Efficiency of continuous positive airway pressure and high-flow nasal oxygen therapy in critically ill patients with COVID-19.

OBJECTIVE: Critically ill patients with COVID-19 develop acute respiratory distress syndrome characterized by relatively well-preserved pulmonary compliance but severe hypoxemia. The challenge in managing such patients lies in optimizing oxygenation, which can be achieved through either high oxygen flow or noninvasive mechanical ventilation. This study was performed to compare the efficiency of two methods of noninvasive oxygen therapy: continuous positive airway pressure (CPAP) and high-flow nasal oxygen therapy (HFNO). METHODS: This retrospective cohort study involved 668 patients hospitalized in the intensive care unit (ICU) of the "Sf. Apostol Andrei" Emergency Clinical Hospital, Galati, Romania from 1 April 2020 to 31 March 2021 (CPAP, n = 108; HFNO, n = 108). RESULTS: Mortality was significantly lower in the CPAP and HFNO groups than in the group of patients who underwent intubation and mechanical ventilation after ICU admission. Mortality in the ICU was not significantly different between the CPAP and HFNO groups. CONCLUSIONS: HFNO and CPAP represent efficient alternative therapies for patients with severe COVID-19 whose respiratory treatment has failed. Studies involving larger groups of patients are necessary to establish a personalized, more complex management modality for critically ill patients with COVID-19.

Obstructive Sleep Apnea in Adults and Ear, Nose, and Throat (ENT) Health: A Narrative Review.

Obstructive sleep apnea (OSA), a form of sleep-disordered breathing, is a significant health concern that leads to substantial morbidity. The collapse or occlusion of the upper airway, which results in reduced or cessation of airflow, is the pathophysiology of sleep apnea. The condition has been attributed to numerous cardiovascular, metabolic, and neuropsychological issues and carries serious health concerns. The ensuing intermittent hypoxia and sleep disruption set off a chain of physiological reactions that aid in developing endothelial dysfunction, systemic inflammation, and oxidative stress. The following line of treatment depends on the appropriate diagnosis of sleep apnea and the underlying cause. The gold standard for diagnosis is polysomnography (PSG), which assesses different physiological parameters during sleep. However, because polysomnography is expensive, patients may use more friendly screening and diagnostic testing kits, like home sleep apnea testing. The clinical symptoms and head and neck history may reveal essential risk factors. The primary objectives of management treatments for sleep apnea are to lessen symptoms, enhance sleep quality, and reduce any health concerns that may be present. It is advised to start with lifestyle changes such as quitting alcohol and sedative use, losing weight, and exercising frequently. The primary treatment for moderate to severe sleep apnea is continuous positive airway pressure (CPAP) therapy, which includes administering pressurized air to keep the airway open while you sleep. Oral appliances, positional therapy, surgery, and complementary therapies are other treatment choices that can be adapted to each patient's needs and preferences. The goal of the review is to evaluate the morphological and functional aspects of the upper airway, including the nose and throat, that influence the onset and severity of OSA. With a focus on the interaction between otorhinolaryngologists, sleep medicine specialists, and other healthcare professionals, we aim to consider how OSA affects otorhinolaryngology-related medical issues, look at any potential reciprocal relationships, and provide a summary of the interdisciplinary management strategy for OSA. We tried to analyse the various surgical and non-surgical therapy options for OSA management available in the otorhinolaryngology field for improving OSA symptoms and results.

Integrative Approach to Managing Obstructive Sleep Apnea.

Conventional therapies for obstructive sleep apnea (OSA), including CPAP and oral appliances, offer the best opportunity for symptomatic improvement and reduction in OSA overall health impact. Integrative medicine brings conventional and complementary approaches together in a coordinated way. With rising obesity rates, weight loss and lifestyle programs seem to be the most favorable integrative methods to combine with conventional OSA therapies. Complementary and integrative approaches to OSA management are varied and, in conjunction with conventional methods, may offer some reduction in the apnea-hypopnea index.

Upper airway multilevel radiofrequency under local anesthesia can improve CPAP adherence for severe OSA patients.

