Published research
Scientific findings from published research conducted around the globe.
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March 18, 2025
Positive airway pressure therapy and all‐cause and cardiovascular mortality in people with obstructive sleep apnoea: a systematic review and meta-analysis of randomised controlled trials and confounder-adjusted, non-randomised controlled studies
Results are consistent with a potentially beneficial effect of PAP therapy on all-cause and cardiovascular mortality in patients with OSA. Patients should be made aware of this effect of their treatment, which could result in greater acceptance of treatment initiation and greater adherence, leading to a higher likelihood of improved outcomes.
Benjafield, Adam V; Pepin, Jean-Louis; Cistulli, Peter A; Wimms, Alison; Lavergne, Florent; Sert Kuniyoshi, Fatima H; Munson, Sibyl H; Schuler, Brendan; Reddy Badikol, Shrikar; Wolfe, Kelly C; Willes, Leslee; Kelly, Colleen; Kendzerska, Tetyana; Johnson, Dayna A; Heinzer, Raphael; Lee, Chi-Hang; Malhotra, Atul; medXcloud Group
December 15, 2024
Feasibility and acceptability of switching from a previous-generation to a new-generation mask for positive airway pressure therapy of sleep apnea using remote care
Remote management of mask change was associated with good outcomes in terms of objective device data and patient acceptability. This approach could be used to improve the overall therapy experience for individuals requiring a PAP therapy mask change for any reason.
"Zhu X, Benjafield A, Deas R, Willes L, Armitstead J, Sleep Medicine: X, Volume 8, 2024, 100128, ISSN 2590-1427, doi.org/10.1016/j.sleepx.2024.100128."
November 21, 2024
Impact of Continuous Positive Airway Pressure Termination on Permanent Work Disability in Obstructive Sleep Apnea: A French Nationwide ALASKA Database Analysis
These real-world data from a comprehensive, unbiased database highlight the potential occupational impact of CPAP therapy termination.
Bailly S, Comte È, Malhotra A, Cistulli P, Benjafield A, Josseran A, Lavergne F, Tamisier R, Pèpin JL, on behalf of the medXcloud Group. August 6, 2024. doi:10.1513/AnnalsATS.202404-389OC
September 5, 2024
Effects of Mask Change/Renewal on Adherence to Positive Airway Pressure Therapy: Analysis of a Large Telemedicine Database
For patients with low PAP adherence on their existing mask system, early intervention to change or renew the mask was associated with clinically relevant improvements in device use.
Schoebel C, Woehrle H, Ficker JH, Graml A, Zeman F, Fietze I, Young P, Arzt M. Ann Am Thorac Soc. 2024 Sep 5. doi: 10.1513/AnnalsATS.202310-913OC.
May 3, 2024
Association Between Sleep Apnea Treatmetn and Health Care Resource Use in Patients With Atrial Fibrillation
These data suggest clinical and economic benefits of PAP therapy in patients with concomitant OSA and atrial fibrillation. This supports the value of diagnosing and managing OSA and highlights the need for strategies to enhance PAP adherence in this population.
Sterling K, Alpert N, Malik A, Pèpin JL, Benjafield A, Malhotra A, Piccini J, Cistulli P, the medXcloud group. 3 May 2024. doi:10.1161/JAHA.123.030679
May 1, 2024
Inequalities in the access to diagnosis and treatment of obstructive sleep apnea in Brazil: a cross-sectional study
This study revealed significant disparities in OSA diagnosis and treatment resources across Brazil, with the North region being particularly underserved. The findings underscore an urgent need for strategies to improve sleep care nationwide.
Drager L, Santos R, Pachito D, Albertini CS, Sert Kuniyoshi F, Eckeli A. May 1, 2024. doi:10.5664/jcsm.10976
May 1, 2024
Performance of Claims-Based Algorithms for Adherence to Positive Airway Pressure Therapy in Commercially Insured Patients With OSA
In aggregate US commercial data with nonstandardized PAP coverage rules, concordance between existing claims-based definitions and objective PAP use was low. Caution is warranted when applying existing claims-based algorithms to commercial populations.
Alpert N, Cole K, Dexter RB, Sterling K, Wickwire E. 2024 May. doi:10.1016/j.chest.2024.01.020
April 21, 2024
Effects of Adaptive Servo-Ventilation on Quality of Life: The READ-ASV Registry
ASV treatment of CSA with or without coexisting OSA was associated with improvements in disease-specific QoL and daytime sleepiness, especially in individuals with sleep-disordered breathing symptoms before therapy initiation. These improvements in patient-reported outcomes support the use of ASV in this population.
