Improving CPAP Therapy with Superimposed Pressure Oscillation
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Abstract
Background: Continuous positive airway pressure (CPAP) is considered the gold standard therapy for Obstructive Sleep Apnea (OSA); however, many side effects, such as uncomfortable high titration pressure (TP) and mouth dryness, are associated with this treatment. This work proposes using pressure oscillations superimposed on a mean pressure to modulate the upper airways, reduce TP, and stimulate the salivary glands to reduce mouth dryness.
Methods: Two nonconsecutive overnight randomized controlled clinical trials were designed, one with a standard CPAP setup but reduced TP and the other by adding superimposed pressure oscillations (SIPO) to the reduced TP CPAP setup. 33 OSA patients who usually received CPAP treatment with predetermined TP settings participated in the two trials. Complete polysomnography was performed for sleep and patient assessments. However, a spitting technique protocol was used on 15 randomly selected patients from the same group to investigate the effect of SIPO on mouth dryness. These trials are registered under ACTRN12622001518752.
Results: The apnea-hypopnea index (AHI) was significantly reduced from 25.08 ± 2.32 to 17.56 ± 2.11 (p = 0.020*) with SIPO, indicating a 29.95% reduction in AHI and a decrease in breathing obstructions during enhanced therapy. Additionally, SIPO significantly decreased the oxygen desaturation index (ODI) (p = 0.002), maintaining the blood oxygen level within the normal range during the trials. ODI≥3 decreased significantly by 38.04% with SIPO. Saliva test results demonstrated that SIPO significantly increased saliva volume by 23.13% in non-stimulation and by 39.09% during stimulation compared to the CPAP trial.
Conclusions: This work demonstrates that SIPO reduces the TP to 70% of its standard clinical setting and stimulates salivary secretion to reduce mouth dryness. Further, significant improvements in AHI, respiratory arousal index (RAI), Arousal index (AI), and sleep efficiency (SE) are observed. This work is proof of concept, and further trials should be undertaken to generalize the proposed technique.
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References
2. Ball, Matthew, et al. “Anatomy, Air-way.” StatPearls, StatPearls Publishing, 31 July 2021.
3. Haba-Rubio, José et al. “Oscillating Positive Airway Pressure Versus CPAP for the Treatment of Obstructive Sleep Apnea.” Frontiers in med¬icine vol. 2 29. 11 May. 2015, doi:10.3389/fmed.2015.00029
4. Michalek-Zrabkowska, Monika et al. “The Rela¬tionship between Simple Snoring and Sleep Bruxism: A Polysomnographic Study.” Interna¬tional journal of environmental research and pub¬lic health vol. 17,23 8960. 2 Dec. 2020, doi:10.3390/ijerph17238960
5. Borsini, Eduardo et al. “Apnea-hypopnea index in sleep studies and the risk of over-simplifica¬tion.” Sleep science (Sao Paulo, Brazil) vol. 11,1 (2018): 45-48. doi:10.5935/1984-0063.20180010
6. Osman, Amal M et al. “Obstructive sleep ap-nea: current perspectives.” Nature and science of sleep vol. 10 21-34. 23 Jan. 2018, doi:10.2147/NSS.S124657
7. Blackwell, Jacob N et al. “Sleep Apnea and Sudden Cardiac Death.” Circulation reports vol. 1,12 (2019): 568-574. doi:10.1253/circrep.cr-19-0085
8. Ahmed, Mohamed-H, and Christopher-D Byrne. “Obstructive sleep apnea syndrome and fatty liver: association or causal link?.” World journal of gastroenterology vol. 16,34 (2010): 4243-52. doi:10.3748/wjg.v16.i34.4243
9. Ashaat, S, and Al-Jumaily, A.M., 2016. “Reduc¬ing upper airway collapse at lower continuous positive airway titration pressure”, Journal of Biomechanics 49 (2016) 3915–3922.
