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Sher, Irina. "Educational Program for Parents of Neonates on Nasal Continuous Positive Airway Pressure." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4757.
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Parents in the neonatal intensive care unit (NICU) whose term or preterm infants are receiving nasal continuous positive airway pressure (NCPAP) experience stress. They often worry about being able to hold their child and possible complications of NCPAP, such as nasal deformities and compromised organ function. Lacking standard educational programming to provide parents information that they need to understand the care their infant is receiving, parents experience unnecessary stress that affects their capacity to care for their infants. A review of the literature suggested family-centered educational programs are able to decrease stress and increase parental confidence. The purpose of this project was to develop a family-centered education program focused on the education of parents of infants on NCPAP in the NICU, including materials needed to implement and evaluate the program. Stetler's evidence-based practice model was used to guide this project. Kolcaba's midrange comfort theory served as a theoretical framework with which to conceptualize care. Evidence was collected in a systematic review of published peer-reviewed journal articles. The Johns Hopkins Nursing evidence-based appraisal tool was used to evaluate relevant articles. Extracted data were reviewed by the advisory project team in order to be utilized for project development. The curriculum, supporting handouts for participants, and implementation and evaluation plans were developed and were provided to the institution as a complete solution to the practice problem. The project may promote positive social change for caregivers, patients, and patients' families by enhancing outcomes such as improved infant behavior, increased parental emotional well-being, and increased caregiver satisfaction.
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Pepperell, Justin Charles Thane. "Obstructive sleep apnoea and cardiovascular risk : the effects of nasal continuous positive airway pressure therapy." Thesis, University of Cambridge, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.431875.
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Lomp, Andrea. "Measurement and assessment of work of breathing in neonates during nasal continuous positive airway pressure therapy." Thesis, Imperial College London, 2010. http://hdl.handle.net/10044/1/7019.
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Introduction: Nasal continuous positive airway pressure (nCPAP) is a widely used form of non-invasive respiratory support in neonates. The general aim of nCPAP therapy is to improve lung volume, oxygenation and decrease work of breathing. There is little data to guide clinicians on how to adjust the pressure and what parameter nCPAP should be titrated against. This is due to the lack of commercially available equipment to measure lung mechanics in patients receiving non-invasive respiratory support. In mechanically ventilated patients, measurements of work of breathing have been found to be useful in optimising ventilation strategies. An indicator of work of breathing or estimate of the metabolic and oxygen cost of breathing is the pressure time product (PTP). Objectives: To develop a monitoring system for the measurement of work of breathing in neonates on nCPAP, to investigate the effects of different nCPAP levels on PTP and to identify non-invasively determined predictors of PTP. Methods: PTP’s (PTPoe=oesophageal, PTPga=gastric and PTPdi=diaphragmatic pressure time product) derived by oesophageal gastric pressure transducer was compared with parameters derived by respiratory inductance plethysmography. Subjects were randomised to receive nCPAP level sequences of 2, 4, 6 and 8 cmH2O. Main results 37 of 57 subjects were analysed. Median gestational age 30 ± 4.9 weeks, median birth weight 1234 ± 443 g, chronological age ≤ 24 hours 24 subjects (64.9%) and baseline FiO2 ≤ 0.35. PTP’s decreased with increasing nCPAP level (p < 0.05). “Optimal” nCPAP as determined by the lowest PTPoe and PTPdi occurred between 6-8 cmH2O for 56% of the subjects. “Optimal” nCPAP as defined by the lowest PTPga occurred between 6-8 cmH2O for 39% of the subjects. Respiratory rate, abdominal excursion decreased, Te increased and heart rate remained unchanged with increased nCPAP level. PTPoe correlated best out of all three PTP’s with selected variables derived by non-invasive techniques. Respiratory rate explained 36.7% of the variance of PTPoe and abdominal excursion explained 45.5% of the variance of PTPoe. Best fitted prediction model for PTPoe included respiratory rate, phase angle, abdominal excursion, birth weight, gestational age and applied nCPAP level and explained 65.8% of the variance of PTPoe. One suspected pneumothorax was reported (1.7%). Conclusion: Respiratory muscle work load is affected by changes in nCPAP levels and can be predicted more accurately by a model consisting of respiratory rate, phase angle, abdominal excursion, gestational age and birth weight than by clinical parameters alone.
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Kita, Hideo. "Effects of nasal continuous positive airway pressure therapy on respiratory parameters of upper airway patency in patients with obstructive sleep apnea syndrome." Kyoto University, 1999. http://hdl.handle.net/2433/156997.
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本文データは平成22年度国立国会図書館の学位論文(博士)のデジタル化実施により作成された画像ファイルを基にpdf変換したものである<br>Kyoto University (京都大学)<br>0048<br>新制・課程博士<br>博士(医学)<br>甲第7578号<br>医博第2065号<br>新制||医||704(附属図書館)<br>UT51-99-D195<br>京都大学大学院医学研究科内科系専攻<br>(主査)教授 一山 智, 教授 人見 滋樹, 教授 泉 孝英<br>学位規則第4条第1項該当
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Masdeu, Margalef Maria Jose. "Effect of nasal resistance on delivered continuous positive airway pressure in the treatment of sleep apnea-hypopnea syndrome." Doctoral thesis, Universitat Autònoma de Barcelona, 2012. http://hdl.handle.net/10803/96866.
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Els pacients amb la síndrome d’apnees-hipopnees del son (SAHS) refereixen dificultat per exhalar contra la pressió positiva i això, pot influir en l’adherència al tractament amb pressió positiva contínua a via aèria superior (CPAP). Durant el tractament amb CPAP, el nas és el principal determinant de la resistència a la via aèria superior, i determinarà l’augment de la pressió supraglòtica respecte a la pressió a la màscara. La CPAP flexible (C-Flex) ha estat dissenyada per millorar el confort dels pacients reduint la pressió a la màscara durant l’expiració de forma proporcional al flux expiratori (3 nivells amb incremental canvi de pressió).
Hem avaluat la utilitat de mesures no invasives de resistència nasal en vigília com a factor predictiu de la resistència a la via aèria superior durant el son en la SAHS. S’ha hipotetitzat que pacients amb una resistència nasal elevada presentarien majors fluctuacions de la pressió expiratòria supraglòtica, les quals podrien ser mitigades amb C-Flex.
Metodologia- Reclutats 17 pacients amb sospita clínica de SAHS (roncs, excessiva somnolència diürna). L’avaluació diürna incloïa la valoració clínica, qüestionaris de símptomes nasals i mesura de la resistència nasal amb rinometria acústica (AR) i rinomanometria anterior (RM) asseguts i en decúbit supí. L’avaluació nocturna constava d’una polisomnografia amb CPAP òptima amb determinació de la pressió supraglòtica. Es va dissenyar un model mecànic de la via aèria superior amb aplicació de CPAP (sense segment col·lapsable) per testar les observacions obtingudes amb els pacients. El model consistia en un tub rígid amb resistència variable modificant el grau d’obertura d’una vàlvula interna.
Intervencions- Es va mesurar la resistència nasal en vigília amb AR i RM i la resistència a la via aèria superior durant el son es determinava a partir de les mesures de la pressió supraglòtica. L’estudi de comparacions s’ha fet entre la resistència nasal en vigília obtinguda amb cadascuna de les tècniques, així com amb la resistència nasal per AR i RM i la resistència a la via aèria superior durant el son. Als pacients amb SAHS i CPAP fixa es va aplicar el diferents nivells de C-Flex. Al model mecànic es van avaluar dos patrons ventilatoris i dos nivells de resistència. Les variables mesurades eren flux aeri, pressió expiratòria a màscara i a supraglotis, amb CPAP i C-Flex. Es van calcular i comprar les fluctuacions de la pressió supraglòtica expiratòria amb CPAP i amb C-Flex.
Resultats- Els valors de resistència nasal en vigília mesurats amb AR i RM no correlacionen entre ells en posició asseguda, però s’ha detectat una correlació lleu entre aquests valors en decúbit supí. La resistència a la via aèria superior durant el son i tractament amb CPAP no va mostrar cap correlació significativa amb els valors de resistència nasal en vigília. Durant tractament amb CPAP, elevada resistència nasal va produir major fluctuació de la pressió supraglòtica durant l’expiració tant als pacient com al model mecànic. C-Flex 3 va reduir la pressió expiratòria a la màscara, però només al model mecànic amb un patró ventilatori sinusoïdal va mitigar l’augment de pressió expiratòria a supraglotis.
Conclusió: Els valors de resistència nasal en vigília no són predictius de la resistència a la via aèria superior durant el son en pacients amb SAHS i tractament amb CPAP. Els canvis en la pressió expiratòria a la màscara induïts per C-Flex no es transmeten de forma uniforme a la supraglotis ni en els pacients amb SAHS ni en el model mecànic de la via aèria superior. Les dades obtingudes suggereixen que la no reducció de la pressió expiratòria a la supraglotis pot estar relacionada amb la dinàmica de l’algoritme de C-Flex.<br>Patients with obstructive sleep apnea/hypopnea syndrome (SAHS) may have difficulty exhaling against positive pressure, hence limiting their acceptance of continuous positive airway pressure (CPAP). When patients use CPAP, the nose is the primary determinant of upper airway resistance, and in this situation nasal resistance determines how much higher supraglottic pressure is than mask pressure. Flexible- CPAP (C-Flex) is designed to improve comfort by reducing pressure in the mask during expiration proportionally to expiratory airflow (3 settings correspond to increasing pressure changes).
We assess utility of noninvasive measures of nasal resistance during wakefulness as a predictor of directly assessed upper airway resistance on CPAP during sleep in patients with SAHS. We hypothesized that increased nasal resistance results in increased expiratory supraglottic pressure swings that could be mitigated by the effects of C-Flex on mask pressure.
Methodology- Patients (17) with complaints of snoring and excessive daytime sleepiness were recruited. Subjects underwent daytime evaluations including clinical assessment, subjective questionnaires to assess nasal symptoms and evaluation of nasal resistance with acoustic rhinometry (AR) and active anterior rhinomanometry (RM) in the sitting and supine positions and nocturnal polysomnography on optimal CPAP with measurements of supraglottic pressure to evaluate upper airway resistance. To create a bench test for some of our observations in patients, we designed a mechanical model of the upper airway in patients on CPAP (ie, without a collapsible airway). This model consisted of a rigid resistive tube, the resistance of which could be varied by changing the aperture size.
Interventions- We evaluated nasal resistance during wakefulness with AR and RM. Comparisons were made between nasal resistance using AR and RM during wakefulness, and between AR and RM awake and upper airway resistance during sleep. In patients on fixed CPAP, CPAP with different C-Flex levels was applied multiple times during the night. In the model, 2 different respiratory patterns and resistances were tested. Airflow, expiratory mask, and supraglottic pressures were measured on CPAP and on C-Flex. Swings in pressure during expiration were determined. Comparisons were made between expiratory pressure swings on CPAP and on C-Flex.
Results- Our study shows that measures of awake nasal resistance using AR and RM had little or no correlation to each other in the sitting position, whereas there was significant but weak correlation in the supine position. Upper airway resistance measured while on CPAP during sleep did not show significant relationships to any of the awake measures of nasal resistance (AR or RM). On CPAP, higher nasal resistance produced greater expiratory pressure swings in the supraglottis in the patients and in the model, as expected. C-Flex 3 produced expiratory drops in mask pressure (range -.03 to -2.49 cm H2O) but mitigated the expiratory pressure rise in the supraglottis only during a sinusoidal respiratory pattern in the model.
Conclusion: Awake measurements of nasal resistance do not seem to be predictive of upper airway resistance during sleep on CPAP. Expiratory changes in mask pressure induced by C-Flex did not uniformly transmit to the supraglottis in either patients with obstructive sleep apnea on CPAP or in a mechanical model of the upper airway with fixed resistance. Data suggest that the observed lack of expiratory drop in supraglottic pressure swings is related to dynamics of the C-Flex algorithm.