OBJECTIVE: To evaluate the effect of upper airway radiofrequency (RF) tissue reduction under local anesthesia (LA) in severe obstructive sleep apnea (OSA) patients using continuous positive airway pressure (CPAP) in order to improve their compliance and adherence. DESIGN: Thirty (30) patients were included in this randomized clinical trial, suffering from severe OSA seeking medical advice for better upper airway management while using CPAP. Multilevel RF tissue reduction at tongue base, soft palate and inferior nasal turbinates was done under LA in multiple sessions. The Apnea hypopnea index (AHI), arousal index, lowest SpO2, CPAP pressure, and CPAP using time were recorded pre-operatively and six months after the last RF session. RESULTS: Post-operatively, there were significant reduction in AHI (86.03 ± 20.5 vs. 54.65 ± 16.6 p < 0.001), arousal index (71.14 ± 17.7 vs. 35.90 ± 11.8 p < 0.001), and CPAP Pressure (17.13 ± 1.7 vs. 10.97 ± 1.5 p < 0.001). Also there was a significant increase in the lowest SpO2 (60.2 ± 0.2 vs. 75 ± 0.1 p < 0.001), and CPAP using time in hours (1.57 ± 0.56 vs. 3.75 ± 0.41 p < 0.001). Visual analogue scale (VAS) for pain was recorded showing that all patients reported throat pain mainly in the first five post-operative days which was well controlled on analgesia. CONCLUSION AND RELEVANCE: Upper airway multilevel RF tissue reduction of tongue base, soft palate and inferior nasal turbinates under local anesthesia significantly improves the tolerance and adherence of severe OSA patients using CPAP.

Cost-Effectiveness of Continuous Positive Airway Pressure Therapy Versus Other Treatments of Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a common disorder that is increasing in prevalence, both in the United States and worldwide. Continuous positive airway pressure (CPAP), the gold-standard treatment for OSA, is cost-effective from both a payer and societal perspective. Alternative treatments of OSA, including oral appliance therapy, various surgeries, and hypoglossal nerve stimulation have also been evaluated from a cost-effectiveness perspective although results are less consistent. Some studies directly compare these alternative therapies with CPAP. This review will discuss the available literature for cost-effectiveness analysis in the treatment of OSA.

Integrative Approach to Managing Obstructive Sleep Apnea.

Conventional therapies for obstructive sleep apnea (OSA), including CPAP and oral appliances, offer the best opportunity for symptomatic improvement and reduction in OSA overall health impact. Integrative medicine brings conventional and complementary approaches together in a coordinated way. With rising obesity rates, weight loss and lifestyle programs seem to be the most favorable integrative methods to combine with conventional OSA therapies. Complementary and integrative approaches to OSA management are varied and, in conjunction with conventional methods, may offer some reduction in the apnea-hypopnea index.

Efectos del tacto terapéutico en el recién nacido prematuro con CPAP nasal: una prueba piloto / Effects of therapeutic touch in preterm infants receiving nasal CPAP: A pilot trial / Efeitos do toque terapêutico em prematuros com CPAP nasal: um estudo piloto

Introducción: El recién nacido prematuro presenta una inmadurez del sistema cardiorespiratorio, lo que dificulta su adaptación al medio extrauterino y conlleva a múltiples complicaciones las cuales se requieren intervenciones que mejoren la ventilación y el intercambio gaseoso tales como la oxigenación a través de dispositivos de apoyo terapéutico como la presión positiva continua de la vía aérea o CPAP. Objetivo: determinar el efecto del tacto terapéutico en la adaptación del recién nacido pretérmino con CPAP. Materiales y métodos: Estudio cuasi-experimental, con una muestra de 13 RNPT a quienes se les aplicó el tacto terapéutico durante 15 minutos, con 2 sesiones diarias (6 am y 8pm), con evaluación antes y después del CRE: "Adaptación del prematuro". A lo cual se le realizó el análisis descriptivo correspondiente. Resultados: El total de los participantes, fue asignado al grupo control y grupo intervenido de forma similar, evidenciando cambios antes y después de la intervención, pero en especial en el indicador postura de las manos, con una diferencia entre ambos grupos de p 0,74 con valor de 0.006. Conclusiones: La aplicación del tacto terapéutico al RNPT con CPAP nasal permite mejorar el confort del RNPT a través de indicadores fisiológicos y neurocomportamentales.

