[Objectives and methodology of recordings with CPAP].
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Continuous Positive Airway Pressure↗
Biomedical subjects
B Fleury
Publications and source records attributed to B Fleury.
[Which mandibular advancement splint should be chosen and how should effective advancement be defined?].
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Humans↗
Economic arguments for the immediate management of moderate-to-severe obstructive sleep apnoea syndrome.
The objective of this study was to measure the impact of a 6-month delay in the diagnosis and treatment of patients with moderate obstructive sleep apnoea syndrome (OSAS) (apnoea/hypopnoea index (AHI) < 30) or severe OSAS (AHI > or = 30) on daytime sleepiness, cognitive functions, quality of life and healthcare expenditure (hospitalisations, medical visits, complementary tests, biological tests and drug prescriptions). In addition, this study aimed to analyse the incremental cost effectiveness ratios related to daytime sleepiness or quality of life following immediate introduction of treatment in these two populations. This study was conducted as a multicentre randomised controlled trial and carried out at two teaching hospitals in France. A total of 171 patients were followed for 6 months, with 82 patients randomised to group 1 "immediate polysomnography" and 89 in group 2 "polysomnography within 6 months". Patients with severe OSAS were deprived of a significant improvement of their daytime sleepiness (5.1 +/- 5.0 at the Epworth Sleepiness Scale score in group 1 versus 0.2 +/- 3.4 in group 2) and quality of life (12.4 +/- 13.3 at the Nottingham Health Profile score in group 1 versus 0.7 +/- 10.1 in group 2) during the waiting time. The impact of delayed management in subjects with less severe OSAS only concerned daytime sleepiness (1.1 +/- 3.3 in group 1 versus 0.3 +/- 4.3 in group 2). Delayed treatment did not affect cognitive functions or healthcare expenditure regardless of the severity of the disease. Incremental cost effectiveness ratios related to rapid introduction of treatment were significantly lower in the patients with more severe OSAS. These results provide fairly clear medical and economic arguments in favour of early management of patients with more severe forms of obstructive sleep apnoea syndrome.
Adolescent↗
Wrist-actigraphic estimation of sleep time under nCPAP treatment in sleep apnoea patients.
The aim of this study was to correlate daily use of nasal continuous positive airway pressure (nCPAP) with total sleep time (TST) evaluated by home actigraphy. Actigraphy was validated by comparing TST determined by actigraphy (aTST) and polysomnography (pTST) in 24 untreated patients with suspected sleep apnoea. The % sleep time spent under nCPAP was estimated on 3 consecutive days in 28 patients receiving long-term nCPAP, by comparing machine-use periods with sleep periods identified by home actigraphy. The mean difference between pTST and aTST was 2.5 min. The correlation coefficient between aTST and pTST was 0.90. Daily use of nCPAP over the 3 study days was 388 +/- 114 min. nCPAP was used 41-100% (82 +/- 17% (mean +/- sD)) of sleep time detected by actigraphy. Some patients used nCPAP during nonsleep periods. In conclusion, comparison of nasal continuous positive airway pressure use with sleep time estimated by home actigraphy shows marked individual differences in the % sleep time under nasal continuous positive airway pressure. These results suggest that actigraphic estimation of sleep time under nasal continuous positive airway pressure could provide a better index than simple daily use of the device to evaluate the impact of treatment in sleep apnoea.
Female↗
[Treatment of obstructive sleep apnea syndrome with mandibular advancement orthesis].
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Equipment Design↗
Transitory increased blood pressure after upper airway surgery for snoring and sleep apnea correlates with the apnea-hypopnea respiratory disturbance index.
