Effect of particulate matter on continuous positive airway pressure adherence in obstructive sleep apnea patients

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Abstract

Background

Sleep quality could be affected by air pollution, especially for particulate matter with a diameter of less than 10 microns (PM ₁₀) and particulate matter with a diameter of less than 2.5 microns (PM _2.5). However, no direct study demonstrates the relationship and impact of air pollution especially PM ₁₀ and PM _2.5 on continuous positive airway pressure (CPAP) adherence. Thus, we aimed to study the correlation between PM ₁₀, PM _2.5, and low CPAP adherence in subjects with obstructive sleep apnea (OSA).

Methods

We conducted a time-series study from August 2016 to May 2022 in Chiang Mai, Thailand. The data from 2,686 visits of CPAP compliance records from 839 OSA patients’ electronic medical records at the Sleep Disorders Center, Center of Medical Excellence, Chiang Mai University, Chiang Mai, Thailand were reviewed. The level of adherence was determined utilizing the provided data. Low CPAP adherence was defined as using CPAP for less than 240 minutes per night or less than 70% of nights (i.e., <5 nights/week) in the previous month. The correlation between the monthly average of PM ₁₀ and PM _2.5 and the rate of low CPAP adherence was analyzed using generalized linear mixed model (GLMM) after adjustment for confounding factors.

Results

There was no effect of an increase in PM ₁₀ and PM _2.5 on low CPAP adherence [adjusted risk ratio (RR) =0.97; 95% confidence interval (CI): 0.87, 1.09; P value =0.624 and adjusted RR =0.93; 95% CI: 0.81, 1.08; P value =0.350 for PM ₁₀ and PM _2.5, respectively].

Conclusions

There was no effect of particulate matter on CPAP adherence in OSA patients.

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Most cited references 21

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Predictors of long-term compliance with continuous positive airway pressure.

V Tippett, J Stradling, Malcolm Kohler … (2010)

There are very few data on objectively assessed long-term compliance with continuous positive airway pressure (CPAP). No single factor has been consistently identified as predictive of continued CPAP use. Adherence to and associations with objective CPAP use were examined in 639 of 3900 patients in whom CPAP treatment was started between 1994 and 2005. Kaplan-Meier survival analyses were used to estimate the proportion of patients still on CPAP. Cox regression models were used to explore the effects of covariates on continued use of CPAP. The median (IQR) follow-up time after initiating CPAP therapy was 3.9 (1.5-6.9) years and the average use of CPAP was 6.2 (4.5-7.3) h/night. The percentage of patients adherent to CPAP after 5 and 10 years was 81% and 70%, respectively. Multivariate analysis, including gender, age, neck circumference, Epworth Sleepiness Score, oxygen desaturation index (ODI) and research study participation, indicated that ODI was the only clinical variable independently associated with long-term adherence to CPAP (HR per 1 event=0.97, p 15-30/h=0.68, p=0.100, 95% CI 0.43 to 1.08; for ODI group >30-60/h=0.37, p 60/h=0.17, p=0.001, 95% CI 0.06 to 0.48). The majority of patients with sleep-disordered breathing are using CPAP in the long term and the severity of sleep-disordered breathing rather than sleepiness determines long-term adherence to CPAP therapy.

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Adherence to continuous positive airway pressure treatment for obstructive sleep apnoea: implications for future interventions.

Broderick A. Sawyer, T. Weaver (2010)

Adherence to continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) is a critical problem. Poor adherence (30-60%) to CPAP is widely recognized as a significant limiting factor in treating OSA, reducing the overall effectiveness of the treatment and leaving many OSA patients at heightened risk for co-morbid conditions, impaired function and quality of life. The extant literature examining adherence to CPAP provides critical insight to measuring adherence outcomes, defining optimal adherence levels, and predicting CPAP adherence. This research has revealed salient factors that are associated with or predict CPAP adherence and may guide the development of interventions to promote CPAP adherence. Over the past 10 years, intervention studies to promote CPAP adherence have incorporated a multitude of strategies including education, support, cognitive behavioural approaches, and mixed strategies. This review of the current status of research on CPAP adherence will (i) synthesize the extant literature with regard to measuring, defining, and predicting CPAP adherence; (ii) review published intervention studies aimed at promoting CPAP adherence; and (iii) suggest directions for future empiric study of adherence to CPAP that will have implications for translational science. Our current understanding of CPAP adherence suggests that adherence is a multi-factorial, complex clinical problem that requires similarly designed approaches to effectively address poor CPAP adherence in the OSA population.