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Nakamura, Takaya. "Acute effect of nasal continuous positive airway pressure therapy on the systemic immunity of patients with obstructive sleep apnea syndrome." Kyoto University, 2002. http://hdl.handle.net/2433/149720.
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Lindwall, Robert B. I. "Respiratory distress syndrome : aspects of inhaled nitric oxide surfactant and nasal CPAP /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-297-7/.
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Newnam, Katherine. "A Comparative Effectiveness Study of Continuous Positive Airway Pressure (CPAP) Related Skin Breakdown when using Different Nasal Interfaces in the Extremely Low Birth Weight (ELBW) Neonate." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/510.
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Nasal continuous positive airway pressure (CPAP) is reportedly superior to mechanical ventilation in the neonatal population by reducing bronchopulmonary dysplasia (BPD). The neonate is vulnerable to injury secondary to immature physiological systems and skin structures and the current CPAP devices place constant pressure on nares, nasal septum and forehead, increasing injury risk. Through the framework of comparative effectiveness research an examination of nasal interfaces currently used during neonatal CPAP was conducted in an effort to provide scientifically supported recommendations and improve clinical outcomes. The primary aim of this study was to determine differences in the frequency, severity and specific types of nasal injuries described when comparing different nasal CPAP interfaces (prongs/mask/rotation) used in the treatment of neonatal respiratory distress syndrome (RDS). A secondary aim of the study was to identify risk factors that may be associated with skin breakdown during nasal CPAP administration. A three group prospective randomized experimental design was used to study78 neonates <1500 grams receiving nasal CPAP using the same delivery system. The subjects were randomized into three groups: 1) continuous nasal prong group, 2) continuous nasal mask group, or 3) alternating mask/prongs group. Serial data collection included: demographic, biophysical measures and the Neonatal Skin Condition Scale (NSCS). This study demonstrated a significant difference in the frequency and severity of skin injury when utilizing a method of rotating mask and prong nasal interfaces during neonatal CPAP therapy; a useful clinical recommendation. Specific nursing care implications related to study findings include; choosing a device for best fit for infant (face shape and infant size); positioning of the CPAP device; developmental position of the infant; and focused skin assessment with rapid intervention. Standardized care including skin barriers, clinical expertise of nursing and respiratory therapy, and skin care management are strategies that warrant additional research.
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Hawkins, Brian John. "The relationship between circulating biomarkers of nitric oxide and endothelin-1 and hemodynamic function in obstructive sleep apnea." Diss., Virginia Tech, 2003. http://hdl.handle.net/10919/28308.
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Obstructive sleep apnea (OSA) is a disorder that affects a significant portion of middle-aged adult population. Patients exhibit recurring episodes of upper airway obstruction during sleep that decrease blood oxygen concentration (hypoxia) and are terminated by brief arousals. Epidemiologically, OSA has been extensively linked to cardiovascular dysfunction and is an independent risk factor for the development of hypertension. The proposed mechanism of cardiovascular dysfunction in patients is chronic sympathoexcitation and altered vascular tone, with a predominance of the vasoconstrictor endothelin-1 (ET-1) and removal of the vasodilator nitric oxide (NO). Means to reduce the effects of ET-1 and increase synthesis of NO may have beneficial effects on the cardiovascular co-morbidity commonly associated with OSA. OBJECTIVES: The major aim of this study was to assess the relative importance of circulating biomarkers of ET-1 and NO in hemodynamic function in OSA patients. Potential production of ET-1 by circulating mononuclear cells was also measured to assess their contribution to plasma ET-1 levels. Biomarker levels before and after 12 wk of continuous partial airway pressure (CPAP) therapy were used to assess standard treatment. Mild/moderate exercise training was initiated with CPAP therapy in a subgroup of OSA patients to evaluate the potential benefits of physical activity on hemodynamic function and NO and ET-1 levels. METHODS: Overall, 16 newly diagnosed OSA patients (5 female, 11 male; age 45.4 ± 2.7 yr; RDI 24.6 ± 4.0 events/hr) were selected for study. Seven apparently healthy control volunteers (5 female, 2 male; age 39.43 ± 2.6 yr) screened for OSA served as control subjects. Blood pressure was recorded over one complete day and prior to, during, and following maximal exercise testing on a cycle ergometer. Blood samples were taken prior to exercise testing and assessed for nitrate and nitrite by HPLC and for big endothelin-1 and ET-1 by ELISA. Relative gene expression of preproendothelin-1 was measured by real-time RT-PCR. Following initial testing, patients were stratified into either a standard therapy group (nCPAP) or a standard therapy group with a mild/moderate intensity aerobic training regimen (nCPAP+Ex). Baseline testing was repeated following 12 wk of treatment. Statistical significance was set at p < 0.05 a priori. RESULTS: 24 hr ambulatory systolic and diastolic blood pressure were elevated in OSA patients vs. control subjects (systolic: 128.9 ± 3.8 mmHg vs. 108.8 +- 1.3 mmHg, respectively; diastolic: 97.5 ± 2.0 mmHg vs. 82.1 ± 1.9 mmHg, respectively). OSA patients experienced significant elevations in systolic (OSA 209.7 ± 5.7 mmHg; Control 174.5 +- 6.2 mmHg) and mean arterial pressures (OSA 125.8 ± 3.2 mmHg; Control 109.05 ± 4.5 mmHg) at peak exercise. No differences in nitrate, nitrite, or big endothelin-1 were noted. Plasma endothelin-1 concentrations were below assay
detection limit. Big endothelin-1 levels were significantly correlated with BMI in both OSA patients (r=0.955; p=0.001) and control subjects (r=0.799; p=0.045). Relative gene expression of preproendothelin-1 was not elevated in OSA patients (0.40 ± 0.20 fold increase over control subjects). Group nCPAP usage was above minimum therapeutic threshold, but was non-uniform in both groups, with an overall range of 182 to 495 min mean usage per night. A mild/moderate exercise training program failed to elicit a training response through standard hemodynamic or cardiopulmonary indices. Plasma nitrite levels rose from 55.3 ± 4.7 μg/ml to 71.0 ± 7.6 μg/ml in the nCPAP group. CONCLUSIONS: Moderate OSA is associated with elevated blood pressure at rest and during exercise stress that bears no relationship to circulating biomarkers of NO and ET-1 or immune preproendothelin production in patients without diagnosed hypertension. nCPAP therapy failed to elicit significant improvements in hemodynamic function, with or without moderate exercise. Plasma nitrite levels rose following nCPAP therapy, indicating a possible increase in basal nitric oxide formation. Higher intensity exercise regimens may be needed to elicit the positive benefits of exercise training in OSA patients without significant cardiovascular dysfunction.<br>Ph. D.
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Carvalho, Clarissa Gutierrez. "Níveis plasmáticos de citocinas em recém-nascidos prematuros antes e após ventilação mecânica e CPAP nasal." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2013. http://hdl.handle.net/10183/115582.
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A necessidade de intubação e uso de ventilação mecânica (VM) na prematuridade está relacionada à chamada lesão pulmonar induzida pela ventilação (VILI) e consequente displasia broncopulmonar (DBP). Estudos com animais e também em humanos mostraram que breves períodos de VM são suficientes para a liberação de interleucinas pró-inflamatórias. Outras formas de VM que regulam o volume-corrente evitando o volutrauma e as ventilações não invasivas como a pressão positiva contínua em via aérea por pronga nasal (CPAPn) parecem medidas protetoras ou menos lesivas para VILI. Esses efeitos protetores do CPAPn não foram ainda estudados em humanos. Objetivo: avaliar os níveis plasmáticos da interleucina (IL)-1β, IL-6, IL-8, IL-10 e fator de necrose tumoral (TNF)-α em recém-nascidos tão logo instituído CPAPn e duas horas após. Secundariamente, avaliação dessa resposta inflamatória em pacientes que necessitaram de VM. Metodologia: estudo de coorte prospectivo, incluindo recém-nascidos admitidos com idade gestacional (IG) de 28-35 semanas e necessidade de assistência ventilatória, excluindo malformações, infecção congênita, sepse, surfactante profilático e suporte ventilatório em sala de parto. Amostras de sangue coletadas nesses dois momentos. Realizada descrição das variáveis em medianas e interquartis (p25-p75), empregado Teste de Wilcoxon. Resultados: 43 recém-nascidos, médias de peso 1883,5±580g e IG 32±2,4semanas, 23 (53%) receberam CPAPn como primeira modalidade ventilatória. Pré-termos após duas horas de VM apresentaram níveis significativamente maiores de IL-6, TNF-α e IL-8. Já os níveis de IL-6 reduziram significativamente após duas horas de CPAPn. Em 15 dos 22 (68%) neonatos cujas mães receberam corticoide pré-natal, as medianas das citocinas foram menores no início do uso do CPAPn, mas esse efeito não se sustentou duas horas após. O uso de surfactante pelos prematuros em VM não alterou a resposta inflamatória em comparação aos que não necessitaram do fármaco. Conclusão: demonstramos que os RN em CPAPn apresentaram mínima liberação de citocinas pro-inflamatórias e essa modalidade pode ter um papel protetor - nesse estudo potencializado pelo uso de corticoide ante natal. Por outro lado, VM promove significativa resposta inflamatória, estimulando-se CPAPn como estratégia ventilatória inicial protetora ao prematuro maior de 28 semanas de IG com desconforto respiratório moderado. Ainda assim, serão necessários mais estudos para determinar o papel de outras formas de ventilação não invasiva e outras formas de VM consideradas protetoras na prevenção da VILI. Essa nova compreensão dos mecanismos de lesão envolvendo resposta inflamatória mediada pelas citocinas possibilitará o desenvolvimento de novas estratégias no cuidado dos recém-nascidos prematuros.<br>The need for intubation and mechanical ventilation (MV) in preterm infants is related to ventilator-induced lung injury (VILI) and subsequent bronchopulmonary dysplasia (BPD). Studies in animals and in humans have shown that short periods of MV are enough for the release of pro-inflammatory interleukins. Other forms of MV that regulate tidal volume avoiding volutrauma and non- invasive ventilation such as continuous positive airway pressure by nasal prongs (nCPAP) seem protective measures against VILI. These protective effects of nCPAP have not been studied in humans. Objective: To evaluate the plasma levels of interleukin (IL) - 1β , IL - 6 , IL - 8 , IL - 10 and tumor necrosis factor (TNF) - α in preterm infants as soon as established nCPAP and two hours after. Secondarily, to evaluate this inflammatory response in patients who required MV. Methods: Prospective cohort including newborns admitted with gestational age (GA) of 28-35 weeks and requiring ventilation support, excluding malformations, congenital infections, sepsis, previous surfactant use and ventilatory support need in the delivery room. Blood samples were collected at those two moments. Cytokines were described as medians and interquartile ranges (p25 - p75), and Wilcoxon test was performed. Results: 43 newborns, medium weight 1883.5 ± 580g and gestational age of 32 ± 2.4 weeks, 23 (53 %) received nCPAP as the first ventilatory mode. Preterm two hours after MV had significantly higher levels of IL - 6, TNF - α and IL - 8. The levels of IL - 6 decreased significantly two hours after nCPAP. In 15 of 22 (68 %) neonates whose mothers received antenatal corticosteroids, the median of cytokines were lower at the onset of the nCPAP, but this effect was not sustained after two hours. The use of surfactant in preterm infants in MV did not alter the inflammatory response compared to those who did not need the drug. Conclusion: we demonstrated that nCPAP presents minimal release of pro-inflammatory cytokines and may have a protective role - in this study enhanced by the use of antenatal corticosteroids. Still, MV promotes significant inflammatory response, thus stimulating nCPAP as initial less harmful ventilatory strategy to preterm greater than 28 weeks of GA with moderate respiratory discomfort. Therefore, further studies are needed to determine the role of other forms of non-invasive ventilation and other forms of MV considered protective in preventing VILI. This new understanding of injury mechanisms involving inflammatory response mediated by cytokines allows the development of new strategies in the care of premature infants.