A transitory increase in blood pressure (BP) is observed following upper airway surgery for obstructive sleep apnea syndrome but the mechanisms implicated are not yet well understood. The objective of the present study was to evaluate changes in BP and heart rate (HR) and putative factors after uvulopalatopharyngoplasty and septoplasty in normotensive snorers. Patients (N = 10) were instrumented for 24-h ambulatory BP monitoring, nocturnal respiratory monitoring and urinary catecholamine level evaluation one day before surgery and on the day of surgery. The influence of postsurgery pain was prevented by analgesic therapy as confirmed using a visual analog scale of pain. Compared with preoperative values, there was a significant (P < 0.05) increase in nighttime but not daytime systolic BP (119 5 vs 107 3 mmHg), diastolic BP (72 4 vs 67 2 mmHg), HR (67 4 vs 57 2 bpm), respiratory disturbance index (RDI) characterized by apnea-hypopnea (30 10 vs 13 4 events/h of sleep) and norepinephrine levels (22.0 4.7 vs 11.0 1.3 g l-1 12 h-1) after surgery. A positive correlation was found between individual variations of BP and individual variations of RDI (r = 0.81, P < 0.01) but not between BP or RDI and catecholamines. The visual analog scale of pain showed similar stress levels on the day before and after surgery (6.0 0.8 vs 5.0 0.9 cm, respectively). These data strongly suggest that the cardiovascular changes observed in patients who underwent uvulopalatopharyngoplasty and septoplasty were due to the increased postoperative RDI.
Analysis of Variance↗
The age and other factors in the evaluation of compliance with nasal continuous positive airway pressure for obstructive sleep apnea syndrome. A Cox's proportional hazard analysis.
Objective: To elucidate the predictive role of age and other pre-treatment, putative confounding factors on compliance with nasal continuous positive airway pressure (nCPAP) therapy.Patients and methods: This study was designed as a prospective cohort study in the setting of a sleep laboratory in a teaching hospital at Saint Antoine, Paris. One hundred and sixty-three patients referred to the sleep laboratory with complaints of snoring and excessive daytime sleepiness for whom nCPAP had been prescribed for obstructive sleep apnea syndrome (OSAS; defined as an apnea-hypopnea index (AHI) of >15/h of sleep during a polysomnographic recording) were followed for a median period of 887 days. The main outcome measure was the risk ratio for elderly patients associated with nCPAP compliance.Results: Four patients, who remained under treatment, died before the end of the study, and 50 patients stopped their nCPAP therapy for reasons other than death (insomnia, equipment too noisy, etc.). When compliance curves were compared by univariate analysis (log-rank test), the oldest group (57/163 patients, >60 years old) was significantly less compliant with nCPAP than the youngest (P=0.01). However, in the Cox's proportional hazards model, age did not exert any independent effect on compliance with nCPAP after controlling for confounding factors (adjusted relative risk, 1.09, 0.5-2; P=0.70). On the other hand, female sex (adjusted relative risk, 2.8, 1.4-5.4; P=0.002), a body mass index (BMI) of </=30 kg/m(2) (adjusted relative risk, 2.2, 1.2-4; P=0.006), an Epworth sleepiness scale (ESS) score of </=15 (adjusted relative risk, 3.2, 1.1-8.9; P=0.025), an AHI of </=30/h (adjusted relative risk, 2.2, 1.2-4; P=0.01) and a nCPAP of >/=12 cmH(2)O (adjusted relative risk, 2.3, 1.2-4.4; P=0.011) were predictive factors for non-compliance.Conclusion: This study suggests that there is no independent effect of age on compliance with nCPAP therapy.
Journal Article↗
Characterization and analysis of a stable serotype-associated membrane protein (P30) of Mycoplasma agalactiae.
The gene for a 30-kDa immunodominant antigen, P30, of Mycoplasma agalactiae was cloned from type strain PG2 and expressed in Escherichia coli. P30 is encoded on a monocistronic operon determined by two -10 boxes and a possible -35 region constituting the potential promoter, and a transcription termination site. The gene for the 266-amino-acid protein is preceded by a polypurine-rich region designed as the consensus sequence for a ribosome-binding site. Analysis of the amino acid sequence of P30 revealed the presence of a recognition site for a prokaryotic signal peptidase II at amino acid (aa) 24, indicating that P30 is a transmembrane protein. Moreover, Triton X-114 phase partitioning of M. agalactiae PG2 total antigen revealed that P30 is strongly hydrophobic and hence a possible membrane component. Immunoblot analysis using the monospecific polyclonal anti-P30-His serum indicated that P30 is specific to M. agalactiae. Furthermore, PCR amplification with specific primers for p30 and Southern blot analysis revealed the presence of the gene in all M. agalactiae strains tested and its absence in the other mycoplasma species. Among 27 strains of M. agalactiae studied, 20 strains belonging to the common serotypes A to D, including PG2, expressed P30 or part of it as detected by the monospecific polyclonal anti-P30 antibodies. The other seven strains belonging to the rarely isolated serotypes E to H were negative for P30. The p30 gene was sequenced in 15 strains of M. agalactiae, 10 of which expressed P30 or at least part of it and 5 of which did not express P30. The negative strains carried mutations in both -10 boxes of the promoters. These mutations seem to be responsible for the lack of P30 expression in these strains. Analysis of sera from sheep that were experimentally infected with M. agalactiae revealed that P30 induced a strong and persistent immune response which was still very high two months after infection. In contrast, currently used enzyme-linked immunosorbent assay serology gave only low titers.