Arzt M, Munt O, Pèpin JL, Heinzer R, K ̈ubeck R, von Hehn U, Ehrsam-Tosi, D, Benjafield A, Woehrle H. 2024 April. doi:10.1513/AnnalsATS.202310-908OC
April 1, 2024
The OSA patient journey: pathways for diagnosis and treatment among commercially insured individuals in the United States
Distinct OSA care pathways exist and are associated with differences in population, care delivery, and economic aspects.
Wickwire E, Zhang X, Munson S, Benjafield A, Sullivan S, Payombar M, Patil S. April 1, 2024. doi:10.5664/jcsm.10908
February 26, 2024
PAP telehealth models and long-term therapy termination: a healthcare database analysis
Use of telemonitoring-guided proactive care and a patient engagement tool was associated with lower rates of PAP therapy termination.
Woehrle H, Schoebel C, Ficker J, Graml A, Schnept J, Fietze I, Young P, Arzt M. 2024 Feb 26. doi:10.1183/23120541.00424-2023
February 1, 2024
CPAP resumption after a first termination and impact on all-cause mortality in France
These data suggests that individuals with OSA who fail initial therapy with CPAP should be offered a second trial with the device to ensure that effective therapy is not withheld from those who might benefit.
Pèpin JL, Tamisier R, Benjafield A, Rinder P, Lavergne F, Josseran A, Sinel-Boucher P, Cistulli P, Malhotra A, Hornus P, Bailly S. 2024 Feb 1. doi:10.1183/13993003.01171-2023
January 1, 2024
Mild obstructive sleep apnoea in females: post hoc analysis of the MERGE randomised controlled trial
Sex differences are apparent in patients with mild OSA. Females experience worse QoL symptoms than males at presentation to the sleep clinic; however, these improve significantly with CPAP treatment.
Wimms A, Kelly J, Turnbull C, McMillan A, Craig S, O'Reilly J, Nickol A, Decker M, Willes L, Calverley P, Benjafield A, Stradling J, Morrell M, MERGE Trial Investigators. 2024 Feb 5. doi:10.1183/23120541.00574-2023
January 1, 2024
FACE study: 2-year follow-up of adaptive servo-ventilation for sleep-disordered breathing in a chronic heart failure cohort
Patients with HF and SDB are a highly heterogeneous group identified using LCA. Systematic deep phenotyping is essential to ensure that ASV is prescribed to those benefit from therapy, as ASV use in patients with severe hypoxic burden and those with HFpEF was associated with a significant reduction in cardiovascular events and mortality.
Tamisier R, Damy T, Bailly S, Goutorbe F, Davy JM, Lavergne F, Palot A, Verbraecken J, d-Ortho MP, Pèpin JL, Davy FM, Damy T, Tamisier R, FACE study investigators. 2024 Jan. doi:10.1016/j.sleep.2023.07.014
December 29, 2023
Depression and comorbid obstructive sleep apnea: Association between positive airway pressure adherence, occurrence of self-harm events, healthcare resource utilization, and costs
Consistent adherence to PAP therapy over 2 years was associated with improved HCRU outcomes for patients with pre-existing depression newly diagnosed with comorbid OSA.
Wickwire EM, Cole KV, Dexter RB, Malhotra A, Cistullil PA, Sterline KL, Pèpin JL, medXcloud group. 2024 Mar 15. doi:10.1016/j.jad.2023.12.055
December 19, 2023
Prevalence and predictors of positive airway pressure therapy prescription in obstructive sleep apnoea: a population-representative study
Only just over half of all individuals with OSA in the current analysis were prescribed PAP. The presence of a variety of comorbidities and use of several medication classes were significant predictors of PAP prescription. Future research should focus on identifying ways to increase PAP use in eligible individuals to optimize clinical outcomes.
Woehrle H, Arzt M, Ficker J, Deger M, Sterling K, Ehrsam-Tosi D, Vogelmann T, Weinand S, Fietze I, Young P, Schoebel C. 19 December 2023. doi:10.1007/s11818-023-00435-2
November 14, 2024
Healthcare resource utilisation and costs in patients with treated obstructive sleep apnea
These results provide additional evidence from a large, diverse sample to support the diagnosis and treatment of OSA and encourage long-term adherence to PAP therapy.
