Factors That Affect Auto-Continuous Positive Airway Pressure Level Designated During Titration Night in Patients with Obstructive Sleep Apnoea (original) (raw)
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IS SEVERITY OF OBSTRUCTIVE SLEEP APNOEA IS A SURROGATE MARKER OF CPAP TITRATION PRESSURE?
National Journal of Medical Research, 2015
Background: Obstructive sleep apnoea (OSA) is emerging epidemic and its presence often goes unnoticed. It may be either consequence or cause of several non-communicable life style related disorders. Identifying OSA and timely intervention makes remarkable difference quality of life and co-existing disorders. CPAP is the mainstay of treatment in dynamic obstruction related OSA. However patient undergoing CPAP titration is economical burden and time consuming. We tried to look at whether severity of OSA can predict approximate CPAP pressure required for domiciliary use. Methodology: We retrospectively analyzed data of patients who have undergone CPAP titration and there severity of OSA based on Apnoea hypopnoea index. We subcategorised them in to mild, moderate and severe categories Results: We looked at 17 serial patients who underwent CPAP titration. Using unpaired t test and two tailed p values, we analysed difference between mild and moderate, mild and severe and moderate and severe categories, however no statistical significance was noted with regard to CPAP titration pressure between these groups. Conclusion: There was no correlation between CPAP pressure and severity of OSA noted in our study.
Biomedical Papers
Background and Aims. Obstructive sleep apnoea is a potentially serious sleep disorder associated with the risk of cardiovascular disease. It is treated with continuous airway pressure (CPAP) but this is not always successful. Unsuccessful cases should be treated by bilevel positive airway pressure (BiPAP). The aim of this study was to determine whether common respiratory parameters and/or body mass index (BMI) can be used to predict the probability CPAP failure and hence start such patients on BiPAP from the outset. Methods. A sample of patients treated by CPAP for OSAS was evaluated a retrospective cohort study. The data measured in sleep monitoring of the successfully treated group and of the group where CPAP had failed were compared. Subsequently, the predictive abilities of BMI, Apnoea Index (AI), Apnoea-Hypopnea Index (AHI), percentage of sleep time in less than 90% oxygen saturation (T90), average oxygen saturation over the duration of sleep (SaO2) and average desaturation per hour of sleep (ODI) were assessed with respect to CPAP failure, both individually and in combination. Results. A sample of 479 patients was included in the study. All of the recorded variables except AI were significantly associated with failure of CPAP and their ability to predict the failure ranged from poor to moderate. Since there was significant correlation among all the variables measured a two-variable prediction model combining T90 and BMI produced no significant improvement in the quality of CPAP failure prediction. Conclusions. BMI was a significant predictor of CPAP failure although it was slightly less predictive than T90. The set of monitored variables included in our study does not allow for CPAP failure to be predicted with clinically relevant reliability.
Prediction of Optimal CPAP Pressure in Patients with OSAS in Turkish Population
International Journal Of Medical Science And Clinical Invention, 2020
The most effective therapy defined for the patients with obstructive sleep apnea syndrome (OSAS) is the continuous positive airway pressure (CPAP). In this study, we aimed to construct a CPAP prediction formula in Turkish population in order to decrease the requirements for polysomnography (PSG) laboratories. The demographic features, age, gender, weight and height of the participants were recorded at the first visit, together with the neck, waist and hip circumferences. Epworth Sleepiness Scale (ESS) was used to evaluate the levels of daytime sleepiness. All patients underwent at least two PSG studies. In a total of 269 patients with a mean age of 53.42 ±13.32 years were included in the study. In step-wise multiple regression analysis; BMI, AHI, ARI, and neck circumference were the independent predictors of CPAP. A new formula was developed using these values: CPAP pred: (BMI X 0.138) + (AHI X 0.044) + (ARI X 0.056) +(NECK X 0.151)-6.180. The mean CPAP was 7.70 ±2.48 and the mean CPAP pred was 7.71 ±1.53. When the mean CPAP and CPAP pred values were compared, there was not a significant difference with a p value of 0.846. There was a significant correlation between CPAP and CPAP pred values (p:0.001 and r:0.613). We determined that, predicting CPAP with high accuracy may be possible with formulations. These formulations are important in order to reduce the requirements for repeated PSG. Further, larger, prospective studies are required to increase the accuracy of CPAP predicting formulas.