Adhesins, Bacterial↗
Predictive factors for the need for additional humidification during nasal continuous positive airway pressure therapy.
OBJECTIVE: To identify potential risk factors for the need for an additional cold or heated humidifier in nasal continuous positive airway pressure (nCPAP) circuitry. DESIGN: A prospective cohort study. SETTING: University hospital sleep-disorders center. PATIENTS: Eighty-two consecutive patients with obstructive sleep apnea syndrome were followed up for a median of 347 days (range, 3 to 530 days) after the initiation of nCPAP therapy. MEASUREMENTS AND RESULTS: In 46 patients (56%), the occurrence of upper-airway symptoms led to the addition of a cold humidifier after a median time of 39 days (range, 2 to 94 days). In 23 of the 46 patients, the persistence of the symptoms indicated the secondary use of a heated humidifier after a median time of 28 days (range, 5 to 70 days). nCPAP use (mean +/- SD) was not influenced by cold humidification (4.58 +/- 2.05 h/d vs 4.7 +/- 2.48 h/d; p = 0.75), but it increased significantly with heated humidification (5.38 +/- 2.26 h/d vs 3.51 +/- 2.53 h/d; p < 0.01). Anthropometric characteristics, drying medications, clinical findings such as deformity of the nasal septum, symptoms of a chronic mucosa disease (CMD), a previous uvulopalatopharyngoplasty (UPPP), and polysomnographic parameters had no significant effect on the need for a cold humidifier. Age > 60 years (odds ratio [OR], 5.58; 95% confidence interval [CI], 1.69 to 18.43), drying medications (OR, 6.59; 95% CI, 1.29 to 33.51), presence of CMD (OR, 4.11; 95% CI, 1.24 to 13.58), and previous UPPP (OR, 4.56; 95% CI, 1.18 to 17.6) were found as significant risk factors for the addition of a heated humidifier. CONCLUSION: Our results demonstrate that heated humidification significantly improves the nCPAP daily rate of use and that its need may be predicted.
Aged↗
A cost-minimization study of telemedicine. The case of telemonitored polysomnography to diagnose obstructive sleep apnea syndrome.
OBJECTIVES: In a context where sleep laboratories are overwhelmed by a growing demand to diagnose obstructive sleep apnea syndrome (OSAS), efficient substitutive solutions to in-laboratory polysomnography should be found. To compare the effectiveness and costs of home unattended polysomnography (Hpsg) and telemonitored polysomnography (TMpsg), a cost minimization study was performed. METHODS: In a crossover trial, 99 patients underwent on two consecutive nights TMpsg and Hpsg according to a randomized order. A legibility recording criterion was retained to measure effectiveness. A microcosting study of TMpsg and Hpsg was performed. The risks to adopt home strategy or telemonitored strategy, according to different scenario chosen to reach the diagnosis in case of failure of Hpsg or TMpsg, were analyzed. RESULTS: The recording was considered to be ineffective in 11.2% of TMpsg (95% CI, 4.9-17.4) and in 23.4% (95% CI, 19.12-27.68) of Hpsg. The effectiveness differential was 12.2% (95% CI, 1.8-22.6) (p = .02). Assuming that in case of failure PSGs would be re-realized in the same condition to reach the diagnosis, then TMpsg could be selected if Hc/TMc (cost of Hpsg/cost of TMpsg) > 0.97; Hpsg could be selected if Hc/TMc < 0.76. If 0.76 < or = Hc/TMc < or = 0.97, the choice of TMpsg would be ambiguous. TMc was estimated to be $244, while Hc was $153 (Hc/TMc = 0.63). CONCLUSION: Unless some specific geographical situations generate significant transport costs, the implementation of a strategy based on unattended polysomnography at home is cost-saving compared to a telemonitoring strategy.
