Bei der Erbringung schlafmedizinischer Leistungen im Zusammenhang mit der Corona-Pandemie sind besondere Aspekte zu berücksichtigen. Trotz aller vorbeugender Maßnahmen muss aufgrund der hohen ...Dunkelziffer mit SARS-CoV2-Kontakten im Schlaflabor gerechnet und entsprechende Vorkehrungen getroffen werden. Die Fortführung bzw. Wiederaufnahme schlafmedizinischer Leistungen unter den gebotenen Hygienemaßnahmen ist dennoch dringend anzustreben zur Vermeidung medizinischer und psychosozialer Komplikationen. Es gibt keine gesicherten Hinweise für eine Verschlechterung der COVID-19 durch eine CPAP-Therapie. Grundsätzlich kann die Anwendung einer Überdrucktherapie über verschiedene Maskensysteme mit der Bildung einer infektiösen Aerosolwolke einhergehen. Bei bestätigter Infektion mit SARS-CoV-2 sollte im ambulanten Umfeld eine vorbestehende Maskentherapie unter Einhaltung der Vorgaben des RKI zur häuslichen Isolierung fortgeführt werden, da eine Therapiebeendigung mit einer zusätzlichen kardiopulmonalen Belastung durch die unbehandelte schlafbezogene Atmungsstörung einhergeht. Mit geeigneter persönlicher Schutzausrüstung (Augenschutz, FFP2/FFP3-Maske, Kittel) kann eine PAP-Therapie nach jetzigem Kenntnisstand vom Personal ohne erhöhtes Infektionsrisiko durchgeführt werden.
Dieses gemeinsame Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) und der Deutschen Gesellschaft für Schlafmedizin (DGSM) beinhaltet konkrete Empfehlungen zur Durchführung schlafmedizinischer Diagnostik und Therapie im Umfeld der Corona-Pandemie.
Since sleep apnea often occurs in heart failure, physicians regularly need to decide whether further diagnostic procedures and/or treatment are required.
Which types of sleep apnea occur in heart ...failure patients? When is treatment needed? Which treatments and treatment goals are appropriate?
Clinical trials and guidelines as well as their implementation in clinical practice are discussed.
At least 40% of patients with heart failure, both with reduced and preserved left ventricular ejection fraction (HFrEF and HFpEF, respectively), suffer from relevant sleep apnea. In heart failure patients both obstructive and central sleep apnea are associated with increased mortality. In HFrEF as well as in HFpEF patients with obstructive sleep apnea, treatment with continuous positive airway pressure (CPAP) achieves symptomatic and functional improvements. In patients with HFpEF, positive airway pressure treatment of central sleep apnea may be beneficial. In patients with HFrEF and left ventricular ejection fraction ≤45%, adaptive servoventilation is contraindicated.
Sleep apnea is highly prevalent in heart failure patients and its treatment in specific patient groups can improve symptoms and functional outcomes. Thus, testing for sleep apnea is recommended.
The association between nocturnal apneas and transient pulmonary hypertension (PHT) has been well documented. However, there is controversy over the frequency and pathophysiological mechanisms of ...daytime pulmonary hypertension in patients with obstructive sleep apnea (OSAS). The present study sought to evaluate frequency and mechanisms of pulmonary hypertension in patients with OSAS. It included 49 consecutive patients with polysomnographically proven OSAS without pathological lung function testing. All patients performed daytime measurements of pulmonary hemodynamics at rest and during exercise (50-75W). Six patients (12%) had resting PHT mean pulmonary of artery pressure (PAPM) of >20 mmHg), whereas 39 patients (80%) showed PHT during exercise (PAPM >30 mmHg). Multiple regression analysis revealed 3 independent contributing factors for mean pulmonary artery pressure during exercise (PAPMmax): body mass index, age and total lung capacity % of predicted. Twenty-five of the 39 patients with pathologically high PAPMmax (64%) showed elevated pulmonary capillary wedge pressures (PCWPmax > 20 mmHg), whereas no patient had elevated pulmonary vascular resistance (PVRmax > 120 dynes x s x cm(-5)). In conclusion, daytime PHT during exercise is frequently seen in patients with OSAS and normal lung function testing and is mainly caused by abnormally high PCWP, whereas PVR seems to play a minor role.
Mucosal drying during continuous positive airway pressure (CPAP) therapy is problematic for many patients. This study assessed the influence of ambient relative humidity (rH) and air temperature (T) ...in winter and summer on mask humidity during CPAP, with and without mask leak, and with or without heated humidification ± heated tubing.
CPAP (8 and 12 cmH
O) without humidification (no humidity nH), with heated humidification controlled by ambient temperature and humidity (heated humidity HH) and HH plus heated tubing climate line (CL), with and without leakage, were compared in 18 subjects with OSA during summer and winter.
The absolute humidity (aH) and the T inside the mask during CPAP were significantly lower in winter versus summer under all applied conditions. Overall, absolute humidity differences between summer and winter were statistically significant in both HH and CL vs. nH (
< 0.05) in the presence and absence of mouth leak. There were no significant differences in aH between HH and CL. However, in-mask temperature during CL was higher (
< 0.05) and rH lower than during HH. In winter, CPAP with CL was more likely to keep rH constant at 80% than CPAP without humidification or with standard HH.
Clinically-relevant reductions in aH were documented during CPAP given under winter conditions. The addition of heated humidification, using a heated tube to avoid condensation is recommended to increase aH, which could be useful in CPAP users complaining of nose and throat symptoms.
Abstract Several features of cardiovascular devices raise considerations for clinical trial conduct. Prospective, randomized, controlled trials remain the highest quality evidence for safety and ...effectiveness assessments, but, for instance, blinding may be challenging. In order to avoid bias and not confound data interpretation, the use of objective endpoints and blinding patients, study staff, core labs, and clinical endpoint committees to treatment assignment are helpful approaches. Anticipation of potential bias should be considered and planned for prospectively in a cardiovascular device trial. Prospective, single-arm studies (often referred to as registry studies) can provide additional data in some cases. They are subject to selection bias even when carefully designed; thus, they are generally not acceptable as the sole basis for pre-market approval of high risk cardiovascular devices. However, they complement the evidence base and fill the gaps unanswered by randomized trials. Registry studies present device safety and effectiveness in day-to-day clinical practice settings and detect rare adverse events in the post-market period. No single research design will be appropriate for every cardiovascular device or target patient population. The type of trial, appropriate control group, and optimal length of follow-up will depend on the specific device, its potential clinical benefits, the target patient population and the existence (or lack) of effective therapies, and its anticipated risks. Continued efforts on the part of investigators, the device industry, and government regulators are needed to reach the optimal approach for evaluating the safety and performance of innovative devices for the treatment of cardiovascular disease.
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