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Andrade, Rafaela Garcia Santos de. "Repercussões da máscara nasal e oronasal sobre a patência da via aérea superior durante uso de pressão positiva contínua para o tratamento de pacientes com apneia obstrutiva do sono." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5150/tde-08092016-144437/.
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Introdução: A aplicação de Pressão Positiva Contínua nas Vias Aéreas Superiores (CPAP) durante o sono é o padrão ouro no tratamento da Apneia Obstrutiva do Sono (AOS) e foi primeiramente descrito utilizando uma máscara nasal. No entanto, na prática clínica a máscara oronasal é comumente. Este estudo foi desenhado para determinar os efeitos agudos da mudança de rota de fluxo do CPAP de nasal para oronasal e oral na patência da via aérea superior durante o sono em pacientes com AOS. Nós hipotetizamos que a pressão transmitida pelo compartimento oral da máscara oronasal pode comprometer a eficácia do CPAP no tratamento da AOS por empurrar a língua posteriormente. Métodos: Dezoito pacientes (idade 44 ± 9 anos, índice de massa corpórea de 33,8 ± 4,7 kg / m², índice de apneia-hipopneia 49,0 ± 39,1 eventos/hora) dormiram com máscara oronasal customizada com dois compartimentos (nasal e oral) selados e independentes conectados a uma válvula multidirecional. O sono dos pacientes foi monitorizado pela polissonografia e induzido por baixas doses de midazolam (3,1 ± 2,2 mg). O CPAP nasal foi titulado até a pressão de manutenção das vias aéreas superiores. A rota de fluxo do CPAP foi mudada de nasal para oronasal (n = 18) e oral (n = 16) durante o sono. A área retroglossal foi continuamente observada durante a nasoendoscopia. Resultados: O CPAP nasal (14,8 ± 4,1 cmH2O) foi suficiente para estabilizar a via aérea superior em todos os pacientes. Em contraste, o CPAP oronasal e oral promoveram eventos obstrutivos em 12 (66,7%) e 14 (87,5%) pacientes, respectivamente. Quando o CPAP foi transmitido pela rota oronasal e oral houve uma redução progressiva e significante na distância entre a epiglote e a base da língua e na área retroglossal em comparação com a respiração estável durante a rota nasal. Conclusões: Mudanças agudas na rota de fluxo do CPAP nasal para as rotas oronasal e oral induzem eventos obstrutivos e diminuem as dimensões da orofaringe em pacientes com AOS durante o sono. A máscara oronasal pode comprometer a efetividade do CPAP no tratamento da AOS<br>Introduction: Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for obstructive sleep apnea (OSA) and was conceived to be applied by nasal route only. However, in clinical practice the oronasal mask is commonly used. This study was designed to determine the acute effects of changing the nasal CPAP route to oronasal and oral in upper airway patency during sleep in patients with. We hypothesized that the pressure transmitted by the oral compartment of oronasal mask will push the tongue backwards and will compromise CPAP effectiveness in OSA treatment. Methods: Eighteen patients with OSA (age: 44±9 years44±9 years44±9 years44±9 years44±9 years44±9 years44±9 years44±9 years44±9 years , body mass index: 33.8±4.733.8±4.733.8±4.7 33.8±4.7 33.8±4.7 Kg/m², apnea-hypopnea index: 49.0 ± 39.149.0 ± 39.149.0 ± 39.149.0 ± 39.149.0 ± 39.149.0 ± 39.1 49.0 ± 39.149.0 ± 39.149.0 ± 39.1 events/hour) slept with a customized oronasal mask with a nasal and oral sealed compartments connected to a multidirectional valve. Sleep was monitored by full polysomnography and induced by low dosis of midazolam (3.1 ± 2.2 mg). Nasal CPAP was titrated up to holding pressure and flow route was changed to oronasal (n = 18) and oral route (n = 16) during sleep. Retroglossal area was continuously observed by nasoendoscopy. Results: Nasal CPAP (14.8±4.1 cmH2O) was able to stabilize breathing in all patients. In contrast, CPAP delivered by oronasal and oral route promoted obstructive events in 12 (66.7%) and 14 (87.5%) patients, respectively. Compared to stable breathing during nasal route, there was a significant and progressive reduction in the distance between epiglottis and tongue base and the retroglossal area when CPAP was delivered by oronasal and oral route, respectively. Conclusions: CPAP delivered by oronasal route may compromise CPAP effectiveness to treat OSA
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Amaro, Aline Cecilia Silva. "Impacto dos distúrbios respiratórios do sono em pacientes com acromegalia." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5150/tde-18042013-133547/.
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Introdução: A acromegalia é uma doença crônica geralmente causada por adenoma hipofisário produtor de hormônio do crescimento (GH). Os pacientes com acromegalia são expostos a altos níveis de GH e do fator de crescimento semelhante à insulina 1 (IGF-1) e têm risco aumentado de doenças cardiovasculares. Os distúrbios respiratórios do sono, caracterizados por apneia obstrutiva do sono (AOS) e apneia central (AC), são comuns nos pacientes com acromegalia. Os distúrbios respiratórios do sono causam hipóxia intermitente e sono fragmentado e são fatores de risco para pior prognóstico cardiovascular. No entanto, não está claro se os distúrbios respiratórios do sono contribuem para pior desfecho cardiovascular entre pacientes com acromegalia. Objetivo: Elucidar a contribuição dos distúrbios respiratórios do sono na gênese de doenças cardiovasculares em pacientes com acromegalia. Neste contexto foram realizados dois estudos, um estudo transversal (Estudo I) e um estudo de intervenção (Estudo II) que serão descritos a seguir. Método: Estudo I: Foram avaliados pacientes consecutivos com diagnóstico confirmado de acromegalia e acompanhados no ambulatório da Disciplina de Endocrinologia e Metabologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Os pacientes foram submetidos à avaliação clínica, questionário de sonolência de Epworth (ESE, escore variando entre 0 - 24), índice de qualidade de sono de Pittsburgh (PSQI, escore variando entre 0 - 21), questionário de qualidade de vida SF-36 (escore variando entre 0 - 100), polissonografia (PSG), monitorização ambulatorial da pressão arterial (MAPA), velocidade de onda de pulso (VOP), e ecocardiograma. Estudo II: Pacientes com acromegalia e AOS moderada a grave (índice de apneias hipopneias (IAH) 15 eventos/h) foram tratados por 3 meses em sequência aleatória com CPAP ou adesivo nasal. Os pacientes foram submetidos à avaliação clínica, questionários de ESE, PSQI, SF-36, questionário de satisfação do tratamento (0 - 10), MAPA, VOP, diâmetro e distensibilidade de carótida e PSG ao entrar no estudo, 3 meses e 6 meses. Resultados: Estudo I: Foram avaliados 48 pacientes (sexo masculino = 31%; idade = 52 ± 11 anos; índice de massa corpórea = 32,0 ± 5,5 Kg/m2). Vinte e nove pacientes (60,4%) apresentaram distúrbios respiratórios do sono moderado a grave (IAH 15 eventos/h) distribuídos em 23 (88%) com AOS e 6 (12%) com AC. Os pacientes com distúrbios respiratórios do sono eram mais velhos (56 ± 9 vs. 48 ± 12 anos, p= 0,018), mais obesos (33,3 ± 5,9 vs. 29,4 ± 4,0 Kg/m2, p = 0,014), apresentaram maior pressão arterial sistólica (131 ± 17 vs. 122 ± 11 mm Hg; p = 0,02) e diastólica (88 ± 14 vs. 81 ± 6 mm Hg, p = 0,02), maior diâmetro da carótida (7244 (6646 - 7685) vs. 6795 (6072 - 7341) m, p = 0,03), menor distensibilidade carotídea (5,01 ± 1,80 vs. 6,32 ± 2,16 m, p = 0,04) e pior qualidade de sono (9 (6 - 14) vs. 6 (5 - 8), p = 0,005) do que pacientes sem distúrbios respiratórios do sono. A presença de distúrbios respiratórios do sono se associou de forma independente com maior idade (p = 0,01), maior pressão arterial diastólica (p = 0,04) e menor distensibilidade carotídea (p = 0,04). Estudo II: Dezessete pacientes com acromegalia e AOS moderada a grave (masculino/feminino = 9/8, idade = 54 ± 10 anos, índice de massa corpórea = 34,0 ± 5,7 Kg/m2, IAH = 49,8 ± 23,7 eventos/h, ESE = 12 ± 6, PSQI = 12 (7- 14) completaram o estudo. A média da pressão do CPAP foi de 11 ± 2 cm H2O. O CPAP foi usado em média 6 ± 2 h/noite. O uso do adesivo nasal foi utilizado em 80% das noites. O IAH diminuiu significativamente com CPAP, mas não mudou com dilatador nasal (8,1 ± 5,2 vs. 47,4 ± 25,4 eventos/h, respectivamente, p = 0,0001). Todos os sintomas subjetivos melhoraram com ambos os tratamentos, no entanto significativamente mais com CPAP do que com dilatador nasal (ESE = 5 ± 4 vs. 9 ± 7, p = 0,002; PSQI = 3 (1- 5) vs. 5 (4-10), p <0,0001; satisfação do tratamento = 9 ± 1 vs. 6 ± 3, p = 0,001, respectivamente). O tratamento da AOS com CPAP comparado com adesivo nasal não resultou em melhora significativa nos níveis de pressão arterial no período da vigília (pressão arterial sistólica = 127 ±11 vs. 129 ± 10, p = 0,23; pressão arterial diastólica = 79 ± 11 vs. 80 ± 10, p = 0,46, respectivamente) e no período do sono (pressão arterial sistólica = 120 ± 14 vs. 124 ± 15, p = 0,66; pressão arterial diastólica = 71 (66 - 82) vs. 54 (52 - 63), p = 0,54, respectivamente) avaliado pela MAPA e rigidez da arterial (VOP = 9,0 ± 1,2 vs. 9,6 ± 1,5 m/s, p = 0,69 respectivamente). Conclusão: Os distúrbios respiratórios do sono são comuns entre os pacientes com acromegalia e estão associados de forma independente com maior pressão arterial diastólica, menor distensibilidade da carótida e pior qualidade do sono. O tratamento da AOS com CPAP em pacientes com acromegalia melhora a qualidade do sono. No entanto, não existe evidência até o momento de melhora em parâmetros cardiovasculares<br>Introduction: Acromegaly is a chronic disease usually caused by pituitary adenoma producing growth hormone (GH). Patients with acromegaly are exposed to high levels of GH and insulin-like growth factor 1 (IGF-1) and have increased risk of cardiovascular disease. Sleep-disordered breathing, characterized by obstructive sleep apnea (OSA) and central sleep apnea (AC), are common in patients with acromegaly. Sleep-disordered breathing cause intermittent hypoxia and fragmented sleep and are risk factors for poor cardiovascular outcome among patients with acromegaly. However, it is unclear whether sleep-disordered breathing are simply a result of acromegaly contribute to worse cardiovascular outcomes in patients with acromegaly. Objective: To elucidate the contribution of sleep-disordered breathing in the genesis of cardiovascular disease in patients with acromegaly. Two studies were conducted a cross sectional study (Study I) and a interventional study (Study II). Method: Study I: We evaluated consecutive patients with a confirmed diagnosis of acromegaly of a dedicated outpatient clinic of tertiary University Hospital (Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo). Patients underwent clinical assessment questionnaire for evaluation of daytime somnolence (Epworth sleepiness - ESS score, ranging from 0 - 24), index of Pittsburgh sleep quality (PSQI score, ranging from 0 - 21), quality of life questionnaire SF-36 (score ranging from 0 - 100), polysomnography (PSG), ambulatory blood pressure (ABMP), pulse wave velocity (PWV), diameter and distensibility carotid and echocardiography. Study II: Patients with acromegaly and moderate to severe OSA (apnea index - hypopnea index (AHI) 15 events / h) were treated for 3 months in random sequence with nasal CPAP or nasal dilator strips. The patients underwent clinical evaluation, questionnaires ESS, PSQI, SF-36, treatment satisfaction questionnaire (0-10), ABMP and PWV, diameter and distensibility carotid and PSG at study entry, 3 months and 6 months. Results: Study I: We evaluated 48 patients (male = 31%, age = 52 ± 11 years, body mass index = 32.0 ± 5.5 kg/m2). Twenty-nine patients (60.4%) had moderate to severe sleep-disordered breathing (AHI 15 events / h) distributed n = 23 (88%) OSA and n = 6 (12%) CA. Patients with sleep-disordered breathing were older (56 ± 9 vs. 48 ± 12 years, p = 0.018), more obese (33.3 ± 5.9 vs. 29.4 ± 4.0 kg/m2, p = 0.014), had higher systolic blood pressure (131 ± 17 vs. 122 ± 11 mm Hg, p = 0.02) and diastolic (88 ± 14 vs. 81 ± 6 mm Hg, p = 0.02), larger Carotid diameter (7244 (6646 - 7685) vs. 6795 (6072 - 7341) m, p = 0.03), lower carotid distensibility (5.01 ± 1.80 vs. 6.32 ± 2.16 mm, p = 0.04) and worse sleep quality (9 (6 -14) vs. 6 (5 - 8) score, p = 0.005) than patients without sleep-disordered breathing. The presence of sleep-disordered breathing was independently associated with older age (p = 0.01), higher diastolic blood pressure (p = 0.04) and lower carotid distensibility (p = 0.04). Study II: Seventeen patients with acromegaly and moderate to severe OSA (male / female = 9/8, age = 54 ± 10 years, body mass index = 34.0 ± 5.7 kg/m2, AHI = 49.8 ± 23.7 events / h, SE = 12 ± 6 score, PSQI = 12 (7 - 14) score) completed the study. The average CPAP pressure was 11 ± 2 cm H2O. CPAP was used on average 6 ± 2 h / night. The use of the nasal dilator strips was used in 80% of nights. The AHI decreased significantly with CPAP, but did not change with nasal dilator (8.1 ± 5.2 vs. 47.4 ± 25.4 events / h, respectively, p = 0.0001). All subjective symptoms improved with both treatments, but significantly more than with CPAP than nasal dilator strips (ESE = 5 ± 4 vs. 9 ± 7, p = 0.002; PSQI = 3 (1 - 5) vs. 5 (4 - 10), p <0.0001; treatment satisfaction = 9 ± 1 vs. 6 ± 3, p = 0.001, respectively). Treatment of OSA with CPAP compared with nasal dilator strips did result in significant improvements in ABMP during wakefulness (systolic blood pressure = 127 ± 11 vs. 129 ± 10, p = 0.23, diastolic blood pressure = 79 ± 11 vs. 80 ± 10, p = 0.46, respectively) and during sleep (systolic blood pressure = 120 ± 14 vs. 124 ± 15, p = 0.66; diastolic blood pressure = 71 (66 - 82) vs. 54 (52 - 63), p = 0.54, respectively) measured by ABMP and arterial stiffness (PWV = 9.0 ± 1.2 vs. 9.6 ± 1.5 m / s, p = 0,69 respectively). Conclusion: Sleep-disordered breathing is independently associated with higher diastolic blood pressure and lower carotid distensibility. However, there is no evidence that treatment of OSA with CPAP in patients with acromegaly results in significant improvement in blood pressure and carotid artery distensibility.