Chronic Respiratory Disease, 2004
Background: Detailed polysomnography (PSG) and overnight continuous positive airway pressure (CPAP) titration as the basis for investigation and treatment of obstructive sleep apnoea/hypopnoea syndrome (OSAHS) incurs high costs from inpatient stays and technician attendance, even when split night studies are employed. Responding to rapidly increasing demand, from 1996 the sleep service at Glasgow Royal Infirmary adopted limited sleep studies and daycase CPAP titration as first line management. Here we describe the outcomes of this service between 1996 and 1999. Methods: Data were collected from prospective records made at follow up by sleep technicians and by casenote review. Results: Results were available for 158 subjects (97.5%) of 162 commenced on CPAP during this period. One hundred and forty-eight (91%) were diagnosed by limited sleep studies and 80 (50%) were diagnosed at home. The median follow up was 23 months (interquartile range (IQR), 13-35). Median use of CPAP in those ...
CHEST Journal, 2004
PURPOSE: The growing epidemic of sleep-related breathing disorders plus the high cost of polysomnography has led most labs across the country to switch to split-night studies(SNS). This has resulted in significant reduction in time allowed for titration. Hence the final effective pressure (Peff)as obtained by SNS may not reflect the ideal pressure needed to consistently overcome the sleep airflow limitation. This may potentially lead to therapeutic failure and poor compliance. Auto-CPAP has emerged as potential alternative which may provide a more physiological background to identify the optimal pressure for CPAP therapy. METHODS: 24 consecutive patients diagnosed with Obstructive apnea hypopnea syndrome (AHI >15/hr) after undergoing split-night study in sleep lab. After SNS patients were prescribed a 2-week Auto CPAP trial (Resmed Auto Set @). The pressures obtained by SNS(Peff) were compared to optimal pressures (95th percentile and maximum)obtained by Auto-CPAP trial at home. Demographics and clinical outcomes were also evaluated. RESULTS: Out of 23 patients (one patient was excluded due to noncompliance with Auto-CPAP) 78% were males. Mean BMI was 34.5 and Mean time spent on CPAP titration was during SNS was 173 mins. Mean AHI (Apnea hypopnea Index) at final CPAP pressure (Peff) was 1.5 versus 6.1 with Auto-CPAP(P<0.001). Mean pressure on (Peff) on SNS titration was 8.8 cm of H2O versus mean 95th percentile pressure on Auto-CPAP of 11.3 cm of H2O (P<0.001) and mean maximum pressure on Auto-CPAP of 12.5 cm of H2O (P<0.001). 20 out of 23 patients (87%) had more than 2 cm H2O difference between SNS titration(Peff) and maximum optimal pressure obtained by Auto-CPAP (P< 0.003). CONCLUSION: There is a significant difference in threapeutic pressures noted between CPAP titration by SNS and subsequent Auto-CPAP trial for 2 weeks. CLINICAL IMPLICATIONS: By allowing greater sleep sampling time and a physiological background, use of Auto-CPAP device to derive maximum optimal pressures may provide an appropriate alternative to SNS.
Sleep and Breathing, 2016
The aim of this study was to determine the frequency and predictors of correctly initiated continuous positive airway pressure (CPAP) settings on the initial night of hospitalization in patients with known obstructive sleep apneahypopnea syndrome (OSAHS). Methods Hospital records of all patients who underwent an outpatient therapeutic polysomnogram (PSG) at our institution between January 2005 and December 2010 were retrospectively reviewed. Data collected included initial CPAP settings on hospital admission, latency to hospitalization (from sleep study), hospital length of stay, demographic variables, and PSG variables. Results One hundred seventy subjects were included in the analysis: 51 % were male, average age (±SD) was 55.3 ± 13.7 years, and body mass index was 43.7 ± 10.4 kg/ m 2. OSAHS was generally severe (apnea-hypopnea index (AHI) 52.8 ± 37.3 event/h). Mean CPAP setting during inlaboratory titration was 11.1 ± 3.1 cm H 2 O and during the first night of hospitalization was 9.5 ± 2.8 cm H 2 O (p < 0.0001). Of 170 subjects, only 71 (42 %) received the correct laboratoryderived CPAP setting on the first night of hospitalization. In a multivariable logistic regression analysis, higher body mass index (BMI), lower CPAP level determined during PSG, and shorter latency (months) between PSG and hospitalization were associated with receiving the correct CPAP setting during the first night of hospitalization: Each 1 kg/m 2 increase in BMI was associated with a 7 % increase odds of receiving the correct CPAP setting during the first night of hospitalization (OR 1.07, 95 % CI 1.02-1.12), while each 1 cm H 2 O increase in CPAP during PSG and each 1 month longer latency between PSG and hospitalization was associated with a 15 and 7 %, respectively, decrease in the odds of receiving the correct CPAP setting during the first night of hospitalization (CPAP OR 0.85, 95 % CI 0.74-0.97 and latency OR 0.93, 95 % CI 0.90-0.97). There was no in-hospital mortality, and correct CPAP settings did not affect hospital length of stay. Conclusions Among patients admitted to the hospital, a correct, laboratory-derived CPAP setting is infrequently prescribed during the first night of hospitalization. Predictors for correctly ordering CPAP include latency from the time of in-laboratory CPAP titration, BMI, and laboratory-derived CPAP level.
