Sara Herculano - Academia.edu (original) (raw)
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Papers by Sara Herculano
American Journal of Respiratory and Critical Care Medicine, 2021
Journal of Clinical Sleep Medicine, 2017
Continuous positive airway pressure (CPAP) is a highly effective treatment for obstructive sleep ... more Continuous positive airway pressure (CPAP) is a highly effective treatment for obstructive sleep apnea (OSA). 1 However, CPAP compliance remains an important obstacle that mitigates the effects of OSA therapy. The experience of side effects with CPAP treatment may impair adherence. 2 Few randomized controlled trials have been designed to address CPAP side effects. Aerophagia is one of the common side effects of CPAP that has not been adequately studied. In this issue of the Journal of Clinical Sleep Medicine, Shirlaw et al. 3 report the results of a randomized controlled trial comparing fixed and auto-CPAP among subjects presenting with aerophagia symptoms but well adapted to CPAP therapy. The primary outcome was CPAP adherence. Although auto-CPAP failed to improve adherence to therapy as compared to fixed CPAP, auto-CPAP significantly improved aerophagia symptoms. The results of this study provide clear evidence to switch treatment of patients experiencing aerophagia from fixed CPAP to auto-CPAP. Auto-CPAP may improve aerophagia symptoms by reducing mean overnight CPAP level. In the study by Shirlaw et al., 3 median CPAP level was reduced from 14 to 9.8 cm H 2 O (fixed CPAP and auto-CPAP, respectively). Another involved mechanism leading to aerophagia is oronasal CPAP in the study by Shirlaw et al. 3 Aerophagia symptoms were significantly greater under oronasal fixed CPAP as compared to nasal fixed CPAP. 3 There is growing evidence that oronasal CPAP may lead to higher unintentional leak, require higher therapeutic pressure level, and lead to poorer adherence as compared to nasal CPAP. 4 The study by Shirlaw et al. 3 provides further evidence to avoid widespread use of oronasal CPAP. Auto-CPAP and other technological improvements such as expiratory pressure relief and humidification have not been shown to substantially improve CPAP adherence in unselected patients with OSA initiating CPAP. 5 The study by Shirlaw et al. 3 used a different approach where specific interventions may improve CPAP side effects and potentially improve adherence. This is a reminder that CPAP therapy for patients with OSA should not use a "one size fits all" approach. Rather, it should be individualized. The evidence from the Shirlaw et al. study 3 is a step closer to individualized sleep medicine.
American Journal of Respiratory and Critical Care Medicine, 2021
Journal of Clinical Sleep Medicine, Jul 15, 2017
Continuous positive airway pressure (CPAP) is a highly effective treatment for obstructive sleep ... more Continuous positive airway pressure (CPAP) is a highly effective treatment for obstructive sleep apnea (OSA). 1 However, CPAP compliance remains an important obstacle that mitigates the effects of OSA therapy. The experience of side effects with CPAP treatment may impair adherence. 2 Few randomized controlled trials have been designed to address CPAP side effects. Aerophagia is one of the common side effects of CPAP that has not been adequately studied. In this issue of the Journal of Clinical Sleep Medicine, Shirlaw et al. 3 report the results of a randomized controlled trial comparing fixed and auto-CPAP among subjects presenting with aerophagia symptoms but well adapted to CPAP therapy. The primary outcome was CPAP adherence. Although auto-CPAP failed to improve adherence to therapy as compared to fixed CPAP, auto-CPAP significantly improved aerophagia symptoms. The results of this study provide clear evidence to switch treatment of patients experiencing aerophagia from fixed CPAP to auto-CPAP. Auto-CPAP may improve aerophagia symptoms by reducing mean overnight CPAP level. In the study by Shirlaw et al., 3 median CPAP level was reduced from 14 to 9.8 cm H 2 O (fixed CPAP and auto-CPAP, respectively). Another involved mechanism leading to aerophagia is oronasal CPAP in the study by Shirlaw et al. 3 Aerophagia symptoms were significantly greater under oronasal fixed CPAP as compared to nasal fixed CPAP. 3 There is growing evidence that oronasal CPAP may lead to higher unintentional leak, require higher therapeutic pressure level, and lead to poorer adherence as compared to nasal CPAP. 4 The study by Shirlaw et al. 3 provides further evidence to avoid widespread use of oronasal CPAP. Auto-CPAP and other technological improvements such as expiratory pressure relief and humidification have not been shown to substantially improve CPAP adherence in unselected patients with OSA initiating CPAP. 5 The study by Shirlaw et al. 3 used a different approach where specific interventions may improve CPAP side effects and potentially improve adherence. This is a reminder that CPAP therapy for patients with OSA should not use a "one size fits all" approach. Rather, it should be individualized. The evidence from the Shirlaw et al. study 3 is a step closer to individualized sleep medicine.