10. Puhan MA, Suarez A, Lo Cascio C, Zahn A, Heitz M, Braendli O. Didgeridoo playing as an alter¬native treatment for obstructive sleep apnoea syndrome: randomized controlled trial. BMJ. 2006;332(7536):266-270. doi:10.1136/bmj.38705.470590.55
11. Ieto V, Kayamori F, Montes MI, et al. Effects of oropharyngeal exercises on snoring: a random¬ized trial. Chest. 2015;148(3):683-691. doi:10.1378/chest.14-2439
12. Zhi-Wei L, Chun-Yu Y, Xue Z, et al. Vibroacous¬tic therapy as a complementary treatment for moderate-to-severe obstructive sleep apnea: a randomized controlled trial. Sleep Breath. 2017;21(3):673-681. doi:10.1007/s11325-016-1434-9
13. Sant'Anna, Marcelo de Lima et al. “Physical ex¬ercise stimulates the salivary secretion of cysta¬tins.” PloS one vol. 14,10 e0224147. 24 Oct. 2019, doi:10.1371/journal.pone.0224147
14. Adil, A., An Investigation into Improving the CPAP and the Electrical Stimulation for the OSA treatment. Ph.D. thesis, Auckland University of Technology, 2019.
15. Tan, Madeleine Wan Yong et al. “Prevalence of Sleep Bruxism and Its Association with Ob-structive Sleep Apnea in Adult Patients: A Ret-rospective Polysomnographic Investiga-tion.” Journal of oral & facial pain and head-ache vol. 33,3 (2019): 269–277. doi:10.11607/ofph.2068
16. Eckert, Danny J, and Atul Malhotra. “Patho-physiology of adult obstructive sleep ap-nea.” Proceedings of the American Thoracic So¬ciety vol. 5,2 (2008): 144-53. doi:10.1513/pats.200707-114MG
17. Manzar, Md Dilshad et al. “Validity of the Pitts¬burgh Sleep Quality Index in Indian University Students.” Oman medical journal vol. 30,3 (2015): 193-202. doi:10.5001/omj.2015.41
18. Lin, Hsin-Yu et al. “Effects of a comprehensive physical therapy on moderate and severe ob-structive sleep apnea- a preliminary random-ized controlled trial.” Journal of the Formosan Medical Association = Taiwan yi zhi vol. 119,12 (2020): 1781-1790. doi:10.1016/j.jfma.2020.01.011
19. Mok Y, Tan A, Hsu PP, Seow A, Chan YH, Wong HS, Poh Y, Wong KKH. Comparing treatment effects of a convenient vibratory positional de¬vice to CPAP in positional OSA: a crossover ran¬domized controlled trial. Thorax. 2020 Apr;75(4):331-337. doi: 10.1136/thoraxjnl-2019-213547. Epub 2020 Jan 2. PMID: 31896735; PMCID: PMC7231442.
20. Menon, Akshay, and Manoj Kumar. “Influence of body position on severity of obstructive sleep apnea: a systematic review.” ISRN otolaryngol¬ogy vol. 2013 670381. 8 Oct. 2013, doi:10.1155/2013/670381
21. van Kesteren, Ellen R et al. “Quantitative effects of trunk and head position on the apnea hypop¬nea index in obstructive sleep ap¬nea.” Sleep vol. 34,8 1075-81. 1 Aug. 2011, doi:10.5665/SLEEP.1164
22. Yamauchi, Motoo et al. “Nonrapid Eye Move-ment-Predominant Obstructive Sleep Apnea: Detection and Mechanism.” Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine vol. 11,9 987-93. 15 Sep. 2015, doi:10.5664/jcsm.5010
23. Kelly, A M et al. “How accurate are pulse oxi-meters in patients with acute exacerbations of chronic obstructive airways dis-ease?.” Respiratory medicine vol. 95,5 (2001): 336-40. doi:10.1053/rmed.2001.1046
24. Bortolotti, Mauro. “The Cause of Dry Mouth Dur¬ing CPAP Application.” Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine vol. 13,4 647. 15 Apr. 2017, doi:10.5664/jcsm.6568
25. Iorgulescu, Gabriela. “Saliva between normal and pathological. Important factors in deter-mining systemic and oral health.” Journal of medicine and life vol. 2,3 (2009): 303-7.
26. Abdeyrim, A., Tang, L., Muhamat, A. et al. “Re¬ceiver operating characteristics of impulse os¬cillometry parameters for predicting obstruc¬tive sleep apnea in preobese and obese snor¬ers”. BMC Pulm Med 16, 125 (2016).