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Acute effects of air pollutants on daily mortality and hospitalizations due to cardiovascular and respiratory diseases

Chaicharn Pothirat, Warawut Chaiwong, Chalerm Liwsrisakun … (2019)

Background Chiang Dao is one of the districts in Chiang Mai, Thailand facing high level of seasonal air pollution every year, the exposure of community dwellers to outdoor air pollutants 24 hours a day during seasonal smog period because of their open-air housing style, and agricultural occupational hazard. In addition, Chiang Dao hospital is the only available hospital serving the community with open-air wards; therefore we could certainly to identify the association between air pollution and mortality of hospitalized patients. Thus, the aim of this study was to determine the association between daily average seasonal air pollutants and daily mortality of hospitalized patients and community dwellers as well as emergency and hospitalization visits for serious respiratory, cardiovascular, and cerebrovascular diseases. Methods This time series study was conducted between 1 March 2016 and 31 March 2017. The association of various air pollutant concentrations including particulate matter diameter less than 10 and 2.5 microns (PM 10 and PM 2.5 ), sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), carbon monoxide (CO), ozone (O 3 ) and daily mortality of hospitalized patients and community dwellers as well as relationship with frequencies of serious respiratory, cardiovascular, and cerebrovascular diseases were analyzed using a general linear model with Poisson distribution. Results Only PM 2.5 was found to be associated with increased daily mortality of hospitalized patients (lag day 6, adjusted RR =1.153, 95% CI: 1.001–1.329), whereas PM 10 , PM 2.5 , NO 2 , and O 3 were associated with increased daily non-accidental mortality of community dwellers (lag day 0–7, adjusted RR =1.006–1.040, 95% CI: 1.000–1.074). For acute serious respiratory events; PM 10 and PM 2.5 were associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), while SO 2 , CO, and O 3 were associated with emergency visits for community-acquired pneumonia (CAP). O 3 was associated with emergency visits for heart failure (HF), NO 2 with emergency visits for myocardial infarction (MI), and SO 2 with hospitalized visits for cerebrovascular accident (CVA). Conclusions Seasonal air pollutants were found to be associated with higher mortality among hospitalized patients and community dwellers with varying effects on severe acute respiratory, cardiovascular, and cerebrovascular diseases.

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Author and article information

Journal

Journal ID (nlm-ta): J Thorac Dis

Journal ID (iso-abbrev): J Thorac Dis

Journal ID (publisher-id): JTD

Title: Journal of Thoracic Disease

Publisher: AME Publishing Company

ISSN (Print): 2072-1439

ISSN (Electronic): 2077-6624

Publication date (Electronic): 08 March 2024

Publication date (Print): 29 March 2024

Volume: 16

Issue: 3

Pages: 2004-2010

Affiliations

[1 ]deptSleep Disorders Center, Center for Medical Excellence , Chiang Mai University , Chiang Mai, Thailand;

[2 ]deptDivision of Pulmonary and Critical Care, Department of Pediatric, Faculty of Medicine , Chiang Mai University , Chiang Mai, Thailand;

[3 ]deptDivision of Pulmonary, Critical Care and Allergy, Department of Internal Medicine , Chiang Mai University , Chiang Mai, Thailand

Author notes

Contributions: (I) Conception and design: All authors; (II) Administrative support: K Sunkonkit, N Tiyapun, R Worasuthaneewan, T Theerakittikul; (III) Provision of study materials or patients: K Sunkonkit, N Tiyapun, R Worasuthaneewan, T Theerakittikul; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Theerakorn Theerakittikul, MD, FCCP. Sleep Disorders Center, Center for Medical Excellence, Chiang Mai University, Chiang Mai, Thailand; Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Chiang Mai University, 110 Inthavaroros Rd., Sriphum, Muang Chiang Mai, Chiang Mai 50200, Thailand. Email: theerakorn.t@ 123456cmu.ac.th .

Author information

Kanokkarn Sunkonkit https://orcid.org/0000-0003-2725-4636

Warawut Chaiwong https://orcid.org/0000-0003-4459-7681

Article

Publisher ID: jtd-16-03-2004

DOI: 10.21037/jtd-23-1507

PMC ID: 11009577

SO-VID: db739f94-1250-4941-bca0-197126cda316

License:

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

Effect of particulate matter on continuous positive airway pressure adherence in obstructive sleep apnea patients

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Abstract

Background

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Conclusions

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Most cited references 21

Predictors of long-term compliance with continuous positive airway pressure.

Adherence to continuous positive airway pressure treatment for obstructive sleep apnoea: implications for future interventions.

Acute effects of air pollutants on daily mortality and hospitalizations due to cardiovascular and respiratory diseases

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