Telephone follow-up as a substitute for standard out-clinic follow-up in CPAP therapy for obstructive sleep apnea patients: a randomized controlled trial.

PURPOSE: This study assessed the feasibility of telephone follow-up consultations (TC) using an online data sharing and editing function (Airview™), as alternative to standard out-clinic follow-up consultations (SC) on adherence to continuous positive airway pressure (CPAP) in obstructive sleep apnea (OSA) patients. Furthermore, we investigated compliance to follow-up consultations and examined potential influencing factors, including baseline AHI (apnea-hypopnea-index), age, and distance from home to the hospital on consultation compliance. METHODS: Two hundred OSA patients, with AHI ≥ 5 were randomly assigned (1:1) to receive TC or SC with follow-up after one month and 12 month of CPAP initiation. Adherence goal was defined as achieving ≥ 4 h of CPAP use daily in 70% of the days in a 365-days period. RESULTS: The proportion of participants achieving CPAP adherence was non-significantly lower in the TC group compared to the SC group (TC: 30% versus SC: 36%, adjusted OR 0.84, p = 0.59). Of participants who completed the study, the TC group had a significant average of 107 min less use of CPAP compared to the SC group (p = 0.048). However, a higher proportion of participants was compliant to consultations in the TC group. The only influencing factor found was increasing baseline AHI, which might be a predictor for compliance to consultations and adherence to CPAP therapy. CONCLUSION: TC might serve as substitute for SC in some part of the OSA population. If TC becomes a part of CPAP therapy management, it is important to consider patient characteristics and treatment-related issues to prevent decline in adherence.

Long-term non-invasive ventilation for stable chronic hypercapnic COPD.

Introduction: Long-term non-invasive ventilation (LTNIV) for the stable hypercapnic chronic obstructive pulmonary disease (COPD)-patients have been a subject of much debate in the last two decades. The aim of this study was to compile the current knowledge on LTNIV in order to evaluate the effects on mortality and hypercapnia. Methods: Literature search in Pubmed, Ovid, and Embase for RCTs in Humans from January 2000 through January 2019 in written English. Results: Six studies with a total of 861 patients were included. LTNIV in stable hypercapnic COPD patients significantly reduced PaCO2 but only one study found significant reduction in mortality. Conclusion: Our meta-analyses demonstrate that LTNIV significantly reduced PaCO2 in stable patients with chronic hypercapnic respiratory failure compared to standard care alone, and subgroup analyses on studies with a predefined plan for ventilation, showed a considerable trend towards significant reduction in mortality. The take home messages on LTNIV in stable hypercapnic COPD are: It is essential that the patients have stable chronic hypercapnia.The degree of stability can best be assessed after a minimum of 2 weeks following an acute hypercapnic respiratory failure (AHRF).It is important to ventilate the patient with the goal to reduce PaCO2 by at least 20% or below 6.5 kPa.

[Congenital methaemoglobinaemia--a rare cause of dyspnoea and cyanosis]. / Kongenit methæmoglobinæmi er en sjælden årsag til dyspnø og cyanose.

Dyspnoea in young people often leads to the diagnosis of asthma. A young female (with related parents) showed symptoms of cyanosis, dyspnoea and fatigue during physical activity despite asthma medication. High levels of methaemoglobin were measured. Genetic testing showed homozygote type 1b5r-deficiency. Cyanosis and lacking effect of asthma treatment should lead to further diagnostic evaluation with arterial blood gas analyses, including assessment of methaemoglobin. Congenitally inherited methaemoglobinaemia is a rare disease, but its diagnosis is important to ensure correct handling and treatment.