Piecing Together the Puzzle of Adherence in Sleep Medicine
SLEEP MEDICINE CLINICS (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - January 21, 2021 Category: Sleep Medicine Authors: Jessie P. Bakker Source Type: research
Piecing Together the Puzzle of Adherence in Sleep Medicine
This issue of Sleep Medicine Clinics focuses primarily on our current understanding and future directions regarding adherence to therapy for sleep disorders, as described by experts in the field. The title, “Piecing Together the Puzzle of Adherence,” nods to how much we have learned to date while acknowledging that adherence remains a complex and puzzling behavioral phenomenon. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - January 12, 2021 Category: Sleep Medicine Authors: Jessie P. Bakker Tags: Preface Source Type: research
Adherence to Cognitive Behavior Therapy for Insomnia
This article discusses information extracted from 53 studies that have measured adherence to cognitive behavior therapy for insomnia. There has been an increase in more complex and less biased methods for assessing adherence that move beyond simply asking the patients whether they have adhered to the intervention or not. There is a need for a consensus around how to measure adherence, if clinicians want to arrive at an estimate of optimal adherence. Heterogeneity of studies, particularly in the way adherence is operationalized, prohibited conclusions about the relationship between adherence and outcome, as well as about pr...
Source: Sleep Medicine Clinics - December 27, 2020 Category: Sleep Medicine Authors: Sommer Agnew, Annie Valli ères, Ailie Hamilton, Stephanie McCrory, Marek Nikolic, Simon D. Kyle, Leanne Fleming, Megan R. Crawford Source Type: research
Using the Remote Monitoring Framework to Promote Adherence to Continuous Positive Airway Pressure
The ability to remotely monitor positive airway pressure therapy adherence and efficacy provides a unique opportunity for the field of sleep medicine to quickly and efficiently improve patient adherence. Smaller randomized studies and larger-scale retrospective evaluations show that telemedicine interventions leveraging these data can increase average usage and efficiency of care. However, more evidence on the impact of these programs on longer-term adherence and improving patient-reported outcomes is needed. Combining data from remote monitoring with clinical information in electronic health records may prove to be invalu...
Source: Sleep Medicine Clinics - December 23, 2020 Category: Sleep Medicine Authors: Brendan T. Keenan, Richard J. Schwab Source Type: research
Considering the Role of Adherence in New and Emerging Sleep Treatments
There are several novel and emerging treatments for obstructive sleep apnea (OSA), including new devices and pharmacotherapies. Long-term efficacy and adherence data for these interventions in the sleep context are lacking. Future studies exploring the long-term adherence and efficacy in novel and emerging treatments of OSA are required to fully understand the place of these treatments in treatment hierarchies. Such research also should aim to evaluate the use of these novel therapies in real-world clinical settings, because many of the studies performed to date have been done under closely monitored research populations a...
Source: Sleep Medicine Clinics - December 23, 2020 Category: Sleep Medicine Authors: Simon A. Joosten, Shane A. Landry, Ai-Ming Wong, Bradley A. Edwards Source Type: research
Summary and Update on Behavioral Interventions for Improving Adherence with Positive Airway Pressure Treatment in Adults
This article reviews studies published on behavioral interventions aimed at improving the uptake and ma intenance of PAP treatment (January 2016–February 2020). It discusses underlying factors in the poor uptake and discontinuation of treatment and the role of qualitative research to better understand the perspective of the patients. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - December 19, 2020 Category: Sleep Medicine Authors: Angela L. D ’Rozario, Yael Galgut, Megan Crawford, Delwyn J. Bartlett Source Type: research
Where to Next for Optimizing Adherence in Large-Scale Trials of Continuous Positive Airway Pressure?
Large-scale randomized trials of positive airway pressure (PAP) efficacy have been largely negative but PAP adherence was notably suboptimal across the trials. To address this limitation, evidence-based PAP adherence protocols embedded within the larger trial protocol are recommended. The complexity of such protocols depends on adequacy of resources, including funding and inclusion of behavioral scientist experts on the scientific team, and trial-specific considerations (eg, target population) and methods. Recommendations for optimizing PAP adherence in large-scale trials are set forth that address rigor and reproducibilit...