Introduction: Premature newborns have an immature cardiorespiratory system that hinders adaptation to the extrauterine environment. This leads to multiple complications which require interventions to improve ventilation and gas exchange, like oxygenating using therapeutic support devices such as continuous positive airway pressure or CPAP. Objective: To determine the effect of therapeutic touch on preterm newborns' adaptation to CPAP. Materials and methods: This is a quasi-experimental study, with a sample of 13 PTNB who underwent therapeutic touch for 15 minutes in 2 daily sessions (6 am and 8 pm), with pre- and post-assessment of NOC "Preterm Infant Organization." Descriptive analysis was performed. Results: The participants were allocated to the control group and the intervention group in a similar way. Pre- and post-intervention changes were observed, but especially in the hand posture indicator, with a difference between both groups of 0.74 with a p-value of 0.006. Conclusions: The practice of therapeutic touch with RNPT receiving nasal CPAP allows for improving the comfort of the RNPT through physiological and neurobehavioral indicators.

Introdução: O recém-nascido prematuro apresenta uma imaturidade do sistema cardiorrespiratório, o que dificulta a adaptação ao ambiente extrauterino e leva a múltiplas complicações que requerem intervenções que melhorem a ventilação e as trocas gasosas como a oxigenação por meio de dispositivos de suporte terapêutico, como via aérea positiva contínua pressão ou CPAP. Objetivo: determinar o efeito do toque terapêutico na adaptação do recém-nascido pré-termo com CPAP. Materiais e métodos: Estudo quase experimental, com uma amostra de 13 PTNIs a quem foi aplicado o toque terapêutico durante 15 minutos, com 2 sessões diárias (6h e 20h), com avaliação antes e após CRE: "Adaptação do prematuro". Ao qual foi realizada a análise descritiva correspondente. Resultados: Todos os participantes foram alocados no grupo controle e no grupo intervenção de forma semelhante, apresentando alterações antes e após a intervenção, mas principalmente no indicador de postura das mãos, com diferença entre os dois grupos foi de 0,74 com um valor de p 0,006. Conclusões: A aplicação do toque terapêutico ao RNPT com CPAP nasal permite melhorar o conforto do RNPT através de indicadores fisiológicos e neurocomportamentais.

Variations in funding for treatment of obstructive sleep apnoea in England.

OBJECTIVES: This study aimed to review the funding policies of clinical commissioning groups for treatment of obstructive sleep apnoea in England. METHODS: Published policies from a randomly selected sample of 60 out of 190 clinical commissioning groups were reviewed. RESULTS: Continuous positive airway pressure was funded based on a clinical assessment or according to criteria that were in line with national guidelines in most clinical commissioning groups (49 of 60), with 11 clinical commissioning groups offering no policy. Mandibular advancement devices, tonsillectomy and nasal surgery were funded based on a clinical assessment or certain criteria in 16, 25 and 16 clinical commissioning groups, respectively. In contrast, only one clinical commissioning group provided funding for soft palate, tongue base or mandibular surgery. Hypoglossal nerve stimulation was not mentioned in any clinical commissioning group's policy. CONCLUSION: Although most clinical commissioning groups provide funding for the use of continuous positive airway pressure, the availability of funding for other obstructive sleep apnoea treatment modalities is heterogeneous, leaving continuous positive airway pressure intolerant patients with limited therapeutic options in some regions.

Contralateral Rerouting of Hypoglossal Nerve Implant Pulse Generator and Stimulation Lead.

As use of hypoglossal nerve stimulators has become more widespread in the treatment of obstructive sleep apnea, certain scenarios have dictated alterations to the previously described surgical technique. This report describes a situation in which revision of a hypoglossal nerve stimulator implant was required given the need for breast cancer surgery. It serves as the first description of the contralateral rerouting of a stimulation lead to a left-sided impulse generator and the first description of respiratory sensing lead placement within the left second intercostal space for such a device. Laryngoscope, 131:E2409-E2412, 2021.

