Impact of continuous positive airway pressure mode on adherence to treatment in obstructive sleep apnea patients awaiting bariatric surgery

Sophie B Kermelly, Annie C Lajoie, Marie-Eve Boucher, Frédéric Sériès, Sophie B Kermelly, Annie C Lajoie, Marie-Eve Boucher, Frédéric Sériès

Abstract

Obstructive sleep apnea is prevalent in the bariatric population, and is associated with various complications. Despite increasing popularity, automatic positive airway pressure has not yet been studied in this population. The objective was to compare treatment adherence between automatic positive airway pressure and fixed positive airway pressure (continuous positive airway pressure) in obstructive sleep apnea patients awaiting bariatric surgery. This randomized controlled trial involved obese patients newly diagnosed with severe obstructive sleep apnea and awaiting bariatric surgery. The primary outcome was the difference in adherence between automatic positive airway pressure and continuous positive airway pressure pre-operatively. Secondary outcomes included positive airway pressure efficacy, adherence at 1 month, adverse effects, quality of life and peri-operative complications. Analyses were conducted using a modified intention-to-treat methodology. Fifty patients were randomized. Baseline characteristics and duration of positive airway pressure therapy were comparable between groups. At the time of surgery, the percentage of overall nights positive airway pressure used was 96.9% [95% confidence interval: 93.5-100] and 86.0% [95% confidence interval: 66.9-100] in the automatic positive airway pressure and continuous positive airway pressure groups, respectively (p = .047). Average use was 6.3 hr per night [95% confidence interval: 5.1-7.2] and 5.9 hr per night [95% confidence interval: 3.0-8.8], with a difference of 0.4 hr favouring automatic positive airway pressure (p = .75). Nightly use ≥ 4 hr per night was 86.4% and 74.0% in the automatic positive airway pressure and fixed continuous positive airway pressure groups, respectively (p = .22). There were no statistically significant differences regarding adherence at 1 month, efficacy parameters, adverse effects, quality of life and peri-operative complications. With no difference on the safety profile and efficiency parameters, treatment adherence is not improved with automatic positive airway pressure compared with fixed continuous positive airway pressure in obstructive sleep apnea patients awaiting bariatric surgery.

Trial registration: ClinicalTrials.gov NCT02209220.

Keywords: automatic positive airway pressure; obstructive sleep apnea; pre-operative; therapy adherence; weight loss surgery.

© 2021 European Sleep Research Society.