American Journal of Respiratory and Critical Care Medicine, 2021
Journal of Clinical Sleep Medicine, 2017
Continuous positive airway pressure (CPAP) is a highly effective treatment for obstructive sleep ... more Continuous positive airway pressure (CPAP) is a highly effective treatment for obstructive sleep apnea (OSA). 1 However, CPAP compliance remains an important obstacle that mitigates the effects of OSA therapy. The experience of side effects with CPAP treatment may impair adherence. 2 Few randomized controlled trials have been designed to address CPAP side effects. Aerophagia is one of the common side effects of CPAP that has not been adequately studied. In this issue of the Journal of Clinical Sleep Medicine, Shirlaw et al. 3 report the results of a randomized controlled trial comparing fixed and auto-CPAP among subjects presenting with aerophagia symptoms but well adapted to CPAP therapy. The primary outcome was CPAP adherence. Although auto-CPAP failed to improve adherence to therapy as compared to fixed CPAP, auto-CPAP significantly improved aerophagia symptoms. The results of this study provide clear evidence to switch treatment of patients experiencing aerophagia from fixed CPAP to auto-CPAP. Auto-CPAP may improve aerophagia symptoms by reducing mean overnight CPAP level. In the study by Shirlaw et al., 3 median CPAP level was reduced from 14 to 9.8 cm H 2 O (fixed CPAP and auto-CPAP, respectively). Another involved mechanism leading to aerophagia is oronasal CPAP in the study by Shirlaw et al. 3 Aerophagia symptoms were significantly greater under oronasal fixed CPAP as compared to nasal fixed CPAP. 3 There is growing evidence that oronasal CPAP may lead to higher unintentional leak, require higher therapeutic pressure level, and lead to poorer adherence as compared to nasal CPAP. 4 The study by Shirlaw et al. 3 provides further evidence to avoid widespread use of oronasal CPAP. Auto-CPAP and other technological improvements such as expiratory pressure relief and humidification have not been shown to substantially improve CPAP adherence in unselected patients with OSA initiating CPAP. 5 The study by Shirlaw et al. 3 used a different approach where specific interventions may improve CPAP side effects and potentially improve adherence. This is a reminder that CPAP therapy for patients with OSA should not use a "one size fits all" approach. Rather, it should be individualized. The evidence from the Shirlaw et al. study 3 is a step closer to individualized sleep medicine.
American Journal of Respiratory and Critical Care Medicine, 2021
Journal of Clinical Sleep Medicine, Jul 15, 2017
Continuous positive airway pressure (CPAP) is a highly effective treatment for obstructive sleep ... more Continuous positive airway pressure (CPAP) is a highly effective treatment for obstructive sleep apnea (OSA). 1 However, CPAP compliance remains an important obstacle that mitigates the effects of OSA therapy. The experience of side effects with CPAP treatment may impair adherence. 2 Few randomized controlled trials have been designed to address CPAP side effects. Aerophagia is one of the common side effects of CPAP that has not been adequately studied. In this issue of the Journal of Clinical Sleep Medicine, Shirlaw et al. 3 report the results of a randomized controlled trial comparing fixed and auto-CPAP among subjects presenting with aerophagia symptoms but well adapted to CPAP therapy. The primary outcome was CPAP adherence. Although auto-CPAP failed to improve adherence to therapy as compared to fixed CPAP, auto-CPAP significantly improved aerophagia symptoms. The results of this study provide clear evidence to switch treatment of patients experiencing aerophagia from fixed CPAP to auto-CPAP. Auto-CPAP may improve aerophagia symptoms by reducing mean overnight CPAP level. In the study by Shirlaw et al., 3 median CPAP level was reduced from 14 to 9.8 cm H 2 O (fixed CPAP and auto-CPAP, respectively). Another involved mechanism leading to aerophagia is oronasal CPAP in the study by Shirlaw et al. 3 Aerophagia symptoms were significantly greater under oronasal fixed CPAP as compared to nasal fixed CPAP. 3 There is growing evidence that oronasal CPAP may lead to higher unintentional leak, require higher therapeutic pressure level, and lead to poorer adherence as compared to nasal CPAP. 4 The study by Shirlaw et al. 3 provides further evidence to avoid widespread use of oronasal CPAP. Auto-CPAP and other technological improvements such as expiratory pressure relief and humidification have not been shown to substantially improve CPAP adherence in unselected patients with OSA initiating CPAP. 5 The study by Shirlaw et al. 3 used a different approach where specific interventions may improve CPAP side effects and potentially improve adherence. This is a reminder that CPAP therapy for patients with OSA should not use a "one size fits all" approach. Rather, it should be individualized. The evidence from the Shirlaw et al. study 3 is a step closer to individualized sleep medicine.