Cost Savings↗
[Obstructive sleep apnea syndrome and the upper airway muscles].
Pharyngeal muscles are prone to distorsion during inspiratory negative pressure. Some pharyngeal muscles, called pharyngeal dilatators, exhibit tonic and/or phasic inspiratory activity. At the velar level, tensor palatini, glossopharyngeus, palatopharyngeus and musculus uvula drive the airflow towards nasal or buccal breathing. Genioglossus and geniohyoid muscles exert a forward propulsion to the tongue. The contraction of the dilatators muscles precedes the diaphram contraction. These muscles show a poor endurance. In obstructive sleep apnea syndrome, they contract during unfavorable metabolic (hypoxia and hypercapnia) as well as mechanical (excentrical contraction) conditions. Histological changes occur in upper airway dilator muscles: muscle volume and proportion of type Ila fibers are increased. These changes, considered as compensatory mechanisms, are variable within the different studied pharyngeal muscles. The initial pharyngeal obstructive site, and its further extension, could be determined by the different strength and endurance properties of these muscles.
Airway Resistance↗
[Obstructive-sleep apnea syndrome: brain oxygenation measured with near-infrared spectroscopy. Preliminary results].
This study assessed cerebral oxygenation in four obstructive sleep apnea syndrome (SAOS) patients (age = 51.8 +/- 15 years, apnea-hypopnea index = 68-125 per hour), during sleep and waking time, using near infrared spectoscopy (NIRS), during a standard polysomnography. Oxyhemoglobin (HbO2, reflecting cerebral oxygenation), total hemoglobin (Hbt, reflecting cerebral blood volumes) and cerebral oxygen saturation (SaO2c = HbO2/Hbt), were compared to the data obtained in four snorers not presenting apneas (age = 51.8 +/- 6.6, apnea-hypopnea index = 2.6-6.2 per hour) examined in the same way. The main result was that HbO2 values were reduced in SAOS patients, both during sleep (at stage 2: 52.54 +/- 9.60 mumol/L versus 73.80 +/- 11.70 mumol/L) and during waking state (53.67 +/- 7.20 mumol/L versus 63.05 +/- 5.55 mumol/L). Hbt was also reduced in apneic patients as compared to snorers during waking state (72.73 +/- 13.90 mumol/L versus 96.05 +/- 6.30 mumol/L). During sleep, Hbt increased in a similar way for snorers and apneics (12.4% versus 13%), whereas HbO2 values were constant for apneics. SaO2c paralleled SaO2p in snorers and apneics, values for SaO2c being 20-30% lower than values for SaO2p. The difference in the values was probably due to the use of different monitoring techniques. Cerebral oxygenation and cerebral blood volumes were continuously low in apneic patients, and peripheral hypoxia was associated with same-range cerebral hypoxia. Cerebral hemodynamic mechanisms related to sleep, although in part efficient in apneic patients, were not able to increase cerebral oxygenation up to normal values.
Brain↗
Mortality of sleep apnoea patients treated by nasal continuous positive airway pressure registered in the ANTADIR observatory. Association Nationale pour le Traitement A Domicile de l'Insuffisance Respiratoire chronique.
The aim of this study was to examine risk factors for and causes of mortality in patients with obstructive sleep apnoea syndrome (OSAS) treated by nasal continuous positive airway pressure (CPAP). Univariate and multivariate analyses of the data on patients registered in the Association Nationale pour le Traitement A Domicile de l'Insuffisance Respiratoire chronique (ANTADIR) Observatory between January 1, 1985 and December 31, 1993 and followed to January 1, 1996. Survival ratios were compared to those of the French population. A case control study compared patients who died with patients of the same age and sex, in the same Regional Association, who were equipped with CPAP at the same time. Five-thousand-six-hundred-and-sixty-nine patients had CPAP treatment. Two-hundred-and-seventy-six had died. One-hundred-and-twenty-four deaths were examined and compared to 123 control subjects. Overall mortality was the same as the general French population. Independent risk factors for death were age, oxygen tension in arterial blood (Pa,O2) and forced expiratory volume in one second (FEV1) (per cent predicted). In the case-control study independent risk factors for death in the past history were cardiac arrhythmia with an odds ratio (OR) of 2.8 (95% confidence interval (CI) 1.1-7.2), respiratory disorders (OR 2.8; CI 1.6-4.9) ischaemic events (OR 2.2; CI 1.2-4.2), neurological and psychiatric disorders (OR 2.4; CI 1.1-5.4). A significant excess of cardiovascular deaths and an excess of deaths from accidents and poisonings was found. In conclusion, patients die on therapy predominantly from cardiovascular causes but many have a past history of cardiovascular conditions. Compliance with treatment may be important for survival. Continuous positive airway pressure is an effective therapy for obstructive sleep apnoea syndrome but older patients with reduced spirometry and hypoxaemia may need more attention paid to these aspects of their condition.