References

REFERENCES

    1. American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea (2014). Practice guidelines for the perioperative management of patients with obstructive sleep apnea: An updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology, 120(2), 268-286.
    1. Antic, N. A., Buchan, C., Esterman, A., Hensley, M., Naughton, M. T., Rowland, S., Williamson, B., Windler, S., Eckermann, S., & McEvoy, R. D. (2009). A randomized controlled trial of nurse-led care for symptomatic moderate-severe obstructive sleep apnea. American Journal of Respiratory and Critical Care Medicine, 179(6), 501-508.
    1. Arias, M. A., Garcia-Rio, F., Alonso-Fernandez, A., Martinez, I., & Villamor, J. (2006). Pulmonary hypertension in obstructive sleep apnoea: Effects of continuous positive airway pressure: A randomized, controlled cross-over study. European Heart Journal, 27(9), 1106-1113.
    1. ASMBS Clinical Issues Committee. (2012). Peri-operative management of obstructive sleep apnea. Surgery for Obesity and Related Diseases, 8(3), e27-e32.
    1. Bradley, T. D., & Floras, J. S. (2009). Obstructive sleep apnoea and its cardiovascular consequences. The Lancet, 373(9657), 82-93.
    1. Bucks, R. S., Olaithe, M., & Eastwood, P. (2013). Neurocognitive function in obstructive sleep apnoea: A meta-review. Respirology, 18(1), 61-70.
    1. Craig, S. E., Kohler, M., Nicoll, D., Bratton, D. J., Nunn, A., Davies, R., & Stradling, J. (2012). Continuous positive airway pressure improves sleepiness but not calculated vascular risk in patients with minimally symptomatic obstructive sleep apnoea: The MOSAIC randomised controlled trial. Thorax, 67(12), 1090-1096.
    1. de Raaff, C. A. L., de Vries, N., & van Wagensveld, B. A. (2018). Obstructive sleep apnea and bariatric surgical guidelines: Summary and update. Current Opinion in Anaesthesiology, 31(1), 104-109.
    1. Fleetham, J., Ayas, N., Bradley, D., Fitzpatrick, M., Oliver, T. K., Morrison, D., Ryan, F., Series, F., Skomro, R., & Tsai, W. (2011). Canadian Thoracic Society 2011 guideline update: Diagnosis and treatment of sleep disordered breathing. Canadian Respiratory Journal, 18(1), 25-47.
    1. Gaddam, S., Gunukula, S. K., & Mador, M. J. (2014). Post-operative outcomes in adult obstructive sleep apnea patients undergoing non-upper airway surgery: A systematic review and meta-analysis. Sleep and Breathing, 18(3), 615-633.
    1. Gottlieb, D. J., Punjabi, N. M., Mehra, R., Patel, S. R., Quan, S. F., Babineau, D. C., Tracy, R. P., Rueschman, M., Blumenthal, R. S., Lewis, E. F., Bhatt, D. L., & Redline, S. (2014). CPAP versus oxygen in obstructive sleep apnea. New England Journal of Medicine, 370(24), 2276-2285.
    1. Ip, S., D'Ambrosio, C., Patel, K., Obadan, N., Kitsios, G. D., Chung, M., & Balk, E. M. (2012). Auto-titrating versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: A systematic review with meta-analyses. Systematic Reviews, 1, 20.
    1. Johns, M. W. (1991). A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep, 14(6), 540-545.
    1. Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017). Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, 13(3), 479-504.
    1. Kasai, T., Floras, J. S., & Bradley, T. D. (2012). Sleep apnea and cardiovascular disease: A bidirectional relationship. Circulation, 126(12), 1495-1510.
    1. Kaw, R., Chung, F., Pasupuleti, V., Mehta, J., Gay, P. C., & Hernandez, A. V. (2012). Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. British Journal of Anaesthesia, 109(6), 897-906.
    1. Lacasse, Y., Bureau, M. P., & Series, F. (2004). A new standardised and self-administered quality of life questionnaire specific to obstructive sleep apnoea. Thorax, 59(6), 494-499.
    1. Liao, P., Luo, Q., Elsaid, H., Kang, W., Shapiro, C. M., & Chung, F. (2013). Perioperative auto-titrated continuous positive airway pressure treatment in surgical patients with obstructive sleep apnea: A randomized controlled trial. Anesthesiology, 119(4), 837-847.
    1. Lopez, P. P., Stefan, B., Schulman, C. I., & Byers, P. M. (2008). Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: More evidence for routine screening for obstructive sleep apnea before weight loss surgery. American Surgeon, 74(9), 834-838.
    1. Malbois, M., Giusti, V., Suter, M., Pellaton, C., Vodoz, J. F., & Heinzer, R. (2010). Oximetry alone versus portable polygraphy for sleep apnea screening before bariatric surgery. Obesity Surgery, 20(3), 326-331.
    1. Marin, J. M., Agusti, A., Villar, I., Forner, M., Nieto, D., Carrizo, S. J., Barbé, F., Vicente, E., Wei, Y., Nieto, F. J., & Jelic, S. (2012). Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA, 307(20), 2169-2176.
    1. Massie, C. A., McArdle, N., Hart, R. W., Schmidt-Nowara, W. W., Lankford, A., Hudgel, D. W., Gordon, N., & Douglas, N. J. (2003). Comparison between automatic and fixed positive airway pressure therapy in the home. American Journal of Respiratory and Critical Care Medicine, 167(1), 20-23.
    1. McEvoy, R. D., Antic, N. A., Heeley, E., Luo, Y., Ou, Q., Zhang, X., Mediano, O., Chen, R., Drager, L. F., Liu, Z., Chen, G., Du, B., McArdle, N., Mukherjee, S., Tripathi, M., Billot, L., Li, Q., Lorenzi-Filho, G., Barbe, F., … Anderson, C. S. (2016). CPAP for prevention of cardiovascular events in obstructive sleep apnea. New England Journal of Medicine, 375(10), 919-931.
    1. McEvoy, R. D., & Thornton, A. T. (1984). Treatment of obstructive sleep apnea syndrome with nasal continuous positive airway pressure. Sleep, 7(4), 313-325.
    1. Parish, J. M., Miller, B. W., & Hentz, J. G. (2008). Autotitration positive airway pressure therapy in patients with obstructive sleep apnea who are intolerant of fixed continuous positive airway pressure. Sleep and Breathing, 12(3), 235-241.
    1. Patil, S. P., Ayappa, I. A., Caples, S. M., Kimoff, R. J., Patel, S. R., & Harrod, C. G. (2019). Treatment of adult obstructive sleep apnea with positive airway pressure: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, 15(2), 335-343.
    1. Sériès, F., Martin, M., Boutin, I., Marceau, S., Bussières, J., & Minville, C. (2020). Does every obese sleep apnea patients need CPAP treatment before bariatric surgery: Results of a validation study. Canadian Journal of Respiratory, Critical Care and Sleep Medicine, 4, 266-271.
    1. Smith, I., & Lasserson, T. J. (2009). Pressure modification for improving usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database of Systematic Reviews, 4, CD003531.
    1. Sullivan, C. E., Issa, F. G., Berthon-Jones, M., McCauley, V. B., & Costas, L. J. (1984). Home treatment of obstructive sleep apnoea with continuous positive airway pressure applied through a nose-mask. Bulletin Européen De Physiopathologie Respiratoire, 20(1), 49-54.
    1. Weaver, T. E., & Grunstein, R. R. (2008). Adherence to continuous positive airway pressure therapy: The challenge to effective treatment. Proceedings of the American Thoracic Society, 5(2), 173-178.
    1. Wolkove, N., Baltzan, M., Kamel, H., Dabrusin, R., & Palayew, M. (2008). Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Canadian Respiratory Journal, 15(7), 365-369.
    1. Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., & Badr, S. (1993). The occurrence of sleep-disordered breathing among middle-aged adults. New England Journal of Medicine, 328(17), 1230-1235.

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