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Lebret, Marius. "Etude des déterminants des fuites non-intentionnelles au cours du traitement des troubles respiratoires du sommeil par pression positive et développement de stratégies innovantes pour le choix des masques et la gestion des fuites Factors contributing to unintentional leak during CPAP treatment : a systematic review Determinants of unintentional leak during CPAP treatment in obstructive sleep apnea syndrome Nasal Obstruction Symptom Evaluation Score to Guide Mask Selection in CPAP-Treated Obstructive Sleep Apnea N and Borel J-C. Comparison of auto-and fixed -continuous positive airway pressure on -air-leak in patients with obstructive sleep apnoea : data from a randomized controlled trial Adherence to CPAP with a nasal mask combined with mandibular advancement device versus an oronasal mask: a randomized crossover trial Nasal obstruction and male gender contribute to the persistence of mouth opening during sleep in CPAP-treated obstructive sleep apnoea." Thesis, Université Grenoble Alpes (ComUE), 2019. http://www.theses.fr/2019GREAS025.
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Au cours du traitement du syndrome d’apnées obstructives du sommeil (SAOS) par pression positive continue (PPC), les fuites non-intentionnelles sont un des effets indésirables les plus fréquents mais leur étiologie est mal comprise. Les objectifs de cette thèse étaient d’identifier les facteurs déterminants des fuites non-intentionnelles au cours du traitement du SAOS par PPC et de proposer des stratégies pour le choix du masque et la gestion des fuites.Dans notre revue de la littérature, nous avons arbitrairement classifié les déterminants potentiels à l’origine de fuites non-intentionnelles en deux catégories. 1) les déterminants non évolutifs au cours de la nuit : l’obstruction nasale, l’âge, un indice de masse corporel élevé, une distribution centrale des masses adipeuses et le genre masculin étaient des déterminants potentiels des fuites non-intentionnelles. Le masque naso-buccal était également associé à des fuites non-intentionnelles plus élevées que le masque nasal ; et 2) les déterminants évolutifs au cours du sommeil tels que les stades de sommeil, la position, l’ouverture buccale. Nous avons étudié ces déterminants évolutifs dans une population de 74 patients SAOS traités par PPC auto-pilotée : l’ouverture buccale, le niveau de pression de la PPC, la position du sujet et le sommeil paradoxal contribuaient au risque de fuite non-intentionnelle. Nous avons également mis en évidence que le masque naso-buccal réduisait le risque de fuite non-intentionnelle en cas d’ouverture buccale et au cours du sommeil paradoxal. Puisque le niveau de pression est un déterminant des fuites non-intentionnelles, nous avons évalué par une analyse ancillaire d’un essai randomisé contrôlé, si le mode de PPC (fixe versus autopiloté) pouvait contribuer aux fuites : nous n’avons pas montré d’association entre le mode et le niveau de fuites après 4 mois de traitement. Le mode PPC n’influençait pas le type de masque utilisé par les patients. Enfin, au cours d’une étude prospective incluant de 214 patients, nous avons évalué l’intérêt du questionnaire Nasal Obstruction Syndrom Evaluation (NOSE) comme outil pour guider le choix du masque. Un score NOSE > 50/100 à l’initiation de la PPC était indépendamment associé à l’utilisation d’un masque naso-buccal après 4 mois de traitement. Ce score est un outil simple pour évaluer objectivement les symptômes d’obstruction nasale et faciliter le choix de l’interface la plus appropriée. En conclusion, au cours de cette thèse nous avons développé une méthode innovante d’analyse des déterminants des fuites non-intentionnelles dont l’application clinique pourrait permettre la mise en place des stratégies de corrections individualisées des fuites. Cela devra faire l’objet d’une évaluation prospective, tout comme l’intérêt clinique de l’utilisation en routine du score NOSE pour guide le choix du masque.Mots clés : syndrome d’apnées obstructives du sommeil, pression positive continue, fuites, masque, interface, obstruction nasale, sommeil<br>Continuous Positive Airway Pressure (CPAP) is the first-line treatment for moderate to severe Obstructive Sleep Apnea (OSA) syndrome. Unintentional leakage and its annoying consequences are the most frequently reported adverse effects. However, the causes of unintentional leaks are poorly understood. This thesis aimed at identifying the determining factors of unintentional leaks during CPAP treatment in OSA and developping innovative strategies for the selection of masks and leaks management.In our systematic review we have arbitrarily split the potential determining factors of leaks into two categories: 1) the non evolving factors overnight: nasal obstruction, age, high body mass index, central fat distribution and male sex were potential contributing factors associated with unintentional leakage. The oronasal mask was associated with higher unintentional leaks than the nasal mask; and 2) the evolving factors overnight such as sleep stages, body position, mouth opening and CPAP level. We studied these evolving factors in 74 OSA patients treated with auto-adjusting CPAP: mouth opening, CPAP level, body position and REM sleep were independently associated with an increased risk of unintentional leakage. We also highlighted that oronasal masks reduced the risk of unintentional leaks in cases of mouth opening and REM sleep. Since the CPAP level is a determining factor of leakage we evaluated through an ancillary analysis of a randomised controlled trial whether the type of CPAP (fixed versus auto-adjusting) could contribute to leakage. In this study, there was no effect of type of CPAP on leaks or the type of interface used after 4 month of treatment. Finally, in 214 patients, we prospectively evaluated the relevance of the Nasal Obstruction Syndrom Evaluation (NOSE) score as a simple decision-making tool to guide the choice of mask during CPAP initiation. A NOSE score > 50/100 at the initiation was independently associated with the use of an oronasal mask at 4 month. This score could be a simple tool for the objective assessment of nasal obstruction related to symptoms, facilitating the choice of an appropriate interface. As a conclusion, during this thesis we have developed a novel methodology to characterise and analyse the overnight determinants of unintentional leakage. Its clinical application could lead to individualised corrective measures of leaks. Further studies are needed to prospectively validate this model, as well as the clinical relevance of the NOSE score to guide the choice of mask in daily practice
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Oliveira, Luciana Rabello de. "Efeitos agudos da pressão positiva contínua de vias aéreas (CPAP) e impacto da umidificação e vazamento aéreo sobre o transporte mucociliar e inflamação nasal de indivíduos sadios." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-28012008-135730/.
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A pressão positiva contínua nas vias aéreas (CPAP) é o tratamento de escolha para pacientes com Apnéia Obstrutiva do Sono, mas muitos sintomas nasais conseqüentes da terapia são relatados. Vazamentos aéreos pela boca e alterações do epitélio respiratório são importantes no desenvolvimento de sintomas nasais e a umidificação aquecida é utilizada no alívio destes sintomas. O objetivo deste trabalho foi o de investigar os efeito agudos do nCPAP e o impacto da umidificação aquecida e vazamento aéreo no transporte mucociliar e inflamação nasal de indivíduos sadios. Para este fim avaliamos o transporte mucociliar nasal in vivo (através do Teste da Sacarina), a transportabilidade in vitro do muco nasal (através do Método Palato de Rã), lavado nasal e sintomas respiratórios (através de uma Escala Visual Analógica) de dezesseis indivíduos sadios antes e após aplicação aguda do CPAP sobre diferentes condições: CPAP com e sem umidificação aquecida e CPAP com e sem vazamento aéreo. O transporte mucociiar nasal in vivo aumentou significativamente após todas as intervenções com CPAP. Não houve diferença significativa da transportabilidade do muco, contagem total e diferencial de células inflamatórias provenientes do lavado nasal após nenhuma das intervenções com o CPAP. Houve um aumento significante da percepção subjetiva dos sintomas respiratórios estudados após o uso do CPAP sem umidificação e com vazamento aéreo. Concluimos que o uso agudo do CPAP independente da umidificação ou vazamento aéreo, aumenta significativamente o transporte mucociliar nasal in vivo, não altera significativamente a transportabilidade do muco nasal nem a composição celular de amostras de lavado nasal. Já o uso do CPAP sem umidificação e com vazamento aéreo causa aumento significativo dos sintomas de ressecamento nasal e de garganta, coriza e obstrução nasal.<br>Continuous positive airway pressure (CPAP) is the treatment of choice for patients with Obstructive Sleep Apnea but yet nasal symptoms are often reported. Air leaks and changes of the respiratory epithelium are important in the development of nasal symptoms and heated humidification is used to alleviate these symptoms. The aim of this study was to investigate the acute effects of CPAP and the impact of heated humidification and air leak on the nasal mucociliary clearance and nasal inflammation of healthy volunteers. To this end we evaluated nasal mucociliary clearance in vivo (through the Saccharin Test), in vitro nasal mucus transportability (through the Frog Palate Model), nasal lavage and respiratory symptoms (through a Visual Analogue Scale) of sixteen healthy volunteers before and after acute CPAP application under different conditions: CPAP with and without heated humidification and with and without air leak. In vivo nasal mucociliary clearance increased significantly after all CPAP interventions. There was no significant difference in mucus transportability, total or differential inflammatory cell count from the nasal lavage after any CPAP intervention. There was a significant increase in the subjective perception of the respiratory symptoms studied after the use of CPAP without humidification and with air leak. We conclude that the acute use of CPAP independently of humidification or air leak significantly increases in vivo nasal mucociliary clearance, doesn\'t change mucus transportability and total or differential cell count. However, the use o CPAP without humidification and with air leak significantly increased nasal and throat dryness, coryza and nasal obstruction subjective perception.
