Family support increases CPAP therapy in patients, new study says

Posted by David O. Volpi, MD, PC, FACS

Attention families of people with obstructive sleep apnea (OSA): you can make a positive difference when it comes to your family member’s use of a Continuous Positive Airway Pressure (CPAP) machine to treat their OSA.

According to new research published in May in the American Academy of Sleep Medicine’s journal, Sleep,    married people with OSA, or those living with a partner, showed better use of their CPAP machine after the first three months of treatment than OSA sufferers who were single.
Additionally, those who rated their family relationship quality as higher also showed better adherence to CPAP therapy.  The results were adjusted for potential confounding factors including age, gender, and body mass index.

Here’s a refresher on what OSA is, and how CPAP therapy can help: When you fall asleep, your muscles relax, and the soft palate at the back of the throat can sag. When this happens, the upper airway can become obstructed, causing the soft palate and uvula to vibrate, causing snoring.

When the airway is completely obstructed, breathing stops for a period of time, until the body is jerked awake in reaction. This is obstructive sleep apnea. OSA can cause interrupted breathing hundreds of times a night, usually around 20 seconds per pause.

This paused breathing causes waking through the night, preventing deep, restorative sleep. This often leads to a host of problems, from daytime sleepiness and reduced job performance, to hypertension, heart disease, mood, and memory problems.

A CPAP machine helps this condition by pumping a continuous flow of air into the nasal passages — via a mask worn at night — keeping the airway open, and preventing or greatly reducing snoring and paused breathing.

In addition to improving paused breathing and reducing snoring, CPAP treatment also reduces systemic inflammation, a common side effect of OSA. Systemic inflammation is inflammation of blood vessel tissues caused by foreign elements, such as pathogens or damaged cells.

Despite its effectiveness, the problem with CPAP therapy is that the patient has to wear an oxygen mask while they sleep at night. Many people find this uncomfortable, so they don’t wear it and subsequently don’t get the benefits of OSA treatment they need.

In an effort to increase CPAP therapy adherence, this study is great news. Family support from loved ones can increase a patient’s treatment and benefits.

If you or someone you know is considering or struggling with CPAP treatment, a qualified sleep specialist can recommend the correct CPAP machine, or one of the many non-surgical in-office treatments. Visit the eOs sleep apnea treatments page for more information.

Read the full study,  “Family support may improve adherence to CPAP therapy for sleep apnea.”

Can nasal surgery help CPAP therapy?

Written by David Volpi, M.D., P.C., F.A.C.S.

This month’s blog is for anyone who has obstructive sleep apnea (OSA) and is having trouble using—or refusing to use—a Continuous Positive Airway Pressure (CPAP) machine while sleeping.

CPAP machines help nighttime interrupted breathing by pumping a continuous flow of air into the nasal passages, keeping the airway open, and preventing or greatly reducing snoring and paused breathing. Still, many people are uncomfortable wearing the CPAP mask at night. Some feel claustrophobic or claim it causes dry mouth, nasal congestion and/or skin irritations.

There are two points I want to make about CPAP machines. One is: realize there are different types of masks and machines available, so take the time to choose one that’s right for you. Choose a small, quiet machine with a comfortable mask that fits you well. A heated humidifier attached to the CPAP machine can reduce throat dryness. Also, adjust titration so the CPAP pressure isn’t too high.

The second point I want to make, is that for some patients with nasal obstruction, a nasal surgery called septoplasty may help make CPAP therapy easier when combined with the above suggestions. An article in the January 2014 issue of The Laryngoscope  explains this first-of-its-kind study.

In response to the difficulty many OSA patients have using CPAP—what doctors call “problematic nonadherence”—three researchers wanted to find out if septoplasty, a surgery for nasal obstruction, would improve CPAP use and effectiveness.

For the study, head researchers Justin Poirier MD, Charles George MD, FRCPC, and Brian Rotenberg MD, MPH studied 18 patients over a six month period. Their average age was 52, 15 were males, and three were female. All the participants had been diagnosed with OSA, were prescribed nasal CPAP, yet were unable to tolerate CPAP treatment mostly due to nasal obstruction and a deviated septum.

