alexa Pressure modification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea.


Journal of Pulmonary & Respiratory Medicine

Author(s): Smith I, Lasserson TJ

Abstract Share this page

Abstract BACKGROUND: Continuous Positive Airways Pressure (CPAP) is considered to be the cornerstone of therapy for obstructive sleep apnoea (OSA). However, compliance with this treatment is frequently poor, which may lead to ongoing symptoms of sleep disruption, daytime sleepiness and poor waking cognitive function. Mechanical interventions which involve changing the way that positive pressure is delivered, and the addition of humidification, might improve compliance. OBJECTIVES: To determine the efficacy of pressure level modifications and additional humidification in increasing CPAP machine usage. SEARCH STRATEGY: We searched the Cochrane Airways Group Specialised Register (September 2008). SELECTION CRITERIA: Randomised controlled trials (RCTs) assessing interventions to improve compliance with CPAP usage. Control groups received fixed pressure CPAP. DATA COLLECTION AND ANALYSIS: Two authors assessed articles for inclusion in the review and extracted data. We made attempts to obtain additional unpublished data from the trialists. MAIN RESULTS: Forty-five studies met the inclusion criteria (1874 participants). Auto-CPAP (30 studies, 1136 participants): a statistically significant difference in machine usage of 0.21 hours/night (0.08 to 0.35) was observed in favour of auto-CPAP from cross-over studies. This difference is of questionable clinical significance. Pooled effect estimates from parallel group trials detected a similar sized difference for average nightly machine usage, but this was not statistically significant. Evidence from parallel group studies did not identify a statistically significant difference between pressure modes in Epworth Sleepiness Scores, but there was an overall reduction of 0.64 units with cross-over studies (-0.12 to -1.16) in favour of auto-CPAP. Parallel group studies did not identify a significant difference. More participants preferred auto-CPAP to fixed CPAP where this was measured. Bi-level PAP (six studies, 285 participants): no significant differences were observed in machine usage. One small study found no difference in preference. C-Flex (six studies, 318 participants): no significant difference was observed in machine usage. Humidification (three studies, 135 participants): there were conflicting findings between the studies. Two parallel group trials found no significant difference in machine usage, whereas a cross-over study found a significant difference. AUTHORS' CONCLUSIONS: Improvement in average machine use of auto-CPAP was superior in studies with a cross-over design; the point estimate in parallel group trials was similar, but did not reach statistical significance. It is uncertain how use of machines in study settings relates to 'real world' use. Where preference was measured participants preferred auto-CPAP to fixed pressure CPAP. Further studies are required to assess the evidence for Bi-PAP, C-Flex(TM) and humidification. The studies assembled were characterised by high machine usage in the control groups, and low withdrawal rates. Future studies need to consider the effects of treatment in participants with more mild disease, and those who struggle to accept therapy despite persistent symptoms. This article was published in Cochrane Database Syst Rev and referenced in Journal of Pulmonary & Respiratory Medicine

Relevant Expert PPTs

Relevant Speaker PPTs

  • Ping Gu
    Myeloid-specific deletion of SIRT1 impairs obesity and ageing-associated endothelial dysfunction
    PPT Version | PDF Version
  • George Rawitscher
    Revival of the phase-amplitude description of a quantum-mechanical wave function
    PDF Version
  • Shoude Jin
    Mechanisms of Chronic obstructive pulmonary disease and airway smooth muscle remodeling: the potential roles of Abhd2
    PDF Version
  • Tina Cloney
    Behavioral change strategies conducive to reducing rates of disease and disability and promoting rehabilitation and daily functioning
    PPT Version | PDF Version
  • Alsayed Alnahal
    Urinary netrin-1 predict early ischemic acute kidney injury after cardiopulmonary bypass
    PPT Version | PDF Version
  • Ping Yang
    Chronic obstructive pulmonary disease (COPD) complicating early-stage lung cancer (LC)
    PDF Version
  • Gunilla Lindqvist
    Chronic obstructive pulmonary disease: A study of the relationship between patients’ feeling of guilt due to their belief of the disease being self inflicted
    PDF Version
  • Roger Mark Engel
    The effect of including manual therapy in the management of mild chronic obstructive pulmonary disease – a randomized controlled trial
    PDF Version
  • Khalid Bashar
    Predictive parameters of arterio-venous fistula functional maturation in a population of patients with end-stage renal disease
    PPT Version | PDF Version
  • Cormac G M Gahan
    Bacterial bile salt hydrolase in the regulation of host lipid metabolism and circadian rhythm: A role in probiotic function?
    PPT Version | PDF Version
  • Tjale Mahopo
    Impact of infant feeding practices on gut function in Dzimauli community, South Africa
    PDF Version
  • Keiko Unno
    Prevention of cognitive dysfunction and amyloid beta accumulation by the ingestion of green soybean extract in aged mice
    PDF Version
  • Chia-chi Liu
    Oxidative inhibition of erythrocyte sodium pump: A functionally relevant circulating marker of oxidative stress
    PPT Version | PDF Version
  • Yosef Yarden
    Classically, the 3’untranslated region (3’UTR) is that region in eukaryotic protein-coding genes from the translation termination codon to the polyA signal. It is transcribed as an integral part of the mRNA encoded by the gene. However, there exists another kind of RNA, which consists of the 3’UTR alone, without all other elements in mRNA such as 5’UTR and coding region. The importance of independent 3’UTR RNA (referred as I3’UTR) was prompted by results of artificially introducing such RNA species into malignant mammalian cells. Since 1991, we found that the middle part of the 3’UTR of the human nuclear factor for interleukin-6 (NF-IL6) or C/EBP gene exerted tumor suppression effect in vivo. Our subsequent studies showed that transfection of C/EBP 3’UTR led to down-regulation of several genes favorable for malignancy and to up-regulation of some genes favorable for phenotypic reversion. Also, it was shown that the sequences near the termini of the C/EBP 3’UTR were important for its tumor suppression activity. Then, the C/EBP 3’UTR was found to directly inhibit the phosphorylation activity of protein kinase CPKC in SMMC-7721, a hepatocarcinoma cell line. Recently, an AU-rich region in the C/EBP 3’UTR was found also to be responsible for its tumor suppression. Recently we have also found evidence that the independent C/EBP 3’UTR RNA is actually exists in human tissues, such as fetal liver and heart, pregnant uterus, senescent fibroblasts etc. Through 1990’s to 2000’s, world scientists found several 3’UTR RNAs that functioned as artificial independent RNAs in cancer cells and resulted in tumor suppression. Interestingly, majority of genes for these RNAs have promoter-like structures in their 3’UTR regions, although the existence of their transcribed products as independent 3’UTR RNAs is still to be confirmed. Our studies indicate that the independent 3’UTR RNA is a novel non-coding RNA species whose function should be the regulation not of the expression of their original mRNA, but of some essential life activities of the cell as a whole.
    PPT Version | PDF Version
  • Alina Borowska
    Postoperative cognitive dysfunctions after cardiac operations
    PPT Version | PDF Version

Recommended Conferences

Peer Reviewed Journals
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version