Cardiovascular Diseases↗
Heated humidification or face mask to prevent upper airway dryness during continuous positive airway pressure therapy.
STUDY OBJECTIVES: The objectives of this study were (1) to evaluate the way in which nasal continuous positive airway pressure (CPAP) therapy influences the relative humidity (rH) of inspired air; and (2) to assess the impact on rH of the addition of an integrated heated humidifier or a full face mask to the CPAP circuitry. DESIGN: The studies were performed in 25 patients with obstructive sleep apnea syndrome receiving long-term nasal CPAP therapy and complaining of nasal discomfort. During CPAP administration, temperature and rH were measured in the mask either during a night's sleep for 8 patients or during a daytime study in which the effects of mouth leaks were simulated in 17 patients fitted with either a nasal mask (with or without humidification) or a face mask alone. SETTING: University hospital sleep disorders center. MEASUREMENTS AND RESULTS: Compared with the values obtained with CPAP alone, integrated heated humidification significantly increased rH during the sleep recording, both when the mouth was closed (60 +/- 14% to 81 +/- 14%, p < 0.01) and during mouth leaks (43 +/- 12% to 64 +/- 8%, p < 0.01). During the daytime study, a significant decrease in rH was observed with CPAP alone. Compared with the values measured during spontaneous breathing without CPAP (80 +/- 2%), the mean rH was 63 +/- 9% (p < 0.01) with the mouth closed and 39 +/- 9% (p < 0. 01) with the mouth open. The addition of heated humidification to CPAP prevented rH changes when the mouth was closed (82 +/- 12%), but did not fully prevent the rH decrease during simulation of mouth leaks (63 +/- 9%) compared with the control period (80 +/- 2%, p < 0. 01). Finally, attachment of a face mask to the CPAP circuitry prevented rH changes both with the mouth closed (82 +/- 9%) and with the mouth open (84 +/- 8%). CONCLUSIONS: These data indicate that inhaled air dryness during CPAP therapy can be significantly attenuated by heated humidification, even during mouth leaks, and can be totally prevented by using a face mask.
Circadian Rhythm↗
[Surgical treatment of severe sleep apnea syndrome by maxillomandibular advancing or mental tranposition].
Surgery of the facial skeleton or the tongue may be envisaged in case of failure of continuous positive pressure ventilation for severe sleep apnea syndrome defined by a apnea-hyponea index greater than 30/h. We present here our results in patients treated by maxillo-mandibular advancing and mental transposition. We define the surgical indications. Between January 1993 and June 1997, 41 patients, mean age 49 years, with severe sleep apnea syndrome (mean apnea-hyponea index =58.5/h) were treated by maxillo-mandibular advancing (21 cases) or mental transposition (20 cases) depending on the cephalometric work-up including lateral teleradiography and sagittal magnetic resonance imaging of the tongue. Functional outcome was good in both groups. Objective success (postoperative apnea-hyponea index <20) was 70.5 % after bimaxillary advancing (mean apnea-hypopnea index =17), but only 25 % after mental transposition (mean apnea-hyponea index =44.5). Maxillomandibular advancing is a major procedure which can be effective in sleep apnea patients with severe craniofacial skeletal anomalies. Its applications in apneic patients with no skeletal anomaly remains a subject of debate. Conversely, there would appear to be very few indications for mental transposition.
Adult↗
[Pharyngeal musculature and obstructive sleep apnea syndromes].