The patients underwent septoplasty surgery with inferior turbinoplasty to improve breathing and sinus drainage. Following the surgery, data was collected regarding the patients’ CPAP usage per night. Patients were also asked to fill out the Nasal Obstruction Symptom Evaluation (NOSE) Scale questionnaire on how their post-surgery nasal obstruction felt.

The results of the study were encouraging. Before surgery, average patient CPAP usage was 0.5 hours per night. Pre-surgery NOSE Scale questionnaire data averaged 16.1 among the patients, with a maximum possible score of 20.

After surgery, the mean nightly CPAP usage was 3.9 hours per night (significant difference compared to preoperative data at P < .05). And the NOSE Scale score decreased to 5.4 (significant difference compared to preoperative data at P < .05).

In summary, the results show improved CPAP compliance rates following septoplasty surgery in OSA patients with documented nasal obstruction. That said, it’s important to keep in mind that septopasty surgery should be considered conservatively and for appropriate patients. Nasal surgery is not a cure-all for OSA, but along with CPAP and/or other therapies, could make a positive difference in easing OSA-related symptoms. Further, the results of this study offers some written proof of the effectiveness of septoplasty surgery for nasal obstruction and OSA treatment.

If you have been diagnosed with OSA, or are suffering from snoring and sleep issues, I urge you to get evaluated by a qualified ear, nose, and throat doctor. Some common symptoms of OSA include snoring, paused breathing during sleep and excessive sleepiness during the day. Increased blood pressure is another sign you may have sleep apnea.

Untreated OSA can result in poor sleep (for you and your partner), lack of focus, increased cardiovascular disease, and even death. So please get checked out. There are multiple options and minimally invasive techniques available today to treat OSA and other sleep disorders.

Read the full article entitled, “The effect of nasal surgery on nasal continuous positive airway pressure compliance” in the January 2014 issue of The Laryngoscope.

Say Hello to the Neurostimulator—an Alternative to CPAP Machines

I’ve been a practicing ear, nose, and throat specialist for more than 20 years, and one thing I know for certain about my obstructive sleep apnea (OSA) patients is—they have to do the treatments in order to get better.

The problem is that some OSA patients who would benefit from Continuous Positive Airway Pressure (CPAP) machines can’t or won’t use it because they find it uncomfortable, even though CPAPs have proven to be very effective in increasing oxygen flow and reducing apneic events that result in snoring.

But thankfully, medical advances are happening almost weekly, and so it is with sleep apnea diagnosis and treatment. One study that has me particularly excited recently appeared in the New England Journal of Medicine.  It was also written about in The New York Times by Catherine Saint Louis.

Inspire Medical Systems, based in Minneapolis, Minnesota, has developed a something called the neurostimulator to treat OSA. The pacemaker-like device is surgically implanted in the chest, and at night, the device sends regular electric impulses to a nerve inside the jaw. These electric impulses cause the tongue to move forward during inhalation, opening up the airway, improving air flow and reducing breathing pauses. 

Inspire Medical Systems funded a study to test the neurostimulator. Doctors surgically implanted remote-controlled neurostimulators in 126 patients, and activated them at night as the patients slept. After one year, patients experienced a marked decline in breathing pauses—from 29.3 episodes per hour to nine per hour, on average. Dangerous drops in blood oxygen levels also declined, from 25.4 per hour to 7.4 per hour, on average. At one year, 86 percent of patients said they use the neurostimulator on a daily basis, and two of the 126 patients stopped using in at night. Sleep apnea worsened in about 20 patients using the device, but doctors are not yet sure why.

The second phase also showed indications that the neurostimulator is effective in OSA treatment. In 46 patients who showed that the treatment was helping their OSA after one year, some were told to continue with the therapy or have it withdrawn for one week. Not surprisingly, those who continued the neurostimulator therapy showed little change in the number of breathing pauses per hour or drops in blood oxygen levels. But in the patients no longer using the therapy, the number of breathing pauses increased sharply, from 7.6 per hour to 25.8 per hour, on average. And the episodes of blood oxygen level drops rose from 6 per hour to 23 per hour, on average.

While more research and study is needed, the results are truly encouraging that upper airway neurostimulator therapy may soon be an effective and welcome alternative for OSA treatment, especially for those patients who have difficulty with CPAP masks and machines.

Read the full article entitled, “Upper-Airway Stimulation for Obstructive Sleep Apnea” in The New England Journal of Medicine.