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AIM: In patients with obstructive sleep apnoea (OSA), the benefits of continuous positive airway pressure (CPAP) therapy are increased for every additional hour of daily CPAP usage. However, the data of predictors of extensive usage is scarce, if any. Therefore, we evaluated potential predictors affecting extensive treatment usage. METHODS: In this retrospective study, we compiled an institutional cohort of consecutive patients diagnosed with who started CPAP therapy 1999-2022 and were included in a wireless telemonitoring system in May 2022 (N = 14,394). Patients using CPAP device ≥ 9 h/d were stratified into a younger (< 65 years; N = 124) and an older group (≥ 65 years; N = 131). RESULTS: We found 255 patients (male 61%) eligible for our study, with a median age of 65 (interquartile range, IQR 55-73) years, and mean body mass index (BMI) of 36 ± 6.9 kg/m2. Median CPAP use was 10 h/d (IQR 10-11). BMI and depressive symptoms (DEPS) in the younger group were higher than in the older group (37.9 ± 7 vs. 34.6 ± 6.4 kg/m2, p < 0.001 and 11 (IQR 5-20) vs. 7 (IQR 5-14), p = 0.01, respectively). During follow-up, the BMI of the younger group increased (39.9 ± 12.5 kg/m2 vs. 37.9 ± 7 kg/m2, p = 0.009). DEPS values decreased in the younger group and became comparable between the groups. In multivariate models, the baseline BMI independently predicted extensive CPAP use among the younger age group, and the mask leak among the older group. CONCLUSION: BMI at baseline in the younger and mask leak in the older group could be independent predictive factors for extensive use of CPAP.
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BACKGROUND: In Turku, Finland, we introduced a home oxygen treatment and app-based monitoring program for hospitalized COVID-19 patients to facilitate an early discharge during the Omicron wave. In this case series we explore the clinical parameters of patients enrolled in the program and evaluate the cost-benefit and safety issues of the program. METHODS: Hospitalized COVID-19 patients with marked hypoxemia but otherwise in stable condition were screened from Turku City Hospital and Turku University Hospital by treating doctors for eligibility in the program. Peripheral oxygen saturation of > 92% and breathing frequency < 30/min in rest with oxygen supplementation were among the criteria. All patients actively participating in the program between 10th of January 2022 and 30th of September 2022 were included in this case series. Clinical data of hospitalization and monitoring were analysed, and cost-benefit evaluation was based on the number of saved hospitalization days. RESULTS: Nineteen COVID-19 patients were included in this case series and recruited from three different hospital departments in the Turku city region, South-West Finland. All patients were male, the median age was 59 years and the median duration of hospitalization before enrolment in the program was 6 days (range 3-20 days). The median duration of home oxygen treatment was 13 days (range 3-72 days) and the median duration of home monitoring was 18 days (range 7-41 days). A total of 210,5 hospital days were prevented, resulting in savings of 144,490 of healthcare expenditure (on average 9 days and 7,605 per patient). No major safety issues were reported during the program. CONCLUSIONS: In our case series, home oxygen treatment combined with home monitoring was safe and economically beneficial. Application based monitoring could be considered in other post-acute pulmonary conditions to reduce hospitalization and healthcare costs.
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COVID-19 , Humanos , Masculino , Lactente , Feminino , SARS-CoV-2 , Finlândia , Oxigenoterapia , Oxigênio/uso terapêuticoRESUMO
BACKGROUND AND PURPOSE: An accurate determination of the cardioembolic risk in patients with atrial fibrillation (AF) is crucial to prevent consequences like stroke. Obstructive sleep apnea (OSA) is a known risk factor for both AF and stroke. We aim to explore a possible association between OSA and an increased cardioembolic risk in patients with AF. METHODS: We assessed data from the ESADA (European Sleep Apnea Database) cohort where patients with known AF and OSA were included. Parameters of OSA severity and related hypoxia like lowest Spo2 and 4% oxygen desaturation index were analyzed. Patients were stratified according to their cardioembolic risk estimated with the CHA2DS2-VASc score. RESULTS: From the initial cohort of 14 646 patients, a final set of 363 patients were included in the analysis. Indices of hypoxia during sleep were associated with increased CHA2DS2-VASc score (4% oxygen desaturation index 17.9 versus 29.6 versus 30.5 events/hour and the lowest Spo2 81.2 versus 77.8 versus 77.5% for low, moderate, and high cardioembolic risk, respectively, P<0.05). CONCLUSIONS: These results support the potential role of OSA-related hypoxia in the risk for cardioembolic complications such as stroke in patients with AF.