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Browde, Kate. "Indication for and outcomes of continuous Positive Airways Pressure (CPAP) and High Flow Nasal Cannula oxygen therapy (HFNC) in children admitted to Red Cross War Memorial's Hospital (RCWMCH) excluding those with primary respiratory aetiologies." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25195.
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Aim: Noninvasive Continuous Positive Airway Pressure (nCPAP) and High Flow Nasal Cannula oxygen therapy (HFNC) are non-invasive ventilation (NIV) modalities appropriate for children in developing countries. There is minimal literature describing nCPAP and HFNC use in children with respiratory compromise secondary to non-pulmonary disease. This study aimed to describe the characteristics and outcomes of all children without primary lung pathology, who received nCPAP and HFNC during their admission to Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Methods: This was a prospective observational study of routinely collected data, between August 2015 and January 2016. Primary and secondary outcome measures were NIV failure (progression to intubation and invasive ventilation) and Paediatric Intensive Care Unit (PICU) admission respectively. Comparative statistics were conducted using Mann-Whitney U tests. Data significantly associated with the primary and secondary outcomes on univariate analysis were entered into backward stepwise logistic regression models to determine independent predictive factors. Results: There were 31 cases of nCPAP and one case of HFNC use in 31 patients (median (IQR) age 3.5 (1.8 – 7.6) months. The majority (n=23; 71.9%) presented with primary diarrhoeal disease. There were two deaths (6.5%), 17 (53.1%) Paediatric Intensive Care (PICU) admissions, and five (15.6%) cases received invasive ventilation (NIV failure). Median (IQR) duration of hospital stay was 11.50 (6.0 – 17.5) days. Patients who failed NIV had lower admission SaO2 than those without treatment failure (95 (95-99)% vs 100 (100-100)%; p = 0.03). On multiple logistic regression, lower temperature (OR 0.19; 95% CI 0.05 – 0.78; p = 0.02) and receiving inotropes in the emergency setting, (OR 23.05; 95% CI 1.64 – 325.06; p = 0.02) were independently associated with PICU admission. Conclusions: nCPAP is used clinically for the management of children with respiratory compromise secondary to non-pulmonary illnesses, particularly diarrhoeal disease. Larger controlled clinical studies are needed to determine the effectiveness and utility of nCPAP in this population. HFNC was not commonly used, and this modality requires further investigation in this population.
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Brammer, Philip Anthony. "Obstructive sleep apnoea, snoring and the use of variable pressure continuous positive airway pressure." Thesis, University of Birmingham, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.532272.
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Lai, Yuen-kwan Agnes, and 賴婉君. "Continuous positive airway pressure education on adherence in adults with obstructive sleep apnoea." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/198849.
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Poor adherence to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnoea (OSA) limits its therapeutic effectiveness and has a major impact on clinical outcomes. Effective education programme is important to enhance CPAP use. However, existing education programmes are either manpower or resource demanding and may not be feasible in clinical practice. Moreover, the Self-Efficacy Measure for Sleep Apnoea (SEMSA) has been widely adopted for assessing adherence-related cognitions on CPAP therapy in OSA patients, but it was not available for Chinese.
The aims of this thesis are: (i) to perform linguistic and psychometric evaluation of a Chinese version of SEMSA (SEMSA-C); (ii) to examine the efficacy of brief motivational enhancement education programme in addition to standard care versus standard care only on improving adherence to CPAP treatment in patients with OSA.
The SEMSA-C was obtained after the standard forward-backward translation process. A randomised controlled trial was then conducted on newly diagnosed OSA patients. Patients in the control group received standard care (SC) comprising advice on the importance of CPAP therapy and its care while those in the intervention group received SC plus motivational enhancement education programme (ME). ME focused to enhance subjects’ knowledge, motivation and self-efficacy to use CPAP, comprising one 45-minute session on the day after CPAP titration and one 10-minute telephone follow-up shortly after commencing CPAP treatment. Epworth Sleepiness Scale (ESS), SEMSA-C, and quality of life were assessed. CPAP usage data were downloaded at the completion of this 3-month study. The primary outcome was the CPAP adherence. Furthermore, 21 patients were randomly sampled at baseline and completed the SEMSA-C at one week.
100 patients (Men : Women, 84 : 16) with OSA indicated for CPAP treatment were recruited, with an average age of 52±10 years, and apnoea hypopnoea index (AHI) of 36.2±22 events/hour. Factor analysis of SEMSA-C identified three factors: risk perception, outcome expectancies and treatment self-efficacy. Their corresponding internal consistency was high with Cronbach’s alpha >0.88, which were larger than all correlations between subscales (Range: 0.14 to 0.58). The correlations between items and their hypothesized subscale (Range: 0.58 to 0.85) were generally higher than the correlations between items and their competing subscales (Range: -0.10 to 0.58). One-week test-retest intra-class correlation ranged from 0.70 to 0.82. CPAP adherence was associated with outcome expectancies and treatment self-efficacy at 3-month assessment. Furthermore, SEMSA-C demonstrated an improvement in self-efficacy (standardised response mean = 0.33, p = .044) but no significant changes were observed in the other two factors, after CPAP use.
The 100 patients were followed for 3 months. The interventional effects maintained during the 3-month study period. There were a better CPAP use [higher daily CPAP usage of 2 hours/day (Cohen d = 1.33, p < .001), four-fold the number of subjects using CPAP for ≥ 70% of days with ≥ 4 hours per day (p < 0.001)], and greater improvements in ESS by 2.2 (p = 0.001) and treatment self-efficacy by 0.2 (p = 0.012) in the intervention group, relative to the control group.
The traditional Chinese SEMSA-C possesses satisfactory psychometric properties. It is a reliable and responsive instrument to measure perceived risks, outcome expectancies and treatment self-efficacy in Chinese patients with OSA. Moreover, the newly developed brief motivational enhancement education programme in addition to standard care is effective in improving adherence to CPAP treatment, treatment self-efficacy and daytime sleepiness.<br>published_or_final_version<br>Nursing Studies<br>Doctoral<br>Doctor of Nursing
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Trupp, Robin J. "The Impact of Message Framing on Adherence to Continuous Positive Airway Pressure Therapy." The Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=osu1228151374.
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Tachikawa, Ryo. "Changes in Energy Metabolism after Continuous Positive Airway Pressure for Obstructive Sleep Apnea." 京都大学 (Kyoto University), 2017. http://hdl.handle.net/2433/225486.
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Chakravorty, Indranil. "Health technology assessment of continuous positive airway pressure devices in sleep apnoea hypopnoea syndrome." Thesis, University of Warwick, 2005. http://wrap.warwick.ac.uk/38056/.
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A. 1 Background The need to assess safety as well as clinical and economic effectiveness of health care innovations and thus prioritise health care provision, created the need for structured health technology assessment (HTA) programs [Gafni et al. 1993b; Henshall et al. 1997; Stevens et al. 20041. Sleep apnoea hypopnoea syndrome (SAHS) affects 2-4% of the adult population [Young et al. 1993] who are disabled by daytime dysfunction [Hardinge et al. 1995; Johns 1993b; Mitler 1993; Sauter et al. 200l and a heightened mortality and morbidity [Greenberg et al. 1995; Kiely et al. 2000; Peker et al. 1999; Sanner et al. 1997; Tremel et al. 1999; Wilcox et al. 1998; Moruzzi et al 1999; Malone et al. 1991]. The advent of continuous positive airway pressure devices (CPAP) [Sullivan et al 1981] made it possible to treat safely, patients over a wider spectrum of disease severity [Borak et al. 1996; Mar et al. 2003; Engleman et al 1997a], yet its diffusion and adoption appears to follow a heterogenous pattern. A. 2 Study design A retrospective case-control study of 603 SAHS patients was followed by a prospective, randomised, parallel group trial (RCT) of CPAP compared to lifestyle intervention (including weight reduction and sleep hygiene strategy) comparing clinical, health related quality of life (HRQL) and cost-utility ratios (CUR). The final study is a qualitative survey assessing the factors influencing the diffusion and adoption of CPAP among 303 Primary care trusts (PCT) and 261 Respiratory physicians in the UYA. 3 Results SAHS patients had a (5x) higher risk of death and (2x) of hypertension, compared to controls. Among 71 SAHS patients in the RCT, those on CPAP demonstrated greater clinical effectiveness (sleep latency, apnoea hypopnoea index, excessive daytime sleepiness & neuropsychiatriefunction) and HRQL (social functioning, mental health & energylvitality) compared to lifestyle intervention. Utilities improved on CPAP and the CUR were lower (E'716-E2027 vs. F-326444243). The diffusion survey demonstrated that the characteristics of CPAP as an innovation, would favour its adoption compared to alternative therapies, except in patient tolerability (PCT respondents). However there appeared to be no regular system for the diffusion of innovation knowledge within the NHS and hindrances in SAHS management due to deficiencies in resources, specialists and facilities. A. 4 Conclusions The results presented in this thesis provide a logical framework for the assessment of the progression of an innovation from the stage of establishing the clinical burden of disease and treatment needs, to its adoption and may help identify potentially modifiable factors in slow diffusion scenarios.
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Urbanek, Kathryn A. "The effect of continuous positive airway pressure (CPAP) session duration on velopharyngeal timing variables." Laramie, Wyo. : University of Wyoming, 2007. http://proquest.umi.com/pqdweb?did=1400961041&sid=1&Fmt=2&clientId=18949&RQT=309&VName=PQD.
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MacLeod, Kendra Deanne. "Evaluating Adherence to Continuous Positive Airway Pressure Therapy in Children with Sleep-Disordered Breathing." University of Cincinnati / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1235768185.
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Woods, Amy. "Effect of Continuous Positive Airway Pressure (CPAP) on Aerodynamic and Acoustic Aspects of Velopharyngeal Function." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1523190308305561.
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Engleman, Heather M. "Daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome (SAHS." Thesis, University of Edinburgh, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.534254.