Hypoglossal Nerve Stimulation Therapy for the Treatment of Obstructive Sleep Apnea.

Hypoglossal nerve stimulation (HGNS) therapy was approved in 2014 for the treatment of obstructive sleep apnea in patients who are intolerant to continuous positive airway pressure (CPAP) therapy, which is reported in up to 40-60% of patients. This therapy works via direct neurostimulation of the hypoglossal nerve in synchrony with respiration, to open the airway via tongue stiffening and protrusion. Studies have demonstrated significant reductions in both respiratory parameters such as disordered breathing indices, as well as subjective sleep complaints, such as daytime sleepiness, with the use of this therapy. This has increased the repertoire of treatment options for sleep providers to recommend to those patients that are intolerant to CPAP therapy.

Efficacy of oral myofunctional therapy in middle-aged to elderly patients with obstructive sleep apnoea treated with continuous positive airway pressure.

BACKGROUND: Oral myofunctional therapy (MFT) is an effective treatment for mild-to-moderate obstructive sleep apnoea (OSA) in middle-aged patients. However, few reports have described its use in elderly patients with moderate and severe OSA. Moreover, no studies have examined the relationship between changes in tongue pressure with MFT and the severity of OSA. OBJECTIVE: We conducted an interventional study using MFT to evaluate the effect of MFT on middle-to-senior-aged patients with moderate or severe OSA and compared changes in apnoea-hypopnea index (AHI) and tongue pressure. METHODS: Thirty-two OSA patients (≥45 years) treated with continuous positive airway pressure (CPAP) were included. MFT was performed in parallel with CPAP. Three days after CPAP discontinuation, polysomnographies were performed and tongue pressures were measured before and after MFT. RESULTS: Patients were 69.3 ± 1.5 years old. After 6 months of MFT, AHI decreased significantly from 34.7 to 29.0/h (P = .03), while tongue pressure significantly increased from 35.9 to 45.6 kPa (P < .01). Seven patients (22%), including 6 of the 12 patients with moderate OSA (50%), experienced successful CPAP discontinuation. CONCLUSIONS: MFT can be a useful intervention even among middle-aged to elderly patients with OSA. Increased tongue pressure may have contributed to the AHI improvement. Clinical trials: Trial registration at www.umin.ac.jp UMIN000027547.

Focus group discussions on low-flow oxygen and bubble CPAP treatments among mothers of young children in Malawi: a CPAP IMPACT substudy.

OBJECTIVE: To determine the acceptability of bubble continuous positive airway pressure (bCPAP) and low-flow oxygen among mothers of children who had received either therapy. SETTING: A district hospital in Salima, Malawi. PARTICIPANTS: We conducted eight focus group discussions (FGDs) with a total of 54 participants. Eligible participants were mothers of children 1 to 59 months of age with severe pneumonia and a comorbidity (HIV-infection, HIV-exposure, malnutrition or hypoxaemia) who, with informed consent, had been enrolled in a randomised clinical trial, CPAP IMPACT (Improving Mortality for Pneumonia in African Children Trial), comparing low-flow oxygen and bCPAP treatments (ClinicalTrials.gov, NCT02484183). PRIMARY AND SECONDARY OUTCOME MEASURES: FGDs assessed mothers' attitudes and feelings towards oxygen and bCPAP before and after therapy along with general community perceptions of respiratory therapies. Data was analysed using inductive thematic analysis to assess themes and subthemes of the transcripts. RESULTS: Community perceptions of oxygen and bCPAP were widely negative. Mothers recounted that they are told that 'oxygen kills babies'. They are often fearful of allowing their child to receive oxygen therapy and will delay treatment or seek alternative therapies. Mothers report limiting oxygen and bCPAP by intermittently removing the nasal cannulas or mask. After oxygen or bCPAP treatment, regardless of patient outcome, mothers were supportive of the treatment their child received and would recommend it to other mothers. CONCLUSION: There are significant community misconceptions around oxygen and bCPAP causing mothers to be fearful of either treatment. In order for low-flow oxygen treatment and bCPAP implementation to be effective, widespread community education is necessary.