Sterling K, Alpert N, Cistulli P, Pèpin JL, More S, Cole K, Malhotra A, medXcloud group. 2024 Aug. doi:10.1111/jsr.14099
November 5, 2023
A new approach to streamline obstructive sleep apnea therapy access using peripheral arterial tone-based home sleep test devices
It is anticipated that the streamlined digital pathway facilitated by new peripheral artery tone-based technology could contribute to reducing the underdiagnosis of OSA, accelerating access to appropriate treatment, and the optimization of OSA therapy.
Zou D, Vit S, Egea C, Ehrsam-Tosi D, Lavergne F, Azpiazu M, Fietze I. 05 November 2023. doi:10.3389/frsle.2023.1256078
August 20, 2023
Relationship between Self-reported Sleepiness and Positive Airway Pressure Treatment Adherence in Obstructive Sleep Apnea
This study demonstrates the feasibility of capturing patient-reported outcomes via a digital platform. Patient-reported outcomes appear to be associated with PAP usage, especially self-reported sleepiness and its response to therapy. Capturing patient-reported outcomes using digital solutions during the course of treatment has the potential to enhance patient outcomes by providing actionable insights.
Cistulli P, Armistead J, Malhotra A, Yan Y, Vuong V, Sterling K, Barrett M, Nunez C, Pèpin JL, Benjafield A. 2023 Aug. doi:10.1513/AnnalsATS.202206-482OC
July 8, 2023
Positive Airway Pressure Therapy Adherence and Health Care Resource Use in Patients With Obstructive Sleep Apnea and Heart Failure With Preserved Ejection Fraction
Treating OSA with PAP therapy in patients with HFpEF was associated with a reduction in health care resource use. These data highlight the importance of managing concomitant OSA in patients with HFpEF, and the need for strategies to enhance PAP adherence in this population.
Cistulli P, Malhotra A, Cole K, Malik A, Pèpin JL, Sert Kuniyoshi F, Benjafield A, Somers V, the medXcloud group. 8 July 2023. doi:10.1161/JAHA.122.028733
June 20, 2023
Dose-Response Relationship between Obstructive Sleep Apnea Therapy Adherence and Healthcare Utilization
These data provide compelling evidence for a dose–response relationship between positive airway pressure usage and healthcare utilization, with benefits seen even when usage was as low as 1–2 hours per night.
Malhotra A, Sterling K, Cistulli, Pèpin JL, Chen J, Woodword C, Alpert N, More S, Nunez C, Benjafield A. 2023 Jun. doi:10.1513/AnnalsATS.202208-738OC
June 6, 2023
Pilot study of positive airway pressure usage, patient journey and program engagement for users of a digital obstructive sleep apnea program
All of the 105 patients in this program diagnosed with OSA and prescribed PAP therapy were able to efficiently complete the entire OSA diagnostic pathway. The majority of these individuals also were able to adhere to their prescribed PAP therapy and had clinically meaningful PAP usage rates over the 90 days of therapy. Future studies might further evaluate the impact of this type of end-to-end virtual program on longer-term adherence and clinical outcomes over time.
Kumar S, Rudie E, Dorsey C, Caswell, K, Blasé A, Sert Kuniyoshi F, Benjafield A, Sullivan S. 06 June 2023. doi:10.3389/fdgth.2023.1043578
May 15, 2023
Positive Airway Pressure Adherence and Health Care Resource Utilization in Patients with Obstructive Sleep Apnea and Heart Failure With Reduced Ejection Fraction
PAP therapy adherence in patients with OSA with heart failure with reduced ejection fraction was associated with a reduction in health care resource utilization. This suggests that greater emphasis should be placed on diagnosing and effectively treating OSA with PAP in patients with heart failure with reduced ejection fraction.
Malhotra A, Cole K, Malik A, Pèpin JL, Sert Kuniyoshi F, Cistulli P, Benjafield A, Somers V, the medXcloud group. 15 May 2023. doi:10.1161/JAHA.122.028732
April 17, 2023
Registry on the Treatment of Central and Complex Sleep-Disordered Breathing with Adaptive Servo-Ventilation (READ-ASV): protocol and cohort profile
The most common indications for ASV were treatment-emergent or persistent CSA or CSA in cardiovascular disease (excluding systolic heart failure). Patients using ASV in clinical practice had severe sleep-disordered breathing and were often symptomatic. One-year follow-up will provide data on the effects of ASV on QoL, respiratory parameters and clinical outcomes in these patients.