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The sleep apnoea/hypopnoea syndrome (SAHS) is characterised by obstruction of the airway during sleep, resulting in repetitive nocturnal breathing pauses, which provoke both oxygen desaturations and arousals from sleep. SAHS is associated with daytime deficits of excessive daytime sleepiness, cognitive impairment and psychological distress, probably as a result of these nocturnal events. The treatment of choice for SAHS is continuous positive airway pressure (CPAP) therapy, a mechanical treatment in which positive airstream pressure is administered to the upper airway through a nasal mask, splinting the airway open and preventing the nocturnal events of SAHS. A limited number of small clinical studies have indicated improvements in daytime function following CPAP therapy, but these have not been well-controlled, particularly in the area of cognitive performance. This thesis contributes controlled studies to the knowledge-base describing CPAP's effects on daytime function. A pilot study employing a parallel-group design in 37 patients showed improvements in objective daytime sleepiness and psychological distress with CPAP, but not cognitive function. This null finding however might have resulted from inter-individual variability. To rectify this, a randomised placebo-controlled crossover study of daytime function on CPAP and on an oral placebo was conducted in 64 patients with a wide range of severity of SAHS. This study showed CPAP-related improvement in symptoms, objective and subjective daytime sleepiness, cognitive performance and well-being. The use of balanced treatment order within a subgroup of 16 patients with mild SAHS (apnoea+hypopnoea index 5 to 14.9) allowed investigation of the minimum illness severity at which daytime benefits from CPAP are observed. Such mild patients demonstrated improvements in symptom score, cognitive performance and psychological distress on CPAP. Although the minimum illness severity meriting CPAP treatment has not been well defined, these data support the efficacy of CPAP at the lowest severity range of SAHS. A randomised study of auditory evoked potentials in 18 patients showed trends only towards improved neurophysiological function after CPAP, and a randomised crossover study of ambulatory blood pressure in 13 patients showed reduced blood pressure on CPAP only in a subgroup of patients who lacked significant dipping of nocturnal blood pressure. The nocturnal determinants of daytime dysfunction in SAHS were explored by correlating factors extracted from polysomnographic and daytime function variables. The principal component extracted from the polysomnographic variables was found to correlate significantly with daytime sleepiness and with intellectual function, corroborating weak or moderate associations between the severity of nocturnal events and daytime deficits. Patients' perceptions of benefit from CPAP, and their self-reported driving competence, were examined in a survey of 215 CPAP users. Patients reported wide-ranging improvements in nocturnal and daytime symptoms of SAHS, and showed a significant improvement in mileage adjusted rates of road traffic incidents following CPAP. Although side-effects of CPAP were common, these were minor in nature. Thus patients' reports corroborated the daytime benefits from CPAP documented in the project's controlled studies. The studies of this thesis demonstrated objective and subjective improvements in symptoms, daytime sleepiness, cognitive performance and well-being in SAHS patients treated with CPAP.
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Flürenbrock, Nicole. "Einfluss der Continuous-Positive-Airway-Pressure-Therapie auf die Infekthäufigkeit von Patienten mit einem obstruktiven Schlafapnoe-Syndrom." [S.l.] : [s.n.], 2001. http://deposit.ddb.de/cgi-bin/dokserv?idn=964664976.
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Ledman, Cassandra A. "The effect of continuous positive airway pressure treatment on physical activity levels in obstructive sleep apnea patients." Virtual Press, 2008. http://liblink.bsu.edu/uhtbin/catkey/1391676.
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Obstructive Sleep Apnea (OSA) is becoming an increasingly prevalent health problem, affecting 4% of men and 2% of women in North America. OSA is associated with many debilitating side-effects and co-morbidities; the most common being excessive daytime sleepiness (EDS), which effects the majority of OSA sufferers. EDS is negatively associated with physical activity (PA) and exercise. As a result, EDS may decrease the levels of PA performed by OSA patients. Previous research has revealed that the OSA population engages in less physical activity than the average healthy population. Studies show that CPAP treatment positively impacts EDS, and therefore; may impact PA. The primary purpose of this study was to objectively measure OSA patients' PA levels prior to CPAP treatment and 8 weeks after treatment initiation to assess whether CPAP treatment' impacts PA levels.Actigraph GT 1 M measures PA was assessed at baseline (prior to CPAP) and 8-weeks after. initiation of CPAP treatment. At each time frame, cardiovascular., blood data, body composition, and maximal cycle ergometer exercise measures were obtained. Also, subjective questionnaires, 1 reflective of sleep apnea and 1 regarding PA, were completed by the subjects.Six male subjects with severe OSA (AHI = 41.2 ± 28.4 events/hr) started and completed the study. No significant changes occurred in PA, represented as steps/day nor mean activity counts/day, throughout the 8 weeks of CPAP treatment. Significant changes were found in diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and Epworth sleepiness scale scores. No significant changes occurred in any other body composition, heart rate, systolic blood pressure, triglycerides, and blood glucose. Exercise parameters, total test time, peak Watts, and V02max trended toward an increase and maximal heart rate and blood pressure toward a decrease, but none changed significantly.In conclusion, these results demonstrated that 8 weeks of CPAP treatment was not successful in increasing PA levels of severe OSA patients. The OSA subjects were categorized as sedentary according to their steps/day. Compliance to CPAP could have been an issue with subjects' average nightly usage ranging from 1.85 – 6.6hours/night. Consequently, more research regarding OSA patients PA habits and CPAP treatments effects on PA should be investigated.<br>School of Physical Education, Sport, and Exercise Science
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Batool-Anwar, Salma, Carol May Baldwin, Shira Fass, and Stuart F. Quan. "ROLE OF SPOUSAL INVOLVEMENT IN CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) ADHERENCE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA (OSA)." Arizona Thoracic Society, 2017. http://hdl.handle.net/10150/623472.
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Introduction: Little is known about the impact of spousal involvement on continuous positive airway pressure (CPAP) adherence. The aim of this study was to determine whether spouse involvement affects adherence with CPAP therapy, and how this association varies with gender.
Methods: 194 subjects recruited from Apnea Positive Pressure Long Term Efficacy Study (APPLES) completed the Dyadic Adjustment Scale (DAS). The majority of participants were Caucasian (83%), and males (73%), with mean age of 56 years, mean BMI of 31 kg/m2. & 62% had severe OSA. The DAS is a validated 32-item self-report instrument measuring dyadic consensus, satisfaction, cohesion, and affectional expression. A high score in the DAS is indicative of a person’s adjustment to the marriage. Additionally, questions related to spouse involvement with general health and CPAP use were asked. CPAP use was downloaded from the device and self-report, and compliance was defined as usage > 4 h per night.
Results: There were no significant differences in overall marital quality between the compliant and noncompliant subjects. However, level of spousal involvement was associated with increased CPAP adherence at 6 months (p=0.01). After stratifying for gender these results were significant only among males (p=0.03). Three years after completing APPLES, level of spousal involvement was not associated with CPAP compliance even after gender stratification.
Conclusion: Spousal involvement is important in determining CPAP compliance in males in the 1st 6 months after initiation of therapy but is not predictive of longer-term adherence. Involvement of the spouse should be considered an integral part of CPAP initiation procedures.
Support: HL068060
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Hofmann, Markus. "Notwendigkeit einer Druckveränderung bei Patienten mit CPAP (Continuous Positive Airway Pressure)-Therapie 2 - 3 Monate nach der Ersteinstellung." [S.l. : s.n.], 2007. http://nbn-resolving.de/urn:nbn:de:bsz:289-vts-60436.
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Jones, Anne. "Arterial stiffness and endothelial function in obstructive sleep apnoea : the effect of Continuous Positive Airway Pressure (CPAP) therapy." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/25391.
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Introduction: Obstructive sleep apnoea (OSA) is common and is caused by repetitive obstruction of the upper airway during sleep. OSA is associated with increased cardiovascular morbidity and mortality and is an independent risk factor for hypertension. The immediate physiological effects of OSA include intermittent hypoxia, repeated arousal from sleep and intra-thoracic pressure swings. The resulting activation of the sympathetic nervous system, systemic inflammation and oxidative stress may result in increased arterial stiffness and endothelial dysfunction, potentially explaining any causal link between OSA and cardiovascular disease (CVD). Continuous positive airway pressure (CPAP) therapy improves excessive daytime sleepiness (EDS) and in non-randomised studies, reduces cardiovascular mortality. Prior to starting this study, there was a limited amount of evidence suggesting that CPAP therapy improved arterial stiffness and endothelial function, but the effects in subjects without pre-existing CVD were unclear. Aims: i) to determine whether CPAP therapy has an effect upon measures of arterial stiffness and endothelial function in patients with OSA, in the absence of known CVD. ii) To compare arterial stiffness and endothelial function in a subset of patients with OSAHS (defined as OSA and EDS), with a group of well-matched control subjects. Methods: Fifty three patients with OSA, defined as an apnoea/hypopnoea index of ≥15, and without known CVD, entered a double-blind placebo-controlled crossover trial of 12 weeks CPAP therapy, of whom forty three completed the study protocol. Sham CPAP was used in the placebo arm of the study and vascular assessments were made at baseline and after each arm of the study. Arterial stiffness was determined by measuring aortic distensibility using cardiovascular magnetic resonance imaging and by measuring the augmentation index (AIx) and aortic pulse wave velocity (PWV) by applanation tonometry. Endothelial function was assessed non-invasively by measuring vascular reactivity after administration of salbutamol and glyceryl trinitrate. In a subset of twenty patients with OSAHS, arterial stiffness and endothelial function at baseline were compared to readings obtained from healthy control subjects, matched on a one-to-one basis for age, sex and BMI. Results: Patients with OSAHS (n=20) had increased arterial stiffness [AIx 19.3(10.9) vs. 12.6(10.2) %; p=0.017] and impaired endothelial function, measured as the change in AIx following salbutamol [-4.3(3.2) vs. -8.0(4.9) %; p=0.02] compared to controls. Twelve weeks of CPAP therapy had no significant effect upon any measure of arterial stiffness or endothelial function in patients with OSA (n=43). A trend towards a reduction in AIx following CPAP therapy was seen, but this was non-significant. There was a reduction in systolic blood pressure following CPAP therapy [126(12) vs. 129(14) mmHg]. Sub group analysis showed CPAP to have no effect on arterial stiffness or endothelial function in patients with EDS or in patients using CPAP for ≥4 hours per night. Conclusions: This study demonstrates that even in the absence of known CVD, patients with OSAHS have evidence of increased arterial stiffness and impaired endothelial function. However, in patients with OSA, free from CVD, CPAP therapy did not lead to an improvement in any measure of arterial stiffness or endothelial function after 12 weeks.
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Gulati, Atul. "Factors affecting initial acceptance of, and subsequent compliance with, continuous positive airway pressure treatment for Obstructive Sleep Apnoea." Thesis, University of Hertfordshire, 2017. http://hdl.handle.net/2299/17731.
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Background: Compliance with CPAP treatment for OSA is not reliably predicted by the severity of symptoms or physiological variables. I conducted a series of studies to examine a range of factors that may affect compliance with CPAP. Methods: I performed a retrospective study examining association of demographic factors and OSA severity with long-term CPAP compliance. In a prospective study, I looked at the correlation of short and long-term CPAP compliance with socio-economic status, education, type D personality, demographics, disease severity, mood and clinician's prediction. I undertook a prospective, cross-over trial comparing the impact of Bi-level PAP therapy in individuals with low tolerance of CPAP. Results: In a retrospective analysis, an improvement in subjective daytime somnolence was correlated with optimal compliance. In the prospective study, median compliance with CPAP at 6 months was 5.6 (3.4- 7.1) hours/night with 73% of subjects using CPAP ≥ 4 hours/night. Compliance with CPAP was not found to be associated with socio-economic class for people in work, type D personality, education, sex, age, baseline sleepiness (ESS score) or disease severity (ODI). The clinician's initial impression had no predictive value for individual patients. Subjects who were long-term unemployed or reporting mood disorders (High Beck's Depression Index scores) were likely to have poor compliance and sub-optimal CPAP usage (OR 4.6, p = 0.011 and OR 1.4. p=0.04 respectively). Subjects experiencing side effects after the first night on treatment showed lower acceptance and subsequent compliance. In the cross-over trial, changing to Bi-level PAP in individuals with suboptimal compliance due to pressure related intolerance, did not lead to an improvement in CPAP compliance. In post-hoc analysis, compliance and comfort were better in the subgroup that complained of difficulty with exhalation on CPAP. Conclusion: My research as presented in this thesis, did not find an association between disease severity (ODI), socio-economic status (for people in employment), education or personality type and CPAP compliance. My research demonstrated that subjects with long-term unemployment, mood disorders and those experiencing side effects on the first night of treatment were likely to have sub-optimal compliance. Changing to Bi-level PAP is only likely to be useful for a sub-group of subjects experiencing pressure related intolerance. More research is needed to explore whether intensive support to individuals with OSA and long term unemployment, as well as mood disorders, may improve compliance.
