Qualitative Assessment of the Effect of Continuous Positive Airway Pressure on the Nasal Cavity (original) (raw)
Related papers
CHEST Journal, 1995
started on N-CPAP before surgery, were put on N-CPAP as soon as extubated, on a near-continuous basis, for 24 to 48 h and thereafter for all sleep periods. None of them had major complications. The intensive care unit and hospital stays were the normal ones for each type of surgery in our institution. We conclude that N-CPAP started before surgery and resumed immediately after extubation allowed us to safely manage a variety of surgical procedures in patients with OSAS, and to freely use sedative, analgesic, and anesthetic drugs without major complications. Every effort should be made to identify patients with OSAS and institute N-CPAP therapy before surgery.
The effect of nasal surgery on nasal continuous positive airway pressure compliance
The Laryngoscope, 2013
Objectives/HypothesisNasal continuous positive airway pressure (CPAP) is the standard therapy for sleep apnea; however, compliance rates are historically poor. Among the most commonly cited reasons for nonadherence is nasal obstruction. Our study sought to examine if nasal surgery actually increases CPAP compliance.Study DesignProspective case series.MethodsNasal CPAP‐intolerant obstructive sleep apnea (OSA) patients, with documented nasal obstruction, underwent septoplasty plus inferior turbinoplasty. Preoperative and postoperative data were collected on CPAP usage per night and subjective nasal obstruction with the Nasal Obstruction Symptom Evaluation (NOSE) Scale questionnaire.ResultsEighteen patients met inclusion criteria and underwent septoplasty. CPAP usage increased significantly from 0.5 hours per night preoperatively to 5 hours per night postoperatively (P < .05). Subjective nasal obstruction on the NOSE Scale decreased from 16.1 preoperatively to 5.4 following surgical...
Functional Nasal Surgery and Use of CPAP in OSAS Patients: Our Experience
Indian Journal of Otolaryngology and Head & Neck Surgery
The surgical correction of nasal obstruction is definitely effective and recommended in patients with poor CPAP compliance, often secondary to the high pressures that need to be given in patients with nasal sub stenosis. For this reason, the objective of this study is the evaluation of the effectiveness and effects of the functional nose surgery on adherence to CPAP-therapy in patients (with moderate to severe OSAS with indication of ventilation therapy) poorly compliant with CPAP. The study was performed on a sample of 52 patients, 40 male and 12 female, aged between 29 and 72 years followed by the Otolaryngology Unit of the University Palermo in the period between January 2015 and January 2017. All patients were subjected to the following s iter: anamnesis with Epworth Sleepiness Scale, NOSE scale, evaluation of ''CPAP usage data.'' Upper airway optical fiber endoscopy with Müller's maneuver. We performed various type of nasal surgery (septoplasty, decongestion of the lower turbinates and FESS) 6 months after the surgery, CPAP usage was evaluated and the NOSE scale has been reapplied. All patients had a subjective degree of obstruction classified in severe or extreme by the NOSE scale before surgery. Almost all patients reported a mild degree of obstruction after the surgery. About CPAP usage, the average usage has passed by 2, 3 h at night to 6, 8 h after the surgery. The result is significant because it shows how the nasal functional surgery can make selected patients suitable to ventilation therapy. As our work shows, a better nasal function allows to reduce the CPAP pressure, Therefore, we believe that all patients with medium to severe obstructive apnea syndrome and for whom night-time ventilation therapy (CPAP) is advised should be evaluated with endoscopy and anamnesis oriented to evaluate nasal obstructive pathologies that may reduce effectiveness of CPAP.
SLEEP, 2015
Background: The relationship between nasal surgery and its effect on continuous positive airway pressure (CPAP) device therapeutic treatment pressures and CPAP device use has not been previously systematically examined. Study Objectives: To conduct a systematic review and meta-analysis evaluating the effect of isolated nasal surgery on therapeutic CPAP device pressures and use in adults with obstructive sleep apnea. Methods: MEDLINE, Scopus, Web of Science, and The Cochrane Library were searched through July 15, 2014. The MOOSE consensus statement and PRISMA statement were followed. Results: Eighteen studies (279 patients) reported CPAP data after isolated nasal surgery. Seven studies (82 patients) reported preoperative and postoperative mean therapeutic CPAP device pressures and standard deviations, which reduced from 11.6 ± 2.2 to 9.5 ± 2.0 centimeters of water pressure (cwp) after nasal surgery. Pooled random effects analysis demonstrated a statistically significant pressure reduction, with a mean difference of −2.66 cwp (95% confidence intervals, −3.65 to −1.67); P < 0.00001. Eleven studies (153 patients) described subjective, selfreported data for CPAP use; and a subgroup analysis demonstrated that 89.1% (57 of 64 patients) who were not using CPAP prior to nasal surgery subsequently accepted, adhered to, or tolerated it after nasal surgery. Objective, device meter-based hours of use increased in 33 patients from 3.0 ± 3.1 to 5.5 ± 2.0 h in the short term (< 6 mo of follow-up). Conclusion: Isolated nasal surgery in patients with obstructive sleep apnea and nasal obstruction reduces therapeutic CPAP device pressures and the currently published literature's objective and subjective data consistently suggest that it also increases CPAP use in select patients.
