic analysis, and complications. Statistical analysis used the SAS 6.12 system. RESULTS: Thirty-six of 40 patients (90%) showed long-term clinical success. The mean preoperative RDI, nasal continuous positive airway pressure RDI, and long-term RDI were 71.2 ± 27.0, 7.6 ± 5.2 and 7.6 ± 5.1, respectively. The mean preoperative LSAT, nasal continuous positive airway pressure LSAT, and long-term LSAT were 67.5% ± 14.8%, 87.1% ± 3.2%, and 86.3% ± 3.9%, respectively. The mean follow-up was 50.7 ± 31.9 months. The patients showed a statistically significant long-term weight gain ( P = 0.0002) compared with their 6-month postoperative level (body mass index 31.4 ± 6.7 vs 32.2 ± 6.3). There was a positive correlation with the amount of skeletal advancement and clinical outcome. CONCLUSION: Comprehensive evaluation and surgical treatment can result in successful long-term clinical outcome.

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Surgery and obstructive sleep apnea: Long-term clinical outcomes

Otolaryngology ◽

10.1067/mhn.2000.102117 ◽

2000 ◽

Vol 122 (3) ◽

pp. 415-420 ◽

Cited By ~ 59

Author(s):

Robert W. Riley ◽

Nelson B. Powell ◽

Kasey K. Li ◽

Robert J. Troell ◽

Christian Guilleminault

Keyword(s):

Body Mass Index ◽

Obstructive Sleep Apnea ◽

Surgical Treatment ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Obstructive Sleep ◽

The Mean

OBJECTIVE Outcome data on the surgical treatment of obstructive sleep apnea are, in general, based on short-term follow-up (<6–9 months). This examination was undertaken to assess long-term results. METHODS Forty patients who underwent soft tissue and skeletal surgery were the subjects of this review. Methods of evaluation included polysomnographic variables (respiratory disturbance index [RDI], low oxyhemoglobin desaturation [LSAT]), body mass index, quality-of-life assessments, roentgenographic analysis, and complications. Statistical analysis used the SAS 6.12 system. RESULTS Thirty-six of 40 patients (90%) showed long-term clinical success. The mean preoperative RDI, nasal continuous positive airway pressure RDI, and long-term RDI were 71.2 ± 27.0, 7.6 ± 5.2 and 7.6 ± 5.1, respectively. The mean preoperative LSAT, nasal continuous positive airway pressure LSAT, and long-term LSAT were 67.5% ± 14.8%, 87.1% ± 3.2%, and 86.3% ± 3.9%, respectively. The mean follow-up was 50.7 ± 31.9 months. The patients showed a statistically significant long-term weight gain ( P = 0.0002) compared with their 6-month postoperative level (body mass index 31.4 ± 6.7 vs 32.2 ± 6.3). There was a positive correlation with the amount of skeletal advancement and clinical outcome. CONCLUSION Comprehensive evaluation and surgical treatment can result in successful long-term clinical outcome.

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Efficacy of Continuous Positive Airway Pressure for Treatment of Hypernasality

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_2002_039_0267_eocpap_2.0.co_2 ◽

2002 ◽

Vol 39 (3) ◽

pp. 267-276 ◽

Cited By ~ 24

Author(s):

David P. Kuehn ◽

Peter B. Imrey ◽

Lucrezia Tomes ◽

David L. Jones ◽

Mary M. O'Gara ◽

...

Keyword(s):

Continuous Positive Airway Pressure ◽

Resistance Training ◽

Cleft Palate ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Regression To The Mean ◽

Expert Clinician ◽

Random Variability ◽

The Mean ◽

Reference Samples

Objective: To determine whether speech hypernasality in subjects born with cleft palate can be reduced by graded velopharyngeal resistance training against continuous positive airway pressure (CPAP). Design: Pretreatment versus immediate posttreatment comparison study. Setting: Eight university and hospital speech clinics. Patients: Forty-three subjects born with cleft palate, aged 3 years 10 months to 23 years 8 months, diagnosed with speech hypernasality. Intervention: Eight weeks of 6 days per week in-home speech exercise sessions, increasing from 10 to 24 minutes, speaking against transnasal CPAP increasing from 4 to 8.5 cm H2O. Main Outcome Measure: Pretreatment to immediate posttherapy change in perceptual nasality score based on blinded comparisons of subjects’ speech samples to standard reference samples by six expert clinician-investigators. Results: Participating clinical centers treated from two to nine eligible subjects, and results differed significantly across centers (interaction p = .004). Overall, there was statistically significant reduction in mean nasality score after 8 weeks of CPAP therapy, whether weighted equally across patients (mean reduction = 0.20 units on a scale of 1.0 to 7.0, p = .016) or across clinical centers (mean = 0.19, p = .046). This change was about one-sixth the maximum possible reduction from pretreatment. Nine patients showed reductions of at least half the maximum possible, but hypernasality of eight patients increased at least 30% above pretreatment level. Most improvement was seen during the second month when therapy was more intense (p = .045 for nonlinearity). No interactions with age or sex were detected. Conclusion: Patients receiving 8 weeks of velopharyngeal CPAP resistance training showed a net overall reduction in speech hypernasality, although response was quite variable across patients and clinical centers. The net reduction in hypernasality is not readily explainable by random variability, subject maturation, placebo effect, or regression to the mean. CPAP appears capable of substantially reducing speech hypernasality for some subjects with cleft palate.