Physical Exercise Combined With CPAP in Subjects Who Underwent Surgical Myocardial Revascularization: A Randomized Clinical Trial.

BACKGROUND: Aerobic exercise and CPAP benefit patients in the postoperative period of cardiac surgery. To our knowledge, the association of aerobic exercise on an exercise bicycle with CPAP has not yet been demonstrated. Therefore, we aimed to evaluate the effectiveness of physical exercise on a cycle ergometer combined with CPAP in the postoperative period after coronary artery bypass graft surgery. METHODS: This was a randomized clinical trial, with recruitment from May 2017 to December 2017 (registered in the Brazilian Clinical Trials Registry: RBR-69CDYF). The step group (n = 16 subjects) started rehabilitation in the immediate postoperative period with breathing exercises and passive mobilization in the sitting position, progressing to active exercises, ambulation, and stair training. For the intervention group (n = 15 subjects), dynamic exercises on a cycle ergometer combined with CPAP were added to the step program from the second to the fourth postoperative day in a single daily session. RESULTS: Functional capacity decreased in both groups, but this reduction was not significant in the intervention group (P = .11). The length of stay in ICU was lower in the intervention group (P = .050). In both groups there was a decrease in maximum inspiratory and expiratory pressure, as well as in the 1-min sit-to-stand test on the fourth postoperative day compared to the preoperative period. CONCLUSIONS: Physical exercise combined with CPAP promoted the maintenance of functional capacity and reduced the length of stay in the ICU.

Clinical research of comprehensive treatment of sleep apnea syndrome with traditional Chinese medicine / 国际中医中药杂志

Objective To evaluate the efficacy of TCM comprehensive therapy in the treatment of sleep apnea syndrome (SAS).Methods Eighty-two SAS patients who met the inclusion criteria were randomly divided into two groups,41 in each group.The control group was treated with continuous positive airway pressure (CPAP).The observation group was treated with traditional Chinese medicine,oral Chinese medicine,acupuncture,massage,and acupuncture points.Both groups were treated for 2 weeks.Polysomnography (PSG) was used to evaluate the various stages of sleep,including total sleep time,hypopnea time,＜90％ oxygen saturation time.Results The total effective rate was 90.2％ (37/41) of the observation group and 70.7％ (29/41) of the control group.The difference between the two groups was statistically significant (x2=4.970,P=0.026).After treatment,the sleep time (5.5 ± 0.7 h vs.5.0 ± 0.6 h,t=3.556) of the treatment group was significantly longer than that of the control group (P＜0.01).The hypoventilation time (45.1 ± 9.5 min vs.50.2 ± 10.1 min,t=2.412),＜90％ oxygen saturation time (19.8 ± 9.6 min vs.25.4 ± 10.1 min,t=2.635) was significantly lower than those of the control group (P＜0.05).Conclusions Then comprehensive TCM therapy can alleviate the clinical symptoms of SAS patients,increase sleep time,and improve sleep quality.

Prevalence and variability of use of home mechanical ventilators, positive airway pressure and oxygen devices in the Lombardy region, Italy.

Few studies have analyzed the prevalence and accessibility of home mechanical ventilation (HMV) in Italy. We aimed to investigate the prevalence and prescription variability of HMV as well as of long-term oxygen therapy (LTOT) and continuous positive airway pressure (CPAP), in the Lombardy Region. Prescribing rates of HMV (both noninvasive and tracheostomies), CPAP (auto-CPAP, CPAP/other sleep machines) and LTOT (liquid-O2, O2-gas, concentrators) in the 15 Local Healthcare districts of Lombardy were gathered from billing data for 2012 and compared. Crude rates (per 100,000 population) and rates for the different healthcare districts were calculated. In 2012, 6325 patients were on HMV (crude prescription rate: 63/100,000) with a high variation across districts (8/100,000 in Milano 1 vs 150/100,000 in Pavia). There were 14,237 patients on CPAP (crude prescription rate: 142/100,000; CPAP/other sleep machines 95.3% vs auto-CPAP 4.7%) with also high intra-regional variation (56/100,000 in Mantova vs. 260/100,000 in Pavia). There were 21,826 patients on LTOT (prescription rate: 217/100,000 rate; liquid-O2 94%, O2-gas 2.08%, O2-concentrators 3.8%), with again high intra-regional variation (100/100,000 in Bergamo vs 410/100,000 in Valle Camonica). The crude rate of HMV prescriptions in Lombardy is very high, with a high intra-regional variability in prescribing HMV, LTOT and CPAP which is partly explainable by the accessibility to specialist centers with HMV/sleep-study facilities. Analysis of administrative data and variability mapping can help identify areas of reduced access for an improved standardization of services. An audit among Health Payer and prescribers to interpret the described huge variability could be welcomed.