Nasal function and CPAP compliance
Auris Nasus Larynx, 2018
Continuous positive airway pressure (CPAP) is the mainstay therapy for patients with obstructive sleep apnea (OSA) however compliance with CPAP is variable. Nasal ailments, such as nasal congestion are frequently mentioned as a cause for CPAP non-compliance, and potentially could be addressed prior to CPAP initiation, however, no specific criteria or recommendations for the evaluation and management of these patients exist. The aim of this retrospective study is to evaluate the effects of nasal anatomic features and disease on adherence to CPAP therapy for patients with OSA and determine the indications for pre-CPAP nasal treatment by using data obtained at clinical examination. Methods: In total, 711 adult patients with initial diagnosis of OSA and an apnea-hypopnea index of 20 who were amenable to CPAP were included. We analyzed nasal parameters, past history of nasal disease, subjective symptoms, and disease severity in addition to whether CPAP therapy had been initiated, rate of CPAP therapy use (initial and 1 year), treatment continuation rate at 2 months and 1 year, and nasal treatments for all patients. Results: CPAP therapy was initiated in 543 of 711 patients. Nasal resistance was significantly higher in patients who discontinued therapy soon after CPAP initiation. Nasal disease and nasal parameters were not found to be predictors of treatment adherence at 1 year. Allergic rhinitis, moderate to severe nasal congestion at bedtime, slight or extensive sinus opacification, and a high nasal septum deviation score were found to be independent predictors of nasal treatment, while strong awareness of nasal congestion, a past history of sinusitis, and a total nasal resistance (supine position) of 0.35 Pa/cm 3 /s were independent predictors of surgical treatment. Conclusion: Long-term CPAP therapy adherence in patients with OSA can be predicted from initial CPAP adherence. Nasal disease and nasal parameters are important factors for early CPAP therapy discontinuation and should be adequately treated before therapy initiation to ensure long-term adherence. Indications for pre-CPAP nasal treatment and nasal surgery for patients with OSA can be predicted from the data obtained at the first examination, and these patients should be treated differently from those without OSA.
Effect of nasal valve dilation on effective CPAP level in obstructive sleep apnea
Respiratory Medicine, 2003
Nasal problems are frequent at high continuous positive airway pressure (CPAP). We hypothesized that a reduction of the nasal resistance reduces CPAP and investigated the effect of a nasal valve dilator (Nozovent s) on CPAP in patients with obstructive sleep apnea. In a randomized cross-over design Nozovent s was inserted in 38 patients during one of two nights using AutoSet T s. CPAP differences 41 cm H 2 O were considered as clinically relevant. With Nozovent s the median CPAP pressure was reduced from 8.6 cm H 2 O to 8.0 H 2 O (P ¼ 0:023) in all patients, but the number of patients with a reduction of CPAP by 1 cm H 2 O was not significant. The median CPAP level among 20 patients requiring a CPAP level of above 9 cm H 2 O was reduced from 10.3 to 9.1 cm H 2 O, Po0:05: A clinical improvement with Nozovent s was seen in 10 of 20 patients requiring a pressure of above 9 cm H 2 O compared with 4 of 18 patients who needed lower pressures, P ¼ 0:025: Nozovent s reduces the CPAP level 1 cm H 2 O in 50% of patients requiring a high pressure (49 cm H 2 O). Future studies should identify possible patients benefiting from a nasal dilator during CPAP therapy.
Sleep and Breathing, 2012
Since its original description in 1981 [1], continuous positive airways pressure (CPAP) is a well established effective and evidence-based treatment for moderate to severe obstructive sleep apnea (OSA) . However, the determination of optimal CPAP pressure in the laboratory is time-consuming and expensive, contributing to delays in the treatment of this condition. As sleep laboratory availability and expense is an issue of concern, several methods that could shorten long waiting lists and lower costs have been suggested. These are split-night studies [3], auto-CPAP titration , home sleep diagnostic studies [5], unattended autotitrating home CPAP studies [6] and more recently CPAP prediction formulas .