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Fibrilação Atrial/complicações , Embolia/epidemiologia , Cardiopatias/epidemiologia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Hipóxia/complicações , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Medição de RiscoRESUMO
PURPOSE: Obstructive sleep apnea (OSA) has been associated with a 2- to 7-fold risk of motor vehicle accidents (MVAs). Continuous positive airway pressure (CPAP) treatment may reduce MVA risk. We further explored this issue in long-term CPAP users and untreated controls. METHODS: We used both before-after and case-control study designs. The observational cohort consisted of CPAP-treated and untreated patients matched for gender, age, and apnea-hypopnea index. All MVAs reported to the police were identified. RESULTS: A total of 2060 patients (75.8% male, mean age 56.0 ± 10.5 years) were included. The CPAP-treated patients (N = 1030) were screened for MVAs for a median of 9.0 years before and after treatment. The median CPAP usage was 6.4 h/day. The control patients (N = 1030) were screened for MVAs for a median of 6.5 years after discontinuation of CPAP. No significant differences were observed between the incidences of MVAs per 1000 person years before treatment (3.2), after treatment (3.9), or in controls (2.6). Compared with controls, patients who had MVA after treatment had a higher body mass index (BMI), but did not differ in terms of other baseline characteristics, sleep study data, or accident conditions. In the majority of these patients, daytime sleepiness was reduced, whereas BMI tended to increase during treatment. CONCLUSIONS: The MVA incidence did not change after CPAP treatment. Among the patients who had MVA, BMI was the only baseline characteristic that differed between the groups and tended to further increase after CPAP treatment. Differences in sleep study data or accident conditions were not observed.
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Acidentes de Trânsito/estatística & dados numéricos , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: Nasal continuous positive airway pressure (CPAP) alleviates sleepiness in patients with obstructive sleep apnoea syndrome (OSAS), but part of OSAS patients keep gaining weight. Leptin and insulin-like growth factor-1 (IGF-1) interact with energy balance, and CPAP therapy has been suggested to influence these endocrine factors. We hypothesised that leptin would decrease during long-term CPAP therapy, and weight gain would associate with OSAS severity, lower CPAP adherence, lower IGF-1, and leptin concentrations. METHODS: Consecutive patients (n = 223) referred to sleep study with suspected OSAS were enrolled. Patients underwent cardiorespiratory polygraphy at baseline. Questionnaires were completed, and blood samples were drawn both at baseline and after 3 years. A total of 149 (67%; M 65, F 84) patients completed the follow-up. Plasma samples were available from 114 patients, 109 of which with CPAP adherence data (49 CPAP users, 60 non-users). RESULTS: At baseline, the CPAP users were more obese and had more severe OSAS than the non-users. Leptin concentrations did not differ. After follow-up, leptin concentrations were higher in CPAP users (30.2 ng/ml vs. 16.8 ng/ml; p = 0.001). In regression analysis, increase in leptin concentrations was independent of age, baseline body mass index (BMI), or the change in BMI. Leptin concentrations increased among females (- 8.9 vs. 12.7 ng/ml; p < 0.001); whereas in men, CPAP did not have an effect, if not opposed the natural decrease in leptin observed in men not using CPAP. Change in IGF-1 levels did not differ. CONCLUSIONS: Our results suggest increase in leptin concentrations during long-term CPAP therapy among females.