Source: Sleep Medicine Clinics - December 14, 2020 Category: Sleep Medicine Authors: Amy M. Sawyer, Douglas M. Wallace, Luis F. Buenaver, Alexa J. Watach, Amy Blase, Bruno Saconi, Sanjay R. Patel, Samuel T. Kuna, Naresh M. Punjabi Source Type: research
Adherence to Sleep Therapies in Children and Adolescents
Improved recognition of obstructive sleep apnea (OSA) in children has led many to identify effective strategies to treat pediatric OSA. Positive airway pressure (PAP) therapy in children, which has been shown to resolve OSA, is highly contingent on adequate adherence. In pediatrics, adherence is complex, related largely to the influence of age. Consequently, reported adherence rates in children are often lower than adults. Notwithstanding, studies have identified significant risk factors, some modifiable, and several intervention strategies that may improve pediatric adherence. Close follow-up, including use of cloud-based...
Source: Sleep Medicine Clinics - December 8, 2020 Category: Sleep Medicine Authors: Rakesh Bhattacharjee Source Type: research
Adherence to Positive Airway Pressure Therapy in Obesity Hypoventilation Syndrome
This article discusses in detail the impact of PAP therapy on outcomes in patients with OHS, compares adherence between continuous PAP and noninvasive ventilation in OHS, and compares PAP adherence in patients with OHS to patients with moderate to severe OSA enrolled in clinical trials designed to improve CPAP adherence. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - December 8, 2020 Category: Sleep Medicine Authors: Jeremy Wearn, Bimaje Akpa, Babak Mokhlesi Source Type: research
Socioeconomic Disparities in Positive Airway Pressure Adherence
Nonadherence with positive airway pressure (PAP) therapy impedes the effectiveness of treatment and increases risk of mortality. Disparities in PAP adherence as a function of socioeconomic status (SES) are not well understood. A literature search identified 16 original publications meeting inclusion criteria that described effects of SES factors on objective PAP adherence; 69% of these articles found evidence of lower adherence as a function of SES. This integrative review provides a structured summary of the findings, highlights factors that may contribute to disparities among adult PAP users, and identifies future direct...
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Earl Charles Crew, William K. Wohlgemuth, Amy M. Sawyer, Natasha J. Williams, Douglas M. Wallace Source Type: research
What Do We Know About Adherence to Oral Appliances?
Long-term effective therapy is essential for obstructive sleep apnea (OSA) control and preventing comorbidity. OSA patients are often reported to be more receptive to oral appliance therapy over positive airway pressure (PAP). Oral appliance usage can now be objectively recorded by temperature microsensors. Studies using commercially available microsensor chips have reported data out to 1 year, with high rates of adherence (>80%), albeit in small samples. There is opportunity to further use this technology to understand individual adherence factors and patterns and in obtaining objective measures of treatment effe...
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Kate Sutherland, Oyku Dalci, Peter A. Cistulli Source Type: research
Alternative Care Pathways for Obstructive Sleep Apnea and the Impact on Positive Airway Pressure Adherence
The high burden of obstructive sleep apnea (OSA), combined with inadequate supply of sleep specialists and constraints on polysomnography resources, has prompted interest in alternative models of care to improve access and treatment effectiveness. In appropriately selected patients, ambulatory clinical pathways and use of nonphysicians or primary care providers to manage OSA can improve timely access and costs without compromising adherence or other clinical outcomes. Although initial studies show promising results, there are several potential barriers that must be considered before broad implementation, and further implem...
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Martha E. Billings, Sachin R. Pendharkar Source Type: research
The Impact of Device Modifications and Pressure Delivery on Adherence
This article reviews the evidence to date examining whether adherence to positive airway pressure (PAP) therapy is affected by any device modifications to pressure delivery. To date there is no robust evidence from systematic reviews and meta-analyses indicating that any modification to standard fixed-pressure PAP makes a clinically significant difference to patient adherence to therapy. The main modifications are reviewed in this article and whether improving pressure could drive adherence, in turn improving patient outcomes, is discussed. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Roo Killick, Nathaniel S. Marshall Source Type: research
Can Smartphone Apps Assist People with Serious Mental Illness in Taking Medications as Prescribed?