Impact of sacubitril-valsartan combination in patients with chronic heart failure and sleep apnoea syndrome: the ENTRESTO-SAS study design.

AIMS: Sleep-disordered breathing (SDB) is a highly prevalent co-morbidity in patients with chronic heart failure (CHF) and can play a detrimental role in the pathophysiology course of CHF. However, the best way to manage SDB in CHF remains a matter of debate. Sacubitril-valsartan has been included in the 2016 European Society of Cardiology guidelines as an alternative to angiotensin-converting enzyme inhibitors to further reduce the risk of progression of CHF, CHF hospitalization, and death in ambulatory patients. Sacubitril and valsartan are good candidates for correcting SDB of CHF patients because their known mechanisms of action are likely to counteract the pathophysiology of SDB in CHF. METHODS AND RESULTS: The ENTRESTO-SAS trial is a 3-month, multicentric, prospective, open-label real-life cohort study. Patients eligible for sacubitril-valsartan treatment (i.e. adults with left ventricular ejection fraction ≤35%, who remain symptomatic despite optimal treatment with an angiotensin-converting enzyme inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist) will be evaluated before and after 3 months of treatment (nocturnal ventilatory polygraphy, echocardiography, laboratory testing, and quality-of-life and SDB questionnaires). The primary outcome is the change in the Apnoea-Hypopnoea Index, before and after 3 months of treatment. One hundred twenty patients are required to detect a significant 20% improvement of the Apnoea-Hypopnoea Index with a power of 90% at an alpha risk of 5%. CONCLUSIONS: In the context of the SERVE-HF study, physicians are waiting for new trials and alternative therapies. We sought to assess in the ENTRESTO-SAS trial whether sacubitril-valsartan could improve the outcome of SDB in CHF patients.

P4 medicine approach to obstructive sleep apnoea.

P4 medicine is an evolving approach to personalized medicine. The four Ps offer a means to: Predict who will develop disease and co-morbidities; Prevent rather than react to disease; Personalize diagnosis and treatment; have patients Participate in their own care. P4 medicine is very applicable to obstructive sleep apnoea (OSA) because each OSA patient has a different pathway to disease and its consequences. OSA has both structural and physiological mechanisms with different clinical subgroups, different molecular profiles and different consequences. This may explain why there are different responses to alternative therapies, such as intraoral devices and hypoglossal nerve stimulation therapy. Currently, technology facilitates patients to participate in their own care from screening for OSA (snoring and apnoea apps) to monitoring response to therapy (sleep monitoring, blood pressure, oxygen saturation and heart rate) as well as monitoring their own continuous positive airway pressure (CPAP) compliance. We present a conceptual framework that provides the basis for a new, P4 medicine approach to OSA and should be considered more in depth: predict and prevent those at high risk for OSA and consequences, personalize the diagnosis and treatment of OSA and build in patient participation to manage OSA.

Optimizing the Management of Uncontrolled/Resistant Hypertension. The Importance of Sleep Apnoea Syndrome.

