Carmen Monasterio

Background: Studies focusing on the effects of lifestyle strategies on patients with obstructive sleep apnea (OSA) that go beyond body weight and explore body composition are currently scarce and inconclusive. Objectives/Methods: The aim of this study was to evaluate the effects of a 12-month intensive life intervention program (ILI), based on a hypocaloric Mediterranean diet, on changes in the body composition parameters as assessed by abdominal computed tomography (CT) and the cardiorespiratory profile of patients with severe OSA and grade I–II obesity, compared to patients receiving standard care. Resultts:Thirty-four patients (30 males and four females) were randomly assigned to an intervention group (IG) (n = 18) or a control group (CG) (n = 16). We observed an improvement in OSA severity following the intervention. Patients in the IG lost 8.2% of their body weight compared to 0.1% of the patients in the CG (p < 0.001), and this loss was primarily due to reductions in total body fat, visceral adipose tissue index (VATI) [IG −19.4 (18.1) cm²/m² versus CG 2.32 (11.6) cm²/m², p < 0.001], and a tendency toward lower intramuscular adipose tissue index (IMATI) [IG −0.69 (0.85) cm²/m² versus CG 0.04 (1.3) cm²/m², p = 0.098]. These changes were associated with an improvement in patients’ metabolic and inflammatory profile. Younger age and a higher degree of obesity at baseline were associated with greater weight loss. Conslusions: In conclusion, the ILI was effective in reducing 8.2% of body weight at 12 months, leading to favorable changes in patients’ body composition profile that resulted in healthier metabolic and inflammatory parameters.

Introduction: Sleep-disordered breathing (SDB) is a major comorbidity in idiopathic pulmonary fibrosis (IPF) and is associated with a poor outcome. There is a lack of knowledge regarding the impact of SDB treatment on IPF. We assessed at one year: (1) the effect of CPAP and/or nocturnal oxygen therapy on IPF regarding lung function, blood mediators, and quality of life; (2) adherence to SDB treatment and SDB changes. Methodology: This is a prospective study of consecutive newly diagnosed IPF patients initiating anti-fibrotic treatment. Lung function, polysomnography, blood tests and quality of life questionnaires were performed at inclusion and after one year. Patients were classified as obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and sleep-sustained hypoxemia (SSH). SDB therapy (CPAP and/or nocturnal oxygen therapy) was initiated if needed. Results: Fifty patients were enrolled (36% had OSA, 22% CSA, and 12% SSH). CPAP was started in 54% of patients and nocturnal oxygen therapy in 16%. At one-year, polysomnography found improved parameters, though 17% of patients had to add nocturnal oxygen therapy or CPAP, while 33% presented SDB onset at this second polysomnography. CPAP compliance at one year was 6.74 h/night (SD 0.74). After one year, matrix metalloproteinase-1 decreased in OSA and CSA (p = 0.029; p = 0.027), C-reactive protein in OSA (p = 0.045), and surfactant protein D in CSA group (p = 0.074). There was no significant change in lung function. Conclusions: Treatment of SBD with CPAP and NOT can be well tolerated with a high compliance. IPF patients may exhibit SDB progression and require periodic re-assessment. Further studies to evaluate the impact of SDB treatment on lung function and serological mediators are needed.

Introduction: Continuous positive airway pressure (CPAP) titration was dramatically affected by the coronavirus disease 2019 (COVID-19) pandemic due to increased biological risk. This study aimed to compare successful CPAP adaptation and compliance with home telemedicine CPAP titration with the usual method based on face-to-face visits.Methodology: A prospective cohort using telemedicine home CPAP titration and follow-up during the COVID-19 pandemic (TC) was compared with a retrospective cohort receiving face-to-face pre-pandemic home titration (RC). The TC included a subgroup with a smartphone application (TC-APP). Successful CPAP adaptation and compliance at 1 month of follow-up were the main endpoints, while patient satisfaction and costs were secondary endpoints.Results: 210 consecutive patients were evaluated (80 RC and 130 TC). 36 patients were in the TC-APP subgroup. CPAP titration was successful in 90% in RCversus95% in TC and 100% in TC-APP. No compliance differences between groups were found at 1 month (4.79 h·night⁻¹RC, 4.33 h·night⁻¹TC and 4.59 h·night⁻¹TC-APP). Mean±sdpatient satisfaction out of 10 was 7.69±2.05 in RCversus9.02±0.64 in TC (pversusEUR 23.79±9.94 in TC-APP (p=0.048).Conclusions: Telemedicine in CPAP titration and early follow-up is equivalent to the usual care in terms of successful adaptation and compliance, while achieving greater patient satisfaction.

Patients with sleep apnea are usually treated with continuous positive airway pressure (CPAP). This therapy is very effective if the patient′s adherence is satisfactory. However, although CPAP adherence is usually acceptable during the first months of therapy, it progressively decreases, with a considerable number of patients accepting average treatment duration below the effectiveness threshold (4 h/night). Herein, our aim was to describe and evaluate a novel telemedicine strategy for rescuing CPAP treatment in patients with low adherence after several months/years of treatment. This two-week intervention includes (1) patient support using a smartphone application, phone and voice recorder messages to be answered by a nurse, and (2) daily transmission and analysis of signals from the CPAP device and potential variation of nasal pressure if required. On average, at the end of the intervention, median CPAP adherence considerably increased by 2.17 h/night (from 3.07 to 5.24 h/night). Interestingly, the procedure was able to markedly rescue CPAP adherence: the number of patients with poor adherence (<4 h/night) was considerably reduced from 38 to 7. After one month, adherence improvement was maintained (median 5.09 h/night), and only 13 patients had poor adherence (<4 h/night). This telemedicine intervention (103€ per included patient) is a cost-effective tool for substantially increasing the number of patients with CPAP adherence above the minimum threshold for achieving positive therapeutic effects.

Study Objectives:To determine whether an intensive weight-loss program (IWLP) is effective for reducing weight, the severity of sleep apnea syndrome (OSA) and metabolic variables in patients with o...