This article presents adherence research as related to people with a diagnosis of a serious mental illness (SMI) and medication adherence through smartphone applications (apps). Individuals with SMI have high rates of not taking medication, increasing risks of relapse and hospitalization. Advances in technology may be advantageous in promoting taking medication. Smartphones apps have been designed for people with SMI. Further research is needed to evaluate their efficacy on improving rates of taking medication. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - December 7, 2020 Category: Sleep Medicine Authors: Cynthia L. Bianco, Amanda L. Myers, Stephen Smagula, Karen L. Fortuna Source Type: research
What is a Clinically Meaningful Target for Positive Airway Pressure Adherence?
Although good adherence to continuous positive airway pressure (PAP) traditionally is defined as greater than or equal to 4 hours/night, the origins and rationale for this remain unclear. Research studies report variation in optimal duration of PAP adherence, depending on outcome of interest. Evidence demonstrates benefit with PAP for daytime sleepiness, quality of life, neurocognitive outcomes, depression, and hyperte nsion, predominantly in symptomatic, moderate–severe obstructive sleep apnea. Recent randomized controlled trials, however, have failed to demonstrate a reduction in cardiovascular and mortality ...
Source: Sleep Medicine Clinics - December 2, 2020 Category: Sleep Medicine Authors: Aaron Oh, Nicole Grivell, Ching Li Chai-Coetzer Source Type: research
Noninvasive Ventilation in Amyotrophic Lateral Sclerosis
This article discusses the indications, timing, initiation, and management of noninvasive ventilation in amyotrophic lateral sclerosis. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - October 30, 2020 Category: Sleep Medicine Authors: Jessica A. Cooksey, Amen Sergew Source Type: research
Management of Chronic Respiratory Failure in Chronic Obstructive Pulmonary Disease: High-Intensity and Low-Intensity Ventilation
This article reviews the physiologic basis for considering NIV in patients with COPD, summarizes existing evidence supporting the role of NIV in COPD, highlights the patient population and ventilatory approach most likely to offer benefit, and suggests a potential clinical pathway for managing patients. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - October 30, 2020 Category: Sleep Medicine Authors: Jeremy E. Orr, Ana Sanchez Azofra, Lauren A. Tobias Source Type: research
A Comprehensive View of Noninvasive Ventilation
Noninvasive ventilation (NIV), often referred to interchangeably as noninvasive positive pressure ventilation, is the focus of the current issue. One of the earliest uses of the modern day NIV machines dates to the 1940s when a group from Columbia University at Bellevue Hospital devised an “automatic respirator” to provide intermittent positive pressure ventilation using a facemask for patients with acute respiratory failure.1 NIV was used during the polio epidemic and was especially important for those with disabilities and chronic respiratory failure to be able to live independe ntly in community-based living...
Source: Sleep Medicine Clinics - October 30, 2020 Category: Sleep Medicine Authors: Lisa F. Wolfe, Amen Sergew Tags: Preface Source Type: research
SLEEP MEDICINE CLINICS (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - October 30, 2020 Category: Sleep Medicine Authors: Lisa F. Wolfe, Amen Sergew Source Type: research
Sleep Medicine Clinics
Unravelling the Puzzle of Adherence in Sleep Medicine (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - October 30, 2020 Category: Sleep Medicine Source Type: research
Noninvasive Ventilation and Spinal Cord Injury
Individuals with spinal cord injury (SCI) are at increased risk of respiratory complications during wake and sleep. Sleep-disordered breathing (SDB) is commonly associated with SCI and requires an individualized approach to its management. Respiratory control plays a key role in the pathogenesis of SDB in cervical SCI. Noninvasive ventilation plays an important role in the management of respiratory complications in individuals with SCI acutely and in chronic phases. Positive airway pressure treatment may be effective in eliminating SDB and improving sleepiness symptoms, but adherence to treatment is poor and effect on long...
Source: Sleep Medicine Clinics - October 5, 2020 Category: Sleep Medicine Authors: Asil Daoud, Samran Haider, Abdulghani Sankari Source Type: research
Perioperative Care and Medication-related Hypoventilation
Cumulative evidence supports the association of adverse postoperative outcomes with obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). Although current guidelines recommend preoperative screening for OSA and OHS, the best perioperative management pathways remain unknown. Interventions attempting to prevent complications in the postoperative period largely are consensus based and focused on enhanced monitoring, conservative measures, and specific OSA therapies, such as positive airway pressure. Until further research is available to improve the quality and strength of these recommendations, patients w...