An analysis of the way the pharyngeal musculature modulates the caliber of the pharynx is important to better understand and treat obstructive sleep apnea syndromes. The caliber of the pharynx at the soft palate depends on the action of the tensor veli, the palatoglossus, the palatopharyngeus and the uvula muscles. At the ligual level, the action of the genioglossus and the geniohyoideus predominate. These different muscle groups contract in co-ordination before the diaphragm contracts. Their activity is diminished and disorganized during sleep. These muscles appears to have a histological composition adapted to short-duration intense contractions making them vulnerable to fatigue. In apneic patients, these muscles are solicited constantly. Muscular lesions related to overwork have been suggested. The histological composition of these muscles is modified in apneic patients compared with non-apneic subjects (increased number of type IIa fibres), the expression of an adaptive process. The degree of adaptation varies depending of the pharyngeal level considered. Similar to their reflex stimulation, the response of these pharyngeal muscles to increased resistance is probably greatest at the soft palate level. Greater solicitation of palatine muscles associated with their greater vulnerability to fatigue could explain why obstruction is particularly important at this level. A study of the mechanical and histological properties of the pharyngeal musculature is required for a better understanding of the occlusive mechanisms of the upper airways and must be undertaken before initiating therapeutic stimulation of these muscles.
Airway Resistance↗
[Retrospective cephalometric analysis for surgically treated obstructive sleep apnea: therapeutic deductions].
PURPOSE OF THE STUDY: The goal of surgical treatment for severe sleep apnea syndrome is to alleviate the upper airway obstruction. The narrowing site must be precisely determined during the preoperative evaluation to ensure success. We suggest that cephalometric analysis using a lateral cephalic radiograph to evaluate bony structures combined with magnetic resonance imaging (MRI) to study soft tissues may achieve this goal. The purpose of this study was to determine the role of two different cephalometric analysis systems for determining surgical strategy and to underline factors predictive of success for different surgical procedures. MATERIALS AND METHOD: We prospectively studied 73 sleep apnea patients. The preoperative evaluation included MRI and two different cephalometric analyses on a lateral cephalic radiograph: Tweed's and Delaire's analyses. Three surgical techniques were performed: mandibular osteotomy and geni tubercule advancement, maxillo-mandibular advancement and tongue base reduction with hypoepiglottoplasty via a cervical approach. RESULTS: Tweed's analysis appeared to underestimate maxillo-mandibular deficiencies compared with Delaire's analysis; the later seemed to be more sensitive. MRI did not prove to be useful in predicting surgical outcome. MRI was non-contributive in our preoperative evaluation. DISCUSSION: We suggest a new surgical strategy using two procedures: maxillo-mandibular advancement and tongue base reduction. Indications are based on the results of two cephalometric analyses (Tweed and Delaire) and the measurement of the oropharyngeal surface.
Adult↗
Long-term efficacy of fixed CPAP recommended by Autoset for OSAS.
The Autoset autotitration system (Resmed, Australia) was designed as an aid for determination of the effective level of CPAP. Two studies have shown that the 95% pressure centile during a night with Autoset, after excluding any periods with severe leak (P95), was well correlated with the pressure determined manually according to the reference method. However, the suitability of P95 under Autoset for treatment with conventional CPAP needed to be evaluated outside of the context of titration. The objective of this study was to measure the compliance and efficacy of CPAP at P95 determined by Autoset, after 3 months. Twenty-four patients who had undergone routine autotitration by Autoset under polysomnographic control in the laboratory for previously untreated OSAS were evaluated after 3 months of treatment with CPAP at P95. This evaluation was based on compliance, daily usage, determined by reading the hourly counter, Epworth sleepiness score and home respiratory recording under CPAP. Polysomnography under Autoset showed a significant reduction of abnormal respiratory events (apnea-hypopnea index (AHI): 5.7 (+/-4.6) vs 69.6 (+/-29.8) n/h; p<0.001). P95 was between 8.5 and 15 cm H2O (mean: 11.2 (+/-1.6)). Two patients were lost to follow-up. At 3 months, 18 out of 22 (82%) patients declared that they were still using their machine with a daily usage of 5.25 (+/-1.82) h. The Epworth sleepiness scale was significantly decreased (5 (+/-4.1) vs 11.4 (+/-5.4); p<0.05). P95 recommended by Autoset remained effective on abnormal respiratory events with a low AHI (4.1 (+/-3.2) n/h) and a low 4% oxygen desaturation index (3.6 (+/-4.5) n/h) under CPAP. This study confirms the efficacy of autotitration and the suitability of P95 determined by Autoset for long-term treatment by conventional CPAP at home.
Female↗