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Pressão Positiva Contínua nas Vias Aéreas , Leptina/sangue , Assistência de Longa Duração , Apneia Obstrutiva do Sono/terapia , Adulto , Idoso , Feminino , Humanos , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Polissonografia , Fatores SexuaisRESUMO
PURPOSE: Obstructive sleep apnea (OSA) is suggested to predispose to cardiovascular disease (CVD) events. It is uncertain whether compliance to continuous positive airway pressure (CPAP) treatment could attenuate the risk. We explored this issue in long-term CPAP users and untreated controls. METHODS: Retrospective observational cohort of CPAP-treated and control patients were pairwise matched for gender, age, and apnea-hypopnea index (AHI). The study end point was a composite of nonfatal and fatal CVD events. Cox regression model was used to determine the association between CPAP treatment and event-free survival. RESULTS: A total of 2060 patients (75.8% male, mean age 56.0 ± 10.5 years), of which 76.4% had moderate-severe OSA, were included. In the CPAP-treated group (N = 1030), the median use of CPAP was 6.4 h/day during a median follow-up of 8.7 years. The control group (N = 1030) was followed for a median of 6.2 years after the CPAP treatment had ended. The study end point occurred in 14.4% (N = 148) of the CPAP-treated and in 18.8% (N = 194) of the control patients (p = 0.006). Using the Cox regression model adjusted for gender, age, AHI, body mass index, and history of CVD, hypertension, type 2 diabetes, and chronic obstructive pulmonary disease at baseline, a beneficial association between CPAP treatment and CVD risk was observed (hazard ratio 0.64, confidence interval 95% 0.5-0.8, p < 0.001). CONCLUSIONS: CPAP treatment was associated with a decreased risk of nonfatal and fatal CVD events. Majority of the patients were compliant to CPAP. The association was demonstrated independent from common cardiovascular risk factors and AHI.
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Doenças Cardiovasculares/mortalidade , Pressão Positiva Contínua nas Vias Aéreas , Cooperação do Paciente , Apneia Obstrutiva do Sono/mortalidade , Adulto , Idoso , Doenças Cardiovasculares/prevenção & controle , Correlação de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Apneia Obstrutiva do Sono/terapiaRESUMO
PURPOSE: The aim of the current study was to further investigate the concept of previously reported high occurrence of comorbidities in obstructive sleep patients (OSA) with insomnia-like symptoms. We hypothesized that this finding at least partly is mediated by nocturnal hypoxia. Moreover, we speculated that the spectrum of the clinical OSA phenotypes differs between European geographical regions. METHODS: Cohort of the European Sleep Apnea Database (n = 17,325; 29.9% females) was divided into five subcohorts according to geographical region (North, East, South, West, Central) and further into four clinical presentation phenotypes based on daytime symptoms (EDS) and characteristics suggestive of insomnia. RESULTS: The insomnia phenotype (alone or together with EDS) dominated in all European regions. Isolated insomnia, however, was less common in the West. Insomnia phenotype was associated with the highest proportion of cardiovascular comorbidity (51.7% in the insomnia vs. 43.9% in the EDS type). Measures of nocturnal hypoxemia were independently associated with cardiovascular comorbidity in phenotypes with insomnia-like symptoms. The burden of comorbidities was high across all geographical regions and clinical phenotypes. Regional differences were clinically relevant for age (48 vs. 54 years), BMI (29 vs. 34 kg/m2), and ODI (15 vs. 32/h). CONCLUSION: High prevalence of particularly cardiovascular comorbidity among patients with insomnia-like symptoms was linked to nocturnal hypoxemia. Considerable differences in clinical presentation were found among OSA patients across Europe. Our data underline that physicians should ask their patients with suspected OSA also for insomnia symptoms. It remains to be explored if a reduction of nocturnal hypoxemia predicts the improvement of insomnia symptoms.
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Doenças Cardiovasculares/epidemiologia , Ritmo Circadiano/fisiologia , Hipóxia/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto , Doenças Cardiovasculares/diagnóstico , Comorbidade , Europa (Continente) , Feminino , Humanos , Hipóxia/diagnóstico , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Apneia Obstrutiva do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/diagnósticoRESUMO
Obstructive sleep apnea (OSA) and asthma are often associated and several studies suggest a bidirectional relationship between asthma and OSA. This study analyzed the characteristics of patients with suspected OSA from the European Sleep Apnea Database according to presence/absence of physician-diagnosed asthma. Cross-sectional data in 16,236 patients (29.1% female) referred for suspected OSA were analyzed according to occurrence of physician-diagnosed asthma for anthropometrics, OSA severity and sleepiness. Sleep structure was assessed in patients studied by polysomnography (i.e. 48% of the sample). The prevalence of physician-diagnosed asthma in the entire cohort was 4.8% (7.9% in women, 3.7% in men, p < 0.0001), and decreased from subjects without OSA to patients with mild-moderate and severe OSA (p = 0.02). Obesity was highly prevalent in asthmatic women, whereas BMI distribution was similar in men with and without physician-diagnosed asthma. Distribution of OSA severity was similar in patients with and without physician-diagnosed asthma, and unaffected by treatment for asthma or gastroesophageal reflux. Asthma was associated with poor sleep quality and sleepiness. Physician-diagnosed asthma was less common in a sleep clinic population than expected from the results of studies in the general population. Obesity appears as the major factor raising suspicion of OSA in asthmatic women, whereas complaints of poor sleep quality were the likely reason for referral in asthmatic men.