Source: Sleep Medicine Clinics - October 5, 2020 Category: Sleep Medicine Authors: Kara Dupuy-McCauley, Bernardo Selim Source Type: research
Tailoring the Sleep Laboratory for Chronic Respiratory Failure
“Many seemingly mundane aspects of the sleep laboratory can have outsized effects on the quality of polysomnographic data obtained from, and care provided to, patients. This is particularly true when performing polysomnography on patients with chronic respiratory failure due to various causes. Thi s article uses a disease-based approach to review physical and protocol-based accommodations that should be considered when performing polysomnography on this patient population.” (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - October 5, 2020 Category: Sleep Medicine Authors: Justin A. Fiala, John M. Coleman Source Type: research
Extubating to Noninvasive Ventilation
Weaning to noninvasive ventilation in intensive care unit and bridging the patients to home with respiratory support is evolving as the technology of noninvasive ventilation is improving. In patients with chronic obstructive pulmonary disease exacerbation, timing of initiation of noninvasive ventilation is the key, as persistently hypercapnic patients show benefits. High-intensity pressure support seems to do better in comparison to low-intensity pressure support. In patients with obesity and hypercapnia, obesity hypoventilation cannot be ruled out especially in an inpatient setting, and it is crucial that these patients a...
Source: Sleep Medicine Clinics - October 5, 2020 Category: Sleep Medicine Authors: Ashima S. Sahni, Lien-Khuong Tran, Lisa Wolfe Source Type: research
Noninvasive Ventilation Downloads and Monitoring
“Home noninvasive ventilation (NIV) is indicated for numerous conditions including neuromuscular disease, thoracic cage disorders, chronic obstructive pulmonary disease, and hypoventilation syndromes. Effective management of patients on home NIV requires clinicians to interpret data downloads from NIV devices. Clinicians must first look at adherence and factors that may impact this including mask comfort and fit. Next, leak assessment is undertaken. Once these are addressed, such information as apnea-hypopnea index, exhaled tidal volume, and percent triggered breaths help clinicians troubles hoot setting changes. Fin...
Source: Sleep Medicine Clinics - October 5, 2020 Category: Sleep Medicine Authors: Philip Choi, Veronique Adam, David Zielinski Source Type: research
Phrenic Nerve Involvement in Neuralgic Amyotrophy (Parsonage-Turner Syndrome)
Neuralgic amyotrophy is a poorly understood neuromuscular disorder affecting peripheral nerves mostly within the brachial plexus distribution but can also involve other sites including the phrenic nerve. In the classic form of the syndrome it causes proximal upper limb and neck pain on the affected side with subsequent muscle weakness that can be highly heterogeneous. Nocturnal noninvasive ventilation support is a first-line treatment after phrenic mononeuropathy. The regular monitoring of diaphragm function with spirometry and diaphragm ultrasound can help determine prognosis and inform decision-making. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - October 4, 2020 Category: Sleep Medicine Authors: Ellen Farr, Dom D ’Andrea, Colin K. Franz Source Type: research
Lifetime Care of Duchenne Muscular Dystrophy
Individuals with Duchenne muscular dystrophy (DMD) have evolving sleep and respiratory pathophysiology over their lifetimes. Across the lifespan of DMD, various sleep-related breathing disorders (SRBD) have been described, including obstructive sleep apnea, central sleep apnea, and nocturnal hypoventilation. In addition to SRBD, individuals with DMD can be affected by insomnia, chronic pain and other factors interfering with sleep quality, and daytime somnolence. The natural progression of DMD pathophysiology has changed with the introduction of therapies for downstream pathologic pathways and will continue to evolve with ...