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Batool-Anwar, Salma, James L. Goodwin, Clete A. Kushida, et al. "Impact of continuous positive airway pressure (CPAP) on quality of life in patients with obstructive sleep apnea (OSA)." Wiley, 2016. http://hdl.handle.net/10150/623127.
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Obstructive sleep apnea is a chronic illness with increasing prevalence. In addition to associated cardiovascular comorbidities, obstructive sleep apnea syndrome has been linked to poor quality of life, occupational accidents, and motor vehicle crashes secondary to excessive daytime sleepiness. Although continuous positive airway pressure is the gold standard for sleep apnea treatment, its effects on quality of life are not well defined. In the current study we investigated the effects of treatment on quality of life using the data from the Apnea Positive Pressure Long-term Efficacy Study (APPLES), a randomized controlled trial of continuous positive airway pressure (CPAP) versus sham CPAP. The Calgary Sleep Apnea Quality of Life Index (SAQLI) was used to assess quality of life. Overall we found no significant improvement in quality of life among sleep apnea patients after CPAP treatment. However, after stratifying by OSA severity, it was found that long-term improvement in quality of life might occur with the use of CPAP in people with severe and possibly moderate sleep apnea, and no demonstrable improvement in quality of life was noted among participants with mild obstructive sleep apnea.
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Gorovoy, Suzanne Beth. "ASSOCIATIONS OF SOCIODEMOGRAPHIC AND HEALTH FACTORS WITH INITIAL ADOLESCENT ADHERENCE AND USAGE PATTERNS TO CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)." Case Western Reserve University School of Graduate Studies / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=case1559927127536236.
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Hsu, C. Y. "The impact of obstructive sleep apnoea/hypopnoea and its treatment with continuous positive airway pressure on the outcome of stroke." Thesis, University of Edinburgh, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.652659.
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The prevalence of sleep-disordered breathing (SDB) in stroke is high. We hypothesised that treatment of SDB in stroke patients would improve rehabilitation. 71 patients were recruited for overnight limited sleep study 14-19 days following stroke. Sixty-six patients with adequate recording were included in the study, 45 men and 21 women, median age 74yrs. The sleep study showed 50% of patients had more than 30 apnoeas + hypopnoeas per hour in bed [expressed as (A+H)•h<sup>-1</sup>]. Pulse oximetry alone had lower sensitivity (70%) but high specificity (90%) to predict (A+H)•h<sup>-1</sup> ³ 30. Thirty patients who had (A+H)•h<sup>-1</sup> ³ 30, with < 30% central apnoea or Cheyne-Stoke respiration, proceeded to a randomized controlled trial starting from the 4th week after stroke with 15 patients randomized to CPAP and 15 to conventional stroke treatment only. Duration of treatment was 8 weeks and blind outcome assessment was performed at 3 months and 6 month after stroke. The result showed compliance with CPAP was poor with mean 1.40 hours and median 0.16 hours per night. There was no statistically significant difference in the outcomes, sleepiness and ambulatory blood pressure with CPAP therapy. Increased length of keeping CPAP was correlated with higher score of language subscale in the Addenbrooke’s Cognitive Examination (Spearman’s rho = 0.544, p = 0.036) and lower score in the depression subscale of the Hospital Anxiety and Depression Scale (HADS, Spearman’s rho =-0.538, p = 0.039). All 66 patients with adequate sleep studies received longitudinal follow-up at 3, 6 12 and 18 months following stroke. The patients with (A+H)•h<sup>-1</sup> ³ 30 had a trend to worse functional capacity in both Barthel Index and Nottingham Extended ADL Index (EADL) than patients with (A+H)•h<sup>-1</sup>< 30 but there was only a statistically significant difference in the mobility subscale of EADL. The negative influence of (A+H)•h<sup>-1</sup> ³ 30 on functional capacity and health-related quality of life following stroke was only statistically significant in patients with mild stroke (NIH Stroke Scale, NIHSS < 7) at both 3 and 6 months, lesser emotional distress (HADS < 8) at both 3 and 6 months and lesser cognitive impairment (Mini Mental State Examination ³ 28) at 6 months after stroke in subgroup analysis. The difference of Modified Rankin Scale between groups was significant at 6 months after stroke (p = 0.026). There was no difference in cognitive or emotional outcome. No significant difference of mortality rate was noted. We focused on a group of patients with mild to moderate stroke (median NIHSS = 6) in a narrow time span (14-19 days) and confirmed a high prevalence of SDB in stroke. CPAP compliance was a major problem but might be enhanced by selecting patients with higher functional capacity, higher cognitive function especially language and less depression in the acute or subacute phase of stroke.
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鄭希翹 and Hai-kiu Kelvin Cheng. "Evaluation on the quality of life for patients with obstructive sleep apnea using the continuous positive airway pressure device treatment." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B4072041X.
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Cheng, Hai-kiu Kelvin. "Evaluation on the quality of life for patients with obstructive sleep apnea using the continuous positive airway pressure device treatment." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B4072041X.
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Al, Mutairi Fouad. "Alternative methods of treating atelectasis in post-operative patients." Thesis, University of Chester, 2013. http://hdl.handle.net/10034/311066.
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Cardiac surgery incisional pain can decrease inspiratory effort, alter normal respiratory mechanics, and increase the potential for post-operative pulmonary complications. Post-surgical atelectasis is the most frequent complication after coronary artery bypass grafting (CABG), ranging from 54% to 92%. All types of therapy such as an incentive spirometry (IS), deep breathing exercises (DBE) or continuous positive airway pressure (CPAP) have a valuable role to play in the prevention or the treatment of post-surgical atelectasis. However, the type of therapy that should be used is not completely clear yet. The present research aims to evaluate the benefit of early use of CPAP via mask therapy to treat or prevent post-surgical atelectasis after CABG, particularly in smokers and elderly patients, as compared to regular (IS) therapy. Also, it aims to evaluate the patients' and medical staff's experience about the use of the new method of CPAP via mask therapy. The present research was conducted at King Fahd Armed Forces Hospital in Saudi Arabia between March 2010 and December 2011. It used a mixed methods approach. The first two studies were intervention quantitative studies, which investigated the benefit of CPAP via mask therapy. The others were qualitative studies that evaluated the experience of patients and medical staff regarding CPAP therapy use.A total of 180 patients (male and female) (36 in each group) participated in the two quantitative studies. Ninety two participants (male and female) participated in the qualitative studies. The first quantitative study results showed an improvement in CPAP via mask therapy for half hours every two hours group measurements as compared to IS therapy groups. IC was increased significantly in the "CPAP every two hours group" as compared to control group (IS) (baseline mean for IS group 1.34L and "CPAP every two hours group" 1.42L, post- therapy mean 1.59L and 1.88L respectively, p= 0.037). In addition, when chest physiotherapy was added to the two regimens, the improvement of CPAP therapy measurements became more than IS therapy. Moreover, the patient’s acceptance rate for CPAP therapy every two hours was 93% and the medical staff acceptance rate was 86%. CPAP via mask therapy for half hour every two hours had better outcomes in treating or preventing post-surgical atelectasis after CABG, particularly in smokers and elderly patients. Adding chest physiotherapy led to even better outcomes. The use of the new method of CPAP therapy had high acceptance rate by the participants and medical staff.
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Kremer, Tina [Verfasser], and Ulrich [Akademischer Betreuer] Koehler. "Intubationsrate und Mortalität mit und ohne präklinischem Continuous Positive Airway Pressure bei Patienten mit akutem kardiogenem Lungenödem / Tina Kremer. Betreuer: Ulrich Koehler." Marburg : Philipps-Universität Marburg, 2016. http://d-nb.info/1106381270/34.
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Lundqvist, Amanda, and Frida Gäfvert. "Sjuksköterskors erfarenheter av att utföra CPAP-behandling inom medicinsk slutenvård." Thesis, Linköpings universitet, Institutionen för medicin och hälsa, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-166705.
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Bakgrund: Continuous Positive Airway Pressure (CPAP) är en non-invasiv behandling som bland annat används vid respiratorisk svikt. CPAP-behandling utförs inte bara på intensivvårdskliniker, vilket ställer högre utbildningskrav på sjuksköterskor verksamma inom slutenvården. Otillräcklig kunskap bland personalen leder till minskad möjlighet att tillgodose patienternas behov. I dagens sjukvård där allt fler sjuka patienter vårdas utanför intensivvårdskliniker krävs det därför regelbunden utbildning för sjuksköterskor för att kunna upprätthålla en säker vård. Syfte: Att beskriva sjuksköterskors erfarenhet av att utföra CPAP-behandling på en medicinsk slutenvårdsavdelning. Design: Kvalitativ studie med induktiv ansats Metod: Femton sjuksköterskor intervjuades på två sjukhus i Mellansverige. Den transkriberade datan analyserades med hjälp av en konventionell innehållsanalys. Fynd: Huvudfyndet i denna studie visar att sjuksköterskans erfarenhet av CPAPbehandling kännetecknas av blandade känslor. Det framkommer att sjuksköterskans utförande av CPAP-behandling påverkas av såväl frustration och osäkerhet som trygghet och säkerhet vilket är länkat till erfarenheten. Trots dessa blandade känslor leder sjuksköterskan teamet med mål att skapa en säker vård för patienten. Konklusion: Det behövs en kontinuerlig utbildning kring CPAP-behandling och ett regelbundet användande för att sjuksköterskor ska känna sig säkra och främja patientsäkerheten.<br>Background: Continuous Positive Airway Pressure (CPAP) is a non-invasive treatment which is useful to treat respiratory failure. CPAP-treatment is not only performed at the intensive care units, and that leads to higher demands of education for nurses in clinical wards. Insufficient knowledge among the health care staff leads to reduced ability to satisfy the patient´s needs. In today’s health care with more complex patients in general wards is regular education important for nurses to maintain quality and safety. Aim: To describe nurses´ experience of performing CPAP-treatment in medical hospital care. Design: A qualitative study, inductive. Method: Fifteen nurses were interviewed in two hospitals in Sweden. The transcribed data where analysed with qualitative content analysis. Findings: The main finding where that nurses had both positive- and negative experience of CPAP-treatment. The study shows that nurses experience feelings such as frustration and insecurity as well as safety around CPAP-treatment. Despite the mixed feelings the nurse could be a team leader with focus on quality and safety. Conclusion: A regular education and regular use of CPAP-treatment is important so the nurses feels secure and to maintain the patient safety.
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Boneberg, Raphael [Verfasser], and Wulf [Akademischer Betreuer] Hildebrandt. "Proatherogene Genexpression in peripheren mononukleären Zellen bei obstruktiver Schlafapnoe: Effekt von Adipositas und Continuous Positive Airway Pressure - Therapie / Raphael Boneberg ; Betreuer: Wulf Hildebrandt." Marburg : Philipps-Universität Marburg, 2020. http://d-nb.info/1223130711/34.
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Donat, Tina [Verfasser]. "Einflussfaktoren für die Entstehung von Nebenwirkungen unter Therapie mit Continuous Positive Airway Pressure : eine Untersuchung bei Very Low Birth Weight Infants / Tina Donat." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2015. http://d-nb.info/106820866X/34.