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Asma/diagnóstico , Asma/epidemiologia , Papel do Médico , Autorrelato , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Asma/fisiopatologia , Estudos de Coortes , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia/métodos , Estudos Prospectivos , Apneia Obstrutiva do Sono/fisiopatologiaRESUMO
PURPOSE: Telemonitoring might enhance continuous positive airway pressure (CPAP) adherence and save nursing time at the commencement of CPAP therapy. We tested wireless telemonitoring (ResTraxx Online System®, ResMed) during the habituation phase of the CPAP therapy in obstructive sleep apnea syndrome (OSAS). METHODS: In total, 111 consecutive OSAS patients were enrolled. After CPAP titration, patients were followed with the telemonitoring (TM, N = 50) or the usual care (UC, N = 61). The TM group used fixed pressure CPAP device with and the UC group similar device without wireless telemonitoring. Patients and study nurses were unblinded. The evaluated end-points were hours of CPAP use >4 h/day, mask leak <0.4 L/s, and AHI <5/h. Nursing time including extra phone calls, visits, and telemonitoring time was recorded during the habituation phase. CPAP adherence was controlled in the beginning and at the end of the habituation phase and after 1-year of use. RESULTS: TM and UC groups did not differ in terms of patient characteristics. The average length of the habituation phase was 4 weeks in the TM group and fixed 3 months in the UC group. Median nursing time was 39 min (range 12-132 min) in the TM group and shorter compared to that of 58 min (range 40-180 min) (p < 0.001) per patient in the UC group. Both treatment groups had high CPAP usage hours (>4 h/day) and the change in usage at the end of the habituation phase did not differ between the groups (p = 0.39). Patients in both groups were equally satisfied with the treatment protocol. CPAP adherence (6.4 h in TM vs. 6.1 h in UC group, p = 0.63) and residual AHI (1.3 in TM vs. 3.2 in UC group, p = 0.04) were good in both groups at 1-year follow-up. CONCLUSIONS: Wireless telemonitoring of CPAP treatment could be relevant in closing the gap between the increasing demand and available health-care resources. It may save nursing time without compromising short- or long-term effectiveness of CPAP treatment in OSAS.
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Pressão Positiva Contínua nas Vias Aéreas/economia , Pressão Positiva Contínua nas Vias Aéreas/enfermagem , Redução de Custos/estatística & dados numéricos , Apneia Obstrutiva do Sono/economia , Apneia Obstrutiva do Sono/enfermagem , Telemetria/economia , Telemetria/enfermagem , Adulto , Idoso , Economia da Enfermagem/estatística & dados numéricos , Feminino , Finlândia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Retrospectivos , Telemetria/instrumentação , Estudos de Tempo e MovimentoAssuntos
Neoplasias/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Estudos Transversais , Bases de Dados Factuais , Europa (Continente)/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Polissonografia , Prevalência , Fatores de RiscoRESUMO
Home non-invasive ventilation (NIV) is used to treat patients with chronic respiratory failure (CRF). However, knowledge on the prevalence and impact of multimorbid aetiology of CRF, patterns of NIV use, and survival of these patients is limited. Our aim was to analyse the multiple aetiologies of CRF, patterns of NIV use and the outcome of those patients. We conducted a retrospective analysis of 1,281 patients treated with home-NIV between 2004 and 2014 in Turku University Hospital, Finland. The patients were divided into nine disease categories: obstructive airways disease (16 %); obesity hypoventilation syndrome (11 %); neuromuscular disease (10 %); chest wall diseases (4 %); sleep apnoea (26 %); interstitial lung diseases (3 %); malignancy (2 %); other (3 %) and acute (8 %), which refers to the patients who did not fulfil criteria of CRF. In addition, multiple aetiologies of CRF were found in 17 %. Mean adherence to home-NIV was 6.0 ± 4.4 h/d and median treatment duration 410 (120-1021) days. Adherence, treatment duration or survival did not significantly differ between patients with either single or multiple causative diseases leading to CRF. Median survival was 4.5 years (95 % CI 3.6 to 5.4). The main reasons for discontinuing NIV were death (56 %) and lack of motivation (19 %). We conclude that home-NIV is used in a variety of diseases. CRF of multiple aetiologies is prevalent and not limited to chronic obstructive lung disease and obstructive sleep apnoea overlap syndrome. However, the adherence to home-NIV or survival did not differ between patients with a single or multiple diseases causing CRF, but the survival of the home-NIV patients differed according to the underlying aetiology of CRF.