Critical Care, 2013
Introduction: Upper airway obstruction (UAO) is a major problem in unconscious subjects, making full face mask ventilation difficult. The mechanism of UAO in unconscious subjects shares many similarities with that of obstructive sleep apnea (OSA), especially the hypotonic upper airway seen during rapid eye movement sleep. Continuous positive airway pressure (CPAP) via nasal mask is more effective at maintaining airway patency than a full face mask in patients with OSA. We hypothesized that CPAP via nasal mask and ventilation (nCPAP) would be more effective than full face mask CPAP and ventilation (FmCPAP) for unconscious subjects, and we tested our hypothesis during induction of general anesthesia for elective surgery. Methods: In total, 73 adult subjects requiring general anesthesia were randomly assigned to one of four groups: nCPAP P0, nCPAP P5, FmCPAP P0, and FmCPAP P5, where P0 and P5 represent positive end-expiratory pressure (PEEP) 0 and 5 cm H 2 O applied prior to induction. After apnea, ventilation was initiated with pressure control ventilation at a peak inspiratory pressure over PEEP (PIP/PEEP) of 20/0, then 20/5, and finally 20/10 cm H 2 O, each applied for 1 min. At each pressure setting, expired tidal volume (Vte) was calculated by using a plethysmograph device.
Acta Anaesthesiologica Scandinavica, 2002
Background: Nasal continuous positive airway pressure (nCPAP) is considered useful for prophylaxis and treatment of respiratory complications following major thoracic surgery. It is unknown, however, which CPAP levels are required to avoid alveolar derecruitment and to consistently improve pulmonary oxygen transfer in patients following thoracotomy. We therefore studied the effects of different nCPAP levels on pressure transmission into the trachea as well as on pulmonary oxygen transfer. Methods: In 10 consecutive patients after cardiac or thoracic vascular surgery, following extubation in the ICU, nCPAP was generated by means of a high-flow gas source and applied randomly at levels of 5 or 10 cm H 2 O. Airway pressure was recorded continuously in the nasal mask and the trachea. The PaO 2 /FiO 2 ratio was calculated from the tracheal oxygen concentration, and PaO 2 was determined while breathing at an ambient and elevated airway pressure. Haemodynamic variables (heart rate, arterial blood pressure, central venous pressure) were also recorded. Results: Mean pressures in the nasal mask were 5.4∫0.1 and 9.7∫0.3 cm H 2 O. Corresponding tracheal pressures were 2.8∫1.0 vs. 7.2∫1.1 cm H 2 O (PΩ0.007). With higher mask pressure, the
Turkish Archives of Otorhinolaryngology, 2020
Objective: To assess the effects of anatomical, clinical parameters, and pulmonary respiratory function on the therapeutic titration pressure of continuous pos itive airway pressure (CPAP) device in obstructive sleep apnea syndrome (OSAS). Methods: The study comprised 41 OSAS patients whose optimum CPAP titration pressures were measured. Each patient underwent an otorhinolaryngologic and thoracic examination, and data was recorded for height, weight, body mass index, neckwaist circumferences, Mallampati classification, tonsillar hypertrophy, hypopharyngeal collapse, soft palate-tongue base obstruction scores, peak nasal inspiratory flow and acoustic rhinometry measures, and CPAP device therapeutic pressures. Forced vital capacity, forced expiratory volume, FEV1/FVC ratio and peak expiratory flow values were noted. Results: Median CPAP optimal pressure cutoff value was determined as 9 mmH 2 O. Statistical analysis was made in two groups as CPAP titration optimal pressure ≤9 and >9 mmH 2 O. In the optimal pressure >9 group, neck and waist circumferences, hypopharyngeal collapse score, retropalatal and retrolingual lateral wall collapse scores were significantly higher (p<0.05). In multivariate and univariate model analysis, neck and waist circumferences, hypopharyngeal collapse score, retropalatal and retrolingual lateral wall collapse scores were observed to be significant in predicting high and low pressures in univariate model. Conclusion: For the prediction of optimal CPAP titration pressure in OSAS treatment, wide neck and waist circumferences, high hypopharyngeal collapse score and retropalatal and retrolingual lateral wall collapse grades may be determinative.