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Miyata, Seiko, Akiko Noda, Kumiko Honda, et al. "Follow-up for Patients with Obstructive Sleep Apnea Syndrome using A Portable Recording Device." Nagoya University School of Medicine, 2007. http://hdl.handle.net/2237/7477.
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Chromik, Julia Tamara [Verfasser], Armin [Akademischer Betreuer] Steffen, and Hermann [Akademischer Betreuer] Heinze. "Nervus-hypoglossus-Stimulationstherapie der Continuous-Positive-Airway-Pressure-intoleranten obstruktiven Schlafapnoe unter Berücksichtigung der Lageabhängigkeit / Julia Tamara Chromik ; Akademische Betreuer: Armin Steffen, Hermann Heinze." Lübeck : Zentrale Hochschulbibliothek Lübeck, 2020. http://d-nb.info/1222767449/34.
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Koike, Yasuo, Seiichi Nakata, 聖子 宮田, et al. "Daytime polysomnography and portable recording device for diagnosis and CPAP therapy in patients with obstructive sleep apnea syndrome." Thesis, Springer Berlin, 2007. http://hdl.handle.net/2237/11067.
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名古屋大学博士学位論文 学位の種類:博士（医療技術学）（課程） 学位授与年月日:平成19年3月23日<br>"Daytime polysomnography and portable recording device for diagnosis and CPAP therapy in patients with obstructive sleep apnea syndrome" Sleep and Breathing, v.11, n.2 (2007) pp.109-115 を、博士論文として提出したもの。
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Azuma, Masanori. "Association Between Endothelial Function (Assessed on Reactive Hyperemia Peripheral Arterial Tonometry) and Obstructive Sleep Apnea, Visceral Fat Accumulation, and Serum Adiponectin." Kyoto University, 2016. http://hdl.handle.net/2433/204577.
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Gupta, Samir. "A randomised controlled trial of two methods of delivering continuous positive airway pressure for successful extubation in pre-term infants : 'infant flow driver' versus 'bubble CPAP'." Thesis, University of Newcastle upon Tyne, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442225.
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Wong, Andrea Jane. "The cognitive effects of Obstructive Sleep Apnoea Syndrome (OSAS) : a comparison between untreated patients and patients on at least 3 months Continuous Positive Airway Pressure (CPAP) treatment." Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/10886.
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Includes bibliographical references (leaves 68-75)<br>Objectives: To investigate whether or not OSAS patients from the South African population showed any cognitive impairment relative to healthy individuals from the same population, and to assess whether or not untreated OSAS patients and patients on CPAP treatment differed in their cognitive functioning.
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Hendriks, Hans Jurgen. "Is CPAP a feasible treatment modality in a rural district hospital for neonates with respiratory distress syndrome." Thesis, Stellenbosch : University of Stellenbosch, 2015. http://hdl.handle.net/10019.1/97244.
Full textAbstract:
Introduction: Limited facilities exist at rural hospitals for the management of newborn infants with respiratory distress syndrome (RDS). Furthermore, the secondary and tertiary hospitals are under severe strain to accept all the referrals from rural hospitals. Many of these infants require intubation and ventilation with a resuscitation bag which must be sustained for hours until the transport team arrives. Not only is lung damage inflicted by the prolonged ventilation, but transferring the infant by helicopter and ambulance is expensive.
CPAP (continuous positive airway pressure), a non-invasive form of ventilatory support, has been used successfully at regional (Level 2) and tertiary (Level 3) neonatal units, to manage infants with RDS. It is cost-effective for infants with mild to moderate grades of RDS to be managed at the rural hospital instead of being transferred to the regional secondary or tertiary hospital. CPAP was introduced to Ceres Hospital, a rural Level 1 hospital, in February 2008 for the management of infants with RDS.
Aim: To determine the impact of CPAP on the management of infants with RDS in a rural level 1 hospital and whether it can reduce the number of referrals to regional hospitals.
Study setting: Nursery at Ceres District Hospital, Cape Winelands District, Western Cape.
Study design: Prospective cohort analytical study with an historic control group (HCG).
Patients and Methods: The study group (SG) comprised all neonates with respiratory distress born between 27/02/2008 and 26/02/2010. The infants were initially resuscitated with a Neopuff® machine in labour-ward and CPAP was commenced for those with RDS. The survival and referral rates of the SG were compared to an historic control group (HCG) of infants born between 1/2/2006 to 31/01/2008 at Ceres Hospital.
Results: During the 2 years of the study, 51 neonates received CPAP (34 <1800g, 17>1800g). Twenty (83%) of the SG infants between 1000g and 1800g and 23 (68%) of the infants between 500g and 1800g survived. Those <1800g that failed CPAP, had either a severe grade of RDS which required intubation and ventilation or were <1000g. Seventeen (33%) of the infants that received CPAP, were in the >1800g group. Thirteen (76%) of these infants were successfully treated with CPAP only. The four infants that failed CPAP suffered from congenital abnormalities and would not have benefited from CPAP. There was no statistically significant difference in the survival between the SG and HCG (80%) (p=0.5490) but the number of referrals decreased significantly from 21% in the HCG to 7% in the SG (p=0.0003). No complications related to CPAP treatment, such as pneumothorax, were noted. The nursing and medical staff quickly became proficient and confident in applying CPAP and were committed to the project.
Conclusion: CPAP can be safely and successfully practised in infants with mild to moderate RDS in a rural Level 1 hospital. The survival rate stayed the same as the HCG, even though a higher risk infants were treated in the SG. The transfers were significantly reduced from 21% to 7%. This resulted in significant cost savings for the hospital.
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Leites, Joana Sofia Santos Silva. "Síndrome de apneia-hipopneia obstrutiva do sono e a sua relação com o Bruxismo do sono: perspectiva médico-dentária." Master's thesis, [s.n.], 2014. http://hdl.handle.net/10284/4403.
Full textAbstract:
Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária<br>A síndrome de apneia-hipopneia do sono (SAHOS) é uma patologia com um impacto crescente na população actual sendo considerado um problema de saúde pública. Esta síndrome é caracterizada por uma obstrução parcial ou total das vias aéreas durante o sono. Os pacientes habitualmente queixam-se de sonolência diurna excessiva e ronco durante a noite. O colapso contínuo das vias aéreas superiores (VAS) causa fragmentação do sono, hipoxemia, hipercapnia e aumento da actividade simpática.
São vários os factores de risco que influenciam esta síndrome. A sua fisiopatologia é multifactorial, sendo que, determinados factores anatómicos e neuromusculares demonstram ter um papel activo na sua ocorrência. O tratamento desta patologia é de carácter multifactorial. O Médico Dentista pode através do exame cefalométrico diagnosticar alterações craniofaciais que, juntamente com outra sintomatologia apresentada pelo paciente e recolhida da história clínica, direccione para uma suspeita de SAHOS. O seu diagnóstico é confirmado através de um estudo polissonográfico do sono. A abordagem terapêutica não cirúrgica faz-se através de aparelhos intra-orais que constituem uma alternativa ao uso de CPAP e são da responsabilidade do Médico Dentista.
O bruxismo do sono (BS) é considerado um distúrbio de movimento que ocorre durante o sono, caracterizado por uma actividade muscular exacerbada com apertos ou ranger de dentes durante o sono, associada a microdespertares. O tratamento do BS passa por goteiras oclusais de estabilização e de avanço. No entanto, algumas das goteiras de estabilização podem piorar episódios obstrutivos do sono.
Durante o sono ocorre actividade rítmica dos músculos da mastigação (ARMM). Existe uma elevada prevalência de associação da ARMM em pacientes portadores de SAHOS associado a microdespertares.
Através desta revisão bibliográfica narrativa pretendo dar uma visão médico-dentária de como abordar estas duas patologias do sono, visto que na SAHOS ocorre fragmentação do sono, avaliar se o BS pode ser secundário a fenómenos obstrutivos que correm durante o sono. Para além da revisão bibliográfica é apresentado um caso clínico de um paciente com SAHOS. The obstructive sleep apnea-hypopnea syndrome (OSAHS) is a disease with an increasing impact on current population being considered a public health problem. This syndrome is characterized by a partial or complete airway obstruction during sleep. Commonly patients complain of excessive daytime sleepiness and snoring during the night. The ongoing collapse of the upper airway causes sleep fragmentation, hypoxemia, hypercapnia and increased sympathetic activity.
There are several risk factors that seem to influence this syndrome. Its pathophysiology is multifactorial and that certain anatomical and neuromuscular factors shown to have an active role in its occurrence. The treatment of this disease is multifactorial character. The Dentist can by cephalometric examination diagnose craniofacial abnormalities, which along with other symptoms presented by the patient and collected the clinical history, forward for suspected OSAHS. The diagnosis is confirmed by a polysomnographic sleep study. The non-surgical therapeutic approach the intra-oral appliances are an alternative to continuous positive airway pressure and is the responsibility of the Dentist.
Sleep Bruxism (SB) is considered a movement disorder that occurs during sleep, characterized by heightened muscle activity with grips or grinding of teeth during sleep associated with arousals. Treatment of BS goes through leaky occlusal stabilization and advancement. However some of the occlusal stabilization may worsen obstructive sleep episodes.
During sleep occurs rhythmic masticatory muscle activity (RMMA). There is a high prevalence of association of RMMA in patients with OSAHS associated with arousals.
Through this narrative bibliographical review, I intend to take a medical dental vision of how to approach these two sleep disorders and since OSAHS occurs in sleep fragmentation, assess whether BS may be secondary to obstructive phenomena that occur during sleep. In addition to the literature review is presente a case of a patient with OSAHS.
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Torquato, Jamili Anbar. ""Influência da pressão positiva expiratória e peso abdominal na pressão de vias aéreas e na pressão intra-abdominal em pacientes ventilados mecanicamente em Unidade de Terapia Intensiva"." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/5/5144/tde-12042006-160343/.
Full textAbstract:
Para avaliar como o uso da PEEP pode influenciar na pressão de platô e na pressão intra-abdominal de pacientes em UTI, foram realizadas medidas da PIA (Kron) e da pressão de vias aéreas em volume controlado em 4 fases, com variação da PEEP em Zero e 10 cmH2O e também com variação do peso de 5kg sobre o abdômen do paciente. Foram determinadas as médias e desvio padrão das pressões de Platô e PIA. Verificou-se que o peso de 5kg elevou a PIA e a P Platô e a associação da PEEP de 10cmH2O com o peso de 5kg aumentou as chances de hipertensão intra-abdominal em 36,6% dos pacientes. Sugerindo a monitorização constante da PIA e pressões de vias aéreas nos pacientes ventilados mecanicamente em UTI<br>To evaluate as the use of the PEEP it can influence in the plateau pressure and the intra-abdominal pressure of patients in ICU, had been carried through measured of the IAP (Kron) and the airway pressure in controlled volume in 4 phases, with variation of the PEEP in Zero and 10 cmH2O and also with variation of the weight of 5kg on the abdomen of the patient. Had been determined the mean and standard deviation of the Plateau pressures and IAP. It was verified that the weight of 5kg raised the IAP and the PPlateau and the association of the PEEP of 10cmH2O with the weight of 5kg increased the possibilities of intra-abdominal hypertension in36, 6% of the patients. Suggesting the constant monitorização of the IAP and airway pressures in the patients mechanically ventilated in ICU
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Bischof, Fabian Alexander Verfasser], Michael [Akademischer Betreuer] Arzt, and Roland [Akademischer Betreuer] [Popp. "Auswirkungen der Continuous Positive Airway Pressure-Therapie bei Patienten mit schwerer obstruktiver Schlafapnoe und endothelialer Dysfunktion auf das 24-Stunden Blutdruckprofil / Fabian Alexander Bischof ; Michael Arzt, Roland Popp." Regensburg : Universitätsbibliothek Regensburg, 2018. http://d-nb.info/1149920351/34.
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