Complex Sleep Apnea Associated with Use of Nasal Expiratory Positive Airway (nEPAP) Device

Chopra, Amit; Das, Piyush; Ramar, Kannan; Staats, Bruce A.; Louis, Erik K. St.

doi:10.5664/jcsm.3716

Cited by 10 publications

(4 citation statements)

References 7 publications

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“…21 Nasal EPAP, like conventional CPAP, has also been associated with development of complex apneas and an increased frequency of central apneas during treatment. 22 Existing evidence suggests that in stroke patients obstructive apneas are much more common than central apneas at baseline, 23 but it is possible that the measured AHI during EPAP treatment may have captured some purely central or complex apneas.…”

Section: Discussionmentioning

confidence: 99%

Expiratory Positive Airway Pressure for Sleep Apnea after Stroke: A Randomized, Crossover Trial

Wheeler

Wing

O’Brien

et al. 2016

Journal of Clinical Sleep Medicine

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Section: Discussionmentioning

confidence: 99%

Expiratory Positive Airway Pressure for Sleep Apnea after Stroke: A Randomized, Crossover Trial

Wheeler

Wing

O’Brien

et al. 2016

Journal of Clinical Sleep Medicine

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“…Fifth, generally adherence was high for most studies that collected data for adherence (e.g., 84.2% in the study by Friedman, 80% by Wash, 88.2% by Berry, 89.3% by Kryger, 94% by Rosenthal, and 99% by Rossi et al). Most studies did not report any serious adverse effects; however minor adverse events were common as much as in 42% of patients based on the longest duration study by Kryger et al On searching literature, only one case report of treatment emergent central sleep apnea with nasal EPAP device was identified [ 35 ]. Common side effects observed in most studies include difficulty breathing, exhaling, and sleeping, dry mouth, nasal congestion/drainage/discomfort/itching, insomnia, and headache.…”

Section: Discussionmentioning

confidence: 99%

Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis

et al. 2015

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Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP) devices or Provent as treatment for obstructive sleep apnea (OSA). Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients) were included. Pre- and post-nasal EPAP means ± standard deviations (M ± SD) for apnea-hypopnea index (AHI) in 345 patients decreased from 27.32 ± 22.24 to 12.78 ± 16.89 events/hr (relative reduction = 53.2%). Random effects modeling mean difference (MD) was −14.78 events/hr [95% CI −19.12, −10.45], p value < 0.00001. Oxygen desaturation index (ODI) in 247 patients decreased from 21.2 ± 19.3 to 12.4 ± 14.1 events/hr (relative reduction = 41.5%, p value < 0.00001). Lowest oxygen saturation (LSAT) M ± SD improved in 146 patients from 83.2 ± 6.8% to 86.2 ± 11.1%, MD 3 oxygen saturation points [95% CI 0.57, 5.63]. Epworth Sleepiness Scale (ESS) M ± SD improved (359 patients) from 9.9 ± 5.3 to 7.4 ± 5.0, MD −2.5 [95% CI −3.2, −1.8], p value < 0.0001. Conclusion. Nasal EPAP (Provent) reduced AHI by 53.2%, ODI by 41.5% and improved LSAT by 3 oxygen saturation points. Generally, there were no clear characteristics (demographic factors, medical history, and/or physical exam finding) that predicted favorable response to these devices. However, limited evidence suggests that high nasal resistance could be associated with treatment failure. Additional studies are needed to identify demographic and polysomnographic characteristics that would predict therapeutic success with nasal EPAP (Provent).

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“…A major obstacle for CPAP is poor patient adherence (7,63,64). Nasal expiratory positive airway pressure (EPAP) uses the patients' own breathing in order to produce positive airway pressure to prevent obstructed breathing (65), although the efficacy of EPAP is not documented (66)(67)(68).…”

Section: Cpap Therapymentioning

confidence: 99%

Obstructive sleep apnoea and the need for its introduction into dental curricula

Güneri

Çal

et al. 2016

Eur J Dental Education

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Obstructive sleep apnoea (OSA) is a major health problem which causes blood oxygen desaturation that may initiate a cascade of events via inflammatory cytokines and adrenocorticotrophic hormone that may have impact upon quality of life and lead to potential life-threatening events. Even though OSA affects an increasing number of individuals, the role of dental practitioners in recognition, screening and management has not developed accordingly. The goal of this article was to provide updated information to dental practitioners on pathophysiology, consequences and treatment options of OSA with a focused discussion on oral appliance (OA) therapy, as this topic is not routinely included in current dental curricula of many dental schools. Additionally, we present a template dental curriculum for predoctoral and/or postdoctoral students in education regarding sleep disordered breathing.

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Complex Sleep Apnea Associated with Use of Nasal Expiratory Positive Airway (nEPAP) Device

Cited by 10 publications

References 7 publications

Expiratory Positive Airway Pressure for Sleep Apnea after Stroke: A Randomized, Crossover Trial

Expiratory Positive Airway Pressure for Sleep Apnea after Stroke: A Randomized, Crossover Trial

Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis

Obstructive sleep apnoea and the need for its introduction into dental curricula

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