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PURPOSE: Sleep-disordered breathing (SDB) differs between genders in terms of the type, signs, and symptoms of the disease. Partial upper airway obstruction is underdiagnosed and undertreated. METHODS: In this study, we retrospectively investigated respiratory sleep recordings of 601 women, ending up with 240 women for the final statistical analyses. We hypothesized that there are differences between the signs and symptoms of sleep-disordered breathing whether women had partial upper airway obstruction or obstructive sleep apnea. RESULTS: The results showed no difference in sleepiness between women with partial upper airway obstruction or obstructive sleep apnea. Also, the other main symptoms of SDB were the same between the groups. Micrognathia was more common in women with partial upper airway obstruction than with obstructive sleep apnea. CONCLUSION: These results indicate that partial upper airway obstruction in women should be clinically recognized like obstructive sleep apnea.
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Obstrução das Vias Respiratórias/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Polissonografia , Estudos Retrospectivos , Fatores SexuaisRESUMO
Prolonged external irritation to the vocal cords may cause an edematous state of the vocal cords known as Reinke's edema. This may lead to hoarseness and dyspnea. We describe a successful syptomatic treatment of severe dyspnea due to Reinke's edema with a self-adjusting CPAP device. An operation ended the symptom of dyspnea of our patient, but before that the CPAP therapy brought about an effective remedy for dyspnea.
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Pressão Positiva Contínua nas Vias Aéreas , Dispneia/etiologia , Dispneia/terapia , Paralisia das Pregas Vocais/complicações , Paralisia das Pregas Vocais/cirurgia , Edema/etiologia , Edema/terapia , Rouquidão/etiologia , Rouquidão/terapia , Humanos , MasculinoRESUMO
BACKGROUND: We evaluated the changes in nasal CPAP treatment and adherence in patients with sleep-disordered breathing (SDB). MATERIAL AND METHODS: Information from the clinic database of 4,385 patients commencing CPAP treatment during 2002-2009. RESULTS: Average CPAP adherence was 74%. In mild SDB over 60% were adherent whereas in severe SDB 18% did not accept the treatment. Low hours of CPAP use right after commencing the treatment indicated poor long-term adherence. CONCLUSIONS: In the 2000s the number of patients starting CPAP treatment increased, but the selection of patients did not change much. Overall CPAP adherence was good.
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Pressão Positiva Contínua nas Vias Aéreas , Síndromes da Apneia do Sono/terapia , Adulto , Feminino , Humanos , Masculino , Cooperação do Paciente , Síndromes da Apneia do Sono/fisiopatologia , Resultado do TratamentoRESUMO
Background: The prevalence of obstructive sleep apnoea (OSA) is growing as the population is ageing. However, data on the clinical characteristics of elderly patients with OSA and their adherence to positive airway pressure (PAP) treatment are scarce. Methods: Data from 23â 418 30-79-year-old OSA patients prospectively collected into the ESADA database during 2007-2019 were analysed. Information on PAP use (h·day-1) in association with a first follow-up visit was available for 6547 patients. The data was analysed according to 10-year age groups. Results: The oldest age group was less obese, less sleepy and had a lower apnoea-hypopnoea index (AHI) compared with middle-aged patients. The insomnia phenotype of OSA was more prevalent in the oldest age group than in the middle-aged group (36%, 95% CI 34-38 versus 26%, 95% CI 24-27, p<0.001). The 70-79-year-old group adhered to PAP therapy equally well as the younger age groups with a mean PAP use of 5.59â h·day-1 (95% CI 5.44-5.75). PAP adherence did not differ between clinical phenotypes based on subjective daytime sleepiness and sleep complaints suggestive of insomnia in the oldest age group. A higher score on the Clinical Global Impression Severity (CGI-S) scale predicted poorer PAP adherence. Conclusion: The elderly patient group was less obese, less sleepy, had more insomnia symptoms and less severe OSA, but were rated to be more ill compared with the middle-aged patients. Elderly patients with OSA adhered to PAP therapy equally well as middle-aged patients. Low global functioning (measured by CGI-S) in the elderly patient predicted poorer PAP adherence.