Arzt M, Munt O, Pèpin JL, Heinzer R, K ̈ubeck R, von Hejhn U, Ehrsam-Tosi D, Benjafield A, Woehrle H. 2023 Apr 17. doi:10.1183/23120541.00618-2022
March 8, 2023
Cost-utility and budget impact analysis of CPAP therapy compared to no treatment in the management of moderate to severe obstructive sleep apnea in Colombia from a third-party payer perspective
CPAP was cost-effective compared to no-treatment in OSA. According to the budget impact analysis, adopting this technology would require a budget allocation that is partially offset by reduced number of strokes and traffic accident events.
Robles A, Gil-Rojas Y, Amaya D, Hernàndez F, Escobar-Cordoba F, Venegas M, Amado S, Restrepo-Gualteros S, Echeverry J, Marin F, Zabala S, Bazurto-Zapata MA, Deger M. 08 Mar 2023. doi:10.1080/14737167.2023.2181792
March 1, 2023
Association between positive airway pressure therapy adjerence and health care resource utilization in patients with obstructive sleep apnea and type 2 diabetes in the United States
Consistent use of PAP therapy over 2 years was associated with decreased HCRU in patients with OSA and type 2 diabetes, strongly suggesting a role for screening and treating OSA in type 2 diabetes.
Sterling K, PharmD, Cistulli P, Linde-Zwirble, Malik A, Benjafield A, Malhotra A, Cole K, Emami H, Woodford C, Bmath, More S, Armitstead J, Nunez C, Reutrakul S, Pèpin JL, on behalf of the medXcloud Group. March 1, 2023. doi:10.5664/jcsm.10388
February 28, 2023
Effect of switching from continuous to bilevel positive airway pressure on sleep quality in patients with obstructive sleep apnea: the prospective POP IN VAuto study
Switching to bilevel PAP had several benefits in patients struggling with CPAP, facilitating therapy acceptance and ongoing device usage.
Palot A, Nguyên XL, Launois S, Prigent A, Graml A, Aversenq E, Koltes C, Recart D, Lavergne F. 2023 Feb 28. doi:10.21037/jtd-22-825
February 15, 2023
Prevalence of sleep apnoea in patients with type 1 diabetes and its association with comorbidities and diabetic complications: A French nationwide prospective study
Sleep apnoea is a significant comorbidity in patients with type 1 diabetes, especially with respect to diabetic complications. This highlights the need for sleep apnoea screening and management in these individuals.
Pèpin JL, Bailly S, Texereau J, Sonnet E, Picard S, Vergès B, Coffin Boutreux C, Arnault Ouary G, Kessler, L, Guerci B, Anton Kuchly B, Fendri Gaied S, Cuperlier A, Voinot C, Derrien C, Dubois S, Lavernge F, Laure Borel A, Tamisier R, Benhamou PY. 2023 Jun. doi:10.1111/dom.15015
October 12, 2022
Early identification of heart failure deterioration through respiratory monitoring with adaptive servo-ventilation
ASV-based device data in the treatment of SDB may serve as a heart failure monitoring tool to predict early clinical cardiac decompensation events. Prediction and avoidance of cardiac decompensation, in turn, may attenuate serious health consequences in patients with heart failure.
Fox H, Rudolph V, Munt O, Malouf G, Framl A, Bitter T, Oldenburg O. 2023 Feb. doi:10.1111/jsr.13749
September 2, 2022
Prevalence and preditors of sleep-disordered breathing in chronic heart failure: the SchlaHF-XT registry
Prevalence of SDB in HFpEF was high, but lower than in patients with HFmrEF or HFrEF. Moderate-to-severe SDB occurred more frequently in males than in females across the whole spectrum of heart failure. In both sexes, the proportion of OSA in SDB patients with HFpEF was higher than in those with HFrEF.
Arzt M, Odenburg O, Graml A, Schnept J, Erdmann E, Teschler H, Schoebel C, Woehrle H, SchlaHT-XT investigators. 2022 Dec. doi:10.1002/ehf2.14027
June 1, 2022
Relationship Between CPAP Termination and All-Cause Mortality: A French Nationwide Database Analysis
These real-world data from a comprehensive, unbiased database highlight the potential for ongoing use of CPAP treatment to reduce all-cause mortality in patients with OSA.