Source: Sleep Medicine Clinics - October 4, 2020 Category: Sleep Medicine Authors: Erin W. MacKintosh, Maida L. Chen, Joshua O. Benditt Source Type: research
Management of Rare Causes of Pediatric Chronic Respiratory Failure
This article reviews pediatric-specific considerations of NiPPV therapy. Indications for NiPPV therapy can be categorized by the cause of the respiratory failure: (1) upper airway obstruction, (2) musculoskeletal and/or neuromuscular disease, (3) lower respiratory tract diseases, and (4) control of breathing abnormalities. The role of NiPPV therapy in select rare conditions (spinal muscular atrophy, congenital central hypoventilation syndrome, cerebral palsy, scoliosis, and Chiari malformations) is also reviewed. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - September 29, 2020 Category: Sleep Medicine Authors: Jenny Shi, Nawal Al-Shamli, Jackie Chiang, Reshma Amin Source Type: research
Obesity hypoventilation syndrome is the most frequent cause of chronic hypoventilation and is increasingly more common with rising obesity rates. It leads to considerable morbidity and mortality, particularly when not recognized and treated adequately. Long-term nocturnal noninvasive ventilation is the mainstay of treatment but evidence suggests that CPAP may be effective in stable patients. Specific perioperative management is required to reduce complications. Some unique syndromes associated with obesity and hypoventilation include rapid-onset obesity with hypoventilation, hypothalamic, autonomic dysregulation (ROHHAD), ...
Source: Sleep Medicine Clinics - September 24, 2020 Category: Sleep Medicine Authors: Roop Kaw, Marta Kaminska Source Type: research
Noninvasive Ventilator Devices and Modes
Noninvasive ventilation has become an increasingly common treatment strategy for patients with diverse conditions involving chronic respiratory failure. An intimate understanding of various advanced respiratory devices and modes is essential in the management of these patients. Pressure-limited modes of ventilation are more commonly used than volume modes for noninvasive ventilation owing to enhanced patient comfort and synchrony with the ventilator, as well as improved leak compensation. Common pressure modes include spontaneous/timed and pressure control, with volume-assured pressure support being an additive feature ava...
Source: Sleep Medicine Clinics - September 24, 2020 Category: Sleep Medicine Authors: Gaurav Singh, Michelle Cao Source Type: research
Tracheostomy to Noninvasive Ventilation
The number of patients experiencing prolonged mechanical ventilation is increasing over time. Patients who have a tracheostomy placed in a critical care setting have been described as having an average of 4 separate transitions between the acute care setting, long-term acute care (LTAC), and home. Transition points can be problematic if not addressed adequately; however, proactive planning can optimize patient care. Individual patient factors will determine if the patient will require long-term tracheostomy, transitioned to noninvasive positive pressure ventilation, or able to be decannulated. Patients and caregivers shoul...
Source: Sleep Medicine Clinics - September 6, 2020 Category: Sleep Medicine Authors: Jeanette Brown Source Type: research
Telemedicine in Pediatric Sleep
This article reviews how telemedicine has been explored in pediatric sleep medicine prior to the pandemic, current applications of telemedicine, challenges, and reimagining pediatric sleep within the realm of telemedicine. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - September 1, 2020 Category: Sleep Medicine Authors: Shalini Paruthi Source Type: research
Implementation of Synchronous Telemedicine into Clinical Practice
This article outlines how to implement a synchronous telemedicine practice into an existing workflow. Telemedicine-specific considerations are discussed, as well as guidance regarding practice assessment, financial feasibility, technical considerations, and clinical guidance to translate in-person visit skills into an effective virtual visit. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 4, 2020 Category: Sleep Medicine Authors: Seema Khosla Source Type: research
EHR Integration of PAP Devices in Sleep Medicine Implementation in the Clinical Setting
Positive airway pressure (PAP) therapy integration is a component of electronic health record (EHR) sleep medicine optimization. EHR optimization facilitates telehealth in continuous care population health. A coordinated care plan can leverage early telehealth interventions. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 4, 2020 Category: Sleep Medicine Authors: Tereza Cervenka, Conrad Iber Source Type: research
Telehealth in Sleep Medicine
SLEEP MEDICINE CLINICS (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - August 4, 2020 Category: Sleep Medicine Authors: Dennis hwang, Jean-louis p épin Source Type: research
Sleep Telemedicine: A Template for Other Specialties?
On March 18, 2020, the doors to our sleep center were physically closed. As with so many other sleep centers worldwide in response to COVID-19, our service transitioned completely to virtual care while care providers were moved to “work from home.” It was perhaps that moment that we felt the emotional impact that the world had changed, altering both our personal lives and sleep medicine as we knew it. This event also presented a transformative opportunity to reimagine our identity, accelerating the efforts to bring the fu ture of sleep medicine into the present. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - July 20, 2020 Category: Sleep Medicine Authors: Jean-Louis P épin, Dennis Hwang Tags: Preface Source Type: research