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Treatment

Feb 03
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The Impact of PAP Therapy on Cardiovascular Risk and Mortality

By Heart Health, Selected Articles, Sleep and Aging, Sleep Apnea, Treatment No Comments

Positive airway pressure (PAP) use is associated with lower all-cause mortality and lower incidence of major adverse cardiovascular events (MACE) among older adult patients with sleep apnea, according to recent findings published in JAMA Network Open.

This large retrospective cohort study evaluated mortality and health outcomes among 888,835 Medicare beneficiaries with obstructive sleep apnea over a median follow-up period of 3.1 years. The researchers found that initiating PAP therapy was associated with a significant reduction in the risk of both all-cause mortality and MACE, including heart attack, stroke, and heart failure.

These findings underscore the critical importance of early diagnosis and treatment of sleep apnea to improve long-term health outcomes.

Identifying Sleep Apnea

Sleep apnea often goes undiagnosed. Common symptoms include snoring, gasping or choking during sleep, morning headaches, and daytime sleepiness.

Risk factors for sleep apnea include high body mass index (BMI), obesity, older age, and certain anatomical features (e.g., enlarged tonsils, upper airway abnormalities). Use of tobacco, alcohol, and certain sedative and pain medications can worsen apnea severity.

Sleep apnea frequently co-occurs with other health conditions, including heart disease, stroke, hypertension, gastroesophageal reflux disease (GERD), hyperlipidemia, and type 2 diabetes.

Sep 28
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New study finds that setting the optimal pressure for PAP can (and probably should) be done WITHOUT IN-LAB TITRATION

By Sleep Apnea, Treatment

A recent study published in the Journal of Clinical Sleep Medicine compared manually and automatically derived therapeutic positive airway pressure (PAP) to determine whether the two methods are equivalent. The findings suggest that in-lab manual titrations overestimate therapeutic pressure requirements, particularly in patients with higher BMI. Study participants were adequately treated with lower pressures using auto-titrating positive airway pressure (APAP) while yielding comparable reductions in AHI to those observed during manual titration studies.

The authors reported, “Our findings suggest that, in most cases, split-night or full-night polysomnograms are not necessary to initiate PAP therapy for patients with uncomplicated OSA.”

They added, “Typically, acceptable titration studies generate the highest pressure required to eliminate all obstructive respiratory events, including snoring. This [highest] pressure is not necessarily needed throughout a single night or on a night-to-night basis due to several factors, including sleep position, sleep stage, alcohol use, medications, and exercise.”

For patients receiving PAP therapy, finding the right pressure settings can make a world of difference. Higher than necessary positive airway pressure may cause dry airways and significant discomfort. This is one of the major contributors toward PAP nonadherence in patients with obstructive sleep apnea.

Accordingly, Snap Diagnostics’ home sleep apnea test report includes a prediction for an optimal level of positive airway pressure, using a clinically validated equation. This prediction can be used to optimize and/or shorten the time it takes to achieve optimal pressure settings.

The new findings further strengthen the case for home sleep apnea testing and treatment. As the COVID-19 pandemic has reduced the capacity of overnight sleep centers, providers are shifting away from attended manual PAP titration towards auto-titrating positive airway pressure, particularly for patients with uncomplicated obstructive sleep apnea.

To learn more about the published studies supporting this post, please reach out to your local Snap Manager or contact us.

[1]     Fashanu OS, Budhiraja R, Batool-Anwar S, Quan SF. Titration studies overestimate continuous positive airway pressure requirements in uncomplicated obstructive sleep apnea. J Clin Sleep Med. 2021 May 3. doi: 10.5664/jcsm.9316. Epub ahead of print. PMID: 34165075.
[2]     Miljeteig H, Hoffstein V. Determinants of continuous positive airway pressure level for treatment of obstructive sleep apnea. Am Rev Respir Dis. 1993 Jun;147(6 Pt 1):1526-30. doi: 10.1164/ajrccm/147.6_Pt_1.1526. PMID: 8503565.