Pèpin JL, Bailly S, Rinder P, Adler D, Benjafield A, Lavergne F, Josseran A, Sinel-Boucher P, Tamisier R, Cistulli P, Malhotra A, Hornus P, medXcloud Group. 2022 Jun. doi:10.1016/j.chest.2022.02.013
February 1, 2022
Adaptive servo ventilation for sleep apnoea in heart failure: the FACE study 3-month data
For the first time, our data identified homogeneous patient clusters representing clinically relevant subgroups relating to SDB management in patients with HF with different ASV usage, each with a different prognosis. This may improve patient phenotyping in clinical practice and allow individualisation of therapy.
Ramisier R, Damy T, Bailly S, Davy JM, Verbraecken J, Lavergne F, Palot A, Goutorbe F, d'Ortho MP, Pèpin JL, FACE study investigators. 22 Feb. doi:10.1136/thoraxjnl-2021-217205
January 12, 2022
Assessment of Patient Journey Metrics for Users of a Digital Obstructive Sleep Apnea Program: Single-Arm Feasibility Pilot Study
These results demonstrate the possibility of a highly efficient, patient-centered pathway for OSA workup and treatment. Such findings support pathways that could increase access to care, reduce loss to follow-up, and reduce health burden and overall cost.
Kumar S, Rudie E, Dorsey C, Blasé A, Benjafield A, Sullivan S. 12 January 2022. doi:10.2196/31698
December 1, 2021
Characterizing respiratory parameter, settings, and adherence in real-world-world patients using adaptive servo ventilation therapy: big data analysis
Our findings showed robust levels of longer-term adherence to ASV therapy in a large group of real-world patients. There were no clinically important differences in respiratory parameters across a range of pressure and pressure support settings. Future work should focus on the different phenotypes of patients using ASV therapy.
Malhotra A, Benjafield A, Cistulli P, Li J, Woehrle H, Armistead J, Sterling K, PharmD, Nunez C, Pèpin JL, on behalf of the medXcloud group. December 1, 2021. doi:10.5664/jcsm.9430
September 1, 2021
Clinical impact of two types of mandibular retention devices - A CAD/CAM design and a traditional design - On upper airway volume in obstructive sleep apnea patients
The CAD/CAM (Narval CC™) device was associated with a significant increase in upper airway volume that may be caused by a lower degree of vertical separation between the jaws when compared to the non-CAD/CAM design.
Kerbrat A, Vinuesa O, Lavergne F, Aversenq E, Graml A, Kerbrat JB, Trost O, Goudot P. 2021 June 9. doi:10.1016/j.jormas.2021.06.002
August 1, 2021
Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow up data
Long-term MAD therapy remained effective after 5 years in >50% of patients, with good levels of patient satisfaction and adherence.
Vecchierini MF, Attali V, Collet JM, d'Ortho MP, Goutorbe F, Kerbrat JB, Leger D, Lavergne F, Monaca C, Monteyrol PJ, Mullens E, Pigearias B, Martin F, Khemliche H, Lerousseau L, Meurice JC, on behalf of the ORCADE Investigators. August 1, 2021. doi:10.5664/jcsm.9308
July 1, 2021
The accuracy of a portable sleep monitor to diagnose obstructive sleep apnea in adolescent patients
In a small cohort of adolescents, our study supports the application of home PM in the diagnosis of suspected obstructive sleep apnea. Until studies implementing PM using larger cohorts become readily available, the findings from this preliminary study could contribute to adolescents receiving sleep apnea therapy more promptly.
Bhattacharjee R, Benjafield A, Blasé A, Dever G, Celso J, Nation J, Good R, Malhotra A. July 1, 2021. doi:10.5664/jcsm.9202
March 1, 2021
CPAP Therapy Termination Rates by OSA Phenotype: A French Nationwide Database Analysis
Comorbidities have an important influence on long-term CPAP continuation in patients with OSA.
Pèpin JL, Bailly S, Rinder P, Adler D, Szeftel D, Malhotra A, Cistulli P, Benjafield A, Lavergne F, Josseran A, Tamisier R, Hornus P, and on behalf of th emedXcloud Group. 1 March 2021. doi:10.3390/jcm10050936
February 12, 2021
Positive Airway Pressure Therapy Adherence with Mask Resupply: A Propensity-Matched Analysis
The replacement of mask interface components was associated with better longer-term adherence to PAP therapy versus no resupply.
Benjafield A, Oldstone L, Willes L, Kelly C, Nunez C, Malhotra, and on behalf of the medXcloud Group. 12 February 2021. doi:10.3390/jcm10040720