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The prevalence of sleep apnoea is increasing globally; however, population-based studies have reported a wide variation of prevalence estimates, and data on incidence of clinically diagnosed sleep apnoea are scant. Data on the overall burden of comorbidities or multimorbidity in individuals with incident sleep apnoea are scarce, and the pathways to multimorbidity have only marginally been studied. To study the current epidemiology of sleep apnoea in Finland, overall burden of comorbidities, and multimorbidity profiles in individuals with incident sleep apnoea, we conducted a register-based, nationwide, retrospective study of data from January 2016 to December 2019. The prevalence of clinically diagnosed sleep apnoea was 3.7% in the Finnish adult population; 1-year incidence was 0.6%. Multimorbidity was present in 63% of individuals at the time of sleep apnoea diagnosis. Of those with incident sleep apnoea, 34% were heavily multimorbid (presenting with four or more comorbidities). The three most common chronic morbidities before sleep apnoea diagnosis were musculoskeletal disease, hypertension and cardiovascular disease. In multimorbid sleep apnoea patients, hypertension and metabolic diseases including obesity and diabetes, cardiovascular diseases, musculoskeletal diseases and dorsopathies, in different combinations, encompassed the most frequent disease pairs preceding a sleep apnoea diagnosis. Our study adds to the few population-based studies by introducing overall and detailed figures on the burden of comorbidities in sleep apnoea in a nationwide sample and provides up-to-date information on the occurrence of sleep apnoea as well as novel insights into multimorbidity in individuals with incident sleep apnoea.
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PURPOSE: The capacity for performing sleep study is limited. We made a simulation to study whether a diagnosis of obstructive sleep apnoea syndrome (OSAS) and prescription of nasal continuous positive airway pressure (CPAP) therapy would be possible and cost-effective without performing a sleep study. METHODS AND OBJECTIVES: One hundred ninety-seven consecutive patients referred to a pulmonary clinic due to suspected OSAS were included. Professional drivers, patients with neurological diseases, heart failure or aged <25 years were excluded. Two experts evaluated patient records retrospectively in a stepwise manner. In step 1, they were blinded to the sleep study results, and in step 2, the results were available. RESULTS: Mean age was 51.5 ± 10.8 years, BMI 31.9 ± 7.2 kg/m(2), apnoea-hypopnoea index 19.8 ± 20.7/h and Epworth Sleepiness Scale 8.3 ± 4.7. Without sleep study results, the experts would initiate CPAP in 52.5% of patients (step 1), equalling to 74.7% of those whom they would suggest it after reviewing the sleep studies (step 2). In step 2, they suggested CPAP for 70.3% of all patients, while the clinicians responsible for the treatment for 66%. Net savings equal to the costs of CPAP device with interface for 50-100% of patients in need of this therapy depending on whether calculations are based on the costs of cardiorespiratory polygraphy or polysomnography. CONCLUSIONS: Nasal CPAP therapy would be possible to initiate without a sleep study for the majority of patients with suspected OSAS resulting in significant cost reduction.
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Pressão Positiva Contínua nas Vias Aéreas/métodos , Polissonografia/métodos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Procedimentos Desnecessários , Adulto , Idoso , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Retrospectivos , Resultado do TratamentoRESUMO
During the last decade, noninvasive bi-level positive pressure ventilation has enabled respiratory support in inpatient wards and at home. In many cases, a bi-level airway pressure ventilator can be used to avoid artificial airway and respirator therapy, and may shorten hospital stay and save costs. The treatment alleviates the patient's dyspnea and fatigue, whereby the quality of life improves, and in certain situations also the life span increases. The implementation of bi-level positive pressure ventilation by the physician requires knowledge of the basics of respiratory physiology and familiarization with the bi-level airway pressure ventilator.