Sleep and Breathing, 2019
Objective To evaluate the performance of clinical criteria (CC) for diagnosis and initiation of empirical treatment with continuous positive airway pressure (CPAP) in patients with suspected obstructive sleep apnea (OSA) compared with the treatment decision based on sleep studies (polysomnography or respiratory polygraphy), guidelines, and experience of participating physicians. Methods This was a simulated intention-to-treat study in a retrospective (G1) and prospective (G2) cohort. Four observers (two per group) called CC1 and CC2 reviewed the sleep questionnaires and indicated CPAP if the patients presented snoring, frequent apneas (≥ 3-4/week), body mass index (BMI) > 25 kg/m 2 , sleepiness (Epworth > 11), or tiredness (at least 3-4 times per week) and some comorbidity (hypertension, coronary/cerebrovascular event, diabetes). Ten independent observers formed two groups of five (FD1 and FD2) and were blinded to each other's opinion. These observers in FD1 and FD2 decided CPAP treatment based on guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) or guidelines of the American Academy of Sleep Medicine (AASM) and factored in their own opinion. Sensitivity (S), specificity (Sp), and positive/negative likelihood ratios (LR+/−) were calculated with the test method: CC1/2, and the reference method: majority decision of FD1/2. Results A total of 653 patients (264 women, 40%) were studied. Median age was 54 years, BMI 28 kg/m 2 , and apnea hypopnea index (AHI) 16.5 events/h. S ranged from 21 to 25% (p 0.60), Sp 96.1 to 97.6% (p 0.39), and LR+ of clinical criteria 6.4 to 8.9 (p 0.52). Conclusion CPAP indication without a previous sleep study showed a low sensitivity (≅ 22%) but a specificity greater than 95% in patients with high pretest probability for OSA (snoring, report of frequent apneas, BMI > 25 kg/m 2 and sleepiness or tiredness plus comorbidity).
Empiric Auto-Titrating CPAP in People with Suspected Obstructive Sleep Apnea
Journal of Clinical Sleep Medicine, 2010
Objective: Efficient diagnosis and treatment of obstructive sleep apnea (OSA) can be difficult because of time delays imposed by clinic visits and serial overnight polysomnography. In some cases, it may be desirable to initiate treatment for suspected OSA prior to polysomnography. Our objective was to compare the improvement of daytime sleepiness and sleep-related quality of life of patients with high clinical likelihood of having OSA who were randomly assigned to receive empiric auto-titrating continuous positive airway pressure (CPAP) while awaiting polysomnogram versus current usual care. Methods: Serial patients referred for overnight polysomnography who had high clinical likelihood of having OSA were randomly assigned to usual care or immediate initiation of auto-titrating CPAP. Epworth Sleepiness Scale (ESS) scores and the Functional Outcomes of Sleep Questionnaire (FOSQ) scores were obtained at baseline, 1 month after randomization, and again after initiation of fixed CPAP in control subjects and after the sleep study in auto-CPAP patients. Results: One hundred nine patients were randomized. Baseline demographics, daytime sleepiness, and sleep-related quality of life scores were similar between groups. One-month
Early predictors of CPAP use for the treatment of obstructive sleep apnea
Sleep, 2004
To identify factors before a trial of nasal continuous positive airway pressure (CPAP) treatment that are associated with lower compliance. A prospective cohort study. Initial Hospital Anxiety and Depression Scale scores and other demographic data were noted. Machine use was recorded by clock timer after a 1-month trial of treatment. District General Hospital sleep-disordered breathing clinic. Eighty consecutive patients with symptoms of sleep apnea-hypopnea syndrome and a 4% Sao2 desaturation index greater than 10 events per hour. N/A. Those reporting 'initial problems' with CPAP went on to have an average of 2.4 hours of on time per night, while those not reporting initial problems had an on time of 5.0 hours per night (P < .001). Those living alone had a machine on time of 3.2 hours compared with 4.5 hours for those with partners (P = .04). Pearson's correlations between hours on time were -0.08 (P = .48) for initial Anxiety score and 0.10 (P = .37) for initial Dep...