Alteration of Auto-CPAP requirements in obstructive sleep apnea patients with COVID-19 history.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an infectious disease that leads to critical respiratory problems. Obstructive sleep apnea (OSA) is the most common sleep-associated breathing disease and is represented by repetitive experiences of constraint of the respiratory tract prompting to reduced or deficient breathing during sleep. Auto-Continuous positive airway pressure (Auto-CPAP) is a modality of respiratory ventilation used as gold standart in the treatment of OSA. OBJECTIVE: This study was performed to conclude the alteration of Auto-CPAP levels in OSA patients who had COVID-19 history. METHODS: Nineteen OSA patients who had cured COVID-19 and used Auto-CPAP were included in this study. Nightly Auto-CPAP 95th percentile pressure (95thpp), median CPAP pressure and AHI before COVID-19 disease and one month after COVID therapy were recorded from electronic cards of Auto-CPAP devices. RESULTS: Before COVID infection, average Auto-CPAP 95thpp was 8.56 ± 0.17 cm H2O. One month after COVID-19, average Auto-CPAP 95thpp was 9.78 ± 0.21 cm H2O (P < 0.01). While Median CPAP pressure was 7.49 ± 0.16 cm H2O before COVID, it was found to be 8.15 ± 0.19 cm H2O after the disease (P < 0.01). CONCLUSIONS: The increase in need of average Auto-CPAP 95thpp and median CPAP pressure in OSA patients who have had COVID-19 disease and use Auto-CPAP shows that this disease causes problems in both the lower and upper airways.

Outcome of CPAP Titration for Moderate-to-Severe OSA Under Drug-Induced Sleep Endoscopy: A Randomized Controlled Crossover Trial.

Background: The titration pressure of continuous positive airway pressure (CPAP) is important in patients with obstructive sleep apnea (OSA). This study aimed to understand the difference between drug-induced sleep endoscopy (DISE)-guided CPAP titration and conventional sleep center (CSC) CPAP titration in patients with OSA. Methods: In this randomized, controlled, and single-blind crossover trial, we compared the effects of 1-month CPAP treatment in patients with OSA with either DISE-guided CPAP titration or CSC CPAP titration. Twenty-four patients with OSA were recruited for the study. All patients underwent polysomnography, DISE-guided CPAP titration, and accommodation. Initially, patients were randomly assigned to receive either DISE-guided CPAP titration or CSC CPAP treatment for the first month. They were then switched to other treatments in the second month. The Epworth sleepiness scale (ESS) score was recorded at baseline, 1 and 2 months. Results: The upper limit of the pressure of DISE-guided titration and CSC CPAP titration was not significantly different (13.9 ± 0.7 vs. 13.5 ± 0.5 cm H2O; P = 0.92). The residual apnea-hypopnea index and compliance were also not significantly different between the groups. ESS score significantly improved from baseline to 1 month after CPAP treatment in both groups. Both epiglottis (anterior-posterior collapse) and tongue base collapse were significantly associated with 95% CPAP pressure (P = 0.031 and 0.038, respectively). After multivariate regression analyses, the epiglottis (anterior-posterior collapse) was an independent factor for 95% CPAP pressure. The incidence rate of bradycardia was 58.3%, which is a safety concern for DISE. Despite the high incidence of bradycardia, all patients with bradycardia recovered with proper management. Conclusion: Both modalities were comparable in terms of establishing the pressure settings required to treat patients. Further large-scale studies are required to confirm these results. Trial registration: https://clinicaltrials.gov/, NCT03523013.

No changes in nocturnal respiration with hypoglossal neurostimulation therapy for obstructive sleep apnoea.

STUDY OBJECTIVES: We initiated Hypoglossal Neurostimulation therapy (HGNS) at the Helsinki University Hospital in late 2014. Here, we report our experience. METHODS: We included all 15 HGNS patients. All patients had previously failed both CPAP and oral appliance therapy for sleep apnoea. Overnight polysomnography parameters were analysed before and at 1.5 years with HGNS. RESULTS: Mean ± SD patient age was 53 ± 6 years; 2 women and 13 men were included. Mean ± SD efficient CPAP level was 11.4 ± 3.4 cm H2 O. Implantation technically succeeded in all patients. There were no significant changes of AHI and ODI4 after HGNS [median (quartile) 29.2/h (19.8-38.7) versus 30.1/h (15.6-52.6) and 15.0/h (5.9-20) versus 12.5/h (6.9-30.2) respectively]. CONCLUSION: We did not observe significant changes in AHI and ODI4 indices with HGNS therapy. Larger multicentre randomised controlled trials are necessary before wider international use of HGNS.