INTRODUCTION: Obstructive Sleep Apnoea (OSA) constitutes the most prevalent form of abnormal respiratory control during sleep in adults. Evidence linked OSA to cardiovascular disease, and the role of OSA in abnormal Blood Pressure (BP) control has been extensively studied. Although longitudinal trials suggest a causative role of OSA in the development of hypertension, the evidence is not fully consistent. Nasal continuous positive airway pressure (nCPAP) applied during sleep is well documented and a highly efficient therapeutic aid to eliminate OSA. It has been repeatedly shown that nCPAP-therapy is also associated with modest BP lowering effect in hypertensive OSA-patients, and the magnitude of the observed effect correlates with the severity of OSA. However, it is unlikely that nCPAP would normalize BP. CONCLUSION: There are few studies which tested the interplay between OSA, nCPAP and certain BPlowering drug classes. Angiotensin receptor blockers may show synergistic hypotensive effect with nCPAP, whereas mineralocorticoid receptor blocker has been shown to modestly attenuate the severity of OSA. Additionally, the application of chronotherapy may be of special use in such patients. The current evidence is sufficient to promote persistent and effective nCPAP-therapy as a standard in all eligible OSA-patients with difficult-to-control hypertension.

The effects of integrated nursing education on quality of life and health-related outcomes among obstructive sleep apnea patients receiving continuous positive airway pressure therapy.

PURPOSE: This study sought to examine the effects of a nursing education program on quality of life and sleep disturbance among obstructive sleep apnea (OSA) patients receiving continuous positive airway pressure (CPAP) therapy. METHODS: This study was a randomized controlled trial with an intervention group consisting of a nursing education program. The intervention group received the instruction of the CPAP nursing education program, and the control group received routine care. Data was collected for both groups before the intervention (pre-test), on the 7th day measurement after the intervention, and on the 30th day measurement after the intervention. RESULTS: The results showed, first, that the intervention group reported a significantly reduced level of disturbance from wearing CPAP compared with that of the control group after the intervention (ß = -1.83, p = .040). Second, the Calgary sleep apnea quality of life index (SAQLI) total scores significantly improved after the intervention (ß = 1.669, p = 0.014). Also, symptoms of the SAQLI sub-items were improved and significantly different (ß = 5.69, p = 0.007) after the intervention in the intervention group. CONCLUSIONS: According to the results of the study, the disturbance from wearing CPAP, the total score of the SAQLI and the symptoms of the SAQLI were significantly improved after the nursing education intervention. Therefore, an adequate nursing education program is recommended for the initial period of CPAP use among OSA patients.

Myofunctional therapy improves adherence to continuous positive airway pressure treatment.

PURPOSE: Few studies have investigated myofunctional therapy in patients with obstructive sleep apnea syndrome (OSAS). The objective of this study was to evaluate the effect of myofunctional therapy on continuous positive airway pressure (CPAP) adherence. METHODS: The study was registered at ClinicalTrials.gov (NCT01289405). Male patients with OSAS were randomly divided into four treatment groups: placebo, patients undergoing placebo myofunctional therapy (N = 24); myofunctional therapy, undergoing myofunctional therapy (N = 27); CPAP, undergoing treatment with CPAP (N = 27); and combined, undergoing CPAP therapy and myofunctional therapy (N = 22). All patients underwent evaluations before and after 3 months of treatment evaluation and after 3 weeks of washout. Evaluations included Epworth sleepiness scale (ESS), polysomnography, and myofunctional evaluation. RESULTS: The 100 men had a mean age of 48.1 ± 11.2 years, body mass index of 27.4 ± 4.9 kg/m2, ESS score of 12.7 ± 3.0, and apnea-hypopnea index (AHI) of 30.9 ± 20.6. All treated groups (myofunctional therapy, CPAP, and combined myofunctional therapy with CPAP) showed decreased ESS and snoring, and the myofunctional therapy group maintained this improvement after the "washout" period. AHI reduction occurred in all treated groups and was more significant in CPAP group. The myofunctional therapy and combined groups showed improvement in tongue and soft palate muscle strength when compared with the placebo group. The association of myofunctional therapy to CPAP (combined group) showed an increased adherence to CPAP compared with the CPAP group. CONCLUSIONS: Our results suggest that in patients with OSAS, myofunctional therapy may be considered as an adjuvant treatment and an intervention strategy to support adherence to CPAP.