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Auto positive airway pressure therapy reduces pulmonary pressures in adults admitted for acute heart failure with pulmonary hypertension and obstructive sleep apnea. The ASAP-HF Pilot Trial

SLEEP ◽

10.1093/sleep/zsz100 ◽

2019 ◽

Vol 42 (7) ◽

Cited By ~ 10

Author(s):

Sunil Sharma ◽

Henrik Fox ◽

Francisco Aguilar ◽

Umer Mukhtar ◽

Leslee Willes ◽

...

Keyword(s):

Heart Failure ◽

Obstructive Sleep Apnea ◽

Pulmonary Hypertension ◽

Sleep Apnea ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Left Ventricular ◽

Obstructive Sleep ◽

The Mean ◽

The Impact

AbstractObjectivesPulmonary hypertension (PH) is extremely common in acute decompensated heart failure (ADHF) patients and predicts increased mortality. Obstructive sleep apnea (OSA), highly prevalent in congestive heart failure patients, may contribute to further elevated pulmonary pressures. This study evaluates the impact of positive airway pressure (PAP) therapy on PH in patients admitted for ADHF with OSA.MethodsA two-center randomized control trial comparing standard of care (SOC) therapy for ADHF versus addition of PAP therapy in patients with concomitant OSA.ResultsTwenty-one consecutive patients were enrolled with 1:1 randomization to SOC versus SOC plus 48-hour PAP therapy protocol. In the intervention arm, the mean pulmonary artery systolic pressure (PASP) difference before therapy and after 48 hours of PAP therapy was −15.8 ± 3.2 (58.6 ± 2.5 mm Hg to 42.8 ± 2.7) versus the SOC arm where the mean PASP difference was −5.2 ± 2.6 (62.7 ± 3.3 mm Hg reduced to 57.5 ± 3.9) (p = 0.025). In addition, ejection fraction in the intervention arm improved (3.4 ± 1.5% versus −0.5 ± 0.5 %) (p = 0.01). Significant improvement was also noted in tricuspid annular plane systolic excursion (TAPSE) and right ventricular systolic area in the intervention arm but not in NT-pro-BNP or 6-minute walk distance.ConclusionsIn patients with ADHF and OSA, addition of 48 hours of PAP therapy to SOC treatment significantly reduced PH. In addition, PAP therapy was able to improve right and left ventricular function.ClinicalTrials.gov identifier: NCT02963597.

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Does the RAM Cannula Provide Continuous Positive Airway Pressure as Effectively as the Hudson Prongs in Preterm Neonates?

American Journal of Perinatology ◽

10.1055/s-0038-1675330 ◽

2018 ◽

Vol 36 (08) ◽

pp. 849-854 ◽

Cited By ~ 6

Author(s):

Neetu Singh ◽

Matthew J. McNally ◽

Robert A. Darnall

Keyword(s):

Continuous Positive Airway Pressure ◽

Respiratory Distress ◽

Preterm Infants ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Nasal Delivery ◽

Preterm Neonates ◽

Convenience Sample ◽

Pharyngeal Pressure ◽

The Mean

Objective To compare the level of continuous positive airway pressure (CPAP) delivered by the RAM cannula system (Neotech, Valencia, CA) with that delivered by a traditional CPAP nasal delivery interface (Hudson prongs; Hudson-RCI, Temecula, CA) in preterm infants with respiratory distress. Methods This was a crossover intervention study in a convenience sample of preterm infants with respiratory distress requiring treatment with CPAP. We measured the mean intraoral (pharyngeal) pressure, which approximates the applied CPAP level, using both the RAM cannula and Hudson prongs. The primary outcome was a comparison of the differences between the set CPAP levels and the measured intraoral pressures of both delivery systems. Results We analyzed data from 12 preterm infants with mean (standard deviation) birth weight of 1,225 (405) g and gestational age of 28.4 (2.1) weeks at a median postnatal age of 10 days. The mean difference (95% confidence interval) between the set CPAP level and measured intraoral pressure was −2.45 cm H2O (−3.36, −1.55) with the RAM cannula and +0.40 cm H2O (−0.30, 1.12) with Hudson prongs, p = 0.0002. Conclusion For given set CPAP pressure level in preterm infants, the RAM cannula system consistently delivers lower pharyngeal pressure (effective CPAP) levels than Hudson prongs.

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